Corticosteroid Treatment of Multiple Sclerosis Relapses Is Associated With Lower Disability Worsening Over 5 Years
| dc.contributor.author | Roberts, J.I. | |
| dc.contributor.author | Sharmin, S. | |
| dc.contributor.author | Horakova, D. | |
| dc.contributor.author | Kubala Havrdova, E. | |
| dc.contributor.author | Ozakbas, S. | |
| dc.contributor.author | Lugaresi, A. | |
| dc.contributor.author | Smirnova, S. | |
| dc.contributor.author | Study Group, MSBase | |
| dc.date.accessioned | 2025-08-25T17:02:45Z | |
| dc.date.available | 2025-08-25T17:02:45Z | |
| dc.date.issued | 2025 | |
| dc.description.abstract | Background: Corticosteroid treatment of multiple sclerosis (MS) relapses is assumed to improve the speed of relapse recovery, without modifying long-term disability risk. We aimed to re-evaluate this assumption in a large cohort of individuals with MS. Methods: Individuals with clinically definite MS and ≥3 Expanded Disability Status Scale (EDSS) measurements over ≥12 months were identified within the international neuroimmunology registry MSBase. Individuals were required to have ≥1 relapse, with complete information on relapse treatment, phenotype and severity for all documented relapses. The primary outcome was disability worsening confirmed over 12 months. The association of the cumulative number of steroid-treated and untreated relapses (as a time-varying exposure) with disability worsening was evaluated with Cox proportional hazards. Results: In total, 3673 individuals met the inclusion criteria (71% female, mean age 38 years, mean disability EDSS step 2); 5809 relapses (4671 treated/1138 untreated) were captured (annualised relapse rate 0.19). Over the study period (total 30 175 person-years), 32.7% reached the outcome of confirmed disability worsening (median survival time 5.2 years). Non-treated relapses were associated with a higher risk of disability worsening (HR 1.72, 95% CI 1.57 to 1.88) than steroid-treated relapses (HR 1.50, 95% CI 1.43 to 1.57). This association was modified by the efficacy of disease-modifying therapy at the time of relapse. Conclusions: Our results suggest that a lack of steroid treatment of MS relapses is associated with a higher risk of future disability worsening. Hence, corticosteroid treatment of MS relapses may impact not only the speed of recovery but also the severity of residual structural damage. © Author(s) (or their employer(s)) 2025. | en_US |
| dc.description.sponsorship | Novartis; Rebecca Hotchkiss International Scholar Exchange Programme; FISM; Sanofi; TEVA; Czech Ministry of Education; Bristol Meyer Squibb; Reload Association; Roche; EMD Serono; Merck; European Union ñ Next Generation EU; Sanofi Genzyme; Genzyme; Queen Elisabeth Medical Foundation for Neurosciences; FWO-TBM; Belgian Charcot Foundation; European Union-Next Generation EU; Start2Cure Foundation; Merck Healthcare KGaA; Italian Health Minister and University of Catania; Biogen; CIHR; National MS Society; National Institute for Neurological Research, (LX22NPO5107); General University Hospital in Prague, (MH CZ-DRO-VFN64165) | en_US |
| dc.description.sponsorship | JIR served on a scientific advisory board for Amgen and received conference travel support and/or speaker honoraria from EMD Serono, Novartis and Roche. SS has nothing to disclose. DH was supported by the Charles University: Cooperation Programme in Neuroscience, by the project National Institute for Neurological Research (Programme EXCELES, ID Project No. LX22NPO5107) - Funded by the European Union ñ Next Generation EU, and by General University Hospital in Prague project MH CZ-DRO-VFN64165. She also received compensation for travel, speaker honoraria and consultant fees from Biogen Idec, Novartis, Merck, Bayer, Sanofi Genzyme, Roche and Teva, as well as support for research activities