62 results on '"Gajofatto, A."'
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2. Signs and symptoms of COVID-19 in patients with multiple sclerosis
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Schiavetti I., Carmisciano L., Ponzano M., Cordioli C., Cocco E., Marfia G. A., Inglese M., Filippi M., Radaelli M., Bergamaschi R., Immovilli P., Capobianco M., De Rossi N., Brichetto G., Scandellari C., Cavalla P., Pesci I., Confalonieri P., Perini P., Trojano M., Lanzillo R., Tedeschi G., Comi G., Battaglia M. A., Patti F., Salvetti M., Sormani M. P., Abbadessa G., Aguglia U., Allegorico L., Rossi Allegri B. M., Alteno A., Amato M. P., Annovazzi P., Antozzi C., Appendino L., Arena S., Baione V., Balgera R., Barcella V., Baroncini D., Barrila C., Bellacosa A., Bellucci G., Bergamaschi V., Bezzini D., Biolzi B., Bisecco A., Bonavita S., Borriello G., Bosa C., Bosco A., Bovis F., Bozzali M., Brambilla L., Brescia Morra V., Buccafusca M., Bucciantini E., Bucello S., Buscarinu M. C., Cabboi M. P., Calabrese M., Calabria F., Caleri F., Camilli F., Caniatti L. M., Cantello R., Capra R., Capuano R., Carta P., Celani M. G., Cellerino M., Cerqua R., Chisari C., Clerici R., Clerico M., Cola G., Conte A., Conti M. Z., Cordano C., Cordera S., Corea F., Correale C., Cottone S., Crescenzo F., Curti E., d'Ambrosio A., D'Amico E., Danni M. C., d'Arma A., Dattola V., de Biase S., De Luca G., De Mercanti S. F., De Mitri P., De Stefano N., Della Cava F. M., Cava M. D., Di Lemme S., di Napoli M., Di Sapio A., Docimo R., Dutto A., Evangelista L., Fanara S., Fantozzi R., Ferraro D., Ferro M. T., Fioretti C., Fratta M., Frau J., Fronza M., Furlan R., Gajofatto A., Gallo A., Gallo P., Gasperini C., Ghazaryan A., Giometto B., Gobbin F., Govone F., Granella F., Grange E., Grasso M. G., Grimaldi L. M. E., Guareschi A., Guaschino C., Guerrieri S., Guidetti D., Juergenson I. B., Iaffaldano P., Ianniello A., Iasevoli L., Imperiale D., Infante M. T., Iodice R., Iovino A., Konrad G., Landi D., Lapucci C., Lavorgna L., L'Episcopo M. R., Leva S., Liberatore G., Lo Re M., Longoni M., Lopiano L., Lorefice L., Lucchini M., Lus G., Maimone D., Malentacchi M., Mallucci G., Malucchi S., Mancinelli C. R., Mancinelli L., Manganotti P., Maniscalco G. T., Mantero V., Marangoni S., Marastoni D., Marinelli F., Marti A., Boneschi Martinelli F., Masserano Z. F., Matta F., Mendozzi L., Meucci G., Miante S., Miele G., Milano E., Mirabella M., Missione R., Moccia M., Moiola L., Montepietra S., MontiBragadin M., Montini F., Motta R., Nardone R., Gabri Nicoletti C., Nobile-Orazio E., Nozzolillo A., Onofrj M., Orlandi R., Palmieri A., Paolicelli D., Pasquali L., Pasto L., Pedrazzoli E., Petracca M., Petrone A., Piantadosi C., Pietroboni A. M., Pinardi F., Portaccio E., Pozzato M., Pozzilli C., Prosperini L., Protti A., Ragonese P., Rasia S., Realmuto S., Repice A., Rigoni E., Rilla M. T., Rinaldi F., Romano C. M., Ronzoni M., Rovaris M., Ruscica F., Sabattini L., Salemi G., Saraceno L., Sartori A., Sbragia E., Scarano G. I., Scarano V., Sessa M., Sgarito C., Sibilia G., Siciliano G., Signori A., Signoriello E., Sinisi L., Sireci F., Sola P., Solaro C., Sotgiu S., Sparaco M., Stromillo M. L., Strumia S., Susani E. L., Tabiadon G., Teatini F., Tomassini V., Tonietti S., Torri V., Tortorella C., Toscano S., Totaro R., Trotta M., Turano G., Ulivelli M., Valentino M., Vaula G., Vecchio D., Vercellino M., Verrengia E. P., Vianello M., Virgilio E., Vitetta F., Vollaro S., Zaffaroni M., Zampolini M., Zarbo I. R., Zito A., Zuliani L., Schiavetti, Irene, Carmisciano, Luca, Ponzano, Marta, Cordioli, Cinzia, Cocco, Eleonora, Marfia, Girolama Alessandra, Inglese, Matilde, Filippi, Massimo, Radaelli, Marta, Bergamaschi, Roberto, Immovilli, Paolo, Capobianco, Marco, De Rossi, Nicola, Brichetto, Giampaolo, Scandellari, Cinzia, Cavalla, Paola, Pesci, Ilaria, Confalonieri, Paolo, Perini, Paola, Trojano, Maria, Lanzillo, Roberta, Tedeschi, Gioacchino, Comi, Giancarlo, Battaglia, Mario Alberto, Patti, Francesco, Salvetti, Marco, Sormani, Maria Pia, Gianmarco, Abbadessa, Umberto, Aguglia, Allegorico, Lia, Beatrice Maria Rossi Allegri, Anastasia, Alteno, Amato, MARIA PIA, Pietro, Annovazzi, Carlo, Antozzi, Lucia, Appendino, Sebastiano, Arena, Viola, Baione, Roberto, Balgera, Valeria, Barcella, Damiano, Baroncini, Caterina, Barrilà, Alessandra, Bellacosa, Gianmarco, Bellucci, Valeria, Bergamaschi, Daiana, Bezzini, Beatrice, Biolzi, Bisecco, Alvino, Simona, Bonavita, Giovanna, Borriello, Chiara, Bosa, Antonio, Bosco, Francesca, Bovi, Marco, Bozzali, Laura, Brambilla, BRESCIA MORRA, Vincenzo, Maria, Buccafusca, Elisabetta, Bucciantini, Sebastiano, Bucello, Maria Chiara Buscarinu, Maria Paola Cabboi, Massimiliano, Calabrese, Francesca, Calabria, Francesca, Caleri, Federico, Camilli, Luisa Maria Caniatti, Roberto, Cantello, Ruggero, Capra, Rocco, Capuano, Patrizia, Carta, Maria Grazia Celani, Maria, Cellerino, Raffaella, Cerqua, Clara, Chisari, Raffaella, Clerici, Marinella, Clerico, Gaia, Cola, Antonella, Conte, Marta Zaffira Conti, Christian, Cordano, Susanna, Cordera, Francesco, Corea, Claudio, Correale, Salvatore, Cottone, Francesco, Crescenzo, Erica, Curti, Alessandro, D’Ambrosio, Emanuele, D’Amico, Maura Chiara Danni, Alessia, D’Arma, Vincenzo, Dattola, Stefano de Biase, Giovanna De Luca, Stefania Federica De Mercanti, Paolo De Mitri, Nicola De Stefano, Fabio Maria Della Cava, Marco Della Cava, Sonia Di Lemme, Mario di Napoli, Alessia Di Sapio, Renato, Docimo, Anna, Dutto, Luana, Evangelista, Salvatore, Fanara, Roberta, Fantozzi, Diana, Ferraro, Maria Teresa Ferrò, Cristina, Fioretti, Mario, Fratta, Jessica, Frau, Marzia, Fronza, Roberto, Furlan, Alberto, Gajofatto, Gallo, Antonio, Paolo, Gallo, Claudio, Gasperini, Anna, Ghazaryan, Bruno, Giometto, Francesca, Gobbin, Flora, Govone, Franco, Granella, Erica, Grange, Grasso, MARIA GRAZIA, Grimaldi, Luigi M. E., Angelica, Guareschi, Clara, Guaschino, Simone, Guerrieri, Donata, Guidetti, Ina Barbara Juergenson, Pietro, Iaffaldano, Ianniello, Antonio, Luigi, Iasevoli, Daniele, Imperiale, Maria Teresa Infante, Iodice, Rosa, Iovino, Aniello, Giovanna, Konrad, Doriana, Landi, Caterina, Lapucci, Luigi, Lavorgna, Maria Rita L’Episcopo, Serena, Leva, Giuseppe, Liberatore, Marianna Lo Re, Marco, Longoni, Leonardo, Lopiano, Lorena, Lorefice, Matteo, Lucchini, Lus, Giacomo, Maimone, Davide, Maria, Malentacchi, Giulia, Mallucci, Simona, Malucchi, Chiara Rosa Mancinelli, Luca, Mancinelli, Paolo, Manganotti, Giorgia Teresa Maniscalco, Vittorio, Mantero, Sabrina, Marangoni, Damiano, Marastoni, Fabiana, Marinelli, Marti, NICOLA ALESSANDRO, Filippo Boneschi Martinelli, Zoli Federco Masserano, Francesca, Matta, Laura, Mendozzi, Giuseppe, Meucci, Silvia, Miante, Giuseppina, Miele, Eva, Milano, Massimiliano, Mirabella, Rosanna, Missione, Moccia, Marcello, Lucia, Moiola, Sara, Montepietra, Margherita, Montibragadin, Federico, Montini, Roberta, Motta, Raffaele, Nardone, Carolina Gabri Nicoletti, Eduardo, Nobile‐orazio, Nozzolillo, Agostino, Marco, Onofrj, Riccardo, Orlandi, Anna, Palmieri, Damiano, Paolicelli, Livia, Pasquali, Luisa, Pastò, Elisabetta, Pedrazzoli, Petracca, Maria, Alfredo, Petrone, Carlo, Piantadosi, Pietroboni, Anna M., Federica, Pinardi, Emilio, Portaccio, Mattia, Pozzato, Pozzilli, Carlo, Luca, Prosperini, Alessandra, Protti, Paolo, Ragonese, Sarah, Rasia, Sabrina, Realmuto, Anna, Repice, Eleonora, Rigoni, Maria Teresa Rilla, DELLA RATTA RINALDI, Francesca, Calogero Marcello Romano, Marco, Ronzoni, Marco, Rovari, Francesca, Ruscica, Loredana, Sabattini, Giuseppe, Salemi, Lorenzo, Saraceno, Alessia, Sartori, Arianna, Sartori, Elvira, Sbragia, Giuditta Ilaria Scarano, Valentina, Scarano, Maria, Sessa, Caterina, Sgarito, Sibilia, Grazia, Gabriele, Siciliano, Alessio, Signori, Signoriello, Elisabetta, Sinisi, Leonardo, Francesca, Sireci, Patrizia, Sola, Claudio, Solaro, Stefano, Sotgiu, Maddalena, Sparaco, Maria Laura Stromillo, Silvia, Strumia, Emanuela Laura Susani, Giulietta, Tabiadon, Francesco, Teatini, Valentina, Tomassini, Simone, Tonietti, Valentina, Torri, Tortorella, Carla, Simona, Toscano, Rocco, Totaro, Maria, Trotta, Gabriella, Turano, Monica, Ulivelli, Manzo, Valentino, Giovanna, Vaula, Domizia, Vecchio, Marco, Vercellino, Elena Pinuccia Verrengia, Marika, Vianello, Eleonora, Virgilio, Francesca, Vitetta, Vollaro, Stefano, Mauro, Zaffaroni, Mauro, Zampolini, Ignazio Roberto Zarbo, Antonio, Zito, and Luigi Zuliani, Schiavetti, I., Carmisciano, L., Ponzano, M., Cordioli, C., Cocco, E., Marfia, G. A., Inglese, M., Filippi, M., Radaelli, M., Bergamaschi, R., Immovilli, P., Capobianco, M., De Rossi, N., Brichetto, G., Scandellari, C., Cavalla, P., Pesci, I., Confalonieri, P., Perini, P., Trojano, M., Lanzillo, R., Tedeschi, G., Comi, G., Battaglia, M. A., Patti, F., Salvetti, M., Sormani, M. P., Abbadessa, G., Aguglia, U., Allegorico, L., Rossi Allegri, B. M., Alteno, A., Amato, M. P., Annovazzi, P., Antozzi, C., Appendino, L., Arena, S., Baione, V., Balgera, R., Barcella, V., Baroncini, D., Barrila, C., Bellacosa, A., Bellucci, G., Bergamaschi, V., Bezzini, D., Biolzi, B., Bisecco, A., Bonavita, S., Borriello, G., Bosa, C., Bosco, A., Bovis, F., Bozzali, M., Brambilla, L., Brescia Morra, V., Buccafusca, M., Bucciantini, E., Bucello, S., Buscarinu, M. C., Cabboi, M. P., Calabrese, M., Calabria, F., Caleri, F., Camilli, F., Caniatti, L. M., Cantello, R., Capra, R., Capuano, R., Carta, P., Celani, M. G., Cellerino, M., Cerqua, R., Chisari, C., Clerici, R., Clerico, M., Cola, G., Conte, A., Conti, M. Z., Cordano, C., Cordera, S., Corea, F., Correale, C., Cottone, S., Crescenzo, F., Curti, E., D'Ambrosio, A., D'Amico, E., Danni, M. C., D'Arma, A., Dattola, V., de Biase, S., De Luca, G., De Mercanti, S. F., De Mitri, P., De Stefano, N., Della Cava, F. M., Cava, M. D., Di Lemme, S., di Napoli, M., Di Sapio, A., Docimo, R., Dutto, A., Evangelista, L., Fanara, S., Fantozzi, R., Ferraro, D., Ferro, M. T., Fioretti, C., Fratta, M., Frau, J., Fronza, M., Furlan, R., Gajofatto, A., Gallo, A., Gallo, P., Gasperini, C., Ghazaryan, A., Giometto, B., Gobbin, F., Govone, F., Granella, F., Grange, E., Grasso, M. G., Grimaldi, L. M. E., Guareschi, A., Guaschino, C., Guerrieri, S., Guidetti, D., Juergenson, I. B., Iaffaldano, P., Ianniello, A., Iasevoli, L., Imperiale, D., Infante, M. T., Iodice, R., Iovino, A., Konrad, G., Landi, D., Lapucci, C., Lavorgna, L., L'Episcopo, M. R., Leva, S., Liberatore, G., Lo Re, M., Longoni, M., Lopiano, L., Lorefice, L., Lucchini, M., Lus, G., Maimone, D., Malentacchi, M., Mallucci, G., Malucchi, S., Mancinelli, C. R., Mancinelli, L., Manganotti, P., Maniscalco, G. T., Mantero, V., Marangoni, S., Marastoni, D., Marinelli, F., Marti, A., Boneschi Martinelli, F., Masserano, Z. F., Matta, F., Mendozzi, L., Meucci, G., Miante, S., Miele, G., Milano, E., Mirabella, M., Missione, R., Moccia, M., Moiola, L., Montepietra, S., Montibragadin, M., Montini, F., Motta, R., Nardone, R., Gabri Nicoletti, C., Nobile-Orazio, E., Nozzolillo, A., Onofrj, M., Orlandi, R., Palmieri, A., Paolicelli, D., Pasquali, L., Pasto, L., Pedrazzoli, E., Petracca, M., Petrone, A., Piantadosi, C., Pietroboni, A. M., Pinardi, F., Portaccio, E., Pozzato, M., Pozzilli, C., Prosperini, L., Protti, A., Ragonese, P., Rasia, S., Realmuto, S., Repice, A., Rigoni, E., Rilla, M. T., Rinaldi, F., Romano, C. M., Ronzoni, M., Rovaris, M., Ruscica, F., Sabattini, L., Salemi, G., Saraceno, L., Sartori, A., Sbragia, E., Scarano, G. I., Scarano, V., Sessa, M., Sgarito, C., Sibilia, G., Siciliano, G., Signori, A., Signoriello, E., Sinisi, L., Sireci, F., Sola, P., Solaro, C., Sotgiu, S., Sparaco, M., Stromillo, M. L., Strumia, S., Susani, E. L., Tabiadon, G., Teatini, F., Tomassini, V., Tonietti, S., Torri, V., Tortorella, C., Toscano, S., Totaro, R., Trotta, M., Turano, G., Ulivelli, M., Valentino, M., Vaula, G., Vecchio, D., Vercellino, M., Verrengia, E. P., Vianello, M., Virgilio, E., Vitetta, F., Vollaro, S., Zaffaroni, M., Zampolini, M., Zarbo, I. R., Zito, A., and Zuliani, L.
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Multiple Sclerosis ,Anosmia ,Clinical Sciences ,neurological disorders ,Neurodegenerative ,Settore MED/26 ,demyelinating disease ,COVID-19 ,demyelinating diseases ,disease-modifying treatment ,multiple sclerosis ,Humans ,neurological disorder ,Aged ,Neurology & Neurosurgery ,SARS-CoV-2 ,Pain Research ,Neurosciences ,Brain Disorders ,Settore MED/26 - NEUROLOGIA ,Good Health and Well Being ,Neurology ,multiple sclerosi ,Neurology (clinical) ,MuSC-19 Study Group ,Ageusia ,Human - Abstract
Background and purpose: Clinical outcomes of multiple sclerosis (MS) patients affected by coronavirus disease 2019 (COVID-19) have been thoroughly investigated, but a further analysis on main signs and symptoms and their risk factors still needs attention. The objective of this study was to group together and describe based on similarity the most common signs and symptoms of COVID-19 in MS patients and identify all factors associated with their manifestation. Method: Logistic and linear regression models were run to recognize factors associated with each pooled group of symptoms and their total number. Results: From March 2020 to November 2021, data were collected from 1354 MS patients with confirmed infection of COVID-19. Ageusia and anosmia was less frequent in older people (odds ratio [OR] 0.98; p=0.005) and more in smoker patients (OR 1.39; p=0.049). Smoke was also associated with an incremental number of symptoms (OR 1.24; p=0.031), substance abuse (drugs or alcohol), conjunctivitis and rash (OR 5.20; p=0.042) and the presence of at least one comorbidity with shortness of breath, tachycardia or chest pain (OR 1.24; p=0.008). Some disease-modifying therapies were associated with greater frequencies of certain COVID-19 symptoms (association between anti-CD20 therapies and increment in the number of concomitant symptoms: OR 1.29; p=0.05). Differences in frequencies between the three waves were found for flu-like symptoms (G1, p=0.024), joint or muscle pain (G2, p=0.013) and ageusia and anosmia (G5, p < 0.001). All cases should be referred to variants up to Delta. Conclusion: Several factors along with the choice of specific therapeutic approaches might have a different impact on the occurrence of some COVID-19 symptoms.
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- 2022
3. Management of hepatitis B virus prophylaxis in patients treated with disease-modifying therapies for multiple sclerosis: a multicentric Italian retrospective study
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Antonio Riccardo, Buonomo, Giulio, Viceconte, Massimiliano, Calabrese, Giovanna, De Luca, Valentina, Tomassini, Paola, Cavalla, Giorgia Teresa, Maniscalco, Diana, Ferraro, Viviana, Nociti, Marta, Radaelli, Maria Chiara, Buscarinu, Damiano, Paolicelli, Alberto, Gajofatto, Pietro, Annovazzi, Federica, Pinardi, Massimiliano, Di Filippo, Cinzia, Cordioli, Emanuela, Zappulo, Riccardo, Scotto, Ivan, Gentile, Antonio Luca, Spiezia, Martina, Petruzzo, Marcello, De Angelis, Vincenzo, Brescia Morra, Claudio, Solaro, Claudio, Gasperini, Eleonora, Cocco, Marcello, Moccia, Roberta, Lanzillo, Buonomo, ANTONIO RICCARDO, Viceconte, Giulio, Calabrese, Massimiliano, De Luca, Giovanna, Tomassini, Valentina, Cavalla, Paola, Maniscalco Giorgia, Teresa, Ferraro, Diana, Nociti, Viviana, Radaelli, Marta, Buscarinu Maria, Chiara, Paolicelli, Damiano, Gajofatto, Alberto, Annovazzi, Pietro, Pinardi, Federica, Di Filippo, Massimiliano, Cordioli, Cinzia, Zappulo, Emanuela, Scotto, Riccardo, Gentile, Ivan, Spiezia, Antonio, Petruzzo, Martina, DE ANGELIS, Marcello, BRESCIA MORRA, Vincenzo, Solaro, Claudio, Gasperini, Claudio, Cocco, Eleonora, Moccia, Marcello, and Lanzillo, Roberta
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Hepatitis B virus ,Multiple Sclerosis ,Vaccination ,Middle Aged ,Hepatitis B ,Antiviral Agents ,Neurology ,DNA, Viral ,Cladribine ,Humans ,Virus Activation ,Ocrelizumab ,Neurology (clinical) ,Rituximab ,Retrospective Studies - Abstract
Background Patients with multiple sclerosis (MS) often receive disease-modifying therapies (DMTs) that can expose them to reactivation of potential occult hepatitis B virus (HBV) infection (pOBI). We aimed to evaluate the MS Centers behavior regarding HBV screening and prophylaxis in a large cohort of MS patients receiving anti-CD20 or cladribine. Methods Retrospective, multicentric study recruiting Italian MS patients treated with rituximab, ocrelizumab and cladribine. Results We included 931 MS patients from 15 centers. All but 38 patients performed a complete HBV screening. Patients’ age > 50 years was significantly associated with no history of vaccination and HBsAb titres p p = 0.5), pre-or post-therapy vaccination (p = 0.2) and number of previous DMTs (p = 0.2). Among pOBI patients (n = 53), 21 received antiviral prophylaxis, while only 13 had HBV DNA monitoring and 19 patients neither monitored HBV DNA nor received prophylaxis. Conclusions Baseline HBV screening in patients receiving anti-CD20 and cladribine is a consolidated practice. Nonetheless, HBV vaccination coverage is still lacking in such population and age is a significant factor associated with low HBV protection. Rituximab, ocrelizumab and cladribine did not impair HBV vaccine response. Almost 35% of pOBI patients fail to receive HBVr prevention. Management of HBV prophylaxis could be improved in MS patients and further prospective studies are needed to assess the effectiveness of prophylactic strategies in such patients.
