Publications by authors named "Bastiaan Moraal"
Importance: Increasing numbers of people with multiple sclerosis (MS) use disease-modifying therapy (DMT). Long-term stable disease while taking such medications provides a rationale for considering DMT discontinuation given patient burden, costs, and potential adverse effects of immunomodulating therapy.
Objective: To investigate whether first-line DMT can be safely discontinued in patients with long-term stable MS.
Article Synopsis
- Serum neurofilament light (sNfL) serves as a biomarker for neuro-axonal damage in multiple sclerosis (MS) but its clinical usage is still limited; this study assessed how its implementation affects clinical decisions at the MS Center Amsterdam.
- Over the study period (August 2021-December 2022), sNfL was evaluated in various contexts, with a notable change in clinical decisions in 19.3% of cases, especially when assessing new symptoms or when higher sNfL levels were present.
- The findings suggest that integrating sNfL into clinical practice improved decision-making certainty and potentially adjusted expectations regarding MRI activity, indicating its potential value in patient care while calling for further research
Article Synopsis
- - This study aimed to evaluate how reliable automatic lesion segmentation tools are when used on MRI scans of people with multiple sclerosis (pwMS) across different scanners, focusing on their repeatability and accuracy compared to manual segmentation methods.
- - Researchers scanned 30 pwMS using three different MRI machines (two 3.0 T and one 1.5 T) and employed various segmentation techniques, including both automated tools and manual methods, to measure their effectiveness.
- - Results showed that optimizing the segmentation settings for each specific scanner significantly improved accuracy (measured by the Dice similarity coefficient) for one of the software tools (LST) compared to using default settings or a combined approach.
Background: Extended interval dosing (EID) of natalizumab is a promising strategy to optimise treatment in multiple sclerosis (MS). Personalised EID by therapeutic drug monitoring can enable further extension of treatment intervals.
Methods: The NEXT-MS trial is an investigator-initiated prospective phase IV non-randomised study.
Background: There is a need in Relapsing-Remitting Multiple Sclerosis (RRMS) treatment for biomarkers that monitor neuroinflammation, neurodegeneration, treatment response, and disease progression despite treatment.
Objective: To assess the value of serum glial fibrillary acidic protein (sGFAP) as a biomarker for clinical disease progression and brain volume measurements in natalizumab-treated RRMS patients.
Methods: sGFAP and neurofilament light (sNfL) were measured in an observational cohort of natalizumab-treated RRMS patients at baseline, +3, +12, and +24 months and at the last sample follow-up (median 5.
Article Synopsis
- The study investigates how childhood and adult diets are linked to multiple sclerosis (MS) risk and progression.
- It involved 361 people with MS and 125 healthy controls, collecting data through questionnaires on their dietary habits at ages 10 and 50.
- Findings suggest a poorer diet in childhood is linked to developing MS and its type, while better fruit intake at age 50 correlates with reduced disability and lower MRI lesion volumes.
Background: Cognitive impairment in people with MS (PwMS) has primarily been investigated using conventional imaging markers or fluid biomarkers of neurodegeneration separately. However, the single use of these markers do only partially explain the large heterogeneity found in PwMS.
Objective: To investigate the use of multimodal (bio)markers: i.
Background And Objectives: Although MRI-based markers of neuroinflammation have proven crucial for the diagnosis of multiple sclerosis (MS), predicting clinical progression with inflammation remains difficult. Neurodegenerative markers such as brain volume loss show stronger clinical (predictive) correlations, but also harbor age-related variation that must be disentangled from disease duration. In this study we investigated how clinical disability is related to volumetric MRI measures in a cohort of MS patients and healthy controls (HC) of the same age: Project Y.
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- Cortical Multiple Sclerosis (MS) lesions are often missed in standard MRI, but new AI techniques can generate more sensitive imaging options (DIR and PSIR) from routine scans.
