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Early differentiation of neuromyelitis optica spectrum disorder (NMO-SD) from multiple sclerosis (MS) is of paramount importance as NMO-SD (especially relapsing variant) has more severe morbidity than MS. We describe a case of an adolescent girl who presented with repeated episodes of optic neuritis over a period of 4 years with normal brain MRI scans. She was treated initially as relapsing remitting MS, before showing clinical evidence of transverse myelitis (TM), and eventually being diagnosed as NMO-SD. Pulse intravenous methyl prednisolone along with immunosuppressive therapy led to remission of her disease. However, delay in diagnosis as NMO-SD led to visual disability in the left eye. Therefore, in young patients with recurrent optic neuritis and normal brain MRI, it may be prudent to get spinal MRI done to look for TM, even when asymptomatic. In addition, we should keep a low threshold for requesting aquaporin-4 antibody testing in these patients.

Objectives This scoping review was undertaken to synthetize and appraise the literature on the potential mechanisms of action of functional electrical stimulation therapy in combination with task-specific training (FEST + TST) in the rehabilitation following stroke, spinal cord injury, traumatic brain injury, or multiple sclerosis. Materials and methods The literature search was performed using multiple databases (including APA, PsycInfo, Medline, PubMed, EMBASE, CCRCT, and Cochrane Database of Systematic Reviews) from 1946 to June 2020. The literature search used the following terms: (spinal cord injury, paraplegia, tetraplegia, quadriplegia, stroke, multiple sclerosis, traumatic brain injury, or acquired brain injury) AND (functional electrical stimulation or FES). The search included clinical and preclinical studies without limits to language. Results Of the 8209 titles retrieved from the primary search, 57 publications fulfilled the inclusion and exclusion criteria for this scoping review. While most publications were clinical studies (n = 50), there were only seven preclinical studies using animal models. The results of this review suggest that FEST + TST can result in multiple effects on different elements from the muscle to the cerebral cortex. However, most studies were focused on the muscle changes after FEST + TST. Conclusions The results of this scoping review suggest that FEST + TST can result in multiple effects on different elements of the neuromuscular system, while most research studies were focused on the muscle changes after FEST + TST. Despite the efficacy of the FEST + TST in the neurorehabilitation after CNS injury or disease, the results of this review underline an important knowledge gap with regards to the actual mechanism of action of FEST + TST.

Background: Progressive Multifocal Leukoencephalopathy (PML) is an opportunistic infection caused by John Cunningham virus (JCV) reactivation, potentially associated with natalizumab (NTZ) treatment for Multiple Sclerosis (MS). The anti-JCV antibodies titre (JCV index) increases during NTZ treatment; however, the effects of other disease-modifying therapies (DMTs) on the JCV index have not been fully explored. Objective: The aim of the study was to evaluate changes in the JCV index during treatment with several DMTs. Methods: This longitudinal study evaluated the JCV index before starting DMT (T0) and during treatment with DMT (T1). Results: A total of 260 participants (65.4 % females, mean age 43 ± 11.3 ) were enrolled: 68 (26.2 %) treated with fingolimod (FTY), 65 (25 %) rituximab or ocrelizumab (RTX/OCR), 37 (14.2 %) dimethyl-fumarate (DMF), 29 (11.2 %) cladribine (CLD), 23 (8.8 %) teriflunomide (TFM), 20 (7.7 %) interferon or glatiramer acetate (IFN/GA), and 18 (6.9 %) alemtuzumab (ALM). At T1, the percentage of patients with JCV index 1.51 was found to be significantly reduced in the RTX/OCR group (51.6 % versus 37.5 %, p = 0.04). In the FTY group, a significant reduction in the percentage of patients with JCV index Conclusion: DMTs with a T and/or B depleting mechanism of action induced a significant reduction in the JCV index. These results may suggest new possible sequencing strategies potentially maximizing disease control while reducing the PML risk.

BACKGROUND: Understanding patterns of MyChart (Epic Systems Corporation) messaging has the potential to alter clinical practice. However, because most research evaluating its use has been conducted in limited contexts, utilization patterns in patients with multiple sclerosis (MS) remain unclear. We characterized factors associated with high rates of MyChart messaging for patients with MS at an academic outpatient clinic. METHODS: We performed a retrospective cross-sectional analysis of 439 patients in our center’s database. Inclusion criteria were 1 or more clinic visits and MS diagnosis. We extracted demographic data, disease-specific characteristics, and MyChart messaging information. RESULTS: Of the patients in the database, 324 (74%) were MyChart users. MyChart users were more often younger (mean ± SD age, 50.1 ± 12.6 vs 55.0 ± 13.7 years; P < .001), had shorter mean ± SD duration since diagnosis (11.9 ± 8.3 vs 15.8 ± 10.8 years; P = .0013), had lower mean ± SD Patient-Determined Disease Steps scale scores (2.8 ± 2.3 vs 3.5 ± 2.5; P = .0107), and were more likely to be using high-efficacy disease-modifying therapies (χ21,323 = 6.7; P = .009). Messaging rates correlated positively with total number of unique medications (R = 0.17; P = .003) and negatively with age (R = −0.11; P = .018). CONCLUSIONS: Although previous research has implicated arm-hand disability and impaired vision as barriers to patient portal use, these findings suggest the relationship between MS-specific disease burden and MyChart utilization is also a function of underlying medical complexity beyond physical disability. These data may serve as groundwork for investigations in other disease-specific settings and for quality improvement research to mitigate these high rates in at-risk patients to optimize provider time investment, clinic productivity, and patient safety and minimize health care provider burnout.

Introduction Multiple sclerosis (MS) is an inflammatory, demyelinating, and neurodegenerative disease that affects the central nervous system. Adherence to treatment is essential to modify the course of the disease. Cognitive impairment affects up to 70% of these patients and is a limitation for administration and adherence to treatment. Objective The main objective was to assess the degree of adherence to treatment in patients with MS and cognitive impairment. Secondary objectives were to describe the tools that can influence adherence to treatment and to evaluate the effectiveness of the technological devices used to alert the patient that he/she must self-inject. Method The method consisted of a descriptive, retrospective, and cross-sectional pilot study. It was carried out in the MS clinic of the Torrecardenas University Hospital from December 2018 to September 2019. The sample included 20 patients diagnosed with MS currently treated with immunomodulatory injectable drugs for at least 6 months. The Symbol Digit Modalities Test (SDMT) was used to assess cognitive impairment and to determine adherence, patients answered the Morisky-Green test (MG). Results Twenty patients (8 men and 12 women) were included over 10 months with MS and cognitive impairment (SDMT score less than 50th percentile). Regarding gender-differentiated adherence, 75% of men were not adherent to treatment; by contrast, 66.6% of women were com-pliant with the dosage schedule. There were no statistically significant differences in terms of differentiated adherence by type of treatment. The main methods used to promote adherence were: 10% calendar, 20% family members, and 30% alarms as reminder. Discussion and conclusion Adherence results show a predominance of adherence in women, even with cognitive impairment. This reinforces our initial hypothesis that relates good therapeutic adherence to lesser progression of cognitive impairment in MS. As a preventive measure, we would like to emphasize the importance of the role of the nursing team in detecting cognitive impairment and in assessing adherence to treatment.

