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Young CA, Rog DJ, Tanasescu R, Kalra S, Langdon D, Tennant A, Mills RJ. Multiple Sclerosis vision questionnaire (MSVQ-7): Reliability, validity, precision and discrimination. Mult Scler Relat Disord 2023; 80:105115. [PMID: 37931488 DOI: 10.1016/j.msard.2023.105115] [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: 06/17/2023] [Revised: 09/20/2023] [Accepted: 10/29/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Visual dysfunction is common in people with Multiple Sclerosis (pwMS), associated with a variety of visual symptoms. Capturing the patient experience of these complex patterns of visual pathology is challenging. A valid and reliable patient reported measure, capable of detecting clinically significant change, would have considerable research and clinical benefits. We examined the properties of the MS Vision Questionnaire (MSVQ-7) in a large MS population. METHODS Data were collected from participants in the UK-wide Trajectories of Outcome in Neurological Conditions-MS (TONiC-MS) study: MS subtype and Expanded Disability Status Scale (EDSS) band from the clinical team, as well as serial packs including the MSVQ-7 and questionnaires on depression, anxiety and stigma. A calibration sample of 1000 pwMS contributing several years of follow-up were split into training and validation samples for a Confirmatory Factor Analysis and Rasch analysis. The Minimal Detectable Change (MDC) was computed as well as the Minimal Clinically Important Change (MIC), by an anchor-based method, for different MS subtypes. RESULTS The MSVQ-7 is unidimensional and can be fit to the Rasch model with a solution discarding 3% of variance. Providing all 7 items are answered, the total can be converted to an interval-level metric for calculation of change scores and other parametric analyses. The % of missing values did not exceed 1.7%. Among 5478 pwMS, 80% reported visual problems. MSVQ-7 scores were categorised as mild for 36.1%, moderate for 33.6% and severe for 10.3%, and varied by MS subtype. In the follow-up sample of 2227 pwMS, 42.5% changed MSVQ-7 category between baseline and first follow-up (mean 22.6 months). The MIC exceeded the MDC so clinically significant change exceeds measurement error. While MDC was identical for relapsing and progressive MS, MIC varied by MS subtype, with smaller MIC in relapsing MS. Over one-quarter of the follow-up sample reported a clinically significant change in MSVQ-7: 12.2% improved and 13.5% deteriorated. For pwMS recruited within 2 years of diagnosis, 17.3% reported significant change on follow-up, all improving. MSVQ-7 scores showed strong associations with anxiety, depression and stigma (effect sizes>0.8). Duration, EDSS band and MS subtype all had effect sizes 0.2-0.49. A multinomial logistic regression exploring vision disturbance and depression, adjusted for age, gender, MS subtype, duration and disability, showed vision is the strongest significant predictor of depression. Each unit increase in interval MSVQ-7 increases risk by 10% of 'possible' and by 17% of 'probable' depression. CONCLUSIONS The MSVQ-7 is a brief self-report measure of visual problems for pwMS. It can easily be converted to interval-level measurement for change scores or power calculations and has good precision and discrimination. Visual problems were reported by 80% of pwMS and changed over time, evidencing the need for regular monitoring. MIC varied by MS subtype, indicating that perception of impact changes over the disease course. Visual dysfunction significantly affects depression risk and perceived stigma, highlighting the importance of routine assessment of visual problems in comprehensive care. The MSVQ-7 has strong psychometric properties for adoption as a measure for vision in clinical and research settings.
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Affiliation(s)
- Carolyn A Young
- Molecular and Integrative Biology, Institute of Systems, University of Liverpool, Liverpool, United Kingdom; Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
| | - David J Rog
- Northern Care Alliance NHS Trust, Salford, United Kingdom
| | | | - Seema Kalra
- University Hospital of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Dawn Langdon
- Royal Holloway, University of London, Egham, Surrey, United Kingdom
| | - Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, United Kingdom
| | - Roger J Mills
- Molecular and Integrative Biology, Institute of Systems, University of Liverpool, Liverpool, United Kingdom; Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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Houshi S, Tavallaei MJ, Barzegar M, Afshari-Safavi A, Vaheb S, Mirmosayyeb O, Shaygannejad V. Prevalence of trigeminal neuralgia in multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2022; 57:103472. [PMID: 34986455 DOI: 10.1016/j.msard.2021.103472] [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: 05/28/2021] [Revised: 08/30/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The prevalence of Trigeminal Neuralgia (TN) in patients diagnosed with multiple sclerosis (MS) is insufficiently understood and controversially reported. This study focused on providing a better understanding of the prevalence of TN in MS patients. METHOD We systematically searched PubMed, Scopus, EMBASE, Web of Science, and Google Scholar to identify studies published from January 1, 1990, to December 30, 2020. We included studies reporting the TN prevalence among MS patients and exclude case reports/series and editorial studies, review studies, and non-English written articles. We used pooled prevalence estimates to determine the TN prevalence among MS patients. RESULTS Pooled overall TN prevalence among 19 studies and 30,348 MS patients was estimated as 3.4% (95% CI: 1.5%-5.9%) with a high level of heterogeneity among studies (I2=98.92%; p<0.001). The pooled prevalence of TN in male and female patients across 9 surveys was 2.4% (95% CI: 0.5%-5.4%) and 3.8% (95% CI: 0.8%-8.7%), respectively. No heterogeneity between the two groups was observed (p = 0.558). A meta-regression was performed to explore the source of the heterogeneity. None of the candidate covariates, including the year of a study publication, the sample size, the average age of patients, and the disease duration, were significant in the model. CONCLUSION Our results showed that TN is a common problem among patients with MS, predominantly male patients. Future studies should target the general prevalence of pain in MS patients.
