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Heat and cold sensitivity in Multiple Sclerosis: a patient-centred perspective on triggers, symptoms, and thermal resilience practices. Mult Scler Relat Disord 2022; 67:104075. [DOI: 10.1016/j.msard.2022.104075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/18/2022] [Accepted: 07/24/2022] [Indexed: 11/18/2022]
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Magalhaes S, Pugliatti M, Riise T, Myhr KM, Ciampi A, Bjornevik K, Wolfson C. Shedding light on the link between early life sun exposure and risk of multiple sclerosis: results from the EnvIMS Study. Int J Epidemiol 2020; 48:1073-1082. [PMID: 30561654 DOI: 10.1093/ije/dyy269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Lower levels of sun exposure in childhood have been suggested to be associated with increased risk of multiple sclerosis (MS). In this paper we extend previous work, using two novel analytical strategies. METHODS Data collected in the Environmental risk factors In MS (EnvIMS) study, a case-control study with MS cases and population-based controls from Canada, Italy and Norway, were used. Participants reported on sun exposure behaviours for 5-year age intervals from birth; we focused on the first three age intervals (≤15 years). We compared two life course epidemiology conceptual models, the critical period and the accumulation model. We also used latent class analysis to estimate MS risk for different latent sun exposure behaviour groups. RESULTS The analyses included 2251 cases and 4028 controls. The accumulation model was found to be the best model, which demonstrated a nearly 50% increased risk of MS comparing lowest reported summer sun exposure with highest [risk ratio (RR) = 1.47 (1.24, 1.74)]. The latent sun exposure behaviour group, characterized by low sun exposure during summer and winter and high sun protection use, had the highest risk of MS; a 76% increased risk as compared with the group with high sun exposure and low sun protection use [RR = 1.76 (1.27, 2.46)]. CONCLUSIONS Our analyses provide novel insights into the link between sun exposure and MS. We demonstrate that more time indoors during childhood and early adolescence is linked with MS risk, and that sun protection behaviours in those who spend most time indoors may play a key role in increasing risk.
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Affiliation(s)
- Sandra Magalhaes
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Sociology, University of New Brunswick, Fredericton, NB, Canada
| | - Maura Pugliatti
- Department of Medicine, McGill University, Montreal, QC, Canada.,Department of Biomedical and Surgical Sciences, Unit of Clinical Neurology, University of Ferrara, Ferrara, Italy
| | - Trond Riise
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,National Multiple Sclerosis Competence Centre, Haukeland University Hospital, Bergen, Norway
| | - Kjell-Morten Myhr
- National Multiple Sclerosis Competence Centre, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Antonio Ciampi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Kjetil Bjornevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christina Wolfson
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
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Menoux D, Chesnel C, Charlanes A, Hentzen C, Motavasseli D, Charoenwong F, Le Breton F, Amarenco G. [Reproducibility of bladder diary in patients with multiple sclerosis]. Prog Urol 2018; 28:387-395. [PMID: 29370967 DOI: 10.1016/j.purol.2018.01.001] [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: 04/25/2017] [Revised: 12/20/2017] [Accepted: 01/01/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a neurological condition characterized by variable levels of symptoms. This variability could also affect bladder dysfunction and impact on the reproducibility or stability of bladder diary (BD). The aim of the study is to investigate the reproducibility and reliability of BD in MS, and then determine its linked factors. METHODS The MS patient provided a 21 days BD and they documented the time of every void. The main criterion was assessed by voiding frequency, represented by the coefficient of variation (CV=average/standard deviation), expressed as a percentage. Two groups were described: stable BD group (CV≤15 %) and instable BD group (CV>15 %). Secondary criteria were completion of BD (complete or not) and the difference of voiding frequency variation between weekend and week. RESULTS Thirty-one patients were included (mean age 51.06 years, SD 11.33) with 65 % of women. Mean CV is 23 % (SD 0.11). The mean completion of BD was 19.35 days (SD 3.99). 8 patients had a CV≤15 %. Stable group was older than instable group (P=0.03). There was no other difference between the 2 groups. There is a strong correlation between mean voiding frequency weekend and week (ρ=0.94, P<0.05). The longer duration of BD, the less reliability is notified. CONCLUSION BD is not a stable reproducible in MS population. Both lack of compliance or variability of LUTS in MS may explain the unreliability of BD. However, BD utility should be discussed in this population. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- D Menoux
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - C Chesnel
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Charlanes
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Hentzen
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - D Motavasseli
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - F Charoenwong
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - F Le Breton
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - G Amarenco
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, UPMC université Paris 06, Sorbonne universités, AP-HP, 4, rue de la Chine, 75020 Paris, France
