Search

Background: Few studies have addressed predictors of long-term mortality after first-ever ischaemic stroke. Methods: We prospectively collected data on 361 consecutive patients admitted to 18 neurology departments in Italy for a first-ever ischaemic stroke in 1999, categorized according to the Oxfordshire Community Stroke Project (OCSP) classification. Age, gender, risk factors, previous vascular disease, in-hospital complications, stroke severity, functional status, therapy and living place at admission, discharge and after 6 months were recorded. Follow-up was available for 97% patients at 5 years. Results: Survival probability was 91% (95% CI = 88–94) at 1 month, 84% (80–88) at 6 months and 64% (58–69) at 5 years. Mortality was higher for the TACI (total anterior circulation infarct) group compared to the other categories (p < 0.0001). Hazard ratios for 5-year mortality in the final model were: 5.4 for age ≥65 years (p < 0.0001), 2.8 for TACI (p < 0.0001), 2.7 for previous vascular disease (p < 0.01) and 1.9 for cardio-embolic risk according to the TOAST risk stratification (p < 0.05). Conclusions: Our study extends the prognostic value of the OCSP classification to 5-year survival.

OBJECTIVE: Interferon is regarded as a promising treatment option for patients with chronic inflammatory demyelinating polyneuropathy. However, sporadic cases of axonal PNP and one case of CIDP after treatment with Interferon (INF) alfa-2a were reported. The objective of this study was to test the onset of PNP in patients affected by relapsing-remitting MS after treatment with INF beta-1b. METHODS: from the OPTIMS trial we have selected 23 patients (9 males, 14 females; mean age 30.5; range 22–50) with diagnosis of relapsing-remitting SM in treatment with INF beta-1b (8–12.000.000 UI). In these patients bilateral motor nerve conduction study (NCS) of peroneal, tibial, median, ulnar nerves and antidromic sensory NCS of sural, median and ulnar nerves were performed according standard techniques. All patients (23/23) were submitted to neurophysiological tests before the treatment (T0), 16/23 (7 drop out) after six months (T1) and after nine months of therapy (T2). RESULTS: at T0 no patient showed electrophysiological signs indicating PNP; after six and nine months of therapy (T1 and T2) no patient submitted to NCS showed alterations in the PNS either. CONCLUSIONS: all tested patients showed absence of electrophysiological signs of PNP as side effects after one year of treatment with high dose of INF beta-1b.

Objectives - To determine threshold titers and diagnostic accuracy of anti-GM and anti-sulfatide antibodies (Ab) for autoimmune polyneuropathies (PN) in overall and for particular subtypes of them. Materials and methods - In this study 84 PN patients, 120 epileptics and 93 healthy controls' sera were tested by enzyme-linked immunosorbent assay for autoAbs and results confirmed by thin-layer chromatography. Frequencies of positive patients at increasing cut-off were compared to determine threshold titers. Accuracy was determined by Receiver Operator Characteristic analysis. Results - A 1:2000 titer for IgM anti-GM 1 and a 1:4000 titer for IgM anti-sulfatide Ab resulted to be threshold titers for autoimmune PN in overall. IgM anti-GM 1 and anti-sulfatide Ab had low discriminating capacity between autoimmune PN and other PN, but good discriminating capacity between motor neuropathy (for anti-GM I Ab) or PN in IgM-paraproteinemia or chronic painful sensory axonal PN (for anti-sulfatide Ab) and other PN. Conclusion - Our results suggest that testing IgM anti-GM 1 or anti-sulfatide Ab is useful only for diagnostic confirmation of specific subtypes of autoimmune PN.

Objective: To prospectively validate MRI activity and neutralising anti-interferon antibody (NAb) during the first 6 months of interferon β treatment as response indicators in multiple sclerosis (MS). Methods: Patients with relapsing–remitting MS were followed during the first 2 years of treatment. Neurological assessments were performed every 3 months or when a relapse was suspected. MRI scans performed at baseline and at 3, 4, 5 and 6 months after the start of treatment were assessed centrally for disease activity: new T2 or gadolinium enhancing T1 lesions. NAb were assessed using the MxA protein assay; positivity was defined as two consecutive titres ⩾20 NU/ml. We evaluated the predictivity of an active scan, NAb positivity, or both, during the first 6 months of treatment, on the occurrence of clinical disease activity in the following 18 months. Results: 147 patients were assessed at 16 centres. Predictivity parameters (with confidence intervals) were as follows: active scan, sensitivity (SN) 52% (34–69%), specificity (SP) 80% (65–91%), negative predictive value (NPV) 73% (58–77%), positive predictive value (PPV) 62% (42–79%), p = 0.002; NAb positivity, SN 71% (45–88%), SP 66% (55–76%), NPV 92% (82–97%), PPV 29% (16–45%), p = 0.01; active scan and NAb positivity, SN 71% (38–91%), SP 86% (73–94%), NPV 94% (86–98%), PPV 50% (29–70%), p = 0.0003. Conclusions: MRI activity and NAb occurrence during the first 6 months of interferon β treatment were reliable predictors of long term clinical response, particularly when combined. Patients with negative predictors showed a less than 10% risk of developing clinical activity. Patients with positive predictors showed a 50% risk of further clinical activity. These patients need to be followed carefully with further MRI and NAb tests.

