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Piscitelli D, Brichetto G, Geri T, Battista S, Testa M, Monti Bragadin M, Pellicciari L. Italian adaptation and psychometric validation of the Fatigue Impact Scale (FIS) and its modified versions in adults with multiple sclerosis: a Rasch analysis study. Disabil Rehabil 2024:1-14. [PMID: 38236054 DOI: 10.1080/09638288.2024.2302878] [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: 05/25/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024]
Abstract
Purpose: Several outcome measures are available to assess the severity of fatigue in people with multiple sclerosis (MS). The aim of this study was to adapt the Italian version of the Fatigue Impact Scale (FIS-40) and its modified versions: a 21-item Modified scale (MFIS-21), its 5-item short version (MFIS-5), and an 8-item version for daily use (DFIS-8) and investigate their measurement properties through classical theory-test (CTT) and Rasch analysis (RA).Methods: 229 Italian-speaking adults with MS were included. Questionnaires were cross-culturally translated and subjected to CTT (i.e. internal consistency through Cronbach's alpha and unidimensionality through confirmatory factor analysis [CFA]) and RA. (i.e. internal construct validity, reliability, and targeting).Results: Internal consistency was high for all scales (>0.850). Final CFAs reported issues in the unidimensionality for all scales except for FIS-40. Baseline RA revealed a misfit for all scales. After adjusting for local dependency, FIS-40, MFIS-21, and MFIS-5 fitted the Rasch model (RM). MFIS-21 and D-FIS-8 required a structural modification, i.e. item deletions to satisfy the RM.Conclusion: The FIS-40, MFIS-21, MFIS-5, and DFIS-8 achieved the fit to the RM after statistical and structural modifications. The fit to the RM allowed for providing ordinal-to-interval measurement conversion tables for all the questionnaires.
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Affiliation(s)
- Daniele Piscitelli
- Doctor of Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian MS Foundation (FISM), Genoa, Italy
- AISM Rehabilitation Center, Italian MS Society (AISM), Genoa, Italy
| | | | - Simone Battista
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Campus of Savona, Italy
| | - Marco Testa
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Campus of Savona, Italy
| | - Margherita Monti Bragadin
- Scientific Research Area, Italian MS Foundation (FISM), Genoa, Italy
- AISM Rehabilitation Center, Italian MS Society (AISM), Genoa, Italy
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Hamilton K, Smith K, Winn K, Oliver B, Newland P, Hendricks-Ferguson V. Quantifying Fatigue Using Electrophysiological Techniques and Non-invasive Brain Stimulation in People With Multiple Sclerosis- A Review and Discussion. Biol Res Nurs 2024; 26:101-114. [PMID: 37558634 DOI: 10.1177/10998004231194954] [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: 08/11/2023]
Abstract
Objective: The purpose of this literature review article is to provide a synthesis of recent research focused on the use of 3 techniques to evaluate MS-related fatigue: electroencephalography [EEG], transcranial direct-current stimulation (tDSC), and transcranial- magnetic stimulation (TMS). Method: We performed a literature search in the Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCOhost), MEDLINE (OVID), APA PsycInfo (OVID), Scopus (Elsevier), and Web of Science (Clarivate) databases, limited to 2015 and after. Results: Our review revealed that fatigue in MS patients can be quantified and predicted using electrophysiological techniques. Such techniques, which yield objective data, are historically assessed in relation to subjective data, or perceived fatigue. We identified studies using EEG, TMS, and/or tDCS to study fatigue in people with MS. In total, 220 records were identified with 19 studies meeting inclusion criteria. Quality appraisal revealed that the level of evidence was generally graded "good". Conclusions: Despite the heterogenous nature of reviewed the studies and selected the varied self-report fatigue measures, our literature synthesis suggests promise for the use of EEG, TMS, and/or tDCS approaches in more accurately assessing fatigue in people with MS. Further research is needed in this arena.
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Affiliation(s)
- Karlie Hamilton
- Valentine School of Nursing at Saint Louis University, Saint Louis, MO, USA
| | - Katy Smith
- Valentine School of Nursing at Saint Louis University, Saint Louis, MO, USA
| | | | - Brant Oliver
- Care Experience, Value Institute, Dartmouth Health, Lebanon, NH, USA
- Departments of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Psychiatry and the Dartmouth Institute, Hanover and Lebanon, NH, USA
| | - Pamela Newland
- Goldfarb School of Nursing at Barnes Jewish College, Saint Louis, MO, USA
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Strauss S, Herr T, Nafz C, Seusing N, Grothe M. The Cortical Silent Period and Its Association with Fatigue in Multiple Sclerosis: The Need for Standardized Data Collection. Brain Sci 2023; 14:28. [PMID: 38248243 PMCID: PMC10813082 DOI: 10.3390/brainsci14010028] [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: 11/15/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
The cortical silent period (CSP), assessed with transcranial magnetic stimulation (TMS), provides insights into motor cortex excitability. Alterations in the CSP have been observed in multiple sclerosis (MS), although a comparison of the sometimes contradictory results is difficult due to methodological differences. The aim of this study is to provide a more profound neurophysiological understanding of fatigue's pathophysiology and its relationship to the CSP. Twenty-three patients with MS, along with a matched control group, underwent comprehensive CSP measurements at four intensities (125, 150, 175, and 200% resting motor threshold), while their fatigue levels were assessed using the Fatigue Scale for Motor and Cognitive Functions (FSMC) and its motor and cognitive subscore. MS patients exhibited a significantly increased CSP duration compared to controls (p = 0.02), but CSP duration was not associated with the total FSMC, or the motor or cognitive subscore. Our data suggest a systematic difference in MS patients compared to healthy controls in the CSP but no association with fatigue when measured with the FSMC. Based on these results, and considering the heterogeneous literature in the field, our study highlights the need for a more standardized approach to neurophysiological data collection and validation. This standardization is crucial for exploring the link between TMS and clinical impairments in diseases like MS.
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Affiliation(s)
| | | | | | | | - Matthias Grothe
- Department of Neurology, University Medicine of Greifswald, 17475 Greifswald, Germany; (S.S.); (N.S.)
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Gaballah S, El-Deen DS, Hebeshy MI. Effect of effleurage massage therapy on sleep disturbance, fatigue, pain, and anxiety in patients with multiple sclerosis: A quasi-experimental study. Appl Nurs Res 2023; 73:151719. [PMID: 37722787 DOI: 10.1016/j.apnr.2023.151719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/26/2023] [Accepted: 07/28/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Fatigue, pain, sleep disturbance, and anxiety are prevalent symptoms of multiple sclerosis (MS) and frequent complaints in MS patients, which reduce their quality of life. Many studies have shown that massage therapy improves MS patients' symptoms. However, the effect of effleurage massage on sleep disturbance, fatigue, pain, and anxiety in patients with MS is not studied in Egypt. AIM To examine the effect of Effleurage massage therapy on sleep disturbance, fatigue, pain, and anxiety in patients with multiple sclerosis (MS). METHODS This research study has a quasi-experimental design, with control and intervention groups, and pre and post-tests conducted at the multiple sclerosis in-patient clinic at one Egyptian hospital between May 2019 and January 2020. Sixty adult female patients with MS were recruited, with 30 patients in the control group and 30 in the intervention group. The intervention group received Effleurage massage therapy intervention three times a week for two weeks, and each session lasted about 20 min. Patients in the control group received routine hospital care. Data were collected using the patient's demographic and medical data sheet, Insomnia Severity Index, Modified Fatigue Impact Scale, Numeric Pain Rating Scale, and Beck Anxiety Inventory before and after the intervention. RESULTS Significant improvement was observed in pain, sleep, fatigue, and anxiety in the massage group (P < 0.001). CONCLUSION Based on the current study, Effleurage massage intervention for MS patients could have possible clinical value for improving sleep disturbance, palliating pain, fatigue, and reducing anxiety. Egyptian nurses can integrate massage therapy into the routine nursing care of patients with MS. Effleurage massage could be an adjunct treatment modality for MS patients; however, more significant studies are needed.
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Affiliation(s)
- Samia Gaballah
- Medical-Surgical Nursing, Faculty of Nursing, Suez Canal University, Egypt.
| | - Dalia Salah El-Deen
- Medical-Surgical Nursing, Faculty of Nursing, Cairo University, Kasr EL ainy, Cairo, Egypt.
| | - Mona Ibrahim Hebeshy
- Medical-Surgical Nursing, Faculty of Nursing, Suez Canal University, Egypt; School of Nursing, University of Northern Colorado, Greeley, USA.
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Jawad A, Baattaiah BA, Alharbi MD, Chevidikunnan MF, Khan F. Factors contributing to falls in people with multiple sclerosis: The exploration of the moderation and mediation effects. Mult Scler Relat Disord 2023; 76:104838. [PMID: 37390785 DOI: 10.1016/j.msard.2023.104838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/12/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND The prevalence of multiple sclerosis (MS) has significantly increased in recent decades. People with MS have a high risk of falling; these falls may lead to serious injuries, affecting their quality of life PURPOSE: The aim of this study is to assess the factors affecting falls in people with MS and map out the most significant ones. This study also aims to determine whether fatigue has a moderation effect and balance has a mediation effect on falls in people with MS METHODS: In total, 103 people with MS with a mean age of 32.09 ± 7.17 were enrolled. All subjects were assessed for multiple variables including balance using the Berg Balance Scale (BBS), speed of gait using the Timed Up and Go (TUG) test, fear of falling using the Falls Efficacy Scale-International (FES-I), level of fatigue using the Modified Fatigue Impact Scale (MFIS), and lower limb muscle strength using a handheld digital dynamometer RESULTS: Simple binary logistic regression analysis showed significant results for BBS (OR: 10.88; 95% CI: 4.24-27.96; p < 0.0001), TUG (OR: 1.18; 95% CI: 1.09-1.28; p < 0.0001), FES-I (OR: 1.06; 95% CI: 1.02-1.10; p = 0.001), and MFIS (OR: 1.04; 95% CI: 1.02-1.07; p < 0.0001) as factors affecting falls. According to multivariate analysis, balance (OR: 3.924; 95% CI: 1.307-11.780, p = 0.015), speed of gait (OR: 1.122; 95% CI: 1.023-1.231; p = 0.015), and fatigue (OR: 1.029; 95% CI: 1.002-1.058; p = 0.038) were the strongest predicting factors of falls. Hayes's PROCESS analysis showed that fatigue had a significant moderation effect on the relationship between gait speed and falls (MFIS; β; 0.10; p < 0.0001; 95% CI: 0.07-0.14) and balance had a mediation effect on the relationship between gait speed and falls (BBS; indirect effect; 0.08; 95% CI: 0.02-0.13) CONCLUSIONS: People with MS with impaired balance, slower gait speeds, higher levels of fatigue, and a fear of falling were at a high risk of falling. The relationship between gait speed and falls can be mediated by impaired balance and moderated by the level of fatigue. Our data suggest that targeting balance and fatigue while developing rehabilitation interventions could decrease the incidence of falls among people with MS.
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Affiliation(s)
- Adel Jawad
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia; Department of Physical Therapy, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Baian A Baattaiah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Mutasim D Alharbi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Mohamed Faisal Chevidikunnan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia.
