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Background and Purpose: Multiple sclerosis (MS) is an unpredictable disease characterised by a highly variable disease onset and clinical course. Three main clinical phenotypes have been described. However, distinguishing between the two progressive forms of MS can be challenging for clinicians. This article examines how the diagnostic definitions of progressive MS impact clinical research, the design of clinical trials and, ultimately, treatment decisions. Methods: We carried out an extensive review of the literature highlighting differences in the definition of progressive forms of MS, and the importance of assessing the extent of the ongoing inflammatory component in MS when making treatment decisions. Results: Inconsistent results in phase III clinical studies of treatments for progressive MS, may be attributable to differences in patient characteristics (e.g., age, clinical and radiological activity at baseline) and endpoint definitions. In both primary and secondary progressive MS, patients who are younger and have more active disease will derive the greatest benefit from the available treatments. Conclusions: We recommend making treatment decisions based on the individual patient's pattern of disease progression, as well as functional, clinical and imaging parameters, rather than on their clinical phenotype. Because the definition of progressive MS differs across clinical studies, careful selection of eligibility criteria and study endpoints is needed for future studies in patients with progressive MS. [ABSTRACT FROM AUTHOR]

Background: The adverse effect of excessive salt intake has been recognized in decades. Researchers have mainly focused on the association between salt intake and hypertension. However, studies in recent years have proposed the existence of extra‐renal sodium storage and provided insight into the immunomodulatory function of sodium. Objectives: In this review, we discuss the modulatory effects of high salt on various innate and adaptive immune cells and immune‐regulated diseases. Methods: We identified papers through electronic searches of PubMed database from inception to March 2022. Results: An increasing body of evidence has demonstrated that high salt can modulate the differentiation, activation and function of multiple immune cells. Furthermore, a high‐salt diet can increase tissue sodium concentrations and influence the immune responses in microenvironments, thereby affecting the development of immune‐regulated diseases, including hypertension, multiple sclerosis, cancer and infections. These findings provide a novel mechanism for the pathology of certain diseases and indicate that salt might serve as a target or potential therapeutic agent in different disease contexts. Conclusion: High salt has a profound impact on the differentiation, activation and function of multiple immune cells. Additionally, an HSD can modulate the development of various immune‐regulated diseases. [ABSTRACT FROM AUTHOR]

Background: There is considerable controversy around the question as to whether Helicobacter pylori (H. pylori) infection has a protective or causative role in the development of multiple sclerosis (MS). This study evaluated published information to assess the association between H. pylori infection and MS., Methods: We conducted a comprehensive systematic review of relevant observational studies in international databases. A random-effects model was used to calculate pooled odds ratio (OR) and 95% confidence interval (CI). I 2 statistic was used to assess the between-study heterogeneity. Subgroup and meta-regression analyses were applied to identify the source of heterogeneity., Results: In total, 22 studies (25 datasets) were eligible for the meta-analysis: 17 datasets had prevalence data and eight datasets had data on the mean titer of anti-H. pylori IgG. The pooled prevalence of H. pylori was 44.1% (908/2606) in the MS patients and 46.1% (1016/2200) in the controls, indicating a non-significant protective effect of H. pylori on MS (OR, 0.82; 95%CI, 0.58-1.17). In the subgroup analysis, studies that used ELISA yielded a significant protective association (OR, 0.59; 95%CI, 0.46-0.77), while a positive non-significant association (OR, 1.33; 95%CI, 0.83-2.15) was found from studies that used other serological methods; interestingly, a significant positive association (OR, 6.64; 95%CI, 2.40-13.76) was found from studies that used histological methods to detect H. pylori infection., Conclusions: Our findings do not support the hypothesis that H. pylori infection represents a protective factor against the development of MS; however, the results varied depending on the diagnostic method(s). Particularly, a significant positive association was identified when studies introduced results based on histological examination, suggesting that active H. pylori infection might be a risk factor for development of MS. Thus, further studies are needed utilizing accurate diagnostic methods to elucidate the association between active H. pylori infection and MS., (© 2022 John Wiley & Sons Ltd.)

Management of multiple sclerosis (MS) may comprise clinical interventions and self-management strategies, including complementary therapies and modifiable lifestyle factors such as exercise and smoking cessation. Lifestyle modifications and complementary therapies with proven safety and efficacy are essential as part of best-practice MS management, especially when faced with limited access to healthcare services. However, it is unclear to what extent MS clinical practice guidelines and consensus statements address these strategies. A systematic review was conducted, wherein MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, Web of Science, guideline databases and developer sites were searched for guidelines and consensus statements that addressed lifestyle modifications and complementary therapies of interest. Two researchers independently screened articles, extracted data and assessed guideline quality using the Appraisal of Guidelines for Research and Evaluation version II. Thirty-one guidelines and consensus statements were included. Quality was high for 'clarity of presentation' (77%) and 'scope and purpose' (73%), moderate for 'stakeholder development' (56%), 'rigour of development' (48%) and 'editorial independence' (47%), and low for 'applicability' (29%). Two guidelines, related to physical activity and exercise, mindfulness, smoking cessation, and vitamin D and polyunsaturated fatty acid supplementation, scored high in all domains. These guidelines were two of only four guidelines intended for use by people with MS. High-quality guidelines and consensus statements to guide lifestyle modifications and complementary therapies in MS management are limited. Our findings indicate the need for more guidelines intended for use by people with MS, and a further focus on implementation resources., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: This study explores the lived experiences of carers of people with Multiple Sclerosis (MS), specifically in relation to their quality of life (QoL), through the use of images and narratives, with the aim of gaining a nuanced insight into the complex nature of QoL in the MS caregiving context., Design: Real-time qualitative design using the photovoice method., Methods: Twelve MS carers (aged 30-73 years) took photographs of objects/places/events that represented enhancement or compromise to their QoL and composed written narratives for each photograph based on their experiences of caregiving. In total, 126 photographs and their corresponding narratives were analysed using content analysis., Results: Seven inter-related themes were identified. MS caregiving-related challenges, sense of loss (e.g., loss of activities), emotional impact (e.g., feeling lonely), urge to escape, and sense of anxiety over the unpredictability of MS carer role were discussed in relation to the negative experiences that compromised their QoL. The themes precious moments (e.g., time spent with loved ones or hobbies) and helpful support (e.g., family and pets) encompassed participants' positive experiences that enhanced their QoL., Conclusions: Findings demonstrated the multi-faceted and complex nature of MS caregiver's QoL and highlighted that although the experiences of MS carers were mostly negative, there were also some positive aspects to caregiving, that helped enhance carers' QoL by ameliorating these negative experiences. These findings can be used to inform support programmes and enhance service provision for MS carers., (© 2020 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Verbal learning and memory deficits are among the most frequent in people with multiple sclerosis (pwMS) and have been shown to be affected by deficits in other cognitive domains, such as information processing speed and executive functioning (EF). In the present study, we aimed to further investigate the differential impact that EF may exert on verbal learning and memory on both behavioural and neural levels. Seventy pwMS were assessed with a comprehensive battery of neuropsychological tests, including tests of verbal memory (Selective Reminding Test; SRT) and EF (Stroop test; Phonemic and Alternate Verbal Fluency; Modified Five-Point Test). Structural 3Tesla magnetic resonance imaging (MRI) scans were available for 68 patients; cortical thickness of several frontal, pre-frontal, and hippocampal regions was calculated. Multivariable linear regression analysis showed that patients' performance on Alternate Fluency Test predicted both their immediate (SRT-LTS: R 2  = .38; p < .001; SRT-CLTR: R 2  = .42; p < .001) and delayed (SRT-D: R 2  = .39; p < .001) verbal memory performance. In addition, we found a significant relationship between the cortical thickness of the hippocampus and several bilateral frontal areas (i.e., anterior cingulate gyrus, superior and inferior frontal gyrus, medial frontal cortex, and frontal pole) with verbal memory tests scores (SRT-LTS: R 2  = .45; p < .001; SRT-CLTR: R 2  = .52; p < .001; SRT-D: R 2  = .49; p < .001). These behavioural and MRI results suggest that EF significantly impacts verbal memory performance in pwMS. The understanding of the complex interaction between these distinct cognitive domains can help foster the development of memory rehabilitation paradigms that take into account also the role of executive functioning., (© 2019 The British Psychological Society.)

