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O'Neill KA, Dugue A, Abreu NJ, Balcer LJ, Branche M, Galetta S, Graves J, Kister I, Magro C, Miller C, Newsome SD, Pappas J, Rucker J, Steigerwald C, William CM, Zamvil SS, Grossman SN, Krupp LB. Relapsing White Matter Disease and Subclinical Optic Neuropathy: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200194. [PMID: 38181317 DOI: 10.1212/nxi.0000000000200194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/28/2023] [Indexed: 01/07/2024]
Abstract
A 16-year-old adolescent boy presented with recurrent episodes of weakness and numbness. Brain MRI demonstrated subcortical, juxtacortical, and periventricular white matter T2 hyperintensities with gadolinium enhancement. CSF was positive for oligoclonal bands that were not present in serum. Despite treatment with steroids, IV immunoglobulins, plasmapheresis, and rituximab, he continued to have episodes of weakness and numbness and new areas of T2 hyperintensity on imaging. Neuro-ophthalmologic examination revealed a subclinical optic neuropathy with predominant involvement of the papillomacular bundle. Genetic evaluation and brain biopsy led to an unexpected diagnosis.
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Affiliation(s)
- Kimberly A O'Neill
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Andrew Dugue
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Nicolas J Abreu
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Laura J Balcer
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Marc Branche
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Steven Galetta
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Jennifer Graves
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Ilya Kister
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Cynthia Magro
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Claire Miller
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Scott D Newsome
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - John Pappas
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Janet Rucker
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Connolly Steigerwald
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Christopher M William
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Scott S Zamvil
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Scott N Grossman
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Lauren B Krupp
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
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Sotirchos ES, Hu C, Smith MD, Lord HN, DuVal AL, Arrambide G, Montalban X, Akgün K, Ziemssen T, Naismith RT, Hersh CM, Hyland M, Krupp LB, Nicholas JA, Bermel RA, Mowry EM, Calabresi PA, Fitzgerald KC. Agreement Between Published Reference Resources for Neurofilament Light Chain Levels in People With Multiple Sclerosis. Neurology 2023; 101:e2448-e2453. [PMID: 37816633 PMCID: PMC10752633 DOI: 10.1212/wnl.0000000000207957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/06/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES To examine the agreement between published reference resources for neurofilament light chain (NfL) applied to a large population of people with multiple sclerosis (MS). METHODS Six published reference resources were used to classify NfL in participants in the Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) network as elevated or normal and to derive age-specific NfL Z-scores. NfL values were classified as elevated if they exceeded the >95th percentile (i.e., Z-score >1.645) of the age-specific reference range. Furthermore, age-specific NfL Z-scores could be derived for 4 of 6 reference resources. RESULTS NfL measurements were assessed from 12,855 visits of 6,687 people with MS (median 2 samples per individual [range 1-7]). The mean ± SD age was 47.1 ± 11.7 years, 72.1% of participants were female, disease duration was 15.0 ± 10.6 years, body mass index was 28.6 ± 6.9 kg/m2, and serum NfL was 12.87 ± 12.86 pg/mL. Depending on the selection of the reference resource, the proportion of NfL measurements classified as elevated varied from 3.7% to 30.9%. The kappa coefficient across the 6 reference resources used was 0.576 (95% CI 0.571-0.580) indicating moderate agreement. Spearman correlations between Z-scores derived from the various reference resources exceeded 0.90; however, concordance coefficients were lower, ranging from 0.72 to 0.89. DISCUSSION Interpretation of blood NfL values may vary markedly depending on the selection of the reference resource. Borderline elevated values should be interpreted with caution, and future studies should focus on standardizing NfL measurement and reporting across laboratories/platforms, better characterizing the effects of confounding/influencing factors, and defining the performance of NfL (including as part of multimodal predictive algorithms) for prediction of disease-specific outcomes.
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Affiliation(s)
- Elias S Sotirchos
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH.
| | - Chen Hu
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH
| | - Matthew D Smith
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH
| | - Hannah-Noelle Lord
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH
| | - Anna L DuVal
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH
| | - Georgina Arrambide
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH
| | - Xavier Montalban
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH
| | - Katja Akgün
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH
| | - Tjalf Ziemssen
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH
| | - Robert T Naismith
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH
| | - Carrie M Hersh
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH
| | - Megan Hyland
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH
| | - Lauren B Krupp
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH
| | - Jacqueline A Nicholas
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH
| | - Robert A Bermel
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH
| | - Ellen M Mowry
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH
| | - Peter A Calabresi
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH
| | - Kathryn C Fitzgerald
- From the Johns Hopkins University School of Medicine (E.S.S., C.H., M.D.S., H.-N.L., A.L.D., E.M.M., P.A.C., K.C.F.), Baltimore, MD; Department of Neurology-Neuroimmunology (G.A., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Center of Clinical Neuroscience (K.A., T.Z.), Department of Neurology, University Clinic Carl-Gustav Carus, TU Dresden, Germany; Department of Neurology (R.T.N.), Washington University in St. Louis, MO; Lou Ruvo Center for Brain Health (C.M.H.), Cleveland Clinic, Las Vegas, NV; Department of Neurology (M.H.), University of Rochester Medical Center, NY; Department of Neurology (L.B.K.), New York University, New York City; OhioHealth Multiple Sclerosis Center (J.A.N.), Riverside Methodist Hospital, Columbus; and Mellen Center (R.A.B.), Neurological Institute, Cleveland Clinic, OH.
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3
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Parrotta E, Kopinsky H, Abate J, Ryerson LZ, Krupp LB. It's not always an infection: Pyoderma gangrenosum of the urogenital tract in two patients with multiple sclerosis treated with rituximab. Mult Scler Relat Disord 2023; 70:104483. [PMID: 36580875 DOI: 10.1016/j.msard.2022.104483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/08/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022]
Abstract
B-cell depleting therapies such as rituximab and ocrelizumab are widely used for the treatment of Multiple Sclerosis but have increased risks of adverse reactions compared to earlier MS therapies. One rarely reported reaction is pyoderma gangrenosum (PG), an inflammatory, ulcerative, skin disease of unclear etiology. Here we describe a male and female patient, each with Relapsing-Remitting Multiple Sclerosis, and both of whom developed PG while on rituximab. Both PG diagnoses were supported by persistent fever, biopsy reports of sterile neutrophilia, and leukocytosis in the absence of an identifiable infectious agent. The diagnoses were further confirmed by dramatic clinical improvement following initiation of high dose steroids and intravenous immunoglobulins, and discontinuation of rituximab.
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Affiliation(s)
- Erica Parrotta
- NYU Langone Multiple Sclerosis Comprehensive Care Center, 240 E. 38th St., 13th Floor, New York, NY 10016, USA
| | - Hannah Kopinsky
- NYU Langone Multiple Sclerosis Comprehensive Care Center, 240 E. 38th St., 13th Floor, New York, NY 10016, USA
| | - Jennifer Abate
- NYU Langone Multiple Sclerosis Comprehensive Care Center, 240 E. 38th St., 13th Floor, New York, NY 10016, USA
| | - Lana Zhovtis Ryerson
- NYU Langone Multiple Sclerosis Comprehensive Care Center, 240 E. 38th St., 13th Floor, New York, NY 10016, USA
| | - Lauren B Krupp
- NYU Langone Multiple Sclerosis Comprehensive Care Center, 240 E. 38th St., 13th Floor, New York, NY 10016, USA.
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4
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Sotirchos ES, Fitzgerald KC, Singh CM, Smith MD, Reyes-Mantilla M, Hersh CM, Hyland MH, Canissario R, Simmons SB, Arrambide G, Montalban X, Comabella M, Naismith RT, Qiao M, Krupp LB, Nicholas JA, Akgün K, Ziemssen T, Rudick R, Fisher E, Bermel RA, Mowry EM, Calabresi PA. Associations of sNfL with clinico-radiological measures in a large MS population. Ann Clin Transl Neurol 2023; 10:84-97. [PMID: 36427295 PMCID: PMC9852396 DOI: 10.1002/acn3.51704] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Evaluation of serum neurofilament light chain (sNfL), measured using high-throughput assays on widely accessible platforms in large, real-world MS populations, is a critical step for sNfL to be utilized in clinical practice. METHODS Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) is a network of healthcare institutions in the United States and Europe collecting standardized clinical/imaging data and biospecimens during routine clinic visits. sNfL was measured in 6974 MS and 201 healthy control (HC) participants, using a high-throughput, scalable immunoassay. RESULTS Elevated sNfL levels for age (sNfL-E) were found in 1238 MS participants (17.8%). Factors associated with sNfL-E included male sex, younger age, progressive disease subtype, diabetes mellitus, impaired renal function, and active smoking. Higher body mass index (BMI) was associated with lower odds of elevated sNfL. Active treatment with disease-modifying therapy was associated with lower odds of sNfL-E. MS participants with sNfL-E exhibited worse neurological function (patient-reported disability, walking speed, manual dexterity, and cognitive processing speed), lower brain parenchymal fraction, and higher T2 lesion volume. Longitudinal analyses revealed accelerated short-term rates of whole brain atrophy in sNfL-E participants and higher odds of new T2 lesion development, although both MS participants with or without sNfL-E exhibited faster rates of whole brain atrophy compared to HC. Findings were consistent in analyses examining age-normative sNfL Z-scores as a continuous variable. INTERPRETATION Elevated sNfL is associated with clinical disability, inflammatory disease activity, and whole brain atrophy in MS, but interpretation needs to account for comorbidities including impaired renal function, diabetes, and smoking.
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Affiliation(s)
- Elias S Sotirchos
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Matthew D Smith
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maria Reyes-Mantilla
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carrie M Hersh
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, Nevada, USA
| | - Megan H Hyland
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Ryan Canissario
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Sarah B Simmons
- Mellen Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Georgina Arrambide
- Department of Neurology and Centre d'Esclerosi Múltiple de Catalunya, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology and Centre d'Esclerosi Múltiple de Catalunya, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Department of Neurology and Centre d'Esclerosi Múltiple de Catalunya, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Robert T Naismith
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Min Qiao
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Lauren B Krupp
- Department of Neurology, New York University, New York City, New York, USA
| | - Jacqueline A Nicholas
- OhioHealth Multiple Sclerosis Center, Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Katja Akgün
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl-Gustav Carus, Dresden, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl-Gustav Carus, Dresden, Germany
| | | | | | - Robert A Bermel
- Mellen Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ellen M Mowry
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Krupp LB, Waubant E, Waltz M, Casper TC, Belman A, Wheeler Y, Ness J, Graves J, Gorman M, Benson L, Mar S, Goyal M, Schreiner T, Weinstock-Guttman B, Rodriguez M, Tillema JM, Lotze T, Aaen G, Rensel M, Rose J, Chitinis T, George A, Charvet LE. A new look at cognitive functioning in pediatric MS. Mult Scler 2023; 29:140-149. [PMID: 36189711 DOI: 10.1177/13524585221123978] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Cognitive involvement in pediatric multiple sclerosis (MS) relative to adult MS is less defined. This study advances our understanding by measuring cognitive performances in pediatric MS, adult MS, and pediatric healthy controls. METHODS Consecutive relapsing pediatric MS participants from the United States Network of Pediatric MS Centers were compared with pediatric healthy controls and adults with relapsing MS. Participants were compared on two screening batteries: the Brief International Cognitive Assessment for MS and the Cogstate Brief Battery. Results were transformed to age-normative z scores. RESULTS The pediatric groups (MS vs. Healthy Controls) did not differ on either battery's composite mean score or individual test scores (ps > 0.32), nor in the proportions impaired on either battery, Brief International Cognitive Assessment for MS (26% vs. 24%, p = 0.83); Cogstate Brief Battery (26% vs. 32%, p = 0.41). The pediatric versus adult MS group even after controlling for differences in disease duration performed better on the Brief International Cognition Assessment for MS composite (p = 0.03), Symbol Digit Modalities Test (p = 0.02), Rey Auditory Verbal Learning Test (p = 0.01), and Cogstate choice reaction time (p < 0.001). CONCLUSION Pediatric MS patients do not differ from healthy pediatric controls on cognitive screens but perform better than adults with MS.
