Angelo Pappalardo

Effects of education level and employment status on HRQoL in early relapsing-remitting multiple sclerosis

Purpose To evaluate the effects of education level and employment status on health-related quality of life (HRQoL) in a large cohort of patients affected by relapsing-remitting multiple sclerosis (RRMS). Patients This study included 648 patients with RRMS attending 40 Italian MS centers. Inclusion criteria were an Expanded Disability Status Scale (EDSS) score between 1.0 and 5.5; stable disease on enrollment; and no previous treatment with interferons, glatiramer acetate, or immunosuppressive drugs. Quality of life (QoL) was evaluated by the Multiple Sclerosis Quality of Life-54 questionnaire (MSQoL-54). Results Employed patients scored significantly higher than other patient groups in the majority of MSQoL-54 domains. Similarly, patients with academic degrees and secondary education had higher scores than those with primary education (ie, eight years of education) in several domains of HRQoL. Patients who were employed with a high educational level achieved significantly better scores than unemployed patients with a lower educational level. In multivariate analysis, occupation and educational level were found to be significant and independent predictors of HRQoL. Conclusions The results of our study suggest the importance of sustaining employment after a recent diagnosis of MS. In addition, education has a great influence on HRQoL; a higher education level may determine a stronger awareness of the disease, and a better ability to cope with the challenges of a chronic disease such as MS. Multiple Sclerosis 2007; 13: 783-791. http://msj.sagepub.com

Predictors of quality of life among patients with multiple sclerosis: An Italian cross-sectional study

The Functional Assessment of Multiple Sclerosis (FAMS) quality of life (QoL) instrument is a disease-specific, self-report questionnaire that was developed originally for US English-speaking patients. Here, the psychometric properties of the FAMS QoL questionnaire for Italian-speaking patients with multiple sclerosis (MS) are evaluated and compared with the results from the original FAMS validation survey (n=377). Eighteen Italian centers and 344 patients with MS participated in the study. The overall reliability (as expressed by Cronbachs alpha value) of the FAMS score, and its subscale scores, was always over the threshold of 0.8. Patients with benign MS showed a better overall QoL compared with patients with relapsing-remitting MS (RRMS; p=0.017), whereas patients with RRMS had a better QoL than patients with primary progressive MS (PPMS). No difference in QoL was found between patients with PPMS and those with secondary progressive MS. The Italian FAMS questionnaire is a valid measure to assess the QoL concerns of patients with MS. FAMS is also easy to administer and is well accepted by patients.

Effects of interferon beta‐1a and ‐1b over time: 6‐year results of an observational head‐to‐head study

Objective –  To evaluate and compare the long‐term efficacy and safety of two different β‐interferon preparations (IFN‐β‐1a vs IFN‐β‐1b).

Frequency and severity of headache is worsened by Interferon‐β therapy in patients with multiple sclerosis

Patti F, Nicoletti A, Pappalardo A, Castiglione A, Lo Fermo S, Messina S, D’Amico E, Cimino V, Zappia M. Frequency and severity of headache is worsened by Interferon‐β therapy in patients with multiple sclerosis. 
Acta Neurol Scand: 2012: 125: 91–95. 
© 2011 John Wiley & Sons A/S.

Pharmacologic management of spasticity in multiple sclerosis

Spasticity is very common in people with multiple sclerosis (MS). It is estimated that between 40 and 60% of all patients are affected. It consists of an abnormal, velocity-dependent increase in the phasic and tonic stretch reflexes, due to an abnormal integration of the nervous system motor responses to sensory input. The cause of spasticity could be due to an interruption of the neural network controlling the muscle stretch reflex in the central nervous system (CNS). Correct management of spasticity is essential and it must start with the identification of achievable goals. Therapeutical approaches include skilled rehabilitation strategies, pharmaceutical agents and surgery. The main objective of the treatment should be minimising the negative impact of the spasticity on disability and quality of life (QoL) of each patient.

