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Tarantino S, Proietti Checchi M, Papetti L, Monte G, Ferilli MAN, Valeriani M. Neuropsychological performances, quality of life, and psychological issues in pediatric onset multiple sclerosis: a narrative review. Neurol Sci 2024; 45:1913-1930. [PMID: 38157101 PMCID: PMC11021227 DOI: 10.1007/s10072-023-07281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
Multiple sclerosis (MS) is primarily a disease diagnosed in young and middle-aged adults. Although MS is a rare condition in pediatric age, an increasing rate of patients is diagnosed under the age of 18. The disabling nature of the disease cannot be reduced only to physical symptoms. Several additional symptoms such as cognitive impairment, fatigue, and psychological symptoms are common features of pediatric MS. The reviewed literature suggests that, despite the lower physical disability, children and adolescents diagnosed with MS are vulnerable to cognitive impairment even in the early stage of the disease. The neuropsychological profile of pediatric MS may resemble that of adult MS, including an impairment in attention/information processing speed, learning, verbal, and visuospatial memory. However, cognitive difficulties in children and adolescents are more likely to involve also general intelligence and linguistic abilities, presumably due to patients' younger age and cognitive growth stage. Cognitive difficulties, beyond physical disability and relapses, may have a considerable impact on learning and school achievement. Depression and fatigue are other highly prevalent disturbances in pediatric MS and may contribute to patients' low functional outcomes. Overall, these manifestations may cause considerable functional impairment on daily activities and quality of life that may require individualized rehabilitative treatment and extensive psychosocial care. Additional neuropsychological research evaluating larger samples, using more homogenous methods, and exploring the role of MS treatment on cognitive and psychological development is required.
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Affiliation(s)
- Samuela Tarantino
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | | | - Laura Papetti
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Gabriele Monte
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Massimiliano Valeriani
- Developmental Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Systems Medicine Department, University of Tor Vergata, Rome, Italy
- Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
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Tomczak M, Walczak M, Brola W, Walczak A, Koper M, Chmielewski B, Wilski M. Physical activity as a mediator in the relationship between health locus of control and health-related quality of life in multiple sclerosis patients with different disease duration. Disabil Health J 2024:101638. [PMID: 38755083 DOI: 10.1016/j.dhjo.2024.101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/09/2024] [Accepted: 04/27/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND The importance of undertaking physical activity for functioning of patients with multiple sclerosis (MS) has been repeatedly highlighted. However, the research on the role of physical activity in shaping the quality of life of patients with different disease duration is scarce. OBJECTIVE The aim of this study was to identify the mediating role of physical activity in the relationship between health locus of control (HLoC) and health-related quality of life in MS patients with varying disease duration. METHODS The study included 339 patients with MS from rehabilitation centers. The Multiple Sclerosis Impact Scale (MSIS-29) was used to measure health-related quality of life, physical activity was assessed by the Godin Leisure Time Exercise Questionnaire (GLTEQ) and the Health Locus of Control Questionnaire was used to measure HLoC. RESULTS Physical activity has been shown to be a mediator in the relationship between intrinsic HLoC and health-related quality of life particularly in patients with longer disease duration. Intrinsic HLoC was positively associated with engaging in physical activity, which in turn was positively associated with the physical component of quality of life in patients with longer (indirect effect: β = -0.077, p < 0.05) and moderate (β = -0.040, p < 0.05) duration of illness. CONCLUSION The results highlight the importance of psychological resources for undertaking quality-of-life-related physical activity by MS patients with long disease duration. Particularly important here is the internal HLoC, which promotes physical activity that increases the chance of a high quality of life.
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Affiliation(s)
- Maciej Tomczak
- Poznan University of Physical Education, Department of Psychology, Poznan, Poland.
| | - Małgorzata Walczak
- Poznan University of Physical Education, Department of Psychology, Poznan, Poland
| | - Waldemar Brola
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Aleksandra Walczak
- Heliodor Święcicki Clinical Hospital of the Poznan University of Medical Sciences, Poznań, Poland
| | - Magdalena Koper
- Poznan University of Physical Education, Department of Adapted Physical Activity, Poznan, Poland
| | - Bartosz Chmielewski
- State University of Applied Sciences in Konin, Faculty of Health Sciences, Konin, Poland
| | - Maciej Wilski
- Poznan University of Physical Education, Department of Adapted Physical Activity, Poznan, Poland.
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Zhong M, Salberg S, Sampangi S, van der Walt A, Butzkueven H, Mychasiuk R, Jokubaitis V. Leukocyte telomere length in multiple sclerosis: relationship between disability severity and pregnancy history. Mult Scler Relat Disord 2024; 86:105607. [PMID: 38631073 DOI: 10.1016/j.msard.2024.105607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Aging-related processes contribute to neurodegeneration and disability in multiple sclerosis (MS). Biomarkers of biological aging such as leukocyte telomere length (LTL) could help personalise prognosis. Pregnancy has been shown to be protective against disability accumulation in women with MS, though it is unclear if this effect relates to aging mechanisms or LTL. OBJECTIVES This study aimed to cross-sectionally characterise LTL in a cohort of individuals with MS, and to correlate LTL with disability severity and pregnancy history. METHODS We extracted DNA from the whole blood of 501 people with MS in Melbourne, Australia. Expanded Disability Status Scale (EDSS) score and demographic data, as well as pregnancy history for 197 females, were obtained at sample collection. Additional data were extracted from the MSBase Registry. LTL was determined in base pairs (bp) using real-time quantitative polymerase chain reaction. RESULTS A relationship between EDSS score and shorter LTL was robust to multivariable adjustment for demographic and clinical factors including chronological age, with an adjusted LTL reduction per 1.0 increase in EDSS of 97.1 bp (95 % CI = 9.7-184.5 bp, p = 0.030). Adjusted mediation analysis found chronological age accounted for 33.6 % of the relationship between LTL and EDSS score (p = 0.018). In females with pregnancy data, history of pregnancy was associated with older age (median 49.7 vs 33.0 years, p < 0.001). There were no significant relationships between adjusted LTL and any history of pregnancy (LTL increase of 65.3 bp, 95 % CI = -471.0-601.5 bp, p = 0.81) or number of completed pregnancies (LTL increase of 14.6 bp per pregnancy, 95 % CI = -170.3-199.6 bp, p = 0.87). CONCLUSIONS The correlation between LTL and disability independent of chronological age and other factors points to a link between neurological reserve in MS and biological aging, and a potential research target for pathophysiological and therapeutic mechanisms. Although LTL did not significantly differ by pregnancy history, longitudinal analyses could help identify interactions with prospectively captured pregnancy effects.
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Affiliation(s)
- Michael Zhong
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred Hospital, Melbourne, Australia.
| | - Sabrina Salberg
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Sandeep Sampangi
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, The Alfred Hospital, Melbourne, Australia
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Shahraki Z, Rastkar M, Rastkar E, Mohammadifar M, Mohamadi A, Ghajarzadeh M. Impact of menopause on relapse rate and disability level in patients with multiple sclerosis (MS): a systematic review and meta-analysis. BMC Neurol 2023; 23:316. [PMID: 37667181 PMCID: PMC10476298 DOI: 10.1186/s12883-023-03332-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/15/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Menopause is a physiologic phase in women's lives. Findings regarding multiple sclerosis (MS) course through menopause are diverse. So, we designed this systematic review and meta-analysis to estimate the impact of menopause on relapse rate, and disability status in women with MS. METHODS PubMed, Scopus, EMBASE, Web of Science, and google scholar were systematically searched by two independent researchers on January 1st, 2023. They also evaluated conference abstracts, and references of the included studies. In addition, data regarding the total number of participants, name of the first author of the publication, publication year, country of origin, disease duration, disease type, annual relapse rate, and Expanded Disability Status Scale (EDSS) before and after menopause were recorded. RESULTS A literature search revealed 1024 records. Twenty-one full texts were evaluated, and finally, four studies were included for meta-analysis. Mean ARR before menopause ranged between 0.21 and 0.37, and after menopause ranged between 0.13 and 0.08. The SMD of mean ARR ranged between - 1.04, and - 0.29, while the pooled SMD was estimated as -0.52(95% CI: -0.88, -0.15) (I2 = 73.6%, P = 0.02). The mean EDSS before menopause ranged between 1.5 and 2, and after menopause ranged between 2 and 3.1. The SMD of EDSS ranged between 0.46, and 0.71. The pooled SMD of EDSS change (after menopause-before menopause) estimated as 0.56(95% CI: 0.38, 0.73)(I2 = 0, P = 0.4). CONCLUSION The result of this systematic review and meta-analysis show that menopause can be associated with relapse rate reduction, unlike increase in disease-related disability in women with MS.
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Affiliation(s)
| | - Mohsen Rastkar
- Student's Scientific research center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elnaz Rastkar
- Faculty of Medicine, Tabriz University of Medical Science, Tabriz, Iran
| | - Mehdi Mohammadifar
- Multiple Sclerosis Research Group (MSRG), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Mohamadi
- Multiple Sclerosis Research Group (MSRG), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Ghajarzadeh
- Multiple Sclerosis Research Group (MSRG), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran.
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
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Harding-Forrester S, Roos I, Nguyen AL, Malpas CB, Diouf I, Moradi N, Sharmin S, Izquierdo G, Eichau S, Patti F, Horakova D, Kubala Havrdova E, Prat A, Girard M, Duquette P, Grand'Maison F, Onofrj M, Lugaresi A, Grammond P, Ozakbas S, Amato MP, Gerlach O, Sola P, Ferraro D, Buzzard K, Skibina O, Lechner-Scott J, Alroughani R, Boz C, Van Pesch V, Cartechini E, Terzi M, Maimone D, Ramo-Tello C, Yamout B, Khoury SJ, La Spitaleri D, Sa MJ, Blanco Y, Granella F, Slee M, Butler E, Sidhom Y, Gouider R, Bergamaschi R, Karabudak R, Ampapa R, Sánchez-Menoyo JL, Prevost J, Castillo-Trivino T, McCombe PA, Macdonell R, Laureys G, Van Hijfte L, Oh J, Altintas A, de Gans K, Turkoglu R, van der Walt A, Butzkueven H, Vucic S, Barnett M, Cristiano E, Hodgkinson S, Iuliano G, Kappos L, Kuhle J, Shaygannejad V, Soysal A, Weinstock-Guttman B, Van Wijmeersch B, Kalincik T. Disability accrual in primary and secondary progressive multiple sclerosis. J Neurol Neurosurg Psychiatry 2023; 94:707-717. [PMID: 37068931 DOI: 10.1136/jnnp-2022-330726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/29/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Some studies comparing primary and secondary progressive multiple sclerosis (PPMS, SPMS) report similar ages at onset of the progressive phase and similar rates of subsequent disability accrual. Others report later onset and/or faster accrual in SPMS. Comparisons have been complicated by regional cohort effects, phenotypic differences in sex ratio and management and variable diagnostic criteria for SPMS. METHODS We compared disability accrual in PPMS and operationally diagnosed SPMS in the international, clinic-based MSBase cohort. Inclusion required PPMS or SPMS with onset at age ≥18 years since 1995. We estimated Andersen-Gill hazard ratios for disability accrual on the Expanded Disability Status Scale (EDSS), adjusted for sex, age, baseline disability, EDSS score frequency and drug therapies, with centre and patient as random effects. We also estimated ages at onset of the progressive phase (Kaplan-Meier) and at EDSS milestones (Turnbull). Analyses were replicated with physician-diagnosed SPMS. RESULTS Included patients comprised 1872 with PPMS (47% men; 50% with activity) and 2575 with SPMS (32% men; 40% with activity). Relative to PPMS, SPMS had older age at onset of the progressive phase (median 46.7 years (95% CI 46.2-47.3) vs 43.9 (43.3-44.4); p<0.001), greater baseline disability, slower disability accrual (HR 0.86 (0.78-0.94); p<0.001) and similar age at wheelchair dependence. CONCLUSIONS We demonstrate later onset of the progressive phase and slower disability accrual in SPMS versus PPMS. This may balance greater baseline disability in SPMS, yielding convergent disability trajectories across phenotypes. The different rates of disability accrual should be considered before amalgamating PPMS and SPMS in clinical trials.
