Resumen Introducción Solo el 20-26% de los pacientes con esclerosis múltiple presenta déficits en habilidades visuoespaciales-visuoconstructivas (VE-VC) pese a la frecuente afectación ...témporo-parieto-occipital en resonancia magnética. No hay estudios que analicen la relación entre estas funciones y el volumen lesional (VL) de estas áreas cerebrales. Objetivo Evaluar la relación del VL parieto-occipito-temporal y la atrofia subcortical con el rendimiento en funciones VE-VC en esclerosis múltiple. Metodología De 100 pacientes de esclerosis múltiple con evaluación neuropsicológica rutinaria se seleccionan 21 por afectación en habilidades VE-VC, medidas por Figuras incompletas, Cubos (WAIS-III) y Figura compleja de Rey-Osterrieth, y 13 sin déficit cognitivo (grupo control). El VL regional se cuantifica por un método semiautomático en secuencias FLAIR y T1, y la atrofia subcortical por el ratio bicaudado y la anchura del iii ventrículo (AIIIV). Se utilizan correlaciones parciales (controlando con edad y escolarización) y regresión lineal para analizar la relación entre los parámetros de resonancia magnética y el rendimiento cognitivo. Resultados Todas las medidas de VL y de atrofia cerebral son significativamente mayores en pacientes con deterioro cognitivo. El VL regional en FLAIR, ratio bicaudado y AIIIV muestran significativa correlación inversa con el rendimiento cognitivo, mayor entre la AIIIV y VC (Cubos: p = 0,001; Figura compleja de Rey-Osterrieth: p < 0,000). En el análisis multivariante, la AIIIV influye significativamente en tareas de VC (Cubos: p = 0,000; Figura compleja de Rey-Osterrieth: p = 0,000) y el VL regional en FLAIR en tareas VE (Figuras incompletas; p = 0,002). Conclusiones Las medidas de atrofia subcortical se relacionan con tareas de visuoconstrucción y el VL regional con tareas VE.
The treatment of symptomatic carotid near-occlusion is controversial. Our aim was to analyze the results of carotid endarterectomy and carotid artery stent placement in patients with symptomatic ...carotid near-occlusion and to identify factors related to technical failure, periprocedural complications, and restenosis.
We conducted a multicenter, prospective nonrandomized study. Patients with angiography-confirmed carotid near-occlusion were included. We assessed the revascularization rate and periprocedural stroke or death. Twenty-four-month clinical and carotid imaging follow-up was performed, and rates of carotid restenosis or occlusion, ipsilateral stroke, and mortality were analyzed. Carotid artery stent placement, carotid endarterectomy, and medical treatment were compared.
One hundred forty-one patients were included. Forty-four carotid artery stent placement and 23 carotid endarterectomy procedures were performed within 6 months after the event. Complete revascularization was achieved in 83.6%, 81.8% in the carotid artery stent placement group and 87% with carotid endarterectomy (
= .360). Periprocedural stroke or death occurred in 6% (carotid artery stent placement = 2.3%; carotid endarterectomy = 13%;
= .077) and was not related to revascularization failure. The carotid restenosis or occlusion rate was 8.3% (5% restenosis, 3.3% occlusion); with carotid artery stent placement it was 10.5%; and with carotid endarterectomy it was 4.5% (
= .419). The 24-month cumulative rate of ipsilateral stroke was 4.8% in the carotid artery stent placement group, 17.4% for carotid endarterectomy, and 13.1% for medical treatment (
= .223). Mortality was 12%, 4.5%, and 5.6%, respectively (
= .422). Revascularization failure and restenosis occurred more frequently in patients with full collapse compared with patients without full collapse (33.3% versus 5.6%,
= .009; 21.4% versus 2.9%,
= .032, respectively).
Carotid artery stent placement and carotid endarterectomy are associated with high rates of failure and periprocedural stroke. Carotid near-occlusion with full collapse appears to be associated with an increased risk of technical failure and restenosis. Carotid near-occlusion revascularization does not seem to reduce the risk of stroke at follow-up compared with medical treatment.
Background and purpose
The unanticipated detection by magnetic resonance imaging (MRI) in the brain of asymptomatic subjects of white matter lesions suggestive of multiple sclerosis (MS) has been ...named radiologically isolated syndrome (RIS). As the difference between early MS i.e. clinically isolated syndrome (CIS) and RIS is the occurrence of a clinical event, it is logical to improve detection of the subclinical form without interfering with MRI as there are radiological diagnostic criteria for that. Our objective was to use machine‐learning classification methods to identify morphometric measures that help to discriminate patients with RIS from those with CIS.
