1
|
Leodori G, Mancuso M, Maccarrone D, Tartaglia M, Ianniello A, Certo F, Ferrazzano G, Malimpensa L, Belvisi D, Pozzilli C, Berardelli A, Conte A. Insight into motor fatigue mechanisms in natalizumab treated multiple sclerosis patients with wearing off. Sci Rep 2024; 14:17654. [PMID: 39085330 PMCID: PMC11291752 DOI: 10.1038/s41598-024-68322-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
Motor fatigue in Multiple Sclerosis (MS) is due to reduced motor cortex (M1) output and altered sensorimotor network (SMN) modulation. Natalizumab, a disease-modifying therapy, reduces neuroinflammation and improves fatigue. However, some patients treated with natalizumab experience fatigue recurrence ('wearing-off') before subsequent infusions. Wearing-off provides a valuable window into MS-related motor fatigue mechanisms in a controlled, clinically stable, setting. This study investigates whether wearing-off is associated with worsening motor fatigue and its neurophysiological mechanisms and assesses natalizumab's effect on MS-related fatigue. Forty-five relapsing-remitting MS patients with wearing-off symptoms were evaluated pre- and post-natalizumab infusion. Assessments included evaluating disability levels, depressive symptoms, and the impact of fatigue symptoms on cognitive, physical, and psychosocial functioning. The motor fatigue index was computed through the number of blocks completed during a fatiguing task and peripheral, central, and supraspinal fatigue (M1 output) were evaluated by measuring the superimposed twitches evoked by peripheral nerve and transcranial magnetic stimulation of M1. Transcranial magnetic stimulation-electroencephalography assessed M1 effective connectivity by measuring TMS-evoked potentials (TEPs) within the SMN before- and after the task. We found that wearing-off was associated with increased motor fatigue index, increased central and supraspinal fatigue, and diminished task-related modulation of TEPs compared to post-natalizumab infusion. Wearing-off was also associated with worsened fatigue impact and depression symptom scores. We conclude that the wearing-off phenomenon is associated with worsening motor fatigue due to altered M1 output and modulation of the SMN. Motor fatigue in MS may reflect reversible, inflammation-related changes in the SMN that natalizumab can modulate. Our findings apply primarily to MS patients receiving natalizumab, emphasizing the need for further research on other treatments with wearing-off.
Collapse
Affiliation(s)
- Giorgio Leodori
- IRCCS Neuromed, 86077, Pozzilli, IS, Italy.
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università, 30, 00185, Rome, Italy.
| | - Marco Mancuso
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università, 30, 00185, Rome, Italy
| | - Davide Maccarrone
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università, 30, 00185, Rome, Italy
| | - Matteo Tartaglia
- IRCCS Neuromed, 86077, Pozzilli, IS, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università, 30, 00185, Rome, Italy
| | - Antonio Ianniello
- IRCCS Neuromed, 86077, Pozzilli, IS, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università, 30, 00185, Rome, Italy
| | - Francesco Certo
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università, 30, 00185, Rome, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università, 30, 00185, Rome, Italy
| | - Leonardo Malimpensa
- IRCCS Neuromed, 86077, Pozzilli, IS, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università, 30, 00185, Rome, Italy
| | - Daniele Belvisi
- IRCCS Neuromed, 86077, Pozzilli, IS, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università, 30, 00185, Rome, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università, 30, 00185, Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, 86077, Pozzilli, IS, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università, 30, 00185, Rome, Italy
| | - Antonella Conte
- IRCCS Neuromed, 86077, Pozzilli, IS, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università, 30, 00185, Rome, Italy
| |
Collapse
|
2
|
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.
