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1. Symptomatic COVID-19 course and outcomes after three mRNA vaccine doses in multiple sclerosis patients treated with high-efficacy DMTs

Author

Capuano, Rocco, primary, Prosperini, Luca, additional, Altieri, Manuela, additional, Lorefice, Lorena, additional, Fantozzi, Roberta, additional, Cavalla, Paola, additional, Guaschino, Clara, additional, Radaelli, Marta, additional, Cordioli, Cinzia, additional, Nociti, Viviana, additional, Boffa, Laura, additional, Ragonese, Paolo, additional, Di Gregorio, Maria, additional, Pinardi, Federica, additional, Torri Clerici, Valentina, additional, De Luca, Giovanna, additional, Gajofatto, Alberto, additional, Paolicelli, Damiano, additional, Tortorella, Carla, additional, Gasperini, Claudio, additional, Solaro, Claudio, additional, Cocco, Eleonora, additional, Bisecco, Alvino, additional, and Gallo, Antonio, additional

Published
2023
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2. Symptomatic COVID-19 course and outcomes after three mRNA vaccine doses in multiple sclerosis patients treated with high-efficacy DMTs

Author

Rocco Capuano, Luca Prosperini, Manuela Altieri, Lorena Lorefice, Roberta Fantozzi, Paola Cavalla, Clara Guaschino, Marta Radaelli, Cinzia Cordioli, Viviana Nociti, Laura Boffa, Paolo Ragonese, Maria Di Gregorio, Federica Pinardi, Valentina Torri Clerici, Giovanna De Luca, Alberto Gajofatto, Damiano Paolicelli, Carla Tortorella, Claudio Gasperini, Claudio Solaro, Eleonora Cocco, Alvino Bisecco, and Antonio Gallo

Subjects
Neurology, ocrelizumab, third booster vaccine dose, Neurology (clinical), COVID-19 course, fingolimod, multiple sclerosis, COVID-19 outcomes
Abstract

Background: Little is known about COVID-19 course and outcomes after a third booster dose of mRNA vaccine against SARS-CoV-2 (mRNA-Vax) in patients with multiple sclerosis (pwMS) treated with ocrelizumab (OCR) and fingolimod (FNG), which showed a weakened immune response to mRNA-vax. Objectives: The aim of this study was to evaluate COVID-19 course and outcomes in pwMS on OCR and FNG after receiving the third dose of mRNA-Vax and to compare it with pwMS on natalizumab (NTZ). Methods: Inclusion criteria: >18 years of age, being treated with OCR/FNG/NTZ since the first mRNA-Vax dose; COVID-19 after a third booster dose of mRNA-Vax; no steroids use. Results: Overall, 290 pwMS (79 NTZ, 126 OCR, and 85 FNG) from 17 Italian MS centers were included. Age, Expanded Disability Status Scale (EDSS) score, MS phenotype, disease, and treatment duration were significantly different across groups. PwMS who had COVID-19 on OCR and FNG compared with those on NTZ were slightly more symptomatic with higher hospitalization rates (11.1% vs 7.1% vs 1.3%, respectively). Regression models showed that the majority of the differences observed were not related to the disease-modifying treatments (DMTs) used. No fatal cases were observed. Conclusion: Our results support the effectiveness of the third booster dose of mRNA-Vax against severe forms of COVID-19 in pwMS treated with OCR and FNG.

