Journal of Personalized Medicine

Editorial

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Open AccessEditorial

Personalized Diagnosis and Therapy for Multiple Sclerosis

by Cristina Ramo-Tello

J. Pers. Med. 2022, 12(6), 1017; https://doi.org/10.3390/jpm12061017 - 20 Jun 2022

Viewed by 1534

Abstract

This Special Issue, entitled “Personalized Diagnosis and Therapy for Multiple Sclerosis” encompasses eight publications that we consider relevant, because their reading will help the clinician working regularly with people who suffer from multiple sclerosis (MS) [...] Full article

(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)

Research

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11 pages, 557 KiB

Open AccessArticle

Cognitive Performance and Health-Related Quality of Life in Patients with Neuromyelitis Optica Spectrum Disorder

by Elisabet Lopez-Soley, Jose E. Meca-Lallana, Sara Llufriu, Yolanda Blanco, Rocío Gómez-Ballesteros, Jorge Maurino, Francisco Pérez-Miralles, Lucía Forero, Carmen Calles, María L. Martinez-Gines, Inés Gonzalez-Suarez, Sabas Boyero, Lucía Romero-Pinel, Ángel P. Sempere, Virginia Meca-Lallana, Luis Querol, Lucienne Costa-Frossard, Maria Sepulveda and Elisabeth Solana

J. Pers. Med. 2022, 12(5), 743; https://doi.org/10.3390/jpm12050743 - 2 May 2022

Cited by 8 | Viewed by 2871

Abstract

Background: The frequency of cognitive impairment (CI) reported in neuromyelitis optica spectrum disorder (NMOSD) is highly variable, and its relationship with demographic and clinical characteristics is poorly understood. We aimed to describe the cognitive profile of NMOSD patients, and to analyse the cognitive [...] Read more.

Background: The frequency of cognitive impairment (CI) reported in neuromyelitis optica spectrum disorder (NMOSD) is highly variable, and its relationship with demographic and clinical characteristics is poorly understood. We aimed to describe the cognitive profile of NMOSD patients, and to analyse the cognitive differences according to their serostatus; furthermore, we aimed to assess the relationship between cognition, demographic and clinical characteristics, and other aspects linked to health-related quality of life (HRQoL). Methods: This cross-sectional study included 41 patients (median age, 44 years; 85% women) from 13 Spanish centres. Demographic and clinical characteristics were collected along with a cognitive z-score (Rao’s Battery) and HRQoL patient-centred measures, and their relationship was explored using linear regression. We used the Akaike information criterion to model which characteristics were associated with cognition. Results: Fourteen patients (34%) had CI, and the most affected cognitive domain was visual memory. Cognition was similar in AQP4-IgG-positive and -negative patients. Gender, mood, fatigue, satisfaction with life, and perception of stigma were associated with cognitive performance (adjusted R² = 0.396, p < 0.001). Conclusions: The results highlight the presence of CI and its impact on HRQoL in NMOSD patients. Cognitive and psychological assessments may be crucial to achieve a holistic approach in patient care. Full article

(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)

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10 pages, 587 KiB

Open AccessArticle

Innovating Care in Multiple Sclerosis: Feasibility of Synchronous Internet-Based Teleconsultation for Longitudinal Clinical Monitoring

by Nima Sadeghi, Piet Eelen, Guy Nagels, Corinne Cuvelier, Katinka Van Gils, Marie B. D’hooghe, Jeroen Van Schependom and Miguel D’haeseleer

J. Pers. Med. 2022, 12(3), 433; https://doi.org/10.3390/jpm12030433 - 10 Mar 2022

Cited by 3 | Viewed by 2129

Abstract

The ‘coronavirus disease of 2019’ crisis has recently forced an expedited adoption of teleconsultation (TC) in most medical domains. Short-term digital interventions have generally been associated with feasibility, clinical benefits, user satisfaction, and cost-effectiveness in patients with multiple sclerosis (MS) but outcomes after [...] Read more.

