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Das J, Snowden JA, Burman J, Freedman MS, Atkins H, Bowman M, Burt RK, Saccardi R, Innocenti C, Mistry S, Laud PJ, Jessop H, Sharrack B. Autologous haematopoietic stem cell transplantation as a first-line disease-modifying therapy in patients with 'aggressive' multiple sclerosis. Mult Scler 2021; 27:1198-1204. [PMID: 33565902 PMCID: PMC8226372 DOI: 10.1177/1352458520985238] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 11/17/2022]
Abstract
BACKGROUND Autologous haematopoietic stem cell transplantation (AHSCT) is an effective treatment for patients with multiple sclerosis (MS) who have highly active disease, despite the use of standard disease-modifying therapies (DMTs). However, the optimal time for offering AHSCT to patients with 'aggressive' MS is yet to be established. OBJECTIVES The objective was to explore the safety and efficacy of AHSCT as a first-line DMT in patients with 'aggressive' MS. METHODS All patients with 'aggressive' MS who received AHSCT as a first-line DMT in five European and North American centres were retrospectively evaluated. RESULTS Twenty patients were identified. The median interval between diagnosis and AHSCT was 5 (1-20) months. All had multiple poor prognostic markers with a median pre-transplant Expanded Disability Status Scale (EDSS) score of 5.0 (1.5-9.5). After a median follow-up of 30 (12-118) months, the median EDSS score improved to 2.0 (0-6.5, p < 0.0001). No patient had further relapses. Three had residual magnetic resonance imaging (MRI) disease activities in the first 6 months post-transplant, but no further new or enhancing lesions were observed in subsequent scans. CONCLUSION AHSCT is safe and effective as a first-line DMT in inducing rapid and sustained remission in patients with 'aggressive' MS.
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Affiliation(s)
- J Das
- Sheffield Institute for Translational Neuroscience, University of Sheffield, UK/Academic Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J Burman
- Department of Neurology, Uppsala University Hospital, Uppsala, Sweden
| | - M S Freedman
- Department of Medicine (Neurology), The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - H Atkins
- Department of Medicine (Neurology), The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Bowman
- Department of Medicine (Neurology), The University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - R K Burt
- Division of Immunotherapy, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R Saccardi
- Department of Cellular Therapies and Transfusion Medicine, Careggi University Hospital, Florence, Italy
| | - C Innocenti
- Department of Cellular Therapies and Transfusion Medicine, Careggi University Hospital, Florence, Italy
| | - S Mistry
- Academic Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - P J Laud
- Statistical Services Unit, University of Sheffield, Sheffield, UK
| | - H Jessop
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - B Sharrack
- Academic Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Sheffield Institute for Translational Neuroscience, University of Sheffield, UK
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Tappenden P, Wang Y, Sharrack B, Burman J, Kazmi M, Saccardi R, Bermejo I, Harvey R, Badoglio M, Farge D, Snowden JA. Evaluating the clinical effectiveness of autologous haematopoietic stem cell transplantation versus disease-modifying therapy in multiple sclerosis using a matching-adjusted indirect comparison: an exploratory study from the Autoimmune Diseases Working Party (ADWP) of the European Society of Bone and Marrow Transplantation (EBMT). Bone Marrow Transplant 2019; 55:1473-1475. [PMID: 31745252 DOI: 10.1038/s41409-019-0747-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 12/29/2022]
Affiliation(s)
- P Tappenden
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Y Wang
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - B Sharrack
- Academic Department of Neuroscience, Sheffield INHR BRC, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J Burman
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - M Kazmi
- Kings Health Partners, Department of Haematology, Guys Hospital, London, UK
| | - R Saccardi
- Haematology Department, Careggi University Hospital, Florence, Italy
| | - I Bermejo
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - R Harvey
- Cabourn Statistics Ltd, Manchester, UK
| | - M Badoglio
- EBMT Paris study office / CEREST-TC-Department of Haematology, Saint Antoine Hospital-INSERM UMR 938-Université Pierre et Marie Curie, Paris, France
| | - D Farge
- Assistance Publique-Hôpitaux de Paris, Saint-Louis Hospital, Autoimmune and Vascular Disease Unit, Internal Medicine (UF04), Center of Reference for Rare Systemic Autoimmune Diseases (FAI2R), Université de Paris, EA 3518, Paris, France.,Department of Medicine, McGill University, Montreal, QC, Canada
| | - J A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Angelini L, Carpinella I, Cattaneo D, Ferrarin M, Gervasoni E, Sharrack B, Paling D, Mazzà C. WITHDRAWN: Assessment of the inter-laboratory repeatability of gait analysis measurements in patients with multiple sclerosis. Gait Posture 2019:S0966-6362(19)31194-4. [PMID: 33518426 DOI: 10.1016/j.gaitpost.2019.07.384] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- L Angelini
- Department of Mechanical Engineering, INSIGNEO Institute for in Silico Medicine, University of Sheffield, Sheffield, UK
| | | | - D Cattaneo
- IRCCS Fondazione Don C. Gnocchi, Milan, Italy
| | - M Ferrarin
- IRCCS Fondazione Don C. Gnocchi, Milan, Italy
| | - E Gervasoni
- IRCCS Fondazione Don C. Gnocchi, Milan, Italy
| | - B Sharrack
- Academic Department of Neuroscience, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - D Paling
- Sheffield Institute of Translational Neuroscience, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - C Mazzà
- Department of Mechanical Engineering, INSIGNEO Institute for in Silico Medicine, University of Sheffield, Sheffield, UK
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Abstract
Gold nanoparticles (AuNPs) provide excellent platforms for the development of colorimetric biosensors as they can be easily functionalised, displaying different colours depending on their size, shape and state of aggregation. In the last decade, a variety of biosensors have been developed to exploit the extent of colour changes as nano-particles (NPs) either aggregate or disperse, in the presence of analytes. Of critical importance to the design of these methods is that the behaviour of the systems has to be reproducible and predictable. Much has been accomplished in understanding the interactions between a variety of substrates and AuNPs, and how these interactions can be harnessed as colorimetric reporters in biosensors. However, despite these developments, only a few biosensors have been used in practice for the detection of analytes in biological samples. The transition from proof of concept to market biosensors requires extensive long-term reliability and shelf life testing, and modification of protocols and design features to make them safe and easy to use by the population at large. Developments in the next decade will see the adoption of user friendly biosensors for point-of-care and medical diagnosis as innovations are brought to improve the analytical performances and usability of the current designs. This review discusses the mechanisms, strategies, recent advances and perspectives for the use of AuNPs as colorimetric biosensors.
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Affiliation(s)
- H Aldewachi
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK.