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Affiliation(s)
- Lauren B Krupp
- Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Emmanuelle Waubant
- Pediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, CA, USA
| | - Michael Waltz
- Data Coordinating and Analysis Center, The University of Utah, Salt Lake City, UT, USA
| | - T Charles Casper
- Data Coordinating and Analysis Center, The University of Utah, Salt Lake City, UT, USA
| | - Anita Belman
- Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Yolanda Wheeler
- Center for Pediatric-Onset Demyelinating Disease, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jayne Ness
- Center for Pediatric-Onset Demyelinating Disease, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer Graves
- Pediatric Multiple Sclerosis Center, University of California San Diego, San Diego, CA, USA
| | - Mark Gorman
- Pediatric Multiple Sclerosis and Related Disorders Program at Boston Children's Hospital, Boston, MA, USA
| | - Leslie Benson
- Pediatric Multiple Sclerosis and Related Disorders Program at Boston Children's Hospital, Boston, MA, USA
| | - Soe Mar
- Washington University in St. Louis, St. Louis, MO, USA
| | - Manu Goyal
- Washington University in St. Louis, St. Louis, MO, USA
| | - Teri Schreiner
- Rocky Mountain Multiple Sclerosis Center, Children's Hospital Colorado, University of Colorado Denver, Aurora, CO, USA
| | - Bianca Weinstock-Guttman
- Jacobs Pediatric Multiple Sclerosis Center, State University of New York at Buffalo, Buffalo, NY, USA
| | - Moses Rodriguez
- Mayo Clinic Pediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, MN, USA
| | - Jan-Mendelt Tillema
- Mayo Clinic Pediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, MN, USA
| | - Timothy Lotze
- The Blue Bird Circle Clinic for Multiple Sclerosis, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Greg Aaen
- Pediatric Multiple Sclerosis Center, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Mary Rensel
- Cleveland Clinic Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - John Rose
- Data Coordinating and Analysis Center, The University of Utah, Salt Lake City, UT, USA
| | - Tanuja Chitinis
- Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, MA, USA
| | - Allan George
- Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Leigh E Charvet
- Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Health, New York, NY, USA
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Ryerson LZ, Naismith RT, Krupp LB, Charvet LE, Liao S, Fisher E, de Moor C, Williams JR, Campbell N. No difference in radiologic outcomes for natalizumab patients treated with extended interval dosing compared with standard interval dosing: Real-world evidence from MS PATHS. Mult Scler Relat Disord 2022; 58:103480. [PMID: 35051898 DOI: 10.1016/j.msard.2021.103480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/24/2021] [Accepted: 12/31/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Extended interval dosing (EID; average dosing interval approximately every 6 weeks) of natalizumab is associated with significantly lower risk of progressive multifocal leukoencephalopathy than standard interval dosing (SID; every 4 weeks) in patients with relapsing-remitting multiple sclerosis (MS). Real-world studies, though limited, suggest that natalizumab effectiveness is generally maintained in patients who switch to EID after initiation of stable treatment with SID. MS PATHS (Multiple Sclerosis Partners Advancing Technology and Health Solutions) is a collaborative, multicenter learning health system that generates real-world clinical and MRI data using highly standardized acquisition protocols. We compared MRI outcomes in MS PATHS patients treated with natalizumab EID versus SID. We also compared MRI outcomes in patients treated with natalizumab (EID and/or SID) versus injectable MS platform therapy. METHODS Natalizumab infusion data from the TOUCH Prescribing Program database and MS PATHS MRI assessment data from seven US sites as of July 23, 2020, were used to identify patients with relapsing-remitting MS who had received natalizumab EID or SID in the interval between two MRI scans (an MRI segment). Patients who received injectable platform MS therapy between two MRI scans were also identified. MRI data were used to determine the incidence rate and odds of developing new or enlarging T2 lesions, annualized percentage change in T2 lesion volume (T2LV), and annualized percentage change in brain parenchymal fraction (BPF). MRI outcomes were compared for 1) natalizumab EID treatment versus natalizumab SID treatment, 2) natalizumab treatment (EID + SID) versus platform therapy, and 3) natalizumab EID versus platform therapy. Propensity score-based weighting or matching were used to balance covariates at the start of MRI segments for all comparisons. RESULTS The MRI outcomes observed with natalizumab EID treatment did not differ significantly from those observed with natalizumab SID treatment. The odds ratio for any new or enlarging T2 lesion was 1.07 (95% confidence interval [CI]: 0.93, 1.24; p = 0.355), and the rate ratio (95% CI) for new or enlarging T2 lesions was 1.62 (0.93, 2.82; p = 0.090). Differences (95% CI) between EID and SID patients in mean annualized percentage change in T2LV and BPF were 1.56% (-3.77%, 6.90%; p = 0.566) and -0.11% (-0.25%, -0.10%; p = 0.096), respectively. Conversely, when MRI outcomes in natalizumab and platform therapy patients were compared, there were significant differences favoring natalizumab in all assessments: the odds of any new or enlarging T2 lesion (odds ratio: 0.69 [95% CI: 0.64, 0.75]; p<0.001), the incidence rate of new or enlarging T2 lesions (rate ratio: 0.47 [95% CI: 0.37, 0.61]; p<0.001), annualized percentage change (decrease) in T2LV (difference: -3.68% [95% CI: -7.06%, -0.30%]; p = 0.033), and annualized percentage change (increase) in BPF (difference: 0.22% [95% CI: 0.16%, 0.29%]; p<0.001). Results of the subgroup comparison of natalizumab EID patients with platform therapy patients were similar to those of the overall-natalizumab-group-versus-platform-therapy comparison. CONCLUSIONS The results indicate that natalizumab EID and SID provide comparable real-world effectiveness on quantitative MRI metrics. These data further demonstrate that natalizumab EID can provide superior real-world effectiveness to injectable platform therapy on quantitative MRI metrics.
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Affiliation(s)
- Lana Zhovtis Ryerson
- New York University Langone Multiple Sclerosis Comprehensive Care Center, 240 East 38th Street, New York, NY 10016, USA.
| | - Robert T Naismith
- Department of Neurology, Washington University, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Lauren B Krupp
- New York University Langone Multiple Sclerosis Comprehensive Care Center, 240 East 38th Street, New York, NY 10016, USA; Perlmutter Cancer Center at NYU Langone Huntington Medical Group, 789 Park Ave, Huntington, NY 11743, USA
| | - Leigh E Charvet
- New York University Langone Multiple Sclerosis Comprehensive Care Center, 240 East 38th Street, New York, NY 10016, USA
| | - Shirley Liao
- Biogen, 225 Binney St., Cambridge, MA 02142, USA, at the time of this analysis
| | | | - Carl de Moor
- Biogen, 225 Binney St., Cambridge, MA 02142, USA
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Eilam-Stock T, George A, Lustberg M, Wolintz R, Krupp LB, Charvet LE. Telehealth transcranial direct current stimulation for recovery from Post-Acute Sequelae of SARS-CoV-2 (PASC). Brain Stimul 2021; 14:1520-1522. [PMID: 34655835 PMCID: PMC8514329 DOI: 10.1016/j.brs.2021.10.381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tehila Eilam-Stock
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Allan George
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Matthew Lustberg
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Robyn Wolintz
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Lauren B Krupp
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Leigh E Charvet
- Department of Neurology, New York University Langone Health, New York, NY, USA.
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Charvet L, George A, Cho H, Krupp LB, Dennis-Tiwary TA. Mobile Attention Bias Modification Training Is a Digital Health Solution for Managing Distress in Multiple Sclerosis: A Pilot Study in Pediatric Onset. Front Neurol 2021; 12:719090. [PMID: 34393986 PMCID: PMC8355356 DOI: 10.3389/fneur.2021.719090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Emotional health is important dimension of care for patients living with pediatric onset multiple sclerosis (POMS), but few options are available for stress and anxiety reduction. The high burden of interventions requiring regular in person and onsite visits for treatment are less feasible. Attention bias modification training (ABMT) is effective for anxiety reduction in adult and adolescent populations. We tested the feasibility and preliminary efficacy of ABMT delivered through a mobile gamified version as a digital emotional health tool for patients with POMS. Methods: Participants with POMS were consecutively recruited from the NYU Langone Pediatric MS Care Center and enrolled to complete a 1-month intervention with use of the Personal Zen ABMT app on their mobile personal device. Feasibility was evaluated by use of the 1-month intervention and efficacy was measured by changes in depression, anxiety, and affect. Results: A total n = 35 patients with POMS were enrolled in the study (Mage = 17.7, SD = 2.2 years, range 14–23). Feasibility criteria were met with 74% completing the full intervention time, and 100% of the sample completing at least 50% of targeted intervention use. Initial efficacy was found for a reduction in negative affect from baseline to intervention end [M = 22.88, SD = 9.95 vs. M = 19.56, SD = 7.37; t(33) = 2.47, p = 0.019]. Anxiety also significantly decreased from pre to post-intervention in adults [M = 11.82, SD = 9.90 vs. M = 7.29, SD = 7.17; t(16) = 3.88, p = 0.001] and youth [M = 51.14, SD = 19.66 vs. M = 40.86, SD = 27.48; t(13) = 3.17, p = 0.007]. Conclusion: Mobile ABMT with the Personal Zen app is a feasible and accessible digital emotional health tool for patients with POMS and may have broader application for managing distress across chronic neurological conditions.
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Affiliation(s)
- Leigh Charvet
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Allan George
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Hyein Cho
- Department of Psychology, The Graduate Center, The City University of New York, New York, NY, United States.,Department of Psychology, Hunter College, The City University of New York, New York, NY, United States
| | - Lauren B Krupp
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Tracy A Dennis-Tiwary
- Department of Psychology, The Graduate Center, The City University of New York, New York, NY, United States.,Department of Psychology, Hunter College, The City University of New York, New York, NY, United States
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Abstract
Pediatric-onset multiple sclerosis (POMS), representing approximately 5% of all MS cases, affects the central nervous system during its ongoing development. POMS is most commonly diagnosed during adolescence but can occur in younger children as well. For pediatric patients with MS, it is critical to manage the full impact of the disease and monitor for any effects on school and social functioning. Disease management includes not only disease-modifying therapies but also strategies to optimize wellbeing. We review the interventions with the highest evidence of ability to improve the disease course and quality of life in POMS. High levels of vitamin D and a diet low in saturated fat are associated with lower relapse rates. Exercise ameliorates fatigue and sleep. Behavioral strategies for sleep hygiene and mood regulation can also improve fatigue and perceived health. POMS management should be addressed holistically, including assessing overall symptom burden as well as the psychological and functional impact of the disease.
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Affiliation(s)
| | - Leigh E Charvet
- NYU Langone Pediatric Multiple Sclerosis Center, New York, NY, USA
| | - Lauren B Krupp
- NYU Langone Pediatric Multiple Sclerosis Center, New York, NY, USA
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10
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Ryerson LZ, Naismith RT, Krupp LB, Charvet LE, Su R, Fisher E, De Moor C, Williams JR, Campbell N. Aucune différence relevée en termes d’activité radiologique entre les patients traités par natalizumab en administration à intervalles prolongés (EID) par rapport à l’administration à intervalles standard (SID) dans MS PATHS. Rev Neurol (Paris) 2021. [DOI: 10.1016/j.neurol.2021.02.367] [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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Eilam-Stock T, Shaw MT, Sherman K, Krupp LB, Charvet LE. Remote administration of the symbol digit modalities test to individuals with multiple sclerosis is reliable: A short report. Mult Scler J Exp Transl Clin 2021; 7:2055217321994853. [PMID: 33643663 PMCID: PMC7890734 DOI: 10.1177/2055217321994853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background The Symbol Digit Modalities Test (SDMT) is the gold standard for cognitive screening in multiple sclerosis (MS). Objective Due to the recent COVID-19 pandemic and the increased need for virtual clinical visits, we examined the reliability of remote administration of the SDMT vs. standard in-person administration to individuals with MS. Methods Pearson’s correlation analysis was performed between SDMT scores on the in-person and remote administrations. Results For n = 132 participants, remote and in-person SDMT scores were strongly correlated (r = .80, p = .000). Conclusion Remote administration of the SDMT is a reliable cognitive screening approach in MS.
