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1
Pérez, C. Ayán, V. Martín Sánchez, F. De Souza Teixeira, and J. A. De Paz Fernández. "Effects of a Resistance Training Program in Multiple Sclerosis Spanish Patients: A Pilot Study." Journal of Sport Rehabilitation 16, no. 2 (May 2007): 143–53. http://dx.doi.org/10.1123/jsr.16.2.143.
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Context:Physical exercise is regarded as a useful tool in the treatment of multiple sclerosis (MS). Generally, physical rehabilitation have been based on the prescription of aerobic exercises, while fewer programs have been aimed at developing muscular strength.Objective:To establish whether the physical fitness of MS sufferers can be improved by a training program for developing muscular strength.Design:Before and after studySetting:University multipurpose roomParticipants:36 patients, all able to walk, belonging to the Leon Multiple Sclerosis Association.Interventions:The physical exercise programme consisted in resistance training sessions, based mainly on callisthenic, or bodyweight, exercises, during six weeks.
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Stojanov, Aleksandar, and Jelena Stojanov. "Depression as a determinant of quality of life in patients with multiple sclerosis." Galenika Medical Journal 1, no. 3 (2022): 22–27. http://dx.doi.org/10.5937/galmed2203023s.
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Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the central nervous system (CNS), which mainly affects women and young adults in their most productive years of life. Given to fact that the disease is unpredictable and has uncertain outcomes, the grater are physical and emotional efforts that an individual has to take, and that inevitably causes additional exhaustion. Assessment of disease severity based only on an objective clinical finding is not enough, because it does not give insight into the subjective experience of disease symptoms and difficulties with which these patients meet in everyday life life. Most MS sufferers most likely will experience a wide range of physical, psychological and social problems. Physical disability, fatigue, motor incapacity and sexual dysfunctions that occur with the progression of the disease, most often lead to the deterioration of the quality of life in people with MS. In addition to these factors, changes in psychological status are inevitable. Depression is the most common psychiatric comorbidity of MS that worsens the health condition of the patient. Studies on psychiatric comorbidities and ways of coping with MS generally highlight the connection between depression and alexithymia in MS. Prevalence alexithymia in MS patients goes up to 50%, it is associated with anxiety and significantly contributes to the severity and severity of depression. When it comes to the therapy of depression in MS of cognitive-behavioral psychotherapy (CBT) is recommended as the first line of treatment, but also the application of pharmacotherapy i.e. administration of sertraline and escitalopram with short-term use of alprazolam, and more recently, more and more studies are investigating neuroprotective effect of antidepressants, and recommend the use of fluoxetine. Directing preventive measures to improving social activities and prevention institutionalization ie. combining medical rehabilitation, psychosocial help and social support prevent that the disease from becoming a disability leading to complete isolation. It is also necessary to direct resources to adequate treatment of depression as determining factor of quality of life, mental health and prognostic factor of the clinical picture and course of MS.
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Mirmosayyeb, Omid, Serge Brand, Mahdi Barzegar, Alireza Afshari-Safavi, Nasim Nehzat, Vahid Shaygannejad, and Dena Sadeghi Bahmani. "Clinical Characteristics and Disability Progression of Early- and Late-Onset Multiple Sclerosis Compared to Adult-Onset Multiple Sclerosis." Journal of Clinical Medicine 9, no. 5 (May 2, 2020): 1326. http://dx.doi.org/10.3390/jcm9051326.
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Background: Compared to the adult onset of multiple sclerosis (AOMS), both early-onset (EOMS) and late-onset (LOMS) are much less frequent, but are often under- or misdiagnosed. The aims of the present study were: 1. To compare demographic and clinical features of individuals with EOMS, AOMS and LOMS, and 2. To identify predictors for disability progression from relapsing remitting MS (RRMS) to secondary progressive MS (SPMS). Method: Data were taken from the Isfahan Hakim MS database. Cases were classified as EOMS (MS onset ≤ 18 years), LOMS (MS onset >50 years) and AOMS (MS >18 and ≤ 50 years). Patients’ demographic and clinical (initial symptoms; course of disease; disease patterns from MRI; disease progress) information were gathered and assessed. Kaplan–Meier and Cox proportional hazard regressions were conducted to determine differences between the three groups in the time lapse in conversion from relapsing remitting MS to secondary progressive MS. Results: A total of 2627 MS cases were assessed; of these 127 were EOMS, 84 LOMS and 2416 AOMS. The mean age of those with EOMS was 14.5 years; key symptoms were visual impairments, brain stem dysfunction, sensory disturbances and motor dysfunctions. On average, 24.6 years after disease onset, 14.2% with relapsing remitting MS (RRMS) were diagnosed with secondary progressive MS (SPMS). The key predictor variable was a higher Expanded Disability Status Scale (EDSS) score at disease onset. Compared to individuals with AOMS and LOMS, those with EOMS more often had one or two relapses in the first two years, and more often gadolinium-enhancing brain lesions. For individuals with AOMS, mean age was 29.4 years; key symptoms were sensory disturbances, motor dysfunctions and visual impairments. On average, 20.5 years after disease onset, 15.6% with RRMS progressed to SPMS. The key predictors at disease onset were: a higher EDSS score, younger age, a shorter inter-attack interval and spinal lesions. Compared to individuals with EOMS and LOMS, individuals with AOMS more often had either no or three and more relapses in the first two years. For individuals with LOMS, mean age was 53.8 years; key symptoms were motor dysfunctions, sensory disturbances and visual impairments. On average, 14 years after disease onset, 25.3% with RRMS switched to an SPMS. The key predictors at disease onset were: occurrence of spinal lesions and spinal gadolinium-enhancement. Compared to individuals with EOMS and AOMS, individuals with LOMS more often had no relapses in the first two years, and higher EDSS scores at disease onset and at follow-up. Conclusion: Among a large sample of MS sufferers, cases with early onset and late onset are observable. Individuals with early, adult and late onset MS each display distinct features which should be taken in consideration in their treatment.
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Svensson, Marianne, and Liberty Fajutrao. "Costs of Formal and Informal Home Care and Quality of Life for Patients with Multiple Sclerosis in Sweden." Multiple Sclerosis International 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/529878.
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Disease progression in multiple sclerosis leads to dramatic changes in a person's ability to perform daily activities and increases reliance on external help. This study aims to describe and to estimate costs of formal/informal home care and quality of life related to multiple sclerosis. A mailed survey to a random sample of MS sufferers(n=1500)collected data on the number of hours of home care received, type of help, productivity losses, quality of life, and disease characteristics. Costs for home care were estimated in 2012 € and factors that may influence the likelihood of getting home care were also evaluated. Formal care was given to 27% of the respondents(n=839)at an average of 238.7 hrs/month at a mean monthly cost of €2873/person with MS. Informal care was received by 49% of the respondents at an average of 47.3 hrs/month at a mean monthly cost of €389/person with MS. Utilities across disease severity are as follows: mild MS = 0.709 (sd = 0.233), moderate MS = 0.562 (sd = 0.232), and severe MS = 0.284 (sd = 0.283). Total home care costs increased with increasing disease severity. Informal caregiving contributes significantly to MS home care in Sweden.
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Vojdani, Aristo, Partha Sarathi Mukherjee, Joshua Berookhim, and Datis Kharrazian. "Detection of Antibodies against Human and Plant Aquaporins in Patients with Multiple Sclerosis." Autoimmune Diseases 2015 (2015): 1–10. http://dx.doi.org/10.1155/2015/905208.
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Multiple sclerosis (MS) is an autoimmune disease that affects the body’s central nervous system. Around 90% of MS sufferers are diagnosed with relapsing-remitting MS (RRMS). We used ELISA to measure IgG, IgA, and IgM antibodies against linear epitopes of human and plant aquaporins (AQP4) as well as neural antigens in RRMS patients and controls to determine whether patients suffering from RRMS have simultaneous elevations in antibodies against these peptides and antigens. In comparison to controls, significant elevations in isotype-specific antibodies against human and plant AQP4 and neural antigens such as MBP, MOG, and S100B were detected in RRMS patients, indicating a high correlation in antibody reaction between plant aquaporins and brain antigens. This correlation between the reactivities of RRMS patients with various tested antigens was the most significant for the IgM isotype. We conclude that a subclass of patients with RRMS reacts to both plant and human AQP4 peptides. This immune reaction against different plant aquaporins may help in the development of dietary modifications for patients with MS and other neuroimmune disorders.
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Kirby, Trevor, and Javier Ochoa-Repáraz. "The Gut Microbiome in Multiple Sclerosis: A Potential Therapeutic Avenue." Medical Sciences 6, no. 3 (August 24, 2018): 69. http://dx.doi.org/10.3390/medsci6030069.
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Recently, there has been a substantial increase in the number of studies focused upon connecting the gut microbiome with cases of central nervous system (CNS) autoimmunity. Multiple sclerosis (MS) is a neurodegenerative autoimmune disorder of the CNS. Recent experimental and clinical evidence suggests the presence of microbial imbalances in the gut of MS sufferers. The gut microbiome is defined as the summation of all the microbial entities as well as their genes, proteins, and metabolic products in a given space and time. Studies show the MS gut microbiome as having general alterations in specific taxa, some associated with the promotion of inflammatory cytokines and overall inflammation. In conjunction with these findings, experimental models of the disease have reported that T regulatory (Treg) cells have deficits in their function as a result of the aberrant gut microbiota composition. The findings suggest that the interactions between the host and the microbiota are reciprocal, although more extensive work is required to confirm this. Moreover, evidence indicates that changes in microbiota composition may result in imbalances that could result in disease, with the gut as a potential novel therapeutic avenue. By understanding the biological effects of aberrant gut microbiome composition, it is possible to contemplate current therapeutic options and their efficacy. Ultimately, more research is necessary in this field, but targeting the gut microbiota may lead to the development of novel therapeutic strategies.
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Shannon, Brad C., and Shirley G. Tollman. "A Neuropsychological Examination of Multiple Sclerosis and its Impact upon Higher Mental Functions." South African Journal of Psychology 24, no. 3 (September 1994): 152–62. http://dx.doi.org/10.1177/008124639402400307.
