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Martínez-Ginés ML, Esquivel A, Hernández YH, Alvarez-Sala LA, Benito-León J. Investigating the relationship between multiple sclerosis disability and driving performance: A comparative study of the multiple sclerosis functional composite and expanded disability status scale. Clin Neurol Neurosurg 2024; 244:108431. [PMID: 39047389 DOI: 10.1016/j.clineuro.2024.108431] [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: 05/30/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Multiple Sclerosis (MS) can affect the ability to perform complex tasks such as driving. The Expanded Disability Status Scale (EDSS) overlooks cognitive deficits crucial for driving. We investigated the relationship between the Multiple Sclerosis Functional Composite (MSFC), which includes cognitive assessment, and EDSS in relation to driving performance. METHODS This exploratory study involved 30 MS patients (mean EDSS 2.4 ± 2.0) and 15 healthy controls. We correlated the results of the EDSS, MSFC, and driving performance tests, namely the Two-Hand Coordination Test (2HAND) and the Speed Anticipation Reaction Test (SART). RESULTS Patients did not differ from the healthy controls regarding age, sex, and driving experience. However, they exhibited lower mean Z-scores in MSFC, particularly in motor domains, but not in cognitive function. The mean Z-score for the 25-foot Walk test was -0.42 in patients compared to -0.04 in controls. For the 9-hole Peg Test, it was 0.17 in patients versus 1.47 in controls. Patients had a mean total error time of 19.7 seconds for both hands in the 2HAND test, compared to 7.7 seconds in controls. In MS patients, the MSFC and EDSS significantly correlated with SART and 2HAND components. While upper limb function (9-HPT) did not correlate with 2HAND, cognitive function (PASAT) did correlate with the number of 2HAND errors, indicating that cognitive dysfunction impacts driving performance more than physical dysfunction. CONCLUSION The MSFC may provide valuable insights into the driving abilities of MS patients, potentially offering advantages over the EDSS in predicting driving performance. Further research with larger, more diverse populations across various driving environments is necessary to validate these findings.
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Affiliation(s)
| | - Alberto Esquivel
- Department of Neurology, University Hospital "Infanta Leonor", Madrid, Spain
| | | | - Luis Antonio Alvarez-Sala
- Department of Internal Medicine, University Hospital "Gregorio Marañón", Madrid, Spain; Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Julián Benito-León
- Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain; Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
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2
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Seebacher B, Helmlinger B, Pinter D, Heschl B, Ehling R, Hechenberger S, Reindl M, Khalil M, Enzinger C, Deisenhammer F, Brenneis MD C. Actual and Imagined Music-Cued Gait Training in People with Multiple Sclerosis: A Double-Blind Randomized Parallel Multicenter Trial. Neurorehabil Neural Repair 2024; 38:555-569. [PMID: 38873806 PMCID: PMC11308272 DOI: 10.1177/15459683241260724] [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] [Indexed: 06/15/2024]
Abstract
BACKGROUND Actual and imagined cued gait trainings have not been compared in people with multiple sclerosis (MS). OBJECTIVE To analyze the effects of cued motor imagery (CMI), cued gait training (CGT), and combined CMI and cued gait training (CMI-CGT) on motor, cognitive, and emotional functioning, and health-related quality of life in people with MS. METHODS In this double-blind randomized parallel-group multicenter trial, people with MS were randomized (1:1:1) to CMI, CMI-CGT, or CGT for 30 minutes, 4×/week for 4 weeks. Patients practiced at home, using recorded instructions, and supported by ≥6 phone calls. Data were collected at weeks 0, 4, and 13. Co-primary outcomes were walking speed and distance, analyzed by intention-to-treat. Secondary outcomes were global cognitive impairment, anxiety, depression, suicidality, fatigue, HRQoL, motor imagery ability, music-induced motivation, pleasure and arousal, self-efficacy, and cognitive function. Adverse events and falls were continuously monitored. RESULTS Of 1559 screened patients, 132 were randomized: 44 to CMI, 44 to CMI-CGT, and 44 to CGT. None of the interventions demonstrated superiority in influencing walking speed or distance, with negligible effects on walking speed (η2 = 0.019) and distance (η2 = 0.005) observed in the between-group comparison. Improvements in walking speed and walking distance over time corresponded to large effects for CMI, CMI-CGT, and CGT (η2 = 0.348 and η2 = 0.454 respectively). No severe study-related adverse events were reported. CONCLUSIONS CMI-GT did not lead to improved walking speed and distance compared with CMI and CGT alone in people with MS. Lack of a true control group represents a study limitation. TRIAL REGISTRATION German Clinical Trials Register, DRKS00023978.
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Affiliation(s)
- Barbara Seebacher
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Rehabilitation Science, Clinic for Rehabilitation Muenster, Austria
- Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
| | - Birgit Helmlinger
- Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Steiermark, Austria
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Daniela Pinter
- Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Steiermark, Austria
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Bettina Heschl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Rainer Ehling
- Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria
| | - Stefanie Hechenberger
- Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Steiermark, Austria
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
- Neurology Biomarker Research Unit, Medical University of Graz, Graz, Steiermark, Austria
| | - Christian Enzinger
- Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Steiermark, Austria
- Department of Neurology, Medical University of Graz, Graz, Austria
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Steiermark, Austria
| | - Florian Deisenhammer
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Brenneis MD
- Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Muenster, Austria
- Department of Neurology, Clinic for Rehabilitation Muenster, Muenster, Austria
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Zertal A, Alami Marrouni K, Arbour N, Jutras-Aswad D, Pomey MP, Rouleau I, Prat A, Larochelle C, Beaulieu P, Chamelian L, Sylvestre MP, Morin D, Ouellette JS, Fréjeau N, Duquette P. Efficacy of cannabinoids compared to the current standard treatments on symptom relief in persons with multiple sclerosis (CANSEP trial): study protocol for a randomized clinical trial. Front Neurol 2024; 15:1440678. [PMID: 39114536 PMCID: PMC11303178 DOI: 10.3389/fneur.2024.1440678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/10/2024] [Indexed: 08/10/2024] Open
Abstract
Background Multiple sclerosis (MS) is an inflammatory and degenerative disease of the central nervous system. More than 90,000 Canadians are affected; a cure is yet to be found. Available treatments to manage the disease course are only partially effective. For many years, persons with MS (PwMS) have used cannabis to relax, to reduce pain and spasticity, or to improve sleep and daily functioning, despite the lack of scientific evidence on the efficacy of specific cannabinoids [i.e., tetrahydrocannabinol (THC) and cannabidiol (CBD)] on these MS symptoms. The purpose of this clinical trial is to assess the effectiveness of different doses of these cannabinoids, alone or combined, on spasticity relief, compared to placebo. Moreover, we aim to determine which treatment is best effective to address other key MS conditions. Methods A double-blinded, randomized, factorial, placebo-controlled trial will be performed. We intend to include up to 250 PwMS aged over 21 recruited from the Centre hospitalier de l'Université de Montréal MS Clinic. PwMS will be randomly assigned on a 1:1:1:1 ratio to one of the trial arms: THC alone, CBD alone, THC/CBD combination, or placebo, using stratified blocked randomization, with random blocks within each stratum. The primary outcome is a self-assessment of spasticity using the mean Numeric Rating Scale score over 7 days. The main outcome will be the difference in this score at 4 weeks compared to baseline. Secondary outcomes include assessments of spasticity as measured by a clinician, pain, fatigue, sleep, bowel, bladder, and sexual dysfunction, restless legs syndrome, mental health, quality of life, mobility, cognitive functioning, and adverse events. Treatment responders are eligible for a 12-week extension phase, using the same treatment allocation and assessments. Discussion Previous clinical studies examined the efficacy of cannabis-based medicines in PwMS, mostly using products with 1:1 THC/CBD ratio. The major barrier to effectively use cannabis in real-world clinical settings is the lack of evidence on benefits of specific cannabinoids and information on possible related risks. The CANSEP study will contribute to overcome these limitations and identify the risks and benefits of cannabis-based treatments in PwMS. Clinical trial registration ClinicalTrials.Gov, NCT05092191.
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Affiliation(s)
- Amel Zertal
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Kanza Alami Marrouni
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Nathalie Arbour
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Didier Jutras-Aswad
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Psychiatrie et d’addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Marie-Pascale Pomey
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Gestion, d’évaluation et de politique de santé, École de santé publique, Université de Montréal, Montreal, QC, Canada
- Centre d’Excellence sur le Partenariat avec les Patients et le Public, Université de Montréal, Montreal, QC, Canada
| | - Isabelle Rouleau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Psychologie, Faculté des Sciences Humaines, Université du Québec à Montréal, Montreal, QC, Canada
| | - Alexandre Prat
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Catherine Larochelle
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Pierre Beaulieu
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
- Département d'anesthésiologie et de Médecine de la Douleur, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Département de Pharmacologie et Physiologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Laury Chamelian
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montreal, QC, Canada
| | - Danielle Morin
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Jean-Sylvain Ouellette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- MS Canada, Toronto, ON, Canada
| | - Nathalie Fréjeau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Pierre Duquette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
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Al‐Zuhairy A, Jakobsen J, Krarup C. Prevention of axonal loss after immediate dosage titration of immunoglobulin in multifocal motor neuropathy. Eur J Neurol 2024; 31:e16305. [PMID: 38651498 PMCID: PMC11235608 DOI: 10.1111/ene.16305] [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: 11/21/2023] [Revised: 02/27/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND To evaluate whether ongoing axonal loss can be prevented in multifocal motor neuropathy (MMN) treated with immunoglobulin G (IgG), a group of patients with a median disease duration of 15.7 years (range: 8.3-37.8), treated with titrated dosages of immunoglobulins, was studied electrophysiologically at time of diagnosis and at follow-up. RESULTS At follow-up, the Z-score of the compound motor action potential amplitude of the median, fibular, and tibial nerves and the neurological performances were determined. In seven patients with a treatment-free period of 0.3 years (0.2-0.4), there was no progression of axonal loss (p = 0.2), whereas a trend toward further axonal loss by 1.3 Z-scores (0.9-17.0, p = 0.06) was observed in five patients with a treatment-free period of 4.0 years (0.9-9.0). The axonal loss in the group with a short treatment delay was significantly smaller than in the group with a longer treatment delay (p = 0.02). Also, there was an association between treatment delay and ongoing axonal loss (p = 0.004). The electrophysiological findings at follow-up were associated with the isokinetic strength performance, the neurological impairment score, and the disability, supporting the clinical relevance of the electrophysiological estimate of axonal loss. CONCLUSION Swift initiation of an immediately titrated IgG dosage can prevent further axonal loss and disability in continuously treated MMN patients.
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Affiliation(s)
- Ali Al‐Zuhairy
- Department of NeurologyCopenhagen University Hospital (Rigshospitalet)CopenhagenDenmark
| | - Johannes Jakobsen
- Department of NeurologyCopenhagen University Hospital (Rigshospitalet)CopenhagenDenmark
| | - Christian Krarup
- Department of Clinical NeurophysiologyRigshospitaletCopenhagenDenmark
- Department of NeuroscienceUniversity of CopenhagenCopenhagenDenmark
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Suh A, Hampel G, Vinjamuri A, Ong J, Kamran SA, Waisberg E, Paladugu P, Zaman N, Sarker P, Tavakkoli A, Lee AG. Oculomics analysis in multiple sclerosis: Current ophthalmic clinical and imaging biomarkers. Eye (Lond) 2024:10.1038/s41433-024-03132-y. [PMID: 38858520 DOI: 10.1038/s41433-024-03132-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 03/18/2024] [Accepted: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
Multiple Sclerosis (MS) is a chronic autoimmune demyelinating disease of the central nervous system (CNS) characterized by inflammation, demyelination, and axonal damage. Early recognition and treatment are important for preventing or minimizing the long-term effects of the disease. Current gold standard modalities of diagnosis (e.g., CSF and MRI) are invasive and expensive in nature, warranting alternative methods of detection and screening. Oculomics, the interdisciplinary combination of ophthalmology, genetics, and bioinformatics to study the molecular basis of eye diseases, has seen rapid development through various technologies that detect structural, functional, and visual changes in the eye. Ophthalmic biomarkers (e.g., tear composition, retinal nerve fibre layer thickness, saccadic eye movements) are emerging as promising tools for evaluating MS progression. The eye's structural and embryological similarity to the brain makes it a potentially suitable assessment of neurological and microvascular changes in CNS. In the advent of more powerful machine learning algorithms, oculomics screening modalities such as optical coherence tomography (OCT), eye tracking, and protein analysis become more effective tools aiding in MS diagnosis. Artificial intelligence can analyse larger and more diverse data sets to potentially discover new parameters of pathology for efficiently diagnosing MS before symptom onset. While there is no known cure for MS, the integration of oculomics with current modalities of diagnosis creates a promising future for developing more sensitive, non-invasive, and cost-effective approaches to MS detection and diagnosis.