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Affiliation(s)
| | - Michael T Shaw
- Departmernt of Psychology, Binghamton University, Binghamton, USA
| | | | | | - Leigh E Charvet
- Department of Neurology, NYU Grossman School of Medicine, New York, USA
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12
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Eilam-Stock T, Shaw MT, Krupp LB, Charvet LE. Early neuropsychological markers of cognitive involvement in multiple sclerosis. J Neurol Sci 2021; 423:117349. [PMID: 33639421 DOI: 10.1016/j.jns.2021.117349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/05/2021] [Accepted: 02/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cognitive impairment due to multiple sclerosis (MS) is common and often limits occupational functioning, contributes to disability, and reduces quality of life. Early detection of cognitive involvement in MS is critical for treatment planning and intervention, and frequent, regular cognitive monitoring may provide insight into subtle changes in disease progression. OBJECTIVE To compare the sensitivity and specificity of clinical, computer-based and experimental measures to early cognitive involvement in MS. METHODS Cognitive functioning was compared in MS participants early in the disease course to matched healthy controls using conventional, computer-based and functional assessments: the Brief International Cognitive Assessment in MS (BICAMS); the computer-based Cogstate Brief Battery (CBB); the Attention Network Test-Interaction (ANT-I), including intra-individual variability; and the Test of Everyday Cognitive Ability (TECA), a functional measure of instrumental activities of daily living. RESULTS MS participants (n = 25, mean disease duration= 5.82 ± 3.65 years) and demographically matched healthy controls (n = 29) completed the cognitive assessments. The Cogstate measure of choice reaction time (AUC = 0.73, p = .004), intra-individual variability on the ANT-I (AUC = 0.79, p = .001), and TECA (AUC = 0.78, p = .001) scores were the most sensitive and specific markers of cognitive involvement in MS. CONCLUSIONS Brief, repeatable, computer-based measures of reaction time and variability detect early MS associated cognitive involvement.
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Affiliation(s)
- Tehila Eilam-Stock
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Michael T Shaw
- Departmernt of Psychology, Binghamton University, Binghamton, NY, United States
| | - Lauren B Krupp
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Leigh E Charvet
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States.
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13
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Eilam-Stock T, Best P, Sherman K, Shaw MT, Ventura J, Krupp LB, Charvet LE. An Interview-Based Assessment of the Experience of Cognitive Impairment in Multiple Sclerosis: The Cognitive Assessment Interview (CAI). Front Neurol 2021; 12:637895. [PMID: 33643211 PMCID: PMC7905222 DOI: 10.3389/fneur.2021.637895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Cognitive impairment is a common feature of multiple sclerosis (MS). A semi-structured interview, including informant input, can characterize the experience of individuals living with MS and cognitive involvement. Objective: We administered the Cognitive Assessment Interview (CAI), a patient- and informant-based semi-structured interview, to characterize the experience of cognitive impairments in those living with MS. Methods: Trained raters administered the CAI to a sample of MS participants and their informants enrolled for a trial of cognitive remediation. Cognitive impairments on the CAI were characterized and compared to those captured by neuropsychological and self-report measures. Results: A total of n = 109 MS participants (mean age = 50.3 ± 12.2) and their available informants (n = 71) were interviewed. Participants reported experiencing processing speed (90/106, 85%), working memory (87/109, 80%), and learning and memory (79/109, 72%) problems most commonly. CAI-based ratings were moderately correlated with a self-report measure (Multiple Sclerosis Neuropsychological Screening Questionnaire, rs = 0.52, p < 0.001) and only mildly correlated with objective neuropsychological measures specific to executive functions (rs = 0.21, p = 0.029). For those with informant interviews, ratings were overall consistent, suggesting that the CAI is valid even in cases in which an informant is unavailable and the interview is conducted with the patient alone (as is often the case in clinical and research settings). Conclusions: The CAI provides a semi-structured interview to characterize the experience of cognitive impairment in MS, with findings representing real-world functioning, adding valuable information to both self-report measures and neuropsychological assessment.
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Affiliation(s)
- Tehila Eilam-Stock
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Pamela Best
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Kathleen Sherman
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Michael T Shaw
- Department of Psychology, Binghamton University, Binghamton, NY, United States
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lauren B Krupp
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Leigh E Charvet
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
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14
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Parrotta E, Kister I, Charvet L, Sammarco C, Saha V, Charlson RE, Howard J, Gutman JM, Gottesman M, Abou-Fayssal N, Wolintz R, Keilson M, Fernandez-Carbonell C, Krupp LB, Zhovtis Ryerson L. COVID-19 outcomes in MS: Observational study of early experience from NYU Multiple Sclerosis Comprehensive Care Center. Neurol Neuroimmunol Neuroinflamm 2020; 7:e835. [PMID: 32646885 PMCID: PMC7357412 DOI: 10.1212/nxi.0000000000000835] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/12/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report outcomes on patients with multiple sclerosis (MS) and related disorders with coronavirus disease 2019 (COVID-19) illness. METHODS From March 16 to April 30, 2020, patients with MS or related disorders at NYU Langone MS Comprehensive Care Center were identified with laboratory-confirmed or suspected COVID-19. The diagnosis was established using a standardized questionnaire or by review of in-patient hospital records. RESULTS We identified 76 patients (55 with relapsing MS, of which 9 had pediatric onset; 17 with progressive MS; and 4 with related disorders). Thirty-seven underwent PCR testing and were confirmed positive. Of the entire group, 64 (84%) patients were on disease-modifying therapy (DMT) including anti-CD20 therapies (n = 34, 44.7%) and sphingosine-1-phosphate receptor modulators (n = 10, 13.5%). The most common COVID-19 symptoms were fever and cough, but 21.1% of patients had neurologic symptom recrudescence preceding or coinciding with the infection. A total of 18 (23.7%) were hospitalized; 8 (10.5%) had COVID-19 critical illness or related death. Features more common among those hospitalized or with critical illness or death were older age, presence of comorbidities, progressive disease, and a nonambulatory status. No DMT class was associated with an increased risk of hospitalization or fatal outcome. CONCLUSIONS Most patients with MS with COVID-19 do not require hospitalization despite being on DMTs. Factors associated with critical illness were similar to the general at-risk patient population. DMT use did not emerge as a predictor of poor COVID-19 outcome in this preliminary sample.
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Affiliation(s)
- Erica Parrotta
- From the NYU Langone Multiple Sclerosis Comprehensive Care Centers (E.P., I.K., L.C., C.S., V.S., R.E.C., J.H., J.M.G., M.G., N.A.-F., R.W., M.K., L.B.K., L.Z.R.), New York, NY; and Cohen's Children Medical Center Northwell Health (C.F.-C.), Lake Success, NY
| | - Ilya Kister
- From the NYU Langone Multiple Sclerosis Comprehensive Care Centers (E.P., I.K., L.C., C.S., V.S., R.E.C., J.H., J.M.G., M.G., N.A.-F., R.W., M.K., L.B.K., L.Z.R.), New York, NY; and Cohen's Children Medical Center Northwell Health (C.F.-C.), Lake Success, NY
| | - Leigh Charvet
- From the NYU Langone Multiple Sclerosis Comprehensive Care Centers (E.P., I.K., L.C., C.S., V.S., R.E.C., J.H., J.M.G., M.G., N.A.-F., R.W., M.K., L.B.K., L.Z.R.), New York, NY; and Cohen's Children Medical Center Northwell Health (C.F.-C.), Lake Success, NY
| | - Carrie Sammarco
- From the NYU Langone Multiple Sclerosis Comprehensive Care Centers (E.P., I.K., L.C., C.S., V.S., R.E.C., J.H., J.M.G., M.G., N.A.-F., R.W., M.K., L.B.K., L.Z.R.), New York, NY; and Cohen's Children Medical Center Northwell Health (C.F.-C.), Lake Success, NY
| | - Valerie Saha
- From the NYU Langone Multiple Sclerosis Comprehensive Care Centers (E.P., I.K., L.C., C.S., V.S., R.E.C., J.H., J.M.G., M.G., N.A.-F., R.W., M.K., L.B.K., L.Z.R.), New York, NY; and Cohen's Children Medical Center Northwell Health (C.F.-C.), Lake Success, NY
| | - Robert Erik Charlson
- From the NYU Langone Multiple Sclerosis Comprehensive Care Centers (E.P., I.K., L.C., C.S., V.S., R.E.C., J.H., J.M.G., M.G., N.A.-F., R.W., M.K., L.B.K., L.Z.R.), New York, NY; and Cohen's Children Medical Center Northwell Health (C.F.-C.), Lake Success, NY
| | - Jonathan Howard
- From the NYU Langone Multiple Sclerosis Comprehensive Care Centers (E.P., I.K., L.C., C.S., V.S., R.E.C., J.H., J.M.G., M.G., N.A.-F., R.W., M.K., L.B.K., L.Z.R.), New York, NY; and Cohen's Children Medical Center Northwell Health (C.F.-C.), Lake Success, NY
| | - Josef Maxwell Gutman
- From the NYU Langone Multiple Sclerosis Comprehensive Care Centers (E.P., I.K., L.C., C.S., V.S., R.E.C., J.H., J.M.G., M.G., N.A.-F., R.W., M.K., L.B.K., L.Z.R.), New York, NY; and Cohen's Children Medical Center Northwell Health (C.F.-C.), Lake Success, NY
| | - Malcolm Gottesman
- From the NYU Langone Multiple Sclerosis Comprehensive Care Centers (E.P., I.K., L.C., C.S., V.S., R.E.C., J.H., J.M.G., M.G., N.A.-F., R.W., M.K., L.B.K., L.Z.R.), New York, NY; and Cohen's Children Medical Center Northwell Health (C.F.-C.), Lake Success, NY
| | - Nada Abou-Fayssal
- From the NYU Langone Multiple Sclerosis Comprehensive Care Centers (E.P., I.K., L.C., C.S., V.S., R.E.C., J.H., J.M.G., M.G., N.A.-F., R.W., M.K., L.B.K., L.Z.R.), New York, NY; and Cohen's Children Medical Center Northwell Health (C.F.-C.), Lake Success, NY
| | - Robyn Wolintz
- From the NYU Langone Multiple Sclerosis Comprehensive Care Centers (E.P., I.K., L.C., C.S., V.S., R.E.C., J.H., J.M.G., M.G., N.A.-F., R.W., M.K., L.B.K., L.Z.R.), New York, NY; and Cohen's Children Medical Center Northwell Health (C.F.-C.), Lake Success, NY
| | - Marshall Keilson
- From the NYU Langone Multiple Sclerosis Comprehensive Care Centers (E.P., I.K., L.C., C.S., V.S., R.E.C., J.H., J.M.G., M.G., N.A.-F., R.W., M.K., L.B.K., L.Z.R.), New York, NY; and Cohen's Children Medical Center Northwell Health (C.F.-C.), Lake Success, NY
| | - Cristina Fernandez-Carbonell
- From the NYU Langone Multiple Sclerosis Comprehensive Care Centers (E.P., I.K., L.C., C.S., V.S., R.E.C., J.H., J.M.G., M.G., N.A.-F., R.W., M.K., L.B.K., L.Z.R.), New York, NY; and Cohen's Children Medical Center Northwell Health (C.F.-C.), Lake Success, NY
| | - Lauren B Krupp
- From the NYU Langone Multiple Sclerosis Comprehensive Care Centers (E.P., I.K., L.C., C.S., V.S., R.E.C., J.H., J.M.G., M.G., N.A.-F., R.W., M.K., L.B.K., L.Z.R.), New York, NY; and Cohen's Children Medical Center Northwell Health (C.F.-C.), Lake Success, NY
| | - Lana Zhovtis Ryerson
- From the NYU Langone Multiple Sclerosis Comprehensive Care Centers (E.P., I.K., L.C., C.S., V.S., R.E.C., J.H., J.M.G., M.G., N.A.-F., R.W., M.K., L.B.K., L.Z.R.), New York, NY; and Cohen's Children Medical Center Northwell Health (C.F.-C.), Lake Success, NY.
