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Lysogorskaia E, Ivanov T, Mendalieva A, Ulmasbaeva E, Youshko M, Brylev L. Yoga vs Physical Therapy in Multiple Sclerosis: Results of Randomized Controlled Trial and the Training Protocol. Ann Neurosci 2023; 30:242-250. [PMID: 38020405 PMCID: PMC10662275 DOI: 10.1177/09727531231161994] [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: 09/08/2022] [Accepted: 10/20/2022] [Indexed: 12/01/2023] Open
Abstract
Background Yoga originated in the territory of modern India more than 3,000 years ago uses techniques for working with the musculoskeletal system, cardiorespiratory system, and attention. Currently, the effectiveness and safety of yoga in patients with various neurological disorders, including multiple sclerosis (MS), is of interest to many scientists and clinicians. Purpose The main aim of this study is to examine the effect of yoga on symptoms and quality of life in patients with MS vs physical therapy (exercise therapy) and no exercise. Methods The patients were randomly assigned to three groups (yoga, physical therapy (PT), or waiting list). After 12 weeks of regular exercises (or the absence of them), the effect of yoga and PT on the functional status and quality of life of patients were evaluated. The data were collected during the patients' two visits to the study center - before the start of the study and at the end of the 12-week period. The in-person examination included a doctor's assessment of the Expanded Disability Status Scale (EDSS), the SF-36 quality of life questionnaire, the fatigue scale, the Berg balance scale, and the 6-min walking test. Results A total of 36 patients finished the clinical study: thirty women and six men. There was no statistically significant difference between the groups in terms of improvement in MS symptoms as measured by the balance, walking test, and fatigue scales. However, in the analysis of eight criteria of SF-36 quality-of-life questionnaire by the covariation analysis, statistically significant differences were found in favor of the yoga group in terms of physical functioning (PF) (p = .003), life activity (VT) (p < .001), mental health (MH) (p = 013), and social functioning (SF) (p = .028). Conclusion Thus, regular yoga classes under the guidance of qualified staff are a promising method of non-drug rehabilitation of patients with MS with motor disorders.
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Affiliation(s)
| | | | | | | | | | - Lev Brylev
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
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Voigt I, Inojosa H, Wenk J, Akgün K, Ziemssen T. Building a monitoring matrix for the management of multiple sclerosis. Autoimmun Rev 2023; 22:103358. [PMID: 37178996 DOI: 10.1016/j.autrev.2023.103358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
Multiple sclerosis (MS) has a longitudinal and heterogeneous course, with an increasing number of therapy options and associated risk profiles, leading to a constant increase in the number of parameters to be monitored. Even though important clinical and subclinical data are being generated, treating neurologists may not always be able to use them adequately for MS management. In contrast to the monitoring of other diseases in different medical fields, no target-based approach for a standardized monitoring in MS has been established yet. Therefore, there is an urgent need for a standardized and structured monitoring as part of MS management that is adaptive, individualized, agile, and multimodal-integrative. We discuss the development of an MS monitoring matrix which can help facilitate data collection over time from different dimensions and perspectives to optimize the treatment of people with MS (pwMS). In doing so, we show how different measurement tools can combined to enhance MS treatment. We propose to apply the concept of patient pathways to disease and intervention monitoring, not losing track of their interrelation. We also discuss the use of artificial intelligence (AI) to improve the quality of processes, outcomes, and patient safety, as well as personalized and patient-centered care. Patient pathways allow us to track the patient's journey over time and can always change (e.g., when there is a switch in therapy). They therefore may assist us in the continuous improvement of monitoring in an iterative process. Improving the monitoring process means improving the care of pwMS.
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Affiliation(s)
- Isabel Voigt
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Hernan Inojosa
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Judith Wenk
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Katja Akgün
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
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Smith KA, Piehl F, Olsson T, Alfredsson L, Hillert J, Kockum I, Stridh P, Montgomery S. Spasticity treatment patterns among people with multiple sclerosis: a Swedish cohort study. J Neurol Neurosurg Psychiatry 2022; 94:337-348. [PMID: 36539267 PMCID: PMC10176386 DOI: 10.1136/jnnp-2022-329886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Spasticity is common among people with multiple sclerosis (MS), but there are few studies of spasticity treatment patterns. We aim to describe associations with spasticity treatment measured primarily by oral baclofen use. METHODS This cohort study using Swedish registers included 1826 and 3519 people with incident and prevalent MS (pwIMS, pwPMS) respectively, followed from 2005 to 2014. Cox regression assessed factors associated with new baclofen prescriptions and its discontinuation. RESULTS A total of 10% of pwIMS and 19% of pwPMS received baclofen, a drug prescribed specifically for spasticity in Sweden, of which many patients had relapsing-remitting course. Prescriptions occurred soon after MS diagnosis: pwIMS received baclofen typically within 6 months of diagnosis, and pwPMS within 3 years. Younger patients compared with older patients were three times more likely to receive baclofen with similar disability level measured using Expanded Disability Severity Scores (EDSS). Patients aged 18-44 years with EDSS 3.0-5.0 have an HR for baclofen use of 5.62 (95% CI 2.91 to 10.85) and EDSS 6+ have an HR of 15.41 (95% CI 7.07 to 33.58) compared with individuals with EDSS 0-2.5. In comparison, patients aged 45+ years with EDSS 3.0-5.0 have an HR of 2.05 (95% CI 1.10 to 3.82) and EDSS 6+ a hour 4.26 (95% CI 1.96 to 9.17). Baclofen discontinuation was high: 49% (95% CI 0.42 to 0.57) of pwIMS discontinued within 150 days of dispensation, 90% discontinued within 2 years including patients with progressive course or higher EDSS. Associations among pwPMS and sensitivity analyses including additional treatments were similar. CONCLUSIONS Younger patients with MS are more likely to receive baclofen compared with older patients with MS. High rates of baclofen discontinuation highlight the need for more tolerable and efficacious spasticity treatments and monitoring of spasticity among people with MS.
