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1. Resting‐state functional connectivity and motor imagery brain activation

Author

Saiote, Catarina, Tacchino, Andrea, Brichetto, Giampaolo, Roccatagliata, Luca, Bommarito, Giulia, Cordano, Christian, Battaglia, Mario, Mancardi, Giovanni Luigi, and Inglese, Matilde

Subjects
Behavioral and Social Science, Neurosciences, Clinical Research, Underpinning research, 1.2 Psychological and socioeconomic processes, Mental health, Neurological, Adult, Brain, Brain Mapping, Female, Hand, Humans, Imagination, Magnetic Resonance Imaging, Male, Middle Aged, Motor Activity, Neuropsychological Tests, Rest, Young Adult, motor imagery, fMRI, isochrony, functional connectivity, resting-state, Cognitive Sciences, Experimental Psychology
Abstract

Motor imagery (MI) relies on the mental simulation of an action without any overt motor execution (ME), and can facilitate motor learning and enhance the effect of rehabilitation in patients with neurological conditions. While functional magnetic resonance imaging (fMRI) during MI and ME reveals shared cortical representations, the role and functional relevance of the resting-state functional connectivity (RSFC) of brain regions involved in MI is yet unknown. Here, we performed resting-state fMRI followed by fMRI during ME and MI with the dominant hand. We used a behavioral chronometry test to measure ME and MI movement duration and compute an index of performance (IP). Then, we analyzed the voxel-matched correlation between the individual MI parameter estimates and seed-based RSFC maps in the MI network to measure the correspondence between RSFC and MI fMRI activation. We found that inter-individual differences in intrinsic connectivity in the MI network predicted several clusters of activation. Taken together, present findings provide first evidence that RSFC within the MI network is predictive of the activation of MI brain regions, including those associated with behavioral performance, thus suggesting a role for RSFC in obtaining a deeper understanding of neural substrates of MI and of MI ability. Hum Brain Mapp 37:3847-3857, 2016. © 2016 Wiley Periodicals, Inc.

Published
2016

2. Autologous hematopoietic stem cell transplantation in multiple sclerosis: A phase II trial

Author

Mancardi, Giovanni L., Sormani, Maria P., Gualandi, Francesca, Saiz, Albert, Carreras, Eric, Merelli, Elisa, Donelli, Amedea, Di Bartolomeo, Paolo, Rottoli, Maria R., Rambaldi, Alessandro, Amato, Maria P., Massacesi, Luca, Di Gioia, Massimo, Vuolo, Luisa, Currò, Daniela, Roccatagliata, Luca, Filippi, Massimo, Aguglia, Umberto, Iacopino, Pasquale, Farge, Dominique, Saccardi, Riccardo, ASTIMS Haemato Neurological Collaborative Group, on behalf of the Autoimmune Disease Working Party of the European Group for Blood, Marrow Transplantation, ASTIMS Haemato Neurological Collaborative Group on behalf of the Autoimmune Disease Working Party ADWP of the European Group for Blood, Marrow Transplantation EBMT, LUGARESI, ALESSANDRA, Mancardi, Gl, Sormani, Mp, Gualandi, F, Saiz, A, Carreras, E, Merelli, E, Donelli, A, Lugaresi, A, Di Bartolomeo, P, Rottoli, Mr, Rambaldi, A, Amato, Mp, Massacesi, L, Di Gioia, M, Vuolo, L, Currà, D, Roccatagliata, L, Filippi, Massimo, Aguglia, U, Iacopino, P, Farge, D, Saccardi, R., Mancardi, Giovanni L., Sormani, Maria P., Gualandi, Francesca, Saiz, Albert, Carreras, Eric, Merelli, Elisa, Donelli, Amedea, Lugaresi, Alessandra, Di Bartolomeo, Paolo, Rottoli, Maria R., Rambaldi, Alessandro, Amato, Maria P., Massacesi, Luca, Di Gioia, Massimo, Vuolo, Luisa, Currò, Daniela, Roccatagliata, Luca, Aguglia, Umberto, Iacopino, Pasquale, Farge, Dominique, Saccardi, Riccardo, ASTIMS Haemato-Neurological Collaborative Group, on behalf of the Autoimmune Disease Working Party (ADWP) of the European Group for Blood and Marrow Transplantation (EBMT)., and ASTIMS Haemato-Neurological Collaborative Group on behalf of the Autoimmune Disease Working Party ADWP of the European Group for Blood and Marrow Transplantation EBMT

Subjects
Oncology, Adult, Male, medicine.medical_specialty, Transplantation Conditioning, medicine.medical_treatment, Antineoplastic Agents, Gadolinium, Hematopoietic stem cell transplantation, Filgrastim, Transplantation, Autologous, Antineoplastic Agent, Young Adult, Multiple Sclerosis, Relapsing-Remitting, Internal medicine, medicine, Clinical endpoint, Humans, Carmustine, Mitoxantrone, Expanded Disability Status Scale, business.industry, Hematopoietic Stem Cell Transplantation, Immunosuppression, Middle Aged, Multiple Sclerosis, Chronic Progressive, Image Enhancement, Magnetic Resonance Imaging, Transplantation, Autologou, Transplantation, Treatment Outcome, Immunology, Female, Neurology (clinical), business, Human, medicine.drug
Abstract

Objective: To assess in multiple sclerosis (MS) the effect of intense immunosuppression followed by autologous hematopoietic stem cells transplantation (AHSCT) vs mitoxantrone (MTX) on disease activity measured by MRI. Methods: We conducted a multicenter, phase II, randomized trial including patients with secondary progressive or relapsing-remitting MS, with a documented increase in the last year on the Expanded Disability Status Scale, in spite of conventional therapy, and presence of one or more gadolinium-enhancing (Gd+) areas. Patients were randomized to receive intense immunosuppression (mobilization with cyclophosphamide and filgrastim, conditioning with carmustine, cytosine-arabinoside, etoposide, melphalan, and anti-thymocyte globulin) followed by AHSCT or MTX 20 mg every month for 6 months. The primary endpoint was the cumulative number of new T2 lesions in the 4 years following randomization. Secondary endpoints were the cumulative number of Gd+ lesions, relapse rate, and disability progression. Safety and tolerability were also assessed. Twenty-one patients were randomized and 17 had postbaseline evaluable MRI scans. Results: AHSCT reduced by 79% the number of new T2 lesions as compared to MTX (rate ratio 0.21, p = 0.00016). It also reduced Gd+ lesions as well as the annualized relapse rate. No difference was found in the progression of disability. Conclusion: Intense immunosuppression followed by AHSCT is significantly superior to MTX in reducing MRI activity in severe cases of MS. These results strongly support further phase III studies with primary clinical endpoints. The study was registered as EUDRACT No. 2007-000064-24.

Published
2015

3. Alemtuzumab for patients with relapsing multiple sclerosis after disease-modifying therapy: a randomised controlled phase 3 trial

Author

Coles, Alasdair J., Twyman, Cary L., Arnold, Douglas L., Cohen, Jeffrey A., Christian, Confavreux, Fox, Edward J., Hans Peter Hartung, Eva, Havrdova, Selmaj, Krzysztof W., Weiner, Howard L., Tamara, Miller, Elizabeth, Fisher, Rupert, Sandbrink, Lake, Stephen L., Margolin, David H., Pedro, Oyuela, Panzara, Michael A., Compston, D Alastair S., Gupta, the CARE MS II investigators: Ajay S., Edward, Fox, Glyman, Steven A., Thoits, Timothy K., Sullivan, Herman C., Cascione, Mark C., Rammohan, Kottil W., Gazda, Suzanne K., Wynn, Daniel R., Wray, Sibyl E., Stanton, Elias, Ford, Corey C., Andrew, Goodman, Hughes, Bruce L., Omar Azhar Khan, Vaishnav, Anand G., Stephen, Kirzinger, Lynch, Sharon G., Mattson, David H., Braley, Tiffany J., Mikol, Daniel D., Stephen, Krieger, Tamara Ann Miller, Riskind, Peter N., Roberto, Bomprezzi, Wingerchuk, Dean M., Brian, Steingo, Jeffrey Alan Cohen, Crayton, Heidi J., Cooper, Joanna A., Weiner, Leslie P., Harold Moses, J. r., Agius, Mark A., Ann Doan Do Bass, Lallana, Enrico C., Mitchell, Galen W., Krolczyk, Stanley J., Alireza, Minagar, Burk, Jubelt, Evans, Bradley K., Hunter, Samuel F., Rizvi, Syed A., Sheppard, Christopher A., David Honeycutt, W. M., Joseph, Herbert, Lathi, Ellen S., Gabriel, Pardo, Lily Jung Ilenson, Rothstein, Ted L., Thrower, Ben W., Mary Ann Picone, Mariko, Kita, Grazioli, Erica M., Silliman, Scott L., Thomas, Giancarlo, Gottesman, Malcolm H., Abou Zeid, Nuhad E., Rowe, Vernon D., Boutwell, Christine M., Schaeffer, John D., Riley, Claire S., Edwards, Keith R., Wendt, Jeanette K., G. Kim Bigley J. r., Shubin, Richard A., Silva Markovic Plese, Jones, Davis E., Gary, Clauser, Freedman, Mark S., Francois, Grand’Maison, Jacques, Francois H., Traboulsee, Anthony L., Brunet, Donald G., Marcelo, Kremenchutzky, Charles, Ayotte, Lava, Neil S., Waldman, Stephen R., Janus, Todd J., Stephen Gerard Vincent, Mark, Gudesblatt, Michael, Rossen, Stein, Lee S., Bennett Irving Machanic, Timothy, Vollmer, Gitt, Jeffrey S., Jeffrey, Dunn, Donald, Negroski, Fletcher, Mark H., Adil, Javed, Frohman, Elliot M., Richard, Macdonell, John Owen King, Paine, Mark A., Karyn, Boundy, Simon, Broadley, Steve, Vucic, Stephen, Reddel, Dreyer, Michael D., Raymond, Schwartz, Pamela Ann McCombe, Suzanne, Hodgkinson, Charles, Tilbery, Ferreira, Maria Lucia B., Dagoberto, Callegaro, Marcio Mena Barreto Martins, Jesus Arturo Violante Villanueva, Noemi Santos Caballero, Claudia Venzor Mendoza, Norma Haydee Deri, Alasdair, Coles, Neil James Scolding, Gavin, Giovannoni, Basil, Sharrack, Rog, David J., Giancarlo, Comi, Angelo, Ghezzi, Mancardi, Giovanni L., Durelli, Luca, Antonio, Bertolotto, Ruggero, Capra, Carlo, Pozzilli, Maria Giovanna Marrosu, Hupperts, Raymond M. M., Erik van Munster, Xavier, Montalbán, Rafael Arroyo González, Guillermo Izquierdo Ayuso, Óscar Fernández Fernández, Patrick, Vermersch, Jerome de Seze, Thibault, Moreau, Pierre, Clavelou, Catherine, Lubetzki, Michel, Clanet, Marc, Debouverie, Gilles, Edan, Judith, Haas, Martin, Stangel, Tjalf, Ziemssen, Bernhard, Hemmer, Karl, Baum, Klaus Zettl, U., Herrlinger, U., Wolfgang, Köhler, Gunter, Ochs, Patrick, Oschmann, Klaus Tiel Wilck, Hayrettin, Tumani, Urban, Peter P., Jan, Lycke, Anders, Svenningsson, Ivana, Kovarova, Marta, Vachova, Ivan, Rektor, Radomir, Talab, Krzysztof, Selmaj, Zbigniew, Stelmasiak, Wojciech, Kozubski, Dubois, Benedicte D. P., Dominique, Dive, Christian, Sindic, Karl, Vass, Per Soelberg Sørensen, Thor, Petersen, Mads, Ravnborg, Anat, Achiron, Adi Vaknin Dembinsky, Arnon, Karni, Gusev, Evgeny I., Stolyarov, Igor D., Zavalishin, Igor A., Skoromets, Alexander A., Boyko, Alexei N., Belova, Anna N., Malkova, Nadezhda A., Barantsevich, Evgeniy R., Yakupov, Eduard Z., Perfiliev, Semen V., Poverennova, Irina E., Voloshyna, Natalia P., Nehrych, Tetyana I., Kobys, Tetyana O., Mario, Habek, Vesna, Brinar, Zlatko, Trkanjec, Anton, Vladić, Spomenka Kidemet Piskać, Licia, Antonelli, Jelena, Drulović, Čongor, Nadj, Evica, Dinčić, Gordana, Tončev, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, Klinische Neurowetenschappen, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: MA Med Staf Spec Neurologie (9), RS: MHeNs School for Mental Health and Neuroscience, Radiology and nuclear medicine, and NCA - Multiple Sclerosis and Other Neuroinflammatory Diseases

