Review of the novelties from the 32nd ECTRIMS Congress, 2016, presented at the 9th Post-ECTRIMS Meeting (II). / Revision de las novedades del XXXII Congreso ECTRIMS 2016, presentadas en la IX Reunion Post-ECTRIMS (II).

For the ninth year in a row the Post-ECTRIMS Meeting has been held in Madrid (Spain) with the aim of presenting and discussing the hottest issues debated at the ECTRIMS Congress by renowned specialists in multiple sclerosis in our country. One outcome of this scientific activity, endorsed by the Spanish Neurology Society, is this review article, which is published in two parts. This second part reflects the current controversy over the management of multiple sclerosis, especially as regards the progressive forms and their differential diagnosis. The work presents the latest advances in remyelination, where the use of the micropillar technique in laboratory stands out, and in neuroprotection, which is reviewed through a study of the optic nerve. Anti-CD20 antibodies are a very promising development and we find ourselves before a new mechanism of action and therapeutic target in cells to which little attention has been paid to date. Another notable fact is the high correlation between the levels of neurofilaments in cerebrospinal fluid and in serum, which could make it possible to avoid the use of cerebrospinal fluid as a biological sample in future studies of biomarkers. The review also provides a preview of the advances in clinical research, which will converge in clinical practice in the future, thereby conditioning the steps that should be taken in the therapeutic management of multiple sclerosis.

TITLE: Revision de las novedades del XXXII Congreso ECTRIMS 2016, presentadas en la IX Reunion Post-ECTRIMS (II).Por noveno año consecutivo se ha celebrado en Madrid (España) la Reunion Post-ECTRIMS con el objetivo de presentar y discutir los temas mas debatidos en el congreso ECTRIMS de la mano de reconocidos especialistas en esclerosis multiple de nuestro pais. Fruto de esta reunion cientifica, avalada por la Sociedad Española de Neurologia, se genera este articulo de revision que sale publicado en dos partes. En esta segunda parte se pone de manifiesto la controversia actual en el manejo de la esclerosis multiple, especialmente en cuanto a formas progresivas y diagnostico diferencial se refiere. Se presentan los ultimos avances en remielinizacion, donde destaca el uso de la tecnica con micropilares en el laboratorio, y en neuroproteccion, la cual se revisa a traves del estudio del nervio optico. Los anticuerpos anti-CD20 ofrecen grandes expectativas, y estamos ante un nuevo mecanismo de accion y diana terapeutica en unas celulas a las que les habiamos prestado poca atencion hasta la fecha. Otro hecho destacable es la elevada correlacion entre los niveles de neurofilamentos en el liquido cefalorraquideo y el suero, que podria evitar el uso del liquido cefalorraquideo como muestra biologica en futuros estudios de biomarcadores. Tambien se anticipan los avances en investigacion clinica que en el futuro acabaran convergiendo en la practica clinica, condicionando los pasos que se deberan seguir en el abordaje terapeutico de la esclerosis multiple.

Neuromodulation of the posterolateral hypothalamus for the treatment of chronic refractory cluster headache: Experience in five patients with a modified anatomical target.

INTRODUCTION: Deep brain stimulation (DBS) of the posterior hypothalamus has been found to be effective in the treatment of refractory chronic cluster headache (CCH). METHODS: We report the long-term outcomes of five patients with refractory CCH on whom stimulation of a modified target of approximately 3 mm in radius, which included the posterolateral hypothalamus, the fasciculus mammillotegmentalis, the fasciculus mammillothalamicus and the fasciculus medialis telencephali, was performed. The stereotaxic coordinates were 4 mm from the third ventricle wall, 2 mm from behind the mid-intercommissural point and 5 mm from under the intercommissural line. RESULTS: All patients became pain-free for 1-2 weeks after the procedure, but then needed an average of 54 days to optimize stimulation parameters. After a mean follow-up of 33 months, two remain pain-free, two have an excellent response (>90% decrease in attack frequency) and in one the attacks have been reduced by half. There were no serious adverse events. Permanent myosis and euphoria/well-being feeling were seen in three patients. Other adverse events, such as diplopia, dizziness, global headache of cervical dystonia, were seen transiently related to an increase in stimulation parameters. Attacks reappeared transiently in two patients as a result of cable rupture and when the stimulator was disconnected. CONCLUSIONS: Our results supports the efficacy of DBS in very refractory CCH with a slightly modified hypothalamic target conceived to avoid the lateral ventricle wall so as to extend the stimulated brain area and to decrease the morbidity of potential haemorrhagic complications.

Resultado clínico a 6 años del trasplante autólogo de progenitores hematopoyéticos en la esclerosis múltiple / Clinical outcome 6 years after autologous hematopoietic stem cell transplantation in multiple sclerosis

Introducción. El trasplante autólogo de progenitoreshematopoyéticos (TAPH) es considerado un tratamiento experimentalpara formas de esclerosis múltiple (EM) de evoluciónagresiva. Describimos la evolución clínica de 14 pacientes incluidosen un protocolo de TAPH tras un seguimiento medianode 6 años.Métodos. Catorce pacientes con EM (cinco remitenterecidivantey nueve secundariamente progresiva) con unamediana de brotes el año previo de 3 (1-7), Expanded DisabilityStatus Scale (EDSS) de 6 (4,5-6,5) y decil de la MultipleSclerosis Severity Store (MSSS) 9 (7-10) fueron incluidos. Elprocedimiento consistió en carmustina, ciclofosfamida, globulinaantitimocítica y depleción de células T mediante selecciónpositiva de progenitores CD34+.Resultados. La supervivencia libre de progresión a los4,5 años fue del 71%. La probabilidad actuarial de estar librede progresión a los 6 años del 62,5% y la supervivencialibre de actividad de la enfermedad del 7,1%. La EDSS medianaera de 6 (4-8,5) y el MSSS 8 (5-10). Sólo dos pacientespresentaron lesiones captantes de gadolinio en la RM. No seobservaron complicaciones tóxicas a largo plazo.Conclusión. El TAPH no puede considerarse un tratamientocurativo, pero puede inducir una estabilización prolongadao cambiar el curso agresivo de la enfermedad (AU)

Introduction. Autologous hematopoietic stem celltransplantation (AHSCT) remains as an experimental treatmentfor severe forms of multiple sclerosis (MS). We describethe clinical outcome of 14 patients included in a protocolof AHSCT after a median follow-up period of 6 years.Methods. 14 patients (5 relapsing-remitting and 9secondary progressive) with a median number of relapsesin the year before of 3 (1-7), Expanded DisabilityStatus Scale (EDSS) of 6 (4.5-6.5) and decile of the MultipleSclerosis Severity Store (MSSS) 9 (7-10) were included.The procedure included carmustine, cyclophosphamide,antithymocyte globulin and T-cell depletion byCD34+ selection.Results. The 4.5-year progression-free survival was71%. The 6 year actuarial probability of progression-freesurvival was 62.5% and the disease activity-free survivalof 7.1%. The median EDSS was 6 (4-8.5) and the MSSS 8(5-10). Only 2 patients presented enhanced T1 lesions.No long-term complications related to the procedure wereobserved.Conclusion. AHSCT cannot be deemed a curativetreatment but may cause prolonged stabilisation or changethe aggressive course of the disease (AU)