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Affiliation(s)
- Alex Suh
- Tulane University School of Medicine, New Orleans, LA, USA.
| | - Gilad Hampel
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sharif Amit Kamran
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Ethan Waisberg
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Phani Paladugu
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Prithul Sarker
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, Reno, NV, USA
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Texas A&M College of Medicine, Galveston, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Sever Aktuna YS, Koskderelioglu A, Eskut N, Aktuna A. Is impairment of facial emotion recognition independent of cognitive dysfunction in multiple sclerosis? Neurol Sci 2024; 45:2791-2800. [PMID: 38246940 PMCID: PMC11081977 DOI: 10.1007/s10072-024-07314-0] [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: 07/12/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Emotions expressed on the face play a key role in social cognition and communication by providing inner emotional experiences. This study aimed to evaluate facial emotion identification and discrimination and empathy abilities in patients with MS and whether it is related to cognitive dysfunction. METHODS One hundred twenty patients with relapsing-remitting MS and age- and sex-matched 120 healthy controls were enrolled in the study. All the subjects were evaluated with the Facial Emotion Identification Test (FEIT), Facial Emotion Discrimination Test (FEIDT), and Empathy Quotient (EQ). We used the Beck Depression Inventory (BDI) for depression and detailed cognitive tests, including the Montreal Cognitive Assessment (MoCA), the Symbol Digit Modalities Test (SDMT), and the Paced Auditory Serial Addition Test (PASAT). The quality of life was assessed with Multiple Sclerosis Quality of Life-54 (MSQL-54). RESULTS Patients with MS were 37.6 ± 9.5 years old, had a mean disease duration of 8.8 ± 6.6 (8-28) years, and a mean EDSS score of 1.6 ± 1.3 (0-4.5). We found significant differences in the identification of facial emotions, discrimination of facial emotions, and empathy in MS patients compared to controls (p < 0.05). Especially the recognition of feelings of sadness, fear, and shame was significantly lower in MS patients. The multivariate logistic regression analysis showed low SDMT and FEIDT scores which showed an independent association with MS. CONCLUSIONS Our findings indicate that facial emotion recognition and identification deficits are remarkable among patients with MS and emotion recognition is impaired together with and independently of cognitive dysfunction in MS patients.
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Affiliation(s)
- Yagmur Simge Sever Aktuna
- Neurology Department, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, 35170, Izmir, Turkey.
| | - Asli Koskderelioglu
- Neurology Department, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, 35170, Izmir, Turkey
| | - Neslihan Eskut
- Neurology Department, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, 35170, Izmir, Turkey
| | - Atalay Aktuna
- Department of Public Health, Ministry of Health, Bornova District Health Directorate, 35030, Bornova, Izmir, Turkey
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Edde M, Houde F, Theaud G, Dumont M, Gilbert G, Houde JC, Maltais L, Théberge A, Doumbia M, Beaudoin AM, Lapointe E, Barakovic M, Magon S, Descoteaux M. Impact of follow ups, time interval and study duration in diffusion & myelin MRI clinical study in MS. Neuroimage Clin 2023; 40:103529. [PMID: 37857232 PMCID: PMC10591008 DOI: 10.1016/j.nicl.2023.103529] [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: 06/12/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
It is currently unknown how quantitative diffusion and myelin MRI designs affect the results of a longitudinal study. We used two independent datasets containing 6 monthly MRI measurements from 20 healthy controls and 20 relapsing-remitting multiple sclerosis (RR-MS) patients. Six designs were tested, including 3 MRI acquisitions, either over 6 months or over a shorter study duration, with balanced (same interval) or unbalanced (different interval) time intervals between MRI acquisitions. First, we show that in RR-MS patients, the brain changes over time obtained with 3 MRI acquisitions were similar to those observed with 5 MRI acquisitions and that designs with an unbalanced time interval showed the highest similarity, regardless of study duration. No significant brain changes were found in the healthy controls over the same periods. Second, the study duration affects the sample size in the RR-MS dataset; a longer study requires more subjects and vice versa. Third, the number of follow-up acquisitions and study duration affect the sensitivity and specificity of the associations with clinical parameters, and these depend on the white matter bundle and MRI measure considered. Together, this suggests that the optimal design depends on the assumption of the dynamics of change in the target population and the accuracy required to capture these dynamics. Thus, this work provides a better understanding of key factors to consider in a longitudinal study and provides clues for better strategies in clinical trial design.
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Affiliation(s)
- Manon Edde
- Imeka Solutions, Inc., Sherbrooke, QC, Canada; Université de Sherbrooke, Sherbrooke, QC, Canada.
| | | | | | | | - Guillaume Gilbert
- MR Clinical Science, Philips Healthcare Canada, Mississauga, Ontario, Canada
| | | | | | - Antoine Théberge
- Université de Sherbrooke, Sherbrooke, QC, Canada; Videos & Images Theory and Analytics Laboratory (VITAL), Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Moussa Doumbia
- Université de Sherbrooke, CIUSSS de l'Estrie-CHUS Fleurimont, Sherbrooke, QC, Canada
| | - Ann-Marie Beaudoin
- Université de Sherbrooke, Sherbrooke, QC, Canada; Université de Sherbrooke, CIUSSS de l'Estrie-CHUS Fleurimont, Sherbrooke, QC, Canada
| | - Emmanuelle Lapointe
- Université de Sherbrooke, CIUSSS de l'Estrie-CHUS Fleurimont, Sherbrooke, QC, Canada
| | - Muhamed Barakovic
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases, Roche Innovation Center Basel Switzerland, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Stefano Magon
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases, Roche Innovation Center Basel Switzerland, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Maxime Descoteaux
- Imeka Solutions, Inc., Sherbrooke, QC, Canada; Université de Sherbrooke, Sherbrooke, QC, Canada
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de Villers-Sidani É, Voss P, Bastien N, Cisneros-Franco JM, Hussein S, Mayo NE, Koch NA, Drouin-Picaro A, Blanchette F, Guitton D, Giacomini PS. Oculomotor analysis to assess brain health: preliminary findings from a longitudinal study of multiple sclerosis using novel tablet-based eye-tracking software. Front Neurol 2023; 14:1243594. [PMID: 37745656 PMCID: PMC10516298 DOI: 10.3389/fneur.2023.1243594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/07/2023] [Indexed: 09/26/2023] Open
Abstract
A growing body of evidence supports the link between eye movement anomalies and brain health. Indeed, the oculomotor system is composed of a diverse network of cortical and subcortical structures and circuits that are susceptible to a variety of degenerative processes. Here we show preliminary findings from the baseline measurements of an ongoing longitudinal cohort study in MS participants, designed to determine if disease and cognitive status can be estimated and tracked with high accuracy based on eye movement parameters alone. Using a novel gaze-tracking technology that can reliably and accurately track eye movements with good precision without the need for infrared cameras, using only an iPad Pro embedded camera, we show in this cross-sectional study that several eye movement parameters significantly correlated with clinical outcome measures of interest. Eye movement parameters were extracted from fixation, pro-saccade, anti-saccade, and smooth pursuit visual tasks, whereas the clinical outcome measures were the scores of several disease assessment tools and standard cognitive tests such as the Expanded Disability Status Scale (EDSS), Brief International Cognitive Assessment for MS (BICAMS), the Multiple Sclerosis Functional Composite (MSFC) and the Symbol Digit Modalities Test (SDMT). Furthermore, partial least squares regression analyses show that a small set of oculomotor parameters can explain up to 84% of the variance of the clinical outcome measures. Taken together, these findings not only replicate previously known associations between eye movement parameters and clinical scores, this time using a novel mobile-based technology, but also the notion that interrogating the oculomotor system with a novel eye-tracking technology can inform us of disease severity, as well as the cognitive status of MS participants.
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Affiliation(s)
- Étienne de Villers-Sidani
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Patrice Voss
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | | | - J. Miguel Cisneros-Franco
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | | | - Nancy E. Mayo
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Nils A. Koch
- Innodem Neurosciences, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | | | | | - Daniel Guitton
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Paul S. Giacomini
- Innodem Neurosciences, Montreal, QC, Canada
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
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9
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Moreno-Morente G, Hurtado-Pomares M, Terol Cantero MC. Bibliometric Analysis of Research on the Use of the Nine Hole Peg Test. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10080. [PMID: 36011713 PMCID: PMC9407738 DOI: 10.3390/ijerph191610080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
Manual dexterity is essential for performing daily life tasks, becoming a primary means of interaction with the physical, social, and cultural environment. In this respect, the Nine Hole Peg Test (NHPT) is considered a gold standard for assessing manual dexterity. Bibliometrics is a discipline that focuses on analyzing publications to describe, evaluate, and predict the status and development trends in certain fields of scientific research. We performed a bibliometric analysis to track research results and identify global trends regarding the use of the NHPT. The bibliographic data were retrieved from the Web of Science database and then analyzed using the Bibliometrix R package, resulting in the retrieval of a total of 615 publications from 1988 to 2021. Among the 263 journals investigated, the most prolific were the Multiple Sclerosis Journal, Clinical Rehabilitation, and Multiple Sclerosis and Related Disorders. North America and Europe were the areas with the highest production of publications, with the United States (n = 104) ranking first in terms of the number of publications, followed by the United Kingdom (n = 62) and Italy (n = 62). The analysis of keywords revealed that there were two main lines of research, with one related to the study of recovery and disability of the upper limbs caused by certain diseases and another related to the study of reliability and validity. Structured information can be useful to understand the research trajectory and the uses of this tool.
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Affiliation(s)
- Gema Moreno-Morente
- Department of Surgery and Pathology, Miguel Hernández University, 03550 Alicante, Spain
| | - Miriam Hurtado-Pomares
- Department of Surgery and Pathology, Miguel Hernández University, 03550 Alicante, Spain
- Grupo de Investigación en Terapia Ocupacional (InTeO), Miguel Hernández University, 03550 Alicante, Spain
| | - M. Carmen Terol Cantero
- Department of Behavioral Sciences and Health, Miguel Hernández University, 03550 Alicante, Spain
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10
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Cerebellar Contributions to Motor and Cognitive Control in Multiple Sclerosis ✰✰✰. Arch Phys Med Rehabil 2022; 103:1592-1599. [PMID: 34998712 DOI: 10.1016/j.apmr.2021.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/25/2021] [Accepted: 12/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate relationships between specific cerebellar regions and common clinical measures of motor and cognitive function in persons with multiple sclerosis (PwMS). DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS Twenty-nine PwMS and 28 age- and sex-matched controls without multiple sclerosis (MS) (N=57). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Both diffusion and lobule magnetic resonance imaging analyses and common clinical measures of motor and cognitive function were used to examine structure-function relationships in the cerebellum. RESULTS PwMS demonstrate significantly worse motor and cognitive function than controls, including weaker strength, slower walking, and poorer performance on the Symbol Digit Modalities Test, but demonstrate no differences in cerebellar volume. However, PwMS demonstrate significantly worse diffusivity (mean diffusivity: P=.0003; axial diffusivity: P=.0015; radial diffusivity: P=.0005; fractional anisotropy: P=.016) of the superior cerebellar peduncle, the primary output of the cerebellum. Increased volume of the motor lobules (I-V, VIII) was significantly related to better motor (P<.022) and cognitive (P=.046) performance, and increased volume of the cognitive lobules (VI-VII) was also related to better motor (P<.032) and cognitive (P=.008) performance, supporting the role of the cerebellum in both motor and cognitive functioning. CONCLUSIONS These data highlight the contributions of the cerebellum to both motor and cognitive function in PwMS. Using novel neuroimaging techniques to examine structure-function relationships in PwMS improves our understanding of individualized differences in this heterogeneous group and may provide an avenue for targeted, individualized rehabilitation aimed at improving cerebellar dysfunction in MS.
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11
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Measuring Treatment Response in Progressive Multiple Sclerosis-Considerations for Adapting to an Era of Multiple Treatment Options. Biomolecules 2021; 11:biom11091342. [PMID: 34572555 PMCID: PMC8470215 DOI: 10.3390/biom11091342] [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: 08/03/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022] Open
Abstract
Disability in multiple sclerosis accrues predominantly in the progressive forms of the disease. While disease-modifying treatment of relapsing MS has drastically evolved over the last quarter-century, the development of efficient drugs for preventing or at least delaying disability in progressive MS has proven more challenging. In that way, many drugs (especially disease-modifying treatments) have been researched in the aspect of delaying disability progression in patients with a progressive course of the disease. While there are some disease-modifying treatments approved for progressive multiple sclerosis, their effect is moderate and limited mostly to patients with clinical and/or radiological signs of disease activity. Several phase III trials have used different primary outcomes with different time frames to define disease progression and to evaluate the efficacy of a disease-modifying treatment. The lack of sufficiently sensitive outcome measures could be a possible explanation for the negative clinical trials in progressive multiple sclerosis. On the other hand, even with a potential outcome measure that would be sensitive enough to determine disease progression and, thus, the efficacy or failure of a disease-modifying treatment, the question of clinical relevance remains unanswered. In this systematic review, we analyzed outcome measures and definitions of disease progression in phase III clinical trials in primary and secondary progressive multiple sclerosis. We discuss advantages and disadvantages of clinical and paraclinical outcome measures aiming for practical ways of combining them to detect disability progression more sensitively both in future clinical trials and current clinical routine.
