Multiple Sclerosis, Spasticity and Nabiximols: A User Experience

This clinical case concerns a 54-year-old woman with onset of multiple sclerosis at the age of 21 years, a long remission for 12 years and a subsequent resumption of disease activity partially contained by therapies. Not surprisingly, the increased burden of disability and impairment of quality of life is related not so much to the severity of the neurological damage as to the spasticity associated with the disease, which is responsible for severe alterations to posture control and trunk instability. A complex therapeutic strategy pathway started combining physical and pharmacological treatment, which reached a delicate balance with the introduction of nabiximols

Hairdresser’s Dystonia: An Unusual Occupational Dystonia

Adult-onset focal dystonias (AOFDs) are non-task-specific or task-specific and may spread to other body segments of affected patients. Case report We report the case of a barber with non-task-specific craniocervical dystonia and a new occupational focal hand dystonia (while using scissors). Discussion Different AOFDs may develop and coexist in the same "vulnerable" patient. Hairdresser’s dystonia is a rare task-specific dystonia

Hairdresser's Dystonia: An Unusual Occupational Dystonia

Background:&nbsp;Adult‐onset focal dystonias (AOFDs) are non‐task‐specific or task‐specific and may spread to other body segments of affected patients.Case report:&nbsp;We report the case of a barber with non‐task‐specific craniocervical dystonia and a new occupational focal hand dystonia (while using scissors). Discussion:&nbsp;Different AOFDs may develop and coexist in the same &ldquo;vulnerable&rdquo; patient. Hairdresser&rsquo;s dystonia is a rare task‐specific dystonia.</p

Change in Non-Motor Symptoms in Parkinson's Disease and Essential Tremor Patients: A One-year Follow-up Study

<p><strong>Background:&nbsp;</strong>Non‐motor symptoms (NMS) in Parkinson's disease (PD) differ from those in essential tremor (ET), even before a definitive diagnosis is made. It is not clear whether patient's knowledge of the diagnosis and treatment influence their subsequent reporting of NMS.</p><p><strong>Methods:&nbsp;</strong>1 year after a clinical and instrumental diagnosis, we compared the motor impairment (Movement Disorders Society (MDS)‐Unified Parkinson's Disease Rating Scale‐III) and non‐motor symptoms (NMSQuest) in PD (n = 31) and ET (n = 21) patients.</p><p><strong>Results:&nbsp;</strong>PD patients reported more NMS than did the ET patients (p = 0.002). When compared to their baseline report, at follow‐up, PD patients reported less nocturia (p = 0.02), sadness (p = 0.01), insomnia (p = 0.02), and restless legs (p = 0.04) and more nausea (p = 0.024), unexplained pain (p = 0.03), weight change (p = 0.009), and daytime sleepiness (p = 0.03). When compared to their baseline report, ET patients reported less loss of interest (p = 0.03), anxiety (p = 0.006), and insomnia (p = 0.02). Differences in reported weight change (p&lt;0.0001) and anxiety (p = 0.001) between PD and ET patients were related to pharmacological side effects or to a reduction in the ET individuals.</p><p><strong>&nbsp;</strong></p><p><strong>Discussion:&nbsp;</strong>The reporting of NMS is influenced by subjective factors, and might vary with the patient's knowledge of the diagnosis or the effectiveness of treatment.</p

Correction: Cognitive impairment in multiple sclerosis: An exploratory analysis of environmental and lifestyle risk factors.

[This corrects the article DOI: 10.1371/journal.pone.0222929.]

Fingolimod versus interferon beta/glatiramer acetate after natalizumab suspension in multiple sclerosis

The comparative effectiveness of fingolimod versus interferon beta/glatiramer acetate was assessed in a multicentre, observational, prospectively acquired cohort study including 613 patients with relapsing multiple sclerosis discontinuing natalizumab in the Italian iMedWeb registry. First, after natalizumab suspension, the relapse risk during the untreated wash-out period and during the course of switch therapies was estimated through Poisson regression analyses in separated models. During the wash-out period an increased risk of relapses was found in patients with a higher number of relapses before natalizumab treatment (incidence rate ratio = 1.31, P = 0.0014) and in patients discontinuing natalizumab due to lack of efficacy (incidence rate ratio = 2.33, P = 0.0288), patient's choice (incidence rate ratio = 2.18, P = 0.0064) and adverse events (incidence rate ratio = 2.09, P = 0.0084). The strongest independent factors influencing the relapse risk after the start of switch therapies were a wash-out duration longer than 3 months (incidence rate ratio = 1.78, P &lt; 0.0001), the number of relapses experienced during and before natalizumab treatment (incidence rate ratio = 1.61, P &lt; 0.0001; incidence rate ratio = 1.13, P = 0.0118, respectively) and the presence of comorbidities (incidence rate ratio = 1.4, P = 0.0097). Switching to fingolimod was associated with a 64% reduction of the adjusted-risk for relapse in comparison with switching to interferon beta/glatiramer acetate (incidence rate ratio = 0.36, P &lt; 0.0001). Secondly, patients who switched to fingolimod or to interferon beta/glatiramer acetate were propensity score-matched on a 1-to-1 basis at the switching date. In the propensity score-matched sample a Poisson model showed a significant lower incidence of relapses in patients treated with fingolimod in comparison with those treated with interferon beta/glatiramer acetate (incidence rate ratio = 0.52, P = 0.0003) during a 12-month follow-up. The cumulative probability of a first relapse after the treatment switch was significantly lower in patients receiving fingolimod than in those receiving interferon beta/glatiramer acetate (P = 0.028). The robustness of this result was also confirmed by sensitivity analyses in subgroups with different wash-out durations (less or more than 3 months). Time to 3-month confirmed disability progression was not significantly different between the two groups (Hazard ratio = 0.58; P = 0.1931). Our results indicate a superiority of fingolimod in comparison to interferon beta/glatiramer acetate in controlling disease reactivation after natalizumab discontinuation in the real life setting