scholarly journals Therapeutic plasma exchange in steroid-refractory multiple sclerosis relapses. A retrospective two-center study

2021 ◽  
Vol 14 ◽  
pp. 175628642097564
Author(s):  
Stephan Blechinger ◽  
Johannes Ehler ◽  
Gabriel Bsteh ◽  
Alexander Winkelmann ◽  
Fritz Leutmezer ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Plasma Exchange ◽  
Primary Outcome ◽  
Disease Duration ◽  
Therapeutic Plasma Exchange ◽  
Secondary Outcome ◽  
Sustained Effects ◽  
Mild Improvement ◽  
Disability Status

Background: Therapeutic plasma exchange (TPE) is frequently used in glucocorticosteroid (GCS)-refractory multiple sclerosis (MS) relapses. Data regarding predictors of treatment response are scarce. The objective of this study was to analyze predictive factors for response to TPE in GCS-refractory MS patients. Methods: A total of 118 MS patients in two tertiary MS centers were analyzed. Primary outcome was TPE response defined as marked, mild, or no improvement. Secondary outcome was change in expanded disability status scale (ΔEDSS). ΔEDSS and relapse activity within 6 months after TPE were studied. Results: Marked or mild improvement was observed in 78.8% of patients. ΔEDSS correlated significantly inversely with time from relapse to start of TPE (τ = –0.239, p = 0.001), age (τ = 0.182, p = 0.009) and disease duration (τ = –0.167, p = 0.017). In multivariate analysis, TPE response was predicted by diagnosis of relapsing MS [odds ratio (OR): 3.1], gadolinum-enhancement on magnetic resonance imaging (OR 3.2), age (OR 0.5 per 5 years older) and time from relapse onset to TPE (OR 0.7 per 7 days longer). Conclusion: Patients with longer disease duration and higher EDSS pre and post-TPE were more likely to show further disability progression or relapses within 6 months after TPE. No sustained effects were observed during the follow-up period.

Short delay to initiate plasma exchange is the strongest predictor of outcome in severe attacks of NMO spectrum disorders

2017 ◽  
Vol 89 (4) ◽  
pp. 346-351 ◽  
Author(s):  
Mickael Bonnan ◽  
Rudy Valentino ◽  
Stéphane Debeugny ◽  
Harold Merle ◽  
Jean-Louis Fergé ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Plasma Exchange ◽  
Primary Outcome ◽  
Rescue Therapy ◽  
Secondary Outcome ◽  
Short Delay ◽  
Clinical Onset ◽  
Disability Status ◽  
Clinical Consequences ◽  
Spectrum Disorders

IntroductionSevere attacks of neuromyelitis optica spectrum disorder (NMO-SD) are improved by plasma exchange (PLEX) given as an adjunctive therapy. Initial studies failed to demonstrate a delay of PLEX treatment influenced clinical outcome; however PLEX was always used late. We examine the clinical consequences of delay in PLEX initiation on severe optic neuritis and spinal cord attacks in NMO-SD.MethodsAll of our patients who suffered attacks of NMO-SD, treated in our centre by PLEX, were retrospectively considered for inclusion. Primary outcome was defined as complete improvement. Secondary poor/good outcomes were respectively defined to be the higher/lower third of Delta-Expanded Disability Status Scale (EDSS) (late minus baseline EDSS). Delays from clinical onset to PLEX initiation were categorised for multivariate analysis.ResultsOf the 60 patients included, NMO-SD criteria (2015) were fulfilled in 92%. One hundred and fifteen attacks were included and received PLEX with a median of 7 days (0–54) after clinical onset. The probability to regain complete improvement continuously decreased from 50% for PLEX given at day 0 to 1%–5% after day 20. Through multivariate analysis, the baseline impairment and PLEX delay were associated with the probability to complete improvement (OR 5.3; 95% CI 1.8 to 15.9). Reducing the PLEX delay also influenced the good secondary outcome but not the poor secondary outcome.ConclusionsThese results confirm an improved clinical benefit of early initiation of PLEX during severe attacks of NMO-SD. Perceiving PLEX as a rescue therapy only after steroid failure could be deleterious.

