scholarly journals Rituximab as Rescue Therapy for Aggressive Pediatric Multiple Sclerosis

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
George Vartzelis ◽  
Despoina Maritsi ◽  
Maria Nikolaidou ◽  
Anastasia Garoufi ◽  
Constantinos Kilidireas
Keyword(s):  
Multiple Sclerosis ◽  
Rescue Therapy ◽  
Brain Mri ◽  
Disease Onset ◽  
Chimeric Antibody ◽  
Pediatric Multiple Sclerosis ◽  
Emerging Therapies ◽  
History Of ◽  
Anti Cd20 ◽  
Lymphocyte Populations

Multiple sclerosis is a chronic, debilitating disease. Almost one in ten patients with MS has a history of disease onset during childhood. Although numerous therapeutic options exist for adult MS, the available treatments for pediatric patients are still limited. One of the emerging therapies is rituximab, a monoclonal anti-CD20 chimeric antibody that can deplete the CD20+ lymphocyte populations. A 12-year-old boy presented with ataxia, paresthesias, and headache while his brain MRI showed numerous T2 contrast-enhancing lesions. Gamma globulin, steroids, and cyclophosphamide failed to intercept his disease, and he progressed to a rapid clinical and radiological deterioration. Treatment with rituximab reversed the disease course in a dramatic fashion, leading to complete remission.

scholarly journals Analytical epidemiology of multiple sclerosis in the Republic of Kabardino-Balkaria

2021 ◽  
Vol 13 (1S) ◽  
pp. 10-14
Author(s):  
L. B. Tlapshokova ◽  
A. R. Zikhova
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Environmental Factors ◽  
Scarlet Fever ◽  
Disease Onset ◽  
Clinical Manifestations ◽  
Control Group ◽  
Place Of Residence ◽  
History Of ◽  
The Republic

Multiple sclerosis (MS) is a common autoimmune disease, which etiology includes a complex of genetic and environmental factors. Data suggests that their interaction can influence the age of the clinical manifestations and the course of the disease. Therefore, the study of risk factors of MS in regions with different ethnic compositions of the population and climatic and geographical characteristics is of considerable interest.Objective: to study MS risk factors prevalence in the Republic of Kabardino-Balkaria (RKB).Patients and methods. This case-control study of the representation of risk factors included a cohort of 112 MS patients living in two regions of the RKB (Nalchik and the Prokhladnensky district). The MS diagnosis was established with the McDonald criteria (2017). MS risk factors were assessed with a unified questionnaire. 112 respondents (matched by the main demographic characteristics and place of residence) were included in the control group.Results and discussion. MS patients from the Prokhladnensky district were significantly more likely to contact harmful chemical compounds, had higher consumption of smoked meat products; and suffered from viral infections more often (all differences were significant, p<0.05). More patients with MS, regardless of their place of residence, had a history of scarlet fever than the controls (n=23; 19.5% and n=14; 13.4%, ratio indicator 0.43 (95% CI 0.32–1.01), p=0.041), and the maximum significance of this factor was found in patients who suffered from scarlet fever after the age of 15 years (n=7; 6.3% and n=1; 0.9%, ratio indicator 2.45 (95% CI 1.92–3.21), p=0.041). More patients with MS had a history of chickenpox (n=70; 62.5% and n=55; 41.1%; ratio indicator 0.78 (95% CI 0.65–0.94, p=0.032), the frequency of this factor was most significant in early (up to 7 years) disease onset. Regardless of the place of residence, patients with MS were more likely to suffer from tonsillitis and sinusitis in childhood (p=0.032).Conclusion. In the RKB, as in other regions of the Russian Federation, the risk of MS, along with a genetic predisposition, is primarily determined by environmental factors, such as contact with potentially harmful chemicals, history of somatic diseases, characteristics of the ecological situation, etc. Therefore, MS risk is higher in people exposed to these factors before the age of 7 years and does not depend on the place of residence. 

scholarly journals A logistic regression analysis of risk factors in ME/CFS pathogenesis

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Eliana M. Lacerda ◽  
Keith Geraghty ◽  
Caroline C. Kingdon ◽  
Luigi Palla ◽  
Luis Nacul
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Regression Analysis ◽  
Risk Factor ◽  
Family History ◽  
Disease Onset ◽  
Healthy Controls ◽  
Lower Income ◽  
Wide Range ◽  
History Of