Published
2023

3. SARS-CoV-2 serology after COVID-19 in multiple sclerosis: An international cohort study

Author

Sormani, Maria Pia, primary, Schiavetti, Irene, additional, Landi, Doriana, additional, Carmisciano, Luca, additional, De Rossi, Nicola, additional, Cordioli, Cinzia, additional, Moiola, Lucia, additional, Radaelli, Marta, additional, Immovilli, Paolo, additional, Capobianco, Marco, additional, Brescia Morra, Vincenzo, additional, Trojano, Maria, additional, Tedeschi, Gioacchino, additional, Comi, Giancarlo, additional, Battaglia, Mario Alberto, additional, Patti, Francesco, additional, Fragoso, Yara Dadalti, additional, Sen, Sedat, additional, Siva, Aksel, additional, Furlan, Roberto, additional, Salvetti, Marco, additional, Abbadessa, Gianmarco, additional, Aguglia, Umberto, additional, Allegorico, Lia, additional, Allegri, Rossi Beatrice Maria, additional, Amato, Maria Pia, additional, Annovazzi, Pietro, additional, Antozzi, Carlo, additional, Appendino, Lucia, additional, Arena, Sebastiano, additional, Baione, Viola, additional, Balgera, Roberto, additional, Barcella, Valeria, additional, Baroncini, Damiano, additional, Barrilà, Caterina, additional, Battaglia, Mario A., additional, Bellacosa, Alessandra, additional, Bellucci, Gianmarco, additional, Bergamaschi, Roberto, additional, Bergamaschi, Valeria, additional, Bezzini, Daiana, additional, Biolzi, Beatrice, additional, Bisecco, Alvino, additional, Bonavita, Simona, additional, Borriello, Giovanna, additional, Bosa, Chiara, additional, Bosco, Antonio, additional, Bovis, Francesca, additional, Bozzali, Marco, additional, Brambilla, Laura, additional, Brescia, Morra Vincenzo, additional, Brichetto, Giampaolo, additional, Buccafusca, Maria, additional, Bucciantini, Elisabetta, additional, Bucello, Sebastiano, additional, Buscarinu, Maria Chiara, additional, Cabboi, Maria Paola, additional, Calabrese, Massimiliano, additional, Calabria, Francesca, additional, Caleri, Francesca, additional, Camilli, Federico, additional, Caniatti, Luisa Maria, additional, Cantello, Roberto, additional, Capra, Ruggero, additional, Capuano, Rocco, additional, Carta, Patrizia, additional, Cavalla, Paola, additional, Celani, Maria Grazia, additional, Cellerino, Maria, additional, Cerqua, Raffaella, additional, Chisari, Clara, additional, Clerici, Raffaella, additional, Clerico, Marinella, additional, Cocco, Eleonora, additional, Cola, Gaia, additional, Confalonieri, Paolo, additional, Conte, Antonella, additional, Conti, Marta Zaffira, additional, Cordano, Christian, additional, Cordera, Susanna, additional, Corea, Francesco, additional, Correale, Claudio, additional, Cottone, Salvatore, additional, Crescenzo, Francesco, additional, Curti, Erica, additional, d’Ambrosio, Alessandro, additional, D’Amico, Emanuele, additional, Danni, Maura Chiara, additional, d’Arma, Alessia, additional, Dattola, Vincenzo, additional, de Biase, Stefano, additional, De Luca, Giovanna, additional, De Mercanti, Stefania Federica, additional, De Mitri, Paolo, additional, De Stefano, Nicola, additional, Della Cava, Marco, additional, di Napoli, Mario, additional, Di Sapio, Alessia, additional, Docimo, Renato, additional, Dutto, Anna, additional, Evangelista, Luana, additional, Fanara, Salvatore, additional, Ferraro, Diana, additional, Ferrò, Maria Teresa, additional, Filippi, Massimo, additional, Fioretti, Cristina, additional, Fratta, Mario, additional, Frau, Jessica, additional, Fronza, Marzia, additional, Gajofatto, Alberto, additional, Gallo, Antonio, additional, Gallo, Paolo, additional, Gasperini, Claudio, additional, Ghazaryan, Anna, additional, Giometto, Bruno, additional, Gobbin, Francesca, additional, Govone, Flora, additional, Granella, Franco, additional, Grange, Erica, additional, Grasso, Maria Grazia, additional, Guareschi, Angelica, additional, Guaschino, Clara, additional, Guerrieri, Simone, additional, Guidetti, Donata, additional, Iaffaldano, Pietro, additional, Ianniello, Antonio, additional, Iasevoli, Luigi, additional, Imperiale, Daniele, additional, Infante, Maria