1
|
Sacco R, Riccitelli GC, Disanto G, Bogousslavsky J, Cavelti A, Czell D, Kamm CP, Kliesch U, Ramseier SP, Gobbi C, Zecca C. Effectiveness, Safety and Patients' Satisfaction of Nabiximols (Sativex ®) on Multiple Sclerosis Spasticity and Related Symptoms in a Swiss Multicenter Study. J Clin Med 2024; 13:2907. [PMID: 38792448 PMCID: PMC11122311 DOI: 10.3390/jcm13102907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Cannabinoid oro-mucosal spray nabiximols is approved for patients with moderate to severe multiple sclerosis spasticity (MSS) resistant to other antispastic medications. Few real-world data are available on the effectiveness, safety and patients' satisfaction in MS patients treated with nabiximols as monotherapy. Methods: To investigate the effectiveness, tolerability and satisfaction of nabiximols in a real-life multicentric Swiss cohort as monotherapy or with stable doses of other antispastic medications, and explore clinical features which may predict treatment response. The following data were collected at treatment start (baseline) and 12 weeks thereafter: Modified Ashworth scale (MAS), scores at numerical rating scales ranging from 0 (absent) to 10 (considerable) for effect on spasticity (sNRS), pain (pNRS), gait (gNRS), urinary symptoms (uNRS), tolerability (tNRS) as assessed by the treating neurologist, and overall treatment satisfaction (TsNRS) and tolerability (tNRS) as assessed by the patient. Results: Ninety-five patients (44 relapsing remitting, 37 secondary progressive and 14 primary progressive MS; median age = 53 (IQR 45-62); female 70%; median EDSS 6 (IQR 4-6), concomitant antispastic treatments in 54% of patients) were included. From baseline to week 12, median MAS score decreased from 3.0 to 2.0 (p < 0.001). Median scores of the each NRS also significantly decreased (p < 0.001 for all comparisons). At week 12, the median TsNRS and tTS scores were 8/10 (IQR: 6-9) and 9/10 (IQR: 7-10), respectively, and 93.7% of patients continued to use nabiximols at the average dose of six sprays/day. No clinical factors, including use of nabiximols as add on vs. monotherapy, were associated with responder status. Conclusions: Our first Swiss, multicentric, observational, real-life study supports and enhances previous finding of nabiximols as monotherapy and as add-on therapy, being an effective, safe and well-tolerated treatment option for resistant MS spasticity and spasticity-related symptoms (pain, bladder dysfunction and gait).
Collapse
Affiliation(s)
- Rosaria Sacco
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland; (R.S.); (G.C.R.); (G.D.); (C.G.)
| | - Gianna Carla Riccitelli
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland; (R.S.); (G.C.R.); (G.D.); (C.G.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Giulio Disanto
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland; (R.S.); (G.C.R.); (G.D.); (C.G.)
| | - Julien Bogousslavsky
- Neurocenter, Swiss Medical Network, Clinique Valmont, 1823 Montreux, Switzerland;
| | | | - David Czell
- NeuroMedics, Praxis Neurologie Uster, 8610 Uster, Switzerland;
| | | | - Uta Kliesch
- Neurologische Praxis Schwyz—Zug, 6430 Schwyz, Switzerland;
| | | | - Claudio Gobbi
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland; (R.S.); (G.C.R.); (G.D.); (C.G.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Chiara Zecca
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland; (R.S.); (G.C.R.); (G.D.); (C.G.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| |
Collapse
|
2
|
De Mase A, Spina E, Servillo G, Barbato S, Leone G, Giordano F, Muto M, Guarnieri G, Alfieri G, Longo K, Di Iorio W, Muto M, Candelaresi P, Andreone V. Effects of immediate thrombolytic treatment in imaging area on functional outcome in patients with acute ischemic stroke. Neurol Sci 2024; 45:1557-1563. [PMID: 37926747 DOI: 10.1007/s10072-023-07166-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Door-to-needle time (DNT) is an established predictor of outcome in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). Several strategies have been proposed to streamline in-hospital pathways, among which treatment at CT/MR bed. AIM To explore the impact of treatment at CT/MR bed, here defined as imaging area (IA), on functional outcome in stroke patients treated with IVT alone. METHODS All AIS patients treated with IVT alone at our center in 2020, 2021, and 2022 were included. Patients with any previous disability were excluded. The cohort was divided into two groups, depending on the treatment site. One group received IVT at IA, the other at emergency room or stroke unit (non-IA). Regression analysis assessed the association between treatment site and 3-month outcome. RESULTS A total of 327 patients who received IVT alone were included in the analysis. One hundred thirty-three (40.7%) were in the IA group and 194 (59.3%) in the non-IA group. The groups showed similar baseline characteristics. In the IA group, DNT was 45 min shorter. Despite similar rates of functional independence (mRS 0-2), the IA group showed higher rates of excellent outcome (mRS 0-1) compared to the non-IA group (60.1% vs 42.8%, p<0.01). Immediate treatment at IA was independently associated to excellent outcome (OR 1.78 [1.03-3.08]). CONCLUSIONS Thrombolytic treatment at IA lowers DNT and is an independent predictor of excellent outcome after AIS. Our study emphasizes the importance of immediate thrombolytic treatment at IA, soon after radiological eligibility is confirmed. Immediate treatment at IA should be a standard-of-care for AIS.
Collapse
Affiliation(s)
- Antonio De Mase
- Neurology and Stroke Unit, A.O.R.N. Cardarelli, Via Cardarelli 9, 80131, Napoli, Italy
| | - Emanuele Spina
- Neurology and Stroke Unit, A.O.R.N. Cardarelli, Via Cardarelli 9, 80131, Napoli, Italy
| | - Giovanna Servillo
- Neurology and Stroke Unit, A.O.R.N. Cardarelli, Via Cardarelli 9, 80131, Napoli, Italy
| | - Stefano Barbato
- Neurology and Stroke Unit, A.O.R.N. Cardarelli, Via Cardarelli 9, 80131, Napoli, Italy
| | - Giuseppe Leone
- Diagnostic and Interventional Neuroradiology, A.O.R.N. Cardarelli, Naples, Italy
| | - Flavio Giordano
- Diagnostic and Interventional Neuroradiology, A.O.R.N. Cardarelli, Naples, Italy
| | - Massimo Muto
- Diagnostic and Interventional Neuroradiology, A.O.R.N. Cardarelli, Naples, Italy
| | - Gianluigi Guarnieri
- Diagnostic and Interventional Neuroradiology, A.O.R.N. Cardarelli, Naples, Italy
| | - Gennaro Alfieri
- Neurology and Stroke Unit, A.O.R.N. Cardarelli, Via Cardarelli 9, 80131, Napoli, Italy
| | - Katia Longo
- Neurology and Stroke Unit, A.O.R.N. Cardarelli, Via Cardarelli 9, 80131, Napoli, Italy
| | - Walter Di Iorio
- Neurology and Stroke Unit, A.O.R.N. Cardarelli, Via Cardarelli 9, 80131, Napoli, Italy
| | - Mario Muto
- Diagnostic and Interventional Neuroradiology, A.O.R.N. Cardarelli, Naples, Italy
| | - Paolo Candelaresi
- Neurology and Stroke Unit, A.O.R.N. Cardarelli, Via Cardarelli 9, 80131, Napoli, Italy.
