Cognitive impairment predicts disability progression and cortical thinning in MS: An 8-year study

2016 ◽  
Vol 23 (6) ◽  
pp. 848-854 ◽  
Author(s):  
Marco Pitteri ◽  
Chiara Romualdi ◽  
Roberta Magliozzi ◽  
Salvatore Monaco ◽  
Massimiliano Calabrese
Keyword(s):  
Cognitive Impairment ◽  
Structural Mri ◽  
Disability Progression ◽  
Cortical Thinning ◽  
Immune Mediated ◽  
Relapsing Remitting ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri ◽  
Few Data

Background: Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system (CNS). Although cognitive impairment (CI) affects a large proportion of MS patients, only few data are available about its prognostic value associated with advanced magnetic resonance imaging (MRI) metrics. Objectives: We aimed at investigating the relationship between the early CI and the disease progression over 8-year follow-up in MS patients. Methods: We conducted a retrospective 8-year longitudinal study involving 78 patients with relapsing-remitting MS, who completed neuropsychological examination and structural MRI at the time of diagnosis. Each patient was clinically evaluated every 6 months, and cortical thickness was quantified at baseline and at the end of the follow-up. Patients were classified as having normal cognition and mild or severe CI. Results: The results show that CI at the time of diagnosis is a good predictor of conversion to definite MS ( p < 0.001), disability progression ( p < 0.001), as well as of transition to secondary progressive phase ( p < 0.001) and of cortical thinning ( p < 0.001). Conclusion: We confirmed and extended the evidence that early CI might be helpful in the identification of MS patients at high risk of disability progression and poor clinical outcome and should be considered as a marker of most aggressive pathology.

High Dose Cyclophosphamide for Moderate to Severe Refractory Multiple Sclerosis: 2-Year Follow-up (investigational new drug No. 65863).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4744-4744
Author(s):  
Douglas Gladstone
Keyword(s):  
Multiple Sclerosis ◽  
Brain Magnetic Resonance Imaging ◽  
High Dose ◽  
Immune Mediated ◽  
Relapsing Remitting ◽  
The Central Nervous System ◽  
Immune Manipulation ◽  
Edss Score ◽  
Disease Modifying Agents

Abstract Abstract 4744 Background High dose cyclophosphamide (HDC) is a chemotherapy treatment designed to eradicate autoreative B- and T-cells responsible for lymphocyte-mediated autoimmune illness, while sparing the pluripotent blood stem cell of any ill effects. Multiple sclerosis (MS) is the most common inflammatory and demyelinating immune-mediated disorder of the central nervous system in young adults. Methods Patients with moderate to severe, refractory MS, defined as an Expanded Disability Status Scale (EDSS) score of 3.5 or higher after 2 or more Food and Drug Administration-approved disease-modifying agents, received 200 mg/kg of cyclophosphamide over 4 days. For the following 2 years, quarterly EDSS score evaluations and biannual brain magnetic resonance imaging and neuro-ophthalmologic evaluations were obtained. Results 15 patients were evaluated for clinical response. During follow-up, no patients increased their baseline EDSS score by more than 1.0. EDSS score stability or decrease was realized in 5 of 7 (71%) patients with relapsing remitting MS and 5 of 8 (62%) patients with secondary progressive MS patients. 4 patients required additional immunomodulatory treatment after treatment. Neurologic improvement involved changes in gait, bladder control, and visual function. Treatment response was seen regardless of the baseline presence or absence of contrast lesion activity. Conclusions HDC can effectively decrease symptoms, stop disease progression, and allow for disability regression in RR and SPMS patients. The most appropriate candidates for HDC, its duration of benefit and the potential need for prophylactic preventative immune manipulation after HDC all require further investigation. Disclosures: Off Label Use: cyclophosphamide: IND# 65863.

scholarly journals Safety and Efficacy of Rituximab in Multiple Sclerosis: A Retrospective Observational Study

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Bassem I. Yamout ◽  
Nabil K. El-Ayoubi ◽  
Johny Nicolas ◽  
Yehya El Kouzi ◽  
Samia J. Khoury ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Relapse Rate ◽  
Perianal Abscess ◽  
Disability Progression ◽  
Surgical Interventions ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Clinical Practice Setting ◽  
Magnetic Resonance Imaging Mri