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Tyler SE, Tyler LD. Pathways to healing: Plants with therapeutic potential for neurodegenerative diseases. IBRO Neurosci Rep 2023; 14:210-234. [PMID: 36880056 PMCID: PMC9984566 DOI: 10.1016/j.ibneur.2023.01.006] [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: 09/24/2022] [Accepted: 01/25/2023] [Indexed: 02/12/2023] Open
Abstract
Some of the greatest challenges in medicine are the neurodegenerative diseases (NDs), which remain without a cure and mostly progress to death. A companion study employed a toolkit methodology to document 2001 plant species with ethnomedicinal uses for alleviating pathologies relevant to NDs, focusing on its relevance to Alzheimer's disease (AD). This study aimed to find plants with therapeutic bioactivities for a range of NDs. 1339 of the 2001 plant species were found to have a bioactivity from the literature of therapeutic relevance to NDs such as Parkinson's disease, Huntington's disease, AD, motor neurone diseases, multiple sclerosis, prion diseases, Neimann-Pick disease, glaucoma, Friedreich's ataxia and Batten disease. 43 types of bioactivities were found, such as reducing protein misfolding, neuroinflammation, oxidative stress and cell death, and promoting neurogenesis, mitochondrial biogenesis, autophagy, longevity, and anti-microbial activity. Ethno-led plant selection was more effective than random selection of plant species. Our findings indicate that ethnomedicinal plants provide a large resource of ND therapeutic potential. The extensive range of bioactivities validate the usefulness of the toolkit methodology in the mining of this data. We found that a number of the documented plants are able to modulate molecular mechanisms underlying various key ND pathologies, revealing a promising and even profound capacity to halt and reverse the processes of neurodegeneration.
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Key Words
- A-H, Alpers-Huttenlocher syndrome
- AD, Alzheimer’s disease
- ALS, Amyotrophic lateral sclerosis
- BBB, blood-brain barrier
- C. elegans,, Caenorhabditis elegans
- CJD, Creutzfeldt-Jakob disease
- CMT, Charcot–Marie–Tooth disease
- CS, Cockayne syndrome
- Ech A, Echinochrome A
- FDA, Food and Drug Administration
- FRDA, Friedreich’s ataxia
- FTD, Frontotemporal dementia
- HD, Huntington’s disease
- Hsp, Heat shock protein
- LSD, Lysosomal storage diseases
- MS, Multiple sclerosis
- MSA, Multiple system atrophy
- MSP, Multisystem proteinopathy
- Medicinal plant
- ND, neurodegenerative disease
- NPC, Neimann-Pick disease type C
- NSC, neural stem cells
- Neuro-inflammation
- Neurodegeneration
- Neurogenesis
- PC, pharmacological chaperone
- PD, Parkinson’s disease
- Protein misfolding
- SMA, Spinal muscular atrophy
- VD, Vascular dementia
- prion dis, prion diseases
- α-syn, alpha-synuclein
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Affiliation(s)
- Sheena E.B. Tyler
- John Ray Research Field Station, Cheshire, United Kingdom
- Corresponding author.
| | - Luke D.K. Tyler
- School of Natural Sciences, Bangor University, Gwynedd, United Kingdom
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Neural bases of motor fatigue in multiple sclerosis: A multimodal approach using neuromuscular assessment and TMS-EEG. Neurobiol Dis 2023; 180:106073. [PMID: 36906073 DOI: 10.1016/j.nbd.2023.106073] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Motor fatigue is one of the most common symptoms in multiple sclerosis (MS) patients. Previous studies suggested that increased motor fatigue in MS may arise at the central nervous system level. However, the mechanisms underlying central motor fatigue in MS are still unclear. This paper investigated whether central motor fatigue in MS reflects impaired corticospinal transmission or suboptimal primary motor cortex (M1) output (supraspinal fatigue). Furthermore, we sought to identify whether central motor fatigue is associated with abnormal M1 excitability and connectivity within the sensorimotor network. Twenty-two patients affected by relapsing-remitting MS and 15 healthy controls (HCs) performed repeated blocks of contraction at different percentages of maximal voluntary contraction with the right first dorsal interosseus muscle until exhaustion. Peripheral, central, and supraspinal components of motor fatigue were quantified by a neuromuscular assessment based on the superimposed twitch evoked by peripheral nerve and transcranial magnetic stimulation (TMS). Corticospinal transmission, excitability and inhibition during the task were tested by measurement of motor evoked potential (MEP) latency, amplitude, and cortical silent period (CSP). M1 excitability and connectivity was measured by TMS-evoked electroencephalography (EEG) potentials (TEPs) elicited by M1 stimulation before and after the task. Patients completed fewer blocks of contraction and showed higher values of central and supraspinal fatigue than HCs. We found no MEP or CSP differences between MS patients and HCs. Patients showed a post-fatigue increase in TEPs propagation from M1 to the rest of the cortex and in source-reconstructed activity within the sensorimotor network, in contrast to the reduction observed in HCs. Post-fatigue increase in source-reconstructed TEPs correlated with supraspinal fatigue values. To conclude, MS-related motor fatigue is caused by central mechanisms related explicitly to suboptimal M1 output rather than impaired corticospinal transmission. Furthermore, by adopting a TMS-EEG approach, we proved that suboptimal M1 output in MS patients is associated with abnormal task-related modulation of M1 connectivity within the sensorimotor network. Our findings shed new light on the central mechanisms of motor fatigue in MS by highlighting a possible role of abnormal sensorimotor network dynamics. These novel results may point to new therapeutical targets for fatigue in MS.
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Yousefnia Babaki F, Khodadoost M, Rezaeizadeh H, Naser Moghadasi A, Fahimi S, Hosseini H, Movahhed M, Gharagozli K. Efficacy and safety of "Jollab Monzej" as a traditional persian compound medicine for the treatment of multiple sclerosis-related fatigue: A randomized placebo-controlled trial. CASPIAN JOURNAL OF INTERNAL MEDICINE 2023; 14:257-266. [PMID: 37223302 PMCID: PMC10201133 DOI: 10.22088/cjim.14.2.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/25/2022] [Accepted: 04/05/2022] [Indexed: 05/25/2023]
Abstract
Background The purpose of this study was to investigate the efficacy and safety of Jollab monzej (JMZ), a Traditional Persian compound medicine, on multiple sclerosis-related fatigue (MSRF). Methods We did a double-blind randomized controlled phase3 clinical trial on the JMZ syrup in fifty-six relapsing-remitting MS (RRMS) patients aged 18-55 years with moderate to severe fatigue using the Expanded Disability Status Scale (EDSS) score ≤ 6. We randomly assigned (1;1) participants to the JMZ syrup or placebo syrup groups treated for one month. Participants, investigators, and assessors were unaware of the assignments. The primary outcome was changes in the fatigue score on the Fatigue Severity Scale (FSS), at baseline and one month after treatment using the intention-to-treat (ITT) analysis. The secondary outcomes were changes in the score of Visual Analogue Scale (VAS), Beck Depression Inventory (BDI), and Pittsburgh Sleep Quality Index (PSQI). Outcomes were measured at baseline, one month after treatment, and 2-week follow-up. Safety was detected in all participants. Results We randomly assigned 56 participants to the JMZ group (n=28) and placebo group (n=28). Fatigue scores significantly changed in both groups; however, the JMZ group had a greater reduction in FSS score in the ITT analysis. The adjusted mean difference was 8.80 (Confidence interval (CI) 95%, 2.90-14.70, P = 0.00). The mean difference of VAS, BDI, and global PSQI scores were statistically significant (P=0.01, P₌0.00, P₌0.01; respectively). Regarding safety, mild adverse events (AEs) were reported. Conclusion The results of our study revealed that the administration of JMZ syrup alleviated MSRF and also could improve depression and sleep disorders.
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Affiliation(s)
- Fatemeh Yousefnia Babaki
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmood Khodadoost
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Rezaeizadeh
- School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple sclerosis Research Center, Neuroscience institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Fahimi
- Department of Traditional Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Hamed Hosseini
- Center for Research and Training in Skin Diseases and Leprosy (CRTSDL), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mina Movahhed
- Department of Traditional Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Kurosh Gharagozli
- Brain mapping research Center, Loghman Hakim educational hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kearns PKA, Martin SJ, Chang J, Meijboom R, York EN, Chen Y, Weaver C, Stenson A, Hafezi K, Thomson S, Freyer E, Murphy L, Harroud A, Foley P, Hunt D, McLeod M, O'Riordan J, Carod-Artal FJ, MacDougall NJJ, Baranzini SE, Waldman AD, Connick P, Chandran S. FutureMS cohort profile: a Scottish multicentre inception cohort study of relapsing-remitting multiple sclerosis. BMJ Open 2022; 12:e058506. [PMID: 35768080 PMCID: PMC9244691 DOI: 10.1136/bmjopen-2021-058506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Multiple sclerosis (MS) is an immune-mediated, neuroinflammatory disease of the central nervous system and in industrialised countries is the most common cause of progressive neurological disability in working age persons. While treatable, there is substantial interindividual heterogeneity in disease activity and response to treatment. Currently, the ability to predict at diagnosis who will have a benign, intermediate or aggressive disease course is very limited. There is, therefore, a need for integrated predictive tools to inform individualised treatment decision making. PARTICIPANTS Established with the aim of addressing this need for individualised predictive tools, FutureMS is a nationally representative, prospective observational cohort study of 440 adults with a new diagnosis of relapsing-remitting MS living in Scotland at the time of diagnosis between May 2016 and March 2019. FINDINGS TO DATE The study aims to explore the pathobiology and determinants of disease heterogeneity in MS and combines detailed clinical phenotyping with imaging, genetic and biomarker metrics of disease activity and progression. Recruitment, baseline assessment and follow-up at year 1 is complete. Here, we describe the cohort design and present a profile of the participants at baseline and 1 year of follow-up. FUTURE PLANS A third follow-up wave for the cohort has recently begun at 5 years after first visit and a further wave of follow-up is funded for year 10. Longer-term follow-up is anticipated thereafter.
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Affiliation(s)
- Patrick K A Kearns
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Chromatin Lab, Genome Regulation Section, The University of Edinburgh MRC Human Genetics Unit, Edinburgh, UK
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Neurology, Institute of Clinical Neurosciences, NHS Greater Glasgow and Clyde, Glasgow, UK
- Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | - Sarah J Martin
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Neurology, Institute of Clinical Neurosciences, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Jessie Chang
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Elizabeth N York
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Yingdi Chen
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
| | - Christine Weaver
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Amy Stenson
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | | | - Stacey Thomson
- Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | - Elizabeth Freyer
- Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | - Lee Murphy
- Wellcome Trust Clinical Research Facility, Edinburgh, UK
| | - Adil Harroud
- Department of Neurology, Weill Institute of Clinical Neuroscience, San Francisco, California, USA
| | - Peter Foley
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - David Hunt
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Margaret McLeod
- Department of Neurology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Jonathon O'Riordan
- Tayside Centre for Clinical Neurosciences, University of Dundee Division of Neuroscience, Dundee, UK
| | | | - Niall J J MacDougall
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Department of Neurology, Wishaw General Hospital, Wishaw, UK
| | - Sergio E Baranzini
- Department of Neurology, Weill Institute of Clinical Neuroscience, San Francisco, California, USA
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Peter Connick
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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Campbell LM, Sun-Suslow N, Heaton A, Heaton RK, Ellis RJ, Moore DJ, Moore RC. Fatigue is associated with worse cognitive and everyday functioning in older persons with HIV. AIDS 2022; 36:763-772. [PMID: 34999606 PMCID: PMC9081180 DOI: 10.1097/qad.0000000000003162] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether there are relationships between fatigue, cognition, and everyday functioning in older persons with and without HIV and to examine if associations remain after accounting for depression, anxiety, and sleep quality. METHODS Sixty-nine persons with HIV (PWH) and 36 persons without HIV, aged 50-74 years, were recruited from ongoing studies at UC San Diego's HIV Neurobehavioral Research Program and from the community. Participants completed neuropsychological testing, a performance-based measure of everyday functioning, and self-report questionnaires of fatigue, depression, anxiety, sleep quality, and everyday functioning. Multivariable linear regressions and logistic regressions stratified by HIV serostatus were used to examine relationships between fatigue, cognition, and everyday functioning. Psychiatric symptoms and sleep quality were examined as covariates. RESULTS In this cross-sectional study, PWH had significantly greater fatigue than the HIV-negative group (g = 0.83; P < 0.01). When stratifying by HIV serostatus, greater fatigue was significantly associated with worse global cognition (β = -0.56;P < 0.01) in PWH even when controlling for covariates;however, fatigue was not significantly associated with global cognition in persons without HIV. In PWH and when accounting for covariates, fatigue was also associated with greater risk of self-reported everyday functioning impairment [odds ratio (OR) = 1.66 for 10-point increase in fatigue, P = 0.04] but not performance-based everyday functioning (P = 0.95). CONCLUSION Fatigue is associated with cognition, particularly measures with a speeded component, and self-reported everyday functioning in older PWH. Findings suggest that fatigue is important to assess and consider in the context of aging with HIV.
