المؤلفون: Michaella Morphis, Johan A. van Staden, Hanlie du Raan, Michael Ljungberg, Katarina Sjögreen Gleisner

المصدر: EJNMMI Physics, Vol 11, Iss 1, Pp 1-18 (2024)

مصطلحات موضوعية: Monte Carlo simulations, SIMIND, Hybrid whole-body planar-SPECT/CT, 123I, 131I, mIBG, Medical physics. Medical radiology. Nuclear medicine, R895-920

الوصف: Abstract Purpose This study aimed to assess the accuracy of patient-specific absorbed dose calculations for tumours and organs at risk in radiopharmaceutical therapy planning, utilizing hybrid planar-SPECT/CT imaging. Methods Three Monte Carlo (MC) simulated digital patient phantoms were created, with time-activity data for mIBG labelled to I-123 (LEHR and ME collimators) and I-131 (HE collimator). The study assessed the accuracy of the mean absorbed doses for I-131-mIBG therapy treatment planning. Multiple planar whole-body (WB) images were simulated (between 1 to 72 h post-injection (p.i)). The geometric-mean image of the anterior and posterior WB images was calculated, with scatter and attenuation corrections applied. Time-activity curves were created for regions of interest over the liver and two tumours (diameters: 3.0 cm and 5.0 cm) in the WB images. A corresponding SPECT study was simulated at 24 h p.i and reconstructed using the OS-EM algorithm, incorporating scatter, attenuation, collimator-detector response, septal scatter and penetration corrections. MC voxel-based absorbed dose rate calculations used two image sets, (i) the activity distribution represented by the SPECT images and (ii) the activity distribution from the SPECT images distributed uniformly within the volume of interest. Mean absorbed doses were calculated considering photon and charged particle emissions, and beta emissions only. True absorbed doses were calculated by MC voxel-based dosimetry of the known activity distributions for reference. Results Considering photon and charged particle emissions, mean absorbed dose accuracies across all three radionuclide-collimator combinations of 3.8 ± 5.5% and 0.1 ± 0.9% (liver), 5.2 ± 10.0% and 4.3 ± 1.7% (3.0 cm tumour) and 15.0 ± 5.8% and 2.6 ± 0.6% (5.0 cm tumour) were obtained for image set (i) and (ii) respectively. Considering charged particle emissions, accuracies of 2.7 ± 4.1% and 5.7 ± 0.7% (liver), 3.2 ± 10.2% and 9.1 ± 1.7% (3.0 cm tumour) and 13.6 ± 5.7% and 7.0 ± 0.6% (5.0 cm tumour) were obtained for image set (i) and (ii) respectively. Conclusion The hybrid WB planar-SPECT/CT method proved accurate for I-131-mIBG dosimetry, suggesting its potential for personalized treatment planning.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2197-7364Test

الوصول الحر: https://doaj.org/article/8e2f81af11314e429f107379caa6f057Test

المؤلفون: Atia Samim, Gitta Bleeker, Kathelijne C.J.M. Kraal, Max M. van Noesel, Bart de Keizer, Godelieve A.M. Tytgat

المصدر: EJC Paediatric Oncology, Vol 3, Iss , Pp 100159- (2024)

مصطلحات موضوعية: Neuroblastoma, Nuclear medicine, Radionuclide therapy, Theranostic, [131I]mIBG therapy, Metastasis, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282

الوصف: Neuroblastoma is the most common extracranial solid malignancy of childhood. Approximately half of the patients have high-risk neuroblastoma (HR-NBL), typically presenting as widespread metastatic disease at diagnosis. Despite aggressive multimodality treatment, patients with HR-NBL have a long-term survival rate of below 50%. This is primarily due to frequent progression and relapse, which often proves to be therapy resistant. To overcome therapy resistance in HR-NBL, researchers are exploring diverse treatment strategies, including radionuclide therapy. Radiolabelled meta-iodobenzylguanidine (mIBG) has served as a theranostic (therapeutic and diagnostic) radiopharmaceutical in the field of neuroblastoma for several decades. [123I]mIBG scintigraphy is recognized as the international standard to evaluate disease dissemination at diagnosis and to monitor treatment response. In contrast, the role of [131I]mIBG therapy in the management of neuroblastoma is less clear. Over the past 35 years, [131I]mIBG therapy has been studied in more than 1500 patients with neuroblastoma. In initial studies, [131I]mIBG monotherapy was applied as a second-line treatment in patients who failed first-line treatment. In current applications, [131I]mIBG therapy is combined with chemotherapy, radiosensitizers, and/or immunotherapy, and is increasingly integrated in the first-line treatment of HR-NBL. This narrative review provides an overview of the literature on [131I]mIBG therapy in HR-NBL. Studies show that [131I]mIBG therapy can be an effective treatment in one-third of patients with acceptable toxicity. Further investigations, particularly randomized controlled trials, are needed to determine the efficacy and optimal use of [131I]mIBG therapy in HR-NBL.

