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Multiple sclerosis is a chronic disease requiring a multidisciplinary approach. Multiple sclerosis nurses are involved in all aspects of care, in particular in patients' education about disease-modifying drugs. The availability of oral firstline treatments has had a considerable impact on disease management. The aim of this study was to valuate if the introduction of oral therapies has led to a change in nurses' time spent on education, empowerment and training. A retrospective study was conducted enrolling naïve patients with relapsing-remitting mutliple sclerosis. Working time spent by nurses was compared between patients treated with oral versus injectable drugs. Correlations between time and clinical variables were investigated. A total of 55 patients were enrolled (34 using injectable and 21 using oral medication). For the oral group, less work time (P=0.018) and number of meetings (P=0.004) were needed. Dimethyl fumarate needed a lower number of meetings compared with other drugs. The availability of oral drugs seemed to reduce the amount of working time nurses spent with naïve patients' discussing education and treatment. [ABSTRACT FROM AUTHOR]

Byline: Robert Zivadinov (1,4), Laura Uxa (2), Tullio Zacchi (2), Davide Nasuelli (1), Maja Ukmar (3), Christina Furlan (3), Roberto Pozzi-Mucelli (3), Maria Antonietta Tommasi (1), Laura Locatelli (1), Sheila Ulivi (2), Alessio Bratina (1), Antonio Bosco (1), Attillio Grop (1), Giuseppe Cazzato (1), Marino Zorzon (2) Keywords: multiple sclerosis; HLA; MRI Abstract: The objective of the study was to examine the relationship between HLA genotypes and disease severity as measured by brain MRI quantitative markers of demyelinating and destructive pathology in patients with multiple sclerosis (MS). We studied 100 patients with MS and 122 age, sex-, ethnic- and residence-matched controls. The DNA extraction and the genomic typing (A, B, DRB1 and DQB1 loci) were obtained with sequence-specific oligonucleotide method, using a commercially available reversible line blot assay (INNO-LIPA). All patients underwent a 1.5 tesla MRI examination of the brain. Disease severity was assessed by clinical (Expanded Disability Status Scale (EDSS)) and MRI (T2- and T1-lesion load (LL) and brain parenchymal fraction (BPF)) outcome measures. HLA-DQB1* 02 (OR 19.9, 95% C. I. 16.2--24.3, uncorrected (uncorr)- p&lt 0.00001, corr-p&lt 0.0006), -DQB1*03 (OR 16.8, 95% C. I. 13.6--20.5, uncorr-p&lt 0.00001, corrp&lt 0.0006), -DRB1*15 (OR 4.6, 95% C. I. 3.7--5.6, uncorrp= 0.0001, corr-p=0.006), and -DRB1*03 (OR 3.9, 95% C. I. 3.2--4.8, uncorr-p=0.0001, corrp= 0.006) alleles were associated with MS. T2-, T1-LL, BPF and EDSS were not significantly different according to the carrier status of these HLA alleles. No differences were found in the ratios of disease severity/disease duration according to the HLA car rier status. Multiple regression analysis showed that a higher T2-LL was associated with the presence of DRB1*04 (uncorr- R2=0.15, p=0.006 and corr- R2=0.11, p=0.025) and B7 alleles (uncorr-R2=0.08, p=0.02 and corr-R2=0.07, p=0.018), T1-LL was associated with B7 (uncorr- R2=0.30, p&lt 0.0001 and corr- R2=0.27, p=0.0001) and DRB1*12 (uncorr-R2=0.25, p&lt 0.0001 and corr-R2=0.21, p=0.0002) alleles, whereas the BPF was predicted only by the presence of DRB1*12 allele (uncorr-R2=0.24, p=0.002 and corr-R2=0.20, p=0.004). The study findings suggest that some HLA alleles may predict the destructive pathological processes visible on MRI. Since the size of the sample studied is relatively small, further studies are needed to draw any firm conclusion about genotype/phenotype correlation in patients with MS. Author Affiliation: (1) Dept. of Clinical Medicine and Neurology, Cattinara Hospital, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy (2) Dept. of Transfusion Medicine, Trieste, Italy (3) Dept. of Clinical,Morphological and Technological Sciences, University of Trieste, Trieste, Italy (4) Department of Neurology, School of Medicine and Biomedical Sciences, The Jacobs Neurological Institute, 100 High St., Buffalo, NY, 14203, USA Article History: Received Date: 18/09/2002 Accepted Date: 08/05/2003

