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Background: In the absence of evidence from randomised controlled trials, observational data can be used to emulate clinical trials and guide clinical decisions. Observational studies are, however, susceptible to confounding and bias. Among the used techniques to reduce indication bias are propensity score matching and marginal structural models. Objective: To use the comparative effectiveness of fingolimod vs natalizumab to compare the results obtained with propensity score matching and marginal structural models. Methods: Patients with clinically isolated syndrome or relapsing remitting MS who were treated with either fingolimod or natalizumab were identified in the MSBase registry. Patients were propensity score matched, and inverse probability of treatment weighted at six monthly intervals, using the following variables: age, sex, disability, MS duration, MS course, prior relapses, and prior therapies. Studied outcomes were cumulative hazard of relapse, disability accumulation, and disability improvement. Results: 4608 patients (1659 natalizumab, 2949 fingolimod) fulfilled inclusion criteria, and were propensity score matched or repeatedly reweighed with marginal structural models. Natalizumab treatment was associated with a lower probability of relapse (PS matching: HR 0.67 [95% CI 0.62-0.80]; marginal structural model: 0.71 [0.62-0.80]), and higher probability of disability improvement (PS matching: 1.21 [1.02 -1.43]; marginal structural model 1.43 1.19 -1.72]). There was no evidence of a difference in the magnitude of effect between the two methods. Conclusions: The relative effectiveness of two therapies can be efficiently compared by either marginal structural models or propensity score matching when applied in clearly defined clinical contexts and in sufficiently powered cohorts.

Background/aim: During multiple sclerosis (MS) treatment different modes of action such as lateral (interferon beta to glatiramer acetate or glatiramer acetate to interferon beta) or vertical (interferon beta/glatiramer acetate to fingolimod) drug switch can be performed. This study aims to investigate the clinical effectiveness of switching from the first-line injectable disease modifying treatments (iDMTs) to fingolimod (FNG) compared to switching between first-line iDMTs. Materials and methods: This is a multicenter, observational and retrospective study of patients with relapsing-remitting MS who had lateral and vertical switch. The observation period included three key assessment time points (before the switch, at switch, and after the switch). Data were collected from the MS patients’ database by neurologists between January 2018 and June 2019. The longest follow-up period of the patients was determined as 24 months after the switch. Results: In 462 MS patients that were included in the study, both treatments significantly decreased the number of relapses during the postswitch 12 months versus preswitch one year while patients in the FNG group experienced significantly fewer relapses compared to iDMT cohort in the postswitch 12 months period. FNG cohort experienced fewer relapses than in the iDMT cohort within the postswitch 2 year. The mean time to first relapse after the switch was significantly longer in the FNG group. Conclusion: The present study revealed superior effectiveness of vertical switch over lateral switch regarding the improvement in relapse outcomes. Patients in the FNG cohort experienced sustainably fewer relapses during the follow-up period after the switch compared the iDMT cohort. Importantly, switching to FNG was more effective in delaying time to first relapse when compared with iDMTs.

Background: COVID-19 vaccines are recommended for people with multiple sclerosis (pwMS). Adequate humoral responses are obtained in pwMS receiving disease-modifying therapies (DMTs) after vaccination, with the exception of those receiving B-cell-depleting therapies and non-selective S1P modulators. However, most of the reported studies on the immunity of COVID-19 vaccinations have included mRNA vaccines, and information on inactivated virus vaccine responses, long-term protectivity, and comparative studies with mRNA vaccines are very limited. Here, we aimed to investigate the association between humoral vaccine responses and COVID-19 infection outcomes following mRNA and inactivated virus vaccines in a large national cohort of pwMS receiving DMTs. Methods: This is a cross-sectional and prospective multicenter study on COVID-19-vaccinated pwMS. Blood samples of pwMS with or without DMTs and healthy controls were collected after two doses of inactivated virus (Sinovac) or mRNA (Pfizer-BioNTech) vaccines. PwMS were sub-grouped according to the mode of action of the DMTs that they were receiving. SARS-CoV-2 IgG titers were evaluated by chemiluminescent microparticle immunoassay. A representative sample of this study cohort was followed up for a year. COVID-19 infection status and clinical outcomes were compared between the mRNA and inactivated virus groups as well as among pwMS subgroups. Results: A total of 1484 pwMS (1387 treated, 97 untreated) and 185 healthy controls were included in the analyses (male/female: 544/1125). Of those, 852 (51.05%) received BioNTech, and 817 (48.95%) received Sinovac. mRNA and inactivated virus vaccines result in similar seropositivity; however, the BioNTech vaccination group had significantly higher antibody titers (7.175±10.074) compared with the Sinovac vaccination group (823±1.774) (p

The development of artificial intelligence began with the transfer of the functioning of the nervous system to a mathematical system. Every day, studies in the field of neuroscience, which is the science that examines memory, cognitive functions and learning functions in the human brain, reveal new discoveries. The most important supporter of these studies is again technology. The nervous system has been better understood with technology-supported neuroscience studies since the beginning of the twenty-first century all over the world. In this way, developments in artificial intelligence have also accelerated.

