Showing papers on "Poser criteria published in 2015"

Chitinase 3-like 1: prognostic biomarker in clinically isolated syndromes

Abstract: Chitinase 3-like 1 (CHI3L1) has been proposed as a biomarker associated with the conversion to clinically definite multiple sclerosis in patients with clinically isolated syndromes, based on the finding of increased cerebrospinal fluid CHI3L1 levels in clinically isolated syndrome patients who later converted to multiple sclerosis compared to those who remained as clinically isolated syndrome. Here, we aimed to validate CHI3L1 as a prognostic biomarker in a large cohort of patients with clinically isolated syndrome. This is a longitudinal cohort study of clinically isolated syndrome patients with clinical, magnetic resonance imaging, and cerebrospinal fluid data prospectively acquired. A total of 813 cerebrospinal fluid samples from patients with clinically isolated syndrome were recruited from 15 European multiple sclerosis centres. Cerebrospinal fluid CHI3L1 levels were measured by enzyme-linked immunosorbent assay. Multivariable Cox regression models were used to investigate the association between cerebrospinal fluid CHI3L1 levels and time to conversion to multiple sclerosis and time to reach Expanded Disability Status Scale 3.0. CHI3L1 levels were higher in patients who converted to clinically definite multiple sclerosis compared to patients who continued as clinically isolated syndrome (P = 8.1 × 10(-11)). In the Cox regression analysis, CHI3L1 levels were a risk factor for conversion to multiple sclerosis (hazard ratio = 1.7; P = 1.1 × 10(-5) using Poser criteria; hazard ratio = 1.6; P = 3.7 × 10(-6) for McDonald criteria) independent of other covariates such as brain magnetic resonance imaging abnormalities and presence of cerebrospinal fluid oligoclonal bands, and were the only significant independent risk factor associated with the development of disability (hazard ratio = 3.8; P = 2.5 × 10(-8)). High CHI3L1 levels were associated with shorter time to multiple sclerosis (P = 3.2 × 10(-9) using Poser criteria; P = 5.6 × 10(-11) for McDonald criteria) and more rapid development of disability (P = 1.8 × 10(-10)). These findings validate cerebrospinal fluid CHI3L1 as a biomarker associated with the conversion to multiple sclerosis and development of disability and reinforce the prognostic role of CHI3L1 in patients with clinically isolated syndrome. We propose that determining cerebrospinal fluid chitinase 3-like 1 levels at the time of a clinically isolated syndrome event will help identify those patients with worse disease prognosis.

Characterisation of uveitis in association with multiple sclerosis

Abstract: Purpose To characterise uveitis in association with multiple sclerosis (MS). Methods We conducted a retrospective chart review of patients with uveitis and MS at two uveitis centres (Portland, Oregon, USA and Heidelberg, Germany). Baseline characteristics and ophthalmic data were collected at the patient9s first and last visits. Additionally, neurological records were obtained when possible. Results We identified 113 patients (196 eyes) with uveitis and MS. Of these, 53 had a diagnosis of MS confirmed by review of neurological records, 50 additional patients fulfilled the Poser criteria for MS and 10 with MS were referred by an outside neurologist. Among them, 83 (73%) were women and the mean age of presentation was 40.6 years (range 13–64 years). The average visual acuity in affected eyes at presentation was 20/39. There were 90 patients (80%) who presented with intermediate uveitis and 24 patients (15%) with anterior uveitis. Posterior and pan-uveitis were found in four patients (3%) and two patients (2%), respectively. During a median follow-up of 3.2 years (range 0.04–21 years), visual acuity improved –0.09 logMar/year. Compared with our location-matched controls with idiopathic intermediate uveitis (n=16), patients with MS and intermediate uveitis were significantly older when diagnosed with uveitis (p=0.027) and more likely to be female (p=0.01). There was no statistical difference in visual acuity or rate of vision change between our cases and controls (p=0.58 and p=0.36, respectively). Conclusions Uveitis with MS generally presents as intermediate uveitis with a minority presenting with anterior uveitis. Patients are significantly older and more likely to be women than patients with idiopathic intermediate uveitis. The visual prognosis is generally favourable.

Evolution of diagnostic criteria for multiple sclerosis.

Abstract: Multiple sclerosis is a chronic demyelinating disease of the central nervous system that occurs primarily in young adults. There is no single diagnostic test to recognize the disease. The diagnostic criteria, based on clinical examination and laboratory tests, have changed considerably over time. The first guidelines involved only the results of the patient's neurological examination. The diagnostic criteria developed by Poser in 1983 were based largely on the results of additional tests, including visual evoked potentials and analysis of cerebrospinal fluid. The McDonald criteria, developed in 2001and updated in 2005 and 2010, reflected the diagnostic breakthrough caused by widespread use of magnetic resonance imaging (MRI). Currently, the diagnosis depends largely on the results of the MRI examination. An early diagnosis is particularly important for starting disease-modifying treatments.

Epidemiological study of multiple sclerosis in La Rioja.

