DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

Émergence d’objets connectés dans la santé : évaluation des déficits neurologiques des membres inférieurs chez des patients atteints de sclérose en plaques à l’aide du Myo

La sclérose en plaques (SEP) est une maladie chronique auto-immune démyélinisante à l’origine de multiples lésions inflammatoires disséminées dans le système nerveux central (SNC) impliquant de nombreux mécanismes immunologiques. L’évaluation et la prise en charge de la progression de la maladie restent à ce jour un défi. L’objectif de ma thèse est donc de démontrer que l’analyse de paramètres biomécaniques et cinétiques simples d'un bracelet biosenseur, le Myo, permet de suivre et quantifier les déficits neurologiques, notamment moteurs et d’équilibre, chez les patients atteints de SEP.MATÉRIELS ET MÉTHODESNous avons réalisé une étude préliminaire prospective, monocentrique, non randomisée, ouverte, contrôlée où nous avons inclus 20 patients sur les 62 patients atteints de sclérose en plaques et suivis au Centre Hospitalier Universitaire (CHU) de Nantes de janvier 2018 à décembre 2018 inclus dans le projet Myo. Les patients ont réalisé plusieurs tests cliniques dont le score EDSS, un test de marche, un test de Romberg et une épreuve talon-genou et ont rempli plusieurs questionnaires dont un pEDSS.RÉSULTATS 20 patients atteints de SEP et 5 témoins appariés en fonction de l’âge et du sexe ont été inclus dans mon travail de thèse. Les moyennes des vitesses de rotation augmentent avec la sévérité de la maladie selon l’axe x, y, z avec r(x) = 0.558, r(y) = 0.328 , r(z) = 0.443 et respectivement p=0.00029, p=0.000298, p=0.0003 lors du test de Romberg. Il existe une corrélation significative négative entre l’accélération linéaire selon l’axe x avec r(x) = -0.731 ( p-=0.030) et l’axe y avec r(y) = -0.273 ( p-=0.0002) , et positive selon l’axe z avec r(z) = 0.792 ( p=10 -4 ). Lors du test de marche, les moyennes d’accélération linéaire diminuent globalement et significativement avec la sévérité de la maladie pour l’axe x avec r(x) =-0.731 ( p=0.0305) , l’axe y avec r(y) = -0.273 avec ( p=0.0002) et augmentent avec l’axe z avec r(z) = 0.792 ( p-value =10 -4 ). CONCLUSIONMon travail de thèse a montré une corrélation entre certaines mesures du bracelet connecté Myo et la sévérité de la Sclérose en plaques. Le Myo permet de différencier le profil de contraction musculaire des membres inférieurs chez des patients par rapport aux sujets sains avec notamment une majoration du signal d’activité musculaire du muscle tibial antérieur et de détecter des troubles de la stabilité posturale

Post-vaccine COVID-19 in patients with multiple sclerosis or neuromyelitis optica

International audienceIntroduction: Recent studies suggested that anti-CD20 and fingolimod may be associated with lower anti-spike protein-based immunoglobulin-G response following COVID-19 vaccination. We evaluated if COVID-19 occurred despite vaccination among patients with multiple sclerosis (MS) and neuromyelitis optica (NMO), using the COVISEP registry. Case series: We report 18 cases of COVID-19 after two doses of BNT162b2-vaccination, 13 of which treated with anti-CD20 and four with fingolimod. COVID-19 severity was mild. Discussion: These results reinforce the recommendation for a third COVID-19 vaccine dose among anti-CD20 treated patients, and stress the need for a prospective clinical and biological study on COVID-19 vaccine efficacy among MS and NMO patients

Association of clinical, biological, and brain magnetic resonance imaging findings with electroencephalographic findings for patients with COVID-19

