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Background: Pediatric-onset multiple sclerosis (POMS) cases, defined as multiple sclerosis (MS) with onset before the age of 18, represent between 3 and 5 % of all MS patients. Anti-CD20 drugs mainly rituximab, ocrelizumab, and ofatumumab are being widely used in adult-onset MS. Their use in POMS is also being increasingly considered by experts., Objective: to review the latest evidence on safety and efficacy of the use of anti-CD20 therapies in POMS., Methods: An extensive search was performed in PubMed, Scopus, and Web of Science databases until the end of July 1st, 2024. Two independent reviewers screened the articles, and collected data. 832 studies were screened using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines., Results: 12 studies on rituximab (328 patients) and 6 studies on ocrelizumab (106 patients) were synthesized. Using monoclonal antibodies in POMS patients has a noteworthy effect on reducing relapses and lesions and achieving no evidence of disease activity especially in highly active POMS patients. However, anti-CD20 therapies in MS are associated with potential adverse events (AEs). Additional data is required on the effect of anti-CD20 therapy on disability accrual., Conclusion: Although anti-CD20 therapy is associated with some AEs, it can be provided in several circumstances, especially to patients with highly active disease, or ones resistant to platform therapies., Competing Interests: Declaration of competing interest The author declares no conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Neuromyelitis Optica Spectrum Disorders (NMOSD) is a neuroinflammatory condition characterized by optic neuritis and transverse myelitis. While the current approach to NMOSD focuses on relapse-associated worsening (RAW), recent evidence indicates Relapse-Independent Disease Activity (RIDA) in patients., Method: Databases including Embase, PubMed, Scopus, and Web of Sciences were systematically searched up to December 2023. No restrictions were applied. Inclusion criteria focused on studies reporting evidence of RIDA in NMOSD patients. Data extraction involved details such as study title, author, participant characteristics, treatment, evaluation methods, positive findings according to RIDA, and prevalence of findings in NMOSD patients. This study is conducted following the PRISMA guidelines with a registered protocol on PROSPERO (ID = CRD42023492352)., Result: Of 802 studies, 38 were included in the systematic review, covering 1881 NMOSD patients. AQP4-IGg status was positive in 90.6 % of the patients. Ocular findings indicative of RIDA were reported in 23 studies, including thinning of GCIPL, RNFL, GCC, and GCL layers, foveal and macular shape and volume abnormalities, vessel loss, and visual evoked potentials (VEPs) abnormalities. MRI findings supporting the RIDA were reported in 13 studies, including new lesion incidence and brain and spinal cord atrophy. Serum and CSF RIDA-supporting findings were reported in five studies, including elevation in sGFAP and sNFL. Biopsies and autopsies suggested inflammatory processes in relapse-free patients in 2 studies. The predominant manifestation of RIDA in NMOSD was identified in the visual system, suggesting the impaired retinal glial cells like Müller cells during the relapse-free period in NMOSD., Interpretation: Our systematic review provides valuable insights into RIDA in NMOSD. Establishing guidelines for the diagnosis and treatment of RIDA is crucial. Further studies are needed to provide robust evidence on RIDA in NMOSD patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Magnetic resonance imaging [MRI] findings in Neuromyelitis optica spectrum disorder [NMOSD] and Multiple Sclerosis [MS] patients could lead us to discriminate toward them. For instance, U-fiber and Dawson's finger-type lesions are suggestive of MS, however linear ependymal lesions raise the possibility of NMOSD. Recently, artificial intelligence [AI] models have been used to discriminate between NMOSD and MS based on MRI features. In this study, we aim to systematically review the capability of AI algorithms in NMOSD and MS discrimination based on MRI features., Method: We searched PubMed, Scopus, Web of Sciences, Embase, and IEEE databases up to August 2023. All studies that used AI-based algorithms to discriminate between NMOSD and MS using MRI features were included, without any restriction in time, region, race, and age. Data on NMOSD and MS patients, Aquaporin-4 antibodies [AQP4-Ab] status, diagnosis criteria, performance metrics (accuracy, sensitivity, specificity, and AUC), artificial intelligence paradigm, MR imaging, and used features were extracted. This study is registered with PROSPERO, CRD42023465265., Results: Fifteen studies were included in this systematic review, with sample sizes ranging between 53 and 351. 