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Affiliation(s)
- Sam Harding-Forrester
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Izanne Roos
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ai-Lan Nguyen
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Charles B Malpas
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ibrahima Diouf
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nahid Moradi
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Sifat Sharmin
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Guillermo Izquierdo
- Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena, Sevilla, Andalucía, Spain
| | - Sara Eichau
- Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena, Sevilla, Andalucía, Spain
| | - Francesco Patti
- Neuroscience, Department of Surgical and Medical Sciences and Advanced Technologies 'G.F. Ingrassia', University of Catania, Catania, Italy
| | - Dana Horakova
- Department of Neurology and Centre of Clinical Neuroscience, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Centre of Clinical Neuroscience, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Alexandre Prat
- Centre Hospitalier, Université de Montréal, Montreal, Québec, Canada
- Department of Neuroscience, Université de Montréal, Montreal, Québec, Canada
| | - Marc Girard
- Centre Hospitalier, Université de Montréal, Montreal, Québec, Canada
- Faculté de Médecine, Université de Montréal, Montreal, Québec, Canada
| | - Pierre Duquette
- Centre Hospitalier, Université de Montréal, Montreal, Québec, Canada
- Faculté de Médecine, Université de Montréal, Montreal, Québec, Canada
| | | | - Marco Onofrj
- Department of Neurosciences, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Pierre Grammond
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches du Québec Centre de Recherche, Levis, Québec, Canada
| | - Serkan Ozakbas
- Department of Neurology, Dokuz Eylul University, İzmir, Turkey
| | - Maria Pia Amato
- Department of Neurological Siences, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Oliver Gerlach
- Department of Neurology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Patrizia Sola
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliero-Universitaria di Modena, Modena, Emilia-Romagna, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Katherine Buzzard
- Department of Neurology, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Olga Skibina
- Department of Neurology, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Raed Alroughani
- Department of Medicine, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Cavit Boz
- Department of Neurology, Karadeniz Technical University, Trabzon, Turkey
| | - Vincent Van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | | | | | - Cristina Ramo-Tello
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Bassem Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Neurology, American University of Beirut, Beirut, Lebanon
| | - Samia Joseph Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
- American University of Beirut, Beirut, Lebanon
| | | | - Maria Jose Sa
- Department of Neurology, Centro Hospitalar de São João, Porto, Portugal
- Health Sciences Faculty, Fernando Pessoa University, Porto, Portugal
| | - Yolanda Blanco
- Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Franco Granella
- Multiple Sclerosis Centre, Neurosciences, University of Parma, Parma, Italy
| | - Mark Slee
- Department of Neurology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Ernest Butler
- Department of Neurology, Monash Medical Centre Clayton, Clayton, Victoria, Australia
| | - Youssef Sidhom
- Department of Neurology, Hopital Razi, La Manouba, Tunisia
| | - Riadh Gouider
- Department of Neurology, Razi Hospital, Rasht, Gilan, Iran
| | | | - Rana Karabudak
- Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Radek Ampapa
- Department of Neurology, Nemocnice Jihlava, Jihlava, Czech Republic
| | | | - Julie Prevost
- Centre integre de sante et de services sociaux des Laurentides point de service de Saint-Jerome, Saint-Jerome, Quebec, Canada
| | | | - Pamela A McCombe
- UQCCR, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Richard Macdonell
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Guy Laureys
- Department of Neurology, University Hospital Ghent, Gent, Oost-Vlaanderen, Belgium
| | - Liesbeth Van Hijfte
- Department of Neurology, University Hospital Ghent, Gent, Oost-Vlaanderen, Belgium
| | - Jiwon Oh
- Division of Neurology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ayse Altintas
- Department of Neurology, Koc Universitesi, Istanbul, Turkey
- Koç University Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey
| | - Koen de Gans
- Department of Neurology, Groene Hart Ziekenhuis, Gouda, Zuid-Holland, The Netherlands
| | - Recai Turkoglu
- Department of Neurology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Anneke van der Walt
- Multiple Sclerosis and Neuroimmunology Unit, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Department of Neurology, The Alfred, Melbourne, Victoria, Australia
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Michael Barnett
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Buenos Aires, Federal District, Argentina
| | - Suzanne Hodgkinson
- Department of Neurology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, Basel, Switzerland
- Research Centre for Clinical Neuroimmunology and Neuroscience, University Hospital Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, Basel, Switzerland
- Research Centre for Clinical Neuroimmunology and Neuroscience, University Hospital Basel, Basel, Switzerland
| | - Vahid Shaygannejad
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aysun Soysal
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Bianca Weinstock-Guttman
- Department of Neurology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Bart Van Wijmeersch
- Universitair MS Centrum, Hasselt University, Hasselt-Pelt, Belgium
- Rehabilitation & MS Centre, Pelt, Belgium
| | - Tomas Kalincik
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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De Masi R, Orlando S, Leo C, Pasca M, Anzilli L, Costa MC. Multi-Criterial Model for Weighting Biological Risk Factors in Multiple Sclerosis: Clinical and Health Insurance Implications. Healthcare (Basel) 2023; 11:2420. [PMID: 37685453 PMCID: PMC10487566 DOI: 10.3390/healthcare11172420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/08/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
The etiology of Multiple Sclerosis (MS) remains undetermined. Its pathogenic risk factors are thought to play a negligible role individually in the development of the disease, instead assuming a pathogenic role when they interact with each other. Unfortunately, the statistical weighting of this pathogenic role in predicting MS risk is currently elusive, preventing clinical and health insurance applications. Here, we aim to develop a population-based multi-criterial model for weighting biological risk factors in MS; also, to calculate the individual MS risk value useful for health insurance application. Accordingly, among 596 MS patients retrospectively assessed at the time of diagnosis, the value of vitamin D < 10 nm/L, BMI (Body Mass Index) < 15 Kg/m2 and >30 Kg/m2, female sex, degree of family kinship, and the range of age at onset of 20-45 years were considered as biological risk factors for MS. As a result, in a 30-year-old representative patient having a BMI of 15 and second degree of family kinship for MS, the major developmental contributor for disease is the low vitamin D serum level of 10 nm/L, resulting in an MS risk of 0.110 and 0.106 for female and male, respectively. Furthermore, the Choquet integral applied to uncertain variables, such as biological risk factors, evidenced the family kinship as the main contributor, especially if coincident with the others, to the MS risk. This model allows, for the first time, for the risk stratification of getting sick and the application of the health insurance in people at risk for MS.
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Affiliation(s)
- Roberto De Masi
- Complex Operative Unit of Neurology, “F. Ferrari” Hospital, Casarano, 73042 Lecce, Italy
- Laboratory of Neuroproteomics, Multiple Sclerosis Centre, “F. Ferrari” Hospital, Casarano, 73042 Lecce, Italy
| | - Stefania Orlando
- Laboratory of Neuroproteomics, Multiple Sclerosis Centre, “F. Ferrari” Hospital, Casarano, 73042 Lecce, Italy
| | - Chiara Leo
- Department of Management, Economics, Mathematics and Statistics, University of Salento, 73100 Lecce, Italy
| | - Matteo Pasca
- Complex Operative Unit of Neurology, “F. Ferrari” Hospital, Casarano, 73042 Lecce, Italy
| | - Luca Anzilli
- Department of Management, Economics, Mathematics and Statistics, University of Salento, 73100 Lecce, Italy
| | - Maria Carmela Costa
- Complex Operative Unit of Ophthalmology, “V. Fazzi” Hospital, 73100 Lecce, Italy
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7
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Zhang Y, Ren R, Yang L, Zhang H, Shi Y, Vitiello MV, Sanford LD, Tang X. Sleep in multiple sclerosis: a systematic review and meta-analysis of polysomnographic findings. J Clin Sleep Med 2023; 19:253-265. [PMID: 36117421 PMCID: PMC9892728 DOI: 10.5664/jcsm.10304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVES This study aims to explore the polysomnographically measured sleep differences between patients with multiple sclerosis (MS) and healthy control patients. METHODS An electronic literature search was conducted in EMBASE, MEDLINE, all EBM databases, CINAHL, and PsycINFO from inception to March 2022. A random-effects model was applied to explore the pooled effect sizes of polysomnographic differences between patients with MS and control patients. RESULTS Thirteen studies were identified for meta-analysis. The meta-analyses revealed significant reductions in stage N2 sleep and sleep efficiency and increases in wake time after sleep onset, the periodic limb movement index, and the periodic limb movement arousal index in patients with MS compared with control patients. Meta-regression analyses showed that some of the heterogeneity was explained by age and daytime sleepiness of patients with MS. CONCLUSIONS Our study showed that polysomnographic abnormalities are present in MS. Our findings also underscore the need for a comprehensive polysomnographic assessment of sleep changes in patients with MS. Furthermore, the effects of age and daytime sleepiness in patients with MS on sleep changes should also be carefully considered and closely monitored in the management of MS. CITATION Zhang Y, Ren R, Yang L, et al. Sleep in multiple sclerosis: a systematic review and meta-analysis of polysomnographic findings. J Clin Sleep Med. 2023;19(2):253-265.
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Affiliation(s)
- Ye Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Linghui Yang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Haipeng Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Shi
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Michael V. Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Larry D. Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, Virginia
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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Multiple Sclerosis in Mongolia; the First Study Exploring Predictors of Disability and Depression in Mongolian MS Patients. PATHOPHYSIOLOGY 2023; 30:15-26. [PMID: 36810422 PMCID: PMC9944952 DOI: 10.3390/pathophysiology30010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
Mongolia is located at 45° north latitude in the center of the Asian continent, and about 80% of the territory is at 1000 m above sea level. Epidemiologically, multiple sclerosis (MS) has not been investigated in Mongolia, although there have been a few MS case reports. We investigated the characteristics of MS in Mongolia for the first time, focusing on the association between MS-related parameters and depression levels. We initiated cross-sectional analyses, using data from 27 MS patients aged 20 to 60 years in Ulaanbaatar, Mongolia. The patients completed a questionnaire on their lifestyles and clinical information. We classified the MS patients on the basis of disability levels using the expanded disability status scale (EDSS) scores: 11.1% mild disability and 88.9% moderate to severe disability (median EDSS score, 5.5). We also classified the patients on the basis of depression levels using the 9-item patient health questionnaire (PHQ-9) scores: 44.4% mild depression, 40.7% moderate depression, and 14.8% severe depression (mean PHQ-9's score, 9.96 ± 5.05). We used multivariate logistical regression analyses to identify predictors of EDSS or PHQ-9 scores. Disability levels were associated with vision and balance problems. Depression levels were associated with corticosteroid treatment; no patients were treated with disease-modifying drugs (DMDs). The odds ratios for disease onset age and treatment duration were associated with EDSS scores. In conclusion, MS onset age and treatment duration were independent predicting factors influencing the level of disability. Appropriate DMD treatment would lower the disability and depression levels.
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Alsaedi EQ, Alsaedi MQ, Mansuri FA. Clinical Profile and the Extent of Disability in Multiple Sclerosis Patients in Madinah, Saudi Arabia. Cureus 2022; 14:e25851. [PMID: 35832757 PMCID: PMC9272901 DOI: 10.7759/cureus.25851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2022] [Indexed: 11/07/2022] Open
Abstract
Objectives: The objective is to study the demographics and clinical characteristics of Saudi multiple sclerosis (MS) patients in Madinah, Saudi Arabia, and assess their extent of disability using the Expanded Disability Status Scale (EDSS). Methods: This hospital-based study intended to address the population of all MS-diagnosed patients registered between 2018 and 2021 in the Neurology Department of King Fahad Hospital in the Madinah region. Data were gathered from medical records and by interviewing participants in the Neurology Clinic. The chi-square test and linear and logistic regression were applied to draw inferences. Results: A total of 195 MS-diagnosed patients were included in the analysis. Of these, 72.3% were female. The mean age of the total sample was 34.9±9.2 years, and 7.7% reported a positive family history. Of all patients, 17.9% (n=35) had comorbidities. The mean age at diagnosis was 29.3±8.2 years. The majority (85.6%) were diagnosed with relapsing-remitting multiple sclerosis (RRMS); 77.9% had an EDSS score between 0.0 and 1.5, showing little or no disability. A statistical significance existed between EDSS and the current age of the patients (p=0.004), age at onset (p=0.007), type of MS (p=0.000), presence of muscle weakness (p=0.044), bladder or bowel difficulties at onset (p=0.043), and the duration of MS (p=0.000). Of the patients, 23.6% were not using disease-modifying therapy (DMT). The most commonly used drug was interferon beta 1-b. Conclusion: A lower EDSS was associated with younger age, diagnosis at a younger age, RRMS, duration less than five years, and lower body mass index (BMI). To increase the generalizability of findings, a national MS registry system and further prospective analytical epidemiological research studies are recommended.
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Groome PA, Webber C, Maxwell CJ, McClintock C, Seitz D, Mahar A, Marrie RA. Multiple Sclerosis and the Cancer Diagnosis: Diagnostic Route, Cancer Stage, and the Diagnostic Interval in Breast and Colorectal Cancer. Neurology 2022; 98:e1798-e1809. [PMID: 35501160 DOI: 10.1212/wnl.0000000000200163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The multiple sclerosis (MS) population's survival from breast cancer and colorectal cancer is compromised. Cancer screening and timely diagnoses affect cancer survival and have not been studied in the MS cancer population. We investigated whether the diagnostic route, cancer stage, or diagnostic interval differed in patients with cancer with and without MS. METHODS We conducted a matched population-based cross-sectional study of breast cancers (2007-2015) and colorectal cancers (2009-2012) in patients with MS from Ontario, Canada, using administrative data. Exclusion criteria included second or concurrent primary cancers, no health care coverage, and, for the patients without MS, those with any demyelinating disease. We based 1:4 matching of MS to non-MS on birth year, sex (colorectal only), postal code, and cancer diagnosis year (breast only). Cancer outcomes were diagnostic route (screen-detected vs symptomatic), stage (stage I vs all others), and diagnostic interval (time from first presentation to diagnosis). Multivariable regression analyses controlled for age, sex (colorectal only), diagnosis year, income quintile, urban/rural residence, and comorbidity. RESULTS We included 351 patients with MS and breast cancer, 1,404 matched patients with breast cancer without MS, 54 patients with MS and colorectal cancer, and 216 matched patients with colorectal cancer without MS. MS was associated with fewer screen-detected cancers in breast (odds ratio [OR] 0.68 [95% CI 0.52, 0.88]) and possibly colorectal (0.52 [0.21, 1.28]) cancer. MS was not associated with differences in breast cancer stage at diagnosis (stage I cancer, OR 0.81 [0.64, 1.04]). MS was associated with greater odds of stage I colorectal cancer (OR 2.11 [1.03, 4.30]). The median length of the diagnostic interval did not vary between people with and without MS in either the breast or colorectal cancer cohorts. Controlling for disability status attenuated some findings. DISCUSSION Breast cancers were less likely to be detected through screening and colorectal cancer more likely to be detected at early stage in people with MS than without MS. MS-related disability may prevent people from getting mammograms and colonoscopies. Understanding the pathways to earlier detection in both cancers is critical to developing and planning interventions to ameliorate outcomes for people with MS and cancer.