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- 2022
4. The effect of air pollution on COVID‐19 severity in a sample of patients with multiple sclerosis
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Bergamaschi, Roberto, Ponzano, Marta, Schiavetti, Irene, Carmisciano, Luca, Cordioli, Cinzia, Filippi, Massimo, Radaelli, Marta, Immovilli, Paolo, Capobianco, Marco, De Rossi, Nicola, Brichetto, Giampaolo, Cocco, Eleonora, Scandellari, Cinzia, Cavalla, Paola, Pesci, Ilaria, Zito, Antonio, Confalonieri, Paolo, Marfia, Girolama Alessandra, Perini, Paola, Inglese, Matilde, Trojano, Maria, Brescia Morra, Vincenzo, Pisoni, Enrico, Tedeschi, Gioacchino, Comi, Giancarlo, Battaglia, Mario Alberto, Patti, Francesco, Salvetti, Marco, Sormani, Maria Pia, Gianmarco Abbadessa, Umberto Aguglia, Lia Allegorico, Rossi Beatrice Maria Allegri, Anastasia Alteno, Maria Pia Amato, Pietro Annovazzi, Carlo Antozzi, Lucia Appendino, Sebastiano Arena, Viola Baione, Roberto Balgera, Valeria Barcella, Damiano Baroncini, Caterina Barrilà, Mario A Battaglia, Alessandra Bellacosa, Gianmarco Bellucci, Roberto Bergamaschi, Valeria Bergamaschi, Daiana Bezzini, Beatrice Biolzi, Alvino Bisecco, Simona Bonavita, Giovanna Borriello, Chiara Bosa, Antonio Bosco, Francesca Bovis, Marco Bozzali, Laura Brambilla, Morra Vincenzo Brescia, Giampaolo Brichetto, Maria Buccafusca, Elisabetta Bucciantini, Sebastiano Bucello, Maria Chiara Buscarinu, Maria Paola Cabboi, Massimiliano Calabrese, Francesca Calabria, Francesca Caleri, Federico Camilli, Luisa Maria Caniatti, Roberto Cantello, Marco Capobianco, Ruggero Capra, Rocco Capuano, Luca Carmisciano, Patrizia Carta, Paola Cavalla, Maria Grazia Celani, Maria Cellerino, Raffaella Cerqua, Clara Chisari, Raffaella Clerici, Marinella Clerico, Eleonora Cocco, Gaia Cola, Giancarlo Comi, Paolo Confalonieri, Antonella Conte, Marta Zaffira Conti, Christian Cordano, Susanna Cordera, Cinzia Cordioli, Francesco Corea, Claudio Correale, Salvatore Cottone, Francesco Crescenzo, Erica Curti, Alessandro d'Ambrosio, Emanuele D'Amico, Maura Chiara Danni, Alessia d'Arma, Vincenzo Dattola, Stefano de Biase, Giovanna De Luca, Stefania Federica De Mercanti, Paolo De Mitri, Nicola De Rossi, Nicola De Stefano, Cava Marco Della, Mario di Napoli, Alessia Di Sapio, Renato Docimo, Anna Dutto, Luana Evangelista, Salvatore Fanara, Diana Ferraro, Maria Teresa Ferrò, Massimo Filippi, Cristina Fioretti, Mario Fratta, Jessica Frau, Marzia Fronza, Roberto Furlan, Alberto Gajofatto, Antonio Gallo, Paolo Gallo, Claudio Gasperini, Anna Ghazaryan, Bruno Giometto, Francesca Gobbin, Flora Govone, Franco Granella, Erica Grange, Maria Grazia Grasso, Angelica Guareschi, Clara Guaschino, Simone Guerrieri, Donata Guidetti, Pietro Iaffaldano, Antonio Ianniello, Luigi Iasevoli, Paolo Immovilli, Daniele Imperiale, Maria Teresa Infante, Matilde Inglese, Rosa Iodice, Aniello Iovino, Giovanna Konrad, Doriana Landi, Roberta Lanzillo, Caterina Lapucci, Luigi Lavorgna, Maria Rita L'Episcopo, Serena Leva, Giuseppe Liberatore, Re Marianna Lo, Marco Longoni, Leonardo Lopiano, Lorena Lorefice, Matteo Lucchini, Giacomo Lus, Davide Maimone, Maria Malentacchi, Giulia Mallucci, Simona Malucchi, Chiara Rosa Mancinelli, Luca Mancinelli, Paolo Manganotti, Giorgia Teresa Maniscalco, Vittorio Mantero, Sabrina Marangoni, Damiano Marastoni, Girolama Alessandra Marfia, Fabiana Marinelli, Alessandro Marti, Boneschi Filippo Martinelli, Zoli Federco Masserano, Francesca Matta, Laura Mendozzi, Giuseppe Meucci, Silvia Miante, Giuseppina Miele, Eva Milano, Massimiliano Mirabella, Rosanna Missione, Marcello Moccia, Lucia Moiola, Sara Montepietra, Margherita MontiBragadin, Federico Montini, Roberta Motta, Raffaele Nardone, Carolina Gabri Nicoletti, Eduardo Nobile-Orazio, Agostino Nozzolillo, Marco Onofrj, Riccardo Orlandi, Anna Palmieri, Damiano Paolicelli, Livia Pasquali, Luisa Pastò, Francesco Patti, Elisabetta Pedrazzoli, Paola Perini, Ilaria Pesci, Maria Petracca, Alfredo Petrone, Carlo Piantadosi, Anna M Pietroboni, Federica Pinardi, Marta Ponzano, Emilio Portaccio, Mattia Pozzato, Carlo Pozzilli, Luca Prosperini, Alessandra Protti, Marta Radaelli, Paolo Ragonese, Sarah Rasia, Sabrina Realmuto, Anna Repice, Eleonora Rigoni, Maria Teresa Rilla, Francesca Rinaldi, Calogero Marcello Romano, Marco Ronzoni, Marco Rovaris, Francesca Ruscica, Loredana Sabattini, Giuseppe Salemi, Marco Salvetti, Lorenzo Saraceno, Alessia Sartori, Arianna Sartori, Elvira Sbragia, Cinzia Scandellari, Giuditta Ilaria Scarano, Valentina Scarano, Irene Schiavetti, Maria Sessa, Caterina Sgarito, Grazia Sibilia, Gabriele Siciliano, Alessio Signori, Elisabetta Signoriello, Leonardo Sinisi, Francesca Sireci, Patrizia Sola, Claudio Solaro, Maria Pia Sormani, Stefano Sotgiu, Maddalena Sparaco, Maria Laura Stromillo, Silvia Strumia, Emanuela Laura Susani, Giulietta Tabiadon, Francesco Teatini, Gioacchino Tedeschi, Valentina Tomassini, Simone Tonietti, Clerici Valentina Torri, Carla Tortorella, Simona Toscano, Rocco Totaro, Maria Trojano, Maria Trotta, Gabriella Turano, Monica Ulivelli, Manzo Valentino, Giovanna Vaula, Domizia Vecchio, Marco Vercellino, Elena Pinuccia Verrengia, Marika Vianello, Eleonora Virgilio, Francesca Vitetta, Stefano Vollaro, Mauro Zaffaroni, Mauro Zampolini, Ignazio Roberto Zarbo, Antonio Zito, Luigi Zuliani, Bergamaschi, R, Ponzano, M, Schiavetti, I, Carmisciano, L, Cordioli, C, Filippi, M, Radaelli, M, Immovilli, P, Capobianco, M, De Rossi, N, Brichetto, G, Cocco, E, Scandellari, C, Cavalla, P, Pesci, I, Zito, A, Confalonieri, P, Marfia, Ga, Perini, P, Inglese, M, Trojano, M, Brescia Morra, V, Pisoni, E, Tedeschi, G, Comi, G, Battaglia, Ma, Patti, F, Salvetti, M, Sormani, Mp, Abbadessa, Gianmarco, Umberto, Aguglia, Lia, Allegorico, Rossi Beatrice Maria Allegri, Anastasia, Alteno, Maria Pia Amato, Pietro, Annovazzi, Carlo, Antozzi, Lucia, Appendino, Sebastiano, Arena, Viola, Baione, Roberto, Balgera, Valeria, Barcella, Damiano, Baroncini, Caterina, Barrilà, Mario, A Battaglia, Alessandra, Bellacosa, Gianmarco, Bellucci, Roberto, Bergamaschi, Valeria, Bergamaschi, Daiana, Bezzini, Beatrice, Biolzi, Bisecco, Alvino, Bonavita, Simona, Giovanna, Borriello, Chiara, Bosa, Bosco, Antonio, Francesca, Bovi, Marco, Bozzali, Laura, Brambilla, Morra Vincenzo Brescia, Giampaolo, Brichetto, Maria, Buccafusca, Elisabetta, Bucciantini, Sebastiano, Bucello, Maria Chiara Buscarinu, Maria Paola Cabboi, Massimiliano, Calabrese, Francesca, Calabria, Francesca, Caleri, Federico, Camilli, Luisa Maria Caniatti, Roberto, Cantello, Marco, Capobianco, Ruggero, Capra, Capuano, Rocco, Luca, Carmisciano, Patrizia, Carta, Paola, Cavalla, Maria Grazia Celani, Maria, Cellerino, Raffaella, Cerqua, Clara, Chisari, Raffaella, Clerici, Marinella, Clerico, Eleonora, Cocco, Gaia, Cola, Giancarlo, Comi, Paolo, Confalonieri, Antonella, Conte, Marta Zaffira Conti, Christian, Cordano, Susanna, Cordera, Cinzia, Cordioli, Corea, Francesco, Claudio, Correale, Salvatore, Cottone, Francesco, Crescenzo, Erica, Curti, Alessandro, D'Ambrosio, Emanuele, D'Amico, Maura Chiara Danni, Alessia, D'Arma, Vincenzo, Dattola, Stefano de Biase, Giovanna De Luca, Stefania Federica De Mercanti, Paolo De Mitri, Nicola De Rossi, Nicola De Stefano, Cava Marco Della, Mario di Napoli, Alessia Di Sapio, Docimo, Renato, Anna, Dutto, Luana, Evangelista, Salvatore, Fanara, Diana, Ferraro, Maria Teresa Ferrò, Massimo, Filippi, Cristina, Fioretti, Fratta, Mario, Jessica, Frau, Marzia, Fronza, Roberto, Furlan, Alberto, Gajofatto, Gallo, Antonio, Paolo, Gallo, Claudio, Gasperini, Anna, Ghazaryan, Bruno, Giometto, Francesca, Gobbin, Flora, Govone, Franco, Granella, Erica, Grange, Maria Grazia Grasso, Angelica, Guareschi, Clara, Guaschino, Simone, Guerrieri, Donata, Guidetti, Pietro, Iaffaldano, Antonio, Ianniello, Luigi, Iasevoli, Paolo, Immovilli, Daniele, Imperiale, Maria Teresa Infante, Matilde, Inglese, Rosa, Iodice, Aniello, Iovino, Giovanna, Konrad, Doriana, Landi, Roberta, Lanzillo, Caterina, Lapucci, Luigi, Lavorgna, Maria Rita L'Episcopo, Serena, Leva, Giuseppe, Liberatore, Re Marianna Lo, Marco, Longoni, Leonardo, Lopiano, Lorena, Lorefice, Matteo, Lucchini, Lus, Giacomo, Davide, Maimone, Maria, Malentacchi, Giulia, Mallucci, Simona, Malucchi, Chiara Rosa Mancinelli, Luca, Mancinelli, Paolo, Manganotti, Giorgia Teresa Maniscalco, Vittorio, Mantero, Sabrina, Marangoni, Damiano, Marastoni, Girolama Alessandra Marfia, Fabiana, Marinelli, Alessandro, Marti, Boneschi Filippo Martinelli, Zoli Federco Masserano, Francesca, Matta, Laura, Mendozzi, Giuseppe, Meucci, Silvia, Miante, Miele, Giuseppina, Eva, Milano, Massimiliano, Mirabella, Missione, Rosanna, Marcello, Moccia, Lucia, Moiola, Sara, Montepietra, Margherita, Montibragadin, Federico, Montini, Roberta, Motta, Raffaele, Nardone, Carolina Gabri Nicoletti, Eduardo, Nobile-Orazio, Agostino, Nozzolillo, Marco, Onofrj, Riccardo, Orlandi, Palmieri, Anna, Damiano, Paolicelli, Livia, Pasquali, Luisa, Pastò, Francesco, Patti, Elisabetta, Pedrazzoli, Paola, Perini, Ilaria, Pesci, Maria, Petracca, Alfredo, Petrone, Carlo, Piantadosi, Anna, M Pietroboni, Federica, Pinardi, Marta, Ponzano, Emilio, Portaccio, Mattia, Pozzato, Carlo, Pozzilli, Luca, Prosperini, Alessandra, Protti, Marta, Radaelli, Paolo, Ragonese, Sarah, Rasia, Sabrina, Realmuto, Anna, Repice, Eleonora, Rigoni, Maria Teresa Rilla, Francesca, Rinaldi, Calogero Marcello Romano, Marco, Ronzoni, Marco, Rovari, Francesca, Ruscica, Loredana, Sabattini, Giuseppe, Salemi, Marco, Salvetti, Lorenzo, Saraceno, Alessia, Sartori, Arianna, Sartori, Elvira, Sbragia, Cinzia, Scandellari, Giuditta Ilaria Scarano, Valentina, Scarano, Irene, Schiavetti, Maria, Sessa, Caterina, Sgarito, Grazia, Sibilia, Gabriele, Siciliano, Alessio, Signori, Signoriello, Elisabetta, Leonardo, Sinisi, Francesca, Sireci, Patrizia, Sola, Claudio, Solaro, Maria Pia Sormani, Stefano, Sotgiu, Sparaco, Maddalena, Maria Laura Stromillo, Silvia, Strumia, Emanuela Laura Susani, Giulietta, Tabiadon, Francesco, Teatini, Tedeschi, Gioacchino, Valentina, Tomassini, Simone, Tonietti, Clerici Valentina Torri, Carla, Tortorella, Simona, Toscano, Rocco, Totaro, Maria, Trojano, Trotta, Maria Consiglia, Gabriella, Turano, Monica, Ulivelli, Manzo, Valentino, Giovanna, Vaula, Domizia, Vecchio, Marco, Vercellino, Elena Pinuccia Verrengia, Marika, Vianello, Eleonora, Virgilio, Francesca, Vitetta, Stefano, Vollaro, Mauro, Zaffaroni, Mauro, Zampolini, Ignazio Roberto Zarbo, Zito, Guido Antonio, Bergamaschi, R., Ponzano, M., Schiavetti, I., Carmisciano, L., Cordioli, C., Filippi, M., Radaelli, M., Immovilli, P., Capobianco, M., De Rossi, N., Brichetto, G., Cocco, E., Scandellari, C., Cavalla, P., Pesci, I., Zito, A., Confalonieri, P., Marfia, G. A., Perini, P., Inglese, M., Trojano, M., Brescia Morra, V., Pisoni, E., Tedeschi, G., Comi, G., Battaglia, M. A., Patti, F., Salvetti, M., Sormani, M. P., Bergamaschi, Roberto, Ponzano, Marta, Schiavetti, Irene, Carmisciano, Luca, Cordioli, Cinzia, Filippi, Massimo, Radaelli, Marta, Immovilli, Paolo, Capobianco, Marco, De Rossi, Nicola, Brichetto, Giampaolo, Cocco, Eleonora, Scandellari, Cinzia, Cavalla, Paola, Pesci, Ilaria, Zito, Antonio, Confalonieri, Paolo, Marfia, Girolama Alessandra, Perini, Paola, Inglese, Matilde, Trojano, Maria, Brescia Morra, Vincenzo, Pisoni, Enrico, Comi, Giancarlo, Battaglia, Mario Alberto, Patti, Francesco, Salvetti, Marco, Sormani, Maria, Pia, Gianmarco, Abbadessa, Alvino, Bisecco, Simona, Bonavita, Antonio, Bosco, Rocco, Capuano, Francesco, Corea, Renato, Docimo, Mario, Fratta, Antonio, Gallo, Iodice, Rosa, Iovino, Aniello, Lanzillo, Roberta, Giacomo, Lu, Giuseppina, Miele, Rosanna, Missione, Moccia, Marcello, Anna, Palmieri, Elisabetta, Signoriello, Maddalena, Sparaco, Gioacchino, Tedeschi, Maria, Trotta, Antonio, Zito, and Luigi, Zuliani
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air pollution ,coronavirus ,multiple sclerosis ,medicine.medical_specialty ,Multivariate analysis ,Coronavirus disease 2019 (COVID-19) ,Clinical Sciences ,Air pollution ,Sample (statistics) ,Neurodegenerative ,Settore MED/26 ,medicine.disease_cause ,Autoimmune Disease ,law.invention ,Sustainable Cities and Communities ,Clinical Research ,law ,Humans ,Medicine ,Climate-Related Exposures and Conditions ,Neurology & Neurosurgery ,MuSC-19 study group ,SARS-CoV-2 ,business.industry ,Multiple sclerosis ,Neurosciences ,COVID-19 ,Retrospective cohort study ,Original Articles ,medicine.disease ,Intensive care unit ,Particulate Matter ,Air Pollution ,Multiple Sclerosis ,Brain Disorders ,coronaviru ,Settore MED/26 - NEUROLOGIA ,Good Health and Well Being ,Neurology ,multiple sclerosi ,Emergency medicine ,Original Article ,Neurology (clinical) ,Ordered logit ,business ,Human - Abstract
Background and purpose Some studies have shown that air pollution, often assessed by thin particulate matter with diameter below 2.5 µg/m3 (PM2.5), may contribute to severe COVID‐19 courses, as well as play a role in the onset and evolution of multiple sclerosis (MS). However, the impact of air pollution on COVID‐19 has never been explored specifically amongst patients with MS (PwMS). This retrospective observational study aims to explore associations between PM2.5 and COVID‐19 severity amongst PwMS. Methods Data were retrieved from an Italian web‐based platform (MuSC‐19) which includes PwMS with COVID‐19. PM2.5 2016–2018 average concentrations were provided by the Copernicus Atmospheric Monitoring Service. Italian patients inserted in the platform from 15 January 2020 to 9 April 2021 with a COVID‐19 positive test were included. Ordered logistic regression models were used to study associations between PM2.5 and COVID‐19 severity. Results In all, 1087 patients, of whom 13% required hospitalization and 2% were admitted to an intensive care unit or died, were included. Based on the multivariate analysis, higher concentrations of PM2.5 increased the risk of worse COVID‐19 course (odds ratio 1.90; p = 0.009). Conclusions Even if several other factors explain the unfavourable course of COVID‐19 in PwMS, the role of air pollutants must be considered and further investigated., Air pollution, often assessed by particulate matter with diameter below 2.5 µg/m3, may contribute to severe COVID‐19 courses. 1087 patients were included, of whom 13% required hospitalization and 2% were admitted to an intensive care unit or died. Even if several other factors explain the unfavourable course of COVID‐19 in patients with multiple sclerosis, the role of air pollutants must be considered and further investigated.
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- 2021
5. Editorial: Bridging the gap between basic neurosciences and clinical neuroimmunology.
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Abbadessa, Gianmarco, Bombaci, Alessandro, Gajofatto, Alberto, and Bonavita, Simona
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CLINICAL neurosciences ,NEUROIMMUNOLOGY ,MONOCYTE lymphocyte ratio ,SCIENTIFIC knowledge ,AUTOIMMUNE diseases ,HEART failure ,PLATELET lymphocyte ratio - Published
- 2023
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6. Defining the course of tumefactive multiple sclerosis: A large retrospective multicentre study
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Lorenzo Gaetani, Doriana Landi, Diana Ferraro, Paolo Ragonese, Alberto Gajofatto, Caterina Di Carmine, Paola Cavalla, Maria Pia Amato, Eleonora Cocco, Roberta Lanzillo, Alessia Manni, Roberta Fantozzi, Claudio Gasperini, D. Farina, Giuseppe Fenu, Sara Zagaglia, Raffaella Cerqua, Claudio Solaro, Antonio Gallo, Carolina Gabri Nicoletti, Pietro Iaffaldano, Federica Pinardi, Valentina Torri Clerici, Isabella Righini, Fabio Buttari, Damiano Paolicelli, Pietro Annovazzi, Carla Tortorella, Rocco Totaro, Giovanna De Luca, Chiara De Fino, Valentina Tomassini, Luca Prosperini, Marcello Moccia, Viviana Nociti, Maria Chiara Buscarinu, Maria Di Gregorio, Massimiliano Di Filippo, Di Gregorio M., Torri Clerici V.L.A., Fenu G., Gaetani L., Gallo A., Cavalla P., Ragonese P., Annovazzi P., Gajofatto A., Prosperini L., Landi D., Nicoletti C.G., Di Carmine C., Totaro R., Nociti V., De Fino C., Ferraro D., Tomassini V., Tortorella C., Righini I., Amato M.P., Manni A., Paolicelli D., Iaffaldano P., Lanzillo R., Moccia M., Buttari F., Fantozzi R., Cerqua R., Zagaglia S., Farina D., De Luca G., Buscarinu M.C., Pinardi F., Cocco E., Gasperini C., Solaro C.M., Di Filippo M., Di Gregorio, M., Torri Clerici, V. L. A., Fenu, G., Gaetani, L., Gallo, A., Cavalla, P., Ragonese, P., Annovazzi, P., Gajofatto, A., Prosperini, L., Landi, D., Nicoletti, C. G., Di Carmine, C., Totaro, R., Nociti, V., De Fino, C., Ferraro, D., Tomassini, V., Tortorella, C., Righini, I., Amato, M. P., Manni, A., Paolicelli, D., Iaffaldano, P., Lanzillo, R., Moccia, M., Buttari, F., Fantozzi, R., Cerqua, R., Zagaglia, S., Farina, D., De Luca, G., Buscarinu, M. C., Pinardi, F., Cocco, E., Gasperini, C., Solaro, C. M., and Di Filippo, M.
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Male ,tumefactive demyelinating lesions (TDLs) ,0302 clinical medicine ,Retrospective Studie ,Interquartile range ,differential diagnosis ,030212 general & internal medicine ,Prospective Studies ,Young adult ,Prospective cohort study ,Child ,treatment ,Tumefactive multiple sclerosi ,Tumefactive demyelinating lesions ,Demyelinating Disease ,Middle Aged ,Magnetic Resonance Imaging ,Differential diagnosis, Multiple sclerosis, Tumefactive demyelinating lesions, Tumefactive multiple sclerosis ,Neurology ,Multiple sclerosis ,Tumefactive multiple sclerosis ,Female ,Human ,Adult ,medicine.medical_specialty ,Multiple Sclerosis ,Adolescent ,differential diagnosi ,Settore MED/26 ,03 medical and health sciences ,Young Adult ,Oligoclonal Band ,Internal medicine ,medicine ,Humans ,Multiple sclerosi ,Tumefactive multiple sclerosis (TuMS) ,Aged ,Retrospective Studies ,Tumefactive demyelinating lesion ,Expanded Disability Status Scale ,business.industry ,Oligoclonal Bands ,Retrospective cohort study ,Odds ratio ,medicine.disease ,Confidence interval ,Prospective Studie ,Demyelinating Diseases ,prognosis ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background and purpose: Tumefactive multiple sclerosis (TuMS) (i.e., MS onset presenting with tumefactive demyelinating lesions [TDLs]) is a diagnostic and therapeutic challenge. We performed a multicentre retrospective study to describe the clinical characteristics and the prognostic factors of TuMS. Methods: One hundred two TuMS patients were included in this retrospective study. Demographic, clinical, magnetic resonance imaging (MRI), laboratory data and treatment choices were collected. Results: TuMS was found to affect women more than men (female:male: 2.4), with a young adulthood onset (median age: 29.5years, range: 11–68 years, interquartile range [IQR]: 38 years). At onset, 52% of TuMS patients presented with the involvement of more than one functional system and 24.5% of them with multiple TDLs. TDLs most frequently presented with an infiltrative MRI pattern (38.7%). Cerebrospinal fluid immunoglobulin G oligoclonal bands were often demonstrated (76.6%). In 25.3% of the cases, more than one acute-phase treatment was administered, and almost one-half of the patients (46.6%) were treated with high-efficacy treatments. After a median follow-up of 2.3years (range: 0.1–10.7 years, IQR: 3.4 years), the median Expanded Disability Status Scale (EDSS) score was 1.5 (range: 0–7, IQR: 2). Independent risk factors for reaching an EDSS score ≥3 were a higher age at onset (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.03–1.14, p 
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- 2021
7. Symptomatic COVID-19 course and outcomes after three mRNA vaccine doses in multiple sclerosis patients treated with high-efficacy DMTs
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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
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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.