Subjects
Male, Adult, medicine.medical_specialty, Adolescent, CD52, multiple sclerosis, Administration, Cutaneous, Antibodies, Monoclonal, Humanized, law.invention, Young Adult, Multiple Sclerosis, Relapsing-Remitting, Adjuvants, Immunologic, Randomized controlled trial, Recurrence, law, Internal medicine, Humans, Medicine, Glatiramer acetate, Infusions, Intravenous, Adverse effect, Alemtuzumab, disease, business.industry, Multiple sclerosis, Interferon beta-1a, Glatiramer Acetate, General Medicine, Middle Aged, medicine.disease, Treatment Outcome, Immunology, Female, Ocrelizumab, Peptides, business, Immunosuppressive Agents, medicine.drug
Abstract

The anti-CD52 monoclonal antibody alemtuzumab reduces disease activity in previously untreated patients with relapsing-remitting multiple sclerosis. We aimed to assess efficacy and safety of alemtuzumab compared with interferon beta 1a in patients who have relapsed despite first-line treatment.In our 2 year, rater-masked, randomised controlled phase 3 trial, we enrolled adults aged 18-55 years with relapsing-remitting multiple sclerosis and at least one relapse on interferon beta or glatiramer. Eligible participants were randomly allocated in a 1:2:2 ratio by an interactive voice response system, stratified by site, to receive subcutaneous interferon beta 1a 44 μg, intravenous alemtuzumab 12 mg per day, or intravenous alemtuzumab 24 mg per day. Interferon beta 1a was given three-times per week and alemtuzumab was given once per day for 5 days at baseline and for 3 days at 12 months. The 24 mg per day group was discontinued to aid recruitment, but data are included for safety assessments. Coprimary endpoints were relapse rate and time to 6 month sustained accumulation of disability, comparing alemtuzumab 12 mg and interferon beta 1a in all patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT00548405.202 (87%) of 231 patients randomly allocated interferon beta 1a and 426 (98%) of 436 patients randomly allocated alemtuzumab 12 mg were included in the primary analyses. 104 (51%) patients in the interferon beta 1a group relapsed (201 events) compared with 147 (35%) patients in the alemtuzumab group (236 events; rate ratio 0·51 [95% CI 0·39-0·65]; p0·0001), corresponding to a 49·4% improvement with alemtuzumab. 94 (47%) patients in the interferon beta 1a group were relapse-free at 2 years compared with 278 (65%) patients in the alemtuzumab group (p0·0001). 40 (20%) patients in the interferon beta 1a group had sustained accumulation of disability compared with 54 (13%) in the alemtuzumab group (hazard ratio 0·58 [95% CI 0·38-0·87]; p=0·008), corresponding to a 42% improvement in the alemtuzumab group. For 435 patients allocated alemtuzumab 12 mg, 393 (90%) had infusion-associated reactions, 334 (77%) had infections (compared with 134 [66%] of 202 patients in the interferon beta 1a group) that were mostly mild-moderate with none fatal, 69 (16%) had thyroid disorders, and three (1%) had immune thrombocytopenia.For patients with first-line treatment-refractory relapsing-remitting multiple sclerosis, alemtuzumab could be used to reduce relapse rates and sustained accumulation of disability. Suitable risk management strategies allow for early identification of alemtuzumab's main adverse effect of secondary autoimmunity.Genzyme (Sanofi) and Bayer Schering Pharma.

Published
2012

4. Comparison of subcutaneous interferon beta-1a with glatiramer acetate in patients with relapsing multiple sclerosis (the REbif vs Glatiramer Acetate in Relapsing MS Disease [REGARD] study): a multicentre, randomised, parallel, open-label trial

Author

Mikol, Dd1, Barkhof, F, Chang, P, Coyle, Pk, Jeffery, Dr, Schwid, Sr, Stubinski, B, Uitdehaag, B, Ballario, Ch, Caceres, Fj, Correale, J, Cristiano, E, Garcea, Do, Leutic, Gg, Aicher, F, Barreira, Aa, Freedman, M, Grand'Maison, F, Jacques, F, Lee, L, Stefanelli, M, Edan, G, Pelletier, J, Berghoff, M, Keifer, R, Koehler, J, Hardiman, O, Comi, G, Mancardi, GIOVANNI LUIGI, Pozzilli, C, Trojano, Mp, Jongen, P, Uitdehaag, Bm, Belova, An, Boyko, An, Elchaninov, Ap, Kozlov, Va, Odinak, Mm, Shvarkov, Sb, Skoromets, Aa, Spirin, Nn, Stolyarov, Id, Vorobieva, Ov, Zavalishin, I, Arbizu, T, Fernandez, O, Izquierdo, G, Montalban, X, Goebels, N, Bates, D, Constantinescu, C, Turner, B, Bashir, K, Bever, Ct, Birnbaum, G, Brod, Sa, Carlini, W, Dunne, P, Elias, S, Estronza, N, Fox, E, Glyman, S, Gross, J, Guarnaccia, Jb, Gupta, A, Kaufman, M, Khan, O, Khatri, B, Kresa reahl, K, Lava, N, Leist, T, Markowitz, C, Mihai, C, Mikol, Dd, Miller, T, Panitch, H, Parry, G, Rammohan, Kw, Reder, A, Sheppard, C, Simsarian, Jp, Smiroldo, J, Spier, L, Thrower, B, Vollmer, T, Wendt, J, Wray, S, Wynn, D., Radiology and nuclear medicine, Epidemiology and Data Science, Neurology, and Neuroscience Campus Amsterdam 2008

Subjects
Adult, Male, medicine.medical_specialty, Multiple Sclerosis, Adolescent, Injections, Subcutaneous, Population, Placebo-controlled study, Relapsing-Remitting, drug therapy/pathology, Drug Administration Schedule, Injections, methods, law.invention, Disability Evaluation, Multiple Sclerosis, Relapsing-Remitting, Randomized controlled trial, law, Internal medicine, Adolescent, Adult, Confidence Intervals, Disability Evaluation, Disease Progression, Drug Administration Schedule, Female, Humans, Immunologic Factors, administration /&/ dosage, Injections, Subcutaneous, methods, Interferon-beta, administration /&/ dosage, Magnetic Resonance Imaging, methods, Male, Middle Aged, Multiple Sclerosis, drug therapy/pathology, Peptides, administration /&/ dosage, Retrospective Studies, Treatment Outcome, Confidence Intervals, medicine, Humans, Immunologic Factors, Glatiramer acetate, administration /&/ dosage, education, Retrospective Studies, education.field_of_study, Intention-to-treat analysis, business.industry, Interferon beta-1a, McDonald criteria, Glatiramer Acetate, Interferon-beta, Middle Aged, Magnetic Resonance Imaging, Treatment Outcome, Tolerability, Immunology, Disease Progression, Female, Neurology (clinical), Peptides, business, medicine.drug
Abstract

Summary Background Interferon beta-1a and glatiramer acetate are commonly prescribed for relapsing-remitting multiple sclerosis (RRMS), but no published randomised trials have directly compared these two drugs. Our aim in the REGARD (REbif vs Glatiramer Acetate in Relapsing MS Disease) study was to compare interferon beta-1a with glatiramer acetate in patients with RRMS. Methods In this multicentre, randomised, comparative, parallel-group, open-label study, patients with RRMS diagnosed with the McDonald criteria who had had at least one relapse within the previous 12 months were randomised to receive 44 μg subcutaneous interferon beta-1a three times per week or 20 mg subcutaneous glatiramer acetate once per day for 96 weeks to assess the time to first relapse. A subpopulation of 460 patients (230 from each group) also had serial MRI scans to assess T2-weighted and gadolinium-enhancing lesion number and volume. Treatments were assigned by a computer-generated randomisation list that was stratified by centre. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00078338. Findings Between February and December, 2004, 764 patients were randomly assigned: 386 to interferon beta-1a and 378 to glatiramer acetate. After 96 weeks, there was no significant difference between groups in time to first relapse (hazard ratio 0·94, 95% CI 0·74 to 1·21; p=0·64). Relapse rates were lower than expected: 258 patients (126 in the interferon beta-1a group and 132 in the glatiramer acetate group) had one or more relapses (the expected number was 460). For secondary outcomes, there were no significant differences for the number and change in volume of T2 active lesions or for the change in the volume of gadolinium-enhancing lesions, although patients treated with interferon beta-1a had significantly fewer gadolinium-enhancing lesions (0·24 vs 0·41 lesions per patient per scan, 95% CI −0·4 to 0·1; p=0·0002). Safety and tolerability profiles were consistent with the known profiles for both compounds. The overall number and severity of adverse events were similar between the treatments and were not an important cause for discontinuation of the trial during the 96 weeks. Interpretation There was no significant difference between interferon beta-1a and glatiramer acetate in the primary outcome. The ability to predict clinical superiority on the basis of results from previous studies might be limited by a trial population with low disease activity, which is an important consideration for ongoing and future trials in patients with RRMS. Funding EMD Serono; Pfizer.