Methods
We used a multimodal 3‐T MRI approach by combining MRI biomarkers (cortical thickness, cortical and subcortical grey matter volume, and white matter integrity) of a cohort of 17 patients with RIS and 17 patients with CIS for single‐subject level classification.
Results
The best proposed models to predict the diagnosis of CIS and RIS were based on the Naive Bayes, Bagging and Multilayer Perceptron classifiers using only three features: the left rostral middle frontal gyrus volume and the fractional anisotropy values in the right amygdala and right lingual gyrus. The Naive Bayes obtained the highest accuracy overall classification, 0.765; area under the receiver operating characteristic (AUROC), 0.782.
Conclusions
A machine‐learning approach applied to multimodal MRI data may differentiate between the earliest clinical expressions of MS (CIS and RIS) with an accuracy of 78%.
Background and purpose
Although the causes of multiple sclerosis (MS) remain partially unknown, environmental and genetic factors are thought to play a role in its aetiopathogenesis. Hypovitaminosis ...D, Epstein–Barr virus (EBV) and human herpesvirus 6 (HHV‐6) infections have been described as possible MS triggers. Our aim was to analyse the possible link between 25‐hydroxyvitamin D 25(OH)D and viruses in patients with MS.
Methods
We included 482 patients with MS in a 2‐year study. Serum samples were collected to analyse 25(OH)D levels and, according to sample availability, antibody titres against EBV and HHV‐6 by enzyme‐linked immunosorbent assay. DNA was extracted from blood in order to analyse EBV and HHV‐6 viral load by quantitative real‐time polymerase chain reaction and to genotype MS‐related single nucleotide polymorphisms (rs3135388, rs2248359 and rs12368653) when possible.
Results
The 25(OH)D levels were significantly higher in the first semester of the year than in the second. Carriers of the risk allele rs2248359‐C showed lower 25(OH)D levels than non‐carriers. For EBV, viral load was significantly higher when 25(OH)D levels were low, demonstrating an inverse correlation between 25(OH)D levels and EBV load.
Conclusions
The 25(OH)D levels could be involved in the regulation of EBV replication/reactivation in patients with MS.
Purpose
The ultrasonographic and hemodynamic features of patients with carotid near-occlusion (CNO) are still not well known. Our aim was to describe the ultrasonographic and hemodynamic ...characteristics of a cohort of patients with CNO.
Methods
A prospective, observational, nationwide, and multicenter study was conducted from January/2010 to May/2016. Patients with digital subtraction angiography (DSA)–confirmed CNO were included. We collected information on clinical and demographic characteristics, carotid and transcranial ultrasonography and DSA findings, presence of full-collapse, collateral circulation, and cerebrovascular reactivity (CVR).
Results
One hundred thirty-five patients were analyzed. Ultrasonographic and DSA diagnosis of CNO were concordant in only 44%. This disagreement was related to the presence/absence of full-collapse: 45% of patients with CNO with full-collapse were classified as a complete carotid occlusion, and 40% with a CNO without full-collapse were interpreted as severe stenosis (
p
< 0.001). Mean velocities (mV) and pulsatility indexes (PIs) were significantly lower in the ipsilateral middle cerebral artery compared with the contralateral (43 cm/s vs 58 cm/s,
p
< 0.001; 0.80 vs 1.00,
p
< 0.001). Collateral circulation was identified in 92% of patients, with the anterior communicating artery (73%) being the most frequent. CVR was decreased or exhausted in 66% of cases and was more frequent in patients with a poor or absent collateral network compared with patients with ≥ 2 collateral arteries (82% vs 56%,
p
= 0.051).
Conclusion
The accuracy of carotid ultrasonography in the diagnosis of CNO seems to be limited, with significant discrepancies with DSA. Decreased ipsilateral mV, PI, and CVR suggest a hemodynamic compromise in patients with CNO.
Background and purpose
The risk of recurrent stroke amongst patients with symptomatic carotid near‐occlusion (SCNO) has not been clearly established, and its management remains controversial. The aim ...was to define the 24‐month risk of recurrent stroke and to analyse the effect of the different treatment modalities (medical treatment and revascularization) in a population of patients with SCNO.
Methods
A multicentre, nationwide, prospective study from January 2010 to May 2016 was performed. Patients with angiography‐confirmed SCNO were included. The primary end‐point was ipsilateral ischaemic stroke including periprocedural events within 24 months following the presenting event. Revascularization results and periprocedural complications, ipsilateral transient ischaemic attack, disabling or fatal stroke, and mortality were also noted.