T cells play a pivotal role in maintaining adaptive immune responses against pathogens. However, misdirected T cell responses against self-tissues may lead to autoimmune disease. Biological sex has profound effects on T cell function and is an important determinant of disease incidence and severity in autoimmune diseases such as multiple sclerosis (MS). Many autoimmune diseases skew towards higher female incidence, including MS; however, it is has become increasingly more accepted that men living with MS are more prone to developing a progressive disease course and to having worsened disease outcomes. In this review, we discuss what is known about the role of biological sex on T cell development and differentiation, examining evidence that male sex can augment T helper 17 (Th17) responses. Next, we outline what is known about sex differences in animal models of MS, and about the distinct roles played by sex hormones versus sex chromosomes in pathogenesis in these models. Finally, we will discuss recent advances that examine the molecular basis for worsened disease outcomes in males, with a particular focus on the role played by Th17 cells in these models.

The ability to reliably monitor disease progression in patients with multiple sclerosis (MS) is integral to patient care. The Expanded Disability Status Scale (EDSS) is a commonly used tool to assess the disability status of patients with MS; however, it has limited sensitivity in detecting subtle changes in disability levels and, as a result, does not consistently provide clinicians with accurate insight into disease progression. At the 2019 European Committee for Treatment and Research in Multiple Sclerosis meeting in Stockholm, Sweden, a panel of neurologists met to discuss the limitations of the EDSS as a short-term predictor of MS progression. Before this panel discussion, a targeted literature review was conducted to evaluate published evidence on prognostic measures such as fatigue, physical assessments, and measures that are more taxing for patients, all of which may be useful to clinicians at different stages of the course of MS. This article summarizes currently available evidence in support of these measures. In addition, this article highlights the current state of expert clinical consensus regarding the current approaches used to predict and monitor disease progression and offers insight for future studies to assist clinicians in accurately monitoring disease progression in patients with MS.

The role of gut microbiota in health and diseases has been receiving increased attention recently. Emerging evidence from previous studies on gut-microbiota-brain axis highlighted the importance of gut microbiota in neurological disorders. Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease of the central nervous system (CNS) resulting from T-cell-driven, myelin-directed autoimmunity. The dysbiosis of gut microbiota in MS patients has been reported in published research studies, indicating that gut microbiota plays an important role in the pathogenesis of MS. Gut microbiota have also been reported to influence the initiation of disease and severity of experimental autoimmune encephalomyelitis, which is the animal model of MS. However, the underlying mechanisms of gut microbiota involvement in the pathogenesis of MS remain unclear. Therefore, in this review, we summerized the potential mechanisms for gut microbiota involvement in the pathogenesis of MS, including increasing the permeability of the intestinal barrier, initiating an autoimmune response, disrupting the blood-brain barrier integrity, and contributing to chronic inflammation. The possibility for gut microbiota as a target for MS therapy has also been discussed. This review provides new insight into understanding the role of gut microbiota in neurological and inflammatory diseases.

Postoperative cystoid macular oedema (CMO) is a recognised complication of cataract surgery, occurring in around 1.5% of cases. It is generally managed with topical steroids or non-steroidal anti-inflammatory medications. We present a case of a patient who developed bilateral sequential CMO following bilateral sequential cataract surgery which was non-responsive to topical therapy and worsened following sub-Tenons administration of steroid. The patient took fingolimod for multiple sclerosis both prior to and during the period of cataract surgery which is known to result in the development of macular oedema in some patients. On fingolimod cessation, the oedema resolved over a period of 5 months with good visual recovery. We present this case to inform cataract surgeons of the risk of fingolimod-associated macular oedema in patients undergoing cataract surgery and to inform neurologists of the potential need to adjust treatment for patients undergoing cataract surgery.

Multiple sclerosis (MS) is a heterogenous condition with differences between patients regarding disease presentation, imaging features, disease activity, prognosis and treatment responses. Following the discovery of new biomarkers, the concept of MS has evolved, with syndromes previously considered to be its variants now recognised as separate entities, including aquaporin-4 (AQP4)-antibody (Ab) neuromyelits optica spectrum disorders (NMOSD), and myelin oligodendrocyte glycoprotein (MOG)-Ab disease (MOGAD). In line with their distinct pathology, the newly emerging conditions have imaging characteristics which are dissimilar to typical MS. Progress in reclassifying such demyelinating CNS conditions has highlighted the challenge in meaningful categorisation of atypical presentations at the borders of MS, such as antibody-negative neuromyelitis optica-like syndromes, tumefactive demyelinating lesions, or Balo's concentric sclerosis. In this review, we discuss the increasing role of imaging in distinguishing MS from non-MS CNS inflammatory/demyelinating conditions and defining undetermined borderline cases. This progress relies both on better characterisation of imaging features of these conditions on conventional imaging in terms of their appearance and location, as well as on the implementation of novel image acquisition and/or post-processing techniques allowing for more in-depth lesion assessment, including the presence of a central vein sign or paramagnetic rim.

Objectives To systematically synthesize the effectiveness of fatigue self-management education (SME) on fatigue and quality of life (QoL) in persons with disease-related fatigue, and to describe the intervention characteristics. Methods We systematically reviewed the literature on SMEs in people with disease-related fatigue. We included randomized controlled trials (RCT), which aimed to improve self-management skills for fatigue in daily life. We synthesized the effectiveness and mapped the intervention characteristics. Results We included 26 RCTs studying samples from eight disease groups. At follow-up, 46% studies reported statistically significant improvements on fatigue and 46% on QoL. For persons with cancer 6/8 and multiple sclerosis 8/10 RCTs showed positive evidence in favor of SME. The range of effect sizes was wide (d: 0.0 ->0.8). Delivery modalities (inpatient, outpatient, home), interactions (individual, group, remote), and duration [range (h): 1–17.5] varied. Conclusions The overall evidence on the effectiveness of SMEs on fatigue and QoL is limited and inconsistent. For persons with cancer and multiple sclerosis, the evidence provides a positive effect. The RCTs with medium to large effect on QoL indicate the potential benefit of SMEs. Practical implication Duration and peer interaction should be considered when tailoring SMEs to populations and contexts.

The population worldwide is largely exposed to bisphenol A (BPA), a commonly used plasticizer, that has a similar molecular structure to endogenous estrogens. Therefore, it is able to influence physiological processes in the human body, taking part in pathophysiology of various endocrinopathies, as well as, cardiovascular, neurological and oncological diseases. BPA has been found to affect the immune system, leading to the development of autoimmunity and allergies, too. In the last few decades, the prevalence of autoimmune diseases has significantly increased that could be explained by a rising exposure of the population to environmental factors, such as BPA. BPA has been found to play a role in the pathogenesis of systemic autoimmune diseases and also organ-specific autoimmunity (thyroid autoimmunity, diabetes mellitus type 1, myocarditis, inflammatory bowel disease, multiple sclerosis, encephalomyelitis etc), but the results of some studies still remain controversial, so further research is needed.

