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Pilehvari S, Morgan Y, Peng W. An analytical review on the use of artificial intelligence and machine learning in diagnosis, prediction, and risk factor analysis of multiple sclerosis. Mult Scler Relat Disord 2024; 89:105761. [PMID: 39018642 DOI: 10.1016/j.msard.2024.105761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 06/19/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024]
Abstract
Medical research offers potential for disease prediction, like Multiple Sclerosis (MS). This neurological disorder damages nerve cell sheaths, with treatments focusing on symptom relief. Manual MS detection is time-consuming and error prone. Though MS lesion detection has been studied, limited attention has been paid to clinical analysis and computational risk factor prediction. Artificial intelligence (AI) techniques and Machine Learning (ML) methods offer accurate and effective alternatives to mapping MS progression. However, there are challenges in accessing clinical data and interdisciplinary collaboration. By analyzing 103 papers, we recognize the trends, strengths and weaknesses of AI, ML, and statistical methods applied to MS diagnosis. AI/ML-based approaches are suggested to identify MS risk factors, select significant MS features, and improve the diagnostic accuracy, such as Rule-based Fuzzy Logic (RBFL), Adaptive Fuzzy Inference System (ANFIS), Artificial Neural Network methods (ANN), Support Vector Machine (SVM), and Bayesian Networks (BNs). Meanwhile, applications of the Expanded Disability Status Scale (EDSS) and Magnetic Resonance Imaging (MRI) can enhance MS diagnostic accuracy. By examining established risk factors like obesity, smoking, and education, some research tackled the issue of disease progression. The performance metrics varied across different aspects of MS studies: Diagnosis: Sensitivity ranged from 60 % to 98 %, specificity from 60 % to 98 %, and accuracy from 61 % to 97 %. Prediction: Sensitivity ranged from 76 % to 98 %, specificity from 65 % to 98 %, and accuracy from 62 % to 99 %. Segmentation: Accuracy ranged up to 96.7 %. Classification: Sensitivity ranged from 78 % to 97.34 %, specificity from 65 % to 99.32 %, and accuracy from 71 % to 97.94 %. Furthermore, the literature shows that combining techniques can improve efficiency, exploiting their strengths for better overall performance.
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Affiliation(s)
- Shima Pilehvari
- University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - Yasser Morgan
- University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - Wei Peng
- University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada.
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Jovanovic A, Pekmezovic T, Mesaros S, Novakovic I, Peterlin B, Veselinovic N, Tamas O, Ivanovic J, Maric G, Andabaka M, Momcilovic N, Drulovic J. Earlier age of symptom onset in younger generation of familial cases of multiple sclerosis. Neurol Sci 2024; 45:4463-4469. [PMID: 38594425 DOI: 10.1007/s10072-024-07512-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/02/2024] [Indexed: 04/11/2024]
Abstract
AIM The aim of this study was to assess the prevalence of familial MS (fMS) in Belgrade MS population, discern the differences between the persons with fMS and sporadic MS, and to detect the presence of anticipation phenomenon in fMS patients. METHODS The data on the demographic and clinical characteristics of MS patients was obtained from the Belgrade MS population Registry. In cases of vertical transmission of MS, the family members were divided into the younger and older generation, in order to assess the potential presence of anticipation phenomenon. To adjust for follow-up time bias, a secondary analysis including only patients who had the onset of symptoms before 39 years (75.percentile), and those who were 39 + years, was performed. RESULTS The prevalence of fMS in Belgrade MS population is 6.4%. FMS cases had earlier age at MS symptom onset (30.4 vs. 32.3 years) compared to sporadic MS cohort. When comparing fMS cases across generations, the younger generation had significantly lower age at onset compared with the older one (25.8 vs. 35.7 years, p < 0.001). After adjustment for the different length of the follow-up, the difference in age at symptom onset between the groups was reduced, but it still existed and was statistically significant (30.0 years in younger vs. 36.4 years in older generation, p = 0.040). CONCLUSION In our study, the analysis of fMS cases across generations, showed an earlier age of symptom onset in the younger generation, even after adjustment. These results indicate the possibility of existence of anticipation phenomenon.
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Affiliation(s)
- Aleksa Jovanovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sarlota Mesaros
- Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Novakovic
- Institute of Medical Genetics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Borut Peterlin
- Clinical Institute for Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nikola Veselinovic
- Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Olivera Tamas
- Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovana Ivanovic
- Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Gorica Maric
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko Andabaka
- Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Nikola Momcilovic
- Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jelena Drulovic
- Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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Orman G, Sungur G. Evaluation of demographic and neuro-ophthalmologic findings of patients with multiple sclerosis. Int Ophthalmol 2024; 44:356. [PMID: 39183241 DOI: 10.1007/s10792-024-03285-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/17/2024] [Indexed: 08/27/2024]
Abstract
PURPOSE The study aims to investigate the demographic and neuroophthalmologic features of patients with multiple sclerosis (MS). METHODS This retrospective study investigated 270 eyes of 135 patients with MS. All subjects underwent a full ophthalmological examination. RESULTS The study investigated 270 eyes of 135 patients with MS. The patients included 102 (74.8%) females and 34 (25.2%) males. The mean age at the time of diagnosis of MS was 29.9 ± 9.6 years. The mean follow-up period was 6.7 ± 10.9 months. Initial symptoms of MS at presentation included optic neuritis (ON) in 42 patients (15.6%), numbness of hands and feet in 20 patients (7.4%) and diplopia in 11 patients (4.1%). Additional diseases were observed in 29 patients (21.5%) and autoimmune diseases were observed in 11 patients (8.1%). Thirteen patients (9.62%) had relatives with MS; the relatives of five patients were first-degree relatives and the relatives of the remaining eight patients were second-degree relatives. Table 2 summarizes the additional systemic and ocular diseases and family history data. During MS, 72 patients (53.4%) were diagnosed with ON. ON was bilateral in 49 patients (68%) and unilateral in 23 patients (32%). Retrobulbar ON was observed in 77 eyes (81.6%) and papillitis was observed in 18 eyes (18.4%). Disorders of efferent visual pathway function were found in 43 patients (30.4%). CONCLUSION Visual impairments are significant in patients with MS. Although ON is the most prevalent symptom of MS, it is important to keep in mind that damage to the efferent visual system can be observed.
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Affiliation(s)
- Gözde Orman
- Department of Ophthalmology, Health Science University Ankara Training and Researching Hospital, Ankara, Turkey.
- Department of Ophthalmology, Health Science Univercity, Ankara Training and Researching Hospital, Ankara, Turkey.
| | - Gülten Sungur
- Department of Ophthalmology, Health Science University Ankara Training and Researching Hospital, Ankara, Turkey
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Pouradeli S, Khadir E, Rezaeian M, Meimand HAE. Exploring suicidal ideation prevalence in multiple sclerosis patients during the COVID-19 pandemic: A study on the relationship between drug use and suicidal ideation. Mult Scler Relat Disord 2024; 87:105676. [PMID: 38776600 DOI: 10.1016/j.msard.2024.105676] [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: 01/01/2024] [Revised: 04/03/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The COVID-19 pandemic has exacerbated psychological challenges, leading to increased rates of clinically significant depression and suicidal ideation among MS patients. Despite advancements in MS treatments, there remains a need to investigate the impact of different drugs on the prevalence of suicidal ideation, particularly in the context of the pandemic. METHOD This cross-sectional study, conducted in 2021, received ethics approval from the Ethics Committee of Kerman University of Medical Science. The study involved 234 MS patients selected from the MS Association in Kerman Province. Questionnaires were prepared and distributed via Google Drive and WhatsApp, with participants providing informed consent. The collected data were analyzed using SPSS software. Inclusion criteria encompassed adults diagnosed with MS according to specific criteria and willing to complete the questionnaires, while exclusion criteria included unclear diagnostic criteria and lack of cooperation. The instruments included a demographic questionnaire, medication checklist, and the Beck Suicidal Thought Scale questionnaire, which has been validated in Iran. RESULTS 202 MS patients completed the questionnaires, most of whom were women and married. The prevalence of Suicidal Ideation was 46.5 %, with 8.9 % at high risk. Factors such as gender, marital status, education, occupation, and city did not show statistically significant differences in SI. Patients with SI had a longer duration of illness and were more likely to have seen a psychiatrist. The COVID-19 pandemic affected the necessary care for 44.6 % of patients and worsened symptoms in 28.7 %. Additionally, 30.2 % of patients had seen a psychiatrist, and the prevalence of SI was significantly higher in this group. The study also explored the prevalence of SI with comorbidities and types of drugs used, finding no statistically significant differences. CONCLUSION The study revealed a high prevalence of suicide ideation among MS patients, emphasizing the need for tailored comprehensive support. Factors contributing to SI included limited healthcare access, fear of COVID-19 complications, social isolation, and heightened anxiety. Recommendations for healthcare providers stress early diagnosis, personalized treatment plans, and collaborative efforts to enhance the well-being of individuals with MS in Iran post-COVID-19.
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Affiliation(s)
- Shiva Pouradeli
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Elham Khadir
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohsen Rezaeian
- Department of Epidemiology and Biostatistics, School of Health, Occupational Environment Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Kugelman N, Staun-Ram E, Volkovitz A, Barnett-Griness O, Glass-Marmor L, Miller A. Familial vs sporadic multiple sclerosis in the Israeli population: Differences in ethnicity distribution and disease progression, with anticipation in successive generations. Mult Scler Relat Disord 2024; 87:105604. [PMID: 38718750 DOI: 10.1016/j.msard.2024.105604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/13/2024] [Accepted: 04/02/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Multiple Sclerosis (MS) may cluster in families, an entity known as familial MS (FMS), possibly due to aggregation of genetic and environmental factors. Though previous studies have characterized FMS in different populations, no study to the best of our knowledge has yet characterized FMS in the unique Israeli population, which is comprised of relatively endogamous ethnicities. Our goal in this study was to compare demographic and clinical characteristics between FMS and sporadic MS (SMS), and to search for intra-familial patterns. METHODS In a retrospective study of 101 FMS patients and 508 SMS patients, ethnicity and sex distribution was assessed. Clinical aspects were compared between 172 paired FMS and SMS patients, matched for sex, age and ethnicity, and between generations of the FMS cohort. RESULTS Females comprised 75.3 % of FMS and 67.5 % of SMS patients (p = 0.1). Ethnic distribution was significantly different between FMS and SMS (p = 0.014), with the former comprising a higher proportion of Christian-Arabs (15.4% vs. 5.1 %, p = 0.004) and lower proportion of Jews (60% vs. 74.2 %, p = 0.016). Age at disease onset or diagnosis, frequency of positive Oligoclonal bands and comorbidity of other autoimmune/inflammatory disease or chronic diseases was comparable between FMS and SMS, yet motor symptoms at onset were more prevalent in FMS (34% vs. 20 %, p = 0.02). Annualized relapse rates throughout 10 years from onset were comparable. Among FMS, mean Expanded-Disability-Status-Scale (EDSS) and slope of deterioration in EDSS over 20 years from diagnosis were higher (p = 0.0004 and p = 0.023, respectively), time to EDSS ≥ 3 was shorter (7.1 vs. 12.1 years, HR 1.6, p = 0.036) and MS-Severity-Score (MSSS) was higher (3.84 vs. 2.95, p = 0.04), compared to SMS. Following adjustment for smoking, which tended to be higher among FMS patients (P = 0.06), mean EDSS and slope of deterioration in EDSS over 20 years remained significantly higher (p = 0.0006 and p = 0.025, respectively) in FMS, time to EDSS ≥ 3 tended to be higher (HR 1.5, p = 0.06), while MSSS was comparable. An inter-generational analysis of the total FMS cohort, as well as an intra-familial analysis, both adjusted for year of diagnosis, revealed significantly earlier age of onset (p < 0.0001 and p < 0.0001) and diagnosis (p = 0.001 and p < 0.0001) in the younger compared to the older generations, respectively. CONCLUSION In this Israeli cohort, the proportions of specific ethnicities differ between FMS and SMS, indicating that FMS has a population-specific prevalence pattern, and that further investigation for susceptibility genes is warranted. Disease progression is faster in FMS patients and anticipation is observed in families with multiple cases of MS. Closer surveillance and application of a pro-active induction or early highly-effective therapeutic strategy for FMS patients should be considered, to reduce high disease activity and fast disability progression.