Teresa, additional, Inglese, Matilde, additional, Iodice, Rosa, additional, Iovino, Aniello, additional, Konrad, Giovanna, additional, Lanzillo, Roberta, additional, Lapucci, Caterina, additional, Lavorgna, Luigi, additional, L’Episcopo Maria, Rita, additional, Leva, Serena, additional, Liberatore, Giuseppe, additional, Lo Re, Marianna, additional, Longoni, Marco, additional, Lopiano, Leonardo, additional, Lorefice, Lorena, additional, Lucchini, Matteo, additional, Lus, Giacomo, additional, Maimone, Davide, additional, Malentacchi, Maria, additional, Mallucci, Giulia, additional, Malucchi, Simona, additional, Mancinelli, Chiara Rosa, additional, Mancinelli, Luca, additional, Manganotti, Paolo, additional, Maniscalco, Teresa Giorgia, additional, Mantero, Vittorio, additional, Marangoni, Sabrina, additional, Marastoni, Damiano, additional, Marfia, Alessandra Girolama, additional, Marinelli, Fabiana, additional, Marti, Alessandro, additional, Martinelli Boneschi, Filippo, additional, Masserano Zoli, Federco, additional, Matta, Francesca, additional, Mendozzi, Laura, additional, Meucci, Giuseppe, additional, Miante, Silvia, additional, Miele, Giuseppina, additional, Milano, Eva, additional, Mirabella, Massimiliano, additional, Missione, Rosanna, additional, Moccia, Marcello, additional, Montepietra, Sara, additional, Monti Bragadin, Margherita, additional, Montini, Federico, additional, Motta, Roberta, additional, Nardone, Raffaele, additional, Nicoletti, Carolina Gabri, additional, Nobile-Orazio, Eduardo, additional, Nozzolillo, Agostino, additional, Onofrj, Marco, additional, Orlandi, Riccardo, additional, Palmieri, Anna, additional, Paolicelli, Damiano, additional, Pasquali, Livia, additional, Pastò, Luisa, additional, Pedrazzoli, Elisabetta, additional, Perini, Paola, additional, Pesci, Ilaria, additional, Petracca, Maria, additional, Petrone, Alfredo, additional, Piantadosi, Carlo, additional, Pietroboni, Anna M., additional, Pinardi, Federica, additional, Ponzano, Marta, additional, Portaccio, Emilio, additional, Pozzato, Mattia, additional, Pozzilli, Carlo, additional, Prosperini, Luca, additional, Protti, Alessandra, additional, Ragonese, Paolo, additional, Rasia, Sarah, additional, Realmuto, Sabrina, additional, Repice, Anna, additional, Rigoni, Eleonora, additional, Rilla, Maria Teresa, additional, Rinaldi, Francesca, additional, Romano, Calogero Marcello, additional, Ronzoni, Marco, additional, Rovaris, Marco, additional, Ruscica, Francesca, additional, Sabattini, Loredana, additional, Salemi, Giuseppe, additional, Saraceno, Lorenzo, additional, Sartori, Alessia, additional, Sartori, Arianna, additional, Sbragia, Elvira, additional, Scandellari, Cinzia, additional, Scarano Giuditta, Ilaria, additional, Scarano, Valentina, additional, Schillaci, Valentina, additional, Sessa, Maria, additional, Sgarito, Caterina, additional, Sibilia, Grazia, additional, Siciliano, Gabriele, additional, Signori, Alessio, additional, Signoriello, Elisabetta, additional, Sinisi, Leonardo, additional, Sireci, Francesca, additional, Sola, Patrizia, additional, Solaro, Claudio, additional, Sormani, Maria Pia, additional, Sotgiu, Stefano, additional, Sparaco, Maddalena, additional, Stromillo, Maria Laura, additional, Strumia, Silvia, additional, Susani, Laura Emanuela, additional, Tabiadon, Giulietta, additional, Teatini, Francesco, additional, Tomassini, Valentina, additional, Tonietti, Simone, additional, Torri, Clerici Valentina, additional, Tortorella, Carla, additional, Toscano, Simona, additional, Totaro, Rocco, additional, Trotta, Maria, additional, Turano, Gabriella, additional, Ulivelli, Monica, additional, Valentino, Manzo, additional, Vaula, Giovanna, additional, Vecchio, Domizia, additional, Vercellino, Marco, additional, Verrengia, Elena Pinuccia, additional, Vianello, Marika, additional, Virgilio, Eleonora, additional, Vitetta, Francesca, additional, Vollaro, Stefano, additional, Zaffaroni, Mauro, additional, Zampolini, Mauro, additional, Zarbo, Ignazio Roberto, additional, Zito, Antonio, additional, and Zuliani, Luigi, additional

