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Prognostic markers of disease course in early stages of multiple sclerosis
Petržalka, Marko ; Marusič, Petr (advisor) ; Taláb, Radomír (referee) ; Lízrová, Jana (referee)
Prognostic markers of disease course in early stages of multiple sclerosis ABSTRACT This thesis analyzes the biomarkers of unfavorable prognosis assessed at early stages of multiple sclerosis. Because specific biomarkers often providerather complex information,the theoretical part provides a summary of biomarkers used not only in prognosis assessment, but also in diagnostics and therapy monitoring. In the empirical part, we have investigatedthe prognostic value of intrathecal synthesis of class M immunoglobulins, serum and cerebrospinal fluid concentrations of interleukin 2, interleukin 6, interleukin 10, chitinase 3-like 2 protein and neurofilament heavy chains, assessed from samples acquired during diagnostic procedures. 58 patients early after the first manifestation of multiple sclerosis were included. All patients initiated therapy with glatiramer acetate, teriflunomide, or interferon beta. To assess the evolution of the disease, we followed the patients clinically and with MRI for two years. Interleukin 2 to interleukin 6 ratio of cerebrospinal fluidvalues ˂0.48 (p=0.0028), interleukin 2 in cerebrospinal fluid ≥1.23 (p=0.0260), chitinase 3-like 2 in cerebrospinal fluid ≥7900 (p=0.0330), age at clinical onset ˂22 years (p=0.0312) and baseline Expanded Disability Status Scale ≥1.5 (p=0.0481), proved to...
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Optical coherence tomography in multiple sclerosis.
Lízrová-Preiningerová, Jana ; Kubala Havrdová, Eva (advisor) ; Vymazal, Josef (referee) ; Taláb, Radomír (referee)
Spectral domain optical coherence tomography (SD-OCT), a non-invasive imaging method, is based on an analysis of a near-infrared light deflected from tisssue layers, that provides detailed images of retinal structures. Nerve cells of the retina, that originate from neuroectoderm, reflect neurodegeneration of the central nervous system (CNS), as well as acute damage of nerve structures caused by optic neuritis. The dissertation first presents established imaging protocol and quality standards for SD-OCT imaging in multiple sclerosis (MS). In the following section we introduce SD-OCT as a biomarker in MS. In a multicentric cross-sectional study, we had shown, that a single time measurement of peripapillary retinal nerve fiber layer thickness (RNFL) has a predictive value for a risk of disease progression in the next five years. Patients with a thickness of RNFL in the lowest tercile of the studied population had a relative risk of disease progression 2x higher than patients in the highest tercile. The second presented study tests whether the history of optic neuritis (ON) in MS is a risk factor for neurodegeneration of RNFL in later years. The study confirmed that long term changes of RNFL thickness in eyes post-ON and in eyes with no history of ON are not different. Therefore, we conclude that both,...
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