Cognitive Impairment in Multiple Sclerosis With Regards to Disease Duration and Clinical Phenotypes

The relationships between cognitive impairment that exist during the clinical course of multiple sclerosis (MS) remain poorly described. The effect of disease duration has been studied in a few longitudinal cohorts and some cross-sectional studies that suggest that cognitive deficits tend to extend with disease duration. However, the effect of disease duration seems to be confounded by the effect of age. At the pre-clinical stage, cognitive deficits have been observed in patients with radiologically isolated syndromes, and their profile is similar than in clinically isolated syndromes (CIS) and relapsing-remitting MS (RRMS). The frequency of cognitive impairment tends to be higher in RRMS than in CIS. In these phenotypes, slowness of information processing speed (IPS) and episodic verbal and visuo-spatial memory deficits are frequently observed, but executive functions, and in particular verbal fluency, could also be impaired. More frequent and severe deficits are reported in SPMS than in RRMS with more severe deficits for memory tests, working memory and IPS. Similarly to what is observed in SPMS, patients with primary progressive MS (PPMS) present with a wide range of cognitive deficits in IPS, attention, working memory, executive functions, and verbal episodic memory with more tests and domains impaired than RRMS patients. Altogether these data suggested that not only the duration of the disease and age play an important role in the cognitive profile of patients, but also the phenotype itself, probably because of its specific pathological mechanism

Serum Neurofilament Levels and PML Risk in Patients With Multiple Sclerosis Treated With Natalizumab

Natalizumab; Neurofilamento séricoNatalizumab; Neurofilament sèricNatalizumab; Serum NeurofilamentObjectives The study aimed to assess the potential for serum neurofilament light chain (NFL) levels to predict the risk of progressive multifocal leukoencephalopathy (PML) in natalizumab (NTZ)-treated patients with multiple sclerosis (MS) and to discriminate PML from MS relapses. Methods NFL levels were measured with single molecule array (Simoa) in 4 cohorts: (1) a prospective cohort of patients with MS who developed PML under NTZ therapy (pre-PML) and non-PML NTZ-treated patients (NTZ-ctr); (2) a cohort of patients whose blood was collected during PML; (3) an independent cohort of non-PML NTZ-treated patients with serum NFL determinations at 2 years (replication cohort); and (4) a cohort of patients whose blood was collected during exacerbations. Results Serum NFL levels were significantly increased after 2 years of NTZ treatment in pre-PML patients compared with NTZ-ctr. The prognostic performance of serum NFL levels to predict PML development at 2 years was similar in the NTZ-ctr group and replication cohort. Serum NFL levels also distinguished PML from MS relapses and were 8-fold higher during PML compared with relapses. Conclusions These results support the use of serum NFL levels in clinical practice to identify patients with relapsing-remitting MS at higher PML risk and to differentiate PML from clinical relapses in NTZ-treated patients. Classification of Evidence This study provides Class I evidence that serum NFL levels can identify NTZ-treated patients with MS who will develop PML with a sensitivity of 67% and specificity of 80%

Regional hippocampal vulnerability in early multiple sclerosis: a dynamic pathological spreading from dentate gyrus to CA1