Published
2021
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4. Distinct serum and cerebrospinal fluid cytokine and chemokine profiles in autoantibody-associated demyelinating diseases

Author

Hofer, Livia S, primary, Mariotto, Sara, additional, Wurth, Sebastian, additional, Ferrari, Sergio, additional, Mancinelli, Chiara R, additional, Delogu, Rachele, additional, Monaco, Salvatore, additional, Gajofatto, Alberto, additional, Schwaiger, Carmen, additional, Rostasy, Kevin, additional, Deisenhammer, Florian, additional, Höftberger, Romana, additional, Berger, Thomas, additional, and Reindl, Markus, additional

Published
2019
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5. Sensory integration balance training in patients with multiple sclerosis: A randomized, controlled trial

Author

Maria Donata Benedetti, A. Midiri, Marialuisa Gandolfi, Christian Geroin, Alberto Gajofatto, Alessandro Picelli, Nicola Smania, Andreas Waldner, Fontana Carla, and Daniele Munari

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Poison control, postural control, equilibrium, rehabilitation, law.invention, Multiple Sclerosis, Relapsing-Remitting, Physical medicine and rehabilitation, Quality of life, Randomized controlled trial, law, falls, Outcome Assessment, Health Care, medicine, Postural Balance, Humans, Single-Blind Method, Balance (ability), Rehabilitation, gait disorders, business.industry, Middle Aged, Proprioception, Exercise Therapy, Clinical trial, gait disorders, quality of life, equilibrium, postural control, falls, rehabilitation, quality of life, Neurology, Berg Balance Scale, Sensation Disorders, Physical therapy, Female, Neurology (clinical), business, Follow-Up Studies
Abstract

Background: Impaired sensory integration contributes to balance disorders in patients with multiple sclerosis (MS). Objective: The objective of this paper is to compare the effects of sensory integration balance training against conventional rehabilitation on balance disorders, the level of balance confidence perceived, quality of life, fatigue, frequency of falls, and sensory integration processing on a large sample of patients with MS. Methods: This single-blind, randomized, controlled trial involved 80 outpatients with MS (EDSS: 1.5–6.0) and subjective symptoms of balance disorders. The experimental group ( n = 39) received specific training to improve central integration of afferent sensory inputs; the control group ( n = 41) received conventional rehabilitation (15 treatment sessions of 50 minutes each). Before, after treatment, and at one month post-treatment, patients were evaluated by a blinded rater using the Berg Balance Scale (BBS), Activities-specific Balance Confidence Scale (ABC), Multiple Sclerosis Quality of Life-54, Fatigue Severity Scale (FSS), number of falls and the Sensory Organization Balance Test (SOT). Results: The experimental training program produced greater improvements than the control group training on the BBS ( p < 0.001), the FSS ( p < 0.002), number of falls ( p = 0.002) and SOT ( p < 0.05). Conclusions: Specific training to improve central integration of afferent sensory inputs may ameliorate balance disorders in patients with MS. Clinical Trial Registration (NCT01040117).

Published
2015

6. Switching first-line disease-modifying therapy after failure: impact on the course of relapsing–remitting multiple sclerosis

Author

Barbara Grimes, Alberto Gajofatto, Peter Bacchetti, A. High, and Emmanuelle Waubant

Subjects
Adult, Male, medicine.medical_specialty, First line, Kaplan-Meier Estimate, Disease, multiple sclerosis, Disease-Free Survival, disease-modifying therapy, therapy switch, treatment failure, Treatment failure, Multiple Sclerosis, Relapsing-Remitting, Internal medicine, Secondary Prevention, medicine, Humans, Immunologic Factors, business.industry, Multiple sclerosis, Glatiramer Acetate, Interferon-beta, medicine.disease, Neurology, Relapsing remitting, Physical therapy, Female, Neurology (clinical), Peptides, business, Immunosuppressive Agents, Follow-Up Studies
Abstract

Background Options for non-responders to relapsing–remitting multiple sclerosis (RRMS) first-line disease-modifying therapies (DMT) are limited. We explored whether switching first-line DMT is effective. Methods Patients with RRMS who first received interferon-beta (IFNB) or glatiramer acetate (GA) were classified in three categories: DMT change because of suboptimal response, DMT change because of other reasons, and no DMT change during follow-up. Outcomes included annualized relapse rate (ARR) and relapse-free proportions. Results We identified 597 patients who initiated first-line DMT. For patients who did not change DMT ( n = 240), pre-DMT and on-DMT median ARR were 0.50 and 0 ( P Conclusions Switching first-line DMT in patients with RRMS failing initial therapy may be effective in many cases.