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Kelsey PJ, Oliveira MC, Badoglio M, Sharrack B, Farge D, Snowden JA. Haematopoietic stem cell transplantation in autoimmune diseases: From basic science to clinical practice. Curr Res Transl Med 2016; 64:71-82. [PMID: 27316390 DOI: 10.1016/j.retram.2016.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/31/2016] [Indexed: 12/20/2022]
Abstract
Based on animal studies and serendipitous clinical cases, haematopoietic stem cell transplantation (HSCT) has been used since 1995 as a specific treatment for patients with severe treatment-resistant autoimmune disease (ADs). Despite other clinical developments for autoimmune diseases, including biological therapies, there has been an ongoing requirement for HSCT in some diseases and several thousand procedures have been registered in databases for a wide variety of diseases, predominantly for treatment with autologous HSCT. Currently, the main indications are multiple sclerosis, systemic sclerosis and Crohn's disease, which are supported by large series and randomised controlled trials (RCTs), whereas retrospective registry analyses support benefit in a range of rarer indications. Research into mechanisms of action has provided insight into how tolerance may be achieved with an intensive one-off treatment. In addition to the profound anti-inflammatory and immunosuppressive effects provided by the cytotoxic regimen, long-term responses in some diseases may be explained by 'resetting' the immune system through thymic reprocessing and generation of increased T-regulatory cell activity. This review aims to summarise the gradual evolution of HSCT in severe autoimmune diseases over the last 20 years, focussing on the recent publication of clinical and scientific studies, as well as evidence-based guidelines and recommendations.
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Affiliation(s)
- P J Kelsey
- Departments of Haematology and Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK.
| | - M-C Oliveira
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - B Sharrack
- Departments of Haematology and Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK
| | - D Farge
- St. Louis hospital, Internal Medicine and Vascular Diseases Unit, Paris, France; INSERM 1160 Unit, Paris 7 Diderot University, Sorbonne Paris Cite 1, Paris, France
| | - J A Snowden
- Departments of Haematology and Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK
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Seytanoglu A, Alsomali NI, Valori CF, McGown A, Kim HR, Ning K, Ramesh T, Sharrack B, Wood JD, Azzouz M. Deficiency in the mRNA export mediator Gle1 impairs Schwann cell development in the zebrafish embryo. Neuroscience 2016; 322:287-97. [PMID: 26921650 DOI: 10.1016/j.neuroscience.2016.02.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 12/12/2022]
Abstract
GLE1 mutations cause lethal congenital contracture syndrome 1 (LCCS1), a severe autosomal recessive fetal motor neuron disease, and more recently have been associated with amyotrophic lateral sclerosis (ALS). The gene encodes a highly conserved protein with an essential role in mRNA export. The mechanism linking Gle1 function to motor neuron degeneration in humans has not been elucidated, but increasing evidence implicates abnormal RNA processing as a key event in the pathogenesis of several motor neuron diseases. Homozygous gle1(-/-) mutant zebrafish display various aspects of LCCS, showing severe developmental abnormalities including motor neuron arborization defects and embryonic lethality. A previous gene expression study on spinal cord from LCCS fetuses indicated that oligodendrocyte dysfunction may be an important factor in LCCS. We therefore set out to investigate the development of myelinating glia in gle1(-/-) mutant zebrafish embryos. While expression of myelin basic protein (mbp) in hindbrain oligodendrocytes appeared relatively normal, our studies revealed a prominent defect in Schwann cell precursor proliferation and differentiation in the posterior lateral line nerve. Other genes mutated in LCCS have important roles in Schwann cell development, thereby suggesting that Schwann cell deficits may be a common factor in LCCS pathogenesis. These findings illustrate the potential importance of glial cells such as myelinating Schwann cells in motor neuron diseases linked to RNA processing defects.
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Affiliation(s)
- A Seytanoglu
- The Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, 385A Glossop Road, Sheffield S10 2HQ, UK
| | - N I Alsomali
- The Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, 385A Glossop Road, Sheffield S10 2HQ, UK
| | - C F Valori
- The Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, 385A Glossop Road, Sheffield S10 2HQ, UK
| | - A McGown
- The Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, 385A Glossop Road, Sheffield S10 2HQ, UK
| | - H R Kim
- Bateson Centre, Department of Biomedical Science, University of Sheffield, Firth Court, Western Bank, Sheffield S10 2TN, UK
| | - K Ning
- The Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, 385A Glossop Road, Sheffield S10 2HQ, UK
| | - T Ramesh
- The Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, 385A Glossop Road, Sheffield S10 2HQ, UK
| | - B Sharrack
- The Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, 385A Glossop Road, Sheffield S10 2HQ, UK; Department of Neurology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals Foundation Trust, Glossop Road, Sheffield S10 2JF, UK
| | - J D Wood
- The Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, 385A Glossop Road, Sheffield S10 2HQ, UK; Bateson Centre, Department of Biomedical Science, University of Sheffield, Firth Court, Western Bank, Sheffield S10 2TN, UK
| | - M Azzouz
- The Sheffield Institute for Translational Neuroscience, Department of Neuroscience, University of Sheffield, 385A Glossop Road, Sheffield S10 2HQ, UK; Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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Kelsey P, Bell SM, Jessop H, Snowden JA, Sharrack B. AUTOLOGOUS HAEMOPOIETIC STEM CELL TRANSPLANT IN MS: SHEFFIELD COHORT. J Neurol Neurosurg Psychiatry 2015. [DOI: 10.1136/jnnp-2015-312379.28] [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
BackgroundAutologous haemopoietic stem cell transplantation (AHSCT) is an evolving therapy for multiple sclerosis (MS). Here we present the Sheffield experience since 2006.MethodsRetrospective review of MS cases referred for and treated with AHSCT. Toxicity, clinical and radiological outcome were assessed.Results14 patients (8 Rapidly evolving severe [REMS], 3 Relapsing Remitting [RRMS], 3 Secondary Progressive [SPMS]) were selected for AHSCT. One patient underwent AHSCT on a clinical trial (data excluded from analysis). Mean age 34.6 years (SD 8.69), median pretreatment EDSS 6.5 (IQR0.5). All had clinically and radiologically aggressive disease, non-responsive to standard treatment. Follow up range was 3 to 96 months.All patients were successfully mobilized, 2 patients progressed only to harvest (1 compliance issues, 1 leg ulcer). All patients were treated according to international guidelines. No excess toxicity or treatment related mortality was observed.Post-transplant MRI's showed no active disease. No patients with RRMS suffered relapse post-transplant, median reduction in EDSS scores was 2 at both 100 days (IQR 2) and at last follow up (IQR 2.5). EDSS scores stabilised in patients with SPMS.ConclusionAHSCT is an effective treatment with acceptable toxicity in patients with aggressive, inflammatory MS.
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Hickman SJ, Raoof N, Panesar H, McMullan JM, Pepper IM, Sharrack B. Visual Outcomes from Shunting for Idiopathic Intracranial Hypertension. Neuroophthalmology 2014; 38:310-319. [PMID: 27928318 DOI: 10.3109/01658107.2014.956183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/15/2014] [Accepted: 08/15/2014] [Indexed: 11/13/2022] Open
Abstract
A retrospective notes review was conducted for 50 consecutive patients who underwent shunt surgery for idiopathic intracranial hypertension (IIH). The decimal visual acuity and the mean radial degrees (MRD) of the I4e isopter of the Goldmann visual field were measured pre-operatively and after a mean follow-up period of 1123 days (range: 13-3551 days). A ventriculo-peritoneal shunt was the first procedure in 38 patients and a lumbo-peritoneal shunt in 12. The mean decimal visual acuity of the worse affected eye improved from 0.75 to 0.84, p = 0.011. The MRD score of the worse affected eye improved on average from 25.6° to 35.5°, p < 0.0001. In those with significant pre-operative visual impairment in their worse affected eye (defined as an MRD score ≤30°), the MRD score improved on average from 10.3° to 26.5°, p = 0.0008. The mean number of surgical procedures for each patient was 2.8 (range: 1-15). Taking all surgical procedures into account, post-operative complications were experienced by 30 patients. At last follow-up, 28 patients still complained of headache, 8 of whom had the intervention performed primarily for headache. Shunting can improve visual function in patients with IIH. There is significant post-operative morbidity and often the need for repeated procedures. Headache also commonly remains in these patients. There is a need for a randomised controlled trial of operative interventions in IIH. Sample size calculations for such a trial to treat significant vision loss are presented.