1,362 MS patients and 1,118 NMOSD patients were included in our systematic review. AQP4-Ab was positive in 94.9% of NMOSD patients in 9 studies. Eight studies used machine learning [ML] as a classifier, while 7 used deep learning [DL]. AI models based on only MRI or MRI and clinical features yielded a pooled accuracy of 82% (95% CI: 78-86%), sensitivity of 83% (95% CI: 79-88%), and specificity of 80% (95% CI: 75-86%). In subgroup analysis, using only MRI features yielded an accuracy, sensitivity, and specificity of 83% (95% CI: 78-88%), 81% (95% CI: 76-87%), and 84% (95% CI: 79-89%), respectively., Conclusion: AI models based on MRI features showed a high potential to discriminate between NMOSD and MS. However, heterogeneity in MR imaging, model evaluation, and reporting performance metrics, among other confounders, affected the reliability of our results. Well-designed studies on multicentric datasets, standardized imaging and evaluation protocols, and detailed transparent reporting of results are needed to reach optimal performance., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Spinal cord is one of the prominent targets of autoimmune mechanisms in Neuromyelitis Optica Spectrum Disorder (NMOSD). Rarely, NMOSD causes damage to the entire length of the spinal cord, from cervical segments to conus medullaris, which has not been characterized in the existing literature., Material and Method: We reviewed medical records, demographic information, and magnetic resonance imaging (MRI) sequences of 174 NMOSD patients from January 2011 to January 2023 who were admitted to Isfahan Multiple Sclerosis center to find patients with whole spinal transverse myelitis (TM)., Results: Whole spinal TM was present in five patients (2.9 %). Three patients were seropositive for Aquaporin-4 (AQP4) antibody; Myelin Oligodendrocyte Glycoprotein antibody (MOG IgG) tested negative for all of them. Lower limb weakness was the most frequent clinical complaint. Two patients presented with optic neuritis; One patient reported having episodes of nausea and vomiting. These patients, overall, yielded a higher expanded disability status scale (EDSS) score than the other NMOSD patients., Conclusion: Whole spinal TM is a rare finding in NMOSD, which is strongly associated with a higher severity and a worse outcome of the disease. The role of anti-AQP4 antibodies in the extent of myelitis in NMOSD has yet to be investigated., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Multiple sclerosis (MS) can present with facial symptoms and signs, such as facial palsy, myokymia, and hemifacial spasm. Considering the importance of early diagnosis, treatment, and exclusion of causes other than MS, we aimed to assess the prevalence of these disorders in patients with MS., Methods: MS patients who were referred to the Isfahan MS clinic from March 2021 to March 2022 were observed for facial presentations of the disease. A checklist of patients' baseline characteristics and disease features were then completed through patient interview and medical files., Results: Of the total of 2260 MS patients who were assessed, 3.27% had facial palsy, 1.28% had myokymia, and 0.84% presented with hemifacial spasm. The mean age of facial symptom onset was 30.74, 29.07, and 31.37 years, respectively. No relationship was found between the type of facial presentation and factors such as age, gender, subtype of MS, affected side of face, and time of presentation., Conclusion: On the grounds that facial disorders can be the first presentation of MS, patients with atypical features of other common facial diseases such as Bell's palsy should therefore be carefully assessed and followed for any clues pertaining to the diagnosis of MS., Competing Interests: Declaration of Competing Interests None., (Copyright © 2022. Published by Elsevier B.V.)