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Affiliation(s)
- Laura M Campbell
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Ni Sun-Suslow
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Anne Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Ronald J Ellis
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
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11
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Adibi I, Sanayei M, Tabibian F, Ramezani N, Pourmohammadi A, Azimzadeh K. Multiple sclerosis-related fatigue lacks a unified definition: A narrative review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2022; 27:24. [PMID: 35419061 PMCID: PMC8995308 DOI: 10.4103/jrms.jrms_1401_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 09/19/2021] [Accepted: 11/01/2021] [Indexed: 11/05/2022]
Abstract
Fatigue is the most common symptom in multiple sclerosis (MS). Although MS-related fatigue (MS-F) strongly affects quality of life and social performance of patients, there is currently a lack of knowledge about its pathophysiology, which in turns leads to poor objective diagnosis and management. Recent studies have attempted to explain potential etiologies as well as treatments for MS-F. However, it seems that without a consensus on its nature, these data could not provide a route to a successful approach. In this Article, we review definitions, epidemiology, risk factors and correlated comorbidities, pathophysiology, assessment methods, neuroimaging findings, and pharmacological and nonpharmacological treatments of MS-F. Further studies are warranted to define fatigue in MS patients more accurately, which could result in precise diagnosis and management.
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Affiliation(s)
- Iman Adibi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Sanayei
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Farinaz Tabibian
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Neda Ramezani
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Pourmohammadi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kiarash Azimzadeh
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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12
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Results from Patient Interviews on Fatigue in Progressive Multiple Sclerosis and Evaluation of Fatigue Patient-Reported Outcome (PRO) Instruments. Neurol Ther 2022; 11:725-739. [PMID: 35266103 PMCID: PMC8906518 DOI: 10.1007/s40120-022-00337-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS) but is challenging to assess and has not been comprehensively characterized in patients with progressive MS. This study aimed to (1) obtain qualitative evidence from patients with progressive MS to characterize MS-related fatigue concepts and their impacts on health-related quality of life (HRQoL), and (2) evaluate the conceptual frameworks of existing MS-specific fatigue patient-reported outcome (PRO) instruments using study data to determine the most suitable PRO instrument in this population. Methods Qualitative interviews were conducted with 30 US participants with confirmed progressive MS and fatigue in the last 6 months to assess their MS-related fatigue. Data were compared with concepts in existing PRO instruments to evaluate their relevance in progressive MS. Results Physical and mental concepts of fatigue were identified and characterized distinctly from patients with progressive MS. Most patients characterized fatigue as occurring daily and lasting several hours, with negative impacts on HRQoL. Concept mapping to existing MS-specific fatigue PRO instruments supported the Fatigue Severity Impact Questionnaire—Relapsing Multiple Sclerosis (FSIQ-RMS) as the most suitable existing option for assessing fatigue in patients with progressive MS, as it separates physical and mental aspects of fatigue and includes every highly endorsed concept reported by the interviewed patients. Conclusions This qualitative study identified meaningful physical and mental fatigue concepts in patients with progressive MS and preliminarily supports the use of the FSIQ-RMS for this population. More research is needed to fully validate this instrument for progressive MS. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00337-9.
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13
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Peters KB, Affronti ML, Woodring S, Lipp E, Healy P, Herndon JE, Miller ES, Freeman MW, Randazzo DM, Desjardins A, Friedman HS. Effects of low-dose naltrexone on quality of life in high-grade glioma patients: a placebo-controlled, double-blind randomized trial. Support Care Cancer 2022; 30:3463-3471. [PMID: 35001215 DOI: 10.1007/s00520-021-06738-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE At diagnosis and throughout the disease course, patients with high-grade glioma (HGG) experience a diminished quality of life (QOL) and increased fatigue. Naltrexone, an orally semisynthetic opiate antagonist, is FDA-approved for the treatment of heroin/alcohol addiction, and low-dose naltrexone (LDN) has been observed to improve QOL and lower fatigue in other neurological illnesses, such as multiple sclerosis. LDN is believed to function as a partial agonist and can lead to shifts in neurochemicals that reduce fatigue. Based on this, we sought to study whether LDN has an impact on QOL and fatigue in patients with HGG. METHODS In a placebo-controlled, double-blind study, we randomized 110 HGG patients to receive placebo (N = 56) or LDN 4.5 mg orally at night (N = 54). Subjects received LDN or placebo at day 1 of concurrent radiation and temozolomide therapy and continued for 16 weeks. Change from baseline in patient-reported outcomes of QOL (Functional Assessment of Cancer Therapy-Brain) and fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue) was assessed. RESULTS Demographics were WHO grade IV (85%), male (56%), KPS 90-100 (51%), grossly resected (55%), and mean age of 56 years. QOL and fatigue changes between baseline and post concurrent chemotherapy and radiation therapy were not significantly different between patients receiving LDN or placebo. The adverse event profiles for LDN and placebo were similar and attributed to concomitant use of temozolomide. CONCLUSIONS LDN has no effect on QOL and fatigue in HGG patients during concurrent chemotherapy and radiation therapy. TRIAL REGISTRATION United States National Library of Medicine Clinical Trials.gov NCT01303835, Date 2/25/2011.
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Affiliation(s)
- Katherine B Peters
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA. .,Department of Neurology, Duke University Medical Center, Durham, NC, USA.
| | - Mary L Affronti
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA.,Duke School of Nursing, Duke University Medical Center, Durham, NC, USA
| | - Sarah Woodring
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA
| | - Eric Lipp
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA
| | - Patrick Healy
- Department of Biostatistics and Informatics, Duke University Medical Center, Durham, NC, USA
| | - James E Herndon
- Department of Biostatistics and Informatics, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth S Miller
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA
| | - Maria W Freeman
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA
| | - Dina M Randazzo
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA.,Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - Annick Desjardins
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA.,Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - Henry S Friedman
- Department of Neurosurgery, Duke University Medical Center, PO Box 3624, Durham, NC, 27710, USA
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14
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Ferorelli P, Antonelli F, Shevchenko A, Mischiati C, Doepp M, Lenzi S, Borromeo I, Feriotto G, Beninati S. Reduction in Fatigue Symptoms Following the Administration of Nutritional Supplements in Patients with Multiple Sclerosis. Med Sci (Basel) 2021; 9:52. [PMID: 34287336 PMCID: PMC8293375 DOI: 10.3390/medsci9030052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 12/14/2022] Open
Abstract
Despite recent advances in immune-modulatory drugs, pharmacological therapies have been proven ineffective in severe presentations of multiple sclerosis (MS), including secondary progressive MS. At present, therapeutic interventions' performance is primarily focused on ameliorating symptoms to improve the patient's quality of life (QOL). Among complementary treatments, nutrition has been considered a decisive factor to control symptoms and enhance the wellness of MS patients. Although no special diets are associated with MS, the impact of diet and dietary supplements on the course of progressive forms of the disease has been studied during the last few years. Fatigue is among the most common and disabling symptoms reported by MS patients. Fatigue has been defined in the Multiple Sclerosis Council for Clinical Practice Guidelines (MSCCPG, 1998) as a "subjective lack of physical and/or mental energy that the individual perceives as an interference with habitual and desired activities". This study aimed to compare the psychometric functioning of the "Fatigue Severity Scale" (FSS) and the "Modified Fatigue Impact Scale" (MFIS) in our sample of people with MS. Specifically, during chronic treatment, the change in these two parameters with two vitamin-rich dietary supplements (Citozym® and Ergozym®) was evaluated. The impact of these nutritional supplements revealed differences in antioxidant and anti-inflammatory parameters among the volunteers in the treatment group, with a subsequent improvement in fatigue. In conclusion, the results obtained have confirmed the effectiveness of complementary nutritional therapies, evaluated essentially based on hematological biomarkers, through which it is possible to act on disability to improve the QOL of MS patients.
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Affiliation(s)
| | | | - Anna Shevchenko
- Department of Pharmacology, Kabardine University, 101000 Nalchik, Russia;
| | - Carlo Mischiati
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44100 Ferrara, Italy;
| | - Manfred Doepp
- Department of Psychology and Sports Science, Giessen Justus, Liebig University Gießen, 35398 Gießen, Germany;
| | - Stefano Lenzi
- Department of Health Engineering, Université Européenne de Bruxelles Jean Monnet, Schaerbeek, 1030 Brussels, Belgium;
| | - Ilaria Borromeo
- Department of Physics, University of Tor Vergata, 00100 Rome, Italy;
| | - Giordana Feriotto
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, 44100 Ferrara, Italy;
| | - Simone Beninati
- Department of Biology, University of Rome Tor Vergata, Via della Ricerca Scientifica, 00100 Rome, Italy
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15
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Newland P, Chen L, Sun P, Zempel J. Neurophysiological Correlates of Fatigue in Multiple Sclerosis. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Ondek K, Nasirishargh A, Dayton JR, Nuño MA, Cruz-Orengo L. Strain and sex differences in somatosensation and sociability during experimental autoimmune encephalomyelitis. Brain Behav Immun Health 2021; 14:100262. [PMID: 34589768 PMCID: PMC8474462 DOI: 10.1016/j.bbih.2021.100262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 12/01/2022] Open
Abstract
Multiple Sclerosis (MS) is an immune-mediated disease that results in major locomotor deficits. However, recent studies have revealed that fatigue, slow processing speed, and memory impairment are the top variables impacting employment status for MS patients. These suggest that cognitive effects may have a greater impact on productivity, lifestyle, and quality of life than do disease-related motor deficits. However, these debilitating non-locomotive effects have been largely overlooked in rodent models of the disease, such as experimental autoimmune encephalomyelitis (EAE). We hypothesized that murine EAE can also be used to assess non-locomotive dysfunctions (mood, sociability, muscle strength, and balance), as well as potential biases in these dysfunctions due to sex and/or strain. We actively immunized male and female C57BL/6 (B6) and SJL mice for EAE and evaluated their performance on the Deacon's weight grip test, Kondziela's inverted screen test, Hall's rope grip test, manual von Frey test for somatic nociception, and a three-chamber social preference paradigm. We hypothesized that EAE progression is associated with changes in muscle strength, balance, pain, and sociability and that these variations are linked to sex and/or strain. Our results indicate that strain but not sex influenced differences in muscle strength and balance during EAE, and both sex and strain have an impact on mechanical nociception, regardless of EAE disease status. Furthermore, both sex and strain had complex effects on differences in sociability. In conclusion, testing these additional modalities during EAE helps to unveil other signs and symptoms that could be used to determine the efficacy of a drug or treatment in the modulation of a MS-like behavior.
