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López-Maza S, Abraira L, Bellido-Castillo E, Lallana S, Campos-Fernández D, Fonseca E, Quintana M, Santamarina E, Rovira A, Sarria-Estrada S, Toledo-Argany M. [Risk of epilepsy after a first epileptic seizure with unknown etiology in elderly patients]. Rev Neurol 2024; 78:277-283. [PMID: 38743021 DOI: 10.33588/rn.7810.2024055] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
AIM Patients whose epilepsy begins with seizures with unknown etiology in old age have been studied to a limited extent. The aim is to clinically characterise these patients, and predict their risk of developing epilepsy in the long term. MATERIALS AND METHODS This is a retrospective observational study of patients over 55 years old experiencing a first epileptic seizure with unknown etiology. The data were collected from their clinical history, including electroencephalogram (EEG) and brain magnetic resonance imaging (MRI) results. RESULTS Eighty-seven patients (58.6% male; 71.5 ± 8.1 years) were included. The mean follow-up was 7.3 ± 4.9 years. The most common vascular risk factor was arterial hypertension (77%; n = 67). Focal seizures with altered consciousness were the most frequent type of seizure (44.8%; n = 39), followed by focal seizures evolving to bilateral tonic-clonic seizures (39.1%; n = 34). Brain MRI showed cortical atrophy (50%; n = 42) and signs of small-vessel vascular disease (SVVD) (67.8%; n = 57). Interictal epileptiform EEG abnormalities were observed in 43.7% (n = 38) of the patients, mostly with temporal localisations (94.7%; n = 36). 44.8% (n = 39) had mild cognitive impairment at baseline. Recurrence of seizures, which was observed in 49 patients (56.1%), occurred after a median of 12 months (interquartile range: 4.4-25.9). Finally, 71 patients (81.6%) developed epilepsy. CONCLUSION The risk of epilepsy in the long term following a single seizure of unknown etiology in elderly patients is greater than 80%. Arterial hypertension and mild cognitive impairment at baseline are the most common clinical features. Cortical atrophy and the presence of SVVD are frequent in MRI, and routine EEGs do not usually show epileptiform alterations.
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Affiliation(s)
- S López-Maza
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
- Vall d´Hebron Institut de Recerca (VHIR), Barcelona, España
- Universitat Autònoma de Barcelona, Cerdanyola del Vallés, España
| | - L Abraira
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
- Vall d´Hebron Institut de Recerca (VHIR), Barcelona, España
- Universitat Autònoma de Barcelona, Cerdanyola del Vallés, España
| | - E Bellido-Castillo
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
- Vall d´Hebron Institut de Recerca (VHIR), Barcelona, España
| | - S Lallana
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
- Vall d´Hebron Institut de Recerca (VHIR), Barcelona, España
- Universitat Autònoma de Barcelona, Cerdanyola del Vallés, España
| | - D Campos-Fernández
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
- Vall d´Hebron Institut de Recerca (VHIR), Barcelona, España
- Universitat Autònoma de Barcelona, Cerdanyola del Vallés, España
| | - E Fonseca
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
- Vall d´Hebron Institut de Recerca (VHIR), Barcelona, España
- Universitat Autònoma de Barcelona, Cerdanyola del Vallés, España
| | - M Quintana
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
- Vall d´Hebron Institut de Recerca (VHIR), Barcelona, España
| | - E Santamarina
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
- Vall d´Hebron Institut de Recerca (VHIR), Barcelona, España
- Universitat Autònoma de Barcelona, Cerdanyola del Vallés, España
| | - A Rovira
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
- Vall d´Hebron Institut de Recerca (VHIR), Barcelona, España
| | - S Sarria-Estrada
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
- Vall d´Hebron Institut de Recerca (VHIR), Barcelona, España
| | - M Toledo-Argany
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, España
- Vall d´Hebron Institut de Recerca (VHIR), Barcelona, España
- Universitat Autònoma de Barcelona, Cerdanyola del Vallés, España
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Bollo L, Arrambide G, Cobo-Calvo A, Alvarez JV, Alberich M, Cabello S, Castilló J, Galan I, Midaglia LS, Acevedo BR, Zabalza A, Pappolla A, Mongay Ochoa N, Tintore M, Rio J, Comabella M, Tur C, Auger C, Sastre-Garriga J, Rovira A, Montalban X, Pareto D, Vidal-Jordana A. Trans-Synaptic Degeneration in the Visual Pathway in Patients With Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. Neurology 2024; 102:e209156. [PMID: 38447105 DOI: 10.1212/wnl.0000000000209156] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/27/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES We aimed to assess the presence of retinal neurodegeneration independent of optic neuritis (ON) in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and to investigate the development of trans-synaptic anterograde degeneration in these patients after ON. METHODS Cross-sectional, retrospective study of 34 adult patients with MOGAD and 23 healthy controls (HC). Clinical, optical coherence tomography (OCT), and MRI data were collected. Peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell inner plexiform layer (GCIPL) were obtained using Heidelberg Spectralis. FreeSurfer7 was used to obtain the lateral geniculate nucleus (LGN), occipital volume fractions (to total estimated intracranial volume), and occipital cortical thickness. For the anterior visual pathway, the analysis was conducted using eyes, classified based on the history of ON (Eye-ON and Eye-NON) and compared with Eye-HC. The analysis of OCT and brain volumetric measures was conducted comparing MOGAD-ON, MOGAD-NON, and HC groups. The analysis of covariance with a Bonferroni-adjusted post hoc test was used to test differences between groups and linear regression analysis to evaluate OCT/MRI associations; age and sex were considered as covariates. RESULTS 24 (70.5%) patients had a prior ON. Median pRNFL and GCIPL thickness (um) was significantly reduced in Eye-ON vs EyeNON and HC (pRNFL: 69.4 (17.3), 89.6 (13.7), 98.2 (11.7), p < 0.001; GCIPL: 55.8 (8.7), 67.39 (8.7), 72.6 (4.5), p < 0.001). pRNFL and GCIPL thickness had a negative correlation with the number of ON episodes (p = 0.025 and p = 0.031, respectively). LGN volume fraction was significantly lower in patients with MOGAD-ON than in HC (0.33 (0.05) vs 0.39 (0.04), p = 0.002). The occipital cortical thickness was lower in MOGAD-ON compared with MOGAD-NON and HC (p = 0.010). In patients with MOGAD-ON, pRNFL correlated with LGN volume (p = 0.006), occipital thickness (p = 0.002), and the medial occipital cortex (p = 0.002), but not the lateral occipital lobe. DISCUSSION Compared with HC, MOGAD-ON exhibits reduced retinal thickness, primarily influenced by the presence and the number of prior ON episodes. Moreover, MOGAD-ON demonstrates significant atrophy in the retinal, subcortical, and cortical regions of the visual pathway, distinguishing them from MOGAD-NON and HC. These findings suggest that in patients with MOGAD neurodegeneration is tightly correlated with damage to the involved pathway.
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Affiliation(s)
- Luca Bollo
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Georgina Arrambide
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Alvaro Cobo-Calvo
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Javier V Alvarez
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Manel Alberich
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Sergio Cabello
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Joaquín Castilló
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Ingrid Galan
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Luciana S Midaglia
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Breogan Rodriguez Acevedo
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Ana Zabalza
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Agustin Pappolla
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Neus Mongay Ochoa
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Mar Tintore
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jordi Rio
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Manuel Comabella
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Carmen Tur
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Cristina Auger
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jaume Sastre-Garriga
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Alex Rovira
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Xavier Montalban
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Deborah Pareto
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Angela Vidal-Jordana
- From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
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Ruggieri S, Prosperini L, Al-Araji S, Annovazzi PO, Bisecco A, Ciccarelli O, De Stefano N, Filippi M, Fleischer V, Evangelou N, Enzinger C, Gallo A, Garjani A, Groppa S, Haggiag S, Khalil M, Lucchini M, Mirabella M, Montalban X, Pozzilli C, Preziosa P, Río J, Rocca MA, Rovira A, Stromillo ML, Zaffaroni M, Tortorella C, Gasperini C. Assessing treatment response to oral drugs for multiple sclerosis in real-world setting: a MAGNIMS Study. J Neurol Neurosurg Psychiatry 2024; 95:142-150. [PMID: 37775266 DOI: 10.1136/jnnp-2023-331920] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/09/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The assessment of treatment response is a crucial step for patients with relapsing-remitting multiple sclerosis on disease-modifying therapies (DMTs). We explored whether a scoring system developed within the MAGNIMS (MRI in Multiple Sclerosis) network to evaluate treatment response to injectable drugs can be adopted also to oral DMTs. METHODS A multicentre dataset of 1200 patients who started three oral DMTs (fingolimod, teriflunomide and dimethyl fumarate) was collected within the MAGNIMS network. Disease activity after the first year was classified by the 'MAGNIMS' score based on the combination of relapses (0-≥2) and/or new T2 lesions (<3 or ≥3) on brain MRI. We explored the association of this score with the following 3-year outcomes: (1) confirmed disability worsening (CDW); (2) treatment failure (TFL); (3) relapse count between years 1 and 3. The additional value of contrast-enhancing lesions (CELs) and lesion location was explored. RESULTS At 3 years, 160 patients experienced CDW: 12% of them scored '0' (reference), 18% scored '1' (HR=1.82, 95% CI 1.20 to 2.76, p=0.005) and 37% scored '2' (HR=2.74, 95% CI 1.41 to 5.36, p=0.003) at 1 year. The analysis of other outcomes provided similar findings. Considering the location of new T2 lesions (supratentorial vs infratentorial/spinal cord) and the presence of CELs improved the prediction of CDW and TFL, respectively, in patients with minimal MRI activity alone (one or two new T2 lesions). CONCLUSIONS Early relapses and substantial MRI activity in the first year of treatment are associated with worse short-term outcomes in patients treated with some of the oral DMTs.
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Affiliation(s)
- Serena Ruggieri
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Luca Prosperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Sarmad Al-Araji
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Pietro Osvaldo Annovazzi
- Neuroimmunology Unit-Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, UK
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Massimo Filippi
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Vinzenz Fleischer
- Department of Neurology and Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Nikos Evangelou
- Mental Health & Clinical Neuroscience Unit, University of Nottingham, Nottingham, UK
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Department of Radiology (Division of Neuroradiology, Vascular and Interventional Radiology), Medical University of Graz, Graz, Austria
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Afagh Garjani
- Mental Health & Clinical Neuroscience Unit, University of Nottingham, Nottingham, UK
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sergiu Groppa
- Department of Neurology and Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Shalom Haggiag
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Matteo Lucchini
- Multiple Sclerosis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Xavier Montalban
- Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Paolo Preziosa
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jordi Río
- Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Maria A Rocca
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria L Stromillo
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Mauro Zaffaroni
- Neuroimmunology Unit-Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy
| | - Carla Tortorella
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Claudio Gasperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
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Vidal-Jordana A, Rovira A, Calderon W, Arrambide G, Castilló J, Moncho D, Rahnama K, Collorone S, Toosy AT, Ciccarelli O, Papadopoulou A, Cerdá-Fuertes N, Lieb JM, Ruggieri S, Tortorella C, Gasperini C, Bisecco A, Capuano R, Gallo A, De Barros A, Salerno A, Auger C, Sastre-Garriga J, Tintore M, Montalban X. Adding the Optic Nerve in Multiple Sclerosis Diagnostic Criteria: A Longitudinal, Prospective, Multicenter Study. Neurology 2024; 102:e200805. [PMID: 38165378 PMCID: PMC10834130 DOI: 10.1212/wnl.0000000000207805] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/20/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The optic nerve is not one of the areas of the CNS that can be used to demonstrate dissemination in space (DIS) within the 2017 McDonald criteria for the diagnosis of multiple sclerosis (MS). Objectives were (1) to assess whether optic nerve-MRI (ON-MRI), optical coherence tomography (OCT), and visual evoked potentials (VEP) detect optic nerve involvement in clinically isolated syndrome (CIS) and (2) to evaluate the contribution of the optic nerve topography to the current diagnostic criteria in a prospective, multicenter cohort. METHODS MAGNIMS centers were invited to provide prospective data on patients with CIS who underwent a visual assessment with at least 2 of 3 investigations (ON-MRI, OCT, or VEP) within 6 months of onset. Modified DIS criteria were constructed by adding the optic nerve topography, defined by each investigation separately and any combination of them, as the fifth area of the CNS. A risk assessment analysis and the performance of the different DIS criteria were analyzed using the diagnosis of MS according to the 2017 McDonald criteria as the primary outcome and new T2 lesions and/or a second relapse as the secondary outcome. RESULTS We included 157 patients with CIS from 5 MAGNIMS centers; 60/157 (38.2%) patients presented with optic neuritis. Optic nerve involvement on ON-MRI was found in 40.2% patients at study entry and in 72.5% of those with optic neuritis.At follow-up (mean 27.9 months, SD 14.5), 111/157 patients (70.7%) were diagnosed with MS according to the 2017 McDonald criteria. Fulfilling either 2017 DIS or any modified DIS criteria conferred a similar high risk for reaching primary and secondary outcomes. The modified DIS criteria had higher sensitivity (92.5% [with ON-MRI] vs 88.2%), but slightly lower specificity (80.0% [with GCIPL IEA ≥4 μm] vs 82.2%), with overall similar accuracy (86.6% [with ON-MRI] vs 86.5%) than 2017 DIS criteria. Consistent results were found for secondary outcomes. DISCUSSION In patients with CIS, the presence of an optic nerve lesion defined by MRI, OCT, or VEP is frequently detected, especially when presenting with optic neuritis. Our study supports the addition of the optic nerve as a fifth topography to fulfill DIS criteria.
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Affiliation(s)
- Angela Vidal-Jordana
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Alex Rovira
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Willem Calderon
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Georgina Arrambide
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Joaquín Castilló
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Dulce Moncho
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Kimia Rahnama
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Sara Collorone
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Ahmed T Toosy
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Olga Ciccarelli
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Athina Papadopoulou
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Nuria Cerdá-Fuertes
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Johanna M Lieb
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Serena Ruggieri
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Carla Tortorella
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Claudio Gasperini
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Alvino Bisecco
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Rocco Capuano
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Antonio Gallo
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Andrea De Barros
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Annalaura Salerno
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Cristina Auger
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Jaume Sastre-Garriga
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Mar Tintore
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Xavier Montalban
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
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5
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Fleischer V, Gonzalez-Escamilla G, Pareto D, Rovira A, Sastre-Garriga J, Sowa P, Høgestøl EA, Harbo HF, Bellenberg B, Lukas C, Ruggieri S, Gasperini C, Uher T, Vaneckova M, Bittner S, Othman AE, Collorone S, Toosy AT, Meuth SG, Zipp F, Barkhof F, Ciccarelli O, Groppa S. Prognostic value of single-subject grey matter networks in early multiple sclerosis. Brain 2024; 147:135-146. [PMID: 37642541 PMCID: PMC10766234 DOI: 10.1093/brain/awad288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/02/2023] [Revised: 07/17/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
The identification of prognostic markers in early multiple sclerosis (MS) is challenging and requires reliable measures that robustly predict future disease trajectories. Ideally, such measures should make inferences at the individual level to inform clinical decisions. This study investigated the prognostic value of longitudinal structural networks to predict 5-year Expanded Disability Status Scale (EDSS) progression in patients with relapsing-remitting MS (RRMS). We hypothesized that network measures, derived from MRI, outperform conventional MRI measurements at identifying patients at risk of developing disability progression. This longitudinal, multicentre study within the Magnetic Resonance Imaging in MS (MAGNIMS) network included 406 patients with RRMS (mean age = 35.7 ± 9.1 years) followed up for 5 years (mean follow-up = 5.0 ± 0.6 years). EDSS was determined to track disability accumulation. A group of 153 healthy subjects (mean age = 35.0 ± 10.1 years) with longitudinal MRI served as controls. All subjects underwent MRI at baseline and again 1 year after baseline. Grey matter atrophy over 1 year and white matter lesion load were determined. A single-subject brain network was reconstructed from T1-weighted scans based on grey matter atrophy measures derived from a statistical parameter mapping-based segmentation pipeline. Key topological measures, including network degree, global efficiency and transitivity, were calculated at single-subject level to quantify network properties related to EDSS progression. Areas under receiver operator characteristic (ROC) curves were constructed for grey matter atrophy and white matter lesion load, and the network measures and comparisons between ROC curves were conducted. The applied network analyses differentiated patients with RRMS who experience EDSS progression over 5 years through lower values for network degree [H(2) = 30.0, P < 0.001] and global efficiency [H(2) = 31.3, P < 0.001] from healthy controls but also from patients without progression. For transitivity, the comparisons showed no difference between the groups [H(2) = 1.5, P = 0.474]. Most notably, changes in network degree and global efficiency were detected independent of disease activity in the first year. The described network reorganization in patients experiencing EDSS progression was evident in the absence of grey matter atrophy. Network degree and global efficiency measurements demonstrated superiority of network measures in the ROC analyses over grey matter atrophy and white matter lesion load in predicting EDSS worsening (all P-values < 0.05). Our findings provide evidence that grey matter network reorganization over 1 year discloses relevant information about subsequent clinical worsening in RRMS. Early grey matter restructuring towards lower network efficiency predicts disability accumulation and outperforms conventional MRI predictors.
