Headache at the Time of First Symptom Manifestation of Multiple Sclerosis: A Prospective, Longitudinal Study

2018 ◽  
Vol 80 (3-4) ◽  
pp. 115-120 ◽  
Author(s):  
Marcel Gebhardt ◽  
Peter Kropp ◽  
Frank Hoffmann ◽  
Uwe K. Zettl
Keyword(s):  
Multiple Sclerosis ◽  
Young Patients ◽  
Final Diagnosis ◽  
Lymphoid Follicle ◽  
Recurrent Pain ◽  
Prospective Longitudinal Study ◽  
Important Symptom ◽  
First Occurrence ◽  
Prospective Longitudinal ◽  
Symptom Manifestation

Aims: Headaches have not been considered a typical symptom of multiple sclerosis (MS), although since 2000, almost every study showed high prevalence. We screened 50 MS patients at the time of first occurrence of neurological symptoms and found the highest prevalence of headache in MS that was ever recorded (78%). Postmortem histological analyses of MS patients’ brains revealed lymphoid follicle-like structures in the cerebral meninges and a pathophysiological link between headache, and high inflammatory activity especially in the initial phase of MS could be suspected. The aim of this study was to get insights into the persistence of headache in the further progress of the disease. Methods: In a prospective, multicenter study, 50 MS patients at the time of first symptom manifestation were screened for the presence of headache within the last 4 weeks and again 6 months later with help of the Rostock Headache Questionnaire (Rokoko) as well as using the evaluation of case history and clinical-neurological investigation. Results: We found a decrease of headache prevalence after 6 months from 78 to 61% (p = 0.01). We could also show a decrease of headache frequency, measured by days with headache in the last 4 weeks (9.5 vs. 5.9, p = 0.001). Migraine or probable migraine was the most frequent headache. In both investigations, the most frequent headache was recurrent pain with pulsating and throbbing character that lasted between 4 and 72 h. Conclusion: Headaches should be taken seriously as an important symptom in early MS. The decrease of headache 6 months after first symptom manifestation of MS could be a result of the immunomodulatory therapy. Young patients in whom migraine-like headaches occur should obligatory undergo an MRI of the head, and in the case of abnormal findings differential diagnosis should be initiated. This could reduce latency until final diagnosis of MS and enable early treatment.

scholarly journals Antibodies to neurofilament light as potential biomarkers in multiple sclerosis

2021 ◽  
Vol 3 (2) ◽  
pp. e000192
Author(s):  
Fabiola Puentes ◽  
Pascal Benkert ◽  
Sandra Amor ◽  
Jens Kuhle ◽  
Gavin Giovannoni
Keyword(s):  
Multiple Sclerosis ◽  
Immune Complexes ◽  
Quantitative Measure ◽  
Immune Reactivity ◽  
High Avidity ◽  
Disability Score ◽  
Neurofilament Light ◽  
Prospective Longitudinal Study ◽  
Baseline Serum ◽  
Prospective Longitudinal

Background and objectiveThe concentration of neurofilament light (NfL) protein in cerebrospinal fluid (CSF) and blood is widely considered as a quantitative measure of neuro-axonal injury. Immune reactivity to NfL released into extracellular fluids induces specific autoantibody response. We investigated the levels and avidity of antibodies to NfL in patients with multiple sclerosis (MS) treated with disease-modifying therapies (DMTs) and their correlation with disease worsening and NfL protein concentration.MethodsWe conducted a prospective longitudinal study in 246 patients with MS (125 DMT-treated and 121 untreated at baseline). Serum levels of NfL antibodies, antibody avidity and immune complexes were determined by ELISA. NfL protein was measured using the Simoa platform. Clinical variables were tested for their association with the measured parameters in multivariate generalised estimating equation models.ResultsMultivariate analysis showed that levels of NfL antibodies were higher in progressive MS compared with clinically isolated syndrome (CIS)/relapsing remitting multiple sclerosis (RRMS) (p=0.010). Anti-NfL levels drop with increasing disability score (Expanded Disability Status Scale (EDSS)) (p=0.002), although conversely, were significantly elevated in CIS/RRMS after a recent EDSS increase (p=0.012). Patients receiving DMTs showed decreased levels of anti-NfL (p=0.008), high-avidity antibodies (p=0.017) and immune-complexes compared with untreated CIS/RRMS. Patients with MS switching to natalizumab showed lower levels of anti-NfL but higher immune complexes compared with healthy controls (p=0.0071). A weak association was observed between the levels of NfL protein and NfL antibodies.ConclusionsThese results support the potential usefulness of quantifying antibody response to NfL as potential markers of progression and treatment response in MS and need to be considered when interpreting peripheral blood NfL levels.