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- 2023
8. Dimethyl fumarate vs Teriflunomide: an Italian time-to-event data analysis
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D'Amico E., Zanghi A., Sciandra M., Lanzillo R., Callari G., Cortese A., Lus G., Lucchini M., Buccafusca M., Bonavita S., Gallo A., Curti E., Gajofatto A., Signoriello E., Bisecco A., Gobbin F., Ferro M. T., Ferrazzano G., Sparaco M., Valentino P., Mirabella M., Granella F., Bresciamorra V., Grimaldi L. M. E., Patti F., Borriello G., Grossi P., Carotenuto A., Siena E., Tsantes E., Giugno A., Abbadessa G. M., Chisari C. G., D'Amico, Emanuele, Zanghì, Aurora, Sciandra, Mariangela, Lanzillo, Roberta, Callari, Graziella, Cortese, Antonio, Lus, Giacomo, Lucchini, Matteo, Buccafusca, Maria, Bonavita, Simona, Gallo, Antonio, Curti, Erica, Gajofatto, Alberto, Signoriello, Elisabetta, Bisecco, Alvino, Gobbin, Francesca, Ferrò, Maria Teresa, Ferrazzano, Gina, Sparaco, Maddalena, Valentino, Paola, Mirabella, Massimiliano, Granella, Franco, Brescia Morra, Vincenzo, Grimaldi, Luigi Maria Edoardo, Patti, Francesco, D'Amico, E., Zanghi, A., Sciandra, M., Lanzillo, R., Callari, G., Cortese, A., Lus, G., Lucchini, M., Buccafusca, M., Bonavita, S., Gallo, A., Curti, E., Gajofatto, A., Signoriello, E., Bisecco, A., Gobbin, F., Ferro, M. T., Ferrazzano, G., Sparaco, M., Valentino, P., Mirabella, M., Granella, F., Bresciamorra, V., Grimaldi, L. M. E., Patti, F., Borriello, G., Grossi, P., Carotenuto, A., Siena, E., Tsantes, E., Giugno, A., Abbadessa, G. M., and Chisari, C. G.
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Adult ,Data Analysis ,Male ,medicine.medical_specialty ,Neurology ,Efficacy ,Toluidines ,Dimethyl Fumarate ,Hydroxybutyrates ,Relapsing-Remitting ,Multiple sclerosis ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Multiple Sclerosis, Relapsing-Remitting ,Internal medicine ,Teriflunomide ,Nitriles ,medicine ,Humans ,Multiple sclerosi ,030212 general & internal medicine ,Neuroradiology ,Dimethyl fumarate ,Proportional hazards model ,business.industry ,Safety ,Female ,Italy ,Middle Aged ,Crotonates ,Immunosuppressive Agents ,medicine.disease ,Settore MED/26 - NEUROLOGIA ,Event data ,chemistry ,Cohort ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background: The introduction of oral disease-modifying therapies (DMTs) for relapsing–remitting multiple sclerosis (RRMS) changed algorithms of RRMS treatment. Objectives: To compare the effectiveness of treatment with dimethyl fumarate (DMF) and teriflunomide (TRF) in a large multicentre Italian cohort of RRMS patients. Materials and Methods: Patients with RRMS who received treatment with DMF and TRF between January 1st, 2012 and December 31st, 2018 from twelve MS centers were identified. The events investigated were “time-to-first-relapse”, “time-to-Magnetic-Resonance-Imaging (MRI)-activity” and “time-to-disability-progression”. Results: 1445 patients were enrolled (1039 on DMF, 406 on TRF) and followed for a median of 34months. Patients on TRF were older (43.5 ± 8.6 vs 38.8 ± 9.2years), with a predominance of men and higher level of disability (p < 0.001 for all). Patients on DMF had a higher number of relapses and radiological activity (p 38DMF = 3.83, CI = 1.11 to 13.23, p = 0.033). Both DMTs controlled similarly MRI activity and disability progression. Conclusions: Patients on DMF had higher relapse-free survival time than TRF group after the first 38 months ontherapy.
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- 2020
9. Characteristics and treatment of Multiple Sclerosis-related trigeminal neuralgia: An Italian multi-centre study
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Giorgia Teresa Maniscalco, Cinzia Cordioli, Maria Chiara Buscarinu, Diana Ferraro, Massimiliano Calabrese, Claudio Gasperini, Marcello Moccia, Alberto Gajofatto, Antonio Gallo, Eleonora Cocco, Valentina Camera, Pietro Annovazzi, Roberta Fantozzi, Marta Radaelli, Giovanna De Luca, Valentina Tomassini, Roberta Lanzillo, Claudio Solaro, Lorena Lorefice, Carla Tortorella, Federica Pinardi, Fabio Buttari, Paolo Ragonese, Paola Cavalla, Viviana Nociti, Salvatore Lo Fermo, Laura Boffa, Rirems, Damiano Paolicelli, Massimiliano Di Filippo, Ferraro, D., Annovazzi, P., Moccia, M., Lanzillo, R., De Luca, G., Nociti, V., Fantozzi, R., Paolicelli, D., Ragonese, P., Gajofatto, A., Boffa, L., Cavalla, P., Lo Fermo, S., Buscarinu, M. C., Lorefice, L., Cordioli, C., Calabrese, M., Gallo, A., Pinardi, F., Tortorella, C., Di Filippo, M., Camera, V., Maniscalco, G. T., Radaelli, M., Buttari, F., Tomassini, V., Cocco, E., Gasperini, C., Solaro, C., Ferraro D., Annovazzi P., Moccia M., Lanzillo R., De Luca G., Nociti V., Fantozzi R., Paolicelli D., Ragonese P., Gajofatto A., Boffa L., Cavalla P., Lo Fermo S., Buscarinu M.C., Lorefice L., Cordioli C., Calabrese M., Gallo A., Pinardi F., Tortorella C., Di Filippo M., Camera V., Maniscalco G.T., Radaelli M., Buttari F., Tomassini V., Cocco E., Gasperini C., and Solaro C.
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Pediatrics ,medicine.medical_treatment ,multiple sclerosis ,microvascular decompression surgery ,time factors ,0302 clinical medicine ,Radiofrequency thermocoagulation ,Trigeminal neuralgia ,Multiple Sclerosi ,Outcome Assessment, Health Care ,italy ,middle aged ,pain ,030212 general & internal medicine ,Oxcarbazepine ,humans ,education.field_of_study ,trigeminal neuralgia ,adult ,Disability ,Multiple Sclerosis ,Pain ,radiosurgery ,General Medicine ,Analgesics, Non-Narcotic ,health care ,follow-up studies ,Settore MED/26 - NEUROLOGIA ,aged ,retrospective studies ,female ,Neurology ,disability ,analgesics, non-narcotic ,male ,severity of illness index ,sex factors ,neurosurgical procedures ,outcome assessment, health care ,analgesics ,medicine.drug ,medicine.medical_specialty ,Population ,Microvascular decompression ,03 medical and health sciences ,medicine ,education ,outcome assessment ,business.industry ,Multiple sclerosis ,Carbamazepine ,medicine.disease ,Discontinuation ,non-narcotic ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background The prevalence of trigeminal neuralgia (TN) in Multiple Sclerosis (MS) patients is higher than in the general population and its management can be particularly challenging. Our aim is to describe the characteristics, treatment and prognostic factors of MS-related TN in a retrospective multicentre study. Methods Neurologists members of the RIREMS group (Rising Researchers in MS) enrolled MS patients with a TN diagnosis and filled out a spreadsheet comprising their clinical data. Results Population consisted of 298 patients. First-choice preventive treatments were carbamazepine and oxcarbazepine. A surgical procedure was performed in 81 (30%) patients, most commonly gamma knife stereotactic radiosurgery (37%), followed by microvascular decompression (22%) and radiofrequency thermocoagulation (21%); one third of patients underwent at least two procedures. Surgery was associated with higher disability, male sex and longer interval between MS and TN onset. Patients (77%) who stayed on at least one preventive medication at most recent follow-up, after a mean period of 8 years, had a higher disability compared to the untreated group. Furthermore, patients with higher disability at TN onset were less likely to discontinue their first preventive medication due to pain remission, had bilateral TN more frequently and underwent surgical interventions earlier. Conclusion MS patients with a higher disability at TN onset and with a longer interval between MS and TN onset had differing clinical features and outcomes: pain was more frequently bilateral, surgery was more frequent and anticipated, and preventive medication discontinuation due to pain remission was less common.
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- 2020
10. Harmonization of real-world studies in multiple sclerosis: Retrospective analysis from the rirems group
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Federica Pinardi, Simona Mallucchi, Paolo Ragonese, Eleonora Cocco, Valentina Tomassini, Alice Laroni, Lorena Lorefice, Claudio Solaro, Alberto Gajofatto, Cinzia Cordioli, Viviana Nociti, Maria Chiara Buscarinu, Claudio Gasperini, Marta Radaelli, Antonio Gallo, Luca Prosperini, Massimiliano Di Filippo, Massimiliano Calabrese, Damiano Paolicelli, Paola Cavalla, Diana Ferraro, Pietro Annovazzi, Roberta Lanzillo, Marcello Moccia, Carla Tortorella, Moccia, M., Annovazzi, P., Buscarinu, M. C., Calabrese, M., Cavalla, P., Cordioli, C., Di Filippo, M., Ferraro, D., Gajofatto, A., Gallo, A., Lanzillo, R., Laroni, A., Lorefice, L., Mallucchi, S., Nociti, V., Paolicelli, D., Pinardi, F., Prosperini, L., Radaelli, M., Ragonese, P., Tomassini, V., Tortorella, C., Cocco, E., Gasperini, C., Solaro, C., Moccia M., Annovazzi P., Buscarinu M.C., Calabrese M., Cavalla P., Cordioli C., Di Filippo M., Ferraro D., Gajofatto A., Gallo A., Lanzillo R., Laroni A., Lorefice L., Mallucchi S., Nociti V., Paolicelli D., Pinardi F., Prosperini L., Radaelli M., Ragonese P., Tomassini V., Tortorella C., Cocco E., Gasperini C., and Solaro C.
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Adult ,Longitudinal study ,medicine.medical_specialty ,Harmonization ,Outcome measures ,Multiple sclerosis ,Outcome measure ,03 medical and health sciences ,0302 clinical medicine ,Real world ,medicine ,Humans ,Multiple sclerosi ,030212 general & internal medicine ,Age of Onset ,Aged ,Retrospective Studies ,Expanded Disability Status Scale ,business.industry ,Retrospective cohort study ,General Medicine ,Variance (accounting) ,medicine.disease ,Neurology ,Italy ,Family medicine ,Observational study ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Multiple Sclerosis - Abstract
Background: Worldwide multiple sclerosis (MS) centers have coordinated their efforts to use data acquired in clinical practice for real-world observational studies. In this retrospective study, we aim to harmonize outcome measures, and to evaluate their heterogeneity within the Rising Italian Researchers in MS (RIReMS) study group. Methods: RIReMS members filled in a structured questionnaire evaluating the use of different outcome measures in clinical practice. Thereafter, thirty-four already-published papers from RIReMS centers were used for heterogeneity analyses, using the DerSimonian and Laird random-effects method to compute the between-study variance (τ2). Results: Based on questionnaire results, we defined basic modules for diagnosis and follow-up, consisting of outcome measures recorded by all participating centers at the time of diagnosis, and, then, at least annually; we also defined more detailed/optional modules, with outcome measures recorded less frequently and/or in the presence of specific clinical indications. Looking at heterogeneity, we found 5-year variance in age at onset (ES=27.34; 95%CI=26.18, 28.49; p41.4 years (ES=4.37; 95%CI=3.40, 5.35; p2 years (ES=5.41; 95%CI=3.22, 7.60; p = 0.02; τ2=1.00). Discussion: We suggest common sets of biomarkers to be acquired in clinical practice, that can be used for research purposes. Also, we provide researchers with specific indications for improving inclusion criteria and data analysis, ultimately allowing data harmonization and high-quality collaborative studies.
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- 2020
11. Prevalence, incidence, and season distribution of MOG antibody-associated disease in the province of Verona, Italy
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Riccardo Orlandi, Sara Mariotto, and Alberto Gajofatto
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Aquaporin 4 ,Incidence ,Neuromyelitis Optica ,Neuroimmunology ,General Medicine ,Neuroepidemiology ,MOGAD ,Demyelinating diseases ,Neurology ,Prevalence ,Humans ,Female ,Myelin-Oligodendrocyte Glycoprotein ,Neurology (clinical) ,Seasons ,Autoantibodies - Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is a demyelinating disorder of the central nervous system whose epidemiological features are still unclear. We report current prevalence and incidence rates of MOGAD in the population of Verona province, Italy, and the seasonal distribution of disease onset.MOGAD patients residing in Verona province were included through the consultation of a database from our Neuropathology Laboratory. Provincial prevalence was determined on 2021/1/1 (resident population: 922,291 people) and incidence rates between 2016/1/1 and 2021/1/1 were calculated from all cases, divided by the total number of person-years at risk. We also examined the distribution of attacks by month and season.We included 23 prevalent MOGAD cases (13 females), with a median age at onset of 36 years (range 5-69). Prevalence rate was 2.5/100,000 (95% CI 1.7-3.7). 22 incident cases were collected, with an incidence rate of 4.8/million person-years (95% CI 3.1-7.2). Among the 23 prevalent patients, disease onset was more frequent in December (4 cases), February, May, and September (3 cases/month), with a global autumn-winter predominance (September-February) of 15 cases (65%), irrespective of the clinical manifestation.This is the first study on an Italian population to report MOGAD prevalence and incidence rates; they are higher than the estimates for aquaporin-4-seropositive neuromyelitis optica spectrum disorder in the Caucasian population, but far lower than Multiple Sclerosis. An autumn-winter predominance of disease onset is suggested, and it could be related to environmental factors that should be ascertained, although validation in larger cohorts is mandatory.
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- 2022
12. SARS-CoV-2 serology after COVID-19 in multiple sclerosis: An international cohort study
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Maria Pia Sormani, Irene Schiavetti, Doriana Landi, Luca Carmisciano, Nicola De Rossi, Cinzia Cordioli, Lucia Moiola, Marta Radaelli, Paolo Immovilli, Marco Capobianco, Vincenzo Brescia Morra, Maria Trojano, Gioacchino Tedeschi, Giancarlo Comi, Mario Alberto Battaglia, Francesco Patti, Yara Dadalti Fragoso, Sedat Sen, Aksel Siva, Roberto Furlan, Marco Salvetti, Gianmarco Abbadessa, Umberto Aguglia, Lia Allegorico, Rossi Beatrice Maria Allegri, Maria Pia Amato, Pietro Annovazzi, Carlo Antozzi, Lucia Appendino, Sebastiano Arena, Viola Baione, Roberto Balgera, Valeria Barcella, Damiano Baroncini, Caterina Barrilà, Mario A. Battaglia, Alessandra Bellacosa, Gianmarco Bellucci, Roberto Bergamaschi, Valeria Bergamaschi, Daiana Bezzini, Beatrice Biolzi, Alvino Bisecco, Simona Bonavita, Giovanna Borriello, Chiara Bosa, Antonio Bosco, Francesca Bovis, Marco Bozzali, Laura Brambilla, Morra Vincenzo Brescia, Giampaolo Brichetto, Maria Buccafusca, Elisabetta Bucciantini, Sebastiano Bucello, Maria Chiara Buscarinu, Maria Paola Cabboi, Massimiliano Calabrese, Francesca Calabria, Francesca Caleri, Federico Camilli, Luisa Maria Caniatti, Roberto Cantello, Ruggero Capra, Rocco Capuano, Patrizia Carta, Paola Cavalla, Maria Grazia Celani, Maria Cellerino, Raffaella Cerqua, Clara Chisari, Raffaella Clerici, Marinella Clerico, Eleonora Cocco, Gaia Cola, Paolo Confalonieri, Antonella Conte, Marta Zaffira Conti, Christian Cordano, Susanna Cordera, Francesco Corea, Claudio Correale, Salvatore Cottone, Francesco Crescenzo, Erica Curti, Alessandro d’Ambrosio, Emanuele D’Amico, Maura Chiara Danni, Alessia d’Arma, Vincenzo Dattola, Stefano de Biase, Giovanna De Luca, Stefania Federica De Mercanti, Paolo De Mitri, Nicola De Stefano, Marco Della Cava, Mario di Napoli, Alessia Di Sapio, Renato Docimo, Anna Dutto, Luana Evangelista, Salvatore Fanara, Diana Ferraro, Maria Teresa Ferrò, Massimo Filippi, Cristina Fioretti, Mario Fratta, Jessica Frau, Marzia Fronza, Alberto Gajofatto, Antonio Gallo, Paolo Gallo, Claudio Gasperini, Anna Ghazaryan, Bruno Giometto, Francesca Gobbin, Flora Govone, Franco Granella, Erica Grange, Maria Grazia Grasso, Angelica Guareschi, Clara Guaschino, Simone Guerrieri, Donata Guidetti, Pietro Iaffaldano, Antonio Ianniello, Luigi Iasevoli, Daniele Imperiale, Maria Teresa Infante, Matilde Inglese, Rosa Iodice, Aniello Iovino, Giovanna Konrad, Roberta Lanzillo, Caterina Lapucci, Luigi Lavorgna, Rita L’Episcopo Maria, Serena Leva, Giuseppe Liberatore, Marianna Lo Re, Marco Longoni, Leonardo Lopiano, Lorena Lorefice, Matteo Lucchini, Giacomo Lus, Davide Maimone, Maria Malentacchi, Giulia Mallucci, Simona Malucchi, Chiara Rosa Mancinelli, Luca Mancinelli, Paolo Manganotti, Teresa Giorgia Maniscalco, Vittorio Mantero, Sabrina Marangoni, Damiano Marastoni, Alessandra Girolama Marfia, Fabiana Marinelli, Alessandro Marti, Filippo Martinelli Boneschi, Federco Masserano Zoli, Francesca Matta, Laura Mendozzi, Giuseppe Meucci, Silvia Miante, Giuseppina Miele, Eva Milano, Massimiliano Mirabella, Rosanna Missione, Marcello Moccia, Sara Montepietra, Margherita Monti Bragadin, Federico Montini, Roberta Motta, Raffaele Nardone, Carolina Gabri Nicoletti, Eduardo Nobile-Orazio, Agostino Nozzolillo, Marco Onofrj, Riccardo Orlandi, Anna Palmieri, Damiano Paolicelli, Livia Pasquali, Luisa Pastò, Elisabetta Pedrazzoli, Paola Perini, Ilaria Pesci, Maria Petracca, Alfredo Petrone, Carlo Piantadosi, Anna M. Pietroboni, Federica Pinardi, Marta Ponzano, Emilio Portaccio, Mattia Pozzato, Carlo Pozzilli, Luca Prosperini, Alessandra Protti, Paolo Ragonese, Sarah Rasia, Sabrina Realmuto, Anna Repice, Eleonora Rigoni, Maria Teresa Rilla, Francesca Rinaldi, Calogero Marcello Romano, Marco Ronzoni, Marco Rovaris, Francesca Ruscica, Loredana Sabattini, Giuseppe Salemi, Lorenzo Saraceno, Alessia Sartori, Arianna Sartori, Elvira Sbragia, Cinzia Scandellari, Ilaria Scarano Giuditta, Valentina Scarano, Valentina Schillaci, Maria Sessa, Caterina Sgarito, Grazia Sibilia, Gabriele Siciliano, Alessio Signori, Elisabetta Signoriello, Leonardo Sinisi, Francesca Sireci, Patrizia Sola, Claudio Solaro, Stefano Sotgiu, Maddalena Sparaco, Maria Laura Stromillo, Silvia Strumia, Laura Emanuela Susani, Giulietta Tabiadon, Francesco Teatini, Valentina Tomassini, Simone Tonietti, Clerici Valentina Torri, Carla Tortorella, Simona Toscano, Rocco Totaro, Maria Trotta, Gabriella Turano, Monica Ulivelli, Manzo Valentino, Giovanna Vaula, Domizia Vecchio, Marco Vercellino, Elena Pinuccia Verrengia, Marika Vianello, Eleonora Virgilio, Francesca Vitetta, Stefano Vollaro, Mauro Zaffaroni, Mauro Zampolini, Ignazio Roberto Zarbo, Antonio Zito, Luigi Zuliani, Sormani, M. P., Schiavetti, I., Landi, D., Carmisciano, L., De Rossi, N., Cordioli, C., Moiola, L., Radaelli, M., Immovilli, P., Capobianco, M., Brescia Morra, V., Trojano, M., Tedeschi, G., Comi, G., Battaglia, M. A., Patti, F., Fragoso, Y. D., Sen, S., Siva, A., Furlan, R., Salvetti, M., Bisecco, Alvino, Pia Sormani, Maria, Schiavetti, Irene, Landi, Doriana, Carmisciano, Luca, De Rossi, Nicola, Cordioli, Cinzia, Moiola, Lucia, Radaelli, Marta, Immovilli, Paolo, Capobianco, Marco, Brescia Morra, Vincenzo, Trojano, Maria, Tedeschi, Gioacchino, Comi, Giancarlo, Alberto Battaglia, Mario, Patti, Francesco, Dadalti Fragoso, Yara, Sen, Sedat, Siva, Aksel, Furlan, Roberto, Salvetti, Marco, Study Group Gianmarco Abbadessa, MuSC-19, Aguglia, Umberto, Allegorico, Lia, Beatrice Maria Allegri, Rossi, Pia Amato, Maria, Annovazzi, Pietro, Antozzi, Carlo, Appendino, Lucia, Arena, Sebastiano, Baione, Viola, Balgera, Roberto, Barcella, Valeria, Baroncini, Damiano, Barrilà, Caterina, A Battaglia, Mario, Bellacosa, Alessandra, Bellucci, Gianmarco, Bergamaschi, Roberto, Bergamaschi, Valeria, Bezzini, Daiana, Biolzi, Beatrice, Bonavita, Simona, Borriello, Giovanna, Bosa, Chiara, Bosco, Antonio, Bovis, Francesca, Bozzali, Marco, Brambilla, Laura, Vincenzo Brescia, Morra, Brichetto, Giampaolo, Buccafusca, Maria, Bucciantini, Elisabetta, Bucello, Sebastiano, Chiara Buscarinu, Maria, Paola Cabboi, Maria, Calabrese, Massimiliano, Calabria, Francesca, Caleri, Francesca, Camilli, Federico, Maria Caniatti, Luisa, Cantello, Roberto, Capra, Ruggero, Capuano, Rocco, Carta, Patrizia, Cavalla, Paola, Grazia Celani, Maria, Cellerino, Maria, Cerqua, Raffaella, Chisari, Clara, Clerici, Raffaella, Clerico, Marinella, Cocco, Eleonora, Cola, Gaia, Confalonieri, Paolo, Conte, Antonella, Zaffira Conti, Marta, Cordano, Christian, Cordera, Susanna, Corea, Francesco, Correale, Claudio, Cottone, Salvatore, Crescenzo, Francesco, Curti, Erica, D'Ambrosio, Alessandro, D'Amico, Emanuele, Chiara Danni, Maura, D'Arma, Alessia, Dattola, Vincenzo, de Biase, Stefano, De Luca, Giovanna, Federica De Mercanti, Stefania, De Mitri, Paolo, De Stefano, Nicola, Della Cava, Marco, di Napoli, Mario, Di Sapio, Alessia, Docimo, Renato, Dutto, Anna, Evangelista, Luana, Fanara, Salvatore, Ferraro, Diana, Teresa Ferrò, Maria, Filippi, Massimo, Fioretti, Cristina, Fratta, Mario, Frau, Jessica, Fronza, Marzia, Gajofatto, Alberto, Gallo, Antonio, Gallo, Paolo, Gasperini, Claudio, Ghazaryan, Anna, Giometto, Bruno, Gobbin, Francesca, Govone, Flora, Granella, Franco, Grange, Erica, Grazia Grasso, Maria, Guareschi, Angelica, Guaschino, Clara, Guerrieri, Simone, Guidetti, Donata, Iaffaldano, Pietro, Ianniello, Antonio, Iasevoli, Luigi, Imperiale, Daniele, Teresa Infante, Maria, Inglese, Matilde, Iodice, Rosa, Iovino, Aniello, Konrad, Giovanna, Lanzillo, Roberta, Lapucci, Caterina, Lavorgna, Luigi, L'Episcopo Maria, Rita, Leva, Serena, Liberatore, Giuseppe, Lo Re, Marianna, Longoni, Marco, Lopiano, Leonardo, Lorefice, Lorena, Lucchini, Matteo, Lus, Giacomo, Maimone, Davide, Malentacchi, Maria, Mallucci, Giulia, Malucchi, Simona, Rosa Mancinelli, Chiara, Mancinelli, Luca, Manganotti, Paolo, Giorgia Maniscalco, Teresa, Mantero, Vittorio, Marangoni, Sabrina, Marastoni, Damiano, Girolama Marfia, Alessandra, Marinelli, Fabiana, Marti, Alessandro, Martinelli Boneschi, Filippo, Masserano Zoli, Federco, Matta, Francesca, Mendozzi, Laura, Meucci, Giuseppe, Miante, Silvia, Miele, Giuseppina, Milano, Eva, Mirabella, Massimiliano, Missione, Rosanna, Moccia, Marcello, Montepietra, Sara, Monti Bragadin, Margherita, Montini, Federico, Motta, Roberta, Nardone, Raffaele, Gabri Nicoletti, Carolina, Nobile-Orazio, Eduardo, Nozzolillo, Agostino, Onofrj, Marco, Orlandi, Riccardo, Palmieri, Anna, Paolicelli, Damiano, Pasquali, Livia, Pastò, Luisa, Pedrazzoli, Elisabetta, Perini, Paola, Pesci, Ilaria, Petracca, Maria, Petrone, Alfredo, Piantadosi, Carlo, M Pietroboni, Anna, Pinardi, Federica, Ponzano, Marta, Portaccio, Emilio, Pozzato, Mattia, Pozzilli, Carlo, Prosperini, Luca, Protti, Alessandra, Ragonese, Paolo, Rasia, Sarah, Realmuto, Sabrina, Repice, Anna, Rigoni, Eleonora, Teresa Rilla, Maria, Rinaldi, Francesca, Marcello Romano, Calogero, Ronzoni, Marco, Rovaris, Marco, Ruscica, Francesca, Sabattini, Loredana, Salemi, Giuseppe, Saraceno, Lorenzo, Sartori, Alessia, Sartori, Arianna, Sbragia, Elvira, Scandellari, Cinzia, Scarano Giuditta, Ilaria, Scarano, Valentina, Schillaci, Valentina, Sessa, Maria, Sgarito, Caterina, Sibilia, Grazia, Siciliano, Gabriele, Signori, Alessio, Signoriello, Elisabetta, Sinisi, Leonardo, Sireci, Francesca, Sola, Patrizia, Solaro, Claudio, Sotgiu, Stefano, Sparaco, Maddalena, Laura Stromillo, Maria, Strumia, Silvia, Emanuela Susani, Laura, Tabiadon, Giulietta, Teatini, Francesco, Tomassini, Valentina, Tonietti, Simone, Valentina Torri, Clerici, Tortorella, Carla, Toscano, Simona, Totaro, Rocco, Trotta, Maria, Turano, Gabriella, Ulivelli, Monica, Valentino, Manzo, Vaula, Giovanna, Vecchio, Domizia, Vercellino, Marco, Pinuccia Verrengia, Elena, Vianello, Marika, Virgilio, Eleonora, Vitetta, Francesca, Vollaro, Stefano, Zaffaroni, Mauro, Zampolini, Mauro, Roberto Zarbo, Ignazio, Zito, Antonio, Zuliani, Luigi, Abbadessa, Gianmarco, Trotta, Maria Consiglia, and Zito, Guido Antonio
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0301 basic medicine ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,immunosuppressive therapie ,coronavirus ,Settore MED/26 ,medicine.disease_cause ,Antibodies, Viral ,immunosuppressive therapies ,Antibodies ,Serology ,Cohort Studies ,Multiple sclerosis ,03 medical and health sciences ,0302 clinical medicine ,Seroepidemiologic Studies ,Pandemic ,Medicine ,Humans ,Multiple sclerosi ,Viral ,Coronavirus ,business.industry ,immunomodulatory therapie ,immunomodulatory therapies ,COVID-19 ,medicine.disease ,Virology ,coronaviru ,Settore MED/26 - NEUROLOGIA ,Sars-COV-2 ,030104 developmental biology ,Neurology ,Neurology (clinical) ,business ,SARS-CoV-2 ,Multiple Sclerosis ,030217 neurology & neurosurgery ,Cohort study - Abstract
Background: The MuSC-19 project is an Italian cohort study open to international partners that collects data on multiple sclerosis (MS) patients with COVID-19. During the second wave of the pandemic, serological tests became routinely available. Objective: To evaluate the seroprevalence of anti-SARS-CoV-2 antibodies according to the use of disease-modifying therapy (DMT) in a subset of patients included in the MuSC-19 data set who had undergone a serological test. Methods: We evaluated the association between positive serological test results and time elapsed since infection onset, age, sex, Expanded Disability Status Scale score, comorbidities and DMT exposure using a multivariable logistic model. Results: Data were collected from 423 patients (345 from Italy, 61 from Turkey and 17 from Brazil) with a serological test performed during follow-up. Overall, 325 out of 423 tested patients (76.8%) had a positive serological test. At multivariate analysis, therapy with anti-CD20 was significantly associated with a reduced probability of developing antibodies after COVID-19 (odds ratio (OR) = 0.20, p = 0.002). Conclusion: Patients with MS maintain the capacity to develop humoral immune response against SARS-COV-2, although to a lesser extent when treated with anti-CD20 drugs. Overall, our results are reassuring with respect to the possibility to achieve sufficient immunization with vaccination.
