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Gandhi F, Jhaveri S, Avanthika C, Singh A, Jain N, Gulraiz A, Shah P, Nasir F. Impact of Vitamin D Supplementation on Multiple Sclerosis. Cureus 2021; 13:e18487. [PMID: 34754649 PMCID: PMC8567111 DOI: 10.7759/cureus.18487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/14/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease affecting a large number of people every year. The exact causal factor for this disease is unclear, but it commonly affects middle-aged women, with known triggers like stress, childbirth, infections, poor diet, lack of sleep, etc. Many epidemiological studies have indicated that various genetic abnormalities are also critical drivers of the onset of MS. The major risk factors of MS identified include hypovitaminosis D while environmental protective factors include allele HLA DRB1 1501, obesity, Epstein-Barr virus infection, sexual hormones, and smoking. Our article explores the correlation between the deficiency of vitamin D and the onset and progression of MS. The study uses a systematic review methodology by researching and reviewing scholarly articles exploring the topic. We conducted online searches of literature on Google Scholar and PubMed using the keywords "vitamin D deficiency" and "multiple sclerosis" and accessed the relevant secondary literature sources for review. The variables under study included vitamin D insufficiency as the dependent variable while MS was the independent variable. Causal variables included environmental, genetic, and protective factors. We hypothesized that there is indeed a correlation between vitamin D deficiency and MS. The findings from our review indicate a strong correlation between the insufficiency of vitamin D and the onset and progression of MS. These results are essential in devising interventions to accomplish primary and secondary prevention of MS, as well as integrating vitamin D supplementation in current treatment protocols for MS.
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Affiliation(s)
- Fenil Gandhi
- Internal Medicine, Shree Krishna Hospital, Anand, IND
| | - Sharan Jhaveri
- Internal Medicine, Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | - Chaithanya Avanthika
- Medicine and Surgery, Karnataka Institute of Medical Sciences, Hubli, IND.,Pediatrics, Karnataka Institute of Medical Sciences, Hubli, IND
| | - Abhishek Singh
- Internal Medicine, Mount Sinai Morningside, New York City, USA
| | - Nidhi Jain
- Internal Medicine, Sir Ganga Ram Hospital, New Delhi, IND
| | - Azouba Gulraiz
- Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | | | - Fareeha Nasir
- Internal Medicine, Harlem Hospital Center, New York City, USA
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Gait Pattern in People with Multiple Sclerosis: A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11040584. [PMID: 33805095 PMCID: PMC8064080 DOI: 10.3390/diagnostics11040584] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the present systematic review was to describe the gait pattern in people with multiple sclerosis (MS) by compiling the main findings obtained from studies using three-dimensional capture systems of human movement. The search was carried out in PubMed, Web of Science, Physiotherapy Evidence Database (PEDro), and the Cumulative Index to Nursing and Allied Health (CINAHL) databases. Studies that used three-dimensional gait analysis systems and that analyzed spatiotemporal, kinematic, kinetic, or electromyographic parameters, were included. The quality of the studies was assessed using the Critical Review Form-Quantitative Studies scale. 12 articles were included with 523 (342 women and 181 men) people with a diagnosis of MS. The present work suggests that people with MS have a decrease in speed and stride length, as well as an increase in double-stance intervals during gait. Likewise, it is common to observe a decrease in hip extension during the stance period, a decrease in knee flexion in the swing period, a decrease in ankle dorsiflexion in the initial contact and a decrease in ankle plantar flexion during the pre-swing phase. The subjects with MS decrease the hip extensor moment and the ankle power during the stance period of walking.
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A preliminary study of the concentration of metallic elements in the blood of patients with multiple sclerosis as measured by ICP-MS. Sci Rep 2020; 10:13112. [PMID: 32753601 PMCID: PMC7403292 DOI: 10.1038/s41598-020-69979-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/21/2020] [Indexed: 12/19/2022] Open
Abstract
It is estimated that multiple sclerosis (MS) affects 35,000 Brazilians and 2.5 million individuals worldwide. Many studies have suggested a possible role of metallic elements in the etiology of MS, but their concentration in the blood of MS patients is nonetheless little investigated in Brazil. In this work, these elements were studied through Inductively Coupled Plasma Mass Spectrometry (ICP-MS), whose analysis provides a tool to quantify the concentrations of metal elements in the blood samples of individuals with neurodegenerative disorders. This study aimed to compare the concentration of metallic elements in blood samples from patients with MS and healthy individuals. Blood was collected from 30 patients with multiple sclerosis and compared with the control group. Blood samples were digested in closed vessels using a microwave and ICP-MS was used to determine the concentrations of 12 metallic elements (Ba, Be, Ca, Co, Cr, Cu, Fe, Mg, Mo, Ni, Pb and Zn). In MS patients, we observed a reduction in the concentrations of beryllium, copper, chromium, cobalt, nickel, magnesium and iron. The mean concentration of lead in blood was significantly elevated in the MS group. However, no difference was observed in the concentrations of Mo, Ba, Ca and Zn in blood samples from MS patients and the control group. According to our data, there is a possible role for the concentrations of 8 of the 12 evaluated metallic elements in multiple sclerosis. Abnormalities in transition metals levels in biological matrices have been reported in several neurological diseases.
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Shaw MT, Best P, Frontario A, Charvet LE. Telerehabilitation benefits patients with multiple sclerosis in an urban setting. J Telemed Telecare 2019; 27:39-45. [PMID: 31307269 DOI: 10.1177/1357633x19861830] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION People living with multiple sclerosis (MS) often require rehabilitation to manage their symptoms. Telerehabilitation offers improved access to treatment options by reducing travel time and cost. Our telerehabilitation program pairs training exercises simultaneously with transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique. In the current study, we characterized the benefits of our remotely supervised tDCS (RS-tDCS) at-home telerehabilitation protocol in an urban sample of MS participants. METHODS Participants with MS were recruited to complete a telerehabilitation trial using tDCS paired with cognitive rehabilitation at-home using remote supervision (RS-tDCS). Participant time and travel costs for study visits to our clinic in midtown New York City were calculated. RESULTS Forty-four patients with MS (aged 18 to 71) with mild to severe neurologic disability (Expanded Disability Status Scale score median = 3.5, range: 0.0 to 8.0) completed the survey. Round-trip clinic attendance required 2.3 ± 2.3 h and US $27.04 ± 38.13 for out-of-pocket expenses. Participants rated difficulty of clinic attendance as moderately to significantly difficult (2.5 ± 1.3). Severity of neurologic disability accounted for the greatest variance in difficulty attending clinic (30%, p < 0.001). RS-tDCS had 95% treatment compliance and 93% of participants reported satisfaction with the at-home treatment. DISCUSSION Attending clinic is associated with significant costs for patients with neurologic disorders, even in urban settings. Rehabilitation can be delivered at home and supervised in real-time via videoconference.