Collapse
|
3
|
Pozzilli C, Prosperini L, Tommasin S, Gasperini C, Barbuti E, De Giglio L. Dalfampridine improves slowed processing speed in multiple sclerosis patients with mild motor disability: post hoc analysis of a randomized controlled trial. Ther Adv Neurol Disord 2021; 14:17562864211011286. [PMID: 34035835 PMCID: PMC8072854 DOI: 10.1177/17562864211011286] [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: 09/20/2020] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate baseline characteristics predictive of improving information processing speed in multiple sclerosis (MS) and the relationship between cognitive and motor response to dalfampridine (DA) treatment. Methods This is a post hoc analysis of a randomized, double-blind, placebo-controlled trial in patients with MS randomized to receive DA 10 mg or placebo twice daily for 12 consecutive weeks. Here, we include only data from 71 patients in the arm treated with DA. According to the median value of Symbol Digit Modalities Test (SDMT) response, patients were categorized as "full responders" (FR) or "partially responders" (PR). Results There was higher possibility of being FR in the presence of a baseline lower Expanded Disability Status Scale [odds ratio (OR) 0.69; 95% confidence interval (CI) 0.5-0.97, p = 0.034], a higher Multiple Sclerosis Functional Composite value (OR 1.37; 95%CI 1.05-1.8, p = 0.022), a lower Timed 25-Foot Walk Test (OR 0.76; 95% CI 0.6-0.98, p = 0.033), and a lower 9-Hole Peg Test with dominant hand (OR 0.92; 95% CI 0.86-0.99, p = 0.029). FR group did not show any significant improvement of motor performance compared with PR group. Conclusion The current analysis shows that in MS patients with cognitive deficit, the greatest improvement in SDMT provided by DA was observed in patients with milder motor impairment; cognitive and motor responses to treatments are not related. Trial registration EU Clinical Trials Register; ID 2013-002558-64 (https://www.clinicaltrialsregister.eu/ctr-search/search?query=2013-002558-64).
Collapse
Affiliation(s)
- Carlo Pozzilli
- Department of Human Neuroscience, Sapienza University, Viale dell'Università 30, Rome, 00185, Italy
| | - Luca Prosperini
- Department of Neuroscience San Camillo-Forlanini Hospital, Rome, Italy
| | - Silvia Tommasin
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Claudio Gasperini
- Department of Neuroscience San Camillo-Forlanini Hospital, Rome, Italy
| | - Elena Barbuti
- MS Center Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Laura De Giglio
- Medicine Department, Neurology Unit San Filippo Neri Hospital, Rome, Italy
| |
Collapse
|
4
|
Postural stability is a valid and meaningful disability metric in progressive MS with potential for use in neuroprotective therapy trials. Mult Scler Relat Disord 2021; 52:102946. [PMID: 33901968 DOI: 10.1016/j.msard.2021.102946] [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: 02/03/2021] [Revised: 03/24/2021] [Accepted: 04/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Balance impairment is observed in up to 70% of people with MS (pwMS) and worsens with disease progression. Posturography using a force platform is the current gold standard in the measurement of balance. However, posturography has not been adequately studied or widely accepted for use as a disability outcome measure for pwMS. Importantly, the recent emergence of both successful and failed neuroprotective therapy trials in progressive MS has emphasised the need for new disability outcome measures for people with progressive MS. The main objectives of this study were to evaluate the clinical validity, reliability and feasibility of posturography as a disability metric in progressive MS. METHODS This was a prospective cross-sectional study. We recruited 73 people with progressive MS (age 18-65 years, EDSS 3.5-6.0). Participants stood in the centre of a force platform, feet comfortably apart, under various conditions: (i) eyes open (EO), (ii) eyes closed (EC) - a single task, each lasting ninety seconds; and simultaneous EO with a cognitive test: (iii) N-Back, a three-minute test whereby participants were instructed to click the mouse when two identical letters were