Natalizumab, Fingolimod and Dimethyl Fumarate Use and Pregnancy-Related Relapse and Disability in Women With Multiple Sclerosis

To investigate pregnancy-related disease activity in a contemporary multiple sclerosis (MS) cohort

First-year treatment response predicts the following 5-year disease course in patients with relapsing-remitting multiple sclerosis

Predicting long-term prognosis and choosing the appropriate therapeutic approach in patients with Multiple Sclerosis (MS) at the time of diagnosis is crucial in view of a personalized medicine. We investigated the impact of early therapeutic response on the 5-year prognosis of patients with relapsing-remitting MS (RRMS). We recruited patients from MSBase Registry covering the period between 1996 and 2022. All patients were diagnosed with RRMS and actively followed-up for at least 5 years to explore the following outcomes: clinical relapses, confirmed disability worsening (CDW) and improvement (CDI), EDSS 3.0, EDSS 6.0, conversion to secondary progressive MS (SPMS), new MRI lesions, Progression Independent of Relapse Activity (PIRA). Predictors included demographic, clinical and radiological data, and sub-optimal response (SR) within the first year of treatment. Female sex (HR 1.27; 95 ​% CI 1.16–1.40) and EDSS at baseline (HR 1.19; 95 ​% CI 1.15–1.24) were independent risk factors for the occurrence of relapses during the first 5 years after diagnosis, while high-efficacy treatment (HR 0.78; 95 ​% CI 0.67–0.91) and age at diagnosis (HR 0.83; 95 ​% CI 0.79–0.86) significantly reduced the risk. SR predicted clinical relapses (HR ​= ​3.84; 95 ​% CI 3.51–4.19), CDW (HR ​= ​1.74; 95 ​% CI 1.56–1.93), EDSS 3.0 (HR ​= ​3.01; 95 ​% CI 2.58–3.51), EDSS 6.0 (HR ​= ​1.77; 95 ​% CI 1.43–2.20) and new brain (HR ​= ​2.33; 95 ​% CI 2.04–2.66) and spinal (HR 1.65; 95 ​% CI 1.29–2.09) MRI lesions. This study highlights the importance of selecting the appropriate DMT for each patient soon after MS diagnosis, also providing clinicians with a practical tool able to calculate personalized risk estimates for different outcomes

Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability

Importance: Understanding the association between pregnancy and clinical outcomes in women with moderate to severe multiple sclerosis (MS) disability is crucial for guiding family planning and management strategies. Objective: To assess peripregnancy relapse activity and disability progression in women with a preconception Expanded Disability Status Scale (EDSS) score of 3 or higher. Design, Setting, and Participants: This multicenter retrospective cohort study used data from the MSBase Registry, with clinical observations spanning 1984 through 2024. Study cohorts included pregnant women with MS with a preconception EDSS score of 3 or higher (range: 3-10, with higher scores indicating more severe MS-related disability) and propensity score-matched nonpregnant women with MS (controls). Main Outcomes and Measures: The main outcomes were peripregnancy annualized relapse rates (ARRs) and time to 6-month confirmed disability worsening (CDW). Results: A total of 1631 women with MS were included, of whom 575 were in the pregnant cohort (median [IQR] age at pregnancy, 32.5 [29.1-36.1] years) and 1056 were in the nonpregnant cohort (median [IQR] age, 32.6 [27.5-37.2] years). The median (range) preconception EDSS score was 3.5 (3.0-7.5). Relapse activity decreased during pregnancy, with a 75% reduction in ARR during the first trimester (rate ratio [RR], 0.25; 95% CI, 0.15-0.43), and increased to 36% above preconception levels in the first 3 months post partum (RR, 1.36; 95% CI, 1.06-1.75). Relapse during pregnancy was associated with a higher preconception ARR (odds ratio [OR], 1.56; 95% CI, 1.10-2.20) and preconception use of natalizumab (OR, 4.42; 95% CI, 1.24-23.57) or fingolimod (OR, 14.07; 95% CI, 2.81-91.30). Older age (OR, 0.92; 95% CI, 0.85-0.99) and continuation of disease-modifying therapy into pregnancy (OR, 0.42; 95% CI, 0.19-1.00) were associated with reduced risk. Disease-modifying therapy reinitiation within 1 month post partum was associated with lower odds of early postpartum relapse (OR, 0.45; 95% CI, 0.23-0.86). There was no significant difference in time to CDW between the pregnant and nonpregnant groups (hazard ratio [HR], 1.15; 95% CI, 0.96-1.38). However, ARR during pregnancy (HR, 1.37; 95% CI, 1.13-1.65) and postpartum EDSS score higher than 4 (HR, 2.69; 95% CI, 1.80-4.03) were associated with shorter time to CDW. Conclusions and Relevance: In this cohort study, women with moderate to severe MS disability exhibited a pattern of peripregnancy relapse activity similar to that reported in women with less disability. Pregnancy was not associated with worse long-term disability outcomes, although optimizing disease control in the peripregnancy period remained critical

