Combination therapy with mitoxantrone and plasma exchange in aggressive relapsing remitting multiple sclerosis: A preliminary clinical study.

BACKGROUND: The efficacy of mitoxantrone induction therapy in rapidly worsening multiple sclerosis (MS) is well established. Plasma exchange is also applied as an adjuvant in exacerbations of relapsing MS. The aim of this study was to compare the efficacy of combination therapy with mitoxantrone and plasma exchange versus mitoxantrone alone in patients with aggressive MS. MATERIALS AND METHODS: Forty patients with aggressive relapsing remitting MS were randomly put into two groups. The first group underwent monthly plasma exchange for three successive months, followed by 12 mg/m(2) mitoxantrone at the end of each course and two more doses of 6 mg/m(2) mitoxantrone in 3-month intervals. The second group received the same doses of mitoxantrone only without plasma exchange. At the end of 8 months treatment course, clinical reassessment and neuroimaging was performed and treatment was continued with interferon-ß. RESULTS: At the end of induction therapy, Expanded Disability Status Scale score was significantly improved in both groups (P < 0.001). Number of demyelinating and gadolinium-enhancing plaques in brain magnetic resonance imaging (MRI) was prominently reduced in group 2(P ≤ 0.05), but the changes were not statistically significant in group 1, except for juxtacortical plaques. CONCLUSION: Administration of mitoxantrone as an induction therapy in patients of aggressive relapsing remitting MS results in significant improvement of their clinical state and MRI activity. However, combination of plasma exchange with mitoxantrone gives no more benefits than mitoxantrone alone and sometimes worsens the situation possibly by reduction of mitoxantrone efficacy as a result of plasma exchange.

Conus medullaris involvement in demyelinating disorders of the CNS: A comparative study.

BACKGROUND: Differentiation of the demyelinating disorders of the CNS seems challenging in practice. Conus medullaris, the cone-shaped end of the spinal cord, is more involved in anti-MOG patients based on preliminary studies, a possibly helpful detail in its differentiation. Nevertheless, the evidence is still limited and the underlying cause is unclear and undiscussed in previous studies. OBJECTIVE: To contribute to preliminary studies by comparing conus involvement among patients with MS, anti-AQP4, and anti-MOG diseases using larger sample size. METHODS: More than a thousand MS, anti-AQP4, and anti-MOG patients were followed up for a maximum of five years, scanned for conus medullaris involvement. Data regarding each cohort were then analyzed and compared using statistical methods. RESULTS: The rate of conus medullaris involvement was significantly higher in anti-MOG patietns (OR = 27.109, P < 0.001), followed by anti-AQP4 (OR = 4.944, P = 0.004), and MS patients (OR = reference). Survival analysis showed higher pace and cumulative incidence of conus attacks in anti-MOG patients. Conus-involved patients, showed no significant difference regarding age, sex, concurrent brain lesions, and their partial recovery. Predictive values show that the probability of being diagnosed with anti-MOG is roughly 13 times higher in conus-involved patients (25.93% vs. 1.97%), although this probability was still higher for MS, as it has a much higher incidence. CONCLUSION: Despite minor differences, the results were in line with previous studies, confirming the higher rate of conus medullaris involvement among anti-MOG patients. Potential underlying causes are proposed and remain to be investigated in future studies.

Comparing myelin oligodendrocyte glycoprotein antibody (MOG-Ab) and non MOG-Ab associated optic neuritis: Clinical course and treatment outcome.

BACKGROUND: Recent studies have suggested that anti-MOG antibodies and optic neuritis are associated and anti-MOG antibody positive patients have had better recoveries. The purpose of this study was to compare the clinical course and treatment outcome of MOG-Ab associated and non-MOG-Ab associated ON. METHODS: Patients diagnosed with optic neuritis were referred for brain and cervical MRI. Blood samples were also taken to measure MOG antibody and NMO antibody levels. The patients were treated based on a standard steroid pulse therapy. RESULTS: Between October 2015 and October 2017, 98 patients with ON were enrolled in the study. MS was diagnosed based on abnormality of patients' MRI results. Moreover, MRI finding of 58% of patients in MOG group and 80% of patients in NMO group was abnormal (P-value = 0.707). The treatment increased the visual acuity significantly in all groups after 12 months. Patients in the NMO group were the only ones without significant change in their visual acuity in the first six months. On the other hand, the only patients with significant change in their visual acuity in the second six month were those in the MS group. CONCLUSION: We showed that patients' response to the steroid treatment is different between the MOG group and non-MOG group. The results suggest that presence of MOG-Ab influences the treatment outcome and its length.

Conversion from radiologically isolated syndrome to multiple sclerosis.

BACKGROUND: The aim of this study was to estimate the conversion rate from radiologically isolated syndrome (RIS) to definite multiple sclerosis (MS). METHODS: During a mean (standard deviation [SD]) follow-up period of 17.4 (5.4) (range 8-29) months, 25 subjects with RIS and without neurological symptom aged 22-45 year from a single-center have been examined for the occurrence of definite MS. The mean (SD) age of participants was 35.1 (6.2) years at first brain magnetic resonance imaging (MRI). The definite MS were assessed using the revised McDonald's criteria (2010). RESULTS: Six of 25 patients developed clinical symptom consistent with criteria for definite MS. The conversion rate from RIS to definite MS was 1.5 (95% confidence interval [CI] 0.54, 3.17) per 100 person-months based on 480 person-months of follow-up. Multivariate analysis revealed that presence of contrast-enhancing lesions on the initial MRI was marginally significantly associated with MS (hazard ratio 1.83, 95% CI 0.98, 3.45, P = 0.060). CONCLUSIONS: This is the first estimate of conversion rate from RIS to definite MS in Iran. The conversion rates from RIS to definite MS in these participants are high and intensive follow-up and intervention strategies are recommended for these high-risk individuals. A larger study is warranted to assess this risk in greater detail.