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15
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Affiliation(s)
- Lauren B Krupp
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
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16
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Pilloni G, Choi C, Coghe G, Cocco E, Krupp LB, Pau M, Charvet LE. Gait and Functional Mobility in Multiple Sclerosis: Immediate Effects of Transcranial Direct Current Stimulation (tDCS) Paired With Aerobic Exercise. Front Neurol 2020; 11:310. [PMID: 32431658 PMCID: PMC7214839 DOI: 10.3389/fneur.2020.00310] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/31/2020] [Indexed: 12/22/2022] Open
Abstract
Walking impairments are a debilitating feature of multiple sclerosis (MS) because of the direct interference with daily activity. The management of motor symptoms in those with MS remains a therapeutic challenge. Transcranial direct current stimulation (tDCS) is a type of non-invasive brain stimulation that is emerging as a promising rehabilitative tool but requires further characterization to determine its optimal therapeutic use. In this randomized, sham-controlled proof-of-concept study, we tested the immediate effects of a single tDCS session on walking and functional mobility in those with MS. Seventeen participants with MS completed one 20-min session of aerobic exercise, randomly assigned to be paired with either active (2.5 mA, n = 9) or sham (n = 8) tDCS over the primary motor cortex (M1). The groups (active vs. sham) were matched according to gender (50% vs. 60% F), age (52.1 ± 12.85 vs. 54.2 ± 8.5 years), and level of neurological disability (median Expanded Disability Status Scale score 5.5 vs. 5). Gait speed on the 10-m walk test and the Timed Up and Go (TUG) time were measured by a wearable inertial sensor immediately before and following the 20-min session, with changes compared between conditions and time. There were no significant differences in gait speed or TUG time changes following the session in the full sample or between the active vs. sham groups. These findings suggest that a single session of anodal tDCS over M1 is not sufficient to affect walking and functional mobility in those with MS. Instead, behavioral motor response of tDCS is likely to be cumulative, and the effects of multiple tDCS sessions require further study. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03658668.
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Affiliation(s)
- Giuseppina Pilloni
- NYU Langone Health, Department of Neurology, New York, NY, United States.,Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Claire Choi
- SUNY Downstate, Department of Medicine, New York, NY, United States
| | - Giancarlo Coghe
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Lauren B Krupp
- NYU Langone Health, Department of Neurology, New York, NY, United States
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Leigh E Charvet
- NYU Langone Health, Department of Neurology, New York, NY, United States
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17
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Wallach AI, Waltz M, Casper TC, Aaen G, Belman A, Benson L, Chitnis T, Gorman M, Graves J, Harris Y, Lotze TE, Mar S, Moodley M, Ness JM, Rensel M, Rodriguez M, Rose JW, Schreiner T, Tillema JM, Waubant E, Weinstock-Guttman B, Charvet LE, Krupp LB. Cognitive processing speed in pediatric-onset multiple sclerosis: Baseline characteristics of impairment and prediction of decline. Mult Scler 2019; 26:1938-1947. [PMID: 31775571 DOI: 10.1177/1352458519891984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cognitive impairment occurs in approximately one-third of pediatric-onset multiple sclerosis (POMS) patients. The Symbol Digit Modalities Test (SDMT), a widely used cognitive screen in adults, has yet to be incorporated early into the standard care of POMS. OBJECTIVE To screen for cognitive impairment early in the course of POMS and analyze predictive factors. METHODS Of the 955 POMS or clinically isolated syndrome (CIS) patients prospectively assessed from March 2014 to July 2018, 500 POMS and 116 CIS patients met inclusion criteria (disease onset before the age of 18, one or more SDMTs, and 8 years or older at the time of testing). Those with relapse were analyzed separately from those who were relapse-free. RESULTS At initial assessment, the mean (interquartile range (IQR)) age at symptom onset was 13.5 years (12.0, 15.9) and the mean (±SD) disease duration was 3.0 ± 2.9 years. Impaired processing speed occurred in 23.4% of POMS and in 16.4% of CIS. On serial testing (n = 383, mean follow-up: 1.8 years), 14.1% had clinically meaningful decline predicted by older age of multiple sclerosis (MS) onset and male gender. Disease relapse or steroid use led to transient worsening on the SDMT. CONCLUSION Early in the disease, some POMS and CIS patients are at risk for cognitive impairment and subsequent decline.
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Affiliation(s)
- Asya I Wallach
- Pediatric Multiple Sclerosis Center, Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Michael Waltz
- Pediatrics, The University of Utah, Salt Lake City, UT, USA
| | | | - Gregory Aaen
- Pediatric Multiple Sclerosis Center, Loma Linda University, Loma Linda, CA, USA
| | - Anita Belman
- Pediatric Multiple Sclerosis Center, Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Leslie Benson
- Partners Multiple Sclerosis Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Partners Multiple Sclerosis Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Jennifer Graves
- Pediatric MS Center, Neurology, University of California, San Diego, San Diego, CA, USA
| | - Yolanda Harris
- Center for Pediatric-Onset Demyelinating Disease, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy E Lotze
- The Blue Bird Circle Clinic for Multiple Sclerosis, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Soe Mar
- Pediatric MS and other Demyelinating Disease Center, Washington University in St Louis, St. Louis, MO, USA
| | - Manikum Moodley
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Jayne M Ness
- Center for Pediatric-Onset Demyelinating Disease, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mary Rensel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Moses Rodriguez
- Pediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, MN, USA
| | - John W Rose
- Pediatrics, The University of Utah, Salt Lake City, UT, USA
| | - Teri Schreiner
- Department of Neurology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | | | - Emmanuelle Waubant
- Regional Pediatric MS Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bianca Weinstock-Guttman
- The Pediatric MS Center, Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, NY, USA
| | - Leigh E Charvet
- Pediatric Multiple Sclerosis Center, Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Lauren B Krupp
- Pediatric Multiple Sclerosis Center, Department of Neurology, NYU Langone Medical Center, New York, NY, USA
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Krupp LB, Vieira MC, Toledano H, Peneva D, Druyts E, Wu P, Boulos FC. A Review of Available Treatments, Clinical Evidence, and Guidelines for Diagnosis and Treatment of Pediatric Multiple Sclerosis in the United States. J Child Neurol 2019; 34:612-620. [PMID: 31234708 DOI: 10.1177/0883073819855592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pediatric multiple sclerosis is associated with challenges in prompt diagnosis and uncertainty regarding optimal treatment. This review aimed to identify treatment guidelines or consensus statements for pediatric patients with multiple sclerosis, US Food and Drug Administration (FDA)-approved treatment options for pediatric multiple sclerosis, and any randomized controlled trials and observational studies examining available pharmacologic treatments in the pediatric multiple sclerosis population. Literature searches were performed in MEDLINE (1946-2016), EMBASE (1974-2016), and the Cochrane Central Register of Controlled Trials to identify treatment guidelines or consensus statements, pediatric multiple sclerosis treatment approvals, and randomized controlled trials and observation studies that examine the safety and effectiveness of available disease-modifying therapies. Only 3 consensus statements provided recommendations for pharmacologic treatments for children, all 3 published before the most recent revisions of the pediatric multiple sclerosis diagnostic guidelines. Despite the changes to the clinical landscape of pediatric multiple sclerosis with the introduction of diagnostic guidelines, fingolimod is the only FDA-approved treatment for pediatric multiple sclerosis in the United States. The effectiveness and safety of other disease-modifying therapies suggested by consensus statements have been reported in relatively small prospective and retrospective observational studies. Clinical evidence from a recently completed randomized controlled trial and future global registries can inform treatment decisions for the pediatric multiple sclerosis population.
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Affiliation(s)
| | | | - Haley Toledano
- 2 Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Desi Peneva
- 3 Precision Health Economics, Los Angeles, CA, USA
| | | | - Ping Wu
- 4 Precision Xtract, Vancouver, BC, USA
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Affiliation(s)
- Lauren B Krupp
- Department of Neurology, Multiple Sclerosis Comprehensive Care Center, NYU Langone, New York, New York
| | - Leigh E Charvet
- Department of Neurology, Multiple Sclerosis Comprehensive Care Center, NYU Langone, New York, New York
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Rhodes JK, Schindler D, Rao SM, Venegas F, Bruzik ET, Gabel W, Williams JR, Phillips GA, Mullen CC, Freiburger JL, Mourany L, Reece C, Miller DM, Bethoux F, Bermel RA, Krupp LB, Mowry EM, Alberts J, Rudick RA. Multiple Sclerosis Performance Test: Technical Development and Usability. Adv Ther 2019; 36:1741-1755. [PMID: 31054035 PMCID: PMC6824297 DOI: 10.1007/s12325-019-00958-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Indexed: 11/28/2022]
Abstract
Introduction In the clinic, the assessment of patients with multiple sclerosis (MS) is typically qualitative and non-standardized. Objectives To describe the MS Performance Test (MSPT), an iPad Air® 2 (Apple, Cupertino, CA, USA)-based neurological assessment platform allowing patients to input relevant information without the aid of a medical technician, creating a longitudinal, clinically meaningful, digital medical record. To report results from human factor (HF) and usability studies, and the initial large-scale implementation in a practice setting. Methods The HF study examined use-error patterns in small groups of MS patients and healthy controls (n = 14), the usability study assessed the effectiveness of patient interaction with the tool by patients with a range of MS disability (n = 60) in a clinical setting, and the implementation study deployed the MSPT across a diverse population of patients (n = 1000) in a large MS center for routine clinical care. Results MSPT assessments were completed by all users in the HF study; minor changes to design were recommended. In the usability study, 73% of patients with MS completed the MSPT, with an average administration time of 32 min; 85% described their experience with the tool as satisfactory. In the initial implementation for routine care, 84% of patients with MS completed the MSPT, with an average administration time of 28 min. Conclusion Patients with MS with varying disability levels completed the MSPT with minimal or no supervision, resulting in comprehensive, efficient, standardized, quantitative, clinically meaningful data collection as part of routine medical care, thus allowing for large-scale, real-world evidence generation. Funding Biogen. Trial Registration NCT02664324. Electronic supplementary material The online version of this article (10.1007/s12325-019-00958-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - David Schindler
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
- Qr8 Health, Boston, MA, USA
| | - Stephen M Rao
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | | | | | | | | | | | - Jaime L Freiburger
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lyla Mourany
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Christine Reece
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Deborah M Miller
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Francois Bethoux
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robert A Bermel
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lauren B Krupp
- New York University Langone Medical Center, New York, NY, USA
| | | | - Jay Alberts
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Peyronnet B, Krupp LB, Reynolds WS, Gamé X, Amarenco G, Cornu JN, Ryerson LZ, Sammarco CL, Howard JE, Charlson RW, Dmochowski RR, Brucker BM. Nocturia in Patients With Multiple Sclerosis. Rev Urol 2019; 21:63-73. [PMID: 31768133 PMCID: PMC6864911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The prevalence of nocturia in patients with multiple sclerosis (MS) is high, ranging from 20.9% to 48.8% in this population. Its underlying pathophysiology is complex and different from the non-neurogenic population. In the MS population, the pathophysiology may involve neurogenic lower urinary tract dysfunction (NLUTD) such as detrusor overactivity (NDO), detrusor-sphincter dyssynergia, or detrusor underactivity resulting in reduced bladder capacity. Nocturnal polyuria is also a significant contributor to the pathogenesis of nocturia in MS patients and may be the result of specific mechanisms such as nocturnal hypertension through autonomic cardiovascular dysfunction or lack of diurnal variation of antidiuretic hormone production (ADH) due to demyelinating lesions of the spinal cord. Nocturia might be particularly burdensome in MS patients by contributing to fatigue, a common and highly debilitating symptom in this population. There is likely a complex and multidirectional relationship between nocturia, other sleep disorders, and fatigue in the MS population that has yet to be explored. The assessment of nocturia in MS should rely upon a thorough history and physical examination. Urinalysis should be done to rule out urinary tract infection, a frequency-volume chart might help elucidating the underlying mechanisms, and post-void residual volume may be of interest to screen for urinary retention that could be asymptomatic in MS patients. Other tests such as urodynamics or polysomnography are indicated in selected patients. The treatment should be tailored to the underlying cause. The first steps involve behavioral interventions and treatment of cofactors. When possible, the predominant mechanism should be addressed first. In case of predominant NDO, antimuscarinics and beta-3 agonists should be offered as a first-line treatment and intradetrusor injections of botulinum toxin as a second-line treatment. In cases of incomplete bladder emptying, clean-intermittent self-catheterization is often used as part of multiple other interventions. In cases of nocturnal polyuria, desmopressin may be offered, inclusive of use of newer formulations (desmopressin acetate nasal spray, desmopressin orally disintegrated tablet) in countries where they are approved.
