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Gerhard L, Dorstyn DS, Murphy G, Roberts RM. Neurological, physical and sociodemographic correlates of employment in multiple sclerosis: A meta-analysis. J Health Psychol 2018; 25:92-104. [PMID: 29460636 DOI: 10.1177/1359105318755262] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Illness severity and sociodemographic characteristics of 7,053 employees with multiple sclerosis and 11,043 peers not in the workforce were compared (Hedges' g with 95% confidence interval and p values). Pooled findings from 25 studies confirmed the main role of a relapsing-remitting disease course and higher education to employment. To a lesser extent, disease duration, fatigue and pain symptoms and age also differentiated the two groups. Vocational interventions for persons with multiple sclerosis should focus on job retention, including mechanisms to accommodate and facilitate functional independence. Longitudinal data are needed to distinguish the characteristics of those who achieve and maintain competitive employment.
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Affiliation(s)
- Larissa Gerhard
- Faculty of Health and Medical Sciences, School of Psychology, The University of Adelaide, Australia
| | - Diana S Dorstyn
- Faculty of Health and Medical Sciences, School of Psychology, The University of Adelaide, Australia
| | - Gregory Murphy
- College of Science, Health and Engineering, School of Psychology and Public Health, La Trobe University Australia
| | - Rachel M Roberts
- Faculty of Health and Medical Sciences, School of Psychology, The University of Adelaide, Australia
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Manouchehrinia A, Westerlind H, Kingwell E, Zhu F, Carruthers R, Ramanujam R, Ban M, Glaser A, Sawcer S, Tremlett H, Hillert J. Age Related Multiple Sclerosis Severity Score: Disability ranked by age. Mult Scler 2017; 23:1938-1946. [PMID: 28155580 PMCID: PMC5700773 DOI: 10.1177/1352458517690618] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/22/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Multiple Sclerosis Severity Score (MSSS) is obtained by normalising the Expanded Disability Status Scale (EDSS) score for disease duration and has been a valuable tool in cross-sectional studies. OBJECTIVE To assess whether use of age rather than the inherently ambiguous disease duration was a feasible approach. METHOD We pooled disability data from three population-based cohorts and developed an Age Related Multiple Sclerosis Severity (ARMSS) score by ranking EDSS scores based on the patient's age at the time of assessment. We established the power to detect a difference between groups afforded by the ARMSS score and assessed its relative consistency over time. RESULTS The study population included 26058 patients from Sweden ( n = 11846), Canada ( n = 6179) and the United Kingdom ( n = 8033). There was a moderate correlation between EDSS and disease duration ( r = 0.46, 95% confidence interval (CI): 0.45-0.47) and between EDSS and age ( r = 0.44, 95% CI: 0.43-0.45). The ARMSS scores showed comparable power to detect disability differences between groups to the updated and original MSSS. CONCLUSION Since age is typically unbiased and readily obtained, and the ARMSS and MSSS were comparable, the ARMSS may provide a more versatile tool and could minimise study biases and loss of statistical power caused by inaccurate or missing onset dates.
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Affiliation(s)
- Ali Manouchehrinia
- Department of Clinical Neuroscience (CNS), Karolinska Institutet, Stockholm, Sweden
| | - Helga Westerlind
- Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
| | - Elaine Kingwell
- Division of Neurology, Faculty of Medicine, UBC Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Feng Zhu
- Division of Neurology, Faculty of Medicine, UBC Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Robert Carruthers
- Division of Neurology, Faculty of Medicine, UBC Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Ryan Ramanujam
- Department of Clinical Neuroscience (CNS), Karolinska Institutet, Stockholm, Sweden
| | - Maria Ban
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Anna Glaser
- Department of Clinical Neuroscience (CNS), Karolinska Institutet, Stockholm, Sweden
| | - Stephen Sawcer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Helen Tremlett
- Division of Neurology, Faculty of Medicine, UBC Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Jan Hillert
- Department of Clinical Neuroscience (CNS), Karolinska Institutet, Stockholm, Sweden
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Farokhian F, Yang C, Beheshti I, Matsuda H, Wu S. Age-Related Gray and White Matter Changes in Normal Adult Brains. Aging Dis 2017; 8:899-909. [PMID: 29344423 PMCID: PMC5758357 DOI: 10.14336/ad.2017.0502] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/02/2017] [Indexed: 12/04/2022] Open
Abstract
Normal aging is associated with both structural changes in many brain regions and functional declines in several cognitive domains with advancing age. Advanced neuroimaging techniques enable explorative analyses of structural alterations that can be used as assessments of such age-related changes. Here we used voxel-based morphometry (VBM) to investigate regional and global brain volume differences among four groups of healthy adults from the IXI Dataset: older females (OF, mean age 68.35 yrs; n=69), older males (OM, 68.43 yrs; n=66), young females (YF, 27.09 yrs; n=71), and young males (YM, 27.91 yrs; n=71), using 3D T1-weighted MRI data. At the global level, we investigated the influence of age and gender on brain volumes using a two-way analysis of variance. With respect to gender, we used the Pearson correlation to investigate global brain volume alterations due to age in the older and young groups. At the regional level, we used a flexible factorial statistical test to compare the means of gray matter (GM) and white matter (WM) volume alterations among the four groups. We observed different patterns in both the global and regional GM and WM alterations in the young and older groups with respect to gender. At the global level, we observed significant influences of age and gender on global brain volumes. At the regional level, the older subjects showed a widespread reduction in GM volume in regions of the frontal, insular, and cingulate cortices compared to the young subjects in both genders. Compared to the young subjects, the older subjects showed a widespread WM decline prominently in the thalamic radiations, in addition to increased WM in pericentral and occipital areas. Knowledge of these observed brain volume differences and changes may contribute to the elucidation of mechanisms underlying aging as well as age-related brain atrophy and disease.
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Affiliation(s)
- Farnaz Farokhian
- 1College of Life Science and Bioengineering, Beijing University of Technology, Beijing, 100022, China.,2Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo Japan
| | - Chunlan Yang
- 1College of Life Science and Bioengineering, Beijing University of Technology, Beijing, 100022, China
| | - Iman Beheshti
- 2Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo Japan
| | - Hiroshi Matsuda
- 2Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo Japan
| | - Shuicai Wu
- 1College of Life Science and Bioengineering, Beijing University of Technology, Beijing, 100022, China
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Guillemin F, Baumann C, Epstein J, Kerschen P, Garot T, Mathey G, Debouverie M. Older Age at Multiple Sclerosis Onset Is an Independent Factor of Poor Prognosis: A Population-Based Cohort Study. Neuroepidemiology 2017; 48:179-187. [DOI: 10.1159/000479516] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 07/15/2017] [Indexed: 11/19/2022] Open
Abstract
Background: Late-onset multiple sclerosis (LOMS) frequently features a primary progressive (PP) course, strongly predicting severe disability. In this population-based cohort, we estimated the prognostic role of age at multiple sclerosis (MS) onset, independent of PP course, on disability progression. Methods: The association of age at disease onset (adult, <50 years [AOMS], vs. late, ≥50 years [LOMS]) and time to Expanded Disability Status Scale (EDSS) score 4 and 6 was estimated by Cox regression modelling. Results: Among 3,597 patients, 245 had LOMS. Relapsing-remitting (RR) disease was less frequent with LOMS than AOMS (51.8 vs. 90.8%, p < 0.0001). PP course, LOMS and male gender predicted short time to EDSS 4 and 6. Worse outcome with LOMS (time to EDSS 4 and 6, HR 2.0 [95% CI 1.7-2.4] and 2.3 [1.9-2.9]) was independent of PP course or male gender. LOMS had greater impact on RR than PP disease (time to EDSS 4 and 6, HR 3.1 [2.3-4.0] and 4.0 [2.9-5.6]). Only LOMS predicted time from EDSS 4 to 6 (p < 0.0001). Conclusions: Late onset MS was strongly associated with poor prognosis, independent of initial disease course, in predicting the disability progression along time.
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Lotti CBDC, Oliveira ASB, Bichuetti DB, Castro ID, Oliveira EML. Late onset multiple sclerosis: concerns in aging patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:451-456. [DOI: 10.1590/0004-282x20170070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/20/2017] [Indexed: 11/22/2022]
Abstract
ABSTRACT Late onset multiple sclerosis (LOMS) is when the first symptom starts after 50 years of age, representing 4.5% of multiple sclerosis (MS) patients. This study describes the clinical characteristics of patients with LOMS followed at a specialized MS center in São Paulo. Data was obtained from medical records of 742 patients with MS. The LOMS frequency was 4.18%, median age at onset was 54 years and the predominant disease course was primary progressive (64.3%). The patients reached the disability landmarks of EDSS grades 3.0, 6.0 and 7.0 in the following proportion and time: EDSS 3.0: 77.42% of patients in 3.7 years; EDSS 6.0: 58.06% in 5.1 years and EDSS 7.0: 32.26% in 5.7 years. The comparative analysis with a matched control group of patients with early onset MS showed that late onset, associated with a progressive course, were predictors of reaching EDSS 3.0 and 6.0 in a shorter time.
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Magnetic resonance imaging perfusion is associated with disease severity and activity in multiple sclerosis. Neuroradiology 2017; 59:655-664. [PMID: 28585082 DOI: 10.1007/s00234-017-1849-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/10/2017] [Indexed: 01/24/2023]
Abstract
PURPOSE The utility of perfusion-weighted imaging in multiple sclerosis (MS) is not well investigated. The purpose of this study was to compare baseline normalized perfusion measures in subgroups of newly diagnosed MS patients. We wanted to test the hypothesis that this method can differentiate between groups defined according to disease severity and disease activity at 1 year follow-up. METHODS Baseline magnetic resonance imaging (MRI) including a dynamic susceptibility contrast perfusion sequence was performed on a 1.5-T scanner in 66 patients newly diagnosed with relapsing-remitting MS. From the baseline MRI, cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) maps were generated. Normalized (n) perfusion values were calculated by dividing each perfusion parameter obtained in white matter lesions by the same parameter obtained in normal-appearing white matter. Neurological examination was performed at baseline and at follow-up approximately 1 year later to establish the multiple sclerosis severity score (MSSS) and evidence of disease activity (EDA). RESULTS Baseline normalized mean transit time (nMTT) was lower in patients with MSSS >3.79 (p = 0.016), in patients with EDA (p = 0.041), and in patients with both MSSS >3.79 and EDA (p = 0.032) at 1-year follow-up. Baseline normalized cerebral blood flow and normalized cerebral blood volume did not differ between these groups. CONCLUSION Lower baseline nMTT was associated with higher disease severity and with presence of disease activity 1 year later in newly diagnosed MS patients. Further longitudinal studies are needed to confirm whether baseline-normalized perfusion measures can differentiate between disease severity and disease activity subgroups over time.
