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Hamedani SG, Pourmasoumi M, Zarifi SH, Askari G, Jamialahmadi T, Bagherniya M, Sahebkar A. Therapeutic effects of saffron and its components on neurodegenerative diseases. Heliyon 2024; 10:e24334. [PMID: 38298664 PMCID: PMC10827773 DOI: 10.1016/j.heliyon.2024.e24334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 02/02/2024] Open
Abstract
Due to an increase in the number of older people in recent years, neurodegenerative diseases as the most important age-related neurological disorders are considered as a great threat to human health. The treatment strategies for these disorders are symptomatic and there is no known definitive treatment; however, recently, several studies have investigated the effectiveness of some herbs and their components in limiting the progression and treatment of neurodegenerative disorders. In this study, we searched Medline (via PubMed), Scopus, Science Direct, and Google Scholar databases. The keywords used in the search were: saffron [title/abstract] or (saffron compound [title/abstract]) and (neurological disorders [title/abstract]), publication date range (2010-2023), and language (English). After applying inclusion and exclusion criteria, 30 articles remained. Of the 30 articles included in the study, six studies on the treatment of neurodegenerative disorders by saffron and its components were in the clinical trial phase, and 24 studies were in the preclinical phase. Saffron and its compounds can play an important role in inhibiting neuroinflammation and excitotoxic pathways, modulating autophagy and apoptosis, attenuating oxidative damage, and activating defensive antioxidant enzymes, resulting in neuroprotection against neurodegenerative diseases. Therefore, this study aimed to review the studies on the effects of saffron and its compounds on the treatment of neurodegenerative diseases.
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Affiliation(s)
- Sahar Golpour- Hamedani
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of medical science, Iran
| | - Makan Pourmasoumi
- Gastrointestinal & Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Gholamreza Askari
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tannaz Jamialahmadi
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Bagherniya
- Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
- Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Hechenberger S, Helmlinger B, Penner IK, Pirpamer L, Fruhwirth V, Heschl B, Ropele S, Wurth S, Damulina A, Eppinger S, Demjaha R, Khalil M, Pinter D, Enzinger C. Psychological factors and brain magnetic resonance imaging metrics associated with fatigue in persons with multiple sclerosis. J Neurol Sci 2023; 454:120833. [PMID: 37866195 DOI: 10.1016/j.jns.2023.120833] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/11/2023] [Accepted: 10/08/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Besides demographics and clinical factors, psychological variables and brain-tissue changes have been associated with fatigue in persons with multiple sclerosis (pwMS). Identifying predictors of fatigue could help to improve therapeutic approaches for pwMS. Therefore, we investigated predictors of fatigue using a multifactorial approach. METHODS 136 pwMS and 49 normal controls (NC) underwent clinical, neuropsychological, and magnetic resonance imaging examinations. We assessed fatigue using the "Fatigue Scale for Motor and Cognitive Functions", yielding a total, motor, and cognitive fatigue score. We further analyzed global and subcortical brain volumes, white matter lesions and microstructural changes (examining fractional anisotropy; FA) along the cortico striatal thalamo cortical (CSTC) loop. Potential demographic, clinical, psychological, and magnetic resonance imaging predictors of total, motor, and cognitive fatigue were explored using multifactorial linear regression models. RESULTS 53% of pwMS and 20% of NC demonstrated fatigue. Besides demographics and clinical data, total fatigue in pwMS was predicted by higher levels of depression and reduced microstructural tissue integrity in the CSTC loop (adjusted R2 = 0.52, p < 0.001). More specifically, motor fatigue was predicted by lower education, female sex, higher physical disability, higher levels of depression, and self-efficacy (adjusted R2 = 0.54, p < 0.001). Cognitive fatigue was also predicted by higher levels of depression and lower self-efficacy, but in addition by FA reductions in the CSTC loop (adjusted R2 = 0.45, p < 0.001). CONCLUSIONS Our results indicate that depression and self-efficacy strongly predict fatigue in MS. Incremental variance in total and cognitive fatigue was explained by microstructural changes along the CSTC loop, beyond demographics, clinical, and psychological variables.
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Affiliation(s)
- Stefanie Hechenberger
- Medical University of Graz, Research Unit for Neuronal Plasticity and Repair, Graz, Austria; Medical University of Graz, Department of Neurology, Graz, Austria
| | - Birgit Helmlinger
- Medical University of Graz, Research Unit for Neuronal Plasticity and Repair, Graz, Austria; Medical University of Graz, Department of Neurology, Graz, Austria
| | - Iris-Katharina Penner
- Department of Neurology. Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Lukas Pirpamer
- Medical University of Graz, Department of Neurology, Graz, Austria; Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Viktoria Fruhwirth
- Medical University of Graz, Research Unit for Neuronal Plasticity and Repair, Graz, Austria; Medical University of Graz, Department of Neurology, Graz, Austria
| | - Bettina Heschl
- Medical University of Graz, Department of Neurology, Graz, Austria
| | - Stefan Ropele
- Medical University of Graz, Department of Neurology, Graz, Austria
| | - Sebastian Wurth
- Medical University of Graz, Department of Neurology, Graz, Austria
| | - Anna Damulina
- Medical University of Graz, Department of Neurology, Graz, Austria
| | - Sebastian Eppinger
- Medical University of Graz, Department of Neurology, Graz, Austria; Medical University of Graz, Division of Neuroradiology & Interventional Radiology, Department of Radiology, Graz, Austria
| | - Rina Demjaha
- Medical University of Graz, Department of Neurology, Graz, Austria; Medical University of Graz, Neurology Biomarker Research Unit, Graz, Austria
| | - Michael Khalil
- Medical University of Graz, Department of Neurology, Graz, Austria; Medical University of Graz, Neurology Biomarker Research Unit, Graz, Austria
| | - Daniela Pinter
- Medical University of Graz, Research Unit for Neuronal Plasticity and Repair, Graz, Austria; Medical University of Graz, Department of Neurology, Graz, Austria.
