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In December 2019, cases of pneumonia caused by infection with the previously unknown severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), leading to coronavirus disease 2019 (COVID-19), were identified. Typical manifestations of COVID-19 are fever, cough, fatigue and dyspnoea. Initially, it was thought that the mechanism of action of SARS-CoV-2 was only associated with respiratory tract invasion, but it was later revealed that the infection might involve many other organs and systems, including the central and peripheral nervous systems. Neurological complications associated with SARS-CoV-2 infection include encephalopathy, encephalitis, meningitis, acute disseminated encephalomyelitis (ADEM), ischaemic and haemorrhagic stroke and cerebral venous sinus thrombosis. In cases of peripheral nervous system involvement, smell and taste disorders, myopathy or the signs and symptoms of Guillain‒Barré syndrome are observed. The most common early neurological complications, particularly during the first year of the epidemic, were anosmia and taste disorders, which, according to some studies, occurred in over 80 percent of patients with COVID-19. The proportion of patients with serious neurological manifestations was small compared to the global number of patients, but the numbers of SARS-CoV-2 infections and critical patients increased substantially. The experience from 2 years of the pandemic has shown that approximately 13% of infected patients suffer from severe neurological complications. The relationship between SARS-CoV-2 and the nervous system is not only a cause of neurological complications in previously healthy individuals but also directly and indirectly affects the courses of many nervous system diseases.

Multiple sclerosis patients are by definition more susceptible to infections, which dependents on the use of disease-modifying treatments. Depending on the mechanism of action, individual disease-modifying treatments carry different risks. As a result, patients require an individualised approach to initiating and continuing new treatments. This problem became very important during the COVID-19 pandemic. In the case of drugs with different mechanisms of action on the immune system, the impact of therapy on susceptibility to SARS-CoV-2 infections and the course of COVID-19 should be considered. Based on the risk/ benefit analysis for the patient, individual therapies have been assigned recommendations: 1) low-risk therapies (glatiramer acetate, interferons, dimethyl fumarate, teriflunomide) – discontinuation of therapy and delay of treatment initiation is not recommended; 2) moderate-risk therapies (fingolimod, natalizumab, ocrelizumab, cladribine) – require caution, individual risk/benefit assessment, risk analysis of multiple sclerosis symptom exacerbation after drug discontinuation; 3) high-risk therapies (alemtuzumab, mitoxantrone, haematopoietic stem cells transplantation) – treatment initiation is not recommended, administration of subsequent doses requires extreme caution. The article reviews the recommendations and publications from the last 2 years, taking into account the changing views on the treatment of multiple sclerosis in the time of COVID-19 pandemic.

Vaccination is the best strategy for preventing most infectious diseases. Along with adhering to the principles of prevention, vaccines are particularly important in the time of the COVID-19 pandemic. There is evidence that multiple sclerosis increases the risk of developing infections, and the immunosuppressive and immunomodulating medications taken by multiple sclerosis patients may increase this risk. No evidence has been found that vaccination increases the risk of developing MS or a relapse. It is believed that people with multiple sclerosis can be vaccinated safely, and it is a mistake not to have a vaccination only because of being diagnosed with multiple sclerosis. When determining the indications for vaccination, as well as when selecting vaccines and determining the optimal time for their administration, the epidemiological situation of the patient’s region of residence and the type of disease-modifying therapy should be taken into account. The vaccination-related restrictions mainly apply to alemtuzumab, fingolimod, ocrelizumab and cladribine. The article reviews the rules for vaccinating multiple sclerosis patients depending on the type of vaccine and the disease-modifying therapy used. Recommendations for vaccination against the SARS-CoV-2 infection in multiple sclerosis patients are also taken into account.

Background: One of the major objectives of the Multiple Sclerosis Data Alliance (MSDA) is to enable better discovery of multiple sclerosis (MS) real-world data (RWD). Methods: We implemented the MSDA Catalogue, which is available worldwide. The current version of the MSDA Catalogue collects descriptive information on governance, purpose, inclusion criteria, procedures for data quality control, and how and which data are collected, including the use of e-health technologies and data on collection of COVID-19 variables. The current cataloguing procedure is performed in several manual steps, securing an effective catalogue. Results: Herein we summarize the status of the MSDA Catalogue as of January 6, 2021. To date, 38 data sources across five continents are included in the MSDA Catalogue. These data sources differ in purpose, maturity, and variables collected, but this landscaping effort shows that there is substantial alignment on some domains. The MSDA Catalogue shows that personal data and basic disease data are the most collected categories of variables, whereas data on fatigue measurements and cognition scales are the least collected in MS registries/cohorts. Conclusions: The Web-based MSDA Catalogue provides strategic overview and allows authorized end users to browse metadata profiles of data cohorts and data sources. There are many existing and arising RWD sources in MS. Detailed cataloguing of MS RWD is a first and useful step toward reducing the time needed to discover MS RWD sets and promoting collaboration.

The aim of this study was to assess the neurological complications of SARS-CoV-2 infection and compare phenotypes and outcomes in infected patients with and without selected neurological manifestations.The data source was a registry established by the European Academy of Neurology during the first wave of the COVID-19 pandemic. Neurologists collected data on patients with COVID-19 seen as in- and outpatients and in emergency rooms in 23 European and seven non-European countries. Prospective and retrospective data included patient demographics, lifestyle habits, comorbidities, main COVID-19 complications, hospital and intensive care unit admissions, diagnostic tests, and outcome. Acute/subacute selected neurological manifestations in patients with COVID-19 were analysed, comparing individuals with and without each condition for several risk factors.By July 31, 2021, 1523 patients (758 men, 756 women, and nine intersex/unknown, aged 16-101 years) were registered. Neurological manifestations were diagnosed in 1213 infected patients (79.6%). At study entry, 978 patients (64.2%) had one or more chronic general or neurological comorbidities. Predominant acute/subacute neurological manifestations were cognitive dysfunction (N = 449, 29.5%), stroke (N = 392, 25.7%), sleep-wake disturbances (N = 250, 16.4%), dysautonomia (N = 224, 14.7%), peripheral neuropathy (N = 145, 9.5%), movement disorders (N = 142, 9.3%), ataxia (N = 134, 8.8%), and seizures (N = 126, 8.3%). These manifestations tended to differ with regard to age, general and neurological comorbidities, infection severity and non-neurological manifestations, extent of association with other acute/subacute neurological manifestations, and outcome.Patients with COVID-19 and neurological manifestations present with distinct phenotypes. Differences in age, general and neurological comorbidities, and infection severity characterize the various neurological manifestations of COVID-19.

Objective Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is the core medical therapy of acute ischaemic stroke (AIS). COVID‐19 infection negatively modifies acute stroke procedures and, due to its pro‐coagulative effect, may potentially impact on IVT outcome. Thus, short‐term efficacy and safety of IVT were compared in patients with and without evidence of SARS‐CoV‐2. Methods An observational, retrospective study included 70 patients with AIS, including 22 subjects (31%) with evidence of acute COVID‐19 infection, consecutively treated with IVT in 4 stroke centres between 15 September and 30 November 2020. Results Patients infected with COVID‐19 were characterized by higher median of National Institute of Health Stroke Scale (NIHSS) score (11.0 vs. 6.5; p

Religiosity can be both beneficial and harmful for happiness. It depends on its operationalization and the measures of religiosity and sociodemographics used, together with cultural and psychosocial factors – still not comprehensively explored. This topic is especially important for religious-affiliated chronic patients such as those diagnosed with Multiple Sclerosis. Religion can deliver a sense of meaning, direction, and purpose in life and be an additional source of support and coping with the stress and limitations connected with the disease. The aim of the present study was to verify whether religiosity, directly and indirectly, through finding meaning in life, is related to one’s level of happiness and whether gender, drinking of alcohol, financial status and age are moderators in this relationship. In sum, 600 patients from Poland who suffered from Multiple Sclerosis were included in the study. Firstly, some gender differences were noticed. In women, religiosity was both directly and indirectly, through finding significance, positively related to happiness. Secondly, it was found that in women, the direct effect of age on happiness was generally negative but affected positively by religiosity but among men age was not correlated with happiness. In the group of women, religiosity and a lower propensity to drink alcohol in an interactive way explained happiness. Thirdly, both in men and women, financial status positively correlated with happiness, but in the group of wealthy men only, religiosity was negatively related to happiness. In conclusion, religion was found to be a valuable and beneficial factor leading to the happiness of Roman Catholic Multiple Sclerosis patients from Poland. They should be encouraged to involve themselves in religion as an effective way to achieve happiness, with the one exception regarding wealthy men.

