Author Of 4 Presentations
P0262 - Searching for Fabry disease in previously diagnosed CIS and defined MS patients: a cohort study. (ID 1693)
Fabry disease (FD) is a rare panethnic x-linked lysosomal storage disorder that can mimic MS, and thus must be considered in differential diagnosis. While clinical profile and MRI studies can overlap, some other considerations help distinguish them, like presence of CSF oligoclonal bands and medullary demyelinating lesions for MS and multi-organ involvement and positive familiar history for FD. In our center a patient was diagnosed with MS in 2004, and with FD in 2015, due to in depth-analysis following the clue of a positive family history.
To identify the possible presence of unacknowledged FD in a cohort of Italian patients previously diagnosed with CIS or MS.
We enrolled consecutive CIS and MS patient that fulfilled McDonald revised criteria referred to our center. In female subjects, the GLA gene was analyzed by PCR and sequencing of the entire coding region. In male subjects the concentration of the alpha-galactosidase enzyme in dry blood spot was measured with fluorescence spectroscopy. For these purposes we used Centogene diagnostic kit for Fabry disease.
411 patients (300 females) were enrolled, 21 with a diagnosis of CIS and 390 with definite MS, mean age 45.5 years (SD:12.0), mean disease duration 15.3 years (SD:10.1), mean EDSS 2.5 (SD:1.9). No one of them presented pathogenic mutations of GLA gene or alpha-galactosidase deficiencies.
Although the diagnosis of FD must be ruled out when studying a patient with suspected MS, the systematic genetic or enzymatic analysis of every patient doesn’t appear necessary in everyday clinical practice. The analysis of GLA gene and of alpha-galactosidase activity should be reserved for patients with elements suspicious for FD, like a positive family history and multi organ involvement (especially renal impairment and angiokeratomas). Our patient with both the diagnosis, other than positive family history, later developed proteinuria as systemic dysfunction; she also showed demyelinating lesions on brain and spinal cord MRI, sometimes with Gadolinium enhancement, and intrathecal synthesis of oligoclonal bands (type 3). Clarifying the correct diagnosis is of fundamental importance due to the different therapeutic approaches.
P0883 - MRI activity and extended interval of Natalizumab dosing: a multicenter Italian study (ID 1269)
- M. Clerico
- S. De Mercanti
- A. Signori
- M. Iudicello
- C. Cordioli
- E. Signoriello
- G. Lus
- S. Bonavita
- L. Lavorgna
- G. Maniscalco
- E. Curti
- L. Lorefice
- E. Cocco
- V. Nociti
- M. Mirabella
- D. Baroncini
- G. Mataluni
- D. Landi
- M. Petruzzo
- R. Lanzillo
- I. Gandoglia
- A. Laroni
- R. Frangiamore
- A. Sartori
- P. Cavalla
- G. Costantini
- M. Sormani
- R. Capra
Extending the natalizumab interval after the 24th administration could reduce the risk of progressive multifocal leukoencephalopathy (PML) without efficacy reduction.
To evaluate the non-inferiority of the efficacy of an extended interval dosing (EID) regimen compared with the standard interval dosing (SID) of natalizumab regarding the multiple sclerosis (MS) MRI activity.
It is an observational, multicenter (14 Italian centers), retrospective cohort study, starting from the 24th natalizumab infusion to the loss of follow-up or 2 years after baseline. Patients were grouped in 2 categories according to the mean number of weeks between doses: < 5 weeks, SID; ≥ 5 weeks, EID. Three hundred and eight patients were enrolled. Median dose interval (MDI) following 24th infusion was 5 weeks, with a bimodal distribution (modes at 4 and 6 weeks).
Two hundred and sixteen patients were in the SID group (MDI = 4.4 weeks) and 144 in the EID group (MDI 6 weeks). The risk to develop active lesions on MRI is similar in SID and EID groups during the 6 and 12 months after the 24th natalizumab infusion, respectively 2.98% (95% CI: 0.56-5.40) vs 3.32% (95% CI: 0.00-6.65%) [p=0.88] and 6.65% (95% CI: 3.02-10.29) vs 5.67% (95% CI: 1.76-9.58%) [p=0.73]. The EID regimen does not increase the occurrence of MRI activity after 6 and 12 months.
