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1. Does post dural puncture headache exist in idiopathic intracranial hypertension? A pilot study

Author: Evelyne Guegan-Massardier, Romain Lefaucheur, David Maltête, Lou Grangeon, S de Gaalon, S.-D. Mihailescu, S. Ferhat, A. Didier-Laurent, and D. Laplaud
Subjects: Pediatrics, medicine.medical_specialty, Post-dural-puncture headache, Pseudotumor cerebri, Population, Pilot Projects, Spinal Puncture, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, 030212 general & internal medicine, education, Retrospective Studies, Pseudotumor Cerebri, education.field_of_study, medicine.diagnostic_test, business.industry, Lumbar puncture, Diagnostic lumbar puncture, medicine.disease, Neurology, Observational study, International Classification of Headache Disorders, Neurology (clinical), Post-Dural Puncture Headache, medicine.symptom, business, Body mass index, 030217 neurology & neurosurgery
Abstract: Background/Objective Occurrence of post-dural puncture headache (PDPH) after diagnostic lumbar puncture (LP) for idiopathic intracranial hypertension (IIH) may seem very unlikely in clinical practice. Nevertheless, it has been suggested by several studies, mainly in sub-group analyses. We aimed to evaluate the prevalence of PDPH in an IIH population and determine any eventual predictive factors of PDPH occurrence. Methods We conducted a retrospective multiple-center observational study. All newly diagnosed IIH patients who met the International Classification of Headache Disorders (ICHD-3) or the Dandy modified criteria were included from three different French hospitals. They all underwent LP following the same process with the same type of needle. We recorded PDPH occurring within five days after LP, as defined by ICHD-3 criteria. Results Seventy-four IIH patients were recruited, of whom 23 (31%) presented with PDPH. Neither classical risk factors for PDPH such as body mass index, age or gender, nor cerebrospinal fluid opening pressure, or specific IIH features were associated with occurrence of PDPH. Conclusion PDPH can occur after LP in IIH patients. Clinicians should be aware of this possible event during the IIH diagnosis assessment and should not automatically reconsider IIH diagnosis. PDPH prevention using an atraumatic needle and dedicated PDPH treatment seem relevant in IIH patients.
Published: 2021
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2. Urinary tract infections and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society

Author: C. Donzé, C. Papeix, C. Lebrun-Frenay, C. Lebrun-Frénay, N. Collongues, M. de Seze, A. Dinh, A. Even, C. Scheiber-Nogueira, C. Bensa, B. Bourre, C. Carra-Dallière, J. Ciron, M. Cohen, A.M. Guennoc, C. Louapre, F. Lebreton, L. Michel, E. Maillart, B. Audoin, X. Ayrignac, P. Bernady, B. Brochet, P. Clavelou, R. Colamarino, A. Declemy, J. de Seze, N. Derache, J.-M. Faucheux, O. Heinzlef, P. Labauge, D. Laplaud, E. Lepage, E. Leray, L. Magy, G. Mathey, C. Mekies, V. Mondain, E. Planque, J. Pelletier, S. Pittion, B. Stankhof, P. Tournaire, E. Thouvenot, S. Vukusic, S. Wiertlevski, H. Zephir, H. Alchaar, G. Androdias, M. Benazet, D. Bensmail, D. Biotti, A. Blanchard-Dauphin, M. Bonnan, C. Boutière, P. Branger, S. Bresch, J.-P. Bru, J.-P. Camdessanché, E. Castel Canal, M. Coustans, O. Casez, B. Castan, A. Creange, E. Creisson, T. De Broucker, R. Depaz, X. Douay, C. Dulau, F. Durand-Dubief, O. Fagniez, M. Faucher, A. Floch, M. Fournier, A. Fromont, P. Gallien, X. Gamé, D. Gault, A. Gayou, M. Giroux, O. Gout, J. Grimaud, P. Hautecoeur, A. Kerbrat, L. Kremer, A. Kwiatkowski, C. Labeyrie, S. Lachaud, C. Lanctin-Garcia, L. Lanotte, E. Manchon, A. Maurousset, A.-M. Milor, X. Moisset, A. Mont-Cuquet, T. Moreau, J.-C. Ouallet, I. Patry, D. Peaureaux, M.-C. Pouget, V. Pourcher Martinez, C. Radot, A. Ruet, C. Saint-Val, A. Salmon, F. Taithe, P. Tatevin, M. Vaillant, J.-P. Stahl, F. Vuoto, C. Zaenker, Hôpital Saint Philibert [Lomme], Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Université catholique de Lille (UCL)-Université catholique de Lille (UCL), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA), Centre Hospitalier Universitaire de Nice (CHU Nice), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Montpellier (UM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Institut de Génomique Fonctionnelle (IGF), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Nice Sophia Antipolis (... - 2019) (UNS), Université de Montpellier (UM)-Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Centre National de la Recherche Scientifique (CNRS), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: medicine.medical_specialty, Urinary system, Population, MESH: Urinary Tract Infections, urologic and male genital diseases, Practice guidelines, Hypogammaglobulinemia, Multiple sclerosis, 03 medical and health sciences, 0302 clinical medicine, MESH: Pregnancy, Health care, medicine, Urinary tracts infections, In patient, 030212 general & internal medicine, Intensive care medicine, education, Asymptomatic bacteriuria, Pregnancy, education.field_of_study, MESH: Humans, Disease modifying therapy, business.industry, MESH: Multiple Sclerosis, medicine.disease, female genital diseases and pregnancy complications, 3. Good health, MESH: Recurrence, Neurology, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Neurology (clinical), business, MESH: Female, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Objectives Establish recommendations for the management of UTIs in MS patients. Background Urinary tract infections (UTIs) are common during multiple sclerosis (MS) and are one of the most common comorbidities potentially responsible for deaths from urinary sepsis. Methods The recommendations attempt to answer three main questions about UTIs and MS. The French Group for Recommendations in MS (France4MS) did a systematic review of articles from PubMed and universities databases (01/1980–12/2019). The RAND/UCLA appropriateness method, which has been developed to synthesize the scientific literature and expert opinions on health care topics, was used for reaching a formal agreement. 26 MS experts worked on the full-text review and a group of 70 multidisciplinary health care specialists validated the final evaluation of summarized evidences. Results UTIs are not associated with an increased risk of relapse and permanent worsening of disability. Only febrile UTIs worsen transient disability through the Uhthoff phenomenon. Some immunosuppressive treatments increase the risk of UTIs in MS patients and require special attention especially in case of hypogammaglobulinemia. Experts recommend to treat UTIs in patients with MS, according to recommendations of the general population. Prevention of recurrent UTIs requires stabilization of the neurogenic bladder. In some cases, weekly oral cycling antibiotics can be proposed after specialist advice. Asymptomatic bacteriuria should not be screened for or treated systematically except in special cases (pregnancy and invasive urological procedures). Conclusion Physicians and patients should be aware of the updated recommendations for UTis and MS.
Published: 2020
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3. New OFSEP recommendations for MRI assessment of multiple sclerosis patients: Special consideration for gadolinium deposition and frequent acquisitions

Author: Jean-Christophe Brisset, Stephane Kremer, Salem Hannoun, Fabrice Bonneville, Francoise Durand-Dubief, Thomas Tourdias, Christian Barillot, Charles Guttmann, Sandra Vukusic, Vincent Dousset, Francois Cotton, R. Ameli, R. Anxionnat, B. Audoin, A. Attye, E. Bannier, C. Barillot, D. Ben Salem, M.-P. Boncoeur-Martel, G. Bonhomme, F. Bonneville, C. Boutet, J.C. Brisset, F. Cervenanski, B. Claise, O. Commowick, J.-M. Constans, F. Cotton, P. Dardel, H. Desal, V. Dousset, F. Durand-Dubief, J.-C. Ferre, A. Gaultier, E. Gerardin, T. Glattard, S. Grand, T. Grenier, R. Guillevin, C. Guttmann, A. Krainik, S. Kremer, S. Lion, N. Menjot De Champfleur, L. Mondot, O. Outteryck, N. Pyatigorskaya, J.-P. Pruvo, S. Rabaste, J.-P. Ranjeva, J.-A. Roch, J.-C. Sadik, D. Sappey-Marinier, J. Savatovsky, B. Stankoff, J.-Y. Tanguy, A. Tourbah, T. Tourdias, B. Brochet, R. Casey, J. De Sèze, P. Douek, F. Guillemin, D. Laplaud, C. Lebrun-Frenay, L. Mansuy, T. Moreau, J. Olaiz, J. Pelletier, C. Rigaud-Bully, S. Vukusic, M. Debouverie, G. Edan, J. Ciron, C. Lubetzki, P. Vermersch, P. Labauge, G. Defer, E. Berger, P. Clavelou, O. Gout, E. Thouvenot, O. Heinzlef, A. Al-Khedr, B. Bourre, O. Casez, P. Cabre, A. Montcuquet, A. Créange, J.-P. Camdessanché, S. Bakchine, A. Maurousset, I. Patry, T. De Broucker, C. Pottier, J.-P. Neau, C. Labeyrie, C. Nifle, Hôpital de Hautepierre [Strasbourg], Nehme and Therese Tohme Multiple Sclerosis Center [Beyrouth, Liban] (AUBMC), American University of Beirut Medical Center [Beyrouth, Liban] (AUBMC), American University of Beirut [Beyrouth] (AUB)-American University of Beirut [Beyrouth] (AUB), Neuroradiologie Diagnostique et Thérapeutique [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL), INSERM, Neurocentre Magendie, U1215, Physiopathologie de la Plasticité Neuronale, F-33000 Bordeaux, France, Empenn, Institut National de la Santé et de la Recherche Médicale (INSERM)-Inria Rennes – Bretagne Atlantique, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE (IRISA-D5), Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Rennes 1 (UR1), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Center for Neurological Imaging, Departments of Radiology and Neurology, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire Français de la Sclérose En Plaques [Lyon] (OFSEP), Service de neuroradiologie [Lyon], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Neurologie, maladies neuro-musculaires [Hôpital de la Timone - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Service de neuroradiologie [Grenoble], CHU Grenoble, Laboratoire de Traitement de l'Information Medicale (LaTIM), Institut National de la Santé et de la Recherche Médicale (INSERM)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Service de Radiologie et Imagerie Médicale [CHU Limoges], CHU Limoges, Auteur indépendant, Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), CHU Clermont-Ferrand, CHU Amiens-Picardie, Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Hôpital des Charpennes [CHU - HCL], Centre Hospitalier Universitaire [Grenoble] (CHU), Centre hospitalier universitaire de Poitiers (CHU Poitiers), CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Pasteur [Nice] (CHU), Hôpital Roger Salengro [Lille], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Aix Marseille Université (AMU), Fondation Ophtalmologique Adolphe de Rothschild [Paris], Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hôpital Raymond Poincaré [AP-HP], CHU de Bordeaux Pellegrin [Bordeaux], Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques (BMNST), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Union pour la lutte contre la sclérose en plaques (UNISEP), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Hôpital de la Timone [CHU - APHM] (TIMONE), Fondation Eugène Devic EDMUS, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Gui de Chauliac, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), CHU Gabriel Montpied [Clermont-Ferrand], Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Hôpital Charles Nicolle [Rouen], Hôpital Pierre Zobda-Quitman [CHU de la Martinique], CHU de la Martinique [Fort de France], Hôpital Dupuytren [CHU Limoges], Hôpital Henri Mondor, Centre Hospitalier Universitaire de Reims (CHU Reims), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Sud Francilien, CH Evry-Corbeil, Hôpital Delafontaine, Centre Hospitalier de Saint-Denis [Ile-de-France], Centre Hospitalier René Dubos [Pontoise], AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Centre Hospitalier de Versailles André Mignot (CHV), French State, 'Investments for the Future', Eugène Devic EDMUS Foundation, ARSEP Foundation, Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse], Pôle imagerie médicale [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Neurocentre Magendie : Physiopathologie de la Plasticité Neuronale (U1215 Inserm - UB), Université de Bordeaux (UB)-Institut François Magendie-Institut National de la Santé et de la Recherche Médicale (INSERM), Neuroimagerie: méthodes et applications (Empenn), Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut Brestois Santé Agro Matière (IBSAM), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Gui de Chauliac [CHU Montpellier], Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Université de Bretagne Sud (UBS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National de Recherche en Informatique et en Automatique (Inria)-École normale supérieure - Rennes (ENS Rennes)-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-CentraleSupélec-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Bretagne Sud (UBS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-École normale supérieure - Rennes (ENS Rennes)-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), CCSD, Accord Elsevier, and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: medicine.medical_specialty, Consensus, Multiple Sclerosis, Gadolinium, chemistry.chemical_element, Contrast Media, Fluid-attenuated inversion recovery, 030218 nuclear medicine & medical imaging, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Atrophy, Quality of life, Medicine, Humans, Radiology, Nuclear Medicine and imaging, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Adverse effect, Radiological and Ultrasound Technology, medicine.diagnostic_test, business.industry, Progressive multifocal leukoencephalopathy, Multiple sclerosis, Brain, Magnetic resonance imaging, medicine.disease, Image Enhancement, Magnetic Resonance Imaging, 3. Good health, chemistry, OFSEP, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Neurology (clinical), Radiology, business, 030217 neurology & neurosurgery
Abstract: Purpose New multiple sclerosis (MS) disease-modifying therapies (DMTs), which exert beneficial effects through prevention of relapse, limitation of disability progression, and improvement of patients’ quality of life, have recently emerged. Nonetheless, these DMTs are not without associated complications (severe adverse events like. progressive multifocal leukoencephalopathy). Patient follow-up requires regular clinical evaluations and close monitoring with magnetic resonance imaging (MRI). Detection of new T2 lesions and potential brain atrophy measurements contribute to the evaluation of treatment effectiveness. Current MRI protocols for MS recommend the acquisition of an annual gadolinium (Gd) enhanced MRI, resulting in administration of high volume of contrast agents over time and Gd accumulation in the brain. Methods A consensus report was established by neuroradiologists and neurologists from the French Observatory of MS, which aimed at reducing the number of Gd injections required during MS patient follow-up. Recommendations The French Observatory of MS recommends the use of macrocyclic Gd enhancement at time of diagnosis, when a new DMT is introduced, at 6-month re-baseline, and when previous scans are unavailable for comparison. Gd administration can be performed as an option in case of relapse or suspicion of intercurrent disease such as progressive multifocal leukoencephalopathy. Other follow-up MRIs do not require contrast enhancement, provided current and previous MRI acquisitions follow the same standardized protocol including 3D FLAIR sequences.
Published: 2020
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4. Immunization and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society

