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Rocca MA, Valsasina P, Romanò F, Tedone N, Amato MP, Brichetto G, Boccia VD, Chataway J, Chiaravalloti ND, Cutter G, Dalgas U, DeLuca J, Farrell RA, Feys P, Freeman J, Inglese M, Meza C, Motl RW, Salter A, Sandroff BM, Feinstein A, Filippi M. Cognitive rehabilitation effects on grey matter volume and Go-NoGo activity in progressive multiple sclerosis: results from the CogEx trial. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333460. [PMID: 38754979 DOI: 10.1136/jnnp-2024-333460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Research on cognitive rehabilitation (CR) and aerobic exercise (EX) to improve cognition in progressive multiple sclerosis (PMS) remains limited. CogEx trial investigated the effectiveness of CR and EX in PMS: here, we present MRI substudy volumetric and task-related functional MRI (fMRI) findings. METHODS Participants were randomised to: 'CR plus EX', 'CR plus sham EX (EX-S)', 'EX plus sham CR (CR-S)' and 'CR-S plus EX-S' and attended 12-week intervention. All subjects performed physical/cognitive assessments at baseline, week 12 and 6 months post intervention (month 9). All MRI substudy participants underwent volumetric MRI and fMRI (Go-NoGo task). RESULTS 104 PMS enrolled at four sites participated in the CogEx MRI substudy; 84 (81%) had valid volumetric MRI and valid fMRI. Week 12/month 9 cognitive performances did not differ among interventions; however, 25-62% of the patients showed Symbol Digit Modalities Test improvements. Normalised cortical grey matter volume (NcGMV) changes at week 12 versus baseline were heterogeneous among interventions (p=0.05); this was mainly driven by increased NcGMV in 'CR plus EX-S' (p=0.02). Groups performing CR (ie, 'CR plus EX' and 'CR plus EX-S') exhibited increased NcGMV over time, especially in the frontal (p=0.01), parietal (p=0.04) and temporal (p=0.04) lobes, while those performing CR-S exhibited NcGMV decrease (p=0.008). In CR groups, increased NcGMV (r=0.36, p=0.01) at week 12 versus baseline correlated with increased California Verbal Learning Test (CVLT)-II scores. 'CR plus EX-S' patients exhibited Go-NoGo activity increase (p<0.05, corrected) at week 12 versus baseline in bilateral insula. CONCLUSIONS In PMS, CR modulated grey matter (GM) volume and insular activity. The association of GM and CVLT-II changes suggests GM plasticity contributes to cognitive improvements. TRIAL REGISTRATION NUMBER NCT03679468.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Romanò
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicolò Tedone
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Vincenzo Daniele Boccia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Rachel A Farrell
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Peter Feys
- REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- University MS Center, Hasselt University, Pelt, Belgium
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, Devon, UK
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, Illinois, USA
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Brian M Sandroff
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milan, Italy
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2
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Zanghì A, Borriello G, Bonavita S, Fantozzi R, Signoriello E, Barone S, Abbadessa G, Cellerino M, Ziccone V, Miele G, Lus G, Valentino P, Bucello S, Inglese M, Centonze D, Avolio C, D'Amico E. Ocrelizumab and ofatumumab comparison: an Italian real-world propensity score matched study. J Neurol 2024:10.1007/s00415-024-12360-x. [PMID: 38704488 DOI: 10.1007/s00415-024-12360-x] [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: 01/15/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The management of Multiple Sclerosis (MS) has undergone transformative evolution with the introduction of high-efficacy disease-modifying therapies (DMTs), specifically anti-CD20 monoclonal antibodies, such as ocrelizumab (OCR) and ofatumumab (OFA). MATERIALS AND METHODS This is an independent retrospective cohort study in Relapsing MS (RMS) patients followed at eight Italian MS centers who initiated treatment with OCR or OFA in the participating centers and with at least 12 months on therapy. A generalized linear regression model inverse probability of treatment weight (IPTW) PS-adjusted was performed to evaluate the relationship between annualized relapse rate (ARR) and treatment groups. No evidence of disease activity-NEDA-3 at 12-month score was also collected. Safety profile of the investigated DMTs was recorded. RESULTS A total cohort of 396 RMS patients fulfilled the required criteria and were enrolled in the study. Out of them, 216 had a prescription of OCR and 180 of OFA. The mean follow-up was 13.2 ± 1.9 months. The estimated means for ARR did not show differences between the two groups, 0.059 for patients on OCR and 0.038 for patients on OFA (p = 0.185). The generalized regression model IPTW PS-adjusted did not reveal differences between patients on OCR and OFA (ExpBOFA 0.974, 95%CI 934-1.015, p = 0.207). NEDA-3 at 12 months was experienced by 199(92.1%) patients on OCR and 170(94.4%) patients on OFA (p = 0.368). Generally, both therapies exhibit good tolerability. CONCLUSIONS The treatment with OCR and OFA resulted in comparable control of disease activity with good safety profile. Our results need further validation in larger multicentre studies with long-term follow-up.
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Affiliation(s)
- Aurora Zanghì
- Department of Medical and Surgical Sciences, University of Foggia, 71122, Foggia, Italy
| | | | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Elisabetta Signoriello
- Second Division of Neurology, Department of Clinical and Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefania Barone
- Azienda Ospedaliera Universitaria "Mater Domini", Catanzaro, Italy
| | - Gianmarco Abbadessa
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Vanessa Ziccone
- Centro Sclerosi Multipla, UOSD Neurologia, ASP8 SR, P.O. Muscatello, Augusta, Italy
| | - Giuseppina Miele
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giacomo Lus
- Second Division of Neurology, Department of Clinical and Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paola Valentino
- Azienda Ospedaliera Universitaria "Mater Domini", Catanzaro, Italy
| | - Sebastiano Bucello
- Centro Sclerosi Multipla, UOSD Neurologia, ASP8 SR, P.O. Muscatello, Augusta, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Diego Centonze
- IRCCS Neuromed, Pozzilli, Italy
- Department of System Medicine, Tor Vergata University, 00133, Rome, Italy
| | - Carlo Avolio
- Department of Medical and Surgical Sciences, University of Foggia, 71122, Foggia, Italy
| | - Emanuele D'Amico
- Department of Medical and Surgical Sciences, University of Foggia, 71122, Foggia, Italy.
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3
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Sharmin S, Roos I, Malpas CB, Iaffaldano P, Simone M, Filippi M, Kubala Havrdova E, Ozakbas S, Brescia Morra V, Alroughani R, Zaffaroni M, Patti F, Eichau S, Salemi G, Di Sapio A, Inglese M, Portaccio E, Trojano M, Amato MP, Kalincik T. Disease-modifying therapies in managing disability worsening in paediatric-onset multiple sclerosis: a longitudinal analysis of global and national registries. Lancet Child Adolesc Health 2024; 8:348-357. [PMID: 38547883 DOI: 10.1016/s2352-4642(24)00047-6] [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: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND High-efficacy disease-modifying therapies have been proven to slow disability accrual in adults with relapsing-remitting multiple sclerosis. However, their impact on disability worsening in paediatric-onset multiple sclerosis, particularly during the early phases, is not well understood. We evaluated how high-efficacy therapies influence transitions across five disability states, ranging from minimal disability to gait impairment and secondary progressive multiple sclerosis, in people with paediatric-onset multiple sclerosis. METHODS Longitudinal data were obtained from the international MSBase registry, containing data from people with multiple sclerosis from 151 centres across 41 countries, and the Italian Multiple Sclerosis and Related Disorders Register, containing data from people with multiple sclerosis from 178 Italian multiple sclerosis centres. People younger than 18 years at the onset of multiple sclerosis symptoms were included, provided they had a confirmed diagnosis of relapsing-remitting multiple sclerosis and at least four Expanded Disability Status Scale (EDSS) scores recorded within 12-month intervals. The primary outcome was the time to change in disability state: minimal disability (EDSS scores 0, 1·0, and 1·5), mild disability (EDSS scores 2·0 and 2·5), moderate disability (EDSS scores 3·0 and 3·5), gait impairment (EDSS scores ≥4·0), and clinician diagnosed secondary progressive multiple sclerosis. A multi-state model was constructed to simulate the natural course of multiple sclerosis, modelling the probabilities of both disability worsening and improvement simultaneously. The impact of high-efficacy disease-modifying therapies (alemtuzumab, cladribine, daclizumab, fingolimod, mitoxantrone, natalizumab, ocrelizumab, rituximab, or autologous haematopoietic stem cell transplantation) and low-efficacy disease-modifying therapies (dimethyl fumarate, glatiramer acetate, interferon beta, or teriflunomide), compared with no treatment, on the course of disability was assessed. Apart from recruitment, individuals with lived experience of multiple sclerosis were not involved in the design and conduct of this study. FINDINGS A total of 5224 people (3686 [70·6%] female and 1538 [29·4%] male) with mean age at onset of multiple sclerosis 15·24 years (SD 2·52) were included. High-efficacy therapies reduced the hazard of disability worsening across the disability states. The largest reduction (hazard ratio 0·41 [95% CI 0·31-0·53]) was observed in participants who were treated with high-efficacy therapies while in the minimal disability state, compared with those remained untreated. The benefit of high-efficacy therapies declined with increasing disability. Young people with minimal disability who received low-efficacy therapy also experienced a reduced hazard (hazard ratio 0·65 [95% CI 0·54-0·77]) of transitioning to mild disability, in contrast to those who remained untreated. INTERPRETATION Treatment of paediatric-onset relapsing-remitting multiple sclerosis with high-efficacy therapy substantially reduces the risk of reaching key disability milestones. This reduction in risk is most pronounced among young people with minimal or mild disability when treatment began. Children with relapsing-remitting multiple sclerosis should be treated early with high-efficacy therapy, before developing significant neurological impairments, to better preserve their neurological capacity. FUNDING National Health and Medical Research Council, Australia; MSBase Foundation Fellowship; MS Australia Postdoctoral Fellowship.
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Affiliation(s)
- Sifat Sharmin
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Izanne Roos
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Charles B Malpas
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Pietro Iaffaldano
- Centro SM Dipartimento di Scienze Mediche di Base, Neuroscienze ed Organi di Senso Universita' di Bari, Bari, Italy
| | - Marta Simone
- Pediatric MS Center, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Massimo Filippi
- Neurology Unit and MS Center, Neurorehabilitation Unit, Neurophysiology Service, and Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Serkan Ozakbas
- Izmir University of Economics, Medical Point Hospital, Izmir, Turkey
| | - Vincenzo Brescia Morra
- Unità Operativa Semplice Dipartimentale Sclerosi Multipla - AOU Policlinico Federico II, Naples, Italy
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - Mauro Zaffaroni
- Centro Sclerosi Multipla, ASST Della Valle Olona, Ospedale Di Gallarate, Gallarate VA, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy; Multiple Sclerosis Centre, AOU Policlinico G Rodolico-San Marco, University of Catania, Catania, Italy
| | - Sara Eichau
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Giuseppe Salemi
- Centro Per La Diagnosi E Cura Della SM E Delle Malattie Demielinizzanti - Dipt Radiologia Diagnostica, Interventistica e Stroke, AOUP P Giaccone di Palermo, Palermo, Italy
| | - Alessia Di Sapio
- SCDO Neurologia, Centro Di Riferimento Regionale Sclerosi Multipla (CReSM)-AOU San Luigi, Turin, Italy
| | - Matilde Inglese
- Centro Per Lo Studio E La Cura Della Sclerosi Multipla E Malattie Demielinizzanti - Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno, Infantili, Clinica Neurologica, Ospedale Policlinico San Martino (DiNOGMI), Genova, Italia
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Maria Trojano
- School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia.
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4
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Ramari C, D'hooge M, Dalgas U, Feinstein A, Amato MP, Brichetto G, Chataway J, Chiaravalloti ND, Cutter GR, DeLuca J, Farrell R, Filippi M, Freeman J, Inglese M, Meza C, Motl RW, Rocca MA, Sandroff BM, Salter A, Kos D, Feys P. Prevalence and Associated Clinical Characteristics of Walking-Related Motor, Cognitive, and Fatigability in Progressive Multiple Sclerosis: Baseline Results From the CogEx Study. Neurorehabil Neural Repair 2024; 38:327-338. [PMID: 38426484 DOI: 10.1177/15459683241236161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND People with progressive multiple sclerosis (PMS) present motor (eg, walking) and cognitive impairments, and report fatigue. Fatigue encompasses fatigability which is objectively measured by the capacity to sustain a motor or cognitive task. OBJECTIVE To investigate the prevalence of walking and cognitive fatigability (CF) and the associated clinical characteristics in a large sample of PMS patients. METHODS PMS patients (25-65 years old) were included from 11 sites (Europe and North America), having cognitive impairment (1.28 standard deviation below normative data for the symbol digit modality test [SDMT]). Walking fatigability (WF) was assessed using the distance walk index (DWI) and CF using the SDMT (scores from the last 30 seconds compared to the first 30 seconds). Additional measures were: cognitive assessment-Brief International Cognitive Assessment for multiple sclerosis (MS), cardiorespiratory fitness, 6-minute walk, physical activity, depressive symptoms, perceived fatigue-Modified Fatigue Impact Scale (MFIS), MS impact-MSIS-29, and walking ability. RESULTS Of 298 participants, 153 (51%) presented WF (DWI = -28.9 ± 22.1%) and 196 (66%) presented CF (-29.7 ± 15%). Clinical characteristics (EDSS, disease duration, and use of assistive device) were worse in patients with versus without WF. They also presented worse scores on MSIS-29 physical, MFIS total and physical and reduced physical capacity. CF patients scored better in the MSIS-29 physical and MFIS psychosocial, compared to non-CF group. Magnitude of CF and WF were not related. CONCLUSIONS Half of the cognitively-impaired PMS population presented WF which was associated with higher disability, physical functions, and fatigue. There was a high prevalence of CF but without strong associations with clinical, cognitive, and physical functions. TRIAL REGISTRATION NUMBER The "CogEx-study," www.clinicaltrial.gov identifier number: NCT03679468.
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Affiliation(s)
- Cintia Ramari
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Limburg, Belgium
- UMSC University MS Center Hasselt Pelt, Hasselt Pelt, Belgium
| | - Mieke D'hooge
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Limburg, Belgium
- National MS Center, Melsbroek, Belgium
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel Farrell
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Devon, UK
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - Brian M Sandroff
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Limburg, Belgium
- UMSC University MS Center Hasselt Pelt, Hasselt Pelt, Belgium
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5
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Makhani N, Lebrun-Frenay C, Siva A, Shabanova V, Wassmer E, Santoro JD, Narula S, Brenton JN, Mar S, Durand-Dubief F, Zephir H, Mathey G, Rojas JI, de Seze J, Tenembaum S, Stone RT, Casez O, Carra-Dallière C, Neuteboom RF, Ahsan N, Arroyo HA, Cabre P, Gombolay G, Inglese M, Louapre C, Margoni M, Palavra F, Pohl D, Reich DS, Ruet A, Thouvenot E, Timby N, Tintore M, Uygunoglu U, Vargas W, Venkateswaran S, Verhelst H, Wickstrom R, Azevedo CJ, Kantarci O, Shapiro ED, Okuda DT, Pelletier D. The diagnostic workup of children with the radiologically isolated syndrome differs by age and by sex. J Neurol 2024:10.1007/s00415-024-12289-1. [PMID: 38564056 DOI: 10.1007/s00415-024-12289-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) and spinal MRIs are often obtained in children with the radiologically isolated syndrome (RIS) for diagnosis and prognosis. Factors affecting the frequency and timing of these tests are unknown. OBJECTIVE To determine whether age or sex were associated with (1) having CSF or spinal MRI obtained or (2) the timing of these tests. METHODS We analyzed children (≤ 18 y) with RIS enrolled in an international longitudinal study. Index scans met 2010/2017 multiple sclerosis (MS) MRI criteria for dissemination in space (DIS). We used Fisher's exact test and multivariable logistic regression (covariates = age, sex, MRI date, MRI indication, 2005 MRI DIS criteria met, and race). RESULTS We included 103 children with RIS (67% girls, median age = 14.9 y). Children ≥ 12 y were more likely than children < 12 y to have CSF obtained (58% vs. 21%, adjusted odds ratio [AOR] = 4.9, p = 0.03). Pre-2017, girls were more likely than boys to have CSF obtained (n = 70, 79% vs. 52%, AOR = 4.6, p = 0.01), but not more recently (n = 30, 75% vs. 80%, AOR = 0.2, p = 0.1; p = 0.004 for interaction). Spinal MRIs were obtained sooner in children ≥ 12 y (median 11d vs. 159d, p = 0.03). CONCLUSIONS Younger children with RIS may be at continued risk for misdiagnosis and misclassification of MS risk. Consensus guidelines are needed.
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Affiliation(s)
- Naila Makhani
- Department of Pediatrics, Yale University, LMP 3088, 333 Cedar Street, New Haven, CT, 06520, USA.