Objectives: To analyze the frequency and demographic characteristics of multiple sclerosis (MS) in the Council of Santiago de Compostela (SPAIN)., Material and Methods: The patients diagnosed with MS according to the McDonald 2010 diagnostic criteria were identified within the population of the District of Santiago de Compostela. Several sources were used (records and databases from Hospital, General Practitioners, Private Clinics, and the MS Patients Association). Demographic and clinical data were obtained from the electronic files., Results: The incidence of MS between 2010 and 2015 was 8/100 000/year (95% CI: 6-10), and the prevalence on December 31, 2015, was 152/100 000 (95% CI: 127-176). The age-standardized prevalence (using the European Standard Population 2013) was 137 (95% CI: 114-159) and the incidence of 7 (95% CI: 2-12). The female:male ratio was 1.84, the mean age at the first symptom was 32.23 years, the diagnosis was delayed 3.12 years, and the mean EDSS was 2.82. 71.17% had relapsing-remitting MS, 16.55% secondary progressive MS, 7.59% primary progressive MS, and 0.69% progressive relapsing MS. A disease-modifying treatment was established in 62.76% of patients in a mean of 1.96 years after the diagnosis., Conclusions: The northwest of Spain is a high-risk area for MS, with frequencies similar to other Atlantic regions and higher than the rest of the country., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To study ten-year change in MS prevalence in the Province of Western Finland in Tampere University Hospital District located in 62.7°N, 23.7°E., Methods: Age-standardized prevalence/10 5 by using direct standardization in European Standard Population (ESP2013) and crude prevalence/10 5 with 95% confidence interval (95% CI) were assessed among resident MS cases fulfilling Poser criteria by sex and disease course in 31.12.2000 and 31.12.2010. MS-related disability and disease-modifying treatment (DMT) use were estimated in 31.12.2010., Results: Crude prevalence increased 49% from 129/10 5 (95% CI 121-137) in 2000 (N 1080) to 196/10 5 (187-203) in 2010 (N 1666). Age-standardized prevalence increased 45% from 133/10 5 (127-140) to 192/10 5 (184-200) and peaked in 40- to 49-year age-group. Age-standardized prevalence increased 58% among women from 176/10 5 (171-176) to 277/10 5 (270-284) and 31% among men from 91/10 5 (87-95) to 119/10 5 (115-124). Increase in RRMS was 61% from 111/10 5 (105-117) to 179/10 5 (171-186), and decrease in PPMS was 14% from 21/10 5 (19-24) to 18/10 5 (15-21).  In 2010 among the 52% RRMS cases on DMT, MS-related disability was mild in 50%. In total, cohort disability was mild in 46%, moderate to severe in 47%, and information was not available in 14%., Conclusion: A significant increase in prevalence was observed in Western Finland. Increase was higher among women and in relapsing-remitting onset MS. Disability showed age- and disease course-specific variation., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Macrophage M2 (MP2)‐based cell therapy is a novel medicinal treatment for animals with Experimental Autoimmune Encephalomyelitis (EAE) as an experimental model of multiple sclerosis (MS). This systematic review and meta‐analysis study was designed to assess the overall therapeutic effects of MP2 cell therapy on Clinical Score and motor impairment in EAE‐induced animals. All experiments on MP2 cell therapy in animals with EAE were gathered (by October 2, 2022) from English (PubMed, Scopus, WoS, Science Direct, and ISC) and Persian (MagIran and SID) databases. The searching strategy was designed using "Experimental Autoimmune Encephalomyelitis," "Multiple Sclerosis," and "Macrophage M2" keywords. Following primary and secondary screenings, eligible papers were selected based on the PRISMA 2020 guideline, and the study quality was assessed using the Animal Research: Reporting of In Vivo Experiments (ARRIVE) checklist. The difference in means of Clinical Score (score 0–5) as the effect size (ES) was analyzed based on the random effect model (CMA software, v.2). Subgrouping (EAE phases of Onset, Peak, and Recovery) was applied, and I2 index was used to assess the heterogeneity index. Publication bias and sensitivity indices were also evaluated. P < 0.05 was considered significant, and the confidence interval (CI) was determined 95%. Among 22 gathered papers, medium to high quality studies were selected for meta‐analysis. Difference in means, P value, and I2 for Onset, Peak, and Recovery phases were 0.082 (CI95%: −0.323–0.159, P value: 0.504, I2: 67.961%), −0.606 (CI95%: −1.518 to −0.305, P value: 0.192, I2: 96.070%), and −1.103 (CI95%: −1.390 to −0.816, P value: 0.000, I2: 30.880%), respectively and Overall Effect was found −0.509 (CI95%: −0.689 to −0.328, P value < 0.001). Also, P value (two‐tailed) indices for publication bias were 0.366 and 0.583 for Egger's regression intercept and Begg rank correlation, respectively. The P value for sensitivity was detected 0.003. Cell therapy procedure using MP2 can potentially alleviate the Clinical Scores Index and correct the motor defects in Recovery phase of EAE animals. In healthy mice, the brain and myelin surrounding neurons are in a healthy and physiological state (1). To evaluate MS in humans, it is necessary to model this type of disease in animals using EAE procedure through subcutaneous injection of CFA, MOG35–55, MT, and Pert. Thus, inflammation and autoimmunity occur, which finally lead to myelin destruction and motor symptoms (2). By aspiration of progenitor cells available in bone marrow, the MP2 can be isolated and cultured. By activation of these types of cells, a rich collection of MP2 can be prepared for the cell‐therapy process (3). After injection through the tail vein or intra‐peritoneal procedure, these cells can be located in CNS through crossing from the BBB. They begin their anti‐inflammatory activities and help repair the damaged myelin (4). Eventually, the clinical symptoms can be modified considerably, and the animal motor function improves (5). CFA, complete Freund's adjuvant; MOG35–55, myelin oligodendrocyte glycoprotein; MT, Mycobacterium tuberculosis; Pert, pertussis; EAE, Experimental Autoimmune Encephalomyelitis; BM, bone marrow; MP2, macrophage M2; and BBB, blood brain barrier. [ABSTRACT FROM AUTHOR]

