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Kwon S, Sillau S, Corboy JR, Nair KV, Carlson AM. Shifting patterns of multiple sclerosis treatment in a highly prevalent United States population. Ann Clin Transl Neurol 2024; 11:1526-1534. [PMID: 38654416 PMCID: PMC11187960 DOI: 10.1002/acn3.52069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE Our objectives were to (1) obtain the prevalence and demography of people with multiple sclerosis (MS) in a representative Colorado population, and (2) to assess the utilization of disease-modifying therapy within this prevalent cohort. METHODS This is a retrospective, observational study of patients that had contact with the University of Colorado Health System from 2012 to 2020. We queried Health Data Compass, a data warehouse, for patient data and applied the MS Prevalence Workgroup Algorithm to generate a prevalent cohort. We calculated prevalence as of 31 December 2020, and stratified by age, sex, race, and ethnicity. Payer information and treatment exposure were obtained from linked claims from the Colorado All Payers Claim Database. Disease-modifying therapies were classified as highly effective and moderately effective based on the clinical trial, TREAT-MS (NCT03500328). RESULTS From a population of 1,382,821 individuals, 8557 people with MS were captured. Age-adjusted prevalence of MS as of 31 December 2020 was 572.3 per 100,000 with a mean age of 47.36. Prevalence varied between demographic subgroups, with the lowest prevalence in Hispanic men (215.6) and highest in White (824.1) and Black women (820.1). Overall disease-modifying therapy exposure was 62.4%, with increased highly effective therapy use and a corresponding decrease in moderately effective therapy use on a yearly basis. INTERPRETATION MS is highly prevalent in a representative Colorado cohort. Overall treatment and proportion of highly effective therapy exposure increased significantly during a critical period of MS therapeutic advances, indicating a shift in disease management driven sharply by the availability of on-label anti-CD20 therapy.
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Affiliation(s)
- Sue Kwon
- Department of Clinical PharmacyUniversity of Colorado Skaggs School of Pharmacy and Pharmaceutical SciencesAuroraColoradoUSA
| | - Stefan Sillau
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - John R. Corboy
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Kavita V. Nair
- Department of Clinical PharmacyUniversity of Colorado Skaggs School of Pharmacy and Pharmaceutical SciencesAuroraColoradoUSA
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Aaron M. Carlson
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
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Zeytin Demiral G, Türk Börü Ü, Bölük C, Betaş Akın S, Çulhaoğlu Gökçek D, Hoşgeldi HT, Yorgancı S. Multiple sclerosis prevalence and its relationship with economic status in Afyonkarahisar, Turkey. Mult Scler Relat Disord 2024; 81:105366. [PMID: 38104477 DOI: 10.1016/j.msard.2023.105366] [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: 08/29/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Over the past decade, the prevalence of Multiple Sclerosis (MS) has increased in Turkey. However, the prevalence of MS in Middle Anatolia, specifically Afyonkarahisar, remains unknown. Additionally, the potential link between economic status and MS has not yet been explored in Turkey. METHODS A stratified sampling method was employed to select samples from the population residing in Afyonkarahisar City Center, taking into account demographic factors such as income level, sex, and age. The sample size was calculated using the formula N = p.q.Zα2/d2, where an average prevalence rate of 70/100,000 was considered based on previous studies. The minimum sample size was 29,858. Considering incomplete, inaccurate, and low-reliability data, data were collected from 30,500 individuals and 30,408 individuals were evaluated. RESULTS The prevalence of Multiple Sclerosis in the center of Afyonkarahisar was 105.2 per 100,000 individuals. Upon investigating the association between economic status and MS prevalence, the findings revealed rates of 193.6 per 100,000 in individuals with high income, contrasting with 80.2 per 100,000 in those with low income. Notably, a heightened prevalence of MS is evident among individuals with higher income levels. CONCLUSION This study revealed a significantly elevated prevalence of MS in Afyonkarahisar, the highest in Turkey. The inverse correlation between the prevalence of MS and socioeconomic status is intriguing. Possible reasons for the high prevalence include the relatively new and specific geologic and environmental conditions in the area.
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Affiliation(s)
- Gökçe Zeytin Demiral
- Department of Neurology, Afyonkarahisar University of Health Sciences/Medicine Hospital, 2078 Street, No: 3, Block C, Afyonkarahisar 03030, Turkey.
| | - Ülkü Türk Börü
- Department of Neurology, Afyonkarahisar University of Health Sciences/Medicine Hospital, 2078 Street, No: 3, Block C, Afyonkarahisar 03030, Turkey
| | - Cem Bölük
- Clinic of Clinical Neurophysiology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Selin Betaş Akın
- Department of Neurology, Afyonkarahisar University of Health Sciences/Medicine Hospital, 2078 Street, No: 3, Block C, Afyonkarahisar 03030, Turkey
| | - Dilara Çulhaoğlu Gökçek
- Department of Neurology, Afyonkarahisar University of Health Sciences/Medicine Hospital, 2078 Street, No: 3, Block C, Afyonkarahisar 03030, Turkey
| | - Hilal Tuğba Hoşgeldi
- Department of Neurology, Afyonkarahisar University of Health Sciences/Medicine Hospital, 2078 Street, No: 3, Block C, Afyonkarahisar 03030, Turkey
| | - Sinem Yorgancı
- Department of Neurology, Afyonkarahisar University of Health Sciences/Medicine Hospital, 2078 Street, No: 3, Block C, Afyonkarahisar 03030, Turkey
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Wallen-Russell C, Pearlman N, Wallen-Russell S, Cretoiu D, Thompson DC, Voinea SC. A Catastrophic Biodiversity Loss in the Environment Is Being Replicated on the Skin Microbiome: Is This a Major Contributor to the Chronic Disease Epidemic? Microorganisms 2023; 11:2784. [PMID: 38004795 PMCID: PMC10672968 DOI: 10.3390/microorganisms11112784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
There has been a catastrophic loss of biodiversity in ecosystems across the world. A similar crisis has been observed in the human gut microbiome, which has been linked to "all human diseases affecting westernized countries". This is of great importance because chronic diseases are the leading cause of death worldwide and make up 90% of America's healthcare costs. Disease development is complex and multifactorial, but there is one part of the body's interlinked ecosystem that is often overlooked in discussions about whole-body health, and that is the skin microbiome. This is despite it being a crucial part of the immune, endocrine, and nervous systems and being continuously exposed to environmental stressors. Here we show that a parallel biodiversity loss of 30-84% has occurred on the skin of people in the developed world compared to our ancestors. Research has shown that dysbiosis of the skin microbiome has been linked to many common skin diseases and, more recently, that it could even play an active role in the development of a growing number of whole-body health problems, such as food allergies, asthma, cardiovascular diseases, and Parkinson's, traditionally thought unrelated to the skin. Damaged skin is now known to induce systemic inflammation, which is involved in many chronic diseases. We highlight that biodiversity loss is not only a common finding in dysbiotic ecosystems but also a type of dysbiosis. As a result, we make the case that biodiversity loss in the skin microbiome is a major contributor to the chronic disease epidemic. The link between biodiversity loss and dysbiosis forms the basis of this paper's focus on the subject. The key to understanding why biodiversity loss creates an unhealthy system could be highlighted by complex physics. We introduce entropy to help understand why biodiversity has been linked with ecosystem health and stability. Meanwhile, we also introduce ecosystems as being governed by "non-linear physics" principles-including chaos theory-which suggests that every individual part of any system is intrinsically linked and implies any disruption to a small part of the system (skin) could have a significant and unknown effect on overall system health (whole-body health). Recognizing the link between ecosystem health and human health allows us to understand how crucial it could be to maintain biodiversity across systems everywhere, from the macro-environment we inhabit right down to our body's microbiome. Further, in-depth research is needed so we can aid in the treatment of chronic diseases and potentially change how we think about our health. With millions of people currently suffering, research to help mitigate the crisis is of vital importance.
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Affiliation(s)
| | - Nancy Pearlman
- Ecology Center of Southern California, Los Angeles, CA 90035, USA;
| | | | - Dragos Cretoiu
- Department of Medical Genetics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 011062 Bucharest, Romania
| | - Dana Claudia Thompson
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 011062 Bucharest, Romania
| | - Silviu Cristian Voinea
- Department of Surgical Oncology, Prof. Dr. Al. Trestioreanu Oncology Institute, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania
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Fereidan‐Esfahani M, Decker PA, Weigand SD, Lopez Chiriboga AS, Flanagan EP, Tillema J, Lucchinetti CF, Eckel‐Passow JE, Tobin WO. Defining the natural history of tumefactive demyelination: A retrospective cohort of 257 patients. Ann Clin Transl Neurol 2023; 10:1544-1555. [PMID: 37443413 PMCID: PMC10502639 DOI: 10.1002/acn3.51844] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE To describe demographic, clinical, and radiographic features of tumefactive demyelination (TD) and identify factors associated with severe attacks and poor outcomes. METHODS Retrospective review of TD cases seen at Mayo Clinic, 1990-2021. RESULTS Of 257 patients with TD, 183/257 (71%) fulfilled the 2017 multiple sclerosis (MS) McDonald criteria at the last follow-up, 12/257 (5%) had myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), 0 had aquaporin-4-IgG seropositive neuromyelitis optic spectrum disorders (AQP4+ NMOSD), and 62/257 (24%) were cryptogenic. Onset before age 18 was present in 18/257 (7%). Female to male ratio was 1.3:1. Cerebrospinal fluid oligoclonal (CSF) bands were present in 95/153 (62%). TD was the first demyelinating attack in 176/257 (69%). At presentation, 59/126 (47%) fulfilled Barkhof criteria for dissemination in space, 59/100 (59%) had apparent diffusion coefficient (ADC) restriction, and 57/126 (45%) had mass effect. Despite aggressive clinical presentation at onset, 181/257 (70%) of patients remained fully ambulatory (Expanded Disability Status Scale [EDSS] ≤4) after a 3.0-year median follow-up duration. Severe initial attack-related disability (EDSS ≥4) was more common in patients with motor symptoms (81/143 vs. 35/106, p < 0.0001), encephalopathy (20/143 vs. 2/106, p < 0.0001) and ADC restriction on initial MRI (42/63 vs. 15/33, p = 0.04). Poor long-term outcome (EDSS ≥4) was more common in patients with older onset age (41.9 ± 15 vs. 36.8 ± 15.6, p = 0.02) and motor symptoms at onset (49/76 vs. 66/171, p < 0.0001). INTERPRETATION Most TD patients should be considered part of the MS spectrum after excluding MOGAD and NMOSD. Motor symptoms and older age at presentation portend a poor outcome.
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Affiliation(s)
- Mahboubeh Fereidan‐Esfahani
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
- Dell Medical SchoolUniversity of TexasAustinTexasUSA
| | - Paul A Decker
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Stephen D. Weigand
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | | | - Eoin P Flanagan
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
- Department of Laboratory Medicine and PathologyMinneapolisMinnesotaUSA
| | - Jan‐Mendelt Tillema
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Claudia F Lucchinetti
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
| | | | - W. Oliver Tobin
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
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Chen JJ, Flanagan EP, Pittock SJ, Stern NC, Tisavipat N, Bhatti MT, Chodnicki KD, Tajfirouz DA, Jamali S, Kunchok A, Eggenberger ER, Nome MAD, Sotirchos ES, Vasileiou ES, Henderson AD, Arnold AC, Bonelli L, Moss HE, Navarro SEV, Padungkiatsagul T, Stiebel-Kalish H, Lotan I, Wilf-Yarkoni A, Danesh-Meyer H, Ivanov S, Huda S, Forcadela M, Hodge D, Poullin P, Rode J, Papeix C, Saheb S, Boudot de la Motte M, Vignal C, Hacohen Y, Pique J, Maillart E, Deschamps R, Audoin B, Marignier R. Visual Outcomes Following Plasma Exchange for Optic Neuritis: An International Multicenter Retrospective Analysis of 395 Optic Neuritis Attacks. Am J Ophthalmol 2023; 252:213-224. [PMID: 36822570 PMCID: PMC10363193 DOI: 10.1016/j.ajo.2023.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE To evaluate the effectiveness of plasma exchange (PLEX) for optic neuritis (ON). METHODS We conducted an international multicenter retrospective study evaluating the outcomes of ON following PLEX. Outcomes were compared to raw data from the Optic Neuritis Treatment Trial (ONTT) using a matched subset. RESULTS A total of 395 ON attack treated with PLEX from 317 patients were evaluated. The median age was 37 years (range 9-75), and 71% were female. Causes of ON included multiple sclerosis (108), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) (92), aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4+NMOSD) (75), seronegative-NMOSD (34), idiopathic (83), and other (3). Median time from onset of vision loss to PLEX was 2.6 weeks (interquartile range [IQR], 1.4-4.0). Median visual acuity (VA) at the time of PLEX was count fingers (IQR, 20/200-hand motion), and median final VA was 20/25 (IQR, 20/20-20/60) with no differences among etiologies except MOGAD-ON, which had better outcomes. In 81 (20.5%) ON attacks, the final VA was 20/200 or worse. Patients with poor outcomes were older (P = .002), had worse VA at the time of PLEX (P < .001), and longer delay to PLEX (P < .001). In comparison with the ONTT subset with severe corticosteroid-unresponsive ON, a final VA of worse than 20/40 occurred in 6 of 50 (12%) PLEX-treated ON vs 7 of 19 (37%) from the ONTT treated with intravenous methylprednisolone without PLEX (P = .04). CONCLUSION Most ON attacks improved with PLEX, and outcomes were better than attacks with similar severity in the ONTT. The presence of severe vision loss at nadir, older age, and longer delay to PLEX predicted a worse outcome whereas MOGAD-ON had a more favorable prognosis. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- John J Chen
- Departments of Ophthalmology (J.J.C., N.C.S., K.D.C., D.A.T., S.J.); Neurology (J.J.C., E.P.F., S.J.P., N.T., D.A.T., A.K.).