Results
The study population comprised 141 patients from 17 Spanish centres. Seventy patients (49.6%) were treated by revascularization (carotid stenting in 47, endarterectomy in 23). Complete revascularization was achieved in 58 patients (83%). Periprocedural stroke or death occurred in 5.7%. The 24‐month cumulative incidence of the primary end‐point was 11.1% (95% confidence interval 5.8–16.4; n = 15), 12% in the medical treatment group and 10.2% in the revascularization group, log‐rank P = 0.817. The cumulative rates of ipsilateral ischaemic stroke or transient ischaemic attack, disabling or fatal stroke, and mortality, were 17%, 4.5% and 7.5%, respectively.
Conclusions
The rate of ipsilateral ischaemic stroke in patients with SCNO seems to be lower than the known rate associated with severe carotid stenosis without near‐occlusion. The potential benefit of revascularization in the prevention of stroke in patients with SCNO may be influenced by the effectiveness and safety of the procedure.
Introduction. Cognitive impairment (CI) affects 40–65% of patients with multiple sclerosis (MS). Few studies address telematic cognitive stimulation (TCS) in MS. The objective of this study is to ...evaluate the efficacy and impact of telestimulation or distance cognitive stimulation (TCS), with and without the support of face-to-face cognitive stimulation (FCS) in cognitive impairment in MS. Methods. Multicentre, prospective, randomised, controlled study. We will include 98 MS patients with EDSS ≤ 6, symbol digit modality test (SDMT) ≤ Pc 25, and Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ) > 26 points. Patients will be randomised into 3 groups, a TCS group, a mixed TCS/FCS group, and a control group. CS is performed 3 days a week for 3 months. Processing speed, memory, attention, and executive functions will be rehabilitated. FCS will include ecological exercises and strategies. EDSS and a cognitive evaluation (SDMT, CTMT, PASAT, and TAVEC), MSNQ, psychological impact scales (MSIS), and depression (BDI) will be carried out, baseline, postrehabilitation, and also 6 and 12 months later, to evaluate the effect of CS in the longer term. Conclusion. This study could help to establish the usefulness of TCS or, in its absence, TCS with face-to-face help for CI in MS. The interest lies in the clear benefits of remote rehabilitation in the daily life of patients.
Aims: Previous studies have reported the presence of low‐grade inflammation in Alzheimer disease (AD). Based on these data, our work attempts to investigate the effects of some promoter ...polymorphisms of pro‐inflammatory cytokines interleukin (IL)‐1 alpha and IL‐1 beta on AD.
Patients and methods: A PCR‐RFLP technique was used to analyze the promoter polymorphisms of both IL‐1 alpha (−889 C/T) and IL‐1 beta (−511 C/T) and the APOE genotype from the DNA samples of 282 patients (according to NINCDS‐ADRDA criteria) and 312 control subjects.
Results: (i) The risk of developing AD in our population was associated with the IL‐1 beta (−511 C/T) promoter polymorphism; (ii) such risk was independent of the risk factor allele in the APOE gene (APOE4); and (iii) the IL‐1 alpha promoter polymorphism (−889 C/T) was not associated with the disease.
Conclusion: In our population, IL‐1 beta promoter polymorphism (−511 C/T) is an independent risk factor for AD.
BackgroundPeginterferon beta-1a (PEGIFNβ-1a) is administered subcutaneously biweekly, which is an advantage over other treatment schedules used in multiple sclerosis (MS) patients.PurposeTo compare ...treatment satisfaction in MS patients treated with interferon beta-1a (IFNβ-1a) intramuscularly (30 µg weekly) after switching to PEGIFNβ-1a 125 µg administered subcutaneously every 2 weeks.Material and methodsThis was a prospective multicentre study. Adult MS patients switching from weekly intramuscular IFNβ-1a to biweekly PEGIFNβ-1a were included. Patient satisfaction was measured according to the Treatment Satisfaction Questionnaire for Medication (TSQM), which consists of 14 items scaled on a 5–7 point bipolar scale. Items are combined into four summary scores: effectiveness, side effects, convenience and overall satisfaction. Higher scores imply higher satisfaction. The Wilcoxon signed rank test was used for evaluating the differences. The study was approved by the ethics committee.Results35 patients were included. Mean age (±SD) was 44.9±8.6 years and 74.4% were women. Intramuscular IFNβ-1a was the firstline treatment for 88.6% of patients. Treatment duration before change was 64.4±50.5 months. Overall satisfaction and satisfaction in terms of effectiveness were higher for IFNβ-1a IM. Convenience was better evaluated for PEGIFNβ-1a. Side effects were reported in a similar percentage (table). 