Purpose: The macular ganglion cell layer (mGCL) is a strong potential biomarker of axonal degeneration in multiple sclerosis (MS). For this reason, this study aims to develop a computer-aided method to facilitate diagnosis and prognosis in MS., Methods: This paper combines a cross-sectional study of 72 MS patients and 30 healthy control subjects for diagnosis and a 10-year longitudinal study of the same MS patients for the prediction of disability progression, during which the mGCL was measured using optical coherence tomography (OCT). Deep neural networks were used as an automatic classifier., Results: For MS diagnosis, greatest accuracy (90.3%) was achieved using 17 features as inputs. The neural network architecture comprised the input layer, two hidden layers and the output layer with softmax activation. For the prediction of disability progression 8 years later, accuracy of 81.9% was achieved with a neural network comprising two hidden layers and 400 epochs., Conclusion: We present evidence that by applying deep learning techniques to clinical and mGCL thickness data it is possible to identify MS and predict the course of the disease. This approach potentially constitutes a non-invasive, low-cost, easy-to-implement and effective method., (© 2023 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

With the continuous updating and advancement of artificial intelligence technology, it gradually begins to shine in various industries, especially playing an increasingly important role in incremental music teaching and assisted therapy systems. This study designs artificial intelligence models from the perspectives of attention mechanism, contextual information guidance, and distant dependencies combined with incremental music teaching for the segmentation of MS (multiple sclerosis) lesions and achieves the automatic and accurate segmentation of MS lesions through the multidimensional analysis of multimodal magnetic resonance imaging data, which provides a basis for physicians to quantitatively analyze MS lesions, thus assisting them in the diagnosis and treatment of MS. To address the highly variable characteristics of MS lesion location, size, number, and shape, this paper firstly designs a 3D context-guided module based on Kronecker convolution to integrate lesion information from different fields of view, starting from lesion contextual information capture. Then, a 3D spatial attention module is introduced to enhance the representation of lesion features in MRI images. The experiments in this paper confirm that the context-guided module, cross-dimensional cross-attention module, and multidimensional feature similarity module designed for the characteristics of MS lesions are effective, and the proposed attentional context U-Net and multidimensional cross-attention U-Net have greater advantages in the objective evaluation index of lesion segmentation, while being combined with the incremental music teaching approach to assist treatment, which provides a new idea for the intelligent assisted treatment approach. In this paper, from algorithm design to experimental validation, both in terms of accuracy, the operational difficulty of the experiment, consumption of arithmetic power, and time cost, the unique superiority of the artificial intelligence attention-based combined with incremental music teaching adjunctive therapy system proposed in this paper can be seen in the MS lesion segmentation task. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Finkelsztejn A, Brooks J, Paschoal F, Fragoso Y. What can we really tell women with multiple sclerosis regarding pregnancy? A systematic review and meta-analysis of the literature. BJOG 2011;118:790-797. Although several papers report on pregnancy and multiple sclerosis (MS), no systematic review of the literature has been carried out. Neurologists and obstetricians need to have proper information to discuss with women presenting with MS who consider pregnancy. Literature review and meta-analysis of data on pregnancy in women with MS. The present work followed the recommendations of the PRISMA Statement. Using the PICO framework, the authors independently searched for the terms 'pregnancy' OR 'gestation' OR 'pregnant' AND 'multiple sclerosis' OR 'MS' in the following databases: EMBASE/Excerpta Medica, Medline, Pubmed, Scopus, Index Medicus, Biomed Central, Ebsco Fulltext, LILACS, Scielo and the Cochrane Database of Systematic Reviews. Selection criteria: only papers presenting original work with analysis of at least one of the outcomes among pregnant women with MS were included. Two independent workers performed the literature review. All the authors selected and read the relevant papers. Two other authors summarised data for analysis. Twenty-two papers reporting on 13 144 women with MS and their pregnancies were analysed. A significant decrease in relapse rate was observed during pregnancy, followed by a significant increase after delivery. Miscarriages, low birthweight, prematurity, neonatal death and malformations were assessed among these women and their offspring. There seems to be a regional influence on the rates of caesarean sections and abortions among women with MS. Neonatal death and malformation rates did not seem to be particularly high. The present work provides evidence-based data that can be discussed with women with MS and their relatives when pregnancy is considered by these families. [ABSTRACT FROM AUTHOR]

Objective: Young adults with spina bifida (and other congenital neurologic diseases) have their own aspirations that may include education, employment, relationships and having children. As they move from pediatric to adult care, they must eventually transition to an adult healthcare team. The objective of this paper is to review the challenges and controversies in the transitional and adult care of people with congenital neurourological diseases. Methods: The Research Group convened a meeting of its members and invited guests to better understand the healthcare challenges faced by these patients as they become adults. The group examined potential research opportunities focused on people with these diagnoses and themes related to their healthcare. Results: Trust and clear communication are essential for effective patient transition. Ideally parents are involved in the transition to help reinforce independent self‐care and responsibility. Adolescents require education about sexual health and independence, which may not be part of the core skillset of a urologist. The healthcare team must promote self‐management and autonomy as early as practical. One of the major limitations is that adult care lacks the coordination of pediatric care, and patients may not have a "medical home." Multidisciplinary clinics are ideal but face logistical barriers in adult medicine. Additional barriers include limited physicians with the required specialized training. In the adult system, financial constraints are a key challenge for patients and providers. Conclusion: Collaboration, supported by institutions and new research, is vital for improving the neurourological care of young adults with complex diseases. Trial Registration: This study reports on the proceedings of a meeting, and therefore clinical trial registration was not necessary. [ABSTRACT FROM AUTHOR]

Age is an important variable to describe the expected brain's anatomy status across the normal aging trajectory. The deviation from that normative aging trajectory may provide some insights into neurological diseases. In neuroimaging, predicted brain age is widely used to analyze different diseases. However, using only the brain age gap information (i.e., the difference between the chronological age and the estimated age) can be not enough informative for disease classification problems. In this paper, we propose to extend the notion of global brain age by estimating brain structure ages using structural magnetic resonance imaging. To this end, an ensemble of deep learning models is first used to estimate a 3D aging map (i.e., voxel‐wise age estimation). Then, a 3D segmentation mask is used to obtain the final brain structure ages. This biomarker can be used in several situations. First, it enables to accurately estimate the brain age for the purpose of anomaly detection at the population level. In this situation, our approach outperforms several state‐of‐the‐art methods. Second, brain structure ages can be used to compute the deviation from the normal aging process of each brain structure. This feature can be used in a multi‐disease classification task for an accurate differential diagnosis at the subject level. Finally, the brain structure age deviations of individuals can be visualized, providing some insights about brain abnormality and helping clinicians in real medical contexts. [ABSTRACT FROM AUTHOR]

In this second part of a two‐part paper, we intend to demonstrate the impact of the previously proposed advanced quality control pipeline. To understand its benefit and challenge the proposed methodology in a real scenario, we chose to compare the outcome when applying it to the analysis of two patient populations with significant but highly different types of fatigue: COVID‐19 and multiple sclerosis (MS). 31P‐MRS was performed on a 3 T clinical MRI, in 19 COVID‐19 patients, 38 MS patients, and 40 matched healthy controls. Dynamic acquisitions using an MR‐compatible ergometer ran over a rest (40 s), exercise (2 min), and a recovery phase (6 min). Long and short TR acquisitions were also made at rest for T1 correction. The advanced data quality control pipeline presented in Part 1 is applied to the selected patient cohorts to investigate its impact on clinical outcomes. We first used power and sample size analysis to estimate objectively the impact of adding the quality control score (QCS). Then, comparisons between patients and healthy control groups using the validated QCS were performed using unpaired t tests or Mann–Whitney tests (p < 0.05). The application of the QCS resulted in increased statistical power, changed the values of several outcome measures, and reduced variability (standard deviation). A significant difference was found between the T1PCr and T1Pi values of MS patients and healthy controls. Furthermore, the use of a fixed correction factor led to systematically higher estimated concentrations of PCr and Pi than when using individually corrected factors. We observed significant differences between the two patient populations and healthy controls for resting [PCr]—MS only, [Pi], [ADP], [H2PO4−], and pH—COVID‐19 only, and post‐exercise [PCr], [Pi], and [H2PO4−]—MS only. The dynamic indicators τPCr, τPi, ViPCr, and Vmax were reduced for COVID‐19 and MS patients compared with controls. Our results show that QCS in dynamic 31P‐MRS studies results in smaller data variability and therefore impacts study sample size and power. Although QCS resulted in discarded data and therefore reduced the acceptable data and subject numbers, this rigorous and unbiased approach allowed for proper assessment of muscle metabolites and metabolism in patient populations. The outcomes include an increased metabolite T1, which directly affects the T1 correction factor applied to the amplitudes of the metabolite, and a prolonged τPCr, indicating reduced muscle oxidative capacity for patients with MS and COVID‐19. [ABSTRACT FROM AUTHOR]