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12
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Chen S, Sierra S, Shin Y, Goldman MD. Gait Speed Trajectory During the Six-Minute Walk Test in Multiple Sclerosis: A Measure of Walking Endurance. Front Neurol 2021; 12:698599. [PMID: 34381416 PMCID: PMC8352578 DOI: 10.3389/fneur.2021.698599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The six-minute walk (6MW) test is a validated assessment method in Multiple Sclerosis (MS) research. While the total distance covered during six minutes (6MWTD) is often used as the standard measurement of gait capacity (i.e., the maximum distance one can achieve), we hypothesize that endurance (i.e., ability to maintain speed over a prolonged time) can be inferred by the gait speed trajectory (GST) during the 6MW test (6MWGST). Objective: To characterize group differences in 6MWGST between MS patients and healthy controls (HCs), and to assess information added by 6MWGST for discerning between MS patients and HCs. Methods: We performed a secondary data analysis on a cross-sectional cohort of 40 MS and 20 HC subjects with three repeated 6MW tests. We modeled 6MWGST using a linear mixed-effects model with time in minutes and replicated walks nested within individuals. We compared the discernibility of 6MWGST with that of conventional metrics using likelihood ratio tests and receiver operating characteristic (ROC) analysis on logistic regression models. Results: MS subjects showed a concave, quadratic GST during 6MW tests, slowing down more than the HC subjects, especially at the beginning of 6MW tests. Despite accelerating at the end of the 6MW, MS subjects were unable to attain or surpass their initial 6MW gait speeds. 6MWGST added useful information (p = 0.002) to the conventional metrics (e.g., 6MWTD) for discerning between MS and HC subjects, and increased the area under the ROC curve from 0.83 to 0.93 (p = 0.037). Conclusions: The distinctive 6MWGST pattern of MS patients provided increased discernibility compared with currently used gait metrics. Both gait capacity measured by the 6MWTD, and gait endurance measured by parameters of 6MWGST, are significant functional indicators for the MS population.
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Affiliation(s)
- Shanshan Chen
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States.,Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Salvador Sierra
- Department of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Yongyun Shin
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States
| | - Myla D Goldman
- Department of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
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13
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Robot-Assisted Gait Training in Patients with Multiple Sclerosis: A Randomized Controlled Crossover Trial. ACTA ACUST UNITED AC 2021; 57:medicina57070713. [PMID: 34356994 PMCID: PMC8306232 DOI: 10.3390/medicina57070713] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 02/04/2023]
Abstract
Background and Objectives: Gait disorders represent one of the most disabling aspects in multiple sclerosis (MS) that strongly influence patient quality of life. The improvement of walking ability is a primary goal for rehabilitation treatment. The aim of this study is to evaluate the effectiveness of robot-assisted gait training (RAGT) in association with physiotherapy treatment in patients affected by MS in comparison with ground conventional gait training. Study design: Randomized controlled crossover trial. Materials and Methods: Twenty-seven participants affected by MS with EDSS scores between 3.5 and 7 were enrolled, of whom seventeen completed the study. They received five training sessions per week over five weeks of conventional gait training with (experimental group) or without (control group) the inclusion of RAGT. The patients were prospectively evaluated before and after the first treatment session and, after the crossover phase, before and after the second treatment session. The evaluation was based on the 25-foot walk test (25FW, main outcome), 6 min walk test (6MWT), Tinetti Test, Modified Ashworth Scale, and modified Motricity Index for lower limbs. We also measured disability parameters using Functional Independence Measure and Quality of Life Index, and instrumental kinematic and gait parameters: knee extensor strength, double-time support, step length ratio; 17 patients reached the final evaluation. Results: Both groups significantly improved on gait parameters, motor abilities, and autonomy recovery in daily living activities with generally better results of RAGT over control treatment. In particular, the RAGT group improved more than control group in the 25FW (p = 0.004) and the 6MWT (p = 0.022). Conclusions: RAGT is a valid treatment option that in association with physiotherapy could induce positive effects in MS-correlated gait disorders. Our results showed greater effectiveness in recovering gait speed and resistance than conventional gait training.
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14
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Henning DA, Edwards EM, Ansara M, Fritz NE. Validating the walking while talking test to measure motor, cognitive, and dual-task performance in ambulatory individuals with multiple sclerosis. Mult Scler Relat Disord 2021; 54:103123. [PMID: 34246023 DOI: 10.1016/j.msard.2021.103123] [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: 03/18/2021] [Revised: 06/15/2021] [Accepted: 06/25/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Multiple Sclerosis (MS) is associated with demyelination of the central nervous system that negatively impacts both motor and cognitive function, resulting in difficulty performing simultaneous motor and cognitive tasks, or dual-tasks. Declines in dual-tasking have been linked with falls in MS; thus, dual-task assessment with the Walking While Talking Test (WWTT) is commonly utilized in the clinical setting. However, the validity and minimal detectable change (MDC) of the WWTT has not been established for persons with MS. The primary objective of the study was to establish the WWTT as a valid measure of dual-task function by examining concurrent validity with other motor, cognitive and dual-task measures, and to establish the MDC for both the simple and complex conditions of the WWTT. METHODS In a single visit, 38 adults (34 female, mean (SD) age 49.8(±9.1), Patient Determined Disease Steps (PDDS) mean 3, range 1-6) completed the WWTT simple (walk while reciting the alphabet) and complex (walk while reciting every other letter of the alphabet) conditions as well as a battery of cognitive and motor tests. Spearman correlations were used to examine concurrent validity. The sample was divided into low and high disability groups to determine the impact of disability severity on relationships among WWTT and cognitive and motor function. RESULTS Excellent concurrent validity (r ≥ 0.79; p < 0.001) was observed for the WWTT simple and complex with both motor (Timed Up-and-Go, Timed 25-Foot Walk, forward and backward walking velocity, Six-Spot Step Test) and dual-task measures (Timed Up-and-Go Cognitive). The WWTT-simple demonstrated moderate concurrent validity with measures of processing speed (Symbol Digit Modalities Test, p = 0.041) and was related to all motor and dual-task measures across disability levels. The WWTT complex was only related to complex motor tasks in the low disability group. Within the low disability group, WWTT was associated with processing speed (p = 0.045) and working memory (California Verbal Learning Test, p = 0.012). The MDC values were established for WWTT simple (6.9 s) and complex (8 s) conditions. DISCUSSION The WWTT is a quick, easy-to-administer clinical measure that captures both motor and cognitive aspects of performance for persons with MS. Clinicians should consider adding the WWTT to the evaluation of persons with MS to examine dual-task performance.
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Affiliation(s)
- David A Henning
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit MI, United States; Department of Health Care Sciences, Program in Physical Therapy, Wayne State University, Detroit MI, United States
| | - Erin M Edwards
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit MI, United States; Translational Neuroscience Program, Wayne State University, Detroit, MI, United States
| | - Melissa Ansara
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit MI, United States
| | - Nora E Fritz
- Neuroimaging and Neurorehabilitation Laboratory, Wayne State University, Detroit MI, United States; Department of Health Care Sciences, Program in Physical Therapy, Wayne State University, Detroit MI, United States; Translational Neuroscience Program, Wayne State University, Detroit, MI, United States; Department of Neurology, Wayne State University, Detroit MI, United States.
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15
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Khan A, Li Y, Ponirakis G, Akhtar N, Gad H, George P, Ibrahim FM, Petropoulos IN, Canibano BG, Deleu D, Shuaib A, Kamran S, Malik RA. Corneal Immune Cells Are Increased in Patients With Multiple Sclerosis. Transl Vis Sci Technol 2021; 10:19. [PMID: 34003997 PMCID: PMC8083118 DOI: 10.1167/tvst.10.4.19] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose Corneal confocal microscopy (CCM) is an ophthalmic imaging technique that has been used to identify increased corneal immune cells in patients with immune-mediated peripheral neuropathy. Given that multiple sclerosis has an immune-mediated etiology, we have compared corneal immune cell (IC) density and near-nerve distance in different subtypes of patients with multiple sclerosis (MS) to controls. Methods This is a blinded, cross-sectional study conducted at a tertiary hospital. Patients with clinically isolated syndrome (CIS) (n = 9), relapsing-remitting multiple sclerosis (RRMS) (n = 43), secondary progressive multiple sclerosis (SPMS) (n = 22), and control subjects (n = 20) underwent CCM. The total, mature, and immature corneal IC density and their nearest nerve distance were quantified. Results The total IC density was higher in patients with MS (P = 0.02), RRMS (P = 0.01), and SPMS (P = 0.04) but not CIS (P = 0.99) compared to controls. Immature IC density was higher in patients with MS (P = 0.03) and RRMS (P = 0.02) but not SPMS (P = 0.10) or CIS (P = 0.99) compared to controls. Mature IC density (P = 0.15) did not differ between patients with MS and controls. The immature IC near-nerve distance was significantly greater in patients with MS (P = 0.001), RRMS (P = 0.007), and SPMS (P = 0.002) compared to controls. Immature IC density correlated with the Symbol Digit Modalities Test (r = –0.281, P = 0.02) and near-nerve distance correlated with the Expanded Disability Status Scale (r = 0.289, P = 0.005). Conclusions In vivo CCM demonstrates an increase in immature IC density and the near-nerve distance in patients with MS. These observations merit further studies to assess the utility of CCM in assessing neuroimmune alterations in MS. Translational Relevance Multiple sclerosis is an immune-mediated neurodegenerative disease. Dendritic cells mediate communication between the innate and adaptive immune systems. We have used in vivo CCM to show increased corneal ICs and suggest it may act as an imaging biomarker for disease status in patients with MS.
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Affiliation(s)
- Adnan Khan
- Weill Cornell Medicine-Qatar, Research Division, Doha, Qatar
| | - Yi Li
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Naveed Akhtar
- Department of Neurology, Hamad General Hospital, Doha, Qatar
| | - Hoda Gad
- Weill Cornell Medicine-Qatar, Research Division, Doha, Qatar
| | - Pooja George
- Department of Neurology, Hamad General Hospital, Doha, Qatar
| | - Faiza M Ibrahim
- Department of Neurology, Hamad General Hospital, Doha, Qatar
| | | | | | - Dirk Deleu
- Department of Neurology, Hamad General Hospital, Doha, Qatar
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Saadat Kamran
- Department of Neurology, Hamad General Hospital, Doha, Qatar
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Research Division, Doha, Qatar.,Institute of Cardiovascular Science, University of Manchester, Manchester, UK
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16
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Choi S, Spini M, Hua J, Harrison DM. Blood-brain barrier breakdown in non-enhancing multiple sclerosis lesions detected by 7-Tesla MP2RAGE ΔT1 mapping. PLoS One 2021; 16:e0249973. [PMID: 33901207 PMCID: PMC8075220 DOI: 10.1371/journal.pone.0249973] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/28/2021] [Indexed: 11/19/2022] Open
Abstract
Although the blood-brain barrier (BBB) is altered in most multiple sclerosis (MS) lesions, gadolinium enhancement is seen only in acute lesions. In this study, we aimed to investigate gadolinium-induced changes in T1 relaxation time in MS lesions on 7-tesla (7T) MRI as a means to quantify BBB breakdown in non-enhancing MS lesions. Forty-seven participants with MS underwent 7T MRI of the brain with a magnitude-prepared rapid acquisition of 2 gradient echoes (MP2RAGE) sequence before and after contrast. Subtraction of pre- and post-contrast T1 maps was used to measure T1 relaxation time change (ΔT1) from gadolinium. ΔT1 values were interrogated in enhancing white matter lesions (ELs), non-enhancing white matter lesions (NELs), and normal appearing white matter (NAWM) and metrics were compared to clinical data. ΔT1 was measurable in NELs (median: -0.139 (-0.304, 0.174) seconds; p < 0.001) and was negligible in NAWM (median: -0.001 (-0.036, 0.155) seconds; p = 0.516). Median ΔT1 in NELs correlated with disability as measured by Expanded Disability Status Scale (EDSS) (rho = -0.331, p = 0.026). Multiple measures of NEL ΔT1 variability also correlated with EDSS. NEL ΔT1 values were greater and more variable in patients with progressive forms of MS and greater in those not on MS treatment. Measurement of the changes in T1 relaxation time caused by contrast on 7T MP2RAGE reveals clinically relevant evidence of BBB breakdown in NELs in MS. This data suggests that NEL ΔT1 should be evaluated further as a potential biomarker of persistently disrupted BBB in MS.