Author: C. Lebrun, S. Vukusic, V. Abadie, C. Achour, F. Ader, H. Alchaar, A. Alkhedr, F. Andreux, G. Androdias, R. Arjmand, B. Audoin, D. Audry, D. Aufauvre, C. Autreaux, X. Ayrignac, M. Bailbe, M. Benazet, C. Bensa, D. Bensmail, E. Berger, P. Bernady, Y. Bertagna, D. Biotti, A. Blanchard-Dauphin, J. Bonenfant, M. Bonnan, B. Bonnemain, F. Borgel, E. Botelho-Nevers, S. Boucly, B. Bourre, C. Boutière, P. Branger, D. Brassat, S. Bresch, V. Breuil, B. Brochet, H. Brugeilles, P. Bugnon, P. Cabre, J.-P. Camdessanché, C. Carra-Dalière, O. Casez, J.-M. Chamouard, B. Chassande, P. Chataignier, M. Chbicheb, A. Chenet, J. Ciron, P. Clavelou, M. Cohen, R. Colamarino, N. Collongues, I. Coman, P.-R. Corail, S. Courtois, M. Coustans, A. Creange, E. Creisson, N. Daluzeau, C. Davenas, J. De Seze, M. Debouverie, R. Depaz, N. Derache, L. Divio, X. Douay, C. Dulau, F. Durand-Dubief, G. Edan, Z. Elias, O. Fagniez, M. Faucher, J.-M. Faucheux, M. Fournier, A. Gagneux-Brunon, P. Gaida, P. Galli, P. Gallien, J. Gaudelus, D. Gault, A. Gayou, M. Genevray, A. Gentil, J. Gere, L. Gignoux, M. Giroux, P. Givron, O. Gout, J. Grimaud, A.-M. Guennoc, N. Hadhoum, P. Hautecoeur, O. Heinzlef, M. Jaeger, S. Jeannin, L. Kremer, A. Kwiatkowski, P. Labauge, C. Labeyrie, S. Lachaud, I. Laffont, C. Lanctin-Garcia, J. Lannoy, L. Lanotte, D. Laplaud, D. Latombe, M. Lauxerois, E. Le Page, C. Lebrun-Frenay, P. Lejeune, P. Lejoyeux, B. Lemonnier, E. Leray, C.-M. Loche, C. Louapre, C. Lubetzki, A. Maarouf, B. Mada, L. Magy, E. Maillart, E. Manchon, R. Marignier, P. Marque, G. Mathey, A. Maurousset, C. Mekies, M. Merienne, L. Michel, A.-M. Milor, X. Moisset, A. Montcuquet, T. Moreau, N. Morel, M. Moussa, J.-P. Naudillon, M. Normand, P. Olive, J.-C. Ouallet, O. Outteryck, C. Pacault, C. Papeix, I. Patry, D. Peaureaux, J. Pelletier, B. Pichon, S. Pittion, E. Planque, M.-C. Pouget, V. Pourcher, C. Radot, I. Robert, F. Rocher, A. Ruet, C. Saint-Val, J.-Y. Salle, A. Salmon, E. Sartori, S. Schaeffer, B. Stankhof, F. Taithe, E. Thouvenot, C. Tizon, A. Tourbah, P. Tourniaire, M. Vaillant, P. Vermersch, S. Vidil, A. Wahab, M.-H. Warter, S. Wiertlewski, B. Wiplosz, B. Wittwer, C. Zaenker, H. Zephir, Université Côte d'Azur (UCA), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Centre de recherche en neurosciences de Lyon (CRNL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hosp Civils Lyon, Serv Malad Infect, Lyon, France, Biogéosciences [UMR 6282] [Dijon] (BGS), Centre National de la Recherche Scientifique (CNRS)-Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS), CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Pontchaillou [Rennes], CHU Saint-Etienne, Centre d'Exploration Métabolique par Résonance Magnétique [Hôpital de la Timone - AP-HM] (CEMEREM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS)- Hôpital de la Timone [CHU - APHM] (TIMONE), Comité de Développement Horticole du Centre Val de Loire (CDHRC), Génétique, physiopathologie et ingénierie du tissu osseux (GéPITOS), Centre National de la Recherche Scientifique (CNRS)-Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA), Service d'Etudes du Comportement des Matériaux de Conditionnement (SECM), Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Galaxies, Etoiles, Physique, Instrumentation (GEPI), Institut national des sciences de l'Univers (INSU - CNRS)-Observatoire de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Service de Neurologie [Rennes] = Neurology [Rennes], Excitabilité nerveuse et thérapeutique (ENT), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-EA 4391, Service de Physiologie Explorations Fonctionnelles-Hôpital Henri Mondor, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), RMN et optique : De la mesure au biomarqueur, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Combustion Research Facility, Sandia National Laboratories - Corporation, Service de Pédiatrie [Jean Verdier], Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Kuriwa Observatory, Fondation Ophtalmologique Adolphe de Rothschild [Paris], Laboratoire de Mécanique, Modélisation et Procédés Propres (M2P2), Centre National de la Recherche Scientifique (CNRS)-École Centrale de Marseille (ECM)-Aix Marseille Université (AMU), Institut de biologie et chimie des protéines [Lyon] (IBCP), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Euromov (EuroMov), Université de Montpellier (UM), Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Université Nice Sophia Antipolis - Faculté de Médecine (UNS UFR Médecine), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA), Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP), École des Hautes Études en Santé Publique [EHESP] (EHESP), Département Méthodes quantitatives en santé publique (METIS), Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Biologie des Interactions Neurones / Glie, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Neurologie [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire d'automatique et de génie des procédés (LAGEP), Université de Lyon-Université de Lyon-École Supérieure Chimie Physique Électronique de Lyon-Centre National de la Recherche Scientifique (CNRS), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Haras National Suisse, Centre Hospitalier Universitaire de Reims (CHU Reims), Center for health studies, Service de neurologie [Nantes], Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Hospices Civils de Lyon, Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center (CRNL), Biogéosciences [UMR 6282] (BGS), Université de Bourgogne (UB)-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Timone [CHU - APHM] (TIMONE)-Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), Hôpital Henri Mondor-EA 4391, Service de Physiologie Explorations Fonctionnelles-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon-Université de Lyon-École Supérieure de Chimie Physique Électronique de Lyon (CPE)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Centre d'Exploration Métabolique par Résonance Magnétique [Hôpital de la Timone - APHM] (CEMEREM), Comité de développement horticole de la région Centre-Val-de-Loire (CDHR CENTRE-VAL-DE-LOIRE), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP), Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Centre National de la Recherche Scientifique (CNRS), Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS)-Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS)- Hôpital de la Timone [CHU - APHM] (TIMONE), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris 13 (UP13)-Hôpital Jean Verdier [AP-HP], Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Gabriel Montpied [Clermont-Ferrand], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA)-Université Côte d'Azur (UCA), Service de Neurologie [Rennes], Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut d’Électronique, de Microélectronique et de Nanotechnologie (IEMN) - UMR 8520 (IEMN), Ecole Centrale de Lille-Institut supérieur de l'électronique et du numérique (ISEN)-Université de Valenciennes et du Hainaut-Cambrésis (UVHC)-Université de Lille-Centre National de la Recherche Scientifique (CNRS)-Université Polytechnique Hauts-de-France (UPHF), Aix Marseille Université (AMU)-École Centrale de Marseille (ECM)-Centre National de la Recherche Scientifique (CNRS), COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA), Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département de Neurologie [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-IFR70-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Neurologie, CHU Clermont-Ferrand, Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: medicine.medical_specialty, Vaccination schedule, MEDLINE, Scientific literature, Multiple sclerosis, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Risk Factors, Health care, Medicine, Humans, 030212 general & internal medicine, Immunization Schedule, Societies, Medical, Vaccines, business.industry, Risk of infection, Prevention, Vaccination, medicine.disease, 3. Good health, Neurology, Immunization, Family medicine, Evidence-Based Practice, Practice Guidelines as Topic, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Neurology (clinical), France, business, Infection, Vaccine, 030217 neurology & neurosurgery
Abstract: Objectives To establish recommendations on immunization for patients with multiple sclerosis (MS). Background Vaccines have been suspected in the past to trigger MS and relapses. With the extension of the immunoactive treatment arsenal, other concerns have been raised more recently about an increased risk of infection or a decreased effectiveness of immunization in immunosuppressed patients. Methods The French Group for Recommendations into Multiple Sclerosis (France4MS) performed a systematic search of papers in Medline and other university databases (January 1975–June 2018). The RAND/UCLA appropriateness method was chosen to review the scientific literature and to formalize the degree of agreement among experts on 5 clinical questions related to immunization and MS. Readers from the steering committee conducted a systematic analysis, wrote a critical synthesis and prepared a list of proposals that were evaluated by a rating group of 28 MS experts. The final version of the recommendations was finally reviewed by a reading group of 110 health care professionals and classified as appropriate, inappropriate or uncertain. Results Neurologists should verify the vaccination status as soon as MS is diagnosed and before disease-modifying treatments (DMTs) are introduced. The French vaccination schedule applies to MS patients and seasonal influenza vaccination is recommended. In the case of treatment-induced immunosuppression, MS patients should be informed about the risk of infection and the vaccination standards of the French High Council of Health should be applied. Live attenuated vaccines are contra-indicated in patients recently treated with immunosuppressive drugs, including corticosteroids; other vaccines can be proposed whatever the treatment, but their effectiveness may be partly reduced with some drugs. Conclusion Physicians and patients should be aware of the updated recommendations for immunizations of patients with MS.
Published: 2019
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5. Histoire naturelle de la sclérose en plaques

Author: Gilles Defer, Marc Debouverie, I. Bardou, M. Benamar, R. Bernard-Valnet, P. Branger, D. Brassat, N. Benallègue, F. Calocer, V. Damotte, O. Dejardin, A. Dejean, N. Derache, F. Docagne, C. Donzé, A.-L. Dubessy, B. Fontaine, G. Fournié, A. Fromont, A. Garcia, P. Hautecœur, L. Lanotte, D. Laplaud, B. Le Mauff, H. Lebas, E. Leray, G. Mathey, D. Merkler, L. Michel, M. Michieletto, J. Morille, B. Nicol, C. Pierrot-Deseilligny, S. Pittion-Vouyovitch, I. Rebeix, A. Saoudi, D. Seilhean, B. Stankoff, O. Toutirais, D. Vivien, and S. Vukusic
Published: 2019
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6. Intégration dans le parcours patient des transplantés rénaux d’un suivi par télésurveillance–expérimentation ETAPES