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Ysrraelit MC, Fiol MP, Gaitán MI, Correale J. Quality of Life Assessment in Multiple Sclerosis: Different Perception between Patients and Neurologists. Front Neurol 2018; 8:729. [PMID: 29375468 PMCID: PMC5769192 DOI: 10.3389/fneur.2017.00729] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/18/2017] [Indexed: 11/13/2022] Open
Abstract
Background In recent years, neurologists are noticing that evaluation of multiple sclerosis (MS) patients based on combining relapses, disability progression, and magnetic resonance imaging activity may be insufficient to adequately assess suboptimal responses to available therapy. Inclusion of quality of life (QoL) parameters may contribute to breach this gap. Objective To evaluate agreement levels between doctor and patient perception of QoL in MS. Methods A total of 700 MS patients and 300 neurologists were invited to participate in a cross-sectional study by answering an e-mail questionnaire. The survey collected information on demographical data and included the Short Form questionnaire (SF-36). After completing the questionnaire, patients were given a standard written description of each of the subdomains assessed by SF-36 and asked to identify which three were the most important determinants of their overall health-related QoL. Results A total of 135 neurologists and 380 MS patients responded the survey. Study population mean age was 42.1 ± 10.5 years, with 61% presenting relapsing-remitting MS. SF-36 results were physical function 68.4 ± 30, physical role limitation 56.8 ± 41.7, vitality 47.6 ± 21.4, pain 71.2 ± 26.1, social function 72.6 ± 28.6, emotional role limitation 63.2 ± 39.8, mental health 60 ± 14.1, and general health 55.8 ± 22. Doctors considered physical function (75%) and physical role limitation (70%) as the most important QoL determinants in MS, followed by emotional role limitation (52%). Patients however, assigned significantly different levels of importance to physical function (58%), and physical role limitation (46%) and considered vitality (52%) more important than their physicians (p < 0.001). Important to note, the results of SF-36 questionnaire were highly correlated with the perception gap between patients and neurologists (r = 0.89; p = 0.0004). Conclusion Concerns on QoL in MS are different for patients and physicians. It is essential to enhance communication in order to better understand actual patient needs.
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Affiliation(s)
- Maria C Ysrraelit
- Institute for Neurological Research Dr. Raúl Carrea, FLENI, Buenos Aires, Argentina
| | - Marcela P Fiol
- Institute for Neurological Research Dr. Raúl Carrea, FLENI, Buenos Aires, Argentina
| | - Maria I Gaitán
- Institute for Neurological Research Dr. Raúl Carrea, FLENI, Buenos Aires, Argentina
| | - Jorge Correale
- Institute for Neurological Research Dr. Raúl Carrea, FLENI, Buenos Aires, Argentina
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Romberg A, Ikonen A, Ruutiainen J, Virtanen A, Hämäläinen P. The effects of heat stress on physical functioning in persons with multiple sclerosis. J Neurol Sci 2012; 319:42-6. [DOI: 10.1016/j.jns.2012.05.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 05/04/2012] [Accepted: 05/09/2012] [Indexed: 01/21/2023]
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Mailhan L, Papeix C. [Non-medicinal treatments of spasticity in multiple sclerosis]. Rev Neurol (Paris) 2012; 168 Suppl 3:S57-61. [PMID: 22721366 DOI: 10.1016/s0035-3787(12)70048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Non-medicinal treatments of spasticity may be proposed in patients with multiple sclerosis as either an adjunct to pharmacological treatments or the first line of treatment. Assessment of non-medicinal treatments, whether manual, surgical or with instrumentation, shows it to be beneficial for limb spasticity. Studies also reveal that, contrary to expectations, physical exercise does not increase spasticity. This means that physical exercise may be prioritized and that sports practice should not be forbidden, provided that the patient has an adequate neurological status and takes sufficient breaks to avoid fatigue.
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Affiliation(s)
- L Mailhan
- Médecine Physique et de Réadaptation, Hôpital des Gardiens de la Paix, 35 Boulevard Saint-Marcel, 75013 Paris, France.
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Keeping cool: use of air conditioning by australians with multiple sclerosis. Mult Scler Int 2012; 2012:794310. [PMID: 22548176 PMCID: PMC3323861 DOI: 10.1155/2012/794310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 10/14/2011] [Indexed: 11/18/2022] Open
Abstract
Despite the known difficulties many people with MS have with high ambient temperatures, there are no reported studies of air conditioning use and MS. This study systematically examined air conditioner use by Australians with MS. A short survey was sent to all participants in the Australian MS Longitudinal Study cohort with a response rate of 76% (n = 2,385). Questions included hours of air-conditioner use, areas cooled, type and age of equipment, and the personal effects of overheating. Air conditioners were used by 81.9% of respondents, with an additional 9.6% who could not afford an air conditioner. Regional and seasonal variation in air conditioning use was reported, with a national annual mean of 1,557 hours running time. 90.7% reported negative effects from overheating including increased fatigue, an increase in other MS symptoms, reduced household and social activities, and reduced work capacity. Households that include people with MS spend between 4 and 12 times more on keeping cool than average Australian households.