| | - Eoin P Flanagan
- Neurology (J.J.C., E.P.F., S.J.P., N.T., D.A.T., A.K.); Laboratory Medicine and Pathology (E.P.F., S.J.P.); Center for MS and Autoimmune Neurology (E.P.F., S.J.P., A.K.), Mayo Clinic, Rochester, Minnesota, USA
| | - Sean J Pittock
- Neurology (J.J.C., E.P.F., S.J.P., N.T., D.A.T., A.K.); Laboratory Medicine and Pathology (E.P.F., S.J.P.); Center for MS and Autoimmune Neurology (E.P.F., S.J.P., A.K.), Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - M Tariq Bhatti
- The Permanente Medical Group (M.T.B.), Kaiser Permanente-Northern California, Roseville, California, USA
| | | | - Deena A Tajfirouz
- Departments of Ophthalmology (J.J.C., N.C.S., K.D.C., D.A.T., S.J.); Neurology (J.J.C., E.P.F., S.J.P., N.T., D.A.T., A.K.)
| | - Sepideh Jamali
- Departments of Ophthalmology (J.J.C., N.C.S., K.D.C., D.A.T., S.J.)
| | - Amy Kunchok
- Neurology (J.J.C., E.P.F., S.J.P., N.T., D.A.T., A.K.); Center for MS and Autoimmune Neurology (E.P.F., S.J.P., A.K.), Mayo Clinic, Rochester, Minnesota, USA; Department of Neurology, Cleveland Clinic (A.K.), Cleveland, Ohio, USA
| | - Eric R Eggenberger
- Departments of Neurology, Neurosurgery, and Neuro-Ophthalmology, Mayo Clinic (E.R.E.), Jacksonville, Florida, USA
| | - Marie A Di Nome
- Departments of Ophthalmology (M.A.D.N.); Neurosurgery, Mayo Clinic (M.A.D.N.), Scottsdale, AZ
| | - Elias S Sotirchos
- Department of Neurology, Johns Hopkins University (E.S.S., E.S.V., A.D.H.), Baltimore, Maryland, USA
| | - Eleni S Vasileiou
- Department of Neurology, Johns Hopkins University (E.S.S., E.S.V., A.D.H.), Baltimore, Maryland, USA
| | - Amanda D Henderson
- Department of Neurology, Johns Hopkins University (E.S.S., E.S.V., A.D.H.), Baltimore, Maryland, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine (A.D.H.), Baltimore, Maryland, USA
| | - Anthony C Arnold
- Department of Ophthalmology, University of California Los Angeles (A.C.A., L.B.), Los Angeles, California, USA
| | - Laura Bonelli
- Department of Ophthalmology, University of California Los Angeles (A.C.A., L.B.), Los Angeles, California, USA
| | - Heather E Moss
- Department of Neurology & Neurological Sciences, Stanford University (H.E.M.), Palo Alto, California, USA; Department of Ophthalmology, Stanford University (H.E.M., S.E.V.N., T.P.), Palo Alto, California, USA
| | | | - Tanyatuth Padungkiatsagul
- Department of Ophthalmology, Stanford University (H.E.M., S.E.V.N., T.P.), Palo Alto, California, USA; Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital (T.P.), Mahidol University, Bangkok, Thailand
| | - Hadas Stiebel-Kalish
- Department of Ophthalmology (H.S.-K.), Neuro-Ophthalmology Division, Rabin Medical Center and Sackler School of Medicine, Tel Aviv University, Israel; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel
| | - Itay Lotan
- Department of Neurology, Rabin Medical Center, Sackler School of Medicine (I.L., A.W.-Y.), Tel Aviv University, Israel
| | - Adi Wilf-Yarkoni
- Department of Neurology, Rabin Medical Center, Sackler School of Medicine (I.L., A.W.-Y.), Tel Aviv University, Israel
| | - Helen Danesh-Meyer
- Department of Ophthalmology, University of Auckland, New Zealand, and Vision Research Foundation (H.D.-M., S.I.), Auckland, New Zealand
| | - Stefan Ivanov
- Department of Ophthalmology, University of Auckland, New Zealand, and Vision Research Foundation (H.D.-M., S.I.), Auckland, New Zealand
| | - Saif Huda
- Department of Neurology, The Walton Centre NHS Foundation Trust (S.H., M.F.), Liverpool, United Kingdom
| | - Mirasol Forcadela
- Department of Neurology, The Walton Centre NHS Foundation Trust (S.H., M.F.), Liverpool, United Kingdom
| | - David Hodge
- Department of Quantitative Health Sciences, Mayo Clinic (D.H.), Jacksonville, Florida
| | - Pascale Poullin
- Department of Neurology, University Hospital of Marseille (P.P., J.R., B.A.), Marseille, France; Aix-Marseille University, CRMBM UMR 7339, CNRS (P.P., J.R., B.A.), Marseille, France
| | - Julie Rode
- Department of Neurology, University Hospital of Marseille (P.P., J.R., B.A.), Marseille, France; Aix-Marseille University, CRMBM UMR 7339, CNRS (P.P., J.R., B.A.), Marseille, France
| | - Caroline Papeix
- Department of Neurology, Pitie-Salpetriere Hospital, APHP (C.P., S.S., E.M.), Paris, France; Centre de référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM) (C.P., S.S., E.M.); Department of Neurology, Adolphe de Rothschild Foundation Hospital (C.P., M.B.d.l.M., R.D.), Paris, France
| | - Samir Saheb
- Department of Neurology, Pitie-Salpetriere Hospital, APHP (C.P., S.S., E.M.), Paris, France; Centre de référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM) (C.P., S.S., E.M.)
| | - Marine Boudot de la Motte
- Department of Neurology, Adolphe de Rothschild Foundation Hospital (C.P., M.B.d.l.M., R.D.), Paris, France
| | - Catherine Vignal
- Department of Neuro-Ophthalmology, Adolphe de Rothschild Foundation Hospital (C.V.), Paris, France
| | - Yael Hacohen
- Department of Neurology, Great Ormond Street Hospital for Children (Y.H.), London, United Kingdom; Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (Y.H.), London, United Kingdom
| | - Julie Pique
- Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon (J.P., R.M.), Lyon, France
| | - Elisabeth Maillart
- Department of Neurology, Pitie-Salpetriere Hospital, APHP (C.P., S.S., E.M.), Paris, France; Centre de référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM) (C.P., S.S., E.M.)
| | - Romain Deschamps
- Department of Neurology, Adolphe de Rothschild Foundation Hospital (C.P., M.B.d.l.M., R.D.), Paris, France
| | - Bertrand Audoin
- Department of Neurology, University Hospital of Marseille (P.P., J.R., B.A.), Marseille, France; Aix-Marseille University, CRMBM UMR 7339, CNRS (P.P., J.R., B.A.), Marseille, France
| | - Romain Marignier
- Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon (J.P., R.M.), Lyon, France
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Taghizadeh-Diva SE, Khosravi A, Zolfaghari S, Hosseinzadeh A. Multiple sclerosis incidence temporal trend in the Northeast of Iran: Using the Empirical Bayesian method. Mult Scler Relat Disord 2023; 70:104469. [PMID: 36587485 DOI: 10.1016/j.msard.2022.104469] [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: 09/20/2022] [Revised: 11/05/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND In recent years dramatic changes in multiple sclerosis (MS) incidence have been reported in different provinces in Iran. This study was conducted to assess MS incidence temporal trends from March 21, 2005, to March 20, 2020, and provide a forecast until the end of 2025 in Shahroud county. METHODS This longitudinal study was carried out based on the data obtained from the MS registration system in Shahroud county. First, the annual incidence rates were calculated based on the year of diagnosis and smoothed using the Empirical Bayesian Method. Then temporal trends and annual percent change (APC) of MS incidence were analyzed using Joinpoint (JP) regression. Finally, the univariate time series model analysis was used to estimate the MS incidence trend until the end of 2025. RESULTS A total of 234 newly diagnosed cases (60 [25.64%] males and 174 [74.36.4%] females) were examined in this study. The mean age of patients at the time of diagnosis was 31.40 ± 3.78. It was 32.01 ± 6.35 and 30.66 ± 4.27 years for males and females, respectively (P<0.22). The mean annual MS incidence was 5.99 ± 1.46, 3.03 ± 0.21, and 8.98 ± 2.79 per 100,000 in overall, males and females respectively. The MS incidence increased significantly from 5.67 (95% CI: 3.63-7.99) in 2005 to 7.58 (95% CI: 5.17-10.28) in 2020 with an APC of 4.5 (2.8 - 6.1). The MS incidence had a non-linear time trend in the study period and the best time trend fitted to the annual MS incidence trend was the non-linear quadratic curve. Based on this model, the annual MS incidence is expected to increase until the end of 2025. CONCLUSION Shahroud county is one of the high-risk areas for MS and the increasing trend of MS incidence in it is similar to regional and global changes. This study, also, showed that MS incidence in Shahroud county will be increasing in the coming years.
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Affiliation(s)
- Seyed Esmail Taghizadeh-Diva
- Student Research Committee, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran; Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ahmad Khosravi
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Sepideh Zolfaghari
- Deputy of Curative Affairs, Shahroud university of medical science, Shahroud, Iran
| | - Ali Hosseinzadeh
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran.
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Langer-Gould AM, Gonzales EG, Smith JB, Li BH, Nelson LM. Racial and Ethnic Disparities in Multiple Sclerosis Prevalence. Neurology 2022; 98:e1818-e1827. [PMID: 35501161 PMCID: PMC9109151 DOI: 10.1212/wnl.0000000000200151] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The goal of this work was to determine whether the prevalence of multiple sclerosis (MS) varies by race and ethnicity. METHODS We conducted a retrospective cohort study of >2.6 million adults from the multiethnic, community-dwelling members of Kaiser Permanente Southern California. The complete electronic health records of individuals with at least 1 ICD-9 code for MS between January 1, 2008 and December 31, 2010 were reviewed. MS prevalence and 95% CIs stratified by age, sex, and race and ethnicity among 2010 members were estimated with binomial regression. Age- and sex-standardized prevalence was estimated according to the 2010 US Census population. RESULTS We identified 3,863 patients with MS. The average age of patients with prevalent MS was 51.7 years (SD 13.1 years), and 76.8% were women. The female preponderance was more pronounced among Black (81.2%) and Asian (83.6%) than White (76.3%) or Hispanic (74.5%) individuals with MS. Age- and sex-standardized MS prevalence per 100,000 was similarly high among Black (225.8, 95% CI 207.1-244.5) and White (237.7, 95% CI 228.2-247.2) and significantly lower among Hispanic (69.9, 95% CI 64.4-75.5) and Asian (22.6, 95% CI 17.1-28.1) persons. MS prevalence was highest between the ages of 35 and 64 years and declined after 65 years of age across all racial and ethnic groups. Among adults 18 to 24 years of age, the crude MS prevalence was low but was highest among Black and Hispanic young adults, lower in White people, and lowest in Asian/Pacific Islander individuals (48.5, 25.0, 18.0, and 7.1 per 100,000, respectively). DISCUSSION MS prevalence varies by race and ethnicity, being similarly high in White and Black and significantly lower in Hispanic and Asian persons in Southern California. Taken together with previous studies, these findings indicate that the burden of MS in the US Black community has long been underrecognized. More studies are needed to determine whether MS is an emerging disease among US Hispanic adults and whether MS susceptibility and prevalence vary among Hispanic or Asian individuals from different cultures or ancestral backgrounds.
