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Doherty M, Chukwusa E, McQuillan R, Cranfield F, Gao W. The Palliative Care Needs of Patients with Multiple Sclerosis, Parkinson's Related Diseases, and Motor Neurone Disease: A Secondary Analysis of the OPTCARE Neuro Trial Data. J Palliat Med 2024; 27:622-629. [PMID: 38597932 DOI: 10.1089/jpm.2023.0437] [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] [Indexed: 04/11/2024] Open
Abstract
Background: Long-term neurological conditions include multiple sclerosis, Parkinson's-related diseases, and motor neurone disease. National and international guidelines recommend a palliative approach for advancing neurological disease, but there is little research describing and comparing the palliative care needs of these patients side by side. Objective: The aim of this study was to describe and compare the symptom burden and psychological distress of patients with multiple sclerosis, Parkinson's-related diseases, and motor neurone disease. Design: A cross-sectional secondary analysis of the OPTCARE Neuro trial data was performed. Setting/Subjects: Recruitment was from seven sites across the United Kingdom. Patients aged 18 years or older, severely affected by advanced stages of multiple sclerosis or Parkinson's-related diseases or any stage of motor neurone disease, with an unresolved symptom, and one other issue despite usual care were eligible. Measurements: Baseline demographics, Integrated Palliative care Outcome Scale (IPOS) Neuro, and Hospital Anxiety and Depression Scale (HADS) results were analyzed. Results: Data from 348 participants were analyzed. The mean IPOS Neuro-S24 score was 27, with no statistical difference found between groups (p = 0.341). The most common symptoms were poor mobility (68.5%), problems using legs (63%), and fatigue (34.8%). The HADS revealed that a quarter of participants met the criteria for a diagnosis of anxiety and depression. Conclusions: Multiple sclerosis, Parkinson's-related disease, and motor neurone disease patients who were eligible for the OPTCARE Neuro trial have unmet needs in the form of distressing physical and psychological symptoms. It is unclear how to address these needs. The answer likely lies in a collaborative approach between neurology, palliative care, psychology, and specialized allied health professionals. Future work should focus on investigating this.
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Affiliation(s)
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | | | | | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
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Huynh TLT, Neal WN, Barstow EA, Motl RW. Physical Activity in Individuals Newly Diagnosed With Multiple Sclerosis Through the Lens of the COM-B Model. Int J MS Care 2024; 26:49-56. [PMID: 38482516 PMCID: PMC10930808 DOI: 10.7224/1537-2073.2022-095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Physical activity (PA) is a promising intervention for disease modification and symptom management in multiple sclerosis (MS); however, there is a lack of research focusing on PA behavior change interventions for persons newly diagnosed with MS. Such PA behavior change interventions should be developed based on a strong empirical foundation of understanding the behavior and its determinants (ie, what to target for changes to occur). To that end, this qualitative study examined factors explaining PA in persons newly diagnosed with MS and identified potential targets for future behavior change intervention development based on the Capability-Opportunity-Motivation-Behavior (COM-B) model. METHODS Twenty individuals diagnosed with MS within the past 2 years underwent one-on-one semistructured interviews using questions developed based on the COM-B model. Data were analyzed using reflective thematic analysis, and the identified themes were then mapped with the COM-B model. RESULTS Factors explaining PA in the study sample were identified across the COM-B components. The typical factors include knowledge and skills to sufficiently engage in PA with appropriate approaches, ability to adapt and navigate through new environmental and social difficulties after diagnosis, and motivation resulting from a combination of factors, such as outcome expectation, belief of capabilities, role/identity, reinforcement, and emotions. CONCLUSIONS The COM-B model was applied successfully in this study to understand PA behavior and identify potential targets for behavior change in individuals newly diagnosed with MS. Future behavior change interventions should consider addressing these factors to generate effective PA behavior change in this population.
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Affiliation(s)
- Trinh L. T. Huynh
- From the Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA (TLTH, RWM)
| | - Whitney N. Neal
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA (WNN)
| | - Elizabeth A. Barstow
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA (EAB)
| | - Robert W. Motl
- From the Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA (TLTH, RWM)
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3
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Huynh TLT, Barstow EA, Motl RW. Feasibility of a theory-based physical activity intervention for persons newly diagnosed with multiple sclerosis. Mult Scler Relat Disord 2024; 83:105446. [PMID: 38262331 DOI: 10.1016/j.msard.2024.105446] [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: 09/08/2023] [Revised: 12/26/2023] [Accepted: 01/13/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Physical activity (PA) is beneficial for rehabilitation and symptom management in multiple sclerosis (MS), yet persons newly diagnosed with MS are insufficiently active and have not been the focus of PA research. This is important as early initiation of lifestyle PA, alongside other disease modifying therapies, might maximize the lasting benefits of this behavior on health outcomes and health-related quality of life (HRQOL) in MS. PURPOSE This single group, pre-post study examined the feasibility and initial efficacy of a 12-week remotely delivered COM-B-based behavior change intervention targeting lifestyle PA in persons newly diagnosed with MS. METHODS Persons newly diagnosed with MS (diagnosis of 2 years or less) were recruited for the study. The intervention was designed based on COM-B and formative research, and included a program manual, newsletters, video coaching calls, pedometer, logbook, and calendar. Feasibility was assessed in four domains: process (e.g., recruitment, retention), resource (e.g., time and costs), management (e.g., data management), and scientific evidence (e.g., safety, treatment effects). RESULTS Thirty-two persons newly diagnosed with MS underwent screening, 17 were eligible, and 14 started the intervention. Twelve participants completed the study (86 % retention rate). All participants in the intervention engaged in 100 % of video coaching calls and participants provided 73 % of online step count entries. Eighty-three percent of participants fully complied with reviewing the newsletters. No relapses were reported during the intervention. There were moderate-to-large increases in PA outcomes, as measured by the Godin Leisure-Time Exercise Questionnaire, International Physical Activity Questionnaire, and accelerometry (light PA) (d ≥ 0.5). There were no significant changes in other accelerometry outcomes, including step counts and moderate-to-vigorous PA (d = 0.2). There were large, positive effects of the intervention on physical and mental health-related quality of life with (d ≥ 1), but the change in fatigue severity was small and not statistically significant among the study participants (d = 0.3). CONCLUSIONS This study provides evidence for feasibility and initial efficacy of a COM-B-based PA intervention for persons newly diagnosed with MS. The results indicate that this intervention was feasible, safe, acceptable, and promising for promoting lifestyle PA in persons newly diagnosed with MS.
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Affiliation(s)
- Trinh L T Huynh
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA.
| | - Elizabeth A Barstow
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
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Ahmed A, Rawshan AEM, Tishe ZH, Shawkat S, Popy MN, Shohag MH, Hossain M, Mostaid MS. Association of CD58 rs12044852 and rs2300747 polymorphisms with the risk of multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2024; 82:105411. [PMID: 38176285 DOI: 10.1016/j.msard.2023.105411] [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: 10/25/2023] [Revised: 12/03/2023] [Accepted: 12/23/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Multiple sclerosis is a serious neurodegenerative disorder that causes disability in young adults. Genetic predisposition of multiple sclerosis is well documented and several single nucleotide polymorphisms (SNPs) of the CD58 were found to be associated with this disease. This systematic review and meta-analysis were done with the aim of finding the association between CD58 gene SNPs (rs12044852 and rs2300747) and the risk of multiple sclerosis (MS). METHOD A comprehensive search was done in PubMed, Google Scholar, Embase, and MSGene.org to find the relevant data. Our search yielded 13 relevant publications which were included for meta-analysis consisting of 5194 cases and 5766 controls. All the statistical analysis was conducted using meta and metafor packages in R studio. The odds ratio (OR) along with 95 % confidence intervals and p values were determined using the fixed effects and random effects model. The I2 test was done to measure heterogeneity. Subgroup analysis was performed along with analysis for publication bias. RESULTS We found significant association for both rs12044852 (allelic, dominant, over-dominant, heterozygous, and homozygous models) and rs2300747 (allelic, dominant, over-dominant, heterozygous models) with multiple sclerosis. Both the SNPs provided a protective effect for multiple sclerosis. Subgroup analysis indicated that rs12044852 polymorphism provided a protective effect in both Asians and Caucasians. However, for rs2300747, the Asian population showed no statistically significant association with the risk of MS. CONCLUSION Polymorphism of rs12044852 and rs2300747 of the CD58 gene provided a protective effect for multiple sclerosis. The protective effect is more prominent in Caucasian populations compared to Asians.
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Affiliation(s)
- Ashfaq Ahmed
- Department of Pharmaceutical Sciences, Faculty of Health and Life Sciences, North South University, Plot 15, Block B, Bashundhara R/A, Dhaka 1229, Bangladesh
| | | | - Zasia Hossain Tishe
- Department of Pharmaceutical Sciences, Faculty of Health and Life Sciences, North South University, Plot 15, Block B, Bashundhara R/A, Dhaka 1229, Bangladesh
| | - Sanjana Shawkat
- Department of Pharmaceutical Sciences, Faculty of Health and Life Sciences, North South University, Plot 15, Block B, Bashundhara R/A, Dhaka 1229, Bangladesh
| | - Meherun Nessa Popy
- Department of Pharmaceutical Sciences, Faculty of Health and Life Sciences, North South University, Plot 15, Block B, Bashundhara R/A, Dhaka 1229, Bangladesh
| | - Md Hasanuzzaman Shohag
- Department of Pharmaceutical Sciences, Faculty of Health and Life Sciences, North South University, Plot 15, Block B, Bashundhara R/A, Dhaka 1229, Bangladesh
| | - Murad Hossain
- Department of Pharmaceutical Sciences, Faculty of Health and Life Sciences, North South University, Plot 15, Block B, Bashundhara R/A, Dhaka 1229, Bangladesh
| | - Md Shaki Mostaid
- Department of Pharmaceutical Sciences, Faculty of Health and Life Sciences, North South University, Plot 15, Block B, Bashundhara R/A, Dhaka 1229, Bangladesh.
