Risk of Persistent Disability in Patients With Pediatric-Onset Multiple Sclerosis

Damiano Baroncini, Marta Simone, Pietro Iaffaldano, Vincenzo Brescia Morra, Roberta Lanzillo, Massimo Filippi, Marzia Romeo, Francesco Patti, Clara Grazia Chisari, Eleonora Cocco, Giuseppe Fenu, Giuseppe Salemi, Paolo Ragonese, Matilde Inglese, Maria Cellerino, Lucia Margari, Giancarlo Comi, Mauro Zaffaroni, Anghelo Ghezzi

ANN NEUROL 2021;78(6): 726-735. 

Selezionato dal Lettore: Dr. Angelo Bellinvia – Università degli studi di Firenze,  Dipartimento NEUROFARBA

MOTIVATION: Early management of patients with Pediatric Onset Multiple Sclerosis can be challenging, and the availability of newer DMTs poses substantial challenges for the clinician. This interesting real-word article evaluated the changes in the prognosis over time of 3198 POMS patients from the Italian MS Registry by comparing different “treatment epochs” (<1993; 1993-1999; 2000-2006; 2007-2013), adjusting for different possible confounders of EDSS detection and disease activity. The cumulative risk for reaching EDSS 4 and 6 decreased over time, with a difference of 0.42 points when comparing the most recent and the most past epochs for EDSS 6, and 0.38 for EDSS 4. These results underline the important role of newer DMTs also in POMS patients, especially when considering that demographic characteristics and clinical disease activity at onset were unchanged in the different epochs among the included patients.

Association of Orthostatic Hypotension With Cerebral Atrophy in Patients With Lewy. Body Disorders

Pilotto A, Romagnolo A, Scalvini A, Masellis M, Shimo Y, Bonanni L, Camicioli R, Wang LL, Dwivedi AK, Longardner K, Rodriguez-Porcel F, DiFrancesco M, Vizcarra JA, Montanaro E, Maule S, Lupini A, Ojeda-Lopez C, Black SE, Pizzi SD, Gee M, Tanaka R, Yamashiro K, Hatano T, Borroni B, Gasparotti R, Rizzetti MC, Hattori N, Lopiano L, Litvan I, Espay AJ, Padovani A, Merola A.

Neurology. 2021 Jun 7:10.1212/WNL.0000000000012342. 

Selezionato dal Lettore: dott.ssa Domiziana Rinaldi - Università "La Sapienza" di Roma

MOTIVATION: Authors performed a multicenter assessment of radiological data from 384 patients (310 with Parkinson’s Disease (PD), 74 with dementia with Lewy Bodies (DLB)) to evaluate whether orthostatic hypotension (OH) or supine hypertension (SH) is associated with brain atrophy and white matter hyperintensities (WMH). This study demonstrates that OH, but not SH, was associated with cerebral atrophy in Lewy body disorders, with prominent temporal region involvement. Neither OH nor SH were associated with WMH. These results are important to future therapeutic protocols for the management of hemodynamic autonomic dysfunction in patients with PD and DLB; the successful treatment of OH often requires accepting a higher frequency of SH. These data seem to suggest that this can be achieved with minimal impact on the vulnerable cortical and subcortical structures.