@article{pmid36827873,

title = {Epidemiology of multiple sclerosis in the Campania Region (Italy): Derivation and validation of an algorithm to calculate the 2015-2020 incidence},

author = {Giuseppina Affinito and Raffaele Palladino and Antonio Carotenuto and Daniele Caliendo and Roberta Lanzillo and Maria Grazia Fumo and Roberta Giordana and Massimo Di Gennaro and Claudia Iodice and Pasquale Macrì and Vincenzo Brescia Morra and Maria Triassi and Marcello Moccia},

doi = {10.1016/j.msard.2023.104585},

issn = {2211-0356},

year  = {2023},

date = {2023-03-01},

journal = {Mult Scler Relat Disord},

volume = {71},

pages = {104585},

abstract = {OBJECTIVE: We aim to validate an algorithm based on routinely-collected healthcare data to detect incidence of multiple sclerosis (MS) in the Campania Region (South Italy) and to explore its spatial and temporal variations.nnMETHODS: We included individuals resident in the Campania Region who had at least one MS record in administrative datasets (drug prescriptions, hospital discharge, outpatients), from 2015 to 2020. We merged administrative to the clinical datasets to ascertain the actual date of diagnosis, and validated the minimum interval from our study baseline (Jan 1, 2015) to first MS records in administrative datasets to detect incident cases. We used Bayesian approach to explore geographical distribution, also including deprivation index as a covariate in the estimation model. We used the capture-recapture method to estimate the proportion of undetected cases.nnRESULTS: The best performance was achieved by the 12-month interval algorithm, detecting 2,150 incident MS cases, with 74.4% sensitivity (95%CI = 64.1%, 85.9%) and 95.3% specificity (95%CI = 90.7%, 99.8%). The cumulative incidence was 36.68 (95%CI = 35.15, 38.26) per 100,000 from 2016 to 2020. The mean annual incidence was 7.34 (95%CI = 7.03, 7.65) per 100,000 people-year. The geographical distribution of MS relative risk shows a decreasing east-west incidence gradient. The number of expected MS cases was 11% higher than the detected cases.nnCONCLUSIONS: We validated a case-finding algorithm based on administrative data to estimate MS incidence, and its spatial/temporal variations. This algorithm provides up-to-date estimates of MS incidence, and will be used in future studies to evaluate changes in MS incidence in relation to different risk factors.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36241917,

title = {Clinical correlates of R1 relaxometry and magnetic susceptibility changes in multiple sclerosis: a multi-parameter quantitative MRI study of brain iron and myelin},

author = {Giuseppe Pontillo and Maria Petracca and Serena Monti and Mario Quarantelli and Roberta Lanzillo and Teresa Costabile and Antonio Carotenuto and Fabio Tortora and Andrea Elefante and Vincenzo Brescia Morra and Arturo Brunetti and Giuseppe Palma and Sirio Cocozza},

doi = {10.1007/s00330-022-09154-y},

issn = {1432-1084},

year  = {2023},

date = {2023-03-01},

journal = {Eur Radiol},

volume = {33},

number = {3},

pages = {2185--2194},

abstract = {OBJECTIVES: The clinical impact of brain microstructural abnormalities in multiple sclerosis (MS) remains elusive. We aimed to characterize the topography of longitudinal relaxation rate (R1) and quantitative susceptibility (χ) changes, as indices of iron and myelin, together with brain atrophy, and to clarify their contribution to cognitive and motor disability in MS.nnMETHODS: In this cross-sectional study, voxel-based morphometry, and voxel-based quantification analyses of R1 and χ maps were conducted in gray matter (GM) and white matter (WM) of 117 MS patients and 53 healthy controls. Voxel-wise between-group differences were assessed with nonparametric permutation tests, while correlations between MRI metrics and clinical variables (global disability, cognitive and motor performance) were assessed both globally and voxel-wise within clusters emerging from the between-group comparisons.nnRESULTS: MS patients showed widespread R1 decrease associated with more limited modifications of χ, with atrophy mainly involving deep GM, posterior and infratentorial regions (p < 0.02). While R1 and χ showed a parallel reduction in several WM tracts (p < 0.001), reduced GM R1 values (p < 0.001) were associated with decreased thalamic χ (p < 0.001) and small clusters of increased χ in the caudate nucleus and prefrontal cortex (p < 0.02). In addition to the atrophy, χ values in the cingulum and corona radiata correlated with global disability and motor performance, while focal demyelination correlated with cognitive performance (p < 0.04).nnCONCLUSIONS: We confirmed the presence of widespread R1 changes, involving both GM and WM, and atrophy in MS, with less extensive modifications of tissue χ. While atrophy and χ changes are related to global and motor disability, R1 changes are meaningful correlates of cognition.nnKEY POINTS: • Compared to healthy controls, multiple sclerosis patients showed R1 and χ changes suggestive of iron increase within the basal ganglia and reduced iron and myelin content within (subnuclei of) the thalamus. • Thalamic volume and χ changes significantly predicted clinical disability, as well as pulvinar R1 and χ changes, independently from atrophy. • Atrophy-independent R1 and χ changes, suggestive of thalamic iron and myelin depletion, may represent a sensitive marker of subclinical inflammation.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36902555,