Author: D. Laplaud, Carole Ayav, M. Kessler, C. Roldo, N. Rudynski, Sophie Girerd, C. Bouin, and L. Frimat
Subjects: Nephrology, Po T05
Abstract: Introduction La télésurveillance (TS) est un composant de la Télémédecine particulièrement adapté aux patients atteints de maladie chronique. Le programme ETAPES encourage et soutient financièrement le déploiement de projets dans 5 pathologies dont l’insuffisance rénale. Description Nous rapportons les résultats obtenus après mise en place d’ETAPES dans le parcours du transplanté rénal, l’objectif étant d’offrir à des greffés ayant bénéficié d’une éducation thérapeutique (ETP) un suivi à distance couplé à un accompagnement thérapeutique, en complément des consultations présentielles. Méthodes L’expérimentation fortement soutenue par le département stratégie du CHRU a commencé en 2018 chez des patients greffés depuis au moins 6 mois. Coordonnée par l’équipe infirmière d’ETP et de coordination en ambulatoire, elle utilise un outil informatique spécifiquement développé pour une étude scientifique (eNephro). Sa prescription doit être renouvelée tous les 6 mois. Résultats De novembre 2018 à avril 2020, 104 patients ont été inclus (72H - âge moyen 50,7 ± 1,3 ans), 49 participants à eNephro. Parmi les 85 % de patients éligibles, ≈50 % ont accepté la TS. En 2020, 7 patients ont été inclus précocement ( 6 mois de suivi, 15 % sortis). Avant le 01/03/2020, le nombre moyen mensuel de messages envoyés par les patients était de 13, après il est passé à 24. Conclusion L’acceptabilité de l’outil par les patients est bonne avec une utilisation renforcée durant la crise sanitaire. Grâce à la collaboration entre soignants, patients, administration et industriel, la mise en place a été rapide, facilitée par l’étude scientifique et la tarification. Grâce aux IDE de coordination, l’équipe s’est bien appropriée l’outil sans augmentation de la charge de travail. Une prochaine étape est l’intégration de l’ETP dans l’outil.
Published: 2020

7. Is the Choosing Wisely

Author: B, Trumbic, H, Zéphir, J-C, Ouallet, E, Le Page, D, Laplaud, C, Bensa, and J, de Sèze
Subjects: Multiple Sclerosis, Patients, Decision Making, Disease Management, Guidelines as Topic, Pilot Projects, Unnecessary Procedures, Urinalysis, Adrenal Cortex Hormones, Recurrence, Physicians, Feasibility Studies, Humans, France, Patient Participation
Abstract: Launched in the US in 2012, Choosing WiselyRecommendations were developed using the formal consensus method from the guidelines of the French National Health Authority (HAS). A steering committee selected the themes and drafted concise evidence reviews. An independent rating group then assessed these recommendations for clarity, relevance and feasibility.Seven recommendations were accepted: (1) avoid systematic ordering of multimodal evoked potential studies for diagnosing MS; (2) do not treat MS relapses with low-dose oral corticosteroids; (3) when treating MS relapse with high-dose corticosteroids, the systematic use of the intravenous route is unnecessary if the oral route can be used; (4) systematic hospitalization is not necessary for treating MS relapse with high-dose corticosteroid therapy, particularly if the oral route is used, except for the first treated relapse and the presence of exclusion or non-eligibility criteria; (5) in the absence of clinical signs or symptoms of urinary infection, avoid systematic screening with urine microscopy and culture before the administration of corticosteroid therapy for MS relapse in patients using intermittent self-catheterization; (6) avoid antibiotic treatment of clinically asymptomatic MS patients using intermittent self-catheterization, even if urine microscopy and culture reveal the presence of microorganisms; and (7) avoid introducing symptomatic drug treatment for MS-related fatigue.This pilot study, the first of its kind in France, has demonstrated the relevance and feasibility of adapting the Choosing Wisely
Published: 2016

8. Journées d’enseignement supérieur de neurologie – Nantes 2016

Author: D. Laplaud, Christophe Verny, Pascal Derkinderen, P. Damier, Hubert Desal, Gilles Edan, C. Boutoleau-Bretonnière, Service de neurologie [Nantes], Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Neuropathies du système nerveux entérique et pathologies digestives, implication des cellules gliales entériques, Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Neurologie [Rennes] = Neurology [Rennes], CHU Pontchaillou [Rennes], Hôpital Guillaume-et-René-Laennec [Saint-Herblain]-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes (UN), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes (UN)
Subjects: 03 medical and health sciences, 0302 clinical medicine, [SDV]Life Sciences [q-bio], 030212 general & internal medicine, Neurology (clinical), 030217 neurology & neurosurgery, ComputingMilieux_MISCELLANEOUS
Abstract: National audience; no abstract
Published: 2016
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9. Training-Induced Changes in Aerobic Aptitudes of Professional Basketball Players

Author: François Hug, D. Laplaud, and R. Menier
Subjects: Adult, Male, medicine.medical_specialty, Basketball, business.industry, media_common.quotation_subject, Body Weight, education, VO2 max, Physical Therapy, Sports Therapy and Rehabilitation, Incremental exercise, Oxygen Consumption, Heart rate, Physical therapy, Humans, Aerobic exercise, Medicine, Orthopedics and Sports Medicine, Aptitude, business, Ventilatory threshold, Exercise, Respiratory exchange ratio, media_common
Abstract: We investigated the effects of a training program on the aerobic aptitudes and the relevance of the instant of equality of pulmonary gas exchange (i. e., RER = 1.00) to assess these effects in professional basketball players. Eight athletes performed two incremental exercise tests on a cycloergometer separated by 4.7 +/- 0.7 months. Physiological variables recorded during these two tests (heart rate, oxygen uptake, carbon dioxide output, respiratory exchange ratio, power output) allowed to determine the first and second ventilatory thresholds and the instant of equality of pulmonary gas exchange. The training program induced significant variations of resting heart rate, oxygen uptake and power output measured for the instant of equality of pulmonary gas exchange. Moreover, the used fractions of heart rate, oxygen uptake and power reserves for the instant of equality of pulmonary gas exchange and the second ventilatory threshold increase significantly. Inversely, maximal oxygen uptake, maximal power reached and the used fractions of reserves for the first ventilatory threshold do not differ significantly. Professional basketball training is not focused on drills aiming to enhance both the aerobic power and aptitude, our results suggest that this training program induce the same physiological changes as a typical aerobic training. We also demonstrated that the instant of equality of pulmonary gas exchange is a powerful tool to quantify the changes in aerobic aptitudes during a sport season.
Published: 2004
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10. Multiple sclerosis (WS-038)

Author: K. Ozato, K. Siewert, C. Lee Chang, S. Nojima, S. Sakoda, H. C. Morse, R. Yamasaki, Y. Kawano, P. Dussart, K. E. Balashov, T. Kanno, L. Bhonsle, Y. Lin, L. Prin, S. Dubucquoi, I. Top, G. C. Ebers, S. Ramagopalan, Y. Nishimura, L. Aung, A. Kumanogoh, N. Isobe, T. Matsushita, B. Oxombre-Vanteghem, D. A. Hafler, D. J. Kim, W. Q. Huynh, H. Wekerle, K. C. O'Connor, H. Zéphir, J. P. Munasinghe, J. Park, M. Moriya, J. Kira, T. Okuno, D. Laplaud, P. Vermersch, Y. Nakatsuji, S. Dhib-Jalbut, I. Yazawa, B. Obermeier, J. Trauet, R. Yoshimi, R. Hohlfeld, M. J. O'Donovan, S. Miyake, A. P. Koretsky, K. Dornmair, L. Lovato, H. Wang, and T. Yamamura
Subjects: medicine.medical_specialty, business.industry, Multiple sclerosis, Immunology, medicine, Immunology and Allergy, General Medicine, medicine.disease, Psychiatry, business
Published: 2010
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11. Do graded exercise tests conceal accurate aerobic endurance and physiological overwork markers?

Author: R. Menier, J. Talmud, and D. Laplaud
Subjects: medicine.medical_specialty, Endurance training, business.industry, Heart rate, Overwork, Physical therapy, medicine, Aerobic exercise, Orthopedics and Sports Medicine, Ventilatory threshold, Cardiac frequency, business, human activities
Abstract: Aim. – To extract from a cycle test aerobic endurance markers and to validate them for longitudinal follow-up of training effects. Materials and methods. – 51 cyclists with high level endurance, 53 ball team sportsmen and 223 sedentary witnesses underwent an incremental cycle test. The notion of used fraction of a functional reserve was systematically applied to three parameters (cardiac frequency fc – mechanical power W · and O 2 intake V · O 2 ) at two selected moments (R =1.00 and second ventilatory threshold VT2). Results. – The fractions Fu of heart rate and power reserves for VT2, and especially for R =1.00, are all the more increased since aerobic endurance is developed: more increased in sportsmen than in sedentary witnesses (very highly significantly) and more increased in cyclists (with very high level endurance) than in ball team sportsmen. Conclusion. – The used fractions of heart rate and power reserve measured at two moments (R =1.00 and VT2) are excellent aerobic endurance markers, usable for longitudinal follow-up of sportsmen (particularly for R =1.00).
Published: 2005
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12. [Nosology and etiologies of acute longitudinally extensive transverse myelitis]

Author: N, Collongues, C, Papeix, H, Zéphir, B, Audoin, F, Cotton, F, Durand-Dubief, S, Vukusic, D, Brassat, D, Laplaud, R, Marignier, and Hélène, Zéphir
Subjects: Consensus, Terminology as Topic, Acute Disease, Neuromyelitis Optica, Practice Guidelines as Topic, Humans, Myelitis, Transverse, Prognosis, Magnetic Resonance Imaging, Autoantibodies
Abstract: Acute transverse myelitis had many names and definitions, based primarily on clinical criteria. The role of MRI in the exploration of myelitis has increased recently after the individualization of neuromyelitis optica (NMO) in 2004. This approach has enabled clarification of the diagnostic and prognostic value of acute longitudinally extensive transverse myelitis (LETM), defined by an extensive T2 lesion affecting three vertebral segments in the sagittal plane. The limitations of this definition, the multiplicity of terms used to characterize it as well as the large number of etiologies associated with it led our group of experts to clarify its etiology and nosology. We conducted a national survey on this subject in order to propose a new definition of LETM. Additional first- and second-intention examinations were determined according to the clinical context. Infectious/para-infectious, inflammatory or paraneoplastic causes can thus be identified. To determine within a short time the cause of LETM is essential, since most of its causes are severe and require urgent treatment.
Published: 2013

13. Peut-on encore améliorer la méthodologie des épreuves d’effort maximales pour un suivi longitudinal plus informatif de la filière énergétique aérobie ?

Author: D Laplaud and R Menier
Subjects: Orthopedics and Sports Medicine
Abstract: Resume Introduction – Le but de ce travail etait dans un premier temps de proposer la validation du concept d’utilisation fractionnelle des reserves (Fu r) et surtout, dans un second temps de tester la pertinence de ce concept dans l’appreciation du retentissement eventuel de l’entrainement sur l’endurance aerobie. Synthese des faits – La premiere serie regroupait 89 sportifs masculins (49 « endurants » et 40 adeptes des sports collectifs) d’endurance aerobie nettement differente. La seconde serie rassemblait 27 sportifs de toutes disciplines suivis au cours d’une periode d’entrainement en endurance. Conclusion – La Fu r des trois grandeurs selectionnees fournit effectivement des indices submaximaux d’endurance aerobie. Les Fu r a SV 1 et a R = 1,00 apparaissent comme d’excellents indicateurs d’endurance aerobie, en particulier a SV1, les Fu r suivent l’evolution a long terme de l’endurance aerobie sur quelques annees. Les Fu r a R = 1,00 (fc–W–VO 2 ) et a SV 2 (fc et W mais pas pour VO 2 ) apparaissent, lors du suivi longitudinal d’un sportif tout au long de la saison, comme des indicateurs de variation de l’endurance aerobie en reponse a l’entrainement a l’interieur d’une saison sportive.
Published: 2002
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14. Clinics and urodynamics in the cerebellar presentation of multiple sclerosis: A risky situation?

