scholarly journals Conversion of clinically isolated syndrome to multiple sclerosis: a prospective multi-center study in Eastern India

2019 ◽  
Vol 5 (2) ◽  
pp. 205521731984972
Author(s):  
TK Banerjee ◽  
M Saha ◽  
E Ghosh ◽  
A Hazra ◽  
A Das ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Conversion Rate ◽  
Age Of Onset ◽  
Demographic Data ◽  
Clinically Isolated Syndrome ◽  
Cerebral Mri ◽  
Long Term Follow Up ◽  
Magnetic Resonance Imaging Mri ◽  
Multi Center Study

Background In White populations more than 60% of clinically isolated syndrome (CIS) convert to multiple sclerosis (MS) on a long-term follow-up; several predictors for conversion have been identified. Objective This study aimed to determine the conversion rate and the predictors of conversion from CIS to MS (McDonald 2010) among Indians. The other objective was to evaluate the diagnostic accuracy of the new McDonald 2017 criteria in prediction of a second clinical attack. Methods Clinical and demographic data of CIS cohorts were collected. Baseline investigations included cerebrospinal magnetic resonance imaging (MRI) with contrast and cerebrospinal fluid (CSF) testing for oligoclonal band (OCB). Follow-up clinical and MRI examinations were performed annually for at least 24 months. Results Of the 82 subjects (age range 15–58 years), 36 (43.9%) converted to MS; 31/82 (37.8%) converted in 24 months. The predictors for conversion were earlier age of onset, CSF-OCB, cerebral MRI T2 lesion count, and periventricular and juxtacortical location of lesions. Twenty-two (26.83%) CIS fulfilled the McDonald MS 2017 criteria at baseline. Conclusion In this first prospective study of CIS in India, the risk factors for conversion are similar but the conversion rate to MS is lower than that in the western nations.

scholarly journals Predictors and Conversion Rate of Clinically Isolated Syndrome to Clinically Definite Multiple Sclerosis: A Follow-up Study in Patients Living in the Southern Part of Iran

2020 ◽  
Vol 6 (1) ◽  
pp. 9-15
Author(s):  
Sadegh Izadi ◽  
◽  
Meysam Ahmadi ◽  
Maryam Poursadeghfard ◽  
◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Conversion Rate ◽  
Regression Models ◽  
Cox Regression ◽  
Clinical Course ◽  
Clinically Isolated Syndrome ◽  
Definite Multiple Sclerosis ◽  
Clinically Definite Multiple Sclerosis ◽  
The Mean

Background: Clinical course of Clinically Isolated Syndrome (CIS) is variable, and identifying patients who will eventually develop Multiple Sclerosis (MS) is essential. Objectives: To assess the conversion rate of CIS to Clinically Definite Multiple Sclerosis (CDMS) and its predictors in southern Iran. Materials & Methods: A total of 143 CIS patients registered to Fars Multiple Sclerosis Society (FMSS) were enrolled in the study from 2006 until 2012, and all of them were followed for 5 years. Also, their demographic and MRI data were recorded. The obtained data were analyzed by univariate and multivariable Cox regression models in SPSS v. 17. P<0.05 was considered statistically significant. Results: About 26.6% of patients progressed to MS after a mean duration of 3.4±1.1 years. The conversion rate was 27.6% in patients presented with optic neuritis, and 25.6% in patients presented with spinal cord problems. Although it was not statistically significant (P=0.23), the mean age of the patients who converted to MS was lower at the onset of the presentation (27.6 vs. 29.4 years). In patients who had 3 or more MRI lesions, the conversion rate was 49.2%; however, it was only 9.8% in subjects who had fewer than 3 lesions (OR=8.95, 95% CI=3.69–21.7, P <0.001). Women had higher conversion rate though it was not statistically significant (OR=2.09, 95% CI=0.57–7.64, P=0.26). Conclusion: Our results supported this supposition that the number of MRI lesions at baseline can be used as a predictor of CIS conversion to MS.

Combined analysis of global and compartmental brain volume changes in early multiple sclerosis in clinical practice

2015 ◽  
Vol 22 (3) ◽  
pp. 340-346 ◽  
Author(s):  
A Pichler ◽  
M Khalil ◽  
C Langkammer ◽  
D Pinter ◽  
G Bachmaier ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Brain Volume ◽  
Volume Changes ◽  
Routine Clinical Setting ◽  
Cortical Grey Matter ◽  
Long Term Follow Up ◽  
Degree Of Disability ◽  
Magnetic Resonance Imaging Mri