Objectives: Differentiating neuromyelitis optica spectrum disorder (NMOSD) and Myelin oligodendrocyte glycoprotein antibody disease (MOG-AD) from multiple sclerosis (MS) is important since MS therapies might result in progression and relapse of the former diseases. Evidence of long extending transverse myelitis (LETM) in magnetic resonance imaging (MRI) is one of the requirements to make an NMOSD diagnosis. However, centrally located lesions on spinal MRI may bring higher sensitivity and specificity to the NMOSD and MOG-AD diagnosis., Methods: We aimed to assess the association between NMOSD diagnosis and the presence of centrally located lesions at disease onset. We reviewed 102 medical records from the Isfahan MS clinic who presented with cervical cord lesions and 17 MS, 23 NMOSD, and 6 MOG-AD patients were selected. We collected demographic, clinical, and MRI data of patients who had clinical presentations of cervical cord lesion at disease onset, and the characteristics of the lesion were studied., Results: There was an association between NMOSD diagnosis and presence of a centrally located lesion (CLTM) (P < 0.001), presence of an LETM (P < 0.001), and an intermediate to high axial cord expansion (P < 0.001). CLTM and LETM can also be found in MOG-AD patients. The presence of CLTM (sensitivity and specificity: 95.65% and 69.56%), possessed higher sensitivity and specificity for NMO diagnosis than LETM presence (sensitivity and specificity: 78.26% and 43.47%)., Conclusion: A diagnostic criteria including the centrality, location, and expansion of the transverse myelitis lesions, in addition to LETM, may be more accurate in the diagnosis of NMOSD and MOG-AD and their distinction from MS., (Copyright © 2022. Published by Elsevier B.V.)

Background: Atherosclerosis is the leading cause of ischemic heart disease and coronary artery disease. The process of atherosclerosis develops over a period of years and is mainly immune-mediated. Data regarding the prevalence of vascular disease and atherosclerosis among people with multiple sclerosis (pwMS) is inconsistent, therefore, we aimed to provide an overview of the prevalence of atherosclerotic risk factors in pwMS., Methods: This is a cross-sectional study over a period of one year among pwMS visiting the Isfahan MS center. Study data have been extracted using participants' files and a checklist that was completed by the observers. Only people with relapsing-remitting (RRMS) and secondary progressive (SPMS) forms of MS were included in the study. Participants with primary progressive (PPMS) disease are only described and have been excluded from analyses., Results: Of the 396 pwMS (343 with RRMS and 53 with SPMS), in descending order, the reported risk factors were tobacco smoking (18.4%), dyslipidemia (10%), hypertension (8.8%), and diabetes mellitus (4.5%). In people with RRMS, 17.4% were smokers, 9.9% had dyslipidemia, 8.1% had hypertension, and 4.3% had diabetes mellitus. In SPMS patients 24.5% reported a history of smoking, 13.2% had hypertension, 9.4% had dyslipidemia, and 3.7% had diabetes mellitus. Smoking was insignificantly associated with higher expanded disability status scale (Z: 1.70, p-value = 0.090). Male sex (RR [95%CI]: 1.628 [1.172, 2.261], p-value = 0.004) and increasing age (RR [95%CI]: 1.024 [1.008, 1.040], p-value = 0.003) were associated with a higher number of risk factors., Conclusion: The highest observed atherosclerosis risk factor among pwMS was smoking. Diabetes mellitus was the least reported risk factor in our population as a whole. Overall, and in participants with RRMS, dyslipidemia and hypertension were the second and third most commonly reported risk factors, however, hypertension exceeded dyslipidemia in participants with SPMS. Male sex and increasing age were associated with a higher number of atherosclerosis risk factors., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Various studies indicated blunted humoral responses to COVID-19 mRNA and viral vector vaccines among people with multiple sclerosis (pwMS) on sphingosine 1-phosphate receptor (S1PR) modulators and anti-CD20 therapies (aCD20); however, limited evidence was found regarding SARS-CoV-2 serology after inactivated virus vaccination., Objective: To provide evidence regarding humoral response to COVID-19 inactivated virus vaccination among pwMS on disease-modifying