Mendelian randomization (MR) is a powerful approach for assessing the causal effect of putative risk factors on an outcome, using genetic variants as instrumental variables. The methodology and application developed in the framework of MR have been dramatically improved, taking advantage of the many public genome-wide association study (GWAS) data. The availability of summary-level data allowed to perform numerous MR studies especially for complex diseases, pinpointing modifiable exposures causally related to increased or decreased disease risk. Multiple sclerosis (MS) is a complex multifactorial disease whose aetiology involves both genetic and non-genetic risk factors and their interplay. Previous observational studies have revealed associations between candidate modifiable exposures and MS risk; although being prone to confounding, and reverse causation, these studies were unable to draw causal conclusions. MR analysis addresses the limitations of observational studies and allows to establish reliable and accurate causal conclusions. Here, we systematically reviewed the studies evaluating the causal effect, through MR, of genetic and non-genetic exposures on MS risk. Among 107 papers found, only 42 were eligible for final evaluation and qualitative synthesis. We found that, above all, low vitamin D levels and high adult body mass index (BMI) appear to be uncontested risk factors for increased MS risk., (© 2023 The Authors. European Journal of Neuroscience published by Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Background and purpose: Successful long‐term treatment of spasticity in people with multiple sclerosis (pwMS) is challenging. We investigated the effects of multidisciplinary inpatient rehabilitation (MIR) and an individualized self‐training program delivered by an app on spasticity in pwMS. Methods: First, we assessed the efficacy of 4‐week MIR in ambulatory pwMS (Expanded Disability Status Scale < 7.0) with moderate to severe lower limb spasticity (defined by ≥4 points on the Numeric Rating Scale for spasticity [NRSs]) in a cohort of 115 pwMS at seven rehabilitation centers in Austria. In the case of a clinically relevant improvement in spasticity of ≥20% on the NRSs following MIR (n = 94), pwMS were randomly allocated in a 1:1 ratio to either the newly designed MS‐Spasticity App or to a paper‐based self‐training program for 12 weeks. The primary outcome was change in NRSs (German Clinical Trials Registry DRKS00023960). Results: MIR led to a significant reduction of 2.0 points on the NRSs (95% confidence interval [CI] = 2.5–2.0, p < 0.000). MIR was further associated with a statistically significant improvement in spasticity on the Modified Ashworth Scale, strength, and all mobility outcomes. Following MIR, self‐training with the MS‐Spasticity App was associated with a sustained positive effect on the NRSs, whereas paper‐based self‐training led to a worsening in spasticity (median NRSs difference = 1.0, 95% CI = 1.7–0.3, p = 0.009). The MS‐Spasticity App was also associated with a significantly better adherence to self‐training (95% vs. 72% completion rate, p < 0.001). Conclusions: In pwMS, MIR is able to significantly improve lower limb spasticity, strength, and mobility. Following MIR, an individually tailored antispasticity program delivered by an app leads to sustained positive long‐term management. [ABSTRACT FROM AUTHOR]

Background and Purpose: Magnetic resonance imaging (MRI) is heavily relied upon for the diagnosis and monitoring of multiple sclerosis (MS), a chronic, demyelinating disease of the central nervous system. Serum biomarkers may serve as an accessible tool for increasing sensitivity, improving accessibility, corroborating symptoms, and providing additional data to guide clinical management. This scoping review investigates the current understanding of how the serum biomarker glial fibrillary acidic protein (sGFAP) relates to brain MRI metrics. Methods: We adhered to the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines. The databases Medline (Ovid), Embase (Ovid), CINAHL (Ebsco), and Web of Science (University of British Columbia institutional access) were searched on August 24, 2023 using a combination of medical subject headings and keyword terms for the topic of serum biomarkers in MS. Results: A total of 9880 articles were retrieved in total of which 6271 unique titles and abstracts were screened. Twelve of the 259 resultant papers contained sGFAP data and proceeded to extraction. It was found that lesion MRI metrics generally had a positive relationship with sGFAP, while gray matter and white matter metrics, including normal‐appearing white matter, were related negatively or not at all. Conclusions: These results highlight that while sGFAP may not be specific for MS, it may have utility for increasing sensitivity in postdiagnosis monitoring of MS progression. [ABSTRACT FROM AUTHOR]

Background: There is growing recognition that communication can be affected in multiple sclerosis (MS) and can negatively impact relationships, employment and psychological well‐being. Some persons with MS (PwMS) implement strategies to facilitate their communication; however, some do not. Most PwMS who report communication changes do not engage with speech–language pathology (SLP) services. This raises concerns that a large portion of communication changes associated with MS go under‐recognized and unmanaged. Little is known about what PwMS want and need to facilitate effective communication. Aim: To explore what PwMS want and need to better manage their communication changes. Methods & Procedures: Three focus groups were conducted online using Zoom, with a total of 12 PwMS. Participants were an opportunistic sample of PwMS within Australia recruited via advertisements distributed to various MS organizations and clinics. Data were transcribed verbatim and analysed using thematic content analysis to provide a qualitative analysis of the data. Outcomes & Results: Two main themes emerged: (1) accessible knowledge and a holistic approach; and (2) partnerships. Specifically, the identified wants and needs of participants included: (1) assessment; (2) information; (3) raising awareness; (4) support groups; (5) a whole‐person approach to intervention; (6) geographically and economically accessible and navigable services; (7) effective patient–physician interactions; and (8) a multidisciplinary team‐based approach (e.g., SLP, psychology, neuropsychology, occupational therapy). Conclusions & Implications: This study identified a wide range of unmet wants and needs of PwMS related to communication changes. Participants wanted improved collaborative partnerships with healthcare professionals to better manage their communication changes. For example, healthcare professionals could ask PwMS about potential communication changes, provide education and make appropriate referrals. Education and information provision could focus on communication changes in MS, factors that trigger or exacerbate communication changes, impacts, self‐management strategies, and available supports and services. Specific implications for clinical practice and future research are suggested in this paper, including ideas for patient education materials and content, suggestions for communication‐specific screening and information that could be shared in patient–physician interactions, the development of guidelines to systematically screen, assess, manage and monitor communication changes in MS, and the design of evidence‐based communication interventions for this clinical population. The results from this study can be used to guide the design of supports and services to help PwMS better manage communication changes, with the aim to reduce the negative impacts. What this paper adds: What is already known on this subject: PwMS can experience communication changes across a range of domains, including speech, voice, fluency, expressive and receptive language, and cognitive–linguistic functions. These changes can have profound and far‐reaching negative impacts on educational and vocational outcomes, social participation, relationships, psychological well‐being, and quality of life. Most PwMS who report communication changes do not engage with SLP services. There has been little research exploring what PwMS want and need to help manage their communication changes. What this paper adds to the existing knowledge: This research is the first study of its kind that sets out specifically to explore what PwMS want and need to better manage their communication changes. This study increases our understanding of, and provides valuable insights into, the specific types of supports and services PwMS desire to access, and the partnerships and kinds of interactions PwMS dream of having with healthcare professionals to manage these changes. This information can facilitate the development of future interventions to manage communication changes in MS. What are the potential or actual clinical implications of this work?: PwMS wanted healthcare professionals to ask about potential communication changes, provide education and make appropriate referrals. When providing education and information on communication changes in MS, healthcare professionals should focus on covering symptoms, triggers, impacts, self‐management strategies, and available supports and services. There is a timely need to develop guidelines and interventions to manage communication changes in MS to reduce their negative impacts. [ABSTRACT FROM AUTHOR]