Disability progression in aggressive multiple sclerosis

2016 ◽  
Vol 23 (3) ◽  
pp. 456-463 ◽  
Author(s):  
Suresh Menon ◽  
Feng Zhu ◽  
Afsaneh Shirani ◽  
Joel Oger ◽  
Mark S Freedman ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Duration ◽  
Patient Characteristics ◽  
Expanded Disability Status Scale ◽  
Disability Progression ◽  
Disease Modifying Drugs ◽  
Primary Progressive ◽  
Disability Status ◽  
The Mean

Objective: To examine disease progression in ‘aggressive’ multiple sclerosis (MS), British Columbia, Canada (1980–2009). Methods: Aggressive (or ‘malignant’) MS was defined as Expanded Disability Status Scale (EDSS) ⩾6 within 5 years from onset. The first EDSS ⩾6 was termed ‘baseline’. Within 2, 3 and 5 years post-baseline, patients were categorized as follows: ‘worsened’ or ‘improved’, relative to baseline EDSS (the remainder exhibited no change or had no new scores). The associations between patient characteristics (sex, relapsing onset/primary progressive, onset age, onset symptoms, disease duration, cumulative prior relapses and baseline EDSS) and worsening in disability were examined longitudinally using logistic regression. Results: Of the 225/4341 (5.2%) aggressive/malignant MS patients, 134 (59.6%) were female, 167 (74.2%) were relapsing onset, 94 (41.8%) had received disease-modifying drugs at some point and the mean follow-up was 8.7 years. The proportion of patients who ‘worsened’ increased from 40.4% to 57.8%, while those who ‘improved’ varied little (range, 8.9%–10.2%). The odds of worsening increased with disease duration (adjusted odds ratio (AOR) = 1.36; 95% confidence interval (CI) = 1.22–1.52) and the presence of primary progressive (vs relapsing-onset) MS (AOR = 1.85; 95% CI = 1.01–3.38). Conclusion: Apart from disease duration and a primary progressive course, no clinically useful associations of subsequent disease worsening in patients with aggressive/malignant MS were identified.

scholarly journals Early cognitive dysfunction as a marker for the poor course of multiple sclerosis: a prospective 12-year follow-up

2019 ◽  
Vol 11 (3) ◽  
pp. 47-51
Author(s):  
D. S. Kasatkin ◽  
S. S. Molchanova ◽  
N. N. Spirin
Keyword(s):  
Multiple Sclerosis ◽  
Processing Speed ◽  
Disease Duration ◽  
Information Processing Speed ◽  
Attentional Function ◽  
Disability Status ◽  
Serial Addition ◽  
Persistent Disability ◽  
Study Inclusion

Owing to the advent of current methods for the prevention of exacerbations of multiple sclerosis (MS), it has become possible to increase the period to the development of obvious persistent cerebellar and motor disorders that mainly lead to disability. This makes it possible to focus on less evident and latent symptoms, in particular on cognitive impairment (CI) that are recorded since the diagnosis of MS and slowly progress over time.Objective: to assess the prognostic capabilities of the Paced Auditory Serial Addition Test (PASAT) to identify a group of patients with early disability (10-year risk of reaching 6.5 Expanded Disability Status Scale (EDSS) scores.Patients and methods. The paper presents the data of a 12-year (2005–2018) follow-up of 36 patients having MS with and without mild CI. The patients' mean age at the time of study inclusion was 31.7 years (confidence interval (CI) 29.2–34.1; α<0.05); the disease duration was 4.69 months (CI 3.31–6.08; α<0.05); the EDSS scores averaged 2.51 (CI 2.23–2.82; α<0.05). Severe disability (6.5 EDSS scores) was observed in 75% of cases in the presence of mild CI and in 25% of cases in the absence of mild CI; it occurred an average of 118.3 (CI 93.1–143.4; α<0.05) and 141.2 (CI 126.0–156.5; α<0.05) months later, respectively.Results and discussion. The findings suggest that the patients with MS in the presence of impaired information processing speed and decreased attentional function (failure to complete more than 25% of the PASAT tasks) had a significantly greater risk for persistent disability than the patients without CI or with its minimal manifestations. Limitation in walking function (4.5 EDSS scores) occurred an average of 3.5 years earlier, and its significant limitation (6.5 EDSS scores) did 2 years earlier in the severe CI group, which may be important in planning therapy.Conclusion. The presence of CI in early MS is likely to have a prognostic value in relation to the course of the disease. 