Evaluating the response to glatiramer acetate in relapsing–remitting multiple sclerosis (RRMS) patients

2014 ◽  
Vol 20 (12) ◽  
pp. 1602-1608 ◽  
Author(s):  
Jordi Río ◽  
Alex Rovira ◽  
Mar Tintoré ◽  
Jaume Sastre-Garriga ◽  
Joaquín Castilló ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Glatiramer Acetate ◽  
Scoring System ◽  
Clinical Activity ◽  
Disability Progression ◽  
Prospective Longitudinal Study ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis ◽  
Prospective Longitudinal

Background: In patients with relapsing–remitting multiple sclerosis (RRMS), a scoring system based on new magnetic resonance imaging (MRI) active lesions, relapses and sustained disability progression after a 1-year treatment with IFNβ predicted patient disability progression over time; however, this score had not been tested in patients receiving glatiramer acetate (GA). Objective: The objective of this study was to evaluate whether this previous scoring system can also be applied to patients treated with GA. Methods: This was a prospective, longitudinal study of 151 RRMS patients treated with GA. Their scores were constructed, based on the clinical and MRI activity after 1 year of therapy. Regression analysis was performed, in order to identify the response variables. Results: The total possible score range was 0–3. Patients with a score of ≥ 2 and those with clinical activity (with or without MRI activity) during their first year of treatment were at increased risk of continuing with relapses and/or sustained disability in the next 2 years (odds ratio (OR): 38.8; p < 0.0001 and OR: 7.8; p < 0.009, respectively). Conclusions: In RRMS patients treated with GA, a combination of clinical activity measures may have prognostic value for identifying patients with disease activity in the next 2 years of therapy.

Macular ganglion cell–inner plexiform layer thinning as a biomarker of disability progression in relapsing multiple sclerosis

2020 ◽  
pp. 135245852093572 ◽  
Author(s):  
Gabriel Bsteh ◽  
Klaus Berek ◽  
Harald Hegen ◽  
Patrick Altmann ◽  
Sebastian Wurth ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Ganglion Cell ◽  
Plexiform Layer ◽  
Inner Plexiform Layer ◽  
Operating Characteristics ◽  
Disability Progression ◽  
Prospective Longitudinal Study ◽  
Increased Risk ◽  
Prospective Longitudinal ◽  
Relapsing Multiple Sclerosis

Background: Macular ganglion cell–inner plexiform layer (mGCIPL) is an emerging biomarker of neuroaxonal degeneration in multiple sclerosis (MS). Objective: We aimed to determine cut-off values of mGCIPL thinning for discriminating between progressing and stable patients in relapsing multiple sclerosis (RMS). Methods: This is a 3-year prospective longitudinal study on 183 RMS patients with annual optical coherence tomography. Best possible cut-off values of baseline mGCIPL and annual loss of macular ganglion cell–inner plexiform layer (aLmGCIPL) for discriminating clinically progressing (physical progression or cognitive decline) from stable patients were defined by receiver operating characteristics analysis and tested using multivariate regression models. Results: Baseline mGCIPL thickness <77 µm was associated with an increased risk (hazard ratio: 2.7, 95% confidence interval (CI): 1.5–4.7, p < 0.001) of disability progression. An aLmGCIPL cut-off ⩾1 µm accurately identified clinically progressing patients (87% sensitivity at 90% specificity) and was a strong predictor of clinical progression (odds ratio: 18.3, 95% CI: 8.8–50.3). Conclusion: We present evidence that cross-sectionally measured mGCIPL thickness and annualized thinning rates of mGCIPL are able to identify clinically progressing RMS with high accuracy.

scholarly journals Retinal inter-eye difference and atrophy progression in multiple sclerosis diagnostics

2021 ◽  
pp. jnnp-2021-327468
Author(s):  
Jenny Nij Bijvank ◽  
B M J Uitdehaag ◽  
Axel Petzold
Keyword(s):  
Multiple Sclerosis ◽  
Diagnostic Criteria ◽  
Area Under The Curve ◽  
Plexiform Layer ◽  
Diagnostic Value ◽  
Absolute Difference ◽  
Inner Plexiform Layer ◽  
Prospective Longitudinal Study ◽  
Percentage Difference ◽  
Prospective Longitudinal

BackgroundThe visual system could be included in the diagnostic criteria for multiple sclerosis (MS) to demonstrate dissemination in space (DIS) and dissemination in time (DIT).ObjectiveTo investigate the diagnostic value of retinal asymmetry in MS.MethodsA prospective, longitudinal study in individuals with MS (n=151) and healthy controls (n=27). Optical coherence tomography (OCT) was performed at 0, 2 and 4 years. Macular ganglion cell and inner plexiform layer (mGCIPL) thickness was determined as well as measures for retinal asymmetry: the inter-eye percentage difference (IEPD) and inter-eye absolute difference (IEAD). Receiver operator characteristics curves were plotted and the area under the curve (AUC) was calculated for group comparisons of the mGCIPL, IEPD, IEAD and atrophy rates.ResultsThe diagnostic accuracy of both the IEPD and IEAD for differentiating bilateral and unilateral MS optic neuritis was high and stable over time (AUCs 0.88–0.93). The IEPD slightly outperformed the IEAD. Atrophy rates showed low discriminatory abilities for differentiating MS from controls (AUC 0.49–0.58).ConclusionThe inter-eye differences of the mGCIPL have value for demonstration of DIS but in individuals with longstanding MS not for DIT. This may be considered as a test to detect DIS in future diagnostic criteria. Validation in a large prospective study in people presenting with symptoms suggestive of MS is required.

144: A Prospective Longitudinal Study of Quality of Life Following Radical Perineal Prostatectomy

2004 ◽  
Vol 171 (4S) ◽  
pp. 38-38
Author(s):  
Benjamin K. Yang ◽  
Matthew D. Young ◽  
Brian Calingaert ◽  
Johannes Vieweg ◽  
Brian C. Murphy ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Longitudinal Study ◽  
Prospective Longitudinal Study ◽  
Perineal Prostatectomy ◽  
Prospective Longitudinal
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