© 2022Background: Patients with relapsing-remitting multiple sclerosis (RRMS) who experience relapses on a first-line therapy (interferon, glatiramer acetate, dimethyl fumarate, or teriflunomide; collectively, “BRACETD”) often switch to another therapy, including natalizumab or fingolimod. Here we compare the effectiveness of switching from a first-line therapy to natalizumab or fingolimod after ≥1 relapse. Methods: Data collected prospectively in the MSBase Registry, a global, longitudinal, observational registry, were extracted on February 6, 2018. Included patients were adults with RRMS with ≥1 relapse on BRACETD therapy in the year before switching to natalizumab or fingolimod. Included patients received natalizumab or fingolimod for ≥3 months after the switch. Results: Following 1:1 propensity score matching, 1000 natalizumab patients were matched to 1000 fingolimod patients. Mean (standard deviation) follow-up time was 3.02 (2.06) years after switching to natalizumab and 2.58 (1.64) years after switching to fingolimod. Natalizumab recipients had significantly lower annualized relapse rate (relative risk=0.66; 95% confidence interval [CI], 0.59–0.74), lower risk of first relapse (hazard ratio [HR]=0.69; 95% CI, 0.60–0.80), and higher confirmed disability improvement (HR=1.27; 95% CI, 1.03–1.57) than fingolimod recipients. No difference in confirmed disability worsening was observed. Conclusions: Patients with RRMS switching from BRACETD demonstrated better outcomes with natalizumab than with fingolimod.

Background: effectiveness of cladribine tablets, an oral disease-modifying treatment (DMT) for multiple sclerosis (MS), was established in clinical trials and confirmed with real-world experience. Objectives: use real-world data to compare treatment patterns and clinical outcomes in people with MS (pwMS) treated with cladribine tablets versus other oral DMTs. Methods: retrospective treatment comparisons were based on data from the international MSBase registry. Eligible pwMS started treatment with cladribine, fingolimod, dimethyl fumarate, or teriflunomide tablets from 2018 to mid-2021 and were censored at treatment discontinuation/switch, death, loss to follow-up, pregnancy, or study period end. Treatment persistence was evaluated as time to discontinuation/switch; relapse outcomes included time to first relapse and annualized relapse rate (ARR). Results: cohorts included 633 pwMS receiving cladribine tablets, 1195 receiving fingolimod, 912 receiving dimethyl fumarate, and 735 receiving teriflunomide. Individuals treated with fingolimod, dimethyl fumarate, or teriflunomide switched treatment significantly more quickly than matched cladribine tablet cohorts (adjusted hazard ratio (95% confidence interval): 4.00 (2.54-6.32), 7.04 (4.16-11.93), and 6.52 (3.79-11.22), respectively). Cladribine tablet cohorts had significantly longer time-to-treatment discontinuation, time to first relapse, and lower ARR, compared with other oral DMT cohorts. Conclusion: cladribine tablets were associated with a significantly greater real-world treatment persistence and more favorable relapse outcomes than all oral DMT comparators., Financial support for this study was provided entirely by a contract with EMD Serono Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA (CrossRef Funder ID: 10.13039/100004755). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. The following authors are employed by the sponsor: NT and SLW.

Background and purpose: This study assessed the effect of patient characteristics on the response to disease-modifying therapy (DMT) in multiple sclerosis (MS).Methods: We extracted data from 61,810 patients from 135 centers across 35 countries from the MSBase registry. The selection criteria were: clinically isolated syndrome or definite MS, follow -up >= 1 year, and Expanded Disability Status Scale (EDSS) score >= 3, with >= 1 score recorded per year. Marginal structural models with interaction terms were used to compare the hazards of 12 -month confirmed worsening and improvement of disability, and the incidence of relapses between treated and untreated patients stratified by their characteristics.Results: Among 24,344 patients with relapsing MS, those on DMTs experienced 48% reduction in relapse incidence (hazard ratio [HR] = 0.52, 95% confidence interval [CI] = 0.45- 0.60), 46% lower risk of disability worsening (HR = 0.54, 95% CI = 0.41- 0.71), and 32% greater chance of disability improvement (HR = 1.32, 95% CI = 1.09- 1.59). The effect of DMTs on EDSS worsening and improvement and the risk of relapses was attenuated with more severe disability. The magnitude of the effect of DMT on suppressing relapses declined with higher prior relapse rate and prior cerebral magnetic resonance imaging activity. We did not find any evidence for the effect of age on the effectiveness of DMT. After inclusion of 1985 participants with progressive MS, the effect of DMT on disability mostly depended on MS phenotype, whereas its effect on relapses was driven mainly by prior relapse activity.Conclusions: DMT is generally most effective among patients with lower disability and in relapsing MS phenotypes. There is no evidence of attenuation of the effect of DMT with age. This study was financially supported by the National Health and Medical Research Council of Australia (1129189, 1140766, 1080518) We thank the patients and their carers who have agreed to participate in the global MSBase cohort study. The MSBase Foundation is a not-for-profit organization that receives support from Roche, Merck, Biogen, Novartis, Bayer-Schering, Sanofi-Genzyme, and Teva. The study was conducted separately and apart from the guidance of the sponsors. Open access publishing facilitated by The University of Melbourne, as part of the Wiley - The University of Melbourne agreement via the Council of Australian University Librarians.