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Affiliation(s)
- Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Piotr Sowa
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Einar A Høgestøl
- Institute of Clinical Medicine, University of Oslo, NO-0316 Oslo, Norway
- Department of Neurology, Oslo University Hospital, 0424 Oslo, Norway
| | - Hanne F Harbo
- Institute of Clinical Medicine, University of Oslo, NO-0316 Oslo, Norway
- Department of Neurology, Oslo University Hospital, 0424 Oslo, Norway
| | - Barbara Bellenberg
- Institute of Neuroradiology, St Josef Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Carsten Lukas
- Institute of Neuroradiology, St Josef Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Serena Ruggieri
- Department of Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Claudio Gasperini
- Department of Neurosciences, San Camillo-Forlanini Hospital, 00152 Rome, Italy
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, 121 08 Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, 121 08 Prague, Czech Republic
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Sara Collorone
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London, WC1E 6BT London, UK
| | - Ahmed T Toosy
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London, WC1E 6BT London, UK
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Frederik Barkhof
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London, WC1E 6BT London, UK
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, 1100 DD Amsterdam, Netherlands
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London, WC1E 6BT London, UK
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
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Midaglia L, Rovira A, Miró B, Río J, Fissolo N, Castilló J, Sánchez A, Montalban X, Comabella M. Association of magnetic resonance imaging phenotypes and serum biomarker levels with treatment response and long-term disease outcomes in multiple sclerosis patients. Eur J Neurol 2024; 31:e16077. [PMID: 37754568 DOI: 10.1111/ene.16077] [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: 01/26/2023] [Revised: 06/02/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND AND PURPOSE The aim was to evaluate whether magnetic resonance imaging (MRI) phenotypes defined by inflammation and neurodegeneration markers correlate with serum levels of neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) in relapsing-remitting multiple sclerosis (RRMS) patients; and to explore the role of radiological phenotypes and biomarker levels on treatment response and long-term prognostic outcomes. METHODS Magnetic resonance imaging scans from 80 RRMS patients were classified at baseline of interferon-beta (IFNβ) treatment into radiological phenotypes defined by high and low inflammation and high and low neurodegeneration, based on the number of contrast-enhancing lesions, brain parenchymal fraction and the relative volume of non-enhancing black holes on T1-weighted images. Serum levels of NfL and GFAP were measured at baseline with single molecule array (Simoa) assays. MRI phenotypes and serum biomarker levels were investigated for their association with IFNβ response, and times to second-line therapies, secondary-progressive MS (SPMS) conversion and Expanded Disability Status Scale (EDSS) 6.0. RESULTS Mean (SD) follow-up was 17 (2.9) years. Serum NfL levels and GFAP were higher in the high inflammation (p = 0.04) and high neurodegeneration phenotypes (p = 0.03), respectively. The high inflammation phenotype was associated with poor response to IFNβ treatment (p = 0.04) and with shorter time to second-line therapies (p = 0.04). In contrast, the high neurodegeneration phenotype was associated with shorter time to SPMS (p = 0.006) and a trend towards shorter time to EDSS 6.0 (p = 0.09). High serum NfL levels were associated with poor response to IFNβ treatment (p = 0.004). CONCLUSIONS Magnetic resonance imaging phenotypes defined by inflammation and neurodegeneration correlate with serum biomarker levels, and both have prognostic implications in treatment response and long-term disease outcomes.
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Affiliation(s)
- Luciana Midaglia
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Berta Miró
- Unitat d'Estadística i Bioinformàtica, Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain
| | - Jordi Río
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nicolás Fissolo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Castilló
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Sánchez
- Unitat d'Estadística i Bioinformàtica, Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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7
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Gramegna LL, Ortega G, Dinia L, Aixut S, Rosati S, Vega P, Lüttich A, Remollo S, González A, Murias E, Chirife Chaparro O, Moreu M, Requena M, de Dios Lascuevas M, Hernandez D, Quintana M, Puig J, Rovira A, Tomasello A. Cognitive improvement following endovascular embolization in patients with intracranial dural arteriovenous fistula: The Neuropsychology in dural ArterIal Fistula (NAIF) Study. J Neurointerv Surg 2023:jnis-2023-021033. [PMID: 38071581 DOI: 10.1136/jnis-2023-021033] [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: 09/14/2023] [Accepted: 11/21/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Cognitive improvement after endovascular embolization of an intracranial dural arteriovenous fistula (dAVF) remains unexplored. We aim to investigate cognitive changes following endovascular embolization of dAVFs. METHODS Neuropsychology in dural ArterIal Fistula (NAIF) was a prospective multicentric study including patients with an angiographic diagnosis of dAVF who underwent endovascular embolization over the course of 4 years. A complete neuropsychological evaluation comprising five cognitive domains (attention and executive functions, memory, language, praxis, gnosis) was performed at baseline and 3 months follow-up. Mean Z scores for cognitive tests were compared pre- and post-treatment using paired sample t-tests, where higher Z scores indicate better cognition. Effect sizes were computed as Cohen's d. RESULTS A total of 32 patients (mean age 61.1±15.4 years, 10 (31.3%) females) were included. Patients exhibited improved performance in attention and executive functions: executive functions-attention (+0.282, P=0.009, d=0.29), executive functions-fluencies (+0.283, P=0.029, d=0.4), and executive functions-processing speed (+0.471, P=0.039, d=0.41). There was an increase in memory: verbal learning and verbal delayed recall scores (+0.513, P<0.001, d=0.55, and +0.385, P=0.001, d=0.41, respectively), while verbal recognition parameters (+0.839, P=0.086, d=0.37) and visual memory (delayed recall) (+0.430, P=0.060, d=0.35) displayed trends toward improved performance. Regarding language, there was significant overall improvement (+0.300, P=0.014, d=0.24), but neither praxis nor gnosis changed significantly. These cognitive outcomes were independent of the severity (measured as Cognard classification), and no patient experienced cognitive worsening. CONCLUSION This study suggests that endovascular embolization confers cognitive benefits on dAVF patients undergoing endovascular embolization and may be beneficial even for patients with a low risk of hemorrhage.
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Affiliation(s)
- Laura Ludovica Gramegna
- Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Servicio de Radiología, Unidad de Neurorradiología, Hospital del Mar, Barcelona, Spain
| | - Gemma Ortega
- Universitat Internacional de Catalunya, Research Center and Memory clinic Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Lavinia Dinia
- Department of Radiology, Hospital de la Santa Creu i Sant Pau, Interventional Neuroradiology Section, Barcelona, Spain
| | - Sonia Aixut
- Department of Neuroradiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Santiago Rosati
- Department of Radiology, Clinical San Carlos Hospital, Interventional Neuroradiology Unit, Madrid, Spain
| | - Pedro Vega
- Department of Radiology, Hospital Universitario Central de Asturias, Interventional Neuroradiology, Oviedo, Spain
| | - Alex Lüttich
- Department of Radiology, Donostia University Hospital, Interventional Neuroradiology Section, Donostia-San Sebastián, Spain
| | - Sebastian Remollo
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Interventional Neuroradiology Unit, Badalona, Spain
| | - Alejandro González
- Department of Radiology, Hospital Universitario Virgen del Rocío, Interventional Neuroradiology, Seville, Spain
| | - Eduardo Murias
- Department of Radiology, Hospital Universitario Central de Asturias, Interventional Neuroradiology, Oviedo, Spain
| | - Oscar Chirife Chaparro
- Department of Neuroradiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Manuel Moreu
- Department of Radiology, Hospital Clínico Universitario San Carlos, Interventional Neuroradiology Unit, Madrid, Spain
| | - Manuel Requena
- Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Interventional Neuroradiology Section, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marta de Dios Lascuevas
- Interventional Neuroradiology Section, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - David Hernandez
- Interventional Neuroradiology Section, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manuel Quintana
- Department of Neurology, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Epilepsy Unit, Barcelona, Spain
| | - Josep Puig
- Radiology Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Alex Rovira
- Department of Radiology, Neuroradiology Section, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandro Tomasello
- Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Interventional Neuroradiology Section, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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8
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Martinez-Heras E, Solana E, Vivó F, Lopez-Soley E, Calvi A, Alba-Arbalat S, Schoonheim MM, Strijbis EM, Vrenken H, Barkhof F, Rocca MA, Filippi M, Pagani E, Groppa S, Fleischer V, Dineen RA, Bellenberg B, Lukas C, Pareto D, Rovira A, Sastre-Garriga J, Collorone S, Prados F, Toosy A, Ciccarelli O, Saiz A, Blanco Y, Llufriu S. Diffusion-based structural connectivity patterns of multiple sclerosis phenotypes. J Neurol Neurosurg Psychiatry 2023; 94:916-923. [PMID: 37321841 DOI: 10.1136/jnnp-2023-331531] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND We aimed to describe the severity of the changes in brain diffusion-based connectivity as multiple sclerosis (MS) progresses and the microstructural characteristics of these networks that are associated with distinct MS phenotypes. METHODS Clinical information and brain MRIs were collected from 221 healthy individuals and 823 people with MS at 8 MAGNIMS centres. The patients were divided into four clinical phenotypes: clinically isolated syndrome, relapsing-remitting, secondary progressive and primary progressive. Advanced tractography methods were used to obtain connectivity matrices. Then, differences in whole-brain and nodal graph-derived measures, and in the fractional anisotropy of connections between groups were analysed. Support vector machine algorithms were used to classify groups. RESULTS Clinically isolated syndrome and relapsing-remitting patients shared similar network changes relative to controls. However, most global and local network properties differed in secondary progressive patients compared with the other groups, with lower fractional anisotropy in most connections. Primary progressive participants had fewer differences in global and local graph measures compared with clinically isolated syndrome and relapsing-remitting patients, and reductions in fractional anisotropy were only evident for a few connections. The accuracy of support vector machine to discriminate patients from healthy controls based on connection was 81%, and ranged between 64% and 74% in distinguishing among the clinical phenotypes. CONCLUSIONS In conclusion, brain connectivity is disrupted in MS and has differential patterns according to the phenotype. Secondary progressive is associated with more widespread changes in connectivity. Additionally, classification tasks can distinguish between MS types, with subcortical connections being the most important factor.
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Affiliation(s)
- Eloy Martinez-Heras
- Neuroimmunology and Multiple Sclerosis Unit and Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Elisabeth Solana
- Neuroimmunology and Multiple Sclerosis Unit and Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Francesc Vivó
- Neuroimmunology and Multiple Sclerosis Unit and Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Elisabet Lopez-Soley
- Neuroimmunology and Multiple Sclerosis Unit and Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Alberto Calvi
- Neuroimmunology and Multiple Sclerosis Unit and Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Salut Alba-Arbalat
- Neuroimmunology and Multiple Sclerosis Unit and Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Menno M Schoonheim
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Eva M Strijbis
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Hugo Vrenken
- Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Sergiu Groppa
- Department of Neurology, Neurostimulation and Neuroimaging, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Vinzenz Fleischer
- Department of Neurology, Neurostimulation and Neuroimaging, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Robert A Dineen
- Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; and NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Barbara Bellenberg
- Institute of Neuroradiology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Carsten Lukas
- Institute of Neuroradiology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital and Research Institute (VHIR), Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital and Research Institute (VHIR), Barcelona, Spain
| | - Jaume Sastre-Garriga
- Neurology-Neuroimmunology Department, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sara Collorone
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London, London, UK
| | - Ferran Prados
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London, London, UK
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Bioengineering, University College London, London, UK
- E-health Centre, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Ahmed Toosy
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London, London, UK
| | - Olga Ciccarelli
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London, London, UK
| | - Albert Saiz
- Neuroimmunology and Multiple Sclerosis Unit and Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Yolanda Blanco
- Neuroimmunology and Multiple Sclerosis Unit and Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sara Llufriu
- Neuroimmunology and Multiple Sclerosis Unit and Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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9
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Dinia L, Vert C, Gramegna LL, Arikan F, Hernández D, Coscojuela P, Martinez-Saez E, Ramón Y Cajal S, Luzi M, Sarria-Estrada S, Salerno A, De Barros A, Gandara D, Quintana M, Rovira A, Tomasello A. Wall enhancement as a biomarker of intracranial aneurysm instability: a histo-radiological study. Acta Neurochir (Wien) 2023; 165:2783-2791. [PMID: 37589724 DOI: 10.1007/s00701-023-05739-8] [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: 01/04/2023] [Accepted: 06/25/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The aim of this is to explore the histological basis of vessel wall enhancement (WE) on magnetic resonance imaging (MRI), which is a strong radiological biomarker of aneurysmal prone to rupture compared to other classical risk predictors (e.g., PHASES score, size, morphology). METHODS A prospective observational study was performed including all consecutive patients presenting with a saccular intracranial aneurysm at Vall d'Hebron University Hospital between October 2017 and May 2019. The patients underwent high-resolution 3 T MRI, and their aneurysms were classified into asymptomatic, symptomatic, and ruptured. A histological and immunohistochemical study was performed in a subgroup of patients (n = 20, of which 15 presented with WE). Multiple regression analyses were performed to identify predictors of rupture and aneurysm symptoms. RESULTS A total of 132 patients were enrolled in the study. WE was present in 36.5% of aneurysms: 22.9% asymptomatic, 76.9% symptomatic, and 100% ruptured. Immunohistochemical markers associated with WE were CD3 T cell receptor (p = 0.05) and CD45 leukocyte common antigen (p = 0.05). Moreover, WE is an independent predictor of symptomatic and ruptured aneurysms (p < 0.001). CONCLUSIONS Aneurysms with WE present multiple histopathological changes that may contribute to wall disruption and represent the pathophysiological basis of radiological WE. Moreover, WE is an independent diagnostic predictor of aneurysm symptoms and rupture.
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Affiliation(s)
- Lavinia Dinia
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
- Interventional Neuroradiology Section, Department of Radiology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Carla Vert
- Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Ludovica Gramegna
- Vall d'Hebron Institute of Research, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Servicio de Radiología, Unidad de Neurorradiología., Hospital del Mar, Barcelona, Spain
| | - Fuat Arikan
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
- Neurotraumatology and Neurosurgery Research Unit, Department of Neurosurgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Hernández
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Pilar Coscojuela
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | | | | | - Michele Luzi
- Interventional Neuroradiology Section, Department of Radiology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Torrette University Hospital, UNIVPM, Ancona, Italy
| | - Silvana Sarria-Estrada
- Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Annalaura Salerno
- Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andrea De Barros
- Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Dario Gandara
- Neurotraumatology and Neurosurgery Research Unit, Department of Neurosurgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Quintana
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Neurology Department, Epilepsy Unit, Vall d'Hebron Hospital, Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandro Tomasello
- Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain.
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
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Cobo-Calvo A, Tur C, Otero-Romero S, Carbonell-Mirabent P, Ruiz M, Pappolla A, Villacieros Alvarez J, Vidal-Jordana A, Arrambide G, Castilló J, Galan I, Rodríguez Barranco M, Midaglia LS, Nos C, Rodriguez Acevedo B, Zabalza de Torres A, Mongay N, Rio J, Comabella M, Auger C, Sastre-Garriga J, Rovira A, Tintore M, Montalban X. Association of Very Early Treatment Initiation With the Risk of Long-term Disability in Patients With a First Demyelinating Event. Neurology 2023; 101:e1280-e1292. [PMID: 37468284 PMCID: PMC10558169 DOI: 10.1212/wnl.0000000000207664] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 06/02/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Early treatment is associated with better long-term outcomes in patients with a first demyelinating event and early multiple sclerosis (MS). However, magnetic resonance (MR) findings are not usually integrated to construct propensity scores (PSs) when evaluating outcomes. We assessed the association of receiving very early treatment with the risk of long-term disability including an MR score (MRS) in patients with a first demyelinating event. METHODS We included 580 patients with a first demyelinating event prospectively collected between 1994 and 2021, who received at least 1 disease-modifying drug (DMD). Patients were classified into tertiles according to the cohort's distribution of the time from the first demyelinating event to the first DMD: first tertile (FT) or very early treatment (6 months; n = 194), second tertile (6.1-16 months, n = 192), and third tertile (TT) (16.1 months, n = 194). A 5-point MRS was built according to the sum of the following indicators: ≥9 brain lesions (1 point); ≥1 infratentorial lesion (1 point); ≥1 spinal cord (SC) lesion (1 point); ≥1 contrast-enhancing (CE) brain lesion (1 point); and ≥1 CE SC lesion (1 point). PS based on covariates and the MRS was computed for each of the outcomes. Inverse PS-weighted Cox and linear regression models assessed the risk of different outcomes between tertile groups. Finally, to confirm the role of MR in treatment decision, we studied the time elapsed from the first demyelinating event to treatment initiation according to the MRS in all patients with radiologic available information, renamed as raw-MRS. RESULTS Very early treatment decreased the risk of reaching Expanded Disability Status Scale 3.0 (hazard ratio [HR] 0.55, 95% CI 0.32-0.97), secondary progressive MS (HR 0.40, 95% CI 0.19-0.85), and sustained disease progression at 12 months after treatment initiation (HR 0.50, 95% CI 0.29-0.84), when compared with patients from the TT group. Patients from the FT group had a lower disability progression rate (β estimate -0.009, 95% CI -0.016 to -0.002) and a lower severe disability measured by the Patient-Determined Disease Step (β estimate -0.52, 95% CI -0.91 to -0.13) than the TT group. Finally, there was a 62.4% reduction in the median time between the first demyelinating event and the first-ever treatment initiation from patients displaying a raw-MRS 1 to patients with a raw-MRS 5. DISCUSSION Using PS models with and without MRS, we showed that treatment initiation at very early stages is associated with a reduction in the risk of long-term disability accrual in patients with a first demyelinating event. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that earlier treatment of patients with MS presenting with a first demyelinating event is associated with improved clinical outcomes.