Objective To assess the effects of adding a neurodynamic intervention into a multimodal management approach in individuals with multiple sclerosis (MS) with upper extremity pain symptoms. Design Randomized clinical trial. Setting Tertiary hospital center. Participants Thirty-two individuals with MS were randomly assigned to multimodal usual care alone (n = 16) or multimodal usual care plus neurodynamic intervention (n = 16). Interventions Both groups received 5 sessions of multimodal usual care of 30 minutes duration, twice per week. Subjects allocated to the neurodynamic group also received bilateral neurodynamic slider interventions targeting the upper extremity nerve trunks. Outcome measures Pressure pain thresholds (PPTs) at the radial, median and ulnar nerve trunks, second metacarpal and tibialis anterior, pain intensity in the upper extremity (NPRS, 0-10), light touch detection threshold (von Frey hairs) and manual dexterity (nine-hole peg test) were assessed before and after the intervention. Results Subjects receiving the neurodynamic interventions experienced larger improvements in PPTs at all locations (moderate effect size, between-groups differences from 89.5 kPa to 186.5 kPa), a higher decrease in pain intensity at rest (large effect, difference 1.7, 95%CI 0.4 to 3.0) and improvements in sensitivity to light touch (moderate effect, difference -0.7, 95%CI -1.3 to -0.1) and in manual dexterity (large effect, difference 7.7, 95%CI 4.0 to 11.4 seconds) than those that did not receive the neurodynamic intervention. Conclusions The inclusion of neural mobilization into a multimodal management approach resulted in reduction of pressure sensitivity, greater reduction in pain and improvement in sensitivity to light touch and manual dexterity in MS. Further studies are necessary to confirm these findings at longer term follow-ups.

We reported a patient with autoimmunity (multiple sclerosis), immunodeficiency (hypogammaglobulinemia with severe infections), enteropathy (diarrhea with intestinal inflammation), splenomegaly, lymphadenopathy and lymphocytic infiltration of non-lymphoid organs (lung, gut and brain). The patient was found to have a heterozygous mutation in cytotoxic T lymphocyte antigen-4, and had excellent response to abatacept.

Background: Multiple sclerosis (MS) is an autoimmune inflammatory disease of the central nervous system characterized by demyelination and neurodegeneration processes. It leads to different clinical courses and degrees of disability that need to be anticipated by the neurologist for personalized therapy. Recently, machine learning (ML) techniques have reached a high level of performance in brain disease diagnosis and/or prognosis, but the decision process of a trained ML system is typically nontransparent. Using brain structural connectivity data, a fully automatic ensemble learning model, augmented with an interpretable model, is proposed for the estimation of MS patients' disability, measured by the Expanded Disability Status Scale (EDSS). Materials and Methods: An ensemble of four boosting-based models (GBM, XGBoost, CatBoost, and LightBoost) organized following a stacking generalization scheme was developed using diffusion tensor imaging (DTI)-based structural connectivity data. In addition, an interpretable model based on conditional logistic regression was developed to explain the best performances in terms of white matter (WM) links for three classes of EDSS (low, medium, and high). Results: The ensemble model reached excellent level of performance (root mean squared error of 0.92 ± 0.28) compared with single-based models and provided a better EDSS estimation using DTI-based structural connectivity data compared with conventional magnetic resonance imaging measures associated with patient data (age, gender, and disease duration). Used for interpretation of the estimation process, the counterfactual method showed the importance of certain brain networks, corresponding mainly to left hemisphere WM links, connecting the left superior temporal with the left posterior cingulate and the right precuneus gray matter regions, and the interhemispheric WM links constituting the corpus callosum. Also, a better accuracy estimation was found for the high disability class. Conclusion: The combination of advanced ML models and sensitive techniques such as DTI-based structural connectivity demonstrated to be useful for the estimation of MS patients' disability and to point out the most important brain WM networks involved in disability. Impact statement An ensemble of "boosting" machine learning (ML) models was more performant than single models to estimate disability in multiple sclerosis. Diffusion tensor imaging (DTI)-based structural connectivity led to better performance than conventional magnetic resonance imaging. An interpretable model, based on counterfactual perturbation, highlighted the most relevant white matter fiber links for disability estimation. These findings demonstrated the clinical interest of combining DTI, graph modeling, and ML techniques.

Introdução: Registos de doentes permitem avaliar melhor resultados terapêuticos e suportar a personalização de cuidados de saúde em diversas patologias. Este trabalho teve como objetivos: implementar um registo local num centro de esclerose múltipla em Portugal; proceder a uma análise crítica das suas etapas de desenvolvimento; e realizar uma primeira análise dos doentes incluídos.Material e Métodos: A criação do registo dividiu-se em duas fases: desenvolvimento (construção da plataforma online) e implementação (recrutamento de doentes e recolha retrospetiva e prospetiva da informação disponível). Realizou-se uma análise demográfica e clínica dos doentes incluídos.Resultados: Especialistas em Neurologia e coordenadores de estudo participaram no projeto, num total de 1050 horas de trabalho na fase de implementação. Dos 498 doentes com esclerose múltipla incluídos no estudo, 72,9% eram do género feminino, tendo sido identificada como subtipo de doença mais comum a esclerose múltipla surto remissão. Os fármacos mais frequentemente prescritos após diagnóstico foram interferões beta. Detetaram-se lacunas no processo clínico dos doentes relativamente à progressão da incapacidade e a exames complementares de diagnóstico.Discussão: As dificuldades encontradas poderão ser mitigadas através da definição de elementos obrigatórios nos processos clínicos dos doentes e da implementação de registos mais minimalistas. Este procedimento possibilitaria reduzir o tempo despendido por profissionais de saúde na recolha de informação, otimizar custos, e permitir o foco na utilização do registo e ferramentas associadas ao mesmo para personalização de cuidados de saúde.Conclusão: Apesar do volume de dados recolhidos no âmbito deste estudo, foram encontradas dificuldades que comprometeram a implementação e manutenção do registo, que poderão ser ultrapassadas com a otimização de estratégias futuras.

A 57-year-old woman presented with optic neuritis with repeated clinical symptoms of focal demyelination of the cerebral white matter and brain stem for 14 years. At the end of the patient's course, the clinical signs mimicked secondary progressive multiple sclerosis, but whether it was caused by interferon administration or neuromyelitis optica spectrum disorders (NMOSD) - or a combination of both or others - was unclear. Histopathological findings indicated the etiology to be NMOSD, with no apparent plaque in spinal cord specimens. This case suggests that an accurate clinical diagnosis requires serum anti-aquaporin 4 antibody measurements as well as an autopsy examination.