- Department of Neurology, Yale University, New Haven, CT, USA.
| | - Christine Lebrun-Frenay
- CRCSEP Neurologie Pasteur 2, CHU de Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice, France
| | - Aksel Siva
- Neuroimmunology Unit, Neurology Department, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Veronika Shabanova
- Department of Pediatrics, Yale University, LMP 3088, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Evangeline Wassmer
- Neurology Department, Birmingham Children's Hospital, Aston University, Birmingham, UK
| | - Jonathan D Santoro
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
- Division of Neurology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, USA
| | - Sona Narula
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA
| | | | - Soe Mar
- Department of Neurology, Washington University School of Medicine, St. Louis, USA
| | - Francoise Durand-Dubief
- Service de sclérose en plaques, Pathologies de la myéline et Neuro-Inflammation, Hôpital Neurologique, Groupement Hospitalier Est, 59 Bd Pinel, 69677, BRON Cedex, France
| | - Helene Zephir
- Inserm UMR-S 1172 LilNcog, Lille University Hospital FHU Precise, Lille University, Lille, France
| | - Guillaume Mathey
- Department of Neurology, Nancy University Hospital, 54035, Nancy, France
| | - Juan I Rojas
- Hospital Universitario de CEMIC, Buenos Aires, Argentina
| | - Jerome de Seze
- Department of Neurology, Hospital Hautepierre, CHU de Strasbourg and Clinical Investigation Center (CIC) INSERM 1434, Strasbourg, France
| | - Silvia Tenembaum
- Department of Neurology, National Pediatric Hospital Dr. Juan P Garrahan, Buenos Aires, Argentina
| | | | - Olivier Casez
- Neurology MS Clinic Grenoble, Grenoble Alpes University Hospital, Grenoble, France
- T-RAIG, TIMC-IMAG, Grenoble Alpes University, Grenoble, France
| | - Clarisse Carra-Dallière
- Neurology MS Clinic, Montpellier University Hospital, 34295, Montpellier, France
- University of Montpellier (MUSE), 34295, Montpellier, France
| | - Rinze F Neuteboom
- Department of Neurology, Erasmus MC Rotterdam, Sophia's Children's Hospital, Rotterdam, The Netherlands
| | - Nusrat Ahsan
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
- Division of Neurology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, USA
| | - Hugo A Arroyo
- Department of Neurology, Hospital de Pediatría SAMIC. Prof. Dr. J.P. Garrahan, Buenos Aires, Argentina
| | - Philippe Cabre
- Centre Hospitalo Universitaire, Fort-de-France, Martinique
| | - Grace Gombolay
- Division of Neurology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Department of Neuroscience (DINOGMI), University of Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Celine Louapre
- Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital de la Pitié Salpêtrière, CIC Neurosciences, Sorbonne Université, Paris Brain Institute - ICM, Paris, France
| | - Monica Margoni
- Department of Neurosciences, Multiple Sclerosis Center of the Veneto Region, University Hospital-School of Medicine, Padua, Italy
| | - Filipe Palavra
- Center for Child Development - Neuropaediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Daniela Pohl
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, USA
| | - Aurélie Ruet
- Department of Neurology, CHU Bordeaux, Bordeaux, France
- INSERM, Neurocentre Magendie, University of Bordeaux, U1215, Bordeaux, France
| | - Eric Thouvenot
- Department of Neurology, Nîmes University Hospital, Nîmes, France
- IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Niklas Timby
- Department of Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden
| | - Mar Tintore
- Neurology Department, MS Center of Catalunya Cemcat, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), UVIC-Universitat Central de Catalunya, Barcelona, Spain
| | - Ugur Uygunoglu
- Neuroimmunology Unit, Neurology Department, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Wendy Vargas
- Department of Neurology, Columbia University Medical Center, New York, USA
| | | | - Helene Verhelst
- Division of Pediatric Neurology, Department of Pediatrics, University Hospital Ghent, Ghent, Belgium
| | - Ronny Wickstrom
- Neuropaediatric Unit, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Christina J Azevedo
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Orhun Kantarci
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eugene D Shapiro
- Department of Pediatrics, Yale University, LMP 3088, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Darin T Okuda
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, USA
| | - Daniel Pelletier
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
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Filippi M, Borriello G, Patti F, Inglese M, Trojano M, Marinelli F, Chisari C, Iaffaldano P, Zanetta C, Chesi P, Termini R, Marini MG. Perspectives on Neuromyelitis Optica Spectrum Disorders, the Narrative Medicine contribution to care. Neurol Sci 2024; 45:1589-1597. [PMID: 37919441 PMCID: PMC10942930 DOI: 10.1007/s10072-023-07146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND This research aimed to investigate the experience of Neuromyelitis Optica Spectrum Disorders (NMOSD) by integrating the perspectives of patients, caregivers and clinicians through narrative-based medicine to provide new insights to improve care relationships. METHODS The research was conducted in the second half of 2022 and involved six Italian centres treating NMOSD and targeted adult patients, their caregivers and healthcare providers to collect the three points of view of living with or caring for this rare disease, still difficult to treat despite the pharmacological options. Narratives followed a structured outline according to the time: yesterday-today-tomorrow, to capture all disease phases. RESULTS Twenty-five patients diagnosed with NMOSD, ten caregivers and 13 healthcare providers participated in the research. Patients reported symptoms limiting their daily activities and strongly impacting their social dimension. We noticed improvements across disease duration, whilst the persistence of limitations was recurrent in patients with longer diagnoses. Caregivers' narratives mainly share experiences of their daily life changes, the burden of the caregiving role and the solutions identified, if any. Healthcare providers defined their role as a guide. CONCLUSION Limitations in activities are prominent in the lives of people with NMOSD, along with fatigue. Family members are the weakest link in the chain and need information and support. Healthcare professionals are attentive to the helping dimension.
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Affiliation(s)
- Massimo Filippi
- IRCCS Ospedale San Raffaele, Unità di Neurologia e Neurofisiologia, Milan, Italy
| | - Giovanna Borriello
- Centro di riferimento Regionale per la Sclerosi Multipla, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | - Francesco Patti
- Dipartimento GF Ingrassia, Scienze Mediche e Chirurgiche e Tecnologie Avanzate, Università di Catania, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico G Rodolico San Marco, Università di Catania, Catania, Italy
| | - Matilde Inglese
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Trojano
- Department of Translational Biomedicine and Neurosciences, DiBraiN, University of Bari Aldo Moro, Bari, Italy
| | - Fabiana Marinelli
- ASL Frosinone, Ospedale Fabrizio Spaziani UOC Neurologia, Centro Sclerosi multipla, Frosinone, Italy
| | - Clara Chisari
- Dipartimento GF Ingrassia, Scienze Mediche e Chirurgiche e Tecnologie Avanzate, Università di Catania, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico G Rodolico San Marco, Università di Catania, Catania, Italy
| | - Pietro Iaffaldano
- Department of Translational Biomedicine and Neurosciences, DiBraiN, University of Bari Aldo Moro, Bari, Italy
| | - Chiara Zanetta
- IRCCS Ospedale San Raffaele, Unità di Neurologia e Neurofisiologia, Milan, Italy
| | - Paola Chesi
- Healthcare area, Fondazione ISTUD, Milano, Italy
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7
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Lorefice L, Ferraro OE, Fenu G, Amato MP, Bresciamorra V, Conte A, De Luca G, Ferraro D, Filippi M, Gazzola P, Iaffaldano P, Inglese M, Lus G, Marfia GA, Patti F, Pesci I, Salemi G, Trojano M, Zaffaroni M, Monti MC, Cocco E. Late-onset multiple sclerosis: disability trajectories in relapsing-remitting patients of the Italian MS Registry. J Neurol 2024; 271:1630-1637. [PMID: 38172380 DOI: 10.1007/s00415-023-12152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Generally infrequent, multiple sclerosis (MS) with late onset (LOMS) is characterized by an onset over the age of 50 and a mainly progressive course, while relapsing-remitting (RR) forms are less frequently observed and explored. This study aimed to characterize a large cohort of MS patients with RRMS at onset to assess the baseline factors related to the worst disability trajectories and explore the role of LOMS. METHODS The data were extracted from the Italian MS Register (IMSR). Disability trajectories, defined using at least two and up to twenty expanded disability status scale (EDSS) assessments annually performed, were implemented using group-based trajectory models (GBTMs) to identify different groups with the same trajectories over time. MS profiles were explored using multinomial logistic regression. RESULTS A total of 16,159 RR patients [1012 (6.26%) presented with LOMS] were analyzed. The GBTM identified four disability trajectories. The group with the most severe EDSS trend included 12.3% of the patients with a mean EDSS score > 4, which increased over time and exceeded 6 score. The group with medium severity EDSS trend comprised 21.9% of the patients and showed a change in EDSS > 3 scores over time. The largest group with 50.8% of patients reported a constant EDSS of 2 score. Finally, the benign group comprised 14.9% of the patients with a low and constant EDSS of 1 score over time. The probability of being in the worst groups increased if the patient was male; had LOMS or experienced brainstem, spinal, or supratentorial symptoms. CONCLUSIONS Four MS severity profiles among RRMS patients in the IMSR have been reported, with LOMS being associated with a rapid worsening of EDSS scores. These findings have important implications for recognizing and managing how older age, aging, and age-related factors interact with MS and its evolution.
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Affiliation(s)
- Lorena Lorefice
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, University of Cagliari, ASL Cagliari, via Is Guadazzonis 2, PO Binaghi, 01916, Cagliari, Italy.
| | - Ottavia Elena Ferraro
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy
| | - Giuseppe Fenu
- Department of Neurosciences, ARNAS Brotzu, Cagliari, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Vincenzo Bresciamorra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, University of Naples "Federico II", Naples, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Centre, Neurology Unit, SS. Annunziata Hospital University "G D'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Diana Ferraro
- Department of Neurosciences, Civil Hospital of Baggiovara, AOU of Modena, Baggiovara, Italy
| | - Massimo Filippi
- Neurology, Neurorehabilitation and Neuroimaging Research Units, Neurophysiology Service, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Gazzola
- Neurology Unit, P.A. Micone Hospital, ASL3 Genovese, Genoa, Italy
| | - Pietro Iaffaldano
- Department of Translational Biomedicine and Neurosciences, DiBraiN University of Bari Aldo Moro, Bari, Italy
| | - Matilde Inglese
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno - Infantili (DINOGMI), Universita' Di Genova, Genoa, Liguria, Italy
| | - Giacomo Lus
- Multiple Sclerosis Center, Second Division of Neurology, Department of Advanced Medical and Surgical Science, University of Campania Luigi Vanvitelli, 80131, Naples, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, 00133, Rome, Italy
| | - Francesco Patti
- Department Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
| | - Ilaria Pesci
- Centro Sclerosi Multipla Unità Operativa Neurologia, Azienda Unità Sanitaria Locale, Ospedale Di Vaio, Fidenza, Parma, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate - ASST Della Valle Olona, Gallarate, Italy
| | - Maria Cristina Monti
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, University of Cagliari, ASL Cagliari, via Is Guadazzonis 2, PO Binaghi, 01916, Cagliari, Italy
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8
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Sbragia E, Boffa G, Varaldo R, Raiola AM, Ghiso A, Gambella M, Benedetti L, Angelucci E, Inglese M. An aggressive form of MOGAD treated with aHSCT: A case report. Mult Scler 2024; 30:612-616. [PMID: 38116593 DOI: 10.1177/13524585231213792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Although myelin-oligodendrocyte-glycoprotein (MOG)-antibody-associated disease (MOGAD) has been considered a more favorable demyelinating central nervous system disorder, recent data evidence that some patients might experience severe relapses and high disability. Actual treatment-options are acquired mostly from anti-aquaporin-4-antibody-positive neuromyelitis optica spectrum disorder and rely on clinical experience. Therefore, treatment of aggressive forms of MOGAD can be challenging. OBJECTIVES AND METHODS To describe a patient with an aggressive MOGAD treated with autologous hematopoietic stem cell transplantation (aHSCT). RESULTS A 56-year-old man was diagnosed with MOGAD in 2017 because of right optic-neuritis and anti-MOG-antibody positivity. In the following 2 years, he experienced two optic neuritis with good recovery after high-dose steroid. At the end of 2019, he presented sensory and motor impairment at lower limbs with evidence of several spinal, longitudinally extended, tumefactive inflammatory lesions. Despite sequential treatment with rituximab and tocilizumab alongside high-dose steroid, intravenous immunoglobulins and plasma-exchange, he experienced several clinical relapses and exhibited persistent magnetic resonance activity. He was finally addressed to intense immunosuppression with myeloablative conditioning regimen followed by autologous hematopoietic stem cell transplantation (aHSCT). After 2 years follow-up, he is free from disease-activity. CONCLUSIONS In a patient affected by aggressive, treatment-refractory MOGAD, aHSCT resulted as safe and was able to suppress disease-activity for over 2 years.
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Affiliation(s)
- Elvira Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
- Department of Neurology, Galliera Hospital, Genoa, Italy
| | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Riccardo Varaldo
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Maria Raiola
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Ghiso
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Massimiliano Gambella
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luana Benedetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
- Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emanuele Angelucci
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
- Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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9
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Iaffaldano P, Lucisano G, Guerra T, Patti F, Cocco E, De Luca G, Brescia Morra V, Pozzilli C, Zaffaroni M, Ferraro D, Gasperini C, Salemi G, Bergamaschi R, Lus G, Inglese M, Romano S, Bellantonio P, Di Monte E, Maniscalco GT, Conte A, Lugaresi A, Vianello M, Torri Clerici VLA, Di Sapio A, Pesci I, Granella F, Totaro R, Marfia GA, Danni MC, Cavalla P, Valentino P, Aguglia U, Montepietra S, Ferraro E, Protti A, Spitaleri D, Avolio C, De Riz M, Maimone D, Cavaletti G, Gazzola P, Tedeschi G, Sessa M, Rovaris M, Di Palma F, Gatto M, Cargnelutti D, De Robertis F, Logullo FO, Rini A, Meucci G, Ardito B, Banfi P, Nasuelli D, Paolicelli D, Rocca MA, Portaccio E, Chisari CG, Fenu G, Onofrj M, Carotenuto A, Ruggieri S, Tortorella C, Ragonese P, Nica M, Amato MP, Filippi M, Trojano M. Evaluation of drivers of treatment switch in relapsing multiple sclerosis: a study from the Italian MS Registry. J Neurol 2024; 271:1150-1159. [PMID: 38135850 DOI: 10.1007/s00415-023-12137-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Active relapsing-remitting (RR) and secondary progressive (SP) multiple sclerosis (MS) are currently defined as "relapsing MS" (RMS). The aim of this cross-sectional study was to assess drivers of treatment switches due to clinical relapses in a population of RMS patients collected in the Italian MS and Related Disorders Register (I-MS&RD). METHODS RRMS and SPMS patients with at least one relapse in a time window of 2 years before of data extraction were defined as RMS. Factors associated with disease-modifying therapy (DMT) switching due to clinical activity were assessed through multivariable logistic regression models in which treatment exposure was included as the last recorded DMT and the last DMT's class [moderate-efficacy (ME), high-efficacy (HE) DMTs and anti-CD20 drugs]. RESULTS A cohort of 4739 RMS patients (4161 RRMS, 578 SPMS) was extracted from the I-MS&RD. A total of 2694 patients switching DMTs due to relapses were identified. Switchers were significantly (p < 0.0001) younger, less disabled, more frequently affected by an RR disease course in comparison to non-switcher patients. The multivariable logistic regression models showed that Alemtuzumab (OR 0.08, 95% CI 0.02-0.37), Natalizumab (0.48, 0.30-0.76), Ocrelizumab (0.1, 0.02-0.45) and Rituximab (0.23, 0.06-0.82) exposure was a protective factor against treatment switch due to relapses. Moreover, the use of HE DMTs (0.43, 0.31-0.59), especially anti-CD20 drugs (0.14, 0.05-0.37), resulted to be a protective factor against treatment switch due to relapses in comparison with ME DMTs. CONCLUSIONS More than 50% of RMS switched therapy due to disease activity. HE DMTs, especially anti-CD20 drugs, significantly reduce the risk of treatment switch.
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Affiliation(s)
- Pietro Iaffaldano
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Giuseppe Lucisano
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Tommaso Guerra
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche E Chirurgiche E Tecnologie Avanzate, GF Ingrassia, Università di Catania, Via Santa Sofia 78, 95123, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico G Rodolico-San Marco, Università di Catania, Catania, Italy
| | - Eleonora Cocco
- Department of Medical Science and Public Health, University of Cagliari/Centro Sclerosi Multipla, ATS Sardegna, Cagliari, Italy
| | - Giovanna De Luca
- Centro Sclerosi MultiplaClinica Neurologica, Policlinico SS Annunziata, Università "G. d'Annunzio", Chieti-Pescara, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Center, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Roma, Rome, Italy
| | - Mauro Zaffaroni
- Neuroimmunology Unit and Multiple Sclerosis Center, ASST Della Valle Olona, Hospital of Gallarate, Via Pastori 4, 21013, Gallarate, VA, Italy
| | - Diana Ferraro
- Department of Neurosciences, Ospedale Civile di BaggiovaraAzienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Claudio Gasperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | | | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Matilde Inglese
- Dipartimento di NeuroscienzeRiabilitazioneOftalmologiaGenetica e Scienze Materno-Infantili (DINOGMI), Universita' di Genova, Genova, Italy
- IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Silvia Romano
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sant'Andrea Hospital, Sapienza University of Rome, 00189, Rome, Italy
| | | | - Elisabetta Di Monte
- Center for Multiple Sclerosis, Hospital ASL 4 "Madonna delle Grazie", 75100, Matera, Italy
| | | | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
- Neurophysiopatology Unit, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Marika Vianello
- MS Unit, OU Neurology "Ca' Foncello" Hospital, Treviso, Italy
| | | | - Alessia Di Sapio
- Department of Neurology, Regional Referral Multiple Sclerosis Center, University Hospital San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Ilaria Pesci
- Neurology Unit, Ospedale Vaio-Fidenza, Parma, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rocco Totaro
- Centro Malattie Demielinizzanti-Clinica Neurologica, Ospedale San Salvatore, L'Aquila, Coppito, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, 00133, Rome, Italy
| | - Maura Chiara Danni
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Paola Cavalla
- Centro Sclerosi Multipla e Neurologia 1 D.U, Dipartimento di Neuroscienze e Salute Mentale, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paola Valentino
- Istituto di neurologia, Università Magna Graecia Catanzaro, Catanzaro, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Sara Montepietra
- MS Centre, SMN Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy
| | | | | | | | - Carlo Avolio
- MS Center, University of Neurology, Foggia, Italy
| | - Milena De Riz
- Centro Sclerosi Multipla-Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, ARNAS Garibaldi, Catania, Italy
| | | | - Paola Gazzola
- SC Neurologia, Ospedale P. Antero Micone-ASL 3 Genovese, Genoa, Italy
| | - Gioacchino Tedeschi
- I Division of Neurology, Universita della Campania "L. Vanvitelli", Naples, Italy
| | - Maria Sessa
- Centro Provinciale Sclerosi Multipla, ASST papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rovaris
- MS Center, Scientific Institute Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Franco Di Palma
- SM Center Neurology Department, ASST Lariana S. Anna Hospital, Como, Italy
| | - Maurizia Gatto
- Centro Malattie Demielinizzanti, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | | | | | | | - Augusto Rini
- Centro Sclerosi Multipla, Ospedale A. Perrino, Brindisi, Italy
| | - Giuseppe Meucci
- Ambulatorio Sclerosi MultiplaUnita' Operativa di Neurologia e Neurofisiopatologia, Spedali Riuniti di Livorno, Livorno, Italy
| | - Bonaventura Ardito
- Centro Sclerosi Mutipla UOC di Neurologia, Ospedale Della Murgia Fabio Perinei, Altamura, Italy
| | - Paola Banfi
- Dipartimento di Neurologia, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Davide Nasuelli
- ASST Della Valle Olona Presidio Ospedaliero di Saronno Ambulatorio Sclerosi Multipla, Saronno, Italy
| | - Damiano Paolicelli
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Maria Assunta Rocca
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - Clara Grazia Chisari
- Dipartimento di Scienze Mediche E Chirurgiche E Tecnologie Avanzate, GF Ingrassia, Università di Catania, Via Santa Sofia 78, 95123, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico G Rodolico-San Marco, Università di Catania, Catania, Italy
| | - Giuseppe Fenu
- Department of Medical Science and Public Health, University of Cagliari/Centro Sclerosi Multipla, ATS Sardegna, Cagliari, Italy
| | - Marco Onofrj
- Centro Sclerosi MultiplaClinica Neurologica, Policlinico SS Annunziata, Università "G. d'Annunzio", Chieti-Pescara, Italy
| | - Antonio Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Center, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Serena Ruggieri
- Department of Human Neurosciences, Sapienza University of Roma, Rome, Italy
| | - Carla Tortorella
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Paolo Ragonese
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | | | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Viale Pieraccini 6, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Massimo Filippi
- Neurology and Neurorehabilitation Units, Neurophysiology Service, Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Trojano
- School of Medicine, University "Aldo Moro" Bari, Piazza Giulio Cesare 11, Bari, Italy.