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In view of the debate regarding the behavioural sequelae accompanying multiple sclerosis (MS), this study aimed to identify the deficits underlying observed behavioural performance difficulties in 24 MS sufferers. Qualitative and quantitative assessment instruments were employed, that is, Christensen's formalization of Luria's Neuropsychological Investigation, the Trail Making Test and Rey's Complex Figure Test. Results were analysed using syndrome analysis, which proceeded according to a hypothetico-deductive process, based on the principle of double dissociation of function. Five underlying factors were identified, namely: fatigability; information overload; disturbed fine control and integration of skilled motor movements; disturbed attention, concentration and tracking; and, disturbed executive control. Subjects divided into two subgroups. Those in subgroup 1 displayed fatigability, information overload and disturbed fine control and integration of skilled motor movement. In addition to these, subjects in subgroup 2 displayed disturbed attention, concentration and tracking, and disturbed executive skills. The identification of two subgroups may assist in explaining why controversy still surrounds the question of cognitive deficits in MS. It was concluded that the five underlying factors gave rise to a specific pattern of neuropsychological dysfunctioning in subjects consistent with a subcortical syndrome.
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Yousefi, Behzad, Samad Shams Vahdati, Hossein Mazouchian, and Reza Dehghan Hesari. "Epidemiological Survey of Multiple Sclerosis in East-Azerbaijan Province, Iran, 2014." Internal Medicine and Medical Investigation Journal 2, no. 2 (May 22, 2017): 42. http://dx.doi.org/10.24200/imminv.v2i2.54.
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Abstract:Introduction and background: MS as a chronic CNS disease is very prevalent in all around the world. Its epidemiology is different region by region and most of geographical and environmental factors may play a role in its incidence. To analyze demographic characteristics of the disease we designed this study.Methods and Materials: This Survey has been conducted in East-Azerbaijan province, North-West of Iran. Prevalence of the disease has been measured using data of Committee for diagnosis and Treatment of Multiple Sclerosis in 2014. Age, gender and type of the disease also been investigated in this research. Independent T Test, Chi square, Pearson and Fisher exact test used to analyze data.Results: We had 2774 MS patients in 2014. 726 were male (26%) and 2003 were female (73%). Mean age of males was 38±9 and mean age of females was 37.09±9. Mean age in male patients was more than in females significantly (P=0.001). We measured 73.26 prevalence per 100000 populations in East-Azerbaijan.Conclusion: Prevalence of the disease showed significant increase in 5 years compared to previous studies. Because of disease's disabilatating entity more interventional investigations are recommended to perform in preventing disease incidence or improving quality of life of sufferers and increasing their life expectancy.
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Viveiros, Cynthia Dumas, and Regina Maria Papais Alvarenga. "Prevalence of epilepsy in a case series of multiple sclerosis patients." Arquivos de Neuro-Psiquiatria 68, no. 5 (October 2010): 731–36. http://dx.doi.org/10.1590/s0004-282x2010000500011.
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OBJECTIVE: The prevalence of epilepsy in multiple sclerosis (MS) patients has been a subject of interest for some years. The objectives of this study were to describe the clinical, radiological and electroencephalographic characteristics of epileptic seizures and to calculate the prevalence of epilepsy in a case series of MS patients. METHOD: Medical charts of MS patients were reviewed and patients who had suffered epileptic seizures were identified. RESULTS: Of 160 cases analyzed, 5 had suffered epileptic seizures and one had comorbid mesial hippocampal sclerosis, confirmed by magnetic resonance imaging in a patient with complex partial seizures that began fifteen years prior to her diagnosis of MS. In the other four patients, seizures occurred both during the acute phase of the disease and in the chronic phase. CONCLUSION: The prevalence of epileptic seizures in MS patients in this study was 2.5%, similar to that found in other studies.
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Kania, Karolina, Elżbieta Tokarz-Kupczyk, and Alicja Kalinowska-Łyszczarz. "COVID-19 in two patients with multiple sclerosis treated with beta interferons." Pharmacotherapy in Psychiatry and Neurology 36, no. 4 (February 8, 2021): 327–34. http://dx.doi.org/10.33450/fpn.2020.12.004.
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Objectives. Treatment of multiple sclerosis (MS) in the era of the COVID-19 (coronavirus disease 2019) pandemic raises many questions for doctors. Case reports. We are presenting two cases of patients suffering from multiple sclerosis (MS) treated with interferon beta-1b and interferon beta-1a, who suffered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with a benign course in one case and an asymptomatic one in another. None of the patients required hospitalisation. Conclusions. MS treatment during coronavirus disease 2019 (COVID-19) pandemics poses several questions. Considering our own clinical experiences, we present a brief review of medical literature on the safety of MS immunotherapy. So far, the published data on MS and COVID-19 do not show increased risk associated with MS diagnosis or disease modifying therapy, even when associated with immunosuppression.
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Himmerich, Hubertus, Armin Szegedi, Christoph Klawe, Ion Anghelescu, and Matthias J. Müller. "Distigmine bromide induced acute psychotic disorder in a patient with multiple sclerosis." European Psychiatry 18, no. 6 (October 2003): 318–19. http://dx.doi.org/10.1016/j.eurpsy.2002.11.001.
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AbstractA female patient with multiple sclerosis (MS) suffered from an acute psychotic disorder after taking distigmine bromide for detrusor dysfunction. She showed a dramatic relief of her symptoms after the medication, distigmine bromide, was stopped. Distigmine is not supposed to penetrate the blood-brain barrier (BBB). However, in MS patients a leakage of the BBB could be hypothesized.
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Tlapshokova, L. B., and A. R. Zikhova. "Analytical epidemiology of multiple sclerosis in the Republic of Kabardino-Balkaria." Neurology, Neuropsychiatry, Psychosomatics 13, no. 1S (September 16, 2021): 10–14. http://dx.doi.org/10.14412/2074-2711-2021-1s-10-14.
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Multiple sclerosis (MS) is a common autoimmune disease, which etiology includes a complex of genetic and environmental factors. Data suggests that their interaction can influence the age of the clinical manifestations and the course of the disease. Therefore, the study of risk factors of MS in regions with different ethnic compositions of the population and climatic and geographical characteristics is of considerable interest.Objective: to study MS risk factors prevalence in the Republic of Kabardino-Balkaria (RKB).Patients and methods. This case-control study of the representation of risk factors included a cohort of 112 MS patients living in two regions of the RKB (Nalchik and the Prokhladnensky district). The MS diagnosis was established with the McDonald criteria (2017). MS risk factors were assessed with a unified questionnaire. 112 respondents (matched by the main demographic characteristics and place of residence) were included in the control group.Results and discussion. MS patients from the Prokhladnensky district were significantly more likely to contact harmful chemical compounds, had higher consumption of smoked meat products; and suffered from viral infections more often (all differences were significant, p<0.05). More patients with MS, regardless of their place of residence, had a history of scarlet fever than the controls (n=23; 19.5% and n=14; 13.4%, ratio indicator 0.43 (95% CI 0.32–1.01), p=0.041), and the maximum significance of this factor was found in patients who suffered from scarlet fever after the age of 15 years (n=7; 6.3% and n=1; 0.9%, ratio indicator 2.45 (95% CI 1.92–3.21), p=0.041). More patients with MS had a history of chickenpox (n=70; 62.5% and n=55; 41.1%; ratio indicator 0.78 (95% CI 0.65–0.94, p=0.032), the frequency of this factor was most significant in early (up to 7 years) disease onset. Regardless of the place of residence, patients with MS were more likely to suffer from tonsillitis and sinusitis in childhood (p=0.032).Conclusion. In the RKB, as in other regions of the Russian Federation, the risk of MS, along with a genetic predisposition, is primarily determined by environmental factors, such as contact with potentially harmful chemicals, history of somatic diseases, characteristics of the ecological situation, etc. Therefore, MS risk is higher in people exposed to these factors before the age of 7 years and does not depend on the place of residence.
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Padilla-Docal, Bárbara, Alberto J. Dorta-Contreras, Hermes Fundora-Hernández, Elena Noris-García, Raisa Bu-Coifiu-Fanego, Marlen González-Hernández, and Alexis Rodríguez-Rey. "C3c intrathecal synthesis evaluation in patients with multiple sclerosis." Arquivos de Neuro-Psiquiatria 65, no. 3b (September 2007): 800–802. http://dx.doi.org/10.1590/s0004-282x2007000500013.
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INTRODUCTION: Multiple sclerosis (MS) is a chronic, inflammatory and progressive disease of the central nervous system in which local inflammatory injuries of the brain white matter appears, being the most outstanding feature the myeline loss (demyelination). OBJECTIVE: To determine if the complement system might be involved in the MS immunopathogeny favouring the mechanism intervening in the myelin destruction. METHOD: Samples of sera and CSF from twelve patients with a diagnosis of MS obtained at the moment of the admission to the hospital at the beginning of the break out, were collected. Levels of C3c and albumin in sera and in CSF were quantified using radial immunodiffusion plates. RESULTS: High values over 80% of intrathecal synthesis were obtained except in one of the patients. CONCLUSION: Intrathecal synthesis of C3c and its liberation to the CSF means that the activation of the complement system in any of the two ways has taken place, and that once performed its biological functions, has suffered a degradation process.
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Özcan, Muhammed Emin, Bahri İnce, Hasan Hüseyin Karadeli, and Talip Asil. "Multiple Sclerosis Presents with Psychotic Symptoms and Coexists with Hypertrophic Cardiomyopathy." Case Reports in Neurological Medicine 2014 (2014): 1–4. http://dx.doi.org/10.1155/2014/383108.
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Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. Psychiatric symptoms are not infrequent during MS, yet onset of MS with psychosis is rarely encountered. A 27-year-old Caucasian male was admitted due to numbness in his right arm and difficulty in walking. His clinical and laboratorial exams lead to the MS diagnosis. Nine months earlier, he also developed psychotic disorder, not otherwise specified (PD-NOS). His sudden onset of PD-NOS, his rapid and complete response to antipsychotics, and a relatively short interval between psychiatric and neurological signs indicate a high likelihood that PD-NOS was a manifestation of underlying MS. He also suffers from hypertrophic obstructive cardiomyopathy (HOCM). The patient’s neurological complaints were recovered with methylprednisolone (1 g/day, i.v.) given for five days. Glatiramer acetate (1 × 1 tb.s.c.) was prescribed for consolidation and, after nine months of his admission, the patient fully recovered from neurological and psychiatric complaints. Interestingly, very recent studies indicate specific alpha-actinin antibodies in MS and alpha-actinin mutations cause HOCM. Thus, concurrence of MS with HOCM can be even a new syndrome, if further genetic studies prove.