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Trojano M, Russo P, Fuiani A, Paolicelli D, Di Monte E, Granieri E, Rosati G, Savettieri G, Comi G, Livrea P. The Italian Multiple Sclerosis Database Network (MSDN): the risk of worsening according to IFNβ exposure in multiple sclerosis. Mult Scler 2016; 12:578-85. [PMID: 17086903 DOI: 10.1177/1352458506070620] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We evaluated the risk of worsening according to the length of exposure to interferon beta (IFNβ)ina large cohort of 2090 multiple sclerosis patients collected by the Italian MS Database Network. Overall 44-140 patient-visits with a follow-up of 22-143 patient-years were evaluated. Forty-one per cent of patients were exposed to IFNβ for up to 2 years, 39% for 2- 4 years and 20% for more than 4 years. A Cox regression model was used to analyse two clinical outcomes: disability progression and worsening of relapse rate. The technique of propensity score was applied to reduce bias in the comparison of non-randomized groups. The risks of disability progression (HR=0.23; 95% CI: 0.17 - 0.30) and worsening of relapse rate (HR=0.19; 95% CI: 0.14 - 0.27) were reduced by about 4- 5- fold in patients exposed to IFNβ for more than four years, compared with patients exposed for up to two years. The propensity score technique confirmed the findings. The proportion of days covered by IFNβ treatment was lower ( P<0.0001) in patients exposed to IFNβ for up to two years than in other groups. A clinical stabilization over two years of IFNβ exposure may predict a subsequent good clinical response to treatment.
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Affiliation(s)
- Maria Trojano
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy.
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Klaren RE, Sebastiao E, Chiu CY, Kinnett-Hopkins D, McAuley E, Motl RW. Levels and Rates of Physical Activity in Older Adults with Multiple Sclerosis. Aging Dis 2016; 7:278-84. [PMID: 27330842 PMCID: PMC4898924 DOI: 10.14336/ad.2015.1025] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/25/2015] [Indexed: 11/01/2022] Open
Abstract
There is much evidence supporting the safety and benefits of physical activity in adults with multiple sclerosis (MS) and recent evidence of beneficial effects on physical function in older adults with MS. However, there is very little known about physical activity participation in older adults with conditions such as MS. This study compared levels of physical activity (i.e., sedentary behavior, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA)) and rates of meeting public health guidelines for MVPA (i.e., ≥30 min/day) among young (i.e., ages 20-39 years), middle-aged (i.e., ages 40-59 years) and older adults (i.e., ages ≥60 years) with MS. The sample included 963 persons with MS who provided demographic and clinical information and wore an accelerometer for a 7-day period. The primary analysis involved a between-subjects ANOVA on accelerometer variables (i.e., accelerometer wear time; number of valid days; sedentary behavior in min/day; LPA in min/day; and MVPA in min/day). Collectively, our data indicated that older adults with MS engaged in less MVPA and more sedentary behavior than middle-aged and young adults with MS. Such results highlight the importance of developing physical activity interventions as an effective means for managing the progression and consequences of MS in older adults.
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Affiliation(s)
- Rachel E Klaren
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, USA
| | - Emerson Sebastiao
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, USA
| | - Chung-Yi Chiu
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, USA
| | | | - Edward McAuley
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, USA
| | - Robert W Motl
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, USA
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Selected health behaviors moderate the progression of functional limitations in persons with multiple sclerosis: Eleven years of annual follow-up. Disabil Health J 2016; 9:472-8. [PMID: 26905974 DOI: 10.1016/j.dhjo.2016.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 01/07/2016] [Accepted: 01/13/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Multiple sclerosis (MS), a chronic neurological disease typically diagnosed in young adulthood, presents with a wide variety of symptoms, impairments and functional limitations. Given the chronic, unpredictable and long-term nature of this disease, preserving function is essential. OBJECTIVE The purpose of this study was to identify psychosocial and behavioral factors that might influence the trajectory of functional limitation through eleven years of longitudinal follow-up of a sample of persons with MS. METHODS Participants (N = 606) completed measures of health behaviors, related constructs and functional limitations annually over eleven years. Longitudinal measures of functional limitations were analyzed using random-effects regression that allows for study of individual differences in the trajectories of a measure. Using the best fitting quadratic growth model, we tested the within and between-person effects of Nutrition, Interpersonal Relationships, Exercise, Stress Management, Health Responsibilities, Spiritual Growth, Self-rated Health and Barriers, controlling for Age, Year since Diagnosis and Year of Dropout, on Functional Limitations in the 11th year. RESULTS After adjusting for covariates, higher mean scores for Exercise and Self-rated Health were related to lower levels of Functional Limitations in Year 11. Higher mean scores for Stress Management, Health Responsibilities and Barriers were related to higher levels of Functional Limitations in Year 11. Higher mean Exercise scores and lower mean Health Responsibilities scores were related to slower rates of progression of functional limitations in Year 11. CONCLUSION Findings suggest that the highly variable trajectory of functional limitations in MS may be extended and shaped through health behavior strategies.
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Alla S, Pearson JF, Taylor BV, Miller DH, Clarke G, Richardson A, Willoughby E, Abernethy DA, Sabel CE, Mason DF. Disability profile of multiple sclerosis in New Zealand. J Clin Neurosci 2016; 28:97-101. [PMID: 26765754 DOI: 10.1016/j.jocn.2015.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/29/2015] [Accepted: 09/06/2015] [Indexed: 10/22/2022]
Abstract
New Zealand is a high risk region for multiple sclerosis (MS). The aim of this study was to investigate demographic, clinical and temporal factors associated with disability status in the New Zealand National Multiple Sclerosis Prevalence Study (NZNMSPS) cohort. Data were obtained from the 2006 NZNMSPS with MS diagnosis based on the 2005 McDonald criteria. Disability was assessed using the Expanded Disability Status Scale (EDSS). Disability profiles were generated using multiple linear regression analysis. A total of 2917 persons with MS was identified, of whom disability data were available for 2422 (75% females). The overall disability was EDSS 4.4±standard deviation 2.6. Higher disability was associated with older age, longer disease duration, older and younger ages of onset, spinal cord syndromes with motor involvement at onset, and a progressive onset type. Lower disability was associated with sensory symptoms at onset and a relapsing onset type. Overall, the factors studied explained about one-third of the variation in disability, and of this, about two-thirds was accounted for by age, age of onset and disease duration and one-third by the nature of first symptoms and type of disease onset (progressive or relapsing). Current age, age at onset and disease duration all had independent associations with disability and their effects also interacted in contributing to higher disability levels over the course of the disease.
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Affiliation(s)
- Sridhar Alla
- New Zealand Brain Research Institute, 66 Stewart Street, Christchurch 8011, New Zealand; University of Otago, Christchurch, New Zealand.
| | | | - Bruce V Taylor
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | - David H Miller
- New Zealand Brain Research Institute, 66 Stewart Street, Christchurch 8011, New Zealand; University of Otago, Christchurch, New Zealand; Queen Square MS Centre, UCL Institute of Neurology, London, UK
| | | | - Ann Richardson
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | | | | | - Clive E Sabel
- School of Geographical Sciences, University of Bristol, Bristol, UK
| | - Deborah F Mason
- New Zealand Brain Research Institute, 66 Stewart Street, Christchurch 8011, New Zealand; University of Otago, Christchurch, New Zealand; Christchurch Public Hospital, Christchurch, New Zealand
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Motl RW, Learmonth YC, Wójcicki TR, Fanning J, Hubbard EA, Kinnett-Hopkins D, Roberts SA, McAuley E. Preliminary validation of the short physical performance battery in older adults with multiple sclerosis: secondary data analysis. BMC Geriatr 2015; 15:157. [PMID: 26630923 PMCID: PMC4668658 DOI: 10.1186/s12877-015-0156-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/23/2015] [Indexed: 01/02/2024] Open
Abstract
Background There are relatively few standard, objective measures for studying physical function among older adults with multiple sclerosis (MS), yet such measures are necessary considering the shift in prevalence and associated consequences of both MS and older age on physical function. We undertook a preliminary examination of the construct validity of Short Physical Performance Battery (SPPB) scores in older adults with MS based on an expected differential pattern of associations with measures of lower and upper extremity function. Methods The sample included 48 persons with MS aged 50 years and older who were enrolled in a pilot, randomized controlled trial of exercise training. Participants completed the SPPB and other objective and self-report measures of lower and upper extremity function as part of baseline testing. Results SPPB scores demonstrated strong associations with measures of lower extremity function (|rs| = .66–.79), and weak associations with measures of upper extremity function (|rs| = .03–.33). Conclusions We provide preliminary evidence that supports the validity of scores from the SPPB as a measure of lower extremity function for inclusion in clinical research and practice involving older adults with MS.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 233 Freer Hall, Urbana, IL, 61801, USA.
| | - Yvonne C Learmonth
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 233 Freer Hall, Urbana, IL, 61801, USA.
| | - Thomas R Wójcicki
- Exercise Science Department, Bellarmine University, Louisville, Kentucky, USA.
| | - Jason Fanning
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 233 Freer Hall, Urbana, IL, 61801, USA.
| | - Elizabeth A Hubbard
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 233 Freer Hall, Urbana, IL, 61801, USA.
| | - Dominique Kinnett-Hopkins
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 233 Freer Hall, Urbana, IL, 61801, USA.
| | - Sarah A Roberts
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 233 Freer Hall, Urbana, IL, 61801, USA.
| | - Edward McAuley
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, 233 Freer Hall, Urbana, IL, 61801, USA.
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Akhtar S, Alroughani R, Ahmed SF, Al-Hashel JY. Prognostic indicators of secondary progression in a paediatric-onset multiple sclerosis cohort in Kuwait. Mult Scler 2015; 22:1086-93. [PMID: 26453683 DOI: 10.1177/1352458515608960] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 09/07/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The frequency of paediatric-onset multiple sclerosis (POMS) and the precise risk of secondary progression of disease are largely unknown in the Middle East. This cross-sectional cohort study assessed the risk and examined prognostic factors for time to onset of secondary progressive multiple sclerosis (SPMS) in a cohort of POMS patients. METHODS The Kuwait National MS Registry database was used to identify a cohort of POMS cases (diagnosed at age <18 years) from 1994 to 2013. Data were abstracted from patients' records. A Cox proportional hazards model was used to evaluate the prognostic significance of the variables considered. RESULTS Of 808 multiple sclerosis (MS) patients, 127 (15.7%) were POMS cases. The median age (years) at disease onset was 16.0 (range 6.5-17.9). Of 127 POMS cases, 20 (15.8%) developed SPMS. A multivariable Cox proportional hazards model showed that at MS onset, brainstem involvement (adjusted hazard ratio 5.71; 95% confidence interval 1.53-21.30; P=0.010), and POMS patient age at MS onset (adjusted hazard ratio 1.38; 95% confidence interval 1.01-1.88; P=0.042) were significantly associated with the increased risk of a secondary progressive disease course. CONCLUSIONS This study showed that POMS patients with brainstem/cerebellar presentation and a relatively higher age at MS onset had disposition for SPMS and warrant an aggressive therapeutic approach.
