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Prigent G, Aminian K, Gonzenbach RR, April R, Paraschiv-Ionescu A. Effects of multidisciplinary inpatient rehabilitation on everyday life physical activity and gait in patients with multiple sclerosis. J Neuroeng Rehabil 2024; 21:88. [PMID: 38807215 PMCID: PMC11131212 DOI: 10.1186/s12984-024-01383-0] [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: 11/17/2023] [Accepted: 05/14/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Multiple sclerosis is a progressive neurological disease that affects the central nervous system, resulting in various symptoms. Among these, impaired mobility and fatigue stand out as the most prevalent. The progressive worsening of symptoms adversely alters quality of life, social interactions and participation in activities of daily living. The main objective of this study is to bring new insights into the impact of a multidisciplinary inpatient rehabilitation on supervised walking tests, physical activity (PA) behavior and everyday gait patterns. METHODS A total of 52 patients, diagnosed with multiple sclerosis, were evaluated before and after 3 weeks of inpatient rehabilitation. Each measurement period consisted of clinical assessments and 7 days home monitoring using foot-mounted sensors. In addition, we considered two subgroups based on the Expanded Disability Status Scale (EDSS) scores: 'mild' (EDSS < 5) and 'severe' (EDSS ≥ 5) disability levels. RESULTS Significant improvements in fatigue, quality of life and perceived mobility were reported. In addition, walking capacity, as assessed by the 10-m walking test, two-minute walk test and timed-up-and-go test, improved significantly after rehabilitation. Regarding the home assessment, mildly disabled patients significantly increased their locomotion per day and complexity of daily PA pattern after rehabilitation, while severely disabled patients did not significantly change. There were distinct and significant differences in gait metrics (i.e., gait speed, stride length, cadence) between mildly and severely disabled patients, but the statistical models did not show a significant overall rehabilitation effect on these gait metrics. CONCLUSION Inpatient rehabilitation showed beneficial effects on self-reported mobility, self-rated health questionnaires, and walking capacity in both mildly and severely disabled patients. However, these improvements do not necessarily translate to home performance in severely disabled patients, or only marginally in mildly disabled patients. Motivational and behavioral factors should also be considered and incorporated into treatment strategies.
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Affiliation(s)
- Gaëlle Prigent
- Laboratory of Movement Analysis and Measurement, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Roman Rudolf Gonzenbach
- Department of Neurological Rehabilitation, Rehabilitation Centre Valens, Valens, Switzerland
| | - Roger April
- Department of Neurological Rehabilitation, Rehabilitation Centre Valens, Valens, Switzerland
| | - Anisoara Paraschiv-Ionescu
- Laboratory of Movement Analysis and Measurement, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
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Englund S, Frisell T, Qu Y, Gandhi K, Hultén A, Kierkegaard M, Piehl F, Longinetti E. Trajectories of self-reported fatigue following initiation of multiple sclerosis disease-modifying therapy. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333595. [PMID: 38744460 DOI: 10.1136/jnnp-2024-333595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/02/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND We analysed the COMparison Between All immunoTherapies for Multiple Sclerosis (NCT03193866), a Swedish nationwide observational study in relapsing-remitting multiple sclerosis (RRMS), to identify trajectories of fatigue and their association with physical disability following start of disease-modifying therapy (DMT). METHODS Using a group-modelling approach, we assessed trajectories of fatigue with the Fatigue Scale for Motor and Cognitive Functions and physical disability with Expanded Disability Status Scale among 1587 and 1818 individuals who initiated a first DMT and had a first DMT switch, respectively, followed during 2011-2022. We investigated predictors of fatigue trajectories using group membership as a multinomial outcome and calculated conditional probabilities linking membership across the trajectories. RESULTS We identified five trajectories of fatigue in participants who initiated their first DMT: no fatigue (mean starting values=23.7; 18.2% of population), low (35.5; 23.9%), mild (49.0; 21.6%), moderate (61.3; 20.1%) and severe (78.7; 16.1%). While no, low, mild and severe fatigue trajectories remained stable, the moderate trajectory increased to severe fatigue. Similarly, we identified six fatigue trajectories among participants who did a DMT switch, all indicating stable values over time. Women initiating a first DMT were more likely than men to display a severe fatigue trajectory, relative to the no fatigue one. There was a strong association between fatigue and physical disability trajectories. CONCLUSIONS In this cohort of people with actively treated RRMS, self-reported fatigue remained stable or increased over the years following DMT start. There was a strong association between fatigue and disability after DMT start.
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Affiliation(s)
- Simon Englund
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ying Qu
- GCSO, Janssen Pharmaceuticals, Stockholm, Sweden
| | - Kavita Gandhi
- Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | | | - Marie Kierkegaard
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Specialist Center, Center of Neurology, Stockholm Health Services, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elisa Longinetti
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Gold R, Schmidt S, Deisenhammer F, Motte J, Richter N, Taipale K, Salmen HC, Bohland C, Schirduan K. Real-world evidence and patient preference for subcutaneous versus intravenous natalizumab in the treatment of relapsing-remitting multiple sclerosis - initial results from the observational SISTER study. Ther Adv Neurol Disord 2024; 17:17562864241241382. [PMID: 38616781 PMCID: PMC11015759 DOI: 10.1177/17562864241241382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/04/2024] [Indexed: 04/16/2024] Open
Abstract
Background The consideration of patient preference for a certain drug route of administration (RoA) plays an important role in promoting patient adherence in chronic diseases. Natalizumab is an established treatment for relapsing-remitting multiple sclerosis (RRMS) and can be administered as intravenous (IV) infusion or subcutaneous (SC) injection developed to enable a shorter and easier administration versus IV RoA. Study objectives Primary objective is to compare patients' preference for RoA and satisfaction with SC versus IV natalizumab at baseline and subsequent visits up to 12 months. Secondary objectives include drug utilization, clinical outcomes, safety, and treatment satisfaction in a usual care setting. Design and methods SISTER (Subcutaneous: Non-Interventional Study for Tysabri Patient Preference - Experience from Real World) is an ongoing, prospective, observational study where natalizumab is utilized according to local label. RRMS patients are included in three natalizumab cohorts: Patients switching from current IV to SC administration (switcher) and patients newly starting natalizumab on either SC or IV route (starter SC/IV). This interim analysis includes 262 patients (184 switchers, 39 SC starters, and 39 IV starters), median observation period was 9 months. Results 80.8% IV starters and 93.9% SC starters reported at baseline that they prefer the assigned RoA. Although initial satisfaction with chosen RoA was maintained over time from baseline through Month 12 in all three cohorts, the wish for change of the current RoA after 6 and 12 months was more frequently expressed among IV starters than in either SC cohort. Consistently, six patients (23.1%) starting with IV changed their RoA from IV to SC route.Mean global treatment satisfaction according to TSQM-II score at baseline remained high in the switcher group and increased through Month 12 in both IV and SC starter cohorts. Conclusion Based on current data, there is a trend toward patients' preference for the natalizumab SC route over the IV route, which provides valuable insights into patients' preference for natalizumab RoA in routine care and complements available data from clinical studies with real-world data on SC natalizumab. Trial registration This observational (non-interventional) study was registered in the local German PEI register for non-interventional studies (NIS-No. 611) and in the international CTgov register (NCT05304520).
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Affiliation(s)
- Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Gudrunstr. 56, Bochum 44791, Germany
| | | | | | - Jeremias Motte
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | - Nils Richter
- Gemeinschaftspraxis für Neurologie, Düsseldorf, Germany
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Hellgren J, Strandberg MC, Källén K, Svenningsson A. A comparative study of fatigue and processing speed in patients with multiple sclerosis treated with natalizumab or rituximab. Mult Scler J Exp Transl Clin 2024; 10:20552173241252566. [PMID: 38807848 PMCID: PMC11131408 DOI: 10.1177/20552173241252566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/17/2024] [Indexed: 05/30/2024] Open
Abstract
Background Fatigue is the most debilitating symptom in patients with multiple sclerosis (MS). Natalizumab and rituximab are the most used MS disease modifying therapies in Sweden, but comparative data on the effect on fatigue is sparse. Objective Primary objective was to compare fatigue levels between patients on natalizumab and rituximab. As secondary objective, we assessed processing speed, an attention domain quality, between treatment groups. Method In this Swedish multicentre cross-sectional study, patients with relapsing-remitting MS and >24 months treatment duration were identified in the Swedish MS-registry. Fatigue was assessed using the Fatigue Scale for Motor and Cognitive functions (FSMC) and processing speed using Symbol Digit Modalities Test (SDMT). Results 128 patients were enrolled (natalizumab: 56, rituximab: 72). No significant differences in FSMC were found when adjusting for potential confounders (p = 0.936), with age having the biggest impact, correlating with increased fatigue. Individuals on natalizumab performed significantly better on SDMT at cross-section (natalizumab 64.7, rituximab 56.2; p = 0.003), with an improvement from treatment initiation, compared to rituximab (change: natalizumab 8.9, rituximab -1.0; p = 0.002). Conclusion We found no difference in fatigue levels between natalizumab and rituximab cohorts. Patients treated with natalizumab showed significantly better results on SDMT than patients on rituximab.
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Affiliation(s)
- Johan Hellgren
- Clinical Sciences Helsingborg Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Neurology Section, Department of Specialised Medicine, Helsingborg General Hospital, Helsingborg, Sweden
| | - Maria Compagno Strandberg
- Neurology Lund Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurology, Rehabilitation medicine, Memory disorders and Geriatrics, Skånes University Hospital, Lund, Sweden
| | - Kristina Källén
- Clinical Sciences Helsingborg Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Neurology Section, Department of Specialised Medicine, Helsingborg General Hospital, Helsingborg, Sweden
- Department of Neurology, Rehabilitation medicine, Memory disorders and Geriatrics, Skånes University Hospital, Lund, Sweden
| | - Anders Svenningsson
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
- Department of Neurology, Danderyd Hospital AB, Stockholm, Sweden
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Hanafy KA, Jovin TG. Brain FADE syndrome: the final common pathway of chronic inflammation in neurological disease. Front Immunol 2024; 15:1332776. [PMID: 38304427 PMCID: PMC10830639 DOI: 10.3389/fimmu.2024.1332776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
Importance While the understanding of inflammation in the pathogenesis of many neurological diseases is now accepted, this special commentary addresses the need to study chronic inflammation in the propagation of cognitive Fog, Asthenia, and Depression Related to Inflammation which we name Brain FADE syndrome. Patients with Brain FADE syndrome fall in the void between neurology and psychiatry because the depression, fatigue, and fog seen in these patients are not idiopathic, but instead due to organic, inflammation involved in neurological disease initiation. Observations A review of randomized clinical trials in stroke, multiple sclerosis, Parkinson's disease, COVID, traumatic brain injury, and Alzheimer's disease reveal a paucity of studies with any component of Brain FADE syndrome as a primary endpoint. Furthermore, despite the relatively well-accepted notion that inflammation is a critical driving factor in these disease pathologies, none have connected chronic inflammation to depression, fatigue, or fog despite over half of the patients suffering from them. Conclusions and relevance Brain FADE Syndrome is important and prevalent in the neurological diseases we examined. Classical "psychiatric medications" are insufficient to address Brain FADE Syndrome and a novel approach that utilizes sequential targeting of innate and adaptive immune responses should be studied.
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Affiliation(s)
- Khalid A Hanafy
- Cooper Neurological Institute and Cooper Medical School at Rowan University, Camden, NJ, United States
- Center for Neuroinflammation at Cooper Medical School at Rowan University, Camden, NJ, United States
| | - Tudor G Jovin
- Cooper Neurological Institute and Cooper Medical School at Rowan University, Camden, NJ, United States
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Filippi M, Grimaldi L, Conte A, Totaro R, Valente MR, Malucchi S, Granella F, Cordioli C, Brescia Morra V, Zanetta C, Perini D, Santoni L. Intravenous or subcutaneous natalizumab in patients with relapsing-remitting multiple sclerosis: investigation on efficiency and savings-the EASIER study. J Neurol 2024; 271:340-354. [PMID: 37715789 PMCID: PMC10769988 DOI: 10.1007/s00415-023-11955-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION EASIER is a multicenter, observational, cross-sectional study investigating the consumption of healthcare resources, including healthcare professional (HCP) active working time, the costs associated with the current natalizumab intravenous (IV) administration, and the potential impact of the adoption of subcutaneous (SC) route. METHODS The EASIER study has three parts: (1) time and motion study to measure healthcare resources and working time needed for natalizumab IV administration using a digital data collection tool operated directly by HCPs; (2) HCP structured questionnaire-based estimation of the potential impact of natalizumab SC vs. IV administration; and (3) patient survey on the burden of natalizumab administration. RESULTS Nine Italian multiple sclerosis (MS) centers measured 404 IV natalizumab administration procedures and administered 26 HCP questionnaires and 297 patient questionnaires. Patients had a mean of 52 (range 1-176) previous IV administrations and spent a mean (median, IQR) of 152 (130, 94-184) minutes in the center per each IV procedure, with IV infusion covering 50% of the total. Including patient travel time, an average of 5 h was dedicated to each IV administration. Active working time by HCP amounted to 29 min per IV administration procedure, 70% of which by nursing staff. With adoption of the SC route, HCPs estimated a 50% reduction in patient procedure time and 55% lower HCP active working time. This translated into a 63% cost reduction for the MS center per natalizumab administration procedure. CONCLUSIONS SC natalizumab administration will consistently reduce consumption of patient and HCP times per procedure and associated costs.