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Becker, Jana, Mareike Geffken, Rolf Diehl, Peter Berlit, and Markus Krämer. "Choosing wisely? Multiple Sclerosis and Laboratory Screening for Autoimmune Differential Diagnoses." Neurology International Open 01, no. 04 (October 2017): E256—E263. http://dx.doi.org/10.1055/s-0043-115429.
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Abstract Background A variety of diseases can mimic the presentation of multiple sclerosis (MS). Diagnosing MS requires the exclusion of conditions considered in the differential diagnosis of MS. The guidelines of the German Society of Neurology (DGN) recommend analyzing 13 mandatory and 9 optional laboratory parameters. The mandatory recommendations include antinuclear antibodies (ANA) as well as antibodies against double-stranded DNA (anti-dsDNA Abs)). Methods In a cohort of MS outpatients, those patient records were analyzed in which test results for all or at least some of the recommended laboratory parameters were available. In addition to these laboratory parameters, MRI data, family history, clinical presentation, evoked potentials, and CSF findings were analyzed. Furthermore, a questionnaire was used to prospectively collect information about rheumatological symptoms relevant to the differential diagnosis of MS. Results In 197 of the included 554 patients, at least some of the recommended differential diagnostic laboratory parameters were available. In 59.4% of these patients, ANA titers ≥ 1:80 were detected. Neither ANA nor ANCA nor anti-dsDNA abs were able to distinguish between MS and non-MS. In 124 MS patients, 54.8% had positive ANA titers ≥1:80. MS patients with these titers suffered more frequently from autoimmune diseases and were more likely to have a family history of MS. Of the remaining 73 patients without MS, 67.1% were ANA positive. In this patient population, the ANA-positive patients were more frequently diagnosed with psychiatric diseases. In the prospectively surveyed MS patients with an ANA titer >1:160, no rheumatologic disease was diagnosed during the average follow-up period of 1.9 years. Conclusion In line with the "Choosing Wisely" recommendations of the American College of Rheumatology, mandatory laboratory screening appears to offer no benefit to the initial diagnosis of multiple sclerosis, unless a specific differential diagnosis is to be excluded.
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Frost, Alexandra C., Nima Golijani-Moghaddam, Rupert Burge, David L. Dawson, Nikos Evangelou, Bryan Roche, James Turton, et al. "Usability and acceptability of a cognitive training intervention (SMART) for people with multiple sclerosis (MS): A prefeasibility formative evaluation." NIHR Open Research 2 (May 23, 2022): 39. http://dx.doi.org/10.3310/nihropenres.13274.1.
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Background: Multiple sclerosis (MS) is a chronic autoimmune, inflammatory neurological disease of the central nervous system (CNS), increasing in incidence and prevalence across both developed and developing countries. Cognitive difficulties are common in MS sufferers with 70% experiencing difficulties in higher-level brain functioning such as planning, attention, problem solving, and memory. Computerised cognitive training programmes may hold promise as a treatment option for improving cognitive function in people with MS, subject to exploring and addressing potential barriers to usability and acceptability. Methods: This study aimed to test the usability and acceptability of a computerised cognitive training intervention—Strengthening Mental Abilities Through Relational Training (SMART) —for people with MS, through a mostly qualitative prefeasibility design (n= 12). There were two phases of testing: (1) initial usability testing via a think-aloud protocol (n= 6) and (2) alpha-testing to assess experienced acceptability over a four-week period of engagement (n= 6). Data from the two phases were subjected to Framework Analysis, wherein we deductively applied the Health IT Usability Evaluation Model and Theoretical Framework of Acceptability to assess usability and acceptability, respectively. Results: Results show SMART to have satisfactory usability with participants reacting positively to the formatting, visuality, and process of the interface. Minor suggestions were made on how best to adapt SMART for people with MS, but the programme and facilitative support were generally perceived to be acceptable, with participants expressing positive feelings about taking part in the intervention, despite associated burdens. Conclusions: This prefeasibility study provides preliminary evidence of the usability and acceptability of SMART as a computerised cognitive training programme for people with MS. We conclude that we can now move forward with a feasibility trial of SMART, with the intention of proceeding to a definitive trial with cost-effectiveness analysis.
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Rougé-Maillart, C. I., N. Guillaume, N. Jousset, and M. Penneau. "Recognition by French courts of compensation for post-vaccination multiple sclerosis: the consequences with regard to expert practice." Medicine, Science and the Law 47, no. 3 (July 2007): 185–90. http://dx.doi.org/10.1258/rsmmsl.47.3.185.
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Over the past few years, despite scientific uncertainties, French courts have awarded compensation to sufferers of multiple sclerosis (MS) which occurred following vaccination against hepatitis B. These legal decisions have aroused fierce criticism in the medical world. Both a judgment given on 25 May 2004 by the Court of Cassation and a new publication in the journal Neurology have encouraged us to look once more at this controversial issue. French judges began compensating patients with MS at the end of the 1990s. One of the first judgments was given in 2001 by the Court of Appeal of Versailles when a pharmaceutical laboratory was held liable for the onset of MS following vaccination against hepatitis B. On appeal, the Court of Cassation overturned the judgment in September 2003, finding that the Court of Appeal judges had based their decision on a hypothetical causal link. However, the only reason why the Court of Appeal judgment was quashed was the contradictory evidence on which the judges had based their presumptions. Several of the judgments given since that date seem to confirm this hypothesis. On 25 May 2004, the 2nd civil law chamber recognized that MS which occurs following a vaccination against hepatitis B (a vaccination carried out for work-related purposes) could be considered as an accident at work, without questioning the possible causal link between the illness and the vaccine. This jurisprudence in the matter of hepatitis B vaccination shows the need for great care in expert practice. Effectively, when confronted with drug related imputability, the expert usually bases his reasoning on three points: the causal role of the generating factor, the chronology and other causes of damage. In terms of MS, all these factors are modified. More than ever, an expert must, in terms of imputability, be objective, prudent and clear in his conclusions.
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Villar, LM, N. García-Barragán, M. Espiño, E. Roldán, MC Sádaba, J. Gómez-Rial, P. González-Porqué, and JC Álvarez-Cermeño. "Influence of oligoclonal IgM specificity in multiple sclerosis disease course." Multiple Sclerosis Journal 14, no. 2 (October 17, 2007): 183–87. http://dx.doi.org/10.1177/1352458507082046.
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Oligoclonal IgM bands (OCMB) against myelin lipids predict an aggressive multiple sclerosis (MS) course. However, the clinical significance of OCMB without lipid specificity, present in other MS patients, remains unknown. We describe here a characterization of these antibodies and study their role in MS progression. Fifty-four MS patients showing CSF-restricted OCMB were included in this study at disease onset and followed-up during 61.1 ± 2.7 months. The specificity of OCMB and the CSF B-cell profile were investigated. A second CSF IgM study was performed in a group of eight patients. Thirty-eight patients showed OCMB against myelin lipids (M+L+) and other sixteen had OCMB lacking this specificity (M+L-). The CD5+ B cell subpopulation, responsible for most persistent IgM responses, was considerably higher in M+L+ than in M+L- patients (3.3 ± 0.6% versus 0.8 ± 0.2, P = 0.009). In addition, M+L+ bands persisted during disease course, while M+L- disappeared during follow-up. M+L+ patients suffered more relapses (4.2 ± 0.6 versus 1.6 ± 0.3, P = 0.002) and reached higher disability (EDSS score of 2.2 ± 0.2 versus 1.2 ± 0.2, P = 0.02) than M+L- group. These data corroborate that anti-lipid OCMB associate with an aggressive MS course and show that OCMB that do not recognize myelin lipids represent a transient immune response related to a more benign disease course. Multiple Sclerosis 2008; 14: 183—187. http://msj.sagepub.com
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Brown, L. N., and L. M. Metz. "Tactile temporal thresholds detect relapse-related changes in multiple sclerosis: a preliminary study." Multiple Sclerosis Journal 11, no. 6 (December 2005): 725–27. http://dx.doi.org/10.1191/1352458505ms1219sr.
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Background: Tactile temporal thresholds, which represent the time separating the onset of two tactile stimuli when they are judged as simultaneous, can differentiate a group of people with multiple sclerosis (MS) from normal controls. Demyelination, axonal injury and loss, and altered information processing all occur in MS and may cause these increased thresholds. Thus, tactile temporal thresholds may be a useful outcome measure in MS. Our objective was to assess whether tactile temporal thresholds reflect change during a MS relapse. Methods: During a study to evaluate the stability of tactile temporal thresholds in people with MS, two participants suffered relapses. Both events were associated with prolonged thresholds (i.e., significantly increased thresholds). Conclusions: Tactile temporal thresholds can detect neurologic worsening and thus warrant further evaluation as a useful method to facilitate in the monitoring of disease change in people with MS.
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Sakhaei, Shahriar, Hossein Motaarefi, Soryya Zinalpoor, and Hassan Ebrahimpour Sadagheyani. "Functional Evaluation of Multiple Sclerosis Patients in Khoy (IRAN)." Open Public Health Journal 11, no. 1 (February 14, 2018): 37–43. http://dx.doi.org/10.2174/1874944501811010037.
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Introduction and Purpose:Multiple Sclerosis (MS) is a common, hidden, degenerative, and progressive chronic disease that is more prevalent in women than in men. It is caused by damage to the myelin of central nervous system and results in neuropathy. The clinical pattern of the disease is 70 percent relapsing - remitting, and depending on the severity and type of nervous involvement, results in a variety of physical, psychological and social disabilities. The present study was designed to determine the functional level of MS patients.Methods:In this cross-sectional study, 70 MS female patients referred to the Health Center for Special Diseases at the Madani Hospital of Khoy in 2016 were selected total samplesviaCensus. Two questionnaires were used: the demographic information form and the 29-question MSISS questionnaire that consists of both physical and psychological dimensions. Data analyses were carried out using SPSS v.16 software for an independent sample T-test, and ANOVA.Results:The 69% of the sample was comprised of married women, 74% were housewives, 83% were found to be disabled, 77% had a relapsing-remitting form of illness and 89% had no communication problems. The average age was 35 years and the average duration of illness was 4 years. Severe physical disability was found in 11.4% and 17.1% suffered from severe psychological disability. The general disease-related disability was considered mild in 65.7%. Disability was related to age, lifestyle, the presence or absence of a caregiver, the type of illness and communication problems. Physical and psychological dimensions of disability were unrelated (p<0.001).Conclusion:According to the high rate of psychological disability compared to physical dimension and effects of physical disorders on the soul, it is necessary to minimize the severity of disability by directing and controlling tensions, changes in lifestyle, the use of complementary therapies, rehabilitation Interventions, psychosocial support, and receiving services from the Association for the supportive of MS patients.Because psychological disability was greater than physical disability, therapy needs to address psychological stressors. Changes in lifestyle, use of complementary therapies, rehabilitation interventions and psychosocial support are recommended. Support associations for MS patients can also be helpful.