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Affiliation(s)
- Saeed Akhtar
- Department of Community Medicine and Behavioural Sciences, University of Kuwait, Kuwait
| | - Raed Alroughani
- Division of Neurology, Amiri Hospital, Kuwait/ Neurology Clinic, Dasman Diabetes Institute, Kuwait
| | - Samar F Ahmed
- Department of Neurology, Ibn Sina Hospital, Kuwait/ Department of Neurology and Psychiatry, Minia University, Egypt
| | - Jasem Y Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Kuwait/ Department of Medicine, University of Kuwait, Kuwait
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Veloso M. A web-based decision support tool for prognosis simulation in multiple sclerosis. Mult Scler Relat Disord 2015; 3:575-83. [PMID: 26265269 DOI: 10.1016/j.msard.2014.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/14/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Abstract
A multiplicity of natural history studies of multiple sclerosis provides valuable knowledge of the disease progression but individualized prognosis remains elusive. A few decision support tools that assist the clinician in such task have emerged but have not received proper attention from clinicians and patients. The objective of the current work is to implement a web-based tool, conveying decision relevant prognostic scientific evidence, which will help clinicians discuss prognosis with individual patients. Data were extracted from a set of reference studies, especially those dealing with the natural history of multiple sclerosis. The web-based decision support tool for individualized prognosis simulation was implemented with NetLogo, a program environment suited for the development of complex adaptive systems. Its prototype has been launched online; it enables clinicians to predict both the likelihood of CIS to CDMS conversion, and the long-term prognosis of disability level and SPMS conversion, as well as assess and monitor the effects of treatment. More robust decision support tools, which convey scientific evidence and satisfy the needs of clinical practice by helping clinicians discuss prognosis expectations with individual patients, are required. The web-based simulation model herein introduced proposes to be a step forward toward this purpose.
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Affiliation(s)
- Mário Veloso
- ARN - Anestesia, Reanimação e Neurologia - Lda, Campo Grande 14 - 6ºA, 1700-092 Lisboa, Portugal.
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Jara M, Sidovar MF, Henney HR. Prescriber utilization of dalfampridine extended release tablets in multiple sclerosis: a retrospective pharmacy and medical claims analysis. Ther Clin Risk Manag 2015; 11:1-7. [PMID: 25565851 PMCID: PMC4274131 DOI: 10.2147/tcrm.s75837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose This study aimed to characterize the prescribing of dalfampridine extended release (D-ER) 10 mg tablet treatment in people with multiple sclerosis (MS). Methods A retrospective cohort study was performed using Medco pharmacy and medical claims. Medical claims were used to identify MS patients with more than one prescription for D-ER with 1 year of prior continuous enrollment (n=704). These patients were matched 2:1 on age, sex, and health insurance source with a comparison group of MS patients who were treatment naïve for D-ER (n=1,403). Categorical data were analyzed by χ2 test; ordinal data by Wilcoxon rank sum test; and continuous data by Student’s t-test. Results Most patients were women aged 45–64 years. In the year preceding D-ER initiation, the prevalence of seizure and renal impairment was numerically lower in the D-ER cohort relative to those who were D-ER naïve (seizure: 3.1% versus 4.7%, respectively; renal impairment: 4.3% versus 5.1%, respectively); however, prescriptions for antiepileptic drugs in the two cohorts were comparable. In the year preceding treatment initiation, 62% of the D-ER cohort was prescribed MS-specific disease-modifying therapies relative to 45% who were D-ER naïve. Conclusion Seizure and renal impairment rates among D-ER-naïve patients were consistent with published literature, yet rates among those prescribed D-ER during the year preceding treatment initiation were slightly lower than rates among D-ER-naïve patients. Given that D-ER is contraindicated in patients with history of seizure or moderate or severe renal impairment, lower rates may indicate that risk-minimization strategies contributed to the lower prevalence.
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Affiliation(s)
- Michele Jara
- Drug Safety and Risk Management, Acorda Therapeutics, Inc, Ardsley, NY, USA
| | - Matthew F Sidovar
- Clinical Development and Medical Affairs, Acorda Therapeutics, Inc, Ardsley, NY, USA
| | - Herbert R Henney
- Clinical Development and Medical Affairs, Acorda Therapeutics, Inc, Ardsley, NY, USA
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McCabe MP, Ebacioni KJ, Simmons R, McDonald E, Melton L. Unmet education, psychological and peer support needs of people with multiple sclerosis. J Psychosom Res 2015; 78:82-7. [PMID: 25516288 DOI: 10.1016/j.jpsychores.2014.05.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/28/2014] [Accepted: 05/28/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Multiple sclerosis is a complex neurological disease which can cause impairment in a range of aspects of an individual's life. It often requires a degree of adjustment and peer support. The aim of the present study was to examine satisfaction with educational, psychological and peer support services of people with MS across gender, age and symptom severity. METHOD Participants completed a needs analysis questionnaire using Likert scales to determine the level of satisfaction with the support services. The questionnaire was sent to participants (n=3502) throughout Australia as paper copy with reply paid envelope, or made available to them online via email links. A total of 2805 responded and completed the questionnaire (80% response rate). Of those, 79% were female and 21% were male. The participants ranged in age from 19 to 92 years, (M=52.10; SD=11.82). RESULTS In terms of psychological services, females were less satisfied with their access to relationship and family counseling. There was also a clear need for more varieties in peer support groups, times, as well as modes of communication, especially among young people and mildly affected groups. Symptom severity was associated with a greater need for almost all education and psychological support services. CONCLUSION The findings of this study highlight current areas of unmet needs and may be used to inform the design and development of future education, psychological and social support services to ensure they are relevant and useful, as well as providing direction for future research.
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Affiliation(s)
- Marita P McCabe
- School of Psychology, Deakin University, Melbourne Australia.
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Hasan KM, Lincoln JA, Nelson FM, Wolinsky JS, Narayana PA. Lateral ventricular cerebrospinal fluid diffusivity as a potential neuroimaging marker of brain temperature in multiple sclerosis: a hypothesis and implications. Magn Reson Imaging 2014; 33:262-9. [PMID: 25485790 DOI: 10.1016/j.mri.2014.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/24/2014] [Accepted: 11/24/2014] [Indexed: 01/03/2023]
Abstract
In this retrospective study we tested the hypothesis that the net effect of impaired electrical conduction and therefore increased heat dissipation in multiple sclerosis (MS) results in elevated lateral ventricular (LV) cerebrospinal fluid (CSF) diffusivity as a measure of brain temperature estimated in vivo using diffusion tensor imaging (DTI). We used validated DTI-based segmentation methods to obtain normalized LV-CSF volume and its corresponding CSF diffusivity in 108 MS patients and 103 healthy controls in the age range of 21-63 years. The LV CSF diffusivity was ~2% higher in MS compared to controls that correspond to a temperature rise of ~1°C that could not be explained by changes in the CSF viscosity due to altered CSF protein content in MS. The LV diffusivity decreased with age in healthy controls (r=-0.29; p=0.003), but not in MS (r=0.15; p=0.11), possibly related to MS pathology. Age-adjusted LV diffusivity increased with lesion load (r=0.518; p=1×10(-8)). Our data suggest that the total brain lesion load is the primary contributor to the increase in LV CSF diffusivity in MS. These findings suggest that LV diffusivity is a potential in vivo biomarker of the mismatch between heat generation and dissipation in MS. We also discuss limitations and possible confounders.
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Affiliation(s)
- Khader M Hasan
- The University of Texas Health Science Center at Houston, Department of Diagnostic & Interventional Imaging, 6431 Fannin Street, Houston, Texas 77030.
| | - John A Lincoln
- The University of Texas Health Science Center at Houston, Department of Neurology, 6431 Fannin Street, Houston, Texas 77030
| | - Flavia M Nelson
- The University of Texas Health Science Center at Houston, Department of Neurology, 6431 Fannin Street, Houston, Texas 77030
| | - Jerry S Wolinsky
- The University of Texas Health Science Center at Houston, Department of Neurology, 6431 Fannin Street, Houston, Texas 77030
| | - Ponnada A Narayana
- The University of Texas Health Science Center at Houston, Department of Diagnostic & Interventional Imaging, 6431 Fannin Street, Houston, Texas 77030
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Paz Soldán MM, Novotna M, Abou Zeid N, Kale N, Tutuncu M, Crusan DJ, Atkinson EJ, Siva A, Keegan BM, Pirko I, Pittock SJ, Lucchinetti CF, Weinshenker BG, Rodriguez M, Kantarci OH. Relapses and disability accumulation in progressive multiple sclerosis. Neurology 2014; 84:81-8. [PMID: 25398229 DOI: 10.1212/wnl.0000000000001094] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We examined the effect of relapses-before and after progression onset-on the rate of postprogression disability accrual in a progressive multiple sclerosis (MS) cohort. METHODS We studied patients with primary progressive MS (n = 322) and bout-onset progressive MS (BOPMS) including single-attack progressive MS (n = 112) and secondary progressive MS (n = 421). The effect of relapses on time to Expanded Disability Status Scale (EDSS) score of 6 was studied using multivariate Cox regression analysis (sex, age at progression, and immunomodulation modeled as covariates). Kaplan-Meier analysis was performed using EDSS 6 as endpoint. RESULTS Preprogression relapses (hazard ratio [HR]: 1.63; 95% confidence interval [CI]: 1.34-1.98), postprogression relapses (HR: 1.37; 95% CI: 1.11-1.70), female sex (HR: 1.19; 95% CI: 1.00-1.43), and progression onset after age 50 years (HR: 1.47; 95% CI: 1.21-1.78) were associated with shorter time to EDSS 6. Postprogression relapses occurred in 29.5% of secondary progressive MS, 10.7% of single-attack progressive MS, and 3.1% of primary progressive MS. Most occurred within 5 years (91.6%) after progressive disease onset and/or before age 55 (95.2%). Immunomodulation after onset of progressive disease course (HR: 0.64; 95% CI: 0.52-0.78) seemingly lengthened time to EDSS 6 (for BOPMS with ongoing relapses) when analyzed as a dichotomous variable, but not as a time-dependent variable. CONCLUSIONS Pre- and postprogression relapses accelerate time to severe disability in progressive MS. Continuing immunomodulation for 5 years after the onset of progressive disease or until 55 years of age may be reasonable to consider in patients with BOPMS who have ongoing relapses.