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2772610X24000187Test; https://doaj.org/toc/2772-610XTest

الوصول الحر: https://doaj.org/article/b93d47989bf542578c9e84319037595bTest

المؤلفون: Okuda, Koichi, Nakajima, Kenichi, Kitamura, Chiemi, Ljungberg, Michael, Hosoya, Tetsuo, Kirihara, Yumiko, Hashimoto, Mitsumasa

المصدر: Journal of Nuclear Cardiology. 30(4):1630-1641

مصطلحات موضوعية: I-MIBG, collimator, heart-to-mediastinum ratio, Monte Carlo simulation, Medicin och hälsovetenskap, Klinisk medicin, Radiologi och bildbehandling, Medical and Health Sciences, Clinical Medicine, Radiology, Nuclear Medicine and Medical Imaging

الوصف: Purpose: We developed a method of standardizing the heart-to-mediastinal ratio in 123I-labeled meta-iodobenzylguanidine (MIBG) images using a conversion coefficient derived from a dedicated phantom. This study aimed to create a machine-learning (ML) model to estimate conversion coefficients without using a phantom. Methods: 210 Monte Carlo (MC) simulations of 123I-MIBG images to obtain conversion coefficients using collimators that differed in terms of hole diameter, septal thickness, and length. Simulated conversion coefficients and collimator parameters were prepared as training datasets, then a gradient-boosting ML was trained to estimate conversion coefficients from collimator parameters. Conversion coefficients derived by ML were compared with those that were MC simulated and experimentally derived from 613 phantom images. Results: Conversion coefficients were superior when estimated by ML compared with the classical multiple linear regression model (root mean square deviations: 0.021 and 0.059, respectively). The experimental, MC simulated, and ML-estimated conversion coefficients agreed, being, respectively, 0.54, 0.55, and 0.55 for the low-; 0.74, 0.70, and 0.72 for the low-middle; and 0.88, 0.88, and 0.88 for the medium-energy collimators. Conclusions: The ML model estimated conversion coefficients without the need for phantom experiments. This means that conversion coefficients were comparable when estimated based on collimator parameters and on experiments.

الوصول الحر: https://lup.lub.lu.se/record/2df89033-c6c7-4c7b-a046-bceee764dd62Test
http://dx.doi.org/10.1007/s12350-023-03198-3Test

المؤلفون: Joana Grand-Guillaume, Rosalba Mansi, Raghuvir H. Gaonkar, Sandra Zanger, Melpomeni Fani, Philippe J. Eugster, Maja Beck Popovic, Eric Grouzmann, Karim Abid

المصدر: Journal of Translational Medicine, Vol 21, Iss 1, Pp 1-20 (2023)

مصطلحات موضوعية: Neuroendocrine tumors, Theranostics, Meta-iodobenzylguanidine (mIBG), Histone deacetylase inhibitor (HDACi), PI3K/AKT/mTOR inhibitor, Xenograft, Medicine