therapies (DMTs)., Methods: A cohort study was carried out in Isfahan, Iran, enrolling DMT-exposed pwMS and unexposed (UX) healthy participants. Post-vaccination anti-SARS-CoV-2 Spike IgG serology testing was carried out among the participants and compared between participants based on their DMT exposure, using proper statistical tests. A multivariable logistic regression model was used to control for confounding. Association between the second vaccine dose-to-phlebotomy (vac2phleb) and the humoral response was investigated in each DMT-exposed cohort, using linear regression. Among the aCD20 cohort, the association of the last aCD20 infusion-to-first vaccine dose period with serostatus was investigated using an unpaired t-test., Results: After enrolling 358 participants (144 pwMS and 214 healthy), blunted humoral responses were only observed in fingolimod (Log 10 mean diff. [SE]: 0.72 [0.18], P = 0.001) and aCD20 (Log 10 mean diff. [SE]: 0.75 [0.15], P < 0.001) cohorts compared to the UX cohort. Multivariable analysis confirmed the results. The study did not achieve enough statistical power to detect a significant association between the vac2phleb period and humoral responses. The last aCD20 infusion to first vaccination dose period was longer in the seroconverted pwMS on aCD20 (mean diff. [SE]: 8.43 weeks [2.57], P = 0.005)., Conclusion: The results of this study mirrored the results of previous studies among mRNA- or viral vector-vaccinated pwMS on DMTs. Therefore, it can be concluded that mode of action contributes less than timing, to the efficiency of vaccination strategies among pwMS on DMTs - especially the ones on S1PR modulators and aCD20. Meanwhile, the mentioned pwMS should be advised to receive early boosters and remain vigilant until further data becomes available and more efficient vaccination strategies are crafted., (Copyright © 2021. Published by Elsevier B.V.)

Background: Multiple sclerosis (MS) is an inflammatory demyelinating CNS disease and the most common neurological immune-mediated disorder. Due to its progressive format, it affects patients' quality of life (QoL) significantly. This study aimed to evaluate epidemiologic parameters of MS in the Asia and Oceania continents., Methods: A comprehensive literature search on October 1st, 2020, was performed in PubMed, Scopus, and Web of Science to retrieve original population-based studies on MS epidemiology in the Asian and Oceanian countries, published between January 1st, 1985 and October 1st, 2020. The designed search strategy was repeated for each country, and the relevant referenced articles were added to our database. A random-effect model was used to combine the epidemiological estimates, and subgroup analysis was also performed by continent, region, and country, when possible. Meta-regression analysis was done to evaluate the effects of Human Developmental Index (HDI), latitude, and study period on the epidemiologic parameters., Results: A total of 3,109 publications were found, of which 89 articles met the eligibility criteria and were included for data extraction. These articles provided data on prevalence, incidence, and mean age at disease onset in 18 countries in Asia and Oceania, including Iran, Turkey, Cyprus, Kuwait, Saudi Arabia, Qatar, UAE, Jordan, Israel, India, Malaysia, China, Hong Kong, Taiwan, Republic of Korea, Japan, Australia, and New Zealand. The pooled total prevalence, incidence, and mean age of onset in Asia and Oceania were 37.89/100000 (95% CI: 35.65 - 40.142), 2.40/100000 (95% CI: 2.22 - 2.58), and 28.21 (95% CI: 27.55 - 28.88), respectively. MS prevalence and incidence in the female gender (68.7/100000 and 4.42/100000, respectively) were infinitely higher than in the male gender (24.52/100000 and 2.06/100000, respectively). Our subgroup analysis showed that MS was much more prevalent in Australia and West Asia among the studied area. The meta-regression showed that the total incidence decreased with an increase in the HDI, and the total prevalence in Asia increased with increasing latitude gradients. Also, the study period had a positive effect on the total prevalence and incidence in Asia and Oceania., Conclusion: MS prevalence and incidence have increased in recent decades. This study highlights the need for further studies to elucidate MS's geographical and temporal variations' exact