The added value of spinal cord lesions to disability accrual in multiple sclerosis
Journal of Neurology,
Год журнала:
2023,
Номер
270(10), С. 4995 - 5003
Опубликована: Июнь 29, 2023
Abstract
Spinal
cord
MRI
is
not
routinely
performed
for
multiple
sclerosis
(MS)
monitoring.
Here,
we
explored
whether
spinal
activity
offers
any
added
value
over
brain
clinical
outcomes
prediction
in
MS.
This
a
retrospective,
monocentric
study
including
830
MS
patients
who
underwent
longitudinal
and
[median
follow-up
7
years
(range:
<
1–26)].
According
to
the
presence
(or
absence)
of
defined
as
at
least
one
new
T2
lesion
and/or
gadolinium
(Gd)
enhancing
lesion,
each
scan
was
classified
as:
(i)
negative/spinal
negative;
(ii)
positive/spinal
(iii)
positive;
(iv)
positive.
The
relationship
between
such
patterns
by
multivariable
regression
models.
When
compared
with
alone:
Gd
+
lesions
spine
alone
both
were
associated
an
increased
risk
concomitant
relapses
(OR
=
4.1,
95%
CI
2.4–7.1,
p
0.001
OR
4.9,
4.6–9.1,
0.001,
respectively);
locations
disability
worsening
(HR
1.4,
1.0–2.1,
0.05).
Beyond
activity,
are
worsening.
In
addition,
16.1%
presented
asymptomatic,
isolated
(Gd
lesions).
Monitoring
may
allow
more
accurate
stratification
treatment
optimization.
Язык: Английский
Prognostic relevance of MRI in early relapsing multiple sclerosis: ready to guide treatment decision making?
Therapeutic Advances in Neurological Disorders,
Год журнала:
2024,
Номер
17
Опубликована: Янв. 1, 2024
Magnetic
resonance
imaging
(MRI)
of
the
brain
and
spinal
cord
plays
a
crucial
role
in
diagnosis
monitoring
multiple
sclerosis
(MS).
There
is
conclusive
evidence
that
MRI
findings
early
disease
stages
also
provide
relevant
insight
into
individual
prognosis.
This
includes
prediction
activity
progression,
accumulation
long-term
disability
conversion
to
secondary
progressive
MS.
The
extent
which
these
should
influence
treatment
decisions
remains
subject
ongoing
discussion.
aim
this
review
present
discuss
current
knowledge
scientific
regarding
utility
at
MS
for
prognostic
classification
patients.
In
addition,
we
use
order
predict
response.
Finally,
propose
potential
approach
as
how
data
may
be
categorized
integrated
clinical
decision
making.
Язык: Английский
Spinal cord MRI activity in multiple sclerosis: Predictive value for relapses and impact on treatment decisions
Journal of the Neurological Sciences,
Год журнала:
2024,
Номер
462, С. 123057 - 123057
Опубликована: Май 25, 2024
Язык: Английский
Fertility, pregnancy and childbirth in women with multiple sclerosis: a population-based study from 2018 to 2020
Journal of Neurology Neurosurgery & Psychiatry,
Год журнала:
2023,
Номер
94(9), С. 689 - 697
Опубликована: Апрель 17, 2023
We
aim
to
evaluate
whether
fertility,
pregnancy,
delivery
and
breastfeeding
have
been
actually
improving
in
women
with
multiple
sclerosis
(MS),
compared
general
population,
relation
treatment
features.We
included
2018-2020
population-level
healthcare
data
on
MS
living
the
Campania
region
(Italy).
Fertility,
pregnancy
outcomes
were
obtained
from
Certificate
of
Delivery
Assistance;
was
collected
up
6
months
after
by
trained
personnel.Out
2748
childbearing
age,
151
delivered
156
babies.
Fertility
rate
0.58
live
births
per
woman
MS,
1.29
1.25
Italy.
Disease-modifying
(DMT)
continuation
during
associated
lower
birth
weight
(coeff
-107.09;
95%
CI
-207.91
-6.26;
p=0.03).
Exposure
DMTs
unknown/negative
effects
defects
(OR
8.88;
1.35
58.41;
p=0.02).
Birth
occurred
pregnancies
exposed
dimethyl
fumarate
(2/21
pregnancies),
fingolimod
(1/11
pregnancies)
natalizumab
(2/30
pregnancies).
After
delivery,
18.8%
escalated
DMT
efficacy,
while
50.7%
started
same/similar-efficacy
DMTs,
30.5%
did
not
receive
DMT.
