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Short-chain fatty acids (SCFAs) can have pro- or anti-inflammatory properties, but their relationship with multiple sclerosis (MS) relapses during pregnancy remains unknown. This study aimed to explore SCFA profiles in MS patients during pregnancy and to assess their association with the appearance of relapses during pregnancy and postpartum.We prospectively included 53 pregnant MS patients and 21 healthy control women. Patients were evaluated during pregnancy and puerperium. SCFAs were measured by liquid chromatography-mass spectrometry.Sixteen patients (32%) had relapses during pregnancy or puerperium, and 37 (68%) did not. All MS patients showed significant increases in acetate levels during pregnancy and the postpartum period compared to non-MS women. However, propionate and butyrate values were associated with disease activity. Their values were higher in nonrelapsing patients and remained similar to the control group in relapsing patients. The variable that best identified active patients was the propionate/acetate ratio. Ratios of0.36 during the first trimester were associated with higher inflammatory activity (odds ratio = 165, 95% confidence interval = 10.2-239.4, p 0.01). Most nonrelapsing patients showed values of0.36, which were similar to those in healthy pregnant women.Low propionate/acetate ratio values during the first trimester of gestation identified MS patients at risk of relapses during pregnancy and the postpartum period.

Introduction Multiple sclerosis (MS) is an immunological, degenerative and chronic neurological disease that is frequently diagnosed in young adults. Medical care might be challenging as MS symptoms are heterogenic and sometimes medical-care team requirements might not meet MS patients’ needs. Objectives To learn the experience of patients and their caregivers of the medical care received in the Gregorio Maranon Hospital Demyelinating Unit. Method we designed a focus group with 26 participants incidentally recruited from the Gregorio Maranon Hospital Demyelinating Unit: 8 with low physical disability, 8 with high physical disability and 10 caregivers. Information was collected regarding three main topics: information, clinical care and medical team. Results High satisfaction was found among all participants with most of the medical care and with the professionals of the MS Unit. They agreed with the interventions they were offered but they considered that physical rehabilitation and psychological support must be offered, not only to MS patients but also to their caregivers and family. They also asked to emphasize transdisciplinary care. Conclusions This information defined the aspects of medical care that participants perceived as quality-care and the goals the Unit needs to achieve in the future.

Resumen Introduccion La esclerosis multiple (EM) es una enfermedad neurologica de origen autoinmune, degenerativa y cronica que aparece en adultos jovenes. Su manejo sanitario es complejo, ya que la enfermedad presenta una sintomatologia muy heterogenea y las necesidades de los pacientes son distintas segun la fase de la enfermedad en que se encuentren. En ocasiones las necesidades medicas pueden ser diferentes a las necesidades personales de los pacientes, por lo que es importante tener en consideracion su opinion sobre todo el proceso. Objetivos Conocer la experiencia de los pacientes con EM y sus familiares en relacion con la atencion recibida en el Hospital General Universitario Gregorio Maranon. Metodo Estudio cualitativo realizado en la consulta de Enfermedades Desmielinizantes del Servicio de Neurologia del Hospital General Universitario Gregorio Maranon. Se organizaron 3 grupos focales con un total de 26 personas provenientes de la mencionada consulta: 8 con una discapacidad fisica baja, 8 con mayor discapacidad fisica y 10 familiares/cuidadores de personas con EM. Se identifican 3 bloques tematicos a tratar: la informacion, la atencion recibida y el equipo sanitario. Resultados Los resultados muestran como la satisfaccion es alta con muchos de los servicios, asi como con los profesionales. Agradecen algunas de las iniciativas de intervencion, pero definen necesidades importantes en otras como la rehabilitacion fisica y la asistencia psicologica, tanto para pacientes como para familiares/cuidadores. Identifican la transdisciplinariedad como objetivo a futuro. Conclusiones Con estos datos buscamos reforzar los aspectos mejor calificados y trabajar posteriormente para cubrir y adaptar los procesos ofrecidos a los pacientes con EM.

