Publications by authors named "Justin R Abbatemarco"

12 Publications

  • Page 1 of 1

The Pursuit of Precision in Paraneoplastic Neurologic Disease.

Neurol Neuroimmunol Neuroinflamm 2021 Jul 13;8(4). Epub 2021 May 13.

From the Department of Neurology (J.R.A., S.L.C.), University of Utah; and George E. Wahlen Veterans Affairs Medical Center (S.L.C.), Salt Lake City, UT.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/NXI.0000000000001015DOI Listing
July 2021

Vitamin D Levels and Visual System Measurements in Progressive Multiple Sclerosis: A Cross-sectional Study.

Int J MS Care 2021 Mar-Apr;23(2):53-58. Epub 2020 Apr 28.

Background: Vitamin D deficiency is associated with increased disease activity in multiple sclerosis (MS), but its role in progressive MS has not been elucidated. The objective was to determine the correlation between vitamin D levels and visual parameters in primary progressive MS (PPMS) and secondary progressive MS (SPMS).

Methods: Serum 25-hydroxyvitamin D (25[OH]D) and 25-hydroxyvitamin D (25[OH]D) levels were obtained from the Secondary and Primary Progressive Ibudilast NeuroNEXT Trial in MS (SPRINT-MS). Visual function measurements and vitamin D associations were determined using the Pearson correlation and the generalized linear mixed model.

Results: The analysis included 258 patients (mean ± SD age of 55.6 ± 7.3 years, 52.7% female, and 52.3% PPMS). Mean vitamin D values were above sufficiency and were similar between PPMS and SPMS ( = .47 and = .31). There was no association between 25(OH)D levels and any visual markers, including peripapillary retinal nerve fiber layer thickness (Spearman = -0.08), macular volume ( = -0.03), ganglion cell-inner plexiform layer ( = -0.07), and 2.5% low-contrast visual acuity test ( = -0.10). No statistically significant associations between vitamin D levels and visual system measurements were detected in the PPMS and SPMS subgroups.

Conclusions: Vitamin D levels were not associated with optical coherence tomography findings or low-contrast letter acuity in this group of patients with progressive MS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7224/1537-2073.2020-005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047686PMC
April 2020

Amyloid Precursor Protein Variant, E665D, Associated With Unique Clinical and Biomarker Phenotype.

Am J Alzheimers Dis Other Demen 2021 Jan-Dec;36:1533317520981225

Lou Ruvo Center for Brain Health, Neurological Institute, 2569Cleveland Clinic, Cleveland, OH, USA.

We describe a clinical, imaging and biomarker phenotype associated with an amyloid precursor gene variant in a 45-year-old man with progressive cognitive and behavioral dysfunction. Brain MRI showed bilateral, confluent T2 hyperintensities predominantly in the anterior white matter. Amyloid imaging and CSF testing were consistent with amyloid deposition. 7 Tesla MRI revealed cerebral microhemorrhages suggestive of cerebral amyloid angiopathy (CAA). Contrary to previous reports, this case raises the possibility that the genetic change may be pathogenic, particularly given the abnormal Alzheimer's disease biomarkers observed in the cerebrospinal fluid, positive amyloid imaging and imaging evidence for CAA in a relatively young patient with progressive cognitive decline.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1533317520981225DOI Listing
April 2021

Comorbidity effect on processing speed test and MRI measures in multiple sclerosis patients.

Mult Scler Relat Disord 2020 Nov 21;46:102593. Epub 2020 Oct 21.

Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.

Background: Comorbid conditions are known to affect the clinical course of multiple sclerosis (MS). Our objective was to determine the impact of comorbidities on the processing speed test (PST).

