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Hand Dexterity Improves in Patients with Progressive Multiple Sclerosis (MS) with Telerehabilitation Using Transcranial Direct Current Stimulation (tDCS) [Meeting Abstract]

Charvet, L; Pilloni, G; Lustberg, M; Malik, M; Feinberg, C; Gutman, J; Krupp, L; Raghavan, P
Abstract Background: Loss of hand dexterity is disabling and reduces quality of life. People living with progressive forms of MS have marked neurologic disabilities but limited rehabilitation options. Transcranial direct current stimulation (tDCS) is a method of noninvasive brain stimulation in which stimulation delivered during motor training can strengthen outcomes. We have established a remotely supervised tDCS (RS-tDCS) protocol that delivers multiple stimulation sessions paired with training to participants at home.
Objective(s): To evaluate a blinded randomized sham-controlled clinical trial of active vs. sham tDCS paired with manual dexterity training for people with progressive MS.
Method(s): We recruited right-hand dominant individuals with progressive MS and hand dexterity impairment. Participants completed 20 sessions of daily (M-F) manual dexterity and were randomized to either active (2.0 mA) or sham primary motor cortex (M1-SO) tDCS. Manual dexterity was measured with the Nine-Hole Peg Test (9HPT) and Dellon-Modified Moberg Pick-Up test (MMPUT) at baseline and study end and transformed to normative z-scores for comparison.
Result(s): Participants were n=60 with primary (32%) or secondary (68%) progressive MS (52% female, ages 37-72 years, and a median Expanded Disability Status Scale (EDSS) score of 5.0 [1.5-7.5]). The intervention was safe and well tolerated, with n=59/60 (98%) completing 18/20 daily sessions. Combining hands and tasks, the full group improved following the manual dexterity training (mean z-score improvement 1.64+/-9.53, p=0.016). Active tDCS led to greater improvement (mean z-score improvement 4.51+/-8.78, p=0.001). Analyzing those with right- or left-hand impairment at baseline, the active tDCS group had significant improvement on the 9HPT (Right: p=0.036, Left: p=0.028) and trended towards significant improvement for the MMPUT (Right: p=0.071, Left: p=0.079).
Conclusion(s): At-home manual dexterity training paired with tDCS is a safe, tolerable, and feasible intervention for people with progressive MS and hand impairment. Training outcomes are augmented with simultaneous M1-SO tDCS. Research Category and Technology and Methods Clinical Research: 9. Transcranial Direct Current Stimulation (tDCS) Keywords: tDCS, motor training, multiple sclerosis, teleintervention
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EMBASE:2022769993
ISSN: 1876-4754
CID: 5511542

Cognitive Functioning in MS Improves with At-Home Online Training Paired with Transcranial Direct Current Stimulation (tDCS): Results from a Sham-Controlled Randomized Clinical Trial [Meeting Abstract]

Charvet, L.; Best, P.; Lustberg, M.; Pilloni, G.; Shaw, M.; Zhovtis, L.; Li, X.; Goldberg, J.; Gutman, J. M.; Krupp, L.
ISI:000796572500034
ISSN: 1352-4585
CID: 5244212

A Prospective Study of Neurologic Disorders in Hospitalized COVID-19 Patients in New York City

Frontera, Jennifer A; Sabadia, Sakinah; Lalchan, Rebecca; Fang, Taolin; Flusty, Brent; Millar-Vernetti, Patricio; Snyder, Thomas; Berger, Stephen; Yang, Dixon; Granger, Andre; Morgan, Nicole; Patel, Palak; Gutman, Josef; Melmed, Kara; Agarwal, Shashank; Bokhari, Matthew; Andino, Andres; Valdes, Eduard; Omari, Mirza; Kvernland, Alexandra; Lillemoe, Kaitlyn; Chou, Sherry H-Y; McNett, Molly; Helbok, Raimund; Mainali, Shraddha; Fink, Ericka L; Robertson, Courtney; Schober, Michelle; Suarez, Jose I; Ziai, Wendy; Menon, David; Friedman, Daniel; Friedman, David; Holmes, Manisha; Huang, Joshua; Thawani, Sujata; Howard, Jonathan; Abou-Fayssal, Nada; Krieger, Penina; Lewis, Ariane; Lord, Aaron S; Zhou, Ting; Kahn, D Ethan; Czeisler, Barry M; Torres, Jose; Yaghi, Shadi; Ishida, Koto; Scher, Erica; de Havenon, Adam; Placantonakis, Dimitris; Liu, Mengling; Wisniewski, Thomas; Troxel, Andrea B; Balcer, Laura; Galetta, Steven
OBJECTIVE:To determine the prevalence and associated mortality of well-defined neurologic diagnoses among COVID-19 patients, we prospectively followed hospitalized SARS-Cov-2 positive patients and recorded new neurologic disorders and hospital outcomes. METHODS:We conducted a prospective, multi-center, observational study of consecutive hospitalized adults in the NYC metropolitan area with laboratory-confirmed SARS-CoV-2 infection. The prevalence of new neurologic disorders (as diagnosed by a neurologist) was recorded and in-hospital mortality and discharge disposition were compared between COVID-19 patients with and without neurologic disorders. RESULTS:Of 4,491 COVID-19 patients hospitalized during the study timeframe, 606 (13.5%) developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset. The most common diagnoses were: toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). No patient had meningitis/encephalitis, or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were RT-PCR negative for SARS-CoV-2. Patients with neurologic disorders were more often older, male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment (SOFA) scores (all P<0.05). After adjusting for age, sex, SOFA-scores, intubation, past history, medical complications, medications and comfort-care-status, COVID-19 patients with neurologic disorders had increased risk of in-hospital mortality (Hazard Ratio[HR] 1.38, 95% CI 1.17-1.62, P<0.001) and decreased likelihood of discharge home (HR 0.72, 95% CI 0.63-0.85, P<0.001). CONCLUSIONS:Neurologic disorders were detected in 13.5% of COVID-19 patients and were associated with increased risk of in-hospital mortality and decreased likelihood of discharge home. Many observed neurologic disorders may be sequelae of severe systemic illness.
PMID: 33020166
ISSN: 1526-632x
CID: 4626712