| | - Christian Enzinger
- Medical University of Graz, Research Unit for Neuronal Plasticity and Repair, Graz, Austria; Medical University of Graz, Department of Neurology, Graz, Austria
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Salter A. Severity and worsening of fatigue among individuals with multiple sclerosis. Mult Scler J Exp Transl Clin 2023; 9:20552173231167079. [PMID: 37101754 PMCID: PMC10123908 DOI: 10.1177/20552173231167079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/15/2023] [Indexed: 04/28/2023] Open
Abstract
Background Fatigue is associated with reduced quality of life and social participation, and poor employment outcomes. However, most studies examining fatigue are limited by small sample sizes or short follow-up periods. Objective To characterize the natural history of fatigue. Methods The North American Research Committee on Multiple Sclerosis Registry participants with ≥7 years of longitudinal data between 2004 and 2019 and a relapsing disease course were included. A subset of participants enrolled within 5 years of diagnosis was identified. The Fatigue Performance Scale assessed fatigue and ≥1-point increase in Fatigue Performance Scale sustained at the next survey defined fatigue worsening. Results Of 3057 participants with longitudinal data, 944 were within 5 years of multiple sclerosis diagnosis. Most participants (52%) reported fatigue worsening during follow-up. Median time to fatigue worsening ranged from 3.5 to 5 years at lower levels of index fatigue. Fatigue worsening was associated with lower annual income, increasing disability, lower initial fatigue level, taking injectable disease-modifying therapies and increasing depression levels in the relapsing multiple sclerosis participants. Conclusion Most multiple sclerosis participants early in their disease suffer from fatigue and at least half reported fatigue worsening over time. Understanding factors associated with fatigue may help to identify populations most at risk of fatigue worsening will be informative for the overall management of patients with multiple sclerosis.
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Affiliation(s)
- Amber Salter
- Amber Salter,
UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8806, USA.
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Javed AR, Khan HU, Alomari MKB, Sarwar MU, Asim M, Almadhor AS, Khan MZ. Toward explainable AI-empowered cognitive health assessment. Front Public Health 2023; 11:1024195. [PMID: 36969684 PMCID: PMC10033697 DOI: 10.3389/fpubh.2023.1024195] [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: 08/21/2022] [Accepted: 02/17/2023] [Indexed: 03/11/2023] Open
Abstract
Explainable artificial intelligence (XAI) is of paramount importance to various domains, including healthcare, fitness, skill assessment, and personal assistants, to understand and explain the decision-making process of the artificial intelligence (AI) model. Smart homes embedded with smart devices and sensors enabled many context-aware applications to recognize physical activities. This study presents XAI-HAR, a novel XAI-empowered human activity recognition (HAR) approach based on key features identified from the data collected from sensors located at different places in a smart home. XAI-HAR identifies a set of new features (i.e., the total number of sensors used in a specific activity), as physical key features selection (PKFS) based on weighting criteria. Next, it presents statistical key features selection (SKFS) (i.e., mean, standard deviation) to handle the outliers and higher class variance. The proposed XAI-HAR is evaluated using machine learning models, namely, random forest (RF), K-nearest neighbor (KNN), support vector machine (SVM), decision tree (DT), naive Bayes (NB) and deep learning models such as deep neural network (DNN), convolution neural network (CNN), and CNN-based long short-term memory (CNN-LSTM). Experiments demonstrate the superior performance of XAI-HAR using RF classifier over all other machine learning and deep learning models. For explainability, XAI-HAR uses Local Interpretable Model Agnostic (LIME) with an RF classifier. XAI-HAR achieves 0.96% of F-score for health and dementia classification and 0.95 and 0.97% for activity recognition of dementia and healthy individuals, respectively.
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Affiliation(s)
- Abdul Rehman Javed
- Department of Cyber Security, Air University, Islamabad, Pakistan
- Department of Electrical and Computer Engineering, Lebanese American University, Byblos, Lebanon
- *Correspondence: Abdul Rehman Javed
| | - Habib Ullah Khan
- Department of Accounting and Information Systems, College of Business and Economics, Qatar University, Doha, Qatar
| | - Mohammad Kamel Bader Alomari
- Department of Accounting and Information Systems, College of Business and Economics, Qatar University, Doha, Qatar
- Mohammad Kamel Bader Alomari
| | | | - Muhammad Asim
- Department of Cyber Security, National University of Computer and Emerging Science, Islamabad, Pakistan
| | - Ahmad S. Almadhor
- College of Computer and Information Sciences, Jouf University, Sakakah, Saudi Arabia
| | - Muhammad Zahid Khan
- Department of Computer Science & IT, University of Malakand, Chakdara, Pakistan
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Ghajarzadeh M, Roman S, Vega L, Nourbakhsh B. Low-dose ketamine infusion for the treatment of multiple sclerosis fatigue (INKLING-MS): Study protocol for a randomized, double-blind, active placebo-controlled phase II trial. Contemp Clin Trials 2023; 126:107106. [PMID: 36738917 DOI: 10.1016/j.cct.2023.107106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Fatigue is one of the most common symptoms of people with Multiple Sclerosis (MS). However, currently-used medications for the treatment of fatigue probably do not work better than a placebo. In a pilot trial, we showed that one infusion of low-dose ketamine significantly improved fatigue severity measured four weeks after the infusion. METHODS The proposed study is a single-center, phase II, randomized, double-blind, parallel-group, active-placebo-controlled trial of intravenous low-dose ketamine in patients with MS fatigue. Participants will be randomized 1:1:1 into three groups: receiving either one or two infusions of ketamine (0.5 mg/kg over 40 min) or zero to one infusion of the active placebo (midazolam, 0.05 mg/kg over 40 min). Eligibility criteria include adult patients diagnosed with MS based on the latest criteria, complaining of fatigue as one of the main symptoms, and having a screening MFIS score higher than a pre-specified threshold. RESULTS One hundred and ten participants will be randomized over 30 months at Johns Hopkins MS Center. Complete enrollment is expected by mid-2025. The study's primary outcome will be the MFIS score at the end of week 4, comparing two-thirds of the participants who received ketamine with one-third who received midazolam. The secondary and exploratory outcomes (measured four weeks after the second infusion) will show how long the effects of a single infusion last and if two infusions of ketamine are better than one in improving MS fatigue. CONCLUSION This study can show whether intervening in the glutamatergic pathways would improves MS fatigue.
