Frequency of new asymptomatic MRI lesions during attacks and follow-up of patients with NMOSD in a real-world setting.

BACKGROUND: We aimed to assess the frequency of new asymptomatic lesions on brain and spinal imaging (magnetic resonance imaging (MRI)) and their association with subsequent relapses in a large cohort of neuromyelitis optica spectrum disorder (NMOSD) patients in Argentina. METHODS: We retrospectively reviewed 675 MRI (225 performed during an attack and 450 during the relapse-free period (performed at least 3 months from the last attack)) of NMOSD patients who had at least 2 years of clinical and MRI follow-up since disease onset. Kaplan-Meier (KM) curves were used for depicting time from remission MRI to subsequent relapse. RESULTS: We included 135 NMOSD patients (64.4% were aquaporin-4-immunoglobulin G (AQP4-IgG)-positive). We found that 26 (19.26%) and 66 (48.88%) of patients experienced at least one new asymptomatic MRI lesion during both the relapse-free period and attacks, respectively. The most frequent asymptomatic MRI lesions were optic nerves followed by short-segment myelitis during the relapse-free period and attacks. KM curves did not show differences in the time taken to develop a new relapse. CONCLUSION: Our findings showed that new asymptomatic lesions are relatively frequent. However, the presence of new asymptomatic MRI lesions during the relapse-free period and at relapses was not associated with a shorter time to developing subsequent relapses.

Argentinean consensus recommendations for the use of telemedicine in clinical practice in adult people with multiple sclerosis.

BACKGROUND: The use of telemedicine has quickly increased during of the COVID-19 pandemic. Given that unmet needs and barriers to multiple sclerosis (MS) care have been reported, telemedicine has become an interesting option to the care of these patients. The objective of these consensus recommendations was to elaborate a guideline for the management of people with MS using telemedicine in order to contribute to an effective and high-quality healthcare. METHODS: A panel of Argentinean neurologist's experts in neuroimmunological diseases and dedicated to the diagnosis, management,and care of MS patients gathered virtually during 2021 and 2022 to conduct a consensus recommendation on the use of telemedicine in clinical practice in adult people with MS. To reach consensus, the methodology of "formal consensus RAND/UCLA Appropriateness method" was used. RESULTS: Recommendations were established based on relevant published evidence and expert opinion focusing on definitions, general characteristics and ethical standards, diagnosis of MS, follow-up (evaluation of disability and relapses of MS), identification and treatment of relapses, and finally disease-modifying treatments using telemedicine. CONCLUSION: The recommendations of this consensus would provide a useful guide for the proper use of telemedicine for the assessment, follow-up, management, and treatment of people with MS. We suggest the use of these guidelines to all the Argentine neurologists committed to the care of people with MS.

Perspective taking deficits and their relationship with theory of mind abilities in patients with relapsing-remitting multiple sclerosis (RRMS).

Introduction and objectives: In recent years, research has reported that between 45% and 70% of patients with Multiple Sclerosis (MS) have cognitive deficits, the most prominent being those associated with the frontal lobe. Among these deficits, we can find Theory of Mind (ToM), which is the ability to infer feelings and thoughts of others. Although it has been suggested that ToM relies on more basic skills, such as perspective taking (PT), no studies have investigated this association in patients with MS. The aim of this study was to investigate PT abilities in patients with MS and to establish their relationship with ToM deficits. Material and methods: 36 patients with relapsing-remitting multiple sclerosis (RRMS) and 42 healthy controls matched by age, sex and educational level were evaluated. Both groups were tested to estimate premorbid and current intellectual capacity, PT, ToM (Reading the Mind in the Eyes Test -RMET- and Faux Pas) and complementary scales (fatigue, depression and disability). Results: Patients with RRMS presented significant differences from controls in both PT and ToM tests. The PT test showed positive correlation with RMET, one of our ToM tests. Conclusion: The results show that there is a relationship between ToM and PT abilities. Our findings are of clinical and academic relevance to both the assessment and interpretation as well as the rehabilitation of social deficits in MS.

Consensus recommendations for family planning and pregnancy in multiple sclerosis in argentina.