International audienceImportance: There is evidence of central nervous system impairments associated with coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Multimodal monitoring of patients with COVID-19 may delineate the specific features of COVID-19-related encephalopathy and guide clinical management.Objectives: To investigate clinical, biological, and brain magnetic resonance imaging (MRI) findings in association with electroencephalographic (EEG) features for patients with COVID-19, and to better refine the features of COVID-19-related encephalopathy.Design, setting, and participants: This retrospective cohort study conducted in Pitié-Salpêtrière Hospital, Paris, France, enrolled 78 hospitalized adults who received a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) and underwent EEG between March 30 and June 11, 2020.Exposures: Detection of SARS-CoV-2 from a nasopharyngeal specimen using a reverse transcription-polymerase chain reaction assay or, in the case of associated pneumonia, on a computed tomography scan of the chest.Main outcomes and measures: Data on the clinical and paraclinical features of the 78 patients with COVID-19 were retrieved from electronic patient records.Results: Of 644 patients who were hospitalized for COVID-19, 78 (57 men [73%]; mean [SD] age, 61 [12] years) underwent EEG. The main indications for EEG were delirium, seizure-like events, and delayed awakening in the intensive care unit after stopping treatment with sedatives. Sixty-nine patients showed pathologic EEG findings, including metabolic-toxic encephalopathy features, frontal abnormalities, periodic discharges, and epileptic activities. Of 57 patients who underwent brain MRI, 41 showed abnormalities, including perfusion abnormalities, acute ischemic lesions, multiple microhemorrhages, and white matter-enhancing lesions. Fifty-five patients showed biological abnormalities, including dysnatremia, kidney failure, and liver dysfunction, the same day as the EEG. The results of cerebrospinal fluid analysis were negative for SARS-Cov-2 for all tested patients. Nine patients who had no identifiable cause of brain injury outside COVID-19 were further isolated; their brain injury was defined as COVID-19-related encephalopathy. They represented 1% (9 of 644) of patients with COVID-19 requiring hospitalization. Six of these 9 patients had movement disorders, 7 had frontal syndrome, 4 had brainstem impairment, 4 had periodic EEG discharges, and 3 had MRI white matter-enhancing lesions.Conclusions and relevance: The results from this cohort of patients hospitalized with COVID-19 suggest there are clinical, EEG, and MRI patterns that could delineate specific COVID-19-related encephalopathy and guide treatment strategy

Association of Clinical, Biological, and Brain Magnetic Resonance Imaging Findings With Electroencephalographic Findings for Patients With COVID-19

International audienceIMPORTANCE There is evidence of central nervous system impairments associated with coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Multimodal monitoring of patients with COVID-19 may delineate the specific features of COVID-19-related encephalopathy and guide clinical management. OBJECTIVES To investigate clinical, biological, and brain magnetic resonance imaging (MRI) findings in association with electroencephalographic (EEG) features for patients with COVID-19, and to better refine the features of COVID-19-related encephalopathy. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study conducted in Pitié-Salpêtrière Hospital, Paris, France, enrolled 78 hospitalized adults who received a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) and underwent EEG between March 30 and June 11, 2020. EXPOSURES Detection of SARS-CoV-2 from a nasopharyngeal specimen using a reverse transcription-polymerase chain reaction assay or, in the case of associated pneumonia, on a computed tomography scan of the chest. MAIN OUTCOMES AND MEASURES Data on the clinical and paraclinical features of the 78 patients with COVID-19 were retrieved from electronic patient records. RESULTS Of 644 patients who were hospitalized for COVID-19, 78 (57 men [73%]; mean [SD] age, 61 [12] years) underwent EEG. The main indications for EEG were delirium, seizure-like events, and delayed awakening in the intensive care unit after stopping treatment with sedatives. Sixty-nine patients showed pathologic EEG findings, including metabolic-toxic encephalopathy features, frontal abnormalities, periodic discharges, and epileptic activities. Of 57 patients who underwent brain MRI, 41 showed abnormalities, including perfusion abnormalities, acute ischemic lesions, multiple Author affiliations and article information are listed at the end of this article.Conclusions and Relevance The results from this cohort of patients hospitalized with COVID-19 suggest there are clinical, EEG, and MRI patterns that could delineate specific COVID-19–related encephalopathy and guide treatment strategy

The wide spectrum of COVID-19 neuropsychiatric complications within a multidisciplinary centre

International audienceA variety of neuropsychiatric complications has been described in association with COVID-19 infection. Large scale studies presenting a wider picture of these complications and their relative frequency are lacking. The objective of our study was to describe the spectrum of neurological and psychiatric complications in patients with COVID-19 seen in a multidisciplinary hospital centre over 6 months. We conducted a retrospective, observational study of all patients showing neurological or psychiatric symptoms in the context of COVID-19 seen in the medical and university neuroscience department of Assistance Publique Hopitaux de Paris-Sorbonne University. We collected demographic data, comorbidities, symptoms and severity of COVID-19 infection, neurological and psychiatric symptoms, neurological and psychiatric examination data and, when available, results from CSF analysis, MRI, EEG and EMG. A total of 249 COVID-19 patients with a de novo neurological or psychiatric manifestation were included in the database and 245 were included in the final analyses. One-hundred fourteen patients (47%) were admitted to the intensive care unit and 10 (4%) died. The most frequent neuropsychiatric complications diagnosed were encephalopathy (43%), critical illness polyneuropathy and myopathy (26%), isolated psychiatric disturbance (18%) and cerebrovascular disorders (16%). No patients showed CSF evidence of SARS-CoV-2. Encephalopathy was associated with older age and higher risk of death. Critical illness neuromyopathy was associated with an extended stay in the intensive care unit. The majority of these neuropsychiatric complications could be imputed to critical illness, intensive care and systemic inflammation, which contrasts with the paucity of more direct SARS-CoV-2-related complications or post-infection disorders

The cerebral network of COVID-19-related encephalopathy: a longitudinal voxel-based 18F-FDG-PET study

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