scholarly journals Leptomeningeal Enhancement in Multiple Sclerosis and Other Neurological Diseases: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Benjamin Victor Ineichen ◽  
Charidimos Tsagkas ◽  
Martina Absinta ◽  
Daniel S Reich
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Neurological Diseases ◽  
Meta Analysis ◽  
Mean Difference ◽  
Clinical Settings ◽  
Imaging Features ◽  
Qualitative Synthesis ◽  
Leptomeningeal Enhancement ◽  
Relapsing Remitting

Background: The lack of systematic evidence on leptomeningeal enhancement (LME) on MRI in neurological diseases, including multiple sclerosis (MS), hampers its interpretation in clinical routine and research settings. Purpose: To perform a systematic review and meta-analysis of MRI LME in MS and other neurologi-cal diseases. Materials and Methods: In a comprehensive literature search in Medline, Scopus, and Embase, out of 2292 publications, 459 records assessing LME in neurological diseases were eligible for qualitative synthesis. Of these, 135 were included in a random effects model meta-analysis with subgroup analyses for MS. Results: Of eligible publications, 161 investigated LME in neoplastic neurological (n=2392), 91 in neuroinfectious (n=1890), and 75 in primary neuroinflammatory diseases (n=4038). The LME proportions for these disease classes were 0.47 [95%CI: 0.37 to 0.57], 0.59 [95%CI: 0.47 to 0.69], and 0.26 [95%CI: 0.20 to 0.35], respectively. In a subgroup analysis comprising 1605 MS cases, LME proportion was 0.30 [95%CI 0.21 to 0.42] with lower proportions in relapsing-remitting (0.19 [95%CI 0.13 to 0.27]) compared to progressive MS (0.39 [95%CI 0.30 to 0.49], p=0.002) and higher proportions in studies imaging at 7T (0.79 [95%CI 0.64 to 0.89]) compared to lower field strengths (0.21 [95%CI 0.15 to 0.29], p<0.001). LME in MS was associated with longer disease duration (mean difference 2.2 years [95%CI 0.2 to 4.2], p=0.03), higher Expanded Disability Status Scale (mean difference 0.6 points [95%CI 0.2 to 1.0], p=0.006), higher T1 (mean difference 1.6ml [95%CI 0.1 to 3.0], p=0.04) and T2 lesion load (mean difference 5.9ml [95%CI 3.2 to 8.6], p<0.001), and lower cortical volume (mean difference -21.3ml [95%CI -34.7 to -7.9], p=0.002). Conclusions: Our study provides high-grade evidence for the substantial presence of LME in MS and a comprehensive panel of other neurological diseases. Our data could facilitate differential diagnosis of LME in clinical settings. Additionally, our meta-analysis corroborates that LME is associ-ated with key clinical and imaging features of MS. PROSPERO No: CRD42021235026.

scholarly journals Cerebrospinal Fluid IgM and Oligoclonal IgG Bands in Multiple Sclerosis: A Meta-Analysis of Prevalence and Prognosis

2021 ◽  
Vol 11 (11) ◽  
pp. 1444
Author(s):  
Mattia Fonderico ◽  
Emilio Portaccio ◽  
Lorenzo Razzolini ◽  
Luisa Pastò ◽  
Angelo Bellinvia ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Clinical Course ◽  
Meta Analysis ◽  
Clinically Isolated Syndrome ◽  
Relapsing Remitting ◽  
Oligoclonal Igg ◽  
Almost All ◽  
Present Systematic Review ◽  
Oligoclonal Igg Bands

The presence of intrathecal IgM synthesis (ITMS) has been associated with an aggressive multiple sclerosis (MS) clinical course. In the present systematic review, we aimed at assessing the prevalence of ITMS among different MS phenotypes. Moreover, we aimed at quantifying the risk of a second relapse in ITMS positive and oligoclonal IgG bands (OCGBs)-positive patients. We selected clinical studies reporting the ITMS prevalence assessed as oligoclonal IgM Bands (OCMBs), lipid-specific OCMBs (LS-OCMBs), and/or as an intrathecal IgM production > 0% (IgMLoc, Reiber formula). The overall prevalence of ITMS was higher in relapsing-remitting (RR) than clinically isolated syndrome (CIS) patients (40.1% versus 23.8%, p < 0.00001), while was in line with that detected in primary progressive MS (PPMS, 26.7%). Almost all patients (98%) with ITMS had also OCGBs. The risk of having a second relapse was higher in OCGBs positive patients (HR = 2.18, p = 0.007) but much higher in ITMS positive patients (HR = 3.62, p = 0.0005). This study revealed that the prevalence of ITMS is higher in RRMS patients. It suggests that the risk of having a second relapse, previously ascribed to OCGBs, may, to a certain extent, be related to the presence of intrathecal IgM.