Background: Spatio-temporal evolution of cord atrophy in multiple sclerosis (MS) has not been investigated yet. Objective: To evaluate voxel-wise distribution and 1-year changes of cervical cord atrophy in a multicentre MS cohort. Methods: Baseline and 1-year 3D T1-weighted cervical cord scans and clinical evaluations of 54 healthy controls (HC) and 113 MS patients (14 clinically isolated syndromes (CIS), 77 relapsing-remitting (RR), 22 progressive (P)) were used to investigate voxel-wise cord volume loss in patients versus HC, 1-year volume changes and clinical correlations (SPM12). Results: MS patients exhibited baseline cord atrophy versus HC at anterior and posterior/lateral C1/C2 and C4–C6 ( p < 0.05, corrected). While CIS patients showed baseline volume increase at C4 versus HC ( p < 0.001, uncorrected), RRMS exhibited posterior/lateral C1/C2 atrophy versus CIS, and PMS showed widespread cord atrophy versus RRMS ( p < 0.05, corrected). At 1 year, 13 patients had clinically worsened. Cord atrophy progressed in MS, driven by RRMS, at posterior/lateral C2 and C3–C6 ( p < 0.05, corrected). CIS patients showed no volume changes, while PMS showed circumscribed atrophy progression. Baseline cord atrophy at posterior/lateral C1/C2 and C3–C6 correlated with concomitant and 1-year disability ( r = −0.40/–0.62, p < 0.05, corrected). Conclusions: Voxel-wise analysis characterized spinal cord neurodegeneration over 1 year across MS phenotypes and helped to explain baseline and 1-year disability.

Background Leg swelling in patients with various central neuromuscular disorders is a common clinical scenario and can lead to significant morbidity. The aim of the present study was to evaluate a subset of patients with central neuromuscular disorders who had undergone iliofemoral venous stenting at a specialty venous clinic at a tertiary care hospital. Methods From January 2000 to December 2020, the medical records of all patients with a known central neuromuscular disorder who had undergone iliofemoral venous stenting for chronic iliofemoral venous obstruction were retrospectively analyzed. Results A total of 42 patients (45 limbs) with central neuromuscular disorders had undergone iliofemoral stenting after failure of a trial of conservative therapy. The central neuromuscular disorders included Parkinson disease (n = 20 limbs), multiple sclerosis (n = 15 limbs), and other neuromuscular conditions (n = 10 limbs). The mean age of the sample was 59 ± 14 years. The ratio of post-thrombotic to nonthrombotic iliac vein lesions was 3:1. Most of the patients had had CEAP (clinical, etiologic, anatomic, pathophysiologic) class ≥C4 (64.4%); 25 limbs had a history of venous thromboembolism (56%). A trend was seen toward improvement in all clinical parameters measured (venous clinical severity score, visual analog scale for pain score, and edema grade) after stenting. An ulcer healing rate of ≤90% was noted after stenting. Of the 45 limbs, 24 had required some form of reintervention (53%) after initial stent placement. Conclusions Venous intervention in the form of endovenous stenting was associated with improvement in the clinical parameters for patients with central neuromuscular disorders. However, these patients should be counseled regarding the relatively higher rate of reinterventions that might be required to correct residual or recurrent symptoms.

OBJECTIVE To explore the association between frailty and history of falls in people living with multiple sclerosis (MS). DESIGN Secondary analysis. SETTING University research laboratories in the United States and Israel. PARTICIPANTS 118 people with relapsing-remitting MS [age=48.9 years (SD=10.0); 74.6% female; expanded disability status scale (EDSS) range=1.0-6.0] were studied in this cross-sectional analysis. INTERVENTION Not applicable. MAIN OUTCOMES A frailty index was calculated from 40 health deficits by following standard validated procedures. The number of falls (12-month history) was recorded. RESULTS Overall, 33.9%, 29.7%, and 36.4% of participants were classified as non-frail, moderately frail, and severely frail, respectively. The frailty index was significantly correlated (ρ=0.37, p

OBJECTIVES: Although previous studies have examined the effects of exercise training on other International Classification of Functioning, Disability and Health (ICF) component levels in persons with multiple sclerosis (MS), the effects of exercise training on participation remain unclear. The objectives of this review were to: (1) characterize systematically the use of outcome measures that capture participation in exercise training studies; (2) quantify the effect of exercise training on participation in persons with MS.METHODS: A search of 6 electronic databases (CINAHL, Sport Discuss, EMBASE, MEDLINE, Cochrane Central, Scopus) was conducted to identify controlled and noncontrolled trials involving exercise training and participation in persons with MS. Search strings were built from Medical Subject Headings and CINAHL headings. ICF linking rules were used to identify participation chapters and categories captured. Meta-analysis was used to quantify the effect of exercise training on participation in randomized controlled trials comparing exercise effects to no intervention/usual care.RESULTS: We included 49 articles involving controlled and noncontrolled exercise trials in the systematic review of outcome measures. We captured 16 different outcome measures that captured all 9 participation chapters and identified 89 unique participation categories. Across these 16 outcome measures, mobility was the most commonly represented participation chapter, with 108 items. A subsample of 23 randomized controlled trials was included in the meta-analysis. An overall effect of 0.60 (standard error = 0.12, 95% confidence interval: 0.37-0.84, z = 4.9, p < 0.001) was calculated, indicating a moderate, positive effect of exercise training on participation.CONCLUSION: The current review provides information that can be used to guide the selection of outcome measures that capture participation in studies of exercise training in persons with MS. Exercise training has a positive effect on outcomes that capture participation, providing further evidence for the role of exercise training in promoting and maintaining engagement in everyday life.

Background Cognitive impairment is frequent and disabling in multiple sclerosis (MS). The Brief International Cognitive Assessment in MS (BICAMS) is a recent short battery usable in clinical practice for cognitive evaluation of MS patients. Objective To find cortical areas or brain volumes on magnetic resonance imaging (MRI) structural sequences associated with BICAMS scores in MS. Methods In this cross-sectional single-center study (NCT03656055, September 4, 2018), 96 relapsing remitting-MS patients under natalizumab and without recent clinical or radiological inflammation were included. Patients underwent brain MRI and the three BICAMS tests, evaluating information processing speed (SDMT), visuo-spatial memory (BVMT-R), and verbal memory (FVLT). Results Cortical thickness in the left frontal superior and the right precentral gyri was associated with BVMT-R scores whereas cortical thickness in the left Broca's area and the right superior temporal gyrus was associated with FVLT scores. We observed associations between white matter inflammatory lesions connected to these cortical regions and BICAMS subscores. Conclusions BICAMS scores are associated with specific cortical areas, the cognitive domain matching the known functions of the cortical area. Specific cognitive impairments in MS may be associated with specific cortical regions, themselves influenced by white matter inflammatory lesions and demographical parameters (age, sex, education level).