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Moslemi Z, Toledo-Aldana EA, Baldwin B, Donkers SJ, Eng JJ, Mondal P, de Zepetnek JOT, Buttigieg J, Levin MC, Mang CS. Task-oriented exercise effects on walking and corticospinal excitability in multiple sclerosis: protocol for a randomized controlled trial. BMC Sports Sci Med Rehabil 2023; 15:175. [PMID: 38129896 PMCID: PMC10734154 DOI: 10.1186/s13102-023-00790-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a degenerative disease of the central nervous system (CNS) that disrupts walking function and results in other debilitating symptoms. This study compares the effects of 'task-oriented exercise' against 'generalized resistance and aerobic exercise' and a 'stretching control' on walking and CNS function in people with MS (PwMS). We hypothesize that task-oriented exercise will enhance walking speed and related neural changes to a greater extent than other exercise approaches. METHODS This study is a single-blinded, three-arm randomized controlled trial conducted in Saskatchewan, Canada. Eligible participants are those older than 18 years of age with a diagnosis of MS and an expanded Patient-Determined Disease Steps (PDDS) score between 3 ('gait disability') and 6 ('bilateral support'). Exercise interventions are delivered for 12 weeks (3 × 60-min per week) in-person under the supervision of a qualified exercise professional. Interventions differ in exercise approach, such that task-oriented exercise involves weight-bearing, walking-specific activities, while generalized resistance and aerobic exercise uses seated machine-based resistance training of major upper and lower body muscle groups and recumbent cycling, and the stretching control exercise involves seated flexibility and relaxation activities. Participants are allocated to interventions using blocked randomization that stratifies by PDDS (mild: 3-4; moderate: 5-6). Assessments are conducted at baseline, post-intervention, and at a six-week retention time point. The primary and secondary outcome measures are the Timed 25-Foot Walk Test and corticospinal excitability for the tibialis anterior muscles determined using transcranial magnetic stimulation (TMS), respectively. Tertiary outcomes include assessments of balance, additional TMS measures, blood biomarkers of neural health and inflammation, and measures of cardiorespiratory and musculoskeletal fitness. DISCUSSION A paradigm shift in MS healthcare towards the use of "exercise as medicine" was recently proposed to improve outcomes and alleviate the economic burden of MS. Findings will support this shift by informing the development of specialized exercise programming that targets walking and changes in corticospinal excitability in PwMS. TRIAL REGISTRATION ClinicalTrials.gov, NCT05496881, Registered August 11, 2022. https://classic. CLINICALTRIALS gov/ct2/show/NCT05496881 . Protocol amendment number: 01; Issue date: August 1, 2023; Primary reason for amendment: Expand eligibility to include people with all forms of MS rather than progressive forms of MS only.
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Affiliation(s)
- Zahra Moslemi
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada
| | - Eduardo A Toledo-Aldana
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada
| | - Bruce Baldwin
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada
| | - Sarah J Donkers
- School of Rehabilitation Sciences, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Janice J Eng
- Centre for Aging SMART at Vancouver Coastal Health, Department of Physical Therapy, University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Prosanta Mondal
- Clinical Research Support Unit, University of Saskatchewan, 3200 Health Science E-wing, Saskatoon, SK, S7N 5B5, Canada
| | - Julia O Totosy de Zepetnek
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada
| | - Josef Buttigieg
- Department of Biology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada
| | - Michael C Levin
- Department of Neurology and Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Cameron S Mang
- Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A1, Canada.
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Sadeghi M, Jamalian M, Mehrabani-Zeinabad K, Turk-Adawi K, Kopec J, AlMahmeed W, Abdul Rahim HF, Farhan HA, Anwar W, Manla Y, Fadhil I, Lui M, Roohafza H, Islam SMS, Sulaiman K, Bazargani N, Saade G, Hassen N, Alandejani A, Abdin A, Bokhari S, Roth GA, Johnson C, Stark B, Sarrafzadegan N, Mokdad AH. The burden of ischemic heart disease and the epidemiologic transition in the Eastern Mediterranean Region: 1990-2019. PLoS One 2023; 18:e0290286. [PMID: 37669274 PMCID: PMC10479892 DOI: 10.1371/journal.pone.0290286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/05/2023] [Indexed: 09/07/2023] Open
Abstract
It has been estimated that in the next decade, IHD prevalence, DALYs and deaths will increase more significantly in EMR than in any other region of the world. This study aims to provide a comprehensive description of the trends in the burden of ischemic heart disease (IHD) across the countries of the Eastern Mediterranean Region (EMR) from 1990 to 2019. Data on IHD prevalence, disability-adjusted life years (DALYs), mortality, DALYs attributable to risk factors, healthcare access and quality index (HAQ), and universal health coverage (UHC) were extracted from the Global Burden of Disease (GBD) database for EMR countries. The data were stratified based on the social demographic index (SDI). Information on cardiac rehabilitation was obtained from publications by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR), and additional country-specific data were obtained through advanced search methods. Age standardization was performed using the direct method, applying the estimated age structure of the global population from 2019. Uncertainty intervals were calculated through 1000 iterations, and the 2.5th and 97.5th percentiles were derived from these calculations. The age-standardized prevalence of IHD in the EMR increased from 5.0% to 5.5% between 1990 and 2019, while it decreased at the global level. In the EMR, the age-standardized rates of IHD mortality and DALYs decreased by 11.4% and 15.4%, respectively, during the study period, although both rates remained higher than the global rates. The burden of IHD was found to be higher in males compared to females. Bahrain exhibited the highest decrease in age-standardized prevalence (-3.7%), mortality (-65.0%), and DALYs (-69.1%) rates among the EMR countries. Conversely, Oman experienced the highest increase in prevalence (14.5%), while Pakistan had the greatest increase in mortality (30.0%) and DALYs (32.0%) rates. The top three risk factors contributing to IHD DALYs in the EMR in 2019 were high systolic blood pressure, high low-density lipoprotein cholesterol, and particulate matter pollution. The trend analysis over the 29-year period (1990-2019) revealed that high fasting plasma glucose (64.0%) and high body mass index (23.4%) exhibited increasing trends as attributed risk factors for IHD DALYs in the EMR. Our findings indicate an increasing trend in the prevalence of IHD and a decrease in mortality and DALYs in the EMR. These results emphasize the need for well-planned prevention and treatment strategies to address the risk factors associated with IHD. It is crucial for the countries in this region to prioritize the development and implementation of programs focused on health promotion, education, prevention, and medical care.
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Affiliation(s)
- Masoumeh Sadeghi
- Cardiovascular Research Institute, Cardiac Rehabilitation Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Jamalian
- Cardiovascular Research Institute, Hypertension Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kamran Mehrabani-Zeinabad
- Cardiovascular Research Institute, Pediatric Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Karam Turk-Adawi
- Department of Public Health, QU-Health, Qatar University, Doha, Qatar
| | - Jacek Kopec
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Wael AlMahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Hanan F. Abdul Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Hasan Ali Farhan
- Scientific Council of Cardiology, Iraqi Board for Medical Specializations. Baghdad Heart Center, Baghdad, Iraq
| | - Wagida Anwar
- Faculty of Medicine, Community Medicine Department, Ain Shams University, Egypt and Armed Forces College of Medicine (AFCM), Cairo, Egypt
| | - Yosef Manla
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | | | - Michelle Lui
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Hamidreza Roohafza
- Cardiovascular Research Institute, Interventional Cardiology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | | | - George Saade
- Department of Cardiology, Bellevue Medical Center, Beirut, Lebanon
| | - Nejat Hassen
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Amani Alandejani
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Amr Abdin
- Syrian Cardiovascular Association, Damascus, Syria
| | - Saira Bokhari
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Gregory A. Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States of America
- Department of Health Metrics Sciences, University of Washington, Seattle, United States of America
| | - Catherine Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States of America
| | - Benjamin Stark
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States of America
| | - Nizal Sarrafzadegan
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Cardiovascular Research Institute, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States of America
- Department of Health Metrics Sciences, University of Washington, Seattle, United States of America
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Vegda M, Panda S, Bhatnagar KR. Utility of optical coherence tomography in patients of central immune mediated demyelinating diseases - A prospective study. eNeurologicalSci 2023; 31:100464. [PMID: 37132011 PMCID: PMC10149178 DOI: 10.1016/j.ensci.2023.100464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/24/2023] [Accepted: 04/14/2023] [Indexed: 05/04/2023] Open
Abstract
Optical coherence tomography (OCT) is a non-invasive tool to measure thickness of various layers of retina. Recently, retinal nerve fibre layer (RNFL) and ganglion cell and inner plexiform layer (GCIP) thinning has been observed in OCT in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), This study compared OCT profile, along with visual acuity (VA), color vision (CV), contrast saturation (CS) and visual evoked potentials (VEP) in two main cohorts of MS and NMOSD and with controls, during acute episode of optic neuritis (ON), at 3 and 6 months. We found that changes of ON were present in 75% of MS eyes and in 45% of NMOSD patients. Of these, subclinical involvement was present in 56.25% of MS eyes and only in 5% of NMOSD eyes suggesting frequent subclinical involvement in the former. Mean RNFL was 95.23 ± 15.53 in MS and 66.14 ± 43.73 in NMOSD after 6 months of ON episode. Thinning of NQ and IQ was observed in NMOSD eyes in the immediate period after ON attack. At 6 months relative sparing of RNFL in TQ was observed in NMOSD ON eyes and MS ON showed predilection for involvement of TQ.
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Affiliation(s)
- Monalisa Vegda
- DM Neurology, All India Institute of Medical Sciences, Jodhpur, India
| | - Samhita Panda
- DM Neurology, Department of Neurology, All India Institute of Medical Sciences, Jodhpur, India
- Corresponding author.
| | - Kavita R. Bhatnagar
- MS Ophthalmology, Department of Ophthalmology, All India Institute Of Medical Sciences, Jodhpur, India
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Shi T, Browne RW, Tamaño-Blanco M, Jakimovski D, Weinstock-Guttman B, Zivadinov R, Ramanathan M, Blair RH. Metabolomic profiles in relapsing-remitting and progressive multiple sclerosis compared to healthy controls: a five-year follow-up study. Metabolomics 2023; 19:44. [PMID: 37079261 DOI: 10.1007/s11306-023-02010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES Multiple sclerosis (MS) is a disease of the central nervous system associated with immune dysfunction, demyelination, and neurodegeneration. The disease has heterogeneous clinical phenotypes such as relapsing-remitting MS (RRMS) and progressive multiple sclerosis (PMS), each with unique pathogenesis. Metabolomics research has shown promise in understanding the etiologies of MS disease. However, there is a paucity of clinical studies with follow-up metabolomics analyses. This 5-year follow-up (5YFU) cohort study aimed to investigate the metabolomics alterations over time between different courses of MS patients and healthy controls and provide insights into metabolic and physiological mechanisms of MS disease progression. METHODS A cohort containing 108 MS patients (37 PMS and 71 RRMS) and 42 controls were followed up for a median of 5 years. Liquid chromatography-mass spectrometry (LC-MS) was applied for untargeted metabolomics profiling of serum samples of the cohort at both baseline and 5YFU. Univariate analyses with mixed-effect ANCOVA models, clustering, and pathway enrichment analyses were performed to identify patterns of metabolites and pathway changes across the time effects and patient groups. RESULTS AND CONCLUSIONS Out of 592 identified metabolites, the PMS group exhibited the most changes, with 219 (37%) metabolites changed over time and 132 (22%) changed within the RRMS group (Bonferroni adjusted P < 0.05). Compared to the baseline, there were more significant metabolite differences detected between PMS and RRMS classes at 5YFU. Pathway enrichment analysis detected seven pathways perturbed significantly during 5YFU in MS groups compared to controls. PMS showed more pathway changes compared to the RRMS group.