| | - Vincenzo Andreone
- Neurology and Stroke Unit, A.O.R.N. Cardarelli, Via Cardarelli 9, 80131, Napoli, Italy
| |
Collapse
|
3
|
Llufriu S, Agüera E, Costa-Frossard L, Galán V, Landete L, Lourido D, Meca-Lallana JE, Moral E, Bravo-Rodríguez F, Koren L, Labiano A, León A, Martín P, Monedero MD, Requeni L, Zubizarreta I, Rovira À. Recommendations for the coordination of Neurology and Neuroradiology Departments in the management of patients with multiple sclerosis. Neurologia 2023; 38:453-462. [PMID: 37120107 DOI: 10.1016/j.nrleng.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/01/2021] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is widely used for the diagnosis and follow-up of patients with multiple sclerosis (MS). Coordination between neurology and neuroradiology departments is crucial for performing and interpreting radiological studies as efficiently and as accurately as possible. However, improvements can be made in the communication between these departments in many Spanish hospitals. METHODS A panel of 17 neurologists and neuroradiologists from 8 Spanish hospitals held in-person and online meetings to draft a series of good practice guidelines for the coordinated management of MS. The drafting process included 4 phases: 1) establishing the scope of the guidelines and the methodology of the study; 2) literature review on good practices or recommendations on the use of MRI in MS; 3) discussion and consensus between experts; and 4) validation of the contents. RESULTS The expert panel agreed a total of 9 recommendations for improving coordination between neurology and neuroradiology departments. The recommendations revolve around 4 main pillars: 1) standardising the process for requesting and scheduling MRI studies and reports; 2) designing common protocols for MRI studies; 3) establishing multidisciplinary committees and coordination meetings; and 4) creating formal communication channels between both departments. CONCLUSIONS These consensus recommendations are intended to optimise coordination between neurologists and neuroradiologists, with the ultimate goal of improving the diagnosis and follow-up of patients with MS.
Collapse
Affiliation(s)
- S Llufriu
- Servicio de Neurología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - E Agüera
- Servicio de Neurología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - L Costa-Frossard
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - V Galán
- Servicio de Neurología, Hospital Virgen de la Salud, Toledo, Spain
| | - L Landete
- Servicio de Neurología, Hospital Universitario Dr. Peset, Valencia, Spain
| | - D Lourido
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J E Meca-Lallana
- CSUR Esclerosis Múltiple y Unidad de Neuroinmunología Clínica, Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - E Moral
- Servicio de Neurología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - F Bravo-Rodríguez
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - L Koren
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Labiano
- Servicio de Neurología, Hospital Virgen de la Salud, Toledo, Spain
| | - A León
- Sección de Neurorradiología, Servicio de Radiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - P Martín
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M D Monedero
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Dr. Peset, Valencia, Spain
| | - L Requeni
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Dr. Peset, Valencia, Spain
| | - I Zubizarreta
- Servicio de Neurología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - À Rovira
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
4
|
Smith KA, Piehl F, Olsson T, Alfredsson L, Hillert J, Kockum I, Stridh P, Montgomery S. Spasticity treatment patterns among people with multiple sclerosis: a Swedish cohort study. J Neurol Neurosurg Psychiatry 2022; 94:337-348. [PMID: 36539267 PMCID: PMC10176386 DOI: 10.1136/jnnp-2022-329886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Spasticity is common among people with multiple sclerosis (MS), but there are few studies of spasticity treatment patterns. We aim to describe associations with spasticity treatment measured primarily by oral baclofen use. METHODS This cohort study using Swedish registers included 1826 and 3519 people with incident and prevalent MS (pwIMS, pwPMS) respectively, followed from 2005 to 2014. Cox regression assessed factors associated with new baclofen prescriptions and its discontinuation. RESULTS A total of 10% of pwIMS and 19% of pwPMS received baclofen, a drug prescribed specifically for spasticity in Sweden, of which many patients had relapsing-remitting course. Prescriptions occurred soon after MS diagnosis: pwIMS received baclofen typically within 6 months of diagnosis, and pwPMS within 3 years. Younger patients compared with older patients were three times more likely to receive baclofen with similar disability level measured using Expanded Disability Severity Scores (EDSS). Patients aged 18-44 years with EDSS 3.0-5.0 have an HR for baclofen use of 5.62 (95% CI 2.91 to 10.85) and EDSS 6+ have an HR of 15.41 (95% CI 7.07 to 33.58) compared with individuals with EDSS 0-2.5. In comparison, patients aged 45+ years with EDSS 3.0-5.0 have an HR of 2.05 (95% CI 1.10 to 3.82) and EDSS 6+ a hour 4.26 (95% CI 1.96 to 9.17). Baclofen discontinuation was high: 49% (95% CI 0.42 to 0.57) of pwIMS discontinued within 150 days of dispensation, 90% discontinued within 2 years including patients with progressive course or higher EDSS. Associations among pwPMS and sensitivity analyses including additional treatments were similar. CONCLUSIONS Younger patients with MS are more likely to receive baclofen compared with older patients with MS. High rates of baclofen discontinuation highlight the need for more tolerable and efficacious spasticity treatments and monitoring of spasticity among people with MS.
Collapse
Affiliation(s)
- Kelsi A Smith
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Fredrik Piehl
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre of Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.,Academic Specialist Centre, Centre of Neurology, SLSO, Stockholm, Sweden
| | - Tomas Olsson
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre of Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.,Academic Specialist Centre, Centre of Neurology, SLSO, Stockholm, Sweden
| | - Lars Alfredsson
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre of Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.,Centre of Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jan Hillert
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre of Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Kockum
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Stridh
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.,Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Orebro, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
| |
Collapse
|
5
|
Needhamsen M, Khoonsari PE, Zheleznyakova GY, Piket E, Hagemann-Jensen M, Han Y, Gierlich J, Ekman D, Jagodic M. Integration of small RNAs from plasma and cerebrospinal fluid for classification of multiple sclerosis. Front Genet 2022; 13:1042483. [DOI: 10.3389/fgene.2022.1042483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022] Open
Abstract
Multiple Sclerosis (MS) is an autoimmune, neurological disease, commonly presenting with a relapsing-remitting form, that later converts to a secondary progressive stage, referred to as RRMS and SPMS, respectively. Early treatment slows disease progression, hence, accurate and early diagnosis is crucial. Recent advances in large-scale data processing and analysis have progressed molecular biomarker development. Here, we focus on small RNA data derived from cell-free cerebrospinal fluid (CSF), cerebrospinal fluid cells, plasma and peripheral blood mononuclear cells as well as CSF cell methylome data, from people with RRMS (n = 20), clinically/radiologically isolated syndrome (CIS/RIS, n = 2) and neurological disease controls (n = 14). We applied multiple co-inertia analysis (MCIA), an unsupervised and thereby unbiased, multivariate method for simultaneous data integration and found that the top latent variable classifies RRMS status with an Area Under the Receiver Operating Characteristics (AUROC) score of 0.82. Variable selection based on Lasso regression reduced features to 44, derived from the small RNAs from plasma (20), CSF cells (8) and cell-free CSF (16), with a marginal reduction in AUROC to 0.79. Samples from SPMS patients (n = 6) were subsequently projected on the latent space and differed significantly from RRMS and controls. On contrary, we found no differences between relapse and remission or between inflammatory and non-inflammatory disease controls, suggesting that the latent variable is not prone to inflammatory signals alone, but could be MS-specific. Hence, we here showcase that integration of small RNAs from plasma and CSF can be utilized to distinguish RRMS from SPMS and neurological disease controls.
