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5. Signs and symptoms of COVID-19 in patients with multiple sclerosis

Author

Schiavetti I., Carmisciano L., Ponzano M., Cordioli C., Cocco E., Marfia G. A., Inglese M., Filippi M., Radaelli M., Bergamaschi R., Immovilli P., Capobianco M., De Rossi N., Brichetto G., Scandellari C., Cavalla P., Pesci I., Confalonieri P., Perini P., Trojano M., Lanzillo R., Tedeschi G., Comi G., Battaglia M. A., Patti F., Salvetti M., Sormani M. P., Abbadessa G., Aguglia U., Allegorico L., Rossi Allegri B. M., Alteno A., Amato M. P., Annovazzi P., Antozzi C., Appendino L., Arena S., Baione V., Balgera R., Barcella V., Baroncini D., Barrila C., Bellacosa A., Bellucci G., Bergamaschi V., Bezzini D., Biolzi B., Bisecco A., Bonavita S., Borriello G., Bosa C., Bosco A., Bovis F., Bozzali M., Brambilla L., Brescia Morra V., Buccafusca M., Bucciantini E., Bucello S., Buscarinu M. C., Cabboi M. P., Calabrese M., Calabria F., Caleri F., Camilli F., Caniatti L. M., Cantello R., Capra R., Capuano R., Carta P., Celani M. G., Cellerino M., Cerqua R., Chisari C., Clerici R., Clerico M., Cola G., Conte A., Conti M. Z., Cordano C., Cordera S., Corea F., Correale C., Cottone S., Crescenzo F., Curti E., d'Ambrosio A., D'Amico E., Danni M. C., d'Arma A., Dattola V., de Biase S., De Luca G., De Mercanti S. F., De Mitri P., De Stefano N., Della Cava F. M., Cava M. D., Di Lemme S., di Napoli M., Di Sapio A., Docimo R., Dutto A., Evangelista L., Fanara S., Fantozzi R., Ferraro D., Ferro M. T., Fioretti C., Fratta M., Frau J., Fronza M., Furlan R., Gajofatto A., Gallo A., Gallo P., Gasperini C., Ghazaryan A., Giometto B., Gobbin F., Govone F., Granella F., Grange E., Grasso M. G., Grimaldi L. M. E., Guareschi A., Guaschino C., Guerrieri S., Guidetti D., Juergenson I. B., Iaffaldano P., Ianniello A., Iasevoli L., Imperiale D., Infante M. T., Iodice R., Iovino A., Konrad G., Landi D., Lapucci C., Lavorgna L., L'Episcopo M. R., Leva S., Liberatore G., Lo Re M., Longoni M., Lopiano L., Lorefice L., Lucchini M., Lus G., Maimone D., Malentacchi M., Mallucci G., Malucchi S., Mancinelli C. R., Mancinelli L., Manganotti P., Maniscalco G. T., Mantero V., Marangoni S., Marastoni D., Marinelli F., Marti A., Boneschi Martinelli F., Masserano Z. F., Matta F., Mendozzi L., Meucci G., Miante S., Miele G., Milano E., Mirabella M., Missione R., Moccia M., Moiola L., Montepietra S., MontiBragadin M., Montini F., Motta R., Nardone R., Gabri Nicoletti C., Nobile-Orazio E., Nozzolillo A., Onofrj M., Orlandi R., Palmieri A., Paolicelli D., Pasquali L., Pasto L., Pedrazzoli E., Petracca M., Petrone A., Piantadosi C., Pietroboni A. M., Pinardi F., Portaccio E., Pozzato M., Pozzilli C., Prosperini L., Protti A., Ragonese P., Rasia S., Realmuto S., Repice A., Rigoni E., Rilla M. T., Rinaldi F., Romano C. M., Ronzoni M., Rovaris M., Ruscica F., Sabattini L., Salemi G., Saraceno L., Sartori A., Sbragia E., Scarano G. I., Scarano V., Sessa M., Sgarito C., Sibilia G., Siciliano G., Signori A., Signoriello E., Sinisi L., Sireci F., Sola P., Solaro C., Sotgiu S., Sparaco M., Stromillo M. L., Strumia S., Susani E. L., Tabiadon G., Teatini F., Tomassini V., Tonietti S., Torri V., Tortorella C., Toscano S., Totaro R., Trotta M., Turano G., Ulivelli M., Valentino M., Vaula G., Vecchio D., Vercellino M., Verrengia E. P., Vianello M., Virgilio E., Vitetta F., Vollaro S., Zaffaroni M., Zampolini M., Zarbo I. R., Zito A., Zuliani L., Schiavetti, Irene, Carmisciano, Luca, Ponzano, Marta, Cordioli, Cinzia, Cocco, Eleonora, Marfia, Girolama Alessandra, Inglese, Matilde, Filippi, Massimo, Radaelli, Marta, Bergamaschi, Roberto, Immovilli, Paolo, Capobianco, Marco, De Rossi, Nicola, Brichetto, Giampaolo, Scandellari, Cinzia, Cavalla, Paola, Pesci, Ilaria, Confalonieri, Paolo, Perini, Paola, Trojano, Maria, Lanzillo, Roberta, Tedeschi, Gioacchino, Comi, Giancarlo, Battaglia, Mario Alberto, Patti, Francesco, Salvetti, Marco, Sormani, Maria Pia, Gianmarco, Abbadessa, Umberto, Aguglia, Allegorico, Lia, Beatrice Maria Rossi Allegri, Anastasia, Alteno, Amato, MARIA PIA, Pietro, Annovazzi, Carlo, Antozzi, Lucia, Appendino, Sebastiano, Arena, Viola, Baione, Roberto, Balgera, Valeria, Barcella, Damiano, Baroncini, Caterina, Barrilà, Alessandra, Bellacosa, Gianmarco, Bellucci, Valeria, Bergamaschi, Daiana, Bezzini, Beatrice, Biolzi, Bisecco, Alvino, Simona, Bonavita, Giovanna, Borriello, Chiara, Bosa, Antonio, Bosco, Francesca, Bovi, Marco, Bozzali, Laura, Brambilla, BRESCIA MORRA, Vincenzo, Maria, Buccafusca, Elisabetta, Bucciantini, Sebastiano, Bucello, Maria Chiara Buscarinu, Maria Paola Cabboi, Massimiliano, Calabrese, Francesca, Calabria, Francesca, Caleri, Federico, Camilli, Luisa Maria Caniatti, Roberto, Cantello, Ruggero, Capra, Rocco, Capuano, Patrizia, Carta, Maria Grazia Celani, Maria, Cellerino, Raffaella, Cerqua, Clara, Chisari, Raffaella, Clerici, Marinella, Clerico, Gaia, Cola, Antonella, Conte, Marta Zaffira Conti, Christian, Cordano, Susanna, Cordera, Francesco, Corea, Claudio, Correale, Salvatore, Cottone, Francesco, Crescenzo, Erica, Curti, Alessandro, D’Ambrosio, Emanuele, D’Amico, Maura Chiara Danni, Alessia, D’Arma, Vincenzo, Dattola, Stefano de Biase, Giovanna De Luca, Stefania Federica De Mercanti, Paolo De Mitri, Nicola De Stefano, Fabio Maria Della Cava, Marco Della Cava, Sonia Di Lemme, Mario di Napoli, Alessia Di Sapio, Renato, Docimo, Anna, Dutto, Luana, Evangelista, Salvatore, Fanara, Roberta, Fantozzi, Diana, Ferraro, Maria Teresa Ferrò, Cristina, Fioretti, Mario, Fratta, Jessica, Frau, Marzia, Fronza, Roberto, Furlan, Alberto, Gajofatto, Gallo, Antonio, Paolo, Gallo, Claudio, Gasperini, Anna, Ghazaryan, Bruno, Giometto, Francesca, Gobbin, Flora, Govone, Franco, Granella, Erica, Grange, Grasso, MARIA GRAZIA, Grimaldi, Luigi M. E., Angelica, Guareschi, Clara, Guaschino, Simone, Guerrieri, Donata, Guidetti, Ina Barbara Juergenson, Pietro, Iaffaldano, Ianniello, Antonio, Luigi, Iasevoli, Daniele, Imperiale, Maria Teresa Infante, Iodice, Rosa, Iovino, Aniello, Giovanna, Konrad, Doriana, Landi, Caterina, Lapucci, Luigi, Lavorgna, Maria Rita L’Episcopo, Serena, Leva, Giuseppe, Liberatore, Marianna Lo Re, Marco, Longoni, Leonardo, Lopiano, Lorena, Lorefice, Matteo, Lucchini, Lus, Giacomo, Maimone, Davide, Maria, Malentacchi, Giulia, Mallucci, Simona, Malucchi, Chiara Rosa Mancinelli, Luca, Mancinelli, Paolo, Manganotti, Giorgia Teresa Maniscalco, Vittorio, Mantero, Sabrina, Marangoni, Damiano, Marastoni, Fabiana, Marinelli, Marti, NICOLA ALESSANDRO, Filippo Boneschi Martinelli, Zoli Federco Masserano, Francesca, Matta, Laura, Mendozzi, Giuseppe, Meucci, Silvia, Miante, Giuseppina, Miele, Eva, Milano, Massimiliano, Mirabella, Rosanna, Missione, Moccia, Marcello, Lucia, Moiola, Sara, Montepietra, Margherita, Montibragadin, Federico, Montini, Roberta, Motta, Raffaele, Nardone, Carolina Gabri Nicoletti, Eduardo, Nobile‐orazio, Nozzolillo, Agostino, Marco, Onofrj, Riccardo, Orlandi, Anna, Palmieri, Damiano, Paolicelli, Livia, Pasquali, Luisa, Pastò, Elisabetta, Pedrazzoli, Petracca, Maria, Alfredo, Petrone, Carlo, Piantadosi, Pietroboni, Anna M., Federica, Pinardi, Emilio, Portaccio, Mattia, Pozzato, Pozzilli, Carlo, Luca, Prosperini, Alessandra, Protti, Paolo, Ragonese, Sarah, Rasia, Sabrina, Realmuto, Anna, Repice, Eleonora, Rigoni, Maria Teresa Rilla, DELLA RATTA RINALDI, Francesca, Calogero Marcello Romano, Marco, Ronzoni, Marco, Rovari, Francesca, Ruscica, Loredana, Sabattini, Giuseppe, Salemi, Lorenzo, Saraceno, Alessia, Sartori, Arianna, Sartori, Elvira, Sbragia, Giuditta Ilaria Scarano, Valentina, Scarano, Maria, Sessa, Caterina, Sgarito, Sibilia, Grazia, Gabriele, Siciliano, Alessio, Signori, Signoriello, Elisabetta, Sinisi, Leonardo, Francesca, Sireci, Patrizia, Sola, Claudio, Solaro, Stefano, Sotgiu, Maddalena, Sparaco, Maria Laura Stromillo, Silvia, Strumia, Emanuela Laura Susani, Giulietta, Tabiadon, Francesco, Teatini, Valentina, Tomassini, Simone, Tonietti, Valentina, Torri, Tortorella, Carla, Simona, Toscano, Rocco, Totaro, Maria, Trotta, Gabriella, Turano, Monica, Ulivelli, Manzo, Valentino, Giovanna, Vaula, Domizia, Vecchio, Marco, Vercellino, Elena Pinuccia Verrengia, Marika, Vianello, Eleonora, Virgilio, Francesca, Vitetta, Vollaro, Stefano, Mauro, Zaffaroni, Mauro, Zampolini, Ignazio Roberto Zarbo, Antonio, Zito, and Luigi Zuliani, Schiavetti, I., Carmisciano, L., Ponzano, M., Cordioli, C., Cocco, E., Marfia, G. A., Inglese, M., Filippi, M., Radaelli, M., Bergamaschi, R., Immovilli, P., Capobianco, M., De Rossi, N., Brichetto, G., Scandellari, C., Cavalla, P., Pesci, I., Confalonieri, P., Perini, P., Trojano, M., Lanzillo, R., Tedeschi, G., Comi, G., Battaglia, M. A., Patti, F., Salvetti, M., Sormani, M. P., Abbadessa, G., Aguglia, U., Allegorico, L., Rossi Allegri, B. M., Alteno, A., Amato, M. P., Annovazzi, P., Antozzi, C., Appendino, L., Arena, S., Baione, V., Balgera, R., Barcella, V., Baroncini, D., Barrila, C., Bellacosa, A., Bellucci, G., Bergamaschi, V., Bezzini, D., Biolzi, B., Bisecco, A., Bonavita, S., Borriello, G., Bosa, C., Bosco, A., Bovis, F., Bozzali, M., Brambilla, L., Brescia Morra, V., Buccafusca, M., Bucciantini, E., Bucello, S., Buscarinu, M. C., Cabboi, M. P., Calabrese, M., Calabria, F., Caleri, F., Camilli, F., Caniatti, L. M., Cantello, R., Capra, R., Capuano, R., Carta, P., Celani, M. G., Cellerino, M., Cerqua, R., Chisari, C., Clerici, R., Clerico, M., Cola, G., Conte, A., Conti, M. Z., Cordano, C., Cordera, S., Corea, F., Correale, C., Cottone, S., Crescenzo, F., Curti, E., D'Ambrosio, A., D'Amico, E., Danni, M. C., D'Arma, A., Dattola, V., de Biase, S., De Luca, G., De Mercanti, S. F., De Mitri, P., De Stefano, N., Della Cava, F. M., Cava, M. D., Di Lemme, S., di Napoli, M., Di Sapio, A., Docimo, R., Dutto, A., Evangelista, L., Fanara, S., Fantozzi, R., Ferraro, D., Ferro, M. T., Fioretti, C., Fratta, M., Frau, J., Fronza, M., Furlan, R., Gajofatto, A., Gallo, A., Gallo, P., Gasperini, C., Ghazaryan, A., Giometto, B., Gobbin, F., Govone, F., Granella, F., Grange, E., Grasso, M. G., Grimaldi, L. M. E., Guareschi, A., Guaschino, C., Guerrieri, S., Guidetti, D., Juergenson, I. B., Iaffaldano, P., Ianniello, A., Iasevoli, L., Imperiale, D., Infante, M. T., Iodice, R., Iovino, A., Konrad, G., Landi, D., Lapucci, C., Lavorgna, L., L'Episcopo, M. R., Leva, S., Liberatore, G., Lo Re, M., Longoni, M., Lopiano, L., Lorefice, L., Lucchini, M., Lus, G., Maimone, D., Malentacchi, M., Mallucci, G., Malucchi, S., Mancinelli, C. R., Mancinelli, L., Manganotti, P., Maniscalco, G. T., Mantero, V., Marangoni, S., Marastoni, D., Marinelli, F., Marti, A., Boneschi Martinelli, F., Masserano, Z. F., Matta, F., Mendozzi, L., Meucci, G., Miante, S., Miele, G., Milano, E., Mirabella, M., Missione, R., Moccia, M., Moiola, L., Montepietra, S., Montibragadin, M., Montini, F., Motta, R., Nardone, R., Gabri Nicoletti, C., Nobile-Orazio, E., Nozzolillo, A., Onofrj, M., Orlandi, R., Palmieri, A., Paolicelli, D., Pasquali, L., Pasto, L., Pedrazzoli, E., Petracca, M., Petrone, A., Piantadosi, C., Pietroboni, A. M., Pinardi, F., Portaccio, E., Pozzato, M., Pozzilli, C., Prosperini, L., Protti, A., Ragonese, P., Rasia, S., Realmuto, S., Repice, A., Rigoni, E., Rilla, M. T., Rinaldi, F., Romano, C. M., Ronzoni, M., Rovaris, M., Ruscica, F., Sabattini, L., Salemi, G., Saraceno, L., Sartori, A., Sbragia, E., Scarano, G. I., Scarano, V., Sessa, M., Sgarito, C., Sibilia, G., Siciliano, G., Signori, A., Signoriello, E., Sinisi, L., Sireci, F., Sola, P., Solaro, C., Sotgiu, S., Sparaco, M., Stromillo, M. L., Strumia, S., Susani, E. L., Tabiadon, G., Teatini, F., Tomassini, V., Tonietti, S., Torri, V., Tortorella, C., Toscano, S., Totaro, R., Trotta, M., Turano, G., Ulivelli, M., Valentino, M., Vaula, G., Vecchio, D., Vercellino, M., Verrengia, E. P., Vianello, M., Virgilio, E., Vitetta, F., Vollaro, S., Zaffaroni, M., Zampolini, M., Zarbo, I. R., Zito, A., and Zuliani, L.