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Affiliation(s)
- Seongjin Choi
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Margaret Spini
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Jun Hua
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United Stated of America
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, United States of America
| | - Daniel M. Harrison
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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17
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Oh J, Chen M, Cybulsky K, Suthiphosuwan S, Seyman E, Dewey B, Diener-West M, van Zijl P, Prince J, Reich DS, Calabresi PA. Five-year longitudinal changes in quantitative spinal cord MRI in multiple sclerosis. Mult Scler 2021; 27:549-558. [PMID: 32476593 PMCID: PMC7704828 DOI: 10.1177/1352458520923970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The spinal cord (SC) is highly relevant to disability in multiple sclerosis (MS), but few studies have evaluated longitudinal changes in quantitative spinal cord magnetic resonance imaging (SC-MRI). OBJECTIVES The aim of this study was to characterize the relationships between 5-year changes in SC-MRI with disability in MS. METHODS In total, 75 MS patients underwent 3 T SC-MRI and clinical assessment (expanded disability status scale (EDSS) and MS functional composite (MSFC)) at baseline, 2 and 5 years. SC-cross-sectional area (CSA) and diffusion-tensor indices (fractional anisotropy (FA), mean, perpendicular, parallel diffusivity (MD, λ⊥, λ||) and magnetization transfer ratio (MTR)) were extracted at C3-C4. Mixed-effects regression incorporating subject-specific slopes assessed longitudinal change in SC-MRI measures. RESULTS SC-CSA and MTR decreased (p = 0.009, p = 0.03) over 5.1 years. There were moderate correlations between 2- and 5-year subject-specific slopes of SC-MRI indices and follow-up EDSS scores (Pearson's r with FA = -0.23 (p < 0.001); MD = 0.31 (p < 0.001); λ⊥ = 0.34 (p < 0.001); λ|| = -0.12 (p = 0.05), MTR = -0.37 (p < 0.001); SC-CSA = -0.47 (p < 0.001) at 5 years); MSFC showed similar trends. The 2- and 5-year subject-specific slopes were robustly correlated (r = 0.93-0.97 for FA, λ⊥, SC-CSA and MTR, all ps < 0.001). CONCLUSION In MS, certain quantitative SC-MRI indices change over 5 years, reflecting ongoing tissue changes. Subject-specific trajectories of SC-MRI index change at 2 and 5 years are strongly correlated and highly relevant to follow-up disability. These findings suggest that individual dynamics of change should be accounted for when interpreting longitudinal SC-MRI measures and that measuring short-term change is predictive of long-term clinical disability.
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Affiliation(s)
- Jiwon Oh
- Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada/Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Min Chen
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA/Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Kateryna Cybulsky
- Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Suradech Suthiphosuwan
- Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada/Division of Neuroradiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Estelle Seyman
- Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Blake Dewey
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA/F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Marie Diener-West
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Peter van Zijl
- F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA/Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | - Jerry Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA/Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel S Reich
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA/Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA/Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
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18
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Fritz NE, Edwards EM, Keller J, Eloyan A, Calabresi PA, Zackowski KM. Combining Magnetization Transfer Ratio MRI and Quantitative Measures of Walking Improves the Identification of Fallers in MS. Brain Sci 2020; 10:E822. [PMID: 33171942 PMCID: PMC7694635 DOI: 10.3390/brainsci10110822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/27/2020] [Accepted: 11/04/2020] [Indexed: 12/22/2022] Open
Abstract
Multiple sclerosis (MS) impacts balance and walking function, resulting in accidental falls. History of falls and clinical assessment are commonly used for fall prediction, yet these measures have limited predictive validity. Falls are multifactorial; consideration of disease-specific pathology may be critical for improving fall prediction in MS. The objective of this study was to examine the predictive value of clinical measures (i.e., walking, strength, sensation) and corticospinal tract (CST) MRI measures, both discretely and combined, to fall status in MS. Twenty-nine individuals with relapsing-remitting MS (mean ± SD age: 48.7 ± 11.5 years; 17 females; Expanded Disability Status Scale (EDSS): 4.0 (range 1-6.5); symptom duration: 11.9 ± 8.7 years; 14 fallers) participated in a 3T brain MRI including diffusion tensor imaging and magnetization transfer ratio (MTR) and clinical tests of walking, strength, sensation and falls history. Clinical measures of walking were significantly associated with CST fractional anisotropy and MTR. A model including CST MTR, walk velocity and vibration sensation explained >31% of the variance in fall status (R2 = 0.3181) and accurately distinguished 73.8% fallers, which was superior to stand-alone models that included only MRI or clinical measures. This study advances the field by combining clinical and MRI measures to improve fall prediction accuracy in MS.
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Affiliation(s)
- Nora E. Fritz
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD 21205, USA; (J.K.); (K.M.Z.)
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
- Program in Physical Therapy and Department of Neurology, Wayne State University, Detroit, MI 48201, USA
- Translational Neuroscience Program, Wayne State University, Detroit, MI 48201, USA;
| | - Erin M. Edwards
- Translational Neuroscience Program, Wayne State University, Detroit, MI 48201, USA;
| | - Jennifer Keller
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD 21205, USA; (J.K.); (K.M.Z.)
| | - Ani Eloyan
- Department of Biostatistics, Brown University, Providence, RI 02912, USA;
| | - Peter A. Calabresi
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA;
| | - Kathleen M. Zackowski
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, MD 21205, USA; (J.K.); (K.M.Z.)
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA;
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19
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Backus D, Moldavskiy M, Sweatman WM. Effects of Functional Electrical Stimulation Cycling on Fatigue and Quality of Life in People with Multiple Sclerosis Who Are Nonambulatory. Int J MS Care 2020; 22:193-200. [PMID: 32863788 PMCID: PMC7446631 DOI: 10.7224/1537-2073.2019-101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Functional electrical stimulation (FES) cycling provides an exercise opportunity for people with multiple sclerosis (MS) who are nonambulatory. This study evaluated the efficacy of FES cycling for reducing fatigue and improving quality of life in people with MS who are nonambulatory and compared outcomes with those in a control group that did not take part in FES cycling. METHODS Adults with MS with self-reported Expanded Disability Status Scale scores of 7.0 to 8.5 were randomized into a training group (n = 12) or a control group (n = 9). The training group performed FES cycling for 30 minutes, two to three times a week for 12 weeks. The primary outcome was safety, measured as the number and type of adverse events and any increase in symptoms. Other outcomes collected before and after the intervention were scores on the modified Ashworth Scale, manual muscle test, 5-item Modified Fatigue Impact Scale (MFIS-5), Fatigue Scale for Motor and Cognitive Functions (FSMC), Medical Outcomes Study Pain Effects Scale, Patient Health Questionnaire-9 (PHQ-9), Multiple Sclerosis Quality of Life-54 (MSQOL-54), and Exercise Self-Efficacy Scale. RESULTS Twelve participants completed the study and were analyzed. Six participants completed training with no adverse events. The MFIS-5 (Cohen's d = 0.60), FSMC (Cohen's d = 0.37), and PHQ-9 (Cohen's d = 0.67) scores and the physical health composite of the MSQOL-54 (Cohen's d = 1.48) improved for the training group compared with the control group (n = 6). CONCLUSIONS Functional electrical stimulation cycling is safe for people with MS who are nonambulatory and may reduce fatigue and improve measurements of quality of life.
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Ergul M, Nodehi Moghadam A, Soh R. The effectiveness of interventions targeting spasticity on functional clinical outcomes in patients with multiple sclerosis: a systematic review of clinical trials. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1775888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Merziye Ergul
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Afsun Nodehi Moghadam
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Rachel Soh
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Abstract
PURPOSE OF REVIEW Recent years have seen the approval of more than 15 disease-modifying drugs for multiple sclerosis (MS), mainly for its relapsing-remitting form (RRMS). The focus of the MS clinical trials is moving toward clinical trials aimed at progressive patients or based on putatively neuroprotective compounds. Here we reviewed the challenges of this paradigm shift. RECENT FINDINGS Progressive MS and neuroprotective drugs trials will both need a change in patients' enrollment criteria, outcome selection, and clinical trials design. Published ocrelizumab Primary Progressive MS data, as well as translational neuroimaging and clinical research suggest that MRI markers of inflammation could be used to enrich progressive MS trials population, albeit with the risk of overestimating the relevance of antiinflammatory therapeutic effects in this population and that conventional MRI-based metrics need to be complemented with volumetric and multiparametric approaches to disease severity quantification. Lastly, regarding statistical design, Bayesian approaches are at last making their way from oncology to neurology improving our ability to evaluate multiple treatments in the same trials' population. SUMMARY Adequate clinical trials design was one of the key factors in the RRMS treatment success story. Multidisciplinary collaborations are needed to adequately plan the progressive MS and restorative therapies trials that lay ahead in the near future.
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Goverover Y, Genova HM, Smith A, Lengenfelder J, Chiaravalloti ND. Changes in Activity Participation After Multiple Sclerosis Diagnosis. Int J MS Care 2020; 22:23-30. [PMID: 32123525 PMCID: PMC7041618 DOI: 10.7224/1537-2073.2018-036] [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 Multiple sclerosis (MS) results in impairments in cognitive and motor skills, which may reduce the level of activity participation in people with MS. This study compares past and current levels of activity participation in adults with MS and controls. The relationship between retained activity participation (since diagnosis) and cognitive, motor, functional status, and depression symptoms of persons with MS was examined. METHODS Twenty-seven individuals with MS living in the community and 21 controls completed cognitive and motor tests and rated their activity participation (using the Activity Card Sort), depression symptoms, and functional status. RESULTS The MS group reported significantly lower current activity participation than the control group. Percentage of retained activity participation (from prediagnosis to current) in the MS group correlated with time since diagnosis, executive function and motor skill ability, depression symptoms, and current functional status. CONCLUSIONS Persons with MS report negative changes in activity participation in most aspects of life after diagnosis. These findings call attention to changes in activity participation in people with MS that are directly related to disease symptoms. Therefore, using a quantitative measure of activity participation-the Activity Card Sort-can provide important information to aid the clinician in developing individualized treatment goals for people with MS.
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Al‐Zuhairy A, Sindrup SH, Andersen H, Jakobsen J. A population‐based study of long‐term outcome in treated chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2020; 61:316-324. [DOI: 10.1002/mus.26772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Ali Al‐Zuhairy
- Department of NeurologyCopenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Søren H. Sindrup
- Department of NeurologyOdense University Hospital Odense Denmark
| | - Henning Andersen
- Department of NeurologyAarhus University Hospital Aarhus Denmark
| | - Johannes Jakobsen
- Department of NeurologyCopenhagen University Hospital Rigshospitalet Copenhagen Denmark
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The Relationship Between Multiple Sclerosis Symptom Severity Measures and Performance on Driving Variability Metrics in a Virtual Reality Simulator. Am J Phys Med Rehabil 2019; 99:278-284. [DOI: 10.1097/phm.0000000000001351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Goldman MD, LaRocca NG, Rudick RA, Hudson LD, Chin PS, Francis GS, Jacobs A, Kapoor R, Matthews PM, Mowry EM, Balcer LJ, Panzara M, Phillips G, Uitdehaag BMJ, Cohen JA. Evaluation of multiple sclerosis disability outcome measures using pooled clinical trial data. Neurology 2019; 93:e1921-e1931. [PMID: 31641014 PMCID: PMC6885577 DOI: 10.1212/wnl.0000000000008519] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/24/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE We report analyses of a pooled database by the Multiple Sclerosis Outcome Assessments Consortium to evaluate 4 proposed components of a multidimensional test battery. METHODS Standardized data on 12,776 participants, comprising demographics, multiple sclerosis disease characteristics, Expanded Disability Status Scale (EDSS) score, performance measures, and Short Form-36 Physical Component Summary (SF-36 PCS), were pooled from control and treatment arms of 14 clinical trials. Analyses of Timed 25-Foot Walk (T25FW), 9-Hole Peg Test (9HPT), Low Contrast Letter Acuity (LCLA), and Symbol Digit Modalities Test (SDMT) included measurement properties; construct, convergent, and known group validity; and longitudinal performance of the measures individually and when combined into a multidimensional test battery relative to the EDSS and SF-36 to determine sensitivity and clinical meaningfulness. RESULTS The performance measures had excellent test-retest reliability and showed expected differences between subgroups based on disease duration and EDSS level. Progression rates in detecting time to 3-month confirmed worsening were lower for T25FW and 9HPT compared to EDSS, while progression rates for LCLA and SDMT were similar to EDSS. When the 4 measures were analyzed as a multidimensional measure rather than as individual measures, progression on any one performance measure was more sensitive than the EDSS. Worsening on the performance measures analyzed individually or as a multidimensional test battery was associated with clinically meaningful SF-36 PCS score worsening, supporting clinical meaningfulness of designated performance test score worsening. CONCLUSION These results support the use of the 4 proposed performance measures, individually or combined into a multidimensional test battery as study outcome measures.