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Affiliation(s)
- S J Hickman
- Department of Neurology, Royal Hallamshire Hospital Sheffield UK
| | - N Raoof
- Department of Ophthalmology, Royal Hallamshire Hospital Sheffield UK
| | - H Panesar
- School of Medicine, University of Sheffield Sheffield UK
| | - J M McMullan
- Department of Neurosurgery, Royal Hallamshire Hospital Sheffield UK
| | - I M Pepper
- Department of Ophthalmology, Royal Hallamshire Hospital Sheffield UK
| | - B Sharrack
- Department of Neurology, Royal Hallamshire Hospital Sheffield UK
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Carter A, Daley A, Humphreys L, Snowdon N, Woodroofe N, Petty J, Roalfe A, Tosh J, Sharrack B, Saxton JM. Pragmatic intervention for increasing self-directed exercise behaviour and improving important health outcomes in people with multiple sclerosis: a randomised controlled trial. Mult Scler 2014; 20:1112-22. [DOI: 10.1177/1352458513519354] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/12/2013] [Indexed: 01/07/2023]
Abstract
Background: Exercise programmes that can demonstrate evidence of long-lasting clinical effectiveness are needed for people with multiple sclerosis (P wMS). Objective: The objective of this study was to assess the effects of a practically implemented exercise programme on self-directed exercise behaviour and important health outcomes in P wMS to nine months of follow-up. Methods: We conducted a parallel-arm, randomised controlled trial: 120 P wMS (Expanded Disability Status Scale (EDSS) 1.0–6.5) randomised to a three-month exercise intervention plus usual care, or usual care only. Two supervised plus one home-exercise session (weeks 1–6) were followed by one supervised and two home-exercise sessions (weeks 7–12). Cognitive-behavioural techniques promoted long-term exercise behaviour change. Outcomes were blindly assessed at baseline and at three and nine months after randomisation. The primary outcome was self-reported exercise behaviour (Godin Leisure Time Exercise Questionnaire (GLTEQ)). Secondary outcomes included fatigue and health-related quality of life (HRQoL). Results: The intervention increased self-reported exercise (9.6 points; 95% CI: 2.0 to 17.3 points; p = 0.01) and improved fatigue ( p < 0.0001) and many HRQoL domains ( p ≤ 0.03) at three months. The improvements in emotional well-being ( p = 0.01), social function ( p = 0.004) and overall quality of life ( p = 0.001) were sustained for nine months. Conclusion: This pragmatic approach to implementing exercise increases self-reported exercise behaviour, improves fatigue and leads to a sustained enhancement of HRQoL domains in P wMS.
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Affiliation(s)
- A Carter
- Centre for Sport and Exercise Science, Sheffield Hallam University, UK
| | - A Daley
- Primary Care Clinical Sciences, University of Birmingham, UK
| | - L Humphreys
- Centre for Sport and Exercise Science, Sheffield Hallam University, UK
| | - N Snowdon
- Centre for Health and Social Care Research, Sheffield Hallam University, UK
| | - N Woodroofe
- Biomedical Research Centre, Sheffield Hallam University, UK
| | - J Petty
- Multiple Sclerosis Society, UK
| | - A Roalfe
- Primary Care Clinical Sciences, University of Birmingham, UK
| | - J Tosh
- School of Health and Related Research, University of Sheffield, UK
| | - B Sharrack
- Neurology Department, Sheffield Teaching Hospitals Foundation Trust, UK
| | - JM Saxton
- School of Rehabilitation Sciences, University of East Anglia, UK
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Tosh J, Dixon S, Carter A, Daley A, Petty J, Roalfe A, Sharrack B, Saxton JM. Cost effectiveness of a pragmatic exercise intervention (EXIMS) for people with multiple sclerosis: economic evaluation of a randomised controlled trial. Mult Scler 2014; 20:1123-30. [DOI: 10.1177/1352458513515958] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 11/12/2013] [Indexed: 11/16/2022]
Abstract
Background: Exercise is a safe, non-pharmacological adjunctive treatment for people with multiple sclerosis but cost-effective approaches to implementing exercise within health care settings are needed. Objective: The objective of this paper is to assess the cost effectiveness of a pragmatic exercise intervention in conjunction with usual care compared to usual care only in people with mild to moderate multiple sclerosis. Methods: A cost-utility analysis of a pragmatic randomised controlled trial over nine months of follow-up was conducted. A total of 120 people with multiple sclerosis were randomised (1:1) to the intervention or usual care. Exercising participants received 18 supervised and 18 home exercise sessions over 12 weeks. The primary outcome for the cost utility analysis was the incremental cost per quality-adjusted life year (QALY) gained, calculated using utilities measured by the EQ-5D questionnaire. Results: The incremental cost per QALY of the intervention was £10,137 per QALY gained compared to usual care. The probability of being cost effective at a £20,000 per QALY threshold was 0.75, rising to 0.78 at a £30,000 per QALY threshold. Conclusion: The pragmatic exercise intervention is highly likely to be cost effective at current established thresholds, and there is scope for it to be tailored to particular sub-groups of patients or services to reduce its cost impact.