BACKGROUND: Multiple sclerosis (MS) is the most common chronic immune-mediated neurological disorder in young adults, more frequently found in women than in men. Therefore, pregnancy-related issues have become an object of concern for MS professionals and patients. The aim of this work was to review the existing data to develop the first Argentine consensus for family planning and pregnancy in MS patients. METHODS: A panel of expert neurologists from Argentina engaged in the diagnosis and care of MS patients met both virtually and in person during 2019 to carry out a consensus recommendation for family planning and pregnancy in MS. To achieve consensus, the procedure of the "formal consensus-RAND/UCLA method" was used. RESULTS: Recommendations were established based on published evidence and expert opinion focusing on pre-pregnancy counseling, pregnancy, and postpartum issues. CONCLUSION: The recommendations of these consensus guidelines are intended to optimize the management and treatment of MS patients during their reproductive age in Argentina.

Application of the 2017 McDonald criteria for the diagnosis of multiple sclerosis after a first demyelinating event in patients from Argentina.

BACKGROUND: The 2017 McDonald criteria are based on data from Caucasian European and North American populations. It is unknown whether they are externally valid in Latin American populations. OBJECTIVE: We aimed to analyze the sensitivity, specificity, predictive values, and diagnostic accuracy of the 2017 McDonald criteria in a cohort of patients with a first demyelinating event in Buenos Aires, Argentina. METHODS: We determined if patients with a first demyelinating event presented dissemination in time and space according to the 2010 and the 2017 McDonald criteria. We calculated the sensitivity, specificity, positive and negative predictive values, and accuracy for both criteria sets to predict a second radiologic or clinical event. Survival analyses were performed to evaluate differences in time to a second event when we applied the 2010 or the 2017 McDonald criteria. We also conducted a genealogical interview in order to analyze ethnicity. RESULTS: 108 patients with a first demyelinating event were included. All patients were European descendants according to ethnic analysis. 67 patients fulfilled the 2017 McDonald criteria and 31 patients met the 2010 criteria, at baseline. 54 patients who fulfilled the 2017 McDonald criteria experienced a second event during the follow up period, while 25 patients who met the 2010 criteria had a new relapse or new MRI activity during this period. Sensitivity, specificity, positive and negative predictive values, and accuracy values for the 2017 McDonald criteria were 67,5%, 53,5%, 80,5%, 36,5%, and 63,8%. For the 2010 McDonald criteria the results were 31,2%, 78,5%, 80,6%, 28,5%, and 43,5%, respectively. Specificity increased after excluding patients treated with disease-modifying therapies prior to a second event. The Kaplan-Meier analysis showed that the 2017 McDonald criteria reduced time to a second event ten months compared with the 2010 criteria. CONCLUSION: Compared to the 2010 criteria, the 2017 McDonald criteria were more sensitive but less specific in our patients. However after excluding patients who received disease-modifying treatment before a second event, the specificity of the 2017 McDonald criteria in our cohort increased to 87.5%.

Fatigue in multiple sclerosis is associated with multimodal interoceptive abnormalities.

BACKGROUND: Fatigue ranks among the most common and disabling symptoms in multiple sclerosis (MS). Recent theoretical works have surmised that this trait might be related to alterations across interoceptive mechanisms. However, this hypothesis has not been empirically evaluated. OBJECTIVES: To determine whether fatigue in MS patients is associated with specific behavioral, structural, and functional disruptions of the interoceptive domain. METHODS: Fatigue levels were established via the Modified Fatigue Impact Scale. Interoception was evaluated through a robust measure indexed by the heartbeat detection task. Structural and functional connectivity properties of key interoceptive hubs were tested by magnetic resonance imaging (MRI) and resting-state functional MRI. Machine learning analyses were employed to perform pairwise classifications. RESULTS: Only patients with fatigue presented with decreased interoceptive accuracy alongside decreased gray matter volume and increased functional connectivity in core interoceptive regions, the insula, and the anterior cingulate cortex. Each of these alterations was positively associated with fatigue. Finally, machine-learning analysis with a combination of the above interoceptive indices (behavioral, structural, and functional) successfully discriminated (area under the curve > 90%) fatigued patients from both non-fatigued and healthy controls. CONCLUSION: This study offers unprecedented evidence suggesting that disruptions of neurocognitive markers subserving interoception may constitute a signature of fatigue in MS.