title = {Alemtuzumab-Related Lymphocyte Subset Dynamics and Disease Activity or Autoimmune Adverse Events: Real-World Evidence},

author = {Elisabetta Signoriello and Giacomo Lus and Francesco Saccà and Marco Puthenparampil and Cinzia Coppola and Andrea Di Pietro and Gianfranco Puoti and Maria Cristina Criscuolo and Matteo Foschi and Giuseppina Miele and Gianmarco Abbadessa and Vincenzo Brescia Morra and Paolo Gallo and Simona Bonavita and Maria Pia Sormani and Alessio Signori},

doi = {10.3390/jcm12051768},

issn = {2077-0383},

year  = {2023},

date = {2023-02-01},

journal = {J Clin Med},

volume = {12},

number = {5},

abstract = {BACKGROUND AND OBJECTIVES: alemtuzumab is a monoclonal anti-CD52 antibody acting on B and T cells in highly active multiple sclerosis (MS). We analyzed changes in lymphocyte subsets after alemtuzumab administration in relation to disease activity and autoimmune adverse events.nnMETHODS: lymphocyte subset counts were assessed longitudinally using linear mixed models. Subset counts at baseline and during follow-up were correlated with relapse rate, adverse events, or magnetic resonance (MRI) activity.nnRESULTS: we recruited 150 patients followed for a median of 2.7 years (IQR: 1.9-3.7). Total lymphocytes, CD4, CD8, and CD20 significantly decreased in all patients over 2 years ( < 0.001). Previous treatment with fingolimod increased the risk of disease activity and adverse events ( = 0.029). We found a higher probability of disease reactivation in males and in patients with over three active lesions at baseline. Higher EDSS scores at baseline and longer disease duration predicted the switch to other treatments after alemtuzumab.nnDISCUSSION AND CONCLUSIONS: Our real-world study supports data from clinical trials in which lymphocyte subsets were not useful for predicting disease activity or autoimmune disease during treatment. The early use of an induction therapy such as alemtuzumab in patients with a lower EDSS score and short history of disease could mitigate the risk of treatment failure.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36229193,

title = {Monoaminergic network abnormalities: a marker for multiple sclerosis-related fatigue and depression},

author = {Antonio Carotenuto and Paola Valsasina and Paolo Preziosa and Damiano Mistri and Massimo Filippi and Maria A Rocca},

doi = {10.1136/jnnp-2022-330109},

issn = {1468-330X},

year  = {2023},

date = {2023-02-01},

journal = {J Neurol Neurosurg Psychiatry},

volume = {94},

number = {2},

pages = {94--101},

abstract = {OBJECTIVE: To investigate monoaminergic network abnormalities in patients with multiple sclerosis (MS) according to their fatigue and depressive status through a positron emission tomography (PET)-based constrained independent component analysis (ICA) on resting state (RS) functional MRI (fMRI).nnMETHODS: In this prospective study, 213 patients with MS (mean age=40.6±12.5 years; 94/119 men/women; 153 relapsing-remitting; 60 progressive) and 62 healthy controls (HCs, mean age=39.0±10.4 years; 30/32 men/women) underwent neurological, fatigue, depression and RS fMRI assessment. Patterns of dopamine, norepinephrine-related and serotonin-related RS functional connectivity (FC) were derived by ICA, constrained to PET atlases for dopamine, norepinephrine and serotonin transporters, obtained in HCs' brain.nnRESULTS: Compared with HCs, patients with MS showed abnormalities in all three explored monoaminergic networks, mostly with decreased RS FC within PET-guided monoaminergic networks in frontal regions and subcortical areas including the cerebellum and thalamus, and increased RS FC in temporo-parieto-occipital cortical areas, including bilateral precunei.MS-related fatigue was associated with decreased RS FC within the PET-guided dopamine network in the left thalamus and left cerebellum, and with increased RS FC within the PET-guided serotonin network in the left middle occipital gyrus. MS-related depression was associated with more distributed abnormalities involving the three explored monoaminergic networks, resulting in overall reduced RS FC in the frontal lobe, limbic areas and the precuneus.nnCONCLUSIONS: Patients with MS present diffuse dysregulation in the monoaminergic networks. Specific alterations in these networks were associated with fatigue and depression, providing a pathological marker for these bothersome symptoms and putative targets for their treatment.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36410373,

title = {Multiple sclerosis progression: time for a new mechanism-driven framework},

author = {Tanja Kuhlmann and Marcello Moccia and Timothy Coetzee and Jeffrey A Cohen and Jorge Correale and Jennifer Graves and Ruth Ann Marrie and Xavier Montalban and V Wee Yong and Alan J Thompson and Daniel S Reich and },

