Benign multiple sclerosis in Crete

2010 ◽  
Vol 16 (6) ◽  
pp. 701-706 ◽  
Author(s):  
V. Mastorodemos ◽  
H. Nikolakaki ◽  
M. Tzagournissakis ◽  
D. Kotzamani ◽  
T. Panou ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Genetic Background ◽  
Disease Duration ◽  
Age At Onset ◽  
Benign Disease ◽  
Disease Evolution ◽  
Relapsing Remitting ◽  
Benign Multiple Sclerosis ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

Our objective was to study multiple sclerosis on Crete, an island of 0.6 million inhabitants sharing a similar genetic background and the same environment. Case ascertainment was achieved using the MS Epidemiology Program Project of Crete. The diagnosis and classification of multiple sclerosis were made by established clinical and magnetic resonance imaging criteria, and disease evolution was assessed by periodic evaluations. Thorough clinical and laboratory evaluations were conducted; a detailed history, including a questionnaire of 36 items, was taken. Data obtained were analysed for possible interaction with disease prognosis. We identified 587 cases of multiple sclerosis (F:M = 1.6), >90% of which were of Cretan origin from both parental lines. Age at onset was 31.5 ± 10.3 years (mean ± SD) and disease duration 12.7 ± 9.1 years. About 84.6% had relapsing remitting multiple sclerosis, 9.4% primary progressive multiple sclerosis and 6% clinically isolated syndrome. Nearly 40% of our multiple sclerosis patients with disease duration >10 years (mean = 16.2 ± 5.3 years) remained with no or mild disability (Expanded Disability Status Scale [EDSS] ≤3). Also, about 30% of patients with relapsing remitting multiple sclerosis showed benign disease evolution (EDSS ≤3) more than 20 years (mean = 24.0 ± 3.3) after onset. Factors predisposing to benign multiple sclerosis included younger age at onset, shorter disease duration and a lower number of relapses. We conclude that a substantial proportion of patients with multiple sclerosis from Crete follow a rather benign disease course, and this may relate to the genetic background of the population and/or to environmental factors.

scholarly journals Exploring polypharmacy phenomenon in newly diagnosed relapsing–remitting multiple sclerosis: a cohort ambispective single-centre study

2021 ◽  
Vol 12 ◽  
pp. 204062232098312
Author(s):  
Aurora Zanghì ◽  
Emanuele D’Amico ◽  
Salvatore Lo Fermo ◽  
Francesco Patti
Keyword(s):  
Multiple Sclerosis ◽  
Age At Onset ◽  
Rank Test ◽  
Multinomial Regression ◽  
Single Centre ◽  
Centre Study ◽  
Relapsing Remitting ◽  
Single Centre Study ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

Aims: We aimed to examine the frequency of polypharmacy in a large cohort of patients at the time of diagnosis of relapsing–remitting multiple sclerosis (RRMS) and to explore its effects on discontinuation of first disease-modifying treatment (DMT) using survival analysis. Methods: This was a cohort ambispective single-centre study. We enrolled RRMS patients starting their first DMT between 1st January 2013 and 31st December 2015. According to the number of medicines prescribed (except DMTs), we divided the patients into three groups: no-poly RRMS, minor-poly RRMS (from one to three medications), and major-poly RRMS (more than three medications). Results: A total of 392 RRMS patients were enrolled (mean age 41.1). The minor-poly RRMS group included 61 patients (15.6%) and the major-poly RRMS group included 112 (28.6%). Individuals in these groups were older and had higher median body mass index (BMI) than patients in the no-poly RRMS group ( p < 0.05). Upon multinomial regression analysis, older age at onset was associated with minor and major polypharmacy (OR 1.050, CI 1.010–1.093, p = 0.015 and OR 1.063, CI 1.026–1.101, p = 0.001, respectively) and higher BMI was associated with major polypharmacy (OR 1.186, CI 1.18–1.29, p = 0.001). The rates of discontinuation of first DMT were similar among the three groups (50.7% for no-Poly RRMS, 50.8% for minor-Poly RRMS, and 53.3% for major-Poly RRMS, p = 0.264). At log-Rank test, there were no differences among the three groups ( p = 0.834). Conclusion: Polypharmacy was more common in older RRMS patients with high BMI.