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Affiliation(s)
- Massimo Filippi
- Neurology Unit, Neurorehabilitation Unit, Neurophysiology Service, and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Luigi Grimaldi
- Multiple Sclerosis Center, Institute Foundation G. Giglio, Cefalù, PA, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- Multiple Sclerosis Center, Policlinico Umberto I Hospital, Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Rocco Totaro
- Demyelinating Disease Center, Department of Neurology, San Salvatore Hospital, L'Aquila, Italy
| | - Maria Rosaria Valente
- Clinical Neurology, Santa Maria della Misericordia University Hospital, and Department of Medicine, University of Udine, Udine, Italy
| | - Simona Malucchi
- SCDO Neurologia, S. Luigi Gonzaga University Hospital, Orbassano, TO, Italy
| | - Franco Granella
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, ASST Spedali Civili di Brescia, Montichiari Hospital (Brescia), Brescia, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Center, Department of Neuroscience (NSRO), Federico II University Hospital, Naples, Italy
| | - Chiara Zanetta
- Neurology Unit, Neurorehabilitation Unit, Neurophysiology Service, and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
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Elkhooly M, Bao F, Bernitsas E. Impact of Disease Modifying Therapy on MS-Related Fatigue: A Narrative Review. Brain Sci 2023; 14:4. [PMID: 38275509 PMCID: PMC10813476 DOI: 10.3390/brainsci14010004] [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: 11/26/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system by causing inflammation, demyelination and neurodegeneration. Fatigue is the most prevalent and one of the most disabling symptoms among people with MS (pwMS). Due to its complexity and subjective character, fatigue is still little understood despite its frequent occurrence and severe impact. The potential causes, effects, and treatments of fatigue associated with MS have been extensively studied in recent years. Though the benefits of such a variety of contributions are obvious, there have not been many attempts to evaluate the effect of disease modifying therapies (DMTs) on MS-related fatigue. In this review, we summarize clinical trials and research studies, and we discuss the effect of different DMTs on MS-related fatigue.
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Affiliation(s)
- Mahmoud Elkhooly
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL 62702, USA;
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Department of Neurology and Psychiatry, Minia University, Minia 61519, Egypt
| | - Fen Bao
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Evanthia Bernitsas
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI 48201, USA
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Zimek D, Miklusova M, Mares J. Overview of the Current Pathophysiology of Fatigue in Multiple Sclerosis, Its Diagnosis and Treatment Options - Review Article. Neuropsychiatr Dis Treat 2023; 19:2485-2497. [PMID: 38029042 PMCID: PMC10674653 DOI: 10.2147/ndt.s429862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Fatigue is a common, debilitating and often underestimated symptom in patients with multiple sclerosis (MS). The exact pathophysiological mechanism of fatigue in MS is still unknown. However, there are many theories involving different immunological, metabolic and inflammatory mechanisms of fatigue. Owing to the subjective nature of this symptom, its diagnosis is still very limited and is still based only on diagnostic questionnaires. Although several therapeutic agents have been used in the past to try to influence fatigue in MS patients, no single effective approach for the treatment of fatigue has yet been found. This review article aims to provide the reader with information on the current theories on the origin and mechanism of fatigue in MS, as well as diagnostic procedures and, finally, current therapeutic strategies for the management of fatigue in MS patients.
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Affiliation(s)
- Dalibor Zimek
- Department of Neurology, Palacky University Hospital Olomouc, Olomouc, Czech Republic
| | - Martina Miklusova
- Department of Neurology, Palacky University Hospital Olomouc, Olomouc, Czech Republic
| | - Jan Mares
- Department of Neurology, Palacky University Hospital Olomouc, Olomouc, Czech Republic
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Broch L, Flemmen HØ, Simonsen CS, Berg-Hansen P, Ormstad H, Brunborg C, Celius EG. "No association between disease modifying treatment and fatigue in multiple sclerosis". Mult Scler Relat Disord 2023; 79:104993. [PMID: 37708819 DOI: 10.1016/j.msard.2023.104993] [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: 03/06/2023] [Revised: 08/06/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Fatigue affects 60-90% of people with multiple sclerosis (MS). It reduces quality of life and the ability to work. The cause of fatigue in MS remains unknown. Several disease-modifying treatments (DMTs) slow the disease process in relapsing MS by suppressing neuroinflammation. We aimed to investigate if treatment with a DMT is associated with lower rates of fatigue. METHODS In this cross-sectional study of the MS population in three counties in Norway, we used the Fatigue Scale for Motor and Cognitive Functions (FSMC) and the Hospital Anxiety and Depression Scale (HADS) to assess patient-reported fatigue, anxiety and depression. Clinical data were retrieved from the electronic patient record system. We categorized DMTs as high-efficacy therapy or moderate-efficacy therapy. High-efficacy drugs included fingolimod, natalizumab, ocrelizumab, rituximab, alemtuzumab, daclizumab, and autologous hematopoietic stem cell transplantation. Moderate-efficacy drugs included interferons, glatiramer acetate, dimethyl fumarate, and teriflunomide. We included persons with relapsing MS only. RESULTS Of 1142 patients, 80% had fatigue. Fifty-six percent of the patients were on DMTs (25% on moderate-efficacy treatment and 30% on high-efficacy treatment), 18% had discontinued treatment and 26% had never received any DMT. Sex, level of disability as measured by the Multiple Sclerosis Severity Score, anxiety and depression were independently associated with fatigue. Moderate-efficacy treatment was associated with less fatigue, but not after adjustment for other variables. There was no association between high-efficacy treatment and fatigue. CONCLUSION We found no independent relationship between the use of disease-modifying treatment and fatigue in MS.
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Affiliation(s)
- Line Broch
- Department of Neurology, Vestre Viken Hospital Trust, Drammen, Norway; Department of Neurology, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | | | | | | | | | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Norway
| | - Elisabeth Gulowsen Celius
- Department of Neurology, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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Pinarello C, Elmers J, Inojosa H, Beste C, Ziemssen T. Management of multiple sclerosis fatigue in the digital age: from assessment to treatment. Front Neurosci 2023; 17:1231321. [PMID: 37869507 PMCID: PMC10585158 DOI: 10.3389/fnins.2023.1231321] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Fatigue is one of the most disabling symptoms of Multiple Sclerosis (MS), affecting more than 80% of patients over the disease course. Nevertheless, it has a multi-faceted and complex nature, making its diagnosis, evaluation, and treatment extremely challenging in clinical practice. In the last years, digital supporting tools have emerged to support the care of people with MS. These include not only smartphone or table-based apps, but also wearable devices or novel techniques such as virtual reality. Furthermore, an additional effective and cost-efficient tool for the therapeutic management of people with fatigue is becoming increasingly available. Virtual reality and e-Health are viable and modern tools to both assess and treat fatigue, with a variety of applications and adaptability to patient needs and disability levels. Most importantly, they can be employed in the patient's home setting and can not only bridge clinic visits but also be complementary to the monitoring and treatment means for those MS patients who live far away from healthcare structures. In this narrative review, we discuss the current knowledge and future perspectives in the digital management of fatigue in MS. These may also serve as sources for research of novel digital biomarkers in the identification of disease activity and progression.
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Affiliation(s)
- Chiara Pinarello
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Julia Elmers
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technical University of Dresden, Dresden, Germany
| | - Hernán Inojosa
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technical University of Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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Graves JS, Elantkowski M, Zhang YP, Dondelinger F, Lipsmeier F, Bernasconi C, Montalban X, Midaglia L, Lindemann M. Assessment of Upper Extremity Function in Multiple Sclerosis: Feasibility of a Digital Pinching Test. JMIR Form Res 2023; 7:e46521. [PMID: 37782540 PMCID: PMC10580133 DOI: 10.2196/46521] [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: 02/24/2023] [Accepted: 08/15/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND The development of touchscreen-based assessments of upper extremity function could benefit people with multiple sclerosis (MS) by allowing convenient, quantitative assessment of their condition. The Pinching Test forms a part of the Floodlight smartphone app (F. Hoffmann-La Roche Ltd, Basel, Switzerland) for people with MS and was designed to capture upper extremity function. OBJECTIVE This study aimed to evaluate the Pinching Test as a tool for remotely assessing upper extremity function in people with MS. METHODS Using data from the 24-week, prospective feasibility study investigating the Floodlight Proof-of-Concept app for remotely assessing MS, we examined 13 pinching, 11 inertial measurement unit (IMU)-based, and 13 fatigability features of the Pinching Test. We assessed the test-retest reliability using intraclass correlation coefficients [second model, first type; ICC(2,1)], age- and sex-adjusted cross-sectional Spearman rank correlation, and known-groups validity (data aggregation: median [all features], SD [fatigability features]). RESULTS We evaluated data from 67 people with MS (mean Expanded Disability Status Scale [EDSS]: 2.4 [SD 1.4]) and 18 healthy controls. In this cohort of early MS, pinching features were reliable [ICC(2,1)=0.54-0.81]; correlated with standard clinical assessments, including the Nine-Hole Peg Test (9HPT) (|r|=0.26-0.54; 10/13 features), EDSS (|r|=0.25-0.36; 7/13 features), and the arm items of the 29-item Multiple Sclerosis Impact Scale (MSIS-29) (|r|=0.31-0.52; 7/13 features); and differentiated people with MS-Normal from people with MS-Abnormal (area under the curve: 0.68-0.78; 8/13 features). IMU-based features showed similar test-retest reliability [ICC(2,1)=0.47-0.84] but showed little correlations with standard clinical assessments. In contrast, fatigability features (SD aggregation) correlated with 9HPT time (|r|=0.26-0.61; 10/13 features), EDSS (|r|=0.26-0.41; 8/13 features), and MSIS-29 arm items (|r|=0.32-0.46; 7/13 features). CONCLUSIONS The Pinching Test provides a remote, objective, and granular assessment of upper extremity function in people with MS that can potentially complement standard clinical evaluation. Future studies will validate it in more advanced MS. TRIAL REGISTRATION ClinicalTrials.gov NCT02952911; https://clinicaltrials.gov/study/NCT02952911.
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Affiliation(s)
- Jennifer S Graves
- Department of Neurosciences, University of California, San Diego, CA, United States
| | | | | | | | | | | | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Luciana Midaglia
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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Turner JA, Laslett LL, Padgett C, Lim CK, Taylor B, van der Mei I, Honan CA. Disease-modifying therapies do not affect sleep quality or daytime sleepiness in a large Australian MS cohort. Mult Scler Relat Disord 2023; 78:104902. [PMID: 37517312 DOI: 10.1016/j.msard.2023.104902] [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: 01/16/2023] [Revised: 05/08/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Poor sleep is common in multiple sclerosis (MS) and may impact daily functioning. The extent to which disease-modifying therapies (DMTs) contribute to sleep outcomes is under-examined. OBJECTIVE To compare the effects of DMTs on sleep outcomes in an Australian cohort of people with MS and investigate associations between DMT use and beliefs about sleep problems and daily functioning (social functioning and activity engagement). METHODS Sleep outcomes were assessed using the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. DMT use and functioning were self-reported. RESULTS Of 1,715 participants, 64% used a DMT. No differences in sleep outcomes were detected between participants who did and did not use DMTs, the type of DMT used (lower vs higher efficacy, interferon-β vs other DMTs), the timing of administration, or adherence to standard administration recommendations. Beliefs that DMT use worsened sleep were associated with poorer sleep quality and perceptions that sleep problems interfered with daily functioning. CONCLUSION The use of a DMT does not appear to affect self-reported sleep outcomes in people with MS. However, beliefs that DMT use makes sleep worse were associated with poorer sleep quality and increased interference in daily functioning, suggesting a need for education to diminish negative perceptions of DMT use.
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Affiliation(s)
- Jason A Turner
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Hobart and Launceston, Australia
| | - Laura L Laslett
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Christine Padgett
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Hobart and Launceston, Australia
| | - Chai K Lim
- Macquarie Medical School, Macquarie University, Sydney, Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Cynthia A Honan
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Hobart and Launceston, Australia; Launceston General Hospital, Launceston, Tasmania, Australia.
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13
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Mogavero MP, Lanza G, Bruni O, DelRosso LM, Ferri R, Ferini-Strambi L. Sleep counts! Role and impact of sleep in the multimodal management of multiple sclerosis. J Neurol 2023:10.1007/s00415-023-11655-9. [PMID: 36905413 DOI: 10.1007/s00415-023-11655-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND In the last years, research on pharmacotherapy and non-pharmacological approaches to Multiple Sclerosis (MS) has significantly increased, along with a greater attention to sleep as a clinical outcome measure. This review aims to update the state of the art on the effects of MS treatments on sleep, but above all to evaluate the role of sleep and its management within the current and future therapeutic perspectives for MS patients. METHOD A comprehensive MEDLINE (PubMed)-based bibliographic search was conducted. This review includes the 34 papers that met the selection criteria. RESULTS First-line disease modifying therapies (especially the interferon-beta) seem to have a negative impact on sleep, assessed subjectively or objectively, while second-line treatments (in particular, natalizumab) do not seem to lead to the onset of daytime sleepiness (also evaluated objectively) and, in some cases, an improvement in sleep quality has been observed as well. Management of sleep is considered a major factor in modifying disease progression in pediatric MS; however, probably because only fingolimod has recently been approved in children, information is still scarce in this group of patients. CONCLUSIONS Studies on the effect of drugs and non-pharmacological treatments for MS on sleep are still insufficient and there is a lack of investigations on the most recent therapies. However, there is preliminary evidence that melatonin, chronotherapy, cognitive-behavioral therapy, and non-invasive brain stimulation techniques might be further assessed as adjuvant therapies, thus representing a promising field of research.
