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Petracca M, Sumowski J, Fabian M, Miller A, Lublin F, Inglese M. Looking into cognitive impairment in primary-progressive multiple sclerosis. Eur J Neurol 2017; 25:192-195. [PMID: 29053884 DOI: 10.1111/ene.13489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/16/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Cognitive impairment in primary-progressive multiple sclerosis (PP-MS) is correlated with global brain atrophy. Unfortunately, brain volume computation requires processing resources that are not widely available in clinical practice. Therefore, we decided to test the predictive role of retinal atrophy metrics on cognitive decline, applying them as a proxy of gray matter atrophy in PP-MS. METHODS Twenty-five patients with PP-MS completed the Brief International Cognitive Assessment for Multiple Sclerosis and underwent spectral-domain optical coherence tomography (OCT) and 3.0-T magnetic resonance imaging. We tested, through a stepwise logistic regression, whether OCT metrics [retinal nerve fiber layer, ganglion cell + inner plexiform layer (GCIPL) and total macular volume] predicted cognitive impairment and explored the role of gray matter atrophy in mediating these correlations. RESULTS Among OCT metrics, only GCIPL was associated with cognitive impairment (rp = 0.448, P = 0.036) and predictive of objective cognitive impairment (Wald [1] = 4.40, P = 0.036). Controlling for demographics, normalized brain volume and thalamic volume were correlated with GCIPL (rp = 0.427, P = 0.047 and rp = 0.674, P = 0.001, respectively) and cognitive scores (rp = 0.593, P = 0.004 and rp = 0.501, P = 0.017, respectively), with thalamic volume nearly mediating the association between GCIPL and cognition (Sobel z = 1.86, P = 0.063). CONCLUSIONS The GCIPL thickness is a suitable measure of neurodegeneration. In comparison with brain atrophy, GCIPL offers higher histopathological specificity, being a pure correlate of neuronal loss, and may be a non-invasive, easy-to-perform way to quantitatively evaluate and monitor neuronal loss related to cognitive impairment in PP-MS.
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Affiliation(s)
- M Petracca
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neuroscience, University of Naples 'Federico II', Naples, Italy
| | - J Sumowski
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Fabian
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Miller
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - F Lublin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Inglese
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Mother-Child Health, University of Genoa, Genoa, Italy
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Ziemssen T, Arnold D, Bar-Or A, Comi G, Hartung H, Hauser S, Kappos L, Lublin F, Selmaj K, Traboulsee A, Masterman D, Chin P, Garren H, Wolinsky J. P 1 Effect of ocrelizumab on magnetic resonance imaging markers of neurodegeneration in patients with relapsing multiple sclerosis – analysis of the phase III, double-blind, double-dummy, interferon beta-1a- controlled OPERA I and OPERA II studies. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.080] [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: 11/28/2022]
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Inglese M, Petracca M, Cocozza S, Tedeschi E, Lanzillo R, Brunetti A, Brescia Morra V, Lublin F. Unicuique suum: Investigating cerebellar lobules contribution to clinical disability in progressive multiple sclerosis. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.743] [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: 10/18/2022]
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Silber E, Arnold DL, Bar-Or A, Comi G, Hartung HP, Hauser SL, Lublin F, Selmaj K, Traboulsee A, Kappos L. OCRELIZUMAB VS INTERFERON β-1A IN RELAPSING MS: TWO STUDIES. J Neurol Neurosurg Psychiatry 2016. [DOI: 10.1136/jnnp-2016-315106.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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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Miller A, Lublin F, O'Connor P, Taniou C, Dive-Pouletty C. Impact of Relapses with Sequelae on Disability, Health-Related Quality of Life, and Fatigue in a Population with Relapsing Forms of Multiple Sclerosis Using Data from TEMSO, a Pivotal Phase III Teriflunomide Trial (P07.082). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.082] [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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Miller A, Lublin F, O'Connor P, Wolinsky J, Comi G, Kappos L, Freedman M, Olsson T, Dive-Pouletty C, Bego-Le-Bagousse G, Confavreux C. Effect of Teriflunomide on Relapses with Sequelae and Relapse Leading to Hospitalization in a Population with Relapsing Forms of Multiple Sclerosis: Results from the TEMSO Study (S30.003). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s30.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Wolinsky J, Narayana P, Nelson F, Datta S, Cofield S, Cutter G, Conwit R, Gustafson T, Lublin F, The CombiRx Investigators. The CombiRx Trial: A Multi-Center, Double-Blind, Randomized Study Comparing the Combined Use of Interferon Beta-1a and Glatiramer Acetate to Either Agent Alone in Participants with Relapsing Remitting Multiple Sclerosis - MRI Outcomes (S11.002). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Macciardi F, Cohen J, Comabella Lopez M, Comi G, Cutter G, Eyal E, Filippi M, Levy J, Lublin F, Montalban X, Oksenberg J, Tchelet A, Weiss S, Wolinsky J. A Genetic Model To Predict Response to Glatiramer Acetate Developed from a Genome Wide Association Study (GWAS) (S20.003). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s20.003] [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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9
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Macciardi F, Cohen J, Comabella Lopez M, Comi G, Cutter G, Eyal E, Filippi M, Levy J, Lublin F, Montalban X, Oksenberg J, Tchelet A, Weiss S, Wolinsky J. A Genetic Model To Predict Response to Glatiramer Acetate Developed from a Genome Wide Association Study (GWAS) (IN3-2.003). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in3-2.003] [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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Macciardi F, Cohen J, Comabella Lopez M, Comi G, Cutter G, Filippi M, Levy J, Lublin F, Montalban X, Oksenberg J, Tchelet A, Weiss S, Wolinsky J. A Genetic Model Predicts the Response to Glatiramer Acetate in Two Different Cohorts (P05.129). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lublin F, Cofield S, Cutter G, Conwit R, Narayana P, Nelson F, Gustafson T, Wolinsky J, and. The CombiRx Trial: A Multi-Center, Double-Blind, Randomized Study Comparing the Combined Use of Interferon Beta-1a and Glatiramer Acetate to Either Agent Alone in Participants with Relapsing-Remitting Multiple Sclerosis - Clinical Outcomes (PL02.003). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pl02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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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Kister I, Chamot E, Bacon JH, Niewczyk PM, De Guzman RA, Apatoff B, Coyle P, Goodman AD, Gottesman M, Granger C, Jubelt B, Krupp L, Lenihan M, Lublin F, Mihai C, Miller A, Munschauer FE, Perel AB, Teter BE, Weinstock-Guttman B, Zivadinov R, Herbert J. Rapid disease course in African Americans with multiple sclerosis. Neurology 2010; 75:217-23. [PMID: 20644149 DOI: 10.1212/wnl.0b013e3181e8e72a] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate utility of a Multiple Sclerosis Severity Scale (MSSS)-based classification system for comparing African American (AA) and white American (WA) multiple sclerosis (MS) subpopulations in the New York State Multiple Sclerosis Consortium (NYSMSC) database. MSSS is a frequency-rank algorithm relating MS disability to disease duration in a large, untreated reference population. Design/ METHODS Distributions of patients in 6 MSSS-based severity grades were calculated for AA and WA registrants. RESULTS There were 419 AA and 5,809 WA patients in the NYSMSC, who had EDSS recorded during years 1-30 since symptom onset. Median EDSS was not different in AA and WA (3.5 vs 3.0, p = 0.60), whereas median MSSS in AA was higher than in WA (6.0 vs 4.8, p = 0.001). AA patients were overrepresented in the 2 most severe grades (41.5% vs 29.3% for WA) and underrepresented in the 2 lowest grades (23.4% vs 35.4%; p < 0.001). In multivariable analysis (ordered logistic and median regression), MSSS for AA remained significantly higher than in WA after adjusting for age, gender, disease duration, disease type distribution, and treatment with disease-modifying therapies. CONCLUSIONS The 6-tiered MSSS grading system is a powerful tool for comparing rate of disease progression in subpopulations of interest. MSSS-based analysis demonstrates that African ancestry is a risk factor for a more rapidly disabling disease course.