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Affiliation(s)
- Katelynn Ondek
- University of California, Davis. Department of Anatomy, Physiology & Cell Biology, School of Veterinary Medicine, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA
| | - Aida Nasirishargh
- University of California, Davis. Department of Anatomy, Physiology & Cell Biology, School of Veterinary Medicine, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA
| | - Jacquelyn R. Dayton
- University of California, Davis. Department of Anatomy, Physiology & Cell Biology, School of Veterinary Medicine, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA
| | - Miriam A. Nuño
- University of California, Davis. Department of Public Health, Division of Biostatistics, School of Medicine, Public Health/Medical Sciences Bldg. 1-C, Davis, CA 95616, USA
| | - Lillian Cruz-Orengo
- University of California, Davis. Department of Anatomy, Physiology & Cell Biology, School of Veterinary Medicine, 1089 Veterinary Medicine Drive, Davis, CA, 95616, USA
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17
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van der Hiele K, van Gorp DAM, van Egmond EEA, Jongen PJ, Reneman MF, van der Klink JJL, Arnoldus EPJ, Beenakker EAC, van Eijk JJJ, Frequin STFM, de Gans K, Hengstman GJD, Hoitsma E, Gerlach OHH, Verhagen WIM, Heerings MAP, Middelkoop HAM, Visser LH. Self-reported occupational functioning in persons with relapsing-remitting multiple sclerosis: Does personality matter? J Neurol Sci 2021; 427:117561. [PMID: 34216973 DOI: 10.1016/j.jns.2021.117561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) poses a major threat to sustainable employability. Identifying conditions and factors that promote work participation is of great importance. Our objective was to explore the contribution of personality traits in explaining occupational functioning in MS. METHODS 241 participants with relapsing-remitting MS (78% female, median age: 42.0 years, median EDSS: 2.0) and 60 healthy controls (70% female, median age: 45.0 years) underwent neuropsychological and neurological examinations and completed questionnaires. Multivariate logistic and linear regression analyses were conducted to examine relations between personality traits and self-reported occupational functioning, while accounting for known correlates. RESULTS Personality traits were not associated with self-reported occupational functioning when correcting for known correlates. A higher impact of fatigue (B = -0.05, p = .005 and B = -0.04, p = .009) and depression (B = -0.22, p = .008 and B = -0.21, p = .01) were associated with no paid job (R2 = 0.13) and considering to reduce work hours (R2 = 0.12). A higher impact of fatigue (B = -0.05, p = .008, β = 0.46, p = .001 and β = -0.36, p = .001) was associated with absenteeism from work (R2 = 0.15), more presenteeism (R2 = 0.35) and lower work ability (R2 = 0.25). A higher impact of fatigue (β = 0.46, p = .001) and anxiety (β = 0.25, p = .001) were associated with more work difficulties (R2 = 0.54). CONCLUSION Personality traits did not explain additional variance in self-reported occupational functioning in persons with relapsing-remitting MS with mild disability. The impact of fatigue was the main and most consistent correlate of occupational functioning, often combined with depression or anxiety. Total explained variance of the models was limited, emphasizing the need to additionally examine other (contextual) factors when considering occupational challenges in MS.
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Affiliation(s)
- K van der Hiele
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden, the Netherlands.
| | - D A M van Gorp
- University of Humanistic Studies, Utrecht, the Netherlands
| | - E E A van Egmond
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden, the Netherlands; University of Humanistic Studies, Utrecht, the Netherlands; National Multiple Sclerosis Foundation, Rotterdam, the Netherlands; Elisabeth-TweeSteden Hospital, Department of Neurology, Tilburg, the Netherlands
| | - P J Jongen
- MS4 Research Institute, Nijmegen, the Netherlands; University of Groningen, University Medical Centre Groningen, Department of Community & Occupational Medicine, Groningen, the Netherlands
| | - M F Reneman
- University of Groningen, University Medical Centre Groningen, Centre for Rehabilitation, Haren, the Netherlands
| | - J J L van der Klink
- Tilburg University, Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg, the Netherlands; Optentia, North West University of South Africa, Vanderbijlspark, South Africa
| | - E P J Arnoldus
- Elisabeth-TweeSteden Hospital, Department of Neurology, Tilburg, the Netherlands
| | - E A C Beenakker
- Medical Centre Leeuwarden, Department of Neurology, Leeuwarden, the Netherlands
| | - J J J van Eijk
- Jeroen Bosch Hospital, Department of Neurology's-Hertogenbosch, the Netherlands
| | - S T F M Frequin
- St. Antonius Hospital, Department of Neurology, Nieuwegein, the Netherlands
| | - K de Gans
- Groene Hart Hospital, Department of Neurology, Gouda, the Netherlands
| | | | - E Hoitsma
- Alrijne Hospital Leiden, Department of Neurology, Leiden, the Netherlands
| | - O H H Gerlach
- Zuyderland Medical Centre, Department of Neurology, Sittard-Geleen, the Netherlands
| | - W I M Verhagen
- Canisius-Wilhelmina Hospital, Department of Neurology, Nijmegen, the Netherlands
| | - M A P Heerings
- Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - H A M Middelkoop
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden, the Netherlands; Leiden University Medical Centre, Department of Neurology, Leiden, the Netherlands
| | - L H Visser
- University of Humanistic Studies, Utrecht, the Netherlands; Elisabeth-TweeSteden Hospital, Department of Neurology, Tilburg, the Netherlands
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18
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Salarvand S, Heidari ME, Farahi K, Teymuri E, Almasian M, Bitaraf S. Effectiveness of massage therapy on fatigue and pain in patients with multiple sclerosis: A systematic review and meta-analysis. Mult Scler J Exp Transl Clin 2021; 7:20552173211022779. [PMID: 34188950 PMCID: PMC8209836 DOI: 10.1177/20552173211022779] [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: 02/17/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background Fatigue and pain are prevalent symptoms of multiple sclerosis (MS) and frequent complaint in MS patients, which reduce their quality of life. This study aimed to assess the effect of massage therapy on pain and fatigue in MS Patients. Method The original and Persian databases were searched included PubMed, web of science, embase, ovid, scopus, and the Cochrane Library, SID, and Iranedex from inception to November 2020. Studies that reported the effect of massage on fatigue and pain were included. Two investigators extracted all relevant data, independently. For deriving analysis, mean difference (MD) and standardized mean difference (SMD) were used. Result Ten studies were eligible acoording criteria. The effect of massage on fatigue showed significant improvement (-1.62; 95% CL -2.40, -0.83; p < .00001), also results of the systematic review showed a significant reduction in pain severity. Conclusion Massage as a complementary and non-pharmacological therapy might have been associated with alleviating fatigue and pain in M.S. patients. Based on the current study, massage intervention for MS patients could have possible clinical value for palliating pain and fatigue and improving quality of life; however, this matter needs further and more significant trial studies.
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Affiliation(s)
- Shahin Salarvand
- Hepatitis Research Center, Faculty of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Eghbal Heidari
- Student Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Farahi
- Student Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Teymuri
- Student Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Almasian
- Department of the English Language, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Saeid Bitaraf
- Department of Epidemiology and Biostatistics, Iran University of Medical Sciences, Tehran, Iran
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19
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Gaemelke T, Riemenschneider M, Dalgas U, Kjølhede T, Rasmussen C, Stenager E, Overgaard K, Hvid LG. Comparison Between Isometric and Concentric Motor Fatigability in Persons With Multiple Sclerosis and Healthy Controls - exploring central and peripheral contributions of motor fatigability. Neurorehabil Neural Repair 2021; 35:644-653. [PMID: 34027727 DOI: 10.1177/15459683211017502] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND Motor fatigability (i.e. contraction-induced reduction in muscle strength) from a concentric task associate stronger to walking and perception of fatigue in persons with multiple sclerosis (pwMS), compared with an isometric task. However, the central and peripheral contributions of motor fatigability between these tasks have not been investigated. OBJECTIVE Compare the central and peripheral contributions of motor fatigability in the knee extensors in a sustained isometric fatigability protocol versus a concentric fatigability protocol and in pwMS versus healthy controls (HCs). METHODS Participants (n=31 pwMS; n=15 HCs) underwent neuromuscular testing before and immediately after two knee extensor fatigability tasks (sustained isometric and concentric) in an isokinetic dynamometer. Neuromuscular testing of fatigability consisted of maximal voluntary contraction, voluntary activation (central/neural contributor), and resting twitch (peripheral/muscular contributor) determined by the interpolated twitch technique. RESULTS Sustained isometric and concentric fatigability protocols resulted in motor fatigability for both pwMS and HCs, with no between-protocols differences for either group. Regression analysis showed that motor fatigability variance in pwMS was mainly attributed to central fatigability in the sustained isometric protocol and to both central and peripheral fatigability in the concentric protocol. In HCs, the variance in sustained isometric and concentric fatigability were attributed to both peripheral and central fatigability. CONCLUSION Central and peripheral contributions of motor fatigability differed between sustained isometric and concentric protocols as well as between pwMS and HCs. These between-protocol differences in pwMS provide a neuromuscular dimension to the reported difference in the strength of associations of concentric and isometric tasks to walking and perception of fatigue in pwMS.
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Affiliation(s)
| | | | | | - Tue Kjølhede
- Aarhus University, Denmark.,Odense University Hospital, Denmark
| | | | - Egon Stenager
- University of Southern Denmark, Odense, Denmark.,MS-Clinic of Southern Jutland (Sønderborg, Esbjerg, Kolding), Sønderborg, Denmark
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20
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Effects of hippotherapy on postural balance, functional mobility, self-perceived fatigue, and quality of life in people with relapsing-remitting multiple sclerosis: Secondary results of an exploratory clinical trial. Mult Scler Relat Disord 2021; 52:102948. [PMID: 33940496 DOI: 10.1016/j.msard.2021.102948] [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: 10/27/2020] [Revised: 03/11/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) results in worsening of postural balance, functional mobility, and self-perceived fatigue as influences of quality of life. OBJECTIVE To examine the effects of hippotherapy on postural balance, functional mobility, self-perceived fatigue, and quality of life in people with MS. METHODS Participants were assigned into a hippotherapy intervention group (n= 17) or a control group (n= 16). The intervention included 16 sessions of 30-minutes of hippotherapy conducted twice a week whereas the control group was maintained their therapeutic routine. Postural balance was evaluated as CoP speed (cm/s) and CoP 95% elliptical area (cm2) using a force platform under 4 experimental conditions: stable surface/ eyes open, stable surface/ eyes closed, foam surface/ eyes open, and foam surface/ eyes closed. Functional mobility was evaluated by the Timed Up and Go (TUG) test. The Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS) measured perceived fatigue, and the Functional Assessment of Multiple Sclerosis (FAMS) measured quality of life. The data were examined using mixed model ANOVA with Bonferroni post hoc. RESULTS CoP speed and CoP 95% elliptical area (p < .05) significantly decreased across all testing conditions for the intervention group compared with control. The TUG improved over time in the intervention group (p = .001) as did the FSS (p < .001). In addition, there was also an improvement for the score and all the MFIS domains (p < .005) for the intervention group compared with control and for FAMS improved over time in the intervention group (p < .05). CONCLUSION Hippotherapy improved postural balance, functional mobility, fatigue, and quality of life in people with relapsing-remitting MS. This suggests that hippotherapy may be a useful approach for complimentary treatment among people with MS.