"This is the peer reviewed version of the following article: Planche, V., Koubiyr, I., Romero, J. E., Manjon, J. V., Coupé, P., Deloire, M., ... & Tourdias, T. (2018). Regional hippocampal vulnerability in early multiple sclerosis: Dynamic pathological spreading from dentate gyrus to CA 1. Human brain mapping, 39(4), 1814-1824., which has been published in final form at https://doi.org/10.1002/hbm.23970. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving."[EN] Background: Whether hippocampal subfields are differentially vulnerable at the earliest stages of multiple sclerosis (MS) and how this impacts memory performance is a current topic of debate. Method: We prospectively included 56 persons with clinically isolated syndrome (CIS) suggestive of MS in a 1-year longitudinal study, together with 55 matched healthy controls at baseline. Participants were tested for memory performance and scanned with 3T MRI to assess the volume of 5 distinct hippocampal subfields using automatic segmentation techniques. Results: At baseline, CA4/dentate gyrus was the only hippocampal subfield with a volume significantly smaller than controls (p < .01). After one year, CA4/dentate gyrus atrophy worsened (-6.4%, p < .0001) and significant CA1 atrophy appeared (both in the stratum-pyramidale and the stratum radiatum-lacunosum-moleculare, -5.6%, p < .001 and -6.2%, p < .01, respectively). CA4/dentate gyrus volume at baseline predicted CA1 volume one year after CIS (R-2 = 0.44 to 0.47, p < .001, with age, T2 lesion-load, and global brain atrophy as covariates). The volume of CA4/dentate gyrus at baseline was associated with MS diagnosis during follow-up, independently of T2-lesion load and demographic variables (p < .05). Whereas CA4/dentate gyrus volume was not correlated with memory scores at baseline, CA1 atrophy was an independent correlate of episodic verbal memory performance one year after CIS (beta = 0.87, p < .05). Conclusion: The hippocampal degenerative process spread from dentate gyrus to CA1 at the earliest stage of MS. This dynamic vulnerability is associated with MS diagnosis after CIS and will ultimately impact hippocampal-dependent memory performance.ARSEP Foundation; Bordeaux University Hospital; TEVA Laboratories; French Agence Nationale de la Recherche, Grant/Award Numbers: ANR-10-LABX-57, ANR-10-LABX-43, ANR-10-IDEX-03-02, ANR-10-COHO-002; UPV, Grant/Award Numbers: UPV2016-0099, TIN2013-43457-R; Ministerio de Economia y competitividadPlanche, V.; Koubiyr, I.; Romero Gómez, JE.; Manjón Herrera, JV.; Coupe, P.; Deloire, M.; Dousset, V.... (2018). Regional hippocampal vulnerability in early multiple sclerosis: a dynamic pathological spreading from dentate gyrus to CA1. 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Diagnostic and prognostic predictors in the early stages of multiple sclerosis