Introduction. The aim of this study was to report the course and outcome of SARS-CoV-2 infection in multiple sclerosis (MS) patients treated with disease-modifying therapies (DMTs) in Poland. A major concern for neurologists worldwide is the course and outcome of SARS-CoV-2 infection in patients with MS treated with different DMTs. Although initial studies do not suggest an unfavourable course of infection in this group of patients, the data is limited. Materials and methods. This study included 396 MS patients treated with DMTs and confirmed SARS-CoV-2 infection from 28 Polish MS centres. Information concerning patient demographics, comorbidities, clinical course of MS, current DMT use, as well as symptoms of SARS-CoV-2 infection, need for pharmacotherapy, oxygen therapy, and/or hospitalisation, and short-term outcomes was collected up to 30 January 2021. Additional data about COVID-19 cases in the general population in Poland was obtained from official reports of the Polish Ministry of Health. Results. There were 114 males (28.8%) and 282 females (71.2%). The median age was 39 years (IQR 13). The great majority of patients with MS exhibited relapsing-remitting course (372 patients; 93.9%). The median EDSS was 2 (SD 1.38), and the mean disease duration was 8.95 (IQR 8) years. Most of the MS patients were treated with dimethyl fumarate (164; 41.41%). Other DMTs were less frequently used: interferon beta (82; 20.70%), glatiramer acetate (42; 10.60%), natalizumab (35;8.84%), teriflunomide (25; 6.31%), ocrelizumab (20; 5.05%), fingolimod (16; 4.04), cladribine (5; 1.26%), mitoxantrone (3; 0.76%), ozanimod (3; 0.76%), and alemtuzumab (1; 0.25%). The overall hospitalisation rate due to COVID-19 in the cohort was 6.81% (27 patients). Only one patient (0.3%) died due to SARS-CoV-2 infection, and three (0.76%) patients were treated with mechanical ventilation; 106 (26.8%) patients had at least one comorbid condition. There were no significant differences in the severity of SARS-CoV-2 infection regarding patient age, duration of the disease, degree of disability (EDSS), lymphocyte count, or type of DMT used. Conclusions and clinical implications. Most MS patients included in this study had a favourable course of SARS-CoV-2 infection. The hospitalisation rate and the mortality rate were not higher in the MS cohort compared to the general Polish population. Continued multicentre data collection is needed to increase the understanding of SARS-CoV-2 infection impact on the course of MS in patients treated with DMTs.

Multiple sclerosis (MS) is a chronic inflammatory and demyelinating disease of the central nervous system that mostly affects younger adults. However, the first symptoms of MS can appear in children and adolescents before the age of 18, and we call this paediatric MS (PMS). It is estimated that paediatric MS accounts for 3-5% of the general population of patients with MS. Despite the fundamental si-milarities to adult MS, PMS has many distinctive features. Paediatric MS has a milder course compared to adults, but leads to sig-nificant disability at an early age. PMS is relapsing-remitting in 95-98% of cases; the primary progressive manifestation is much less common than in adults. The differential diagnosis of MS in children should include other childhood demyelinating diseases, mitochondrial and metabolic diseases, connective tissue diseases, and neuroborreliosis. Differentiating acute disseminated en-cephalomyelitis (ADEM) from the first onset of MS remains the biggest challenge. Over the past 10 years, understanding of the epidemiology, pathophysiology, diagnosis, and treatment of MS in children has significantly expanded. The diagnostic criteria leading to earlier diagnosis and initiation of disease-modifying therapy (DMT) have changed, and the number of drugs used in children has increased. However, many important issues require further research. This review discusses the current state of knowledge regarding the epidemiology, diagnosis, and treatment of multiple sclerosis in children.

Diet plays a major role in the aetiopathogenesis of many neurological diseases and may exacerbate their symptoms by inducing the occurrence of metabolic disorders. The results of research on the role of diet in the course of multiple sclerosis (MS) are ambiguous, and there is still no consensus concerning dietary recommendations for patients with MS. The aim of this study was to analyse the dietary patterns (DPs) of patients with MS and to assess the relationships between these DPs and the metabolic disorders. The study participants were comprised of 330 patients aged 41.9 ± 10.8 years. A survey questionnaire was used to collect data related to diet, lifestyle and health. The DPs were identified using a principal component analysis (PCA). Three DPs were identified: Traditional Polish, Prudent and Fast Food & Convenience Food. An analysis of the odds ratios adjusted for age, gender, smoking and education showed that a patient’s adherence to the Traditional Polish and the Fast Food & Convenience Food DPs increased the likelihood of abdominal obesity and low HDL-cholesterol concentration. Conversely, adherence to the Prudent DP was not significantly associated with any metabolic disorder. The results of this study confirmed that an unhealthy diet in patients with MS is connected with the presence of some metabolic risk factors. There is also an urgent need to educate patients with MS on healthy eating, because the appropriate modifications to their diet may improve their metabolic profile and clinical outcomes.

Purpose The proportion of older people in Poland is higher in rural areas than in urban areas. Thus, we aimed to evaluate treatment rate and factors associated with outcome and safety of intravenous thrombolysis (IVT) in rural residents aged ≥80 years admitted to primary stroke centers. Patients and Methods This study was a retrospective, observational cohort study of 873 patients treated with recombinant tissue plasminogen activator (rt-PA) in primary stroke centers between February 1, 2009 and December 31, 2017. Among them were 527 rural residents and 231 (26.5%) were ≥80 years of age. The analyses between rural and urban patients aged ≥80 and between rural patients aged

Objective Patient's engagement in their own treatment has been shown to improve clinical outcomes. A better understanding of the association between self-management in multiple sclerosis (MS) and potentially modifiable psychological factors may provide clinicians with strategies to design and stimulate better patient activation for self-managing health. Therefore, in this study, we examined whether cognitive factors, namely self-efficacy, acceptance of illness, optimism, and health locus of control (HLC), are associated with self-management in MS. Methods This is a cross-sectional study. A total of 382 patients with MS who completed the MS Self-Management Scale-Revised and the questionnaires that measure self-efficacy, optimism, illness acceptance, and HLC were included in the study. Results A hierarchical multiple regression revealed that power of others' HLC (b = 0.42, P ≤ .001), optimism (b = 0.27, P ≤ .01), internal HLC (b = -0.11, P = .017), and self-efficacy (b = 0.11, P = .031), together with control variables (longer disease duration and higher disability), explained 30% of the variance in the dependent variable. Conclusions In the case of MS, self-management is associated with patient's perception that healthcare professionals control their health, higher self-efficacy, optimism, and, surprisingly, lower internal HLC. The results of this study indicate the vital role of the healthcare staff in encouraging the patients with MS toward activities related to self-management and provide new insights on the psychological intervention aimed at improving self-management by patients.

Zespol ekspertow Polskiego Towarzystwa Neurologicznego opracowal zasady postepowania w leczeniu poszczegolnych objawow wystepujących u pacjentow ze stwardnieniem rozsianym. Rekomendacje opracowano na podstawie wynikow najnowszych badan klinicznych, zalecen zagranicznych towarzystw naukowych oraz wlasnego doświadczenia klinicznego autorow. Omowiono postepowanie w spastyczności, ataksji i drzeniu, zespole zmeczenia, w przypadku zaburzen zwieraczy drog moczowych i przewodu pokarmowego, zaburzen seksualnych oraz w zespolach bolowych wystepujących typowo w stwardnieniu rozsianym. Przedstawiono rowniez zasady postepowania w przypadku zaburzen psychicznych i zaburzen funkcji poznawczych. W dokumencie podsumowano mozliwości terapii objawowej w stwardnieniu rozsianym w warunkach polskich.