Abstract: Introduction Multiple sclerosis is a demyelinating disease that causes severe disability in younger patients. Many epidemiology studies have confirmed a variable prevalence. The objective of this study was to analyse the prevalence of this disease in La Rioja (Spain), using such variables as age and sex; type of progression, initial form of the disease, EDSS and number of relapses; disease-modifying treatment and reasons for treatment withdrawal; personal and family history of cancer; and incidence and mortality. Methods Analysis of patients in La Rioja diagnosed with MS (according to Poser criteria or the 2005 McDonald criteria) during a 10-year period (2001-2011). Data were collected from hospital records, multiple sclerosis associations, and personal records kept by neurologists. Results The MS prevalence rate in La Rioja is 65 patients/100 000 inhabitants with an incidence rate of 3.5 cases/100 000 residents per year. Relapsing-remitting MS is present in 67.6% of the patient total. Mean age of onset is 20-29 years (range 12-70). Most EDSS scores were mostly ≤2. Untreated MS cases account for 47.6% of the total, and the most commonly used therapy is interferon. We detected four haematological tumours and seven families with multiple members affected by MS. Conclusions Prevalence and incidence are similar to those found in other regions of Spain. The average age at onset age for primary progressive MS is slightly higher than in other papers (40-49 years). In families with multiple patients, MS may be more aggressive. Disability in these patients remains very severe. We require more epidemiology studies with a variety of data gathering methods to support findings for prevalence obtained in different provinces.

Register-based incidence of multiple sclerosis in Brittany (north-western France), 2000-2001.

Abstract: Objectives – To report on multiple sclerosis (MS) incidence in Brittany, north-western France. Materials & Methods – From 2000, we set up a population-based register for patients presenting a putative incident MS (PIMS), that is first symptoms compatible with MS onset. We used 3 medical sources of case ascertainment (neurologists, CSF, regional MS-Clinic). Eligibility criteria required both clinical onset and being permanent resident of Brittany in 2000 or 2001. From 2010, all medical records were tracked, the 10-year follow-up allowing previously reported data to be updated. Results – Of 313 eligible PIMS, there were 208 definite MS (both McDonald and Poser criteria), 41 CIS-probable MS (Poser criteria), 32 CIS-possible MS and 32 non-MS. Our incident cohort of 249 MS cases with definite/ probable MS (sex ratio 2.95) gave a crude annual incidence of 4.28 per 100,000 inhabitants (6.22 for women, 2.23 for men), and age-standardized rates (adjustment to the European population) of 4.41 [3.32–5.51], 6.68 [4.75–8.60], and 2.21 [1.12–3.31], respectively. Age-specific rates by gender and initial course showed that attack onset MS peaked at 25–29 years and progressive onset MS at 40–44 years in women (20–24 years and 45–49 years in men, respectively). Conclusions – Brittany is confirmed a high-risk region for MS. Our data show marked differences in sex-specific pattern of MS incidence by clinical course and point out 25-to 29-year-old women as having the highest MS risk. While temporal variations cannot be excluded, comparison with overall French data suggests that other factors rather than latitude may influence the MS risk in France.

What Does An Isolated Cerebrospinal Fluid Monoclonal Band Mean: A Tertiary Centre Experience (P5.247)

Abstract: Background:The presence of oligoclonal bands (OCBs) in cerebrospinal fluid (CSF) of multiple sclerosis (MS) is now well established to support the clinical diagnosis. On the other hand,a monoclonal response can represent the initial stage of an oligoclonal response, before the other antibody clones become visible. Objectives:To evaluate the presence of an isolated CSF monoclonal immunoglobulin(Ig) band and to analyse the clinical and radiological diagnosis of those samples with a single Ig band. Methods:3524 CSF samples using agarose gel isoelectric focusing (IEF) were re-examined and those with an isolated CSF monoclonal Ig band were detected. Results:In 1.4[percnt] a monoclonal band in CSF was detected. 27.5[percnt] of them were diagnosed clinically isolated syndrome (CIS),49[percnt] relapsing remitting multiple sclerosis (RRMS) according to Poser criteria, 11.8[percnt] secondary progressive MS (SPMS),and 2[percnt] radiologically isolated syndrome (RIS). There was no primary progressive MS (PPMS) patient. The mean disease duration and the mean EDSS score of MS patients including CIS and RIS patients were 59.8±71.4 months and 2.6±1.8 respectively. 69[percnt] of them met all the Barhoff criteria. The remaining was diagnosed other inflammatory neurological diseases (OIND) (9.8[percnt]) (1p with chronic inflammatory demyelinating polyneuropathy, 1pt with neuromyelitis optica, 1pt with paraneoplastic syndrome, 2pts with acute disseminated encephalomyelitis). Conclusions:The presence of an isolated CSF monoclonal Ig band is rare. Although most of the samples were diagnosed as MS according to both clinical and paraclinical (MRI) parameters, they had only a single Ig band in CSF. Not only OCBs, but also an isolated CSF monoclonal band might be a cornerstone for the diagnosis of MS at least for some patients. On the other hand, single CSF band is an indication for repeating a CSF analysis, unless other criteria clearly point to a diagnosis of MS,and to consider an alternative diagnosis. Patients with an isolated CSF monoclonal band need careful consideration. Disclosure: Dr. Poyraz has nothing to disclose. Dr. Kaya has nothing to disclose. Dr. Idiman has nothing to disclose. Dr. Cevik has nothing to disclose. Dr. Karabay has nothing to disclose. Dr. Arslan has nothing to disclose. Dr. Karakaptan has nothing to disclose.