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Affiliation(s)
- Myla D Goldman
- From the University of Virginia (M.D.G.), Charlottesville; National Multiple Sclerosis Society (N.G.L.), New York, NY; Biogen (R.A.R., G.P.), Cambridge, MA; Critical Path Institute (L.D.H.), Tucson, AZ; Genentech (P.S.C.), South San Francisco, CA; Independent Neurology Clinical Development Consultant (G.S.F.); Premier Research (A.J.), Wokingham, UK; UCL Institute of Neurology (R.K.), London, UK; Imperial College London and UK Dementia Research Institute (P.M.M.); Johns Hopkins (E.M.M.), Baltimore, MD; New York University School of Medicine (L.J.B.), NY; Wave Life Sciences (M.P.), Cambridge, MA; VU University Medical Center (B.M.J.U.), Amsterdam, the Netherlands; and Cleveland Clinic (J.A.C.), OH
| | - Nicholas G LaRocca
- From the University of Virginia (M.D.G.), Charlottesville; National Multiple Sclerosis Society (N.G.L.), New York, NY; Biogen (R.A.R., G.P.), Cambridge, MA; Critical Path Institute (L.D.H.), Tucson, AZ; Genentech (P.S.C.), South San Francisco, CA; Independent Neurology Clinical Development Consultant (G.S.F.); Premier Research (A.J.), Wokingham, UK; UCL Institute of Neurology (R.K.), London, UK; Imperial College London and UK Dementia Research Institute (P.M.M.); Johns Hopkins (E.M.M.), Baltimore, MD; New York University School of Medicine (L.J.B.), NY; Wave Life Sciences (M.P.), Cambridge, MA; VU University Medical Center (B.M.J.U.), Amsterdam, the Netherlands; and Cleveland Clinic (J.A.C.), OH
| | - Richard A Rudick
- From the University of Virginia (M.D.G.), Charlottesville; National Multiple Sclerosis Society (N.G.L.), New York, NY; Biogen (R.A.R., G.P.), Cambridge, MA; Critical Path Institute (L.D.H.), Tucson, AZ; Genentech (P.S.C.), South San Francisco, CA; Independent Neurology Clinical Development Consultant (G.S.F.); Premier Research (A.J.), Wokingham, UK; UCL Institute of Neurology (R.K.), London, UK; Imperial College London and UK Dementia Research Institute (P.M.M.); Johns Hopkins (E.M.M.), Baltimore, MD; New York University School of Medicine (L.J.B.), NY; Wave Life Sciences (M.P.), Cambridge, MA; VU University Medical Center (B.M.J.U.), Amsterdam, the Netherlands; and Cleveland Clinic (J.A.C.), OH
| | - Lynn D Hudson
- From the University of Virginia (M.D.G.), Charlottesville; National Multiple Sclerosis Society (N.G.L.), New York, NY; Biogen (R.A.R., G.P.), Cambridge, MA; Critical Path Institute (L.D.H.), Tucson, AZ; Genentech (P.S.C.), South San Francisco, CA; Independent Neurology Clinical Development Consultant (G.S.F.); Premier Research (A.J.), Wokingham, UK; UCL Institute of Neurology (R.K.), London, UK; Imperial College London and UK Dementia Research Institute (P.M.M.); Johns Hopkins (E.M.M.), Baltimore, MD; New York University School of Medicine (L.J.B.), NY; Wave Life Sciences (M.P.), Cambridge, MA; VU University Medical Center (B.M.J.U.), Amsterdam, the Netherlands; and Cleveland Clinic (J.A.C.), OH
| | - Peter S Chin
- From the University of Virginia (M.D.G.), Charlottesville; National Multiple Sclerosis Society (N.G.L.), New York, NY; Biogen (R.A.R., G.P.), Cambridge, MA; Critical Path Institute (L.D.H.), Tucson, AZ; Genentech (P.S.C.), South San Francisco, CA; Independent Neurology Clinical Development Consultant (G.S.F.); Premier Research (A.J.), Wokingham, UK; UCL Institute of Neurology (R.K.), London, UK; Imperial College London and UK Dementia Research Institute (P.M.M.); Johns Hopkins (E.M.M.), Baltimore, MD; New York University School of Medicine (L.J.B.), NY; Wave Life Sciences (M.P.), Cambridge, MA; VU University Medical Center (B.M.J.U.), Amsterdam, the Netherlands; and Cleveland Clinic (J.A.C.), OH
| | - Gordon S Francis
- From the University of Virginia (M.D.G.), Charlottesville; National Multiple Sclerosis Society (N.G.L.), New York, NY; Biogen (R.A.R., G.P.), Cambridge, MA; Critical Path Institute (L.D.H.), Tucson, AZ; Genentech (P.S.C.), South San Francisco, CA; Independent Neurology Clinical Development Consultant (G.S.F.); Premier Research (A.J.), Wokingham, UK; UCL Institute of Neurology (R.K.), London, UK; Imperial College London and UK Dementia Research Institute (P.M.M.); Johns Hopkins (E.M.M.), Baltimore, MD; New York University School of Medicine (L.J.B.), NY; Wave Life Sciences (M.P.), Cambridge, MA; VU University Medical Center (B.M.J.U.), Amsterdam, the Netherlands; and Cleveland Clinic (J.A.C.), OH
| | - Adam Jacobs
- From the University of Virginia (M.D.G.), Charlottesville; National Multiple Sclerosis Society (N.G.L.), New York, NY; Biogen (R.A.R., G.P.), Cambridge, MA; Critical Path Institute (L.D.H.), Tucson, AZ; Genentech (P.S.C.), South San Francisco, CA; Independent Neurology Clinical Development Consultant (G.S.F.); Premier Research (A.J.), Wokingham, UK; UCL Institute of Neurology (R.K.), London, UK; Imperial College London and UK Dementia Research Institute (P.M.M.); Johns Hopkins (E.M.M.), Baltimore, MD; New York University School of Medicine (L.J.B.), NY; Wave Life Sciences (M.P.), Cambridge, MA; VU University Medical Center (B.M.J.U.), Amsterdam, the Netherlands; and Cleveland Clinic (J.A.C.), OH
| | - Raj Kapoor
- From the University of Virginia (M.D.G.), Charlottesville; National Multiple Sclerosis Society (N.G.L.), New York, NY; Biogen (R.A.R., G.P.), Cambridge, MA; Critical Path Institute (L.D.H.), Tucson, AZ; Genentech (P.S.C.), South San Francisco, CA; Independent Neurology Clinical Development Consultant (G.S.F.); Premier Research (A.J.), Wokingham, UK; UCL Institute of Neurology (R.K.), London, UK; Imperial College London and UK Dementia Research Institute (P.M.M.); Johns Hopkins (E.M.M.), Baltimore, MD; New York University School of Medicine (L.J.B.), NY; Wave Life Sciences (M.P.), Cambridge, MA; VU University Medical Center (B.M.J.U.), Amsterdam, the Netherlands; and Cleveland Clinic (J.A.C.), OH
| | - Paul M Matthews
- From the University of Virginia (M.D.G.), Charlottesville; National Multiple Sclerosis Society (N.G.L.), New York, NY; Biogen (R.A.R., G.P.), Cambridge, MA; Critical Path Institute (L.D.H.), Tucson, AZ; Genentech (P.S.C.), South San Francisco, CA; Independent Neurology Clinical Development Consultant (G.S.F.); Premier Research (A.J.), Wokingham, UK; UCL Institute of Neurology (R.K.), London, UK; Imperial College London and UK Dementia Research Institute (P.M.M.); Johns Hopkins (E.M.M.), Baltimore, MD; New York University School of Medicine (L.J.B.), NY; Wave Life Sciences (M.P.), Cambridge, MA; VU University Medical Center (B.M.J.U.), Amsterdam, the Netherlands; and Cleveland Clinic (J.A.C.), OH
| | - Ellen M Mowry
- From the University of Virginia (M.D.G.), Charlottesville; National Multiple Sclerosis Society (N.G.L.), New York, NY; Biogen (R.A.R., G.P.), Cambridge, MA; Critical Path Institute (L.D.H.), Tucson, AZ; Genentech (P.S.C.), South San Francisco, CA; Independent Neurology Clinical Development Consultant (G.S.F.); Premier Research (A.J.), Wokingham, UK; UCL Institute of Neurology (R.K.), London, UK; Imperial College London and UK Dementia Research Institute (P.M.M.); Johns Hopkins (E.M.M.), Baltimore, MD; New York University School of Medicine (L.J.B.), NY; Wave Life Sciences (M.P.), Cambridge, MA; VU University Medical Center (B.M.J.U.), Amsterdam, the Netherlands; and Cleveland Clinic (J.A.C.), OH
| | - Laura J Balcer
- From the University of Virginia (M.D.G.), Charlottesville; National Multiple Sclerosis Society (N.G.L.), New York, NY; Biogen (R.A.R., G.P.), Cambridge, MA; Critical Path Institute (L.D.H.), Tucson, AZ; Genentech (P.S.C.), South San Francisco, CA; Independent Neurology Clinical Development Consultant (G.S.F.); Premier Research (A.J.), Wokingham, UK; UCL Institute of Neurology (R.K.), London, UK; Imperial College London and UK Dementia Research Institute (P.M.M.); Johns Hopkins (E.M.M.), Baltimore, MD; New York University School of Medicine (L.J.B.), NY; Wave Life Sciences (M.P.), Cambridge, MA; VU University Medical Center (B.M.J.U.), Amsterdam, the Netherlands; and Cleveland Clinic (J.A.C.), OH
| | - Michael Panzara
- From the University of Virginia (M.D.G.), Charlottesville; National Multiple Sclerosis Society (N.G.L.), New York, NY; Biogen (R.A.R., G.P.), Cambridge, MA; Critical Path Institute (L.D.H.), Tucson, AZ; Genentech (P.S.C.), South San Francisco, CA; Independent Neurology Clinical Development Consultant (G.S.F.); Premier Research (A.J.), Wokingham, UK; UCL Institute of Neurology (R.K.), London, UK; Imperial College London and UK Dementia Research Institute (P.M.M.); Johns Hopkins (E.M.M.), Baltimore, MD; New York University School of Medicine (L.J.B.), NY; Wave Life Sciences (M.P.), Cambridge, MA; VU University Medical Center (B.M.J.U.), Amsterdam, the Netherlands; and Cleveland Clinic (J.A.C.), OH
| | - Glenn Phillips
- From the University of Virginia (M.D.G.), Charlottesville; National Multiple Sclerosis Society (N.G.L.), New York, NY; Biogen (R.A.R., G.P.), Cambridge, MA; Critical Path Institute (L.D.H.), Tucson, AZ; Genentech (P.S.C.), South San Francisco, CA; Independent Neurology Clinical Development Consultant (G.S.F.); Premier Research (A.J.), Wokingham, UK; UCL Institute of Neurology (R.K.), London, UK; Imperial College London and UK Dementia Research Institute (P.M.M.); Johns Hopkins (E.M.M.), Baltimore, MD; New York University School of Medicine (L.J.B.), NY; Wave Life Sciences (M.P.), Cambridge, MA; VU University Medical Center (B.M.J.U.), Amsterdam, the Netherlands; and Cleveland Clinic (J.A.C.), OH
| | - Bernard M J Uitdehaag
- From the University of Virginia (M.D.G.), Charlottesville; National Multiple Sclerosis Society (N.G.L.), New York, NY; Biogen (R.A.R., G.P.), Cambridge, MA; Critical Path Institute (L.D.H.), Tucson, AZ; Genentech (P.S.C.), South San Francisco, CA; Independent Neurology Clinical Development Consultant (G.S.F.); Premier Research (A.J.), Wokingham, UK; UCL Institute of Neurology (R.K.), London, UK; Imperial College London and UK Dementia Research Institute (P.M.M.); Johns Hopkins (E.M.M.), Baltimore, MD; New York University School of Medicine (L.J.B.), NY; Wave Life Sciences (M.P.), Cambridge, MA; VU University Medical Center (B.M.J.U.), Amsterdam, the Netherlands; and Cleveland Clinic (J.A.C.), OH
| | - Jeffrey A Cohen
- From the University of Virginia (M.D.G.), Charlottesville; National Multiple Sclerosis Society (N.G.L.), New York, NY; Biogen (R.A.R., G.P.), Cambridge, MA; Critical Path Institute (L.D.H.), Tucson, AZ; Genentech (P.S.C.), South San Francisco, CA; Independent Neurology Clinical Development Consultant (G.S.F.); Premier Research (A.J.), Wokingham, UK; UCL Institute of Neurology (R.K.), London, UK; Imperial College London and UK Dementia Research Institute (P.M.M.); Johns Hopkins (E.M.M.), Baltimore, MD; New York University School of Medicine (L.J.B.), NY; Wave Life Sciences (M.P.), Cambridge, MA; VU University Medical Center (B.M.J.U.), Amsterdam, the Netherlands; and Cleveland Clinic (J.A.C.), OH.