Published
2008

5. Randomized double-blind placebo-controlled trial of acetyl-L-carnitine for ALS

Author

Beghi, E, Pupillo, E, Bonito, V, Buzzi, P, Caponnetto, C, Chiò, A, Corbo, M, Giannini, F, Inghilleri, M, Bella, Vl, Logroscino, G, Lorusso, L, Lunetta, C, Mazzini, L, Messina, P, Mora, G, Perini, M, Quadrelli, Ml, Silani, V, Simone, Il, Tremolizzo, L, Samarelli, V, Tortelli, R, D'Errico, E, Merello, M, Tavernelli, F, Mancardi, GIOVANNI LUIGI, Mascolo, M, Bendotti, C, Buratti, M, Floriani, I, Giordano, L, Giussani, G, Maderna, L, Maestri, E, Marinou, K, Mennini, T, Messina, S, Morelli, C, Papetti, L, Rizzo, A, Ticozzi, N, Verde, F, Ferrarese, C, Marzorati, L, Testa, L, Valentino, F, Frasca, V, Giacomelli, E, Casali, S, Malentacchi, M, Calvo, A, Cammarosano, S, Moglia, C, Cavallo, E, Fuda, G., Beghi,E, Pupillo, E, Bonito, V, Buzzi, P, Caponnetto, C, Chiò, A, Corbo, M, Giannini, F, Inghilleri, M, La Bella, V, Logroscino,G, Lorusso,L, Lunetta,C, Mazzini, L, Messina, P, Mora, G, Perini, M, Quadrelli, ML, Silani, V, Simone, IL, Tremolizzo, L, Valentino, F, The Italian ALS, Study Group, Beghi, E, Bella, V, Logroscino, G, Lorusso, L, Lunetta, C, Quadrelli, M, Simone, I, The Italian ALS Study Group, I, and Ferrarese, C

Subjects
Male, amyotrophic lateral sclerosis, Vital Capacity, Placebo-controlled study, Pilot Projects, Gastroenterology, law.invention, Randomized controlled trial, law, Acetyl-L-carnitine, motor neuron disease, randomized trial, acetyl-l-carnitine, Amyotrophic lateral sclerosis, Acetylcarnitine, ALS, acetyl-L-carnitine, Nootropic Agents, Riluzole, Middle Aged, Treatment Outcome, Neurology, Combination, Disease Progression, Drug Therapy, Combination, Settore MED/26 - Neurologia, Female, medicine.drug, Adult, medicine.medical_specialty, Acetyl-L-carnitine, amyotrophic lateral sclerosis, motor neuron disease, randomized trial, Double blind, Double-Blind Method, Drug Therapy, Internal medicine, medicine, Humans, Aged, MED/26 - NEUROLOGIA, business.industry, Disease progression, medicine.disease, Surgery, Quality of Life, Amyotrophic Lateral Sclerosis, Excitatory Amino Acid Antagonists, Neurology (clinical), business
Abstract

Our objective was to assess the effects of acetyl-L-carnitine (ALC) with riluzole on disability and mortality of amyotrophic lateral sclerosis (ALS). Definite/probable ALS patients, 40-70 years of age, duration 6-24 months, self-sufficient (i.e. able to swallow, cut food/handle utensils, and walk), and with forced vital capacity (FVC) > 80% entered a pilot double-blind, placebo-controlled, parallel group trial and were followed for 48 weeks. ALC or placebo 3 g/day was added to riluzole 100 mg/day. Primary endpoint: number of patients no longer self-sufficient. Secondary endpoints: changes in ALSFRS-R, MRC, FVC and McGill Quality of Life (QoL) scores. Analysis was made in the intention-to-treat (ITT) and per-protocol (PP) population, completers and completers/compliers (i.e. taking > 75% of study drug). Forty-two patients received ALC and 40 placebo. In the ITT population, 34 (80.9%) patients receiving ALC and 39 (97.5%) receiving placebo became non-self-sufficient (p = 0.0296). In the PP analysis, percentages were 84.4 and 100.0% (p = 0.0538), respectively. Mean ALSFRS-R scores at 48 weeks were 33.6 (SD 10.4) and 27.6 (9.9) (p = 0.0388), respectively, and mean FVC scores 90.3 (32.6) and 58.6 (31.2) (p = 0.0158), respectively. Median survival was 45 months (ALC) and 22 months (placebo) (p = 0.0176). MRC, QoL and adverse events were similar. In conclusion, ALC may be effective, well-tolerated and safe in ALS. A pivotal phase III trial is needed.

Published
2013

6. Comparison of fingolimod with interferon beta-1a in relapsing-remitting multiple sclerosis: a randomised extension of the TRANSFORMS study

Author

Khatri, B, Barkhof, F, Comi, G, Hartung, Hp, Kappos, L, Montalban, X, Pelletier, J, Stites, T, Wu, S, Holdbrook, F, Zhang auberson, L, Francis, G, Cohen, Ja, Cohen, J, Easton, Jd, Calandra, T, Dimarco, J, Hudson, L, Kesselring, J, Laupacis, A, Temkin, N, Weinshenker, B, Zarbin, M, Poppe, P, Luetic, G, Cristiano, E, Caceres, F, Garcea, O, Correale, J, Ballario, C, Piedrabuena, R, Pollard, J, Beran, R, Hodgkinson, S, Schwartz, R, Heard, R, King, J, Butzkueven, H, Maida, Em, Vass, K, Franta elmer, C, Berger, T, Aichner, F, Ladurner, G, Bissay, V, Sindic, C, D'Hooghe, M, Mulleners, E, Damasceno, B, Barreira, A, Naylor, R, Alvarenga, R, Bacellar, A, Haussen, S, Duquette, P, Antel, J, Lamontagne, A, Grand'Maison, F, Freedman, M, Christie, S, O'Connor, P, Vorobeychik, G, Devonshire, V, Ramadan, M, Hamdy, S, Reda, E, Hashem, S, Fouad, M, Lebrun frenay, C, Clanet, M, Brochet, B, Debouverie, M, Heinzlef, O, Ziemssen, T, Koehler, W, Tiel wilck, K, Bachus, R, Altmann, N, Faiss, J, Baum, K, Dressel, A, Luckner, K, Ebke, M, Stangel, M, Diener, Hc, Bethke, F, Limmroth, V, Maschke, M, Thoemke, F, Reifschneider, G, Diehm, R, Wildemann, B, Melms, A, Rauer, S, Karlbauer, G, Berthele, A, Lang, M, Tumani, H, Krauseneck, P, Klein, M, Papadimitriou, A, Karageorgiou, K, Liakopoulos, D, Tascos, N, Plaitakis, A, Papathanasopoulos, P, Panczel, G, Jakab, G, Csiba, L, Komoly, S, Csanyi, A, Bartos, L, Centonze, D, Pozzilli, C, Marrosu, Mg, Bertolotto, A, Mancardi, GIOVANNI LUIGI, Scarpini, E, Protti, A, Ghezzi, A, Capra, R, Bergamaschi, R, Gallo, P, Stecchi, S, Montanari, E, Tola, Mr, Amato, Mp, Silvestrini, M, Lugaresi, A, Trojano, M, Morra, Vb, Ruggieri, S, Patti, F, Kim, Sm, Lee, Kh, Kim, Hj, Park, Sp, Ginestal, R, Salgado, Av, Fontoura, P, Cunha, L, Sousa, L, Mj, Sá, Pedrosa, R, Arbizu, T, Arroyo, R, Merino, Ja, Fernandez, O, Izquierdo, G, Casanova, B, Antigüedad, A, Goebels, N, Young, C, Lee, M, Chaudhuri, A, Nicholas, R, Martinez, Ac, Preiningerova, J, Greco, D, Gross, J, Newman, S, Mitchell, G, Pawar, G, Freedman, Sm, Kaufman, M, Absher, J, Kantor, D, Ayala, R, Honeycutt, W, Shafer, S, Steingo, B, Delgado, S, Cascione, M, Brock, C, Keegan, A, Laganke, C, Hunter, S, Wilson, E, Mazhari, A, Bauer, W, Singer, B, Lynch, S, Rowe, V, Hutton, G, Gazda, S, Dihenia, B, Campagnolo, D, Chippendale, T, Ash, P, Jung, L, Olek, M., Radiology and nuclear medicine, NCA - Multiple Sclerosis and Other Neuroinflammatory Diseases, Khatri B, Barkhof F, Comi G, Hartung HP, Kappos L, Montalban X, Pelletier J, Stites T, Wu S, Holdbrook F, Zhang-Auberson L, Francis G, Cohen JA, TRANSFORMS Study Group, Lugaresi A, Diener, Hans Christoph (Beitragende*r), Khatri, B, Barkhof, F, Comi, G, Hartung, Hp, Kappos, L, Montalban, X, Pelletier, J, Stites, T, Wu, S, Holdbrook, F, Zhang Auberson, L, Francis, G, Cohen, Ja, BRESCIA MORRA, Vincenzo, Comi, Giancarlo, TRANSFORMS Study, Group, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, and UCL - (SLuc) Service de neurologie