Objective: In this study, it was aimed to investigate the effects of nutrition education given to persons with multiple sclerosis and their families on anthropometric and biochemical measurements and diet quality. Methods: Data from 51 persons with multiple sclerosis were analysed in this intervention study. The study was conducted with 3 groups. The education group consisted of only persons with multiple sclerosis, the family education group consisted of persons with multiple sclerosis and a family member living with them, and the control group consisted of persons with multiple sclerosis who had not received an education. Anthropometric and biochemical measurements and dietary quality assessments were made before (T1) and immediately after education (T2) and also 3 months after education (follow-up, T3). Results: The distribution of family education group diet quality scores showed a significant increase from “poor” to “needs improvement” at T3 compared to T1. The upper middle arm circumference measurements of the female control group were decreased at T2 and T3 [from 29.0 (23-34) cm to 28.0 (22-31) cm and to 27.5 (22-31) cm]. Women in family education group, levels of serum haemoglobin and haematocrit were higher than in control group at T2 and T3. Also, men in family education group, levels of alanine aminotransferase were lower than those in education group at follow up. Levels of total cholesterol and low-density lipoprotein cholesterol in education group were higher than those control group at T1, T2, and T3. Conclusion: This study indicates that nutrition education affects some biochemical and anthropometric measurements in persons with multiple sclerosis. Diet quality improved when receiving education together with families. RESUMO Objetivo: Objetivou-se investigar os efeitos da educação nutricional dada a pessoas com esclerose múltipla e seus familiares, avaliação de medidas antropométricas, bioquímicas e da qualidade da dieta. Métodos: Dados de 51 participantes com esclerose múltipla foram analisados neste estudo de intervenção. O estudo foi dividido em 3 grupos, sendo o primeiro composto por indivíduos que obtiveram educação nutricional, o segundo, composto por indivíduos mais um membro da família que morava com eles e obtiveram educação nutricional, e o terceiro, grupo controle, composto por indivíduos que não obtiveram educação nutricional. Medidas antropométricas, bioquímicas e avaliações da qualidade da dieta foram feitas antes (T1) imediatamente após a educação nutricional (T2) e também 3 meses após a educação nutricional (T3). Resultados: A distribuição dos escores de qualidade da dieta do grupo de educação familiar mostrou um aumento significativo de “ruim” para “precisa melhorar” no T3 em comparação ao T1. As medidas da circunferência do braço médio do grupo controle feminino foram menores em T2 e T3 [de 29,0 (23-34) cm para 28,0 (22-31) cm e para 27,5 (22-31) cm]. Nas mulheres do grupo família, os níveis séricos de hemoglobina e hematocrito foram maiores do que no grupo controle em T2 e T3. Também nos homens do grupo família, os níveis de alanina aminotransferasa foram mais baixos do que os do grupo educação no seguimento. Os níveis de CT e LDL-C no grupo educação foram superiores aos do grupo controle em T1, T2 e T3. Conclusão: Este estudo observou que a educação nutricional afeta algumas medidas bioquímicas antropométricas em pessoas com esclerose múltipla. A qualidade da dieta melhorou quando recebeu educação junto com as famílias.

Demyelination and subsequent remyelination are well-known mechanisms in multiple sclerosis (MS) pathology. Current research mainly focused on preventing demyelination or regulating the peripheral immune system to protect further damage to the central nervous system. However, information about another essential mechanism, remyelination, and its balance of the immune response within the central nervous system's boundaries is still limited.In this study, we tried to demonstrate the effect of the recently introduced Janus kinase (JAK)-signal transducer and activator of transcription (STAT) inhibitor, tofacitinib, on remyelination.Demyelination was induced by 6-week cuprizone administration, followed by 2-week tofacitinib (10, 30, and 100 mg/kg) treatment.At the functional level, tofacitinib improved cuprizone-induced decline in motor coordination and muscle strength, which were assessed by rotarod and hanging wire tests. Tofacitinib also showed anti-inflammatory effect by alleviating the cuprizone-induced increase in the central levels of interferon-γ (IFN-γ), interleukin (IL)-6, IL-1β, and tumor necrosis alpha (TNF-α). Furthermore, tofacitinib also suppressed the cuprizone-induced increase in matrix metalloproteinases (MMP)-9 and MMP-2 levels. Additionally, cuprizone-induced loss of myelin integrity and myelin basic protein expression was inhibited by tofacitinib. At the molecular level, we also assessed phosphorylation of STAT-3 and STAT-5, and our data indicates tofacitinib suppressed cuprizone-induced phosphorylation in those proteins.Our study highlights JAK/STAT inhibition provides beneficial effects on remyelination via inhibition of inflammatory cascade.

