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1.
Eur J Neurol ; 24(4): 631-637, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28220581

RESUMO

BACKGROUND AND PURPOSE: Receiving clear, complete and up-to-date information and having a satisfying relationship with the health professional (HP) are of primary importance for MS patients. Healthcare organization plays a key role in promoting an effective relationship and communication between patients and HPs. The present study aims to explore which care organization and service characteristics provided by Italian MS centres best predict patients' satisfaction with healthcare. METHODS: Eighty-one centres and 707 patients (502 women, mean age 40.5 years, SD 10.2; mean education 12.2 years, SD 3.6; time since diagnosis 5.9 years, SD 1.5) were included in the analysis. The care organization and service provided by each centre were evaluated in comparison with the National Institute for Health and Care Excellence (NICE) guidelines on management of MS. Patients' satisfaction with care was measured using the patient self-assessed questionnaire 'Comunicazione medico-paziente nella Sclerosi Multipla, revised' section 2 (COSM-R section 2). RESULTS: The clinical characteristics of patients significantly affected their satisfaction. A multivariate regression model showed that higher patients' satisfaction (COSM-R score) was inversely associated with hospital size (number of patients under care) (ß = -0.21, 95% confidence interval -0.35; -0.07) and directly associated with psychological interventions (ß = 2.44, 95% confidence interval 0.29; 4.59). CONCLUSIONS: Multiple sclerosis patients from larger hospitals are less satisfied with the information received and the relationship with HPs. Building an individualized relationship between patients and HPs and tailoring the communication of information improve patients' satisfaction. Such a goal is probably less likely to be accomplished in larger centres with many incoming patients. Moreover, when the centres also provide structured psychological interventions, the patients are more satisfied.


Assuntos
Atenção à Saúde/organização & administração , Esclerose Múltipla/terapia , Satisfação do Paciente , Relações Médico-Paciente , Adulto , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
2.
J Neural Transm (Vienna) ; 121(6): 633-42, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24398781

RESUMO

Many studies confirmed the efficacy and safety of continuous infusion of intrajejunal levodopa/carbidopa gel (CIILG) for advanced Parkinson's disease (PD). Although this treatment is widely used, definite inclusion/exclusion criteria do not exist. In this prospective open-label study, we evaluated the long-term outcome in 28 consecutive patients and sought to detect any predictive factor to identify the best candidates for CIILG therapy. The assessment was carried out routinely at baseline, after 6 months and every year with UPDRS III-IV, FOG Questionnaire, non-motor symptoms scale, PD questionnaire (PDQ-8), cognitive and psychiatric status evaluation (MMSE, FAB, NPI) and caregiver's quality of life. 17/28 patients reached the 24-month follow-up. A statistically significant beneficial effect was shown on motor complications in short- and long-term follow-up, also on axial symptoms like gait disturbances. A concomitant improvement in PDQ8 score was observed, with a parallel mild amelioration, but not significant, on Caregivers QoL. When classified according to their outcome on QoL, the only predictive positive factor was less severe at Neuropsychiatric Inventory (NPI) score at baseline. Considering the improvement in motor scores (duration of "off" period), the more advanced age was associated with a poorer outcome. Our results confirmed a sustained efficacy and safety in long-term follow-up and suggest that younger age at operation and absence or mild presence of psychiatric/behavioural symptoms could be considered valid predicting factors in selecting the best candidates for this efficacious therapy.


Assuntos
Antiparkinsonianos/uso terapêutico , Carbidopa/administração & dosagem , Levodopa/administração & dosagem , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/fisiopatologia , Seleção de Pacientes , Idoso , Amantadina/uso terapêutico , Apomorfina/administração & dosagem , Cuidadores/psicologia , Vias de Administração de Medicamentos , Combinação de Medicamentos , Sistemas de Liberação de Medicamentos , Feminino , Seguimentos , Humanos , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Inquéritos e Questionários , Resultado do Tratamento
3.
Neurol Sci ; 34(9): 1633-7, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23354606

RESUMO

Although it is still debated whether chronic cerebro-spinal venous insufficiency (CCSVI) plays a role in multiple sclerosis (MS) development, many patients underwent endovascular treatment (ET) of CCSVI. The objective of the study is to evaluate the outcome and safety of ET in Italian MS patients. Italian MS centers that are part of the Italian MS Study Group were all invited to participate to this retrospective study. A structured questionnaire was used to collect detailed clinical data before and after the ET. Data from 462 patients were collected in 33 centers. ET consisted of balloon dilatation (93 % of cases) or stent application. The mean follow-up duration after ET was 31 weeks. Mean EDSS remained unchanged after ET (5.2 vs. 4.9), 144 relapses occurred in 98/462 cases (21 %), mainly in RR-MS patients. Fifteen severe adverse events were recorded in 3.2 % of cases. Given the risk of severe adverse events and the lack of objective beneficial effects, our findings confirm that at present ET should not be recommended to patients with MS.