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Affiliation(s)
- M Mateo Paz Soldán
- From the Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology (M.M.P.S., M.N., B.M.K., I.P., S.J.P., C.F.L., B.G.W., M.R., O.H.K.), and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Czech Republic; Department of Neurology (N.A.Z.), American University of Beirut Medical Center, Lebanon; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. N.A.Z., N.K., and M.T. were previous fellows of the Department of Neurology, Mayo Clinic College of Medicine
| | - Martina Novotna
- From the Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology (M.M.P.S., M.N., B.M.K., I.P., S.J.P., C.F.L., B.G.W., M.R., O.H.K.), and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Czech Republic; Department of Neurology (N.A.Z.), American University of Beirut Medical Center, Lebanon; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. N.A.Z., N.K., and M.T. were previous fellows of the Department of Neurology, Mayo Clinic College of Medicine
| | - Nuhad Abou Zeid
- From the Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology (M.M.P.S., M.N., B.M.K., I.P., S.J.P., C.F.L., B.G.W., M.R., O.H.K.), and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Czech Republic; Department of Neurology (N.A.Z.), American University of Beirut Medical Center, Lebanon; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. N.A.Z., N.K., and M.T. were previous fellows of the Department of Neurology, Mayo Clinic College of Medicine
| | - Nilufer Kale
- From the Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology (M.M.P.S., M.N., B.M.K., I.P., S.J.P., C.F.L., B.G.W., M.R., O.H.K.), and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Czech Republic; Department of Neurology (N.A.Z.), American University of Beirut Medical Center, Lebanon; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. N.A.Z., N.K., and M.T. were previous fellows of the Department of Neurology, Mayo Clinic College of Medicine
| | - Melih Tutuncu
- From the Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology (M.M.P.S., M.N., B.M.K., I.P., S.J.P., C.F.L., B.G.W., M.R., O.H.K.), and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Czech Republic; Department of Neurology (N.A.Z.), American University of Beirut Medical Center, Lebanon; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. N.A.Z., N.K., and M.T. were previous fellows of the Department of Neurology, Mayo Clinic College of Medicine
| | - Daniel J Crusan
- From the Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology (M.M.P.S., M.N., B.M.K., I.P., S.J.P., C.F.L., B.G.W., M.R., O.H.K.), and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Czech Republic; Department of Neurology (N.A.Z.), American University of Beirut Medical Center, Lebanon; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. N.A.Z., N.K., and M.T. were previous fellows of the Department of Neurology, Mayo Clinic College of Medicine
| | - Elizabeth J Atkinson
- From the Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology (M.M.P.S., M.N., B.M.K., I.P., S.J.P., C.F.L., B.G.W., M.R., O.H.K.), and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Czech Republic; Department of Neurology (N.A.Z.), American University of Beirut Medical Center, Lebanon; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. N.A.Z., N.K., and M.T. were previous fellows of the Department of Neurology, Mayo Clinic College of Medicine
| | - Aksel Siva
- From the Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology (M.M.P.S., M.N., B.M.K., I.P., S.J.P., C.F.L., B.G.W., M.R., O.H.K.), and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Czech Republic; Department of Neurology (N.A.Z.), American University of Beirut Medical Center, Lebanon; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. N.A.Z., N.K., and M.T. were previous fellows of the Department of Neurology, Mayo Clinic College of Medicine
| | - B Mark Keegan
- From the Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology (M.M.P.S., M.N., B.M.K., I.P., S.J.P., C.F.L., B.G.W., M.R., O.H.K.), and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Czech Republic; Department of Neurology (N.A.Z.), American University of Beirut Medical Center, Lebanon; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. N.A.Z., N.K., and M.T. were previous fellows of the Department of Neurology, Mayo Clinic College of Medicine
| | - Istvan Pirko
- From the Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology (M.M.P.S., M.N., B.M.K., I.P., S.J.P., C.F.L., B.G.W., M.R., O.H.K.), and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Czech Republic; Department of Neurology (N.A.Z.), American University of Beirut Medical Center, Lebanon; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. N.A.Z., N.K., and M.T. were previous fellows of the Department of Neurology, Mayo Clinic College of Medicine
| | - Sean J Pittock
- From the Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology (M.M.P.S., M.N., B.M.K., I.P., S.J.P., C.F.L., B.G.W., M.R., O.H.K.), and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Czech Republic; Department of Neurology (N.A.Z.), American University of Beirut Medical Center, Lebanon; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. N.A.Z., N.K., and M.T. were previous fellows of the Department of Neurology, Mayo Clinic College of Medicine
| | - Claudia F Lucchinetti
- From the Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology (M.M.P.S., M.N., B.M.K., I.P., S.J.P., C.F.L., B.G.W., M.R., O.H.K.), and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Czech Republic; Department of Neurology (N.A.Z.), American University of Beirut Medical Center, Lebanon; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. N.A.Z., N.K., and M.T. were previous fellows of the Department of Neurology, Mayo Clinic College of Medicine
| | - Brian G Weinshenker
- From the Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology (M.M.P.S., M.N., B.M.K., I.P., S.J.P., C.F.L., B.G.W., M.R., O.H.K.), and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Czech Republic; Department of Neurology (N.A.Z.), American University of Beirut Medical Center, Lebanon; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. N.A.Z., N.K., and M.T. were previous fellows of the Department of Neurology, Mayo Clinic College of Medicine
| | - Moses Rodriguez
- From the Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology (M.M.P.S., M.N., B.M.K., I.P., S.J.P., C.F.L., B.G.W., M.R., O.H.K.), and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Czech Republic; Department of Neurology (N.A.Z.), American University of Beirut Medical Center, Lebanon; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. N.A.Z., N.K., and M.T. were previous fellows of the Department of Neurology, Mayo Clinic College of Medicine
| | - Orhun H Kantarci
- From the Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology (M.M.P.S., M.N., B.M.K., I.P., S.J.P., C.F.L., B.G.W., M.R., O.H.K.), and Division of Biomedical Statistics & Informatics (D.J.C., E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; International Clinical Research Center (M.N.), St. Anne's University Hospital Brno, Czech Republic; Department of Neurology (N.A.Z.), American University of Beirut Medical Center, Lebanon; Department of Neurology (N.K.), Bakirkoy State Hospital, Istanbul; and Department of Neurology (M.T., A.S.), Cerrahpasa School of Medicine, Istanbul University, Turkey. N.A.Z., N.K., and M.T. were previous fellows of the Department of Neurology, Mayo Clinic College of Medicine.
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Vitkova M, Gdovinova Z, Rosenberger J, Szilasiova J, Nagyová I, Mikula P, Krokavcova M, Groothoff JW, van Dijk JP. Factors associated with poor sleep quality in patients with multiple sclerosis differ by disease duration. Disabil Health J 2014; 7:466-71. [DOI: 10.1016/j.dhjo.2014.05.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/16/2014] [Accepted: 05/17/2014] [Indexed: 10/25/2022]
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Cocco E, Sardu C, Spinicci G, Musu L, Massa R, Frau J, Lorefice L, Fenu G, Coghe G, Massole S, Maioli MA, Piras R, Melis M, Porcu G, Mamusa E, Carboni N, Contu P, Marrosu MG. Influence of treatments in multiple sclerosis disability: A cohort study. Mult Scler 2014; 21:433-41. [DOI: 10.1177/1352458514546788] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and objective: A critical aspect of multiple sclerosis (MS) treatments is understanding the effect of disease-modifying drugs (DMDs) on the long-term risk of disability and whether the effect is related to disability at start of treatment. Methods: We performed an observational study on 3060 MS patients. The effect of therapy on progression to Expanded Disability Status Scale (EDSS) 3.0 and 6.0 from onset was analysed in treated vs untreated (UTP) patients using Cox regression analysis adjusted for propensity score and immortal time bias. Results: Compared to UTP, the risks of EDSS 3.0 were 94% and 73% lower in immunomodulant (IMTP-) and immunosuppressant (ISTP-) treated patients, respectively, while the risk of EDSS 6.0 was 86% lower in IMTP. The risk of EDSS 6.0 was, respectively, 91% and 75% lower in 1275 IMTP before and 114 after EDSS 3.0 than in 539 UTP; the risk was higher in IMTP starting therapy after EDSS 3.0 than before (HR = 4.42). Conclusions: DMDs delayed long-term disability in MS patients treated either in the early or, to a lesser extent, in the later phase of the disease. Thus, the window of therapeutic opportunity is relatively extended, assuming that early is better than late treatment, but late is better than never.
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Affiliation(s)
- Eleonora Cocco
- Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
| | | | | | | | | | - Jessica Frau
- Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
| | - Lorena Lorefice
- Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
| | - Giuseppe Fenu
- Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
| | - Giancarlo Coghe
- Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
| | | | | | - Rachele Piras
- Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
| | - Marta Melis
- Multiple Sclerosis Center, ASL 8, Cagliari/ University of Cagliari, Italy
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Abstract
Knowledge of the epidemiology and natural history of multiple sclerosis (MS) is essential for practitioners and patients to make informed decisions about their care. This knowledge, in turn, depends upon the findings from reliable studies (i.e., those which adhere to the highest methodological standards). For a clinically variable disease such as MS, these standards include case ascertainment using a population-based design; a large-sized sample of patients, who are followed for a long time-period in order to provide adequate statistical power; a regular assessment of patients that is prospective, frequent, and standardized; and the application of rigorous statistical techniques, taking into account confounding factors such as the use of disease modifying therapy or the age at clinical onset. In this chapter we review the available epidemiologic and natural history data as it relates clinical issues such as the likelihood of incomplete recovery from a first attack; the likelihood and time course of a second attack; the likelihood and time course of disease progression and the accumulation of irreversible disability; the disease prognosis based both upon the clinical nature and presentation of the first episode and upon the initial disease course; and the impact of disease on mortality. In addition, these studies provide insight to the pathophysiologic mechanisms underlying the course and prognosis of MS. Studies of the Lyon cohort have been particularly helpful in this regard and observations from this cohort have led to the hypothesis that, in large part, the accumulation of disability in MS is an age-related process, which is independent of the clinical subtype of MS (i.e., relapsing-remitting, primary progressive, secondary progressive, or relapsing progressive). And finally, we consider briefly the impact of various life events (e.g., pregnancy, infection, vaccination, trauma, and stress) on the clinical course of disease.
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Affiliation(s)
- Christian Confavreux
- Service de Neurologie A, EDMUS Coordinating Center, INSERM U 842, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Sandra Vukusic
- Service de Neurologie A, EDMUS Coordinating Center, INSERM U 842, Hôpital Neurologique Pierre Wertheimer, Lyon, France.