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Affiliation(s)
- Kelsi A Smith
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Fredrik Piehl
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre of Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.,Academic Specialist Centre, Centre of Neurology, SLSO, Stockholm, Sweden
| | - Tomas Olsson
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre of Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.,Academic Specialist Centre, Centre of Neurology, SLSO, Stockholm, Sweden
| | - Lars Alfredsson
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre of Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.,Centre of Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jan Hillert
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre of Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Kockum
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Stridh
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.,Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Orebro, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
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Putscher E, Hecker M, Fitzner B, Boxberger N, Schwartz M, Koczan D, Lorenz P, Zettl UK. Genetic risk variants for multiple sclerosis are linked to differences in alternative pre-mRNA splicing. Front Immunol 2022; 13:931831. [PMID: 36405756 PMCID: PMC9670805 DOI: 10.3389/fimmu.2022.931831] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/12/2022] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system to which a genetic predisposition contributes. Over 200 genetic regions have been associated with increased disease risk, but the disease-causing variants and their functional impact at the molecular level are mostly poorly defined. We hypothesized that single-nucleotide polymorphisms (SNPs) have an impact on pre-mRNA splicing in MS. METHODS Our study focused on 10 bioinformatically prioritized SNP-gene pairs, in which the SNP has a high potential to alter alternative splicing events (ASEs). We tested for differential gene expression and differential alternative splicing in B cells from MS patients and healthy controls. We further examined the impact of the SNP genotypes on ASEs and on splice isoform expression levels. Novel genotype-dependent effects on splicing were verified with splicing reporter minigene assays. RESULTS We were able to confirm previously described findings regarding the relation of MS-associated SNPs with the ASEs of the pre-mRNAs from GSDMB and SP140. We also observed an increased IL7R exon 6 skipping when comparing relapsing and progressive MS patients to healthy subjects. Moreover, we found evidence that the MS risk alleles of the SNPs rs3851808 (EFCAB13), rs1131123 (HLA-C), rs10783847 (TSFM), and rs2014886 (TSFM) may contribute to a differential splicing pattern. Of particular interest is the genotype-dependent exon skipping of TSFM due to the SNP rs2014886. The minor allele T creates a donor splice site, resulting in the expression of the exon 3 and 4 of a short TSFM transcript isoform, whereas in the presence of the MS risk allele C, this donor site is absent, and thus the short transcript isoform is not expressed. CONCLUSION In summary, we found that genetic variants from MS risk loci affect pre-mRNA splicing. Our findings substantiate the role of ASEs with respect to the genetics of MS. Further studies on how disease-causing genetic variants may modify the interactions between splicing regulatory sequence elements and RNA-binding proteins can help to deepen our understanding of the genetic susceptibility to MS.