doi = {10.1016/S1474-4422(22)00289-7},

issn = {1474-4465},

year  = {2023},

date = {2023-01-01},

journal = {Lancet Neurol},

volume = {22},

number = {1},

pages = {78--88},

abstract = {Traditionally, multiple sclerosis has been categorised by distinct clinical descriptors-relapsing-remitting, secondary progressive, and primary progressive-for patient care, research, and regulatory approval of medications. Accumulating evidence suggests that the clinical course of multiple sclerosis is better considered as a continuum, with contributions from concurrent pathophysiological processes that vary across individuals and over time. The apparent evolution to a progressive course reflects a partial shift from predominantly localised acute injury to widespread inflammation and neurodegeneration, coupled with failure of compensatory mechanisms, such as neuroplasticity and remyelination. Ageing increases neural susceptibility to injury and decreases resilience. These observations encourage a new consideration of the course of multiple sclerosis as a spectrum defined by the relative contributions of overlapping pathological and reparative or compensatory processes. New understanding of key mechanisms underlying progression and measures to quantify progressive pathology will potentially have important and beneficial implications for clinical care, treatment targets, and regulatory decision-making.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37434878,

title = {Multiple sclerosis patients treated with cladribine tablets: expert opinion on practical management after year 4},

author = {Diego Centonze and Maria Pia Amato and Vincenzo Brescia Morra and Eleonora Cocco and Nicola De Stefano and Claudio Gasperini and Paolo Gallo and Carlo Pozzilli and Maria Trojano and Massimo Filippi},

doi = {10.1177/17562864231183221},

issn = {1756-2856},

year  = {2023},

date = {2023-01-01},

journal = {Ther Adv Neurol Disord},

volume = {16},

pages = {17562864231183221},

abstract = {Multiple sclerosis (MS) is a chronic, progressive neurological disease involving neuroinflammation, neurodegeneration, and demyelination. Cladribine tablets are approved for immune reconstitution therapy in patients with highly active relapsing-remitting MS based on favorable efficacy and tolerability results from the CLARITY study that have been confirmed in long-term extension studies. The approved 4-year dosing regimen foresees a cumulative dose of 3.5 mg/kg administered in two cycles administered 1 year apart, followed by 2 years of observation. Evidence on managing patients beyond year 4 is scarce; therefore, a group of 10 neurologists has assessed the available evidence and formulated an expert opinion on management of the growing population of patients now completing the approved 4-year regimen. We propose five patient categories based on response to treatment during the first 4-year regimen, and corresponding management pathways that envision close monitoring with clinical visits, magnetic resonance imaging (MRI) and/or biomarkers. At the first sign of clinical or radiological disease activity, patients should receive a highly effective disease-modifying therapy, comprising either a full cladribine regimen as described in regulatory documents (cumulative dose 7.0 mg/kg) or a comparably effective treatment. Re-treatment decisions should be based on the intensity and timing of onset of disease activity, clinical and radiological assessments, as well as patient eligibility for treatment and treatment preference.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36114980,

title = {Unmet needs and gaps in the identification of secondary progression in multiple sclerosis: a Southern Italy healthcare professionals' perspective},

author = {Giacomo Lus and Marco André Bassano and Vincenzo Brescia Morra and Simona Bonavita and Antonio Gallo and Davide Maimone and Laura Malerba and Giorgia Teresa Maniscalco and Francesco Saccà and Giuseppe Salemi and Renato Turrini and Salvatore Cottone and Edoardo Sessa and Maria Buccafusca and Luigi Maria Edoardo Grimaldi},

doi = {10.1007/s10072-022-06402-3},

issn = {1590-3478},

year  = {2023},

date = {2023-01-01},

journal = {Neurol Sci},

volume = {44},

number = {1},

pages = {45--58},

abstract = {OBJECTIVE: Multiple sclerosis (MS) is a chronic disease with different clinical courses and a tendency to worsening. The relapsing-remitting MS presents acute onset and relapses of neurological symptoms, followed by their remission. This form can convert to secondary progressive MS (SPMS) with irreversible neurological worsening and disability. The identification of signs, symptoms, markers of progression, and strategies to manage MS patients is mandatory to allow early identification of those at higher risk of conversion to SPMS, for prompt intervention to cope with the progression of the disease.nnMETHODS: A panel of Italian experts from Southern Italy have reviewed the current knowledge on MS and its management and identified the crucial tools for SPMS recognition.nnRESULTS: More effective communication between patients and clinicians should be established, with the support of digital tools. Moreover, the improvement in the clinical use of biomarkers for progression (cellular structures and tissue organization, such as neurofilaments and chitinase 3-like 1, axonal and neurons density) and of instrumental analyses for recognition of whole-brain atrophy, chronic active lesions, spinal cord lesions and atrophy, and the improvement the combination of the Expanded Disability Status Scale and the evaluation of cognitive dysfunction are discussed.nnCONCLUSION: Given the availability of a pharmacological option, adequate education both for patients, regarding the evolution of the disease and the specific treatment, and for professionals, to allow more effective and sensitive communication and the best use of diagnostic and management tools, could represent a strategy to improve patient management and their quality of life.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36776745,