Assuntos
Encéfalo/irrigação sanguínea , Procedimentos Endovasculares/efeitos adversos , Esclerose Múltipla/cirurgia , Medula Espinal/irrigação sanguínea , Insuficiência Venosa/cirurgia , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Inquéritos e Questionários , Resultado do Tratamento , Insuficiência Venosa/complicações
4.
Int J Clin Pract ; 66(5): 504-14, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22512609

RESUMO

BACKGROUND: In the light of the new diagnostic criteria for multiple sclerosis (MS) and currently available early treatment, this study aimed to explore whether, and to what extent, disclosure of the diagnosis of MS or clinically isolated syndrome (CIS) affects patients' anxiety, mood and quality of life (QoL). METHODS: Eligible participants were all patients referred for the first time to the Neurological Unit who had manifested symptoms suggestive of MS for no more than 6 months. All patients were evaluated for (i) QoL (SEIQoL and MS-QoL54), (ii) Anxiety (STAI) and Depression (CMDI) on study inclusion (T0), 30 days after diagnosis disclosure (T30), and after 1 (T1y) and 2 (T2y) years' follow-up. RESULTS: Two hundred and twenty-nine patients were enrolled; 93 of these were unaware of their diagnosis. Patients who already knew their diagnosis (100 with CIS and 22 with MS) were excluded from the main analyses and used to perform control analyses. At the end of the screening, an MS diagnosis was disclosed to 18 of the 93 patients, whereas a CIS diagnosis was disclosed to 62 patients (12 patients received a diagnosis other than MS or CIS). Thirty days after diagnosis disclosure, irrespective of the diagnosis disclosed, both QoL and Anxiety and Depression were significantly rated as better compared to the start of screening, (p(s) < 0.03), and this improvement remained stable over the two annual follow-ups. However, as suggested by a significant 'Time' × 'Diagnosis' interaction with regard to both QoL and Anxiety and Depression (p(s) < 0.02), the effect of the disclosure in the short term differed depending on CIS or MS diagnosis. Specifically, on MSQoL, which is a health-related QoL scale, we found a statically significant improvement, immediately after the diagnosis disclosure, in both the MS and CIS groups (p(s) < 0.01). Differently, on SEIQoL, which is a non health-related QoL measure, and on the anxiety scale, we observed a statistically significant improvement only in the group which received a MS diagnosis (p(s) < 0.03). CONCLUSIONS: This first prospective study provides objective data showing that early disclosure of MS diagnosis improves both the patient's QoL and psychological well-being. In addition, the results seem to suggest that CIS disclosure does not lead to the same favourable effects.


Assuntos
Transtornos de Ansiedade/etiologia , Transtorno Depressivo/etiologia , Esclerose Múltipla/psicologia , Qualidade de Vida , Adolescente , Adulto , Revelação , Feminino , Humanos , Masculino , Estudos Prospectivos , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
5.
Mult Scler ; 18(6): 835-42, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22127896

RESUMO

BACKGROUND: Over recent years numerous patients with severe forms of multiple sclerosis (MS) refractory to conventional therapies have been treated with intense immunosuppression followed by autologous haematopoietic stem cell transplantation (AHSCT). The clinical outcome and the toxicity of AHSCT can be diverse, depending on the various types of conditioning protocols and on the disease phase. OBJECTIVES: To report the Italian experience on all the consecutive patients with MS treated with AHSCT with an intermediate intensity conditioning regimen, named BEAM/ATG, in the period from 1996 to 2008. METHODS: Clinical and magnetic resonance imaging outcomes of 74 patients were collected after a median follow-up period of 48.3 (range = 0.8-126) months. RESULTS: Two patients (2.7%) died from transplant-related causes. After 5 years, 66% of patients remained stable or improved. Among patients with a follow-up longer than 1 year, eight out of 25 subjects with a relapsing-remitting course (31%) had a 6-12 months confirmed Expanded Disability Status Scale improvement > 1 point after AHSCT as compared with one out of 36 (3%) patients with a secondary progressive disease course (p = 0.009). Among the 18 cases with a follow-up longer than 7 years, eight (44%) remained stable or had a sustained improvement while 10 (56%), after an initial period of stabilization or improvement with median duration of 3.5 years, showed a slow disability progression. CONCLUSIONS: This study shows that AHSCT with a BEAM/ATG conditioning regimen has a sustained effect in suppressing disease progression in aggressive MS cases unresponsive to conventional therapies. It can also cause a sustained clinical improvement, especially if treated subjects are still in the relapsing-remitting phase of the disease.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Esclerose Múltipla Crônica Progressiva/cirurgia , Esclerose Múltipla Recidivante-Remitente/cirurgia , Condicionamento Pré-Transplante/métodos , Adolescente , Adulto , Distribuição de Qui-Quadrado , Avaliação da Deficiência , Progressão da Doença , Intervalo Livre de Doença , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/mortalidade , Humanos , Itália , Estimativa de Kaplan-Meier , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Esclerose Múltipla Crônica Progressiva/diagnóstico , Esclerose Múltipla Crônica Progressiva/mortalidade , Esclerose Múltipla Recidivante-Remitente/diagnóstico , Esclerose Múltipla Recidivante-Remitente/mortalidade , Valor Preditivo dos Testes , Sistema de Registros , Índice de Gravidade de Doença , Fatores de Tempo , Condicionamento Pré-Transplante/efeitos adversos , Condicionamento Pré-Transplante/mortalidade , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
6.
Neurology ; 77(2): 145-50, 2011 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-21734184