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Affiliation(s)
- Elena Putscher
- Rostock University Medical Center, Department of Neurology, Division of Neuroimmunology, Rostock, Germany
| | - Michael Hecker
- Rostock University Medical Center, Department of Neurology, Division of Neuroimmunology, Rostock, Germany
| | - Brit Fitzner
- Rostock University Medical Center, Department of Neurology, Division of Neuroimmunology, Rostock, Germany
| | - Nina Boxberger
- Rostock University Medical Center, Department of Neurology, Division of Neuroimmunology, Rostock, Germany
| | - Margit Schwartz
- Rostock University Medical Center, Department of Neurology, Division of Neuroimmunology, Rostock, Germany
| | - Dirk Koczan
- Rostock University Medical Center, Institute of Immunology, Rostock, Germany
| | - Peter Lorenz
- Rostock University Medical Center, Institute of Immunology, Rostock, Germany
| | - Uwe Klaus Zettl
- Rostock University Medical Center, Department of Neurology, Division of Neuroimmunology, Rostock, Germany
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Özer D, Emine Ata E, DİkeÇ G, Demİr S. The relationship between stress, anxiety, and depression levels and pseudobulbar affect in patients with Multiple Sclerosis. Contemp Nurse 2022; 58:317-329. [PMID: 35880717 DOI: 10.1080/10376178.2022.2107037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Pseudobulbar affect (PBA) has recently been added to the list of mental disorders commonly observed in patients with Multiple Sclerosis (MS). The emotional changes experienced by MS patients may be associated with other mental problems and adversely affect disease prognosis. However, there are limited studies in the international and national literature on this subject. AIM This study aimed to evaluate the relationship between PBA and stress, anxiety, and depression levels in patients with MS. DESIGN This is a descriptive, relational, and cross-sectional study. METHODS A total of 442 MS patients followed in the neurology outpatient clinic of a hospital and registered with the MS Society in Turkey participated in this study. Data were collected using a personal information form, the Turkish version of the Center for Neurologic Study-Lability Scale (CNS-LS), and the Depression Anxiety Stress Scale (DASS). RESULTS In this study, 63.3% of the patients had PBA, 21% had extremely severe depression, 41.6% had extremely severe anxiety, and 24.9% had severe stress. Correlation analysis revealed weak positive correlations between CNS-LS total score and DASS subscale and total scores. Depression, anxiety, and stress levels accounted for 22.5% of the variation in CNS-LS total score. CONCLUSION The results of this study indicate that a majority of MS patients in Turkey experience PBA, depression, anxiety, and stress, and that PBA is positively associated with depression, anxiety, and stress. IMPACT STATEMENT This study, indicates that should be increased consultation-liaison psychiatry services in Turkey, and MS patients should benefit from comprehensive psychiatric services.
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Affiliation(s)
- Duygu Özer
- MsN, PhD Candidate, University of Health Sciences, Sultan II. Abdulhamid Han Training and Research Hospital, Department of Psychiatry, Istanbul, Turkey
| | - Elvan Emine Ata
- Assis. Prof., University of Health Sciences, Hamidiye Faculty of Nursing, Department of Psychiatric Nursing, Istanbul, Turkey. E-mail:
| | - Gül DİkeÇ
- Assoc. Prof., Fenerbahce University, Faculty of Health Sciences, Department of Nursing, Istanbul, Turkey. E-mail:
| | - Serkan Demİr
- Assoc. Prof., MD, Department of Neurology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey. E-mail:
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Zhang HL, Jin RJ, Guan L, Zhong DL, Li YX, Liu XB, Xiao QW, Xiao XL, Li J. Extracorporeal Shock Wave Therapy on Spasticity After Upper Motor Neuron Injury: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2022; 101:615-623. [PMID: 35152251 PMCID: PMC9197142 DOI: 10.1097/phm.0000000000001977] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the effectiveness and safety of extracorporeal shock wave therapy on spasticity after upper motor neuron injury. DESIGN Eight electronic databases were searched systematically from their inception to August 3, 2021, to provide robust evidence for the efficacy of extracorporeal shock wave therapy for spasticity and range of motion after upper motor neuron injury. Study screening, data extraction, risk of bias assessment, and evaluation of the certainty of evidence were performed independently by two independent reviewers. Data analysis was conducted using RevMan 5.3.5 and R 3.6.1 software. RESULTS Forty-two studies with 1973 patients who met the eligibility criteria were selected from articles published from 2010 to 2021, of which 34 were included in the meta-analysis. A comparison intervention revealed that extracorporeal shock wave therapy significantly decreased the Modified Ashworth Scale score and increased the passive range of motion of a joint. Regarding the safety of extracorporeal shock wave therapy, slightly adverse effects, such as skin injury, bone distortion, muscle numbness, pain, petechiae, and weakness, were reported in five studies. CONCLUSIONS Extracorporeal shock wave therapy may be an effective and safe treatment for spasticity after upper motor neuron injury. However, because of poor methodological qualities of the included studies and high heterogeneity, this conclusion warrants further investigation. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Determine the impact of extracorporeal shock wave therapy on spasticity after upper motor neuron injury; (2) Describe the factors that affect the efficacy of extracorporeal shock wave therapy on spasticity; and (3) Discuss the mechanism of action of extracorporeal shock wave therapy on spasticity. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Gebhardt M, Kropp P, Hoffmann F, Zettl UK. Headache in multiple sclerosis - pharmacological aspects. Curr Pharm Des 2021; 28:445-453. [PMID: 34551691 DOI: 10.2174/1381612827666210922114100] [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: 02/22/2021] [Accepted: 07/19/2021] [Indexed: 12/11/2022]
Abstract
For decades, headache was not considered a typical symptom of multiple sclerosis (MS) and was construed as a "red flag" for important differential diagnoses such as cerebral vasculitis. Meanwhile, several studies have demonstrated an increased prevalence of headache in MS compared to the general population. This is due to the heterogeneity of headache genesis with frequent occurrence of both primary and secondary headaches in MS. On the one hand, MS and migraine are often comorbid. On the other hand, secondary headaches occur frequently, especially in the course of MS relapses. These are often migraine-like headaches caused by inflammation, which can improve as a result of MS-specific therapy. Headaches are particularly common in the early stages of chronic inflammatory CNS disease, where inflammatory activity is greatest. In addition, headache can also occur as a side effect of disease-modifying drugs (DMDs). Headache can occur with most DMDs and is most frequently described with interferon-beta therapy. The aim of this work is to present the prevalence of headache and describe the heterogeneity of possible causes of headache in MS. In addition, important therapeutic aspects in the treatment of MS patients in general will be presented as well as different approaches to the treatment of headache in MS depending on the etiological classification.