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Affiliation(s)
- Annette M Langer-Gould
- From the Los Angeles Medical Center (A.M.L.-G.); Department of Neurology (A.M.L.-G.), and Department of Research & Evaluation (E.G.G., J.B.S., B.H.L.), Southern California Permanente Medical Group, Pasadena; and Department of Epidemiology and Population Health (L.M.N.), Stanford University School of Medicine, CA
| | - Edlin Grisell Gonzales
- From the Los Angeles Medical Center (A.M.L.-G.); Department of Neurology (A.M.L.-G.), and Department of Research & Evaluation (E.G.G., J.B.S., B.H.L.), Southern California Permanente Medical Group, Pasadena; and Department of Epidemiology and Population Health (L.M.N.), Stanford University School of Medicine, CA
| | - Jessica B Smith
- From the Los Angeles Medical Center (A.M.L.-G.); Department of Neurology (A.M.L.-G.), and Department of Research & Evaluation (E.G.G., J.B.S., B.H.L.), Southern California Permanente Medical Group, Pasadena; and Department of Epidemiology and Population Health (L.M.N.), Stanford University School of Medicine, CA
| | - Bonnie H Li
- From the Los Angeles Medical Center (A.M.L.-G.); Department of Neurology (A.M.L.-G.), and Department of Research & Evaluation (E.G.G., J.B.S., B.H.L.), Southern California Permanente Medical Group, Pasadena; and Department of Epidemiology and Population Health (L.M.N.), Stanford University School of Medicine, CA
| | - Lorene M Nelson
- From the Los Angeles Medical Center (A.M.L.-G.); Department of Neurology (A.M.L.-G.), and Department of Research & Evaluation (E.G.G., J.B.S., B.H.L.), Southern California Permanente Medical Group, Pasadena; and Department of Epidemiology and Population Health (L.M.N.), Stanford University School of Medicine, CA
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Fereidan-Esfahani M, Decker PA, Passow JEE, Lucchinetti CF, Flanagan EP, Tobin WO. Population-based incidence and clinico-radiological characteristics of tumefactive demyelination in Olmsted County, Minnesota, United States. Eur J Neurol 2022; 29:782-789. [PMID: 34773343 PMCID: PMC8831478 DOI: 10.1111/ene.15182] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/06/2021] [Accepted: 10/21/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Tumefactive demyelination (TD) presents with large inflammatory lesions mimicking tumors or other space-occupying lesions. Limited epidemiological, clinical and radiological data exist for TD. We aimed to report the incidence rate, and clinical and radiological features of TD in Olmsted County, Minnesota. METHODS We retrospectively reviewed patients with central nervous system inflammatory demyelination-related diagnostic codes (January 1, 1998 to December 31, 2018) in the Rochester Epidemiology Project database, and adjusted incidence rates by age and sex to the 2010 US total population. We used the Expanded Disability Status Scale (EDSS) to assess outcomes (index attack and last follow-up). RESULTS Of 792 multiple sclerosis (MS) patients, 15 (eight males, seven females) had tumefactive MS, representing 1.9% of the MS population. The median (range) age at attack onset was 34.2 (2-61) years. Tumefactive lesion was the first clinical MS attack in 8/16 patients. Cerebrospinal fluid oligoclonal bands (OCBs) were present in 8/12 patients and 11/16 patients met the Barkhof criteria for dissemination in space. Most patients remained fully ambulatory (EDSS score ≤4 in 13/16 patients [81%]) after a median (range) follow-up duration of 10.5 (1-20.5) years. Age-adjusted annual incidence rates were 0.46/100,000 (95% confidence interval [CI] 0.12-0.81) for female patients, 0.66/100,000 (95% CI 0.23-1.02) for male patients, and 0.56/100,000 [95% CI 0.28-0.83] overall. When age- and sex-adjusted to the 2010 US total population, the overall annual incidence rate was 0.57 (95% CI 0.28-0.84). Despite aggressive clinical presentation at disease onset, most patients remained fully ambulatory (EDSS score ≤4 in 13/16 patients) with a relapsing-remitting course. CONCLUSIONS Although incidence is rare, TD should be suspected in patients presenting with subacutely progressive neurological deficits associated with magnetic resonance imaging findings of ring enhancement, apparent diffusion coefficient restriction, and OCB on spinal fluid analysis.
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Affiliation(s)
- Mahboubeh Fereidan-Esfahani
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA.,Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Paul A Decker
- Department of Quantitative Health Sciences, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Jeanette E Eckel Passow
- Department of Quantitative Health Sciences, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Claudia F Lucchinetti
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA.,Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Eoin Patrick Flanagan
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - William Oliver Tobin
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA.,Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA.,Corresponding Author: William Oliver Tobin, M.B., B.Ch., B.A.O., Ph.D., Mayo Clinic, 200 First Street SW, Rochester, MN 55905, Phone: 507-284-3359,
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9
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Benninger F, Steiner I. Non-infectious mechanisms of neurological damage due to infection. J Neurol Sci 2021; 431:120057. [PMID: 34800841 DOI: 10.1016/j.jns.2021.120057] [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: 01/29/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
Infections of the nervous system is a growing aspect of clinical neurology. Accumulating knowledge in early diagnosis, course, therapy and prognosis is enlarging the clinical tools required for effective therapy. Of special importance is the ability to differentiate between proper infections, where anti-microbial agents, when available, should be introduced and used and post infectious conditions where therapy is mainly directed against the host immune system. The two conditions sometimes overlap, a situation that requires the ability to combine clinical skills with the use of laboratory tools such as polymerase chain reaction (PCR), serology, and antigenic detection. In the era of the SARS-CoV-2 pandemic, the need to make this distinction is emphasized as correct diagnosis of post infectious conditions and expedited therapy is important and sometimes lifesaving. We here attempt to present several infectious agents and their possible indirect damage to the nervous system causing in some cases significant neurological deficits. We try to limit our focus on those mechanisms which do not involve the direct tissue damage by the infectious agents but rather are connected to para- and post-infectious mechanisms. We attempt to delineate the features that will enable to tailor the correct diagnosis and following the effective therapy.
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Affiliation(s)
- Felix Benninger
- Felsenstein Medical Research Center, Petach Tikva, Israel; Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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10
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Ozdogar AT, Kahraman T, Ozakbas S, Achiron A, Kalron A. Fatigue is associated with physical inactivity in people with multiple sclerosis despite different environmental backgrounds: Merging and comparing cohorts from Turkey and Israel. Mult Scler Relat Disord 2021; 57:103456. [PMID: 34896878 DOI: 10.1016/j.msard.2021.103456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/15/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Examining leisure-time physical activity in people with multiple sclerosis (PwMS) from different environmental backgrounds might increase understanding and awareness of inactivity in PwMS. Therefore, the study objective was twofold; to compare the level of physical activity in PwMS in Israel and Turkey and to examine the relationship between the level of physical activity with common disease-related symptoms and demographical characteristics of PwMS. METHODS Cross-sectional data collected by two centers were combined. The physical activity level was determined by the Godin Leisure-Time Exercise Questionnaire, and subsequently, classified into one of three subgroups: "active", "moderately active" and "insufficiently active". Logistic regressions determined the risks of insufficiently active PwMS, according to age, gender, body mass index, disability, impact of walking impairment, disease duration, type of MS and perceived fatigue. The analysis of variance test determined the differences between countries in terms of outcome variables. RESULTS The study comprised 458 patients from Israel and 575 from Turkey; 68.2% Turkish PwMS were classified as insufficiently active compared with 52.0% of Israeli PwMS. The percentage of insufficiently active PwMS was significantly higher in those categorized as fatigued compared to non-fatigued in the total cohort (72.4% vs. 51.9%, p<0.001) and in each country separately. Based on the regression analysis, fatigue was the main factor associated with the insufficiently physically active group; odds ratio=1.968. CONCLUSION PwMS with increased fatigue tend to participate in less leisure-time physical activities compared with the non-fatigued. This observation is supported by the merged data collected from two countries, Turkey and Israel, representing PwMS from different environmental backgrounds.
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Affiliation(s)
- Asiye Tuba Ozdogar
- Graduate School of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Serkan Ozakbas
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Anat Achiron
- Sackler Faculty of Medicine, Tel-Aviv University, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel; Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Alon Kalron
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel; Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel; Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine Tel-Aviv University, Israel.
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11
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Koch-Henriksen N, Magyari M. Apparent changes in the epidemiology and severity of multiple sclerosis. Nat Rev Neurol 2021; 17:676-688. [PMID: 34584250 DOI: 10.1038/s41582-021-00556-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 02/08/2023]
Abstract
Multiple sclerosis (MS) is an immunological disease that causes acute inflammatory lesions and chronic inflammation in the CNS, leading to tissue damage and disability. As awareness of MS has increased and options for therapy have come into use, a large amount of epidemiological data have been collected, enabling studies of changes in incidence and disease course over time. Overall, these data seem to indicate that the incidence of MS has increased, but the course of the disease has become milder, particularly in the 25 years since the first disease-modifying therapies (DMTs) became available. A clear understanding of these trends and the reasons for them is important for understanding the factors that influence the development and progression of MS, and for clinical management with respect to prevention and treatment decisions. In this Review, we consider the evidence for changes in the epidemiology of MS, focusing on trends in the incidence of the disease over time and trends in the disease severity. In addition, we discuss the factors influencing these trends, including refinement of diagnostic criteria and improvements in health-care systems that have increased diagnosis in people with mild disease, and the introduction and improvement of DMT.
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Affiliation(s)
- Nils Koch-Henriksen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. .,The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark.,Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
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12
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Correale L, Buzzachera CF, Liberali G, Codrons E, Mallucci G, Vandoni M, Montomoli C, Bergamaschi R. Effects of Combined Endurance and Resistance Training in Women With Multiple Sclerosis: A Randomized Controlled Study. Front Neurol 2021; 12:698460. [PMID: 34421801 PMCID: PMC8374042 DOI: 10.3389/fneur.2021.698460] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: To test the hypothesis that combined resistance and endurance training would improve muscle strength, fatigue, depression, and quality of life in persons with MS. Methods: Twenty-seven women with MS were randomly assigned to either control (CON, n = 13) or the experimental (EXP, n = 14) group. The participants in the EXP group trained twice a week for 12 weeks, followed by 12 weeks of detraining. Both CON and EXP groups were tested before and after 12 weeks of the intervention period, as well as 12 weeks after training cessation (follow-up), where measures of muscle strength, fatigue, depression, and quality of life were evaluated. Results: There were significant changes in maximal voluntary isometric contraction (MVIC), 1RM leg extension, and 1RM chest press following the intervention period in the EXP group (P < 0.05), but not in the CON group (P > 0.05). These changes persisted after 12 weeks of detraining. Similar findings were found for fatigue, depression, and physical and mental composites of quality of life. Conclusion: These results suggest that combined exercise training, at a minimum, prevents the disease-related deterioration of muscular performance and quality of life and well-being in persons with MS.
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Affiliation(s)
- Luca Correale
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | | | - Giulia Liberali
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Erwan Codrons
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Giulia Mallucci
- Inter-Department Multiple Sclerosis Research Centre, National Neurological Institute Casimiro Mondino, Pavia, Italy
| | - Matteo Vandoni
- Laboratory of Adapted Motor Activity, Department of Public Health, Experimental & Forensic Medicine, University of Pavia, Pavia, Italy
| | - Cristina Montomoli
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Roberto Bergamaschi
- Inter-Department Multiple Sclerosis Research Centre, National Neurological Institute Casimiro Mondino, Pavia, Italy
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13
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Kalinowska-Lyszczarz A, Tillema JM, Tobin WO, Guo Y, Fitz-Gibbon PD, Weigand SD, Giraldo-Chica M, Port JD, Lucchinetti CF. Long-term clinical, MRI, and cognitive follow-up in a large cohort of pathologically confirmed, predominantly tumefactive multiple sclerosis. Mult Scler 2021; 28:441-452. [PMID: 34212755 DOI: 10.1177/13524585211024162] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited studies have described long-term outcomes in pathology confirmed multiple sclerosis (MS). OBJECTIVES To describe long-term clinical-radiographic-cognitive outcomes in a prospectively followed cohort of patients with pathologically confirmed CNS demyelinating disease, consistent with MS. METHODS Subjects underwent clinical assessment, standardized 3T-MRI brain, and cognitive battery. RESULTS Seventy-five patients were included. Biopsied lesion size was ⩾ 2 cm in 62/75. At follow-up, median duration since biopsy was 11 years. Median EDSS was 3 and lesion burden was large (median 10 cm3). At follow-up, 57/75 met MS criteria, 17/75 had clinically isolated syndrome, and 1 radiographic changes only. Disability scores were comparable to a prevalence cohort in Olmsted County (p < 0.001, n = 218). Cognitive outcomes below age-normed standards included psychomotor, attention, working memory, and executive function domains. Total lesion volume and index lesion-related severity correlated with EDSS and cognitive performance. Volumetric cortical/subcortical GM correlated less than lesion metrics to cognitive outcomes. CONCLUSION Despite early aggressive course in pathologically confirmed MS, its long-term course was comparable to typical MS in our study. Cognitive impairment in this group seemed to correlate strongest to index lesion severity and total lesion volume. It remains to be established how the aggressive nature of the lesion, biopsy, and treatment affect clinical/cognitive outcomes.