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Tazza F, Schiavi S, Leveraro E, Cellerino M, Boffa G, Ballerini S, Dighero M, Uccelli A, Sbragia E, Aluan K, Inglese M, Lapucci C. Clinical and radiological correlates of apathy in multiple sclerosis. Mult Scler 2024; 30:247-256. [PMID: 38095151 DOI: 10.1177/13524585231217918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Although apathy has been associated with fronto-striatal dysfunction in several neurological disorders, its clinical and magnetic resonance imaging (MRI) correlates have been poorly investigated in people with multiple sclerosis (PwMS). OBJECTIVES To evaluate clinical variables and investigate microstructural integrity of fronto-striatal grey matter (GM) and white matter (WM) structures using diffusion tensor imaging (DTI). METHODS A total of 123 PwMS (age: 40.25 ± 11.5; female: 60.9%; relapsing-remitting multiple sclerosis: 75.6%) were prospectively enrolled and underwent neurological and neuropsychological evaluation, including Expanded Disability Status Scale (EDSS), Apathy Evaluation Scale (AES-S), Hospital Anxiety and Depression Scale (HADS), Modified Fatigue Impact Scale (MFIS) and brain 3T-MRI volumes of whole brain, frontal/prefrontal cortex (PFC) and subcortical regions were calculated. DTI-derived metrics were evaluated in the same GM regions and in connecting WM tracts. RESULTS Apathetic PwMS (32.5%) showed lower education levels, higher HADS, MFIS scores and WM lesions volume than nonapathetic PwMS. Significant differences in DTI metrics were found in middle frontal, anterior cingulate and superior frontal PFC subregions and in caudate nuclei. Significant alterations were found in the right cingulum and left striatal-frontorbital tracts. CONCLUSIONS Apathy in PwMS is associated with higher levels of physical disability, depression, anxiety and fatigue together with lower educational backgrounds. Microstructural damage within frontal cortex, caudate and fronto-striatal WM bundles is a significant pathological substrate of apathy in multiple sclerosis (MS).
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Affiliation(s)
- Francesco Tazza
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simona Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Leveraro
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefania Ballerini
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mara Dighero
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elvira Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Kenda Aluan
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Caterina Lapucci
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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11
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Bosisio L, Gastaldi M, Inglese M, Rossi A, Franciotta D, Cataldi M, Leone C, Giacomini T, Benedetti L, Nobili L, Mancardi MM. Asynchronous combined central and peripheral demyelination (CCPD) in a girl with anti-MOG positivity: A case report and review of the literature. J Neuroimmunol 2023; 384:578213. [PMID: 37820535 DOI: 10.1016/j.jneuroim.2023.578213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
The occurrence of combined central and peripheral demyelination (CCPD) is rare, data are limited to small case and cohort studies, mainly concerning adults. In few patients positivity to anti MOG antibody is reported, thus widening the spectrum of anti-MOG associated disorders (MOGAD). We describe a 7-year-old girl with optic neuritis followed 8 years later by peripheral demyelination, with fluctuating anti-MOG antibody positivity at cell-based assay. From the review of the literature, MOGAD-CCPD appear very rare in childhood, especially with asynchronous course. Clinicians should keep this possibility in mind to better define diagnosis in atypical demyelination syndromes, with therapeutical implications.
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Affiliation(s)
- Luca Bosisio
- Child Neuropsychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Department of Neuroscience (DINOGMI), IRCCS Istituto Giannina Gaslini, University of Genoa, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Diego Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Cataldi
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Carmela Leone
- Department of Neurology, Ospedale "R. Guzzardi" - ASP Ragusa, Vittoria, Italy
| | - Thea Giacomini
- Department of Mental Health and Addiction, Azienda Sanitaria Locale 3, Genova, Italy
| | | | - Lino Nobili
- Child Neuropsychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Department of Neuroscience (DINOGMI), IRCCS Istituto Giannina Gaslini, University of Genoa, Italy; Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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12
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Tacchino A, Ponzio M, Confalonieri P, Leocani L, Inglese M, Centonze D, Cocco E, Gallo P, Paolicelli D, Rovaris M, Sabattini L, Tedeschi G, Prosperini L, Patti F, Bramanti P, Pedrazzoli E, Battaglia MA, Brichetto G. An Internet- and Kinect-Based Multiple Sclerosis Fitness Intervention Training With Pilates Exercises: Development and Usability Study. JMIR Serious Games 2023; 11:e41371. [PMID: 37938895 PMCID: PMC10666018 DOI: 10.2196/41371] [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: 07/23/2022] [Revised: 01/30/2023] [Accepted: 07/30/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Balance impairments are common in people with multiple sclerosis (MS), with reduced ability to maintain position and delayed responses to postural adjustments. Pilates is a popular alternative method for balance training that may reduce the rapid worsening of symptoms and the increased risk of secondary conditions (eg, depression) that are frequently associated with physical inactivity. OBJECTIVE In this paper, we aimed to describe the design, development, and usability testing of MS Fitness Intervention Training (MS-FIT), a Kinect-based tool implementing Pilates exercises customized for MS. METHODS MS-FIT has been developed using a user-centered design approach (design, prototype, user feedback, and analysis) to gain the target user's perspective. A team composed of 1 physical therapist, 2 game programmers, and 1 game designer developed the first version of MS-FIT that integrated the knowledge and experience of the team with MS literature findings related to Pilates exercises and balance interventions based on exergames. MS-FIT, developed by using the Unity 3D (Unity Technologies) game engine software with Kinect Sensor V2 for Windows, implements exercises for breathing, posture, and balance. Feedback from an Italian panel of experts in MS rehabilitation (neurologists, physiatrists, physical therapists, 1 statistician, and 1 bioengineer) and people with MS was collected to customize the tool for use in MS. The context of MS-FIT is traveling around the world to visit some of the most important cities to learn the aspects of their culture through pictures and stories. At each stay of the travel, the avatar of a Pilates teacher shows the user the exercises to be performed. Overall, 9 people with MS (n=4, 44% women; mean age 42.89, SD 11.97 years; mean disease duration 10.19, SD 9.18 years; Expanded Disability Status Scale score 3.17, SD 0.75) were involved in 3 outpatient user test sessions of 30 minutes; MS-FIT's usability was assessed through an ad hoc questionnaire (maximum value=5; higher the score, higher the usability) evaluating easiness to use, playability, enjoyment, satisfaction, and acceptance. RESULTS A user-centered design approach was used to develop an accessible and challenging tool for balance training. All people with MS (9/9, 100%) completed the user test sessions and answered the ad hoc questionnaire. The average score on each item ranged from 3.78 (SD 0.67) to 4.33 (SD 1.00), which indicated a high usability level. The feedback and suggestions provided by 64% (9/14) of people with MS and 36% (5/14) of therapists involved in the user test were implemented to refine the first prototype to release MS-FIT 2.0. CONCLUSIONS The participants reported that MS-FIT was a usable tool. It is a promising system for enhancing the motivation and engagement of people with MS in performing exercise with the aim of improving their physical status.
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Affiliation(s)
- Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Paolo Confalonieri
- Multiple Sclerosis Center, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Letizia Leocani
- Vita-Salute University & Hospital San Raffaele, Milan, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS San Martino Hospital, Genoa, Italy
| | | | - Eleonora Cocco
- Department of Medical Science and Public health, University of Cagliari, Cagliari, Italy
| | - Paolo Gallo
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Marco Rovaris
- Multiple Sclerosis Center, IRCCS Don Carlo Gnocchi Foundation, Milan, Italy
| | - Loredana Sabattini
- Uosi Multiple Sclerosis Rehabilitation, IRCCS Istituto delle Scienze Neurologiche of Bologna, Bologna, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | | | | | | | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- Rehabilitation Service of Genoa, Italian Multiple Sclerosis Society, Genoa, Italy
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13
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Ponzio M, Podda J, Pignattelli E, Verri A, Persechino B, Vitturi BK, Bandiera P, Manacorda T, Inglese M, Durando P, Battaglia MA. Work Difficulties in People with Multiple Sclerosis. J Occup Rehabil 2023:10.1007/s10926-023-10149-9. [PMID: 37921967 DOI: 10.1007/s10926-023-10149-9] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE This study identifies potential predictors of unemployment and describes specific work difficulties and their determinants in a subgroup of employed people with multiple sclerosis (PwMS). The specific work difficulties were evaluated using a validated tool that measures the impact of respondents' symptoms and of workplace features. METHODS A cross-sectional study was carried out in Italy during 2021-2022. The subjects included were adults (18-65 years) with a diagnosis of MS, currently employed or unemployed. Logistic regression models were used to determine the association between each potential determinant and employment status, while linear regression models were used to determine the association between determinants and specific work difficulties. RESULTS The main risk factors associated with a higher risk of being unemployed were being older, living in the South of Italy/islands, and having a higher disability level, while protective factors against unemployment were having a high level of education and 'stable' employment (an open-ended contract). Fatigue was found to be associated with all work difficulties analyzed; mood disorders emerged as the main predictors of mental health-related work difficulties; level of disability and comorbidity significantly impacted physical health-related ones, and a good quality of life was found to improve both workplace-related and mental health-related difficulties at work. CONCLUSION Identifying the most significant difficulties is a crucial step in the development of vocational rehabilitation interventions tailored to maximize the ability of PwMS to handle their job-related duties and demands.
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Affiliation(s)
- Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy.
- Department of Research, Italian Multiple Sclerosis Foundation, via Operai 40, 16149, Genoa, Italy.
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Elena Pignattelli
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Anna Verri
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | | | | | - Paolo Bandiera
- Italian Multiple Sclerosis Association (AISM), Genoa, Italy
| | | | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- Department of Life Science, University of Siena, Siena, Italy
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14
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Boccia VD, Saitta L, Inglese M, Lapucci C. Cortical ischemic lesions from atrial myxoma as a mimic of disease activity in an RRMS antiCD20-treated patient. Mult Scler 2023; 29:1688-1692. [PMID: 37712415 DOI: 10.1177/13524585231195356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Cortical lesions (CLs) detected with double inversion recovery (DIR) magnetic resonance imaging (MRI) are very helpful in differentiating multiple sclerosis (MS) from other neuroinflammatory diseases of the central nervous system (CNS), that is, neuromyelitis optica spectrum disorders (NMOSDs). Furthermore, CLs are closely related to motor and cognitive impairment. We report a case of a 48-year-old female MS patient who developed several CLs during anti-CD20 therapy. Some CLs disappeared during follow-up MRIs. In the suspicion of a treatment failure, the screening for the autologous hematopoietic stem cell transplant (AHSCT) was performed with the evidence of an atrial myxoma. In MS patients with new CLs, a comorbid ischemic pathology should be considered and carefully investigated.
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Affiliation(s)
- V D Boccia
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - L Saitta
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M Inglese
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - C Lapucci
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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15
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Feinstein A, Amato MP, Brichetto G, Chataway J, Chiaravalloti ND, Cutter G, Dalgas U, DeLuca J, Farrell R, Feys P, Filippi M, Freeman J, Inglese M, Meza C, Motl RW, Rocca MA, Sandroff BM, Salter A. Cognitive rehabilitation and aerobic exercise for cognitive impairment in people with progressive multiple sclerosis (CogEx): a randomised, blinded, sham-controlled trial. Lancet Neurol 2023; 22:912-924. [PMID: 37739574 DOI: 10.1016/s1474-4422(23)00280-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/03/2023] [Accepted: 07/17/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Cognitive dysfunction in people with relapsing-remitting multiple sclerosis can improve with cognitive rehabilitation or exercise. Similar effects have not been clearly shown in people with progressive multiple sclerosis. We aimed to investigate the individual and synergistic effects of cognitive rehabilitation and exercise in patients with progressive multiple sclerosis. METHODS CogEx was a randomised, sham-controlled trial completed in 11 hospital clinics, universities, and rehabilitation centres in Belgium, Canada, Denmark, Italy, UK, and USA. Patients with progressive multiple sclerosis were eligible for inclusion if they were aged 25-65 years and had an Expanded Disability Status Scale (EDSS) score of less than 7. All had impaired processing speed defined as a performance of 1·282 SD or greater below normative data on the Symbol Digit modalities Tests (SDMT). Participants were randomly assigned (1:1:1:1), using an interactive web-response system accessed online from each centre, to cognitive rehabilitation plus exercise, cognitive rehabilitation plus sham exercise, exercise plus sham cognitive rehabilitation, or sham exercise plus sham cognitive rehabilitation. The study statistician created the randomisation sequence that was stratified by centre. Participants, outcome assessors, and investigators were blinded to group allocation. The study statistician was masked to treatment during analysis only. Interventions were conducted two times per week for 12 weeks: cognitive rehabilitation used an individualised, computer-based, incremental approach to improve processing speed; sham cognitive rehabilitation consisted of internet training provided individually; the exercise intervention involved individualised aerobic training using a recumbent arm-leg stepper; and the sham exercise involved stretching and balance tasks without inducing cardiovascular strain. The primary outcome measure was processing speed measured by SDMT at 12 weeks; least squares mean differences were compared between groups using linear mixed model in all participants who had a 12-week assessment. The trial is registered with ClinicalTrials.gov, NCT03679468, and is completed. FINDINGS Between Dec 14, 2018, and April 2, 2022, 311 people with progressive multiple sclerosis were enrolled and 284 (91%) completed the 12-week assessment (117/311 [38%] male and 194/311 [62%] female). The least squares mean group differences in SDMT at 12 weeks did not differ between groups (p=0·85). Compared with the sham cognitive rehabilitation and sham exercise group (n=67), differences were -1·30 (95% CI -3·75 to 1·16) for the cognitive rehabilitation plus exercise group (n=70); -2·78 (-5·23 to -0·33) for the sham cognitive rehabilitation plus exercise group (n=71); and -0·71 (-3·11 to 1·70) for the cognitive rehabilitation plus sham exercise group (n=76). 11 adverse events possibly related to the interventions occurred, six in the exercise plus sham cognitive rehabilitation group (pain, dizziness, and falls), two in the cognitive rehabilitation plus sham exercise group (headache and pain), two in the cognitive rehabilitation and exercise group (increased fatigue and pain), and one in the dual sham group (fall). INTERPRETATION Combined cognitive rehabilitation plus exercise does not seem to improve processing speed in people with progressive multiple sclerosis. However, our sham interventions were not inactive. Studies comparing interventions with a non-intervention group are needed to investigate whether clinically meaningful improvements in processing speed might be attainable in people with progressive multiple sclerosis. FUNDING MS Canada.
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Affiliation(s)
- Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy; AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK; National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John DeLuca
- Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel Farrell
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK; National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Belgium; UMSC University MS Center Hasselt Pelt, Belgium
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCSS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCSS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Devon, UK
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCSS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Brian M Sandroff
- Kessler Foundation, East Hanover, NJ, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
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16
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Petracca M, Carotenuto A, Scandurra C, Moccia M, Rosa L, Arena S, Ianniello A, Nozzolillo A, Turrini M, Streito LM, Abbadessa G, Cellerino M, Bucello S, Ferraro E, Mattioli M, Chiodi A, Inglese M, Bonavita S, Clerico M, Cordioli C, Moiola L, Patti F, Lavorgna L, Filippi M, Borriello G, D'Amico E, Pozzilli C, Brescia Morra V, Lanzillo R. Sexual dysfunction in multiple sclerosis: The impact of different MSISQ-19 cut-offs on prevalence and associated risk factors. Mult Scler Relat Disord 2023; 78:104907. [PMID: 37523809 DOI: 10.1016/j.msard.2023.104907] [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: 10/03/2022] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Although multiple sclerosis (MS) Intimacy and Sexuality Questionnaire-19 (MSISQ-19) is a widely applied tool, no unique definition of sexual dysfunction (SD) based on its score exists. OBJECTIVE To explore the impact of different MSISQ-19 cut-offs on SD prevalence and associated risk factors, providing relevant information for its application in research and clinical settings. METHODS After defining SD according to two different MSISQ-19 cut-offs in 1155 people with MS (pwMS), we evaluated SD prevalence and association with sociodemographic and clinical features, mood status and disability via logistic regression. RESULTS Depending on the chosen cut-off, 45% to 54% of pwMS reported SD. SD defined as MSISQ-19 score >30 was predicted by age (OR=1.01, p=0.047), cognition (OR=0.96, p=0.004) and anxiety (OR=1.03, p=0.019). SD defined as a score >3 on any MSISQ-19 item was predicted by motor disability (OR=1.12, p=0.003) and cognition (OR= 0.96, p=0.002). CONCLUSION Applying different MSISQ-19 cut-offs influences both the estimated prevalence and the identification of risk factors for SD, a finding that should be considered during study planning and data interpretation. Preserved cognition exerts a protective effect towards SD regardless from the specific study setting, representing a key point for the implementation of preventive and therapeutic strategies.
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Affiliation(s)
- M Petracca
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Naples 810145, Italy
| | - A Carotenuto
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Naples 810145, Italy
| | - C Scandurra
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Naples 810145, Italy
| | - M Moccia
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Italy; MS Unit, Federico II University Hospital, Naples, Italy
| | - L Rosa
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - S Arena
- Department "G.F. Ingrassia", MS Center, University of Catania, Catania, Italy
| | - A Ianniello
- MS Center, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - A Nozzolillo
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Turrini
- Centro Sclerosi Multipla, ASST Spedali Civili di Brescia, Ospedale di Montichiari, Brescia, Italy
| | - L M Streito
- San Luigi Gonzaga Academic Hospital, Orbassano, TO 10043, Italy
| | - G Abbadessa
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - S Bucello
- Multiple Sclerosis Centre, "E. Muscatello" Hospital - ASP8, Augusta, SR, Italy
| | - E Ferraro
- S. Filippo Neri Hospital, Rome, Italy
| | - M Mattioli
- NCL-Istituto di Neuroscienze Gruppo Neuromed, Rome, Italy
| | - A Chiodi
- Intradepartmental Program of Clinical Psychology, Federico II University Hospital, Naples, Italy
| | - M Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M Clerico
- San Luigi Gonzaga Academic Hospital, Orbassano, TO 10043, Italy; Department of Clinical and Biological Sciences, University of Torino, Torino 10128, Italy
| | - C Cordioli
- Centro Sclerosi Multipla, ASST Spedali Civili di Brescia, Ospedale di Montichiari, Brescia, Italy
| | - L Moiola
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - F Patti
- Department "G.F. Ingrassia", MS Center, University of Catania, Catania, Italy
| | - L Lavorgna
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M Filippi
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - G Borriello
- MS Center, San Pietro Hospital Fatebenefratelli, Rome, Italy
| | - E D'Amico
- Department "G.F. Ingrassia", MS Center, University of Catania, Catania, Italy
| | - C Pozzilli
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - V Brescia Morra
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Naples 810145, Italy
| | - R Lanzillo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Naples 810145, Italy.
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Lapucci C, Boccia VD, Sirito T, Cellerino M, Mikulska M, Sticchi L, Inglese M. Safety of anti-varicella zoster virus vaccination in patients with multiple sclerosis treated with natalizumab: A case series. Mult Scler 2023; 29:1514-1517. [PMID: 37786976 DOI: 10.1177/13524585231204121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
The vaccination with live attenuated vaccines is generally not recommended during natalizumab (NTZ), as it is included among immunosuppressive/immunomodulating therapies. Nevertheless, considering the lack of evidence of a non-Central Nervous System (CNS) immunosuppressive effect of NTZ, after a risk/benefit evaluation, we decided to vaccinate four multiple sclerosis (MS) patients (three with an indication to switch to ocrelizumab for high-risk Progressive Multifocal Leukoencephalopathy (PML) and one for pregnancy planning). No vaccine-related adverse events of any type nor varicella zoster virus (VZV) infections were observed. To the best of our knowledge, these case series represent the first description of the good safety profile of anti-VZV vaccination in MS patients during NTZ treatment.