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Affiliation(s)
- I Kister
- Department of Neurology, NYU School of Medicine, Multiple Sclerosis Care Center, New York, NY 10003-3804, USA.
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Goodman AD, Rossman H, Bar-Or A, Miller A, Miller DH, Schmierer K, Lublin F, Khan O, Bormann NM, Yang M, Panzara MA, Sandrock AW. GLANCE: results of a phase 2, randomized, double-blind, placebo-controlled study. Neurology 2009; 72:806-12. [PMID: 19255407 DOI: 10.1212/01.wnl.0000343880.13764.69] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the safety and tolerability of natalizumab when added to glatiramer acetate (GA) in patients with relapsing multiple sclerosis. The primary outcome assessed whether this combination would increase the rate of development of new active lesions on cranial MRI scans vs GA alone. METHODS This phase 2, randomized, double-blind, placebo-controlled study included patients aged 19 to 55 years who were treated with GA for at least 1 year before randomization and experienced at least one relapse during the previous year. Patients received IV natalizumab 300 mg (n = 55) or placebo (n = 55) once every 4 weeks plus GA 20 mg subcutaneously once daily for < or = 20 weeks. RESULTS The mean rate of development of new active lesions was 0.03 with combination therapy vs 0.11 with GA alone (p = 0.031). Combination therapy resulted in lower mean numbers of new gadolinium-enhancing lesions (0.6 vs 2.3 for GA alone, p = 0.020) and new/newly enlarging T2-hyperintense lesions (0.5 vs 1.3, p = 0.029). The incidence of infection and infusion reactions was similar in both groups; no hypersensitivity reactions were observed. One serious adverse event occurred with combination therapy (elective hip surgery). With the exception of an increase in anti-natalizumab antibodies with combination therapy, laboratory data were consistent with previous clinical studies of natalizumab alone. CONCLUSION The combination of natalizumab and glatiramer acetate seemed safe and well tolerated during 6 months of therapy.
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Affiliation(s)
- A D Goodman
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA.
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Abstract
Background Initiation of immunomodulators in patients experiencing a clinically isolated syndrome (CIS) may delay progression to clinically definite MS. However, lack of consensus remains on many issues affecting optimal management of MS. Method A panel of 21 MS experts met during 9 meetings to explore key issues in MS and CIS. Meetings addressed 3 phases: 1. CIS definition and diagnosis; 2. initial therapy; and 3. monitoring disease progression and treatment efficacy. Newsletters covering each phase were sent to 5000 U.S.-based neurologists who were invited to participate in an online survey on key issues. Results Most panel members agreed that early treatment may minimize neurodegeneration and most would recommend it for patients; that a dose-response relationship exists for beta-interferon therapy; that more aggressive therapy was most effective early in the disease course; and, that MRI has a role in monitoring disease progression. In face of suboptimal response, most would switch patients to a different therapy; while combination therapy would be reserved for those failing monotherapy regimes. Most online survey respondents agreed with these positions. Conclusions There was uniform consensus from this panel of MS experts that early initiation of immunomodulator therapy was beneficial for CIS patients.
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Affiliation(s)
- P Coyle
- Dept. of Neurology, Stony Brook University Medical Center, HSC T12–020, Stony Brook, NY, 11794–8121
| | - B Arnason
- Dept. of Neurology, Stony Brook University Medical Center, HSC T12–020, Stony Brook, NY, 11794–8121
| | - B Hurwitz
- Dept. of Neurology, Stony Brook University Medical Center, HSC T12–020, Stony Brook, NY, 11794–8121
| | - F Lublin
- Dept. of Neurology, Stony Brook University Medical Center, HSC T12–020, Stony Brook, NY, 11794–8121
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Abstract
The attention of researchers and clinicians specializing in both multiple sclerosis (MS) and JC virus (JCV), the etiologic agent of progressive multifocal leukoencephalopathy (PML), was rekindled by the development of PML in two patients with MS enrolled in a clinical trial of combination therapy with natalizumab (Tysabri) and interferon beta-1A (Avonex) in recent years. PML had not been previously reported with either MS or treatment with interferon beta alone. This occurrence of PML with alpha4beta1-integrin inhibition in MS raised a number of issues in terms both of the scientific understanding of these diseases and for the future of immunomodulatory treatment for MS. In this review, we examine the current status of knowledge of the virus, its molecular biology, life cycle, and pathogenetic mechanisms, and how this relates to the basic science and clinical perspectives of MS. A better understanding of the specific steps from JCV infection to the development of PML is key to this issue. Other critical issues for further investigation include the role of alpha4beta1-integrin inhibition by natalizumab in the re-expression of JCV from latent sites and in the inhibition of entry into the brain and peripheral sites.