- A study compared lesion detection using AI-generated DIR and PSIR images to traditional MRI-acquired images across multiple centers and found a significant increase in lesions identified in AI-generated DIR images.
- The findings suggest AI could enhance MS diagnosis and monitoring, with good reliability in interpreting results, although the performance of AI-generated PSIR images was less conclusive.
Neuroaxonal and Glial Markers in Patients of the Same Age With Multiple Sclerosis.
Neurol Neuroimmunol Neuroinflamm
March 2023
Background And Objectives: The specificity of novel blood biomarkers for multiple sclerosis (MS)-related neurodegeneration is unclear because neurodegeneration also occurs during normal aging. To understand which aspects of neurodegeneration the serum biomarkers neurofilament light (sNfL), serum glial fibrillary acidic protein (sGFAP), and serum contactin-1 (sCNTN1) reflect, we here explore their cross-sectional association with disability outcome measures and MRI volumes in a unique cohort of people with MS (PwMS) of the same age.
Methods: sNfL, sGFAP (both singe-molecule array technology) and sCNTN1 (Luminex) were measured in serum samples of 288 PwMS and 125 healthy controls (HCs) of the Project Y cohort, a population-based cross-sectional study of PwMS born in the Netherlands in 1966 and age-matched HC.
Article Synopsis
- Patients with relapsing-remitting multiple sclerosis (RRMS) often experience significant long-term neurodegeneration despite effective treatments.
- The study evaluated the predictive value of serum neurofilament-light (sNfL) and serum contactin-1 (sCNTN1) in assessing neurodegeneration using MRI in RRMS patients treated with natalizumab over several years.
- Results showed that sNfL levels after the first year of treatment were associated with brain atrophy metrics, while sCNTN1 levels did not demonstrate a clear predictive value.
Background: Upper cervical cord atrophy and lesions have been shown to be associated with disease and disability progression already in early relapsing-remitting multiple sclerosis (RRMS). However, their longitudinal relationship remains unclear.
Objective: To investigate the cross-sectional and longitudinal relation between focal T2 cervical cord lesion volume (CCLV) and regional and global mean upper cervical cord area (UCCA), and their relations with disability.
Background: To study phenotypic variability in MS patients, well-defined unbiased cohort studies are necessary. The most common and probably most important confounding factor when studying disease phenotype in MS is age.
Objective: To describe study design and subject characteristics of a unique birth cohort (Project Y).
Background: To investigate smartphone keystroke dynamics (KD), derived from regular typing, on sensitivity to relevant change in disease activity, fatigue, and clinical disability in multiple sclerosis (MS).
Methods: Preplanned interim analysis of a cohort study with 102 MS patients assessed at baseline and 3-month follow-up for gadolinium-enhancing lesions on magnetic resonance imaging, relapses, fatigue and clinical disability outcomes. Keyboard interactions were unobtrusively collected during typing using the Neurokeys App.
Background: Regional collaboration and appropriate referral management are crucial in neuro-oncological care. Lack of electronic access to medical records across health care organizations impedes interhospital consultation and may lead to incomplete and delayed referrals. To improve referral management, we have established a multidisciplinary neuro-oncological triage panel (NOTP) with digital image exchange and determined the effects on lead times, costs, and time investment.
View Article and Find Full Text PDFBackground And Objectives: To investigate the potential of serum neurofilament light (NfL) to reflect or predict progression mostly independent of acute inflammatory disease activity in patients with relapsing-remitting multiple sclerosis (RRMS) treated with natalizumab.
Methods: Patients were selected from a prospective observational cohort study initiated in 2006 at the VU University Medical Center Amsterdam, the Netherlands, including patients with RRMS treated with natalizumab. Selection criteria included an age of 18 years or older and a minimum follow-up of 3 years from natalizumab initiation.