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Arm J, Al-Iedani O, Ribbons K, Lea R, Lechner-Scott J, Ramadan S. Biochemical Correlations with Fatigue in Multiple Sclerosis Detected by MR 2D Localized Correlated Spectroscopy. J Neuroimaging 2021; 31:508-516. [PMID: 33615583 DOI: 10.1111/jon.12836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND AND PURPOSE Fatigue is the common symptom in patients with multiple sclerosis (MS), yet its pathophysiological mechanism is poorly understood. We investigated the metabolic changes in fatigue in a group of relapsing-remitting MS (RRMS) patients using MR two-dimensional localized correlated spectroscopy (2D L-COSY). METHODS Sixteen RRMS and 16 healthy controls were included in the study. Fatigue impact was assessed with the Modified Fatigue Impact Scale (MFIS). MR 2D L-COSY data were collected from the posterior cingulate cortex. Nonparametric statistical analysis was used to calculate the changes in creatine scaled metabolic ratios and their correlations with fatigue scores. RESULTS Compared to healthy controls, the RRMS group showed significantly higher fatigue and lower metabolic ratios for tyrosine, glutathione, homocarnosine (GSH+Hca), fucose-3, glutamine+glutamate (Glx), glycerophosphocholine (GPC), total choline, and N-acetylaspartate (NAA-2), while increased levels for isoleucine and glucose (P ≤ .05). Only GPC showed positive correlation with all fatigue domains (r = .537, P ≤ .05). On the other hand, Glx-upper, NAA-2, GSH+Hca, and fucose-3 showed negative correlations with all fatigue domains (r = -.345 to -.580, P ≤ .05). While tyrosine showed positive correlation with MFIS (r = .499, P ≤ .05), cognitive fatigue was negatively correlated with total GSH (r = -.530, P ≤ .05). No correlations were found between lesion load or brain volumes with fatigue score. CONCLUSIONS Our results suggest that fatigue in MS is strongly correlated with an imbalance in neurometabolites but not structural brain measurements.
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Affiliation(s)
- Jameen Arm
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Oun Al-Iedani
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Karen Ribbons
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, Australia
| | - Rod Lea
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, Australia.,Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, Australia.,Department of Neurology, John Hunter Hospital, New Lambton Heights, Newcastle, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Saadallah Ramadan
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, Newcastle, Australia
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Sleep architecture, obstructive sleep apnea and functional outcomes in adults with a history of Tick-borne encephalitis. PLoS One 2021; 16:e0246767. [PMID: 33556106 PMCID: PMC7870069 DOI: 10.1371/journal.pone.0246767] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/25/2021] [Indexed: 01/02/2023] Open
Abstract
Tick-borne encephalitis (TBE) is a widespread viral infection of the central nervous system with increasing incidence in Europe and northern Asia. Post-infectious sequelae are frequent, and patients with TBE commonly experience long-term fatigue and subjective sleep disturbances. Obstructive sleep apnea (OSA) may be a contributing factor, and objective sleep studies with polysomnography (PSG) are lacking. Forty-two adults, 22 TBE patients (cases), diagnosed in Region Västra Götaland, Sweden, between 2012 and 2015, and 20 controls without a known TBE history, underwent an overnight PSG, respectively. All participants responded to questionnaires. The cases and controls were similar regarding age, sex, obesity, concomitant diseases, smoking, and alcohol habits. Despite similar PSG characteristics such as total sleep time and OSA severity indices, the TBE cases reported statistically more sleep-related functional impairment on the Functional Outcome of Sleep Questionnaire (FOSQ) compared with the controls (median scores 18.1 vs. 19.9; p<0.05). In a multivariate analysis, TBE correlated significantly with the lower FOSQ scores (unstandardized β -1.80 [%95 confidence interval -3.02 - -0.58]; p = 0.005) independent of age, sex, total sleep time and apnea-hypopnea-index. TBE cases with OSA reported the lowest scores on the FOSQ compared with the other subgroups with TBE or OSA alone, and the ones with neither TBE nor OSA. TBE is associated with impaired functional outcomes, in which concomitant OSA may worsen the subjective symptoms. Further studies are warranted to determine the effect of treatment of concomitant OSA on functional outcomes with regard to optimal rehabilitation of TBE.
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23
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Cisbani G, Poggini S, Laflamme N, Pons V, Tremblay MÈ, Branchi I, Rivest S. The Intellicage system provides a reproducible and standardized method to assess behavioral changes in cuprizone-induced demyelination mouse model. Behav Brain Res 2020; 400:113039. [PMID: 33279637 DOI: 10.1016/j.bbr.2020.113039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/18/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Multiple sclerosis is a neurodegenerative disorder characterized by myelin loss in the brain parenchyma. To mimic the disease, mice are fed a cuprizone-supplemented diet for 5 weeks, which leads to demyelination of white and grey matter regions, with the corpus callosum being the most susceptible to cuprizone intoxication. Although this model is highly exploited, classical behavioural tests showed inconsistent results. OBJECTIVE In our study, we aimed to use the automated system Intellicage to phenotype the behaviour of cuprizone-fed mice. METHODS Mice were continuously monitored during the 5 weeks of intoxication in their home cages, with minimal interference from the experimenter. Mice were assessed for spontaneous activity, fine movements, and impulsivity. RESULTS Consistently, cuprizone-fed mice showed reduced activity and impulsivity throughout the test period. These behavioral results were confirmed by repeating the battery of behavioral tests in a second cohort of cuprizone-fed mice. Our results suggest that the behavioural phenotyping of cuprizone-fed mice using Intellicage is reproducible and sensitive enough to detect changes normally missed in standard behavioral test batteries. CONCLUSION Using a reproducible and standardized method to assess behavioral changes in mice intoxicated with cuprizone is crucial to better understand the disease as well as the functional outcome of treatments.
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Affiliation(s)
- Giulia Cisbani
- CHU de Québec Research Center and Department of Molecular Medicine, Faculty of Medicine, Laval University, 2705 Laurier Boul., Québec City, QC, G1V 4G2, Canada
| | - Silvia Poggini
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Roma, Italy
| | - Nataly Laflamme
- CHU de Québec Research Center and Department of Molecular Medicine, Faculty of Medicine, Laval University, 2705 Laurier Boul., Québec City, QC, G1V 4G2, Canada
| | - Vincent Pons
- CHU de Québec Research Center and Department of Molecular Medicine, Faculty of Medicine, Laval University, 2705 Laurier Boul., Québec City, QC, G1V 4G2, Canada
| | - Marie-Ève Tremblay
- CHU de Québec Research Center and Department of Molecular Medicine, Faculty of Medicine, Laval University, 2705 Laurier Boul., Québec City, QC, G1V 4G2, Canada; Division of Medical Sciences, University of Victoria, Victoria, BC, V8W 2Y2, Canada
| | - Igor Branchi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Roma, Italy
| | - Serge Rivest
- CHU de Québec Research Center and Department of Molecular Medicine, Faculty of Medicine, Laval University, 2705 Laurier Boul., Québec City, QC, G1V 4G2, Canada.
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24
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Aldughmi M, Al-Shorman A, Khalil H, El-Salem K, Alghwiri A. Translation and validation of the Arabic version of the patient determined disease steps in people with multiple sclerosis. Physiother Theory Pract 2020; 38:1281-1288. [DOI: 10.1080/09593985.2020.1839988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Mayis Aldughmi
- Department of Physiotherapy, School of Rehabilitation Sciences, University of Jordan, Amman, Jordan
| | - Alham Al-Shorman
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Hanan Khalil
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid El-Salem
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Alia Alghwiri
- Department of Physiotherapy, School of Rehabilitation Sciences, University of Jordan, Amman, Jordan
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Associations Between Self-Reported Symptoms and Gait Parameters Using In-Home Sensors in Persons With Multiple Sclerosis. Rehabil Nurs 2020; 45:80-87. [PMID: 30649037 DOI: 10.1097/rnj.0000000000000210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis (MS) is a progressive neurological disorder, characterized by exacerbations and remissions, often resulting in disability affecting multiple neurological functions. The purpose of this article was (1) to describe the frequencies of self-reported symptoms in a natural environment and (2) to determine characteristics and associations between self-reported symptoms and home gait parameters (speed, stride time, and stride length) at baseline and at 3 months in patients with MS. METHODS Participants completed the self-report MS-Related Symptom Scale to measure symptoms. A three-dimensional depth imaging system (Foresite Healthcare) was used to measure gait parameters in the home environment. RESULTS These data show significant correlations between the following symptoms: knee locking or collapsing, difficulty sleeping, depression, and anxiety with decreased number of average walks per day; however, the symptoms including trouble-making toilet: day and difficulty in starting urine were positively correlated with average walks per day. The symptom numbness was significantly correlated with decreased speed and decreased stride length. DISCUSSION AND CONCLUSIONS Our findings suggest that certain groups of symptoms were more frequently reported with certain gait parameters (stride time/speed) in persons with MS. Rehabilitation nurses can provide optimal care to prevent future decline in symptoms and gait.
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Ormstad H, Simonsen CS, Broch L, Maes DM, Anderson G, Celius EG. Chronic fatigue and depression due to multiple sclerosis: Immune-inflammatory pathways, tryptophan catabolites and the gut-brain axis as possible shared pathways. Mult Scler Relat Disord 2020; 46:102533. [PMID: 33010585 DOI: 10.1016/j.msard.2020.102533] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/03/2020] [Accepted: 09/25/2020] [Indexed: 02/07/2023]
Abstract
Chronic fatigue and major depression (MDD)-like symptoms are common manifestations of multiple sclerosis (MS), both with huge impact on quality of life. Depression can manifest itself as fatigue, and depressive symptoms are often mistaken for fatigue, and vice versa. The two conditions are sometimes difficult to differentiate, and their relationship is unclear. Whether chronic fatigue and depression occur primarily, secondarily or coincidentally with activated immune-inflammatory pathways in MS is still under debate. We have carried out a descriptive review aiming to gain a deeper understanding of the relationship between chronic fatigue and depression in MS, and the shared pathways that underpin both conditions. This review focuses on immune-inflammatory pathways, the kynurenine pathway and the gut-brain axis. It seems likely that proinflammatory cytokines, tryptophan catabolites (the KYN pathway) and the gut-brain axis are involved in the mechanisms causing chronic fatigue and MDD-like symptoms in MS. However, the evidence base is weak, and more research is needed. In order to advance our understanding of the underlying pathological mechanisms, MS-related fatigue and depression should be examined using a longitudinal design and both immune-inflammatory and KYN pathway biomarkers should be measured, relevant clinical characteristics judiciously registered, and self-report instruments for both fatigue and depression should be used.