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Malik MT, Healy BC, Benson LA, Kivisakk P, Musallam A, Weiner HL, Chitnis T. Factors associated with recovery from acute optic neuritis in patients with multiple sclerosis. Neurology 2014; 82:2173-9. [PMID: 24850491 DOI: 10.1212/wnl.0000000000000524] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify clinical and demographic features associated with the severity and recovery from acute optic neuritis (AON) episodes in patients with multiple sclerosis (MS). METHODS Adult (n = 253) and pediatric (n = 38) patients whose first symptom was AON were identified from our MS database. Severity measured by loss of visual acuity (mild attack ≤20/40, moderate attack 20/50-20/190, and severe attack ≥20/200) and recovery in visual acuity at 1 year after the attack (complete recovery ≤20/20, fair recovery 20/40, and poor recovery ≥20/50) were recorded. Demographic and clinical features associated with attack severity and recovery were identified using proportional odds logistic regression. For another group of patients, blood samples were available within 6 months of an AON attack. In this group, the impact of vitamin D level on the severity/recovery was also assessed. RESULTS Men (adjusted odds ratio [OR] = 2.28, p = 0.03) and subjects with severe attacks (adjusted OR = 5.24, p < 0.001) had worse recovery. AON severity was similar between the pediatric and adult subjects, but recovery was significantly better in pediatric subjects in the unadjusted analysis (p = 0.041) and the analysis adjusted for sex (p = 0.029). Season-adjusted vitamin D level was significantly associated with attack severity (OR for 10-U increase in vitamin D level = 0.47; 95% confidence interval: 0.32, 0.68; p < 0.001). Vitamin D level was not associated with recovery from the attack (p = 0.98) in univariate analysis or after accounting for attack severity (p = 0.10). CONCLUSION Vitamin D levels affect AON severity, whereas younger age, attack severity, and male sex affect AON recovery. Underlying mechanisms and potential therapeutic targets may identify new measures to mitigate disability accrual in MS.
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Affiliation(s)
- Muhammad Taimur Malik
- From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston
| | - Brian C Healy
- From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston
| | - Leslie A Benson
- From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston
| | - Pia Kivisakk
- From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston
| | - Alexander Musallam
- From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston
| | - Howard L Weiner
- From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston
| | - Tanuja Chitnis
- From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston.
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Rudko DA, Solovey I, Gati JS, Kremenchutzky M, Menon RS. Multiple sclerosis: improved identification of disease-relevant changes in gray and white matter by using susceptibility-based MR imaging. Radiology 2014; 272:851-64. [PMID: 24828000 DOI: 10.1148/radiol.14132475] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the potential of quantitative susceptibility (QS) and R2* mapping as surrogate biomarkers of clinically relevant, age-adjusted demyelination and iron deposition in multiple sclerosis (MS). MATERIALS AND METHODS All study participants gave written informed consent, and the study was approved by the institutional review board. Quantitative maps of the magnetic resonance imaging susceptibility parameters (R2* and QS) were computed for 25 patients with either clinically isolated syndrome (CIS) or relapsing-remitting MS, as well as for 15 age- and sex-matched control subjects imaged at 7 T. The candidate MR imaging biomarkers were correlated with Extended Disability Status Scale (EDSS), time since CIS diagnosis, time since MS diagnosis, and age. RESULTS QS maps aided identification of significant, voxel-level increases in iron deposition in subcortical gray matter (GM) of patients with MS compared with control subjects. These voxel-level increases were not observed on R2* maps. Region-of-interest analysis of mean R2* and QS in subcortical GM demonstrated that R2* (R ≥ 0.39, P < .01) and QS (R ≥ 0.44, P < .01) were strongly correlated with EDSS. In white matter (WM), the volume of total WM damage (defined by a z score of less than -2.0 criterion, indicating demyelination) on QS maps correlated significantly with EDSS (R = 0.46, P = .02). Voxelwise QS also supported a significant contribution of age to demyelination in patients with MS, suggesting that age-adjusted clinical scores may provide more robust measures of MS disease severity compared with non-age-adjusted scores. CONCLUSION Using QS and R2* mapping, evidence of both significant increases in iron deposition in subcortical GM and myelin degeneration along the WM skeleton of patients with MS was identified. Both effects correlated strongly with EDSS.
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Affiliation(s)
- David A Rudko
- From the Department of Physics (D.A.R., R.S.M.), Center for Functional and Metabolic Mapping, Robarts Research Institute (D.A.R., I.S., J.S.G., R.S.M.), and Department of Neurology, University Hospital (M.K.), University of Western Ontario, 1151 Richmond St North, London, ON, Canada N6A 5B7
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Abstract
The onset of multiple sclerosis (MS) in childhood and adolescence is being increasingly recognized. Relative to MS in adults, little is known about the diagnostic evaluation, clinical course, outcome, and management of MS in children. To remedy some of these deficiencies, pediatric MS clinics have been created in several countries to provide specialized care to, and to study, affected children. Research is currently underway to investigate the pathobiologic features of childhood-onset MS, to study the mechanisms of myelin inflammation and repair, to evaluate patient outcomes collaboratively between the different clinics, and to increase knowledge of pediatric MS for children living with the disease. It is hoped that, through an understanding of the earliest aspects of the MS disease process, critical insights will be gained about the genesis of MS.
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75
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Calabrese M, Romualdi C, Poretto V, Favaretto A, Morra A, Rinaldi F, Perini P, Gallo P. The changing clinical course of multiple sclerosis: a matter of gray matter. Ann Neurol 2013; 74:76-83. [PMID: 23494723 DOI: 10.1002/ana.23882] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 02/18/2013] [Accepted: 03/01/2013] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Clinical and neuroimaging parameters predictive of the changing clinical course of multiple sclerosis (MS) from relapsing-remitting to secondary progressive have not been clarified yet. We specifically designed a prospective 5-year longitudinal study aimed at assessing demographic, clinical, and magnetic resonance imaging (MRI) parameters that could predict the changing clinical course of MS. METHODS At study entry and after 5 years, clinical and MRI (ie, gray matter and white matter lesions, including spinal cord lesions, and global and regional cortical thinning) parameters were assessed in a training set of 334 consecutive relapsing-remitting MS patients and in an independent validation set of 84 relapsing-remitting MS patients. RESULTS Sixty-six (19.7%) relapsing-remitting MS patients changed their clinical course during the study and entered into the secondary progressive phase. Age (p = 0.001, odds ratio [OR] = 1.2), cortical lesion volume (p < 0.001, OR = 1.7), and cerebellar cortical volume (p < 0.001, OR = 0.2) at study entry were found to predict the changing clinical course. The model including only these 3 variables correctly identified 252 of 268 (94.0%) patients who maintained the relapsing-remitting course and 58 of 66 (87.8%) patients who became secondary progressive (cross-validated error rate = 7.2%). When applied on the validation set, the model obtained a similar error rate (8.4%). INTERPRETATION A prediction model based on age, cortical lesion load, and cerebellar cortical volume suitably explains the probability of relapsing-remitting MS patients evolving into the progressive phase. Gray matter damage appears to play a pivotal role in determining the changing clinical course of MS.
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Affiliation(s)
- Massimiliano Calabrese
- First Neurological Clinic, Department of Neurosciences, University Hospital of Padua, Padua, Italy; Neuroimaging Unit, Euganea Medica, Padua, Italy
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Khademi M, Dring AM, Gilthorpe JD, Wuolikainen A, Al Nimer F, Harris RA, Andersson M, Brundin L, Piehl F, Olsson T, Svenningsson A. Intense inflammation and nerve damage in early multiple sclerosis subsides at older age: a reflection by cerebrospinal fluid biomarkers. PLoS One 2013; 8:e63172. [PMID: 23667585 PMCID: PMC3646751 DOI: 10.1371/journal.pone.0063172] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 03/28/2013] [Indexed: 02/02/2023] Open
Abstract
Inflammatory mediators have crucial roles in leukocyte recruitment and subsequent central nervous system (CNS) neuroinflammation. The extent of neuronal injury and axonal loss are associated with the degree of CNS inflammation and determine physical disability in multiple sclerosis (MS). The aim of this study was to explore possible associations between a panel of selected cerebrospinal fluid biomarkers and robust clinical and demographic parameters in a large cohort of patients with MS and controls (n = 1066) using data-driven multivariate analysis. Levels of matrix metalloproteinase 9 (MMP9), chemokine (C-X-C motif) ligand 13 (CXCL13), osteopontin (OPN) and neurofilament-light chain (NFL) were measured by ELISA in 548 subjects comprising different MS subtypes (relapsing-remitting, secondary progressive and primary progressive), clinically isolated syndrome and persons with other neurological diseases with or without signs of inflammation/infection. Principal component analyses and orthogonal partial least squares methods were used for unsupervised and supervised interrogation of the data. Models were validated using data from a further 518 subjects in which one or more of the four selected markers were measured. There was a significant association between increased patient age and lower levels of CXCL13, MMP9 and NFL. CXCL13 levels correlated well with MMP9 in the younger age groups, but less so in older patients, and after approximately 54 years of age the levels of CXCL13 and MMP9 were consistently low. CXCL13 and MMP9 levels also correlated well with both NFL and OPN in younger patients. We demonstrate a strong effect of age on both inflammatory and neurodegenerative biomarkers in a large cohort of MS patients. The findings support an early use of adequate immunomodulatory disease modifying drugs, especially in younger patients, and may provide a biological explanation for the relative inefficacy of such treatments in older patients at later disease stages.