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Affiliation(s)
- Shakiba Houshi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mahdi Barzegar
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Afshari-Safavi
- Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Saeed Vaheb
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Universal council of epidemiology (UCE), universal scientific education and research network (USERN), Tehran University of Medical Sciences, Tehran, Iran.
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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van der Feen FE, de Haan GA, van der Lijn I, Huizinga F, Meilof JF, Heersema DJ, Heutink J. Recognizing visual complaints in people with multiple sclerosis: Prevalence, nature and associations with key characteristics of MS. Mult Scler Relat Disord 2021; 57:103429. [PMID: 34863058 DOI: 10.1016/j.msard.2021.103429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 11/15/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Visual disturbances are common in multiple sclerosis (MS), but visual complaints may be underestimated. While these complaints decrease quality of life, they may not be discussed during clinic visits. People with MS (pwMS) may not be referred to appropriate care. We therefore investigated the prevalence, nature and associations of visual complaints of pwMS. METHODS We performed a cohort study with a comparison group. PwMS (n = 493) and healthy controls (n = 661) filled out the Screening Visual Complaints questionnaire (SVCq). Primary outcomes were the percentage of pwMS and controls that reported the 19 complaints, and total scores of the SVCq. We also compared the scores on the SVCq between different groups of pwMS. RESULTS In general, the complaints were reported more often by pwMS than by controls. PwMS especially reported experiencing complaints 'often/always', while controls reported the complaints primarily 'sometimes'. PwMS with and without a history of optic neuritis showed similar complaints. PwMS with a longer disease duration and those with SPMS reported more complaints. EDSS score and disease duration only showed a limited association with discomfort of visual complaints. CONCLUSION The prevalence of visual complaints among pwMS is high and any person with MS may experience a wide array of different visual complaints anywhere along the disease course, regardless of a history of optic neuritis. Using the SVCq may help detect pwMS' visual complaints and may facilitate referrals to appropriate care.
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Affiliation(s)
- F E van der Feen
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 1/2, 9712 TS, Groningen, The Netherlands; Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, PO box 1180, Huizen 1270 BD, The Netherlands.
| | - G A de Haan
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 1/2, 9712 TS, Groningen, The Netherlands; Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, PO box 1180, Huizen 1270 BD, The Netherlands
| | - I van der Lijn
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 1/2, 9712 TS, Groningen, The Netherlands; Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, PO box 1180, Huizen 1270 BD, The Netherlands
| | - F Huizinga
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO box 196, FA 21, Groningen 9700, The Netherlands
| | - J F Meilof
- Department of Neurology, Martini Hospital, PO box 30033, Groningen 9700 RM, The Netherlands
| | - D J Heersema
- Department of Neurology, University Medical Center Groningen, PO box 30001, Groningen 9700 RB, The Netherlands
| | - J Heutink
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 1/2, 9712 TS, Groningen, The Netherlands; Royal Dutch Visio, Center of Expertise for Blind and Partially Sighted People, PO box 1180, Huizen 1270 BD, The Netherlands
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Sukkarieh G, Ghorayeb R, Issa M, Koussa S, Waked N. Evaluation of corneal sensitivity in multiple sclerosis patients. Indian J Ophthalmol 2021; 69:2421-2424. [PMID: 34427235 PMCID: PMC8544080 DOI: 10.4103/ijo.ijo_3052_20] [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] [Indexed: 11/04/2022] Open
Abstract
Purpose To measure the corneal sensitivity in patients with multiple sclerosis (MS), to compare it with normal values and to study its correlation with different disease characteristics. Methods Corneal sensitivity of 28 MS patients was compared to corneal sensitivity of 28 age- and gender-matched normal controls. Corneal sensitivity was measured using the Cochet-Bonnet esthesiometer and was correlated to the duration, type and severity indexes of the disease. Results Corneal sensitivity was comparable between both groups (P = 0.79). No statistically significant correlation was found between corneal sensitivity and the duration of MS (P = 0.55) nor the severity indexes of MS (expanded disability status scale [EDSS] P = 0.52, global multiple sclerosis severity score [MSSS] P = 0.64). Following subgroup analysis, only the primary progressive (PPMS) form of MS had a reduced corneal sensitivity with P = 0.023, while remittent-recurrent (RRMS), secondary progressive (SPMS), and clinically isolated (CIS) forms of MS did not have any reduction in the corneal sensitivity. "ROC curve analysis" showed an area under the curve of 0.48. Conclusion In the exception of PPMS subtype, MS patients have similar corneal sensitivity in comparison to controls. Cochet-Bonnet esthesiometer does not seem to be a good diagnostic tool or a disease severity marker for patients with MS.