Background: Cerebrospinal fluid (CSF) analysis in patients with particular neurologic disorders is a powerful tool to evaluate specific central nervous system inflammatory markers for diagnostic needs, because CSF represents the specific immune micro-environment to the central nervous system.Methods: CSF samples from 49 patients with multiple sclerosis (MS), chronic inflammatory demyelinating polyneuropathy (CIDP), and non-inflammatory neurologic disorders (NIND) as controls were submitted to protein expression profiles of 47 inflammatory biomarkers by multiplex Luminex bead assay to investigate possible differences in the inflammatory process for MS and CIDP.Results: Our results showed differences in CSF cytokine levels in MS and CIDP; in particular, IL12 (p40) was significantly highly expressed in MS in comparison with CIDP and NIND, while SDF-1α and SCGF-β were significantly highly expressed in CIDP cohort when compared to MS and NIND. IL-9, IL-13, and IL-17 had higher expression levels in NIND if compared with the other groups.Conclusions: Our study showed that, despite some common pathogenic mechanisms, central and peripheral nervous system demyelinating diseases, such as MS and CIDP, differ in some specific inflammatory soluble proteins in CSF, underlining differences in the immune response involved in those autoimmune diseases. [ABSTRACT FROM PUBLISHER]

Objective: To test the effect of serial magnetic resonance (MR) coregistration on short-term brain volume changes using different semiautomated and automated brain volume techniques in patients with relapsing-remitting (RR) multiple sclerosis (MS). Coregistration is frequently used to increase precision in serial MR imaging (MRI) analyses. However, the effect of coregistration on measurement of whole brain volume changes from serial scans in the short term has not been tested in MS patients. Methods: Twenty-eight patients with RR MS [mean disease duration: 4.9 years, mean age: 34.4 years and mean expanded disability status scale (EDSS): 1.4] were scanned at baseline and monthly for a period of 3 months with 2D spin-echo T1-weighted sequences obtained with nongapped 3 mm axial slices. Percent brain parenchymal fraction change (PBPFC) was calculated by a semiautomated (Buffalo) and, separately, by two automated (Buffalo automated and SIENAX) techniques, whereas percent brain volume change (PBVC) was calculated by the SIENA technique. For coregistration of serial images we used a robust, fully automated linear image coregistration tool. PBPFC and PBVC were calculated before and after coregistration, comparing scans from the following time periods: (1) baseline to month 3; (2) baseline to month 1; (3) month 1 to 2 and (4) month 2 to 3. Results: The highest median PBPFCs measured on non-coregistered images were detected for the baseline-to-month-3 time period and ranged from -0.11% for Buffalo semiautomated to -0.45% for Buffalo automated (p=ns). On coregistered images, the highest PBPFCs were detected for the baseline-to-month-3 time period and ranged from 0.3% for Buffalo semiautomated, -0.3% for Buffalo automated, 0.02% for SIENAX and -0.02% for SIENA (PBVC). At all time points of the study, no significant differences of median volume changes were measured on coregistered and non-coregistered images when comparing the results among the segmentation algorithms. Conclusions: Over a 3 month period we did not detect short-term changes in normalized brain volumes using different measurement techniques. A longer observation period is needed to assess whether coregistration can affect the measurement of long-term brain volume changes. [ABSTRACT FROM AUTHOR]