Tarih boyunca insan ve çevre ilişkisi mekân ile açıklanmaya çalışılmıştır. Sosyolojik ve çevresel şartlar temelde bireyi şekillendirirken mekân, bu etkileşim içerisinde en önemli ve en belirleyici unsur olmuştur. Nitekim çevre, insan ve toplum ilişkilerini düşünsel ve kültürel imgelerle yoğrulmuş olan mekân kavramından ayrıca düşünmek mümkün değildir. Tarih boyunca hem bireysel hem de ortak yaşam alanları inşa edilirken bilinçli ya da bilinçsiz bir şekilde mekân üzerinden kültür ve kimlik inşası süreci içerisine girilmiştir. Bu çalışmada mekân ve toplum ilişkisinden hareketle, sosyalist kentleşme modelinin ne olduğu, bu alandaki çalışmaların tarihsel gelişimi incelenmiştir. Sosyalist kent kuramlarından yola çıkılarak sosyalist kentleşmenin en önemli uygulama alanı olan Sovyetler Birliği’nde sosyal kent anlayışının bir ürünü olan komün evler (Sosyal Konutlar) incelenmiştir. Sovyet döneminde insanlar komün evlerde yıllarca ortak yaşam sürmek mecburiyetinde bırakılmışlardır. Bu ortak yaşam evleri, zamanla kültür ve kimliği etkilemiş; aile hayatı ve ahlaki değerleri yeniden kurgulanmış yeni tip insan ve toplum modeli olan Sovyet İnsanının (Homo Sovieticus) ortaya çıkmasına sebep olmuştur. Bu çalışmada, İnsan tabiatını, ihtiyaçlarını ve toplumsal değerleri dikkate almadan tasarlanan ve insanları biyolojik varlıklar olarak eşitleyen bir anlayışı yansıtan sosyalist konut modelinin ahlaki değerlere ve günümüz aile hayatına olan etkileri incelenecektir.

Background: Timely initiation of disease modifying therapy is crucial for managing multiple sclerosis (MS). Objective: We aimed to validate a previously published predictive model of individual treatment response using a non-overlapping cohort from the Middle East. Methods: We interrogated the MSBase registry for patients who were not included in the initial model development. These patients had relapsing MS or clinically isolated syndrome, a recorded date of disease onset, disability and dates of disease modifying therapy, with sufficient follow-up pre- and post-baseline. Baseline was the visit at which a new disease modifying therapy was initiated, and which served as the start of the predicted period. The original models were used to translate clinical information into three principal components and to predict probability of relapses, disability worsening or improvement, conversion to secondary progressive MS and treatment discontinuation as well as changes in the area under disability-time curve (ΔAUC). Prediction accuracy was assessed using the criteria published previously. Results: The models performed well for predicting the risk of disability worsening and improvement (accuracy: 81%–96%) and performed moderately well for predicting the risk of relapses (accuracy: 73%–91%). The predictions for ΔAUC and risk of treatment discontinuation were suboptimal (accuracy Conclusion: The previously published models are generalisable to patients with a broad range of baseline characteristics in different geographic regions.

Background and ObjectivesPatients with pediatric-onset multiple sclerosis (POMS) typically experience higher levels of inflammation with more frequent relapses and reach irreversible disability at a younger age than adult-onset patients. There have been few randomized placebo-controlled clinical trials of multiple sclerosis (MS) disease-modifying therapies (DMTs) in patients with POMS, and most available data are based on observational studies of off-label use of DMTs approved for adults. We assessed the effectiveness of natalizumab compared with fingolimod using injectable platform therapies as a reference in pediatric patients in the global MSBase registry.MethodsThis retrospective study included patients with POMS who initiated treatment with an injectable DMT, natalizumab, or fingolimod between January 1, 2006, and May 3, 2021 (N=1218). The primary outcome was the time to first relapse from index therapy initiation. Secondary study outcomes included annualized relapse rate; proportions of relapse-free patients at 1, 2, and 5 years post baseline; time to treatment discontinuation; and times to 24-week confirmed disability worsening and confirmed disability improvement.ResultsPatients treated with fingolimod had a significantly lower risk of relapse than patients treated with injectable DMT (hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.29–0.83;P=0.008). After adjustment for prior DMT experience in the unmatched sample, patients treated with natalizumab had a significantly lower risk of relapse than patients treated either with injectable DMT (HR, 0.15; 95% CI, 0.07–0.31;PP=0.049). The adjusted secondary study outcomes were generally consistent with the primary outcome or with previous observations. The findings in the inverse probability treatment weighting–adjusted patient populations were confirmed in multiple sensitivity analyses.DiscussionOur results suggest that natalizumab and fingolimod have broadly equivalent therapeutic efficacies in patients with POMS, consistent with previous studies of natalizumab and fingolimod in adult-onset patients and POMS. However, analyses of relapse outcomes suggest natalizumab is superior to fingolimod in the control of relapses in this population with high rates of new inflammatory activity.Classification of EvidenceThis study provides Class III evidence that natalizumab may provide better disease control than fingolimod in patients with POMS.