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Sormani MP, Naismith RT. Measuring disability in multiple sclerosis: Walking plus much more. Neurology 2019; 93:919-920. [PMID: 31641015 DOI: 10.1212/wnl.0000000000008515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Maria Pia Sormani
- From the Department of Health Sciences (M.P.S.), Section of Biostatistics, University of Genoa; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genoa, Italy; and Department of Neurology (R.T.N.), Washington University, St. Louis, MO.
| | - R T Naismith
- From the Department of Health Sciences (M.P.S.), Section of Biostatistics, University of Genoa; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genoa, Italy; and Department of Neurology (R.T.N.), Washington University, St. Louis, MO
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Yael G, Nancy C, John D. Money Management in Multiple Sclerosis: The Role of Cognitive, Motor, and Affective Factors. Front Neurol 2019; 10:1128. [PMID: 31708860 PMCID: PMC6819515 DOI: 10.3389/fneur.2019.01128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/09/2019] [Indexed: 01/12/2023] Open
Abstract
Introduction: Few studies have examined the motor, cognitive, and emotional factors involved in effective money management in persons with multiple sclerosis (MS). The aim of this study was to assess money management in persons MS and examine whether cognitive, motor, and emotional processes can predict money management. Methods: This study included 72 persons with MS and 26 healthy controls (HC). Using an a priori definition of efficient vs. inefficient money management skills, based on the money management questionnaire (self and others), and performance on Actual Reality™ (AR) money management items, MS participants were divided into two groups: efficient or inefficient money management (MS Efficient- MM, n = 34 vs. MS Inefficient-MM, n = 38). These groups were compared on cognitive, motor, and emotional variables. Results: Participants in the MS efficient MM group performed significantly better on executive function and processing speed measures, as well as performance on the 25WT. The MS Efficient -MM group also showed significantly less affective symptomatology (depressive and state anxiety). Importantly, HC performed similarly to the Efficient MM group on these tests. Good executive functioning and low depressive symptomatology predicted efficient money management. Conclusions: This study characterizes some of the major problems and underlying impairments persons with MS are encountering in money management. Practitioners working with persons with MS should be aware that executive function impairments together with depressive symptomatology could signal possible money management dysfunction. The early identification of at-risk persons for money management difficulties could have a profound impact on the quality of life for this subsample of the MS population.
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Affiliation(s)
- Goverover Yael
- Department of Occupational Therapy, New York University, New York, NY, United States.,Kessler Foundation, West Orange, NJ, United States
| | - Chiaravalloti Nancy
- Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
| | - DeLuca John
- Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
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Sikes EM, Cederberg KL, Sandroff BM, Bartolucci A, Motl RW. Quantitative Synthesis of Timed 25-Foot Walk Performance in Multiple Sclerosis. Arch Phys Med Rehabil 2019; 101:524-534. [PMID: 31669296 DOI: 10.1016/j.apmr.2019.08.488] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/20/2019] [Accepted: 08/16/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To provide a meta-analysis of articles that have included the timed 25-foot walk (T25FW) in persons with multiple sclerosis (MS), quantify differences in T25FW scores between those with MS and controls without MS, and quantify differences between categories of disability status and clinical disease courses within MS. DATA SOURCES The literature search was conducted using 4 databases (Google Scholar, PubMed, Cumulative Index to Nursing and Allied Health, EBSCO Host). We searched reference lists of published articles to identify additional articles. STUDY SELECTION A systematic literature search identified articles reporting average T25FW performance in seconds between those with MS and controls without MS, between those with MS who had mild and moderate and/or severe disability status, and between relapsing-remitting and progressive clinical courses of MS. DATA EXTRACTION Information was extracted and categorized based on reported data: comparisons of controls without MS and MS, comparisons of mild and moderate and/or severe MS based on study-defined Expanded Disability Status Scale groups, and comparisons of relapsing-remitting and progressive MS clinical courses. DATA SYNTHESIS We performed a random effects meta-analysis to quantify differences between groups as estimated by effect sizes (ESs). We expressed the differences in Cohen d as well as the original units of the T25FW (ie, seconds). CONCLUSIONS There was a large difference in T25FW performance in MS compared with controls without MS (ES=-0.93, mean difference=2.4s, P<.01). Persons with moderate and/or severe disability walked substantially slower compared with mild disability (ES=-1.02, mean difference=5.4s, P<.01), and persons with progressive courses of MS walked substantially slower than relapsing-remitting MS (ES=-1.4, mean difference=13.4s, P<.01).
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Affiliation(s)
- E Morghen Sikes
- School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Katie L Cederberg
- School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brian M Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alfred Bartolucci
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama
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Björngrim S, van den Hurk W, Betancort M, Machado A, Lindau M. Comparing Traditional and Digitized Cognitive Tests Used in Standard Clinical Evaluation - A Study of the Digital Application Minnemera. Front Psychol 2019; 10:2327. [PMID: 31681117 PMCID: PMC6813236 DOI: 10.3389/fpsyg.2019.02327] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/30/2019] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to compare a new digitized cognitive test battery, Minnemera, with its correspondent traditional paper-based cognitive tests. Eighty-one healthy adults between the ages of 21 and 85 participated in the study. Participants performed the two different test versions (traditional paper-based and digitized) with an interval of four weeks between the tests. Test presentation (the order of the test versions presented) was counterbalanced in order to control for any possible test learning effects. The digitized tests were constructed so that there were only minor differences when compared to the traditional paper-based tests. Test results from the paper-based and digitized versions of the cognitive screening were compared within individuals by means of a correlation analysis and equivalence tests. The effects of demographic variables (age, gender and level of education) and test presentation were explored for each test measure and each test version through linear regression models. For each test measure, a significant correlation between traditional and digitized version was observed ranging between r = 0.34 and r = 0.67 with a median of r = 0.53 (corresponding to a large effect size). Score equivalence was observed for five out of six tests. In line with previous traditional cognitive studies, age was found to be the most prominent predictor of performance in all digitized tests, with younger participants performing better than older adults. Gender was the second strongest predictor, where women outperformed men in tests measuring verbal memory; men performed better than women in tests with a strong visual component. Finally, the educational level of the test subjects had an effect on executive functions, with a higher educational level linked to a better inhibition response and working memory span. This study suggests that the tests in the Minnemera cognitive screening battery are acceptably comparable to the traditional paper-based counterparts.
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Affiliation(s)
- Stina Björngrim
- Department of Psychology, University of Stockholm, Stockholm, Sweden
| | | | - Moises Betancort
- Department of Clinical Psychology, Psychobiology and Methodology, Faculty of Psychology, University of La Laguna, Tenerife, Spain
| | - Alejandra Machado
- Mindmore AB, Stockholm, Sweden.,Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Lindau
- Department of Psychology, University of Stockholm, Stockholm, Sweden
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30
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Johansson S, Ytterberg C, Gottberg K, Holmqvist LW, von Koch L, Conradsson D. Participation in social/lifestyle activities in people with multiple sclerosis: Changes across 10 years and predictors of sustained participation. Mult Scler 2019; 26:1775-1784. [DOI: 10.1177/1352458519881991] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Identification of people with multiple sclerosis (PwMS) with increased risk of restricted participation in social and lifestyle activities (e.g. social outings and pursuing a hobby) could guide the development of interventions supporting sustained participation. Objective: To explore changes in participation in complex and social everyday activities over 10 years in PwMS in relation to multiple sclerosis (MS) severity and to identify predictors of sustained participation. Methods: This study was based on a 10-year follow-up of 264 PwMS living in Stockholm County, Sweden. Ten-year changes in participation in social/lifestyle activities were assessed and compared between PwMS with different MS severity with the Frenchay Activities Index using age- and sex-related normative values. Multiple logistic regression analyses were used to predict sustained participation at 10 years using personal factors, disease severity and functioning as independent variables. Results: While a majority of people with mild MS demonstrated sustained participation (67%), a minority of PwMS moderately (26%) and severely affected by MS (5%) demonstrated sustained participation. Significant predictors of sustained participation after 10 years were walking speed ⩾1.2 m/s and ⩾32 correct responses on the Symbol Digit Modalities Test. Conclusion: Our findings accentuate the importance for health services to support mobility and cognition to obtain sustained participation.
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Affiliation(s)
- Sverker Johansson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden/Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Ytterberg
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden/Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Gottberg
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Widén Holmqvist
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden/Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Lena von Koch
- Theme Neuro, Karolinska University Hospital, Stockholm, Sweden; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - David Conradsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden/Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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31
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Akatani R, Chihara N, Tachibana H, Koto S, Kowa H, Kanda F, Matsumoto R, Toda T. Validation of the Guy's Neurological Disability Scale as a screening tool for cognitive impairment in multiple sclerosis. Mult Scler Relat Disord 2019; 35:272-275. [DOI: 10.1016/j.msard.2019.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 06/23/2019] [Accepted: 08/11/2019] [Indexed: 10/26/2022]
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Hommes OR, Maas-Enriquez M. ESIMS - An Ongoing Clinical Trial in Secondary Progressive Multiple Sclerosis. Mult Scler 2019. [DOI: 10.1177/135245850000602s08] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The design of a double-blind, placebo-controlled, European-Canadian Study on IVIG treatment in multiple sclerosis-ESIMS- is described. Three hundred and eighteen multiple sclerosis patients with a secondary progressive course, are treated with monthly infusions of immunoglobulin 10% I g/kg bodyweight or with 0.1 g albumin/vial for 27 months. The primary efficacy parameter is the percentage of patients with a confirmed treatment failure in the EDSS scale and/or the Nine Hole Peg Test Secondary outcome measures are MRI T2 lesion load, Magnetization Transfer Imaging, and MRI brainatrophy measures. Documentation of health resource utilisation and ability to work will cover socio-economic aspects. Recruitment of patients was completed in October 1998. The clinical part of the trial will be completed in April 2001.
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Affiliation(s)
- OR Hommes
- European Charcot Foundation, Heiweg 97, 6533 PA Nijmegen, The Netherlands
| | - M Maas-Enriquez
- Bayer AG, PH Europe/Biologische Produkte, D-51368 Leverkusen, Germany
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33
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Al‐Zuhairy A, Sindrup SH, Andersen H, Jakobsen J. A population‐based and cross‐sectional study of the long‐term prognosis in multifocal motor neuropathy. J Peripher Nerv Syst 2019; 24:64-71. [DOI: 10.1111/jns.12311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/09/2019] [Accepted: 02/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Ali Al‐Zuhairy
- Department of NeurologyCopenhagen University Hospital (Rigshospitalet) Copenhagen Denmark
| | - Søren H. Sindrup
- Department of NeurologyOdense University Hospital Odense Denmark
| | - Henning Andersen
- Department of NeurologyAarhus University Hospital Aarhus Denmark
| | - Johannes Jakobsen
- Department of NeurologyCopenhagen University Hospital (Rigshospitalet) Copenhagen Denmark
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34
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Dalla Costa G, Martinelli V, Sangalli F, Moiola L, Colombo B, Radaelli M, Leocani L, Furlan R, Comi G. Prognostic value of serum neurofilaments in patients with clinically isolated syndromes. Neurology 2019; 92:e733-e741. [PMID: 30635483 PMCID: PMC6382362 DOI: 10.1212/wnl.0000000000006902] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 12/14/2018] [Indexed: 01/21/2023] Open
Abstract
Objective To assess the prognostic role of serum neurofilament light chains (NfL) for clinically defined multiple sclerosis (CDMS) and McDonald 2017 multiple sclerosis (MS) in patients with clinically isolated syndromes (CIS). Methods We retrospectively analyzed data of patients admitted to our neurologic department between 2000 and 2015 for a first demyelinating event. We evaluated baseline serum NfL in addition to CSF, MRI, and clinical data. Results Among 222 patients who were enrolled (mean follow-up 100.6 months), 45 patients (20%) developed CDMS and 141 patients (63.5%) developed 2017 MS at 2 years. Serum NfL (median 22.0, interquartile range 11.6–40.4 pg/mL) was noticeably increased in patients with a recent relapse, with a high number of T2 and gadolinium-enhancing lesions at baseline MRI. Serum NfL was prognostic for both CDMS and McDonald 2017 MS, with a threefold and a twofold respective reduction in CDMS and 2017 MS risk in those patients with low and extremely low levels of NfL. The results remained unchanged subsequent to adjustment for such established MS prognostic factors as oligoclonal bands, Gd-enhancing lesions, and a high T2 lesion load at baseline MRI. NfL was associated with disability at baseline but not at follow-up. Conclusions Serum NfL have a prognostic value for CIS patient conversion to MS. NfL might play a twin role as biomarker in MS as peak level measurements can act as a quantitative marker of serious inflammatory activity, while steady-state levels can be a reflection of neurodegenerative and chronic inflammatory processes.