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Affiliation(s)
- Mahsa Ghajarzadeh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Samantha Roman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lauren Vega
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bardia Nourbakhsh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Characterizing fatigue phenotypes with other symptoms and clinically relevant outcomes among people with multiple sclerosis. Qual Life Res 2023; 32:151-160. [PMID: 35982203 DOI: 10.1007/s11136-022-03204-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Fatigue is a common symptom of multiple sclerosis (MS) and can adversely affect all aspect of quality of life. The etiology of fatigue remains unclear, and its treatments are suboptimal. Characterizing the phenotypes of fatigued persons with MS may help advance research on fatigue's etiology and identify ways to personalize fatigue interventions to improve quality of life. The purpose of this study was to identify fatigue phenotypes; examine phenotype stability overtime; and characterize phenotypes by health and function, social and environmental determinants, psychosocial factors, and engagement in healthy behaviors. METHODS We conducted a longitudinal study over a 3-month period with 289 fatigued participants with MS. To identify fatigue phenotypes and determine transition probabilities, we used latent profile and transition analyses with valid self-report measures of mental and physical fatigue severity, the mental and physical impact of fatigue, depression, anxiety, and sleep quality. We used ANOVAs and effect sizes to characterize differences among phenotypes. RESULTS The best fitting model included six subgroups of participants: Mild Phenotype, Mild-to-Moderate Phenotype, Moderate-to-Severe Phenotype, Severe Phenotype, Fatigue-dominant Phenotype, and Mental Health-dominant Phenotype. The transition analysis indicated that phenotypic membership was highly stable. Variables with a large eta squared effect size included environmental barriers, self-efficacy, and fatigue catastrophizing. CONCLUSION These results indicate that the magnitude of fatigue experienced may be more important to consider than the type of fatigue when characterizing fatigue phenotypes. Future research should explore whether tailoring interventions to environmental barriers, self-efficacy, and fatigue catastrophizing reduce the likelihood of transitioning to a more severe phenotype.
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Zarotti N, Eccles F, Broyd A, Longinotti C, Mobley A, Simpson J. Third wave cognitive behavioural therapies for people with multiple sclerosis: a scoping review. Disabil Rehabil 2022; 45:1720-1735. [PMID: 35514235 DOI: 10.1080/09638288.2022.2069292] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Multiple sclerosis (MS) is a chronic condition linked to a wide range of psychological difficulties. While traditional cognitive behavioural therapy has been studied extensively with people with MS, much less is known about more recent "third wave" approaches. METHODS A scoping review was carried out by performing a systematic search across MEDLINE Complete, PsycINFO, CINAHL, Academic Search Ultimate, and Cochrane Library up to January 2022. RESULTS From an initial return of 8306 citations, 35 studies were included, 20 of which were randomised controlled trials (RCTs). These showed that four third wave approaches have been investigated with people with MS to date: acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT). MBSR and MBCT may be helpful to address a range of psychological difficulties up to three months post-intervention. However, MS-specific adaptations may be required, and more evidence is needed on longer-term effectiveness. Limited evidence is also available for DBT and ACT, but additional research is warranted before any recommendation can be made. CONCLUSIONS As third wave approaches keep being refined, further more rigorous investigations are needed to implement them to the benefit of people with MS. Implications for RehabilitationMultiple sclerosis is linked to a wide range of psychological difficulties in adults.Little is currently known on third wave psychotherapies for people with MS.Mindfulness-based stress reduction and mindfulness-based cognitive therapy may be helpful to address a wide range of difficulties in MS.Specific adaptations may be needed to deliver suitable therapies to people with MS.Additional research is warranted to build on preliminary findings for DBT and ACT.
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Affiliation(s)
- Nicolò Zarotti
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Fiona Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Annabel Broyd
- University College London Hospitals NHS Trust, London, UK
| | | | - Amanda Mobley
- Worcestershire Health and Care NHS Trust, Worcester, UK
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Ayache SS, Serratrice N, Abi Lahoud GN, Chalah MA. Fatigue in Multiple Sclerosis: A Review of the Exploratory and Therapeutic Potential of Non-Invasive Brain Stimulation. Front Neurol 2022; 13:813965. [PMID: 35572947 PMCID: PMC9101483 DOI: 10.3389/fneur.2022.813965] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Fatigue is the most commonly reported symptom in patients with multiple sclerosis (MS). It is a worrisome, frequent, and debilitating manifestation that could occur at any time during the course of MS and in all its subtypes. It could engender professional, familial, and socioeconomic consequences and could severely compromise the patients' quality of life. Clinically, the symptom exhibits motor, cognitive, and psychosocial facets. It is also important to differentiate between perceived or subjective self-reported fatigue and fatigability which is an objective measure of decrement in the performance of cognitive or motor tasks. The pathophysiology of MS fatigue is complex, and its management remains a challenge, despite the existing body of literature on this matter. Hence, unraveling its neural mechanisms and developing treatment options that target the latter might constitute a promising field to explore. A PubMed/Medline/Scopus search was conducted to perform this review which aims (a) to reappraise the available electrophysiological studies that explored fatigue in patients with MS with a particular focus on corticospinal excitability measures obtained using transcranial magnetic stimulation and (b) to assess the potential utility of employing neuromodulation (i.e., non-invasive brain stimulation techniques) in this context. A special focus will be put on the role of transcranial direct current stimulation and transcranial magnetic stimulation. We have provided some suggestions that will help overcome the current limitations in upcoming research.