Subjects
Multiple Sclerosis, Anosmia, Clinical Sciences, neurological disorders, Neurodegenerative, Settore MED/26, demyelinating disease, COVID-19, demyelinating diseases, disease-modifying treatment, multiple sclerosis, Humans, neurological disorder, Aged, Neurology & Neurosurgery, SARS-CoV-2, Pain Research, Neurosciences, Brain Disorders, Settore MED/26 - NEUROLOGIA, Good Health and Well Being, Neurology, multiple sclerosi, Neurology (clinical), MuSC-19 Study Group, Ageusia, Human
Abstract

Background and purpose: Clinical outcomes of multiple sclerosis (MS) patients affected by coronavirus disease 2019 (COVID-19) have been thoroughly investigated, but a further analysis on main signs and symptoms and their risk factors still needs attention. The objective of this study was to group together and describe based on similarity the most common signs and symptoms of COVID-19 in MS patients and identify all factors associated with their manifestation. Method: Logistic and linear regression models were run to recognize factors associated with each pooled group of symptoms and their total number. Results: From March 2020 to November 2021, data were collected from 1354 MS patients with confirmed infection of COVID-19. Ageusia and anosmia was less frequent in older people (odds ratio [OR] 0.98; p=0.005) and more in smoker patients (OR 1.39; p=0.049). Smoke was also associated with an incremental number of symptoms (OR 1.24; p=0.031), substance abuse (drugs or alcohol), conjunctivitis and rash (OR 5.20; p=0.042) and the presence of at least one comorbidity with shortness of breath, tachycardia or chest pain (OR 1.24; p=0.008). Some disease-modifying therapies were associated with greater frequencies of certain COVID-19 symptoms (association between anti-CD20 therapies and increment in the number of concomitant symptoms: OR 1.29; p=0.05). Differences in frequencies between the three waves were found for flu-like symptoms (G1, p=0.024), joint or muscle pain (G2, p=0.013) and ageusia and anosmia (G5, p < 0.001). All cases should be referred to variants up to Delta. Conclusion: Several factors along with the choice of specific therapeutic approaches might have a different impact on the occurrence of some COVID-19 symptoms.

Published
2022

9. Dimethyl fumarate vs Teriflunomide: an Italian time-to-event data analysis

Author

D'Amico E., Zanghi A., Sciandra M., Lanzillo R., Callari G., Cortese A., Lus G., Lucchini M., Buccafusca M., Bonavita S., Gallo A., Curti E., Gajofatto A., Signoriello E., Bisecco A., Gobbin F., Ferro M. T., Ferrazzano G., Sparaco M., Valentino P., Mirabella M., Granella F., Bresciamorra V., Grimaldi L. M. E., Patti F., Borriello G., Grossi P., Carotenuto A., Siena E., Tsantes E., Giugno A., Abbadessa G. M., Chisari C. G., D'Amico, Emanuele, Zanghì, Aurora, Sciandra, Mariangela, Lanzillo, Roberta, Callari, Graziella, Cortese, Antonio, Lus, Giacomo, Lucchini, Matteo, Buccafusca, Maria, Bonavita, Simona, Gallo, Antonio, Curti, Erica, Gajofatto, Alberto, Signoriello, Elisabetta, Bisecco, Alvino, Gobbin, Francesca, Ferrò, Maria Teresa, Ferrazzano, Gina, Sparaco, Maddalena, Valentino, Paola, Mirabella, Massimiliano, Granella, Franco, Brescia Morra, Vincenzo, Grimaldi, Luigi Maria Edoardo, Patti, Francesco, D'Amico, E., Zanghi, A., Sciandra, M., Lanzillo, R., Callari, G., Cortese, A., Lus, G., Lucchini, M., Buccafusca, M., Bonavita, S., Gallo, A., Curti, E., Gajofatto, A., Signoriello, E., Bisecco, A., Gobbin, F., Ferro, M. T., Ferrazzano, G., Sparaco, M., Valentino, P., Mirabella, M., Granella, F., Bresciamorra, V., Grimaldi, L. M. E., Patti, F., Borriello, G., Grossi, P., Carotenuto, A., Siena, E., Tsantes, E., Giugno, A., Abbadessa, G. M., and Chisari, C. G.

Subjects
Adult, Data Analysis, Male, medicine.medical_specialty, Neurology, Efficacy, Toluidines, Dimethyl Fumarate, Hydroxybutyrates, Relapsing-Remitting, Multiple sclerosis, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Multiple Sclerosis, Relapsing-Remitting, Internal medicine, Teriflunomide, Nitriles, medicine, Humans, Multiple sclerosi, 030212 general & internal medicine, Neuroradiology, Dimethyl fumarate, Proportional hazards model, business.industry, Safety, Female, Italy, Middle Aged, Crotonates, Immunosuppressive Agents, medicine.disease, Settore MED/26 - NEUROLOGIA, Event data, chemistry, Cohort, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Background: The introduction of oral disease-modifying therapies (DMTs) for relapsing–remitting multiple sclerosis (RRMS) changed algorithms of RRMS treatment. Objectives: To compare the effectiveness of treatment with dimethyl fumarate (DMF) and teriflunomide (TRF) in a large multicentre Italian cohort of RRMS patients. Materials and Methods: Patients with RRMS who received treatment with DMF and TRF between January 1st, 2012 and December 31st, 2018 from twelve MS centers were identified. The events investigated were “time-to-first-relapse”, “time-to-Magnetic-Resonance-Imaging (MRI)-activity” and “time-to-disability-progression”. Results: 1445 patients were enrolled (1039 on DMF, 406 on TRF) and followed for a median of 34months. Patients on TRF were older (43.5 ± 8.6 vs 38.8 ± 9.2years), with a predominance of men and higher level of disability (p < 0.001 for all). Patients on DMF had a higher number of relapses and radiological activity (p 38DMF = 3.83, CI = 1.11 to 13.23, p = 0.033). Both DMTs controlled similarly MRI activity and disability progression. Conclusions: Patients on DMF had higher relapse-free survival time than TRF group after the first 38 months ontherapy.

Published
2020

10. On the topochronic map of the human brain dynamics

Author

Sorrentino, P., primary, Petkoski, S., additional, Sparaco, M., additional, Troisi Lopez, E., additional, Signoriello, E., additional, Baselice, F., additional, Bonavita, S., additional, Pirozzi, M.A., additional, Quarantelli, M., additional, Sorrentino, G., additional, and Jirsa, V., additional

Published
2021
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11. Lifestyle and Mediterranean diet adherence in a cohort of Southern Italian patients with Multiple Sclerosis

Author

Esposito, S., primary, Sparaco, M., additional, Maniscalco, G.T., additional, Signoriello, E., additional, Lanzillo, R., additional, Russo, C., additional, Carmisciano, L., additional, Cepparulo, S., additional, Lavorgna, L., additional, Gallo, A., additional, Trojsi, F., additional, Brescia Morra, V., additional, Lus, G., additional, Tedeschi, G., additional, Saccà, F., additional, Signori, A., additional, and Bonavita, S., additional

Published
2021
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14. Disability assessment in the Google Maps era: a pilot study

Author

Lavorgna, L., Laffaldano, P., Abbadessa, G., Lanzillo, R., Esposito, S., Ippolito, D., Sparaco, M., Cepparulo, S., Lus, G., Viterbo, R., Marinella CLERICO, Ragonese, P., Borriello, G., Signoriello, E., Trojano, M., Tedeschi, G., and Bonavita, S.