COVID-19 outcomes in MS: Observational study of early experience from NYU Multiple Sclerosis Comprehensive Care Center

Parrotta, Erica; Kister, Ilya; Charvet, Leigh; Sammarco, Carrie; Saha, Valerie; Charlson, Robert Erik; Howard, Jonathan; Gutman, Josef Maxwell; Gottesman, Malcolm; Abou-Fayssal, Nada; Wolintz, Robyn; Keilson, Marshall; Fernandez-Carbonell, Cristina; Krupp, Lauren B; Zhovtis Ryerson, Lana
OBJECTIVE:To report outcomes on patients with multiple sclerosis (MS) and related disorders with coronavirus disease 2019 (COVID-19) illness. METHODS:From March 16 to April 30, 2020, patients with MS or related disorders at NYU Langone MS Comprehensive Care Center were identified with laboratory-confirmed or suspected COVID-19. The diagnosis was established using a standardized questionnaire or by review of in-patient hospital records. RESULTS:We identified 76 patients (55 with relapsing MS, of which 9 had pediatric onset; 17 with progressive MS; and 4 with related disorders). Thirty-seven underwent PCR testing and were confirmed positive. Of the entire group, 64 (84%) patients were on disease-modifying therapy (DMT) including anti-CD20 therapies (n = 34, 44.7%) and sphingosine-1-phosphate receptor modulators (n = 10, 13.5%). The most common COVID-19 symptoms were fever and cough, but 21.1% of patients had neurologic symptom recrudescence preceding or coinciding with the infection. A total of 18 (23.7%) were hospitalized; 8 (10.5%) had COVID-19 critical illness or related death. Features more common among those hospitalized or with critical illness or death were older age, presence of comorbidities, progressive disease, and a nonambulatory status. No DMT class was associated with an increased risk of hospitalization or fatal outcome. CONCLUSIONS:Most patients with MS with COVID-19 do not require hospitalization despite being on DMTs. Factors associated with critical illness were similar to the general at-risk patient population. DMT use did not emerge as a predictor of poor COVID-19 outcome in this preliminary sample.
PMID: 32646885
ISSN: 2332-7812
CID: 4518282

Total Hip and Knee Arthroplasty in Patients with Multiple Sclerosis

Gutman, Josef Maxwell; Kim, Kelvin; Schwarzkopf, Ran; Kister, Ilya
Background/UNASSIGNED:Hip and knee replacements for osteoarthritis are established procedures for improving joint pain and function, yet their safety in patients with multiple sclerosis (MS) is unknown. Patients with MS face unique surgical challenges due to underlying neurologic dysfunction. Current literature on arthroplasty in MS is limited to case reports focusing on adverse events. Methods/UNASSIGNED:Of 40 identified patients who underwent hip or knee replacement, 30 had sufficient data for inclusion. We reviewed their medical records and recorded reasons for surgery, age at surgery, MS characteristics, surgical complications, and ambulatory aid status before and after surgery. We supplemented medical record review with questionnaires regarding preoperative and postoperative pain and satisfaction with surgical outcomes. Results/UNASSIGNED:Median follow-up was 26 months. Complications of surgery were reported in ten patients (33%), mostly mild and self-limited, although four patients (13%) required repeated operation. Six patients (20%) reported improvements in ambulatory aid use compared with presurgery baseline, ten (33%) worsened, and 14 (47%) were unchanged. In 20 patients who completed the questionnaire, mean ± SD joint pain scores (on 0-10 scale) decreased from 8.6 ± 2.0 preoperatively to 2.9 ± 2.4 postoperatively (P < .001). Five patients (25%) were free of joint pain at last follow-up. Conclusions/UNASSIGNED:These results suggest that pain reduction is a realistic outcome of total knee or hip arthroplasty in people with MS and that improved functional gait outcomes are possible in some patients. Prospective, multicenter, collaborative studies are needed to optimize selection and improve outcomes in people with MS considering arthroplasty.
PMID: 30374255
ISSN: 1537-2073
CID: 3399572