scholarly journals Oxygen Cost of Walking in People with Multiple Sclerosis and Its Association with Fatigue: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Scott Rooney ◽  
Gavin McWilliam ◽  
Leslie Wood ◽  
Fiona Moffat ◽  
Lorna Paul
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Energy Expenditure ◽  
Meta Analysis ◽  
Positive Association ◽  
Mean Difference ◽  
Oxygen Cost ◽  
Future Studies ◽  
Standardized Mean Difference ◽  
The Relationship

Abstract Background: This systematic review and meta-analysis aimed to compare the oxygen cost of walking in people with multiple sclerosis (MS) and controls and to assess the relationship between oxygen cost of walking and fatigue in people with MS. Methods: Four databases (CINAHL, MEDLINE, ProQuest, Web of Science) were searched up to September 2020. Studies were included if they recruited adults with MS and either compared oxygen cost of walking in those with MS and a control population or determined the relationship between oxygen cost of walking and fatigue. Meta-analysis of the standardized mean difference in oxygen cost of walking between people with MS and controls was performed. Results: Nine studies were included in this review, of which seven compared oxygen cost of walking in people with MS (n = 176) and controls (n = 142) and four investigated the relationship between oxygen cost of walking and fatigue. Meta-analysis revealed that people with MS (with predominantly mild-to-moderate disability) had a significantly higher oxygen cost of walking compared with controls (standardized mean difference = 2.21, 95% CI = 0.88 to 3.54, P = .001). In addition, three studies found a significant yet weak positive association between oxygen cost of walking and fatigue. Conclusions: People with MS expend more energy when walking compared with controls. This increase in energy expenditure may contribute to the development of fatigue, as some studies found that higher oxygen costs of walking were associated with greater fatigue. Future studies should investigate whether reducing energy expenditure during movement improves fatigue.

Disease-modifying treatments and cognition in relapsing-remitting multiple sclerosis

Neurology ◽  
2020 ◽  
Vol 94 (22) ◽  
pp. e2373-e2383 ◽  
Author(s):  
Nils C. Landmeyer ◽  
Paul-Christian Bürkner ◽  
Heinz Wiendl ◽  
Tobias Ruck ◽  
Hans-Peter Hartung ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Cognitive Impairment ◽  
Test Performance ◽  
Meta Analysis ◽  
Cognitive Test ◽  
Current Evidence ◽  
Relapsing Remitting ◽  
Disease Modifying ◽  
Cognitive Test Performance

ObjectiveDisease-modifying treatments (DMTs) are the gold standard for slowing disability progression in multiple sclerosis (MS), but their effects on cognitive impairment, a key symptom of the disease, are mostly unknown. We conducted a systematic review and meta-analysis to evaluate the differential effects of DMTs on cognitive test performance in relapsing-remitting MS (RRMS).MethodsPubMed, Scopus, and Cochrane Library were searched for studies reporting longitudinal cognitive performance data related to all major DMTs. The standardized mean difference (Hedges g) between baseline and follow-up cognitive assessment was used as the main effect size measure.ResultsForty-four studies, including 55 distinct MS patient samples, were found eligible for the systematic review. Twenty-five studies were related to platform therapies (mainly β-interferon [n = 17] and glatiramer acetate [n = 4]), whereas 22 studies were related to escalation therapies (mainly natalizumab [n = 14] and fingolimod [n = 6]). Reported data were mostly confined to the cognitive domain processing speed. A meta-analysis including 41 studies and 7,131 patients revealed a small to moderate positive effect on cognitive test performance of DMTs in general (g = 0.27, 95% confidence interval [CI] = [0.21–0.33]), but no statistically significant differences between platform (g = 0.27, 95% CI = [0.18–0.35]) and escalation therapies (g = 0.28, 95% CI = [0.19–0.37]) or between any single DMT and β-interferon.ConclusionsDMTs are effective in improving cognitive test performance in RRMS, but a treatment escalation mainly to amend cognition is not supported by the current evidence. Given the multitude of DMTs and their widespread use, the available data regarding differential treatment effects on cognitive impairment are remarkably scant. Clinical drug trials that use more extensive cognitive outcome measures are urgently needed.

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