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1. Long-term effectiveness of natalizumab in secondary progressive multiple sclerosis: A propensity-matched study

Author

Avolio, Carlo, Balgera, Roberto, Banfi, Paola, Bellantonio, Paolo, Bramanti, Placido, Capone, Lorenzo, Cavalletti, Guido, Chiveri, Luca, Clerici, Raffaella, Clerico, Marinella, Corea, Francesco, Dattola, Vincenzo, De Robertis, Francesca, Di Battista, Giancarlo, Galgani, Simonetta, Gatto, Maurizia, Grasso, Maria Grazia, Inglese, Matilde, Lo Russo, Lorenzo, Logullo, Francesco Ottavio, Mantegazza, Renato, Protti, Alessandra, Rezzonico, Monica, Rottoli, Mariarosa, Salvetti, Marco, Scarpini, Elio, Sinisi, Leonardo, Sparaco, Maddalena, Spitaleri, Daniele, Tassinari, Tiziana, Tonietti, Simone, Valentino, Paola, Valzania, Franco, Venturi, Simonetta, Chisari, Clara G., Aguglia, Umberto, Amato, Maria Pia, Bergamaschi, Roberto, Bertolotto, Antonio, Bonavita, Simona, Morra, Vincenzo Brescia, Cavalla, Paola, Cocco, Eleonora, Conte, Antonella, Cottone, Salvatore, De Luca, Giovanna, Di Sapio, Alessia, Filippi, Massimo, Gallo, Antonio, Gasperini, Claudio, Granella, Franco, Lus, Giacomo, Maimone, Davide, Maniscalco, Giorgia Teresa, Marfia, Girolama, Moiola, Lucia, Paolicelli, Damiano, Pesci, Ilaria, Ragonese, Paolo, Rovaris, Marco, Salemi, Giuseppe, Solaro, Claudio, Totaro, Rocco, Trojano, Maria, Vianello, Marika, Zaffaroni, Mauro, Lepore, Vito, and Patti, Francesco

Published
2024
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2. Long-term effectiveness of natalizumab in secondary progressive multiple sclerosis: A propensity-matched study

Author

Chisari, Clara G., primary, Aguglia, Umberto, additional, Amato, Maria Pia, additional, Bergamaschi, Roberto, additional, Bertolotto, Antonio, additional, Bonavita, Simona, additional, Morra, Vincenzo Brescia, additional, Cavalla, Paola, additional, Cocco, Eleonora, additional, Conte, Antonella, additional, Cottone, Salvatore, additional, De Luca, Giovanna, additional, Di Sapio, Alessia, additional, Filippi, Massimo, additional, Gallo, Antonio, additional, Gasperini, Claudio, additional, Granella, Franco, additional, Lus, Giacomo, additional, Maimone, Davide, additional, Maniscalco, Giorgia Teresa, additional, Marfia, Girolama, additional, Moiola, Lucia, additional, Paolicelli, Damiano, additional, Pesci, Ilaria, additional, Ragonese, Paolo, additional, Rovaris, Marco, additional, Salemi, Giuseppe, additional, Solaro, Claudio, additional, Totaro, Rocco, additional, Trojano, Maria, additional, Vianello, Marika, additional, Zaffaroni, Mauro, additional, Lepore, Vito, additional, Patti, Francesco, additional, Avolio, Carlo, additional, Balgera, Roberto, additional, Banfi, Paola, additional, Bellantonio, Paolo, additional, Bramanti, Placido, additional, Capone, Lorenzo, additional, Cavalletti, Guido, additional, Chiveri, Luca, additional, Clerici, Raffaella, additional, Clerico, Marinella, additional, Corea, Francesco, additional, Dattola, Vincenzo, additional, De Robertis, Francesca, additional, Di Battista, Giancarlo, additional, Galgani, Simonetta, additional, Gatto, Maurizia, additional, Grasso, Maria Grazia, additional, Inglese, Matilde, additional, Lo Russo, Lorenzo, additional, Logullo, Francesco Ottavio, additional, Mantegazza, Renato, additional, Protti, Alessandra, additional, Rezzonico, Monica, additional, Rottoli, Mariarosa, additional, Salvetti, Marco, additional, Scarpini, Elio, additional, Sinisi, Leonardo, additional, Sparaco, Maddalena, additional, Spitaleri, Daniele, additional, Tassinari, Tiziana, additional, Tonietti, Simone, additional, Valentino, Paola, additional, Valzania, Franco, additional, and Venturi, Simonetta, additional