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Mulvey, Michael R., Malcolm Doupe, Michael Prout, Christine Leong, Romeo Hizon, Amy Grossberndt, Meghann Klowak, et al. "Staphylococcus aureus harbouring Enterotoxin A as a possible risk factor for multiple sclerosis exacerbations." Multiple Sclerosis Journal 17, no. 4 (January 6, 2011): 397–403. http://dx.doi.org/10.1177/1352458510391343.
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Background: Staphylococcus aureus may produce superantigens that can non-specifically activate CD4+ cells to potentially target the myelin basic protein. Objective: This study examined the association between individuals with multiple sclerosis (MS) and colonization with S. aureus harbouring superantigens. Methods: Nasal swabs were collected from non-MS subjects and patients with MS who had not experienced a relapse in the past six months (MS stable group) and who had suffered a relapse within 30 days of study recruitment (MS exacerbation group). S. aureus was isolated from the anterior nares of participants following standard procedures and staphylococcal superantigen genes ( sea, seb, and tsst-1) were detected using standard laboratory PCR techniques. Results: The study enrolled 204 patients, 80 in the non-MS and MS stable groups and 44 patients in the MS exacerbation group. Overall, 27.0% of patients were colonized with S. aureus with no significant differences identified between study groups. Amongst individuals colonized with S. aureus, the prevalence of sea was significantly greater in the MS exacerbation versus non-MS study group ( p < 0.05; odds ratio 7.9; 95% confidence interval 1.2–49.5). Conclusions: The ability to rapidly screen patients for the presence of S. aureus producing sea may serve as a useful marker of a potential MS exacerbation.
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Juyani, Yaser, Dorsa Hamedi, Seyede Sedighe Hosseini Jebeli, and Maryam Qasham. "Multiple Sclerosis and Catastrophic Health Expenditure in Iran." Global Journal of Health Science 8, no. 9 (January 21, 2016): 194. http://dx.doi.org/10.5539/gjhs.v8n9p194.
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<p><strong>BACKGROUND: </strong>There are many disabling medical conditions which can result in catastrophic health expenditure. Multiple Sclerosis is one of the most costly medical conditions through the world which encounter families to the catastrophic health expenditures. This study aims to investigate on what extent Multiple sclerosis patients face catastrophic costs.</p><p><strong>METHOD:</strong> This study was carried out in Ahvaz, Iran (2014). The study population included households that at least one of their members suffers from MS. To analyze data, Logit regression model was employed by using the default software STATA12.</p><p><strong>RESULTS: </strong>3.37% of families were encountered with catastrophic costs. Important variables including brand of drug, housing, income and health insurance were significantly correlated with catastrophic expenditure.</p><p><strong>CONCLUSIONS: </strong>This study suggests that although a small proportion of MS patients met the catastrophic health expenditure, mechanisms that pool risk and cost (e.g. health insurance) are required to protect them and improve financial and access equity in health care.</p>
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Egg, R., M. Reindl, F. Deisenhammer, C. Linington, and T. Berger. "Anti-MOG and anti-MBP antibody subclasses in multiple sclerosis." Multiple Sclerosis Journal 7, no. 5 (October 2001): 285–89. http://dx.doi.org/10.1177/135245850100700503.
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In a subset of multiple sclerosis (MS) patients antibodies against myelin antigens seem to be important in the demyelinating process. In this study we investigated IgM, IgA and IgG serum antibodies against the myelin oligodendrocyte glycoprotein (MOG) and the myelin basic protein (MBP) in 261 MS patients. Seventy-two per cent had anti-MOG antibodies, 59% were anti-MBP seropositive. The dominating antibody was anti-MOG IgM. A significant relationship between IgA and a progressive disease course was found. The predominance of IgG1 together with the significantly associated occurrence of IgG3 against MOG corresponds to the prevailing IgG1 and IgG3 isotypes in other autoimmune diseases. Patients who actually suffered from a relapse were significant more often anti-MOG and anti-MBP IgG3 seropositive than those in remission. However, patients treated either with intravenous immunoglobulins or interferon-b showed a significant reduction of anti-MOG IgG3 antibodies.
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D’Souza, Marcus, Saskia Steinheimer, Jonas Dorn, Cecily Morrison, Jacques Boisvert, Kristina Kravalis, Jessica Burggraaff, et al. "Reference videos reduce variability of motor dysfunction assessments in multiple sclerosis." Multiple Sclerosis Journal - Experimental, Translational and Clinical 4, no. 3 (July 2018): 205521731879239. http://dx.doi.org/10.1177/2055217318792399.
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Motor dysfunction, particularly ataxia, is one of the predominant clinical manifestations in patients with multiple sclerosis (MS). Assessment of motor dysfunction suffers from a high variability. We investigated whether the clinical rating of ataxia can be improved through the use of reference videos, covering the spectrum of severity degrees as defined in the Neurostatus-Expanded Disability Status Scale. Twenty-five neurologists participated. The variability of their assessments was significantly lower when reference videos were used (SD = 0.12; range = 0.40 vs SD = 0.26; range = 0.88 without reference videos; p = 0.013). Reference videos reduced the variability of clinical assessments and may be useful tools to improve the precision and consistency in the clinical assessment of motor functions in MS.
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Kallweit, Ulf, Christian R. Baumann, Michael Harzheim, Hildegard Hidalgo, Dieter Pöhlau, Claudio L. Bassetti, Michael Linnebank, and Philipp O. Valko. "Fatigue and Sleep-Disordered Breathing in Multiple Sclerosis: A Clinically Relevant Association?" Multiple Sclerosis International 2013 (2013): 1–7. http://dx.doi.org/10.1155/2013/286581.
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Background. Fatigue in patients with multiple sclerosis (MS) is highly prevalent and severely impacts quality of life. Recent studies suggested that sleep-disordered breathing (SDB) significantly contributes to fatigue in MS.Study Objective. To evaluate the importance of routine respirography in MS patients with severe fatigue and to explore the effects of treatment with continuous positive airway pressure (CPAP).Patients and Methods. We prospectively assessed the presence of severe fatigue, as defined by a score of ≥5.0 on the Fatigue Severity Scale (FSS), in 258 consecutive MS patients. Ninety-seven patients (38%) suffered from severe fatigue, whereof 69 underwent overnight respirography.Results. We diagnosed SDB in 28 patients (41%). Male sex was the only independent associate of SDB severity (P=0.003). CPAP therapy in 6 patients was associated with a significant reduction of FSS scores (5.8±0.5versus4.8±0.6,P=0.04), but the scores remained pathological (≥4.0) in all patients.Conclusion. Respirography in MS patients with severe fatigue should be considered in daily medical practice, because SDB frequency is high and CPAP therapy reduces fatigue severity. However, future work is needed to understand the real impact of CPAP therapy on quality of life in this patient group.
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Frau, Jessica, Giancarlo Coghe, Lorena Lorefice, Giuseppe Fenu, Maria Giovanna Marrosu, and Eleonora Cocco. "Mitoxantrone exposure in pregnancy: a new case report in a multiple sclerosis patient." Case Reports in Perinatal Medicine 5, no. 2 (September 1, 2016): 125–26. http://dx.doi.org/10.1515/crpm-2016-0009.
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Abstract Background: Mitoxantrone (MIX) is a chemotherapeutic agent used in aggressive multiple sclerosis (MS). It is considered a potential human teratogen and it is classified by the US Food and Drug Administration in pregnancy category D. There are some cases reported of MIX exposure in the pregnancy or preconception period, four in polytherapy in oncological patients and two in MS women. In the first MS case, the baby had low birth weight; in the second the infant suffered from the Pierre Robin sequence. Case history: We describe a 24-year-old female with MS. She started MIX treatment after 4 months from diagnosis, receiving a cumulative dose of 60 mg/m2 and a total of six infusions since discovering she was pregnant. The last infusion was after the supposed conception day. The pregnancy was regular, with growth restriction during the entire period. On week 39, the patient delivered a healthy baby. Her weight was 2.314 kg (<5th percentile), the length 45 cm (<5th percentile), and the cranial circumference 30 cm. Conclusions: We described the third case of MIX exposition in MS-pregnant patients. The only consequence was low birth weight. It is important to collect all the accidental MIX exposition in pregnancy to have more safety data.
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Morales-Gonzáles, J. M., J. Benito-León, J. Rivera-Navarro, and A. J. Mitchell. "A systematic approach to analyse health-related quality of life in multiple sclerosis: the GEDMA study." Multiple Sclerosis Journal 10, no. 1 (February 2004): 47–54. http://dx.doi.org/10.1191/1352458504ms967oa.
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Objective: To describe a holistic and comprehensive approach to the assessment of sufferer’s perceptio ns of health-related quality of life (HRQ oL) in a cohort of multiple sclerosis (MS) patients. Methods: The G EDMA (Grupo de Enfermedades Desmielinizantes de Madrid, in Spanish) study is an ongoing longitudinal survey using quantitative and qualitative methodologies. The baseline cohort consisted of a large sample of MS patients recruited from 13 hospitals in Madrid, Spain. Using a standardized protocol we collected data concerning the sociodemographic and health status characteristics of patients, as well as implementing a modified Spanish version of the Functio nal A ssessment of Multiple Sclerosis quality of life instrument. Primary caregivers were interviewed using a specific protocol combined with the Zarit Burden Interview. Results: The index cohort comprised 371 MS patients (68.7% female) of mean age 38.9 ± 0.9 years. A ge, sex and clinical form distribution were similar to other MS population-based surveys. There were 258 (69.5%) relapsing-remitting (RR) MS patients and 113 (30.5%) progressive MS patients. More than one-third of the married patients with progressive MS and almost a quarter of the RRMS patients separated or divorced following a diagnosis of MS; 71.3% of the progressive MS patients as well as 65.8% of the RRMS patients were unemployed as a consequence of the disease. Q ualitative analysis showed that friendship and family relationships and occupational status were the most significant dimensions influenced by MS. O n the other hand, the speech analysis of primary caregivers showed that emotional burden was related to patients’ physical disability. Furthermore, primary caregivers described the influence of MS on their own occupatio nal status, their nonacceptance of the disease, a perceptio n of a lack of support by other members of the family as well as a ‘selfish and intransigent’ attitude of the patients themselves. Conclusions: The analysis of the G EDMA cohort provides valuable information that helps clarify the impact of MS on patients’ HRQ oL.