Collapse
|
6
|
Brenner R, Witzig-Brändli V, Vetsch J, Kohler M. Nursing Interventions Focusing on Self-efficacy for Patients With Multiple Sclerosis in Rehabilitation: A Systematic Review. Int J MS Care 2022; 24:189-198. [PMID: 35875457 PMCID: PMC9296055 DOI: 10.7224/1537-2073.2021-166] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Rehabilitative nursing interventions are vital in the treatment of multiple sclerosis (MS), but there is a lack of evidence on the effectiveness of such interventions. This review aims to summarize outcomes of nurse-led rehabilitation interventions for patients with MS, focusing on patients' self-efficacy and self-management and their satisfaction with the intervention. This review is the first step of our overarching goal of developing, implementing, and evaluating a research-supported nursing consultation intervention in inpatient rehabilitation. METHODS We searched 3 databases from their dates of inception until April 2020 (and performed another search in August 2021) for studies involving adult patients diagnosed as having MS. We focused on studies with interventions aimed at self-efficacy and self-management of MS and studies on intervention satisfaction. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS We included 4 studies in this review with a total of 271 participants. All interventions were educational and included training programs. All studies assessed self-efficacy, and all identified an improvement in self-efficacy, particularly through group training interventions. One study focused on self-management, reporting an improvement resulting from the intervention. Two studies evaluating satisfaction with the intervention obtained good overall satisfaction scores from participants, and 1 study's program was strongly recommended by participants. CONCLUSIONS This review indicates that self-efficacy and self-management abilities may be effectively promoted, particularly through group training interventions. An intervention tailored and adapted to the needs of patients with MS may promote satisfaction with the intervention and might consequently improve adherence to rehabilitation interventions.
Collapse
Affiliation(s)
- Rouven Brenner
- From the Department of Health, Eastern Switzerland University of Applied Sciences, St Gallen, Switzerland (RB, VW-B, JV, MK)
| | - Verena Witzig-Brändli
- From the Department of Health, Eastern Switzerland University of Applied Sciences, St Gallen, Switzerland (RB, VW-B, JV, MK)
| | - Janine Vetsch
- From the Department of Health, Eastern Switzerland University of Applied Sciences, St Gallen, Switzerland (RB, VW-B, JV, MK)
| | - Myrta Kohler
- From the Department of Health, Eastern Switzerland University of Applied Sciences, St Gallen, Switzerland (RB, VW-B, JV, MK)
| |
Collapse
|
7
|
Vecchio M, Chiaramonte R, DI Benedetto P. Management of bladder dysfunction in multiple sclerosis: a systematic review and meta-analysis of studies regarding bladder rehabilitation. Eur J Phys Rehabil Med 2022; 58:387-396. [PMID: 35102733 PMCID: PMC9980558 DOI: 10.23736/s1973-9087.22.07217-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of the study was to investigate the efficacy of rehabilitation programs for bladder disorders in patients with multiple sclerosis (MS) and to guide physicians in delineating therapeutic tools and programs for physiatrists, using the best current strategies. EVIDENCE ACQUISITION A search was conducted on PubMed, EMBASE, the Cochrane Library and Web of Science. Studies were eligible if they included adults with bladder disorders related to MS and described specific treatments of rehabilitation interest. The search identified 190,283 articles using the key words "multiple sclerosis" AND "rehabilitation" AND "urinary" OR "bladder," of which the reviewers analyzed 81 full-texts; 21 publications met the criteria and were included in the systematic review. EVIDENCE SYNTHESIS The systematic review identified the specific rehabilitation treatments reported in the current literature. The meta-analysis compared the scores and scales used to quantify bladder disorders due to MS, both before and after rehabilitation or in a comparison with a control group. CONCLUSIONS The present study suggests the need of a specific therapeutic protocol, based on the degree of disability and symptom complexity in patients with MS-related neurogenic lower urinary tract dysfunction (NLUTD). Particularly, the meta-analysis shows the effectiveness of peripheral tibial nerve stimulation (PTNS) and pelvic floor muscle training (PFMT) for neurogenic detrusor overactivity (NDO). However, the goal of physiotherapy is to treat incontinence without making urinary retention worse and vice-versa, reducing the loss of urine urgency, while ensuring the emptying of the bladder.
Collapse
Affiliation(s)
- Michele Vecchio
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy - .,Unit of Rehabilitation, Vittorio Emanuele Polyclinic, Catania, Italy -
| | - Rita Chiaramonte
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | |
Collapse
|
8
|
El‐Wahsh S, Balandin S, Bogaardt H, Kumfor F, Ballard KJ. Managing communication changes in persons with multiple sclerosis: Findings from qualitative focus groups. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:680-694. [PMID: 35338749 PMCID: PMC9311724 DOI: 10.1111/1460-6984.12717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is growing recognition that communication can be affected in multiple sclerosis (MS) and can negatively impact relationships, employment and psychological well-being. Some persons with MS (PwMS) implement strategies to facilitate their communication; however, some do not. Most PwMS who report communication changes do not engage with speech-language pathology (SLP) services. This raises concerns that a large portion of communication changes associated with MS go under-recognized and unmanaged. Little is known about what PwMS want and need to facilitate effective communication. AIM To explore what PwMS want and need to better manage their communication changes. METHODS & PROCEDURES Three focus groups were conducted online using Zoom, with a total of 12 PwMS. Participants were an opportunistic sample of PwMS within Australia recruited via advertisements distributed to various MS organizations and clinics. Data were transcribed verbatim and analysed using thematic content analysis to provide a qualitative analysis of the data. OUTCOMES & RESULTS Two main themes emerged: (1) accessible knowledge and a holistic approach; and (2) partnerships. Specifically, the identified wants and needs of participants included: (1) assessment; (2) information; (3) raising awareness; (4) support groups; (5) a whole-person approach to intervention; (6) geographically and economically accessible and navigable services; (7) effective patient-physician interactions; and (8) a multidisciplinary team-based approach (e.g., SLP, psychology, neuropsychology, occupational therapy). CONCLUSIONS & IMPLICATIONS This study identified a wide range of unmet wants and needs of PwMS related to communication changes. Participants wanted improved collaborative partnerships with healthcare professionals to better manage their communication changes. For example, healthcare professionals could ask PwMS about potential communication changes, provide education and make appropriate referrals. Education and information provision could focus on communication changes in MS, factors that trigger or exacerbate communication changes, impacts, self-management strategies, and available supports and services. Specific implications for clinical practice and future research are suggested in this paper, including ideas for patient education materials and content, suggestions for communication-specific screening and information that could be shared in patient-physician interactions, the development of guidelines to systematically screen, assess, manage and monitor communication changes in MS, and the design of evidence-based communication interventions for this clinical population. The results from this study can be used to guide the design of supports and services to help PwMS better manage communication changes, with the aim to reduce the negative impacts. WHAT THIS PAPER ADDS What is already known on this subject PwMS can experience communication changes across a range of domains, including speech, voice, fluency, expressive and receptive language, and cognitive-linguistic functions. These changes can have profound and far-reaching negative impacts on educational and vocational outcomes, social participation, relationships, psychological well-being, and quality of life. Most PwMS who report communication changes do not engage with SLP services. There has been little research exploring what PwMS want and need to help manage their communication changes. What this paper adds to the existing knowledge This research is the first study of its kind that sets out specifically to explore what PwMS want and need to better manage their communication changes. This study increases our understanding of, and provides valuable insights into, the specific types of supports and services PwMS desire to access, and the partnerships and kinds of interactions PwMS dream of having with healthcare professionals to manage these changes. This information can facilitate the development of future interventions to manage communication changes in MS. What are the potential or actual clinical implications of this work? PwMS wanted healthcare professionals to ask about potential communication changes, provide education and make appropriate referrals. When providing education and information on communication changes in MS, healthcare professionals should focus on covering symptoms, triggers, impacts, self-management strategies, and available supports and services. There is a timely need to develop guidelines and interventions to manage communication changes in MS to reduce their negative impacts.