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Affiliation(s)
- Michael T Shaw
- New York University Langone Health, Neurology Department
| | - Pamela Best
- New York University Langone Health, Neurology Department
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Auricchio F, Scavone C, Cimmaruta D, Di Mauro G, Capuano A, Sportiello L, Rafaniello C. Drugs approved for the treatment of multiple sclerosis: review of their safety profile. Expert Opin Drug Saf 2017; 16:1359-1371. [PMID: 28976217 DOI: 10.1080/14740338.2017.1388371] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic immune-mediated inflammatory disorder of the brain and spinal cord characterized by inflammation, demyelination, and axonal degeneration. Area covered: Even though the pharmacological armamentarium for MS treatment is considerably improved in the last 20 years, safety data especially for the second-line and innovative treatments are lacking. In order to analyze the safety profile of drugs used for the treatment of MS, a literature review of pre-marketing, post-marketing studies and case reports was performed. Expert opinion: Nowadays, the numerous drugs approved in the last years for the treatment of MS allow a better control of the disease and a better patient compliance. The main advantages of the new disease-modifying agents for MS (DMTs), in fact, derive from the new oral administration and the prolonged half-life with consequent improvement in compliance compared to first-line therapy which required subcutaneous administrations. However, DMTs can cause serious, sometimes life-threatening or fatal, drug adverse reactions. Due to the lack of safety data and given the recent marketing approval of the last DMTs for MS, observational studies and post-marketing surveillance activities will be necessary in order to improve the knowledge about the safety profile of these drugs and the improvement of their use in clinical practice.
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Affiliation(s)
- Fabiana Auricchio
- a Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", School of Medicine , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Cristina Scavone
- a Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", School of Medicine , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Daniela Cimmaruta
- a Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", School of Medicine , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Gabriella Di Mauro
- a Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", School of Medicine , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Annalisa Capuano
- a Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", School of Medicine , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Liberata Sportiello
- a Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", School of Medicine , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Concetta Rafaniello
- a Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", School of Medicine , University of Campania "Luigi Vanvitelli" , Naples , Italy
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Charvet LE, Dobbs B, Shaw MT, Bikson M, Datta A, Krupp LB. Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: Results from a randomized, sham-controlled trial. Mult Scler 2017; 24:1760-1769. [PMID: 28937310 DOI: 10.1177/1352458517732842] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fatigue is a common and debilitating feature of multiple sclerosis (MS) that remains without reliably effective treatment. Transcranial direct current stimulation (tDCS) is a promising option for fatigue reduction. We developed a telerehabilitation protocol that delivers tDCS to participants at home using specially designed equipment and real-time supervision (remotely supervised transcranial direct current stimulation (RS-tDCS)). OBJECTIVE To evaluate whether tDCS can reduce fatigue in individuals with MS. METHODS Dorsolateral prefrontal cortex left anodal tDCS was administered using a RS-tDCS protocol, paired with 20 minutes of cognitive training. Here, two studies are considered. Study 1 delivered 10 open-label tDCS treatments (1.5 mA; n = 15) compared to a cognitive training only condition ( n = 20). Study 2 was a randomized trial of active (2.0 mA, n = 15) or sham ( n = 12) delivered for 20 sessions. Fatigue was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS)-Fatigue Short Form. RESULTS AND CONCLUSION In Study 1, there was modest fatigue reduction in the active group (-2.5 ± 7.4 vs -0.2 ± 5.3, p = 0.30, Cohen's d = -0.35). However, in Study 2 there was statistically significant reduction for the active group (-5.6 ± 8.9 vs 0.9 ± 1.9, p = 0.02, Cohen's d = -0.71). tDCS is a potential treatment for MS-related fatigue.
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Affiliation(s)
- Leigh E Charvet
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Bryan Dobbs
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Michael T Shaw
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City University of New York, New York, NY, USA
| | | | - Lauren B Krupp
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
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Charvet L, Shaw M, Dobbs B, Frontario A, Sherman K, Bikson M, Datta A, Krupp L, Zeinapour E, Kasschau M. Remotely Supervised Transcranial Direct Current Stimulation Increases the Benefit of At-Home Cognitive Training in Multiple Sclerosis. Neuromodulation 2017; 21:383-389. [PMID: 28225155 DOI: 10.1111/ner.12583] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/03/2017] [Accepted: 01/06/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To explore the efficacy of remotely-supervised transcranial direct current stimulation (RS-tDCS) paired with cognitive training (CT) exercise in participants with multiple sclerosis (MS). METHODS In a feasibility study of RS-tDCS in MS, participants completed ten sessions of tDCS paired with CT (1.5 mA × 20 min, dorsolateral prefrontal cortex montage). RS-tDCS participants were compared to a control group of adults with MS who underwent ten 20-min CT sessions through the same remotely supervised procedures. Cognitive outcomes were tested by composite scores measuring change in performance on standard tests (Brief International Cognitive Assessment in MS or BICAMS), basic attention (ANT-I Orienting and Attention Networks, Cogstate Detection), complex attention (ANT-I Executive Network, Cogstate Identification and One-Back), and intra-individual response variability (ANT-I and Cogstate identification; sensitive markers of disease status). RESULTS After ten sessions, the tDCS group (n = 25) compared to the CT only group (n = 20) had significantly greater improvement in complex attention (p = 0.01) and response variability (p = 0.01) composites. The groups did not differ in measures of basic attention (p = 0.95) or standard cognitive measures (p = 0.99). CONCLUSIONS These initial findings indicate benefit for RS-tDCS paired with CT in MS. Exploratory analyses indicate that the earliest tDCS cognitive benefit is seen in complex attention and response variability. Telerehabilitation using RS-tDCS combined with CT may lead to improved outcomes in MS.