Objective. To evaluate the efficacy and safety of rituximab in multiple sclerosis in a clinical practice setting. Methods. Clinical data for all adult patients with multiple sclerosis (MS) treated with off-label rituximab at a single MS center in Lebanon between March 2008 and April 2017 were retrospectively collected from medical charts. The main efficacy outcomes assessed were annualized relapse rate (ARR) and proportion of patients free from relapses, disability progression, or magnetic resonance imaging (MRI) activity. Results. A total of 89 rituximab-treated patients were included: 59 relapsing-remitting MS (RRMS) and 30 progressive MS (PMS). Patients were treated with 1000 or 2000 mg rituximab IV every 6–12 months for a mean duration of 22.2 ± 24.8 months. The subjects were 65.2% females with a mean age of 40.5 ± 12.3 years and a mean disease duration of 7.9 ± 6.2 years. During treatment, the ARR decreased from 1.07 at baseline to 0.11 in RRMS (p<0.0001) and from 0.25 to 0.16 in PMS patients (p=0.593). The mean Expanded Disability Status Scale (EDSS) remained unchanged in both RRMS and PMS patients. Between baseline and the last follow-up, the percent of patients free from any new MRI lesions increased from 18.6% to 92.6% in the RRMS group and from 43.3% to 82% in the PMS group. No evidence of disease activity (NEDA) was achieved in 74% of patients at 1 year of treatment. A total of 64 adverse events (AEs) (71.9%) were recorded with the most common being infusion-related reactions in 25.8% of patients, all mild in nature. Two of our rituximab-treated patients experienced serious AEs requiring surgical interventions: pyoderma gangrenosum vaginalis with perianal abscess and fistula and an increase in the size of a meningioma. No case of progressive multifocal leukoencephalopathy (PML) was detected. Conclusion. In our real-world cohort, rituximab was well-tolerated and effective in reducing relapse rate and disability progression in relapsing-remitting and progressive MS patients.

Longitudinal cortical thinning progression differs across multiple sclerosis phenotypes and is clinically relevant: A multicentre study

2020 ◽  
pp. 135245852094054
Author(s):  
Milagros Hidalgo de la Cruz ◽  
Paola Valsasina ◽  
Claudio Gobbi ◽  
Antonio Gallo ◽  
Chiara Zecca ◽  
...  
Keyword(s):  
Severe Disability ◽  
Cortical Atrophy ◽  
Group Differences ◽  
Lesion Volume ◽  
Resonance Imaging ◽  
Cortical Thinning ◽  
Relapsing Remitting ◽  
Weighted Magnetic Resonance Imaging ◽  
Magnetic Resonance Imaging Mri

Background: Longitudinal evolution of cortical thickness (CTh) in different MS phenotypes has been rarely studied. Aim: To investigate the regional pattern and 1-year progression of cortical thinning in relapsing-remitting (RR) and progressive (P) MS. Methods: 3T high-resolution T1-weighted magnetic resonance imaging (MRI) was obtained from 86 patients (75 RRMS, 11 PMS) and 34 healthy controls (HC) at three European sites at baseline and 1-year follow-up. Using FreeSurfer, baseline CTh between-group differences, longitudinal CTh changes and their correlations with clinical and MRI variables were assessed. Results: Baseline frontal, parietal and sensorimotor atrophy was found in MS versus HC. Such pattern was driven by RRMS, while PMS showed additional parietal, insular and sensorimotor cortical atrophy versus RRMS. At 1-year versus baseline, additional frontal and temporal cortical thinning was detected in RRMS patients, while a widespread CTh reduction was found in PMS patients (significant at time-by-group interaction vs RRMS). In MS, baseline fronto-parietal atrophy correlated with more severe disability and higher lesion volume. Baseline inferior parietal CTh decrease and 1-year temporal cortical thinning correlated with more severe disability. Conclusion: Parieto-temporal baseline CTh abnormalities and thinning pattern over time characterized the main MS clinical phenotypes and were associated with 1-year disability worsening.