from Biogen Idec. EKH received honoraria/research support from Biogen, Merck Serono, Novartis, Roche and Teva; has been member of advisory boards for Actelion, Biogen, Celgene, Merck Serono, Novartis and Sanofi Genzyme; received honoraria/research support from Biogen, Merck Serono, Novartis, Roche and Teva; has been member of advisory boards for Actelion, Biogen, Celgene, Merck Serono, Novartis and Sanofi Genzyme; and has been supported by the Czech Ministry of Education ñ project Cooperatio LF1, research area Neuroscience, and the project National Institute for Neurological Research (Programme EXCELES, ID project No LX22NPO5107) ñ funded by the European Union-Next Generation EU. SO has nothing to disclose. AL has received personal compensation for consulting, serving on a scientific advisory board, speaking or other activities from Alexion, Biogen, Bristol Myers Squibb, Horizon, Janssen, Merck Serono, Novartis and Sanofi/Genzyme, and her institutions have received research grants from Novartis and Sanofi/Genzyme. VT has received consultation and speaker fees, travel grants and research support from: Biogen, Sanofi Genzyme, Merck, Novartis, Roche, Alexion, Viatris, Janssen, Bristol Myers Squibb, Almirall. RA received honoraria as a speaker and for serving on scientific advisory boards from Bayer, Biogen, GSK, Merck, Novartis, Roche and Sanofi-Genzyme. KB received speaker honoraria and/or education support from Biogen, Teva, Novartis, Genzyme-Sanofi, Roche, Merck and Alexion; has been a member of advisory boards for Merck and Biogen. OS received honoraria and consulting fees from Bayer Schering, Novartis, Merck, Biogen and Genzyme. CB received conference travel support from Biogen, Novartis, Bayer-Schering, Merck and Teva; has participated in clinical trials by Sanofi Aventis, Roche and Novartis. RT has nothing to disclose. DM received speaker honoraria for Advisory Board and travel grants from Alexion, Almirall, Bayer, Biogen, Bristol Myers Squibb, Merck, Novartis, Roche, Sanofi-Genzyme and Teva. BY received honoraria as a speaker and member of scientific advisory boards from Sanofi, Bayer, Biogen, Merck, Janssen, Novartis, Roche and Aspen. SJK received compensation for scientific advisory board activity from Merck and Roche, and received compensation for serving on the IDMC for Biogen. DS received honoraria as a consultant on scientific advisory boards by Bayer-Schering, Novartis and Sanofi-Aventis and compensation for travel from Novartis, Biogen, Sanofi Aventis, Teva and Merck. JL-S received travel compensation from Novartis, Biogen, Roche and Merck. Her institution receives the honoraria for talks and advisory board commitment as well as research grants from Biogen, Merck, Roche, TEVA and Novartis. MG has nothing to disclose. PD served on editorial boards and has been supported to attend meetings by EMD, Biogen, Novartis, Genzyme and TEVA Neuroscience. He holds grants from the CIHR and the MS Society of Canada and has received funding for investigator-initiated trials from Biogen, Novartis and Genzyme. AA-A received personal compensation for serving as a Scientific Advisory or speaker/moderator for Novartis, Biogen, Roche, Sanofi-Genzyme and Merck. RA received conference travel support from Novartis, Teva, Biogen, Bayer and Merck and has participated in clinical trials by Biogen, Novartis, Teva and Actelion. MF received travel and meeting attendance support from Novartis, Biogen, Roche, Sanofi-Genzyme and Merck. AS received travel and meeting attendance support from Novartis, Biogen, Roche, Merck, Bristol, Sanofi-Genzyme, Almirall, Piam. FP received personal compensation for serving on advisory board by Almirall, Alexion, Biogen, Bristol, Janssen, Merck, Novartis and Roche. He further received research grant by Alexion, Almirall, Biogen, Bristol, Merck, Novartis