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Affiliation(s)
- Leigh Charvet
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Michael Shaw
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Bryan Dobbs
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | | | - Kathleen Sherman
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Marom Bikson
- Engineering Department, City College of New York, New York, NY, USA
| | | | - Lauren Krupp
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Esmail Zeinapour
- Engineering Department, City College of New York, New York, NY, USA
| | - Margaret Kasschau
- School of Health Technology and Management, Stony Brook Medicine, Stony Brook, NY, USA
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Abstract
The epidemiology of multiple sclerosis (MS) includes a consideration of genetic and environmental factors. Comparative studies of different populations have revealed prevalence and incidence rates that vary with geography and ethnicity. With a prevalence ranging from 2 per 100,000 in Japan to greater than 100 per 100,000 in Northern Europe and North America, the burden of MS is similarly unevenly influenced by longevity and comorbid disorders. Well-powered genome-wide association studies have investigated the genetic substrate of MS, providing insight into autoimmune mechanisms involved in the etiopathogenesis of MS and elucidating possible avenues of biological treatment.
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Affiliation(s)
- Jonathan Howard
- Division of Neuroepidemiology, Department of Neurology, Comprehensive Care Center, New York University, New York, NY, USA.
| | - Stephen Trevick
- New York University Langone Medical Center, New York, NY, USA
| | - David S Younger
- Division of Neuroepidemiology, Department of Neurology, New York University School of Medicine, College of Global Public Health, New York University, New York, NY, USA
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Kasschau M, Reisner J, Sherman K, Bikson M, Datta A, Charvet LE. Transcranial Direct Current Stimulation Is Feasible for Remotely Supervised Home Delivery in Multiple Sclerosis. Neuromodulation 2016; 19:824-831. [PMID: 27089545 DOI: 10.1111/ner.12430] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/11/2016] [Accepted: 02/05/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Transcranial direct current stimulation (tDCS) has potential clinical application for symptomatic management in multiple sclerosis (MS). Repeated sessions are necessary in order to adequately evaluate a therapeutic effect. However, it is not feasible for many individuals with MS to visit clinic for treatment on a daily basis, and clinic delivery is also associated with substantial cost. We developed a research protocol to remotely supervise self- or proxy-administration for home delivery of tDCS using specially designed equipment and a telemedicine platform. MATERIALS AND METHODS We targeted ten treatment sessions across two weeks. Twenty participants (n = 20) diagnosed with MS (any subtype), ages 30 to 69 years with a range of disability (Expanded Disability Status Scale or EDSS scores of 1.0 to 8.0) were enrolled to test the feasibility of the remotely supervised protocol. RESULTS Protocol adherence exceeded what has been observed in studies with clinic-based treatment delivery, with all but one participant (95%) completing at least eight of the ten sessions. Across a total of 192 supervised treatment sessions, no session required discontinuation and no adverse events were reported. The most common side effects were itching/tingling at the electrode site. CONCLUSIONS This remotely supervised tDCS protocol provides a method for safe and reliable delivery of tDCS for clinical studies in MS and expands patient access to tDCS.
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Affiliation(s)
- Margaret Kasschau
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Jesse Reisner
- Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | - Kathleen Sherman
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY, USA
| | | | - Leigh E Charvet
- Department of Neurology, New York University School of Medicine, New York, NY, USA
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Bargagli AM, Colais P, Agabiti N, Mayer F, Buttari F, Centonze D, Di Folco M, Filippini G, Francia A, Galgani S, Gasperini C, Giuliani M, Mirabella M, Nociti V, Pozzilli C, Davoli M. Prevalence of multiple sclerosis in the Lazio region, Italy: use of an algorithm based on health information systems. J Neurol 2016; 263:751-9. [PMID: 26886201 PMCID: PMC4826660 DOI: 10.1007/s00415-016-8049-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 11/22/2022]
Abstract
Compared with other areas of the country, very limited data are available on multiple sclerosis (MS) prevalence in Central Italy. We aimed to estimate MS prevalence in the Lazio region and its geographical distribution using regional health information systems (HIS). To identify MS cases we used data from drug prescription, hospital discharge and ticket exemption registries. Crude, age- and gender-specific prevalence estimates on December 31, 2011 were calculated. To compare MS prevalence between different areas within the region, we calculated age- and gender-adjusted prevalence and prevalence ratios using a multivariate Poisson regression model. Crude prevalence rate was 130.5/100,000 (95 % CI 127.5–133.5): 89.7/100,000 for males and 167.9/100,000 for females. The overall prevalence rate standardized to the European Standard Population was 119.6/100,000 (95 % CI 116.8–122.4). We observed significant differences in MS prevalence within the region, with estimates ranging from 96.3 (95 % CI 86.4–107.3) for Latina to 169.6 (95 % CI 147.6–194.9) for Rieti. Most districts close to the coast showed lower prevalence estimates compared to those situated in the eastern mountainous area of the region. In conclusion, this study produced a MS prevalence estimate at regional level using population-based health administrative databases. Our results showed the Lazio region is a high-risk area for MS, although with an uneven geographical distribution. While some limitations must be considered including possible prevalence underestimation, HIS represent a valuable source of information to measure the burden of SM, useful for epidemiological surveillance and healthcare planning.
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Affiliation(s)
- Anna Maria Bargagli
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142, Rome, Italy
| | - Paola Colais
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142, Rome, Italy.