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Affiliation(s)
| | - Vincenzo Daniele Boccia
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Tommaso Sirito
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Maria Cellerino
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Malgorzata Mikulska
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Laura Sticchi
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
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18
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Vitturi BK, Rahmani A, Dini G, Montecucco A, Debarbieri N, Bandiera P, Ponzio M, Battaglia MA, Brichetto G, Inglese M, Persechino B, Durando P. Work Barriers and Job Adjustments of People with Multiple Sclerosis: A Systematic Review. J Occup Rehabil 2023; 33:450-462. [PMID: 36399281 DOI: 10.1007/s10926-022-10084-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
Purpose The aim was to carry out a systematic review dedicated to describing the work barriers and the job adjustments that are particularly sensitive to people with Multiple Sclerosis (PwMS). Methods Four electronic databases (PubMed/MEDLINE, Scopus, SciVerse ScienceDirect, and Web of Science) were searched for peer-reviewed original articles reporting the barriers at work and/or the job adjustments used by PwMS. MS must have been diagnosed according to accepted international criteria at the time of the study and/or confirmed by a doctor. No time limits were set for the search. Articles that were published in English, Italian, Spanish, French, and Portuguese were accepted. Each article was screened by three experienced and trained investigators. The protocol was registered in PROSPERO (CRD42022299994). Results The initial systematic search yielded 104,228 results, of which 49 articles provided sufficient information and were considered suitable for inclusion in the study. Overall, the studies included 30283 participants with MS. Thirteen (27.1%) studies reported on barriers to work, 14 (29.2%) addressed reasonable adjustments and 21 (43.7%) assessed both outcomes. Job characteristics are the most important barriers for PwMS. Other reported barriers concern the work environment, social relationships at work, negative work events and lack of information. PwMS are more vulnerable to the need for adjustments at the workplace, being the management of the workload the most commonly used one. Conclusions PwMS are exposed to a wide variety of work barriers and job adjustments. Future studies are still highly encouraged on the topic.
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Affiliation(s)
- Bruno Kusznir Vitturi
- Department of Health Sciences, University of Genoa, Building 3, L.Go R. Benzi, 10-16132, Genoa, Italy.
| | - Alborz Rahmani
- Department of Health Sciences, University of Genoa, Building 3, L.Go R. Benzi, 10-16132, Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Building 3, L.Go R. Benzi, 10-16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Alfredo Montecucco
- Department of Health Sciences, University of Genoa, Building 3, L.Go R. Benzi, 10-16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Nicoletta Debarbieri
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Paolo Bandiera
- Italian Multiple Sclerosis Association (AISM), Genoa, Italy
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- Department of Life Sciences, University of Siena, Siena, Italy
| | | | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Neurology Unit, Genoa, Italy
| | | | - Paolo Durando
- Department of Health Sciences, University of Genoa, Building 3, L.Go R. Benzi, 10-16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
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19
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Morbelli S, Gambella M, Raiola AM, Ghiggi C, Bauckneht M, Raimondo TD, Lapucci C, Sambuceti G, Inglese M, Angelucci E. Brain FDG-PET findings in chimeric antigen receptor T-cell therapy neurotoxicity for diffuse large B-cell lymphoma. J Neuroimaging 2023; 33:825-836. [PMID: 37291470 DOI: 10.1111/jon.13135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Chimeric antigen receptor (CAR) T-cell therapy is potentially associated with treatment-related toxicities mainly consisting of cytokine release syndrome (CRS) and immune-effector cell-associated neurotoxicity syndrome (ICANS). We evaluated brain metabolic correlates of CRS with and without ICANS in diffuse large B-cell lymphoma patients treated with CAR-T. METHODS Twenty-one refractory DLCBLs underwent whole-body and brain [18 F]-fluorodeoxyglucose (FDG) PET before and 30 days after treatment with CAR-T. Five patients did not develop inflammatory-related side effects, 11 patients developed CRS, while in 5 patients CRS evolved in ICANS. Baseline and post-CAR-T brain FDG-PET were compared with a local controls dataset to identify hypometabolic patterns both at single-patient and group levels (p < .05 after correction for family-wise error [FWE). Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were computed on baseline FDG-PET and compared between patients' subgroups (t-test). RESULTS ICANS showed an extended and bilateral hypometabolic pattern mainly involving the orbitofrontal cortex, frontal dorsolateral cortex, and anterior cingulate (p < .003 FWE-corrected). CRS without ICANS showed significant hypometabolism in less extended clusters mainly involving bilateral medial and lateral temporal lobes, posterior parietal lobes, anterior cingulate, and cerebellum (p < .002 FWE-corrected). When compared, ICANS showed a more prominent hypometabolism in the orbitofrontal and frontal dorsolateral cortex in both hemispheres than CRS (p < .002 FWE-corrected). Mean baseline MTV and TLG were significantly higher in ICANS than CRS (p < .02). CONCLUSIONS Patients with ICANS are characterized by a frontolateral hypometabolic signature coherently with the hypothesis of ICANS as a predominant frontal syndrome and with the more prominent susceptibility of frontal lobes to cytokine-induced inflammation.
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Affiliation(s)
- Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Massimiliano Gambella
- Department of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Anna Maria Raiola
- Department of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Ghiggi
- Department of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Bauckneht
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Tania Di Raimondo
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Caterina Lapucci
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
| | - Gianmario Sambuceti
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
| | - Emanuele Angelucci
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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20
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Schiavi S, Palombo M, Zacà D, Tazza F, Lapucci C, Castellan L, Costagli M, Inglese M. Mapping tissue microstructure across the human brain on a clinical scanner with soma and neurite density image metrics. Hum Brain Mapp 2023; 44:4792-4811. [PMID: 37461286 PMCID: PMC10400787 DOI: 10.1002/hbm.26416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/02/2023] [Accepted: 06/23/2023] [Indexed: 08/05/2023] Open
Abstract
Soma and neurite density image (SANDI) is an advanced diffusion magnetic resonance imaging biophysical signal model devised to probe in vivo microstructural information in the gray matter (GM). This model requires acquisitions that include b values that are at least six times higher than those used in clinical practice. Such high b values are required to disentangle the signal contribution of water diffusing in soma from that diffusing in neurites and extracellular space, while keeping the diffusion time as short as possible to minimize potential bias due to water exchange. These requirements have limited the use of SANDI only to preclinical or cutting-edge human scanners. Here, we investigate the potential impact of neglecting water exchange in the SANDI model and present a 10-min acquisition protocol that enables to characterize both GM and white matter (WM) on 3 T scanners. We implemented analytical simulations to (i) evaluate the stability of the fitting of SANDI parameters when diminishing the number of shells; (ii) estimate the bias due to potential exchange between neurites and extracellular space in such reduced acquisition scheme, comparing it with the bias due to experimental noise. Then, we demonstrated the feasibility and assessed the repeatability and reproducibility of our approach by computing microstructural metrics of SANDI with AMICO toolbox and other state-of-the-art models on five healthy subjects. Finally, we applied our protocol to five multiple sclerosis patients. Results suggest that SANDI is a practical method to characterize WM and GM tissues in vivo on performant clinical scanners.
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Affiliation(s)
- Simona Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
| | - Marco Palombo
- CUBRIC, School of PsychologyCardiff UniversityCardiffUK
- School of Computer Science and InformaticsCardiff UniversityCardiffUK
| | | | - Francesco Tazza
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- HNSR, IRRCS Ospedale Policlinico San MartinoGenoaItaly
| | - Lucio Castellan
- Department of NeuroradiologyIRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Mauro Costagli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- Laboratory of Medical Physics and Magnetic ResonanceIRCCS Stella MarisPisaItaly
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- IRCCS Ospedale Policlinico San MartinoGenoaItaly
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21
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Zanghì A, Galgani S, Bellantonio P, Zaffaroni M, Borriello G, Inglese M, Romano S, Conte A, Patti F, Trojano M, Avolio C, D'Amico E. Relapse-associated worsening in a real-life multiple sclerosis cohort: the role of age and pyramidal phenotype. Eur J Neurol 2023; 30:2736-2744. [PMID: 37294976 DOI: 10.1111/ene.15910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/27/2023] [Accepted: 06/05/2023] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND PURPOSE The overall disability in patients with relapsing-remitting multiple sclerosis is likely to be partly rather than entirely attributed to relapse. MATERIALS AND METHODS The aim was to investigate the determinants of recovery from first relapse and relapse-associated worsening (RAW) in relapsing-remitting multiple sclerosis patients from the Italian MS Registry during a 5-year epoch from the beginning of first-line disease-modifying therapy. To determine recovery, the functional system (FS) score was used to calculate the difference between the score on the date of maximum improvement and the score before the onset of relapse. Incomplete recovery was defined as a combination of partial (1 point in one FS) and poor recovery (2 points in one FS or 1 point in two FSs or any other higher combination). RAW was indicated by a confirmed disability accumulation measured by the Expanded Disability Status Scale score confirmed 6 months after the first relapse. RESULTS A total of 767 patients had at least one relapse within 5 years of therapy. Of these patients, 57.8% experienced incomplete recovery. Age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.04; p = 0.007) and pyramidal phenotype were associated with incomplete recovery (OR = 2.1, 95% CI 1.41-3.14; p < 0.001). RAW was recorded in 179 (23.3%) patients. Age (OR = 1.02, 95% CI 1.01-1.04; p = 0.029) and pyramidal phenotype (OR = 1.84, 95% CI 1.18-2.88; p = 0.007) were the strongest predictors in the multivariable model. CONCLUSIONS Age and pyramidal phenotype were the strongest determinants of RAW in early disease epochs.
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Affiliation(s)
- Aurora Zanghì
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Simonetta Galgani
- Centro Sclerosi Multipla, Az. Osp. S. Camillo Forlanini, Rome, Italy
| | | | - Mauro Zaffaroni
- Multiple Sclerosis Center, Gallarate Hospital, ASST della Valle Olona, Gallarate, Italy
| | | | - Matilde Inglese
- Centro Per Lo Studio E La Cura Della Sclerosi Multipla E Malattie Demielinizzanti, Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili, Clinica Neurologica-Ospedale Policlinico San Martino (DiNOGMI), Genoa, Italy
| | - Silvia Romano
- Neurology Unit, NESMOS Department, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonella Conte
- Multiple Sclerosis Center, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Francesco Patti
- Department "G.F. Ingrassia", MS Center, University of Catania, Catania, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Carlo Avolio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Emanuele D'Amico
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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22
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Aprea MG, Schiavetti I, Portaccio E, Ballerini C, Battaglia MA, Bergamaschi R, Brichetto G, Bunul SD, Calabrese M, Capobianco M, Cavalla P, Celani MG, Clerico M, Cocco E, Comi G, Confalonieri P, Conte A, Cordioli C, De Luca G, De Rossi N, Filippi M, Gumes H, Immovilli P, Inglese M, Karabudak R, Landi D, Lanzillo R, L’Episcopo MR, Lorefice L, Mantero V, Marangoni S, Marfia GA, Masciulli C, Milano E, Moiola L, Orlandi R, Patti F, Perini P, Pesci I, Pucci E, Puthenparampil M, Radaelli M, Salvetti M, Sartori A, Scandellari C, Sen S, Siva A, Strumia S, Teatini F, Tedeschi G, Trojano M, Tutuncu M, Vaula G, Sormani MP, Amato MP. Sars-CoV2 infection in pregnant women with multiple sclerosis. Mult Scler 2023; 29:1090-1098. [PMID: 37232279 PMCID: PMC10225808 DOI: 10.1177/13524585231176174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND In the general population, maternal SARS-CoV-2 infection during pregnancy is associated with worse maternal outcomes; however, only one study so far has evaluated COVID-19 clinical outcomes in pregnant and postpartum women with multiple sclerosis, showing no higher risk for poor COVID-19 outcomes in these patients. OBJECTIVE In this multicenter study, we aimed to evaluate COVID-19 clinical outcomes in pregnant patients with multiple sclerosis. METHODS We recruited 85 pregnant patients with multiple sclerosis who contracted COVID-19 after conception and were prospectively followed-up in Italian and Turkish Centers, in the period 2020-2022. A control group of 1354 women was extracted from the database of the Multiple Sclerosis and COVID-19 (MuSC-19). Univariate and subsequent logistic regression models were fitted to search for risk factors associated with severe COVID-19 course (at least one outcome among hospitalization, intensive care unit [ICU] admission and death). RESULTS In the multivariable analysis, independent predictors of severe COVID-19 were age, body mass index ⩾ 30, treatment with anti-CD20 and recent use of methylprednisolone. Vaccination before infection was a protective factor. Vaccination before infection was a protective factor. Pregnancy was not a risk nor a protective factor for severe COVID-19 course. CONCLUSION Our data show no significant increase of severe COVID-19 outcomes in patients with multiple sclerosis who contracted the infection during pregnancy.
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Affiliation(s)
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Chiara Ballerini
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy/Department of Life Sciences, University of Siena, Siena, Italy
| | | | | | - S Destan Bunul
- Kocaeli University School of Medicine, Kocaeli, Kocaeli, Turkey
| | - Massimiliano Calabrese
- The Multiple Sclerosis Centre, Department of Neurosciences, Biomedicine and Movement, University Hospital of Verona, Verona, Italy
| | - Marco Capobianco
- Department of Neurology, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience, City of Health and Science, University Hospital of Turin, Turin, Italy
| | - Maria Grazia Celani
- Servizio Malattie Demielinizzanti, SC di Neurofisiopatologia, AO di Perugia, Perugia, UK
| | - Marinella Clerico
- Clinical and Biological Sciences Department, University of Turin, Turin, Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla Ospedale Binaghi, Cagliari, Italy
| | | | - Paolo Confalonieri
- Multiple Sclerosis Centre, IRCCS Foundation “Carlo Besta” Neurological Institute, Milan, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy/IRCCS Neuromed, Pozzilli (IS), Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy/MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy
| | - Giovanna De Luca
- MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy
| | - Nicola De Rossi
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy/MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy
| | - Massimo Filippi
- Neurology Unit and MS Center, Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Haluk Gumes
- Selcuk University School of Medicine, Konya, Turkey
| | - Paolo Immovilli
- Emergency Department, Neurology Unit, G. da Saliceto Hospital, Piacenza, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | | | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy/Neurology Unit, Michele e Pietro Ferrero Hospital, Verduno, Italy
| | | | | | - Vittorio Mantero
- UOC Neurologia—Stroke Unit, Presidio “A. Manzoni,” ASST Lecco, Italy/Department of Neurology, Ospedale Santa Chiara, Trento, Italy
| | - Sabrina Marangoni
- Department of Systems Medicine, Multiple Sclerosis Clinical & Research Center, “Tor Vergata” University, Rome, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | - Eva Milano
- SC Neurologia 1, Ospedale Maria Vittoria, Torino, Italy
| | - Lucia Moiola
- Department of Neurology and Multiple Sclerosis Center, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Riccardo Orlandi
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Patti
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
| | - Paola Perini
- Centro Regionale Sclerosi Multipla, Dipartimento di Neuroscienze, Azienda Ospedale Università di Padova, Padova, Italy
| | - Ilaria Pesci
- Multiple Sclerosis Center, UO Neurology, Fidenza, Fidenza, Italy
| | | | - Marco Puthenparampil
- Centro Regionale Sclerosi Multipla, Dipartimento di Neuroscienze, Azienda Ospedale Università di Padova, Padova, Italy
| | - Marta Radaelli
- Centro Sclerosi Multipla Ospedale Binaghi, Cagliari, Italy
| | - Marco Salvetti
- IRCCS Neuromed, Pozzilli (IS), Department of Human Neuroscience, Sapienza University, Rome, Italy/Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Arianna Sartori
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Cinzia Scandellari
- IRCCS Institute of Neurological Sciences, UOSI Multiple Sclerosis Rehabilitation, Bologna, Italy
| | - Sedat Sen
- Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Aksel Siva
- Cerrahpasa School of Medicine, Istanbul University, Istanbul, Istanbul, Turkey
| | - Silvia Strumia
- UOC di Neurologia, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Francesco Teatini
- Multiple Sclerosis Outpatient Clinic, Clinical Neurology and Stroke Unit, Central Country Hospital, Bolzano, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari, Bari, Italy
| | - Melih Tutuncu
- Cerrahpasa School of Medicine, Istanbul University, Istanbul, Istanbul, Turkey
| | - Giovanna Vaula
- Department of Neuroscience, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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Koudriavtseva T, Lorenzano S, Cellerino M, Truglio M, Fiorelli M, Lapucci C, D’Agosto G, Conti L, Stefanile A, Zannino S, Filippi MM, Cortese A, Piantadosi C, Maschio M, Maialetti A, Galiè E, Salvetti M, Inglese M. Tissue factor as a potential coagulative/vascular marker in relapsing-remitting multiple sclerosis. Front Immunol 2023; 14:1226616. [PMID: 37583699 PMCID: PMC10424925 DOI: 10.3389/fimmu.2023.1226616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/10/2023] [Indexed: 08/17/2023] Open
Abstract
Objectives Recent studies supported coagulation involvement in multiple sclerosis, an inflammatory-demyelinating and degenerative disease of the central nervous system. The main objectives of this observational study were to identify the most specific pro-coagulative/vascular factors for multiple sclerosis pathogenesis and to correlate them with brain hemodynamic abnormalities. Methods We compared i) serum/plasma levels of complement(C)/coagulation/vascular factors, viral/microbiological assays, fat-soluble vitamins and lymphocyte count among people with multiple sclerosis sampled in a clinical remission (n=30; 23F/7M, 40 ± 8.14 years) or a relapse (n=30; 24F/6M, age 41 ± 10.74 years) and age/sex-matched controls (n=30; 23F/7M, 40 ± 8.38 years); ii) brain hemodynamic metrics at dynamic susceptibility contrast-enhanced 3T-MRI during relapse and remission, and iii) laboratory data with MRI perfusion metrics and clinical features of people with multiple sclerosis. Two models by Partial Least Squares Discriminant Analysis were performed using two groups as input: (1) multiple sclerosis vs. controls, and (2) relapsing vs. remitting multiple sclerosis. Results Compared to controls, multiple sclerosis patients had a higher Body-Mass-Index, Protein-C and activated-C9; and a lower activated-C4. Levels of Tissue-Factor, Tie-2 and P-Selectin/CD62P were lower in relapse compared to remission and HC, whereas Angiopoietin-I was higher in relapsing vs. remitting multiple sclerosis. A lower number of total lymphocytes was found in relapsing multiple sclerosis vs. remitting multiple sclerosis and controls. Cerebral-Blood-Volume was lower in normal-appearing white matter and left caudatum while Cerebral-Blood-Flow was inferior in bilateral putamen in relapsing versus remitting multiple sclerosis. The mean-transit-time of gadolinium-enhancing lesions negatively correlated with Tissue-Factor. The top-5 discriminating variables for model (1) were: EBV-EBNA-1 IgG, Body-Mass-Index, Protein-C, activated-C4 and Tissue-Factor whereas for model (2) were: Tissue-Factor, Angiopoietin-I, MCHC, Vitamin A and T-CD3. Conclusion Tissue-factor was one of the top-5 variables in the models discriminating either multiple sclerosis from controls or multiple sclerosis relapse from remission and correlated with mean-transit-time of gadolinium-enhancing lesions. Tissue-factor appears a promising pro-coagulative/vascular biomarker and a possible therapeutic target in relapsing-remitting multiple sclerosis. Clinical trial registration ClinicalTrials.gov, identifier NCT04380220.