displayed consecutively on a screen, (iv) Sustained Attention Response Task, a five-minute test whereby participants were instructed to click the mouse for every number "1″ to "9″ except "3″ - i.e., dual-tasks. Additionally, we performed a battery of validated physical and cognitive outcome measures. Posturographic data was processed using Matlab. Statistical analysis was performed using SPSS version 26. We used multiple linear regression modelling to determine whether significant univariate correlations between posturography and clinical metrics were independent of covariates that may influence the associations seen. A two-tailed significance level of 0.05 was used. RESULTS Of 73 participants, mean age 52.4 (8.5) years, mean MS disease duration 13.8 (10.3) years, median EDSS 5.0 (IQR 4.0-6.0), 44 (60.4%) were female. EO-Path-Length independently predicted upper extremity function (9-Hole-Peg-Test) with a larger effect size (adjusted R2=20.0%, p = 0.001) than that for walking measures (Timed 25-Foot Walk, adjusted R2=1.6%, p = 0.01; Two-Minute Walk Test, adjusted R2=7.2%, p = 0.002), while controlling for age, disease duration, height, weight, and sex. The addition of EO-Mediolateral-Displacement to the MS Functional Composite (MSFC) created a four-component z-score that increased the variance explained for quality of life (QOL) by 62.1%. Postural stability was significantly lower with mediolateral vs anteroposterior direction of sway, removal of vision, increased body weight, male sex, and fampridine use. Postural stability improved during dual-tasks compared to EO single task. Posturography detected significant worsening of balance over a single prolonged stance. CONCLUSION Postural stability independently predicted a wide range of clinical metrics including upper extremity function, walking ability, cognition and QOL, therefore establishing construct and concurrent validity as a disability outcome measure for people with progressive MS. Additionally, posturography is a quantitative, non-invasive, quick-and-easy-to-administer, and highly sensitive device, demonstrating its high feasibility for use as a time- and resource-efficient disability metric in neuroprotective therapy trials for progressive MS.
Collapse
|
5
|
De Giglio L, De Luca F, Gurreri F, Ferrante I, Prosperini L, Borriello G, Quartuccio E, Gasperini C, Pozzilli C. Effect of dalfampridine on information processing speed impairment in multiple sclerosis. Neurology 2019; 93:e733-e746. [DOI: 10.1212/wnl.0000000000007970] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 04/30/2019] [Indexed: 02/02/2023] Open
Abstract
ObjectiveTo test a possible benefit of dalfampridine on information processing speed (IPS), a key function for cognitive impairment (CogIm) in multiple sclerosis (MS).MethodsIn this randomized, double-blind, placebo-controlled trial, we included patients with a score on the Symbol Digit Modalities Test (SDMT) under the 10th percentile of the reference value. Patients were randomized in a 2:1 ratio to receive dalfampridine 10 mg or placebo twice daily for 12 weeks. They underwent a comprehensive neuropsychological evaluation at screening (T0), at the end of treatment (T1), and after a 4-week follow-up (T2). The primary endpoint was improvement in SDMT.ResultsOut of 208 patients screened, 120 were randomized to receive either dalfampridine (n = 80) or placebo (n = 40). At T1, the dalfampridine group presented an increase of SDMT scores vs placebo group (mean change 9.9 [95% confidence interval (CI) 8.5–11.4] vs 5.2 [95% CI 2.8–7.6], p = 0.0018; d = 0.60 for raw score; and 0.8 [95% CI 0.6–1] vs 0.3 [95% CI 0.0–0.5], p = 0.0013; d = 0.61 for z scores; by linear mixed model with robust standard error). The improvement was not sustained at T2. A beneficial effect of dalfampridine was observed in the Paced Auditory Serial Addition Test and in cognitive fatigue.ConclusionDalfampridine could be considered as an effective treatment option for IPS impairment in MS.Trial registration2013-002558-64 EU Clinical Trials Register.Classification of evidenceThis study provides Class I evidence that for patients with MS with low scores on the SDMT, dalfampridine improves IPS.