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Affiliation(s)
- Heidi Ormstad
- University of South-Eastern Norway and University Oslo Metropolitan University.
| | | | | | - Dr Michael Maes
- Chulalongkorn University, Bangkok, Thailand; Medical University of Plovdiv, Plovdiv, Bulgaria; IMPACT Strategic Center, Deakin University, Australia
| | - George Anderson
- CRC Scotland & London, Eccleston Square, London, United Kingdom
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Taborri J, Studer V, Grossi P, Brambilla L, Patanè F, Ferrò MT, Mantegazza R, Rossi S. Reliability and Repeatability Analysis of Indices to Measure Gait Deterioration in MS Patients during Prolonged Walking. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5063. [PMID: 32899946 PMCID: PMC7570495 DOI: 10.3390/s20185063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 11/23/2022]
Abstract
Gait deterioration caused by prolonged walking represents one of the main consequences of multiple sclerosis (MS). This study aims at proposing quantitative indices to measure the gait deterioration effects. The experimental protocol consisted in a 6-min walking test and it involved nine patients with MS and twenty-six healthy subjects. Pathology severity was assessed through the Expanded Disability Status Scale. Seven inertial units were used to gather lower limb kinematics. Gait variability and asymmetry were assessed by coefficient of variation (CoV) and symmetry index (SI), respectively. The evolution of ROM (range of motion), CoV, and SI was computed analyzing data divided into six 60-s subgroups. Maximum difference among subgroups and the difference between the first minute and the remaining five were computed. The indices were analyzed for intra- and inter-day reliability and repeatability. Correlation with clinical scores was also evaluated. Good to excellent reliability was found for all indices. The computed standard deviations allowed us to affirm the good repeatability of the indices. The outcomes suggested walking-related fatigue leads to an always more variable kinematics in MS, in terms of changes in ROM, increase of variability and asymmetry. The hip asymmetry strongly correlated with the clinical disability.
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Affiliation(s)
- Juri Taborri
- Department of Economics, Engineering, Society and Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy;
| | - Valeria Studer
- Multiple Sclerosis Center, Neurology Department, Martini Hospital, 10121 Turin, Italy;
| | - Paola Grossi
- Neuroimmunology Center for Multiple Sclerosis, Cerebrovascular Department, ASST Crema, 52242 Crema, Italy; (P.G.); (M.T.F.)
| | - Laura Brambilla
- Operating Units of Autoimmune and Neuromuscular Diseases, IRCCS Foundation Neurological Institute Carlo Besta, 20133 Milano, Italy; (L.B.); (R.M.)
| | - Fabrizio Patanè
- Department of Engineering, Mech. Meas. and Microelectr.lab (M3lab), University Niccolò Cusano, 00166 Rome, Italy;
| | - Maria Teresa Ferrò
- Neuroimmunology Center for Multiple Sclerosis, Cerebrovascular Department, ASST Crema, 52242 Crema, Italy; (P.G.); (M.T.F.)
| | - Renato Mantegazza
- Operating Units of Autoimmune and Neuromuscular Diseases, IRCCS Foundation Neurological Institute Carlo Besta, 20133 Milano, Italy; (L.B.); (R.M.)
| | - Stefano Rossi
- Department of Economics, Engineering, Society and Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy;
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28
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Singhal T, Cicero S, Pan H, Carter K, Dubey S, Chu R, Glanz B, Hurwitz S, Tauhid S, Park MA, Kijewski M, Stern E, Bakshi R, Silbersweig D, Weiner HL. Regional microglial activation in the substantia nigra is linked with fatigue in MS. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/5/e854. [PMID: 32769103 PMCID: PMC7643614 DOI: 10.1212/nxi.0000000000000854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/18/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The goal of our study is to assess the role of microglial activation in MS-associated fatigue (MSAF) using [F-18]PBR06-PET. METHODS Fatigue severity was measured using the Modified Fatigue Impact Scale (MFIS) in 12 subjects with MS (7 relapsing-remitting and 5 secondary progressive) and 10 healthy control participants who underwent [F-18]PBR06-PET. The MFIS provides a total fatigue score as well as physical, cognitive, and psychosocial fatigue subscale scores. Standardized Uptake Value (SUV) 60-90 minute frame PET maps were coregistered to 3T MRI. Voxel-by-voxel analysis using Statistical Parametric Mapping and atlas-based regional analyses were performed. SUV ratios (SUVRs) were global brain normalized. RESULTS Peak voxel-based level of significance for correlation between total fatigue score and PET uptake was localized to the right substantia nigra (T-score 4.67, p = 0.001). Similarly, SUVRs derived from atlas-based segmentation of the substantia nigra showed significant correlation with MFIS (r = 0.76, p = 0.004). On multiple regression, the right substantia nigra was an independent predictor of total MFIS (p = 0.02) and cognitive MFIS subscale values (p = 0.007), after adjustment for age, disability, and depression. Several additional areas of significant correlations with fatigue scores were identified, including the right parahippocampal gyrus, right precuneus, and juxtacortical white matter (all p < 0.05). There was no correlation between fatigue scores and brain atrophy and lesion load in patients with MS. CONCLUSION Substantia nigra microglial activation is linked to fatigue in MS. Microglial activation across key brain regions may represent a unifying mechanism for MSAF, and further evaluation of neuroimmunologic basis of MSAF is warranted.
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Affiliation(s)
- Tarun Singhal
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Steven Cicero
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Hong Pan
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kelsey Carter
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Shipra Dubey
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Renxin Chu
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Bonnie Glanz
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Shelley Hurwitz
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Shahamat Tauhid
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mi-Ae Park
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Marie Kijewski
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Emily Stern
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Rohit Bakshi
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David Silbersweig
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Howard L Weiner
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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29
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Phosphorus magnetic resonance spectroscopy and fatigue in multiple sclerosis. J Neural Transm (Vienna) 2020; 127:1177-1183. [DOI: 10.1007/s00702-020-02221-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/17/2020] [Indexed: 02/03/2023]
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Matesic I, Marcinko I. Identifying the relevant determinants of MS related fatigue: The role of the clinical indicators of disease and personality. Mult Scler Relat Disord 2020; 42:102054. [PMID: 32213466 DOI: 10.1016/j.msard.2020.102054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/17/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Research on the factors contributing to multiple sclerosis (MS) related fatigue are far from conclusive. Some studies put forward that clinical aspects of the disease give rise to this symptom whilst others emphasize the effects of psychological factors on its etiology. This study investigated the relationship between clinical aspects of MS and personality with MS fatigue. METHOD A total of 201 participants with MS of which 48 (23.9%) males and 153 (76.1%) females took part in this online study. Questionnaires were populated measuring clinical features of the disease (disease duration, type of MS, Expanded Disability Status Scale - EDSS), personality traits, and MS-related fatigue. Data was analyzed by hierarchical regression analyses. RESULTS Personality traits accounted for a greater variance in MS fatigue (R² = .482, p < .01) than clinical aspects of the disease, these results were conclusive after controlling for the sociodemographic variables and depression. Temperament explained in total 10.5% variance of fatigue and character an additional 4.0 %. High Harm avoidance (HA) (β = .229, p < .01) and low Self-directedness (SD) (β = -.217, p < .01) directly predicted fatigue. Also, temperament was shown to indirectly affect fatigue, through character. High HA and high Novelty-seeking (NS) through low SD predicted fatigue. The association between clinical features and fatigue was not observed unless paired with personality traits. EDSS in conjunction with HA and Secondary - progressive MS (SPMS) coupled with SD negatively affected fatigue levels. CONCLUSION Personality traits directly and indirectly predicted MS-related fatigue. Furthermore, the impact of clinical indicators of disease on fatigue would not be observed unless these features occurred together with particular personality traits.
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Affiliation(s)
- I Matesic
- Primary school Julije Kempf Pozega, Croatia
| | - I Marcinko
- Faculty of Humanities and Social Sciences Osijek, Croatia.
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31
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Kashoo FZ, Alqahtani M, Ahmad F. Awareness of patients with multiple sclerosis in Saudi Arabia regarding the relationship between smoking and multiple sclerosis. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2020; 25:73. [PMID: 31982900 PMCID: PMC8015626 DOI: 10.17712/nsj.2020.1.20190105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Faizan Z Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, Kingdom of Saudi Arabia
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32
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Khodaei F, Rashedinia M, Heidari R, Rezaei M, Khoshnoud MJ. Ellagic acid improves muscle dysfunction in cuprizone-induced demyelinated mice via mitochondrial Sirt3 regulation. Life Sci 2019; 237:116954. [PMID: 31610192 DOI: 10.1016/j.lfs.2019.116954] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/24/2019] [Accepted: 10/10/2019] [Indexed: 01/10/2023]
Abstract
Sirt3 enzyme and mitochondrial abnormality can be related to excess fatigue or muscular dysfunction in multiple sclerosis (MS).Ellagic acid (EA) has a mitochondrial protector, iron chelator, antioxidant, and axon regenerator in neurons.In this study the effect of EAon muscle dysfunction, its mitochondria, and Sirt3 enzyme incuprizone-induced model of MSwas examined. Demyelination was induced by a diet containing 0.2% w/w cuprizone (Cup) for 42 days and EA administered daily (5, 50, and 100 mg/kg P.O) either with or without cuprizone in mice. Behavioral tests were assessed, and muscle tissue markers ofoxidative stress, mitochondrial parameters, mitochondrial respiratory chain activity, the Sirt3 protein level, and Sirt3 expression were also determined. Luxol fast blue staining and the behavioral tests were performed toassess the implemented model. In Cup group an increased oxidative stress in their muscle tissues was observed. Also, muscle mitochondria exhibited mitochondria dysfunction, lowered mitochondrial respiratory chain activity, Sirt3 protein level, and Sirt3 expression.EA prevented most of these anomalous alterations. Sub-chronicEA co-treatment dose-dependently ameliorated behavioral and muscular impairment in mice that received Cup.EA can effectively protect muscle tissue against cuprizone-induced demeylination via the mitochondrial protection, oxidative stress prevention and Sirt3 overexpression.
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Affiliation(s)
- Forouzan Khodaei
- Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; College of Animal Science and Veterinary Medicine, Shanxi Agricultural University, Taigu, China
| | - Marzieh Rashedinia
- Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Heidari
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Rezaei
- Department of Toxicology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Javad Khoshnoud
- Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
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33
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Sen MK, Mahns DA, Coorssen JR, Shortland PJ. Behavioural phenotypes in the cuprizone model of central nervous system demyelination. Neurosci Biobehav Rev 2019; 107:23-46. [PMID: 31442519 DOI: 10.1016/j.neubiorev.2019.08.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/01/2019] [Accepted: 08/12/2019] [Indexed: 12/14/2022]
Abstract
The feeding of cuprizone (CPZ) to animals has been extensively used to model the processes of demyelination and remyelination, with many papers adopting a narrative linked to demyelinating conditions like multiple sclerosis (MS), the aetiology of which is unknown. However, no current animal model faithfully replicates the myriad of symptoms seen in the clinical condition of MS. CPZ ingestion causes mitochondrial and endoplasmic reticulum stress and subsequent apoptosis of oligodendrocytes leads to central nervous system demyelination and glial cell activation. Although there are a wide variety of behavioural tests available for characterizing the functional deficits in animal models of disease, including that of CPZ-induced deficits, they have focused on a narrow subset of outcomes such as motor performance, cognition, and anxiety. The literature has not been systematically reviewed in relation to these or other symptoms associated with clinical MS. This paper reviews these tests and makes recommendations as to which are the most important in order to better understand the role of this model in examining aspects of demyelinating diseases like MS.
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Affiliation(s)
- Monokesh K Sen
- School of Medicine, Western Sydney University, New South Wales, Australia
| | - David A Mahns
- School of Medicine, Western Sydney University, New South Wales, Australia
| | - Jens R Coorssen
- Departments of Health Sciences and Biological Sciences, Faculties of Applied Health Sciences and Mathematics & Science, Brock University, Ontario, Canada.
| | - Peter J Shortland
- Science and Health, Western Sydney University, New South Wales, Australia.