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Affiliation(s)
- J Tosh
- School of Health and Related Research, University of Sheffield, UK
| | - S Dixon
- School of Health and Related Research, University of Sheffield, UK
| | - A Carter
- Centre for Sport and Exercise Science, Sheffield Hallam University, UK
| | - A Daley
- Primary Care Clinical Sciences, University of Birmingham, UK
| | - J Petty
- Multiple Sclerosis Society, UK
| | - A Roalfe
- Primary Care Clinical Sciences, University of Birmingham, UK
| | - B Sharrack
- Neurology Department, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - JM Saxton
- School of Rehabilitation Sciences, University of East Anglia, UK
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Saxton J, Carter A, Daley A, Snowdon N, Woodroofe M, Petty J, Roalfe A, Tosh J, Sharrack B. Pragmatic exercise intervention for people with multiple sclerosis (ExIMS Trial): Study protocol for a randomised controlled trial. Contemp Clin Trials 2013; 34:205-11. [DOI: 10.1016/j.cct.2012.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 10/22/2012] [Accepted: 10/25/2012] [Indexed: 11/27/2022]
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Iqbal A, Blackburn D, Rafiq M, Sharrack B. MULTIPLE CRANIAL NERVE PALSIES IN A YOUNG SINGER. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2012-304200a.66] [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: 11/04/2022]
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Waller R, Woodroofe M, Francese S, Heath P, Wharton S, Ince P, Sharrack B, Simpson J. Isolation of enriched glial populations from post-mortem human CNS material by immuno-laser capture microdissection. J Neurosci Methods 2012; 208:108-13. [DOI: 10.1016/j.jneumeth.2012.04.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 04/16/2012] [Accepted: 04/18/2012] [Indexed: 12/11/2022]
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Sharrack B, Elias R, Reuber M. Factors Influencing Patients' Choices of Disease Modifying Therapies in Multiple Sclerosis (P06.202). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lee H, Ismail A, Dhungana S, Woodroofe N, Sharrack B. Leptin Levels in Multiple Sclerosis (P02.078). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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16
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Kheder A, Sharrack B, Bowen J. 030 Variations in grading referral letters from primary care to a neurology department. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.72] [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: 11/04/2022]
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Fouillet A, Mawson J, Suliman O, Sharrack B, Romero IA, Woodroofe MN. CCL2 binding is CCR2 independent in primary adult human astrocytes. Brain Res 2012; 1437:115-26. [PMID: 22226505 DOI: 10.1016/j.brainres.2011.11.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [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: 02/03/2011] [Revised: 10/04/2011] [Accepted: 11/28/2011] [Indexed: 02/08/2023]
Abstract
Chemokines are low relative molecular mass proteins, which have chemoattractant actions on many cell types. The chemokine, CCL2, has been shown to play a major role in the recruitment of monocytes in central nervous system (CNS) lesions in multiple sclerosis (MS). Since resident astrocytes constitute a major source of chemokine synthesis including CCL2, we were interested to assess the regulation of CCL2 by astrocytes. We showed that CCL2 bound to the cell surface of astrocytes and binding was not modulated by inflammatory conditions. However, CCR2 protein was not detected nor was activation of the classical CCR2 downstream signaling pathways. Recent studies have shown that non-signaling decoy chemokine receptors bind and modulate the expression of chemokines at site of inflammation. Here, we show that the D6 chemokine decoy receptor is constitutively expressed by primary human adult astrocytes at both mRNA and protein level. In addition, CCL3, which binds to D6, but not CCL19, which does not bind to D6, displaced CCL2 binding to astrocytes; indicating that CCL2 may bind to this cell type via the D6 receptor. Our results suggest that CCL2 binding to primary adult human astrocytes is CCR2-independent and is likely to be mediated via the D6 decoy chemokine receptor. Therefore we propose that astrocytes are implicated in both the establishment of chemokine gradients for the migration of leukocytes into and within the CNS and in the regulation of CCL2 levels at inflammatory sites in the CNS.
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Affiliation(s)
- A Fouillet
- Biomedical Research Centre, Faculty of Health and Wellbeing, Sheffield Hallam University, Howard Street, Sheffield S1 1WB, UK.
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Jenkins TM, Sharrack B. The cost of long hospital stays. Clin Med (Lond) 2012; 12:98-9. [PMID: 22372241 PMCID: PMC4953440 DOI: 10.7861/clinmedicine.12-1-98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Blackburn D, Chavada G, Dunleavy D, Hoggard N, Sharrack B, Ponnusamy S, Price S. PO.18 Guillain-Barre syndrome (GBS) presenting with posterior reversible encephalopathy syndrome. Journal of Neurology, Neurosurgery & Psychiatry 2011. [DOI: 10.1136/jnnp-2011-300645.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND AND PURPOSE The purpose of this study was to identify the incidence and prevalence of idiopathic intracranial hypertension (IIH) in Sheffield, UK. METHODS A retrospective review of case notes was conducted to identify cases of IIH seen between 1 January 2007 and 31 December 2008. RESULTS Sixteen (15 women and 1 man) new patients were identified to give an incidence within Sheffield of 1.56/100,000/year and 2.86/100,000/year for women. The incidence of IIH in obese women was 11.9/100,000/year. The prevalence of IIH was calculated as 10.9/100,000, and 85.7/100,000 in obese women. CONCLUSION A higher incidence of IIH than previously reported UK data was found, which may be because of increasing obesity within the population, or improved case ascertainment.
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Affiliation(s)
- N Raoof
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
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21
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Hadjivassiliou M, Aeschlimann D, Grünewald RA, Sanders DS, Sharrack B, Woodroofe N. GAD antibody-associated neurological illness and its relationship to gluten sensitivity. Acta Neurol Scand 2011; 123:175-80. [PMID: 20456245 DOI: 10.1111/j.1600-0404.2010.01356.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [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: 12/27/2022]
Abstract
BACKGROUND The high prevalence of gluten sensitivity in patients with stiff-person syndrome (SPS) lead us to investigate the relationship between gluten sensitivity and GAD-antibody-associated diseases. METHODS We used ELISA assays for anti-GAD and for serological markers of gluten sensitivity. Patients were recruited from clinics based at the Royal Hallamshire hospital, Sheffield, UK. Patients with gluten sensitivity were followed up after the introduction of a gluten-free diet and serological testing was repeated. RESULTS Six of seven (86%) patients with SPS were positive for anti-GAD, mean titre 109 U/ml; This compared with 9/90 (11%) patients with idiopathic sporadic ataxia, mean titre 32 U/ml, 16/40 (40%) patients with gluten ataxia, mean titre 25 U/ml, and 6/10 patients with type 1 diabetes only, mean titre 8 U/ml. None of 32 patients with celiac disease only, and of 40 patients with genetic ataxia were positive for anti-GAD. The titre of anti-GAD reduced following the introduction of a gluten-free diet in patients with SPS who had serological evidence of gluten sensitivity. The same was observed in patients with gluten ataxia and anti-GAD antibodies. This was also associated with clinical improvement. CONCLUSION These findings suggest a link between gluten sensitivity and GAD antibody-associated diseases.
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Affiliation(s)
- M Hadjivassiliou
- Department of Neurology, The Royal Hallamshire Hospital, Sheffield, UK.
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22
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Comi G, Abramsky O, Arbizu T, Boyko A, Gold R, Havrdová E, Komoly S, Selmaj K, Sharrack B, Filippi M. Oral laquinimod in patients with relapsing-remitting multiple sclerosis: 36-week double-blind active extension of the multi-centre, randomized, double-blind, parallel-group placebo-controlled study. Mult Scler 2010; 16:1360-6. [PMID: 20834039 DOI: 10.1177/1352458510378127] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Laquinimod, an oral novel immunomodulator, was shown to reduce MRI-measured disease activity in relapsing-remitting MS (RRMS) patients. OBJECTIVES To determine whether the safety and efficacy profile of laquinimod, as shown in a placebo-controlled 36-week trial (LAQ/5062), is sustained and reproducible. METHODS Two hundred and fifty seven patients entered the extension phase in which MRI was performed at the beginning and at the end of the active extension phase. Clinical assessments were performed at weeks 4, 12 and every 12 weeks thereafter. RESULTS Two hundred and thirty nine (93%) patients completed the extension phase and 222 (86.3%) had a final scan available. Gadolinium-enhanced (GdE) T1 lesions were significantly reduced for patients switching from placebo to 0.3/ 0.6 mg doses (52%, p = 0.0006). In patients initially randomized to 0.6 mg in LAQ/5062 the reduction of MRI activity observed in the placebo-controlled phase was maintained in the extension. The proportion of GdE-free patients for those who switched from placebo increased from a baseline of 31% to 47% at the end of the extension phase (p = 0.01). The most prominent safety signal was elevations of liver enzymes, reversible in all cases. CONCLUSIONS The good efficacy and the excellent safety and tolerability profiles of laquinimod 0.6 mg/day are confirmed in this extension study.
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Affiliation(s)
- G Comi
- Department of Neurology, University Vita-Salute and Scientific Institute San Raffaele, Milan, Italy.