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Affiliation(s)
- Marcel Gebhardt
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Neurologie, Röntgenstraße 1, 06120 Halle. Germany
| | - Peter Kropp
- Institute of Medical Psychology and Medical Sociology, Medical Faculty, University of Rostock, Gehlsheimer Straße 20, 18147, Rostock. Germany
| | | | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock. Germany
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Abstract
The relationship between headache and multiple sclerosis (MS) has been a matter of controversy for over 60 years. Headaches are still rated as a "red flag", indicating alternative diagnoses to MS, although in the last few years numerous studies have shown a frequent association between headache and MS. In recent studies on MS patients, a link was found between lower age/shorter disease duration of MS and frequent headaches. A study of 50 patients manifesting MS for the first time showed the highest headache prevalence in MS of 78% reported so far.Headaches can also be a possible side effect of most disease-modifying MS drugs. In many cases, however, the headache appears to be a symptom of MS in terms of secondary headache. This is also supported by pathophysiological implications, for example, by detecting B cell follicles in the meninges of MS patients.Migraine is the most common type of headache in MS. In some cases, this is a comorbidity of two diseases with many similarities, but headaches caused by inflammatory MS lesions also appear to be phenomenologically very similar to classic migraines; thus, distinguishing between them is often only successful with the help of thorough differential diagnostics (cerebrospinal fluid, MRI etc.).The task of future studies must be to specify the phenomenology of headache in MS even more precisely, in order to, to gain knowledge in, among others, patients with radiologically isolated syndrome, who often suffer from headache, because in these patients a considerable differential diagnostic and therapeutic uncertainty exists.
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De Giglio L, Cortese F, Pennisi EM. Aminopiridines in the treatment of multiple sclerosis and other neurological disorders. Neurodegener Dis Manag 2020; 10:409-423. [PMID: 33054615 DOI: 10.2217/nmt-2020-0018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Symptomatic treatment has a great relevance for the management of patients with neurologic diseases, since it reduces disease burden and improves quality of life. Aminopyridines (APs) are a group of potassium (K+) channel blocking agents that exert their activity both at central nervous system level and on neuromuscular junction. This review describes the use of APs for the symptomatic treatment of neurological conditions. We will describe trials leading to the approval of the extended-release 4-aminopyridine for MS and evidence in support of the use in other neurological diseases.
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Affiliation(s)
- Laura De Giglio
- Department of Medicine, San Filippo Neri Hospital, Neurology Unit, Rome, Italy
| | - Francesca Cortese
- Department of Medicine, San Filippo Neri Hospital, Neurology Unit, Rome, Italy
| | - Elena Maria Pennisi
- Department of Medicine, San Filippo Neri Hospital, Neurology Unit, Rome, Italy
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Sarbaz Y, Beni KN, Hosseininejad A, Eftekharsadat B, Jahanjoo F. The effect of yoga practice on muscular strength improvement in patients with multiple sclerosis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background/Aims Multiple sclerosis is a common condition in the central nervous system where patients experience many issues, including muscle weakness. This study offers an investigation of continuous hatha yoga exercises on patients with multiple sclerosis. Methods A total of 22 participants with multiple sclerosis were selected, 11 were allocated to the intervention group, and 11 to the control group. In both groups, surface electromyography and dynamometer were performed at the beginning and the end of the study. The intervention group undertook 90-minute sessions of hatha yoga training three times a week for 6 months and the control group did not do any particular exercise during this period. Results Dynamometer results indicated that yoga significantly improved the muscle strength of the participants with multiple sclerosis (before the intervention: 40.00 Nm ± 14.66 Nm vs 56.82 Nm ± 20.28 Nm after the intervention, P=0.037). However, there was no significant difference in muscle strength changes between the intervention and control groups (16.82 Nm ± 23.26 Nm vs -2.86 Nm ± 23.36 Nm, P=0.171). Yoga significantly increased participants muscle strength according to the surface electromyography signals (before the intervention: 39.91 V ± 8.86 V vs 54.09 v ± 8.95 V after the intervention, P=0.007). The muscle strength of the control group participants with multiple sclerosis decreased after 6 months, however it was not statistically significant (41.55 Nm ± 9.3 Nm vs 34.55 Nm ± 8.36 Nm, P=0.073). The comparison of changes showed that the surface electromyography signals in the intervention group were significantly higher than those of the control group (P=0.001). Conclusions: Yoga exercises, in addition to common multiple sclerosis treatment methods, can be considered as a complementary therapy to improve the physical aspects of multiple sclerosis symptoms.