| | - Flavia Mayer
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142, Rome, Italy
| | - Fabio Buttari
- MS Clinical and Research Center, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy.,IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Via Atinense 18, 86077, Pozzilli, Isernia, Italy
| | - Diego Centonze
- MS Clinical and Research Center, Tor Vergata University and Hospital, Via Montpellier 1, 00133, Rome, Italy.,IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Via Atinense 18, 86077, Pozzilli, Isernia, Italy
| | - Marta Di Folco
- Department of Neurology and Psychiatry, Sapienza University, Viale Dell'Università 30, 00185, Rome, Italy
| | - Graziella Filippini
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Besta, Via Celoria 11, 20133, Milan, Italy
| | - Ada Francia
- Department of Neurology and Psychiatry, Sapienza University, Viale Dell'Università 30, 00185, Rome, Italy
| | - Simonetta Galgani
- Department of Neurosciences, S Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
| | - Claudio Gasperini
- Department of Neurosciences, S Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
| | - Manuela Giuliani
- Multiple Sclerosis Center, S Andrea Hospital, Sapienza University, Via di Grottarossa 1037, 00189, Rome, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Viviana Nociti
- Multiple Sclerosis Center, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Institute of Neurorehabilitation, Don C Gnocchi Foundation, Via Pier Alessandro Paravia 71, 20148, Milan, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, S Andrea Hospital, Sapienza University, Via di Grottarossa 1037, 00189, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142, Rome, Italy
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Björkenstam C, Tinghög P, Brenner P, Mittendorfer-Rutz E, Hillert J, Jokinen J, Alexanderson K. Is disability pension a risk indicator for future need of psychiatric healthcare or suicidal behavior among MS patients- a nationwide register study in Sweden? BMC Psychiatry 2015; 15:286. [PMID: 26573305 PMCID: PMC4647565 DOI: 10.1186/s12888-015-0668-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 11/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental disorders and suicidal behavior are common in patients with multiple sclerosis (MS), they also carry a higher risk of disability pension (DP). Our aim was to investigate if DP and other factors are associated with psychiatric disorders and suicidal behavior among MS patients, and whether DP is a stronger risk indicator among certain groups. METHOD A prospective population-based cohort study with six-year follow-up (2005-2010), including 11 346 MS patients who in 2004 were aged 16-64 and lived in Sweden. Incidence rate ratios (IRR) with 95 % confidence intervals (CI) were calculated. RESULTS MS patients on DP had a modestly higher risk of requiring psychiatric healthcare, IRR: 1.36 (95 % CI: 1.18-1.58). MS patients with previous psychiatric healthcare had a higher IRR for both psychiatric healthcare and suicidal behavior; 2.32 (2.18-2.47) and 1.91 (1.59-2.30), respectively. DP moderated the association between sex and psychiatric healthcare, where women on DP displayed higher risk than men, X(2) 4.74 (p = 0.03). CONCLUSION The findings suggest that losing one's role in work life aggravates rather than alleviates the burden of MS, as MS patients on DP seem to have a higher need for psychiatric healthcare, especially among women; which calls for extra awareness among clinicians.
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Affiliation(s)
- Charlotte Björkenstam
- Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | - Petter Tinghög
- Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | - Philip Brenner
- Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | - Jan Hillert
- Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Jussi Jokinen
- Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Kristina Alexanderson
- Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
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12
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Galuppo M, Giacoppo S, De Nicola GR, Iori R, Navarra M, Lombardo GE, Bramanti P, Mazzon E. Antiinflammatory activity of glucomoringin isothiocyanate in a mouse model of experimental autoimmune encephalomyelitis. Fitoterapia 2014; 95:160-74. [PMID: 24685508 DOI: 10.1016/j.fitote.2014.03.018] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/12/2014] [Accepted: 03/22/2014] [Indexed: 12/16/2022]
Abstract
Glucomoringin (4(α-L-rhamnosyloxy)-benzyl glucosinolate) (GMG) is an uncommon member of glucosinolate group belonging to the Moringaceae family, of which Moringa oleifera Lam. is the most widely distributed. Bioactivation of GMG with the enzyme myrosinase forms the corresponding isothiocyanate (4(α-L-rhamnosyloxy)-benzyl isothiocyanate) (GMG-ITC), which can play a key role in antitumoral activity and counteract the inflammatory response. The aim of this study was to assess the effect of GMG-ITC treatment in an experimental mouse model of multiple sclerosis (MS), an inflammatory demyelinating disease with neurodegeneration characterized by demyelinating plaques, neuronal, and axonal loss. For this reason, C57Bl/6 male mice were injected with myelin oligodendrocyte glycoprotein35-55 which is able to evoke an autoimmune response against myelin fibers miming human multiple sclerosis physiopatogenesis. Results clearly showed that the treatment was able to counteract the inflammatory cascade that underlies the processes leading to severe MS. In particular, GMG-ITC was effective against proinflammatory cytokine TNF-α. Oxidative species generation including the influence of iNOS, nitrotyrosine tissue expression and cell apoptotic death pathway was also evaluated resulting in a lower Bax/Bcl-2 unbalance. Taken together, this work adds new interesting properties and applicability of GMG-ITC and this compound can be suggested as a useful drug for the treatment or prevention of MS, at least in association with current conventional therapy.
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Affiliation(s)
- Maria Galuppo
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Provinciale Palermo, contrada Casazza, 98124 Messina, Italy
| | - Sabrina Giacoppo
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Provinciale Palermo, contrada Casazza, 98124 Messina, Italy
| | - Gina Rosalinda De Nicola
- Consiglio per la Ricerca e la sperimentazione in Agricoltura, Centro di Ricerca per le Colture Industriali (CRA-CIN), Via di Corticella 133, 40128 Bologna, Italy
| | - Renato Iori
- Consiglio per la Ricerca e la sperimentazione in Agricoltura, Centro di Ricerca per le Colture Industriali (CRA-CIN), Via di Corticella 133, 40128 Bologna, Italy
| | - Michele Navarra
- Università degli Studi di Messina, Facoltà di Farmacia, Dipartimento di Scienze del farmaco e dei Prodotti per la Salute, Viale Annunziata, 98168 Messina, Italy
| | - Giovanni Enrico Lombardo
- Università degli Studi di Messina, Facoltà di Farmacia, Dipartimento di Scienze del farmaco e dei Prodotti per la Salute, Viale Annunziata, 98168 Messina, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Provinciale Palermo, contrada Casazza, 98124 Messina, Italy
| | - Emanuela Mazzon
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Provinciale Palermo, contrada Casazza, 98124 Messina, Italy.
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Finkelsztejn A, Lopes JS, Noal J, Finkelsztejn JM. The prevalence of multiple sclerosis in Santa Maria, Rio Grande do Sul, Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:104-6. [DOI: 10.1590/0004-282x20130216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 09/17/2013] [Indexed: 11/21/2022]
Abstract
Multiple sclerosis (MS) is one of the leading causes of neurologic deficits in young adults and can lead to physical, intellectual and emotional problems. Approved treatments are expensive and are among the 10 highest budgets of the Brazilian Health Ministry. Given the diverse prevalence of MS among Brazilian regions, it is important to determine prevalence rates across the country. Seven studies have assessed MS in Brazil and reported rates ranging from 15 cases to 18 cases per 100,000 inhabitants. It has been hypothesized that this rate is even higher in southern Brazil, which has a high proportion of European heritage (mostly German and Italian) immigrants. Here, we report that the prevalence of MS in the city of Santa Maria, Rio Grande do Sul, Brazil, is 27.2 cases/100,000 inhabitants.