Background: The extent and clinical significance of brain volume changes in different phases of multiple sclerosis (MS) is still under discussion. Objective: To determine the rate of global and compartmental brain volume changes in patients with a clinically-isolated syndrome (CIS) compared to patients with definite MS, by long-term follow-up and as a predictor of conversion to MS in a routine clinical setting. Methods: We investigated 120 patients (63 CIS and 57 MS) at baseline and after a mean follow-up period of 43 months, including detailed clinical examination and 3-Tesla magnetic resonance imaging (MRI). Our imaging analyses comprised the normalized brain volume (NBV), cortical grey matter (cGMV) and white matter (WMV) volumes using SIENA/X, the percentage of brain volume change (PBVC) using SIENA and the change in the volume of the thalami (TV) and basal ganglia (BGV). We also determined the amount and change of T2-lesion load (T2-LL). Results: At baseline, all the brain volume metrics, except cGMV, were significantly lower; and the T2-LL was significantly higher, in patients with MS rather than CIS. During the follow-up, only the PBVC was higher in MS ( p = 0.008) and this difference was driven by converters from CIS to MS. Quartiles of PBVC did not allow us to predict conversion to MS, but were associated with the degree of disability. Conclusions: PBVC is the most sensitive marker of progressing atrophy and a higher PBVC was generally associated with more active disease; however, it did not serve to predict the course of MS on an individual basis, in this study.

C onversion to multiple sclerosis after a clinically isolated syndrome of the brainstem: cranial magnetic resonance imaging, cerebrospinal fl uid and neurophysiological findings

2003 ◽  
Vol 9 (1) ◽  
pp. 39-43 ◽  
Author(s):  
J Sastre-Garriga ◽  
M Tintoré ◽  
A Rovira ◽  
E Grivé ◽  
I Pericot ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Clinically Isolated Syndrome ◽  
Oligoclonal Bands ◽  
Resonance Imaging ◽  
Predictive Values ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity

B ackground and aim: C onversion to multiple sclerosis (MS) after optic neuritis and myelitis has been thoroughly studied; however, limited data are available regarding conversion to MS after a clinically isolated syndrome of the brainstem (CISB). The aim of this study was to investigate conversion to MS in patients with C ISB. Methods: Fifty-one patients with C ISB were prospectively studied. C ranial magnetic resonance imaging (MRI), determination of oligoclonal bands (OBs) in the cerebrospinal fluid (C SF) and evoked potentials (EPs) were performed. Based on conversion to MS at follow-up, the sensitivity, specificity, accuracy and positive and negative predictive values of these tests were calculated. Results: C linically definite MS developed in 18 (35%) patients after a mean follow-up of 37 months. Paty’s MRI criteria showed a sensitivity of 89%, a specificity of 52% and an accuracy of 65%; Fazekas’ criteria showed a sensitivity of 89%, a specificity of 48% and an accuracy of 63%; Barkhof’s criteria showed a sensitivity of 78%, a specificity of 61% and an accuracy of 67%. The presence of O Bs in the C SF showed a sensitivity of 100%, a specificity of 42% and an accuracy of 63%. No differences for neurophysiological parameters were found between patients who did and those who did not convert to MS. C onclusion: Fulfilling Paty’s, Fazekas’ or Barkhof’s MRI criteria and the presence of O Bs in the C SF are associated with a higher risk of conversion to MS in patients with C ISB. Determinatio n of O Bs in the C SF has the greatest sensitivity of all tests. Barkhof’s MRI criteria have greater specificity (although less than previously published for mixed cohorts of clinically isolated syndromes) in predicting conversion to MS for C ISB than either Paty’s or Fazekas’ criteria.

scholarly journals Disability improvement as a clinically relevant outcome in clinical trials of relapsing forms of multiple sclerosis

2021 ◽  
pp. 135245852110002
Author(s):  
Bruce AC Cree ◽  
Jeffrey A Cohen ◽  
Anthony T Reder ◽  
Davorka Tomic ◽  
Diego Silva ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Trials ◽  
Therapeutic Benefit ◽  
Disease Modifying Therapies ◽  
Long Term Follow Up ◽  
Post Hoc ◽  
Switch Group ◽  
Relevant Outcome

Background: Disease-modifying therapies (DMTs) can reduce the risk of disability worsening in patients with relapsing forms of multiple sclerosis (RMS). High-efficacy DMTs can lead to confirmed or sustained disability improvement (CDI and SDI). Objective and Methods: Post hoc analyses of data from the TRANSFORMS, FREEDOMS, and FREEDOMS II trials and their extensions assessed the effects of fingolimod (0.5–1.25 mg/day) on stabilizing or improving disability over ⩽8 years in participants with RMS. CDI and SDI rates were compared between participants initially randomized to fingolimod, interferon (IFNβ-1a), or placebo. Results: At 8 years’ follow-up in TRANSFORMS, 35.1% (95% confidence interval [CI], 28.2%–43.1%) of assessed participants in the IFNβ-1a–fingolimod switch group and 41.9% (36.6%–47.6%) on continuous fingolimod experienced CDI; disability did not worsen in approximately 70%. Similar results were seen in the combined FREEDOMS population. Proportionally fewer TRANSFORMS participants achieved SDI in the IFNβ-1a–fingolimod switch group than on continuous fingolimod (5.4% [3.0%–9.5%] vs 14.2% [10.8%–18.4%], p = 0.01). Conclusion: CDI and SDI are outcomes of interest for clinical trials and for long-term follow-up of participants with RMS. Monitoring CDI and SDI in addition to disability worsening may facilitate understanding of the therapeutic benefit of RMS treatments.

