RESUMO
BACKGROUND: The identification of biomarkers able to improve the differential diagnosis between multiple sclerosis (MS) and neuromyelitis optica (NMO) is challenging because of a different prognosis and response to treatment. Growing evidence indicates that brain and CSF N-acetyl aspartate (NAA) concentration is a useful marker for characterising different phases of axonal pathology in demyelinating diseases, and preliminary studies suggest that increased serum NAA levels may be a telltale sign of acute neuronal damage or defective NAA metabolism in oligodendrocytes. OBJECTIVE: To evaluate whether serum and CSF NAA concentration differs in patients with MS and NMO. DESIGN: Observational, multicentre, prospective, cross sectional study. METHODS: Serum samples were collected from 48 relapsing-remitting MS, 32 NMO and 76 age matched healthy controls. Coeval CSF samples were available for all MS and for 8/32 NMO patients. NAA was measured in serum and CSF by liquid chromatography-mass spectrometry. RESULTS: MS patients showed higher serum and CSF NAA levels than NMO patients, and higher serum NAA levels than healthy controls (p<0.001). High serum NAA values, exceeding the 95th percentile of serum NAA values in healthy controls, were found in 100% of patients with MS and in no patient with NMO. No differences in serum NAA levels were found between NMO and healthy controls. In MS, serum and CSF NAA levels correlated with disability score. CONCLUSIONS: Determination of serum and CSF NAA levels may represent a suitable tool in the diagnostic laboratory workup to differentiate MS and NMO.
Assuntos
Ácido Aspártico/análogos & derivados , Esclerose Múltipla Recidivante-Remitente/diagnóstico , Neuromielite Óptica/diagnóstico , Adolescente , Adulto , Idoso , Ácido Aspártico/sangue , Ácido Aspártico/líquido cefalorraquidiano , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Estudos de Casos e Controles , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/sangue , Esclerose Múltipla Recidivante-Remitente/líquido cefalorraquidiano , Neuromielite Óptica/sangue , Neuromielite Óptica/líquido cefalorraquidianoRESUMO
The objective of this study was to assess the effects of subcutaneous (sc) interferon beta-1a (IFNbeta-1a) on cognition in mildly disabled patients with relapsing-remitting multiple sclerosis (RRMS). Patients aged 18-50 years with RRMS (McDonald criteria; Expanded Disability Status Scale score Assuntos
Transtornos Cognitivos/tratamento farmacológico
, Transtornos Cognitivos/psicologia
, Fatores Imunológicos/uso terapêutico
, Interferon beta/uso terapêutico
, Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico
, Esclerose Múltipla Recidivante-Remitente/psicologia
, Adolescente
, Adulto
, Transtornos Cognitivos/etiologia
, Estudos de Coortes
, Avaliação da Deficiência
, Progressão da Doença
, Relação Dose-Resposta a Droga
, Determinação de Ponto Final
, Feminino
, Humanos
, Injeções Subcutâneas
, Interferon beta-1a
, Interferon beta/administração & dosagem
, Estimativa de Kaplan-Meier
, Masculino
, Pessoa de Meia-Idade
, Esclerose Múltipla Recidivante-Remitente/complicações
, Testes Neuropsicológicos
, Estudos Prospectivos
, Análise de Sobrevida
, Adulto Jovem
RESUMO
BACKGROUND: Cognitive impairment is a common symptom of multiple sclerosis (MS), but the association between cognitive impairment and magnetic resonance imaging (MRI) disease measures in patients with relapsing-remitting (RR) MS is unclear. OBJECTIVES: To study the prevalence of cognitive impairment and its relation with MRI disease measures in mildly disabled patients with RRMS. METHODS: Patients aged 18-50 years with RRMS (McDonald criteria) and an Expanded Disability Status Scale (EDSS) score
Assuntos
Transtornos Cognitivos/diagnóstico , Avaliação da Deficiência , Imageamento por Ressonância Magnética , Esclerose Múltipla Recidivante-Remitente/psicologia , Exame Neurológico , Testes Neuropsicológicos , Adolescente , Adulto , Fatores Etários , Cognição , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Estudos Transversais , Feminino , Humanos , Fatores Imunológicos/uso terapêutico , Inteligência , Interferon beta/uso terapêutico , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/diagnóstico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Esclerose Múltipla Recidivante-Remitente/epidemiologia , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto JovemRESUMO
The Multiple Sclerosis Database Network (MSDN) is the first Italian multiple sclerosis (MS) registry. The preliminary results on the MSDN cohort demonstrated that the risk of disability progression, in a sample of 2090 MS patients, was reduced by about four- to five-fold in patients exposed to IFNbeta for more than 4 years compared with patients exposed for up to 2 years. More recent results showed, in a subset of 1170 relapsing-remitting MS patients, of whom 918 were treated with IFNbeta and 252 were untreated, that IFNbeta-treated patients had a differential reduction in EDSS score change of -0.055 for each year of follow-up in comparison with the untreated group. These results provide significant information on the effectiveness of IFNbeta treatment on long-term disability progression in MS.
Assuntos
Redes de Comunicação de Computadores , Bases de Dados Factuais/estatística & dados numéricos , Esclerose Múltipla/epidemiologia , Humanos , Interferon beta/uso terapêutico , Itália/epidemiologia , Esclerose Múltipla/tratamento farmacológicoRESUMO
This independent, population-based surveillance study monitored, in clinical practice, the efficacy of interferon beta (IFNbeta) products in 1173 patients with multiple sclerosis (MS) from the Department of Neurological and Psychiatric Sciences, University of Bari, Italy. Relapses and Expanded Disability Status Scale (EDSS) scores were evaluated for up to 6 years for Avonex, Betaferon and Rebif 22 groups, and for up to 3 years for the Rebif 44 group. IFNbeta products produced significant reductions from baseline in relapse rates at 2, 4 and >4 years (p<0.0001), with no differences among treatments (p=0.2). A modest significant (p<0.05) increase of EDSS was observed in all treatment groups from baseline to 48 months, followed thereafter by a plateau. The IFNbeta-1b group showed more withdrawals (19%) compared with Avonex (6%) and Rebif (7%) at 6 years.
Assuntos
Adjuvantes Imunológicos/uso terapêutico , Interferon beta/uso terapêutico , Esclerose Múltipla Crônica Progressiva/tratamento farmacológico , Esclerose Múltipla Recidivante-Remitente/prevenção & controle , Adulto , Estudos de Coortes , Avaliação da Deficiência , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Interferon beta-1a , Interferon beta-1b , Itália , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Crônica Progressiva/imunologia , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Esclerose Múltipla Recidivante-Remitente/imunologia , Vigilância da População , Vigilância de Produtos Comercializados , Estudos Prospectivos , Prevenção Secundária , Resultado do TratamentoRESUMO
Multiple sclerosis (MS) patients complain with the first symptoms of the disease in a range period which varies from childhood to adult life. The extent to which clinical presentation, disease course and demographic features may differ between childhood and adult onset has been the object of investigation. This paper aims to demonstrate that the different clinical phenotypes in young and old patients might simply reflect different phases of a same pathological process.