Collapse
Affiliation(s)
- Sarah El‐Wahsh
- Faculty of Medicine and Health, School of Health SciencesThe University of SydneyCamperdownNSWAustralia
| | | | - Hans Bogaardt
- School of Allied Health Science and PracticeThe University of AdelaideAdelaideSAAustralia
| | - Fiona Kumfor
- Faculty of ScienceSchool of PsychologyThe University of SydneySydneyNSWAustralia
- Brain and Mind CentreThe University of SydneySydneyNSWAustralia
| | - Kirrie J. Ballard
- Faculty of Medicine and Health, School of Health SciencesThe University of SydneyCamperdownNSWAustralia
- Brain and Mind CentreThe University of SydneySydneyNSWAustralia
| |
Collapse
|
9
|
Kassie SA, Alia J, Hyland L. Biopsychosocial implications of living with multiple sclerosis: a qualitative study using interpretative phenomenological analysis. BMJ Open 2021; 11:e049041. [PMID: 34404710 PMCID: PMC8372815 DOI: 10.1136/bmjopen-2021-049041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is estimated to affect 2.8 million people worldwide, with increasing prevalence in all world regions (Walton et al). While there is no cure for MS, medication and lifestyle modifications can slow disease progression and enhance patients' quality of life. The biopsychosocial model of health recognises important interactions among biological, psychological and social factors in illness, including those relating to illness management, which contribute to the experience of those diagnosed with MS. OBJECTIVE This qualitative, idiographic study aimed to explore the lived experiences of patients in the United Arab Emirates (UAE) diagnosed with S. METHODS Semistructured interviews were conducted with a purposive sample of eight patients with MS ranging in age from 25 to 56 years. All participants were residing in the UAE at the time of data collection. Interpretative phenomenological analysis was used to analyse the data. RESULTS Three superordinate themes were identified from patients' candid accounts of their lives with MS, highlighting issues of illness management, acceptance and gratitude, and adaptive coping. These themes broadly illustrate biological, psychological and social aspects of patients' MS experiences. CONCLUSION The study emphasised the importance of adopting the biopsychosocial model to treat and manage MS. Additionally, it highlights the need for routine assessment and early, multidimensional approach with multidisciplinary team efforts to improve patients' quality of life.
Collapse
Affiliation(s)
- Seada A Kassie
- Shared Clinical Services, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
- Psychology, Middlesex University Dubai, Dubai, UAE
| | - Jannat Alia
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE
| | - Lynda Hyland
- Psychology, Middlesex University Dubai, Dubai, UAE
| |
Collapse
|
10
|
An ID-Associated Application to Facilitate Patient-Tailored Management of Multiple Sclerosis. Brain Sci 2021; 11:brainsci11081061. [PMID: 34439680 PMCID: PMC8392440 DOI: 10.3390/brainsci11081061] [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: 07/15/2021] [Revised: 07/29/2021] [Accepted: 08/11/2021] [Indexed: 11/21/2022] Open
Abstract
Despite improvements in diagnosis and treatment, multiple sclerosis (MS) is the leading neurological cause of disability in young adults. As a chronic disease, MS requires complex and challenging management. In this context, eHealth has gained an increasing relevance. Here, we aim to summarize beneficial features of a mobile app recently implemented in clinical MS routine as well as beyond MS. PatientConcept is a CE-certified, ID-associated multilingual software application allowing patients to record relevant health data without disclosing any identifying data. Patients can voluntarily share their health data with selected physicians. Since its implementation in 2018, about 3000 MS patients have used PatientConcept. Initially developed as a physician–patient communication platform, the app maps risk management plans of all current disease modifying therapies and thereby facilitates adherence to specified monitoring appointments. It also allows continuous monitoring of various PROs (Patient Reported Outcomes), enabling a broad overview of the disease course. In addition, various studies/projects currently assess monitoring, follow-up, diagnostics and telemetric evaluations of patients with other diseases beyond MS. Altogether, PatientConcept offers a broad range of possibilities to support physician–patient communication, implementation of risk management plans and assessment of PROs. It is a promising tool to facilitate patient-tailored management of MS and other chronic diseases.
Collapse
|
11
|
Llufriu S, Agüera E, Costa-Frossard L, Galán V, Landete L, Lourido D, Meca-Lallana JE, Moral E, Bravo-Rodríguez F, Koren L, Labiano A, León A, Martín P, Monedero MD, Requeni L, Zubizarreta I, Rovira À. Recommendations for the coordination of Neurology and Neuroradiology Departments in the management of patients with multiple sclerosis. Neurologia 2021; 38:S0213-4853(21)00029-3. [PMID: 33744061 DOI: 10.1016/j.nrl.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/01/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is widely used for the diagnosis and follow-up of patients with multiple sclerosis (MS). Coordination between Neurology and Neuroradiology departments is crucial for performing and interpreting radiological studies as efficiently and as accurately as possible. However, improvements can be made in the communication between these departments in many Spanish hospitals. METHODS A panel of 17 neurologists and neuroradiologists from 8 Spanish hospitals held in-person and online meetings to draft a series of good practice guidelines for the coordinated management of MS. The drafting process included 4 phases: 1) establishing the scope of the guidelines and the methodology of the study; 2) literature review on good practices or recommendations on the use of MRI in MS; 3) discussion and consensus between experts; and 4) validation of the contents. RESULTS The expert panel agreed a total of 9 recommendations for improving coordination between neurology and neuroradiology departments. The recommendations revolve around 4 main pillars: 1) standardising the process for requesting and scheduling MRI studies and reports; 2) designing common protocols for MRI studies; 3) establishing multidisciplinary committees and coordination meetings; and 4) creating formal communication channels between both departments. CONCLUSIONS These consensus recommendations are intended to optimise coordination between neurologists and neuroradiologists, with the ultimate goal of improving the diagnosis and follow-up of patients with MS.