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Affiliation(s)
- Tiange Shi
- Department of Biostatistics, University at Buffalo, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Richard W Browne
- Department of Biotechnical and Laboratory Sciences, University at Buffalo, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Miriam Tamaño-Blanco
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Dejan Jakimovski
- Department of Neurology, University at Buffalo, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, University at Buffalo, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Robert Zivadinov
- Department of Neurology, University at Buffalo, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Murali Ramanathan
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York at Buffalo, Buffalo, NY, USA
- Department of Neurology, University at Buffalo, The State University of New York at Buffalo, Buffalo, NY, USA
- Institute for Artificial Intelligence and Data Science, University at Buffalo, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Rachael H Blair
- Department of Biostatistics, University at Buffalo, The State University of New York at Buffalo, Buffalo, NY, USA.
- Institute for Artificial Intelligence and Data Science, University at Buffalo, The State University of New York at Buffalo, Buffalo, NY, USA.
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9
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The Impact of Neurogenic Lower Urinary Tract Symptoms and Erectile Dysfunctions on Marital Relationship in Men with Multiple Sclerosis: A Single Cohort Study. J Clin Med 2022; 11:jcm11195639. [PMID: 36233507 PMCID: PMC9570884 DOI: 10.3390/jcm11195639] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Aims: Multiple sclerosis (MS) is an autoimmune and neurodegenerative disease that is characterized by a great variety symptoms. Most MS patients suffer from neurogenic lower urinary tract symptoms (nLUTS) and erectile dysfunctions (ED). The aim this study is to assess the impact of nLUTS and ED on marital relationships in MS patients. Materials and Methods: MS male patients that arrived for our attention were prospectively enrolled in the study. All of the patients were evaluated on an Expanded Disability Status Scale (EDSS), an IIEF-5 for sexual function, an ICIQ-MLUTS for urinary function, and a Dyadic Adjustment Scale (DAS) for marital relationships. The data were analyzed using descriptive and inferential statistical tests in STATA/MP14. Results: The data of 57 male MS patients were eligible. The mean age was 45 (13.7) years, the mean disease duration was 15.49 (7.86) years, and the mean EDSS score was 3.5 (1.89). In total, 33 (57.89%) MS patients reported urine incontinence, of those, 24 (42.11%) reported UUI. The mean DAS score was 74.40 (34.58). The mean IIEF-5 score was 12.40 (8.05). The mean ICIQ-MLUTS score was 71.94 (41.06). The DAS and ICIQ-MLUTS scores were negatively correlated (r = −0.30, p < 0.001). The DAS and IIEF-5 were moderately correlated (r = 0.47, p < 0.001). The DAS and EDSS were strongly correlated (r = −0.72, p < 0.001). A univariate analysis showed that increasing age (p < 0.001), a longer disease duration (p = 0.029), a higher EDSS score (p < 0.001), and a higher ICIQ-MLUTS score (p < 0.001) were all significantly associated with lower DAS scores. Conclusions: This study demonstrated the large negative impact that nLUTS and ED due to MS have on patients’ marital relationships, highlighting the importance of a multidisciplinary approach in MS patients.
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Alsaedi EQ, Alsaedi MQ, Mansuri FA. Clinical Profile and the Extent of Disability in Multiple Sclerosis Patients in Madinah, Saudi Arabia. Cureus 2022; 14:e25851. [PMID: 35832757 PMCID: PMC9272901 DOI: 10.7759/cureus.25851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2022] [Indexed: 11/07/2022] Open
Abstract
Objectives: The objective is to study the demographics and clinical characteristics of Saudi multiple sclerosis (MS) patients in Madinah, Saudi Arabia, and assess their extent of disability using the Expanded Disability Status Scale (EDSS). Methods: This hospital-based study intended to address the population of all MS-diagnosed patients registered between 2018 and 2021 in the Neurology Department of King Fahad Hospital in the Madinah region. Data were gathered from medical records and by interviewing participants in the Neurology Clinic. The chi-square test and linear and logistic regression were applied to draw inferences. Results: A total of 195 MS-diagnosed patients were included in the analysis. Of these, 72.3% were female. The mean age of the total sample was 34.9±9.2 years, and 7.7% reported a positive family history. Of all patients, 17.9% (n=35) had comorbidities. The mean age at diagnosis was 29.3±8.2 years. The majority (85.6%) were diagnosed with relapsing-remitting multiple sclerosis (RRMS); 77.9% had an EDSS score between 0.0 and 1.5, showing little or no disability. A statistical significance existed between EDSS and the current age of the patients (p=0.004), age at onset (p=0.007), type of MS (p=0.000), presence of muscle weakness (p=0.044), bladder or bowel difficulties at onset (p=0.043), and the duration of MS (p=0.000). Of the patients, 23.6% were not using disease-modifying therapy (DMT). The most commonly used drug was interferon beta 1-b. Conclusion: A lower EDSS was associated with younger age, diagnosis at a younger age, RRMS, duration less than five years, and lower body mass index (BMI). To increase the generalizability of findings, a national MS registry system and further prospective analytical epidemiological research studies are recommended.
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Elhussein N, Alazmi N, Fadulemulla IA, Hamd ZY, Ahmed AM, Seifeldin SA, Alshammari QT. Comparative between Double Inversion Recovery and Fluid-Attenuated Inversion Recovery Sequences for Detection of Brain Multiple Sclerosis. CLINICAL CANCER INVESTIGATION JOURNAL 2022. [DOI: 10.51847/zaqwktglhh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Huang J, Xu J, Lai JHC, Chen Z, Lee CY, Mak HKF, Chan KH, Chan KWY. Relayed nuclear Overhauser effect weighted (rNOEw) imaging identifies multiple sclerosis. NEUROIMAGE-CLINICAL 2021; 32:102867. [PMID: 34751151 PMCID: PMC8569719 DOI: 10.1016/j.nicl.2021.102867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/12/2021] [Accepted: 10/25/2021] [Indexed: 10/25/2022]
Abstract
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system in which the immune system attacks the myelin and axons, consequently leading to demyelination and axonal injury. Magnetic resonance imaging (MRI) plays a pivotal role in the diagnosis of MS, and currently various types of MRI techniques have been used to detect the pathology of MS based on unique mechanisms. In this study, we applied the relayed nuclear Overhauser effect weighted (rNOEw) imaging to study human MS at clinical 3T. Three groups of subjects, including 20 normal control (NC) subjects, 14 neuromyelitis optica spectrum disorders (NMOSD) patients and 21 MS patients, were examined at a clinical 3T MRI scanner. Whole-brain rNOEw images of each subject were obtained by acquiring a control and a labeled image within four minutes. Significantly lower brain rNOEw contrast was detected in MS group compared to NC (P = 0.008) and NMOSD (P = 0.014) groups, while no significant difference was found between NC and NMOSD groups (P = 0.939). The lower rNOEw contrast of MS group compared to NC/NMOSD group was significant in white matter (P = 0.041/0.021), gray matter (P = 0.004/0.020) and brain parenchyma (P = 0.015/0.021). Moreover, MS lesions showed higher number and larger size but lower rNOEw contrast than NMOSD lesions (P = 0.002). Our proposed rNOEw imaging scheme has potential to serve as a new method for assisting MS diagnosis. Importantly, it may be used to identify MS from NMOSD.
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Affiliation(s)
- Jianpan Huang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Jiadi Xu
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph H C Lai
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Zilin Chen
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Chi Yan Lee
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Henry K F Mak
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Koon Ho Chan
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China.
| | - Kannie W Y Chan
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China; Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; City University of Hong Kong Shenzhen Research Institute, Shenzhen, China; Hong Kong Centre for Cerebro-Cardiovascular Health Engineering, Hong Kong, China.
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Detection of Health-Related Events and Behaviours from Wearable Sensor Lifestyle Data Using Symbolic Intelligence: A Proof-of-Concept Application in the Care of Multiple Sclerosis. SENSORS 2021; 21:s21186230. [PMID: 34577437 PMCID: PMC8470200 DOI: 10.3390/s21186230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
In this paper, we demonstrate the potential of a knowledge-driven framework to improve the efficiency and effectiveness of care through remote and intelligent assessment. More specifically, we present a rule-based approach to detect health related problems from wearable lifestyle sensor data that add clinical value to take informed decisions on follow-up and intervention. We use OWL 2 ontologies as the underlying knowledge representation formalism for modelling contextual information and high-level concepts and relations among them. The conceptual model of our framework is defined on top of existing modelling standards, such as SOSA and WADM, promoting the creation of interoperable knowledge graphs. On top of the symbolic knowledge graphs, we define a rule-based framework for infusing expert knowledge in the form of SHACL constraints and rules to recognise patterns, anomalies and situations of interest based on the predefined and stored rules and conditions. A dashboard visualizes both sensor data and detected events to facilitate clinical supervision and decision making. Preliminary results on the performance and scalability are presented, while a focus group of clinicians involved in an exploratory research study revealed their preferences and perspectives to shape future clinical research using the framework.