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Affiliation(s)
- Georges Sukkarieh
- Ophthalmology Department, Hȏtel-Dieu de France Hospital, Faculty of Medecine, Saint Joseph University, Beirut, Lebanon
| | - Ralph Ghorayeb
- Ophthalmology Department, Hȏtel-Dieu de France Hospital, Faculty of Medecine, Saint Joseph University, Beirut, Lebanon
| | - Mohamad Issa
- Ophthalmology Department, Hȏtel-Dieu de France Hospital, Faculty of Medecine, Saint Joseph University, Beirut, Lebanon
| | | | - Naji Waked
- Ophthalmology Department, Hȏtel-Dieu de France Hospital, Faculty of Medecine, Saint Joseph University, Beirut, Lebanon
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Video-oculography in multiple sclerosis: Links between oculomotor disorders and brain magnetic resonance imaging (MRI). Mult Scler Relat Disord 2020; 40:101969. [PMID: 32028119 DOI: 10.1016/j.msard.2020.101969] [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: 12/05/2019] [Revised: 01/24/2020] [Accepted: 01/26/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Eye movement abnormalities (EMA) are common in multiple sclerosis (MS). However, type and severity according to the MS stage are poorly known, especially in Radiologically Isolated Syndrome (RIS) and in Clinically Isolated Syndrome (CIS). Although MRI has been included in the MS diagnostic criteria, there may be clinical-radiological dissociation. OBJECTIVE To analyze by video-oculography (VOG) prevalence of EMA in different MS phenotypes and study correlations with brain and cervical cord MRI T2 lesions location. METHODS 76 participants were prospectively recruited (12 RIS, 10 CIS, 11 relapsing-remitting-MS, 10 secondary progressive-MS, 10 primary progressive MS and 23 gender and age-matched healthy controls). We analyzed fixations, anti-saccades, horizontal and vertical reflex saccades and smooth pursuit. RESULTS EMA were frequent and of gradual severity from RIS to progressive forms. Internuclear ophthalmoplegia (INO) and centripetal hypermetria were strong arguments for the diagnosis of a demyelinating disorder versus a control population. Some EMA were linked to infratentorial T2 lesion location, but others like INO were not. CONCLUSION This study confirm that EMA are common in all MS phenotypes, even at the earliest stages. VOG can be useful to detect demyelinating process at preclinical stage by highlighting subclinical EMA even in absence of characteristic lesions visible on MRI.
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Lee SU, Kim HJ, Choi JH, Choi JY, Kim JS. Comparison of Ocular Motor Findings Between Neuromyelitis Optica Spectrum Disorder and Multiple Sclerosis Involving the Brainstem and Cerebellum. THE CEREBELLUM 2019; 18:511-518. [DOI: 10.1007/s12311-019-01018-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
BACKGROUND Multiple sclerosis (MS) is a demyelinating disease of the central nervous system leading to disability, especially in young patients. Acute or chronic lesions of MS within the brainstem and the cerebellum frequently result in ocular motor disorders. EVIDENCE ACQUISITION This review encompasses the spectrum of ocular motor disorders in patients with MS emphasizing prevalence, examination findings, diagnostic features, functional consequences, classification of MS course, and management of these disturbances of ocular motility. RESULTS Ocular motor manifestations of MS can occur acutely in relapse or chronically, the latter as a consequence of previous relapses or as a chronic course of the disease. The most frequent and specific acute ocular motor manifestation is uni- or bilateral internuclear ophthalmoplegia (INO). The most frequent chronic manifestations include INO and cerebellar ocular motor disorders such as gaze-evoked nystagmus, saccadic hypermetria, and lack of vestibulo-ocular reflex inhibition. The most disabling syndrome is pendular nystagmus. CONCLUSIONS The high prevalence of ocular motor manifestations emphasizes the importance of neuro-ophthalmological examination among patients with MS. Because chronic manifestations may cause minimal or no symptoms, a systematic investigation of the most common manifestations should be performed in daily practice. Appropriate treatment may improve visual outcome in some of these ocular motor disorders.
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Affiliation(s)
- Julie Vadboncoeur
- Resident in Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
| | - Katarzyna Biernacki
- Department of Ophthalmology, Hôpital Notre-Dame (CHUM), Montreal, Quebec, Canada
| | - Alexandre Prat
- Department of Neurology, Hôpital Notre-Dame (CHUM), Montreal, Quebec, Canada
| | - Laurence Jaworski
- Department of Ophthalmology, Hôpital Notre-Dame (CHUM), Montreal, Quebec, Canada
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