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Affiliation(s)
- Alicja Kalinowska-Lyszczarz
- Department of Neurology, Mayo Clinic, Rochester, MN, USA/Department of Neurology, Poznań University of Medical Sciences, Poznań, Poland
| | | | - W Oliver Tobin
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Yong Guo
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Stephen D Weigand
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - John D Port
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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14
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U.S. Population-Based background incidence rates of medical conditions for use in safety assessment of COVID-19 vaccines. Vaccine 2021; 39:3666-3677. [PMID: 34088506 PMCID: PMC8118666 DOI: 10.1016/j.vaccine.2021.05.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/20/2021] [Accepted: 05/05/2021] [Indexed: 11/21/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has had a devastating impact on global health, and has resulted in an unprecedented, international collaborative effort to develop vaccines to control the outbreak, protect human lives, and avoid further social and economic disruption. Mass vaccination campaigns are underway in multiple countries and are expected worldwide once more vaccine becomes available. Some early candidate vaccines use novel platforms, such as mRNA encapsulated in lipid nanoparticles, and relatively new platforms, such as replication-deficient viral vectors. While these new vaccine platforms hold promise, limited safety data in humans are available. Serious health outcomes linked to vaccinations are rare, and some outcomes may occur incidentally in the vaccinated population. Knowledge of background incidence rates of these medical conditions is a critical component of vaccine safety monitoring to aid in the assessment of adverse events temporally associated with vaccination and to put these events into context with what would be expected due to chance alone. A list of 22 potential adverse events of special interest (AESI), including neurologic, autoimmune, and cardiovascular disorders, was compiled by subject matter experts at the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention. The most recently available U.S. background rates for these medical conditions, overall and by age, sex, and race/ethnicity (when available), were sourced from reported statistics (data published by medical panels/ associations or federal government reports), and literature reviews in PubMed. This review provides estimates of background incidence rates for medical conditions that may be monitored or studied as AESI during safety surveillance and research for COVID-19 vaccines and other new vaccines.
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15
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Hutto SK, Rice DR, Mateen FJ. CNS demyelination with TNFα inhibitor exposure: A retrospective cohort study. J Neuroimmunol 2021; 356:577587. [PMID: 33945946 DOI: 10.1016/j.jneuroim.2021.577587] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/21/2021] [Accepted: 04/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study long-term outcomes in patients with CNS demyelinating events exposed to TNFa-inhibitors (TNFai), including subsequent clinical relapse, MRI lesions, and use of disease modifying therapy (DMT) for MS. METHODS Adult patients evaluated for a CNS demyelinating disease during TNFai use were identified at Mass General Brigham [01/1998-08/2020] and analyzed in clinically-relevant subgroups. Inclusion criteria required a first neurological event while taking a TNFai, MRI lesions consistent with demyelination, and the absence of a more probable alternative diagnosis. RESULTS 21 cases (mean age 44 years, 20 female, 14 ≥ 2 MS risk factors) had an index neurological event (INE) at a median of 12 months (range 1-176) from onset of TNFai use (adalimumab in 10, etanercept 6, infliximab 5). MRI lesions were most often present in periventricular (16/20, 80%) and spinal zones (10/20, 50%); 37% (7/19) met ≥ 2 Barkhof criteria at onset. CSF testing was abnormal in 64% (7/11). 67% (10/15) with available follow-up MRIs developed new lesions by a median of 29.5 months of MRI surveillance (median MRI surveillance 60 months); 55% (11/20) met ≥ 2 Barkhof criteria. 47% (8/17) suffered a clinical relapse by a median of 40.5 months of clinic follow-up (median clinic follow-up since INE: 26 months). In patients discontinuing TNFai (18/21, 86%) at INE onset, 56% (10/18) had further evidence of CNS demyelination. Six patients (6/21, 29%) started an MS disease modifying therapy (DMT) at INE of whom 50% (3/6) had subsequent disease activity. Continuing or restarting TNFai was followed by relapse in 75% (3/4). 65% (13/20) met 2017 McDonald criteria for MS at INE with another 10% (15/20, 75%) by study conclusion. CONCLUSIONS With extended follow-up, a majority of patients had a relapsing CNS demyelinating disorder-as evidenced by new MRI lesions or clinical relapses-despite TNFai discontinuation.
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Affiliation(s)
- Spencer K Hutto
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Dylan R Rice
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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16
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Bonnan M, Berthelot E, Cabre P. Multiple sclerosis-like NMOSD patients suffer severe worsening of status after fingolimod initiation. Mult Scler Relat Disord 2021; 52:102975. [PMID: 33951589 DOI: 10.1016/j.msard.2021.102975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Initial clinical manifestations of NMOSD may rarely overlap with MS. Fingolimod may trigger severe attacks in patients with NMOSD previously misdiagnosed as MS. These cases are rare and their pathophysiology remains elusive. METHODS We recruited all NMOSD patients treated by fingolimod in a single-center cohort of Afro-Caribbean neuro-inflammatory patients in Fort-de-France (French West Indies). Six patients were collected from the literature. RESULTS Among 622 patients followed locally for MS, 101 received fingolimod and two suffered severe attacks revealing a typical NMOSD presentation. These two patients were found to have AQP4-IgG. The risk of misdiagnosed NMOSD in MS in our high-risk Afro-Caribbean patients was estimated to be 1.9% (0 to 4.7%). Among the whole cohort, relapses occurred within a month after fingolimod initiation in five patients. All attacks were severe and contrasted with previously benign attacks, suggesting a shift to a more severe disorder. An unusual finding in these patients was large brain lesions. CONCLUSION AQP4-IgG should be obtained before initiation of fingolimod in high-risk patients, especially in those from areas of high NMOSD prevalence.
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Affiliation(s)
- Mickael Bonnan
- Service de Neurologie, Centre Hospitalier de Pau, 4 Bd Hauterive, 64000 Pau, France.
| | - Emeline Berthelot
- Service de Neurologie, Hôpital Zobda Quitman, 97261 Fort-de-France, French West Indies
| | - Philippe Cabre
- Service de Neurologie, Hôpital Zobda Quitman, 97261 Fort-de-France, French West Indies
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17
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Chen X, Hou H, Qiao H, Fan H, Zhao T, Dong M. Identification of blood-derived candidate gene markers and a new 7-gene diagnostic model for multiple sclerosis. Biol Res 2021; 54:12. [PMID: 33795012 PMCID: PMC8015180 DOI: 10.1186/s40659-021-00334-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/08/2021] [Indexed: 02/08/2023] Open
Abstract
Background Multiple sclerosis (MS) is a central nervous system disease with a high disability rate. Modern molecular biology techniques have identified a number of key genes and diagnostic markers to MS, but the etiology and pathogenesis of MS remain unknown. Results In this study, the integration of three peripheral blood mononuclear cell (PBMC) microarray datasets and one peripheral blood T cells microarray dataset allowed comprehensive network and pathway analyses of the biological functions of MS-related genes. Differential expression analysis identified 78 significantly aberrantly expressed genes in MS, and further functional enrichment analysis showed that these genes were associated with innate immune response-activating signal transduction (p = 0.0017), neutrophil mediated immunity (p = 0.002), positive regulation of innate immune response (p = 0.004), IL-17 signaling pathway (p < 0.035) and other immune-related signaling pathways. In addition, a network of MS-specific protein–protein interactions (PPI) was constructed based on differential genes. Subsequent analysis of network topology properties identified the up-regulated CXCR4, ITGAM, ACTB, RHOA, RPS27A, UBA52, and RPL8 genes as the hub genes of the network, and they were also potential biomarkers of MS through Rap1 signaling pathway or leukocyte transendothelial migration. RT-qPCR results demonstrated that CXCR4 was obviously up-regulated, while ACTB, RHOA, and ITGAM were down-regulated in MS patient PBMC in comparison with normal samples. Finally, support vector machine was employed to establish a diagnostic model of MS with a high prediction performance in internal and external datasets (mean AUC = 0.97) and in different chip platform datasets (AUC = (0.93). Conclusion This study provides new understanding for the etiology/pathogenesis of MS, facilitating an early identification and prediction of MS.
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Affiliation(s)
- Xin Chen
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Huiqing Hou
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Huimin Qiao
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Haolong Fan
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Tianyi Zhao
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Mei Dong
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.
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Tian DC, Zhang C, Yuan M, Yang X, Gu H, Li Z, Wang Y, Shi FD. Incidence of multiple sclerosis in China: A nationwide hospital-based study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2020; 1:100010. [PMID: 34327341 PMCID: PMC8315658 DOI: 10.1016/j.lanwpc.2020.100010] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a leading cause of disability among young adults and effects considerable social and economic burdens. Data of MS incidence in China at the national level is lacking. We conducted the first nationwide hospital-based study to estimate the incidence and hospitalization burden of MS in China. METHODS This study is based on an administrative database of the National Hospital Quality Monitoring System, which covers all 1665 tertiary hospitals in mainland China. The "Medical Record Homepage" of all patients, including 346 variables including demographic characteristics, diagnoses, procedures, and expenses etc., were uniformly collected across each tertiary hospital via standard protocol. MS was defined by the 2010 International Panel criteria for MS and was identified by ICD-10 code (G35•0). FINDINGS We identified 27,336 hospital admissions for 15,060 MS patients from 2016 to 2018; amongst these patients, 9,879 were newly diagnosed. The age- and sex-adjusted incidence per 100,000 person-years is 0•235 (95% confidence interval [CI] 0•230-0•240), with 0•055 (0•050-0•060) in children and 0•288 (0•282-0•294) in adults, respectively. The female to male ratio is 2•02; the peak disease onset is age of 40-49 years. Residents in high-latitude and high-altitude areas are more likely to develop MS (F = 8•99; p < 0•001). Prevalent comorbidities include hypertension (18•8%), diabetes (7•2%), stroke (14•7%), depression or anxiety (3•7%), and autoimmune disease (2•3%). Through 2016-2018, 104 adults and 2 children died, with a hospital mortality rate of 9•9 per 1,000 person-years. INTERPRETATION For the first time, we obtain the national incidence of MS as 0.055 in children and 0.288 in adults per 100,000 in China. The geographical distribution of MS incidence presented a north-south latitude gradient and a west-east altitude gradient. FUNDING National Science Foundation of China (81801199, 91642205, and 81830038); Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing.
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Affiliation(s)
- De-Cai Tian
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Chengyi Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Meng Yuan
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Hongqiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Zixiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Fu-Dong Shi
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China
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19
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Zeydan B, Lowe VJ, Reichard RR, Przybelski SA, Lesnick TG, Schwarz CG, Senjem ML, Gunter JL, Parisi JE, Machulda MM, Vemuri P, Mielke MM, Knopman DS, Petersen RC, Jack CR, Kantarci OH, Kantarci K. Imaging Biomarkers of Alzheimer Disease in Multiple Sclerosis. Ann Neurol 2020; 87:556-567. [PMID: 31970802 PMCID: PMC7078013 DOI: 10.1002/ana.25684] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/07/2020] [Accepted: 01/19/2020] [Indexed: 12/13/2022]
Abstract
Objective To investigate β‐amyloid and tau depositions using Pittsburgh compound B (PiB) positron emission tomography (PET) and AV1451 tau PET imaging in aging multiple sclerosis (MS) patients. Methods Patients with MS (n = 16) and controls (n = 80) matched for age, sex, and APOE ε4 status from the population‐based Mayo Clinic Study of Aging who underwent PiB PET imaging were studied. Of these individuals, 12 patients with MS and 60 matching controls also underwent AV1451 tau PET. Cortical PiB and AV1451 standard uptake value ratios (SUVrs) from the entire cortex and previously determined Alzheimer disease (AD) signature regions in the same population were calculated for group comparisons and testing for associations with age. Results AD signature PiB SUVr (odds ratio [OR] [95% confidence interval (CI)] = 0.52 [0.27–0.98], p = 0.044), total cortical PiB SUVr (OR [95% CI] = 0.52 [0.28–0.99], p = 0.048), and the frequency of abnormal PiB SUVrs (OR [95% CI] = 0.10 [0.01–0.90], p = 0.040) were lower in MS than controls. Although AD‐signature and total cortical AV1451 SUVrs were not different between the groups, the frequency of abnormal AV1451 SUVrs was higher (OR [95% CI] = 10.65 [1.10–103.35], p = 0.041) in MS than controls. The association of AD signature PiB SUVr with age was steeper in the controls compared to patients with MS (estimate [95% CI] = −0.14 [−0.023 to −0.006], p = 0.002). Similarly, the association of total cortical PiB SUVr with age was steeper in the controls compared to patients with MS (estimate [95% CI] = −0.13 [−0.021 to −0.005], p = 0.002). There was no difference in the association of AV1451 SUVr findings with age between the MS patients and controls. Interpretation Although both β‐amyloid and tau are biomarkers of cognitive aging and AD, cortical β‐amyloid deposition was lower in MS than age‐matched controls, suggesting that some aspect of MS pathobiology retards the accumulation of β‐amyloid but not the accumulation of tau. ANN NEUROL 2020;87:556–567
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Affiliation(s)
- Burcu Zeydan
- Department of Radiology, Mayo Clinic, Rochester, MN.,Department of Neurology, Mayo Clinic, Rochester, MN.,Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - Ross R Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | | | | | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN.,Department of Information Technology, Mayo Clinic, Rochester, MN
| | - Jeffrey L Gunter
- Department of Radiology, Mayo Clinic, Rochester, MN.,Department of Information Technology, Mayo Clinic, Rochester, MN
| | - Joseph E Parisi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | | | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | | | - Orhun H Kantarci
- Department of Neurology, Mayo Clinic, Rochester, MN.,Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN
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20
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Vaughn CB, Jakimovski D, Kavak KS, Ramanathan M, Benedict RHB, Zivadinov R, Weinstock-Guttman B. Epidemiology and treatment of multiple sclerosis in elderly populations. Nat Rev Neurol 2020; 15:329-342. [PMID: 31000816 DOI: 10.1038/s41582-019-0183-3] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The prevalence of multiple sclerosis (MS) and the age of affected patients are increasing owing to increased longevity of the general population and the availability of effective disease-modifying therapies. However, ageing presents unique challenges in patients with MS largely as a result of their increased frequency of age-related and MS-related comorbidities as well as transition of the disease course from an inflammatory to a neurodegenerative phenotype. Immunosenescence (the weakening of the immune system associated with natural ageing) might be at least partly responsible for this transition, which further complicates disease management. Currently approved therapies for MS are effective in preventing relapse but are not as effective in preventing the accumulation of disability associated with ageing and disease progression. Thus, ageing patients with MS represent a uniquely challenging population that is currently underserved by existing therapeutic regimens. This Review focuses on the epidemiology of MS in ageing patients. Unique considerations relevant to this population are discussed, including the immunology and pathobiology of the complex relationship between ageing and MS, the safety and efficacy of disease-modifying therapies, when discontinuation of treatment might be appropriate and the important role of approaches to support wellness and cognition.