The aim of this systematic review was to assess the effectiveness of Internet-based psychological interventions in the treatment of physical, socio-affective and cognitive symptoms and quality of life (QoL) in people with multiple sclerosis (pwMS) to provide currently available evidence. Systematic searches for eligible studies were carried out in four databases (August 2021) using key words. Studies were screened, data extracted, quality appraised and analysed by three independent reviewers, using predefined criteria and following the PRISMA rules. Study quality was assessed using Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields QUALSYST tool. Physical, socio-affective and cognitive symptoms and QoL were the primary outcomes. Thirteen studies were included. Two principal approaches were reported: Cognitive behavioural therapy (CBT) and mindfulness-based interventions (MBI). Interventions varied from tailored versions to videoconference by a clinician, duration mean 8 weeks, delivered via individually and groups, all online. The review found that iCBT interventions were effective for improve depression, anxiety, fatigue and QoL, and slightly in cognitive functioning in pwMS, whereas MBI interventions reported benefits in depression, anxiety, stress and QoL, and less evidence in fatigue. Generally, study quality was acceptable in most studies; eleven of the studies scored a low risk of bias on all items in the Qualsyst Tool, whereas only two studies were considered unacceptable. Psychological online interventions may improve physical, socio-affective and cognitive symptoms as well as QoL in pwMS, overcoming the face-to-face barriers (i.e. disability). Contact with the therapist and groups sessions have been identified as enablers of the online interventions. Nevertheless, the limited number of studies and the heterogeneity of health outcomes reported made difficult to afford robust conclusions on psychological intervention effects in pwMS., (© 2022 The Authors. Acta Neurologica Scandinavica published by John Wiley & Sons Ltd.)

Purpose: This paper is a scoping review of research on multiple sclerosis (MS)‐associated uveitis to determine its epidemiology, pathophysiology, clinical features and treatment. Methods: A comprehensive search of the medical databases MEDLINE (PubMed), EMBASE, Web of Science and Cochrane was carried out on 25 November 2019, to identify papers published between 1980 and 2019 that focus on patients with MS‐associated uveitis. Results: Based on large cohort studies (n ≥ 1000), the prevalence of uveitis in patients with MS is estimated to be 0.53–1.34% (mean = 0.83%), and MS is diagnosed in 0.52–3.20% (mean = 1.30%) of patients with uveitis. The condition is most frequent among middle‐aged women. Patients usually complain of floaters and/or blurred vision, with bilateral intermediate uveitis (with retinal vasculitis) as the most frequent ophthalmological finding. Both MS and intermediate uveitis are associated with HLA‐DRB1*15:01 and IL‐2RA gene polymorphism rs2104286 A > G, suggesting a common genetic background. T cells, and possibly B cells, play an important role in both autoimmune disorders. Multiple sclerosis (MS)‐related uveitis is classically treated as non‐infectious uveitis, with corticosteroids as the first treatment step. Other treatments include immunosuppressants, cryotherapy, laser photocoagulation and vitrectomy. These treatment options have a limited, if any, effect on the course of MS and can be complicated by side‐effects. As treatment strategies for MS have increased in the last decade, it would be interesting to evaluate the efficacy of these new treatments during the course of uveitis. Moreover, the correlation between retinal periphlebitis and MS could be established more accurately with the recently developed techniques of wide‐field fluorescein angiography in a large cohort of MS patients. Conclusion: MS‐associated uveitis is a rare, highly discussed pathology about which much is still unknown. Large epidemiological studies and extrapolation of new MS treatments to this condition are warranted. [ABSTRACT FROM AUTHOR]

Epidemiological data suggest that the prevalence of autoimmune diseases is increasing. Although evidence implies that people with chronic illnesses experience higher levels of burnout, there are few available insights for developing preventative interventions. This paper builds on the conservation of resources (COR) and the job demands–resources (JD‐R) framework to investigate the association between impaired health, burnout, and work engagement. In two studies, we research the role of health status as a resource, respectively, autoimmune illness symptom severity as a diminished resource, and investigate its variance explanation in burnout and work engagement above and beyond the effects of job demands and resources. Study 1 investigated the hypotheses among 87 employees with inflammatory bowel diseases. Controlling for job demands and resources, symptom severity was positively associated with (exhaustion) burnout and negatively associated with work engagement. In Study 2, we applied mixed model analyses using a sample of 129 employees with multiple sclerosis. We found significant associations of symptom severity on burnout and vigor work engagement above and beyond the effects of job demands and social support. Our studies provide important insights for employees with chronic illnesses and the organizations in which they work and give indications for theory development, future research, and the development of interventions. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Randomized controlled trial of an energy conservation course for persons with multiple sclerosis," by Lin and Steultjens in 2006 issue.

Multiple sclerosis (MS) is a chronic central nervous system (CNS) disorder characterized by demyelination, neuronal damage, and oligodendrocyte depletion. Reliable biomarkers are essential for early diagnosis and disease management. Emerging research highlights the role of mitochondrial dysfunction and oxidative stress in CNS disorders, including MS, in which mitochondria are central to the degenerative process. Adenosine monophosphate‐activated protein kinase (AMPK) regulates the mitochondrial energy balance and initiates responses in neurodegenerative conditions. This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, aimed to comprehensively assess the literature on AMPK pathways, mitochondrial dysfunction, and in vivo studies using MS animal models. The search strategy involved the use of AMPK syntaxes, MS syntaxes, and animal model syntaxes. The PubMed, Scopus, Web of Science, and Google Scholar databases were systematically searched on August 26, 2023 without publication year restrictions. The review identified and analyzed relevant papers to provide a comprehensive overview of the current state of related research. Eight studies utilizing various interventions and methodological approaches were included. Risk of bias assessment revealed some areas of low risk but lacked explicit reporting in others. These studies collectively revealed a complex relationship between AMPK, mitochondrial dysfunction, and MS pathogenesis, with both cuprizone and experimental autoimmune encephalomyelitis models demonstrating associations between AMPK and mitochondrial disorders, including oxidative stress and impaired expression of mitochondrial genes. These studies illuminate the multifaceted role of AMPK in MS animal models, involving energy metabolism, inflammatory processes, oxidative stress, and gene regulation leading to mitochondrial dysfunction. However, unanswered questions about its mechanisms and clinical applications underscore the need for further research to fully harness its potential in addressing MS‐related mitochondrial dysfunction. [ABSTRACT FROM AUTHOR]