RESUMO

OBJECTIVE: To assess the relationship between breastfeeding and risk of puerperal relapses in a large cohort of patients with multiple sclerosis (MS). METHODS: We prospectively followed-up pregnancies occurring between 2002 and 2008 in women with MS, recruited from 21 Italian MS centers, and gathered data on breastfeeding through a standardized interview. The risk of relapses after delivery was assessed using the Cox regression analysis. RESULTS: A total of 302 out of 423 pregnancies in 298 women resulted in full-term deliveries. Patients were followed up for at least 1 year after delivery. The time-dependent profile of the relapse rate before, during, and after pregnancy did not differ between patients who breastfed and patients who did not. In the multivariate analysis, adjusting for age at onset, age at pregnancy, disease duration, disability level, and relapses in the year prior to pregnancy and during pregnancy, treatment with disease-modifying drugs (DMDs), and exposure to toxics, the only significant predictors of postpartum relapses were relapses in the year before pregnancy (hazard ratio [HR] = 1.5; 95%confidence interval [CI] 1.3-1.9; p < 0.001) and during pregnancy (HR = 2.2; 95% CI 1.5-3.3; p < 0.001). CONCLUSIONS: In our sample, postpartum relapses were predicted only by relapses before and during pregnancy. Therefore, the reported association between breastfeeding and a lower risk of postpartum relapses may simply reflect different patient behavior, biased by the disease activity. Our results can assist neurologists facing the breastfeeding issue in mother counseling and shared decision-making. Especially, among patients with high risk of postpartum relapses, breastfeeding may not be feasible and early postpartum treatment should be an option.


Assuntos
Aleitamento Materno/efeitos adversos , Esclerose Múltipla/etiologia , Complicações na Gravidez/etiologia , Adulto , Aleitamento Materno/epidemiologia , Estudos de Coortes , Feminino , Humanos , Esclerose Múltipla/epidemiologia , Período Pós-Parto , Gravidez , Recidiva , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Adulto Jovem
7.
Mult Scler ; 17(8): 991-1001, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21502310

RESUMO

BACKGROUND: The precise relationships among quality of life, depression, fatigue and cognitive impairment in multiple sclerosis (MS) are complex and poorly understood. OBJECTIVE: To assess the effects of subcutaneous interferon beta-1a on quality of life, depression and fatigue over 3 years in the COGIMUS study, and to examine the relationship between these outcomes and baseline cognitive status. METHODS: COGIMUS was an observational 3-year trial assessing cognitive function in 459 patients with relapsing-remitting MS treated with subcutaneous interferon beta-1a. RESULTS: In total, 331 patients completed the study (168 received interferon beta-1a, 44 µg subcutaneously three times weekly, and 163 received interferon beta-1a, 22 µg subcutaneously three times weekly). Mean MS Quality of Life-54 (MSQoL-54) composite scores did not change over time. There were no significant differences between groups in MSQoL-54 composite scores when patients were grouped by treatment dose and baseline cognitive status. Mean (standard deviation) Hamilton Depression Rating Scale score decreased from 6.8 (4.9) at baseline to 5.8 (5.9) at year 3. Mean total Fatigue Impact Scale scores were low (<30) at all time points. CONCLUSION: Quality of life, depression and fatigue remained largely stable over 3 years; no effects of treatment dose or baseline cognitive status were found.


