1,721,071 research outputs found
Verbal fluency deficits in clinically isolated syndrome suggestive of multiple sclerosis.
No full textNatalizumab discontinuation is associated with a rebound of cognitive impairment in multiple sclerosis patients
No full textNatalizumab discontinuation is associated with a disease reactivation in multiple sclerosis (MS) patients. Whether this reactivation involves also cognitive functions is not known to date. To assess the persistence of the effect of natalizumab on cognitive functions 1 year after its discontinuation, we compared the longitudinal changes of cognitive performances in two groups of patients. The interrupters, 30 MS patients, have stopped natalizumab due to PML concern, and the continuers, 28 MS patients, continued the treatment. The cognitive impairment index (CII) was used as main outcome measure. As expected, during the natalizumab treatment, we observed a significant reduction of the relapse rate and the number of gadolinium-enhancing lesions along with a reduction of the CII. After 1 year of discontinuation, the beneficial effect on cognitive functions was lost in the interrupters group, as the mean CII increased in comparison with the mean at the end of natalizumab treatment (12.2 ± 7.9 vs 9.3 ± 8.1, p < 0.0001). As opposite, in the continuers group, the CII further decreased after an additional year of treatment (8.4 ± 5.1 vs 9.8 ± 4.6, p = 0.007). A multivariate logistic regression model revealed as predictors of cognitive worsening male sex, disease duration, and the treatment discontinuation. The worsening of cognitive functions after natalizumab discontinuation goes in parallel with the clinical/radiological disease reactivation. Our data reinforce the hypothesis that, in the short-term, natalizumab exerts its positive impact on cognitive functions by means of its anti-inflammatory properties
Assessing long-term effectiveness of MS treatment — a matter of debate
No full textNo abstract availabl
The improvement of cognitive functions is associated with a decrease of plasma Osteopontin levels in Natalizumab treated relapsing multiple sclerosis.
No full textFirst evidence of in vivo pro-angiogenic activity of cerebrospinal fluid samples from multiple sclerosis patients
No full textIncreased vascular density and endothelial cell
proliferation have been demonstrated in multiple sclerosis
(MS) white matter, as well as an elevated vascular endothelial
growth factor expression was detected in reactive
astrocytes of both active and inactive chronic demyelinated
lesions and in sera of MS patients during clinical relapses.
In this study, we have investigated the angiogenic activity
of cerebrospinal fluid (CSF) samples from MS patients
with different stages of disease by means of the chick
embryo chorioallantoic membrane (CAM), a well-known
assay to study angiogenesis in vivo. Results have shown
that CSF samples from MS patients induced a significant
(p.05) angiogenic response in CAM in comparison
with CSF from neurological controls. The vessel density
was higher (p.0001) in secondary (23.60 ± 1.14) and
primary (23.50 ± 1.87) progressive patients in comparison
with relapsing MS (17.25 ± 1.75) and clinically isolated
syndrome suggestive of MS (13.00 ± 1.79), and a significant
correlation (r = 0.611, p = 0.005) was found
between the angiogenic response and disability level. The
results of this preliminary report demonstrate for the first
time an angiogenic activity in vivo of CSF samples from
MS patients and confirm the importance of angiogenesis as
a key event in MS pathogenesis and progression
Interrogating large multiple sclerosis registries and databases: what information can be gained?
Full text linkPurpose of review Although substantial progress has been made in understanding the natural history of multiple sclerosis (MS) and the development of new therapies, many questions concerning disease behavior and therapeutics remain to be answered. Data generated from real-world observational studies, based on large MS registries and databases and analyzed with advanced statistical methods, are offering the scientific community answers to some of these questions that are otherwise difficult or impossible to address. This review focuses on observational studies published in the last 2 years designed to compare the effectiveness of escalation vs. induction treatment strategies, to assess the effectiveness of treatment in pediatric-onset and late-onset MS, and to identify the clinical phenotype of secondary progressive (SP)MS. Recent findings The main findings originating from real-world studies suggest that MS patients who will qualify for high-efficacy disease-modifying therapies (DMTs) should be offered these as early as possible to prevent irreversible accumulation of neurological disability. Especially pediatric patients derive substantial benefits from early treatment. In patients with late-onset MS, sustained exposure to DMTs may result in more favorable outcomes. Data-driven definitions are more accurate in defining transition to SPMS than diagnosis based solely on neurologists' judgment. Patients, physicians, industry, and policy-makers have all benefited from real-world evidence based on registry data, in answering questions of diagnostics, choice of treatment, and timing of treatment decisions
Dengue fever in a multiple sclerosis patient taking Ocrelizumab
No full textDengue fever (DF) is an endemic infectious disease in tropical and subtropical regions. Ocrelizumab is a humanized monoclonal antibody that targets the CD20 antigen on B cells, which is approved for the treatment of both relapsing-remitting multiple sclerosis (RRMS) and primary-progressive multiple sclerosis (PPMS). We describe the favorable clinical outcome of DF in an RRMS patient treated with Ocrelizumab, who neither presented hemorrhagic or systemic shock symptoms nor reported neurological worsening
Interdisciplinary approach to opportunistic infections: staphylococcal meningitis in a patient with multiple sclerosis on treatment with dimethyl fumarate
No full textDear Editor,
Multiple Sclerosis (MS) is a chronic infammatory disease
of the central nervous system (CNS) representing a relevant
cause of disability in young adults. In the last 20 years, new
and emerging disease-modifying drugs (DMD) have been
introduced in clinical practice revolutionizing the natural
history of the disease [1]. However, immunomodulatory and
immunosuppressive treatments for MS are associated with
an increased risk of severe infections, which ranges from
0.2% to 2.6% [2
Treating multiple sclerosis with natalizumab.
No full textNatalizumab is the first monoclonal antibody approved for the treatment of relapsing multiple sclerosis. Pivotal trials demonstrated the efficacy of natalizumab on clinical and paraclinical measures of disease activity and disability progression. Although a direct comparison has not been performed yet, natalizumab seems to be more efficacious than the currently available immunomodulant drugs, such as IFN-β and glatiramer acetate. Despite its efficacy, the occurrence of an increased risk of progressive multifocal leukoencephalopathy with the treatment, raises concerns about its widespread use in multiple sclerosis patients. This paper provides an overview of the most relevant results from the Phase I-IV studies on natalizumab and highlights the challenges addressed to minimize and manage its adverse events in clinical practic
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