scholarly journals Olfactory alterations in patients with multiple sclerosis

2016 ◽  
Vol 74 (9) ◽  
pp. 697-700 ◽  
Author(s):  
Sergio Semeraro Jordy ◽  
Alberto Starzewski Junior ◽  
Felipe André Basso Macedo ◽  
Gabriela Reginatto Manica ◽  
Charles Peter Tilbery ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Duration ◽  
Cross Sectional Study ◽  
Control Group ◽  
Sectional Study ◽  
Cross Sectional ◽  
Increased Risk ◽  
Disability Status ◽  
Healthy Control

ABSTRACT This cross-sectional study involves 100 multiple sclerosis (MS) and 100 non-MS patients, under the age of 60 years old, with nasal obstruction, traumatic brain injury, previous rhinoplasty or neurosurgery, and so forth. Objective To assess olfactory function using the Connecticut test and verify correlations between olfactory alteration, disease duration and the Expanded Disability Status Scale (EDSS). Methods One hundred MS patients and 100 healthy control patients responded to a questionnaire. Those with olfactory alteration underwent a facial CT to exclude other causes. Results Thirty-two percent of patients showed alterations, compared with 3% in the healthy control group. Patients having EDSS above 4, showed a 5.2-times increased risk of dysfunction. Patients over 38 years of age have a 2.2-times increased risk over younger patients. Conclusions Because MS patients are likely to experience olfactory alterations, this study is a useful tool in follow-up care, although more studies are necessary to evaluate the correlations in MS evolution.

Comparative study of intracranial access in thrombectomy using next generation 0.088 inch guide catheter technology

2021 ◽  
pp. neurintsurg-2021-017341
Author(s):  
Devin V Bageac ◽  
Blake S Gershon ◽  
Jan Vargas ◽  
Maxim Mokin ◽  
Zeguang Ren ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Control Group ◽  
Anterior Circulation ◽  
Guide Catheter ◽  
Catheter Failure ◽  
Catheter Technology ◽  
Intracranial Vasculature

BackgroundMost conventional 0.088 inch guide catheters cannot safely navigate intracranial vasculature. The objective of this study is to evaluate the safety of stroke thrombectomy using a novel 0.088 inch guide catheter designed for intracranial navigation.MethodsThis is a multicenter retrospective study, which included patients over 18 years old who underwent thrombectomy for anterior circulation large vessel occlusions. Technical outcomes for patients treated using the TracStar Large Distal Platform (TracStar LDP) or earlier generation TRX LDP were compared with a matched cohort of patients treated with other commonly used guide catheters. The primary outcome measure was device-related complications. Secondary outcome measures included guide catheter failure and time between groin puncture and clot engagement.ResultsEach study arm included 45 patients. The TracStar group was non-inferior to the control group with regard to device-related complications (6.8% vs 8.9%), and the average time to clot engagement was 8.89 min shorter (14.29 vs 23.18 min; p=0.0017). There were no statistically significant differences with regard to other technical outcomes, including time to recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2B). The TracStar was successfully advanced into the intracranial internal carotid artery in 33 cases (73.33%); in three cases (6.67%), it was swapped for an alternate catheter. Successful reperfusion (mTICI 2B-3) was achieved in 95.56% of cases. Ninety-day follow-up data were available for 86.67% of patients, among whom 46.15% had an modified Rankin Score of 0–2%, and 10.26% were deceased.ConclusionsTracstar LDP is safe for use during stroke thrombectomy and was associated with decreased time to clot engagement. Intracranial access was regularly achieved.

scholarly journals Determinants of therapeutic lag in multiple sclerosis

2021 ◽  
pp. 135245852098130
Author(s):  
Izanne Roos ◽  
Emmanuelle Leray ◽  
Federico Frascoli ◽  
Romain Casey ◽  
J William L Brown ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Expanded Disability Status Scale ◽  
Disability Progression ◽  
Delayed Onset ◽  
Disease Characteristics ◽  
Disability Status ◽  
Male Sex ◽  
Pre Treatment ◽  
Patient Subgroups