Published
2019

19. Diagnostic tools for assessment of urinary dysfunction in MS patients without urinary disturbances

Author

Ghezzi, A., primary, Mutta, E., additional, Bianchi, F., additional, Bonavita, S., additional, Buttari, F., additional, Caramma, A., additional, Cavarretta, R., additional, Centonze, D., additional, Coghe, G. C., additional, Coniglio, G., additional, Del Carro, U., additional, Ferrò, M. T., additional, Marrosu, M. G., additional, Patti, F., additional, Rovaris, M., additional, Sparaco, M., additional, Simone, I., additional, Tortorella, C., additional, and Bergamaschi, R., additional

Published
2015
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20. Computer-aided cognitive rehabilitation improves cognitive performances and induces brain functional connectivity changes in relapsing remitting multiple sclerosis patients: an exploratory study

Author

Bonavita, S., primary, Sacco, R., additional, Della Corte, M., additional, Esposito, S., additional, Sparaco, M., additional, d’Ambrosio, A., additional, Docimo, R., additional, Bisecco, A., additional, Lavorgna, L., additional, Corbo, D., additional, Cirillo, S., additional, Gallo, A., additional, Esposito, F., additional, and Tedeschi, G., additional

Published
2014
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22. The THRombolysis and STatins (THRaST) study

Author

Cappellari, M., primary, Bovi, P., additional, Moretto, G., additional, Zini, A., additional, Nencini, P., additional, Sessa, M., additional, Furlan, M., additional, Pezzini, A., additional, Orlandi, G., additional, Paciaroni, M., additional, Tassinari, T., additional, Procaccianti, G., additional, Di Lazzaro, V., additional, Bettoni, L., additional, Gandolfo, C., additional, Silvestrelli, G., additional, Rasura, M., additional, Martini, G., additional, Melis, M., additional, Calloni, M. V., additional, Chiodo-Grandi, F., additional, Beretta, S., additional, Guarino, M., additional, Altavista, M. C., additional, Marcheselli, S., additional, Galletti, G., additional, Adobbati, L., additional, Del Sette, M., additional, Mancini, A., additional, Orrico, D., additional, Monaco, S., additional, Cavallini, A., additional, Sciolla, R., additional, Federico, F., additional, Scoditti, U., additional, Brusaferri, F., additional, Grassa, C., additional, Specchio, L., additional, Bongioanni, M. R., additional, Sparaco, M., additional, Zampolini, M., additional, Greco, G., additional, Colombo, R., additional, Passarella, B., additional, Adami, A., additional, Consoli, D., additional, and Toni, D., additional

Published
2013
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24. Cytoskeletal changes and ubiquitin expression in dystrophic axons of Seitelberger's disease

Author

Moretto G, Sparaco M, Monaco S, Bruno BONETTI, and Rizzuto N

Subjects
Inclusion Bodies, Motor Neurons, Medulla Oblongata, Seitelberger disease, Intermediate Filaments, axonal spheroids, Infant, neurofilaments, Axons, Immunoenzyme Techniques, Cytoskeletal Proteins, Spinal Cord, Central Nervous System Diseases, Tubulin, ubiquitin, Humans, Ubiquitins, tubulin
Abstract

Central nervous system specimens of 4 cases of Infantile Neuroaxonal Dystrophy (Seitelberger's disease) were processed for Bodian's silver stain and for immunostaining with antibodies against neurofilaments (NF), tubulin and ubiquitin (UBQ). Reactivity to NF and UBQ was restricted to spheroids of small size; swellings larger than 30 mu were negative, in spite of their positivity to Bodian's silver stain. Reactivity to tubulin was evident only in normal fibers, whereas no positive material was observed in dystrophic axons. These findings suggest that loss of microtubules (MT) and denaturation of NF might play a crucial role in the mechanisms responsible for the formation of axonal spheroids; in addition the focal activation of the UBQ system suggests an attempt of the neuron to remove abnormal material even at sites remote from the perikaryon.

26. Disability assessment using Google Maps

Author

Francesca Trojsi, Domenico Ippolito, Paolo Ragonese, Sabrina Esposito, Giacomo Lus, Giovanna Borriello, Gioacchino Tedeschi, Maddalena Sparaco, Gianmarco Abbadessa, Luigi Lavorgna, Francesco Brigo, Elisabetta Signoriello, Marinella Clerico, Pietro Iaffaldano, Roberta Lanzillo, Simona Bonavita, Raffaele Palladino, Rosa Gemma Viterbo, Simone Cepparulo, Marcello Moccia, Maria Troiano, Lavorgna, L., Iaffaldano, P., Abbadessa, G., Lanzillo, R., Esposito, S., Ippolito, D., Sparaco, M., Cepparulo, S., Lus, G., Viterbo, R., Clerico, M., Trojsi, F., Raganose, P., Borriello, G., Signoriello, E., Palladino, R., Moccia, M., Brigo, F., Troiano, M., Tedeschi, G., Bonavita, S., Lavorgna L., Iaffaldano P., Abbadessa G., Lanzillo R., Esposito S., Ippolito D., Sparaco M., Cepparulo S., Lus G., Viterbo R., Clerico M., Trojsi F., Ragonese P., Borriello G., Signoriello E., Palladino R., Moccia M., Brigo F., Troiano M., Tedeschi G., and Bonavita S.

Subjects
medicine.medical_specialty, Neurology, Multiple Sclerosis, Concordance, Ambulatory disorders, Dermatology, 03 medical and health sciences, Disability Evaluation, 0302 clinical medicine, Internal medicine, medicine, Google Maps, Humans, 030212 general & internal medicine, Depression (differential diagnoses), Ambulatory disorder, Fatigue, Neuroradiology, Expanded Disability Status Scale, business.industry, General Medicine, Odds ratio, Confidence interval, Search Engine, Psychiatry and Mental health, Cross-Sectional Studies, Ambulatory, e-Health, Original Article, Neurology (clinical), business, Digital health, 030217 neurology & neurosurgery
Abstract

Objectives To evaluate the concordance between Google Maps® application (GM®) and clinical practice measurements of ambulatory function (e.g., Ambulation Score (AS) and respective Expanded Disability Status Scale (EDSS)) in people with multiple sclerosis (pwMS). Materials and methods This is a cross-sectional multicenter study. AS and EDSS were calculated using GM® and routine clinical methods; the correspondence between the two methods was assessed. A multinomial logistic model is investigated which demographic (age, sex) and clinical features (e.g., disease subtype, fatigue, depression) might have influenced discrepancies between the two methods. Results Two hundred forty-three pwMS were included; discrepancies in AS and in EDDS assessments between GM® and routine clinical methods were found in 81/243 (33.3%) and 74/243 (30.4%) pwMS, respectively. Progressive phenotype (odds ratio [OR] = 2.8; 95% confidence interval [CI] 1.1–7.11, p = 0.03), worse fatigue (OR = 1.03; 95% CI 1.01–1.06, p = 0.01), and more severe depression (OR = 1.1; 95% CI 1.04–1.17, p = 0.002) were associated with discrepancies between GM® and routine clinical scoring. Conclusion GM® could easily be used in a real-life clinical setting to calculate the AS and the related EDSS scores. GM® should be considered for validation in further clinical studies. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05389-7.

Published
2021

27. Lifestyle and Mediterranean diet adherence in a cohort of Southern Italian patients with Multiple Sclerosis

Author

G. Tedeschi, Alessio Signori, Francesca Trojsi, Simona Bonavita, Luigi Lavorgna, V. Brescia Morra, Antonio Gallo, Simone Cepparulo, Luca Carmisciano, Camilla Russo, Maddalena Sparaco, Elisabetta Signoriello, G. T. Maniscalco, Sabrina Esposito, Giacomo Lus, Francesco Saccà, R Lanzillo, Esposito, S, Sparaco, M, Maniscalco, G T, Signoriello, E, Lanzillo, R, Russo, C, Carmisciano, L, Cepparulo, S, Lavorgna, L, Gallo, A, Trojsi, F, Brescia Morra, V, Lus, G, Tedeschi, G, Saccà, F, Signori, A, Bonavita, S, Esposito, S., Sparaco, M., Maniscalco, G. T., Signoriello, E., Lanzillo, R., Russo, C., Carmisciano, L., Cepparulo, S., Lavorgna, L., Gallo, A., Trojsi, F., Brescia Morra, V., Lus, G., Tedeschi, G., Sacca, F., Signori, A., and Bonavita, S.

Subjects
medicine.medical_specialty, Multiple Sclerosis, Mediterranean diet, Physical examination, Systemic inflammation, Diet, Mediterranean, 03 medical and health sciences, 0302 clinical medicine, Retrospective Studie, Internal medicine, medicine, Outpatient clinic, Humans, Multiple sclerosi, 030212 general & internal medicine, Life Style, Retrospective Studies, Cross-Sectional Studie, Expanded Disability Status Scale, medicine.diagnostic_test, business.industry, Multiple sclerosis, General Medicine, medicine.disease, Cardiovascular risk, Lifestyle, Cross-Sectional Studies, Neurology, Italy, Cohort, Neurology (clinical), medicine.symptom, business, Body mass index, 030217 neurology & neurosurgery, Human
Abstract

Background/objectives Several studies supported the beneficial effects of the Mediterranean diet (MeDi) on chronic diseases. In Multiple Sclerosis (MS), the MeDi might interfere with systemic inflammatory state, gut microbiota, and comorbidities. The Med Diet Score (MDS) estimates the adherence to the MeDi and the cardiovascular (CV) risk. Aims of our study were i) to photograph lifestyle and diet habits of a southern Italy cohort of people with MS (pwMS), and ii) to investigate the impact of the MeDi on MS clinical outcomes. Subjects/methods We conducted a multi-center, cross-sectional study, enrolling 435 consecutive consenting pwMS, attending the outpatient clinics for routine follow-up visits. Participants underwent a clinical examination and a 29-item self-administered questionnaire on life and dietary habits. Disease phenotype, Expanded Disability Status Scale (EDSS), MS Severity Score (MSSS), waist circumference (WC), Body Mass Index (BMI), therapies, and comorbidities, were updated. MDS was assessed and correlated with current and retrospective clinical data. Results 75.8% of respondents were interested in nutrition, 72.8% were non-smokers, 52.9% performed physical activity, and 45.6% used food supplements. MDS was higher in pwMS with normal WC (p = 0.031), and inversely correlated with MSSS (p = 0.013) and EDSS (p = 0.012) at survey time. MDS did not correlate with the total number of relapses (before and after diagnosis) (p = 0.372). Metabolic comorbidities were associated with an increased 10-year CV risk (r = 0.85, p = 0.002). Conclusion Our findings suggest a putative beneficial effect of the MeDi on WC, MS course and disability. Given the role of chronic systemic inflammation in maintenance of autoimmunity and secondary neurodegeneration, both involved in long-term disability, we may suppose a beneficial effect of the MeDi on MS long-term disability outcomes, probably mediated by a modulation of the gut microbiota and the low-grade chronic systemic inflammation.

Published
2021

28. A snapshot on patient-reported outcome measures of people with multiple sclerosis on first-line therapies in a real world setting

Author

Luigi Lavorgna, Teresa Costabile, Luca Carmisciano, R Lanzillo, N. Frattaruolo, Giacomo Lus, Alvino Bisecco, Alessio Signori, Simona Bonavita, A. Strianese, G. T. Maniscalco, V. Brescia Morra, Maddalena Sparaco, Elisabetta Signoriello, Simone Cepparulo, Francesco Saccà, Camilla Russo, Lanzillo, R, Sparaco, M, Lavorgna, L, Carmisciano, L, Signoriello, E, Signori, A, Costabile, T, Maniscalco, G T, Saccà, F, Cepparulo, S, Russo, C V, Bisecco, A, Frattaruolo, N, Strianese, A, Lus, G, Brescia Morra, V, Bonavita, S, Lanzillo, R., Sparaco, M., Lavorgna, L., Carmisciano, L., Signoriello, E., Signori, A., Costabile, T., Maniscalco, G. T., Sacca, F., Cepparulo, S., Russo, C. V., Bisecco, A., Frattaruolo, N., Strianese, A., Lus, G., Brescia Morra, V., and Bonavita, S.