الوصف: Abstract Background Neuroblastoma (NB) and pheochromocytoma/paraganglioma (PHEO/PGL) are neuroendocrine tumors. Imaging of these neoplasms is performed by scintigraphy after injection of radiolabeled meta-iodobenzylguanidine (mIBG), a norepinephrine analog taken up by tumoral cells through monoamine transporters. The pharmacological induction of these transporters is a promising approach to improve the imaging and therapy (theranostics) of these tumors. Methods Transporters involved in mIBG internalization were identified by using transfected Human Embryonic Kidney (HEK) cells. Histone deacetylase inhibitors (HDACi) and inhibitors of the PI3K/AKT/mTOR pathway were tested in cell lines to study their effect on mIBG internalization. Studies in xenografted mice were performed to assess the effect of the most promising HDACi on 123I-mIBG uptake. Results Transfected HEK cells demonstrated that the norepinephrine and dopamine transporter (NET and DAT) avidly internalizes mIBG. Sodium-4-phenylbutyrate (an HDACi), CUDC-907 (a dual HDACi and PI3K inhibitor), BGT226 (a PI3K inhibitor) and VS-5584 and rapamycin (two inhibitors of mTOR) increased mIBG internalization in a neuroblastoma cell line (IGR-NB8) by 2.9-, 2.1-, 2.5-, 1.5- and 1.3-fold, respectively, compared with untreated cells. CUDC-907 also increased mIBG internalization in two other NB cell lines and in one PHEO cell line. We demonstrated that mIBG internalization occurs primarily through the NET. In xenografted mice with IGR-NB8 cells, oral treatment with 5 mg/kg of CUDC-907 increased the tumor uptake of 123I-mIBG by 2.3- and 1.9-fold at 4 and 24 h post-injection, respectively, compared to the untreated group. Conclusions Upregulation of the NET by CUDC-907 lead to a better internalization of mIBG in vitro and in vivo.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1479-5876Test

الوصول الحر: https://doaj.org/article/d02749981c7d40669065e704f066964bTest

المؤلفون: Piccardo, Arnoldo, Treglia, Giorgio, Fiz, Francesco, Bar-Sever, Zvi, Bottoni, Gianluca, Biassoni, Lorenzo, Borgwardt, Lise, de Keizer, Bart, Jehanno, Nina, Lopci, Egesta, Kurch, Lars, Massollo, Michela, Nadel, Helen, Roca Bielsa, Isabel, Shulkin, Barry, Vali, Reza, De Palma, Diego, Cecchin, Diego, Santos, Ana Isabel, Zucchetta, Pietro

المساهمون: MS Radiologie, Cancer

مصطلحات موضوعية: Catecholamine, Guideline, Neuroblastoma, Paediatric PET, PET-CT, [I]MIBG, 18F-MFBG, 11C-HED, [F]F-DOPA, Radiology Nuclear Medicine and imaging

الوصف: Background: Molecular imaging is pivotal in staging and response assessment of children with neuroblastoma (NB). [123I]-metaiodobenzylguanidine (mIBG) is the standard imaging method; however, it is characterised by low spatial resolution, time-consuming acquisition procedures and difficult interpretation. Many PET catecholaminergic radiotracers have been proposed as a replacement for [123I]-mIBG, however they have not yet made it into clinical practice. We aimed to review the available literature comparing head-to-head [123I]-mIBG with the most common PET catecholaminergic radiopharmaceuticals. Methods: We searched the PubMed database for studies performing a head-to-head comparison between [123I]-mIBG and PET radiopharmaceuticals including meta-hydroxyephedrine ([11C]C-HED), 18F-18F-3,4-dihydroxyphenylalanine ([18F]DOPA) [124I]mIBG and Meta-[18F]fluorobenzylguanidine ([18F]mFBG). Review articles, preclinical studies, small case series (< 5 subjects), case reports, and articles not in English were excluded. From each study, the following characteristics were extracted: bibliographic information, technical parameters, and the sensitivity of the procedure according to a patient-based analysis (PBA) and a lesion-based analysis (LBA). Results: Ten studies were selected: two regarding [11C]C-HED, four [18F]DOPA, one [124I]mIBG, and three [18F]mFBG. These studies included 181 patients (range 5–46). For the PBA, the superiority of the PET method was reported in two out of ten studies (both using [18F]DOPA). For LBA, PET detected significantly more lesions than scintigraphy in seven out of ten studies. Conclusions: PET/CT using catecholaminergic tracers shows superior diagnostic performance than mIBG scintigraphy. However, it is still unknown if such superiority can influence clinical decision-making. Nonetheless, the PET examination appears promising for clinical practice as it offers faster image acquisition, less need for sedation, and a single-day examination.

وصف الملف: application/pdf

العلاقة: https://dspace.library.uu.nl/handle/1874/450541Test

الإتاحة: https://dspace.library.uu.nl/handle/1874/450541Test

المؤلفون: Samim, Atia, Bleeker, Gitta, Kraal, Kathelijne C.J.M., van Noesel, Max M., de Keizer, Bart, Tytgat, Godelieve A.M.