BackgroundDisability progression is a key milestone in the disease evolution of people with multiple sclerosis (PwMS). Prediction models of disability progression have not yet reached the level of trust needed to be adopted in the clinic. A common benchmark to assess model development in multiple sclerosis is also currently lacking.MethodsData of adult PwMS with a follow-up of at least three years from 146 MS centers, spread over 40 countries and collected by the MSBase consortium was used. With basic inclusion criteria for quality requirements, it represents a total of 15, 240 PwMS. External validation was performed and repeated five times to assess the significance of the results. TRIPOD guidelines were followed.Confirmed disability progression after two years was predicted, with a confirmation window of six months. Only routinely collected variables were used such as the expended disability status scale, treatment, relapse information, and MS course.To learn the probability of disability progression, state-of-the-art machine learning models were investigated. The discrimination performance of the models is evaluated on their area under the receiver operator curve (ROC-AUC) and under the precision recall curve (AUC-PR), and their calibration via the Brier score and the expected calibration error.FindingsA temporal attention model was the best model. It achieved a ROC-AUC of 0·71 ± 0·01, an AUC-PR of 0·26 ± 0·02, a Brier score of 0·1 ± 0·01 and an expected calibration error of 0·07 ± 0·04. The history of disability progression is more predictive for future disability progression than the treatment or relapses.InterpretationGood discrimination and calibration performance on an external validation set is achieved, using only routinely collected variables. This makes these models ready for a clinical impact study. All our preprocessing and model code is available at https://gitlab.com/edebrouwer/ms_benchmark, making this task an ideal benchmark for predicting disability progression in MS.

Background and purpose The prevention of disability over the long term is the main treatment goal in multiple sclerosis (MS); however, randomized clinical trials evaluate only short-term treatment effects on disability. This study aimed to define criteria for 6-month confirmed disability progression events of MS with a high probability of resulting in sustained long-term disability worsening. Methods In total, 14,802 6-month confirmed disability progression events were identified in 8741 patients from the global MSBase registry. For each 6-month confirmed progression event (13,321 in the development and 1481 in the validation cohort), a sustained progression score was calculated based on the demographic and clinical characteristics at the time of progression that were predictive of long-term disability worsening. The score was externally validated in the Cladribine Tablets Treating Multiple Sclerosis Orally (CLARITY) trial. Results The score was based on age, sex, MS phenotype, relapse activity, disability score and its change from baseline, number of affected functional system domains and worsening in six of the domains. In the internal validation cohort, a 61% lower chance of improvement was estimated with each unit increase in the score (hazard ratio 0.39, 95% confidence interval 0.29-0.52; discriminatory index 0.89). The proportions of progression events sustained at 5 years stratified by the score were 1: 72%; 2: 88%; 3: 94%; 4: 100%. The results of the CLARITY trial were confirmed for reduction of disability progression that was >88% likely to be sustained (events with score >1.5). Conclusions Clinicodemographic characteristics of 6-month confirmed disability progression events identify those at high risk of sustained long-term disability. This knowledge will allow future trials to better assess the effect of therapy on long-term disability accrual. NHMRC [1129189, 1157717, 1140766]; Merck; Biogen; Novartis; Roche; Bayer; Schering; Sanofi Genzyme; Teva Pharmaceutical Industries

BackgroundOver the decades, several natural history studies on patients with primary (PPMS) or secondary progressive multiple sclerosis (SPMS) were reported from international registries. In PPMS, a consistent heterogeneity on long-term disability trajectories was demonstrated. The aim of this study was to identify subgroups of patients with SPMS with similar longitudinal trajectories of disability over time.MethodsAll patients with MS collected within Big MS registries who received an SPMS diagnosis from physicians (cohort 1) or satisfied the Lorscheider criteria (cohort 2) were considered. Longitudinal Expanded Disability Status Scale (EDSS) scores were modelled by a latent class growth analysis (LCGA), using a non-linear function of time from the first EDSS visit in the range 3–4.ResultsA total of 3613 patients with SPMS were included in the cohort 1. LCGA detected three different subgroups of patients with a mild (n=1297; 35.9%), a moderate (n=1936; 53.6%) and a severe (n=380; 10.5%) disability trajectory. Median time to EDSS 6 was 12.1, 5.0 and 1.7 years, for the three groups, respectively; the probability to reach EDSS 6 at 8 years was 14.4%, 78.4% and 98.3%, respectively. Similar results were found among 7613 patients satisfying the Lorscheider criteria.ConclusionsContrary to previous interpretations, patients with SPMS progress at greatly different rates. Our identification of distinct trajectories can guide better patient selection in future phase 3 SPMS clinical trials. Additionally, distinct trajectories could reflect heterogeneous pathological mechanisms of progression.