The ‘coronavirus disease of 2019’ crisis has recently forced an expedited adoption of teleconsultation (TC) in most medical domains. Short-term digital interventions have generally been associated with feasibility, clinical benefits, user satisfaction, and cost-effectiveness in patients with multiple sclerosis (MS) but outcomes after repeated utilization over extended periods need to be further evaluated. In this feasibility study, 60 subjects with MS were 1:1 randomized to receive standard care augmented by four TCs using an audiovisual Internet platform (intervention) versus standard care alone (controls), over a period of 12 months. Effects on functional status, medical costs, and satisfaction were explored as secondary outcomes. Eighty-nine out of 108 scheduled TCs (82.4%) were completed, and 26 patients could complete at least one TC (86.7%), meeting our prespecified feasibility target of 80%. The intervention did not lead to significant differences in functional status (with the potential exception of fatigue) nor medical costs. Most interventional patients declared themselves to be (very) satisfied about the quality of care and technical aspects associated with the TCs. Our results demonstrate that longitudinal clinical monitoring using real-time audiovisual TC over the Internet is feasible and well-received by patients with MS. Such an approach can be a promising new care strategy. Full article

(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)

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12 pages, 525 KiB

Open AccessArticle

Recommendations for the Diagnosis and Treatment of Multiple Sclerosis Relapses

by Cristina Ramo-Tello, Yolanda Blanco, Luis Brieva, Bonaventura Casanova, Eva Martínez-Cáceres, Daniel Ontaneda, Lluís Ramió-Torrentá and Àlex Rovira

J. Pers. Med. 2022, 12(1), 6; https://doi.org/10.3390/jpm12010006 - 22 Dec 2021

Cited by 13 | Viewed by 9949

Abstract

Minimizing the risk of relapse is essential in multiple sclerosis (MS). As none of the treatments currently available are capable of completely preventing relapses, treatment of these episodes remains a cornerstone of MS care. The objective of this manuscript is to reduce uncertainty [...] Read more.

Minimizing the risk of relapse is essential in multiple sclerosis (MS). As none of the treatments currently available are capable of completely preventing relapses, treatment of these episodes remains a cornerstone of MS care. The objective of this manuscript is to reduce uncertainty and improve quality of care of this neurological process. This article addresses definitions of key concepts, recommendations for clinical examination, classification criteria, magnetic resonance imaging, biomarkers, and specific therapeutic counsels including special populations such as pregnant and breastfeeding women, and children. An algorithm for treating MS relapses is also provided. Full article

(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)

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19 pages, 7685 KiB

Open AccessArticle

Assessing Blood-Based Biomarkers to Define a Therapeutic Window for Natalizumab

by Júlia Granell-Geli, Cristina Izquierdo-Gracia, Ares Sellés-Rius, Aina Teniente-Serra, Silvia Presas-Rodríguez, María José Mansilla, Luis Brieva, Javier Sotoca, María Alba Mañé-Martínez, Ester Moral, Irene Bragado, Susan Goelz, Eva Martínez-Cáceres and Cristina Ramo-Tello

J. Pers. Med. 2021, 11(12), 1347; https://doi.org/10.3390/jpm11121347 - 10 Dec 2021

Cited by 3 | Viewed by 2599

Abstract

Natalizumab is a monoclonal antibody that binds CD49d. Although it is one of the most effective treatments for Relapsing-Remitting Multiple Sclerosis (RRMS), a dosing regimen has not been optimized for safety and efficacy in individual patients. We aimed to identify biomarkers to monitor [...] Read more.

Natalizumab is a monoclonal antibody that binds CD49d. Although it is one of the most effective treatments for Relapsing-Remitting Multiple Sclerosis (RRMS), a dosing regimen has not been optimized for safety and efficacy in individual patients. We aimed to identify biomarkers to monitor Natalizumab treatment and to establish a personalized dose utilizing an ongoing longitudinal study in 29 RRMS patients under Natalizumab with standard interval dose (SD) of 300 mg/4wks or extended interval dose (EID) of 300 mg/6wks. Blood samples were analyzed by flow cytometry to determine CD49d saturation and expression in several T and B lymphocytes subpopulations. Each patient was analyzed at two different timepoints separated by 3 Natalizumab administrations. Natalizumab and sVCAM-1 levels in serum were also analyzed using ELISA. To determine the reproducibility of various markers, two different timepoints were compared and no significant differences were observed for CD49d expression nor for saturation; SD patients had higher saturation levels (~80%) than EID patients (~60%). A positive correlation exists between CD49d saturation and Natalizumab serum levels. CD49d expression and saturation are stable parameters that could be used as biomarkers in the immunomonitoring of Natalizumab treatment. Moreover, Natalizumab and sVCAM-1 serum levels could be used to optimize an individual’s dosing schedule. Full article