Assuntos
Depressão/tratamento farmacológico , Fadiga/tratamento farmacológico , Esclerose Múltipla Recidivante-Remitente/complicações , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Qualidade de Vida , Adjuvantes Imunológicos/administração & dosagem , Adulto , Idoso , Transtornos Cognitivos/tratamento farmacológico , Transtornos Cognitivos/etiologia , Depressão/etiologia , Fadiga/etiologia , Feminino , Humanos , Injeções Subcutâneas , Interferon beta-1a , Interferon beta/administração & dosagem , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/psicologia , Adulto Jovem
8.
Neurol Sci ; 32(2): 351-8, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21234775

RESUMO

Three years after the introduction of natalizumab (NA) therapy for the second line treatment of relapsing-remitting multiple sclerosis (MS), Italian MS centers critically reviewed the scientific literature and their own clinical experience. Natalizumab was shown to be highly efficacious in the treatment of MS. However, the risk of progressive multifocal leukoencephalopathy was confirmed and defined better. This article summarizes the MS-SIN Study Group recommendations on the use of NA in MS, with particular reference to the appropriate selection and monitoring of patients as well as to the management of adverse events.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Anticorpos Monoclonais Humanizados , Humanos , Leucoencefalopatia Multifocal Progressiva/induzido quimicamente , Natalizumab
9.
Neurol Sci ; 31 Suppl 3: 295-7, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20644975

RESUMO

At the end of 2006, a pharmacovigilance program on natalizumab was settled by the Italian Pharmaceutical Agency, and on January 2007, multiple sclerosis patients poorly responding to the immunomodulating therapies or with an aggressive clinical form of disease from onset initiated to be registered and to receive the medication. On February 2010, almost 3,000 cases have been treated with natalizumab. The drop-out rate is 10%. Almost 800 cases received cycles of natalizumab for more than 18 months. One case of PML was reported and other adverse events are similar to those described in phase III studies. The majority of cases remained stable, while in 25% of cases, an improvement of disability was documented.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Vigilância de Produtos Comercializados/tendências , Sistema de Registros , Adulto , Anticorpos Monoclonais Humanizados/efeitos adversos , Feminino , Humanos , Itália/epidemiologia , Masculino , Esclerose Múltipla/epidemiologia , Natalizumab , Sistema de Registros/estatística & dados numéricos
10.
Neurology ; 75(20): 1794-802, 2010 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-21079181

RESUMO

OBJECTIVE: To assess pregnancy and fetal outcomes after in utero exposure to interferon-ß (IFNß) in all pregnancies occurring in women with multiple sclerosis (MS) during the study period, with a specific focus on the risk of spontaneous abortion. METHODS: In this cohort study, data were gathered through a standardized, semi-structured interview. Patients who discontinued IFNß less than 4 weeks from conception (exposed) were compared with those who had discontinued the drug at least 4 weeks from conception or who were never treated (not exposed). Possible confounders were handled through multivariate analyses adjusted for propensity score (PS). RESULTS: We collected data on 396 pregnancies in 388 women, 88 classified as exposed (mean exposure 4.6 ± 5.8 weeks). IFNß exposure was not associated with an increased risk of spontaneous abortion (PS-adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 0.4 to 2.9, p = 0.88), although it was associated with both lower baby weight (PS-adjusted ß -113.8, p < 0.0001) and length (PS-adjusted ß -1.102, p < 0.0001). Proportion of spontaneous abortion in exposed patients fell within the range expected for the Italian population in the same period. IFNß exposure (PS-adjusted OR 2.11, 95% CI 1.18 to 3.78, p = 0.012) and cesarean delivery were the only predictors of preterm delivery. In the exposed group, we did not observe any significant fetal complications, malformations, or developmental abnormalities over a median follow-up of 2.1 years. CONCLUSIONS: Our findings point to the relative safety of IFNß exposure times of up to 4 weeks and can assist neurologists facing therapeutic decisions in women with MS with a pregnancy plan.


Assuntos
Aborto Espontâneo/induzido quimicamente , Interferon beta/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Aborto Espontâneo/etiologia , Aborto Espontâneo/fisiopatologia , Adulto , Estudos de Coortes , Feminino , Doenças Fetais/induzido quimicamente , Doenças Fetais/diagnóstico , Doenças Fetais/fisiopatologia , Peso Fetal/efeitos dos fármacos , Seguimentos , Humanos , Recém-Nascido , Interferon beta/efeitos adversos , Masculino , Esclerose Múltipla/complicações , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Prospectivos
11.
Neurology ; 75(7): 619-25, 2010 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-20702794