Collapse
Affiliation(s)
- S Llufriu
- Servicio de Neurología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España.
| | - E Agüera
- Servicio de Neurología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
| | - L Costa-Frossard
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - V Galán
- Servicio de Neurología, Hospital Virgen de la Salud, Toledo, España
| | - L Landete
- Servicio de Neurología, Hospital Universitario Dr. Peset, Valencia, España
| | - D Lourido
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J E Meca-Lallana
- CSUR Esclerosis Múltiple y Unidad de Neuroinmunología Clínica, Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, España
| | - E Moral
- Servicio de Neurología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - F Bravo-Rodríguez
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Reina Sofía, Córdoba, España
| | - L Koren
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Labiano
- Servicio de Neurología, Hospital Virgen de la Salud, Toledo, España
| | - A León
- Sección de Neurorradiología, Servicio de Radiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - P Martín
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario 12 de Octubre, Madrid, España
| | - M D Monedero
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Dr. Peset, Valencia, España
| | - L Requeni
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Dr. Peset, Valencia, España
| | - I Zubizarreta
- Servicio de Neurología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - À Rovira
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Vall d'Hebron, Barcelona, España
| |
Collapse
|
12
|
Gulati P, Boski N, Gulati V, Raj R. Multiple Sclerosis-Minimizing Errors in Radiological Diagnosis. Neurol India 2021; 69:1539-1546. [DOI: 10.4103/0028-3886.333497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
13
|
Approved and Emerging Disease Modifying Therapies on Neurodegeneration in Multiple Sclerosis. Int J Mol Sci 2020; 21:ijms21124312. [PMID: 32560364 PMCID: PMC7348940 DOI: 10.3390/ijms21124312] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 12/16/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune, chronic, progressive disease leading to a combination of inflammation, demyelination, and neurodegeneration throughout the central nervous system (CNS). The outcome of these processes can be visualized in magnetic resonance imaging (MRI) scans as brain atrophy, or brain volume loss (BVL), as well as lesions, “black holes” and spinal cord atrophy. MRI outcomes such as BVL have been used as biomarkers of neurodegeneration and other measures of MS disease progression in clinical research settings. Several FDA-approved medications seek to alleviate disease progression by reducing the impact of such factors as demyelination and neurodegeneration, but there are still many shortcomings that current clinical research aims to mitigate. This review attempts to provide an overview of the FDA-approved medications available for treating multiple sclerosis and their effect on neurodegeneration, measured by BVL.
Collapse
|
14
|
Outcomes and future directions for neuroimmunology/multiple sclerosis fellowship training: Survey of recent trainees. Mult Scler Relat Disord 2020; 44:102296. [PMID: 32585616 DOI: 10.1016/j.msard.2020.102296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Neuroimmunology/multiple sclerosis is a rapidly evolving, but still poorly defined subspecialty. Fellowship training is not standardized, and there is substantial variability across sites. Outcomes of fellowship training have not yet been studied. We therefore examined early career choices of neuroimmunology/MS fellowship program graduates and solicited the perspective of current and recent trainees on their fellowship experience as well as opportunities to improve neuroimmunology education. METHODS We developed a questionnaire to collect information about fellowship training experiences and current medical practice. We identified recent graduates based on records from US training programs and the National MS Society and electronically sent the survey to current trainees and recent graduates (within the last 5 years). RESULTS We identified 179 current/recent trainees and successfully reached 157 with survey distributions. Ninety-five individuals (60.5%) returned surveys. Most graduates assumed an academic practice (68%) focused mostly or exclusively on MS and other CNS neuroimmune diseases (55%), and practiced in regions where there were ≥5 other neuroimmunology specialists (51%). Graduates felt well-prepared to manage diagnoses of MS and neuromyelitis optica spectrum disorders but their comfort with rarer CNS neuroimmune diseases varied substantially. Basic immunology, neuro-rheumatology, grant writing and neuro-rehabilitation were identified as high impact areas for cross-disciplinary didactic training. The majority of recent trainees (57%) favored standardizing a core neuroimmunology curriculum, and 48% favored developing a subspecialty certification. CONCLUSIONS This is the first study to examine practice outcomes and trainee experiences for neuroimmunology training programs. We anticipate that these data will help educators define a core curriculum for the subspecialty and identify complementary skill sets that enhance the traditional clinic-based model of teaching.
Collapse
|
15
|
Marques KAP, Trindade CBB, Almeida MCV, Bento-Torres NVO. Pilates for rehabilitation in patients with multiple sclerosis: A systematic review of effects on cognition, health-related physical fitness, general symptoms and quality of life. J Bodyw Mov Ther 2020; 24:26-36. [PMID: 32507148 DOI: 10.1016/j.jbmt.2020.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/07/2019] [Accepted: 01/28/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aims of this systematic review is to analyze the effectiveness of Pilates intervention programs on cognitive function, health-related physical fitness, general symptoms, physical function, quality of life, and the impact Pilates can have on activities of daily living in Multiple Sclerosis (MS) patients. This review also aims to provide a synthesis of the most commonly used protocols regarding exercise parameters, such as periodicity and treatment duration. DATA SOURCES Systematic review of the literature was carried out following the PRISMA guidelines (PROSPERO no. CRD42017070004). A literature search was undertaken for studies that investigated the effects of Pilates training on MS patients, using databases included PubMed, Medline, Scopus and the Physiotherapy Evidence Database (PEDro) up to May 2018. STUDY SELECTION Three researchers independently reviewed the titles and abstract of each article to screen the papers in relation to the inclusion criteria. DATA EXTRACTION Data were extracted by three researchers independently. The eligible articles were read in full and their levels of evidence were evaluated using the PEDro scale. DATA SYNTHESIS Forty-two papers were found during the research phase. Duplicated (n = 23) or incomplete articles (n = 1) were excluded. Studies were also eliminated from the sample based on methodological approach (study design) quality assessment (n = 6). Twelve studies were ultimately selected and analyzed. CONCLUSIONS The majority of the studies analyzed showed positive results after Pilates training intervention and concluded that Pilates intervention is safe and effective for the treatment of dysfunction of balance, strength, quality of life, cognition, physical performance, walking and posture parameters on MS patients. The articles investigated in this review provide a scientific basis to support Pilates as an option for rehabilitation programs for MS patients.
Collapse
|
16
|
Obeidat AZ, Jassam YN, Hua LH, Cutter G, Ford CC, Halper J, Lisak RP, Sicotte NL, Longbrake EE. Education Research: Multiple sclerosis and neuroimmunology fellowship training status in the United States. Neurology 2020; 94:495-500. [PMID: 32107321 DOI: 10.1212/wnl.0000000000009096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the current status of postgraduate training in neuroimmunology and multiple sclerosis (NI/MS) in the United States. METHODS We developed a questionnaire to collect information on fellowship training focus, duration of training, number of fellows, funding application process, rotations, visa sponsorship, and an open-ended question about challenges facing training in NI/MS. We identified target programs and sent the questionnaires electronically to fellowship program directors. RESULTS We identified and sent the questionnaire to 69 NI/MS fellowship programs. We successfully obtained data from 64 programs. Most programs were small, matriculating 1-2 fellows per year, and incorporated both NI and MS training into the curriculum. Most programs were flexible in their duration, typically lasting 1-2 years, and offered opportunities for research during training. Only 56% reported the ability to sponsor nonimmigrant visas. Most institutions reported having some internal funding, although the availability of these funds varied from year to year. Several program directors identified funding availability and the current absence of national subspecialty certification as major challenges facing NI/MS training. CONCLUSION Our study is the first to describe the current status of NI/MS training in the United States. We found many similarities across programs. We anticipate that these data will serve as a first step towards developing a standard NI/MS curriculum and help identify areas where shared resources could enhance trainee education despite differences in training environments. We identified funding availability, certification status, and nonimmigrant visa sponsorship as potential barriers to future growth in the field.