Author: Brigitte Perrouin-Verbe, L. Michel, D. Laplaud, J.-J. Labat, Sandrine Wiertlewski, L. Le Normand, M. Le Fort, and B. Reiss
Subjects: Cerebellum, medicine.medical_specialty, business.industry, Bladder, Multiple sclerosis, Rehabilitation, Urodynamic, medicine.disease, medicine.anatomical_structure, Physical medicine and rehabilitation, medicine, Physical therapy, Orthopedics and Sports Medicine, Presentation (obstetrics), business
Published: 2011
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15. Hyperréflexie autonome et neuromyélite optique de Devic : une association logique mais méconnue ; à partir d’un cas

Author: D. Laplaud, Brigitte Perrouin-Verbe, M. Le Fort, and Sandrine Wiertlewski
Subjects: Hyperréflexie autonome, Dyssynergie vésicosphinctérienne, Rehabilitation, Orthopedics and Sports Medicine, Devic, Neuromyélite optique
Published: 2011
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16. Intérêt d’un système de télémédecine dans le suivi des patients apnéiques traités par pression positive continue et présentant un risque cardiovasculaire élevé : essai randomisé contrôlé TéléSAS

Author: D. Laplaud, Monique Mendelson, Patrice Flore, Patrick Levy, Isabelle Vivodtzev, Sonia Dias-Domingos, F. Herengt, Renaud Tamisier, J.-P. Baguet, and J.L. Pépin
Subjects: Pulmonary and Respiratory Medicine
Published: 2014
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17. [Natural history of adult-onset eIF2B-related disorders: a multicentric survey of 24 cases]

Author: C, Carra-Dalliere, L, Horzinski, X, Ayrignac, S, Vukusic, D, Rodriguez, F, Mauguiere, L, Peter, C, Goizet, F, Bouhour, C, Denier, C, Confavreux, M, Obadia, F, Blanc, J, de Seze, F, Sedel, A-M, Guennoc, E, Sartori, D, Laplaud, J-C, Antoine, A, Fogli, O, Boespflug-Tanguy, and P, Labauge
Subjects: Adult, Male, Adolescent, Data Collection, Middle Aged, Cohort Studies, Eukaryotic Initiation Factor-2B, Hereditary Central Nervous System Demyelinating Diseases, Young Adult, Mutation, Disease Progression, Humans, Female, Age of Onset, Child, Retrospective Studies
Abstract: The childhood ataxia with central nervous system hypomyelination-vanishing white matter syndrome (CACH-VWM) was first characterized in children (2-5 years) on clinical and MRI criteria: cerebellospastic signs associated with episodes of rapid deterioration following stress and extensive cavitatingleucoencephalopathy. Causative mutations were found in the five genes encoding the subunits of the eukaryotic initiation factor 2B (eIF2B), involved in protein synthesis and its regulation under cellular stresses. A broad clinical spectrum has been subsequently described from congenital to adult-onset forms leading to the concept of eIF2B-related disorders. Our aim was to describe clinical and brain magnetic resonance imaging characteristics, genetic findings and natural history of patients with adult-onset eIF2B-related disorders.The inclusion criteria were based on the presence of EIF2B mutations and a disease onset after the age of 16 years. One patient with an asymptomatic diagnosis was also included. Clinical and MRI findings were retrospectively recorded in all patients. This multicentric study included 24 patients from 22 families.A sex-ratio imbalance was noted (male/female=5/19). The mean age of onset was 30 years (range 12-62). Initial symptoms were neurologic (n=20), psychiatric (n=3) and ovarian failure (n=6). During follow-up (mean: 11 years, range 2-35 years), two patients died. Of the 22 survivors, 67% showed a decline in their cognitive functions and mean EDSS was 5.6 (range=0-9.5). One case remained asymptomatic. Stress worsened clinical symptoms in 33% of the patients. Magnetic resonance imaging findings consisted of cerebral atrophy (92%), extensive cystic leucoencephalopathy (83%), corpus callosum involvement (92%) and cerebellar (37%) T2-weighted hyperintensities. Most patients (83%) showed mutations in the EIF2B5 gene. The recurrent p.Arg113His-eIF2Be mutation was found at a homozygous state in 58% of the 24 eIF2B-mutated patients.eIF2B-related disorder is probably underestimated as an adult-onset inherited leucoencephalopathy. Cerebral atrophy is constant, whereas the typical vanishing of the white matter can be absent. Functional and cognitive prognosis remains severe. Molecular diagnosis is facilitated for these forms by screening for the recurrent p.Arg113His-eIF2Be mutation.
Published: 2010

18. EMG threshold determination in eight lower limb muscles during cycling exercise: a pilot study

Author: François Hug, Laurent Grélot, Alejandro Lucia, and D. Laplaud
Subjects: Adult, Male, medicine.medical_specialty, Coefficient of variation, Physical Therapy, Sports Therapy and Rehabilitation, Physical exercise, Pilot Projects, Electromyography, Biceps, Models, Biological, Lower limb, Internal medicine, medicine, Humans, Orthopedics and Sports Medicine, Educación física, Muscle, Skeletal, Condición física, Reproducibility, medicine.diagnostic_test, business.industry, Ciclismo, Reproducibility of Results, Anatomy, Deporte, musculoskeletal system, body regions, Motor unit, Lower Extremity, Cardiology, Exercise Test, Physical Endurance, Cycling, business
Abstract: The first aim of this study was to verify the occurrence of the EMG threshold (EMG (Th)) in each of eight lower limb muscles (vastus lateralis [VL], vatus medialis [VM], rectus femoris [RF], semimembranosus [SM], biceps femoris [BF], gastrocnemius lateralis [GL] and medialis [GM], and tibialis anterior [TA]) during incremental cycling exercise. The second aim was to investigate the test-retest reproducibility of the EMG (Th) occurrence. Six sedentary male subjects (27 +/- 1 years) performed the same incremental cycling test until exhausted, (workload increments of 25 W/min starting at 100 W) twice. During the tests, the EMG Root Mean Square (RMS) response was studied in the aforementioned muscles. The EMG (Th) was detected mathematically from the RMS vs. workload relationship. All the subjects showed an EMG (Th) in the VL muscle, and the response was reliable in both tests (246 +/- 33 W and 254 +/- 33 W for the first and second test, respectively; coefficient of variation: 9.6 %, standard error of measurement: 28.9). However, few of them showed an EMG (Th) in the other muscles, especially in RF, SM or GM. When present, the EMG (Th) occurred at 75 - 80 % of the peak power output obtained during the tests. Our results suggest that EMG (Th) determination can be used as a reliable method for studying neuromuscular adjustments in the VL of untrained individuals, but not in other lower limb muscles. Sin financiación 1.240 JCR (2006) Q2, 31/73 Sport sciences UEM
Published: 2006

19. Laboratory running test vs. field roller skiing test in cross-country skiers: a longitudinal study

Author: P. Flore, D Laplaud, Samuel Verges, Michel Guinot, and A. Favre-Juvin
Subjects: Male, medicine.medical_specialty, Longitudinal study, Adolescent, Physical Therapy, Sports Therapy and Rehabilitation, Physical exercise, Oxygen Consumption, Heart Rate, Skiing, Heart rate, Blood lactate, Medicine, Humans, Orthopedics and Sports Medicine, Roller skiing, Lactic Acid, Longitudinal Studies, Physical Education and Training, business.industry, Oxygen uptake, Test (assessment), Physical therapy, Exercise intensity, Exercise Test, Physical Endurance, business, human activities
Abstract: Laboratory treadmill running tests are commonly used to assess the effect of training programs and to prescribe training intensity for cross-country skiers. The present study compared the physiological parameters during a treadmill running (R) test and a field roller skiing (RS) test both at the beginning (Beg) and at the end (End) of a 6-month specific training program in seven competitive cross-country skiers. Oxygen uptake (VO2) and blood lactate concentration ([La]) were assessed for exercise intensity corresponding to 70%, 80%, 90% of maximal heart rate (HRmax) and to HRmax.VO2 was lower for the RS test compared to the R test at any HR levels at Beg only (p0.05). Maximal VO2 increased from Beg to End for the RS test only (+23.7+/-10.4; p0.05). [La] was lower for the R test compared to the RS test during both testing periods at 90% HRmax (p0.05), and no significant modification in [La] from Beg to End at any HR levels was observed (p0.05). The [La]/V.O2 curve shifted toward the right from Beg to End to a greater extent for the RS test compared to the R test. The present study emphasised the importance of exercise specificity in order to assess the effect of specific training program in competitive cross-country skiers.
Published: 2006

20. Le niveau d’activité physique est le déterminant principal de la tension artérielle du soir chez des patients apnéiques à haut risque cardio-vasculaire

Author: M. Mendelson, R. Tamisier, D. Laplaud, S. Dias-Domingos, J.-P. Baguet, L. Moreau, G. Koltes, L. Chaves, G. De Lamberterie, F. Herengt, P. Levy, P. Flore, and J.-L. Pepin
Subjects: Pulmonary and Respiratory Medicine
Published: 2013
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21. Reproducibility of eight lower limb muscles activity level in the course of an incremental pedaling exercise

Author: François Hug, Laurent Grélot, and D. Laplaud
Subjects: Adult, Male, medicine.medical_specialty, Vastus medialis, Biophysics, Neuroscience (miscellaneous), Electromyography, Biceps, Lower limb, Incremental exercise, Physical medicine and rehabilitation, Medicine, Humans, Muscle, Skeletal, Reproducibility, medicine.diagnostic_test, business.industry, Reproducibility of Results, Muscle activation, musculoskeletal system, Adaptation, Physiological, body regions, Leg exercise, Muscle Fatigue, Physical therapy, Exercise Test, Physical Endurance, Neurology (clinical), business, human activities
Abstract: Despite the wide use of surface electromyography (EMG) recorded during dynamic exercises, the reproducibility of EMG variables has not been fully established in a course of a dynamic leg exercise. The aim of this study was to investigate the reproducibility of eight lower limb muscles activity level during a pedaling exercise performed until exhaustion. Eight male were tested on two days held three days apart. Surface EMG was recorded from vastus lateralis, rectus femoris (RF), vastus medialis, semimembranosus, biceps femoris, gastrocnemius lateral, gastrocnemius medianus and tibialis anterior during incremental exercise test. The root mean square, an index of global EMG activity, was averaged every five crank revolutions (corresponding to about 3 s at 85 rpm) throughout the tests. Despite inter-subjects variations, we showed a high reproducibility of the activity level of lower limb muscles during a progressive pedaling exercise performed until exhaustion. However, RF muscle seemed to be the less reproducible of the eight muscles investigated during incremental pedaling exercise. These results suggest that each subject adopt a personal muscle activation strategy in a course of an incremental cycling exercise but fatigue phenomenon can induce some variations in the most fatigable muscles (RF).
Published: 2004

22. Reproducibility of the instant of equality of pulmonary gas exchange and its physiological significance

Author: D, Laplaud and R, Menier
Subjects: Adult, Male, Pulmonary Gas Exchange, Exercise Test, Physical Endurance, Humans, Reproducibility of Results, Female, Lactic Acid
Abstract: The goal of this work was to highlight the effectiveness of a new submaximal exercise index of aerobic endurance using a single incremental test: the time at which oxygen uptake and carbon dioxide output are equal, i.e., when the respiratory exchange ratio (RER)=1.00. We studied 2 experimental sets, the 1(st) to assess the reproducibility and the variability of measured variables, the 2(nd) to assess the physiological significance of the instant RER=1.00.The 1(st) group consisted of 8 subjects who performed 3 maximal ramp tests, the 2(nd) of 32 athletes. All subjects performed an incremental ramp test until exhaustion with determination of 1(st) and 2(nd) ventilatory and lactic thresholds (VT(1)-LT(1), VT(2)-LT(2)) and the RER=1.00 instant.There was no significant difference in the used fractions of reserves (UF r) for heart rate, oxygen uptake and power output for RER=1.00 between tests, the coefficients of variation being non-significant. In group 2, there were no significant difference of UF r between VT(1) and LT(1), VT(2) and RER=1.00, LT(2) and RER=1.00. In contrast, VT(2) differed significantly from LT(2).Measurement of the instant of equality of pulmonary gas exchange was therefore reproducible with a low intraindividual variability. Moreover, it exists a concordance of the apparitions of VT(1) and LT(1) and between these of RER=1.00 and VT(2) and LT(2). Thus, with the instant RER=1.00 provides the physiologist and the sports physician with an efficient submaximal tool to evaluate aerobic endurance of athletes using a single incremental exercise test.
Published: 2004