Life-Threatening Constipation Induced by Intrathecal Baclofen Therapy

drugs (4 azathioprine, 2 methotrexate, 1 interferon beta-1b, 8 gabapentin, 2 pregabalin, 2 phenobarbital, 2 paroxetine, 1 citalopram, 1 venlafaxine, 7 furosemide, 4 heparin, 1 risperidone and 1 olanzapine). Fifteen patients did not receive any concomitant medication. ITB was administered with a mean effective daily dose of 251.3 8 11 g (range 90–580 g). Adverse events of ITB were monitored by evaluating patients’ monthly records and constipation was defined as Dear Sir, Intrathecal baclofen (ITB) delivery is a therapeutic option for patients with severe spasticity not responding to common oral medications, such as baclofen, dantrolene or tizanidine. At common doses, ITB is usually tolerated by patients [1] . Unfortunately, higher doses could be necessary to treat many cases of spasticity, thus enhancing the frequency of side effects [2–4] . Concerning gastrointestinal function, ITB could affect peristalsis, which could be severely slowed down to paralytic ileus. Nevertheless, constipation has previously been reported as an infrequent ITB-induced adverse effect, ranging from 3 to 10% of treated patients [2–4] . Here we report that, in our series of patients treated with ITB, constipation was a frequent and serious side effect, leading to death in 1 case. Thirty-eight patients (26 men and 12 women; age 48.7 8 15.4 years, mean 8 SD) were implanted for continuous ITB infusion from August 2002 to July 2006. They had severe spasticity due to different neurological diseases. Thirty-six patients out of 38 (95%) were affected by spinal cord diseases (myelitis, n = 19; multiple sclerosis, n = 13; traumatic injury, n = 4). The remaining 2 patients suffered from spasticity due to anoxic encephalopathy. All patients had previously been treated with oral baclofen, dantrolene, or tizanidine at their optimal doses, without relevant clinical benefit. Twenty-three out of 38 patients (61%) were on treatment with other Received: June 27, 2007 Accepted: October 9, 2007 Published online: June 14, 2008

Non-pharmacologic interventions for spasticity associated with multiple sclerosis

Spasticity is a common disabling symptom in people affected by multiple sclerosis (MS). It is estimated that between 40% and 75% of patients with MS are affected. The hyperexcitability of the stretch reflex arc with α- and γ-motor neurons hyperactivity is reported to explain the increase of the muscle tone. Medical management of spasticity includes pharmacologic, physical therapeutic and surgical approaches. In the initial phase of the disease, spasticity is usually mild to moderate and can be managed by exercise, physiotherapy and changes in daily activities. However, there is still a need for clinical studies to find the real effectiveness of physical therapy in spasticity due to MS.

Clinical efficacy issues in the treatment of multiple sclerosis: update of natalizumab.

Multiple sclerosis is a frequent neurologic disease, which causes sensory impairment, fatigue, cognitive deficits, imbalance, loss of mobility, spasticity, and bladder and bowel dysfunction. Several new therapies have been introduced in the past decade, but additional drugs are needed to slow disease progression and reduce disability. Natalizumab (NA) is an α4 integrin antagonist, effective in decreasing the development of brain lesions in experimental models and in several studies of patients with MS. Six randomized controlled trials of NA in MS have been published in the last 10 years. Overall, 2,688 relapsing-remitting MS subjects have been enrolled in these studies. Hence, there are already sufficient data to draw some conclusions about the effectiveness of NA in the treatment of MS, although for definitive considerations it would be reasonable to wait for the observational phase IV studies of clinical practice to complete. Moreover, the medical community is concerned with the safety of NA, particularly with the risk of developing progressive multifocal leukoencephalopathy while on NA therapy. From the analyses of the six cases, it seems that the overall risk is around 1/1,000 and could increase with the number of NA infusions.

Neurorehabilitation in Persons with Multiple Sclerosis: Scientific Basis and Options of Treatment

Introduction: Multiple Sclerosis is the leading cause of no traumatic disability in young people. Nowadays, neurorehabilitation is commonly prescribed in patients with MS, but there are still some issues to be explored further. In this review, we discuss the following topics: 1) the neuroscientific basis of neurorehabilitation in multiple sclerosis; 2) what would be the ideal set of rehabilitative treatment: inpatients, outpatient or home-based therapy? Methods: A systematic search was made, using combination of the following terms: rehabilitation, multiple sclerosis, disability, plasticity, motor learning, cognitive rehabilitation, quality of life. Results: A growing amount of evidence suggest that motor and cognitive rehabilitation may enhance functional and structural brain plasticity in patients with multiple sclerosis. Improvement of function seems to be correlated with functional Magnetic Resonance Imaging changes in brain. Moreover, several studies show the effectiveness of cognitive rehabilitation to improve some domains of neuropsychological functions, such as attention, information processing and executive functions. Regarding the rehabilitative setting, it should be chosen taking into account the personal needs of each patient. All the studies, performed in different setting, demonstrated the effectiveness of rehabilitation in Persons affected by multiple sclerosis. Conclusion: Rehabilitation is effective in mitigating disability and improving QoL in persons with MS. Setting for rehabilitation treatment should be chosen taking into account many personal needs and desires of each patient.