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Affiliation(s)
- Gloria Dalla Costa
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy
| | - Vittorio Martinelli
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy
| | - Francesca Sangalli
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy
| | - Lucia Moiola
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy
| | - Bruno Colombo
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy
| | - Marta Radaelli
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy
| | - Letizia Leocani
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy
| | - Roberto Furlan
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy
| | - Giancarlo Comi
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy.
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Sormani MP, De Stefano N, Giovannoni G, Langdon D, Piani-Meier D, Haering DA, Kappos L, Tomic D. Learning ability correlates with brain atrophy and disability progression in RRMS. J Neurol Neurosurg Psychiatry 2019; 90:38-43. [PMID: 30322898 PMCID: PMC6327865 DOI: 10.1136/jnnp-2018-319129] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/10/2018] [Accepted: 09/17/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess the prognostic value of practice effect on Paced Auditory Serial Addition Test (PASAT) in multiple sclerosis. METHODS We compared screening (day -14) and baseline (day 0) PASAT scores of 1009 patients from the FTY720 Research Evaluating Effects of Daily Oral therapy in Multiple Sclerosis (FREEDOMS) trial. We grouped patients into high and low learners if their PASAT score change was above or below the median change in their screening PASAT quartile group. We used Wilcoxon test to compare baseline disease characteristics between high and low learners, and multiple regression models to assess the respective impact of learning ability, baseline normalised brain volume and treatment on brain volume loss and 6-month confirmed disability progression over 2 years. RESULTS The mean PASAT score at screening was 45.38, increasing on average by 3.18 from day -14 to day 0. High learners were younger (p=0.003), had lower Expanded Disability Status Scale score (p=0.031), higher brain volume (p<0.001) and lower T2 lesion volume (p=0.009) at baseline. Learning status was not significantly associated with disability progression (HR=0.953, p=0.779), when adjusting for baseline normalised brain volume, screening PASAT score and treatment arm. However, the effect of fingolimod on disability progression was more pronounced in high learners (HR=0.396, p<0.001) than in low learners (HR=0.798, p=0.351; p for interaction=0.05). Brain volume loss at month 24 tended to be higher in low learners (0.17%, p=0.058), after adjusting for the same covariates. CONCLUSIONS Short-term practice effects on PASAT are related to brain volume, disease severity and age and have clinically meaningful prognostic implications. High learners benefited more from fingolimod treatment.
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Affiliation(s)
- Maria Pia Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Gavin Giovannoni
- Barts and The London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
| | - Dawn Langdon
- Department of Psychology, Royal Holloway, University of London, Egham, UK
| | | | | | - Ludwig Kappos
- Neurological Clinic and Polyclinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland
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Knox KB, Clay L, Stuart-Kobitz K, Nickel D. Perspectives on walking from people with multiple sclerosis and reactions to video self-observation. Disabil Rehabil 2018; 42:211-218. [PMID: 30348030 DOI: 10.1080/09638288.2018.1496154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: People with multiple sclerosis (MS) rank walking among the most challenging aspects of their condition. A greater understanding of people's perspectives concerning their walking may help to prioritize walking outcomes and strategies for optimizing walking. The purpose was to explore perceptions of walking in people with MS and to describe their reactions after observing themselves walk on video.Materials and methods: An interpretive thematic analysis study using face-to-face, semi-structured interviews was conducted with 14 people who self-identified a change in their walking due to MS. Participants were video-recorded walking and watched their video during the interview.Results: Four themes were identified: "awareness," "acceptance," "constant change," and "increased effort." People with MS develop awareness of how their walking performance looks and awareness of constantly-changing internal factors and external factors which impact their walking. Awareness of change in fatigue, temperature, terrain, and the use of aids in particular are perceived relevant to walking and to impact the effort required to walk. People with MS also describe differences in their acceptance of how others view their walking and the changes related to walking. An analogy with a marionette performing describes how people perceive walking as no longer automatic; instead walking requires the person to consciously pull the strings to walk. An increase in both the physical and cognitive effort is required to walk and an awareness and acceptance of a variety of changes in oneself and the lived world may help or hinder walking. People with MS are willing to watch themselves walk on video and are not surprised by what they observe.Conclusions: People with MS develop a learned self-awareness with variable levels of acceptance about their walking function and what it looks like. The perceptions on walking from persons with MS suggest that focusing on reducing the effort to walk and minimizing the constantly-changing variables may help to optimize walking.Implications for rehabilitationPeople with multiple sclerosis are challenged by the increased effort and constant change required to walk in their day-to-day lives.A focus on minimizing both the effort to walk and the changing variables (i.e., fluctuating symptoms and environmental factors) is warranted.People with multiple sclerosis develop a learned awareness of how they walk and how their walking looks.Acceptance of loss of walking function is variable.Video self-observation is a feasible tool which warrants further exploration for enhancing acceptance of walking function and accommodating strategies.
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Affiliation(s)
- Katherine B Knox
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Lynne Clay
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Kiersten Stuart-Kobitz
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Darren Nickel
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Borragán G, Gilson M, Atas A, Slama H, Lysandropoulos A, De Schepper M, Peigneux P. Cognitive Fatigue, Sleep and Cortical Activity in Multiple Sclerosis Disease. A Behavioral, Polysomnographic and Functional Near-Infrared Spectroscopy Investigation. Front Hum Neurosci 2018; 12:378. [PMID: 30294266 PMCID: PMC6158319 DOI: 10.3389/fnhum.2018.00378] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 09/03/2018] [Indexed: 01/15/2023] Open
Abstract
Patients with multiple sclerosis (MS) disease frequently experience fatigue as their most debilitating symptom. Fatigue in MS partially refers to a cognitive component, cognitive fatigue (CF), characterized by a faster and stronger than usual development of the subjective feeling of exhaustion that follows sustained cognitive demands. The feeling of CF might result from supplementary task-related brain activity following MS-related demyelination and neurodegeneration. Besides, CF in MS disease might also stem from disrupted sleep. The present study investigated the association between the triggering of CF, task-related brain activity and sleep features. In a counterbalance mixed design, 10 patients with MS and 11 healthy controls were exposed twice for 16 min to a CF-inducing dual working memory updating task (TloadDback) under low or high cognitive demands conditions, counterbalanced. Considering known inter-individual differences and potential cognitive deficits in MS, the maximal cognitive load of the task was individually adapted to each participant’s own upper limits. During the experimental sessions, cortical brain activity was measured using near-infrared spectroscopy (NIRS) during the CF-induction task, and in a resting state immediately before and after. Ambulatory polysomnography recordings were obtained on the nights preceding experimental sessions. When cognitive load was individually adapted to their processing capabilities, patients with MS exhibited similar than healthy controls levels of subjectively perceived CF, evolution of performance during the task, and brain activity patterns. Linear mixed models indicate a negative association between oxygenation level changes in the dorsolateral prefrontal cortex (DLPFC) and the triggering of subjective CF in patients with MS only. Longer total sleep time was also associated with higher CF in MS patients. These results suggest that controlling for cognitive load between individuals with and without MS results in a similar task-related development of subjective CF. Besides comparable performance and cortical brain activity between groups, mixed model analyses suggest a possible association between CF, DLPFC activity and sleep duration in MS disease.
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Affiliation(s)
- Guillermo Borragán
- Neuropsychology and Functional Neuroimaging Research Unit, Université Libre de Bruxelles, Brussels, Belgium.,Centre de Recherches en Cognition et Neurosciences and ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Médhi Gilson
- Neuropsychology and Functional Neuroimaging Research Unit, Université Libre de Bruxelles, Brussels, Belgium.,Centre de Recherches en Cognition et Neurosciences and ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Atas
- Centre de Recherches en Cognition et Neurosciences and ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium.,Consciousness, Cognition and Computational Group, Université Libre de Bruxelles, Brussels, Belgium
| | - Hichem Slama
- Neuropsychology and Functional Neuroimaging Research Unit, Université Libre de Bruxelles, Brussels, Belgium.,Centre de Recherches en Cognition et Neurosciences and ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium.,Cognitive Neurosciences Research Unit, Université Libre de Bruxelles, Brussels, Belgium.,Department of Clinical and Cognitive Neuropsychology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Andreas Lysandropoulos
- Neuroimmunology Unit - Multiple Sclerosis, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Melanie De Schepper
- Neuropsychology and Functional Neuroimaging Research Unit, Université Libre de Bruxelles, Brussels, Belgium.,Centre de Recherches en Cognition et Neurosciences and ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Peigneux
- Neuropsychology and Functional Neuroimaging Research Unit, Université Libre de Bruxelles, Brussels, Belgium.,Centre de Recherches en Cognition et Neurosciences and ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels, Belgium
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Abstract
The design of clinical trials is a key aspect to maximizing the possibility to detect a treatment effect. This fact is particularly challenging in progressive multiple sclerosis (PMS) studies due to the uncertainty about the right target and/or outcome in phase-2 studies. The aim of this review is to evaluate the current challenges facing the design of clinical trials for PMS. The selection of patients, the instrumental and clinical outcomes that can be used in PMS trials, and issues in their design will be covered in this report.
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Affiliation(s)
- Matteo Pardini
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy/Policlinic Hospital San Martino-IST, Genoa, Italy
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria Pia Sormani
- Biostatistics Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Abstract
Treatment options for progressive multiple sclerosis remain the main unmet need of the field. As the understanding of multiple sclerosis (MS) pathogenesis improves, new pathways and molecules will be tested for potential reparative, remyelinating, or neuroprotective effects. The clinical outcomes used will determine successful demonstration of beneficial treatment effects to regulatory agencies, clinicians, and persons with MS. This review focuses on clinical outcome measures including the Expanded Disability Status Scale, Multiple Sclerosis Functional Composite, and novel composite measures of disability. The paper also covers cognitive outcomes and screening tests for use in clinical trials. The growing importance of patient-reported outcomes and their suitability for clinical trials is also presented. The review aims to create consensus in regard to these topics and suggestions for future research.
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Affiliation(s)
- Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Jeffrey A Cohen
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
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40
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Treatment of progressive multiple sclerosis: Challenges and promising perspectives. Rev Neurol (Paris) 2018; 174:441-448. [DOI: 10.1016/j.neurol.2018.01.370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/04/2018] [Indexed: 11/21/2022]
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41
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Sanchez-Dalmau B, Martinez-Lapiscina EH, Pulido-Valdeolivas I, Zubizarreta I, Llufriu S, Blanco Y, Sola-Valls N, Sepulveda M, Guerrero A, Alba S, Andorra M, Camos A, Sanchez-Vela L, Alfonso V, Saiz A, Villoslada P. Predictors of vision impairment in Multiple Sclerosis. PLoS One 2018; 13:e0195856. [PMID: 29664921 PMCID: PMC5903642 DOI: 10.1371/journal.pone.0195856] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 03/31/2018] [Indexed: 01/02/2023] Open
Abstract
Visual impairment significantly alters the quality of life of people with Multiple Sclerosis (MS). The objective of this study was to identify predictors (independent variables) of visual outcomes, and to define their relationship with neurological disability and retinal atrophy when assessed by optical coherence tomography (OCT). We performed a cross-sectional analysis of 119 consecutive patients with MS, assessing vision using high contrast visual acuity (LogMar), 2.5% and 1.25% low contrast visual acuity (Sloan charts), and color vision (Hardy-Rand-Rittler plates). Quality of vision is a patient reported outcome based on an individual's unique perception of his or her vision and was assessed with the Visual Functioning Questionnaire-25 (VFQ-25) with the 10 neuro-ophthalmologic items. MS disability was assessed using the expanded disability status scale (EDSS), the MS functional composite (MSFC) and the brief repetitive battery-neuropsychology (BRB-N). Retinal atrophy was assessed using spectral domain OCT, measuring the thickness of the peripapillar retinal nerve fiber layer (pRNFL) and the volume of the ganglion cell plus inner plexiform layer (GCIPL). The vision of patients with MS was impaired, particularly in eyes with prior optic neuritis. Retinal atrophy (pRNFL and GCIPL) was closely associated with impaired low contrast vision and color vision, whereas the volume of the GCIPL showed a trend (p = 0.092) to be associated with quality of vision. Multiple regression analysis revealed that EDSS was an explanatory variable for high contrast vision after stepwise analysis, GCIPL volume for low contrast vision, and GCIPL volume and EDSS for color vision. The explanatory variables for quality of vision were high contrast vision and color vision. In summary, quality of vision in MS depends on the impairment of high contrast visual acuity and color vision due to the disease.
