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Richard Roxburgh - One of the best experts on this subject based on the ideXlab platform.
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multiple sclerosis severity score using disability and Disease Duration to rate Disease severity
Neurology, 2005Co-Authors: Richard Roxburgh, S R Seama, T Masterma, Anke Hensiek, Stephe Sawce, Sandra Vukusic, Iuliana Achiti, C Confavreu, M CoustansAbstract:Background: There is no consensus method for determining progression of disability in patients with multiple sclerosis (MS) when each patient has had only a single assessment in the course of the Disease. Methods: Using data from two large longitudinal databases, the authors tested whether cross-sectional disability assessments are representative of Disease severity as a whole. An algorithm, the Multiple Sclerosis Severity Score (MSSS), which relates scores on the Expanded Disability Status Scale (EDSS) to the distribution of disability in patients with comparable Disease Durations, was devised and then applied to a collection of 9,892 patients from 11 countries to create the Global MSSS. In order to compare different methods of detecting such effects the authors simulated the effects of a genetic factor on disability. Results: Cross-sectional EDSS measurements made after the first year were representative of overall Disease severity. The MSSS was more powerful than the other methods the authors tested for detecting different rates of Disease progression. Conclusion: The Multiple Sclerosis Severity Score (MSSS) is a powerful method for comparing Disease progression using single assessment data. The Global MSSS can be used as a reference table for future disability comparisons. While useful for comparing groups of patients, Disease fluctuation precludes its use as a predictor of future disability in an individual.
Arturo Brunetti - One of the best experts on this subject based on the ideXlab platform.
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brain tissue volume changes in relapsing remitting multiple sclerosis correlation with lesion load
NeuroImage, 2003Co-Authors: Mario Quarantelli, Andrea Ciarmiello, Vincenzo Brescia Morra, G Orefice, Michele Larobina, Roberta Lanzillo, Vittorio Schiavone, Elena Salvatore, Bruno Alfano, Arturo BrunettiAbstract:The aim of this study was to simultaneously measure in vivo volumes of gray matter (GM), normal white matter (WM), abnormal white matter (aWM), and cerebro-spinal fluid (CSF), and to assess their relationship in 50 patients with relapsing-remitting multiple sclerosis (RR-MS) (age range, 21–59; mean EDSS, 2.5; mean Disease Duration, 9.9 years), using an unsupervised multiparametric segmentation procedure applied to brain MR studies. Tissue volumes were normalized to total intracranial volume providing corresponding fractional volumes (fGM, faWM, fWM, and fCSF), subsequently corrected for aWM-related segmentation inaccuracies and adjusted to mean patients’ age according to age-related changes measured in 54 normal volunteers (NV) (age range 16–70). In MS patients aWM was 23.8 ± 29.8 ml (range 0.4–138.8). A significant decrease in fGM was present in MS patients as compared to NV (49.5 ± 3.2% vs 53.3 ± 2.1%; P < 0.0001), with a corresponding increase in fCSF (13.0 ± 3.8% vs 9.1 ± 2.4%; P < 0.0001). No difference could be detected between the two groups for fWM (37.5 ± 2.6% vs 37.6 ± 2.2%). faWM correlated inversely with fGM (R = −0.434, P < 0.001 at regression analysis), and directly with fCSF (R = 0.473, P < 0.001), but not with fWM. There was a significant correlation between Disease Duration and EDSS, while no relationship was found between EDSS or Disease Duration and fractional volumes. Brain atrophy in RR-MS is mainly related to GM loss, which correlates with faWM. Both measures do not appear to significantly affect EDSS, which correlates to Disease Duration.
Brigid S Boland - One of the best experts on this subject based on the ideXlab platform.
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short Disease Duration is associated with increased risk of treatment failure in biologic treated patients with ulcerative colitis
Inflammatory Bowel Diseases, 2020Co-Authors: Nghia Nguyen, Soumya Kurnool, Parambir S Dulai, Brigid S Boland, William J Sandborn, Siddharth SinghAbstract:Background Longer Disease Duration is associated with inferior response to biologic therapy in Crohn's Disease. However, the effect of Disease Duration on response to biologic therapy in ulcerative colitis (UC) has not been well studied. Methods In a single-center retrospective cohort study of outpatients with UC starting a biologic agent, we evaluated treatment response by Disease Duration. The primary outcome was treatment failure (composite outcome of inflammatory bowel Disease [IBD]-related surgery/hospitalization or treatment modification including dose escalation, treatment discontinuation, or addition of corticosteroids); secondary outcomes were risk of IBD-related surgery/hospitalization and endoscopic remission. We conducted multivariate Cox proportional hazard analyses to evaluate the independent impact of Disease Duration on clinical outcomes. Results We included 160 biologic-treated UC patients (73% biologic-naive) with a median age (interquartile range) of 36 (26-52) years and Disease Duration (range) of 4.5 (1-9) years. After adjusting for immunosuppressive medications, albumin, and body mass index, each 1-year increase in Disease Duration was associated with a 5% lower risk of treatment failure (adjusted hazard ratio, 0.95; 95% confidence interval [CI], 0.91-0.99) and a 9% higher risk of achieving endoscopic remission (adjusted odds ratio, 1.09; 95% CI, 1.01-1.18). This association of short Disease Duration with treatment failure was observed only in biologic-naive patients, but not biologic-experienced patients. No significant association was seen between Disease Duration and risk of surgery or hospitalization. Conclusion Shorter Disease Duration is independently associated with increased risk of treatment failure in biologic-treated patients with UC. Requirement of biologic therapy early in the course of Disease may be a negative prognostic marker in patients with UC.