Abstract Background Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex disease, whose exact cause remains unclear. A wide range of risk factors has been proposed that helps understanding potential disease pathogenesis. However, there is little consistency for many risk factor associations, thus we undertook an exploratory study of risk factors using data from the UK ME/CFS Biobank participants. We report on risk factor associations in ME/CFS compared with multiple sclerosis participants and healthy controls. Methods This was a cross-sectional study of 269 people with ME/CFS, including 214 with mild/moderate and 55 with severe symptoms, 74 people with multiple sclerosis (MS), and 134 healthy controls, who were recruited from primary and secondary health services. Data were collected from participants using a standardised written questionnaire. Data analyses consisted of univariate and multivariable regression analysis (by levels of proximity to disease onset). Results A history of frequent colds (OR = 8.26, P <= 0.001) and infections (OR = 25.5, P = 0.015) before onset were the strongest factors associated with a higher risk of ME/CFS compared to healthy controls. Being single (OR = 4.41, P <= 0.001), having lower income (OR = 3.71, P <= 0.001), and a family history of anxiety is associated with a higher risk of ME/CFS compared to healthy controls only (OR = 3.77, P < 0.001). History of frequent colds (OR = 6.31, P < 0.001) and infections before disease onset (OR = 5.12, P = 0.005), being single (OR = 3.66, P = 0.003) and having lower income (OR = 3.48, P = 0.001), are associated with a higher risk of ME/CFS than MS. Severe ME/CFS cases were associated with lower age of ME/CFS onset (OR = 0.63, P = 0.022) and a family history of neurological illness (OR = 6.1, P = 0.001). Conclusions Notable differences in risk profiles were found between ME/CFS and healthy controls, ME/CFS and MS, and mild-moderate and severe ME/CFS. However, we found some commensurate overlap in risk associations between all cohorts. The most notable difference between ME/CFS and MS in our study is a history of recent infection prior to disease onset. Even recognising that our results are limited by the choice of factors we selected to investigate, our findings are consistent with the increasing body of evidence that has been published about the potential role of infections in the pathogenesis of ME/CFS, including common colds/flu.

Rituximab in patients with pediatric multiple sclerosis and other demyelinating disorders of the CNS: Practical considerations

2020 ◽  
pp. 135245852093279 ◽  
Author(s):  
Angelo Ghezzi ◽  
Brenda Banwell ◽  
Amit Bar-Or ◽  
Tanuja Chitnis ◽  
Russell C Dale ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Pediatric Patients ◽  
Neurological Diseases ◽  
Duration Of Treatment ◽  
Pediatric Multiple Sclerosis ◽  
Immune Mediated ◽  
The Central Nervous System ◽  
Anti Cd20 ◽  
Demyelinating Disorders

Anti-CD20 therapies have established efficacy in the treatment of immune-mediated neurological and non-neurological diseases. Rituximab, one of the first B-cell-directed therapies, is relatively inexpensive compared to newer anti-CD20 molecules, is available in many countries, and has been used off-label in pediatric patients with neuroimmune conditions. The objective of this paper is to describe the experience with rituximab in pediatric multiple sclerosis and other inflammatory immune-mediated disorders of the central nervous system (CNS), and to define a protocol for its use in clinical practice, in particular addressing doses, interval of administration, duration of treatment, and tests to perform at baseline and during follow-up.

scholarly journals Vaccine Hesitancy in Patients With Multiple Sclerosis

2021 ◽  
Vol 8 (3) ◽  
pp. e991
Author(s):  
Lara Diem ◽  
Christoph Friedli ◽  
Andrew Chan ◽  
Anke Salmen ◽  
Robert Hoepner
Keyword(s):  
Multiple Sclerosis ◽  
Pneumococcal Vaccination ◽  
Standard Of Care ◽  
University Hospital ◽  
Vaccine Hesitancy ◽  
Public Health Issue ◽  
Future Research ◽  
Medical Chart Review ◽  
History Of ◽  
Anti Cd20

