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Müller KJ, Schmidbauer ML, Schönecker S, Kamm K, Pelz JO, Holzapfel K, Papadopoulou M, Bakola E, Tsivgoulis G, Naumann M, Hermann A, Walter U, Dimitriadis K, Reilich P, Schöberl F. Diagnostic accuracy and confounders of vagus nerve ultrasound in amyotrophic lateral sclerosis-a single-center case series and pooled individual patient data meta-analysis. J Neurol 2024:10.1007/s00415-024-12601-z. [PMID: 39085618 DOI: 10.1007/s00415-024-12601-z] [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: 06/09/2024] [Revised: 07/11/2024] [Accepted: 07/20/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Several single-center studies proposed utility of vagus nerve (VN) ultrasound for detecting disease severity, autonomic dysfunction, and bulbar phenotype in amyotrophic lateral sclerosis (ALS). However, the resulting body of literature shows opposing results, leaving considerable uncertainty on the clinical benefits of VN ultrasound in ALS. METHODS Relevant studies were identified up to 04/2024 and individual patient data (IPD) obtained from the respective authors were pooled with a so far unpublished cohort (from Munich). An IPD meta-analysis of 109 patients with probable or definite ALS (El Escorial criteria) and available VN cross-sectional area (CSA) was performed, with age, sex, ALS Functional Rating Scale-revised (ALSFRS-R), disease duration, and bulbar phenotype as independent variables. RESULTS Mean age was 65 years (± 12) and 47% of patients (± 12) had bulbar ALS. Mean ALSFRS-R was 38 (± 7), and mean duration was 18 months (± 18). VN atrophy was highly prevalent [left: 67% (± 5), mean CSA 1.6mm2 (± 0.6); right: 78% (± 21), mean CSA 1.8 mm2 (± 0.7)]. VN CSA correlated with disease duration (mean slope: left - 0.01; right - 0.01), but not with ALSFRS-R (mean slope: left 0.004; mean slope: right - 0.002). Test accuracy for phenotyping bulbar vs. non-bulbar ALS was poor (summary receiver operating characteristic area under the curve: left 0.496; right 0.572). CONCLUSION VN atrophy in ALS is highly prevalent and correlates with disease duration, but not with ALSFRS-R. VN CSA is insufficient to differentiate bulbar from non-bulbar ALS phenotypes. Further studies are warranted to analyze the link between VN atrophy, autonomic impairment, and survival in ALS.
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Affiliation(s)
- Katharina J Müller
- Department of Neurology With Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany
| | - Moritz L Schmidbauer
- Department of Neurology With Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sonja Schönecker
- Department of Neurology With Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany
| | - Katharina Kamm
- Department of Neurology With Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany
| | - Johann O Pelz
- Department of Neurology, Leipzig University Hospital, Leipzig, Germany
| | - Korbinian Holzapfel
- Department of Neurology and Clinical Neurophysiology, University of Augsburg, Augsburg, Germany
| | - Marianna Papadopoulou
- Department of Physiotherapy, Laboratory of Neuromuscular and Cardiovascular Study of Motion, University of West Attica, Athens, Greece
| | - Eleni Bakola
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Markus Naumann
- Department of Neurology and Clinical Neurophysiology, University of Augsburg, Augsburg, Germany
| | - Andreas Hermann
- Deutsches Zentrum Für Neurodegenerative, Erkrankungen Rostock/Greifswald, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock, Rostock University Medical Center, Rostock, Germany
- Translational Neurodegeneration Section Albrecht Kossel, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Uwe Walter
- Deutsches Zentrum Für Neurodegenerative, Erkrankungen Rostock/Greifswald, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock, Rostock University Medical Center, Rostock, Germany
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Konstantinos Dimitriadis
- Department of Neurology With Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany
| | - Peter Reilich
- Department of Neurology With Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany
| | - Florian Schöberl
- Department of Neurology With Friedrich Baur Institute, LMU University Hospital, LMU Munich, Munich, Germany.
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Reis J, Buguet A, Radomski M, Stella AB, Vásquez TC, Spencer PS. Neurological patients confronting climate change: A potential role for the glymphatic system and sleep. J Neurol Sci 2024; 458:122900. [PMID: 38310733 DOI: 10.1016/j.jns.2024.122900] [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: 11/20/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/06/2024]
Abstract
Interest in the health consequences of climate change (global warming, heatwaves) has increased in the neurological community. This review addresses the impact of elevated ambient temperatures and heatwaves on patients with neurological and mental health disorders, including multiple sclerosis, synucleinopathies, dementia, epilepsies, mental health, and stroke. Patients with such conditions are highly vulnerable during heatwaves because of functional disorders affecting sleep, thermoregulation, autonomic system reactivity, mood, and cognitive ability. Several medications may also increase the risk of heatstroke. Special attention is devoted to the involvement of common underlying mechanisms, such as sleep and the glymphatic system. Disease prevention and patient care during heatwaves are major issues for caregivers. Beyond the usual recommendations for individuals, we favor artificially induced acclimation to heat, which provides preventive benefits with proven efficacy for healthy adults.
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Affiliation(s)
- Jacques Reis
- Department of Neurology, University Hospital of Strasbourg, 67000 Strasbourg, France; Association RISE, 3 rue du Loir, 67205 Oberhausbergen, France.
| | - Alain Buguet
- Malaria Research Unit, UMR 5246 CNRS, Claude-Bernard Lyon-1 University, 69622 Villeurbanne, France; 21 rue de Champfranc, 38630 Les Avenières Veyrins-Thuellin, France
| | - Manny Radomski
- Emeritus at the University of Toronto, Apt n° 2501, 2010 Islington Avenue, Toronto, ON M9P3S8, Canada
| | - Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital, University of Trieste, Trieste, Italy
| | - Teresa Corona Vásquez
- División de Estudios de Posgrado, Universidad Nacional Autónoma de México, Mexico City, Mexico; Clinical Neurodegenerative Diseases Laboratory, Instituto Nacional de Neurología y Neurocirugía, Manuel Velasco Suárez, Mexico City, Mexico
| | - Peter S Spencer
- Department of Neurology, School of Medicine, Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR 97239, USA
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Dubuisson N, de Maere d'Aertrijcke O, Marta M, Gnanapavan S, Turner B, Baker D, Schmierer K, Giovannoni G, Verma V, Docquier MA. Anaesthetic management of people with multiple sclerosis. Mult Scler Relat Disord 2023; 80:105045. [PMID: 37866022 DOI: 10.1016/j.msard.2023.105045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/27/2023] [Accepted: 09/29/2023] [Indexed: 10/24/2023]
Abstract
There is a lack of published guidelines on the management of patients with multiple sclerosis (MS) undergoing procedures that require anaesthesia and respective advice is largely based on retrospective studies or case reports. The aim of this paper is to provide recommendations for anaesthetists and neurologists for the management of patients with MS requiring anaesthesia. This review covers issues related to the anaesthetic management of patients with MS, with a focus on preoperative assessment, choice of anaesthetic techniques and agents, side-effects of drugs used during anaesthesia and their potential impact on the disease evolution, drug interactions that may occur, and the need to use monitoring devices. A systematic PubMed research was performed to retrieve relevant articles.
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Affiliation(s)
- N Dubuisson
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Neuromuscular Reference Center, Department of Neurology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels 1200, Belgium.
| | - O de Maere d'Aertrijcke
- Department of Anesthesia and Perioperative Medicine, Cliniques Universitaires Saint-Luc, St Luc Hospital, Avenue Hippocrate 10, Brussels 1200, Belgium
| | - M Marta
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - S Gnanapavan
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - B Turner
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - D Baker
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK
| | - K Schmierer
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - G Giovannoni
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - V Verma
- Department of Anesthesia, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M-A Docquier
- Department of Anesthesia and Perioperative Medicine, Cliniques Universitaires Saint-Luc, St Luc Hospital, Avenue Hippocrate 10, Brussels 1200, Belgium
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Asiaei S, Nasiri N, Ravari MP, Shahmoradi D, Mohamadbagher M, Jarrahi F, Jafari SK, Azarbayjani MA. Exercise regulates NG2-expressing cells in a cuprizone-induced demyelination rat model of multiple sclerosis. SPORT SCIENCES FOR HEALTH 2023. [DOI: 10.1007/s11332-023-01116-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/10/2023] [Indexed: 10/30/2023]
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Razi O, Teixeira AM, Tartibian B, Zamani N, Knechtle B. Respiratory issues in patients with multiple sclerosis as a risk factor during SARS-CoV-2 infection: a potential role for exercise. Mol Cell Biochem 2023; 478:1533-1559. [PMID: 36411399 PMCID: PMC9684932 DOI: 10.1007/s11010-022-04610-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Abstract
Coronavirus disease-2019 (COVID-19) is associated with cytokine storm and is characterized by acute respiratory distress syndrome (ARDS) and pneumonia problems. The respiratory system is a place of inappropriate activation of the immune system in people with multiple sclerosis (MS), and this may cause damage to the lung and worsen both MS and infections.The concerns for patients with multiple sclerosis are because of an enhance risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The MS patients pose challenges in this pandemic situation, because of the regulatory defect of autoreactivity of the immune system and neurological and respiratory tract symptoms. In this review, we first indicate respiratory issues associated with both diseases. Then, the main mechanisms inducing lung damages and also impairing the respiratory muscles in individuals with both diseases is discussed. At the end, the leading role of physical exercise on mitigating respiratory issues inducing mechanisms is meticulously evaluated.