It has been suggested that bilingualism is beneficial for executive control and could have positive long-term effects by delaying the onset of symptoms of degenerative diseases. This research investigates, for the first time, the impact of bilingualism on executive control (monitoring and inhibitory control) in individuals with Multiple Sclerosis (MS), a neurodegenerative disease which commonly causes deficiencies in the cognitive system. Bilingual and monolingual adults, with and without an MS diagnosis, performed a flanker task with two degrees of monitoring demands (high monitoring vs. low monitoring). Results showed that bilingual MS patients had inhibitory control and monitoring abilities that were similar to healthy bilingual controls. In contrast, monolingual MS patients showed similar inhibitory control but significantly worse monitoring abilities compared to monolingual healthy controls. We propose that the similar behaviour between bilingual groups suggests that bilingualism might counteract cognitive deficits related to MS, especially with respect to monitoring. The high monitoring cost observed in monolingual patients seems related to underlying deficits in monitoring and possibly switching, executive control abilities commonly impaired in MS patients from early stages. Our findings provide some preliminary evidence for the cognitive reserve hypothesis in bilingual MS patients.

Epstein–Barr virus (EBV), human herpesvirus 6A/B (HHV-6A/B) and multiple sclerosis (MS)-associated retrovirus (MSRV) have been described as possible MS triggers. We analysed antibody titres against EBV and HHV-6, and MSRV envelope (env) mRNA expression, in the serum of pregnant multiple sclerosis patients (P-MS) to study their possible link to the clinical activity of MS during pregnancy and postpartum and their possible role as relapse predictors. For that purpose, serum samples were collected from 71 pregnant women (50 pregnant MS and 21 pregnant healthy controls—P-HC) during pregnancy and postpartum. Relating to antibody titres, IgM antibody titres against HHV-6A/B were significantly higher in P-MS than in P-HC both in each pregnancy trimester and in the postpartum period. Moreover, IgM antibody titres against HHV-6A/B were higher in P-MS who suffered a relapse during the postpartum. Regarding MSRV env mRNA expression, the prevalence in the first trimester of pregnancy was significantly higher in P-MS who suffered relapses during pregnancy. Summing it up, high IgM antibody titres against HHV-6A/B and MSRV env mRNA expression during the first trimester of pregnancy could act as relapse predictors for the gestation/postpartum periods.

Objective To explore the serum cytokine profile associated with disease activity during pregnancy and postpartum in MS, and to assess any potential biomarkers predicting the occurrence of relapses during this period. Methods We included 53 MS pregnant women recruited between 2007 and 2018. Interferon-gamma, Tumor necrosis factor-alpha, interleukin-17, granulocyte/macrophage-colony stimulating factor, Activin-A, interleukin-10, and programmed-death-ligand-1 (PD-L1) were measured quarterly in serum by ELISA. Results Seventeen patients (32%) experienced relapses during pregnancy or puerperium and 37(68%) did not. We did not found differences in clinical characteristics or treatment status between the two groups. However, relapsing patients showed at the first trimester of pregnancy considerably lower levels of serum Activin-A (336.4 pg/dl [289.6–491.7], median [IQR] vs. 760.0 pg/dl [493.2–1108.0],p = .003), which correlated positively with serum PD-L1 (r = 0.53,p = .0005) and IL-10 (r = 0.43,p = .004) values. Activin-A levels lower than 515 pg/ml at the first trimester identified patients with high probability of relapsing during pregnancy and postpartum (OR = 13.75, CI: 2.5–76.8, p = .001). Conclusions MS patients with no relapses during pregnancy and puerperium showed an early triggering of a tolerogenic innate immune response evidenced by high serum Activin-A concentrations during the first trimester of pregnancy. Thus, serum Activin-A can be a useful biomarker to predict clinical activity during this period.