23. Occurrence of electromyographic and ventilatory thresholds in professional road cyclists

Author: B. Savin, D. Laplaud, François Hug, and Laurent Grélot
Subjects: Adult, Male, medicine.medical_specialty, Sports medicine, Anaerobic Threshold, Physiology, Physical exercise, Electromyography, Incremental exercise, Physical medicine and rehabilitation, Physiology (medical), medicine, Humans, Orthopedics and Sports Medicine, Muscle, Skeletal, medicine.diagnostic_test, business.industry, Pulmonary Gas Exchange, Public Health, Environmental and Occupational Health, VO2 max, General Medicine, Bicycling, Ventilatory threshold, Cycling, business, human activities, Anaerobic exercise
Abstract: The temporal relationship between the electromyographic (EMG) and ventilatory thresholds was investigated during incremental exercise performed by eight professional road cyclists. The exercise, performed on a cycloergometer, started at 100 W with successive increments of 26 Wx min(-1) until exhaustion. Gas exchange and the root mean square value of EMG (RMS) from eight lower limb muscles were examined throughout the exercise period. Professional cyclists achieved a maximal oxygen consumption, i.e. VO(2max), of 5.4 (0.5) l x min(-1) [74.6 (2.5) ml x min(-1) x kg(-1), range: 67.8-82.4 ml x min(-1) x kg(-1)] and a maximum power ( W(max)) of 475 (30) W (range: 438-516 W). Our results showed at least the occurrence of a first EMG threshold (EMG(Th1)) in 50% (gastrocnemius lateralis) of the subjects and a second EMG threshold (EMG(Th2)) in 63% (gastrocnemius medialis). EMG(Th1) occurred significantly before the first ventilatory threshold (VT(1)), i.e. at 52 (2)% and 62 (9)% of W(max), respectively. Inversely, no significant difference was observed between the occurrence of EMG(Th2) and the second ventilatory threshold (VT(2)), i.e. at 86 (1)% and 89 (7)% of W(max), respectively. These results suggest that the use of EMG may be a useful non-invasive method for detecting the second ventilatory threshold in most of the muscles involved in cycling exercise.
Published: 2003

24. Analyse clinique et urodynamique des formes cérébelleuses de sclérose en plaques : une situation à risque ?

Author: Sandrine Wiertlewski, D. Laplaud, Brigitte Perrouin-Verbe, M. Le Fort, B. Reiss, J.-J. Labat, L. Le Normand, and L. Michel
Subjects: Rehabilitation, Orthopedics and Sports Medicine
Published: 2011
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25. An update on multiple sclerosis physiopathology

Author: D. Laplaud
Subjects: Pathology, medicine.medical_specialty, B lymphocyte, business.industry, Multiple sclerosis, Immunology, Physiopathology, Rehabilitation, T lymphocyte, medicine.disease, Pathophysiology, medicine, Orthopedics and Sports Medicine, business
Published: 2011
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26. Intérêt d’un système de télémédecine dans le suivi de patients apnéiques traités par PPC et à risque cardiovasculaire élevé : étude randomisée TéléSAS

Author: Patrick Levy, Isabelle Vivodtzev, J.-P. Baguet, Patrice Flore, D. Laplaud, Sonia Dias-Domingos, F. Herengt, Renaud Tamisier, Monique Mendelson, and J.L. Pépin
Subjects: Behavioral Neuroscience, Neuropsychology and Physiological Psychology, Neurology, Cognitive Neuroscience, Neurology (clinical)
Published: 2014
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27. Branched-chain aminoacids and retraining of patients with chronic obstructive lung disease

Author: R, Menier, J, Talmud, D, Laplaud, and M P, Bernard
Subjects: Bronchitis, Chronic, Case-Control Studies, Humans, Prospective Studies, Middle Aged, Amino Acids, Branched-Chain
Abstract: The aim of this work was to improve the efficacy of rehabilitation by retraining, by oral supply in branched-chain aminoacids (BCAA). Patients with chronic respiratory insufficiency mainly suffer from obstructive bronchitis due to tobacco or asthma. Nutritional assessment is one of the components of respiratory rehabilitation, with retraining. Intense physical training for several days negativates the nitrogen balance, the beginning of a training programme for sedentary patients increases their need in proteins. An additional supply in branched-chain aminoacids increases proteic anabolism, by synthesis increase and catabolism slackening of proteins. Moreover it is known that exposure to high altitude reduces lean mass by inducing a muscular atrophy, which can be avoided by the BCAA provided. This leads to wonder if extra supply of BCAA could play similar role in muscular mass loss induced by pathological chronic hypoxia.The prospective and comparative survey carried out in Toki-Eder (private hospital in Cambo) consisted in supplying (during five weeks or more) 30 retrained patients suffering from chronic obstructive bronchitis, and in matching them with 30 witnesses (obstructive patients retrained without additional supply in BCAA). Their mean hypoxemia amounted to 7 torr for age.Each of them improved their reached maximal power, and their VO2 SL, very highly significantly. Each of them developed a moderate metabolic acidosis (whose possible mechanisms are discussed) and slightly increased their ventilation at rest. On the other hand only the supplied patients improved their PaO2 at rest highly significantly, a result which poses the question of the responsible mechanism, most likely a decrease of pulmonary shunt effect. The hypotheses concerning the acid load due to BCAA ingestion are discussed. Only the supplied patients developed hypocapnia expressing a gaseous alkalosis which might be due to a direct effect of BCAA on the respiratory centers.This observation could have practical outcomes in the management of rehabilitation of chronic respiratory insufficiency: it should be useful to systematically supplement the patients with BCAA during their retraining in order to obtain a more effective improvement of their respiratory function.
Published: 2001

28. [Assessment of physical and sports aptitudes, overtraining prevention, and prevention of doping]

Author: R, Menier, D, Laplaud, F, Dalmay, and J, Talmud
Subjects: Doping in Sports, Physical Fitness, Physical Exertion, Humans
Abstract: Present levels of training loads--which can exceed thirty hours a week for high level sportsmen--expose to overwork then to overtraining syndrome and finally to temptation of doping. At the same time testing techniques improve, particularly exercise tests with a linearly increasing load, and the follow-up of training effects on physical fitness provides more accurate data. The specialized literature has developed the notions of cardiac frequency reserve and of oxygen intake reserve within the last ten years. These notions, as those of produced power reserve, were applied here to assess the ventilatory threshold of 104 sportsmen (51 cyclists with high endurance and 53 team sportsmen with lower endurance) and of 223 sedentary witnesses. They allow, when completed with absolute level of aerobic endurance, to appreciate physical fitness of sportsmen all along sports season, to predict their capabilities to progress by an increase of training load or to reinforce the hypothesis of an over-working onset.
Published: 2000

29. [Capillary telangiectasis, angiographically occult vascular malformations. MRI symptomatology apropos of 7 cases]

Author: E, Auffray-Calvier, H A, Desal, P, Freund, D, Laplaud, G, Mathon, and A, De Kersaint-Gilly
Subjects: Adult, Aged, 80 and over, Male, Contrast Media, Gadolinium, Middle Aged, Image Enhancement, Magnetic Resonance Imaging, Capillaries, Cerebral Angiography, Cerebrovascular Disorders, Cranial Fossa, Posterior, Pons, Image Processing, Computer-Assisted, Humans, Female, Telangiectasis, Vertebral Artery, Aged, Follow-Up Studies, Retrospective Studies
Abstract: Describe the MRI findings in capillary telangiectasias.Between 1996 and 1999, we observed 9 cases of capillary telangiectasia in 7 patients explored 5 times for posterior fossa symptoms. In two cases capillary telangiectasia was a fortuitous discovery. All patients were explored by MRI with T1 sequences with and without gadolinium injections, turbo spin echo T2 coupled in 5 cases with a double echo gradient echo T2 sequence (TR: 970 ms, TE: 15 and 35 ms). Two patients also underwent vertebral angiography.The telangiectasia gave a low intensity signal on T1 sequences in 2 of the 9 cases and a discretely high intensity signal on T2 sequences in all cases. After gadolinium injection, 9 telangiectasias showed homogeneous or speckled enhancement. The echo-gradient T2 images showed a very low intensity signal in 7 out of 7 cases on the second echo. At the first echo, 4 capillary telangiectasias were undetectable. The two vertebral angiographies were normal and the follow-up MRI in 5 patients showed lesion stability.Pontile lesions with no mass effect showing enhancement after gadolinium injection and with or without a discrete T2 high intensity signal but with a frank echo-gradient T2 signal strongly suggest capillary telangiectasia.
Published: 2000

30. Le niveau d’activité physique est le déterminant principal de la tension artérielle du soir chez des patients SAOS à haut risque cardiovasculaire

Author: Renaud Tamisier, Patrice Flore, Patrick Levy, D. Laplaud, Monique Mendelson, Christian Koltes, Sonia Dias-Domingos, L. Moreau, J.-L. Pépin, and J.-P. Baguet
Subjects: Behavioral Neuroscience, Neuropsychology and Physiological Psychology, Neurology, Physiology (medical), Cognitive Neuroscience, General Medicine, Neurology (clinical)
Published: 2013
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31. Étude prospective, observationnelle de la sécurité d’emploi de la 3,4-diaminopyridine base

Author: D. Laplaud, E. Rousselet, S. Wiertlewski, A. Trainaud, A. Chincholle, A. Chiffoleau, M. Pennetier, and L. Flet
Subjects: business.industry, Medicine, Pharmacology (medical), business
Published: 2012
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32. Réentraı̂nement des bronchiteux chroniques obstructifs supplémentés en acides aminés ramifiés

Author: R. Menier, J. Talmud, and D. Laplaud
Subjects: Gynecology, medicine.medical_specialty, Lung disease, business.industry, medicine, Aminoacids branched chain, Orthopedics and Sports Medicine, business
Abstract: Resume Introduction – Le but de ce travail est de verifier s'il est possible d'accroitre l'efficacite du reentrainement sur la rehabilitation des bronchiteux chroniques obstructifs, en y adjoignant une supplementation orale en acides amines ramifies. Synthese des faits – Trente patients bronchitiques chroniques obstructifs reentraines ont ete supplementes en acides amines ramifies et apparies a 30 temoins (patients identiques suivant le meme reentrainement) non supplementes. Les deux groupes ont ameliore leur puissance maximale atteinte et leur VO 2 sl . Seuls les patients supplementes ont ameliore leur PaO 2 au repos de facon hautement significative, et developpe une hypocapnie traduisant une alcalose ventilatoire. La discussion du mecanisme responsable amene a privilegier l'hypothese d'une action directe des acides amines ramifies sur les centres respiratoires. Conclusion – une administration systematique d'acides amines ramifies pourrait accroitre l'efficacite de l'entrainement sur l'amelioration de la fonction respiratoire chez des bronchitiques chroniques obstructifs.
Published: 2002
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33. Intérêt d’un dispositif de tele suivi dans un programme de réhabilitation à domicile de long terme2

Author: L. Moreau, E. Lonsdorfer, E. Weitzenblum, and D. Laplaud
Subjects: Pulmonary and Respiratory Medicine
Published: 2006
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34. A Comparison of Visual and Mathematical Detection of the Electromyographic Threshold During Incremental Pedaling Exercise: A Pilot Study

Author: Alejandro Lucia, D. Laplaud, Laurent Grélot, and François Hug
Subjects: Adult, Male, medicine.medical_specialty, Ergometry, Computer science, Pilot Projects, Physical Therapy, Sports Therapy and Rehabilitation, Context (language use), Models, Biological, Lower limb, Physical medicine and rehabilitation, medicine, Humans, Orthopedics and Sports Medicine, Power output, Reliability (statistics), Leg, Electromyography, Medicina deportiva, General Medicine, body regions, Visual inspection, Ciclismo-Entrenamiento, Condición física-Ejercicios, Neuromuscular fatigue, Motor unit recruitment, Linear Models, Visual Perception, Physical therapy, Ventilatory threshold, Algorithms
Abstract: Hug, F., D. Laplaud, A. Lucia, and L. Grelot. A comparison of visual and mathematical detection of the electromyographic threshold during incremental pedaling exercise: A pilot study. J. Strength Cond. Res. 20(3):704-708. 2006.-During exhaustive incremental pedaling exercises, root mean square or amplitude of integrated electromyographic values exhibits a nonlinear increase, i.e., the so-called electromyographic threshold (EMGTh). As proposed by various authors, this EMGTh could be used as a complementary indicator of the aerobic-anaerobic transition in physiological evaluations. However, most of these studies used visual detection for the EMGTh and to date no previous study has shown the reliability of this type of EMGTh detection. We aimed to compare a visual and a mathematical method for EMGTh detection in each of 8 lower limb muscles during incremental cycling exercise. Our results showed an overestimation in the number of cases in which EMGTh was detected when using visual inspection (n = 45) compared with the mathematical method (n = 32). However, no significant differences were observed between the 2 methods concerning the power output at which EMGTh occurred. These results suggest that EMGTh should be mathematically detected. In this context, coaches can easily perform such measurements in order to evaluate the impact of their training programs on the neuromuscular adaptations of their athletes. For example, an automatic mathematical detection of EMGTh could be performed during a pedaling exercise in order to detect neuromuscular fatigue. Furthermore, this index could be used during test or training sessions performed either in a lab or in ecological situations. Moreover, the use of EMGTh to predict ventilatory threshold occurrence could be an interesting tool for trainers who cannot use the very expensive devices needed to analyze respiratory gas exchanges
Published: 2006
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35. Training-Induced Changes in Aerobic Aptitudes of Professional Basketball Players.