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Affiliation(s)
- Mohsen Khademi
- Karolinska Institute, Department of Clinical Neuroscience, Neuroimmunology Unit, Stockholm, Sweden
| | - Ann M. Dring
- Umeå University, Department of Pharmacology and Clinical Neuroscience, Umeå, Sweden
| | | | | | - Faiez Al Nimer
- Karolinska Institute, Department of Clinical Neuroscience, Neuroimmunology Unit, Stockholm, Sweden
- Karolinska University Hospital, Department of Neurology, Stockholm, Sweden
| | - Robert A. Harris
- Karolinska Institute, Department of Clinical Neuroscience, Neuroimmunology Unit, Stockholm, Sweden
| | - Magnus Andersson
- Karolinska University Hospital, Department of Neurology, Stockholm, Sweden
| | - Lou Brundin
- Karolinska Institute, Department of Clinical Neuroscience, Neuroimmunology Unit, Stockholm, Sweden
- Karolinska University Hospital, Department of Neurology, Stockholm, Sweden
| | - Fredrik Piehl
- Karolinska Institute, Department of Clinical Neuroscience, Neuroimmunology Unit, Stockholm, Sweden
- Karolinska University Hospital, Department of Neurology, Stockholm, Sweden
| | - Tomas Olsson
- Karolinska Institute, Department of Clinical Neuroscience, Neuroimmunology Unit, Stockholm, Sweden
- Karolinska University Hospital, Department of Neurology, Stockholm, Sweden
| | - Anders Svenningsson
- Umeå University, Department of Pharmacology and Clinical Neuroscience, Umeå, Sweden
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Tutuncu M, Tang J, Zeid NA, Kale N, Crusan DJ, Atkinson EJ, Siva A, Pittock SJ, Pirko I, Keegan BM, Lucchinetti CF, Noseworthy JH, Rodriguez M, Weinshenker BG, Kantarci OH. Onset of progressive phase is an age-dependent clinical milestone in multiple sclerosis. Mult Scler 2013; 19:188-98. [PMID: 22736750 PMCID: PMC4029334 DOI: 10.1177/1352458512451510] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND It is unclear if all patients with relapsing-remitting multiple sclerosis (RRMS) ultimately develop progressive MS. Onset of progressive disease course seems to be age- rather than disease duration-dependent. Some forms of progressive MS (e.g. primary progressive MS (PPMS)) are uncommon in population-based studies. Ascertainment of patients with PPMS from clinic-based populations can facilitate a powerful comparison of age at progression onset between secondary progressive MS (SPMS) and PPMS but may introduce unclear biases. OBJECTIVE Our aim is to confirm that onset of progressive disease course is more relevant to the patient's age than the presence or duration of a pre-progression relapsing disease course in MS. METHODS We studied a population-based MS cohort (n=210, RRMS n=109, progressive MS n=101) and a clinic-based progressive MS cohort (n=754). Progressive course was classified as primary (PPMS; n=322), single attack (SAPMS; n=112) and secondary progressive (SPMS; n=421). We studied demographics (chi(2) or t-test), age-of-progression-onset (t-test) and time to Expanded Disability Status Scale of 6 (EDSS6) (Kaplan-Meier analyses). RESULTS Sex ratio (p=0.58), age at progression onset (p=0.37) and time to EDSS6 (p=0.16) did not differ between the cohorts. Progression had developed before age 75 in 99% of patients with known progressive disease course; 38% with RRMS did not develop progression by age 75. Age at progression onset did not differ between SPMS (44.9±9.6), SAPMS (45.5±9.6) and PPMS (45.7±10.8). In either cohort, only 2% of patients had reached EDSS6 before onset of progression. CONCLUSIONS Patients with RRMS do not inevitably develop a progressive disease course. Onset of progression is more dependent on age than the presence or duration of a pre-progression symptomatic disease course. Moderate disability is sustained predominantly after the onset of a progressive disease course in MS.
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Affiliation(s)
- Melih Tutuncu
- Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Junger Tang
- Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Nuhad Abou Zeid
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon. Previously a fellow of the Department of Neurology, Mayo Clinic College of Medicine
| | - Nilufer Kale
- Department of Neurology, Bakirkoy State Hospital, Istanbul, Turkey. Previously a fellow of the Department of Neurology, Mayo Clinic College of Medicine
| | - Daniel J. Crusan
- Division of Biomedical Statistics & Informatics, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Elizabeth J. Atkinson
- Division of Biomedical Statistics & Informatics, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Aksel Siva
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Sean J. Pittock
- Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Istvan Pirko
- Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - B. Mark Keegan
- Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Claudia F. Lucchinetti
- Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - John H. Noseworthy
- Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Moses Rodriguez
- Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Brian G. Weinshenker
- Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Orhun H. Kantarci
- Mayo Clinic Center for Multiple Sclerosis and CNS Demyelinating Diseases, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
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78
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Increasing age at disability milestones among MS patients in the MSBase Registry. J Neurol Sci 2012; 318:94-9. [DOI: 10.1016/j.jns.2012.03.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 03/21/2012] [Accepted: 03/22/2012] [Indexed: 11/18/2022]
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Hampton DW, Innes N, Merkler D, Zhao C, Franklin RJ, Chandran S. Focal Immune-Mediated White Matter Demyelination Reveals an Age-Associated Increase in Axonal Vulnerability and Decreased Remyelination Efficiency. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 180:1897-905. [DOI: 10.1016/j.ajpath.2012.01.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 01/16/2012] [Accepted: 01/19/2012] [Indexed: 01/18/2023]
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How does age at onset influence the outcome of autoimmune diseases? Autoimmune Dis 2011; 2012:251730. [PMID: 22195277 PMCID: PMC3238350 DOI: 10.1155/2012/251730] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 10/31/2011] [Indexed: 12/22/2022] Open
Abstract
The age at onset refers to the time period at which an individual experiences the first symptoms of a disease. In autoimmune diseases (ADs), these symptoms can be subtle but are very relevant for diagnosis. They can appear during childhood, adulthood or late in life and may vary depending on the age at onset. Variables like mortality and morbidity and the role of genes will be reviewed with a focus on the major autoimmune disorders, namely, systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), multiple sclerosis (MS), type 1 diabetes mellitus (T1D), Sjögren's syndrome, and autoimmune thyroiditis (AITD). Early age at onset is a worst prognostic factor for some ADs (i.e., SLE and T1D), while for others it does not have a significant influence on the course of disease (i.e., SS) or no unanimous consensus exists (i.e., RA and MS).
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81
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Hasan KM, Walimuni IS, Abid H, Datta S, Wolinsky JS, Narayana PA. Human brain atlas-based multimodal MRI analysis of volumetry, diffusimetry, relaxometry and lesion distribution in multiple sclerosis patients and healthy adult controls: implications for understanding the pathogenesis of multiple sclerosis and consolidation of quantitative MRI results in MS. J Neurol Sci 2011; 313:99-109. [PMID: 21978603 DOI: 10.1016/j.jns.2011.09.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 08/31/2011] [Accepted: 09/13/2011] [Indexed: 01/18/2023]
Abstract
Multiple sclerosis (MS) is the most common immune-mediated disabling neurological disease of the central nervous system. The pathogenesis of MS is not fully understood. Histopathology implicates both demyelination and axonal degeneration as the major contributors to the accumulation of disability. The application of several in vivo quantitative magnetic resonance imaging (MRI) methods to both lesioned and normal-appearing brain tissue has not yet provided a solid conclusive support of the hypothesis that MS might be a diffuse disease. In this work, we adopted FreeSurfer to provide standardized macrostructure or volumetry of lesion free normal-appearing brain tissue in combination with multiple quantitative MRI metrics (T(2) relaxation time, diffusion tensor anisotropy and diffusivities) that characterize tissue microstructural integrity. By incorporating a large number of healthy controls, we have attempted to separate the natural age-related change from the disease-induced effects. Our work shows elevation in diffusivity and relaxation times and reduction in volume in a number of normal-appearing white matter and gray matter structures in relapsing-remitting multiple sclerosis patients. These changes were related in part with the spatial distribution of lesions. The whole brain lesion load and age-adjusted expanded disability status score showed strongest correlations in regions such as corpus callosum with qMRI metrics that are believed to be specific markers of axonal dysfunction, consistent with histologic data of others indicating axonal loss that is independent of focal lesions. Our results support that MS at least in part has a neurodegenerative component.
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Affiliation(s)
- Khader M Hasan
- The University of Texas Health Science Center at Houston, Department of Diagnostic & Interventional Imaging, 6431 Fannin Street, MSB 2.100, Houston, Texas 77030, USA.
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82
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Patti F, Amato MP, Bastianello S, Caniatti L, Di Monte E, Lijoi F, Goretti B, Messina S, Picconi O, Tola MR, Trojano M. Subcutaneous Interferon Beta-1a Has a Positive Effect on Cognitive Performance in Mildly Disabled Patients with Relapsing-Remitting Multiple Sclerosis: 2-Year Results from the COGIMUS Study. Ther Adv Neurol Disord 2011; 2:67-77. [PMID: 21180642 DOI: 10.1177/1756285608101379] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The effect of interferon (IFN) beta-1a (44 and 22 μg subcutaneously [sc] three times weekly [tiw]) on cognition in mildly disabled patients with relapsing-remitting multiple sclerosis (McDonald criteria; Expanded Disability Status Scale =4.0) was assessed by validated neuropsychological testing at baseline and at regular intervals for up to 2 years in this ongoing open-label, 3-year study. Year-2 data were available for 356 patients (22 μg, n = 175; 44μg, n = 181). The proportion of patients with impaired cognitive function was stable during the study: 21.4% at baseline and 21.6% at 2 years. At 2 years, the proportion of patients with =3 impaired cognitive tests was significantly lower in the 44 μg treatment group (17.0%) compared with the 22 μg group (26.5%; p = 0.034), although there was already a trend towards a higher proportion of patients with cognitive impairment in the 22 μg group at baseline. Factors associated with impairment in = three cognitive tests after 2 years were age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.00-1.09), verbal intelligence quotient (OR: 0.95; 95% CI: 0.92-0.98), and having = three impaired cognitive tests at baseline (OR: 11.60; 95% CI: 5.94-22.64). These interim results show that IFN beta-1a sc tiw may have beneficial effects on cognitive function as early as 2 years after treatment initiation, but the final 3-year data of the study are required to confirm these results.
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Affiliation(s)
- Francesco Patti
- Multiple Sclerosis Centre Sicilia Region, First Neurology Clinic, University Hospital Catania, Via Santa Sofia 78, 95123 Catania, Italy
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Wetzel JL, Fry DK, Pfalzer LA. Six-minute walk test for persons with mild or moderate disability from multiple sclerosis: performance and explanatory factors. Physiother Can 2011; 63:166-80. [PMID: 22379256 DOI: 10.3138/ptc.2009-62] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The primary purpose of this study was to determine the extent to which health factors, functional measures, and pulmonary impairment explain performance on 6-Minute Walk Test (6MWT) distance in ambulatory persons with multiple sclerosis (MS). Another purpose was to determine the effect of disability and age on 6MWT performance and explanatory factors. METHODS A cross-sectional study design was used to evaluate factors that explain performance on the 6MWT in 64 community-dwelling persons with MS-related disability (Expanded Disability Status Scale [EDSS] 3.8±1.6). Of the 64 participants, 43 (67.2%) exhibited mild disability (EDSS <4.0) and 21 (32.8%) had moderate disability (EDSS 4.0-6.5). A regression analysis compared 6MWT performance to measures of health factors (EDSS, number of medications, number of comorbidities, resting HR, systolic and diastolic blood pressure [BP]); physical performance (functional stair test [FST], sit-to-stand test [SST], static standing balance [BAL], Fatigue Severity Scale [FSS], Activities-specific Balance Confidence [ABC] Scale); and pulmonary function (forced expiratory volume in 1 second [FEV(1)], forced vital capacity [FVC], maximal voluntary ventilation [MVV], maximal inspiratory pressure [MIP], maximal expiratory pressure [MEP]). RESULTS EDSS, ABC, FST, SST, BAL, MVV, MIP, and MEP were significantly associated with 6MWT distance after adjusting for age. Multiple step-wise linear regression analysis revealed that ABC, FST, and BAL were significant and independent explanatory factors of 6MWT distance. ABC and FST explained 75% of the variance in 6MWT performance (R(2)=0.75). Curvilinear regression analysis revealed that the FST is the most significant explanatory factor for 6MWT distance, explaining 79% of the variance (R(2)=0.79). CONCLUSIONS 6MWT performance in persons with MS was explained by balance confidence (ABC) and stair-climbing ability (FST). The ABC and FST may be practical clinical measures for explaining walking ability and determining risk for disablement in persons with MS.