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Affiliation(s)
- Samar S. Ayache
- EA4391 Excitabilité Nerveuse and Thérapeutique, Université Paris Est Créteil, Créteil, France
- Department of Clinical Neurophysiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Créteil, France
- *Correspondence: Samar S. Ayache
| | - Nicolas Serratrice
- Department of Spine Surgery, Centre Médico Chirurgical Bizet, Paris, France
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), Centre Médico Chirurgical Bizet, Paris, France
| | - Georges N. Abi Lahoud
- Department of Spine Surgery, Centre Médico Chirurgical Bizet, Paris, France
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), Centre Médico Chirurgical Bizet, Paris, France
| | - Moussa A. Chalah
- EA4391 Excitabilité Nerveuse and Thérapeutique, Université Paris Est Créteil, Créteil, France
- Department of Clinical Neurophysiology, DMU FIxIT, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Créteil, France
- Moussa A. Chalah
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Managing neuropsychological impairment in multiple sclerosis – controlled study on a standardized metacognitive intervention (MATIMS). Mult Scler Relat Disord 2022; 59:103687. [DOI: 10.1016/j.msard.2022.103687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 11/22/2022]
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10
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Cuneo AZ, Maisha K, Minen MT. Strategies for Behavioral Research in Neurology: Lessons Learned During the COVID-19 Pandemic and Applications for the Future. Curr Neurol Neurosci Rep 2021; 21:63. [PMID: 34705122 PMCID: PMC8548698 DOI: 10.1007/s11910-021-01146-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
Purpose of Review Behavioral therapies are proven treatments for many neurologic conditions. However, the COVID-19 pandemic has posed significant challenges for conducting behavioral research. This article aims to (1) highlight the challenges of running behavioral clinical trials during the pandemic, (2) suggest approaches to maximize generalizability of pandemic-era studies, and (3) offer strategies for successful behavioral trials beyond the pandemic. Recent Findings Thousands of clinical trials have been impacted by the COVID-19 pandemic, from undergoing protocol revisions to suspension altogether. Furthermore, for ongoing trials, recruitment of diverse populations has suffered, thereby exacerbating existing inequities in clinical research. Patient adherence and retention have been affected by a myriad of pandemic-era restraints, and medical, psychiatric, and other complications from the pandemic have the potential to have long-term effects on pandemic-era study results. Summary In the development of post-pandemic study protocols, attention should be given to designing studies that incorporate successful aspects of pre-pandemic and pandemic-era strategies to (1) broaden recruitment using new techniques, (2) improve access for diverse populations, (3) expand protocols to include virtual and in-person participation, and (4) increase patient adherence and retention.
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Affiliation(s)
- Ami Z Cuneo
- Neurology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
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George DD, Baer NK, Berliner JM, Jones J, Kluger BM. What Fatigue Means to Persons Living with Parkinson's Disease? A Qualitative Study. Mov Disord Clin Pract 2021; 8:919-924. [PMID: 34405099 PMCID: PMC8354068 DOI: 10.1002/mdc3.13270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/01/2021] [Accepted: 06/05/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Fatigue is one of the most prevalent non-motor symptoms of Parkinson's disease (PD). Research is hampered by imprecise terminology and the lack of case definition criteria. OBJECTIVES To elicit the experiences of persons living with PD-related fatigue and provide ecological validation for case definition criteria. METHODS Qualitative interviews were conducted with 22 individuals and 4 focus groups, and analyzed using an inductive qualitative method. RESULTS Six core themes emerged: (i) difficulty initiating and completing important tasks; (ii) desire for others to understand their fatigue experience; (iii) heterogeneity of experiences and descriptions of fatigue; (iv) complex relationships with other non-motor symptoms; (v) variable self-management strategies; and (vi) general alignment with proposed case definition criteria. CONCLUSIONS PD-related fatigue impacts function, is subjectively distinguishable from other non-motor symptoms, has heterogeneous descriptions, and may be mitigated by various self-management strategies. Proposed case definition criteria appear ecologically valid and warrant further optimization and testing.
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Affiliation(s)
- Derek D. George
- Department of Neurology, School of MedicineUniversity of Colorado‐Anschutz Medical CampusAuroraColoradoUSA
| | - Nicholas K. Baer
- Department of Neurology, School of MedicineUniversity of Colorado‐Anschutz Medical CampusAuroraColoradoUSA
| | - Jean M. Berliner
- Rehabilitation Sciences ProgramSchool of Medicine, University of Colorado‐Anschutz Medical CampusAuroraColoradoUSA
| | - Jacqueline Jones
- College of NursingUniversity of Colorado‐Anschutz Medical CampusAuroraColoradoUSA
| | - Benzi M. Kluger
- Departments of Neurology and MedicineSchool of Medicine, University of Rochester Medical CenterRochesterNew YorkUSA
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Momsen AMH, Ørtenblad L, Maribo T. Effective rehabilitation interventions and participation among people with multiple sclerosis: an overview of reviews. Ann Phys Rehabil Med 2021; 65:101529. [PMID: 33940247 DOI: 10.1016/j.rehab.2021.101529] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/02/2021] [Accepted: 03/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common cause of non-traumatic disability in people aged 10 to 65 years. Evidence exists for the effectiveness of multidisciplinary rehabilitation and exercise. However, the effectiveness of other rehabilitation approaches in MS needs further evaluation. OBJECTIVE We aimed to systematically synthesize and evaluate knowledge on effectiveness of rehabilitation interventions and determinants for participation among people with MS (pwMS) to inform clinical guidelines on rehabilitation. METHODS Joanna Briggs Institute methodology was used. PubMed, Embase, CINAHL, PsycINFO and Web of Science were searched for reviews, systematic reviews, meta-analyses, and meta-syntheses published during 2009-2019. All types of rehabilitation interventions provided to pwMS at any time and in all settings were eligible. Two reviewers independently screened and extracted data. The most recently published reviews on mixed and specific modalities were included. The findings were reported in a narrative summary and a mixed-methods analysis. RESULTS Among 108 eligible reviews, 6 qualitative or mixed-methods reviews and 66 quantitative reviews were included (total pwMS >90,000). This overview provides solid evidence for the effectiveness of a spectrum of modalities. Among the modalities, there was strong evidence for the effectiveness of multidisciplinary, cognitive and exercise approaches, physiotherapy, and occupational therapy, including full body training on functioning, and participation outcomes. Employment significantly affected quality of life; thus, vocational rehabilitation should be initiated early. Healthcare professionals should identify personal factors including relations and coping, and the rehabilitation process should involve partners or close family. CONCLUSIONS The mixed-methods analysis revealed insufficient consensus between the perspectives of pwMS on their rehabilitation and reported effects, indicating that further research should target the experiences of pwMS. Furthermore, rehabilitation should be patient-centred, focus on the complexity of needs, and be organised and performed by an experienced multidisciplinary team. Evidence-based rehabilitation should be initiated early after pwMS are diagnosed and follow international guidelines. Database registration. PROSPERO ID (CRD42020152422).