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Affiliation(s)
- Alessandro Finkelsztejn
- Hospital das Clínicas de Porto Alegre; Regional Center for Drugs Dispensation for Multiple Sclerosis, Brazil
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14
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Incidence and prevalence of multiple sclerosis in Europe: a systematic review. BMC Neurol 2013; 13:128. [PMID: 24070256 PMCID: PMC3856596 DOI: 10.1186/1471-2377-13-128] [Citation(s) in RCA: 317] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 09/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common cause of neurological disability in young adults worldwide and approximately half of those affected are in Europe. The assessment of differential incidence and prevalence across populations can reveal spatial, temporal and demographic patterns which are important for identifying genetic and environmental factors contributing to MS. However, study methodologies vary and the quality of the methods can influence the estimates. This study aimed to systematically review European studies of incidence and prevalence of MS and to provide a quantitative assessment of their methodological quality. METHODS A comprehensive literature search was performed to obtain all original population-based studies of MS incidence and prevalence in European populations conducted and published between January 1985 and January 2011. Only peer-reviewed full-text articles published in English or French were included. All abstracts were screened for eligibility and two trained reviewers abstracted the data and graded the quality of each study using a tool specifically designed for this study. RESULTS There were 123 studies that met the inclusion criteria. The study estimates were highly heterogeneous, even within regions or countries. Quality was generally higher in the more recent studies, which also tended to use current diagnostic criteria. Prevalence and incidence estimates tended to be higher in the more recent studies and were higher in the Nordic countries and in northern regions of the British Isles. With rare exceptions, prevalence and incidence estimates were higher in women with ratios as high as 3:1. Few studies examined ethnicity. Epidemiological data at the national level was uncommon and there were marked geographical disparities in available data, with large areas of Europe unrepresented and other regions well-represented in the literature. Only 37% of the studies provided standardized estimates. CONCLUSIONS Despite the breadth of the literature on the epidemiology of MS in Europe, inter-study comparisons are hampered by the lack of standardization. Further research should focus on regions not yet studied and the evaluation of ethnic differences in MS prevalence and incidence. National-level studies using current diagnostic criteria, validated case definitions and similar age- and sex-standardization would allow better geographical comparisons.
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Alroughani R, Ahmed SF, Behbehani R, Khan R, Thussu A, Alexander KJ, Ashkanani A, Nagarajan V, Al-Hashel J. Increasing prevalence and incidence rates of multiple sclerosis in Kuwait. Mult Scler 2013; 20:543-7. [DOI: 10.1177/1352458513504328] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background: Kuwait was considered as low to intermediate risk area for MS. Objectives: To determine the prevalence and incidence rates of MS among Kuwaiti nationals based on 2011 population census. Methods: This cross-sectional study was conducted between October 2010 and April 2013 using the newly developed national MS registry in Kuwait. Patients with a diagnosis of MS according to 2010 revised McDonald criteria were identified. The crude, age- and sex-specific prevalence and incidence rates among Kuwaiti patients were calculated. Results: 1176 MS patients were identified of which 927 (78.8%) were Kuwaitis and 249 (21.2%) were expatriates. Among Kuwaiti patients, female to male ratio was 1.8:1 with a mean age of 35.40 ± 10.99 years. The prevalence rate of MS was 85.05 per 100,000 persons (95% CI: 82.80 – 87.04). There was a peak in prevalence among patients aged 30–39 years. The incidence of MS was 6.88 per 100,000 persons (95% CI 5.52–8.55). Between 2003 and 2011, the incidence increased 3.22 and 2.54 times in women and men respectively. Conclusion: Kuwait is considered a high-risk area for MS. The significant increase in prevalence and incidence rates may represent a true increase despite the improvement in case ascertainment and case definition.
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Affiliation(s)
- R Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait
- Neurology Clinic, Department of Medicine, Dasman Diabetes Institute, Kuwait
| | - SF Ahmed
- Department of Neurology, Ibn Sina Hospital, Kuwait
- Department of Neurology and Psychiatry, Al-Minia Hospital, Egypt
| | - R Behbehani
- Neurology Clinic, Department of Medicine, Dasman Diabetes Institute, Kuwait
- Department of Ophthalmology, Al-Bahar Eye Center, Kuwait
| | - R Khan
- Department of Neurology, Ibn Sina Hospital, Kuwait
| | - A Thussu
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait
- Neurology Clinic, Department of Medicine, Dasman Diabetes Institute, Kuwait
| | - KJ Alexander
- Department of Neurology, Ibn Sina Hospital, Kuwait
| | - A Ashkanani
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait
| | - V Nagarajan
- Department of Neurology, Ibn Sina Hospital, Kuwait
| | - J Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Kuwait
- Department of Medicine, Kuwait University, Kuwait
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16
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Sharafaddinzadeh N, Moghtaderi A, Majdinasab N, Dahmardeh M, Kashipazha D, Shalbafan B. The influence of ethnicity on the characteristics of multiple sclerosis: A local population study between Persians and Arabs. Clin Neurol Neurosurg 2013; 115:1271-5. [DOI: 10.1016/j.clineuro.2012.11.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 11/19/2012] [Accepted: 11/27/2012] [Indexed: 10/27/2022]
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17
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Tannenbaum C, Gray M, Hoffstetter S, Cardozo L. Comorbidities associated with bladder dysfunction. Int J Clin Pract 2013; 67:105-13. [PMID: 23305472 DOI: 10.1111/ijcp.12085] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- C Tannenbaum
- Faculties of Pharmacy and Medicine, University of Montreal, Montreal, QC, Canada
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18
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Pozuelo-Moyano B, Benito-León J, Mitchell AJ, Hernández-Gallego J. A systematic review of randomized, double-blind, placebo-controlled trials examining the clinical efficacy of vitamin D in multiple sclerosis. Neuroepidemiology 2012; 40:147-53. [PMID: 23257784 DOI: 10.1159/000345122] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 10/03/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND An association between multiple sclerosis (MS) prevalence as well as MS mortality and vitamin D nutrition has led to the hypothesis that high levels of vitamin D could be beneficial for MS. The purpose of this systematic review is to establish whether there is evidence for or against vitamin D in the treatment of MS. METHODS Systematic literature searches were performed to locate randomized, placebo-controlled, double-blind trials measuring the clinical effect of vitamin D on MS in human participants. Data were extracted in a standardized manner, and methodological quality was assessed by the Jadad score. RESULTS Five trials were located that met the selection criteria. Of the 5 trials, 4 showed no effect of vitamin D on any outcome, and 1 showed a significant effect, namely by a reduction in the number of T1 enhancing lesions on brain magnetic resonance imaging. Three studies commented on adverse effects of vitamin D, with gastrointestinal adverse effects being the most frequently reported. The literature is limited by small study sizes (ranging from 23 to 68 patients), heterogeneity of dosing, form of vitamin D tested (vitamin D3 in 4 trials and vitamin D2 in 1) and clinical outcome measures. Therefore, a meta-analysis was not performed. CONCLUSIONS The evidence for vitamin D as a treatment for MS is inconclusive. Larger studies are warranted to assess the effect of vitamin D on clinical outcomes in patients with MS. We further encourage researchers to also test the effect of vitamin D on the health-related quality of life experienced by patients and their families.