Anti-myelin oligodendrocyte glycoprotein (MOG) antibodies in patients with optic neuritis and seizures

Gutman, Josef Maxwell; Kupersmith, Mark; Galetta, Steven; Kister, Ilya
We describe four patients who experienced optic neuritis (ON) and seizures and were found to have antibodies to myelin oligodendrocyte glycoprotein (MOG) in serum. The index case was a previously healthy 39-year-old man who developed steroid dependent ON and had a generalized seizure when steroids were tapered. He tested positive for antibodies to MOG. We have reviewed the charts of all 11 anti-MOG antibody positive patients in our practice and found that 4 patients, all of whom had experienced one or more episodes of ON, also had a generalized seizure during the course of their illness. In 2 patients - including the index case - seizure occurred during steroid taper and in 2 others at the time of an episode of acute disseminated encephalomyelitis (ADEM). Association of anti-MOG antibodies and relapsing demyelinating disorders of the central nervous system is increasingly recognized. Testing for anti-MOG antibodies should be considered in patients with optic neuritis and seizures, especially in those with who also have a history of ADEM.
PMID: 29571858
ISSN: 1878-5883
CID: 3010732

A Case of Progressive Multifocal Leukoencephalopathy in a Patient on Extended Interval Dose Natalizumab [Meeting Abstract]

Gutman, Josef; Ryerson, Lana Zhovtis; Kister, Ilya
ISI:000453090804197
ISSN: 0028-3878
CID: 3561752

Anti-Myelin Oligodendrocyte Glycoprotein (MOG) Antibodies in a Patient with Ataxia, Diplopia, and an Enhancing Cerebellar Lesion [Meeting Abstract]

Gutman, Josef; Fouladvand, Mohammad; Jafar, Jafar; Jain, Rajan; Kister, Ilya
ISI:000453090805156
ISSN: 0028-3878
CID: 3732432

Clinical Reasoning: A patient with a history of encephalomyelitis and recurrent optic neuritis

Gutman, Josef Maxwell; Levy, Michael; Galetta, Steven; Kister, Ilya
PMCID:5679419
PMID: 29109139
ISSN: 1526-632x
CID: 2772062

Tonic spasms in multiple sclerosis: A case series [Meeting Abstract]

Gutman, J M; Stember, D; Howard, J
Background: Paroxysmal tonic spasms, also known as tonic seizures or paroxysmal dystonia, can be an atypical presenting or complicating feature of multiple sclerosis (MS). They entail sudden, stereotyped episodes of abnormal posture. They are often brief, occurring many times a day, either spontaneously or provoked by movement, touch, or other maneuvers. We describe five such patients, all of whom had a demyelinating lesion in the contralateral corticospinal tract in the posterior limb of the internal capsule. Objective: To present a case series of five patients with MS who experienced tonic spasms and their localisation. Methods: Chart review and literature search. Results: Five cases of tonic spasms in MS with correlating corticospinal tract lesions: Case 1: A 29-year-old female presented with cramping in her right arm and leg with abnormal posturing of the hand and foot with clenching and overlapping of digits. Case 2: A 30-year-old female with frequent episodes of right arm and leg dystonic movements with fanning of the fingers and toes. Case 3: A 39-year-old male with left facial twitching and spams of the left hand elicited by yawning. Case 4: A 29-year-old female with MS with involuntary clenching of the left hand. Case 5: A 34-year-old female with tingling of the right arm and leg followed by involuntary flexion of the right wrist and fingers. In all cases, a brain MRI showed a demyelinating lesion in the contralateral corticospinal tract in the posterior limb of the internal capsule, as well as other lesions consistent with MS. Conclusions: Tonic spasms in MS can be localised to the contralateral posterior limb of the internal capsule. While non-epileptic in origin, they often respond to anti-epileptic drugs. Prompt recognition of this phenomenon can expedite work up and facilitate treatment
EMBASE:619358839
ISSN: 1477-0970
CID: 2871612