One the disease modifying therapies (DMTs) that has been reported to be beneficial in multiple sclerosis (MS) is ponesimod, and as it holds true for all other autoimmune diseases, attempts to design immunosuppressive agents to help control the progression of MS while causing minimal side effects play a pivotal role in helping individuals suffering from the disease. Consequently, we have designed this review to comprehensively look into the safety and efficacy of ponesimod in persons with MS. A systematic database search was performed in March 2021. Double‐blinded RCTs on patients with MS with Ponesimod as their experimental medication were included. Annualized relapse rate (ARR), disability accumulation rate (DAR), the score of Fatigue Symptom and Impact Questionnaire–Relapsing Multiple Sclerosis (FSIQ–RMS), and adverse reactions were interpreted as efficacy and safety measurements, respectively. Ninety‐Five papers were retrieved in the literature search. After duplicate elimination, 92 studies remained. Finally, the review included two studies that met the criteria and used varied study designs. Ponesimod reduced ARR by 30.5% (p value = 0.001), DRA by 58% (p value = 0.29), and FSIQ‐RMS mean score by 3.57 (p value = 0.002). Meanwhile, the drugs have few side effects which were mild or moderate in intensity but has less cardiovascular side effects comparing to other S1P drugs like fingolimod. The advantageous properties of ponesimod in terms of its favorable risk: benefit and convenience profile, ponesimod has been regarded recently as a potential SIP‐1 drug for treating MS. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has brought challenges for healthcare management of patients with multiple sclerosis (MS). Concerns regarding vulnerability to infections and disease-modifying therapies (DMTs) and their complications have been raised. Recent published guidelines on the use of DMTs in relation to COVID-19 in MS patients have been diverse between countries with lack of evidence-based facts. In Sweden, there exists a particular interest in anti-CD20 therapy as a possible risk factor for severe COVID-19 due to the large number of rituximab-treated patients off-label in the country. Rapid responses from the Swedish MS Association (SMSS) and the Swedish MS registry (SMSreg) have resulted in national guidelines on DMT use for MS patients and implementation of a COVID-19 module in the SMSreg. Recently updated guidelines also included recommendations on COVID-19 vaccination with regard to the different DMTs. Social distancing policies forced implementation of telemedicine consultation to replace in-person consultations as part of regular MS health care. Patient-reported outcome measures (PROMs) in SMSreg have been useful in this respect. This paper reports our experiences on the progress of national MS health care during the COVID-19 pandemic, in addition to offering an overview of the present scientific context., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Multiple sclerosis (MS) is a chronic serious condition of uncertain course and outcome. There is relatively little literature on the experiences of people who live with a person with MS. They inhabit a locus of care that spans caring for (a relational act) and caring about (a moral stance, addressing fairness, compassion and justice) the person with MS. Methods: Using the theoretical lens of personhood, we undertook a scoping review and meta‐synthesis of the qualitative literature on the experiences of people who live with a person with MS, focusing on the nature of, and constraints upon, caring. Results: Of 330 articles, 49 were included in the review. We identified five themes. One of these—seeking information and support—reflects the political economy of care. Two are concerned with the moral domain of care: caring as labour and living with uncertainty. The final two themes—changing identities and adapting to life with a person with MS—point to the negotiation and reconstitution of personhood for both the person with MS and the people they live with. Conclusion: People with MS are embedded in relational social networks of partners, family and friends, which are fundamental in the support of their personhood; the people who live with them are 'co‐constituents of the patient's identity' assisting them to make sense of their world and self in times of disruption due to illness. Support services and health care professionals caring for people with MS are currently very much patient‐centred; young people in particular report that their roles are elided in the health system's interaction with a parent with MS. There is a need to look beyond the person with MS and recognize the relational network of people who surround them and broaden their focus to encompass this network. Patient and Public Involvement: Our research team includes four members with MS and two members with lived experience of living or working with people with MS. A third person (not a team member) who lives with a partner with MS provided feedback on the paper. [ABSTRACT FROM AUTHOR]

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Eur J Clin Invest 2011; 41 (11): 1254-1258 Abstract Background Research using experimental autoimmune encephalitis (EAE) models accounts for almost 20% of the papers. published in multiple sclerosis (MS). Methods We performed a literature review of papers indexed with ISI Web of Science on EAE and MS over the last 30 years and a detailed analysis of studies of molecular pathways in EAE published in 2008 and 2009. Results The impact of EAE studies declines more rapidly than other studies published on MS (EAE cited corrected half-life = 4·00 years vs. MS cited corrected half-life = 9·66 years, P < 0·0001). The pathology of EAE differs quite markedly from that observed in the human disease. EAE has implicated many different genes as important to pathogenesis but only a minority of these are supported by human studies. Conclusions Future research should critically appraise precisely what is being modelled by EAE before drawing conclusions about human disease. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is the most common inflammatory neurological disease in young adults, with a high prevalence worldwide (2.8 million people). To aid in the MS treatment, using VR tools in cognitive and motor rehabilitation of such disease has been growing progressively in the last years. However, the role of VR as a rehabilitative tool in MS treatment is still under debate. This paper explores the effects of VR training using EMG activation in upper limb functionality. An experimental training protocol using video games controlled using an MYO armband sensor was conducted in a sample of patients with MS. Results support the use of EMG-commanded video games as a rehabilitative tool in patients with MS, obtaining favorable outcomes related to upper limb functionality and satisfaction. [ABSTRACT FROM AUTHOR]

We read with great interest the review by Rostami Mansoor and Ghasemi-Kasman entitled "Impact of disease-modifying drugs on the severity of coronavirus disease 2019 (COVID-19) infection in multiple sclerosis patients" in your journal.1 After examining the papers published on this topic, they conclude that it seems that disease-modifying drugs (DMTs) do not confer an increased risk or provoke COVID-19 infection in multiple sclerosis (MS) patients. Multiple sclerosis and COVID-19: How could therapeutic scenarios change during the pandemic? Managing disease-modifying therapies and breakthrough activity in multiple sclerosis patients during the COVID-19 pandemic: toward an optimized approach. B-cell depleting therapies may affect susceptibility to acute respiratory illness among patients with multiple sclerosis during the early COVID-19 epidemic in Iran. [Extracted from the article]