Published
2009

7. Serum Neurofilament Light Chain in NMOSD and Related Disorders: Comparison According to Aquaporin-4 and Myelin Oligodendrocyte Glycoprotein Antibodies Status

Author

S, Mariotto, primary, A, Farinazzo, additional, S, Monaco, additional, A, Gajofatto, additional, G, Zanusso, additional, K, Schanda, additional, R, Capra, additional, C, Mancinelli, additional, A, Bonora, additional, R, Bombardi, additional, M, Reindl, additional, and S, Ferrari, additional

Published
2017
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8. Antibody response against HERV-W env surface peptides differentiates multiple sclerosis and neuromyelitis optica spectrum disorder

Author

Arru, Giannina, primary, Sechi, Elia, additional, Mariotto, Sara, additional, Farinazzo, Alessia, additional, Mancinelli, Chiara, additional, Alberti, Daniela, additional, Ferrari, Sergio, additional, Gajofatto, Alberto, additional, Capra, Ruggero, additional, Monaco, Salvatore, additional, Deiana, Giovanni A, additional, Caggiu, Elisa, additional, Mameli, Giuseppe, additional, Sechi, Leonardo A, additional, and Pietro Sechi, Gian, additional

Published
2017
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9. Epilepsy in multiple sclerosis: The role of temporal lobe damage

Author

Calabrese, M, primary, Castellaro, M, additional, Bertoldo, A, additional, De Luca, A, additional, Pizzini, FB, additional, Ricciardi, GK, additional, Pitteri, M, additional, Zimatore, S, additional, Magliozzi, R, additional, Benedetti, MD, additional, Manganotti, P, additional, Montemezzi, S, additional, Reynolds, R, additional, Gajofatto, A, additional, and Monaco, S, additional

Published
2016
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13. Symptomatic COVID-19 course and outcomes after three mRNA vaccine doses in multiple sclerosis patients treated with high-efficacy DMTs.

Author

Capuano R, Prosperini L, Altieri M, Lorefice L, Fantozzi R, Cavalla P, Guaschino C, Radaelli M, Cordioli C, Nociti V, Boffa L, Ragonese P, Di Gregorio M, Pinardi F, Torri Clerici V, De Luca G, Gajofatto A, Paolicelli D, Tortorella C, Gasperini C, Solaro C, Cocco E, Bisecco A, and Gallo A

Subjects
Humans, COVID-19 Vaccines, SARS-CoV-2, Natalizumab therapeutic use, Fingolimod Hydrochloride, RNA, Messenger, mRNA Vaccines, Multiple Sclerosis drug therapy, COVID-19 prevention & control
Abstract

Background: Little is known about COVID-19 course and outcomes after a third booster dose of mRNA vaccine against SARS-CoV-2 (mRNA-Vax) in patients with multiple sclerosis (pwMS) treated with ocrelizumab (OCR) and fingolimod (FNG), which showed a weakened immune response to mRNA-vax., Objectives: The aim of this study was to evaluate COVID-19 course and outcomes in pwMS on OCR and FNG after receiving the third dose of mRNA-Vax and to compare it with pwMS on natalizumab (NTZ)., Methods: Inclusion criteria: >18 years of age, being treated with OCR/FNG/NTZ since the first mRNA-Vax dose; COVID-19 after a third booster dose of mRNA-Vax; no steroids use., Results: Overall, 290 pwMS (79 NTZ, 126 OCR, and 85 FNG) from 17 Italian MS centers were included. Age, Expanded Disability Status Scale (EDSS) score, MS phenotype, disease, and treatment duration were significantly different across groups. PwMS who had COVID-19 on OCR and FNG compared with those on NTZ were slightly more symptomatic with higher hospitalization rates (11.1% vs 7.1% vs 1.3%, respectively). Regression models showed that the majority of the differences observed were not related to the disease-modifying treatments (DMTs) used. No fatal cases were observed., Conclusion: Our results support the effectiveness of the third booster dose of mRNA-Vax against severe forms of COVID-19 in pwMS treated with OCR and FNG.

Published
2023
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14. Epilepsy in multiple sclerosis: The role of temporal lobe damage.