Subjects
Adult, Male, medicine.medical_specialty, multiple sclerosis, interferon beta, fingolimod, treatment, Multiple Sclerosis, Adolescent, Medizin, Phases of clinical research, Relapsing-Remitting, Injections, Intramuscular, Young Adult, Humans, Adjuvants, Immunologic, Interferon-beta, Immunosuppressive Agents, Multiple Sclerosis, Relapsing-Remitting, Treatment Outcome, Middle Aged, Propylene Glycols, Sphingosine, Female, law.invention, Injections, Randomized controlled trial, law, Immunologic, analogs /&/ derivatives/therapeutic use, Internal medicine, Fingolimod Hydrochloride, Medicine, Adjuvants, Young adult, Intramuscular, business.industry, Multiple sclerosis, Interferon beta-1a, medicine.disease, Fingolimod, Surgery, drug therapy/pathology/physiopathology, Clinical research, therapeutic use, Adolescent, Adult, Female, Humans, Immunosuppressive Agents, therapeutic use, Injections, Intramuscular, Interferon-beta, therapeutic use, Male, Middle Aged, Multiple Sclerosis, drug therapy/pathology/physiopathology, Propylene Glycols, therapeutic use, Sphingosine, analogs /&/ derivatives/therapeutic use, Treatment Outcome, Young Adult, therapeutic use, Settore MED/26 - Neurologia, Neurology (clinical), business, medicine.drug
Abstract

In a 12-month phase 3 study in patients with relapsing-remitting multiple sclerosis (RRMS), TRANSFORMS, fingolimod showed greater efficacy on relapse rates and MRI outcomes compared with interferon beta-1a. We had two aims in our extension: to compare year 2 with year 1 in the switched patients to assess the effect of a change from interferon beta-1a to fingolimod, and to compare over 24 months the treatment groups as originally randomised to assess the effect of delaying the start of treatment with fingolimod. METHODS: Patients randomly assigned to receive 0.5 mg or 1.25 mg daily oral fingolimod in the core study continued with the same treatment in our extension; patients who originally received 30 μg weekly intramuscular interferon beta-1a were randomly reassigned (1:1) to receive either 0.5 mg or 1.25 mg fingolimod. The initial randomisation and dose of fingolimod assigned for the extension remained masked to the patients and investigators. As in the core study, re-randomisation was done centrally in blocks of six and stratified according to site. Our efficacy endpoints were annualised relapse rate (ARR), disability progression, and MRI outcomes. Our within-group analyses were based on the intention-to-treat and safety populations that entered our extension study. Our between-group analyses were based on the intention-to-treat and safety populations from the core study. This study is registered with ClinicalTrials.gov, number NCT00340834. FINDINGS: 1027 patients entered our extension and received the study drug, and 882 completed 24 months of treatment. Patients receiving continuous fingolimod showed persistent benefits in ARR (0.5 mg fingolimod [n=356], 0.12 [95% CI 0.08-0.17] in months 0-12 vs 0.11 [0.08-0.16] in months 13-24; 1.25 mg fingolimod [n=330], 0.15 [0.10-0.21] vs 0.11 [0.08-0.16]; however, in patients who initially received interferon beta-1a, ARR was lower after switching to fingolimod compared with the previous 12 months (interferon beta-1a to 0.5 mg fingolimod [n=167], 0.31 [95% CI 0.22-0.43] in months 0-12 vs 0.22 [0.15-0.31], in months 13-24 p=0.049; interferon beta-1a to 1.25 mg fingolimod [n=174], 0.29 [0.20-0.40] vs 0.18 [0.12-0.27], p=0.024). After switching to fingolimod, numbers of new or newly enlarging T2 and gadolinium (Gd)-enhancing T1 lesions were significantly reduced compared with the previous 12 months of interferon beta-1a therapy (p

Published
2011

7. Natalizumab plus interferon beta-1a reduces lesion formation in relapsing multiple sclerosis

Author

Ernst Wilhelm, Radue, William, H. Stuart, Peter, A. Calabresi, Christian, Confavreux, Steven, L. Galetta, Richard, A. Rudick, Fred, D. Lublin, Bianca, Weinstock Guttman, Daniel, R. Wynn, Elizabeth, Fisher, Athina, Papadopoulou, Frances, Lynn, Michael, A. Panzara, Alfred, W. Sandrock, For, the SENTINEL Investigators including F. Fazekas, Enzinger, C., Seifert, T., Storch, M., Strasser Fuchs, S., Berger, T., Dilitz, E., Egg, R., Deisenhammer, F., Decoo, D, Lampaert, J., Bartholome, E., Bier, J., Stenager, E., Rasmussen, M., Binzer, M., Shorsh, K., Christensen, M., Ravnborg, M., Soelberg Sørensen, P., Blinkenberg, M., Petersen, B., Hansen, H. J., Bech, E., Petersen, T., Kirkegaard, M., Finland:, J. Eralinna, Ruutiainen, J., Soilu Hänninen, M., Säkö, E., Laaksonen, M., Reunanen, M., Remes, A., Keskinarkaus, I., Moreau, T., Noblet, M., Rouaud, O., Couvreur, G., Edan, G., Lepage, E., Drapier, S., De Burghgraeve, V., Yaouanq, J., Merienne, M., Cahagne, V., Gout, O., Deschamps, R., Le Canuet, P., Moulignier, A., Vermersch, P., De Seze, J., Stojkovic, T., Griffié, G., Engles, Ferriby, D., Debouverie, M., Pittion Vouyouvitch, S., Lacour, J. C., Pelletier, J., Feuillet, L., Suchet, L., Dalecky, A., Tammam, D., Lubetzki, C., Youssov, K., Mrejen, S., Charles, P., Yaici, S., Clavelou, P., Aufauvre, D., Renouil Guy, N., Cesaro, P., Degos, F., Benisty, S., Rumbach, L., Decavel, P., Confavreux, C., Blanc, S., Aubertin, P., Riche, G., Brochet, B., Ouallet, J. C., Anne, O., Menck, S., Grupe, Guttman, Lensch, E., Fucik, E., Heitmann, S., Hartung, H. P., Schröter, M., Kurz, F. M. W., Heidenreich, F., Trebst, C., Pul, R., Hohlfeld, R., Krumbholz, M., Pellkofer, H., Haas, J., Segert, A., Meyer, R., Anagnostou, P., Kabus, C., Poehlau, D., Schneider, K., Hoffmann, V., Zettl, U., Steinhagen, V., Adler, S., Steinbrecher E. Rothenfusser Körber, A. Steinbrecher E. Rothenfusser Körber, Zellner, Baum, K., Günther, A., Bläsing, H., Stoll, G., Gold, R., Bayas, A., Kleinschnitz, C., Limmroth, V., Katsarava, Z., Kastrup, O., Haller, P., Stoeve, S., Höbel, D., Oschmann, P., Voigt, K., Burger, C. V., Israel:, O. Abramsky, Karusiss, D., Achiron, A., Kishner, I., Stern, Y., Sarove Pinhas, I., Dolev, M., Magalashvili, D., Pozzili, : C., Lenzi, D., Scontrini, A., Millefiorini, E., Buttinelli, C., Gallo, P., Ranzato, F., Tiberio, M., Perini, P., Laroni, Alice, Marrosu, M., Cocco P. Marchi, E. Cocco P. Marchi, Spinicci, G., Massole, S., Mascia, M., Floris, G., Trojano, M., Bellacosa, A., Paolicelli, D., Bosco Zimatore, G., Simone, I. L., Giorelli, M., Di Monte, E., Mancardi, GIOVANNI LUIGI, Pizzorno, M., Murialdo, A., Narciso, E., Capello, A., Comi, G., Martinelli, V., Rodegher, M., Esposito, F., Colombo, B., Rossi, P., Polman, C. H., Jasperse, M. M. S., Zwemmer, J. N. P., Nielsen, J., Kragt, J. J., Jongen, P. J. H., De Smet, E., Tacken, H., Frequin, S. T. F. M., Siegers, H. P., Mauser, H. W., Fernandez Fernandez, O., León, A., Romero, F., Alonso, A., Tamayo, J., Montalban, X., Nos, C., Pelayo, R., Tellez, N., Rio, J., Tintore, M., Arbizu, T., Romero, L., Moral, E., Martinez, S., Switzerland:, L. Kappos, Achtnichts, L., Wilmes, S., Turkey:, R. Karabudak, Kurne, A., Erdem, S., Siva, A., Saip, S., Altintas, A., Atamer, A., Eraksoy, M., Bilgili, F., Topcular, B., Giovannoni, G., Lim, E. T., Lava, N., Murnane, M., Dentinger, M., Zimmerman, E., Reiss, M., Gupta, V., Scott, T., Brillman, J., Kunschner, L., Wright, D., Perel, A., Babu, A., Rivera, V., Killian, J., Hutton, G., Lai, E., Picone, M., Cadivid, D., Kamin, S., Shanawani, M., Gauthier, S., Morgan, A., Buckle, G., Margolin, D., Weinstock Guttman, B., Kwen, P. L., Garg, N., Munschauer, F., Khatri, B., Rassouli, M., Saxena, V., Ahmed, A., Turner, A., Fox, E., Couch, C., Tyler, R., Horvit, A., Fodor, P., Humphries, S., Wynn, D., Nagar, C., O'Brien, D., Allen, N., Turel, A., Friedenberg, S., Carlson, J., Hosey, J., Crayton, H., Richert, J., Tornatore, C., Sirdofsky, M., Greenstein, J., Shpigel, Y., Mandel, S., Adbelhak, T., Schmerler, M., Zadikoff, C., Rorick, M., Reed, R., Elias, S., Feit, H., Angus, E., Sripathi, N., Herbert, J., Kiprovski, K., Qu, X., Del Bene, M., Mattson, D., Hingtgen, C., Fleck, J., Horak, H., Javerbaum, J., Elmore, R., Garcia, E., Tasch, E., Gruener, G., Celesia, G., Chawla, J., Miller, A., Drexler, E., Keilson, M., Wolintz, R., Drasby, E., Muscat, P., Belden, J., Sullivan, R., Cohen, J., Stone, L., Marrie, R. A., Fox, R., Hughes, B., Babikian, P., Jacoby, M., Doro, J., Puricelli, M., Rossman, H., Boudoris, W., Belkin, M., Pierce, R., Eggenberger, E., Birbeck, G., Martin, J., Kaufman, D., Stuart, W., English, J. B., Stuart, D. S., Gilbert, R. W., Kaufman, M., Putman, S., Diedrich, A., Follmer, R., Pelletier, D., Waubant, E., Cree, B., Genain, C., Goodin, D., Guarnaccia, J., Patwa, H., Rizo, M., Kitaj, M., Blevins, J., Smith, T., Mcgee, F., Honeycutt, W., Brown, M., Isa, A., Nieves Quinones, D., Krupp, L., Smiroldo, J., Zarif, M., Perkins, C., Sumner, A., Fisher, A., Gutierrez, Jacoby, R., Svoboda, S., Dorn, D., Groeschel, A., Steingo, B., Kishner, R., Cohen, B., Melen, O., Simuni, T., Zee, P., Cohan, S., Yerby, M., Hendin, B., Levine, T., Tamm, H., Travis, L. H., Freedman, S. M., Tim, R., Ferrell, W., Stefoski, D., Stevens, S., Katsamakis, G., Topel, J., Ko, M., Gelber, D., Fortin, C., Green, B., Logan, W., Carpenter, D., Temple, L., Sadiq, S., Sylvester, A., Sim, G., Mihai, C., Vertino, M., Jubelt, B., Mejico, L., Phillips, J. T., Martin, A., Heitzman, D., Greenfield, C. F., Riskind, P., Cabo, A., Paskavitz, J., Moonis, M., Bashir J. Brockington, K. Bashir J. Brockington, Nicholas, A., Slaughter, R., Archer S. Harik, R. Archer S. Harik, Haddad, N., Pippenger, M. A., Van den Noort, S., Thai, G., Olek, M., Demetriou, M., Shin, R., Calabresi, P., Rus, H., Bever, C., Johnson, K., Sheremata, W., Delgado, S., Sherbert, R., Herndon, R., Uschmann, H., Chandler, A., Markowitz, C., Jacobs, D., Balcer, L., Mitchell, G., Chakravorty, S., Heyman, R., Stauber, Z., Goodman, A., Segal, B., Schwid, S., Samkoff, L., Levin, M., Jacewicz, M., Menkes, D., Pulsinelli, W., Frohman, E., Racke, M., Hawker, K., Ulrich, R., Panitch, H., Hamill, R., Tandon, R., Dulaney, E., Simnad, V., Miller, J., Wooten, G. F., Harrison, M., Bowen, J., Doherty, M., Wundes, A., Garden, G. A., Distad, J., Kachuck, N., Berkovich, R., Burnett, M., Sahai, S., Bandari, D., Weiner, L., Storey, J. R., Beesley, B., Hart, D., Moses, H., Sriram, S., Fang, J., O'Duffy, A., Kita, M., Taylor, L., Elliott, M., Roberts, J., Jeffery, D., Maxwell, S., Lefkowitz, D., Kumar, S., Sinclair, M., Neurology, and NCA - Multiple Sclerosis and Other Neuroinflammatory Diseases

