Serial Evoked Potentials in Multiple Sclerosis Patients Treated with T-Cell Vaccine.
Abstract number :
1.083
Submission category :
Year :
2001
Submission ID :
2314
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
P. Gott, PhD, Neurology, USC, Los Angeles, CA; D.Y. Ko, MD, Neurology, USC, Los Angeles, CA; S. Hammer, REEGT, Neurology, USC, Los Angeles, CA; J. Correale, MD, Institute for Neurlogical Research, FLENI, Buenos Aires, Argentina; B. Lund, PhD, Neurology, U
RATIONALE: An attenuated autoreactive T cell as a vaccine for secondary progressive multiple sclerosis (MS) was performed as a pilot trial. The T cell are taken from the patient and and individual vaccine against certain white cells which react with myelin is selected out and then killed with radiation. This creates an inactivate myelin reactive T cells which is then injected back the patient as a vaccine to prevent further progression of MS. Recently MRI have become the primary study endpoint in many MS trials but evoked potential studies may be useful marker for functional assessment of MS in comparison to the structural nature of MRI. This T cell vaccine study incorporated serial evoked potentials to follow MS treatment response.
METHODS: Four patients with chronic progressive MS, three female and one male patient with age range from 29-42 years with EDSS of 6.5 or above were vaccinated in this open label trial. Each time they were vaccinated, visual evoked potentials (VEP) and upper extremity somatosensory evoked potentials (SSEP) were obtained using the guidelines of the American Clinical Neurophysiology Society. The T-cell vaccine was adminsterered at 6-12 week intervals over one year and 5-7 EP studies were obtained for each patient. The details of the immunologic study was published in [italic]Journal of Immunology [/italic]107(2000):130-139.
RESULTS: An immunologic response was seen in all patients with decreased myelin specific T cells as well as other markers. The clinical course was evaluated with EDSS which showed no significant change for two patients and one had improvement and one had worsening. The MRI of these patients showed one patient had fewer lesion, two were stable, and one had one addition lesion.The first EP for both VEP and median SSEP were severely abnormal for most patients. The median SSEP showed no change with treatment. One patient[ssquote]s VEP for the left eye P100 showed marked improvement going from 176 to 122 to 92 then 112 ms.
CONCLUSIONS: Evoked potential studies may be helpful in following MS treatment outcome especially if a treatment is targeted at repairing damaged myelin. Evoked potentials may be complementary to neruoimaging and clinical assessments in MS clinical trials. Evoked potentials have been incorporated into the ongoing double blind trial of this T-cell vaccine in 80 patients.
Support: Kenneth Norris Foundation (LPW)