Brain atrophy in multiple sclerosis: mechanisms, clinical relevance and treatment options

AbstractMultiple sclerosis (MS) is an immune-mediated disease of the central nervous system characterized by focal or diffuse inflammation, demyelination, axonal loss and neurodegeneration. Brain atrophy can be seen in the earliest stages of MS, progresses faster compared to healthy adults, and is a reliable predictor of future physical and  cognitive disability. In addition, it is widely accepted to be a valid, sensitive and reproducible measure of neurodegeneration in MS. Reducing the rate of brain atrophy has only recently been incorporated as a critical endpoint into the clinical trials of new or emerging disease modifying drug s (DMDs) in MS. With the advent of easily accessible neuroimaging softwares along with the accumulating evidence, clinicians may be able to use brain atrophy measures in their everyday clinical practice to monitor disease course and response to DMDs. In this review, we will describe the differe nt mechanisms contributing to brain atrophy, their clinical relevance on disease presentation and course and the effect of current or emergent DMDs on brain atrophy and neuroprotection.
Source: Autoimmunity Highlights - Category: Allergy & Immunology Source Type: research

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SummaryData regarding effectiveness and safety of ocrelizumab in the post-marking setting are lacking. The aim of our study was to provide effectiveness and safety data of ocrelizumab treatment in patients with relapsing –remitting (RR-) and progressive multiple sclerosis (PMS) and to evaluate clinical and immunological predictors of early treatment response. In this single-center prospective observational study, we investigated effectiveness outcomes (time-to-confirmed disability worsening, time-to-first relapse, time-to-first evidence of MRI activity and time-to-first evidence of disease activity), clinical and imm...
Source: Neurotherapeutics - Category: Neurology Source Type: research
ABSTRACTExcessive extracellular concentrations of L-glutamate (L-Glu) can be neurotoxic and contribute to neurodegenerative processes in multiple sclerosis (MS).The association between cerebrospinal fluid (CSF) L-Glu levels, clinical features, and inflammatory biomarkers in patients with MS remains unclear.In 179 MS patients (relapsing remitting, RR, n = 157; secondary progressive/primary progressive, SP/PP, n = 22), CSF levels of L-Glu at diagnosis were determined and compared with those obtained in a group of 40 patients with non-inflammatory/non-degenerative disorders. Disability at the time of diagnosis, and after 1 ye...
Source: Journal of Neurochemistry - Category: Neuroscience Authors: Tags: ORIGINAL ARTICLE Source Type: research
CONCLUSION: One session of DN for the hamstring muscle decreased spasticity and improved mobility in this patient with MS. Further studies are suggested.PMID:34546842 | DOI:10.1080/09593985.2021.1978118
Source: Physiotherapy Theory and Practice - Category: Physiotherapy Authors: Source Type: research
This study is the first to assess if the National Disability Insurance Scheme (NDIS) package allocated to people with multiple sclerosis (pwMS) is correlated with the disability level measured by standardised neurological assessment.MethodsWe aimed to recruit 10 pwMS per expanded disability status score (EDSS) step, including EDSS 0 (no disability) up to 9 (bedridden), and requested information about their NDIS application. Value of their packages was compared with mobility, cognition and psychological impact.ResultsOut of 186 pwMS, only 49% of all patients had an NDIS package approved. The mean values of the annual allowa...
Source: Australian Health Review - Category: Hospital Management Authors: Source Type: research
Rev Neurol (Paris). 2021 Sep 11:S0035-3787(21)00651-2. doi: 10.1016/j.neurol.2021.09.001. Online ahead of print.ABSTRACTWe performed an online survey to assess lockdown impact in 176 patients with multiple sclerosis (PwMS) in the north of France. Access to healthcare was reduced for 38% of PwMS, mainly in physiotherapy, general practitioners and neurologists. 49.2% have implemented self-rehabilitation programs. Medical support was maintained for 39.2% through teleconsultations. 76.2% reported a negative impact of lockdown related to worsen disability. 45.5% expressed beneficial effects like strengthening family relationshi...
Source: Revue Neurologique - Category: Neurology Authors: Source Type: research
This study is the first to assess if the National Disability Insurance Scheme (NDIS) package allocated to people with multiple sclerosis (pwMS) is correlated with the disability level measured by standardised neurological assessment.MethodsWe aimed to recruit 10 pwMS per expanded disability status score (EDSS) step, including EDSS 0 (no disability) up to 9 (bedridden), and requested information about their NDIS application. Value of their packages was compared with mobility, cognition and psychological impact.ResultsOut of 186 pwMS, only 49% of all patients had an NDIS package approved. The mean values of the annual allowa...
Source: Australian Health Review - Category: Hospital Management Authors: Source Type: research
Rev Neurol (Paris). 2021 Sep 11:S0035-3787(21)00651-2. doi: 10.1016/j.neurol.2021.09.001. Online ahead of print.ABSTRACTWe performed an online survey to assess lockdown impact in 176 patients with multiple sclerosis (PwMS) in the north of France. Access to healthcare was reduced for 38% of PwMS, mainly in physiotherapy, general practitioners and neurologists. 49.2% have implemented self-rehabilitation programs. Medical support was maintained for 39.2% through teleconsultations. 76.2% reported a negative impact of lockdown related to worsen disability. 45.5% expressed beneficial effects like strengthening family relationshi...
Source: Revue Neurologique - Category: Neurology Authors: Source Type: research
This study is the first to assess if the National Disability Insurance Scheme (NDIS) package allocated to people with multiple sclerosis (pwMS) is correlated with the disability level measured by standardised neurological assessment.MethodsWe aimed to recruit 10 pwMS per expanded disability status score (EDSS) step, including EDSS 0 (no disability) up to 9 (bedridden), and requested information about their NDIS application. Value of their packages was compared with mobility, cognition and psychological impact.ResultsOut of 186 pwMS, only 49% of all patients had an NDIS package approved. The mean values of the annual allowa...
Source: Australian Health Review - Category: Hospital Management Authors: Source Type: research
Rev Neurol (Paris). 2021 Sep 11:S0035-3787(21)00651-2. doi: 10.1016/j.neurol.2021.09.001. Online ahead of print.ABSTRACTWe performed an online survey to assess lockdown impact in 176 patients with multiple sclerosis (PwMS) in the north of France. Access to healthcare was reduced for 38% of PwMS, mainly in physiotherapy, general practitioners and neurologists. 49.2% have implemented self-rehabilitation programs. Medical support was maintained for 39.2% through teleconsultations. 76.2% reported a negative impact of lockdown related to worsen disability. 45.5% expressed beneficial effects like strengthening family relationshi...
Source: Revue Neurologique - Category: Neurology Authors: Source Type: research
AbstractIntroductionNatalizumab has proved to be more effective than fingolimod in reducing disease activity in relapsing-remitting multiple sclerosis (RRMS). Whether this association is universal for all patient groups remains to be determined.ObjectiveThe aim of this study was to compare the relative effectiveness of natalizumab and fingolimod in RRMS subgroups defined by the baseline demographic and clinical characteristics of interest.MethodsPatients with RRMS who were given natalizumab or fingolimod were identified in a merged cohort from three international registries. Efficacy outcomes were compared across subgroups...
Source: CNS Drugs - Category: Neurology Source Type: research
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