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1. Classification of Radiologically Isolated Syndrome and Clinically Isolated Syndrome with Machine-Learning Techniques

Author

Mato-Abad, V, Labiano-Fontcuberta, A, Rodriguez-Yanez, S, Garcia-Vazquez, R, Munteanu, CR, Andrade-Garda, J, Domingo-Santos, A, Sanchez-Seco, V Galan, Aladro, Y, Martinez-Gines, ML, Ayuso, L, and Benito-Leon, J

Subjects
Computer Science - Machine Learning
Abstract

Background and purpose: The unanticipated detection by magnetic resonance imaging (MRI) in the brain of asymptomatic subjects of white matter lesions suggestive of multiple sclerosis (MS) has been named radiologically isolated syndrome (RIS). As the difference between early MS [i.e. clinically isolated syndrome (CIS)] and RIS is the occurrence of a clinical event, it is logical to improve detection of the subclinical form without interfering with MRI as there are radiological diagnostic criteria for that. Our objective was to use machine-learning classification methods to identify morphometric measures that help to discriminate patients with RIS from those with CIS. Methods: We used a multimodal 3-T MRI approach by combining MRI biomarkers (cortical thickness, cortical and subcortical grey matter volume, and white matter integrity) of a cohort of 17 patients with RIS and 17 patients with CIS for single-subject level classification. Results: The best proposed models to predict the diagnosis of CIS and RIS were based on the Naive Bayes, Bagging and Multilayer Perceptron classifiers using only three features: the left rostral middle frontal gyrus volume and the fractional anisotropy values in the right amygdala and right lingual gyrus. The Naive Bayes obtained the highest accuracy [overall classification, 0.765; area under the receiver operating characteristic (AUROC), 0.782]. Conclusions: A machine-learning approach applied to multimodal MRI data may differentiate between the earliest clinical expressions of MS (CIS and RIS) with an accuracy of 78%. Keywords: Bagging; Multilayer Perceptron; Naive Bayes classifier; clinically isolated syndrome; diffusion tensor imaging; machine-learning; magnetic resonance imaging; multiple sclerosis; radiologically isolated syndrome., Comment: 24 pages, 2 tables

Published
2024
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2. Review of the novelties from the 32nd ECTRIMS Congress, 2016, presented at the 9th Post-ECTRIMS Meeting (II)

Author

Fernandez, O, Oterino, A, Oreja-Guevara, C, Prieto, JM, Mendibe-Bilbao, MD, Garcia-Merino, JA, Ramio-Torrenta, L, Ginestal, R, Meca-Lallana, JE, Romero-Pinel, L, Munoz, D, Oliva-Nacarino, P, Calles-Hernandez, MC, Izquierdo, G, Martinez-Gines, ML, Saiz, A, Comabella, M, Casanova-Estruch, B, Brieva, L, Arroyo, R, and Rodriguez-Antiguedad, A

Subjects
ECTRIMS, Multiple sclerosis, Post-ECTRIMS
Abstract

For the ninth year in a row the Post-ECTRIMS Meeting has been held in Madrid (Spain) with the aim of presenting and discussing the hottest issues debated at the ECTRIMS Congress by renowned specialists in multiple sclerosis in our country. One outcome of this scientific activity, endorsed by the Spanish Neurology Society, is this review article, which is published in two parts. This second part reflects the current controversy over the management of multiple sclerosis, especially as regards the progressive forms and their differential diagnosis. The work presents the latest advances in remyelination, where the use of the micropillar technique in laboratory stands out, and in neuroprotection, which is reviewed through a study of the optic nerve. Anti-CD20 antibodies are a very promising development and we find ourselves before a new mechanism of action and therapeutic target in cells to which little attention has been paid to date. Another notable fact is the high correlation between the levels of neurofilaments in cerebrospinal fluid and in serum, which could make it possible to avoid the use of cerebrospinal fluid as a biological sample in future studies of biomarkers. The review also provides a preview of the advances in clinical research, which will converge in clinical practice in the future, thereby conditioning the steps that should be taken in the therapeutic management of multiple sclerosis.

Published
2017

3. Cognitive Performance and Health-Related Quality of Life in Patients with Neuromyelitis Optica Spectrum Disorder.

Author

Lopez-Soley E, Meca-Lallana JE, Llufriu S, Blanco Y, Gómez-Ballesteros R, Maurino J, Pérez-Miralles F, Forero L, Calles C, Martinez-Gines ML, Gonzalez-Suarez I, Boyero S, Romero-Pinel L, Sempere ÁP, Meca-Lallana V, Querol L, Costa-Frossard L, Sepulveda M, and Solana E

Abstract

Background: The frequency of cognitive impairment (CI) reported in neuromyelitis optica spectrum disorder (NMOSD) is highly variable, and its relationship with demographic and clinical characteristics is poorly understood. We aimed to describe the cognitive profile of NMOSD patients, and to analyse the cognitive differences according to their serostatus; furthermore, we aimed to assess the relationship between cognition, demographic and clinical characteristics, and other aspects linked to health-related quality of life (HRQoL). Methods: This cross-sectional study included 41 patients (median age, 44 years; 85% women) from 13 Spanish centres. Demographic and clinical characteristics were collected along with a cognitive z-score (Rao’s Battery) and HRQoL patient-centred measures, and their relationship was explored using linear regression. We used the Akaike information criterion to model which characteristics were associated with cognition. Results: Fourteen patients (34%) had CI, and the most affected cognitive domain was visual memory. Cognition was similar in AQP4-IgG-positive and -negative patients. Gender, mood, fatigue, satisfaction with life, and perception of stigma were associated with cognitive performance (adjusted R2 = 0.396, p < 0.001). Conclusions: The results highlight the presence of CI and its impact on HRQoL in NMOSD patients. Cognitive and psychological assessments may be crucial to achieve a holistic approach in patient care.