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Affiliation(s)
- Tatiana Koudriavtseva
- Medical Direction, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- Department of Clinical Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Svetlana Lorenzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Maria Cellerino
- Department of Clinical Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Mauro Truglio
- Clinical Pathology and Cancer Biobank, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Fiorelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Giovanna D’Agosto
- Clinical Pathology and Microbiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Gallicano Dermatological Institute, Rome, Italy
| | - Laura Conti
- Clinical Pathology and Cancer Biobank, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Annunziata Stefanile
- Clinical Pathology and Cancer Biobank, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Silvana Zannino
- Department of Clinical Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | | | - Antonio Cortese
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Piantadosi
- Unità Operativa Complessa (UOC) Neurology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Marta Maschio
- Department of Clinical Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Andrea Maialetti
- Department of Clinical Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Edvina Galiè
- Department of Clinical Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Marco Salvetti
- Department of Neuroscience Mental Health and Sensory Organs (NEMOS), Sapienza University, Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Department of Neurology, Mount Sinai Hospital, New York, NY, United States
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24
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Veldkamp R, D'hooge M, Sandroff BM, DeLuca J, Kos D, Salter A, Feinstein A, Amato MP, Brichetto G, Chataway J, Farrell R, Chiaravalloti ND, Dalgas U, Filippi M, Freeman J, Motl RW, Meza C, Inglese M, Rocca MA, Cutter G, Feys P. Profiling cognitive-motor interference in a large sample of persons with progressive multiple sclerosis and impaired processing speed: results from the CogEx study. J Neurol 2023; 270:3120-3128. [PMID: 36881147 DOI: 10.1007/s00415-023-11636-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Performing cognitive-motor dual tasks (DTs) may result in reduced walking speed and cognitive performance. The effect in persons with progressive multiple sclerosis (pwPMS) having cognitive dysfunction is unknown. OBJECTIVE To profile DT-performance during walking in cognitively impaired pwPMS and examine DT-performance by disability level. METHODS Secondary analyses were conducted on baseline data from the CogEx-study. Participants, enrolled with Symbol Digit Modalities Test 1.282 standard deviations below normative value, performed a cognitive single task ([ST], alternating alphabet), motor ST (walking) and DT (both). Outcomes were number of correct answers on the alternating alphabet task, walking speed, and DT-cost (DTC: decline in performance relative to the ST). Outcomes were compared between EDSS subgroups (≤ 4, 4.5-5.5, ≥ 6). Spearman correlations were conducted between the DTCmotor with clinical measures. Adjusted significance level was 0.01. RESULTS Overall, participants (n = 307) walked slower and had fewer correct answers on the DT versus ST (both p < 0.001), with a DTCmotor of 15.8% and DTCcognitive of 2.7%. All three subgroups walked slower during the DT versus ST, with DTCmotor different from zero (p's < 0.001). Only the EDSS ≥ 6 group had fewer correct answers on the DT versus ST (p < 0.001), but the DTCcognitive did not differ from zero for any of the groups (p ≥ 0.039). CONCLUSION Dual tasking substantially affects walking performance in cognitively impaired pwPMS, to a similar degree for EDSS subgroups.
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Affiliation(s)
- R Veldkamp
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.
- UMSC, Hasselt-Pelt, Belgium.
| | - M D'hooge
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- UMSC, Hasselt-Pelt, Belgium
- National MS Center Melsbroek, Steenokkerzeel, Belgium
| | - B M Sandroff
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - J DeLuca
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - D Kos
- National MS Center Melsbroek, Steenokkerzeel, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - A Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
| | - A Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - M P Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - G Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society (AISM), Via Operai 30, 16149, Genoa, Italy
| | - J Chataway
- Queen Square MS Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - R Farrell
- Queen Square MS Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - N D Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - U Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000, Aarhus, Denmark
| | - M Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - J Freeman
- School of Health Professions, Faculty of Health, University of Plymouth, Devon, UK
| | - R W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - C Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - M Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - G Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - P Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- UMSC, Hasselt-Pelt, Belgium
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25
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Inglese M, Amato MP. Presymptomatic MS or radiologically isolated syndrome should be actively monitored and treated: Commentary. Mult Scler 2023:13524585231172941. [PMID: 37212243 DOI: 10.1177/13524585231172941] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- Matilde Inglese
- Clinica Neurologica, Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Pia Amato
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy/Department of NEUROFARBA, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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26
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Schiavetti I, Inglese M, Frau J, Signoriello E, Caleri F, Stromillo ML, Ferrò MT, Rilla MT, Gandoglia I, Gazzola P, Brichetto G, Pasquali L, Grimaldi L, Ulivelli M, Marinelli F, Cordera S, Clerico M, Conte A, Salvetti M, Battaglia MA, Franciotta D, Uccelli A, Sormani MP. Antibody response elicited by the SARS-CoV-2 vaccine booster in patients with multiple sclerosis: who gains from it? Eur J Neurol 2023. [PMID: 37154406 DOI: 10.1111/ene.15830] [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: 02/10/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Although two doses of Covid-19 vaccine elicited a protective humoral response in most persons with multiple sclerosis (pwMS), a significant group of them treated with immunosuppressive disease modifying therapies (DMTs) showed less efficient responses. METHODS This prospective multiCenter observational study evaluates differences in immune response after a third vaccine dose in pwMS. RESULTS 473 pwMS were analyzed. Compared to untreated patients, there was a 50-fold decrease (95%CI=14.3-100.0, p < 0.001) in serum SARS-CoV-2 antibody levels in those on rituximab, a 20-fold decrease (95%CI=8.3-50.0, p < 0.001) in those on ocrelizumab, and a 2.3-fold decrease (95%CI=1.2-4.6, p = 0.015) in those on fingolimod. As compared to the antibody levels after the second vaccine dose, patients on the anti-CD20 drugs rituximab/ocrelizumab showed a 2.3-fold lower gain (95%CI=1.4-3.8; p = 0.001), whereas, in contrast, those on fingolimod showed a 1.7-fold higher gain (95%CI: 1.1-2.7; p = 0.012), compared to patients treated with other DMTs. Conclusions All pwMS increased their serum SARS-CoV-2 antibodies levels after the third vaccine dose. The mean antibody values of patients treated with ocrelizumab/rituximab remained well below the empirical 'protective threshold' for risk of infection identified in the CovaXiMS study (> 659 BAU/mL), whereas for patients treated with fingolimod this value was significantly closer to the cut-off.
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Affiliation(s)
- Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Italy
| | | | - Elisabetta Signoriello
- Centro Sclerosi Multipla, II Clinica Neurologica, Università della Campania Luigi Vanvitelli, Italy
| | - Francesca Caleri
- MS Center, Department of Neurology, F. Tappeiner Hospital Meran (BZ), Italy
| | - Maria Laura Stromillo
- Clinica Neurologica e Malattie Neurometaboliche, Università degli Studi di Siena, Italy
| | - Maria Teresa Ferrò
- Neuroimmunology, Center for Multiple Sclerosis, Cerobrovascular Department, Neurological Unit, ASST, Crema, Italy
| | | | | | - Paola Gazzola
- Centro Sclerosi Multipla S.C. Neurologia Asl 3 Genovese, Italy
| | | | - Livia Pasquali
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Italy
| | - Luigi Grimaldi
- UOC Neurologia e Centro SM Fondazione Istituto G. Giglio, Cefalù, Italy
| | - Monica Ulivelli
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Fabiana Marinelli
- Multiple Sclerosis Center, Fabrizio Spaziani Hospital, via Armando Fabi, Frosinone, Italy
| | | | - Marinella Clerico
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino Università di Torino, Italy
| | - Antonella Conte
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Marco Salvetti
- IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Italy
| | - Mario Alberto Battaglia
- Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy
- Department of Life Sciences, University of Siena, Italy
| | | | - Antonio Uccelli
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
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27
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Bouman PM, Noteboom S, Nobrega Santos FA, Beck ES, Bliault G, Castellaro M, Calabrese M, Chard DT, Eichinger P, Filippi M, Inglese M, Lapucci C, Marciniak A, Moraal B, Morales Pinzon A, Mühlau M, Preziosa P, Reich DS, Rocca MA, Schoonheim MM, Twisk JWR, Wiestler B, Jonkman LE, Guttmann CRG, Geurts JJG, Steenwijk MD. Multicenter Evaluation of AI-generated DIR and PSIR for Cortical and Juxtacortical Multiple Sclerosis Lesion Detection. Radiology 2023; 307:e221425. [PMID: 36749211 PMCID: PMC10102645 DOI: 10.1148/radiol.221425] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 02/08/2023]
Abstract
Background Cortical multiple sclerosis lesions are clinically relevant but inconspicuous at conventional clinical MRI. Double inversion recovery (DIR) and phase-sensitive inversion recovery (PSIR) are more sensitive but often unavailable. In the past 2 years, artificial intelligence (AI) was used to generate DIR and PSIR from standard clinical sequences (eg, T1-weighted, T2-weighted, and fluid-attenuated inversion-recovery sequences), but multicenter validation is crucial for further implementation. Purpose To evaluate cortical and juxtacortical multiple sclerosis lesion detection for diagnostic and disease monitoring purposes on AI-generated DIR and PSIR images compared with MRI-acquired DIR and PSIR images in a multicenter setting. Materials and Methods Generative adversarial networks were used to generate AI-based DIR (n = 50) and PSIR (n = 43) images. The number of detected lesions between AI-generated images and MRI-acquired (reference) images was compared by randomized blinded scoring by seven readers (all with >10 years of experience in lesion assessment). Reliability was expressed as the intraclass correlation coefficient (ICC). Differences in lesion subtype were determined using Wilcoxon signed-rank tests. Results MRI scans of 202 patients with multiple sclerosis (mean age, 46 years ± 11 [SD]; 127 women) were retrospectively collected from seven centers (February 2020 to January 2021). In total, 1154 lesions were detected on AI-generated DIR images versus 855 on MRI-acquired DIR images (mean difference per reader, 35.0% ± 22.8; P < .001). On AI-generated PSIR images, 803 lesions were detected versus 814 on MRI-acquired PSIR images (98.9% ± 19.4; P = .87). Reliability was good for both DIR (ICC, 0.81) and PSIR (ICC, 0.75) across centers. Regionally, more juxtacortical lesions were detected on AI-generated DIR images than on MRI-acquired DIR images (495 [42.9%] vs 338 [39.5%]; P < .001). On AI-generated PSIR images, fewer juxtacortical lesions were detected than on MRI-acquired PSIR images (232 [28.9%] vs 282 [34.6%]; P = .02). Conclusion Artificial intelligence-generated double inversion-recovery and phase-sensitive inversion-recovery images performed well compared with their MRI-acquired counterparts and can be considered reliable in a multicenter setting, with good between-reader and between-center interpretative agreement. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Zivadinov and Dwyer in this issue.
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Affiliation(s)
- Piet M. Bouman
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Samantha Noteboom
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Fernando A. Nobrega Santos
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Erin S. Beck
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Gregory Bliault
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Marco Castellaro
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Massimiliano Calabrese
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Declan T. Chard
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Paul Eichinger
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Massimo Filippi
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Matilde Inglese
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Caterina Lapucci
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Andrzej Marciniak
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Bastiaan Moraal
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Alfredo Morales Pinzon
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Mark Mühlau
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Paolo Preziosa
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Daniel S. Reich
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Maria A. Rocca
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Menno M. Schoonheim
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Jos W. R. Twisk
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Benedict Wiestler
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Laura E. Jonkman
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Charles R. G. Guttmann
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Jeroen J. G. Geurts
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Martijn D. Steenwijk
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
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Romanò F, Motl RW, Valsasina P, Amato MP, Brichetto G, Bruschi N, Chataway J, Chiaravalloti ND, Cutter G, Dalgas U, DeLuca J, Farrell R, Feys P, Freeman J, Inglese M, Meza C, Salter A, Sandroff BM, Feinstein A, Rocca MA, Filippi M. Abnormal thalamic functional connectivity correlates with cardiorespiratory fitness and physical activity in progressive multiple sclerosis. J Neurol 2023; 270:3213-3224. [PMID: 36933030 DOI: 10.1007/s00415-023-11664-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Altered thalamic volumes and resting state (RS) functional connectivity (FC) might be associated with physical activity (PA) and cardiorespiratory fitness (CRF) in people with progressive multiple sclerosis (PMS). OBJECTIVES To assess thalamic structural and functional alterations and investigate their correlations with PA/CRF levels in people with PMS. METHODS Seven-day accelerometry and cardiopulmonary exercise testing were used to assess PA/CRF levels in 91 persons with PMS. They underwent 3.0 T structural and RS fMRI acquisition with 37 age/sex-matched healthy controls (HC). Between-group comparisons of MRI measures and their correlations with PA/CRF variables were assessed. RESULTS PMS people had lower volumes compared to HC (all p < 0.001). At corrected threshold, PMS showed decreased intra- and inter-thalamic RS FC, and increased RS FC between the thalamus and the hippocampus, bilaterally. At uncorrected threshold, decreased thalamic RS FC with caudate nucleus, cerebellum and anterior cingulate cortex (ACC), as well as increased thalamic RS FC with occipital regions, were also detected. Lower CRF, measured as peak oxygen consumption (VO2peak), correlated with lower white matter volume (r = 0.31, p = 0.03). Moreover, lower levels of light PA correlated with increased thalamic RS FC with the right hippocampus (r = - 0.3, p = 0.05). DISCUSSION People with PMS showed widespread brain atrophy, as well as pronounced intra-thalamic and thalamo-hippocampal RS FC abnormalities. White matter atrophy correlated with CRF, while increased thalamo-hippocampal RS FC was associated to worse PA levels. Thalamic RS FC might be used to monitor physical impairment and efficacy of rehabilitative and disease-modifying treatments in future studies.
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Affiliation(s)
- Francesco Romanò
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Maria Pia Amato
- Section Neurosciences, Department NEUROFARBA, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy.,AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Via Operai 30, 16149, Genoa, Italy
| | - Nicolò Bruschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Jeremy Chataway
- Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, UCL, London, UK.,Biomedical Research Centre, National Institute for Health Research, University College London Hospitals, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000, Aarhus, Denmark
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Rachel Farrell
- Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Peter Feys
- Faculty of Rehabilitation Sciences, REVAL, Hasselt University, Diepenbeek, Belgium.,UMSC Hasselt, Pelt, Belgium
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Devon, UK
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - Amber Salter
- Section on Statistical Planning and Analysis, Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Brian M Sandroff
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy. .,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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29
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Boffa G, Signori A, Massacesi L, Mariottini A, Sbragia E, Cottone S, Amato MP, Gasperini C, Moiola L, Meletti S, Repice AM, Brescia Morra V, Salemi G, Patti F, Filippi M, De Luca G, Lus G, Zaffaroni M, Sola P, Conte A, Nistri R, Aguglia U, Granella F, Galgani S, Caniatti LM, Lugaresi A, Romano S, Iaffaldano P, Cocco E, Saccardi R, Angelucci E, Trojano M, Mancardi GL, Sormani MP, Inglese M. Hematopoietic Stem Cell Transplantation in People With Active Secondary Progressive Multiple Sclerosis. Neurology 2023; 100:e1109-e1122. [PMID: 36543569 PMCID: PMC10074454 DOI: 10.1212/wnl.0000000000206750] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Uncontrolled evidence suggests that autologous hematopoietic stem cell transplantation (AHSCT) can be effective in people with active secondary progressive multiple sclerosis (SPMS). In this study, we compared the effect of AHSCT with that of other anti-inflammatory disease-modifying therapies (DMTs) on long-term disability worsening in active SPMS. METHODS We collected data from the Italian Bone Marrow Transplantation Study Group and the Italian Multiple Sclerosis Register. Patients were considered eligible if treatment had been started after the diagnosis of SPMS. Disability worsening was assessed by the cumulative proportion of patients with a 6-month confirmed disability progression (CDP) according to the Expanded Disability Status Scale (EDSS) score. Key secondary endpoints were the EDSS time trend after treatment start and the prevalence of disability improvement over time. Time to first CDP was assessed by means of proportional hazard Cox regression models. A linear mixed model with a time × treatment group interaction was used to assess the longitudinal EDSS time trends. Prevalence of improvement was estimated using a modified Kaplan-Meier estimator and compared between groups by bootstrapping the area under the curve. RESULTS Seventy-nine AHSCT-treated patients and 1975 patients treated with other DMTs (beta interferons, azathioprine, glatiramer-acetate, mitoxantrone, fingolimod, natalizumab, methotrexate, teriflunomide, cyclophosphamide, dimethyl fumarate, and alemtuzumab) were matched to reduce treatment selection bias using propensity score and overlap weighting approaches. Time to first CDP was significantly longer in transplanted patients (hazard ratio [HR] = 0.50; 95% CI = 0.31-0.81; p = 0.005), with 61.7% of transplanted patients free from CPD at 5 years. Accordingly, EDSS time trend over 10 years was higher in patients treated with other DMTs than in AHSCT-treated patients (+0.157 EDSS points per year compared with -0.013 EDSS points per year; interaction p < 0.001). Patients who underwent AHSCT were more likely to experience a sustained disability improvement: 34.7% of patients maintained an improvement (a lower EDSS than baseline) 3 years after transplant vs 4.6% of patients treated by other DMTs (p < 0.001). DISCUSSION The use of AHSCT in people with active SPMS is associated with a slowing of disability progression and a higher likelihood of disability improvement compared with standard immunotherapy. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that autologous hematopoietic stem cell transplants prolonged the time to CDP compared with other DMTs.
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Affiliation(s)
- Giacomo Boffa
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Alessio Signori
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Luca Massacesi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Alice Mariottini
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Elvira Sbragia
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Salvatore Cottone
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Maria Pia Amato
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Claudio Gasperini
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Lucia Moiola
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Stefano Meletti
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Anna Maria Repice
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Vincenzo Brescia Morra
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Giuseppe Salemi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Francesco Patti
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Massimo Filippi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Giovanna De Luca
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Giacomo Lus
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Mauro Zaffaroni
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Patrizia Sola
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Antonella Conte
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Riccardo Nistri
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Umberto Aguglia
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Franco Granella
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Simonetta Galgani
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Luisa Maria Caniatti
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Alessandra Lugaresi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Silvia Romano
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Pietro Iaffaldano
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Eleonora Cocco
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Riccardo Saccardi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Emanuele Angelucci
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Maria Trojano
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Giovanni Luigi Mancardi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Maria Pia Sormani
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Matilde Inglese
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy.