title = {Impact of treatment with dimethyl fumarate on sleep quality in patients with relapsing-remitting multiple sclerosis: A multicentre Italian wearable tracker study},

author = {Giancarlo Comi and Letizia Leocani and Luigi Ferini-Strambi and Marta Radaelli and Gloria D Costa and Roberta Lanzillo and Giacomo Lus and Valentina Bianchi and Sebastiano Traccis and Fioravante Capone and Luigi Me Grimaldi and Giuseppe Salemi and Alessandra Cardillo and Valentina Zipoli and },

doi = {10.1177/20552173221144229},

issn = {2055-2173},

year  = {2023},

date = {2023-01-01},

journal = {Mult Scler J Exp Transl Clin},

volume = {9},

number = {1},

pages = {20552173221144229},

abstract = {BACKGROUND: Sleep disorders are common in patients with multiple sclerosis and have a bidirectional interplay with fatigue and depression.nnOBJECTIVE: To evaluate the effect of treatment with oral dimethyl fumarate on the quality of sleep in relapsing-remitting multiple sclerosis.nnMETHODS: This was a multicentre observational study with 223 relapsing-remitting multiple sclerosis subjects starting treatment with dimethyl fumarate (=177) or beta interferon (=46). All patients underwent subjective (Pittsburgh Sleep Quality Index) and objective (wearable tracker) measurements of quality of sleep. Fatigue, depression, and quality of life were also investigated and physical activity was monitored.nnRESULTS: Patients treated with dimethyl fumarate had significant improvement in the quality of sleep as measured with the Pittsburgh Sleep Quality Index (<0.001). At all-time points, no significant changes in Pittsburgh Sleep Quality Index score were observed in the interferon group. Total and deep sleep measured by wearable tracker decreased at week 12 with both treatments, then remained stable for the total study duration. Depression significantly improved in patients treated with dimethyl fumarate. No significant changes were observed in mobility, fatigue and quality of life.nnCONCLUSION: In patients with relapsing-remitting multiple sclerosis, the treatment with dimethyl fumarate was associated with improvements in patient-reported quality of sleep. Further randomised clinical trials are needed to confirm the benefits of long-term treatment with dimethyl fumarate.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37332984,

title = {Aging in multiple sclerosis: from childhood to old age, etiopathogenesis, and unmet needs: a narrative review},

author = {Nicola Capasso and Eleonora Virgilio and Antonio Covelli and Beatrice Giovannini and Matteo Foschi and Federico Montini and Martina Nasello and Annacarmen Nilo and Elio Prestipino and Giuseppe Schirò and Silvia Sperandei and Marinella Clerico and Roberta Lanzillo},

doi = {10.3389/fneur.2023.1207617},

issn = {1664-2295},

year  = {2023},

date = {2023-01-01},

journal = {Front Neurol},

volume = {14},

pages = {1207617},

abstract = {Multiple sclerosis (MS) primarily affects adult females. However, in the last decades, rising incidence and prevalence have been observed for demographic extremes, such as pediatric-onset MS (POMS; occurring before 18 years of age) and late-onset MS (corresponding to an onset above 50 years). These categories show peculiar clinical-pathogenetic characteristics, aging processes and disease courses, therapeutic options, and unmet needs. Nonetheless, several open questions are still pending. POMS patients display an important contribution of multiple genetic and environmental factors such as EBV, while in LOMS, hormonal changes and pollution may represent disease triggers. In both categories, immunosenescence emerges as a pathogenic driver of the disease, particularly for LOMS. In both populations, patient and caregiver engagement are essential from the diagnosis communication to early treatment of disease-modifying therapy (DMTs), which in the elderly population appears more complex and less proven in terms of efficacy and safety. Digital technologies (e.g., exergames and e-training) have recently emerged with promising results, particularly in treating and following motor and cognitive deficits. However, this offer seems more feasible for POMS, being LOMS less familiar with digital technology. In this narrative review, we discuss how the aging process influences the pathogenesis, disease course, and therapeutic options of both POMS and LOMS. Finally, we evaluate the impact of new digital communication tools, which greatly interest the current and future management of POMS and LOMS patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36436395,

title = {The independent contribution of brain, spinal cord and gadolinium MRI in treatment decision in multiple sclerosis: A population-based retrospective study},

author = {Giulia Dallera and Giuseppina Affinito and Daniele Caliendo and Maria Petracca and Antonio Carotenuto and Maria Triassi and Vincenzo Brescia Morra and Raffaele Palladino and Marcello Moccia},