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Affiliation(s)
- Yashar Sarbaz
- Faculty of Electrical and Computer Engineering, University of Tabriz, Tabriz, Iran
| | - Kamran Naderi Beni
- Faculty of Electrical and Computer Engineering, University of Tabriz, Tabriz, Iran
| | - Azar Hosseininejad
- Faculty of Electrical and Computer Engineering, University of Tabriz, Tabriz, Iran
| | - Bina Eftekharsadat
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Jahanjoo
- Department of Biostatistics and Epidemiology, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Flachenecker P, Eichstädt K, Berger K, Ellenberger D, Friede T, Haas J, Kleinschnitz C, Pöhlau D, Rienhoff O, Stahmann A, Zettl UK. [Multiple sclerosis in Germany: updated analysis of the German MS Registry 2014-2018]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 88:436-450. [PMID: 32717768 DOI: 10.1055/a-0985-4124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Zusammenfassung
Einleitung Unter Federführung der Deutschen Multiple Sklerose Gesellschaft (DMSG), Bundesverband e. V. wurde 2001 ein bundesweites MS-Register initiiert, um epidemiologische Daten zur MS, deren Verlaufsformen und der Versorgungssituation in Deutschland zu erheben. Das Ziel der vorliegenden Auswertung war es, die Daten der letzten Auswertung von vor 10 Jahren zu aktualisieren.
Methodik Zum Stichtag 28. Februar 2018 nahmen 168 Zentren verschiedener Versorgungsbereiche (Universitätskliniken, Akutkliniken, Rehabilitationskliniken und neurologische Praxen) teil. Von 2014 bis 2016 wurde der Wechsel der Dokumentationsplattform zu einem internetbasierten elektronischen Datenerfassungssysstem (EDC) vorgenommen, das eine umfassende Datenerhebung und die Integration verschiedener Dokumentationssysteme erlaubt. Eine Reihe von Qualitätssicherungsmaßnahmen sichert eine valide und representative Datenerhebung. Um eine möglichst aktuelle Beschreibung der Versorgungssituation zu gewährleisten, wurde die Querschnittsanalyse auf Patientendaten der aktuellsten Visite aus den letzten 4 Jahren beschränkt.
Ergebnisse Daten von 18.030 MS-Betroffenen konnten ausgewertet werden. Das mittlere (± Standardabweichung) Alter betrug 46,3 ± 12,2 Jahre, 72 % der Patienten waren weiblich, im Mittel waren die Patienten 10,6 ± 8,7 Jahre erkrankt, der mediane EDSS lag bei 3,0. Die Mehrzahl der Patienten litt an einem schubförmigen Verlauf (74,2 %), 16,1 % hatten einen sekundär und 5,5 % einen primär progredienten Verlauf. Eine Immuntherapie wurde bei 75,2 % durchgeführt, am häufigsten mit Interferonen, gefolgt von Fingolimod, Glatirameracetat, Dimethylfumarat, Natalizumab und Teriflunomid. Symptomatische Therapiemaßnahmen erhielten zwischen 28,3 % (kognitive Störungen) und 86,0 % (Spastik) der Patienten, die an diesen Symptomen litten. Voll berufstätig waren nur noch 37,5 % der Betroffenen; 22,5 % waren vorzeitig berentet. Die berufliche Leistungsfähigkeit war negativ mit dem Alter und dem Behinderungsgrad assoziiert.
Diskussion Die vorliegende Auswertung des deutschen MS-Registers gibt einen aktuellen Überblick zur MS und deren Versorgungssituation in Deutschland. Die Ergebnisse sprechen für einen günstigeren Verlauf der MS im Lauf der letzten 10 Jahre. Während die Mehrzahl der Patienten mit immunmodulatorischen Substanzen therapiert wird, sind nach wie vor einige Symptome der MS wie Fatigue und kognitive Störungen unzureichend behandelt. Zwar hat die Beschäftigungsrate im Vergleich zu früheren Auswertungen zugenommen; dennoch erfordert der hohe Anteil der vorzeitig Berenteten effektive Maßnahmen, um die funktionellen Einschränkungen der Betroffenen zu verringern und ihnen die Teilhabe am gesellschaftlichen und beruflichen Leben möglichst lange zu ermöglichen.