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Affiliation(s)
- Omid Razi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Razi University, Kermanshah, Iran
| | - Ana Maria Teixeira
- Research Center for Sport and Physical Activity, Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Bakhtyar Tartibian
- Department of Exercise Physiology, Faculty of Physical Education and Sports Sciences, Allameh Tabataba’i University, Tehran, Iran
| | - Nastaran Zamani
- Department of Biology, Faculty of Science, Payame-Noor University, Tehran, Iran
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, Vadianstrasse 26, 9001 St. Gallen, Switzerland
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Palladino L, Ruotolo I, Berardi A, Carlizza A, Galeoto G. Efficacy of aquatic therapy in people with spinal cord injury: a systematic review and meta-analysis. Spinal Cord 2023; 61:317-322. [PMID: 36966260 DOI: 10.1038/s41393-023-00892-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 02/28/2023] [Accepted: 03/13/2023] [Indexed: 03/27/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. Spinal cord injury (SCI) is a pathological condition that provokes the loss of one or more body functions due to an injury to the spinal cord as a result of trauma or disease. Hydrotherapy plays a key role in the rehabilitation of neurological patients due to the properties of water environments. OBJECTIVES The goal of this study was to evaluate the efficacy of hydrotherapy in patients who suffer from SCIs. METHODS We searched 5 different databases: CINAHL, PubMed, Scopus, Web of Science, and PEDro for studies to include. Only randomized controlled trials (RCTs) published in English were considered. To evaluate the risk of bias, Jadad and PEDro scales were used. RESULTS Eleven Randomized Controlled Trials were included, and 3 articles remained to be analyzed. According to the evaluation through Cochrane Risk of Bias tool, one study had a high level of quality. The remaining 2 studies achieved a score indicative of a low level of quality. A total of 71 individuals with SCI were included in the studies; age and level of injury varied in each study. The outcome measures used in the studies were: Functional Independence Measure (FIM), Ashworth scale, CardioTouch 3000 s in sitting position and Quark CPET. CONCLUSION The aquatic environment provides a rehabilitation tool able to facilitate movement, physical and cardiovascular exercise, resistance training, and body relaxation.
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Affiliation(s)
| | - Ilaria Ruotolo
- MS Center, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Anna Berardi
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | | | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University, Rome, Italy.
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Christogianni A, Bibb R, Filingeri D. Body temperatures, thermal comfort, and neuropsychological responses to air temperatures ranging between 12°C and 39°C in people with Multiple Sclerosis. Physiol Behav 2023; 266:114179. [PMID: 37019295 DOI: 10.1016/j.physbeh.2023.114179] [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: 01/25/2023] [Revised: 03/22/2023] [Accepted: 03/26/2023] [Indexed: 04/05/2023]
Abstract
The negative effects of thermal stress on Multiple Sclerosis (MS)' symptoms have long been known. However, the underlying mechanisms of MS heat and cold intolerance remain unclear. The aim of this study was to evaluate body temperatures, thermal comfort, and neuropsychological responses to air temperatures between 12 to 39°C in people with MS compared to healthy controls (CTR). Twelve MS (5 males/7 females; age: 48.3±10.8 years; EDSS range: 1-7) and 11 CTR participants (4 males /7 females; age: 47.5±11.3 years) underwent two 50-min trials in a climatic chamber. Air temperature was ramped from 24°C to either 39°C (HEAT) or 12°C (COLD) and we continuously monitored participants' mean skin (Tsk) and rectal temperatures (Trec), heart rate and mean arterial pressure. We recorded participants' self-reported thermal sensation and comfort, mental and physical fatigue, and we assessed their cognitive performance (information processing). Changes in mean Tsk and Trec did not differ between MS and CTR neither during HEAT nor COLD. However, at the end of the HEAT trial, 83% of MS participants and 36% of CTR participants reported being "uncomfortable". Furthermore, self-reports of mental and physical fatigue increased significantly in MS but not CTR (p<0.05), during both HEAT and COLD. Information processing was lower in MS vs. CTR (p<0.05); yet this cognitive impairment was not exacerbated by HEAT nor COLD (p>0.05). Our findings indicate that neuropsychological factors (i.e. discomfort and fatigue) could contribute to MS heat and cold intolerance in the absence of deficits in the control of body temperature.
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Affiliation(s)
- Aikaterini Christogianni
- THERMOSENSELAB, School of Design and Creative Arts, Loughborough University, Loughborough, LE11 3TU, United Kingdom
| | - Richard Bibb
- School of Design and Creative Arts, Loughborough University, Loughborough, LE11 3TU, United Kingdom
| | - Davide Filingeri
- THERMOSENSELAB, School of Design and Creative Arts, Loughborough University, Loughborough, LE11 3TU, United Kingdom; THERMOSENSELAB, Skin Sensing Research Group, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom.
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Comparing Two Protocols of Exercise on Physical Fitness and Psychological Factors of Mild to Moderate Multiple Sclerosis Patients. Asian J Sports Med 2023. [DOI: 10.5812/asjsm-127947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS). Previous studies have shown that aerobic activity is inversely related to MS symptoms and may be restorative and possibly protective. Objectives: This study aimed to compare the effects of high-intensity functional training (HIFT) protocols and aerobic exercise on functional fitness as well as the cognitive aspect of female patients with multiple sclerosis. Methods: This quasi-experimental and applied clinical trial study consisted of all patients with MS registered in an MS clinic. Among eligible individuals, 30 female RRMS patients were randomly and equally divided into three groups high-intensity functional training (n = 10); aerobic exercise (n = 10), and control group (n = 10). The forearm test, the 30-second standing test, and single leg stance test (SLST), The Timed Up and Go (TUG), expanded disability status scale (EDSS) were performed to assess physical factors as well as the 21-DAS questionnaire to assess cognitive aspects. Results: This study showed a meaningful difference between the intervention groups and the control group (P < 0.05), in the level of power in the upper body (P = 0.001), Lower torso strength (P = 0.001), Static balance (P = 0.001), Dynamic balance (P = 0.001). the psychological and behavioral components. Conclusions: Present study suggests that aerobic exercise and HIFT in women with MS can improve and further enhance physical function plus psychological and behavioral factors.
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Shariat A, Ghayour Najafabadi M, Soroush Fard Z, Nakhostin-Ansari A, Shaw BS. A systematic review with meta-analysis on balance, fatigue, and motor function following aquatic therapy in patients with multiple sclerosis. Mult Scler Relat Disord 2022; 68:104107. [PMID: 35988329 DOI: 10.1016/j.msard.2022.104107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE In this systematic review and meta-analysis, we aimed to evaluate the impact of long-term aquatic exercise training on balance, fatigue, and motor function. METHODS Scopus, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Ovid Medline, EBSCO Cumulative Index to Nursing, and Allied Health Literature were searched on April 19, 2021. The search included randomized and non-randomized controlled trials, case-control studies, case series, and case reports. Two independent reviewers reviewed titles and abstracts to determine which studies satisfied the eligibility criteria. Two reviewers independently surveyed the full texts and conducted the study selection, data extraction, and quality assessment. Data synthesis was applied to summarize information from included studies. Meta-analysis was performed using RevMan 5. RESULTS From 170 studies that were identified in the initial search, 16 trials (794 participants) satisfied the eligibility criteria. Aquatic therapy had a positive effect on fatigue compared to control group based on Modified Fatigue Impact Scale (MFIS) in physical (SMD, -1.29; 95% CI, [(-1.65) - (-0.93)]; I2=88%) cognitive (SMD, -0.75; 95% CI, [(-1.08)-(- 0.43)]; I2=78%), and psychological (SMD, -1.25; 95% CI, [(-1.59) - (-0.90)]; I2=79%) domains, and Fatigue Severity Scale (FSS) (SMD, -0.53; 95% CI, [(-0.86) - (-0.20)]; I2=57%). In addition, aquatic therapy improved balance based on the Berg Balance Scale (BBS) compared to the control group (SMD, 1.19; 95% CI, [(0.62)-(1.76)]; I2=11%) CONCLUSIONS: Aquatic therapy has positive effects on fatigue and balance. Further research is needed to confirm the clinical utility of aquatic therapy for multiple sclerosis patients in the long term.
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Affiliation(s)
- Ardalan Shariat
- Department of Digital Health, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Ghayour Najafabadi
- Department of motor behavior, Faculty of physical education and sport science, University of Tehran, Tehran, Iran.
| | - Zahra Soroush Fard
- Department of Sports Injury, Faculty of physical education and sport science, University of Tehran, Tehran, Iran
| | - Amin Nakhostin-Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Brandon S Shaw
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, United Kingdom
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Neurorehabilitation in Multiple Sclerosis-A Review of Present Approaches and Future Considerations. J Clin Med 2022; 11:jcm11237003. [PMID: 36498578 PMCID: PMC9739865 DOI: 10.3390/jcm11237003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Multiple sclerosis is an increasingly prevalent disease, representing the leading cause of non-traumatic neurological disease in Europe and North America. The most common symptoms include gait deficits, balance and coordination impairments, fatigue, spasticity, dysphagia and an overactive bladder. Neurorehabilitation therapeutic approaches aim to alleviate symptoms and improve the quality of life through promoting positive immunological transformations and neuroplasticity. The purpose of this study is to evaluate the current treatments for the most debilitating symptoms in multiple sclerosis, identify areas for future improvement, and provide a reference guide for practitioners in the field. It analyzes the most cited procedures currently in use for the management of a number of symptoms affecting the majority of patients with multiple sclerosis, from different training routines to cognitive rehabilitation and therapies using physical agents, such as electrostimulation, hydrotherapy, cryotherapy and electromagnetic fields. Furthermore, it investigates the quality of evidence for the aforementioned therapies and the different tests applied in practice to assess their utility. Lastly, the study looks at potential future candidates for the treatment and evaluation of patients with multiple sclerosis and the supposed benefits they could bring in clinical settings.
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11
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Mateen FJ. Progress towards the 2030 sustainable development goals: direct and indirect impacts on neurological disorders. J Neurol 2022; 269:4623-4634. [PMID: 35583660 DOI: 10.1007/s00415-022-11180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
The United Nations' Sustainable Development Goals (SDGs) were set forth in 2015 as a blueprint for all nations to create a more sustainable future together. These 17 social, environmental, and economic goals have established targets to meet globally by the year 2030, with a focus on pro-poor initiatives, gender equality, and ending hunger. The relationship of the SDGs with neurological disorders and how the achievement of the SDGs intersects with the future of neurological practice have not been comprehensively examined. However, the incidence of neurological disorders, the outcomes of people living with neurological disorders, and the training of future neurologists can be interlinked, directly or indirectly, with programming for the SDGs and their eventual achievement. Each SDG is reviewed in the context of neurology. This lens can inform programming and policy, enhance research and training, and improve inter-sectoral action for neurological disorders worldwide.
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Affiliation(s)
- Farrah J Mateen
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, 165 Cambridge Street, #627, Boston, MA, 02114, USA.