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Affiliation(s)
- Alvaro Cobo-Calvo
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
| | - Carmen Tur
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Susana Otero-Romero
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Pere Carbonell-Mirabent
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Mariano Ruiz
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Agustin Pappolla
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Javier Villacieros Alvarez
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Angela Vidal-Jordana
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Georgina Arrambide
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Joaquín Castilló
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Ingrid Galan
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Marta Rodríguez Barranco
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Luciana Soledad Midaglia
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Carlos Nos
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Breogan Rodriguez Acevedo
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Ana Zabalza de Torres
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Neus Mongay
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jordi Rio
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Manuel Comabella
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Cristina Auger
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jaume Sastre-Garriga
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Alex Rovira
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Mar Tintore
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Xavier Montalban
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
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Villacieros-Álvarez J, Espejo C, Arrambide G, Castillo M, Carbonell-Mirabent P, Rodriguez M, Bollo L, Castilló J, Comabella M, Galán I, Midaglia L, Mongay-Ochoa N, Nos C, Rio J, Rodríguez-Acevedo B, Sastre-Garriga J, Tur C, Vidal-Jordana A, Vilaseca A, Zabalza A, Auger C, Rovira A, Montalban X, Tintoré M, Cobo-Calvo Á. Myelin Oligodendrocyte Glycoprotein Antibodies in Adults with a First Demyelinating Event Suggestive of Multiple Sclerosis. Ann Neurol 2023. [PMID: 37705507 DOI: 10.1002/ana.26793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/21/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) distinguish multiple sclerosis (MS) from MOG-associated disease in most cases. However, studies analyzing MOG-Ab at the time of a first demyelinating event suggestive of MS in adults are lacking. We aimed to (1) evaluate the prevalence of MOG-Ab in a first demyelinating event suggestive of MS and (2) compare clinical and paraclinical features between seropositive (MOG-Ab+) and seronegative (MOG-Ab-) patients. METHODS Six hundred thirty adult patients with available serum samples obtained within 6 months from the first event were included. MOG-Ab were analyzed using a live cell-based assay. Statistical analyses included parametric and nonparametric tests, logistic regression, and survival models. RESULTS MOG-Ab were positive in 17 of 630 (2.7%). Fourteen out of 17 (82.4%) MOG-Ab+ patients presented with optic neuritis (ON) compared to 227of 613 (37.0%) MOG-Ab- patients (p = 0.009). Cerebrospinal fluid-restricted oligoclonal bands (CSF-OBs) were found in 2 of 16 (12.5%) MOG-Ab+ versus 371 of 601 (61.7%) MOG-Ab- subjects (p < 0.001). Baseline brain magnetic resonance imaging (MRI) was normal in 9 of 17 (52.9%) MOG-Ab+ versus 153 of 585 (26.2%) MOG-Ab- patients (p = 0.029). Absence of CSF-OBs and ON at onset were independently associated with MOG-Ab positivity (odds ratio [OR] = 9.03, 95% confidence interval [CI] = 2.04-53.6, p = 0.009; and OR = 4.17, 95% CI = 1.15-19.8, p = 0.042, respectively). Of MOG-Ab+ patients, 22.9% (95% CI = 0.0-42.7) compared to 67.6% (95% CI = 63.3-71.3) of MOG-Ab- patients fulfilled McDonald 2017 criteria at 5 years (log-rank p = 0.003). INTERPRETATION MOG-Ab are infrequent in adults with a first demyelinating event suggestive of MS. However, based on our results, we suggest to determine these antibodies in those patients with ON and absence of CSF-OBs, as long as the brain MRI is not suggestive of MS. ANN NEUROL 2023.
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Affiliation(s)
- Javier Villacieros-Álvarez
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Espejo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Mireia Castillo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Marta Rodriguez
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Luca Bollo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Joaquín Castilló
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Neus Mongay-Ochoa
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Carlos Nos
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Jordi Rio
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Breogan Rodríguez-Acevedo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Tur
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Angela Vidal-Jordana
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Andreu Vilaseca
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Cristina Auger
- Autonomous University of Barcelona, Barcelona, Spain
- Section of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alex Rovira
- Autonomous University of Barcelona, Barcelona, Spain
- Section of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Xavier Montalban
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
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12
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Comabella M, Tintore M, Sao Avilés A, Carbonell-Mirabent P, Malhotra S, Rovira A, Fissolo N, Lünemann JD, Montalban X. Increased cytomegalovirus immune responses at disease onset are protective in the long-term prognosis of patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2023; 94:173-180. [PMID: 36344261 DOI: 10.1136/jnnp-2022-330205] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE It remains unclear whether viral infections interfere with multiple sclerosis (MS) disease progression. We evaluated the prognostic role of antibody responses toward viruses determined at disease onset on long-term disease outcomes. METHODS Humoral immune responses against Epstein-Barr virus (EBV)-encoded nuclear antigen EBNA1, viral capsid antigen (VCA) and early antigen, and toward cytomegalovirus (HCMV), human herpesvirus 6 and measles were investigated in a cohort of 143 patients with MS for their association with long-term disability and inflammation disease outcomes. RESULTS Median (IQR) follow-up was 20 (17.2-22.8) years. In univariable analysis, increased HCMV levels were associated with a lower risk to Expanded Disability Status Scale 4.0 (HR 0.95; 95% CI 0.91 to 0.99; p=0.03), to develop a secondary progressive MS (HR 0.94; 95% CI 0.90 to 0.99; p=0.02) and to first-line treatment (HR 0.98; 95% CI 0.96 to 0.99; p=0.04). High HCMV IgG levels were associated with a longer time to first-line treatment (p=0.01). Increased immune responses against EBV-VCA were associated with higher risk for first-line (HR 1.45; 95% CI 1.12 to 1.88; p=0.005) and second-line treatments (HR 2.03; 95% CI 1.18 to 3.49; p=0.01), and high VCA IgG levels were associated with shorter time to first-line (p=0.004) and second-line (p=0.02) therapies. EBNA1-specific IgG levels correlated with disease severity (0.17; p=0.04) and with an increased relapse rate during follow-up (relapse rate 1.26; 95% CI 1.03 to 1.56; p=0.02) that remained stable in multivariable analysis. CONCLUSIONS These results indicate that elevated immune responses against HCMV at disease onset have protective effects on long-term disability and inflammation disease outcomes. Our data also indicate that increased immune responses against EBV in early phases may influence long-term disease prognosis.
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Affiliation(s)
- Manuel Comabella
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mar Tintore
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Augusto Sao Avilés
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sunny Malhotra
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alex Rovira
- Servei de Neuroradiología, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Nicolás Fissolo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jan D Lünemann
- Neurology, Faculty of Medicine, University of Münster, Munster, Germany
| | - Xavier Montalban
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain
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13
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Calvi A, Clarke MA, Prados F, Chard D, Ciccarelli O, Alberich M, Pareto D, Rodríguez Barranco M, Sastre-Garriga J, Tur C, Rovira A, Barkhof F. Relationship between paramagnetic rim lesions and slowly expanding lesions in multiple sclerosis. Mult Scler 2023; 29:352-362. [PMID: 36515487 PMCID: PMC9972234 DOI: 10.1177/13524585221141964] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) markers for chronic active lesions in MS include slowly expanding lesions (SELs) and paramagnetic rim lesions (PRLs). OBJECTIVES To identify the relationship between SELs and PRLs in MS, and their association with disability. METHODS 61 people with MS (pwMS) followed retrospectively with MRI including baseline susceptibility-weighted imaging, and longitudinal T1 and T2-weighted scans. SELs were computed using deformation field maps; PRLs were visually identified. Mixed-effects models assessed differences in Expanded Disability Status Scale (EDSS) score changes between the group defined by the presence of SELs and or PRLs. RESULTS The median follow-up time was 3.2 years. At baseline, out of 1492 lesions, 616 were classified as SELs, and 80 as PRLs. 92% of patients had ⩾ 1 SEL, 56% had ⩾ 1 PRL, while both were found in 51%. SELs compared to non-SELs were more likely to also be PRLs (7% vs. 4%, p = 0.027). PRL counts positively correlated with SEL counts (ρ= 0.28, p = 0.03). SEL + PRL + patients had greater increases in EDSS over time (beta = 0.15/year, 95% confidence interval (0.04, 0.27), p = 0.009) than SEL+PRL-patients. CONCLUSION SELs are more numerous than PRLs in pwMS. Compared with either SELs or PRLs found in isolation, their joint occurrence was associated with greater clinical progression.
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Affiliation(s)
- Alberto Calvi
- A Calvi Queen Square MS Centre, Department
of Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences,
University College London (UCL), London, WC1B 5 EH, UK.
| | | | - Ferran Prados
- Queen Square MS Centre, Department of
Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences,
University College London (UCL), London UK/Centre for Medical Image
Computing (CMIC), Department of Medical Physics and Biomedical Engineering,
University College London, London, UK/e-Health Centre, Universitat Oberta de
Catalunya, Barcelona, Spain
| | - Declan Chard
- Queen Square MS Centre, Department of
Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences,
University College London (UCL), London, UK/Biomedical Research Centre,
National Institute for Health Research (NIHR) and University College London
Hospitals (UCLH), London, UK
| | - Olga Ciccarelli
- Queen Square MS Centre, Department of
Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences,
University College London (UCL), London, UK/Biomedical Research Centre,
National Institute for Health Research (NIHR) and University College London
Hospitals (UCLH), London, UK
| | - Manel Alberich
- Section of Neuroradiology, Department of
Radiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of
Radiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Marta Rodríguez Barranco
- Neurology-Neuroimmunology Department, Multiple
Sclerosis Centre of Catalonia (CEMCAT), Vall d’Hebron Barcelona Hospital
Campus, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Neurology-Neuroimmunology Department, Multiple
Sclerosis Centre of Catalonia (CEMCAT), Vall d’Hebron Barcelona Hospital
Campus, Barcelona, Spain
| | - Carmen Tur
- Queen Square MS Centre, Department of
Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences,
University College London (UCL), London, UK/Neurology-Neuroimmunology
Department, Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d’Hebron
Barcelona Hospital Campus, Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of
Radiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Frederik Barkhof
- Queen Square MS Centre, Department of
Neuroinflammation, Institute of Neurology, Faculty of Brain Sciences,
University College London (UCL), London, UK/Centre for Medical Image
Computing (CMIC), Department of Medical Physics and Biomedical Engineering,
University College London, London, UK Biomedical Research Centre, National
Institute for Health Research (NIHR) and University College London Hospitals
(UCLH), London, UK/Radiology & Nuclear medicine, VU University Medical
Centre, Amsterdam, The Netherlands
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14
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Sastre-Garriga J, Rovira A, García-Vidal A, Carbonell-Mirabent P, Alberich M, Vidal-Jordana A, Auger C, Tintore M, Montalban X, Pareto D. Spinal cord reserve in multiple sclerosis. J Neurol Neurosurg Psychiatry 2023:jnnp-2022-330613. [PMID: 36690430 DOI: 10.1136/jnnp-2022-330613] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND The spinal cord (SC) is a preferential target of multiple sclerosis (MS) damage highly relevant towards disability. Differential impact of such damage could be due to the initial amount of SC tissue, as described for the brain parenchyma (brain reserve concept). We aimed to test the existence of SC reserve by using spinal canal area (SCaA) as a proxy. METHODS Brain sagittal three-dimensional T1-weighted scans covering down to C5 level were acquired in 2930 people with MS and 43 healthy controls (HCs) in a cross-sectional, multicentre study. SC area (SCA) and SCaA were obtained with the Spinal Cord Toolbox. Demographical data and patient-derived disability scores were obtained. SC parameters were compared between groups with age-adjusted and sex-adjusted linear regression models. The main outcome of the study, the existence of an association between SCaA and Patient Determined Disease Steps, was tested with scaled linear models. RESULTS 1747 persons with MS (mean age: 46.35 years; 73.2% female) and 42 HCs (mean age: 45.56 years; 78.6% female) were analysed after exclusion of post-processing errors and application of quality criteria. SCA (60.41 mm2 vs 65.02 mm2, p<0.001) was lower in people with MS compared with HC; no differences in SCaA were observed (213.24 mm2 vs 212.61 mm2, p=0.125). Adjusted scaled linear models showed that a larger SCaA was significantly associated with lower scores on Patient Determined Disease Steps (beta coefficient: -0.12, p=0.0124) independently of spinal cord atrophy, brain T2 lesion volume, age and sex. CONCLUSIONS A larger SCaA may be protective against disability in MS, possibly supporting the existence of SC reserve.
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Affiliation(s)
- Jaume Sastre-Garriga
- Servei de Neurologia / Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alex Rovira
- Secció de Neuroradiologia, Servei de Radiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Aran García-Vidal
- Secció de Neuroradiologia, Servei de Radiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Servei de Neurologia / Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Manel Alberich
- Secció de Neuroradiologia, Servei de Radiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Angela Vidal-Jordana
- Servei de Neurologia / Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cristina Auger
- Secció de Neuroradiologia, Servei de Radiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mar Tintore
- Servei de Neurologia / Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia / Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Deborah Pareto
- Secció de Neuroradiologia, Servei de Radiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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15
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Rocca MA, Valsasina P, Meani A, Gobbi C, Zecca C, Barkhof F, Schoonheim MM, Strijbis EM, Vrenken H, Gallo A, Bisecco A, Ciccarelli O, Yiannakas M, Rovira A, Sastre-Garriga J, Palace J, Matthews L, Gass A, Eisele P, Lukas C, Bellenberg B, Margoni M, Preziosa P, Filippi M. Spinal cord lesions and brain grey matter atrophy independently predict clinical worsening in definite multiple sclerosis: a 5-year, multicentre study. J Neurol Neurosurg Psychiatry 2023; 94:10-18. [PMID: 36171105 DOI: 10.1136/jnnp-2022-329854] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/05/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the combined contribution of brain and cervical cord damage in predicting 5-year clinical worsening in a multicentre cohort of definite multiple sclerosis (MS) patients. METHODS Baseline 3.0T brain and cervical cord T2-weighted and three-dimensional T1-weighted MRI was acquired in 367 patients with MS (326 relapse-onset and 41 progressive-onset) and 179 healthy controls. Expanded Disability Status Scale (EDSS) score was obtained at baseline and after a median follow-up of 5.1 years (IQR=4.8-5.2). At follow-up, patients were classified as clinically stable/worsened according to EDSS changes. Generalised linear mixed models identified predictors of clinical worsening, evolution to secondary progressive (SP) MS and reaching EDSS=3.0, 4.0 and 6.0 milestones at 5 years. RESULTS At follow-up, 120/367 (33%) patients with MS worsened clinically; 36/256 (14%) patients with relapsing-remitting evolved to SPMS. Baseline predictors of EDSS worsening were progressive-onset versus relapse-onset MS (standardised beta (β)=0.97), higher EDSS (β=0.41), higher cord lesion number (β=0.41), lower normalised cortical volume (β=-0.15) and lower cord area (β=-0.28) (C-index=0.81). Older age (β=0.86), higher EDSS (β=1.40) and cord lesion number (β=0.87) independently predicted SPMS conversion (C-index=0.91). Predictors of reaching EDSS=3.0 after 5 years were higher baseline EDSS (β=1.49), cord lesion number (β=1.02) and lower normalised cortical volume (β=-0.56) (C-index=0.88). Baseline age (β=0.30), higher EDSS (β=2.03), higher cord lesion number (β=0.66) and lower cord area (β=-0.41) predicted EDSS=4.0 (C-index=0.92). Finally, higher baseline EDSS (β=1.87) and cord lesion number (β=0.54) predicted EDSS=6.0 (C-index=0.91). CONCLUSIONS Spinal cord damage and, to a lesser extent, cortical volume loss helped predicting worse 5-year clinical outcomes in MS.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy .,Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy.,Vita-Salute San Raffaele University, Milano, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Claudio Gobbi
- Neurology Clinic, MS Center/Headache Center, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Chiara Zecca
- Neurology Clinic, MS Center/Headache Center, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Frederik Barkhof
- Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands.,Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Eva M Strijbis
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands
| | - Hugo Vrenken
- Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands.,Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, and 3T MRI-Center, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, and 3T MRI-Center, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Marios Yiannakas
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lucy Matthews
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Achim Gass
- Department of Neurology, and Mannheim Center of Translational Neurosciences (MCTN), Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim, Mannheim, Germany
| | - Philipp Eisele
- Department of Neurology, and Mannheim Center of Translational Neurosciences (MCTN), Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim, Mannheim, Germany
| | - Carsten Lukas
- Institute of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Department of Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Barbara Bellenberg
- Institute of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy.,Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy.,Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy.,Vita-Salute San Raffaele University, Milano, Italy.,Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milano, Italy.,Neurophysiology Service, IRCCS Ospedale San Raffaele, Milano, Italy
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Bonaterra-Pastra A, Benítez S, Pancorbo O, Rodríguez-Luna D, Vert C, Rovira A, Freijo MM, Tur S, Martínez-Zabaleta M, Cardona Portela P, Vera R, Lebrato-Hernández L, Arenillas JF, Pérez-Sánchez S, Domínguez-Mayoral A, Fàbregas JM, Mauri G, Montaner J, Sánchez-Quesada JL, Hernández-Guillamon M. Association of candidate genetic variants and circulating levels of ApoE/ApoJ with common neuroimaging features of cerebral amyloid angiopathy. Front Aging Neurosci 2023; 15:1134399. [PMID: 37113571 PMCID: PMC10126235 DOI: 10.3389/fnagi.2023.1134399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction Cerebral amyloid angiopathy (CAA) is characterized by the accumulation of amyloid-β (Aβ) in brain vessels and is a main cause of lobar intracerebral hemorrhage (ICH) in the elderly. CAA is associated with magnetic resonance imaging (MRI) markers of small vessel disease (SVD). Since Aβ is also accumulated in Alzheimer's disease (AD) in the brain parenchyma, we aimed to study if several single nucleotide polymorphisms (SNPs) previously associated with AD were also associated with CAA pathology. Furthermore, we also studied the influence of APOE and CLU genetic variants in apolipoprotein E (ApoE) and clusterin/apolipoprotein J (ApoJ) circulating levels and their distribution among lipoproteins. Methods The study was carried out in a multicentric cohort of 126 patients with lobar ICH and clinical suspicion of CAA. Results We observed several SNPs associated with CAA neuroimaging MRI markers [cortical superficial siderosis (cSS), enlarged perivascular spaces in the centrum semiovale (CSO-EPVS), lobar cerebral microbleeds (CMB), white matter hyperintensities (WMH), corticosubcortical atrophy and CAA-SVD burden score]. Concretely, ABCA7 (rs3764650), CLU (rs9331896 and rs933188), EPHA1 (rs11767557), and TREML2 (rs3747742) were significantly associated with a CAA-SVD burden score. Regarding circulating levels of apolipoproteins, protective AD SNPs of CLU [rs11136000 (T) and rs9331896 (C)] were significantly associated with higher HDL ApoJ content in the lobar ICH cohort. APOEε2 carriers presented higher plasma and LDL-associated ApoE levels whereas APOEε4 carriers presented lower plasma ApoE levels. Additionally, we observed that lower circulating ApoJ and ApoE levels were significantly associated with CAA-related MRI markers. More specifically, lower LDL-associated ApoJ and plasma and HDL-associated ApoE levels were significantly associated with CSO-EPVS, lower ApoJ content in HDL with brain atrophy and lower ApoE content in LDL with the extent of cSS. Discussion This study reinforces the relevance of lipid metabolism in CAA and cerebrovascular functionality. We propose that ApoJ and ApoE distribution among lipoproteins may be associated with pathological features related to CAA with higher ApoE and ApoJ levels in HDL possibly enhancing atheroprotective, antioxidative, and anti-inflammatory responses in cerebral β-amyloidosis.
