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Proteomics in Multiple Sclerosis: The Perspective of the Clinician. Int J Mol Sci 2022; 23:ijms23095162. [PMID: 35563559 PMCID: PMC9100097 DOI: 10.3390/ijms23095162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 02/08/2023] Open
Abstract
Multiple sclerosis (MS) is the inflammatory demyelinating and neurodegenerative disease of the central nervous system (CNS) that affects approximately 2.8 million people worldwide. In the last decade, a new era was heralded in by a new phenotypic classification, a new diagnostic protocol and the first ever therapeutic guideline, making personalized medicine the aim of MS management. However, despite this great evolution, there are still many aspects of the disease that are unknown and need to be further researched. A hallmark of these research are molecular biomarkers that could help in the diagnosis, differential diagnosis, therapy and prognosis of the disease. Proteomics, a rapidly evolving discipline of molecular biology may fulfill this dire need for the discovery of molecular biomarkers. In this review, we aimed to give a comprehensive summary on the utility of proteomics in the field of MS research. We reviewed the published results of the method in case of the pathogenesis of the disease and for biomarkers of diagnosis, differential diagnosis, conversion of disease courses, disease activity, progression and immunological therapy. We found proteomics to be a highly effective emerging tool that has been providing important findings in the research of MS.
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Tauil CB, da Rocha Lima AD, Ferrari BB, da Silva VA, Moraes AS, da Silva FM, Melo-Silva CA, Farias AS, Brandão CO, Leonilda MD, dos Santos-Neto LL. Depression and anxiety in patients with multiple sclerosis treated with interferon-beta or fingolimod: Role of indoleamine 2,3-dioxygenase and pro-inflammatory cytokines. Brain Behav Immun Health 2020; 9:100162. [PMID: 34589900 PMCID: PMC8474597 DOI: 10.1016/j.bbih.2020.100162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 01/25/2023] Open
Abstract
Depression/anxiety (D/A) occurs in up to 50% of multiple sclerosis (MS) patients. Proinflammatory cytokines induce classical symptoms of depression. Activation of the inflammatory response also triggers production of indoleamine 2,3-dioxygenase (IDO), which catabolizes tryptophan, the amino acid precursor of serotonin and melatonin. It has been suggested that IDO is the link between the immune and serotonergic systems. This study aimed to quantify the levels of IDO and pro-inflammatory and anti-inflammatory cytokines in patients with MS and depression, according to treatment with interferon-beta (IFN-β) or fingolimod. The study inclusion criteria were age 18-60 years and a clinical and radiological diagnosis of MS. One hundred and thirty-two patients diagnosed by McDonald's criteria and followed up at Brasília District Hospital, Brazil, with relapsing-remitting MS were identified as potential study participants. Thirty-five of these patients were identified to be receiving treatment with fingolimod or IFN-β and to have a diagnosis of D/A. IDO and pro-inflammatory and anti-inflammatory cytokine levels were compared between these 35 patients and 18 healthy controls. The level of IL-10 (an anti-inflammatory cytokine) was lower in both the fingolimod-treated (P < 0.001) and IFN-β-treated (P < 0.01) patient groups than in the control group. IFN-β-treated patients showed increased IDO expression and decreased inflammatory cytokine levels. In contrast, fingolimod-treated patients showed significantly decreased expression of IDO and significantly increased levels of proinflammatory cytokines produced by innate immune cells, including tumor necrosis factor-alpha and interleukin-6. The agents used to treat MS maintain symptoms of D/A in patients with MS via different mechanisms.