The
probability
higher
who
treated
breastfeeding-safe
5.57;
1.09
28.55;
p=0.03).Fertility
remains
below
population.
Family
planning
subsequent
decisions
should
achieve
successful
outcomes,
controlling
disease
activity.
Язык: Английский
Spinal cord evaluation in multiple sclerosis: clinical and radiological associations, present and future
Brain Communications,
Год журнала:
2024,
Номер
6(6)
Опубликована: Янв. 1, 2024
Spinal
cord
disease
is
important
in
most
people
with
multiple
sclerosis,
but
assessment
remains
less
emphasized
patient
care,
basic
and
clinical
research
therapeutic
trials.
The
North
American
Imaging
Multiple
Sclerosis
Cord
Interest
Group
was
formed
to
determine
present
the
contemporary
landscape
of
sclerosis
spinal
evaluation,
further
existing
advanced
imaging
techniques,
foster
collaborative
work.
Important
themes
arose:
(i)
lesions
(differential
diagnosis,
association
course);
(ii)
radiological-pathological
associations;
(iii)
'critical'
lesions;
(iv)
topographical
model;
(v)
atrophy;
(vi)
automated
special
techniques.
Distinguishing
from
other
myelopathic
aetiology
increasingly
refined
by
serological
studies.
Post-mortem
findings
MRI
pathological
correlative
studies
demonstrate
MRI's
high
sensitivity
detecting
microstructural
demyelination
axonal
loss.
leptomeninges
include
immune
inflammatory
infiltrates,
some
B-cell
lymphoid-like
structures.
'Critical'
demyelinating
along
corticospinal
tracts
are
anatomically
consistent
may
be
disproportionately
associated
motor
progression.
model
implicates
as
an
area
where
threshold
impairment
associates
disability.
Progressive
atrophy
'silent'
progression
emerging
prognostic
biomarker.
Manual
complicated
rater
bias,
while
automation
(e.g.
Toolbox),
artificial
intelligence
reduce
this.
Collaborative
similar
groups
experts
combining
distinct
strengths
key
advancing
treatment
disease.
Язык: Английский
Utilização de Gadolínio nas Ressonâncias Magnéticas de Controlo em Doentes com Esclerose Múltipla: Recomendações Atuais
Acta Médica Portuguesa,
Год журнала:
2024,
Номер
37(1), С. 53 - 63
Опубликована: Янв. 3, 2024
A
esclerose
múltipla
é
a
doença
desmielinizante
do
sistema
nervoso
central
mais
frequente,
caracterizando-se
pelo
início
precoce
e
incapacidade
progressiva.
ressonância
magnética,
pela
elevada
sensibilidade
especificidade
na
deteção
de
lesões
desmielinizantes,
o
exame
complementar
útil
nesta
patologia,
sendo
administração
meios
contraste
com
gadolínio
um
importante
contributo
interpretação
imagiológica.
Embora
seja
imprescindível
no
âmbito
diagnóstico,
sua
utilização
por
rotina
monitorização
da
atividade
doença,
resposta
ao
tratamento
respetivas
complicações
controversa.
O
objetivo
deste
artigo
reunir
as
recomendações
atuais
relativas
à
seguimento
imagiológico
definir
protocolo
clínico
efetivo
seguro.
revisão
literatura
foi
conduzida
PubMed,
recorrendo
aos
termos
‘esclerose
múltipla’,
‘ressonância
magnética’
‘gadolínio’
ou
‘meio
contraste’.
Foram
selecionados
artigos
publicados
entre
janeiro
2013
2023
relativos
segurança
magnética
controlo
dos
doentes
adultos
diagnóstico
múltipla.
Apesar
nenhuma
consequência
biológica
clínica
ter
sido
inequivocamente
atribuída
retenção
cerebral
gadolínio,
que
reportada
maioritariamente
agentes
lineares,
autoridades
saúde
têm
vindo
recomendar
restrição
circunstâncias
clínicas
essenciais.
Na
múltipla,
subclínicas
captação
sem
tradução
em
novas/aumentadas
nas
sequências
ponderadas
T2
ocorre
raramente
impacto
decisão
terapêutica
questionável.
Por
outro
lado,
assume
uma
superior
diferencial
surtos
clínicos,
inflamatória
recente,
antes
após
nos
carga
lesional
difusas/confluentes
T2.
Contrariamente
rastreio
leucoencefalopatia
multifocal
progressiva,
síndrome
reconstituição
imunológica
beneficia
também
inclusão
gadolínio.
É
exequível
segura
exclusão
apesar
seu
adicional
específicas
devem
ser
conhecimento
articulado
neurologista
neurorradiologista.