- Published
- 2021
13. COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context
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Maria Pia Sormani, Irene Schiavetti, Luca Carmisciano, Cinzia Cordioli, Massimo Filippi, Marta Radaelli, Paolo Immovilli, Marco Capobianco, Nicola De Rossi, Giampaolo Brichetto, Eleonora Cocco, Cinzia Scandellari, Paola Cavalla, Ilaria Pesci, Antonio Zito, Paolo Confalonieri, Girolama Alessandra Marfia, Paola Perini, Matilde Inglese, Maria Trojano, Vincenzo Brescia Morra, Gioacchino Tedeschi, Giancarlo Comi, Mario Alberto Battaglia, Francesco Patti, Marco Salvetti, Gianmarco Abbadessa, Umberto Aguglia, Lia Allegorico, Beatrice Maria Allegri Rossi, Maria Pia Amato, Pietro Annovazzi, Carlo Antozzi, Lucia Appendino, Sebastiano Arena, Viola Baione, Roberto Balgera, Valeria Barcella, Damiano Baroncini, Caterina Barrilà, Alessandra Bellacosa, Gianmarco Bellucci, Roberto Bergamaschi, Valeria Bergamaschi, Daiana Bezzini, Beatrice Biolzi, Alvino Bisecco, Simona Bonavita, Giovanna Borriello, Chiara Bosa, Antonio Bosco, Francesca Bovis, Marco Bozzali, Laura Brambilla, Maria Buccafusca, Elisabetta Bucciantini, Sebastiano Bucello, Maria Chiara Buscarinu, Maria Paola Cabboi, Massimiliano Calabrese, Francesca Calabria, Francesca Caleri, Federico Camilli, Luisa Maria Caniatti, Roberto Cantello, Ruggero Capra, Rocco Capuano, Patrizia Carta, Maria Grazia Celani, Maria Cellerino, Raffaella Cerqua, Clara Chisari, Raffaella Clerici, Marinella Clerico, Gaia Cola, Antonella Conte, Marta Zaffira Conti, Christian Cordano, Susanna Cordera, Francesco Corea, Claudio Correale, Salvatore Cottone, Francesco Crescenzo, Erica Curti, Alessandro d'Ambrosio, Emanuele D'Amico, Maura Chiara Danni, Alessia d'Arma, Vincenzo Dattola, Stefano de Biase, Giovanna De Luca, Stefania Federica De Mercanti, Paolo De Mitri, Nicola De Stefano, Marco Della Cava, Mario di Napoli, Alessia Di Sapio, Renato Docimo, Anna Dutto, Luana Evangelista, Salvatore Fanara, Ferraro Diana, Maria Teresa Ferrò, Cristina Fioretti, Mario Fratta, Jessica Frau, Marzia Fronza, Roberto Furlan, Alberto Gajofatto, Antonio Gallo, Paolo Gallo, Claudio Gasperini, Anna Ghazaryan, Bruno Giometto, Francesca Gobbin, Flora Govone, Franco Granella, Erica Grange, Maria Grazia Grasso, Angelica Guareschi, Clara Guaschino, Simone Guerrieri, Donata Guidetti, Pietro Iaffaldano, Antonio Ianniello, Luigi Iasevoli, Daniele Imperiale, Maria Teresa Infante, Rosa Iodice, Aniello Iovino, Giovanna Konrad, Doriana Landi, Roberta Lanzillo, Caterina Lapucci, Luigi Lavorgna, Maria Rita L'Episcopo, Serena Leva, Giuseppe Liberatore, Marianna Lo Re, Marco Longoni, Leonardo Lopiano, Lorena Lorefice, Matteo Lucchini, Giacomo Lus, Davide Maimone, Maria Malentacchi, Giulia Mallucci, Simona Malucchi, Chiara Rosa Mancinelli, Luca Mancinelli, Paolo Manganotti, Giorgia Teresa Maniscalco, Vittorio Mantero, Sabrina Marangoni, Damiano Marastoni, Fabiana Marinelli, Alessandro Marti, Filippo Martinelli Boneschi, Federco Masserano Zoli, Francesca Matta, Laura Mendozzi, Giuseppe Meucci, Silvia Miante, Giuseppina Miele, Eva Milano, Massimiliano Mirabella, Rosanna Missione, Marcello Moccia, Lucia Moiola, Sara Montepietra, Margherita MontiBragadin, Federico Montini, Roberta Motta, Raffaele Nardone, Carolina Gabri Nicoletti, Eduardo Nobile-Orazio, Agostino Nozzolillo, Marco Onofrj, Riccardo Orlandi, Anna Palmieri, Damiano Paolicelli, Livia Pasquali, Luisa Pastò, Elisabetta Pedrazzoli, Maria Petracca, Alfredo Petrone, Carlo Piantadosi, Anna M Pietroboni, Federica Pinardi, Marta Ponzano, Emilio Portaccio, Mattia Pozzato, Carlo Pozzilli, Luca Prosperini, Alessandra Protti, Paolo Ragonese, Sarah Rasia, Sabrina Realmuto, Anna Repice, Eleonora Rigoni, Maria Teresa Rilla, Francesca Rinaldi, Calogero Marcello Romano, Marco Ronzoni, Marco Rovaris, Francesca Ruscica, Loredana Sabattini, Giuseppe Salemi, Lorenzo Saraceno, Alessia Sartori, Arianna Sartori, Elvira Sbragia, Giuditta Ilaria Scarano, Valentina Scarano, Valentina Schillaci, Maria Sessa, Caterina Sgarito, Grazia Sibilia, Gabriele Siciliano, Alessio Signori, Elisabetta Signoriello, Leonardo Sinisi, Francesca Sireci, Patrizia Sola, Claudio Solaro, Stefano Sotgiu, Maddalena Sparaco, Maria Laura Stromillo, Silvia Strumia, Emanuela Laura Susani, Giulietta Tabiadon, Francesco Teatini, Valentina Tomassini, Simone Tonietti, Clerici Valentina Torri, Carla Tortorella, Simona Toscano, Rocco Totaro, Maria Trotta, Gabriella Turano, Monica Ulivelli, Manzo Valentino, Giovanna Vaula, Domizia Vecchio, Marco Vercellino, Elena Pinuccia Verrengia, Marika Vianello, Eleonora Virgilio, Francesca Vitetta, Stefano Vollaro, Mauro Zaffaroni, Mauro Zampolini, Ignazio Roberto Zarbo, Luigi Zuliani, Pia Sormani, Maria, Schiavetti, Irene, Carmisciano, Luca, Cordioli, Cinzia, Filippi, Massimo, Radaelli, Marta, Immovilli, Paolo, Capobianco, Marco, De Rossi, Nicola, Brichetto, Giampaolo, Cocco, Eleonora, Scandellari, Cinzia, Cavalla, Paola, Pesci, Ilaria, Zito, Guido Antonio, Confalonieri, Paolo, Alessandra Marfia, Girolama, Perini, Paola, Inglese, Matilde, Trojano, Maria, Brescia Morra, Vincenzo, Tedeschi, Gioacchino, Comi, Giancarlo, Alberto Battaglia, Mario, Patti, Francesco, Salvetti, Marco, Abbadessa, Gianmarco, Aguglia, Umberto, Allegorico, Lia, Maria Allegri Rossi, Beatrice, Pia Amato, Maria, Annovazzi, Pietro, Antozzi, Carlo, Appendino, Lucia, Arena, Sebastiano, Baione, Viola, Balgera, Roberto, Barcella, Valeria, Baroncini, Damiano, Barrilà, Caterina, Bellacosa, Alessandra, Bellucci, Gianmarco, Bergamaschi, Roberto, Bergamaschi, Valeria, Bezzini, Daiana, Biolzi, Beatrice, Bisecco, Alvino, Bonavita, Simona, Borriello, Giovanna, Bosa, Chiara, Bosco, Antonio, Bovis, Francesca, Bozzali, Marco, Brambilla, Laura, Buccafusca, Maria, Bucciantini, Elisabetta, Bucello, Sebastiano, Chiara Buscarinu, Maria, Paola Cabboi, Maria, Calabrese, Massimiliano, Calabria, Francesca, Caleri, Francesca, Camilli, Federico, Maria Caniatti, Luisa, Cantello, Roberto, Capra, Ruggero, Capuano, Rocco, Carta, Patrizia, Grazia Celani, Maria, Cellerino, Maria, Cerqua, Raffaella, Chisari, Clara, Clerici, Raffaella, Clerico, Marinella, Cola, Gaia, Conte, Antonella, Zaffira Conti, Marta, Cordano, Christian, Cordera, Susanna, Corea, Francesco, Correale, Claudio, Cottone, Salvatore, Crescenzo, Francesco, Curti, Erica, D'Ambrosio, Alessandro, D'Amico, Emanuele, Chiara Danni, Maura, D'Arma, Alessia, Dattola, Vincenzo, de Biase, Stefano, De Luca, Giovanna, Federica De Mercanti, Stefania, De Mitri, Paolo, De Stefano, Nicola, Della Cava, Marco, di Napoli, Mario, Di Sapio, Alessia, Docimo, Renato, Dutto, Anna, Evangelista, Luana, Fanara, Salvatore, Diana, Ferraro, Teresa Ferrò, Maria, Fioretti, Cristina, Fratta, Mario, Frau, Jessica, Fronza, Marzia, Furlan, Roberto, Gajofatto, Alberto, Gallo, Antonio, Gallo, Paolo, Gasperini, Claudio, Ghazaryan, Anna, Giometto, Bruno, Gobbin, Francesca, Govone, Flora, Granella, Franco, Grange, Erica, Grazia Grasso, Maria, Guareschi, Angelica, Guaschino, Clara, Guerrieri, Simone, Guidetti, Donata, Iaffaldano, Pietro, Ianniello, Antonio, Iasevoli, Luigi, Imperiale, Daniele, Teresa Infante, Maria, Iodice, Rosa, Iovino, Aniello, Konrad, Giovanna, Landi, Doriana, Lanzillo, Roberta, Lapucci, Caterina, Lavorgna, Luigi, Rita L'Episcopo, Maria, Leva, Serena, Liberatore, Giuseppe, Lo Re, Marianna, Longoni, Marco, Lopiano, Leonardo, Lorefice, Lorena, Lucchini, Matteo, Lus, Giacomo, Maimone, Davide, Malentacchi, Maria, Mallucci, Giulia, Malucchi, Simona, Rosa Mancinelli, Chiara, Mancinelli, Luca, Manganotti, Paolo, Teresa Maniscalco, Giorgia, Mantero, Vittorio, Marangoni, Sabrina, Marastoni, Damiano, Marinelli, Fabiana, Marti, Alessandro, Martinelli Boneschi, Filippo, Masserano Zoli, Federco, Matta, Francesca, Mendozzi, Laura, Meucci, Giuseppe, Miante, Silvia, Miele, Giuseppina, Milano, Eva, Mirabella, Massimiliano, Missione, Rosanna, Moccia, Marcello, Moiola, Lucia, Montepietra, Sara, Montibragadin, Margherita, Montini, Federico, Motta, Roberta, Nardone, Raffaele, Gabri Nicoletti, Carolina, Nobile-Orazio, Eduardo, Nozzolillo, Agostino, Onofrj, Marco, Orlandi, Riccardo, Palmieri, Anna, Paolicelli, Damiano, Pasquali, Livia, Pastò, Luisa, Pedrazzoli, Elisabetta, Petracca, Maria, Petrone, Alfredo, Piantadosi, Carlo, M Pietroboni, Anna, Pinardi, Federica, Ponzano, Marta, Portaccio, Emilio, Pozzato, Mattia, Pozzilli, Carlo, Prosperini, Luca, Protti, Alessandra, Ragonese, Paolo, Rasia, Sarah, Realmuto, Sabrina, Repice, Anna, Rigoni, Eleonora, Teresa Rilla, Maria, Rinaldi, Francesca, Marcello Romano, Calogero, Ronzoni, Marco, Rovaris, Marco, Ruscica, Francesca, Sabattini, Loredana, Salemi, Giuseppe, Saraceno, Lorenzo, Sartori, Alessia, Sartori, Arianna, Sbragia, Elvira, Ilaria Scarano, Giuditta, Scarano, Valentina, Schillaci, Valentina, Sessa, Maria, Sgarito, Caterina, Sibilia, Grazia, Siciliano, Gabriele, Signori, Alessio, Signoriello, Elisabetta, Sinisi, Leonardo, Sireci, Francesca, Sola, Patrizia, Solaro, Claudio, Sotgiu, Stefano, Sparaco, Maddalena, Laura Stromillo, Maria, Strumia, Silvia, Laura Susani, Emanuela, Tabiadon, Giulietta, Teatini, Francesco, Tomassini, Valentina, Tonietti, Simone, Valentina Torri, Clerici, Tortorella, Carla, Toscano, Simona, Totaro, Rocco, Trotta, Maria Consiglia, Turano, Gabriella, Ulivelli, Monica, Valentino, Manzo, Vaula, Giovanna, Vecchio, Domizia, Vercellino, Marco, Pinuccia Verrengia, Elena, Vianello, Marika, Virgilio, Eleonora, Vitetta, Francesca, Vollaro, Stefano, Zaffaroni, Mauro, Zampolini, Mauro, Roberto Zarbo, Ignazio, Zuliani, Luigi, Sormani, M. P., Schiavetti, I., Carmisciano, L., Cordioli, C., Filippi, M., Radaelli, M., Immovilli, P., Capobianco, M., De Rossi, N., Brichetto, G., Cocco, E., Scandellari, C., Cavalla, P., Pesci, I., Zito, A., Confalonieri, P., Marfia, G. A., Perini, P., Inglese, M., Trojano, M., Brescia Morra, V., Tedeschi, G., Comi, G., Battaglia, M. A., Patti, F., Salvetti, M., Zito, Antonio, BRESCIA MORRA, Vincenzo, Trotta, Maria, Sormani, Maria Pia, Marfia, Girolama Alessandra, and Battaglia, Mario Alberto
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Adult ,Male ,medicine.medical_specialty ,Multiple Sclerosis ,Coronavirus disease 2019 (COVID-19) ,Population ,Intensive Care Unit ,COVID-19 ,Cohort Studies ,Comorbidity ,Female ,Hospitalization ,Humans ,Intensive Care Units ,Italy ,Middle Aged ,Retrospective Studies ,Risk Factors ,Severity of Illness Index ,Context (language use) ,Settore MED/26 ,Lower risk ,Retrospective Studie ,Internal medicine ,Multiple Sclerosi ,Medicine ,In patient ,National level ,education ,education.field_of_study ,Expanded Disability Status Scale ,business.industry ,Risk Factor ,Ethics committee ,medicine.disease ,Icu admission ,Settore MED/26 - NEUROLOGIA ,Neurology ,Relative risk ,Family medicine ,Cohort ,Honorarium ,Observational study ,Neurology (clinical) ,Cohort Studie ,business ,Human - Abstract
Background: It is unclear how multiple sclerosis (MS) affects the severity of Covid-19. Methods: Hospitalization, Intensive Care Unit (ICU) admission and death after Covid-19 diagnosis of 1362 MS patients were compared to the age and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher-risk: EDSS>3 or at least one comorbidity, lower-risk: EDSS
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- 2021
14. Study protocol on advance care planning in multiple sclerosis (ConCure-SM): Intervention construction and multicentre feasibility trial
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Paola Kruger, Simone Veronese, Sara Montepietra, Leigh Manson, Eugenio Pucci, Francesco Patti, Alberto Gajofatto, Ludovica De Panfilis, Andrea Giordano, Claudio Solaro, Alessandra Solari, Alessandra Lugaresi, Maria Grazia Grasso, Marta Cascioli, Michela Bruzzone, De Panfilis, Ludovica, Veronese, Simone, Bruzzone, Michela, Cascioli, Marta, Gajofatto, Alberto, Grasso, Maria Grazia, Kruger, Paola, Lugaresi, Alessandra, Manson, Leigh, Montepietra, Sara, Patti, Francesco, Pucci, Eugenio, Solaro, Claudio, Giordano, Andrea, and Solari, Alessandra
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Advance care planning ,Palliative care ,animal structures ,Multiple Sclerosis ,education ,Context (language use) ,Young Adult ,Advance Care Planning ,Nursing ,stomatognathic system ,Intervention (counseling) ,Medicine ,Humans ,Multicenter Studies as Topic ,palliative care ,business.industry ,medical ethic ,Communication ,Patient Preference ,General Medicine ,Bioethics ,Caregiver burden ,Focus group ,humanities ,Feasibility Studie ,Neurology ,medical ethics ,multiple sclerosi ,bacteria ,Feasibility Studies ,business ,qualitative research ,Qualitative research ,Human - Abstract
IntroductionMultiple sclerosis (MS) is the most common cause of progressive neurological disability in young adults. The use of advance care planning (ACP) for people with progressive MS (pwPMS) remains limited. The ConCure-SM project aims to assess the effectiveness of a structured ACP intervention for pwPMS. The intervention consists of a training programme on ACP for healthcare professionals caring for pwPMS, and a booklet to be used during the ACP conversation. Herein, we describe the first two project phases.MethodsIn phase 1 we translated and adapted, to the Italian legislation and MS context, the ACP booklet of the National ACP Programme for New Zealand. Acceptability, comprehensibility and usefulness of the booklet were assessed via 13 personal cognitive interviews with pwPMS and significant others (SOs), and one health professional focus group. Based on these findings, we will revise the booklet. In phase 2 we will conduct a single-arm pilot/feasibility trial with nested qualitative study. Participants will be 40 pwPMS, their SOs, health professionals from six MS and rehabilitation centres in Italy. In the 6 months following the ACP conversation, we will assess completion of an advance care plan document (primary outcome), as well as safety of the intervention. Secondary outcomes will be a range of measures to capture the full process of ACP; patient-carer congruence in treatment preferences; quality of patient-clinician communication and caregiver burden. A qualitative process evaluation will help understand the factors likely to influence future implementation and scalability of the intervention.Ethics and disseminationThe project is coleaded by a neurologist and a bioethicist. Phase 1 has received ethical approvals from each participating centre, while phase 2 will be submitted to the centres in May 2021. Findings from both phases will be disseminated widely through peer-reviewed publications, conferences and workshops.Trial registration numberISRCTN48527663; Pre-results.