Aim: This study was planned to investigate the relationship between hand function and quality of life in MS patients. Method: This study was conducted between December 2019 - April 2020 in Ondokuz Mayis University, Faculty of Medicine, Department of Neurology, MS Outpatient Clinic. The population of the study was composed of patients who applied to the outpatient clinic. During the acquisition of the data; demographic information form that developed by the researcher after the literature review related to the subject, Monitoring My Multiple Sclerosis Scale, Multiple Sclerosis International Quality of Life Scale, The Disabilities of the Arm, Shoulder and Hand, Chedoke Arm & Hand Activity-9 were used. The data in the study were analyzed with IBM SPSS version 21 package program.Findings: According to the results, there is a significiant negative correlation between Monitoring My Multiple Sclerosis Scale and The Disabilities of the Arm, Shoulder and Hand. Also, there is a significant positive correlation between Monitoring My Multiple Sclerosis Scale and Chedoke Arm & Hand Activity-9. There is a significant positive correlation between Multiple Sclerosis International Quality of Life Scale and The Disabilities of the Arm, Shoulder and Hand. There is a significant negative correlation between Multiple Sclerosis International Quality of Life Scale and Chedoke Arm & Hand Activity-9. A positive correlation was observed between the hand function and quality of life of patients with MS who are participating in the study.Conclusion and Recommendations: : Hand function problems negatively affect quality of life in patients with MS., Amaç: Çalışma Multipl Skleroz hastalarında el fonksiyonunun yaşam kalitesi ile olan ilişkisini araştırmak amacıyla planlanmıştır.Yöntem: Çalışma Samsun Ondokuz Mayıs Üniversitesi Tıp Fakültesi Hastanesi Nöroloji Anabilim Dalı MS Polikliniğinde Aralık 2019 – Nisan 2020 tarihleri arasında yapılmıştır. Araştırmanın evrenini, polikliniğe başvuran hastalar oluşturmuştur. Verilerin elde edilmesi aşamasında araştırmacı tarafından konu ile ilgili literatür taraması sonrası geliştirilen demografik bilgi formu, Multipl Skleroz İzlem Ölçeği, Multipl Skleroz Uluslararası Yaşam Kalitesi Ölçeği, Kol, Omuz ve El Sorunları Ölçeği, Chedoke Kol ve El Aktivite Testi – 9 kullanılmıştır. Çalışmadaki veriler IBM SPSS versiyon 21 paket programıyla analiz edilmiştir.Bulgular: Çalışmadan elde edilen bulgulara göre Multipl Skleroz İzlem Ölçeği ile Kol, Omuz ve El Sorunları Ölçeği arasında negatif yönde anlamlı, Multipl Skleroz İzlem Ölçeği ile Chedoke Kol ve El Aktivite Testi – 9 arasında pozitif yönde anlamlı bir ilişki bulunmuştur. Multipl Skleroz Uluslararası Yaşam Kalitesi Ölçeği ile Kol, Omuz ve El Sorunları Ölçeği arasında pozitif yönde anlamlı, Multipl Skleroz Uluslararası Yaşam Kalitesi Ölçeği ile Chedoke Kol ve El Aktivite Testi – 9 arasında negatif yönde anlamlı bir ilişki bulunmuştur. Çalışmaya katılan MS hastalarının el fonksiyonu ve yaşam kalitesi arasında pozitif yönlü bir ilişki olduğu görüldü. Sonuç ve Öneriler: MS hastalarında el fonksiyon problemleri yaşam kalitesini olumsuz etkilemektedir.

Geleneksel diplomasi yanında önemini artırmaya devam eden Kamu Diplomasisi, devletlerin dış politikasının önemli bir parçası haline gelmiştir. Bu çerçevede devlet ve sivil toplum kuruluşları tarafından halkların rızasını kazanmak için birçok farklı faaliyet yürütülmektedir. Bu makalede önce kamu diplomasisi kavramı farklı açılardan ele alınacak, sonra da bu yeni kavramın önemli bir parçası olarak görülen burs programları tartışılacaktır. Bu bağlamda farklı ülkelerin burs programları ve Türk Keneşi üye ülkelerindeki uygulamaları analiz edilecektir. Türk Keneşi üye ülkelerinin bursluluk programları, özellikle Türkiye Bursları değerlendirilecek ve bu programdan yararlanan öğrencilerin eğitim sosyolojisi açısından da önem arz eden görüşleri paylaşılacaktır. Bu makalede diğer ülkeler ile üye devletlerin burs programları karşılaştırılmaya çalışılacaktır. Türk Keneşi üye devletlerinin eğer varsa bursluluk programlarının ikili ve çok taraflı ilişkilerin geliştirilmesindeki etkinliği sorgulanacaktır. Analizler ülke ve bölge düzeyinde olacaktır. Türk Keneşi üye ülkeleri için yeni bir değişim programının oluşturulması imkanı değerlendirilecektir. Bölgesel koşullara uygun ve farklıaktörler tarafından uygulanan benzer programları da dikkate alan bir program yapısı için önerilerde bulunulmaya çalışılacaktır. Bursluluk programları yolu ile ilişkilerin geliştirilmesine yönelik bir farkındalık oluşturulması ve ortak değişim programlarının geliştirilmesine bu çalışma ile katkı sağlanması amaçlanmaktadır., Public Diplomacy which continues to increase its importance alongsidetraditional diplomacy, become essential part of foreign policy of states. There aremany activities in this content carried by governmental and nongovernmentalinstitutions to gain consent of people. The article first defines the concept ofpublic diplomacy in its diverse angles, then discusses the scholarship programsas they are considered important part of this emerging phenomenon. In thiscontext, different countries’ scholarship programs and their implementationsin Turkic Council member states will be analyzed. Turkic Council membercountries’ scholarships programs, particularly Turkiye Scholarships will alsobe assessed. The views of students who benefited from this program, whichalso be evaluated in terms of educational sociology will be shared. This articletries to compare scholarship programs of external powers and member states.Effectiveness of member states’ scholarship programs, if any, on developmentof bilateral and multilateral relations will be questioned. Analyses will be oncountry and regional level. Possibility of creating new exchange programs forTurkic Council member states will be evaluated. Suggestions will be made forsuch program’s structure that are suitable to regional conditions and consideringsimilar programs implemented by different actors. The aim of the study isto raise awareness about the development of relations through scholarshipprograms and to contribute to the development of joint exchange programs.