etiologies., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Differentiation of the demyelinating disorders of the CNS seems challenging in practice. Conus medullaris, the cone-shaped end of the spinal cord, is more involved in anti-MOG patients based on preliminary studies, a possibly helpful detail in its differentiation. Nevertheless, the evidence is still limited and the underlying cause is unclear and undiscussed in previous studies., Objective: To contribute to preliminary studies by comparing conus involvement among patients with MS, anti-AQP4, and anti-MOG diseases using larger sample size., Methods: More than a thousand MS, anti-AQP4, and anti-MOG patients were followed up for a maximum of five years, scanned for conus medullaris involvement. Data regarding each cohort were then analyzed and compared using statistical methods., Results: The rate of conus medullaris involvement was significantly higher in anti-MOG patietns (OR = 27.109, P < 0.001), followed by anti-AQP4 (OR = 4.944, P = 0.004), and MS patients (OR = reference). Survival analysis showed higher pace and cumulative incidence of conus attacks in anti-MOG patients. Conus-involved patients, showed no significant difference regarding age, sex, concurrent brain lesions, and their partial recovery. Predictive values show that the probability of being diagnosed with anti-MOG is roughly 13 times higher in conus-involved patients (25.93% vs. 1.97%), although this probability was still higher for MS, as it has a much higher incidence., Conclusion: Despite minor differences, the results were in line with previous studies, confirming the higher rate of conus medullaris involvement among anti-MOG patients. Potential underlying causes are proposed and remain to be investigated in future studies., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: COVID-19 is speculated to increase the likelihood of relapsing-remitting multiple sclerosis (RRMS) exacerbation., Objective: To investigate the association between contraction of COVID-19 and incidence of acute MS attacks in RRMS patients six months post-infection., Methods: This retrospective cohort study compares the risk of relapse in RRMS patients with (n=56) and without COVID-19 (n=69). Incidence of relapse was recorded for six-month following contraction of COVID-19. Incidence of RRMS exacerbation in patients with COVID-19 was compared to patients without COVID-19 (the independent control group) and the same patients six months prior to the COVID-19 pandemic., Results: A lower incidence rate of RRMS exacerbation was observed in patients that contracted COVID-19 than in patients who did not contract COVID-19 (incidence rate ratio: 0.275; p=0.026). Self-controlled analysis showed no significant difference in relapse rates before the COVID-19 pandemic and after contracting COVID-19 (p=0.222). The relapse risk was not different between patients who had been hospitalized due to COVID-19 severity and those who had not (p=0.710)., Conclusion: COVID-19 contraction may not increase the risk of acute MS attacks shortly following contraction. We hypothesize that COVID-19-associated lymphopenia may partly preclude the autoreactive memory cells from expansion and initiating relapses through a so-called bystander effect of COVID-19 infection., Competing Interests: Conflict of interest The authors have no conflict of interest to disclose., (Copyright © 2021. Published by Elsevier B.V.)

The differential diagnosis of the central nervous system (CNS) demyelinating diseases can be greatly facilitated by visualization and appreciation of pathognomonic radiological signs, visualized on magnetic resonance imaging (MRI) sequences. Given the distinct therapeutic approaches for each of these diseases, a decisive and reliable diagnosis in patients presenting with demyelination-associated symptoms is of crucial value. Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are major examples of such conditions, each possessing a number of MRI signs, closely associated with the disorder. This pictorial review aims to describe seventeen pathognomonic MRI signs associated with several CNS demyelinating disorders including MS, NMOSD, myelin oligodendrocyte glycoprotein-associated disease, Baló's concentric sclerosis, metachromatic leukodystrophy, progressive multifocal leukoencephalopathy, and neurosarcoidosis., (Copyright © 2020. Published by Elsevier B.V.)