(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)

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11 pages, 268 KiB

Open AccessFeature PaperArticle

Associations between Lifestyle Behaviors and Quality of Life Differ Based on Multiple Sclerosis Phenotype

by Nupur Nag, Maggie Yu, George A. Jelinek, Steve Simpson-Yap, Sandra L. Neate and Hollie K. Schmidt

J. Pers. Med. 2021, 11(11), 1218; https://doi.org/10.3390/jpm11111218 - 17 Nov 2021

Cited by 7 | Viewed by 3812

Abstract

Multiple sclerosis (MS), a neuroinflammatory disorder, occurs as non-progressive or progressive phenotypes; both forms present with diverse symptoms that may reduce quality of life (QoL). Adherence to healthy lifestyle behaviors has been associated with higher QoL in people with MS; whether these associations [...] Read more.

Multiple sclerosis (MS), a neuroinflammatory disorder, occurs as non-progressive or progressive phenotypes; both forms present with diverse symptoms that may reduce quality of life (QoL). Adherence to healthy lifestyle behaviors has been associated with higher QoL in people with MS; whether these associations differ based on MS phenotype is unknown. Cross-sectional self-reported observational data from 1108 iConquerMS participants were analysed. Associations between lifestyle behaviors and QoL were assessed by linear regression, and phenotype differences via moderation analyses. Diet, wellness, and physical activity, but not vitamin D or omega-3 supplement use, were associated with QoL. Specifically, certain diet types were negatively associated with QoL in relapsing-remitting MS (RRMS), and positively associated in progressive MS (ProgMS). Participation in wellness activities had mixed associations with QoL in RRMS but was not associated in ProgMS. Physical activity was positively associated with QoL in RRMS and ProgMS. Phenotype differences were observed in diet and wellness with physical QoL, and physical activity with most QoL subdomains. Our findings show lifestyle behaviors are associated with QoL and appear to differ based on MS phenotype. Future studies assessing timing, duration, and adherence of adopting lifestyle behaviors may better inform their role in MS management. Full article

(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)

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11 pages, 1007 KiB

Open AccessArticle

Dynamics and Predictors of Cognitive Impairment along the Disease Course in Multiple Sclerosis

by Elisabet Lopez-Soley, Eloy Martinez-Heras, Magi Andorra, Aleix Solanes, Joaquim Radua, Carmen Montejo, Salut Alba-Arbalat, Nuria Sola-Valls, Irene Pulido-Valdeolivas, Maria Sepulveda, Lucia Romero-Pinel, Elvira Munteis, Jose E. Martínez-Rodríguez, Yolanda Blanco, Elena H. Martinez-Lapiscina, Pablo Villoslada, Albert Saiz, Elisabeth Solana and Sara Llufriu

J. Pers. Med. 2021, 11(11), 1107; https://doi.org/10.3390/jpm11111107 - 28 Oct 2021

Cited by 14 | Viewed by 2541

Abstract

(1) Background: The evolution and predictors of cognitive impairment (CI) in multiple sclerosis (MS) are poorly understood. We aimed to define the temporal dynamics of cognition throughout the disease course and identify clinical and neuroimaging measures that predict CI. (2) Methods: This paper [...] Read more.