11.4% of patients returned to intramuscular IFNβ-1a.IFNβ-1a IMPEGIFNβ-1a SCp Value Effectiveness16.0±2.914.2±3.90.01Q1. Ability to treat/prevent condition5.4±1.44.9±1.50.03Q2. Ability to relieve symptoms5.3±1.24.9±1.40.06Q3. Time it takes medication to start working5.3±0.94.5±1.4<0.01Side effects13.5±2.812.3±2.90.08% who reported side effects94.193.9Q5. Bothersomeness of side effects3.0±0.72.8±0.80.18Q6. Interfere with physical function2.9±0.83.0±10.64Q7. Interfere with mental function4.0±1.13.7±0.90.18Q8. Impact overall satisfaction3.6±12.8±1.10.01Convenience15.3±2.816.9±2.6<0.01Q9. Ease/difficulty of use4.8±1.25.8±0.9<0.01Q10. Ease/difficulty of planning to use5.2±1.15.6±0.90.05Q11. Convenience of taking as instructed5.3±1.35.6±1.10.15Overall satisfaction13.1±2.411.9±3.20.02Q12. Confidence that taking medication is good4.9±1.53.6±10.01Q13. Certainty that good things outweigh bad4.9±1.43.5±10.02Q14. Satisfaction with medication5.2±1.24.8±1.40.08ConclusionSwitching from intramuscular IFNβ-1a to PEGIFNβ-1a resulted in better convenience and a similar reported rate of adverse effects although overall satisfaction was lower.No conflict of interest
About 20% to 26% of patients with multiple sclerosis (MS) show alterations in visuospatial/visuoconstructive (VS–VC) skills even though temporo-parieto-occipital impairment is a frequent finding in ...magnetic resonance imaging. No studies have specifically analysed the relationship between these functions and lesion volume (LV) in these specific brain areas.
To evaluate the relationship between VS–VC impairment and magnetic resonance imaging temporo-parieto-occipital LV with subcortical atrophy in patients with MS.
Of 100 MS patients undergoing a routine neuropsychological evaluation, 21 were selected because they displayed VS–VC impairments in the following tests: incomplete picture, block design (WAIS-III), and Rey–Osterrieth Complex Figure Test. We also selected 13 MS patients without cognitive impairment (control group). Regional LV was measured in FLAIR and T1-weighted images using a semiautomated method; subcortical atrophy was measured by bicaudate ratio and third ventricle width. Partial correlations (controlling for age and years of schooling) and linear regression analysis were employed to analyse correlations between magnetic resonance imaging parameters and cognitive performance.
All measures of LV and brain atrophy were significantly higher in patients with cognitive impairment. Regional LV, bicaudate ratio, and third ventricle width are significantly and inversely correlated with cognitive performance; the strongest correlation was between third ventricle width and VC performance (block design: P=.001; Rey–Osterrieth complex figure: P<.000). In the multivariate analysis, third ventricle width only had a significant effect on performance of VC tasks (block design: P=.000; Rey–Osterrieth complex figure: P=.000), and regional FLAIR VL was linked to the VS task (incomplete picture; P=.002).
Measures of subcortical atrophy explain the variations in performance on visuocostructive tasks, and regional FLAIR VL measures are linked to VS tasks.
Solo el 20-26% de los pacientes con esclerosis múltiple presenta déficits en habilidades visuoespaciales-visuoconstructivas (VE-VC) pese a la frecuente afectación témporo-parieto-occipital en resonancia magnética. No hay estudios que analicen la relación entre estas funciones y el volumen lesional (VL) de estas áreas cerebrales.
Evaluar la relación del VL parieto-occipito-temporal y la atrofia subcortical con el rendimiento en funciones VE-VC en esclerosis múltiple.
De 100 pacientes de esclerosis múltiple con evaluación neuropsicológica rutinaria se seleccionan 21 por afectación en habilidades VE-VC, medidas por Figuras incompletas, Cubos (WAIS-III) y Figura compleja de Rey-Osterrieth, y 13 sin déficit cognitivo (grupo control). El VL regional se cuantifica por un método semiautomático en secuencias FLAIR y T1, y la atrofia subcortical por el ratio bicaudado y la anchura del iii ventrículo (AIIIV). Se utilizan correlaciones parciales (controlando con edad y escolarización) y regresión lineal para analizar la relación entre los parámetros de resonancia magnética y el rendimiento cognitivo.
Todas las medidas de VL y de atrofia cerebral son significativamente mayores en pacientes con deterioro cognitivo. El VL regional en FLAIR, ratio bicaudado y AIIIV muestran significativa correlación inversa con el rendimiento cognitivo, mayor entre la AIIIV y VC (Cubos: p=0,001; Figura compleja de Rey-Osterrieth: p<0,000). En el análisis multivariante, la AIIIV influye significativamente en tareas de VC (Cubos: p=0,000; Figura compleja de Rey-Osterrieth: p=0,000) y el VL regional en FLAIR en tareas VE (Figuras incompletas; p=0,002).
Las medidas de atrofia subcortical se relacionan con tareas de visuoconstrucción y el VL regional con tareas VE.
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