Collapse
|
6
|
Psychiatric disorders in multiple sclerosis. J Neurol 2019; 268:45-60. [PMID: 31197511 DOI: 10.1007/s00415-019-09426-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is characterized by a large spectrum of symptoms, involving all functional systems. Psychiatric symptoms are common in people with MS (pwMS) having an important impact on quality of life and on some features of MS (fatigue, sleep, disability, adherence to disease-modifying drugs). The main psychiatric disturbances in MS are depressive, bipolar, anxiety, schizophrenic and obsessive-compulsive syndromes. METHODS Literature search for original articles and review in the databases, including PubMed and Scopus from 1959 to 2019. RESULTS AND CONCLUSION Studies answering the aim of this review were selected and reported. Epidemiological and clinical aspects of psychiatric syndromes (PS) in MS as well as self-report diagnostic scales and radiological correlates of PS in MS are described. Moreover, some radiological studies about primary psychiatric disorders (PD) are reported to underline how gray matter atrophy, white matter abnormalities and corpus callosum involvement in these diseases, as features in common with MS, may explain the more frequent occurrence of PD in MS than in the general population.
Collapse
|
7
|
Palm U, Chalah MA, Créange A, Lefaucheur JP, Ayache SS. The evaluation of depression in multiple sclerosis using the newly proposed Multiple Sclerosis Depression Rating Scale. Encephale 2018; 44:565-567. [PMID: 29463384 DOI: 10.1016/j.encep.2017.11.004] [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: 08/21/2017] [Revised: 11/24/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
Fatigue and depression are frequent symptoms in multiple sclerosis (MS). Both are overlapping and shadowing each other and may impair the quality of life. For detection of depression symptoms in MS, the Multiple Sclerosis Depression Rating Scale (MSDRS) has been proposed recently. Here, we compare the performance of MSDRS in MS patients with and without fatigue to that of established rating scales, i.e. Hospital Anxiety and Depression Scale and Beck Depression Inventory. Twenty-nine MS patients were screened for fatigue and depression symptoms. Patients with fatigue showed significantly higher depression scores compared to patients without fatigue, whereas the number of depressed patients did not differ between the two groups. MSDRS seems to have higher sensitivity to detect severe depression than established rating scales. However, one should keep in mind that such a finding might be due to an increase in false positive cases when using MSDRS. Implementing this scale in future studies might be of help to enhance the understanding of its potential utility.
Collapse
Affiliation(s)
- U Palm
- EA 4391, excitabilité nerveuse et thérapeutique, université Paris-Est-Créteil, 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Department of Psychiatry, Psychotherapy and Psychosomatics, Ludwig-Maximilian University, Geschwister-Scholl Platz 1, 80539 Munich, Germany
| | - M A Chalah
- EA 4391, excitabilité nerveuse et thérapeutique, université Paris-Est-Créteil, 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Service de physiologie-explorations fonctionnelles, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 31, rue du Parc, 94000 Créteil, France
| | - A Créange
- EA 4391, excitabilité nerveuse et thérapeutique, université Paris-Est-Créteil, 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Service de neurologie, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 31, rue du Parc, 94000 Créteil, France
| | - J-P Lefaucheur
- EA 4391, excitabilité nerveuse et thérapeutique, université Paris-Est-Créteil, 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Service de physiologie-explorations fonctionnelles, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 31, rue du Parc, 94000 Créteil, France
| | - S S Ayache
- EA 4391, excitabilité nerveuse et thérapeutique, université Paris-Est-Créteil, 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Service de physiologie-explorations fonctionnelles, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 31, rue du Parc, 94000 Créteil, France; Lebanese American University Medical Center, Rizk hospital (LAUMC-RH), Zahar street, Beirut, Lebanon.