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Affiliation(s)
- Anna Bonaterra-Pastra
- Neurovascular Research Laboratory, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sònia Benítez
- Cardiovascular Biochemistry Group, Research Institute of the Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain
- Center for Biomedical Research Network on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Olalla Pancorbo
- Stroke Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | | | - Carla Vert
- Section of Neuroradiology, Department of Radiology, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M. Mar Freijo
- Neurovascular Group, BioCruces Health Research Institute, Barakaldo, Spain
| | - Silvia Tur
- Department of Neurology, Son Espases University Hospital, Balearic Islands, Spain
| | | | - Pere Cardona Portela
- Department of Neurology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Spain
| | - Rocío Vera
- Stroke Unit, Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain
| | - Lucia Lebrato-Hernández
- Stroke Unit, Department of Neurology and Neurophysiology, Virgen del Rocío University Hospital, Seville, Spain
| | - Juan F. Arenillas
- Stroke Program, Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain
- Clinical Neurosciences Research Group, Department of Medicine, University of Valladolid, Valladolid, Spain
| | | | | | - Joan Martí Fàbregas
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gerard Mauri
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Stroke Research Program, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, University of Seville, Seville, Spain
- Department of Neurology, Virgen Macarena University Hospital, Seville, Spain
| | - Jose Luis Sánchez-Quesada
- Cardiovascular Biochemistry Group, Research Institute of the Hospital de Sant Pau (IIB Sant Pau), Barcelona, Spain
- Center for Biomedical Research Network on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Jose Luis Sánchez-Quesada,
| | - Mar Hernández-Guillamon
- Neurovascular Research Laboratory, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- *Correspondence: Mar Hernández-Guillamon,
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Cortese R, Battaglini M, Prados F, Bianchi A, Haider L, Jacob A, Palace J, Messina S, Paul F, Wuerfel J, Marignier R, Durand-Dubief F, de Medeiros Rimkus C, Callegaro D, Sato DK, Filippi M, Rocca MA, Cacciaguerra L, Rovira A, Sastre-Garriga J, Arrambide G, Liu Y, Duan Y, Gasperini C, Tortorella C, Ruggieri S, Amato MP, Ulivelli M, Groppa S, Grothe M, Llufriu S, Sepulveda M, Lukas C, Bellenberg B, Schneider R, Sowa P, Celius EG, Proebstel AK, Yaldizli Ö, Müller J, Stankoff B, Bodini B, Carmisciano L, Sormani MP, Barkhof F, De Stefano N, Ciccarelli O. Clinical and MRI measures to identify non-acute MOG-antibody disease in adults. Brain 2022:6901544. [PMID: 36515653 DOI: 10.1093/brain/awac480] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 11/14/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
MRI and clinical features of myelin oligodendrocyte glycoprotein (MOG)-antibody disease may overlap with those of other inflammatory demyelinating conditions posing diagnostic challenges, especially in non-acute phases and when serologic testing for MOG-antibodies is unavailable or shows uncertain results. We aimed to identify MRI and clinical markers that differentiate non-acute MOG-antibody disease from aquaporin4 (AQP4)-antibody neuromyelitis optica spectrum disorder and relapsing remitting multiple sclerosis, guiding in the identification of MOG-antibody disease patients in clinical practice. In this cross-sectional retrospective study, data from 16 MAGNIMS centres were included. Data collection and analyses were conducted from 2019 to 2021. Inclusion criteria were: diagnosis of MOG-antibody disease, AQP4-neuromyelitis optica spectrum disorder and multiple sclerosis, brain and cord MRI at least 6 months from relapse, EDSS on the day of MRI. Brain white matter T2 lesions, T1-hypointense lesions, cortical and cord lesions were identified. Random-forest models were constructed to classify patients as MOG-antibody disease/AQP4-neuromyelitis optica spectrum disorder/multiple sclerosis; a leave one out cross-validation procedure assessed the performance of the models. Based on the best discriminators between diseases, we proposed a guide to target investigations for MOG-antibody disease. One hundred sixty-two patients with MOG-antibody disease (99F, mean age: 41 [±14] years, median EDSS: 2 [0-7.5]), 162 with AQP4-neuromyelitis optica spectrum disorder (132F, mean age: 51 [±14] years, median EDSS: 3.5 [0-8]), 189 with multiple sclerosis (132F, mean age: 40 [±10] years, median EDSS: 2 [0-8]) and 152 healthy controls (91F) were studied. In young patients (<34 years), with low disability (EDSS < 3), the absence of Dawson's fingers, temporal lobe lesions and longitudinally extensive lesions in the cervical cord pointed towards a diagnosis of MOG-antibody disease instead of the other two diseases (accuracy: 76%, sensitivity: 81%, specificity: 84%, p < 0.001). In these non-acute patients, a number of brain lesions < 6 predicted MOG-antibody disease versus multiple sclerosis (accuracy: 83%, sensitivity: 82%, specificity: 83%, p < 0.001). An EDSS < 3 and the absence of longitudinally extensive lesions in the cervical cord predicted MOG-antibody disease versus AQP4-neuromyelitis optica spectrum disorder (accuracy: 76%, sensitivity: 89%, specificity: 62%, p < 0.001). A workflow with sequential tests and supporting features has been proposed to guide a better identification of MOG-antibody disease patients. Adult non-acute MOG-antibody disease patients showed distinctive clinical and MRI features when compared to AQP4-neuromyelitis optica spectrum disorder and multiple sclerosis. A careful inspection of the morphology of brain and cord lesions together with clinical information, can guide for further analyses towards diagnosis of MOG-antibody disease in clinical practice.
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Affiliation(s)
- Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.,NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Ferran Prados
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,Center for Medical Imaging Computing, Medical Physics and Biomedical Engineering, UCL, London, UK.,Universitat Oberta de Catalunya, Barcelona, Spain
| | - Alessia Bianchi
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Lukas Haider
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Anu Jacob
- NMO Clinical Service at the Walton Centre, Liverpool, UK.,Department of Neurology, Cleveland Clinic, AbuDhabi, UAE
| | - Jacqueline Palace
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - Silvia Messina
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | | | - Romain Marignier
- Department of Biomedical Engineering, University of Basel, Switzerland.,Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Françoise Durand-Dubief
- Department of Biomedical Engineering, University of Basel, Switzerland.,Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Carolina de Medeiros Rimkus
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Radiologia e Oncologia, São Paulo SP, Brazil
| | - Dagoberto Callegaro
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Douglas Kazutoshi Sato
- Pontifícia Universidade Católica do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre RS, Brazil
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Claudio Gasperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Carla Tortorella
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Serena Ruggieri
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,Neuroimmunology Unit, IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Monica Ulivelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Sergiu Groppa
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Matthias Grothe
- Department of Neurology, University Medicine of Greifswald, Germany
| | - Sara Llufriu
- Center of Neuroimmunology, Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain
| | - Maria Sepulveda
- Center of Neuroimmunology, Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain
| | - Carsten Lukas
- Institute of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Barbara Bellenberg
- Institute of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Ruth Schneider
- Institute of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Piotr Sowa
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Elisabeth G Celius
- Department of Neurology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Özgür Yaldizli
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jannis Müller
- Department of Neurology, University Hospital, Kantonsspital, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Bruno Stankoff
- Sorbonne University, Paris Brain Institute, ICM, Pitié Salpêtrière Hospital, Paris, France
| | - Benedetta Bodini
- Sorbonne University, Paris Brain Institute, ICM, Pitié Salpêtrière Hospital, Paris, France
| | | | | | - Frederik Barkhof
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,Center for Medical Imaging Computing, Medical Physics and Biomedical Engineering, UCL, London, UK.,Radiology & Nuclear medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
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18
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Doniselli FM, Zanardo M, Mazon M, Cuccarini V, Rovira A, Costa A, Sconfienza LM, Arana E. A Critical Appraisal of the Quality of Vertigo Practice Guidelines Using the AGREE II Tool: A EuroAIM Initiative. Otol Neurotol 2022; 43:1108-1115. [PMID: 36214510 DOI: 10.1097/mao.0000000000003724] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this review is to assess the methodological quality of guidelines for the management of vertigo and dizziness and to compare their recommendations, with specific focus on neuroimaging. DATABASES REVIEWED MEDLINE, EMBASE, National Guideline Clearinghouse, and National Institute for Health and Clinical Excellence database. METHODS In March 2022, a systematic search was performed to find practice guidelines of management of vertigo and dizziness. The evaluation of guidelines quality was performed independently by four authors using the AGREE II tool. We excluded from the results those guidelines that were not primarily focused on vertigo and dizziness, such as national/international guidelines in which vertigo and dizziness were only briefly mentioned. RESULTS Our strategy of literature search identified 161 studies, and 18 guidelines were selected for the appraisal. Only five guidelines reached the acceptance level in the overall result (at least 60%), with three of them reaching the highest scores (at least 80%). The highest scores were found in Domain 6 "Editorial Independence," Domain 1 "Scope and purpose," and Domain 4 "Clarity of presentation" (median value = 66%, 62%, and 61%, respectively). The remaining domains showed a low level of quality: Domain 2 "Stakeholder Involvement," Domain 3 "Rigor of development," and Domain 5 "Applicability" had median values of 27%, 27%, and 22%, respectively. The quality of these guidelines was very low, because of low involvement of multidisciplinary teams in writing guidelines recommendations. CONCLUSION Considering all guidelines, only three had a "high" overall score, whereas 13 of 18 (72%) of them were rated as of "low" quality. Future guidelines might take this into account to improve clinical applicability.
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Affiliation(s)
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano
| | - Miguel Mazon
- Radiology and Biomedical Imaging Research Group (GIBI230), La Fe University and Polytechnic Hospital and La Fe Health Research Institute, Valencia
| | - Valeria Cuccarini
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy
| | - Alex Rovira
- Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology (IDI), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonella Costa
- Department of Neuroradiology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico
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19
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Arrambide G, Espejo C, Carbonell-Mirabent P, Dieli-Crimi R, Rodríguez-Barranco M, Castillo M, Auger C, Cárdenas-Robledo S, Castilló J, Cobo-Calvo Á, Galán I, Midaglia L, Nos C, Otero-Romero S, Río J, Rodríguez-Acevedo B, Ruiz-Ortiz M, Salerno A, Tagliani P, Tur C, Vidal-Jordana A, Zabalza A, Sastre-Garriga J, Rovira A, Comabella M, Hernández-González M, Montalban X, Tintore M. The kappa free light chain index and oligoclonal bands have a similar role in the McDonald criteria. Brain 2022; 145:3931-3942. [PMID: 35727945 DOI: 10.1093/brain/awac220] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 01/19/2022] [Revised: 05/10/2022] [Accepted: 05/29/2022] [Indexed: 11/13/2022] Open
Abstract
Intrathecal production of kappa free light chains (KFLC) occurs in multiple sclerosis and can be measured using the KFLC index. KFLC index values can be determined more easily than oligoclonal bands (OB) detection and seem more sensitive than the immunoglobulin (Ig)G index to diagnose multiple sclerosis. We assessed the value of OB, KFLC index cut-offs 5.9, 6.6, and 10.61, and IgG index to diagnose multiple sclerosis with prospectively acquired data from a clinically isolated syndrome (CIS) inception cohort. We selected patients with sufficient data to determine OB positivity, MRI dissemination in space (DIS) and time (DIT), IgG index, and sufficient quantities of paired CSF and blood samples to determine KFLC indexes (n = 214). We used Kendall´s Tau coefficient to estimate concordance; calculated the number of additional diagnoses when adding each positive index to DIS and positive OB; performed survival analyses for OB and each index with the outcomes second attack and 2017 MRI DIS and DIT; and estimated the diagnostic properties of OB and the different indexes for the abovementioned outcomes at five years. OB were positive in 138 patients (64.5%), KFLC-5.9 in 136 (63.6%), KFLC-6.6 in 135 (63.1%), KFLC-10.61 in 126 (58.9%) and IgG index in 101 (47.2%). The highest concordance was between OB and KFLC-6.6 (τ=0.727) followed by OB and KFLC-5.9 (τ=0.716). Combining DIS plus OB or KFLC-5.9 increased the number of diagnosed patients by 11 (5.1%), with KFLC-6.6 by 10 (4.7%), with KFLC-10.61 by 9 (4.2%), and with IgG index by 3 (1.4%). Patients with positive OB or indexes reached second attack and MRI DIS and DIT faster than patients with negative results (P < 0.0001 except IgG index in second attack: P = 0.016). In multivariable Cox models [aHR (95% CI)], the risk for second attack was very similar between KFLC-5.9 [2.0 (0.9-4.3), P = 0.068] and KFLC-6.6 [2.1 (1.1-4.2), P = 0.035]. The highest risk for MRI DIS and DIT was demonstrated with KFLC-5.9 [4.9 (2.5-9.6), P < 0.0001], followed by KFLC-6.6 [3.4 (1.9-6.3), P < 0.0001]. KFLC-5.9 and KFLC-6.6 had a slightly higher diagnostic accuracy than OB for second attack (70.5, 71.1, and 67.8) and MRI DIS and DIT (85.7, 85.1, and 81.0). KFLC indexes 5.9 and 6.6 performed slightly better than OB to assess multiple sclerosis risk and in terms of diagnostic accuracy. Given the concordance between OB and these indexes, we suggest using DIS plus positive OB or positive KFLC index as a modified criterion to diagnose multiple sclerosis.