Methods: We conducted a retrospective, longitudinal analysis of all patients who completed PST testing from June 2015 - August 2019 at our center. Our electronic medical record was queried to determine the presence of the following comorbidities: diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLD), coronary artery disease, and depression. To help address baseline PST performance and practice effect, patients were also divided into four quartiles by baseline PST scores. Brain MRIs obtained within a 90-day window from the initial clinical assessment were quantitatively analyzed via fully-automated methods to calculate whole brain fraction (WBF), T2 lesion volume (T2LV), gray matter fraction (GMF), and thalamic volume (TV). Univariable and multivariable linear regression models were used to determine the relationship between the comorbidities, PST performance and MRI metrics over time.

Results: A total of 4,344 patients (mean age 49.5 ± 12.4 years, 72.3% female, and 63.7% relapsing remitting MS) were included in the analysis with 13,375 individual patient encounters. Over half the cohort (52.4%) suffered from at least one comorbidity with the most common being depression (37.4%), HLD (20.9%), HTN (19.6%), and DM (6.4%). Patients with one or more comorbidity had lower baseline PST scores. Longitudinally, patients with two comorbidities lost 1.46 points on the PST per year relative to those with no comorbidities (95% CI -2.46 - -0.46, p = 0.004). Individuals with depression had lower PST scores than those without, and this difference persisted over time (β = -2.40, 95% CI -3.08 - -1.73, p < 0.001). At baseline, HLD patients had higher PST scores than non-HLD patients (β = 1.10, 95% CI 0.15 - 2.05, p = 0.022), but this difference did not remain over time. Individuals in the highest PST performance quartile were negatively impacted when diagnosed with depression, HTN, and DM relative to those without the comorbidities. There were no other correlations with PST scores and the remaining comorbidities. Depression was associated with lower baseline WBF (β = -0.0043, 95% CI -0.0084 - -0.0003, p = 0.033) and GMF (β = -0.0046, 95% CI -0.0078 - -0.0015, p = 0.004) along with larger T2LV (β = 0.1605, 95% CI 0.0082 - 0.3128, p = 0.039). HLD patients had more favorable baseline MRI measures, including higher WBF (β = 0.0076, 95% CI 0.0017 - 0.0135, p = 0.012) and TV (β = 0.0002, 95% CI 0.0000 - 0.0005, p = 0.041), with a lower T2LV (β = -0.2963, 95% CI -0.5219 - -0.0706, p = 0.010).

Conclusions: Comorbidities are common within a MS cohort and adversely impact processing speed. Depression adversely impacted PST scores with worse MRI outcomes. HLD was associated with lower longitudinal PST measures but favorable quantitative MRI metrics. MS patients with faster baseline processing speeds were most sensitive to comorbid conditions. Our findings suggest a complex interplay between cognition and comorbid conditions in MS patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.msard.2020.102593DOI Listing
November 2020

Long-term outcomes of intrathecal baclofen in ambulatory multiple sclerosis patients: A single-center experience.

Mult Scler 2021 May 14;27(6):933-941. Epub 2020 Jul 14.

Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA/Department of Physical Medicine & Rehabilitation, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.

Background: Intrathecal baclofen (ITB) is traditionally reserved for non-ambulatory patients.

Objective: To investigate outcomes of ITB in ambulatory multiple sclerosis (MS) patients.

Methods: Changes in outcome measures were estimated by a mixed effect model, while the complication rate was calculated using a logistic regression. Predictors of non-ambulatory status were identified by Cox model.

Results: In all, 256 patients received an ITB test injection and 170 underwent ITB surgery. Aggregate Modified Ashworth Scale (MAS) scores for the ambulatory ITB cohort decreased from 13.5 ± 6.96 to 4.54 ± 4.18 at 5 years ( < 0.001). There was no significant change in walking speed 1 year post ITB surgery (0.45 m/second ± 0.30 vs 0.38 m/second ± 0.39,  = 0.80) with 77.8% of patients remaining ambulatory which decreased to 41.7% at year 5. Longer MS disease duration (hazard ratio (HR): 1.04; 95% confidence interval (CI): 1.01-1.07;  = 0.018) and lower hip flexor strength (HR: 0.40; 95% CI: 0.27-0.57;  < 0.001) predicted non-ambulatory status after surgery. Complications were more likely in the ambulatory cohort (odds ratio (OR): 3.30, 95% CI: 2.17-5.02;  = 0.017).