| |
Collapse
|
8
|
Rossi S, Studer V, Motta C, Polidoro S, Perugini J, Macchiarulo G, Giovannetti AM, Pareja-Gutierrez L, Calò A, Colonna I, Furlan R, Martino G, Centonze D. Neuroinflammation drives anxiety and depression in relapsing-remitting multiple sclerosis. Neurology 2017; 89:1338-1347. [DOI: 10.1212/wnl.0000000000004411] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/13/2017] [Indexed: 11/15/2022] Open
Abstract
Objective:To explore the inflammatory processes in the pathogenesis of psychiatric symptoms and the prognostic value of psychiatric comorbidities in multiple sclerosis (MS).Methods:Four hundred five patients with relapsing-remitting (RR) MS underwent psychiatric evaluation by means of Beck Depression Inventory II (BDI-II) and State/Trait Anxiety Inventory (STAI-Y). The inflammatory activity level was assessed by MRI. In a subset of 111 treatment-naive patients, CSF levels of proinflammatory cytokines were determined. Correlation and regression analyses were performed to determine associations between variables.Results:Relapsing patients demonstrated greater values of STAI-state and BDI-II compared with remitting patients but comparable trait-anxiety scores. There were no significant differences in psychometric parameters between relapsing and asymptomatic MRI-active patients, highlighting the effect of subclinical inflammation on mood disturbances. A significant reduction of STAI-state and BDI-II scores was recorded, along with the subsiding of neuroinflammation. Interleukin-2 CSF levels were found to correlate with STAI-state, while tumor necrosis factor-α and interleukin-1β correlated with BDI-II. Because emotional disorders were associated with subclinical inflammation, variations of the psychometric profile were able to detect subclinical reactivation earlier. In line with this, high STAI-state values considerably predicted the possibility of disease reactivation.Conclusions:Mood alterations are induced by intrathecal inflammation, even though not clinically apparent, and are able to predict inflammatory reactivations in RRMS. Inflammation is therefore a biological event, not less important than the traditional psychosocial factors, involved in mood disorders.
Collapse
|
9
|
Brenner P, Piehl F. Fatigue and depression in multiple sclerosis: pharmacological and non-pharmacological interventions. Acta Neurol Scand 2016; 134 Suppl 200:47-54. [PMID: 27580906 DOI: 10.1111/ane.12648] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 12/18/2022]
Abstract
Multiple sclerosis (MS) is a neuroinflammatory condition with a prominent progressive neurodegenerative facet that typically affects young- or middle-aged adults. Although physical disabilities have been in the foreground by being easier to assess, there is an increasing interest in mental disabilities and psychiatric co-morbidities, which have a disproportionally high impact on important outcome measures such as quality of life and occupational disability. In particular, cognitive impairment, depression and mental fatigue, which mutually interact with each other, seem to be of importance in this context. In recent decades, major efforts have been invested in developing more effective disease modulatory treatments. This has resulted in novel therapeutic options and awareness of the importance of early intervention. In comparison, good quality and adequately powered studies on symptomatic treatments of fatigue and psychiatric co-morbidities in MS are rare, and awareness of treatment options is much lower. We here review the existing evidence base for symptomatic treatment of fatigue and depression in MS patients. With regard to fatigue, off-label prescription of alertness improving drugs is common, in spite of all but absent evidence of efficacy. In contrast, a number of smaller studies suggest that physical exercise and fatigue management courses may have some clinical benefit. Very few studies have addressed the efficacy of antidepressants and non-pharmaceutical interventions specifically in MS patients. Therefore, treatment guidelines largely rely on data from non-MS populations. In the future, there is a strong motive to direct additional resources to the study of these important aspects of MS.