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Affiliation(s)
| | | | - Klaus Berger
- Institut für Epidemiologie und Sozialmedizin, Universität Münster
| | | | - Tim Friede
- Institut für Medizinische Statistik, Universitätsmedizin Göttingen
| | - Judith Haas
- Zentrum für Multiple Sklerose, Jüdisches Krankenhaus Berlin
| | | | | | - Otto Rienhoff
- Institut für Medizinische Informatik, Universitätsmedizin Göttingen
| | | | - Uwe K Zettl
- Klinik und Poliklinik für Neurologie, Sektion Neuroimmunologie, Universitätsmedizin Rostock
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Cost-Effectiveness Analysis of Cannabinoid Oromucosal Spray Use for the Management of Spasticity in Subjects with Multiple Sclerosis. Clin Drug Investig 2020; 40:319-326. [DOI: 10.1007/s40261-020-00895-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Hecker M, Rüge A, Putscher E, Boxberger N, Rommer PS, Fitzner B, Zettl UK. Aberrant expression of alternative splicing variants in multiple sclerosis - A systematic review. Autoimmun Rev 2019; 18:721-732. [PMID: 31059848 DOI: 10.1016/j.autrev.2019.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 02/22/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Alternative splicing is an important form of RNA processing that affects nearly all human genes. The differential expression of specific transcript and protein isoforms holds the potential of novel biomarkers for complex diseases. In this systematic review, we compiled the existing literature on aberrant alternative splicing events in multiple sclerosis (MS). METHODS A systematic literature search in the PubMed database was carried out and supplemented by screening the reference lists of the identified articles. We selected only MS-related original research studies which compared the levels of different isoforms of human protein-coding genes. A narrative synthesis of the research findings was conducted. Additionally, we performed a case-control analysis using high-density transcriptome microarray data to reevaluate the genes that were examined in the reviewed studies. RESULTS A total of 160 records were screened. Of those, 36 studies from the last two decades were included. Most commonly, peripheral blood samples were analyzed (32 studies), and PCR-based techniques were usually employed (27 studies) for measuring the expression of selected genes. Two studies used an exploratory genome-wide approach. Overall, 27 alternatively spliced genes were investigated. Nine of these genes appeared in at least two studies (CD40, CFLAR, FOXP3, IFNAR2, IL7R, MOG, PTPRC, SP140 and TNFRSF1A). The microarray data analysis confirmed differential alternative pre-mRNA splicing for 19 genes. CONCLUSIONS An altered RNA processing of genes mediating immune signaling pathways has been repeatedly implicated in MS. The analysis of individual exon-level expression patterns is stimulated by the advancement of transcriptome profiling technologies. In particular, the examination of genes encoded in MS-associated genetic regions may provide important insights into the pathogenesis of the disease and help to identify new biomarkers.
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Affiliation(s)
- Michael Hecker
- University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany.
| | - Annelen Rüge
- University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Elena Putscher
- University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Nina Boxberger
- University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Paulus Stefan Rommer
- University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany; Medical University of Vienna, Department of Neurology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Brit Fitzner
- University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Uwe Klaus Zettl
- University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany
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Gebhardt M, Kropp P, Hoffmann F, Zettl UK. Headache in the course of multiple sclerosis: a prospective study. J Neural Transm (Vienna) 2018; 126:131-139. [PMID: 30506270 DOI: 10.1007/s00702-018-1959-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/22/2018] [Indexed: 01/03/2023]
Abstract
Multiple sclerosis (MS) is the most common immune-mediated inflammatory disease of the central nervous system (CNS). Early diagnosis and treatment is important to prevent progression of disability in the course of the chronic disease. Therefore, correct and fast identification of early symptoms is vital. Headache is generally not recognized as an early symptom of MS, although numerous studies could show a high prevalence of headache in MS patients. The most common misdiagnosis is migraine. The aim of this study is to investigate the prevalence as well as the phenomenology of headache in MS especially with regard to the progression of the disease. In a prospective, multicenter study, we unbiasedly recruited 150 patients with manifest MS based on the criteria of McDonald. 50 patients at the timepoint of initial diagnosis and 100 of them with a long-term course of the disease were included. Based on a semi-structured interview, we evaluated the occurrence of headache over the last 4 weeks as well as case history, clinical-neurological investigation and questionnaires about depression, fatigue, and quality of life. Prevalence of headache in all patients was 67%. Patients at the timepoint of symptom manifestation of MS showed the highest prevalence of headache that was ever been recorded of 78%. In general, patients with headache were younger, had a shorter duration of the disease, and were less physically affected. We noticed frequent occurrence of migraine and migraine-like headache. In the course of the disease, patients without disease-modifying drug (DMD) complained more frequently headaches than patients with any kind of therapy. Headache is an important early symptom of MS. This could be shown especially among 78% of patients with clinically isolated syndrome (CIS). Therefore, young people with frequent headache should undergo MRI of the head and in the case of abnormal findings a consecutive detailed differential diagnosis. This could reduce the latency until final diagnosis of MS, which is in general much too long. That way these patients could get the earliest possible treatment, which is important to stop the progression of the disease.