Conclusion: ITB is effective for ambulatory MS patients without compromising short-term walking speed, although a higher complication rate was observed in this cohort.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1352458520936912DOI Listing
May 2021

A case of severe Legionella pneumonia following alemtuzumab infusion for multiple sclerosis.

Clin Neurol Neurosurg 2020 09 29;196:105961. Epub 2020 May 29.

Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, Ohio, USA. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clineuro.2020.105961DOI Listing
September 2020

Vitamin D and MRI measures in progressive multiple sclerosis.

Mult Scler Relat Disord 2019 Oct 13;35:276-282. Epub 2019 Aug 13.

Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address:

Background: Vitamin D deficiency is a proposed risk factor for multiple sclerosis (MS), but its role in progressive MS is not well understood.

Objective: To examine the association between vitamin D levels and MRI features in primary progressive (PPMS) and secondary progressive MS (SPMS).

Methods: Serum 25-hydroxyvitamin D (25[OH]D) and 25-hydroxyvitamin D (25[OH]D) levels were obtained from 267 subjects enrolled into the Secondary and Primary Progressive Ibudilast NeuroNEXT Trial in Multiple Sclerosis (SPRINT-MS). Associations between imaging data and vitamin D levels was determined using Pearson or Spearman correlation and multivariate regression analyses.

Results: 267 patients (age 55.6 ± 7.4, 47.2% male, and 51.3% PPMS) were evaluated with quantitative MRI and vitamin D levels. 25(OH)D and 25(OH)D were similar between PPMS and SPMS. There was no significant association between vitamin D and T1/2 lesion volume and brain parenchymal fraction. Modest associations were found between 25(OH)D and whole brain-magnetization transfer ratio (WB-MTR, r = 0.17, p = 0.007) and normal appearing grey matter MTR (NAGM-MTR, r = 0.15, p = 0.02).

Conclusions: 25(OH)D levels were not associated with brain volume or lesional measures in progressive MS contrary to what has been described in relapsing remitting MS. An association between WB-MTR and NAGM-MTR suggest higher vitamin D levels may exert a protective role on myelin content in progressive MS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.msard.2019.08.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830523PMC
October 2019

An Assessment of Training Characteristics Associated with Atrial Fibrillation in Masters Runners.

Sports (Basel) 2019 Jul 23;7(7). Epub 2019 Jul 23.

Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH 44195, USA.

A growing body of literature supports an association between long-term endurance exercise and the development of atrial fibrillation (AF). Given the benefits of lifelong exercise, a better understanding of this association is critical to allow healthcare providers to counsel aging exercisers on the proper "dose" of exercise to maximize health benefits but minimize AF risk. The current study examines the relationship between specific aspects of training volume and intensity and the occurrence of AF among older runners in order to better understand what aspects of endurance exercise may contribute to the development of AF. The study was an Internet-based survey of endurance training and health characteristics of runners 35 years of age and older. A total 2819 runners participated and 69 (2.4%) reported a current or prior diagnosis of AF. Among "traditional" risk factors, runners reporting AF were older, more likely to be male, and had higher rates of hypertension and diabetes. Among training characteristics, only accumulated years of training was associated with AF. In contrast, average weekly mileage, training pace, and days of training per week were not associated with AF. In a multivariable analysis that included chronologic age, sex, diabetes, and hypertension, accumulated years of training remained significantly associated with the report of AF. These findings suggest that the relationship between chronic endurance exercise and AF is dependent on the accumulated training duration but does not appear to be influenced by specific training characteristics such as frequency or intensity of endurance exercise. Further confirmation of these relationships may help healthcare providers counsel exercisers on optimal training habits and identify endurance athletes who are at risk for the development of AF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/sports7070179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681262PMC
July 2019

Transient neurologic syndromes: A diagnostic approach.