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Affiliation(s)
- Netta Kugelman
- Neuroimmunology Unit & Multiple Sclerosis Center, Department of Neurology, Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Elsebeth Staun-Ram
- Neuroimmunology Unit & Multiple Sclerosis Center, Department of Neurology, Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Anat Volkovitz
- Neuroimmunology Unit & Multiple Sclerosis Center, Department of Neurology, Carmel Medical Center, Haifa, Israel
| | - Ofra Barnett-Griness
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Lea Glass-Marmor
- Neuroimmunology Unit & Multiple Sclerosis Center, Department of Neurology, Carmel Medical Center, Haifa, Israel
| | - Ariel Miller
- Neuroimmunology Unit & Multiple Sclerosis Center, Department of Neurology, Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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6
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Liu Z, Fan T, Mo X, Kan J, Zhang B. Association between multiple sclerosis and cancer risk: A two-sample Mendelian randomization study. PLoS One 2024; 19:e0298271. [PMID: 38502664 PMCID: PMC10950213 DOI: 10.1371/journal.pone.0298271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/22/2024] [Indexed: 03/21/2024] Open
Abstract
Multiple Sclerosis (MS) is an immune-related disease and the relationship between MS and cancer has raised attention. Previous studies of the relationship between MS and cancer have reached conflicting conclusions. In this study, the two-sample MR method is used to investigate whether MS has a causal correlation with cancers and offer scientific evidence for cancer prevention. Single nucleotide polymorphisms (SNPs) related to MS were obtained from the genome-wide association study (GWAS) based on International Multiple Sclerosis Genetics Consortium (IMSGC) and SNPs related to 15 types of cancers were obtained from the GWASs based on UK Biobank. Inverse variance weighted (IVW) method was mainly used to assess causal effects. Sensitivity analyses were conducted with Cochran's Q-test, MR Egger intercept, leave-one-out test, and MR Steiger method. IVW analysis showed that MS was only associated with a marginal increased risk of cervical cancer (OR 1.0004, 95% CI 1.0002-1.0007, p = 0.0003). Sensitivity analyses showed that the results of MR analysis were robust and found no heterogeneity, no pleiotropy, and no reverse causation. In conclusion, this study finds no causal relationship between MS and 15 types of cancers except cervical cancer.
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Affiliation(s)
- Zeyu Liu
- VIP Inpatient Department, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China
| | - Teng Fan
- VIP Inpatient Department, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China
| | - Xiaoyan Mo
- VIP Inpatient Department, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China
| | - Jun Kan
- VIP Inpatient Department, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China
| | - Bei Zhang
- VIP Inpatient Department, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China
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Sanghi P, Luis J, Ajamil S, Yeung IY, Hindle E, Sandhu S, Hassan S, Turner B, Rees A, Westcott M. Predictive Factors for Magnetic Resonance Imaging Changes Suggestive of Demyelination in Adult Patients with Uveitis Scanned Prior to Commencing Adalimumab Therapy. Ocul Immunol Inflamm 2023; 31:1804-1812. [PMID: 36099542 DOI: 10.1080/09273948.2022.2118134] [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: 07/13/2021] [Accepted: 08/23/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To report the predictive clinical factors for abnormal magnetic resonance imaging (MRI) scans suggestive of demyelination by analysis of MRI's performed for adult non-infectious uveitic patients prior to commencing adalimumab therapy. METHODS Retrospective case review of 240 patients was conducted in a single tertiary institution between November 2017 and March 2020. Aetiology of underlying disease, clinical characteristics, and MRI outcomes were analysed. RESULTS The presence of bilateral idiopathic intermediate uveitis (IIU) (p = .0048) and neurological symptoms (p = .028) were highly predictive of an abnormal MRI strongly suggestive of demyelination (MRSSD); 5 out of 64 scans (7.8%) with these clinical characteristics had MRSSD. CONCLUSIONS Tumor necrosis factor antagonist-induced demyelination is a concern in adalimumab use. We propose an MRI screening protocol to identify those at high risk of demyelination; positive results can be maximised by screening all patients with IIU and those with neurological symptoms.
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Affiliation(s)
- Priyanka Sanghi
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Joshua Luis
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Sofia Ajamil
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Ian Yl Yeung
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Edward Hindle
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Selina Sandhu
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Said Hassan
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Ben Turner
- Department of Ophthalmology, Barts Health NHS Trust, London, UK
| | - Angela Rees
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mark Westcott
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Department of Ophthalmology, Barts Health NHS Trust, London, UK
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Asgari N, Ghaemi EA, Naeimi MH, Tahamtan A, Sechi LA, Zamani S. Cross-reactivity between Mycobacterium avium subspecies paratuberculosis 4027 peptide and Human IRF5 may contribute to Multiple Sclerosis in Iranian patients. Heliyon 2023; 9:e22137. [PMID: 38034802 PMCID: PMC10686849 DOI: 10.1016/j.heliyon.2023.e22137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/21/2023] [Accepted: 11/05/2023] [Indexed: 12/02/2023] Open
Abstract
Background The etiology of Multiple sclerosis (MS) is complicated and can be affected by several environmental factors, such as Mycobacterium avium subspecies paratuberculosis (MAP) infection in genetically predisposed individuals. The link between MAP and MS depends on host genetic and epigenetic aspects and population-based features that require further investigation. We aimed to study the possible role of MAP in triggering MS using molecular and serological methods. Materials and methods This case-control study examined 200 blood samples (100 MS patients and 100 HCs) to search for the MAP-specific IS900 gene. In addition, ELISA was conducted to determine the humoral response against MAP_402718-32 and its human IRF5424-434 peptide homolog. Results The frequency of MAP detection based on the molecular method in MS patients and HCs was 48 % and 13 %, respectively (p < 0.0001). The presence of antibodies against MAP_402718-32 and IRF5424-434 was 55 % and 65 % in MS patients versus 9 % and 7 % in HCs, respectively (p < 0.0001). A good correlation was observed between MAP_4027 and IRF5 antibodies (r = 0.5782, p < 0.0001), indicating that the same antibodies recognized common peptide epitopes. Conclusion Our research revealed a significant association between MAP and MS, highlighting the possible role of MAP as an important infection trigger factor of MS. It is hypothesized that cross-reactivity between MAP4027 and IRF5 may dysregulate immune homeostasis.
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Affiliation(s)
- Negar Asgari
- Neuroscience Research Center, Golestan University of Medical Sciences, Gorgan, Iran
- Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ezzat Allah Ghaemi
- Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohammad Hasan Naeimi
- Department of Neurology, Sayyad Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Alireza Tahamtan
- Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Leonardo Antonio Sechi
- Azienda Ospedaliera Universitaria, Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43b, 07100, Sassari, Italy
| | - Samin Zamani
- Neuroscience Research Center, Golestan University of Medical Sciences, Gorgan, Iran
- Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
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Alkolfat F, Said S, Mekky J, Eldeeb H. What an adult multiple sclerosis registry can tell us about pediatric onset multiple sclerosis? Mult Scler Relat Disord 2023; 79:104962. [PMID: 37714097 DOI: 10.1016/j.msard.2023.104962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/05/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is an immune-mediated, chronic disease of the central nervous system that affects mainly adults. However, it is increasingly recognized that MS may start in childhood resulting in a relentlessly progressive disability and cognitive impairment. Registries across the globe are reporting inconstant data about their Pediatric-Onset Multiple Sclerosis (POMS) patients. Moreover, newer lines of treatments are emerging and showing efficacy in controlling the MS disease regardless of the onset. Therefore, there is a requirement for more research into the clinical profile of POMS in different populations and ethnicities. METHODS This study was a cross-sectional study that included MS patients who visited the MS unit at Alexandria University from January 2019 to January 2021. We analyzed their epidemiological, clinical, radiological data, and cerebrospinal fluid (CSF) results from their updated records as well as follow-up interviews. RESULTS Annual Relapse Rate (ARR) was marginally less in POMS than AOMS (0.72 ± 0.57 vs 1.04 ± 0.78 relapse/year, P =.008). POMS patients had a bigger gap to their first relapse (40.0 ± 47.35 vs 22.71 ± 34.33 months, p= .066). The difference in relapse rate between the two groups was abolished after the exclusion of patients who had a gap of more than 5 years to their first relapse. AOMS patients were significantly more likely to start with a second-line disease-modifying treatment (DMT) than POMS patients (11.5% vs 31%, p= .04), whereas POMS patients were more likely to be escalated to the second line (34.6% vs 19.3%, p= .07). ARR had a positive and significant correlation with expanded disability status scale (EDSS) progression per year (rs(24)= .57 p=.003). A Mann-Whitney test indicated that POMS patients who had infratentorial involvement in the initial MRI brain had higher EDSS (3.08 ± 1.99) than POMS who did not (1.07 ± 0.79) U=24 P =.013. IgG index had a significant and positive correlation with annual EDSS progression rate rs (8) = 0.8 p=.001. CONCLUSION Early disease onset does not mean a higher relapse rate when including the full spectrum of POMS and longer follow-up duration. POMS patients relapsed more on the first-line DMT and escalation should be considered early. Infratentorial involvement in the initial magnetic resonance imaging (MRI) brain and high IgG index are potential predictors for aggressive disease course in POMS.
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Affiliation(s)
- Fatma Alkolfat
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Sameh Said
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jaidaa Mekky
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hany Eldeeb
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Tamanini JVG, Sabino JV, Cordeiro RA, Mizubuti V, Villarinho LDL, Duarte JÁ, Pereira FV, Appenzeller S, Damasceno A, Reis F. The Role of MRI in Differentiating Demyelinating and Inflammatory (not Infectious) Myelopathies. Semin Ultrasound CT MR 2023; 44:469-488. [PMID: 37555683 DOI: 10.1053/j.sult.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
Demyelinating and inflammatory myelopathies represent a group of diseases with characteristic patterns in neuroimaging and several differential diagnoses. The main imaging patterns of demyelinating myelopathies (multiple sclerosis, neuromyelitis optica spectrum disorder, acute disseminated encephalomyelitis, and myelin oligodendrocyte glycoprotein antibody-related disorder) and inflammatory myelopathies (systemic lupus erythematosus-myelitis, sarcoidosis-myelitis, Sjögren-myelitis, and Behçet's-myelitis) will be discussed in this article, highlighting key points to the differential diagnosis.
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Affiliation(s)
| | - João Vitor Sabino
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Rafael Alves Cordeiro
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Sao Paulo University, SP, Brazil
| | - Vanessa Mizubuti
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Juliana Ávila Duarte
- Department of Radiology and Diagnostic Imaging, HCPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernanda Veloso Pereira
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Alfredo Damasceno
- Department of Neurology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Fabiano Reis
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
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11
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Bunul SD. Comparing Clinical and Radiological Features in Familial and Sporadic Multiple Sclerosis. Cureus 2023; 15:e44504. [PMID: 37662512 PMCID: PMC10472085 DOI: 10.7759/cureus.44504] [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: 09/01/2023] [Indexed: 09/05/2023] Open
Abstract
Objective To compare the initial presentation, clinical features, disease courses, and radiological parameters between familial multiple sclerosis (fMS) and sporadic multiple sclerosis (sMS) to determine if the two represent distinct clinical entities. Methods This retrospective study was conducted at the Neurology Clinic at Kocaeli University Hospital. Records of 114 fMS and 150 sMS patients, aged 18-65, diagnosed based on either the Poser criteria or the McDonald 2001 criteria were analyzed. Radiological data and Expanded Disability Status Scale (EDSS) evaluations were conducted by a specialist neurologist. Variables included age at MS onset, first symptoms, relapses, EDSS scores at diagnosis and last examination, and MRI findings. Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 28, Armonk, NY) was utilized for data analysis. Results Both fMS and sMS groups were comparable in age (43.55±12.50 and 42.35±10.61 years, respectively) and gender distribution (females: fMS 71.9%, sMS 71.3%). No significant difference was noted regarding disease onset age (fMS 29.83±10.77, sMS 30.42±9.7). Age of onset, final EDSS, and relapse rate didn't significantly vary among sMS, fMS with first-degree relatives having MS (fMS(1)), and fMS with second or third-degree relatives having MS (fMS(2)). The fMS group showed a significantly higher incidence of initial spinal cord lesions on MRI compared to the sMS group (38.6% vs. 17.3%; p<0.001). Within the fMS group, the presence of spinal cord lesions on initial MRI correlated with a higher relapse rate and elevated initial and final EDSS scores. Conclusion Despite overarching similarities between fMS and sMS, spinal cord lesions' prevalence and implications in fMS may point to a genetic underpinning warranting in-depth exploration.
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Faraji F, Mohaghegh P, Talaie A. Epidemiology of familial multiple sclerosis and its comparison to sporadic form in Markazi Province, Iran. Mult Scler Relat Disord 2022; 68:104231. [PMID: 36270251 DOI: 10.1016/j.msard.2022.104231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Limited data have been published about the epidemiology of familial multiple sclerosis (FMS) and its comparison to the sporadic form. Additionally, the epidemiology of FMS varies significantly in numerous provinces of Iran. OBJECTIVES The current study aimed to establish the epidemiology and clinical presentations of FMS and compare this form of the disease to sporadic multiple sclerosis (SMS) in Markazi province, Iran. METHODS In this cross-sectional registry-based study, the data were collected by the Multiple Sclerosis (MS) Society of Markazi province within 2012-2021. The demographic and clinical characteristics, diagnosis, and treatment of the MS patients living in the province were registered in this system. RESULTS A total of 924 MS cases who completed the data about the familial history of MS participated in this study. Based on the results, the female/male ratios were equal to 3.11 and 3.96 in FMS and SMS groups, respectively. Furthermore, 29.4% of the individuals had a history of the disease in their first- to third-degree relatives. The prevalence of primary-progressive multiple sclerosis was higher among the FMS patients (8.5%) than in the SMS patients (4.6%). Along with motor, sphincter, cognitive, and brain stem signs as the onset symptoms, the FMS group experienced a higher rate of polysymptomatic onset (P = 0.000). Moreover, significantly more autoimmune diseases and consanguineous marriages (P = 0.000) were observed in the FMS group than in the SMS group. The individuals with FMS reported a higher mean number of recurrences and higher Expanded Disability Status Scale (EDSS) scores (P = 0.000). CONCLUSION The results showed a significant prevalence of FMS in Markazi province. The FMS and SMS patients were significantly different regarding first presentations, onset symptoms, MS clinical characteristics, and EDSS scores. Finally, consanguineous marriage was significantly more common in the FMS group than in the SMS group.