Published
2022
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4. Review of the novelties presented at the 2018 ECTRIMS Congress: 11th Post-ECTRIMS Meeting (II).

Author

Fernandez O, Tintore M, Saiz A, Calles-Hernandez MC, Comabella M, Ramio-Torrenta L, Oterino A, Izquierdo G, Tellez N, Garcia-Merino JA, Brieva L, Arnal-Garcia C, Aladro Y, Mendibe-Bilbao MM, Meca-Lallana JE, Romero-Pinel L, Martinez-Gines ML, Arroyo R, Oreja-Guevara C, Costa-Frossard L, Carrascal P, and Rodriguez-Antiguedad A

Subjects
Adult, Child, Family Planning Services, Female, Health Services Needs and Demand, Hematopoietic Stem Cell Transplantation, Humans, Immunologic Factors adverse effects, Immunologic Factors therapeutic use, Lactation, Mesenchymal Stem Cell Transplantation, Myelin Sheath drug effects, Practice Guidelines as Topic, Pregnancy, Pregnancy Complications, Randomized Controlled Trials as Topic, Societies, Medical, Spain, Multiple Sclerosis drug therapy, Multiple Sclerosis rehabilitation, Multiple Sclerosis therapy, Neurology trends
Abstract

The Post-ECTRIMS Meeting was held for the eleventh consecutive year in October 2018 in Madrid, with the aim of analysing the advances made in multiple sclerosis that were highlighted at the latest ECTRIMS annual congress. Based on the issues discussed at this meeting, attended by the nation's foremost opinion leaders on multiple sclerosis, two review articles are presented. This second part includes the growing body of evidence confirming the safety of exposure to disease-modifying treatments in women planning a pregnancy, and the beneficial effect of breastfeeding, provided that the disease is not very active. It addresses data showing how the application of the 2017 McDonald criteria in the paediatric population has significantly improved diagnosis compared to the previous criteria. With regard to progressive multiple sclerosis, the results of neuroprotective drugs are inconclusive, but biomarkers are proposed to improve the evaluation of the therapeutic response. Studies on myelin repair treatments suggest that remyelination in multiple sclerosis is possible. Likewise, there are favourable indications for haematopoietic stem cell transplantation, provided that patients are selected appropriately. On the other hand, we also conduct a review of the similarities and differences of the recommendations in the new clinical practice guidelines. Finally, the positive results of cognitive and motor rehabilitation with the use of new technologies point to the systematic incorporation of these tools in the treatment of the disease in the near future.

Published
2019
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5. [Efficacy and safety of fingolimod in routine clinical practice in patients with relapsing-remitting multiple sclerosis in Spain: an intermediate analysis of the MS NEXT study].

Author

Mallada-Frechin J, Meca-Lallana V, Barrero F, Martinez-Gines ML, Marzo-Sola ME, Ricart J, Garcia E, and En Representacion de Los Investigadores Del Estudio Ms Next ERLIDEMN

Subjects
Adult, Disease Progression, Drug Resistance, Drug Substitution, Female, Fingolimod Hydrochloride adverse effects, Gastrointestinal Diseases chemically induced, Heart Diseases chemically induced, Hematologic Diseases chemically induced, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Sclerosis, Relapsing-Remitting diagnostic imaging, Natalizumab therapeutic use, Retrospective Studies, Fingolimod Hydrochloride therapeutic use, Multiple Sclerosis, Relapsing-Remitting drug therapy
Abstract

Introduction: Fingolimod is a disease modifying therapies, which has showed clinical efficacy and an acceptable safety profile in clinical trials with relapsing-remitting multiple sclerosis (RRMS) patients., Aim: To assess fingolimod effectiveness and safety in patients with RRMS in clinical practice., Patients and Methods: We present an interim analysis (July 2015) of MS NEXT, an observational, retrospective and multicenter study. 442 patients were included (mean age: 41 ± 9 years; median baseline EDSS: 3.0; 70% female; 284 previously treated with first-line disease modifying therapies, 139 with natalizumab and 19 without a previous treatment; mean fingolimod treatment duration: 25 ± 9 months) treated with fingolimod from November 2011 and with at least 12 months follow-up. 56 neurology-unit Spanish hospitals enrolled patients. Basal clinical and demographic data were recorded. Relapses, EDSS scores and radiological activity were recorded at baseline and annually. Adverse events were also recorded during the follow-up period., Results: After two years of follow-up: annual relapse rates decreased by 76%, the proportion of relapse-free patients was 67%, of disability progression-free patients confirmed at 3 months was 91%, of relapse and disability progression-free patients was 63%, of radiological activity-free patients was 50%, and the proportion of relapse, disability progression and radiological activity-free patients was 35%. Only 3.9% of patients discontinued fingolimod permanently during the first year of treatment., Conclusions: In this interim analysis, most of patients treated with fingolimod in clinical practice had a controlled clinical disease activity, stable disability progression and high persistency.