Toplumsal yapıyı anlayabilmek için “kültürel bellek” ve “toplumsal değişim” kavramlarının izini sürmek gerekmektedir. Sosyokültürel bir ürün olan toplumsal hafıza ile bağımlı/bağımsız değişkenlerden oluşan ve karmaşık bir süreç içerisinde şekillenen toplumsal değişim kavramlarının her biri tarihsel özellik arz eder. Bu bağlamda toplumsal hafızanın ve değişimin bir bütünü olarak ortaya çıkan toplumsal yapı, nesiller boyunca toplanan bilgi ve birikiminin tarihsel süreç içerisinde çeşitli değişimlere uğrayarak sürekli hatırlanışı olarak tanımlanabilir. İdil-Ural bölgesinde yaşayan Tatar Türkleri kendi tarihleri boyunca aynı coğrafyayı paylaştıkları toplumlarla birlikte yaşamanın yollarını aramışlardır. Etnik kimliklerin çeşitliliği ve beraberinde getirdiği çatışmaların en yoğun olduğu dönemlerde bile Tatar Türklerinin birlikte yaşam arayışı devam ederken Tatar Türk toplumsal yapısının ve kültürünün muhafazası için çeşitli mücadele ve savaşlar da verilmiştir. Özellikle bu coğrafyada toplumlar, bazen kaynaştırılarak bazen de ayrıştırılarak çeşitli suni ve politik coğrafi sınırlar içerisinde azınlık kimliklere dönüştürülmüşler, çoğu zaman bir problem nazarıyla bakılan siyasi enstrümana dönüşmüşlerdir. Günümüz Rusya Federasyonu içerisinde Sovyetler Birliği’nin dağılmasıyla birlikte tüm federasyonda olduğu gibi İdil-Ural bölgesinde de yeniden gündeme gelen kültür ve aidiyet arayışları, Rusya içerisinde hem nüfus hem de nüfuz olarak önemli bir yer teşkil eden Tatar – Türk milletini de etkilemiştir. Bu çalışma ile bölgede yüzlerce yıldır farklı toplumlarla kesintisiz etkileşim ile demografik ve toplumsal değişim içerisinde olan Tatar Türk kültür ve kimliğinin araştırılması amaçlanmıştır. İdil-Ural bölgesinde yaşayan Tatar-Türk kültür ve kimliğinin araştırıldığı bu çalışma nitel veri toplama yöntemleri kullanılarak hazırlanmıştır.

ObjectiveTo evaluate whether eculizumab helps patients with anti–acetylcholine receptor–positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension.MethodsPatients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study.ResultsA total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1–4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected.ConclusionEculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population.ClinicalTrials.gov IdentifierREGAIN, NCT01997229; REGAIN open-label extension, NCT02301624.Classification of EvidenceThis study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo.

WOS: 000529333500011 Early diagnosis and treatment of smoking addiction is considered to be one of the most cost-effective prevention methods. The aim of this study is to determine nicotine dependence levels and some related features in university students. The target population of this descriptive study consists of 30147 students studying at a public university. In the sample calculation, it was determined that at least 453 people should be reached. Volunteer students who smoke regularly were included in the study. A 17-item questionnaire developed by the researchers and the Fagerstrom Test for Nicotine Dependence Score were administered to the participants. SPSS program was used for statistical analysis of the survey data. Descriptive and statistical significance tests were performed. Statistical significance level was accepted as p

This study examined university students’ levels of smartphone addiction according to several variables. The study surveyed 1241 students studying at a university in the Central Black Sea region in the 2018-2019 academic year. The data were collected using the Smartphone Addiction Scale and a Personal Information Form. The results of the analysis showed that there was a significant difference between male and female students in their mean scores on the daily-life disturbance and tolerance subscales. Those whose parents hold a high school or above had a higher mean score on the overuse subscale. A statistically significant positive linear relationship was found between smartphone addiction scores, the duration of smartphone usage, and the amount of pocket money. There was however no linear relationship between smartphone addiction scores and age., Bu araştırmada üniversite öğrencilerinin akıllı telefon bağımlılık düzeyleri çeşitli değişkenlere göre incelenmiştir. Araştırma 2018-2019 öğrenim yılında Orta Karadeniz Bölgesi’ndeki bir üniversitede 1241 üniversite öğrenci üzerinde yürütülmüştür. Araştırmanın verileri Akıllı Telefon Bağımlılığı Ölçeği ve Kişisel Bilgi Formu ile toplanmıştır. Verilerin analizinde Günlük yaşamı bozma ve tolerans alt boyutu puan ortalamaları ile cinsiyet değişkeni arasında anlamlı fark olduğu bulunmuştur. Annesi ve babası lise ve üstü eğitim alanların akıllı telefon bağımlılığı alt boyut puan ortalamalarının yüksek olduğu görülmüştür. Akıllı telefon kullanma süresi ve harçlık miktarı ile akıllı telefon bağımlılığı puanı arasında pozitif yönde doğrusal ve istatistiksel düzeyde anlamlı bir ilişki, yaş ile akıllı telefon bağımlılığı düzeyi arasında doğrusal ilişki olmadığı belirlenmiştir. Araştırmadan elde edilen bulgular literatür eşliğinde karşılaştırmalı olarak tartışılmıştır.