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Affiliation(s)
- Fardin Faraji
- Department of Neurology, School of Medicine, Arak University of Medical Sciences, Arak, Iran; Traditional and Complementary Medicine Research Center, Arak University of Medical Sciences, Arak, Iran; Applied Neuroscience Research Center, Arak branch, Islamic Azad University, Arak, Iran
| | - Pegah Mohaghegh
- Department of Community Medicine, School of Medicine, Arak University of Medical Sciences, Arak, Iran.
| | - Afsoon Talaie
- Health Department, Arak Branch, Islamic Azad University, Arak, Iran
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13
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Grudziecka Pyrek M, Selmaj K. Optical coherence tomography assessment of axonal and neuronal damage of the retina in patients with familial and sporadic multiple sclerosis. Front Neurol 2022; 13:953188. [PMID: 36188381 PMCID: PMC9524155 DOI: 10.3389/fneur.2022.953188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To assess axonal and neuronal damage of the retina in patients with familial (fMS) and sporadic multiple sclerosis (sMS). Methods 87 relapsing-remitting MS patients (45 patients with sMS, 42 patients with fMS) and 30 healthy controls were included in the study. Optical coherence tomography (OCT) was performed with the spectral domain optical coherence tomography (SD-OCT, Heidelberg Engineering, Germany). The peripapillary retinal nerve fiber layer (pRNFL) thickness, ganglion cell-inner plexiform layer (GCIPL) thickness, total macular volume (TMV) and the inner nuclear layer (INL) thickness were measured. Results A significant reduction of the pRNFL thickness was detected in sMS and fMS compared to the control group (86.29 (+/- 16.13) μm in sMS, 84.78 (+/- 12.92) μm in fMS, 98.93 (+/- 6.71) μm in control group; p < 0.001). There was no significant difference in the pRNFL thickness between sMS and fMS (p = 0.5239). The GCIPL thickness was significantly decreased in sMS and fMS compared to the control group [66.0581 (+/- 11.2674) μm in sMS, 63.8386 (+/-10.004) μm in fMS, 76.5074 (+/- 5.0004) μm in control group; p < 0.001]. A significant reduction of the TMV was shown in sMS and fMS compared to the control group [8.4541(+/- 0.4727) mm3 in sMS, 8.3612 (+/- 0.4448) mm3 in fMS, 8.8387 (+/- 0.314) mm3 in control group; p < 0.0011]. No difference in the GCIPL thickness and TMV between sMS and fMS was found (p = 0.3689 and p = 0.3758, respectively). The INL thickness in sMS and fMS did not differ compared to the control group [34.2323 (+/- 2.7006) μm in sMS, 34.5159 (+/- 2.9780) μm in fMS, 33.6148 (+/- 2.0811) μm in control group; p = 0.5971 and p = 0.1870, respectively] and between the two forms (p = 0.4894). Conclusion We confirmed the presence of axonal and neuronal damage of the retina in sMS and fMS. Both forms of MS did not differ significantly from each other with respect to RFNL, GCIPL, MV and INL. ON induced significant reduction of the pRNFL, GCIPL and MV in both groups of pwMS.
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Affiliation(s)
| | - Krzysztof Selmaj
- Department of Neurology, University of Warmia and Mazury, Olsztyn, Poland
- Centrum of Neurology, Lodz, Poland
- *Correspondence: Krzysztof Selmaj
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14
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Özer D, Emine Ata E, DİkeÇ G, Demİr S. The relationship between stress, anxiety, and depression levels and pseudobulbar affect in patients with Multiple Sclerosis. Contemp Nurse 2022; 58:317-329. [PMID: 35880717 DOI: 10.1080/10376178.2022.2107037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Pseudobulbar affect (PBA) has recently been added to the list of mental disorders commonly observed in patients with Multiple Sclerosis (MS). The emotional changes experienced by MS patients may be associated with other mental problems and adversely affect disease prognosis. However, there are limited studies in the international and national literature on this subject. AIM This study aimed to evaluate the relationship between PBA and stress, anxiety, and depression levels in patients with MS. DESIGN This is a descriptive, relational, and cross-sectional study. METHODS A total of 442 MS patients followed in the neurology outpatient clinic of a hospital and registered with the MS Society in Turkey participated in this study. Data were collected using a personal information form, the Turkish version of the Center for Neurologic Study-Lability Scale (CNS-LS), and the Depression Anxiety Stress Scale (DASS). RESULTS In this study, 63.3% of the patients had PBA, 21% had extremely severe depression, 41.6% had extremely severe anxiety, and 24.9% had severe stress. Correlation analysis revealed weak positive correlations between CNS-LS total score and DASS subscale and total scores. Depression, anxiety, and stress levels accounted for 22.5% of the variation in CNS-LS total score. CONCLUSION The results of this study indicate that a majority of MS patients in Turkey experience PBA, depression, anxiety, and stress, and that PBA is positively associated with depression, anxiety, and stress. IMPACT STATEMENT This study, indicates that should be increased consultation-liaison psychiatry services in Turkey, and MS patients should benefit from comprehensive psychiatric services.
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Affiliation(s)
- Duygu Özer
- MsN, PhD Candidate, University of Health Sciences, Sultan II. Abdulhamid Han Training and Research Hospital, Department of Psychiatry, Istanbul, Turkey
| | - Elvan Emine Ata
- Assis. Prof., University of Health Sciences, Hamidiye Faculty of Nursing, Department of Psychiatric Nursing, Istanbul, Turkey. E-mail:
| | - Gül DİkeÇ
- Assoc. Prof., Fenerbahce University, Faculty of Health Sciences, Department of Nursing, Istanbul, Turkey. E-mail:
| | - Serkan Demİr
- Assoc. Prof., MD, Department of Neurology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey. E-mail:
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Nefodov OO, Belenichev IF, Fedchenko MP, Popazova OO, Ryzhenko VP, Morozova OV. Evaluation of methods of modeling and formation of experimental allergic encephalomyelitis. RESEARCH RESULTS IN PHARMACOLOGY 2022. [DOI: 10.3897/rrpharmacology.8.77361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Experimental autoimmune (allergic) encephalomyelitis (EAE) induced by intradermal injection of homogenate of the brain, spinal cord and peripheral nerve with Freund’s stimulator, refers to a true autoimmune disease of the nervous system.
Materials and methods: Experimental studies were conducted on white nonlinear rats. To induce experimental allergic encephalomyelitis (EAE), homologous brain homogenates was used, which leads among other drugs (homologous, heterogeneous brain and spinal cord homogenates) by encephalitogenity. The connective tissue of the animal’s tail base was injected with a mixture of encephalitogenic suspension of 0.1 ml per 100 g of the body weight.
Results and discussion: According to the results, in the rats, there was weight loss, and the abnormal neurological symptoms were found on an average of 10–12th days. Our experimental studies on the formation of EAE were confirmed morphologically by electron microscopy.
Conclusion: Thus, the use of this technique allowed us to obtain a simulated pathologic condition of multiple sclerosis in the form of experimental allergic encephalomyelitis and can be used in future studies to identify appropriate laws, the extent and nature of changes in the immune and nervous systems of the body when inducing experimental pathological conditions.
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16
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Arji G, Rezaeizadeh H, Moghadasi AN, Sahraian MA, Karimi M, Alizadeh M. Complementary and alternative therapies in multiple sclerosis: a systematic literature classification and analysis. Acta Neurol Belg 2022; 122:281-303. [PMID: 35060096 DOI: 10.1007/s13760-021-01847-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIM Multiple Sclerosis (MS) is a disease determined by inflammatory demyelination and neurodegeneration in the Central Nervous System (CNS). Despite the extensive utilization of Complementary and Alternative Medicine (CAM) in MS, there is a need to have comprehensive evidence regarding their application in the management of MS symptoms. This manuscript is a Systematic Literature Review and classification (SLR) of CAM therapies for the management of MS symptoms based on the International Classification of Functioning Disability and Health (ICF) model. METHOD Studies published between 1990 and 2020 IN PubMed, Science Direct, Scopus, Pro-Quest, and Google Scholar using CAM therapies for the management of MS symptoms were analyzed. RESULTS Thirty-one papers on the subject were analyzed and classified. The findings of this review clearly show that mindfulness, yoga, and reflexology were frequently used for managing MS symptoms. Moreover, most of the papers used mindfulness and yoga as a CAM therapy for the management of MS symptoms, which mostly devoted to mental functions such as fatigue, depression, cognition, neuromuscular functions such as gait, muscle strength, and spasticity, and sensory function such as balance, in addition to, reflexology is vastly used to management of mental functions of MS patients. CONCLUSION Evidence suggested that CAM therapies in patients with MS have the potential to target and enhancement numerous elements outlined in the ICF model. Although the use of CAM therapies in MS symptom management is promising, there is a need for strict clinical trials. Future research direction should concentrate on methodologically powerful studies to find out the potential efficacy of CAM intervention.
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Affiliation(s)
- Goli Arji
- School of Nursing and Midwifery, Health Information Technology Department, Saveh University of Medical Sciences, Saveh, Iran
| | - Hossein Rezaeizadeh
- Department of Persian Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Abdolrreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Karimi
- Department of Persian Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Mojtaba Alizadeh
- Department of Computer Engineering, Lorestan University, Khorramabad, Iran.
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17
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Salehi Z, Almasi-Hashiani A, Sahraian MA, Ashtari F, Baghbanian SM, Razazian N, Moghadasi AN, Bayati A, Azimi AR, Beladimoghadam N, Harirchian MH, Poursadeghfard M, Navardi S, Shirkoohi R, Heidari H, Ghaffari M, Eskandarieh S. Epidemiology of familial multiple sclerosis in Iran: a national registry-based study. BMC Neurol 2022; 22:76. [PMID: 35248009 PMCID: PMC8897924 DOI: 10.1186/s12883-022-02609-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Admittedly, little is known about the epidemiological signatures of familial multiple sclerosis (FMS) in different geographical regions of Iran. Objective To determine the epidemiology and the risk of FMS incidence in several provinces of Iran with a different ethnic population including, Fars, Tehran, Isfahan (Persians), and Mazandaran (Mazanis), Kermanshah (Kurds), and Chaharmahal and Bakhtiari (Lors). Methods This cross-sectional registry-based study was performed on nationwide MS registry of Iran (NMSRI) data collected from 2018 to 2021. This system, registers baseline characteristics, clinical presentations and symptoms, diagnostic and treatments at regional and national levels. Results A total of 9200 patients including, 7003 (76.1%) female and 2197 (23.9%) male, were participated. About 19% of patients reported a family history of MS; the order from highest to lowest FMS prevalence was as follows: Fars (26.5%), Chaharmahal and Bakhtiari (21.1%), Tehran (20.5%), Isfahan (20.3%), Mazandaran (18.0%), and Kermanshah (12.5%). Of all FMS cases, 74.7% (1308 cases) were female and 25.3% (442 cases) were male. FMS occurrence was much more common in females than males (P-value = 0.001). Further, the mean age at onset was 30 years among FMS cases. A substantially higher probability of relapsing-remitting MS and secondary-progressive MS was found among FMS cases than sporadic MS (SMS) (P_value = 0.001). There was no significant difference in Expanded Disability Status Scale (EDSS) scores between FMS and SMS. The majority of FMS cases were observed among first-degree relatives, with the highest rate in siblings. There was a significant association between MS risk and positive familial history in both maternal and paternal aunt/uncle (P_value = 0.043 and P_value = 0.019, respectively). Multiple sclerosis occurrence among offspring of females was higher than males (P_value = 0.027). Conclusions In summary, our findings imply a noteworthy upward trend of FMS in Iran, even more than the global prevalence, which suggests a unique Atlas of FMS prevalence in this multi-ethnic population. Despite the highest rate of FMS within Persian and Lor ethnicities, no statistically significant difference was observed among the provinces.