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Affiliation(s)
- Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Carmen Espejo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Romina Dieli-Crimi
- Immunology Department, Vall d'Hebron Hospital Universitari. 08035 Barcelona, Spain
| | - Marta Rodríguez-Barranco
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Mireia Castillo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology and Magnetic Resonance Unit. Department of Radiology (IDI). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Simón Cárdenas-Robledo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain.,Department of Neurology, Multiple Sclerosis Center (CEMHUN), Hospital Universitario Nacional de Colombia. 111321 Bogotá, Colombia
| | - Joaquín Castilló
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Ingrid Galán
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Luciana Midaglia
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Carlos Nos
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Susana Otero-Romero
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Jordi Río
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Mariano Ruiz-Ortiz
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain.,Department of Neurology, Hospital Universitario Doce de Octubre, 28041 Madrid, Spain
| | - Annalaura Salerno
- Section of Neuroradiology and Magnetic Resonance Unit. Department of Radiology (IDI). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Paula Tagliani
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Carmen Tur
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Angela Vidal-Jordana
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Ana Zabalza
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology and Magnetic Resonance Unit. Department of Radiology (IDI). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Manuel Hernández-González
- Immunology Department, Vall d'Hebron Hospital Universitari. 08035 Barcelona, Spain.,Diagnostic Immunology Research Group, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Mar Tintore
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
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20
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Barucca L, Hering W, Perez Martin S, Bubelis E, Del Nevo A, Di Prinzio M, Caramello M, D'Alessandro A, Tarallo A, Vallone E, Moscato I, Quartararo A, D'amico S, Giannetti F, Lorusso P, Narcisi V, Ciurluini C, Montes Pita M, Sánchez C, Rovira A, Santana D, Gonzales P, Barbero R, Zaupa M, Szogradi M, Normann S, Vaananen M, Ylatalo J, Lewandowska M, Malinowski L, Martelli E, Froio A, Arena P, Tincani A. Maturation of critical technologies for the DEMO balance of plant systems. Fusion Engineering and Design 2022. [DOI: 10.1016/j.fusengdes.2022.113096] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Hobart J, Pesch VV, Rovira A, Alroughani R, Cutter G, Craveiro L, Dzhenkova D, Kuenzel T, Kantaria R, Trojano M. 036 Ocrelizumab real-world effectiveness in patients with relapsing and primary progressive multiple sclerosis: MuSicalE baseline data. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundMuSicalE (NCT03593590) is an ongoing, observational study assessing ocrelizumab effec- tiveness/safety in patients with relapsing or primary progressive multiple sclerosis (MS) treated with ocre- lizumab in routine care.MethodsPatients with relapsing-remitting MS (RRMS), relapsing secondary progressive MS (rSPMS) or primary progressive MS (PPMS) initiating ocrelizumab per local label/guidelines are included. The primary endpoint is change in SymptoMScreen score (measures 12 common MS symptoms [range, 0–6]; higher scores indicate greater impairment).ResultsAs of 5 August 2019, 324 patients were eligible for analyses. Overall, patients with rSPMS (n=25) had a longer mean disease duration (16.7 years) versus patients with RRMS (8.6 years; n=243) or PPMS (9.2 years; n=54). Mean [SD] baseline Expanded Disability Status Scale score was higher in patients with rSPMS (5.2 [1.7]) or PPMS (5.0 [1.5]), versus RRMS (3.3 [1.7]). Baseline mean (SD) total SymptoMScreen scores in patients with RRMS, rSPMS and PPMS were 23.0 (13.3), 26.8 (11.9) and 28.7 (11.2), respectively. UK-specific baseline data, including other patient-reported outcomes from secondary end points, will also be presented.ConclusionsBaseline demographics and disease characteristics show expected differences in relapsing and progressive patients. MuSicalE will inform the real-world effectiveness/safety of ocrelizumab in a broad MS population. Recruitment is ongoing.jeremy.hobart@plymouth.ac.uk
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Comabella M, Sastre-Garriga J, Carbonell-Mirabent P, Fissolo N, Tur C, Malhotra S, Pareto D, Aymerich FX, Río J, Rovira A, Tintoré M, Montalban X. Serum neurofilament light chain levels predict long-term disability progression in patients with progressive multiple sclerosis. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329020. [PMID: 35487685 DOI: 10.1136/jnnp-2022-329020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/15/2022] [Indexed: 12/22/2022]
Abstract
ObjectiveThere is a lack of sensitive and specific biomarkers for use in progressive multiple sclerosis (MS). The study aimed to assess the potential of serum neurofilament light chain (sNfL) levels as biomarker of disability progression in patients with progressive MS. METHODS We performed a prospective observational cohort study in 51 patients with progressive MS who participated in a 2-year phase II single-centre, randomised, double-blind, placebo-controlled trial of interferon-beta. Mean (SD) follow-up duration was 13.9 (6.2) years. Levels of sNfL were measured using a single molecule array immunoassay at baseline, 1, 2 and 6 years. Univariable and multivariable analyses were carried out to evaluate associations between sNfL levels and disability progression at short term (2 years), medium term (6 years) and long term (at the time of the last follow-up). RESULTS A sNfL cut-off value of 10.2 pg/mL at baseline discriminated between long-term progressors and non-progressors with a 75% sensitivity and 67% specificity (adjusted OR 7.8; 95% CI 1.8 to 46.4; p=0.01). Similar performance to discriminate between long-term progressors and non-progressors was observed using age/body mass index-adjusted sNfL Z-scores derived from a normative database of healthy controls. A cut-off increase of 5.1 pg/mL in sNfL levels between baseline and 6 years also discriminated between long-term progressors and non-progressors with a 71% sensitivity and 86% specificity (adjusted OR 49.4; 95% CI 4.4 to 2×103; p=0.008). CONCLUSIONS sNfL can be considered a prognostic biomarker of future long-term disability progression in patients with progressive MS. These data expand the little knowledge existing on the role of sNfL as long-term prognostic biomarker in patients with progressive MS.
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Affiliation(s)
- Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nicolás Fissolo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carmen Tur
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sunny Malhotra
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc X Aymerich
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Jordi Río
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Rodríguez-Acevedo B, Rovira A, Vidal-Jordana A, Moncho D, Pareto D, Sastre-Garriga J. [Optic neuritis: aetiopathogenesis, diagnosis, prognosis and management]. Rev Neurol 2022; 74:93-104. [PMID: 35084734 DOI: 10.33588/rn.7403.2021473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The main causes of optic neuritis (ON) are multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease, also known as MOGAD. When all screening is negative, we can speak of idiopathic ON, although this diagnosis should be provisional. ON can be diagnosed clinically and paraclinical tests are not routinely required to confirm it. However, tests such as magnetic resonance imaging (MRI), visual evoked potentials (VEP) and optical coherence tomography (OCT) can lend support to the diagnosis if the clinical presentation is atypical. The use of new MRI sequences, OCT, multifocal VEPs and the determination of neurofilaments has allowed ON to be used as a model for remyelination and neuroprotection, leading to phase II clinical trials. Some of these drugs, such as opicinumab, clemastine, phenytoin or simvastatin, have shown positive results; however, their clinical effect remains to be defined. It is accepted that corticosteroids do not improve the long-term prognosis of ON, although some retrospective studies suggest that there is a therapeutic window from the onset of symptoms. Plasmapheresis has also been shown to be effective in patients with ON. In this review we will address basic aspects of the management of ON, in the fundamental context of MS, NMOSD and MOGAD, with emphasis on etiopathogenic, diagnostic, prognostic and therapeutic developments.
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Affiliation(s)
| | - A Rovira
- Hospital Universitari Vall d´Hebron - UAB, Barcelona, España
| | - A Vidal-Jordana
- Hospital Universitari Vall d´Hebron - UAB, Barcelona, España
| | - D Moncho
- Hospital Universitari Vall d´Hebron - UAB, Barcelona, España
| | - D Pareto
- Hospital Universitari Vall d´Hebron - UAB, Barcelona, España
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Rovira A, Corral JF, Auger C, Valverde S, Vidal-Jordana A, Oliver A, de Barros A, Ng Wong YK, Tintoré M, Pareto D, Aymerich FX, Montalban X, Lladó X, Alonso J. Assessment of automatic decision-support systems for detecting active T2 lesions in multiple sclerosis patients. Mult Scler 2021; 28:1209-1218. [PMID: 34859704 DOI: 10.1177/13524585211061339] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Active (new/enlarging) T2 lesion counts are routinely used in the clinical management of multiple sclerosis. Thus, automated tools able to accurately identify active T2 lesions would be of high interest to neuroradiologists for assisting in their clinical activity. OBJECTIVE To compare the accuracy in detecting active T2 lesions and of radiologically active patients based on different visual and automated methods. METHODS One hundred multiple sclerosis patients underwent two magnetic resonance imaging examinations within 12 months. Four approaches were assessed for detecting active T2 lesions: (1) conventional neuroradiological reports; (2) prospective visual analyses performed by an expert; (3) automated unsupervised tool; and (4) supervised convolutional neural network. As a gold standard, a reference outcome was created by the consensus of two observers. RESULTS The automated methods detected a higher number of active T2 lesions, and a higher number of active patients, but a higher number of false-positive active patients than visual methods. The convolutional neural network model was more sensitive in detecting active T2 lesions and active patients than the other automated method. CONCLUSION Automated convolutional neural network models show potential as an aid to neuroradiological assessment in clinical practice, although visual supervision of the outcomes is still required.
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Affiliation(s)
- Alex Rovira
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain/Neuroradiology Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain/Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Francisco Corral
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain/Neuroradiology Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Cristina Auger
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain/Neuroradiology Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain/Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sergi Valverde
- TensorMedical, Girona, Spain/Department of Computer Architecture and Technology, University of Girona, Girona, Spain
| | - Angela Vidal-Jordana
- Department of Neurology and Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain/Clinical Neuroimmunology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain/Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arnau Oliver
- Department of Computer Architecture and Technology, University of Girona, Girona, Spain
| | - Andrea de Barros
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Yiken Karelys Ng Wong
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mar Tintoré
- Department of Neurology and Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain/Clinical Neuroimmunology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain/Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain/Neuroradiology Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Francesc Xavier Aymerich
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain/Neuroradiology Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain/Universitat Autònoma de Barcelona, Barcelona, Spain/Automatic Control Department, Universitat Politècnica de Catalunya BarcelonaTech, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology and Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain/Clinical Neuroimmunology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain/Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Lladó
- Department of Computer Architecture and Technology, University of Girona, Girona, Spain
| | - Juli Alonso
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain/Neuroradiology Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain/Universitat Autònoma de Barcelona, Barcelona, Spain
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Otero-Romero S, Carbonell-Mirabent P, Midaglia L, Zuluaga M, Galán I, Cobo-Calvo A, Rio J, Arrambide G, Vidal-Jordana A, Castillo J, Rodríguez-Acevedo B, Comabella M, Rodríguez M, Tur C, Auger C, Rovira A, Sastre-Garriga J, Montalban X, Tintoré M. Oral contraceptives do not modify the risk of a second attack and disability accrual in a prospective cohort of women with a clinically isolated syndrome and early multiple sclerosis. Mult Scler 2021; 28:950-957. [PMID: 34841948 PMCID: PMC9024022 DOI: 10.1177/13524585211053001] [Citation(s) in RCA: 7] [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: 11/21/2022]
Abstract
Objective: To evaluate whether oral contraceptive (OC) use is associated with the risk of a second attack and disability accrual in women with a clinically isolated syndrome (CIS) and early multiple sclerosis (MS). Methods: Reproductive information from women included in the Barcelona CIS prospective cohort was collected through a self-reported cross-sectional survey. We examined the relationship of OC exposure with the risk of a second attack and confirmed Expanded Disability Status Scale of 3.0 using multivariate Cox regression models, adjusted by age, topography of CIS, oligoclonal bands, baseline brain T2 lesions, body size at menarche, smoking, and disease-modifying treatment (DMT). OC and DMT exposures were considered as time-varying variables. Findings were confirmed with sensitivity analyses using propensity score models. Results: A total of 495 women were included, 389 (78.6%) referred to ever use OC and 341 (68.9%) started OC before the CIS. Exposure to OC was not associated with a second attack (adjusted hazard ratio (aHR) = 0.73, 95% confidence interval (CI) = 0.33–1.61) or disability accrual (aHR = 0.81, 95% CI = 0.17–3.76). Sensitivity analyses confirmed these results. Conclusion: OC use does not modify the risk of second attack or disability accrual in patients with CIS and early MS, once considered as a time-dependent exposure and adjusted by other potential confounders.
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Affiliation(s)
- Susana Otero-Romero
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain/Servicio de Medicina Preventiva y Epidemiología, Antigua Escuela de Enfermeria, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Zuluaga
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alvaro Cobo-Calvo
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Rio
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angela Vidal-Jordana
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Castillo
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Rodríguez
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carmen Tur
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Sección de Neuroradiologia, Servei de Radiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Rovira
- Sección de Neuroradiologia, Servei de Radiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Centro de Esclerosis Múltiple de Catalunya (Cemcat), Department of Neurology and Neuroimmunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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Filippi M, Preziosa P, Meani A, Costa GD, Mesaros S, Drulovic J, Ivanovic J, Rovira A, Tintorè M, Montalban X, Ciccarelli O, Brownlee W, Miszkiel K, Enzinger C, Khalil M, Barkhof F, Strijbis EMM, Frederiksen JL, Cramer SP, Fainardi E, Amato MP, Gasperini C, Ruggieri S, Martinelli V, Comi G, Rocca MA. Performance of the 2017 and 2010 Revised McDonald Criteria in Predicting MS Diagnosis After a Clinically Isolated Syndrome: A MAGNIMS Study. Neurology 2021; 98:e1-e14. [PMID: 34716250 DOI: 10.1212/wnl.0000000000013016] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/30/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To compare the performance of the 2017 revisions to the McDonald criteria with the 2010 McDonald criteria in establishing MS diagnosis and predicting prognosis in patients with clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS). METHODS CSF examination, brain and spinal cord MRI obtained ≤5 months from CIS onset, and a follow-up brain MRI acquired within 15 months from CIS onset were evaluated in 785 CIS patients from 9 European centers. Date of second clinical attack and of reaching Expanded Disability Status Score (EDSS) ≥ 3.0, if they occurred, were also collected. Performance of the 2017 and 2010 McDonald criteria for dissemination in space (DIS), time (DIT) (including oligoclonal bands assessment) and DIS + DIT for predicting a second clinical attack (clinically definite [CD] MS) and EDSS ≥ 3.0 at follow-up was evaluated. Time to MS diagnosis for the different criteria was also estimated. RESULTS At follow-up (median = 69.1 months), 406/785 CIS patients developed CDMS. At 36 months, the 2017 DIS + DIT criteria had higher sensitivity (0.83 vs 0.66), lower specificity (0.39 vs 0.60) and similar area under the curve values (0.61 vs 0.63). Median time to MS diagnosis was shorter with the 2017 vs the 2010 or CDMS criteria (2017 revision = 3.2; 2010 revision = 13.0; CDMS = 58.5 months). The 2 sets of criteria similarly predicted EDSS ≥ 3.0 milestone. Three periventricular lesions improved specificity in patients ≥45 years. DISCUSSION The 2017 McDonald criteria showed higher sensitivity, lower specificity and similar accuracy in predicting CDMS compared to 2010 McDonald criteria, while shortening time to diagnosis of MS. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the 2017 McDonald Criteria more accurately distinguish CDMS in patients early after a CIS when compared to the 2010 McDonald criteria.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gloria Dalla Costa
- Neurorehabilitation Unit IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Sarlota Mesaros
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Serbia
| | - Jelena Drulovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Serbia
| | - Jovana Ivanovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Serbia
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mar Tintorè
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Wallace Brownlee
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Katherine Miszkiel
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | | | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - Eva M M Strijbis
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Jette L Frederiksen
- Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Stig P Cramer
- Department of Clinical Physiology, Nuclear Medicine and PET, FIU unit, Rigshospitalet Glostrup, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Hvidovre, Denmark
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Maria Pia Amato
- Department of Neurofarba, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Claudio Gasperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Serena Ruggieri
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Valsasina P, Gobbi C, Zecca C, Rovira A, Sastre-Garriga J, Kearney H, Yiannakas M, Matthews L, Palace J, Gallo A, Bisecco A, Gass A, Eisele P, Filippi M, Rocca MA. Characterizing 1-year development of cervical cord atrophy across different MS phenotypes: A voxel-wise, multicentre analysis. Mult Scler 2021; 28:885-899. [PMID: 34605323 DOI: 10.1177/13524585211045545] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Spatio-temporal evolution of cord atrophy in multiple sclerosis (MS) has not been investigated yet. OBJECTIVE To evaluate voxel-wise distribution and 1-year changes of cervical cord atrophy in a multicentre MS cohort. METHODS Baseline and 1-year 3D T1-weighted cervical cord scans and clinical evaluations of 54 healthy controls (HC) and 113 MS patients (14 clinically isolated syndromes (CIS), 77 relapsing-remitting (RR), 22 progressive (P)) were used to investigate voxel-wise cord volume loss in patients versus HC, 1-year volume changes and clinical correlations (SPM12). RESULTS MS patients exhibited baseline cord atrophy versus HC at anterior and posterior/lateral C1/C2 and C4-C6 (p < 0.05, corrected). While CIS patients showed baseline volume increase at C4 versus HC (p < 0.001, uncorrected), RRMS exhibited posterior/lateral C1/C2 atrophy versus CIS, and PMS showed widespread cord atrophy versus RRMS (p < 0.05, corrected). At 1 year, 13 patients had clinically worsened. Cord atrophy progressed in MS, driven by RRMS, at posterior/lateral C2 and C3-C6 (p < 0.05, corrected). CIS patients showed no volume changes, while PMS showed circumscribed atrophy progression. Baseline cord atrophy at posterior/lateral C1/C2 and C3-C6 correlated with concomitant and 1-year disability (r = -0.40/-0.62, p < 0.05, corrected). CONCLUSIONS Voxel-wise analysis characterized spinal cord neurodegeneration over 1 year across MS phenotypes and helped to explain baseline and 1-year disability.
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Affiliation(s)
- Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Gobbi
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano. Switzerland
| | - Chiara Zecca
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano. Switzerland
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Hugh Kearney
- Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland/NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Marios Yiannakas
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Lucy Matthews
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, 3T-MRI Research Centre, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, 3T-MRI Research Centre, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Achim Gass
- Department of Neurology/Neuroimaging, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - Philipp Eisele
- Department of Neurology/Neuroimaging, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Neurology Unit, Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Filippi M, Wattjes M, Ciccarelli O, Reich D, Banwell B, De Stefano N, Enzinger C, Fazekas F, Frederiksen J, Gasperini C, Hacohen Y, Kappos L, Li D, Mankad K, Montalban X, Newsome S, Oh J, Palace J, Rocca M, Sastre-Garriga J, Tintoré M, Traboulsee A, Vrenken H, Yousry T, Barkhof F, Rovira A. International magnims-CMSC-NAIMS consensus recommendations on the use of standardized MRI in MS. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sarria-Estrada S, Santamarina E, Quintana M, Pareto D, Sueiras M, Auger C, Toledo M, Rovira A. Magnetic resonance imaging findings in focal-onset status epilepticus. Eur J Neurol 2021; 29:3-11. [PMID: 34390102 DOI: 10.1111/ene.15065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/08/2021] [Accepted: 08/10/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Magnetic resonance imaging (MRI) is commonly used in the diagnostic work-up for status epilepticus (SE). The purpose of this study was to characterize MRI features in SE patients and determine their association with clinical and electroencephalography (EEG) findings. The mid-term consequences of baseline MRI features were also analysed. METHODS This is a prospective study including consecutive patients with SE who underwent brain MRI within 240 h after SE onset. The MRI protocol included T1-weighted (T1WI), T2-weighted (T2W), fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging (DWI) sequences. Follow-up MRI was performed after SE resolution in some patients. RESULTS Sixty patients (56.7% men, mean age 58.3 years) were included. SE-related MRI abnormalities were seen in 31 (51.7%), manifesting as hyperintensities on T2W/FLAIR imaging (58.1%) and DWI (74.2%) sequences. Hippocampal and pulvinar involvement was seen in 58.0% and 25.8% of patients, respectively. MRI abnormalities were associated with a longer SE duration (p = 0.013) and the presence of lateralized periodic discharges (LPDs) on EEG (p < 0.001). Amongst the 33 follow-up MRIs, nine (27.3%) showed mesial temporal sclerosis (MTS), which was associated with severe clinical status (p = 0.031), hippocampal oedema (p = 0.001) and LPDs (p = 0.001) at baseline. A poorer clinical outcome was associated with baseline T2W/FLAIR imaging hyperintensities (p = 0.003). CONCLUSION MRI showed abnormalities in more than half of SE patients. A longer SE duration and LPDs on EEG were associated with SE-related MRI abnormalities and the development of MTS.