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Faraji J, Bettenson D, Babatunde S, Gangur-Powell T, Yong VW, Metz GA. Thermoregulatory dynamics reveal sex-specific inflammatory responses to experimental autoimmune encephalomyelitis in mice: Implications for multiple sclerosis-induced fatigue in females. Brain Behav Immun Health 2022; 23:100477. [PMID: 35677535 PMCID: PMC9167694 DOI: 10.1016/j.bbih.2022.100477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/21/2022] [Accepted: 05/30/2022] [Indexed: 11/21/2022] Open
Abstract
The course of multiple sclerosis (MS) is characterized by striking sex differences in symptoms such as fatigue and impaired thermal regulation, which are associated with aggravated systemic pro-inflammatory processes. The purpose of this study was to replicate these symptoms in experimental autoimmune encephalomyelitis (EAE) in C57BL/6 mice in the quest to advance the preclinical study of non-motor symptoms of MS. Male and female C57BL/6 mice exposed to a mild form of EAE were evaluated for the progression of clinical, behavioural, thermal, and inflammatory processes. We show higher susceptibility in females to EAE than males based on greater clinical score and cumulative disease index (CDI), fatigue-like and anxiety-like behaviours. Accordingly, infrared (IR) thermography indicated higher cutaneous temperatures in females from post-induction days 12-23. Females also responded to EAE with greater splenic and adrenal gland weights than males as well as sex-specific changes in pro- and anti-inflammatory cytokines. These findings provide the first evidence of a sex-specific thermal response to immune-mediated demyelination, thus proposing a non-invasive assessment approach of the psychophysiological dynamics in EAE mice. The results are discussed in relation to the thermoregulatory correlates of fatigue and how endogenously elevated body temperature without direct heat exposure may be linked to psychomotor inhibition in patients with MS.
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Affiliation(s)
- Jamshid Faraji
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada
| | - Dennis Bettenson
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada
| | - Stella Babatunde
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada
| | - Tabitha Gangur-Powell
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada
| | - Voon Wee Yong
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta T2N 4N1, Canada
| | - Gerlinde A.S. Metz
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada
- Southern Alberta Genome Sciences Centre, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada
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Gervasoni E, Bertoni R, Anastasi D, Solaro C, Di Giovanni R, Grange E, Gunga HC, Rovaris M, Cattaneo D, Maggioni MA, Merati G. Acute Thermoregulatory and Cardiovascular Response to Submaximal Exercise in People With Multiple Sclerosis. Front Immunol 2022; 13:842269. [PMID: 35874684 PMCID: PMC9296825 DOI: 10.3389/fimmu.2022.842269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Heat sensitivity occurs in a high percentage of people with multiple sclerosis (PwMS), in response to environmental or exercise-induced increase in body temperature. However, the kinetic and magnitude of adaptation of the internal load and of the core body temperature (CBT) to a submaximal continuous exercise has been poorly addressed in PwMS; this may be relevant for the brief exercise bouts usually occurring in normal daily life. The aim of this work was to evaluate whether multiple sclerosis influences the acute adaptation of the internal load, the CBT and the perceptual load in response to a constant submaximal work step. Methods CBT has been continuously monitored (0.5 Hz) by a validated wearable heat-flux sensor and electrocardiography was recorded (250 Hz) by a wearable device during a standard 6-minute walk test (6MWT) in 14 PwMS (EDSS, 4.7 ± 1.2; disease duration: 13.0 ± 10.2 years; m ± SD) and 14 age, sex and BMI-matched healthy subjects (HS). The rate of perceived exertion (RPE) of the lower limbs was assessed during the 6MWT by the Borg scale (6-20). Results As expected, PwMS walked a significantly shorter distance (361 ± 98 m) than the HS group (613 ± 62 m, p<0.001 vs PwMS). However, the kinetics of adaptation of CBT and the magnitude of CBT change from baseline did not differ between groups. Similarly, heart rate (HR) kinetics and HR change from baseline were comparable between groups during the 6MWT. Finally, lower limbs RPE gradually increased during the exercise test, but without significant differences between groups. Conclusion The internal load, the metabolic heat production, and the perceptive load due to a standard submaximal walking exercise seems to be preserved in PwMS, suggesting a comparable acute heat production and dissipation during exercise. Therefore, it is unlikely that the different distance achieved during the 6MWT may be caused by altered thermoregulatory responses to exercise. Rather, this appears to be a consequence of the known increased energy cost of locomotion in PwMS.
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Affiliation(s)
| | | | | | - Claudio Solaro
- Rehabilitation Department, CRRF Mons. L. Novarese, Moncrivello, Italy
| | | | - Erica Grange
- Rehabilitation Department, CRRF Mons. L. Novarese, Moncrivello, Italy
| | - Hanns-Christian Gunga
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments, Berlin, Germany
| | | | - Davide Cattaneo
- IRCCS Fondazione Don Gnocchi, Milano, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Martina Anna Maggioni
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments, Berlin, Germany
- Department of Biomedical Sciences for Health (SCIBIS), University of Milan, Milan, Italy
| | - Giampiero Merati
- IRCCS Fondazione Don Gnocchi, Milano, Italy
- Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
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14
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Touma L, Muccilli A. Diagnosis and Management of Central Nervous System Demyelinating Disorders. Neurol Clin 2021; 40:113-131. [PMID: 34798965 DOI: 10.1016/j.ncl.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The spectrum of demyelinating diseases affecting the central nervous system is broad. Although many have a chronic course, neuroinflammatory conditions often present with acute to subacute onset symptoms requiring hospitalization when severe. This article reviews the acute phase assessment and management of these disorders, with a particular focus on multiple sclerosis, neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody disorder, and several atypical demyelinating diseases.
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Affiliation(s)
- Lahoud Touma
- Department of Neurosciences, Unviersity of Montreal, Centre Hospitalier de l'Université de Montréal
| | - Alexandra Muccilli
- Department of Medicine, Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, Canada.
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15
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Adamec I, Krbot Skorić M, Habek M. Understanding and managing autonomic dysfunction in persons with multiple sclerosis. Expert Rev Neurother 2021; 21:1409-1417. [PMID: 34654355 DOI: 10.1080/14737175.2021.1994856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic demyelinating immune mediated disease of the central nervous system. Autonomic dysfunction (AD) is frequently present in persons with MS (pwMS) and increases with disease duration and progression. AREAS COVERED Cardiovascular, genitourinary, and sudomotor autonomic dysfunction in pwMS are reviewed and managing of these disorders is addressed. EXPERT OPINION AD in pwMS can manifest with a myriad of symptoms including cardiovascular, urogenital, and sweating disorders. These symptoms can significantly impact the quality of life of pwMS with poor tolerance of upright position, difficulties in sexual function, and low endurance of physical activity especially in warm environments. Health professionals involved in care of pwMS should possess basic knowledge of the function of the autonomic nervous system and be informed of the way disorders of the autonomic function may manifest in pwMS in order to provide the proper care.
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Affiliation(s)
- Ivan Adamec
- Department of Neurology, University Hospital Center Zagreb, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia
| | - Magdalena Krbot Skorić
- Department of Neurology, University Hospital Center Zagreb, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia.,Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Mario Habek
- Department of Neurology, University Hospital Center Zagreb, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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16
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Tarakci E, Tarakci D, Hajebrahimi F, Budak M. Supervised exercises versus telerehabilitation. Benefits for persons with multiple sclerosis. Acta Neurol Scand 2021; 144:303-311. [PMID: 33961295 DOI: 10.1111/ane.13448] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/05/2021] [Accepted: 04/16/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the effectiveness of structured telerehabilitation on fatigue, health status, quality of life (QoL), and activities of daily living (ADL) and compare the possible effects with structured supervised exercise programs in patients with Multiple Sclerosis. MATERIALS AND METHODS This study was a randomized, single-blind trial. Thirty patients with relapsing-remitting Multiple Sclerosis were included in the study and randomly divided into two groups; structured supervised exercise group (Group 1) and telerehabilitation group (Group 2). Group 1 (n = 15) completed a 12 week structured supervised exercise program. Group 2 (n = 15) completed a 12 week structured home-based exercise program. Patients were evaluated with functional independence measure (FIM), first section of Nottingham Health Profile (NHP-I), fatigue severity scale (FSS), and quality of life scale (QoLS) before and after the intervention. RESULTS Significant differences were found in all parameters in both groups after the treatment (p < .05). No significant difference was found between groups regarding FIM-total, FIM-motor, FIM-cognitive, NHP sub-parameters, and QoLS (p > .05). Between-group differences revealed a significant difference in FSS and NHP total in favor of Group 1 (p < .05). CONCLUSION A structured home-based exercise program can be an alternative to supervised exercises with no side effects in patients with multiple sclerosis. Home-based rehabilitation exercises that are checked and controlled through telerehabilitation can help patients improve their health-related QoL and ADL. However, supervised exercises can be more beneficial regarding the fatigue and health profile compared to the home-based exercises.
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Affiliation(s)
- Ela Tarakci
- Department of Physiotherapy and Rehabilitation Faculty of Health Sciences Istanbul University Cerrahpaşa Istanbul Turkey
| | - Devrim Tarakci
- Department of Ergotherapy School of Health Sciences Istanbul Medipol University Istanbul Turkey
| | - Farzin Hajebrahimi
- Department of Physical Therapy and Rehabilitation School of Health Sciences Istanbul Medipol University Istanbul Turkey
| | - Miray Budak
- Department of Ergotherapy School of Health Sciences Istanbul Medipol University Istanbul Turkey
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17
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Chacko G, Patel S, Galor A, Kumar N. Heat Exposure and Multiple Sclerosis-A Regional and Temporal Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115962. [PMID: 34199394 PMCID: PMC8199586 DOI: 10.3390/ijerph18115962] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/24/2022]
Abstract
Multiple sclerosis (MS) is a neurological disorder that progressively distorts the myelination of axons within the central nervous system (CNS). Increased core body temperature or metabolism as a result of exercise are common causes of short-term exacerbations of neurological symptoms in MS. About 60–80% of patients with MS experience a worsening of their symptoms when exposed to heat. In comparison, less data are available on the relationship between ambient meteorological conditions (e.g., temperature and relative humidity (RH)) and fluctuations in such variables in relation to MS symptoms. Thus, this study examined associations between time-lagged exposure to meteorological conditions and risk of a clinic visit due to MS among US veterans between 2010 and 2013. This study leveraged data from the Veterans Affairs (VA) and National Climactic Data Center (NCDC) for the continental US, partitioned into eight climate zones. We used a case crossover design to assess the risk of a MS clinic visit with respect to several meteorological conditions. Location-specific time-lagged daily (ambient) exposure to temperature, RH, and temperature variations (standard deviation (SD) of temperature) were computed (up to 30 days) for each case (i.e., day of MS visit) and control (a randomly assigned date ± 90–270 days prior to visit). Statistical analyses were conducted to examine independent associations between the selected meteorological conditions and risk of MS visits at the national and regional levels. A total of 533,066 patient visits received a MS diagnosis (International Classifications of Diseases (ICD)-9 code = 340). The Northeast (NE) and Upper Midwest (UMW) regions reported the highest frequency of clinic visits due to MS. Clinic visits were 9% more likely to occur in the spring, summer, and fall months (March–October) than in the winter (OR = 1.089; 95% CI = 1.076–1.103; p < 0.01). In the univariate analyses, the SD of temperature, temperature, and temperature–RH interaction were positively associated with an elevated risk of a MS clinic visit, while the RH was negatively associated with the risk for a clinic visit. In multivariate analyses, the strongest association of a MS clinic visit was observed with the SD of the temperature (OR = 1.012; 95% CI 1.008–1.017; p < 0.01). These associations between MS clinic visits and meteorological conditions varied across climate regions, with the strongest associations being observed in the LMW, UMW, DSW, and NE zones. The SD of the temperature was again the strongest associated predictor when examined regionally. Temperature variations and temperature–RH interactions (a proxy of the heat index) showed significant associations with MS clinic visits. These associations varied across climate regions when examined geographically. Our findings have implications for the management of MS in severe or recurrent cases, especially considering the impending changes in the daily temperature variations and intensity of the heatwaves expected with the intensification of global warming.