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shorter Disease Duration is associated with higher rates of response to vedolizumab in patients with crohn s Disease but not ulcerative colitis
Clinical Gastroenterology and Hepatology, 2019Co-Authors: David Faleck, Adam Winters, Shreya Chablaney, Preeti Shashi, Joseph Meserve, A Weiss, Satimai Aniwan, Jenna L Kolianipace, Gursimran Kochhar, Brigid S BolandAbstract:Background & Aims Patients with Crohn’s Disease (CD), but not ulcerative colitis (UC), of shorter Duration have higher rates of response to tumor necrosis factor (TNF) antagonists than patients with longer Disease Duration. Little is known about the association between Disease Duration and response to other biologic agents. We aimed to evaluate response of patients with CD or UC to vedolizumab, stratified by Disease Duration. Methods We analyzed data from a retrospective, multicenter, consortium of patients with CD (n = 650) or UC (n = 437) treated with vedolizumab from May 2014 through December 2016. Using time to event analyses, we compared rates of clinical remission, corticosteroid-free remission (CSFR), and endoscopic remission between patients with early-stage (≤2 years Duration) and later-stage (>2 years) CD or UC. We used Cox proportional hazards models to identify factors associated with outcomes. Results Within 6 months initiation of treatment with vedolizumab, significantly higher proportions of patients with early-stage CD, vs later-stage CD, achieved clinical remission (38% vs 23%), CSFR (43% vs 14%), and endoscopic remission (29% vs 13%) (P Conclusions Patients with CD for 2 years or less are significantly more likely to achieve a complete response, CSFR, or endoscopic response to vedolizumab than patients with longer Disease Duration. Disease Duration does not associate with response vedolizumab in patients with UC.
Roy W Lyness - One of the best experts on this subject based on the ideXlab platform.
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ocular pathology in multiple sclerosis retinal atrophy and inflammation irrespective of Disease Duration
Brain, 2010Co-Authors: Ari J Green, Stephen Mcquaid, Stephen L Hauser, Ingrid V Allen, Roy W LynessAbstract:There has been growing interest in the use of retinal imaging for tracking Disease progression in multiple sclerosis. However, systematic and detailed pathological descriptions of retinal tissue in multiple sclerosis are lacking. Graded, histological evaluations on eyes from 82 patients with multiple sclerosis and 10 subjects with other neurological Diseases, with immunohistochemistry on a subset, were performed and correlated with clinical and pathological findings. Multiple sclerosis cases demonstrated evidence of retinal atrophy and inflammation even in late-stage Disease. Retinal ganglion cell loss was significant and remaining neurons appeared shrunken and were partially engulfed by human leukocyte antigen-DR positive cells with the phenotype of microglia in samples subjected to immunohistochemistry. Neurofilament staining revealed variable but prominent degrees of axonal loss and injury. Neuronal loss was noted in the inner nuclear layer with focal reduction in cell density. Foamy-appearing human leukocyte antigen-DR positive cells were evident near vessels and periphlebitis was found in a small but significant number of multiple sclerosis cases. Glial fibrillary acidic protein staining showed extensive astrocyte hypertrophy and proliferation with prominent gliosis in multiple sclerosis cases. Frequent but previously unreported abnormalities in the iris were documented in the majority of chronic multiple sclerosis cases. The injury to both iris and retina could be seen at all stages of Disease. Severity of retinal atrophy was correlated with overall brain weight at time of autopsy (P = 0.04) and a trend for increased atrophy was seen with longer Disease Duration (P = 0.13). This study provides the first large-scale pathological description of retinas in multiple sclerosis, including patients with different subtypes of Disease at all stages, and with variable clinical severity. Changes were seen not only in the retinal nerve fibre layer and ganglion cell layer, but also in the inner nuclear layer, suggesting that retinal injury is more widespread than previously appreciated. Furthermore, the human retina is devoid of myelin, but inflammation was demonstrated to be prominent in multiple sclerosis and to persist in the retina at late stages of Disease. The prominent gliosis and inflammation surrounding vessels of the inner retina could potentially impact optical coherence tomography evaluations in multiple sclerosis—as standard techniques exploit presumed differences in tissue reflectivity and utilize automated edge detection algorithms to judge axon loss in the nerve fibre layer. Deciphering the relationships between the different types of retinal pathology may aid us in understanding the factors that drive both inflammation and tissue atrophy in multiple sclerosis.
Fatma Gundogdu - One of the best experts on this subject based on the ideXlab platform.
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olfactory bulb and olfactory sulcus depths are associated with Disease Duration and attack frequency in multiple sclerosis patients
Journal of the Neurological Sciences, 2015Co-Authors: Nermin Tanik, Asuman Celikbilek, Levent Ertuğrul İnan, Halil Ibrahim Serin, Fatma GundogduAbstract:Abstract Background and purpose: Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative Disease that progresses to axonal loss and demyelinization. Olfactory dysfunction in patients with MS has been reported frequently. We were interested in the associations of olfactory bulb (OB) and olfactory sulcus depth (OSD) with Disease Duration and attack frequency. Methods: We included 25 patients with MS and 30 age- and sex-matched controls in this study. The Expanded Disability Status Scale, Beck Depression Inventory, and Mini Mental State Examination were applied. OB, OSD, and magnetic resonance imaging plaque numbers were calculated. Results: OB volume and OSD in patients with MS were significantly lower than those in the control group (right and left OB: p Conclusions: The OB and OSD were atrophied significantly in patients with MS, and this was correlated with Disease Duration and attack frequency. The left side tended to be dominant.