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34
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Rezaeizadeh H, Rahimi R, Abbasi M. Fatigue Due to Multiple Sclerosis: A Comparison Between Persian Medicine and Conventional Medicine. Galen Med J 2019; 8:e1139. [PMID: 34466464 PMCID: PMC8343931 DOI: 10.31661/gmj.v8i0.1139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 07/06/2018] [Accepted: 08/02/2018] [Indexed: 11/22/2022] Open
Abstract
Fatigue is one of the most debilitating symptoms of multiple sclerosis (MS), and its definite pathophysiology is unclear. Studies have suggested some correlates for it including dysfunction or atrophy in different parts of the brain. This narrative review study compares the viewpoint of conventional medicine and Persian medicine (PM) about fatigue due to MS and introduces the treatments used for this complaint in PM with an evidence-based approach. PM scholars have used the term I’ya equal to fatigue and stated that I’ya might be due to exertion or not, while the latter (spontaneous I’ya) can be prodromal of a disease. This pathologic fatigue can be seen in a wide variety of neurologic diseases, though it is the most common in MS patients. Fatigue in MS can be considered one of the equivalents of spontaneous I’ya. According to PM texts, neurotonic herbs like Ferula, Citrus medica, Asarum europaeum, Ficus carica, and Juglans regia may be beneficial in alleviating fatigue by brain reinforcement. Different pharmacological mechanisms have been introduced for these plants including antioxidant and/or anti-inflammatory activities. The medicinal plants can be assumed as a valuable source for discovering new medicines for fatigue in MS. Designing preclinical and clinical studies evaluating the effects of mentioned medicinal herbs in fatigue is proposed for obtaining more conclusive results.
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Affiliation(s)
- Hossein Rezaeizadeh
- Department of Traditional Iranian Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Roja Rahimi
- Department of Traditional Pharmacy, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Abbasi
- Department of Traditional Iranian Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Correspondence to: Maryam Abbasi, Department of Traditional Iranian Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran Telephone Number: +982188990837 Email Address :
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35
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Mordillo-Mateos L, Soto-Leon V, Torres-Pareja M, Peinado-Palomino D, Mendoza-Laiz N, Alonso-Bonilla C, Dileone M, Rotondi M, Aguilar J, Oliviero A. Fatigue in Multiple Sclerosis: General and Perceived Fatigue Does Not Depend on Corticospinal Tract Dysfunction. Front Neurol 2019; 10:339. [PMID: 31024433 PMCID: PMC6465550 DOI: 10.3389/fneur.2019.00339] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 03/19/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Multiple sclerosis (MS) is an autoimmune disorder of the CNS in which inflammation, demyelination, and axonal damage of the central nervous system coexist. Fatigue is one of the most disabling symptoms in MS and little is known about the neurophysiological mechanisms involved. Methods: To give more mechanistic insight of fatigue in MS, we studied a cohort of 17 MS patients and a group of 16 age-matched healthy controls. Baseline Fatigue Severity Scales and Fatigue Rating were obtained from both groups to check the level of fatigue and to perform statistical correlations with fatigue-induced neurophysiologic changes. To induce fatigue we used a handgrip task. During the fatiguing task, we evaluated fatigue state (using a dynamometer) and after the task we evaluated the Borg Rating of Perceived Exertion Scale. Transcranial magnetic stimulation and peripheral electric stimulation were used to assess corticospinal tract and peripheral system functions before and after the task. Results: Clinically significant fatigue and central motor conduction time were greater in patients than in controls, while motor cortex excitability was decreased and maximal handgrip strength reduced in patients. Interestingly, fatigue state was positively correlated to perceived fatigue in controls but not in patients. Furthermore, in the presence of similar fatigue state over time, controls showed a significant fatigue-related reduction in motor evoked potential (a putative marker of central fatigue) whereas this effect was not seen in patients. Conclusions: in MS patients the pathogenesis of fatigue seems not driven by the mechanisms directly related to corticospinal function (that characterize fatigue in controls) but seems probably due to other "central abnormalities" upstream to primary motor cortex.
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Affiliation(s)
- Laura Mordillo-Mateos
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain
| | - Vanesa Soto-Leon
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain
| | - Marta Torres-Pareja
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain.,Facultad de Ciencias del Deporte, University of Castilla La Mancha, Toledo, Spain
| | - Diego Peinado-Palomino
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain.,Facultad de Ciencias del Deporte, University of Castilla La Mancha, Toledo, Spain
| | | | - Carlos Alonso-Bonilla
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain
| | - Michele Dileone
- Advanced Neurorehabilitation Unit, Hospital Los Madroños, Madrid, Spain
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, IRCCS Scientific Clinical Institutes Maugeri, University of Pavia, Pavia, Italy
| | - Juan Aguilar
- Experimental Neurophysiology, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain
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36
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Hudgens S, Schüler R, Stokes J, Eremenco S, Hunsche E, Leist TP. Development and Validation of the FSIQ-RMS: A New Patient-Reported Questionnaire to Assess Symptoms and Impacts of Fatigue in Relapsing Multiple Sclerosis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:453-466. [PMID: 30975397 DOI: 10.1016/j.jval.2018.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/05/2018] [Accepted: 11/11/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES A new patient-reported outcome (PRO) instrument to measure fatigue symptoms and impacts in relapsing multiple sclerosis (RMS) was developed in a qualitative stage, followed by psychometric validation and migration from paper to an electronic format. METHODS Adult patients with relapsing-remitting multiple sclerosis (RRMS) were interviewed to elicit fatigue-related symptoms and impacts. A draft questionnaire was debriefed in cognitive interviews with further RRMS patients, and revised. Content confirmation interviews were conducted with patients with progressive-relapsing multiple sclerosis (PRMS) and relapsing secondary-progressive multiple sclerosis (RSPMS). Psychometric analyses used data from adult patients with different RMS subtypes and matched non-RMS controls in a multicenter, observational study. After item reduction, the final instrument was migrated to a smartphone (eDiary) and usability was confirmed in interviews with additional adult RMS patients. RESULTS The qualitative stage included 37 RRMS, 5 PRMS, and 5 RSPMS patients. Saturation of concepts was reached during concept elicitation. Cognitive interviews confirmed that participants understood the instructions, items, and response options of the instrument-named FSIQ-RMS-as intended. Psychometric validation included 164 RMS and 74 control patients. Internal consistency and test-retest reliability were demonstrated. The symptoms domain discriminated along the RMS symptom-severity continuum and between patients and controls. Patients were able to attribute fatigue-related symptoms to RMS. Usability and conceptual equivalence of the eDiary were confirmed (n = 10 participants). CONCLUSIONS With 7 symptom items and 13 impact items (in 3 impacts subdomains: physical, cognitive and emotional, and coping) after item reduction, the FSIQ-RMS is a comprehensive, valid, and reliable measure of fatigue-related symptoms and impacts in RMS patients.
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Affiliation(s)
| | - René Schüler
- Global Market Access & Pricing, Actelion, Singapore
| | | | | | - Elke Hunsche
- Global Market Access & Pricing, Actelion, Allschwil, Switzerland
| | - Thomas P Leist
- Comprehensive Multiple Sclerosis Center, Thomas Jefferson University, Philadelphia, PA, USA
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37
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Adamopoulou F, Alikari V, Zyga S, Tsironi M, Tzavella F, Giannakopoulou N, Theofilou P. The Effect of Fatigue and Pain Self- Efficacy on Health-Related Quality of Life Among Patients with Multiple Sclerosis. Mater Sociomed 2019; 31:40-44. [PMID: 31213954 PMCID: PMC6511379 DOI: 10.5455/msm.2019.31.40-44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Health-related quality of life is a major issue among patients with Multiple sclerosis (MS). Aim: To explore the effect of fatigue and pain self-efficacy on health-related quality of life among patients with MS. Methods: Between March and May 2018, 85 MS patients from a large Hospital of Athens region completed the questionnaires: a) Missoula-VITAS Quality of Life Index-15, which examines 5 dimensions of quality of life, b) Pain Self Efficacy Questionnaire which measures the pain self-efficacy that an individual perceives, c) Fatigue Assessment Scale (FAS) which measures fatigue, d) a questionnaire about the sociodemographic elements. Statistical analysis was performed using the IBM SPSS Statistics version 21. The significance level was set up to 0.001. Results: Fatigue might predict the dimension of quality of life “Function” while Pain Self-Efficacy might, also, predict the dimension of quality of life “Interpersonal”. A strong correlation was found between the dimensions of quality of life “Well-being” and “Transcendent” and between “Interpersonal” and Pain Self-Efficacy. The total score of fatigue was strongly correlated with Physical Fatigue and very strongly correlated with Mental Fatigue. Conclusion: Fatigue and Pain Self-Efficacy are important predictors of the dimensions of quality of life among patients with MS. Pain in MS has to be taken into serious consideration in every patient with MS.
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Affiliation(s)
| | - Victoria Alikari
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | - Sofia Zyga
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | - Maria Tsironi
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | - Fotini Tzavella
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | | | - Paraskevi Theofilou
- Ministry of Health, Athens, Greece.,Institution for Counseling & Psychological Studies, Athens, Greece
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38
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Chitnis T, Gonzalez C, Healy BC, Saxena S, Rosso M, Barro C, Michalak Z, Paul A, Kivisakk P, Diaz-Cruz C, Sattarnezhad N, Pierre IV, Glanz BI, Tomic D, Kropshofer H, Häring D, Leppert D, Kappos L, Bakshi R, Weiner HL, Kuhle J. Neurofilament light chain serum levels correlate with 10-year MRI outcomes in multiple sclerosis. Ann Clin Transl Neurol 2018; 5:1478-1491. [PMID: 30564615 PMCID: PMC6292183 DOI: 10.1002/acn3.638] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/31/2018] [Accepted: 08/06/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To assess the value of annual serum neurofilament light (NfL) measures in predicting 10‐year clinical and MRI outcomes in multiple sclerosis (MS). Methods We identified patients in our center's Comprehensive Longitudinal Investigations in MS at Brigham and Women's Hospital (CLIMB) study enrolled within 5 years of disease onset, and with annual blood samples up to 10 years (n = 122). Serum NfL was measured using a single molecule array (SIMOA) assay. An automated pipeline quantified brain T2 hyperintense lesion volume (T2LV) and brain parenchymal fraction (BPF) from year 10 high‐resolution 3T MRI scans. Correlations between averaged annual NfL and 10‐year clinical/MRI outcomes were assessed using Spearman's correlation, univariate, and multivariate linear regression models. Results Averaged annual NfL values were negatively associated with year 10 BPF, which included averaged year 1–5 NfL values (unadjusted P < 0.01; adjusted analysis P < 0.01), and averaged values through year 10. Linear regression analyses of averaged annual NfL values showed multiple associations with T2LV, specifically averaged year 1–5 NfL (unadjusted P < 0.01; adjusted analysis P < 0.01). Approximately 15–20% of the BPF variance and T2LV could be predicted from early averaged annual NfL levels. Also, averaged annual NfL levels with fatigue score worsening between years 1 and 10 showed statistically significant associations. However, averaged NfL measurements were not associated with year 10 EDSS, SDMT or T25FW in this cohort. Interpretation Serum NfL measured during the first few years after the clinical onset of MS contributed to the prediction of 10‐year MRI brain lesion load and atrophy.