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Affiliation(s)
- Caila B Vaughn
- Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York (SUNY), Buffalo, NY, USA
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York (SUNY), Buffalo, NY, USA
| | - Katelyn S Kavak
- Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York (SUNY), Buffalo, NY, USA
| | - Murali Ramanathan
- Department of Pharmaceutical Sciences, Jacobs School of Medicine and Biomedical Sciences, State University of New York (SUNY), Buffalo, NY, USA
| | - Ralph H B Benedict
- Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York (SUNY), Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York (SUNY), Buffalo, NY, USA.,Center for Biomedical Imaging at the Clinical Translational Science Institute, State University of New York (SUNY), Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York (SUNY), Buffalo, NY, USA.
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21
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Increasing prevalence of multiple sclerosis in Tuscany, Italy. Neurol Sci 2019; 41:397-402. [PMID: 31691867 DOI: 10.1007/s10072-019-04090-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND RATIONALE An increase of prevalence and incidence of multiple sclerosis (MS) has been reported in several countries, especially taking into account a long-term evaluation. This increasing trend often reflects improved case identification and ascertainment due to the refinement of diagnostic criteria. The aim of this study was to update the prevalence rate of MS in Tuscany (central Italy) as of 2017, and to assess if there has been an increasing trend of prevalence in this Region considering a short period of analysis, from 2014 to 2017. METHODS To capture prevalent cases, a case-finding algorithm based on administrative data, previously created and validated, was used. As data sources, we considered hospital discharge records, drug-dispensing records, disease-specific exemptions from copayment to health care, home and residential long-term care, and inhabitant registry. RESULTS As of January 1, 2017, 7809 cases were identified, of which 69.4% were females and 30.6% were males. Considering temporal variation, an increasing trend was observed, with standardized rates rising from 189.2 in 2014 to 208.7 per 100,000 in 2017. CONCLUSIONS Results confirm that prevalence increases every year, probably mainly due to the difference between incidence and mortality, resulting in an increasing trend. Moreover, administrative data may accurately identify MS patients in a routinary way and monitor this cohort along disease care pathways.
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22
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Hosseinzadeh A, Baneshi MR, Sedighi B, Kermanchi J, Haghdoost AA. Incidence of multiple sclerosis in Iran: a nationwide, population-based study. Public Health 2019; 175:138-144. [PMID: 31476710 DOI: 10.1016/j.puhe.2019.07.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/22/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The incidence of multiple sclerosis (MS) is not well known in Iran. This study was conducted to estimate the trends in annual MS incidence in Iran from March 21, 2010, to March 20, 2016. STUDY DESIGN Longitudinal study. METHODS In this longitudinal study, data for all MS patients fulfilling McDonald criteria were obtained from a national registry, coordinated by the Ministry of Health (MOH). In Iran, all MS patients are eligible to receive public care and treatment services based on their records in this registry, and thus nearly all MS patients are registered in this database. The annual incidence rates were calculated based on year of diagnosis and were standardized using the World Health Organization (2000-2025) population as a standard. RESULTS In this registry, 36,287 (8202 [22.6%] males and 28,085 [77.4%] females) confirmed MS cases were registered by the MOH between 2010 and 2016. The female-to-male ratio was 3.11. The mean age of patients was 31.6 ± 0.9 years at the time of diagnosis. It was 31.3 ± 0.8 and 32.3 ± 0.9 for females and males, respectively. Overall incidence rate was 6.7/100,000 population (95% confidence interval [CI]: 6.2-7.2); 10.5 and 3.0 in females and males, respectively. The age-adjusted incidence rates increased significantly from 4.4 (95% CI: 4.3-4.6) in 2010 to 5.8 (95% CI: 5.7-6.0) in 2016, with its peak at 6.5 (95% CI: 6.3-6.6) in 2014. CONCLUSIONS This study revealed that Iran is a high-risk area for MS disease and that MS incidence and female-to-male ratio are more or less comparable with the dominant patterns in developed countries. Also, this study showed that the incidence trend of MS in Iran is similar to regional and global observed patterns.
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Affiliation(s)
- A Hosseinzadeh
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - M R Baneshi
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - B Sedighi
- Neurology Research Center, Kerman University of Medical Science, Kerman, Iran
| | - J Kermanchi
- Deputy of Curative Affairs, Ministry of Health and Medical Education (MOHME), Tehran, Iran
| | - A A Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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23
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Aging With Multiple Sclerosis. TOPICS IN GERIATRIC REHABILITATION 2019. [DOI: 10.1097/tgr.0000000000000233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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24
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Wilbanks B, Smestad J, Heider RM, Warrington AE, Rodriguez M, Maher LJ. Optimization of a 40-mer Antimyelin DNA Aptamer Identifies a 20-mer with Enhanced Properties for Potential Multiple Sclerosis Therapy. Nucleic Acid Ther 2019; 29:126-135. [PMID: 30855209 PMCID: PMC6555174 DOI: 10.1089/nat.2018.0776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/06/2019] [Indexed: 12/17/2022] Open
Abstract
We previously reported the in vitro selection and characterization of a DNA aptamer capable of stimulating remyelination in a mouse model of multiple sclerosis. This aptamer was selected for its ability to bind to suspensions of crude murine myelin in vitro. Our initial studies in vitro and in vivo involved a 40-nucleotide derivative (LJM-3064) of the original 100-nucleotide aptamer. LJM-3064 retained robust myelin-binding properties. Structural characterization of LJM-3064 revealed that the guanosine-rich 5' half of the sequence forms different G-quadruplex-type structures that are variably stable in the presence of physiologically relevant ions. We hypothesized that this structured domain is sufficient for myelin binding. In this study, we confirm that a 20-nucleotide DNA, corresponding to the 5' half of LJM-3064, retains myelin-binding properties. We then optimize this minimal myelin-binding aptamer via systematic evolution of ligands by exponential enrichment after sparse rerandomization. We report a sequence variant (LJM-5708) of the 20-nucleotide myelin-binding aptamer with enhanced myelin-binding properties and the ability to bind cultured human oligodendroglioma cells in vitro, providing the first evidence of cross-species reactivity of this myelin-binding aptamer. As our formulation of DNA aptamers for in vivo remyelination therapy involves conjugation to streptavidin, we verified that the myelin-binding properties of LJM-5708 were retained in conjugates to avidin, streptavidin, and neutravidin. DNA aptamer LJM-5708 is a lead for further preclinical development of remyelinating aptamer technologies.
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Affiliation(s)
- Brandon Wilbanks
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - John Smestad
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
- Medical Scientist Training Program, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Robin M. Heider
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Arthur E. Warrington
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
- Department of Immunology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Moses Rodriguez
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
- Department of Immunology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - L. James Maher
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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25
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Wilbanks B, Maher LJ, Rodriguez M. Glial cells as therapeutic targets in progressive multiple sclerosis. Expert Rev Neurother 2019; 19:481-494. [PMID: 31081705 DOI: 10.1080/14737175.2019.1614443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Multiple sclerosis is a serious demyelinating disease of the central nervous system (CNS) with treatments generally restricted to immunosuppression to reduce attack rate and for symptom management. Glial cells may be useful targets for future CNS regenerative therapies to reverse disease. Areas covered: In this review, the authors cover currently available multiple sclerosis treatments and examine potential upcoming therapies targeting glial cells. The potential for new therapeutic approaches in the treatment of progressive multiple sclerosis is examined. Expert opinion: Microglia, astrocytes, and oligodendrocytes are each promising targets for the disease-altering treatment of multiple sclerosis. Though challenging, the opportunities presented have great potential for CNS regeneration and further investigation of glial cells in therapy is warranted. Patient-specific combinatorial therapy targeting the three glial cell types is expected to be the future of MS treatment.
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Affiliation(s)
- Brandon Wilbanks
- a Department of Biochemistry and Molecular Biology , Mayo Clinic College of Medicine and Science , Rochester , MN , USA
| | - L J Maher
- a Department of Biochemistry and Molecular Biology , Mayo Clinic College of Medicine and Science , Rochester , MN , USA
| | - Moses Rodriguez
- b Departments of Neurology and Immunology , Mayo Clinic College of Medicine and Science , Rochester , MN , USA
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26
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Bollaert RE, Motl RW. Self-efficacy and Physical and Cognitive Function in Older Adults with Multiple Sclerosis. Int J MS Care 2019; 21:63-69. [PMID: 31049036 DOI: 10.7224/1537-2073.2018-001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background There is evidence of a demographic shift in the prevalence of multiple sclerosis (MS) such that it is now common in older adults. Older adults with MS undergo declines in function, and aging with MS may compromise one's perception of confidence for managing this disease and its manifestations. This cross-sectional study examined the associations between self-efficacy and physical and cognitive function in older (≥ 60 years) adults with MS. Methods The sample included 40 older adults with MS who completed the Multiple Sclerosis Self-efficacy (MSSE) Scale, undertook measures of physical and cognitive function, and wore an accelerometer for 7 days. The data were analyzed using partial Spearman correlations and linear regression. Results Correlation analyses indicated that function, but not control, subscale scores on the MSSE Scale correlated with all measures of physical, but not cognitive, function. Linear regression analyses indicated that the function subscale of the MSSE Scale was the only variable that consistently explained variance in physical function outcomes. Conclusions The findings are novel evidence of the association between self-efficacy for function and physical function outcomes in older adults with MS. Future research on self-efficacy is warranted with the goal of improving physical function in older adults with MS.
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27
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Nelson LM, Wallin MT, Marrie RA, Culpepper WJ, Langer-Gould A, Campbell J, Buka S, Tremlett H, Cutter G, Kaye W, Wagner L, Larocca NG. A new way to estimate neurologic disease prevalence in the United States: Illustrated with MS. Neurology 2019; 92:469-480. [PMID: 30770422 PMCID: PMC6442012 DOI: 10.1212/wnl.0000000000007044] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/22/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Considerable gaps exist in knowledge regarding the prevalence of neurologic diseases, such as multiple sclerosis (MS), in the United States. Therefore, the MS Prevalence Working Group sought to review and evaluate alternative methods for obtaining a scientifically valid estimate of national MS prevalence in the current health care era. METHODS We carried out a strengths, weaknesses, opportunities, and threats (SWOT) analysis for 3 approaches to estimate MS prevalence: population-based MS registries, national probability health surveys, and analysis of administrative health claims databases. We reviewed MS prevalence studies conducted in the United States and critically examined possible methods for estimating national MS prevalence. RESULTS We developed a new 4-step approach for estimating MS prevalence in the United States. First, identify administrative health claim databases covering publicly and privately insured populations in the United States. Second, develop and validate a highly accurate MS case-finding algorithm that can be standardly applied in all databases. Third, apply a case definition algorithm to estimate MS prevalence in each population. Fourth, combine MS prevalence estimates into a single estimate of US prevalence, weighted according to the number of insured persons in each health insurance segment. CONCLUSIONS By addressing methodologic challenges and proposing a new approach for measuring the prevalence of MS in the United States, we hope that our work will benefit scientists who study neurologic and other chronic conditions for which national prevalence estimates do not exist.