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18
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Shafin N, Ismail CAN, Mustafa MZ, Ghani N, Ahmad AH, Othman Z, Wijaya A, Zakaria R. Thematic analysis of multiple sclerosis research by enhanced strategic diagram. Mult Scler 2022; 28:2160-2170. [PMID: 35164590 DOI: 10.1177/13524585221075542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent interest in multiple sclerosis research warrants literature analysis to evaluate the current state of the discipline and new research domains. This bibliometric review summarised the research trends and analysed research areas in multiple sclerosis over the last decade. The documents containing the term 'multiple sclerosis' in the article title were retrieved from the Scopus database. We used Harzing's Publish or Perish and VOSviewer for citation analysis and data visualisation, respectively. We found a total of 18,003 articles published in journals in the English language between 2012 and 2021. The emerging keywords identified utilising the enhanced strategic diagram were 'covid-19', 'teriflunomide', 'clinical trial', 'microglia', 'b cells', 'myelin', 'brain', 'white matter', 'functional connectivity', 'pain', 'employment', 'health-related quality of life', 'meta-analysis' and 'comorbidity'. This study demonstrates the tremendous growth of multiple sclerosis literature worldwide, which is expected to grow more than double during the next decade especially in the identified emerging topics.
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Affiliation(s)
| | | | | | - Nurhafizah Ghani
- School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Asma Hayati Ahmad
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Zahiruddin Othman
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Adi Wijaya
- Department of Health Information Management, STIKES Indonesia Maju, Jakarta, Indonesia
| | - Rahimah Zakaria
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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19
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Genetics and familial distribution of multiple sclerosis: A review. Rev Neurol (Paris) 2022; 178:512-520. [DOI: 10.1016/j.neurol.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/30/2021] [Accepted: 11/04/2021] [Indexed: 11/18/2022]
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20
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Abuawad M, Ziyadeh-Isleem A, Alkaiyat A, Ziyadeh J, Afifi B, Saidi M, Sous A. Epidemiology of multiple sclerosis in West bank of Palestine. Mult Scler Relat Disord 2022; 59:103686. [DOI: 10.1016/j.msard.2022.103686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/21/2022] [Accepted: 02/11/2022] [Indexed: 02/07/2023]
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21
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Razazian N, Eskandarieh S, Siabani S, Afshari D, Sahraian MA, Khezri O, Rezaei M, Fakhri N. Prevalence of Multiple sclerosis and its clinical and demographic characteristics in Kurdish populations in western Iran (2020). Mult Scler Relat Disord 2021; 57:103441. [PMID: 34896874 DOI: 10.1016/j.msard.2021.103441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a costly burdensome nervous system disorder leading several disabilities in young and middle-aged people. Knowing MS clinical, epidemiologic and demographic characteristics may help to estimate and predict the required health services and medication facilities for the affected people. This study was aimed to determine the prevalence of MS and its demographic characteristic in about 2 million Kurdish populations in western Iran in 2020. METHODS This cross-sectional study was conducted in 2020 on MS patients with Kurdish Ethnicity living in Kermanshah /western Iran which is a Mountainous area in. MS patients were registered and recruited to this study from several centers. The settings have been approved by the nationwide MS registry of Iran (NMSRI). Using two questioners, a questionnaire included sex, age, the age in which the MS symptoms onset, the age of diagnosis, family history of MS, and type of MS, and second one was the Expanded Disability Status Scale (EDSS) checklist. The demographic information of Kermanshah province was adopted from the Statistical Center of Iran. In addition to descriptive statistics, U-Mann-Whitney and Chi-square tests were also used. RESULTS A total of 1557 MS patients with a mean age (±SD) of 38.66 ± 9.9 years were recruited in this study. Of them, 1216 (78.1%) were female. The majority of patients, 300 patients (19.3%), were in the age range 35-39 years, and the highest prevalence (184.82 per 100,000 populations) was observed in the age range 40-44 years. The prevalence of MS in Kermanshah province is estimated 79.50 per 100,000 people, 125.71 per 100,000 in female and 34.41 per 100,000 in male. This prevalence was higher in female (female to male was 3.65 to 1). The EDSS score was significantly higher in male than in female (3.06 ± 2.2 in male versus 2.42 ± 1.8 in female) (p = 0.001). The type of MS was significantly different between male and female, so that SPMS and PPMS were more common in male (31(10.3%), 22(7.3%)) than female (81(7.5%), 39(3.6%)) (p = 0.012). A positive family history of MS was found in 12.6% of patients. CONCLUSION Given the information about prevalence of MS in Kermanshah (in 2012), the prevalence of MS in Kermanshah has increased during last decade. MS disabilities were more extensive in male rather than female.
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Affiliation(s)
- Nazanin Razazian
- Professor, Department of Neurology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soraya Siabani
- Department of Health Promotion and Health Education, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran; Public health, Health school, University of Technology Sydney (UTS)
| | - Daryoush Afshari
- Associate, Department of Neurology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad-Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Orkideh Khezri
- Neurologist, Department of Neurology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mansour Rezaei
- Professor, Biostatistics Department, Social Development and Health Promotion Research Center, Kermanshah University of medical sciences, Kermanshah, Iran
| | - Negin Fakhri
- Master, Department of Biostatistics, Student's research committee, Faculty of Health, Kermanshah University of medical sciences, Kermanshah, Iran.
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Barizzone N, Cagliani R, Basagni C, Clarelli F, Mendozzi L, Agliardi C, Forni D, Tosi M, Mascia E, Favero F, Corà D, Corrado L, Sorosina M, Esposito F, Zuccalà M, Vecchio D, Liguori M, Comi C, Comi G, Martinelli V, Filippi M, Leone M, Martinelli-Boneschi F, Caputo D, Sironi M, Guerini FR, D’Alfonso S. An Investigation of the Role of Common and Rare Variants in a Large Italian Multiplex Family of Multiple Sclerosis Patients. Genes (Basel) 2021; 12:1607. [PMID: 34681001 PMCID: PMC8535321 DOI: 10.3390/genes12101607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/26/2021] [Accepted: 10/01/2021] [Indexed: 12/30/2022] Open
Abstract
Known multiple sclerosis (MS) susceptibility variants can only explain half of the disease's estimated heritability, whereas low-frequency and rare variants may partly account for the missing heritability. Thus, here we sought to determine the occurrence of rare functional variants in a large Italian MS multiplex family with five affected members. For this purpose, we combined linkage analysis and next-generation sequencing (NGS)-based whole exome and whole genome sequencing (WES and WGS, respectively). The genetic burden attributable to known common MS variants was also assessed by weighted genetic risk score (wGRS). We found a significantly higher burden of common variants in the affected family members compared to that observed among sporadic MS patients and healthy controls (HCs). We also identified 34 genes containing at least one low-frequency functional variant shared among all affected family members, showing a significant enrichment in genes involved in specific biological processes-particularly mRNA transport-or neurodegenerative diseases. Altogether, our findings point to a possible pathogenic role of different low-frequency functional MS variants belonging to shared pathways. We propose that these rare variants, together with other known common MS variants, may account for the high number of affected family members within this MS multiplex family.
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Affiliation(s)
- Nadia Barizzone
- Department of Health Sciences, CAAD (Center for Translational Research on Autoimmune and Allergic Diseases), University of Eastern Piedmont, 28100 Novara, Italy; (C.B.); (M.T.); (L.C.); (M.Z.)
| | - Rachele Cagliani
- Bioinformatics, Scientific Institute IRCCS E.MEDEA, 23842 Bosisio Parini, Italy; (R.C.); (D.F.); (M.S.)
| | - Chiara Basagni
- Department of Health Sciences, CAAD (Center for Translational Research on Autoimmune and Allergic Diseases), University of Eastern Piedmont, 28100 Novara, Italy; (C.B.); (M.T.); (L.C.); (M.Z.)
| | - Ferdinando Clarelli
- Laboratory of Genetics of Neurological Complex Disorders, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (F.C.); (E.M.); (M.S.); (F.E.)
| | - Laura Mendozzi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (L.M.); (C.A.); (D.C.); (F.R.G.)
| | - Cristina Agliardi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (L.M.); (C.A.); (D.C.); (F.R.G.)
| | - Diego Forni
- Bioinformatics, Scientific Institute IRCCS E.MEDEA, 23842 Bosisio Parini, Italy; (R.C.); (D.F.); (M.S.)
| | - Martina Tosi
- Department of Health Sciences, CAAD (Center for Translational Research on Autoimmune and Allergic Diseases), University of Eastern Piedmont, 28100 Novara, Italy; (C.B.); (M.T.); (L.C.); (M.Z.)
| | - Elisabetta Mascia
- Laboratory of Genetics of Neurological Complex Disorders, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (F.C.); (E.M.); (M.S.); (F.E.)
| | - Francesco Favero
- Department of Translational Medicine, CAAD (Center for Translational Research on Autoimmune and Allergic Diseases), University of Eastern Piedmont, 28100 Novara, Italy; (F.F.); (D.C.)
| | - Davide Corà
- Department of Translational Medicine, CAAD (Center for Translational Research on Autoimmune and Allergic Diseases), University of Eastern Piedmont, 28100 Novara, Italy; (F.F.); (D.C.)
| | - Lucia Corrado
- Department of Health Sciences, CAAD (Center for Translational Research on Autoimmune and Allergic Diseases), University of Eastern Piedmont, 28100 Novara, Italy; (C.B.); (M.T.); (L.C.); (M.Z.)
| | - Melissa Sorosina
- Laboratory of Genetics of Neurological Complex Disorders, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (F.C.); (E.M.); (M.S.); (F.E.)
| | - Federica Esposito
- Laboratory of Genetics of Neurological Complex Disorders, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (F.C.); (E.M.); (M.S.); (F.E.)
| | - Miriam Zuccalà
- Department of Health Sciences, CAAD (Center for Translational Research on Autoimmune and Allergic Diseases), University of Eastern Piedmont, 28100 Novara, Italy; (C.B.); (M.T.); (L.C.); (M.Z.)
| | - Domizia Vecchio
- Department of Translational Medicine, IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), University of Eastern Piedmont, 28100 Novara, Italy; (D.V.); (C.C.)
| | - Maria Liguori
- Institute of Biomedical Technologies, Bari Unit, National Research Council, 70126 Bari, Italy;
| | - Cristoforo Comi
- Department of Translational Medicine, IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), University of Eastern Piedmont, 28100 Novara, Italy; (D.V.); (C.C.)
| | - Giancarlo Comi
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.C.); (M.F.)
| | - Vittorio Martinelli
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Massimo Filippi
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.C.); (M.F.)
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Maurizio Leone
- Dipartimento di Emergenza e Area Critica, UO Neurologia, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy;
| | - Filippo Martinelli-Boneschi
- Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, Neuroscience Section, University of Milan, 20122 Milan, Italy;
- Neurology Unit and MS Centre, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Domenico Caputo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (L.M.); (C.A.); (D.C.); (F.R.G.)
| | - Manuela Sironi
- Bioinformatics, Scientific Institute IRCCS E.MEDEA, 23842 Bosisio Parini, Italy; (R.C.); (D.F.); (M.S.)
| | - Franca Rosa Guerini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (L.M.); (C.A.); (D.C.); (F.R.G.)
| | - Sandra D’Alfonso
- Department of Health Sciences, CAAD (Center for Translational Research on Autoimmune and Allergic Diseases), University of Eastern Piedmont, 28100 Novara, Italy; (C.B.); (M.T.); (L.C.); (M.Z.)
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Algahtani H, Shirah B, Khafaji R, Algahtani S. Novel Heterozygous Variants in the HLA-DRB1 Gene in a Saudi Family with Early-Onset Familial Multiple Sclerosis: Therapeutic Failure and Success. Int J MS Care 2021; 24:100-103. [DOI: 10.7224/1537-2073.2020-125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Multiple sclerosis (MS) is a chronic neurodegenerative disease that affects the central nervous system. Familial MS is arbitrarily defined as a type of MS that runs in families with one or more first- to third-degree relatives in addition to the index case affected by MS. The aim of this article is to report a unique case of familial MS from Saudi Arabia with two novel variants in the HLA-DRB1 gene that may contribute to the pathogenesis. We observed an unfavorable response to interferon therapy and successful treatment using fingolimod therapy. This observation needs further study, including whether this lack of response is really specific to interferon treatment or possibly a chance occurrence. This family work-up illustrates the importance of genetic testing in identifying variants associated with familial MS, especially if more than two members of the same family are affected. Although this genetic tool is used mainly for research purposes, it had clinical implications for our patient, including the appropriate selection of disease-modifying therapy and prognostic counseling. Further large-scale studies are needed to expand the genetic spectrum of familial MS with clinical and pharmacologic correlation.
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Affiliation(s)
- Hussein Algahtani
- From the King Abdulaziz Medical City/King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia (HA)
| | - Bader Shirah
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia (BS)
| | - Randa Khafaji
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia (RK)
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Moghadam NB, Ghaffari M, Rashed SS, Valaie N, Hesami O, Niloofar P, Ghazanfari Y. MRI but not demographic or clinical characteristics differ between familial and sporadic MS cases. Mult Scler Relat Disord 2021; 56:103235. [PMID: 34678703 DOI: 10.1016/j.msard.2021.103235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/20/2021] [Accepted: 08/31/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic immune-mediated demyelinating disease. The prevalence and incidence of MS in Iran is high and is rising over time. This study was conducted to compare the demographic, clinical features and MRI findings of MS patients with history of the disease in the first-degree family members (fMS) with sporadic MS patients (sMS) to determine the importance of genetic or non-genetic factors in the development of the disease and its effect in diagnostic and therapeutic modalities. METHODS Among the 185 patients admitted to the study, 62 were fMS patients and 123 were sMS patients. All patients underwent clinical examination and data was gathered on age, sex, age of onset, symptoms, number of attacks, disease course, family history, disease-modifying drugs, and other accompanying diseases as well as MRI findings and EDSS scores. RESULTS In this study, we demonstrated that the frequency of plaques in the periventricular area was significantly higher in sMS patients (97.56% vs 88.71%, p = 0.01) while the callosal plaques were more common in fMS patients (62.9% vs 47.97%, p = 0.05) which was statistically borderline and nonsignificant. In other evaluated parameters, no significant difference was observed. CONCLUSION In our study, no significant difference was observed between the demographic and clinical characteristics of fMS and sMS patients, while there was a significant difference between the two groups in MRI findings.