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Affiliation(s)
- Tanuja Chitnis
- Department of Neurology Partners Multiple Sclerosis Center Brigham and Women's Hospital Boston Massachusetts.,Harvard Medical School Boston Massachusetts 02115.,Ann Romney Center for Neurologic Disease Harvard Medical School Boston Massachusetts 02115
| | - Cindy Gonzalez
- Harvard Medical School Boston Massachusetts 02115.,Ann Romney Center for Neurologic Disease Harvard Medical School Boston Massachusetts 02115
| | - Brian C Healy
- Harvard Medical School Boston Massachusetts 02115.,Ann Romney Center for Neurologic Disease Harvard Medical School Boston Massachusetts 02115.,Massachusetts General Hospital Biostatistics Center Boston Massachusetts
| | - Shrishti Saxena
- Harvard Medical School Boston Massachusetts 02115.,Ann Romney Center for Neurologic Disease Harvard Medical School Boston Massachusetts 02115
| | - Mattia Rosso
- Harvard Medical School Boston Massachusetts 02115.,Ann Romney Center for Neurologic Disease Harvard Medical School Boston Massachusetts 02115
| | - Christian Barro
- Departments of Medicine, Biomedicine and Clinical Research Neurologic Clinic and Policlinic University Hospital Basel University of Basel Basel Switzerland
| | - Zuzanna Michalak
- Departments of Medicine, Biomedicine and Clinical Research Neurologic Clinic and Policlinic University Hospital Basel University of Basel Basel Switzerland
| | - Anu Paul
- Harvard Medical School Boston Massachusetts 02115.,Ann Romney Center for Neurologic Disease Harvard Medical School Boston Massachusetts 02115
| | - Pia Kivisakk
- Harvard Medical School Boston Massachusetts 02115.,Ann Romney Center for Neurologic Disease Harvard Medical School Boston Massachusetts 02115
| | - Camilo Diaz-Cruz
- Harvard Medical School Boston Massachusetts 02115.,Ann Romney Center for Neurologic Disease Harvard Medical School Boston Massachusetts 02115
| | - Neda Sattarnezhad
- Harvard Medical School Boston Massachusetts 02115.,Ann Romney Center for Neurologic Disease Harvard Medical School Boston Massachusetts 02115
| | - Isabelle V Pierre
- Harvard Medical School Boston Massachusetts 02115.,Ann Romney Center for Neurologic Disease Harvard Medical School Boston Massachusetts 02115
| | - Bonnie I Glanz
- Department of Neurology Partners Multiple Sclerosis Center Brigham and Women's Hospital Boston Massachusetts.,Harvard Medical School Boston Massachusetts 02115.,Ann Romney Center for Neurologic Disease Harvard Medical School Boston Massachusetts 02115
| | - Davorka Tomic
- Novartis Neuroscience Development Unit Basel Switzerland
| | | | - Dieter Häring
- Novartis Neuroscience Development Unit Basel Switzerland
| | - David Leppert
- Novartis Neuroscience Development Unit Basel Switzerland
| | - Ludwig Kappos
- Departments of Medicine, Biomedicine and Clinical Research Neurologic Clinic and Policlinic University Hospital Basel University of Basel Basel Switzerland
| | - Rohit Bakshi
- Department of Neurology Partners Multiple Sclerosis Center Brigham and Women's Hospital Boston Massachusetts.,Harvard Medical School Boston Massachusetts 02115.,Ann Romney Center for Neurologic Disease Harvard Medical School Boston Massachusetts 02115
| | - Howard L Weiner
- Department of Neurology Partners Multiple Sclerosis Center Brigham and Women's Hospital Boston Massachusetts.,Harvard Medical School Boston Massachusetts 02115.,Ann Romney Center for Neurologic Disease Harvard Medical School Boston Massachusetts 02115
| | - Jens Kuhle
- Departments of Medicine, Biomedicine and Clinical Research Neurologic Clinic and Policlinic University Hospital Basel University of Basel Basel Switzerland
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Vallée A, Lecarpentier Y, Guillevin R, Vallée JN. Demyelination in Multiple Sclerosis: Reprogramming Energy Metabolism and Potential PPARγ Agonist Treatment Approaches. Int J Mol Sci 2018; 19:ijms19041212. [PMID: 29659554 PMCID: PMC5979570 DOI: 10.3390/ijms19041212] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 12/20/2022] Open
Abstract
Demyelination in multiple sclerosis (MS) cells is the site of several energy metabolic abnormalities driven by dysregulation between the opposed interplay of peroxisome proliferator-activated receptor γ (PPARγ) and WNT/β-catenin pathways. We focus our review on the opposing interactions observed in demyelinating processes in MS between the canonical WNT/β-catenin pathway and PPARγ and their reprogramming energy metabolism implications. Demyelination in MS is associated with chronic inflammation, which is itself associated with the release of cytokines by CD4+ Th17 cells, and downregulation of PPARγ expression leading to the upregulation of the WNT/β-catenin pathway. Upregulation of WNT/β-catenin signaling induces activation of glycolytic enzymes that modify their energy metabolic behavior. Then, in MS cells, a large portion of cytosolic pyruvate is converted into lactate. This phenomenon is called the Warburg effect, despite the availability of oxygen. The Warburg effect is the shift of an energy transfer production from mitochondrial oxidative phosphorylation to aerobic glycolysis. Lactate production is correlated with increased WNT/β-catenin signaling and demyelinating processes by inducing dysfunction of CD4+ T cells leading to axonal and neuronal damage. In MS, downregulation of PPARγ decreases insulin sensitivity and increases neuroinflammation. PPARγ agonists inhibit Th17 differentiation in CD4+ T cells and then diminish release of cytokines. In MS, abnormalities in the regulation of circadian rhythms stimulate the WNT pathway to initiate the demyelination process. Moreover, PPARγ contributes to the regulation of some key circadian genes. Thus, PPARγ agonists interfere with reprogramming energy metabolism by directly inhibiting the WNT/β-catenin pathway and circadian rhythms and could appear as promising treatments in MS due to these interactions.
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Affiliation(s)
- Alexandre Vallée
- Délégation à la Recherche Clinique et à l'Innovation (DRCI), Hôpital Foch, 92150 Suresnes, France.
| | - Yves Lecarpentier
- Centre de Recherche Clinique, Grand Hôpital de l'Est Francilien (GHEF), 77100 Meaux, France.
| | - Rémy Guillevin
- Data Analysis and Computations Through Imaging Modeling-Mathématiques (DACTIM), Unité mixte de recherche (UMR), Centre National de la Recherche Scientifique (CNRS) 7348 (Laboratoire de Mathématiques et Application), University of Poitiers, Centre Hospitalier Universitaire (CHU) de Poitiers, 86000 Poitiers, France.
| | - Jean-Noël Vallée
- Centre Hospitalier Universitaire (CHU) Amiens Picardie, University of Picardie Jules Verne (UPJV), 80000 Amiens, France.
- LMA (Laboratoire de Mathématiques et Applications), Unité mixte de recherche (UMR), Centre National de la Recherche Scientifique (CNRS) 7348, Université de Poitiers, 86000 Poitiers, France.
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40
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Schakel W, Bode C, van der Aa HPA, Hulshof CTJ, Bosmans JE, van Rens GHMB, van Nispen RMA. Exploring the patient perspective of fatigue in adults with visual impairment: a qualitative study. BMJ Open 2017; 7:e015023. [PMID: 28775181 PMCID: PMC5724118 DOI: 10.1136/bmjopen-2016-015023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Fatigue is an often mentioned symptom by patients with irreversible visual impairment. This study explored the patient perspective of fatigue in visually impaired adults with a focus on symptoms of fatigue, causes, consequences and coping strategies. SETTING Two large Dutch low vision multidisciplinary rehabilitation organisations. PARTICIPANTS 16 visually impaired adults with severe symptoms of fatigue selected by purposive sampling. METHODS A qualitative study involving semistructured interviews. A total of four first-level codes were top-down predetermined in correspondence with the topics of the research question. Verbatim transcribed interviews were analysed with a combination of a deductive and inductive approach using open and axial coding. RESULTS Participants often described the symptoms of fatigue as a mental, daily and physical experience. The most often mentioned causes of fatigue were a high cognitive load, the intensity and amount of activities, the high effort necessary to establish visual perception, difficulty with light intensity and negative cognitions. Fatigue had the greatest impact on the ability to carry out social roles and participation, emotional functioning and cognitive functioning. The most common coping strategies were relaxation, external support, socialising and physical exercise and the acceptance of fatigue. CONCLUSIONS Our results indicate that low vision-related fatigue is mainly caused by population specific determinants that seem different from the fatigue experience described in studies with other patient populations. Fatigue may be central to the way patients react, adapt and compensate to the consequences of vision loss. These findings indicate a need for future research aimed at interventions specifically tailored to the unique aspects of fatigue related to vision loss.
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Affiliation(s)
- Wouter Schakel
- Department of Ophthalmology, VU University Medical Centre and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Christina Bode
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Hilde P A van der Aa
- Department of Ophthalmology, VU University Medical Centre and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences and Amsterdam Public Health Research Institute, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Gerardus H M B van Rens
- Department of Ophthalmology, VU University Medical Centre and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Ophthalmology, Elkerliek Hospital, Helmond, The Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology, VU University Medical Centre and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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41
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Potential pathophysiological pathways that can explain the positive effects of exercise on fatigue in multiple sclerosis: A scoping review. J Neurol Sci 2017; 373:307-320. [PMID: 28131211 DOI: 10.1016/j.jns.2017.01.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/22/2016] [Accepted: 01/03/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fatigue is one of the most common and most disabling symptoms of multiple sclerosis (MS). It is a multidimensional and complex symptom with multifaceted origins, involving both central and peripheral fatigue mechanisms. Exercise has proven to be safe for people with MS, with cumulating evidence supporting significant reductions in fatigue. However, the potential pathophysiological pathways that can explain the positive effects of exercise on fatigue in MS remain elusive. OBJECTIVES The objectives were, in PwMS (1) to update the knowledge on the pathophysiology underlying primary and secondary fatigue, and (2) to discuss potential pathophysiological pathways that can explain the positive effects of exercise on MS fatigue. METHODS A comprehensive literature search of six databases (PubMed, Embase, Cochrane Library, PEDro, CINAHL and SPORTDiscus) was performed. To be included, the study had to 1) enroll participants with definite MS according to defined criteria, 2) assess explicit pathophysiological mechanisms related to MS fatigue, 3) be available in English, Danish or French, and 4) had undergone peer-review. RESULTS A total of 234 studies fulfilled the inclusion criteria. Primary MS fatigue mainly originated from a dysfunction of central nervous system neuronal circuits secondary to increased inflammation, reduced glucose metabolism, brain atrophy and diffuse demyelination and axonal lesions. Secondary MS fatigue was linked with sleep disturbances, depression, cognitive impairments, and deconditioning. Cardiovascular, immunologic, neuroendocrine, and neurotrophic changes associated with exercise may alleviate primary MS fatigue while exercise may improve secondary MS fatigue through symptomatic improvement of deconditioning, sleep disorders, and depression. CONCLUSIONS >30 primary and secondary pathophysiological fatigue pathways were identified underlining the multidimensionality and complexity of MS fatigue. Though the underlying key cellular and molecular cascades still have to be fully elucidated, exercise holds the potential to alleviate MS fatigue, through both primary and secondary fatigue pathways.
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