Subjects
Adult, Male, medicine.medical_specialty, Multiple Sclerosis, Adolescent, Relapsing-Remitting, Placebo, Antibodies, Monoclonal, Humanized, Gastroenterology, Antibodies, Central nervous system disease, Pharmacotherapy, Natalizumab, Multiple Sclerosis, Relapsing-Remitting, pathology/therapy, Drug Therapy, Internal medicine, Monoclonal, Medicine, Humans, Immunologic Factors, Humanized, medicine.diagnostic_test, business.industry, Multiple sclerosis, Patient Selection, Interferon beta-1a, Antibodies, Monoclonal, Brain, Magnetic resonance imaging, Interferon-beta, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Surgery, Treatment Outcome, Neurology, therapeutic use, Combination, Drug Therapy, Combination, pathology, Female, Neurology (clinical), Adolescent, Adult, Antibodies, Humanized, Antibodies, therapeutic use, Brain, pathology, Drug Therapy, Combination, Female, Humans, Immunologic Factors, therapeutic use, Interferon-beta, therapeutic use, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Sclerosis, pathology/therapy, Patient Selection, Treatment Outcome, business, medicine.drug
Abstract

The SENTINEL study showed that the addition of natalizumab improved outcomes for patients with relapsing multiple sclerosis (MS) who had experienced disease activity while receiving interferon beta-1a (IFNbeta-1a) alone. Previously unreported secondary and tertiary magnetic resonance imaging (MRI) measures are presented here. Patients received natalizumab 300 mg (n=589) or placebo (n=582) intravenously every 4 weeks plus IFNbeta-1a 30 microg intramuscularly once weekly. Annual MRI scans allowed comparison of a range of MRI end points versus baseline. Over 2 years, 67% of patients receiving natalizumab plus IFNbeta-1a remained free of new or enlarging T2-lesions compared with 30% of patients receiving IFNbeta-1a alone. The mean change from baseline in T2 lesion volume over 2 years decreased in patients receiving natalizumab plus IFNbeta-1a and increased in those receiving IFNbeta-1a alone (-277.5mm(3) versus 525.6mm(3); p0.001). Compared with IFNbeta-1a alone, add-on natalizumab therapy resulted in a smaller increase in mean T1-hypointense lesion volume after 2 years (1821.3mm(3) versus 2210.5mm(3); p0.001), a smaller mean number of new T1-hypointense lesions over 2 years (2.3 versus 4.1; p0.001), and a slower rate of brain atrophy during the second year of therapy (-0.31% versus -0.40%; p=0.020). Natalizumab add-on therapy reduced gadolinium-enhancing, T1-hypointense, and T2 MRI lesion activity and slowed brain atrophy progression in patients with relapsing MS who experienced disease activity despite treatment with IFNbeta-1a alone.

Published
2010

8. Reliability of clinical outcome measures in Charcot-Marie-Tooth disease

Author

Solari, A, Laurà, M, Salsano, E, Radice, D, Pareyson, D, CMT TRIAAL, Sg, Marelli, C, Scaioli, V, Ciano, C, Rimoldi, M, Lauria, G, Rizzetto, E, Camozzi, F, Schenone, Angelo, Grandis, Marina, Narciso, E, Nobbio, L, Benedetti, L, Rizzuto, N, Fabrizi, Gm, Cavallaro, T, Bertolasi, L, Casano, A, Santoro, L, Manganelli, F, Pisciotta, C, Nolano, M, Vita, G, Mazzeo, A, Di Leo, R, Girlanda, P, Majorana, G, Aguennouz, M, Ciranni, A, Lanzano, N, Quattrone, A, Valentino, P, Nisticò, R, Pirritano, D, Clodomiro, A, Canino, M, Padua, L, Pazzaglia, C, Mignogna, T, Gemignani, F, Brindani, F, Vitetta, F, Visioli, F, Bogani, P, Hughes, Ra, Schenone, A, Mancardi, GIOVANNI LUIGI, Cavaletti, G, Galimberti, S, Calabrese, D, Ferrari, G, Sereda, Mw, Lauria, G., Solari, A, Laurà, M, Salsano, E, Radice, D, Pareyson, D, The CMT TRIAAL Study, G, Cavaletti, G, Marelli, C, Scaioli, V, Ciano, C, Rimoldi, M, Lauria, G, Rizzetto, E, Camozzi, F, Schenone, A, Grandis, M, Narciso, E, Nobbio, L, Benedetti, L, Rizzuto, N, Fabrizi, G, Cavallaro, T, Bertolasi, L, Casano, A, Santoro, L, Manganelli, F, Pisciotta, C, Nolano, M, Vita, G, Mazzeo, A, Di Leo, R, Girlanda, P, Majorana, G, Aguennouz, M, Ciranni, A, Lanzano, N, Quattrone, A, Valentino, P, Nisticò, R, Pirritano, D, Clodomiro, A, Canino, M, Padua, L, Pazzaglia, C, Mignogna, T, Gemignani, F, Brindani, F, Vitetta, F, Bogani, P, Hughes, R, Visioli, F, Mancardi, G, Galimberti, S, Calabrese, D, Ferrari, G, and Sereda, M

Subjects
Male, instrumentation/methods, Predictive Value of Test, Isometric exercise, Ascorbic Acid, Outcome measures, Randomised clinical trial, Tooth disease, Disability Evaluation, Charcot-Marie-Tooth Disease, Medicine, Genetics (clinical), Reliability (statistics), Reliability, Charcot-Marie-Tooth disease, Observer Variation, Neurologic Examination, Muscle Weakness, innervation/physiopathology, Skeletal, Middle Aged, Treatment Outcome, Neurology, Predictive value of tests, Arm, Muscle, Female, medicine.symptom, Foot (unit), Human, Muscle Weakne, Muscle Contraction, Restraint, Physical, Adult, medicine.medical_specialty, Adolescent, Movement, education, Reproducibility of Result, diagnosis/etiology/therapy, Restraint, Adolescent, Adult, Aged, Arm, innervation/physiopathology, Ascorbic Acid, therapeutic use, Charcot-Marie-Tooth Disease, diagnosis/drug therapy/physiopathology, Disability Evaluation, Female, Humans, Leg, physiopathology, Male, Middle Aged, Movement, physiology, Muscle Contraction, physiology, Muscle Weakness, diagnosis/etiology/therapy, Muscle, innervation/physiopathology, Neurologic Examination, instrumentation/methods, Observer Variation, Placebo Effect, Predictive Value of Tests, Reproducibility of Results, Restraint, Physical, instrumentation/methods, Treatment Outcome, Physical medicine and rehabilitation, Predictive Value of Tests, Humans, Muscle, Skeletal, Aged, Leg, business.industry, Muscle weakness, Reproducibility of Results, Ascorbic acid, Placebo Effect, diagnosis/drug therapy/physiopathology, body regions, therapeutic use, Pediatrics, Perinatology and Child Health, physiology, Physical therapy, Neurology (clinical), physiopathology, business
Abstract

We assessed inter- and intra-rater reliability of outcome measures in Charcot-Marie-Tooth disease (CMT) patients. In 40 CMT patients, we assessed reliability of Overall Neuropathy Limitations Scale (ONLS), 10-m timed walk (T10MW), 9-hole-peg test (9-HPT), maximal voluntary isometric contraction (MVIC) of arm (elbow flexion, hand-grip, and three-point pinch) and leg (knee extension, foot dorsiflexion/plantar flexion). Reliability was substantial for ONLS, excellent for T10MW and 9-HPT. For MVIC, inter and intra-rater reliability was excellent for hand contractions; for leg contractions, intra-rater agreement was moderate to substantial, whereas inter-rater agreement was poor. An ad hoc device was produced to immobilize the foot and MVIC reliability was re-assessed in 26 CMT patients, resulting in excellent inter-rater and intra-rater reliability for foot dorsiflexion, and clear inter-rater improvement for foot plantar flexion. All outcome measures appear adequate for CMT assessment. Use of an immobilization device improves foot MVIC reliability, preventing biased findings in patients with greater strength.