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Affiliation(s)
- Nahid Beladi Moghadam
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehran Ghaffari
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saba Sadeghi Rashed
- Department of Biology, Faculty of Sciences, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Naser Valaie
- Department of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Hesami
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parastoo Niloofar
- Clinical Research Development Unit of Imam Hassan Hospital, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Yalda Ghazanfari
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Gharaylou Z, Sahraian MA, Hadjighassem M, Kohanpour M, Doosti R, Nahardani S, Moghadasi AN. Widespread Disruptions of White Matter in Familial Multiple Sclerosis: DTI and NODDI Study. Front Neurol 2021; 12:678245. [PMID: 34484098 PMCID: PMC8415561 DOI: 10.3389/fneur.2021.678245] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022] Open
Abstract
Diffusion tensor imaging (DTI) is a noninvasive, quantitative MRI technique that measures white matter (WM) integrity. Many brain dimensions are heritable, including white matter integrity measured with DTI. Family studies are valuable to provide insights into the interactive effects of non-environmental factors on multiple sclerosis (MS). To examine the contribution of familial factors to the diffusion signals across WM microstructure, we performed DTI and calculated neurite orientation dispersion plus density imaging (NODDI) diffusion parameters in two patient groups comprising familial and sporadic forms of multiple sclerosis and their unaffected relatives. We divided 111 subjects (49 men and 62 women: age range 19-60) into three groups conforming to their MS history. The familial MS group included 30 participants (patients; n = 16, healthy relatives; n = 14). The sporadic group included 41 participants (patients; n = 10, healthy relatives; n = 31). Forty age-matched subjects with no history of MS in their families were defined as the control group. To study white matter integrity, two methods were employed: one for calculating the mean of DTI, FA, and MD parameters on 18 tracts using Tracts Constrained by Underlying Anatomy (TRACULA) and the other for whole brain voxel-based analysis using tract-based spatial statistics (TBSS) on NDI and ODI parameters derived from NODDI and DTI parameters. Voxel-based analysis showed considerable changes in FA, MD, NDI, and ODI in the familial group when compared with the control group, reflecting widespread impairment of white matter in this group. The analysis of 18 tracts with TRACULA revealed increased MD and FA reduction in more tracts (left and right ILF, UNC, and SLFT, forceps major and minor) in familial MS patients vs. the control group. There were no significant differences between the patient groups. We found no consequential changes in healthy relatives of both patient groups in voxel-based and tract analyses. Considering the multifactorial etiology of MS, familial studies are of great importance to clarify the effects of certain predisposing factors on demyelinating brain pathology.
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Affiliation(s)
- Zeinab Gharaylou
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoudreza Hadjighassem
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Kohanpour
- Neuroimaging and Analysis Group (NIAG), Research Center for Molecular and Cellular Imaging, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rozita Doosti
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Nahardani
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Shoeibi A, Khodatars M, Jafari M, Moridian P, Rezaei M, Alizadehsani R, Khozeimeh F, Gorriz JM, Heras J, Panahiazar M, Nahavandi S, Acharya UR. Applications of deep learning techniques for automated multiple sclerosis detection using magnetic resonance imaging: A review. Comput Biol Med 2021; 136:104697. [PMID: 34358994 DOI: 10.1016/j.compbiomed.2021.104697] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 11/18/2022]
Abstract
Multiple Sclerosis (MS) is a type of brain disease which causes visual, sensory, and motor problems for people with a detrimental effect on the functioning of the nervous system. In order to diagnose MS, multiple screening methods have been proposed so far; among them, magnetic resonance imaging (MRI) has received considerable attention among physicians. MRI modalities provide physicians with fundamental information about the structure and function of the brain, which is crucial for the rapid diagnosis of MS lesions. Diagnosing MS using MRI is time-consuming, tedious, and prone to manual errors. Research on the implementation of computer aided diagnosis system (CADS) based on artificial intelligence (AI) to diagnose MS involves conventional machine learning and deep learning (DL) methods. In conventional machine learning, feature extraction, feature selection, and classification steps are carried out by using trial and error; on the contrary, these steps in DL are based on deep layers whose values are automatically learn. In this paper, a complete review of automated MS diagnosis methods performed using DL techniques with MRI neuroimaging modalities is provided. Initially, the steps involved in various CADS proposed using MRI modalities and DL techniques for MS diagnosis are investigated. The important preprocessing techniques employed in various works are analyzed. Most of the published papers on MS diagnosis using MRI modalities and DL are presented. The most significant challenges facing and future direction of automated diagnosis of MS using MRI modalities and DL techniques are also provided.
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Affiliation(s)
- Afshin Shoeibi
- Faculty of Electrical Engineering, Biomedical Data Acquisition Lab (BDAL), K. N. Toosi University of Technology, Tehran, Iran.
| | - Marjane Khodatars
- Faculty of Engineering, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Mahboobeh Jafari
- Electrical and Computer Engineering Faculty, Semnan University, Semnan, Iran
| | - Parisa Moridian
- Faculty of Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mitra Rezaei
- Electrical and Computer Engineering Dept., Tarbiat Modares University, Tehran, Iran
| | - Roohallah Alizadehsani
- Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Geelong, Australia
| | - Fahime Khozeimeh
- Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Geelong, Australia
| | - Juan Manuel Gorriz
- Department of Signal Theory, Networking and Communications, Universidad de Granada, Spain; Department of Psychiatry. University of Cambridge, UK
| | - Jónathan Heras
- Department of Mathematics and Computer Science, University of La Rioja, La Rioja, Spain
| | | | - Saeid Nahavandi
- Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Geelong, Australia
| | - U Rajendra Acharya
- Department of Biomedical Engineering, School of Science and Technology, Singapore University of Social Sciences, Singapore; Dept. of Electronics and Computer Engineering, Ngee Ann Polytechnic, 599489, Singapore; Department of Bioinformatics and Medical Engineering, Asia University, Taiwan
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Ehtesham N, Rafie MZ, Mosallaei M. The global prevalence of familial multiple sclerosis: an updated systematic review and meta-analysis. BMC Neurol 2021; 21:246. [PMID: 34182943 PMCID: PMC8237453 DOI: 10.1186/s12883-021-02267-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/03/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Considering that many recent studies have reported the prevalence of familial multiple sclerosis (FMS), we performed an updated meta-analysis of the worldwide prevalence of FMS by the addition of recent publications. METHODS A search in PubMed, Scopus, the ISI Web of Science, and Google Scholar was undertaken up to 20 December 2020. The inclusion criteria were based on the CoCoPop approach (condition, context, and population). Meta-analysis of the qualified studies was conducted by comprehensive meta-analysis ver. 2 software. RESULTS The pooled prevalence of MS in relatives of 16,179 FMS cases was estimated to be 11.8% (95% CI: 10.7-13) based on a random-effects model. The pooled mean age of disease onset in adult probands was calculated to be 28.7 years (95% CI: 27.2 ± 30.2). Regarding 13 studies that reported the data of FMS in pediatrics (n = 877) and adults (n = 6636), the FMS prevalence in pediatrics and adults was 15.5% (95% CI: 13.8-17.4) and 10.8% (95% CI: 8.1-14.2), respectively. The prevalence of FMS in affected males (n = 5243) and females (n = 11,503) was calculated to be 13.7% (95% CI: 10.1-18.2) and 15.4% (95% CI: 10.3-22.4), respectively. The odds ratio of male/female in FMS cases was not statistically significant (OR = 0.9; 95% CI: 0.6-1.2, P = 0.55). Subgroup analysis demonstrated a significant difference in the prevalence of FMS between the geographical areas (P = 0.007). The meta-regression model indicated that the prevalence of FMS is lower with higher latitude and higher MS prevalence (P < 0.001). In contrast, meta-regression based on prevalence day was not statistically significant (P = 0.29). CONCLUSIONS The prevalence of FMS is higher in the pediatric group than that of adults, distinct between geographical areas, and diminishes with the increment of MS prevalence and latitude. Also, the symptoms initiate relatively at younger ages in the FMS cases. Interestingly, our analysis unveiled that FMS is not more prevalent in men than women and the risk of MS development in relatives is not higher when the affected proband is male.
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Affiliation(s)
- Naeim Ehtesham
- Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Koodakyar Alley, Daneshjoo Blvd., Evin St, Tehran, Iran.
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Maryam Zare Rafie
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Meysam Mosallaei
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Jamal I, Shah J, Mativo P, Hooker J, Wallin M, Sokhi DS. Multiple sclerosis in Kenya: Demographic and clinical characteristics of a registry cohort. Mult Scler J Exp Transl Clin 2021; 7:20552173211022782. [PMID: 34188951 PMCID: PMC8209835 DOI: 10.1177/20552173211022782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background Multiple Sclerosis (MS) is the leading cause of non-traumatic neurological disability in young adults. There is limited literature regarding the burden of MS in sub-Saharan Africa (SSA). Objective To describe the demographic and clinical characteristics of patients with MS (PwMS) presenting to a tertiary referral hospital in Nairobi. Methods We conducted a retrospective descriptive study for PwMS presenting to Aga Khan University Hospital, Nairobi from 2008–2018. Results 99 cases met the diagnostic criteria for MS with a male to female ratio of 1:4. Majority (68.7%) of PwMS were indigenous Africans with a mean age of onset of 30.7 years. Mean duration from symptom onset to first neuro-imaging was 5.04 years. Only 33% of patients had sensory symptoms at onset whereas 54.5% had vitamin D deficiency/insufficiency. Majority (79.5%) had relapsing remitting MS (RRMS) and 56.6% were initiated on disease modifying therapy (DMT). Only 21.2% of patients on DMT were non-compliant. Patients with RRMS were more likely to be initiated on DMT at our hospital (p < 0.001). Conclusion Clinical characteristics of these patients largely resemble those of other SSA cohorts and African American patients. There was a delay between symptom onset and neuroimaging. There were also issues with DMT compliance.
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Affiliation(s)
- Imran Jamal
- Aga Khan University Medical College of East Africa, Faculty of Health Sciences, The Aga Khan University Hospital, Nairobi, Kenya
| | - Jasmit Shah
- Aga Khan University Medical College of East Africa, Faculty of Health Sciences, The Aga Khan University Hospital, Nairobi, Kenya
| | - Peter Mativo
- Aga Khan University Medical College of East Africa, Faculty of Health Sciences, The Aga Khan University Hospital, Nairobi, Kenya
| | - Juzar Hooker
- Aga Khan University Medical College of East Africa, Faculty of Health Sciences, The Aga Khan University Hospital, Nairobi, Kenya
| | - Mitchell Wallin
- Department of Veterans Affairs Multiple Sclerosis Centre of Excellence - East, Washington, DC, USA
| | - Dilraj Singh Sokhi
- Aga Khan University Medical College of East Africa, Faculty of Health Sciences, The Aga Khan University Hospital, Nairobi, Kenya
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Exome sequencing reveals novel rare variants in Iranian familial multiple sclerosis: The importance of POLD2 in the disease pathogenesis. Genomics 2021; 113:2645-2655. [PMID: 34116171 DOI: 10.1016/j.ygeno.2021.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/20/2021] [Accepted: 06/06/2021] [Indexed: 02/07/2023]
Abstract
The prevalence of familial multiple sclerosis (FMS) is increasing worldwide which endorses the heritability of the disease. Given that many genome variations are ethnicity-specific and consanguineous marriage could affect genetic diseases, hereditary disease gene analysis among FMS patients from Iran, a country with high rates of parental consanguinity, could be highly effective in finding mutations underlying disease pathogenesis. To examine rare genetic mutations, we selected three Iranian FMS cases with ≥3 MS patients in more than one generation and performed whole exome sequencing. We identified a homozygous rare missense variant in POLD2 (p. Arg141Cys; rs372336011). Molecular dynamics analysis showed reduced polar dehydration energy and conformational changes in POLD2 mutant. Further, we found a heterozygote rare missense variant in NBFP1 (p. Gly487Asp; rs778806175). Our study revealed the possible role of novel rare variants in FMS. Molecular dynamic simulation provided the initial evidence of the structural changes behind POLD2 mutant.