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Affiliation(s)
- Benoit Peyronnet
- Department of Urology, University of Rennes Rennes, France
- Department of Urology, New York University New York, NY
| | - Lauren B Krupp
- Department of Neurology, New York University New York, NY
| | - W Stuart Reynolds
- Department of Urology, Vanderbilt University Medical Center Nashville, TN
| | - Xavier Gamé
- Department of Urology, University of Toulouse Toulouse, France
| | | | | | | | | | | | | | - Roger R Dmochowski
- Department of Urology, Vanderbilt University Medical Center Nashville, TN
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Bartlett E, Shaw M, Schwarz C, Feinberg C, DeLorenzo C, Krupp LB, Charvet LE. Brief Computer-Based Information Processing Measures are Linked to White Matter Integrity in Pediatric-Onset Multiple Sclerosis. J Neuroimaging 2018; 29:140-150. [DOI: 10.1111/jon.12566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Elizabeth Bartlett
- Department of Biomedical Engineering; Stony Brook University; Stony Brook NY
| | - Michael Shaw
- Department of Neurology, New York University Langone Medical Center; NYU Langone Health; New York NY
| | - Colleen Schwarz
- Department of Nursing; Stony Brook University; Stony Brook NY
| | - Charles Feinberg
- Department of Neurology, New York University Langone Medical Center; NYU Langone Health; New York NY
| | - Christine DeLorenzo
- Department of Biomedical Engineering; Stony Brook University; Stony Brook NY
- Department of Psychiatry; Stony Brook University; Stony Brook NY
| | - Lauren B. Krupp
- Department of Neurology, New York University Langone Medical Center; NYU Langone Health; New York NY
| | - Leigh E. Charvet
- Department of Neurology, New York University Langone Medical Center; NYU Langone Health; New York NY
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Charvet LE, Shaw MT, Sherman K, Haas S, Krupp LB. Timed instrumental activities of daily living in multiple sclerosis: The test of everyday cognitive ability (TECA). Mult Scler Relat Disord 2018; 23:69-73. [DOI: 10.1016/j.msard.2018.05.001] [Citation(s) in RCA: 2] [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] [Received: 12/28/2017] [Revised: 02/16/2018] [Accepted: 05/02/2018] [Indexed: 10/17/2022]
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Charvet LE, Yang J, Shaw MT, Sherman K, Haider L, Xu J, Krupp LB. Correction: Cognitive function in multiple sclerosis improves with telerehabilitation: Results from a randomized controlled trial. PLoS One 2018; 13:e0192317. [PMID: 29381774 PMCID: PMC5790288 DOI: 10.1371/journal.pone.0192317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Friedman JH, Beck JC, Chou KL, Clark G, Fagundes CP, Goetz CG, Herlofson K, Kluger B, Krupp LB, Lang AE, Lou JS, Marsh L, Newbould A, Weintraub D. Erratum: Corrigendum: Fatigue in Parkinson’s disease: report from a multidisciplinary symposium. NPJ Parkinsons Dis 2017. [DOI: 10.1038/npjparkd.2017.1] [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: 11/09/2022] Open
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26
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Charvet LE, Dobbs B, Shaw MT, Bikson M, Datta A, Krupp LB. Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: Results from a randomized, sham-controlled trial. Mult Scler 2017; 24:1760-1769. [PMID: 28937310 DOI: 10.1177/1352458517732842] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fatigue is a common and debilitating feature of multiple sclerosis (MS) that remains without reliably effective treatment. Transcranial direct current stimulation (tDCS) is a promising option for fatigue reduction. We developed a telerehabilitation protocol that delivers tDCS to participants at home using specially designed equipment and real-time supervision (remotely supervised transcranial direct current stimulation (RS-tDCS)). OBJECTIVE To evaluate whether tDCS can reduce fatigue in individuals with MS. METHODS Dorsolateral prefrontal cortex left anodal tDCS was administered using a RS-tDCS protocol, paired with 20 minutes of cognitive training. Here, two studies are considered. Study 1 delivered 10 open-label tDCS treatments (1.5 mA; n = 15) compared to a cognitive training only condition ( n = 20). Study 2 was a randomized trial of active (2.0 mA, n = 15) or sham ( n = 12) delivered for 20 sessions. Fatigue was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS)-Fatigue Short Form. RESULTS AND CONCLUSION In Study 1, there was modest fatigue reduction in the active group (-2.5 ± 7.4 vs -0.2 ± 5.3, p = 0.30, Cohen's d = -0.35). However, in Study 2 there was statistically significant reduction for the active group (-5.6 ± 8.9 vs 0.9 ± 1.9, p = 0.02, Cohen's d = -0.71). tDCS is a potential treatment for MS-related fatigue.
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Affiliation(s)
- Leigh E Charvet
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Bryan Dobbs
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Michael T Shaw
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City University of New York, New York, NY, USA
| | | | - Lauren B Krupp
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
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Shaw MT, Pawlak NO, Frontario A, Sherman K, Krupp LB, Charvet LE. Adverse Childhood Experiences Are Linked to Age of Onset and Reading Recognition in Multiple Sclerosis. Front Neurol 2017. [PMID: 28626445 PMCID: PMC5454080 DOI: 10.3389/fneur.2017.00242] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Adverse childhood experiences (ACEs) exert a psychological and physiological toll that increases risk of chronic conditions, poorer social functioning, and cognitive impairment in adulthood. Objective To investigate the relationship between childhood adversity and clinical disease features in multiple sclerosis (MS). Methods Sixty-seven participants with MS completed the ACE assessment and neuropsychological assessments as part of a larger clinical trial of cognitive remediation. Results Adverse childhood experience scores, a measure of exposure to adverse events in childhood, significantly predicted age of MS onset (r = –0.30, p = 0.04). ACEs were also linked to reading recognition (a proxy for premorbid IQ) (r = –0.25, p = 0.04). ACE scores were not related to age, current disability, or current level of cognitive impairment measured by the Symbol Digit Modalities Test (SDMT). Conclusion Childhood adversity may increase the likelihood of earlier age of onset and poorer estimated premorbid IQ in MS.
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Affiliation(s)
- Michael T Shaw
- Department of Neurology, NYU Langone Medical Center, New York, NY, United States
| | - Natalie O Pawlak
- Department of Neurology, NYU Langone Medical Center, New York, NY, United States
| | - Ariana Frontario
- Lake Erie College of Osteopathic Medicine, Erie, PA, United States
| | - Kathleen Sherman
- Department of Neurology, NYU Langone Medical Center, New York, NY, United States
| | - Lauren B Krupp
- Department of Neurology, NYU Langone Medical Center, New York, NY, United States
| | - Leigh E Charvet
- Department of Neurology, NYU Langone Medical Center, New York, NY, United States
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Krupp LB, Rintell D, Charvet LE, Milazzo M, Wassmer E. Pediatric multiple sclerosis: Perspectives from adolescents and their families. Neurology 2017; 87:S4-7. [PMID: 27572860 DOI: 10.1212/wnl.0000000000002879] [Citation(s) in RCA: 11] [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: 08/19/2015] [Accepted: 01/27/2016] [Indexed: 11/15/2022] Open
Abstract
Supporting young people with pediatric multiple sclerosis can be challenging for families and health care providers. Adolescents may be more resilient than adults in reaction to the diagnosis but can have more difficulty planning for their futures. Appropriate, sensitive, and focused health provision should include consideration of the perspective of both the patient and parents. Multidisciplinary management strategies are often effective, as are referrals to programs that enhance individual and family coping and strengthen a sense of community.
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Affiliation(s)
- Lauren B Krupp
- From the Pediatric MS Center at NYU Langone (L.B.K., L.E.C.), New York, NY; Partners Pediatric MS Center (D.R.), Massachusetts General Hospital, Boston; Department of Nursing (M.M.), Stony Brook Children's Hospital, NY; and Birmingham Children's Hospital (E.W.), Birmingham, UK.
| | - David Rintell
- From the Pediatric MS Center at NYU Langone (L.B.K., L.E.C.), New York, NY; Partners Pediatric MS Center (D.R.), Massachusetts General Hospital, Boston; Department of Nursing (M.M.), Stony Brook Children's Hospital, NY; and Birmingham Children's Hospital (E.W.), Birmingham, UK
| | - Leigh E Charvet
- From the Pediatric MS Center at NYU Langone (L.B.K., L.E.C.), New York, NY; Partners Pediatric MS Center (D.R.), Massachusetts General Hospital, Boston; Department of Nursing (M.M.), Stony Brook Children's Hospital, NY; and Birmingham Children's Hospital (E.W.), Birmingham, UK
| | - Maria Milazzo
- From the Pediatric MS Center at NYU Langone (L.B.K., L.E.C.), New York, NY; Partners Pediatric MS Center (D.R.), Massachusetts General Hospital, Boston; Department of Nursing (M.M.), Stony Brook Children's Hospital, NY; and Birmingham Children's Hospital (E.W.), Birmingham, UK
| | - Evangeline Wassmer
- From the Pediatric MS Center at NYU Langone (L.B.K., L.E.C.), New York, NY; Partners Pediatric MS Center (D.R.), Massachusetts General Hospital, Boston; Department of Nursing (M.M.), Stony Brook Children's Hospital, NY; and Birmingham Children's Hospital (E.W.), Birmingham, UK
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29
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Charvet LE, Yang J, Shaw MT, Sherman K, Haider L, Xu J, Krupp LB. Cognitive function in multiple sclerosis improves with telerehabilitation: Results from a randomized controlled trial. PLoS One 2017; 12:e0177177. [PMID: 28493924 PMCID: PMC5426671 DOI: 10.1371/journal.pone.0177177] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/21/2017] [Indexed: 11/19/2022] Open
Abstract
Cognitive impairment affects more than half of all individuals living with multiple sclerosis (MS). We hypothesized that training at home with an adaptive online cognitive training program would have greater cognitive benefit than ordinary computer games in cognitively-impaired adults with MS. This was a double-blind, randomized, active-placebo-controlled trial. Participants with MS were recruited through Stony Brook Medicine and randomly assigned to either the adaptive cognitive remediation (ACR) program or active control of ordinary computer games for 60 hours over 12 weeks. Training was remotely-supervised and delivered through a study-provided laptop computer. A computer generated, blocked stratification table prepared by statistician provided the randomization schedule and condition was assigned by a study technician. The primary outcome, administered by study psychometrician, was measured by change in a neuropsychological composite measure from baseline to study end. An intent-to-treat analysis was employed and missing primary outcome values were imputed via Markov Chain Monte Carlo method. Participants in the ACR (n = 74) vs. active control (n = 61) training program had significantly greater improvement in the primary outcome of cognitive functioning (mean change in composite z score±SD: 0·25±0·45 vs. 0·09±0·37, p = 0·03, estimated difference = 0·16 with 95% CI: 0·02–0·30), despite greater training time in the active control condition (mean±SD:56·9 ± 34·6 vs. 37·7 ±23 ·8 hours played, p = 0·006). This study provides Class I evidence that adaptive, computer-based cognitive remediation accessed from home can improve cognitive functioning in MS. This telerehabilitation approach allowed for rapid recruitment and high compliance, and can be readily applied to other neurological conditions associated with cognitive dysfunction. Trial Registration: Clinicaltrials.gov NCT02141386
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Affiliation(s)
- Leigh E. Charvet
- Department of Neurology, NYU School of Medicine, New York, New York, United States of America
- * E-mail:
| | - Jie Yang
- Department of Family, Population, and Preventive Medicine, Stony Brook Medicine, New York, New York, United States of America
| | - Michael T. Shaw
- Department of Neurology, NYU School of Medicine, New York, New York, United States of America
| | - Kathleen Sherman
- Department of Neurology, NYU School of Medicine, New York, New York, United States of America
| | - Lamia Haider
- Taub Institute, Columbia University Medical Center, New York, New York, United States of America
| | - Jianjin Xu
- Department of Applied Mathematics and Statistics, Stony Brook Medicine, Stony Brook, New York, United States of America
| | - Lauren B. Krupp
- Department of Neurology, NYU School of Medicine, New York, New York, United States of America
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Charvet LE, Shaw M, Frontario A, Langdon D, Krupp LB. Cognitive impairment in pediatric-onset multiple sclerosis is detected by the Brief International Cognitive Assessment for Multiple Sclerosis and computerized cognitive testing. Mult Scler 2017; 24:512-519. [PMID: 28322606 DOI: 10.1177/1352458517701588] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cognitive impairment is a common and troubling feature of pediatric-onset multiple sclerosis (POMS). Brief cognitive assessment in the outpatient setting can identify and longitudinally monitor cognitive involvement so that early intervention is possible. OBJECTIVES The goal of this study was to measure the sensitivity of two cognitive assessment approaches that are brief, repeatable, and suitable for clinical practice and for multicenter investigation. METHODS Participants with POMS ( n = 69) were consecutively evaluated as part of outpatient neurologic visits and compared to healthy control participants (HC, n = 66) using the Brief International Cognitive Assessment for MS (BICAMS) approach and timed information processing measures from Cogstate, a computer-based assessment. RESULTS There was strong agreement in the detection rate of impairment between both assessments, with 26% for the BICAMS and 27% for Cogstate. Two of the Cogstate tasks were the most sensitive individual measures. CONCLUSION Both the BICAMS and Cogstate timed processing measures offer practical, sensitive, and standardized approaches for cognitive screening assessment in POMS.