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Lourenco P, Shirani A, Saeedi J, Oger J, Schreiber WE, Tremlett H. Oligoclonal bands and cerebrospinal fluid markers in multiple sclerosis: associations with disease course and progression. Mult Scler 2012; 19:577-84. [DOI: 10.1177/1352458512459684] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: The use of oligoclonal bands (OCBs) and cerebrospinal fluid (CSF) parameters are established in the diagnosis of MS, but poorly as markers of disease. Objective: To investigate the role of OCBs in disease course and progression. Methods: CSF data for 1120 patients with MS were analyzed for associations between OCBs and CSF parameters and clinical data (disease course [relapsing-onset MS (ROMS) vs primary-progressive MS (PPMS)]), disability progression (proportion reaching Expanded Disability Status Scale 6 within 10 years of onset and progression index) and ethnicity. Results: Of patients with MS, 72.5% had detectable OCBs. For patients with detectable OCBs, 84.6% had ROMS and 15.4% PPMS versus 89.7% and 10.3%, respectively for those without detectable OCBs ( p=0.04). Total CSF IgG and protein levels were higher in PPMS compared with ROMS ( p<0.001). Disease progression appeared independent of OCB status. Patients with CSF (vs without) data were more likely to be male, older at onset, have PPMS and lack optic neuropathy at onset ( p<0.001). Conclusions: OCB positivity and elevated total CSF IgG and protein were moderately associated with a PPMS disease course, but not disease progression. Patients with atypical clinical presentations were more likely to have had CSF work-up, suggesting a testing bias.
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Affiliation(s)
- Pedro Lourenco
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Afsaneh Shirani
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jameelah Saeedi
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Joel Oger
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - William E Schreiber
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Helen Tremlett
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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20
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Greene DN, Schmidt RL, Wilson AR, Freedman MS, Grenache DG. Cerebrospinal fluid myelin basic protein is frequently ordered but has little value: a test utilization study. Am J Clin Pathol 2012; 138:262-72. [PMID: 22904139 DOI: 10.1309/ajcpcych96qyphjm] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Diagnosis of multiple sclerosis (MS) is facilitated by analyzing biochemical properties of cerebrospinal fluid (CSF). Oligoclonal bands (OCBs) and immunoglobulin G (IgG) index are well-established markers for evaluating patients suspected of having MS. Myelin basic protein (MBP) is also ordered frequently, but its usefulness remains questionable. OCB, IgG index, and MBP were measured in 16,690 consecutive CSF samples. Samples were divided into 2 groups based on MS status known (n = 71) or unknown (n = 16,118). Medical charts of the MS status known group were reviewed to determine their MS status. OCBs have a stronger association to IgG index results than does MBP. Importantly, MBP does not add a statistically significant increase in diagnostic sensitivity or specificity when used in combination with OCB and/or IgG index. The data indicate that MBP is an unnecessary and overused test.
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Affiliation(s)
- Dina N. Greene
- The Permanente Medical Group Regional Laboratories, Berkeley, CA
- Department of Pathology, University of Utah School of Medicine, Salt Lake City
| | - Robert L. Schmidt
- Department of Pathology, University of Utah School of Medicine, Salt Lake City
| | - Andrew R. Wilson
- ARUP Institute for Clinical and Experimental Pathology,Salt Lake City
| | - Mark S. Freedman
- Department of Medicine (Neurology), Multiple Sclerosis Research Clinic, University of Ottawa, Ontario
| | - David G. Grenache
- Department of Pathology, University of Utah School of Medicine, Salt Lake City
- ARUP Institute for Clinical and Experimental Pathology,Salt Lake City
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21
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Moghtaderi A, Rakhshanizadeh F, Shahraki-Ibrahimi S. Incidence and prevalence of multiple sclerosis in southeastern Iran. Clin Neurol Neurosurg 2012; 115:304-8. [PMID: 22717599 DOI: 10.1016/j.clineuro.2012.05.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 05/23/2012] [Accepted: 05/25/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Based on data available, Iran is located in a low risk area for multiple sclerosis (MS). The objective of the current study is to determine the age and sex adjusted prevalence and incidence of MS in southeastern Iran. METHODS This cross-sectional case register study was conducted from January to August 2010. Considering that MS affects people aged between 16 and 50 years, we intended to find the incidence and prevalence of MS during this age range. Since all cases in this area are referred to our university hospital for confirmation of diagnosis, misdiagnosis is rare. Population data, based on the censuses carried out in 1996 and 2006, were obtained from the Iranian Bureau of Statistics to determine the number of people at risk. RESULTS Totally 206 patients were identified according to the McDonald criteria. In 2009 the age-adjusted prevalence and incidence rates of MS for 16-50 year-old adults were 13.96 and 2.67 per 100,000 persons, respectively. Based on those values; the female to male ratio was 2.18. Between 2006 and 2009, the incidence rates increased 2.4 and 2.7 times in women and men, respectively. In 2009, the prevalence rates among the age ranges of <15, 16-35, 36-50 and ≥51 years were 1.44, 14.34, 12.24 and 1.45 per 100,000 persons, respectively, and the relapsing-remitting type of MS was the most prevalent form (65.8%). CONCLUSION According to the Kurtzke geographical distribution, the authors conclude that the prevalence of MS in southeastern Iran is in the intermediate range, and the incidence rate is showing a faster growth rate, compared to previous years.
