Multiple Sclerosis Journal最新文献

Background: Multiple sclerosis (MS) slowly expanding lesions (SELs) are defined on magnetic resonance imaging (MRI) as contiguous regions of pre-existing focal non-contrast-enhancing T2 lesions with constant and concentric local expansion on conventional T1-weighted and T2-weighted images. SELs are associated with an increased risk of disability progression.

Methods: Myelin-related changes detected using myelin water fraction (MWF) and magnetisation transfer ratio (MTR) in SELs and T2 lesions were measured over 192 weeks in participants with relapsing MS.

Results: In participants with SELs (SEL+), SELs (MWF: 0.12 ± 0.03, MTR: 33.1 ± 3.6 pu) showed reduced myelin measures at baseline compared to T2 lesions (MWF: 0.13 ± 0.02, MTR: 35.1 ± 2.4 pu). In participants without SELs (SEL-), T2 lesions had higher myelin measures (MWF: 0.15 ± 0.02, MTR: 36.2 ± 2.0 pu) compared to T2 lesions in SEL+. Over 4 years, only SELs showed decreases in MWF (-11.4%). The percentage of abnormal voxels within normal-appearing white matter was higher in SEL+ and increased over time (SEL+ MWF Week 0: 0.56%, Week 192: 0.98%; SEL- MWF Week 0: 0.13%, Week 192: 0.25%).

Conclusion: Our results indicate progressive focal and global demyelination in SEL+ participants and that the presence of SELs might be a biomarker for participants with ongoing diffuse or smouldering inflammation within the whole brain.

Background: Although gastrointestinal (GI) adverse reactions (ARs) were commonly observed in registrational clinical trials of fumarate acid ester (FAE) drugs for the treatment of multiple sclerosis, serious GI reactions were uncommon.

Objective: The objective of the study is to describe the serious GI ARs that supported the post-market safety labeling change for FAE drugs.

Methods: Review of the FDA Adverse Events Reporting System (FAERS) database and published medical literature was conducted to identify cases of serious GI events in patients taking FAE drugs.

Results: Forty-nine cases of GI ARs with clinical events of perforation, ulceration, hemorrhage, or obstruction causally associated with FAE drug use were identified. Most cases occurred within 4 months of FAE drug initiation and required hospitalization. Ten of the cases required red blood cell transfusions, nine cases required surgical intervention, and two cases resulted in a fatal outcome.

Conclusion: Review of postmarketing reports supported the identification of a class association between FAE drugs and serious GI ARs. As these reactions have implications for prescribing decisions and patient management, a safety labeling change was issued to add serious GI reactions to the Warnings and Precautions section of the prescribing information for FAE drugs.

Background: Predicting treatment response and disease progression in multiple sclerosis (MS) is challenging. Treatment Response Scoring Systems (TRSS) are potentially useful, but their utility in patients receiving high-efficacy therapies and very high-efficacy therapies (HET/vHET) remains unclear.

Objective: This study aimed to evaluate the performance of TRSS in patients treated with HET/vHET.

Methods: We retrospectively studied MS patients treated with HET/vHET in an MS specialized centre. TRSS, including the Rio Score, modified Rio Score and MAGNIMS score, were applied to assess response to treatment. We evaluated the predictive value of the TRSS on disease activity and disability progression.

Results: TRSS effectively predicted disease activity and progression of disability in patients treated with HET/vHET. Patients with high TRSS scores at 12 months post-HET/vHET initiation had a significantly increased risk of relapses, new lesions on magnetic resonance imaging (MRI) scans and progression of disability at 4 years.

Discussion: Our findings highlight the importance of personalized treatment strategies in MS. TRSS are valuable tools for monitoring treatment response, guiding clinical decision-making and optimizing patient care.

Background: It is essential to exclude alternative diagnoses to diagnose multiple sclerosis (MS). However, detailed descriptions of alternative diagnoses in patients with suspected MS presenting with clinically isolated syndrome (CIS) are limited.