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30
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Exome Sequencing Analysis of Familial Cases of Multiple Sclerosis and a Monozygotic Discordant Twin. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2021. [DOI: 10.1007/s13369-020-05242-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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31
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Hartmann M, Fenton N, Dobson R. Current review and next steps for artificial intelligence in multiple sclerosis risk research. Comput Biol Med 2021; 132:104337. [PMID: 33773193 DOI: 10.1016/j.compbiomed.2021.104337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/30/2022]
Abstract
In the last few decades, the prevalence of multiple sclerosis (MS), a chronic inflammatory disease of the nervous system, has increased, particularly in Northern European countries, the United States, and United Kingdom. The promise of artificial intelligence (AI) and machine learning (ML) as tools to address problems in MS research has attracted increasing interest in these methods. Bayesian networks offer a clear advantage since they can integrate data and causal knowledge allowing for visualizing interactions between dependent variables and potential confounding factors. A review of AI/ML research methods applied to MS found 216 papers using terms "Multiple Sclerosis", "machine learning", "artificial intelligence", "Bayes", and "Bayesian", of which 90 were relevant and recently published. More than half of these involve the detection and segmentation of MS lesions for quantitative analysis; however clinical and lifestyle risk factor assessment and prediction have largely been ignored. Of those that address risk factors, most provide only association studies for some factors and often fail to include the potential impact of confounding factors and bias (especially where these have causal explanations) that could affect data interpretation, such as reporting quality and medical care access in various countries. To address these gaps in the literature, we propose a causal Bayesian network approach to assessing risk factors for MS, which can address deficiencies in current epidemiological methods of producing risk measurements and makes better use of observational data.
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Affiliation(s)
- Morghan Hartmann
- Risk and Information Management Research Group, School of Electronic Engineering and Computer Science, Queen Mary University of London, London, E1 4NS, UK.
| | - Norman Fenton
- Risk and Information Management Research Group, School of Electronic Engineering and Computer Science, Queen Mary University of London, London, E1 4NS, UK
| | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, E1 4NS, UK
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Talebi M, Sadigh-Eteghad S, Sahraian MA, Fahidi A. Age and sex adjusted prevalence and annual incidence of multiple sclerosis in East-Azerbaijan, Iran. Mult Scler Relat Disord 2021; 50:102839. [PMID: 33592381 DOI: 10.1016/j.msard.2021.102839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/16/2021] [Accepted: 02/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Incidence and prevalence of multiple sclerosis (MS) is postulated to be rising in recent decades. Therefore, updating and completing the information of patients is essential, especially in high population areas. East-Azerbaijan is the largest and most populous province in the northwest of Iran. This study aimed to determine the prevalence and annual incidence of MS from 2008 to 2017 in East-Azerbaijan. METHODS We evaluated the data of all patients who had registered at the MS center in the university hospital. The data include nearly all MS patients in the East-Azerbaijan region, because it is the only referral site in the area. All of the reported rates were calculated in 100,000 of the total population. RESULTS By the end of 2017, the number of MS patients was 2995 (residing in the, with 769 (25.67%) men and 2226 (74.32%) women. The prevalence rate was 75.72/100,000 (95 % CI: 73.06-78.48), 38.2 in men (95% CI: 35.5-41.0), and 114.61 for women (95% CI: 109.9-119.4), with a female to male (F/M) ratio of 3:1. The mean annual incidence rate was 7.63/100,000 (95% CI: 5.6-9.3), and this rate was higher in women than men. During the nine years, the incidence rate increased. The patients' mean age was 32.33 ± 8.92, with a peak prevalence in 25-29 years for both genders. In this study, 13.9% of patients had a positive MS family history. CONCLUSIONS This study showed a high prevalence of MS in the region. There is a significant increase in the incidence of MS during the nine years in East-Azerbaijan. The increment of incidence was more prominent in women. Also, considering the increasing incidence rate, it is concluded that the risk of MS is increasing in this region.
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Affiliation(s)
- Mahnaz Talebi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Saeed Sadigh-Eteghad
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Ali Sahraian
- Sina MS Research Center, Sina Hospital, and Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Fahidi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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De-Bernardi-Ojuel L, Torres-Collado L, García-de-la-Hera M. Occupational Therapy Interventions in Adults with Multiple Sclerosis or Amyotrophic Lateral Sclerosis: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1432. [PMID: 33546507 PMCID: PMC7913738 DOI: 10.3390/ijerph18041432] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022]
Abstract
This scoping review aims to describe occupational therapy interventions carried out with multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) patients in occupational therapy. A peer review of the literature was conducted in different databases: Pubmed, Scopus, Web of Science and Embase, and in some occupational therapy journals. A search of the literature published was carried out before December 2019. The inclusion criteria were as follows: (1) articles evaluating the intervention of occupational therapy in MS or ALS including experimental, randomized, nonrandomized and exploratory studies; (2) written in English or Spanish; (3) adult population (over 18 years old). The initial search identified 836 articles of which we included 32 divided into four areas of intervention: fatigue-targeted interventions, cognitive interventions, physical interventions and others. Only 16 studies were carried out exclusively by occupational therapists. Most occupational therapy interventions are aimed at fatigue and physical rehabilitation. The majority of the studies in our review included MS patients, with little representation from the ALS population. These interventions have shown an improvement in perceived fatigue, manual dexterity, falls prevention and improvement in cognitive aspects such as memory, communication, depression and quality of life in the MS and ALS populations.
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Affiliation(s)
- Luis De-Bernardi-Ojuel
- Department of Public Health, History of Medicine and Gynecology, University Miguel Hernández, 03550 Alicante, Spain; (L.D.-B.-O.); (M.G.-d.-l.-H.)
| | - Laura Torres-Collado
- Department of Public Health, History of Medicine and Gynecology, University Miguel Hernández, 03550 Alicante, Spain; (L.D.-B.-O.); (M.G.-d.-l.-H.)
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Alicante Institute for Health and Biomedical Research, ISABIAL-UMH, 03010 Alicante, Spain
| | - Manuela García-de-la-Hera
- Department of Public Health, History of Medicine and Gynecology, University Miguel Hernández, 03550 Alicante, Spain; (L.D.-B.-O.); (M.G.-d.-l.-H.)
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Alicante Institute for Health and Biomedical Research, ISABIAL-UMH, 03010 Alicante, Spain
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Alirezaei M, Forouzannia SM, Yarahmadi P, Sahraian MA, Owji M, Bidadian M, Ghadiri F, Naser Moghadasi A. Demographic features, behavioral measures, and clinical factors as predictors of cognitive function in patients with multiple sclerosis. Mult Scler Relat Disord 2021; 49:102758. [PMID: 33567391 DOI: 10.1016/j.msard.2021.102758] [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: 07/14/2020] [Revised: 12/12/2020] [Accepted: 12/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND One of the most concerning features that involves 40-70% of patients with multiple sclerosis (MS) is cognitive impairment. Moreover, it affects various aspects of patients' life. In this regard, this study was conducted to find independent predictors of cognitive function. METHOD We performed a cross-sectional analysis on 92 patients chosen from MS clinic of Sina hospital, Iran. After completing a general questionnaire of demographic and various clinical features, the included participants (patients with RRMS) underwent neuropsychological assessment using Minimal Assessment of Cognitive function in Multiple Sclerosis (MACFIMS), Expanded disability Status Scale (EDSS), Beck Depression Inventory II (BDI-II), and National American Adult Reading Test (NAART). An un-weighted average of MACFIMS subscales z-scores was reported as cognitive index. In order to find the association between CI and different factors, each variable was entered in a simple regression model first. Then, a univariate multiple regression model was invoked to evaluate the predictors of cognitive index in patients. RESULTS Simple regression for cognitive index of 92 patients (86% female) with a mean age of 33.4±7.6 years old suffering of RRMS for 6.8±4.8 years revealed patients with history of former smoking (p=0.001), sole visual symptoms as the presentation sign of the study (β=-0.341, p=0.001), lower EDSS score (β=-0.299, p=0.005), higher NAART score (β=0.416, p≤0.0001), and college education (p=0.001), had better cognitive function in our study population. Such factors including age, educational status, BDI-II score, EDSS score, and disease duration were fixed and the other significant factors entered once separately and then simultaneously in the univariate multiple linear regression model. It was revealed that former smoking (β=-0.372, p≤0.0001), NAART (β=0.304, p=0.002), and EDSS (β= -0.185, P=0.045) are associated significantly with the cognitive function of patients with multiple sclerosis. CONCLUSION This study demonstrated NAART, as a proxy of premorbid intelligence, history of former smoking, and EDSS score may have effects on cognitive function in MS. Future studies need to be invoked for the evaluation of the causality relation of these factors.
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Affiliation(s)
- Mohammad Alirezaei
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Seyed Mohammad Forouzannia
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Pourya Yarahmadi
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Mahsa Owji
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Maryam Bidadian
- Department of psychology, School of humanities, Tarbiat Modares University, Tehran, Iran
| | - Fereshteh Ghadiri
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran.
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Ozanimod to Treat Relapsing Forms of Multiple Sclerosis: A Comprehensive Review of Disease, Drug Efficacy and Side Effects. Neurol Int 2020; 12:89-108. [PMID: 33287177 PMCID: PMC7768354 DOI: 10.3390/neurolint12030016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022] Open
Abstract
Multiple sclerosis (MS) is a prevalent and debilitating neurologic condition characterized by widespread neurodegeneration and the formation of focal demyelinating plaques in the central nervous system. Current therapeutic options are complex and attempt to manage acute relapse, modify disease, and manage symptoms. Such therapies often prove insufficient alone and highlight the need for more targeted MS treatments with reduced systemic side effect profiles. Ozanimod is a novel S1P (sphingosine-1-phosphate) receptor modulator used for the treatment of clinically isolated syndrome, relapsing–remitting, and secondary progressive forms of multiple sclerosis. It selectively modulates S1P1 and S1P5 receptors to prevent autoreactive lymphocytes from entering the CNS where they can promote nerve damage and inflammation. Ozanimod was approved by the US Food and Drug Administration (US FDA) for the management of multiple sclerosis in March 2020 and has been proved to be both effective and well tolerated. Of note, ozanimod is associated with the following complications: increased risk of infections, liver injury, fetal risk, increased blood pressure, respiratory effects, macular edema, and posterior reversible encephalopathy syndrome, among others. Further investigation including head-to-head clinical trials is warranted to evaluate the efficacy of ozanimod compared with other S1P1 receptor modulators.
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AlJumah M, Otaibi HA, Al Towaijri G, Hassan A, Kareem A, Kalakatawi M, Alrajeh S, Al Mejally M, Algahtani H, Almubarak A, Alawi S, Qureshi S, Al Malik Y, El-Metwally A, Shami S, Ishak S, Bunyan R. Familial aggregation of multiple sclerosis: Results from the national registry of the disease in Saudi Arabia. Mult Scler J Exp Transl Clin 2020; 6:2055217320960499. [PMID: 33110617 PMCID: PMC7556172 DOI: 10.1177/2055217320960499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/05/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022] Open
Abstract
Background Multiple Sclerosis (MS) is a chronic CNS inflammatory disease commonly affecting young adults. Both genetics and environmental factors have been reported to have a role in pathophysiology of the disease. Objective This article aims to report familial nature and aspects of MS in Saudi Arabia. Method The study utilized data collected by the National Saudi MS Registry between 2015 and 2018; especially data relevant to the familial history of MS. SPSS 22 was used for all analysis and reporting. Statistical significance was set at p-value < 0.05. Results The registry included 20 hospitals and a total of 2516 patients from the different regions of Saudi Arabia with median age 32.00 (Range: 11-63) and 66.5% being female. About 12.8% of all registered patients reported a family history of MS (95%CI: 11.2-13.9). Reported parental consanguinity was significantly higher among patients with family history (FMS) (56.3%) compared to non-FMS patients (27.9%). 42.53% of FMS patients reported having siblings affected with MS (95%CI: 37.01-48.21), with more female siblings affected than males (63.4% vs 36.6% respectively). Conclusion Our Findings suggested that FMS was less prevalent than what was reported previously; however, parental consanguinity was significantly more prevalent among FMS patients than non-FMS. Our findings were in line with those reported in recent studies in the region, but lower than those reported by western countries indicating that increasing prevalence of MS in Saudi Arabia could be multifactorial and other environmental factors should be considered for understanding this recent rise in the prevalence of MS in Saudi Arabia.