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24
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Abstract
Idiopathic intracranial hypertension (IIH) is a condition which affects predominantly overweight women and is characterized by raised intracranial pressure without any identifiable pathology in the brain and with normal cerebrospinal fluid (CSF) composition. The cause of IIH is unclear and as such it remains a diagnosis of exclusion. Although the pathophysiology of IIH remains elusive, some observations have recently been added to our understanding of this, including the presence of transverse sinus stenosis on many patients and the possible role of leptin and inflammation in the disease pathogenesis. Headache is the most common symptom and papilloedema is the major clinical finding. Choices of medical treatment are limited to the use of diuretics particularly acetazolamide and encouragement of weight loss. Surgical therapies such as CSF diversion procedures and fenestration of the optic nerve may be necessary in some cases with persistent symptoms or progressive visual deterioration. While not life-threatening, IIH has a significant morbidity with up to 25% of patients developing visual impairment from optic atrophy. Visual surveillance is therefore vital. Long-term follow-up is recommended as the disease may worsen after an initial period of stability.
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Affiliation(s)
- S Dhungana
- Sheffield Teaching Hospitals NHS Trust, University of Sheffield, Sheffield, UK.
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25
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Tappenden P, Saccardi R, Confavreux C, Sharrack B, Muraro PA, Mancardi GL, Kozak T, Farge-Bancel D, Madan J, Rafia R, Akehurst R, Snowden J. Autologous haematopoietic stem cell transplantation for secondary progressive multiple sclerosis: an exploratory cost-effectiveness analysis. Bone Marrow Transplant 2009; 45:1014-21. [PMID: 19855441 DOI: 10.1038/bmt.2009.305] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Treatment options for secondary progressive multiple sclerosis (SPMS) are limited. Mitoxantrone is routinely used to stabilize disease progression; however, evolving evidence suggests clinical benefit from intensive treatment with autologous haematopoietic stem cell transplantation (HSCT). Given differences in cost and outcomes, preliminary cost-effectiveness studies are warranted if this approach is to be developed for more widespread application in SPMS. We developed a decision-analytic Markov model to explore the potential cost-effectiveness of autologous HSCT versus mitoxantrone in SPMS, using patient-level data from registry sources. The model evaluates the lifetime costs and health outcomes associated with disability progression and relapse. Sensitivity analyses were undertaken to examine the uncertainty surrounding cost-effectiveness outcomes. In the absence of randomised controlled trial (RCT) evidence, conditions for comparative analysis were not ideal. Under optimistic assumptions, HSCT is estimated to cost below pound3000 per quality adjusted life year gained. However, when a strict 6-month sustained progression rule is adopted, HSCT may be less effective and more expensive than mitoxantrone. The model results were sensitive to reducing procedural costs and HSCT-related mortality. We conclude that HSCT could potentially achieve an acceptable level of cost-effectiveness. However, caution should be exercised as large, high-quality RCTs comparing HSCT versus mitoxantrone are necessary to validate these findings.
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Affiliation(s)
- P Tappenden
- Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
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26
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Ismail A, Rao DG, Sharrack B. Pure motor Herpes Zoster induced brachial plexopathy. J Neurol 2009; 256:1343-5. [PMID: 19434442 DOI: 10.1007/s00415-009-5149-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 03/23/2009] [Accepted: 04/15/2009] [Indexed: 11/30/2022]
Abstract
Brachial plexus neuritis in the presence of herpes zoster infection is uncommon. Motor involvement is probably due to the spreading of inflammation from the dorsal root ganglia to the ventral roots and may be more extensive than the affected dermatomes. We present a case of herpes zoster brachial plexopathy with pure motor involvement both clinically and electrophysiologically.
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Affiliation(s)
- A Ismail
- Department of Neurology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
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27
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Hadjivassiliou M, Alder SJ, Van Beek EJR, Hanney MB, Lorenz E, Rao DG, Sharrack B, Tindale WB. PET scan in clinically suspected paraneoplastic neurological syndromes: a 6-year prospective study in a regional neuroscience unit. Acta Neurol Scand 2009; 119:186-93. [PMID: 18855873 DOI: 10.1111/j.1600-0404.2008.01089.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The role of PET in the diagnosis of paraneoplastic neurological syndromes (PNS) has previously been reported in retrospective studies, from specialized neuro-oncology units, often selecting patients with positive paraneoplastic antibodies. OBJECTIVES To prospectively assess the usefulness of PET in detecting malignancy in patients clinically suspected of having PNS. METHODS PET was performed in patients suspected of PNS within 4 weeks of the normal CT body scan. All patients were followed up. RESULTS Eighty patients suspected of having PNS underwent PET. 18/80 (23%) were abnormal and suspicious of malignancy. The total number of definite and probable PNS with abnormal PET was 11/18 (61%). The total number of definite and probable PNS with a normal PET was 3/62 (5%). Only 50% of patients with biopsy-proven malignancy were positive for paraneoplastic antibodies. The prevalence of abnormal PET in patients presenting with classical PNS was 41% as opposed to 21% in patients with non-classical PNS. The sensitivity and specificity of PET in diagnosing PNS was 75% and 87% respectively. CONCLUSIONS PET is a valuable tool in clinically suspected PNS. Its use should not be restricted to specialized neuro-oncology units or in patients with positive paraneoplastic antibodies. Positive yield is the highest amongst patients with classical PNS.
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Affiliation(s)
- M Hadjivassiliou
- Department of Neurology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, NHS Trust, Sheffield, UK.
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28
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Comi G, Pulizzi A, Rovaris M, Abramsky O, Arbizu T, Boiko A, Gold R, Havrdova E, Komoly S, Selmaj K, Sharrack B, Filippi M. Effect of laquinimod on MRI-monitored disease activity in patients with relapsing-remitting multiple sclerosis: a multicentre, randomised, double-blind, placebo-controlled phase IIb study. Lancet 2008; 371:2085-92. [PMID: 18572078 DOI: 10.1016/s0140-6736(08)60918-6] [Citation(s) in RCA: 193] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND A 24-week phase II trial has shown that 0.3 mg of laquinimod given daily to patients with relapsing-remitting multiple sclerosis was well tolerated and reduced the formation of active lesions. We assessed the effect of oral daily 0.3 and 0.6 mg laquinimod on MRI-monitored disease activity in a 36-week double-blind, placebo-controlled phase IIb study. METHODS The study was done in 51 centres in nine countries. Inclusion criteria were one or more relapses in the year before entry and at least one gadolinium enhancing (GdE) lesion on screening MRI. Of 720 patients screened, 306 eligible patients were enrolled. Patients, aged 18-50 years, were randomly assigned to placebo (n=102), laquinimod 0.3 mg a day (n=98), or 0.6 mg a day (n=106). Brain MRI scans and clinical assessments were done at week -4, baseline, and monthly from week 12 to week 36. The primary outcome was the cumulative number of GdE lesions at weeks 24, 28, 32, and 36. The principal analysis of the primary endpoint was done on the intention-to-treat cohort. This study is registered with ClinicalTrials.gov, number NCT00349193. FINDINGS Compared with placebo, treatment with laquinimod 0.6 mg per day showed a 40.4% reduction of the baseline adjusted mean cumulative number of GdE lesions per scan on the last four scans (simple means 4.2 [SD 9.2] vs 2.6 [5.3], p=0.0048); treatment with 0.3 mg per day showed no significant effects (3.9 [5.5] vs placebo, p=0.6740). Both doses of laquinimod were well tolerated, with some transient and dose-dependent increases in liver enzymes. A case of Budd-Chiari syndrome-ie, a thrombotic venous outflow obstruction of the liver-occurred after 1 month of exposure in a patient with underlying hypercoagulability who received 0.6 mg laquinimod. Anticoagulant treatment resulted in a decline of liver enzymes to normal without any clinical signs of hepatic decompensation. INTERPRETATION In patients with relapsing-remitting multiple sclerosis, 0.6 mg per day laquinimod significantly reduced MRI-measured disease activity and was well tolerated.