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Affiliation(s)
- Carlos B. Tauil
- Department of Medical Sciences, University of Brasília, Brazil
| | - Amanda D. da Rocha Lima
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology and Immunology, Biology Institute, University of Campinas, Brazil
| | - Breno B. Ferrari
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology and Immunology, Biology Institute, University of Campinas, Brazil
| | - Verônica A.G. da Silva
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology and Immunology, Biology Institute, University of Campinas, Brazil
| | - Adriel S. Moraes
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology and Immunology, Biology Institute, University of Campinas, Brazil
| | | | | | - Alessandro S. Farias
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology and Immunology, Biology Institute, University of Campinas, Brazil
- National Institute of Science and Technology on Neuroimmunomodulation (INCT-NIM), CNPq, Brazil
| | - Carlos O. Brandão
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology and Immunology, Biology Institute, University of Campinas, Brazil
| | - M.B. dosSantos Leonilda
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology and Immunology, Biology Institute, University of Campinas, Brazil
- National Institute of Science and Technology on Neuroimmunomodulation (INCT-NIM), CNPq, Brazil
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Biernacki T, Sandi D, Fricska-Nagy Z, Kincses ZT, Füvesi J, Laczkó R, Kokas Z, Klivényi P, Vécsei L, Bencsik K. Epidemiology of multiple sclerosis in Central Europe, update from Hungary. Brain Behav 2020; 10:e01598. [PMID: 32196981 PMCID: PMC7218241 DOI: 10.1002/brb3.1598] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/25/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Not so long ago, a novel phenotypic classification of multiple sclerosis (MS) and revisions to the McDonald diagnostic criteria were published. Good quality, standardized, and therefore comparable epidemiological data from the Central European region altogether are scarce, and data based on the aforementioned criteria are nonexistent; thus, an update is needed. MATERIALS AND METHODS Patients residing in Csongrád county with a definitive diagnosis of MS according to the 2017 McDonald criteria were included and evaluated by the 2014 revised phenotypic classification. RESULTS A total of 420 patients were included, of whom 313 were females (female/male ratio 2.925:1). Standardized prevalence was 101.8/100,000, and incidence was 4.44/100,000. Relapsing-remitting disease type was identified in 288 (68.57%) cases, of which 230 patients (79.86%) were treated and of which 202 patients (87.8%) showed no disease activity with their current treatment. Progressive disease type was seen in 132 (31.43%) cases, with 72 patients (54.54%) receiving treatment. More than half of the treated patients (178, 57%) were administered platform therapies, while 134 (43%) received highly active disease modifying therapies. CONCLUSION The prevalence of MS in Hungary similarly to other countries shows a constant increase in the past decades. The majority of our patients received treatment and had a stable disease while being treated. The distribution of disease courses, phenotypes, and treatment status fell in line with data in the literature based on MS registries with a large number of participants. Ours is the first study to give epidemiological data based on the most recent McDonald criteria and phenotypic classification from the Central European region.
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Affiliation(s)
- Tamás Biernacki
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Dániel Sandi
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Zsanett Fricska-Nagy
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Judit Füvesi
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Rózsa Laczkó
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Zsófia Kokas
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary.,MTA - SZTE Neuroscience Research Group, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
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GÖKÇE ŞF, ÇİĞDEM B, NEMMEZİ KARACA S, BOLAYIR A, KAYIM YILDIZ Ö, TOPAKTAŞ AS, BALABAN H. Prevalence of multiple sclerosis in an urban population of Sivas province in Turkey. Turk J Med Sci 2019; 49:288-294. [PMID: 30761870 PMCID: PMC7350802 DOI: 10.3906/sag-1808-112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background/aim Multiple sclerosis (MS) is a common neurological disorder that can be a leading cause of nontraumatic disability in several countries. Recent reports have indicated a moderate to high risk of MS in European countries. In this study, we examined the prevalence of MS in a well-defined urban population of provincial center in Sivas Province in Turkey. Materials and methods This study sampled all registered residents of urban areas of provincial center in Sivas Province in April 2017 and 2018 January. All the included patients met the McDonald 2010 criteria. Medical records were reviewed, including all available previously acquired magnetic resonance imaging data. All patients were subsequently subjected to neurologic examination to confirm the MS diagnosis. Results We identified 21 possible MS patients, with MS diagnosis confirmed in 19. The prevalence of MS was 288 per 100,000 inhabitants. Conclusion For future studies, these high ratio results can be used in regional and national comparisons to determine cofactors contributing to the high prevalence of MS in our region and can help health-decision makers to better plan healthcare policies to improve neurological services and awareness about multifaceted clinical presentations of MS.