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Affiliation(s)
- Patti A Groome
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Colleen Webber
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Colleen J Maxwell
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Chad McClintock
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Dallas Seitz
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alyson Mahar
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- From ICES Queen's (P.A.G., C.M., D.S., A.M.) and Division of Cancer Care and Epidemiology, Cancer Research Institute (P.A.G.), Queen's University, Kingston; Ottawa Hospital Research Institute (C.W.); Bruyère Research Institute (C.W.), Ottawa; ICES (C.J.M.), Toronto; Schools of Pharmacy and Public Health & Health Systems (C.J.M.), University of Waterloo; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Department of Community Health Sciences (A.M., R.A.M.), Manitoba Centre for Health Policy (A.M.), and Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Age-related changes in multiple sclerosis and experimental autoimmune encephalomyelitis. Semin Immunol 2022; 59:101631. [PMID: 35752572 DOI: 10.1016/j.smim.2022.101631] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 01/15/2023]
Abstract
A better understanding of the pathological mechanisms that drive neurodegeneration in people living with multiple sclerosis (MS) is needed to design effective therapies to treat and/or prevent disease progression. We propose that CNS-intrinsic inflammation and re-modelling of the sub-arachnoid space of the leptomeninges sets the stage for neurodegeneration from the earliest stages of MS. While neurodegenerative processes are clinically silent early in disease, ageing results in neurodegenerative changes that become clinically manifest as progressive disability. Here we review pathological correlates of MS disease progression, highlight emerging mouse models that mimic key progressive changes in MS, and provide new perspectives on therapeutic approaches to protect against MS-associated neurodegeneration.
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Marrie RA, Tan Q, Ekuma O, Marriott JJ. Development and Internal Validation of a Disability Algorithm for Multiple Sclerosis in Administrative Data. Front Neurol 2021; 12:754144. [PMID: 34795632 PMCID: PMC8592934 DOI: 10.3389/fneur.2021.754144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/11/2021] [Indexed: 12/04/2022] Open
Abstract
Objective: We developed and internally validated an algorithm for disability status in multiple sclerosis (MS) using administrative data. Methods: We linked administrative data from Manitoba, Canada to a clinical dataset with Expanded Disability Status Scale (EDSS) scores for people with MS. Clinical EDSS scores constituted the reference standard. We created candidate indicators using the administrative data. These included indicators based on use of particular health care services (home care, long-term care, rehabilitation admission), use of specific diagnostic codes (such as spasticity, quadriplegia), and codes based on use of Employment and Income Insurance. We developed algorithms to predict severe disability (EDSS ≥6.0), and to predict disability as a continuous measure. We manually developed algorithms, and also employed regression approaches. After we selected our preferred algorithms for disability, we tested their association with health care use due to any cause and infection after potential confounders. Results: We linked clinical and administrative data for 1,767 persons with MS, most of whom were women living in urban areas. All individual indicators tested had specificities >90% for severe disability, and all but a diagnosis of visual disturbance had positive predictive values (PPV) >70%. The combination of home care or long-term care use or rehabilitation admission had a sensitivity of 61.9%, specificity of 90.76%, PPV of 70.06% and negative predictive of 87.21%. Based on regression modeling, the best-performing algorithm for predicting the EDSS as a continuous variable included age, home care use, long-term care admission, admission for rehabilitation, visual disturbance, other paralytic syndromes and spasticity. The mean difference between observed and predicted values of the EDSS was −0.0644 (95%CI −0.1632, 0.0304). Greater disability, whether measured using the clinical EDSS or either of the administrative data algorithms was similarly associated with increased hospitalization rates due to any cause and infection. Conclusion: We developed and internally validated an algorithm for disability in MS using administrative data that may support population-based studies that wish to account for disability status but do not have access to clinical data sources with this information. We also found that more severe disability is associated with increased health care use, including due to infection.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Qier Tan
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James J Marriott
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Tintore M, Cobo-Calvo A, Carbonell P, Arrambide G, Otero-Romero S, Río J, Tur C, Comabella M, Nos C, Arévalo MJ, Midaglia L, Galán I, Vidal-Jordana A, Castilló J, Rodríguez-Acevedo B, Zabalza de Torres A, Salerno A, Auger C, Sastre-Garriga J, Rovira À, Montalban X. Effect of Changes in MS Diagnostic Criteria Over 25 Years on Time to Treatment and Prognosis in Patients With Clinically Isolated Syndrome. Neurology 2021; 97:e1641-e1652. [PMID: 34521693 DOI: 10.1212/wnl.0000000000012726] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 08/12/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To explore whether time to diagnosis, time to treatment initiation, and age to reach disability milestones have changed in patients with clinically isolated syndrome (CIS) according to different multiple sclerosis (MS) diagnostic criteria periods. METHODS This retrospective study was based on data collected prospectively from the Barcelona-CIS cohort between 1994 and 2020. Patients were classified into 5 periods according to different MS criteria, and the times to MS diagnosis and treatment initiation were evaluated. The age at which patients with MS reached an Expanded Disability Status Scale (EDSS) score ≥3.0 was assessed by Cox regression analysis according to diagnostic criteria periods. Last, to remove the classic Will Rogers phenomenon by which the use of different MS criteria over time might result in a changes of prognosis, the 2017 McDonald criteria were applied, and age at EDSS score ≥3.0 was assessed by Cox regression. RESULTS In total, 1,174 patients were included. The median time from CIS to MS diagnosis and from CIS to treatment initiation showed a 77% and 82% reduction from the Poser to the McDonald 2017 diagnostic criteria periods, respectively. Patients of a given age diagnosed in more recent diagnostic criteria periods had a lower risk of reaching an EDSS score ≥3.0 than patients of the same age diagnosed in earlier diagnostic periods (reference category Poser period): adjusted hazard ratio (aHR) 0.47 (95% confidence interval 0.24-0.90) for McDonald 2001, aHR 0.25 (0.12-0.54) for McDonald 2005, aHR 0.30 (0.12-0.75) for McDonald 2010, and aHR 0.07 (0.01-0.45) for McDonald 2017. Patients in the early-treatment group displayed an aHR of 0.53 (0.33-0.85) of reaching age at EDSS score ≥3.0 compared to those in the late-treatment group. Changes in prognosis together with early-treatment effect were maintained after the exclusion of possible bias derived from the use of different diagnostic criteria over time (Will Rogers phenomenon). DISCUSSION A continuous decrease in the time to MS diagnosis and treatment initiation was observed across diagnostic criteria periods. Overall, patients diagnosed in more recent diagnostic criteria periods displayed a lower risk of reaching disability. The prognostic improvement is maintained after the Will Rogers phenomenon is discarded, and early treatment appears to be the most likely contributing factor.
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Affiliation(s)
- Mar Tintore
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain.
| | - Alvaro Cobo-Calvo
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Pere Carbonell
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Georgina Arrambide
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Susana Otero-Romero
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jordi Río
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Carmen Tur
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Manuel Comabella
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Carlos Nos
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - María Jesús Arévalo
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Luciana Midaglia
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Ingrid Galán
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Angela Vidal-Jordana
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Joaquin Castilló
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Ana Zabalza de Torres
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Annalaura Salerno
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Cristina Auger
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jaume Sastre-Garriga
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Àlex Rovira
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
| | - Xavier Montalban
- From the Department of Neurology/Neuroimmunology (M.T., A.C.-C., P.C., G.A., S.O.-R., J.R., C.T., M.C., C.N., M.J.A., L.M., I.G., A.V.-J., J.C., B.R.-A., A.Z., J.S.-G., X.M.) Centre d'Esclerosi Múltiple de Catalunya (Cemcat), and Department of Radiology (IDI) (A.S., C.A., À.R.), Section of Neuroradiology and Magnetic Resonance Unit, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain
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14
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Oh J, Vukusic S, Tiel-Wilck K, Inshasi JS, Rog D, Baker DP, Pyatkevich Y, Poole EM, Vermersch P. Efficacy and Safety of Teriflunomide in Multiple Sclerosis across Age Groups: Analysis from Pooled Pivotal and Real-world Studies. J Cent Nerv Syst Dis 2021; 13:11795735211028781. [PMID: 34377047 PMCID: PMC8330455 DOI: 10.1177/11795735211028781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Evidence suggests that efficacy and safety of disease-modifying treatments for multiple sclerosis may differ with age. We evaluate efficacy and safety of teriflunomide across age subgroups of patients from pooled clinical trials and real-world studies. Methods: Post hoc analyses of patients who received teriflunomide 14 mg in the pooled phase II and III TEMSO, TOWER, TENERE, and TOPIC core and extension studies (n = 1978), and the real-world Teri-PRO (n = 928) and TAURUS-MS I (n = 1126) studies were conducted. Data were stratified by age at study entry: ⩽25, >25 to ⩽35, >35 to ⩽45, and >45 years. In Teri-PRO and TAURUS-MS I, an additional group, >55 years, was assessed. Results: In the pooled core studies, teriflunomide reduced annualized relapse rate (ARR) versus placebo across all ages. Unadjusted ARRs remained low across age groups in pooled extensions (0.18-0.30), Teri-PRO (0.10-0.35), and TAURUS-MS I (0.14-0.35). Baseline Expanded Disability Status Scale scores were higher with age, but stable through core and extension studies (mean increases over 7 years: ⩽25 years, +0.59; >25 to ⩽35 years, +0.46; >35 to ⩽45 years, +0.35; >45 years, +0.81). Across age groups, adverse event (AE) incidences were 78.4% to 90.7% in pooled core and extension studies and Teri-PRO, and 29.2% to 37.7% in TAURUS-MS I; serious AE incidences were ⩽21.3% in all studies. In pooled phase III and Teri-PRO studies, lymphocyte count decreases over 1 year after initiating teriflunomide, and proportions of patients developing lymphopenia, were small across age groups. Conclusions: Teriflunomide efficacy was demonstrated regardless of age. Safety was generally consistent across age groups.
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Affiliation(s)
- Jiwon Oh
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Sandra Vukusic
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation et Fondation Eugène Devic EDMUS Pour la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon-Bron, France.,Centre des Neurosciences de Lyon, INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France.,Université Claude Bernard Lyon 1, Villeurbanne, France
| | | | | | - David Rog
- Manchester Centre for Clinical Neurosciences, Salford, UK
| | | | - Yelena Pyatkevich
- Sanofi, Cambridge, MA, USA.,Takeda Pharmaceutical, Cambridge, MA, USA
| | | | - Patrick Vermersch
- Universite de Lille, Inserm U1172, CHU Lille, FHU Precise, Lille, France
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15
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Motl RW, Cutter G, Bamman MM, Brown CJ, Rinker J. The Importance and Opportunity for Healthy Aging Through Lifestyle, Behavior Medicine Among Older Adults With Multiple Sclerosis: the Case Based on Physical Activity. Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-021-00680-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Miner AE, Graves JS. What telomeres teach us about MS. Mult Scler Relat Disord 2021; 54:103084. [PMID: 34371369 DOI: 10.1016/j.msard.2021.103084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/14/2021] [Accepted: 06/09/2021] [Indexed: 02/03/2023]
Abstract
While the precise mechanisms driving progressive forms of MS are not fully understood, patient age has clear impact on disease phenotype. The very young with MS have high relapse rates and virtually no progressive disease, whereas older patients tend to experience more rapid disability accumulation with few relapses. Defining a patient's biological age may offer more precision in determining the role of aging processes in MS phenotype and pathophysiology than just working with an individual's birthdate. The most well recognized measurement of an individual's "biological clock" is telomere length (TL). While TL may differ across tissue types in an individual, most cells TL correlate well with leukocyte TL (LTL), which is the most common biomarker used for aging. LTL has been associated with risk for aging related diseases and most recently with higher levels of disability and brain atrophy in people living with MS. LTL explains 15% of the overall association of chronological age with MS disability level. While LTL may be used just as a biomarker of overall somatic aging processes, triggering of the DNA damage response by telomere attrition leads to senescence pathways that are likely highly relevant to a chronic autoimmune disease. Considering reproductive aging factors, particularly ovarian aging in women, which correlates with LTL and oocyte telomere length, may complement measurements of somatic aging in understanding MS progression. The key to stopping non-relapse related progression in MS might lie in targeting pathways related to biological aging effects on the immune and nervous systems.