Given the considerable emphasis placed on informed choice, the management of health information has become an increasingly important part of living with chronic illness. This paper explores the intra‐familial dynamics of managing health information in the context of chronic illness. Drawing on 77 interviews with people affected by Multiple Sclerosis in the UK (patients, partners, family members and close friends), we show how families develop their own idiosyncratic information practices, including the careful, at times strategic, seeking, sharing and withholding of information. We describe how one individual, most commonly either the patient or their partner, often takes primary responsibility for managing growing quantities of health information. Doing this is a complex task, yet its dynamics within the family unit remain invisible and unacknowledged. In this paper we: (a) stress the importance of understanding information management in chronic illness as a collective process across all those affected, patients as well as carers; (b) conceptualise the process of managing health information in this context as 'health information work'; and (c) analyse it as part of the wider care practices families engage in and as a form of care in its own right. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is an inflammatory disease defined by damage to the myelin sheaths of neurons. MS is classified into different subtypes including relapsing–remitting MS, secondary progressive MS and primary progressive MS. The present study aimed to estimate the prevalence of different forms and clinical symptoms of MS among Iranian people using meta‐analysis. We searched all available databanks, such as SID, Magiran, PubMed, Google scholar, Scopus and Science, directly to identify relevant evidence. All findings were reviewed and eligible articles were selected. The standard error of prevalence was calculated based on binomial distribution formula. The heterogeneity between the results of primary studies was detected using Cochrane (Q) and I2 indices. The primary results were combined according to a random effects model. The effect of related factors in heterogeneity was investigated using a meta‐regression model. During the primary search, 17 352 articles were identified. After limiting the search strategy, and excluding duplicates and irrelevant papers, finally, 21 primary studies were entered into the final meta‐analysis. The total prevalences of relapsing–remitting MS, primary progressive MS and secondary progressive MS types among Iranian people were estimated to be 69.7% (95% CI 63.7–75.8), 7.01% (95% CI 4.05–9.96) and 17.8% (95% CI 11.7–23.9) respectively. In addition, prevalences of fatigue and motor dysfunction were estimated to be 71.1% (95% CI 60.9–81.3) and 56.3% (95% CI 27.9–84.6), respectively. Our meta‐analysis showed that relapsing–remitting MS is the most common type of MS, and fatigue is the most common clinical manifestation in patients. Motor dysfunction and balance disorder are the other common problems in patients. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is an immune-mediated demyelinating disorder involving the central nervous system (CNS). It is common amongst young females. Although the exact cause of MS is yet unknown, viral infections such as EBV, environmental factors, and autoimmune and genetic mechanisms involving HLA-DRB1 loci are implicated. Familial MS is reported from some geographic locations and ethnic groups but is thought to be rare in Asia. In this paper, we present both a Sri Lankan mother and her son, with clinically definite MS conforming to McDonald's 2017 clinical and MAGNIMS 2016 radiological criteria. Both had oligoclonal bands in their CSF (OCB-IEF) with no serum bands indicating intrathecal production and were negative for AQP4 and MOG IgG serology. Familial MS is more common among siblings, with sister-sister relationship having the highest rate. The lowest relation was amongst father-son and mother-son pairs. Amongst siblings, the risk of MS is between 3.5% and 4.7%. Inherited factors rather than common environmental exposure influence susceptibility in such cases. To the best of our knowledge, MS occurring in a mother-son pair has not been reported before either from Sri Lanka or South Asia. [ABSTRACT FROM AUTHOR]

Introduces articles in the "Journal of Evaluation in Clinical Practice". Factors that influence spontaneous reporting of adverse drug reactions; Discusses of prescription-related disease; Risk factors for adverse drug effects; Effectiveness of interferon-beta treatment in relapsing multiple sclerosis.

Multiple sclerosis (MS) is a chronic and autoimmune disease that forms lesions in the central nervous system. Quantitative analysis of these lesions has proved to be very useful in clinical trials for therapies and assessing disease prognosis. However, the efficacy of these quantitative analyses greatly depends on how accurately the MS lesions have been identified and segmented in brain MRI. This is usually carried out by radiologists who label 3D MR images slice by slice using commonly available segmentation tools. However, such manual practices are time consuming and error prone. To circumvent this problem, several automatic segmentation techniques have been investigated in recent years. In this paper, we propose a new framework for automatic brain lesion segmentation that employs a novel convolutional neural network (CNN) architecture. In order to segment lesions of different sizes, we have to pick a specific filter or size 3 × 3 or 5 × 5. Sometimes, it is hard to decide which filter will work better to get the best results. Google Net has solved this problem by introducing an inception module. An inception module uses 3 × 3 , 5 × 5 , 1 × 1 and max pooling filters in parallel fashion. Results show that incorporating inception modules in a CNN has improved the performance of the network in the segmentation of MS lesions. We compared the results of the proposed CNN architecture for two loss functions: binary cross entropy (BCE) and structural similarity index measure (SSIM) using the publicly available ISBI-2015 challenge dataset. A score of 93.81 which is higher than the human rater with BCE loss function is achieved. [ABSTRACT FROM AUTHOR]

Background and purpose: Bradykinesia is one of the cardinal motor symptoms of Parkinson's disease. However, clinical and experimental studies indicate that bradykinesia may also be observed in various neurological diseases not primarily characterized by parkinsonism. These conditions include hyperkinetic movement disorders, such as dystonia, chorea, and essential tremor. Bradykinesia may also be observed in patients with neurological conditions that are not seen as "movement disorders," including those characterized by the involvement of the cerebellum and corticospinal system, dementia, multiple sclerosis, and psychiatric disorders. Methods: We reviewed clinical reports and experimental studies on bradykinesia in non‐parkinsonian conditions and discussed the major findings. Results: Bradykinesia is a common motor abnormality in non‐parkinsonian conditions. From a pathophysiological standpoint, bradykinesia in neurological conditions not primarily characterized by parkinsonism may be explained by brain network dysfunction. Conclusion: In addition to the pathophysiological implications, the present paper highlights important terminological issues and the need for a new, more accurate, and more widely used definition of bradykinesia in the context of movement disorders and other neurological conditions. [ABSTRACT FROM AUTHOR]

Epidemiological and clinical features of demyelinating disorders in the Indian context have been sparsely reported. This paper aims to provide a review of literature from the past decade on the same. PubMed, Google scholar, and PubMed search databases were searched using subject headings and key words for data from the past 10 years (1999‐2019). Data from studies that collected Incidence and prevalence of demyelinating disorders were prioritized. In addition, clinical and demographic features of demyelinating disorders were obtained from hospital‐based studies published from different regions within India. The sole epidemiological study from India showed a prevalence of multiple sclerosis (MS) among Indians to be 8.3/100 000 and that of neuromyelitis optica spectrum disorders (NMOSD) to be 2.7/100 000. Clinical features of MS obtained from hospital‐based studies showed female predominance, an onset of disease predominantly in the second decade of life and pyramidal dysfunction as a common initial attack. Aquaporin 4‐IgG‐associated NMOSD were predominantly in woman with myelitis as the most common initial attack. In contrast, MOG‐IgG‐associated disorders showed no gender bias and presented often with optic neuritis. There is growing awareness of demyelinating disorders in India, and the availability of imaging and serological tests has allowed for accurate and early diagnosis. In the absence of large epidemiological studies at the national level, there is likely to be a significant underestimation of prevalence and incidence of these diseases. [ABSTRACT FROM AUTHOR]

Multiple Sclerosis (MS) is a demyelinating disease affecting the central nervous system, with no curative medicine available. The use of herbal drugs and dietary supplements is increasing among people with MS (PwMS), raising a need for knowledge about potential interactions between conventional MS medicine and herbal drugs/dietary supplements. This systematic review provides information about the safety of simultaneous use of conventional MS‐drugs and herbal drugs frequently used by PwMS. The study included 14 selected disease‐modifying treatments and drugs frequently used for symptom‐alleviation. A total of 129 published papers found via PubMed and Web of Science were reviewed according to defined inclusion‐ and exclusion criteria. Findings suggested that daily recommended doses of Panax ginseng and Ginkgo biloba should not be exceeded, and herbal preparations differing from standardized products should be avoided, especially when combined with anticoagulants or substrates of certain cytochrome P450 isoforms. Further studies are required regarding ginseng's ability to increase aspirin bioavailability. Combinations between chronic cannabis use and selective serotonin reuptake inhibitors or non‐steroidal antiinflammatory drugs should be carefully monitored, whereas no significant evidence for drug‐interactions between conventional MS‐drugs and ginger, cranberry, vitamin D, fatty acids, turmeric, probiotics or glucosamine was found. [ABSTRACT FROM AUTHOR]