RESUMO

BACKGROUND: A neuroprotective effect of lithium in amyotrophic lateral sclerosis (ALS) has been recently reported. We performed a multicenter trial with lithium carbonate to assess its tolerability, safety, and efficacy in patients with ALS, comparing 2 different target blood levels (0.4-0.8 mEq/L, therapeutic group [TG], vs 0.2-0.4 mEq/L, subtherapeutic group [STG]). METHODS: The study was a multicenter, single-blind, randomized, dose-finding trial, conducted from May 2008 to November 2009 in 21 Italian ALS centers. The trial was registered with the public database of the Italian Agency for Drugs (http://oss-sper-clin.agenziafarmaco.it/) (EudraCT number 2008-001094-15). RESULTS: As of October 2009, a total of 171 patients had been enrolled, 87 randomized to the TG and 84 to the STG. The interim data analysis, performed per protocol, showed that 117 patients (68.4%) discontinued the study because of death/tracheotomy/severe disability, adverse events (AEs)/serious AEs (SAEs), or lack of efficacy. The Data Monitoring Committee recommended stopping the trial on November 2, 2009. CONCLUSIONS: Lithium was not well-tolerated in this cohort of patients with ALS, even at subtherapeutic doses. The 2 doses were equivalent in terms of survival/severe disability and functional data. The relatively high frequency of AEs/SAEs and the reduced tolerability of lithium raised serious doubts about its safety in ALS. CLASSIFICATION OF EVIDENCE: The study provides Class II evidence that therapeutic (0.4-0.8 mEq/L) vs subtherapeutic (0.2-0.4 mEq/L) lithium carbonate did not differ in the primary outcome of efficacy (survival/loss of autonomy) in ALS. Both target levels led to dropouts in more than 30% of participants due to patient-perceived lack of efficacy and AEs.


Assuntos
Esclerose Lateral Amiotrófica/tratamento farmacológico , Inibidores Enzimáticos/uso terapêutico , Carbonato de Lítio/uso terapêutico , Adolescente , Adulto , Idoso , Esclerose Lateral Amiotrófica/sangue , Esclerose Lateral Amiotrófica/mortalidade , Relação Dose-Resposta a Droga , Inibidores Enzimáticos/sangue , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Carbonato de Lítio/sangue , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
Eur J Neurol ; 17(7): 930-8, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20192980

RESUMO

BACKGROUND: Polymorphisms of the interleukin-1 (IL-1) gene family have been proposed as potential variants for different diseases including multiple sclerosis (MS). With respect to MS, IL-1 beta (-511 C/T; rs16944), IL-1 beta (+3954 C/T; rs1143634), IL-1 alpha (-889 C/T; rs1800587), IL-1 alpha (+4845 G/T; rs17561), and the variable number of tandem repeats in intron 2 of the IL-1 receptor antagonist (IL-1RN) gene polymorphisms have been studied in different ethnic groups, leading to conflicting results. METHODS: This study investigates the association between IL-1 genes and MS by means of 70 markers spanning the 1.1 Mb region where the IL-1 genes map and exploring both the linkage disequilibrium (LD) and the haplotype structure in a case-control design including 410 subjects (160 patients and 250 controls). RESULTS: From allelic/genotypic tests, significant association was found for several polymorphisms including the IL-1 beta (-511 C/T) variant (P-adjusted = 4.5 x 10(-4)) and some polymorphisms around the IL-1RN gene. The 'block-step' pattern obtained from both the LD map and pairwise analysis identifies four LD regions. Region 1 showed a significant association with MS for the global test (P < 0.0001) and haplotypes containing the IL-1 beta (-511 C/T) variant still demonstrate highly significant association with disease (P-value range: 9.9 x 10(-5) to 0.02). CONCLUSIONS: Our findings support the existence of a causative variant for MS within this candidate region in a representative Italian Caucasian population and, in particular, the role of the IL-1 beta (-511 C/T) variant warrants further investigation.


Assuntos
Predisposição Genética para Doença/genética , Interleucina-1/genética , Família Multigênica/genética , Esclerose Múltipla/genética , Esclerose Múltipla/imunologia , Polimorfismo de Nucleotídeo Único/genética , Adulto , Estudos de Casos e Controles , Mapeamento Cromossômico , Feminino , Predisposição Genética para Doença/etnologia , Haplótipos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/etnologia , População Branca
13.
Mult Scler ; 16(1): 68-77, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19995846
14.
Neurol Sci ; 30 Suppl 2: S163-5, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19882367

RESUMO

At the end of 2006 a country-based surveillance program on natalizumab therapy in multiple sclerosis was settled in Italy by a collaborative effort of the Italian Drug Agency (AIFA) and a group of experts and neurologists appointed by the National Society of Neurology (SIN). After 2 years, 1,818 patients are registered in the database. The majority of cases (88.6%) failed the therapy with beta interferon or glatiramer acetate and had relapses or accumulated disability during immunomodulating treatment, while 11.4% of patients enrolled in the surveillance study were not previously treated with immunomodulating therapies and had a rapidly evolving clinical course. Almost 10% of the patients treated with natalizumab interrupted, for various different reasons, the therapy. Treatment was well tolerated and side effects were similar to those reported in the registrative studies. The majority of treated cases are stable or ameliorated.