Collapse
Affiliation(s)
- P. Brenner
- Centre for Psychiatry Research; Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - F. Piehl
- Division of Neurology; Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Department of Neurology; Karolinska University Hospital Solna; Stockholm Sweden
| |
Collapse
|
10
|
Hasselmann H, Bellmann-Strobl J, Ricken R, Oberwahrenbrock T, Rose M, Otte C, Adli M, Paul F, Brandt AU, Finke C, Gold SM. Characterizing the phenotype of multiple sclerosis–associated depression in comparison with idiopathic major depression. Mult Scler 2016; 22:1476-1484. [DOI: 10.1177/1352458515622826] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/26/2015] [Indexed: 11/17/2022]
Abstract
Background: Depression is a common co-morbidity in patients with multiple sclerosis (MS). While somatic symptoms of MS correlate with depression levels, it is unclear whether the clinical presentation of MS-associated depression differs from patients with “idiopathic” major depressive disorder (MDD). Objective: To compare the clinical phenotype of depression among MS and idiopathic MDD patients. Methods: Mean relative contribution of individual Beck Depression Inventory-II (BDI-II) items was evaluated among n = 139 patients with relapsing-remitting MS and n = 85 MDD patients without somatic illness. Next, comparisons were repeated in n = 38 MS with clinically relevant depressive symptoms (BDI-II > 19) and n = 38 MDD patients matched for sex, age, and depression severity. Finally, the underlying construct of depression was compared across groups using confirmatory factor analysis (CFA). Results: Comparisons on a whole-group level produced the expected differences along somatic/non-somatic symptoms. However, when appropriately controlling for depression severity, age, and sex, only four items contributed differentially to BDI-II total scores in MS versus MDD. CFA suggested that the underlying depression construct is essentially identical in both groups. Conclusion: The clinical phenotype of “idiopathic” MDD and MS-associated depression appears similar when adequately examined. The relevance of these findings for psychotherapeutic approaches for MS-associated depression should be explored in future studies.
Collapse
Affiliation(s)
- Helge Hasselmann
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany/NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Berlin, Germany/Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Roland Ricken
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Timm Oberwahrenbrock
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Rose
- Division of Psychosomatic Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Otte
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany/Fliedner Klinik Berlin, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Berlin, Germany/Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany/Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Finke
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany/Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefan M Gold
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany/Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
11
|
Santoro M, Nociti V, De Fino C, Caprara A, Giordano R, Palomba N, Losavio F, Marra C, Patanella AK, Mirabella M, Gainotti G, Quaranta D. Depression in multiple sclerosis: effect of brain derived neurotrophic factor Val66Met polymorphism and disease perception. Eur J Neurol 2016; 23:630-40. [PMID: 26756166 DOI: 10.1111/ene.12913] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 10/01/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Depression is common amongst subjects with multiple sclerosis (MS), and several investigations have explored different determinants of this condition, including physical disability, psychological and psychosocial factors. The brain derived neurotrophic factor (BDNF) Val66Met polymorphism has been associated with depression. The aim of this study was to analyze the influence of disease-related factors, BDNF Val66Met polymorphism and perception of disease on the severity of depression in MS. METHOD In total, 136 MS patients (88 women) were recruited and genotyped for BDNF rs6265 polymorphism at nucleotide 196 (G/A) using 'high resolution melting'. Depressive symptoms were assessed by the Multiple Sclerosis Depression Rating Scale. Perception of health status was assessed using the SF-36 questionnaire. RESULTS A multivariable linear regression model showed that the best predictors of depression were the SF-36 General health (β = -0.209; P = 0.013), Mental health (β = -0.410; P < 0.001) and Social activity (β = -0.195; P = 0.035) scores; physical disability (assessed by the Extended Disability Status Scale score) was directly correlated to depression severity on univariate analysis, but it was not a relevant predictor of depression on multivariate analysis; other variables directly related to the disease (treatment, annual relapsing rate) and the BDNF Val66Met polymorphism were not significantly associated with depression. CONCLUSION Perception of the health status is the principal predictor of depressive symptoms in our sample. This result supports the hypothesis that the subjective interpretation of the disease's consequences is one of the main factors in determining depression in MS.