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Affiliation(s)
- Mohammed AlJumah
- Neurology Department, King Fahd Medical City (KFMC), MOH, Riyadh, Saudi Arabia
| | - Hessa Al Otaibi
- Neurology Department, King Fahd General Hospital-Jeddah, Jeddah, Saudi Arabia
| | - Ghada Al Towaijri
- Neurology Department, King Fahd Medical City (KFMC), MOH, Riyadh, Saudi Arabia
| | - Ahmed Hassan
- Neurology Department, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Abid Kareem
- Neurology Department, King Fahd General Hospital-Al-Madinah, Madinah, Saudi Arabia
| | | | - Saad Alrajeh
- Neurology Department, Dr. Sulaiman Al Habib Hospital-Olaya Branch, Riyadh, Saudi Arabia
| | - Mousa Al Mejally
- Neurology Department, Heraa General Hospital, Makkah, Saudi Arabia
| | - Hussein Algahtani
- Neurology Department, King Abdul-Aziz Medical City (National Guard Health Affairs), Jeddah, Saudi Arabia
| | - Ali Almubarak
- Neurology Department, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Sadaga Alawi
- Neurology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Shireen Qureshi
- Neurology Department, Johns Hopkins Aramco Healthcare Company (JHAH), Dhahran, Saudi Arabia
| | - Yaser Al Malik
- Neurology Department, King Saud bin Abdulaziz University For Health Sciences, Riyadh, Saudi Arabia
| | - Ashraf El-Metwally
- King Saud bin Abdulaziz University For Health Sciences, Riyadh, Saudi Arabia
| | - Sahar Shami
- King Fahd Specialist Hospital (KFSH)-Dammam, Dammam, Saudi Arabia
| | - Samah Ishak
- Itkan Health Consulting, Riyadh, Saudi Arabia
| | - Reem Bunyan
- King Fahd Specialist Hospital (KFSH)-Dammam, Dammam, Saudi Arabia
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Salehi Z, Almasi-Hashiani A, Sahraian MA, Eskandarieh S. Epidemiology of familial multiple sclerosis: A population-based study in Tehran during 1999–2018. Mult Scler Relat Disord 2020; 43:102178. [DOI: 10.1016/j.msard.2020.102178] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 12/27/2022]
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Quinn É, Hynes SM. Occupational therapy interventions for multiple sclerosis: A scoping review. Scand J Occup Ther 2020; 28:399-414. [PMID: 32643486 DOI: 10.1080/11038128.2020.1786160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence for the effectiveness of occupational therapy for people with multiple sclerosis (MS) is yet to be established. AIMS/OBJECTIVES To review the evidence regarding the effectiveness of occupational therapy interventions in improving outcomes for adults with MS. MATERIAL AND METHODS We completed a scoping review of occupational therapy and multiple sclerosis following a scoping review methodological framework. Search included articles published up until June 2019. Studies were included if they were original research that included adults with MS published in English and assessed interventions delivered by occupational therapists. RESULTS The search yielded 1646 results. Following screening and review of articles, thirty papers met the inclusion criteria and were included in the review. Studies were charted and discussed in the areas of: (1) fatigue management or energy conservation; (2) upper-limb rehabilitation; (3) occupation-focussed cognitive rehabilitation; and (4) other types of interventions. CONCLUSIONS The quality of evidence that exists for occupational therapy with people with MS is mixed but there are studies that show that occupational therapy can improve occupational and other outcomes in this population. Significance: Patients have reported many benefits of occupational therapy but the evidence-base to support this needs to be developed.Implications for rehabilitationOccupational therapists are well-placed to intervene with multiple sclerosis symptoms.Evidence for the effectiveness of occupational therapy for people with multiple sclerosis is yet to be established.Fatigue management programmes delivered by occupational therapists are effective in reducing symptoms.Additional training in client-centred practice is no more effective than usual occupational therapy.
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Affiliation(s)
- Éle Quinn
- School of Health Sciences, National University of Ireland, Galway
| | - Sinéad M Hynes
- School of Health Sciences, National University of Ireland, Galway
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Demographic and clinical characteristics of familial and sporadic multiple sclerosis: A single center exploratory study from Abu Dhabi. J Clin Neurosci 2020; 76:145-147. [PMID: 32284288 DOI: 10.1016/j.jocn.2020.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022]
Abstract
Demographic and clinical characteristics of Familial Multiple Sclerosis (FMS) have not been fully investigated yet in Abu Dhabi. The aim of this single center exploratory study was to investigate demographic and clinical characteristics of FMS compared to sporadic MS (SMS) in Abu Dhabi. A chart review single center study was conducted in 98 patients with MS. Group comparisons were performed using Mann-Whitney and Chi-Square tests as appropriate. A p < 0.05 was considered statistically significant. 24.5% were patients with FMS and 83% were Emirates. No significant differences in demographic and clinical characteristics were found between patients with FMS and SMS in overall all MS patients and in the Emirati group analyzed alone. Patients with FMS did not differ in demographic and clinical characteristics compared to patients with SMS. Further prospective studies are needed to elucidate environmental and genetic risk factors contributing to FMS in the Emirati population.
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40
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Boyko AN, Kozin MS, Osmak GZ, Kulakova OG, Favorova OO. Mitochondrial genome and risk of multiple sclerosis. ACTA ACUST UNITED AC 2019. [DOI: 10.14412/2074-2711-2019-3-43-46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Mitochondrial DNA (mtDNA) polymorphism makes a certain contribution to the formation of a genetic risk of multiple sclerosis (MS).Objective: to analyze the frequency of mtDNA variants in patients with MS and control individuals in the Russian population. A similar study was conducted for the first time.Patients and methods. The polymorphism of mtDNA was studied in the Russian population: in 283 unrelated patients with relapsing-remitting MS and in 290 unrelated healthy controls matched for gender and age.Results and discussion. The frequency of haplogroup J in the patients with MS was twice higher than that in the control group (p=0.0055) (odds ratio (OR) 2.00; 95% confidence interval (CI). 1.21–3.41). This association was mostly observed in women (p=0.0083) (OR 2.20; 95% CI, 1.19–4.03). There was also a significant association of the A allele of MT-ND5 (m. 13708G>A) with MS (p=0.03) (OR 1.89; 95% CI 1.11–3.32). Sex stratification showed that the association with MS was significant only in women (p=0.009; OR, 2.52; 95% CI, 1.29–5.14). Further investigations will aim to analyze mtDNA variability (at the level of individual polymorphisms, haplogroups, and whole genome) in patients with relapsing-remitting MS and in those with primary progressive MS versus healthy individuals and patients with relapsing-remitting MS according to disease severity.Conclusion. The data obtained in the Russian population suggest that mtDNA variations are involved in MS risk, to a greater extent in women.
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Affiliation(s)
- A. N. Boyko
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia;
Federal Center of Cerebrovascular Disease and Stroke, Ministry of Health of Russia
| | - M. S. Kozin
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia;
Federal Center of Cerebrovascular Disease and Stroke, Ministry of Health of Russia
| | - G. Zh. Osmak
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia;
Federal Center of Cerebrovascular Disease and Stroke, Ministry of Health of Russia
| | - O. G. Kulakova
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
| | - O. O. Favorova
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
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Zarei S, Maldonado I, Franqui-Dominguez L, Rubi C, Rosa YT, Diaz-Marty C, Coronado G, Nieves MCR, Akhlaghipour G, Chinea A. Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients. Surg Neurol Int 2019; 10:200. [PMID: 31768280 PMCID: PMC6826276 DOI: 10.25259/sni_252_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/26/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are limited data on multiple sclerosis (MS) patients in underserved groups, including Puerto Rico. In this study, we analyzed the characteristic of MS symptoms and number of relapses in Puerto Rican patients. We then compare these characteristics with MS patients from the US. The number of MS relapses is highly correlated with the treatment onset and adherence. Patients in Puerto Rico have been experiencing lengthy treatment delay. We will discuss the possible causes of such delay and its impact on MS prognosis. METHODS This retrospective cohort study consisted of the evaluation of 325 medical records from MS patients attending the Caribbean Neurological Center from 2014 to 2019. We gathered symptoms and comorbidities data as binary objects. The treatment delay was calculated based on the mean value of days between diagnosis and treatment onset for these groups of patients. RESULTS We found that on average, the treatment delay for MS patients in Puerto Rico (PR) to receive their medication was 120 days. The most common MS subtype was relapsing-remitting 72.8%, with a mean of 1.684 relapses per year. Initial symptoms were sensory 54%, visual 33.1%, motor 28.8%, coordination 23.2%, fatigue 9.7%, memory 7.3%, depression 6.5%, urinary 4.9%, gastrointestinal 2.4%, and sexual dysfunction 1.6%. The most common comorbidities were hypertension 18.4%, asthma 13.6%, and thyroid disease 12.8%. When we compared the comorbidities between the two populations, immune thrombocytopenia had the highest percent change with the value of almost 200% (0.001% of US patient vs. 0.8% of Puerto Rican MS patients). CONCLUSION Patients from Puerto Rico had a 33% higher relapse rate compared to the one reported for MS patients in the US. This higher rate may be related to the long delay in receiving their medications. They also had a higher rate of complex comorbidities such as immune thrombocytopenia or thyroid disease. Our findings provide a proof of concept that delay in receiving medications can increase the number of relapses and complex comorbidities among MS patients.
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Affiliation(s)
- Sara Zarei
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Irvin Maldonado
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | | | - Yanibel Tapia Rosa
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Cristina Diaz-Marty
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Guadalupe Coronado
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
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Katsavos S, Artemiadis A, Gontika M, Skarlis C, Markoglou N, Davaki P, Stamboulis E, Kilindireas K, Stefanis L, Anagnostouli M. HLA-DRB1 differences in allelic distribution between familial and sporadic multiple sclerosis in a Hellenic cohort. Postgrad Med 2019; 131:490-495. [DOI: 10.1080/00325481.2019.1655382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Serafeim Katsavos
- Immunogenetics Laboratory, 1st Dept of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Artemios Artemiadis
- Immunogenetics Laboratory, 1st Dept of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - Maria Gontika
- Immunogenetics Laboratory, 1st Dept of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Charalampos Skarlis
- Immunogenetics Laboratory, 1st Dept of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Nikolaos Markoglou
- Immunogenetics Laboratory, 1st Dept of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Panagiota Davaki
- Demyelinating Diseases Clinic, 1st Dept of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Eleftherios Stamboulis
- 1st Dept of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Konstantinos Kilindireas
- Demyelinating Diseases Clinic, 1st Dept of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Leonidas Stefanis
- 1st Dept of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Maria Anagnostouli
- Immunogenetics Laboratory, 1st Dept of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
- Demyelinating Diseases Clinic, 1st Dept of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
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Vilariño-Güell C, Zimprich A, Martinelli-Boneschi F, Herculano B, Wang Z, Matesanz F, Urcelay E, Vandenbroeck K, Leyva L, Gris D, Massaad C, Quandt JA, Traboulsee AL, Encarnacion M, Bernales CQ, Follett J, Yee IM, Criscuoli MG, Deutschländer A, Reinthaler EM, Zrzavy T, Mascia E, Zauli A, Esposito F, Alcina A, Izquierdo G, Espino-Paisán L, Mena J, Antigüedad A, Urbaneja-Romero P, Ortega-Pinazo J, Song W, Sadovnick AD. Exome sequencing in multiple sclerosis families identifies 12 candidate genes and nominates biological pathways for the genesis of disease. PLoS Genet 2019; 15:e1008180. [PMID: 31170158 PMCID: PMC6553700 DOI: 10.1371/journal.pgen.1008180] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/07/2019] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) is an inflammatory disease of the central nervous system characterized by myelin loss and neuronal dysfunction. Although the majority of patients do not present familial aggregation, Mendelian forms have been described. We performed whole-exome sequencing analysis in 132 patients from 34 multi-incident families, which nominated likely pathogenic variants for MS in 12 genes of the innate immune system that regulate the transcription and activation of inflammatory mediators. Rare missense or nonsense variants were identified in genes of the fibrinolysis and complement pathways (PLAU, MASP1, C2), inflammasome assembly (NLRP12), Wnt signaling (UBR2, CTNNA3, NFATC2, RNF213), nuclear receptor complexes (NCOA3), and cation channels and exchangers (KCNG4, SLC24A6, SLC8B1). These genes suggest a disruption of interconnected immunological and pro-inflammatory pathways as the initial event in the pathophysiology of familial MS, and provide the molecular and biological rationale for the chronic inflammation, demyelination and neurodegeneration observed in MS patients.