Published
2008

9. Natalizumab plus interferon beta-1a for relapsing multiple sclerosis

Author

Richard, A. Rudick, William, H. Stuart, Peter, A. Calabresi, Christian, Confavreux, Steven, L. Galetta, Ernst Wilhelm, Radue, Fred, D. Lublin, Bianca, Weinstock Guttman, Daniel, R. Wynn, Frances, Lynn, Msc, M. S. c., Michael, A. Panzara, Alfred, W. Sandrock, For, the SENTINEL Investigators including: F. Fazekas, Enzinger, C., Seifert, T., Storch, M., Strasser Fuchs, S., Berger, T., Dilitz, E., Egg, R., Eisenhammer, F., Decoo J. Lampaert, D. Decoo J. Lampaert, Bartholome J. Bier, E. Bartholome J. Bier, Stenager, E., Rasmussen, M., Binzer, M., Shorsh, K., Christensen, M., Ravnborg, M., Soelberg Sørensen, P., Blinkenberg, M., Petersen, B., Hansen, H. J., Bech, E., Petersen, T., Kirkegaard, M., Eralinna, J., Ruutiainen, J., Soilu Hänninen, M., Säkö, E., Laaksonen, M., Reunanen, M., Remes, A., Keskinarkaus, I., Moreau, T., Noblet, M., Rouaud, O., Couvreur, G., Edan, G., Lepage, E., Drapier, S., De Burghgraeve, V., Yaouanq, J., Merienne, M., Cahagne, V., Gout, O., Deschamps, R., Le Canuet, P., Moulignier, A., Vermersch, P., De Seze, J., Stojkovic, T., Griffié, G., Engles, A., Ferriby, D., Debouverie, M., Pittionvouyouvitch, S., Lacour, J. C., Pelletier, J., Feuillet, L., Suchet, L., Dalecky, A., Tammam, D., Lubetzki, C., Youssov, K., Mrejen, S., Charles, P., Yaici, S., Clavelou, P., Aufauvre, D., Renouil Guy, N., Cesaro, P., Degos, F., Benisty, S., Rumbach P. Decavel, L. Rumbach P. Decavel, Confavreux, C., Blanc, S., Aubertin, P., Riche, G., Brochet, B., Ouallet, J. C., Anne, O., Menck, S., Grupe, A., Guttman, E., Lensch, E., Fucik, E., Heitmann, S., Hartung, H. P., Schröter, M., Kurz, F. M. W., Heidenreich, F., Trebst, C., Pul, R., Hohlfeld, R., Krumbholz, M., Pellkofer, H., Haas, J., Segert, A., Meyer, R., Anagnostou, P., Kabus, C., Poehlau, D., Schneider, K., Hoffmann, V., Zettl, U., Steinhagen, V., Adler, S., Steinbrecher, A., Rothenfusser Körber, E., Zellner, R., Baum, K., Günther, A., Bläsing, H., Stoll, G., Gold, R., Bayas, A., Kleinschnitz, C., Limmroth, V., Katsarava, Z., Kastrup, O., Haller, P., Stoeve, S., Höbel, D., Oschmann, P., Voigt, K., Burger, C. V., Abramsky D. Karusiss, O. Abramsky D. Karusiss, Achiron, A., Kishner, I., Stern, Y., Sarove Pinhas, I., Dolev, M., Magalashvili, D., Pozzili, C., Lenzi, D., Scontrini, A., Millefiorini, E., Buttinelli, C., Gallo, P., Ranzato, F., Tiberio, M., Perini, P., Laroni, Alice, Marrosu, M., Cocco P. Marchi, E. Cocco P. Marchi, Spinicci, G., Massole, S., Mascia, M., Floris, G., Trojano, M., Bellacosa, A., Paolicelli, D., Bosco Zimatore, G., Simone, I. L., Giorelli, M., Di Monte, E., Mancardi, GIOVANNI LUIGI, Pizzorno, M., Murialdo, A., Narciso, E., Capello, A., Comi, G., Martinelli, V., Rodegher, M., Esposito, F., Colombo, B., Rossi, P., Polman, C. H., Jasperse, M. M. S., Zwemmer, J. N. P., Nielsen, J., Kragt, J. J., Jongen, P. J. H., De Smet, E., Tacken, H., Frequin, S. T. F. M., Siegers, H. P., Mauser, H. W., Fern ez Fern ez, O., León, A., Romero, F., Alonso, A., Tamayo, J., Montalban, X., Nos, C., Pelayo, R., Tellez, N., Rio, J., Tintore, M., Arbizu, T., Romero, L., Moral, E., Martinez, S., Kappos, L., Achtnichts, L., Wilmes, S., Karabudak, R., Kurne, A., Erdem, S., Siva, A., Saip, S., Altintas, A., Atamer, A., Eraksoy, M., Bilgili, F., Topcular, B., Giovannoni ET Lim, G. Giovannoni E. T. Lim, Lava, N., Murnane, M., Dentinger, M., Zimmerman, E., Reiss V. Gupta, M. Reiss V. Gupta, Scott, T., Brillman, J., Kunschner, L., Wright, D., Perel A. Babu, A. Perel A. Babu, Rivera, V., Killian, J., Hutton, G., Lai, E., Picone, M., Cadivid, D., Kamin, S., Shanawani, M., Gauthier, S., Morgan, A., Buckle, G., Margolin, D., Weinstock Guttman, B., Kwen, P. L., Garg, N., Munschauer, F., Khatri, B., Rassouli, M., Saxena, V., Ahmed, A., Turner, A., Fox, E., Couch, C., Tyler, R., Horvit, A., Fodor S. Humphries, P. Fodor S. Humphries, Wynn, D., Nagar, C., O’Brien, D., Allen, N., Turel, A., Friedenberg, S., Carlson, J., Hosey, J., Crayton, H., Richert, J., Tornatore, C., Sirdofsky, M., Greenstein, J., Shpigel, Y., S. M, El, Adbelhak, T., Schmerler, M., Zadikoff, C., Rorick, M., Reed, R., Elias, S., Feit, H., Angus, E., Sripathi, N., Herbert, J., Kiprovski, K., Qu, X., Del Bene, M., Mattson, D., Hingtgen, C., Fleck, J., Horak, H., Kaiser, J. Javerbaum, Elmore, R., Garcia, E., Tasch, E., Gruener, G., Celesia, G., Chawla, J., Miller, A., Drexler, E., Keilson, M., Wolintz, R., Drasby, E., Muscat, P., Belden, J., Sullivan, R., Cohen, J., Stone, L., Marrie, R. A., Fox, R., Hughes, B., Babikian, P., Jacoby, M., Doro, J., Puricelli, M., Rossman, H., Boudoris, W., Belkin, M., Pierce, R., Eggenberger, E., Birbeck, G., Martin, J., Kaufman, D., Stuart, W., English, J. B., Stuart, D. S., Gilbert, R. W., Kaufman, M., Putman, S., Diedrich, A., Follmer, R., Pelletier, D., Waubant, E., Cree, B., Genain, C., Goodin, D., Guarnaccia, J., Patwa, H., Rizo, M., Kitaj, M., Blevins, J., Smith, T., Mcgee, F., Honeycutt, W., Brown, M., Isa, A., Nieves Quinones, D., Krupp, L., Smiroldo, J., Zarif, M., Perkins, C., Sumner, A., Fisher, A., Gutierrez, A., Jacoby, R., Svoboda, S., Dorn, D., Groeschel, A., Steingo R. Kishner, B. Steingo R. Kishner, Cohen, B., Melen, O., Simuni, T., Zee, P., Cohan M. Yerby, S. Cohan M. Yerby, Hendin, B., Levine, T., Tamm, H., Travis, L. H., Freedman, S. M., Tim, R., Ferrell, W., Stefoski, D., Stevens, S., Katsamakis, G., Topel, J., KoD Gelber C. Fortin, M. K. o. D. Gelber C. Fortin, Green, B., Logan, W., Carpenter, D., Temple, L., Sadiq, S., Sylvester, A., Sim, G., Mihai, C., Vertino, M., Jubelt, B., Mejico, L., Phillips, J. T., Martin, A., Heitzman, D., Greenfield, C. F., Riskind, P., Cabo, A., Paskavitz, J., Moonis, M., Bashir, K., Brockington, J., Nicholas, A., Slaughter, R., Archer, R., Harik, S., Haddad, N., Pippenger, M. A., Van den Noort, S., Thai, G., Olek, M., Demetriou, M., Shin, R., Calabresi, P., Rus, H., Bever, C., Johnson, K., Sheremata, W., Delgado, S., Sherbert, R., Herndon, R., Uschmann, H., Ch ler, A., Markowitz, C., Jacobs, D., Balcer, L., Mitchell, G., Chakravorty, S., Heyman, R., Stauber, Z., Goodman, A., Segal, B., Schwid, S., Samkoff, L., Levin, M., Jacewicz, M., Menkes, D., Pulsinelli, W., Frohman, E., Racke, M., Hawker, K., Ulrich, R., Panitch, H., Hamill, R., R. T, On, Dulaney, E., Simnad, V., Miller, J., Wooten, G. F., Harrison, M., Bowen, J., Doherty, M., Wundes, A., Garden, G. A., Distad, J., Kachuck, N., Berkovich, R., Burnett, M., Sahai, S., Ari, D. B, Weiner, L., Storey, J. R., Beesley, B., Hart, D., Moses, H., Sriram, S., Fang, J., O’Duffy, A., Kita, M., Taylor, L., Elliott, M., Roberts, J., Jeffery, D., Maxwell, S., Lefkowitz, D., Kumar, S., Sinclair EW Radue, M. S. i. n. c. l. a. i. r. E. W. Radue, de Vera, A., Bacelar, O., Kuster, P., and Kappos, L. .