scholarly journals Fibromuscular dysplasia with recurrence after “long-term” following percutaneous transcatheter renal angioplasty: two case reports with a review of 26 patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shuntaro Oribe ◽  
Takafumi Toyohara ◽  
Eikan Mishima ◽  
Takehiro Suzuki ◽  
Koichi Kikuchi ◽  
...  
Keyword(s):  
Fibromuscular Dysplasia ◽  
Age Of Onset ◽  
Case Reports ◽  
Case Presentation ◽  
Renal Angioplasty ◽  
Long Term Follow Up ◽  
Percutaneous Transluminal Renal Angioplasty ◽  
The Difference

Abstract Background Fibromuscular dysplasia (FMD) often causes renal artery stenosis with renovascular hypertension. Recent clinical outcomes encourage percutaneous transluminal renal angioplasty (PTRA) to treat FMD; however, the necessary follow-up period remains unclear. Moreover, previous studies have not revealed the difference in the period until recurrence between two major types of FMD—multifocal and focal. Case presentation We describe two patients with multifocal FMD who developed hypertension during their teenage years and had recurrence of FMD > 10 years after PTRA. We further examined the types of FMD and age of onset in 26 patients who underwent PTRA. The period until recurrence of multifocal FMD was longer than that of focal FMD. Moreover, patients with early-onset multifocal FMD are likely to have a delayed recurrence after PTRA compared to other types. Conclusions Our report suggests that patients with multifocal FMD, especially those with onset at an early age, may need long-term follow-up for at least ≥ 10 years.

Post-Operative Dysphagia in Anterior Cervical Discectomy and Fusion

2021 ◽  
pp. 000348942110155
Author(s):  
Leonard Haller ◽  
Khush Mehul Kharidia ◽  
Caitlin Bertelsen ◽  
Jeffrey Wang ◽  
Karla O’Dell
Keyword(s):  
Risk Factors ◽  
Medical Records ◽  
Assessment Tool ◽  
Demographic Data ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Long Term Follow Up

Objective: We sought to identify risk factors associated with long-term dysphagia, characterize changes in dysphagia over time, and evaluate the incidence of otolaryngology referrals for patients with long-term dysphagia following anterior cervical discectomy with fusion (ACDF). Methods: About 56 patients who underwent ACDF between May 2017 to February 2019 were included in the study. All patients were assessed for dysphagia using the Eating Assessment Tool (EAT-10) survey preoperatively and late postoperatively (≥1 year). Additionally, 28 patients were assessed for dysphagia early postoperatively (2 weeks—3 months). Demographic data, medical comorbidities, intraoperative details, and post-operative otolaryngology referral rates were collected from electronic medical records. Results: Of the 56 patients enrolled, 21 patients (38%) had EAT-10 scores of 3 or more at long-term follow-up. None of the demographics, comorbidities, or surgical factors assessed were associated with long-term dysphagia. Patients who reported no long-term dysphagia had a mean EAT-10 score of 6.9 early postoperatively, while patients with long-term symptoms had a mean score of 18.1 ( P = .006). Of the 21 patients who reported persistent dysphagia symptoms, 3 (14%) received dysphagia testing or otolaryngology referrals post-operatively. Conclusion: Dysphagia is a notable side effect of ACDF surgery, but there are no significant demographics, comorbidities, or surgical risk factors that predict long-term dysphagia. Early postoperative characterization of dysphagia using the EAT-10 questionnaire can help predict long-term symptoms. There is inadequate screening and otolaryngology follow-up for patients with post-ACDF dysphagia.