المساهمون: Researchgr. Nucleaire Geneeskunde, Cancer, Onderzoek Beeld, MS Radiologie

مصطلحات موضوعية: Disease progression, Metastasis, Neuroblastoma, Nuclear medicine, Radionuclide therapy, Refractory, Relapse, Theranostic, Therapy resistance, [I]mIBG therapy, Oncology, Dentistry (miscellaneous)

الوصف: Neuroblastoma is the most common extracranial solid malignancy of childhood. Approximately half of the patients have high-risk neuroblastoma (HR-NBL), typically presenting as widespread metastatic disease at diagnosis. Despite aggressive multimodality treatment, patients with HR-NBL have a long-term survival rate of below 50%. This is primarily due to frequent progression and relapse, which often proves to be therapy resistant. To overcome therapy resistance in HR-NBL, researchers are exploring diverse treatment strategies, including radionuclide therapy. Radiolabelled meta-iodobenzylguanidine (mIBG) has served as a theranostic (therapeutic and diagnostic) radiopharmaceutical in the field of neuroblastoma for several decades. [123I]mIBG scintigraphy is recognized as the international standard to evaluate disease dissemination at diagnosis and to monitor treatment response. In contrast, the role of [131I]mIBG therapy in the management of neuroblastoma is less clear. Over the past 35 years, [131I]mIBG therapy has been studied in more than 1500 patients with neuroblastoma. In initial studies, [131I]mIBG monotherapy was applied as a second-line treatment in patients who failed first-line treatment. In current applications, [131I]mIBG therapy is combined with chemotherapy, radiosensitizers, and/or immunotherapy, and is increasingly integrated in the first-line treatment of HR-NBL. This narrative review provides an overview of the literature on [131I]mIBG therapy in HR-NBL. Studies show that [131I]mIBG therapy can be an effective treatment in one-third of patients with acceptable toxicity. Further investigations, particularly randomized controlled trials, are needed to determine the efficacy and optimal use of [131I]mIBG therapy in HR-NBL.

وصف الملف: application/pdf

العلاقة: https://dspace.library.uu.nl/handle/1874/451873Test

الإتاحة: https://dspace.library.uu.nl/handle/1874/451873Test

المؤلفون: Rasmussen, Thorsten K, Borghammer, Per, Finnerup, Nanna B, Jensen, Troels S, Hansen, John, Knudsen, Karoline, Singer, Wolfgang, Lamotte, Guillaume, Terkelsen, Astrid J

المصدر: Rasmussen , T K , Borghammer , P , Finnerup , N B , Jensen , T S , Hansen , J , Knudsen , K , Singer , W , Lamotte , G & Terkelsen , A J 2024 , ' Functional and 123I-MIBG scintigraphy assessment of cardiac adrenergic dysfunction in diabetes ' , Autonomic Neuroscience: Basic and Clinical , vol. 252 , 103155 . https://doi.org/10.1016/j.autneu.2024.103155Test

مصطلحات موضوعية: Autonomic nervous system, Autonomic vascular control, Cardiac autonomic regulation, I-metaiodobenzylguanidine (MIBG), Type 2 diabetes

الوصف: Objectives: To assess the agreement between clinical cardiovascular adrenergic function and cardiac adrenergic innervation in type 2 diabetes patients (T2D). Methods: Thirty-three patients with T2D were investigated bimodally through (1) a standardized clinical cardiovascular adrenergic assessment, evaluating adequacy of blood pressure responses to the Valsalva maneuver and (2) 123 I-meta-iodobenzylguanidine (MIBG) scintigraphy assessing myocardial adrenergic innervation measured as early and delayed heart heart/mediastinum (H/M) ratio, and washout rate (WR). Results: T2D patients had significantly lower early and delayed H/M-ratios, and lower WR, compared to laboratory specific reference values. Thirteen patients had an abnormal adrenergic composite autonomic severity score (CASS > 0). Patients with abnormal CASS scores had significantly higher early H/M ratios (1.76 [1.66–1.88] vs. 1.57 [1.49–1.63], p < 0.001), higher delayed H/M ratios (1.64 [1.51:1.73] vs. 1.51 [1.40:1.61] (p = 0.02)), and lower WR (−0.13(0.10) vs −0.05(0.07), p = 0.01). Lower Total Recovery and shorter Pressure Recovery Time responses from the Valsalva maneuver was significantly correlated to lower H/M early (r = 0.55, p = 0.001 and r = 0.5, p = 0.003, respectively) and lower WR for Total Recovery (r = −0.44, p = 0.01). Conclusion: The present study found impairment of sympathetic innervation in T2D patients based on parameters derived from MIBG cardiac scintigraphy (low early H/M, delayed H/M, and WR). These results confirm prior studies. We found a mechanistically inverted relationship with favourable adrenergic cardiovascular responses being significantly associated unfavourable MIBG indices for H/M early and delayed. This paradoxical relationship needs to be further explored but could indicate adrenergic hypersensitivity in cardiac sympathetic denervated T2D patients.