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Affiliation(s)
- Şeyda Figül GÖKÇE
- Department of Neurology, Faculty of Medicine, Cumhuriyet University, SivasTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Burhanettin ÇİĞDEM
- Department of Neurology, Faculty of Medicine, Cumhuriyet University, SivasTurkey
| | - Sanem NEMMEZİ KARACA
- Department of Family Medicine, Faculty of Medicine, Cumhuriyet University, SivasTurkey
| | - Aslı BOLAYIR
- Department of Neurology, Faculty of Medicine, Cumhuriyet University, SivasTurkey
| | - Özlem KAYIM YILDIZ
- Department of Neurology, Faculty of Medicine, Cumhuriyet University, SivasTurkey
| | - Ahmet Suat TOPAKTAŞ
- Department of Neurology, Faculty of Medicine, Cumhuriyet University, SivasTurkey
| | - Hatice BALABAN
- Department of Neurology, Sivas Medicana Hospital, SivasTurkey
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Multiple sclerosis in the Republic of San Marino, Italian peninsula: an incidence and prevalence study from a high-risk area. Neurol Sci 2018; 39:1231-1236. [PMID: 29671168 DOI: 10.1007/s10072-018-3402-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 03/30/2018] [Indexed: 10/17/2022]
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Polat C, Tülek Z, Kürtüncü M, Eraksoy M. Validity and Reliability of the Turkish Version of the Monitoring My Multiple Sclerosis Scale. Noro Psikiyatr Ars 2017; 54:131-136. [PMID: 28680310 DOI: 10.5152/npa.2016.12694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/20/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This research was conducted to adapt the Monitoring My Multiple Sclerosis (MMMS) scale, which is a scale used for self-evaluation by multiple sclerosis (MS) patients of their own health and quality of life, to Turkish and to determine the psychometric properties of the scale. METHODS The methodological research was conducted in the outpatient MS clinic of a university hospital between January and September 2013. The sample in this study consisted of 140 patients aged above 18 who had a diagnosis of definite MS. Patients who experienced attacks in the previous month or had any serious medical problems other than MS were not included in the group. The linguistic validity of MMMS was tested by a backward-forward translation method and an expert panel. Reliability analysis was performed using test-retest correlations, item-total correlations, and internal consistency analysis. Confirmatory factor analysis and concurrent validity were used to determine the construct validity. The Multiple Sclerosis Quality of Life-54 instrument was used to determine concurrent validity and the Expanded Disability Status Scale, Hospital Anxiety and Depression Scale, and Mini Mental State Examination were used for further determination of the construct validity. RESULTS We determined that the scale consisted of four factors with loadings ranging from 0.49 to 0.79. The correlation coefficients of the scale were determined to be between 0.47 and 0.76 for item-total score and between 0.60 and 0.81 for items and subscale scores. Cronbach's alpha coefficient was determined to be 0.94 for the entire scale and between 0.64 and 0.89 for the subscales. Test-retest correlations were significant. Correlations between MMMS and other scales were also found to be significant. CONCLUSION The Turkish MMMS provides adequate validity and reliability for assessing the impact of MS on quality of life and health status in patients.
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Affiliation(s)
- Cansu Polat
- İstanbul University Florence Nightingale Faculty of Nursing, İstanbul, Turkey
| | - Zeliha Tülek
- İstanbul University Florence Nightingale Faculty of Nursing, İstanbul, Turkey
| | - Murat Kürtüncü
- Department of Neurology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Mefkure Eraksoy
- Department of Neurology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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Motl RW, Pilutti LA. Is physical exercise a multiple sclerosis disease modifying treatment? Expert Rev Neurother 2016; 16:951-60. [DOI: 10.1080/14737175.2016.1193008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Motl RW, Sandroff BM, DeLuca J. Exercise Training and Cognitive Rehabilitation. Neurorehabil Neural Repair 2015; 30:499-511. [DOI: 10.1177/1545968315606993] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current review develops a rationale and framework for examining the independent and combined effects of exercise training and cognitive rehabilitation on walking and cognitive functions in persons with multiple sclerosis (MS). To do so, we first review evidence for improvements in walking and cognitive outcomes with exercise training and cognitive rehabilitation in MS. We then review evidence regarding cognitive–motor coupling and possible cross-modality transfer effects of exercise training and cognitive rehabilitation. We lastly present a macro-level framework for considering mechanisms that might explain improvements in walking and cognitive dysfunction with exercise and cognitive rehabilitation individually and combined in MS. We conclude that researchers should consider examining the effects of exercise training and cognitive rehabilitation on walking, cognition, and cognitive–motor interactions in MS and the possible physiological and central mechanisms for improving these functions.