doi = {10.1016/j.msard.2022.104423},

issn = {2211-0356},

year  = {2023},

date = {2023-01-01},

journal = {Mult Scler Relat Disord},

volume = {69},

pages = {104423},

abstract = {BACKGROUND: Spinal cord and gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) can provide additional information to brain MRI to determine prognosis of multiple sclerosis (MS). However, the real-world impact of routine use of brain MRI with spinal cord and/or Gd sequences is unknown. Our aim was to evaluate the effect of brain, spinal cord and Gd MRI on treatment decisions in MS.nnMETHODS: In this 2015-2020 population-based study, we performed a retrospective analysis on MS patients resident in the Campania Region (South Italy), with disease modifying treatment (DMT) prescription (n = 6,161). DMTs were classified as platform (dimethyl fumarate, glatiramer acetate, interferon-beta, peg-interferon-beta, teriflunomide), or high-efficacy (alemtuzumab, cladribine, fingolimod, natalizumab, ocrelizumab). We evaluated the association between binary MRI variables and switch from platform to high-efficacy DMT using multivariable logistic regression.nnRESULTS: The likelihood of switch from platform to high-efficacy DMT was 47% higher when including post-Gd acquisitions to brain and/or spinal cord MRI, 59% higher when including spinal cord acquisitions to brain MRI, and 132% higher when including any MRI compared with no MRI (all p < 0.05). The likelihood of switch to high-efficacy DMT decreased over time from treatment start.nnCONCLUSION: Our results show that spinal cord and Gd MRI acquisitions can provide relevant information to influence subsequent treatment decisions, especially in early treatment phases, compared with stand-alone brain MRI.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36048265,

title = {Ocrelizumab effect on humoral and cellular immunity in multiple sclerosis and its clinical correlates: a 3-year observational study},

author = {Nicola Capasso and Raffaele Palladino and Vincenza Cerbone and Antonio Luca Spiezia and Bianca Covelli and Antonia Fiore and Roberta Lanzillo and Antonio Carotenuto and Maria Petracca and Lucia Stanziola and Giulia Scalia and Vincenzo Brescia Morra and Marcello Moccia},

doi = {10.1007/s00415-022-11350-1},

issn = {1432-1459},

year  = {2023},

date = {2023-01-01},

journal = {J Neurol},

volume = {270},

number = {1},

pages = {272--282},

abstract = {OBJECTIVE: We aim to evaluate 3-year effects of ocrelizumab (humanized anti-CD20 monoclonal antibody for the treatment of multiple sclerosis (MS)) on lymphocytes, neutrophils and immunoglobulins: (1) when compared with pre-infusion assessment; (2) over the course of treatment; and (3) possible clinical correlates of the observed immunological modifications.nnMETHODS: This real-world observational cohort study has been conducted on prospectively collected data from 78 MS patients (mean age 47.8 ± 10.5 years; females 48.7%) commencing on ocrelizumab from 2018, with mean follow-up of 36.5 ± 6.8 months. Clinical data and blood samples were collected every three months. Total lymphocyte count and subpopulations were assessed on peripheral blood using flow cytometry. Serum immunoglobulins were evaluated with nephelometry.nnRESULTS: When compared with pre-infusion values, we observed reduction of total, CD19 and CD20 lymphocyte counts; however, after the first infusion, their levels remained substantially stable. Over time we observed a progressive reduction of CD8 lymphocytes, while no changes were observed for CD4, CD27, CD3CD27, and CD19CD27. After the first infusion, we observed reduction in IgG, which further decreased during the follow-up. Higher probability of EDSS progression was associated with reduced modulation of CD8 lymphocytes.nnINTERPRETATION: Ocrelizumab affects both humoral and cellular immune responses. Disability progression over the follow-up was associated with lower CD8 cytotoxic T-lymphocyte reduction. Changes in humoral response are immediate and sustained, while modulation of cellular immunity occurs progressively through regular re-treatment, and is related to clinical stability.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36464666,

title = {Multimodal imaging in differential diagnosis between papilledema and choroidal neovascularization associated with morning glory syndrome},

author = {Gilda Cennamo and Daniela Montorio and Vincenzo Brescia Morra and Ciro Costagliola},

doi = {10.1177/11206721221143606},

issn = {1724-6016},

year  = {2022},

date = {2022-12-01},

journal = {Eur J Ophthalmol},

pages = {11206721221143606},

abstract = {PURPOSE: To describe the role of optical coherence tomography angiography (OCTA) to help in differential diagnosis between papilledema and a rare case of choroidal neovascularization (CNV) associated with Morning Glory Syndrome (MGS).nnMETHODS: Observational case report.nnRESULTS: A 22-year old man was referred to Eye clinic from Neurological unit with a diagnosis of papilledema in right eye. OCTA scans on the optic disc revealed a dense radial peripapillary vascular network while two polypoidal choroidal vasculopathy (PCV) were present in peripapillary region at the edge of staphyloma in corrispondence of choriocapillary layer. Therefore, the patient underwent three-monthly intravitreal injections of anti-vascular endothelial growth factor. One and six months after loading phase, the PCVs showed no clinical activity at structural spectral domain-OCT and OCTA.nnCONCLUSION: This case revealed the crucial role of OCTA as an efficace diagnostic technique in discriminating papilledema from MGS complicated by CNV, allowing to make differential diagnosis, useful in ophthalmological and neurological clinical practice.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36086905,