Background: Fampridine was first approved by the US Food and Drug Administration (FDA) to improve walking in multiple sclerosis (MS) patients, which was demonstrated by an increase in their walking speed. Nevertheless, the medication has been reported to possess an epileptogenic effect since it blocks the voltage-gated potassium channels in neural fibers. Several studies have indicated that the risk of seizure among fampridine consumers is not substantially higher than that in the general MS population, however. The objective of this study is to describe 97 MS patients for whom fampridine was prescribed and to assess the incidence of post-medication seizures., Methods: This cohort study included 97 MS patients with gait problems who referred to the Isfahan Clinic of MS from August 2017 to September 2019. The exclusion criteria were a previous or family history of seizure or a history of renal impairment. Fampridine was prescribed for all the patients at a dose of 10 mg twice daily (12 hours apart)., Results: three patients (with an approximate incidence rate of 0.015 per 100 patient-years) presented with generalized tonic-clonic seizures, 7, 9, and 14 months after initiating fampridine consumption. The radiological findings revealed significant cortical and subcortical lesions in the three patients. Further, two of them consumed baclofen or fingolimod simultaneously with fampridine., Conclusion: The reported incidence rate is relatively higher than that in the general MS population. The extensive (sub) cortical lesions and the concomitant medications probably have an important role in the epileptogenesis, regardless of fampridine. However, the potential pro-convulsant properties of fampridine should not be overlooked., Competing Interests: Declarations of competing interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Few data are available on the prevalence of midbrain lesions among NMOSD patients. The study aimed to address the frequency of midbrain lesions, especially dorsal midbrain involvement, among a group of NMOSD patients., Methods: The medical records of 108 NMOSD patients were reviewed, who were registered at the Al-Zahra MS Clinic, Isfahan, Iran. The patients´ information including sex, age, first recorded chief complaint, and midbrain lesion presence in the first brain MRI was collected., Results: Out of the 108 NMOSD patients, eight had midbrain lesions in their first brain MRI (7.4%). Of these patients, 50% were male and 50% were female, with the mean age being 35.25 ± 12.17 years. The most frequent first chief complaints included diplopia due to incomplete third nerve palsy and vertigo. The brain MRIs of the patients showed symmetric dorsal midbrain involvement in all the patients, and enhancement was discovered in only one of the brain MRIs., Conclusion: Among the patients, 7.4% presented midbrain involvement at onset. Therefore, midbrain lesions should also be considered as a possible core clinical manifestation in the NMOSD diagnostic criteria., Competing Interests: Declaration of Competing Interest The authors declare there is no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: There is an unapprehended diversity in the epidemiology of multiple sclerosis (MS) in different geographical regions. In this study, for the first time, we systematically review the studies estimating the incidence and/or prevalence of MS in the Persian Gulf area. The goal is to obtain the overall incidence and prevalence of MS and elucidate the reasons for the geographical variation., Methods: A comprehensive literature search was carried out using MEDLINE and EMBASE through articles published between January 1985 and December 2018 on MS epidemiology in Persian Gulf countries including Bahrain, Iran, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Search terms included 'Multiple sclerosis', 'Incidence', 'Prevalence', 'Epidemiology', 'Persian Gulf', 'Arabian Gulf' and name of each country. Only full-text articles published in English were included. All abstracts were considered and two trained reviewers evaluated the study quality using an assessment tool specifically designed for this study., Results: 39 studies met the inclusion criteria. The mean age at disease onset varied in each country and the pooled mean age of onset was 23.11. The overall pooled MS incidence was 5.03/100,000 person-years (95% CI: 0.04 - 10.02). Prevalence was 39.31/100,000 (95% CI: 29.12 - 49.50) and the result of the meta-regression method showed that prevalence increased by 2.3% per year between 1985-2018 (p = 0.04). Quality scores ranged from 4/7 to 8/8., Conclusion: The prevalence and incidence of MS in the Persian Gulf region has gone through significant changes during the past decades. This study highlights the need for future studies of MS prevalence and incidence, which will further elucidate the possible etiologies leading to periodical and geographical variations in MS incidence., Competing Interests: Declaration of Competing Interest The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Multiple sclerosis (MS) and neuromyelitis optica (NMO) are demyelinating disorders of the central nervous system. There is growing evidence that viruses may play a causal role in these diseases. Human herpes viruses have been of