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Affiliation(s)
- Gill Chacko
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - Sneh Patel
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL 33136, USA; (S.P.); (A.G.)
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Anat Galor
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL 33136, USA; (S.P.); (A.G.)
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Research Services, Miami Veterans Affairs Medical Center, Miami, FL 33136, USA
| | - Naresh Kumar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
- Correspondence: ; Tel.: +1-305-243-4854
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18
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Abstract
Very limited progress has been made to date in the treatment of
debilitating Multiple Sclerosis (MS) daily onset symptoms. These daily
symptoms include motor, sensory, and cognitive impairments as well as
an overwhelming feeling of tiredness, often referred to as “MS
fatigue.” Although widely cited as a main cause of inability to work
and poor quality of life in patients with MS, daily onset MS-related
tiredness continues to defy definition, and, consequently, measurement
and treatment. Beginning with a historical overview of observations of
daily onset MS-related tiredness, this Topical Review demonstrates how
the misnomer “MS fatigue” has introduced ongoing misunderstanding for
patients, investigators, clinicians, and therapists. Finally,
combining current findings in clinical neuroscience with the striking
set of long-standing commonalities present throughout the past
200 years of clinical observations, we underscore the immediate
necessity for conceptual and applied change, to be initiated by the
renaming of this distinct syndrome.
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Affiliation(s)
- Amy Lynn Hubbard
- Department of Neurology, Psychosomatic Medicine, and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University Cologne, Cologne, Germany
| | - Heidrun Golla
- Department of Palliative Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Hedda Lausberg
- Department of Neurology, Psychosomatic Medicine, and Psychiatry, Institute of Health Promotion and Clinical Movement Science, German Sport University Cologne, Cologne, Germany
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19
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Amedoro A, Berardi A, Conte A, Pelosin E, Valente D, Maggi G, Tofani M, Galeoto G. The effect of aquatic physical therapy on patients with multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2020; 41:102022. [PMID: 32114368 DOI: 10.1016/j.msard.2020.102022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aquatic environment has unique properties, such a buoyancy, turbulence, hydrostatic pressure, and resistance, which can be used to gain a range of exercise benefits. During the last decade, hydrotherapy has spread in a very heterogeneous rehabilitation field. However, the efficacy of this kind of rehabilitation is not clear in scientific literature. The purpose of this study is to conduct a systematic review with meta-analysis to evaluate the qualitative and quantitative results of physical therapy treatments in an aquatic setting for individuals with Multiple Sclerosis. METHOD PRISMA guidelines were used to carry out the systematic review and meta-analysis. Three bibliographic databases were searched: MEDLINE, PEDro, and the Cochrane Library. Papers included in the study have the following characteristics: (a) a randomized controlled trial design of research and (b) published in English. The quality of the clinical trials included were evaluated according to a Jadad score and through meta-analysis. RESULTS After the elimination of duplicates, 116 records were screened. Among these, 11 Randomized Controlled Trials (RCTs) were included in the systematic review. Ten of these were involved in the meta-analysis. From the qualitative analysis, a larger number of studies were found with a high level of quality. Most of the results of the quantitative analysis were statistically significant (p< 0.05). CONCLUSION Aquatic physical therapy is a valid means of rehabilitation for people with Multiple Sclerosis. The integration of this methodological approach with conventional physical therapy is recommended. Nevertheless, more studies, a larger number of participants, and short-, medium-, and long-term follow-up are required to confirm current results.
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Affiliation(s)
- Alessio Amedoro
- Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy.
| | - Anna Berardi
- Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy; IRCCS Neuromed Pozzili, Italy.
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Via Balbi, 5, Genova 16126, Italy
| | - Donatella Valente
- Department of Paediatrics and Child Neuropsychiatry, Sapienza University, Rome, Italy.
| | - Giuseppe Maggi
- Policlinico Umberto I University Hospital, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy.
| | - Marco Tofani
- Neurorehabilitation Unit, Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Via della Torre di Palidoro, Rome 00054, Italy.
| | - Giovanni Galeoto
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy.
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20
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Devasahayam AJ, Chaves AR, Lasisi WO, Curtis ME, Wadden KP, Kelly LP, Pretty R, Chen A, Wallack EM, Newell CJ, Williams JB, Kenny H, Downer MB, McCarthy J, Moore CS, Ploughman M. Vigorous cool room treadmill training to improve walking ability in people with multiple sclerosis who use ambulatory assistive devices: a feasibility study. BMC Neurol 2020; 20:33. [PMID: 31969132 PMCID: PMC6975092 DOI: 10.1186/s12883-020-1611-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/10/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Aerobic training has the potential to restore function, stimulate brain repair, and reduce inflammation in people with Multiple Sclerosis (MS). However, disability, fatigue, and heat sensitivity are major barriers to exercise for people with MS. We aimed to determine the feasibility of conducting vigorous harness-supported treadmill training in a room cooled to 16 °C (10 weeks; 3times/week) and examine the longer-term effects on markers of function, brain repair, and inflammation among those using ambulatory aids. METHODS Ten participants (9 females) aged 29 to 74 years with an Expanded Disability Status Scale ranging from 6 to 7 underwent training (40 to 65% heart rate reserve) starting at 80% self-selected walking speed. Feasibility of conducting vigorous training was assessed using a checklist, which included attendance rates, number of missed appointments, reasons for not attending, adverse events, safety hazards during training, reasons for dropout, tolerance to training load, subjective reporting of symptom worsening during and after exercise, and physiological responses to exercise. Functional outcomes were assessed before, after, and 3 months after training. Walking ability was measured using Timed 25 Foot Walk test and on an instrumented walkway at both fast and self-selected speeds. Fatigue was measured using fatigue/energy/vitality sub-scale of 36-Item Short-Form (SF-36) Health Survey, Fatigue Severity Scale, modified Fatigue Impact Scale. Aerobic fitness (maximal oxygen consumption) was measured using maximal graded exercise test (GXT). Quality-of-life was measured using SF-36 Health Survey. Serum levels of neurotrophin (brain-derived neurotrophic factor) and cytokine (interleukin-6) were assessed before and after GXT. RESULTS Eight of the ten participants completed training (attendance rates ≥ 80%). No adverse events were observed. Fast walking speed (cm/s), gait quality (double-support (%)) while walking at self-selected speed, fatigue (modified Fatigue Impact Scale), fitness (maximal workload achieved during GXT), and quality-of-life (physical functioning sub-scale of SF-36) improved significantly after training, and improvements were sustained after 3-months. Improvements in fitness (maximal respiratory exchange ratio and maximal oxygen consumption during GXT) were associated with increased brain-derived neurotrophic factor and decreased interleukin-6. CONCLUSION Vigorous cool room training is feasible and can potentially improve walking, fatigue, fitness, and quality-of-life among people with moderate to severe MS-related disability. TRIAL REGISTRATION The study was approved by the Newfoundland and Labrador Health Research Ethics Board (reference number: 2018.088) on 11/07/2018 prior to the enrollment of first participant (retrospectively registered at ClinicalTrials.gov: NCT04066972. Registered on 26 August 2019.
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Affiliation(s)
- Augustine J Devasahayam
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Arthur R Chaves
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Wendy O Lasisi
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Marie E Curtis
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Katie P Wadden
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Liam P Kelly
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Ryan Pretty
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Alice Chen
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Elizabeth M Wallack
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Caitlin J Newell
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - John B Williams
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, Rm H4360, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Hannah Kenny
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Matthew B Downer
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Jason McCarthy
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Craig S Moore
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, Rm H4360, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Michelle Ploughman
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada.