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Affiliation(s)
- Maria P Mogavero
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Lanza
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy.,Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | | | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
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14
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Comi G, Leocani L, Ferini-Strambi L, Radaelli M, Costa GD, Lanzillo R, Lus G, Bianchi V, Traccis S, Capone F, Grimaldi LME, Salemi G. Impact of treatment with dimethyl fumarate on sleep quality in patients with relapsing-remitting multiple sclerosis: A multicentre Italian wearable tracker study. Mult Scler J Exp Transl Clin 2023; 9:20552173221144229. [PMID: 36776745 PMCID: PMC9912562 DOI: 10.1177/20552173221144229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/23/2022] [Indexed: 02/11/2023] Open
Abstract
Background Sleep disorders are common in patients with multiple sclerosis and have a bidirectional interplay with fatigue and depression. Objective To evaluate the effect of treatment with oral dimethyl fumarate on the quality of sleep in relapsing-remitting multiple sclerosis. Methods This was a multicentre observational study with 223 relapsing-remitting multiple sclerosis subjects starting treatment with dimethyl fumarate (n=177) or beta interferon (n=46). All patients underwent subjective (Pittsburgh Sleep Quality Index) and objective (wearable tracker) measurements of quality of sleep. Fatigue, depression, and quality of life were also investigated and physical activity was monitored. Results Patients treated with dimethyl fumarate had significant improvement in the quality of sleep as measured with the Pittsburgh Sleep Quality Index (p<0.001). At all-time points, no significant changes in Pittsburgh Sleep Quality Index score were observed in the interferon group. Total and deep sleep measured by wearable tracker decreased at week 12 with both treatments, then remained stable for the total study duration. Depression significantly improved in patients treated with dimethyl fumarate. No significant changes were observed in mobility, fatigue and quality of life. Conclusion In patients with relapsing-remitting multiple sclerosis, the treatment with dimethyl fumarate was associated with improvements in patient-reported quality of sleep. Further randomised clinical trials are needed to confirm the benefits of long-term treatment with dimethyl fumarate.
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Affiliation(s)
- Giancarlo Comi
- Giancarlo Comi, Centro Sclerosi Multipla
Ospedale di Gallarate, ASST Valle Olona, Italy.
| | - Letizia Leocani
- Experimental Neurophysiology Unit, INSPE IRCCS
Ospedale San Raffaele, Università Vita Salute San Raffaele, Milan,
Italy
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, San
Raffaele Scientific Institute, Sleep Disorders Center, Università Vita
Salute San Raffaele, Milan, Italy
| | - Marta Radaelli
- Experimental Neurophysiology Unit, INSPE IRCCS
Ospedale San Raffaele, Università Vita Salute San Raffaele, Milan,
Italy
| | - Gloria D Costa
- Experimental Neurophysiology Unit, INSPE IRCCS
Ospedale San Raffaele, Università Vita Salute San Raffaele, Milan,
Italy
| | - Roberta Lanzillo
- Neurosciences, Reproductive and
Odontostomatological Sciences Department, Federico II, University of Naples,
Italy
| | - Giacomo Lus
- Multiple Sclerosis Center, II Division of
Neurology, University of Campania ‘L. Vanvitelli’ Napoli, Italy
| | | | | | | | - Luigi ME Grimaldi
- Centro Sclerosi Multipla Fondazione Istituto
‘G. Giglio’, Cefalù (PA), Italy
| | - Giuseppe Salemi
- UOC Neurologia e Neurofisiopatologia
Policlinico ‘Paolo Giaccone’, Palermo, Italy
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15
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Englund S, Kierkegaard M, Burman J, Fink K, Fogdell-Hahn A, Gunnarsson M, Hillert J, Langer-Gould A, Lycke J, Nilsson P, Salzer J, Svenningsson A, Mellergård J, Olsson T, Longinetti E, Frisell T, Piehl F. Predictors of patient-reported fatigue symptom severity in a nationwide multiple sclerosis cohort. Mult Scler Relat Disord 2023; 70:104481. [PMID: 36603296 DOI: 10.1016/j.msard.2022.104481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 11/30/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Fatigue is a debilitating symptom of multiple sclerosis (MS), but its relation to sociodemographic and disease-related characteristics has not been investigated in larger studies. The objectives of this study were to evaluate predictors of self-reported fatigue in a Swedish nationwide register-based MS cohort. METHODS Using a repeated cross-sectional design, we included 2,165 persons with relapsing- remitting and secondary progressive MS with one or multiple Fatigue Scale for Motor and Cognitive Functions (FSMC) scores, which was modelled using multivariable linear regressions for multiple predictors. RESULTS Only associations to expanded disability status scale (EDSS) and Symbol Digit Modalities Test (SDMT) were considered clinically meaningful among MS-associated characteristics in our main model; compared to mild disability (EDSS 0-2.5), those with severe disability (EDSS ≥6) scored 17.6 (95% CI 13.1-22.2) FSMC points higher, while the difference was 10.7 (95% CI 8.0-13.4) points for the highest and lowest quartiles of SDMT. Differences between highest and lowest quartiles of health-related quality of life (HRQoL) instruments were even greater and considered clinically meaningful; EuroQoL Visual Analogue Scale (EQ-VAS) 31.9 (95% CI 29.9-33.8), Multiple Sclerosis Impact Scale (MSIS-29) psychological component 35.6 (95% CI 33.8-37.4) and MSIS-29 physical component 45.5 (95% CI 43.7-47.4). CONCLUSION Higher self-reported fatigue is associated with higher disability level and worse cognitive processing speed, while associations to other MS-associated characteristics including MS type, line of disease modifying therapy (DMT), MS duration, relapse and new cerebral lesions are weak. Furthermore, we found a strong correlation between high fatigue rating and lower ratings on health-related quality of life instruments.
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Affiliation(s)
- Simon Englund
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Marie Kierkegaard
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Joachim Burman
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Katharina Fink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Fogdell-Hahn
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Gunnarsson
- Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Annette Langer-Gould
- Clinical and Translational Neuroscience, Southern California Permanente Medical Group, Kaiser Permanente, Pasadena, United States
| | - Jan Lycke
- Department of Clinical Neuroscience, University of Gothenburg, Gothenburg, Sweden
| | - Petra Nilsson
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Jonatan Salzer
- Department of Pharmacology and Clinical Neuroscience, Umea University, Umeå, Sweden
| | | | - Johan Mellergård
- Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elisa Longinetti
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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16
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Foley J, Berkovich R, Gudesblatt M, Luce E, Schneider B, de Moor C, Liao S, Lee L, Bodhinathan K, Avila R. Characterizing the 'feel-good experience' in multiple sclerosis patients treated with natalizumab or other therapies. Neurodegener Dis Manag 2023; 13:23-34. [PMID: 36285716 DOI: 10.2217/nmt-2022-0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Aim: Patients with relapsing-remitting multiple sclerosis (RRMS) treated with natalizumab have anecdotally reported a 'feel-good experience' (FGE). The authors characterized the FGE using survey data from patients with RRMS treated with natalizumab or other disease-modifying therapies (other-DMT). Methods: Questionnaire data from RRMS patients who use MyMSTeam, an online patient social network, were analyzed. Results: The survey included 347 patients (95 natalizumab; 252 other-DMT). More natalizumab than other-DMT patients self-reported having an FGE (62.1 vs 44.8%; p = 0.001) as well as other physical, emotional and cognitive benefits. Conclusion: This study demonstrates that physical, emotional and cognitive benefits were more commonly reported by patients treated with natalizumab than those treated with other disease-modifying therapies and helps characterize patient-reported factors associated with the FGE.
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Affiliation(s)
- John Foley
- Rocky Mountain MS Clinic, Salt Lake City, UT 80031, USA
| | - Regina Berkovich
- Neurology Program, Los Angeles County, & USC Medical Center, Los Angeles, CA 90033, USA
| | | | | | | | | | | | - Lily Lee
- Biogen, Cambridge, MA 02142, USA
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17
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Achtnichts L, Zecca C, Findling O, Kamm CP, Mueller S, Kuhle J, Lutterotti A, Gobbi C, Viviani C, Villiger-Borter E, Nedeltchev K. Correlation of disability with quality of life in patients with multiple sclerosis treated with natalizumab: primary results and post hoc analysis of the TYSabri ImPROvement study (PROTYS). BMJ Neurol Open 2023; 5:e000304. [PMID: 36727105 PMCID: PMC9884862 DOI: 10.1136/bmjno-2022-000304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/09/2022] [Indexed: 01/28/2023] Open
Abstract
Background In patients with multiple sclerosis (MS), relapses and disability progression have been associated with decreased health-related quality of life (HRQoL). Methods PROTYS, a prospective, multicentre, single-arm, observational study in seven Swiss MS centres, evaluated correlations between change in disability status (measured through the Expanded Disability Status Scale (EDSS)) and HRQoL changes (measured through the global Multiple Sclerosis International Quality of Life (MusiQoL) index questionnaire) in 35 patients with relapsing remitting MS on natalizumab for 1 year. In addition, several other scales were also used, such as: Multiple Sclerosis Intimacy and Sexuality Questionnaire-19, EuroQoL-5 Dimension, and Fatigue Scale of Motor and Cognitive Function. A post hoc analysis further assessed the association between HRQoL changes after 1 year and the MusiQoL subscores and other patient-reported outcome (PRO) measures. Results At 1 year, patients were categorised into 'EDSS improved' (6/35), 'EDSS stable' (28/35) and 'EDSS worsened' (1/35). Mean disability scores decreased for 'EDSS improved' and 'EDSS stable' but increased for 'EDSS worsened'. Mean MusiQoL index score for 'EDSS improved' increased from 61.2 at baseline to 66.3 at 1 year, while the 'EDSS stable' group increased from 67.9 to 70.8. No meaningful statistical relationship was observed between EDSS group and changes in MusiQoL score. For the post hoc analysis, patients were categorised in 'MusiQoL improved' (n=21) and 'MusiQoL worsened' (n=14) groups. MusiQoL subscores for 'symptoms,' 'psychological well-being' and 'activities of daily living', as well as scores for several related PRO measures, correlated with improvement of the MusiQoL global index. There was no correlation between the changes in MusiQoL global index and EDSS score. Conclusions Natalizumab treatment for 1 year resulted in either improved or stable EDSS status in most patients, and although no significant relationship was observed between global HRQoL change and EDSS change, several domains of HRQoL seemed to improve with natalizumab treatment. Trial registration number NCT02386566.
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Affiliation(s)
- Lutz Achtnichts
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Chiara Zecca
- Department of Neurology, Multiple Sclerosis Center (MSC), Neurocenter of Southern Switzerland, Lugano, Switzerland,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Oliver Findling
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Christian P Kamm
- Neurocenter, Cantonal Hospital Lucerne, Luzern, Switzerland,Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Stefanie Mueller
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Jens Kuhle
- Multiple Sclerosis Centre, Neurology, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Andreas Lutterotti
- Neurology Clinic, University Hospital Zurich & University of Zurich, Zurich, Switzerland
| | - Claudio Gobbi
- Department of Neurology, Multiple Sclerosis Center (MSC), Neurocenter of Southern Switzerland, Lugano, Switzerland,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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18
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Kuendig S, Kool J, Polhemus A, Schallert W, Bansi J, Gonzenbach RR. Three weeks of rehabilitation improves walking capacity but not daily physical activity in patients with multiple sclerosis with moderate to severe walking disability. PLoS One 2022; 17:e0274348. [PMID: 36121792 PMCID: PMC9484681 DOI: 10.1371/journal.pone.0274348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background Patients with multiple sclerosis have low levels of physical activity. This is of concern because low activity levels are related to cardiovascular disease, poor walking ability, and reduced quality of life. The aim of this study was to evaluate the impact of rehabilitation on daily physical activity and walking capacity in patients with multiple sclerosis who have moderate to severe walking disability. Methods This exploratory, observational study of 24 patients with multiple sclerosis examined daily physical activity, walking capacity and fatigue before and after 3 weeks of inpatient rehabilitation. Inpatient rehabilitation included physiotherapy (30–60 min, 5 times/week), strength and endurance training (30–45 min, 3–5 times/week), occupational therapy (30 min, 2–3 times/week), and neuropsychological training (30 min, 2 times/week). There were no specific interventions to target daily levels of physical activity. Results Daily physical activity did not change after rehabilitation (physical activity: effect size = –0.23, 95% confidence interval (95% CI) 0.02‒0.62). There were significant improvements in walking capacity (Two-Minute Walk Test: effect size = 0.74, 95% CI 0.31‒1.16, +17 m, 20.2%) and mobility (Timed Up and Go Test: effect size = 0.65, 95% CI 0.22‒1.07, ‒2.1 s, 14.9%). Motor and cognitive fatigue (Fatigue Scale for Motor: effect size = 0.56, 95% CI 0.14‒0.99 and Cognitive Functions: effect size = 0.44, 95% CI 0.01‒0.86) improved significantly after rehabilitation. Conclusion Three weeks of rehabilitation improved walking capacity, but not daily physical activity, in patients with multiple sclerosis with moderate to severe walking disability. To increase physical activity, it may be necessary to add specific behavioural interventions to the rehabilitation programme. The intervention plan should include strategies to overcome personal and environmental barriers.