In this observational study, 159 patients with multiple sclerosis received personalized dosing of ocrelizumab incentivized by the COVID-19 pandemic. Re-dosing was scheduled when CD19 B-cell count was ⩾10 cells/µL (starting 24 weeks after the previous dose, repeated 4-weekly). Median interval until re-dosing or last B-cell count was 34 [30-38] weeks.
View Article and Find Full Text PDFBackground: Natalizumab treatment provides a model for non-inflammation-induced disease progression in multiple sclerosis (MS).
Objective: To study serum contactin-1 (sCNTN1) as a novel biomarker for disease progression in natalizumab-treated relapsing-remitting MS (RRMS) patients.
Methods: Eighty-nine natalizumab-treated RRMS patients with minimum follow-up of 3 years were included.
Importance: Although magnetic resonance imaging (MRI) is useful for monitoring disease dissemination in space and over time and excluding multiple sclerosis (MS) mimics, there has been less application of MRI to progressive MS, including diagnosing primary progressive (PP) MS and identifying patients with relapsing-remitting (RR) MS who are at risk of developing secondary progressive (SP) MS. This review addresses clinical application of MRI for both diagnosis and prognosis of progressive MS.
Observations: Although nonspecific, some spinal cord imaging features (diffuse abnormalities and lesions involving gray matter [GM] and ≥2 white matter columns) are typical of PPMS.
Tumor-educated platelets (TEPs) are potential biomarkers for cancer diagnostics. We employ TEP-derived RNA panels, determined by . We assessed specificity by comparing the spliced RNA profile of TEPs from glioblastoma patients with multiple sclerosis and brain metastasis patients (validation series, n = 157; accuracy, 80%; AUC, 0.
View Article and Find Full Text PDFObjective: To investigate the prevalence and clinical relevance regarding disability progression in multiple sclerosis patients with a dissociation in clinical and radiological disease expression.
Methods: We prospectively selected patients with early relapsing-remitting multiple sclerosis (MS) or a clinically isolated syndrome (CIS) from the Amsterdam MS cohort. Patients underwent clinical examination at baseline, after 2 years, 6 years and a subset also after 11 years, including the Expanded Disability Status Scale (EDSS), 25-foot walk test (25-FWT) and 9-hole peg test (9-HPT).
Background: Infections of the neck are frequently seen in young children and are usually harmless and transient. In the case of atypical symptoms, however, it is important to be alert to the possibility of less common causes requiring specific treatment.
Case Description: A 4-year-old girl was seen in the outpatient clinic with a recurrent, inflamed swelling in the neck.
Objective: The objective of the study was to determine whether early infratentorial and/or spinal cord lesions are long-term cumulative predictors of disability progression in multiple sclerosis (MS).
Methods: We selected 153 MS patients from the longitudinal Amsterdam MS cohort. Lesion analysis was performed at baseline and year 2.
Early central atrophy rate predicts 5 year clinical outcome in multiple sclerosis.
J Neurol Neurosurg Psychiatry
December 2010
Article Synopsis
- The study investigates how central atrophy in early multiple sclerosis (MS) patients can predict disease progression over a medium-term period of 5.5 years.
- Researchers analyzed MRI and clinical data from 54 newly diagnosed MS patients, focusing on brain and ventricular volume changes during initial follow-up periods.
- The findings reveal that the rate of ventricular volume change within the first two years is a significant predictor of disease progression, making it a valuable prognostic marker in the early stages of MS.
Objective: To compare long-interval T2-weighted subtraction (T2w-Sub) imaging with monthly gadolinium-enhanced T1-weighted (Gd-T1w) imaging for (1) detection of active lesions, (2) assessment of treatment efficacy, and (3) statistical power, in a multiple sclerosis (MS), phase 2, clinical trial setting.
Methods: Magnetic resonance imaging (MRI) data over 9 months from 120 patients (61 treatment, 59 placebo) from the oral temsirolimus trial were used. T2w-Sub images were scored for active lesions, independent of the original reading of the monthly Gd-T1w images.