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Affiliation(s)
- Jane L Wetzel
- Jane L. Wetzel, PT, PhD: Associate Professor, Department of Physical Therapy, Youngstown State University, Youngstown, Ohio (current); Duquesne University, Pittsburgh, Pennsylvania (at time of study)
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Glial fibrillary acidic protein: a potential biomarker for progression in multiple sclerosis. J Neurol 2011; 258:882-8. [PMID: 21197541 DOI: 10.1007/s00415-010-5863-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 11/20/2010] [Accepted: 12/01/2010] [Indexed: 10/18/2022]
Abstract
The major intermediate cytoskeletal protein of astrocytes, glial fibrillary acidic protein (GFAP), and that of axons, neurofilament light protein (NFL), may both be released into the cerebrospinal fluid (CSF) during pathological processes in the central nervous system (CNS). We investigated GFAP and NFL levels in CSF as possible biomarkers for progression in multiple sclerosis (MS). Patients with relapsing-remitting MS (RRMS, n = 15) or secondary progressive MS (SPMS, n = 10) and healthy control subjects (n = 28) were examined twice with an interval of 8-10 years apart. Neurological deficits were scored with the Expanded Disability Status Scale (EDSS). GFAP and NFL levels were determined in CSF by enzyme-linked immunosorbent assay (ELISA). GFAP levels and NFL levels correlated with age (r and r (s) = 0.50, p = 0.006). Adjusting for age, MS patients had increased GFAP levels compared with controls (p = 0.03) and GFAP levels correlated with neurological disability (EDSS, r = 0.51, p < 0.05) and disease progression [Multiple Sclerosis Severity Score (MSSS), r = 0.47, p < 0.05]. The mean annual increase of GFAP was 6.5 ng/L for controls, 8.1 ng/L for RRMS patients, and 18.9 ng/L for SPMS patients. GFAP level at the first examination had predictive value for neurological disability 8-10 years later (EDSS, r = 0.45, p < 0.05) but not for EDSS increase between the examinations. NFL levels were not significantly increased in MS patients compared with controls and had no relationship to disability or progression and no prognostic value for disability development. GFAP, a marker for astrogliosis, is a potential biomarker for MS progression and may have a role in clinical trials for assessing the impact of therapies on MS progression.
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86
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Ghezzi A, Comi G, Federico A. Chronic cerebro-spinal venous insufficiency (CCSVI) and multiple sclerosis. Neurol Sci 2010; 32:17-21. [PMID: 21161309 DOI: 10.1007/s10072-010-0458-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 11/17/2010] [Indexed: 11/26/2022]
Abstract
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the CNS caused by the interplay of genetic and environmental factors. In the last years, it has been suggested that an abnormal venous drainage due to stenosis or malformation of the internal jugular and/or azygous veins may play a major pathogenetic role in MS. This abnormality called chronic cerebro-spinal venous insufficiency (CCSVI) could result in increased permeability of blood brain barrier, local iron deposition and secondary multifocal inflammation. In the present paper, literature data in favour and against this hypothesis are reported. A great variability of CCSVI has been found in both MS patients (ranging from 0 to 100%) and in control subjects (from 0 to 23%). This large variability is explained by methodological aspects, problems in assessing CCSVI, and differences among clinical series. It is urgent to perform appropriate epidemiological studies to define the possible relationship between CCSVI and MS.
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Affiliation(s)
- A Ghezzi
- Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Coordinator of Multiple Sclerosis Study Group, Italian Society of Neurology, Gallarate, Italy.
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87
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Abstract
BACKGROUND There is limited understanding of the utilization of and perceived need for physical therapy services among middle-aged and older adults with multiple sclerosis (MS). The resulting knowledge gap compromises efforts for physical therapy service planning for this population. OBJECTIVE The purpose of this study was to examine the use of and need for physical therapy services in a sample of adults with MS living in the Midwestern United States. DESIGN This was a cross-sectional, descriptive study. METHODS Data from telephone interviews with 1,065 people with MS, aged 45 to 90 years, were used for the study. A multinomial regression model was used to determine factors associated with use of physical therapy services (never, within the past year, more than a year ago). Logistic regression analysis examined factors associated with unmet needs for these services. RESULTS Thirty-six percent of the sample reported never using physical therapy services, 33% reported using physical therapy services within the past year, and 31% reported using physical therapy services more than a year prior to the interview. Factors associated with recent use of physical therapy services included living in an urban or suburban community, deteriorating MS status, experiencing problems with spasticity (ie, hypertonicity), having difficulty moving inside the house, being hospitalized in the past 6 months, and seeing a family physician. These same factors were associated with unmet needs. Limitations Physical therapy service use was self-reported. Data were collected in 5 Midwestern states from people 45 years of age or older, which may limit generalizability. CONCLUSIONS Factors associated with use of and need for physical therapy services reflect issues of access (geographical, referrals), MS status, and mobility difficulties.
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88
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Abstract
Although the interaction between comorbidities and chronic diseases is strong, the effect of comorbidities receives little attention in many chronic diseases. In multiple sclerosis (MS), an increasing amount of evidence suggests that physical and mental comorbidities, and adverse health factors such as smoking and obesity, are common and can affect the disease. These comorbid diseases and lifestyle factors affect clinical phenotype, the diagnostic delay between symptom onset and diagnosis, disability progression, and health-related quality of life. Future studies of comorbidity and MS should consider comorbidities and health behaviours and should take into account the modifying effects of socioeconomic status, ethnic origin, and cultural factors. Studies of the frequency of comorbidities in patients with MS should be population based, incorporating appropriate comparator groups. These studies should expand the range of comorbidities assessed, and examine how the frequency of comorbidities is changing over time. Further research is needed to answer many other questions about comorbidities and their associations with MS, including the best way to measure and analyse comorbidities to understand these associations.
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89
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Bermel RA, Rae-Grant AD, Fox RJ. Diagnosing multiple sclerosis at a later age: more than just progressive myelopathy. Mult Scler 2010; 16:1335-40. [DOI: 10.1177/1352458510377334] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Multiple sclerosis (MS) is usually considered a ‘young persons’ disease’, typically presenting between the ages of 20 and 40. In this study we review our experience with patients diagnosed at age 60 or over, with particular emphasis on patients who continue to have evidence of active inflammation despite a later onset. Methods: We reviewed all cases of MS diagnosed at or over age 60 in our center over a 5-year period. We identified 111 patients and recorded their clinical and imaging characteristics using prespecified variables. Analyses were performed to describe their interval to diagnosis, clinical syndromes, imaging and laboratory characteristics. Results: At the time of diagnosis, 8% of patients had a clinically isolated syndrome, 33% were in the relapsing—remitting stage, while 23% had a secondary progressive course, and 32% were primary progressive. Eighty-eight percent of patients had a brain MRI judged ‘typical for MS’, and 32% of all patients receiving gadolinium had enhanced lesions. Forty-six percent of patients with relapsing—remitting MS or clinically isolated syndrome exhibited gadolinium enhancement. Myelitis was the most common initial clinical syndrome, and progressive myelopathy was a common but not exclusive clinical syndrome at the time of diagnosis. Conclusions: A relapsing pattern of MS is not uncommon, even in patients diagnosed over the age of 60. Active inflammation (clinical relapses and gadolinium enhancement) occurs in a significant number of patients with MS with later diagnosis. These observations have implications for evaluation and treatment of patients with MS presenting at an older age.
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Affiliation(s)
- Robert A Bermel
- Mellen Center for MS Treatment and Research, Cleveland Clinic, Cleveland, OH, USA, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA,
| | - Alexander D Rae-Grant
- Mellen Center for MS Treatment and Research, Cleveland Clinic, Cleveland, OH, USA, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert J Fox
- Mellen Center for MS Treatment and Research, Cleveland Clinic, Cleveland, OH, USA, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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90
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Abstract
BACKGROUND Pediatric multiple sclerosis (MS), once considered a rare childhood illness, has been increasingly identified as an important childhood acquired neurologic disease requiring early recognition and intervention. SUMMARY We present a comprehensive review of the current terminology of acquired central nervous system demyelination in children, pertinent investigations, including magnetic resonance imaging and cerebrospinal fluid cerebrospinal fluid studies, and an approach to the differential diagnosis of pediatric onset MS. In addition, the recent studies exploring the epidemiology and pathobiology will be discussed. Finally, we present an algorithm for the treatment of episodes of demyelination along with chronic immunomodulatory therapeutic options in this patient population. CONCLUSIONS Although some similarities exist to adult onset MS, MS onset during childhood and adolescence presents unique diagnostic challenges and requires specialized multidisciplinary care for optimal management. National and international collaborative studies are underway to aid in the understanding of the early and ongoing pathogenesis of MS.
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91
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Anderson JM, Patani R, Reynolds R, Nicholas R, Compston A, Spillantini MG, Chandran S. Abnormal tau phosphorylation in primary progressive multiple sclerosis. Acta Neuropathol 2010; 119:591-600. [PMID: 20306268 DOI: 10.1007/s00401-010-0671-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 03/07/2010] [Accepted: 03/12/2010] [Indexed: 01/01/2023]
Abstract
Although neurodegeneration is the pathological substrate of progression in multiple sclerosis (MS), the underlying mechanisms remain unresolved. Abnormal phosphorylation of tau, implicated in the aetiopathogenesis of a number of classic neurodegenerative disorders, has also recently been described in secondary progressive MS (SPMS). In contrast to SPMS, primary progressive MS (PPMS) represents a significant subset of patients with accumulating neurological disability from onset. The neuropathological relationship between SPMS and PPMS is unknown. Against this background, we investigated tau phosphorylation status in five cases of PPMS using immunohistochemical and biochemical methods. We report widespread abnormal tau hyperphosphorylation of the classic tau phospho-epitopes occurring in multiple cell types but with a clear immunohistochemical glial bias. In addition, biochemical analysis revealed abnormally phosphorylated insoluble tau in all cases. These findings establish a platform for further study of the role of insoluble tau formation, including determining the relevance of glial tau pathology, in the neurodegenerative phase of MS.