special attention since their DNA have been detected in many of MS patients' samples. Human herpes simplex virus 2 (HSV-2) is a member of this family which has not been investigated thoroughly in MS and NMO., Methods: We took blood samples from 90 subjects including 30 RRMS patients, 30 NMO patients and 30 healthy controls. After serum isolation, all serum samples were frozen at -70 °C to be used for enzyme linked immunosorbent assay (ELISA) for detection of specific antibodies against HSV-2. Presence or absence of antibodies against HSV-2 was determined based on the cut-off calibrator and index values were then determined. A value of <0.9: negative, between 0.9 and 1.1: equivocal and <1.1: positive., Results: Mean age of all subjects was 33.36 and female to male ratio was 4.3/1. None of the subjects were seropositive for anti-HSV-2 antibody. Analysis indicated no significant differences (P-value >0.05) among antibody levels between MS (0.19 ± 0.08), NMO (0.22 ± 0.16) and control (0.21 ± 0.09) groups. There were also no correlations between mean antibody index or O.D. and subjects' sex, family history, blood group, smoking history, age and presence of visual-motor-sensory or other forms of disability in any of the three MS, NMO and control groups (P-value >0.05)., Conclusion: We found no associations between patients' diagnosis of MS or NMO and mean anti-HSV-2 antibody index and O.D. levels., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Recent studies have suggested that anti-MOG antibodies and optic neuritis are associated and anti-MOG antibody positive patients have had better recoveries. The purpose of this study was to compare the clinical course and treatment outcome of MOG-Ab associated and non-MOG-Ab associated ON., Methods: Patients diagnosed with optic neuritis were referred for brain and cervical MRI. Blood samples were also taken to measure MOG antibody and NMO antibody levels. The patients were treated based on a standard steroid pulse therapy., Results: Between October 2015 and October 2017, 98 patients with ON were enrolled in the study. MS was diagnosed based on abnormality of patients' MRI results. Moreover, MRI finding of 58% of patients in MOG group and 80% of patients in NMO group was abnormal (P-value = 0.707). The treatment increased the visual acuity significantly in all groups after 12 months. Patients in the NMO group were the only ones without significant change in their visual acuity in the first six months. On the other hand, the only patients with significant change in their visual acuity in the second six month were those in the MS group., Conclusion: We showed that patients' response to the steroid treatment is different between the MOG group and non-MOG group. The results suggest that presence of MOG-Ab influences the treatment outcome and its length., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Tumors have been frequently reported to be associated with neuromyelitis optica (NMO). Here we review a case of a 34-year-old woman who presented with complaint of one-sided visual loss. All Lab tests exhibited negative results which decreased the possibility of Auto-immune or neuro-inflammatory disorders. Magnetic resonance imaging (MRI) of the brain and spinal cord was done as a part of work up, which showed Meningioma in anterior fossa without any other findings supporting neuro-demyelinating disorders. After complete surgical removal of the meningioma, patient's visual loss was completely resolved. 4 weeks later, she was admitted to the hospital for the second time with fever fulfilling the Fever of Unknown Origin (FUO) criteria. One week after she was discharged, she came back with paraplegia. MRI with Gadolinium showed an enhancing lesion involving T6-T9 segments of the thoracic spine. In order to rule in NMO, we checked for antibody to aquaporin-4 (AQP4-Ab) and the result was positive. This is the first report showing a probable association between FUO and NMO. Our case also demonstrates how variable the clinical presentations of NMO can be. We suggest that the diagnosis of NMO should be considered in the appropriate clinical setting despite of the presence of unconventional manifestations., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) which initiated and mediated by autoreactive T helper1 cells directed against myelin antigens. One of T cell surface receptors is T cell immunoglobulin and mucin domain (TIM) family which its importance in immunology is recently discovered. These molecules have important immunological function by regulation of T effector cells., Methods: In the present study, we analyzed the frequency of +4259A>C polymorphism in TIM-3 and -1637C>T polymorphism in TIM-1 gene in MS patients and healthy controls using restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) method., Results: We found that the polymorphism +4259A>C in exon 3 of the TIM-3 gene is associated with susceptibility to the MS (P = 0.029, OR (95%CI) = 1.841) but the other polymorphism, -1637T>C, in the promoter region of TIM-1 is not (p= 0.064)., Conclusion: Our findings suggest that +4259A>C polymorphism in TIM-3 gene may be one of the important genetic factors associated with the MS susceptibility among Iranian populations., (Copyright © 2017. Published by Elsevier B.V.)