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Ariapooran, Saeed, Masuod Rajabi, and Amirhosein Goodarzi. "Relationship between Social Support, Time Perspective and Suicide Ideations in Patients with Multiple Sclerosis." Asian Social Science 12, no. 8 (July 7, 2016): 192. http://dx.doi.org/10.5539/ass.v12n8p192.
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<p><strong>Introduction:</strong> Patients with Multiple Sclerosis (MS) are at risk for Suicide Ideation (SI). The relationship between Social Support (SS) and Time Perspective (TP) with SI is important among patients with MS. This study was performed to determine the prevalence of SI and the correlation between SS and TP with SI in Iranian patients with MS in Nahavand and Malayer.</p><p><strong>Methods:</strong> Using a cross-sectional analytic research design, we selected 79 participants among patients with MS in Nahavand and Malayer, Iran. Beck Scale for Suicidal Ideation, Multidimensional Scale of Perceived Social Support and Zimbardo’s Time Perspective Inventory were used for collecting the data.</p><p><strong>Results:</strong> The obtained results indicated that 30.3% of the patients with MS suffered from SI. There was a negative correlation between SS (from family, friends and significant other), Past Positive (PP) and Future (F) orientations and a positive correlation between Past Negative (PN) orientation and SI; SS from significant other and PP negatively predicted the SI in patients with MS.</p><p><strong>Conclusion: </strong>Based on the obtained results, the relationship between SS, PN, PP, F and SI and the role of SS from significant other and PP in predicting the SI in Nahavand and Malayer patients with MS were confirmed. Thus, it is necessary to develop support systems and apply the TP-based treatments for patients with MS who are at risk for SI.</p>
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Knapik, Andrzej, Ewa Krzystanek, Justyna Szefler–Derela, Joanna Siuda, Jerzy Rottermund, Ryszard Plinta, and Anna Brzęk. "Affective Disorder and Functional Status as well as Selected Sociodemographic Characteristics in Patients with Multiple Sclerosis, Parkinson’s Disease and History of Stroke." Medicina 56, no. 3 (March 7, 2020): 117. http://dx.doi.org/10.3390/medicina56030117.
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The main arguments in support of researching anxiety and depression in patients with chronic somatic diseases are the prevalence of affective disorders in the population, somatic conditions as risk factors of affective disorders and the search for effective preventative and therapeutic strategies. The aim of the study was to determine the association between the functional status, selected sociodemographic characteristics and prevalence as well as severity of anxiety and depression in patients with multiple sclerosis (MS), Parkinson’s disease (PD) and history of stroke (S). Material and methods: Eighty participants (44 women and 36 men) with MS (n = 22), PD (n = 31) and history of stroke (n = 27) were enrolled. All participants completed a questionnaire consisting of metrics, the Katz Index of Independence in Activities of Daily Living and the Hospital Anxiety and Depression Scale (HADS). Results: Fifty-five per cent of all participants did not present with anxiety or depression, 20% scored above the diagnostic threshold on the anxiety scale and 26% scored above the diagnostic threshold on the depression scale. Subgroup analysis revealed that anxiety and depression sufferers were 13.64% and 13.64% of MS patients, respectively; 22.58% and 35.48% of PD patients, respectively; and 22.22% and 25.93% of stroke survivors, respectively. There was a significant correlation between depression and independence level in the entire group and between depression and marital status in stroke survivors. Conclusions: Although depression and anxiety are highly prevalent in patients with neurological conditions, the disorder has a very individual nature and is not associated with the patient’s age, duration of a condition or concomitant diseases. Screening for depression and anxiety as a part of comprehensive approach may increase treatment efficacy in neurological patients
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Paybast, Sepideh, Mohammad Aghaali, Tayebeh Sabokbar, Mohammad Hosien Asi, Sara Rahmati Aram, Freshete Shahab, and Seyyed Amir Hejazi. "Evaluation of Sleep Disorders in Patients With Multiple Sclerosis: A Cross-sectional Study in Qom Province, Iran." Qom Univ Med Sci J 15, no. 7 (October 1, 2021): 490–97. http://dx.doi.org/10.32598/qums.15.7.2308.1.
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Background and Objectives: Multiple sclerosis is an autoimmune disease characterized by inflammation and demyelination of the central nervous system. About half of patients with MS complaint of sleep disorder which could be an indicator of the quality of life. The present study was conducted to evaluate the prevalence of sleep disturbances in patients with multiple sclerosis in Qom province. Methods: We included 120 patients from the MS community list and assessed the participants based on the demographic, Pittsburgh sleep quality index (PSQI) and Global Sleep Assessment (GSA) questionnaire. Data were analyzed using SPSS v. 23 software. Results: We showed that the majority of our patients (74.2) were women with a Mean±SD age of 33.95±8.01 years old. 90(75%) of our patients suffered from at least one sleep disturbance in which difficulty initiating or maintaining sleep were the main complaints. Age was estimated to be the main independent factor significantly associated with sleep disturbance. Except the gender, other studied variables had a considerable impact on certain types of sleep-related disorders. Conclusion: As sleep disorders is frequent and mainly undiagnosed in patients with MS, it is necessary to routine evaluate the patients for sleep disorders.
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Thiel, Sandra, Andrea I. Ciplea, Ralf Gold, and Kerstin Hellwig. "The German Multiple Sclerosis and Pregnancy Registry: rationale, objective, design, and first results." Therapeutic Advances in Neurological Disorders 14 (January 2021): 175628642110549. http://dx.doi.org/10.1177/17562864211054956.
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Objectives: Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) predominantly affect women of reproductive age. During the last few decades many disease-modifying therapies (DMTs) have been approved. It is therefore important to provide epidemiological structures for the collection of safety information on exposed pregnancies. Data on disease activity after withdrawal of DMTs are in high demand especially as severe relapses have been described after ceasing highly effective DMTs. Although breastfeeding is recommended, it is still unclear if the early reintroduction, especially of highly effective DMTs, has a beneficial effect on postpartum relapse risk or a combination of both, however safety data are lacking. Methods: The German MS and Pregnancy Registry (DMSKW) is a nationwide, observational, cohort study of pregnant women with MS or NMOSD, founded in 2006. As the study procedure has undergone important adaptation in recent years, described here is the updated methodology including data source and acquisition as well as variables collected within the DMSKW. Results: As of December 2020, the DMSKW database comprises 2579 pregnancies, 2568 with MS and 11 with NMOSD. Women are enrolled at a median gestational week of 11 (range: 0.02–42.1), have a median postpartum follow up of 1.2 years (range: 0–9.2) with 76% of all pregnancies being exposed to a DMT, mostly in the first trimester. Spontaneous abortion and preterm birth occurred in 7% and 10%, respectively; 19% of all women suffered from at least one relapse during pregnancy, with a minimum of 6% during the third trimester of pregnancy. Conclusion: The DMSKW is a valuable structure in providing safety data on drug exposure during pregnancy and lactation in combination with information on disease activity up to 6 years postpartum. This article will be the reference for describing the methods of future publications from the DMSKW.
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Yokoseki, Akiko, Etsuji Saji, Musashi Arakawa, Mariko Hokari, Takanobu Ishiguro, Fumihiro Yanagimura, Tomohiko Ishihara, Kouichirou Okamoto, Masatoyo Nishizawa, and Izumi Kawachi. "Relapse of multiple sclerosis in a patient retaining CCR7-expressing T cells in CSF under fingolimod therapy." Multiple Sclerosis Journal 19, no. 9 (March 21, 2013): 1230–33. http://dx.doi.org/10.1177/1352458513481395.
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Fingolimod acts as a functional antagonist of the sphingosine-1-phosphate receptor, and it traps lymphocytes in secondary lymphoid organs and precludes their migration into the central nervous system. We report the case of a patient who suffered a relatively severe relapse of multiple sclerosis (MS) during the initial 3 months of fingolimod therapy, with retention of CCR7 expression on CD4+ T cells in the cerebrospinal fluid (CSF) despite decreased numbers of lymphocytes and decreased expression of CCR7 on CD4+ T cells in the blood. These data suggest that fingolimod may cause differential effects on the CSF and blood lymphocytes of patients with MS during the initial months of therapy.
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Coric, Danko, Lisanne J. Balk, Merike Verrijp, Anand Eijlers, Menno M. Schoonheim, Joep Killestein, Bernard MJ Uitdehaag, and Axel Petzold. "Cognitive impairment in patients with multiple sclerosis is associated with atrophy of the inner retinal layers." Multiple Sclerosis Journal 24, no. 2 (February 1, 2017): 158–66. http://dx.doi.org/10.1177/1352458517694090.
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Background: Inner retinal layer (IRL) atrophy is a potential biomarker for neurodegeneration in multiple sclerosis (MS). Objective: To investigate the relationship between cognitive impairment and IRL atrophy in MS. Methods: Cross-sectional study design, including 217 patients and 59 healthy controls. Subjects were investigated clinically, underwent retinal optical coherence tomography (OCT) and comprehensive cognitive assessments. The association between these modalities was evaluated by regression analyses. Results: Of the patients, 44.2% were cognitively impaired. In the absence of multiple sclerosis–associated optic neuritis (MSON), cognitively impaired patients had a significantly lower mean peripapillary retinal nerve fiber layer (pRNFL, Δ: 8.13 µm, p < 0.001) and mean macular ganglion cell–inner plexiform layer (mGCIPL, Δ: 11.50 µm, p < 0.001) thickness compared to cognitively preserved patients. There was a significant association between the presence of cognitive impairment and pRNFL (odds ratio (OR): 1.11, 95% confidence interval (CI): 1.04–1.18, p = 0.001) and mGCIPL (OR = 1.11, 95% CI = 1.05–1.18, p < 0.001) atrophy. This association was masked by the severe IRL atrophy seen following MSON. Conclusion: The strong relationship between cognitive impairment across multiple cognitive domains and atrophy of the pRNFL and mGCIPL in patients who never suffered from MSON suggests that OCT is useful in assessing central nervous system neurodegeneration in MS.