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Affiliation(s)
- Silvana Sarria-Estrada
- Neuroradiology Section, Radiology Department, Vall d'Hebron Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute, Neuroradiology Research, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Estevo Santamarina
- Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain.,Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Manuel Quintana
- Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain.,Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Deborah Pareto
- Neuroradiology Section, Radiology Department, Vall d'Hebron Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute, Neuroradiology Research, Barcelona, Spain
| | - Maria Sueiras
- EEG Unit, Neurophysiology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Cristina Auger
- Neuroradiology Section, Radiology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Alex Rovira
- Neuroradiology Section, Radiology Department, Vall d'Hebron Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute, Neuroradiology Research, Barcelona, Spain
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Rimkus CM, Schoeps VA, Boaventura M, Godoy LF, Apostolos-Pereira SL, Calich AL, Callegaro D, Lucato LT, Rovira A, Sastre-Garriga J, Leite CDC. Drug-related demyelinating syndromes: understanding risk factors, pathophysiological mechanisms and magnetic resonance imaging findings. Mult Scler Relat Disord 2021; 55:103146. [PMID: 34332456 DOI: 10.1016/j.msard.2021.103146] [Citation(s) in RCA: 3] [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: 03/04/2021] [Revised: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 01/08/2023]
Abstract
Some drugs and medications can precipitate immune system deregulations, which might be confused with recurrent demyelinating diseases, such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMO), exacerbations of an existing disease, neoplastic lesions or other conditions. In this narrative review we describe some of the most relevant drugs and medications associated with iatrogenic demyelination. The anthelminthic agent levamisole is a frequent cocaine adulterant and can precipitate an exacerbated immune response attacking the central nervous system (CNS). High-efficacy multiple sclerosis (MS) drugs might induce a selective CNS immunosuppression, making it susceptible for opportunistic infections that course with demyelination, such as progressive multifocal leukoencephalopathy. Sometimes, the interruption of a high-efficacy drug to treat MS can induce a rapid CNS reentry of lymphocytes, exacerbating demyelinating processes and triggering rebound syndromes. Furthermore, selective cytokines inhibition, such as anti-TNFα agents, might induce an imbalance between cell death and proliferation inducing a paradoxical increase of CNS tumor necrosis factor (TNF), affecting the activity of lymphocytes, microglia and macrophages, triggering aberrant inflammation and demyelination. Immune checkpoint inhibitors are a new class of antineoplastic drugs that enhance the immune response against tumor cells by an upregulation of T-cell activity. However, this hyperactivation of the immune system might be associated with induction of unwanted autoimmune responses. In this paper we review the risk factors, the possible pathological mechanisms and the magnetic resonance imaging (MRI) findings of these drug-related demyelinating syndromes.
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Affiliation(s)
- Carolina M Rimkus
- Departamento de Radiologia e Oncologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Vinicius Andreoli Schoeps
- Departamento de Neurologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Mateus Boaventura
- Departamento de Neurologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Luis Filipe Godoy
- Departamento de Radiologia e Oncologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Samira Luisa Apostolos-Pereira
- Departamento de Neurologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | | | - Dagoberto Callegaro
- Departamento de Neurologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Leandro Tavares Lucato
- Departamento de Radiologia e Oncologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Claudia da Costa Leite
- Departamento de Radiologia e Oncologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
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Torres-Ferrus M, Pareto D, Gallardo VJ, Cuberas-Borrós G, Alpuente A, Caronna E, Vila-Balló A, Lorenzo-Bosquet C, Castell-Conesa J, Rovira A, Pozo-Rosich P. Cortical metabolic and structural differences in patients with chronic migraine. An exploratory 18FDG-PET and MRI study. J Headache Pain 2021; 22:75. [PMID: 34273945 PMCID: PMC8285838 DOI: 10.1186/s10194-021-01289-5] [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: 05/24/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022] Open
Abstract
Background To describe interictal brain structural and metabolic differences between patients with episodic migraine (EM), chronic migraine (CM) and healthy controls (HC). Methods This is an exploratory study including right-handed age-matched women with EM, CM and HC. On the same day, a sequential interictal scan was performed with 18FDG-PET and MRI. 3D T1-weighted images were segmented with FreeSurfer, normalized to a reference atlas and the mean values of metabolism, cortical thickness (CTh) and local gyrification index (IGI) were determined. Groups were compared using age-adjusted linear models, corrected for multiple comparisons. 18FDG-PET measurements between groups were also analysed adjusting by patient’s age, CTh and lGI. The variables independently associated with diagnosis were obtained using a logistic regression analysis. Results Fifteen patients (8 EM, 7 CM) and 11 HC were included. Morphometric data showed an increased CTh in 6 frontal areas (L/R-Caudal Middle Frontal, L/R-Rostral Middle Frontal, L-Medial Orbitofrontal and L-Superior Frontal) in CM patients compared to HC without differences for IGI. The structural adjusted analysis in CM showed a statistically significantly hypometabolism in 9 frontal areas (L-Lateral Orbitofrontal, L/R-Medial Orbitofrontal, L-Frontal Superior, R-Frontal pole, R-Parts Triangularis, L/R-Paracentral and R-Precentral) and 7 temporal areas (L/R-Insula, L/R-Inferior temporal, L/R-Temporal pole and R-Banks superior temporal sulcus) compared to HC. EM patients presented intermediate metabolic values between EM and HC (non-significant). Conclusions CM patients showed frontotemporal hypometabolism and increased frontal cortical thickness when compared to HC that may explain some cognitive and behavioural pain-processing and sensory integration alterations in CM patients. Combined information from sequential or simultaneous PET and MRI could optimize the study of complex functional neurological disorders such as migraine. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01289-5.
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Affiliation(s)
- Marta Torres-Ferrus
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital and Research Institute (VHIR), Barcelona, Spain
| | - Victor J Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gemma Cuberas-Borrós
- Research and Innovation Unit , Althaia Xarxa Assistencial Universitària de Manresa , Manresa, Spain.,Nuclear Medicine Department , Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alicia Alpuente
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Caronna
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Adrià Vila-Balló
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Joan Castell-Conesa
- Nuclear Medicine Department , Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital and Research Institute (VHIR), Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain. .,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
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Fornell-Pérez R, Merino-Bonilla J, Morandeira-Arrizabalaga C, Marín-Díez E, Rovira A, Ros-Mendoza L. A bibliometric study of the journal Radiología during the period 2010–2019. Radiología (English Edition) 2021. [DOI: 10.1016/j.rxeng.2021.02.001] [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: 11/25/2022]
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Comabella M, Clarke MA, Schaedelin S, Tintoré M, Pareto D, Fissolo N, Pinteac R, Granziera C, Sastre-Garriga J, Benkert P, Auger C, Kuhle J, Montalban X, Rovira A. CSF chitinase 3-like 1 is associated with iron rims in patients with a first demyelinating event. Mult Scler 2021; 28:71-81. [PMID: 33870790 DOI: 10.1177/13524585211010082] [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: 01/22/2023]
Abstract
BACKGROUND Chronic active lesions with iron rims have prognostic implications in patients with multiple sclerosis. OBJECTIVE To assess the relationship between iron rims and levels of chitinase 3-like 1 (CHI3L1), neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) in patients with a first demyelinating event. METHODS Iron rims were identified using 3T susceptibility-weighted imaging. Serum NfL and GFAP levels were measured by single-molecule array assays. CSF (cerebrospinal fluid) CHI3L1 levels were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS Sixty-one patients were included in the study. The presence of iron rims was associated with higher T2 lesion volume and higher number of gadolinium-enhancing lesions. In univariable analysis, having ⩾2 iron rims (vs 0) was associated with increased CSF CHI3L1 levels (β = 1.41; 95% confidence interval (CI) = 1.10-1.79; p < 0.01) and serum NfL levels (β = 2.30; 95% CI = 1.47-3.60; p < 0.01). In multivariable analysis, however, only CSF CHI3L1 levels remained significantly associated with the presence of iron rim lesions (β = 1.45; 95% CI = 1.11-1.90; p < 0.01). The presence of ⩾2 iron rims was not associated with increased serum GFAP levels in univariable or multivariable analyses. CONCLUSION These findings support an important contribution of activated microglia/macrophages to the pathophysiology of chronic active lesions with iron rims in patients with a first demyelinating event.
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Affiliation(s)
- Manuel Comabella
- Unitat de Neuroimmunologia Clínica, Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Margareta A Clarke
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sabine Schaedelin
- Clinical Trial Unit, Department of Clinical Research, University Hospital of Basel, Basel, Switzerland
| | - Mar Tintoré
- Unitat de Neuroimmunologia Clínica, Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nicolás Fissolo
- Unitat de Neuroimmunologia Clínica, Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rucsanda Pinteac
- Unitat de Neuroimmunologia Clínica, Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Neurology Clinic and Policlinic and RC2NB, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Jaume Sastre-Garriga
- Unitat de Neuroimmunologia Clínica, Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pascal Benkert
- Clinical Trial Unit, Department of Clinical Research, University Hospital of Basel, Basel, Switzerland
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Xavier Montalban
- Unitat de Neuroimmunologia Clínica, Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Álvarez-Torres MDM, Fuster-García E, Reynés G, Juan-Albarracín J, Chelebian E, Oleaga L, Pineda J, Auger C, Rovira A, Emblem KE, Filice S, Mollà-Olmos E, García-Gómez JM. Differential effect of vascularity between long- and short-term survivors with IDH1/2 wild-type glioblastoma. NMR Biomed 2021; 34:e4462. [PMID: 33470039 DOI: 10.1002/nbm.4462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/28/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION IDH1/2 wt glioblastoma (GB) represents the most lethal tumour of the central nervous system. Tumour vascularity is associated with overall survival (OS), and the clinical relevance of vascular markers, such as rCBV, has already been validated. Nevertheless, molecular and clinical factors may have different influences on the beneficial effect of a favourable vascular signature. PURPOSE To evaluate the association between the rCBV and OS of IDH1/2 wt GB patients for long-term survivors (LTSs) and short-term survivors (STSs). Given that initial high rCBV may affect the patient's OS in follow-up stages, we will assess whether a moderate vascularity is beneficial for OS in both groups of patients. MATERIALS AND METHODS Ninety-nine IDH1/2 wt GB patients were divided into LTSs (OS ≥ 400 days) and STSs (OS < 400 days). Mann-Whitney and Fisher, uni- and multiparametric Cox, Aalen's additive regression and Kaplan-Meier tests were carried out. Tumour vascularity was represented by the mean rCBV of the high angiogenic tumour (HAT) habitat computed through the haemodynamic tissue signature methodology (available on the ONCOhabitats platform). RESULTS For LTSs, we found a significant association between a moderate value of rCBVmean and higher OS (uni- and multiparametric Cox and Aalen's regression) (p = 0.0140, HR = 1.19; p = 0.0085, HR = 1.22) and significant stratification capability (p = 0.0343). For the STS group, no association between rCBVmean and survival was observed. Moreover, no significant differences (p > 0.05) in gender, age, resection status, chemoradiation, or MGMT methylation were observed between LTSs and STSs. CONCLUSION We have found different prognostic and stratification effects of the vascular marker for the LTS and STS groups. We propose the use of rCBVmean at HAT as a vascular marker clinically relevant for LTSs with IDH1/2 wt GB and maybe as a potential target for randomized clinical trials focused on this group of patients.
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Affiliation(s)
| | | | - Gaspar Reynés
- Cancer Research Group, Health Research Institute Hospital La Fe, Valencia, Spain
| | | | | | | | - Jose Pineda
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Magnetic Resonance Unit, Department of Radiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Rovira
- Magnetic Resonance Unit, Department of Radiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Kyrre E Emblem
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Silvano Filice
- Medical Physics, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Enrique Mollà-Olmos
- Departamento de Radiodiagnóstico, Hospital Universitario de la Ribera, Alzira, Spain
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Del Rev-Vergara R, Galindo-Campos M, Hardy-Werbin M, Moliner L, Ríos-Hoyo A, Martínez C, Carpes M, González-Gallardo S, Taus Á, Rovira A, Arriola E. 53P Antitumoral effects of the Met inhibitor savolitinib in combination with durvalumab in a syngeneic small cell lung cancer mouse model. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01895-5] [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: 11/29/2022]
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Pessini Ferreira LM, Auger C, Kortazar Zubizarreta I, Gonzalez Chinchon G, Herrera I, Pla A, de Barros A, Tortajada C, Rovira A. MRI findings in cervical spondylotic myelopathy with gadolinium enhancement: Review of seven cases. BJR Case Rep 2021; 7:20200133. [PMID: 33841903 PMCID: PMC8008469 DOI: 10.1259/bjrcr.20200133] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 11/22/2022] Open
Abstract
Cervical spondylotic myelopathy (CSM) is a clinical syndrome secondary to a spinal cord compression due to cervical spondylosis. In some cases, conventional MRI typically shows an intramedullary hyperintense signal on T2W imaging and contrast enhancement on post-gadolinium T1W imaging. We report a series of seven patients with CSM who had typical clinical presentation and imaging findings on T2W and contrast-enhanced T1W sequences. The imaging findings included degenerative changes of the cervical spine, intramedullary T2-signal hyperintensity, and an intramedullary enhancement on post-gadolinium T1W images. Our results support the statement that the presence of an intramedullary gadolinium-enhancement with a flat transverse pancake-like pattern (on sagittal images) and a circumferential pattern (on axial images), located within a T2-signal abnormality, in patients with cervical spondylosis and clinical myelopathy is indicative of spondylosis as the cause of the myelopathy.
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Affiliation(s)
| | | | | | | | - Isabel Herrera
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Albert Pla
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | | | - Alex Rovira
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Fornell-Pérez R, Merino-Bonilla JA, Morandeira-Arrizabalaga C, Marín-Díez E, Rovira A, Ros-Mendoza LH. A bibliometric study of the journal Radiología during the period 2010-2019. Radiologia (Engl Ed) 2021; 63:209-217. [PMID: 33678459 DOI: 10.1016/j.rx.2021.02.002] [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: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS Bibliometrics makes it possible to measure the relative importance of a scientific journal in its field. The current study analyzed the scientific publications in Radiología and the bibliometric parameters of the journal in the period comprising 2010 through 2019. MATERIALS AND METHODS We reviewed the bibliometrics for Radiología through information obtained from three sources: Scopus, the online version of the journal, and the publisher (Elsevier). We retrospectively analyzed aspects related to the editorial process (final decision and speed), the articles published (type, subspecialty of radiology, and imaging technique), the trends in citation and various indices (CiteScore, SNIP, and SJR), visibility, downloads, author characteristics (geographical origin and institutional collaboration), and the most cited articles. RESULTS The number of articles published in Radiología gradually decreased during the decade, and the time to publication increased. Original research articles account for the largest share of the articles published. The most common subject areas were radiology of the digestive tract and neuroradiology. Nevertheless, the bibliometric indicators and the number of downloads of articles increased every year. Regarding the authorship of the articles published, although authors from Spain predominate, the participation of authors from other countries became increasingly common. Collaboration among different institutions also became increasingly common in the period analyzed. CONCLUSIONS This review shows the progression of the journal's scientific work and some aspects that must be addressed to favor the growth of Radiología.
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Affiliation(s)
- R Fornell-Pérez
- Editor adjunto junior de la revista Radiología. Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, España.
| | - J A Merino-Bonilla
- Editor adjunto junior de la revista Radiología. Servicio de Radiodiagnóstico, Hospital Santiago Apóstol, Miranda de Ebro, España
| | - C Morandeira-Arrizabalaga
- Editor adjunto junior de la revista Radiología. Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, España
| | - E Marín-Díez
- Editor adjunto junior de la revista Radiología. Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - A Rovira
- Responsable de publicaciones de la SERAM. Servicio de Radiodiagnóstico, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - L H Ros-Mendoza
- Editor jefe de la revista Radiología. Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
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Marazuela P, Bonaterra-Pastra A, Faura J, Penalba A, Pizarro J, Pancorbo O, Rodríguez-Luna D, Vert C, Rovira A, Pujadas F, Freijo MM, Tur S, Martínez-Zabaleta M, Cardona Portela P, Vera R, Lebrato-Hernández L, Arenillas JF, Pérez-Sánchez S, Montaner J, Delgado P, Hernández-Guillamon M. Circulating AQP4 Levels in Patients with Cerebral Amyloid Angiopathy-Associated Intracerebral Hemorrhage. J Clin Med 2021; 10:jcm10050989. [PMID: 33801197 PMCID: PMC7957864 DOI: 10.3390/jcm10050989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 12/27/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA) is a major cause of lobar intracerebral hemorrhage (ICH) in elderly patients. Growing evidence suggests a potential role of aquaporin 4 (AQP4) in amyloid-beta-associated diseases, including CAA pathology. Our aim was to investigate the circulating levels of AQP4 in a cohort of patients who had suffered a lobar ICH with a clinical diagnosis of CAA. AQP4 levels were analyzed in the serum of 60 CAA-related ICH patients and 19 non-stroke subjects by enzyme-linked immunosorbent assay (ELISA). The CAA–ICH cohort was divided according to the time point of the functional outcome evaluation: mid-term (12 ± 18.6 months) and long-term (38.5 ± 32.9 months) after the last ICH. Although no differences were found in AQP4 serum levels between cases and controls, lower levels were found in CAA patients presenting specific hemorrhagic features such as ≥2 lobar ICHs and ≥5 lobar microbleeds detected by magnetic resonance imaging (MRI). In addition, CAA-related ICH patients who presented a long-term good functional outcome had higher circulating AQP4 levels than subjects with a poor outcome or controls. Our data suggest that AQP4 could potentially predict a long-term functional outcome and may play a protective role after a lobar ICH.