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Affiliation(s)
- Sandra Kuendig
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Winterthur, Switzerland
| | - Jan Kool
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Ashley Polhemus
- Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Wolfgang Schallert
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
- * E-mail:
| | - Jens Bansi
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
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19
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Glasmacher SA, Kearns PK, Hassan Z, Connick P, Tauber S, Reetz K, Foley P, Chandran S. The influence of disease-modifying therapy on hidden disability burden in people with newly diagnosed relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2022; 63:103837. [PMID: 35576728 DOI: 10.1016/j.msard.2022.103837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/02/2022] [Accepted: 04/28/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND In addition to motor disability, "hidden disability" such as depression, anxiety, fatigue, sleep disturbance, cognitive impairment and pain is a major complaint of people with multiple sclerosis. We explored changes in hidden disability burden in the early post-diagnostic period and examined the hypothesis that disease modifying therapies have a beneficial effect on hidden disability burden. METHODS Adults with recently diagnosed (< 6 months) relapsing-remitting multiple sclerosis (n = 440, mean age 37.4 ± 10.4, 76% female), from a national multicentre cohort study (FutureMS) underwent testing with clinical and neuropsychological instruments as well as brain MRI at baseline and after 12-months. Disease modifying therapies were only started after baseline assessment and were classified into injectables (n = 70, interferons, glatiramer acetate), other DMTs (n = 215) and no DMT (n = 117, reference). Sensitivity analyses were undertaken using alternative classifications (disease modifying therapy vs none, and a 3-category system). We performed latent transition analysis with hidden disability burden as the latent variable including propensity score weights. RESULTS We identified three classes with low (58%), moderate (25%) and high (17%) hidden disability burden. 70% did not transition ("unchanged", reference), 26% transitioned into a lower burden class ("improvement") and 4% transitioned into a higher burden class ("worsening"). Median treatment duration was 11 months (IQR 9-12). Injectables [OR 1.3 (95%CIs 0.7, 2.3); P = 0.4] and other DMTs [OR 1.4 (95%CIs 0.9, 2.1); P = 0.2] were not associated with significant change in hidden disability burden in either direction ("improvement" or "worsening"). In the alternative 3-category classification, category 2 treatment (fingolimod, cladribine, n = 22) was associated with improvement [OR 4.3 (2.6, 7.0); P < 0.001]. CONCLUSION Hidden disability was present in most newly diagnosed people with multiple sclerosis. The majority remained unchanged and approximately a quarter improved over the immediate post-diagnostic period. Disease modifying therapy had no significant influence on hidden disability burden in the study period of one year following diagnosis. The trend towards favourable outcomes with fingolimod and cladribine should be interpreted with caution due to the small sample size. Our exploratory data are observational, with scope for attendant biases, but highlight the need for further study including longer-term evaluation as well as randomised trials for non-motor disability.
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Affiliation(s)
- Stella A Glasmacher
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK; RWTH Aachen University, Department of Neurology, Aachen, Germany
| | - Patrick Ka Kearns
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK; MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Zackary Hassan
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK
| | - Peter Connick
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK
| | - Simone Tauber
- RWTH Aachen University, Department of Neurology, Aachen, Germany
| | - Kathrin Reetz
- RWTH Aachen University, Department of Neurology, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH, Jülich, Germany
| | - Peter Foley
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, Edinburgh, UK; Euan MacDonald Centre for Motor Neurone Disease Research, Chancellor's Building, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at University of Edinburgh, Chancellor's Building, Edinburgh, UK.
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20
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Prolonged visual evoked potential latency predicts longitudinal worsening of fatigue in people with multiple sclerosis. Mult Scler Relat Disord 2022; 67:104073. [DOI: 10.1016/j.msard.2022.104073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/25/2022] [Accepted: 07/24/2022] [Indexed: 11/19/2022]
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21
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Wang Y, Wu Y, Liu B, Yang H, Qian H, Cheng Y, Li X, Yang G, Zheng X, Shen F. Binding domain peptide ameliorates alveolar hypercoagulation and fibrinolytic inhibition in mice with lipopolysaccharide-induced acute respiratory distress syndrome Via NF-κB signaling pathway. Am J Transl Res 2022; 14:3854-3863. [PMID: 35836863 PMCID: PMC9274609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Alveolar hypercoagulation and fibrinolytic inhibition are shown to be associated with refractory hypoxemia in acute respiratory distress syndrome (ARDS), and the NF-κB pathway is involved in this process. The purpose of this study is to explore the role of NEMO-binding domain peptide (NBDP) in alleviating alveolar hypercoagulation and fibrinolytic inhibition induced by lipopolysaccharide (LPS) in ARDS mice and its related mechanisms. MATERIALS AND METHODS ARDS was induced by inhalation of LPS (mg/L) in adult male BALB/c mice. Mice were treated with intratracheal inhalation of NBDP or saline aerosol at increased concentrations 30 minutes before LPS administration. Six hours after LPS treatment, bronchoalveolar lavage fluids (BALF) were collected and then all mice were euthanized. In addition, coagulation and fibrinolysis associated factors in lung tissues and BALF were detected, and the activation of NF-κB signaling pathway was observed. RESULTS NBDP pretreatment dose-dependently inhibited the expression of tissue factor (TF) and plasminogen activator inhibitor (PAI) 1 in lung tissues, reduced the secretions of TF, PAI-1, thrombin-antithrombin (TAT) complex, and promoted activated protein C (APC) secretion in BALF induced by LPS. LPS-induced high expression of pulmonary procollagen peptide type lll (PIIIP) was also reduced in a dose-dependent manner under NBDP pretreatment. Western blotting showed that NBDP pretreatment significantly attenuated LPS-induced activation of IKKα/β, Iκα and NF-κB p65. NBDP pretreatment also inhibited the DNA binding activity of p65 induced by LPS. We also noticed that NBDP protected mice against LPS-induced lung injury in a dose-dependent manner. CONCLUSIONS The experimental findings demonstrate that through inhibiting the NF-κB signaling pathway, NBDP dose-dependently ameliorates LPS-induced alveolar hypercoagulation and fibrinolytic inhibition, which is expected to be a new therapeutic target to correct the abnormalities of alveolar coagulation and fibrinolytic pathways in ARDS.
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Affiliation(s)
- Yahui Wang
- Department of Intensive Care Unit, Guizhou Medical University Affiliated HospitalGuiyang 550001, Guizhou, China
- Department of Intensive Care Unit, The People’s Hospital of Weining CountyWeining County 553100, Guizhou, China
| | - Yanqi Wu
- Department of Intensive Care Unit, Guizhou Medical University Affiliated HospitalGuiyang 550001, Guizhou, China
| | - Bo Liu
- Department of Intensive Care Unit, Guizhou Medical University Affiliated HospitalGuiyang 550001, Guizhou, China
| | - Huilin Yang
- Department of Intensive Care Unit, Guizhou Medical University Affiliated HospitalGuiyang 550001, Guizhou, China
| | - Hong Qian
- Department of Intensive Care Unit, Guizhou Medical University Affiliated HospitalGuiyang 550001, Guizhou, China
| | - Yumei Cheng
- Department of Intensive Care Unit, Guizhou Medical University Affiliated HospitalGuiyang 550001, Guizhou, China
| | - Xiang Li
- Department of Intensive Care Unit, Guizhou Medical University Affiliated HospitalGuiyang 550001, Guizhou, China
| | - Guixia Yang
- Department of Intensive Care Unit, Guizhou Medical University Affiliated HospitalGuiyang 550001, Guizhou, China
| | - Xinghao Zheng
- Department of Intensive Care Unit, Guizhou Medical University Affiliated HospitalGuiyang 550001, Guizhou, China
| | - Feng Shen
- Department of Intensive Care Unit, Guizhou Medical University Affiliated HospitalGuiyang 550001, Guizhou, China
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22
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Broch L, Flemmen HØ, Simonsen CS, Berg-Hansen P, Ormstad H, Brunborg C, Celius EG. Fatigue in multiple sclerosis is associated with socioeconomic factors. Mult Scler Relat Disord 2022; 64:103955. [PMID: 35753177 DOI: 10.1016/j.msard.2022.103955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Fatigue is one of the leading causes of reduced quality of life and inability to work in people with multiple sclerosis (pwMS). Currently, no treatment effectively ameliorates fatigue. We still know little about what causes fatigue and which factors may contribute to fatigue. Knowledge about socioeconomic factors' role in fatigue might help us recognize strategies for the management of fatigue. Our aim was to explore whether socioeconomic factors are associated with the presence or level of perceived fatigue. METHODS This is a cross-sectional study of the MS population in three Norwegian counties. We used the Fatigue Scale for Motor and Cognitive Functions to assess self-reported fatigue, and obtained socioeconomic data from Statistics Norway and questionnaires. To assess self-reported anxiety and depression, we employed the Hospital Anxiety and Depression Scale. Clinical data were gathered from the hospital record system. RESULTS The response rate was 64% (1599/2512). Seventy percent of the respondents were female, and the mean age was 52 years. Higher levels of education were associated with lower levels of fatigue. Receiving a disability pension, being divorced and having children were all factors associated with higher levels of fatigue, as were low parental education, low income, current smoking, and autoimmune comorbidities. We found a higher prevalence of anxiety and depression in pwMS with fatigue compared to those without fatigue CONCLUSION: Female sex, high level of disability, anxiety, depression and socioeconomic factors were independently associated with fatigue in contemporary patients with MS. These factors should be considered when devising management strategies.
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Affiliation(s)
- Line Broch
- Department of Neurology, Vestre Viken Hospital Trust, Drammen, Norway; Department of Neurology, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Heidi Øyen Flemmen
- Department of Neurology, Hospital Telemark HF, Skien, Norway; Institute of Health and Society, University of Oslo, Norway
| | - Cecilia Smith Simonsen
- Department of Neurology, Vestre Viken Hospital Trust, Drammen, Norway; Department of Neurology, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | | | | | - Cathrine Brunborg
- Oslo Center for Biostatistics and Epidemiology, Oslo University Hospital, Norway
| | - Elisabeth Gulowsen Celius
- Department of Neurology, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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23
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Fatigue in multiple sclerosis: A UK MS-register based study. Mult Scler Relat Disord 2022; 64:103954. [PMID: 35716477 DOI: 10.1016/j.msard.2022.103954] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/28/2022] [Accepted: 06/06/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Fatigue is a widely experienced, incapacitating symptom of MS. It hinders daily functioning and has deleterious effects on quality of life. The UK MS Register is an online registry of over 20,000 participants with MS. The aim of this study was to estimate the prevalence, predictors, and impact of fatigue on people with MS using data from the UKMS register. METHODS All participants who completed the Fatigue Severity Scale (FSS), WebEDSS, Hospital Anxiety and Depression Scale (HADS) within 28 days of each other were selected from the UK MS Register. Data on age, gender, duration and type of MS, use of disease modifying drugs and comorbidities were obtained from the UKMS register. We categorised people with FSS score of 5 or more as with fatigue and those with scores of 4 or less as without fatigue. Descriptive statistics and logistical and multiple regressions were used to explore predictors of fatigue and the effect of fatigue on mobility (MS Walking Scale), physical and psychological aspects of life (MS Impact Scale) and quality of life (European Quality of Life 5D-3 L). RESULTS Amongst the 20,946 participants of the UK MS registry, 4620 completed FSS. Out of these, 775 (mean age= 54.71 years, SD= 10.90; mean duration of MS diagnosis =13.21 years, SD=9.75) had completed the FSS, Web EDSS and Hospital Anxiety and Depression Scale within 28 days of each other. 427 (55.1%) of pwMS had a FSS score >5 consistent with clinical fatigue. Logistic regression analysis showed that depression (p=<0.001), duration of MS (p = 0.017), secondary progressive MS (p = 0.001) and EDSS (p=<0.001) predicted fatigue. FSS scores had a significant negative impact on both psychological (p > 0.001) and physical (p > 0.001) domains of the MS Impact scale, MS walking scale (p = 0.003) and EQoL (p = 0.005). CONCLUSIONS Fatigue was a common symptom amongst people with MS. Depression, longer duration of MS, secondary progressive MS, and high EDSS predicted fatigue. Fatigue had an adverse effect on physical activities, mobility, psychological wellbeing, and quality of life of people with MS.
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24
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Kalle J, Pontus W, Lenka N, Simon S, Ann B, Gunnar B, Kaj B, Henrik Z, Markus A. Cerebrospinal fluid amyloid precursor protein as a potential biomarker of fatigue in multiple sclerosis: A pilot study. Mult Scler Relat Disord 2022; 63:103846. [DOI: 10.1016/j.msard.2022.103846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/15/2022] [Accepted: 05/01/2022] [Indexed: 11/28/2022]
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25
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Adibi I, Sanayei M, Tabibian F, Ramezani N, Pourmohammadi A, Azimzadeh K. Multiple sclerosis-related fatigue lacks a unified definition: A narrative review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2022; 27:24. [PMID: 35419061 PMCID: PMC8995308 DOI: 10.4103/jrms.jrms_1401_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 09/19/2021] [Accepted: 11/01/2021] [Indexed: 11/05/2022]
Abstract
Fatigue is the most common symptom in multiple sclerosis (MS). Although MS-related fatigue (MS-F) strongly affects quality of life and social performance of patients, there is currently a lack of knowledge about its pathophysiology, which in turns leads to poor objective diagnosis and management. Recent studies have attempted to explain potential etiologies as well as treatments for MS-F. However, it seems that without a consensus on its nature, these data could not provide a route to a successful approach. In this Article, we review definitions, epidemiology, risk factors and correlated comorbidities, pathophysiology, assessment methods, neuroimaging findings, and pharmacological and nonpharmacological treatments of MS-F. Further studies are warranted to define fatigue in MS patients more accurately, which could result in precise diagnosis and management.