Published
2024
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3. Early diagnosis of progressive multifocal leucoencephalopathy: Longitudinal lesion evolution

Author

Scarpazza, Cristina, Signori, Alessio, Prosperini, Luca, Sormani, Maria Pia, Cosottini, Mirco, Capra, Ruggero, Gerevini, Simonetta, Altieri, Marta, Amato, Maria Pia, Artusi, Carlo Alberto, Bandini, Fabio, Barcella, Valeria, Bertolotto, Antonio, Morra, Vincenzo Brescia, Capobianco, Marco, Cavaletti, Guido, Cavalla, Paola, Centonze, Diego, Chiusole, Maurizia, Clerico, Marinella, Cordioli, Cinzia, D'Aleo, Giangaetano, De Luca, Giovanna, De Riz, Milena, De Rossi, Nicola, Deotto, Luciano, Durelli, Luca, Falcini, Mario, Ferrante, Claudio, Ferrari, Ernesta, Fusco, Maria Luisa, Gasperini, Claudio, Ghezzi, Angelo, Grimaldi, Luigi, Guidotti, Mario, Laroni, Alice, Lugaresi, Alessandra, Moiola, Lucia, Naldi, Paola, Pane, Chiara, Palmeri, Barbara, Perrone, Patrizia, Pizzorno, Matteo, Pozzilli, Carlo, Rezzonico, Monica, Rottoli, Maria Rosa, Rovaris, Marco, Salemi, Giuseppe, Salvetti, Marco, Santuccio, Giuseppe, Scarpini, Elio, Sessa, Edoardo, Solaro, Claudio, Stenta, Gianola, Tabiadon, Giulietta, Tortorella, Carla, Trojano, Maria, Valentino, Paola, Rottoli, Maira Rosa, Scarpazza, C, Signori, A, Prosperini, L, Sormani, M, Cosottini, M, Capra, R, Gerevini, S, Altieri, M, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Morra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Chiusole, M, Clerico, M, Cordioli, C, D'Aleo, G, De Luca, G, De Riz, M, De Rossi, N, Deotto, L, Durelli, L, Falcini, M, Ferrante, C, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Moiola, L, Naldi, P, Pane, C, Palmeri, B, Perrone, P, Pizzorno, M, Pozzilli, C, Rezzonico, M, Rottoli, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Stenta, G, Tabiadon, G, Tortorella, C, Trojano, M, and Valentino, P

Subjects
natalizumab treatment, Adult, Male, medicine.medical_specialty, Multiple Sclerosis, Surgery, Neurology (clinical), Psychiatry and Mental Health, natalizumab, progressive multifocal leucoencephalopathy, Progressive Multifocal, Lesion, Leukoencephalopathy, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Psychiatry and Mental Health, progressive multifocal leucoencephalopathy, medicine, Humans, Immunologic Factors, Young adult, Progressive multifocal leucoencephalopathy, Retrospective Studies, medicine.diagnostic_test, business.industry, Multiple sclerosis, Natalizumab, Leukoencephalopathy, Progressive Multifocal, Magnetic resonance imaging, Retrospective cohort study, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Early Diagnosis, Female, Italy, Cohort, Settore MED/26 - Neurologia, Radiology, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