title = {Signs and symptoms of COVID-19 in patients with multiple sclerosis},

author = {Irene Schiavetti and Luca Carmisciano and Marta Ponzano and Cinzia Cordioli and Eleonora Cocco and Girolama Alessandra Marfia and Matilde Inglese and Massimo Filippi and Marta Radaelli and Roberto Bergamaschi and Paolo Immovilli and Marco Capobianco and Nicola De Rossi and Giampaolo Brichetto and Cinzia Scandellari and Paola Cavalla and Ilaria Pesci and Paolo Confalonieri and Paola Perini and Maria Trojano and Roberta Lanzillo and Gioacchino Tedeschi and Giancarlo Comi and Mario Alberto Battaglia and Francesco Patti and Marco Salvetti and Maria Pia Sormani and },

doi = {10.1111/ene.15554},

issn = {1468-1331},

year  = {2022},

date = {2022-12-01},

journal = {Eur J Neurol},

volume = {29},

number = {12},

pages = {3728--3736},

abstract = {BACKGROUND AND PURPOSE: Clinical outcomes of multiple sclerosis (MS) patients affected by coronavirus disease 2019 (COVID-19) have been thoroughly investigated, but a further analysis on main signs and symptoms and their risk factors still needs attention. The objective of this study was to group together and describe based on similarity the most common signs and symptoms of COVID-19 in MS patients and identify all factors associated with their manifestation.nnMETHOD: Logistic and linear regression models were run to recognize factors associated with each pooled group of symptoms and their total number.nnRESULTS: From March 2020 to November 2021, data were collected from 1354 MS patients with confirmed infection of COVID-19. Ageusia and anosmia was less frequent in older people (odds ratio [OR] 0.98; p = 0.005) and more in smoker patients (OR 1.39; p = 0.049). Smoke was also associated with an incremental number of symptoms (OR 1.24; p = 0.031), substance abuse (drugs or alcohol), conjunctivitis and rash (OR 5.20; p = 0.042) and the presence of at least one comorbidity with shortness of breath, tachycardia or chest pain (OR 1.24; p = 0.008). Some disease-modifying therapies were associated with greater frequencies of certain COVID-19 symptoms (association between anti-CD20 therapies and increment in the number of concomitant symptoms: OR 1.29; p = 0.05). Differences in frequencies between the three waves were found for flu-like symptoms (G1, p = 0.024), joint or muscle pain (G2, p = 0.013) and ageusia and anosmia (G5, p < 0.001). All cases should be referred to variants up to Delta.nnCONCLUSION: Several factors along with the choice of specific therapeutic approaches might have a different impact on the occurrence of some COVID-19 symptoms.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35971322,

title = {Towards a validated definition of the clinical transition to secondary progressive multiple sclerosis: A study from the Italian MS Register},

author = {Pietro Iaffaldano and Giuseppe Lucisano and Tommaso Guerra and Francesco Patti and Marco Onofrj and Vincenzo Brescia Morra and Mauro Zaffaroni and Carlo Pozzilli and Eleonora Cocco and Patrizia Sola and Giuseppe Salemi and Matilde Inglese and Roberto Bergamaschi and Claudio Gasperini and Antonella Conte and Marco Salvetti and Giacomo Lus and Giorgia Teresa Maniscalco and Rocco Totaro and Marika Vianello and Franco Granella and Elisabetta Ferraro and Umberto Aguglia and Maurizia Gatto and Francesca Sangalli and Clara Grazia Chisari and Giovanna De Luca and Antonio Carotenuto and Damiano Baroncini and Delia Colombo and Mihaela Nica and Damiano Paolicelli and Giancarlo Comi and Massimo Filippi and Maria Pia Amato and Maria Trojano},

doi = {10.1177/13524585221114007},

issn = {1477-0970},

year  = {2022},

date = {2022-12-01},

journal = {Mult Scler},

volume = {28},

number = {14},

pages = {2243--2252},

abstract = {BACKGROUND: Definitions for reliable identification of transition from relapsing-remitting multiple sclerosis (MS) to secondary progressive (SP)MS in clinical cohorts are not available.nnOBJECTIVES: To compare diagnostic performances of two different data-driven SPMS definitions.nnMETHODS: Data-driven SPMS definitions based on a version of Lorscheider's algorithm (DDA) and on the EXPAND trial inclusion criteria were compared, using the neurologist's definition (ND) as gold standard, in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), Akaike information criterion (AIC) and area under the curve (AUC).nnRESULTS: A cohort of 10,240 MS patients with ⩾5 years of follow-up was extracted from the Italian MS Registry; 880 (8.5%) patients were classified as SPMS according to the neurologist definition, 1806 (17.6%) applying the DDA and 1134 (11.0%) with the EXPAND definition. The DDA showed greater discrimination power (AUC: 0.8 vs 0.6) and a higher sensitivity (77.1% vs 38.0%) than the EXPAND definition, with similar specificity (88.0% vs 91.5%). PPV and NPV were higher using the DDA than considering EXPAND definition (37.5% vs 29.5%; 97.6% vs 94.0%).nnCONCLUSION: Data-driven definitions demonstrated greater ability to capture SP transition than neurologist's definition and the global accuracy of DDA seems to be higher than the EXPAND definition.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35953597,