(1) Background: The evolution and predictors of cognitive impairment (CI) in multiple sclerosis (MS) are poorly understood. We aimed to define the temporal dynamics of cognition throughout the disease course and identify clinical and neuroimaging measures that predict CI. (2) Methods: This paper features a longitudinal study with 212 patients who underwent several cognitive examinations at different time points. Dynamics of cognition were assessed using mixed-effects linear spline models. Machine learning techniques were used to identify which baseline demographic, clinical, and neuroimaging measures best predicted CI. (3) Results: In the first 5 years of MS, we detected an increase in the z-scores of global cognition, verbal memory, and information processing speed, which was followed by a decline in global cognition and memory (p < 0.05) between years 5 and 15. From 15 to 30 years of disease onset, cognitive decline continued, affecting global cognition and verbal memory. The baseline measures that best predicted CI were education, disease severity, lesion burden, and hippocampus and anterior cingulate cortex volume. (4) Conclusions: In MS, cognition deteriorates 5 years after disease onset, declining steadily over the next 25 years and more markedly affecting verbal memory. Education, disease severity, lesion burden, and volume of limbic structures predict future CI and may be helpful when identifying at-risk patients. Full article

(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)

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Review

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14 pages, 299 KiB

Open AccessFeature PaperReview

Escalation vs. Early Intense Therapy in Multiple Sclerosis

by Bonaventura Casanova, Carlos Quintanilla-Bordás and Francisco Gascón

J. Pers. Med. 2022, 12(1), 119; https://doi.org/10.3390/jpm12010119 - 17 Jan 2022

Cited by 23 | Viewed by 5604

Abstract

The treatment strategy of multiple sclerosis (MS) is a highly controversial debate. Currently, there are up to 19 drugs approved. However, there is no clear evidence to guide fundamental decisions such as what treatment should be chosen in first place, when treatment failure [...] Read more.

The treatment strategy of multiple sclerosis (MS) is a highly controversial debate. Currently, there are up to 19 drugs approved. However, there is no clear evidence to guide fundamental decisions such as what treatment should be chosen in first place, when treatment failure or suboptimal response should be considered, or what treatment should be considered in these cases. The “escalation strategy” consists of starting treatment with drugs of low side-effect profile and low efficacy, and “escalating” to drugs of higher efficacy—with more potential side-effects—if necessary. This strategy has prevailed over the years. However, the evidence supporting this strategy is based on short-term studies, in hope that the benefits will stand in the long term. These studies usually do not consider the heterogeneity of the disease and the limited effect that relapses have on the long-term. On the other hand, “early intense therapy” strategy refers to starting treatment with drugs of higher efficacy from the beginning, despite having a less favorable side-effect profile. This approach takes advantage of the so-called “window of opportunity” in hope to maximize the clinical benefits in the long-term. At present, the debate remains open. In this review, we will critically review both strategies. We provide a summary of the current evidence for each strategy without aiming to reach a definite conclusion. Full article

(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)

17 pages, 2516 KiB

Open AccessFeature PaperReview

Towards Multimodal Machine Learning Prediction of Individual Cognitive Evolution in Multiple Sclerosis

by Stijn Denissen, Oliver Y. Chén, Johan De Mey, Maarten De Vos, Jeroen Van Schependom, Diana Maria Sima and Guy Nagels

J. Pers. Med. 2021, 11(12), 1349; https://doi.org/10.3390/jpm11121349 - 11 Dec 2021

Cited by 14 | Viewed by 4700

Abstract

Multiple sclerosis (MS) manifests heterogeneously among persons suffering from it, making its disease course highly challenging to predict. At present, prognosis mostly relies on biomarkers that are unable to predict disease course on an individual level. Machine learning is a promising technique, both [...] Read more.

Multiple sclerosis (MS) manifests heterogeneously among persons suffering from it, making its disease course highly challenging to predict. At present, prognosis mostly relies on biomarkers that are unable to predict disease course on an individual level. Machine learning is a promising technique, both in terms of its ability to combine multimodal data and through the capability of making personalized predictions. However, most investigations on machine learning for prognosis in MS were geared towards predicting physical deterioration, while cognitive deterioration, although prevalent and burdensome, remained largely overlooked. This review aims to boost the field of machine learning for cognitive prognosis in MS by means of an introduction to machine learning and its pitfalls, an overview of important elements for study design, and an overview of the current literature on cognitive prognosis in MS using machine learning. Furthermore, the review discusses new trends in the field of machine learning that might be adopted for future studies in the field. Full article

(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)

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