A prospective study on the natural history of multiple sclerosis: clues to the conduct and interpretation of clinical trials

Amato, Maria Pia; Ponziani, Giuseppina; Bartolozzi, Maria Letizia; Siracusa, G.

doi:10.1016/s0022-510x(99)00143-4

Cited by 118 publications

(103 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…She suffered additional neurologic impairment as a result of this traumatic hemorrhage confounding further assessment of any treatment. Her platelet count at the time of the injury was 88 000/mm 3 . This patient went on to develop progressive neurologic deterioration and died 18 months following the procedure.…”

Section: Safetymentioning

confidence: 99%

“…Over time most such patients eventually develop secondary progressive disease manifested as gradual neurologic impairment often progressing without acute relapses, although acute relapses may persist. [2][3][4][5][6] Natural history studies show that by 15 years following disease onset, at least 50%, and by 30 years at least 80%, of subjects lose the ability to ambulate without support. [6][7][8][9] Neurologic disability is defined at 0.5-step increments by the expanded disability status scale (EDSS) from zero (no disability) to 10.0 (death related to neurologic progression).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hematopoietic stem cell transplantation for progressive multiple sclerosis: failure of a total body irradiation–based conditioning regimen to prevent disease progression in patients with high disability scores

Burt

Cohen

Russell

et al. 2003

Blood

190

121

View full text Add to dashboard Cite

There were 21 patients with rapidly progressive multiple sclerosis (MS) treated on a phase 1/2 study of intense immune suppressive therapy and autologous hematopoietic stem cell (HSC) support with no 1-year mortality. Following transplantation, one patient had a confirmed acute attack of MS. Neurologic progression defined by the expanded disability status scale (EDSS) did not increase in disability by 1.0 or more steps in any of 9 patients with a pretransplantation EDSS of 6.0 or less. In 8 of 12 patients with high pretransplantation disability scores (EDSS > 6.0), progressive neurologic disability as defined by at least a 1-point increase in the EDSS has occurred and was manifested as gradual neurologic deterioration. There were 2 patients with a pretransplantation EDSS of 7.0 and 8.0 who died from complications of progressive disease at 13 and 18 months following treatment. Our experience suggests that intense immune suppression using a total body irradiation (TBI)-based regimen and hematopoietic stem cell transplantation (HSCT) are not effective for patients with progressive disease and high pretransplantation disability scores. Further studies are necessary to determine the role of intense immune suppressive therapy and HSC support in ambulatory patients with less accumulated disability and more inflammatory disease activity. Specifically, more patients and longer follow-up would be required in patients with an EDSS of 6.0 or less before drawing conclusions on this subgroup.

show abstract

Section: Safetymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hematopoietic stem cell transplantation for progressive multiple sclerosis: failure of a total body irradiation–based conditioning regimen to prevent disease progression in patients with high disability scores

Burt

Cohen

Russell

et al. 2003

Blood

190

121

View full text Add to dashboard Cite

show abstract

“…Indeed, frequency of cognitive dysfunction is high in MS, present in nearly half of patients, as soon as at the early stage of the disease, even in subjects with low disability [Amato et al, 1999;Bagert et al, 2002;Dujardin et al, 1998;Rao et al, 1991]. Dysfunction frequently concerns information processing speed and recall of recently learned verbal or visual information, one aspect of memory [Amato et al, 1999;Bagert et al, 2002;Dujardin et al, 1998;Rao et al, 1991].…”

Section: Introductionmentioning

confidence: 99%

Compensatory cortical activation observed by fMRI during a cognitive task at the earliest stage of multiple sclerosis