Assuntos
Anticorpos Monoclonais/efeitos adversos , Esclerose Múltipla/tratamento farmacológico , Vigilância de Produtos Comercializados , Adulto , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Itália , Imageamento por Ressonância Magnética , Masculino , Natalizumab , Pacientes Desistentes do Tratamento
15.
Mult Scler ; 15(7): 779-88, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19542262

RESUMO

BACKGROUND: Cognitive impairment is a common symptom of multiple sclerosis (MS), but the association between cognitive impairment and magnetic resonance imaging (MRI) disease measures in patients with relapsing-remitting (RR) MS is unclear. OBJECTIVES: To study the prevalence of cognitive impairment and its relation with MRI disease measures in mildly disabled patients with RRMS. METHODS: Patients aged 18-50 years with RRMS (McDonald criteria) and an Expanded Disability Status Scale (EDSS) score or=3 cognitive tests) was present in approximately 20% of all patients and in the subgroup who underwent MRI. T2 hyperintense and T1 hypointense lesion volumes were significantly higher in patients with cognitive impairment (defined as impaired performance on at least three tests of the Rao's battery) than those without. EDSS score was also significantly higher in cognitively impaired than in cognitively preserved patients. Disease duration, depression, and years in formal education did not differ significantly between cognitively impaired and cognitively preserved patients. T2 lesion volume, performance intelligence quotient, and age were significant predictors of cognitive impairment in this population. Weak correlations were found between performance on individual cognitive tests and specific MRI measures, with T1 and T2 lesion volumes correlating with performance on most cognitive tests. CONCLUSIONS: Cognitive impairment occurs in approximately one-fifth of mildly disabled patients with MS and is associated with specific MRI disease measures. Assessment of cognitive function at diagnosis could facilitate the identification of patients who may benefit from therapeutic intervention with disease-modifying therapies to prevent further lesion development.


Assuntos
Transtornos Cognitivos/diagnóstico , Avaliação da Deficiência , Imageamento por Ressonância Magnética , Esclerose Múltipla Recidivante-Remitente/psicologia , Exame Neurológico , Testes Neuropsicológicos , Adolescente , Adulto , Fatores Etários , Cognição , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Estudos Transversais , Feminino , Humanos , Fatores Imunológicos/uso terapêutico , Inteligência , Interferon beta/uso terapêutico , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/diagnóstico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Esclerose Múltipla Recidivante-Remitente/epidemiologia , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
16.
Mult Scler ; 15(5): 547-54, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19318509

RESUMO

BACKGROUND: Little is known about the involvement of matrix metalloproteinase-2 (MMP-2) and its tissue inhibitor TIMP-2 in multiple sclerosis (MS). OBJECTIVE: To elucidate the actual implication of MMP-2 and TIMP-2 in MS. METHODS: Cerebrospinal fluid (CSF) and serum levels of active MMP-2 and TIMP-2 were measured by activity assay system and ELISA, respectively, in 67 patients with relapsing-remitting MS (RRMS), categorized according clinical and magnetic resonance imaging (MRI), and in 129 controls. RESULTS: Cerebrospinal fluid and serum active MMP-2/TIMP-2 ratio mean values and an intrathecal active MMP-2 production were more increased in RRMS than in non-inflammatory conditions (P < 0.001, P < 0.05, and P < 0.0001, respectively) and in MRI inactive than in MRI active RRMS (P < 0.02, P < 0.01 and P < 0.001, respectively). An intrathecal synthesis of active MMP-2 was more frequent in RRMS than in inflammatory disorders (P < 0.01). Serum active MMP-2/TIMP-2 ratio and MS disease duration were positively correlated (P < 0.02). CONCLUSION: These findings suggest a potential role for MMP-2 activity in the termination of MS neuroinflammation related to remission of the disease and seem to indicate that serum MMP-2/TIMP-2 ratio may represent a useful biomarker for monitoring MS recovery phase.