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Jin X, Wang L, Liu S, Zhu L, Loprinzi PD, Fan X. The Impact of Mind-body Exercises on Motor Function, Depressive Symptoms, and Quality of Life in Parkinson's Disease: A Systematic Review and Meta-analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E31. [PMID: 31861456 PMCID: PMC6981975 DOI: 10.3390/ijerph17010031] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 12/14/2022]
Abstract
Purpose: To systematically evaluate the effects of mind-body exercises (Tai Chi, Yoga, and Health Qigong) on motor function (UPDRS, Timed-Up-and-Go, Balance), depressive symptoms, and quality of life (QoL) of Parkinson's patients (PD). Methods: Through computer system search and manual retrieval, PubMed, Web of Science, The Cochrane Library, CNKI, Wanfang Database, and CQVIP were used. Articles were retrieved up to the published date of June 30, 2019. Following the Cochrane Collaboration System Evaluation Manual (version 5.1.0), two researchers independently evaluated the quality and bias risk of each article, including 22 evaluated articles. The Pedro quality score of 6 points or more was found for 86% (19/22) of these studies, of which 21 were randomized controlled trials with a total of 1199 subjects; and the trial intervention time ranged from 4 to 24 weeks. Interventions in the control group included no-intervention controls, placebo, waiting-lists, routine care, and non-sports controls. Meta-analysis was performed on the literature using RevMan 5.3 statistical software, and heterogeneity analysis was performed using Stata 14.0 software. Results: (1) Mind-body exercises significantly improved motor function in PD patients, including UPDRS (SMD = -0.61, p < 0.001), TUG (SMD = -1.47, p < 0.001) and balance function (SMD = 0.79, p < 0.001). (2) Mind-body exercises also had significant effects on depression (SMD = -1.61, p = 0.002) and QoL (SMD = 0.66, p < 0.001). (3) Among the indicators, UPDRS (I2 = 81%) and depression (I2 = 91%) had higher heterogeneity; according to the results of the separate combined effect sizes of TUG(I2 = 29%), Balance(I2 = 16%) and QoL(I2 = 35%), it shows that the heterogeneity is small; (4) After meta-regression analysis of the age limit and other possible confounding factors, further subgroup analysis showed that the reason for the heterogeneity of UPDRS motor function may be related to the sex of PD patients and severity of the disease; the outcome of depression was heterogeneous. The reason for this may be the use of specific drugs in the experiment and the duration of intervention in the trial. Conclusion: (1) Mind-body exercises were found to have significant improvements in motor function, depressive symptoms, and quality of life in patients with Parkinson's disease, and can be used as an effective method for clinical exercise intervention in PD patients. (2) Future clinical intervention programs for PD patients need to fully consider specific factors such as gender, severity of disease, specific drug use, and intervention cycle to effectively control heterogeneity factors, so that the clinical exercise intervention program for PD patients is objective, scientific, and effective.
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Affiliation(s)
- Xiaohu Jin
- Department of Physical Education, Wuhan University of Technology, Wuhan 430070, China;
| | - Lin Wang
- Department of Physical Education, Wuhan University of Technology, Wuhan 430070, China;
| | - Shijie Liu
- School of Physical Education & Training, Shanghai University of Sport, Shanghai 200438, China;
| | - Lin Zhu
- School of Physical Education, Soochow University, Suzhou, Jiangsu 205301, China;
| | - Paul Dinneen Loprinzi
- Exercise & Memory Laboratory, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, Oxford, MS 38677, USA;
| | - Xin Fan
- College of Physical Education, Hubei Normal University, Huangshi 435002, China;
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22
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Hsieh DT, Warden GI, Butler JM, Nakanishi E, Asano Y. Multiple Sclerosis Exacerbation Associated With High-Altitude Climbing Exposure. Mil Med 2019; 185:e1322-e1325. [DOI: 10.1093/milmed/usz421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The spectrum of the neurological effects of high-altitude exposure can range from high-altitude headache and acute mountain sickness, to the more severe end of the spectrum with high-altitude cerebral edema. In general, patients with known unstable preexisting neurological conditions and those patients with residual neurological deficits from a preexisting neurological condition are discouraged from climbing to high altitudes because of the risk of exacerbation or worsening of symptoms. Although multiple sclerosis exacerbations can be triggered by environmental factors, high-altitude exposure has not been reported as a potential trigger. We are reporting the case of a multiple sclerosis exacerbation presenting in an active duty U.S. Air Force serviceman upon ascending and descending Mt. Fuji within the same day.
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Affiliation(s)
- David T Hsieh
- Department of Pediatrics, 374th Medical Group, Yokota AB, Unit 5071, APO, AP 96328, Japan
- The Office of the Chief, manuscript writing and revision and provided Japanese translation capabilities Medical Staff, 374th Medical Group, Yokota AB, Unit 5071, APO, AP 96328, Japan
| | - Graham I Warden
- Radiology, 374th Medical Group, Yokota AB, Unit 5071, APO, AP 96328, Japan
| | - Jay M Butler
- Optometry, Department of Pediatrics, 374th Medical Group, Yokota AB, Unit 5071, APO, AP 96328, Japan
| | - Erika Nakanishi
- The Office of the Chief, manuscript writing and revision and provided Japanese translation capabilities Medical Staff, 374th Medical Group, Yokota AB, Unit 5071, APO, AP 96328, Japan
| | - Yuri Asano
- Department of Neurology, patient and contributed to the writing and revision of the manuscript, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashi dai Fuchu-City, Tokyo 183-0042, Japan
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23
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Karnoe A, Pedersen LM, Karlsen S, Boesen F, Skovgaard L, Kayser L. How people with multiple sclerosis experience the influence of nutrition and lifestyle factors on the disease. Disabil Rehabil 2019; 42:3504-3515. [PMID: 31017025 DOI: 10.1080/09638288.2019.1602675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: Increasing knowledge suggests that nutrition and lifestyle factors affect multiple sclerosis. This study explores how people with multiple sclerosis experience daily multiple sclerosis disease activity and the influence of nutrition and lifestyle factors (e.g., stress, sleep, and environmental temperature).Methods: Four phases mix qualitative and quantitative elements in an exploratory study. The initial two phases consisted of an exploratory study with 14 participants followed by 15 semi-structured interviews. Results from the two first phases were substantiated in a survey completed by 425 respondents (response rate: 42.5%). Finally, findings and inconsistencies were elaborated in three focus group interviews.Results: In the initial exploratory study, several of the participants linked nutrition and lifestyle factors to disease activity. Results from the semi-structured interviews showed that particularly stress, meat, fatty foods, and processed sugar were perceived to have a negative impact on disease activity, and some participants had experienced immediate effects of these factors on their disease activity. The survey supported these findings that were further elaborated in focus groups.Conclusion: People with multiple sclerosis perceive nutrition and lifestyle to affect daily disease activity. Individuals who have experienced links between their multiple sclerosis, and nutrition and lifestyle attribute some of these changes to e.g., stress, and the consumption of sugar, meat, and fatty food.Implications for rehabilitationA majority of the participants in this study perceived nutrition and lifestyle factors to have an effect on their multiple sclerosis, particularly stress, meat, fatty foods, and processed sugar.Some participants with multiple sclerosis experienced that nutrition, stress, environmental temperature, and physical activity had a direct effect on the severity of daily symptom manifestations.Nutrition and lifestyle factors that potentially influence multiple sclerosis disease activity should be considered when organizing rehabilitation and care to better meet the needs of the individual with multiple sclerosis.
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Affiliation(s)
- Astrid Karnoe
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Section of Research and Development, Danish Multiple Sclerosis Society Valby, Denmark
| | - Lise M Pedersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sashia Karlsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Finn Boesen
- Danish Multiple Sclerosis Hospital, Haslev, Denmark
| | - Lasse Skovgaard
- Section of Research and Development, Danish Multiple Sclerosis Society Valby, Denmark
| | - Lars Kayser
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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24
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Young HJ, Mehta TS, Herman C, Wang F, Rimmer JH. The Effects of M2M and Adapted Yoga on Physical and Psychosocial Outcomes in People With Multiple Sclerosis. Arch Phys Med Rehabil 2019; 100:391-400. [DOI: 10.1016/j.apmr.2018.06.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/15/2018] [Accepted: 06/25/2018] [Indexed: 11/29/2022]
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25
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Kaltsatou A, Flouris AD. Impact of pre-cooling therapy on the physical performance and functional capacity of multiple sclerosis patients: A systematic review. Mult Scler Relat Disord 2018; 27:419-423. [PMID: 30544086 DOI: 10.1016/j.msard.2018.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 10/04/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
Patients with multiple sclerosis experience many complications that gradually lead them to comorbidity and disability. Exercise could prevent and ameliorate the symptoms that comorbidity or inactivity generate. However, until recently it was suggested that multiple sclerosis patients should not participate in exercise training programs because these patients are characterized by thermoregulatory failure and the heat stress due to physical work could exacerbate the disease symptoms. Furthermore, taken into account that 60-80% of the multiple sclerosis patients present adverse clinical symptoms when their body temperature is increased (not only due to physical working but even when immerse in hot water or by exposure to infrared lamps or to the sun), the need for the development of treatment strategies to overcome the thermoregulatory problem in these patients is crucial. Given that pre-cooling has been proposed as an effective method, the aim of this systematic review is to discuss the current knowledge for the effects of cooling therapy on the functional capacity of multiple sclerosis patients. The relevant literature includes many articles, but only a handful of studies published thus far have used a cooling intervention in multiple sclerosis patients and have examined the effects of pre-cooling on functional capacity. These studies used active cooling methods, namely garments or other material that are cooled by circulating liquid through a tube, as well as passive, cooling methods. Passive cooling methods include passive cooling garments or other material namely garments that have ice or gel packs inside them. Overall, the results of all the studies analysed in this review demonstrated that pre-cooling therapy can prevent the symptom worsening due to increased body temperature in multiple sclerosis patients without causing adverse effects. Therefore, such strategies could serve as a complimentary therapeutic approach in multiple sclerosis patients.
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Affiliation(s)
- Antonia Kaltsatou
- FAME Laboratory, Department of Exercise Science, University of Thessaly, Trikala, Karies 42100, Greece
| | - Andreas D Flouris
- FAME Laboratory, Department of Exercise Science, University of Thessaly, Trikala, Karies 42100, Greece.
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26
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Davis SL, Jay O, Wilson TE. Thermoregulatory dysfunction in multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2018; 157:701-714. [PMID: 30459034 DOI: 10.1016/b978-0-444-64074-1.00042-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Multiple sclerosis (MS) is a progressive neurologic disorder that disrupts axonal myelin in the central nervous system. Demyelination produces alterations in saltatory conduction, slowed conduction velocity, and a predisposition to conduction block. An estimated 60-80% of MS patients experience temporary worsening of clinical signs and neurologic symptoms with heat exposure (Uhthoff's phenomenon). This heat intolerance in MS is related to the detrimental effects of increased temperature on action potential propagation in demyelinated axons, resulting in conduction slowing and/or block. Additionally, MS may produce impaired neural control of autonomic and endocrine functions. Isolating and interpreting mechanisms responsible for autonomic dysfunction due to MS can be difficult as it may involve sensory impairments, altered neural integration within the central nervous system, impaired effector responses, or combinations of all of these factors. MS lesions occur in areas of the brain responsible for the control and regulation of body temperature and thermoregulatory effector responses, resulting in impaired neural control of sudomotor pathways or neural-induced changes in eccrine sweat glands, as evidenced by observations of reduced sweating responses in MS patients. Although not comprehensive, some evidence exists concerning treatments (cooling, precooling, and pharmacologic) for the MS patient to preserve function and decrease symptom worsening during heat stress. This review focuses on four main themes influencing current understanding of thermoregulatory dysfunction in MS: (1) heat intolerance; (2) central regulation of body temperature; (3) thermoregulatory effector responses; and (4) countermeasures to improve or maintain function during thermal stress.