Subjects
medicine.medical_specialty, Neurology, Multiple Sclerosis, Disease-modifying therapies, First-line therapies, Multiple sclerosis, Patient-reported outcomes, Dermatology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Multiple Sclerosis, Relapsing-Remitting, Teriflunomide, medicine, Humans, Multiple sclerosi, Disease-modifying therapie, 030212 general & internal medicine, Effects of sleep deprivation on cognitive performance, Patient Reported Outcome Measures, Glatiramer acetate, First-line therapie, Aged, business.industry, Cognition, General Medicine, Glatiramer Acetate, medicine.disease, humanities, Psychiatry and Mental health, chemistry, Physical therapy, Quality of Life, Patient-reported outcome, Neurology (clinical), Analysis of variance, business, 030217 neurology & neurosurgery, medicine.drug
Abstract

Background: Patient-reported outcomes (PROs) may help patients and clinicians in selecting disease-modifying therapies (DMTs) for multiple sclerosis (MS). Objective: To evaluate PRO differences among first-line DMTs for relapsing-remitting (RR) people with MS (pwMS). Methods: Multicenter study. RR pwMS on first-line DMTs completed Fatigue Severity Scale (FSS), PROs Indices for MS (PRIMUS), 36-item Short-Form Health Survey (SF-36), treatment satisfaction questionnaire for medication (TSQM), Beck Depression Inventory-II (BDI-II), and Symbol Digit Modalities Test (SDMT). Differences among PROs across DMTs were tested by ANOVA. Multivariable linear regressions were used to investigate associations between PROs and the treatment group. Results: Two-hundred eighty pwMS were enrolled: 56% were on interferons (INF), 22% on dimethylfumarate (DMF), 13% on glatiramer acetate, and 9% on teriflunomide (Teri). Compared with INF, pwMS on Teri were the oldest, with higher disability, worst depression at BDI, worst cognitive performances at SDMT (p = 0.001), fatigue at FSS (p = 0.001), and activity limitation and quality of life respectively at PRIMUS (p = 0.005) and SF-36 Mental Composite Score (p < 0.001); pwMS on DMF reported highest side effects and, together with pwMS on Teri, better treatment satisfaction at TSQM. Conclusions: Compared with INF-treated patients, pwMS on DMF and Teri reported the best treatment satisfaction, although DMF-treated pwMS reported higher side effects and those on Teri the worst QoL and fatigue; however, the older age, higher disability and depression, and worse cognitive performance of pwMS on Teri suggest to be careful in evaluating these results.

Published
2019

30. Association between relapses, stress, and depression in people with multiple sclerosis during the COVID-19 pandemic

Author

Maddalena Sparaco, Giuseppina Miele, Luigi Lavorgna, Gianmarco Abbadessa, Simona Bonavita, Sparaco, M., Miele, G., Lavorgna, L., Abbadessa, G., and Bonavita, S.

Subjects
Pandemic, Stre, Depression, SARS-CoV-2, COVID-19, Dermatology, General Medicine, Multiple Sclerosis, Chronic Progressive, Stress, Multiple sclerosis, Psychiatry and Mental health, Multiple Sclerosis, Relapsing-Remitting, Recurrence, Multiple Sclerosi, Humans, Neurology (clinical), Relapse, Pandemics, Human
Abstract

Background Stress is a potential trigger for clinical and radiological activity in Multiple Sclerosis (MS). COVID-19 pandemic has been a relevant source of mental distress in people with MS (pwMS) and deeply impacted on disease management. Objective To investigate the association between stress, anxiety, depression, and risk of relapse during the COVID-19 pandemic. Methods From an electronic database used for clinical practice, we extracted data of relapsing–remitting (RR) or relapsing-progressive (RP) MS patients and calculated the annualized relapse rate (ARR) during 2019 and 2020. From 01/12/2020 to 30/12/2020, enrolled patients were invited to fill in a Google Forms survey to investigate depression, anxiety, stress, and Post-Traumatic Stress Disorder (PTSD). Results We selected 216 patients with RR or RP-MS to calculate ARR: compared to 2019, in 2020 there was a significant increase in ARR (p = 0.0142). Over 216 selected pwMS, 154 completed the survey. Matching the survey responses and incidence of relapses in 2020, there was a significant association between relapses and stress (p = 0.030) and relapses and depression (p = 0.011), but not between relapses and anxiety (p = 0.130) or PTSD (p = 0.279). Conclusions Our results support the hypothesis that pandemic-related stress is associated to clinical exacerbations, both as a possible consequence of the COVID-19 impact on MS care.

Published
2022

31. Telemedicine application to headache: a critical review

Author

Spina, Emanuele, Tedeschi, Gioacchino, Russo, Antonio, Trojsi, Francesca, Iodice, Rosa, Tozza, Stefano, Iovino, Aniello, Iodice, Francesco, Abbadessa, Gianmarco, di Lorenzo, Francesco, Miele, Giuseppina, Maida, Elisabetta, Cerullo, Giovanni, Sparaco, Maddalena, Silvestro, Marcello, Leocani, Letizia, Bonavita, Simona, Manganelli, Fiore, Lavorgna, Luigi, Spina, E., Tedeschi, G., Russo, A., Trojsi, F., Iodice, R., Tozza, S., Iovino, A., Iodice, F., Abbadessa, G., di Lorenzo, F., Miele, G., Maida, E., Cerullo, G., Sparaco, M., Silvestro, M., Leocani, L., Bonavita, S., Manganelli, F., and Lavorgna, L.

Subjects
Migraine Disorders, Headache, COVID-19, Reproducibility of Results, Tele-rehabilitation, Dermatology, General Medicine, Telemedicine, Psychiatry and Mental health, Telehealth, Humans, Original Article, Neurology (clinical), Child, Pandemics, Migraine
Abstract

Background Migraine affects more than a billion people all over the world and requires critical employment of healthcare resources. Telemedicine could be a reasonable tool to manage people suffering from headaches, and it received a big push from the COVID-19 pandemic. Objective This review aims to propose a practical approach for the virtual management of these patients. Methods To do this, we conducted a literature search, including 32 articles relevant to the topic treated in this review. Results The most challenging step in telemedicine applied to practical neurology remains the clinical assessment, but through a careful headache history and a recently proposed entirely virtual neurological assessment, this hitch can be easily overcome. Electronic diary compilations and virtual administration of disability-measuring scales, conversely, are the key features of effective long-term follow-up although we do not have apps that met the criteria of scientific reliability. Furthermore, tele-rehabilitation seems to be effective and has demonstrated to be a solution to alternatively treat chronic patients at home, and can be considered part of the remote management of headache patients. Moreover, virtual management of headaches finds an application in specific communities of patients, as pediatric patients and for rural communities of low- and middle-income countries suffer from health disparities, with inadequate resources and knowledge gaps. Conclusion Telemedicine could be promising for patients with no regular or convenient access to headache specialists and seems to be a priority in managing migraine patients to avoid non-urgent hospitalizations

Published
2022

32. Clinical effectiveness of different natalizumab interval dosing schedules in a large Italian population of patients with multiple sclerosis

Author

Chisari, CLARA GRAZIA, Grimaldi Luigi Maria, Salemi, Giuseppe, Ragonese, Paolo, Iaffaldano, Pietro, Bonavita, Simona, Sparaco, Maddalena, Rovaris, Marco, D'Arma, Alessia, Lugaresi, Alessandra, Ferrò Maria Teresa, Grossi, Paola, Di Sapio Alessia, Cocco, Eleonora, Granella, Franco, Curti, Erica, Lepore, Vito, Trojano, Maria, Patti, Francesco, on behalf of the Italian MS Register Study Group, Chisari, Clara Grazia, Grimaldi, Luigi Maria, Salemi, Giuseppe, Ragonese, Paolo, Iaffaldano, Pietro, Bonavita, Simona, Sparaco, Maddalena, Rovaris, Marco, D'Arma, Alessia, Lugaresi, Alessandra, Ferrò, Maria Teresa, Grossi, Paola, Di Sapio, Alessia, Cocco, Eleonora, Granella, Franco, Curti, Erica, Lepore, Vito, Trojano, Maria, Patti, Francesco, Chisari C.G., Grimaldi L.M., Salemi G., Ragonese P., Iaffaldano P., Bonavita S., Sparaco M., Rovaris M., D'Arma A., Lugaresi A., Ferro M.T., Grossi P., DI Sapio A., Cocco E., Granella F., Curti E., Lepore V., Trojano M., and Patti F.

Subjects
Adult, medicine.medical_specialty, Population, multiple sclerosis, Drug Administration Schedule, 03 medical and health sciences, Multiple Sclerosis, Relapsing-Remitting, natalizumab, 0302 clinical medicine, Natalizumab, Dosing schedules, Internal medicine, medicine, Humans, Immunologic Factors, natalizumab, risk stratification, multiple sclerosis, safety, effectiveness, Dosing, education, Proportional Hazards Models, Retrospective Studies, 030304 developmental biology, 0303 health sciences, education.field_of_study, Proportional hazards model, business.industry, Multiple sclerosis, Retrospective cohort study, Middle Aged, medicine.disease, Psychiatry and Mental health, Treatment Outcome, Italy, Tolerability, Settore MED/26 - Neurologia, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery, medicine.drug
Abstract

IntroductionNatalizumab (NTZ) is one of the most effective treatment options for multiple sclerosis (MS) treatment. Our study aimed to evaluate the effectiveness of NTZ when administered according to the extended dosing strategy compared with standard 4-weekly administration in a large Italian MS population.Materials and methodsThis retrospective multicentre study included patients with relapsing-remitting MS (RR-MS) who received NTZ administrations between the 1 June 2012 and the 15 May 2018 and were followed by the ‘Italian MS Register’. All patients with MS were stratified into two groups based on NTZ administration schedule: standard interval dosing (SID) patients who received infusions on average from 28 to 32 days (median 30) and extended interval dosing (EID) including patients who have been infused with interval between 33 and 49 days (median 43). Clinical data were assessed at baseline (before starting NTZ), after 12 (T1) and 24 months (T2) of treatment.ResultsOut of 5231 patients with RR-MS screened, 2092 (mean age 43.2±12.0, 60.6% women) were enrolled. A total of 1254 (59.9%) received NTZ according to SID, and 838 (40.1%) according to EID. At 12 and 24 months, no differences in terms of annualised relapse rate and disability status were found between the two groups. Progression index and confirmed disability worsening were similar between the two groups.DiscussionThe use of NTZ with an extended interval schedule showed similar effectiveness compared with SID. Unchanged clinical efficacy of EID schedule may raise the question of a possible advantage in terms of tolerability and safety.

Published
2020

33. Multiple sclerosis and genetic polymorphisms in fibrinogen-mediated hemostatic pathways: a case–control study

Author

Raffaele Palladino, Ignazio Armetta, Giuseppina Miele, Francesca Trojsi, Luigi Lavorgna, Giovanna D'Elia, Gianmarco Abbadessa, Andrea Di Pietro, Elisabetta Signoriello, Giacomo Lus, Maddalena Sparaco, Simona Bonavita, Abbadessa, G., Miele, G., Di Pietro, A., Sparaco, M., Palladino, R., Armetta, I., D'Elia, G., Trojsi, F., Signoriello, E., Lus, G., Lavorgna, L., and Bonavita, S.