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Affiliation(s)
- K Khalili
- Department of Neuroscience, Center for Neurovirology, Temple University School of Medicine, Philadelphia, PA 19122, USA.
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Frohman EM, Havrdova E, Lublin F, Barkhof F, Achiron A, Sharief MK, Stuve O, Racke MK, Steinman L, Weiner H, Olek M, Zivadinov R, Corboy J, Raine C, Cutter G, Richert J, Filippi M. Most Patients With Multiple Sclerosis or a Clinically Isolated Demyelinating Syndrome Should Be Treated at the Time of Diagnosis. ACTA ACUST UNITED AC 2006; 63:614-9. [PMID: 16606781 DOI: 10.1001/archneur.63.4.614] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- E M Frohman
- Departments of Neurology and Ophthalmology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75235, USA.
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Goodkin DE, Reingold S, Sibley W, Wolinsky J, McFarland H, Cookfair D, Lublin F. Guidelines for clinical trials of new therapeutic agents in multiple sclerosis: reporting extended results from phase III clinical trials. National Multiple Sclerosis Society Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Ann Neurol 1999; 46:132-4. [PMID: 10401793 DOI: 10.1002/1531-8249(199907)46:1<132::aid-ana22>3.0.co;2-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- D E Goodkin
- UCSF/MT Zion Multiple Sclerosis Center, San Francisco, CA 95115, USA
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Cutter GR, Baier ML, Rudick RA, Cookfair DL, Fischer JS, Petkau J, Syndulko K, Weinshenker BG, Antel JP, Confavreux C, Ellison GW, Lublin F, Miller AE, Rao SM, Reingold S, Thompson A, Willoughby E. Development of a multiple sclerosis functional composite as a clinical trial outcome measure. Brain 1999; 122 ( Pt 5):871-82. [PMID: 10355672 DOI: 10.1093/brain/122.5.871] [Citation(s) in RCA: 820] [Impact Index Per Article: 32.8] [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: 11/13/2022] Open
Abstract
The primary clinical outcome measure for evaluating multiple sclerosis in clinical trials has been Kurtzke's expanded disability status scale (EDSS). New therapies appear to favourably impact the course of multiple sclerosis and render continued use of placebo control groups more difficult. Consequently, future trials are likely to compare active treatment groups which will most probably require increased sample sizes in order to detect therapeutic efficacy. Because more responsive outcome measures will be needed for active arm comparison studies, the National Multiple Sclerosis Society's Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis appointed a Task Force that was charged with developing improved clinical outcome measures. This Task Force acquired contemporary clinical trial and historical multiple sclerosis data for meta-analyses of primary and secondary outcome assessments to provide a basis for recommending a new outcome measure. A composite measure encompassing the major clinical dimensions of arm, leg and cognitive function was identified and termed the multiple sclerosis functional composite (MSFC). The MSFC consists of three objective quantitative tests of neurological function which are easy to administer. Change in this MSFC over the first year of observation predicted subsequent change in the EDSS, suggesting that the MSFC is more sensitive to change than the EDSS. This paper provides details concerning the development and testing of the MSFC.
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Affiliation(s)
- G R Cutter
- AMC Cancer Research Center, Center for Research Methodology and Biometrics, Lakewood, Colarado 80214, USA.