title = {Persistence, adherence, healthcare resource utilization and costs for ocrelizumab in the real-world of the Campania Region of Italy},

author = {Marcello Moccia and Giuseppina Affinito and Giulia Berera and Giuseppina Marrazzo and Raffaele Piscitelli and Antonio Carotenuto and Maria Petracca and Roberta Lanzillo and Maria Triassi and Vincenzo Brescia Morra and Raffaele Palladino},

doi = {10.1007/s00415-022-11320-7},

issn = {1432-1459},

year  = {2022},

date = {2022-12-01},

journal = {J Neurol},

volume = {269},

number = {12},

pages = {6504--6511},

abstract = {AIMS: We aim to provide real-world evidence on the use of ocrelizumab for treating multiple sclerosis (MS), with specific regard to prescription pattern, adherence, persistence, healthcare resource utilization and related costs, also in relation to other disease-modifying treatments (DMTs).nnMETHODS: We included 2495 people with MS from the Campania Region (South Italy) who received first or switch DMT prescription from Jan 2018 to Dec 2020, and with at least 6-month follow-up. We collected hospital discharge records, drug prescriptions, and related costs, and calculated persistence (time from first prescription to discontinuation or switch to other DMT), adherence (proportion of days covered (PDC)), annualized hospitalization rate (AHR) for MS-related hospital admissions, and DMT costs.nnRESULTS: Ocrelizumab was the most commonly prescribed DMT (n = 399; age = 45.74 ± 10.98 years; females = 224), after dimethyl fumarate (n = 588) and fingolimod (n = 401); 26% patients treated with ocrelizumab were naïve. When compared with ocrelizumab, the risk of discontinuation was higher for other highly active DMTs (HR = 3.78; p = 0.01), and low/medium efficacy DMTs (HR = 7.59; p < 0.01). When compared with ocrelizumab, PDC was similar to other highly active DMTs (Coeff = 0.01; p = 0.31), but higher for low/medium efficacy DMTs (Coeff = 0.09; p < 0.01). When compared with ocrelizumab, AHR was similar to other highly active DMTs (Coeff = 0.01; p = 0.51), and low/medium efficacy DMTs (Coeff = 0.01; p = 0.55). When compared with ocrelizumab, DMT monthly costs were higher for other highly active DMTs (Coeff = 92.30; p < 0.01), but lower for low/medium efficacy DMTs (Coeff = - 1043.61; p < 0.01).nnDISCUSSION: Ocrelizumab was among the most frequently prescribed DMTs, with 26% prescriptions to treatment-naïve patients, suggesting its relevance in addressing unmet clinical needs (e.g., first approved treatment for primary progressive MS). Ocrelizumab was associated with the highest persistence, confirming its favorable benefit-risk profile. Costs for ocrelizumab were lower than those associated to similarly effective DMTs, in absence of changes in healthcare resource utilization.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35064863,

title = {Mental Health in Multiple Sclerosis During the COVID-19 Outbreak: A Delicate Balance between Fear of Contagion and Resilience},

author = {Laura Rosa and Cristiano Scandurra and Alessandro Chiodi and Maria Petracca and Teresa Costabile and Francesca Lauro and Marcello Moccia and Antonio Carotenuto and Nelson Mauro Maldonato and Vincenzo Brescia Morra and Roberta Lanzillo},

doi = {10.1007/s10880-022-09849-w},

issn = {1573-3572},

year  = {2022},

date = {2022-12-01},

journal = {J Clin Psychol Med Settings},

volume = {29},

number = {4},

pages = {798--807},

abstract = {The current study aimed at exploring the relationship between objective disability, illness perceptions, resilience, fear of COVID-19, and psychological distress (i.e., anxiety, depression, and stress) in people with multiple sclerosis (pwMS) during the second wave of the COVID-19 outbreak. A group of 122 pwMS recruited in an Italian university hospital took part in this cross-sectional monocentric study. Hierarchical multiple linear regression analyses were performed to assess the strength of the hypothesized associations. Results indicated that, differently from cognitive impairment, motor disability was positively associated with anxiety. However, accounting for subjective illness perception, such association was no longer significant. Moreover, accounting for both protective and risk factors in the models, even illness perception was no longer significant, highlighting the central role of resilience and fear of COVID-19 in explaining the negative emotional outcomes. Implications for clinical interventions and psychoeducational trainings are discussed.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36385137,

