Kalinowska-Lyszczarz, Alicja

Mayo Clinic

From the Department of Neurology (W.O.T., Y.G., L.L.), Health Sciences Research (S.D.W., N.T.), and Department of Pathology (J.E.P.), Mayo Clinic, Rochester, MN; Poznan University of Medical Sciences (A.K.-L.), Poland; University of Göttingen (I.M., W.B.),

Clinical Correlation of Multiple Sclerosis Immunopathologic Subtypes

Tobin, W. Oliver , Kalinowska, Alicja , Weigand, Stephen D. , Guo, Yong , Tosakulwong, Nirubol , Parisi, Joseph E. , Metz, Imke , Frischer, Josa M. , Lassmann, Hans , Brück, Wolfgang , Linbo, L., Lucchinetti, Claudia F. , Kalinowska-Lyszczarz, Alicja , Linbo, Linda, Tobin, W Oliver

Neurology | September 10, 2021 | Volume: 97 | Issue: 19 | Pages: No page available

10.1212/wnl.0000000000012782

Long-term clinical, MRI, and cognitive follow-up in a large cohort of pathologically confirmed, predominantly tumefactive multiple sclerosis

Kalinowska, Alicja , Tillema, Jan‐Mendelt , Tobin, W. Oliver , Guo, Yong , Fitz‐Gibbon, Patrick D., Weigand, Stephen D. , Giraldo‐Chica, Mónica , Lucchinetti, Claudia F. , Kalinowska-Lyszczarz, Alicja , Tobin, W Oliver , Port, John D.

Multiple Sclerosis Journal | July 2, 2021 | Volume: 28 | Issue: 3 | Pages: 441-452

10.1177/13524585211024162

Background: Limited studies have described long-term outcomes in pathology confirmed multiple sclerosis (MS). Objectives: To describe long-term clinical–radiographic–cognitive outcomes in a prospectively followed cohort of patients with pathologically confirmed CNS demyelinating disease, consistent with MS. Methods: Subjects underwent clinical assessment, standardized 3T-MRI brain, and cognitive battery. Results: Seventy-five patients were included. Biopsied lesion size was ⩾ 2 cm in 62/75. At follow-up, median duration since biopsy was 11 years. Median EDSS was 3 and lesion burden was large (median 10 cm 3 ). At follow-up, 57/75 met MS criteria, 17/75 had clinically isolated syndrome, and 1 radiographic changes only. Disability scores were comparable to a prevalence cohort in Olmsted County ( p < 0.001, n = 218). Cognitive outcomes below age-normed standards included psychomotor, attention, working memory, and executive function domains. Total lesion volume and index lesion-related severity correlated with EDSS and cognitive performance. Volumetric cortical/subcortical GM correlated less than lesion metrics to cognitive outcomes. Conclusion: Despite early aggressive course in pathologically confirmed MS, its long-term course was comparable to typical MS in our study. Cognitive impairment in this group seemed to correlate strongest to index lesion severity and total lesion volume. It remains to be established how the aggressive nature of the lesion, biopsy, and treatment affect clinical/cognitive outcomes.

Pathological findings in central nervous system demyelination associated with infliximab

Kalinowska, Alicja , Fereidan-Esfahani, Mahboobeh , Guo, Yong , Lucchinetti, Claudia F. , Tobin, W. Oliver , Kalinowska-Lyszczarz, Alicja, Tobin, W Oliver , Kalinowska-Lyszczarz, Alicja , Guo, Yong

Multiple Sclerosis Journal | December 17, 2019 | Volume: 26 | Issue: 9 | Pages: 1124-1129

10.1177/1352458519894710

Background: Tumor necrosis factor alpha (TNF-alpha) inhibitors, such as infliximab, are commonly used to treat rheumatoid arthritis (RA) and other immune-mediated disorders. Objective: To determine whether infliximab-associated central nervous system (CNS) demyelination can be differentiated from multiple sclerosis (MS). Methods: We present a case of pathologically proven CNS demyelination in a patient treated with infliximab and describe clinical–radiographic–neuropathological findings. Putative mechanisms of TNF-alpha inhibitor-associated CNS demyelination are described. Results and conclusion: Infliximab treatment is associated with CNS inflammatory demyelinating activity, which is histopathologically indistinguishable from MS.