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- 2021
15. Risk of disease relapse following COVID-19 vaccination in patients with AQP4-IgG-positive NMOSD and MOGAD
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Paolo Manganotti, Vincenzo Andreone, Alberto Gajofatto, Sara Mariotto, Paolo Solla, Alessandro Dinoto, Alessandra Maccabeo, Riccardo Orlandi, Sarah Rasia, Arianna Sartori, Giorgia Teresa Maniscalco, Elia Sechi, Sergio Ferrari, Ruggero Capra, and Chiara Rosa Mancinelli
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medicine.medical_specialty ,COVID-19 Vaccines ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,NMOSD ,NMOSD, neuromyelitis optica spectrum disorder ,Disease ,MOGAD ,Recurrence ,Internal medicine ,Correspondence ,medicine ,Humans ,MOG ,In patient ,BNT162 Vaccine ,Autoantibodies ,Retrospective Studies ,Aquaporin 4 ,SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2 ,business.industry ,SARS-CoV-2 ,Multiple sclerosis ,Neuromyelitis Optica ,Vaccination ,COVID-19 ,General Medicine ,medicine.disease ,AQP4 ,AQP4, aquaporin-4-IgG ,Neurology ,MOGAD, myelin oligodendrocyte glycoprotein associated disease ,Immunoglobulin G ,Myelin-Oligodendrocyte Glycoprotein ,Neurology (clinical) ,business ,DISEASE RELAPSE - Abstract
Post-vaccination disease relapses have been reported in patients with MOGAD and AQP4-IgG+NMOSD. In this retrospective multicenter Italian study we assessed the frequency of relapses after SARS-CoV-2 vaccination. We included 56 cases: MOGAD, 30; AQP4-IgG+NMOSD, 26. Vaccines received were BNT162b2-Pfizer-BioNTech in 42 patients and mRNA-1273-Moderna in 14 patients. Six patients had a history of SARS-CoV-2 infection; two of them experienced a post-infection disease relapse (MOGAD). The frequency of relapses within one month of SARS-CoV-2 vaccination was 4% (1/26) in the AQP4-IgG+NMOSD group and 0% in the MOGAD group. In these patients the potential benefits of vaccination overcome the risk of relapses.
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- 2021
16. Conversion to Secondary Progressive Multiple Sclerosis: Patient Awareness and Needs. Results From an Online Survey in Italy and Germany
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Alessandra Solari, Ambra Mara Giovannetti, Andrea Giordano, Carla Tortorella, Valentina Torri Clerici, Giampaolo Brichetto, Franco Granella, Alessandra Lugaresi, Francesco Patti, Marco Salvetti, Ilaria Pesci, Eugenio Pucci, Diego Centonze, Maura Chiara Danni, Simona Bonavita, Diana Ferraro, Antonio Gallo, Alberto Gajofatto, Viviana Nociti, Luigi Grimaldi, Monica Grobberio, Roberta Lanzillo, Rachele Di Giovanni, Silvia Gregori, Alessia Manni, Erika Pietrolongo, Sarah Bertagnoli, Marco Ronzoni, Laura Compagnucci, Roberta Fantozzi, Beatrice Allegri, Sebastiano Arena, Maria Chiara Buscarinu, Loredana Sabattini, Maria Esmeralda Quartuccio, Elena Tsantes, Paolo Confaloneri, Andrea Tacchino, Insa Schiffmann, Anne Christin Rahn, Ingo Kleiter, Michele Messmer Uccelli, Anna Barabasch, Christoph Heesen, the ManTra Project, Solari, Alessandra, Giovannetti, Ambra Mara, Giordano, Andrea, Tortorella, Carla, Torri Clerici, Valentina, Brichetto, Giampaolo, Granella, Franco, Lugaresi, Alessandra, Patti, Francesco, Salvetti, Marco, Pesci, Ilaria, Pucci, Eugenio, Centonze, Diego, Danni, Maura Chiara, Bonavita, Simona, Ferraro, Diana, Gallo, Antonio, Gajofatto, Alberto, Nociti, Viviana, Grimaldi, Luigi, Grobberio, Monica, Lanzillo, Roberta, Di Giovanni, Rachele, Gregori, Silvia, Manni, Alessia, Pietrolongo, Erika, Bertagnoli, Sarah, Ronzoni, Marco, Compagnucci, Laura, Fantozzi, Roberta, Allegri, Beatrice, Arena, Sebastiano, Buscarinu, Maria Chiara, Sabattini, Loredana, Quartuccio, Maria Esmeralda, Tsantes, Elena, Confaloneri, Paolo, Tacchino, Andrea, Schiffmann, Insa, Rahn, Anne Christin, Kleiter, Ingo, Messmer Uccelli, Michele, Barabasch, Anna, Heesen, Christoph, Solari, A., Giovannetti, A. M., Giordano, A., Tortorella, C., Clerici, V. T., Brichetto, G., Granella, F., Lugaresi, A., Patti, F., Salvetti, M., Pesci, I., Pucci, E., Centonze, D., Danni, M. C., Bonavita, S., Ferraro, D., Gallo, A., Gajofatto, A., Nociti, V., Grimaldi, L., Grobberio, M., Lanzillo, R., Di Giovanni, R., Gregori, S., Manni, A., Pietrolongo, E., Bertagnoli, S., Ronzoni, M., Compagnucci, L., Fantozzi, R., Allegri, B., Arena, S., Buscarinu, M. C., Sabattini, L., Quartuccio, M. E., Tsantes, E., Confaloneri, P., Tacchino, A., Schiffmann, I., Rahn, A. C., Kleiter, I., Uccelli, M. M., Barabasch, A., Heesen, C., Borreani, C., De Luca, G., Gitto, L., Trojano, M., and Alessandra Solari, Ambra Mara Giovannetti, Andrea Giordano, Carla Tortorella, Valentina Torri Clerici, Giampaolo Brichetto, Franco Granella, Alessandra Lugaresi, Francesco Patti, Marco Salvetti, Ilaria Pesci, Eugenio Pucci, Diego Centonze, Maura Chiara Danni, Simona Bonavita, Diana Ferraro, Antonio Gallo, Alberto Gajofatto, Viviana Nociti, Luigi Grimaldi, Monica Grobberio, Roberta Lanzillo, Rachele Di Giovanni, Silvia Gregori, Alessia Manni, Erika Pietrolongo, Sarah Bertagnoli, Marco Ronzoni, Laura Compagnucci, Roberta Fantozzi, Beatrice Allegri, Sebastiano Arena, Maria Chiara Buscarinu, Loredana Sabattini, Maria Esmeralda Quartuccio, Elena Tsantes, Paolo Confaloneri, Andrea Tacchino, Insa Schiffmann, Anne Christin Rahn, Ingo Kleiter, Michele Messmer Uccelli, Anna Barabasch, Christoph Heesen, ManTra Project
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medicine.medical_specialty ,secondary progressive multiple sclerosis ,Disease ,Settore MED/26 ,multiple sclerosis ,lcsh:RC346-429 ,03 medical and health sciences ,0302 clinical medicine ,patient needs ,patient-physician communication ,Intervention (counseling) ,Health care ,Medicine ,030212 general & internal medicine ,Cognitive rehabilitation therapy ,conversion ,lcsh:Neurology. Diseases of the nervous system ,Original Research ,patient need ,business.industry ,Odds ratio ,Neurology ,Family medicine ,multiple sclerosi ,Secondary progressive multiple sclerosis ,online survey ,Neurology (clinical) ,Conversion ,Multiple sclerosis ,Online survey ,Patient needs ,Patient-physician communication ,business ,Patient awareness ,030217 neurology & neurosurgery ,Qualitative research - Abstract
Background: Few studies have investigated the experiences of patients around the conversion to secondary progressive multiple sclerosis (SPMS). ManTra is a mixed-method, co-production research project conducted in Italy and Germany to develop an intervention for newly-diagnosed SPMS patients. In previous project actions, we identified the needs and experiences of patients converting to SPMS via literature review and qualitative research which involved key stakeholders. Aims: The online patient survey aimed to assess, on a larger and independent sample of recently-diagnosed SPMS patients: (a) the characteristics associated to patient awareness of SPMS conversion; (b) the experience of conversion; (c) importance and prioritization of the needs previously identified. Methods: Participants were consenting adults with SPMS since ≤5 years. The survey consisted of three sections: on general and clinical characteristics; on experience of SPMS diagnosis disclosure (aware participants only); and on importance and prioritization of 33 pre-specified needs. Results: Of 215 participants, those aware of their SPMS diagnosis were 57% in Italy vs. 77% in Germany (p = 0.004). In both countries, over 80% of aware participants received a SPMS diagnosis from the neurologist; satisfaction with SPMS disclosure was moderate to high. Nevertheless, 28–35%obtained second opinions, and 48–56% reported they did not receive any information on SPMS. Participants actively seeking further information were 63% in Germany vs. 31% in Italy (p < 0.001). Variables independently associated to patient awareness were geographic area (odds ratio, OR 0.32, 95% CI 0.13–0.78 for Central Italy; OR 0.21, 95% CI 0.08–0.58 for Southern Italy [vs. Germany]) and activity limitations (OR 7.80, 95% CI 1.47–41.37 for dependent vs. autonomous patients). All pre-specified needs were scored a lot or extremely important, and two prioritized needs were shared by Italian and German patients: “physiotherapy” and “active patient care involvement.” The other two differed across countries: “an individualized health care plan” and “information on social rights and policies” in Italy, and “psychological support” and “cognitive rehabilitation” in Germany. Conclusions: Around 40% of SPMS patients were not aware of their disease form indicating a need to improve patient-physician communication. Physiotherapy and active patient care involvement were prioritized in both countries.
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- 2019
17. A multicenter survey on access to care in Multiple Sclerosis-related trigeminal neuralgia
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Ilaria Pesci, Pietro Annovazzi, Claudio Solaro, Alberto Gajofatto, Cinzia Cordioli, G. T. Maniscalco, Eleonora Cocco, Roberta Fantozzi, Antonio Gallo, Marta Radaelli, Maria Chiara Buscarinu, Federica Pinardi, M. Di Filippo, Damiano Paolicelli, Valentina Tomassini, Diana Ferraro, Massimiliano Calabrese, G. De Luca, R Lanzillo, Paolo Ragonese, Paola Cavalla, S. Lo Fermo, C. Gasperini, Marcello Moccia, C. Tortorella, Viviana Nociti, Valentina Camera, Ferraro, D., Annovazzi, P., Lanzillo, R., Calabrese, M., Fantozzi, R., De Luca, G., Cordioli, C., Paolicelli, D., Ragonese, P., Gajofatto, A., Lo Fermo, S., Cavalla, P., Tortorella, C., Pesci, I., Gallo, A., Pinardi, F., Di Filippo, M., Maniscalco, G. T., Nociti, V., Radaelli, M., Tomassini, V., Buscarinu, M. C., Moccia, M., Camera, V., Cocco, E., Gasperini, C., Solaro, C., Ferraro D., Annovazzi P., Lanzillo R., Calabrese M., Fantozzi R., De Luca G., Cordioli C., Paolicelli D., Ragonese P., Gajofatto A., Lo Fermo S., Cavalla P., Tortorella C., Pesci I., Gallo A., Pinardi F., Di Filippo M., Maniscalco G.T., Nociti V., Radaelli M., Tomassini V., Buscarinu M.C., Moccia M., Camera V., Cocco E., Gasperini C., and Solaro C.
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medicine.medical_specialty ,Multiple Sclerosis ,multiple sclerosis ,trigeminal neuralgia ,Cross-sectional study ,medicine.medical_treatment ,Population ,Microvascular decompression ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,Retrospective Studie ,Trigeminal neuralgia ,Multiple Sclerosi ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,education ,Oxcarbazepine ,Retrospective Studies ,Cross-Sectional Studie ,education.field_of_study ,business.industry ,Multiple sclerosis ,Retrospective cohort study ,Trigeminal Neuralgia ,medicine.disease ,Cross-Sectional Studies ,Treatment Outcome ,Italy ,Neurology ,Multicenter survey ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Human ,medicine.drug - Abstract
The prevalence of trigeminal neuralgia (TN) in patients with Multiple Sclerosis (MS) is higher than in the general population and its management can be particularly challenging due to a number of reasons including high recurrence rates, lack of MS-specific treatment guidelines and uncertainties about pain pathophysiology. Aim of this cross-sectional, multicentre survey was to gather information on the current treatment modalities and options of MS-related TN across 23 Italian MS centres. Initial medical management (carbamazepine or oxcarbazepine) of MS-related TN was fairly homogeneous throughout Italian centres. The most commonly available surgical procedure was microvascular decompression, but the frequency and types of surgical procedures available locally differed considerably throughout MS centers, and were unavailable in one quarter of them. This survey reveals some of the issues that could hamper an optimal patient management and underlines the need for a consensus on MS-related TN to support health-care professionals in their approach to this challenging condition and to facilitate the development of local guidelines aimed at ensuring equity in access to care and treatment optimization.
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- 2021
18. NfL levels predominantly increase at disease onset in MOG-Abs-associated disorders
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Sergio Ferrari, Daniela Alberti, Markus Reindl, Sara Mariotto, Serena Zanzoni, Francesca Calabria, Salvatore Monaco, Romaine Marignier, Kathrin Schanda, Matteo Gastaldi, Alberto Gajofatto, Ruggero Capra, Chiara Rosa Mancinelli, Luisa Grazian, and Diego Franciotta
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Disease onset ,Neurofilament light ,Myelitis ,Optic neuritis ,MOGAD ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,MOG ,030212 general & internal medicine ,Autoantibodies ,biology ,business.industry ,Multiple sclerosis ,General Medicine ,medicine.disease ,Oligodendrocyte ,NfL ,medicine.anatomical_structure ,Neurology ,Immunology ,biology.protein ,Treatment strategy ,Myelin-Oligodendrocyte Glycoprotein ,Neurology (clinical) ,Antibody ,business ,030217 neurology & neurosurgery ,Neurofilament light chain levels - Abstract
The unpredictable course and uncertain impact of relapses make treatment strategies of anti-myelin oligodendrocyte glycoprotein antibodies associated disorders (MOGAD) challenging. We analysed neurofilament light chain levels (NfL) in onset and follow-up sera of 18 patients with MOGAD to clarify the timing of axonal damage. In comparison with disease onset values (median 8.9 pg/mL, range 1.8-97), NfL levels remained stable or decreased in most follow-up measurements (n=52, median 6.7 pg/mL, range 0.2-207), including those measured on relapses. The predominant axonal damage occurs during onset, which could be the main driving factor of final disability, with subsequent relevant clinical and therapeutic implications.
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- 2021
19. A multicentRE observational analysiS of PErsistenCe to Treatment in the new multiple sclerosis era: the RESPECT study
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Massimiliano Calabrese, Eleonora Cocco, Roberta Fantozzi, Viviana Nociti, Antonio Gallo, Laura Boffa, Alice Laroni, Claudio Solaro, Valentina Torri Clerici, Giancarlo Coghe, Simona Malucchi, Massimiliano Di Filippo, Valentina Tomassini, Marcello Moccia, Pietro Annovazzi, Federica Pinardi, Carla Tortorella, Paola Cavalla, Ilaria Pesci, Luca Prosperini, Giorgia Teresa Maniscalco, Alberto Gajofatto, Claudio Gasperini, Roberta Lanzillo, Fabio Buttari, Paolo Ragonese, Marta Radaelli, Maria Chiara Buscarinu, Lanzillo, Roberta, Prosperini, Luca, Gasperini, Claudio, Moccia, Marcello, Fantozzi, Roberta, Tortorella, Carla, Nociti, Viviana, Annovazzi, Pietro, Cavalla, Paola, Radaelli, Marta, Malucchi, Simona, Clerici, Valentina Torri, Boffa, Laura, Buttari, Fabio, Ragonese, Paolo, Maniscalco, Giorgia Teresa, Di Filippo, Massimiliano, Buscarinu, Maria Chiara, Pinardi, Federica, Gallo, Antonio, Coghe, Giancarlo, Pesci, Ilaria, Laroni, Alice, Gajofatto, Alberto, Calabrese, Massimiliano, Tomassini, Valentina, Cocco, Eleonora, Solaro, Claudio, Lanzillo R., Prosperini L., Gasperini C., Moccia M., Fantozzi R., Tortorella C., Nociti V., Annovazzi P., Cavalla P., Radaelli M., Malucchi S., Clerici V.T., Boffa L., Buttari F., Ragonese P., Maniscalco G.T., Di Filippo M., Buscarinu M.C., Pinardi F., Gallo A., Coghe G., Pesci I., Laroni A., Gajofatto A., Calabrese M., Tomassini V., Cocco E., and Solaro C.
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Male ,Injection ,Time Factors ,Patient Dropout ,disease-modifying therapies ,multiple sclerosis ,outcome measurement ,persistence to treatment ,quality of life ,Administration, Oral ,Self Administration ,Sex Factor ,Kaplan-Meier Estimate ,Relapsing-Remitting ,Immunologic Factor ,0302 clinical medicine ,Quality of life ,Retrospective Studie ,Risk Factors ,Medicine ,030212 general & internal medicine ,Disease-modifying therapie ,Disease-modifying therapies, Multiple sclerosis, Outcome measurement, Persistence to treatment, Quality of life, Administration, Oral, Adult ,Female, Follow-Up Studies, Humans, Immunologic Factors, Injections, Kaplan-Meier Estimate,Male, Multiple Sclerosis, Relapsing-Remitting, Patient Dropouts, Prognosis, Proportional Hazards Models, Retrospective Studies, Risk Factors, Self Administration, Sex Factors, Time Factors ,Hazard ratio ,Prognosis ,Neurology ,Tolerability ,Administration ,Settore MED/26 - Neurologia ,Female ,Human ,Oral ,Adult ,medicine.medical_specialty ,Patient Dropouts ,Time Factor ,Prognosi ,Follow-Up Studie ,Injections ,03 medical and health sciences ,Route of administration ,Multiple Sclerosis, Relapsing-Remitting ,Sex Factors ,Internal medicine ,Humans ,Immunologic Factors ,Multiple sclerosi ,Adverse effect ,Proportional Hazards Models ,Retrospective Studies ,business.industry ,Proportional hazards model ,Risk Factor ,Retrospective cohort study ,Discontinuation ,Disease-modifying therapies ,Multiple sclerosis ,Outcome measurement ,Persistence to treatment ,Follow-Up Studies ,Proportional Hazards Model ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
In this independent, multicenter, retrospective study, we investigated the short-term persistence to treatment with first-line self-injectable or oral disease-modifying treatments (DMTs) in patients with relapsing–remitting multiple sclerosis. Data of patients regularly attending 21 Italian MS Centres who started a self-injectable or an oral DMT in 2015 were collected to: (1) estimate the proportion of patients discontinuing the treatment; (3) explore reasons for discontinuation; (3) identify baseline predictors of treatment discontinuation over a follow-up period of 12months. We analyzed data of 1832 consecutive patients (1289 women, 543 men); 374 (20.4%) of them discontinued the prescribed DMT after a median time of 6 months (range 3days to 11.5months) due to poor tolerability (n = 163; 43.6%), disease activity (n = 95; 25.4%), adverse events (n = 64; 17.1%), convenience (i.e. availability of new drug formulations) and pregnancy planning (n = 21; 1.1%). Although the proportion of discontinuers was higher with self-injectable (n = 107; 22.9%) than with oral DMT (n = 215; 16.4%), the Cox regression model revealed no significant between-group difference (p = 0.12). Female sex [hazard ratio (HR) = 1.39, p = 0.01] and previous exposure to ≥ 3 DMTs (HR = 1.71, p = 0.009) were two independent risk factors for treatment discontinuation, regardless of prescribed DMTs. Our study confirms that persistence to treatment represents a clinical challenge, irrespective of the route of administration.
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- 2018
20. Neurofilament light chain in demyelinating conditions of the central nervous system: a promising biomarker
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Alberto Gajofatto, Silvia Bozzetti, Sergio Ferrari, and Sara Mariotto
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Pathology ,medicine.medical_specialty ,biology ,business.industry ,Multiple sclerosis ,Neurofilament light ,Immunology ,Central nervous system ,medicine.disease ,Myelin oligodendrocyte glycoprotein ,medicine.anatomical_structure ,Neurology ,Neuromyelitis Optica Spectrum Disorders ,biology.protein ,Medicine ,Biomarker (medicine) ,Neurology (clinical) ,business - Published
- 2020
21. Up-regulated serum miR-128-3p in progressive and relapse-free multiple sclerosis patients
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Giulia Rossetti, Elisa Orlandi, Marco Turatti, Macarena Gomez Lira, Massimiliano Calabrese, Mattia Zanoni, and Alberto Gajofatto
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Adult ,Male ,medicine.medical_specialty ,mir-128-3p ,multiple sclerosis ,biomarkers ,serum ,disease activity ,disease progression ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Downregulation and upregulation ,Recurrence ,Internal medicine ,microRNA ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Circulating MicroRNA ,business.industry ,Multiple sclerosis ,General Medicine ,Middle Aged ,medicine.disease ,University hospital ,MicroRNAs ,Neurology ,Biomarker (medicine) ,Female ,Neurology (clinical) ,Sample collection ,business ,030217 neurology & neurosurgery - Abstract
Background Circulating microRNAs have emerged as novel multiple sclerosis (MS) biomarkers. Aims To assess the association between candidate miR expression in serum samples of patients with MS and the disease course. Methods Serum levels of ten microRNAs (ie, miR-199, miR-128-3p, miR-20a-5p, miR-27a-3p, miR-15b-5p, miR-325, miR-92a1-5p, miR-223-5p, miR-22-5p, and miR-23a-5p) were measured in 74 MS cases and 17 non-MS controls consecutively enrolled at Verona University Hospital. The association of microRNA expression with patients' clinical and MRI features was analyzed. Candidate microRNAs were detected by real-time PCR and expressed as ratio of each microRNA level to a normalizer. Results Serum miR-128-3p levels were higher in progressive than relapsing MS (median ratio 2.86 vs 0.73, P = .036). In addition, miR-128-3p was upregulated in patients without relapses after sample collection compared to cases who relapsed (1.64 vs 0.82; P = .014). miR-128-3p levels and relapse rate were inversely correlated (r = -.44, P = .008). Conclusions Serum levels of mir-128-3p could be related to biological mechanisms underlying MS activity and progression.