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Llufriu, Sara, Teresa Pujol, Yolanda Blanco, Karolina Hankiewicz, Mattia Squarcia, Joan Berenguer, Pablo Villoslada, Francesc Graus, and Albert Saiz. "T2 hypointense rims and ring-enhancing lesions in MS." Multiple Sclerosis Journal 16, no. 11 (August 4, 2010): 1317–25. http://dx.doi.org/10.1177/1352458510377905.
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Background: Hypointense rims peripherally on T2-weighted MRI (rim lesions) have been associated with gadolinium ring-enhancing lesions in multiple sclerosis (MS) in pathological studies. However, little is known about their frequency, we analyzed clinical significance in a cohort of MS sufferers according to routine clinical practice. Methods: We retrospectively reviewed all available MRI scans performed on our MS patients between 2000 and 2009. A total of 580 MRI scans from 257 patients were analyzed. The presence of rim lesions and ring enhancement was assessed and counted blind. Furthermore, the correlation between both patterns, and with clinical characteristics, was evaluated. Results: Thirty-five rim lesions were identified and 9% (24/257) of the patients showed at least one of these lesions. Forty ring-enhancing lesions were counted and 12% (29/245) of the patients who had undergone gadolinium MRI presented at least one such lesion. Thirteen lesions co-localized both patterns (40% of the rim lesions and 33% of the ring-enhancing lesions). Rim lesions and ring-enhancing lesions were observed in patients with clinically isolated syndrome (7%, 7%), relapsing—remitting (11%, 15%) and secondary progressive (13%, 9%) but none with primary progressive MS. Presence of ring-enhancing lesions was significantly associated with a shorter time to reach EDSS (Expanded Disability Status Scale) 4.0 and 6.0 (hazard ratio 7.6, 95% confidence interval 2.3—24.6). Conclusions: Rim lesions and ring-enhancing lesions are present in close to 10% of patients with MS, and frequently both lesions appear independently one to the other. The association of ring enhancement with worst prognosis needs to be confirmed in prospective studies.
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Niklas, A., H. Sebraoui, E. Heß, A. Wagner, and F. Then Bergh. "Outcome measures for trials of remyelinating agents in multiple sclerosis: retrospective longitudinal analysis of visual evoked potential latency." Multiple Sclerosis Journal 15, no. 1 (January 2009): 68–74. http://dx.doi.org/10.1177/1352458508095731.
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Objective Visual evoked potentials (VEP) may be suitable surrogate outcome measures in multiple sclerosis (MS) remyelination trials. The extent of spontaneous changes of subclinically delayed VEP is unknown, whereas VEP improve after acute optic neuritis (ON). Methods In all, 124 patients with three VEP recordings at least 3 months apart: 71 patients with MS who had never suffered clinical ON; 53 patients with ON (isolated ON or ON as an attack of MS at first recording). Latencies of P100 were analyzed by multivariate analysis of variance. Results Eyes of patients with MS had a mean P100 latency of 110.2 ms, worsening mildly over time ( n = 104 eyes, P = 0.022). MS patients' eyes with subclinical demyelination (delayed P100 latency at first recording >116 ms) showed no significant evidence of remyelination ( n = 24 eyes, P = 0.27). By contrast, in ON patients' affected eyes, mean P100 latency decreased ( P = 0.001), whereas unaffected eyes remained stable ( P = 0.26). Clinically non-affected eyes from both diagnostic groups with subclinically prolonged latencies remained stable ( n = 32: mean P100 at 124.8 ± 10.7, 123.5 ± 13.6, and 122.8 ± 13.1 ms; P = 0.57), whereas non-affected eyes with normal latency at baseline deteriorated slightly ( P = 0.001). A subgroup with more homogeneously defined follow-up periods confirmed this observation. Non-affected eyes selected for stability (difference <5 ms) between first and second recording deteriorated (normal baseline, n = 66 eyes, P = 0.013) or remained stable (prolonged baseline, n = 18 eyes, 95% confidence interval of change –5.42 to +6.89 ms, P = 0.805). Conclusion Prolonged P100 latencies in eyes never affected by clinical ON remain stable and thus can be used as surrogate outcome measure for remyelination trials.
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Hoogervorst, E. LJ, C. H. Polman, and F. Barkhof. "Cerebral volume changes in multiple sclerosis patients treated with high-dose intravenous methylprednisolone." Multiple Sclerosis Journal 8, no. 5 (October 2002): 415–19. http://dx.doi.org/10.1191/1352458502ms838oa.
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Objective: Multiple sclerosis (MS) patients develop varying degrees of cerebral atrophy, which may already begin at disease onset. The purpose of this study is to examine the effect of steroid treatment on cerebral volume in MS patients. Methods: Thirty-five MS patients participating in a clinical trial of oral interferon beta, which included monthly MRI, were included in this study. They suffered from an acute relapse and were treated with intravenous methylprednisolone (IV-MP); 13 of the patients were treated with oral prednisolone tapering after IV-MP. The last MRI scan before and the first (and second for oral tapering patients) scan after IV-MP treatment were used for measuring parenchymal fraction (PF) and ventricular fraction (VF). Changes in PF and VF were analysed using Student’s t test. Results: For the total population no significant changes in PF or VF were found. However, the subgroup of patients receiving oral tapering after IV-MP showed changes, compatible with atrophy in both PF and VF, that were significant immediately after IV-MP treatment and still persisted (though not statistically significant anymore) after a mean interval of 30 days. The magnitude of these changes was about the same as the annual change in cerebral volume as reported in natural history studies. Conclusion: Our data indicate that short courses of intravenous steroids (restricted to three or five days) have no major impact, whereas prolonged treatment with oral tapering does significantly affect brain volume. These findings are important for longitudinal studies and clinical trials in which brain volume is used as an outcome measure.
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Ashjazadeh, Nahid, and Zahra Shamszadeh. "Restless Leg Syndrome in Patients with Multiple Sclerosis and its Effect on Frequency of Daytime Sleepiness and Fatigue of the Patients." Galen Medical Journal 5, no. 1 (March 9, 2016): 7–12. http://dx.doi.org/10.31661/gmj.v5i1.422.
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Background: Restless leg syndrome (RLS), fatigue and daytime sleepiness are three known co-morbidities in patients with multiple sclerosis (MS). The aim of this study was to evaluate the frequency of RLS in patients with MS and its effect on the frequency of fatigue and daytime sleepiness in these patients. Material and Methods: One hundred twenty patients who referred to the Inpatients Neurology Ward of Chamran hospital, affiliated with the Shiraz University of Medical Sciences, from June 2014 to March 2015, were selected as the study participants. The patients with clinically definite MS, according to the 2010 Revised Mc-Donald criteria, and expanded disability status scale (EDSS) ≤5.5 were included. RLS, fatigue and daytime sleepiness were assessed by the criteria of the International RLS study group (IRLSSG), fatigue severity scale (FSS) and Epworth sleepiness scale (ESS) respectively and the related statistical analyzes were conducted. Results: Seventy eight patients (65%) met all the four IRLSSG criteria, 77 patients (64.1%) suffered from fatigue and only 36 patients (30%) had excessive daytime sleepiness. RLS was not significantly linked to mean age, sex, MS duration, and daytime sleepiness of the studied MS patients, but fatigue was more frequent in MS patients with RLS, which was statistically significant (P=0.018). Conclusion: The main result of this study is that RLS is a common comorbidity in MS and the patients with MS, who also suffer from RLS. They have frequently experienced higher fatigue symptoms than those without RLS. Therefore, the appropriate diagnosis and management of RLS may improve both RLS and fatigue in these patients. [GMJ. 2016;5(1):7-12]
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Iriarte, J., G. Katsamakis, and P. De Castro. "The fatigue descriptive scale (FDS): a useful tool to evaluate fatigue in multiple sclerosis." Multiple Sclerosis Journal 5, no. 1 (February 1999): 010–16. http://dx.doi.org/10.1177/135245859900500103.
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Although fatigue is common among multiple sclerosis (MS) patients, evaluation of this symptom is difficult due to the subjectivity and variability of the complaint. We proposed the Fatigue Descriptive Scale (FDS) as a tool to evaluate the severity and quality of fatigue in a group of patients suffering from MS. As a way to demonstrate the usefulness of this scale we applied the FDS in a group of 155 patients (105 women and 50 men) with clinically-definite multiple sclerosis, as outlined according to Poser’s criteria. Age was 36.2±11.1 years (range 12-62) and time of evolution was 8.3±9.4 years (range 1-44). The Fatigue Severity Scale (FSS) was also used. Descriptive statistics techniques and techniques for nonparametric distribution (Spearman Rank, Kruskal-Wallis ANOVA) were used. One hundred and eighteen patients reported fatigue (73 spontaneously, 45 when questioned). All descriptions of fatigue were ranked according to FDS categories. Eighty-five patients defined the symptom as fatigue with exercise, 26 as asthenia and seven as the worsening of other symptoms. Fatigue by itself produced limited or disrupted activity in 78 patients; work-related functions were limited in 48 patients; social relations were limited in 29 patients; and self-care was difficult for one patient. Fifty-six patients suffered fatigue daily. FDS score was 4.9±3.9 (range 0-13). FSS was 3.1±1.7 (range 0.2-6.6). FDS and FSS of Krupp were highly correlated (R=0.87, p<0.001). Therefore, in comparison with other scales, the FDS shows remarkable usefulness in classifying, periodicity, and severity of fatigue in MS patients. The high correlation with the FSS implies that it is a valid method to measure the severity of fatigue, as was demonstrated in our paper proposing the FDS. The importance of this new scale is its ability to inform the clinicians in a very quick, easy, and at the same time complete way, how severe the fatigue really is and how it affects the patient.
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Ruiz-Sánchez, Francisco Javier, Maria do Rosário Martins, Salete Soares, Carlos Romero-Morales, Daniel López-López, Juan Gómez-Salgado, and Ana María Jiménez-Cebrián. "Kinesiophobia Levels in Patients with Multiple Sclerosis: A Case-Control Investigation." Biology 11, no. 10 (September 29, 2022): 1428. http://dx.doi.org/10.3390/biology11101428.
