117,657 research outputs found

    Fingolimod as an effective therapeutic strategy for pediatric relapsing-remitting multiple sclerosis: two case reports

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    Approximately 3–10% of patients with multiple sclerosis (MS) have onset during childhood. Pediatric MS is characterized by a relapsing-remitting course and a high relapse rate. In 2010, fingolimod (Gilenya®) was approved in the USA for the treatment of relapsing-remitting MS in adults. In 2018, both the United States Food and Drug Administration and the European Medicines Agency expanded the approved indications of fingolimod to include its use in children with relapsing MS, and the drug was approved in Italy for this indication in September 2020. We describe two cases of children with relapsing-remitting MS who were treated with fingolimod at IRCCS Ospedale San Raffaele Multiple Sclerosis Center (Milan, Italy) for more than 2 years. Our real-world data confirm that fingolimod is an effective therapeutic strategy for children with relapsing MS, and its use could be considered in pediatric patients with active disease

    Acoustic transmission problems: wavenumber-explicit bounds and resonance-free regions

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    We consider the Helmholtz transmission problem with one penetrable star-shaped Lipschitz obstacle. Under a natural assumption about the ratio of the wavenumbers, we prove bounds on the solution in terms of the data, with these bounds explicit in all parameters. In particular, the (weighted) H1H^1 norm of the solution is bounded by the L2L^2 norm of the source term, independently of the wavenumber. These bounds then imply the existence of a resonance-free strip beneath the real axis. The main novelty is that the only comparable results currently in the literature are for smooth, convex obstacles with strictly positive curvature, while here we assume only Lipschitz regularity and star-shapedness with respect to a point. Furthermore, our bounds are obtained using identities first introduced by Morawetz (essentially integration by parts), whereas the existing bounds use the much-more sophisticated technology of microlocal analysis and propagation of singularities. We also recap existing results that show that if the assumption on the wavenumbers is lifted, then no bound with polynomial dependence on the wavenumber is possible.Comment: 26 pages, 2 figure

    What is the potential of paramagnetic rim lesions as diagnostic indicators in multiple sclerosis?

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    Introduction In multiple sclerosis (MS), paramagnetic rim lesions (PRLs) on MRI identify a subset of chronic active lesions (CALs), which have been linked through clinical and pathological studies to more severe disease course and greater disability accumulation. Beside their prognostic relevance, increasing evidence supports the use of PRL as a diagnostic biomarker. Areas covered This review summarizes the most recent updates regarding the MRI pathophysiology of PRL, their prevalence in MS (by clinical phenotypes) vs mimicking conditions, and their potential role as diagnostic MS biomarkers. We searched PubMed with terms including 'multiple sclerosis' AND 'paramagnetic rim lesions' OR 'iron rim lesions' OR 'rim lesions' for manuscripts published between January 2008 and July 2022. Expert opinion Current research suggests that PRL can improve the diagnostic specificity and the overall accuracy of MS diagnosis when used together with the dissemination in space MRI criteria and the central vein sign. Nevertheless, future prospective multicenter studies should further define the real-world prevalence and specificity of PRL. International guidelines are needed to establish methodological criteria for PRL identification before its implementation into clinical practice

    Marchiafava-Bignami disease: Longitudinal MR imaging and MR spectroscopy study

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    A case of Marchiafava-Bignami disease was serially evaluated with MR imaging and MR spectroscopy at 1, 2,4, and 11 months after the onset of symptoms. The first MR imaging study showed extensive abnormal signal intensity of the corpus callosum without macroscopic changes; a diagnosis of Marchiafava-Bignami disease was made, and vitamin therapy was initiated. Follow-up studies showed progressive reduction of signal intensity abnormalities and residual callosal atrophy. MR spectroscopy revealed progressive reduction of the N-acetylaspartate:creatine ratio, with partial recovery in the last study, and a normalization of the choline:creatine ratio, which was initially slightly increased. Lactate was detectable during the subacute phase and was replaced by lipids after 4 months. This study confirmed the role of MR imaging in diagnosing Marchiafava-Bignami disease and particularly the value of MR spectroscopy in focusing the pathogenesis of the disease, monitoring its evolution and changes related to therapy
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