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- 2020
22. Inflammatory intrathecal profiles and cortical damage in multiple sclerosis
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Massimiliano Calabrese, Owain W. Howell, Marco Pitteri, Chiara Romualdi, Marco Castellaro, Richard Reynolds, Stefania Rossi, Alberto Gajofatto, Richard Nicholas, Ruggero Capra, Francesca B. Pizzini, Francesco Facchiano, Carolina Cruciani, Alessandra Bertoldo, Sarah Rasia, Maria Donata Benedetti, Salvatore Monaco, Roberta Magliozzi, and Stefania Montemezzi
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0301 basic medicine ,Pathology ,medicine.medical_specialty ,business.industry ,Multiple sclerosis ,medicine.medical_treatment ,Meninges ,medicine.disease ,Proinflammatory cytokine ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Cerebrospinal fluid ,medicine.anatomical_structure ,Cytokine ,Neurology ,medicine ,CXCL10 ,Tumor necrosis factor alpha ,Neurology (clinical) ,CXCL13 ,business ,030217 neurology & neurosurgery - Abstract
Objective Gray matter (GM) damage and meningeal inflammation have been associated with early disease onset and a more aggressive disease course in multiple sclerosis (MS), but can these changes be identified in the patient early in the disease course? Methods To identify possible biomarkers linking meningeal inflammation, GM damage, and disease severity, gene and protein expression were analyzed in meninges and cerebrospinal fluid (CSF) from 27 postmortem secondary progressive MS and 14 control cases. Combined cytokine/chemokine CSF profiling and 3T magnetic resonance imaging (MRI) were performed at diagnosis in 2 independent cohorts of MS patients (35 and 38 subjects) and in 26 non-MS patients. Results Increased expression of proinflammatory cytokines (IFNγ, TNF, IL2, and IL22) and molecules related to sustained B-cell activity and lymphoid-neogenesis (CXCL13, CXCL10, LTα, IL6, and IL10) was detected in the meninges and CSF of postmortem MS cases with high levels of meningeal inflammation and GM demyelination. Similar proinflammatory patterns, including increased levels of CXCL13, TNF, IFNγ, CXCL12, IL6, IL8, and IL10, together with high levels of BAFF, APRIL, LIGHT, TWEAK, sTNFR1, sCD163, MMP2, and pentraxin III, were detected in the CSF of MS patients with higher levels of GM damage at diagnosis. Interpretation A common pattern of intrathecal (meninges and CSF) inflammatory profile strongly correlates with increased cortical pathology, both at the time of diagnosis and at death. These results suggest a role for detailed CSF analysis combined with MRI as a prognostic marker for more aggressive MS. Ann Neurol 2018 Ann Neurol 2018;83:739-755.
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- 2018
23. 2017 McDonald criteria for multiple sclerosis: Earlier diagnosis with reduced specificity?
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Laura Crestani, Riccardo Orlandi, Maria Donata Benedetti, Mattia Zanoni, Alberto Gajofatto, Antonio Marangi, and Francesca Gobbin
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Adult ,Male ,multiple sclerosis (MS) ,diagnosis ,McDonald criteria ,2017 revision ,sensitivity ,specificity ,medicine.medical_specialty ,Multiple Sclerosis ,Sensitivity and Specificity ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Retrospective Studies ,business.industry ,Multiple sclerosis ,Disease progression ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Early Diagnosis ,Neurology ,Practice Guidelines as Topic ,Disease Progression ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background McDonald criteria for multiple sclerosis (MS) diagnosis were revised in 2017. Objective Aim of our study was to evaluate and compare the sensitivity and specificity of 2017 and 2010 McDonald criteria in patients presenting with an initial demyelinating event (IDE). Methods We retrospectively identified patients with an IDE and collected clinical, MRI and CSF data in order to demonstrate fulfilment of 2010 and 2017 McDonald criteria. Results 2017 McDonald criteria showed 100% (86.8–100%) sensitivity and 13.8% (3.9–31.7%) specificity. Conclusion 2017 McDonald criteria appear to have higher sensitivity but reduced specificity compared to 2010 McDonald criteria.
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- 2019
24. Brain volume measures in adults with MOG-antibody associated disease: A longitudinal multicentre study
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Marco Zoccarato, Marco Turatti, Diana Ferraro, Luigi Zuliani, Francesca Rossi, Riccardo Orlandi, Chiara Rosa Mancinelli, Alberto Gajofatto, Francesca Gobbin, and Sara Mariotto
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Neurology ,biology ,business.industry ,Brain size ,Immunology ,biology.protein ,Medicine ,Neurology (clinical) ,Disease ,Antibody ,business - Published
- 2021
25. Sativex in resistant multiple sclerosis spasticity: Discontinuation study in a large population of Italian patients (SA.FE. study)
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Silvia Messina, Claudio Solaro, Isabella Righini, Roberto Bergamaschi, Simona Bonavita, Roberto Bruno Bossio, Vincenzo Brescia Morra, Gianfranco Costantino, Paola Cavalla, Diego Centonze, Giancarlo Comi, Salvatore Cottone, Maura Chiara Danni, Ada Francia, Alberto Gajofatto, Claudio Gasperini, Mauro Zaffaroni, Loredana Petrucci, Elisabetta Signoriello, Giorgia Teresa Maniscalco, Gabriella Spinicci, Manuela Matta, Massimiliano Mirabella, Graziella Pedà, Letizia Castelli, Marco Rovaris, Edoardo Sessa, Daniele Spitaleri, Damiano Paolicelli, Alfredo Granata, Mario Zappia, Francesco Patti, SA.FE. study group, Messina, S, Solaro, C, Righini, I, Bergamaschi, R, Bonavita, S, Bossio, Rb, Brescia Morra, V, Costantino, G, Cavalla, P, Centonze, D, Comi, G, Cottone, S, Danni, Mc, Francia, A, Gajofatto, A, Gasperini, C, Zaffaroni, M, Petrucci, L, Signoriello, E, Maniscalco, Gt, Spinicci, G, Matta, M, Mirabella, M, Pedà, G, Castelli, L, Rovaris, M, Sessa, E, Spitaleri, D, Paolicelli, D, Granata, A, Zappia, M, Patti, F., Messina, Silvia, Solaro, Claudio, Righini, Isabella, Bergamaschi, Roberto, Bonavita, Simona, Bossio, Roberto Bruno, Brescia Morra, Vincenzo, Costantino, Gianfranco, Cavalla, Paola, Centonze, Diego, Comi, Giancarlo, Cottone, Salvatore, Danni, Maura Chiara, Francia, Ada, Gajofatto, Alberto, Gasperini, Claudio, Zaffaroni, Mauro, Petrucci, Loredana, Signoriello, Elisabetta, Maniscalco, Giorgia Teresa, Spinicci, Gabriella, Matta, Manuela, Mirabella, Massimiliano, Pedà, Graziella, Castelli, Letizia, Rovaris, Marco, Sessa, Edoardo, Spitaleri, Daniele, Paolicelli, Damiano, Granata, Alfredo, Zappia, Mario, Patti, Francesco, Morra, Vincenzo Brescia, and Pedã , Graziella
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Registrie ,Genetics and Molecular Biology (all) ,Male ,Economics ,Social Sciences ,Drug research and development ,Biochemistry ,Severity of Illness Index ,0302 clinical medicine ,Multiple Sclerosi ,80 and over ,Ethnicities ,Medicine ,Dronabinol ,lcsh:Science ,Drug Approval ,Aged, 80 and over ,evaluation ,Sativex ,multiple sclerosis spasticity ,discontinuation ,effectiveness ,Drug Combinations ,Neurology ,Italy ,Regression Analysis ,Human ,medicine.medical_specialty ,Multiple Sclerosis ,Drug Industry ,Immunology ,Plant Extract ,03 medical and health sciences ,Health Economics ,Pharmacotherapy ,Drug Therapy ,Severity of illness ,Humans ,Spasticity ,Adult ,Aged ,Cannabidiol ,Cost Sharing ,Drug Costs ,Female ,Kaplan-Meier Estimate ,Middle Aged ,Multivariate Analysis ,Muscle Spasticity ,Parasympatholytics ,Plant Extracts ,Proportional Hazards Models ,Registries ,Young Adult ,Biochemistry, Genetics and Molecular Biology (all) ,Agricultural and Biological Sciences (all) ,Adverse effect ,Demography ,Pharmacology ,Proportional hazards model ,Parasympatholytic ,lcsh:R ,Biology and Life Sciences ,Management of multiple sclerosis ,medicine.disease ,Discontinuation ,Health Care ,Proportional Hazards Model ,Population Groupings ,lcsh:Q ,Clinical Medicine ,030217 neurology & neurosurgery ,Multivariate analysis ,lcsh:Medicine ,Medicine (all) ,Geographical Locations ,Clinical trials ,Drug Combination ,Medicine and Health Sciences ,030212 general & internal medicine ,Multivariate Analysi ,Drug Cost ,Multidisciplinary ,Pharmaceutics ,Neurodegenerative Diseases ,Italian People ,Phase III clinical investigation ,Europe ,Settore MED/26 - NEUROLOGIA ,Research Design ,medicine.symptom ,Research Article ,Clinical Research Design ,Research and Analysis Methods ,Settore MED/26 ,Regression Analysi ,Autoimmune Diseases ,Internal medicine ,business.industry ,Demyelinating Disorders ,People and Places ,Physical therapy ,Clinical Immunology ,Adverse Events ,business - Abstract
Background The approval of Sativex for the management of multiple sclerosis (MS) spasticity opened a new opportunity to many patients. In Italy, the healthcare payer can be fully reimbursed by the involved pharma company with the cost of treatment for patients not responding after a 4 week (28 days) trial period (Payment by Results, PbR), and 50% reimbursed with the cost of 6 weeks (42 days) treatment for other patients discontinuing (Cost Sharing, CS). The aim of our study was to describe the Sativex discontinuation profile from a large population of spasticity treated Italian MS patients. Methods We collected data of patients from 30 MS centres across the country starting Sativex between January 2014 and February 2015. Data were collected from the mandatory Italian Medicines Agency (AIFA) web-registry. Predictors of treatment discontinuation were assessed using a multivariate Cox proportional regression analysis. Results During the observation period 631 out of 1597 (39.5%) patients discontinued Sativex. The Kaplan-Meier estimates curve showed that 333 patients (20.8%) discontinued treatment at 4 weeks while 422 patients (26.4%) discontinued at 6 weeks. We found after adjusted modeling that a higher NRS score at T1 (adjHR 2.23, 95% 2.07–2.41, p
- Published
- 2017
26. What Is the Role of the Placebo Effect for Pain Relief in Neurorehabilitation? Clinical Implications From the Italian Consensus Conference on Pain in Neurorehabilitation
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Castelnuovo, Gianluca, Giusti, Emanuele Maria, Manzoni, Gian Mauro, Saviola, Donatella, Gabrielli, Samantha, Lacerenza, Marco, Pietrabissa, Giada, Cattivelli, Roberto, Maria Spatola, Chiara Anna, Rossi, Alessandro, Varallo, Giorgia, Novelli, Margherita, Villa, Valentina, Luzzati, Francesca, Cottini, Andrea, Lai, Carlo, Volpato, Eleonora, Cavalera, Cesare, Pagnini, Francesco, Tesio, Valentina, Castelli, Lorys, Tavola, Mario, Torta, Riccardo, Arreghini, Marco, Zanini, Loredana, Brunani, Amelia, Seitanidis, Ionathan, Ventura, Giuseppe, Capodaglio, Paolo, D'Aniello, Guido Edoardo, Scarpina, Federica, Brioschi, Andrea, Bigoni, Matteo, Priano, Lorenzo, Mauro, Alessandro, Riva, Giuseppe, Di Lernia, Daniele, Repetto, Claudia, Regalia, Camillo, Molinari, Enrico, Notaro, Paolo, Paolucci, Stefano, Sandrini, Giorgio, Simpson, Susan, Wiederhold, Brenda Kay, Gaudio, Santino, Jackson, Jeffrey B., Tamburin, Stefano, Benedetti, Fabrizio, Agostini, Michela, Alfonsi, Enrico, Aloisi, Anna Maria, Alvisi, Elena, Aprile, Irene, Armando, Michela, Avenali, Micol, Azicnuda, Eva, Barale, Francesco, Bartolo, Michelangelo, Bergamaschi, Roberto, Berlangieri, Mariangela, Berlincioni, Vanna, Berliocchi, Laura, Berra, Eliana, Berto, Giulia, Bonadiman, Silvia, Bonazza, Sara, Bressi, Federica, Brugnera, Annalisa, Brunelli, Stefano, Buzzi, Maria Gabriella, Cacciatori, Carlo, Calvo, Andrea, Cantarella, Cristina, Caraceni, Augusto, Carone, Roberto, Carraro, Elena, Casale, Roberto, Castellazzi, Paola, Castino, Adele, Cerbo, Rosanna, Chiò, Adriano, Ciotti, Cristina, Cisari, Carlo, Coraci, Daniele, Dalla Toffola, Elena, Defazio, Giovanni, De Icco, Roberto, Del Carro, Ubaldo, Dell'Isola, Andrea, De Tanti, Antonio, D'Ippolito, Mariagrazia, Fazzi, Elisa, Ferrari, Adriano, Ferrari, Sergio, Ferraro, Francesco, Formaglio, Fabio, Formisano, Rita, Franzoni, Simone, Gajofatto, Francesca, Gandolfi, Marialuisa, Gardella, Barbara, Geppetti, Pierangelo, Giammò, Alessandro, Gimigliano, Raffaele, Greco, Elena, Ieraci, Valentina, Invernizzi, Marco, Jacopetti, Marco, La Cesa, Silvia, Lobba, Davide, Magrinelli, Francesca, Mandrini, Silvia, Manera, Umberto, Marchettini, Paolo, Marchioni, Enrico, Mariotto, Sara, Martinuzzi, Andrea, Masciullo, Marella, Mezzarobba, Susanna, Miotti, Danilo, Modenese, Angela, Molinari, Marco, Monaco, Salvatore, Morone, Giovanni, Nappi, Rossella, Negrini, Stefano, Pace, BIAGIO ANDREA, Padua, Luca, Pagliano, Emanuela, Palmerini, Valerio, Pazzaglia, Costanza, Pecchioli, Cristiano, Picelli, Alessandro, Porro, CARLO ADOLFO, Porru, Daniele, Romano, Marcello, Roncari, Laura, Rosa, Riccardo, Saccavini, Marsilio, Sacerdote, Paola, Schenone, Angelo, Schweiger, Vittorio, Scivoletto, Giorgio, Smania, Nicola, Solaro, Claudio, Spallone, Vincenza, Springhetti, Isabella, Tassorelli, Cristina, Tinazzi, Michele, Togni, Rossella, Torre, Monica, Traballesi, Marco, Tramontano, Marco, Truini, Andrea, Tugnoli, Valeria, Turolla, Andrea, Vallies, Gabriella, Verzini, Elisabetta, Vottero, Mario, Zerbinati, Paolo, Castelnuovo, Gianluca, Giusti, Emanuele Maria, Manzoni, Gian Mauro, Saviola, Donatella, Gabrielli, Samantha, Lacerenza, Marco, Pietrabissa, Giada, Cattivelli, Roberto, Maria Spatola, Chiara Anna, Rossi, Alessandro, Varallo, Giorgia, Novelli, Margherita, Villa, Valentina, Luzzati, Francesca, Cottini, Andrea, Lai, Carlo, Volpato, Eleonora, Cavalera, Cesare, Pagnini, Francesco, Tesio, Valentina, Castelli, Lory, Tavola, Mario, Torta, Riccardo, Arreghini, Marco, Zanini, Loredana, Brunani, Amelia, Seitanidis, Ionathan, Ventura, Giuseppe, Capodaglio, Paolo, D'Aniello, Guido Edoardo, Scarpina, Federica, Brioschi, Andrea, Bigoni, Matteo, Priano, Lorenzo, Mauro, Alessandro, Riva, Giuseppe, Di Lernia, Daniele, Repetto, Claudia, Regalia, Camillo, Molinari, Enrico, Notaro, Paolo, Paolucci, Stefano, Sandrini, Giorgio, Simpson, Susan, Wiederhold, Brenda Kay, Gaudio, Santino, Jackson, Jeffrey B., Tamburin, Stefano, Benedetti, Fabrizio, Agostini, Michela, Alfonsi, Enrico, Aloisi, Anna Maria, Alvisi, Elena, Aprile, Irene, Armando, Michela, Avenali, Micol, Azicnuda, Eva, Barale, Francesco, Bartolo, Michelangelo, Bergamaschi, Roberto, Berlangieri, Mariangela, Berlincioni, Vanna, Berliocchi, Laura, Berra, Eliana, Berto, Giulia, Bonadiman, Silvia, Bonazza, Sara, Bressi, Federica, Brugnera, Annalisa, Brunelli, Stefano, Buzzi, Maria Gabriella, Cacciatori, Carlo, Calvo, Andrea, Cantarella, Cristina, Caraceni, Augusto, Carone, Roberto, Carraro, Elena, Casale, Roberto, Castellazzi, Paola, Castino, Adele, Cerbo, Rosanna, Chiò, Adriano, Ciotti, Cristina, Cisari, Carlo, Coraci, Daniele, Dalla Toffola, Elena, Defazio, Giovanni, De Icco, Roberto, Del Carro, Ubaldo, Dell'Isola, Andrea, De Tanti, Antonio, D'Ippolito, Mariagrazia, Fazzi, Elisa, Ferrari, Adriano, Ferrari, Sergio, Ferraro, Francesco, Formaglio, Fabio, Formisano, Rita, Franzoni, Simone, Gajofatto, Francesca, Gandolfi, Marialuisa, Gardella, Barbara, Geppetti, Pierangelo, Giammò, Alessandro, Gimigliano, Raffaele, Greco, Elena, Ieraci, Valentina, Invernizzi, Marco, Jacopetti, Marco, La Cesa, Silvia, Lobba, Davide, Magrinelli, Francesca, Mandrini, Silvia, Manera, Umberto, Marchettini, Paolo, Marchioni, Enrico, Mariotto, Sara, Martinuzzi, Andrea, Masciullo, Marella, Mezzarobba, Susanna, Miotti, Danilo, Modenese, Angela, Molinari, Marco, Monaco, Salvatore, Morone, Giovanni, Nappi, Rossella, Negrini, Stefano, Pace, Andrea, Padua, Luca, Pagliano, Emanuela, Palmerini, Valerio, Pazzaglia, Costanza, Pecchioli, Cristiano, Picelli, Alessandro, Porro, Carlo Adolfo, Porru, Daniele, Romano, Marcello, Roncari, Laura, Rosa, Riccardo, Saccavini, Marsilio, Sacerdote, Paola, Schenone, Angelo, Schweiger, Vittorio, Scivoletto, Giorgio, Smania, Nicola, Solaro, Claudio, Spallone, Vincenza, Springhetti, Isabella, Tassorelli, Cristina, Tinazzi, Michele, Togni, Rossella, Torre, Monica, Traballesi, Marco, Tramontano, Marco, Truini, Andrea, Tugnoli, Valeria, Turolla, Andrea, Vallies, Gabriella, Verzini, Elisabetta, Vottero, Mario, Zerbinati, Paolo, and Italian Consensus Conference on Pain in Neurorehabilitation
- Subjects
medicine.medical_specialty ,Clinical psychology ,Consensus conference ,Health psychology ,Neurorehabilitation ,Pain ,Placebo ,Placebo effect ,Neurologi ,consensus conference ,Analgesic ,Neurology ,Neurology (clinical) ,Context (language use) ,Review ,Settore M-PSI/08 - PSICOLOGIA CLINICA ,helath psychology ,lcsh:RC346-429 ,03 medical and health sciences ,0302 clinical medicine ,health psychology ,Fibromyalgia ,medicine ,pain ,030212 general & internal medicine ,lcsh:Neurology. Diseases of the nervous system ,neurorehabilitation ,Postherpetic neuralgia ,business.industry ,medicine.disease ,Complex regional pain syndrome ,Neuropathic pain ,placebo ,Physical therapy ,placebo effect ,clinical psychology ,business ,030217 neurology & neurosurgery ,Neuroscience - Abstract
Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy. Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy.
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- 2018
27. Clinical spectrum and IgG subclass analysis of anti-myelin oligodendrocyte glycoprotein antibody-associated syndromes: a multicenter study
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Nicola De Rossi, Maria Donata Benedetti, Marco Zoccarato, Antonino Pavone, Marco Turatti, Luigi Zuliani, Luisa Grazian, Markus Reindl, Daniela Alberti, GianPietro Sechi, Alessia Farinazzo, Roberto Bombardi, Massimiliano Calabrese, Elia Sechi, Luciano Deotto, Sara Mariotto, Sergio Ferrari, Alberto Polo, Kathrin Schanda, Raffaella Tanel, Morena Cadaldini, Rachele Delogu, Ruggero Capra, Daniele Urso, Chiara Rosa Mancinelli, Gaetano Cantalupo, Alberto Gajofatto, Francesco Janes, Maria Rachele Bianchi, Adriana Bonora, and Salvatore Monaco
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Male ,0301 basic medicine ,Pathology ,Optic neuritis ,Demyelinating Autoimmune Diseases, CNS ,Subclass ,Cohort Studies ,0302 clinical medicine ,immune system diseases ,Image Processing, Computer-Assisted ,Anti-myelin oligodendrocyte glycoprotein (MOG) antibodies ,Original Communication ,biology ,medicine.diagnostic_test ,Brain ,Middle Aged ,Myelitis ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Italy ,Spinal Cord ,Neurology ,Female ,Antibody ,Adult ,medicine.medical_specialty ,Neuropathology ,Immunofluorescence ,Myelin oligodendrocyte glycoprotein ,Young Adult ,03 medical and health sciences ,medicine ,Humans ,Neuromyelitis optica spectrum disorders (NMOSD) ,business.industry ,medicine.disease ,Multiple sclerosis (MS) ,Oligodendrocyte ,nervous system diseases ,030104 developmental biology ,nervous system ,Immunoglobulin G ,Immunology ,biology.protein ,Acute disseminated encephalomyelitis (ADEM) ,Myelin-Oligodendrocyte Glycoprotein ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Anti-myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) recently emerged as a potential biomarker in patients with inflammatory demyelinating diseases of the central nervous system. We here compare the clinical and laboratory findings observed in a cohort of MOG-Ab seropositive and seronegative cases and describe IgG subclass analysis results. Consecutive serum samples referred to Verona University Neuropathology Laboratory for aquaporin-4 (AQP4)-Ab and/or MOG-Ab testing were analysed between March 2014 and May 2017. The presence of AQP4-Ab was determined using a cell-based assay. A live cell immunofluorescence assay was used for the detection of MOG-IgG and IgG subclass analysis. Among 454 analysed samples, 29 were excluded due to AQP4-Ab positivity or to the final demonstration of a disorder not compatible with MOG-Ab. We obtained clinical data in 154 out of 425 cases. Of these, 22 subjects resulted MOG-Ab positive. MOG-Ab positive patients were mainly characterised by the involvement of the optic nerve and/or spinal cord. Half of the cases presented relapses and the recovery was usually partial. Brain MRI was heterogeneous while short lesions were the prevalent observation on spinal cord MRI. MOG-Ab titre usually decreased in non-relapsing cases. In all MOG-IgG positive cases, we observed IgG1 antibodies, which were predominant in most subjects. IgG2 (5/22), IgG3 (9/22) and IgG4 (3/22) antibodies were also detectable. We confirm that MOG-Ab-related syndromes have distinct features in the spectrum of demyelinating conditions, and we describe the possible role of the different IgG subclasses in this condition. Electronic supplementary material The online version of this article (doi:10.1007/s00415-017-8635-4) contains supplementary material, which is available to authorized users.