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Demaille-Wlodyka S, Donze C, Givron P, Gallien P. Self care programs and multiple sclerosis: physical therapeutics treatment - literature review. Ann Phys Rehabil Med 2011; 54:109-28. [PMID: 21388907 DOI: 10.1016/j.rehab.2011.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 01/21/2011] [Accepted: 01/21/2011] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To clarify the therapeutic education program impact with multiple sclerosis patients, literature review. Highlight contents and efficacy. METHOD A non-systematic review on Medline, PubMed and Cochrane library databases from 1966 to 2010 using the following keywords: "multiple sclerosis", "self-care", "self-management" and specific symptoms keywords. Clinical trials and randomized clinical trials, as well as literature reviews published in English, French and German will be analyzed. RESULTS Counseling is a part of the non-pharmacological management of chronic illnesses such as multiple sclerosis. Symptoms' diversity and the different clinical forms limit standardized programs of self-care management, applicable to patients. In the literature review, counseling programs have often low metrology. A behavior change with patients and medical staff could exist. To empower the patient, to reduce symptoms' impact and to improve treatment access are the aims of educational therapy. CONCLUSION Therapeutic education program for multiple sclerosis patients could progress with their standardization and assessment, for each sign. To promote the educational therapy of multiple sclerosis patients, a specific training for medical staff, as specific financing are necessary.
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Affiliation(s)
- S Demaille-Wlodyka
- Groupe hospitalier de l'institut catholique lillois, 59000 Lille, France.
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Nilsagård Y, Denison E, Gunnarsson LG, Boström K. Factors perceived as being related to accidental falls by persons with multiple sclerosis. Disabil Rehabil 2009; 31:1301-10. [PMID: 19479575 DOI: 10.1080/09638280802532639] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This study explores and describes factors that persons with multiple sclerosis (MS) perceive as being related to accidental falls. METHOD A qualitative content analysis with primarily deductive approach was conducted using the International Classification of Functioning, Disability and Health. Twelve persons with MS, and identified as fallers, were interviewed. RESULTS Factors perceived to cause accidental falls that had not previously been targeted in MS populations in relation to falls were identified as divided attention, reduced muscular endurance, fatigue and heat sensitivity. Previously reported risk factors such as changed gait pattern, limited walking ability, impaired proprioception, vision and spasticity were supported. Activities involving walking, recreation and leisure, maintaining and changing body position, lifting or carrying, taking care of the home, washing the body, moving around, preparing meals and housekeeping were limited and considered to be risk activities. Supportive persons and assistive device reduced falls, and unsuitable physical environments and climate conditions induced falls. Several preventative strategies were described as partially compensating for the impairments, limitations and restrictions. CONCLUSIONS Investigating accidental falls using the perspective of the patient gave important information about variables not earlier targeted in MS research.
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Affiliation(s)
- Ylva Nilsagård
- Department of Physiotherapy, Orebro University Hospital, Orebro, Sweden.
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Nilsagård Y, Denison E, Gunnarsson LG. Evaluation of a single session with cooling garment for persons with multiple sclerosis – a randomized trial. Disabil Rehabil Assist Technol 2009; 1:225-33. [DOI: 10.1080/09638280500493696] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chatap G, De Sousa A, Giraud K, Vincent JP. Pain in the elderly: Prospective study of hyperbaric CO2 cryotherapy (neurocryostimulation). Joint Bone Spine 2007; 74:617-21. [PMID: 17897861 DOI: 10.1016/j.jbspin.2006.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 10/09/2006] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the analgesic effects of hyperbaric CO(2) cryotherapy in elderly inpatients. METHODS An open-label prospective study was conducted in two geriatrics departments in patients with a broad range of pain characteristics. Each patient underwent a physical evaluation followed by hyperbaric CO(2) cryotherapy sessions, whose spacing and number were at the discretion of the physiotherapist. Patients completed a 100-mm visual analog scale for pain severity before and after the sessions. RESULTS We included 51 patients, who were treated between May 2 and June 30, 2005. Mean age was 83.7years, and the female-to-male ratio was 4/1. The patients had acute or chronic pain whose origin was usually musculoskeletal (80.3%) or neurological (18.6%). Pain scores decreased significantly after four sessions, from 52mm to 13mm (P<0.001) in patients with acute pain and from 45mm to 13mm (P<0.001) in those with chronic pain. CONCLUSION Hyperbaric CO(2) cryotherapy is an innovative tool that should be incorporated within the non-pharmacological armamentarium for achieving pain relief in older patients.