International audience; Frailty, a physiological syndrome (FS) affecting primarily the older adults, manifests itself through significantly depleted bodily reserves, and appreciably higher (up to over threefold) individual exposure to fall risk. Concomitant medical conditions such as balance impairment, reduced visual acuity, limited mobility, and significantly diminished daily functional performance further exacerbate the patients’ condition. Their resultant susceptibility to frequent hospitalisations makes their prognosis even worse. This narrative review aimed to provide an overview of published studies focused on rehabilitation management approaches aided by virtual reality (VR) technology in frail older adults. The authors had it also augmented with their own, evidence-based body of experience in rehabilitation. Making use of technologically advanced exercise machinery, specially adapted for rehabilitating frail older adults, combined with a structured exercise regimen, further aided by the application of select virtual reality (VR) technology solutions, clearly proved effective. Consequently, the patients were helped to move back from the frail to the pre-frail stage, as well as had their motor and cognitive functions appreciably enhanced. The application of modern technology in rehabilitating older adults over 65, affected by FS, when specifically aided by the select VR technology solutions, was also proven to complement successfully the conventional rehabilitation management. The overall versatility of the VR technology solutions, e.g., adaptation for home use allowing remote supervision, also makes this novel approach to rehabilitation far more appealing to the patients. They find it both very attractive and far more mentally engaging. Its considerable potential lies mostly in being appreciably more effective in bringing in desirable therapeutic outcomes.

In Poland, access to second-line disease-modifying treatments (DMTs) for relapsing-remitting multiple sclerosis is limited by reimbursement criteria that require evidence of more aggressive disease compared to the approved indications.In a retrospective study carried out in DMT clinics across Poland, we asked neurologists to provide patient data on relapses and neuroimaging disease activity. Included were only patients with active disease, defined as one or more relapse and at least one new lesion between starting DMT and the last visit. For patients who had not received DMT, active disease was defined as at least one gadolinium-positive lesion or two or more new T2 lesions and two or more relapses within 12 months. We analysed the proportions of patients eligible for second-line DMTs based on the current reimbursement criteria and based on the broader criteria, which were in line with the approved indications.In total, 48 neurologists provided data for 641 patients (women 64%; mean age 38 years). Of the 641 patients, 610 (95%) received DMTs: 532 first-line and 78 second-line. Of the 532 patients on first-line DMTs, 40 (7.5%) were eligible for second-line treatment based on the current reimbursement criteria, and an additional 126 (23.6%) would be eligible for second-line treatment based on the broader criteria. Of the 31 patients who did not receive any DMTs, one patient was eligible for second-line treatment, and another two patients would be eligible for second-line treatment based on the broader criteria. Moreover, 13 previously treated patients would be eligible for second-line DMTs based on the broader criteria. When extrapolated to the whole of Poland, our study shows that an additional 1,581 patients would be eligible for second-line DMTs if the current reimbursement criteria were to be replaced by broader criteria complying with the approved indications.An urgent change is required in the reimbursement criteria in order to expand access to second-line DMTs for patients with relapsing-remitting MS in Poland.

Background It has been reported that acute stroke services were compromised during COVID-19 due to various pandemic-related issues. We aimed to investigate these changes by recruiting centers from different countries. Methods Eight countries participated in this cross-sectional, observational, retrospective study by providing data from their stroke data base. We compared 1 year before to 1 year during COVID-19 as regards onset to door (OTD), door to needle (DTN), door to groin (DTG), duration of hospital stay, National Institute of Health Stroke Scale (NIHSS) at baseline, 24 h, and at discharge as well as modified Rankin score (mRS) on discharge and at 3 months follow-up. Results During the pandemic year, there was a reduction in the number of patients, median age was significantly lower, admission NIHSS was higher, hemorrhagic stroke increased, and OTD and DTG showed no difference, while DTN time was longer, rtPA administration was decreased, thrombectomy was more frequent, and hospital stay was shorter. mRS was less favorable on discharge and at 3 months. Conclusion COVID-19 showed variable effects on stroke services. Some were negatively impacted as the number of patients presenting to hospitals, DTN time, and stroke outcome, while others were marginally affected as the type of management.

BACKGROUND: Pisa syndrome (PS) is a postural disorder characterised by lateral flexion of the spine (> 10°), predisposing the affected individuals to falls, and contributing to increased mortality in neurodegenerative diseases. OBJECTIVE: An overview of currently applied therapeutic management options, primarily focused on specifically structured rehabilitation exercises, in conjunction with falls-risk assessment in the individuals affected by PS. METHODS: A narrative literature review, augmented with the authors’ own experience in physical rehabilitation management. RESULTS: As individuals affected by PS are evidenced to be intrinsically exposed to higher falls-risk through acquired postural deformities, they often fall victims of traumatic accidents, occasionally also facing relocation into 24-hour nursing facilities due to the injuries sustained/resultant disability, consequently having overall quality of their life appreciably reduced. CONCLUSIONS:s A comprehensive approach is postulated in designing optimal therapeutic management, comprised of the exercises controlling postural stability, whilst reducing lower back pain, and the ones also promoting specific skills essential for coping unassisted after an accidental fall effectively. Rehabilitation of individuals affected by PS should be a fully integrated service, eliminating all identified risk factors for falls. As clinical PS symptoms tend to recur after completion of a full course of therapeutic management, all PS patients should continue the pursuit of therapeutic exercises on an individual basis, to effectively retard their recurrence. In view of overall scarcity of clinical studies completed on the large population samples of PS patients, further in-depth research is still required to ensure higher credence to overall efficacy of the presently proposed therapeutic solutions.

Migraine is a neurological disorder characterised by recurrent attacks of headache accompanied by vegetative symptoms. It is estimated that 11–12% of the world’s population suffers from migraine. Triptans are the drugs of choice for emergency treatment, but they are ineffective in 30–35% of patients. Triptans also have serious contraindications, mainly from the cardiovascular system. Hence the need to look for new, more effective therapeutic methods for both interrupting and preventing migraine attacks. Studies on the pathogenesis of migraine have shown that the dominant role during an attack is played by the trigeminovascular system and release of a number of peptides, of which the calcitonin gene-related peptide (CGRP) is the strongest. Great hopes are associated with the use of CGRP receptor antagonists (gepants) and monoclonal antibodies directed against CGRP and its receptors. Selective 5-HT1F receptor agonists (ditans) may also make some progress. Studies are ongoing on antagonists of other neuropeptides associated with migraine pathogenesis – pituitary adenylate cyclase-activating polypeptide (PACAP), nitric oxide synthase (NOS), glutamate, a vasoactive intestinal peptide (VIP), and neurokinin A (NKA). The results of studies assessing the efficacy and safety of CGRP antagonists are promising. Some of them have already been registered for the prevention of migraine attacks and there is hope that in the near future they will expand the possibilities of effective emergency and preventive treatment.

The aim of the work is to present current knowledge on epidemiology, causes, symptomatology and diagnosis of hereditary neuropathy with liability to pressure palsy. This neuropathy usually manifests itself in the 2nd and 3rd decade of life, but also can occur at any age. Its genetic basis is the deletion or, less frequently, a point mutation of the PMP22 gene in chromosome 17p11. Symptoms appear after a small extension or compression of a nerve. In the recent years, special attention has been paid to its occurrence in the course of intense physical exercises. The most common clinical syndromes occurring in the course of the disease are paresis and sensory disturbances in the area of the median, ulnar, radial and peroneal nerves as well as brachial plexus palsy. Presence of structures called tomaculas in a nerve biopsy is characteristic for the disease. Electrophysiological and genetic studies play a key role in diagnostics. In the light of the recent studies, the frequency of occurrence of hereditary neuropathy with liability to pressure palsy seems to be significantly underestimated and ranges from 0.84 to 58.9 per 100,000. Hereditary neuropathy with liability to pressure palsies should be differentiated from compression syndromes, hereditary motor and sensory neuropathy (HMSN IA), multifocal axonal neuropathy and familial brachial plexus palsy. After recognising the syndrome, it is important to properly rehabilitate and avoid situations where there may be compression on peripheral nerves. In addition, the paper presents a case of genetically confirmed familial neuropathy with hypersensitivity to pressure in a 24-year-old male patient with a negative family history.