Author: D. Laplaud
Subjects: *BASKETBALL training, *AEROBIC exercises, *PULMONARY gas exchange, *RESPIRATION
Abstract: We investigated the effects of a training program on the aerobic aptitudes and the relevance of the instant of equality of pulmonary gas exchange (i. e., RER = 1.00) to assess these effects in professional basketball players. Eight athletes performed two incremental exercise tests on a cycloergometer separated by 4.7 ± 0.7 months. Physiological variables recorded during these two tests (heart rate, oxygen uptake, carbon dioxide output, respiratory exchange ratio, power output) allowed to determine the first and second ventilatory thresholds and the instant of equality of pulmonary gas exchange. The training program induced significant variations of resting heart rate, oxygen uptake and power output measured for the instant of equality of pulmonary gas exchange. Moreover, the used fractions of heart rate, oxygen uptake and power reserves for the instant of equality of pulmonary gas exchange and the second ventilatory threshold increase significantly. Inversely, maximal oxygen uptake, maximal power reached and the used fractions of reserves for the first ventilatory threshold do not differ significantly. Professional basketball training is not focused on drills aiming to enhance both the aerobic power and aptitude, our results suggest that this training program induce the same physiological changes as a typical aerobic training. We also demonstrated that the instant of equality of pulmonary gas exchange is a powerful tool to quantify the changes in aerobic aptitudes during a sport season. [ABSTRACT FROM AUTHOR]
Published: 2004
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36. [Dopamine and dobutamine as treatment of circulatory shock initially non-cardiogenic: a clinical study (author's transl)]

Author: B, Constantin, J P, Racle, R, Chausset, C, Ferrier, and D, Laplaud
Subjects: Catecholamines, Oxygen Consumption, Central Venous Pressure, Dobutamine, Dopamine, Humans, Blood Pressure, Shock, Cardiac Output, Diuresis
Published: 1980

37. Mise au point sur la physiopathologie de la sclérose en plaques

Author: D. Laplaud
Subjects: Lymphocyte T, Physiopathologie, Lymphocyte B, Rehabilitation, Immunologie, Orthopedics and Sports Medicine, Sclérose en plaque
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38. Autonomous hyperreflexia and Devic’ optic neuromyelitis: A logical but poorly recognized combination: a case report

Author: Brigitte Perrouin-Verbe, Sandrine Wiertlewski, M. Le Fort, and D. Laplaud
Subjects: business.industry, Rehabilitation, Medicine, Orthopedics and Sports Medicine, Hyperreflexia, medicine.symptom, Optic neuromyelitis, business, Neuroscience
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39. MRI management for NMOSD and MOGAD: Proposals from the French Expert Group NOMADMUS.

Author: Durand-Dubief F, Shor N, Audoin B, Bourre B, Cohen M, Kremer S, Maillart E, Papeix C, Ruet A, Savatovsky J, Tourdias T, Ayrignac X, Ciron J, Collongues N, Laplaud D, Michel L, Thouvenot E, Zephir H, Marignier R, and Cotton F
Abstract: Background: Currently, there are no available recommendations or guidelines on how to perform MRI monitoring in the management of neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). The issue is to determine a valuable MRI monitoring protocol to be applied in the management of NMOSD and MOGAD, as previously proposed for the monitoring of multiple sclerosis., Objectives: The objectives of this work are to establish proposals for a standardized and feasible MRI acquisition protocol, and to propose control time points for systematic MRI monitoring in the management of NMOSD and MOGAD., Methods: A steering committee composed of 7 neurologists and 5 neuroradiologists, experts in NMOSD and MOGAD from the French group NOMADMUS, defined 8 proposals based on their expertise and a review from the literature. These proposals were then submitted to a Rating Group composed of French NMOSD / MOGAD experts., Results: In the management of NMOSD and MOGAD, a consensus has been reached to perform systematic MRI of the brain, optic nerve and spinal cord, including cauda equina nerve roots, at the time of diagnosis, both without and after gadolinium administration. Moreover, it has been agreed to perform a systematic MRI scan 6 months after diagnosis, focusing on the area of interest, both without and after gadolinium administration. For long-term follow-up of NMOSD and MOGAD, and in the absence of clinical activity, it has been agreed to perform gadolinium-free MRI of the brain (+/- optic nerves) and spinal cord, every 36 months. Ideally, these MRI scans should be performed on the same MRI system, preferably a 3T MRI system for brain and optic nerve MRI, and at least a 1.5T MRI system for spinal cord MRI., Conclusions: This expert consensus approach provides physicians with proposals for the MRI management of NMOSD and MOGAD., Competing Interests: Declaration of Interest statement Françoise DURAND-DUBIEF has nothing to disclose. Natalia SHOR has nothing to disclose. Bertrand AUDOIN has nothing to disclose. Bertrand BOURRE serves on scientific advisory board, has received funding for travel and honoraria from Alexion, Biogen, BMS, Horizon, Janssen, Merck, Novartis, Sanofi, Sandoz and Roche. Mikael Cohen has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Merck, Sanofi, Roche, Celgene-BMS, Janssen, Alexion, Horizon Therapeutics and Ad Scientiam. Stéphane KREMER has nothing to disclose. Elisabeth MAILLART reports research support from Biogen and personal fees for lectures and advisory boards from Alexion, Biogen, Horizon, Janssen, Merck, Novartis, Roche, Sanofi, and Teva. Caroline PAPEIX has received personal compensation for consulting, serving on a scientific advisory board, speaking from Alexion, Horizon, Roche. Aurélie RUET has received funding for travel or speaker or consultant honoraria from Biogen, Alexion, Novartis, Sanofi, Merck, Horizon Therapeutic; and received research support from Biogen, BMS, Sanofi, Roche, Merck. Julien SAVATOVSKY has nothing to disclose. Thomas TOURDIAS has nothing to disclose. Xavier AYRIGNAC has received consulting fees and lecturing fess, travel grants and undoncitional research support from Alexion, Biogen, Genzyme, Janssen, Merck Serono, Novartis, Roche, Sanofi Aventis and Teva Pharma. Jonathan CIRON has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Novartis, Merck, Sanofi, Roche, Alexion, Horizon Therapeutics, none related to this study. Nicolas COLLONGUES has received honoraria for consulting or presentation from Alexion, Biogen Idec, Bristol-Myers Squibb, Horizon Therapeutics, Merck Serono, Novartis, Roche and Sanofi-Genzyme and is a member of the Editorial Board of the Journal de la Ligue Française contre la Sclérose en plaques and the Neurology and Therapy Journal. David LAPLAUD served on scientific advisory boards for Alexion, BMS, Roche, Sanofi, Novartis, Merck, Janssen and Biogen, received conference travel support and/or speaker honoraria from Alexion, Novartis, Biogen, Roche, Sanofi, BMS and Merck and received research support from Fondation ARSEP, Fondation EDMUS and Agence Nationale de la Recherche. Laure MICHEL has nothing to disclose. Eric THOUVENOT received consulting and lecturing fees, travel grants or unconditional research support from Actelion, Biogen, BMS, Merck, Novartis, Roche, Teva pharma. Hélène ZEPHIR received consulting fees and invitation for congresses from Alexion, Horizon Therapeutics, Roche, Sanofi, Janssen, Biogen Idex, Merck, BMS. HZ received research supports from Novartis, Roche. Romain MARIGNIER serves on scientific advisory boards for Horizon Therapeutics/Amgen; and has received funding for travel and fees from Alexion, Amgen Biogen, Roche, Sanofi. François COTTON reports grants, consulting fees, and non-financial support from Biogen, Bracco imaging, Merck-Serono, Novartis, Philips and Roche., (Copyright © 2024. Published by Elsevier Masson SAS.)
Published: 2024
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40. Scoping review of clinical decision support systems for multiple sclerosis management: Leveraging information technology and massive health data.

Author: Demuth S, Ed-Driouch C, Dumas C, Laplaud D, Edan G, Vince N, De Sèze J, and Gourraud PA
Subjects: Humans, Information Technology, Big Data, Multiple Sclerosis therapy, Decision Support Systems, Clinical
Abstract: Background and Purpose: Multiple sclerosis (MS) is a complex autoimmune disease of the central nervous system, with numerous therapeutic options, but a lack of biomarkers to support a mechanistic approach to precision medicine. A computational approach to precision medicine could proceed from clinical decision support systems (CDSSs). They are digital tools aiming to empower physicians through the clinical applications of information technology and massive data. However, the process of their clinical development is still maturing; we aimed to review it in the field of MS., Methods: For this scoping review, we screened systematically the PubMed database. We identified 24 articles reporting 14 CDSS projects and compared their technical and software development aspects., Results: The projects position themselves in various contexts of usage with various algorithmic approaches: expert systems, CDSSs based on similar patients' data visualization, and model-based CDSSs implementing mathematical predictive models. So far, no project has completed its clinical development up to certification for clinical use with global release. Some CDSSs have been replaced at subsequent project iterations. The most advanced projects did not necessarily report every step of clinical development in a dedicated article (proof of concept, offline validation, refined prototype, live clinical evaluation, comparative prospective evaluation). They seek different software distribution options to integrate into health care: internal usage, "peer-to-peer," and marketing distribution., Conclusions: This review illustrates the potential of clinical applications of information technology and massive data to support MS management and helps clarify the roadmap for future projects as a multidisciplinary and multistep process., (© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)
Published: 2025
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41. Neurosarcoidosis: Clinical, biological, and MRI presentation of central nervous system disease in a national multicenter cohort.

Author: Dos Santos A, Courtin E, Ruet A, Duffau P, Mathey G, Bekkour I, Ciron J, Michel L, Blanc FX, Aguilar J, Lejeune P, Marc G, Laplaud D, Magot A, Hamidou M, and Wiertlewski S
Subjects: Humans, Male, Female, Middle Aged, Adult, Retrospective Studies, France, Aged, Immunosuppressive Agents therapeutic use, Adrenal Cortex Hormones therapeutic use, Sarcoidosis diagnostic imaging, Sarcoidosis drug therapy, Central Nervous System Diseases diagnostic imaging, Central Nervous System Diseases drug therapy, Magnetic Resonance Imaging
Abstract: Introduction: Neurosarcoidosis (NS) is a systemic inflammatory granulomatous disease affecting of patients with sarcoidosis. Its diagnosis is difficult as there is no specific test for it. Because of its rarity, the management of NS has so far only been described in case series and short retrospective cohorts. The objective of this study is description of the clinical, paraclinical presentation and the therapeutic management of central nervous system (CNS) involvement in NS patients in France., Methods: This multicenter, retrospective, observational study involved patients hospitalized between 2010 and 2019 with a diagnosis of sarcoidosis and CNS involvement., Results: We included 118 patients (38 with isolated NS, 80 with NS associated with systemic sarcoidosis). NS was the initial presentation in 78% of patients, with cranial nerve involvement (36%), medullary symptoms (23%), and seizures (21%). Twenty-one percent of the patients had already been diagnosed with systemic sarcoidosis. The most frequent biological abnormality was lymphopenia (62.5%), while angiotensin-converting enzyme was increased in 21%. Meningitis was present in 45% and hyperproteinorachia in 69.5% of cases. MRI mainly revealed white matter abnormalities and leptomeningeal enhancement (34%). Corticosteroids were the most useful treatment, and immunosuppressive agents were used in steroid-resistant patients and to limit side effects. Methotrexate, cyclophosphamide, and anti-TNFα were also used, exhibiting good efficacy., Conclusions: This cohort contributes to a better understanding of the clinical phenotype and associated imaging and biological abnormalities. Sharing of clinical, biological, and imaging data, as well as the therapeutic responses, of patients with NS helps to better understand and manage this disease that affects a small number of patients per center. A database project could be implemented in the future to enable this., (© 2024 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)
Published: 2024
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42. COVID-19 outcomes in patients with multiple sclerosis: Understanding changes from 2020 to 2022.

