Search

Aims: Our goal was to expand the spectrum of clinico-radiologic characteristics and the possible therapeutic choices in patients with tumefactive demyelinating lesions (TDLs). Methods: A retrospective analysis of 50 patients with at least one TDL was performed at an academic neurology center (2008–2020). Results: Our cohort comprised mostly women (33/50) with a mean age of 38 years at TDL onset. The mean follow-up time was 76 months. The mean Expanded Disability Status Scale score at TDL onset and at the latest neurological evaluation was 3.7 and 2.3, respectively. We subcategorized the patients into seven groups based mainly on the clinical/radiological findings and disease course. Group A included patients presenting with a Marburg-like TDL (n = 4). Groups B and C comprised patients presenting with monophasic (n = 7) and recurrent TDLs (n = 12), respectively. Multiple sclerosis (MS) patients who subsequently developed TDL (n = 16) during the disease course were categorized as Group D. Group E comprised patients who initially presented with TDL and subsequently developed a classical relapsing–remitting MS without further evidence of TDL (n = 5). Groups F (n = 2) and G (n = 4) involved MS patients who developed TDL during drug initiation (natalizumab, fingolimod) and cessation (interferon, fingolimod), respectively. Regarding long-term treatments applied after corticosteroid administration in the acute phase, B-cell-directed therapies were shown to be highly effective especially in cases with recurrent TDLs. Cyclophosphamide was spared for more aggressive disease indicated by a poor response to corticosteroids and plasma exchange failure. Conclusion: Tumefactive central nervous system demyelination is an heterogenous disease; its stratification into distinct groups according to different phenotypes can establish more efficient treatment strategies, thus improving clinical outcomes in the future. [ABSTRACT FROM AUTHOR]

Objectives - Multiple Sclerosis (MS) has been linked with the presence of coronary artery disease including Acute Coronary Syndrome with Normal Coronary Arteries (ACSNCA), but limited data exist regarding the underlying mechanisms. We aimed to explore potential classic risk factors and novel vascular biomarkers related to ACSNCA in MS patients. Methods - One hundred six patients with MS were enrolled. Two groups were defined according to the presence and/or history of ACSNCA. The presence of predisposing factors such as hypertension, diabetes, hyperlipidemia, smoking, obesity and family history was reported. Arterial stiffness and aortic wave reflections were also assessed by pulse wave velocity (PWV) and augmentation index, respectively, calculated by a validated, brachial cuff-based automated oscillometric device. Multiple logistic regression models were constructed to determine the strongest parameters related with the presence of ACSNCA. Results - Eleven patients with episodes of ACSNCA (Group-A) and 95 MS patients free of ACSNCA (Group-B) were identified. Among blood pressure parameters (peripheral and aortic), arterial stiffness and wave reflections, PWV had the strongest independent association with ACSNCA (enter-method). PWV values above 7 m/sec were related with the history of ACSNCA independently from age, diabetes and blood pressure. When all hemodynamic, arterial and classic risk factors were examined in a step-wise (backward) model diabetes and hyperlipidemia were the strongest independent factors associated with ACSNCA's presence. Conclusions - In MS patients, diabetes and hyperlipidemia represent the strongest, independent parameters related with the presence of ACSNCA. Arterial stiffness seems to play an underlying role in the development of ACSNCA which merits further investigation. [ABSTRACT FROM AUTHOR]

We aimed to determine whether Alemtuzumab-induced immune reconstitution affects immunoglobulin and complement levels in the serum of Relapsing-Remitting Multiple Sclerosis (RRMS) patients. IgG4-levels were increased 24-months after treatment initiation compared to baseline levels in twenty-nine patients. Alemtuzumab-treated patients with the highest IgG4-levels were more prone to thyroid-related autoimmune manifestations and specific autoimmune adverse events such as Crohn's disease, Graves' disease, and hemolytic anemia. Compared to baseline, total IgG-levels showed a trend towards reduced levels following two-courses of Alemtuzumab, but no significant change of C3 and/or C4-levels was observed. In conclusion, monitoring of IgG4-levels can serve as a marker for secondary autoimmunity risk in multiple sclerosis patients treated with Alemtuzumab. [Display omitted] • Distinct modulation pattern of serum IgG4 compared to IgG in Alemtuzumab treated Multiple Sclerosis patients. • IgG4/IgG ration displayed significant increase after 12-months from treatment initiation. • Patients with high IgG4-levels were more prone to autoimmune manifestations. • The highest IgG4 levels were found among patients developing Grave's disease. • Monitoring IgG4-levels could represent a surrogate marker of late-onset autoimmunity. [ABSTRACT FROM AUTHOR]