Background Identifying the profiles of multiple sclerosis (MS) patients who employ similar patterns of coping may improve the understanding of how coping is associated with psychological adjustment. The purpose of this study was to identify the groups of MS patients using different coping strategies and compare the levels of psychological resources across the groups. Methods In this cross-sectional study 382 patients with MS completed a battery of self-report measures that assessed their use of different coping strategies, optimism, self-efficacy, health locus of control (HLC), and perception of disease. The groups with different coping profiles were selected by performing a cluster analysis. Results Five different coping profiles were highlighted and were defined as follows: “Emotional,” “Temperate,” “Active,” “Passive,” and “Problem copers.” Significant differences were detected between the groups in the levels of optimism, self-efficacy, HLC, and perception of disease. Conclusion Patients with MS use a varied repertoire of coping strategies, which allowed distinguishing coping profiles. Groups representing particular profiles differ in terms of psychological resources. This study contributed to increasing the interest in investigating coping profiles. Identifying subgroups of individuals based on their coping profiles and recognizing the differences is important for providing psychological support.

Background People with Multiple Sclerosis (PwMS) suffer from an increased risk of unemployment during the course of the disease. In recent years progress has been made in increasing the time until patients have to leave the workforce permanently. Such a retirement is often associated with MS but the driving factors including disability progression, support measures at the workplace, and societal aspects are not yet fully understood. Methods We consolidated data from four European MS databases from Germany, Poland, Sweden, and the United Kingdom, which were able to provide data on working status, disability progression and quality of life in accordance with the data harmonization framework of the EUReMS (European Registry in Multiple Sclerosis) project. Results Factors strongly associated with unemployment are disability progression, low quality of life and being close to the statutory retirement age. Overall, highest employment rate (77%) and lowest effects of gender and disease duration were found in Sweden. Conclusions We found remarkable differences between the European registers and the countries studied, which may indicate inequalities at European level. Furthermore, our findings suggest that it is feasible and useful to combine data from different MS registers in Europe, albeit the data structures are heterogeneous.

Importance Reduction of subsequent disabling stroke is the main goal of preventive treatment in the acute setting after transient ischemic attack (TIA) or minor ischemic stroke. Objective To evaluate the superiority of ticagrelor added to aspirin in preventing disabling stroke and to understand the factors associated with recurrent disabling stroke. Design, Setting, and Participants The Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and Aspirin for Prevention of Stroke and Death (THALES) was a randomized clinical trial conducted between January 22, 2018, and December 13, 2019, with a 30-day follow-up, at 414 hospitals in 28 countries. The trial included 11 016 patients with a noncardioembolic, nonsevere ischemic stroke or high-risk TIA, including 10 803 with modified Rankin Scale score (mRS) recorded at 30 days. Interventions Ticagrelor (180-mg loading dose on day 1 followed by 90 mg twice daily for days 2-30) or placebo within 24 hours of symptom onset. All patients received aspirin, 300 to 325 mg on day 1 followed by 75 to 100 mg daily for days 2 to 30. Main Outcomes and Measures Time to the occurrence of disabling stroke (progression of index event or new stroke) or death within 30 days, as measured by mRS at day 30. Disabling stroke was defined by mRS greater than 1. Results Among participants with 30-day mRS greater than 1, mean age was 68.1 years, 1098 were female (42.6%), and 2670 had an ischemic stroke (95.8%) as a qualifying event. Among 11 016 patients, a primary end point with mRS greater than 1 at 30 days occurred in 221 of 5511 patients (4.0%) randomized to ticagrelor and in 260 of 5478 patients (4.7%) randomized to placebo (hazard ratio [HR], 0.83; 95% CI, 0.69-0.99,P = .04). A primary end point with mRS 0 or 1 at 30 days occurred in 70 of 5511 patients (1.3%) and 87 of 5478 patients (1.6%) (HR, 0.79; 95% CI, 0.57-1.08;P = .14). The ordinal analysis of mRS in patients with recurrent stroke showed a shift of the disability burden following a recurrent ischemic stroke in favor of ticagrelor (odds ratio, 0.77; 95% CI, 0.65-0.91;P = .002). Factors associated with disability were baseline National Institutes of Health Stroke Scale score 4 to 5, ipsilateral stenosis of at least 30%, Asian race/ethnicity, older age, and higher systolic blood pressure, while treatment with ticagrelor was associated with less disability. Conclusions and Relevance In patients with TIA and minor ischemic stroke, ticagrelor added to aspirin was superior to aspirin alone in preventing disabling stroke or death at 30 days and reduced the total burden of disability owing to ischemic stroke recurrence. Trial Registration ClinicalTrials.gov Identifier:NCT03354429

Purpose The proportion of older people in Poland is higher in rural areas than in urban areas. Thus, we aimed to evaluate treatment rate and factors associated with outcome and safety of intravenous thrombolysis (IVT) in rural residents aged ≥80 years admitted to primary stroke centers. Patients and Methods This study was a retrospective, observational cohort study of 873 patients treated with recombinant tissue plasminogen activator (rt-PA) in primary stroke centers between February 1, 2009 and December 31, 2017. Among them were 527 rural residents and 231 (26.5%) were ≥80 years of age. The analyses between rural and urban patients aged ≥80 and between rural patients aged

Objective. This study assesses and compares the mental health status of people with multiple sclerosis (PwMS) in Poland during the second wave of the Coronavirus Disease 2019 (COVID-19) pandemic (November 2020) to a similar group whose mental health status was examined in November 2017. It also analyzed the psychological resources such as self-efficacy and health locus of control (HLC) and their relationship to mental health in both groups. Methods. Cross-sectional study included two groups of PwMS with 113 respondents each. The respondents completed the General Health Questionnaire-12 and questionnaires for assessing self-efficacy and HLC. The clinical and demographic data of participants were also collected. Results. No differences in mental health status were observed between the studied groups. A hierarchical regression model of the group studied in 2020 revealed that general self-efficacy (β = −0.21, p = 0.032), HLC—internal (β = −0.21, p = 0.035), and education (β = −0.18, p = 0.048) explained 18% of the variance in the mental health of PwMS, whereas according to the model of the group assessed in 2017 self-efficacy (β = –0.31, p < 0.001), HLC—chance (β = 0.45, p < 0.001), and HLC—internal (β = −0.37, p < 0.001) explained 48% of the variance. Conclusions. Study results suggest that the pandemic and the related lockdown had no effect on the mental health status of PwMS. At the same time, it was noted that well known determinants of mental health such as self-efficacy and HLC seemed to retain their prominent role for mental functioning in the pandemic.