Author: Jeantin L, Januel E, Labauge P, Maillart E, de Seze J, Zéphir H, Pelletier J, Kerschen P, Biotti D, Heinzlef O, Guilloton L, Bensa C, Théaudin M, Vukusic S, Casez O, Maurousset A, Laplaud D, Berger E, Lebrun-Frenay C, Bourre B, Branger P, Stankoff B, Clavelou P, Thouvenot E, Manchon E, Moreau T, Sellal F, Zedet M, Papeix C, and Louapre C
Subjects: Humans, Male, Child, Retrospective Studies, Heart, Hospitalization, COVID-19, Multiple Sclerosis
Abstract: Background: Epidemiologic studies on coronavirus disease 2019 (COVID-19) in patients with multiple sclerosis (pwMS) have focused on the first waves of the pandemic until early 2021., Objectives: We aimed to extend these data from the onset of the pandemic to the global coverage by vaccination in summer 2022., Methods: This retrospective, multicenter observational study analyzed COVISEP registry data on reported COVID-19 cases in pwMS between January 2020 and July 2022. Severe COVID-19 was defined as hospitalization or higher severity., Results: Among 2584 pwMS with confirmed/highly suspected COVID-19, severe infection rates declined from 14.6% preomicron wave to 5.7% during omicron wave ( p < 0.001). Multivariate analysis identified age (odds ratio (OR) = 1.43, 95% confidence interval (CI) = [1.25-1.64] per 10 years), male sex (OR = 2.01, 95% CI = [1.51-2.67]), obesity (OR = 2.36, 95% CI = [1.52-3.68]), cardiac comorbidities (OR = 2.36, 95% CI = [1.46-3.83]), higher Expanded Disability Status Scale (EDSS) scores (OR = 2.09, 95% CI = [1.43-3.06] for EDSS 3-5.5 and OR = 4.53, 95% CI = [3.04-6.75] for EDSS ⩾6), and anti-CD20 therapies (OR = 2.67, 95% CI = [1.85-3.87]) as risk factors for COVID-19 severity. Vaccinated individuals experienced less severe COVID-19, whether on (risk ratio (RR) = 0.64, 95% CI = [0.60-0.69]) or off (RR = 0.32, 95% CI = [0.30-0.33]) anti-CD20., Discussion: In pwMS, consistent risk factors were anti-CD20 therapies and neurological disability, emerging as vital drivers of COVID-19 severity regardless of wave, period, or vaccination status., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: L.J. reports no disclosure. E.J. reports no disclosure. P.L. reports no disclosure. E.M. has received research support from Fondation ARSEP and Biogen Idec, travel funding and/or consulting fees from Alexion, Biogen Idec, BMS, Janssen, Merck, Novartis, Roche, Sanofi-Genzyme, and Teva. J.D.S. reports no disclosure. H.Z. has no disclosure related to this manuscript. Unrelated to this manuscript H.Z. received consulting fees from Biogen Idec, Sanofi, Merck, Novartis, Roche, Horizon Therpaeutics, Alexion, BMS, and Grant Research Support from ROCHE. J.P. reports no disclosure. P.K. reports no disclosure. D.B. reports no disclosure. O.H. has received consulting and lecture fees from Bayer Schering, Merck, Teva, Genzyme, Novartis, Almirall, and Biogen Idec, travel grants from Novartis, Teva, Genzyme, Merck Serono, and Biogen Idec, and research support from Roche, Merck, and Novartis. L.G. has received consulting and/or lecture fees and/or travel funding from Novartis, Merck, Sanofi, BMS, and Biogen. C.B. has received consulting honoraria from Alexion, Sanofi, Merck, Biogen, BMS, Novartis, Roche, and Teva. M.T. reports receiving consulting and lecture fees from Merck, Novartis, and Biogen Idec, travel grants from Sanofi, Merck Serono, and Biogen Idec. S.V. has received lecturing fees, travel grants, and research support from Biogen, BMS-Celgene, Janssen, Merck, Novartis, Roche, Sanofi-Genzyme, and Teva. O.C. reports receiving personal fees from Biogen, Roche, Merck, Novartis, Janssen, and Sanofi and nonfinancial support from Roche, Merck, and Novartis outside the submitted work. A.M. reports no disclosure. D.L. reports receiving grants from Roche, Sanofi, the ARSEP Foundation, the EDMUS Foundation, and the National Agency of Research and receiving personal fees from Biogen, Novartis, Alexion, Merck, and MSD outside the submitted work. E.B. has received honoraria and consulting fees from Alexion, Novartis, Sanofi Aventis, Biogen Idec, Genzyme, Merck, Roche, and Teva. C.L-F. reports no disclosure. B.B. serves on scientific advisory board, has received funding for travel and honoraria from Alexion, Biogen, BMS, Janssen, Merck, Novartis, Sanofi, Roche, and Teva. P.B. reports receiving personal fees from Novartis, Biogen, Merck, BMS, Alexion, and Sanofi outside the submitted work. B.S. reports research support from Roche, Sanofi, and Merck and personal fees for lectures or advisory boards from Novartis, Sanofi, Biogen, Janssen, and Merck. P.C. reports receiving personal fees for board participation from Janssen and Novartis and for board participation and travel from Sanofi and Merck outside the submitted work. E.T. reports receiving personal fees from Biogen, BMS, Janssen, Horizon, Merck, Novartis, and Sanofi outside the submitted work. E.M. reports no disclosure. T.M. reports receiving travel grants and fees for advisory boards from Biogen, Roche, Novartis, Sanofi, and Teva outside the submitted work. F.S. reports receiving consulting and/or lecture fees and/or travel funding from Novartis-Pharma, Biogen, Roche, Sanofi, Linde, and LVL. M.Z. reports receiving expert testimony from Alexion and Novartis, and travel grants from Merck, Roche, and Sanofi Aventis France. C.P. reports receiving honoraria and consulting fees from Alexion, Biogen, Merck, Horizon, and Roche outside the submitted work and serving as president of the Francophone Multiple Sclerosis Society from 2021 to 2024. C.L. has received consulting or travel fees from Biogen, Novartis, Roche, Sanofi, Teva, and Merck Serono, and research grant from Biogen.
Published: 2024
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43. Real-life study to assess effectiveness and safety of eculizumab in patients with neuromyelitis optica spectrum disorders in France: protocol for ECUP4, an observational study.

Author: Marignier R, Laplaud D, Zéphir H, Papeix C, Leray E, Amri E, Piotaix M, and de Sèze J
Abstract: Background: Eculizumab, a humanized monoclonal antibody targeting the C5 complement protein, has been approved for the treatment of neuromyelitis optica spectrum disorders (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive (Ab+). The aim of this study is to evaluate the long-term effectiveness and safety of eculizumab in French adults with NMOSD and to describe patients' characteristics, disability, and quality of life using data collected in a real-world setting., Methods: This is the protocol for ECUP4, an ongoing prospective, observational, non-comparative, multicenter study conducted in 32 reference centers in France. Eligible patients must also be enrolled in NOMADMUS, a nested cohort of the French national multiple sclerosis registry (OFSEP). The primary endpoint is the annualized relapse rate. Secondary endpoints include the long-term safety of eculizumab, as well as patients' characteristics, treatment outcomes, disability, pain, visual acuity, and quality of life. Visits and treatments follow routine clinical practice. The case report forms (CRF) comprise data recorded in the context of the NOMADMUS cohort, collected during routine visits. The inclusion period is planned for 3 years, with no limitation on the number of patients enrolled. The maximum follow-up duration will be 5.5 years., Conclusion: The efficacy and safety of eculizumab in patients with AQP4+ NMOSD have been demonstrated in randomized clinical trials that showed a significant reduction in the risk of relapse, with a safety profile consistent with other indications. This study will provide clinical and patient-reported evidence of the benefits of eculizumab, using data from a real-world setting in France., Trial Registration Number: This study is registered at the French public repertory Health data Hub, N° F20211228123801. All information can be accessed at: https://www.health-data-hub.fr/., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Marignier, Laplaud, Zéphir, Papeix, Leray, Amri, Piotaix and de Sèze.)
Published: 2024
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44. PD-L1 positive astrocytes attenuate inflammatory functions of PD-1 positive microglia in models of autoimmune neuroinflammation.

Author: Linnerbauer M, Beyer T, Nirschl L, Farrenkopf D, Lößlein L, Vandrey O, Peter A, Tsaktanis T, Kebir H, Laplaud D, Oellinger R, Engleitner T, Alvarez JI, Rad R, Korn T, Hemmer B, Quintana FJ, and Rothhammer V
Subjects: Animals, Mice, Astrocytes, Neuroinflammatory Diseases, Programmed Cell Death 1 Receptor genetics, B7-H1 Antigen genetics, Inflammation, Microglia, Multiple Sclerosis
Abstract: Multiple Sclerosis (MS) is a chronic autoimmune inflammatory disorder of the central nervous system (CNS). Current therapies mainly target inflammatory processes during acute stages, but effective treatments for progressive MS are limited. In this context, astrocytes have gained increasing attention as they have the capacity to drive, but also suppress tissue-degeneration. Here we show that astrocytes upregulate the immunomodulatory checkpoint molecule PD-L1 during acute autoimmune CNS inflammation in response to aryl hydrocarbon receptor and interferon signaling. Using CRISPR-Cas9 genetic perturbation in combination with small-molecule and antibody-mediated inhibition of PD-L1 and PD-1 both in vivo and in vitro, we demonstrate that astrocytic PD-L1 and its interaction with microglial PD-1 is required for the attenuation of autoimmune CNS inflammation in acute and progressive stages in a mouse model of MS. Our findings suggest the glial PD-L1/PD-1 axis as a potential therapeutic target for both acute and progressive MS stages., (© 2023. Springer Nature Limited.)
Published: 2023
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45. The biological sample collection of the OFSEP French MS registry: An essential tool dedicated to researchers.

Author: Brocard G, Casey R, Dufay N, Marignier R, Michel L, Hisbergues M, Ayrignac X, Lehmann S, Thouvenot E, Gallot G, Collongues N, Herpe YE, Lebrun-Frenay C, Cotton F, De Sèze J, Guillemin F, Moreau T, Pelletier J, Stankoff B, Vukusic S, Zephir H, and Laplaud D
Subjects: Humans, Registries, Multiple Sclerosis
Abstract: Today's medicine strives to be personalized, preventive, predictive and participatory. This implies to have access to multimodal data to better characterize patients groups and to combine clinical and imaging data with high-quality biological samples. Collecting such data is one of the objectives of the Observatoire français de la sclérose en plaques (OFSEP), the French MS registry. On December 2022, the OFSEP biocollection includes 4,888 patients with scientific characteristics and about 90,000 samples. Thanks to its richness, this biocollection open for the scientific community, contributes to address unmet needs in MS through identification of multiomics determinants of MS activity, progression and secondary effects., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Laure Michel reports a relationship with Biogen that includes: consulting or advisory. Laure Michel reports a relationship with Teva Health that includes: consulting or advisory. Laure Michel reports a relationship with Roche that includes: consulting or advisory. Laure Michel reports a relationship with Sanofi Genzyme that includes: consulting or advisory. Laure Michel reports a relationship with Janssen Pharmaceuticals Inc that includes: consulting or advisory. Laure Michel reports a relationship with Novartis that includes: consulting or advisory. Laure Michel reports a relationship with Merck & Co Inc that includes: consulting or advisory. Eric Thouvenot reports a relationship with Actelion Ltd that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Eric Thouvenot reports a relationship with Biogen that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Eric Thouvenot reports a relationship with Bristol Myers Squibb Co that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Eric Thouvenot reports a relationship with Merck & Co Inc that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Eric Thouvenot reports a relationship with Novartis that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Eric Thouvenot reports a relationship with Roche that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Sandra Vukusic reports a relationship with Biogen Inc that includes: speaking and lecture fees and travel reimbursement. Sandra Vukusic reports a relationship with Bristol Myers Squibb Co that includes: speaking and lecture fees and travel reimbursement. Sandra Vukusic reports a relationship with Janssen Pharmaceuticals Inc that includes: speaking and lecture fees and travel reimbursement. Sandra Vukusic reports a relationship with Merck & Co Inc that includes: speaking and lecture fees and travel reimbursement. Sandra Vukusic reports a relationship with Novartis that includes: speaking and lecture fees and travel reimbursement. Sandra Vukusic reports a relationship with Roche that includes: speaking and lecture fees and travel reimbursement. Sandra Vukusic reports a relationship with Sandoz Inc that includes: speaking and lecture fees and travel reimbursement. Sandra Vukusic reports a relationship with Sanofi Genzyme that includes: speaking and lecture fees and travel reimbursement. Helene Zephir reports a relationship with Alexion that includes: consulting or advisory. Helene Zephir reports a relationship with Biogen Inc that includes: consulting or advisory. Helene Zephir reports a relationship with Horizon Therapeutics plc that includes: consulting or advisory. Helene Zephir reports a relationship with Merck & Co Inc that includes: consulting or advisory. Helene Zephir reports a relationship with Novartis that includes: consulting or advisory. Helene Zephir reports a relationship with Sanofi that includes: consulting or advisory. Helene Zephir reports a relationship with Roche that includes: consulting or advisory and funding grants. Helene Zephir reports a relationship with Foundation for Help in Research of Multiple Sclerosis that includes: funding grants., (Copyright © 2023. Published by Elsevier B.V.)
Published: 2023
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46. Association Between Anti-CD20 Therapies and COVID-19 Severity Among Patients With Relapsing-Remitting and Progressive Multiple Sclerosis.