Interferon beta (IFN-beta) reduces exacerbation rates in patients with relapsing-remitting multiple sclerosis (MS), but some patients do not respond to treatment. Recent studies have shown a clear dose-response effect on the reduction of exacerbation rates, and on burden of disease accumulation and active lesion frequency seen on MRI. During treatment with 8 MIU IFN-beta we noticed a 30% rate of treatment failure. We then treated non-responders with 12 MIU IFN-beta and observed significant improvement in the clinical signs of disease activity. In order to compare the efficacy of two different doses of IFN-beta-1b, a multicenter study for the optimization of interferon for MS (OPTIMS) has been organized. The design of the study is presented here.

Background In RRMS, clinical exacerbations are usually associated with different types of active lesions at MRI, including: hyperintense lesions on T1-weighted post-gadolinium sequences; new hyperintense lesions or enlarging old lesions on PD/T2-weighted scans; or new hypointense lesions on T1-weighted pre-Gd sequences. Objective/methods Primary outcome was the occurrence of patients with at least one active MRI lesion of the different types indicated above during treatment with 250 mg every other day (EOD) interferon beta (IFNβ)-1b or 30 mg once weekly (OW) IFNβ-1a in outpatients with RRMS (INCOMIN Trial). Results The number of patients with at least one ‘active’ lesion, evaluated over the two-year follow-up, was significantly (P=0.014) lower in the EOD IFNβ-1b arm (13/76, 17%) then in the OW IFNβ-1a arm (25/73, 34%). NAb frequency over two-year follow-up was 22/65 (33.8%) in the EOD IFNβ-1b arm and 4/62 (6.5%) in the OW IFNβ-1a arm, significantly greater in the EOD IFNβ-1b arm. Conclusions The development of MRI active lesions is strongly reduced by EOD-IFNβ-1b compared with OW-IFNβ-1a, indicating that EOD-IFNβ-1b is more effective than OW-IFNβ-1a in reducing ongoing inflammation and demyelination in MS. Logistic regression showed that NAb status did not affect the risk of MRI activity.

We use the official daily PLN/USD and PLN/DEM exchange rates to compare various bivariate ARCH-type models through their Bayes factors, similarly to Osiewalski and Pipien (2004). In the previous paper a pure VAR(1)-VechGARCH(1,1) framework (with no exogenous variable) was assumed. In this chapter we introduce the DEM/USD rate from the FOREX market; it is assumed exogenous. Using the relation (PLN/USD)/(PLN/DEM) ≈ DEM/USD, treated as the cointegration equation, we build a conditional ECM model with competing bivariate GARCH structures for the error process. We also use much longer time series than in the previous work. Bayesian comparison of different GARCH specifications indicates that a simple t -BEKK(1,1) is clearly the best, no matter whether our exogenous variable and the ECM term are included or not. The presence of these important variables in the conditional mean of the bivariate process enormously helps in improving the model fit, but has only small effect on our inference on the conditional covariance matrix.

Long-term trials have demonstrated the continued efficacy of interferon (IFN) beta treatment in patients with relapsing-remitting (RR) multiple sclerosis (MS) during prolonged administration. The objective of the work was to evaluate the effects of reducing IFN beta administration frequency and total weekly dose in patients with RR MS who have achieved clinical and MRI disease activity stabilization during long-term IFN beta-1b treatment. Prospective 1-year follow-up of 27 RR MS patients on long-term 250 microg every other day (standard dose) IFN beta-1b treatment were randomized either to gradually reduce dose to 30 microg once-a-week IFN beta-1a (13 patients), or to continue on IFN beta-1b standard dose (14 patients). We found significant differences in the two group of patients. In the group of patients continuously treated with IFN beta-1b standard dose, 79% remained relapse free compared to 23% in the group receiving once-weekly IFN beta-1a (p=0.006). The number of patients without new PD/T2 lesions was higher in the group of patients continuously treated with IFN beta-1b standard dose (77%) compared to the once-weekly IFN beta-1a group (23%) (p=0.04). IFN beta is a long-term treatment for MS. The reduction of IFN beta-1b administration frequency and dose is not advisable even in patients free from clinical and MRI disease activity for many years.