Objectives: The importance of health‐related quality of life (HRQoL) in multiple sclerosis (MS) is widely acknowledged. In 2015, a multicenter study was launched to assess the HRQoL and coping styles of chronically ill persons in Germany. The aims of this paper were (i) to describe how persons affected by MS assess their HRQoL and (ii) find out sociodemographic and disease‐specific determinants of HRQoL. Materials and methods: A quantitative survey (optionally per paper‐pencil or online) was conducted between March and October 2015 in Germany. Recruitment ways were as follows: Associations of the German Multiple Sclerosis Society (DMSG), medical practices specialized in neurology/MS, hospitals, public events, social networks, and self‐help clearinghouses. To measure HRQoL, the Multiple Sclerosis International Quality of Life (MusiQoL) questionnaire and the short form of the Fear of Progression Questionnaire (FoP‐Q) were used. Results: A total of 1220 individuals with MS participated in the study. Frequent problems reported were related to activities of daily living as well as sentimental and sexual life. Multiple regression analyses identified disease severity and comorbidity—in different directions (positive and negative)—as the strongest factors in predicting activities of daily living, symptoms, sentimental and sexual life, and reject. The demographic variables sex, age, education, and employment status also have different impact on the HRQoL. Conclusions: Using HRQoL measures can be feasible outcomes in addition to clinical assessments of MS and other chronic diseases and can help better managing the care. Some challenges have to be taken into account involving patients and the limitations of our empirical study. [ABSTRACT FROM AUTHOR]

Background and purpose Restless legs syndrome ( RLS) has been reported to occur more frequently in patients with multiple sclerosis ( MS) than in people without MS. Methods Systematic review and meta-analysis of studies investigating RLS in patients with MS published through April 2012. We calculated the prevalences and 95% confidence intervals ( CIs) of RLS in patients with MS and people without MS as well as odds ratios ( ORs) and 95% CIs of the association between MS and RLS based on data from the publications. We then calculated pooled effect estimates for the association between MS and RLS. Results We identified 24 studies. RLS prevalence amongst patients with MS ranged from 12.12% to 57.50% and from 2.56% to 18.33% amongst people without MS. Heterogeneity amongst studies was high ( RLS prevalence in patients with MS I2 = 94.4%; RLS prevalence amongst people without MS I2 = 82.2%). Hence, we did not pool the prevalence data for meta-analysis. Heterogeneity amongst studies investigating the association between MS and RLS was moderate ( I2 = 53.6%). Pooled analysis indicates that MS is associated with a fourfold increased odds for RLS (pooled OR = 4.19, 95% CI 3.11-5.66). This association was smaller amongst studies published as full papers (pooled OR = 3.94, 95% CI 2.81-5.54) than amongst studies published as abstracts only (pooled OR = 6.23, 95% CI 3.25-11.95). Conclusion This systematic review indicates that RLS prevalence amongst patients with MS ranges from 12.12% to 57.50% in different populations. Pooled analysis further indicates that the odds of RLS amongst patients with MS are fourfold higher compared to people without MS. [ABSTRACT FROM AUTHOR]

Objectives: Finland is a high-risk multiple sclerosis (MS) region, but a national MS register has not existed until 2014. In this paper, we present the Finnish MS register variables and data collected by 31 December 2018., Materials and Methods: Numbers and data counts of MS patients in the register (ICD-10 code G35) are presented. The disease types and proportion of patients receiving disease-modifying treatments (DMTs) were analysed in five hospital districts with most complete data sets. MS prevalence in Finland was estimated using administrative hospital discharge data as an additional resource., Results: There were a total of 8722 MS patients in the Finnish MS register by 31 December 2018 (71.5% females). Mean age at MS diagnosis was 38.7 years and peak prevalence was at age 50-54 years. Disease course was relapsing remitting (RRMS) in 66.7%, secondary progressive (SPMS) in 13.5%, and primary progressive (PPMS) in 7.9% of the 5365 MS patients in the selected districts with most complete data. A total of 66.0% of RRMS patients, 19.6% of SPMS patients and 9.9% of PPMS patients were receiving DMTs. By combining MS register data with databases of those hospitals that had not joined the register, the nationwide prevalence estimate was between 10 and 11 thousand patients (corresponding to crude prevalence 180-200/100 000)., Conclusions: The Finnish MS register is currently used in 15/21 Finnish hospital districts. By register integration into the electronic patient files, the coverage of the register has increased to approximately 80% of the estimated Finnish MS population., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Lunde Larsen LS, Larsson HBW, Frederiksen JL. The value of conventional high-field MRI in MS in the light of the McDonald criteria: a literature review. Acta Neurol Scand: 122: 149–158. © 2010 John Wiley & Sons A/S. The diagnosis of MS is based on the revised McDonald criteria and is multidisciplinary. Both clinical and paraclinical measures are included. High-field magnetic resonance imaging (MRI) is becoming increasingly available and it is therefore necessary to clarify possible advantages of high-field MRI in MS. The aim of this paper was to review MRI studies in MS where a direct comparison of MRI at high field with MRI at 1–1.5 tesla (T) had been performed. The studies evaluated were found by searching Pubmed with relevant terms including MeSH terms. The reviewed studies all found the conspicuity of lesions to be better at high field. Of the seven studies, six found more and bigger lesions at high-field MRI. In the present paper, the relevant MRI sequences are evaluated in detail. The detection of more lesions at high-field strength did not seem to lead to earlier diagnosis of clinically definite multiple sclerosis. Further larger studies of patients with clinically isolated syndromes are needed to settle the question of a diagnostic consequence of high-field imaging in MS. We suggest that the next revision of the McDonald diagnostic criteria include a recommendation of field strength. [ABSTRACT FROM AUTHOR]

Background and Purpose: Use of fluid-attenuated inversion recovery (FLAIR) scans to quantify multiple sclerosis (MS) lesion volume on 7 Tesla (7T) magnetic resonance imaging (MRI) has many downsides, including poor image homogeneity. There are little data about the relative benefit of alternative modalities. The purpose of this paper is to investigate if magnetization-prepared 2 rapid acquisition gradient echo (MP2RAGE) is a viable alternative to FLAIR for robust lesion volume measurement and disability correlations.Methods: Forty-seven participants with MS underwent annual brain 7T MRIs. Magnetization-prepared FLAIR (MPFLAIR) and MP2RAGE (both at .7 mm3 isotropic resolution) sequences from a total of 80 MRI scans from 47 subjects were reviewed. White matter lesion (WML) masks were manually constructed from MPFLAIR and T1 maps (from MP2RAGE). Lesion volumes (normalized to intracranial volume) were compared to clinical characteristics and disability scales scores by Pearson or Spearman correlation, as appropriate. Relative correlation strength was compared by Fisher r- to z-transformation.Results: Normalized lesion volume was greater in MPFLAIR masks (median .005 [range, .001-.030]) than from T1 maps (median .003 [range, .000-.015]). However, lesion volumes between MPFLAIR and T1 maps were highly correlated (rho = .87, P < .001). WML masks from both modalities correlated with most disability measures with no significant difference in the strength of correlation.Conclusions: 7T MPFLAIR and MP2RAGE T1 map-based WML volumes are highly intercorrelated and both correlate with disability. Thus, MP2RAGE may be a viable alternative to FLAIR-based methods for WML measurement on 7T MRI in MS research. [ABSTRACT FROM AUTHOR]