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Affiliation(s)
- Scott L Davis
- Department of Applied Physiology and Wellness, Southern Methodist University, Dallas, TX, United States.
| | - Ollie Jay
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Thad E Wilson
- Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, IN, United States
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27
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Smets I, Van Deun L, Bohyn C, van Pesch V, Vanopdenbosch L, Dive D, Bissay V, Dubois B. Corticosteroids in the management of acute multiple sclerosis exacerbations. Acta Neurol Belg 2017; 117:623-633. [PMID: 28391390 DOI: 10.1007/s13760-017-0772-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/12/2017] [Indexed: 11/29/2022]
Abstract
Multiple sclerosis (MS) is an autoimmune, inflammatory demyelinating disease of the central nervous system characterized in the majority of the patients by a relapsing-remitting disease course. For decades high-dosage corticosteroids (CS) are considered the cornerstone in the management of acute MS relapses. However, many unanswered questions remain when it comes to the exact modalities of CS administration. In this review on behalf of the Belgian Study Group for MS we define the efficacy of CS in reducing MS-related morbidity and examine whether the effect is different according to type of CS, route of administration, cumulative dosage, timing of initiation and disease course. We also review the use of CS in combination with other MS treatments and during pregnancy and lactation. Furthermore, we delineate the relevant adverse events due to a pulse CS regimen and present a decision tree that can be used when treating MS relapses in clinical practice.
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Affiliation(s)
- I Smets
- Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.
| | - L Van Deun
- Department of Neurology, University Hospitals Brussels, Laarbeeklaan 101, Jette, Belgium
| | - C Bohyn
- Department of Radiology, University Hospitals Leuven, Herestraat 49, Louvain, Belgium
| | - V van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, Hippokrateslaan 10, Sint-Lambrechts-Woluwe, Belgium
| | - L Vanopdenbosch
- Department of Neurology, Hospital AZ Sint-Jan, Ruddershove 10, Brugge, Belgium
| | - D Dive
- Neuroimmunological and Rehabilitation Unit, University Hospitals Liège, Avenue de L'Hòpital 1, Liège, Belgium
| | - V Bissay
- Department of Neurology, University Hospitals Brussels, Laarbeeklaan 101, Jette, Belgium
| | - B Dubois
- Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
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28
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Bradshaw MJ, Farrow S, Motl RW, Chitnis T. Wearable biosensors to monitor disability in multiple sclerosis. Neurol Clin Pract 2017; 7:354-362. [PMID: 29185551 DOI: 10.1212/cpj.0000000000000382] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/24/2017] [Indexed: 12/15/2022]
Abstract
Purpose of review Biosensors capable of measuring physiologic and kinetic parameters associated with disability are being applied to the study of people with multiple sclerosis (MS). We review the use of biosensors in people with MS with an emphasis on measuring/monitoring disability and understanding knowledge gaps between biosensor data and clinical care. Recent findings Accelerometers are available to the public and may be able to help the clinician understand a patient's degree of disability. Further studies with wearable biosensors capable of measuring other physiologic features, such as vital signs, are needed and are likely to contribute to our understanding of MS. Summary Wearable biosensors can improve our understanding of disability, response to treatment, and natural history of MS.
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Affiliation(s)
- Michael J Bradshaw
- Department of Neurology (MJB), Vanderbilt University Medical Center, Nashville, TN; Wentworth Biotechnology (SF), NC; Department of Physical Therapy (RWM), University of Alabama at Birmingham; and Partners Multiple Sclerosis Center (TC, MJB, SF, TC), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Samantha Farrow
- Department of Neurology (MJB), Vanderbilt University Medical Center, Nashville, TN; Wentworth Biotechnology (SF), NC; Department of Physical Therapy (RWM), University of Alabama at Birmingham; and Partners Multiple Sclerosis Center (TC, MJB, SF, TC), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Robert W Motl
- Department of Neurology (MJB), Vanderbilt University Medical Center, Nashville, TN; Wentworth Biotechnology (SF), NC; Department of Physical Therapy (RWM), University of Alabama at Birmingham; and Partners Multiple Sclerosis Center (TC, MJB, SF, TC), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Tanuja Chitnis
- Department of Neurology (MJB), Vanderbilt University Medical Center, Nashville, TN; Wentworth Biotechnology (SF), NC; Department of Physical Therapy (RWM), University of Alabama at Birmingham; and Partners Multiple Sclerosis Center (TC, MJB, SF, TC), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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29
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Gonzales B, Chopard G, Charry B, Berger E, Tripard J, Magnin E, Groslambert A. Effects of a Training Program Involving Body Cooling on Physical and Cognitive Capacities and Quality of Life in Multiple Sclerosis Patients: A Pilot Study. Eur Neurol 2017; 78:71-77. [DOI: 10.1159/000477580] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/18/2017] [Indexed: 12/20/2022]
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30
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Stellmann JP, Young KL, Vettorazzi E, Pöttgen J, Heesen C. No relevant impact of ambient temperature on disability measurements in a large cohort of patients with multiple sclerosis. Eur J Neurol 2017; 24:851-857. [PMID: 28544407 DOI: 10.1111/ene.13301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/23/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Many patients with multiple sclerosis (MS) report a worsening of symptoms due to high ambient temperatures, but objective data about this association are rare and contradictory. The aim of this study was to investigate the influence of ambient temperature on standard clinical tests. METHODS We extracted the Symbol Digit Modality Test, Nine Hole Peg Test, Timed 25 Foot Walk (T25FW), Timed Tandem Walk, Expanded Disability Status Scale (EDSS) and quality-of-life items on cognition, fatigue and depression from our clinical database and matched them to historical temperatures. We used linear mixed-effect models to investigate the association between temperature and outcomes. RESULTS A total of 1254 patients with MS (mean age, 42.7 years; 69.9% females; 52.1% relapsing-remitting MS, mean EDSS, 3.8) had 5751 assessments between 1996 and 2012. We observed a worsening in the T25FW with higher ambient temperatures in moderately disabled patients (EDSS ≥ 4) but not in less disabled patients. However, an increase of 10°C prolonged the T25FW by just 0.4 s. Other outcomes were not associated with ambient temperatures. CONCLUSIONS Higher ambient temperature might compromise walking capabilities in patients with MS with a manifest walking impairment. However, effects are small and not detectable in mildly disabled patients. Hand function, cognition, mood and fatigue do not appear to be correlated with ambient temperature.
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Affiliation(s)
- J-P Stellmann
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - K L Young
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - E Vettorazzi
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - J Pöttgen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - C Heesen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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31
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Allen DR, Huang M, Parupia IM, Dubelko AR, Frohman EM, Davis SL. Impaired sweating responses to a passive whole body heat stress in individuals with multiple sclerosis. J Neurophysiol 2017; 118:7-14. [PMID: 28275061 DOI: 10.1152/jn.00897.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/02/2017] [Accepted: 03/07/2017] [Indexed: 01/11/2023] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system (CNS), disrupting autonomic function. The aim of this study was to test the hypothesis that individuals with MS have blunted control of thermoregulatory reflex increases in sweat rate (SR) and cutaneous vasodilation compared with controls during a passive whole body heat stress (WBH). Eighteen individuals with relapsing-remitting MS and 18 healthy controls (Con) participated in the study. Core temperature (Tcore), skin temperature, heart rate, arterial blood pressure (10-min intervals), skin blood flow (laser-Doppler flux, LDF), and SR were continuously measured during normothermic baseline (34°C water perfusing a tube-lined suit) and WBH (increased Tcore 0.8°C via 48°C water perfusing the suit). Following WBH, local heaters were warmed to 42°C, inducing peak cutaneous vasodilation at the site of LDF collection. Cutaneous vascular conductance (CVC) was calculated as the ratio of LDF to mean arterial pressure and expressed as a percentage of peak achieved during local heating. Individuals with MS had attenuated SR responses to WBH (ΔSR from baseline: Con, 0.65 ± 0.27; MS, 0.42 ± 0.17 mg·cm-2·min-1, P = 0.003), whereas Δ%CVC42C from baseline was similar between groups (Con, 42 ± 16%; MS, 38 ± 12%, P = 0.39). SR responses were blunted as a function of Tcore in MS (interaction: group × Tcore, P = 0.03), of which differences were evident at ΔTcore 0.7°C and 0.8°C (P < 0.05). No interaction was observed in Δ%CVC42C Taken together, the findings show MS blunts sweating responses, whereas control of the cutaneous vasculature is preserved, in response to WBH.NEW & NOTEWORTHY This study is the first to assess the reflex control of the thermoregulatory system in individuals living with multiple sclerosis (MS). The novel findings are twofold. First, attenuated increases in sweat rate in subjects with MS compared with healthy controls were observed in response to a moderate increase (0.8°C) in core temperature via passive whole body heat stress. Second, it appears the reflex control of the cutaneous vasculature is preserved in MS.
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Affiliation(s)
- Dustin R Allen
- Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, Texas; and
| | - Mu Huang
- Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, Texas; and
| | - Iqra M Parupia
- Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, Texas; and
| | - Ariana R Dubelko
- Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, Texas; and
| | - Elliot M Frohman
- Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Scott L Davis
- Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, Texas; and .,Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
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32
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Poh PYS, Adams AN, Huang M, Allen DR, Davis SL, Tseng AS, Crandall CG. Increased postural sway in persons with multiple sclerosis during short-term exposure to warm ambient temperatures. Gait Posture 2017; 53:230-235. [PMID: 28222370 DOI: 10.1016/j.gaitpost.2017.01.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/12/2017] [Accepted: 01/31/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a neurological disease marked by demyelination and axonal loss. Individuals with MS experience increases in clinical signs and symptoms during heat exposure. OBJECTIVE To test the hypothesis that moderate heat exposure adversely affects postural sway in individuals with MS. METHODS Ten individuals with relapsing-remitting MS (50±8y) and nine controls (47±10y) were examined under a Thermal and a Time Control trial. Following a 30min thermoneutral baseline (25°C, 30% relative humidity (RH)), stand tests randomized with eyes open and closed, were performed. For Thermal, subjects were first exposed to 60min of heating (40°C, 30%RH) followed by 60min of cooling (20°C, 30%RH). For Time Control, subjects remained in a thermoneutral environment throughout. Stand tests were repeated at consistent times in both trials. RESULTS No difference in skin and core temperatures between groups were observed for any trial (P>0.05). During heating, postural sway was higher in MS relative to control subjects (eyes open, P=0.03; eyes closed, P=0.011). No differences in postural sway, regardless of eye status, were observed during the Time Control trial for either group (P>0.05). CONCLUSION These data demonstrate that exposure to a moderate heating environment increases postural sway in patients with MS.