Serial gadolinium-enhanced MRI in relapsing/remitting multiple sclerosis of varying disease duration

Neurology ◽  
1992 ◽  
Vol 42 (1) ◽  
pp. 60-60 ◽  
Author(s):  
A. J. Thompson ◽  
D. Miller ◽  
B. Youl ◽  
D. MacManus ◽  
S. Moore ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Duration ◽  
Enhanced Mri ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

In-vivo evidence for stable neuroaxonal damage in the brain of patients with benign multiple sclerosis

2009 ◽  
Vol 15 (7) ◽  
pp. 789-794 ◽  
Author(s):  
B Benedetti ◽  
M Rovaris ◽  
MA Rocca ◽  
D Caputo ◽  
M Zaffaroni ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Duration ◽  
Axonal Damage ◽  
Lesion Volume ◽  
Hyperintense Lesion ◽  
Disease Evolution ◽  
Clinical Onset ◽  
Relapsing Remitting ◽  
Benign Multiple Sclerosis

Objective The term benign multiple sclerosis (BMS) is referred to patients who have a mild or absent disability several years after disease clinical onset. Axonal damage can be measured in vivo using proton MR spectroscopy (1H-MRS). In this study, we quantified the severity of “global” axonal damage in BMS and early relapsing–remitting (RR) MS patients, using whole brain N-acetylaspartate (WBNAA) 1H-MRS, to better elucidate the structural correlates of a non-disabling disease evolution. Methods WBNAA concentration was measured in 37 patients with BMS (mean disease duration 22.3 years) and 17 patients with early RRMS (mean disease duration 4.0 years), using an unlocalized 1H-MRS sequence. Dual echo and T1-weighted scans were also obtained to measure T2-hyperintense lesion volume (TLV) and normalized brain volume (NBV). Results TLV was higher in BMS (mean TLV = 13.1 mL) than in early RRMS patients (mean TLV = 7.2 mL) ( P = 0.018), whereas neither NBV (mean NBV: 1491.0 mL in BMS vs 1520.3 mL in RRMS) nor WBNAA concentration (mean WBNAA: 10.5 mmol in BMS vs 11.4 mmol in RRMS) significantly differed between the two groups. In MS patients, no correlation was found between WBNAA concentration and Expanded Disability Status Scale (EDSS), TLV and NBV. Conclusions The similar WBNAA concentrations seen in BMS and early RRMS patients fit with the notion that a non-disabling long-term evolution of MS may be due, at least in part, to non-progression of pathology. Such a condition seems to be independent from MRI-visible lesions burden.

scholarly journals REALMS study: real-world effectiveness and safety of fingolimod in patients with relapsing-remitting multiple sclerosis in Portugal

2020 ◽  
Author(s):  
S. Batista ◽  
C. C. Nunes ◽  
J. J. Cerqueira ◽  
Ana Martins Silva ◽  
J. Correia de Sá ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Real World ◽  
Previous Treatment ◽  
Disease Evolution ◽  
Safety Issues ◽  
Receptor Modulator ◽  
Study Results ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

Abstract Background Fingolimod, an oral sphingosine 1-phosphate receptor modulator, is approved by EMA for relapsing-remitting multiple sclerosis (RRMS). Objectives To assess the effectiveness and safety of fingolimod in patients with RRMS in real-world clinical practice in Portugal. Methods Retrospective, multicentre, non-interventional study, reporting 3 years follow-up of data collected from October 2015 to July 2016. Sociodemographic data and previous treatments at baseline and data regarding disease evolution, including number of relapses, annualised relapse rates (ARR) and Expanded Disability Status Scale (EDSS), were collected. Results Two-hundred and seventy-five participants were enrolled in the REALMS study. Results showed that the main reason to switch to fingolimod was failure of previous treatment (56.7%) and only 3.6% were naïve patients. In the total population, there was a significant decrease in ARR of 64.6% in the first year of treatment, 79.7% in the second year and 82.3% in the third year, compared with baseline. More than 67.0% of patients had no relapses during the 3 years after switching to fingolimod. EDSS remained stable throughout the study. Conclusions Therapy with fingolimod showed a sustained effectiveness and safety over the 3 years, particularly on patients switched from first-line drugs (BRACE). No new safety issues were reported.