Background: Magnetic resonance imaging (MRI) of brain volume measures are widely used outcomes in secondary progressive multiple sclerosis (SPMS), but it is unclear whether they are associated with physical and cognitive disability. Objective: To investigate the association between MRI outcomes and physical and cognitive disability worsening in people with SPMS. Methods: We used data from ASCEND, a large randomized controlled trial ( n = 889). We investigated the association of change in whole brain and gray matter volume, contrast enhancing lesions, and T2 lesions with significant worsening on the Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk (T25FW), Nine-Hole Peg Test (NHPT), and Symbol Digit Modalities Test (SDMT) with logistic regression models. Results: We found no association between MRI measures and EDSS or SDMT worsening. T25FW worsening at 48 and 96 weeks, and NHPT worsening at 96 weeks were associated with cumulative new or newly enlarging T2 lesions at 96 weeks. NHPT worsening at 48 and 96 weeks was associated with normalized brain volume loss at 48 weeks, but not with other MRI outcomes. Conclusion: The association of standard MRI outcomes and disability was noticeably weak and inconsistent over 2 years of follow-up. These MRI outcomes may not be useful surrogates of disability measures in SPMS.

Background: Curcumin, a hydrophobic polyphenolic compound present in Curcuma longa Linn. (Turmeric), has been used to improve various neurodegenerative conditions, including Amyotrophic lateral sclerosis, multiple sclerosis, Parkinson's disease, Prion disease, stroke, anxiety, depression, and ageing. However, the Blood-Brain Barrier (BBB) impedes the delivery of curcumin to the brain, limiting its therapeutic potential. Objective/Aim: This review summarises the recent advances towards the therapeutic efficacy of curcumin along with various novel strategies to overcome its poor bioavailability across the bloodbrain barrier. Methods: The data for the compilation of this review work were searched in PubMed Scopus, Google Scholar, and Science Direct. Result: The review also summarises the numerous toxicological studies and the role of curcumin in CNS disorders. Conclusion: The review also summarises the numerous toxicological studies and the role of curcumin in CNS disorders.

Background People with multiple sclerosis (MS) are increasingly using the Internet in the daily management of their condition. They search for high-quality information in plain language, from independent sources, based on reliable and up-to-date evidence. The Integrating and Deriving Evidence, Experiences and Preferences (IN-DEEP) project in Italy and Australia aimed to provide people with MS and family members with an online source of evidence-based information, starting from their information needs. This paper reports on the Italian project’s website. Methods Contents, layout and wording were developed with people with MS and pilot-tested. The website was evaluated using an online 29-item questionnaire for ease of language, contents, navigation, and usefulness of information aimed at people with MS, family members and the general population. Results The website (http://indeep.istituto-besta.it/) is structured in multiple levels of information. The first topic was interferons-β for people with relapsing-remitting MS. In all, 433 people responded to the survey (276 people with MS, 68 family members and 89 others). The mean age was 45 years, almost 90 % had a high school diploma, about 80 % had relapsing-remitting MS, and the median disease duration was seven years. About 90 % judged the website clear, understandable, useful, and easy to navigate. Ninety percent of people with MS and family members would recommend it to others. Sixty-two percent reported they felt confident in making decisions on interferons-β after reading the website. Conclusions The model was judged clear and useful. It could be adapted to other topics and diseases. Clinicians may find it useful in their relationship with patients. Electronic supplementary material The online version of this article (doi:10.1186/s12883-016-0552-0) contains supplementary material, which is available to authorized users.

Background: Neurogenic bowel dysfunction (NBD), like fecal incontinence and constipation, is a common symptom of disease in patients with multiple sclerosis (MS). The NBD score is a validated symptom-based questionnaire consisting of 10 multiple-choice questions. The aim of this study was to validate the Dutch version of the NBD score in patients with MS, creating an objective measuring tool of bowel dysfunction. Methods: Translation and validation of the NBD score was performed according to standardized guidelines. Adult patients with MS visiting a urology department completed a set of questionnaires (test): the NBD score, the Fecal Incontinence Quality of Life scale (FIQL), the Fecal Incontinence Severity Index (FISI), and the EQ-5D 3-Level questionnaire (EQ-5D-3L). After 1 to 2 weeks, the questionnaires were completed again (retest). A control group recruited at a general practitioner’s practice completed the questionnaires once. Data were analyzed for measurement properties. Results: Sixty-one patients and 50 controls were included. Content validity was adequate, internal consistency was moderate (Cronbach α = 0.57 and 0.41), and reproducibility was excellent (interclass correlation coefficient = 0.78). Criterion validity was confirmed; the NBD score correlated moderately/strongly with the FIQL, FISI, and EQ-5D-3L. The NBD scores in the patient group were significantly higher than those in the control group, demonstrating good construct validity. Conclusions: The Dutch version of the NBD score showed moderate to good validity and good reliability for assessment of NBD in patients with MS.

MS is a rare neurodegenerative disease with an immunopathological background. Although, it has a rather low global prevalence, it can be considered among one of the most common youth disabling disorders that are not related to trauma. It is also classified as a complex disease with many susceptibility genes incriminated in its etiology and prognosis. In addition, several well identified and extensively studied environmental factors are implicated as vitamin D metabolism & ultraviolet B (UVB) exposure, Epstein Barr virus (EBV) infection, smoking and morbid obesity. The infamous relationship between Vitamin D and MS has been an area of extensive research in many aspects; pathophysiology, disease course, prognosis and even response to treatment.

Objectives Most spending for prescription drugs is on branded drugs that do not have direct generic equivalents but many of these drugs do have therapeutic alternatives within class. We estimate the potential savings from providing patients a financial incentive to switch from a higher cost drug to a lower cost, therapeutic alternative drug. Methods We used individual state-transition microsimulations to model medication use and spending with and without financial incentives over a 12-month time horizon with a healthcare sector perspective. Costs and utilization inputs were from individuals on branded insulins or multiple sclerosis drugs enrolled in a regional mixed-model health maintenance organization. Base-case model used a one-time financial incentive of $83 and $250 offered to patients on higher cost insulin and multiple sclerosis treatments, respectively, to switch to lower cost drugs within class. Results Savings per individual offered an incentive in the insulin and multiple sclerosis classes were, respectively, $84 (95% CI $46-$122) and $2,127 (95% CI $267-$3,987). Varying the incentive size and switch probability resulted in maximum savings of $712 at elasticity of 0.2 and incentive size $250 for the insulin drug class. For the multiple sclerosis drug class, maximum savings of $5945 was at elasticity of 0.2 and incentive size of $1000. Short time horizon makes our savings estimates conservative. Conclusions If programs such as financial incentives could encourage even a small proportion of patients to switch among drugs within therapeutic class, then substantial savings could be generated.