Steroid-Responsive Myeloneuropathy Associated With Antithyroid Antibodies

Background/Objective: To present information about 2 steroid-responsive, antithyroid antibody-positive patients with myeloneuropathy and myelopathy

Brainstem encephalitis following influenza vaccination: Favorable response to steroid treatment

We report a 44-year-old man presenting with left hemiparesis following influenza vaccination. The neuroimaging studies showed a large, contrast-enhancing brainstem lesion and multiple punctate lesions suggesting microhaemorrhages in both cerebral hemispheres. The patient showed a remarkable response to high dose steroid treatment. Detailed diagnostic studies failed to yield any results supporting inflammatory/demyelinating diseases, suggesting that influenza vaccination might have been associated with the clinical findings. Our case implies that vaccination might be related with a wide range of clinical syndromes, including brainstem, encephalitis. (C) 2009 Elsevier Ltd. All rights reserved

Unihemispheric acute disseminated encephalomyelitis: A case report Tek hemisferi tutan akut dissemine ensefalomiyelit: Olgu sunumu

Acute disseminated encephalomyelitis (ADEM) is a rare idiopathic inflammatory demyelinating disease of the central nervous system (CNS), which usually occurs following a viral or bacterial infection, or vaccination. Characteristically, ADEM presents with acute encephalopathy with accompanying multifocal neurological symptoms and signs. Due to unavailability of a specific biological marker, neuroimaging is very important in establishing the diagnosis of ADEM. The typical magnetic resonance imaging findings of ADEM are large, multiple and almost symmetrical white matter lesions. Herein, we report a 31-year-old woman presenting with headache, confusion, left hemiparesis and hemihypoesthesia preceded by an infection. The patient fully recovered after intravenous methylprednisolone treatment. MRI revealed white-matter lesions that were typical for ADEM, but the unihemispheric involvment broadened the spectrum of disseminated encephalomyelitis. (Archives of Neuropsychiatry 2010; 47: 166-8

Tek Hemisferi Tutan Akut Dissemine Ensefalomiyelit: Olgu Sunumu

Acute disseminated encephalomyelitis (ADEM) is a rare idiopathic inflammatory demyelinating disease of the central nervous system (CNS), which usually occurs following a viral or bacterial infection, or vaccination. Characteristically, ADEM presents with acute encephalopathy with accompanying multifocal neurological symptoms and signs. Due to unavailability of a specific biological marker, neuroimaging is very important in establishing the diagnosis of ADEM. The typical magnetic resonance imaging findings of ADEM are large, multiple and almost symmetrical white matter lesions. Herein, we report a 31-year-old woman presenting with headache, confusion, left hemiparesis and hemihypoesthesia preceded by an infection. The patient fully recovered after intravenous methylprednisolone treatment. MRI revealed white-matter lesions that were typical for ADEM, but the unihemispheric involvment broadened the spectrum of disseminated encephalomyelitis. (Archives of Neuropsychiatry 2010; 47: 166-8