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Affiliation(s)
- Paula Marazuela
- Neurovascular Research Laboratory, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (P.M.); (A.B.-P.); (J.F.); (A.P.); (J.P.); (J.M.); (P.D.)
| | - Anna Bonaterra-Pastra
- Neurovascular Research Laboratory, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (P.M.); (A.B.-P.); (J.F.); (A.P.); (J.P.); (J.M.); (P.D.)
| | - Júlia Faura
- Neurovascular Research Laboratory, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (P.M.); (A.B.-P.); (J.F.); (A.P.); (J.P.); (J.M.); (P.D.)
| | - Anna Penalba
- Neurovascular Research Laboratory, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (P.M.); (A.B.-P.); (J.F.); (A.P.); (J.P.); (J.M.); (P.D.)
| | - Jesús Pizarro
- Neurovascular Research Laboratory, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (P.M.); (A.B.-P.); (J.F.); (A.P.); (J.P.); (J.M.); (P.D.)
| | - Olalla Pancorbo
- Stroke Unit, Department of Neurology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (O.P.); (D.R.-L.)
| | - David Rodríguez-Luna
- Stroke Unit, Department of Neurology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (O.P.); (D.R.-L.)
| | - Carla Vert
- Neuroradiology, Department of Radiology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (C.V.); (A.R.)
| | - Alex Rovira
- Neuroradiology, Department of Radiology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (C.V.); (A.R.)
| | - Francesc Pujadas
- Dementia Unit, Neurology Department, Vall d’Hebron Hospital, 08035 Barcelona, Spain;
| | - M. Mar Freijo
- Neurovascular Group, Biocruces Health Research Institute, 48903 Barakaldo, Spain;
| | - Silvia Tur
- Neurology, Son Espases University Hospital, 07120 Balearic Islands, Spain;
| | | | - Pere Cardona Portela
- Department of Neurology, Bellvitge University Hospital, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Rocío Vera
- Stroke Unit, Department of Neurology, Ramon y Cajal University Hospital, 28034 Madrid, Spain;
| | | | - Juan F. Arenillas
- Stroke Program, Department of Neurology, Hospital Clínico Universitario, 47003 Valladolid, Spain;
- Clinical Neurosciences Research Group, Department of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | | | - Joan Montaner
- Neurovascular Research Laboratory, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (P.M.); (A.B.-P.); (J.F.); (A.P.); (J.P.); (J.M.); (P.D.)
- Department of Neurology, Virgen Macarena University Hospital, 41009 Sevilla, Spain;
- Stroke Research Program, Institute of Biomedicine of Sevilla, IBiS, Virgen del Rocío University Hospital, University of Sevilla, 41009 Sevilla, Spain
| | - Pilar Delgado
- Neurovascular Research Laboratory, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (P.M.); (A.B.-P.); (J.F.); (A.P.); (J.P.); (J.M.); (P.D.)
| | - Mar Hernández-Guillamon
- Neurovascular Research Laboratory, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (P.M.); (A.B.-P.); (J.F.); (A.P.); (J.P.); (J.M.); (P.D.)
- Correspondence:
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Otero-Romero S, Midaglia L, Carbonell-Mirabent P, Zuluaga M, Galán I, Río J, Arrambide G, Rodríguez-Barranco M, Vidal-Jordana A, Castillo J, Rodríguez-Acevedo B, Zabalza A, Nos C, Comabella-Lopez M, Mulero P, Auger C, Sastre-Garriga J, Pérez-Hoyos S, Rovira A, Montalban X, Tintoré M. Menopause does not modify disability trajectories in a longitudinal cohort of women with clinically isolated syndrome and multiple sclerosis followed from disease onset. Eur J Neurol 2021; 29:1075-1081. [PMID: 33609298 DOI: 10.1111/ene.14782] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the effect of menopause on disability accumulation in women followed from their clinically isolated syndrome (CIS). METHODS We examined the longitudinal changes in Expanded Disability Status Scale (EDSS) scores from CIS until the last follow-up in women belonging to the Barcelona CIS prospective cohort, followed through their menopausal transition. The analysis is based on 13,718 EDSS measurements, with an average of 28 EDSS measurements per patient. Differences in EDSS trajectories between menopausal and nonmenopausal women, controlling for age and disease duration, were evaluated. We performed two sensitivity analyses in women with confirmed MS and in those experiencing early menopause. RESULTS From 764 eligible women, 496 (65%) responded to the questionnaire, and 74 (14.9%) reached menopause over the follow-up. We did not find a significant inflection point in EDSS trajectories around menopause (slope change -0.009; 95% CI -0.066; 0.046). The annual increase in EDSS over the complete course of the disease was significantly higher in menopausal women (0.049; 95% CI, 0.026-0.074) versus nonmenopausal (0.019; 95% CI, 0.008-0.031; interaction p value 0.025). This difference was lost when controlling for age and disease duration (EDSS annual increase of 0.059; 95% CI, 0.025-0.094 vs. 0.038; 95% CI, 0.021-0.057, respectively; interaction p value 0.321). No inflection point was detected when the analysis was restricted to women with confirmed MS or with earlier menopause. CONCLUSIONS Menopause is not associated with an increased risk of disability in a CIS population, considering EDSS trajectories throughout the course of the disease together with age and disease duration.
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Affiliation(s)
- Susana Otero-Romero
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain.,Preventive Medicine and Epidemiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Zuluaga
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Rodríguez-Barranco
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angela Vidal-Jordana
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquin Castillo
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Nos
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella-Lopez
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Mulero
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Santiago Pérez-Hoyos
- Statistics and bioinformatics unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Rovira
- Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Neurology-Neuroimmunology Department, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
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Rocca MA, Valsasina P, Meani A, Gobbi C, Zecca C, Rovira A, Sastre-Garriga J, Kearney H, Ciccarelli O, Matthews L, Palace J, Gallo A, Bisecco A, Lukas C, Bellenberg B, Barkhof F, Vrenken H, Preziosa P, Filippi M. Association of Gray Matter Atrophy Patterns With Clinical Phenotype and Progression in Multiple Sclerosis. Neurology 2021; 96:e1561-e1573. [PMID: 33441452 DOI: 10.1212/wnl.0000000000011494] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/03/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Gay matter (GM) involvement is clinically relevant in multiple sclerosis (MS). Using source-based morphometry (SBM), we characterized GM atrophy and its 1-year evolution across different MS phenotypes. METHODS Clinical and MRI data were obtained at 8 European sites from 170 healthy controls (HCs) and 398 patients with MS (34 with clinically isolated syndrome [CIS], 226 with relapsing-remitting MS [RRMS], 95 with secondary progressive MS [SPMS], and 43 with primary progressive MS [PPMS]). Fifty-seven HCs and 144 with MS underwent 1-year follow-up. Baseline GM loss, atrophy progression, and correlations with disability and 1-year clinical worsening were assessed. RESULTS SBM identified 26 cerebellar, subcortical, sensory, motor, and cognitive GM components. GM atrophy was found in patients with MS vs HCs in almost all components (p range <0.001-0.04). Compared to HCs, patients with CIS showed circumscribed subcortical, cerebellar, temporal, and salience GM atrophy, while patients with RRMS exhibited widespread GM atrophy. Cerebellar, subcortical, sensorimotor, salience, and frontoparietal GM atrophy was found in patients with PPMS vs HCs and in patients with SPMS vs those with RRMS. At 1 year, 21 (15%) patients had clinically worsened. GM atrophy progressed in MS in subcortical, cerebellar, sensorimotor, and fronto-temporo-parietal components. Baseline higher disability was associated (R 2 = 0.65) with baseline lower normalized brain volume (β = -0.13, p = 0.001), greater sensorimotor GM atrophy (β = -0.12, p = 0.002), and longer disease duration (β = 0.09, p = 0.04). Baseline normalized GM volume (odds ratio 0.98, p = 0.008) and cerebellar GM atrophy (odds ratio 0.40, p = 0.01) independently predicted clinical worsening (area under the curve 0.83). CONCLUSION GM atrophy differed across disease phenotypes and progressed at 1 year in MS. In addition to global atrophy measures, sensorimotor and cerebellar GM atrophy explained baseline disability and clinical worsening.
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Affiliation(s)
- Maria A Rocca
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK.
| | - Paola Valsasina
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Alessandro Meani
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Claudio Gobbi
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Chiara Zecca
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Alex Rovira
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Jaume Sastre-Garriga
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Hugh Kearney
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Olga Ciccarelli
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Lucy Matthews
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Jacqueline Palace
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Antonio Gallo
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Alvino Bisecco
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Carsten Lukas
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Barbara Bellenberg
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Frederik Barkhof
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Hugo Vrenken
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Paolo Preziosa
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
| | - Massimo Filippi
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.), Division of Neuroscience, Neurology Unit (M.A.R., P.P., M.F.), Neurorehabilitation Unit, and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (M.A.R., M.F.), Milan, Italy; Multiple Sclerosis Center (C.G., C.Z.), Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital; Faculty of Biomedical Sciences Università della Svizzera Italiana (C.G., C.Z.), Lugano, Switzerland; Section of Neuroradiology (A.R.), Department of Radiology, and Department of Neurology/Neuroimmunology (J.S.-G.), Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences (A.G., A.B.) and 3T MRI-Center (A.G., A.B.), University of Campania Luigi Vanvitelli, Naples, Italy; Institute of Neuroradiology at the Department of Radiology and Nuclear Medicine (C.L., B.B.), St. Josef Hospital, Ruhr University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK
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Vidal-Jordana A, Rovira A, Arrambide G, Otero-Romero S, Río J, Comabella M, Nos C, Castilló J, Galan I, Cabello S, Moncho D, Rahnama K, Thonon V, Rodríguez-Acevedo B, Zabalza A, Midaglia L, Auger C, Sastre-Garriga J, Montalban X, Tintoré M. Optic Nerve Topography in Multiple Sclerosis Diagnosis: The Utility of Visual Evoked Potentials. Neurology 2020; 96:e482-e490. [PMID: 33328323 PMCID: PMC7905792 DOI: 10.1212/wnl.0000000000011339] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the added value of the optic nerve region (by using visual evoked potentials [VEPs]) to the current diagnostic criteria. Methods From the Barcelona clinically isolated syndrome (CIS) cohort, patients with complete information to assess dissemination in space (DIS), the optic nerve region, and dissemination in time at baseline (n = 388) were selected. Modified DIS (modDIS) criteria were constructed by adding the optic nerve to the current DIS regions. The DIS and modDIS criteria were evaluated with univariable Cox proportional hazard regression analyses with the time to the second attack as the outcome. A subset of these patients who had at least 10 years of follow-up or a second attack occurring within 10 years (n = 151) were selected to assess the diagnostic performance. The analyses were also performed according to CIS topography (optic neuritis vs non–optic neuritis). Results The addition of the optic nerve as a fifth region improved the diagnostic performance by slightly increasing the accuracy (2017 DIS 75.5%, modDIS 78.1%) and the sensitivity (2017 DIS 79.2%, modDIS 82.3%) without lowering the specificity (2017 DIS 52.4%, modDIS 52.4%). When the analysis was conducted according to CIS topography, the modDIS criteria performed similarly in both optic neuritis and non–optic neuritis CIS. Conclusion The addition of the optic nerve, assessed by VEP, as a fifth region in the current DIS criteria slightly improves the diagnostic performance because it increases sensitivity without losing specificity.
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Affiliation(s)
- Angela Vidal-Jordana
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada.
| | - Alex Rovira
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Georgina Arrambide
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Susana Otero-Romero
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Jordi Río
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Manuel Comabella
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Carlos Nos
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Joaquin Castilló
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Ingrid Galan
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Sergio Cabello
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Dulce Moncho
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Kimia Rahnama
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Vanessa Thonon
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Breogan Rodríguez-Acevedo
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Ana Zabalza
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Luciana Midaglia
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Cristina Auger
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Jaume Sastre-Garriga
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Xavier Montalban
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
| | - Mar Tintoré
- From the Servicio de Neurología-Neuroinmunología (A V.-J., G.A., S.O.-R., J.R., M.C., C.N., J.C., I.G., S.C., B.R.-A., A.Z., L.M., J.S.-G., X.M., M.T.), Centro de Esclerosis Múltiple de Catalunya (Cemcat), Sección de Neuroradiologia (A.R., C.A.), Servei de Radiologia, Servicio de Medicina Preventiva y Epidemiologia (S.O.-R.), and Servicio de Neurofisiología Clínica (D.M., K.R., V.T.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; and Division of Neurology (X.M.), St. Michael's Hospital. University of Toronto, Ontario, Canada
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Valdés P, Rovira A, Guerrero J, Morales Á, Rovira M, Martínez C. Managing the pandemic from the radiology department's point of view. Radiologia (Engl Ed) 2020; 62:503-514. [PMID: 33213870 PMCID: PMC7834116 DOI: 10.1016/j.rx.2020.10.004] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/24/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic is forcing our entire society to adopt numerous changes, at least until an effective treatment and/or vaccine becomes widely available. Because COVID-19 is a new disease that has required us to make complex decisions based on scant evidence, the pandemic is having an enormous impact on our health system. Radiology departments play a fundamental role in the management of COVID-19, both in the diagnosis of the disease and in the posterior management of patients. To ensure the safety of patients and healthcare professionals, it is essential to understand the infection so that safe circuits can be implemented. This article summarizes the pathophysiology of COVID-19 infection and explains the measures that radiology departments need to adopt during the pandemic.
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Affiliation(s)
- P Valdés
- Agencia Sanitaria Costa del Sol, Marbella, Málaga, España.
| | - A Rovira
- Hospital Vall d'Hebron, Barcelona, España
| | - J Guerrero
- Agencia Sanitaria Costa del Sol, Marbella, Málaga, España
| | - Á Morales
- Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - M Rovira
- Hospital Universitari Sagrat Cor, Barcelona, España
| | - C Martínez
- Hospital Son LLàtzer. Palma de Mallorca, España
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Fuster-Garcia E, Lorente Estellés D, Álvarez-Torres MDM, Juan-Albarracín J, Chelebian E, Rovira A, Acosta CA, Pineda J, Oleaga L, Mollá-Olmos E, Filice S, Due-Tønnessen P, Meling TR, Emblem KE, García-Gómez JM. MGMT methylation may benefit overall survival in patients with moderately vascularized glioblastomas. Eur Radiol 2020; 31:1738-1747. [PMID: 33001310 PMCID: PMC7880975 DOI: 10.1007/s00330-020-07297-4] [Citation(s) in RCA: 9] [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] [Received: 06/18/2020] [Revised: 08/05/2020] [Accepted: 09/15/2020] [Indexed: 11/29/2022]
Abstract
Objectives To assess the combined role of tumor vascularity, estimated from perfusion MRI, and MGMT methylation status on overall survival (OS) in patients with glioblastoma. Methods A multicentric international dataset including 96 patients from NCT03439332 clinical study were used to study the prognostic relationships between MGMT and perfusion markers. Relative cerebral blood volume (rCBV) in the most vascularized tumor regions was automatically obtained from preoperative MRIs using ONCOhabitats online analysis service. Cox survival regression models and stratification strategies were conducted to define a subpopulation that is particularly favored by MGMT methylation in terms of OS. Results rCBV distributions did not differ significantly (p > 0.05) in the methylated and the non-methylated subpopulations. In patients with moderately vascularized tumors (rCBV < 10.73), MGMT methylation was a positive predictive factor for OS (HR = 2.73, p = 0.003, AUC = 0.70). In patients with highly vascularized tumors (rCBV > 10.73), however, there was no significant effect of MGMT methylation (HR = 1.72, p = 0.10, AUC = 0.56). Conclusions Our results indicate the existence of complementary prognostic information provided by MGMT methylation and rCBV. Perfusion markers could identify a subpopulation of patients who will benefit the most from MGMT methylation. Not considering this information may lead to bias in the interpretation of clinical studies. Key Points • MRI perfusion provides complementary prognostic information to MGMT methylation. • MGMT methylation improves prognosis in glioblastoma patients with moderate vascular profile. • Failure to consider these relations may lead to bias in the interpretation of clinical studies. Electronic supplementary material The online version of this article (10.1007/s00330-020-07297-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elies Fuster-Garcia
- Department of Diagnostic Physics, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway.
| | - David Lorente Estellés
- Medical Oncology Service, Hospital Provinicial de Castellón, Castellón de La Plana, Castellón, Spain
| | - María Del Mar Álvarez-Torres
- Instituto Universitario de Tecnologías de la Información y Comunicaciones, Universitat Politècnica de València, València, Spain
| | - Javier Juan-Albarracín
- Instituto Universitario de Tecnologías de la Información y Comunicaciones, Universitat Politècnica de València, València, Spain
| | - Eduard Chelebian
- Instituto Universitario de Tecnologías de la Información y Comunicaciones, Universitat Politècnica de València, València, Spain
| | - Alex Rovira
- Section of Neuroradiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | - Silvano Filice
- Department of Medical Physics, University Hospital of Parma, Parma, Italy
| | | | - Torstein R Meling
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.,Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Kyrre E Emblem
- Department of Diagnostic Physics, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Juan M García-Gómez
- Instituto Universitario de Tecnologías de la Información y Comunicaciones, Universitat Politècnica de València, València, Spain
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Geraldes R, Juryńczyk M, dos Passos GR, Pichler A, Chung K, Hagens M, Ruggieri S, Auger C, Sastre-Garriga J, Enzinger C, Chard D, Barkhof F, Gasperini C, Rovira A, DeLuca G, Palace J. The role of pontine lesion location in differentiating multiple sclerosis from vascular risk factor-related small vessel disease. Mult Scler 2020; 27:968-972. [PMID: 32757905 PMCID: PMC8114427 DOI: 10.1177/1352458520943777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Differentiating multiple sclerosis (MS) from vascular risk factor (VRF)-small vessel disease (SVD) can be challenging. Objective and Methods: In order to determine whether or not pontine lesion location is a useful discriminator of MS and VRF-SVD, we classified pontine lesions on brain magnetic resonance imaging (MRI) as central or peripheral in 93 MS cases without VRF, 108 MS patients with VRF and 43 non-MS cases with VRF. Results: MS without VRF were more likely to have peripheral pons lesions (31.2%, 29/93) than non-MS with VRF (0%, 0/43) (Exp(B) = 29.8; 95% confidence interval (CI) = (1.98, 448.3); p = 0.014) but there were no significant differences regarding central pons lesions between MS without VRF (5.4%, 5/93) and non-MS with VRF patients (16.3%, 7/43) (Exp(B) = 0.89; 95% CI = (0.2, 3.94); p = 0.87). The presence of peripheral pons lesions discriminated between MS and VRF-SVD with 100% (95% CI = (91.8, 100)) specificity. The proportion of peripheral pons lesions in MS with VRF (30.5%, 33/108) was similar to that seen in MS without VRF (31.2%, 29/93, p = 0.99). Central lesions occurred in similar frequency in MS with VRF (8.3%, 9/108) and non-MS with VRF (16.3%, 7/43, p = 0.15). Conclusion: Peripheral pons lesion location is a good discriminator of MS from vascular lesions.