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Affiliation(s)
- Marcel Gebhardt
- Klinik für Neurologie, Krankenhaus Martha-Maria Halle-Dölau, Röntgenstraße 1, 06120, Halle, Germany.
| | - Peter Kropp
- Institute of Medical Psychology and Medical Sociology, Medical Faculty, University of Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Frank Hoffmann
- Klinik für Neurologie, Krankenhaus Martha-Maria Halle-Dölau, Röntgenstraße 1, 06120, Halle, Germany
| | - Uwe K Zettl
- Neuroimmunological Section, Department of Neurology, University of Rostock, Rostock, Germany
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15
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Kraft M, Zettl UK, Noack T, Patejdl R. The sphingosine analog fingolimod (FTY720) enhances tone and contractility of rat gastric fundus smooth muscle. Neurogastroenterol Motil 2018; 30:e13372. [PMID: 29740911 DOI: 10.1111/nmo.13372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/10/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sphingosine and its metabolite sphingosine phosphate (S1P) regulate a multitude of biological functions, including the contractile state of smooth. Gastrointestinal side effects have been reported in patients treated with FTY720, a sphingosine analog that is approved for the treatment of multiple sclerosis. The aim of this study was to characterize the effects of FTY720 on rat gastric fundus smooth muscle under basal conditions and during activation induced by high-K+ solution. METHODS Isometric contractions of isolated circular strips of gastric fundus smooth muscle were recorded using the organ bath method. The effects of FTY720 or vehicle were recorded under control conditions and in the presence of indomethacin, L-NAME, HA-1100, nifedipine, JTE-013, and suramin. Tone and contractions recorded in the presence of FTY720 or vehicle are reported as % of the amplitude of an initial high-K+ contraction obtained under control conditions. KEY RESULTS From a concentration of 10 μmol L-1 onwards, FTY720 increased the tone, reaching 8.9% ± 7.5% at 100 μmol L-1 (P < .05). With indomethacin in the solution, the effects of FTY720 were enhanced (32.1% ± 7.7%; P < .001). The FTY720-induced increase in tone was abolished in the absence of extracellular Ca2+ and reduced by nifedipine, HA-1100, JTE-013, and suramin. Furthermore, FTY720 increased high-K+ contractions in the presence of indomethacin. CONCLUSIONS & INFERENCES FTY720 increases tone and contractile responses to depolarization in gastric fundus smooth muscle by triggering calcium entry and calcium sensitization in a S1P receptor-dependent manner. Taken together, the experimental results presented in this work suggest that FTY720 may increase gastric tone and contractility in patients.
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Affiliation(s)
- M Kraft
- Oscar Langendorff Institut für Physiologie, Universität Rostock, Rostock, Germany
| | - U K Zettl
- Klinik und Poliklinik für Neurologie, Sektion Neuroimmunologie, Universität Rostock, Rostock, Germany
| | - T Noack
- Oscar Langendorff Institut für Physiologie, Universität Rostock, Rostock, Germany
| | - R Patejdl
- Oscar Langendorff Institut für Physiologie, Universität Rostock, Rostock, Germany
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Rommer PS, Eichstädt K, Ellenberger D, Flachenecker P, Friede T, Haas J, Kleinschnitz C, Pöhlau D, Rienhoff O, Stahmann A, Zettl UK. Symptomatology and symptomatic treatment in multiple sclerosis: Results from a nationwide MS registry. Mult Scler 2018; 25:1641-1652. [PMID: 30230952 DOI: 10.1177/1352458518799580] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease. Over time, symptoms accumulate leading to increased disability of patients. OBJECTIVE The objective of this article is to analyze the prevalence of symptoms and symptomatic treatment patterns in a nationwide MS registry. METHODS Data sets from 35,755 patients were analyzed. RESULTS More than two-thirds of patients were women with a mean age of 46.1 (±12.8) years. Median Expanded Disability Status Score (EDSS) was 3.0. The most frequently reported symptoms were fatigue, spasticity, and voiding disorders. In patients with short disease duration, fatigue was reported most frequently. Symptomatic treatment was most common for spasticity and depression, whereas fatigue was treated only in a third of affected patients. Almost a fifth of patients with EDSS ⩽ 3.5 and neuropsychological symptoms had retired from work. CONCLUSION Whereas treatment for spasticity and depression is common in our cohort, sexual dysfunction, dysphagia, cognitive dysfunction, and fatigue are treated to a far lesser extent. The need for psychological support, physical, and occupational therapy has to be recognized as neuropsychological symptoms have a great impact on retirement at an early stage. Overall symptomatic treatment rates for the most common symptoms have increased over the last years (p < 0.001).