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Affiliation(s)
- Iman Adibi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Sanayei
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Farinaz Tabibian
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Neda Ramezani
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Pourmohammadi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kiarash Azimzadeh
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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26
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Tarasiuk J, Kapica-Topczewska K, Czarnowska A, Chorąży M, Kochanowicz J, Kułakowska A. Co-occurrence of Fatigue and Depression in People With Multiple Sclerosis: A Mini-Review. Front Neurol 2022; 12:817256. [PMID: 35242093 PMCID: PMC8886154 DOI: 10.3389/fneur.2021.817256] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/20/2021] [Indexed: 12/11/2022] Open
Abstract
Fatigue and depression are common conditions diagnosed in people with multiple sclerosis (MS). Fatigue defined as subjective lack of physical and/or mental energy is present in 35–97% of people with MS, who classify it as one of the most serious symptoms interfering with daily activities and influencing the quality of life. Depression is diagnosed in about 50% of people with MS. Since fatigue and depression frequently coexists, it may be quite hard to differentiate them. Primary fatigue and primary depression in MS are caused by inflammatory, oxidative/nitrosative, and neurodegenerative processes leading to demyelination, axonal damage, and brain atrophy. In people with MS and comorbid fatigue and/or depression there is reported increased serum and cerebrospinal fluid concentration of inflammatory mediators such as tumor necrosis factor, interleukins (IL-1a, IL-1b, IL-6), interferon γ and neopterin. Moreover, the brain atrophy of prefrontal, frontal, parietotemporal regions, thalamus, and basal ganglia was observed in people with MS with fatigue and/or depression. The secondary fatigue and secondary depression in people with MS may be caused by emotional factors, sleep disorders, pain, the coexistence of other diseases, and the use of medications. In some studies, the use of disease-modifying therapies positively influenced fatigue, probably by reducing the inflammatory response, which proves that fatigue and depression are closely related to immunological factors. In this mini-review, the pathogenesis, methods of evaluation and differentiation, and possible therapies for fatigue and depression in MS are discussed.
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Affiliation(s)
- Joanna Tarasiuk
- Department of Neurology, Medical University of Bialystok, Białystok, Poland
| | | | - Agata Czarnowska
- Department of Neurology, Medical University of Bialystok, Białystok, Poland
| | - Monika Chorąży
- Department of Neurology, Medical University of Bialystok, Białystok, Poland
| | - Jan Kochanowicz
- Department of Neurology, Medical University of Bialystok, Białystok, Poland
| | - Alina Kułakowska
- Department of Neurology, Medical University of Bialystok, Białystok, Poland
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27
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Fleischer V, Ciolac D, Gonzalez-Escamilla G, Grothe M, Strauss S, Molina Galindo LS, Radetz A, Salmen A, Lukas C, Klotz L, Meuth SG, Bayas A, Paul F, Hartung HP, Heesen C, Stangel M, Wildemann B, Bergh FT, Tackenberg B, Kümpfel T, Zettl UK, Knop M, Tumani H, Wiendl H, Gold R, Bittner S, Zipp F, Groppa S, Muthuraman M. Subcortical volumes as early predictors of fatigue in multiple sclerosis. Ann Neurol 2021; 91:192-202. [PMID: 34967456 DOI: 10.1002/ana.26290] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Fatigue is a frequent and severe symptom in multiple sclerosis (MS), but its pathophysiological origin remains incompletely understood. We aimed to examine the predictive value of subcortical gray matter volumes for fatigue severity at disease onset and after four years by applying structural equation modeling (SEM). METHODS This multi-center cohort study included 601 treatment-naive MS patients after the first demyelinating event. All patients underwent a standardized 3T MRI protocol. A subgroup of 230 patients with available clinical follow-up data after four years was also analyzed. Associations of subcortical volumes (included into SEM) with MS-related fatigue were studied regarding their predictive value. In addition, subcortical regions that have a central role in the brain network (hubs) were determined through structural covariance network (SCN) analysis. RESULTS Predictive causal modeling identified volumes of the caudate (s [standardized path coefficient]=0.763, p=0.003 [left]; s=0.755, p=0.006 [right]), putamen (s=0.614, p=0.002 [left]; s=0.606, p=0.003 [right]) and pallidum (s=0.606, p=0.012 [left]; s=0.606, p=0.012 [right]) as prognostic factors for fatigue severity in the cross-sectional cohort. Moreover, the volume of the pons was additionally predictive for fatigue severity in the longitudinal cohort (s=0.605, p=0.013). In the SCN analysis, network hubs in patients with fatigue worsening were detected in the putamen (p=0.008 [left]; p=0.007 [right]) and pons (p=0.0001). INTERPRETATION We unveiled predictive associations of specific subcortical gray matter volumes with fatigue in an early and initially untreated MS cohort. The colocalization of these subcortical structures with network hubs suggests an early role of these brain regions in terms of fatigue evolution. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Dumitru Ciolac
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Matthias Grothe
- Department of Neurology, University Medicine of Greifswald, Greifswald, Germany
| | - Sebastian Strauss
- Department of Neurology, University Medicine of Greifswald, Greifswald, Germany
| | - Lara S Molina Galindo
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Angela Radetz
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Anke Salmen
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany.,Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Carsten Lukas
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany
| | - Luisa Klotz
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Germany
| | - Sven G Meuth
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Germany.,Department of Neurology, University of Duesseldorf, Duesseldorf, Germany
| | - Antonios Bayas
- Department of Neurology, University Hospital Augsburg, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Charité, Universitätsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Hans-Peter Hartung
- Department of Neurology, University of Duesseldorf, Duesseldorf, Germany
| | - Christoph Heesen
- Institute for Neuroimmunology and Multiple Sclerosis, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Stangel
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | | | - Björn Tackenberg
- Department of Neurology, Philipps-University Marburg, Germany.,F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig Maximilian University of Munich, Germany
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Germany
| | | | | | - Heinz Wiendl
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Germany
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28
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Tan LSY, Francis HM, Lim CK. Exploring the roles of tryptophan metabolism in MS beyond neuroinflammation and neurodegeneration: A paradigm shift to neuropsychiatric symptoms. Brain Behav Immun Health 2021; 12:100201. [PMID: 34589733 PMCID: PMC8474511 DOI: 10.1016/j.bbih.2021.100201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 11/05/2022] Open
Abstract
The metabolism of tryptophan through the kynurenine pathway (KP) has been increasingly recognised in contributing to disease progression in the autoimmune and inflammatory disease multiple sclerosis (MS). In this review, the roles of inflammation and the KP are recontextualised to better understand the aetiology of the neuropsychiatric symptoms (depression, postpartum depression, suicidality, fatigue and cognitive dysfunction) in MS. These symptoms will be discussed in the context of cytokine-induced sickness behaviours, KP activation and levels of neurotoxicity and neuroprotection in MS. In particular, there will be emphasis on how neuropsychiatric symptoms in MS occur against the shared background of inflammation and KP dysregulation. The discourse of this review aims to promote future research in elucidating KP mechanisms in MS that would inevitably lead to more targeted treatment options for neuropsychiatric symptoms and disease progression. Research on tryptophan metabolism and neuroinflammation on neurodegeneration in multiple sclerosis (MS) is mounting. This review reframes the roles of neuroinflammation and tryptophan metabolism dysregulation on mental health issues in MS. The impact of neuroinflammation and tryptophan metabolism on depression, suicidality, fatigue, and cognitive impairment in MS are discussed.
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Affiliation(s)
- Lorraine S Y Tan
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | - Heather M Francis
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | - Chai K Lim
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
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29
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Mäcken J, Wiegand M, Müller M, Krawinkel A, Linnebank M. A Mobile App for Measuring Real Time Fatigue in Patients with Multiple Sclerosis: Introducing the Fimo Health App. Brain Sci 2021; 11:brainsci11091235. [PMID: 34573257 PMCID: PMC8465979 DOI: 10.3390/brainsci11091235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/21/2022] Open
Abstract
Although fatigue is one of the most disabling symptoms of MS, its pathogenesis is not well understood yet. This study aims to introduce a new holistic approach to measure fatigue and its influencing factors via a mobile app. Fatigue is measured with different patient-reported outcome measures (Visual Analog Scale, Fatigue Severity Scale) and tests (Symbol Digit Modalities Test). The influencing vital and environmental factors are captured with a smartwatch and phone sensors. Patients can track these factors within the app. To individually counteract their fatigue, a fatigue course, based on the current treatment guidelines, was implemented. The course implies knowledge about fatigue and MS, exercises, energy-conservation management, and cognitive behavioral therapy. Based on the Transtheoretical Model of Behavior Change, the design of the Fimo health app follows the ten strategies of the process of change, which is a proven approach to designing health intervention programs. By monitoring fatigue and individual influencing factors, patients can better understand and manage their fatigue. They can share their data and insights about fatigue and its influencing factors with their doctors. Thus, they can receive individualized therapies and drug plans.
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Affiliation(s)
- Jana Mäcken
- Department of Health Economics and Clinical Epidemiology, University Hospital Cologne, 50935 Cologne, Germany
- Correspondence:
| | - Marie Wiegand
- Department of Psychology, University of Cologne, 50923 Cologne, Germany;
| | | | | | - Michael Linnebank
- Evangelische Kliniken Gelsenkirchen, 45879 Gelsenkirchen, Germany;
- Faculty of Health, University Witten/Herdecke, 58455 Witten, Germany
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30
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Davidescu EI, Odajiu I, Sandu CD, Ghergu A, Luca D, Mureșanu DF, Popescu BO. Real-World Data Regarding Long-Term Administration of Natalizumab from a Neurology Department along Literature Review. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 21:326-334. [PMID: 34455973 DOI: 10.2174/1871527320666210827113733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 06/21/2021] [Accepted: 07/03/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Natalizumab is a humanized monoclonal antibody with high efficacy and an acceptable safety profile used in the treatment of patients with multiple sclerosis (MS). OBJECTIVES Our aim was to report data regarding long-term administration of Natalizumab in patients with relapsing-remitting multiple sclerosis (RRMS) from our clinic. METHODS A retrospective observational study was performed including RRMS patients who underwent treatment with ≥ 24 Natalizumab infusions. We analyzed the EDSS values, the relapse rate and the rate and type of adverse events related to Natalizumab administration. RESULTS 51 subjects were included with a predominance of women (62.74%), an average age of 40.43±1.49 years, a mean disease duration of 9.86±0.7 years and mean number of Natalizumab infusions of 45.58±2.74. An increased number of patients (80.39%) were relapse-free and there was observed a mild reduction of the mean EDSS value following Natalizumab initiation in patients who had not been treated with other disease modifying therapies anteriorly. Among the encountered adverse events we registered: increased liver transaminases (13.72%), local infections (7.84%) and dysmenorrhea in one patient. The rate of severe adverse events was 3.92 and there were registered no cases of Progressive Multifocal Leukoencephalopathy (PML). CONCLUSIONS Natalizumab proves to be effective, has an adequate safety profile and can be administered with good tolerability for a rather extended period of time, provided that the patients are closely monitored.
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Affiliation(s)
- Eugenia Irene Davidescu
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest. Romania
| | - Irina Odajiu
- Neurology Department, Colentina Clinical Hospital, Bucharest. Romania
| | | | - Amalia Ghergu
- Neurology Department, Colentina Clinical Hospital, Bucharest. Romania
| | - Dimela Luca
- Neurology Department, Colentina Clinical Hospital, Bucharest. Romania
| | - Dafin Fior Mureșanu
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca. Romania
| | - Bogdan Ovidiu Popescu
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest. Romania
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31
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Glanz BI, Zurawski J, Casady EC, Shamah R, Weiner M, Chitnis T, Weiner HL, Healy BC. The impact of ocrelizumab on health-related quality of life in individuals with multiple sclerosis. Mult Scler J Exp Transl Clin 2021; 7:20552173211007523. [PMID: 34046184 PMCID: PMC8138295 DOI: 10.1177/20552173211007523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background Ocrelizumab is approved for the treatment of both relapsing and progressive
multiple sclerosis (MS). Objective To examine the impact of ocrelizumab on health-related quality of life
(HRQOL) in individuals with MS. Methods Ninety-eight individuals with relapsing and 32 with progressive MS were
enrolled. Participants were administered a battery of patient-reported
outcome (PRO) measures at their first ocrelizumab infusion, and infusions at
6 and 12 months. PRO measures included the Medical Outcomes Study SF-36 and
Neuro-QoL. Results At baseline, participants had low mean scores across HRQOL domains. After
12 months, increases were observed on SF-36 Role-Physical, General Health,
Vitality, Role-Emotional, Mental health and Mental Component Summary. On
Neuro-QoL, improvements were seen in Positive Affect, Anxiety, Emotional and
Behavioral Dyscontrol and Fatigue. Several demographic and clinical
characteristics were associated with HRQOL at baseline. The strongest
associations were between physical HRQOL measures and measures of MS
disability. Associations between the longitudinal change in HRQOL scores and
baseline demographic and clinical characteristics were mild. Conclusions We observed significant improvements across multiple mental HRQOL domains at
12 months in individuals treated with ocrelizumab. These findings support
the use of HRQOL measures to provide a subjective measure of treatment
impact that complements traditional outcomes.