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Affiliation(s)
- Robert W. Motl
- University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA
- Rutgers, New Jersey Medical School, Newark, NJ, USA
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Przybek J, Gniatkowska I, Mirowska-Guzel D, Członkowska A. Evolution of diagnostic criteria for multiple sclerosis. Neurol Neurochir Pol 2015; 49:313-21. [DOI: 10.1016/j.pjnns.2015.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 07/19/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022]
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Motl RW, Learmonth YC, Pilutti LA, Gappmaier E, Coote S. Top 10 research questions related to physical activity and multiple sclerosis. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2015; 86:117-129. [PMID: 25874730 DOI: 10.1080/02701367.2015.1023099] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
An estimated 2.5 million people worldwide are living with multiple sclerosis (MS), and this disease may be increasing in prevalence. MS is a disease of the central nervous system that is associated with heterogeneous symptoms and functional consequences, and the current first-line disease-modifying therapies often become ineffective later in the disease. There is increasing evidence for the benefits of physical activity (PA) in people with MS, but this population is generally physically inactive and sedentary. We proposed 10 research questions to guide future research on PA and MS: (1) Is PA an MS disease-modifying behavior? (2) What are the benefits of PA among people with MS? (3) What is the optimal PA prescription for people with MS? (4) What are the safety issues with PA in people with MS? (5) What characteristics of people with MS modify the benefits of PA? (6) What variables explain participation in PA among people with MS? (7) What are effective behavioral interventions for PA change in people with MS? (8) How do we translate PA research into clinical MS practice? (9) What is the role of sedentary behavior in people with MS? And (10) what is the optimal measurement of PA in people with MS? These questions are critical for informing our understanding of the short- and long-term consequences of PA in MS as well as for identifying approaches for promoting and sustaining PA in MS. Addressing these questions may greatly improve the lives of people with this chronic disease.
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Motl RW. Benefits, safety, and prescription of exercise in persons with multiple sclerosis. Expert Rev Neurother 2014; 14:1429-36. [DOI: 10.1586/14737175.2014.983904] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Lizán L, Comellas M, Paz S, Poveda JL, Meletiche DM, Polanco C. Treatment adherence and other patient-reported outcomes as cost determinants in multiple sclerosis: a review of the literature. Patient Prefer Adherence 2014; 8:1653-64. [PMID: 25525341 PMCID: PMC4262214 DOI: 10.2147/ppa.s67253] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Treatment adherence is one of the key factors for achieving optimal clinical outcomes. In order to assess costs related to adherence to, and persistence and compliance with, disease-modifying therapies (DMTs) in patients with multiple sclerosis (MS), a narrative review of the literature was performed. Satisfaction with and preference for DMTs and their delivery devices were also assessed, as both can have an influence on patients' adherence and persistence. METHODS Electronic databases (MEDLINE, PubMed, Google Scholar, congress proceedings) were searched to identify publications analyzing MS costs related to adherence, persistence, satisfaction, and preferences for MS treatments. Bibliographic references were hand searched. English or Spanish studies published between January 2007 and January 2013 were selected. RESULTS A total of 398 titles were identified, of which 12 met the inclusion criteria. Six studies evaluated the impact of adherence, persistence, and compliance on treatment costs; four publications analyzed satisfaction with DMTs; and two assessed treatment preferences based on attributes of the delivery device. Increased adherence and persistence were associated with better clinical outcomes, leading to lower relapse risk (odds ratio [OR]: 0.71; 95% confidence interval [CI]: 0.59-0.85) and a decrease in health care resource use, such as MS-related hospitalizations (OR: 0.63; 95% CI: 0.47-0.83) and emergency department visits (OR: 0.80; 95% CI: 0.60-1.07). This reduction in resource use led to a patient/year total cost reduction (excluding DMT costs) of up to 22%. CONCLUSION This review highlights the importance of ensuring adequate adherence in MS patients through treatments and devices better tailored to patients' needs that could enhance clinical outcomes and reduce MS costs. Understanding the factors underlying satisfaction and compliance with treatment and patients' preference for certain therapies could help in the development of strategies that can improve adherence.