Subjects
Oncology, medicine.medical_specialty, Multiple Sclerosis, Population, Single-nucleotide polymorphism, Dermatology, Fibrinogen, Polymorphism, Single Nucleotide, Hemostatics, Hemostatic, Internal medicine, medicine, Factor V Leiden, Humans, Multiple sclerosi, Genetic Predisposition to Disease, Allele, Polymorphism, education, education.field_of_study, Coagulation, biology, business.industry, Multiple sclerosis, Case-control study, Factor V, General Medicine, medicine.disease, Psychiatry and Mental health, Case-Control Studies, biology.protein, Neurology (clinical), business, Polymorphisms, Case-Control Studie, medicine.drug, Human
Abstract

Introduction Blood coagulation constituents might exert immunomodulatory functions in the CNS and may trigger neuroinflammation and demyelination. We evaluated whether particular single-nucleotide polymorphisms (SNPs), thought to be involved in fibrinogen-mediated hemostatic pathways, are overrepresented in patients with MS compared with controls. Methods The case–control study consisted of 119 MS patients recruited consecutively at our clinic, and 68 healthy controls. Afterwards, we created a cumulative genetic risk score (CGRS) which included the 5 selected hemostatic risk alleles (Beta-Fibrinogen 455G/A, Glycoprotein IIIa P1A2, Factor V Leiden, Factor V H2R, and Prothrombin 20210G/A). Multivariate ordinal logistic regression and multivariate multinomial logistic regression were applied to evaluate the effect of CGRS on MS susceptibility. Results The FGB 455 G/A and Factor V H1299R variants might be associated with MS status, in the recessive and dominant model, respectively. A cumulative association of the five SNPs investigated with the disease was observed. Discussion We found that MS patients carried more pro-hemostatic variants than healthy controls. An increasing number of unfavorable alleles might increase the likelihood of being in the MS group, in the cumulative analysis. Our findings encourage to evaluating these variants in a larger population-based cohort.

Published
2022

34. Pelvic Floor Dysfunctions and Their Rehabilitation in Multiple Sclerosis

Author

Maddalena Sparaco, Simona Bonavita, Sparaco, M., and Bonavita, S.

Subjects
multiple sclerosi, pelvic floor, General Medicine, rehabilitation
Abstract

Urinary, bowel, and sexual dysfunctions are the most frequent and disabling pelvic floor (PF) disorders in patients with multiple sclerosis (MS). PF dysfunction negatively impacts the performance of daily living activities, walking, and the physical dimension of quality of life (QoL) in people with MS. Patient-reported outcomes on sphincteric functioning could be useful to detect PF disorders and their impact on patients’ lives. PF rehabilitation proposed by Kegel is based on a series of regularly repeated exercises for “the functional restoration of the perineal muscles”. Over time, various therapeutic modalities have been added to PF muscles exercises, through the application of physical or instrumental techniques, such as intravaginal neuromuscular electrical stimulation, electromyographic biofeedback, transcutaneous tibial nerve stimulation. PF rehabilitation has been applied in MS treatment, with improvements of lower urinary tract symptoms severity, QoL, level of anxiety and depression, and sexual dysfunction. This review aims to examine the different PF disorders in MS to evaluate the application of PF rehabilitation in MS and to highlight its advantages and limits, suggesting a multidisciplinary management of PF disorders, with a well-deserved space reserved for PF rehabilitation.

Published
2022

35. CD19 Cell Count at Baseline Predicts B Cell Repopulation at 6 and 12 Months in Multiple Sclerosis Patients Treated with Ocrelizumab

Author

Girolama Alessandra Marfia, Giuseppina Miele, Giacomo Lus, Doriana Landi, Rosanna Missione, Paola Cavalla, Maddalena Sparaco, Paola Valentino, Luigi Lavorgna, Simona Bonavita, Gianmarco Abbadessa, Antonio De Martino, Elisabetta Signoriello, Marco Vercellino, Chiara Bosa, Abbadessa, G., Miele, G., Cavalla, P., Valentino, P., Marfia, G. A., Signoriello, E., Landi, D., Bosa, C., Vercellino, M., De Martino, A., Missione, R., Sparaco, M., Lavorgna, L., Lus, G., and Bonavita, S.

Subjects
0301 basic medicine, medicine.medical_specialty, Every Six Months, Health, Toxicology and Mutagenesis, Cell, Settore MED/26, Antibodies, Monoclonal, Humanized, multiple sclerosis, Gastroenterology, Article, CD19, 03 medical and health sciences, 0302 clinical medicine, Multiple Sclerosis, Relapsing-Remitting, ocrelizumab, Internal medicine, Multiple Sclerosi, medicine, Humans, CD20, Lymphocyte Count, B cell, Kinetic, B-Lymphocytes, medicine.diagnostic_test, biology, business.industry, Multiple sclerosis, Public Health, Environmental and Occupational Health, B-Lymphocyte, Magnetic resonance imaging, medicine.disease, 030104 developmental biology, medicine.anatomical_structure, kinetics, biology.protein, schedule, Medicine, Ocrelizumab, business, 030217 neurology & neurosurgery, medicine.drug, Human
Abstract

Background: The kinetics of B cell repopulation in MS patients treated with Ocrelizumab is highly variable, suggesting that a fixed dosage and time scheduling might be not optimal. We aimed to investigate whether B cell repopulation kinetics influences clinical and radiological outcomes and whether circulating immune asset at baseline affects B cell repopulation kinetics. Methods: 218 MS patients treated with Ocrelizumab were included. Every six months we collected data on clinical and magnetic resonance imaging (MRI) activity and lymphocyte subsets at baseline. According to B cell counts at six and twelve months, we identified two groups of patients, those with fast repopulation rate (FR) and those with slow repopulation rate (SR). Results: A significant reduction in clinical and radiological activity was found. One hundred fifty-five patients had complete data and received at least three treatment cycles (twelve-month follow-up). After six months, the FR patients were 41/155 (26.45%) and 10/41 (29.27%) remained non-depleted after twelve months. FR patients showed a significantly higher percentage of active MRI scan at twelve months (17.39% vs. 2.53%, p = 0,008). Furthermore, FR patients had a higher baseline B cell count compared to patients with an SR (p = 0.02 and p = 0.002, at the six- and twelve-month follow-ups, respectively). Conclusion: A considerable proportion of MS patients did not achieve a complete CD19 cell depletion and these patients had a higher baseline CD19 cell count. These findings, together with the higher MRI activity found in FR patients, suggest that the Ocrelizumab dosage could be tailored depending on CD19 cell counts at baseline in order to achieve complete disease control in all patients.

Published
2021

36. Public Engagement and Neurology: An Update

Author

Pasquale De Micco, Emanuele Spina, Sabrina Esposito, Matilde Inglese, Gioacchino Tedeschi, Francesca Trojsi, Roberta Lanzillo, Marcello Moccia, Marinella Clerico, Luca Bonfanti, Luigi Lavorgna, Simona Bonavita, Francesco Brigo, Gianmarco Abbadessa, Antonio Russo, Maddalena Sparaco, Lavorgna, L., Brigo, F., Esposito, S., Abbadessa, G., Sparaco, M., Lanzillo, R., Moccia, M., Inglese, M., Bonfanti, L., Trojsi, F., Spina, E., Russo, A., De Micco, P., Clerico, M., Tedeschi, G., and Bonavita, S.

Subjects
medicine.medical_specialty, Neurology, campaign, Associa-tion, Awareness, Campaign, Educational, Foundation, Fundraising, Prevention, Public engagement, Neurogenetics, Disease, Review, educational, foundation, lcsh:RC321-571, public engagement, 03 medical and health sciences, 0302 clinical medicine, fundraising, medicine, Dementia, awareness, 030212 general & internal medicine, Amyotrophic lateral sclerosis, Psychiatry, lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry, General Neuroscience, Public health, Social nature, association, Awarene, medicine.disease, Psychology, 030217 neurology & neurosurgery
Abstract

Background: Public engagement (PE) is defined as the involvement of “specialists who listen, develop their understanding, and interact with non-specialists in non-profit activities of educational, cultural, and social nature to engage the public in science-related matters”. The public health relevance of PE consists in building up a scientifically literate society, able to participate in and support scientific and technological developments and their implications for educational settings. Neurological disorders account for 35% of all diseases. PE could have a positive impact on the lives of people affected by neurological diseases. Method: This review evaluates the role of PE in dementia, stroke, epilepsy, multiple sclerosis, Parkinson’s disease, migraine, neurogenetics, and amyotrophic lateral sclerosis. Results and Conclusions: PE can provide accessible information, support research activities and prevention through appropriate lifestyles, and increase knowledge and awareness of neurological disorders, improving their diagnosis and treatment.

Published
2021

37. Digital work engagement among Italian neurologists

Author

Fabiana Colucci, Francesca Trojsi, Simona Bonavita, Letizia Leocani, Gioacchino Tedeschi, Maria Pia Sormani, Francesco Brigo, Marta Ponzano, Luigi Lavorgna, Marinella Clerico, Roberta Lanzillo, Gianmarco Abbadessa, Emanuele Spina, Luca Carmisciano, Maddalena Sparaco, Giovanni Cossu, Giuseppina Miele, Carla Tortorella, G. Servillo, Marco Bozzali, Carlo Alberto Artusi, Brigo, F., Ponzano, M., Sormani, M. P., Clerico, M., Abbadessa, G., Cossu, G., Trojsi, F., Colucci, F., Tortorella, C., Miele, G., Spina, E., Artusi, C. A., Carmisciano, L., Servillo, G., Bozzali, M., Sparaco, M., Leocani, L., Lanzillo, R., Tedeschi, G., Bonavita, S., Lavorgna, L., Brigo, Francesco, Ponzano, Marta, Sormani, Maria Pia, Clerico, Marinella, Abbadessa, Gianmarco, Cossu, Giovanni, Trojsi, Francesca, Colucci, Fabiana, Tortorella, Carla, Miele, Giuseppina, Spina, Emanuele, Artusi, Carlo Alberto, Carmisciano, Luca, Servillo, Giovanna, Bozzali, Marco, Sparaco, Maddalena, Leocani, Letizia, Lanzillo, Roberta, Tedeschi, Gioacchino, Bonavita, Simona, and Lavorgna, Luigi

Subjects
Digital work, The Role of Telemedicine in Chronic Disease, medicine.medical_specialty, Telemedicine, Medical education, Neurology, 020205 medical informatics, business.industry, Medicine (miscellaneous), 02 engineering and technology, RM1-950, Digital health, 03 medical and health sciences, 0302 clinical medicine, 0202 electrical engineering, electronic engineering, information engineering, medicine, Therapeutics. Pharmacology, business, 030217 neurology & neurosurgery, Original Research
Abstract

Background: Digital health, including telemedicine, is increasingly recommended for the management of chronic neurological disorders, and it has changed the roles of patients and clinicians. Methods: In this cross-sectional study we aimed to investigate the digital work engagement of Italian neurologists through a survey collected between September 2020 and January 2021. Questionnaires were anonymous and collected demographic characteristics, attitudes towards digital devices and social media, and details about the clinician–patient relationship. We used logistic-regression models to identify characteristics associated with the propensity to communicate with patients using social media. Results: Among the 553 neurologists who participated to the study, smartphones and computers were widely preferred compared with tablets; wearable devices were not common, although some neurologists desired them. A total of 48% of participants reported communicating with patients using social media but only a few were in favor of social friendship with patients; WhatsApp was the social media most popular for professional (86%) and personal (98%) purposes. Propensity to communicate with social media was significantly higher among those who were older ( p Conclusions: The preferred social media were those which were rapid and which safeguard privacy more effectively; neurologists made many efforts to disprove fake news circulating online, providing help to patients in various ways. This analysis can help direct future interventions for the management of chronic neurological disorders.