and Roche and by FISM, Reload Association (Onlus), Italian Health Minister and University of Catania. VVP received travel grants from Merck Healthcare KGaA (Darmstadt, Germany), Biogen, Sanofi, Bristol Meyer Squibb, Almirall and Roche. His institution has received research grants and consultancy fees from Roche, Biogen, Sanofi, Merck Healthcare KGaA (Darmstadt, Germany), Bristol Meyer Squibb, Janssen, Almirall, Novartis Pharma and Alexion. CR-T has received consulting fees, speaker honoraria, support for attending meetings and/or travel, participation on advisory board and research grants for her institution from Biogen, Novartis, Sanofi, Bristol, Roche, Almirall, Janssen, Sandoz and Merck. JLS-M accepted travel compensation from Novartis, Merck and Biogen, speaking honoraria from Biogen, Novartis, Sanofi, Merck, Almirall, Bayer and Teva and has participated in clinical trials by Biogen, Merck and Roche. AA received speaker honoraria from Novartis and Alexion. PG has served in advisory boards for Novartis, EMD Serono, Roche, Biogen idec, Sanofi Genzyme, Pendopharm and has received grant support from Genzyme and Roche, has received research grants for his institution from Biogen idec, Sanofi Genzyme and EMD Serono. EC has nothing to disclose. TC received speaker honoraria/ conference travel support from Biogen, Merck, Novartis, Roche, Sanofi-Aventis and Teva. GL received travel and/or consultancy compensation from Sanofi-Genzyme, Roche, Teva, Merck, Novartis, Celgene, Biogen. BW received honoraria for acting as a member of Scientific Advisory Boards/Consultancy for Alexion, Almirall, Biogen, Celgene/BMS, Merck, Janssen, Novartis, Roche, Sandoz and Sanofi-Genzyme; speaker honoraria and travel support from Biogen, Celgene/BMS, Merck, Novartis, Roche and Sanofi-Genzyme; and research and/or patient support grants from Biogen, Janssen, Merck, Sanofi-Genzyme and Roche. Honoraria and grants were paid to UZA/UZA Foundation. Further, she received research funding from FWO-TBM, Belgian Charcot Foundation, Start2Cure Foundation, Queen Elisabeth Medical Foundation for Neurosciences and the National MS Society USA. RM received remuneration for his speaking engagements, advisory board memberships, research and travel from Biogen, Merck, Genzyme, Bayer, Roche, Teva, Novartis, CSL, BMS, MedDay and NHMRC. IR served on scientific advisory boards/steering committees for Novartis and Merck; and received conference travel support and/or speaker honoraria from Roche, Novartis, Biogen, Teva, SanofiGenzyme and Merck. | |
| dc.description.sponsorship | Fellowship funding for JIR was provided by the Canadian Network of MS Clinics, the University of Calgary Medical Group Helios Award, and the Rebecca Hotchkiss International Scholar Exchange Programme. Funders were not involved in the study design; in the collection, analysis and interpretation of the data; in the writing of the report; or in the decision to submit the paper for publication. | |
| dc.identifier.doi | 10.1136/jnnp-2025-336343 | |
| dc.identifier.issn | 0022-3050 | |
| dc.identifier.issn | 1468-330X | |
| dc.identifier.scopus | 2-s2.0-105012431984 | |
| dc.identifier.uri | https://doi.org/10.1136/jnnp-2025-336343 | |
| dc.identifier.uri | https://hdl.handle.net/20.500.14365/6377 | |
| dc.language.iso | en | en_US |
| dc.publisher | BMJ Publishing Group | en_US |
| dc.relation.ispartof | Journal of Neurology Neurosurgery and Psychiatry | en_US |
| dc.rights | info:eu-repo/semantics/closedAccess | en_US |
| dc.subject | Clinical Neurology | en_US |
| dc.subject | Demyelinating Diseases | en_US |
| dc.subject | Evidence-Based Neurology | en_US |
| dc.subject | Multiple Sclerosis | en_US |
| dc.title | Corticosteroid Treatment of Multiple Sclerosis Relapses Is Associated With Lower Disability Worsening Over 5 Years | en_US |
