Puthenparampil Marco, Scialpi Graziana, Gaggiola Marta, Zanotelli Giovanni, Miscioscia Alessandro, Berardi Angela, Riccardi Alice, Nosadini Margherita, Sartori Stefano, Perini Paola, Rinaldi Francesca, Gallo Paolo
Department of Neurosciences, University of Padua, Padova, Italy.
Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padova, Italy.
Front Neurol. 2024 Nov 6;15:1475161. doi: 10.3389/fneur.2024.1475161. eCollection 2024.
Pediatric-onset multiple sclerosis (POMS) patients often exhibit a wide range of cognitive deficits. Therefore, therapeutic approaches should aim not only to prevent cognitive decline but also to promote cognitive improvement.
This study aimed to explore the effects of natalizumab (NTZ) on cognitive function, as measured by the Symbol Digit Modalities Test (SDMT), in both POMS and adult-onset multiple sclerosis (AOMS) patients.
A total of 63 patients (34 AOMS and 29 POMS) were enrolled in this retrospective, single-center study. Patients were clinically and radiologically assessed every 6 months, and they completed the SDMT at baseline and after at least 24 months of follow-up. SDMT values were reported as corrected values (cSDMT) and z-scores (zSDMT). Annualized cSDMT and zSDMT scores were calculated by dividing the change in scores by the length of the follow-up period (expressed in years).
Both POMS and AOMS groups showed improvement in annualized cSDMT and zSDMT scores, but the improvement was significantly greater in the POMS group compared to the AOMS group (+3.85 ± 4.32 vs. +1.76 ± 2.80, = 0.010 for cSDMT; 0.41 ± 0.40 vs. 0.25 ± 0.34, = 0.026 for zSDMT). After re-baselining at 6 months, 93% of POMS patients (27 patients) and 85.3% of AOMS patients (29 patients, = 0.84) achieved NEDA-3 (no evidence of disease activity). The NEDA-3 status, along with clinical and demographic parameters at baseline, did not account for the observed SDMT improvement.
The favorable clinical, radiological, and neuropsychological outcomes observed in this study support the use of natalizumab as a viable treatment option in POMS.
儿童期起病的多发性硬化症（POMS）患者常表现出广泛的认知缺陷。因此，治疗方法不仅应旨在预防认知衰退，还应促进认知改善。
本研究旨在探讨那他珠单抗（NTZ）对POMS患者和成人期起病的多发性硬化症（AOMS）患者认知功能的影响，通过符号数字模式测验（SDMT）进行测量。
本回顾性单中心研究共纳入63例患者（34例AOMS患者和29例POMS患者）。每6个月对患者进行临床和影像学评估，患者在基线时以及至少随访24个月后完成SDMT。SDMT值报告为校正值（cSDMT）和z分数（zSDMT）。年化cSDMT和zSDMT分数通过将分数变化除以随访期长度（以年表示）来计算。
POMS组和AOMS组的年化cSDMT和zSDMT分数均有所改善，但POMS组的改善明显大于AOMS组（cSDMT为+3.85±4.32对+1.76±2.80，P=0.010；zSDMT为0.41±0.40对0.25±0.34，P=0.026）。在6个月重新设定基线后，93%的POMS患者（27例患者）和85.3%的AOMS患者（29例患者，P=0.84）达到无疾病活动证据-3（NEDA-3）。NEDA-3状态以及基线时的临床和人口统计学参数并不能解释观察到的SDMT改善情况。
本研究中观察到的良好临床、影像学和神经心理学结果支持将那他珠单抗作为POMS的一种可行治疗选择。