Background Altered callosal integrity has been associated with motor deficits in patients with multiple sclerosis (MS), but its contribution to disability has, to the knowledge of the authors, not been investigated by using multiparametric MRI approaches. Purpose To investigate structural and functional interhemispheric MRI substrates of global disability at different milestones and upper limb motor impairment in MS. Materials and Methods In this cross-sectional study, healthy control patients and patients with MS (between January 1, 2008, and December 31, 2016) were retrospectively selected from our hospital database. Clinical assessment included Expanded Disability Status Scale (EDSS), nine-hole peg test, and digital finger tapping test. By using structural and resting-state functional MRI sequences, probabilistic tractography of hand corticospinal tract fibers, and transcallosal fibers between hand-motor cortices (hereafter, referred to as hand-M1), supplementary motor areas (SMAs), premotor cortices (PMCs), and voxel-mirror homotopic connectivity (VMHC) were analyzed. Random forest analyses identified the MRI predictors of clinical disability at different milestones (EDSS scores of 3.0, 4.0, 6.0) and upper limb motor impairment (nine-hole peg test and finger tapping test z scores < healthy control patients 5th percentile). Results One-hundred thirty healthy control patients (median age, 39 years; interquartile range, 31-50 years; 70 women) and 340 patients with MS (median age, 43 years; interquartile range, 33-51 years; 213 women) were studied. EDSS 3.0 predictors (n = 159) were global measures of atrophy and lesions together with damage measures of corticospinal tracts and transcallosal fibers between PMCs and SMAs (accuracy, 86%; P = .001-.01). For EDSS 4.0 (n = 131), similar predictors were found in addition to damage in transcallosal fibers between hand-M1 (accuracy, 89%; P = .001-.049). No MRI predictors were found for EDSS 6.0 (n = 70). Nine-hole peg test (right, n = 161; left, n = 166) and finger tapping test (right, n = 117; left, n = 111) impairments were predicted by damage in transcallosal fibers between SMAs and PMCs (accuracy range, 69%-77%; P = .001-.049). VMHC abnormalities did not explain clinical outcomes. Conclusion Structural, not functional, abnormalities at MRI in transcallosal premotor and motor white matter fibers predicted severity of global disability and upper limb motor impairment in patients with multiple sclerosis. The informative role of such predictors appeared less evident at higher disability levels. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Barkhof and Pontillo in this issue.

Purpose This study evaluates the grey and white brain matter characteristics in women with multiple sclerosis (MS) and detrusor sphincter dyssynergia (DSD). Grey matter is assessed via the functional connectivity (FC) of brain regions activated during voiding, using functional magnetic resonance imaging (fMRI). Two white matter tracts involved in bladder function, the anterior thalamic radiation (ATR) and superior longitudinal fasciculus (SLF), were evaluated using diffusion tensor imaging (DTI). Methods Twenty-seven women with MS (two groups: no-DSD (n=23) or DSD (n=4)), and eight healthy controls (HC) underwent concurrent urodynamic-fMRI evaluation with four cycles of bladder filling and emptying. A FC similarity measure (FC_sim) was calculated for each subject to express the similarity of individual FC at voiding initiation compared to all FC patterns. ATR and SLF tracts were traced and their fractional anisotropy (FA) and mean diffusivity (MD) were recorded. Results Mean FC_sim values were significantly different among the three groups indicating distinct FC patterns; however, no significant difference was found between DSD and no-DSD groups. DSD group showed trends of lower FA and higher MD - indicating loss of coherence - in all tracts compared to HCs, and in the left and right ATR when compared to MS women with neither DSD nor voiding dysfunction (VD), suggesting more damage in these tracts for MS women with DSD. Conclusions Women with MS show distinctly different FC patterns compared to HCs. There are trends showing more damage in the ATR in women with MS and DSD compared to those with neither DSD nor VD.

BACKGROUND: Perivascular space (PVS) is associated with neurodegenerative and neuroimmune diseases. Multiple sclerosis (MS) is traditionally a neuroimmune disease. However, studies show neurodegeneration also plays a vital role in MS. At present, most studies conclude severer PVS in MS is an imaging marker of neuroinflammation, while a 7T MRI study suggests that PVS in MS is associated with neurodegeneration. METHODS: In this study, 82 MS patients (n=82) and 32 healthy controls (n=32) were enrolled. The following indexes were measured: the number, size and distribution of PVS, the PVS score, corpus callosum index (CCI), corpus callosum area (CCA), the ratio of the corpus callosum to the cranium (CCR), aligned third ventricle width (a3VW), and unaligned third ventricle width (u3VW). RESULTS: The PVS score (4 vs. 3, P=0.041), PVSs number (103.280±45.107 vs. 87.625±30.139, P=0.035), and enlarged perivascular spaces (EPVSs) number (9 vs. 1, P

BackgroundThe visual system could be included in the diagnostic criteria for multiple sclerosis (MS) to demonstrate dissemination in space (DIS) and dissemination in time (DIT).ObjectiveTo investigate the diagnostic value of retinal asymmetry in MS.MethodsA prospective, longitudinal study in individuals with MS (n=151) and healthy controls (n=27). Optical coherence tomography (OCT) was performed at 0, 2 and 4 years. Macular ganglion cell and inner plexiform layer (mGCIPL) thickness was determined as well as measures for retinal asymmetry: the inter-eye percentage difference (IEPD) and inter-eye absolute difference (IEAD). Receiver operator characteristics curves were plotted and the area under the curve (AUC) was calculated for group comparisons of the mGCIPL, IEPD, IEAD and atrophy rates.ResultsThe diagnostic accuracy of both the IEPD and IEAD for differentiating bilateral and unilateral MS optic neuritis was high and stable over time (AUCs 0.88–0.93). The IEPD slightly outperformed the IEAD. Atrophy rates showed low discriminatory abilities for differentiating MS from controls (AUC 0.49–0.58).ConclusionThe inter-eye differences of the mGCIPL have value for demonstration of DIS but in individuals with longstanding MS not for DIT. This may be considered as a test to detect DIS in future diagnostic criteria. Validation in a large prospective study in people presenting with symptoms suggestive of MS is required.

The spectrum of demyelinating diseases affecting the central nervous system is broad. Although many have a chronic course, neuroinflammatory conditions often present with acute to subacute onset symptoms requiring hospitalization when severe. This article reviews the acute phase assessment and management of these disorders, with a particular focus on multiple sclerosis, neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody disorder, and several atypical demyelinating diseases.

OBJECTIVE: To determine differences in obesity, type 2 diabetes, and hypertension in Black patients compared with White patients with multiple sclerosis (MS). DESIGN: Cross-sectional database review. SETTING: Large academic medical center research records database. PARTICIPANTS: A total of 3191 patient cases (N=3191; 77% female, 34% Black) identified by MS diagnosis within the medical record. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Diagnosis codes for type 2 diabetes and hypertension. Body mass index (BMI), race, age, and sex were collected. Analysis of variance (continuous variables) and chi-square analyses (categorical variables) were conducted to determine differences in obesity, diabetes, and hypertension between race and sex. Logistic regression was conducted to determine odds ratios (ORs) of developing diabetes and hypertension based on race, sex, BMI, and age. RESULTS: Black patients were more than twice as likely to be diagnosed as having diabetes (OR, 2.15 [95% CI, 1.70–2.72]; P