ObjectiveEarly diagnosis of natalizumab-related progressive multifocal leucoencephalopathy (NTZ-PML) in multiple sclerosis has been deemed a major priority by the regulatory agencies but has yet to become a reality. The current paper aims to: (1) investigate whether patients with NTZ-PML pass through a prolonged presymptomatic phase with MRI abnormalities, (2) estimate the longitudinal PML lesion volume increase during the presymptomatic phase and (3) estimate the presymptomatic phase length and its impact on therapy duration as a risk stratification parameter.MethodsAll Italian patients who developed NTZ-PML between 2009 and 2018 were included. The data of patients with available prediagnostic MRI were analysed (n=41). Detailed clinical and neuroradiological information was available for each participant.Results(1) PML lesions were detectable in the presymptomatic phase in 32/41 (78%) patients; (ii) the lesion volume increased by 62.8 % for each month spent in the prediagnostic phase; (3) the prediagnostic phase length was 150.8±74.9 days; (4) PML MRI features were detectable before the 24th month of therapy in 31.7 % of patients in our cohort.ConclusionsConsidering the latency of PML clinical manifestation, the presymptomatic phase length supports the usefulness of MRI surveillance every 3–4 months. Early diagnosis could prompt a better outcome for patients due to the relationship between lesion volume and JC virus infection. The insight from this study might also have an impact on risk stratification algorithms, as therapy duration as a parameter of stratification appears to need reassessment.

Published
2019

4. Prognostic indicators in pediatric clinically isolated syndrome

Author

Iaffaldano, Pietro, Simone, Marta, Lucisano, Giuseppe, Ghezzi, Angelo, Coniglio, Gabriella, Brescia Morra, Vincenzo, Salemi, Giuseppe, Patti, Francesco, Lugaresi, Alessandra, Izquierdo, Guillermo, Bergamaschi, Roberto, Cabrera-Gomez, Jose Antonio, Pozzilli, Carlo, Millefiorini, Enrico, Alroughani, Raed, Boz, Cavit, Pucci, Eugenio, Zimatore, Giovanni Bosco, Sola, Patrizia, Lus, Giacomo, Maimone, Davide, Avolio, Carlo, Cocco, Eleonora, Sajedi, Seyed Aidin, Costantino, Gianfranco, Duquette, Pierre, Shaygannejad, Vahid, Petersen, Thor, Fernández Bolaños, Ricardo, Paolicelli, Damiano, Tortorella, Carla, Spelman, Tim, Margari, Lucia, Amato, Maria Pia, Comi, Giancarlo, Butzkueven, Helmut, Trojano, Maria, Spitaleri, Daniele, Rottoli, Maria Rosa, Ardito, Bonaventura, Iuliano, Gerardo, Montanari, Enrico, Granieri, Enrico, Tedeschi, Gioacchino, Bertolotto, Antonio, Granella, Franco, Di Battista, Giancarlo, Gallo, Paolo, Cavalla, Paola, Bellantonio, Paolo, De Robertis, Francesca, Durelli, Luca, Scarpini, Elio, Rezzonico, Monica, Protti, Alessandra, Solaro, Claudio, Corea, Francesco, Bosco, Antonio, Vianello, Marika, Ferrò, Maria Teresa, Balgera, Roberto, Grasso, Roberta, De Luca, Giovanna, Farina, Deboah, Travaglini, Daniela, di Ioia, Maria, Di Tommaso, Valeria, Mancinelli, Luca, Pietrolongo, Erika, Hupperts, Raymond, Rio, Maria Edite, Terzi, Murat, Barnett, Michael, Slee, Mark, Van Pesch, Vincent, Savino, Aldo, Lechner-Scott, Jeannette, Grammond, Pierre, Singhal, Bhim, Zwanikken, Cees, Fiol, Marcela, Patrucco, Liliana, Paine, Mark, Mccombefrom, Pamela, Grand'Maison, Francois, Iaffaldano, Pietro, Simone, Marta, Lucisano, Giuseppe, Ghezzi, Angelo, Coniglio, Gabriella, Brescia Morra, Vincenzo, Salemi, Giuseppe, Patti, Francesco, Lugaresi, Alessandra, Izquierdo, Guillermo, Bergamaschi, Roberto, Cabrera-Gomez, Jose Antonio, Pozzilli, Carlo, Millefiorini, Enrico, Alroughani, Raed, Boz, Cavit, Pucci, Eugenio, Zimatore, Giovanni Bosco, Sola, Patrizia, Lus, Giacomo, Maimone, Davide, Avolio, Carlo, Cocco, Eleonora, Sajedi, Seyed Aidin, Costantino, Gianfranco, Duquette, Pierre, Shaygannejad, Vahid, Petersen, Thor, Fernández Bolaños, Ricardo, Paolicelli, Damiano, Tortorella, Carla, Spelman, Tim, Margari, Lucia, Amato, Maria Pia, Comi, Giancarlo, Butzkueven, Helmut, Trojano, Maria, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: MA Med Staf Spec Neurologie (9), Klinische Neurowetenschappen, Morra, Vincenzo Brescia, Cabrera Gomez, Jose Antonio, and Bolaños, Ricardo Fernández