Author

Calabrese M, Castellaro M, Bertoldo A, De Luca A, Pizzini FB, Ricciardi GK, Pitteri M, Zimatore S, Magliozzi R, Benedetti MD, Manganotti P, Montemezzi S, Reynolds R, Gajofatto A, and Monaco S

Subjects
Adult, Epilepsy etiology, Epilepsy pathology, Female, Gray Matter pathology, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging methods, Male, Middle Aged, Multiple Sclerosis, Relapsing-Remitting pathology, Epilepsy diagnostic imaging, Gray Matter diagnostic imaging, Multiple Sclerosis, Relapsing-Remitting complications, Multiple Sclerosis, Relapsing-Remitting diagnostic imaging, Temporal Lobe diagnostic imaging, Temporal Lobe pathology
Abstract

Background: Although temporal lobe pathology may explain some of the symptoms of multiple sclerosis (MS), its role in the pathogenesis of seizures has not been clarified yet., Objectives: To investigate the role of temporal lobe damage in MS patients suffering from epilepsy, by the application of advanced multimodal 3T magnetic resonance imaging (MRI) analysis., Methods: A total of 23 relapsing remitting MS patients who had epileptic seizures (RRMS/E) and 23 disease duration matched RRMS patients without any history of seizures were enrolled. Each patient underwent advanced 3T MRI protocol specifically conceived to evaluate grey matter (GM) damage. This includes grey matter lesions (GMLs) identification, evaluation of regional cortical thickness and indices derived from the Neurite Orientation Dispersion and Density Imaging model., Results: Regional analysis revealed that in RRMS/E, the regions most affected by GMLs were the hippocampus (14.2%), the lateral temporal lobe (13.5%), the cingulate (10.0%) and the insula (8.4%). Cortical thinning and alteration of diffusion metrics were observed in several regions of temporal lobe, in insular cortex and in cingulate gyrus of RRMS/E compared to RRMS ( p< 0.05 for all comparisons)., Conclusions: Compared to RRMS, RRMS/E showed more severe damage of temporal lobe, which exceeds what would be expected on the basis of the global GM damage observed.

Published
2017
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15. Sensory integration balance training in patients with multiple sclerosis: A randomized, controlled trial.

Author

Gandolfi M, Munari D, Geroin C, Gajofatto A, Benedetti MD, Midiri A, Carla F, Picelli A, Waldner A, and Smania N

Subjects
Adult, Female, Follow-Up Studies, Humans, Male, Middle Aged, Multiple Sclerosis, Relapsing-Remitting complications, Sensation Disorders etiology, Single-Blind Method, Exercise Therapy methods, Multiple Sclerosis, Relapsing-Remitting rehabilitation, Outcome Assessment, Health Care methods, Postural Balance physiology, Proprioception physiology, Sensation Disorders rehabilitation
Abstract

Background: Impaired sensory integration contributes to balance disorders in patients with multiple sclerosis (MS)., Objective: The objective of this paper is to compare the effects of sensory integration balance training against conventional rehabilitation on balance disorders, the level of balance confidence perceived, quality of life, fatigue, frequency of falls, and sensory integration processing on a large sample of patients with MS., Methods: This single-blind, randomized, controlled trial involved 80 outpatients with MS (EDSS: 1.5-6.0) and subjective symptoms of balance disorders. The experimental group (n = 39) received specific training to improve central integration of afferent sensory inputs; the control group (n = 41) received conventional rehabilitation (15 treatment sessions of 50 minutes each). Before, after treatment, and at one month post-treatment, patients were evaluated by a blinded rater using the Berg Balance Scale (BBS), Activities-specific Balance Confidence Scale (ABC), Multiple Sclerosis Quality of Life-54, Fatigue Severity Scale (FSS), number of falls and the Sensory Organization Balance Test (SOT)., Results: The experimental training program produced greater improvements than the control group training on the BBS (p < 0.001), the FSS (p < 0.002), number of falls (p = 0.002) and SOT (p < 0.05)., Conclusions: Specific training to improve central integration of afferent sensory inputs may ameliorate balance disorders in patients with MS. Clinical Trial Registration (NCT01040117)., (© The Author(s), 2015.)

Published
2015
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16. Late-onset multiple sclerosis presenting with cognitive dysfunction and severe cortical/infratentorial atrophy.