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Affiliation(s)
- Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, Oxford, UK
| | | | | | - Alexander Pichler
- Department of Neurology, Medical University of Graz, Graz, Austria/Division of Neuroradiology, Vascular & Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Karen Chung
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London Institute of Neurology, London, UK
| | - Marloes Hagens
- MS Center Amsterdam, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Serena Ruggieri
- Multiple Sclerosis Center, Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria/Division of Neuroradiology, Vascular & Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Declan Chard
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK/National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
| | - Frederik Barkhof
- MS Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands/NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK/National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
| | - Claudio Gasperini
- Multiple Sclerosis Center, Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Jacqueline Palace
- J Palace Nuffield Department of Clinical Neurosciences, Level 3, West Wing, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK.
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Mowry EM, Bermel RA, Williams JR, Benzinger TLS, de Moor C, Fisher E, Hersh CM, Hyland MH, Izbudak I, Jones SE, Kieseier BC, Kitzler HH, Krupp L, Lui YW, Montalban X, Naismith RT, Nicholas JA, Pellegrini F, Rovira A, Schulze M, Tackenberg B, Tintore M, Tivarus ME, Ziemssen T, Rudick RA. Harnessing Real-World Data to Inform Decision-Making: Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS). Front Neurol 2020; 11:632. [PMID: 32849170 PMCID: PMC7426489 DOI: 10.3389/fneur.2020.00632] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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: 12/20/2019] [Accepted: 05/28/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) is the first example of a learning health system in multiple sclerosis (MS). This paper describes the initial implementation of MS PATHS and initial patient characteristics. Methods: MS PATHS is an ongoing initiative conducted in 10 healthcare institutions in three countries, each contributing standardized information acquired during routine care. Institutional participation required the following: active MS patient census of ≥500, at least one Siemens 3T magnetic resonance imaging scanner, and willingness to standardize patient assessments, share standardized data for research, and offer universal enrolment to capture a representative sample. The eligible participants have diagnosis of MS, including clinically isolated syndrome, and consent for sharing pseudonymized data for research. MS PATHS incorporates a self-administered patient assessment tool, the Multiple Sclerosis Performance Test, to collect a structured history, patient-reported outcomes, and quantitative testing of cognition, vision, dexterity, and walking speed. Brain magnetic resonance imaging is acquired using standardized acquisition sequences on Siemens 3T scanners. Quantitative measures of brain volume and lesion load are obtained. Using a separate consent, the patients contribute DNA, RNA, and serum for future research. The clinicians retain complete autonomy in using MS PATHS data in patient care. A shared governance model ensures transparent data and sample access for research. Results: As of August 5, 2019, MS PATHS enrolment included participants (n = 16,568) with broad ranges of disease subtypes, duration, and severity. Overall, 14,643 (88.4%) participants contributed data at one or more time points. The average patient contributed 15.6 person-months of follow-up (95% CI: 15.5–15.8); overall, 166,158 person-months of follow-up have been accumulated. Those with relapsing–remitting MS demonstrated more demographic heterogeneity than the participants in six randomized phase 3 MS treatment trials. Across sites, a significant variation was observed in the follow-up frequency and the patterns of disease-modifying therapy use. Conclusions: Through digital health technology, it is feasible to collect standardized, quantitative, and interpretable data from each patient in busy MS practices, facilitating the merger of research and patient care. This approach holds promise for data-driven clinical decisions and accelerated systematic learning.
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Affiliation(s)
- Ellen M Mowry
- Johns Hopkins University, Baltimore, MD, United States
| | | | | | | | | | | | - Carrie M Hersh
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Megan H Hyland
- University of Rochester Medical Center, Rochester, NY, United States
| | - Izlem Izbudak
- Johns Hopkins University, Baltimore, MD, United States
| | | | | | - Hagen H Kitzler
- Center of Clinical Neuroscience, University Clinic Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Lauren Krupp
- New York University, New York, NY, United States
| | - Yvonne W Lui
- New York University, New York, NY, United States
| | | | | | | | | | - Alex Rovira
- Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Mar Tintore
- Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, University Clinic Carl Gustav Carus, TU Dresden, Dresden, Germany
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Vidal‐Jordana A, Pareto D, Cabello S, Alberich M, Rio J, Tintore M, Auger C, Montalban X, Rovira A, Sastre‐Garriga J. Optical coherence tomography measures correlate with brain and spinal cord atrophy and multiple sclerosis disease‐related disability. Eur J Neurol 2020; 27:2225-2232. [DOI: 10.1111/ene.14421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/18/2020] [Indexed: 12/28/2022]
Affiliation(s)
- A. Vidal‐Jordana
- Servicio de Neurologia‐Neuroinmunologia Centro de Esclerosis Múltiple de Cataluña (Cemcat) Hospital Universitario Vall d'Hebron Barcelona
| | - D. Pareto
- Servicio de Radiologia Hospital Universitario Vall d'Hebron Unidad de Resonancia Magnética Barcelona Spain
| | - S. Cabello
- Servicio de Neurologia‐Neuroinmunologia Centro de Esclerosis Múltiple de Cataluña (Cemcat) Hospital Universitario Vall d'Hebron Barcelona
| | - M. Alberich
- Servicio de Radiologia Hospital Universitario Vall d'Hebron Unidad de Resonancia Magnética Barcelona Spain
| | - J. Rio
- Servicio de Neurologia‐Neuroinmunologia Centro de Esclerosis Múltiple de Cataluña (Cemcat) Hospital Universitario Vall d'Hebron Barcelona
| | - M. Tintore
- Servicio de Neurologia‐Neuroinmunologia Centro de Esclerosis Múltiple de Cataluña (Cemcat) Hospital Universitario Vall d'Hebron Barcelona
| | - C. Auger
- Servicio de Radiologia Hospital Universitario Vall d'Hebron Unidad de Resonancia Magnética Barcelona Spain
| | - X. Montalban
- Servicio de Neurologia‐Neuroinmunologia Centro de Esclerosis Múltiple de Cataluña (Cemcat) Hospital Universitario Vall d'Hebron Barcelona
- Division of Neurology University of TorontoSt Michael´s Hospital Toronto ON Canada
| | - A. Rovira
- Servicio de Radiologia Hospital Universitario Vall d'Hebron Unidad de Resonancia Magnética Barcelona Spain
| | - J. Sastre‐Garriga
- Servicio de Neurologia‐Neuroinmunologia Centro de Esclerosis Múltiple de Cataluña (Cemcat) Hospital Universitario Vall d'Hebron Barcelona
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Cole JH, Raffel J, Friede T, Eshaghi A, Brownlee WJ, Chard D, De Stefano N, Enzinger C, Pirpamer L, Filippi M, Gasperini C, Rocca MA, Rovira A, Ruggieri S, Sastre-Garriga J, Stromillo ML, Uitdehaag BMJ, Vrenken H, Barkhof F, Nicholas R, Ciccarelli O. Longitudinal Assessment of Multiple Sclerosis with the Brain-Age Paradigm. Ann Neurol 2020; 88:93-105. [PMID: 32285956 DOI: 10.1002/ana.25746] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE During the natural course of multiple sclerosis (MS), the brain is exposed to aging as well as disease effects. Brain aging can be modeled statistically; the so-called "brain-age" paradigm. Here, we evaluated whether brain-predicted age difference (brain-PAD) was sensitive to the presence of MS, clinical progression, and future outcomes. METHODS In a longitudinal, multicenter sample of 3,565 magnetic resonance imaging (MRI) scans, in 1,204 patients with MS and clinically isolated syndrome (CIS) and 150 healthy controls (mean follow-up time: patients 3.41 years, healthy controls 1.97 years), we measured "brain-predicted age" using T1-weighted MRI. We compared brain-PAD among patients with MS and patients with CIS and healthy controls, and between disease subtypes. Relationships between brain-PAD and Expanded Disability Status Scale (EDSS) were explored. RESULTS Patients with MS had markedly higher brain-PAD than healthy controls (mean brain-PAD +10.3 years; 95% confidence interval [CI] = 8.5-12.1] versus 4.3 years; 95% CI = 2.1 to 6.4; p < 0.001). The highest brain-PADs were in secondary-progressive MS (+13.3 years; 95% CI = 11.3-15.3). Brain-PAD at study entry predicted time-to-disability progression (hazard ratio 1.02; 95% CI = 1.01-1.03; p < 0.001); although normalized brain volume was a stronger predictor. Greater annualized brain-PAD increases were associated with greater annualized EDSS score (r = 0.26; p < 0.001). INTERPRETATION The brain-age paradigm is sensitive to MS-related atrophy and clinical progression. A higher brain-PAD at baseline was associated with more rapid disability progression and the rate of change in brain-PAD related to worsening disability. Potentially, "brain-age" could be used as a prognostic biomarker in early-stage MS, to track disease progression or stratify patients for clinical trial enrollment. ANN NEUROL 2020 ANN NEUROL 2020;88:93-105.
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Affiliation(s)
- James H Cole
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Department of Medicine, Imperial College London, London, UK
| | - Joel Raffel
- Centre for Neuroinflammation and Neurodegeneration, Faculty of Medicine, Imperial College London, London, UK
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Arman Eshaghi
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Wallace J Brownlee
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Declan Chard
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Christian Enzinger
- Research Unit for Neural Repair and Plasticity, Department of Neurology and Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Lukas Pirpamer
- Neuroimaging Research Unit, Department of Neurology, Medical University of Graz, Graz, Austria
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Claudio Gasperini
- Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alex Rovira
- MR Unit and Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Serena Ruggieri
- Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Jaume Sastre-Garriga
- Department of Neurology / Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
- National Institute for Health Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, UK
| | - Richard Nicholas
- Centre for Neuroinflammation and Neurodegeneration, Faculty of Medicine, Imperial College London, London, UK
- Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
| | - Olga Ciccarelli
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
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Alonso J, Pareto D, Alberich M, Kober T, Maréchal B, Lladó X, Rovira A. Assessment of brain volumes obtained from MP-RAGE and MP2RAGE images, quantified using different segmentation methods. Magn Reson Mater Phy 2020; 33:757-767. [DOI: 10.1007/s10334-020-00854-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 11/30/2022]
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Geraldes R, Juryńczyk M, Dos Passos G, Prichler A, Chung K, Hagens M, Ruggieri S, Huerga E, Sastre-Garriga J, Enzinger C, Chard DT, Barkhof F, Gasperini C, Rovira A, DeLuca GC, Palace J. Distinct influence of different vascular risk factors on white matter brain lesions in multiple sclerosis. J Neurol Neurosurg Psychiatry 2020; 91:388-391. [PMID: 32034114 DOI: 10.1136/jnnp-2019-322369] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine if vascular risk factor (VRF), that is, smoking, arterial hypertension (HT), dyslipidaemia and diabetes, have an effect on multiple sclerosis (MS) pathology as measured by MS typical brain lesions, we have compared brain MRIs from patients with MS with and without VRF age-matched and sex-matched. METHODS Brain MRIs from five centres were scored for the presence of Dawson's fingers (DF) and juxtacortical lesions (JCL). A regression model was built to predict the effect of each individual VRF on DF and JCL, considering age and disease duration. RESULTS 92 MS cases without VRF and 106 MS with one or more VRF (80 ever-smokers, 43 hypertensives, 25 dyslipidaemics and 10 diabetics) were included. Ever-smoking associated with a higher burden of DF (Exp(B)=1.29, 95% CI 1.10 to 1.51, p<0.01) and JCL (Exp(B)=1.38, 95% CI 1.21 to 1.57, p<0.01). No other VRF had an impact on DF. Dyslipidaemia associated with increased JCL (Exp(B)=1.30, 95% CI 1.10 to 1.56, p<0.01) but HT did not associate with any of the outcomes. CONCLUSIONS Individual VRF appear to affect MS-specific lesions differently. An increase in MS lesions was mainly seen in smokers; however, this VRF is most likely to be present from onset of MS, and other VRF effects may be partly mitigated by treatment. Our findings support that treating VRF and cessation of smoking may be important in the management of MS.
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Affiliation(s)
- Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Neurology, Frimley Health NHS Foundation Trust, Frimley, UK
| | - Maciej Juryńczyk
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Giordani Dos Passos
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alexander Prichler
- Department of Neurology, Medical University of Graz, Graz, Österreich, Austria
| | - Karen Chung
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London, London, UK
| | - Marloes Hagens
- Department of Neurology, MS Center, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Serena Ruggieri
- Centro Sclerosi Multipla, Osp. San Camillo Forlanini, Roma, Italy
| | - Elena Huerga
- Magnetic Resonance Unit. Department of Radiology (IDI), Hospital Vall d\'Hebron, Barcelona, Catalunya, Spain
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Österreich, Austria
| | - Declan T Chard
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London, London, UK.,National Institute for Health Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
| | - Frederik Barkhof
- Department of Radiology, VU Medical Center, MS Center, Amsterdam, Netherlands.,Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, UK; and National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
| | | | - Alex Rovira
- Unitat de Ressonància Magnètica (IDI), Servei de Radiologia, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Gabriele C DeLuca
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
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50
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Pribic T, Lopez Q, Lucas E, Livovsky DM, Rovira A, Accarino A, Azpiroz F, Pareto D. Testing the Food Experience in Healthy Human Volunteers: a Proof-of-Concept Study. J Gastrointestin Liver Dis 2020; 29:65-68. [PMID: 32176761 DOI: 10.15403/jgld-806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/02/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS For a healthy food to be introduced to the consumer's diet, it has to be attractive, yet testing for food acceptance and the sensory postprandial responses is still not standardized. The main objective of this study was to demonstrate that healthier foods can be obtained without impact on the responses to ingestion. METHODS A randomized, cross-over, double-blind, pilot study in non-obese, healthy men (n=8) comparing the responses to a standard sausage rich in animal fat (mortadella) versus a modified product based on a plant-derived fat analogue and an aroma. Palatability and postprandial sensations were measured on 10 cm scales and brain activity was evaluated by functional magnetic resonance imaging before and after each meal on separate days. RESULTS Both meals were rated equally palatable and induced the same degree of homeostatic sensations (satiety, fullness) with a similar hedonic dimension (improved mood and digestive well-being). Both meals induced similar changes in brain connectivity: decreased activity in the frontal-parietal, basal ganglia and thalamus, visual occipital, sensory-motor, temporal superior and in the "default-mode" networks, while increased activity was detected in the network associated with white matter. CONCLUSION A substantial improvement in the nutritional profile of food can be achieved without affecting the responses to ingestion.
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Affiliation(s)
- Teodora Pribic
- Digestive System Research Unit, University Hospital Vall d'Hebron; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd); Departament de Medicina, Universitat Autònoma de Barcelona, Spain. .
| | - Quiro Lopez
- Grupo Carinsa, 08192 Sant Quirze del Vallès, Barcelona, Spain.
| | - Eduardo Lucas
- Grupo Carinsa, 08192 Sant Quirze del Vallès, Barcelona, Spain.
| | - Dan M Livovsky
- Digestive Diseases Institute Shaare Zedek Medical Center Lecturer Hebrew University Faculty of Medicine, Jerusalem, Israel..
| | - Alex Rovira
- Digestive Diseases Institute; Shaare Zedek Medical Center, Hebrew University of Jerusalem, Israel.
| | - Anna Accarino
- Digestive System Research Unit, University Hospital Vall d'Hebron; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd); Departament de Medicina, Universitat Autònoma de Barcelona, Spain.
| | - Fernando Azpiroz
- Digestive System Research Unit, University Hospital Vall d'Hebron; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd); Departament de Medicina, Universitat Autònoma de Barcelona, Spain.
| | - Deborah Pareto
- Neuroradiology Section, Radiology Department, University Hospital Vall d'Hebron, Barcelona, Spain.
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