Subjects
Registrie, Male, Multiple Sclerosis, Adolescent, Age of Onset, Child, Demyelinating Diseases, Female, Follow-Up Studies, Humans, Prognosis, Retrospective Studies, Risk Factors, Disease Progression, Registries, Neurology, Neurology (clinical), Prognosi, ONSET MULTIPLE-SCLEROSIS, CHILDHOOD, CHILDREN, PARACLINICAL FEATURES, DISABILITY PROGRESSION, NO, Follow-Up Studie, Retrospective Studie, prognostic indicators, Multiple Sclerosi, pediatric, multiple sclerosis, prognosis, indicators, OPTIC NEURITIS, Risk Factor, Demyelinating Disease, NATURAL-HISTORY, multiple sclerosis, clinically isolated syndrome, prognostic indicators, TRANSVERSE MYELITIS, clinically isolated syndrome, INTERFERON BETA-1B, Settore MED/26 - Neurologia, FOLLOW-UP, Human
Abstract

To assess prognostic factors for a second clinical attack and a first disability worsening event in pediatric clinically isolated syndrome (pCIS) suggestive of Multiple Sclerosis (MS) patients. Objective: To assess prognostic factors for a second clinical attack and a first disability-worsening event in pediatric clinically isolated syndrome (pCIS) suggestive of multiple sclerosis (MS) patients. Methods: A cohort of 770 pCIS patients was followed up for at least 10 years. Cox proportional hazard models and Recursive Partitioning and Amalgamation (RECPAM) tree-regression were used to analyze data. Results: In pCIS, female sex and a multifocal onset were risk factors for a second clinical attack (hazard ratio [HR], 95% confidence interval [CI] = 1.28, 1.06–1.55; 1.42, 1.10–1.84, respectively), whereas disease-modifying drug (DMD) exposure reduced this risk (HR, 95% CI = 0.75, 0.60–0.95). After pediatric onset MS (POMS) diagnosis, age at onset younger than 15 years and DMD exposure decreased the risk of a first Expanded Disability Status Scale (EDSS)-worsening event (HR, 95% CI = 0.59, 0.42–0.83; 0.75, 0.71–0.80, respectively), whereas the occurrence of relapse increased this risk (HR, 95% CI = 5.08, 3.46–7.46). An exploratory RECPAM analysis highlighted a significantly higher incidence of a first EDSS-worsening event in patients with multifocal or isolated spinal cord or optic neuritis involvement at onset in comparison to those with an isolated supratentorial or brainstem syndrome. A Cox regression model including RECPAM classes confirmed DMD exposure as the most protective factor against EDSS-worsening events and relapses as the most important risk factor for attaining EDSS worsening. Interpretation: This work represents a step forward in identifying predictors of unfavorable course in pCIS and POMS and supports a protective effect of early DMD treatment in preventing MS development and disability accumulation in this population. Ann Neurol 2017;81:729–739.

