Flu-like syndrome due to interferon-beta injections does not increase anxiety, depression, and lost working days in multiple sclerosis patients during the Sars-CoV-2 pandemic.

BACKGROUND AND PURPOSE: Aim of this study was to evaluated anxiety, depression, and possible negative implications on work activities during the Sars-CoV-2 pandemic, in a group of Multiple Sclerosis (MS) patients at risk of flu-like syndrome (FLS) compared with FLS- free treatments. METHODS: The present study included patients treated with interferon-ß (IFNß), glatiramer, and natalizumab for at least one year. Collected data included the diagnosis of COVID-19 infection, Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), together with questions about FLS, change in work habits, use of antipyretics, anxiety, and depression. RESULTS: 100 patients were included in the study. Six patients in IFNß and 5 in the natalizumab group had a confirmed COVID-19 infection. 68% in the IFNß patients reported FLS and only one reported an increase in flu-like frequency during the pandemic; 14% reported lower compliance with treatment, and 40% reported uptake of antipyretics several times. Only one IFNß patient reported having lost more working days than the previous year. The average BAI (p = 0.039) was higher in natalizumab group. Correcting these data by age, sex and EDSS to a multivariate analysis we did not find any statistically significant difference in terms of BAI and BDI-II between the three treatment groups. CONCLUSIONS: FLS were not perceived as COVID19-like symptoms but as expected by traditional pharmacological treatments indeed. These data suggest that IFNß can be used safely.

Safety of Natalizumab infusion in multiple sclerosis patients during active SARS-CoV-2 infection.

COVID-19 pandemic represented a challenge in the management of treatments for Multiple Sclerosis (MS), such as Natalizumab (NTZ). NTZ interferes with the homing of lymphocytes into the central nervous system, reducing immune surveillance against opportunistic infection. Although NTZ efficacy starts to decline 8 weeks after the last infusion, increasing the risk of disease reactivation, evidence is lacking on the safety of reinfusion during active SARS-CoV-2 infection. We report clinical outcomes of 18 pwMS receiving NTZ retreatment during confirmed SARS-CoV-2 infection. No worsening of infection or recovery delay was observed. Our data supports the safety of NTZ redosing in these circumstances.

Diagnostic validity of optic disc and retinal nerve fiber layer evaluations in detecting structural changes after optic neuritis.

PURPOSE: To assess the diagnostic validity of morphometric examination of the optic disc and retinal nerve fiber layer (RNFL) thickness to detect permanent structural changes after retrobulbar optic neuritis (ON). DESIGN: Evaluation of a diagnostic test. PARTICIPANTS: Twenty-five patients with a history of retrobulbar ON and 29 disease-free controls. METHODS: The optic discs were evaluated by means of confocal scanning laser ophthalmoscopy (Heidelberg Retinal Tomograph [HRT III]), and RNFL thickness by means of scanning laser polarimetry (GDx), and optical coherence tomography (OCT). Vision function was assessed in all subjects by testing visual acuity, contrast sensitivity, color vision, visual field (VF), and visual evoked potentials (VEPs). Statistical comparisons were made between the affected (ON) and unaffected eyes (non-ON) of the patients with ON, and between these eyes and control eyes (Mann-Whitney test and Wilcoxon's test). Receiver operating characteristic (ROC) curves, and sensitivity and specificity in discriminating ON from control eyes, were calculated for the significant parameters. Correlations between the tests were calculated by means of Spearman's correlation coefficient. MAIN OUTCOME MEASURES: We compared OCT, GDx, HRT, and visual testing results in ON eyes versus control eyes. RESULTS: All of the visual function test parameters and RNFL thickness (GDx and OCT) were significantly different between the ON eyes and both the non-ON and control eyes (P<0.01), and there were significant differences in some GDx parameters between the non-ON and control eyes. There were no significant differences in the HRT parameters. The ROC curves indicated that the greatest diagnostic validity was associated with the GDx nerve fiber indicator (AUC, 0.92; sensitivity, 0.80; specificity, 0.97 using a cutoff point of 20.5 between ON and non-ON eyes), and OCT temporal thickness (AUC, 0.92; sensitivity, 0.72; specificity, 0.95 using a cutoff point of 51.5 microm). CONCLUSIONS: When investigating permanent damage after ON, RNFL thickness is a promising biomarker. The GDx and OCT are reliable, noninvasive, user-friendly devices; both show good diagnostic validity and good correlations with functional tests in discriminating affected from unaffected eyes. Retinal nerve fiber layer thinning in non-ON eyes should be further studied as a possible subclinical indicator of disease.

