Contributions
Abstract: P1250
Type: Poster
Abstract Category: Therapy - disease modifying - Risk management for disease modifying treatments
Background: Progressive multifocal leukoencephalopathy (PML) is a serious side effect of natalizumab (Nat). The value of electroencephalography (EEG) for diagnosis and prediction of Nat-PML outcome in MS patients is unclear.
Methods: Digital EEGs (according to the international 10/20-system) were obtained from two patient groups (Nat-PML (n=24) vs. relapsing MS (n=22)). In Nat-PML patients, EEGs were recorded at diagnosis, one and two years after virus elimination. EEGs were analysed during wakefulness in resting state with closed eyes. The first epoch of two seconds without artefacts was chosen from every minute of the recording. The relative spectral magnitude (RSM) for each frequency band (beta (β): 14-30Hz; alpha (α): 8-13.5Hz; theta (θ): 4-7.5Hz; delta (δ): 1-3.5Hz) was calculated by discrete fourier transform. Disability was assessed by EDSS.
Results: Age and gender were equally distributed between groups. However, MS patients showed lower disability compared to Nat-PML patients (difference of mean EDSS: 2.12; Mann-Whitney-Test (MWT): p< 0.05). At diagnosis, Nat-PML patients demonstrated a significantly higher RSM of slow frequencies (θ: 1.3-fold; δ: 1.4-fold) and lower RSM of α (0.6-fold) and β (0.8-fold) bands compared to MS controls (MWT: each p≤0.01). RSM of θ and β frequencies correlated with expansion of Nat-PML lesions on MRI at diagnosis (Spearman´s Rho: θ corr. 0.51; β corr. -0.62; each p< 0.05). Further RSM of θ and α frequencies correlated with EDSS at all time points of Nat-PML (Spearman´s Rho: θ corr. 0.44; α corr. -0.42; each p≤0.01). Finally using the following cut-off for RSM of θ and δ frequencies (δ≥28% or θ>21%) for the first recorded EEG during Nat-PML, the EDSS 1-2 years after virus elimination could be predicted (odds ratio (EDSS≥4) 17.6 (95%CI 1.2-250.4)).
Conclusion: To our knowledge, this study is the first to show, that quantitative EEG analysis can be used to support PML diagnosis and is the first objective parameter predicting Nat-PML outcome.
Disclosure:
G Classen reports travel grants from Nutricia.
R Hoepner received research and travel grants from Novartis and Biogen Idec.
C Classen reports no disclosures.
A Salmen received personal compensation for activities with Novartis, Sanofi and Almirall Hermal GmbH.
C Brandt has received personal compensation from Otsuka, Eisai, Desitin, Pfizer, and UCB Pharma for serving on scientific advisory boards, for speaking activities, and for congress travel, and financial support for research activities from UCB Pharma and Otsuka.
R Gold received speaker"s and board honoraria from Biogen Idec, Baxter, Bayer Schering, Chugai Pharmaceuticals, Merck Serono, Novartis, Roche, Sanofi-Aventis, Talecris and TEVA. He also received scientific grant support from Biogen Idec, Bayer Schering, Genzyme, Merck Serono and TEVA.
A Chan received personal compensation as a speaker or consultant for Bayer, Biogen, Genzyme, Merck, Sanofi-Aventis, Roche and Teva as well as research support from Biogen, Genzyme and Novartis.
Abstract: P1250
Type: Poster
Abstract Category: Therapy - disease modifying - Risk management for disease modifying treatments
Background: Progressive multifocal leukoencephalopathy (PML) is a serious side effect of natalizumab (Nat). The value of electroencephalography (EEG) for diagnosis and prediction of Nat-PML outcome in MS patients is unclear.
Methods: Digital EEGs (according to the international 10/20-system) were obtained from two patient groups (Nat-PML (n=24) vs. relapsing MS (n=22)). In Nat-PML patients, EEGs were recorded at diagnosis, one and two years after virus elimination. EEGs were analysed during wakefulness in resting state with closed eyes. The first epoch of two seconds without artefacts was chosen from every minute of the recording. The relative spectral magnitude (RSM) for each frequency band (beta (β): 14-30Hz; alpha (α): 8-13.5Hz; theta (θ): 4-7.5Hz; delta (δ): 1-3.5Hz) was calculated by discrete fourier transform. Disability was assessed by EDSS.
Results: Age and gender were equally distributed between groups. However, MS patients showed lower disability compared to Nat-PML patients (difference of mean EDSS: 2.12; Mann-Whitney-Test (MWT): p< 0.05). At diagnosis, Nat-PML patients demonstrated a significantly higher RSM of slow frequencies (θ: 1.3-fold; δ: 1.4-fold) and lower RSM of α (0.6-fold) and β (0.8-fold) bands compared to MS controls (MWT: each p≤0.01). RSM of θ and β frequencies correlated with expansion of Nat-PML lesions on MRI at diagnosis (Spearman´s Rho: θ corr. 0.51; β corr. -0.62; each p< 0.05). Further RSM of θ and α frequencies correlated with EDSS at all time points of Nat-PML (Spearman´s Rho: θ corr. 0.44; α corr. -0.42; each p≤0.01). Finally using the following cut-off for RSM of θ and δ frequencies (δ≥28% or θ>21%) for the first recorded EEG during Nat-PML, the EDSS 1-2 years after virus elimination could be predicted (odds ratio (EDSS≥4) 17.6 (95%CI 1.2-250.4)).
Conclusion: To our knowledge, this study is the first to show, that quantitative EEG analysis can be used to support PML diagnosis and is the first objective parameter predicting Nat-PML outcome.
Disclosure:
G Classen reports travel grants from Nutricia.
R Hoepner received research and travel grants from Novartis and Biogen Idec.
C Classen reports no disclosures.
A Salmen received personal compensation for activities with Novartis, Sanofi and Almirall Hermal GmbH.
C Brandt has received personal compensation from Otsuka, Eisai, Desitin, Pfizer, and UCB Pharma for serving on scientific advisory boards, for speaking activities, and for congress travel, and financial support for research activities from UCB Pharma and Otsuka.
R Gold received speaker"s and board honoraria from Biogen Idec, Baxter, Bayer Schering, Chugai Pharmaceuticals, Merck Serono, Novartis, Roche, Sanofi-Aventis, Talecris and TEVA. He also received scientific grant support from Biogen Idec, Bayer Schering, Genzyme, Merck Serono and TEVA.
A Chan received personal compensation as a speaker or consultant for Bayer, Biogen, Genzyme, Merck, Sanofi-Aventis, Roche and Teva as well as research support from Biogen, Genzyme and Novartis.