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Affiliation(s)
- Annalise E Miner
- Department of Neurosciences, University of California, San Diego, USA
| | - Jennifer S Graves
- Department of Neurosciences, University of California, San Diego, USA.
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17
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Speed but Not Smoothness of Gait Reacts to Rehabilitation in Multiple Sclerosis. Mult Scler Int 2021; 2021:5589562. [PMID: 34123427 PMCID: PMC8192191 DOI: 10.1155/2021/5589562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Improved gait is one of the leading therapy goals in multiple sclerosis. A plethora of clinical timed trials and state-of-the-art technology-based approaches are available to assess gait performance. Objectives To examine what aspects of gait react to inpatient rehabilitation in MS and which parameters should be best assessed. Design In this longitudinal study, we examined the performance of 76 patients with MS to shed further light on factors influencing gait, associations between tests, and the reaction to inpatient rehabilitation during an average time span of 16 d. Setting. Private specialist clinic for inpatient neurorehabilitation. Main Outcome Measures. Clinical walk tests (timed 25-foot walk test at normal pace, maximum pace over 10 m or 6 min) and IMU-based measures of movement smoothness. Results All gait parameters were strongly intercorrelated (all p < 0.05), and a model multiple linear regression for the 6MWT revealed short distance velocity (10 m) and movement smoothness as predictors in a strong model (R2adjusted 0.75, p < 0.01). A second model with natural pace on short distance and movement smoothness was almost equally strong (R2adjusted 0.71, p < 0.01). Patients improved their walking speed (p < 0.01), but not smoothness (p = 0.08–0.12), over the course of rehabilitation. Conclusions Since we were not able to observe improvements in smoothness of gait, we conclude that rehabilitation programs should be adapted to the patient's physiological capacities in order to allow for such improvements in smoothness of gait. Externally valid gait capacity (6MWT) could be predicted by a single walk for 10 s at natural pace.
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18
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Mathey G, Ancel T, Garot T, Soudant M, Pittion-Vouyovitch S, Guillemin F, Debouverie M, Epstein J. Clinical and radiological activity of secondary progressive multiple sclerosis in a population-based cohort. Eur J Neurol 2021; 28:2238-2248. [PMID: 33838072 DOI: 10.1111/ene.14861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/07/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Patients with secondary progressive multiple sclerosis (SP MS) and clinical and/or radiological activity could be the more likely to benefit from disease-modifying treatments. To evaluate the proportions each year after progression onset, patients with SP MS onset between 2002 and 2012 from a population-based multiple sclerosis registry in northeastern France were studied. METHODS Progression onset was first identified by the neurologist's diagnosis (N cohort), and then by using an automated data-driven definition (D cohort). In a given year after onset of progression, clinical activity was defined as at least one relapse, and radiological activity as at least one new T2 and/or gadolinium-enhancing lesion. A multivariate mixed logistic regression was used to assess factors associated with activity during the year. RESULTS In the N cohort, amongst 833 patients with SP MS with a median follow-up of 8 years, 10.0%-14.8% had at least one relapse in a year during the first 5 years of progression. Including both clinical and radiological activity increased these proportions to 11.9%-23.7%, with the proportion having a magnetic resonance imaging scan in the year ranging from 29.8% to 40.5%. The first year of progression, a young age and a high relapse rate during the 5 years before progression were associated with activity in a given year. The D cohort results confirmed these findings. CONCLUSIONS A substantial proportion of patients with SP MS present disease activity. Further studies should evaluate the impact of disease-modifying treatments on the disease course of these patients.
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Affiliation(s)
- Guillaume Mathey
- Department of Neurology, Nancy University Hospital, Nancy, France.,Université de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Thomas Ancel
- Department of Neurology, Nancy University Hospital, Nancy, France
| | - Teresa Garot
- CIC-EC 1433, CHRU, Inserm, Université de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Marc Soudant
- CIC-EC 1433, CHRU, Inserm, Université de Lorraine, Vandoeuvre-Lès-Nancy, France
| | | | - Francis Guillemin
- Université de Lorraine, Vandoeuvre-Lès-Nancy, France.,CIC-EC 1433, CHRU, Inserm, Université de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Marc Debouverie
- Department of Neurology, Nancy University Hospital, Nancy, France.,Université de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Jonathan Epstein
- Université de Lorraine, Vandoeuvre-Lès-Nancy, France.,CIC-EC 1433, CHRU, Inserm, Université de Lorraine, Vandoeuvre-Lès-Nancy, France
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19
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Elser H, Parks RM, Moghavem N, Kiang MV, Bozinov N, Henderson VW, Rehkopf DH, Casey JA. Anomalously warm weather and acute care visits in patients with multiple sclerosis: A retrospective study of privately insured individuals in the US. PLoS Med 2021; 18:e1003580. [PMID: 33901187 PMCID: PMC8109782 DOI: 10.1371/journal.pmed.1003580] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/10/2021] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As the global climate changes in response to anthropogenic greenhouse gas emissions, weather and temperature are expected to become increasingly variable. Although heat sensitivity is a recognized clinical feature of multiple sclerosis (MS), a chronic demyelinating disorder of the central nervous system, few studies have examined the implications of climate change for patients with this disease. METHODS AND FINDINGS We conducted a retrospective cohort study of individuals with MS ages 18-64 years in a nationwide United States patient-level commercial and Medicare Advantage claims database from 2003 to 2017. We defined anomalously warm weather as any month in which local average temperatures exceeded the long-term average by ≥1.5°C. We estimated the association between anomalously warm weather and MS-related inpatient, outpatient, and emergency department visits using generalized log-linear models. From 75,395,334 individuals, we identified 106,225 with MS. The majority were women (76.6%) aged 36-55 years (59.0%). Anomalously warm weather was associated with increased risk for emergency department visits (risk ratio [RR] = 1.043, 95% CI: 1.025-1.063) and inpatient visits (RR = 1.032, 95% CI: 1.010-1.054). There was limited evidence of an association between anomalously warm weather and MS-related outpatient visits (RR = 1.010, 95% CI: 1.005-1.015). Estimates were similar for men and women, strongest among older individuals, and exhibited substantial variation by season, region, and climate zone. Limitations of the present study include the absence of key individual-level measures of socioeconomic position (i.e., race/ethnicity, occupational status, and housing quality) that may determine where individuals live-and therefore the extent of their exposure to anomalously warm weather-as well as their propensity to seek treatment for neurologic symptoms. CONCLUSIONS Our findings suggest that as global temperatures rise, individuals with MS may represent a particularly susceptible subpopulation, a finding with implications for both healthcare providers and systems.
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Affiliation(s)
- Holly Elser
- Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
| | - Robbie M. Parks
- Earth Institute, Columbia University, New York, New York, United States of America
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Nuriel Moghavem
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States of America
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, United States of America
| | - Nina Bozinov
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States of America
| | - Victor W. Henderson
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States of America
| | - David H. Rehkopf
- Center for Population Health Sciences, Stanford, California, United States of America
| | - Joan A. Casey
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
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20
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Uher T, Krasensky J, Malpas C, Bergsland N, Dwyer MG, Kubala Havrdova E, Vaneckova M, Horakova D, Zivadinov R, Kalincik T. Evolution of Brain Volume Loss Rates in Early Stages of Multiple Sclerosis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/3/e979. [PMID: 33727311 PMCID: PMC7984675 DOI: 10.1212/nxi.0000000000000979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/05/2021] [Indexed: 11/15/2022]
Abstract
Objective To describe the dynamics of brain volume loss (BVL) at different stages of relapsing-remitting multiple sclerosis (RRMS), to describe the association between BVL and clinical measures, and to investigate an effect of treatment escalation on the rate of BVL. Methods Together, 1903 patients predominantly with RRMS from the Avonex-Steroids-Azathioprine cohort (N = 166), the study of early IFN-β1a treatment cohort (N = 180), and the quantitative MRI cohort (N = 1,557) with ≥2 MRI scans and ≥1-year of follow-up were included. Brain MRI scans (N = 7,203) were performed using a single 1.5-T machine. Relationships between age or disease duration and global and tissue-specific BVL rates were analyzed using mixed models. Results Age was not associated with the rate of BVL (β = −0.003; Cohen f2 = 0.0005; adjusted p = 0.39). Although disease duration was associated with the rate of BVL, its effect on the BVL rate was minimal (β = −0.012; Cohen f2 = 0.004; adjusted p = 4 × 10−5). Analysis of association between tissue-specific brain volume changes and age (β = −0.019 to −0.011; adjusted p = 0.028–1.00) or disease duration (β = −0.028 to −0.008; adjusted p = 0.16–0.96) confirmed these results. Although increase in the relapse rate (β = 0.10; adjusted p = 9 × 10−9), Expanded Disability Status Scale (EDSS; β = 0.17; adjusted p = 8 × 10−5), and EDSS change (β = 0.15; adjusted p = 2 × 10−5) were associated with accelerated rate of BVL, their effect on the rate of BVL was minimal (all Cohen f2 ≤ 0.007). In 94 patients who escalated therapy, the rate of BVL decreased following treatment escalation by 0.29% (β = −0.29; Cohen f2 = 0.133; p = 5.5 × 10−8). Conclusions The rate of BVL is relatively stable throughout the course of RRMS. The accelerated BVL is weakly associated with concurrent higher disease activity, and timely escalation to high-efficacy immunotherapy helps decrease the rate of BVL.
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Affiliation(s)
- Tomas Uher
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia.
| | - Jan Krasensky
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
| | - Charles Malpas
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
| | - Niels Bergsland
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
| | - Michael G Dwyer
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
| | - Eva Kubala Havrdova
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
| | - Manuela Vaneckova
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
| | - Dana Horakova
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
| | - Robert Zivadinov
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
| | - Tomas Kalincik
- From the CORe (T.U., C.M., T.K.), Department of Medicine, the University of Melbourne, VIC, Australia; Department of Neurology and Center of Clinical Neuroscience (T.U., E.K.H., D.H.), Charles University in Prague, 1st Faculty of Medicine and General University Hospital; Department of Radiology (J.K., M.V.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic; Buffalo Neuroimaging Analysis Center (N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York; and Melbourne MS Centre (T.K.), Department of Neurology, the Royal Melbourne Hospital, VIC, Australia
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21
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De Masi R, Orlando S, De Donno A. The Age-Related Efficacy of Dimethyl Fumarate and Natalizumab in the Real-World Management of Multiple Sclerosis. Pharmaceuticals (Basel) 2021; 14:ph14020081. [PMID: 33499269 PMCID: PMC7911127 DOI: 10.3390/ph14020081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 11/25/2022] Open
Abstract
We investigated the comparative age-related efficacy of dimethyl fumarate (DMF) and natalizumab (NTZ) in clinical practice on multiple sclerosis (MS). Research in this area is lacking in the previous literature. In a three-year retrospective and clinical–paraclinical study, we compared 173 DMF patients and 94 NTZ patients with a similar average age (40 years) and disease duration (DD) (10 years). Expanded Disability Status Scale (EDSS) scores were higher in the NTZ group than in the DMF group at 3.5 vs. 2.5, respectively (p = 0.001). However, in both groups, age values correlated with DD (r = 0.42; p < 0.001), EDSS (r = 0.52; p < 0.001) and age at onset (r = 0.18; p < 0.001). Furthermore, age-adjusted Kaplan–Meier curves showed that NTZ-treated subjects maintained a 1.0–3.0 EDSS status score (p = 0.003) more frequently and a 3.5–7.0 score (p = 0.022) significantly less frequently compared with DMF-treated subjects. The EDSS percentage mean difference between NTZ and DMF groups was 81.6%, decreasing inversely with age (r = −0.34; p < 0.001). Finally, high EDSS score values were reached at the age of 39–40 years, regardless of their experimental group. We demonstrated age as a major contributor in disability and response to therapy in current management of MS. Thus, age should be considered in the risk/benefit evaluation in decision making for the disease modifying treatments in MS.