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Th17-Related Cytokines as Potential Discriminatory Markers between Neuromyelitis Optica (Devic's Disease) and Multiple Sclerosis-A Review. Int J Mol Sci 2021; 22:ijms22168946. [PMID: 34445668 PMCID: PMC8396435 DOI: 10.3390/ijms22168946] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023] Open
Abstract
Multiple sclerosis (MS) and Devic’s disease (NMO; neuromyelitis optica) are autoimmune, inflammatory diseases of the central nervous system (CNS), the etiology of which remains unclear. It is a serious limitation in the treatment of these diseases. The resemblance of the clinical pictures of these two conditions generates a partial possibility of introducing similar treatment, but on the other hand, a high risk of misdiagnosis. Therefore, a better understanding and comparative characterization of the immunopathogenic mechanisms of each of these diseases are essential to improve their discriminatory diagnosis and more effective treatment. In this review, special attention is given to Th17 cells and Th17-related cytokines in the context of their potential usefulness as discriminatory markers for MS and NMO. The discussed results emphasize the role of Th17 immune response in both MS and NMO pathogenesis, which, however, cannot be considered without taking into account the broader perspective of immune response mechanisms.
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Goodin DS, Khankhanian P, Gourraud PA, Vince N. The nature of genetic and environmental susceptibility to multiple sclerosis. PLoS One 2021; 16:e0246157. [PMID: 33750973 PMCID: PMC7984655 DOI: 10.1371/journal.pone.0246157] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/15/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To understand the nature of genetic and environmental susceptibility to multiple sclerosis (MS) and, by extension, susceptibility to other complex genetic diseases. BACKGROUND Certain basic epidemiological parameters of MS (e.g., population-prevalence of MS, recurrence-risks for MS in siblings and twins, proportion of women among MS patients, and the time-dependent changes in the sex-ratio) are well-established. In addition, more than 233 genetic-loci have now been identified as being unequivocally MS-associated, including 32 loci within the major histocompatibility complex (MHC), and one locus on the X chromosome. Despite this recent explosion in genetic associations, however, the association of MS with the HLA-DRB1*15:01~HLA-DQB1*06:02~a1 (H+) haplotype has been known for decades. DESIGN/METHODS We define the "genetically-susceptible" subset (G) to include everyone with any non-zero life-time chance of developing MS. Individuals who have no chance of developing MS, regardless of their environmental experiences, belong to the mutually exclusive "non-susceptible" subset (G-). Using these well-established epidemiological parameters, we analyze, mathematically, the implications that these observations have regarding the genetic-susceptibility to MS. In addition, we use the sex-ratio change (observed over a 35-year interval in Canada), to derive the relationship between MS-probability and an increasing likelihood of a sufficient environmental exposure. RESULTS We demonstrate that genetic-susceptibitly is confined to less than 7.3% of populations throughout Europe and North America. Consequently, more than 92.7% of individuals in these populations have no chance whatsoever of developing MS, regardless of their environmental experiences. Even among carriers of the HLA-DRB1*15:01~HLA-DQB1*06:02~a1 haplotype, far fewer than 32% can possibly be members the (G) subset. Also, despite the current preponderance of women among MS patients, women are less likely to be in the susceptible (G) subset and have a higher environmental threshold for developing MS compared to men. Nevertheless, the penetrance of MS in susceptible women is considerably greater than it is in men. Moreover, the response-curves for MS-probability in susceptible individuals increases with an increasing likelihood of a sufficient environmental exposure, especially among women. However, these environmental response-curves plateau at under 50% for women and at a significantly lower level for men. CONCLUSIONS The pathogenesis of MS requires both a genetic predisposition and a suitable environmental exposure. Nevertheless, genetic-susceptibility is rare in the population (< 7.3%) and requires specific combinations of non-additive genetic risk-factors. For example, only a minority of carriers of the HLA-DRB1*15:01~HLA-DQB1*06:02~a1 haplotype are even in the (G) subset and, thus, genetic-susceptibility to MS in these carriers must result from the combined effect this haplotype together with the effects of certain other (as yet, unidentified) genetic factors. By itself, this haplotype poses no MS-risk. By contrast, a sufficient environmental exposure (however many events are involved, whenever these events need to act, and whatever these events might be) is common, currently occurring in, at least, 76% of susceptible individuals. In addition, the fact that environmental response-curves plateau well below 50% (especially in men), indicates that disease pathogenesis is partly stochastic. By extension, other diseases, for which monozygotic-twin recurrence-risks greatly exceed the disease-prevalence (e.g., rheumatoid arthritis, diabetes, and celiac disease), must have a similar genetic basis.
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Affiliation(s)
- Douglas S. Goodin
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Pouya Khankhanian
- Center for Neuro-Engineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Pierre-Antoine Gourraud
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States of America
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Nicolas Vince
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
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Naseri A, Nasiri E, Sahraian MA, Daneshvar S, Talebi M. Clinical Features of Late-Onset Multiple Sclerosis: a Systematic Review and Meta-analysis. Mult Scler Relat Disord 2021; 50:102816. [PMID: 33571792 DOI: 10.1016/j.msard.2021.102816] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) commonly affects young adults at the ages 20 to 40 years old, but it can onset at each age. Late-onset multiple sclerosis (LOMS) is defined as symptoms initiating after the age of 50. Misdiagnosis and a remarkable gap in diagnosis of LOMS is a challenge of the elderly population so in this article we described the proportion of LOMS and the clinical features and phenotype of the disease in this age group. METHODS After registration of the study protocol, an electronic search was performed in 3 databases and for full coverage of the published studies, we also checked the references of each related article. Two independent researchers screened the records in title/abstract and full-text stages and extracted the data using a data extraction table. The risk of bias was assessed using Joanna Briggs Institute checklist and meta-analysis was conducted by CMA 2. Only the studies with 50 years old cut-off and using McDonald or Poser diagnostic criteria were included in the meta-analysis. RESULTS After removing duplicated studies, out of 733 results of electronic and hand searching, 31 studies met our inclusion criteria for the systematic review, and 11 of them were included in the quantitative synthesis. With different cut-offs and diagnostic methods 1.1% to 21.3% proportion of LOMS, has been reported in the studies. Meta-analysis reached a 5.01% (95% CI: 3.78% to 6.57%), proportion of LOMS in total MS cases. The female cases were more than males (range between 57.7% to 70.2%) and 64.46% (95% CI: 61.94% to 66.91%) proportion of females has been found in this study. 65.00% (95% CI: 44.71% to 81.02%) proportion of spinal cord involvements and 49.80% (95% CI: 39.28% to 60.24%) proportion of relapsing-remitting multiple sclerosis (RRMS) was also observed in LOMS cases. In 4 of included studies, the progressive form was the predominant phenotype. The most prevalent first disease presentation of LOMS was motor dysfunction (ranges between 100% to 35.4%) followed by sensory problems (ranges between 94% to 5%), visual symptoms (ranges between 22.9% to 5%), and brainstem dysfunction (ranges between 25% to 12.3%). The proportion of positive oligoclonal band (OCB), was varied from 46% to 98% in different studies and positive immunoglobulin G (IgG) index also was seen in 45.04% and 66% of the patients. 2.2% - 12.5% of the LOMS cases had a positive family history. CONCLUSION In about 5% of cases, MS can be diagnosed at ages above 50 years old. There is an increasing concern of a more progressive form of MS in LOMS cases. Unlike the adult-onset MS, the first presentation of LOMS is usually motor dysfunction. Understanding the proportion and clinical features of LOMS will help clinicians with the diagnosis of MS in this age group and prevention of wrong management plans and complications in these patients. Although the proportion of females is still more than males in LOMS cases; but there is a trend to increase in male cases with aging.
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Affiliation(s)
- Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran; Research Center for Evidence Based Medicine, Iranian EBM Centre, a Joanna Briggs Institute Affiliated Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ehsan Nasiri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran; Research Center for Evidence Based Medicine, Iranian EBM Centre, a Joanna Briggs Institute Affiliated Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Ali Sahraian
- Sina MS Research Center, Sina hospital, and department of neurology, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sara Daneshvar
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mahnaz Talebi
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran.
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Disability and its association with psychological factors in multiple sclerosis patients. Mult Scler Relat Disord 2021; 49:102733. [PMID: 33571947 DOI: 10.1016/j.msard.2020.102733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a neurological, and immune-mediated demyelinating disease. Psychological factors in MS disease and psychosocial interventions based on these factors have a major role in the adjustment of MS patients toward their disease. The aim of the study was to compare the psychological components of happiness, psychological well-being, love of life, meaning in life, and somatic health between MS patients with low Expanded Disability Status Scale (EDSS) scores and MS patients with higher EDSS scores. METHOD A sample of 128 patients with MS was recruited. Patients were administered the EDSS, the Self-Rating Scale of Happiness (SRH), the World Health Organization-five Well-Being Index (WHO-5), the Love of Life Scale (LLS), the Meaning in Life Questionnaire (MLQ) and the Patient Health Questionnaire-15 (PHQ-15). Patients with EDSS>3 (cases) and EDSS≤3 (controls) were compared. RESULTS The cases had lower scores for happiness, love of life, psychological well-being, meaning in life, the present of meaning in life subscale, and somatic health, compared with the controls. The differences between cases and controls remained statistically significant after controlling for age and sex. CONCLUSION Positive health promotion and education intervention programs to reduce disability and increase MS patients' well-being should be one of the priorities in the Iran healthcare system for MS patients. Therapists should take these components into account when working with MS patients with moderate and severe disability.
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Omraninava M, Mehranfar S, Vahedi P, Razi B, Imani D, Aslani S, Feyzinia S. Association between IL7 Receptor Alpha (Il7ra) gene rs6897932 polymorphism and the risk of Multiple Sclerosis: A meta-regression and meta-analysis. Mult Scler Relat Disord 2020; 48:102687. [PMID: 33348212 DOI: 10.1016/j.msard.2020.102687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND In this systematic review and meta-analysis, we aimed to find a consistent conclusion for the association between the interleukin 7 receptor alpha (IL7RA) gene rs6897932 single nucleotide polymorphism (SNP) and multiple sclerosis (MS) risk. METHODS Here, we performed a comprehensive systematic search in PubMed, Scopus, and Web of Science to find relevant studies published before November 2020 investigating the association between rs6897932 SNP and MS risk. In the pooled analysis, we determined the odds ratio (OR) and the corresponding 95% confidence interval (CI) for the association level between rs6897932 SNP and the risk of MS. RESULTS In the current meta-analysis 33 case-control studies (30 articles) containing 19351 patients and 21005 healthy controls certify the inclusion criteria. According to the pooled analysis, a statistically significant association of IL7RA gene rs6897932 SNP with MS risk was found across recessive model (OR= 0.84, 95% CI= 0.77-0.92, P< 0.001, FEM), allelic model (OR= 0.91, 95% CI= 0.85-0.99, P= 0. 02, REM), TT vs. CC model (OR= 0.79, 95% CI= 0.67-0.93, P= 0.005, REM). Moreover, the subgroup analysis based on the ethnicity indicated a negative significant association in Europeans; dominant model (OR= 0.88, 95% CI= 0.78-1.01, P= 0.06, REM), recessive model (OR= 0.79, 95% CI= 0.71-0.88, P< 0.001, REM), allelic model (OR= 0.88, 95% CI= 0.81-0.96, P= 0.003, REM), TT vs. CC model (OR= 0.74, 95% CI= 0.61-0.88, P<0.001, REM) models. Nonetheless, no significant association was detected in Asians and Americans. CONCLUSIONS IL7RA gene rs6897932 SNP decreases MS susceptibility in overall population and Europeans.