Measures in the first year of therapy predict the response to interferon β in MS

2009 ◽  
Vol 15 (7) ◽  
pp. 848-853 ◽  
Author(s):  
J Río ◽  
J Castilló ◽  
A Rovira ◽  
M Tintoré ◽  
J Sastre-Garriga ◽  
...  
Keyword(s):  
Disease Activity ◽  
Logistic Model ◽  
First Year ◽  
Interferon Β ◽  
Clinical Predictors ◽  
Predictors Of Response ◽  
Relapsing Remitting ◽  
Magnetic Resonance Imaging Mri ◽  
Relapsing Remitting Multiple Sclerosis

Background and objective Several criteria for treatment response to interferon beta (IFNβ) have been proposed, although there is no consensus among different investigators. Hence, the aim of this study was to investigate magnetic resonance imaging (MRI) and clinical predictors of response during the first 12 months of therapy. Methods This is a prospective and longitudinal study of relapsing-remitting multiple sclerosis (RRMS) patients treated with IFNβ. Patients were classified based on the presence of new lesions on MRI, relapses, confirmed disability increase, or combinations of all these variables after 1 year of therapy. Regression analysis was performed in order to identify variables of response after a follow-up of 3 years. Results We included 222 RRMS patients. The logistic model demonstrated that only the combination of new active lesions on MRI with the presence of relapses (OR 4.4; 95% CI 1.6–12.5) or disability progression (Odds Ratio (OR) 7.1; 95% Confidence Interval (CI) 1.6–33.9), or both (OR 6.5; 95% CI 1.9–23.4) achieved significant values to identify those patients with a poor outcome. Conclusions In RRMS patients treated with IFNβ, the combination of measures of disease activity and the presence of new active lesions on MRI may have a prognostic value for identifying patients with disease activity in the second and third year of therapy.

scholarly journals Intramedullary spinal cysticercosis simulating a conus medullaris tumor: case report

2006 ◽  
Vol 64 (1) ◽  
pp. 149-152 ◽  
Author(s):  
José Fernando Guedes-Corrêa ◽  
Ricardo Caratta Macedo ◽  
Rafael Pereira Vaitsman ◽  
Jorge Gomes de Mattos ◽  
Jovita Marques Agra
Keyword(s):  
Spinal Cord ◽  
Daily Living ◽  
Conus Medullaris ◽  
Acute Onset ◽  
Pathological Examination ◽  
Low Back ◽  
The Central Nervous System ◽  
Intradural Extramedullary ◽  
Magnetic Resonance Imaging Mri

Cysticercosis is an endemic condition in many developing countries. Although it is the most common parasitic disease of the central nervous system, cysticercal involvement of the spinal cord is rare. It may occur as intradural extramedullary, intramedullary, intramedullary associated with intradural-extramedullary or as the vertebral presentation. We report the case of a 53-year-old woman who presented with low back pain of acute onset and no other symptoms. Magnetic resonance imaging (MRI) showed an intramedullary cyst of the conus medullaris region which, at pathological examination, was diagnosed as a cysticercal cyst. She refused anticysticercal agents and steroids postoperatively. After an eight-year follow-up, the patient performs the activities of her daily living with no difficulties, and annual spinal MRIs show no residual signs of the disease. Clinical, pathofisiological, diagnostic and therapeutic aspects of spinal cord intramedullary cysticercosis are discussed.

A Case of Monocular Blurred Vision

2018 ◽  
pp. 1-8
Author(s):  
Aaron E. Miller ◽  
Tracy M. DeAngelis ◽  
Michelle Fabian ◽  
Ilana Katz Sand
Keyword(s):  
Demyelinating Disease ◽  
Clinical Manifestations ◽  
Blurred Vision ◽  
Hyperintense Lesion ◽  
Mcdonald Criteria ◽  
Relapsing Remitting ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri ◽  
Disease Modifying Agents ◽  
Middle Aged Adults

Multiple sclerosis (MS), an inflammatory demyelinating disease of the central nervous system, typically affects young to middle-aged adults. Women are affected nearly three times as often as men. The diagnosis requires the demonstration of dissemination in space (DIS) and time (DIT) in a patient with no better clinical explanation. Evidence for either DIS or DIT or both may now be obtained from MRI, in addition to clinical manifestations. The most widely used diagnostic criteria are known as the McDonald criteria, and have been revised several times, most recently in 2017. In the current criteria, DIS may be achieved by the demonstration of at least one lesion in at least two different locations: periventricular, cortical/juxtacortical, infratentorial, or spinal cord. DIT may be considered in an initial magnetic resonance imaging (MRI) if there are simultaneously at least one gadolinium-enhancing lesion and one non-enhancing T2 hyperintense lesion; or alternatively, by the demonstration of a new lesion on any MRI subsequent to the first. The course of MS is characterized as relapsing-remitting (RRMS), secondary progressive, or primary progressive. Many effective disease-modifying agents are available for RRMS, but progressive forms have been much less successfully treated.