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Affiliation(s)
- Guy Chatap
- Geriatrics Department 4, Emile Roux Hospital, Limeil-Brévannes 94450, France.
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Gallien P, Nicolas B, Robineau S, Pétrilli S, Houedakor J, Durufle A. Réentrainement à l'effort et sclérose en plaques. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.annrmp.2007.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gallien P, Nicolas B, Robineau S, Pétrilli S, Houedakor J, Durufle A. Physical training and multiple sclerosis. ACTA ACUST UNITED AC 2007; 50:373-6, 369-72. [PMID: 17482708 DOI: 10.1016/j.annrmp.2007.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 04/03/2007] [Indexed: 10/23/2022]
Abstract
For many years, patients with multiple sclerosis (MS) were advised to avoid exercise because of the risk of increased neurological impairment. This article reviews the literature related to MS and physical exercise. Physical exercise depends on patients' physiological tolerance and response to exercise. MS patients can exhibit dysfunction of cardiovascular adjustment accompanied by respiratory involvement, which can alter aerobic capacity. These abnormalities tend to increase with the neurological impairment. Muscle weakness is the consequence of not only altered central motor drive but also disuse. Several studies have shown the benefits of physical training, with improvements in aerobic capacity, gait parameters and fatigue, and an influence on quality of life. Regular aerobic physical activity is necessary to maintain the benefit of physical training.
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Affiliation(s)
- P Gallien
- Centre MPR, Notre-Dame-de-Lourdes, 54, rue Saint-Hélier, 35000 Rennes, France.
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Béthoux F. Fatigue and multiple sclerosis. ACTA ACUST UNITED AC 2006; 49:265-71, 355-60. [PMID: 16757056 DOI: 10.1016/j.annrmp.2006.04.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 04/03/2006] [Indexed: 11/28/2022]
Abstract
Even if the definition and pathophysiology of fatigue in multiple sclerosis (MS) are still debated, and despite the scarcity of objective markers correlated with the subjective sensation of fatigue, a review of the literature shows the importance of its detection and management, and allows one to propose therapeutic strategies. Fatigue is not only the most frequently reported symptom in MS, but also a frequent source of activity and participation limitations, psychological distress, and impairment of quality of life. Its management, which must be initiated early, is based on a comprehensive evaluation of its characteristics and consequences (sometimes with the use of scales such as the Fatigue Severity Scale and the Modified Fatigue Impact Scale), and on the identification of many potential contributing factors (psychological disorders, sleep disturbances, pain, infections and other comorbidities, medications, and deconditioning). Rehabilitative interventions are essential to the treatment of fatigue. Beyond the traditional energy conservation strategies and cooling techniques, several randomized controlled studies have demonstrated the positive impact of aerobic exercise. Medications are partially beneficial, and with the exception of amantadine, their efficacy has not been confirmed by randomized double-blind trials.
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Affiliation(s)
- F Béthoux
- The Mellen Center for Multiple Sclerosis Treatment and Research, the Cleveland clinic, 9500 Euclid avenue, Cleveland, OH 44195, USA.
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Kerdoncuff V, Durufle A, Le Tallec H, Lassalle A, Petrilli S, Nicolas B, Robineau S, Edan G, Gallien P. Activité sportive et sclérose en plaques. ACTA ACUST UNITED AC 2006; 49:32-6. [PMID: 16236378 DOI: 10.1016/j.annrmp.2005.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Accepted: 08/29/2005] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a neurological disease of the central nervous system that most often affects young people. It is characterized by various debilitating symptoms. The aim of this study was to assess physical activities in patients with MS and how these affect their quality of life. METHODS Forty-five patients were questioned about their physical activities. The following were taken into account: the characteristics of MS within each patient, the level of disease severity (EDSS score) and the quality of life (on the SEP-59 questionnaire). RESULTS Fifteen patients had to give up a physical activity because of their illness but more so due to ataxia, fatigue and muscular weakness. Fifteen patients take part in a physical activity, the principal motivation being for their personal well-being. The mean EDSS was 4.2. Answers on the SEP-59 revealed found that patients with MS who took part in a physical activity had significantly better well-being in general. DISCUSSION AND CONCLUSION Physical activities seem to improve the quality of life of patients with MS who, in general, already have a poor quality of life in relation to the general population. Knowing that muscular function is improved through exercise in patients with an EDSS less than 6, it would seem advantageous for them to take part in a regular physical activity.
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Affiliation(s)
- V Kerdoncuff
- Service de médecine physique et réadaptation, CHRU de Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
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