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Affiliation(s)
| | | | - Filippo Martinelli-Boneschi
- Laboratory of Human Genetics of Neurological Disorders, CNS Inflammatory Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- MS Unit and Department of Neurology, IRCCS Policlinico San Donato, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Bruno Herculano
- Townsend Family Laboratories, Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Zhe Wang
- Townsend Family Laboratories, Department of Psychiatry, University of British Columbia, Vancouver, Canada
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of the Capital Medical University, Beijing, China
| | - Fuencisla Matesanz
- Department of Cell Biology and Immunology, Instituto de Parasitología y Biomedicina López Neyra (IPBLN), CSIC, Granada, Spain
| | - Elena Urcelay
- Immunology Dept, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Red Española de Esclerosis Múltiple REEM, Madrid, Spain
| | - Koen Vandenbroeck
- Achucarro Basque Center for Neuroscience, Universidad del País Vasco (UPV/EHU), Leioa, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - Laura Leyva
- Red Española de Esclerosis Múltiple REEM, Madrid, Spain
- Instituto de Investigación Biomédica de Málaga-IBIMA, Unidad de Gestion Clínica de Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Denis Gris
- Division of Immunology, Department of Pediatrics, CR-CHUS, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Canada
| | - Charbel Massaad
- Toxicology, Pharmacology and Cell Signalisation—UMR-S 1124 Université Paris Descartes, Paris, France
| | - Jacqueline A. Quandt
- Department of Pathology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Anthony L. Traboulsee
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mary Encarnacion
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Cecily Q. Bernales
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Jordan Follett
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Irene M. Yee
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Maria G. Criscuoli
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Angela Deutschländer
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, United States of America
- Department of Clinical Genomics, Mayo Clinic Florida, Jacksonville, FL, United States of America
- Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FL, United States of America
| | - Eva M. Reinthaler
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Tobias Zrzavy
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Elisabetta Mascia
- Laboratory of Human Genetics of Neurological Disorders, CNS Inflammatory Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Zauli
- Laboratory of Human Genetics of Neurological Disorders, CNS Inflammatory Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Esposito
- Laboratory of Human Genetics of Neurological Disorders, CNS Inflammatory Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Alcina
- Department of Cell Biology and Immunology, Instituto de Parasitología y Biomedicina López Neyra (IPBLN), CSIC, Granada, Spain
| | | | - Laura Espino-Paisán
- Immunology Dept, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Red Española de Esclerosis Múltiple REEM, Madrid, Spain
| | - Jorge Mena
- Achucarro Basque Center for Neuroscience, Universidad del País Vasco (UPV/EHU), Leioa, Spain
| | - Alfredo Antigüedad
- Neurology Department, Hospital Universitario de Cruces, S/N, Baracaldo, Spain
| | - Patricia Urbaneja-Romero
- Red Española de Esclerosis Múltiple REEM, Madrid, Spain
- Instituto de Investigación Biomédica de Málaga-IBIMA, Unidad de Gestion Clínica de Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Jesús Ortega-Pinazo
- Instituto de Investigación Biomédica de Málaga-IBIMA, Unidad de Gestion Clínica de Neurociencias, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Weihong Song
- Townsend Family Laboratories, Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - A. Dessa Sadovnick
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Steenhof M, Stenager E, Nielsen NM, Kyvik K, Möller S, Hertz JM. Familial multiple sclerosis patients have a shorter delay in diagnosis than sporadic cases. Mult Scler Relat Disord 2019; 32:97-102. [PMID: 31078918 DOI: 10.1016/j.msard.2019.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/25/2019] [Accepted: 04/10/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The diagnosis of multiple sclerosis (MS) is still complicated despite improvement in diagnostic guidelines. This means that time from first symptom to diagnosis in some cases is prolonged. Many aspects of MS aetiology are unknown, but the involvement of a genetic component is well established. This is also highlighted by the occurrence of familial MS cases, which represent 10-20% of all MS cases. We hypothesize that subsequent family members in a MS family, have a shorter time from onset of disease to diagnosis compared to sporadic MS cases. To investigate this, we have conducted a register study comparing time from onset to diagnosis in familial and sporadic MS cases. METHODS This is a nationwide register study based on information from the Danish Multiple Sclerosis Registry and the Danish Civil Registration System. We included familial (first-degree relatives) and sporadic MS cases and calculated time lag between onset and diagnosis of MS for sporadic MS cases and for1st, 2nd and 3rd family members within the MS families. Median test and Cox regression were the statistical methods used to compare the familial and sporadic groups. RESULTS We found that 2nd and 3rd affected family member had a significant shorter time from first symptom to diagnosis compared to sporadic MS cases (2nd family member: Hazard Ratio (HR): 1.12, CI: 1.03-1.21, p = 0.007 adjusted: HR: 0.95 p = 0.22, CI 0.89-1-03 and 3rd family member HR: 1.64 CI: 1.22-2.20, p = 0.001 adjusted model: HR: 1.70, p-value: 0.000, CI: 1.32-2.18). The same difference was not seen between 1st family members and sporadic cases (HR: 1.05, CI: 0.98-1.13, p = 0.15, adjusted: 0.98, p-value: 0.53, CI: 0.91-1.05). Estimated marginal mean delay in the four groups were 4.60 years (95% CI: 4.11-5.01) in1st family members, 4.23 years (3.71-4.75) in 2nd family members, 2.11 years (0.95-3.26) in 3rd family members and 4.99 years (4.99-4.99) in sporadic MS cases. CONCLUSION The 2nd and 3rd family members in MS families tend do get diagnosed faster than sporadic cases. This has implications in the diagnostic process of familial MS cases.
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Affiliation(s)
- Maria Steenhof
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; Department of Neurology, Hospital of Southern Jutland, Sønderborg, Denmark; Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Egon Stenager
- Department of Neurology, Hospital of Southern Jutland, Sønderborg, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark; MS Clinics of Southern Jutland (Sønderborg, Esbjerg, Kolding), Hospital of Southern Jutland, Sønderborg, Denmark
| | - Nete Munk Nielsen
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Kirsten Kyvik
- Department of Clinical Research, University of Southern Denmark, Denmark; Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Denmark; Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Jens Michael Hertz
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
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Van Der Walt A, Nguyen A, Jokubaitis V. Family planning, antenatal and post partum care in multiple sclerosis: a review and update. Med J Aust 2019; 211:230-236. [DOI: 10.5694/mja2.50113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Anneke Van Der Walt
- Monash University Melbourne VIC
- University of Melbourne Melbourne VIC
- Alfred Health Melbourne VIC
- Royal Melbourne Hospital Melbourne VIC
| | - Ai‐Lan Nguyen
- University of Melbourne Melbourne VIC
- Royal Melbourne Hospital Melbourne VIC
| | - Vilija Jokubaitis
- Monash University Melbourne VIC
- University of Melbourne Melbourne VIC
- Alfred Health Melbourne VIC
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46
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Steenhof M, Nielsen NM, Stenager E, Kyvik K, Möller S, Hertz JM. Distribution of disease courses in familial vs sporadic multiple sclerosis. Acta Neurol Scand 2019; 139:231-237. [PMID: 30412642 DOI: 10.1111/ane.13044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/28/2018] [Accepted: 11/01/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The overall distribution of disease courses in multiple sclerosis (MS) is well established, but little is known about the distribution among familial MS cases. We examine the frequency of the different MS courses among familial and sporadic MS cases and determine whether MS cases within the same family had the same age at diagnosis and have experienced the same disease course. MATERIALS AND METHODS This is a nationwide register study, based on data from the Danish MS Registry, the Danish Civil Registration System, and the Danish National Patient Registry. The main variables are MS diagnosis, MS course, and first-degree relatives with MS The statistical analyses were carried out using logistic regression analysis, Kappa coefficient, and intraclass correlations coefficient. RESULTS In total, 7402 MS cases were included in the study, of which 531 have an affected first-degree relatives, and 6871 are sporadic. We found that relapsing-remitting MS including secondary progressive MS was more common among familial MS cases than among sporadic MS cases (Odds ratio = 1.64, 95% CI: 1.20-2.24, P = 0.002). We subsequently analyzed data on 133 MS families and found that MS courses correlate between the first and the second MS case diagnosed, while age at diagnosis does not. CONCLUSION Familial MS cases are more likely to have relapsing-remitting MS than a progressive course compared to sporadic MS cases. Secondly, we find that within MS families, first-degree relatives are likely to have the same MS course, but we do not find that they are diagnosed at the same age.
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Affiliation(s)
- Maria Steenhof
- Department of Clinical Genetics; Odense University Hospital; Odense Denmark
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
- Neurological Research Unit; Hospital of Southern Jutland; Sønderborg Denmark
- Odense Patient data Explorative Network; Odense University Hospital; Odense Denmark
| | - Nete Munk Nielsen
- Department of Epidemiology Research; Statens Serum Institut; Copenhagen Denmark
| | - Egon Stenager
- Neurological Research Unit; Hospital of Southern Jutland; Sønderborg Denmark
- Department of Regional Health Research; University of Southern Denmark; Odense Denmark
- MS clinics of Southern Jutland (Sønderborg, Esbjerg, Kolding); Hospital of Southern Jutland; Sønderborg Denmark
| | - Kirsten Kyvik
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
- Odense Patient data Explorative Network; Odense University Hospital; Odense Denmark
| | - Sören Möller
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
- Odense Patient data Explorative Network; Odense University Hospital; Odense Denmark
| | - Jens Michael Hertz
- Department of Clinical Genetics; Odense University Hospital; Odense Denmark
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
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47
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Dobson R, Giovannoni G. Multiple sclerosis - a review. Eur J Neurol 2018; 26:27-40. [PMID: 30300457 DOI: 10.1111/ene.13819] [Citation(s) in RCA: 922] [Impact Index Per Article: 153.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/04/2018] [Indexed: 12/14/2022]
Abstract
Multiple sclerosis (MS) is the commonest non-traumatic disabling disease to affect young adults. The incidence of MS is increasing worldwide, together with the socioeconomic impact of the disease. The underlying cause of MS and mechanisms behind this increase remain opaque, although complex gene-environment interactions almost certainly play a significant role. The epidemiology of MS indicates that low serum levels of vitamin D, smoking, childhood obesity and infection with the Epstein-Barr virus are likely to play a role in disease development. Changes in diagnostic methods and criteria mean that people with MS can be diagnosed increasingly early in their disease trajectory. Alongside this, treatments for MS have increased exponentially in number, efficacy and risk. There is now the possibility of a diagnosis of 'pre-symptomatic MS' being made; as a result potentially preventive strategies could be studied. In this comprehensive review, MS epidemiology, potential aetiological factors and pathology are discussed, before moving on to clinical aspects of MS diagnosis and management.
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Affiliation(s)
- R Dobson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, London, UK.,Royal London Hospital, London, UK
| | - G Giovannoni
- Royal London Hospital, London, UK.,Blizard Institute, London, UK
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48
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Abstract
Multiple sclerosis (MS) is the most common chronic inflammatory, demyelinating and neurodegenerative disease of the central nervous system in young adults. This disorder is a heterogeneous, multifactorial, immune-mediated disease that is influenced by both genetic and environmental factors. In most patients, reversible episodes of neurological dysfunction lasting several days or weeks characterize the initial stages of the disease (that is, clinically isolated syndrome and relapsing-remitting MS). Over time, irreversible clinical and cognitive deficits develop. A minority of patients have a progressive disease course from the onset. The pathological hallmark of MS is the formation of demyelinating lesions in the brain and spinal cord, which can be associated with neuro-axonal damage. Focal lesions are thought to be caused by the infiltration of immune cells, including T cells, B cells and myeloid cells, into the central nervous system parenchyma, with associated injury. MS is associated with a substantial burden on society owing to the high cost of the available treatments and poorer employment prospects and job retention for patients and their caregivers.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. .,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Amit Bar-Or
- Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Neuroimmunology Unit, Center for Molecular Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sandra Vukusic
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Fondation Eugène Devic EDMUS Contre la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Harazim H, Štourač P, Janků P, Zelinková H, Frank K, Dufek M, Štourač P. Obstetric anesthesia/analgesia does not affect disease course in multiple sclerosis: 10-year retrospective cohort study. Brain Behav 2018; 8:e01082. [PMID: 30047260 PMCID: PMC6160638 DOI: 10.1002/brb3.1082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/22/2018] [Accepted: 07/01/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Multiple sclerosis (MS) often occurs in young women and the effect of obstetric anesthesia/analgesia on the disease is poorly understood. No previous study has investigated the course of the disease in women in labor in the Czech Republic. The aim of this study was to evaluate the occurrence or absence of relapses in the 6-month postpartum period in MS parturients with and without obstetric anesthesia/analgesia. MATERIALS AND METHODS We retrospectively studied all deliveries (n = 58,455) at the University Hospital Brno from 2004 to 2013 and identified those of the women with an ICD-10 code G35 (MS) recorded anytime in their medical history (n = 428). We included only deliveries of women with confirmed diagnosis at the time of labor (n = 70). Statistical analysis was performed using the Fischer Exact Test. RESULTS There were 70 deliveries of 65 women, including 45 vaginal deliveries and 25 Cesarean deliveries (16 under general anesthesia, 8 with epidural anesthesia and 1 with spinal anesthesia). Epidural obstetric analgesia was performed in 11 deliveries. There was no statistically significant difference in relapses between the vaginal delivery group (n = 15; 33%) and Cesarean section group (n = 10; 40%), p = 0.611. CONCLUSION Neither delivery mode (vaginal vs Caesarean) nor type of obstetric anesthesia/analgesia was found to have any impact on the course of MS at 6 months postpartum in women with this condition.
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Affiliation(s)
- Hana Harazim
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty of Masaryk University, University Hospital Brno, Brno, Czech Republic
| | - Pavel Štourač
- Department of Neurology, Medical Faculty of Masaryk University, University Hospital Brno, Brno, Czech Republic
| | - Petr Janků
- Department of Gynaecology and Obstetrics, Medical Faculty of Masaryk University, University Hospital Brno, Brno, Czech Republic
| | - Hana Zelinková
- Institute of Biostatistics and Analysis, Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Kamil Frank
- Department of Gynaecology and Obstetrics, Medical Faculty of Masaryk University, University Hospital Brno, Brno, Czech Republic
| | - Michal Dufek
- First Department of Neurology, Medical Faculty of Masaryk University, St Anne's University Hospital, Brno, Czech Republic
| | - Petr Štourač
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, Medical Faculty of Masaryk University, University Hospital Brno, Brno, Czech Republic
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