Assessing the susceptibility to acute respiratory illness COVID-19-related in a cohort of multiple sclerosis patients.

INTRODUCTION: Italy has been the first European country severely affected by the COVID-19 pandemic. OBJECTIVE: To analyze the incidence of the clinical presentations suggestive for COVID-19 infection among patients with Multiple Sclerosis in the province of Lecco, in the North Italy, the closest province capital to Bergamo. To describe the association of demographics, clinical characteristics, and use of DMTs categories with the risk of contracting the disease. METHODS: We telephonically interviewed all the 275 MS patients followed in the MS center. The collected data included recent contact with a patient with COVID-19 diagnosis or a subject with respiratory symptoms and the developing of COVID-19 symptoms or a confirmed diagnosis. RESULTS: 15 out of 275 patients reported symptoms suggestive for COVID-19 infection, only one of them with PCR-confirmed diagnosis. No one of them presented severe symptoms or needed hospitalization. Using a multivariable logistic regression model, the only factor associated with being in the COVID-suspect group was the report of a recent contact with a patient with a COVID-19 diagnosis. CONCLUSIONS: The prevalence of COVID-19 within MS patients seems to resemble the prevalence in general population. The lack of associations with other factors assessed, including DMTs, may reflect a lack of statistical power. Larger population studies are needed to explore the correlation between different disease-modifying therapies and COVID-19 course.

Clinical Application of 2017 McDonald Diagnostic Criteria for Multiple Sclerosis.

BACKGROUND AND PURPOSE: McDonald criteria for multiple sclerosis diagnosis have been revised over the years, diagnostic procedures have been simplified and earlier diagnosis facilitated. The new 2017 revision introduces other important changes, with a further simplification for the diagnosis. Oligoclonal bands reassume a more relevant role in the workup. METHODS: We describe 3 typical cases of patients admitted for clinically isolated syndrome and illustrate how the application of the new criteria can change the diagnostic approach with respect to the previous criteria. RESULTS: In two of the three cases a diagnosis of multiple sclerosis is now possible. CONCLUSIONS: The new 2017 Multiple Sclerosis criteria may have an important impact in clinical practice with an earlier treatment to avoid the risk of disease dissemination. Their application requires a careful assessment to avoid misdiagnosis and mistreatments.

Recurrent horner syndrome and persistent trigeminal artery.

INTRODUCTION: A persistent primitive trigeminal artery (PTA) is the most common type of fetal carotid-basilar anastomosis in adulthood; however, its prevalence is low and estimated between 0.1% and 0.7% in angiographic studies. PTA is usually diagnosed incidentally during an angiographic examination, though some symptomatic cases associated with cranial nerve dysfunction have been described. We describe the unusual association between PTA and ipsilateral Horner syndrome triggered by hypertensive crisis. CASE REPORT: A 40-year-old man presented to medical attention for recurrent episodes, over the last 3 years, characterized by hypertensive crisis (up to 220/150 mm Hg), dizziness, tachycardia, flushing of the forehead on the left side, ptosis, miosis, and conjunctival injection of the left eye without pain. Imaging revealed a left PTA originating from the carotid siphon with moderate ectasia of the proximal tract. We speculate that the recurrent Horner syndrome observed in our patient could be due to the disruption of the postganglionic peripheral fibers in the pericarotid plexus. Adequate antihypertensive therapy led to resolution of signs and symptoms. CONCLUSIONS: To our knowledge, we present the first case of persistent PTA and ipsilateral Horner syndrome during hypertensive crisis. Adequate antihypertensive therapy can be useful in patients bearing trigeminal artery variants.

Subacute inflammatory polyradiculopathy associated with Sjögren's syndrome.

Peripheral nervous system involvement is common in Sjögren's syndrome (SS); however, polyradiculopathy has been reported rarely in association with SS, and predominantly chronic forms have been described. We describe a patient with clinical, cerebrospinal fluid, neurophysiological, and neuroradiological evidence of subacute inflammatory polyradiculopathy in whom Sjögren's syndrome was diagnosed after the onset of neurological symptoms. Our case suggests that SS should be included in the differential diagnosis of subacute inflammatory polyradiculopathy.