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Affiliation(s)
- Leigh E Charvet
- Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Medical Center, School of Medicine, New York University, New York, NY, USA
| | - Michael Shaw
- Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Medical Center, School of Medicine, New York University, New York, NY, USA
| | - Ariana Frontario
- Lake Erie College of Osteopathic Medicine, Pennsylvania, PA, USA
| | | | - Lauren B Krupp
- Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU Langone Medical Center, School of Medicine, New York University, New York, NY, USA
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Wassmer E, Chitnis T, Pohl D, Amato MP, Banwell B, Ghezzi A, Hintzen RQ, Krupp LB, Makhani N, Rostásy K, Tardieu M, Tenembaum S, Waldman A, Waubant E, Kornberg AJ. International Pediatric MS Study Group Global Members Symposium report. Neurology 2016; 87:S110-6. [PMID: 27572855 PMCID: PMC10688073 DOI: 10.1212/wnl.0000000000002880] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 03/28/2016] [Indexed: 11/15/2022] Open
Abstract
The International Pediatric Multiple Sclerosis Study Group held its inaugural educational program, "The World of Pediatric MS: A Global Update," in September 2014 to discuss advances and challenges in the diagnosis and management of pediatric multiple sclerosis (MS) and other neuroinflammatory CNS disorders. Highlights included a discussion on the revised diagnostic criteria, which enable the differentiation of MS, acute disseminated encephalomyelitis, neuromyelitis optica, and other neuroinflammatory disorders. While these criteria currently identify clinical and MRI features for a particular diagnosis, advances in biomarkers may prove to be useful in the future. An update was also provided on environmental factors associated with pediatric MS risk and possibly outcomes, notably vitamin D deficiency. However, optimal vitamin D intake and its role in altering MS course in children have yet to be established. Regarding MS outcomes, our understanding of the cognitive consequences of early-onset MS has grown. However, further work is needed to define the course of cognitive function and its long-term outcome in diverse patient samples and to develop strategies for effective cognitive rehabilitation specifically tailored to children and adolescents. Finally, treatment strategies were discussed, including a need to consider additional drug treatment options and paradigms (escalation vs induction), although treatment should be tailored to the individual child. Of critical importance, clinical trials of newer MS agents in children are required. Although our understanding of childhood MS has improved, further research is needed to have a positive impact for children and their families.
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Affiliation(s)
- Evangeline Wassmer
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia.
| | - Tanuja Chitnis
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Daniela Pohl
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Maria Pia Amato
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Brenda Banwell
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Angelo Ghezzi
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Rogier Q Hintzen
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Lauren B Krupp
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Naila Makhani
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Kevin Rostásy
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Marc Tardieu
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Silvia Tenembaum
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Amy Waldman
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Emmanuelle Waubant
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
| | - Andrew J Kornberg
- From the Department of Neurology (E. Wassmer), Birmingham Children's Hospital, UK; Partners Pediatric MS Center (T.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department NEUROFARBA (M.P.A.), Section Neurosciences, University of Florence, Italy; Division of Neurology (A.W.), Perelman School of Medicine (B.B.), The Children's Hospital of Philadelphia, University of Pennsylvania; Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy; Department of Neurology (R.Q.H.), MS Centre ErasMS, Erasmus MC, Rotterdam, the Netherlands; Lourie Center for Pediatric MS (L.B.K.), Stony Brook Children's, Stony Brook University, NY; Departments of Pediatrics and Neurology (N.M.), Yale University School of Medicine, New Haven, CT; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, University Witten/Herdecke, Germany; National Reference Center for Inflammatory Diseases of the Brain (M.T.), Hôpitaux Universitaires Paris-Sud, University Paris-Sud, France; Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina; Pediatric MS Center (E. Waubant), UCSF Benioff Children's Hospital, and Neurology Department, UCSF, San Francisco, CA; and the Department of Neurology (A.J.K.), Royal Children's Hospital, Parkville, Australia
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Tardieu M, Banwell B, Wolinsky JS, Pohl D, Krupp LB. Consensus definitions for pediatric MS and other demyelinating disorders in childhood: Table. Neurology 2016; 87:S8-S11. [DOI: 10.1212/wnl.0000000000002877] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 03/01/2016] [Indexed: 11/15/2022] Open
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Amato MP, Krupp LB, Charvet LE, Penner I, Till C. Pediatric multiple sclerosis. Neurology 2016; 87:S82-7. [DOI: 10.1212/wnl.0000000000002883] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 03/01/2016] [Indexed: 11/15/2022] Open
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Charvet L, Cersosimo B, Schwarz C, Belman A, Krupp LB. Behavioral Symptoms in Pediatric Multiple Sclerosis: Relation to Fatigue and Cognitive Impairment. J Child Neurol 2016; 31:1062-7. [PMID: 26961266 PMCID: PMC4925200 DOI: 10.1177/0883073816636227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 02/05/2016] [Indexed: 11/16/2022]
Abstract
The emotional and behavioral problems associated with pediatric multiple sclerosis remain unclear. Participants with pediatric multiple sclerosis or clinically isolated syndrome (n = 140; ages 5-18 years) completed self- and parent ratings using the Behavioral Assessment System for Children, Second Edition, neurologic exam, the Fatigue Severity Scale, and neuropsychological assessment. Mean self- and parent-ratings on the Behavioral Assessment System for Children, Second Edition, were in the typical range across all scales. However, 33.1% indicated a clinically significant problem on a least 1 scale. Although the type of clinical problems varied across participants, attention problems, somatization, and anxiety were found to be most common. Disease features including duration, age of onset, neurologic disability, and fatigue did not distinguish those with and without clinical problems. However, cognitive functioning significantly predicted the presence of a clinical problem (P =02). Pediatric multiple sclerosis is associated with a range of nonspecific emotional and behavioral clinical problems, occurring more frequently in those patients with cognitive involvement.
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Affiliation(s)
- Leigh Charvet
- New York University MS Comprehensive Care Center, New York, NY, USA
| | - Bianca Cersosimo
- Department of Neurology, Stony Brook Medicine, Stony Brook, NY, USA
| | - Colleen Schwarz
- New York University MS Comprehensive Care Center, New York, NY, USA Department of Neurology, Stony Brook Medicine, Stony Brook, NY, USA
| | - Anita Belman
- New York University MS Comprehensive Care Center, New York, NY, USA Department of Neurology, Stony Brook Medicine, Stony Brook, NY, USA
| | - Lauren B Krupp
- New York University MS Comprehensive Care Center, New York, NY, USA Department of Neurology, Stony Brook Medicine, Stony Brook, NY, USA
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Belman AL, Krupp LB, Olsen CS, Rose JW, Aaen G, Benson L, Chitnis T, Gorman M, Graves J, Harris Y, Lotze T, Ness J, Rodriguez M, Tillema JM, Waubant E, Weinstock-Guttman B, Casper TC. Characteristics of Children and Adolescents With Multiple Sclerosis. Pediatrics 2016; 138:peds.2016-0120. [PMID: 27358474 PMCID: PMC4925083 DOI: 10.1542/peds.2016-0120] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [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] [Accepted: 04/18/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe the demographic and clinical characteristics of pediatric multiple sclerosis (MS) in the United States. METHODS This prospective observational study included children and adolescents with MS. Cases were evaluated across 9 geographically diverse sites as part of the US Network of Pediatric MS Centers. RESULTS A total of 490 children and adolescents (324 girls, 166 boys) were enrolled; 28% developed symptoms before 12 years of age. The proportion of girls increased with age from 58% (<12 years) to 70% (≥12 years). Race and ethnicity as self-identified were: white, 67%; African American, 21%; and non-Hispanic, 70%. Most (94%) of the cases were born in the United States, and 39% had 1 or both foreign-born parents. Fifty-five percent of cases had a monofocal presentation; 31% had a prodrome (most frequently infectious), most often among those aged <12 years (P < .001). Children aged <12 years presented more commonly with encephalopathy and coordination problems (P < .001). Sensory symptoms were more frequently reported by older children (ie, those aged ≥12 years) (P < .001); 78% of girls had MS onset postmenarche. The initial Expanded Disability Status Scale score for the group was <3.0, and the annualized relapse rate was 0.647 for the first 2 years. Interval from symptom onset to diagnosis and from diagnosis to initiation of disease-modifying therapy was longer among those <12 years of age. CONCLUSIONS Pediatric MS in the United States is characterized by racial and ethnic diversity, a high proportion of children with foreign-born parents, and differences in clinical features and timing of treatment among those <12 years of age compared with older children.