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30
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Lapucci C, Tazza F, Rebella S, Boffa G, Sbragia E, Bruschi N, Mancuso E, Mavilio N, Signori A, Roccatagliata L, Cellerino M, Schiavi S, Inglese M. Central vein sign and diffusion MRI differentiate microstructural features within white matter lesions of multiple sclerosis patients with comorbidities. Front Neurol 2023; 14:1084661. [PMID: 36970546 PMCID: PMC10030505 DOI: 10.3389/fneur.2023.1084661] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/30/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction The Central Vein Sign (CVS) has been suggested as a potential biomarker to improve diagnostic specificity in multiple sclerosis (MS). Nevertheless, the impact of comorbidities on CVS performance has been poorly investigated so far. Despite the similar features shared by MS, migraine and Small Vessel Disease (SVD) at T2-weighted conventional MRI sequences, ex-vivo studies demonstrated their heterogeneous histopathological substrates. If in MS, inflammation, primitive demyelination and axonal loss coexist, in SVD demyelination is secondary to ischemic microangiopathy, while the contemporary presence of inflammatory and ischemic processes has been suggested in migraine. The aims of this study were to investigate the impact of comorbidities (risk factors for SVD and migraine) on the global and subregional assessment of the CVS in a large cohort of MS patients and to apply the Spherical Mean Technique (SMT) diffusion model to evaluate whether perivenular and non-perivenular lesions show distinctive microstructural features. Methods 120 MS patients stratified into 4 Age Groups performed 3T brain MRI. WM lesions were classified in "perivenular" and "non-perivenular" by visual inspection of FLAIR* images; mean values of SMT metrics, indirect estimators of inflammation, demyelination and fiber disruption (EXTRAMD: extraneurite mean diffusivity, EXTRATRANS: extraneurite transverse diffusivity and INTRA: intraneurite signal fraction, respectively) were extracted. Results Of the 5303 lesions selected for the CVS assessment, 68.7% were perivenular. Significant differences were found between perivenular and non-perivenular lesion volume in the whole brain (p < 0.001) and between perivenular and non-perivenular lesion volume and number in all the four subregions (p < 0.001 for all). The percentage of perivenular lesions decreased from youngest to oldest patients (79.7%-57.7%), with the deep/subcortical WM of oldest patients as the only subregion where the number of non-perivenular was higher than the number of perivenular lesions. Older age and migraine were independent predictors of a higher percentage of non-perivenular lesions (p < 0.001 and p = 0.013 respectively). Whole brain perivenular lesions showed higher inflammation, demyelination and fiber disruption than non perivenular lesions (p = 0.001, p = 0.001 and p = 0.02 for EXTRAMD, EXTRATRANS and INTRA respectively). Similar findings were found in the deep/subcortical WM (p = 0.001 for all). Compared to non-perivenular lesions, (i) perivenular lesions located in periventricular areas showed a more severe fiber disruption (p = 0.001), (ii) perivenular lesions located in juxtacortical and infratentorial regions exhibited a higher degree of inflammation (p = 0.01 and p = 0.05 respectively) and (iii) perivenular lesions located in infratentorial areas showed a higher degree of demyelination (p = 0.04). Discussion Age and migraine have a relevant impact in reducing the percentage of perivenular lesions, particularly in the deep/subcortical WM. SMT may differentiate perivenular lesions, characterized by higher inflammation, demyelination and fiber disruption, from non perivenular lesions, where these pathological processes seemed to be less pronounced. The development of new non-perivenular lesions, especially in the deep/subcortical WM of older patients, should be considered a "red flag" for a different -other than MS- pathophysiology.
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Affiliation(s)
- Caterina Lapucci
- HNSR, IRRCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Francesco Tazza
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | | | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Elvira Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Nicolò Bruschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Elisabetta Mancuso
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Nicola Mavilio
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Roccatagliata
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Simona Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino IRCCS, Genoa, Italy
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Dufour J, Hamzaoui M, Baptista RP, Boffa G, Ricigliano VAG, Branzoli F, Vignaud A, Inglese M, Stankoff B, Boumezbeur F, Bodini B. La deregulation energetique evaluee par rmn multi-noyaux 23na/31p a 7 tesla au cours de la sclerose en plaques. J Neuroradiol 2023. [DOI: 10.1016/j.neurad.2023.01.153] [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: 03/03/2023]
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Boccia VD, Lapucci C, Cellerino M, Tazza F, Rossi A, Schiavi S, Mancardi MM, Inglese M. Evaluating the central vein sign in paediatric-onset multiple sclerosis: A case series study. Mult Scler 2023; 29:475-478. [PMID: 36514274 DOI: 10.1177/13524585221142319] [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] [Indexed: 12/15/2022]
Abstract
The central vein sign (CVS) has been proposed as a biomarker of multiple sclerosis (MS). In adult-onset MS (AOMS), 40%-threshold of CVS positive (+) lesions demonstrated high accuracy for MS diagnosis. However, CVS+ lesions' performance has not been characterized in paediatric-onset (POMS) yet. We compared the CVS contribution to MS diagnosis in 10 POMS and 12 disease-duration-matched AOMS patients. Three POMS patients did not meet the 40%-threshold, while all AOMS patients were correctly diagnosed as having MS. The high proportion of periventricular confluent lesions, excluded from the CVS assessment, seemed to impair CVS sensitivity in POMS diagnosis.
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Affiliation(s)
- Vincenzo Daniele Boccia
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Caterina Lapucci
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy/HNSR, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Cellerino
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Francesco Tazza
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Andrea Rossi
- UO Neuroradiologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy/Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Simona Schiavi
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | | | - Matilde Inglese
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy/IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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33
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Preziosa P, Rocca MA, Pagani E, Valsasina P, Amato MP, Brichetto G, Bruschi N, Chataway J, Chiaravalloti ND, Cutter G, Dalgas U, DeLuca J, Farrell R, Feys P, Freeman J, Inglese M, Meani A, Meza C, Motl RW, Salter A, Sandroff BM, Feinstein A, Filippi M. Structural and functional magnetic resonance imaging correlates of fatigue and dual-task performance in progressive multiple sclerosis. J Neurol 2023; 270:1543-1563. [PMID: 36436069 DOI: 10.1007/s00415-022-11486-0] [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] [Received: 09/28/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Frontal cortico-subcortical dysfunction may contribute to fatigue and dual-task impairment of walking and cognition in progressive multiple sclerosis (PMS). PURPOSE To explore the associations among fatigue, dual-task performance and structural and functional abnormalities of frontal cortico-subcortical network in PMS. METHODS Brain 3 T structural and functional MRI sequences, Modified Fatigue Impact Scale (MFIS), dual-task motor and cognitive performances were obtained from 57 PMS patients and 10 healthy controls (HC). The associations of thalamic, caudate nucleus and dorsolateral prefrontal cortex (DLPFC) atrophy, microstructural abnormalities of their connections and their resting state effective connectivity (RS-EC) with fatigue and dual-task performance were investigated using random forest. RESULTS Thirty-seven PMS patients were fatigued (F) (MFIS ≥ 38). Compared to HC, non-fatigued (nF) and F-PMS patients had significantly worse dual-task performance (p ≤ 0.002). Predictors of fatigue (out-of-bag [OOB]-accuracy = 0.754) and its severity (OOB-R2 = 0.247) were higher Expanded Disability Status scale (EDSS) score, lower RS-EC from left-caudate nucleus to left-DLPFC, lower fractional anisotropy between left-caudate nucleus and left-thalamus, higher mean diffusivity between right-caudate nucleus and right-thalamus, and longer disease duration. Microstructural abnormalities in connections among thalami, caudate nuclei and DLPFC, mainly left-lateralized in nF-PMS and more bilateral in F-PMS, higher RS-EC from left-DLPFC to right-DLPFC in nF-PMS and lower RS-EC from left-caudate nucleus to left-DLPFC in F-PMS, higher EDSS score, higher WM lesion volume, and lower cortical volume predicted worse dual-task performances (OOB-R2 from 0.426 to 0.530). CONCLUSIONS In PMS, structural and functional frontal cortico-subcortical abnormalities contribute to fatigue and worse dual-task performance, with different patterns according to the presence of fatigue.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy.,AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Nicolò Bruschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Rachel Farrell
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | - Peter Feys
- REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, UK
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
| | - Brian M Sandroff
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
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Magnè F, Cellerino M, Balletto E, Aluan K, Inglese M, Mikulska M, Bassetti M. Anti-SARS-CoV-2 monoclonal antibodies for the treatment of active COVID-19 in multiple sclerosis: An observational study. Mult Scler 2023; 29:481-482. [PMID: 35762136 PMCID: PMC9971698 DOI: 10.1177/13524585221103787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Federica Magnè
- Infectious Disease Clinic, Policlinico
San Martino IRCCS, Genoa, Italy
| | - Maria Cellerino
- Department of Neuroscience,
Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI),
University of Genoa, Genoa, Italy
| | - Elisa Balletto
- Infectious Disease Clinic, Policlinico
San Martino IRCCS, Genoa, Italy
| | - Kenda Aluan
- Department of Neuroscience,
Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI),
University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience,
Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI),
University of Genoa, Genoa, Italy,Department of Neurology, Ospedale
Policlinico San Martino IRCCS, Genoa, Italy,M Inglese Ospedale Policlinico San Martino
IRCCS, Largo Daneo 3, 16100 Genoa, Italy.
| | - Malgorzata Mikulska
- Infectious Disease Clinic, Policlinico
San Martino IRCCS, Genoa, Italy,Department of Neuroscience,
Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI),
University of Genoa, Genoa, Italy,Department of Neurology, Ospedale
Policlinico San Martino IRCCS, Genoa, Italy,Department of Health Science (DISSAL),
Infectious Diseases Unit, University of Genoa, Italy
| | - Matteo Bassetti
- Infectious Disease Clinic, Policlinico
San Martino IRCCS, Genoa, Italy,Department of Health Science (DISSAL),
Infectious Diseases Unit, University of Genoa, Italy
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Schiavetti I, Barcellini L, Lapucci C, Tazza F, Cellerino M, Capello E, Franciotta D, Inglese M, Sormani MP, Uccelli A, Laroni A. CD19+ B cell values predict the increase of anti-SARS CoV2 antibodies in fingolimod-treated and COVID-19-vaccinated patients with multiple sclerosis. Mult Scler Relat Disord 2023; 70:104494. [PMID: 36603292 PMCID: PMC9800324 DOI: 10.1016/j.msard.2022.104494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Treatment with fingolimod for multiple sclerosis (MS) reduces the efficacy of COVID-19 vaccination. The aim of this exploratory study was to evaluate whether main lymphocyte subsets and demographic features correlated to the subsequent increase in anti-SARS-CoV2 antibodies following the third dose of COVID-19 vaccination in fingolimod-treated MS patients. METHODS This was a prospective single-center observational exploratory study including a subgroup of adult patients with MS (pwMS) in treatment with fingolimod who underwent COVID-19 vaccination. The association of anti-SARS-CoV2 antibody levels (reported as the Log10 of the difference between the post and pre third dose levels) with the total number and percentage of CD3+ T and CD19+ B was assessed by a linear regression model adjusted for age and sex. RESULTS We found that peripheral blood CD19+ B lymphocytes before the third dose of vaccination in pwMS treated with fingolimod predict the subsequent increase of anti-SARS-CoV2 antibodies. CONCLUSION This work suggests that evaluating the percentage of CD19+ B cells may be important to identify patients at risk of not producing SARS-CoV-2 antibodies, with possible reduced protection from COVID-19.
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Affiliation(s)
- Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova 16132, Italy
| | - Lucrezia Barcellini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Largo Daneo 3, Genova, Italy
| | - Caterina Lapucci
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | - Francesco Tazza
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Largo Daneo 3, Genova, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Largo Daneo 3, Genova, Italy
| | - Elisabetta Capello
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | - Diego Franciotta
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Largo Daneo 3, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova 16132, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Largo Daneo 3, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Largo Daneo 3, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy.
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Cellerino M, Schiavi S, Lapucci C, Sbragia E, Boffa G, Rolla-Bigliani C, Tonelli S, Boccia D, Bruschi N, Tazza F, Franciotta D, Inglese M. In-vivo characterization of macro- and microstructural injury of the subventricular zone in relapsing-remitting and progressive multiple sclerosis. Front Neurosci 2023; 17:1112199. [PMID: 37113155 PMCID: PMC10126477 DOI: 10.3389/fnins.2023.1112199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction The subventricular zone (SVZ) represents one of the main adult brain neurogenesis niche. In-vivo imaging of SVZ is very challenging and little is known about MRI correlates of SVZ macro- and micro-structural injury in multiple sclerosis (MS) patients. Methods The aim of the present study is to evaluate differences in terms of volume and microstructural changes [as assessed with the novel Spherical Mean Technique (SMT) model, evaluating: Neurite Signal fraction (INTRA); Extra-neurite transverse (EXTRATRANS) and mean diffusivity (EXTRAMD)] in SVZ between relapsing-remitting (RR) or progressive (P) MS patients and healthy controls (HC). We are also going to explore whether SVZ microstructural injury correlate with caudate (a nucleus that is in the vicinity of the SVZ) or thalamus (another well-defined grey matter area which is further from SVZ than caudate) volume and clinical disability. Clinical and brain MRI data were prospectively acquired from 20 HC, 101 RRMS, and 50 PMS patients. Structural and diffusion metrics inside the global SVZ, normal appearing (NA-) SVZ, caudate and thalamus were collected. Results We found a statistically significant difference between groups in terms of NA-SVZ EXTRAMD (PMS>RRMS>HC; p = 0.002), EXTRATRANS (PMS>RRMS>HC; p<0.0001), and INTRA (HC>RRMS>PMS; p = 0.009). Multivariable models showed that NA-SVZ metrics significantly predicted caudate (R 2 = 0.21, p < 0.0001), but not thalamus, atrophy. A statistically significant correlation between EXTRAMD and EXTRATRANS of the NA-SVZ and EDSS (r=0.25, p=0.003 and r=0.24, p = 0.003, respectively) was found. These findings were confirmed in analyses restricted to RRMS, but not to PMS patients. Discussion In conclusion, the microstructural damage we observed within the NA-SVZ of MS patients - reflecting higher free water content (higher EXTRAMD), cytoarchitecture disruption and astrogliosis (higher EXTRATRANS and lower INTRA) - was more evident in the progressive as compared to the relapsing phases of MS. These abnormalities were significantly associated with a more pronounced caudate atrophy and higher clinical disability scores. Our findings may support the neuroprotective role of SVZ in MS patients.
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Affiliation(s)
- Maria Cellerino
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Simona Schiavi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Caterina Lapucci
- Laboratory of Experimental Neurosciences, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elvira Sbragia
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Giacomo Boffa
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | | | - Serena Tonelli
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniele Boccia
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Nicolò Bruschi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Francesco Tazza
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Diego Franciotta
- Neuroimmunology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- *Correspondence: Matilde Inglese,
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Michelis D, Brunetti N, Solaro C, Mancardi GL, Uccelli A, Inglese M, Laroni A. Aging with multiple sclerosis: Clinical characterization of an elderly population, a cross-sectional study. Mult Scler Relat Disord 2023; 69:104464. [PMID: 36521384 DOI: 10.1016/j.msard.2022.104464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/07/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Daniele Michelis
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Nicole Brunetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Claudio Solaro
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Loc. Trompone, Moncrivello, Italy
| | - Giovanni Luigi Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy.
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Petracca M, Palladino R, Droby A, Kurz D, Graziano N, Wang K, Riley C, Howard J, Klineova S, Lublin F, Inglese M. Disability outcomes in early-stage African American and White people with multiple sclerosis. Mult Scler Relat Disord 2023; 69:104413. [PMID: 36399964 PMCID: PMC9892256 DOI: 10.1016/j.msard.2022.104413] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/28/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Factors driving differences in disease burden between African American and White people with multiple sclerosis (pwMS) remain unclear. Here, we explored whether differences in disability outcomes could be observed after controlling for major sociodemographic factors and comorbidities, and assessed the presence of a possible interaction between MS and race. METHODS In this cross-sectional study, 120 pwMS within 6 years from disease onset and 82 healthy controls between 18 and 70 years of age, self-identified as either African American or White, were prospectively enrolled. Inclusion criteria for pwMS were: diagnosis of MS according to the revised McDonald criteria, relapsing-remitting phenotype and Expanded Disability Status Scale (EDSS) < 6.5. Study outcomes included: (i) global disability (EDSS); (ii) quantitative mobility and leg function (Timed 25 Foot Walk Test-T25FWT); (iii) quantitative finger dexterity (9-Hole Peg Test-9HPT); (iv) cognitive efficiency and speed performance (Symbol Digit Modalities Test-SDMT). Differences in disability outcomes were assessed employing multivariable linear regression models. Based on their association with MS or disability, covariates included age, gender, race, years of education, total income, body mass index, comorbidities. The interaction between MS and race on disability outcomes was estimated via relative excess risk of interaction and attributable proportion. RESULTS Accounting for age, gender, total income, education, body mass index and comorbidities, African American pwMS showed significantly worse performances in manual dexterity and cognition than White pwMS (White pwMS coeff. 3.24, 95% CI 1.55, 4.92 vs African American pwMS coeff. 5.52, 95% CI 3.55, 7.48 and White pwMS coeff. -5.87, 95% CI -8.86, -2.87 vs African American pwMS coeff. -7.99, 95% CI -11.58,-4.38). MS and race independently contributed to the observed gradient in disability severity. CONCLUSIONS Complex social disparities and systemic racism might contribute to clinical heterogeneity in MS.
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Affiliation(s)
- Maria Petracca
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Raffaele Palladino
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Amgad Droby
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Kurz
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole Graziano
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine Wang
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claire Riley
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Jonathan Howard
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Sylvia Klineova
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fred Lublin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matilde Inglese
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; DINOGMI, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino-IRCSS, Genoa, Italy.
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Ponzano M, Schiavetti I, Bergamaschi R, Pisoni E, Bellavia A, Mallucci G, Carmisciano L, Inglese M, Cordioli C, Marfia GA, Cocco E, Immovilli P, Pesci I, Scandellari C, Cavalla P, Radaelli M, Vianello M, Vitetta F, Montepietra S, Amato MP, Fioretti C, Filippi M, Sartori A, Caleri F, Clerico M, Gallo A, Conte A, Clerici R, De Luca G, Boneschi FM, Cantello R, Calabrese M, Tortorella C, Rovaris M, Verrengia EP, Patti F, Morra VB, Salvetti M, Sormani MP. The impact of PM2.5, PM10 and NO2 on Covid-19 severity in a sample of patients with multiple sclerosis: A case-control study. Mult Scler Relat Disord 2022; 68:104243. [PMID: 36288659 PMCID: PMC9581645 DOI: 10.1016/j.msard.2022.104243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/19/2022] [Accepted: 10/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Many studies investigated the association between air pollution and Covid-19 severity but the only study focusing on patients with Multiple Sclerosis (MS) exclusively evaluated exposure to PM2.5. We aim to study, in a sample of MS patients, the impact of long-term exposure to PM2.5, PM10 and NO2 on Covid-19 severity, described as occurrence of pneumonia. METHODS A 1:2 ratio case-control study was designed, differentiating cases and controls based on Covid-19 pneumonia. Associations between pollutants and outcome were studied using logistic regression. Weighted quantile sum (WQS) logistic regression was used to identify the individual contribution of each pollutant within the mixture; Least Absolute Shrinkage and Selection Operator (LASSO) penalized regression was performed to confirm the variable selection from WQS. All the analyses were adjusted for confounders selected a priori. RESULTS Of the 615 eligible patients, 491 patients provided detailed place of exposure and were included in the principal analysis. Higher concentrations of air pollutants were associated with increased odds of developing Covid-19 pneumonia (PM2.5: 3rd vs 1st tercile OR(95% CI)=2.26(1.29;3.96); PM10: 3rd vs 1st tercile OR(95% CI)=2.12(1.22;3.68); NO2: 3rd vs 1st tercile OR(95% CI)=2.12(1.21;3.69)). Pollutants were highly correlated with each other; WQS index was associated to an increased risk of pneumonia (β=0.44; p-value=0.004) and the main contributors to this association were NO2 (41%) and PM2.5 (34%). Consistently, Lasso method selected PM2.5 and NO2. CONCLUSIONS Higher long-term exposure to PM2.5, PM10 and NO2 increased the odds of Covid-19 pneumonia among MS patients and the most dangerous pollutants were NO2 and PM2.5.
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Affiliation(s)
- Marta Ponzano
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Genoa, Italy.