title = {Global disparities in SARS-CoV-2 genomic surveillance},

author = {Anderson F Brito and Elizaveta Semenova and Gytis Dudas and Gabriel W Hassler and Chaney C Kalinich and Moritz U G Kraemer and Joses Ho and Houriiyah Tegally and George Githinji and Charles N Agoti and Lucy E Matkin and Charles Whittaker and  and  and  and  and  and  and  and  and Benjamin P Howden and Vitali Sintchenko and Neta S Zuckerman and Orna Mor and Heather M Blankenship and Tulio de Oliveira and Raymond T P Lin and Marilda Mendonça Siqueira and Paola Cristina Resende and Ana Tereza R Vasconcelos and Fernando R Spilki and Renato Santana Aguiar and Ivailo Alexiev and Ivan N Ivanov and Ivva Philipova and Christine V F Carrington and Nikita S D Sahadeo and Ben Branda and Céline Gurry and Sebastian Maurer-Stroh and Dhamari Naidoo and Karin J von Eije and Mark D Perkins and Maria van Kerkhove and Sarah C Hill and Ester C Sabino and Oliver G Pybus and Christopher Dye and Samir Bhatt and Seth Flaxman and Marc A Suchard and Nathan D Grubaugh and Guy Baele and Nuno R Faria},

doi = {10.1038/s41467-022-33713-y},

issn = {2041-1723},

year  = {2022},

date = {2022-11-01},

journal = {Nat Commun},

volume = {13},

number = {1},

pages = {7003},

abstract = {Genomic sequencing is essential to track the evolution and spread of SARS-CoV-2, optimize molecular tests, treatments, vaccines, and guide public health responses. To investigate the global SARS-CoV-2 genomic surveillance, we used sequences shared via GISAID to estimate the impact of sequencing intensity and turnaround times on variant detection in 189 countries. In the first two years of the pandemic, 78% of high-income countries sequenced >0.5% of their COVID-19 cases, while 42% of low- and middle-income countries reached that mark. Around 25% of the genomes from high income countries were submitted within 21 days, a pattern observed in 5% of the genomes from low- and middle-income countries. We found that sequencing around 0.5% of the cases, with a turnaround time <21 days, could provide a benchmark for SARS-CoV-2 genomic surveillance. Socioeconomic inequalities undermine the global pandemic preparedness, and efforts must be made to support low- and middle-income countries improve their local sequencing capacity.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36394286,

title = {Applying a Military Teleophthalmology Mobile App in a Noncombat Emergent Care Setting},

author = {Robert T Chung and Gary L Legault and Jennifer S Stowe and Kyle E Miller and Michelle A Moccia and Mabel R Cooper and Jeanette R Little and William G Gensheimer},

doi = {10.1093/milmed/usac345},

issn = {1930-613X},

year  = {2022},

date = {2022-11-01},

journal = {Mil Med},

abstract = {INTRODUCTION: Teleophthalmology has a natural role in the military due to the inherent organization of its medical system, which provides care to patients in remote locations around the world. Improving access to ophthalmic care enhances force readiness because ocular trauma and disease can cause vision impairment or blindness and can occur anywhere service members are located. Recently, a secure, Health Insurance Portability and Accountability Act-compliant mobile phone application (app) for teleophthalmology called Forward Operating Base Expert Telemedicine Resource Utilizing Mobile Application for Trauma (FOXTROT) was beta tested in Afghanistan and demonstrated that this solution can improve and extend ophthalmic care in a deployed environment. There are few civilian or military teleophthalmology solutions for ocular trauma and disease in an urgent or emergent ophthalmic care setting. Civilian teleophthalmology solutions have largely been developed for disease-specific models of care. In this work, we address this gap by testing the FOXTROT app in a non-deployed, emergent care setting.nnMATERIALS AND METHODS: We evaluated the use of the teleophthalmology mobile phone app (FOXTROT) in a non-deployed military setting at the Malcolm Grow Medical Clinics and Surgery Center at Joint Base Andrews in Maryland. Consults from the emergent care center were placed by providers using the app, and the on-call ophthalmologist responded with treatment and management recommendations. The primary outcomes were response within the requested time, visual acuity tested in both eyes, agreement between the teleophthalmology and the final diagnosis, and the number of communication or technical errors that prevented the completion of consults. The secondary outcomes were average response time and the number of consults uploaded to the medical record.nnRESULTS: From October 2020 to January 2022, 109 consults were received. Ten consults had communication or technical errors that prevented the completion of consults within the app and were excluded from the analysis of completed consults. Of the 99 completed consults, responses were given within the requested time in 95 (96.0%), with the average response time in 11 minutes 48 seconds (95% confidence interval, 8 minutes 57 seconds to 14 minutes 41 seconds). Visual acuity was tested in both eyes in 56 (56.6%). There was agreement between the teleophthalmology diagnosis and the final diagnosisin 40 of 50 (80.0%) consults with both a teleophthalmology and final diagnosis. Ninety-eight (99.0%) consults were uploaded to the patient's medical record.nnCONCLUSIONS: Beta testing of a teleophthalmology mobile phone app (FOXTROT) in a noncombat emergent care setting demonstrated that this solution can extend ophthalmic care in this environment at a military treatment facility. However, improvements in the reliability of the platform are needed in future developments to reduce communication and technical errors.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}