Summary Background No treatment has consistently shown efficacy in slowing disability progression in patients with secondary progressive multiple sclerosis (SPMS). We assessed the effect of siponimod, a selective sphingosine 1-phosphate (S1P) receptor 1,5 modulator, on disability progression in patients with SPMS. Methods This event-driven and exposure-driven, double-blind, phase 3 trial was done at 292 hospital clinics and specialised multiple sclerosis centres in 31 countries. Using interactive response technology to assign numbers linked to treatment arms, patients (age 18–60 years) with SPMS and an Expanded Disability Status Scale score of 3·0–6·5 were randomly assigned (2:1) to once daily oral siponimod 2 mg or placebo for up to 3 years or until the occurrence of a prespecified number of confirmed disability progression (CDP) events. The primary endpoint was time to 3-month CDP. Efficacy was assessed for the full analysis set (ie, all randomly assigned and treated patients); safety was assessed for the safety set. This trial is registered with ClinicalTrials.gov, number NCT01665144. Findings 1651 patients were randomly assigned between Feb 5, 2013, and June 2, 2015 (1105 to the siponimod group, and 546 to the placebo group). One patient did not sign the consent form, and five patients did not receive study drug, all of whom were in the siponimod group. 1645 patients were included in the analyses (1099 in the siponimod group and 546 in the placebo). At baseline, the mean time since first multiple sclerosis symptoms was 16·8 years (SD 8·3), and the mean time since conversion to SPMS was 3·8 years (SD 3·5); 1055 (64%) patients had not relapsed in the previous 2 years, and 918 (56%) of 1651 needed walking assistance. 903 (82%) patients receiving siponimod and 424 (78%) patients receiving placebo completed the study. 288 (26%) of 1096 patients receiving siponimod and 173 (32%) of 545 patients receiving placebo had 3-month CDP (hazard ratio 0·79, 95% CI 0·65–0·95; relative risk reduction 21%; p=0·013). Adverse events occurred in 975 (89%) of 1099 patients receiving siponimod versus 445 (82%) of 546 patients receiving placebo; serious adverse events were reported for 197 (18%) patients in the siponimod group versus 83 (15%) patients in the placebo group. Lymphopenia, increased liver transaminase concentration, bradycardia and bradyarrhythmia at treatment initiation, macular oedema, hypertension, varicella zoster reactivation, and convulsions occurred more frequently with siponimod than with placebo. Initial dose titration mitigated cardiac first-dose effects. Frequencies of infections, malignancies, and fatalities did not differ between groups. Interpretation Siponimod reduced the risk of disability progression with a safety profile similar to that of other S1P modulators and is likely to be a useful treatment for SPMS. Funding Novartis Pharma AG.

The detailed data concerning multiple sclerosis (MS) epidemiology in Poland are based on studies from few and less populated provinces. Therefore, we evaluated MS incidence and prevalence in Poland using electronic administrative health claims (AHCs) from the National Health Fund.We retrospectively analyzed the AHC financial database collected from 2009 to 2019, encompassing all patients using public health resources. Three different algorithms for identification of MS cases were used: based on studies performed in German population (type 1), tested in the United States (type 2), and one created for the purpose of this study (type 3) that required at least 3 AHCs since 2009 with G35 ICD-10 diagnosis in outpatient specialist care, during hospitalization, and/or at rehabilitation service in any combination within maximally 3 years between the first and the last AHC, and provided that at least one AHC was either in neurological outpatient care or during hospitalization at a neurological ward or prescription of disease-modifying therapy. The American algorithm (type 2) required 3 AHCs within the analyzed year, while the German algorithm (type 1) required only one AHC in the analyzed year.According to the type 3 algorithm, age-adjusted MS incidence and prevalence in 2019 was 6.6 and 131.2 / 100,000 inhabitants, respectively. From 2014 to 2019, the significant trend in increasing prevalence and decreasing incidence of MS was observed (p0.001). Median age of prevalent MS patients was 50 years (interquartile range, IQR 39-61) whereas median age of incident MS cases was 37 years (IQR 28-48). Female-to-male ratio in MS patients was 2.4. According to the type 1 algorithm, age-adjusted MS incidence and prevalence in 2019 was 11.6 and 244.9 / 100,000 inhabitants, respectively. Use of the type 2 algorithm resulted in estimated age-adjusted MS incidence and prevalence values in 2019 of 6.2 and 120.1 / 100,000 inhabitants, respectively.Multiple sclerosis incidence and prevalence in Poland are higher than previously reported and similar to the numbers shown for central European countries.

Andrzej Potemkowski,1 Waldemar Brola,2,3 Anna Ratajczak,4 Marcin Ratajczak,5 Mariusz Kowalewski,6 Małgorzata Lewita,6 Katarzyna Kapica-Topczewska,7 Joanna Tarasiuk,7 Adam Stępień,8 Katarzyna Gocyła-Dudar,8 Jacek Zaborski,9 Halina Bartosik-Psujek10 1Department of Clinical Psychology and Psychoprophylaxis, University of Szczecin, 2Department of Neurology, Specialist Hospital, Końskie, 3The Faculty of Medicine and Health Science, Institute of Physiotherapy, Jan Kochanowski University, Kielce, 4Pomeranian Medical University, Szczecin, 5Clinical Trial Center for MS-Patients, Szczecin, 6John Paul II Multiple Sclerosis Rehabilitation Center, Borne Sulinowo, 7Department of Neurology, Medical University of Białystok, Białystok, 8Department of Neurology, Military Institute of Medicine,Warsaw, 9Department of Neurology, Specialist Hospital in Międzylesie, Warsaw, 10Medical Faculty, University of Rzeszów, Rzeszów,Poland Background: People with multiple sclerosis (MS) and their relatives often have multiple, complex needs which require support from a wide range of services. The aim of the study, the first of its kind in Poland, was to identify the most important needs of patients with MS and their significant others (SO). Methods: A questionnaire developed from focus groups consisting of 20 needs-related statements was administered in seven MS centers to 573 MS patients and 220 SO. The mean age of the patients was 42.61 years old; the mean MS duration was 9.43 years. The respondents were asked to rate the needs statements according to their importance on an 11-point scale. The questionnaire was similar for the MS patients and their SO. Results: The most important needs in the patient group were: to feel needed and efficient in life; to have easy access to professional rehabilitation; and to be sure that doctors are interested in my condition. The three most important needs in the SO group were: to know that relatives/friends feel needed and efficient in life; to have good living conditions; and to be sure that doctors are interested in my relative’s/friend’s condition. Correlation analysis revealed that in the patients group, there was a positive correlation between patient’s age and the importance of factors such as the need for support and interest in their disease from the family doctor (P

Objectives: The aim of the study was the epidemiological analysis and evaluation of selected clinical and sociodemographic factors in Polish patients with primary progressive multiple sclerosis. Methods: The study included patients from 7 provinces in central and eastern Poland registered in the Registry of Patients with Multiple Sclerosis on 31 December 2016. The incidence of various forms of the disease was compared, and clinical, demographic and social disparities between relapsing-remitting and primary progressive multiple sclerosis were analysed. Results: Of 3,199 registered patients, 2,188 persons (66.2%) had the relapsing-remitting form of multiple sclerosis, 774 (24.2%) had the secondary progressive type and 307 (9.6%) suffered from primary progressive disease. The first symptoms of primary progressive multiple sclerosis appeared almost 10 years later than in patients with the relapsing-remitting type (39.2 ± 11.4 vs. 29.8 ± 9.8). The period from the first symptoms to diagnosis was more than twice as long in patients with primary progressive multiple sclerosis (5.8 ± 3.4) as in those with relapsing-remitting disease (2.4 ± 1.6). The average degree of disability in the Expanded Disability Status Scale was similar and amounted to 3.2 ± 2.1 for relapsing-remitting and 3.6 ± 2.4 for primary progressive multiple sclerosis. The relapsing-remitting form was observed more often in women (2.4:1), and the primary progressive form appeared with equal frequency in both sexes (1:1). Disease-modifying treatment was received by 34% of patients with relapsing-remitting and in only 1.9% of patients with primary progressive multiple sclerosis. Conclusions: The primary progressive form affects approximately 10% of Polish patients with multiple sclerosis. The first symptoms appear at about 40 years of age with equal frequency in both sexes, and its diagnosis takes more than twice as much time as in the case of relapsing-remitting multiple sclerosis.

