Posterior reversible encephalopathy and Guillain-Barré syndrome: which came first, the chicken or the egg? A review of literature.

Posterior reversible encephalopathy (PRES) is a rare occurrence in patients with Guillain-Barré syndrome (GBS) with only nine adult cases reported to date. We conducted a review of the literature and compared previous cases with a novel case admitted to our clinic. In light of the timing of the symptoms, it is assumable that arterial hypertension can develop acutely during a phase of GBS-related autonomic dysfunction and subsequently precipitates PRES. According to this, dysautonomia caused by GBS could precede motor weakness; thus, PRES in the absence of any strong alternative etiology may suggest an underlying GBS.

Fostering adherence to injectable disease-modifying therapies in multiple sclerosis.

Multiple sclerosis requires long-term management, often with disease-modifying therapies. Poor medication adherence, especially to injectables, can increase relapse and hospitalisation rates and consume healthcare resources. We discuss adherence definitions and terminology and its prevalence in multiple sclerosis (MS). Typical causes of poor adherence in patients with MS include: insufficient efficacy or tolerability, concurrent disorders, and consequences of MS (e.g., forgetfulness, depression, fatigue and poor motor skills). Ways to improve adherence rates are reviewed, focusing on interdisciplinary healthcare teams, good communication between healthcare workers and patients (and their families), ongoing support and digital tools to promote adherence. We consider open communication and continuing education to be key, and that MS nurses have a pivotal role in ensuring patients' adherence to MS medicines.

MxA mRNA quantification and disability progression in interferon beta-treated multiple sclerosis patients.

Even though anti-interferon beta (IFNß) antibodies are the main determinants of IFNß bioactivity loss and Myxovirus-resistance protein A (MxA) is the most established marker of IFNß biological activity in IFNß-treated multiple sclerosis patients, their usefulness in the routine clinical practice is still debated. Therefore, 118 multiple sclerosis patients naïve for treatment were enrolled for a 3-year longitudinal observational study mimicking the conditions of a real-world setting. In order to evaluate the kinetics of bioactivity loss in blood samples obtained every 6 months after therapy initiation, MxA and interferon receptor isoform/subunit mRNA were quantified by real-time PCR, anti-IFNß binding antibodies were detected by radioimmunoprecipitation, and neutralizing antibodies by cytopathic effect inhibition assay. Clinical measures of disease activity and disability progression were also obtained at all time points. We found that, at the individual-patient level, the response to IFNß therapy was extremely heterogeneous, including patients with stable or transitory, early or late loss of IFNß bioactivity, and patients with samples lacking MxA mRNA induction in spite of absence of antibodies. No interferon receptor isoform alterations that could explain these findings were found. At the group level, none of these biological features correlated with the measures of clinical disease activity or progression. However, when MxA mRNA was evaluated not at the single time point as a dichotomic marker (induced vs. non-induced), but as the mean of its values measured over the 6-to-24 month period, the increasing average MxA predicted a decreasing risk of short-term disability progression, independently from the presence of relapses. Therefore, a more bioactive treatment, even if unable to suppress relapses, reduces their severity by an amount that is proportional to MxA levels. Together with its feasibility in the routine laboratory setting, these data warrant the quantification of MxA mRNA as a primary tool for a routine monitoring of IFNß therapy.