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Affiliation(s)
- G Comi
- Institute of Experimental Neurology, Department of Neurology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy.
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29
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Morris ES, Sharrack B, Dalley CD, Snowden JA. The Uhthoff phenomenon: a potential post transplant complication in advanced progressive multiple sclerosis. Bone Marrow Transplant 2007; 40:1003-4. [PMID: 17891188 DOI: 10.1038/sj.bmt.1705854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Haddock G, Cross AK, Allan S, Sharrack B, Callaghan J, Bunning RAD, Buttle DJ, Woodroofe MN. Brevican and phosphacan expression and localization following transient middle cerebral artery occlusion in the rat. Biochem Soc Trans 2007; 35:692-4. [PMID: 17635124 DOI: 10.1042/bst0350692] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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] [Indexed: 11/17/2022]
Abstract
The ECM (extracellular matrix) is a complex molecular framework that provides physical support to cells and tissues, while also providing signals for cell growth, migration, differentiation and survival. The ECM of the CNS (central nervous system) is unusual in that it is rich in CSPGs (chondroitin sulfate proteoglycans), hyaluronan and tenascins. The CSPGs are widely expressed throughout the developing and adult CNS and have a role in guiding or limiting neurite outgrowth and cell migration. Alterations in the synthesis or breakdown of the ECM may contribute to disease processes. Here, we examine changes in the brain-specific CSPGs, brevican and phosphacan, following transient middle cerebral artery occlusion, a model of stroke in the rat. We have investigated their expression at various time points as well as their spatial relationship with ADAMTS-4 (adisintegrin and metalloprotease with thrombospondin motifs 4). The co-localization of ADAMTS or its activity may indicate a functional role for this matrix–protease pair in degeneration/regeneration processes that occur in stroke.
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Affiliation(s)
- G Haddock
- Biomedical Research Centre, Faculty of Health and Well-being, Sheffield Hallam University, Howard St, Sheffield S1 1WB, UK.
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31
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Hadjivassiliou M, Grünewald RA, Kandler RH, Chattopadhyay AK, Jarratt JA, Sanders DS, Sharrack B, Wharton SB, Davies-Jones GAB. Neuropathy associated with gluten sensitivity. J Neurol Neurosurg Psychiatry 2006; 77:1262-6. [PMID: 16835287 PMCID: PMC2077388 DOI: 10.1136/jnnp.2006.093534] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To prospectively study the clinical, neurophysiological and neuropathological characteristics of axonal neuropathies associated with positive antigliadin antibodies and the prevalence of such neuropathies in a cohort of patients with sporadic axonal neuropathy. METHODS Prospective screening (using antigliadin, antiendomysium and tissue transglutaminase antibodies) of patients with peripheral neuropathy attending a neurology clinic. RESULTS 215 patients with axonal neuropathy were screened. 141 patients had symmetrical sensorimotor neuropathy, 47 had mononeuropathy multiplex, 17 had motor neuropathy and 10 had small-fibre neuropathy. Despite extensive investigations of the 215 patients, 140 had idiopathic neuropathy. Positive immunoglobulin (Ig)G with or without IgA antigliadin antibodies was found in 34% (47/140) of the patients with idiopathic neuropathy. This compares with 12% prevalence of these antibodies in the healthy controls. The prevalence of coeliac disease as shown by biopsy in the idiopathic group was at least 9% as compared with 1% in the controls. The clinical features of 100 patients (47 from the prevalence study and 53 referred from elsewhere) with gluten neuropathy included a mean age at onset of 55 (range 24-77) years and a mean duration of neuropathy of 9 (range 1-33) years. Gluten-sensitive enteropathy was present in 29% of patients. The human leucocyte antigen types associated with coeliac disease were found in 80% of patients. CONCLUSIONS Gluten sensitivity may be aetiologically linked to a substantial number of idiopathic axonal neuropathies.
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Affiliation(s)
- M Hadjivassiliou
- Department of Neurology, The Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
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McDermott CJ, Burness CE, Kirby J, Cox LE, Rao DG, Hewamadduma C, Sharrack B, Hadjivassiliou M, Chinnery PF, Dalton A, Shaw PJ. Clinical features of hereditary spastic paraplegia due to spastin mutation. Neurology 2006; 67:45-51. [PMID: 16832076 DOI: 10.1212/01.wnl.0000223315.62404.00] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mutations in the spastin gene are the commonest cause of hereditary spastic paraparesis (HSP), accounting for up to 40% of autosomal dominant cases. The phenotype associated with HSP due to mutation in the spastin gene (SPG4) tends to be pure HSP. OBJECTIVE To characterize in more detail the genetic and phenotypic characteristics of SPG4 by examining a large cohort of patients with HSP. METHODS The authors identified patients who tested positive for spastin mutation using a direct sequencing approach of all exons. RESULTS The authors identified spastin mutations in 53 patients. Twenty-seven of the mutations identified were novel. The phenotype in the majority of patients was of pure HSP. In one individual, a complicated phenotype with progressive bulbar dysfunction and respiratory insufficiency was observed. Evidence of lower motor neuron dysfunction in a subgroup of SPG4 patients was identified. The missense changes S44L and P45Q were identified in patients with other spastin mutations and seemed to be exerting a phenotype-modifying effect. CONCLUSION These findings add to the number of spastin mutations identified and demonstrate the importance of screening the whole gene, given the possibility of double mutations and intragenic modifiers. The identification of the complicated phenotypes has important implications for identifying the phenotype of patients in whom spastin screening should be considered. The presence of lower motor neuron dysfunction in a subgroup of SPG4 patients suggests that the cellular dysfunction in SPG4 extends beyond the axonal projections of upper motor neurons and ascending sensory pathways.
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Affiliation(s)
- C J McDermott
- Sheffield Care and Research Centre for Motor Neuron Disorders, Academic Neurology Unit, University of Sheffield, Sheffield, UK
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de Noronha RJ, Sharrack B, Hadjivassiliou M, Romanowski CAJ. Subdural haematoma: a potentially serious consequence of spontaneous intracranial hypotension. J Neurol Neurosurg Psychiatry 2003; 74:752-5. [PMID: 12754345 PMCID: PMC1738487 DOI: 10.1136/jnnp.74.6.752] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Spontaneous intracranial hypotension (SIH) is characterised by postural headache and low opening pressure at lumbar puncture without obvious cause. Cranial magnetic resonance imaging often shows small subdural collections without mass effect, dural enhancement, venous sinus dilatation, or downward displacement of the brain. The condition is thought to be benign. OBJECTIVES To evaluate the incidence of subdural haematoma as a serious complication of SIH. METHODS A prospective survey of all cases of SIH presenting to a large neuroscience unit over a two year period. RESULTS Nine cases of SIH were seen. Four of these were complicated by acute clinical deterioration with reduced conscious level because of large subdural haematomas requiring urgent neurosurgical drainage. CONCLUSIONS SIH should not be considered a benign condition. Acute deterioration of patients' clinical status may occur secondary to large subdural haematomas, requiring urgent neurosurgical intervention.