Multiple sclerosis (MS) is one of the most disabling disorders of the central nervous system. Caregivers of individuals with MS may experience unique caregiver strain due to the age at onset and progressive nature of the disease. Additionally, because MS is more prevalent in women, men often become spousal caregivers. This places women in the position of being care recipients rather than caregivers. Some results also supported hypothesis that female caregivers reported a higher need for emotional support than male caregivers. As with female caregivers, decreased emotional support predicted poorer QoL among male caregivers. Caring for a MS patient may negatively impact several objective and subjective aspects of caregiver's life, such as physical and emotional health, morale, work life, finances, social mobility, interpersonal relationships and sexual life. In studies assessing the psychological consequences of care a higher level of anxiety and depression in caregivers than in the general population has been reported. Caregivers who experience burden are more likely to have a higher risk of depression and a lower quality of life. Early recognition of caregiver burden is important in determining appropriate interventions. In this review report the current state of knowledge about the QoL of MS caregivers as well the burden of MS caregivers has been described.

Epidemiologic data on multiple sclerosis (MS) in Poland are limited. Our objectives were to assess a mean annual incidence rate, and MS prevalence on December 31, 2015 in the Swietokrzyskie province (central Poland). We analyzed data of 1525 patients, collected in the Polish Multiple Sclerosis Registry. On December 31, 2015, overall crude prevalence of MS was not less than 121.3/100,000 (95% CI, 114.6-128.4). Significantly higher prevalence was recorded in females (167.1; 95% CI, 155.6-179.1) than in males (73.2; 95% CI, 64.2-82.6; P0.001). The age-adjusted prevalence standardized to the European standard population was 114.2/100,000 (95% CI, 106.2-121.5). The female-male ratio was 2.4:1. The mean annual incidence was 4.5/100,000 (95% CI, 3.8-5.2). Increased MS prevalence and incidence compared to 2010 and previous studies from Poland confirmed that central Poland is a high risk area for MS.

Aim of study. The aim of this study was to collect and analyse data on relapsing-remitting multiple sclerosis (RRMS) patients receiving disease-modifying therapies (DMTs) in Poland. Material and methods. This observational, multicentre study with prospective data collection included RRMS patients receiving DMTs reimbursed by the National Health Fund (NFZ) in Poland, monitored by the Therapeutic Programme Monitoring System (SMPT). Demographic profiles, disability status, and treatment modalities were analysed. Results. Data from 11,632 RRMS patients was collected (from 15,368 new prescriptions), including 10,649 patients in the first-line and 983 in the second-line therapeutic programme of DMTs. The proportion of females to males was 2.39 in the first-line and 1.91 in the second-line. The mean age at DMTs start was 36.6 years in the first-line and 35.1 in the second-line. The median time from the first symptoms to MS diagnosis was 7.4 months, and from MS diagnosis to treatment it was 18.48 months. A total of 43.4% of MS patients started DMT during the 12 months following diagnosis. There was a positive correlation between the duration from MS diagnosis to the start of DMT and a higher initial EDSS value [correlation 0.296 (p < 0.001)]. About 10% of patients stopped DMTs. In Poland, about one third of all MS patients are treated in both lines, and the choice of first-line treatment depends on the region of the country. Conclusions. In Poland there is a need to increase MS patient access to DMTs by improving the organisation of drug programmes.

Objectives Fingolimod is indicated for the treatment of relapsing-remitting multiple sclerosis (RRMS) patients with highly aggressive disease characterized by frequent relapses and active magnetic resonance imaging. Its efficacy has been demonstrated in three large phase III trials, used in the regulatory submissions throughout the world. Fingolimod in licensed in Europe since 2011 but with a growing number of disease-modifying drugs (DMD) becoming available for RRMS, it is important to gather real-world evidence data regarding long-term effectiveness in treated patients with MS. The aim of this study was to assess fingolimod effectiveness in a real life Polish group of RRMS patients receiving fingolimod as second line treatment. Patients and methods The observational study with retrospective data collection was performed at 13 sites that were asked to document eligible patients in consecutive chronological order to avoid selection bias. Demographic and clinical data from 253 adult patients with RRMS treated with fingolimod were analyzed. Results Mean treatment time with fingolimod was 42 months. Relapses reduction during 3 years treatment period was observed (2.0 v 0.2) and majority of patients were free of relapses. Mean EDSS score was stable during the time of observation. The proportion of patients who were free from any clinical disease activity, i.e. without relapses and disability progression, was over 70%. During the first and second year of observation significant reduction of new MRI lesions was observed. Conclusion In the Polish group of patients with RRMS treated with fingolimod, the majority of them showed freedom from relapses, disability progression and reduction of new MRI lesions. Switching from injectable immunomodulatory drugs to fingolimod is associated with fewer relapses and lower disability progression.

Sphenopalatine ganglion stimulation increased cerebral collateral blood flow, stabilised the blood-brain barrier, and reduced infarct size, in preclinical models of acute ischaemic stroke, and showed potential benefit in a pilot randomised trial in humans. The pivotal ImpACT-24B trial aimed to determine whether sphenopalatine ganglion stimulation 8-24 h after acute ischaemic stroke improved functional outcome.ImpACT-24B is a randomised, double-blind, sham-controlled, pivotal trial done at 73 centres in 18 countries. It included patients (men aged 40-80 years and women aged 40-85 years) with anterior-circulation acute ischaemic stroke, not undergoing reperfusion therapy. Enrolled patients were randomly assigned via web-based randomisation to receive active sphenopalatine ganglion stimulation (intervention group) or sham stimulation (sham-control group) 8-24 h after stroke onset. Patients, clinical care providers, and all outcome assessors were masked to treatment allocation. The primary efficacy endpoint was the difference between active and sham groups in the proportion of patients whose 3-month level of disability improved above expectations. This endpoint was evaluated in the modified intention-to-treat (mITT) population (defined as all patients who received one active or sham treatment session) and the population with confirmed cortical involvement (CCI) and was analysed using the Hochberg multi-step procedure (significance in both populations if p0·05 in both, and in one population if p0·025 in that one). Safety endpoints at 3 months were all serious adverse events (SAEs), SAEs related to implant placement or removal, SAEs related to stimulation, neurological deterioration, and mortality. All patients who underwent an attempted sphenopalatine ganglion stimulator or sham stimulator placement procedure were included in the safety analysis. This trial is registered with ClinicalTrials.gov, number NCT00826059.Between June 10, 2011, and March 7, 2018, 1078 patients were enrolled and randomly assigned to either the intervention or the sham-control group. 1000 patients received at least one session of sphenopalatine ganglion stimulation or sham stimulation and entered the mITT population (481 [48%] received sphenopalatine ganglion stimulation, 519 [52%] were sham controls), among whom 520 (52%) patients had CCI on imaging. The proportion of patients in the mITT population whose 3-month disability level was better than expected was 49% (234/481) in the intervention group versus 45% (236/519) in the sham-control group (odds ratio 1·14, 95% CI 0·89-1·46; p=0·31). In the CCI population, the proportion was 50% (121/244) in the intervention group versus 40% (110/276) in the sham-control group (1·48, 1·05-2·10; p=0·0258). There was an inverse U-shaped dose-response relationship between attained sphenopalatine ganglion stimulation intensity and the primary outcome in the CCI population: the proportion with favourable outcome increased from 40% to 70% at low-midrange intensity and decreased back to 40% at high intensity stimulation (p=0·0034). There were no differences in mortality or SAEs between the intervention group (n=536) and the sham-control group (n=519) in the safety population.Sphenopalatine ganglion stimulation is safe for patients with acute ischaemic stroke 8-24 h after onset, who are ineligible for thrombolytic therapy. Although not reaching significance, the trial's results support that, among patients with imaging evidence of cortical involvement at presentation, sphenopalatine ganglion stimulation is likely to improve functional outcome.BrainsGate Ltd.