Behcet Disease: Long-term Follow-up of Three Children and Review of the Literature

PEDIATRICS ◽  
1989 ◽  
Vol 83 (6) ◽  
pp. 986-992
Author(s):  
Yardena Rakover ◽  
Hanna Adar ◽  
Itamar Tal ◽  
Yaron Lang ◽  
Amos Kedar
Keyword(s):  
Fever Of Unknown Origin ◽  
Age Of Onset ◽  
Unknown Origin ◽  
Behçet Disease ◽  
Behcet Disease ◽  
Cns Involvement ◽  
Course Of Illness ◽  
Long Term Follow Up

Behcet disease is rare in children. There are only two reports of Behcet disease in childhood, describing seven patients. Three pediatric patients are described, in whom the age of onset ranged from 6 to 11 years. Aphthous stomatitis and arthritis were present in all of the patients; genital ulcers, iridocylitis, erythema nodosum, and CNS involvement were present in two patients. Other manifestations included Stevens-Johnson-like eruption, fever of unknown origin, and testicular involvement. All of the patients responded to glucocorticoids; two were also treated with colchicine and one was treated with chlorambucil. In two patients, follow-up of more than 10 years was done, with complete cure in one patient and benign course of illness in the other. Because of the rarity of the disease in childhood and the difficulty in making the diagnosis, there is not enough awareness by pediatricians concerning this disease.

scholarly journals SUMMIT (Serially Unified Multicenter Multiple Sclerosis Investigation): creating a repository of deeply phenotyped contemporary multiple sclerosis cohorts

2017 ◽  
Vol 24 (11) ◽  
pp. 1485-1498 ◽  
Author(s):  
Riley Bove ◽  
Tanuja Chitnis ◽  
Bruce AC Cree ◽  
Mar Tintoré ◽  
Yvonne Naegelin ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
San Francisco ◽  
Medical Center ◽  
Clinically Isolated Syndrome ◽  
American University ◽  
American University Of Beirut ◽  
Longitudinal Investigation ◽  
American Academic

Background: There is a pressing need for robust longitudinal cohort studies in the modern treatment era of multiple sclerosis. Objective: Build a multiple sclerosis (MS) cohort repository to capture the variability of disability accumulation, as well as provide the depth of characterization (clinical, radiologic, genetic, biospecimens) required to adequately model and ultimately predict a patient’s course. Methods: Serially Unified Multicenter Multiple Sclerosis Investigation (SUMMIT) is an international multi-center, prospectively enrolled cohort with over a decade of comprehensive follow-up on more than 1000 patients from two large North American academic MS Centers (Brigham and Women’s Hospital (Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women’s Hospital (CLIMB; BWH)) and University of California, San Francisco (Expression/genomics, Proteomics, Imaging, and Clinical (EPIC))). It is bringing online more than 2500 patients from additional international MS Centers (Basel (Universitätsspital Basel (UHB)), VU University Medical Center MS Center Amsterdam (MSCA), Multiple Sclerosis Center of Catalonia-Vall d’Hebron Hospital (Barcelona clinically isolated syndrome (CIS) cohort), and American University of Beirut Medical Center (AUBMC-Multiple Sclerosis Interdisciplinary Research (AMIR)). Results and conclusion: We provide evidence for harmonization of two of the initial cohorts in terms of the characterization of demographics, disease, and treatment-related variables; demonstrate several proof-of-principle analyses examining genetic and radiologic predictors of disease progression; and discuss the steps involved in expanding SUMMIT into a repository accessible to the broader scientific community.

Therapeutic Hypothermia in Brazil: A MultiProfessional National Survey

2018 ◽  
Vol 36 (11) ◽  
pp. 1150-1156 ◽  
Author(s):  
G. F. Variane ◽  
L. M. Cunha ◽  
P. Pinto ◽  
P. Brandao ◽  
R. S. Mascaretti ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
National Survey ◽  
Health Care Professionals ◽  
Brain Magnetic Resonance Imaging ◽  
Significant Heterogeneity ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Long Term Follow Up ◽  
Magnetic Resonance Imaging Mri

Objective To determine the rate of therapeutic hypothermia (TH) use, current practices, and long-term follow-up. Study Design Prospective cross-sectional national survey with 19 questions related to the assessment of hypoxic–ischemic encephalopathy (HIE) and TH practices. An online questionnaire was made available to health care professionals working in neonatal care in Brazil. Results A total of 1,092 professionals replied, of which 681 (62%) reported using TH in their units. Of these, 624 (92%) provided TH practices details: 136 (20%) did not use any neurologic score or amplitude-integrated electroencephalogram (aEEG) to assess encephalopathy and 81(13%) did not answer this question. Any specific training for encephalopathy assessment was provided to only 81/407 (19%) professionals. Infants with mild HIE are cooled according to 184 (29%) of the respondents. Significant variations in practice were noticed concerning time of initiation and cooling methods, site of temperature measurements and monitoring, and access to aEEG, electroencephalogram (EEG), and neurology consultation. Only 19% could perform a brain magnetic resonance imaging (MRI), and 31% reported having a well-established follow-up program for these infants. Conclusion TH has been implemented in Brazil but with significant heterogeneity for most aspects of hypothermia practices, which may affect safety or efficacy of the therapy. A step forward toward quality improvement is important.

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