IV steroids during long episodes of Kleine-Levin syndrome

Neurology ◽  
2018 ◽  
Vol 90 (17) ◽  
pp. e1488-e1492 ◽  
Author(s):  
Antoine Léotard ◽  
Elisabeth Groos ◽  
Charlotte Chaumereuil ◽  
Laure Peter-Derex ◽  
Andrea O. Rossetti ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Adverse Effects ◽  
Risk Ratio ◽  
Muscle Pain ◽  
Disease Duration ◽  
Naturalistic Study ◽  
Previous Episode ◽  
Episode Duration ◽  
Class Iv

ObjectiveTo retrospectively compare the benefits (episode cessation) and risks of IV methylprednisolone (IV-MP) vs abstention during prolonged Kleine-Levin syndrome (KLS) episodes.MethodsA total of 26 patients with KLS received 1 g/d IV-MP for 3 days during 1 to 6 episodes each (totaling 43 IV-MP sessions). The change of episode duration with IV-MP (vs previous episode duration) was compared with the change duration between 2 consecutive episodes in 48 untreated patients matched for age, sex, age at KLS onset, number of episodes, and disease duration (more treated than untreated patients had long episodes).ResultsEleven patients (42.3%) had an episode that was at least 1 week shorter than the preceding one when they received IV-MP therapy, whereas shorter episodes were significantly less frequent (10.4%) in the untreated group. This benefit was more marked (65.5% responders, 12 fewer days in an episode vs 0 days in the untreated patients) when IV-MP was infused before the 10th day of the episode. Mild, transient adverse effects (insomnia, muscle pain, nervousness/restlessness, but no manic switching) were reported by 61.3% of patients. No specific responder profile was identified.ConclusionIn this open-labeled, naturalistic study, early IV-MP (following the protocol for multiple sclerosis relapses) had a good benefit/risk ratio during KLS episodes in patients with long episodes (with half of the patients having an early cessation of episodes).Classification of evidenceThis study provides Class IV evidence that for patients with long episodes of KLS, IV steroids decrease the duration of KLS episodes.

scholarly journals Pathology and Pathogenesis of Progressive Multiple Sclerosis: Concepts and Controversies

2017 ◽  
Vol 01 (03) ◽  
pp. E171-E181
Author(s):  
Adrian-Minh Schumacher ◽  
Christoph Mahler ◽  
Martin Kerschensteiner
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Deficits ◽  
Progressive Disease ◽  
Disease Duration ◽  
Disease Process ◽  
Progressive Multiple Sclerosis ◽  
Relapsing Remitting ◽  
Inflammatory Processes ◽  
The Central Nervous System

AbstractMultiple sclerosis (MS) is an inflammatory disease of the central nervous system that initially is often dominated by relapsing-remitting neurological symptoms. With increasing disease duration these relapses are more and more superimposed by a progressive disease process that leads to an irreversible accumulation of motor, sensory and cognitive deficits. This progressive phase of MS is still only incompletely understood and by and large refractory to therapy. Here we aim to use recent pathological and pathomechanistic insights to outline a unifying concept of progressive MS. Based on this view of the disease we examine current controversies surrounding progressive MS. We discuss whether neurodegenerative or inflammatory processes drive progression, question whether the classification of primary and secondary progressive MS is all that useful and deliberate, which therapeutic strategies are best suited to limit the insidious neurological decline of progressive MS patients.

scholarly journals Impact of Disease-Modifying Treatments of Multiple Sclerosis on Anti–SARS-CoV-2 Antibodies

2021 ◽  
Vol 8 (5) ◽  
pp. e1055
Author(s):  
Kévin Bigaut ◽  
Laurent Kremer ◽  
Thibaut Fabacher ◽  
Livia Lanotte ◽  
Marie-Celine Fleury ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Monoclonal Antibodies ◽  
Recurrent Infection ◽  
Humoral Response ◽  
Interferon Β ◽  
Igg Index ◽  
Disease Modifying ◽  
Anti Cd20 ◽  
Class Iv

ObjectiveTo compare the humoral response after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with multiple sclerosis (MS) receiving different disease-modifying treatments (DMTs).MethodsPatients with MS with coronavirus disease 2019 (COVID-19) and available anti–SARS-CoV-2 serology were included. The primary endpoint was the anti–SARS-CoV-2 immunoglobulin G (IgG) index. The multivariate analysis was adjusted for COVID-19 severity, SARS-CoV-2 PCR result, and the time between COVID-19 onset and the serology.ResultsWe included 61 patients with available IgG index. The IgG index was lower in patients with fingolimod or anti-CD20 monoclonal antibodies compared with patients without treatment (p < 0.01), patients with interferon β-1a or glatiramer (p < 0.01), and patients with another DMT (p = 0.01). The IgG index was correlated with the time between COVID-19 onset and serology (r = −0.296 [−0.510; −0.0477], p = 0.02).ConclusionsHumoral response after COVID-19 was lower in patients with MS with fingolimod or anti-CD20 mAb. These patients could therefore be at risk of recurrent infection and could benefit from anti–SARS-CoV-2 vaccination. The humoral response after vaccination and the delay before vaccination need to be evaluated.Classification of EvidenceThis study provides Class IV evidence that patients treated with fingolimod or anti-CD20 monoclonal antibodies for MS have a lower humoral response after COVID-19 compared with patients without DMTs or with another DMTs.