Access and unmet needs to multiple sclerosis care in a cohort of Argentinean patients.

BACKGROUND: Multiple sclerosis (MS) has a low prevalence in Argentina. However, MS has a high burden of disease, which implies frequent neurological visits, magnetic resonance images (MRI) use and chronic MS medication during follow-up, with a high impact on the healthcare system. Therefore, MS care is essential to optimize disease management and improve patients' outcome. We aimed to evaluate the access and barriers to MS care and identified differences in treatment and management of MS patients over a period of 12 months in an Argentinean cohort. METHODS: A cross-sectional study based on a self-administered survey was carried out from August to December 2017 in 13 provinces from Argentina. MS patients (n = 219) were divided into three groups as follows: prepaid health insurance (PHI), social health insurance (SHI) and state-run health insurance (SRHI, Public Health Ministry) and they were assessed in order to detect differences in employment, access and barriers to MS care (neurological visit, MRI use and MS medication). RESULTS: A total of 185 (84.5%) MS patients were employed (full-time: 59%), 34 (15.5%) were currently unemployed and 15 (6.8%) retired by MS. In addition, 132 had SHI, 45 PHI and 40 SRHI. No statistical differences were found in disease severity, frequency of neurological visit, waiting time for neurological visit as well as frequency and waiting time for MRI use. MS patients with SRHI experienced a longer waiting time (first prescription and during follow-up) and inappropriate delivery of MS medication during follow-up compared to MS patients with PHI and SHI. A total of 8/45 (17.7%) in PHI, 17/40 (42.5%) in SRHI and 25/132 (18.9%) in SHI did not receive the MS medication as properly as prescribed for their neurologists. PHI was independently associated with appropriate delivery of MS medication (OR = 0.81, p = 0.01). CONCLUSION: This study showed that MS patients had access barriers to receive MS medication properly, especially those with SRHI (public sector).

Neuropatía óptica inflamatoria recurrente crónica: revisión de la bibliografía / Chronic relapsing inflammatory optic neuropathy: a literature review

Introducción. La neuropatía óptica inflamatoria recurrente crónica (CRION) es una enfermedad inflamatoria caracterizada por episodios recurrentes de neuritis óptica dolorosa con una clara respuesta a corticoides y recaídas debido a su retirada. Objetivos. Se realiza una revisión de la bibliografía sobre CRION desde 2003 hasta la actualidad en bases de datos médicas. Se excluyen artículos en edad pediátrica o de investigación animal. Los términos de búsqueda fueron: CRION, neuritis óptica, neuropatía óptica inflamatoria remitente crónica, neuritis óptica recurrente, neuritis óptica corticodependiente y neuritis óptica dependiente de inmunosupresores. Desarrollo. La CRION es una neuritis óptica recurrente de etiología no conocida. Su fuerte respuesta a corticoides, que evita las recaídas, sugiere un origen inmunomediado. La CRION se manifiesta como una neuropatía óptica subaguda y recurrente con grave afectación de la agudeza visual. Los principales diagnósticos diferenciales son las enfermedades desmielinizantes, como la esclerosis múltiple, el espectro de neuromielitis óptica y la enfermedad por anticuerpos anti-MOG, las enfermedades sistémicas, sobre todo la sarcoidosis, y las enfermedades infecciosas. La CRION tiene una excelente respuesta a corticoides, pero es corticodependiente; para evitar los efectos adversos de la corticoterapia se utilizan inmunosupresores a largo plazo para el tratamiento. Conclusión. La CRION es una rara enfermedad recurrente del nervio óptico corticodependiente. Su reconocimiento precoz y tratamiento preciso mejorarán el pronóstico