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Affiliation(s)
- Roberto De Masi
- Laboratory of Neuroproteomics, Multiple Sclerosis Centre, “F. Ferrari” Hospital, 73042 Casarano, Lecce, Italy;
- Complex Operative Unit of Neurology, “F. Ferrari” Hospital, 73042 Casarano, Lecce, Italy
| | - Stefania Orlando
- Laboratory of Neuroproteomics, Multiple Sclerosis Centre, “F. Ferrari” Hospital, 73042 Casarano, Lecce, Italy;
- Correspondence: ; Tel.: +39-0833-508-412
| | - Antonella De Donno
- Laboratory of Hygiene, Department of Biological and Environmental Sciences and Technologies, University of the Salento, 73100 Lecce, Italy;
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22
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Rosso M, Healy BC, Saxena S, Paul A, Bjornevik K, Kuhle J, Benkert P, Leppert D, Guttmann C, Bakshi R, Weiner HL, Chitnis T. MRI Lesion State Modulates the Relationship Between Serum Neurofilament Light and Age in Multiple Sclerosis. J Neuroimaging 2021; 31:388-393. [DOI: 10.1111/jon.12826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Mattia Rosso
- Brigham and Women's Hospital Harvard Medical School Boston MA
- Ann Romney Center for Neurologic Diseases Harvard Medical School Boston MA
| | - Brian C. Healy
- Brigham and Women's Hospital Harvard Medical School Boston MA
- Ann Romney Center for Neurologic Diseases Harvard Medical School Boston MA
- Biostatistics Center Massachusetts General Hospital Boston MA
| | - Shrishti Saxena
- Brigham and Women's Hospital Harvard Medical School Boston MA
- Ann Romney Center for Neurologic Diseases Harvard Medical School Boston MA
| | - Anu Paul
- Brigham and Women's Hospital Harvard Medical School Boston MA
- Ann Romney Center for Neurologic Diseases Harvard Medical School Boston MA
| | - Kjetil Bjornevik
- Harvard T.H. Chan School of Public Health Harvard University Boston MA
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research University Hospital Basel University of Basel Basel Switzerland
| | - Pascal Benkert
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel University of Basel Basel Switzerland
| | - David Leppert
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research University Hospital Basel University of Basel Basel Switzerland
| | - Charles Guttmann
- Brigham and Women's Hospital Harvard Medical School Boston MA
- Ann Romney Center for Neurologic Diseases Harvard Medical School Boston MA
| | - Rohit Bakshi
- Brigham and Women's Hospital Harvard Medical School Boston MA
- Ann Romney Center for Neurologic Diseases Harvard Medical School Boston MA
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Howard L. Weiner
- Brigham and Women's Hospital Harvard Medical School Boston MA
- Ann Romney Center for Neurologic Diseases Harvard Medical School Boston MA
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Tanuja Chitnis
- Brigham and Women's Hospital Harvard Medical School Boston MA
- Ann Romney Center for Neurologic Diseases Harvard Medical School Boston MA
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital Harvard Medical School Boston MA
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23
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Klistorner S, Barnett MH, Yiannikas C, Barton J, Parratt J, You Y, Graham SL, Klistorner A. Expansion of chronic lesions is linked to disease progression in relapsing-remitting multiple sclerosis patients. Mult Scler 2020; 27:1533-1542. [PMID: 33215557 DOI: 10.1177/1352458520974357] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Slow-burning inflammation is putatively associated with lesion expansion and leads to progressive loss of axons and disability worsening. OBJECTIVE To investigate the incidence and extent of chronic white matter lesion expansion in relapsing-remitting multiple sclerosis (RRMS) patients and to evaluate its relationship with biomarkers of disease progression. METHODS Pre- and post-gadolinium T1, fluid-attenuated inversion recovery (FLAIR) and diffusion tensor images were acquired from 33 patients. Lesional activity were analysed between baseline and 48 months using custom-designed software. RESULTS A total of 569 lesions were identified as chronic at baseline, of which 261 were expanding, 236 were stable and 72 were shrinking. In addition, 139 new lesions (both confluent and free-standing) were observed. Chronic lesion expansion was associated with patient's age and accounted for the bulk (67.3%) of total brain lesion volume increase, while only 32.7% was attributable to new lesion formation. Change in chronic lesion volume correlated with the rate of brain atrophy (r = -0.57, p = 0.001), change of Expanded Disability Status Scale (EDSS; r = 0.38, p = 0.03) and an increase of isotropic diffusivity inside the lesions (r = 0.75, p < 0.001). CONCLUSION Expansion of chronic lesions in RRMS patients is the primary determinant of increased T2 total lesion load. It significantly contributes to disease progression and partially driving axonal loss inside the lesions and brain damage outside of lesional tissue.
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Affiliation(s)
- Samuel Klistorner
- Sydney Medical School, Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Michael H Barnett
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia/Sydney Neuroimaging Analysis Centre, Sydney, NSW, Australia
| | | | - Joshua Barton
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - John Parratt
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Yuyi You
- Sydney Medical School, Save Sight Institute, The University of Sydney, Sydney, NSW, Australia/Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Stuart L Graham
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Alexander Klistorner
- Sydney Medical School, Save Sight Institute, The University of Sydney, Sydney, NSW, Australia/Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
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24
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Xu L, Zhang LJ, Yang L, Yang CS, Yi M, Zhang SN, Wang N, Huang CN, Liu MQ. Positive association of herpes simplex virus-IgG with multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2020; 47:102633. [PMID: 33254090 DOI: 10.1016/j.msard.2020.102633] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common chronic inflammatory demyelinating disease of the central nervous system (CNS), and whether herpes simplex virus (HSV) infection is associated with the development of MS remains controversial. We aimed to investigate potential associations between MS or clinically isolated syndrome (CIS) and the prevalence of IgG and DNA for HSV in the clinical samples. METHODS A systematic search of English databases (PubMed, Embase and Cochrane Library) was performed. The prevalence of IgG against herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) and DNA for HSV-1 or HSV-2 in clinical samples were pooled and compared between patients with MS/CIS and controls using Stata 12.0. RESULTS A total of 1756 patients with MS/CIS and 6429 controls from eight studies were included. The pooled results showed a significantly statistical difference in the seroprevalence of IgG against HSV-2 (OR 1.764, 95% CI [1.410 to 2.206], P = 0.000) between patients with MS/CIS and controls. However, no significantly statistical difference was shown in the seroprevalence of IgG against HSV-1 (OR 1.166, 95% CI [0.737 to 1.845], P = 0.512) between patients with MS/CIS and controls. Similarly, there was no significantly statistical difference in the prevalence of HSV-1 DNA (OR 0.957, 95% CI [0.310 to 2.949], P = 0.938) and HSV-2 DNA in cerebrospinal fluid (CSF) and peripheral blood mononuclear cells (PBMC) (OR 0.506, 95% CI [0.022 to 11.416], P = 0.668) between patients with MS/CIS and controls. Subgroup analysis suggested that mean age at sampling might be a source of heterogeneity, and the seroprevalence of IgG against HSV-1 was significantly increased in the pediatric patients with MS/CIS (OR 1.488, 95% CI [1.130 to 1.959], P = 0.005), compared with the controls. CONCLUSIONS The study demonstrated that prior HSV-1 infection might relate to the onset of pediatric MS/CIS and might not play a role in the development of adult MS. Furthermore, prior HSV-2 infection might have a correlation with MS/CIS. The mechanism remains to be further studied.
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Affiliation(s)
- Lu Xu
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Lin-Jie Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.
| | - Li Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Chun-Sheng Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Yi
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Sheng-Nan Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Nan Wang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Chen-Na Huang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Ming-Qi Liu
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
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25
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Late onset multiple sclerosis is associated with more severe ventricle expansion. Mult Scler Relat Disord 2020; 46:102588. [PMID: 33296984 DOI: 10.1016/j.msard.2020.102588] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Late-onset multiple sclerosis (LOMS) is associated with faster disability progression than persons with adult-onset MS (PwAOMS). The differences in brain atrophy are currently unknown. OBJECTIVES To determine MRI-derived atrophy rates in persons with late-onset MS (PwLOMS) and compare them to an age-matched and disease duration-matched sample of PwAOMS. METHODS 870 persons with MS (290 PwLOMS, 290 age-matched PwAOMS, and 290 disease duration-matched PwAOMS), and 150 healthy controls (HCs), were followed for 5 years and 3 years, respectively. Cross-sectional and longitudinal measures of T2-lesion volume (LV), lateral ventricular volume (LVV) and whole brain volume (WBV) were derived. Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Severity Score (MSSS) were calculated. Both analyses were corrected for false discovery rate. RESULTS Persons with MS exhibited significantly greater annualized WBV loss (-0.88% vs. -0.38%, p<0.001) and annualized LVV expansion (3.1% vs. 1.7%, p=0.002) when compared to HCs. PwLOMS had significantly higher baseline and follow-up median MSSS when compared to both age-matched and disease duration-matched PwAOMS (p<0.026). PwLOMS showed significantly greater percent LVV change (14.3% vs. 9.3% p=0.001) and greater annualized percent LVV change (4.1% vs. 1.6%, p<0.001) compared to age-matched PwAOMS. CONCLUSION PwLOMS had higher MSSS and greater ventricle expansion when compared to PwAOMS.
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26
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Cognitive Event-Related Potentials-The P300 Wave Is a Prognostic Factor of Long-Term Disability Progression in Patients With Multiple Sclerosis. J Clin Neurophysiol 2020; 39:390-396. [PMID: 33031128 DOI: 10.1097/wnp.0000000000000788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Multiple sclerosis (MS) is a chronic disorder with a variable course. The aim of our study was to find out whether cognitive event-related potentials are prognostic for patient disability at the 15-year follow-up. METHODS In the observed cohort of patients with MS, we examined the event-related potentials at baseline (2003). Functional status (Expanded Disability Status Scale score) was then assessed 15 years later, and the prognostic model was developed using binary logistic regression analysis. The independent variables included demographic (age, sex, and education), clinical (disability in 2003), radiologic (MRI lesion load), and event-related potentials parameters. The prognostic accuracy of the proposed model was evaluated by calculating the area under the receiver-operating characteristics curve. RESULTS The study sample consisted of 85 patients with MS. The mean age was 35.5 (SD, 11.2) years, and the median disability score was 3.0 (1-7) in 2003 and 5.0 (1.5-9.5) in 2018. The significant prognostic factors of poor Expanded Disability Status Scale are higher baseline Expanded Disability Status Scale, longer MS duration, and prolonged P300 latency. The sensitivity and specificity of the cutoff at 5.0 for the disability score were 94% and 89%, respectively, with the area under the receiver-operating characteristics curve 0.94 (95% confidence interval, 0.889-0.984; P < 0.001). CONCLUSIONS The results show that out of event-related potentials, the P300 wave latency is a prognostic of long-term disability progression in patients with MS.
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27
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Richardson EV, Motl RW. The experience and meaning of aging with multiple sclerosis: An existential phenomenological approach. J Aging Stud 2020; 54:100872. [PMID: 32972621 DOI: 10.1016/j.jaging.2020.100872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Over the past 3 decades there have been significant advances in the development of pharmaceutical and rehabilitative treatments for persons with multiple sclerosis (MS), such that life expectancy is continuing to increase. Whilst these advancements are exciting, there are also concerns and unknowns regarding what it is like to age with MS. The objectives of this research were to explore the lived experiences and meaning of aging in conjunction with having MS. METHODS Semi-structured interviews with 40 persons with MS over 60 years were conducted. Thereafter data were subject to an existential phenomenological analysis. RESULTS Four different ways were discussed with regards to embodied experiences of aging with MS: aging makes MS worse; MS makes aging worse; aging makes MS better; and MS makes aging better. DISCUSSION This research highlighted the complexity of aging with MS and the various of ways persons over 60 with MS experience and interpret this phenomenon.
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Affiliation(s)
- Emma V Richardson
- School of Sport and Exercise, College of Business, Psychology and Sport, University of Worcester, UK.
| | - Robert W Motl
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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28
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da Silva AM, Torres C, Ferreira I, Moreira I, Samões R, Sousa AP, Santos E, Teixeira-Pinto A, Cavaco S. Prognostic value of odor identification impairment in multiple sclerosis: 10-Years follow-up. Mult Scler Relat Disord 2020; 46:102486. [PMID: 32916510 DOI: 10.1016/j.msard.2020.102486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/23/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Olfactory dysfunction has been linked to clinical severity variables in multiple MS populations. Though, its prognostic value is still unknown. OBJECTIVE The aim of this study was to explore the long-term outcome associated with Brief-Smell Identification Test (B-SIT) performance in a cohort of MS patients. METHODS A retrospective review of the clinical records was conducted in 149 patients who participated in a previous study, with a median follow-up of 121 months. Demographic and clinical data regarding the last clinical appointment with EDSS measurement were collected. Multiple Sclerosis Severity Scale (MSSS) and Age-Related Multiple Sclerosis Severity (ARMSS) scores were calculated. Date of the last clinical contact or death was recorded. RESULTS Among MS patients with progressive clinical course (n = 33), those with impaired B-SIT at baseline had greater change per month during follow-up (as measured by increases in MSSS and ARMSS scores) and a higher hazard of death. No significant associations were found among patients with relapsing and remitting MS (n = 116). CONCLUSIONS The study results demonstrate that odor identification impairment has prognostic value in progressive MS, suggesting that a brief odor identification measure can be a marker of neurodegeneration in progressive MS.