Subjects
Adult, Male, Infusions, medicine.medical_specialty, Multiple Sclerosis, Adolescent, Combination therapy, Integrin alpha4, Peripheral edema, Progressive Multifocal, Relapsing-Remitting, Gastroenterology, Antibodies, Natalizumab, Drug Therapy, Leukoencephalopathy, Internal medicine, Monoclonal, Secondary Prevention, medicine, Humans, Humanized, Proportional Hazards Models, Expanded Disability Status Scale, business.industry, Antibodies, Monoclonal, Antibodies, Monoclonal, Humanized, Brain, Cell Adhesion Molecules, Disease Progression, Drug Therapy, Combination, Female, Infusions, Intravenous, Interferon-beta, JC Virus, Leukoencephalopathy, Progressive Multifocal, Middle Aged, Multiple Sclerosis, Relapsing-Remitting, Medicine (all), Progressive multifocal leukoencephalopathy, Multiple sclerosis, Hazard ratio, Interferon beta-1a, General Medicine, medicine.disease, Surgery, Combination, medicine.symptom, Intravenous, business, medicine.drug
Abstract

Background Interferon beta is used to modify the course of relapsing multiple sclerosis. Despite interferon beta therapy, many patients have relapses. Natalizumab, an α 4 integrin antagonist, appeared to be safe and effective alone and when added to interferon beta-1a in preliminary studies. Methods We randomly assigned 1171 patients who, despite interferon beta-1a therapy, had had at least one relapse during the 12-month period before randomization to receive continued interferon beta-1a in combination with 300 mg of natalizumab (589 patients) or placebo (582 patients) intravenously every 4 weeks for up to 116 weeks. The primary end points were the rate of clinical relapse at 1 year and the cumulative probability of disability progression sustained for 12 weeks, as measured by the Expanded Disability Status Scale, at 2 years. Results Combination therapy resulted in a 24 percent reduction in the relative risk of sustained disability progression (hazard ratio, 0.76; 95 percent confidence interval, 0.61 to 0.96; P = 0.02). Kaplan–Meier estimates of the cumulative probability of progression at two years were 23 percent with combination therapy and 29 percent with interferon beta-1a alone. Combination therapy was associated with a lower annualized rate of relapse over a two-year period than was interferon beta-1a alone (0.34 vs. 0.75, P

Published
2006

10. Symptomatic medication use in multiple sclerosis

Author

Brichetto, G., Uccelli, M. M., Mancardi, GIOVANNI LUIGI, and Solaro, C.

Subjects
Adult, Complementary Therapies, Male, Questionnaires, Multiple Sclerosis, Mood Disorders, complications/drug therapy/epidemiology, Pain, Middle Aged, Urination Disorders, Disability Evaluation, Cross-Sectional Studies, drug therapy/epidemiology/etiology, Italy, Muscle Spasticity, Adult, Complementary Therapies, Cross-Sectional Studies, Disability Evaluation, Female, Humans, Italy, epidemiology, Male, Middle Aged, Mood Disorders, drug therapy/epidemiology/etiology, Multiple Sclerosis, complications/drug therapy/epidemiology, Muscle Spasticity, drug therapy/epidemiology/etiology, Pain, drug therapy/epidemiology/etiology, Prevalence, Questionnaires, Urination Disorders, Prevalence, Humans, Female, epidemiology
Published
2003

11. Autoantibodies in multiple sclerosis patients before and during IFN-beta 1b treatment: are they correlated with the occurrence of autoimmune diseases?

Author

Verdun, E, Giuliani, F, Salvi, F, Stecchi, S, Reggio, A, Reggio, E, Montanari, E, Negri, G, Ludovico, L, Ghezzi, A, Zaffaroni, M, Isoardo, G, Mancardi, GIOVANNI LUIGI, Inglese, MARIA MATILDE, Carolei, A, Totaro, R, Milanese, C, La Mantia, L, Caputo, D, Mini, M, Mendozzi, L, Cotrufo, R, Oggero, A, Lus, G, Cosi, V, Romani, A, Gallai, V, Sarchielli, P, Nocentini, U, Rizzato, B, Tonali, P. A, Massaro, A. R, Rosati, G, Ferrero, B, Sotgiu, S, Annunziata, P, Barbero, P, Pipieri, A, Ricci, A, Clerico, M, Bosio, A, Cucci, M. A, Aimo, G, Giorda, L, Bortolon, F, Stenta, G, Sormani, MARIA PIA, Ecari, U, Ciampini, M, Beckmann, K, Durelli, L, and Trojano, M.

Subjects
Adult, Male, Multiple Sclerosis, Adolescent, Adjuvants, Immunologic, Age of Onset, Autoantibodies, Autoimmune Diseases, Female, Follow-Up Studies, Humans, Interferon-beta, Liver Diseases, Longitudinal Studies, Middle Aged, Prospective Studies, Recombinant Proteins, Reference Values, Immunology, Virology, Cell Biology, medicine.disease_cause, Autoimmunity, Immunologic, medicine, Adjuvants, business.industry, Multiple sclerosis, Thyroid, Interferon beta-1b, Autoantibody, Interferon beta-1a, medicine.disease, medicine.anatomical_structure, Settore MED/26 - Neurologia, Liver function, Thyroid function, business, medicine.drug
Abstract

Autoimmune side effects, namely autoantibody (autoAb) occurrence and thyroid function alteration, have been described during interferon-beta (IFN-beta) treatment for multiple sclerosis (MS). AutoAb occurrence and autoimmune thyroid diseases are also frequently detected in MS patients free of any treatment. The aim of this study was to evaluate the relationship between IFN-beta 1b treatment, autoAb occurrence, and autoimmune diseases in MS. Thyroid and liver function and serum autoAb (antithyroid, antinuclear, anti-liver, anti-kidney microsomes, anti-smooth muscle and parietal cell antigens) occurrence were evaluated in 156 relapsing-remitting MS (RRMS) patients before and every 3 months after starting IFN-beta 1b treatment (8 MIU subcutaneously [s.c.] on alternate days). The probability of having liver or thyroid function alteration or autoAb occurrence was analyzed longitudinally with the generalized estimating equations (GEE) approach. At baseline, 16.1% of patients had autoAb. During treatment, autoAb occurred de novo in 7.2% of patients. GEE analysis showed that the probability of having autoAb at any time during IFN-beta 1b treatment did not change significantly compared with baseline. AutoAb occurring de novo rarely persisted during treatment and significantly less than those already present at baseline. Positivity for autoAb at baseline or during treatment was not correlated with the development of thyroid or liver function alteration during IFN-beta 1b treatment. Our study indicates that IFN-beta treatment is a safe treatment for MS patients, free of risk of autoimmunity and of associated liver or thyroid function alteration.

Published
2002

12. Hematopoietic stem cell transplantation for multiple sclerosis. A retrospective multicenter study

Author

Fassas, A., Passweg, J. R., Anagnostopoulos, A., Kazis, A., Kozak, T., Havrdova, E., Carreras, E., Graus, F., Kashyap, A., Openshaw, H., Schipperus, M., Deconinck, E., Mancardi, GIOVANNI LUIGI, Marmont, A., Hansz, J., Rabusin, M., Zuazu, F. J., Besalduch, J., Dentamaro, T., Fouillard, L., Hertenstein, B., Nasa, G. L., Musso, M., Papineschi, F., Rowe, J. M., Saccardi, R., Steck, A., Kappos, L., Gratwohl, A., Tyndall, A., Samijn, J., Samign, J., Working, A. D., and Transplantation), M.

Subjects
Adult, Male, immunology/mortality/therapy, Multiple Sclerosis, Transplantation Conditioning, Hematopoietic Stem Cell Transplantation, Middle Aged, Adult, Bone Marrow Transplantation, adverse effects/mortality, CD4 Lymphocyte Count, Disease Progression, Disease-Free Survival, Female, Hematopoietic Stem Cell Mobilization, adverse effects, Hematopoietic Stem Cell Transplantation, adverse effects/mortality, Humans, Male, Middle Aged, Multiple Sclerosis, Chronic Progressive, immunology/mortality/therapy, Retrospective Studies, Transplantation Conditioning, adverse effects, Treatment Outcome, Disease-Free Survival, Hematopoietic Stem Cell Mobilization, CD4 Lymphocyte Count, adverse effects/mortality, Treatment Outcome, Disease Progression, adverse effects, Humans, Female, Bone Marrow Transplantation, Retrospective Studies
Published
2002

13. Topiramate relieves idiopathic and symptomatic trigeminal neuralgia

Author

Solaro, C., Uccelli, M. M., Brichetto, G., Gaspperini, C., and Mancardi, GIOVANNI LUIGI

Subjects
Adult, Male, Adult, Anticonvulsants, therapeutic use, Female, Fructose, analogs /&/ derivatives/therapeutic use, Humans, Male, Middle Aged, Trigeminal Neuralgia, drug therapy, analogs /&/ derivatives/therapeutic use, therapeutic use, Humans, Anticonvulsants, Female, Fructose, Middle Aged, Trigeminal Neuralgia
Published
2001

14. Human brain endothelial cells and astrocytes produce IL-1 beta but not IL-10

Author

Corsini, E., Dufour, A., Ciusani, E., Gelati, M., Frigerio, S., Gritti, A., Cajola, L., Mancardi, GIOVANNI LUIGI, Massa, G., and Salmaggi, A.

Subjects
Adult, metabolism/pathology, Male, Umbilical Veins, Multiple Sclerosis, Cells, Messenger, Gene Expression, biosynthesis/genetics, immunology/metabolism, Vascular, Meningeal Neoplasms, Humans, Endothelium, cytology/metabolism, Cultured, Tumor Necrosis Factor-alpha, Adult, Astrocytes, immunology/metabolism, Brain, blood supply/pathology, Capillaries, cytology/metabolism, Cells, Cultured, Endothelium, metabolism, Female, Gene Expression, Humans, Infant, Newborn, Interleukin-1, biosynthesis/genetics, Interleukin-10, biosynthesis/genetics, Intracranial Aneurysm, metabolism/pathology, Male, Meningeal Neoplasms, metabolism/pathology, Meningioma, metabolism/pathology, Middle Aged, Multiple Sclerosis, metabolism/pathology, RNA, biosynthesis/genetics, Tumor Necrosis Factor-alpha, biosynthesis/genetics, Umbilical Veins, cytology/metabolism, beta 2-Microglobulin, Brain, Infant, Intracranial Aneurysm, Middle Aged, Newborn, Capillaries, Interleukin-10, blood supply/pathology, Astrocytes, RNA, Female, Meningioma, beta 2-Microglobulin, metabolism, Interleukin-1
Published
1996

15. Endothelial mitochondrial content of cerebral cortical capillaries in Alzheimer's disease. An ultrastructural quantitative study

Author

Mancardi, GIOVANNI LUIGI, Tabaton, Massimo, and Liwnicz, B. H.