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Fear of movement or kinesiophobia is an irrational fear of physical movement and fatigue that causes a limitation of functional capacity and decreased physical activity. The purpose of this study was to ascertain the level of kinesiophobia in people with multiple sclerosis (pwMS) and compare it with a group of healthy people, through the Tampa Scale for Kinesiophobia with 11 items (TSK-11). Method: A total of 116 subjects were recruited in a multicenter case-control study; 58 subjects suffered from MS and 58 were healthy subjects from different associations and the same locality. To assess the levels of fear of movement, the Spanish version of the TSK-11 self-questionnaire was used. Results: Most pwMS suffer from some degree of kinesiophobia (TSK-11 ≥ 18), and 60.3% had moderate to maximum kinesiophobia scores (TSK-11 ≥ 25). In contrast, healthy subjects presented a percentage of kinesiophobia from none to moderate (82.7%). Conclusions: Kinesiophobia is higher in pwMS than in the healthy control group. Accordingly, individuals showing pwMS should be assessed and monitored in order to diagnosed initial kinesiophobia levels, to allow planning treatment and preventive care activities that may improve the foot health and overall health in this group of patients.
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Voldsgaard, A., P. Bager, E. Garde, P. Åkeson, AM Leffers, CG Madsen, C. Kapel, et al. "Trichuris suis ova therapy in relapsing multiple sclerosis is safe but without signals of beneficial effect." Multiple Sclerosis Journal 21, no. 13 (February 19, 2015): 1723–29. http://dx.doi.org/10.1177/1352458514568173.
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Background: An observational study has suggested that relapsing–remitting multiple sclerosis patients with helminth infections have lower disease activity and progression than uninfected multiple sclerosis patients. Objective: To evaluate the safety and efficacy on MRI activity of treatment with TSO in relapsing MS. Methods: The study was an open-label, magnetic resonance imaging assessor-blinded, baseline-to-treatment study including ten patients with relapsing forms of multiple sclerosis. Median (range) age was 41 (24–55) years, disease duration 9 (4–34) years, Expanded Disability Status Scale score 2.5 (1–5.0), and number of relapses within the last two years 3 (2–5). Four patients received no disease modifying therapy, while six patients received IFN-β. After an observational period of 8 weeks, patients received 2500 ova from the helminth Trichuris suis orally every second week for 12 weeks. Patients were followed with serial magnetic resonance imaging, neurological examinations, laboratory safety tests and expression of immunological biomarker genes. Results: Treatment with Trichuris suis orally was well-tolerated apart from some gastrointestinal symptoms. Magnetic resonance imaging revealed 6 new or enlarged T2 lesions in the run-in period, 7 lesions in the early period and 21 lesions in the late treatment period. Two patients suffered a relapse before treatment and two during treatment. Eight patients developed eosinophilia. The expression of cytokines and transcription factors did not change. Conclusions: In a small group of relapsing multiple sclerosis patients, Trichuris suis oral therapy was well tolerated but without beneficial effect.
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Correale, Jorge, Isabel Peirano, and Lucas Romano. "Benign multiple sclerosis: a new definition of this entity is needed." Multiple Sclerosis Journal 18, no. 2 (August 24, 2011): 210–18. http://dx.doi.org/10.1177/1352458511419702.
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Background: To study a cohort of benign multiple sclerosis (BMS) patients beyond physical disability, including the evaluation of cognitive and social function, as well as fatigue, pain and MRI studies. Methods: A cohort of 342 patients was prospectively followed for 10.9 ± 0.71 years. Forty-three patients (12.5%) met the BMS diagnosis criteria [Expanded Disability Status Scale (EDSS) < 3 after at least 10 years’ disease duration], undergoing full neurological examination every 6 months. Neuropsychological status, pain, fatigue, social functioning and work-related disability, as well as brain MRIs, were assessed yearly. Results: By the end of follow-up, 20 of 43 BMS patients (47%) had suffered cognitive impairment and 23 (53.3%) referred depression. Furthermore, 21 (48.8%) reported significant changes in pain intensity, with fatigue and environmental severity scores significantly increasing over time in 33–35% of patients. Finally, 32 BMS patients (74%) showed significant increase in the number of new or enlarging T2 lesions, gadolinium-enhanced lesions, and persistent black holes, without changes in EDSS. Thirty-five of 43 patients (81%) fulfilling the BMS diagnostic criteria showed significant worsening of cognitive function, fatigue, pain or depression during the 10-year follow-up. Conclusions: Currently accepted criteria for BMS diagnosis may cause overestimation of true prevalence, underscoring the need for routine monitoring of non-motor symptoms and imaging studies, to help physicians improve diagnostic accuracy as well as therapeutic decision-making in this subgroup of MS patients.
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Engel, Sinah, Maria Protopapa, Falk Steffen, Vakis Papanastasiou, Christoforos Nicolaou, Michalis Protopapas, Frauke Zipp, Stefan Bittner, and Felix Luessi. "Implications of extreme serum neurofilament light chain levels for the management of patients with relapsing multiple sclerosis." Therapeutic Advances in Neurological Disorders 14 (January 2021): 175628642110019. http://dx.doi.org/10.1177/17562864211001977.
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Background: Serum neurofilament light chain (sNfL) is a promising biomarker to complement the decision-making process in multiple sclerosis (MS) patients. However, although sNfL levels are able to detect disease activity and to predict future disability, the growing evidence has not yet been translated into practicable recommendations for an implementation into clinical routine. Methods: The observation of a patient with extensive inflammatory activity in magnetic resonance imaging (MRI) along with an extremely high sNfL level in the absence of any clinical symptoms prompted us to investigate common characteristics of our MS patients with the highest sNfL levels in a retrospective cohort study. The 97.5th percentile was chosen as a cut-off value because the mean sNfL level of the resulting extreme neurofilament light chain (NfL) cohort corresponded well to the sNfL level of the presented case. Patient characterization included clinical and MRI assessment with a focus on disease activity markers. sNfL levels were determined by single molecule array. Results: The 97.5th percentile of our MS cohort (958 sNfL measurements in 455 patients) corresponded to a threshold value of 46.1 pg/ml. The mean sNfL level of the extreme sNfL cohort ( n = 24) was 95.6 pg/ml (standard deviation 68.4). Interestingly, only 15 patients suffered from a relapse at the time point of sample collection, whereas nine patients showed no signs of clinical disease activity. sNfL levels of patients with and without relapse did not differ [median 81.3 pg/ml (interquartile range [IQR] 48.0–128) versus 80.2 pg/ml (IQR 46.4–97.6), p = 0.815]. The proportion of patients with contrast-enhancing lesions was high and also did not differ between patients with and without relapse (92.9% versus 87.5%, p = 0.538); 78.9% of the patients not receiving a high-efficacious therapy had ongoing disease activity during a 2-year follow-up. Conclusion: Extremely high sNfL levels are indicative of subclinical disease activity and might complement treatment decisions in ambiguous cases.
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Kelsey, P., SM Bell, H. Jessop, JA Snowden, and B. Sharrack. "AUTOLOGOUS HAEMOPOIETIC STEM CELL TRANSPLANT IN MS: SHEFFIELD COHORT." Journal of Neurology, Neurosurgery & Psychiatry 86, no. 11 (October 14, 2015): e4.116-e4. http://dx.doi.org/10.1136/jnnp-2015-312379.28.
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BackgroundAutologous haemopoietic stem cell transplantation (AHSCT) is an evolving therapy for multiple sclerosis (MS). Here we present the Sheffield experience since 2006.MethodsRetrospective review of MS cases referred for and treated with AHSCT. Toxicity, clinical and radiological outcome were assessed.Results14 patients (8 Rapidly evolving severe [REMS], 3 Relapsing Remitting [RRMS], 3 Secondary Progressive [SPMS]) were selected for AHSCT. One patient underwent AHSCT on a clinical trial (data excluded from analysis). Mean age 34.6 years (SD 8.69), median pretreatment EDSS 6.5 (IQR0.5). All had clinically and radiologically aggressive disease, non-responsive to standard treatment. Follow up range was 3 to 96 months.All patients were successfully mobilized, 2 patients progressed only to harvest (1 compliance issues, 1 leg ulcer). All patients were treated according to international guidelines. No excess toxicity or treatment related mortality was observed.Post-transplant MRI's showed no active disease. No patients with RRMS suffered relapse post-transplant, median reduction in EDSS scores was 2 at both 100 days (IQR 2) and at last follow up (IQR 2.5). EDSS scores stabilised in patients with SPMS.ConclusionAHSCT is an effective treatment with acceptable toxicity in patients with aggressive, inflammatory MS.
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Bashford, James, and Eli Silber. "A LOCAL SURVEY AMONGST 92 PATIENTS WITH MULTIPLE SCLEROSIS: WHAT CAN WE LEARN ABOUT THIS POPULATION'S DISEASE MANAGEMENT? HOW SATISFIED ARE PATIENTS WITH OUR SERVICE?" Journal of Neurology, Neurosurgery & Psychiatry 86, no. 11 (October 14, 2015): e4.4-e4. http://dx.doi.org/10.1136/jnnp-2015-312379.101.
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In order to better inform local clinical practice, we collected primary data from our local MS population. We addressed important aspects concerning relapse management, bone health, mental health, sphincter dysfunction, symptom burden, recognition of comorbidities and pharmacological treatment. An emphasis was placed on discovering the extent of patient satisfaction with the local service.An 11-page patient questionnaire was distributed to consecutive consenting patients attending the MS clinic. A supplemental questionnaire was provided to those patients on regular natalizumab therapy. In total, 92 full and 22 natalizumab questionnaires were completed.Two particular areas highlighted for improvement with regards to patient management and patient education were bone and mental health:1. Only 26% of respondents confirmed having had a dual-energy X-ray absorptiometry (DEXA) scan. When asked if reduced ability in MS is an important risk factor for osteoporosis, only 44/92 patients confirmed they thought this was true.2. In the last year, 41% and 58% of respondents have suffered from depression and anxiety, respectively. Despite this, only a third of these patients received any treatment (pharmacological or non-pharmacological) for anxiety, depression or both.Encouragingly, 95% of those surveyed would recommend our MS service to a friend or family member.
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Vladimirova, Olga, John O'Connor, Alan Cahill, Hansjuerg Alder, Catalin Butunoi, and Bernadette Kalman. "Oxidative damage to DNA in plaques of MS brains." Multiple Sclerosis Journal 4, no. 5 (October 1998): 413–18. http://dx.doi.org/10.1177/135245859800400503.