La sclérose en plaques (SEP) est la maladie chronique la plus fréquente parmi les pathologies neurologiques invalidantes non-traumatiques de l’adulte jeune en France. Le phénotype le plus fréquent est la SEP récurrente-rémittente (SEP-RR). Le diagnostic de SEP-RR est fondé sur la démonstration de la dissémination des lésions dans l'espace et dans le temps après un premier événement clinique démyélinisant dénommé syndrome clinique isolé (SCI). Les 2 principaux objectifs de cette thèse étaient de déterminer des marqueurs prédictifs d'un diagnostic précoce de la SEP après un SCI typique, et de démontrer que l’atteinte cognitive pouvait être utilisée comme un marqueur pronostique dès les stades précoces de la maladie. Le premier article décrit les résultats d’une étude rétrospective de 114 patients atteints d'un SCI médullaire. Le diagnostic de la SEP a été prédit par 3 facteurs indépendants: âge ≤40 ans, présence de bandes oligoclonales surnuméraires dans le liquide céphalo-rachidien ou une élévation de l’index IgG, et ≥3 lésions périventriculaires lors du SCI. Ces 3 facteurs prédictifs ont été validés dans une étude prospective de 652 patients avec différentes topographies de SCI (article 2). Il a été retrouvé des performances égales ou supérieures à celles des critères de dissémination spatiale proposés par McDonald et coll. pour la prédiction du diagnostic de la SEP après un SCI. Une fois le diagnostic de SEP établi, le principal défi consiste à évaluer la gravité de la maladie. Il manque de marqueurs prédictifs du handicap à long-terme. La perte axonale représente le substrat anatomique du handicap accumulé dans la SEP. Par ailleurs, les troubles cognitifs sont fréquents dans la SEP, ont été détectés dès les stades précoces de la maladie, et ont été associés à des marqueurs d’imagerie reflétant l’atteinte diffuse cérébrale. Par conséquent, l’atteinte cognitive semble être un candidat intéressant comme marqueur pronostique aux stades précoces de la SEP. Dans le troisième article, la relation entre les troubles cognitifs et les paramètres d’IRM reflétant l’atteinte diffuse cérébrale a été confirmé dans une étude longitudinale sur 7 ans de 44 patients ayant une SEP-RR nouvellement diagnostiquée. Dans le quatrième article, il a été montré la capacité de l’atteinte cognitive détectée après le diagnostic de SEP-RR à prédire la progression du handicap physique au cours du temps, étayant la valeur pronostique des déficits cognitifs dans la SEP. Dans le cinquième article, les évaluations cognitives ont été effectuées chez des patients présentant 2 phénotypes cliniques de SEP aux pronostics différents: SEP-RR et SEP progressive primaire (SEP-PP). L'étendue et la sévérité des déficits cognitifs étaient plus élevées chez les 41 patients ayant une SEP-PP par rapport aux 60 patients atteints de SEP-RR. Dans le sixième article, la valeur pronostique de l’atteinte cognitive dans la SEP a été illustrée par les effets négatifs des déficits cognitifs sur la qualité de la vie et les statuts professionnels de 48 patients atteints de SEP suivis pendant 7 ans. Après avoir montré que les déficits cognitifs pouvaient prédire l'invalidité précoce chez les patients atteints de SEP, et sachant que le handicap précoce est un marqueur prédictif de l’invalidité à long terme, la détection des déficits cognitifs apparaît comme une priorité dans la gestion des patients ayant une SEP. Par ailleurs, la vitesse de traitement de l'information (VTI) est le principal domaine cognitif altéré dans la SEP. Dans le septième article, un nouvel outil cognitif développé dans notre unité de recherche appelé «computerised speed cognitive test» a été utilisé pour détecter un ralentissement de la VTI dans un échantillon de 101 patients atteints de SEP et 415 sujets sains. Ce test a été associé à une excellente fiabilité, une bonne validité écologique, et de bonnes performances pour détecter un ralentissement de la VTI chez les patients atteints de SEP.Multiple sclerosis (MS) is the most frequent chronic, disabling, non-traumatic neurologic disease of young adults in France. Relapsing-remitting MS (RRMS) is the most frequent phenotype of this disease. The diagnosis of RRMS is based on the demonstration of the dissemination of lesions in space and time after a first typical clinical event, which is called a clinically isolated syndrome (CIS). The 2 main objectives of this thesis were, first, to investigate predictors of an early diagnosis of MS after a typical CIS and, second, to provide support for cognitive impairment as a potentially useful prognostic marker in the early stages of MS. The first article reported the results obtained in a retrospective study that included a homogeneous sample of 114 patients with a spinal cord CIS. The diagnosis of MS was predicted by 3 independent factors: ≤40 years of age, positive for oligoclonal bands in the cerebrospinal fluid or a raised IgG index, and ≥3 periventricular lesions at the time of the CIS. In the second article, a confirmation of the validity of these 3 predictive factors was provided through a large prospective study that included 652 patients with a CIS, regardless of the anatomical location of the lesions. Notably, these predictive factors achieved the same accuracy as the dissemination in space criteria which were proposed in the McDonald criteria for the prediction of the diagnosis of MS. Once an MS diagnosis is established, the main challenge is to assess the severity of the disease, and early clinical predictors of long-term disability are still lacking. The anatomical substrate of the disabilities that are accumulated in MS appears primarily to be cumulative axonal loss. Cognitive impairment is frequent in MS, even at the early stages of the disease, and has been associated with MRI markers of diffuse brain damage. Therefore, cognitive impairment appears to be an interesting candidate as a prognostic factor in the early stages of MS. In the third article, the relationship between cognitive impairment and MRI parameters reflecting early diffuse brain damage was confirmed in a 7-year longitudinal study of 44 newly diagnosed RRMS patients. In the fourth article, the ability of the cognitive impairment detected after RRMS diagnosis in this sample of patients to predict the progression of disability over time supported the prognostic value of cognitive deficits in early MS. In the fifth article, cognitive assessments were performed on patients with 2 clinical phenotypes of MS with different prognoses: RRMS and primary progressive MS (PPMS). The extent and the severity of cognitive deficits were greater in the 41 PPMS patients compared to the 60 RRMS patients; this finding supports the relationship between cognitive impairment and widespread brain damage. In the sixth article, the prognostic value of cognitive dysfunction in MS was illustrated through the negative impacts of cognitive deficits on the qualities of life and vocational statuses of 48 patients living with MS who were followed for 7 years. Finally, as cognitive deficits were shown to have the potential to predict early disability in patients with MS, and early disability is known to be relevant to predict long-term disability in MS, the detection of cognitive deficits appears to be a priority in managing patients with MS and adapting early-stage therapeutic strategies. Information processing speed (IPS) is the main cognitive domain impaired in MS that has clinical implications. In the seventh article, the ability of a new, in-house cognitive tool called the computerised speed cognitive test to detect lowered processing speed was assessed in a validation study using samples obtained from 101 patients with MS and 415 healthy subjects. This test was clinically relevant, and had excellent reliability, ecological validity, and predictive value for detecting IPS impairment in patients with MS