Collapse
Affiliation(s)
- M Santoro
- Fondazione Don Gnocchi - ONLUS, Milan, Italy
| | - V Nociti
- Fondazione Don Gnocchi - ONLUS, Milan, Italy.,Institute of Neurology, Catholic University, Rome, Italy
| | - C De Fino
- Institute of Neurology, Catholic University, Rome, Italy
| | - A Caprara
- Institute of Neurology, Catholic University, Rome, Italy
| | - R Giordano
- Institute of Neurology, Catholic University, Rome, Italy
| | - N Palomba
- Institute of Neurology, Catholic University, Rome, Italy
| | - F Losavio
- Institute of Neurology, Catholic University, Rome, Italy
| | - C Marra
- Institute of Neurology, Catholic University, Rome, Italy.,Research Center for Neuropsychology, Institute of Neurology, Catholic University, Rome, Italy
| | - A K Patanella
- Institute of Neurology, Catholic University, Rome, Italy
| | - M Mirabella
- Institute of Neurology, Catholic University, Rome, Italy
| | - G Gainotti
- Institute of Neurology, Catholic University, Rome, Italy.,Research Center for Neuropsychology, Institute of Neurology, Catholic University, Rome, Italy
| | - D Quaranta
- Institute of Neurology, Catholic University, Rome, Italy.,Research Center for Neuropsychology, Institute of Neurology, Catholic University, Rome, Italy
| |
Collapse
|
12
|
Fischer A, Fischer M, Nicholls RA, Lau S, Poettgen J, Patas K, Heesen C, Gold SM. Diagnostic accuracy for major depression in multiple sclerosis using self-report questionnaires. Brain Behav 2015; 5:e00365. [PMID: 26445703 PMCID: PMC4589811 DOI: 10.1002/brb3.365] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/31/2015] [Accepted: 06/07/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Multiple sclerosis and major depressive disorder frequently co-occur but depression often remains undiagnosed in this population. Self-rated depression questionnaires are a good option where clinician-based standardized diagnostics are not feasible. However, there is a paucity of data on diagnostic accuracy of self-report measures for depression in multiple sclerosis (MS). Moreover, head-to-head comparisons of common questionnaires are largely lacking. This could be particularly relevant for high-risk patients with depressive symptoms. Here, we compare the diagnostic accuracy of the Beck Depression Inventory (BDI) and 30-item version of the Inventory of Depressive Symptomatology Self-Rated (IDS-SR30) for major depressive disorder (MSS) against diagnosis by a structured clinical interview. METHODS Patients reporting depressive symptoms completed the BDI, the IDS-SR30 and underwent diagnostic assessment (Mini International Neuropsychiatric Interview, M.I.N.I.). Receiver-Operating Characteristic analyses were performed, providing error estimates and false-positive/negative rates of suggested thresholds. RESULTS Data from n = 31 MS patients were available. BDI and IDS-SR30 total score were significantly correlated (r = 0.82). The IDS-SR30total score, cognitive subscore, and BDI showed excellent to good accuracy (area under the curve (AUC) 0.86, 0.91, and 0.85, respectively). CONCLUSION Both the IDS-SR30 and the BDI are useful to quantify depressive symptoms showing good sensitivity and specificity. The IDS-SR30 cognitive subscale may be useful as a screening tool and to quantify affective/cognitive depressive symptomatology.
Collapse
Affiliation(s)
- Anja Fischer
- Department of Health Psychology, King's College London SE1 9RT, London, UK ; Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Marcus Fischer
- Department of Pharmaceutical Chemistry, University of California San Francisco San Francisco, California, 94158
| | - Robert A Nicholls
- Structural Studies Division, MRC Laboratory of Molecular Biology Cambridge, CB2 0QH, UK
| | - Stephanie Lau
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Jana Poettgen
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Kostas Patas
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Christoph Heesen
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany ; Department of Neurology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Stefan M Gold
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany ; Department of Medical Psychology, University Medical Center Hamburg-Eppendorf Hamburg, Germany ; Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (CBF), Charité Universitätsmedizin Berlin, Germany
| |
Collapse
|
13
|
Facial and bodily emotion recognition in multiple sclerosis: the role of alexithymia and other characteristics of the disease. J Int Neuropsychol Soc 2014; 20:1004-14. [PMID: 25373767 DOI: 10.1017/s1355617714000939] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Multiple sclerosis (MS) may be associated with impaired perception of facial emotions. However, emotion recognition mediated by bodily postures has never been examined in these patients. Moreover, several studies have suggested a relation between emotion recognition impairments and alexithymia. This is in line with the idea that the ability to recognize emotions requires the individuals to be able to understand their own emotions. Despite a deficit in emotion recognition has been observed in MS patients, the association between impaired emotion recognition and alexithymia has received little attention. The aim of this study was, first, to investigate MS patient's abilities to recognize emotions mediated by both facial and bodily expressions and, second, to examine whether any observed deficits in emotions recognition could be explained by the presence of alexithymia. Thirty patients with MS and 30 healthy matched controls performed experimental tasks assessing emotion discrimination and recognition of facial expressions and bodily postures. Moreover, they completed questionnaires evaluating alexithymia, depression, and fatigue. First, facial emotion recognition and, to a lesser extent, bodily emotion recognition can be impaired in MS patients. In particular, patients with higher disability showed an impairment in emotion recognition compared with patients with lower disability and controls. Second, their deficit in emotion recognition was not predicted by alexithymia. Instead, the disease's characteristics and the performance on some cognitive tasks significantly correlated with emotion recognition. Impaired facial emotion recognition is a cognitive signature of MS that is not dependent on alexithymia.