Collapse
Affiliation(s)
- Ahmed Z Obeidat
- From the Department of Neurology (A.Z.O.), Medical College of Wisconsin, Milwaukee; Department of Neurology (Y.N.J.), The University of Kansas, Kansas City; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Department of Biostatistics (G.C.), University of Alabama at Birmingham; Department of Neurology (C.F.), University of New Mexico, Albuquerque; The Consortium of Multiple Sclerosis Centers and International Organization of Multiple Sclerosis Nurses (J.H.), Multiple Sclerosis Nurses International Certification Board, Hackensack, NJ; Departments of Neurology, Biochemistry, Microbiology, and Immunology (R.P.L.), School of Medicine, Wayne State University and Detroit Medical Center, MI; Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA; and Center for Neuroepidemiology and Clinical Neurological Research (E.E.L.), Yale School of Medicine (E.E.L.), Yale University, New Haven, CT.
| | - Yasir N Jassam
- From the Department of Neurology (A.Z.O.), Medical College of Wisconsin, Milwaukee; Department of Neurology (Y.N.J.), The University of Kansas, Kansas City; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Department of Biostatistics (G.C.), University of Alabama at Birmingham; Department of Neurology (C.F.), University of New Mexico, Albuquerque; The Consortium of Multiple Sclerosis Centers and International Organization of Multiple Sclerosis Nurses (J.H.), Multiple Sclerosis Nurses International Certification Board, Hackensack, NJ; Departments of Neurology, Biochemistry, Microbiology, and Immunology (R.P.L.), School of Medicine, Wayne State University and Detroit Medical Center, MI; Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA; and Center for Neuroepidemiology and Clinical Neurological Research (E.E.L.), Yale School of Medicine (E.E.L.), Yale University, New Haven, CT
| | - Le H Hua
- From the Department of Neurology (A.Z.O.), Medical College of Wisconsin, Milwaukee; Department of Neurology (Y.N.J.), The University of Kansas, Kansas City; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Department of Biostatistics (G.C.), University of Alabama at Birmingham; Department of Neurology (C.F.), University of New Mexico, Albuquerque; The Consortium of Multiple Sclerosis Centers and International Organization of Multiple Sclerosis Nurses (J.H.), Multiple Sclerosis Nurses International Certification Board, Hackensack, NJ; Departments of Neurology, Biochemistry, Microbiology, and Immunology (R.P.L.), School of Medicine, Wayne State University and Detroit Medical Center, MI; Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA; and Center for Neuroepidemiology and Clinical Neurological Research (E.E.L.), Yale School of Medicine (E.E.L.), Yale University, New Haven, CT
| | - Gary Cutter
- From the Department of Neurology (A.Z.O.), Medical College of Wisconsin, Milwaukee; Department of Neurology (Y.N.J.), The University of Kansas, Kansas City; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Department of Biostatistics (G.C.), University of Alabama at Birmingham; Department of Neurology (C.F.), University of New Mexico, Albuquerque; The Consortium of Multiple Sclerosis Centers and International Organization of Multiple Sclerosis Nurses (J.H.), Multiple Sclerosis Nurses International Certification Board, Hackensack, NJ; Departments of Neurology, Biochemistry, Microbiology, and Immunology (R.P.L.), School of Medicine, Wayne State University and Detroit Medical Center, MI; Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA; and Center for Neuroepidemiology and Clinical Neurological Research (E.E.L.), Yale School of Medicine (E.E.L.), Yale University, New Haven, CT
| | - Corey C Ford
- From the Department of Neurology (A.Z.O.), Medical College of Wisconsin, Milwaukee; Department of Neurology (Y.N.J.), The University of Kansas, Kansas City; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Department of Biostatistics (G.C.), University of Alabama at Birmingham; Department of Neurology (C.F.), University of New Mexico, Albuquerque; The Consortium of Multiple Sclerosis Centers and International Organization of Multiple Sclerosis Nurses (J.H.), Multiple Sclerosis Nurses International Certification Board, Hackensack, NJ; Departments of Neurology, Biochemistry, Microbiology, and Immunology (R.P.L.), School of Medicine, Wayne State University and Detroit Medical Center, MI; Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA; and Center for Neuroepidemiology and Clinical Neurological Research (E.E.L.), Yale School of Medicine (E.E.L.), Yale University, New Haven, CT
| | - June Halper
- From the Department of Neurology (A.Z.O.), Medical College of Wisconsin, Milwaukee; Department of Neurology (Y.N.J.), The University of Kansas, Kansas City; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Department of Biostatistics (G.C.), University of Alabama at Birmingham; Department of Neurology (C.F.), University of New Mexico, Albuquerque; The Consortium of Multiple Sclerosis Centers and International Organization of Multiple Sclerosis Nurses (J.H.), Multiple Sclerosis Nurses International Certification Board, Hackensack, NJ; Departments of Neurology, Biochemistry, Microbiology, and Immunology (R.P.L.), School of Medicine, Wayne State University and Detroit Medical Center, MI; Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA; and Center for Neuroepidemiology and Clinical Neurological Research (E.E.L.), Yale School of Medicine (E.E.L.), Yale University, New Haven, CT
| | - Robert P Lisak
- From the Department of Neurology (A.Z.O.), Medical College of Wisconsin, Milwaukee; Department of Neurology (Y.N.J.), The University of Kansas, Kansas City; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Department of Biostatistics (G.C.), University of Alabama at Birmingham; Department of Neurology (C.F.), University of New Mexico, Albuquerque; The Consortium of Multiple Sclerosis Centers and International Organization of Multiple Sclerosis Nurses (J.H.), Multiple Sclerosis Nurses International Certification Board, Hackensack, NJ; Departments of Neurology, Biochemistry, Microbiology, and Immunology (R.P.L.), School of Medicine, Wayne State University and Detroit Medical Center, MI; Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA; and Center for Neuroepidemiology and Clinical Neurological Research (E.E.L.), Yale School of Medicine (E.E.L.), Yale University, New Haven, CT
| | - Nancy L Sicotte
- From the Department of Neurology (A.Z.O.), Medical College of Wisconsin, Milwaukee; Department of Neurology (Y.N.J.), The University of Kansas, Kansas City; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Department of Biostatistics (G.C.), University of Alabama at Birmingham; Department of Neurology (C.F.), University of New Mexico, Albuquerque; The Consortium of Multiple Sclerosis Centers and International Organization of Multiple Sclerosis Nurses (J.H.), Multiple Sclerosis Nurses International Certification Board, Hackensack, NJ; Departments of Neurology, Biochemistry, Microbiology, and Immunology (R.P.L.), School of Medicine, Wayne State University and Detroit Medical Center, MI; Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA; and Center for Neuroepidemiology and Clinical Neurological Research (E.E.L.), Yale School of Medicine (E.E.L.), Yale University, New Haven, CT
| | - Erin E Longbrake
- From the Department of Neurology (A.Z.O.), Medical College of Wisconsin, Milwaukee; Department of Neurology (Y.N.J.), The University of Kansas, Kansas City; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Department of Biostatistics (G.C.), University of Alabama at Birmingham; Department of Neurology (C.F.), University of New Mexico, Albuquerque; The Consortium of Multiple Sclerosis Centers and International Organization of Multiple Sclerosis Nurses (J.H.), Multiple Sclerosis Nurses International Certification Board, Hackensack, NJ; Departments of Neurology, Biochemistry, Microbiology, and Immunology (R.P.L.), School of Medicine, Wayne State University and Detroit Medical Center, MI; Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA; and Center for Neuroepidemiology and Clinical Neurological Research (E.E.L.), Yale School of Medicine (E.E.L.), Yale University, New Haven, CT
| |
Collapse
|
17
|
Oh J, Alikhani K, Bruno T, Devonshire V, Giacomini PS, Giuliani F, Nakhaipour HR, Schecter R, Larochelle C. Diagnosis and management of secondary-progressive multiple sclerosis: time for change. Neurodegener Dis Manag 2019; 9:301-317. [PMID: 31769344 DOI: 10.2217/nmt-2019-0024] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Identifying the transition of relapsing-remitting multiple sclerosis (MS) to the secondary-progressive MS form remains a clinical challenge due to the gradual nature of the transition, superimposed relapses, the heterogeneous course of disease among patients and the absence of validated biomarkers and diagnostic tools. The uncertainty associated with the transition makes clinical care challenging for both patients and physicians. The emergence of new disease-modifying treatments for progressive MS and the increasing emphasis of nonpharmacological strategies mark a new era in the treatment of progressive MS. This article summarizes challenges in diagnosis and management, discusses novel treatment strategies and highlights the importance of establishing a clear diagnosis and instituting an interdisciplinary management plan in the care of patients with progressive MS.