Randomized, double-blind, placebo-controlled study of subcutaneous interferon beta-1a in relapsing-remitting multiple sclerosis: a categorical disability trend analysis

2002 ◽  
Vol 8 (1) ◽  
pp. 10-14 ◽  
Author(s):  
C Liu ◽  
L D Blumhardt
Keyword(s):  
Multiple Sclerosis ◽  
Disease Duration ◽  
Significant Proportion ◽  
Phase Iii ◽  
Controlled Study ◽  
Double Blind ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis ◽  
Immunomodulatory Therapies

The treatment effects of recent immunomodulatory therapies on disease progression in relapsing-remitting multiple sclerosis (MS) have been mostly established from ‘confirmed progression’ endpoints. However, the reliability of this outcome measure is poor and a significant proportion of patients may be erroneously classified. We previously proposed the area under disability/time curves to quantify in-trial disability changes, but although these have advantages, they lack information on the direction of change. We have therefore performed disease trend analyses and categorical classifications using serial Expanded Disability Status Scale (EDSS) scores from the 533 complete datasets in a double-blind, randomized, placebo-controlled, phase III trial of subcutaneous interferon β-1a (IFNβ-1a) (PRISMS study). We found significant treatment benefits for IFNβ-1a on in-trial disability course (P=0.002). Therapeutic advantages remained when relapse-related assessments were excluded (P=0.018). Post hoc analyses demonstrated that IFNβ-1a was mainly effective in both increasing the proportion of patients with a ‘stable’ course and reducing those with prolonged, disabling deteriorations. Baseline disease duration and EDSS levels, but not MRI lesion load, predicted the subsequent disability trends. Mean ‘numbers needed to treat’ (NNTs) to obtain preferred disability courses were reduced in patients with shorter disease duration. These results have important implications for the targeting of immunomodulatory therapies in MS.

A longitudinal study of ventricular volume in early relapsing-remitting multiple sclerosis

2000 ◽  
Vol 6 (5) ◽  
pp. 332-337 ◽  
Author(s):  
T L Luks ◽  
D E Goodkin ◽  
S J Nelson ◽  
S Majumdar ◽  
P Bacchetti ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Brain Atrophy ◽  
Baseline Level ◽  
Disease Duration ◽  
Ventricular Volume ◽  
Quantitative Mri ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis ◽  
Monthly Change

The specific aim of this study was to determine whether progressive brain atrophy could be detected within 18 months of establishing a diagnosis of relapsing-remitting multiple sclerosis (RRMS). Fifteen patients with clinically definite RRMS (mean disease duration from first symptom=6 months, mean EDSS=1.2) completed 6-14 monthly quantitative MRI sessions. The volume of the lateral ventricles was determined each month using a semi-automated thresholding technique from T1-weighted axial images. The number of new monthly gadolinium-enhancing (Gd+) lesions and EDSS scores were also recorded. Lateral ventricular volumes increased significantly during this study. When individual data were examined, statistically significant changes were observed in six of 15 patients. Monthly change in ventricular volume was related to baseline EDSS and total number of new Gd+ lesions. These observations indicate brain atrophy, a putative imaging marker of diffuse demyelination and axonal loss, can occur as early as 18 months after first symptons of RRMS, and is related to the baseline level of disability and to the number of new Gd+ lesions.

Sign in / Sign up

Export Citation Format

Share Document