| dc.type | Article | en_US |
| dspace.entity.type | Publication | |
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| gdc.description.department | İEÜ, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü | en_US |
| gdc.description.departmenttemp | [Roberts J.I.] Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada, CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia; [Sharmin S.] CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia, Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia; [Horakova D.] Department of Neurology and Center of Clinical Neuroscience, Charles University First Faculty of Medicine, Prague, Czech Republic; [Kubala Havrdova E.] Department of Neurology and Center of Clinical Neuroscience, Charles University First Faculty of Medicine, Prague, Czech Republic; [Ozakbas S.] Medical Point Hospital, Izmir University of Economics, Konak, Izmir, Turkey; [Lugaresi A.] Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy; [Tomassini V.] Institute for Advanced Biomedical Technologies (ITAB) and Centre for Rehabilitation, Disability and Sport Medicine (CARES),, Department of Neurosciences, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy, Clinical Neurology, SS Annunziata Hospital, Chieti, Italy; [Alroughani R.] Division of Neurology, Department of Medicine, Al-Amiri Hospital, Sharq, Kuwait; [Buzzard K.] Eastern Health Clinical School, Monash University, Box Hill Hospital, Melbourne, VIC, Australia; [Skibina O.] Eastern Health Clinical School, Monash University, Box Hill Hospital, Melbourne, VIC, Australia, Department of Neurology, The Alfred, Melbourne, VIC, Australia; [Boz C.] Department of Neurology, Farabi Hospital, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey; [Turkoglu R.] Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey; [Maimone D.] Centro Sclerosi Multipla, UOC Neurologia,, Azienda Ospedaliera Cannizzaro, Catania, Italy; [Yamout B.] Neurology Institute, Harley Street Medical Center, Abu Dhabi, United Arab Emirates; [Khoury S.J.] Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon; [Spitaleri D.] Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialita San Giuseppe Moscati, Avellino, Italy; [Lechner-Scott J.] Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia, Hunter New England Health, John Hunter Hospital, Newcastle, NSW, Australia; [Girard M.] CRCHUM, CHUM MS Center and Department of Neurosciences, Universite de Montreal Faculte de Medecine, Montreal, QC, Canada; [Duquette P.] CRCHUM, CHUM MS Center and Department of Neurosciences, Universite de Montreal Faculte de Medecine, Montreal, QC, Canada; [Al-Asmi A.] College of Medicine & Health Sciences, Sultan Qaboos University, Al-Khodh, Oman; [Ampapa R.] Nemocnice Jihlava, Jihlava, Czech Republic; [Foschi M.] Department of Neuroscience, MS Center, Neurology Unit, Ospedale Santa Maria delle Croci, Ravenna, Italy, Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy; [Surcinelli A.] Department of Neuroscience, MS Center, Neurology Unit, Ospedale Santa Maria delle Croci, Ravenna, Italy; [Patti F.] University of Catania Department of Surgical and Medical Sciences and Advanced Technologies 'G.F. Ingrassia', Catania, Italy, Multiple Sclerosis Unit, Azienda Ospedaliero Universitaria Policlinico G Rodolico San Marco, Catania, Italy; [Van Pesch V.] Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium, UCLouvain, Brussels, Belgium; [Ramo-Tello C.] Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain; [Sánchez-Menoyo J.L.] Department of Neurology, Hospital de Galdakao-Usansolo, Galdakao, Spain, Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain; [Altintas A.] Department of Neurology, School of Medicine and Koc University Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey; [Grammond P.] CISSS de Chaudiere-Appalaches, Levis, QC, Canada; [Cartechini E.] Neurology Unit, P O Unico Macerata, AST Macerata, Macerata, Italy; [Csepany T.] Department of Neurology, University of Debrecen Faculty of Medicine, Debrecen, Hungary; [Laureys G.] Department of Neurology, University Hospital Ghent, Ghent, Belgium; [Willekens B.] Department of Neurology, Antwerp University Hospital and Translational Neurosciences Research Group, University of Antwerp Faculty of Medicine and Health Sciences, Antwerp, Belgium; [Roos I.] CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia, Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia; [Kalincik T.] CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia, Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia; [Grand'maison F.] Centro Internacional de Restauracion Neurologica, Havana, Cuba; [Cabrera-Gomez J.A.] Centro Internacional de Restauracion Neurologica, Havana, Cuba; [Roullet E.] MS Clinic, Hopital Tenon, Paris, France; [Campbell J.] MS Clinic, Hopital Tenon, Paris, France; [Zwanikken C.] Craigavon Area Hospital, Craigavon, United Kingdom; [Braber-Moerland L.D.] Craigavon Area Hospital, Craigavon, United Kingdom; [Inshasi J.] University Hospital Nijmegen, Nijmegen, Netherlands; [Deri N.] University Hospital Nijmegen, Nijmegen, Netherlands; [Firstenfeld A.] Francicus Ziekenhuis, Roosendaal, Netherlands; [Saladino M.L.] Francicus Ziekenhuis, Roosendaal, Netherlands; [Cristiano E.] Rashid Hospital, Dubai, United Arab Emirates; [Rojas J.I.] Rashid Hospital, Dubai, United Arab Emirates; [Vrech C.] Hospital Fernandez, Capital Federal, Argentina; [Shaw C.] Hospital Fernandez, Capital Federal, Argentina; [Shuey N.] Hospital Fernandez, Capital Federal, Argentina; [John N.] Clinica Modelo de Lanus, Lanús, Argentina; [Hodgkinson S.] Clinica Modelo de Lanus, Lanús, Argentina; [Garber J.] Clinica Modelo de Lanus, Lanús, Argentina; [Slee M.] INEBA - Institute of Neuroscience Buenos Aires, Buenos Aires, Argentina; [Mccombe P.] INEBA - Institute of Neuroscience Buenos Aires, Buenos Aires, Argentina; [Boggild M.] Centro de Esclerosis M'ltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina; [Taylor B.] Centro de Esclerosis M'ltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina; [Walt A.V.D.] Centro de Esclerosis M'ltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina; [Butzkueven H.] Centro de Esclerosis M'ltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina; [Macdonell R.] Sanatorio Allende, Cordoba, Argentina; [Hardy T.] Barwon Health, Geelong, Australia; [Vucic S.] Barwon Health, Geelong, Australia; [Mccombe P.] St Vincents Hospital, Fitzroy, Melbourne, Australia; [Decoo D.] St Vincents Hospital, Fitzroy, Melbourne, Australia; [Willekens B.] Monash University, Melbourne, Australia; [Wijmeersch B.V.] UNSW, Sydney, Australia; [Vasconcelos C.] UNSW, Sydney, Australia; [Prevost J.] Westmead Hospital, Sydney, Australia; [Moore F.] Flinders University, Adelaide, Australia; [Lapointe E.] Flinders University, Adelaide, Australia; [Oh J.] University of Queensland, Brisbane, Australia; [Zakaria M.] Townsville Hospital, Townsville, Australia; [Shalaby N.] Royal Hobart Hospital, Hobart, Australia; [Olascoaga J.] Royal Hobart Hospital, Hobart, Australia; [Oreja-Guevara C.] the Alfred Hospital, Melbourne, Australia; [Eichau S.] Austin Health, Melbourne, Australia; [Dominguez J.A.] Concord Repatriation General Hospital, Sydney, Australia; [Blanco Y.] Royal Brisbane and Women's Hospital, Brisbane, Australia, St Vincent's University Hospital, Dublin, Ireland; [Gray O.] AZ Alma Ziekenhuis, Sijsele, Damme, Belgium, Bombay Hospital Institute of Medical Sciences, Mumbai, India; [Grigoriadis N.] Antwerp University Hospital, Edegem, Belgium, PGIMER, Chandigarh, India; [Piroska I.] Pelt and Hasselt University, Hasselt, Belgium, Bombay Hospital Institute of Medical Sciences, Mumbai, India; [Simo M.] Hospital Universitario Gaffree E Guinle, Rio de Janeiro, Brazil, PGIMER, Chandigarh, India; [Rajda C.] CSSS Saint-JÈrÙme, Saint-Jerome, Canada, PGIMER, Chandigarh, India; [Mcguigan C.] Jewish General Hospital, Montreal, Canada, Isfahan University of Medical Sciences, Isfahan, Iran; [Singhal B.] Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada, University of Florence, Florence, Italy; [Khurana D.] St. Michael's Hospital, Toronto, Canada, University of Florence, Florence, Italy; [Shaygannejad V.] NA, Cairo, Egypt, University of Florence, Florence, Italy; [Amato M.P.] Kasr Al Ainy MS Research Unit (KAMSU), Cairo, Egypt, University of Florence, Florence, Italy; [Gregorio M.D.] Hospital Universitario Donostia, San Sebastin, Spain, University of Salerno, Salerno, Italy; [Solaro C.] Hospital Clinico San Carlos, Madrid, Spain, ASL3 Genovese, Genova, Italy; [Petkovska-Boskova T.] Hospital Universitario Virgen Macarena, Sevilla, Spain, ASL3 Genovese, Genova, Italy; [Cauchi M.] Hospital Universitario de la Ribera, Alzira, Spain, ASL3 Genovese, Genova, Italy; [Gerlach O.] Hospital Clinic de Barcelona, Barcelona, Spain, ASL3 Genovese, Genova, Italy; [Hupperts R.] South Eastern HSC Trust, Belfast, United Kingdom, ASL3 Genovese, Genova, Italy; [Gans K.D.] AHEPA University Hospital, Thessaloniki, Greece, Clinic of Neurology Clinical Center, Skopje, North Macedonia; [Verheul F.] VeszprÈm Megyei Csolnoky Ferenc KÛrh•z zrt., Veszprem, Hungary, Clinic of Neurology Clinical Center, Skopje, North Macedonia; [Sinnige L.G.F.] Semmelweis University Budapest, Budapest, Hungary, Mater Dei Hospital, Balzan, Malta; [Mason D.] University of Szeged, Szeged, Hungary, Mater Dei Hospital, Balzan, Malta; [Schepel J.] St Vincent's University Hospital, Dublin, Ireland, Zuyderland Medical Center, Sittard-Geleen, Netherlands; [Alkhaboori J.] Bombay Hospital Institute of Medical Sciences, Mumbai, India, Zuyderland Medical Center, Sittard-Geleen, Netherlands; [Sa M.J.] PGIMER, Chandigarh, India, Groene Hart Ziekenhuis, Gouda, Netherlands; [Mihaela S.] Isfahan University of Medical Sciences, Isfahan, Iran, Groene Hart Ziekenhuis, Gouda, Netherlands; [Al-Harbi T.] University of Florence, Florence, Italy, Medical Center Leeuwarden, Leeuwarden, Netherlands; [Gouider R.] University of Salerno, Salerno, Italy, Christchurch Hospital, Christchurch, New Zealand; [Mrabet S.] ASL3 Genovese, Genova, Italy, Christchurch Hospital, Christchurch, New Zealand; [Karabudak R.] Clinic of Neurology Clinical Center, Skopje, North Macedonia, Waikato Hospital, Hamilton, New Zealand; [Marriott M.] Waikato Hospital, Hamilton, New Zealand; [Kilpatrick T.] Royal Hospital, Muscat, Oman; [King J.] Royal Hospital, Muscat, Oman; [Buzzard K.] Centro Hospitalar Universitario de Sao Joao, Porto, Portugal; [Nguyen A.-L.] Department of Neurology, Timisoara, Romania; [Dwyer C.] Centro Hospitalar Universitario de Sao Joao, Porto, Portugal; [Monif M.] Department of Neurology, Timisoara, Romania; [Roos I.] King Fahad Specialist Hospital-Dammam, Khobar, Saudi Arabia; [Taylor L.] Razi University Hospital, Tunis, Tunisia; [Baker J.] Hacettepe University, Ankara, Turkey; [Larochelle C.] Hacettepe University, Ankara, Turkey; [Chisari C.] Royal Melbourne Hospital, Melbourne, Australia; [D'amico E.] Royal Melbourne Hospital, Melbourne, Australia; [Salvatore L.F.] CHUM MS Center and Universite de Montreal, Montreal, Canada; [Diamanti M.] CHUM MS Center and Universite de Montreal, Montreal, Canada; [Sartori C.] GF Ingrassia, Catania, Italy; [Farr P.] GF Ingrassia, Catania, Italy; [Moore R.] GF Ingrassia, Catania, Italy; [Stupar D.] P O Unico Macerata, ast Macerata, Macerata, Italy; [Tang C.] P O Unico Macerata, ast Macerata, Macerata, Italy; [Smirnova S.] P O Unico Macerata, ast Macerata, Macerata, Italy | en_US |
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