scholarly journals Cognitive Impairment in Multiple Sclerosis

Folia Medica ◽  
2016 ◽  
Vol 58 (3) ◽  
pp. 157-163 ◽  
Author(s):  
Anastasiya G. Trenova ◽  
Georgi S. Slavov ◽  
Maria G. Manova ◽  
Jana B. Aksentieva ◽  
Lyuba D. Miteva ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Cognitive Disorders ◽  
Social Burden ◽  
Immune Mediated ◽  
The Social ◽  
The Central Nervous System ◽  
Axonal Transection ◽  
The Relationship

Abstract Multiple sclerosis (MS) is a socially significant immune-mediated disease, characterized by demyelination, axonal transection and oligodendropathy in the central nervous system. Inflammatory demyelination and neurodegeneration lead to brain atrophy and cognitive deficit in up to 75% of the patients. Cognitive dysfunctions impact significantly patients’ quality of life, independently from the course and phase of the disease. The relationship between pathological brain findings and cognitive impairment is a subject of intensive research. Summarizing recent data about prevalence, clinical specificity and treatment of cognitive disorders in MS, this review aims to motivate the necessity of early diagnosis and complex therapeutic approach to these disturbances in order to reduce the social burden of the disease.

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 CD56bright Natural Killer Cells: A Possible Biomarker of Different Treatments in Multiple Sclerosis

2020 ◽  
Vol 9 (5) ◽  
pp. 1450 ◽  
Author(s):  
Alice Laroni ◽  
Antonio Uccelli
Keyword(s):  
Multiple Sclerosis ◽  
Nk Cells ◽  
Natural Killer ◽  
Dimethyl Fumarate ◽  
Regulatory Function ◽  
Clinical Activity ◽  
Hematopoietic Stem ◽  
Immune Mediated ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri

Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system, which leads, in many cases, to irreversible disability. More than 15 disease-modifying treatments (DMTs) are available for the treatment of MS. Clinical activity or activity at magnetic resonance imaging (MRI) are now used to assess the efficacy of DMTs, but are negative prognostic factors per se. Therefore, a biomarker permitting us to identify patients who respond to treatment before they develop clinical/radiological signs of MS activity would be of high importance. The number of circulating CD56bright natural killer (NK) cells may be such a biomarker. CD56bright NK cells are a regulatory immune population belonging to the innate immune system. The number of CD56bright NK cells increases upon treatment with interferon-beta, alemtuzumab, dimethyl fumarate, after autologous hematopoietic stem cell transplantation, and is higher in those who respond to fingolimod. In some cases, an increased number of CD56bright NK cells is associated with an increase in their regulatory function. In the current review, we will evaluate the known effect on CD56bright NK cells of DMTs for MS, and will discuss their possible role as a biomarker for treatment response in MS.

A cute verbal dyspraxia, a rare presentation in multiple sclerosis: a case report with MRI localization

2003 ◽  
Vol 9 (6) ◽  
pp. 630-632 ◽  
Author(s):  
Stephen L Jaffe ◽  
Michael F Glabus ◽  
Roger E Kelley ◽  
Alireza Minagar
Keyword(s):  
Multiple Sclerosis ◽  
White Matter Lesion ◽  
Inferior Frontal Gyrus ◽  
Speech Disorders ◽  
Rare Presentation ◽  
Qualitative And Quantitative ◽  
Relapsing Remitting ◽  
Brodmann Areas ◽  
Magnetic Resonance Imaging Mri

C ortical speech disorders rarely occur in multiple sclerosis (MS). We report a patient with relapsing-remitting MS, who presented with acute verbal dyspraxia. Magnetic resonance imaging (MRI) demonstrated an acute T2/Flair hyperintense, primarily white matter lesion underlying the middle third of the inferior frontal gyrus. The verbal dyspraxia cleared beginning 48 hours after the initiation of iv dexamethasone. Follow-up MRI demonstrated qualitative and quantitative diminution of the hyperintensity. This is the first report of a clinically definite MS patient with acute verbal dyspraxia. Moreover, there was a suggestive localization of verbal praxis to Brodmann areas 44/45.

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