Collapse
|
14
|
Watson TM, Ford E, Worthington E, Lincoln NB. Validation of mood measures for people with multiple sclerosis. Int J MS Care 2014; 16:105-9. [PMID: 25061435 DOI: 10.7224/1537-2073.2013-013] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Valid assessments are needed in order to identify anxiety and depression in people with multiple sclerosis (MS). The objective of this study was to assess the validity of questionnaire measures of mood in people with MS. METHODS People with MS were recruited from a clinic database and asked to complete and return a questionnaire containing the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), and Hospital Anxiety and Depression Scale (HADS). Those who returned the questionnaire were invited to complete a structured clinical interview, which was blind to the results of the questionnaire. RESULTS The BDI-II and HADS were both found to be valid measures to detect depression and anxiety in people with MS. An optimum cutoff score of 23 for the BDI-II yielded high sensitivity (85%) and high specificity (76%). An optimum cutoff score of 11 for the HADS demonstrated high sensitivity and specificity for both the Anxiety subscale (sensitivity 90%, specificity 92%) and the Depression subscale (sensitivity 77%, specificity 81%). The BAI had high sensitivity (80%) but poor specificity (46%) for detecting anxiety. CONCLUSION The BDI-II and HADS can be used to identify mood disorders in people with MS.
Collapse
Affiliation(s)
- Tessa M Watson
- Institute of Work, Health and Organisations, University of Nottingham, Nottingham, UK
| | - Emma Ford
- Institute of Work, Health and Organisations, University of Nottingham, Nottingham, UK
| | - Esme Worthington
- Institute of Work, Health and Organisations, University of Nottingham, Nottingham, UK
| | - Nadina B Lincoln
- Institute of Work, Health and Organisations, University of Nottingham, Nottingham, UK
| |
Collapse
|
15
|
Fragoso YD, Adoni T, Anacleto A, da Gama PD, Goncalves MVM, Matta APDC, Parolin MFK. Recommendations on diagnosis and treatment of depression in patients with multiple sclerosis. Pract Neurol 2014; 14:206-9. [DOI: 10.1136/practneurol-2013-000735] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
16
|
Abstract
Depression is a troublesome issue in the lives of people with multiple sclerosis (MS). However, there are many questions about how to measure depression in people with MS. Depression is a syndrome that is characterized by emotional, cognitive and somatic symptoms. Depression scales are usually designed to cover each of these domains but in MS there is concern that cognitive deficits and somatic symptoms related to the illness itself may inflate depressive symptom scores, potentially leading to false-positive ratings. Such misclassification may consume excessive resources in screening programs due to the triggering of unnecessary clinical assessments. In research, such misclassification could lead to bias. In an effort to address these issues, the authors of the article under evaluation have recently developed a new scale, the Multiple Sclerosis Depression Rating Scale.
Collapse
Affiliation(s)
- Kirsten M Fiest
- Department of Community Health Sciences, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive N.W., Calgary, AB, T2N 4Z6, Canada
| | | |
Collapse
|