Background: A delayed onset of treatment effect, termed therapeutic lag, may influence the assessment of treatment response in some patient subgroups. Objectives: The objective of this study is to explore the associations of patient and disease characteristics with therapeutic lag on relapses and disability accumulation. Methods: Data from MSBase, a multinational multiple sclerosis (MS) registry, and OFSEP, the French MS registry, were used. Patients diagnosed with MS, minimum 1 year of exposure to MS treatment and 3 years of pre-treatment follow-up, were included in the analysis. Studied outcomes were incidence of relapses and disability accumulation. Therapeutic lag was calculated using an objective, validated method in subgroups stratified by patient and disease characteristics. Therapeutic lag under specific circumstances was then estimated in subgroups defined by combinations of clinical and demographic determinants. Results: High baseline disability scores, annualised relapse rate (ARR) ⩾ 1 and male sex were associated with longer therapeutic lag on disability progression in sufficiently populated groups: females with expanded disability status scale (EDSS) < 6 and ARR < 1 had mean lag of 26.6 weeks (95% CI = 18.2–34.9), males with EDSS < 6 and ARR < 1 31.0 weeks (95% CI = 25.3–36.8), females with EDSS < 6 and ARR ⩾ 1 44.8 weeks (95% CI = 24.5–65.1), and females with EDSS ⩾ 6 and ARR < 1 54.3 weeks (95% CI = 47.2–61.5). Conclusions: Pre-treatment EDSS and ARR are the most important determinants of therapeutic lag.

scholarly journals A Pilot Study of 24-h Motor Activity Patterns in Multiple Sclerosis: Pre-Planned Follow-Up at 2 Years

2021 ◽  
Vol 3 (3) ◽  
pp. 366-376
Author(s):  
Lorenzo Tonetti ◽  
Federico Camilli ◽  
Sara Giovagnoli ◽  
Vincenzo Natale ◽  
Alessandra Lugaresi
Keyword(s):  
Multiple Sclerosis ◽  
Motor Activity ◽  
Activity Pattern ◽  
Activity Patterns ◽  
Expanded Disability Status Scale ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Edss Score ◽  
Activity Prognosis

Early multiple sclerosis (MS) predictive markers of disease activity/prognosis have been proposed but are not universally accepted. Aim of this pilot prospective study is to verify whether a peculiar hyperactivity, observed at baseline (T0) in early relapsing-remitting (RR) MS patients, could represent a further prognostic marker. Here we report results collected at T0 and at a 24-month follow-up (T1). Eighteen RRMS patients (11 females, median Expanded Disability Status Scale-EDSS score 1.25, range EDSS score 0–2) were monitored at T0 (mean age 32.33 ± 7.51) and T1 (median EDSS score 1.5, range EDSS score 0–2.5). Patients were grouped into two groups: responders (R, 14 patients) and non-responders (NR, 4 patients) to treatment at T1. Each patient wore an actigraph for one week to record the 24-h motor activity pattern. At T0, NR presented significantly lower motor activity than R between around 9:00 and 13:00. At T1, NR were characterized by significantly lower motor activity than R between around 12:00 and 17:00. Overall, these data suggest that through the 24-h motor activity pattern, we can fairly segregate at T0 patients who will show a therapeutic failure, possibly related to a more active disease, at T1. These patients are characterized by a reduced morning level of motor activation. Further studies on larger populations are needed to confirm these preliminary findings.

scholarly journals Routine colonoscopy may be needed for uncomplicated acute right colonic diverticulitis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kil-yong Lee ◽  
Jaeim Lee ◽  
Youn Young Park ◽  
Seong Taek Oh
Keyword(s):  
Computed Tomography ◽  
Colon Cancer ◽  
Detection Rate ◽  
Primary Outcome ◽  
Advanced Adenoma ◽  
Secondary Outcome ◽  
Colonic Diverticulitis ◽  
Right Colon ◽  
Colon Diverticulitis