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A major cause of clinical disability in multiple sclerosis (MS) is related to a degenerative process in the central nervous system (CNS) which ultimately develops from a potentially reversible inflammation and demyelination. The mechanism of this degenerative process within MS lesions is not completely understood. We hypothesize that oxidative damage to DNA secondary to inflammation may contribute to irreversible tissue alterations in a plaque. To test this assumption, we determined the level of a DNA oxidative marker, 8-hydroxy-deoxy-guanosine (8-OH-dG) in the normal appearing white matter (NAWM), plaque and cortical regions of cerebella from MS patients who suffered from severe cerebellar symptoms during the course of the disease, and in NAWM and cortical regions of cerebella from non-neurological controls. We found a significant increase in DNA oxidation within plaques compared to NAWM specimens in MS cerebella. A tendency for increase of oxidative markers in normal appearing cortical tissues located in the proximity of MS plaques was also observed when compared to those in control cortical specimens. Oxidative damage to DNA in MS lesions, and in neuron rich areas located in the proximity of these lesions is likely related to the release of reactive oxygen species (ROS) and nitric oxide (NO) during inflammation in the brain. This biochemical impairment of DNA and of other macromolecules may contribute to the development of severe clinical disability through the induction of degenerative changes within and outside of plaques in MS brains.
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Berk, Caglar, Jason Carr, Marci Sinden, Jeff Martzke, and Christopher R. Honey. "Thalamic deep brain stimulation for the treatment of tremor due to multiple sclerosis: a prospective study of tremor and quality of life." Journal of Neurosurgery 97, no. 4 (October 2002): 815–20. http://dx.doi.org/10.3171/jns.2002.97.4.0815.
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Object. In several studies a significant reduction in tremor after thalamic deep brain stimulation (DBS) has been reported among patients with multiple sclerosis (MS). It has not been determined if this results in an improved quality of life. In this study the authors prospectively evaluated the effects of thalamic DBS on tremor and quality of life. Methods. Videotapes of the patients' tremor were made preoperatively and 2 and 12 months postoperatively, and tremor was scored by a neurologist blinded to the treatment. Patients were tested pre- and postoperatively to measure any changes in their reported ability to perform selected activities of daily living and in their health-related quality of life. Patients were asked to complete a questionnaire about their satisfaction with the surgery. Postoperative changes were examined using paired t-tests. There were significant reductions in postural, action, and overall tremor at 2 and 12 months postoperatively. The patients' reported ability to feed themselves was significantly improved 2 months after surgery (p = 0.01). There were short-term trends toward improvement in reported dressing ability, personal hygiene, and writing. There were no significant changes in the SF-36 subscales or total score. Conclusions. In this cohort of patients with MS who suffered from tremor, thalamic DBS significantly improved their tremor and ability to feed themselves. Patient satisfaction with the procedure, however, was variable. Preoperative patient education about what functions might (and might not) be improved is crucial to avoid unrealistic expectations. Our results indicate that younger patients with MS tremor who had a shorter disease duration and no superimposed ataxia benefited most from this surgery.
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Fazekas, Franz, Florian Deisenhammer, Siegrid Strasser-Fuchs, Gerhard Nahler, and Bruno Mamoli. "Treatment effects of monthly intravenous immunoglobulin on patients with relapsing - remitting Multiple Sclerosis: Further analyses of the Austrian immunoglobulin in MS Study." Multiple Sclerosis Journal 3, no. 2 (April 1997): 137–41. http://dx.doi.org/10.1177/135245859700300214.
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Recently, the Austrian Immunoglobulin in Multiple Sclerosis (AIMS) study showed patients with relapsing - remitting multiple sclerosis to benefit from repeated administration of intravenous immunoglobulin (IVIg). To provide a more detailed understanding of IV/g's action we performed further analyses on the time course of treatment effects and in regard to the impact of clinical disability at study entry on patients' response to medication. The AIMS trial was a randomized, placebo-controlled, double blind, multicenter trial. It included 148 patients (IVIg : 75; placebo 73) who suffered from relapsing-remitting MS, were 15-65 years old and scored from I -6 on the Expanded Disability Status Score (EDSS). IVIg was given over 2 years in a monthly dosage of 0.15 - 0.2 g/kg body weight. Within the first 6 months of the trial clinical disability of IVIg treated patients improved significantly from a baseline EDSS of 3.33 ± 1.38 to a score of 3.05 ± 1.73 (P=0.002). This improvement was retained over the subsequent 18 months of the trial (final EDSS: 3.09 ± 1.62). In contrast, placebo-treated patients showed a slight trend for deterioration over the study period (baseline EDSS: 3.37± 1.67; final EDSS: 3.49± 1.83). IVIg treatment was associated with a significant reduction of relapses throughout the study which was independent of the patients' disability at baseline. The observation of clinical improvement in the early phase of IVIg medication may suggest the activation of repair mechanisms such as the promotion of remyelination while immunoregulatory effects would be expected as the cause of fewer exacerbations throughout the AIMS study. These hypotheses need to be tested in future trials.
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Melanson, M., P. Miao, D. Eisenstat, Y. Gong, X. Gu, K. Au, W. Zhu, F. Begum, EE Frost, and M. Namaka. "Experimental autoimmune encephalomyelitis-induced upregulation of tumor necrosis factor-alpha in the dorsal root ganglia." Multiple Sclerosis Journal 15, no. 10 (August 10, 2009): 1135–45. http://dx.doi.org/10.1177/1352458509106856.
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Background: Multiple sclerosis (MS) is a chronic, neurological disease characterized by targeted destruction of central nervous system (CNS) myelin. The autoimmune theory is the most widely accepted explanation of disease pathology. Circulating Th1 cells become activated by exposure to CNS-specific antigens such as myelin basic protein. The activated Th1 cells secrete inflammatory cytokines, which are pivotal for inflammatory responses. We hypothesize that enhanced production of inflammatory cytokines triggers cellular events within the dorsal root ganglia (DRG) and/or spinal cord, facilitating the development of neuropathic pain (NPP) in MS. NPP, the second worst disease-induced symptom suffered by patients with MS, is normally regulated by DRG and/or spinal cord. Objective: To determine gene and protein expression levels of tumor necrosis factor-alpha (TNFα) within DRG and/or spinal cord in an animal model of MS. Methods: Experimental autoimmune encephalomyelitis (EAE) was induced in adolescent female Lewis rats. Animals were sacrificed every 3 days post-disease induction. DRG and spinal cords were harvested for protein and gene expression analysis. Results: We show significant increases in TNFα expression in the DRG and of EAE animals at peak disease stage, as assessed by clinical symptoms. Conclusion: Antigen-induced production of inflammatory cytokines such as TNFα within the DRG identifies a potential novel mechanism for MS-induced NPP.
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Zakariya, Eimad, Mariko Yabe, Armistead Williams, Randy L. Levine, and Mark T. Friedman. "Therapeutic Plasma Exchange for Progressive Multifocal Leukoencephalopathy Related to Multiple Sclerosis Therapy with Natalizumab." Blood 120, no. 21 (November 16, 2012): 4386. http://dx.doi.org/10.1182/blood.v120.21.4386.4386.
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Abstract Abstract 4386 Background: Progressive multifocal leukoencephalopathy (PML) associated with natalizumab in multiple sclerosis (MS) treatment is a complication for which therapeutic plasma exchange (TPE) has been used. We describe such a case treated with TPE. Case Report: A 54 year old woman with a past medical history of relapsing-remitting MS presented with recent onset ataxia and bilateral upper and lower extremity weakness and right hand dysmetria. Two weeks prior to presentation, she completed 57 treatments with natalizumab, a monoclonal antibody against cellular adhesion molecule α4-integrin that blocks lymphocytes from crossing the blood-brain barrier. Brain MRI showed new non-enhancing lesions in the right cerebellum and anterior left temporal lobe. Natalizumab was discontinued and investigation revealed high serum and CSF titers of JC virus DNA indicative of PML. The patient underwent a total of 3 TPE's (1 every other day) with 3L of 5% albumin solution (1.4 plasma volume [PV]) used as replacement each TPE. After TPE, the patient initially showed improvement of neurological function and was transferred to inpatient acute rehabilitation. However, 4 days later she suffered a seizure and developed slurred speech. MRI showed that the cerebellar lesion had extended into the pons. The patient also developed dysphagia requiring nasogastric tube feeding and poorly-localized pain requiring pain management. She was treated with steroids for possible Immune Reconstitution Inflammatory Syndrome (IRIS) and discharged to hospice care for rehabilitation and pain management. The patient's condition continued to deteriorate and she died shortly after being arriving at hospice. Conclusion: Natalizumab selectively immune suppresses the CNS putting patients at risk for PML and TPE with or without immunadsorption, can rapidly reverse the immune suppression by clearing natalizumab. Although we did not measure natalizumab concentrations in our patient, 1 report showed that a series of 3 TPE's (1.5 PV) significantly decreased natalizumab levels while another showed that 3–5 TPE's (1–1.5 PV) was effective. The effect of reducing natalizumab is to exchange the problem of a typically fatal opportunistic infection for the problem of an aggressive potentially injurious immune response to that virus. IRIS itself requires intense management to prevent brain injury or death and while there is no set standard of care, steroids are typically used. According to the manufacturer's global monitoring system, the majority of natalizumab induced PML cases are treated with TPE which typically induces IRIS within days to weeks. The most recent mortality rate for all PML cases related to this drug is 22%, significantly lower than that seen with AIDS or in the oncology setting. Although our patient initially improved after TPE, the proximity of the PML to her brainstem, with or without IRIS, made her particularly vulnerable. Whether TPE may lead to more severe IRIS, as suggested by one report, requires further study. Nevertheless, given the severe consequences of PML itself, we would recommend TPE for natalizumab -induced PML. Disclosures: No relevant conflicts of interest to declare.
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Pearce, Caroline. "World Interrupted: An Autoethnographic Exploration into the Rupture of Self and Family Narratives Following the Onset of Chronic Illness and the Death of a Mother." Qualitative Sociology Review 4, no. 1 (April 30, 2008): 131–49. http://dx.doi.org/10.18778/1733-8077.4.1.07.
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Informed by the developments in autoethnography, narrative analysis and biographical sociology this paper seeks to affirm that understanding our narrative enables self-understanding and more importantly enables the understanding of others. Using an autoethnographic approach this paper explores the rupture in self and family identity following two traumatic events: the onset of a chronic illness (Multiple Sclerosis) and the death of a mother. It is the story of the life of my mother, who suffered with MS for 9 years and the story of my sister and myself, who cared for her throughout our childhood up to her death in 2000. The rupture in identity that we suffered interrupted the world in which we lived and exposed the contents of our individual and collective world(s). The themes that emerged from the narratives in this study suggest rupture is experienced as a movement of transgression that leads to movements of regression and progression.