Published
2017

5. To do or not to do? plasma exchange and timing of steroid administration in progressive multifocal leukoencephalopathy

Author

Scarpazza, Cristina, Prosperini, Luca, De Rossi, Nicola, Moiola, Lucia, Sormani, Maria Pia, Gerevini, Simonetta, Capra, Ruggero, Altieri, Marta, Amato, Maria Pia, Artusi, Carlo Alberto, Bandini, Fabio, Barcella, Valeria, Bertolotto, Antonio, Morra, Vincenzo Brescia, Capobianco, Marco, Cavaletti, Guido, Cavalla, Paola, Centonze, Diego, Clerico, Marinella, Cocco, Eleonora, Cordioli, Cinzia, Cosottini, Mirco, D'Aleo, Giangaetano, de Luca, Giovanna, de Riz, Marilena, Deotto, Luciano, Durelli, Luca, Falcini, Mario, Ferrari, Ernesta, Ferrante, Claudio, Fusco, Maria Luisa, Gasperini, Claudio, Ghezzi, Angelo, Grimaldi, Luigi, Guidotti, Mario, Laroni, Alice, Lugaresi, Alessandra, Naldi, Paola, Pane, Chiara, Perrone, Patrizia, Pizzorno, Matteo, Pozzilli, Carlo, Rezzonico, Monica, Rovaris, Marco, Salemi, Giuseppe, Salvetti, Marco, Santuccio, Giuseppe, Scarpini, Elio, Sessa, Edoardo, Solaro, Claudio, Tabiadon, Giulia, Tortorella, Carla, Trojano, Maria, Valentino, Paola, Scarpazza, Cristina, Prosperini, Luca, De Rossi, Nicola, Moiola, Lucia, Sormani, Maria Pia, Gerevini, Simonetta, and Capra, Ruggero, Amato MP, Artusi CA, Bandini F, Barcella V, Bertolotto A, Bresciamorra V, Capobianco M, Cavaletti G, Cavalla P, Centonze D, Clerico M, Cordioli C, D’Aleo G, de Riz M, Deotto L, Durelli L, Falcini M, Ferrari E, Fusco ML, Gasperini C, Ghezzi A, Grimaldi L, Guidotti M, Laroni A, Lugaresi A, Naldi P, Pane C, Perrone P, Pizzorno M, Pozzilli C, Prosperini L, Rezzonico M, Rovaris M, Salemi G, Salvetti M, Santuccio G, Scarpini E, Sessa E, Solaro C, Tabiadon G, Tortorella C, Trojano M, Valentino P

Subjects
Adult, Male, Databases, Factual, Disability Evaluation, Female, Humans, Immune Reconstitution Inflammatory Syndrome, Leukoencephalopathy, Progressive Multifocal, Plasma Exchange, Retrospective Studies, Steroids, Young Adult, Neurology, Neurology (clinical), Progressive Multifocal, Databases, Leukoencephalopathy, Retrospective Studie, Settore MED/26 - Neurologia, Steroid, Factual, Human
Abstract