ObjectiveVaccine hesitancy is a complex public health issue referring to concerns about safety, efficacy, or need for vaccination. Using pneumococcal vaccination, which is recommend in anti-CD20–treated multiple sclerosis (MS) patients, as a model, we assessed vaccination behavior in patients with MS to prepare for the upcoming SARS-CoV-2 vaccination challenge.MethodsBy a medical chart review, we retrospectively identified patients with MS treated with ocrelizumab at the University Hospital Bern in 2018–2020. Pneumococcal vaccination was discussed with the patients during clinical visits and highlighted in the after-visit summary addressed to the general practitioner before ocrelizumab initiation as part of our clinical standard of care.ResultsPneumococcal vaccination was performed in 71/121 (58.7%) of patients, and 50/121 (41.3%) patients were not vaccinated. Patients who did not get a pneumococcal vaccination were younger (no vaccination vs vaccination; mean [95% CI] 40.1 [36.1–44.1] vs 45.4 [41.9–48.8], p = 0.028) and had more frequently a relapsing remitting disease course (no vaccination vs vaccination, n [%]; 43/50 [86.0%] vs 49/71 [69.0%], p = 0.031). Furthermore, patients who did not get vaccination had more frequently a history of comorbid psychiatric disorder (no vaccination vs vaccination, n (%); 12/50 [24.0] vs 7/71 [9.8], p = 0.035).ConclusionOur study demonstrated that in our single-center cohort, 41.3% of patients with MS do not get the recommended pneumococcal vaccination. Future research should focus on vaccine hesitancy in the vulnerable cohort of patients with MS to improve the safety of MS immunotherapies.

scholarly journals Acquisition of Early Developmental Milestones and Need for Special Education Services in Pediatric Multiple Sclerosis

2018 ◽  
Vol 34 (3) ◽  
pp. 148-152 ◽  
Author(s):  
Gregory Aaen ◽  
Michael Waltz ◽  
Wendy Vargas ◽  
Naila Makhani ◽  
Jayne Ness ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Onset ◽  
The United States ◽  
Fine Motor ◽  
Developmental Milestones ◽  
Pediatric Multiple Sclerosis ◽  
Special Services ◽  
Learning Assistance ◽  
Early Developmental ◽  
Multiple Sclerosis Onset

Children with pediatric-onset multiple sclerosis and pediatric controls were enrolled across 16 pediatric multiple sclerosis centers in the United States and completed questionnaires that addressed time of first unaided walking and acquisition of 2-word phrases. A total of 467 (308 female) cases and 428 (209 female) controls were enrolled. Pediatric multiple sclerosis (n = 467) were not delayed in walking or using 2-word phrases compared to healthy controls (n = 428) (2.2% vs 5.7%, respectively). Children with disease onset before age 11 versus onset at 11 years or after were more likely to need an individualized education plan ( P = .002), reading assistance ( P = .0003), and math assistance ( P = .001). Children with multiple sclerosis onset prior to age 18 are not delayed in meeting the 2 major early developmental milestones but do have a significantly increased use of special services or learning assistance at school. Further research will need to address whether other measures of development (eg, rate of language acquisition or fine motor skills) differ between pediatric multiple sclerosis and controls.

scholarly journals Menarche increases relapse risk in pediatric multiple sclerosis

2015 ◽  
Vol 22 (2) ◽  
pp. 193-200 ◽  
Author(s):  
Sabeen Lulu ◽  
Jennifer Graves ◽  
Emmanuelle Waubant
Keyword(s):  
Multiple Sclerosis ◽  
Sex Ratio ◽  
Clinical Features ◽  
Regression Models ◽  
Disease Onset ◽  
Disease Course ◽  
Pediatric Multiple Sclerosis ◽  
Males And Females ◽  
Age Of Menarche

Background: Multiple sclerosis (MS) predominantly affects women with a sex ratio of 3:1 in contrast with a 1:1 sex ratio seen in pre-pubertal onset. Thus, puberty may influence MS risk differentially in males and females. How puberty may be associated with MS clinical features and disease course remains unknown. Objective: The objective of this paper is to determine the association of menarche with disease course in girls with MS. Methods: This is a longitudinal retrospective study from the UCSF Regional Pediatric MS Center database. We categorized patients by time of disease onset: pre-menarche, peri-menarche and post-menarche. Poisson regression models were used for within-subject relapse analyses offset by follow-up time. Results: Seventy-six girls were included (pre-menarche onset = 17; peri-menarche onset = 9; post-menarche onset = 50). Age of menarche was similar in all groups (Kruskal-Wallis p = 0.19). Relapse rate was the same in all three groups during the first two years of follow-up. In girls with follow-up overlapping at least two time periods, within-subject analyses showed increased relapses during the peri-menarche compared to post-menarche period (adjusted IRR = 8.5, 95% CI 2.5–28.7, p = 0.001). Conclusion: Pubertal status may influence MS course at least in female patients. Understanding how puberty influences MS clinical features may offer new insights into important factors regulating disease processes.