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Affiliation(s)
- Ana Martins da Silva
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal; Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - C Torres
- Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - I Ferreira
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; Neuropsychology Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - I Moreira
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; Neuropsychology Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - R Samões
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - A P Sousa
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; Neurophysiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - E Santos
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - A Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - S Cavaco
- Neurology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; Neuropsychology Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
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29
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Berriozabalgoitia R, Sanz B, Fraile-Bermúdez AB, Otxoa E, Yeregui I, Bidaurrazaga-Letona I, Duñabeitia I, Antigüedad A, Domercq M, Irazusta J, Rodriguez-Larrad A. An Overground Robotic Gait Training Program for People With Multiple Sclerosis: A Protocol for a Randomized Clinical Trial. Front Med (Lausanne) 2020; 7:238. [PMID: 32582732 PMCID: PMC7295911 DOI: 10.3389/fmed.2020.00238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 05/06/2020] [Indexed: 12/24/2022] Open
Abstract
Maintaining the ability to walk is one of the significant challenges in people with multiple sclerosis (MS) for keeping a good quality of life as the disease and the aging process progresses. Overground robotic (OR) wearable exoskeletons are promising tools for gait rehabilitation, but currently there is no evidence of their clinical effects on patients with MS. The present study aims to determine the effects of an OR intervention in people with MS and moderate to severe walking disabilities and ascertain if benefits are maintained over a follow-up period of 3 months. This randomized controlled trial will include 36 participants with MS. Inclusion criteria are: older than 18 years, definitive diagnosis of MS, 4.5-7 points on the EDSS (Expanded Disability Status Scale), and needing one or two canes or crutches for walking outdoors. Subjects in the control group will receive conventional physiotherapy sessions at ADEMBI (Asociación de Esclerosis Múltiple de Bizkaia) provided to control spasticity, maintain articular range and exercise balance. Subjects in the intervention group will receive the same physiotherapy but also participate in a progressive OR gait training program assisted by the EksoTM exoskeleton. The program consists of twice a week individually supervised sessions in two setting modalities: PreGait and ProStepPlus. The training parameters (duration, speed, cadence, length of steps) will be set during the first session and the progression and intensity of the intervention will be adapted to the tolerance of each participant. The primary outcome of this study is gait speed. Secondary outcomes will include physical and cognitive performance tests, clinical, fatigue and quality of life assessments, and changes in the plasma levels of inflammatory cytokines. The present trial is the first analyzing the effectiveness of an OR intervention for gait training in patients with MS. It will help clarify the applicability of robotic technologies to clinical practice, extending the functionality and quality of life of people with MS to face a successful aging process. (ACTRN12619000014156; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376548).
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Affiliation(s)
- Rakel Berriozabalgoitia
- ADEMBI, Multiple Sclerosis Association of Bizkaia, Bilbao, Spain.,Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Begoña Sanz
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Ana Belén Fraile-Bermúdez
- Department of Nursing I, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Erika Otxoa
- ADEMBI, Multiple Sclerosis Association of Bizkaia, Bilbao, Spain
| | - Izaskun Yeregui
- ADEMBI, Multiple Sclerosis Association of Bizkaia, Bilbao, Spain.,Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Iraia Bidaurrazaga-Letona
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Iratxe Duñabeitia
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Alfredo Antigüedad
- Biocruces-Bizkaia Research Institute, Department of Neurology, Cruces University Hospital, Osakidetza Basque Health Service, Barakaldo, Spain
| | - Maria Domercq
- Department of Neurosciences, University of the Basque Country, Achucarro Basque Center for Neuroscience-UPV/EHU, Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Leioa, Spain
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Ana Rodriguez-Larrad
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
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30
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Jones CD, Cederberg KL, Sikes EM, Wylie GR, Motl RW, Sandroff BM. Walking and cognitive performance in adults with multiple sclerosis: Do age and fatigability matter? Mult Scler Relat Disord 2020; 42:102136. [PMID: 32387975 DOI: 10.1016/j.msard.2020.102136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/27/2020] [Accepted: 04/15/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Co-occurring walking and cognitive performance deficits are debilitating consequences of multiple sclerosis (MS) that worsen with age. However, it is unknown if fatigability influences such age-related worsening of walking and cognitive performance. OBJECTIVE This cross-sectional study examined possible age-related differences in walking-related motor fatigability (incremental six-minute-walk (6MW) performance) and cognitive fatigability (incremental Symbol Digit Modalities Test (SDMT) performance) in adults with MS. METHODS 196 adults with MS were categorized into age-groups: younger (20-39 years; n = 53), middle-aged (40-59 years; n = 89), and older (60-79 years; n = 54), and completed the 6MW and SDMT. Age-group differences in incremental 6MW and SDMT performance, controlling for disability status, were examined using separate, mixed-factor ANCOVAs. RESULTS There were no statistically significant age-group-by-time interactions on walking-related motor or cognitive fatigability when controlling for disability. However, there were significant main effects of time on incremental 6MW (p = 0.01) and SDMT (p < 0.01) performance indicating the presence of walking-related motor and cognitive fatigability, respectively, collapsed across age-groups. CONCLUSION Fatigability does not exert a primary influence on age-related worsening of walking and cognitive neuroperformance outcomes among adults with MS. This suggests that walking-related motor fatigability and cognitive fatigability may not be optimal targets for mitigating age-related declines in ambulation and cognition among adults with MS.
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Affiliation(s)
- C Danielle Jones
- University of Alabama at Birmingham, Department of Physical Therapy, Birmingham, AL, USA
| | - Katie L Cederberg
- University of Alabama at Birmingham, Department of Physical Therapy, Birmingham, AL, USA
| | - E Morghen Sikes
- Shenandoah University, Division of Occupational Therapy, Winchester, VA, USA
| | | | - Robert W Motl
- University of Alabama at Birmingham, Department of Physical Therapy, Birmingham, AL, USA
| | - Brian M Sandroff
- University of Alabama at Birmingham, Department of Physical Therapy, Birmingham, AL, USA.
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Murley C, Karampampa K, Alexanderson K, Hillert J, Friberg E. Diagnosis-specific sickness absence and disability pension before and after multiple sclerosis diagnosis: An 8-year nationwide longitudinal cohort study with matched references. Mult Scler Relat Disord 2020; 42:102077. [PMID: 32353754 DOI: 10.1016/j.msard.2020.102077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) typically onsets when of working age and may reduce work capacity. Previous studies have examined the risk of sickness absence (SA) and disability pension (DP) among MS patients, however, limited knowledge is available on whether MS patients have an excess risk for SA/DP when compared with the general population in Sweden. Moreover, no information exists on the actual diagnoses for SA and DP among MS patients and whether the patterns of SA/DP diagnoses differs to those without MS. We aimed to explore diagnosis-specific SA and DP among working-aged MS patients both before and after MS diagnosis, in comparison to the levels and distributions of SA and DP diagnoses of a matched reference group and analyze the risk of diagnosis-specific DP. MATERIALS AND METHODS Longitudinal Swedish register data of the 2567 MS patients diagnosed with MS in 2009-2012 when aged 25-59 and 10,268 population-based matched references (matched on sex, age, educational level, type of living area, and country of birth) were analysed regarding annual diagnosis-specific SA and DP in the four years before and four years after MS diagnosis. Annual differences in the mean numbers of SA and/or DP net days were calculated with 95% confidence intervals (CI). Hazard ratios (HR) with 95% CI from Cox proportional hazard models were used to compare risks for new all-cause and diagnosis-specific DP after MS diagnosis among the MS patients and references. RESULTS The mean SA/DP net days/year increased among MS patients over follow-up, due to both MS and other diagnoses. During follow-up, around 50% of MS patients had some SA/DP compared to 20% of references. The mean days of SA/DP among the MS patients compared to references increased from 10.3 more days (95% CI: 6.6-14.2) four years prior to MS diagnosis to 68.9 days (62.8-75.1) 4 years after MS diagnosis. Although most new DP among MS patients were due to MS, 15% were not. The adjusted HR for all-cause DP was 23.1 (18.1-29.5). MS patients also had higher risks of new DP due to all diagnoses except MS (HR 3.4; 2.4-4.8), musculoskeletal (HR 2.6; 1.1-6.0) and mental (HR 2.0; 1.1-3.6) diagnoses compared with references. CONCLUSION MS patients had higher levels of SA/DP days/year than the references, already 4 years before the MS diagnosis, and increasingly so thereafter. The excess of SA/DP prior to MS diagnosis could be related to MS onset. However, the excess of SA/DP days were not all due to MS diagnoses, even after being diagnosed with MS. MS patients had a higher risk of having a new DP after being diagnosed with MS in total, but also for diagnoses other than MS.
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Affiliation(s)
- Chantelle Murley
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Korinna Karampampa
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Jan Hillert
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
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Bagnato F, Franco G, Ye F, Fan R, Commiskey P, Smith SA, Xu J, Dortch R. Selective inversion recovery quantitative magnetization transfer imaging: Toward a 3 T clinical application in multiple sclerosis. Mult Scler 2020; 26:457-467. [PMID: 30907234 PMCID: PMC7528886 DOI: 10.1177/1352458519833018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Assessing the degree of myelin injury in patients with multiple sclerosis (MS) is challenging due to the lack of magnetic resonance imaging (MRI) methods specific to myelin quantity. By measuring distinct tissue parameters from a two-pool model of the magnetization transfer (MT) effect, quantitative magnetization transfer (qMT) may yield these indices. However, due to long scan times, qMT has not been translated clinically. OBJECTIVES We aim to assess the clinical feasibility of a recently optimized selective inversion recovery (SIR) qMT and to test the hypothesis that SIR-qMT-derived metrics are informative of radiological and clinical disease-related changes in MS. METHODS A total of 18 MS patients and 9 age- and sex-matched healthy controls (HCs) underwent a 3.0 Tesla (3 T) brain MRI, including clinical scans and an optimized SIR-qMT protocol. Four subjects were re-scanned at a 2-week interval to determine inter-scan variability. RESULTS SIR-qMT measures differed between lesional and non-lesional tissue (p < 0.0001) and between normal-appearing white matter (NAWM) of patients with more advanced disability and normal white matter (WM) of HCs (p < 0.05). SIR-qMT measures were associated with lesion volumes, disease duration, and disability scores (p ⩽ 0.002). CONCLUSION SIR-qMT at 3 T is clinically feasible and predicts both radiological and clinical disease severity in MS.
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Affiliation(s)
- Francesca Bagnato
- Department of Neurology, Neuro-Immunology Division/Neuro-Imaging Unit, Vanderbilt University Medical Center (VUMC), Nashville, TN
| | - Giulia Franco
- Department of Neurology, Neuro-Immunology Division/Neuro-Imaging Unit, Vanderbilt University Medical Center (VUMC), Nashville, TN
- IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN; USA
| | - Run Fan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN; USA
| | | | - Seth A. Smith
- Vanderbilt University Institute of Imaging Science; Nashville, TN
| | - Junzhong Xu
- Vanderbilt University Institute of Imaging Science; Nashville, TN
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - Richard Dortch
- Vanderbilt University Institute of Imaging Science; Nashville, TN
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN
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Baird JF, Silveira SL, Motl RW. Social Cognitive Theory and Physical Activity in Older Adults with Multiple Sclerosis. Int J MS Care 2020; 23:21-25. [PMID: 33658902 DOI: 10.7224/1537-2073.2019-071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The expanding population of older adults with multiple sclerosis (MS) likely experiences many of the same benefits of physical activity (PA) as younger and middle-aged adults with MS. However, participation in PA is exceedingly low in this segment of the MS population. This study examined variables from social cognitive theory (SCT) as correlates of PA in older adults with MS to inform the subsequent development of behavioral interventions. Methods Older adults with MS (≥60 years of age, N = 180) completed an online survey including demographic and clinical characteristics, SCT variables (exercise self-efficacy, exercise goal setting, social support, and outcome expectations), and PA (total PA [TPA] and moderate-to-vigorous PA [MVPA]). Results Bivariate correlation analyses indicated that all SCT variables were significantly associated with TPA and MVPA (all P ≤ .001). Hierarchical linear regression analyses indicated that disability status was a significant correlate of TPA (β = -0.48, R2 = 0.23) and MVPA (β = -0.44, R2 = 0.19) in step 1; disability and self-efficacy were significant correlates of TPA (disability β = -0.20, self-efficacy β = 0.59, R2 = 0.50) and MVPA (disability β = -0.16, self-efficacy β = 0.60, R2 = 0.47) in step 2; and disability, self-efficacy, and exercise goal setting were significant correlates of TPA (disability β = -0.21, self-efficacy β = 0.50, exercise goal setting β = 0.14, R2 = 0.55) and MVPA (disability β = -0.17, self-efficacy β = 0.51, exercise goal setting β = 0.15, R2 = 0.51) in step 3. Conclusions These results suggest that behavioral interventions focusing on self-efficacy and exercise goal setting as targets from SCT may be appropriate for increasing PA in older adults with MS.
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Effects of aging on finger movements in multiple sclerosis. Mult Scler Relat Disord 2019; 37:101449. [PMID: 32173006 DOI: 10.1016/j.msard.2019.101449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/30/2019] [Accepted: 10/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND People with multiple sclerosis (PwMS) report impaired hand movements and coordination. With an engineered glove we demonstrated altered finger movements in PwMS; increasing age resulted in decreased performance in healthy subjects (normative data). This study aims at investigating aging effects on finger motor performance in PwMS, in relation to disease duration and Expanded Disability Status Scale (EDSS). METHODS Ninety-six PwMS performed repetitive finger opposition movements with the dominant hand and both hands at maximal velocity or metronome-paced. Performance was compared with the norms, and correlation coefficients between finger motor parameters, age, disease duration and EDSS were calculated. RESULTS The majority of subjects was outside of the normal range according to age and probability increased with level of disability. Age significantly correlated with the glove parameters (r ranged in absolute value between 0.22-0.31; p-value in the range 0.002-0.049). Older subjects with lower disability showed worse performance than younger (p = 0.044 and 0.02), whilst younger subjects with higher disability performed similarly to older (p = 0.72 and 0.49). CONCLUSION Finger motor performance assessment provides important hints about upper limb disability, which should be evaluated in relation to age, disease duration and EDSS.