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Genoa, Italy
| | | | - Enrico Pisoni
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Andrea Bellavia
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Giulia Mallucci
- Multiple Sclerosis Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Luca Carmisciano
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, ASST Spedali Civili di Brescia, Montichiari, Italy
| | - Girolama Alessandra Marfia
- Department of Systems Medicine, Multiple Sclerosis Clinical and Research Unit, Tor Vergata University, Rome, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, Ospedale Binaghi, Cagliari, Italy
| | - Paolo Immovilli
- Multiple Sclerosis Center, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Ilaria Pesci
- Multiple Sclerosis Center, UO Neurology, Fidenza, Fidenza, Italy
| | - Cinzia Scandellari
- IRCCS Institute of Neurological Sciences, UOSI Multiple Sclerosis Rehabilitation, Bologna, Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience, City of Health and Science University Hospital of Turin, Turin, Italy
| | - Marta Radaelli
- Department of Neurology and Multiple Sclerosis Center, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Marika Vianello
- Unit of Neurology, Ca' Fancello Hospital, AULSS2, Treviso, Italy
| | - Francesca Vitetta
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Sara Montepietra
- Neurology Unit, Neuromotor and Rehabilitation Department, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Arianna Sartori
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, ASUGI, University of Trieste, Trieste, Italy
| | - Francesca Caleri
- Department of Neurology, MS Center, F. Tappeiner Hospital, Merano, Italy
| | - Marinella Clerico
- Clinical and Biological Sciences Department, University of Turin, Turin, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, (NA), Italy
| | - Antonella Conte
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | | | - Giovanna De Luca
- Institute for Advanced Biomedical Technologies (ITAB), Department of Neurosciences, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | | | - Roberto Cantello
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Massimiliano Calabrese
- Department of Neuroscience, Biomedicine and Movement, The Multiple Sclerosis Center of the University Hospital of Verona, Verona, Italy
| | - Carla Tortorella
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | | | | | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Federico II University, Naples, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy; Unit of Neurology, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Sbragia E, Olobardi D, Novi G, Lapucci C, Cellerino M, Boffa G, Laroni A, Mikulska M, Sticchi L, Inglese M. Vaccinations in patients with multiple sclerosis: a real-world, single-center experience. Hum Vaccin Immunother 2022; 18:2099171. [PMID: 35863064 DOI: 10.1080/21645515.2022.2099171] [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] [Indexed: 12/15/2022] Open
Abstract
Vaccines prevent infections in patients with multiple sclerosis (MS). Though recommendations regarding vaccinating patients with MS have been recently published, real-world data regarding vaccines' planning in patients receiving disease-modifying drugs (DMDs) for MS are missing. Our aim was, therefore, to describe vaccination coverage rates, timing-proposal and safety in real-life vaccinating patients with MS undergoing DMDs before the start of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination campaign. Patients followed at our MS-center were referred to individualized immunization-programs customized to Italian recommendations, patients' risks, immunity to exanthematic diseases, ongoing DMDs, or therapy-start urgency. Disease-activity stated the need for an essential immunization-cycle, whose core was composed by four vaccines: meningococcal-B, pneumococcal conjugated, Haemophilus influenzae B, and meningococcal-ACWY vaccines. Vaccines were administered prior to the planned DMD-start when possible, inactivated-vaccines >2 weeks and live-vaccines >4 weeks before treatment-start. Patients received a 6-months clinical-/radiological-follow-up after immunization. One-hundred and ninety-five patients were vaccinated between April 2017 and January 2021. 124/195 (63.6%) started a vaccination-program before therapy-start/-switch and 108/124 (87.1%) effectively completed immunization before new therapy-start without any delay. The time needed for immunization-conclusion reached a median of 27 (confidence interval 22) days in 2020. No increase in clinical-/radiological-activity 3-/6-months after immunization was noted. In conclusion, our study confirmed feasibility and safety of a vaccination-protocol in patients with MS whose duration resulted in a median of 27 days.
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Affiliation(s)
- Elvira Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Dario Olobardi
- Hygiene Unit and Department of Health Sciences (DiSSal), IRCCS Ospedale Policlinico San Martino and University of Genoa, Genoa, Italy
| | - Giovanni Novi
- Department of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Caterina Lapucci
- Laboratory of Experimental Neurosciences and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), IRCCS Ospedale Policlinico San Martino and University of Genoa, Genoa, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Malgorzata Mikulska
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
| | - Laura Sticchi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Bach-Morrow L, Boccalatte F, DeRosa A, Devos D, Garcia-Sanchez C, Inglese M, Droby A. Functional changes in prefrontal cortex following frequency-specific training. Sci Rep 2022; 12:20316. [PMID: 36434008 PMCID: PMC9700664 DOI: 10.1038/s41598-022-24088-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
Numerous studies indicate a significant role of pre-frontal circuits (PFC) connectivity involving attentional and reward neural networks within attention deficit hyperactivity disorder (ADHD) pathophysiology. To date, the neural mechanisms underlying the utility of non-invasive frequency-specific training systems in ADHD remediation remain underexplored. To address this issue, we created a portable electroencephalography (EEG)-based wireless system consisting of a novel headset, electrodes, and neuro program, named frequency specific cognitive training (FSCT). In a double-blind, randomized, controlled study we investigated the training effects in N = 46 school-age children ages 6-18 years with ADHD. 23 children in experimental group who underwent FCST training showed an increase in scholastic performance and meliorated their performance on neuropsychological tests associated with executive functions and memory. Their results were compared to 23 age-matched participants who underwent training with placebo (pFSCT). Electroencephalogram (EEG) data collected from participants trained with FSCT showed a significant increase in 14-18 Hz EEG frequencies in PFC brain regions, activities that indicated brain activation in frontal brain regions, the caudate nucleus, and putamen. These results demonstrate that FSCT targets specific prefrontal and striatal areas in children with ADHD, suggesting a beneficial modality for non-invasive modulation of brain areas implicated in attention and executive functions.
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Affiliation(s)
| | - Francesco Boccalatte
- grid.240324.30000 0001 2109 4251Department of Pathology, NYU Langone Medical Center, New York, NY USA
| | - Antonio DeRosa
- grid.164295.d0000 0001 0941 7177Department of Mathematics, University of Maryland, College Park, MD USA
| | - David Devos
- grid.503422.20000 0001 2242 6780Department of Neurology, University Hospital, Univ of Lille, Lille, France
| | - Carmen Garcia-Sanchez
- grid.413396.a0000 0004 1768 8905Neuropsychology Unit, Neurology Service, Hospital de Sant Pau, Barcelona, Spain
| | - Matilde Inglese
- grid.59734.3c0000 0001 0670 2351Neurology Department, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Amgad Droby
- grid.59734.3c0000 0001 0670 2351Neurology Department, Icahn School of Medicine at Mount Sinai, New York, NY USA
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Islam S, Inglese M, Aravind P, Barwick T, Wang J, O’Neill K, Waldman A, Williams M, Aboagye E. 18F-Fluoropivalate PET/MRI: imaging of treatment naïve patients and patients treated with radiosurgery. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00930-3] [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: 11/03/2022]
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Gelato F, Mastorino L, Cavalla P, Quaglino P, Cavaliere G, Vercellino M, Bosa C, Inglese M, De Palma R, Ortoncelli M, Ribero S. Onset of multiple sclerosis in a patient on dupilumab therapy for atopic dermatitis: A case report. Dermatol Ther 2022; 35:e15740. [PMID: 35899485 PMCID: PMC9788158 DOI: 10.1111/dth.15740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/24/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Federica Gelato
- Dermatology Clinic, Department of Medical SciencesUniversity of TurinTurinItaly
| | - Luca Mastorino
- Dermatology Clinic, Department of Medical SciencesUniversity of TurinTurinItaly
| | - Paola Cavalla
- Department of Neurosciences and Mental HealthCity of Health and Science University Hospital of TurinTurinItaly
| | - Pietro Quaglino
- Dermatology Clinic, Department of Medical SciencesUniversity of TurinTurinItaly
| | - Giovanni Cavaliere
- Dermatology Clinic, Department of Medical SciencesUniversity of TurinTurinItaly
| | - Marco Vercellino
- Department of Neurosciences and Mental HealthCity of Health and Science University Hospital of TurinTurinItaly
| | - Chiara Bosa
- Department of NeurosciencesUniversity of TurinTurinItaly
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical ResearchUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly,Division of Clinical Immunology, Department of Internal Medicine (DIMI)University of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Raffaele De Palma
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical ResearchUniversity of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly,Division of Clinical Immunology, Department of Internal Medicine (DIMI)University of Genoa and IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Michela Ortoncelli
- Dermatology Clinic, Department of Medical SciencesUniversity of TurinTurinItaly
| | - Simone Ribero
- Dermatology Clinic, Department of Medical SciencesUniversity of TurinTurinItaly
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Landi D, Bovis F, Grimaldi A, Annovazzi PO, Bertolotto A, Bianchi A, Borriello G, Brescia Morra V, Bucello S, Buscarinu MC, Caleri F, Capobianco M, Capra R, Cellerino M, Centonze D, Cerqua R, Chisari CG, Clerico M, Cocco E, Cola G, Cordioli C, Curti E, d'Ambrosio A, D'Amico E, De Luca G, Di Filippo M, Di Lemme S, Fantozzi R, Ferraro D, Ferraro E, Gallo A, Gasperini C, Granella F, Inglese M, Lanzillo R, Lorefice L, Lus G, Malucchi S, Margoni M, Mataluni G, Mirabella M, Moiola L, Nicoletti CG, Nociti V, Patti F, Pinardi F, Portaccio E, Pozzilli C, Ragonese P, Rasia S, Salemi G, Signoriello E, Vitetta F, Totaro R, Sormani MP, Amato MP, Marfia GA. Exposure to natalizumab throughout pregnancy: effectiveness and safety in an Italian cohort of women with multiple sclerosis. J Neurol Neurosurg Psychiatry 2022:jnnp-2022-329657. [PMID: 36180219 DOI: 10.1136/jnnp-2022-329657] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/23/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Assessing the risk of clinical and radiological reactivation during pregnancy and post partum in women with multiple sclerosis (MS) treated with natalizumab (NTZ) throughout pregnancy (LONG_EXP) compared with women interrupting treatment before (NO_EXP) and within >-30 days and ≤90 days from conception (SHORT_EXP), and describing newborns' outcomes. METHODS Maternal clinical and radiological outcomes and obstetric and fetal outcomes were retrospectively collected and compared among groups (NO_EXP, SHORT_EXP, LONG_EXP). Predictors of clinical and radiological reactivation were investigated through univariable and multivariable analysis. RESULTS 170 eligible pregnancies from 163 women referring to 29 Italian MS centres were included. Annualised relapse rate (ARR) was significantly lower in LONG_EXP (n=66, 0.02 (0.001-0.09)) compared with NO_EXP (n=31, 0.43 (0.21-0.75), p=0.002) and SHORT_EXP (n=73, 0.46 (0.30-0.66), p=0.0004) during pregnancy, and in LONG_EXP (0.12 (0.05-0.24)) compared with SHORT_EXP (0.30 (0.17-0.50), p=0.008) during post partum. Gadolinium-enhancing (Gd+) lesions were less frequent in LONG_EXP (n=6/50, 2.00%) compared with NO_EXP (n=9/21, 42.86%) and SHORT_EXP after delivery (n=17/49, 34.69%, p=0.010).Delaying NTZ resumption after delivery significantly increased the risk of relapses (OR=1.29 (95% CI 1.07 to 1.57), p=0.009) and Gd+ lesions (OR=1.49 (95% CI 1.17 to 1.89, p=0.001). Newborns' weight, length, head circumference and gestational age did not differ among groups after adjusting for confounders. Anaemia was tracked in 4/69 LONG_EXP newborns. Congenital anomaly rate was within the expected range for the untreated MS population. CONCLUSIONS Our findings indicate that in women with MS treated with NTZ before conception, continuation of NTZ throughout pregnancy and its early resumption after delivery mitigate the risk of clinical and radiological reactivation. This approach has no major impact on newborns' outcomes.
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Affiliation(s)
- Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy
| | - Francesca Bovis
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genoa, Italy
| | - Alfonso Grimaldi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy
| | - Pietro Osvaldo Annovazzi
- Multiple Sclerosis Center, Neurology II Unit, ASST Valle Olona, Gallarate Hospital, Gallarate, Italy
| | - Antonio Bertolotto
- Multiple Sclerosis Center (CRESM), Department of Neurology, 'San Luigi Gonzaga' University Hospital, Orbassano, Italy
| | - Alessia Bianchi
- Unit of Neurology, Department of Biomedicine, Neurosciences and Advanced Diagnostics, Palermo University, Palermo, Italy
| | - Giovanna Borriello
- Multiple Sclerosis Center, 'S. Andrea' Hospital, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples, Italy
| | - Sebastiano Bucello
- Multiple Sclerosis Center, "E. Muscatello" Hospital - ASP8, Augusta (SR), Italy
| | - Maria Chiara Buscarinu
- Department of Neuroscience, Mental Health and Sensory Organs, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Francesca Caleri
- Multiple Sclerosis Center, Department of Neurology, 'F. Tappeiner' Hospital, Merano (BZ), Italy
| | - Marco Capobianco
- Multiple Sclerosis Center (CRESM), Department of Neurology, 'San Luigi Gonzaga' University Hospital, Orbassano, Italy
| | - Ruggero Capra
- Multiple Sclerosis Center, Spedali Civili of Brescia, Montichiari (BS), Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Italy
| | - Diego Centonze
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Unit of Neurology, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Raffaella Cerqua
- Neurological Clinic, Department of Experimental and Clinical Medicine, Ospedali Riuniti, Ancona, Italy
| | - Clara Grazia Chisari
- Department of Medical and Surgical Sciences and Advanced Technologies 'G.F. Ingrassia', Section of Neurosciences, University of Catania, Catania, Italy
| | - Marinella Clerico
- Clinical and Biological Sciences Department, Neurology Unit, University of Torino, 'San Luigi Gonzaga' Hospital, Orbassano, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Gaia Cola
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, Spedali Civili of Brescia, Montichiari (BS), Italy
| | - Erica Curti
- Unit of Neurology, Department of General and Specialized Medicine, Parma University Hospital, Parma, Italy
| | - Alessandro d'Ambrosio
- I Division of Neurology, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Emanuele D'Amico
- Department of Medical and Surgical Sciences and Advanced Technologies 'G.F. Ingrassia', Section of Neurosciences, University of Catania, Catania, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Center, 'SS Annunziata' Hospital, 'Gabriele d'Annunzio' University Chieti-Pesacara, Chieti, Italy
| | - Massimiliano Di Filippo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | | | - Diana Ferraro
- Department of Biomedical Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Antonio Gallo
- I Division of Neurology, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Claudio Gasperini
- Department of Neurosciences, 'San Camillo Forlanini' Hospital, Rome, Italy
| | - Franco Granella
- Unit of Neurology, Department of General and Specialized Medicine, Parma University Hospital, Parma, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Italy
- Department of Neurology, Policlinico 'San Martino Hospital'-Sistema Sanitario Regione, Genoa, Italy
| | - Roberta Lanzillo
- Department of Neurosciences Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples, Italy
| | - Lorena Lorefice
- Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna-Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, II Division of Neurology, Multiple Sclerosis Center, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Simona Malucchi
- Multiple Sclerosis Center (CRESM), Department of Neurology, 'San Luigi Gonzaga' University Hospital, Orbassano, Italy
| | - Monica Margoni
- Multiple Sclerosis Center of the Veneto Region, Department of Neurosciences, University of Padua, Padua, Italy
| | - Giorgia Mataluni
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy
| | - Massimiliano Mirabella
- Department of Neurosciences, Centro di Ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy, 'A.Gemelli' University Hospital, Rome, Italy
| | - Lucia Moiola
- Multiple Sclerosis Center, Neurology Department, San Raffaele Hospital IRCCS, Milan, Italy
| | - Carolina Gabri Nicoletti
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy
| | - Viviana Nociti
- Department of Neurosciences, Centro di Ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy, 'A.Gemelli' University Hospital, Rome, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies 'G.F. Ingrassia', Section of Neurosciences, University of Catania, Catania, Italy
| | - Federica Pinardi
- UOSI Multiple Sclerosis Rehabilitation, IRCCS Istituto delle scienze neurologiche, Bologna, Italy
| | - Emilio Portaccio
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, Department of Human Neurosciences, 'S.Andrea' Hospital, Sapienza University of Rome, Rome, Italy
| | - Paolo Ragonese
- Unit of Neurology, Department of Biomedicine, Neurosciences and Advanced Diagnostics, Palermo University, Palermo, Italy
| | - Sarah Rasia
- Multiple Sclerosis Center, Spedali Civili of Brescia, Montichiari (BS), Italy
| | - Giuseppe Salemi
- Unit of Neurology, Department of Biomedicine, Neurosciences and Advanced Diagnostics, Palermo University, Palermo, Italy
| | - Elisabetta Signoriello
- Department of Advanced Medical and Surgical Sciences, II Division of Neurology, Multiple Sclerosis Center, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Francesca Vitetta
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Rocco Totaro
- Demyelinating Disease Center, Neurology Unit, University of L'Aquila, L'Aquila, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genoa, Italy
| | - Maria Pia Amato
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, Italy
- IRCCS, Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy
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Filippi M, Amato MP, Centonze D, Gallo P, Gasperini C, Inglese M, Patti F, Pozzilli C, Preziosa P, Trojano M. Correction to: Early use of high-efficacy disease-modifying therapies makes the difference in people with multiple sclerosis: an expert opinion. J Neurol 2022; 269:6690-6691. [PMID: 36138162 PMCID: PMC9618484 DOI: 10.1007/s00415-022-11385-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Diego Centonze
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
- Unit of Neurology, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Paolo Gallo
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Claudio Gasperini
- Department of Neurosciences, S Camillo Forlanini Hospital Rome, Rome, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Patti
- Department GF Ingrassia, Medical, Surgical Science and Advanced Technologies, University of Catania, Catania, Italy
- Center for Multiple Sclerosis, Policlinico "G Rodolico", University of Catania, Catania, Italy
| | | | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
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Schiavetti I, Carmisciano L, Ponzano M, Cordioli C, Cocco E, Marfia GA, Inglese M, Filippi M, Radaelli M, Bergamaschi R, Immovilli P, Capobianco M, De Rossi N, Brichetto G, Scandellari C, Cavalla P, Pesci I, Confalonieri P, Perini P, Trojano M, Lanzillo R, Tedeschi G, Comi G, Battaglia MA, Patti F, Salvetti M, Sormani MP. Signs and symptoms of Covid‐19 in patients with multiple sclerosis. Eur J Neurol 2022; 29:3728-3736. [PMID: 36086905 PMCID: PMC9538224 DOI: 10.1111/ene.15554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Abstract
Background and purpose Clinical outcomes of multiple sclerosis (MS) patients affected by coronavirus disease 2019 (COVID‐19) have been thoroughly investigated, but a further analysis on main signs and symptoms and their risk factors still needs attention. The objective of this study was to group together and describe based on similarity the most common signs and symptoms of COVID‐19 in MS patients and identify all factors associated with their manifestation. Method Logistic and linear regression models were run to recognize factors associated with each pooled group of symptoms and their total number. Results From March 2020 to November 2021, data were collected from 1354 MS patients with confirmed infection of COVID‐19. Ageusia and anosmia was less frequent in older people (odds ratio [OR] 0.98; p = 0.005) and more in smoker patients (OR 1.39; p = 0.049). Smoke was also associated with an incremental number of symptoms (OR 1.24; p = 0.031), substance abuse (drugs or alcohol), conjunctivitis and rash (OR 5.20; p = 0.042) and the presence of at least one comorbidity with shortness of breath, tachycardia or chest pain (OR 1.24; p = 0.008). Some disease‐modifying therapies were associated with greater frequencies of certain COVID‐19 symptoms (association between anti‐CD20 therapies and increment in the number of concomitant symptoms: OR 1.29; p = 0.05). Differences in frequencies between the three waves were found for flu‐like symptoms (G1, p = 0.024), joint or muscle pain (G2, p = 0.013) and ageusia and anosmia (G5, p < 0.001). All cases should be referred to variants up to Delta. Conclusion Several factors along with the choice of specific therapeutic approaches might have a different impact on the occurrence of some COVID‐19 symptoms.