Assuntos
Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Metaloproteinase 2 da Matriz/sangue , Metaloproteinase 2 da Matriz/líquido cefalorraquidiano , Esclerose Múltipla Recidivante-Remitente/sangue , Esclerose Múltipla Recidivante-Remitente/líquido cefalorraquidiano , Adulto , Ativação Enzimática , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/patologia , Indução de Remissão , Sensibilidade e Especificidade , Inibidor Tecidual de Metaloproteinase-2/sangue , Inibidor Tecidual de Metaloproteinase-2/líquido cefalorraquidiano
17.
Clin Neurophysiol ; 120(1): 174-80, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19022703

RESUMO

OBJECTIVE: To evaluate the after-effects of low frequency, sub-threshold repetitive Transcranial Magnetic Stimulation (rTMS) of primary motor cortex, on the excitability of Blink Reflex (BR) in healthy subjects. METHODS: The BR recovery cycle was carried out in 10 healthy volunteers in basal conditions, immediately after rTMS (30s), 15 and 60min later. A paired electric supraorbital stimulus paradigm with inter-stimulus intervals (ISI) of 100-600-1000-1500ms was used. The "real" rTMS consisted of a 200 stimuli long train delivered at 1Hz and intensity 80% of rest Motor Threshold of the FDI muscle, using a focal coil applied over the primary motor cortex region. The basal BR recovery cycle was also compared with that obtained after a "sham" rTMS. RESULTS: The recovery of the R2 component of the BR was significantly suppressed 30s after rTMS. This effect was also observed at 15min, though of lower magnitude and only at long ISIs (1000-1500ms). No significant effect on R2 recovery was observed 60min after real rTMS as well as after sham rTMS. CONCLUSIONS: rTMS of motor cortex modulates the excitability of BR through its action on cortical excitability and on the cortical facilitatory drive to the brainstem reflex pathways. SIGNIFICANCE: Slow (1Hz), sub-threshold rTMS of motor cortex determines a long-lasting reduction of excitability of BR.


Assuntos
Piscadela/fisiologia , Potencial Evocado Motor/fisiologia , Córtex Motor/fisiologia , Estimulação Magnética Transcraniana , Adulto , Mapeamento Encefálico , Estimulação Elétrica/métodos , Eletromiografia , Feminino , Lateralidade Funcional/fisiologia , Humanos , Masculino , Músculo Esquelético/fisiologia , Vias Neurais/fisiologia , Tempo de Reação/fisiologia , Adulto Jovem
18.
Mult Scler ; 14(4): 446-54, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18208868

RESUMO

Cerebrospinal fluid (CSF) concentrations of soluble human leukocyte antigen class I (HLA-I) (sHLA-I), HLA-G (sHLA-G) and anti-apoptotic Fas (sFas) molecules were measured by enzyme linked immunosorbent assay technique in 65 relapsing-remitting (RR) MS patients classified according to clinical and magnetic resonance imaging (MRI) evidence of disease activity. Sixty-four patients with other inflammatory neurological disorders (OIND) and 64 subjects with noninflammatory neurological disorders (NIND) served as controls. CSF concentrations were higher in RRMS and in OIND than in NIND patients for sHLA-I (P < 0.02), greater in RRMS than in OIND and in NIND for sHLA-G (P < 0.001 and P < 0.01, respectively) and lower in RRMS than in OIND and in NIND for sFas (P < 0.001 and P < 0.02, respectively). An increase in CSF levels was identified in MRI active RRMS for sHLA-I (P < 0.01) and in MRI stable RRMS for sHLA-G (P < 0.01), whereas CSF values of sFas were decreased in RRMS without Gd-enhancing lesions (P < 0.02). In MS patients with no evidence of MRI disease activity, a trend towards an inverse correlation was found between CSF concentrations of sHLA-G and sHLA-I and between CSF levels of sHLA-G and sFas. Our results indicate that enhanced CSF levels of sHLA-I antigens most likely represent an indirect manifestation of intrathecal immune activation taking place in neuroinflammation. Conversely, reciprocal fluctuations in CSF sHLA-G and sFas levels observed when MRI disease activity resolved suggest that sHLA-G could play an immunomodulatory role in MS through Fas/FasL-mediated mechanisms.


Assuntos
Antígenos HLA/líquido cefalorraquidiano , Antígenos de Histocompatibilidade Classe I/líquido cefalorraquidiano , Imageamento por Ressonância Magnética , Esclerose Múltipla Recidivante-Remitente/líquido cefalorraquidiano , Esclerose Múltipla Recidivante-Remitente/patologia , Índice de Gravidade de Doença , Receptor fas/líquido cefalorraquidiano , Adulto , Apoptose/imunologia , Ensaio de Imunoadsorção Enzimática , Feminino , Citometria de Fluxo , Antígenos HLA-G , Humanos , Masculino , Pessoa de Meia-Idade , Neurite (Inflamação)/líquido cefalorraquidiano , Neurite (Inflamação)/patologia
19.
J Neurol ; 254(12): 1642-8, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18008026