وصف الملف: application/pdf

العلاقة: https://vbn.aau.dk/da/publications/b2f36ca7-9153-48d8-88c3-3150b5878fccTest

الإتاحة: https://doi.org/10.1016/j.autneu.2024.103155Test
https://vbn.aau.dk/da/publications/b2f36ca7-9153-48d8-88c3-3150b5878fccTest
https://vbn.aau.dk/ws/files/661452714/1-s2.0-S1566070224000092-main.pdfTest
http://www.scopus.com/inward/record.url?scp=85185550744&partnerID=8YFLogxKTest

المؤلفون: Tatyana D. Fedorova, Karoline Knudsen, Thorsten K. Rasmussen, Jacob Horsager, Adjmal Nahimi, Casper Skjærbæk, Eva Schaeffer, Daniela Berg, Astrid J. Terkelsen, Per Borghammer

المصدر: IBRO Neuroscience Reports, Vol 14, Iss , Pp 342-345 (2023)

مصطلحات موضوعية: Parkinson’s disease, Diabetes mellitus, MIBG, Thyroid gland, Scintigraphy, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571

الوصف: Thyroid [123I]MIBG uptake is proposed as a tool for differentiating between Parkinson’s disease (PD) and diabetes mellitus (DM) on [123I]MIBG scintigraphies since both patient groups show decreased cardiac uptake. One study compared thyroid [123I]MIBG uptake in DM and PD patients and reported reduced [123I]MIBG uptake only in the PD group. Here, we investigated thyroid [123I]MIBG uptake in patients with PD and DM and found severely reduced thyroid [123I]MIBG uptake in DM. Larger studies are needed to substantiate whether DM patients are more or less likely to exhibit decreased thyroid MIBG uptake compared to controls and PD patients.

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2667242123000234Test; https://doaj.org/toc/2667-2421Test

الوصول الحر: https://doaj.org/article/d2fa5d4fb84642daabee7e05aad0318aTest

المؤلفون: Shun Kudo, Takahito Uchida, Hana Nishida, Akihiro Takamiya, Toshiaki Kikuchi, Bun Yamagata, Masaru Mimura, Jinichi Hirano

المصدر: BMC Psychiatry, Vol 23, Iss 1, Pp 1-8 (2023)

مصطلحات موضوعية: DaT-SPECT, Dementia with Lewy bodies, Major depressive disorder, Maintenance ECT, MIBG scintigraphy, Parkinson’s disease, Psychiatry, RC435-571

الوصف: Abstract Background Maintaining remission after electroconvulsive therapy (ECT) is clinically relevant in patients with depression, and maintenance ECT has been introduced in patients who fail to maintain remission after ECT. However, the clinical characteristics and biological background of patients who receive maintenance ECT are poorly understood. Thus, this study aimed to examine the clinical background of patients who underwent maintenance ECT. Methods Patients with major depressive disorder who underwent ECT followed by maintenance ECT (mECT group) and those who did not (acute ECT [aECT] group) were included. Clinical characteristics, including the results of neuroimaging examinations for Parkinson’s disease (PD) and dementia with Levy body (DLB) such as myocardial 123I-metaiodobenzylguanidine (MIBG) scintigraphy and dopamine transporter imaging single-photon emission computerized tomography (DaT-SPECT), were compared between the groups. Results In total, 13 and 146 patients were included in the mECT and aECT groups, respectively. Compared to the aECT group, the mECT group showed a significantly higher prevalence of melancholic features (92.3% vs. 27.4%, p