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Affiliation(s)
- Anne-Mette Hedeager Momsen
- DEFACTUM - Social & Health Services and Labour Market, Corporate Quality, Central Denmark Region, Aarhus, Denmark.
| | - Lisbeth Ørtenblad
- DEFACTUM - Social & Health Services and Labour Market, Corporate Quality, Central Denmark Region, Aarhus, Denmark
| | - Thomas Maribo
- DEFACTUM - Social & Health Services and Labour Market, Corporate Quality, Central Denmark Region, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
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Young CA, Mills R, Rog D, Sharrack B, Majeed T, Constantinescu CS, Kalra S, Harrower T, Santander H, Courtald G, Ford HL, Woolmore J, Tennant A. Quality of life in multiple sclerosis is dominated by fatigue, disability and self-efficacy. J Neurol Sci 2021; 426:117437. [PMID: 33991718 DOI: 10.1016/j.jns.2021.117437] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/18/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Quality of life in multiple sclerosis (MS) reflects complex relationships between symptoms (fatigue, spasticity pain, and bladder or vision dysfunction), disability, health perceptions, and self-efficacy. METHODS In this cross-sectional study, a self-report questionnaire pack of patient reported outcome measures was collected from 5695 people with MS (pwMS) alongside clinical data from their neurologists. Each patient reported outcome measure was converted to interval-scaled estimates following fit to the Rasch model. The patient reported outcome measures, as well as perceived health, age, disease subtype and gender, were then subject to path analysis to analyse their relationships with quality of life (QoL), guided by the Wilson and Clearly conceptual framework. RESULTS The final model explains 81.2% of the variance of QoL. Fatigue is clearly dominant, suggesting a means to intervene and improve QoL. The next most influential factors were disability and self-efficacy, which have similar effect levels. The model can be replicated for pwMS on disease modifying therapy and is largely invariant for gender and disease subtype. Age had an insignificant effect. CONCLUSIONS In order to promote better QoL, MS care should include management of fatigue, interventions to ameliorate disability, and support to enhance self-efficacy. The range of skills needed for these treatments will require input from medical, nursing, therapy and psychology staff, so these findings provide evidence substantiating the need for pwMS to be provided with care by comprehensive multidisciplinary teams.
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Affiliation(s)
- Carolyn A Young
- Walton Centre NHS Trust, Liverpool, UK; University of Liverpool, UK,.
| | - Roger Mills
- Walton Centre NHS Trust, Liverpool, UK; University of Liverpool, UK,.
| | - David Rog
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, UK.
| | - Basil Sharrack
- Academic Department of Neurology and NIHR Translational Neuroscience BRC, University of Sheffield, UK.
| | | | | | - Seema Kalra
- University Hospital of North Midlands NHS Trust, Stoke-on-Trent, UK.
| | | | | | | | | | | | - Alan Tennant
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK.
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14
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Sazesh S, Esmaelzadeh Saeieh S, Farid M, Refaei M, Yazdkhasti M. Effectiveness of Group Counseling with a Client-Centered Approach Based on the GATHER Principles on Sexual Satisfaction in Women with Multiple Sclerosis: A Randomized Clinical Trial. IRANIAN JOURNAL OF MEDICAL SCIENCES 2021; 46:103-111. [PMID: 33753954 PMCID: PMC7966937 DOI: 10.30476/ijms.2020.82616.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/13/2019] [Accepted: 10/06/2019] [Indexed: 11/19/2022]
Abstract
Background Multiple sclerosis (MS) is the most prevalent progressive sensory/neurological disability in young adults, with important psychological consequences. The present study was designed to assess the effectiveness of group counseling with a client-centered approach based on the GATHER principles on sexual satisfaction in women with MS. Methods In this clinical trial, conducted from January 2018 to May 2019, in the MS Referral Center of Tehran (Iran), 72 eligible participants were assigned to intervention and control groups (36 in each group) via simple randomization. The intervention group received group counseling based on the client-centered approach, while the control group received routine counseling. Data were collected using the Larson Sexual Satisfaction Questionnaire (LSSQ) at three different time points: before the intervention, after the final session, and one month after the intervention. The collected data were analyzed in SPSS software (version 19). In order to analyze the obtained data, independent t test, Mann-Whitney U test, paired t test, Wilcoxon test, Chi-square test, Fisher exact test, and Friedman test were used. Results The mean score of sexual satisfaction before the intervention showed no statistically significant difference between the two groups. Based on the Friedman test in the intervention group, the trend of changes in the mean score of sexual satisfaction had a significant difference before the intervention, after the final session, and one month after the intervention (P=0.001); however, no significant difference was observed in the control group. Conclusion Our results showed the effectiveness of group counseling with a client-centered approach based on the GATHER principles on sexual satisfaction and intimacy among women with MS. Trial Registration Number IRCT20180110038302N3.