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Affiliation(s)
- Bonnie I Glanz
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jonathan Zurawski
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Mira Weiner
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Howard L Weiner
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian C Healy
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
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32
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Broch L, Simonsen CS, Flemmen HØ, Berg-Hansen P, Skardhamar Å, Ormstad H, Celius EG. High prevalence of fatigue in contemporary patients with multiple sclerosis. Mult Scler J Exp Transl Clin 2021; 7:2055217321999826. [PMID: 33796331 PMCID: PMC7985949 DOI: 10.1177/2055217321999826] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 01/10/2023] Open
Abstract
Objective The prevalence of multiple sclerosis (MS)-related fatigue may have changed due to new diagnostic criteria and new disease modifying drugs. We aimed to assess the prevalence of fatigue in a contemporary MS cohort, and to explore associations between fatigue and clinical and demographic factors. Methods This is a cross-sectional study of the MS population in three Norwegian counties. Fatigue was assessed with the Fatigue Scale for Motor and Cognitive Functions (FSMC). We also assessed self-reported anxiety, depression and daytime sleepiness. Results The response rate was 64% (1599/2512). The mean age of the participants was 52 ± 13 years, median EDSS was 2.5 (IQR 1.5-3.0) and median disease duration from onset was 16 years (IQR 8-25). We found a prevalence of fatigue of 81%. Women had a higher prevalence of fatigue than men (83% vs 78%, p = 0.02). The prevalence increased with age (p < 0.001) and with increasing disease severity (p < 0.001), but in multivariate analyses, only sex and disease severity remained independent determinants of fatigue. Anxiety, depression, and daytime sleepiness were more prevalent in patients with fatigue than in those without fatigue (all p-values < 0.001). Conclusion The prevalence of fatigue is high in contemporary patients with MS. Fatigue is associated with female sex and level of disability, as well as with anxiety, depression and excessive daytime sleepiness.
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Affiliation(s)
- Line Broch
- Department of Neurology, Vestre Viken Hospital Trust, Drammen, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cecilia Smith Simonsen
- Department of Neurology, Vestre Viken Hospital Trust, Drammen, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Heidi Øyen Flemmen
- Department of Neurology, Hospital Telemark HF, Skien, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Pål Berg-Hansen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Heidi Ormstad
- University of South-Eastern Norway, Notodden, Norway
| | - Elisabeth Gulowsen Celius
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Capra R, Morra VB, Mirabella M, Gasperini C, Scandellari C, Totaro R, De Rossi N, Masera S, Zipoli V, Patti F. Natalizumab is associated with early improvement of working ability in relapsing-remitting multiple sclerosis patients: WANT observational study results. Neurol Sci 2020; 42:2837-2845. [PMID: 33205373 DOI: 10.1007/s10072-020-04838-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Work Ability in Natalizumab-Treated MS Patients (WANT) study assessed work ability, quality of life, and cognitive processing speed during natalizumab treatment. METHODS WANT was a 1-year, prospective, multicenter observational study conducted in Italy. Inclusion criteria included relapsing-remitting multiple sclerosis (MS), natalizumab treatment, full-time worker status, and loss of working hours due to MS as measured by the Work Productivity and Activity Impairment Questionnaire for MS (WPAI:MS). The primary endpoint was change in WPAI:MS domain scores after 1 year on natalizumab. Secondary endpoints included change in annualized relapse rate (ARR), Multiple Sclerosis Impact Scale (MSIS-29) score, and Symbol Digit Modalities Test (SDMT) score. RESULTS At enrollment, the 91 patients had a mean age of 38.3 (standard deviation [SD], 9.0) years and a mean ARR of 1.5 (SD, 0.8). After 1 year, improvements were observed in all WPAI:MS domains, with significant reductions in Absenteeism (-4.2 [SD, 26.0], p = 0.0190) and Work Productivity Loss (-7.2 [SD, 28.6]; p = 0.0456). These changes were accompanied by a low ARR (0.1), and 87.9% of patients were relapse free. Significant improvement was observed in MSIS-29 physical and psychological domains (reductions of 2.8 [SD, 11.6; p = 0.0295] and 6.3 [SD, 15.6; p = 0.0007], respectively) and SDMT score (increase of 2.4 [SD, 7.9; p = 0.0006]). Adverse events were reported in 32 of 104 patients (30.8%). CONCLUSIONS The reductions in Absenteeism and Work Productivity Loss and the improved physical and psychological functioning reported after 1 year of natalizumab treatment in real-world settings extend our understanding of natalizumab's effects on patient-centric and health economics outcomes.
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Affiliation(s)
- Ruggero Capra
- Multiple Sclerosis Center, Spedali Civili of Brescia, Montichiari, Brescia, Italy.
| | - Vincenzo Brescia Morra
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Universita degli Studi di Napoli Federico II, Naples, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome, Rome, Italy
| | - Claudio Gasperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Cinzia Scandellari
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOsI Riabilitazione Sclerosi Multipla, Ospedale Bellaria, Bologna, Italy
| | - Rocco Totaro
- Multiple Sclerosis Center, San Salvatore Hospital, L'Aquila, Italy
| | - Nicola De Rossi
- Multiple Sclerosis Center, Spedali Civili of Brescia, Montichiari, Brescia, Italy
| | | | | | - Francesco Patti
- DANA Department, "GF Ingrassia", Medical and Surgical Sciences, Advanced Technologies, Multiple Sclerosis Center, University of Catania, Catania, Italy
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Cognitive Fatigability is Independent of Subjective Cognitive Fatigue and Mood in Multiple Sclerosis. Cogn Behav Neurol 2020; 33:113-121. [PMID: 32496296 DOI: 10.1097/wnn.0000000000000228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sustained cognitive testing is used to detect cognitive fatigability and is often considered a substitute for subjective cognitive fatigue (CF). However, the relationship between cognitive fatigability and subjective CF in people with multiple sclerosis (PwMS) remains undetermined. OBJECTIVE To explore potential associations between fatigability induced by sustained cognitive testing and subjective CF in PwMS. METHODS We gave 120 PwMS and 60 demographically matched, healthy individuals the Beck Depression Inventory-FastScreen (BDI-FS) to measure mood and the Modified Fatigue Impact Scale to measure CF. In addition, we used the Quotient ADHD Test, a sustained attention test, to measure cognitive fatigability. We also explored potential correlations between the individuals' performance on the sustained attention test and thalamic volume using recent MRI scans. RESULTS Forty-one (34.2%) of the PwMS exhibited cognitive fatigability. These 41 were found to be significantly older (P=0.006), had been diagnosed with the disease for longer (P=0.03), had higher scores (P<0.001) on the Expanded Disability Status Scale, and had reduced thalamic volume (P=0.04) compared with the 79 (65.8%) PwMS not exhibiting cognitive fatigability. The PwMS exhibiting cognitive fatigability scored similarly on the BDI-FS (P=0.21) and self-reported similar rates of CF (P=0.62) as the PwMS not exhibiting cognitive fatigability. CONCLUSION Cognitive fatigability induced by sustained cognitive testing is not an accurate clinical alternative to subjective CF. This study provides evidence to support cognitive fatigability and CF in PwMS as two distinct concepts.
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Cathérine D, Annelien DP, Anne S, Luc A, Liesbeth VH, Gerlo S, Guy L. End of dose interval symptoms in patients treated with natalizumab: A role for serum cytokines? Mult Scler Relat Disord 2020; 41:102020. [PMID: 32146430 DOI: 10.1016/j.msard.2020.102020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/22/2020] [Accepted: 02/21/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many natalizumab treated patients experience end of dose interval (EDI) symptoms towards the end of the administration cycle. Natalizumab has previously shown to influence cytokine profiles in relapsing remitting MS patients. We hypothesize that EDI symptoms might be explained by variability in serum cytokine levels during natalizumab treatment. METHODS 42 relapsing remitting MS patients were included. Participants were evaluated before natalizumab administration (day 0) and 7 days afterwards (day 7). At both time points fatigue, depressed mood and cognition were evaluated using the fatigue severity scale (FSS), the visual analogue scale for fatigue (VAS-F), the symbol digit modality test (SDMT) and the inventory for depressive symptomatology (IDS-SR). Serum samples were tested for concentrations of IL-6, IFN-γ and TNF-α at both timepoints. On day 7 an additional EDI questionnaire was completed. Data were analyzed with SPSS by means of non-parametric tests. RESULTS EDI symptoms were reported by 59.5%. Although fatigue was most frequently reported, fatigue scales did not significantly change from day 0 to 7 in (fatigued) EDI patients. Mood and cognition significantly ameliorated in both EDI and non-EDI patients. Cytokines remained stable at day 0 vs 7 except for a significant increase in IFN-γ. On day 0, IFN-γ concentration was positively correlated with a depressed mood in the whole cohort, and with mood and fatigue in the EDI group. Depressed mood positively whilst cognition negatively correlated with IFN-γ concentration on day 0 in the EDI subgroup reporting fatigue. No significant correlations between IL-6 nor TNF-α and symptom scores could be found. CONCLUSION In our study EDI symptoms could not be objectified since EDI and non-EDI groups did not differ in terms of change in mood, cognition and fatigue between day 0 and 7 suggesting that symptom recrudescence could be a subjective experience. Although our results need to be interpreted cautiously, we found no clear correlation between studied serum cytokines concentrations and the occurrence of EDI symptoms.
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Affiliation(s)
- Dekeyser Cathérine
- Department of Neurology, UZ Gent, Corneel Heymanslaan 10, Gent, Belgium.
| | - De Pue Annelien
- Department of Neurology, AZ St. Lucas, Groenebriel 1, Gent, Belgium
| | - Sieben Anne
- Department of Neurology, UZ Gent, Corneel Heymanslaan 10, Gent, Belgium; Department of Neurology, AZ Jan Palfijn, Henri Dunantlaan 5, Gent, Belgium
| | - Algoed Luc
- Department of Neurology, AZ Maria Middelares, Buitenring-Sint-Denijs 30, Gent, Belgium
| | | | - Sarah Gerlo
- VIB Center for Medical Biotechnology, Albert Baertsoenkaai 3, Gent, Belgium; Department of Biomolecular Medicine, UGent, Albert Baertsoenkaai 3, Gent, Belgium
| | - Laureys Guy
- Department of Neurology, UZ Gent, Corneel Heymanslaan 10, Gent, Belgium.
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Manjaly ZM, Harrison NA, Critchley HD, Do CT, Stefanics G, Wenderoth N, Lutterotti A, Müller A, Stephan KE. Pathophysiological and cognitive mechanisms of fatigue in multiple sclerosis. J Neurol Neurosurg Psychiatry 2019; 90:642-651. [PMID: 30683707 PMCID: PMC6581095 DOI: 10.1136/jnnp-2018-320050] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 02/07/2023]
Abstract
Fatigue is one of the most common symptoms in multiple sclerosis (MS), with a major impact on patients' quality of life. Currently, treatment proceeds by trial and error with limited success, probably due to the presence of multiple different underlying mechanisms. Recent neuroscientific advances offer the potential to develop tools for differentiating these mechanisms in individual patients and ultimately provide a principled basis for treatment selection. However, development of these tools for differential diagnosis will require guidance by pathophysiological and cognitive theories that propose mechanisms which can be assessed in individual patients. This article provides an overview of contemporary pathophysiological theories of fatigue in MS and discusses how the mechanisms they propose may become measurable with emerging technologies and thus lay a foundation for future personalised treatments.
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Affiliation(s)
- Zina-Mary Manjaly
- Department of Neurology, Schulthess Clinic, Zürich, Switzerland .,Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Neil A Harrison
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Cao Tri Do
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Gabor Stefanics
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.,Laboratory for Social and Neural Systems Research (SNS), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Nicole Wenderoth
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Andreas Lutterotti
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Alfred Müller
- Department of Neurology, Schulthess Clinic, Zürich, Switzerland
| | - Klaas Enno Stephan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.,Wellcome Centre for Human Neuroimaging, University College London, London, UK.,Max Planck Institute for Metabolism Research, Cologne, Germany
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Arroyo R, Bury DP, Guo JD, Margolin DH, Melanson M, Daizadeh N, Cella D. Impact of alemtuzumab on health-related quality of life over 6 years in CARE-MS II trial extension patients with relapsing-remitting multiple sclerosis. Mult Scler 2019; 26:955-963. [PMID: 31144568 PMCID: PMC7350196 DOI: 10.1177/1352458519849796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: In CARE-MS II (Comparison of Alemtuzumab and Rebif® Efficacy in Multiple Sclerosis; NCT00548405), alemtuzumab (12 mg/day; baseline: 5 days; 12 months later: 3 days) significantly improved health-related quality of life (HRQL) outcomes versus subcutaneous interferon beta-1a (SC IFNB-1a) in relapsing-remitting multiple sclerosis (RRMS) patients over 2 years. Patients completing CARE-MS II could enter a 4-year extension study (NCT00930553). Objective: The aim of this study is to assess 6-year HRQL outcomes in alemtuzumab-treated CARE-MS II patients, including those with highly active disease (HAD). Methods: During extension, patients could receive additional alemtuzumab for clinical/magnetic resonance imaging (MRI) activity or other disease-modifying therapies per investigator’s discretion. Assessments include Functional Assessment of Multiple Sclerosis (FAMS), 36-Item Short-Form Health Survey (SF-36), and EQ-5D visual analog scale (EQ-VAS). Results: Alemtuzumab-treated patients improved or stabilized all HRQL measures over 6 years with significant improvements from baseline at all time points on EQ-VAS and for up to 5 years on FAMS, SF-36 MCS, and SF-36 PCS. Alemtuzumab-treated patients with HAD showed significant improvements versus baseline at Year 2 on all HRQL measures, and significant improvements versus SC IFNB-1a on SF-36 PCS and EQ-VAS; however, the improvements did not reach the threshold for clinical relevance. Conclusion: Alemtuzumab-treated CARE-MS II patients improved or stabilized HRQL versus baseline over 6 years. This is the first study to show long-term HRQL benefits in patients with HAD.