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Affiliation(s)
- R J de Noronha
- Department of Radiology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Trust, Sheffield, UK
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35
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Sharrack B, Hughes RA, Morris RW, Soudain S, Wade-Jones O, Barnes D, Brown P, Britton T, Francis DA, Perkin GD, Rudge P, Swash M, Katifi HA, Farmer S, Frankel JP. The effect of oral and intravenous methylprednisolone treatment on subsequent relapse rate in multiple sclerosis. J Neurol Sci 2000; 173:73-7. [PMID: 10675582 DOI: 10.1016/s0022-510x(99)00304-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [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: 11/29/2022]
Abstract
We investigated the effect of oral and intravenous methylprednisolone treatment on subsequent relapse rate in patients with multiple sclerosis. Following a double blind trial designed to compare the effect of oral and intravenous methylprednisolone treatment on promoting recovery from acute relapses of multiple sclerosis, 80 patients were followed for two years with six-monthly assessments during which all subsequent relapses were recorded. The annual relapse rate was slightly higher in the oral compared with the intravenous methylprednisolone-treated patients (1.06 vs. 0.78), but the adjusted difference between the two groups was not statistically significant (0.18; 95% CI -0.19 to 0.55, P=0.3). The time to onset and the severity of the first relapse after treatment, the number of relapse free patients at the end of the follow-up period, and the severity of the relapses during the follow-up period were similar in the two groups. This trial did not show a statistically significant difference in relapse rate during the first two years following oral compared with intravenous methylprednisolone treatment.
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Affiliation(s)
- B Sharrack
- Guy's, Kings and St. Thomas' School of Medicine, London, UK
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Tubridy N, Behan PO, Capildeo R, Chaudhuri A, Forbes R, Hawkins CP, Hughes RA, Palace J, Sharrack B, Swingler R, Young C, Moseley IF, MacManus DG, Donoghue S, Miller DH. The effect of anti-alpha4 integrin antibody on brain lesion activity in MS. The UK Antegren Study Group. Neurology 1999; 53:466-72. [PMID: 10449105 DOI: 10.1212/wnl.53.3.466] [Citation(s) in RCA: 238] [Impact Index Per Article: 9.5] [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] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To determine the effect of humanized monoclonal antibody against alpha4 integrin (reactive with alpha4beta1 integrin or very-late antigen-4) on MRI lesion activity in MS. METHODS A randomized, double-blind, placebo-controlled trial in 72 patients with active relapsing-remitting and secondary progressive MS was performed. Each patient received two IV infusions of anti-alpha4 integrin antibody (natalizumab; Antegren) or placebo 4 weeks apart and was followed up for 24 weeks with serial MRI and clinical assessment. RESULTS The treated group exhibited significantly fewer new active lesions (mean 1.8 versus 3.6 per patient) and new enhancing lesions (mean 1.6 versus 3.3 per patient) than the placebo group over the first 12 weeks. There was no significant difference in the number of new active or new enhancing lesions in the second 12 weeks of the study. The number of baseline-enhancing lesions (i.e., lesions that enhanced on the baseline scan) that continued to enhance 4 weeks following the first treatment was not significantly different between the two groups. The number of patients with acute MS exacerbations was not significantly different in the two groups during the first 12 weeks (9 in the treated group versus 10 in placebo) but was higher in the treatment group in the second 12 weeks (14 versus 3; p = 0.005). The study was not, however, designed to look definitively at the effect of treatment on relapse rate. Treatment was well tolerated. CONCLUSIONS Short-term treatment with monoclonal antibody against alpha4 integrin results in a significant reduction in the number of new active lesions on MRI. Further studies will be required to determine the longer term effect of this treatment on MRI and clinical outcomes.
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Abstract
A postal survey showed that the majority of 49 leading international neurologists involved with multiple sclerosis research felt that currently existing outcome measures for this illness were inadequate, and that there was a need for a new measure which should be patient orientated, multidimensional, and not biased towards any particular disability. The Guy's Neurological Disability Scale (GNDS) was subsequently devised as a simple and user-friendly clinical disability scale capable of embracing the whole range of disabilities which could be encountered in the course of multiple sclerosis. It has 12 separate categories which include cognition, mood, vision, speech, swallowing, upper limb function, lower limb function, bladder function, bowel function, sexual function, fatigue, and 'others'. The GNDS was found to be acceptable to neurologists and patients, reliable, responsive, and valid as a measure of disability. The scale was also found to be valid when applied by non-neurologists, over the phone, or via a postal questionnaire.
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Affiliation(s)
- B Sharrack
- Department of Clinical Neuroscience, Hodgkin Building, Guy's, King's and St. Thomas' School of Medicine, Guy's Hospital, London, SE1 9RT, UK
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Hadden RD, Sharrack B, Bensa S, Soudain SE, Hughes RA. Randomized trial of interferon beta-1a in chronic inflammatory demyelinating polyradiculoneuropathy. Neurology 1999; 53:57-61. [PMID: 10408537 DOI: 10.1212/wnl.53.1.57] [Citation(s) in RCA: 123] [Impact Index Per Article: 4.9] [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: 11/15/2022] Open
Abstract
OBJECTIVE To test the safety and efficacy of interferon beta-1a (IFN-beta) in treatment-resistant chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). BACKGROUND Current treatment regimens leave 4% to 30% of patients with CIDP with moderate or severe disability. IFN-beta has been reported as beneficial in one treatment-resistant patient. METHODS Ten consecutive treatment-resistant patients were randomized in a double-blind, crossover design to receive placebo or IFN-beta (3 MIU for 2 weeks and then 6 MIU for 10 weeks) subcutaneously three times weekly, followed by 4 weeks without treatment, and then the opposite treatment for 12 weeks. The primary outcome measure was "clinically important" improvement by specified amounts in any three of eight clinical measures: timed 10-m walk, Ambulation Index, expanded Medical Research Council sum score, nine-hole peg test time, Functional Independence Measure, Hammersmith Motor Ability, a new Guy's Neurological Disability Scale, and the EuroQoL quality-of-life scale. These and motor median nerve conduction studies were measured before and after 12 weeks of each treatment. RESULTS Clinically important improvement was observed in one patient while taking IFN-beta and two patients while taking placebo. There was no significant difference between IFN-beta and placebo in the change in any of the individual clinical or neurophysiological measures between the beginning and end of treatment. There were no serious adverse events. CONCLUSION This trial shows that IFN-beta is safe but not efficacious in treatment-resistant CIDP.