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-244XTest

الوصول الحر: https://doaj.org/article/06a77426b8584ce7906627bd5d9390b2Test

المؤلفون: V. Cantarín-Extremera, M. Jiménez-Legido, S. Aguilera-Albesa, A. Hedrera-Fernández, L. Arrabal-Fernández, N. Gorría-Redondo, I. Martí-Carrera, M.E. Yoldi-Pedtri, M. Sagaseta-De Ilúrdoz, L. González-Gutiérrez-Solana

المصدر: Neurología, Vol 38, Iss 2, Pp 93-105 (2023)

مصطلحات موضوعية: Opsoclonus-myoclonus-ataxia syndrome, Neuroinflammation, Immunotherapy, MIBG, Neuroblastoma, Neurocognitive, Neurology. Diseases of the nervous system, RC346-429

الوصف: Resumen: Introducción: El síndrome opsoclono-mioclono-ataxia es un raro trastorno de inicio pediátrico; de base neuroinflamatoria y origen paraneoplásico, parainfeccioso o idiopático. Actualmente no hay biomarcadores, siendo el diagnóstico clínico. El pronóstico cognitivo parece estar relacionado con el inicio temprano de la terapia inmunomoduladora. Método: Se describen las características epidemiológicas, clínicas, terapéuticas y pronósticas a largo plazo de una cohorte de 20 pacientes españoles. Resultados: La edad media de debut fue de 21 meses (2-59 meses). La ataxia y el opsoclonus fueron los síntomas de inicio más frecuentes y predominantes en la evolución. El tiempo medio desde los primeros síntomas hasta el diagnóstico fue de 1,1 mes. Un tumor de extirpe neuroblástica fue detectado en el 45%, realizándose resección quirúrgica en siete y quimioterapia en dos pacientes. En el estudio de líquido cefalorraquídeo se constató pleocitosis en cuatro (25%), con negatividad de anticuerpos antineuronales y bandas oligoclonales en todos los casos estudiados. En el 100% se emplearon fármacos inmunomoduladores. En nueve pacientes el tratamiento combinado inmunomodulador se inició desde el momento del diagnóstico, y en cinco el tiempo medio de implementación fue de 2,2 meses. A largo plazo, seis de 10 pacientes con seguimiento superior a cinco años presentaban secuelas cognitivas leves o moderadas; cuatro pacientes presentaron recaídas, generalmente coincidiendo con el descenso de la corticoterapia. Conclusiones: El inicio precoz de la inmunoterapia, así como de la triple terapia en los casos que lo precisaron, se relacionó con una menor frecuencia de afectación cognitiva a los dos años del debut. Abstract: Introduction: Opsoclonus-myoclonus-ataxia syndrome is a rare neuroinflammatory disorder with onset during childhood; aetiology may be paraneoplastic, para-infectious, or idiopathic. No biomarkers have yet been identified, and diagnosis is clinical. Better cognitive prognosis appears to be related to early onset of immunomodulatory therapy. Methods: We describe the epidemiological, clinical, therapeutic, and long-term prognostic characteristics of a cohort of 20 Spanish patients. Results: The mean age of onset was 21 months (range, 2-59). Ataxia and opsoclonus were the most frequent symptoms both at disease onset and throughout disease progression. The mean time from onset to diagnosis was 1.1 months. Neuroblast lineage tumours were detected in 45% of patients; these were treated with surgical resection in 7 cases and chemotherapy in 2. Cerebrospinal fluid analysis revealed pleocytosis in 4 cases (25%) and neither antineuronal antibodies nor oligoclonal bands were detected in any patient. Immunomodulatory drugs were used in all cases. Nine patients started combined immunomodulatory treatment at the time of diagnosis, and 5 patients after a mean of 2.2 months. In the long term, 6 of the 10 patients followed up for more than 5 years presented mild or moderate cognitive sequelae. Four patients presented relapses, generally coinciding with the decrease of corticosteroid doses. Conclusions: Early initiation of immunotherapy, as well as triple combination therapy, where needed, was associated with a lower frequency of cognitive impairment 2 years after onset.

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S0213485320301377Test; https://doaj.org/toc/0213-4853Test

الوصول الحر: https://doaj.org/article/d93458a52c0045a68005cbd0f33136c3Test