Background To determine and compare comorbidity levels in the multiple sclerosis (MS) population in Poland using a matched cohort from the general population. Methods We compared our database (standardized medical histories and medical records) from a MS center at the Department of Neurology, Medical University of Bialystok, Poland) with local National Health Fund (NHF) data (all patients presenting to healthcare facilities with a diagnosis of MS (ICD 10: G35)). We identified 1299 MS cases from the NHF data and 952,434 age and geographically matched controls. We estimated the prevalence of depression, sleep disorders, epilepsy, hypertension, hyperlipidemia, diabetes, atherosclerosis, lung infections, thyroid disease, discopathy, and urinary tract infections in the MS population versus matched controls. Results In all, 815 cases of MS (67.6% women and 32.4% men) were registered with the MS center. According to the patients' medical records (with ICD 10 coding), the most common comorbidities were hypertension (4.3%) and thyroid diseases (3.3%). In addition, in standardized medical histories comorbidities were reported by MS patients: depression/depressed mood in 37.6% of patients (67% of whom had sought treatment), pain in 69.6% patients, urinary incontinence in 39.2% patients (44.9% of whom were treated), memory-related problems and fatigue in 39.2% and 70.8% patients, respectively. In the local NHF data, the most common comorbidities were hypertension (8%), diseases that cause back pain [ICD 10:M50-54 (4.3%),G54-55 (3%), M47-48 (5.4%)], urinary tract infection (3.5%), depression (2.4%), hyperlipidemia (2%), and diabetes (2%). All comorbidities except depression and sleep disorders were more common in the matched controls than in the MS population. Diabetes and hyperlipidemia in the MS population were more common in men than women. Most patients (89%) were not treated with disease-modifying therapies. Conclusion The most common comorbidity in the MS population is hypertension. The MS population has an increased prevalence of depression versus the matched controls. MS patients—especially men and older individuals—are at increased risk of developing vascular diseases.

In patients with multiple sclerosis (MS), mental health is significantly affected and conditioned by many factors, including psychological ones. This study team aimed to determine whether different coping strategies mediate the relationship between health locus of control (HLC) and mental health in MS patients. In this cross-sectional study, a total of 382 patients with MS were included. The patients completed General Health Questionnaire-12, Coping Inventory for Stressful Situations, and Multidimensional Health Locus of Control Scale. The demographic and clinical characteristics of the patients were collected using a self-report survey and neurological assessment. A mediation analysis was used to test the study hypothesis. Problem-oriented coping was found to be a significant mediator in the relationship between internal HLC and mental health (indirect effect: -0.129 [95% confidence interval [CI]: -0.193, -0.079]; standardized indirect effect: -0.113 [95% CI: -0.165, -0.070]). Emotion-focused coping was found to be a significant mediator in the relationship between power of others HLC and mental health (indirect effect: 0.114 [95% CI: 0.058, 0.178]; standardized indirect effect: 0.125 [95% CI: 0.062, 0.195]). Emotion-focused coping was also found to be a significant mediator in the relationship between chance HLC and mental health (indirect effect: 0.215 [95% CI: 0.154, 0.281]; standardized indirect effect: 0.209 [95% CI: 0.149, 0.272]). Patients with internal HLC were found to have positive mental health due to their problem-focused coping strategies, while patients with external HLC had worse mental health as they used more emotion-focused strategies. Hence, problem-focused and emotion-focused coping strategies can be considered mediators of the relationship between HLC and mental health in patients with MS.

People with multiple sclerosis (MS) report lower health-related quality of life (HRQoL). Improvements in quality of life can be made by identifying the factors that contribute to HRQoL in MS, which are both person specific and disease related.The primary objective of this study was to examine the mutual roles of acceptance, coping, and MS severity on HRQoL.This study included 382 patients with MS who completed the 29-item Multiple Sclerosis Impact Scale, Coping Inventory for Stressful Situations, and Acceptance of Illness Scale. A standardized questionnaire was used to collect patient clinical and demographics data. General MS severity was determined using the Expanded Disability Status Scale.Six variables, acceptance of illness (β = -0.24, p 0.001), emotional coping strategy (β = 0.40, p 0.001), avoidance coping strategy (β = -0.19, p 0.001), illness duration (β = -0.18, p 0.001), age at the time of the study (β = 0.14, p = 0.009) and problem coping strategy (β = -0.09, p = 0.05), were found to be the significant correlates of HRQoL in MS. The model that included these variables explained 36% of variance in self-management in MS.Psychological variables are more salient correlates of HRQoL in MS than the objective clinical variables, such as the severity or type of MS. Specifically, this study showed that MS patients who accept their illness and use more problem-solving and avoidance coping strategies and less emotional coping strategies assess their HRQoL highly.

Low level of self-management in people with multiple sclerosis (MS) is considered to be a predominant factor that leads to poor rehabilitation efficacy. Studies focusing on the relationship between self-management and psychological variables that can be modified could contribute to expanding the knowledge needed to propose interventional programs aiming at patient activation. This study aimed to analyze whether coping strategies play a mediating role in the association between the perceived impact of MS and level of self-management in people with MS. The cross-sectional study included 382 people with MS. The participants completed the Multiple Sclerosis Self-Management Scale—Revised, Multiple Sclerosis Impact Scale-29, and Coping Inventory for Stressful Situations. The study hypothesis was evaluated using mediation analysis. The STROBE checklist specifically prepared for cross-sectional research was applied in this study for reporting. Results indicate that the emotion- and problem-focused strategies of coping can be treated as mediating the association between the MS impact and level of self-management in people with MS. A negative relationship was found between the perceived MS impact and problem-oriented coping, while a positive relationship was found between problem-oriented coping and self-management. Furthermore, a positive relationship was found between the MS impact and emotion-oriented coping, while a negative relationship was found between emotion-oriented coping and self-management. The indirect role of avoidance-oriented coping was not significant. Our study confirms the role played by coping strategies in individuals’ self-management. In MS, self-management determined by perceived MS impact can be controlled by decreasing emotional-coping while increasing problem-coping strategies. Our study imparts new knowledge regarding the potential interventions for improving the level of self-management in people with MS. It indicates that recognition of individuals’ illness perceptions as well as maladaptive coping strategies can help health professionals identify those who might be having lower level of self-management.

The aim of this study was to evaluate the association of serum 25-hydroxyvitamin D (25(OH)D) with disability and frequency of relapses in relapsing-remitting multiple sclerosis (MS) patients. The study included 184 patients with relapsing-remitting MS who were receiving immune-modulating drugs and no vitamin D supplementation. The concentration of 25(OH)D was measured in February and August 2014. The level of disability was assessed twice according to the Expanded Disability Status Scale (EDSS). The patients were divided into two groups: EDSS 0.0–2 and 2.5–4. The control group comprised 58 age- and sex-matched healthy subjects. The 25(OH)D levels were compared with the occurrence of relapses and the level of disability. Mean serum 25(OH)D concentrations were significantly lower in winter in both MS patients and controls. Winter level of 25(OH)D was significantly lower in severe MS cases (EDSS 2.5–4.0) than in mild cases (EDSS 0.0–2.0) (P=0.022), and in the controls (P=0.008), especially in females (r=0.38, P=0.0015). Logistic regression analysis showed the winter serum 25(OH)D was significantly associated with MS (odds ratio 0.925; 95% confidence interval, 0.822–0.970). Serum 25(OH)D levels were significantly lower in MS patients with relapses than in those without relapses both in winter, and in summer. Hypovitaminosis D was more prevalent during winter than summer, both in the sample group and the control, especially in female MS patients with higher levels of disability. Low vitamin D levels are associated with a more severe course of disease and an increased number of relapses.