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- 2017
28. HPV-related papillary squamous cell carcinoma of the tonsil during treatment with fingolimod
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Maria Donata Benedetti, Maurizio Pea, Stelio Mocella, Alberto Gajofatto, Marco Turatti, Antonio Marangi, Francesca Gobbin, and Silvia Bozzetti
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Male ,Oncology ,medicine.medical_specialty ,Fingolimod ,human papillomavirus ,multiple sclerosis ,oropharyngeal carcinoma ,medicine.medical_treatment ,Tonsillar Neoplasms ,Disease ,Palatine tonsil ,Immunocompromised Host ,03 medical and health sciences ,Multiple Sclerosis, Relapsing-Remitting ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Human papillomavirus 16 ,Fingolimod Hydrochloride ,business.industry ,Multiple sclerosis ,Papillomavirus Infections ,HPV infection ,General Medicine ,Middle Aged ,medicine.disease ,Tonsillectomy ,medicine.anatomical_structure ,Neurology ,Oropharyngeal Carcinoma ,030220 oncology & carcinogenesis ,Tonsil ,Carcinoma, Squamous Cell ,Neurology (clinical) ,business ,Immunosuppressive Agents ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Fingolimod is a commonly used treatment for highly active relapsing-remitting multiple sclerosis (MS). We describe the case of a 50-year old man on fingolimod since 2011 who presented, in April 2017, with a voluminous swelling of the left tonsil. A left tonsillectomy was performed, and histological exam disclosed a papillary squamous cell carcinoma of the palatine tonsil, with an in situ hybridization positive for human papillomavirus (HPV)-16 DNA. Neither lymph nodes involvement nor other metastases were detected. Fingolimod was stopped as a precautionary measure in May 2017, and the patient currently continues his follow up at our Department. Immunocompromised patients are at risk for developing HPV-related malignancies probably in light of the suppression of T-cell immunity, therefore an increased risk for HPV activation in MS patients treated with disease modifying therapies (DMTs) characterized by a more pronounced immunosuppressant activity cannot be excluded. Given the absence of studies on larger cohorts of MS patients exposed to DMTs, additional monitoring for HPV infection during fingolimod treatment is not currently recommended. However, vigilance for this possible association is warranted.
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- 2018
29. A case of multiple sclerosis and necrotizing autoimmune myopathy with anti-SRP antibodies
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Antonio Marangi, Francesca Gobbin, Damiano Marastoni, Flavio Guiotto, Maria Donata Benedetti, Paola Tonin, and Alberto Gajofatto
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Male ,Pathology ,medicine.medical_specialty ,Multiple Sclerosis ,Necrotizing myopathy ,Corticotropin-Releasing Hormone ,Azathioprine ,Neurological examination ,Autoimmune myopathy ,Autoimmune Diseases ,Necrosis ,03 medical and health sciences ,0302 clinical medicine ,Muscular Diseases ,Anti-SRP ,medicine ,Humans ,Urocortins ,Autoantibodies ,030203 arthritis & rheumatology ,Muscle biopsy ,medicine.diagnostic_test ,biology ,business.industry ,Multiple sclerosis ,General Medicine ,Middle Aged ,medicine.disease ,Spinal cord ,medicine.anatomical_structure ,Neurology ,Concomitant ,biology.protein ,Neurology (clinical) ,Antibody ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Only few reports exist regarding the coexistence of multiple sclerosis (MS) and autoimmune myopathies. We describe the case of a man with a long history of undiagnosed left lower limb motor impairment who was hospitalized for subacute onset of a myopathic syndrome. In addition, neurological examination revealed sensory impairment and pyramidal signs in the left limbs. Muscle biopsy revealed a necrotizing myopathy and serum anti-signal recognition particle (SRP) antibodies were found. Brain and spinal cord MRI displayed several non-enhancing demyelinating lesions, and CSF-restricted oligoclonal bands were detected. Multimodal evoked potentials showed increased latency of central conduction. Total body PET-CT did not reveal malignancies. A final diagnosis of anti-SRP necrotizing autoimmune myopathy (NAM) and MS was made, and subsequent therapy with azathioprine resulted in a complete stability for both diseases during the follow up. To the best of our knowledge this is the first reported case of concomitant NAM and MS.
- Published
- 2018
30. Changing therapeutic strategies and persistence to disease-modifying treatments in a population of multiple sclerosis patients from Veneto region, Italy
- Author
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Virginia Vicenzi, Maria Donata Benedetti, Antonio Marangi, Marika Vianello, Gianola Stenta, Gabriele Farina, Antonio Forgione, Francesca Calabria, Stefano Forlivesi, Fabio Marchioretto, Alberto Gajofatto, and Francesca Rossi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Multiple Sclerosis ,Time Factors ,Epidemiology ,Persistence to treatment ,Dimethyl Fumarate ,Population ,Drug Prescriptions ,Persistence (computer science) ,Medication Adherence ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Azathioprine ,medicine ,Humans ,Immunologic Factors ,030212 general & internal medicine ,Glatiramer acetate ,education ,Observational studies ,education.field_of_study ,business.industry ,Proportional hazards model ,Fingolimod Hydrochloride ,General Medicine ,Glatiramer Acetate ,Middle Aged ,Fingolimod ,Drug Utilization ,Discontinuation ,Italy ,Multiple sclerosis ,Neurology ,Cohort ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Background The availability of new disease-modifying treatments (DMTs) in the last years has changed the therapeutic strategies used in Multiple Sclerosis (MS). We aimed to describe trend in DMTs utilization and persistence to treatment in a large sample of patients attending 10 MS centres from four provinces of Veneto, Italy. Methods Demographic, clinical and DMTs information of patients regularly followed from January 2011 to August 2018 were recorded and analysed. Persistence at 12, 24 months and at last follow-up was assessed by Kaplan Meier survival analysis. Multivariable Cox- proportional hazard model was used to identify predictors of persistence. Results Of 3025 MS patients 65.7% were in treatment al last follow-up. Dimethylfumarate (DMF) was the most prescribed single drug among first-line and fingolimod among second-line DMTs. In the cohort of 1391 cases starting any DMT since 2011 12.9% stopped within 6 months, 24% within 12 and 40.3% within 24 months. Disease duration > 5 years at therapy start was predictive of greater risk of discontinuation, while age and sex were not. DMF use was predictive of higher persistence at 12 and 24 months, but not at last follow-up when azathioprine and glatiramer acetate showed the highest persistence compared to other DMTs. Side effects represented the main reason of discontinuation. Conclusion The use of the new oral DMTs greatly increased since their approval but persistence in the long-term is not better than with old drugs. The treatment choice is still a challenge both for patients and their doctors.
- Published
- 2019
31. Serum and CSF neurofilament light chain levels in antibody-mediated encephalitis
- Author
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Francesca Piardi, Alberto Gajofatto, Sara Mariotto, Daniela Alberti, Stefano Sartori, Marco Zoccarato, Gaetano Cantalupo, Diego Franciotta, Luigi Zuliani, Matteo Gastaldi, Gianluigi Zanusso, Salvatore Monaco, Luigi Agrò, GianPietro Sechi, Elia Sechi, Alberto Polo, Sergio Ferrari, and Rita Demurtas
- Subjects
Adult ,Male ,Pathology ,medicine.medical_specialty ,Neurology ,CASPR2 ,Adolescent ,Neurofilament light ,Autoimmune encephalitis ,LGI1 ,NMDAR ,Neurofilament light chain ,NfL ,Hashimoto Disease ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Cerebrospinal fluid ,Neurofilament Proteins ,80 and over ,medicine ,Humans ,030212 general & internal medicine ,Preschool ,Child ,Neuroradiology ,Aged ,Retrospective Studies ,Aged, 80 and over ,biology ,business.industry ,Autoantibody ,Middle Aged ,medicine.disease ,Biomarkers ,Child, Preschool ,Encephalitis ,Female ,Follow-Up Studies ,biology.protein ,Neurology (clinical) ,Antibody ,business ,030217 neurology & neurosurgery - Abstract
Circulating and cerebrospinal fluid (CSF) neurofilament light chain (NfL) levels represent a reliable indicator of disease activity and axonal damage in different neuroinflammatory conditions. Recently, high CSF NfL levels have been detected in active autoimmune encephalitis, as opposed to significant lower levels after clinical improvement. The aim of the present study was to evaluate serum and CSF NfL concentration in patients with autoimmune encephalitis and to analyse the association between NfL levels and clinical, MRI, and CSF data. We retrospectively included 25 patients with neurological syndromes associated with autoantibodies to neuronal cell surface antigens and we collected clinical, MRI, CSF, and follow-up data. Using an ultrasensitive method (Simoa, Quanterix), we measured NfL levels in serum and CSF samples of all patients and in 25 sera of healthy controls. Serum NfL levels were higher in all cases, including 20 patients with inflammatory MRI/CSF features and 5 non-inflammatory cases (median 16.9 pg/ml, range 4.5–90) than in controls (median 6.9 pg/ml, range 2.7–12.8; p
- Published
- 2019
32. Increase of CSF inflammatory profile in a case of highly active multiple sclerosis
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Salvatore Monaco, Marco Castellaro, Valentina Mazziotti, Marco Pitteri, Alberto Gajofatto, Roberta Magliozzi, Massimiliano Calabrese, M. D. Benedetti, Damiano Marastoni, and Stefania Rossi
- Subjects
Adult ,medicine.medical_specialty ,Neurology ,Case Report ,CSF ,multiple sclerosis ,lcsh:RC346-429 ,03 medical and health sciences ,biomarkers ,chemokynes ,cytokines ,Multiple Sclerosis, Relapsing-Remitting ,0302 clinical medicine ,Cerebrospinal fluid ,medicine ,Humans ,030212 general & internal medicine ,Interleukin 8 ,CXCL13 ,B-cell activating factor ,lcsh:Neurology. Diseases of the nervous system ,business.industry ,Multiple sclerosis ,General Medicine ,medicine.disease ,Pathophysiology ,Immunology ,Female ,Tumor necrosis factor alpha ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background Clinical and imaging follow-up coupled with cerebrospinal fluid (CSF) and possibly serum profiling could provide information on disease activity and disability evolution in multiple sclerosis patients. Case presentation We describe the case of a relapsing-remitting MS patient whose history was characterized by failure of several therapeutic approaches and sustained disease activity. By using a highly sensitive immunoassay methodology, we examined protein expression of 70 inflammatory/cytotoxic molecules in two consecutive paired CSF and serum samples, obtained respectively in 2006 and 2013. At disease diagnosis, elevated CSF protein levels of an inflammatory pattern, including CXCL13, CXCL12, IFNγ, TNF, sTNFR1, IL8, sCD163, APRIL, BAFF, pentraxin III and MMP2 were found compared with a group of controls. At the second lumbar puncture, sustained disease activity was accompanied by considerable (more than 2 fold changes) increase expression of most of these inflammatory molecules while no significant changes in serum inflammatory markers were detected in the two consecutive serum samples. Conclusions Elevated CSF protein expression of pro-inflammatory mediators, possibly specifically associated to GM demyelination, could remain stable or increase over time in patients with active multiple sclerosis. We underline the role of fluid analysis in understanding the pathophysiology of the disease and providing information on possible markers of disease activity and evolution.
- Published
- 2019
33. Epilepsy in multiple sclerosis: The role of temporal lobe damage
- Author
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Marco Pitteri, Marco Castellaro, S Zimatore, Richard Reynolds, Alberto Gajofatto, Salvatore Monaco, Alessandra Bertoldo, Paolo Manganotti, Stefania Montemezzi, Roberta Magliozzi, Giuseppe Ricciardi, Benedetti, A De Luca, Francesca B. Pizzini, Massimiliano Calabrese, Calabrese, M., Castellaro, M., Bertoldo, A., De Luca, A., Pizzini, F. B., Ricciardi, G. K., Pitteri, M., Zimatore, S., Magliozzi, R., Benedetti, M. D., Manganotti, P., Montemezzi, S., Reynolds, R., Gajofatto, A., and Monaco, S.
- Subjects
0301 basic medicine ,Adult ,Male ,Pathology ,medicine.medical_specialty ,Disease duration ,Hippocampus ,grey matter ,Grey matter ,multiple sclerosis ,Temporal lobe ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,Multiple Sclerosis, Relapsing-Remitting ,Neuroimaging ,medicine ,Image Processing, Computer-Assisted ,Humans ,Multiple sclerosi ,Gray Matter ,neuroimaging ,medicine.diagnostic_test ,Multiple sclerosis ,epilepsy ,temporal lobe ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,030104 developmental biology ,medicine.anatomical_structure ,Neurology ,Female ,Neurology (clinical) ,Psychology ,Neuroscience ,030217 neurology & neurosurgery - 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
34. Antibody response against HERV-W in patients with MOG-IgG associated disorders, multiple sclerosis and NMOSD
- Author
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Giovanni A. Deiana, Salvatore Monaco, Alberto Gajofatto, Marco Bo, Leonardo Antonio Sechi, Elia Sechi, Sergio Ferrari, Ignazio Roberto Zarbo, Sara Mariotto, Giannina Arru, and Gian Pietro Sechi
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Male ,0301 basic medicine ,viruses ,human endogenous retroviruses ,Pregnancy Proteins ,myelin oligodendrocyte glycoprotein ,medicine.disease_cause ,Autoimmunity ,0302 clinical medicine ,immune system diseases ,Immunology and Allergy ,Spectrum disorder ,Aged, 80 and over ,biology ,Neuromyelitis Optica ,autoimmunity ,neuromyelitis optica spectrum disorder ,Middle Aged ,Pathophysiology ,MS ,Neurology ,embryonic structures ,Female ,Antibody ,Adult ,Multiple Sclerosis ,Immunology ,Myelin oligodendrocyte glycoprotein ,03 medical and health sciences ,medicine ,Humans ,Demyelinating Disorder ,Aged ,Autoantibodies ,Retrospective Studies ,Aquaporin 4 ,Neuromyelitis optica ,business.industry ,Multiple sclerosis ,Gene Products, env ,medicine.disease ,nervous system diseases ,030104 developmental biology ,Immunoglobulin G ,biology.protein ,Myelin-Oligodendrocyte Glycoprotein ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Increased expression of the retroviruses of HERV-W family has been linked to multiple sclerosis (MS) pathophysiology; nothing is known at the moment about MOG-IgG associated disorders. We compared antibody response against HERV-W peptides among patients with MOG-IgG associated disorders, multiple sclerosis (MS) and aquaporin-4 (AQP4)-IgG positive neuromyelitis optica spectrum disorder (NMOSD). A total of 102 serum samples were retrospectively analyzed. Antibody reactivity against HERV-W env peptides was similar in MOG-IgG associated disorders and MS, but different from AQP4-IgG positive NMOSD. Our findings expand the diagnostic role of HERV-W antibodies to the spectrum of demyelinating disorders associated with MOG-IgG.
- Published
- 2020
35. Inflammatory intrathecal profiles and cortical damage in multiple sclerosis
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Roberta, Magliozzi, Owain W, Howell, Richard, Nicholas, Carolina, Cruciani, Marco, Castellaro, Chiara, Romualdi, Stefania, Rossi, Marco, Pitteri, Maria Donata, Benedetti, Alberto, Gajofatto, Francesca B, Pizzini, Stefania, Montemezzi, Sarah, Rasia, Ruggero, Capra, Alessandra, Bertoldo, Francesco, Facchiano, Salvatore, Monaco, Richard, Reynolds, Massimiliano, Calabrese, and Parkinson's UK
- Subjects
Adult ,Male ,MENINGEAL INFLAMMATION ,intrathecal inflammatory profile ,Clinical Neurology ,LESION DETECTION ,grey matter ,Neurology ,Neurology (clinical) ,multiple sclerosis ,Cohort Studies ,Meninges ,CEREBROSPINAL-FLUID ,Image Processing, Computer-Assisted ,Humans ,Gray Matter ,cerebrospinal fluid analysis ,Aged ,Aged, 80 and over ,Cerebral Cortex ,cortical damage ,biomarkers ,meningeal inflammation ,MRI ,prognosis ,Science & Technology ,Neurology & Neurosurgery ,CENTRAL-NERVOUS-SYSTEM ,Neurosciences ,NECROSIS-FACTOR-ALPHA ,GRAY-MATTER ,1103 Clinical Sciences ,Middle Aged ,Magnetic Resonance Imaging ,GREY-MATTER PATHOLOGY ,SUBARACHNOID SPACE ,ROC Curve ,Disease Progression ,Cytokines ,Female ,Autopsy ,Neurosciences & Neurology ,B-CELL FOLLICLES ,1109 Neurosciences ,Life Sciences & Biomedicine ,WHITE-MATTER - Abstract
OBJECTIVE: Grey matter (GM) damage and meningeal inflammation have been associated with early disease onset and a more aggressive disease course in Multiple Sclerosis (MS), but can these changes be identified in the patient early in the disease course? METHODS: To identify possible biomarkers linking meningeal inflammation, GM damage and disease severity, gene and protein expression were analysed in meninges and CSF from 27 post-mortem secondary progressive MS (SPMS) and 14 control cases. Combined cytokine/chemokine CSF profiling and 3T-MRI were performed at diagnosis in two independent cohorts of MS patients (35 and 38 subjects) and in 26 non-MS patients. RESULTS: Increased expression of pro-inflammatory cytokines (IFNγ, TNF, IL2 and IL22) and molecules related to sustained B-cell activity and lymphoid-neogenesis (CXCL13, CXCL10, LTα, IL6, IL10) was detected in the meninges and CSF of post-mortem MS cases with high levels of meningeal inflammation and GM demyelination. Similar pro-inflammatory patterns, including increased levels of CXCL13, TNF, IFNγ, CXCL12, IL6, IL8 and IL10, together with high levels of BAFF, APRIL, LIGHT, TWEAK, sTNFR1, sCD163, MMP2 and pentraxin III, were detected in the CSF of MS patients with higher levels of GM damage at diagnosis. INTERPRETATION: A common pattern of intrathecal (meninges and CSF) inflammatory profile strongly correlates with increased cortical pathology, both at time of the diagnosis and of death. These results suggest a role for detailed CSF analysis combined with MRI, as a prognostic marker for more aggressive MS. This article is protected by copyright. All rights reserved.
- Published
- 2018
36. Mycobacterium avium subspecies paratuberculosis and myelin basic protein specific epitopes are highly recognized by sera from patients with Neuromyelitis optica spectrum disorder
- Author
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Giannina Arru, Salvatore Monaco, Alberto Gajofatto, Alessia Farinazzo, Sara Mariotto, Daniela Alberti, Ruggero Capra, Magdalena Niegowska, Chiara Rosa Mancinelli, GianPietro Sechi, Marco Bo, Elia Sechi, Sergio Ferrari, and Leonardo Antonio Sechi
- Subjects
0301 basic medicine ,Adult ,Male ,Immunology ,Paratuberculosis ,Autoantigens ,Epitope ,03 medical and health sciences ,Epitopes ,0302 clinical medicine ,Antigen ,IRF5 ,MBP ,medicine ,Immunology and Allergy ,Humans ,Epstein-Barr virus ,Autoantibodies ,Antigens, Bacterial ,Neuromyelitis optica ,biology ,AQP4 ,Mycobacterium avium subsp. paratuberculosis ,neuromyelitis optica spectrum disorder ,Multiple sclerosis ,Neuromyelitis Optica ,Myelin Basic Protein ,Middle Aged ,medicine.disease ,biology.organism_classification ,Mycobacterium avium subspecies paratuberculosis ,Virology ,Antibodies, Bacterial ,Myelin basic protein ,030104 developmental biology ,Neurology ,Interferon Regulatory Factors ,biology.protein ,Female ,Neurology (clinical) ,Antibody ,030217 neurology & neurosurgery - Abstract
Epstein-Barr virus (EBV) is the main environmental agent associated to neuromyelitis optica spectrum disorder (NMOSD). Following to studies reporting an increased prevalence of antibodies against peptides derived from Mycobacterium avium subsp. paratuberculosis (MAP) homologous to EBV and human epitopes (MBP85–98, IRF5424–434) in multiple sclerosis (MS), we investigated whether seroreactivity to these antigens display a NMOSD-specific pattern. The sera of 34 NMOSD patients showed elevated levels of antibodies against MAP and MBP compared to healthy controls (44% vs. 5%, p
- Published
- 2018
37. Effects of high-intensity robot-assisted hand training on upper limb recovery and muscle activity in individuals with multiple sclerosis: a randomized, controlled, single-blinded trial
- Author
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Marialuisa Gandolfi, Nicola Valè, Eleonora Kirilova Dimitrova, Stefano Mazzoleni, Elena Battini, Maria Donata Benedetti, Alberto Gajofatto, Francesco Ferraro, Matteo Castelli, Maruo Camin, Mirko Filippetti, Carola De Paoli, Elena Chemello, Alessandro Picelli, Jessica Corradi, Andreas Waldner, Leopold Saltuari, and Nicola Smania
- Subjects
030506 rehabilitation ,medicine.medical_specialty ,electromyography ,learning ,quality of life ,rehabilitation ,robotics ,upper limb abnormalities ,medicine.medical_treatment ,Electromyography ,lcsh:RC346-429 ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Randomized controlled trial ,Quality of life ,International Classification of Functioning, Disability and Health ,law ,Medicine ,lcsh:Neurology. Diseases of the nervous system ,Original Research ,Rehabilitation ,Expanded Disability Status Scale ,medicine.diagnostic_test ,business.industry ,Multiple sclerosis ,medicine.disease ,body regions ,medicine.anatomical_structure ,Neurology ,Upper limb ,Neurology (clinical) ,0305 other medical science ,business ,030217 neurology & neurosurgery - Abstract
Background : Integration of robotics and upper limb rehabilitation in people with multiple sclerosis (PwMS) has rarely been investigated. Objective: To compare the effects of robot-assisted hand training against non-robotic hand training on upper limb activity in PwMS. To compare the training effects on hand dexterity, muscle activity, and upper limb dysfunction as measured with the International Classification of Functioning. Methods: This single-blind, randomized, controlled trial involved 44 PwMS (Expanded Disability Status Scale:1.5-8) and hand dexterity deficits. The experimental group (n = 23) received robot-assisted hand training; the control group (n = 21) received non-robotic hand training. Training protocols lasted for 5 weeks (50 min/session, 2 sessions/week). Before (T0), after (T1), and at 1 month follow-up (T2), a blinded rater evaluated patients using a comprehensive test battery. Primary outcome: Action Research Arm Test. Secondary outcomes: Nine Holes Peg Test; Fugl-Meyer Assessment Scale-upper extremity section; Motricity Index; Motor Activity Log; Multiple Sclerosis (MS) Quality of Life-54; Life Habits assessment-general short form and surface electromyography. Results: There were no significant between-group differences in primary and secondary outcomes. Electromyography showed relevant changes providing evidence increased activity in the extensor carpi at T1 and T2. Conclusion: The training effects on upper limb activity and function were comparable between the two groups. However, robot-assisted training demonstrated remarkable effects on upper limb use and muscle activity. https://clinicaltrials.gov NCT03561155.