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Affiliation(s)
- R D Hadden
- Department of Clinical Neurosciences, Guy's King's and St. Thomas School of Medicine, Guy's Hospital, London, UK
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Abstract
OullII;l y Many clinical rating scales have been proposed to assess the impact of multiple sclerosis on patients, but only few have been evaluated formally for reliability, validity and responsiveness. We assessed the psychometric properties of five commonly used scales in multiple sclerosis, the Expanded Disability Status Scale (EDSS), the Scripps Neurological Rating Scale (SNRS), the Functional Independence Measure (FIM), the Ambulation Index (AI) and the Cambridge Multiple Sclerosis Basic Score (CAMBS). The score frequency distributions of all five scales were either bimodal (EDSS and AI) or severely skewed (SNRS, FIM and CAMBS). The reliability of each scale depended on the definition of 'agreement'. Inter-and intra-rater reliabilities were high when 'agreement' was considered to exist despite a difference of up to 1.0 EDSS point (two 0.5 steps), 13 SNRS points, 9 FIM points, 1 AI point and 1 point on the various CAMBS domains. The FIM, AI, and the relapse and progression domains of the CAMBS were sensitive to clinical change, but the EDSS and the SNRS were unresponsive. The validity of these scales as impairment (SNRS and EDSS) and disability (EDSS, FIM, AI and the disability domain of the CAMBS) measures was established. All scales correlated closely with other measures of handicap and quality of life. None of these scales satisfied the psychometric requirements of outcome measures completely, but each had some desirable properties. The SNRS and the EDSS were reliable and valid measures of impairment and disability, but they were unresponsive. The FIM was a reliable, valid and responsive measure of disability, but it is cumbersome to administer and has a limited content validity. The AI was a reliable and valid ambulation-related disability scale, but it was weakly responsive. The CAMBS was a reliable (all four domains) and responsive (relapse and progression domains) outcome measure, but had a limited validity (handicap domain). These psychometric properties should be considered when designing further clinical trials in multiple sclerosis.
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Affiliation(s)
- B Sharrack
- Department of Neurology, UMDS, Guy's Hospital, London, UK
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Abstract
OBJECTIVE To assess the reliability and accuracy of distance estimated by doctors and patients. DESIGN Comparison between estimated and measured distances of six familiar sites around Guy's Hospital, London. SUBJECTS 100 hospital consultants and 100 patients. MAIN OUTCOME MEASURES Median (range) of estimated distances, and mean (SD) of the difference between estimated and measured distances. RESULTS Both doctors and patients gave a wide range of estimates of distance. The estimates differed by up to 14.6-fold from the measured distances, and the difference between minimum and maximum estimates was up to 62.5-fold. CONCLUSION Doctors and patients were inaccurate at estimating distances, which implies that estimates of distances walked are not reliable indicators of a person's health.
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Affiliation(s)
- B Sharrack
- Department of Neurology, United Medical School, Guy's Hospital, London
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Pitzalis C, Sharrack B, Gray IA, Lee A, Hughes RA. Comparison of the effects of oral versus intravenous methylprednisolone regimens on peripheral blood T lymphocyte adhesion molecule expression, T cell subsets distribution and TNF alpha concentrations in multiple sclerosis. J Neuroimmunol 1997; 74:62-8. [PMID: 9119980 DOI: 10.1016/s0165-5728(96)00206-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [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: 02/04/2023]
Abstract
We investigated in multiple sclerosis the difference between two commonly used oral and intravenous steroid regimens on the level of adhesion molecule expression on blood T lymphocytes, the distribution of circulating T cell subsets, and the concentration of serum tumour necrosis factor alpha. Venous blood samples were collected from a cohort of 22 patients with acute relapses who were participating in a randomised trial comparing intravenous methylprednisolone 1000 mg daily for 3 days with oral methylprednisolone 48 mg daily for one week, 24 mg daily for one week, and finally 12 mg daily for one week. There was a similar significant reduction of T cell LFA-1 surface expression and serum TNF alpha concentrations after 4 days of treatment with each regimen. There was no change in other lymphocyte adhesion molecules expression (ICAM-1, LFA-3 or CD2) at day 4, although LFA-3 and CD2 expression was moderately decreased at day 28 and day 90 respectively; nor was there any change in the distribution of lymphocyte subsets (CD4, CD8, and CD45RA, CD45RO), although a small decrease in CD45RO circulatory T cells was noted at day 28. This study suggests that some of the beneficial effects of glucocorticosteroids may be related to the inhibition of lymphocyte adhesion as well as the modulation of proinflammatory cytokines.
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Affiliation(s)
- C Pitzalis
- Department of Rheumatology, UMDS, Guy's Hospital, London, UK
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Abstract
An underlying carcinoma is an important differential diagnosis in peripheral neuropathy. While direct compression and infiltration of spinal roots or peripheral or cranial nerve trunks or branches can be identified easily when they occur in association with established malignancy, their diagnosis when they are presenting features may be difficult. In paraneoplastic sensory neuronopathy autoantibodies to neuronal antigens have become useful diagnostic markers for an underlying carcinoma, especially anti-Hu antibodies. Strong circumstantial evidence suggests that these antibodies form part of an autoimmune response which is responsible for the pathogenesis of some of these syndromes. Neuropathy appearing during the course of treatment of carcinoma may be due to radiation-induced damage or the neurotoxic effects of some chemotherapeutic agents. Neurotrophic factors are being investigated as a strategy for reducing the neurotoxic effects of these agents.
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Affiliation(s)
- R Hughes
- Department of Neurology, UMDS, Guy's Hospital, London, UK
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Abstract
Many neurological rating scales have been suggested to assess the impact of multiple sclerosis on patients, but none has been universally accepted. The Kurtzke Extended Disability Status Scale has been the most widely used despite its imperfections. It combines disability and impairment, has moderate inter-rater reliability, and its overall score is heavily weighted toward ambulation. The Scripps Neurological Rating Scale attempts to quantify impairment as measured by the traditional neurological examination. However, this and other impairment scales lack direct relevance to patients' functional health status. The Ambulation Index and some of the quantitative upper limb dysfunction assessment methods are sensitive and reproducible, but they only measure limited aspects of the wide range of disabilities encountered in multiple sclerosis. Current scales of disability and activities of daily living, such as the Incapacity Status Scale and the Functional Independent Measure, are not sensitive to the type of change which occurs in multiple sclerosis. The relationship between abnormalities on magnetic resonance images of the brain and disability has been difficult to ascertain. Although recently developed imaging acquisition methods may demonstrate abnormalities which are more closely correlated with disability, the demonstration of prevention, stabilization or recovery from disability using clinical scales will remain the final arbiter of success in clinical trials. We suggest guidelines for an improved disability scale.
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Affiliation(s)
- B Sharrack
- Department of Neurology, United Medical and Dental Schools, London, UK
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Hughes RA, Heywood P, Sharrack B. Drug trials in neuropathy. Baillieres Clin Neurol 1995; 4:607-27. [PMID: 8599727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Drug trials in peripheral neuropathy have used different outcome measures, the choice of which has depended on the nature of the neuropathy and the hypothesis being tested. The majority of the published trials have relied on measuring impairment (reflecting the desirable sensitivity of these outcome measures), and only few have used measures of disability or handicap. Drug trials in inflammatory neuropathy (GBS and CIDP), diabetic, paraproteinaemic, and toxic neuropathies have been discussed in this chapter, to illustrate the different therapeutic approaches used in the literature. Future drug trials in peripheral neuropathy should pay more attention to disability and handicap measures.
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Affiliation(s)
- R A Hughes
- Guy's Hospital, Department of Neurology, UMDS, London, UK
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Abstract
We describe two patients with associations of hereditary neuropathies and heritable skeletal disorders not previously reported. The first patient had Marfan's syndrome and hereditary motor and sensory neuropathy Type 1. The second patient had Ehlers-Danlos syndrome, Klippel-Feil syndrome and tomaculous neuropathy.
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