Collapse
Affiliation(s)
- Jiwon Oh
- Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada
| | - Katayoun Alikhani
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Tania Bruno
- Division of Physiatry, Department of Medicine, University Health Network - Toronto Rehabilitation Institute, University of Toronto, Toronto, ON M4G 1R7, Canada
| | - Virginia Devonshire
- Division of Neurology, Department of Medicine, University of British Columbia MS/NMO Center, Vancouver, BC V6T 1Z3, Canada
| | - Paul S Giacomini
- Department of Neurology, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
| | - Fabrizio Giuliani
- Division of Neurology, Neuroscience & Mental Health Institute, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | | | - Robyn Schecter
- Novartis Pharmaceuticals Canada, Montreal, QC H9S 1A9, Canada
| | | |
Collapse
|
18
|
Decavel P, Sagawa Y. Gait quantification in multiple sclerosis: A single-centre experience of systematic evaluation. Neurophysiol Clin 2019; 49:165-171. [DOI: 10.1016/j.neucli.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 12/24/2018] [Accepted: 01/08/2019] [Indexed: 01/14/2023] Open
|
19
|
Al-Sharman A, Khalil H, Nazzal M, Al-Sheyab N, Alghwiri A, El-Salem K, AlDughmi M. Living with multiple sclerosis: A Jordanian perspective. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018. [DOI: 10.1002/pri.1709] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alham Al-Sharman
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences; Jordan University of Science and Technology; Irbid Jordan
| | - Hanan Khalil
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences; Jordan University of Science and Technology; Irbid Jordan
| | - Mohammad Nazzal
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences; Jordan University of Science and Technology; Irbid Jordan
| | - Nihaya Al-Sheyab
- Faculty of Nursing, Department of Maternal and Child Nursing-Faculty member; Jordan University of Science and Technology; Irbid Jordan
| | - Alia Alghwiri
- School of Rehabilitation Sciences; The University of Jordan; Amman Jordan
| | - Khalid El-Salem
- Faculty of Medicine; Jordan University of Science and Technology; Irbid Jordan
| | - Mais AlDughmi
- School of Rehabilitation Sciences; The University of Jordan; Amman Jordan
| |
Collapse
|
20
|
Osborne PJ, Jimenez-Torres GJ, Landa Y, Mahoney J, Madan A. Chronic pain management group psychotherapy for psychiatric inpatients: A pilot study. Bull Menninger Clin 2017; 81:123-149. [PMID: 28609146 DOI: 10.1521/bumc.2017.81.2.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Individuals with serious mental illness (SMI) experience significant comorbid chronic pain (CP). Little is known about CP management in psychiatric inpatient settings. To address this gap in clinical practice, the authors developed CP management group psychotherapy for adult inpatients with SMI. In this report, the authors highlight (1) the theoretical underpinnings of and execution of the psychotherapy group, (2) the characteristics of participants in the pilot phase of the group, and (3) outcomes of group participants. Data were collected from 16 participants in the pain management psychotherapy group. The mean number of groups attended was two (SD = 1.7). Participants endorsed pain across five regions of the body with high pain intensity and severity. Improvements in depression, anxiety, somatic, and emotional regulation symptoms were evidenced during the course of treatment. CP group psychotherapy may be an effective modality to disseminate "best practices" and prevent diagnostic overshadowing for SMI patients.
Collapse
Affiliation(s)
- Patricia J Osborne
- VISN 2 South Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Yulia Landa
- VISN 2 South Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jane Mahoney
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Alok Madan
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
21
|
Miletta M, Bogliatto F, Bacchio L. Multidisciplinary Management of Sexual Dysfunction, Perineal Pain, and Elimination Dysfunction in a Woman with Multiple Sclerosis. Int J MS Care 2017; 19:25-28. [PMID: 28243183 DOI: 10.7224/1537-2073.2015-082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disease that commonly affects young women and is associated with sexual dysfunction (SD) and lower anourogenital dysfunction, which affect quality of life. We evaluated the importance of an integrated multidisciplinary approach in the Lower Female Ano-Uro-Genital Network (LFAUGN) to manage a variety of complex symptoms. METHODS A 40-year-old woman with MS and primary concerns about perineal pain and SD was treated by a trained midwife from the LFAUGN and a physical therapist after a multidisciplinary diagnostic process that included gynecologic evaluation for perineal pain and SD, physiatric assessment, urologic assessment for bladder retention (BR), and surgical examination for obstructed defecation syndrome (ODS). Physical therapy was integrated with pharmacologic therapy for ODS and with self-catheterization for BR. RESULTS After 5 months of treatment, the patient reported improvement in functional perineal parameters and perineal pain (visual analogue scale score: 9 at T1 vs. 5 at T2), with resolution of pelvic floor hypertonia. Furthermore, ODS and BR symptoms improved (5-item score: 18 of 20 at T1 vs. 10 of 20 at T2; 1 self-catheterization daily, with postvoid residual volume [PRV] <200 mL at T1 vs. 1 self-catheterization weekly, with PRV <100 mL at T2) and sexual satisfaction increased (Female Sexual Function Index score: 18 of 36 at T1 vs. 23 of 36 at T2). CONCLUSIONS These results suggest that physical therapy, as an integral component of a multidisciplinary approach in a multiprofessional network, may play a pivotal role in improving anourogenital dysfunction and sexual satisfaction.