RESUMO

BACKGROUND: Epidemiological studies on the distribution of multiple sclerosis (MS) conducted in the Mediterranean area in the last two decades have disclosed a significant increase in frequency of the disease, indicating caution when a latitude-related model of MS is accepted. Previous descriptive surveys in the province of Ferrara, northern Italy, carried out by our own epidemiological research group, have established that this area is at high risk for MS. OBJECTIVE: To confirm the above assumption and to update MS frequency estimates in this area. DESIGN AND SETTING: We conducted a community-based intensive prevalence and incidence study, by adopting a complete enumeration approach. RESULTS: On December 31, 2004, 423 patients (300 women and 123 men) suffering from definite or probable MS (Poser's criteria) living in the province of Ferrara, yielded a crude prevalence rate of 120.93 (95 % CI, 110.05-134.23) per 100,000, 164.26 for women and 73.59 for men. The average incidence from 1990 to 2003 was 4.35 per 100,000 (95 % CI, 3.77-4.99), 5.91 for women and 2.63 for men. The incidence rate,which was relatively stable during the previous 25 years (1965-1989) with a mean rate of 2.3 per 100,000, increased to a value of 3.39 per 100,000 in the period 1990-1994, 4.09 per 100,000 in the period 1995-1999 and 3.84 per 100,000 in the period 2000-2003. CONCLUSIONS: These results confirm that in Ferrara MS occurs more frequently than suggested by the geographic- related distribution model and, based on other recent national surveys, support the view that northern Italy is a high-risk area for the disease. The marked increase in MS prevalence rate, in comparison with previous investigations, is in part due to the increasing survival of patients as a result of improved supportive care and the accumulation of new incidence cases owing to the reduction in diagnostic latency for better quality of neurological diagnostic procedures. The incidence in the province of Ferrara was found to slowly change with an incremental trend,which cannot only be attributed to improvements in diagnostic ability. Environmental risk factors in genetically predisposed people over time could be considered.


Assuntos
Estudos Epidemiológicos , Esclerose Múltipla/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos
20.
Mult Scler ; 12(1): 2-12, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16459714

RESUMO

The aim of this study was to provide further insight into the effective contribution of classical soluble HLA-A, B and C class Ia (sHLA-I) and non-classical soluble HLA-G class Ib (sHLA-G) molecules in immune dysregulation occurring in multiple sclerosis (MS). We evaluated by enzyme-linked immunosorbent assay (ELISA) technique intrathecal synthesis and cerebrospinal fluid (CSF) and serum levels of sHLA-I and sHLA-G in 69 relapsing-remitting (RR), 21 secondary progressive (SP) and 13 primary progressive (PP) MS patients stratified according to clinical and magnetic resonance imaging (MRI) evidence of disease activity. We also tested, as neurological controls, 91 patients with other inflammatory neurological disorders (OIND) and 92 with non-inflammatory neurological disorders (NIND). Eighty-two healthy volunteers served as further controls for sHLA-I and sHLA-G determinations. An intrathecal production of sHLA-I and sHLA-G detected by specific indexes was significantly more frequent in MS patients than in controls (P<0.01). An intrathecal synthesis of sHLA-I was prevalent in clinically (P<0.02) and MRI active (P<0.001) MS, whereas a CSF-restricted release of sHLA-G predominated in clinically (P<0.01) and MRI stable (P<0.001) MS. sHLA-I levels were low in the serum of clinically active (P<0.001) and high in the CSF of MRI active (P<0.01) MS. Conversely, sHLA-G concentrations were decreased in the serum of clinically stable MS (P<0.01) and increased in the CSF of MRI inactive MS (P<0.001). The trends towards a negative correlation observed between CSF and serum concentrations and intrathecal synthesis of sHLA-I and sHLA-G in patients without evidence of clinical and MRI activity confirmed that intrathecal production and fluctuations in CSF and serum concentrations of sHLA-I and sHLA-G were reciprocal in MS. Our results suggest that, in MS, a balance between classical sHLA-I and non-classical sHLA-G products modulating both MRI and clinical disease activity in opposite directions may exist.


Assuntos
Antígenos HLA/líquido cefalorraquidiano , Antígenos de Histocompatibilidade Classe I/líquido cefalorraquidiano , Esclerose Múltipla/líquido cefalorraquidiano , Esclerose Múltipla/imunologia , Medula Espinal/imunologia , Adulto , Progressão da Doença , Feminino , Antígenos HLA/biossíntese , Antígenos HLA/sangue , Antígenos HLA-G , Antígenos de Histocompatibilidade Classe I/biossíntese , Antígenos de Histocompatibilidade Classe I/sangue , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/patologia
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