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Affiliation(s)
- Anita L. Belman
- Department of Neurology, Stony Brook University, Stony Brook, New York;,NYU Langone Multiple Sclerosis Comprehensive Care Center, New York, New York
| | - Lauren B. Krupp
- NYU Langone Multiple Sclerosis Comprehensive Care Center, New York, New York
| | | | - John W. Rose
- Neurology, University of Utah, Salt Lake City, Utah
| | - Greg Aaen
- Pediatric Multiple Sclerosis Center, Loma Linda University Children’s Hospital, Loma Linda, California
| | - Leslie Benson
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Tanuja Chitnis
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women’s Hospital, Brookline, Massachusetts
| | - Mark Gorman
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Jennifer Graves
- Department of Neurology, University of California at San Francisco, San Francisco, California
| | - Yolander Harris
- University of Alabama Center for Pediatric Onset Demyelinating Disease, Children’s Hospital of Alabama, Birmingham, Alabama
| | - Tim Lotze
- Blue Bird Circle Multiple Sclerosis Center, Baylor College of Medicine, Houston, Texas
| | - Jayne Ness
- University of Alabama Center for Pediatric Onset Demyelinating Disease, Children’s Hospital of Alabama, Birmingham, Alabama
| | - Moses Rodriguez
- Mayo Clinic's Pediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, Minnesota
| | - Jan-Mendelt Tillema
- Mayo Clinic's Pediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, Minnesota
| | - Emmanuelle Waubant
- Department of Neurology, University of California at San Francisco, San Francisco, California;,Department of Pediatrics, Benioff Children’s Hospital, San Francisco, California; and
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Friedman JH, Beck JC, Chou KL, Clark G, Fagundes CP, Goetz CG, Herlofson K, Kluger B, Krupp LB, Lang AE, Lou JS, Marsh L, Newbould A, Weintraub D. Fatigue in Parkinson's disease: report from a mutidisciplinary symposium. NPJ Parkinsons Dis 2016; 2:15025. [PMID: 27239558 PMCID: PMC4883681 DOI: 10.1038/npjparkd.2015.25] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 09/28/2015] [Accepted: 10/25/2015] [Indexed: 12/12/2022] Open
Abstract
Fatigue is a severe problem for many people living with Parkinson's disease (PD). Best estimates suggest that more than 50% of patients experience this debilitating symptom. Little is known about its etiology or treatment, making the understanding of fatigue a true unmet need. As part of the Parkinson's Disease Foundation Community Choice Research Program, patients, caregivers, and scientists attended a symposium on fatigue on 16 and 17 October 2014. We present a summary of that meeting, reviewing what is known about the diagnosis and treatment of fatigue, its physiology, and what we might learn from multiple sclerosis (MS), depression, and cancer-disorders in which fatigue figures prominently too. We conclude with focused recommendations to enhance our understanding and treatment of this prominent problem in PD.
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Affiliation(s)
- Joseph H Friedman
- Movement Disorders Program, Butler Hospital, Province, RI, USA
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - James C Beck
- Parkinson’s Disease Foundation, New York, NY, USA
| | - Kelvin L Chou
- Department of Neurology, University of Michigan Health System, Ann Arbor, MI, USA
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Gracia Clark
- Parkinson’s Disease Foundation, New York, NY, USA
| | - Christopher P Fagundes
- Department of Psychology, Rice University, M.D. Anderson Cancer Center, Houston, TX, USA
- Department of Health Disparities, Houston, TX, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Karen Herlofson
- Department of Neurology, Sorlandet Hospital, Arendal, Norway
| | - Benzi Kluger
- Department of Neurology, University of Colorado Anschutz Campus, Aurora, CO, USA
| | - Lauren B Krupp
- Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Anthony E Lang
- Toronto Western Hospital, Morton and Gloria Shulman Movement Disorders Clinic and Edmond J Safra Program in Parkinson’s Disease, Toronto, ON, Canada
| | - Jao-Shin Lou
- University of North Dakota School of Medicine and Health Services, Sanford Health, Grand Forks, ND, USA
| | - Laura Marsh
- Department of Psychiatry, Baylor College of Medicine, Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | | | - Daniel Weintraub
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Graves JS, Barcellos LF, Shao X, Noble J, Mowry EM, Quach H, Belman A, Casper TC, Krupp LB, Waubant E. Genetic predictors of relapse rate in pediatric MS. Mult Scler 2016; 22:1528-1535. [PMID: 26769066 DOI: 10.1177/1352458515624269] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/25/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Genetic ancestry, sex, and individual alleles have been associated with multiple sclerosis (MS) susceptibility. OBJECTIVE To determine whether established risk factors for disease onset are associated with relapse rate in pediatric MS. METHODS Whole-genome genotyping was performed for 181 MS or high-risk clinically isolated syndrome patients from two pediatric MS centers. Relapses and disease-modifying therapies were recorded as part of continued follow-up. Participants were characterized for 25-hydroxyvitamin D serum status. Ancestral estimates (STRUCTURE v2.3.1), human leukocyte antigen (HLA)-DRB1*15 carrier status (direct sequencing), sex, and a genetic risk score (GRS) of 110 non-HLA susceptibility single-nucleotide polymorphisms (SNPs) were evaluated for association with relapse rate with Cox and negative binomial regression models. RESULTS Over 622 patient-years, 408 relapses were captured. Girls had greater relapse rate than boys (incident rate ratio (IRR) = 1.40, 95% confidence interval (CI) = 1.04-1.87, p = 0.026). Participants were genetically diverse; ~40% (N = 75) had <50% European ancestry. HLA-DRB1*15 status modified the association of vitamin D status (pixn = 0.022) with relapse rate (per 10 ng/mL, in DRB1*15+ hazard ratio (HR) = 0.72, 95% CI = 0.58-0.88, p = 0.002; in DRB1*15- HR = 0.96, 95% CI = 0.83-1.12, p = 0.64). Neither European ancestry nor GRS was associated with relapse rate. CONCLUSION We demonstrate that HLA-DRB1*15 modifies the association of vitamin D status with relapse rate. Our findings emphasize the need to pursue disease-modifying effects of MS genes in the context of environmental factors.
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Affiliation(s)
| | - Lisa F Barcellos
- Genetic Epidemiology and Genomics Lab, School of Public Health, and California Institute for Quantitative Biosciences, University of California-Berkeley, Berkeley, CA, USA
| | - Xiaorong Shao
- Genetic Epidemiology and Genomics Lab, School of Public Health, and California Institute for Quantitative Biosciences, University of California-Berkeley, Berkeley, CA, USA
| | - Janelle Noble
- Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - Ellen M Mowry
- The Multiple Sclerosis Center, Johns Hopkins University, Baltimore, MD, USA
| | - Hong Quach
- Genetic Epidemiology and Genomics Lab, School of Public Health, and California Institute for Quantitative Biosciences, University of California-Berkeley, Berkeley, CA, USA
| | - Anita Belman
- National Pediatric Multiple Sclerosis Center, Stony Brook, NY, USA
| | - T Charles Casper
- Data Coordinating and Analysis Center, University of Utah, Salt Lake City, UT, USA
| | - Lauren B Krupp
- National Pediatric Multiple Sclerosis Center, Stony Brook, NY, USA
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Charvet LE, Shaw MT, Haider L, Melville P, Krupp LB. Remotely-delivered cognitive remediation in multiple sclerosis (MS): protocol and results from a pilot study. Mult Scler J Exp Transl Clin 2015; 1:2055217315609629. [PMID: 28607707 PMCID: PMC5433334 DOI: 10.1177/2055217315609629] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/08/2015] [Indexed: 11/23/2022] Open
Abstract
Background Cognitive impairment represents a critical unmet treatment need in multiple sclerosis (MS). Cognitive remediation is promising but traditionally requires multiple clinic visits to access treatment. Computer-based programs provide remote access to intensive and individually-adapted training. Objective Our goal was to develop a protocol for remotely-supervised cognitive remediation that enables individuals with MS to participate from home while maintaining the standards for clinical study. Methods MS participants (n = 20) were randomized to either an active cognitive remediation program (n = 11) or a control condition of ordinary computer games (n = 9). Participants were provided study laptops to complete training for five days per week over 12 weeks, targeting a total of 30 hours. Treatment effects were measured with composite change via scores of a repeated neuropsychological battery. Results Compliance was high with an average of 25.0 hours of program use (80% of the target) and did not differ between conditions (25.7 vs. 24.2 mean hours, p = 0.80). The active vs. control participants significantly improved in both the cognitive measures (mean composite z-score change of 0.46 ± 0.59 improvement vs. −0.14 ± 0.48 decline, p = 0.02) and motor tasks (mean composite z-score change of 0.40 ± 0.71improvement vs. −0.64 ± 0.73 decline, p = 0.005). Conclusions Remotely-supervised cognitive remediation is feasible for clinical study with potential for meaningful benefit in MS.
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Affiliation(s)
| | | | | | | | - L B Krupp
- Department of Neurology, Stony Brook Medicine, Stony Brook, NY, USA
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Charvet LE, Beekman R, Amadiume N, Belman AL, Krupp LB. The Symbol Digit Modalities Test is an effective cognitive screen in pediatric onset multiple sclerosis (MS). J Neurol Sci 2014; 341:79-84. [DOI: 10.1016/j.jns.2014.04.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/08/2014] [Accepted: 04/05/2014] [Indexed: 11/29/2022]
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Charvet LE, O'Donnell EH, Belman AL, Chitnis T, Ness JM, Parrish J, Patterson M, Rodriguez M, Waubant E, Weinstock-Guttman B, Krupp LB. Longitudinal evaluation of cognitive functioning in pediatric multiple sclerosis: report from the US Pediatric Multiple Sclerosis Network. Mult Scler 2014; 20:1502-10. [PMID: 24687807 DOI: 10.1177/1352458514527862] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Approximately one-third of those with pediatric-onset multiple sclerosis (MS) experience cognitive impairment. Less is known concerning their change in cognitive functioning over time. OBJECTIVE Changes in cognitive function over time were measured in the largest pediatric cohort to date through the US Network of Pediatric MS Centers. METHODS A total of 67 individuals with pediatric MS (n=62) or clinically isolated syndrome (CIS, n=5), ranging from 8-17 years of age (mean age ± standard deviation (SD)=14.37 ± 2.02) completed initial and follow-up neuropsychological testing after an average of 1.64 ± 0.63 years apart. The nine tests administered measure general intellect, attention and working memory, verbal memory, visuomotor integration, language, and executive functioning. RESULTS Rate of impairment (having one-third or more scores in the impaired range) was 37% at baseline and 33% at follow-up. Tests commonly impaired were measures of visuomotor integration, speeded processing, and attention. Most tested did not decline over two years. There was no clear pattern of change on any specific measure. CONCLUSION Findings suggest that, over short timeframes, stable or even improved performances on measures of cognitive ability can occur. Pediatric MS may instead prevent expected age-related cognitive gains.
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Affiliation(s)
- L E Charvet
- Lourie Center for Pediatric Multiple Sclerosis (MS), Stony Brook Medicine, USA
| | - E H O'Donnell
- Partners Pediatric MS Center, Massachusetts General Hospital for Children, USA
| | - A L Belman
- Lourie Center for Pediatric Multiple Sclerosis (MS), Stony Brook Medicine, USA
| | - T Chitnis
- Partners Pediatric MS Center, Massachusetts General Hospital for Children, USA
| | - J M Ness
- Center for Pediatric-Onset Demyelinating Disease, Children's Hospital of Alabama, University of Alabama at Birmingham USA
| | - J Parrish
- Pediatric MS Center, University at Buffalo, USA
| | | | | | - E Waubant
- Regional Pediatric MS Center, University of California at San Francisco, USA
| | | | - L B Krupp
- Stony Brook Medicine Lourie Center for Pediatric MS, Department of Neurology, Stony Brook, NY, USA
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Abstract
BACKGROUND Pediatric-onset multiple sclerosis (MS) patients represent a subpopulation who are diagnosed during the course of development. Social cognitive deficits have recently been recognized in adults with MS. It is critical to identify whether these youngest patients with the disorder are also at risk. OBJECTIVE To determine whether pediatric-onset MS is associated with social cognitive deficits. METHODS Consecutively-recruited participants with pediatric-onset MS were compared to a group of age- and gender-matched healthy controls on Theory of Mind (ToM) task performance. Tasks measured facial affect recognition (Reading the Mind in the Eyes Test), detecting social faux pas (Faux Pas Test), and understanding the perspective of another (False Beliefs Task). RESULTS Twenty-eight (28) pediatric-onset MS participants (median age 17 years) and 32 healthy controls (median age 16 years) completed the study. The MS participants performed worse than controls on all three ToM tasks: Reading the Mind in the Eyes Test (p = 0.008), the Faux Pas Test (p = 0.009), and the False Beliefs Task (p = 0.06). While more MS than control participants were impaired on a measure of information processing speed (the Symbol Digit Modalities Test; 38% versus 6%), it did not account for the differences in ToM performance. CONCLUSIONS Social cognition may represent an area of cognitive functioning affected by MS in the pediatric-onset population. These processes are especially important to study in younger patients as they may have long range implications for social adjustment, employment, and well-being.