Subjects
Cerebral Cortex, Microscopy, Alzheimer Disease, Humans, pathology, Endothelium, Middle Aged, pathology, Capillaries, ultrastructure, Cerebral Cortex, blood supply, Endothelium, ultrastructure, Humans, Microscopy, Electron, Middle Aged, Mitochondria, ultrastructure, blood supply, Electron, Capillaries, Mitochondria
Published
1985

16. Cerebrospinal fluid and neuropathological study in Devic's syndrome. Evidence of intrathecal immune activation

Author

Leonardi, A., Arata, L., Farinelli, M., Cocito, Leonardo, Schenone, Angelo, Tabaton, Massimo, and Mancardi, GIOVANNI LUIGI

Subjects
Central Nervous System, Multiple Sclerosis, Neuromyelitis Optica, Albumins, cerebrospinal fluid, Central Nervous System, pathology, Demyelinating Diseases, cerebrospinal fluid, Diagnosis, Differential, Female, Humans, Immunoglobulin G, cerebrospinal fluid, Isoelectric Focusing, Middle Aged, Multiple Sclerosis, cerebrospinal fluid, Neuromyelitis Optica, cerebrospinal fluid/immunology/pathology, Middle Aged, cerebrospinal fluid, Immunoglobulin G, Diagnosis, Differential, Humans, pathology, Female, Isoelectric Focusing, Demyelinating Diseases
Published
1987

17. Direct immunofluorescence in sural nerve biopsies

Author

Schenone, Angelo, DE MARTINI, Isabella, Tabaton, Massimo, Romagnoli, P., Akkad, A. S., Bianchini, D., and Mancardi, GIOVANNI LUIGI

Subjects
Adult, Male, Adolescent, analysis, Biopsy, Paraproteinemias, Immunoglobulins, Peripheral Nervous System Diseases, Middle Aged, Immunohistochemistry, immunology, Spinal Nerves, Sural Nerve, immunology/pathology, Humans, Adolescent, Adult, Aged, Biopsy, Child, Child, Preschool, Female, Hereditary Sensory and Autonomic Neuropathies, immunology/pathology, Humans, Immunoglobulins, analysis, Immunohistochemistry, Male, Middle Aged, Paraproteinemias, immunology/pathology, Peripheral Nervous System Diseases, immunology/pathology, Spinal Nerves, immunology, Sural Nerve, Female, Hereditary Sensory and Autonomic Neuropathies, Child, Preschool, Aged
Published
1988

18. Polyglucosan bodies in the sural nerve of a diabetic patient with polyneuropathy

Author

Mancardi, GIOVANNI LUIGI, Schenone, Angelo, Tabaton, Massimo, Tassinari, T., and Mainardi, PAOLO FRANCESCO

Subjects
Inclusion Bodies, Microscopy, Biopsy, Middle Aged, ultrastructure, Electron, Axons, ultrastructure, Biopsy, Diabetic Neuropathies, pathology, Female, Glucans, metabolism, Humans, Inclusion Bodies, ultrastructure, Microscopy, Electron, Middle Aged, Muscular Atrophy, pathology, Myelin Sheath, ultrastructure, Spinal Nerves, pathology, Sural Nerve, pathology, Muscular Atrophy, Spinal Nerves, Diabetic Neuropathies, Sural Nerve, Humans, Female, Glucans, metabolism, Myelin Sheath
Published
1985

19. Safety and tolerability of fingolimod in patients with relapsing-remitting multiple sclerosis: results of an open-label clinical trial in Italy

Author

Debora Raimondi, Renato Turrini, Carlo Pozzilli, Alessandra Lugaresi, Leonello Guidi, Alice Laroni, Giancarlo Comi, Antonio Uccelli, Davide Brogi, Vincenzo Brescia Morra, Giovanni Luigi Mancardi, Laroni, Alice, Brogi, Davide, Brescia Morra, Vincenzo, Guidi, Leonello, Pozzilli, Carlo, Comi, Giancarlo, Lugaresi, Alessandra, Turrini, Renato, Raimondi, Debora, Uccelli, Antonio, and Mancardi, Giovanni Luigi

Subjects
Adult, Male, medicine.medical_specialty, Population, Dermatology, Infections, Macular Edema, Immunosuppressive Agent, 03 medical and health sciences, Multiple Sclerosis, Relapsing-Remitting, 0302 clinical medicine, Fingolimod, Relapsing-remitting multiple sclerosis, Safety, Tolerability, Female, Fingolimod Hydrochloride, Headache, Humans, Immunosuppressive Agents, Infection, Italy, Middle Aged, Treatment Outcome, 2708, Neurology (clinical), Psychiatry and Mental Health, Internal medicine, Medicine, 030212 general & internal medicine, education, Adverse effect, education.field_of_study, business.industry, General Medicine, Surgery, Clinical trial, Psychiatry and Mental health, Concomitant, Cohort, Relapsing-remitting multiple sclerosi, business, 030217 neurology & neurosurgery, Human, medicine.drug
Abstract

The safety profile of fingolimod is well established in clinical trials and post-marketing studies. This study aimed to evaluate the safety and tolerability of fingolimod in a cohort of Italian patients with relapsing-remitting multiple sclerosis (RRMS). This is a non-comparative, open-label, multicentre, interventional study conducted in patients with RRMS with no suitable alternative treatment option. Safety and tolerability of fingolimod 0.5Â mg were assessed by recording adverse events (AEs) and serious AEs (SAEs). Of the 906 patients enrolled in the study, 91Â % of the patients completed the study. AEs and SAEs were reported in 35.4 and 2.9Â % of the patients, respectively. Most common AEs reported were headache (4.1Â %), influenza (2.1Â %), lymphopenia (1.8Â %), asthenia (1.8Â %) and pyrexia (1.8Â %). Increased alanine aminotransferase levels and hypertension were reported as AE in 1.0 and 1.4Â % of the patients, respectively. Macular oedema was reported in three patients. These results emphasize the safety of fingolimod in patients representing the real-world clinical practice in the Italian population. Fingolimod was safe and well tolerated in this population, which, compared to those enrolled in pivotal trials in terms of concomitant diseases and used medications, is broader. Trial registration: EudraCT 2011-000770-60.

Published
2016

20. Upper limb motor rehabilitation impacts white matter microstructure in multiple sclerosis

Author

Adriano Dessypris, Luca Roccatagliata, Marco Bove, Laura Bonzano, Giovanni Luigi Mancardi, Maria Laura Lopes de Carvalho, Mario Alberto Battaglia, Andrea Tacchino, Paola Feraco, Giampaolo Brichetto, Bonzano, Laura, Tacchino, Andrea, Brichetto, Giampaolo, Roccatagliata, Luca, Dessypris, Adriano, Feraco, Paola, Lopes De Carvalho, Maria L., Battaglia, Mario A., Mancardi, Giovanni L., and Bove, Marco

Subjects
Adult, Male, medicine.medical_specialty, Multiple Sclerosis, Cognitive Neuroscience, medicine.medical_treatment, Voluntary movement, Elbow, Pyramidal Tracts, Corpus callosum, Nerve Fibers, Myelinated, Upper Extremity, White matter, Physical medicine and rehabilitation, Motor rehabilitation, Fractional anisotropy, Image Processing, Computer-Assisted, medicine, Humans, Multiple sclerosi, Upper limb, Rehabilitation, Diffusion tensor imaging, Motor rehabilitation, Multiple sclerosis, Upper limb, Voluntary movements, White matter, Multiple sclerosis, Brain, Middle Aged, medicine.disease, Diffusion Tensor Imaging, medicine.anatomical_structure, Neurology, Voluntary movements, Physical therapy, Female, Psychology, Psychomotor Performance, Diffusion MRI
Abstract

Upper limb impairments can occur in patients with multiple sclerosis, affecting daily living activities; however there is at present no definite agreement on the best rehabilitation treatment strategy to pursue. Moreover, motor training has been shown to induce changes in white matter architecture in healthy subjects.This study aimed at evaluating the motor behavioral and white matter microstructural changes following a 2-month upper limb motor rehabilitation treatment based on task-oriented exercises in patients with multiple sclerosis.Thirty patients (18 females and 12 males; age. = 43.3. ±. 8.7. years) in a stable phase of the disease presenting with mild or moderate upper limb sensorimotor deficits were randomized into two groups of 15 patients each. Both groups underwent twenty 1-hour treatment sessions, three times a week. The "treatment group" received an active motor rehabilitation treatment, based on voluntary exercises including task-oriented exercises, while the "control group" underwent passive mobilization of the shoulder, elbow, wrist and fingers.Before and after the rehabilitation protocols, motor performance was evaluated in all patients with standard tests. Additionally, finger motor performance accuracy was assessed by an engineered glove.In the same sessions, every patient underwent diffusion tensor imaging to obtain parametric maps of fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity. The mean value of each parameter was separately calculated within regions of interest including the fiber bundles connecting brain areas involved in voluntary movement control: the corpus callosum, the corticospinal tracts and the superior longitudinal fasciculi.The two rehabilitation protocols induced similar effects on unimanual motor performance, but the bimanual coordination task revealed that the residual coordination abilities were maintained in the treated patients while they significantly worsened in the control group (p. = 0.002). Further, in the treatment group white matter integrity in the corpus callosum and corticospinal tracts was preserved while a microstructural integrity worsening was found in the control group (fractional anisotropy of the corpus callosum and corticospinal tracts: p. = 0.033 and p. = 0.022; radial diffusivity of the corpus callosum and corticospinal tracts: p. = 0.004 and p. = 0.008). Conversely, a significant increase of radial diffusivity was observed in the superior longitudinal fasciculi in both groups (p. = 0.02), indicating lack of treatment effects on this structure, showing damage progression likely due to a demyelination process.All these findings indicate the importance of administering, when possible, a rehabilitation treatment consisting of voluntary movements. We also demonstrated that the beneficial effects of a rehabilitation treatment are task-dependent and selective in their target; this becomes crucial towards the implementation of tailored rehabilitative approaches. © 2013 The Authors.

Published
2014

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