There is no evidence of a reduced efficacy of natalizumab in an EID setting regarding the MRI activity. This observation confirms previous clinical results and together with the increasing evidence of a reduced risk of PML associated to an EID regimen, supports the need of a bigger randomized study to assess the need to change the standard of the natalizumab dosing schedule, in order to better manage JCV-positive patients after 24 doses of natalizumab.
P1003 - A cohort analysis of MS patients exposed to high-dose corticosteroids (ID 768)
Corticosteroids in high dose (HDC) is the recommended treatment for multiple sclerosis (MS) relapses. Most common first line treatment consists of three to five days courses of 1 g of intravenous methylprednisolone. The choice of HDC duration varies due to different clinical considerations.
Our aim was to determine which demographic factors, comorbidities and MS clinical considerations led to the choice of a longer or shorter HDC course duration, also exploring the possible effect on clinical benefit reported by treated patients after one month.
MS subjects with a clinical relapse of MS or with MRI activity who underwent a treatment with HDC were enrolled. Demographics (sex and age), clinical features (type of relapse and EDSS) and medical history (occurrence of metabolic, immune and psychiatric comorbidities) were collected prior to HDC. After a month, subjective clinical benefit was also evaluated. Regression models were used to evaluate the relationships of HDC duration and clinical benefits after 1 month with demographic and medical variables.
101 MS patients were enrolled (mean age 44 years, male 24.8%, mean EDSS 3.1). Most of them (92.1%) had a clinical relapse (31.1% with multisystem involvement), 7.9% only had brain MRI activity. 66.3% were on DMDs. 36.6% had comorbidities (autoimmune comorbidities 16.8%) and 45.8% had mood disorder. Linear regression showed that older age (p 0.039) and psychiatric comorbidities (p 0.019) correlate with the choice of shorter HDC treatment (3 days). Conversely, multisystem deficit relapses correlate with the choice of longer treatment (5 days) (p 0.001). Subjective clinical benefit after one month was only associated with EDSS score pre HCD treatment (p 0.004), while no association was reported with number of days of treatment.
Data suggests that some clinical factors, such as severity of relapse, age and comorbidities can affect the choice of HDC course duration. Shorter HDC treatments in selected patients appear to be an appropriate treatment option that does not affect the reported clinical benefit.
P1011 - Complications after lumbar puncture: a preliminary comparative analysis on the use of atraumatic vs standard needle (ID 805)
Lumbar puncture (LP) is a frequently used procedure in Multiple Sclerosis (MS) diagnosis. Atraumatic needles have been proposed to reduce complication rates after lumbar puncture (LP), despite this, many clinicians prefer to continue using standard needles.
The study aimed to evaluate the frequency of post procedural headache, low back pain and other complications in a cohort of multiple sclerosis (MS) patients underwent LP by using atraumatic or standard needle.
The study included patients underwent the procedure of LP. Demographic (gender, age, BMI) and clinical features (disease duration) were collected for each patient. In addition, information on chronic headache and its treatment were also recorded. For each patient, it was indicated whether the LP was performed with the use of standard or atraumatic needle. Then, the occurrence of post-procedural complications (headache, low back pain and nausea) and the possible relationships with the type of needle used was investigated.
The study included 100 patients (28% male; mean age 42.3±11.9 years). 21% of these had a history of chronic headache with use of medications for 5%. Regression analysis showed that lower body mass index (p 0.032) and younger age (p 0.002) were associated with the use of atraumatic needles, while no association was reported with gender. A lower frequency of post-procedural headache (31% vs 50.7%) and low back pain (34.5% vs 40.8%) were reported respectively by using atraumatic vs standard needles (p<0.05). Multivariate analyses showed that post-procedural headache, with a tendency toward statistical significance (p=0.058), but not low back pain and nausea were associated to the use of standard needles after controlling for other demographic variables. Finally, an association between lower back pain and female gender (p=0.018), and between nausea and lower BMI (p=0.032) were also reported.
Our data seem to suggest the usefulness of the atraumatic needle for PL to prevent post procedural headache. Further investigations into larger cohorts are needed.