Introduction. Chronic relapsing inflammatory optic neuropathy (CRION) is an inflammatory disease characterized by painful recurrent episodes of optic neuritis with clear response to steroids and relapses with treatment withdrawal. Aims. To performed a systematic review of the literature about CRION, since 2003 to present in medical database. We excluded pediatric or animal research articles. Search terms: CRION, chronic relapsing inflammatory optic neuropathy, recurrent optic neuritis, steroid dependent optic neuritis, and immunosuppression dependent optic neuritis. DEvelopment. CRION is a relapsing optic neuritis of unknown aetiology. The strong response to corticosteroids to avoid recurrence suggests that it might be an immune-mediated disease. CRION typically presents as a subacute and recurrent optic neuropathy with severe visual loss. The principal differential diagnoses are the demyelinating (multiple sclerosis, neuromyelitis optica spectrum disorders and anti-MOG), systemic (mostly sarcoidosis) and infectious diseases. CRION has a dramatic and dependent corticoids response; to avoid adverse events, we use immunosuppressive treatment in long-term. Conclusion. CRION is a rare, recurrent and cortico-dependent disease of optic nerve. An early diagnosis and accuracy treatment will improve the prognosis

Stroke Severity Score based on Six Signs and Symptoms The 6S Score: A Simple Tool for Assessing Stroke Severity and In-hospital Mortality.

BACKGROUND AND PURPOSE: Ascertaining stroke severity and predicting risk of in-hospital mortality is crucial to advise patients and families about medical decisions. We developed and tested the validity of a new stroke score, the 6S Score (Stroke Severity Score based on Six Signs and Symptoms), for quantifying ischemic stroke severity and predicting in-hospital mortality. METHODS: We prospectively assessed 210 consecutive acute ischemic stroke patients. The cohort was further divided into a derivation (n=120) and a validation (n=90) sample. From a total of 10 stroke signs and symptoms, we selected those with likelihood ratio's P<0.005. We tested the validity of the score for predicting in-hospital mortality by using receiver operating characteristic curves. We used a scatterplot and the Spearman's test to evaluate the correlation between the 6S Score and the National Institutes of Health Stroke Scale as a marker of stroke severity. We used principal component and exploratory factor analyses for assessing qualitative aspects of the 6S Score. RESULTS: The C statistic for in-hospital mortality was 0.82 for the 6S Score and 0.86 for the National Institutes of health Stroke Scale, respectively, with no significant differences between each other (P=0.79). The correlation between both scores was strong (Spearman's rho 0.68, P<0.001). The factor analyses showed a good balance between left/right hemispheres and anterior/posterior circulations. CONCLUSIONS: The 6S Score may constitute a tool for easily assessing stroke severity and predicting stroke mortality. Further research is needed for further assessing its external validity.

Newly diagnosed atrial fibrillation linked to wake-up stroke and TIA: hypothetical implications.

BACKGROUND: Based on the higher frequency of paroxysmal atrial fibrillation during night and early morning hours, we sought to analyze the association between newly diagnosed atrial fibrillation and wake-up ischemic cerebrovascular events. METHODS: We prospectively assessed every acute ischemic stroke and TIA patient admitted to our hospital between 2008 and 2011. We used a forward step-by-step multiple logistic regression analysis to assess the relationship between newly diagnosed atrial fibrillation and wake-up ischemic stroke or TIA, after adjusting for significant covariates. RESULTS: The study population comprised 356 patients, 274 (77.0%) with a diagnosis of acute ischemic stroke and 82 (23.0%) with TIA. A total of 41 (11.5%) of these events occurred during night sleep. A newly diagnosed atrial fibrillation was detected in 27 patients of 272 without known atrial fibrillation (9.9%). We found an independent association between newly diagnosed atrial fibrillation and wake-up ischemic stroke and TIA (odds ratio 3.6, 95% confidence interval 1.2-7.7, p = 0.019). CONCLUSIONS: The odds of detecting a newly diagnosed atrial fibrillation were 3-fold higher among wake-up cerebrovascular events than among non-wake-up events. The significance of this independent association between newly diagnosed atrial fibrillation and wake-up ischemic stroke and TIA and the role of other comorbidities should be investigated in future studies.