Audoin

Ibarrola

Ranjeva

et al. 2003

Human Brain Mapping

254

174

View full text Add to dashboard Cite

Recent functional magnetic resonance imaging (fMRI) studies have suggested that functional cortical changes seen in patients with early relapsing-remitting multiple sclerosis (MS) can have an adaptive role to limit the clinical impact of tissue injury. To determine whether cortical reorganization occurs during high cognitive processes at the earliest stage of multiple sclerosis (MS), we performed an fMRI experiment using the conventional Paced Auditory Serial Addition Test (PASAT) as paradigm in a population of ten patients with clinically isolated syndrome suggestive of multiple sclerosis (CISSMS). At the time of the fMRI exploration, mean disease duration was 6.8 Ϯ 3.3 months. We compared these results to those obtained in a group of ten education-, age-, and sex-matched healthy controls. Subjects were explored on a 1.5 T MRI system using single-shot gradient-echo EPI sequence. Performances of the two groups during PASAT recorded inside the MR scanner were not different. Statistical assessment of brain activation was based on the random effect analysis (between-group analysis two-sample t-test P Ͻ 0.005 confirmed by individual analyses performed in the surviving regions P Ͻ 0.05 Mann Whitney U-test). Compared to controls, patients showed significantly greater activation in the right frontopolar cortex, the bilateral lateral prefrontal cortices, and the right cerebellum. Healthy controls did not show greater activation compared to CISSMS patients. The present study argues in favor of the existence of compensatory cortical activations at the earliest stage of MS mainly located in regions involved in executive processing in patients performing PASAT. It also suggests that fMRI can evidence the active processes of neuroplasticity contributing to mask the clinical cognitive expression of brain pathology at the earliest stage of MS. Hum. Brain

show abstract

“…18 les symptômes associés à une poussée, comme les troubles moteurs plutôt que sensoriels et la localisation des lésions à l'origine d'une poussée, peuvent constituer d'importants facteurs pronostiques. il a été constaté une association faible entre les troubles sensitifs et l'évolution de la SEP [19][20][21] . une poussée de névrite optique est plus favorable qu'une ataxie grave, qui a été associée à des poussées multiples 22 .…”

Section: Indicateurs Cliniques De L'évolution De La Maladieunclassified

Paramètres cliniques, biochimiques et dimagerie prédictifs de I évolution de la sclérose en plaques

Svenningsson

Hendin²

2013

European Neurological Review

View full text Add to dashboard Cite

Mieux prédire Iévolution de la maladie et la réponse aux traitements de fond de la sclérose en plaques (SEP) pourrait améliorer les résultats de traitement en proposant aux patients une approche thérapeutique spécifique. Plusieurs facteurs affectant Iévolution de la maladie ont été identifiés, parmi lesquels : Iorigine ethnique, Iâge dapparition de la maladie, lâge des premiers symptômes, Iévolution au début de la maladie et les résultats dimagerie. Malgré les résultats mitigés des études des facteurs pronostiques à IIRM (Imagerie par Résonance Magnétique), les avancées technologiques améliorent la capacité prédictive de IIRM, et de nouvelles techniques et mesures fournissent dautres moyens pour prédire Iévolution de la maladie et la réponse au traitement. La recherché dun biomarqueur prédictif est un domaine de recherche trés actif, mais les études restent peu concluantes. Les biomarqueurs potentiels incluent les protéines des neurofilaments, les microARN, Iexpression génique et les anticorps. Étant donné quil est peu probable quun seul facteur puisse prédire le cours de la maladie, plusieurs systémes de notation composite ont été proposés, mais aucun na encore été largement accepté. Cependant, il semble probable quà Iavenir, une combinaison dIRM et de biomarqueurs biochimiques servira de base pour la décision thérapeutique dans la SEP et permettra une approche individualisée.

show abstract

A prospective study on the natural history of multiple sclerosis: clues to the conduct and interpretation of clinical trials

Cited by 118 publications

References 31 publications

Hematopoietic stem cell transplantation for progressive multiple sclerosis: failure of a total body irradiation–based conditioning regimen to prevent disease progression in patients with high disability scores

Hematopoietic stem cell transplantation for progressive multiple sclerosis: failure of a total body irradiation–based conditioning regimen to prevent disease progression in patients with high disability scores

Compensatory cortical activation observed by fMRI during a cognitive task at the earliest stage of multiple sclerosis

Paramètres cliniques, biochimiques et dimagerie prédictifs de I évolution de la sclérose en plaques

Contact Info

Product

Resources

About

A prospective study on the natural history of multiple sclerosis: clues to the conduct and interpretation of clinical trials

Cited by 118 publications

References 31 publications

Hematopoietic stem cell transplantation for progressive multiple sclerosis: failure of a total body irradiation–based conditioning regimen to prevent disease progression in patients with high disability scores

Hematopoietic stem cell transplantation for progressive multiple sclerosis: failure of a total body irradiation–based conditioning regimen to prevent disease progression in patients with high disability scores

Compensatory cortical activation observed by fMRI during a cognitive task at the earliest stage of multiple sclerosis

Paramètres cliniques, biochimiques et dimagerie prédictifs de I évolution de la sclérose en plaques

Contact Info

Product

Resources

About

Paramètres cliniques, biochimiques et dimagerie prédictifs de I évolution de la sclérose en plaques