Published
2021

38. Gait abnormalities in minimally disabled people with Multiple Sclerosis: A 3D-motion analysis study

Author

Luigi Lavorgna, Giuseppe Sorrentino, Roberta Minino, Marianna Liparoti, Rosaria Rucco, Rocco Capuano, Simona Bonavita, Maddalena Sparaco, Pierpaolo Sorrentino, Marida Della Corte, Valeria Agosti, Liparoti, M., Della Corte, M., Rucco, R., Sorrentino, P., Sparaco, M., Capuano, R., Minino, R., Lavorgna, L., Agosti, V., Sorrentino, G., Bonavita, S., Institut de Neurosciences des Systèmes (INS), and Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, Three-dimensional Motion analysi, Kinematics, Cognitive functions, Dual task paradigm, MRI, Three-dimensional Motion analysis, Adult, Biomechanical Phenomena, Cognitive Dysfunction, Executive Function, Female, Gait Disorders, Neurologic, Humans, Magnetic Resonance Imaging, Middle Aged, Multiple Sclerosis, Relapsing-Remitting, Settore M-PED/04 - Pedagogia Sperimentale, 0302 clinical medicine, Gait (human), Medicine, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Subclinical infection, Settore M-EDF/01 - Metodi e Didattiche delle Attivita' Motorie, Neuropsychology, Cognition, General Medicine, Kinematic, Neurology, Settore M-EDF/02 - Metodi e Didattiche delle Attivita' Sportive, Settore MED/26 - Neurologia, Cognitive function, medicine.symptom, Human, medicine.medical_specialty, Gait Disorders, Neurologic, Multiple Sclerosis, Relapsing-Remitting, Asymptomatic, 03 medical and health sciences, Physical medicine and rehabilitation, Atrophy, Expanded Disability Status Scale, business.industry, [SCCO.NEUR]Cognitive science/Neuroscience, Multiple sclerosis, medicine.disease, Settore ING-INF/06 - Bioingegneria Elettronica e Informatica, Neurology (clinical), business, human activities, 030217 neurology & neurosurgery
Abstract

Background People with Relapsing-Remitting Multiple Sclerosis (pwRR-MS), may be affected by subclinical gait impairment. The Expanded Disability Status Scale, the most used scale to assess MS related disability, may be insensitive to subclinical gait disability. Minor gait abnormalities may be detected by three Dimensional-Gait Analysis (3D-GA). Objectives To investigate gait pattern in minimally disabled pwRR-MS by 3D-GA during walking (single task, SinT), and cognitive dual tasks (CogDT) and to evaluate correlations between altered gait parameters, cognitive scores, lesion load (LL) and brain atrophy measures. Methods Twenty-two pwRR-MS and twenty-one healthy controls (HCs), underwent neuropsychological (NP) evaluation, and brain MRI to assess brain volumes and lesion load (only in pwRR-MS) and 3D-GA. Results Both pwRR-MS and HCs were considered cognitively preserved (CP). During SinT pwRR-MS, compared to HCs, showed an impairment of velocity (increase of cycle time), stability (increase of stance time, swing time and coefficients of variability (CV) of swing time) and kinematic (increase of ankle dorsiflexion) parameters. During CogDT, the changes of velocity and stability parameters observed in SinT were confirmed. Moreover, a statistically significant increase of the double limb support was observed. Regarding the kinematic parameters, during CogDT, an increase of ankle dorsiflexion during mid and terminal stance phases of gait cycle was observed. No significant correlations were found between gait abnormalities and cognitive status or MRI structural damage in both groups. Conclusions The subclinical abnormal gait in asymptomatic and CP pwRR-MS, may be detected by 3D-GA.

Published
2019

39. Cardiovascular autonomic individual profile of relapsing-remitting multiple sclerosis patients and risk of extending cardiac monitoring after first dose fingolimod

Author

Francesca Frigerio, Simona Bonavita, Clara Grazia Chisari, Assunta Bianco, Emilio Vanoli, Gianluigi Mancardi, Marta Bartezaghi, Nicola Montano, Silvia Rossi, Massimiliano Mirabella, Fabio Badilini, Maddalena Sparaco, Francesco Patti, Renato Turrini, Giuseppe De Angelis, Alice Laroni, Vanoli, E., Montano, N., De Angelis, G., Badilini, F., Mirabella, M., Bonavita, S., Patti, F., Bianco, A., Sparaco, M., Chisari, C., Laroni, A., Frigerio, F., Bartezaghi, M., Rossi, S., Turrini, R., and Mancardi, G.

Subjects
Adult, Male, medicine.medical_specialty, Autonomic system, Adolescent, medicine.medical_treatment, Asymptomatic, Electrocardiography, Young Adult, 03 medical and health sciences, Multiple Sclerosis, Relapsing-Remitting, 0302 clinical medicine, Heart Rate, Internal medicine, Heart rate, medicine, Humans, Heart rate variability, Prospective Studies, 030212 general & internal medicine, Aged, Fingolimod Hydrochloride, business.industry, Multiple sclerosis, Therapeutic effect, Autonomic system, Fingolimod, Heart rate variability, Safety, Fingolimod, Middle Aged, medicine.disease, Autonomic Agents, Settore MED/26 - NEUROLOGIA, Neurology, Cardiology, Female, Neurology (clinical), Drug Monitoring, medicine.symptom, Cardiac monitoring, Safety, business, Atrioventricular block, 030217 neurology & neurosurgery, medicine.drug
Abstract

Fingolimod exerts its therapeutic effect in multiple sclerosis by modulating sphingosine-1P receptors which are expressed in the heart mediating fingolimod first dose effects. Understanding potential interactions of baseline characteristics and autonomic profile with fingolimod first dose effects may add novel safety information and help explain cases requiring extension of the 6-hour ECG monitoring period. We aimed at characterizing the patient population treated with the first dose of fingolimod in clinical practice in an observational, multicenter, prospective 6-hours (up to 24) study. ECG was recorded for 15 min before first fingolimod administration and for 6 h after. Heart rate (HR) and HR variability in the frequency domain were derived from ECG traces. Out of the 625 enrolled patients, 580 (92.8%) were discharged at the sixth hour after fingolimod first dose; 45 (7.2%) required monitoring extension. Data confirm the well characterized cardiovascular fingolimod profile upon treatment initiation. Ten (1.6%) patients showed an atrioventricular block, all asymptomatic and self-resolving. Normalized spectral power in the High Frequency band (marking vagal modulation) and previous annualized relapse rate were independently correlated with the probability of undergoing extended monitoring. Our results could provide useful information for the stratification and individualized monitoring of MS patients prescribed with fingolimod.

Published
2019

40. Fake news, influencers and health-related professional participation on the Web: A pilot study on a social-network of people with Multiple Sclerosis

Author

G. Tedeschi, Daniela Buonanno, Gianmarco Abbadessa, L. Rosa, Luigi Lavorgna, Simona Bonavita, Alvino Bisecco, Francesca Trojsi, Maddalena Sparaco, Marcello Moccia, Domenico Ippolito, M. De Stefano, Marinella Clerico, Sabrina Esposito, V. Brescia Morra, C. Cenci, Giorgia Teresa Maniscalco, Patrizia Montella, R Lanzillo, Lavorgna, L., De Stefano, M., Sparaco, Rosa, Moccia, M., Abbadessa, Pietro, Montella, P., Buonanno, D., Esposito, S., Clerico, M., Cenci, Beniamino, Trojsi, F., Lanzillo, R., Rosa, L., Morra, V. Brescia, Ippolito, D., Maniscalco, G., Bisecco, A., Tedeschi, G., Bonavita, S., Lavorgna, L, De Stefano, M, Sparaco, M, Moccia, M, Abbadessa, G, Montella, P, Buonanno, D, Esposito, S, Clerico, M, Cenci, C, Trojsi, F, Lanzillo, R, Rosa, L, Morra, Vb, Ippolito, D, Maniscalco, G, Bisecco, A, Tedeschi, G, and Bonavita, S

Subjects
Male, Multiple Sclerosis, 020205 medical informatics, Digital health, E-health, Fake news, Influencers, Female, Health Personnel, Humans, Interpersonal Relations, Italy, Pilot Projects, Internet, Physician-Patient Relations, Social Networking, Neurology, Neurology (clinical), Internet privacy, 02 engineering and technology, Computer-assisted web interviewing, Fake new, 03 medical and health sciences, Influencer, 0302 clinical medicine, Multiple Sclerosi, 0202 electrical engineering, electronic engineering, information engineering, Medicine, Confidentiality, Misinformation, Web community, business.industry, Information seeking, General Medicine, Influencer marketing, The Internet, business, 030217 neurology & neurosurgery
Abstract

Background Over the last few decades, patients have increasingly been searching for health information on the Internet. This aspect of information seeking is important, especially for people affected by chronic pathologies and require lifelong treatment and management. These people are usually very well informed about the disease but are nonetheless vulnerable to hopes of being cured or saved, often amplified by misinformation, myths, legends, and therapies that are not always scientifically proven. Many studies suggest that some individuals prefer to rely on the Internet as their main source of information, often hindering the patient-doctor relationship. A professional approach is imperative to maintain confidentiality, honesty, and trust in the medical profession. Objective we aimed to examine, in a medically supervised Italian web community (SMsocialnetwotk.com) dedicated to people with Multiple Sclerosis (pwMS), the posts shared by users and to verify the reliability of contents of posts shared by users pinpointed as Influencers through an online questionnaire. Methods we grouped the posts published on SMsocialnetwork from April to June 2015 into those with medical content (scientifically correct or fake news), and those related to social interactions. Later, we gave a questionnaire to the community asking to identify the three users/Influencers providing the most reliable advice for everyday life with MS and the three users/Influencers providing the most useful information about MS treatments. Results 308 posts reported scientific and relevant medical information, whereas 72 posts included pieces of fake news. 1420 posts were of general interest. Four out of the 6 Influencers had written only posts with correct medical information (3 were pwMS, 1 was a Neurologist) and never any fake news. The remaining 2 appointed Influencers (2 pwMS) had written only posts about general interests. Conclusion the identification of fake news and their authors has shown that the latter are never appointed as Influencers. SMsocialnetwork.com acted as a “web safe environment” where the Influencers contributed by sharing only correct medical information and never fake news. We speculate that the presence of neurologists and psychologists supervising the information flow might have contributed to reduce the risk of fake news spreading and to avoid their acquisition of authoritative meaning.