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35
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Hughes J, Jokubaitis V, Lugaresi A, Hupperts R, Izquierdo G, Prat A, Girard M, Duquette P, Grand'Maison F, Grammond P, Sola P, Ferraro D, Ramo-Tello C, Trojano M, Slee M, Shaygannejad V, Boz C, Lechner-Scott J, Van Pesch V, Pucci E, Solaro C, Verheul F, Terzi M, Granella F, Spitaleri D, Alroughani R, Jun JK, Fambiatos A, Van der Walt A, Butzkueven H, Kalincik T. Association of Inflammation and Disability Accrual in Patients With Progressive-Onset Multiple Sclerosis. JAMA Neurol 2019; 75:1407-1415. [PMID: 30083762 DOI: 10.1001/jamaneurol.2018.2109] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance The role of inflammatory disease activity as a determinant of disability in progressive-onset multiple sclerosis (MS) remains contested. Objective To examine the association of superimposed relapses in progressive-onset MS on disease outcomes. Design, Setting, and Participants Observational cohort study from MSBase, a prospectively collected, international database. Data were collected between January 1995 and February 2017. Analyses began in February 2017. From 44 449 patients at time of extraction, 1419 eligible patients (31.9%) were identified for analysis. Inclusion criteria consisted of primary progressive MS (PPMS) or progressive-relapsing MS (PRMS), adult-onset disease, and minimum data set (including ≥3 visits with disability recorded, ≥3 months between second and last visit). Data were analyzed using multivariable regression models (Andersen-Gill) with mixed effects. Two sensitivity analyses to exclude both relapse-related disability progression and bout-onset progressive MS were performed. Exposures Grouped according to presence or absence of relapse, defined as an acute episode of clinical worsening. Quantifiable disability change or correlation on imaging was not required to confirm relapse. Main Outcomes and Measures Cumulative hazard of disability progression. Results Patients with PRMS were younger than those with PPMS (mean [SD] age, 46 [15] vs 51 [10] years, Cohen d = 0.40) and demonstrated a mean lower Expanded Disability Status Scale score (mean [SD] score, 4.0 [3] vs 4.5 [2.5], Cohen d = 0.28) at inclusion. The ratio of men to women was similar in the PRMS and PPMS groups (252:301 vs 394:472). The overall mean (SD) age was 48 (11) years for men and 50 (10) years for women. Likelihood of confirmed disability progression was lower in patients with superimposed relapses (hazard ratio [HR], 0.83; 95% CI, 0.74-0.94; P = .003). Proportion of follow-up time spent on disease-modifying therapy significantly reduced the hazard of confirmed disability progression in the cohort with relapse (HR, 0.96; 95% CI, 0.94-0.99; P = .01) but not in those without relapse (HR, 1.02; 95% CI, 0.99-1.05; P = .26). When accounting for relapse-related progression, the association of disease-modifying therapy in the cohort with superimposed relapse was no longer observed (HR, 1.10; 95% CI, 0.96-1.24; P = .16). Conclusions and Relevance In progressive-onset MS, superimposed relapses are associated with a lower risk of confirmed disability progression. This is most likely attributed to the association of disease-modifying therapy with the prevention of relapse-related disability accrual in patients with superimposed relapse. These findings suggest that inflammatory relapses are an important and modifiable determinant of disability accrual in progressive-onset disease.
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Affiliation(s)
- Jordana Hughes
- CORe, Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Alessandra Lugaresi
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | | | - Alexandre Prat
- Hopital Notre Dame, Montreal, Quebec, Canada.,CHUM and Universite de Montreal, Montreal, Quebec, Canada
| | - Marc Girard
- Hopital Notre Dame, Montreal, Quebec, Canada.,CHUM and Universite de Montreal, Montreal, Quebec, Canada
| | - Pierre Duquette
- Hopital Notre Dame, Montreal, Quebec, Canada.,CHUM and Universite de Montreal, Montreal, Quebec, Canada
| | | | | | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | | | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Mark Slee
- Flinders University, Adelaide, Australia
| | | | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | - Jeanette Lechner-Scott
- School of Medicine and Public Health, University Newcastle, Newcastle, Australia.,Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia
| | | | - Eugenio Pucci
- UOC Neurologia, Azienda Sanitaria Unica Regionale Marche-AV3, Macerata, Italy
| | | | | | - Murat Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | | | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | | | - Jae-Kwan Jun
- CORe, Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Adam Fambiatos
- CORe, Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Anneke Van der Walt
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Helmut Butzkueven
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Neurology, Box Hill Hospital, Monash University, Melbourne, Australia
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
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Krysko KM, Henry RG, Cree BAC, Lin J, Caillier S, Santaniello A, Zhao C, Gomez R, Bevan C, Smith DL, Stern W, Kirkish G, Hauser SL, Oksenberg JR, Graves JS. Telomere Length Is Associated with Disability Progression in Multiple Sclerosis. Ann Neurol 2019; 86:671-682. [PMID: 31486104 DOI: 10.1002/ana.25592] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/23/2019] [Accepted: 09/01/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess whether biological aging as measured by leukocyte telomere length (LTL) is associated with clinical disability and brain volume loss in multiple sclerosis (MS). METHODS Adults with MS/clinically isolated syndrome in the University of California, San Francisco EPIC cohort study were included. LTL was measured on DNA samples by quantitative polymerase chain reaction and expressed as telomere to somatic DNA (T/S) ratio. Expanded Disability Status Scale (EDSS) and 3-dimensional T1-weighted brain magnetic resonance imaging were performed at baseline and follow-up. Associations of baseline LTL with cross-sectional and longitudinal outcomes were assessed using simple and mixed effects linear regression models. A subset (n = 46) had LTL measured over time, and we assessed the association of LTL change with EDSS change with mixed effects models. RESULTS Included were 356 women and 160 men (mean age = 43 years, median disease duration = 6 years, median EDSS = 1.5 [range = 0-7], mean T/S ratio = 0.97 [standard deviation = 0.18]). In baseline analyses adjusted for age, disease duration, and sex, for every 0.2 lower LTL, EDSS was 0.27 higher (95% confidence interval [CI] = 0.13-0.42, p < 0.001) and brain volume was 7.4mm3 lower (95% CI = 0.10-14.7, p = 0.047). In longitudinal adjusted analyses, those with lower baseline LTL had higher EDSS and lower brain volumes over time. In adjusted analysis of the subset, LTL change was associated with EDSS change over 10 years; for every 0.2 LTL decrease, EDSS was 0.34 higher (95% CI = 0.08-0.61, p = 0.012). INTERPRETATION Shorter telomere length was associated with disability independent of chronological age, suggesting that biological aging may contribute to neurological injury in MS. Targeting aging-related mechanisms is a potential therapeutic strategy against MS progression. ANN NEUROL 2019;86:671-682.
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Affiliation(s)
- Kristen M Krysko
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Roland G Henry
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Bruce A C Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Jue Lin
- Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA
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- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Stacy Caillier
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Adam Santaniello
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Chao Zhao
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Refujia Gomez
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Carolyn Bevan
- Department of Neurology, Northwestern University, Evanston, IL
| | - Dana L Smith
- Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA
| | - William Stern
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Gina Kirkish
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Jorge R Oksenberg
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Jennifer S Graves
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA.,Department of Neurosciences, University of California, San Diego, San Diego, CA
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Baird JF, Cederberg KL, Sikes EM, Silveira SL, Jeng B, Sasaki JE, Sandroff BM, Motl RW. Physical activity and walking performance across the lifespan among adults with multiple sclerosis. Mult Scler Relat Disord 2019; 35:36-41. [DOI: 10.1016/j.msard.2019.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/12/2019] [Accepted: 07/04/2019] [Indexed: 11/28/2022]
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Flauzino T, Simão ANC, de Carvalho Jennings Pereira WL, Alfieri DF, Oliveira SR, Kallaur AP, Lozovoy MAB, Kaimen-Maciel DR, Maes M, Reiche EMV. Disability in multiple sclerosis is associated with age and inflammatory, metabolic and oxidative/nitrosative stress biomarkers: results of multivariate and machine learning procedures. Metab Brain Dis 2019; 34:1401-1413. [PMID: 31302813 DOI: 10.1007/s11011-019-00456-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 07/03/2019] [Indexed: 12/17/2022]
Abstract
The aim of this study was to evaluate the immune-inflammatory, metabolic, and nitro-oxidative stress (IM&NO) biomarkers as predictors of disability in multiple sclerosis (MS) patients. A total of 122 patients with MS were included; their disability was evaluated using the Expanded Disability Status Scale (EDSS) and IM&NO biomarkers were evaluated in peripheral blood samples. Patients with EDSS ≥3 were older and showed higher homocysteine, uric acid, advanced oxidized protein products (AOPP) and low-density lipoprotein (LDL)-cholesterol and higher rate of metabolic syndrome (MetS), while high-density lipoprotein (HDL)-cholesterol was lower than in patients with EDSS <3; 84.6% of all patients were correctly classified in these EDSS subgroups. We found that 36.3% of the variance in EDSS score was explained by age, Th17/T regulatory (Treg) and LDL/HDL ratios and homocysteine (all positively related) and body mass index (BMI) (inversely related). After adjusting for MS treatment modalities, the effects of the LDL/HDL and zTh17/Treg ratios, homocysteine and age on disability remained, whilst BMI was no longer significant. Moreover, carbonyl proteins were associated with increased disability. In conclusion, the results showed that an inflammatory Th17 profile coupled with age and increased carbonyl proteins were the most important variables associated with high disability followed at a distance by homocysteine, MetS and LDL/HDL ratio. These data underscore that IM&NO pathways play a key role in increased disability in MS patient and may be possible new targets for the treatment of these patients. Moreover, a panel of these laboratory biomarkers may be used to predict the disability in MS.
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Affiliation(s)
- Tamires Flauzino
- Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Andrea Name Colado Simão
- Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, University Hospital, State University of Londrina, Av. Robert Koch 60, Londrina, Paraná, CEP 86038-350, Brazil
| | | | - Daniela Frizon Alfieri
- Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Sayonara Rangel Oliveira
- Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, University Hospital, State University of Londrina, Av. Robert Koch 60, Londrina, Paraná, CEP 86038-350, Brazil
| | - Ana Paula Kallaur
- Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Marcell Alysson Batisti Lozovoy
- Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, University Hospital, State University of Londrina, Av. Robert Koch 60, Londrina, Paraná, CEP 86038-350, Brazil
| | | | - Michael Maes
- Impact Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry, King Chulalongkorn Memorial Hospital, Chulalongkorn, Bangkok, Thailand
| | - Edna Maria Vissoci Reiche
- Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, University Hospital, State University of Londrina, Av. Robert Koch 60, Londrina, Paraná, CEP 86038-350, Brazil.
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Aging With Multiple Sclerosis. TOPICS IN GERIATRIC REHABILITATION 2019. [DOI: 10.1097/tgr.0000000000000233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Ahmad H, van der Mei I, Taylor BV, Lucas RM, Ponsonby AL, Lechner-Scott J, Dear K, Valery P, Clarke PM, Simpson S, Palmer AJ. Estimation of annual probabilities of changing disability levels in Australians with relapsing-remitting multiple sclerosis. Mult Scler 2018; 25:1800-1808. [PMID: 30351240 DOI: 10.1177/1352458518806103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Transition probabilities are the engine within many health economics decision models. However, the probabilities of progression of disability due to multiple sclerosis (MS) have not previously been estimated in Australia. OBJECTIVES To estimate annual probabilities of changing disability levels in Australians with relapsing-remitting MS (RRMS). METHODS Combining data from Ausimmune/Ausimmune Longitudinal (2003-2011) and Tasmanian MS Longitudinal (2002-2005) studies (n = 330), annual transition probabilities were obtained between no/mild (Expanded Disability Status Scale (EDSS) levels 0-3.5), moderate (EDSS 4-6.0) and severe (EDSS 6.5-9.5) disability. RESULTS From no/mild disability, 6.4% (95% confidence interval (CI): 4.7-8.4) and 0.1% (0.0-0.2) progressed to moderate and severe disability annually, respectively. From moderate disability, 6.9% (1.0-11.4) improved (to no/mild state) and 2.6% (1.1-4.5) worsened. From severe disability, 0.0% improved to moderate and no/mild disability. Male sex, age at onset, longer disease duration, not using immunotherapies greater than 3 months and a history of relapse were related to higher probabilities of worsening. CONCLUSION We have estimated probabilities of changing disability levels in Australians with RRMS. Probabilities differed between various subgroups, but due to small sample sizes, results should be interpreted with caution. Our findings will be helpful in predicting long-term disease outcomes and in health economic evaluations of MS.