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Affiliation(s)
- Melodi Omraninava
- Department of Infectious Disease, Faculty of Medical Sciences, Sari Branch, Islamic Azad University, Sari, Iran
| | - Sahar Mehranfar
- Department of Genetics and Immunology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran; Social Determinant of Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Parviz Vahedi
- Department of anatomical sciences, Maragheh University of Medical Sciences. Maragheh, Iran
| | - Bahman Razi
- Department of Hematology, School of Medicine, Tarbiat Modares University, Tehran, Iran
| | - Danyal Imani
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Aslani
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Feyzinia
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Rahat Breath and Sleep Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Okolicsanyi RK, Bluhm J, Miller C, Griffiths LR, Haupt LM. An investigation of genetic polymorphisms in heparan sulfate proteoglycan core proteins and key modification enzymes in an Australian Caucasian multiple sclerosis population. Hum Genomics 2020; 14:18. [PMID: 32398079 PMCID: PMC7218574 DOI: 10.1186/s40246-020-00264-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/08/2020] [Indexed: 12/24/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease affecting the central nervous system in young adults. Heparan sulfate proteoglycans (HSPGs) are ubiquitous to the cell surface and the extracellular matrix. HSPG biosynthesis is a complex process involving enzymatic attachment of heparan sulfate (HS) chains to a core protein. HS side chains mediate specific ligand and growth factor interactions directing cellular processes including cell adhesion, migration and differentiation. Two main families of HSPGs exist, the syndecans (SDC1-4) and glypicans (GPC1-6). The SDCs are transmembrane proteins, while the GPC family are GPI linked to the cell surface. SDC1 has well-documented interactions with numerous signalling pathways. Genome-wide association studies (GWAS) have identified regions of the genome associated with MS including a region on chromosome 13 containing GPC5 and GPC6. International studies have revealed significant associations between this region and disease development. The exostosin-1 (EXT1) and sulfatase-1 (SULF1) are key enzymes contributing to the generation of HS chains. EXT1, with documented tumour suppressor properties, is involved in the initiation and polymerisation of the growing HS chain. SULF1 removes 6-O-sulfate groups from HS chains, affecting protein-ligand interactions and subsequent downstream signalling with HS modification potentially having significant effects on MS progression. In this study, we identified significant associations between single nucleotide polymorphisms in SDC1, GPC5 and GPC6 and MS in an Australian Caucasian case-control population. Further significant associations in these genes were identified when the population was stratified by sex and disease subtype. No association was found for EXT1 or SULF1.
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Affiliation(s)
- Rachel K Okolicsanyi
- Genomics Research Centre, Institute for Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Musk Avenue, Kelvin Grove, Brisbane, Queensland, 4059, Australia
| | - Julia Bluhm
- Genomics Research Centre, Institute for Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Musk Avenue, Kelvin Grove, Brisbane, Queensland, 4059, Australia
| | - Cassandra Miller
- Genomics Research Centre, Institute for Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Musk Avenue, Kelvin Grove, Brisbane, Queensland, 4059, Australia
| | - Lyn R Griffiths
- Genomics Research Centre, Institute for Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Musk Avenue, Kelvin Grove, Brisbane, Queensland, 4059, Australia.
| | - Larisa M Haupt
- Genomics Research Centre, Institute for Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Musk Avenue, Kelvin Grove, Brisbane, Queensland, 4059, Australia.
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Exercise as Medicine in Multiple Sclerosis—Time for a Paradigm Shift: Preventive, Symptomatic, and Disease-Modifying Aspects and Perspectives. Curr Neurol Neurosci Rep 2019; 19:88. [DOI: 10.1007/s11910-019-1002-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Hostenbach S, Pauwels A, Michiels V, Raeymaekers H, Van Binst AM, Van Merhaeghen-Wieleman A, Van Schuerbeek P, De Keyser J, D'Haeseleer M. Role of cerebral hypoperfusion in multiple sclerosis (ROCHIMS): study protocol for a proof-of-concept randomized controlled trial with bosentan. Trials 2019; 20:164. [PMID: 30871594 PMCID: PMC6416892 DOI: 10.1186/s13063-019-3252-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 02/25/2019] [Indexed: 11/12/2022] Open
Abstract
Background Axonal degeneration is related to long-term disability in patients with multiple sclerosis (MS). The underlying mechanism remains ill understood but appears to involve axonal energetic dysfunction. A globally impaired cerebral blood flow (CBF) has been observed in the normal-appearing white matter (NAWM) of patients with MS, which is probably related to astrocytic overexpression of endothelin-1 (ET-1). Cerebral hypoperfusion has been associated with reduced mitochondrial activity and disabling symptoms (e.g. fatigue and cognitive decline) of MS. Countering this process could therefore be beneficial in the disease course. Short-term CBF restoration with a single 62.5-mg dose of the ET-1 receptor antagonist bosentan has already been demonstrated in patients with MS. Methods The ROCHIMS study is a proof-of-concept double-blind randomized clinical trial in which patients with relapsing-remitting MS will receive either 62.5 mg bosentan or matching placebo twice daily during 28 ± 2 days. Clinical evaluation and brain magnetic resonance imaging (MRI) will be performed at baseline and treatment termination. Based on previous work, we expect a global increase of CBF in the individuals treated with bosentan. The primary outcome measure is the change of N-acetyl aspartate in centrum semiovale NAWM, which is a marker of regional axonal mitochondrial activity. Other parameters of interest include changes in fatigue, cognition, motor function, depression, and brain volume. Discussion We hypothesize that restoring cerebral hypoperfusion in MS patients improves axonal metabolism. Early positive effects on fatigue and cognitive dysfunction related to MS might additionally be detected. There is a medical need for drugs that can slow down the progressive axonal degeneration in MS, making this an important topic of interest. Trial registration Clinical Trials Register, EudraCT 2017-001253-13. Registered on 15 February 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3252-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stéphanie Hostenbach
- Department of Neurology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium. .,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Ayla Pauwels
- Department of Neurology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium
| | - Veronique Michiels
- Department of Neurology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium
| | - Hubert Raeymaekers
- Department of Radiology and Medical Physics, UZ Brussel, Brussels, Belgium
| | | | | | | | - Jacques De Keyser
- Department of Neurology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Neurology, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
| | - Miguel D'Haeseleer
- Department of Neurology, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,National Multiple Sclerosis Centrum, Melsbroek, Belgium
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Association Between IL7R Promoter Polymorphisms and Multiple Sclerosis in Turkish Population. J Mol Neurosci 2018; 67:38-47. [PMID: 30443838 DOI: 10.1007/s12031-018-1205-0] [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] [Received: 06/09/2018] [Accepted: 10/30/2018] [Indexed: 12/27/2022]
Abstract
Multiple sclerosis (MS) is a chronic progressive neurodegenerative disease that affects myelin fibers within the central nervous system resulting in neurological impairment. Although the etiology of MS is not fully understood, environmental and genetic factors are thought to play important roles. IL7R gene polymorphisms which are associated with several autoimmune diseases have also been implicated as a genetic factor for MS following genome-wide association studies. To further examine this association, we investigated the association between MS and IL7R gene - 449 (A/G), - 504 (T/C), and - 1085 (G/T) promoter polymorphisms in Turkish population. Three hundred sixty-four MS patients and 191 healthy controls were involved in this study. Three polymorphic regions in the promoter of IL7R were identified and these regions were amplified by appropriate primers. The PCR products were digested by PstI enzyme for - 504 (T/C) SNP and HphI enzyme for - 1085 (G/T) and - 449 (A/G) SNPs and genotyping was done based on digested PCR product sizes. Genotype distributions and allele frequencies of - 449 polymorphism did not show any significant association with MS directly (p = 0.120 and p = 0.490, respectively). But the genotypes of IL7R - 449 GA for AOMS and AA for EOMS were a risk factor in according to age of onset (p = 0.002, OR = 4.021, 95% CI = 1.642-9.845). Furthermore, IL7R - 449 A allele was found to be a risk factor for EOMS (p = 0.011, OR = 1.3, 95% CI = 1.107-1.527). Significant association was seen between IL7R - 504 TC heterozygote genotype and MS (p = 0.02, OR = 1.702, 95% CI = 1.169-2.478). The IL7R - 1085 (G/T) polymorphism did not show association with MS; however, the haplotype of ACG may be susceptibility to MS and RRMS (p = 0.035, OR = 1.349, 95% CI = 1.020-1.785, and p = 0.041, OR = 1.368, 95% CI = 1.012-1.850, respectively) and the haplotypes of ACG, ATT, and GTG demonstrate a protective effect in EOMS (p = 0.008, OR = 0.326, 95% CI = 0.136-0.782, p = 0.012 and p = 0.012, OR = 0.462, 95% CI = 0.249-0.859, respectively). RRMS frequency in the Turkish population was decreased and SPMS frequency was strongly increased based on comparison to results from other populations. Furthermore, male patients had an increased frequency of SPMS significantly (p = 0.033, OR = 1.667, 95% CI = 1.036-2.682). In conclusion, this is the first study to show a significant association between the IL7R promoter polymorphisms and the age of onset of MS.
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Sormani MP. Prognostic factors versus markers of response to treatment versus surrogate endpoints: Three different concepts. Mult Scler 2018; 23:378-381. [PMID: 28260416 DOI: 10.1177/1352458516676899] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Multiple sclerosis is a highly heterogeneous disease; the quantitative assessment of disease progression is problematic for many reasons, including the lack of objective methods to measure disability and the long follow-up times needed to detect relevant and stable changes. For these reasons, the importance of prognostic markers, markers of response to treatments and of surrogate endpoints, is crucial in multiple sclerosis research. Aim of this report is to clarify some basic definitions and methodological issues about baseline factors to be considered prognostic markers or markers of response to treatment; to define the dynamic role that variables must have to be considered surrogate markers in relation to specific treatments.