Objectives: To describe alternative diagnoses in patients presenting with CIS suggestive of MS.

Methods: We conducted a descriptive analysis of patients from the Barcelona CIS cohort including subjects under 50 years of age with a CIS suggestive of MS but later diagnosed with conditions other than MS. We collected clinical, biological, and radiological data, and described the alternative etiologies identified.

Results: Among 1468 patients in the Barcelona CIS cohort, 100 (6.8%) were diagnosed with an alternative condition. The most common neurological syndrome was optic neuritis (43.0%). Four patients (4.0%) had inflammatory-demyelinating lesions in at least two typical MS topographies on baseline magnetic resonance imaging (MRI), and 2 (2.0%) met the 2017 McDonald MS criteria. The most common etiologies were immune-mediated diseases (42.0%), especially MOGAD, followed by functional neurological disorders (15.0%) and vascular disease (10.0%).

Conclusion: The range of alternative diagnoses encountered during the MS diagnostic process highlights the need to rule out better explanations than MS. However, current MS diagnostic criteria effectively identify patients without MS in this context.

Background: Existing metrics of patient-reported cognitive difficulties in multiple sclerosis (MS) are lengthy, lack psychometric rigor, and/or fail to query prevalent expressive language deficits.

Objective: Develop a brief psychometrically robust metric of patient-reported cognitive deficits that includes language items; the Multiple Sclerosis Cognitive Scale (MSCS).

Method: Exploratory factor analysis (EFA) was conducted on 20 Perceived Deficits Questionnaire (PDQ) items plus five newly developed language questions in a large MS sample and matched respondents without neurologic disease. Independent confirmatory principal components analysis (PCA) assessed EFA factor structure. Reliability of the new scale and subscales, and relationships with objective cognitive impairment and cognitive change, were assessed.

Results: EFA in patients (n = 502) and controls (n = 350), item analyses, and confirmatory PCA in an independent sample (n = 361 patients; 150 controls) supported construction of an eight-item scale with four two-item subscales: Executive/Speed, Working Memory, Expressive Language, and Episodic Memory. Internal consistency and test-retest reliability were excellent for the total MSCS (α = 0.93, ICC = 0.95) and good for each subscale (α's:0.83-0.87; ICCs: 0.86-0.92). MSCS showed medium-size links to cross-sectional objective cognitive impairment (η² = .06) and cognitive change over time (η² = .07); the traditional PDQ did not (η²s = 0.01 and 0.02).

Conclusion: The brief MSCS is a psychometrically robust, reliable, and valid metric of patient-reported cognitive deficits in MS that holds promise for improving assessment of MS cognitive dysfunction.

Background: Previous studies have shown that people with multiple sclerosis (MS) had frequent healthcare visits up to 10 years before being diagnosed but with no information from magnetic resonance imaging (MRI) scans of the connection with the radiologically isolated syndrome (RIS).

Objective: To analyze healthcare use 3 years before the RIS diagnosis.

Methods: We examined healthcare usage before the first scan in RIS cases from 2010 to 2019. RIS subjects were identified from the French National MS observatory and compared to the general population (matched 10:1) and MS patients (matched 4:1).

Results: Among 482 RIS individuals, 223 (46.3%) were not linked to the healthcare resources database. The remaining RIS individuals (53.7%) had higher healthcare usage before their RIS diagnosis for issues related to neurology visits, headaches (odds ratio (OR): 3.34, confidence interval (CI): [2.00-5.57], p < 0.0001), and the use of anti-migraine drugs (OR: 2.61, CI: [1.37-4.99], p = 0.004) compared to MS.

Conclusion: Only about half of RIS patients had MS-selected healthcare resources, which allowed for data linkage. Those who did seek care before their RIS diagnosis were most commonly known for other neurological comorbidities. These findings do not support the idea of a systemic prodrome before RIS diagnosis.