Multiple sclerosis and related challenges to young women's health: Canadian expert review

Home-based telerehabilitation in multiple sclerosis: a scoping review

BACKGROUND

Introducing home-based telerehabilitation (TR) approaches helps clinical experts to choose appropriate and effective interventions and researchers identify knowledge gaps to design clinical trial studies and systematic reviews.

PURPOSE

This study aimed to review the knowledge of home-based TR in multiple sclerosis.

METHOD

This scoping review study was conducted based on Arksey and O'Malley's five-step approach. The Embase, PubMed, Cochrane, Web of Sciences, Scopus and ProQuest databases were searched in 2017-2024 to find full-text English-language articles.

FINDINGS

In 25 studies reviewed, various and extensive home-based interventions have been used in physical and cognitive aspects.

CONCLUSION

Home-based rehabilitation is applicable, useful, safe and affordable, maintains the continuity of the rehabilitation process and increases patients' adherence to the rehabilitation programme. However, there are challenges such as patients' lack of familiarity with technology and limitations of outcome measurement tools that should be addressed in future studies.

Validity, reliability, and responsiveness of Persian version of mini-balance evaluation system test among ambulatory people with multiple sclerosis

BACKGROUND AND PURPOSE

Mini-Balance Evaluation Systems Test (mini-BESTest) is a widely used measure to assess balance impairments. This study aimed to assess the validity, reliability, responsiveness, and minimal clinically important change (MCIC) of the Persian mini-BESTest among ambulatory People with Multiple Sclerosis (PwMS).

METHODS

Fifty ambulatory PwMS participated in this study. Persian mini-BESTest validated against Berg Balance Scale (BBS) and Timed-Up and Go (TUG) with/without a cognitive task. To assess the reliability, the Persian mini-BESTest was re-administered for a sample of 30 participants after 1 week. Also, 32 PwMS were tested before and after a 4-week of balance and gait training to assess the responsiveness.

RESULTS

No floor/ceiling effect was found for the mini-BESTest total score. There were significant excellent correlations (p < .001) between mini-BESTest and BBS (r = 0.71), TUG (r = -0.76), and cognitive TUG (r = -0.73). No strong correlations were observed between the subscales (r = 0.37-0.55). Test-retest reliability and internal consistency of Persian mini-BESTest total score were excellent, with Intra-class Correlation Coefficient (ICC3,1 and Cronbach's alpha level of 0.89 and 0.80, respectively. The minimal detectable change was 4 points. The Persian mini-BESTest had acceptable responsiveness (AUC = 0.83), and MCIC was 5 points.

CONCLUSION

The Persian mini-BESTest is a valid, reliable, and responsive measure of balance performance in Iranian ambulatory PwMS.

[Comorbid anxiety disorders in patients with neurological pathology: current state of the problem and the role of etifoxine in treatment strategy]

The article presents theses of the resolution of the Interdisciplinary Council of Experts in Psychiatry and Neurology (Moscow, 2024) on the issue of comorbid anxiety disorders (AD) in patients with neurological pathologies. The authors highlight the high prevalence of comorbid ADs and their significant negative impact on the course of underlying diseases, such as epilepsy, pain syndromes and post-stroke conditions. Modern approaches to the diagnosis and treatment of ADs in this group of patients are discussed. Special attention is given to the role of etifoxine as an effective anxiolytic in the comprehensive therapy of ADs. Etifoxine, due to its dual mechanism of action on GABA receptors, demonstrates high efficacy in reducing anxiety and has neuroprotective, neurotrophic, neuroplastic, analgesic, and anti-inflammatory properties, making it an important tool in the treatment of comorbid ADs in patients with neurological pathologies. The article also reviews recently published data confirming its efficacy and favourable safety profile compared to traditional benzodiazepines and other anxiolytic drugs.

Cost-consequence analysis of ofatumumab for the treatment of relapsing-remitting multiple sclerosis in Canada

Aim: The costs and consequences of initial and delayed ofatumumab treatment were evaluated in relapsing-remitting multiple sclerosis with active disease in Canada. Materials & methods: A Markov cohort model was used (10-year horizon, annual cycle length, 1.5% discounting). Scenario analyses examined ofatumumab as first-line treatment versus 3 and 5 years following switch from commonly used first-line therapies. Results: Ofatumumab resulted in improvements in clinical outcomes (relapses and disease progression) and productivity (employment and full-time work), and reduction of economic burden (administration, monitoring and non-drug costs) that were comparable to other high-efficacy therapies (ocrelizumab, cladribine and natalizumab). Switching to ofatumumab earlier in the disease course may improve these outcomes. Conclusion: Results highlight the value of a high-efficacy therapy such as ofatumumab as initial treatment (i.e., first-line) in newly diagnosed relapsing-remitting multiple sclerosis patients with active disease.

Magnolol prevented brain injury through the modulation of Nrf2-dependent oxidative stress and apoptosis in PLP-induced mouse model of multiple sclerosis

Multiple sclerosis (MS) is an immune-mediated chronic inflammatory demyelinating disease of the central nervous system (CNS). The aim of the current study was to investigate the effects of magnolol in an experimental autoimmune encephalomyelitis (EAE) model of MS in female mice. Magnolol (0.1, 1, and 10 mg/kg) was administered once daily for 21 days after immunization of mice. Magnolol post-immunization treatment significantly reversed clinical scoring, EAE-associated pain parameters, and motor dysfunction in a dose-dependent manner. Magnolol treatment significantly inhibited oxidative stress by reducing malondialdehyde (MDA), nitric oxide (NO) production, and myeloperoxidase (MPO) activity while enhancing the level of antioxidants such as reduced glutathione (GSH), glutathione-S-transferase (GST), catalase, and superoxide dismutase (SOD) in the brain and spinal cord. It reduced cytokine levels in the brain and spinal cord. It suppressed CD8+ T cells frequency in the spleen tissue. Magnolol remarkably reversed the EAE-associated histopathology of the brain and spinal cord tissue. Magnolol significantly intensifies the antioxidant defense system by enhancing the expression level of nuclear factor erythroid 2-related factor (Nrf2) while decreasing the expression of inducible nitric oxide synthase (iNOS) and cleaved-caspase-3 in the brain. Molecular docking results showed that magnolol possesses a better binding affinity for Nrf2, iNOS, and caspase-3 proteins. Taken together, the present study demonstrated that magnolol has significant neuroprotective properties in EAE via inhibition of oxidative stress.