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Affiliation(s)
- Shabnam Sazesh
- Department of Midwifery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Sara Esmaelzadeh Saeieh
- Department of Social Determinants of Health, Faculty of Midwifery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Malihe Farid
- Department of Community Medicine, School of Community Medicine, Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mansoureh Refaei
- Mother and Childcare Research Center, Department of Midwifery, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mansoureh Yazdkhasti
- Department of Social Determinants of Health, Faculty of Midwifery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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15
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Lin X, Zhang X, Liu Q, Zhao P, Zhong J, Pan P, Wang G, Yi Z. Empathy and Theory of Mind in Multiple Sclerosis: A Meta-Analysis. Front Psychiatry 2021; 12:628110. [PMID: 33897490 PMCID: PMC8062809 DOI: 10.3389/fpsyt.2021.628110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/18/2021] [Indexed: 12/25/2022] Open
Abstract
Multiple sclerosis (MS) is an immune-mediated demyelinating disease of the central nervous system. Studies have shown that MS disrupts several social cognitive abilities [including empathy and theory of mind (ToM)]. Overall ToM deficits in MS are well documented, but how the specific ToM subcomponents and empathic capacity are affected remains unclear. For this meta-analysis, we searched PubMed, Web of Science, and Embase from inception to July 2020. Effect sizes were calculated using Hedges g with a random-effects model. Thirty-three studies were included. Relative to healthy controls (HCs), patients with MS were moderately impaired in overall empathy (g = -0.67), overall ToM (g = -74), cognitive ToM (g = -0.72), and the overlapping domains of cognitive empathy/affective ToM (g = -0.79); no group differences were identified for affective empathy (g = -0.19). Compared with HCs, patients with relapsing-remitting MS (RRMS) and progressive MS were impaired in overall empathy, overall ToM, cognitive ToM, and cognitive empathy/affective ToM, without significant RRMS-progressive MS differences in impairment degree. We conducted the first meta-analytic review investigating the empathy and ToM functioning patterns in patients with MS and examined the overlapping and distinct subcomponents of these constructs. The findings suggest differential impairment of the core aspects of social cognitive processing in patients with MS, which may importantly inform the development of structured social cognitive MS interventions.
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Affiliation(s)
- XiaoGuang Lin
- Department of Neurology, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - XueLing Zhang
- Department of Neurology, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - QinQin Liu
- Department of Neurology, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - PanWen Zhao
- Department of Central Laboratory, Affiliated Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, China
| | - JianGuo Zhong
- Department of Neurology, Affiliated Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, China
| | - PingLei Pan
- Department of Neurology and Department of Central Laboratory, Affiliated Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, China
| | - GenDi Wang
- Department of Neurology, Affiliated Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, China
| | - ZhongQuan Yi
- Department of Central Laboratory, Affiliated Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng, China
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16
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Anatomical Covariance Analysis: Detection of Disrupted Correlation Network Related to Clinical Trait Fatigue in Multiple Sclerosis: A Pilot Study. Behav Neurol 2020. [PMID: 32175581 PMCID: PMC7775148 DOI: 10.1155/2020/5807496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Fatigue is one of the most distressing symptoms among persons with multiple sclerosis (PwMS). The experience of fatigue is inherently interoceptive, yet no study to date has explicitly investigated the insular cortex (IC) as a primary goal in the experience of fatigue in PwMS. In addition, it is unknown how brain regions such as IC play a role in state or trait fatigue. Objective Assess the involvement of the IC in trait fatigue and state fatigue in PwMS with and without clinical fatigue. Methods Trait and state fatigue, cognitive status, and structural MRI were assessed in 27 PwMS. PwMS were stratified into nonclinical fatigue (nF-MS, FSS ≤ 4.0) (n = 10) and clinical fatigue (F-MS, FSS ≥ 5.0) (n = 10). Voxel-based morphometry analysis (VBM) for the whole sample (n = 20) and for the two groups was performed. Anatomical covariance analysis (ACA) analysis was conducted by selecting different volumes included in the corticostriatal network (CoStN) and analyzing interhemispheric correlations between those volumes to explore the state of the CoStN in both groups. Results In the VBM analysis, when considering the whole sample of PwMS, higher levels of trait fatigue were negatively associated with grey matter (GM) volume in the left dorsal anterior insula (dAI) (rho = −0.647; p = 0.002; R2 = 0.369). When comparing nF-MS versus F-MS, significant differences were found in the left dAI, where the F-MS group showed less GM volume in the left dAI. In the ACA analysis, the F-MS group showed fewer significant interhemispheric correlations in comparison with the Low-FSS group. Conclusions The present results provide support to the interoceptive component of self-reported fatigue and suggest that changes in the relationship between the different anatomical regions involved in the CoStN are present even in nonclinical trait fatigue. Those changes might be responsible for the experience of trait fatigue in PwMS. Future studies with larger samples and multimodal MRI acquisitions should be considered to fully understand the changes in the CoStN and the specific role of the IC in trait fatigue.
