Early diagnosis of progressive multifocal leucoencephalopathy: longitudinal lesion evolution. Issue 3 (2nd November 2018)

• Record Type: Journal Article
• Authors: Scarpazza, Cristina; Signori, Alessio; Prosperini, Luca; Sormani, Maria Pia; Cosottini, Mirco; Capra, Ruggero; Gerevini, Simonetta
• Other Names: author non-byline.; Altieri Marta author non-byline.; Pia Amato Maria author non-byline.; Alberto Artusi Carlo author non-byline.; Bandini Fabio author non-byline.; Barcella Valeria author non-byline.; Bertolotto Antonio author non-byline.; Brescia Morra Vincenzo author non-byline.; Capobianco Marco author non-byline.; Cavaletti Guido author non-byline.; Cavalla Paola author non-byline.; Centonze Diego author non-byline.; Chiusole Maurizia author non-byline.; Clerico Marinella author non-byline.; Cordioli Cinzia author non-byline.; D'Aleo Giangaetano author non-byline.; De Luca Giovanna author non-byline.; De Riz Milena author non-byline.; De Rossi Nicola author non-byline.; Deotto Luciano author non-byline.; Durelli Luca author non-byline.; Falcini Mario author non-byline.; Ferrante Claudio author non-byline.; Ferrari Ernesta author non-byline.; Luisa Fusco Maria author non-byline.; Gasperini Claudio author non-byline.; Ghezzi Angelo author non-byline.; Grimaldi Luigi author non-byline.; Guidotti Mario author non-byline.; Laroni Alice author non-byline.; Lugaresi Alessandra author non-byline.; Moiola Lucia author non-byline.; Naldi Paola author non-byline.; Pane Chiara author non-byline.; Palmeri Barbara author non-byline.; Perrone Patrizia author non-byline.; Pizzorno Matteo author non-byline.; Pozzilli Carlo author non-byline.; Rezzonico Monica author non-byline.; Rovaris Marco author non-byline.; Salemi Giuseppe author non-byline.; Salvetti Marco author non-byline.; Santuccio Giuseppe author non-byline.; Scarpini Elio author non-byline.; Sessa Edoardo author non-byline.; Solaro Claudio author non-byline.; Stenta Gianola author non-byline.; Tabiadon Giulietta author non-byline.; Tortorella Carla author non-byline.; Trojano Maria author non-byline.; Valentino Paola author non-byline.; Rosa Rottoli Maria author non-byline.;
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 90:Issue 3(2019)
• Page Start: 261
• Page End: 267
• Publication Date: 2018-11-02
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2018-319208
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Objective: Early diagnosis of natalizumab-related progressive multifocal leucoencephalopathy (NTZ-PML) in multiple sclerosis has been deemed a major priority by the regulatory agencies but has yet to become a reality. The current paper aims to: (1) investigate whether patients with NTZ-PML pass through a prolonged presymptomatic phase with MRI abnormalities, (2) estimate the longitudinal PML lesion volume increase during the presymptomatic phase and (3) estimate the presymptomatic phase length and its impact on therapy duration as a risk stratification parameter. Methods: All Italian patients who developed NTZ-PML between 2009 and 2018 were included. The data of patients with available prediagnostic MRI were analysed (n=41). Detailed clinical and neuroradiological information was available for each participant. Results: (1) PML lesions were detectable in the presymptomatic phase in 32/41 (78%) patients; (ii) the lesion volume increased by 62.8 % for each month spent in the prediagnostic phase; (3) the prediagnostic phase length was 150.8±74.9 days; (4) PML MRI features were detectable before the 24th month of therapy in 31.7 % of patients in our cohort. Conclusions: Considering the latency of PML clinical manifestation, the presymptomatic phase length supports the usefulness of MRI surveillance every 3–4 months. Early diagnosis could prompt a better outcome for patients due to the relationship between lesion volume and JC virus infection. The insight from this study might also have an impact on risk stratification algorithms, as therapy duration as a parameter of stratification appears to need reassessment.