Therapeutic Plasma Exchange in Multiple Sclerosis Patients with Abolished Interferon-beta Bioavailability

Giedraitienė, Nataša; Kaubrys, Gintaras; Kizlaitienė, Rasa; Bagdonaitė, Loreta; Griškevičius, Laimonas; Valceckiene, Vilma; Stoškus, Mindaugas

doi:10.12659/msm.894119

Cited by 6 publications

(4 citation statements)

References 41 publications

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“…CI is the leading predictor of occupational disability, while physical disability, age, sex, and education account for less than 15% of the likelihood of being employed [ 5 ]. Therefore, the assessment and follow-up of cognitive status, as well as treatment (in case of deterioration), should be as much a priority as is the evaluation and treatment of physical disability [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

The BICAMS Battery for Assessment of Lithuanian-Speaking Multiple Sclerosis Patients: Relationship with Age, Education, Disease Disability, and Duration

2015

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BackgroundAssessment of cognitive impairment (CI) in multiple sclerosis (MS) patients is very useful, but it requires time-consuming expert evaluation with specialized materials. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) was created as a brief and specific instrument for the evaluation of CI.The aims of this study were to assess the cognitive status of MS patients by using the Lithuanian version of BICAMS, to evaluate the test-retest reliability of the Lithuanian version of BICAMS, and to measure the impact of CI on disability and duration of MS.Material/MethodsWe enrolled 50 MS patients and 20 cognitively normal control subjects, matched for age, gender, and level of education. Cognitive functions were assessed by the BICAMS tests, which include the Symbol Digit Modalities Test, the Brief Visuospatial Memory Test Revised, and the California Verbal Learning Test, 2nd edition.ResultsMS patients performed significantly worse than controls on the 3 neuropsychological tests of BICAMS (p<0.001). Younger and intellectually employed persons performed significantly better on these tests than older persons, manual workers, or unemployed persons (p<0.05). MS patients with higher disability scores tended to perform worse on the tests (p<0.05), but we found no relationship between BICAMS test scores and the duration of the disease or relapse rate (p>0.05). Test-retest reliability was excellent for all 3 subtests (r>0.8, p<0.05).ConclusionsOur study shows that BICAMS is a valid and acceptable cognitive assessment tool that can be recommended for routine use in Lithuania for assessing patients with MS.

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Section: Introductionmentioning

confidence: 99%

The BICAMS Battery for Assessment of Lithuanian-Speaking Multiple Sclerosis Patients: Relationship with Age, Education, Disease Disability, and Duration

2015

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“…However, these secondary effects, albeit bothersome, are rarely serious [ 8 ]. Sometimes long-term treatment with IFNβ-1a is hampered by the appearance of neutralizing antibodies, which in most cases lead to treatment suspension, but this only happens in 6% of the patients with IFNβ-1a preparations, and if they do not develop after 2 years, it is unlikely that they will appear later [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

IFN beta 1a as Glucocorticoids-Sparing Therapy in a Patient with CLIPPERS

et al. 2016

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Patient: Male, 31Final Diagnosis: CLIPPERSSymptoms: Ataxia • diplopiaMedication: IFNbeta 1aClinical Procedure: —Specialty: NeurologyObjective:Rare diseaseBackground:Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a recently described inflammatory disease of the central nervous system, distinguished by brainstem- and spinal cord-centered lesions with a characteristic contrast enhancement on MRI, a lymphocytic perivascular infiltrate on pathological exam, and a dramatic response to and dependence on steroids therapy. Since its initial description in 2010, different glucocorticoid-sparing agents, mostly immunosuppressant drugs, have been used to minimize the dosage, but these therapies also carry the risk of important secondary effects. We present the first reported case of CLIPPERS treated with interferon beta 1a as add-on therapy.Case Report:A previously healthy 31-year-old man presented with gait ataxia and dysarthria. MRI showed pons-centered hyperintense patchy lesions on T2-weighted images. Additional tests ruled out other possible diagnoses and symptoms reversed with intravenous methylprednisolone. Over the years the patient presented with several episodes of deterioration each year, which were partly reversed with glucocorticoid therapy, but leaving him with growing sequelae. Four years after the initial event, treatment with interferon-beta-1a was initiated, achieving reduced frequency of the relapses to 1 every 4 years, which were no longer associated to increasing disability. This allowed reducing glucocorticoids to 30 mg of Deflazacort every other day.Conclusions:Interferon beta-1a could be an alternative to corticosteroid-combined therapy in CLIPPERS and its more benign profile of secondary effects compared to immunosuppressants could make it an attractive choice.

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“…In case only 1 threshold was reached, a patient was assigned to the group of poor biological responders. If neither of the 2 thresholds was reached, a patient was defined as a biological non-responder 45 – 47 .…”

Section: Methodsmentioning

confidence: 99%

Cognition During and After Multiple Sclerosis Relapse as Assessed With the Brief International Cognitive Assessment for Multiple Sclerosis

Giedraitienė

Kaubrys

Kizlaitienė

2018

Sci Rep

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There is some evidence that cognition may be impaired during multiple sclerosis (MS) relapse. The aims of this study were to assess the cognitive status with the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) in MS patients during relapse, in stable patients, and in healthy controls; to evaluate cognitive changes up to 3 months after relapse; and to estimate the impact of different factors on cognition after relapse. BICAMS was performed in 60 relapsing, 30 stable patients and 30 controls. Relapsing MS patients were assessed during relapse and one and three months after relapse. SDMT score was lower in relapsing than in stable patients. The mean scores of all BICAMS tests were higher one month after relapse than during relapse (p < 0.001). SDMT score after relapse improved in younger patients, who had more severe relapse (p < 0.05). BVMT-R score improved more in men, in patients with biologically active interferon-beta, in patients treated with methylprednisolone and in patients who were rehabilitated (p < 0.05). CVLT-II score improved in women and in patients with shorter relapse (p < 0.05). A neuropsychological assessment, like the evaluation of physical disability, is important during relapse. BICAMS may be suitable for a quick and effective assessment of cognition during relapse.

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Therapeutic Plasma Exchange in Multiple Sclerosis Patients with Abolished Interferon-beta Bioavailability

Cited by 6 publications

References 41 publications

The BICAMS Battery for Assessment of Lithuanian-Speaking Multiple Sclerosis Patients: Relationship with Age, Education, Disease Disability, and Duration

The BICAMS Battery for Assessment of Lithuanian-Speaking Multiple Sclerosis Patients: Relationship with Age, Education, Disease Disability, and Duration

IFN beta 1a as Glucocorticoids-Sparing Therapy in a Patient with CLIPPERS

Cognition During and After Multiple Sclerosis Relapse as Assessed With the Brief International Cognitive Assessment for Multiple Sclerosis

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