Background: Multiple sclerosis is a central nervous system demyelinating disease with unknown etiology. However, it is believed to be a multifactorial disease resulting from an interaction of genetic and environmental factors. Immigrant studies have been performed to provide a better view of the pattern of this interaction. We aimed to report the prevalence of MS Afghan immigrants of Isfahan, a population who share the same environment as Isfahan residents but with different genetic backgrounds., Patients and Methods: Medical documents of 4536 patients registered by Isfahan Multiple Sclerosis Society (IMSS), the only MS registry in the province of Isfahan, were reviewed for Afghan patients and the demographic and clinical characteristics. The information on the current population of Afghans residing in the province was gathered through Bureau for Aliens and Foreign Immigrants Affairs (BAFIA)., Results: Six Afghan cases were identified among 4536 patients registered by IMSS. Current population of Afghans in the province was 123,578 people (65,041 male and 58,537 female). One of the cases was male and the other five were females with a female/male ratio of 5:1. Sex-adjusted prevalence for males and females was 1.53 and 8.54 per 100,000, respectively. The overall crude prevalence for Afghan population of Isfahan is 4.85 per 100,000., Conclusion: This study shows a lower prevalence of MS among Afghan residents of Isfahan compared to the overall prevalence of the province. Our result could be implying a stronger bond between genetic factors and developing MS, rather than the environmental factors., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Multiple sclerosis (MS) is one of the most common joint disorders that influence walking performance., Objectives: The objectives are to determine if energy consumption of three different clinical forms of MS differs from each other. Is there any difference between MS and normal subjects? Is there an association between the Physiological Cost Index (PCI) and the Expanded Disability States Scale (EDSS)?, Methods: MS subjects (EDSS>4) were separated in three groups based on the Ashworth and Ataxia scales, including ataxic (n=16), spastic (n=15) and ataxic-spastic (n=14). In addition, 13 age-and-gender-matched healthy subjects were used as the control group. A Heart Rate (HR) Polar Electro Finland was used to record the heart rate during resting and walking. The energy consumption was measured based on PCI. ANOVA, MANOVA, Post-hoc Tukey analysis and Pearson correlations were used for statistical analysis (P<0.05)., Results: There was a significant difference between the walking speeds of normal (76.05±5.70m/min) with ataxic (36.78±12.68m/min), spastic (34.45±16.32m/min) and ataxic-spastic (27.21±14.76m/min) groups (P<0.001). There were no significant differences between the resting HR and walking HR of four groups, and no significant difference between the PCI of ataxic, spastic and normal groups (P>0.1). The correlation between PCI and EDSS was 0.65 (P<0.001)., Conclusion: The performance of the cardiovascular system in MS subjects was the same as normal subjects. Their energy consumption increased significantly due to a decrease in their walking speed. It seems that the weakness of muscles of the lower extremity and spasticity of knee extensors play a significant role in this regard., (Copyright © 2016 Elsevier B.V. All rights reserved.)