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Margaritella N.,Scientific Institute Irccs S Maria Nascente | Mendozzi L.,Multiple Sclerosis Rehabilitation Unit | Garegnani M.,Scientific Institute Irccs S Maria Nascente | Colicino E.,Bocconi University | And 4 more authors.
Neurological Sciences | Year: 2012

To devise a multivariate parametric model for short-term prediction of disability using the Expanded Disability Status Scale (EDSS) and multimodal sensory EP (mEP). A total of 221 multiple sclerosis (MS) patients who underwent repeated mEP and EDSS assessments at variable time intervals over a 20-year period were retrospectively analyzed. Published criteria were used to compute a cumulative score (mEPS) of abnormalities for each of 908 individual tests. Data of a statistically balanced sample of 58 patients were fed to a parametrical regression analysis using time-lagged EDSS and mEPS along with other clinical variables to estimate future EDSS scores at 1 year. Whole sample cross-sectional mEPS were moderately correlated with EDSS, whereas longitudinal mEPS were not. Using the regression model, lagged mEPS and lagged EDSS along with clinical variables provided better future EDSS estimates. The R2 measure of fit was significant and 72% of EDSS estimates showed an error value of ±0.5. A parametrical regression model combining EDSS and mEPS accurately predicts short-term disability in MS patients and could be used to optimize decisions concerning treatment. © 2011 Springer-Verlag. Source

Mendozzi L.,Multiple Sclerosis Rehabilitation Unit | Tronci F.,Multiple Sclerosis Rehabilitation Unit | Garegnani M.,Scientific Institute Irccs | Pugnetti L.,Scientific Institute Irccs
Multiple Sclerosis | Year: 2010

Background: poor sleep is common in MS and it contributes to fatigue. The β interferons produce systemic effects which may not adapt and may induce fatigue. Objective: to verify whether subjective poor sleep and fatigue during chronic therapy correspond to reduced sleep efficiency obtained by actigraphy at home. Methods: 42 ambulatory relapsing remitting MS patients with mild disability were monitored for at least 7 nights. Habitual sleep quality and fatigue were assessed with the MOS sleep measure and the Fatigue Severity Scale. Sleep logs provided daily sleep quality assessments during actigraphy at home. Patients were grouped according to their current treatment: no therapy, glatiramer acetate, IFNβ 3 times a week, and IFNβ once a week. Results and Conclusion: sleep efficiency was reduced by an average of 5% in 2/3 of the nights following IFNβ injections compared to the other nights, and daily sleep ratings correlated with actigraphy. Patients on glatiramer acetate also showed a lower sleep efficiency than patients without therapy. Actigraphy data were only modestly correlated with MOSsm scores, not with fatigue. Long term adaptation of sleep effects of immunomodulant agents is incomplete and needs to be considered in treatment planning and assessment of sleep in MS. Source

Cavalera C.,Catholic University of the Sacred Heart | Pagnini F.,Catholic University of the Sacred Heart | Rovaris M.,Multiple Sclerosis Rehabilitation Unit | Mendozzi L.,Multiple Sclerosis Rehabilitation Unit | And 3 more authors.
Trials | Year: 2016

Background: Mindfulness-based interventions, modified and shortened versions of meditation teachings, have proved to be effective in the improvement of quality of life in many clinical conditions, including chronic diseases. Preliminary results available in the literature and in clinical experience indicate a high potential for this treatment for the reduction of psychological suffering in people with chronic diseases. Methods/Design: This randomized controlled trial will investigate the impact of a multiple sclerosis (MS) specific telemedicine meditation intervention on the quality of life of people with multiple sclerosis and their caregivers. This trial will recruit 120 patients, men and women, with a diagnosis of relapsing-remitting or secondary progressive MS and their caregivers to participate in a 2-month intervention. Patients will undergo assessments of quality of life, anxiety, depression, quality of sleep, mindfulness and fatigue levels conducted at baseline, at week 8 (conclusion of the intervention) and at week 27 (6 months follow-up). Caregivers will complete assessments conducted at the same time for the same areas, plus caregiver burden. The intervention condition will consist of 2 hours/week of online meditation in a group setting led by a trainer, plus 1 hour/week of individual exercises. The control condition will incorporate a psycho-education online program and will require the same contact time commitment as the intervention condition. Discussion: Primary outcome measures will consist of assessments of quality of life, anxiety, and depression level. Assessments of mindfulness level, quality of sleep and fatigue level will be considered secondary outcome measures. This investigation will increase understanding of the role of meditation as part of a treatment plan for people with MS and their caregivers. Overall, this study design has the potential to lead to effective meditation intervention strategies for this population and improve their quality of life. Trial registration: Clinical Trials Register NCT02364505. https://clinicaltrials.gov/ct2/show/NCT02364505 © 2016 Cavalera et al. Source

Arpaia G.,Vascular Medicine | Bavera P.M.,Vascular Unit | Caputo D.,Multiple Sclerosis Rehabilitation Unit | Mendozzi L.,Multiple Sclerosis Rehabilitation Unit | And 5 more authors.
Thrombosis Research | Year: 2010

Background: Multiple sclerosis (MS) often causes progressive loss of mobility, leading to limb paralysis. Venous and lymphatic stasis is a risk condition for venous thromboembolism (VTE). There is, however, no data on the frequency of VTE complicating the progression of MS. The aim of this study was to assess the frequency of deep vein thrombosis (DVT) in patients with late-stage MS attending a neurology center for rehabilitation. Patients and Methods: A total of 132 patients with MS were enrolled, 87 women and 45 men, mean age 58 ± 11 years. The disease had started on average 18.7 years before; patients reported 9.6 hours bedridden per day or 14.3 hours wheelchair-bound. Only 25 patients reported a residual ability to walk alone or with help. Lower limb edema was present in 113 patients, bilateral in 41 cases. At admission all patients underwent extended compression ultrasonography. Their plasma D-dimer levels were measured. No antithrombotic prophylaxis was given. Results: DVT was found in 58 patients (43.9%); 32 had a history of VTE. Forty of these patients (69%) had chronic lower limb edema, in 19 cases bilateral. D-dimer levels in the DVT patients were significantly higher than in patients without DVT (553 ± 678 vs. 261 ± 152 ng/mL, p = 0.0112, Mann-Whitney Test). Nearly half the DVT patients (26, 45%) had high D-dimer levels (701 ± 684 ng/mL). Of the 74 patients without DVT, 48 had normal D-dimer (193.37 ± 67.28 ng/mL) and 26 high (387.61 ± 187.42 ng/mL). Conclusions: The frequency of DVT in late-stage MS may be over 40%. The long history of the disease means the onset of each episode cannot be established with certainty. A number of patients with positive CUS findings had negative D-dimer values, suggesting a VTE event in the past. However, the level of DVT risk in this series should lead physicians to consider the systematic application of long-term preventive measures. © 2009 Elsevier Ltd. All rights reserved. Source

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