The International Classification of Functioning, Disability, and Health (ICF) as a community participation model for people with multiple sclerosis: A hierarchical regression analysis

2020 ◽  
Vol 26 (2) ◽  
pp. 55-72
Author(s):  
Joseph Pfaller ◽  
Fong Chan ◽  
Kanako Iwanaga ◽  
Jia-Rung Wu ◽  
Stuart Rumrill ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Regression Analysis ◽  
Community Participation ◽  
International Classification Of Functioning ◽  
Self Management ◽  
Hierarchical Regression ◽  
Personal Factors ◽  
Disability And Health ◽  
The Relationship

AbstractMultiple sclerosis (MS) is a central nervous system disorder that impacts more than 400,000 people in the U.S. The disease results in multiple functional impairments that are diverse and varied across individuals. Additonally, MS has a profound impact on community participation which, like other rehabilitation outcomes, cannot be explained on the basis of functional limitations alone. The purpose of this study was to develop and evaluate a model of community participation for people living with MS using the World Health Organization (WHO) International Classification of Functioning, Disability, and Health (ICF) framework. The model focused on the roles that personal factors have as predictors of community participation, while also serving as mediators and moderators for the relationship between activity limitation and participation. Results from the hierarchical regression analysis indicated that demographic characteristics (i.e. MS type), personal factors (i.e. core self-evaluations (CSE), MS self-management, resilience, and social skills), and activity limitations accounted for 64% of the variance in participation. Further, mediation analysis indicated that CSE mediated the relationship between activity limitation and community participation. Finally, moderation analysis indicated an interaction effect between educational attainment and MS self-management. Implications for future research in rehabilitation and clinical application are discussed.

Current Treatment Strategies for Multiple Sclerosis - Efficacy Versus Neurological Adverse Effects

2012 ◽  
Vol 18 (2) ◽  
pp. 209-219 ◽  
Author(s):  
Martin S. Weber ◽  
Til Menge ◽  
Klaus Lehmann-Horn ◽  
Helena C. Kronsbein ◽  
Uwe Zettl ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Adverse Effects ◽  
Treatment Strategies ◽  
Current Treatment

scholarly journals Internet Usage by Patients with Multiple Sclerosis: Implications to Participatory Medicine and Personalized Healthcare

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Izabella Lejbkowicz ◽  
Tamar Paperna ◽  
Nili Stein ◽  
Sara Dishon ◽  
Ariel Miller
Keyword(s):  
Multiple Sclerosis ◽  
Support Groups ◽  
Disease Duration ◽  
Internet Usage ◽  
Online Health Information ◽  
Online Information ◽  
Improve Symptom ◽  
Disabled Patients ◽  
Healthcare Optimization ◽  
Participatory Medicine

Online health information and services for patients were suggested to improve symptom management and treatment adherence, thereby contributing to healthcare optimization. This paper aimed to characterize multiple sclerosis (MS) patients Internet usage. Information regarding browsing habits, Internet reliability, and the medical team's attitude to information collected online was obtained by questionnaires from MS patients. Data was compared between nonbrowsers, browsers on MS topics, and browsers on non-MS topics only. From the 96 patients recruited, 61 (63.5%) performed MS-related searches. The most viewed topics were “understanding the disease” and “treatments”. Patients reported that the information helped coping with MS and assured them of the appropriateness of their therapy. Shorter disease duration was correlated with higher Internet activity. Disabled patients were more interested in online interaction with specialists and support groups. This paper suggests that MS patients benefit from online information, and it emphasizes the importance of resources tailored to patients needs.

Clinical and laboratory features of neuromyelitis optica with oligoclonal IgG bands

2007 ◽  
Vol 13 (3) ◽  
pp. 332-335 ◽  
Author(s):  
M. Nakamura ◽  
I. Nakashima ◽  
S. Sato ◽  
I. Miyazawa ◽  
K. Fujihara ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Autoimmune Diseases ◽  
Myasthenia Gravis ◽  
Neuromyelitis Optica ◽  
Disease Duration ◽  
Sicca Syndrome ◽  
Common Features ◽  
Laboratory Features ◽  
Oligoclonal Igg ◽  
Oligoclonal Igg Bands

Of 23 neuromyelitis optica (NMO) cases, we found two cases with oligoclonal IgG bands (OBs). Both patients were positive for NMO-IgG. Their common features were long disease duration and co-existing autoimmune diseases (myasthenia gravis and sicca syndrome). Although OBs are mostly negative in NMO, which distinguishes it from multiple sclerosis (MS), they can be positive by long-standing autoimmunity, which may not be directly related to NMO. Multiple Sclerosis 2007; 13: 332-335. http://msj.sagepub.com

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