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Affiliation(s)
- Lorene M Nelson
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY.
| | - Mitchell T Wallin
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Ruth Ann Marrie
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - W J Culpepper
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Annette Langer-Gould
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Jon Campbell
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Stephen Buka
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Helen Tremlett
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Gary Cutter
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Wendy Kaye
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Laurie Wagner
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Nicholas G Larocca
- From the Division of Epidemiology, Department of Health Research and Policy (L.M.N.), Stanford University School of Medicine, Stanford, CA; Department of Veterans Affairs Multiple Sclerosis Center of Excellence (VA MSCoE) and Georgetown University School of Medicine (M.T.W.), Washington, DC; Department of Internal Medicine (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; VA MS Center of Excellence and University of Maryland (W.J.C.), Baltimore; Neurology Department (A.L.-G.), Kaiser Permanente Southern California, Los Angeles; University of Colorado (J.C.), Denver; Brown University (S.B.), Providence, RI; University of British Columbia (H.T.), Vancouver, Canada; University of Alabama at Birmingham (G.C.); McKing Consulting Corporation (W.K., L.W.), Atlanta, GA; and National Multiple Sclerosis Society (N.G.L.), New York, NY
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Wallin MT, Culpepper WJ, Campbell JD, Nelson LM, Langer-Gould A, Marrie RA, Cutter GR, Kaye WE, Wagner L, Tremlett H, Buka SL, Dilokthornsakul P, Topol B, Chen LH, LaRocca NG. The prevalence of MS in the United States: A population-based estimate using health claims data. Neurology 2019; 92:e1029-e1040. [PMID: 30770430 PMCID: PMC6442006 DOI: 10.1212/wnl.0000000000007035] [Citation(s) in RCA: 690] [Impact Index Per Article: 138.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 08/17/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To generate a national multiple sclerosis (MS) prevalence estimate for the United States by applying a validated algorithm to multiple administrative health claims (AHC) datasets. METHODS A validated algorithm was applied to private, military, and public AHC datasets to identify adult cases of MS between 2008 and 2010. In each dataset, we determined the 3-year cumulative prevalence overall and stratified by age, sex, and census region. We applied insurance-specific and stratum-specific estimates to the 2010 US Census data and pooled the findings to calculate the 2010 prevalence of MS in the United States cumulated over 3 years. We also estimated the 2010 prevalence cumulated over 10 years using 2 models and extrapolated our estimate to 2017. RESULTS The estimated 2010 prevalence of MS in the US adult population cumulated over 10 years was 309.2 per 100,000 (95% confidence interval [CI] 308.1-310.1), representing 727,344 cases. During the same time period, the MS prevalence was 450.1 per 100,000 (95% CI 448.1-451.6) for women and 159.7 (95% CI 158.7-160.6) for men (female:male ratio 2.8). The estimated 2010 prevalence of MS was highest in the 55- to 64-year age group. A US north-south decreasing prevalence gradient was identified. The estimated MS prevalence is also presented for 2017. CONCLUSION The estimated US national MS prevalence for 2010 is the highest reported to date and provides evidence that the north-south gradient persists. Our rigorous algorithm-based approach to estimating prevalence is efficient and has the potential to be used for other chronic neurologic conditions.
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Affiliation(s)
- Mitchell T Wallin
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY.
| | - William J Culpepper
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Jonathan D Campbell
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Lorene M Nelson
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Annette Langer-Gould
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Ruth Ann Marrie
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Gary R Cutter
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Wendy E Kaye
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Laurie Wagner
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Helen Tremlett
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Stephen L Buka
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Piyameth Dilokthornsakul
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Barbara Topol
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Lie H Chen
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
| | - Nicholas G LaRocca
- From the Department of Veterans Affairs Multiple Sclerosis Center of Excellence (M.T.W., W.J.C.); Georgetown University School of Medicine (M.T.W.), Washington, DC; University of Maryland (W.J.C.), Baltimore; University of Colorado (J.D.C., P.D.), Aurora; Stanford University School of Medicine (L.M.N., B.T.), CA; Southern California Permanente Medical Group (A.L.-G., L.H.C.), Pasadena; Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; University of Alabama at Birmingham (G.R.C.); McKing Consulting Corp (W.E.K., L.W.), Atlanta, GA; Faculty of Medicine (Neurology) and Centre for Brain Health (H.T.), University of British Columbia, Vancouver, Canada; Brown University (S.L.B.), Providence, RI; and National Multiple Sclerosis Society (N.G.L.), New York, NY
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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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Geographic variations of multiple sclerosis in Iran: A population based study. Mult Scler Relat Disord 2019; 28:244-249. [PMID: 30634104 DOI: 10.1016/j.msard.2019.01.001] [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] [Received: 08/15/2018] [Revised: 10/22/2018] [Accepted: 01/01/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The epidemiology of Multiple sclerosis (MS) has changed in recent decades. Considering that the incidence and geographical variations of MS is not well known in Iran. The present study was conducted to investigate the incidence of MS and its geographic variations in Iran. METHODS Data from a national registry, coordinated by the Ministry of Health (MOH), were collected for this study. In Iran, all MS patients are eligible to receive care and treatment services based on their records in this registry. Therefore, it seems that the related data are comprehensive with very high coverage, particularly in recent years. In this study, the annual incidence rates were calculated based on year of diagnosis of MS. RESULTS In this registry, 32,633 new cases were recorded between 2011 and 2016. After standardized for age, the mean annual incidence rate was 6.5 per 100,000 populations. It was 10.2 and 2.9 in women and men respectively. This incidence ranged from 1.7 to 12.8 in provincial level, with a higher intensity in the central part of the country. CONCLUSION It seems that the incidence rate of MS and its ratio in females and males are more or less comparable with the dominant patterns in developed countries, although its variation within the country is very considerable.
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The contribution of the instrumented Timed-Up-and-Go test to detect falls and fear of falling in people with multiple sclerosis. Mult Scler Relat Disord 2019; 27:226-231. [DOI: 10.1016/j.msard.2018.10.111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/16/2018] [Accepted: 10/26/2018] [Indexed: 11/20/2022]
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Conway BL, Zeydan B, Uygunoğlu U, Novotna M, Siva A, Pittock SJ, Atkinson EJ, Rodriguez M, Kantarci OH. Age is a critical determinant in recovery from multiple sclerosis relapses. Mult Scler 2018; 25:1754-1763. [DOI: 10.1177/1352458518800815] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate the impact of age on recovery from multiple sclerosis relapses. Background: Increasing disability in multiple sclerosis is a consequence of progressive disease and incomplete relapse recovery. Methods: The first and last-ever relapse data (357 relapses in 193 patients) from the Olmsted County population-based multiple sclerosis cohort were systematically reviewed for age, fulminance, location (optic nerve, brainstem/cerebellar, spinal cord), peak deficit, and maximum recovery. Three different relapse-outcome measures were studied both as paired analyses and as an overall group effect: change from peak deficit to maximum recovery in raw functional system score related to the relapse (ΔFSS), a previously published FSS-based relapse-impact model, and change from peak deficit to maximum recovery in Extended Disability Status Scale (ΔEDSS) score. Results: Older age was linearly associated with worse recovery in the ΔFSS outcome ( p = 0.002), ΔEDSS outcome ( p < 0.001), and the FSS-based relapse-impact model ( p < 0.001). A multivariate analysis of ΔFSS outcome linked poor recovery to older age ( p = 0.015), relapse location (transverse myelitis or brainstem/cerebellar syndrome; p < 0.001), and relapse fulminance ( p = 0.004). Conclusion: Multiple sclerosis-relapse recovery declines in a linear fashion with increased age, which should be considered when making treatment decisions.
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Affiliation(s)
- Brittani L Conway
- Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, and Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA/ HealthPartners Neuroscience Center, Saint Paul, MN, USA
| | - Burcu Zeydan
- Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, and Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA/ Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Uğur Uygunoğlu
- Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, and Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA/ Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Martina Novotna
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA/ Polyclinic Medicina Plus, Prague, Czech Republic
| | - Aksel Siva
- Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sean J Pittock
- Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, and Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Elizabeth J Atkinson
- Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Moses Rodriguez
- Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, and Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Orhun H Kantarci
- Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, and Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Kalron A, Aloni R, Givon U, Menascu S. Fear of falling, not falls, impacts leisure-time physical activity in people with multiple sclerosis. Gait Posture 2018; 65:33-38. [PMID: 30558943 DOI: 10.1016/j.gaitpost.2018.06.174] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/13/2018] [Accepted: 06/28/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is a consensus that physical activity is imperative for people with MS (PwMS). However, regardless of the benefits, many PwMS do not participate in any meaningful physical activity. AIM To examine the relationship between leisure-time physical activity with clinical characteristics and common symptoms in PwMS. METHODS The sample included 190 PwMS (107 women), mean age 40.8 (S.D = 13.1) and mean disease duration of 6.4 (SD = 8.3) years since diagnosis. Outcome measures included the Godin Leisure-Time Exercise Questionnaire (GLTEQ), Four Square Step Test (FSST), 2-Minute Walk test (2 mWT), Timed Up and Go test (TUG), Timed 25-Foot Walk test (T25FW), fall status, Falls Efficacy Scale International (FES-I), Modified Fatigue Impact Scale (MFIS), walking speed and the Multiple Sclerosis Walking Scale self-reported questionnaire (MSWS-12). RESULTS Eighty-six PwMS were classified as active (GLTEQ = 31.6 (S.D = 16.7); 104 were insufficiently active (GLTEQ = 3.0 (S.D = 4.3). Insufficiently active PwMS demonstrated a slower walking speed, elevated fatigue, more concerns of falling and additional walking difficulties compared to active PwMS. Non-significant differences between groups were observed in the TUG, 2 mWT, FSST, T25FWT and fall status. According to the linear regression, by utilizing the FES-I we observed a 12.2% variance related to leisure-time physical activity. The independent variables: EDSS, MSWS-12, fatigue and walking speed were non-significant. SIGNIFICANCE The present findings highlight the impact of concern of falling on physical activity in PwMS. This knowledge may represent an opportunity to improve care and enhance physical activity in the MS population.
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Affiliation(s)
- Alon Kalron
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel-Aviv University, Israel.
| | - Roy Aloni
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel.
| | - Uri Givon
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel; Department of Pediatric Orthopedics, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
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Sharma NK, Sharma R, Mathur D, Sharad S, Minhas G, Bhatia K, Anand A, Ghosh SP. Role of Ionizing Radiation in Neurodegenerative Diseases. Front Aging Neurosci 2018; 10:134. [PMID: 29867445 PMCID: PMC5963202 DOI: 10.3389/fnagi.2018.00134] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 04/23/2018] [Indexed: 02/03/2023] Open
Abstract
Ionizing radiation (IR) from terrestrial sources is continually an unprotected peril to human beings. However, the medical radiation and global radiation background are main contributors to human exposure and causes of radiation sickness. At high-dose exposures acute radiation sickness occurs, whereas chronic effects may persist for a number of years. Radiation can increase many circulatory, age related and neurodegenerative diseases. Neurodegenerative diseases occur a long time after exposure to radiation, as demonstrated in atomic bomb survivors, and are still controversial. This review discuss the role of IR in neurodegenerative diseases and proposes an association between neurodegenerative diseases and exposure to IR.
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Affiliation(s)
- Neel K. Sharma
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Rupali Sharma
- Center for Neuroscience and Regenerative Medicine, Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Deepali Mathur
- Neurobiology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, India
| | - Shashwat Sharad
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Gillipsie Minhas
- Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | | | - Akshay Anand
- Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sanchita P. Ghosh
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Zeydan B, Lowe VJ, Schwarz CG, Przybelski SA, Tosakulwong N, Zuk SM, Senjem ML, Gunter JL, Roberts RO, Mielke MM, Benarroch EE, Rodriguez M, Machulda MM, Lesnick TG, Knopman DS, Petersen RC, Jack CR, Kantarci K, Kantarci OH. Pittsburgh compound-B PET white matter imaging and cognitive function in late multiple sclerosis. Mult Scler 2018; 24:739-749. [PMID: 28474977 PMCID: PMC5665724 DOI: 10.1177/1352458517707346] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND There is growing interest in white matter (WM) imaging with positron emission tomography (PET). OBJECTIVES We studied the association of cognitive function in late multiple sclerosis (MS) with cortical and WM Pittsburgh compound-B PET (PiB-PET) binding. METHODS In the population-based Mayo Clinic Study of Aging, 24 of 4869 participants had MS (12 underwent PiB-PET). Controls were age and sex matched (5:1). We used automated or semi-automated processing for quantitative image analyses and conditional logistic regression for group differences. RESULTS MS patients had lower memory ( p = 0.03) and language ( p = 0.02) performance; smaller thalamic volumes ( p = 0.003); and thinner temporal ( p = 0.001) and frontal ( p = 0.045) cortices on magnetic resonance imaging (MRI) than controls. There was no difference in global cortical PiB standardized uptake value ratios between MS and controls ( p = 0.35). PiB uptake was lower in areas of WM hyperintensities compared to normal-appearing white matter (NAWM) in MS ( p = 0.0002). Reduced PiB uptake in both the areas of WM hyperintensities ( r = 0.65; p = 0.02) and NAWM ( r = 0.69; p = 0.01) was associated with decreased visuospatial performance in MS. CONCLUSION PiB uptake in the cortex in late MS is not different from normal age-matched controls. PiB uptake in the WM in late MS may be a marker of the large network structures' integrity such as those involved in visuospatial performance.