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Affiliation(s)
- Paula Y S Poh
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and UT Southwestern Medical Center, Dallas, TX, USA
| | - Amy N Adams
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and UT Southwestern Medical Center, Dallas, TX, USA
| | - Mu Huang
- Department of Applied Physiology and Wellness, Southern Methodist University, Dallas, TX, USA
| | - Dustin R Allen
- Department of Applied Physiology and Wellness, Southern Methodist University, Dallas, TX, USA
| | - Scott L Davis
- Department of Applied Physiology and Wellness, Southern Methodist University, Dallas, TX, USA
| | - Anna S Tseng
- Neurology Consultants of Dallas, Texas Health Presbyterian Hospital, Dallas, TX, USA
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and UT Southwestern Medical Center, Dallas, TX, USA.
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33
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Sun H. Temperature dependence of multiple sclerosis mortality rates in the United States. Mult Scler 2017; 23:1839-1846. [DOI: 10.1177/1352458516688954] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: It is well known that multiple sclerosis (MS) patients are very sensitive to heat events. However, how MS patients respond to the significant temperature difference between the high- and low-latitude regions is not understood. Objective: The goal is to identify the primary factor responsible for the fact that MS mortality rates of the United States is more than three times higher in the northern states than in the southern states. Methods: Correlation coefficients between the age-adjusted mortality rate of MS as the underlying cause of death and the state average temperature, altitude, latitude, duration of sunshine hours, and solar radiation in the 48 contiguous states were compared. Results: MS mortality rates correlate significantly and inversely with temperatures in the 48 states (correlation coefficient r = −0.812 and significance p = 0.00). Durations of sunshine hours and solar radiation do not correlate significantly with MS mortality rates ( r = −0.245, −0.14, and p = 0.101, 0.342, respectively). Conclusion: High environmental temperature is the primary reason for the low MS mortality rates and likely the low MS prevalence in low-latitude regions. Implication of the study result is that benefits of long-term heat acclimation through gradual and prolonged exposure to environmental heat for MS patients may be greatly underappreciated.
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Affiliation(s)
- Hongbing Sun
- Center for Healthcare Studies, GEMS Department, Rider University, Lawrenceville, NJ, USA
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34
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Denton A, Bunn L, Hough A, Bugmann G, Marsden J. Superficial warming and cooling of the leg affects walking speed and neuromuscular impairments in people with spastic paraparesis. Ann Phys Rehabil Med 2016; 59:326-332. [DOI: 10.1016/j.rehab.2016.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 12/11/2022]
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35
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Wilshire CE, Ward T. Psychogenic Explanations of Physical Illness. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2016; 11:606-631. [DOI: 10.1177/1745691616645540] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In some patients with chronic physical complaints, detailed examination fails to reveal a well-recognized underlying disease process. In this situation, the physician may suspect a psychological cause. In this review, we critically evaluated the evidence for this causal claim, focusing on complaints presenting as neurological disorders. There were four main conclusions. First, patients with these complaints frequently exhibit psychopathology but not consistently more often than patients with a comparable “organic” diagnosis, so a causal role cannot be inferred. Second, these patients report a high incidence of adverse life experiences, but again, there is insufficient evidence to indicate a causal role for any particular type of experience. Third, although psychogenic illnesses are believed to be more responsive to psychological interventions than comparable “organic” illnesses, there is currently no evidence to support this claim. Finally, recent evidence suggests that biological and physical factors play a much greater causal role in these illnesses than previously believed. We conclude that there is currently little evidential support for psychogenic theories of illness in the neurological domain. In future research, researchers need to take a wider view concerning the etiology of these illnesses.
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36
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Cianfrone G, Turchetta R, Mazzei F, Bartolo M, Parisi L. Temperature-Dependent Auditory Neuropathy: Is it an Acoustic Uhthoff-like Phenomenon?; A Case Report. Ann Otol Rhinol Laryngol 2016; 115:518-27. [PMID: 16900806 DOI: 10.1177/000348940611500706] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: We describe the case of a young girl in whom transient deafness occurred when her core body temperature rose. Methods: The patient was referred for a series of audiological and neurologic evaluations performed over time in both afebrile and febrile states, as well as after a stress test (with a treadmill) in which the body temperature rise simulated the febrile state. Results: The patient was found to have a temporary bilateral hearing loss, but had normal distortion product otoacoustic emissions. Moreover, auditory brain stem responses revealed the absence of neural synchrony when her core body temperature increased. Conclusions: These results are consistent with a temperature-dependent auditory neuropathy, a rare condition in which patients show normal outer hair cell function and abnormal neural function of the eighth cranial nerve. The symptom is reminiscent of Uhthoff's phenomenon, which is described as transient visual loss and is usually observed in multiple sclerosis. This case of temperature-dependent auditory neuropathy is noteworthy because it sheds light on a disorder of which there have been few reports in the literature. We discuss its similarity to Uhthoff's phenomenon.
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Affiliation(s)
- Giancarlo Cianfrone
- Department of Otorhinolaryngology, Audiology and Phoniatrics "Giorgio Ferreri", University of Rome La Sapienza, v.le del Policlinico 155, 00185 Rome, Italy
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37
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Backus D. Increasing Physical Activity and Participation in People With Multiple Sclerosis: A Review. Arch Phys Med Rehabil 2016; 97:S210-7. [PMID: 27211007 DOI: 10.1016/j.apmr.2015.09.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 08/14/2015] [Accepted: 09/10/2015] [Indexed: 11/29/2022]
Abstract
Multiple sclerosis (MS) is a chronic progressive disease of the central nervous system (CNS) affecting >2.5 million people worldwide. Damage to neurons in the CNS causes various sensorimotor and cognitive symptoms, such as fatigue, pain, spasticity, memory deficits, and impairment of mobility. Until the late 1990s, it was believed that symptoms of MS would be worsened with physical exertion and people with MS were encouraged to limit physical activity and exertion. Not only has emerging evidence suggested that physical activity, including exercise, is safe for people with MS, there is also evidence that at least some of the disability that occurs after MS is due to secondary deconditioning from the sedentary lifestyle adopted because of the symptoms of MS, not just CNS damage alone. Therefore, not only is physical activity safe, it is also required for maintaining function and health in people with MS. The purpose of this article is to review the unique physical and social barriers to physical activity in people with MS, including those with moderate to severe disability who use a wheelchair or scooter for mobility. We will discuss how existing guidelines for physical activity may not meet the needs of people with MS and present evidence-based considerations for promoting physical activity in people with MS. Ultimately, the goal is to overcome the barriers to physical activity and improve health, participation, and quality of life in people with MS.
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Affiliation(s)
- Deborah Backus
- Crawford Research Institute, Shepherd Center, Atlanta, GA.
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Effects of Intermittent Versus Continuous Walking on Distance Walked and Fatigue in Persons With Multiple Sclerosis: A Randomized Crossover Trial. J Neurol Phys Ther 2016; 39:172-8. [PMID: 26050076 DOI: 10.1097/npt.0000000000000091] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE Fatigue is a common, disabling symptom experienced by persons with multiple sclerosis (MS). Evidence shows that intermittent exercise is associated in improved performance and negligible fatigue. The purpose of this study was to examine whether subjects with MS walk greater distances with less fatigue under intermittent (INT) or continuous (CONT) walking condition. METHODS Twenty-seven subjects with MS (median Extended Disability Severity Scale 3.5, interquartile range 1.6) walked in the CONT (ie, 6 uninterrupted minutes) and INT (ie, three 2-minute walking bouts) conditions in a randomized crossover. Distance was measured for the entire 6-minute walking period and each 2-minute increment. Fatigue was measured as the difference in a visual analog scale of fatigue (ΔVAS-F) immediately preceding and following each trial. RESULTS Participants walked greater distances in the INT condition compared to the CONT condition (P = 0.005). There was a significant interaction of walking condition and time (P < 0.001), indicating that the distances walked in the INT condition changed across time. ΔVAS-F was significantly lower in the INT condition than in the CONT condition (P = 0.036). DISCUSSION AND CONCLUSION Subjects with MS walked farther, and with less fatigue, when walking intermittently rather than continuously. Persons with MS may be able to tolerate a greater dose of walking training if the walking bouts are intermittent. Further study to determine the benefits of a walking exercise program using intermittent walking is recommended.Video Abstract available for additional insights from the authors (Supplemental Digital Content 1, http://links.lww.com/JNPT/A103).
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Pintér A, Cseh D, Sárközi A, Illigens BM, Siepmann T. Autonomic Dysregulation in Multiple Sclerosis. Int J Mol Sci 2015; 16:16920-52. [PMID: 26213927 PMCID: PMC4581177 DOI: 10.3390/ijms160816920] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 07/13/2015] [Accepted: 07/20/2015] [Indexed: 02/07/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic, progressive central neurological disease characterized by inflammation and demyelination. In patients with MS, dysregulation of the autonomic nervous system may present with various clinical symptoms including sweating abnormalities, urinary dysfunction, orthostatic dysregulation, gastrointestinal symptoms, and sexual dysfunction. These autonomic disturbances reduce the quality of life of affected patients and constitute a clinical challenge to the physician due to variability of clinical presentation and inconsistent data on diagnosis and treatment. Early diagnosis and initiation of individualized interdisciplinary and multimodal strategies is beneficial in the management of autonomic dysfunction in MS. This review summarizes the current literature on the most prevalent aspects of autonomic dysfunction in MS and provides reference to underlying pathophysiological mechanisms as well as means of diagnosis and treatment.
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Affiliation(s)
- Alexandra Pintér
- Institute of Human Physiology and Clinical Experimental Research, Faculty of Medicine, Semmelweis University, Budapest 1085, Hungary.