Diagnostic and prognostic predictors in the early stages of multiple sclerosis

La sclérose en plaques (SEP) est la maladie chronique la plus fréquente parmi les pathologies neurologiques invalidantes non-traumatiques de l’adulte jeune en France. Le phénotype le plus fréquent est la SEP récurrente-rémittente (SEP-RR). Le diagnostic de SEP-RR est fondé sur la démonstration de la dissémination des lésions dans l'espace et dans le temps après un premier événement clinique démyélinisant dénommé syndrome clinique isolé (SCI). Les 2 principaux objectifs de cette thèse étaient de déterminer des marqueurs prédictifs d'un diagnostic précoce de la SEP après un SCI typique, et de démontrer que l’atteinte cognitive pouvait être utilisée comme un marqueur pronostique dès les stades précoces de la maladie. Le premier article décrit les résultats d’une étude rétrospective de 114 patients atteints d'un SCI médullaire. Le diagnostic de la SEP a été prédit par 3 facteurs indépendants: âge ≤40 ans, présence de bandes oligoclonales surnuméraires dans le liquide céphalo-rachidien ou une élévation de l’index IgG, et ≥3 lésions périventriculaires lors du SCI. Ces 3 facteurs prédictifs ont été validés dans une étude prospective de 652 patients avec différentes topographies de SCI (article 2). Il a été retrouvé des performances égales ou supérieures à celles des critères de dissémination spatiale proposés par McDonald et coll. pour la prédiction du diagnostic de la SEP après un SCI. Une fois le diagnostic de SEP établi, le principal défi consiste à évaluer la gravité de la maladie. Il manque de marqueurs prédictifs du handicap à long-terme. La perte axonale représente le substrat anatomique du handicap accumulé dans la SEP. Par ailleurs, les troubles cognitifs sont fréquents dans la SEP, ont été détectés dès les stades précoces de la maladie, et ont été associés à des marqueurs d’imagerie reflétant l’atteinte diffuse cérébrale. Par conséquent, l’atteinte cognitive semble être un candidat intéressant comme marqueur pronostique aux stades précoces de la SEP. Dans le troisième article, la relation entre les troubles cognitifs et les paramètres d’IRM reflétant l’atteinte diffuse cérébrale a été confirmé dans une étude longitudinale sur 7 ans de 44 patients ayant une SEP-RR nouvellement diagnostiquée. Dans le quatrième article, il a été montré la capacité de l’atteinte cognitive détectée après le diagnostic de SEP-RR à prédire la progression du handicap physique au cours du temps, étayant la valeur pronostique des déficits cognitifs dans la SEP. Dans le cinquième article, les évaluations cognitives ont été effectuées chez des patients présentant 2 phénotypes cliniques de SEP aux pronostics différents: SEP-RR et SEP progressive primaire (SEP-PP). L'étendue et la sévérité des déficits cognitifs étaient plus élevées chez les 41 patients ayant une SEP-PP par rapport aux 60 patients atteints de SEP-RR. Dans le sixième article, la valeur pronostique de l’atteinte cognitive dans la SEP a été illustrée par les effets négatifs des déficits cognitifs sur la qualité de la vie et les statuts professionnels de 48 patients atteints de SEP suivis pendant 7 ans. Après avoir montré que les déficits cognitifs pouvaient prédire l'invalidité précoce chez les patients atteints de SEP, et sachant que le handicap précoce est un marqueur prédictif de l’invalidité à long terme, la détection des déficits cognitifs apparaît comme une priorité dans la gestion des patients ayant une SEP. Par ailleurs, la vitesse de traitement de l'information (VTI) est le principal domaine cognitif altéré dans la SEP. Dans le septième article, un nouvel outil cognitif développé dans notre unité de recherche appelé «computerised speed cognitive test» a été utilisé pour détecter un ralentissement de la VTI dans un échantillon de 101 patients atteints de SEP et 415 sujets sains. Ce test a été associé à une excellente fiabilité, une bonne validité écologique, et de bonnes performances pour détecter un ralentissement de la VTI chez les patients atteints de SEP.Multiple sclerosis (MS) is the most frequent chronic, disabling, non-traumatic neurologic disease of young adults in France. Relapsing-remitting MS (RRMS) is the most frequent phenotype of this disease. The diagnosis of RRMS is based on the demonstration of the dissemination of lesions in space and time after a first typical clinical event, which is called a clinically isolated syndrome (CIS). The 2 main objectives of this thesis were, first, to investigate predictors of an early diagnosis of MS after a typical CIS and, second, to provide