Published
2018

6. [Review of the novelties from the 2017 ECTRIMS Congress, presented at the 10th Post-ECTRIMS Meeting (II)].

Author

Fernandez O, Tintore M, Saiz A, Calles-Hernandez MC, Comabella M, Ramio-Torrenta L, Oterino A, Izquierdo G, Tellez N, Garcia-Merino JA, Brieva L, Arnal-Garcia C, Aladro Y, Mendibe-Bilbao MM, Meca-Lallana JE, Romero-Pinel L, Ginestal R, Martinez-Gines ML, Arroyo R, and Rodriguez-Antiguedad A

Subjects
Adult, Aging physiology, Child, Clinical Trials as Topic, Cognition Disorders etiology, Cognition Disorders psychology, Cohort Studies, Comorbidity, Connectome, Female, Humans, Male, Practice Guidelines as Topic, Pregnancy, Pregnancy Complications drug therapy, Pregnancy Complications physiopathology, Congresses as Topic, Multiple Sclerosis drug therapy, Multiple Sclerosis psychology, Neurology
Abstract

The Post-ECTRIMS Meeting is an emblematic event in the field of multiple sclerosis in Spain. Its chief aim is bring together the country's leading specialist neurologists to analyse the main advances made in multiple sclerosis and to review the most important topics addressed at the ECTRIMS Congress. The tenth Post-ECTRIMS Meeting was held in November 2017. Over the years this event has firmly established itself as an important meeting point where experts from all over the country get together to foster communication, establish synergies and promote and enhance research ultimately aimed at improving the prognosis and quality of life of patients with multiple sclerosis. This second part addresses the different strategies for the management of patients in advanced stages of the disease and the safety of therapy in multiple sclerosis. Likewise, attention is also drawn to the areas that require further scientific and clinical evidence. In this edition, particular importance is given to multiple sclerosis in the paediatric population and ageing in the disease. At the same time emphasis is placed on the need to conduct collaborative studies and to foster greater awareness among specialists regarding the detection and management of the comorbidities in multiple sclerosis.

Published
2018

7. Review of the novelties from the 32nd ECTRIMS Congress, 2016, presented at the 9th Post-ECTRIMS Meeting (II).

Author

Fernandez O, Oterino A, Oreja-Guevara C, Prieto JM, Mendibe-Bilbao MM, Garcia-Merino JA, Ramio-Torrenta L, Ginestal R, Meca-Lallana JE, Romero-Pinel L, Munoz D, Oliva-Nacarino P, Calles-Hernandez MC, Izquierdo G, Martinez-Gines ML, Saiz A, Comabella M, Casanova-Estruch B, Brieva L, Arroyo R, and Rodriguez-Antiguedad A

Subjects
Animals, Biomarkers blood, Biomarkers cerebrospinal fluid, Bone Marrow Transplantation, Clinical Trials as Topic, Disease Management, Electric Stimulation Therapy, Encephalomyelitis, Autoimmune, Experimental drug therapy, Evoked Potentials, Visual, Humans, Immunologic Factors therapeutic use, Immunosuppressive Agents therapeutic use, Induced Pluripotent Stem Cells transplantation, Magnetic Resonance Imaging, Mice, Myelin Sheath physiology, Neuroimaging methods, Neurology organization & administration, Neuroprotective Agents therapeutic use, Societies, Medical, Spain, Multiple Sclerosis etiology, Multiple Sclerosis physiopathology, Multiple Sclerosis therapy, Neurology trends
Abstract

For the ninth year in a row the Post-ECTRIMS Meeting has been held in Madrid (Spain) with the aim of presenting and discussing the hottest issues debated at the ECTRIMS Congress by renowned specialists in multiple sclerosis in our country. One outcome of this scientific activity, endorsed by the Spanish Neurology Society, is this review article, which is published in two parts. This second part reflects the current controversy over the management of multiple sclerosis, especially as regards the progressive forms and their differential diagnosis. The work presents the latest advances in remyelination, where the use of the micropillar technique in laboratory stands out, and in neuroprotection, which is reviewed through a study of the optic nerve. Anti-CD20 antibodies are a very promising development and we find ourselves before a new mechanism of action and therapeutic target in cells to which little attention has been paid to date. Another notable fact is the high correlation between the levels of neurofilaments in cerebrospinal fluid and in serum, which could make it possible to avoid the use of cerebrospinal fluid as a biological sample in future studies of biomarkers. The review also provides a preview of the advances in clinical research, which will converge in clinical practice in the future, thereby conditioning the steps that should be taken in the therapeutic management of multiple sclerosis.

Published
2017

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