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Affiliation(s)
- Burcu Zeydan
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America
- Mayo Clinic College of Medicine, Department of Radiology, Rochester, Minnesota, United States of America
| | - Val J. Lowe
- Mayo Clinic College of Medicine, Department of Radiology, Rochester, Minnesota, United States of America
| | - Christopher G. Schwarz
- Mayo Clinic College of Medicine, Department of Radiology, Rochester, Minnesota, United States of America
| | - Scott A. Przybelski
- Mayo Clinic College of Medicine, Department of Health Sciences Research, Rochester, Minnesota, United States of America
| | - Nirubol Tosakulwong
- Mayo Clinic College of Medicine, Department of Health Sciences Research, Rochester, Minnesota, United States of America
| | - Samantha M. Zuk
- Mayo Clinic College of Medicine, Department of Radiology, Rochester, Minnesota, United States of America
| | - Matthew L. Senjem
- Mayo Clinic College of Medicine, Department of Radiology, Rochester, Minnesota, United States of America
- Mayo Clinic College of Medicine, Department of Information Technology, Rochester, Minnesota, United States of America
| | - Jeffrey L. Gunter
- Mayo Clinic College of Medicine, Department of Information Technology, Rochester, Minnesota, United States of America
| | - Rosebud O. Roberts
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America
- Mayo Clinic College of Medicine, Department of Health Sciences Research, Rochester, Minnesota, United States of America
| | - Michelle M. Mielke
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America
- Mayo Clinic College of Medicine, Department of Health Sciences Research, Rochester, Minnesota, United States of America
| | - Eduardo E. Benarroch
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America
| | - Moses Rodriguez
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America
| | - Mary M. Machulda
- Mayo Clinic College of Medicine, Department of Psychiatry and Psychology, Rochester, Minnesota, United States of America
| | - Timothy G. Lesnick
- Mayo Clinic College of Medicine, Department of Health Sciences Research, Rochester, Minnesota, United States of America
| | - David S. Knopman
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America
| | - Ronald C. Petersen
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America
| | - Clifford R. Jack
- Mayo Clinic College of Medicine, Department of Radiology, Rochester, Minnesota, United States of America
| | - Kejal Kantarci
- Mayo Clinic College of Medicine, Department of Radiology, Rochester, Minnesota, United States of America
| | - Orhun H. Kantarci
- Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America
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Morrison JD, Becker H, Stuifbergen AK. Evaluation of Intervention Fidelity in a Multisite Clinical Trial in Persons With Multiple Sclerosis. J Neurosci Nurs 2017; 49:344-348. [PMID: 28991096 PMCID: PMC5677548 DOI: 10.1097/jnn.0000000000000315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Careful consideration of intervention fidelity is critical to establishing the validity and reliability of research findings, yet such reports are often lacking in the research literature. It is imperative that intervention fidelity be methodically evaluated and reported to promote the translation of effective interventions into sound evidence-based practice. PURPOSE The purpose of this article is to explore strategies used to promote intervention fidelity, incorporating examples from a multisite clinical trial, that illustrate the National Institutes of Health Behavior Change Consortium's 5 domains for recommended treatment practices: (1) study design, (2) facilitator training, (3) intervention delivery, (4) intervention receipt, and (5) intervention enactment. A multisite randomized clinical trial testing the efficacy of a computer-assisted cognitive rehabilitation intervention for adults with multiple sclerosis is used to illustrate strategies promoting intervention fidelity. METHODS Data derived from audiotapes of intervention classes, audits of computer exercises completed by participants, participant class attendance, and goal attainment scaling suggested relatively high fidelity to the intervention protocol. CONCLUSION This study illustrates how to report intervention fidelity in the literature guided by best practice strategies, which may serve to promote fidelity monitoring and reporting in future studies.
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Affiliation(s)
- Janet D Morrison
- Questions or comments about this article may be directed to Janet D. Morrison, PhD RN, at . She is a Research Associate, School of Nursing, The University of Texas at Austin, Austin, TX. Heather Becker, PhD, is Research Scientist, School of Nursing, The University of Texas at Austin, Austin, TX. Alexa K. Stuifbergen, PhD RN FAAN, is Dean and Professor, School of Nursing, The University of Texas at Austin, Austin, TX
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Brubaker WD, Li S, Baker LC, Eisenberg ML. Increased risk of autoimmune disorders in infertile men: analysis of US claims data. Andrology 2017; 6:94-98. [DOI: 10.1111/andr.12436] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/21/2017] [Accepted: 09/25/2017] [Indexed: 12/24/2022]
Affiliation(s)
- W. D. Brubaker
- Department of Urology; Stanford University School of Medicine; Palo Alto CA USA
| | - S. Li
- Department of Urology; Stanford University School of Medicine; Palo Alto CA USA
| | - L. C. Baker
- Department of Health Research and Policy; Stanford University School of Medicine; Palo Alto CA USA
| | - M. L. Eisenberg
- Department of Urology, Obstetrics and Gynecology; Stanford University School of Medicine; Stanford CA USA
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Sepúlveda M, Aldea M, Escudero D, Llufriu S, Arrambide G, Otero-Romero S, Sastre-Garriga J, Romero-Pinel L, Martínez-Yélamos S, Sola-Valls N, Armangué T, Sotoca J, Escartín A, Robles-Cedeño R, Ramió-Torrentà L, Presas-Rodríguez S, Ramo-Tello C, Munteis E, Pelayo R, Gubieras L, Brieva L, Ortiz N, Hervás M, Mañé-Martínez MA, Cano A, Vela E, Tintoré M, Blanco Y, Montalban X, Graus F, Saiz A. Epidemiology of NMOSD in Catalonia: Influence of the new 2015 criteria in incidence and prevalence estimates. Mult Scler 2017; 24:1843-1851. [PMID: 28984163 DOI: 10.1177/1352458517735191] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Population-based studies on neuromyelitis optica spectrum disorders (NMOSD) are limited, and it is unclear whether the rates have changed with the implementation of the new 2015 criteria. OBJECTIVES To estimate the incidence and prevalence of NMOSD in Catalonia (Spain), using both the 2006 and the 2015 criteria. METHODS In this clinic-based retrospective study, patients diagnosed with NMOSD between 2006 and 2015 were identified using multiple sources, including direct contact to all Catalan hospitals, identification of cases through the Catalan Health Surveillance System, and registry of antibodies to aquaporin-4 (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG-IgG) in a reference laboratory. The incidence rate was calculated for the period 1 January 2006-1 January 2016 and prevalence for the date 1 January 2016. RESULTS We identified 74 patients (by the 2015 criteria). Most patients were Caucasian (81%), and female (76%) with a median age at disease onset of 42 years (range, 10-76 years). In total, 54 (73%) patients were positive for AQP4-IgG, 11 (15%) double-seronegative, and 9 (12%) MOG-IgG-positive. Rates of incidence and prevalence (0.63/1,000,000 person-years and 0.89/100,000, respectively) were 1.5-fold higher than those reported by the 2006 criteria. Lowest rates were seen in children and elder people and highest in women and middle-aged people (40-59 years). The female predominance was lost in incident AQP4-IgG-seronegative children and AQP4-IgG-positive elder people. MOG-IgG and double-seronegativity contributed similarly but did not influence the long-term outcome. CONCLUSION The new criteria increase the estimates, but NMOSD remains as a rare disease. The differences in age- and sex-specific estimates highlight the importance of the serologic classification.
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Affiliation(s)
- Maria Sepúlveda
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Marta Aldea
- Department of Preventive Medicine and Epidemiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Domingo Escudero
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sara Llufriu
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Otero-Romero
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lucía Romero-Pinel
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Sergio Martínez-Yélamos
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - N Sola-Valls
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Thais Armangué
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain/Pediatric Neuroimmunology and Neuroinfections Unit, Hospital Sant Joan de Déu Barcelona, University of Barcelona, Spain/Centre for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain
| | - Javier Sotoca
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Escartín
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - René Robles-Cedeño
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Doctor Josep Trueta University Hospital, Girona, Spain/ Santa Caterina Hospital, Girona, Spain/Biomedical Research Institute (IDIBGI), Girona, Spain/Medical Sciences Department, University of Girona, Girona, Spain
| | - Lluís Ramió-Torrentà
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Doctor Josep Trueta University Hospital, Girona, Spain/ Santa Caterina Hospital, Girona, Spain/Biomedical Research Institute (IDIBGI), Girona, Spain/Medical Sciences Department, University of Girona, Girona, Spain
| | - Silvia Presas-Rodríguez
- Multiple Sclerosis Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Cristina Ramo-Tello
- Multiple Sclerosis Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Elvira Munteis
- Multiple Sclerosis Unit, Neurology Department, Parc de Salut Mar, Barcelona, Spain
| | | | - Laura Gubieras
- Multiple Sclerosis Unit, Neurology Department, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Luis Brieva
- Multiple Sclerosis Unit, Neurology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Nicolau Ortiz
- Neurology Department, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - Mariona Hervás
- Multiple Sclerosis Unit, Neurology Department, Hospital Parc Taulí de Sabadell, Barcelona, Spain
| | | | - Antonio Cano
- Neurology Department, Hospital de Mataró, Barcelona, Spain
| | - Emili Vela
- Unit of Information and Knowledge, Catalan Health Service, Barcelona, Spain
| | - Mar Tintoré
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Yolanda Blanco
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Francesc Graus
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Albert Saiz
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Salhofer-Polanyi S, Cetin H, Leutmezer F, Baumgartner A, Blechinger S, Dal-Bianco A, Altmann P, Bajer-Kornek B, Rommer P, Guger M, Leitner-Bohn D, Reichardt B, Alasti F, Temsch W, Stamm T. Epidemiology of Multiple Sclerosis in Austria. Neuroepidemiology 2017; 49:40-44. [PMID: 28848208 DOI: 10.1159/000479696] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 07/11/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To assess the incidence rate and prevalence ratio of multiple sclerosis (MS) in Austria. METHODS Hospital discharge diagnosis and MS-specific immunomodulatory treatment prescriptions from public health insurances, covering 98% of Austrian citizens with health insurance were used to extrapolate incidence and prevalence numbers based on the capture-recapture method. RESULTS A total of 1,392,629 medication prescriptions and 40,956 hospitalizations were extracted from 2 data sources, leading to a total of 13,205 patients. The incidence rate and prevalence ratio of MS in Austria based on the capture-recapture method were 19.5/100,000 person-years (95% CI 14.3-24.7) and 158.9/100,000 (95% CI 141.2-175.9), respectively. Female to male ratio was 1.6 for incidence and 2.2 for prevalence. CONCLUSIONS Incidence rates and prevalence ratios of MS in our study are within the upper range of comparable studies across many European countries as well as the United States.
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Correa E, Paredes V, Martínez B. Prevalence of multiple sclerosis in Latin America and its relationship with European migration. Mult Scler J Exp Transl Clin 2017; 2:2055217316666407. [PMID: 28607738 PMCID: PMC5433402 DOI: 10.1177/2055217316666407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/04/2016] [Indexed: 12/03/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic, degenerative autoimmune inflammatory disease of the central nervous system. The prevalence is different in every continent, changing according to geographical and environmental characteristics. The areas with the highest prevalence in the world are Europe and North America. In Latin America, the prevalence is higher in areas where there was greater European migration, as in the case of Argentina, Chile, Brazil, Uruguay and Mexico, and there have been no identified cases amongst native Indian populations. It should be considered that environmental factors may influence the prevalence of MS in Latin America, and it seems as if there are protective factors such as exposure to ultraviolet radiation and the presence of parasitosis.
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Affiliation(s)
| | | | - Braulio Martínez
- Department of Neurology and Autoimmune Diseases, Carlos Andrade Marin Hospital, Quito, Ecuador
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Abstract
BACKGROUND AND PURPOSE Impairment of walking function is a prevalent and burdensome feature of multiple sclerosis (MS), and represents a primary focus of rehabilitation research and clinical care. Research examining self-efficacy as a correlate of walking performance in MS is lacking; self-efficacy represents a theory-based, modifiable target of rehabilitation approaches for improving walking outcomes. This cross-sectional study examined the association between self-efficacy and walking performance in persons living with MS. METHODS The sample included 69 persons with MS who completed the Multiple Sclerosis Self-Efficacy (MSSE) Scale and Exercise Self-Efficacy (EXSE) Scale and undertook the Timed 25-Foot Walk (T25FW) and the 6-Minute Walk (6MW) tests. The data were analyzed using the Pearson product moment correlation coefficients and linear regression. RESULTS Correlation analysis indicated that function subscale scores on the MSSE correlated more strongly with T25FW (r = 0.55) than did the control subscale (r = 0.40) and EXSE (r = 0.38) scores, and both function (r = 0.67) and control (r = 0.53) subscale scores on the MSSE correlated more strongly with 6MW than did EXSE scores (r = 0.40). Linear regression analyses indicated that (1) function MSSE subscale, but not control subscale, explained significant variance in T25FW speed and 6MW distance and (2) function MSSE subscale, but not EXSE, explained significant variance in T25FW speed and 6MW distance. DISCUSSION AND CONCLUSIONS We provide the first evidence of an association between self-efficacy, particularly for functioning with MS, and objective walking performance in MS. Future research to replicate and extend these results can inform rehabilitation efforts that target improvement of walking performance in persons with MS.Digital Abstract available for more insights from the authors (see Slides, Supplemental Digital Content 1, http://links.lww.com/JNPT/A171).
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Kim SM, Kim SJ, Lee HJ, Kuroda H, Palace J, Fujihara K. Differential diagnosis of neuromyelitis optica spectrum disorders. Ther Adv Neurol Disord 2017; 10:265-289. [PMID: 28670343 PMCID: PMC5476332 DOI: 10.1177/1756285617709723] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 03/31/2017] [Indexed: 12/31/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system (CNS) mostly manifesting as optic neuritis and/or myelitis, which are frequently recurrent/bilateral or longitudinally extensive, respectively. As the autoantibody to aquaporin-4 (AQP4-Ab) can mediate the pathogenesis of NMOSD, testing for the AQP4-Ab in serum of patients can play a crucial role in diagnosing NMOSD. Nevertheless, the differential diagnosis of NMOSD in clinical practice is often challenging despite the phenotypical and serological characteristics of the disease because: (1) diverse diseases with autoimmune, vascular, infectious, or neoplastic etiologies can mimic these phenotypes of NMOSD; (2) patients with NMOSD may only have limited clinical manifestations, especially in their early disease stages; (3) test results for AQP4-Ab can be affected by several factors such as assay methods, serologic status, disease stages, or types of treatment; (4) some patients with NMOSD do not have AQP4-Ab; and (5) test results for the AQP4-Ab may not be readily available for the acute management of patients. Despite some similarity in their phenotypes, these NMOSD and NMOSD-mimics are distinct from each other in their pathogenesis, prognosis, and most importantly treatment. Understanding the detailed clinical, serological, radiological, and prognostic differences of these diseases will improve the proper management as well as diagnosis of patients.