Published
2018

41. Computer-aided cognitive rehabilitation improves cognitive performances and induces brain functional connectivity changes in relapsing remitting multiple sclerosis patients: an exploratory study

Author

G. Tedeschi, Alvino Bisecco, Fabrizio Esposito, Luigi Lavorgna, Sabrina Esposito, Alessandro d’Ambrosio, M. Della Corte, Daniele Corbo, Maddalena Sparaco, Sossio Cirillo, Simona Bonavita, Renato Docimo, Antonio Gallo, Rosaria Sacco, Bonavita, Simona, Sacco, R, Della Corte, M, Esposito, S, Sparaco, M, D'Ambrosio, Alessandro, Docimo, R, Bisecco, Alvino, Lavorgna, L, Corbo, D, Cirillo, Sossio, Gallo, Antonio, Esposito, F, and Tedeschi, Gioacchino

Subjects
Adult, Male, medicine.medical_specialty, Resting-state functional magnetic resonance imaging, Audiology, Multiple sclerosis, Multiple Sclerosis, Relapsing-Remitting, medicine, Humans, Cognitive rehabilitation therapy, Cognitive impairment, Cognitive rehabilitation, fMRI, Cognitive reserve, Cerebral Cortex, medicine.diagnostic_test, Neuropsychology, Cognition, Middle Aged, Magnetic Resonance Imaging, Cognitive training, Treatment Outcome, Neurology, Practice, Psychological, Therapy, Computer-Assisted, Posterior cingulate, Female, Neurology (clinical), Nerve Net, Cognition Disorders, Psychology, Functional magnetic resonance imaging, Neuroscience, Psychomotor Performance, Stroop effect
Abstract

To better understand the effects of short-term computer-based cognitive rehabilitation (cCR) on cognitive performances and default mode network (DMN) intrinsic functional connectivity (FC) in cognitively impaired relapsing remitting (RR) multiple sclerosis (MS) patients. Eighteen cognitively impaired RRMS patients underwent neuropsychological evaluation by the Rao's brief repeatable battery and resting-state functional magnetic resonance imaging to evaluate FC of the DMN before and after a short-term (8 weeks, twice a week) cCR. A control group of 14 cognitively impaired RRMS patients was assigned to an aspecific cognitive training (aCT), and underwent the same study protocol. Correlations between DMN and cognitive performances were also tested. After cCR, there was a significant improvement of the following tests: SDMT (p < 0.01), PASAT 3" (p < 0.00), PASAT 2" (p < 0.03), SRT-D (p < 0.02), and 10/36 SPART-D (p < 0.04); as well as a significant increase of the FC of the DMN in the posterior cingulate cortex (PCC) and bilateral inferior parietal cortex (IPC). After cCR, a significant negative correlation between Stroop Color-Word Interference Test and FC in the PCC emerged. After aCT, the control group did not show any significant effect either on FC or neuropsychological tests. No significant differences were found in brain volumes and lesion load in both groups when comparing data acquired at baseline and after cCR or aCT. In cognitively impaired RRMS patients, cCR improves cognitive performances (i.e., processing speed and visual and verbal sustained memory), and increases FC in the PCC and IPC of the DMN. This exploratory study suggests that cCR may induce adaptive cortical reorganization favoring better cognitive performances, thus strengthening the value of cognitive exercise in the general perspective of building either cognitive or brain reserve.

Published
2015

42. The THRombolysis and STatins (THRaST) study

Author

Giampiero Galletti, Rinaldo M. Colombo, Vincenzo Di Lazzaro, Maria Concetta Altavista, Umberto Scoditti, Daniele Orrico, Maria Sessa, Gaetano Procaccianti, Massimo Del Sette, Manuel Cappellari, Fabio Brusaferri, Giuseppe Moretto, Giuseppe Martini, Gabriele Greco, Serena Monaco, Alessandro Adami, Andrea Zini, Fabio Chiodo-Grandi, Claudio Grassa, Paolo Bovi, Maria Guarino, Domenico Consoli, Anna Cavallini, Maria Vittoria Calloni, Mauro Zampolini, Tiziana Tassinari, Simone Beretta, Francesco Federico, Danilo Toni, Luigi Maria Specchio, Maurizio Paciaroni, Maurizia Rasura, Carlo Gandolfo, Simona Marcheselli, Armando Mancini, Alessandro Pezzini, Marco Sparaco, Bruno Passarella, Maurizio Melis, Giorgio Silvestrelli, Rossella Sciolla, Mauro Furlan, Giovanni Orlandi, L. Adobbati, Luigi Bettoni, Patrizia Nencini, Maria Roberta Bongioanni, Cappellari, M, Bovi, P, Moretto, G, Zini, A, Nencini, P, Sessa, M, Furlan, M, Pezzini, A, Orlandi, G, Paciaroni, M, Tassinari, T, Procaccianti, G, Di Lazzaro, V, Bettoni, L, Gandolfo, C, Silvestrelli, G, Rasura, M, Martini, G, Melis, M, Calloni, M, Chiodo Grandi, F, Beretta, S, Guarino, M, Altavista, M, Marcheselli, S, Galletti, G, Adobbati, L, Del Sette, M, Mancini, A, Orrico, D, Monaco, S, Cavallini, A, Sciolla, R, Federico, F, Scoditti, U, Brusaferri, F, Grassa, C, Specchio, L, Bongioanni, M, Sparaco, M, Zampolini, M, Greco, G, Colombo, R, Passarella, B, Adami, A, Consoli, D, and Toni, D

Subjects
Male, Multivariate analysis, Time Factors, medicine.medical_treatment, Severity of Illness Index, non presente, Retrospective Studie, Modified Rankin Scale, Outcome Assessment, Health Care, 80 and over, Prospective Studies, Multivariate Analysi, Stroke, Aged, 80 and over, Neurologic Examination, Fibrinolytic Agent, Thrombolysis, Middle Aged, stroke, X-Ray Computed, Tissue Plasminogen Activator, Cardiology, Female, Human, medicine.medical_specialty, thrombolysis, Tomography Scanners, X-Ray Computed, Logistic Model, Time Factor, Article, Outcome Assessment (Health Care), Arts and Humanities (miscellaneous), Fibrinolytic Agents, Internal medicine, medicine, Humans, cardiovascular diseases, Aged, Retrospective Studies, Intracerebral hemorrhage, Tomography Scanners, business.industry, Odds ratio, medicine.disease, Confidence interval, Surgery, Prospective Studie, Logistic Models, Multicenter study, Multivariate Analysis, Hydroxymethylglutaryl-CoA Reductase Inhibitor, Neurology (clinical), Hydroxymethylglutaryl-CoA Reductase Inhibitors, business
Abstract

Objective: To assess the impact on stroke outcome of statin use in the acute phase after IV thrombolysis. Methods: Multicenter study on prospectively collected data of 2,072 stroke patients treated with IV thrombolysis. Outcome measures of efficacy were neurologic improvement (NIH Stroke Scale [NIHSS] ≤ 4 points from baseline or NIHSS = 0) and major neurologic improvement (NIHSS ≤ 8 points from baseline or NIHSS = 0) at 7 days and favorable (modified Rankin Scale [mRS] ≤ 2) and excellent functional outcome (mRS ≤ 1) at 3 months. Outcome measures of safety were 7-day neurologic deterioration (NIHSS ≥ 4 points from baseline or death), symptomatic intracerebral hemorrhage type 2 with NIHSS ≥ 4 points from baseline or death within 36 hours, and 3-month death. Results: Adjusted multivariate analysis showed that statin use in the acute phase was associated with neurologic improvement (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.26-2.25; p < 0.001), major neurologic improvement (OR 1.43, 95% CI 1.11-1.85; p = 0.006), favorable functional outcome (OR 1.63, 95% CI 1.18-2.26; p = 0.003), and a reduced risk of neurologic deterioration (OR: 0.31, 95% CI 0.19-0.53; p < 0.001) and death (OR 0.48, 95% CI 0.28-0.82; p = 0.007). Conclusion: Statin use in the acute phase of stroke after IV thrombolysis may positively influence short- and long-term outcome. © 2013 American Academy of Neurology.

Published
2013

43. Dermatological Neoplastic Diseases Complicating Treatment with Monoclonal Antibodies for Multiple Sclerosis.

Author

Bile F, Sparaco M, Ruocco E, Miele G, Maida E, Vele R, Mele D, Bonavita S, and Lavorgna L

Abstract

Background: Over the past 20 years, the treatment scenario of multiple sclerosis (MS) has radically changed, and an ever-increasing number of disease-modifying treatments has emerged. Among high-efficacy treatment agents, monoclonal antibodies (mAbs) have become a mainstay in a MS patient's treatment due to their targeted mechanism, high efficacy, and favorable risk profile. The latter varies from drug to drug and a skin cancer warning has emerged with sphingosine 1-phosphate receptor inhibitors. Several cases of skin malignancy in people with MS (pwMS) undergoing therapy with mAbs have also been described, but dermatological follow-up is not currently indicated. Objectives: The aim of this review is to investigate cases of cutaneous malignancy during mAb therapy and to explore possible pathophysiological mechanisms to evaluate the potential need for regular dermatological follow-ups in pwMS treated with mAbs. Methods: A literature search for original articles and reviews in PubMed was conducted with no date restrictions. Results: A total of 1019 results were retrieved. Duplicates were removed using Endnote and manually. Only peer-reviewed studies published in English were considered for inclusion. At the end of these screening procedures, 54 studies published between 2001 and 2024 that met the objectives of this review were selected and reported. Conclusions: The available data do not show a clear link between monoclonal antibody (mAb) treatment in pwMS and the risk of skin cancer. At present, these treatments remain contraindicated for people with cancer. Dermatological screening is advisable before starting mAb treatment in pwMS, and subsequent follow-ups should be individualized according to each patient's risk profile.

Published
2024
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44. Identifying definite patterns of unmet needs in patients with multiple sclerosis using unsupervised machine learning.

Author

Maida E, Abbadessa G, Cocco E, Valentino P, Lerede A, Frau J, Miele G, Bile F, Vercellino M, Patti F, Borriello G, Cavalla P, Sparaco M, Lavorgna L, and Bonavita S

Subjects
Humans, Male, Female, Cross-Sectional Studies, Middle Aged, Adult, Health Services Needs and Demand, Surveys and Questionnaires, Needs Assessment, Cluster Analysis, Health Services Accessibility statistics & numerical data, Unsupervised Machine Learning, Multiple Sclerosis diagnosis, Multiple Sclerosis therapy
Abstract

Introduction: People with multiple sclerosis (PwMS) exhibit a spectrum of needs that extend beyond solely disease-related determinants. Investigating unmet needs from the patient perspective may address daily difficulties and optimize care. Our aim was to identify patterns of unmet needs among PwMS and their determinants., Methods: We conducted a cross-sectional multicentre study. Data were collected through an anonymous, self-administered online form. To cluster PwMS according to their main unmet needs, we performed agglomerative hierarchical clustering algorithm. Principal component analysis (PCA) was applied to visualize cluster distribution. Pairwise comparisons were used to evaluate demographics and clinical distribution among clusters., Results: Out of 1764 mailed questionnaires, we received 690 responses. Access to primary care was the main contributor to the overall unmet need burden. Four patterns were identified: cluster C1, 'information-seekers with few unmet needs'; cluster C2, 'high unmet needs'; cluster C3, 'socially and assistance-dependent'; cluster C4, 'self-sufficient with few unmet needs'. PCA identified two main components in determining the patterns: the 'public sphere' (access to information and care) and the 'private sphere' (need for assistance and social life). Older age, lower education, longer disease duration and higher disability characterized clusters with more unmet needs in the private sphere. However, demographic and clinical factors failed in explaining the four identified patterns., Conclusion: Our study identified four unmet need patterns among PwMS, emphasizing the importance of personalized care. While clinical and demographic factors provide some insight, additional variables warrant further investigation to fully understand unmet needs in PwMS., (© 2024. The Author(s).)

Published
2024
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45. ChatGPT vs. neurologists: a cross-sectional study investigating preference, satisfaction ratings and perceived empathy in responses among people living with multiple sclerosis.

Author

Maida E, Moccia M, Palladino R, Borriello G, Affinito G, Clerico M, Repice AM, Di Sapio A, Iodice R, Spiezia AL, Sparaco M, Miele G, Bile F, Scandurra C, Ferraro D, Stromillo ML, Docimo R, De Martino A, Mancinelli L, Abbadessa G, Smolik K, Lorusso L, Leone M, Leveraro E, Lauro F, Trojsi F, Streito LM, Gabriele F, Marinelli F, Ianniello A, De Santis F, Foschi M, De Stefano N, Morra VB, Bisecco A, Coghe G, Cocco E, Romoli M, Corea F, Leocani L, Frau J, Sacco S, Inglese M, Carotenuto A, Lanzillo R, Padovani A, Triassi M, Bonavita S, and Lavorgna L

Subjects
Adult, Female, Humans, Male, Middle Aged, Cross-Sectional Studies, Patient Preference, Patient Satisfaction, Personal Satisfaction, Physician-Patient Relations, Empathy physiology, Multiple Sclerosis psychology, Neurologists psychology, Artificial Intelligence
Abstract

Background: ChatGPT is an open-source natural language processing software that replies to users' queries. We conducted a cross-sectional study to assess people living with Multiple Sclerosis' (PwMS) preferences, satisfaction, and empathy toward two alternate responses to four frequently-asked questions, one authored by a group of neurologists, the other by ChatGPT., Methods: An online form was sent through digital communication platforms. PwMS were blind to the author of each response and were asked to express their preference for each alternate response to the four questions. The overall satisfaction was assessed using a Likert scale (1-5); the Consultation and Relational Empathy scale was employed to assess perceived empathy., Results: We included 1133 PwMS (age, 45.26 ± 11.50 years; females, 68.49%). ChatGPT's responses showed significantly higher empathy scores (Coeff = 1.38; 95% CI = 0.65, 2.11; p > z < 0.01), when compared with neurologists' responses. No association was found between ChatGPT' responses and mean satisfaction (Coeff = 0.03; 95% CI = - 0.01, 0.07; p = 0.157). College graduate, when compared with high school education responder, had significantly lower likelihood to prefer ChatGPT response (IRR = 0.87; 95% CI = 0.79, 0.95; p < 0.01)., Conclusions: ChatGPT-authored responses provided higher empathy than neurologists. Although AI holds potential, physicians should prepare to interact with increasingly digitized patients and guide them on responsible AI use. Future development should consider tailoring AIs' responses to individual characteristics. Within the progressive digitalization of the population, ChatGPT could emerge as a helpful support in healthcare management rather than an alternative., (© 2024. The Author(s).)