Multiple sclerosis (MS) patients often report high levels of illness intrusiveness. The direct and indirect effects of disability and psychological symptoms on illness intrusiveness remain largely unknown, despite their pervasiveness. The present study aimed to examine how depression and anxiety can serve as mechanisms through which disability may impact illness intrusiveness in 3 life domains-instrumental activities, intimacy, and relationships and personal development.Participants (Depression and anxiety were significant mediators through which disability may impact overall illness intrusiveness. When examining life domains, depression was a significant mediator in all domains. Anxiety was only a significant mediator between disability and relationships/personal development.Results suggest that greater disability both directly and indirectly interferes with illness intrusiveness via depression and anxiety. However, life domains are differentially impacted. Thus, this study helps to guide interventions on the best symptoms to target to improve illness intrusiveness and overall quality of life. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objectives Multiple sclerosis (MS), the most common chronic and progressive neurological condition of the central nervous system, affects 26,000 Australian adults. Exercise training has beneficial effects on MS-related impairments including reduced muscular strength, poor aerobic capacity and impaired mobility, and in consequence can improve quality of life. This Position Statement provides evidence-based recommendations for exercise prescription and delivery of exercise training for people with MS with mild to moderate disability. Design and methods Synthesis of published works within the field of exercise training in MS. Results Exercise provides many benefits to people with MS. There is strong evidence that resistance and aerobic training, performed 2 to 3 times per week at a moderate intensity, are safe and can improve muscle strength, cardiorespiratory fitness, balance, fatigue, functional capacity, mobility and quality of life in people with MS with mild to moderate disability (Expanded Disease Severity Scale (EDSS) ≤ 6.5). However, the evidence for those with severe disability (EDSS >6.5) is less clear. The effects of exercise on MS pathogenesis, central nervous structures and other outcomes such as depression and cognitive impairment, have not been adequately investigated. Effective exercise interventions to improve balance, joint contractures and reduce falls in people with MS are also urgently needed as well as investigations of long-term (≥1 year) effects of exercise training. Conclusions Resistance and aerobic training exercises are effective to alleviate some characteristic signs and symptoms in MS and should be supplemented by balance exercise to prevent falls. Exercise training programs should be prescribed and delivered by qualified exercise professionals. It is important to recognise and accommodate exercise-associated complications such as fatigue and heat sensitivity.

Цель исследования — оценка контрастно-цветовой чувствительности в центральной области поля зрения, контрастно-частотной чувствительности и динамической остроты зрения у здоровых испытуемых, в больных и здоровых глазах при рассеянном склерозе (РС) у пациентов с перенесенным ретробульбарным оптическим невритом (РБН) и без него. Материал и методы. Исследование зрительных функций проведено в 150 глазах 114 здоровых испытуемых, 49 глазах 36 пациентов с РС, перенесших острый РБН, и 43 глазах 29 пациентов с РС без перенесенного РБН. У всех испытуемых перед исследованием показателей световой чувствительности проводились определение статической остроты зрения, рефракции и офтальмоскопия глазного дна. Результаты и заключение. На основании анализа показателей контрастно-цветовой чувствительности, контрастно-частотной чувствительности и динамической остроты зрения проведена оценка изменений световой чувствительности больных и здоровых глаз у пациентов с РС с перенесенным РБН и без него. Выявлено, что световая чувствительность снижена во вторых — здоровых глазах при РС с перенесенным монокулярным РБН и что снижение световой чувствительности в глазах при РС с перенесенным РБН более глубокое. Световая чувствительность остается сниженной, несмотря на восстановление статической остроты зрения после перенесенного РБН. Различия показателей cветовой чувствительности зрительной системы используются для обсуждения связи острой демиелинизирующей оптической нейропатии с нейрональными повреждениями и характером течения рассеянного склероза. Обсуждается также возможность использования данных о снижении световой чувствительности для ранней диагностики и оценки нейрональных нарушений в зрительной системе при РС.

Метою цієї роботи була валідація україномовної версії шкали Patient Determined Disease Steps (PDDS) у пацієнтів із розсіяним склерозом для застосування в щоденній практиці невролога та оцінка її зв’язку зі шкалою Expanded Disability Status Scale (EDSS). Валідаційний процес включав переклад, оцінку валідності, надійності та чутливості. Найвищі показники кореляції PDDS виявлені з пірамідною (r = 0,71, p

This paper presents the findings of a ten-year prospective follow-up of 180 patients with multiple sclerosis starting from the first clinical signs of the disease. We have determined the clinical and MRI signs of disease activity and their prognostic significance. The impact of the number of relapses, the number of T2-lesions and their sizes, location on the disease activity, disability progression at different periods of the study has been proved.

Objetivo: Establecer la relación entre la fatiga y el nivel de independencia funcional en actividades de la vida diaria en personas con esclerosis múltiple. Material y método: Se realizó un estudio descriptivo trasversal con alcance correlacional. Participaron 107 personas con esclerosis múltiple, mayores de 18 años, con puntuaciones entre 0 y 8 en la Escala Ampliada del Estado de Discapacidad de Kurtzke. Se evaluó la fatiga con la Escala de Gravedad de la Fatiga, las actividades básicas cotidianas con el Índice de Barthel y las instrumentales con la Escala de Lawton y Brody. Se correlacionaron estas variables y se realizaron pruebas de homogeneidad entre la severidad de la fatiga y variables sociodemográficas y clínicas. Resultados: Se encontró una relación significativa inversamente proporcional entre el grado de severidad de la fatiga y las variables de dependencia para las actividades básicas e instrumentales de la vida diaria (p0,05). Se encontraron diferencias significativas en el nivel de fatiga respecto al uso de ayudas externas, hipertensión arterial, diabetes mellitus, compromiso motor, trastornos de la sensibilidad, alteraciones del control de esfínteres, deterioro cognitivo y depresión. Conclusiones: Se encontró que la fatiga fue el síntoma más predominante (>75 %). Las personas que informan altos niveles de fatiga mostraron menor independencia para las actividades de la vida diaria.

Актуальність. Метою роботи було дослідити взаємозв’язок між рівнем 48 кДа форми неконвенційного міозину 1с (48 кДа Муо1с) (маркер апоптозу В-клітин) у сироватці крові хворих на розсіяний склероз (РС) та особливостями дебюту захворювання в контексті сучасного уявлення про ключову роль В-лімфоцитів уже на початковій стадії патологічного процесу при РС. Матеріали та методи. У дослідженні взяли участь 61 хворий на РС та 20 практично здорових осіб віком від 19 до 57 років. Методи дослідження: клінічні — аналіз скарг, анамнезу захворювання та життя, загальний та неврологічний огляди; лабораторні — шляхом послідовного осадження сироваткових білків, електрофорезу та цифрового аналізу одержаних електрофореграм сироватки крові хворих на розсіяний склероз визначали вміст 48 кДа Myo1c, при цьому наявність Myo1c підтверджували за допомогою вестерн-блоту з анти-Myo1c антитілами. Результати. У групі хворих на РС з високим рівнем 48 кДа Myo1c середній вік обстежених на момент початку захворювання був найнижчим, однак вірогідних статистичних залежностей між концентрацією 48 кДа Myo1c у сироватці крові хворих та віком дебюту РС не було виявлено. При дебюті РС у вигляді порушення гостроти зору в сироватці крові хворих вірогідно частіше виявляли середній рівень 48 кДа Myo1c, а при дебюті з окорухових розладів — низький рівень, що вказує на менш сприятливий перебіг захворювання внаслідок зниженого апоптозу автореактивних В-лімфоцитів. Рівень 48 кДа Myo1c у сироватці крові обстежених осіб статистично вірогідно не залежав від активності захворювання у хворих на РС на момент огляду та забору крові, а отже, використання даного біомаркера є можливим не лише при загостренні хвороби, а й в ремісії. Висновки. Сучасні дослідження доводять, що при РС В-лімфоцити беруть участь не лише в синтезі олігоклональних автоантитіл, а також в антитілонезалежних механізмах, насамперед у презентації антигенів Т-лімфоцитам, синтезі прозапальних цитокінів, утворенні ектопічних лімфоїдних фолікулоподібних скупчень у центральній нервовій системі. Саме тому є обґрунтованим використання В-клітинних маркерів, у тому числі 48 кДа Myo1c, у клінічній практиці, зокрема для прогнозування агресивності перебігу РС та оцінки ефективності хворобомодифікуючої терапії.