BACKGROUND The internet is a source of knowledge and medium widely used in services that facilitate access to information and networking. Multiple sclerosis (MS) patients find the possibility of acquiring information relating to their condition particularly rewarding. OBJECTIVE We aimed to identify Polish MS patients’ preferences by analyzing a percentage of internet users and determining the most common search subjects and patients’ approach to information on the internet. Disability connected with the condition, its duration, and other factors that influence patients’ internet use were examined along with instances of relations established through the internet and their durability. METHODS The study examined 1045 patients (731 women, 314 men) treated in 10 Polish MS centers, of whom 932 (89.19%) declared to be internet users. Their average age was 40.65 (SD 11.06) and average MS duration was 9.08 (SD 6.97) years. The study used a proprietary survey on information seeking, the range of searched subjects, and internet usage frequency. RESULTS The majority of the patients (494/932, 53.0%) used the internet 6-7 times per week and 4.3% (40/932) declared they spent minimum 2 hours per day. The most commonly searched subjects were world news (604/932, 72.9% of patients using the internet); 60.8% (504/932) searched for information on their condition, particularly for new treatment methods (562/932, 67.8%) and the course of illness (520/932, 62.7%). One’s sex had no impact on internet usage (female vs male, odds ratio [OR] 1.13, 95% CI 0.72-1.77), although a patient’s age might, at varying degrees. We found several significant associations using a .05 significance level: a patient with higher education used the internet 9 times more often than one with primary education (OR 8.64, 95% CI 3.31-22.57); lasting relationships increased chances of internet usage by 10-fold compared to widowers (OR 0.12, 95% CI 0.05-0.31); living in a city with a population over 100,000 increased chances by nearly 6 times compared with the countryside (OR 5.59, 95% CI 2.72-11.48); the relapsing-remitting MS type saw a 2-fold increase compared with the primary progressive MS type (OR 0.47, 95% CI 0.29-0.75); and those needing assistance were 2 times less likely to use the internet than patients who could move independently (OR 0.53, 95% CI 0.31-0.89). More than half of the patients (489/932, 52.5%) did not discuss the information found on the internet with their neurologists; 15.9% (148/932) believed that relationships established through the internet can be stable. CONCLUSIONS The majority of Polish patients use the internet as a crucial information source on their condition and innovative treatment methods. The internet can be helpful in establishing new relationships, which are usually short-lived. Polish patients do not frequently discuss the information gathered on the internet with their doctors.

Metabolic syndrome (MetS) predisposes individuals to cardiovascular disease or stroke development. We aimed at evaluating the prevalence of MetS in a population of acute ischemic stroke (IS) patients from central Poland and at estimating the relationship between MetS and stroke risk.We analyzed 672 IS patients who were consecutively admitted to stroke units. The control group was composed of 612 patients with other neurologic disorders. MetS was diagnosed if 3 of 5 factors were present (obesity, increased blood pressure, increased triglycerides, low high-density lipoprotein [HDL] cholesterol, and fasting hyperglycemia) according to the Unified Criteria for Clinical Diagnosis of the Metabolic Syndrome (2009).MetS was diagnosed in 61.2% of stroke patients versus 18.1% of the control group (P .001). Multiple logistic regression showed that MetS was 1.8 times more common in women than in men (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.4-2.5). The adjusted OR (95% CI) associated with MetS was 2.44 (1.48-3.64; P .001) for IS. Hypertension and hypertriglyceridemia were the most frequent disturbances of IS patients (87.2% and 68.2%, respectively). The analysis of the interaction between MetS and its components showed significant associations with hypertension (OR, 2.15; 95% CI, .98-4.24; P .01), high triglyceride levels (OR, 4.35; 95% CI, 2.87-9.43; P .0001), and low HDL cholesterol levels (OR, 5.12; 95% CI, 3.15-8.20; P .001).Over 60% of Polish IS patients have MetS. The prevalence of MetS was significantly higher in women than in men. Thus, MetS may be a risk factor for IS.

The prevalence of multiple sclerosis (MS)was previously unknown in Poland. The aim of this study was to determine the prevalence of MS in Poland.MS prevalence was determined on the basis of data from the Swietokrzyskie (central Poland) and Podlaskie (northeastern Poland) Voivodeships. The area population on the prevalence study day (December 31, 2013) was 1,268,239 (649,007 women; 619,232 men) in central and 1,195,625 (612,979 women; 582,646 men) in northeastern Poland.The overall crude prevalence rate of confirmed MS patients was 109.1/100,000 (95% confidence interval[CI]103.5-115.0) in the Swietokrzyskie and 108.7/100,000 (95% CI 103.0-114.7) in the Podlaskie Voivodeships. A significantly higher prevalence was recorded in females (149.8/100,000, 95% CI 140.6-159.3 vs. 142.4/100,000, 95% CI 133.3-152.0) than in males (66.5/100,000, 95% CI 60.4-73.1 vs.57.8/100,000, 95% CI 52.0-64.2)(p 0.001). Age-adjusted rates for the Polish Standard Population were the same in both regions (110.3/100,000 (95% CI 104.6-116.1) vs.110.9/100,000 (95% CI 105.1-117.1)) and for the European Standard Population did not different statistically between both voivodeships (103.9/100,000 (95% CI 98.6-109.5) vs.108.5/100,000 (95% CI 102.7-114.5)).This is the first data that obtained the level of MS prevalence in Poland and confirmed that Poland is a high-risk area for multiple sclerosis.

Summary Background Subcutaneous pegylated interferon (peginterferon) beta-1a is being developed for treatment of relapsing multiple sclerosis, with less frequent dosing than currently available first-line injectable treatments. We assessed the safety and efficacy of peginterferon beta-1a after 48 weeks of treatment in the placebo-controlled phase of the ADVANCE trial, a study of patients with relapsing-remitting multiple sclerosis. Methods We did this 2-year, double-blind, parallel group, phase 3 study, with a placebo-controlled design for the first 48 weeks, at 183 sites in 26 countries. Patients with relapsing-remitting multiple sclerosis (age 18–65 years, with Expanded Disability Status Scale score ≤5) were randomly assigned (1:1:1) via an interactive voice response or web system, and stratified by site, to placebo or subcutaneous peginterferon beta-1a 125 μg once every 2 weeks or every 4 weeks. The primary endpoint was annualised relapse rate at 48 weeks. This trial is registered with ClinicalTrials.gov, number NCT00906399. Findings We screened 1936 patients and enrolled 1516, of whom 1512 were randomly assigned (500 to placebo, 512 to peginterferon every 2 weeks, 500 to peginterferon every 4 weeks); 1332 (88%) patients completed 48 weeks of treatment. Adjusted annualised relapse rates were 0·397 (95% CI 0·328–0·481) in the placebo group versus 0·256 (0·206–0·318) in the every 2 weeks group and 0·288 (0·234–0·355) in the every 4 weeks group (rate ratio for every 2 weeks group 0·644, 95% CI 0·500–0·831, p=0·0007; rate ratio for the every 4 weeks group 0·725, 95% CI 0·565–0·930, p=0·0114). 417 (83%) patients taking placebo, 481 (94%) patients taking peginterferon every 2 weeks, and 472 (94%) patients taking peginterferon every 4 weeks reported adverse events including relapses. The most common adverse events associated with peginterferon beta-1a were injection site reactions, influenza-like symptoms, pyrexia, and headache. 76 (15%) patients taking placebo, 55 (11%) patients taking study drug every 2 weeks, and 71 (14%) patients taking study drug every 4 weeks reported serious adverse events; relapse, pneumonia, and urinary tract infection were the most common. Interpretation After 48 weeks, peginterferon beta-1a significantly reduced relapse rate compared with placebo. The drug might be an effective treatment for relapsing-remitting multiple sclerosis with less frequent administration than available treatments. Funding Biogen Idec.

Multiple sclerosis (MS) is a progressive disease of the central nervous system. It is characterized by disseminated foci of demyelination, which are responsible for the diverse clinical picture of MS. Pain is a frequent but underestimated symptom of multiple sclerosis. It is estimated to affect 29-86% of MS patients in various stages of the disease and severely influences rehabilitation and quality of life. The pain experienced by MS patients is generally caused by nervous system damage during the course of the disease process and can usually be characterized as central neuropathic pain (less frequently as peripheral or nociceptive pain). The most frequent symptoms include dysesthetic extremity pain, painful tonic spasms, Lhermitte's sign, trigeminal neuralgia, headaches and low back pain. This paper discusses the probable mechanisms behind the development of pain in MS, the prevalence, classification, types of pain, as well as the most effective treatment methods.