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Affiliation(s)
- Jane Marian Anderson
- Cambridge Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Forvie Site, Robinson Way, Cambridge, UK
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92
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Stern M, Sorkin L, Milton K, Sperber K. Aging with Multiple Sclerosis. Phys Med Rehabil Clin N Am 2010; 21:403-17. [DOI: 10.1016/j.pmr.2009.12.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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93
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Plow M, Cho C, Finlayson M. Utilization of health promotion and wellness services among middle-aged and older adults with multiple sclerosis in the mid-west US. Health Promot Int 2010; 25:318-30. [PMID: 20427373 DOI: 10.1093/heapro/daq023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Routine engagement in healthy behaviors may improve quality of life in older adults with chronic disabling conditions, such as multiple sclerosis (MS). However, older adults with chronic conditions may face many barriers to engaging in healthy behaviors. Health promotion and wellness services may help older adults with chronic conditions engage in healthy behaviors. Thus, the purpose of this study was to identify factors associated with the use of and unmet needs for heath promotion services among middle-aged and older adults with MS. Data from a cross-sectional telephone survey of individuals aging with MS in the mid-west USA were used for this study (n = 1282). A multinomial regression model was used to identify variables associated with the utilization of health promotion services. A logistic regression model was used to identify variables associated with unmet needs for these services. Females (OR = 1.51; CI: 1.13, 2.00), high school graduates (OR = 1.77; CI: 1.34, 2.34) and people who reported no problems with mobility or balance (OR = 1.68; CI: 1.12, 2.51) were more likely to utilize health promotion and wellness services. Factors that increased the likelihood of reporting an unmet need for these services were being female (OR = 2.34; CI: 1.56, 3.51), greater than a high school education (OR = 1.58; CI: 1.14, 2.20), not being married (OR = 1.79; CI: 1.31, 2.43), having inadequate income (OR = 1.83; CI: 1.31, 2.56), experiencing pain (OR = 1.96; CI: 1.34, 2.87) and reporting less ability to do everyday activities now compared with 1 year ago (OR = 2.13; CI: 1.16, 3.92). To avoid widening the health-disparities gap, future research needs to explore strategies that promote utilization of health promotion services among all middle-aged and older adults with MS.
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Affiliation(s)
- Matthew Plow
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA.
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94
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Age-related changes in grey and white matter structure throughout adulthood. Neuroimage 2010; 51:943-51. [PMID: 20211265 PMCID: PMC2896477 DOI: 10.1016/j.neuroimage.2010.03.004] [Citation(s) in RCA: 346] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 01/27/2010] [Accepted: 03/02/2010] [Indexed: 01/27/2023] Open
Abstract
Normal ageing is associated with gradual brain atrophy. Determining spatial and temporal patterns of change can help shed light on underlying mechanisms. Neuroimaging provides various measures of brain structure that can be used to assess such age-related change but studies to date have typically considered single imaging measures. Although there is consensus on the notion that brain structure deteriorates with age, evidence on the precise time course and spatial distribution of changes is mixed. We assessed grey matter (GM) and white matter (WM) structure in a group of 66 adults aged between 23 and 81. Multimodal imaging measures included voxel-based morphometry (VBM)-style analysis of GM and WM volume and diffusion tensor imaging (DTI) metrics of WM microstructure. We found widespread reductions in GM volume from middle age onwards but earlier reductions in GM were detected in frontal cortex. Widespread age-related deterioration in WM microstructure was detected from young adulthood onwards. WM decline was detected earlier and more sensitively using DTI-based measures of microstructure than using markers of WM volume derived from conventional T1-weighted imaging.
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95
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Deloire M, Ruet A, Hamel D, Bonnet M, Brochet B. Early cognitive impairment in multiple sclerosis predicts disability outcome several years later. Mult Scler 2010; 16:581-7. [DOI: 10.1177/1352458510362819] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cognition is frequently impaired in the early stages of multiple sclerosis (MS). The predictive value of cognitive impairment on disability is unknown. The objective of this study was to correlate cognitive impairment and the progression of disability over 7 years. Forty-five patients, recruited after MS diagnosis, were followed for 7 years by yearly Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC) evaluations and were classified as cognitively impaired (CI) or unimpaired (CU) according to neuropsychological testing at baseline. At baseline, 47.8% of patients were CI, with deficits in mainly memory and information processing speed (IPS). The baseline EDSS correlated significantly with one IPS test. The EDSS, but not the MSFC, deteriorated significantly over the 7 years in the whole group and the CI group, but not the CU group. A multivariate analysis showed correlations between the EDSS change over 5 and 7 years and two baseline tests evaluating IPS and verbal memory. The deterioration of the EDSS after 7 years was significantly correlated with verbal memory testing at baseline after adjustment for age and baseline EDSS. In conclusion, in this sample of MS patients early in the disease, the baseline IPS and verbal memory impairments predict the EDSS score 5 and 7 years later.
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Affiliation(s)
- Mathilde Deloire
- EA 2966, Université de Bordeaux 2, Bordeaux, France, Services de Neurologie, CHU Bordeaux, France
| | | | | | | | - Bruno Brochet
- EA 2966, Université de Bordeaux 2, Bordeaux, France, , Services de Neurologie, CHU Bordeaux, France
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96
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Buchanan RJ, Minden SL, Chakravorty BJ, Hatcher W, Tyry T, Vollmer T. A pilot study of young adults with multiple sclerosis: demographic, disease, treatment, and psychosocial characteristics. Disabil Health J 2009; 3:262-70. [PMID: 21122795 DOI: 10.1016/j.dhjo.2009.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 09/11/2009] [Accepted: 09/15/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although multiple sclerosis (MS) is the most common neurologic disease disabling younger adults, very little is known about the characteristics of young adults with MS and the impact of MS on their lives. OBJECTIVES To conduct a pilot study of the demographic, disease, treatment, and psychosocial characteristics of young adults with MS (aged 18 and 31 years). METHODS We solicited participation from all 452 members of the Registry of the North American Research Committee On Multiple Sclerosis (NARCOMS) Project aged 18 to 31 years, collecting data from 100 of these young adults (22%) by computer-assisted telephone interviews. Data included basic demographic, disease, and treatment characteristics, ratings of satisfaction with access to and quality of MS and mental health care, and beliefs about the impact of MS on their current and future lives. RESULTS Participants were 93% female and averaged 28.6 years of age, and 88% had relapsing-remitting MS. Forty-three percent received the majority of their MS-focused care at an MS clinic and 94% had seen a neurologist in the previous 12 months. More than 40% reported depressive symptoms at the time of the survey. These young adults with MS had relatively low rates of concern about the impact of MS in the present but higher rates of worry about their future. CONCLUSIONS These findings suggest the need for a study with a larger, representative sample of young adults with MS to guide development of programs, interventions, and services tailored to meet their needs.
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Affiliation(s)
- Robert J Buchanan
- Department of Political Science and Public Administration, Mississippi State University, Mississippi State, MS 39762, USA.
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97
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Munschauer FE, Benedict RHB, Granger CV, Niewczyk PM. Introduction to Best practice recommendations for the selection and management of patients with MS on natalizumab. Mult Scler 2009. [DOI: 10.1177/1352458509347127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Frederick E Munschauer
- Department of Neurology, State University of New York (SUNY) at Buffalo and The Jacobs Neurological Institute, Buffalo, NY, USA
| | - Ralph HB Benedict
- Department of Neurology, State University of New York (SUNY) at Buffalo and The Jacobs Neurological Institute, Buffalo, NY, USA
| | - Carl V Granger
- Rehabilitation Medicine, State University of New York (SUNY) at Buffalo, Buffalo, NY, USA
- Uniform Data Systems for Medical Rehabilitation, Buffalo, NY, USA
| | - Paulette M Niewczyk
- Uniform Data Systems for Medical Rehabilitation, Buffalo, NY, USA
- Department of Health Care Studies, Daemen College, Amherst, NY, USA
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98
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Trojano M, Pellegrini F, Paolicelli D, Fuiani A, Zimatore GB, Tortorella C, Simone IL, Patti F, Ghezzi A, Zipoli V, Rossi P, Pozzilli C, Salemi G, Lugaresi A, Bergamaschi R, Millefiorini E, Clerico M, Lus G, Vianello M, Avolio C, Cavalla P, Lepore V, Livrea P, Comi G, Amato MP. Real-life impact of early interferon beta therapy in relapsing multiple sclerosis. Ann Neurol 2009; 66:513-20. [PMID: 19847899 DOI: 10.1002/ana.21757] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recent findings support greater efficacy of early vs. delayed interferon beta (IFNbeta) treatment in patients with a first clinical event suggestive of multiple sclerosis (MS). We aimed to evaluate the effectiveness of early IFNbeta treatment in definite relapsing-remitting MS (RRMS) and to assess the optimal time to initiate IFNbeta treatment with regard to the greatest benefits on disability progression. METHODS A cohort of 2,570 IFNbeta-treated RRMS patients was prospectively followed for up to 7 years in 15 Italian MS Centers. A Cox proportional hazards regression model adjusted for propensity score (PS) quintiles was used to assess differences between groups of patients with early vs. delayed IFNbeta treatment on risk of reaching a 1-point progression in the Expanded Disability Status Scale (EDSS) score, and the EDSS 4.0 and 6.0 milestones. A set of PS-adjusted Cox hazards regression models were calculated according to different times of treatment initiation (within 1 year up to within 5 years from disease onset). A sensitivity analysis was performed to assess the robustness of findings. RESULTS The lowest hazard ratios (HRs) for the three PS quintiles-adjusted models were obtained by a cutoff of treatment initiation within 1 year from disease onset. Early treatment significantly reduced the risk of reaching a 1-point progression in EDSS score (HR = 0.63; 95% CI = 0.48-0.85; p < 0.002), and the EDSS 4.0 milestone (HR = 0.56; 95% CI = 0.36-0.90; p = 0.015). Sensitivity analysis showed the bound of significance for unmeasured confounders. INTERPRETATION Greater benefits on disability progression may be obtained by an early IFNbeta treatment in RRMS.
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Affiliation(s)
- M Trojano
- Department of Neurological and Psychiatric Sciences, University of Bari, Italy.
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99
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Finlayson M, Garcia JD, Preissner KL. Retracted:Development of an education programme for caregivers of people aging with multiple sclerosis. Occup Ther Int 2009. [DOI: 10.1002/oti.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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100
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Imrell K, Greiner E, Hillert J, Masterman T. HLA-DRB115 and cerebrospinal-fluid-specific oligoclonal immunoglobulin G bands lower age at attainment of important disease milestones in multiple sclerosis. J Neuroimmunol 2009; 210:128-30. [PMID: 19327846 DOI: 10.1016/j.jneuroim.2009.03.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 03/02/2009] [Accepted: 03/06/2009] [Indexed: 11/15/2022]
Abstract
Carriage of HLA-DRB1*15 is the most important genetic risk factor in multiple sclerosis (MS), while CSF-specific oligoclonal immunoglobulin G bands (OCB) constitute the most sensitive biochemical marker for diagnosing MS. We demonstrated in an earlier study the interdependence of HLA-DRB1 genotype and OCB status; the effect of these phenotypic features on MS prognosis remains controversial, however. We investigated by survival analysis the impact of each variable on age at two important MS milestones: onset of clinical symptoms and an Expanded Disability Status Scale (EDSS) score of 6.0. Both carriage of HLA-DRB1*15 and the presence of OCB hastened attainment of EDSS 6.0.
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Affiliation(s)
- Kerstin Imrell
- Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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