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Bramanti P, Sessa E, Rifici C, D'Aleo G, Floridia D, Di Bella P, Lublin F. Enhanced spasticity in primary progressive MS patients treated with interferon beta-1b. Neurology 1998; 51:1720-3. [PMID: 9855531 DOI: 10.1212/wnl.51.6.1720] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [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: 11/15/2022] Open
Abstract
Spasticity is a disabling symptom of MS that is enhanced during interferon beta-lb (IFNbeta-1b) treatment. Nineteen patients with primary progressive MS were treated with IFNbeta-1b; an additional 19 patients did not receive this treatment. Thirteen of the 19 patients treated with IFNbeta-1b had increased spasticity requiring increased antispasticity drug administration. This observation suggests that further studies are needed before interferons can be so widely used in primary progressive MS patients.
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Affiliation(s)
- P Bramanti
- Centro per lo Studio ed il Trattamento dei Neurolesi Lungodegenti, Cattedra di Neurofisiopatologia, University of Messina, Italy
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Rudick R, Antel J, Confavreux C, Cutter G, Ellison G, Fischer J, Lublin F, Miller A, Petkau J, Rao S, Reingold S, Syndulko K, Thompson A, Wallenberg J, Weinshenker B, Willoughby E. Recommendations from the National Multiple Sclerosis Society Clinical Outcomes Assessment Task Force. Ann Neurol 1997; 42:379-82. [PMID: 9307263 DOI: 10.1002/ana.410420318] [Citation(s) in RCA: 227] [Impact Index Per Article: 8.4] [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: 02/05/2023]
Abstract
This article provides recommendations from the National Multiple Sclerosis Society's Clinical Outcomes Assessment Task Force. The Task Force was appointed in 1994 and charged with recommendending improved approaches for clinical outcomes assessment in future controlled clinical trials. The recommendations herein follow extensive deliberation and data analysis during 2.5 years. General principles and desirable measurement attributes were used to assess alternative measurement techniques and clinical scales. On the basis of the analysis of existing multiple sclerosis (MS) data sets, a new measurement approach is proposed. The approach is based on quantitative functional composites that consist of simple quantitative measures from the major clinical dimensions of MS combined into a single score. Quantitative functional composites are likely to provide improved precision and sensitivity in future MS clinical trials. Studies necessary to further refine quantitative functional composites as useful MS clinical trial outcomes are delineated.
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Affiliation(s)
- R Rudick
- Mellen Center, Cleveland Clinic Foundation, OH 44106, USA
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Sibley WA, Ebers GC, Lublin F, Paty D, Reder A. Treatment of multiple sclerosis with interferon beta-1b. Neurology 1997. [DOI: 10.1212/wnl.49.2.641-a] [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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Sibley WA, Paty D, Ebers G, Reder A, Lublin F. Reply from the Authors to Drs. Milanese, Savettieri, and Terizan: IFNB in MS. Neurology 1996. [DOI: 10.1212/wnl.47.4.1112] [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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23
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Rudick R, Antel J, Confavreux C, Cutter G, Ellison G, Fischer J, Lublin F, Miller A, Petkau J, Rao S, Reingold S, Syndulko K, Thompson A, Wallenberg J, Weinshenker B, Willoughby E. Clinical outcomes assessment in multiple sclerosis. Ann Neurol 1996; 40:469-79. [PMID: 8797541 DOI: 10.1002/ana.410400321] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.1] [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: 02/02/2023]
Abstract
This article represents initial deliberation of an international task force appointed by the US National Multiple Sclerosis Society to develop recommendations for optimal clinical assessment tools for multiple sclerosis clinical trials. Presented within this article are the key issues identified by the task force during its initial year of deliberation. These include the precise purpose for a clinical assessment tool, the clinical dimensions to be measured in a multidimensional outcome measure, desirable attributes of an optimal clinical outcome measure, the complexities of multidimensional outcome measures, the relative merits of categorical clinical ratings and quantitative functional assessments, and a number of other important design issues that relate to the use of a multidimensional outcome measure. An action plan for analysis of existing data is summarized, as are the plans for more detailed recommendations from the task force.