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Affiliation(s)
- Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University, College of Medicine, Seoul, Korea
| | - Haeng Jin Lee
- Department of Ophthalmology, Seoul National University, College of Medicine, Seoul, Korea
| | - Hiroshi Kuroda
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Kazuo Fujihara
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, and MS & NMO Center, Southern TOHOKU Research Institute for Neuroscience (STRINS), Koriyama 963-8563, Japan
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Learmonth YC, Adamson BC, Balto JM, Chiu CY, Molina-Guzman IM, Finlayson M, Barstow EA, Motl RW. Investigating the needs and wants of healthcare providers for promoting exercise in persons with multiple sclerosis: a qualitative study. Disabil Rehabil 2017; 40:2172-2180. [DOI: 10.1080/09638288.2017.1327989] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Yvonne C. Learmonth
- Department of Kinesiology and Community Health, University of Illinois at Urbana–Champaign, Champaign, IL, USA
| | - Brynn C. Adamson
- Department of Kinesiology and Community Health, University of Illinois at Urbana–Champaign, Champaign, IL, USA
| | - Julia M. Balto
- Department of Kinesiology and Community Health, University of Illinois at Urbana–Champaign, Champaign, IL, USA
| | - Chung-Yi Chiu
- Department of Kinesiology and Community Health, University of Illinois at Urbana–Champaign, Champaign, IL, USA
| | - Isabel M. Molina-Guzman
- Departments of Latina/Latino studies, Media & Cinema Studies, University of Illinois at Urbana–Champaign, Champaign, IL, USA
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Elizabeth A. Barstow
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert W. Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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Catic T, Culig J, Suljic E, Masic A, Gojak R. Validation of the Disease-specific Questionnaire MSQoL-54 in Bosnia and Herzegovina Multiple Sclerosis Patients Sample. Med Arch 2017; 71:103-106. [PMID: 28790539 PMCID: PMC5511536 DOI: 10.5455/medarh.2017.71.103-106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 04/20/2017] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The purpose of this study was to validate Bosnian translation of disease specific quality of life measure MSQoL-54 which is widely used in practice. MATERIAL AND METHODS Previously translated and culturally adopted MSQoL-54 questionnaire used in this study has been provided and licensed by Optum Inc. The questionnaire was validated in 62 MS patients seen at Neurology clinic at University Clinical Center Sarajevo, during April 2016 until May 2016. Internal reliabilities of Bosnian version MSQoL-54 were assessed for multiple item scales by using Cronbach's alpha coefficient. Clinical validity was assessed comparing means of the two summary MSQoL-54 scores by the EDSS score. Pearson's (r) correlation coefficient was used to investigate the relationship between the composite scores and the main clinical and demographic variables. RESULTS Patients' participation was satisfactory and all scales fulfilled the usual psychometric standards. Highly significant inverse relationship was found between both composite scores and clinical characteristics of the disease and the EDSS. The lowest internal consistency reliability is found on social function scale (0.743), overall quality of life (0.782) and pain (0.833). The highest internal consistency reliability is found on role limitations due to physical problems (0.959), physical health (0.962) and role limitations due to emotional problems (0.966). The mean value of MSQoL-54 PHC (Physical Health Composite) and MHC (Mental Health Composite) were 49.82±18.90 (36.05-61.38) 51.84±22.22 (34.93-70.20) respectively. Our study has shown that the Bosnian version of MSQoL-54 is easy to administer and well accepted by patients and may be useful as clinical outcome measures in patients with MS.
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Affiliation(s)
- Tarik Catic
- Society for Pharmacoeconomics and Outcomes Research in Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Josip Culig
- Andrija Stampar" School of Public Health, Zagreb, Croatia
| | - Enra Suljic
- University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Admir Masic
- University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Refet Gojak
- University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
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Cikrikcioglu MA, Ozcan ME, Halac G, Gultepe I, Celik K, Sekin Y, Eser EE, Burhan S, Cetin G, Uysal O. Could Heterozygous Beta Thalassemia Provide Protection Against Multiple Sclerosis? Med Sci Monit 2016; 22:4854-4858. [PMID: 27941710 PMCID: PMC5154712 DOI: 10.12659/msm.898192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Heterozygous beta thalassemia (HBT) has been proposed to increase the risk of developing autoimmune disease. Our aim in this study was to examine the prevalence of HBT among multiple sclerosis (MS) patients. Material/Methods HBT frequency was investigated in our MS group (243 patients with MS). Hemoglobin electrophoresis (HE) was carried out if MS patients had a mean corpuscular volume of (MCV) <80 fL and a mean corpuscular hemoglobin level of (MCH) <27 pg/L according to a complete blood count (CBC). If MCV was lower than 80 fL, MCH was lower than 27 pg/L, and Hemoglobin A2 equal to or higher than 3.5%, a diagnosis of HBT was established. The frequency of patients with HBT in our MS patient group was statistically compared with the prevalence of HBT in the city of Istanbul, where our MS patients lived. Results The HBT prevalence was 0.823% (2 patients) in the MS patient group. The prevalence of HBT in Istanbul has been reported to be 4.5%. According to the z-test, the HBT prevalence in our MS patient group was significantly lower than that in Istanbul (Z=6.3611, two-sided p value <0.0001, 95% confidence interval of prevalence of HBT in our MS patient group: 0.000998–0.029413). Conclusions Contrary to our hypothesis at the outset of study, the reduced HBT prevalence in the MS group compared to HBT frequency in the city of Istanbul might indicate that HBT is protective against MS.
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Affiliation(s)
- Mehmet Ali Cikrikcioglu
- Department of Internal Medicine, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
| | - Muhammed Emin Ozcan
- Department of Neurology, Biruni University, Medical Faculty, Istanbul, Turkey
| | - Gulistan Halac
- Department of Neurology, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
| | - Ilhami Gultepe
- Department of Internal Medicine, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
| | - Kenan Celik
- Department of Internal Medicine, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
| | - Yahya Sekin
- Department of Internal Medicine, Eskisehir Military Hospital, Eskisehir, Turkey
| | - Elif Ece Eser
- Department of Internal Medicine, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
| | - Sebnem Burhan
- Department of Internal Medicine, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
| | - Guven Cetin
- Division of Hematology, Department of Internal Medicine, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
| | - Omer Uysal
- Department of Biostatistics, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
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Podkowa A, Miller RJ, Motl RW, Fish R, Oelze ML. Focused Ultrasound Treatment of Cervical Lymph Nodes in Rats with EAE: A Pilot Study. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2957-2964. [PMID: 27639434 DOI: 10.1016/j.ultrasmedbio.2016.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 07/18/2016] [Accepted: 08/02/2016] [Indexed: 06/06/2023]
Abstract
In this pilot study, focused ultrasound (FUS) was used to produce hyperthermia in cervical lymph nodes of rats having experimental autoimmune encephalomyelitis (EAE) to alleviate symptoms associated with EAE. EAE was induced in dark agouti rats, and EAE scores were recorded over 21 d. At the onset of EAE symptoms, rats were treated with FUS to induce temperatures of 43-44°C for 20 min in the superficial cervical lymph nodes. An EAE remittance score was tallied for all rats, defined as the maximum EAE score observed minus the minimum EAE score observed after the maximum EAE was reached. On average, the peak remittance score for FUS-treated rats was 1.14 ± 0.48 versus 0.33 ± 0.27 for sham-treated rats. These differences were statistically significant (p = 0.037). Therefore, FUS treatment of cervical lymph nodes in rats with EAE resulted in a significant reduction in EAE score.
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Affiliation(s)
- Anthony Podkowa
- Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Rita J Miller
- Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Raymond Fish
- Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Michael L Oelze
- Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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Jiang TT, Martinov T, Xin L, Kinder JM, Spanier JA, Fife BT, Way SS. Programmed Death-1 Culls Peripheral Accumulation of High-Affinity Autoreactive CD4 T Cells to Protect against Autoimmunity. Cell Rep 2016; 17:1783-1794. [PMID: 27829150 PMCID: PMC5108556 DOI: 10.1016/j.celrep.2016.10.042] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/25/2016] [Accepted: 10/13/2016] [Indexed: 01/06/2023] Open
Abstract
Self-reactive CD4 T cells are incompletely deleted during thymic development, and their peripheral seeding highlights the need for additional safeguards to avert autoimmunity. Here, we show an essential role for the coinhibitory molecule programmed death-1 (PD-1) in silencing the activation of high-affinity autoreactive CD4 T cells. Each wave of self-reactive CD4 T cells that escapes thymic deletion autonomously upregulates PD-1 to maintain self-tolerance. By tracking the progeny derived from individual autoreactive CD4 T cell clones, we demonstrate that self-reactive cells with the greatest autoimmune threat and highest self-antigen affinity express the most PD-1. Reciprocally, PD-1 deprivation unleashes high-affinity self-reactive CD4 T cells in target tissues to exacerbate neuronal inflammation and autoimmune diabetes. Reliance on PD-1 to actively maintain self-tolerance may explain why exploiting this pathway by cancerous cells and invasive microbes efficiently subverts protective immunity, and why autoimmune side effects can develop after PD-1-neutralizing checkpoint therapies.
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Affiliation(s)
- Tony T Jiang
- Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; Immunology Graduate Program, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Tijana Martinov
- Center for Immunology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55455, USA
| | - Lijun Xin
- Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Jeremy M Kinder
- Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; Immunology Graduate Program, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Justin A Spanier
- Center for Immunology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55455, USA
| | - Brian T Fife
- Center for Immunology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55455, USA.
| | - Sing Sing Way
- Division of Infectious Diseases and Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
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Kalron A, Givon U. Construct Validity of the Four Square Step Test in Multiple Sclerosis. Arch Phys Med Rehabil 2016; 97:1496-1501. [DOI: 10.1016/j.apmr.2016.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/13/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
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Abstract
The epidemiology of multiple sclerosis (MS) includes a consideration of genetic and environmental factors. Comparative studies of different populations have revealed prevalence and incidence rates that vary with geography and ethnicity. With a prevalence ranging from 2 per 100,000 in Japan to greater than 100 per 100,000 in Northern Europe and North America, the burden of MS is similarly unevenly influenced by longevity and comorbid disorders. Well-powered genome-wide association studies have investigated the genetic substrate of MS, providing insight into autoimmune mechanisms involved in the etiopathogenesis of MS and elucidating possible avenues of biological treatment.
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Affiliation(s)
- Jonathan Howard
- Division of Neuroepidemiology, Department of Neurology, Comprehensive Care Center, New York University, New York, NY, USA.
| | - Stephen Trevick
- New York University Langone Medical Center, New York, NY, USA
| | - David S Younger
- Division of Neuroepidemiology, Department of Neurology, New York University School of Medicine, College of Global Public Health, New York University, New York, NY, USA
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Pilutti LA, Motl RW, Edwards TA, Wilund KR. Rationale and design of a randomized controlled clinical trial of functional electrical stimulation cycling in persons with severe multiple sclerosis. Contemp Clin Trials Commun 2016; 3:147-152. [PMID: 29736463 PMCID: PMC5935873 DOI: 10.1016/j.conctc.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/27/2016] [Accepted: 05/11/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This randomized controlled trial (RCT) will examine the efficacy of supervised functional electrical stimulation (FES) cycling on walking performance and physiological function among persons with multiple sclerosis (MS) with severe mobility disability. METHODS/DESIGN This RCT will recruit 16 persons with MS that require unilateral or bilateral assistance for ambulation (i.e., Expanded Disability Status Scale (EDSS) score = 6.0-6.5). Participants will be randomized to one of two conditions: supervised FES cycling or passive cycling. The FES cycling condition will involve mild electrical stimulation that will generate an activation pattern that results in cycling the leg ergometer. The passive cycling condition will not provide any electrical stimulation, rather the movement of the pedals will be controlled by the electrical motor. Both conditions will be delivered 3 days/week for the same duration, over 6 months. Primary outcomes will include walking performance assessed as walking speed, endurance, and agility. Secondary outcomes will include physiological function assessed as cardiorespiratory fitness, muscular strength, and balance. Assessments will take place at baseline, mid-point (3-months), and immediately following the intervention (6-months). DISCUSSION This study will lay the foundation for the design of a future RCT by: (1) providing effect sizes that can be included in a power analysis for optimal sample size estimation; and (2) identifying cardiorespiratory fitness, muscular strength, and balance (i.e., physiological function) as mechanisms for the beneficial effects of FES cycling on walking performance. This trial will provide important information on a novel exercise rehabilitation therapy for managing walking impairment in persons with severe MS.
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Affiliation(s)
- Lara A Pilutti
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
| | - Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
| | - Thomas A Edwards
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
| | - Kenneth R Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801, USA
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