OBJECTIVE: To retrospectively analyze the effect of plasma exchange (PLEX; yes = PLEX+ , no = PLEX- ) and steroids administration timing (prophylactically [proST] or therapeutically [therST]) on the longitudinal clinical course of patients with natalizumab-related progressive multifocal leukoencephalopathy (PML) and full-blown immune reconstitution inflammatory syndrome (PML-IRIS). METHODS: Clinical and radiological data of 42 Italian patients with PML were analyzed. Patient's data are available until 12 months after PML diagnosis. PLEX and steroids treatment as time-dependent covariates were entered in: (1) a Cox model to investigate their impact on full-blown PML-IRIS latency; (2) an analysis of variance ANOVA to investigate their impact on IRIS duration; and (3) a linear mixed model to assess their impact on the longitudinal clinical course (measured by means of Expanded Disability Status Scale [EDSS]). RESULTS: Treatment with PLEX was not associated to PML-IRIS latency (hazard ratio [HR] = 1.05; p = 0.92), but once IRIS emerged, its duration was significantly longer in patients who underwent PLEX (101 vs 54 days in PLEX+ and PLEX- patients; p = 0.028). Receiving proST versus therST was not associated to IRIS latency (HR = 0.67; p = 0.39) or duration (p = 0.95). Patients who underwent proST had a significantly higher EDSS increase during PML (0.09 EDSS points per month; p = 0.04) as compared to those who had therST. INTERPRETATION: This study highlights that: (1) caution on the use of PLEX should be considered as the current data do not support a beneficial effect of PLEX and (2) caution on the early use of steroids is suggested because their prophylactic use to prevent full-blown PML-IRIS seems to negatively impact on the longitudinal disability course.

Published
2017

6. The still under-investigated role of cognitive deficits in PML diagnosis

Author

Scarpazza, Cristina, De Rossi, Nicola, Moiola, Lucia, Gerevini, Simonetta, Cosottini, Mirco, Capra, Ruggero, Mattioli, Flavia, Amato, Maria Pia, Artusi, Carlo Alberto, Bandini, Fabio, Barcella, Valeria, Bertolotto, Antonio, Bresciamorra, Vincenzo, Capobianco, Marco, Cavaletti, Guido, Cavalla, Paola, Centonze, Diego, Clerico, Marinella, Cordioli, Cinzia, D'Aleo, Giangaetano, de Riz, Marilena, Deotto, Luciano, Durelli, Luca, Falcini, Mario, Ferrari, Ernesta, Fusco, Maria Luisa, Gasperini, Claudio, Ghezzi, Angelo, Grimaldi, Luigi, Guidotti, Mario, Laroni, Alice, Lugaresi, Alessandra, Naldi, Paola, Pane, Chiara, Perrone, Patrizia, Pizzorno, Matteo, Pozzilli, Carlo, Prosperini, Luca, Rezzonico, Monica, Rovaris, Marco, Salemi, Giuseppe, Salvetti, Marco, Santuccio, Giuseppe, Scarpini, Elio, Sessa, Edoardo, Solaro, Claudio, Tabiadon, Giulia, Tortorella, Carla, Trojano, Maria, Valentino, Paola, Scarpazza C, De Rossi N, Gerevini S, Cosottini M, Capra R, Mattioli F, Amato MP, Artusi CA, Bandini F, Barcella V, Bertolotto A, Bresciamorra V, Capobianco M, Cavaletti G, Cavalla P, Centonze D, Clerico M, Cordioli C, D’Aleo G, de Riz M, Deotto L, Durelli L, Falcini M, Ferrari E, Fusco ML, Gasperini C, Ghezzi A, Grimaldi L, Guidotti M, Laroni A, Lugaresi A, Naldi P, Pane C, Perrone P, Pizzorno M, Pozzilli C, Prosperini L, Rezzonico M, Rovaris M, Salemi G, Salvetti M, Santuccio G, Scarpini E, Sessa E, Solaro C, Tabiadon G, Tortorella C, Trojano M, Valentino P., Scarpazza, C, De Rossi, N, Moiola, L, Gerevini, S, Cosottini, M, Capra, R, Mattioli, F, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Bresciamorra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Clerico, M, Cordioli, C, D'Aleo, G, de Riz, M, Deotto, L, Durelli, L, Falcini, M, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Naldi, P, Pane, C, Perrone, P, Pizzorno, M, Pozzilli, C, Prosperini, L, Rezzonico, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Tabiadon, G, Tortorella, C, Trojano, M, and Valentino, P