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Affiliation(s)
- Ali Moghtaderi
- Neurology Department, Zahedan University of Medical Sciences, Zahedan, Iran.
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22
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Lana-Peixoto MA, Frota ERC, Campos GB, Monteiro LP. The prevalence of multiple sclerosis in Belo Horizonte, Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 70:102-7. [DOI: 10.1590/s0004-282x2012000200006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 09/05/2011] [Indexed: 11/22/2022]
Abstract
Investigations on the prevalence rates of multiple sclerosis (MS) around the world have yielded important clues on the interplay between genetic susceptibility and environmental factors. As Brazil is a huge country laid on many latitudes and inhabited by population with distinct ethnic backgrounds, it might be assumed that the frequency of MS varies in its different regions. Objective: To determine the prevalence rate of MS in Belo Horizonte, the capital of the State of Minas Gerais, Southeastern Brazil. Methods: We used six sources to draw up a provisional list of identified cases of MS. Only patients with diagnosis of clinically definite MS according to Poser Committee criteria were included. Results: The calculated crude MS prevalence was 18.1/100,000 inhabitants. Conclusions: The MS prevalence in Belo Horizonte is similar to that found in São Paulo and Botucatu, two other cities in southeastern Brazil with similar ethnic background.
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Christensen S, Farkas DK, Pedersen L, Miret M, Christiansen CF, Sørensen HT. Multiple sclerosis and risk of venous thromboembolism: a population-based cohort study. Neuroepidemiology 2012; 38:76-83. [PMID: 22286104 DOI: 10.1159/000335496] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 11/29/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) patients may be at increased risk of venous thromboembolism (VTE), but evidence is limited. OBJECTIVES To examine long-term risk of VTE among MS patients. PATIENTS AND METHODS We conducted a population-based cohort study among 17,418 Danish MS patients and 87,090 comparison cohort members from the general population. Data on MS, VTE and comorbidities were obtained from the Danish National Registry of Patients including all admissions to Danish hospitals since 1977. We computed cumulative risks for VTE and adjusted incidence rate ratios (IRRs). RESULTS A total of 34 (0.2%) MS patients and 36 (0.04%) comparison cohort members had a deep venous thrombosis (DVT) within 1 year following the date of initial MS diagnosis/index date [adjusted IRR = 3.02 (95% CI: 2.14-4.27)]. During this period, 16 (0.09%) MS patients and 26 (0.03%) comparison cohort members had a documented pulmonary embolism (PE) [adjusted IRR = 2.85 (95% CI: 1.72-4.70)]. During the subsequent up to 29 years, 315 (1.9% of MS patients alive at year 1) MS patients had a record of a DVT [adjusted IRR = 2.28 (95% CI: 2.01-2.59)] and 129 (0.8%) had PE [IRR = 1.58 (95% CI: 1.31-1.92]. CONCLUSION MS is a risk factor for VTE, but the absolute risk is low.
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Affiliation(s)
- Steffen Christensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Abstract
This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is 'The trainee consistently demonstrates a knowledge of management approaches for specific impairments including spasticity, ataxia.'
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Affiliation(s)
- Jon Marsden
- School of Health Professions, Peninsula Allied Health Centre, Derriford Road, University of Plymouth, PL6 8BH, UK.
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25
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Graves J, Balcer LJ. Eye disorders in patients with multiple sclerosis: natural history and management. Clin Ophthalmol 2010; 4:1409-22. [PMID: 21188152 PMCID: PMC3000766 DOI: 10.2147/opth.s6383] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system and leading cause of disability in young adults. Vision impairment is a common component of disability for this population of patients. Injury to the optic nerve, brainstem, and cerebellum leads to characteristic syndromes affecting both the afferent and efferent visual pathways. The objective of this review is to summarize the spectrum of eye disorders in patients with MS, their natural history, and current strategies for diagnosis and management. We emphasize the most common disorders including optic neuritis and internuclear ophthalmoparesis and include new techniques, such as optical coherence tomography, which promise to better our understanding of MS and its effects on the visual system.
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Affiliation(s)
- Jennifer Graves
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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26
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Koch-Henriksen N, Sørensen PS. The changing demographic pattern of multiple sclerosis epidemiology. Lancet Neurol 2010; 9:520-32. [PMID: 20398859 DOI: 10.1016/s1474-4422(10)70064-8] [Citation(s) in RCA: 760] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The uneven distribution of multiple sclerosis (MS) across populations can be attributed to differences in genes and the environment and their interaction. Prevalence and incidence surveys could be affected by inaccuracy of diagnosis and ascertainment, and prevalence also depends on survival. These sources of error might play a part in the geographical and temporal variations. Our literature search and meta-regression analyses indicated an almost universal increase in prevalence and incidence of MS over time; they challenge the well accepted theory of a latitudinal gradient of incidence of MS in Europe and North America, while this gradient is still apparent for Australia and New Zealand; and suggest a general, although not ubiquitous, increase in incidence of MS in females. The latter observation should prompt epidemiological studies to focus on changes in lifestyle in females. New insights into gene-environment and gene-gene interactions complicate interpretations of demographic epidemiology and have made obsolete the idea of simple causative associations between genes or the environment and MS.
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Affiliation(s)
- Nils Koch-Henriksen
- Department of Neurology, Aarhus University Hospital in Aalborg, Aalborg, Denmark.