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden 01067, Germany.
| | - Domonkos Cseh
- Institute of Human Physiology and Clinical Experimental Research, Faculty of Medicine, Semmelweis University, Budapest 1085, Hungary.
| | - Adrienn Sárközi
- Institute of Human Physiology and Clinical Experimental Research, Faculty of Medicine, Semmelweis University, Budapest 1085, Hungary.
| | - Ben M Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Timo Siepmann
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden 01067, Germany.
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany.
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany.
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Moradi M, Sahraian MA, Aghsaie A, Kordi MR, Meysamie A, Abolhasani M, Sobhani V. Effects of Eight-week Resistance Training Program in Men With Multiple Sclerosis. Asian J Sports Med 2015; 6:e22838. [PMID: 26448834 PMCID: PMC4592758 DOI: 10.5812/asjsm.6(2)2015.22838] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 11/08/2014] [Accepted: 11/20/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Muscle weakness and fatigue contribute to the reduction of daily activity in multiple sclerosis (MS) patients. Therapeutic strategies to promote improvements in muscle strength and endurance are limited in individuals with MS. Some evidence showed that exercise may improve and affect different aspects of the disease including quality of life, fatigue, motor and cognitive functions. OBJECTIVES To investigate the value of resistance training of moderate to high intensity on motor function, muscle strength, balance and perceived disability in male patients with multiple sclerosis compared to a control group. PATIENTS AND METHODS 20 male patients with MS (mean ± SD, age: 34.05 ± 7.8 y; Expanded Disability Status Scale (EDSS): 2.94 ± 1.5) were recruited and randomized either to the exercise (E) or control group (C). Group E participated in a three-time weekly individualized progressive resistance-training program (both upper and lower extremities) for eight weeks, while group C was advised not to change their physical activity habits. All initial measures (including EDSS, balance, muscle strength, and functional mobility) were re-evaluated at the end of the program. RESULTS Two patients of group E left the program. The other eight subjects completed the program with no MS-related exacerbations/complications. There was a significant change in 2 of 3 aspects of ambulatory function [Three minutes step test (P = 0.001), Timed Up and Go test (P = 0.009)], muscle strength (P = 0.000), and EDSS (P = 0.014). Comparing the two groups, we did not observe any significant change in "Balance" (P = 0.407). CONCLUSIONS The resistance training of moderate to high intensity was well-tolerated in MS patients and may be an effective intervention for improving muscle strength, functional ability and EDSS-based disease severity.
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Affiliation(s)
- Mahbubeh Moradi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IR Iran
- Department of Sports Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, IR Iran
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IR Iran
- Sina MS Research Center, Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Aida Aghsaie
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IR Iran
- Sina MS Research Center, Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Reza Kordi
- Department of Sports Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, IR Iran
| | - Alipasha Meysamie
- Department of Community and Preventive Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Maryam Abolhasani
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IR Iran
- Department of Sports Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Maryam Abolhasani, Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188630228, Fax: +98-2166348570, E-mail:
| | - Vahid Sobhani
- Exercise Physiology Research Center, Baqyatallah University of Medical Sciences, Tehran, IR Iran
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Nuzzo D, Picone P, Caruana L, Vasto S, Barera A, Caruso C, Di Carlo M. Inflammatory mediators as biomarkers in brain disorders. Inflammation 2015; 37:639-48. [PMID: 24292800 DOI: 10.1007/s10753-013-9780-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neurodegenerative diseases such as Alzheimer, Parkinson, amyotrophic lateral sclerosis, and Huntington are incurable and debilitating conditions that result in progressive death of the neurons. The definite diagnosis of a neurodegenerative disorder is disadvantaged by the difficulty in obtaining biopsies and thereby to validate the clinical diagnosis with pathological results. Biomarkers are valuable indicators for detecting different phases of a disease such as prevention, early onset, treatment, progression, and monitoring the effect of pharmacological responses to a therapeutic intervention. Inflammation occurs in neurodegenerative diseases, and identification and validation of molecules involved in this process could be a strategy for finding new biomarkers. The ideal inflammatory biomarker needs to be easily measurable, must be reproducible, not subject to wide variation in the population, and unaffected by external factors. Our review summarizes the most important inflammation biomarkers currently available, whose specificity could be utilized for identifying and monitoring distinctive phases of different neurodegenerative diseases.
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Affiliation(s)
- Domenico Nuzzo
- Institute of Biomedicine ed Molecular Immunology, National Research Council of Italy, Palermo, Italy
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Enriquez-Algeciras M, Bhattacharya SK, Serra HM. Deimination level and peptidyl arginine deiminase 2 expression are elevated in astrocytes with increased incubation temperature. J Neurosci Res 2015; 93:1388-98. [PMID: 25801379 DOI: 10.1002/jnr.23587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 02/20/2015] [Accepted: 02/26/2015] [Indexed: 11/10/2022]
Abstract
Astrocytes respond to environmental cues, including changes in temperatures. Increased deimination, observed in many progressive neurological diseases, is thought to be contributed by astrocytes. We determined the level of deimination and expression of peptidyl arginine deiminase 2 (PAD2) in isolated primary astrocytes in response to changes on either side (31°C and 41°C) of the optimal temperature (37°C). We investigated changes in the astrocytes by using a number of established markers and accounted for cell death with the CellTiter-Blue assay. We found increased expression of glial fibrillary acidic protein, ALDH1L1, and J1-31, resulting from increased incubation temperature and increased expression of TSP1, S100β, and AQP4, resulting from decreased incubation temperature vs. optimal temperature, suggesting activation of different biochemical pathways in astrocytes associated with different incubation temperatures. Mass spectrometric analyses support such trends. The PAD2 level was increased only as a result of increased incubation temperature with a commensurate increased level of deimination. Actin cytoskeleton and iso[4]LGE, a lipid peroxidase modification, also showed an increase with higher incubation temperature. Altogether, these results suggest that temperature, as an environmental cue, activates astrocytes in a different manner on either side of the optimal temperature and that increase in deimination is associated only with the higher temperature side of the spectrum.
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Affiliation(s)
- Mabel Enriquez-Algeciras
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida.,CIBICI, Department of Clinical Biochemistry, Faculty of Chemistry, National University of Córdoba, Córdoba, República Argentina
| | - Sanjoy K Bhattacharya
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Horacio M Serra
- CIBICI, Department of Clinical Biochemistry, Faculty of Chemistry, National University of Córdoba, Córdoba, República Argentina
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Agarwal N, Hanumunthadu D, Afrasiabi M, Malaguarnera G, Cordeiro MF. Clinical update in optic nerve disorders. EXPERT REVIEW OF OPHTHALMOLOGY 2015. [DOI: 10.1586/17469899.2015.1003544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Papandony M, Wesselingh R, Stark R. Uhthoff phenomenon in osmotic demyelination syndrome. Intern Med J 2014; 44:1144-5. [DOI: 10.1111/imj.12573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/25/2014] [Indexed: 11/30/2022]
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Abstract
Multiple sclerosis (MS) is the leading cause of neurological disability in young adults. Since the pathophysiology of MS is characterized by dissemination in space, as well as in time, the autonomic nervous system is inevitably damaged in the course of the disease in many patients and the proportion of affected patients increases with disease duration. Autonomic dysfunction (AD) in MS is explained by lesions in regions responsible for autonomic regulation such as nuclei in the periventricular region of fourth ventricle in the brainstem as well as medullar lesions. Reports about frequency of AD in MS patients vary notably between groups. Nevertheless its impact on quality of life is substantial but, unfortunately, often overlooked. The aim of this article is to present a concise review of various symptoms and signs of autonomic system dysfunction in MS.
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Affiliation(s)
- Ivan Adamec
- University Hospital Center Zagreb, Department of Neurology, Refferal Center for Demyelinating Diseases of the Central Nervous System, Zagreb, Croatia.
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Sethi S, Kapil S. Anesthetic management of a patient with multiple sclerosis undergoing cesarean section with low dose epidural bupivacaine. Saudi J Anaesth 2014; 8:402-5. [PMID: 25191198 PMCID: PMC4141396 DOI: 10.4103/1658-354x.136633] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 32-year-old Indian female 38 weeks pregnant, with a history of multiple sclerosis since 2008 was admitted in obstetric ward for safe confinement. She had a history of diminution of vision in both eyes and limb weakness, relapsing – remitting type with movement-induced muscle spasms, in all the four limbs. Her symptoms were usually diplopia, difficulty in vision and ataxic gait. Sh was then treated with methylprednisolone. She was on oral dimethyl fumarate trial, which was stopped at the beginning of pregnancy. Presently, she was completely asymptomatic. Epidural anesthesia with an indwelling catheter was administered with 15 ml of 0.25% bupivacaine in 5 ml increments. A total of 3 mg of epidural morphine was given for post-operative analgesia. The surgery evolved without any intercurrences and patient was discharged from the hospital 72 h after surgery without worsening of her symptoms. We report a safe anesthetic management of a patient with MS undergoing cesarean section with low dose epidural bupivacaine with the addition of morphine for post-operative analgesia.
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Affiliation(s)
- Sameer Sethi
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonia Kapil
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Park K, Tanaka K, Tanaka M. Uhthoff's phenomenon in multiple sclerosis and neuromyelitis optica. Eur Neurol 2014; 72:153-6. [PMID: 25195501 DOI: 10.1159/000361045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 03/03/2014] [Indexed: 11/19/2022]
Abstract
To evaluate and compare the incidence and clinical features of Uhthoff's phenomenon in Japanese patients with neuromyelitis optica (NMO) and those with multiple sclerosis (MS), we asked 135 consecutive patients with MS and an NMO-related disorder (NMOrd) whether they experienced worse neurological symptoms after an increase in body temperature. Responses were obtained from 54 MS and 37 NMOrd patients. Uhthoff's phenomenon was observed in 26 MS (48.1%) and 20 NMOrd patients (54.1%). Motor and sensory symptoms were more frequent than visual symptoms in both diseases. The incidence of Uhthoff's phenomenon was similar in MS and NMOrd.
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Affiliation(s)
- Kwiyoung Park
- Multiple Sclerosis Center, Utano National Hospital, Kyoto, Japan
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Comi G, Leocani L. Assessment, pathophysiology and treatment of fatigue in multiple sclerosis. Expert Rev Neurother 2014; 2:867-76. [DOI: 10.1586/14737175.2.6.867] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tallner A, Mäurer M, Pfeifer K. Multiple Sklerose und körperliche Aktivität. DER NERVENARZT 2013; 84:1238-44. [DOI: 10.1007/s00115-013-3838-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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