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Dialogues in Clinical Neuroscience & Mental Health
Number of Followers: 0  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2585-2795
Published by Obrela Homepage  [1 journal]
  • Safety of the newer disease-modifying agents for multiple sclerosis:
           disproportionality analysis in the FDA Adverse Events Reporting System
           database.

    • Authors: Vasiliki Nikolopoulou, Spyridon Siafis, Antonios Milonas, Dimitrios Kouvelas, Georgios Papazisis
      Pages: 81 - 93
      Abstract: Purpose: Aim of the present study was to identify potential safety signals for the six newer disease-modifying therapies
      (DMTs) for multiple sclerosis using the FDA Adverse Events Reporting System (FAERS) database.
      Methods: A case/non-case study was conducted with data from spontaneous reports submitted in FAERS between 2004 and 2018, using the OpenVigil2.1-MedDRA. Daclizumab, natalizumab integrin, alemtuzumab dimethyl fumarate, fingolimod, teriflunomide were examined. Adverse events were selected by the Summary Product Characteristics of the products, including all frequency levels. The reporting odds ratio (ROR) was used to express the association between DMTs and reporting adverse events.
      Results: Currently approved DMTs share some common side effects such as increased risk for infections (especially progressive multifocal leukoencephalopathy and herpes virus infections), risk for neoplasms (basal and squamous cell carcinoma, kaposi's sarcoma) and blood disorders (lymphopenia, leukopenia, pure red cell aplasia) which were confirmed by our analysis.
      Conclusion: This disproportionality analysis strengthens the already knowledge about the safety of DMTs for multiple sclerosis and emerges some new potential safety signals.
      PubDate: 2019-06-10
      Issue No: Vol. 2, No. 2 (2019)
       
  • Randomized Controlled Trials: The case of Multiple Sclerosis - Refining
           the constraints of a treasure, a short outline

    • Authors: Theodoros S. Constantinidis
      Pages: 93 - 103
      Abstract: Randomized controlled trials (RCTs) are the most valid methodological tool for establishing causal relationships. Nevertheless, their validity is constrained by various methodological details concerning their design, conduction and implementation. Failure of successful randomization, absence of correction for multiple comparisons, use of noisy scales for measuring a disease parameter, are a few of these constraints. Furthermore, there are constraints inherent in the scientific research methodology, like the use of the p-value as a threshold of statistical significance and in succession of inferential reasoning, as a threshold of truth. In this work, the examples of RCTs illustrating these limitations are drawn from the field of multiple sclerosis (MS). In general, RCTs in MS mostly are well designed, adequately powered, and well conducted. Nevertheless, sometimes there are exceptions, leading to false conclusions and steering clinical practice toward wrong choices.
      PubDate: 2019-06-10
      Issue No: Vol. 2, No. 2 (2019)
       
  • Is there a therapeutic potential for repetitive Transcranial Magnetic
           Stimulation (rTMS) in the management of cognitive impairment in Multiple
           Sclerosis'

    • Authors: Grigorios Nasios, Lambros Messinis
      Pages: 104 - 109
      Abstract: Multiple sclerosis (MS) is an autoimmune central nervous system disease, with inflammatory and degenerative components, affecting mostly young individuals, and resulting in accumulation of motor and cognitive dysfunction. Even from its insidious, subclinical phase, and through the entire course, cognitive impairment is frequently present, although often undiagnosed, and almost always untreated. Cognitive impairment is important, due to its impact on patients’ quality of life and everyday functioning capacacity as current pharmaceutical interventions have not provided sufficient therapeutic efficacy. One reason why cognitive impairment remains hidden for long periods is the brains functional reorganization, in other words its capacity to recruiting reserve networks in order to compensate for damaged ones, retaining “normal” functioning. In the era of neuromodulation, techniques such as repetitive Transcranial Magnetic Stimulation (rTMS) can serve as a non-pharmacological therapeutic option, enhancing neuroplasticity changes, and maintaining or improving cognitive functioning. In this short review we discuss the therapeutic potential of rTMS in the management of cognitive impairment in MS patients.
      PubDate: 2019-06-10
      Issue No: Vol. 2, No. 2 (2019)
       
  • Does multiple sclerosis cause progressive and widespread cognitive
           decline'

    • Authors: Marina Katsari, Dimitrios Kasselimis, Georgios Koutsis, Constantin Potagas
      Pages: 110 - 115
      Abstract: The existence of cognitive deficits in Multiple Sclerosis (MS) can be supported by clinical observation and assessment or large-scale research studies. The fact that part of the MS patient population does demonstrate some type of cognitive impairment may be unequivocal, although a crucial question remains: Is this impairment in the context of a progressive decline' The literature provides inconclusive evidence. Nevertheless, the notion of “MS dementia” seems to be gaining popularity during the last decade. In this short review, we present the findings of the main longitudinal studies on cognitive course of MS patients in an attempt to reveal the vulnerabilities of that particular view. Overall, we corroborate the idea that MS does not inevitably result in cognitive decline with advancing age, and further argue that researchers and clinicians should take the emerging trend of “MS Dementia”with a grain of salt.
      PubDate: 2019-06-10
      Issue No: Vol. 2, No. 2 (2019)
       
  • Is psychosis, at least in part, an immune-related dysmyelination
           disease'

    • Authors: Orestis Giotakos
      Pages: 116 - 129
      Abstract: Epidemiological studies have borne out the association between psychotic disorders and autoimmune disease, while the immunogenetic contribution in psychosis is largely dominated by the major histocompatibility complex genetic diversity. On the other hand, demyelinating diseases, like multiple sclerosis, are characterized by a large array of invading immune cells that degrade the myelin sheath, the myelin producing oligodendrocytes and the nerve itself. Schizophrenia has been proposed to be a dysconnectivity syndrome, and numerous lines of evidence implicate myelin and oligodendrocyte function as critical processes that could affect neuronal connectivity. Disruption in myelination and dysmyelination-induced delays in information processing can produce phenocopies of psychosis similar to schizophrenia. Rethinking the clinical and pathophysiological similarities between de- or dysmyelination diseases and psychosis, we may consider that the dysconnectivity syndrome of psychosis represents the phenomenological and behavioral result of a multiple-faces dysmyelination disorder, which is based on a lifelong immunogenetic dysregulation process.
      PubDate: 2019-06-10
      Issue No: Vol. 2, No. 2 (2019)
       
 
 
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