Subjects
0301 basic medicine, cognition, medicine.medical_specialty, Pediatrics, italian database, natalizumab, neuropsychological impairment, progressive multifocal leukoencephalopathy, neurology (clinical), neurology, immunology, immunology and allergy, Neurology, Settore MED/17 - Malattie Infettive, Asymptomatic, Apraxia, 03 medical and health sciences, 0302 clinical medicine, medicine, Dementia, Psychiatry, Cognitive deficit, Progressive multifocal leukoencephalopathy, Neuropsychology, Cognition, Progressive multifocal leukoencephalopathy Natalizumab Cognition Neuropsychological impairment Italian database, medicine.disease, 030104 developmental biology, Italian database, Natalizumab, Neuropsychological impairment, Cognition, Italian database, Natalizumab, Neuropsychological impairment, Progressive multifocal leukoencephalopathy, Immunology and Allergy, Immunology, Neurology (clinical), Settore MED/26 - Neurologia, medicine.symptom, Psychology, 030217 neurology & neurosurgery
Abstract

Background: Despite cognitive deficits frequently represent the first clinical manifestations of Progressive Multifocal Leukoencephalopathy (PML) in Natalizumab-treated MS patients, the importance of cognitive deficits in PML diagnosis is still under-investigated. The aim of the current study is to investigate the cognitive deficits at PML diagnosis in a group of Italian patients with PML. Methods: Thirty-four PML patients were included in the study. The demographic and clinical data, the lesion load and localization, and the longitudinal clinical course was compared between patients with (n = 13) and without (n = 15) cognitive deficit upon PML suspicion (the remaining six patients were asymptomatic). Clinical presentation of cognitive symptoms was described in detail. Result: After symptoms detection, the time to diagnosis resulted to be shorter for patients presenting with cognitive than for patients with non cognitive onset (p = 0.03). Within patients with cognitive onset, six patients were presenting with language and/or reading difficulties (46.15%); five patients with memory difficulties (38.4%); three patients with apraxia (23.1%); two patients with disorientation (15.3%); two patients with neglect (15.3%); one patients with object agnosia (7.7%), one patient with perseveration (7.7%) and one patient with dementia (7.7%). Frontal lesions were less frequent (p = 0.03), whereas temporal lesions were slightly more frequent (p = 0.06) in patients with cognitive deficits. The longitudinal PML course seemed to be more severe in cognitive than in non cognitive patients (F = 2.73, p = 0.03), but differences disappeared (F = 1.24, p = 0.29) when balancing for the incidence of immune reconstitution syndrome and for other treatments for PML (steroids, plasma exchange (PLEX) and other therapies (Mefloquine, Mirtazapine, Maraviroc). Conclusion: Cognitive deficits at PML onset manifest with symptoms which are absolutely rare in MS. Their appearance in MS patients should strongly suggest PML. Clinicians should be sensitive to the importance of formal neuropsychological evaluation, with particular focus on executive function, which are not easily detected without a formal assessment.

Published
2017

7. Natalizumab-Related Progressive Multifocal Leukoencephalopathy (PML) in Multiple Sclerosis (MS) Italian Patients: Course, Outcome and Follow-Up (P2.061)

Author

De Rossi, Nicola, primary, Cordioli, Cinzia, additional, Amato, Maria Pia, additional, Gerevini, Simonetta, additional, Clerico, Marinella, additional, Deotto, Luciano, additional, De Riz, Milena Alessandra, additional, Scarpazza, Cristina, additional, Fusco, Maria Letizia, additional, Ghezzi, Angelo, additional, Grimaldi, Luigi Maria, additional, Lugaresi, Alessandra, additional, Moiola, Lucia, additional, Perrone, Patrizia Susanna Mar, additional, Prosperini, Luca, additional, Rezzonico, Monica, additional, Rovaris, Marco, additional, Salemi, Giuseppe, additional, Salvetti, Marco, additional, Santuccio, Giuseppe, additional, Tortorella, Carla, additional, and Capra, Ruggero, additional