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Affiliation(s)
- L E Charvet
- Lourie Center for Pediatric Multiple Sclerosis, Department of Neurology, Stony Brook Medicine, USA
| | - R E Cleary
- Lourie Center for Pediatric Multiple Sclerosis, Department of Neurology, Stony Brook Medicine, USA
| | - K Vazquez
- Lourie Center for Pediatric Multiple Sclerosis, Department of Neurology, Stony Brook Medicine, USA
| | - A L Belman
- Lourie Center for Pediatric Multiple Sclerosis, Department of Neurology, Stony Brook Medicine, USA
| | - L B Krupp
- Lourie Center for Pediatric Multiple Sclerosis, Department of Neurology, Stony Brook Medicine, USA
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Tenembaum SN, Banwell B, Pohl D, Krupp LB, Boyko A, Meinel M, Lehr L, Rocak S, Cantogno EVD, Moraga MS, Ghezzi A. Subcutaneous interferon Beta-1a in pediatric multiple sclerosis: a retrospective study. J Child Neurol 2013; 28:849-56. [PMID: 23666046 DOI: 10.1177/0883073813488828] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To expand current knowledge, we examined the safety and tolerability of subcutaneous interferon β-1a in patients with pediatric-onset multiple sclerosis. Records from 307 patients who had received at least 1 injection of subcutaneous interferon β-1a for demyelinating events when aged younger than 18 years were reviewed. Overall, 168 (54.7%) patients had at least 1 prespecified medical event related to or under close monitoring with subcutaneous interferon β-1a or specific to pediatric patients, 184 (59.9%) had nonserious medical events related to treatment or of unknown causality, and 12 (3.9%) had serious medical events irrespective of causality. The most common laboratory abnormalities were increased alanine (74/195; 37.9%) and aspartate aminotransferase levels (59/194; 30.4%). Annualized relapse rates were 1.79 before treatment and 0.47 during treatment. In conclusion, adult doses of subcutaneous interferon β-1a (44 and 22 μg, 3 times weekly) were well tolerated in pediatric patients and were associated with reduced relapse rates.
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Affiliation(s)
- Silvia N Tenembaum
- Hospital de Pediatría S.A.M.I.C. Prof Juan P Garrahan, Buenos Aires, Argentina.
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Vingara LK, Yu HJ, Wagshul ME, Serafin D, Christodoulou C, Pelczer I, Krupp LB, Maletić-Savatić M. Metabolomic approach to human brain spectroscopy identifies associations between clinical features and the frontal lobe metabolome in multiple sclerosis. Neuroimage 2013; 82:586-94. [PMID: 23751863 DOI: 10.1016/j.neuroimage.2013.05.125] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 05/27/2013] [Accepted: 05/29/2013] [Indexed: 11/26/2022] Open
Abstract
Proton magnetic resonance spectroscopy ((1)H-MRS) is capable of noninvasively detecting metabolic changes that occur in the brain tissue in vivo. Its clinical utility has been limited so far, however, by analytic methods that focus on independently evaluated metabolites and require prior knowledge about which metabolites to examine. Here, we applied advanced computational methodologies from the field of metabolomics, specifically partial least squares discriminant analysis and orthogonal partial least squares, to in vivo (1)H-MRS from frontal lobe white matter of 27 patients with relapsing-remitting multiple sclerosis (RRMS) and 14 healthy controls. We chose RRMS, a chronic demyelinating disorder of the central nervous system, because its complex pathology and variable disease course make the need for reliable biomarkers of disease progression more pressing. We show that in vivo MRS data, when analyzed by multivariate statistical methods, can provide reliable, distinct profiles of MRS-detectable metabolites in different patient populations. Specifically, we find that brain tissue in RRMS patients deviates significantly in its metabolic profile from that of healthy controls, even though it appears normal by standard MRI techniques. We also identify, using statistical means, the metabolic signatures of certain clinical features common in RRMS, such as disability score, cognitive impairments, and response to stress. This approach to human in vivo MRS data should promote understanding of the specific metabolic changes accompanying disease pathogenesis, and could provide biomarkers of disease progression that would be useful in clinical trials.
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Affiliation(s)
- Lisa K Vingara
- Department of Chemistry, Princeton University, Princeton, NJ 08540, USA
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Krupp LB, Tardieu M, Amato MP, Banwell B, Chitnis T, Dale RC, Ghezzi A, Hintzen R, Kornberg A, Pohl D, Rostasy K, Tenembaum S, Wassmer E. International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions. Mult Scler 2013; 19:1261-7. [PMID: 23572237 DOI: 10.1177/1352458513484547] [Citation(s) in RCA: 685] [Impact Index Per Article: 62.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There has been tremendous growth in research in pediatric multiple sclerosis (MS) and immune mediated central nervous system demyelinating disorders since operational definitions for these conditions were first proposed in 2007. Further, the International Pediatric Multiple Sclerosis Study Group (IPMSSG), which proposed the criteria, has expanded substantially in membership and in its international scope. OBJECTIVE The purpose of this review is to revise the 2007 definitions in order to incorporate advances in delineating the clinical and neuroradiologic features of these disorders. METHODS Through a consensus process, in which input was sought from the 150 members of the Study Group, criteria were drafted, revised and finalized. Final approval was sought through a web survey. RESULTS Revised criteria are proposed for pediatric acute disseminated encephalomyelitis, pediatric clinically isolated syndrome, pediatric neuromyelitis optica and pediatric MS. These criteria were approved by 93% or more of the 56 Study Group members who responded to the final survey. CONCLUSIONS These definitions are proposed for clinical and research purposes. Their utility will depend on the outcomes of their application in prospective research.
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Affiliation(s)
- Lauren B Krupp
- Lourie Center for Pediatric MS. Stony Brook University Medical Center, USA.
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Abstract
Fatigue is commonly reported in many neurologic illnesses, including multiple sclerosis, Parkinson disease, myasthenia gravis, traumatic brain injury, and stroke. Fatigue contributes substantially to decrements in quality of life and disability in these illnesses. Despite the clear impact of fatigue as a disabling symptom, our understanding of fatigue pathophysiology is limited and current treatment options rarely lead to meaningful improvements in fatigue. Progress continues to be hampered by issues related to terminology and assessment. In this article, we propose a unified taxonomy and a novel assessment approach to addressing distinct aspects of fatigue and fatigability in clinical and research settings. This taxonomy is based on our current knowledge of the pathophysiology and phenomenology of fatigue and fatigability. Application of our approach indicates that the assessment and reporting of fatigue can be clarified and improved by utilizing this taxonomy and creating measures to address distinct aspects of fatigue and fatigability. We review the strengths and weaknesses of several common measures of fatigue and suggest, based on our model, that many research questions may be better addressed by using multiple measures. We also provide examples of how to apply and validate the taxonomy and suggest directions for future research.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, University of Colorado Denver, Aurora, USA.
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Chitnis T, Tardieu M, Amato MP, Banwell B, Bar-Or A, Ghezzi A, Kornberg A, Krupp LB, Pohl D, Rostasy K, Tenembaum S, Waubant E, Wassmer E. International Pediatric MS Study Group Clinical Trials Summit: meeting report. Neurology 2013; 80:1161-8. [PMID: 23509048 PMCID: PMC3662305 DOI: 10.1212/wnl.0b013e318288694e] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 12/10/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Pediatric studies for new biological agents are mandated by recent legislation, necessitating careful thought to evaluation of emerging multiple sclerosis (MS) therapies in children with MS. Challenges include a small patient population, the lack of prior randomized clinical trials, and ethical concerns. The goal of this meeting was to assess areas of consensus regarding clinical trial design and outcome measures among academic experts involved in pediatric MS care and research. METHODS The Steering Committee of the International Pediatric MS Study Group identified key focus areas for discussion. A total of 69 meeting attendees were assembled, including 35 academic experts. Regulatory and pharmaceutical representatives also attended, and provided input, which informed academic expert consensus decisions. RESULTS The academic experts agreed that clinical trials were necessary in pediatric MS to obtain pharmacokinetic, safety and efficacy data, and regulatory approval allowing for greater medication access. The academic experts agreed that relapse was an appropriate primary outcome measure for phase III pediatric trials. An international standardized cognitive battery was identified. The pros and cons of various trial designs were discussed. Guidelines surrounding MRI studies, pharmacokinetics, pharmacodynamics, and registries were developed. The academic experts agreed that given the limited subject pool, a stepwise approach to the launch of clinical trials for the most promising medications is necessary in order to ensure study completion. Alternative approaches could result in unethical exposure of patients to trial conditions without gaining knowledge. CONCLUSION Consensus points for conduct of clinical trials in the rare disease pediatric MS were identified amongst a panel of academic experts, informed by regulatory and industry stakeholders.
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Affiliation(s)
- Tanuja Chitnis
- Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, MA, USA.
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Julian L, Serafin D, Charvet L, Ackerson J, Benedict R, Braaten E, Brown T, O’Donnell E, Parrish J, Preston T, Zaccariello M, Belman A, Chitnis T, Gorman M, Ness J, Patterson M, Rodriguez M, Waubant E, Weinstock-Guttman B, Yeh A, Krupp LB. Cognitive impairment occurs in children and adolescents with multiple sclerosis: results from a United States network. J Child Neurol 2013; 28:102-7. [PMID: 23155206 PMCID: PMC3652651 DOI: 10.1177/0883073812464816] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the largest sample studied to date, we measured cognitive functioning in children and adolescents with pediatric multiple sclerosis (n = 187) as well as those with clinically isolated syndrome (n = 44). Participants were consecutively enrolled from six United States Pediatric Multiple Sclerosis Centers of Excellence. Participants had a mean of 14.8 ± 2.6 years of age and an average disease duration of 1.9 ± 2.2 years. A total of 65 (35%) children with multiple sclerosis and 8 (18%) with clinically isolated syndrome met criteria for cognitive impairment. The most frequent areas involved were fine motor coordination (54%), visuomotor integration (50%), and speeded information processing (35%). A diagnosis of multiple sclerosis (odds ratio = 3.60, confidence interval = 1.07, 12.36, P = .04) and overall neurologic disability (odds ratio = 1.47, confidence interval = 1.10, 2.10, P = .03) were the only independent predictors of cognitive impairment. Cognitive impairment may occur early in these patients, and prompt recognition is critical for their care.
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Affiliation(s)
- Laura Julian
- Department of Neuropsychology, University of California San Francisco, San Francisco, CA, USA
| | - Dana Serafin
- Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Leigh Charvet
- Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Joseph Ackerson
- Department of Psychiatry and behavioral Neurobiology, University of Alabama, Birmingham, AL, USA
| | - Ralph Benedict
- Department of Neurology, Jacobs Neurological Institute, State University of New York, Buffalo, NY, USA
| | - Ellen Braaten
- Department of Psychology, Massachusetts General Hospital, Boston, MA, USA
| | - Tanya Brown
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Ellen O’Donnell
- Department of Psychology, Massachusetts General Hospital, Boston, MA, USA
| | - Joy Parrish
- Department of Neuropsychology, Jacobs Neurological Institute, State University of New York, Buffalo, NY, USA
| | - Thomas Preston
- Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | | | - Anita Belman
- Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Tanuja Chitnis
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Mark Gorman
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jayne Ness
- Department of Neurology, University of Alabama, Birmingham, AL, USA
| | - Marc Patterson
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Emmanuelle Waubant
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs Neurological Institute, State University of New York, Buffalo, NY, USA
| | - Ann Yeh
- Department of Neurology, Jacobs Neurological Institute, State University of New York, Buffalo, NY, USA
| | - Lauren B. Krupp
- Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA
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MacAllister WS, Christodoulou C, Milazzo M, Preston TE, Serafin D, Krupp LB, Harder L. Pediatric Multiple Sclerosis: What we know and where are we headed? Child Neuropsychol 2013; 19:1-22. [DOI: 10.1080/09297049.2011.639758] [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] [Indexed: 10/28/2022]
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