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Nourbakhsh B, Revirajan N, Morris B, Cordano C, Creasman J, Manguinao M, Krysko K, Rutatangwa A, Auvray C, Aljarallah S, Jin C, Mowry E, McCulloch C, Waubant E. Safety and efficacy of amantadine, modafinil, and methylphenidate for fatigue in multiple sclerosis: a randomised, placebo-controlled, crossover, double-blind trial. Lancet Neurol 2020; 20:38-48. [PMID: 33242419 PMCID: PMC7772747 DOI: 10.1016/s1474-4422(20)30354-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Methylphenidate, modafinil, and amantadine are commonly prescribed medications for alleviating fatigue in multiple sclerosis; however, the evidence supporting their efficacy is sparse and conflicting. Our goal was to compare the efficacy of these three medications with each other and placebo in patients with multiple sclerosis fatigue. METHODS In this randomised, placebo-controlled, four-sequence, four-period, crossover, double-blind trial, patients with multiple sclerosis who reported fatigue and had a Modified Fatigue Impact Scale (MFIS) score of more than 33 were recruited at two academic multiple sclerosis centres in the USA. Participants received oral amantadine (up to 100 mg twice daily), modafinil (up to 100 mg twice daily), methylphenidate (up to 10 mg twice daily), or placebo, each given for up to 6 weeks. All patients were intended to receive all four study medications, in turn, in one of four different sequences with 2-week washout periods between medications. A biostatistician prepared a concealed allocation schedule, stratified by site, randomly assigning a sequence of medications in approximately a 1:1:1:1 ratio, in blocks of eight, to a consecutive series of numbers. The statistician and pharmacists had no role in assessing the participants or collecting data, and the participants, caregivers, and assessors were masked to allocation. The primary outcome measure was the MFIS measured while taking the highest tolerated dose at week 5 of each medication period, analysed by use of a linear mixed-effect regression model. This trial is registered with ClinicalTrials.gov, NCT03185065 and is closed. FINDINGS Between Oct 4, 2017, and Feb 27, 2019, of 169 patients screened, 141 patients were enrolled and randomly assigned to one of four medication administration sequences: 35 (25%) patients to the amantadine, placebo, modafinil, and methylphenidate sequence; 34 (24%) patients to the placebo, methylphenidate, amantadine, and modafinil sequence; 35 (25%) patients to the modafinil, amantadine, methylphenidate, and placebo sequence; and 37 (26%) patients to the methylphenidate, modafinil, placebo, and amantadine sequence. Data from 136 participants were available for the intention-to-treat analysis of the primary outcome. The estimated mean values of MFIS total scores at baseline and the maximal tolerated dose were as follows: 51·3 (95% CI 49·0-53·6) at baseline, 40·6 (38·2-43·1) with placebo, 41·3 (38·8-43·7) with amantadine, 39·0 (36·6-41·4) with modafinil, and 38·6 (36·2-41·0) with methylphenidate (p=0·20 for the overall medication effect in the linear mixed-effect regression model). As compared with placebo (38 [31%] of 124 patients), higher proportions of participants reported adverse events while taking amantadine (49 [39%] of 127 patients), modafinil (50 [40%] of 125 patients), and methylphenidate (51 [40%] of 129 patients). Three serious adverse events occurred during the study (pulmonary embolism and myocarditis while taking amantadine, and a multiple sclerosis exacerbation requiring hospital admission while taking modafinil). INTERPRETATION Amantadine, modafinil, and methylphenidate were not superior to placebo in improving multiple sclerosis fatigue and caused more frequent adverse events. The results of this study do not support an indiscriminate use of amantadine, modafinil, or methylphenidate for the treatment of fatigue in multiple sclerosis. FUNDING Patient-Centered Outcomes Research Institute.
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Affiliation(s)
- Bardia Nourbakhsh
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
| | - Nisha Revirajan
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Bridget Morris
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Christian Cordano
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Creasman
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Michael Manguinao
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Kristen Krysko
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Alice Rutatangwa
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Caroline Auvray
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Salman Aljarallah
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Chengshi Jin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Ellen Mowry
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Charles McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Emmanuelle Waubant
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
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A feasibility trial of an internet-delivered psychological intervention to manage mental health and functional outcomes in neurological disorders. J Psychosom Res 2020; 136:110173. [PMID: 32623193 DOI: 10.1016/j.jpsychores.2020.110173] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/15/2020] [Accepted: 06/08/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Mental health and cognitive difficulties are highly prevalent across neurological disorders and significantly contribute to poorer patient outcomes. Unfortunately, access to effective psychological services for these comorbidities are limited. To determine whether a novel transdiagnostic internet-delivered psychological intervention, the Wellbeing Neuro Course, was feasible, acceptable and efficacious a single-group feasibility open trial was employed. METHODS The Wellbeing Neuro Course, targets mental health and cognitive difficulties, across a variety of neurological disorders. It is comprised of six online lessons, based on Cognitive Behavioural Therapy and Compensatory Cognitive Rehabilitation, delivered over 10 weeks and provided with weekly support from a mental health professional via email and telephone. 105 adults with diagnoses of either epilepsy, multiple sclerosis, Parkinson's disease and/or acquired brain injury, underwent the intervention. RESULTS The intervention was found to be highly acceptable with high intervention completion and levels of satisfaction (>95%). There was evidence of clinically significant improvements in primary outcomes (within-group Cohen's d; average reductions) of depression (d = 0.93; avg. reduction ≥36%), anxiety (ds = 0.66, avg. reduction ≥36%), and disability (ds ≥ 0.49; avg. reduction ≥23%) at post-intervention, maintained at 3-month follow-up. For secondary outcomes there were significant improvements in fatigue severity and perceived cognitive difficulties of attention, planning and prospective memory. Findings were achieved with minimal clinician time, highlighting its public health potential. CONCLUSION This open trial provides preliminary evidence the Wellbeing Neuro Course is acceptable and reduces symptoms of depression, anxiety and disability in neurological disorders. Future controlled trials of the intervention are now needed. TRIAL REGISTRATION ACTRN12617000581369.
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19
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Sexual dysfunction and associated risk factors in multiple sclerosis. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.800830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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20
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Fitzgerald KC, Morris B, Soroosh A, Balshi A, Maher D, Kaplin A, Nourbakhsh B. Pilot randomized active-placebo-controlled trial of low-dose ketamine for the treatment of multiple sclerosis-related fatigue. Mult Scler 2020; 27:942-953. [PMID: 32633662 DOI: 10.1177/1352458520936226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Fatigue is the most common symptom of MS and has no effective pharmacotherapy. OBJECTIVE To determine the tolerability, safety, and efficacy of low-dose ketamine infusion for MS-related fatigue. METHODS In this double-blind, randomized, active-placebo-controlled trial, 18 subjects with multiple sclerosis (MS) and reported fatigue received a single intravenous infusion of ketamine (0.5 mg/kg) or midazolam (0.05 mg/kg). The primary outcome was change in Daily Fatigue Severity (DFS) for 7 days following the infusion. Secondary outcomes included Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS) measured up to day 28 post-infusion. We analyzed changes in all outcomes using mixed-effect models. RESULTS In total, 18 participants were enrolled; 67% participants received ketamine. Side effects of ketamine were transient. No change in the DFS was observed after 7 days (-0.10 point; 95% confidence interval (CI): -0.32, 0.12; p = 0.40). We observed a trend in reduced FSS scores at 1 week (-5.2 points; 95% CI: -10.4, 0.14; p = 0.06) and a clinically and statistically significant reduction in MFIS score at day 28 (-13.5 point; 95% CI: -25.0, -1.98; p = 0.04). CONCLUSIONS Ketamine infusions were safe and well-tolerated. While no change in DFS after 7 days was observed, secondary analyses suggest a benefit of ketamine infusion for reduction of longer term fatigue severity in people with MS.