support for cognitive impairment as a potentially useful prognostic marker in the early stages of MS. The first article reported the results obtained in a retrospective study that included a homogeneous sample of 114 patients with a spinal cord CIS. The diagnosis of MS was predicted by 3 independent factors: ≤40 years of age, positive for oligoclonal bands in the cerebrospinal fluid or a raised IgG index, and ≥3 periventricular lesions at the time of the CIS. In the second article, a confirmation of the validity of these 3 predictive factors was provided through a large prospective study that included 652 patients with a CIS, regardless of the anatomical location of the lesions. Notably, these predictive factors achieved the same accuracy as the dissemination in space criteria which were proposed in the McDonald criteria for the prediction of the diagnosis of MS. Once an MS diagnosis is established, the main challenge is to assess the severity of the disease, and early clinical predictors of long-term disability are still lacking. The anatomical substrate of the disabilities that are accumulated in MS appears primarily to be cumulative axonal loss. Cognitive impairment is frequent in MS, even at the early stages of the disease, and has been associated with MRI markers of diffuse brain damage. Therefore, cognitive impairment appears to be an interesting candidate as a prognostic factor in the early stages of MS. In the third article, the relationship between cognitive impairment and MRI parameters reflecting early diffuse brain damage was confirmed in a 7-year longitudinal study of 44 newly diagnosed RRMS patients. In the fourth article, the ability of the cognitive impairment detected after RRMS diagnosis in this sample of patients to predict the progression of disability over time supported the prognostic value of cognitive deficits in early MS. In the fifth article, cognitive assessments were performed on patients with 2 clinical phenotypes of MS with different prognoses: RRMS and primary progressive MS (PPMS). The extent and the severity of cognitive deficits were greater in the 41 PPMS patients compared to the 60 RRMS patients; this finding supports the relationship between cognitive impairment and widespread brain damage. In the sixth article, the prognostic value of cognitive dysfunction in MS was illustrated through the negative impacts of cognitive deficits on the qualities of life and vocational statuses of 48 patients living with MS who were followed for 7 years. Finally, as cognitive deficits were shown to have the potential to predict early disability in patients with MS, and early disability is known to be relevant to predict long-term disability in MS, the detection of cognitive deficits appears to be a priority in managing patients with MS and adapting early-stage therapeutic strategies. Information processing speed (IPS) is the main cognitive domain impaired in MS that has clinical implications. In the seventh article, the ability of a new, in-house cognitive tool called the computerised speed cognitive test to detect lowered processing speed was assessed in a validation study using samples obtained from 101 patients with MS and 415 healthy subjects. This test was clinically relevant, and had excellent reliability, ecological validity, and predictive value for detecting IPS impairment in patients with MS

Etude de 135 cas de myélites aiguës de l'adulte

BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

: Rapport d'expertise

L’expertise faisant l’objet de ce rapport a été sollicitée par l’association de l’Oppidum dans le cadre d’une étude de territoire, initiée en 2017, sur le secteur de Chaux-des-Crotenay, dans le département du Jura. Ce secteur, qui a fait l’objet de nombreuses polémiques, a été le lieu de travaux de recherches archéologiques durant près de 30 ans, sous l’égide d’André Berthier.L'expertise du fonds Berthier a consisté en une relecture des archives et en l’identification des mobiliers, afin de les réinsérer dans leur contexte de découverte.Cette analyse a notamment permis la mise en lumière d'un site rural antique puis médiéval aux "Étangs" de Crans, de plusieurs occurrences médiévales et modernes, dont de très probables fours à chaux à Chaux-des-Crotenay, et l'absence d'indice d'occupation protohistorique parmi les données recueillies par les équipes d'A. Berthier

: MR and cognitive decline in RRMS

International audienceThe main predictors of cognitive changes over 7 years are baseline diffuse brain damage and progressive central brain atrophy over the 2 years after MS diagnosis