Cleve Clin J Med 2018 Feb;85(2):155-163

Mellen Center for Multiple Sclerosis, Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.

Clinicians are often confronted with patients who have transient neurologic symptoms lasting seconds to hours. In many of these patients, their symptoms have gone away or returned to baseline by the time of evaluation, making the diagnosis even more challenging. Elements such as correlation of symptoms with vascular territory, prodromes, triggers, motor symptoms, confusion, and sleep behavior can guide the diagnostic workup.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3949/ccjm.85a.17022DOI Listing
February 2018

Acute monocular vision loss: Don't lose sight of the differential.

Cleve Clin J Med 2017 Oct;84(10):779-787

Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3949/ccjm.84a.16096DOI Listing
October 2017

Isolated Cranial Nerve-III Palsy Secondary to Perimesencephalic Subarachnoid Hemorrhage.

Case Rep Neurol Med 2016 1;2016:6319548. Epub 2016 Feb 1.

Division of Neurology, Center for Advanced Health Care, Lehigh Valley Health Network, 1250 South Cedar Crest Boulevard, Allentown, PA 18103, USA.

We describe isolated cranial nerve-III palsy as a rare clinical finding in a patient with perimesencephalic subarachnoid hemorrhage. In this unusual case, the patient presented with complete cranial nerve-III palsy including ptosis and pupillary involvement. Initial studies revealed subarachnoid hemorrhage in the perimesencephalic, prepontine, and interpeduncular cisterns. Angiographic studies were negative for an intracranial aneurysm. The patient's neurological deficits improved with no residual deficits on follow-up several months after initial presentation. Our case report supports the notion that patients with perimesencephalic subarachnoid hemorrhage have an excellent prognosis. Our report further adds a case of isolated cranial nerve-III palsy as a rare initial presentation of this type of bleeding, adding to the limited body of the literature.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2016/6319548DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753334PMC
March 2016

Application of pre-participation cardiovascular screening guidelines to novice older runners and endurance athletes.

SAGE Open Med 2016 8;4:2050312115616136. Epub 2016 Jan 8.

Division of Cardiology, Richard & Marion Pearsall Heart Hospital, Geisinger Medical Center, Wilkes-Barre, PA, USA.

Objectives: Despite robust growth in participation in marathons and endurance sports among older individuals, guidance regarding pre-participation cardiovascular evaluation of these athletes is lacking. The objective of this study was to assess the utility of currently available pre-participation cardiovascular evaluation guidelines as applied to a cohort of older novice endurance athletes.

Methods: We applied data from 1457 novice runners and endurance athletes aged 35 years and older to two pre-participation screening tools, the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and the 2001 Working Group recommendations for pre-participation screening of masters athletes (2001 Masters).

Results: Application of the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire identified 42.1% for which pre-participation cardiovascular evaluation was indicated. Of those who met criteria, 51.5% reported completion of a healthcare evaluation. Application of the 2001 Masters guidelines identified 75.2% who qualified for pre-participation electrocardiogram and 34.0% for pre-participation stress testing. Of those who met 2001 Masters criteria for pre-participation testing, 43.7% and 24.6% underwent recommended electrocardiogram and stress testing, respectively. While there was modest concordance with recommendations for pre-participation evaluations based on both American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and 2001 Masters, only athlete age was independently associated with completion of a pre-participation healthcare evaluation and only athlete age and athlete's participation in marathons were independently associated with pre-participation stress testing.

Conclusion: Among older novice endurance athletes, application of the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and 2001 Masters guidelines identifies a significant percentage of athletes for whom pre-participation evaluation and testing are recommended. Concordance with these guidelines was modest and providers were primarily influenced by athlete age and competitive goals when planning pre-participation testing. Given the rarity of cardiovascular events among older participants in endurance events, the cost-effectiveness of the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and 2001 Masters guidelines may be unacceptable for general use.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2050312115616136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4724764PMC
February 2016