This article presents the clinical observation of a female patient diagnosed with Harding syndrome — a combination of Le­ber’s hereditary optic neuropathy and multiple sclerosis. Distinctive features of pathogenesis are discussed.

In spite of decreasing incidence of multiple sclerosis relapses in disease-modifying treatment, the problem of relapses treatment is still actual. Every relapse contributes to stable neurological deficiency and, hence, the progress of invalidization. It should be noted, that it is not always possible to definitely evaluate the activity of disease because of the variable magnetic resonance picture: some focuses disappear or reduce, at the same time other focuses appear or increase. In this case, the use of magnetic resonance spectroscopy is advisable. Magnetic resonance spectroscopy helps to evaluate the activity of disease at the early stage and to assess the biochemical and neurophysiological signs of demyelination. We present the description of a difficult clinical case of the multiple sclerosis relapse and the evaluation of the metabolic response on the treatment by means of the magnetic resonance spectroscopy. Hence, the treatment of multiple sclerosis relapses is very important because it helps to delay the invalidization. It is necessary to evaluate accurately all risks and advantages of every type of relapse treatment.

Multiple sclerosis (MS) is a chronic autoimmune, inflammatory, and neurodegenerative disease that affects the central nervous system (CNS). MS is characterized by immune dysregulation, which results in the infiltration of the CNS by immune cells, triggering demyelination, axonal damage, and neurodegeneration. Although the exact causes of MS are not fully understood, genetic and environmental factors are thought to control MS onset and progression. In this article, we review the main immunological mechanisms involved in MS pathogenesis.

Актуальність. Викликають зацікавлення повідомлення про вплив місяця народження (МН) на розвиток і перебіг розсіяного склерозу (РС). Мета: проаналізувати анамнестичні дані хворих на РС залежно від МН, сезону й місяця дебюту РС; уточнити зв’язки між МН і розвитком дебюту РС в аспекті коморбідності. Матеріали та методи. Обстежено 216 хворих на РС із різними формами перебігу, які були розподілені на 2 групи: без супутніх захворювань (БСЗ, n = 109) і з наявністю супутніх захворювань (НСЗ, n = 107). Проаналізовано розподіл хворих залежно від МН та сезону й місяця дебюту РС. Результати. З’ясовано, що найчастіше хворі на РС народжувались у травні — 56 (25,9 %) хворих загальної вибірки, 31 (29,0 %) — групи НСЗ і 25 (23,0 %) — групи БСЗ. Щодо місяця дебюту РС: в обстежених хворих найчастіше це був квітень (14,7 % хворих групи БСЗ і 21,5 % — групи НСЗ). Висновки. Прогностично несприятливим місяцем народження хворих на РС є травень і квітень, а за частотою дебюту РС — квітень.

BACKGROUND: Peer-facilitated interventions have been successfully used in chronic disease management. Less is known about their application in vocational rehabilitation. OBJECTIVE: To pilot-test an online peer discussion forum to improve exploration of employment options in job-seekers with long-term multiple sclerosis (MS). METHODS: Twenty-nine persons with relapsing/progressive MS (4–27 years since diagnosis) were recruited online and randomly assigned to an 8-week discussion forum led by peers and a moderator, MS JobSeek (n = 14), or an active control group (n = 15). Forum engagement and user satisfaction were examined, as were pre-post self-evaluations of job search behaviour, efficacy, and quality of life. RESULTS: A high (43%) attrition rate was noted, although intervention completers acknowledged and valued online mentors’ guidance and expertise. Group and time effects were not significant (p

Gadolinium (Gd) is a based contrast agent is used for Magnetic Resonance Imaging (MRI). In India, gadobutrol has been is approved for MRI of the Central Nervous System (CNS), liver, kidneys, and breast. It has been noted in several studies that the accumulation of gadolinium occurs in different structures in the brain. Patients with Multiple Sclerosis (MS) are regularly followed up with MRI scans and MRI with contrast enh- ancement is the most common method of distinguishing new-onset pathological changes. Developments in tech- nology and methods in artificial intelligence have shown that there is reason to map out the X-ray technician’s work with examinations and medicines administered to patients may be altered to prevent the accumulation of gadolinium. Technological advancements in this field may also mean that X-ray technician’s jobs may entail greater amounts of autonomy in making decisions regarding the administration of pharmaceuticals, which may have a lasting impact on the profession's future development.

Multiple sclerosis (MS) is a chronic neurologic disease defined by inflammation and demyelination of the central nervous system that comes with variable degrees of axonal and neuronal damage. The efficacy of β-D-mannuronic acid (M2000) as a novel drug with immunosuppressive properties (patented: PCT/EP2017/067920), has been shown in an experimental model of MS. In this study, the effects of M2000 on interleukin (IL)-1β, IL-17A, signal transducer and activator of transcription (STAT) 1, and STAT3 gene expressions and Toll-like receptor 2 (TLR2) and toll-like receptor 4 (TLR4) molecules in patients with secondary progressive MS were evaluated. In this study, 14 patients with secondary progressive MS and 14 healthy subjects (as control group) were entered from the phase 2 clinical trial (Clinical Trial identifier, IRCT2016111313739N6). The gene expressions of IL-1β, IL-17A, STAT1, and STAT3 were assessed at the baseline and then measured after 6 months of therapy with M2000 by using the quantitative real-time polymerase chain reaction method. Moreover, the expressions of TLR2 and TLR4 molecules on peripheral blood mononuclear cells were evaluated by the flow cytometry method. The gene expressions of IL-17A, STAT1, and STAT3 in patients with MS decreased after 6 months of therapy with M2000 comparing before treatment. Also, the gene expression of IL-1β decreased numerically after 6 months. Furthermore, the expressions of TLR2 and TLR4 on PBMCs of the patients declined when compared to baseline. The results of this investigation revealed that M2000 could downregulate IL-17, STAT1, and STAT3 genes in patients with secondary progressive MS and also reduce the expressions of TLR2 and TLR4 on PBMCs. Moreover, M2000 declined numerically IL-β gene expression.