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Affiliation(s)
- Paulus Stefan Rommer
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany/Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - David Ellenberger
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | | | - Tim Friede
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Judith Haas
- MS-Center, Jewish Hospital Berlin, Berlin, Germany
| | | | - Dieter Pöhlau
- Department of Neurology, German Red Cross-Kamillus-Clinic, Asbach, Germany
| | - Otto Rienhoff
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | | | - Uwe Klaus Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
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Rommer PS, König N, Sühnel A, Zettl UK. Coping behavior in multiple sclerosis-complementary and alternative medicine: A cross-sectional study. CNS Neurosci Ther 2018; 24:784-789. [PMID: 29635832 PMCID: PMC6120478 DOI: 10.1111/cns.12857] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/12/2018] [Accepted: 03/13/2018] [Indexed: 12/13/2022] Open
Abstract
Main Problem Treatment options for multiple sclerosis (MS) have enlarged tremendously over the last years. Nonetheless, lots of patients look for alternative treatment options. The use of complementary and alternative medicine (CAM) is widespread in MS, however, its scientific investigation is limited so far. The aim of the study is to analyse clinical and demographical differences of MS patients in dependency of their CAM utilization as coping strategy. Methods A total of 254 patients with a clinically definite MS were examined in a semistructured interview. Additional standardized questionnaires were used to measure different aspects of coping with illness. All patients underwent neurological examination. Results About 206 of all enrolled patients are CAM users (81.1%). They have a longer disease duration (8.3 years vs 7.3 years, P = 0.028) and show higher disability (median EDSS 4.0 vs 2.0, P < 0.001) than nonusers. CAM users differed significantly from nonusers in their coping behavior (P = 0.035). Users are brooding more heavily over the disease, looking for more information about MS, and are looking for a sense of their disease in religion more often than nonusers. CAM users are at a higher risk of depression. Almost two‐thirds of CAM users (57.6%) reported positive effects on the well‐being of their state of health. Conclusion Coping behavior differs significantly between CAM users and nonusers. CAM utilization is associated with higher disability and depression. More than 80% of our cohort has used alternative or complementary methods. CAM utilization may mirror unmet needs in the treatment of MS.
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Affiliation(s)
- Paulus S Rommer
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany.,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Annett Sühnel
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
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Patejdl R, Zettl UK. Spasticity in multiple sclerosis: Contribution of inflammation, autoimmune mediated neuronal damage and therapeutic interventions. Autoimmun Rev 2017; 16:925-936. [PMID: 28698092 DOI: 10.1016/j.autrev.2017.07.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/26/2017] [Indexed: 12/19/2022]
Abstract
In contrast to other diseases that go along with spasticity (e.g. spinal cord injury), spasticity in chronic autoimmune diseases involving the CNS is complicated by the ongoing damage of neuronal networks that leads to permanent changes in the clinical picture of spasticity. Multiple sclerosis (MS) is the most frequent autoimmune disease of the central nervous system (CNS) and spasticity is one of the most disabling symptoms. It occurs in more than 80% MS patients at some point of the disease and is associated with impaired ambulation, pain and the development of contractures. Besides causing cumulative structural damage, neuroinflammation occurring in MS leads to dynamic changes in motor circuit function and muscle tone that are caused by cytokines, prostaglandins, reactive oxygen species and stress hormones that affect neuronal circuits and thereby spasticity. The situation is complicated further by the fact that therapeutics used for the immunotherapy of MS may worsen spasticity and drugs used for the symptomatic treatment of spasticity have been shown to have the potential to alter immune cell function and CNS autoimmunity itself. This review summarizes the current knowledge on the immunologic pathways that are involved in the development, maintenance, dynamic changes and pharmacological modulation of spasticity in MS.
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Affiliation(s)
- Robert Patejdl
- University of Rostock, Department of Physiology, Germany.
| | - Uwe K Zettl
- University of Rostock, Department of Neurology, Division of Neuroimmunology, Germany
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van Ettinger-Veenstra H. Cumulative evidence for MS as a neural network disconnection syndrome consistent with cognitive impairment mechanisms and the confounding role of fatigue and depression-outlook from the Fourth Nordic MS symposium. Acta Neurol Scand 2016; 134 Suppl 200:4-7. [PMID: 27580899 DOI: 10.1111/ane.12655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 12/14/2022]
Abstract
The Fourth Nordic MS symposium served as a platform to present an overview over the rise and impact of cognitive impairment in people with MS, from early stages on, impairing their quality of life. After discussing MS and cognitive impairment symptoms, a review on the pathophysiology underlying cognitive impairment was given, followed by a talk on neuroimaging highlighting cortical reorganization in MS-affected brains. As a conclusion, therapy and treatment options were discussed. The symposium presented several cutting-edge research studies providing or testing working models that appear successful in predicting and explaining cognitive impairment in MS, such as the disconnection syndrome.
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Affiliation(s)
- H. van Ettinger-Veenstra
- Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
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