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Affiliation(s)
- Maria Pia Sormani
- Biostatistics Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
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Pakbaz Z, Sahraian MA, Sabzi S, Mahmoodi M, Pourmand MR. Prevalence of sea, seb, sec, sed, and tsst-1 genes of Staphylococcus aureus in nasal carriage and their association with multiple sclerosis. Germs 2017; 7:171-177. [PMID: 29264354 DOI: 10.18683/germs.2017.1123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/15/2017] [Accepted: 10/22/2017] [Indexed: 11/08/2022]
Abstract
Background Microbial superantigens might initiate or exacerbate autoimmune responses against particular tissues, organs or systems. This study aimed to examine the prevalence of sea, seb, sec, sed, and tsst-1 genes of Staphylococcus aureus in nasal carriage and their association with multiple sclerosis (MS). Methods Nasal swabs were collected from 150 MS patients and 150 healthy individuals (control group) to isolate S. aureus and investigate their superantigen genes (sea, seb, sec, sed and tsst-1) using PCR. Results A total of 300 participants were enrolled in the study, matched for age and gender (150 patients in the MS group and 150 in the control group). The prevalence of S. aureus colonization in MS patients and control groups was 42% and 23.3%, respectively. There was a statistically significant association between S. aureus colonization and MS disease (p<0.001; odds ratio 2.4; 95% confidence interval 1.4-3.9). No significant association was observed between the presence of S. aureus harboring sea, seb, sec, sed and tsst-1 genes with MS disease. Conclusion The rate of S. aureus nasal carriage is higher in patients with MS. Our study's results suggest that further investigation into whether there is a connection between MS and nasal exposure to staphylococcal superantigens is warranted.
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Affiliation(s)
- Zahra Pakbaz
- PhD, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Poursina St., Tehran, Iran
| | - Mohammad Ali Sahraian
- MD, MS Research Center, Neuroscience Institute, Neurology Department, Tehran University of Medical Science, Sina Hospital, Hasan Abad Sq., Tehran, Iran
| | - Samira Sabzi
- MSc, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Poursina St., Tehran, Iran
| | - Mahmood Mahmoodi
- PhD, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poursina St., Tehran, Iran
| | - Mohammad Reza Pourmand
- PhD, Department of Pathobiology, School of Public Health, and Biotechnology Research Center, Tehran University of Medical Sciences, Poursina St., Tehran, Iran
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Guillemin F, Baumann C, Epstein J, Kerschen P, Garot T, Mathey G, Debouverie M. Older Age at Multiple Sclerosis Onset Is an Independent Factor of Poor Prognosis: A Population-Based Cohort Study. Neuroepidemiology 2017; 48:179-187. [DOI: 10.1159/000479516] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 07/15/2017] [Indexed: 11/19/2022] Open
Abstract
Background: Late-onset multiple sclerosis (LOMS) frequently features a primary progressive (PP) course, strongly predicting severe disability. In this population-based cohort, we estimated the prognostic role of age at multiple sclerosis (MS) onset, independent of PP course, on disability progression. Methods: The association of age at disease onset (adult, <50 years [AOMS], vs. late, ≥50 years [LOMS]) and time to Expanded Disability Status Scale (EDSS) score 4 and 6 was estimated by Cox regression modelling. Results: Among 3,597 patients, 245 had LOMS. Relapsing-remitting (RR) disease was less frequent with LOMS than AOMS (51.8 vs. 90.8%, p < 0.0001). PP course, LOMS and male gender predicted short time to EDSS 4 and 6. Worse outcome with LOMS (time to EDSS 4 and 6, HR 2.0 [95% CI 1.7-2.4] and 2.3 [1.9-2.9]) was independent of PP course or male gender. LOMS had greater impact on RR than PP disease (time to EDSS 4 and 6, HR 3.1 [2.3-4.0] and 4.0 [2.9-5.6]). Only LOMS predicted time from EDSS 4 to 6 (p < 0.0001). Conclusions: Late onset MS was strongly associated with poor prognosis, independent of initial disease course, in predicting the disability progression along time.
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Laurence M, Benito-León J. Epstein–Barr virus and multiple sclerosis: Updating Pender's hypothesis. Mult Scler Relat Disord 2017; 16:8-14. [DOI: 10.1016/j.msard.2017.05.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/14/2017] [Accepted: 05/26/2017] [Indexed: 10/19/2022]
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Lotti CBDC, Oliveira ASB, Bichuetti DB, Castro ID, Oliveira EML. Late onset multiple sclerosis: concerns in aging patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:451-456. [DOI: 10.1590/0004-282x20170070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/20/2017] [Indexed: 11/22/2022]
Abstract
ABSTRACT Late onset multiple sclerosis (LOMS) is when the first symptom starts after 50 years of age, representing 4.5% of multiple sclerosis (MS) patients. This study describes the clinical characteristics of patients with LOMS followed at a specialized MS center in São Paulo. Data was obtained from medical records of 742 patients with MS. The LOMS frequency was 4.18%, median age at onset was 54 years and the predominant disease course was primary progressive (64.3%). The patients reached the disability landmarks of EDSS grades 3.0, 6.0 and 7.0 in the following proportion and time: EDSS 3.0: 77.42% of patients in 3.7 years; EDSS 6.0: 58.06% in 5.1 years and EDSS 7.0: 32.26% in 5.7 years. The comparative analysis with a matched control group of patients with early onset MS showed that late onset, associated with a progressive course, were predictors of reaching EDSS 3.0 and 6.0 in a shorter time.
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28
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Alla S, Pearson JF, Taylor BV, Miller DH, Clarke G, Richardson A, Willoughby E, Abernethy DA, Sabel CE, Mason DF. Disability profile of multiple sclerosis in New Zealand. J Clin Neurosci 2016; 28:97-101. [PMID: 26765754 DOI: 10.1016/j.jocn.2015.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/29/2015] [Accepted: 09/06/2015] [Indexed: 10/22/2022]
Abstract
New Zealand is a high risk region for multiple sclerosis (MS). The aim of this study was to investigate demographic, clinical and temporal factors associated with disability status in the New Zealand National Multiple Sclerosis Prevalence Study (NZNMSPS) cohort. Data were obtained from the 2006 NZNMSPS with MS diagnosis based on the 2005 McDonald criteria. Disability was assessed using the Expanded Disability Status Scale (EDSS). Disability profiles were generated using multiple linear regression analysis. A total of 2917 persons with MS was identified, of whom disability data were available for 2422 (75% females). The overall disability was EDSS 4.4±standard deviation 2.6. Higher disability was associated with older age, longer disease duration, older and younger ages of onset, spinal cord syndromes with motor involvement at onset, and a progressive onset type. Lower disability was associated with sensory symptoms at onset and a relapsing onset type. Overall, the factors studied explained about one-third of the variation in disability, and of this, about two-thirds was accounted for by age, age of onset and disease duration and one-third by the nature of first symptoms and type of disease onset (progressive or relapsing). Current age, age at onset and disease duration all had independent associations with disability and their effects also interacted in contributing to higher disability levels over the course of the disease.
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Affiliation(s)
- Sridhar Alla
- New Zealand Brain Research Institute, 66 Stewart Street, Christchurch 8011, New Zealand; University of Otago, Christchurch, New Zealand.
| | | | - Bruce V Taylor
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | - David H Miller
- New Zealand Brain Research Institute, 66 Stewart Street, Christchurch 8011, New Zealand; University of Otago, Christchurch, New Zealand; Queen Square MS Centre, UCL Institute of Neurology, London, UK
| | | | - Ann Richardson
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | | | | | - Clive E Sabel
- School of Geographical Sciences, University of Bristol, Bristol, UK
| | - Deborah F Mason
- New Zealand Brain Research Institute, 66 Stewart Street, Christchurch 8011, New Zealand; University of Otago, Christchurch, New Zealand; Christchurch Public Hospital, Christchurch, New Zealand
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Goodin DS. The epidemiology of multiple sclerosis: insights to a causal cascade. HANDBOOK OF CLINICAL NEUROLOGY 2016; 138:173-206. [PMID: 27637959 DOI: 10.1016/b978-0-12-802973-2.00011-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
MS-pathogenesis involves both genetic-susceptibility and environmental determinants. Three (or more) sequential environmental-factors are implicated. The first acts near birth, the second acts during childhood/adolescence, and the third acts subsequently. Two candidate factors (vitamin D deficiency and Epstein-Barr viral infection) seem particularly well-suited to the first two environmental-events but other factors (e.g., obesity and smoking behavior) seem also to be involved in the causal scheme. MS-pathogenesis can be modeled by incorporating both the environmental and genetic-factors into a causal scheme, which can then help to explain some of the changes in MS-epidemiology (e.g., increasing disease-prevalence, changing sex-ratio, and regional-variations in monozygotic-twin-concordance-rates), which have been taking place recently. This model suggests that genetic-susceptibility is overwhelmingly the most important determinant of MS and that, at least, 92.5% of individuals (and likely much more) are, essentially, incapable of developing MS, regardless of their specific environmental-exposures. Nevertheless, the genetics is complex and the contribution of any specific gene to MS-susceptibility seems to be quite modest. Thus, even for the DRB1*1501 allele (the strongest known MS-susceptibility marker), most carriers are not in the genetically-susceptible group. Moreover, 45-50% of individuals with MS lack this allele entirely and some of the haplotypes that carry this allele don't also confer any disease-risk. Finally, because the prevalence of genetic-susceptibility seems to be so similar throughout North America and Europe, and despite the crucial importance of a person's genetic make-up to disease pathogenesis, it is the environmental-factors, which largely responsible for the observed regional variations in disease-characteristics. Thus, despite MS being more common in women, men are more likely to be genetically-susceptible. This apparent paradox seems to relate to the fact that women are much more responsive than men to the recent changes in environmental-exposure (whatever these have been). These gender-differences may help to explain changes in the sex-ratio and the increasing disease-prevalence, which have both been observed recently. The potential importance of these conclusions regarding the role of environment in MS-pathogenesis is that they open the door to the possibility of pursuing strategies for primary primary disease prevention in the future.
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Affiliation(s)
- D S Goodin
- Multiple Sclerosis Center at the University of California, San Francisco, San Francisco, CA, USA.