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Affiliation(s)
- Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA/Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Bridget Morris
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aurash Soroosh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexandra Balshi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dermot Maher
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adam Kaplin
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bardia Nourbakhsh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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21
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Thrue C, Riemenschneider M, Hvid LG, Stenager E, Dalgas U. Time matters: Early-phase multiple sclerosis is accompanied by considerable impairments across multiple domains. Mult Scler 2020; 27:1477-1485. [DOI: 10.1177/1352458520936231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Impairments across multiple domains are a disabling consequence of multiple sclerosis (MS). Originating from preventive medical strategies, the “time matters”-perspective has become a focal point when treating MS. In particular, early detection of physical and cognitive deficits, along with deficits in patient-reported outcomes seems crucial to further optimize both pharmacological and non-pharmacological MS treatment strategies. Therefore, this topical review investigates the level of impairments across multiple domains (physical function, cognitive function, and patient-reported outcomes) in the early stage of MS (⩽5 years since diagnosis, including clinically isolated syndrome (CIS)), when compared to matched healthy controls. Even at early disease stages, studies show impairments corresponding to 8%–34% and small-to-large numerical effect sizes (0.35–2.85) in MS/CIS patients across domains. This evidence call for early screening programs along with early interventions targeting the multiple impaired domains. This further highlights the importance of preventive initiatives preserving and/or restoring physical and cognitive reserve capacity if possible.
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Affiliation(s)
- C Thrue
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - M Riemenschneider
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - LG Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - E Stenager
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark/Department of Neurology, MS-Clinic of Southern Jutland (Sønderborg, Esbjerg, Kolding), Sønderborg, Denmark
| | - U Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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Dacosta-Aguayo R, Wylie G, DeLuca J, Genova H. Changes in plant function and root mycobiome caused by flood and drought in a riparian tree. Behav Neurol 2020; 40:886-903. [PMID: 32175581 PMCID: PMC7775148 DOI: 10.1093/treephys/tpaa031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 06/10/2023] Open
Abstract
Under increasingly harsh climatic conditions, conservation of threatened species requires integrative studies to understand stress tolerance. Riparian Ulmus minor Mill. populations have been massively reduced by Dutch Elm disease (DED). However, resistant genotypes were selected to restore lost populations. To understand the acclimation mechanisms to the succession of abiotic stresses, ramets of five DED-tolerant U. minor genotypes were subjected to flood and subsequently to drought. Physiological and biochemical responses were evaluated together with shifts in root-fungal assemblages. During both stresses, plants exhibited a decline in leaf net photosynthesis and an increase in percentage loss of stem hydraulic conductivity and in leaf and root proline content. Stomatal closure was produced by chemical signals during flood and hydraulic signals during drought. Despite broad similarities in plant response to both stresses, root-mycobiome shifts were markedly different. The five genotypes were similarly tolerant to moderate drought, however, flood tolerance varied between genotypes. In general, flood did not enhance drought susceptibility due to fast flood recovery, nevertheless, different responses to drought after flood were observed between genotypes. Associations were found between some fungal taxonomic groups and plant functional traits varying with flood and drought (e.g. proline, chlorophyll and starch content) indicating that the thriving of certain taxa depends on host responses to abiotic stress.
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Affiliation(s)
- Rosalia Dacosta-Aguayo
- Neuropsychology and Neuroscience, Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, New Jersey 07936, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ 07101, USA
| | - Glenn Wylie
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ 07101, USA
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, USA
| | - John DeLuca
- Neuropsychology and Neuroscience, Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, New Jersey 07936, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ 07101, USA
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, USA
| | - Helen Genova
- Neuropsychology and Neuroscience, Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, New Jersey 07936, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ 07101, USA
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Aristotelous P, Stefanakis M, Pantzaris M, Pattichis C, Hadjigeorgiou GM, Giannaki CD. Associations between functional capacity, isokinetic leg strength, sleep quality and cognitive function in multiple sclerosis patients: a cross-sectional study. Postgrad Med 2019; 131:453-460. [DOI: 10.1080/00325481.2019.1662271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Manos Stefanakis
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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Moral Judgment: An Overlooked Deficient Domain in Multiple Sclerosis? Behav Sci (Basel) 2018; 8:bs8110105. [PMID: 30453483 PMCID: PMC6262463 DOI: 10.3390/bs8110105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/02/2018] [Accepted: 11/13/2018] [Indexed: 12/17/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system through which patients can suffer from sensory, motor, cerebellar, emotional, and cognitive symptoms. Although cognitive and behavioral dysfunctions are frequently encountered in MS patients, they have previously received little attention. Among the most frequently impaired cognitive domains are attention, information processing speed, and working memory, which have been extensively addressed in this population. However, less emphasis has been placed on other domains like moral judgment. The latter is a complex cognitive sphere that implies the individuals’ ability to judge others’ actions and relies on numerous affective and cognitive processes. Moral cognition is crucial for healthy and adequate interpersonal relationships, and its alteration might have drastic impacts on patients’ quality of life. This work aims to analyze the studies that have addressed moral cognition in MS. Only three works have previously addressed moral judgement in this clinical population compared to healthy controls, and none included neuroimaging or physiological measures. Although scarce, the available data suggest a complex pattern of moral judgments that deviate from normal response. This finding was accompanied by socio-emotional and cognitive deficits. Only preliminary data are available on moral cognition in MS, and its neurobiological foundations are still needing to be explored. Future studies would benefit from combining moral cognitive measures with comprehensive neuropsychological batteries and neuroimaging/neurophysiological modalities (e.g., functional magnetic resonance imaging, tractography, evoked potentials, electroencephalography) aiming to decipher the neural underpinning of moral judgement deficits and subsequently conceive potential interventions in MS patients.
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