Abstract Background Routine colonoscopy is recommended to determine the coexistence of colon cancer after medical treatment for colon diverticulitis. However, in the case of uncomplicated diverticulitis diagnosed by computed tomography, the clinical relevance of routine follow-up colonoscopy has recently been debated. Yet, the role of follow-up colonoscopy for right colon diverticulitis, which tends to develop at a younger age than left colon diverticulitis, has not been specifically evaluated. Therefore, we aimed to evaluate the incidence of right colon cancer or colonic adenomatous polyps, detected by routine colonoscopy, after conservative management of acute uncomplicated right colon diverticulitis. Methods Patients with uncomplicated right colon diverticulitis (modified Hinchey stage Ia) diagnosed by computed tomography imaging, between 2011 and 2017, and who underwent follow-up colonoscopy surveillance after treatment were included. The primary outcome was the incidence of colon cancer, with the detection rate of adenoma being the secondary outcome. Information for analysis was retrieved retrospectively from patients’ medical records. Results The study group included 330 consecutive patients, with a mean age of 41.9 years, and 51.9% being men. For the primary outcome, the rate of colon cancer on follow-up colonoscopy was 0.3% (1/330 cases). The rate of adenoma detection was 20.9% (69/330 cases) and advanced adenoma (> 10 mm in diameter; or exhibiting a > 25% villous component or severe dysplasia), including colon cancer, was observed in 9 patients (2.7%). Conclusions In patients with acute uncomplicated right colonic diverticulitis, routine colonoscopy after conservative treatment may be necessary because although the colon cancer detection rate is low, it is possible to detect advanced colon adenoma.

Walking capacities in multiple sclerosis measured by global positioning system odometer

2007 ◽  
Vol 13 (2) ◽  
pp. 220-223 ◽  
Author(s):  
A Créange ◽  
I Serre ◽  
M Levasseur ◽  
D Audry ◽  
A Nineb ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Global Positioning System ◽  
Walking Speed ◽  
Walking Distance ◽  
Expanded Disability Status Scale ◽  
Satellite Technology ◽  
Promising Tool ◽  
Disability Status ◽  
Global Positioning

We used a global positioning satellite technology odometer to determine the maximum objective walking distance capacity (MOWD) of patients with multiple sclerosis (MS). The MOWD correlated with Expanded Disability Status Scale (EDSS) score (r2 =0.41; P < 0.0001), the MSWS-12 scale (r2 = 0.46; P < 0.0001), time to walk 10 m (r2 = 0.51; P < 0.02) and walking speed (r2 =0.75; P < 0.001). Limitation of walking capacities was measurable up to 4550 m, strikingly above the 500-m limit of the EDSS. This objective odometer is a promising tool for evaluation and follow-up of patients with MS. Multiple Sclerosis 2007; 13: 220–223. http://msj.sagepub.com

Prospective study of multiple sclerosis with early onset

2002 ◽  
Vol 8 (2) ◽  
pp. 115-118 ◽  
Author(s):  
A Ghezzi ◽  
C Pozzilli ◽  
M Liguori ◽  
M G Marrosu ◽  
N Milani ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
First Year ◽  
Hormonal Changes ◽  
Disability Status ◽  
Definite Multiple Sclerosis ◽  
Relapsing Remitting ◽  
Clinically Definite Multiple Sclerosis ◽  
The Mean ◽  
And Gender

Fifty-four subjects (36 females and 18 males) affected by clinically definite multiple sclerosis (MS) and with onset of the disease at 15 years of age or before were prospectively studied in five Italian MS centres. Female/male ratio was 4.7 in subjects with age ≥12 years, suggesting a role of hormonal changes in triggering MS onset. The mean follow-up duration was 10.9-5.6 years. The functional systems more frequently involved at onset were the pyramidal and brainstem (both in 28% of cases). The onset was monosymptomatic in 31 subjects (57%). The course was relapsing-remitting in 39 subjects (72%) and relapsing-progressive in 15 (28%). Disability was assessed by the Expanded Disability Status Scale (EDSS): the mean score after 8 years of follow up was 3.5 (-2.5). The score was <4 in 68% of cases, between 4 and 6 in 8% of cases, > 6 in 24% of cases. Disability after 8 years was highly predicted by disability in the first year (p=0.008). There was a tendency to a worse prognosis in relation to the number of relapses in the first 2 years (p=0.08). The outcome was not influenced by the characteristics of symptoms at onset, age and gender.

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