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Affiliation(s)
| | - Elena H. Martinez-Lapiscina
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Irene Pulido-Valdeolivas
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Irati Zubizarreta
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sara Llufriu
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Yolanda Blanco
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Nuria Sola-Valls
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maria Sepulveda
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ana Guerrero
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Salut Alba
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Magi Andorra
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Anna Camos
- Department of Ophthalmology, Hospital Clinic, Barcelona, Spain
| | - Laura Sanchez-Vela
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Albert Saiz
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Pablo Villoslada
- Department of Neurology and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- * E-mail:
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Azevedo CJ, Cen SY, Khadka S, Liu S, Kornak J, Shi Y, Zheng L, Hauser SL, Pelletier D. Thalamic atrophy in multiple sclerosis: A magnetic resonance imaging marker of neurodegeneration throughout disease. Ann Neurol 2018; 83:223-234. [PMID: 29328531 DOI: 10.1002/ana.25150] [Citation(s) in RCA: 160] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 11/17/2017] [Accepted: 11/26/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Thalamic volume is a candidate magnetic resonance imaging (MRI)-based marker associated with neurodegeneration to hasten development of neuroprotective treatments. Our objective is to describe the longitudinal evolution of thalamic atrophy in MS and normal aging, and to estimate sample sizes for study design. METHODS Six hundred one subjects (2,632 MRI scans) were analyzed. Five hundred twenty subjects with relapse-onset MS (clinically isolated syndrome, n = 90; relapsing-remitting MS, n = 392; secondary progressive MS, n = 38) underwent annual standardized 3T MRI scans for an average of 4.1 years, including a 1mm3 3-dimensional T1-weighted sequence (3DT1; 2,485 MRI scans). Eighty-one healthy controls (HC) were scanned longitudinally on the same scanner using the same protocol (147 MRI scans). 3DT1s were processed using FreeSurfer's longitudinal pipeline after lesion inpainting. Rates of normalized thalamic volume loss in MS and HC were compared in linear mixed effects models. Simulation-based sample size calculations were performed incorporating the rate of atrophy in HC. RESULTS Thalamic volume declined significantly faster in MS subjects compared to HC, with an estimated decline of -0.71% per year (95% confidence interval [CI] = -0.77% to -0.64%) in MS subjects and -0.28% per year (95% CI = -0.58% to 0.02%) in HC (p for difference = 0.007). The rate of decline was consistent throughout the MS disease duration and across MS clinical subtypes. Eighty or 100 subjects per arm (α = 0.1 or 0.05, respectively) would be needed to detect the maximal effect size with 80% power in a 24-month study. INTERPRETATION Thalamic atrophy occurs early and consistently throughout MS. Preliminary sample size calculations appear feasible, adding to its appeal as an MRI marker associated with neurodegeneration. Ann Neurol 2018;83:223-234.
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Affiliation(s)
| | - Steven Y Cen
- Department of Neurology, University of Southern California, Los Angeles, CA
| | | | - Shuang Liu
- Department of Neurology, Yale University, New Haven, CT
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Yonggang Shi
- Department of Neurology, University of Southern California, Los Angeles, CA
| | - Ling Zheng
- Department of Neurology, University of Southern California, Los Angeles, CA
| | - Stephen L Hauser
- Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Daniel Pelletier
- Department of Neurology, University of Southern California, Los Angeles, CA
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Smith VM, Varsanik JS, Walker RA, Russo AW, Patel KR, Gabel W, Phillips GA, Kimmel ZM, Klawiter EC. Movement measurements at home for multiple sclerosis: walking speed measured by a novel ambient measurement system. Mult Scler J Exp Transl Clin 2018; 4:2055217317753465. [PMID: 29383266 PMCID: PMC5784463 DOI: 10.1177/2055217317753465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/25/2017] [Indexed: 11/29/2022] Open
Abstract
Background Gait disturbance is a major contributor to clinical disability in multiple sclerosis (MS). A sensor was developed to assess walking speed at home for people with MS using infrared technology in real-time without the use of wearables. Objective To develop continuous in-home outcome measures to assess gait in adults with MS. Methods Movement measurements were collected continuously for 8 months from six people with MS. Average walking speed and peak walking speed were calculated from movement data, then analyzed for variability over time, by room (location), and over the course of the day. In-home continuous gait outcomes and variability were correlated with standard in-clinic gait outcomes. Results Measured in-home average walking speed of participants ranged from 0.33 m/s to 0.96 m/s and peak walking speed ranged from 0.89 m/s to 1.51 m/s. Mean total within-participant coefficient of variation for daily average walking speed and peak walking speed were 10.75% and 10.93%, respectively. Average walking speed demonstrated a moderately strong correlation with baseline Timed 25-Foot Walk (rs = 0.714, P = 0.111). Conclusion New non-wearable technology provides reliable and continuous in-home assessment of walking speed.
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Affiliation(s)
| | | | | | - Andrew W Russo
- Massachusetts General Hospital, Harvard Medical School, USA
| | - Kevin R Patel
- Massachusetts General Hospital, Harvard Medical School, USA
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Abstract
Functional disorders due to multiple sclerosis are evaluated using rating scales. EDSS is a scant which is very inadequate in evaluating cognitive functions, is significantly limited in evaluating upper extremity functions and is highly difficult to repeat. Multiple Sclerosis Functional Composite (MSFC) is considered as a test that has been proposed in recent years in MS clinical trials and can overcome these negative features of EDSS. Three primary assessment methods were suggested for MSFC (9): 1) 25-step walking, 2) 9-Hole Peg test (9-HPT), and 3) Paced Auditory Serial Addition Test-3 (PASAT-3).
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Affiliation(s)
- Serkan Demir
- Sultan Abdülhamid Han Research and Training Hospital, Neurology Clinic, İstanbul, Turkey
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The paced auditory serial addition test for working memory assessment: Psychometric properties. Med J Islam Repub Iran 2017; 31:61. [PMID: 29445690 PMCID: PMC5804453 DOI: 10.14196/mjiri.31.61] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Indexed: 11/18/2022] Open
Abstract
Background: The paced auditory serial addition test (PASAT) was primarily developed to assess the effects of traumatic brain injury
on cognitive functioning. Working memory (WM) is one of the most important aspects of cognitive function, and WM impairment
is one of the clinically remarkable signs of aphasia. To develop the Persian version of PASAT, an initial version was used in individuals
with aphasia (IWA).
Methods: In this study, 25 individuals with aphasia (29-60 years) and 85 controls (18-60 years) were included. PASAT was presented
in the form of recorded 61 single-digit numbers (1 to 9). The participants repeatedly added the 2 recent digits. The psychometric
properties of PASAT including convergent validity (using the digit memory span tasks), divergent validity (using results in the control
group and IWA group), and face validity were investigated. Test-retest reliability was considered as well.
Results: The relationship between the PASAT and digit memory span tests was moderate to strong in the control group (forward
digit memory span test: r= 0.52, p< 0.0001; backward digit memory span test: r = 0.48, p< 0.0001). A strong relationship was found in
IWA (forward digit memory span test: r= 0.72, p< 0.0001; backward digit memory span test: r= 0.53, p= 0.006). Also, strong testretest
reliability (intraclass correlation= 0.95, p< 0.0001) was observed.
Conclusion: According to our results, the PASAT is a valid and reliable test to assess working memory, particularly in IWA. It
could be used as a feasible tool for clinical and research applications.
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Gerstenecker A, Lowry K, Myers T, Bashir K, Triebel KL, Martin RC, Marson DC. Medical decision-making capacity and its cognitive predictors in progressive MS: Preliminary evidence. J Neurol Sci 2017; 380:38-43. [PMID: 28870585 DOI: 10.1016/j.jns.2017.06.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/01/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Medical decision-making capacity (MDC) refers to the ability to make informed decisions about treatment and declines in cognition are associated with declines in MDC across multiple disease entities. However, although it is well known that cognitive impairment is prevalent in multiple sclerosis (MS), little is known about MDC in the disease. METHODS Data from 22 persons with progressive MS and 18 healthy controls were analyzed. All diagnoses were made by a board-certified neurologist with experience in MS. All study participants were administered a vignette-based measure of MDC and also a neuropsychological battery. RESULTS Performance on three MDC consent standards (i.e., Appreciation, Reasoning, Understanding) was significantly lower for people with progressive MS as compared to healthy controls. In the progressive MS group, verbal fluency was the primary cognitive predictor for both Reasoning and Understanding consent standards. Verbal learning and memory was the primary cognitive predictor for Appreciation. MS severity was not significantly correlated with any MDC variable. CONCLUSION MDC is a complex and cognitively mediated functional ability that is impaired in many people with progressive MS. Verbal measures of fluency and memory are strongly associated with MDC performances in the current sample of people with MS and could potentially be utilized to quickly screen for MDC impairment in MS.
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Affiliation(s)
- Adam Gerstenecker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kathleen Lowry
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Terina Myers
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Khurram Bashir
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kristen L Triebel
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Roy C Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Daniel C Marson
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States.
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Disease modifying treatments and symptomatic drugs for cognitive impairment in multiple sclerosis: where do we stand? ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s40893-017-0025-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kondo Y, Zhao Y, Petkau J. Identification of treatment responders based on multiple longitudinal outcomes with applications to multiple sclerosis patients. Stat Med 2017; 36:1862-1883. [PMID: 28147439 DOI: 10.1002/sim.7230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 12/03/2016] [Accepted: 01/03/2017] [Indexed: 11/10/2022]
Abstract
Identification of treatment responders is a challenge in comparative studies where treatment efficacy is measured by multiple longitudinally collected continuous and count outcomes. Existing procedures often identify responders on the basis of only a single outcome. We propose a novel multiple longitudinal outcome mixture model that assumes that, conditionally on a cluster label, each longitudinal outcome is from a generalized linear mixed effect model. We utilize a Monte Carlo expectation-maximization algorithm to obtain the maximum likelihood estimates of our high-dimensional model and classify patients according to their estimated posterior probability of being a responder. We demonstrate the flexibility of our novel procedure on two multiple sclerosis clinical trial datasets with distinct data structures. Our simulation study shows that incorporating multiple outcomes improves the responder identification performance; this can occur even if some of the outcomes are ineffective. Our general procedure facilitates the identification of responders who are comprehensively defined by multiple outcomes from various distributions. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yumi Kondo
- Robert Bosch LLC Research and Technology Center North America, Data Mining Services and Solutions, Palo Alto, California, U.S.A
| | - Yinshan Zhao
- BC Centre for Improved Cardiovascular Health, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Petkau
- Department of Statistics, University of British Columbia, Vancouver, BC, Canada
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Sousa CS, Neves MR, Passos AM, Ferreira A, Sá MJ. Paced Auditory Serial Addition Test (PASAT 3.0 s): Demographically corrected norms for the Portuguese population. APPLIED NEUROPSYCHOLOGY-ADULT 2017; 25:417-423. [PMID: 28535073 DOI: 10.1080/23279095.2017.1323752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The main goal of this study was to produce adjusted normative data for the Portuguese population on the Paced Auditory Serial Addition Test (PASAT 3.0 s), the version used in the Brief Repeatable Battery of Neuropsychological Tests developed by the National Multiple Sclerosis Society. The study included 326 community-dwelling individuals (199 women and 127 men) aged between 20 and 70 (mean = 40.33, SD = 14.40), who had educational backgrounds ranging from 4 to 23 years of schooling (mean = 12.28, SD = 4.39). Age, gender and qualifications revealed differences in explaining their performance on the PASAT 3.0 s. Men had significantly better performance on the PASAT 3.0 s than women, even though this represents a small effect size r = 0.18. Demographically corrected normative data was developed and important information regarding performance on the PASAT 3.0 s test is provided. Results are discussed and presented in tables and a formula is presented for computing age, gender and education adjusted T-scores for performance on the PASAT 3.0 s. These results should be considered as useful reference values for clinicians and investigators when applying the PASAT 3.0 s to assess cognitive function like information processing speed in different pathologies.
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Affiliation(s)
- Claudia Sofia Sousa
- a Centro Hospitalar São João Porto , Neurology, Alameda Prof. Hernâni Monteiro , Porto , Portugal
| | | | | | - Aristides Ferreira
- b BRU-IUL , Instituto Universitário de Lisboa (ISCTE-IUL) , Lisbon , Portugal
| | - Maria José Sá
- c Serviço de Neurologia , Centro Hospitalar São João , Porto , Portugal
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Gerstenecker A, Myers T, Lowry K, Martin RC, Triebel KL, Bashir K, Marson DC. Financial Capacity and its Cognitive Predictors in Progressive Multiple Sclerosis. Arch Clin Neuropsychol 2017; 32:943-950. [DOI: 10.1093/arclin/acx039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 04/03/2017] [Indexed: 11/12/2022] Open
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