scholarly journals A Milestone in Multiple Sclerosis Therapy: Monoclonal Antibodies Against CD20—Yet Progress Continues

2021 ◽  
Author(s):  
Esther S. Frisch ◽  
Roxanne Pretzsch ◽  
Martin S. Weber
Keyword(s):  
Multiple Sclerosis ◽  
Monoclonal Antibodies ◽  
B Cells ◽  
B Cell ◽  
Current Knowledge ◽  
Disease Onset ◽  
Chronic Inflammatory Disease ◽  
Targeting Therapy ◽  
Long Term Treatment ◽  
Anti Cd20

AbstractMultiple sclerosis (MS), which is a chronic inflammatory disease of the central nervous system, still represents one of the most common causes of persisting disability with an early disease onset. Growing evidence suggests B cells to play a crucial role in its pathogenesis and progression. Over the last decades, monoclonal antibodies (mabs) against the surface protein CD20 have been intensively studied as a B cell targeting therapy in relapsing MS (RMS) as well as primary progressive MS (PPMS). Pivotal studies on anti-CD20 therapy in RMS showed remarkable clinical and radiological effects, especially on acute inflammation and relapse biology. These results paved the way for further research on the implication of B cells in the pathogenesis of MS. Besides controlling relapse development in RMS, ocrelizumab (OCR) also showed clinical benefits in patients with PPMS and became the first approved drug for this disease course. In this review, we provide an overview of the current anti-CD20 mabs used or tested for the treatment of MS—namely rituximab (RTX), OCR, ofatumumab (OFA), and ublituximab (UB). Besides their effectiveness, we also discuss possible limitations and safety concerns especially in regard to long-term treatment, both for this class of drugs overall as well as for each anti-CD20 mab individually. Additionally, we elucidate to what extent anti-CD20 therapy may alter the function of other immune cells, both directly or indirectly. Finally, we cover the current knowledge on repopulation of CD20+ cells after cessation of anti-CD20 treatment and discuss future aspirations towards alternative, further developed B cell silencing therapies.

scholarly journals The Critical Role of Imaging in Primary Progressive Multiple Sclerosis

2020 ◽  
Vol 8 (C) ◽  
pp. 195-200
Author(s):  
Yuyun Yueniwati ◽  
Dotti Inggrianita
Keyword(s):  
Multiple Sclerosis ◽  
Physical Examination ◽  
Cranial Nerve ◽  
Brain Mri ◽  
Critical Role ◽  
Disease Onset ◽  
Primary Progressive Multiple Sclerosis ◽  
Primary Progressive ◽  
The Past ◽  
Cranial Nerve Palsies

BACKGROUND: Multiple sclerosis (MS) is an autoimmune-related neurological disorder as a result of chronic inflammation and demyelination which affect the central nervous system. The number of MS cases in Indonesia is about 1–5/100.000 people. This disease causes disability and requires immense treatment costs. One of the MS subtypes is primary progressive which is marked by the decline of neurological functions since the disease onset, without any period of relapse attacks. CASE REPORT: A 59-year-old female came with complaints on spinning dizziness, accompanied by vomiting and waddling for the past month before hospital administration. Based on physical examination, we found multiple cranial nerve palsies on the cranial nerve III, IV, V, VI, and VII on the left side. Initially, it suspected as an intracranial lesion in the cerebellopontine angle. However, brain computed tomography scan showed a normal result. Brain magnetic resonance imaging (MRI) was conducted and we found multiple lesions on the supratentorial and infratentorial region. The second patient was a 24-year-old female complained about waddling gait for the past year, which grew heavier. Based on physical examination, we found a cerebellar sign on the left side, cerebellar ataxia, paraparesis of lower extremity, and paresthesia. Brain MRI with contrast displayed white matter periventricular and infratentorial lesion. CONCLUSION: In both cases, radiological imaging examination, which was MRI with contrast, was beneficial in the establishment of patient’s diagnosis, which made therapeutic management suitable as needed.

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