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Al-Temaimi R, Alroughani R, Jacob S, Al-Mulla F. Gender influence in EBV antibody response in multiple sclerosis patients from Kuwait. J Neuroimmunol 2015. [PMID: 26198919 DOI: 10.1016/j.jneuroim.2015.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Epstein-Barr virus (EBV) infection is implicated with multiple sclerosis (MS) risk, exacerbation, and progression. The HLA-DRB1*1501 haplotype is a strong MS risk factor consistently documented in MS populations. There are no studies of EBV infections and HLA-DRB1*1501 haplotype associating with MS from Kuwait where MS prevalence has increased significantly. OBJECTIVES To determine the association of EBV infection with MS incidence, and to investigate HLA-DRB1*1501 as a potential genetic risk factor for MS in Kuwait. METHODS This is a case-control study involving 141 MS patients and 40 healthy controls. Antibody titers against EBV antigens' viral capsid antigen (VCA) and Epstein-Barr nuclear antigen 1 (EBNA1) were measured using enzyme-linked immunosorbent assays. HLA-DRB1*1501 haplotype assessment was done using rs3135005 TaqMan genotyping assay. RESULTS Antibody titers against EBV were significantly elevated in MS patients compared to healthy controls (anti-EBNA1, p=0.008; anti-VCA, p=0.028). MS males had higher antibody titers to EBNA1 than healthy male controls (p=0.005) and female MS patients (p=0.03). HLA-DRB1*1501 haplotype genotypes failed to generate a risk association with MS or EBV antibody titers (p=0.6). CONCLUSION An increased immune response to EBV infection is associated with MS incidence influenced by the type of antigen and sex. HLA-DRB1*1501 haplotype is not associated with MS risk in our Kuwaiti MS cohort.
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Affiliation(s)
- Rabeah Al-Temaimi
- Human Genetics Unit, Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait.
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait, Kuwait; Neurology Clinic, Department of Medicine, Dasman Diabetes Institute, Kuwait
| | - Sindhu Jacob
- Molecular Pathology Unit, Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait
| | - Fahd Al-Mulla
- Molecular Pathology Unit, Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait
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Lew-Starowicz M, Gianotten WL. Sexual dysfunction in patients with multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:357-70. [DOI: 10.1016/b978-0-444-63247-0.00020-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Thati S, Kuehl C, Hartwell B, Sestak J, Siahaan T, Forrest ML, Berkland C. Routes of administration and dose optimization of soluble antigen arrays in mice with experimental autoimmune encephalomyelitis. J Pharm Sci 2014; 104:714-21. [PMID: 25447242 DOI: 10.1002/jps.24272] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 01/26/2023]
Abstract
Soluble antigen arrays (SAgAs) were developed for treating mice with experimental autoimmune encephalomyelitis (EAE), a mouse model of multiple sclerosis. SAgAs are composed of hyaluronan with grafted EAE antigen and LABL peptide (a ligand of ICAM-1). SAgA dose was tested by varying injection volume, SAgA concentration, and administration schedule. Routes of administration were explored to determine the efficacy of SAgAs when injected intramuscularly, subcutaneously, intraperitoneally, intravenously, or instilled into lungs. Injections proximal to the central nervous system (CNS) were compared with distal injection sites. Intravenous dosing was included to determine if SAgA efficiency results from systemic exposure. Pulmonary instillation (p.i.) was included as reports suggest T cells are licensed in the lungs before moving to the CNS. Decreasing the volume of injection or SAgA dose reduced treatment efficacy. Treating mice with a single injection on day 4, 7, and 10 also reduced efficacy compared with injecting on all three days. Surprisingly, changing the injection site did not lead to a significant difference in efficacy. Intravenous administration showed efficacy similar to other routes, suggesting SAgAs act systemically. When SAgAs were delivered via p.i., however, EAE mice failed to develop any symptoms, suggesting a unique lung mechanism to ameliorate EAE in mice.
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Affiliation(s)
- Sharadvi Thati
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, Kansas, 66047
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Goodin DS. The epidemiology of multiple sclerosis: insights to disease pathogenesis. HANDBOOK OF CLINICAL NEUROLOGY 2014; 122:231-66. [PMID: 24507521 DOI: 10.1016/b978-0-444-52001-2.00010-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of studying the epidemiology of multiple sclerosis (MS) is twofold. First, it is important to understand clearly the natural history of the illness in order to assist patients in making decisions about their future with respect to issues such as family planning, the importance of securing lifelong healthcare, their ability to get and maintain employment, and making appropriate choices of therapy for their particular circumstances. This is not to suggest that, even with the best possible information, the ultimate prognosis for any individual can be predicted with absolute accuracy. It cannot. Nevertheless, accurate information can be very helpful both to reassure patients that many individuals with MS do remarkably well in the long term (perhaps, especially, with current and future therapies) and also to empower individuals with respect to their ability to make their own life choices. Second, and arguably the more important purpose for studying the epidemiology of MS, is to gain insights to the underlying causes of the disease. Indeed, if the principal mechanisms of disease pathogenesis were to be understood clearly, then it might be possible to entertain notions of either a cure for existing disease or the primary prevention of future disease. Much of our current understanding of disease pathogenesis, as discussed in other chapters of this volume, has been derived from basic science investigations of animal models of MS such as experimental autoimmune encephalomyelitis (EAE), and these models have provided considerable insight both to the complexity of the mammalian immune system and to the mechanisms underlying its dysfunction in inflammatory autoimmune conditions. Nevertheless, MS is a disease of humans without any known, naturally occurring, counterpart in any nonhuman species. For this reason, the clues to disease pathogenesis provided by a study of basic epidemiologic facts regarding MS (and by a systematic consideration of their implications) are essential to a comprehensive understanding of the human illness we call MS.
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Affiliation(s)
- Douglas S Goodin
- Department of Neurology, University of California, San Francisco, USA.
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34
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Roohani P, Emiru T, Carpenter A, Luzzio C, Freeman J, Scarberry S, Beaver G, Davidson L, Parry G. Late onset multiple sclerosis: Is it really late onset? Mult Scler Relat Disord 2014; 3:444-9. [DOI: 10.1016/j.msard.2014.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/10/2014] [Accepted: 02/19/2014] [Indexed: 10/25/2022]
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Stüve O, Cravens PD, Eagar TN. DNA-based vaccines: the future of multiple sclerosis therapy? Expert Rev Neurother 2014; 8:351-60. [DOI: 10.1586/14737175.8.3.351] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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36
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Hampson CO, Soares GM, Jaffan AA. Reported outcomes after the endovascular treatment of chronic cerebrospinal venous insufficiency. Tech Vasc Interv Radiol 2012; 15:144-9. [PMID: 22640503 DOI: 10.1053/j.tvir.2012.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic cerebrospinal venous insufficiency (CCSVI) has recently been implicated as a potential causal factor in the development of multiple sclerosis (MS). The treatment of jugular and azygous vein stenoses, characteristic of CCSVI, has been proposed as a potential component of therapy for MS. In the few short years since Dr. Paulo Zamboni published "A Prospective Open label Study of Endovascular Treatment of Chronic Cerebrospinal Venous Insufficiency", there has been tremendous patient-driven demand for treatment. Concurrently, there have been numerous publications since 2009 addressing CCSVI and its association with MS. The purpose of this article is to present a brief review of CCSVI and its association with MS and to review the available literature to date with a focus on outcomes data.
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Affiliation(s)
- Christopher O Hampson
- Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, RI 02903, USA.
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Gupta AA, Ding D, Lee RK, Levy RB, Bhattacharya SK. Spontaneous ocular and neurologic deficits in transgenic mouse models of multiple sclerosis and noninvasive investigative modalities: a review. Invest Ophthalmol Vis Sci 2012; 53:712-24. [PMID: 22331505 DOI: 10.1167/iovs.11-8351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune, inflammatory, neurodegenerative, demyelinating disease of the central nervous system, predominantly involving myelinated neurons of the brain, spinal cord, and optic nerve. Optic neuritis is frequently associated with MS and often precedes other neurologic deficits associated with MS. A large number of patients experience visual defects and have abnormalities concomitant with neurologic abnormalities. Transgenic mice manifesting spontaneous neurologic and ocular disease are unique models that have revolutionized the study of MS. Spontaneous experimental autoimmune encephalomyelitis (sEAE) presents with spontaneous onset of demyelination, without the need of an injectable immunogen. This review highlights the various models of sEAE, their disease characteristics, and applicability for future research. The study of optic neuropathy and neurologic manifestations of demyelination in sEAE will expand our understanding of the pathophysiological mechanisms underlying MS. Early and precise diagnosis of MS with different noninvasive methods has opened new avenues in managing symptoms, reducing morbidity, and limiting disease burden. This review discusses the spectrum of available noninvasive techniques, such as electrophysiological and behavioral assessment, optical coherence tomography, scanning laser polarimetry, confocal scanning laser ophthalmoscopy, pupillometry, magnetic resonance imaging, positron emission tomography, gait, and cardiovascular monitoring, and their clinical relevance.
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Affiliation(s)
- Archana A Gupta
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33136, USA
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Abstract
Multiple sclerosis (MS) is a chronic, complex neurological disease with a variable clinical course in which several pathophysiological mechanisms such as axonal/ neuronal damage, demyelination, inflammation, gliosis, remyelination and repair, oxidative injury and excitotoxicity, alteration of the immune system as well as biochemical disturbances and disruption of blood-brain barrier are involved.(1,2) Exacerbations of MS symptoms reflect inflammatory episodes, while the neurodegenerative aspects of gliosis and axonal loss result in the progression of disability. The precise aetiology of MS is not yet known, although epidemiological data indicate that it arises from a complex interactions between genetic susceptibility and environmental factors.(3) In this chapter the brain structures and processes involved in immunopathogenesis of MS are presented. Additionally, clinical phenotypes and biomarkers of MS are showed.
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Abstract
Three types of vascular dysfunction have been described in multiple sclerosis (MS). First, findings from epidemiological studies suggest that patients with MS have a higher risk for ischaemic stroke than people who do not have MS. The underlying mechanism is unknown, but might involve endothelial dysfunction secondary to inflammatory disease activity and increased plasma homocysteine concentrations. Second, patients with MS have global cerebral hypoperfusion, which might predispose them to the development of ischaemic stroke. The widespread decrease in perfusion in normal-appearing white matter and grey matter in MS seems not to be secondary to axonal degeneration, but might be a result of reduced axonal activity, reduced astrocyte energy metabolism, and perhaps increased blood concentrations of endothelin-1. Data suggest that a subtype of focal MS lesions might have an ischaemic origin, and there seems to be a link between reduced white matter perfusion and cognitive dysfunction in MS. Third, the pathology of MS might be the consequence of a chronic state of impaired venous drainage from the CNS, for which the term chronic cerebrospinal venous insufficiency (CCSVI) has been coined. A number of recent vascular studies do not support the CCSVI theory, but some elements of CCSVI might be explained by slower cerebral venous blood flow secondary to the reduced cerebral perfusion in patients with MS compared with healthy individuals.