Published
2024
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46. Clinical implications for the association of psoriasis and multiple sclerosis: an observational study.

Author

Miele G, Sparaco M, Maida E, Bile F, Lavorgna L, Bonavita S, and Ruocco E

Abstract

Background: Multiple sclerosis (MS) and psoriasis (PsO) are distinct chronic autoimmune conditions with varying impacts on patients' lives. While the co-occurrence of MS and PsO has been reported, the underlying pathogenic link remains unclear. This study aimed to investigate the prevalence of PsO in a MS outpatient clinic population and explore the potential interplay between these conditions., Methods: 316 MS patients who had at least one visit at our MS center in the last year, were selected from our outpatient MS Clinic electronic database and were e-mailed in August 2023 and inquired about a previous diagnosis of PsO. Demographic and MS history data were retrospectively gathered for two groups: MS patients without and with PsO. Information about MS phenotype, Expanded Disability Status Scale (EDSS) score at the diagnosis and at last follow-up, disease modifying therapy (DMT) were collected retrospectively from our MS data set. PsO diagnosis was confirmed by an experienced dermatologist and severity was assessed with the Psoriasis Area and Severity Index (PASI)., Results: Among 253 respondents, 5.85% reported a PsO diagnosis that was confirmed after the dermatological evaluation Among patients with psoriasis 66.67% had progressive course of MS (p = 0.032) and the onset of PsO typically occurred after MS diagnosis. 9 out 15 patients had a PASI score of 0 and 6 are currently undergoing treatment with an anti-CD20 therapy. Notably, a subset of our patients were on anti-CD20 therapy and did not experience a worsening of dermatological symptoms., Discussion and Conclusion: The prevalence of PsO in our outpatient MS population aligns with previous studies. Treatment approaches should be tailored to individual patient needs, emphasizing collaboration between neurologists and dermatologists. Medications like dimethyl fumarate, effective in both conditions, could be considered. The data from our study also suggest that anti-CD20 therapy may be a viable option for some patients with concurrent MS and mild PsO, without a significant worsening of dermatological symptoms. Further research is needed to elucidate the complex relationship between MS and PsO and to develop more effective therapeutic strategies for patients with both conditions., (© 2024. The Author(s).)

Published
2024
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47. Vitamin D Supplementation: Effect on Cytokine Profile in Multiple Sclerosis.

Author

Sparaco M and Bonavita S

Abstract

Vitamin D is known for its role in modulating calcium and phosphate homeostasis and is implicated both in bone mineralization and immune system regulation. The immune-modulatory role of vitamin D and its impact on multiple sclerosis (MS) courses are still debated. The aim of this review was to check the effect of vitamin D supplementation on cytokine profile regulation in people with MS. A significant increase in serum concentrations of interleukin (IL)-10 and Transforming growth factor (TGF)-β1 after vitamin D supplementation was demonstrated in most studies, with some of them reporting a reduction in disability scores after vitamin D supplementation and an inverse correlation between IL-10 levels and disability. The effect of vitamin D on the serum levels of IL-17 and IL-6 was controversial; different results across studies could be explained by a variability in the treatment duration, route, and frequency of administration, as well as the dosage of vitamin D supplementation, responses to vitamin D treatment and the serum levels reached with supplementation, including the methods used for cytokine analysis and the different cell types investigated, the MS phenotype, the disease phase (active vs. non-active) and duration, and concomitant treatment with disease-modifying therapies. Nevertheless, the significant increase in the serum concentrations of IL-10 and TGF-β1, demonstrated in most studies, suggests an anti-inflammatory effect of vitamin D supplementation.

Published
2024
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48. Validation of the swallowing disturbance questionnaire in people with multiple sclerosis.

Author

Sparaco M, Maida E, Bile F, Vele R, Lavorgna L, Miele G, and Bonavita S

Subjects
Humans, Female, Adult, Male, Deglutition, Reproducibility of Results, Surveys and Questionnaires, Multiple Sclerosis complications, Multiple Sclerosis diagnosis, Deglutition Disorders diagnosis, Deglutition Disorders etiology
Abstract

Background: The DYSPHAGIA IN MULTIPLE SCLEROSIS (DYMUS) questionnaire is the only specific tool developed to screen for dysphagia in people with Multiple Sclerosis (pwMS). However, some limitations of DYMUS could potentially be addressed by the SWALLOWING DISTURBANCE QUESTIONNAIRE (SDQ), which has not yet been validated in pwMS. The objective of this study was to translate and validate the SDQ into the Italian language for use in pwMS to detect swallowing disturbances., Methods: We translated the SDQ into Italian and adapted it for use in Italian pwMS. PwMS aged > 18 years, assessed for disability using the Expanded Disability Status Scale (EDSS), completed the SDQ and DYMUS questionnaires and performed the 3-OUNCE WATER SWALLOW TEST (WST). Clinical and demographic data were collected for each patient. The Italian version of the SDQ was retested after 30 days., Results: A total of 84 pwMS were recruited for the study, consisting of 73.8 % women and 48.8 % with a relapsing-remitting form of MS. The mean age of participants was 44.5 years (SD: ±12.46), with a mean disease duration of 17 years (SD: ±10.27), and a median EDSS of 4 (range 1.5-7.5). The Cronbach's alpha for SDQ (to assess internal consistency) was 0.902, which increased to 0.908 after the elimination of item 15, resulting in the SDQ composed of 14 items. ROC analysis demonstrated good accuracy of the 14-item SDQ in pwMS (AUC: 0.811). By dividing the 14-item SDQ score into quartiles, three risk levels for dysphagia were identified: low (score 1-3), intermediate (score 4-8), and high (score ≥9). 14-item SDQ scores significantly correlated with DYMUS (r = 0.820; p<0.0001) and with EDSS (r = 0.541; p<0.0001). PwMS who reported dysphagia had a significantly higher mean 14-item SDQ score (8.27 ± SD 8.15) compared to those without swallowing problems (2.77 ± SD 4.25; p = 0.003). Additionally, pwMS with a positive WST had a significantly higher mean 14-item SDQ score (10.17 ± SD 8.96) than those with a negative WST (2.96 ± SD 3.93; p = 0.02). The Intraclass Correlation Coefficient for the retest, calculated on 48 pwMS in a stable phase of the disease, was 0.91 (95 % CI 0.84-0.95)., Conclusion: The 14-item SDQ has demonstrated high internal consistency, good accuracy, and reliability in pwMS, making it a readily applicable tool for investigating dysphagia in MS., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Published
2024
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49. Assisted Reproductive Technology and Disease Management in Infertile Women with Multiple Sclerosis.

Author

Sparaco M, Carbone L, Landi D, Ingrasciotta Y, Di Girolamo R, Vitturi G, Marfia GA, Alviggi C, and Bonavita S

Abstract

Multiple sclerosis (MS) predominantly affects women of fertile age. Various aspects of MS could impact on fertility, such as sexual dysfunction, endocrine alterations, autoimmune imbalances, and disease-modifying therapies (DMTs). The proportion of women with MS (wMS) requesting infertility management and assisted reproductive technology (ART) is increasing over time. In this review, we report on data regarding ART in wMS and address safety issues. We also discuss the clinical aspects to consider when planning a course of treatment for infertility, and provide updated recommendations to guide neurologists in the management of wMS undergoing ART, with the goal of reducing the risk of disease activation after this procedure. According to most studies, there is an increase in relapse rate and magnetic resonance imaging activity after ART. Therefore, to reduce the risk of relapse, ART should be considered in wMS with stable disease. In wMS, especially those with high disease activity, fertility issues should be discussed early as the choice of DMT, and fertility preservation strategies might be proposed in selected cases to ensure both disease control and a safe pregnancy. For patients with stable disease taking DMTs compatible with pregnancy, treatment should not be interrupted before ART. If the ongoing therapy is contraindicated in pregnancy, then it should be switched to a compatible therapy. Prior to beginning fertility treatments in wMS, it would be reasonable to assess vitamin D serum levels, thyroid function and its antibody serum levels; start folic acid supplementation; and ensure smoking and alcohol cessation, adequate sleep, and food hygiene. Cervico-vaginal swabs for Ureaplasma urealyticum, Mycoplasma hominis, and Chlamydia trachomatis, as well as serology for viral hepatitis, HIV, syphilis, and cytomegalovirus, should be performed. Steroids could be administered under specific indications. Although the available data do not clearly show a definite raised relapse risk associated with a specific ART protocol, it seems reasonably safe to prefer the use of gonadotropin-releasing hormone (GnRH) antagonists for ovarian stimulation. Close clinical and radiological monitoring is reasonably recommended, particularly after hormonal stimulation and in case of pregnancy failure., (© 2023. The Author(s).)

Published
2023
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50. Health related quality of life in the domain of physical activity predicts confirmed disability progression in people with relapsing remitting multiple sclerosis.

Author

Abbadessa G, Ponzano M, Bile F, Miele G, Signori A, Cepparulo S, Sparaco M, Signoriello E, Maniscalco GT, Lanzillo R, Morra VB, Lus G, Sormani MP, Lavorgna L, and Bonavita S

Subjects
Humans, Retrospective Studies, Prospective Studies, Quality of Life, Exercise, Multiple Sclerosis, Relapsing-Remitting diagnosis, Multiple Sclerosis
Abstract

Introduction: The diagnosis of the progression phase of Multiple Sclerosis (MS) is still retrospective and based on the objectivation of clinical disability accumulation., Objectives: To assess whether the Patient Reported Outcomes Measures (PROMs) scores predict the occurrence of disease progression within three years of follow-up., Methods: Observational prospective multicenter study. Stable Relapsing-Remitting MS (RRMS) patients were enrolled. At enrollment, patients completed the following PROMs: Beck Depression Inventory- II, The Treatment Satisfaction Questionnaire for Medications, Medical Outcomes Study Short Form 36- Item (SF36), Fatigue Severity Scale. EDSS was assessed at enrollment and three years later. The outcome measure was defined as the occurrence of confirmed disability progression (CDP) within three years of follow-up. Univariable and multivariable logistic regression models were performed to study the association between the final score of each test and the outcome., Results: SF36-Physical Functioning (SF36-PF) was the only independent variable associated with the outcome. The ROC curve analysis determined a score of 77.5 at SF36-PF as the cut-off point identifying patients experiencing CDP within three years of follow-up [AUC: 0.66 (95% CI: 0.56-0.75)]., Conclusions: RRMS patients scoring higher (>77.5) at SF36-PF subscale have a higher likelihood to experience CDP within the next three years., Competing Interests: Declaration of Competing Interest The authors declare no competing interests for this work., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Published
2023
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