Search

Roztrousena skleroza (RS) je chronicke zanětlive autoimunitni a neurodegenerativni onemocněni centralniho nervoveho systemu postihujici zejmena mlade dospěle. Terapie RS zaznamenala v poslednich letech výrazný pokrok. Ocrelizumab je humanizovana monoklonalni protilatka působici selektivni depleci CD20+ B-lymfocytů. Lek prokazal ucinnost v lecbě RS u relaps-remitentni i primarně progresivni formy. Adherence a perzistence maji v terapii RS nezastupitelnou roli. Adherence k lecbě zcela zasadně přispiva k dosaženi optimalnich výsledků terapie, zlepseni kvality života pacientů i sniženi nakladů na zdravotni peci. V běžne klinicke praxi je nutno adherenci neustale podporovat.

Background A high multiple sclerosis activity while on alemtuzumab is rather uncommon compared to moderate-efficacy drugs. The purpose of this case report is to present a case of a 37-year-old female patient with bronchial asthma and no other medical history, whose disease activity required switching from dimethyl fumarate to fingolimod, then to alemtuzumab and finally to ocrelizumab. Case presentation In our patient, two severe attacks were observed and treated after administration of the first pulse of alemtuzumab. After six months of therapy, patient’s immunological profile showed the expected decrease in CD4+ and CD8+ T-cells and, markedly increased values of CD19+ B-cells. Surprisingly memory B-cells, which typically repopulate very slowly following alemtuzumab treatment, were above baseline levels. Regular administration of ocrelizumab based on a standardised scheme, after the alemtuzumab therapy failure, resulted in the stabilisation of the patient’s condition both clinically and radiologically. Conclusion Thus, when the alemtuzumab treatment is unsuccessful, the authors recommend testing T- and B-cell levels and proceeding with an early switch to ocrelizumab if high B-cell counts are found.

Background: Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system. Well-established drugs used for MS patients after the first demyelinating event in the Czech Republic include glatiramer acetate (GA), interferon beta-1a (IFNβ-1a), IFN beta-1b (IFNβ-1b), peginterferon beta-1a (peg-IFNβ-1a), and teriflunomide.Objective: The objective of this observational study was to compare the effectiveness of the abovementioned drugs in patients with MS who initiated their therapy after the first demyelinating event. Patients were followed for up to 2 years in real clinical practice in the Czech Republic.Methods: A total of 1,654 MS patients treated after the first demyelinating event and followed up for 2 years were enrolled. Evaluation parameters (endpoints) included the annualized relapse rate (ARR), time to next relapse, change in the Expanded Disability Status Scale (EDSS) score, and time of confirmed disease progression (CDP). When patients ended the therapy before the observational period, the reason for ending the therapy among different treatments was compared.Results: No significant difference was found among the groups of patients treated with IFNβ-1a/1b, GA, or teriflunomide for the following parameters: time to the first relapse, change in the EDSS score, and the proportion of patients with CDP. Compared to IFNβ-1a (44 mcg), a significant increase in the percentage of relapse-free patients was found for GA, but this treatment effect was not confirmed by the validation analysis. Compared to the other drugs, there was a significant difference in the reasons for terminating GA therapy.Conclusion: Small differences were found among GA, IFNβ and teriflunomide therapies, with no significant impact on the final outcome after 2 years. Therefore, in clinical practice, we recommend choosing the drug based on individual potential risk from long-term therapy and on patient preferences and clinical characteristics.

Background: Adherence to Multiple Sclerosis (MS) treatment is considered one of the crucial factors for ensuring optimal clinical outcomes. Research has shown that the use of self-injector devices ...

Anterior circulation stroke (ACS) is associated with typical symptoms, while posterior circulation stroke (PCS) may cause a wide spectrum of less specific symptoms. We aim to assess the correlation between the initial presentation of acute ischemic stroke (AIS) symptoms and the treatment timeline. Using a retrospective, observational, single-center study, the set consists of 809 AIS patients treated with intravenous thrombolysis (IVT) and/or endovascular treatment (EVT). We investigate the impact of baseline clinical AIS symptoms and the affected vascular territory on recanalization times in patients treated with IVT only and EVT (±IVT). Regarding the IVT-only group, increasing the National Institutes of Health Stroke Scale (NIHSS) score on admission and speech difficulties are associated with shorter (by 1.59 ± 0.76 min per every one-point increase, p = 0.036, and by 24.56 ± 8.42 min, p = 0.004, respectively) and nausea/vomiting with longer (by 43.72 ± 13.13 min, p = 0.001) onset-to-needle times, and vertigo with longer (by 8.58 ± 3.84 min, p = 0.026) door-to-needle times (DNT). Regarding the EVT (±IVT) group, coma is associated with longer (by 22.68 ± 6.05 min, p = 0.0002) DNT, anterior circulation stroke with shorter (by 47.32 ± 16.89 min, p = 0.005) onset-to-groin time, and drooping of the mouth corner with shorter (by 20.79 ± 6.02 min, p = 0.0006) door-to-groin time. Our results demonstrate that treatment is initiated later in strokes with less specific symptoms than in strokes with typical symptoms.

Background: Multiple sclerosis (MS) is a neurodegenerative disease that affects the central nervous system. The cause of MS is still unknown, and the role of innate immunity is still poorly understood. Objective: The goal of this study was to understand whether, compared to healthy controls, the elements of innate immunity are altered in the blood of MS patients in the remitting phase. Methods: A total of 77 na&iuml, ve MS patients and 50 healthy controls were included in this cohort study. Peripheral blood samples were collected and analyzed. All the calculations were performed with the statistical system R (r-project.org). Results: The results showed that MS patients had significantly lower relative representations of granulocytes than healthy controls, while the relative representations of monocytes remained unchanged. CD64- and PD-L1-positive granulocytes exhibited a nonsignificant decreasing trend, while granulocytes with other membrane markers remained noticeably unchanged. Conclusion: The results of this study suggest that studies of the causes of MS and its treatment should also be focused on the elements of the innate immune response.

AIM To assess the safety and efficacy of mechanical thrombectomy (MT) with stent-retrievers in anterior circulation stroke (ACS) patients due to the occlusion of major cerebral arteries, and to compare the results achieved in patients on oral anticoagulation (OAC) and those not on OAC. MATERIALS AND METHODS The present retrospective study comprised 285 consecutive patients (115 males; mean age 74±13 years). The following data were collected: baseline characteristics, occurrence of risk factors, pre-event treatment with OAC, neurological deficit at the time of treatment, time to therapy, recanalisation rate (successful recanalisation defined as Thrombolysis in Cerebral Infarction score ≥2b), post-treatment imaging findings. The 90-day clinical outcome was assessed using modified Rankin scale (good outcome defined as 0–2). RESULTS The following statistically insignificant differences were found in 26 patients on OAC versus 259 patients without OAC: occurrence of symptomatic intracerebral haemorrhage 7.7% versus 8.1%, achievement of successful recanalisation 69.2% versus 82.6%, good 90-day clinical outcome 34.6% versus 56.8%, 90-day mortality 26.9% versus 20.8% (p>0.05 in all cases). Age and neurological deficit at the time of treatment were identified as independent negative predictors of good 90-day clinical outcome (odds ratio [OR]=0.90, 95% confidence interval [CI]: 0.88–0.94 and OR=0.83, 95% CI: 0.77–0.90, respectively) and as independent positive predictors of mortality (OR=1.12, 95% CI: 1.06–1.18 and, OR=1.17, 95% CI: 1.07–1.27, respectively; p CONCLUSIONS MT with stent-retrievers is safe and effective in ACS patients on OAC.