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Affiliation(s)
- Rafael Arroyo
- Department of Neurology, Hospital Universitario Quirónsalud, Madrid, Spain
| | | | - Jennifer D Guo
- Sanofi, Cambridge, MA, USA; Bristol-Myers Squibb, Lawrence Township, NJ, USA
| | | | | | | | - David Cella
- Department of Medical Social Sciences, Center for Patient-Centered Outcomes, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Why patients with multiple sclerosis perceive improvement of gait during treatment with natalizumab? J Neural Transm (Vienna) 2019; 126:731-737. [DOI: 10.1007/s00702-019-02013-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
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Adherence to Subcutaneous IFN β-1a in Multiple Sclerosis: Final Analysis of the Non-Interventional Study READOUTsmart Using the Dosing Log and Readout Function of RebiSmart ®. Adv Ther 2019; 36:175-186. [PMID: 30488338 DOI: 10.1007/s12325-018-0839-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Patient adherence is a key determinant of treatment success in multiple sclerosis (MS). The RebiSmart® autoinjector facilitates patient self-injection of subcutaneous interferon β-1a (sc IFN β-1a) and allows quantitative measurement of adherence via its automated dosing log. We evaluated patient adherence and patient-reported cognitive and health-economic outcomes over 2 years in patients using RebiSmart®. METHODS In this non-interventional, single-arm study, enrolled patients were 12-65 years of age, had relapsing-remitting MS or a single demyelinating event, and had been prescribed 44 or 22 μg sc IFN β-1a. Quantitative adherence (proportion of scheduled injections administered) and qualitative adherence (proportion of weeks with treatment schedule correctly followed) were monitored over 2 years. Other end points included self-assessed adherence, patient-reported outcomes (fatigue, depression and quality of life), cognitive outcomes and health-economic outcomes. RESULTS A total of 368 of 392 (93.9%) enrolled patients were analyzed. Mean quantitative adherence was 85.3% overall (months 1-24), 89.6% for months 1-12 and 83.3% for months 13-24. No major impact on quantitative adherence was observed for sex, age (< 37 years vs. ≥ 37 years), prior medication or participation in the patient support program RebiSTAR®. Mean qualitative adherence was 67.0% overall (months 1-24). Self-assessed adherence was reported as being higher than RebiSmart®-monitored adherence. There was a trend toward more MS-related visits to physicians among patients with high adherence. CONCLUSIONS Patients using RebiSmart® demonstrated high adherence to treatment that was associated with a slight improvement in information processing speed and working memory and an overall tendency for more intensive self-management. FUNDING Merck Serono GmbH, Germany, an affiliate of Merck KGaA, Darmstadt, Germany.
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Vaughn CB, Kavak KS, Dwyer MG, Bushra A, Nadeem M, Cookfair DL, Ramanathan M, Benedict RHB, Zivadinov R, Goodman A, Krupp L, Motl RW, Weinstock-Guttman B, Kolb C, Robb JF, Jubelt B, Gerber A, Kister I, Ryerson LZ, Coyle P, Perel A, Gottesman M, Lenihan M, Edwards K, Garten L, Picone MA. Fatigue at enrollment predicts EDSS worsening in the New York State Multiple Sclerosis Consortium. Mult Scler 2018; 26:99-108. [DOI: 10.1177/1352458518816619] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Fatigue is one of the most common and distressing symptoms among persons with multiple sclerosis (pwMS). Objective: The aim of this study is to evaluate fatigue as a predictor for disease worsening among pwMS. Methods: In this retrospective cohort study of New York State MS Consortium (NYSMSC) registry, MS patients reporting moderate-to-severe fatigue at study enrollment ( n = 2714) were frequency matched to less-fatigued subjects ( n = 2714) on age, baseline Kurtzke Expanded Disability Status Scale (EDSS), disease duration, and MS phenotype. Change from baseline patient-reported outcomes (PROs), as measured by LIFEware™, categorized participants into two groups: those with stable/improved outcomes and those who worsened. In a subgroup of patients with longitudinal data ( n = 1951), sustained EDSS worsening was analyzed using Cox proportional hazards modeling to explore the effect of fatigue. Results: The median survival time from study enrollment to sustained EDSS worsening was 8.7 years (CI: 7.2–10.1). Participants who reported fatigue at baseline were more likely to experience sustained EDSS worsening during follow-up (HR: 1.4, 95% CI: 1.2–1.7). Patients who were fatigued at baseline were also more likely to report worsening psychosocial limitations (all ps ⩽ 0.01). Conclusion: In addition to being a common symptom of MS, severe fatigue was a significant predictor for EDSS worsening in the NYSMSC.
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Affiliation(s)
- Caila B Vaughn
- New York State Multiple Sclerosis Consortium, Buffalo, NY, USA/Jacobs MS Center for Treatment and Research, Buffalo, NY, USA/ Department of Neurology, University at Buffalo, Buffalo, NY, USA
| | - Katelyn S Kavak
- New York State Multiple Sclerosis Consortium, Buffalo, NY, USA/Jacobs MS Center for Treatment and Research, Buffalo, NY, USA
| | | | - Aisha Bushra
- New York State Multiple Sclerosis Consortium, Buffalo, NY, USA/Jacobs MS Center for Treatment and Research, Buffalo, NY, USA
| | - Muhammad Nadeem
- New York State Multiple Sclerosis Consortium, Buffalo, NY, USA/Jacobs MS Center for Treatment and Research, Buffalo, NY, USA
| | - Diane L Cookfair
- Jacobs MS Center for Treatment and Research, Buffalo, NY, USA/ Department of Neurology, University at Buffalo, Buffalo, NY, USA
| | - Murali Ramanathan
- Department of Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Robert Zivadinov
- New York State Multiple Sclerosis Consortium, Buffalo, NY, USA/ Department of Neurology, University at Buffalo, Buffalo, NY, USA; Buffalo Neuroimaging Analysis Center, Buffalo, NY, USA
| | - Andrew Goodman
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bianca Weinstock-Guttman
- New York State Multiple Sclerosis Consortium, Buffalo, NY, USA/Jacobs MS Center for Treatment and Research, Buffalo, NY, USA/ Department of Neurology, University at Buffalo, Buffalo, NY, USA
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Bose G, Atkins HL, Bowman M, Freedman MS. Autologous hematopoietic stem cell transplantation improves fatigue in multiple sclerosis. Mult Scler 2018; 25:1764-1772. [PMID: 30251913 DOI: 10.1177/1352458518802544] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Fatigue is a common problem in multiple sclerosis (MS) affecting as many as 90% of patients. The Fatigue Impact Scale (FIS) is a validated measure of fatigue in MS patients. The cause of fatigue in MS is likely multifactorial, with some evidence that ongoing central nervous system (CNS) inflammation is a contributing factor. Immunoablation and autologous hematopoietic stem cell transplantation (aHSCT) have been shown to halt ongoing CNS inflammation. OBJECTIVE To investigate whether halting all ongoing inflammation with aHSCT impacts FIS scores in patients with severe MS. METHODS In the Canadian aHSCT study ( ClinicalTrials.gov , NCT01099930), 23 patients underwent aHSCT and had FIS prospectively collected every 6 months for 36 months of follow-up. Change in FIS was analysed by repeated-measures analysis of variance (RMANOVA) with multiple linear regression to determine independent predictors. RESULTS The median FIS score decreased 36%, from 36 to 23 (p = 0.001), and four patients had 100% reduction. Improvement in FIS correlated with lower age and Expanded Disability Status Scale at baseline, as well as increased independence as evidenced by a return to gainful employment and even driving. CONCLUSION Patients had significantly less fatigue on average after aHSCT. This may serve to better understand the contribution of ongoing CNS inflammation to fatigue peculiar to MS.
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Affiliation(s)
- Gauruv Bose
- Department of Neurology, The Ottawa Hospital Civic Campus, Ottawa, ON, Canada/Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Harold L Atkins
- Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Mark S Freedman
- Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Adverse psychiatric effects of disease-modifying therapies in multiple Sclerosis: A systematic review. Mult Scler Relat Disord 2018; 26:124-156. [PMID: 30248593 DOI: 10.1016/j.msard.2018.09.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/16/2018] [Accepted: 09/10/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Psychiatric comorbidity is prevalent in persons with multiple sclerosis (MS). Few studies have assessed whether second-generation disease-modifying therapies (DMT) are associated with adverse psychiatric effects. OBJECTIVE We aimed to systematically review the literature regarding the APEs associated with natalizumab, fingolimod, dimethyl fumarate, teriflunomide and alemtuzumab in MS. As a secondary objective, we evaluated changes in anxiety or depression scores following treatment with the aforementioned DMTs. METHODS We searched MEDLINE, EMBASE, International Pharmaceutical Abstracts, PsychINFO, Central Register of Controlled Trials & Cochrane database of systematic reviews for published studies, and clinicaltrials.gov and regulatory documents from the US and Canada for unpublished studies. Data sources were searched from inception to September 2017. Studies reporting adverse psychiatric effects involving any DMT of interest were included. We report the incidence proportions of the adverse psychiatric effects and, where applicable, risk differences between DMT-exposed and unexposed individuals along with the corresponding 95% confidence intervals. We calculated the standardized mean differences (SMD) of changes in anxiety and depression scores if reported as study outcomes, and pooled the data using random effects meta-analysis. RESULTS Of 4389 abstracts screened, 78 met the inclusion criteria, including 48 clinical trials, 28 observational studies and 2 case reports. Depression was the most commonly reported adverse psychiatric effect. Incidence proportions for all adverse psychiatric effects ranged from 0 to 24.7%. None of the DMT studied were associated with a statistically significant increased risk of any adverse psychiatric effect (range of risk difference: -7.69% [95%CI: -16.06%, 5.56%] to 6.67 [-8.56, 15.59]). Eighteen studies examined changes in depression or anxiety following fingolimod, natalizumab or dimethyl fumarate treatment; depression symptoms improved in fingolimod-treated groups (SMD [95%CI]: 1.18 [0.17, 2.19]). We did not identify studies examining changes in these outcomes following treatment with any of the other DMTs. CONCLUSION The DMTs reviewed were not associated with an increased risk of adverse psychiatric effect in MS, and some may reduce the incidence of depressive symptoms. This may reflect either a positive direct effect (e.g. immune modulation) or an indirect effect arising due to a positive impact on disease activity or course.
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Chalah MA, Ayache SS. Is there a link between inflammation and fatigue in multiple sclerosis? J Inflamm Res 2018; 11:253-264. [PMID: 29922081 PMCID: PMC5995280 DOI: 10.2147/jir.s167199] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Among autoimmune diseases of the central nervous system stands multiple sclerosis (MS), which is characterized by demyelination, synaptopathy, and neurodegeneration. MS fatigue can affect up to 90% of patients and be very disabling, with a drastic impact on their quality of life. To date, the evaluation of MS fatigue has relied mainly on subjective scales, and actual therapeutic interventions are challenged by modest efficacy and numerous undesirable effects. Therefore, finding biomarkers of MS fatigue might help in optimizing evaluation and treatment strategies. The main objective here was to assess the relationship between MS fatigue and inflammatory or other immunomediated markers. Methods Research was conducted according to PRISMA guidelines. Computerized databases (ie, PubMed/Medline and Scopus) were consulted till February 2018 aiming to identify articles that addressed inflammation and MS fatigue. Studies in English and French published at any time were considered. Results A total of 27 studies matched the research criteria. Inconsistency existed regarding the relationship between fatigue and the orexin A system, hypothalamus–pituitary–adrenal axis, and cerebrospinal fluid inflammatory markers. As for peripheral markers, although there was scarcity in the available data, serum proinflammatory cytokines (ie, IL6, TNFα, and IFNγ) seem to be associated with MS fatigue. Finally, no link was found between MS fatigue and T-cell populations (ie, CD3+CD4+ T lymphocytes, regulatory T cells) or other peripheral markers of inflammation (ie, CRP, erythrocyte-sedimentation rate, soluble ICAM1). Conclusion Future large-scale studies would benefit from comparing the relationship between fatigue and immune measures in patients with different disease phenotypes with and without disease-modifying drugs. With the subjective nature of fatigue scales, finding objective biomarkers for fatigue would be of great help.
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Affiliation(s)
- Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France.,Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France.,Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.,Neurology Division, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
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Phyo AZZ, Demaneuf T, De Livera AM, Jelinek GA, Brown CR, Marck CH, Neate SL, Taylor KL, Mills T, O'Kearney E, Karahalios A, Weiland TJ. The Efficacy of Psychological Interventions for Managing Fatigue in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Front Neurol 2018; 9:149. [PMID: 29670565 PMCID: PMC5893652 DOI: 10.3389/fneur.2018.00149] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/28/2018] [Indexed: 12/13/2022] Open
Abstract
Background Multiple sclerosis (MS) is a complex, demyelinating disease of the central nervous system. Fatigue is commonly reported by people with MS (PwMS). MS-related fatigue severely affects daily activities, employment, socioeconomic status, and quality of life. Objective We conducted this systematic review and meta-analysis to determine whether psychological interventions are effective in managing fatigue in PwMS. Data sources We performed systematic searches of Medline, EMBASE, PsycINFO, and CINAHL to identify relevant articles published from database inception to April 5, 2017. Reference lists from relevant reviews were also searched. Study selection and design Two independent reviewers screened the papers, extracted data, and appraised the included studies. A clinical psychologist verified whether interventions were psychological approaches. A narrative synthesis was conducted for all included studies. For relevant randomized controlled trials that reported sufficient information to determine standardized mean differences (SMDs) and 95% confidence intervals (CIs), meta-analyses were conducted using a random-effects model. Results Of the 353 identified articles, 20 studies with 1,249 PwMS were included in this systematic review. Narrative synthesis revealed that psychological interventions reduced fatigue in PwMS. Meta-analyses revealed that cognitive behavioral therapy decreased levels of fatigue compared with non-active controls (SMD = −0.32; 95% CI: −0.63 to −0.01) and compared with active controls (relaxation or psychotherapy) (SMD = −0.71; 95% CI: −1.05 to −0.37). Meta-analyses further showed that both relaxation (SMD = −0.90; 95% CI: −1.30 to −0.51), and mindfulness interventions (SMD = −0.62; 95% CI: −1.12 to −0.12), compared with non-active control, decreased fatigue levels. The estimates of heterogeneity for the four meta-analyses varied between none and moderate. Conclusion This study found that the use of psychological interventions for MS-related fatigue management reduced fatigue in PwMS. While psychological interventions are generally considered first-line therapy for MS-related fatigue, further studies are needed to explore the long-term effect of this therapy.