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Affiliation(s)
| | | | - Marta Ponzano
- Department of Health Sciences University of Genova Genova Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla, ATS Sardegna Cagliari Italy
- Dipartimento Scienze Mediche e Sanità Pubblica, Università di Cagliari Cagliari Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine Tor Vergata University Rome Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Massimo Filippi
- Neurology Unit IRCCS San Raffaele Scientific Institute Milan Italy
- Neurorehabilitation Unit IRCCS San Raffaele Scientific Institute Milan Italy
- Neurophysiology Unit IRCCS San Raffaele Scientific Institute Milan Italy
- Neuroimaging Research Unit, Division of Neuroscience IRCCS San Raffaele Scientific Institute Milan Italy
- Vita‐Salute San Raffaele University Milan Italy
| | - Marta Radaelli
- Department of Neurology and Multiple Sclerosis Center, ASST ‘Papa Giovanni XXIII’ Bergamo Italy
| | | | - Paolo Immovilli
- Multiple Sclerosis Center, Ospedale Guglielmo da Saliceto Piacenza Italy
| | - Marco Capobianco
- Regional Referral Multiple Sclerosis Centre, Department of Neurology University Hospital San Luigi Orbassano (Torino) Italy
| | - Nicola De Rossi
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari Italy
| | | | - Cinzia Scandellari
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Riabilitazione Sclerosi Multipla Bologna Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience City of Health and Science University Hospital of Turin Turin Italy
| | - Ilaria Pesci
- Centro SM UOC Neurologia, Fidenza, AUSL PR, Fidenza Italy
| | - Paolo Confalonieri
- Multiple Sclerosis Centre, Neuroimmunology Department ‘Carlo Besta’ Neurological Institute Milan Italy
| | - Paola Perini
- Department of Neurology Multiple Sclerosis Center University of Padua Padova Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs University of Bari Bari Italy
| | | | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences University of Campania Napoli Italy
| | - Giancarlo Comi
- Università Vita Salute San Raffaele, Casa di Cura Privata del Policlinico Milan Italy
| | - Mario Alberto Battaglia
- Research Department, Italian Multiple Sclerosis Foundation Genoa Italy
- Department of Life Sciences University of Siena Siena Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia University of Catania Catania Italy
- Centro Sclerosi Multipla, Policlinico Catania University of Catania Catania Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs Sapienza University of Rome Rome Italy
- Unit of Neurology, IRCCS Neuromed Pozzilli Italy
| | - Maria Pia Sormani
- Department of Health Sciences University of Genova Genova Italy
- IRCCS Ospedale Policlinico San Martino Genoa Italy
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Portaccio E, Fonderico M, Iaffaldano P, Pastò L, Razzolini L, Bellinvia A, De Luca G, Ragonese P, Patti F, Brescia Morra V, Cocco E, Sola P, Inglese M, Lus G, Pozzilli C, Maimone D, Lugaresi A, Gazzola P, Comi G, Pesci I, Spitaleri D, Rezzonico M, Vianello M, Avolio C, Logullo FO, Granella F, Salvetti M, Zaffaroni M, Lucisano G, Filippi M, Trojano M, Amato MP. Disease-Modifying Treatments and Time to Loss of Ambulatory Function in Patients With Primary Progressive Multiple Sclerosis. JAMA Neurol 2022; 79:869-878. [PMID: 35877104 PMCID: PMC9315975 DOI: 10.1001/jamaneurol.2022.1929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/19/2022] [Indexed: 12/20/2022]
Abstract
Importance Except for ocrelizumab, treatment options in primary progressive multiple sclerosis (PPMS) are lacking. Objective To investigate the effectiveness of DMTs on the risk of becoming wheelchair dependent in a real-world population of patients with PPMS. Design, Setting, and Participants This was a multicenter, observational, retrospective, comparative effectiveness research study. Data were extracted on November 28, 2018, from the Italian multiple sclerosis register and analyzed from June to December 2021. Mean study follow-up was 11 years. Included in the study cohort were patients with a diagnosis of PPMS and at least 3 years of Expanded Disability Status Scale (EDSS) evaluations and 3 years of follow-up. Main Outcomes and Measures The risk of reaching an EDSS score of 7.0 was assessed through multivariable Cox regression models. Exposures Patients who received DMT before the outcome were considered treated. DMT was assessed as a time-dependent variable and by class of DMT (moderately and highly effective). Results From a total of 3298 patients with PPMS, 2633 were excluded because they did not meet the entry criteria for the phase 3, multicenter, randomized, parallel-group, double-blind, placebo-controlled study to evaluate the efficacy and safety of ocrelizumab in adults with PPMS (ORATORIO) trial. Among the remaining 665 patients (mean [SD] age, 43.0 [10.7] years; 366 female patients [55.0%]), 409 were further selected for propensity score matching (288 treated and 121 untreated patients). In the matched cohort, during the study follow-up, 37% of patients (152 of 409) reached an EDSS score of 7.0 after a mean (SD) follow-up of 10.6 (5.6) years. A higher EDSS score at baseline (adjusted hazard ratio [aHR], 1.32; 95% CI, 1.13-1.55; P < .001), superimposed relapses (aHR, 2.37; 95% CI, 1.24-4.54; P = .009), and DMT exposure (aHR, 1.75; 95% CI, 1.04-2.94; P = .03) were associated with a higher risk of an EDSS score of 7.0, whereas the interaction term between DMT and superimposed relapses was associated with a reduced risk of EDSS score of 7.0 (aHR, 0.33; 95% CI, 0.16-0.71; P = .004). Similar findings were obtained when treatment according to DMT class was considered and when DMT was included as a time-dependent covariate. These results were confirmed in the subgroup of patients with available magnetic resonance imaging data. Conclusions and Relevance Results of this comparative effectiveness research study suggest that inflammation also occurs in patients with PPMS, may contribute to long-term disability, and may be associated with a reduced risk of becoming wheelchair dependent by current licensed DMTs.
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Affiliation(s)
- Emilio Portaccio
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Mattia Fonderico
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro Policlinico, Bari, Italy
| | - Luisa Pastò
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Lorenzo Razzolini
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Angelo Bellinvia
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Policlinico Santissima Annunziata, Università G. d’Annunzio Chieti-Pescara, Abruzzo, Italia
| | - Paolo Ragonese
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, Gian Filippo Ingrassia, Sezione Neuroscienze, Centro Sclerosi Multipla, University of Catania, Catania, Italy
| | - Vincenzo Brescia Morra
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Napoli, Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla; Dipartimento di Scienze Mediche e Sanità Pubblica, University of Cagliari, Cagliari, Italy
| | - Patrizia Sola
- Centro Malattie Demielinizzanti, Dipartimento di Neuroscienze, Azienda Ospedaliero-Universitaria, Unità Operativa Neurologia, University of Modena and Reggio Emilia, Modena, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genoa, Italia
| | - Giacomo Lus
- Università della Campania Luigi Vanvitelli, Naples, Italia
| | - Carlo Pozzilli
- Multiple Sclerosis Center, Sant’Andrea Hospital, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, Unità Operativa Complessa Neurologia, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione, Garibaldi, Catania, Italia
| | - Alessandra Lugaresi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italia
- Istituto di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia
| | - Paola Gazzola
- Struttura Complessa Neurologia, L’Ospedale Antero Micone di Sestri Ponente, Genovese, Italia
| | - Giancarlo Comi
- San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ilaria Pesci
- Centro Sclerosi Multipla Unità Operativa Neurologia, Ospedale Di Vaio, Fidenza, Azienda Unità Sanitaria Locale, Parma, Italia
| | - Daniele Spitaleri
- Centro Sclerosi Multipla, Unità Operativa Complessa di Neurologia, Azienda Ospedaliera di Rilievo Nazionale, San G. Moscati di Avellino, Avellino, Italia
| | - Marta Rezzonico
- Centro Sclerosi Multipla Unità Operativa Neurologia, Azienda Socio Sanitaria Territoriale, Lariana Ospedale Sant’Anna, Como, Italia
| | - Marika Vianello
- Centro Sclerosi Multipla, Ospedale Regionale ‘Ca’ Foncello, Neurology Unit, Treviso, Italia
| | - Carlo Avolio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Multiple Sclerosis Intradipartimental Center, Department of Neurosciences, Policlinico Riuniti, Foggia, Italy
| | | | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, Sant’Andrea Hospital/Sapienza University, Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico Mediterraneo, Neuromed, Pozzilli, Isernia, Italia
| | - Mauro Zaffaroni
- Centro Sclerosi Multipla, ASST della Valle Olona, Ospedale di Gallarate, Gallarate, Italia
| | - Giuseppe Lucisano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro Policlinico, Bari, Italy
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italia
| | - Massimo Filippi
- Neurology, Neurorehabilitation and Neurophysiology Units, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro Policlinico, Bari, Italy
| | - Maria Pia Amato
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Florence, Italy
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Zanghì A, Avolio C, Signoriello E, Abbadessa G, Cellerino M, Ferraro D, Messina C, Barone S, Callari G, Tsantes E, Sola P, Valentino P, Granella F, Patti F, Lus G, Bonavita S, Inglese M, D'Amico E. Is It Time for Ocrelizumab Extended Interval Dosing in Relapsing Remitting MS? Evidence from An Italian Multicenter Experience During the COVID-19 Pandemic. Neurotherapeutics 2022; 19:1535-1545. [PMID: 36036858 PMCID: PMC9422942 DOI: 10.1007/s13311-022-01289-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Accepted: 08/10/2022] [Indexed: 01/05/2023] Open
Abstract
In the COVID-19 pandemic era, safety concerns have been raised regarding the risk of severe infection following administration of ocrelizumab (OCR), a B-cell-depleting therapy. We enrolled all relapsing remitting multiple sclerosis (RRMS) patients who received maintenance doses of OCR from January 2020 to June 2021. Data were extracted in December 2021. Standard interval dosing (SID) was defined as a regular maintenance interval of OCR infusion every 6 months, whereas extended interval dosing (EID) was defined as an OCR infusion delay of at least 4 weeks. Three infusions were considered in defining SID vs. EID (infusions A, B, and C). Infusion A was the last infusion before January 2020. The primary study outcome was a comparison of disease activity during the A-C interval, which was defined as either clinical (new relapses) or radiological (new lesions on T1-gadolinium or T2-weighted magnetic resonance imaging (MRI) sequences). Second, we aimed to assess confirmed disability progression (CDP). A total cohort of 278 patients (174 on SID and 104 on EID) was enrolled. Patients who received OCR on EID had a longer disease duration and a higher rate of vaccination against severe acute respiratory syndrome-coronavirus 2 (p < 0.05). EID was associated with an increased risk of MRI activity during the A-C interval (OR 5.373, 95% CI 1.203-24.001, p = 0.028). Being on SID or EID did not influence CDP (V-Cramer 0.47, p = 0.342). EID seemed to be associated with a higher risk of MRI activity in our cohort. EID needs to be carefully considered for OCR-treated patients.
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Affiliation(s)
- Aurora Zanghì
- UOC Neurology, Sant'Elia Hospital, Caltanissetta, Italy
| | - Carlo Avolio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Head of Multiple Sclerosis Center, Dept. of Neurosciences, Policlinico Riuniti Hospital, Foggia, Italy
| | - Elisabetta Signoriello
- Multiple Sclerosis Center, II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Gianmarco Abbadessa
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università della Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Diana Ferraro
- University of Modena and Reggio Emilia, Modena, Italy
| | - Christian Messina
- Department "G.F. Ingrassia", MS Center University of Catania, Catania, Italy
| | - Stefania Barone
- Azienda Ospedaliera Universitaria "Mater Domini", Catanzaro, Italy
| | | | - Elena Tsantes
- Department of General Medicine, Parma University Hospital, Parma, Italy
| | - Patrizia Sola
- University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Valentino
- Azienda Ospedaliera Universitaria "Mater Domini", Catanzaro, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
- Multiple Sclerosis Centre, Department of General Medicine, Parma University Hospital, Parma, Italy
| | - Francesco Patti
- Department "G.F. Ingrassia", MS Center University of Catania, Catania, Italy
| | - Giacomo Lus
- Multiple Sclerosis Center, II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Simona Bonavita
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università della Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emanuele D'Amico
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
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49
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Iaffaldano P, Lucisano G, Guerra T, Patti F, Onofrj M, Brescia Morra V, Zaffaroni M, Pozzilli C, Cocco E, Sola P, Salemi G, Inglese M, Bergamaschi R, Gasperini C, Conte A, Salvetti M, Lus G, Maniscalco GT, Totaro R, Vianello M, Granella F, Ferraro E, Aguglia U, Gatto M, Sangalli F, Chisari CG, De Luca G, Carotenuto A, Baroncini D, Colombo D, Nica M, Paolicelli D, Comi G, Filippi M, Amato MP, Trojano M. Towards a validated definition of the clinical transition to secondary progressive multiple sclerosis: A study from the Italian MS Register. Mult Scler 2022; 28:2243-2252. [PMID: 35971322 DOI: 10.1177/13524585221114007] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Definitions for reliable identification of transition from relapsing-remitting multiple sclerosis (MS) to secondary progressive (SP)MS in clinical cohorts are not available. OBJECTIVES To compare diagnostic performances of two different data-driven SPMS definitions. METHODS Data-driven SPMS definitions based on a version of Lorscheider's algorithm (DDA) and on the EXPAND trial inclusion criteria were compared, using the neurologist's definition (ND) as gold standard, in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), Akaike information criterion (AIC) and area under the curve (AUC). RESULTS A cohort of 10,240 MS patients with ⩾5 years of follow-up was extracted from the Italian MS Registry; 880 (8.5%) patients were classified as SPMS according to the neurologist definition, 1806 (17.6%) applying the DDA and 1134 (11.0%) with the EXPAND definition. The DDA showed greater discrimination power (AUC: 0.8 vs 0.6) and a higher sensitivity (77.1% vs 38.0%) than the EXPAND definition, with similar specificity (88.0% vs 91.5%). PPV and NPV were higher using the DDA than considering EXPAND definition (37.5% vs 29.5%; 97.6% vs 94.0%). CONCLUSION Data-driven definitions demonstrated greater ability to capture SP transition than neurologist's definition and the global accuracy of DDA seems to be higher than the EXPAND definition.
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Affiliation(s)
- Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Giuseppe Lucisano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy/Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Tommaso Guerra
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania, Catania, Italy
| | - Marco Onofrj
- Centro Sclerosi Multipla, Clinica Neurologica, Policlinico SS Annunziata, Università 'G. d'Annunzio', Chieti-Pescara, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Center, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Napoli, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, Sant' Andrea Hospital, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Eleonora Cocco
- Department Medical Science and Public health, University of Cagliari, Cagliari, Italy/Centro Sclerosi Multipla, ATS Sardegna, Cagliari, Italy
| | - Patrizia Sola
- Neurology Unit, Department of Neurosciences, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino/Estense, Modena, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Matilde Inglese
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno - Infantili (DINOGMI), Universita' di Genova, Genova, Italy/Ospedale Policlinico San Martino, IRCCS, Genova, Italy
| | | | - Claudio Gasperini
- Centro Sclerosi Multipla, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy/IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Marco Salvetti
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy/Centro Neurologico Terapie Sperimentali (CENTERS), Sapienza Universita' Di Roma, Azienda Ospedaliera Sant' Andrea, Rome, Italy
| | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | - Rocco Totaro
- Centro Malattie Demielinizzanti, Clinica Neurologica, Ospedale San Salvatore, L'Aquila, Italy
| | - Marika Vianello
- MS Unit, O.U. Neurology 'Ca' Foncello' Hospital, Treviso, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Maurizia Gatto
- Centro Malattie Demielinizzanti, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - Francesca Sangalli
- Neurology, Neurorehabilitation and Neuroimaging Research Units, Neurophysiology Service, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Clara Grazia Chisari
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania, Catania, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Policlinico SS Annunziata, Università 'G. d'Annunzio', Chieti-Pescara, Italy
| | - Antonio Carotenuto
- Multiple Sclerosis Clinical Care and Research Center, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Napoli, Italy
| | - Damiano Baroncini
- Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy
| | | | | | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Giancarlo Comi
- Università Vita Salute San Raffaele, Milano, Italy/Casa di Cura del Policlinico, Milano, Italy
| | - Massimo Filippi
- Neurology, Neurorehabilitation and Neuroimaging Research Units, Neurophysiology Service, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro' Bari, Piazza G. Cesare, 11, 70124 Bari, Italy.,Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
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50
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Vitturi BK, Rahmani A, Dini G, Montecucco A, Debarbieri N, Bandiera P, Battaglia MA, Manacorda T, Persechino B, Buresti G, Ponzio M, Inglese M, Durando P. Spatial and temporal distribution of the prevalence of unemployment and early retirement in people with multiple sclerosis: A systematic review with meta-analysis. PLoS One 2022; 17:e0272156. [PMID: 35901070 PMCID: PMC9333213 DOI: 10.1371/journal.pone.0272156] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background We aimed to summarise the prevalence of unemployment and early retirement among people with MS and analyze data according to a spatio-temporal perspective. Methods We undertook a systematic search of PubMed/MEDLINE, Scopus, SciVerse ScienceDirect, and Web of Science. We included any peer-reviewed original article reporting the prevalence of unemployment and early retirement in the working-age population with MS. We excluded articles off-topic, with other study designs, whose study sample were unlikely to be representative of the MS population and in case of unavailability of the full text or essential information. A random-effects meta-analysis was used to measure overall prevalence estimates of unemployment and early retirement. We used meta-regression and subgroup analysis to evaluate potential moderators of prevalence estimates and the leave-one-out method for sensitivity analyses. Results Our research identified 153 studies across 29 countries encompassing 188436 subjects with MS. The pooled overall effect size for unemployment and early retirement was 35.6% (95% CI 32.8–38.4; I2 = 99.31) and 17.2% (95% CI 14.6–20.2; I2 = 99.13), respectively. The prevalence of unemployment varied according to the year of publication (p < 0.001) and there was a statistically significant decrease in the prevalence of unemployment over time (p = 0.042). Regarding early retirement, only seven (31.8%) estimates obtained from studies that were published before 2010 were below the overall effect size in comparison to 27 (60.0%) estimates extracted from data published between 2010 and 2021 (p = 0.039). There was a significant difference in prevalence according to countries (p < 0.001). Psychiatric illness was an important clinical feature responsible for patients leaving the workforce in regions with a high MS prevalence. Conclusions Unemployment and early retirement due to MS remain highly prevalent, despite a slight decline in the last decade. The prevalence of unemployment and early retirement varies globally.
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Affiliation(s)
| | - Alborz Rahmani
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Alfredo Montecucco
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Nicoletta Debarbieri
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Paolo Bandiera
- Italian Multiple Sclerosis Association (AISM), Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- Department of Life Science, University of Siena, Siena, Italy
| | - Tommaso Manacorda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | | | | | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
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