Untreated patients with multiple sclerosis: A study of French expert centers.

BACKGROUND AND PURPOSE: Disease-modifying therapies (DMTs) have an impact on relapses and disease progression. Nonetheless, many patients with multiple sclerosis (MS) remain untreated. The objectives of the present study were to determine the proportion of untreated patients with MS followed in expert centers in France and to determine the predictive factors of nontreatment. METHODS: We conducted a retrospective cohort study. Data were extracted from the 38 centers participating in the European Database for Multiple Sclerosis (EDMUS) on December 15, 2018, and patients with MS seen at least once during the study period (from June 15, 2016 to June 14, 2017) were included. RESULTS: Of the 21,189 patients with MS (age 47.1 ± 13.1 years; Expanded Disability Status Scale (EDSS) score 3.4 ± 2.4), 6,631 (31.3%; 95% confidence interval [CI] 30.7-31.9) were not receiving any DMT. Although patients with a relapsing-remitting course (n = 11,693) were the most likely to receive DMT, 14.8% (95% CI 14.2-15.4) were still untreated (6.8% never treated). After multivariate analysis among patients with relapsing-remitting MS, the main factors explaining never having been treated were: not having ≥9 lesions on brain magnetic resonance imaging (odds ratio [OR] 0.52 [95% CI 0.44-0.61]) and lower EDSS score (OR 0.78 [95% CI 0.74-0.82]). Most patients with progressive MS (50.4% for secondary and 64.2% for primary progressive MS) did not receive any DMT during the study period, while 11.6% of patients with secondary and 34.0% of patients with primary progressive MS had never received any DMT. CONCLUSION: A significant proportion of patients with MS did not receive any DMT, even though such treatments are reimbursed by the healthcare system for French patients. This result highlights the unmet need for current DMTs for a large subgroup of patients with MS.

[Transient epileptic amnesia]. / L'amnésie épileptique transitoire (AET).

Transient epileptic amnesia (TEA) is a sub-type of mesial temporal lobe epilepsy, with amnesic seizures. TEA is characterized by recurrent episodes of amnesia. Diagnostic criteria are available for TEA, and these memory disturbances should not be misdiagnosed with transient global amnesia. The neuropsychological evaluation is normal, however, autobiographical memory impairment is present in 70% of the cases and accelerated long term forgetting in 44%. When a patient complains of memory disturbances, especially autobiographical memory, TEA must be considered especially if there was an amnesic episode and symptoms that suggest temporal epilepsia. Video electroencephalography monitoring of sleep is a precious diagnostic tool, as epileptiform activities are found during sleep in 83% cases. TEA is pharmaco-sensitive, with full treatment response in 73 to 96% of the cases.