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Affiliation(s)
- Miguel D'haeseleer
- Department of Neurology, Universitair Ziekenhuis Brussel, Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.
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Scotter EL, Abood ME, Glass M. The endocannabinoid system as a target for the treatment of neurodegenerative disease. Br J Pharmacol 2010; 160:480-98. [PMID: 20590559 DOI: 10.1111/j.1476-5381.2010.00735.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The Cannabis sativa plant has been exploited for medicinal, agricultural and spiritual purposes in diverse cultures over thousands of years. Cannabis has been used recreationally for its psychotropic properties, while effects such as stimulation of appetite, analgesia and anti-emesis have lead to the medicinal application of cannabis. Indeed, reports of medicinal efficacy of cannabis can been traced back as far as 2700 BC, and even at that time reports also suggested a neuroprotective effect of the cultivar. The discovery of the psychoactive component of cannabis resin, Delta(9)-tetrahydrocannabinol (Delta(9)-THC) occurred long before the serendipitous identification of a G-protein coupled receptor at which Delta(9)-THC is active in the brain. The subsequent finding of endogenous cannabinoid compounds, the synthesis of which is directed by neuronal excitability and which in turn served to regulate that excitability, further widened the range of potential drug targets through which the endocannabinoid system can be manipulated. As a result of this, alterations in the endocannabinoid system have been extensively investigated in a range of neurodegenerative disorders. In this review we examine the evidence implicating the endocannabinoid system in the cause, symptomatology or treatment of neurodegenerative disease. We examine data from human patients and compare and contrast this with evidence from animal models of these diseases. On the basis of this evidence we discuss the likely efficacy of endocannabinoid-based therapies in each disease context.
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Affiliation(s)
- Emma L Scotter
- Centre for Brain Research and Department of Pharmacology, University of Auckland, Auckland, New Zealand
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Buchanan RJ, Minden SL, Chakravorty BJ, Hatcher W, Tyry T, Vollmer T. A pilot study of young adults with multiple sclerosis: demographic, disease, treatment, and psychosocial characteristics. Disabil Health J 2009; 3:262-70. [PMID: 21122795 DOI: 10.1016/j.dhjo.2009.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 09/11/2009] [Accepted: 09/15/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although multiple sclerosis (MS) is the most common neurologic disease disabling younger adults, very little is known about the characteristics of young adults with MS and the impact of MS on their lives. OBJECTIVES To conduct a pilot study of the demographic, disease, treatment, and psychosocial characteristics of young adults with MS (aged 18 and 31 years). METHODS We solicited participation from all 452 members of the Registry of the North American Research Committee On Multiple Sclerosis (NARCOMS) Project aged 18 to 31 years, collecting data from 100 of these young adults (22%) by computer-assisted telephone interviews. Data included basic demographic, disease, and treatment characteristics, ratings of satisfaction with access to and quality of MS and mental health care, and beliefs about the impact of MS on their current and future lives. RESULTS Participants were 93% female and averaged 28.6 years of age, and 88% had relapsing-remitting MS. Forty-three percent received the majority of their MS-focused care at an MS clinic and 94% had seen a neurologist in the previous 12 months. More than 40% reported depressive symptoms at the time of the survey. These young adults with MS had relatively low rates of concern about the impact of MS in the present but higher rates of worry about their future. CONCLUSIONS These findings suggest the need for a study with a larger, representative sample of young adults with MS to guide development of programs, interventions, and services tailored to meet their needs.
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Affiliation(s)
- Robert J Buchanan
- Department of Political Science and Public Administration, Mississippi State University, Mississippi State, MS 39762, USA.
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Clinical characteristics of patients with late-onset multiple sclerosis. J Neurol 2008; 255:697-702. [DOI: 10.1007/s00415-008-0778-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2007] [Revised: 10/01/2007] [Accepted: 10/16/2007] [Indexed: 10/22/2022]
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Dhib-Jalbut S, Arnold DL, Cleveland DW, Fisher M, Friedlander RM, Mouradian MM, Przedborski S, Trapp BD, Wyss-Coray T, Yong VW. Neurodegeneration and neuroprotection in multiple sclerosis and other neurodegenerative diseases. J Neuroimmunol 2006; 176:198-215. [PMID: 16983747 DOI: 10.1016/j.jneuroim.2006.03.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Multiple sclerosis is considered a disease of myelin destruction; Parkinson's disease (PD), one of dopaminergic neuron depletion; ALS, a disease of motor neuron death; and Alzheimer's, a disease of plaques and tangles. Although these disorders differ in important ways, they also have common pathogenic features, including inflammation, genetic mutations, inappropriate protein aggregates (e.g., Lewy bodies, amyloid plaques), and biochemical defects leading to apoptosis, such as oxidative stress and mitochondrial dysfunction. In most disorders, it remains uncertain whether inflammation and protein aggregation are neurotoxic or neuroprotective. Elucidating the mechanisms that orchestrate neuronal diseases should facilitate development of neuroprotective and neurorestorative strategies.
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Affiliation(s)
- Suhayl Dhib-Jalbut
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, and The Cleveland Clinic, OH, USA.
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Minden SL, Frankel D, Hadden L, Perloffp J, Srinath KP, Hoaglin DC. The Sonya Slifka Longitudinal Multiple Sclerosis Study: methods and sample characteristics. Mult Scler 2006; 12:24-38. [PMID: 16459717 DOI: 10.1191/135248506ms1262oa] [Citation(s) in RCA: 189] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Sonya Slifka Longitudinal Multiple Sclerosis Study follows a population-based cohort of approximately 2000 people with multiple sclerosis (MS) to study demographic and clinical characteristics, course of illness, utilization and cost of health services, provider characteristics, use of MS specialists and disease modifying agents, and neurologic, economic and psychosocial outcomes. This report describes the study methodology, presents baseline demographic and clinical data, and evaluates the representativeness of the sample. A stratified random sample of persons with established and recently-diagnosed MS selected from the National Multiple Sclerosis Society (NMSS) mailing lists was supplemented with recently-diagnosed patients recruited through systematic nationwide outreach. Baseline data were collected by computer-assisted telephone interviews derived from standardized instruments; data collection continues at six-month intervals. The cohort was comparable to population-based and clinical samples with respect to demographics, course, relapse rate, symptoms, and severity of disability. Almost two-thirds of the cohort needed help with activities of daily living, three-quarters were limited in work or other activities, and half had emotional problems that compromised quality of life. The Slifka Study cohort is broadly representative of the MS population and the database can be used to address questions not answered by natural history studies, clinical databases, or population-based surveys.
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Affiliation(s)
- S L Minden
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Teuscher C, Bunn JY, Fillmore PD, Butterfield RJ, Zachary JF, Blankenhorn EP. Gender, age, and season at immunization uniquely influence the genetic control of susceptibility to histopathological lesions and clinical signs of experimental allergic encephalomyelitis: implications for the genetics of multiple sclerosis. THE AMERICAN JOURNAL OF PATHOLOGY 2004; 165:1593-602. [PMID: 15509529 PMCID: PMC1618666 DOI: 10.1016/s0002-9440(10)63416-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/13/2004] [Indexed: 11/30/2022]
Abstract
Multiple sclerosis (MS), the principal inflammatory demyelinating disease of the central nervous system (CNS), is believed to have an immunopathological etiology arising from gene-environment interactions. In this study, we examined the effect of sex, age, and season at immunization on the susceptibility of (B10.S x SJL/J) F(2) intercross mice to experimental allergic encephalomyelitis (EAE), the foremost animal model of MS. Results of logistic regression analyses suggest that female mice were more likely to exhibit CNS lesions than male mice [odds ratio (OR) = 2.28 for brain lesions; OR = 2.37 for spinal cord (SC) lesions]. Although statistically significant associations were seen between brain and SC lesions and age at the time of injection or month of injection when examined separately; these associations disappeared when controlling for sex in multiple logistic regression analyses. These results suggest that the sex of the mouse is more important in influencing the development of brain and SC lesions than was either age or month of immunization. When examining clinical disease as the endpoint, the OR for the age at immunization is 1.04, indicating that the odds of being affected increase by 4% for each increasing week of age. When controlled for age, the OR for injection in the summer months (July through September) is 1.90, suggesting that the odds of being clinically affected are 90% greater for F(2) intercross animals injected in the summercompared to those injected in the winter to spring months (February through May). In contrast to CNS lesions, the age and season at immunization significantly and independently influenced susceptibility to clinical EAE and did so equally in both males and females. Linkage analysis to eae5, the H2-linked locus controlling susceptibility to clinical disease, was performed using 6- to 12- and >12-week-old cohorts as well as summer and winter/spring cohorts of F(2) mice. Significant linkage of clinical EAE to eae5 was observed with the 6- to 12-week-old and summer populations. In contrast, linkage of clinical EAE to eae5 was not detected with the >12-week-old and winter/spring populations. These results indicate that age and seasonal effects are capable of overriding eae5-dependent genetic control of susceptibility to clinical EAE and have significant implications for the genetics of MS.
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Affiliation(s)
- Cory Teuscher
- Immunobiology Program, C317 Given Medical Building, University of Vermont, Burlington, VT 05405, USA.
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Abstract
Abstract
This chapter provides information on the epidemiology of multiple sclerosis (MS), the most common disabling neurological disease in young adults. It describes the clinical and pathologic features of MS and how these features pose challenges for clinical diagnosis and case definition criteria. Information is provided regarding the descriptive epidemiology of MS, including studies of incidence, prevalence, and temporal trends in MS frequency. Also included is a discussion of the interesting geographical features of the MS distribution, including MS disease clusters, the latitude gradient in disease risk, and migrant studies of individuals who move from high-risk to low-risk regions. Other sections of the chapter cover evidence regarding the infectious etiology of MS, including the important role that Epstein-Barr virus appears to play in disease susceptibility. The role of lifestyle factors is receiving increasing emphasis in MS epidemiologic studies, and evidence is summarized regarding the potential role of cigarette smoking, diet, and hormonal factors.
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