Author: Januel E, Hajage D, Labauge P, Maillart E, De Sèze J, Zephir H, Pelletier J, Guilloton L, Bensa C, Heinzlef O, Casez O, Biotti D, Bourre B, Vukusic S, Maurousset A, Berger E, Laplaud D, Lebrun-Frénay C, Dubessy AL, Branger P, Thouvenot E, Clavelou P, Sellal F, Manchon E, Moreau T, Papeix C, Tubach F, and Louapre C
Subjects: Humans, Female, Adult, Middle Aged, Male, Cohort Studies, Retrospective Studies, COVID-19 Vaccines, Multiple Sclerosis, COVID-19
Abstract: Importance: In patients with multiple sclerosis (MS), factors associated with severe COVID-19 include anti-CD20 therapies and neurologic disability, but it is still unclear whether these 2 variables are independently associated with severe COVID-19 or whether the association depends on MS clinical course., Objective: To assess the association between anti-CD20 therapies and COVID-19 severity in patients with relapsing-remitting MS (RRMS) and progressive MS (PMS)., Design, Setting, and Participants: This multicenter, retrospective cohort study used data from the COVISEP study, which included patients with MS and COVID-19 from February 1, 2020, to June 30, 2022, at 46 French MS expert centers, general hospitals, and private neurology practices. Eligible patients with RRMS were those treated with high-efficacy MS therapy (ie, anti-CD20, fingolimod, or natalizumab), and eligible patients with PMS were those younger than 70 years with an Expanded Disability Status Scale (EDSS) score of 8 or lower. Patients were monitored from COVID-19 symptom onset until recovery or death., Exposures: Current anti-CD20 therapy (ocrelizumab or rituximab)., Main Outcomes and Measures: The main outcome was severe COVID-19 (ie, hospitalization with any mode of oxygenation or death). All analyses were conducted separately in patients with RRMS and PMS using propensity score-weighted logistic regression. Subgroup analyses were performed according to COVID-19 vaccine status, sex, EDSS score, and age., Results: A total of 1400 patients, 971 with RRMS (median age, 39.14 years [IQR, 31.38-46.80 years]; 737 [76.1%] female) and 429 with PMS (median age, 54.21 years [IQR, 48.42-60.14 years]; 250 [58.3%] female) were included in the study. A total of 418 patients with RRMS (43.0%) and 226 with PMS (52.7%) were treated with anti-CD20 therapies. In weighted analysis, 13.4% and 2.9% of patients with RRMS treated and not treated with anti-CD20 had severe COVID-19, respectively, and anti-CD20 treatment was associated with increased risk of severe COVID-19 (odds ratio [OR], 5.20; 95% CI, 2.78-9.71); this association persisted among vaccinated patients (7.0% vs 0.9%; OR, 8.85; 95% CI, 1.26-62.12). Among patients with PMS, 19.0% and 15.5% of patients treated and not treated with anti-CD20 had severe COVID-19, respectively, and there was no association between anti-CD20 treatment and severe COVID-19 (OR, 1.28; 95% CI, 0.76-2.16). In PMS subgroup analysis, anti-CD20 exposure interacted negatively with EDSS score (P = .009 for interaction) and age (P = .03 for interaction); anti-CD20 therapies were associated with risk of severe COVID-19 only in patients with less neurologic disability and younger patients with PMS., Conclusions and Relevance: In this cohort study, risk of severe COVID-19 was higher in patients with PMS than in those with RRMS. Use of anti-CD20 therapies was associated with an increased risk of severe COVID-19 among patients with RRMS. In patients with PMS, there was no association between anti-CD20 therapies and risk of severe COVID-19.
Published: 2023
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47. Immune Profiling Reveals the T-Cell Effect of Ocrelizumab in Early Relapsing-Remitting Multiple Sclerosis.

Author: Garcia A, Dugast E, Shah S, Morille J, Lebrun-Frenay C, Thouvenot E, De Sèze J, Le Page E, Vukusic S, Maurousset A, Berger E, Casez O, Labauge P, Ruet A, Raposo C, Bakdache F, Buffels R, Le Frère F, Nicot A, Wiertlewski S, Gourraud PA, Berthelot L, and Laplaud D
Subjects: Humans, Leukocytes, Mononuclear, Antibodies, Monoclonal, Humanized therapeutic use, Multiple Sclerosis, Relapsing-Remitting drug therapy, Multiple Sclerosis drug therapy
Abstract: Background and Objectives: Ocrelizumab (OCR), a humanized anti-CD20 monoclonal antibody, is highly efficient in patients with relapsing-remitting multiple sclerosis (RR-MS). We assessed early cellular immune profiles and their association with disease activity at treatment start and under therapy, which may provide new clues on the mechanisms of action of OCR and on the disease pathophysiology., Methods: A first group of 42 patients with an early RR-MS, never exposed to disease-modifying therapy, was included in 11 centers participating to an ancillary study of the ENSEMBLE trial (NCT03085810) to evaluate the effectiveness and safety of OCR. The phenotypic immune profile was comprehensively assessed by multiparametric spectral flow cytometry at baseline and after 24 and 48 weeks of OCR treatment on cryopreserved peripheral blood mononuclear cells and analyzed in relation to disease clinical activity. A second group of 13 untreated patients with RR-MS was included for comparative analysis of peripheral blood and CSF. The transcriptomic profile was assessed by single-cell qPCRs of 96 genes of immunologic interest., Results: Using an unbiased analysis, we found that OCR as an effect on 4 clusters of CD4 + T cells: one corresponding to naive CD4 + T cells was increased, the other clusters corresponded to effector memory (EM) CD4 + CCR6 - T cells expressing homing and migration markers, 2 of them also expressing CCR5 and were decreased by the treatment. Of interest, one CD8 + T-cell cluster was decreased by OCR corresponding to EM CCR5-expressing T cells with high expression of the brain homing markers CD49d and CD11a and correlated with the time elapsed since the last relapse. These EM CD8 + CCR5 + T cells were enriched in the CSF of patients with RR-MS and corresponded to activated and cytotoxic cells., Discussion: Our study provides novel insights into the mode of action of anti-CD20, pointing toward the role of EM T cells, particularly a subset of CD8 T cells expressing CCR5., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)
Published: 2023
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48. Pregnancy and post-partum in patients with myelin-oligodendrocyte glycoprotein antibody-associated disease.

Author: Carra-Dallière C, Rollot F, Deschamps R, Ciron J, Vukusic S, Audoin B, Ruet A, Maillart E, Papeix C, Zephir H, Laplaud D, Cohen M, Bourre B, El-Bahi I, Labauge P, Casey R, Ayrignac X, and Marignier R
Subjects: Pregnancy, Humans, Female, Myelin-Oligodendrocyte Glycoprotein, Retrospective Studies, Prospective Studies, Recurrence, Postpartum Period, Autoantibodies
Abstract: Background and Objective: Myelin-oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) frequently initiates during childbearing years. This study investigated the impact of pregnancy and post-partum on MOGAD activity., Methods: Retrospective analysis of clinical and demographic data from a multicenter French cohort of adult patients with MOGAD. All adult female patients who had a pregnancy after disease onset or in the year before disease onset were included. The annualized relapse rate was evaluated in patients who had a pregnancy after disease onset, to evaluate the impact of pregnancy and post-partum on MOGAD course., Results: Twenty-five informative pregnancies after disease onset were identified. No relapse was recorded during these pregnancies and only three relapses occurred during the first 3 months post-partum. The annualized relapse rate decreased from 0.67 (95% confidence interval: 0.40-1.10) during the pre-pregnancy period to 0 (95% confidence interval: 0-0.21) during pregnancy and to 0.22 (95% confidence interval: 0.09-0.53) during the first year post-partum. Among 144 female patients in their childbearing age recorded in the database, 18 (12.5%) reported their first symptoms during pregnancy or in the 12 months post-partum., Discussion: Our study suggests a marked reduction of MOGAD relapse rate during pregnancy and the post-partum period. Prospective studies on the role of pregnancy and delivery in MOGAD course are needed.
Published: 2023
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49. Pregnancy and neuromyelitis optica spectrum disorders: 2022 recommendations from the French Multiple Sclerosis Society.

Author: Vukusic S, Marignier R, Ciron J, Bourre B, Cohen M, Deschamps R, Guillaume M, Kremer L, Pique J, Carra-Dalliere C, Michel L, Leray E, Guennoc AM, Laplaud D, Androdias G, Bensa C, Bigaut K, Biotti D, Branger P, Casez O, Daval E, Donze C, Dubessy AL, Dulau C, Durand-Dubief F, Hebant B, Kwiatkowski A, Lannoy J, Maarouf A, Manchon E, Mathey G, Moisset X, Montcuquet A, Roux T, Maillart E, and Lebrun-Frenay C
Subjects: Pregnancy, Humans, Female, Vaccination, Postpartum Period, Recurrence, Neuromyelitis Optica diagnosis, Neuromyelitis Optica therapy, Multiple Sclerosis diagnosis, Multiple Sclerosis therapy
Abstract: Background: In 2020, the French Multiple Sclerosis (MS) Society (SFSEP) decided to develop a national evidence-based consensus on pregnancy in MS. As neuromyelitis optica spectrum disorders (NMOSD) shares a series of commonalities with MS, but also some significant differences, specific recommendations had to be developed., Objectives: To establish recommendations on pregnancy in women with NMOSD., Methods: The French Group for Recommendations in Multiple Sclerosis (France4MS) reviewed PubMed and universities databases (January 1975 through June 2021). The RAND/UCLA appropriateness method, which was developed to synthesise the scientific literature and expert opinions on health care topics, was used to reach a formal agreement. Fifty-six MS experts worked on the full-text review and initial wording of recommendations. A sub-group of nine NMOSD experts was dedicated to analysing available data on NMOSD. A group of 62 multidisciplinary healthcare specialists validated the final proposal of summarised evidence., Results: A strong agreement was reached for all 66 proposed recommendations. They cover diverse topics, such as pregnancy planning, follow-up during pregnancy and postpartum, delivery routes, loco-regional analgesia or anaesthesia, prevention of postpartum relapses, breastfeeding, vaccinations, reproductive assistance, management of relapses, and disease-modifying treatments., Conclusion: Physicians and patients should be aware of the new and specific evidence-based recommendations of the French MS Society for pregnancy in women with NMOSD. They should help harmonise counselling and treatment practise, allowing for better individualised choices.
Published: 2023
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50. Discontinuation of second- versus first-line disease-modifying treatment in middle-aged patients with multiple sclerosis.

Author: Chappuis M, Rousseau C, Bajeux E, Wiertlewski S, Laplaud D, Le Page E, Michel L, Edan G, and Kerbrat A
Subjects: Middle Aged, Humans, Fingolimod Hydrochloride therapeutic use, Natalizumab therapeutic use, Retrospective Studies, Recurrence, Immunosuppressive Agents therapeutic use, Multiple Sclerosis diagnostic imaging, Multiple Sclerosis drug therapy, Multiple Sclerosis, Relapsing-Remitting
Abstract: Background and Purpose: There has been scant research on the consequences of discontinuing second-line disease-modifying treatment (DMT) in middle-aged patients with multiple sclerosis (MS). The objective was therefore to examine the occurrence of focal inflammatory activity after the discontinuation of second versus first-line DMT in patients over 45 years., Methods: Patients who had been treated for at least 6 months with second (natalizumab, fingolimod, anti CD20) or first-line DMT and who stopped their DMT were retrospectively included. Kaplan-Meier survival curves were used to study the occurrence of relapse and MRI activity according to the type of DMT stopped. Proportional hazard Cox models were calculated to identify factors associated with focal inflammatory activity. The annualized relapse rate was calculated under treatment and for every 3 months after DMT discontinuation., Results: We included 232 patients (median age: 52.8 years), 49 of whom stopped second-line DMT. The probability of having a relapse within the year following discontinuation was 6% for first-line DMT, 9% for fingolimod and 43% for natalizumab. In multivariate analysis, the probability of relapse after DMT discontinuation was significantly increased with natalizumab compared to first-line DMT (HR = 3.24; 95% CI [1.52; 6.90]). A peak of relapse was observed at 0-3 months after stopping natalizumab or fingolimod., Conclusion: Our study suggests that the risk of inflammatory activity is greater after discontinuation of natalizumab compared to other DMT even in middle-aged patients. As for younger patients, natalizumab discontinuation should only be considered if there is an adequate substitution of a different therapy. ., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Published: 2023
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