Collapse
|
22
|
Carter E, Yilmaz Z, Devine M, Renton T. An update on the causes, assessment and management of third division sensory trigeminal neuropathies. Br Dent J 2016; 220:627-35. [DOI: 10.1038/sj.bdj.2016.444] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2016] [Indexed: 11/09/2022]
|
23
|
Papeix C, Lubetzki C. Integrated multidisciplinary clinics should be the gold standard in managing progressive MS - NO. Mult Scler 2016; 22:1128-30. [PMID: 27225675 DOI: 10.1177/1352458516643397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Caroline Papeix
- Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Catherine Lubetzki
- Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France/Sorbonne Universités, UPMC, Paris, France
| |
Collapse
|
24
|
Junqueira SC, dos Santos Coelho I, Lieberknecht V, Cunha MP, Calixto JB, Rodrigues ALS, Santos ARS, Dutra RC. Inosine, an Endogenous Purine Nucleoside, Suppresses Immune Responses and Protects Mice from Experimental Autoimmune Encephalomyelitis: a Role for A2A Adenosine Receptor. Mol Neurobiol 2016; 54:3271-3285. [DOI: 10.1007/s12035-016-9893-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 04/17/2016] [Indexed: 11/30/2022]
|
25
|
Castelnuovo G, Giusti EM, Manzoni GM, Saviola D, Gatti A, Gabrielli S, Lacerenza M, Pietrabissa G, Cattivelli R, Spatola CAM, Corti S, Novelli M, Villa V, Cottini A, Lai C, Pagnini F, Castelli L, Tavola M, Torta R, Arreghini M, Zanini L, Brunani A, Capodaglio P, D'Aniello GE, Scarpina F, Brioschi A, Priano L, Mauro A, Riva G, Repetto C, Regalia C, Molinari E, Notaro P, Paolucci S, Sandrini G, Simpson SG, Wiederhold B, Tamburin S. Psychological Treatments and Psychotherapies in the Neurorehabilitation of Pain: Evidences and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation. Front Psychol 2016; 7:115. [PMID: 26924998 PMCID: PMC4759289 DOI: 10.3389/fpsyg.2016.00115] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/21/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the paper.
Collapse
Affiliation(s)
- Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | | | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
- Faculty of Psychology, eCampus UniversityNovedrate (Como), Italy
| | - Donatella Saviola
- Cardinal Ferrari Rehabilitation Center, Santo Stefano Rehabilitation IstituteFontanellato, Italy
| | | | | | | | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Roberto Cattivelli
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Chiara A. M. Spatola
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Stefania Corti
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Margherita Novelli
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Valentina Villa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | | | - Carlo Lai
- Department of Dynamic and Clinical PsychologySapienza University of Rome, Italy
| | - Francesco Pagnini
- Department of Psychology, Catholic University of MilanMilan, Italy
- Department of Psychology, Harvard UniversityCambridge, MA, USA
| | - Lorys Castelli
- Department of Psychology, University of TurinTurin, Italy
| | | | - Riccardo Torta
- Department of Neuroscience “Rita Levi Montalcini”University of Turin, Italy
| | - Marco Arreghini
- Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Loredana Zanini
- Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Amelia Brunani
- Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Paolo Capodaglio
- Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Guido E. D'Aniello
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Federica Scarpina
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
- Department of Neuroscience “Rita Levi Montalcini”University of Turin, Italy
| | - Andrea Brioschi
- Department of Neurology and Neurorehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Lorenzo Priano
- Department of Neuroscience “Rita Levi Montalcini”University of Turin, Italy
- Department of Neurology and Neurorehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Alessandro Mauro
- Department of Neuroscience “Rita Levi Montalcini”University of Turin, Italy
- Department of Neurology and Neurorehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
| | - Giuseppe Riva
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Claudia Repetto
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Camillo Regalia
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Enrico Molinari
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Paolo Notaro
- “Pain Center II Level - Department of Surgery” - ASST Grande Ospedale Metropolitano NiguardaMilano, Italy
| | | | - Giorgio Sandrini
- Department of Brain and Behavioral Sciences, C. Mondino National Neurological Institute, University of PaviaPavia, Italy
| | - Susan G. Simpson
- School of Psychology, Social Work and Social PolicyUniversity of South Australia, Australia
| | | | - Stefano Tamburin
- Department of Neurological and Movement Sciences, University of VeronaVerona, Italy
| |
Collapse
|
26
|
Beadnall HN, Kuppanda KE, O'Connell A, Hardy TA, Reddel SW, Barnett MH. Tablet-based screening improves continence management in multiple sclerosis. Ann Clin Transl Neurol 2015; 2:679-87. [PMID: 26125042 PMCID: PMC4479527 DOI: 10.1002/acn3.205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/17/2015] [Indexed: 11/12/2022] Open
Abstract
Objective To investigate whether electronic continence questionnaires aid early identification and optimizes management of sphincter dysfunction in a multiple sclerosis clinic. Methods A custom designed, tablet-based cross-platform software tool was designed to capture validated multiple sclerosis (MS) patient-reported outcomes. An unselected cohort of MS patients from a tertiary referral clinic completed electronic tablet-based versions of the Bladder Control Scale (BLCS) and the Bowel Control Scale in the waiting room. Data were captured wirelessly “on-the-fly” and stored in a deidentified, secure database; and individual questionnaire results were immediately available to the treating neurologist in the electronic medical record. Scores of ≥2 on either questionnaire generated an automated electronic referral to the clinic MS continence nurse (MS CN). Results One hundred and fifty-seven MS patients completed a total of 184 electronic continence test sets and on two occasions only the BLCS was completed. An automatic electronic referral for formal continence review was generated 128 times in 108 patients. Fifty-seven formal continence assessments were undertaken by the MS CN following automated referral. All reviews resulted in at least one clinical intervention being made. Interpretation Tablet-based data capture and automated continence referral using this software tool is an efficient, sensitive, and feasible method of screening MS patients for bladder and bowel dysfunction. Concordance with the results of formal continence assessment in this pilot study validates the use of this technology as a screening tool.
Collapse
Affiliation(s)
- Heidi N Beadnall
- Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Multiple Sclerosis Clinic, Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Department of Neurology, Royal Prince Alfred Hospital Sydney, New South Wales, Australia
| | - Kushi E Kuppanda
- Multiple Sclerosis Clinic, Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Multiple Sclerosis Australia Sydney, New South Wales, Australia
| | - Annmaree O'Connell
- Multiple Sclerosis Clinic, Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Multiple Sclerosis Australia Sydney, New South Wales, Australia
| | - Todd A Hardy
- Multiple Sclerosis Clinic, Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Neuroimmunology Clinic, Concord Hospital and University of Sydney Sydney, New South Wales, Australia
| | - Stephen W Reddel
- Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Department of Neurology, Concord Repatriation General Hospital Sydney, New South Wales, Australia ; Concord Clinical School, University of Sydney Sydney, New South Wales, Australia
| | - Michael H Barnett
- Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Multiple Sclerosis Clinic, Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Department of Neurology, Royal Prince Alfred Hospital Sydney, New South Wales, Australia
| |
Collapse
|