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27
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Jankovic SM. Injectable interferon beta-1b for the treatment of relapsing forms of multiple sclerosis. J Inflamm Res 2010; 3:25-31. [PMID: 22096354 PMCID: PMC3218739 DOI: 10.2147/jir.s9480] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Multiple sclerosis (MS) is chronic inflammatory and demyelinating disease with either a progressive (10%–15%) or relapsing-remitting (85%–90%) course. The pathological hallmarks of MS are lesions of both white and grey matter in the central nervous system. The onset of the disease is usually around 30 years of age. The patients experience an acute focal neurologic dysfunction which is not characteristic, followed by partial or complete recovery. Acute episodes of neurologic dysfunction with diverse signs and symptoms will then recur throughout the life of a patient, with periods of partial or complete remission and clinical stability in between. Currently, there are several therapeutic options for MS with disease-modifying properties. Immunomodulatory therapy with interferon beta-1b (IFN-β1b) or -1a, glatiramer and natalizumab shows similar efficacy; in a resistant or intolerant patient, the most recently approved therapeutic option is mitoxantrone. IFN-β1b in patients with MS binds to specific receptors on surface of immune cells, changing the expression of several genes and leading to a decrease in quantity of cell-associated adhesion molecules, inhibition of major histocompatibility complex class II expression and reduction in inflammatory cells migration into the central nervous system. After 2 years of treatment, IFN-β1b reduces the risk of development of clinically defined MS from 45% (with placebo) to 28% (with IFN-β1b). It also reduces relapses for 34% (1.31 exacerbations annually with placebo and 0.9 with higher dose of IFN-β1b) and makes 31% more patients relapse-free. In secondary-progressive disease annual rate of progression is 3% lower with IFN-β1b. In recommended doses IFN-β1b causes the following frequent adverse effects: injection site reactions (redness, discoloration, inflammation, pain, necrosis and non-specific reactions), insomnia, influenza-like syndrome, asthenia, headache, myalgia, hypoesthesia, nausea, paresthesia, myasthenia, chills and depression. Efficacy of IFN-β1b in relapsing-remitting MS is higher than that of IFN-β1a, and similar to the efficacy of glatiramer acetate. These facts promote IFN-β1b as one of the most important drugs in the spectrum of immunological therapies for this debilitating disease.
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Affiliation(s)
- Slobodan M Jankovic
- Pharmacology Department, Medical Faculty, University of Kragujevac, Kragujevac, Serbia
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Akcali A, Pehlivan S, Pehlivan M, Sever T, Akgul P, Neyal M. TNF-alpha promoter polymorphisms in multiple sclerosis: no association with -308 and -238 alleles, but the -857 alleles in associated with the disease in Turkish patients. Int J Immunogenet 2010; 37:91-5. [PMID: 20082645 DOI: 10.1111/j.1744-313x.2009.00895.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Dysregulation in the expression of pro- and anti-inflammatory cytokines is one of the milestones in multiple sclerosis (MS) development and progression. Tumour necrosis factor (TNF-alpha), a proinflammatory cytokine is believed to play an important role in MS pathogenesis. The objective of this study is to investigate the association between TNF-alpha promoter region (TNF-alpha-238, -308 and -857) and susceptibility to MS and clinical course of the disease. Eighty-six relapsing remitting MS patients and 150 sex-, age- and ethnic-matched controls were enrolled in the study. Genotyping was performed by PCR-RFLP method. We observed a statistically significant increase in TNF-alpha 857 CC genotype in MS patients than controls (P < 0.001) while TNF-alpha 857 CT genotype showed a significant negative correlation with MS patients (P = 0.033). No differences in the distribution of the TNF-alpha-238 and -308 alleles were observed. None of the three polymorphisms (-238, -308 and -857) did not show relation with disease duration, Expanded Disability Status Scale or age of onset. On the other hand, significant difference of TNF -857 CC genotype was identified with the low disease index (P = 0.025). Although the study group is small, the results indicate that TNF-alpha 857 CC genotype may cause susceptibility to MS in the Turkish population.
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Affiliation(s)
- A Akcali
- Department of Neurology, Gaziantep University School of Medicine, Gaziantep, Turkey.
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Jason LA, Paavola E, Porter N, Morello ML. Frequency and content analysis of chronic fatigue syndrome in medical text books. Aust J Prim Health 2010; 16:174-8. [PMID: 21128580 PMCID: PMC3691015 DOI: 10.1071/py09023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Text books are a cornerstone in the training of medical staff and students, and they are an important source of references and reviews for these professionals. The objective of this study was to determine both the quantity and quality of chronic fatigue syndrome (CFS) information included in medical texts. After reviewing 119 medical text books from various medical specialties, we found that 48 (40.3%) of the medical text books included information on CFS. However, among the 129 527 total pages within these medical text books, the CFS content was presented on only 116.3 (0.090%) pages. Other illnesses that are less prevalent, such as multiple sclerosis and Lyme disease, were more frequently represented in medical text books. These findings suggest that the topic ofCFS is underreported in published medical text books.
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Affiliation(s)
- Leonard A Jason
- DePaul University, Center for Community Research, 990 W. Fullerton Avenue, Suite 3100, Chicago, IL 60614, USA.
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Petzold A. Isolated, relapsing and progressive demyelinating diseases of the central nervous system. J Neurol 2009; 255 Suppl 6:69-76. [PMID: 19300963 DOI: 10.1007/s00415-008-6013-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Many patients ask, "Can I get this again?" (a relapse) and "How bad is it? Will I end up in a wheelchair?" (severity/progression). These two questions guide this brief review of the clinical spectrum of demyelinating diseases of the central nervous system.
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Affiliation(s)
- Axel Petzold
- The Department of Neuroimmunology, Institute of Neurology, University College London (UCL), Queen Square, London, WC1N 3BG, UK.
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Siritho S, Freedman MS. The prognostic significance of cerebrospinal fluid in multiple sclerosis. J Neurol Sci 2009; 279:21-5. [PMID: 19181345 DOI: 10.1016/j.jns.2008.12.029] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 12/22/2008] [Accepted: 12/23/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) patients lacking CSF oligoclonal bands are purported to have a milder course of disease. We reviewed the natural history of oligoclonal band (OCB) - negative (OCB-) compared to OCB positive (OCB+) patients. METHOD A retrospective study of 451 MS patients. RESULTS Only 48/451 patients (10.6%) were CSF OCB-. The mean age at onset was 37.1+/-8.8 years with female:male ratio=2. First CNS location presentation was less well defined in OCB- vs. OCB+ patients with significantly more supratentorial presentation. The clinical course of OCB- vs OCB+ was somewhat different; 22.9 vs 15.1% PPMS; 18.8 vs 12.4% SPMS; and 56.3 vs 71% RRMS, respectively. There were significantly fewer WBC, less IgG and a lower IgG index in OCB- cases. Fewer OCB- cases fulfilled McDonald MRI criteria. There were no discernable differences in disease severity between the two groups as determined by the EDSS, progression index, MSSS, number of relapses or annualized relapse rate. CONCLUSION The presence of OCB correlates better with other indications of acute inflammatory MS, especially an RR course. This study suggests that the simple lack of OCB positivity does not necessarily insure a more benign disease course.
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Affiliation(s)
- Sasitorn Siritho
- The Ottawa Hospital, General Campus, 4th Floor, Multiple Sclerosis Research Unit, Ottawa, ON, Canada
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