Publications by authors named "Portaccio E"
Objective: Cognitive impairment affects approximately 30% of pediatric onset Multiple Sclerosis (POMS) patients with a negative impact on everyday life. The aim of this study was to evaluate the feasibility and effectiveness of a home-based, computer-assisted training of attention in patients with POMS.
Methods: This was a randomized double-blind study.
Background: Multiple sclerosis (MS) is a chronic inflammatory disorder affecting the brain and spinal cord, characterized by immune-mediated myelin damage. Early intervention and detection programs have emerged as promising strategies to improve patient outcomes by identifying and treating MS in its earliest stages.
Objective: This systematic literature review aims to provide an overview of the preferences, attitudes, and opinions of both patients and healthcare professionals regarding early intervention or early detection programs for MS.
Multiple sclerosis: emerging epidemiological trends and redefining the clinical course.
Lancet Reg Health Eur
September 2024
Multiple sclerosis is a chronic, inflammatory, and neurodegenerative disease of the central nervous system and a major cause of neurological disability in young adults. Its prevalence and incidence are increasing, and it has been estimated at over 2.8 million cases worldwide, in addition to recent trends towards a shift in MS prevalence to older ages, with peak prevalence estimates in the sixth decade of life.
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- The study compares disability progression in Multiple Sclerosis (MS) patients based on age of onset: pediatric (POMS), adult (AOMS), and late-onset (LOMS), as well as those with and without progression independent of relapse activity (PIRA).
- Data from 3,777 MS patients revealed that AOMS showed significant disability increases compared to POMS starting in the second year, with POMS having a less steep disability trajectory over time.
- The findings underscore that younger patients with MS experience different disability progression patterns than older patients, highlighting the importance of age in MS disease management.
Background: Pediatric-onset Multiple Sclerosis (POMS) patients show more inflammatory disease compared with adult-onset MS. However, highly effective treatments are limited with only fingolimod being approved in Italy and natalizumab prescribed as off-label treatment.
Objectives: to compare the efficacy of natalizumab versus fingolimod in POMS.
Objective: No direct comparisons of the effect of natalizumab and ocrelizumab on progression independent of relapse activity (PIRA) and relapse-associated worsening (RAW) events are currently available. We aimed to compare the risk of achieving first 6 months confirmed PIRA and RAW events and irreversible Expanded Disability Status Scale (EDSS) 4.0 and 6.
View Article and Find Full Text PDFObjectives: We investigated the occurrence and relative contribution of relapse-associated worsening (RAW) and progression independent of relapse activity (PIRA) to confirmed disability accrual (CDA) and transition to secondary progression (SP) in relapsing multiple sclerosis (MS).
Methods: Relapsing-onset MS patients with follow-up > / = 5 years (16,130) were extracted from the Italian MS Registry. CDA was a 6-month confirmed increase in Expanded Disability Status Scale (EDSS) score.
Background: There is limited information on interpretation of cognitive changes over time in multiple sclerosis (MS).
Objective: This study aimed to provide normative data for the assessment of statistically meaningful change in all tests of the Minimal Assessment of Cognitive Function in MS (MACFIMS).
Methods: We applied the reliable change methodology to a healthy Italian cohort, assessed with two alternate versions of the MACFIMS 1 year apart.
Background: High-efficacy disease-modifying therapies have been proven to slow disability accrual in adults with relapsing-remitting multiple sclerosis. However, their impact on disability worsening in paediatric-onset multiple sclerosis, particularly during the early phases, is not well understood. We evaluated how high-efficacy therapies influence transitions across five disability states, ranging from minimal disability to gait impairment and secondary progressive multiple sclerosis, in people with paediatric-onset multiple sclerosis.
View Article and Find Full Text PDFThrombotic microangiopathy (TMA) has been observed in some patients receiving interferon beta (IFNβ) therapy for relapsing-remitting multiple sclerosis, but little is known about its clinical features and outcomes. We searched the literature to identify cases with IFNβ-related TMA and assessed their pattern of organ involvement, the presence of prodromal manifestations, the treatments used, and the outcomes. Thirty-five articles met the inclusion criteria, and data of 67 patients were collected.