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Affiliation(s)
- Hasnat Ahmad
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, Australia/Centre for Ophthalmology and Visual Sciences, The University of Western Australia, Perth, WA, Australia
| | - Anne-Louise Ponsonby
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, Australia/Murdoch Children's Research Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute and The University of Newcastle, Callaghan, NSW, Australia
| | | | - Patricia Valery
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Philip M Clarke
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia/Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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42
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Sebastião E, McAuley E, Shigematsu R, Adamson BC, Bollaert RE, Motl RW. Home-based, square-stepping exercise program among older adults with multiple sclerosis: results of a feasibility randomized controlled study. Contemp Clin Trials 2018; 73:136-144. [DOI: 10.1016/j.cct.2018.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/10/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
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43
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Musella A, Gentile A, Rizzo FR, De Vito F, Fresegna D, Bullitta S, Vanni V, Guadalupi L, Stampanoni Bassi M, Buttari F, Centonze D, Mandolesi G. Interplay Between Age and Neuroinflammation in Multiple Sclerosis: Effects on Motor and Cognitive Functions. Front Aging Neurosci 2018; 10:238. [PMID: 30135651 PMCID: PMC6092506 DOI: 10.3389/fnagi.2018.00238] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/20/2018] [Indexed: 01/09/2023] Open
Abstract
Aging is one of the main risk factors for the development of many neurodegenerative diseases. Emerging evidence has acknowledged neuroinflammation as potential trigger of the functional changes occurring during normal and pathological aging. Two main determinants have been recognized to cogently contribute to neuroinflammation in the aging brain, i.e., the systemic chronic low-grade inflammation and the decline in the regulation of adaptive and innate immune systems (immunosenescence, ISC). The persistence of the inflammatory status in the brain in turn may cause synaptopathy and synaptic plasticity impairments that underlie both motor and cognitive dysfunctions. Interestingly, such inflammation-dependent synaptic dysfunctions have been recently involved in the pathophysiology of multiple sclerosis (MS). MS is an autoimmune neurodegenerative disease, typically affecting young adults that cause an early and progressive deterioration of both cognitive and motor functions. Of note, recent controlled studies have clearly shown that age at onset modifies prognosis and exerts a significant effect on presenting phenotype, suggesting that aging is a significant factor associated to the clinical course of MS. Moreover, some lines of evidence point to the different impact of age on motor disability and cognitive deficits, being the former most affected than the latter. The precise contribution of aging-related factors to MS neurological disability and the underlying molecular and cellular mechanisms are still unclear. In the present review article, we first emphasize the importance of the neuroinflammatory dependent mechanisms, such as synaptopathy and synaptic plasticity impairments, suggesting their potential exacerbation or acceleration with advancing age in the MS disease. Lastly, we provide an overview of clinical and experimental studies highlighting the different impact of age on motor disability and cognitive decline in MS, raising challenging questions on the putative age-related mechanisms involved.
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Affiliation(s)
- Alessandra Musella
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Rome, Italy.,San Raffaele University of Rome, Rome, Italy
| | - Antonietta Gentile
- Laboratory of Synaptic Immunopathology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Unit of Neurology, Istituto Neurologico Mediterraneo (IRCCS Neuromed), Pozzilli, Italy
| | - Francesca Romana Rizzo
- Laboratory of Synaptic Immunopathology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesca De Vito
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Rome, Italy.,Laboratory of Synaptic Immunopathology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Diego Fresegna
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Rome, Italy.,Laboratory of Synaptic Immunopathology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Bullitta
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Rome, Italy.,Laboratory of Synaptic Immunopathology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Vanni
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Rome, Italy.,Laboratory of Synaptic Immunopathology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Livia Guadalupi
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Rome, Italy
| | | | - Fabio Buttari
- Unit of Neurology, Istituto Neurologico Mediterraneo (IRCCS Neuromed), Pozzilli, Italy
| | - Diego Centonze
- Laboratory of Synaptic Immunopathology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Unit of Neurology, Istituto Neurologico Mediterraneo (IRCCS Neuromed), Pozzilli, Italy
| | - Georgia Mandolesi
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Rome, Italy.,San Raffaele University of Rome, Rome, Italy
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44
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D'Amico E, Patti F, Zanghì A, Chisari CG, Lo Fermo S, Zappia M. Late-onset and young-onset relapsing-remitting multiple sclerosis: evidence from a retrospective long-term follow-up study. Eur J Neurol 2018; 25:1425-1431. [PMID: 29956427 DOI: 10.1111/ene.13745] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/20/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Late-onset multiple sclerosis (MS) has a prevalence of about 10-20% in natural history MS studies. Few data have been published about the long-term disease trajectory in the cohort of late-onset relapsing-remitting MS (LORRMS). The aim of this study was to identify the risk factors for reaching an Expanded Disability Status Scale (EDSS) score of 6.0 in LORRMS (onset at >40 years of age) and young-onset relapsing-remitting MS (YORRMS) (onset between 18 and 40 years of age). METHODS Clinical and radiological [magnetic resonance imaging (MRI) of the brain] follow-up data were collected. Disability was assessed by EDSS score. A Cox proportional hazards model was used to evaluate the demographic and clinical predictors of reaching an EDSS score of 6.0 in the two cohorts. RESULTS A total of 671 patients with relapsing-remitting MS were enrolled, 143 (21.3%) with LORRMS and 528 (78.7%) with YORRMS. In LORRMS, age at onset was 47.8 ± 5.3 (mean ± SD) years and duration of follow-up was 120.7 ± 52.7 months. In YORRMS, age at onset was 27 ± 2.7 years and duration of follow-up was 149.9 ± 92.7 months. The survival curve analyses showed a higher probability of reaching an EDSS score of 6.0 for LORRMS in a shorter time (months) than for YORRMS (94.2 vs. 103.2 months; log-rank 8.8; P < 0.05). On MRI, YORRMS showed more brain inflammatory features than LORRMS. In the multivariate Cox model, age at onset [Exp(B) value, 6.5; 95% confidence interval, 1.9-22.6; P < 0.001] and male gender [Exp(B) value, 1.7; 95% confidence interval, 1.0-2.8; P < 0.05] were the strongest predictors of reaching an EDSS score of 6.0. CONCLUSIONS The male population with LORRMS reached severe disability faster than those with YORRMS, even when YORRMS showed more brain inflammatory features on MRI.
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Affiliation(s)
- E D'Amico
- Department G. F. Ingrassia, MS Center University of Catania, Catania, Italy
| | - F Patti
- Department G. F. Ingrassia, MS Center University of Catania, Catania, Italy
| | - A Zanghì
- Department G. F. Ingrassia, MS Center University of Catania, Catania, Italy
| | - C G Chisari
- Department G. F. Ingrassia, MS Center University of Catania, Catania, Italy
| | - S Lo Fermo
- Department G. F. Ingrassia, MS Center University of Catania, Catania, Italy
| | - M Zappia
- Department G. F. Ingrassia, MS Center University of Catania, Catania, Italy
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45
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Tomassini V, Fanelli F, Prosperini L, Cerqua R, Cavalla P, Pozzilli C. Predicting the profile of increasing disability in multiple sclerosis. Mult Scler 2018; 25:1306-1315. [PMID: 30070597 PMCID: PMC6681428 DOI: 10.1177/1352458518790397] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Effective therapeutic strategies to preserve function and delay progression
in multiple sclerosis (MS) require early recognition of individual disease
trajectories. Objectives: To determine the profiles of disability evolution, identify their early
predictors and develop a risk score of increasing disability. Methods: We analysed demographic, clinical and magnetic resonance imaging (MRI) data
from patients with relapsing MS, Expanded Disability Status Scale (EDSS)
score of 3.0–4.0 and follow-up ≥ 2 years. Attaining EDSS = 6.0 defined
increasing disability; relapses and/or MRI defined
disease activity. Results: In total, 344 out of 542 (63.5%) patients reached EDSS ≥ 6.0; of these, 220
(64.0%) showed disease activity. In patients with activity, the number of
relapses before reaching EDSS 3.0–4.0 predicted increasing disability;
age > 45 at baseline predicted increasing disability without activity.
Combining age and number of relapses increased the risk of and shortened the
time to EDSS = 6.0. Conclusion: Increasing disability is frequently associated with persistent activity. The
high number of relapses identifies early those patients worsening in the
presence of activity. Age predicts increasing disability in the absence of
activity. The presence of both factors increases the risk of developing
severe disability. As this study likely describes the transition to
progression, our findings contribute to improving patient management and
stratification in trials on progressive MS.
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Affiliation(s)
- Valentina Tomassini
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University and University Hospital of Wales, Cardiff, UK
| | - Fulvia Fanelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Luca Prosperini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy/Department of Neurosciences, San Camillo- Forlanini Hospital, Rome, Italy
| | - Raffaella Cerqua
- Neurological Clinic, Marche Polytechnic University, Ancones, Italy
| | - Paola Cavalla
- Department of Neurosciences, City of Health and Science University Hospital of Turin, Turin, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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46
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Gärtner J, Chitnis T, Ghezzi A, Pohl D, Brück W, Häring DA, Karlsson G, Putzki N. Relapse Rate and MRI Activity in Young Adult Patients With Multiple Sclerosis: A Post Hoc Analysis of Phase 3 Fingolimod Trials. Mult Scler J Exp Transl Clin 2018; 4:2055217318778610. [PMID: 29854416 PMCID: PMC5971396 DOI: 10.1177/2055217318778610] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/18/2018] [Accepted: 04/24/2018] [Indexed: 11/22/2022] Open
Abstract
Background Disease activity differs in young patients with multiple sclerosis (MS) compared with the overall adult MS population. Objective The objective of this paper is to evaluate the effect of fingolimod 0.5 mg on disease activity in young adults with MS from three randomized, double-blind Phase 3 trials. Methods Annualized relapse rate (ARR), number of new/newly enlarging T2 lesions (neT2), and no evidence of disease activity (NEDA-3) were estimated in the intent-to-treat population at age 20 (youngest) and 30 (young) and compared to the overall population. Models used included a negative binomial regression (ARR/neT2) and a logistic regression (NEDA), with age at baseline as a continuous covariate. Results ARRs were higher in younger patients (all p < 0.05), and significantly reduced with fingolimod versus placebo or interferon beta-1a (IFN β-1a), with the percentage reduction inversely proportional to age. Fingolimod was significantly associated with a lower number of neT2 lesions versus placebo/IFN in all age groups except versus IFN in the youngest patients. Regardless of age, fingolimod-treated patients were more likely to achieve NEDA-3 versus placebo/IFN β-1a, with strongest benefits in the youngest patients (all p < 0.05). Conclusions Young adults show higher levels of MS disease activity, and may particularly benefit from fingolimod treatment compared with the overall study population.
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Affiliation(s)
- Jutta Gärtner
- Department of Pediatrics and Adolescent Medicine, German Centre for Multiple Sclerosis in Childhood and Adolescence, University Medical Center Göttingen, Germany
| | - Tanuja Chitnis
- Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, USA
| | | | - Daniela Pohl
- Division of Neurology, Children's Hospital of Eastern Ontario, University of Ottawa, Canada
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center Göttingen, Germany
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47
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Manouchehrinia A, Hedström AK, Alfredsson L, Olsson T, Hillert J, Ramanujam R. Association of Pre-Disease Body Mass Index With Multiple Sclerosis Prognosis. Front Neurol 2018; 9:232. [PMID: 29867705 PMCID: PMC5958198 DOI: 10.3389/fneur.2018.00232] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/26/2018] [Indexed: 01/01/2023] Open
Abstract
Both high body mass index (BMI) and smoking tobacco are known risk factors for developing multiple sclerosis (MS). However, it is unclear whether BMI, like smoking, is a risk factor for the secondary progressive (SP) course. We, therefore, sought to determine if high/low BMI at age 20 is associated to risk of SP development, in the context of smoking status. Using data from MS patients with BMI and smoking information available, we examined relapsing onset patients with MS onset after 20 years of age. Cox regressions were conducted on smokers and non-smokers, with BMI as the main exposure. In total, 5,598 relapsing onset MS patients were included. The models demonstrated that BMI > 30 was associated to increased risk of SPMS in smokers (hazard ratio 1.50, p = 0.036). This association of obesity at age 20 with increased risk of SP was not observed in non-smokers (hazard rate 0.97, p = 0.900). Since the risk is confined to smokers, the interaction observed may give insight to disease driving mechanisms.
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Affiliation(s)
- Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Anna Karin Hedström
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars Alfredsson
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Ryan Ramanujam
- Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.,Department of Mathematics, The Royal Institute of Technology, Stockholm, Sweden
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48
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Physical Activity, Sedentary Behavior, and Physical Function in Older Adults With Multiple Sclerosis. J Aging Phys Act 2018; 26:177-182. [DOI: 10.1123/japa.2016-0358] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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49
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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: 14] [Impact Index Per Article: 2.3] [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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50
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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: 82] [Impact Index Per Article: 11.7] [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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