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Affiliation(s)
- R Rudick
- Mellen Center, Cleveland Clinic Foundation, OH, USA
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Cambi F, Tartaglino L, Lublin F, McCarren D. X-linked pure familial spastic paraparesis. Characterization of a large kindred with magnetic resonance imaging studies. Arch Neurol 1995; 52:665-9. [PMID: 7619021 DOI: 10.1001/archneur.1995.00540310035013] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Families with pure X-linked familial spastic paraparesis are rare. We describe a large kindred with the "pure" form of X-linked familial spastic paraparesis with seven clinically affected males. The current study was designed to identify the presence of nuclear magnetic resonance imaging (MRI) abnormalities in the affected individuals. PATIENTS AND METHODS Twenty-three individuals were examined, and MRIs of the brain were obtained in all seven affected males and two females. RESULTS The disease is characterized by spastic gait and increased reflexes without other associated neurologic signs. No male-to-male transmission has been documented in this pedigree. Magnetic resonance images of the brain in affected individuals demonstrate discrete white matter lesions in the periatrial regions, more prominent posteriorly. Similar, although not as extensive, white matter lesions were detected in the brain of the single obligate female carrier studied with MRI. CONCLUSIONS We report previously undescribed (to our knowledge) findings of MRI in pure X-linked familial spastic paraparesis and discuss the use of MRI in the diagnosis of this disorder and as a possible screening study of potential carriers.
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Affiliation(s)
- F Cambi
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pa., USA
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Abstract
Standardized and computerized neurological data will be a requirement for clinical studies in the future. MS COSTAR is a system that has been designed for multiple sclerosis clinical research. Adoption of standards and a computer method for recording and storing these data should be a high priority for the design and future of multi-center studies on multiple sclerosis.
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Affiliation(s)
- D Paty
- Division of Neurology, University of British Columbia, Vancouver, Canada
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Studney D, Lublin F, Marcucci L, Farquhar R, Redekop K, Nelson J, Paty DW. MS COSTAR: A Computerized Record for Use in Clinical Research in Multiple Sclerosis. Neurorehabil Neural Repair 1993. [DOI: 10.1177/136140969300700309] [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: 11/16/2022]
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Swirsky-Sacchetti T, Mitchell DR, Seward J, Gonzales C, Lublin F, Knobler R, Field HL. Neuropsychological and structural brain lesions in multiple sclerosis: a regional analysis. Neurology 1992; 42:1291-5. [PMID: 1620336 DOI: 10.1212/wnl.42.7.1291] [Citation(s) in RCA: 149] [Impact Index Per Article: 4.7] [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] Open
Abstract
Quantified lesion scores derived from MRI correlate significantly with neuropsychological testing in patients with multiple sclerosis (MS). Variables used to reflect disease severity include total lesion area (TLA), ventricular-brain ratio, and size of the corpus callosum. We used these general measures of cerebral lesion involvement as well as specific ratings of lesion involvement by frontal, temporal, and parieto-occipital regions to quantify the topographic distribution of lesions and consequent effects upon cognitive function. Lesions were heavily distributed in the parieto-occipital regions bilaterally. Neuropsychological tests were highly related to all generalized measures of cerebral involvement, with TLA being the best predictor of neuropsychological deficit. Mean TLA for the cognitively impaired group was 28.30 cm2 versus 7.41 cm2 for the cognitively intact group (p less than 0.0001). Multiple regression analyses revealed that left frontal lobe involvement best predicted impaired abstract problem solving, memory, and word fluency. Left parieto-occipital lesion involvement best predicted deficits in verbal learning and complex visual-integrative skills. Analysis of regional cerebral lesion load may assist in understanding the particular pattern and course of cognitive deficits in MS.
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Abstract
A case of subacute motor neuronopathy in association with thymoma is described. Subacute motor neuronopathy is marked by a painless, progressive, and asymmetric muscle weakness that usually affects the lower extremities. It is a rare paraneoplastic effect of tumors that has been described with both Hodgkin's and non-Hodgkin's lymphoma. This is the first case report of its association with thymoma.
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