- Published
- 2018
38. Levofloxacin-induced hemichorea-hemiballism in a patient with previous thalamic infarction
- Author
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Ruggero Bacchin, Riccardo Orlandi, Alberto Gajofatto, Francesco Macchione, Gianluigi Zanusso, Davide Cardellini, and Gaetano Vattemi
- Subjects
medicine.medical_specialty ,Neurology ,neurological side effect ,Thalamus ,Dermatology ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,thalamic infarction ,Levofloxacin ,0502 economics and business ,Medicine ,Neuroradiology ,levofloxacin ,medicine.diagnostic_test ,business.industry ,05 social sciences ,hemiballism ,Magnetic resonance imaging ,Chorea ,General Medicine ,Psychiatry and Mental health ,hemichorea ,Neurology (clinical) ,Radiology ,Neurosurgery ,medicine.symptom ,business ,050203 business & management ,030217 neurology & neurosurgery ,medicine.drug - Published
- 2018
39. Benign multiple sclerosis: physical and cognitive impairment follow distinct evolutions
- Author
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Stefano Forlivesi, Marco Turatti, Alberto Gajofatto, Maria Rachele Bianchi, Maria Donata Benedetti, Salvatore Monaco, A. Azzarà, and Francesca Gobbin
- Subjects
Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Physical disability ,multiple sclerosis ,benign course ,cognitive impairment ,physical disability ,030106 microbiology ,Neuropsychological Tests ,Disability Evaluation ,03 medical and health sciences ,Multiple Sclerosis, Relapsing-Remitting ,0302 clinical medicine ,Internal medicine ,medicine ,Benign multiple sclerosis ,Humans ,Neuropsychological assessment ,Effects of sleep deprivation on cognitive performance ,Cognitive impairment ,Expanded Disability Status Scale ,medicine.diagnostic_test ,Multiple sclerosis ,digestive, oral, and skin physiology ,Cognition ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,stomatognathic diseases ,Treatment Outcome ,Neurology ,Disease Progression ,Physical therapy ,Female ,Neurology (clinical) ,Cognition Disorders ,Psychology ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Background Benign multiple sclerosis (BMS) definitions rely on physical disability level but do not account sufficiently for cognitive impairment which, however, is not rare. Objective To study the evolution of physical disability and cognitive performance of a group of patients with BMS followed at an University Hospital Multiple Sclerosis Center. Methods A consecutive sample of 24 BMS cases (diagnosis according to 2005 McDonald's criteria, relapsing–remitting course, disease duration ≥10 years, and expanded disability status scale [EDSS] score ≤2.0) and 13 sex- and age-matched non-BMS patients differing from BMS cases for having EDSS score 2.5–5.5 were included. Main outcome measures were as follows: (i) baseline and 5-year follow-up cognitive impairment defined as failure of at least two tests of the administered neuropsychological battery; (ii) EDSS score worsening defined as confirmed increase ≥1 point (or 0.5 point if baseline EDSS score = 5.5). Results At inclusion, BMS subjects were 41 ± 8 years old and had median EDSS score 1.5 (range 0–2), while non-BMS patients were 46 ± 8 years old and had median EDSS score 3.0 (2.5–5.5). At baseline 16% of patients in both groups were cognitively impaired. After 5 years, EDSS score worsened in 8% of BMS and 46% of non-BMS patients (P = 0.008), while the proportion of cognitively impaired subjects increased to 25% in both groups. Conclusions Patients with BMS had better physical disability outcome at 5 years compared to non-BMS cases. However, cognitive impairment frequency and decline over time appeared similar. Neuropsychological assessment is essential in patients with BMS given the distinct pathways followed by disease progression in cognitive and physical domains.
- Published
- 2015
40. Sensory integration balance training in patients with multiple sclerosis: A randomized, controlled trial
- Author
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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
41. A case of acute fulminant multiple sclerosis treated with alemtuzumab
- Author
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Marco Turatti, Francesca Gobbin, A. Forgione, Massimiliano Calabrese, M. D. Benedetti, Silvia Richelli, Alberto Gajofatto, Riccardo Orlandi, Antonio Marangi, Salvatore Monaco, and Franco Alessandrini
- Subjects
Fulminant multiple sclerosis ,Pediatrics ,medicine.medical_specialty ,Multiple Sclerosis ,Fulminant ,03 medical and health sciences ,0302 clinical medicine ,Acute onset ,medicine ,Animals ,Humans ,030212 general & internal medicine ,Cognitive impairment ,Left hemiplegia ,Alemtuzumab ,Marburg's variant multiple ,Sclerosis ,business.industry ,Multiple sclerosis ,Brain ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Inflammatory demyelinating disease ,Treatment Outcome ,Neurology ,Immunology ,Etiology ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
We describe the case of a woman who came to our attention for acute onset and very rapidly worsening left hemiplegia, vision loss and cognitive impairment. MRI, laboratory and clinical investigations were highly suggestive of an active inflammatory demyelinating disease. Following exclusion of other possible etiologies, a diagnosis of Marburg's variant multiple sclerosis was made. After repeated high-dose steroids and plasma-exchange, the patient was treated with a first course of alemtuzumab followed by improvement of the clinical and MRI picture. This is the first reported case of Marburg type multiple sclerosis treated with alemtuzumab.
- Published
- 2017
42. A multicenter study on the diagnostic significance of a single cerebrospinal fluid IgG band
- Author
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Paolo Immovilli, Eleonora Cocco, Francesca Vitetta, Riccardo Orlandi, Massimiliano Di Filippo, Roberta Bedin, Anna Maria Simone, Antongiulio Gallina, Diana Ferraro, Patrizia Sola, Claudio Solaro, Diego Franciotta, Jessica Frau, Alberto Gajofatto, Elisabetta Capello, Massimiliano Calabrese, A. Murialdo, Claudio Gasperini, Mario Santangelo, Sara Mariotto, and Debora Giunti
- Subjects
0301 basic medicine ,Adult ,Male ,Pathology ,medicine.medical_specialty ,Oligoclonal band ,Neurology ,Disease ,Immunoglobulin G ,Multiple sclerosis ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Cerebrospinal fluid ,Immune system ,Central Nervous System Diseases ,medicine ,Humans ,Longitudinal Studies ,Aged ,Retrospective Studies ,cerebrospinal fluid ,isoelectric focusing ,multiple sclerosis ,single IgG band ,biology ,business.industry ,Oligoclonal Bands ,Middle Aged ,medicine.disease ,030104 developmental biology ,Italy ,biology.protein ,Female ,Neurology (clinical) ,Differential diagnosis ,Isoelectric Focusing ,business ,Isoelectric focusing ,Single IgG band ,030217 neurology & neurosurgery - Abstract
The analysis of paired cerebrospinal fluid (CSF) and serum samples with isolectric focusing (IEF) can yield different patterns which can be of aid in the differential diagnosis of central nervous system (CNS) disorders. Rarely, a single CSF-restricted IgG band, which is not included within these patterns, can be detected in association with inflammatory disorders, multiple sclerosis (MS) above all. However, the diagnostic meaning of this abnormality is still uncertain. The main aim of our multicenter study was to establish the frequency and disease associations of single CSF IgG bands. Differences in the CSF profiles between MS and other diseases, and the follow-up patterns were also evaluated. Medical records of patients who underwent CSF analysis, which included IEF, over a 11.5-year period were retrospectively scrutinized at the participating centers, which used similar IEF techniques. One hundred and fifty-one of 9422 CSF reports (1.6%) showed single CSF-restricted IgG bands. Of the 129 patients with a definite diagnosis, 58.2% had CNS inflammatory-demyelinating diseases (the most frequent being MS: 21.7%), 6.2% tumours, 5.4% inflammatory peripheral nervous system diseases and 30.2% miscellaneous diseases. At follow-up, 3 out of the 10 patients with a repeated CSF analysis had developed an oligoclonal band pattern. Our findings indicate that single CSF IgG bands tend to associate with diseases characterized by the involvement of intrathecal humoral immune responses, and strongly support the notion that this abnormality should be regularly reported, thus alerting clinicians of possible inflammatory disorders of the CNS.
- Published
- 2017
43. Response to Nagai et al
- Author
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Alberto Gajofatto, Vincenzo Marafioti, Salvatore Monaco, Giulia Turri, Massimiliano Calabrese, and Elia Pancheri
- Subjects
autonomic nervous system ,cardiac control ,insula ,03 medical and health sciences ,Autonomic nervous system ,0302 clinical medicine ,Autonomic Nervous System Diseases ,Neurology ,Humans ,030212 general & internal medicine ,Neurology (clinical) ,Cardiac control ,Psychology ,Insula ,Neuroscience ,030217 neurology & neurosurgery - Published
- 2017
44. QTc interval in patients with multiple sclerosis: an inference from the insula of Reil?
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Salvatore Monaco, Alberto Gajofatto, Vincenzo Marafioti, Giulia Turri, Massimiliano Calabrese, and Elia Pancheri
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Cingulate cortex ,Adult ,Male ,medicine.medical_specialty ,QTc interval ,030204 cardiovascular system & hematology ,Grey matter ,Insular cortex ,Autonomic Nervous System ,multiple sclerosis ,QT interval ,Sudden death ,insula ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Multiple Sclerosis, Relapsing-Remitting ,Heart Rate ,Internal medicine ,Heart rate ,medicine ,Humans ,Gray Matter ,Cerebral Cortex ,business.industry ,Multiple sclerosis ,Middle Aged ,cortical thickness ,medicine.disease ,Magnetic Resonance Imaging ,White Matter ,Long QT Syndrome ,medicine.anatomical_structure ,Neurology ,Spinal Cord ,Anesthesia ,lesion volume ,Cardiology ,Female ,Neurology (clinical) ,business ,Insula ,030217 neurology & neurosurgery ,Brain Stem - Abstract
Background and purpose The aim of this study was to investigate the correlation between the duration of the QTc interval and the brain lesion load at the level of the structures involved in superior autonomic control (insula, cingulate cortex and amygdala-hippocampus) in multiple sclerosis (MS) patients. Methods Thirty-one consecutive patients with relapsing−remitting MS were recruited. The QT interval was measured manually in all 12 leads by a single blinded observer, with the longest QT value adjusted for heart rate by using the Bazett's formula. All patients performed a brain magnetic resonance imaging (MRI) scan including three-dimensional double inversion recovery and three volumetric fast-field echo sequences. The following MRI measures were obtained: (i) global and regional cortical thickness (CTh); (ii) white matter lesion load volume; (iii) cortical damage blindly assessed by a trained observer who assigned, on the basis of the number of cortical lesions, a score from 0 to 5 for each of the brain areas analysed. Results In all, 16% of the patients had an increased QTc interval. The QTc interval was correlated with disease duration, cortical insular lesion volume and grey matter lesion volume in the three examined areas and inversely correlated with global and insular CTh. Conclusions An increased QTc interval in patients with MS may have a cerebral origin possibly driven by involvement of the insular cortex. With the recent introduction in clinical practice of treatments with potential cardiac effects such as fingolimod, the recognition of a long QTc interval could be clinically crucial and should encourage appropriate electrocardiographic monitoring in order to prevent the risk of malignant ventricular pro-arrhythmia and iatrogenic sudden death.
- Published
- 2017
45. Informing MS patients on treatment options: a consensus on the process of consent taking.
- Author
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Tortorella, C., Solaro, C., Annovazzi, P., Boffa, L., Buscarinu, M. C., Buttari, F., Calabrese, M., Cavalla, P., Cocco, E., Cordioli, C., De Luca, G., Di Filippo, M., Fantozzi, R., Ferraro, D., Gajofatto, A., Gallo, A., Lanzillo, R., Laroni, A., Fermo, S. Lo, and Malucchi, S.
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NEUROLOGY ,DECISION making ,MULTIPLE sclerosis ,INFORMED consent (Medical law) ,NEUROLOGISTS - Abstract
In the last years, change in multiple sclerosis (MS) therapeutic scenario has highlighted the need for an improved doctor-patient communication in advance of treatment initiation in order to allow patient's empowerment in the decision-making process. Aims: The aims of our project were to review the strategies used by Italian MS specialists to inform patients about treatment options and to design a multicentre shared document that homogenizes the information about disease-modifying treatment (DMTs) and the procedure of taking informed consent in clinical practice. Results: The new resource, obtained by consensus among 31 neurologists from 27 MS Centres in Italy with the supervision of a medico-legal advisor, received the aegis of Italian Neurological Society (SIN) and constitutes a step toward a standardized decision process around DMTs in MS. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
46. Increased cortical lesion load and intrathecal inflammation is associated with oligoclonal bands in multiple sclerosis patients: a combined CSF and MRI study
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Salvatore Monaco, Maria Donata Benedetti, Francesco Facchiano, Stefania Rossi, Marco Pitteri, Gabriele Farina, Massimiliano Calabrese, Roberta Magliozzi, Richard Reynolds, Alberto Gajofatto, Multiple Sclerosis Society, and The Progressive MS Alliance
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0301 basic medicine ,Male ,Pathology ,Neurology ,Lymphocyte ,Pathogenesis ,0302 clinical medicine ,Cerebrospinal fluid ,Neuroinflammation ,DEMYELINATION ,Longitudinal Studies ,Cerebral Cortex ,B-Lymphocytes ,General Neuroscience ,CXCL13 ,CSF ,cytokines ,grey matter ,IgG ,MRI ,multiple sclerosis ,neurodegeneration ,neuroinflammation ,OCB ,oligoclonal bands ,Middle Aged ,medicine.anatomical_structure ,1107 Immunology ,Cytokines ,Matrix Metalloproteinase 2 ,Female ,medicine.symptom ,B-CELL FOLLICLES ,Life Sciences & Biomedicine ,EXPRESSION ,Adult ,medicine.medical_specialty ,Oligoclonal bands ,MENINGEAL INFLAMMATION ,Multiple Sclerosis ,Grey matter ,Adolescent ,MATTER DAMAGE ,Immunology ,Inflammation ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,Young Adult ,CEREBROSPINAL-FLUID ,medicine ,Humans ,Neurodegeneration ,Aged ,Science & Technology ,Neurology & Neurosurgery ,business.industry ,DISABILITY ,Multiple sclerosis ,Research ,CENTRAL-NERVOUS-SYSTEM ,Neurosciences ,Granulocyte-Macrophage Colony-Stimulating Factor ,1103 Clinical Sciences ,medicine.disease ,PATHOLOGY ,030104 developmental biology ,Cross-Sectional Studies ,Osteopontin ,Neurosciences & Neurology ,1109 Neurosciences ,business ,Cognition Disorders ,030217 neurology & neurosurgery - Abstract
Background Although IgG oligoclonal bands (OCBs) in the cerebrospinal fluid (CSF) are a frequent phenomenon in multiple sclerosis (MS) patients, their relationship with grey matter lesions, intrathecal/meningeal inflammation and clinical evolution has not been clarified yet. The aim of our study was to assess the relationship between the OCBs, the inflammatory/neurodegenerative CSF profile at diagnosis, the cortical lesion load and the clinical evolution after 10 years. Methods This is a 10-year observational, cross-sectional study based on a combined MRI, cognitive and CSF profiling of the examined patients. Forty consecutive OCB-negative (OCB−) and 50 OCB-positive (OCB+) MS patients were included in this study. Both groups had mean disease duration of 10 years and were age and gender matched. Each patient underwent neurological and neuropsychological evaluation and 3-T MRI. Analysis of the presence and levels of 28 inflammatory mediators was performed in the CSF obtained from 10 OCB− MS, 11 OCB+ MS and 10 patients with other neurological conditions. Results Increased number of CLs was found in OCB+ compared to OCB− patients (p
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- 2016
47. Refractory trigeminal neuralgia responsive to nabiximols in a patient with multiple sclerosis
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Alberto Gajofatto
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0301 basic medicine ,Male ,Urinary urgency ,Nabiximols ,Central nervous system ,multiple sclerosis ,03 medical and health sciences ,cannabinoids ,0302 clinical medicine ,Trigeminal neuralgia ,Cannabinoid Receptor Modulators ,Medicine ,Cannabidiol ,Humans ,Spasticity ,Dronabinol ,Sleep disorder ,trigeminal neuralgia ,business.industry ,Muscle Relaxants, Central ,Multiple sclerosis ,spasticity ,General Medicine ,Middle Aged ,Multiple Sclerosis, Chronic Progressive ,medicine.disease ,nervous system diseases ,Drug Combinations ,Sativex® ,030104 developmental biology ,medicine.anatomical_structure ,Neurology ,Muscle Spasticity ,Anesthesia ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Introduction Nabiximols is a cannabinoid compound approved for the treatment of multiple sclerosis (MS)-related spasticity. However, additional symptoms, such as pain, urinary urgency and sleep disturbance, may benefit from treatment. Case report The present report describes a patient with secondary progressive MS and severe lower limbs spasticity who was started on treatment with nabiximols. The patient also suffered from trigeminal neuralgia, which he was not treating due to inefficacy or side effects of all previously tried medications. After nabiximols initiation the patient experienced a marked benefit on trigeminal neuralgia, which completely resolved, while spasticity responded only partially to treatment. Conclusion Nabiximols mechanism of action is based on the interaction with CB1 and CB2 receptors, which are expressed by central nervous system neurons and are known to modulate pain among other effects. The present case indicates that nabiximols and other cannabinoids need to be further tested for the treatment of trigeminal neuralgia.
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- 2016
48. Prognostic value of multimodal evoked potentials in multiple sclerosis: the EP score
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Maria Donata Benedetti, Paolo Invernizzi, Alberto Gajofatto, Maria Rachele Bianchi, Laura Bertolasi, and Marco Turatti
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Adult ,Male ,medicine.medical_specialty ,Multiple Sclerosis ,Neurology ,Adolescent ,Sensitivity and Specificity ,Central nervous system disease ,Young Adult ,EP score ,Internal medicine ,medicine ,Humans ,Evoked potential ,Evoked Potentials ,Neuroradiology ,Expanded Disability Status Scale ,medicine.diagnostic_test ,Receiver operating characteristic ,business.industry ,Multiple sclerosis ,Magnetic resonance imaging ,Middle Aged ,Prognosis ,medicine.disease ,Surgery ,Area Under Curve ,Disease Progression ,Female ,EDSS ,Neurology (clinical) ,multiple sclerosis ,evoked potentials ,prognosis ,business - Abstract
Evoked potentials (EPs) have long been used as diagnostic tools in multiple sclerosis (MS), although their importance decreased as magnetic resonance imaging (MRI) became available. However, the prognostic value of EPs in MS has not been completely established. The aim of the study was to analyze the prognostic significance of EPs in a cohort of MS cases. From the Verona University Hospital MS Clinic database we retrospectively identified 80 MS patients who underwent a complete neurophysiological evaluation, including visual, brain stem, somatosensory and motor EPs and who were followed for at least 5 years after the study. EPs abnormalities were quantified through an index of global EPs alteration (EP score). The relationship between EP score and disability in terms of Expanded Disability Status Scale (EDSS) was analyzed by the Kaplan–Meier survival method and Spearman ρ correlation coefficient. ROC curves were used to determine the best EP score cut off to predict different EDSS endpoints. For each endpoint, sensitivity, specificity, positive and negative predictive value of EP score were calculated. We found a significant correlation (p < 0.001) between EP score and EDSS score at the time of neurophysiological study and at 1, 3 and 5 years of follow-up, particularly for motor and somatosensory EPs. Kaplan–Meier curves confirmed an increased risk of disability in those patients with EP score higher than the median value. EP score of 8 or 9 showed the highest sensitivity and specificity in predicting EDSS 4.0 and 6.0. EPs are reliable procedures to predict disability in MS patients. The correlation between EPs abnormalities and EDSS is higher than between conventional MRI and EDSS.
- Published
- 2011
49. Switching first-line disease-modifying therapy after failure: impact on the course of relapsing–remitting multiple sclerosis
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Barbara Grimes, Alberto Gajofatto, Peter Bacchetti, A. High, and Emmanuelle Waubant
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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
50. Neurological complications of HIV infection in pre-HAART and HAART era: a retrospective study
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Sergio Ferrari, Salvatore Monaco, Sandro Vento, Maria Angela Bonometti, Angela Matinella, Massimiliano Lanzafame, Ercole Concia, and Alberto Gajofatto
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Adult ,CD4-Positive T-Lymphocytes ,Male ,medicine.medical_specialty ,Cell Count ,HIV Infections ,Neuroimaging ,Neurological examination ,HIV-associated neurocognitive disorder ,progressive multifocal leukoencephalopathy ,Statistics, Nonparametric ,Acquired immunodeficiency syndrome (AIDS) ,Antiretroviral Therapy, Highly Active ,Internal medicine ,HIV ,neurotoxoplasmosis ,primary central nervous system lymphoma ,cryptococcal encephalitis ,medicine ,Humans ,Survival rate ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Progressive multifocal leukoencephalopathy ,Primary central nervous system lymphoma ,virus diseases ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Survival Rate ,Treatment Outcome ,Neurology ,Immunoglobulin G ,Immunology ,Female ,Neurology (clinical) ,Nervous System Diseases ,business ,Toxoplasma ,Viral load ,Follow-Up Studies - Abstract
The introduction of highly active anti-retroviral therapy (HAART) led to a radical change in the natural history of HIV infection and of the associated neurological opportunistic infections. However, the mortality of central nervous system (CNS) complications and opportunistic infections is still high in untreated HIV-infected individuals or in patients unaware of their HIV infection. We describe the outcome of HIV-infected patients followed at a single center for AIDS-related neurological syndromes in the 16 years following the introduction of HAART, and compare the findings with those in patients admitted up to 1996. We have conducted a retrospective study of patients with HIV infection or AIDS (based on WHO criteria and classified according to the 1993 CDC criteria) admitted during 20 years (January 1992 to March 2012) to the Infectious Diseases Unit of the University of Verona for the presence of focal or widespread CNS lesion on neuroimaging. Clinical history, CD4 cell count, HIV-RNA level, neurological examination, imaging, cerebrospinal fluid examination and eventual cerebral biopsy results were reviewed as well as the final neurological diagnosis and the treatment. The survival time from the clinical onset of the neurologic syndrome to death was calculated for each patient who died. A statistical analysis was performed comparing data collected up to and after 1996, i.e., before and after HAART introduction. Among 1043 patients with HIV infection or AIDS admitted to the Infectious Diseases Unit of the University of Verona between January 1992 and March 2012, 114 had a CNS lesion. The following diseases were observed: neurotoxoplasmosis (NT), progressive multifocal leukoencephalopathy), primary central nervous system lymphoma (PCNSL), the severe form of HIV-associated neurocognitive disorder, cryptococcal encephalitis (CE) and lesions of undetermined origin. The follow-up period was 4 weeks to 72 months both in the pre-HAART and HAART era. Cerebral lesions were detected in 53/243 patients (21.8 %) in the pre-HAART era and in 61/801 patients (7.6 %) in the HAART era (p < 0.001). Most patients who developed a neurological complication in the HAART period (40/59, 67.8 %) were untreated or did not know to be HIV-infected; in particular, 27.9 % of patients with a CNS lesion in the HAART era were unaware of their HIV infection vs 13.2 % in the pre-HAART era (p < 0.05). Some patients were not virologically suppressed (14/59, 23.7 %) or were immunological non-responders (undetectable viral load, with CD4 count
- Published
- 2015
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