Author

Calabrese M, Gajofatto A, Gobbin F, Turri G, Richelli S, Matinella A, Oliboni ES, Benedetti MD, and Monaco S

Subjects
Adult, Age of Onset, Aged, Atrophy, Brain pathology, Cognition Disorders etiology, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neuropsychological Tests, Retrospective Studies, Supranuclear Palsy, Progressive pathology, Supranuclear Palsy, Progressive psychology, Cerebral Cortex pathology, Cognition Disorders psychology, Multiple Sclerosis pathology, Multiple Sclerosis psychology
Abstract

Objective: Although cognitive dysfunction is a relevant aspect of multiple sclerosis (MS) from the earliest disease phase, cognitive onset is unusual thus jeopardizing early and accurate diagnosis. Here we describe 12 patients presenting with cognitive dysfunction as primary manifestation of MS with either mild or no impairment in non-cognitive neurological domains., Methods: Twelve patients with cognitive onset who were subsequently diagnosed with MS (CI-MS) were included in this retrospective study. Twelve cognitively normal MS patients (CN-MS), 12 healthy controls and four patients having progressive supranuclear palsy (PSP) served as the reference population., Results: Ten CI-MS patients had progressive clinical course and all patients had late disease onset (median age = 49 years; range = 40-58 years). Among cognitive functions, frontal domains were the most involved. Compared to CN-MS and healthy controls, significant cortical and infratentorial atrophy characterized CI-MS patients. Selective atrophy of midbrain tegmentum with relative sparing of pons, known as "The Hummingbird sign," was observed in eight CI-MS and in three PSP patients., Discussion: Our observation suggests that MS diagnosis should be taken into consideration in case of cognitive dysfunction, particularly when associated with slowly progressive disease course and severe cortical, cerebellar and brainstem atrophy even in the absence of other major neurological symptoms and signs., (© The Author(s), 2014.)

Published
2015
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17. Switching first-line disease-modifying therapy after failure: impact on the course of relapsing-remitting multiple sclerosis.

Author

Gajofatto A, Bacchetti P, Grimes B, High A, and Waubant E

Subjects
Adult, Disease-Free Survival, Female, Follow-Up Studies, Glatiramer Acetate, Humans, Kaplan-Meier Estimate, Male, Secondary Prevention, Treatment Failure, Immunologic Factors administration & dosage, Immunosuppressive Agents administration & dosage, Interferon-beta administration & dosage, Multiple Sclerosis, Relapsing-Remitting drug therapy, Peptides administration & dosage
Abstract

Background: Options for non-responders to relapsing-remitting multiple sclerosis (RRMS) first-line disease-modifying therapies (DMT) are limited. We explored whether switching first-line DMT is effective., Methods: Patients with RRMS who first received interferon-beta (IFNB) or glatiramer acetate (GA) were classified in three categories: DMT change because of suboptimal response, DMT change because of other reasons, and no DMT change during follow-up. Outcomes included annualized relapse rate (ARR) and relapse-free proportions., Results: We identified 597 patients who initiated first-line DMT. For patients who did not change DMT (n = 240), pre-DMT and on-DMT median ARR were 0.50 and 0 (P < 0.0001). At 24 months, 76% (95%CI = 69-81%) of patients who did not change DMT were relapse-free. Of the 155 who switched because of suboptimal response, 101 switched to another first-line DMT. Median ARR pre-DMT, on first DMT and second DMT were: 0.50, 0.55, and 0.25 for switchers from IFNB to GA (IFNB/GA, n = 12) (pre-DMT versus first DMT: P = 0.92; first versus second DMT: P = 0.31); 0.90, 0.50, and 0 for switchers from GA to IFNB (GA/IFNB, n = 18; P = 0.19; P = 0.01); 0.50, 0.68, and 0 for switchers from an IFNB to another IFNB (IFNB/IFNB', n = 71; P = 0.34; P = 0.02). Estimated relapse-free proportion after 24 months of treatment was 42% (95%CI=15-66%) during the period on IFNB versus 53% (95%CI = 17-80%) on GA for IFNB/GA (P = 0.21); 12% (95%CI = 0-40%) on GA versus 87% (95%CI = 59-97%) on IFNB for GA/IFNB (P = 0.001); and 41% (95%CI = 29-52%) on initial IFNB versus 67% (95%CI = 53-79%) on subsequent IFNB for IFNB/IFNB' (P = 0.0001)., Conclusions: Switching first-line DMT in patients with RRMS failing initial therapy may be effective in many cases.

Published
2009
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