View Article and Find Full Text PDFBackground: Predicting disease progression in patients with the first clinical episode suggestive of multiple sclerosis (MS) is crucial for personalized therapeutic approaches. This study aimed to develop the EUMUS score for accurately estimating the risk of early evidence of disease activity and progression (EDA).
Methods: Retrospective analysis was conducted on data from 221 patients with a first clinical MS episode collected from four Italian MS centers.
Article Synopsis
- Maternal COVID-19 is linked to worse outcomes for mothers, but its effects on pregnant women with multiple sclerosis (MS) had not been thoroughly examined prior to this study.
- This multicenter study focused on pregnant women with MS who contracted COVID-19, assessing their maternal and fetal health outcomes compared to a control group.
- Findings revealed that while COVID-19 increased the risk of maternal complications, it did not significantly affect rates of spontaneous abortion or fetal malformations.
Article Synopsis
- - The study analyzed the factors behind treatment changes in 4,739 patients with active relapsing-remitting and secondary progressive multiple sclerosis from the Italian MS Register, focusing on those who experienced relapses within the past two years.
- - Results revealed that over half of the patients switched their disease-modifying therapy (DMT) due to clinical relapses, with those who switched being typically younger and less disabled than non-switchers.
- - The use of high-efficacy DMTs, particularly anti-CD20 drugs like Alemtuzumab and Ocrelizumab, was shown to significantly lower the risk of needing to switch treatments due to disease activity.
Article Synopsis
- The study explored how pediatric-onset multiple sclerosis (POMS) compares to adult-onset (AOMS) and late-onset MS (LOMS) in terms of progression without relapse and disability levels, suggesting POMS patients may have better outcomes due to their ability to recover more effectively.* -
- Data from over 16,000 MS patients indicated that while POMS patients showed less disability, they had higher disease activity and longer exposure to disease-modifying therapy (DMT) compared to AOMS and LOMS patients.* -
- Key findings revealed that older age at onset and longer disease duration increased the risk of progression, while shorter DMT exposure correlated with better outcomes for POMS patients, highlighting the importance of
Background: Cognitive impairment (CI) is a prevalent and debilitating manifestation of multiple sclerosis (MS); however, it is not included in the widely used concept of No Evidence of Disease Activity (NEDA-3). We expanded the NEDA-3 concept to NEDA-3 + by encompassing CI assessed through the Symbol Digit Modality Test (SDMT) and evaluated the effect of teriflunomide on NEDA3 + in patients treated in a real-world setting. The value of NEDA-3 + in predicting disability progression was also assessed.
View Article and Find Full Text PDFBackground: In the general population, maternal SARS-CoV-2 infection during pregnancy is associated with worse maternal outcomes; however, only one study so far has evaluated COVID-19 clinical outcomes in pregnant and postpartum women with multiple sclerosis, showing no higher risk for poor COVID-19 outcomes in these patients.
Objective: In this multicenter study, we aimed to evaluate COVID-19 clinical outcomes in pregnant patients with multiple sclerosis.
Methods: We recruited 85 pregnant patients with multiple sclerosis who contracted COVID-19 after conception and were prospectively followed-up in Italian and Turkish Centers, in the period 2020-2022.
Introduction: Cognitive impairment (CI) is a core feature of Multiple Sclerosis (MS), being detectable in up to 65% of subjects. Treatment of CI can be considered of paramount importance. However, no standardized strategies are available to date to define the best treatment approach, especially for the pharmacological management.
View Article and Find Full Text PDFCognitive impairment (CI) is a core feature of multiple sclerosis (MS) and affects up to 65% of patients in every phase of the disease, having a deep impact on all aspects of patients' lives. Cognitive functions most frequently involved include information processing speed, learning and memory, visuospatial abilities, and executive function. The precise pathogenetic mechanisms underpinning CI in MS are still largely unknown, but are deemed to be mainly related to pathological changes in lesioned and normal-appearing white matter, specific neuronal grey matter structures, and immunological alterations, with particular impact on synaptic transmission and plasticity.
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