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Affiliation(s)
- Aung Zaw Zaw Phyo
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Thibaut Demaneuf
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alysha M De Livera
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Biostatistics Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - George A Jelinek
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Chelsea R Brown
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Claudia H Marck
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sandra L Neate
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Keryn L Taylor
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Taylor Mills
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Emily O'Kearney
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Amalia Karahalios
- Biostatistics Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Tracey J Weiland
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Højsgaard Chow H, Schreiber K, Magyari M, Ammitzbøll C, Börnsen L, Romme Christensen J, Ratzer R, Soelberg Sørensen P, Sellebjerg F. Progressive multiple sclerosis, cognitive function, and quality of life. Brain Behav 2018; 8:e00875. [PMID: 29484253 PMCID: PMC5822575 DOI: 10.1002/brb3.875] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 09/22/2017] [Accepted: 10/10/2017] [Indexed: 01/18/2023] Open
Abstract
Background Patients with progressive multiple sclerosis (MS) often have cognitive impairment in addition to physical impairment. The burden of cognitive and physical impairment progresses over time, and may be major determinants of quality of life. The aim of this study was to assess to which degree quality of life correlates with physical and cognitive function in progressive MS. Methods This is a retrospective study of 52 patients with primary progressive (N = 18) and secondary progressive MS (N = 34). Physical disability was assessed using the Expanded Disability Status Scale, Timed 25 Foot Walk (T25FW) test and 9-Hole Peg Test (9HPT). Cognitive function was assessed using Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test, and Trail Making Test B (TRAIL-B). In addition, quality of life was assessed by the Short Form 36 (SF-36) questionnaire. Results Only measures of cognitive function correlated with the overall SF-36 quality of life score and the Mental Component Summary score from the SF-36. The only physical measure that correlated with a measure of quality of life was T25FW test, which correlated with the Physical Component Summary from the SF-36. We found no other significant correlations between the measures of cognitive function and the overall physical measures but interestingly, we found a possible relationship between the 9HPT score for the nondominant hand and the SDMT and TRAIL-B. Conclusion Our findings support inclusion of measures of cognitive function in the assessment of patients with progressive MS as these correlated closer with quality of life than measures of physical impairment.
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Affiliation(s)
- Helene Højsgaard Chow
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Karen Schreiber
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Melinda Magyari
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Cecilie Ammitzbøll
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Lars Börnsen
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Jeppe Romme Christensen
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Rikke Ratzer
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Per Soelberg Sørensen
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Finn Sellebjerg
- Department of NeurologyDanish Multiple Sclerosis CenterRigshospitaletUniversity of CopenhagenCopenhagenDenmark
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Antidepressant activity of anti-cytokine treatment: a systematic review and meta-analysis of clinical trials of chronic inflammatory conditions. Mol Psychiatry 2018; 23:335-343. [PMID: 27752078 PMCID: PMC5794896 DOI: 10.1038/mp.2016.167] [Citation(s) in RCA: 392] [Impact Index Per Article: 65.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/01/2016] [Accepted: 08/12/2016] [Indexed: 02/07/2023]
Abstract
Inflammatory cytokines are commonly elevated in acute depression and are associated with resistance to monoaminergic treatment. To examine the potential role of cytokines in the pathogenesis and treatment of depression, we carried out a systematic review and meta-analysis of antidepressant activity of anti-cytokine treatment using clinical trials of chronic inflammatory conditions where depressive symptoms were measured as a secondary outcome. Systematic search of the PubMed, EMBASE, PsycINFO and Cochrane databases, search of reference lists and conference abstracts, followed by study selection process yielded 20 clinical trials. Random effect meta-analysis of seven randomised controlled trials (RCTs) involving 2370 participants showed a significant antidepressant effect of anti-cytokine treatment compared with placebo (standardised mean difference (SMD)=0.40, 95% confidence interval (CI), 0.22-0.59). Anti-tumour necrosis factor drugs were most commonly studied (five RCTs); SMD=0.33 (95% CI; 0.06-0.60). Separate meta-analyses of two RCTs of adjunctive treatment with anti-cytokine therapy and eight non-randomised and/or non-placebo studies yielded similar small-to-medium effect estimates favouring anti-cytokine therapy; SMD=0.19 (95% CI, 0.00-0.37) and 0.51 (95% CI, 0.34-0.67), respectively. Adalimumab, etanercept, infliximab and tocilizumab all showed statistically significant improvements in depressive symptoms. Meta-regression exploring predictors of response found that the antidepressant effect was associated with baseline symptom severity (P=0.018) but not with improvement in primary physical illness, sex, age or study duration. The findings indicate a potentially causal role for cytokines in depression and that cytokine modulators may be novel drugs for depression in chronically inflamed subjects. The field now requires RCTs of cytokine modulators using depression as the primary outcome in subjects with high inflammation who are free of other physical illnesses.
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Rorsman I, Petersen C, Nilsson P. Cognitive functioning following one-year natalizumab treatment: A non-randomized clinical trial. Acta Neurol Scand 2018; 137:117-124. [PMID: 28901547 DOI: 10.1111/ane.12833] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Cognitive impairment is common in multiple sclerosis (MS) and can have serious impact on social and occupational functioning. Natalizumab reduces relapse rates, magnetic resonance imaging (MRI) lesions, and progression of disability. Previous studies on cognitive functioning have not based inclusion on cognitive performance criteria. The aim of the present study was to determine any potential natalizumab-related cognitive effects on MS patients performing below normal limits on neuropsychological testing. MATERIALS AND METHODS Patients starting natalizumab (n = 21) and a quasi-control group of stable MS patients (n = 13) on first line disease modifying treatment were included following neuropsychological assessment demonstrating subnormal cognitive performance. Assessment, using ten cognitive variables, was repeated after 12 months. Symptoms of fatigue, anxiety and depression were also examined. Raw scores on the cognitive tests were transformed into Z-scores based on published age-corrected normative data. RESULTS Between-group analyses on difference Z-scores (baseline - follow-up) yielded significant results on Paced Auditory Serial Addition Test-2 (PASAT-2) (P = .008), with the natalizumab group showing larger improvement than quasi control patients. On PASAT-2, 28,5% from the natalizumab group demonstrated >1 SD improvement, indicative of clinically meaningful change, compared with none in the quasi control group. Patients receiving natalizumab showed within-group improvements on six of the ten cognitive variables. There were no group differences in symptoms of fatigue, anxiety or depression. CONCLUSIONS The results demonstrate improvement in information processing speed following 12-months of natalizumab treatment. The results are interpreted as reflection of anti-inflammatory properties of natalizumab rather than retest- or long-term restorative effects.
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Affiliation(s)
- I. Rorsman
- Department of Neurology and Rehabilitation Medicine; Skåne University Hospital; Lund Sweden
- Department of Clinical Sciences Neurology; Lund University; Lund Sweden
| | - C. Petersen
- Department of Clinical Sciences Neurology; Lund University; Lund Sweden
- Department of Diagnostic Radiology; Skåne University Hospital; Lund Sweden
| | - P.C. Nilsson
- Department of Neurology and Rehabilitation Medicine; Skåne University Hospital; Lund Sweden
- Department of Clinical Sciences Neurology; Lund University; Lund Sweden
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49
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Planche V, Moisset X, Morello R, Dumont E, Gibelin M, Charré-Morin J, Saubusse A, Mondou A, Reuter F, Defer G, Pelletier J, Brochet B, Clavelou P. Improvement of quality of life and its relationship with neuropsychiatric outcomes in patients with multiple sclerosis starting treatment with natalizumab: A 3-year follow-up multicentric study. J Neurol Sci 2017; 382:148-154. [PMID: 29111011 DOI: 10.1016/j.jns.2017.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/25/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is impaired in multiple sclerosis (MS) but can be improved by disease-modifying therapies such as natalizumab. However, the predictive factors and neuropsychiatric correlates of HRQoL improvement are unknown. METHODS In this study, 48 patients with relapsing-remitting MS were included in a 3-year open-label, single group, multicenter, clinical trial (NCT01392872). HRQoL was measured by the disease-specific MusiQoL questionnaire, together with physical disability, cognition, fatigue, anxiety and depression scores at baseline, 6months, 12months, 18months and 36months after starting natalizumab therapy. RESULTS Compared to baseline, global HRQoL, as measured with the index of the MusiQoL, was significantly increased 6months after the beginning of natalizumab therapy, with medium effect-size (58.6±16.2 vs 69.8±18.9, p<0.001, Cohen's d=0.63). This improvement was maintained over time for up to 3years and mainly concerned activity of daily living, psychological well-being, symptoms and coping (p<0.001 for every dimensions). The variation of global HRQoL after 3years was negatively correlated with the variation of fatigue score (r=-0.44, p=0.015). Furthermore, a higher fatigue score at baseline was correlated with improvement in global HRQoL 3years afterwards (r=0.34, p=0.041), independently of age, educational level, disease duration and disability at baseline (β=2.45, p=0.020). Disability at baseline, cognitive impairment, anxiety and depression failed to predict or correlate with global HRQoL improvement in multivariate analyses. CONCLUSION Natalizumab improved HRQoL quickly and sustainably in patients with relapsing-remitting MS. In terms of HRQoL, natalizumab seems to benefit mostly patients with more marked fatigue at baseline.
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Affiliation(s)
- Vincent Planche
- Service de Neurologie, CHU de Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France.
| | - Xavier Moisset
- Service de Neurologie, CHU de Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; Neuro-Dol, Inserm U1107, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Remy Morello
- Unité de Biostatistique et Recherche Clinique, CHU de Caen, Université de Normandie, F-14033 Caen, France
| | - Emilie Dumont
- Service de Neurologie, CHU de Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | | | - Julie Charré-Morin
- Service de Neurologie, CHU de Bordeaux, Université de Bordeaux, F-33007 Bordeaux, France
| | - Aurore Saubusse
- Service de Neurologie, CHU de Bordeaux, Université de Bordeaux, F-33007 Bordeaux, France
| | - Audrey Mondou
- Service de Neurologie, CHU de Caen, Université de Normandie, F-14033 Caen, France
| | - Françoise Reuter
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, F-13000 Marseille, France
| | - Gilles Defer
- Service de Neurologie, CHU de Caen, Université de Normandie, F-14033 Caen, France
| | - Jean Pelletier
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, F-13000 Marseille, France
| | - Bruno Brochet
- Service de Neurologie, CHU de Bordeaux, Université de Bordeaux, F-33007 Bordeaux, France
| | - Pierre Clavelou
- Service de Neurologie, CHU de Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; Neuro-Dol, Inserm U1107, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
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Giacoppo S, Ruscica M, Grimaldi LM, Bramanti P, Mazzon E. The Italian Pharmacovigilance Program: An Observational Study of Adverse Effects of Natalizumab in Multiple Sclerosis Therapy. Med Sci Monit 2017; 23:4230-4240. [PMID: 28864818 PMCID: PMC5592973 DOI: 10.12659/msm.903301] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background This study shows the results of a regional pharmacovigilance program on Natalizumab therapy in relapsing-remitting multiple sclerosis (RR-MS) patients after 3 years of experience. Material/Methods The primary objectives of this study were to estimate the incidence of expected and unexpected adverse effects correlated to Natalizumab therapy in a cohort of 88 RR-MS patients from Sicily, Italy, and to investigate the procedures adopted by the physicians to minimize the risk of developing severe adverse reactions correlated to Natalizumab therapy. Secondary objectives of this study were to evaluate the effectiveness of Natalizumab therapy for a careful examination of the risk/benefit ratio and to assess the actions undertaken in case of adverse reactions. Results Among 88 RR-MS patients, 55.68% did not report any type of adverse reaction, 35.22% showed expected adverse reactions (58.70% slight, 22.58% moderate, and 19.35% severe), and 9.10% showed unexpected adverse effects (62.50% slight, 25.00% moderate, and 12.50% severe). Approximately 4.54% of the patients treated with Natalizumab interrupted the therapy. Overall, among all patients, 56.62% showed ameliorated condition, 32.53% had stable disease condition, and 10.85% worsened. Conclusions We provide a short overview of evidence, which may be useful to better characterize the efficacy and potential adverse effects correlated to Natalizumab therapy.
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Affiliation(s)
- Sabrina Giacoppo
- Experimental Neurology Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Maria Ruscica
- Departmen of Neurology, Fondazione Istituto San Raffaele G. Giglio, Cefalù, Italy
| | - Luigi Maria Grimaldi
- Departmen of Neurology, Fondazione Istituto San Raffaele G. Giglio, Cefalù, Italy
| | - Placido Bramanti
- Experimental Neurology Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Emanuela Mazzon
- Experimental Neurology Laboratory, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
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