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Affiliation(s)
| | | | | | | | | | - Carlos Polanco
- Merck S.L., Madrid, Spain
- Correspondence: Carlos Polanco, Corporate Affairs, Merck SL, María de Molina, 40, 28006 Madrid, Spain, Tel +34 917 453 158, Fax +34 917 454 444, Email
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Raimundo K, Tian H, Zhou H, Zhang X, Kahler KH, Agashivala N, Kim E. Resource utilization, costs and treatment patterns of switching and discontinuing treatment of MS patients with high relapse activity. BMC Health Serv Res 2013; 13:131. [PMID: 23565628 PMCID: PMC3626727 DOI: 10.1186/1472-6963-13-131] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 04/04/2013] [Indexed: 11/10/2022] Open
Abstract
Background Multiple sclerosis (MS) is a chronic disease that affects mainly adults in the prime of their lives. However, few studies report the impact of high annual relapse rates on outcomes. The purpose of this study was to identify high relapse activity (HRA) in patients with MS, comparing differences in outcomes between patients with and without HRA. Methods A retrospective longitudinal study was conducted using the MarketScan® Commercial Claims and Encounters and Medicare Supplemental Database. Patients had to have at least one ICD-9 for MS (340.XX) in 2009 and one in 2008, be older than 18 years, and have continuous enrolment in the years 2009–2010. HRA was defined as having ≥2 relapses in 2009. Multivariate analyses compared all-cause and MS-specific emergency room (ER) visits, hospitalizations, and all-cause costs, excluding disease modifying therapy (DMT) costs, in 2010 between patients with and without HRA, controlling for baseline characteristics. A subgroup analysis using treatment exposure was also performed. Results 19,219 patients were included: 5.3% (n=1,017) had ≥2 relapses in 2009. Patients with HRA were more likely to have all-cause and MS-specific resource utilization than patients without HRA. Mean total all-cause non DMT costs were $12,057 higher for the HRA group. In the subgroup analysis, HRA treatment-naïve patients were more likely to start treatment, and HRA treatment-experienced patients were more likely to discontinue or switch index DMT (P<0.01). Conclusions Patients with ≥2 relapses annually have higher resource utilization and costs. The difference in cost was over twice as large in treatment-naïve patients versus treatment-experienced patients. HRA was also associated with an increased likelihood of starting DMT treatment (treatment-naïve patients), and switching or discontinuing DMT therapy (treatment-experienced patients).
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Affiliation(s)
- Karina Raimundo
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936-1080, USA.
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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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Labiano-Fontcuberta A, Benito-León J. Understanding tremor in multiple sclerosis: prevalence, pathological anatomy, and pharmacological and surgical approaches to treatment. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2012; 2. [PMID: 23439953 PMCID: PMC3500135 DOI: 10.7916/d8z60mr3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 07/06/2012] [Indexed: 12/01/2022]
Abstract
Background Given that tremor is one of the most prevalent and disabling features of multiple sclerosis (MS), we will review the most significant milestones in tremor in this disease in recent years, focusing on prevalence, clinical features, anatomical basis, and treatment. Methods Data for this review were identified by searching MEDLINE with the search terms “multiple sclerosis” and “tremor”. References were also identified from relevant articles published between January 1966 and May 2012. Results The predominant type of MS tremor is a large-amplitude, postural, and kinetic tremor, which most commonly affects the arms, although tremor can also involve head, neck, vocal cords, and trunk. Involvement of the tongue, jaw, or palate has not been reported. Although the anatomical basis underlying tremor in MS is poorly understood, the link between the cerebellum and the MS-related tremor is supported by clinical and experimental studies. Currently available medication is often unsuccessful in most cases. Surgical treatment can be a satisfactory alternative to treat severe and disabling tremor. Discussion Tremor in MS patients could be considered as an advanced consequence of the disease and its presence suggests a more aggressive course. MS tremor can be severe and very disabling for a small group of patients. Treatment of MS tremor remains a great challenge. Recent studies suggest that dissociating tremor from cerebellar dysfunction using selected clinical tests would be the key issue to successful surgical treatment. Understanding the pathophysiology and biochemistry of tremor production in MS may lead to new therapeutic approaches.
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Affiliation(s)
- Andrés Labiano-Fontcuberta
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain ; Department of Medicine, Complutense University, Madrid, Spain
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