Published
2016
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8. Natalizumab-related PML in multiple sclerosis patients in Italy. Report of the Italian Group for MS-PML Study (P4.034)

Author

Cordioli, Cinzia, primary, De Rossi, Nicola, additional, Gerevini, Simonetta, additional, Amato, Maria Pia, additional, Bandini, Fabio, additional, Cavalla, Paola, additional, Capobianco, Marco, additional, Deotto, Luciano, additional, De Riz, Milena Alessandra, additional, Ferrari, Ernesta, additional, Fusco, Maria Letizia, additional, Ghezzi, Angelo, additional, Grimaldi, Luigi Maria, additional, Lugaresi, Alessandra, additional, Moiola, Lucia, additional, Perrone, Patrizia Susanna Mar, additional, Prosperini, Luca, additional, Rezzonico, Monica, additional, Rovaris, Marco, additional, Salemi, Giuseppe, additional, Salvetti, Marco, additional, Solaro, Claudio, additional, Tortorella, Carla, additional, and Capra, Ruggero, additional

Published
2015
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12. Quantitative Detection of Epstein-Barr Virus DNA in Cerebrospinal Fluid and Blood Samples of Patients with Relapsing-Remitting Multiple Sclerosis.

Author

Cocuzza, Clementina E., Piazza, Fabrizio, Musumeci, Rosario, Oggioni, Davide, Andreoni, Simona, Gardinetti, Margherita, Fusco, Letizia, Frigo, Maura, Banfi, Paola, Rottoli, Maria R., Confalonieri, Paolo, Rezzonico, Monica, Ferrò, Maria T., and Cavaletti, Guido

Subjects
QUANTITATIVE research, EPSTEIN-Barr virus diseases, DNA analysis, CEREBROSPINAL fluid examination, BLOOD sampling, MULTIPLE sclerosis, DIAGNOSIS, PATIENTS
Abstract

The presence of Epstein-Barr Virus (EBV) DNA in cerebrospinal fluid (CSF) and peripheral blood (PB) samples collected from 55 patients with clinical and radiologically-active relapsing-remitting MS (RRMS) and 51 subjects with other neurological diseases was determined using standardized commercially available kits for viral nucleic acid extraction and quantitative EBV DNA detection. Both cell-free and cell-associated CSF and PB fractions were analyzed, to distinguish latent from lytic EBV infection. EBV DNA was detected in 5.5% and 18.2% of cell-free and cell-associated CSF fractions of patients with RRMS as compared to 7.8% and 7.8% of controls; plasma and peripheral blood mononuclear cells (PBMC) positivity rates were 7.3% and 47.3% versus 5.8% and 31.4%, respectively. No significant difference in median EBV viral loads of positive samples was found between RRMS and control patients in all tested samples. Absence of statistically significant differences in EBV positivity rates between RRMS and control patients, despite the use of highly sensitive standardized methods, points to the lack of association between EBV and MS disease activity. [ABSTRACT FROM AUTHOR]

Published
2014
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13. Natalizumab-Related Progressive Multifocal Leukoencephalopathy (PML) in Multiple Sclerosis (MS) Italian Patients: Course, Outcome and Follow-Up

Author

Rossi, Nicola, Cardinli, Cinzia, Amato, Maria Pia, Gerevini, Simonetta, Marinella CLERICO, Deotto, Luciano, Riz, Milena Alessandra, Scarpazza, Cristina, Fusco, Maria Letizia, Ghezzi, Angelo, Grimaldi, Luigi Maria, Lugaresi, Alessandra, Moiola, Lucia, Perrone, Patrizia Susanna Mar, Prosperini, Luca, Rezzonico, Monica, Rovaris, Marco, Salemi, Giuseppe, Salvetti, Marco, Santuccio, Giuseppe, Tortorella, Carla, and Capra, Ruggero

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