Nutrition modulation can reduce multiple sclerosis (MS) related symptoms and fatigue severity. Mediterranean diet may be beneficial regarding anti-inflammatory components. However, previous studies are limited. This study aims to investigate the relationship between Mediterranean diet adherence and MS-related symptoms and fatigue severity.One hundred and two adult MS patients were enrolled in this cross-sectional study. Dietary adherence was assessed using the Mediterranean diet assessment tool (MEDAS). MS-related symptoms were determined using the MS-related symptom checklist (MS-RS), and the fatigue severity scale (FSS) was applied. Linear regression models were established to assess predicted factors of MS-RS and FSS.The mean age of the participants was 33.1 ± 9.81 years. Being female and having higher education degree was 71.6% and 60.8%, respectively. In the linear regression model, MEDAS were not associated with MS-RS but negatively associated with FSS scores. MS-RS scores were significantly higher among participants who consumed more than one serving of red meat or products per day. Those who consumed less than one serving of butter, margarine, or cream per day reported lower FSS scores. Some trend significances were shown to consume limited sweet and lower FSS scores. Likewise, MS-RS scores were lower in those ≥three serving/week intake of fish.Following a Mediterranean-style diet should be encouraged to improve fatigue severity. Components, such as reduced consumption of red meat, saturated fatty acids, sweets and increased fish consumption, could be promising to reduce MS symptoms or fatigue severity. These findings should be proven with further intervention studies.

Background: Among the comorbidities that accompany multiple sclerosis (MS), restless legs syndrome (RLS) is one of the most common. Anxiety and depression are common psychological comorbidities that impact the quality of life of patients with MS (PwMS), as well as patients with RLS. Objective: To investigate the psychiatric burden of MS and RLS coexistence, we conducted a nationwide, multicenter and cross-sectional survey. Methods: Participants were assessed by using demographic and clinical parameters along with the Hamilton Anxiety and Hamilton Depression Scales (HAM-A and HAM-D). Results: Out of the 1,068 participants, 173 (16.2%) were found to have RLS [RLS(+)] and 895 (83.8%) did not [RLS(-)]. The mean scores for HAM-A and HAM-D were significantly higher among RLS(+) subjects than among RLS(-) subjects (p

The incidence of early onset multiple sclerosis (EOMS) is increasing. We therefore aimed to compare the demographic, clinical, and magnetic resonance imaging features of early onset and adult onset multiple sclerosis patients. Furthermore, the effects of age of onset were evaluated for patients who reached an expanded disability status scale (EDSS) scores of six.This was a retrospective study of MS patient medical charts between 1977 and 2021, which were registered in the MS database. Only patients with relapsing remitting MS longer than 1 year were included in the study. The patients included in the study were divided into the EOMS and adult onset MS (AOMS) groups. General demographic datas, clinical datas such as the characteristics of the first clinical period, the time between the first two attacks, the attack rate in the first 2 and 3 years, the treatment status, the EDSS at the first evaluation, the EDSS score at 6 month intervals, the time to reach an EDSS score of six, and magnetic resonance imaging features such brain and spinal T2 lesions were recorded.Total of 3477 including 353 (10.2 %) EOMS and 3124 (89.8 %) AOMS patients were analyzed. There was no statistically significant difference in symptom patterns between the EOMS and AOMS groups ( p = 0.649). Supratentorial clinical features at first attack were more common in AOMS patients, while optic neuropathy at first attack was more common in EOMS patients. Using univariable analysis, clinical supratentorial features at first attack, clinical optic neuropathy at first attack, clinical spinal cord at fist attack, spinal cord lesions, first EDSS score, relapse in the first 3 years, and onset patterns in terms of age were found to be statistically significant risk factors. In multivariable-adjusted analysis, clinical supratentorial features at first attack, clinical spinal cord lesions at first attack, first EDSS scores relapses in the first 3 years, and onset patterns in terms of age were found to be independent risk factors for EDSS in reaching a score of six. Early treatment start was associated with reduced hazard rate of reaching an EDSS score of 6.Onset pattern in terms of age was an independent prognostic factor for neurological disabilities in MS patients.

Objective The Coronavirus disease 2019 is a global public health problem that has led to psychological disorders (depression, anxiety, etc.), especially in fragile individuals such as those affected by multiple sclerosis. This study investigated the relationship between anxiety and nutritional habits during the Coronavirus disease 2019 outbreak in multiple sclerosis patients. Methods This cross-sectional study was an online survey of multiple sclerosis patients living in Turkey. The total sample consisted of 294 multiple sclerosis patients. A questionnaire containing general demographic data, the Beck Anxiety Inventory, and nutritional attitudes and habits was applied to multiple sclerosis patients. Results Moderate or severe anxiety scores were found in 42.2% of multiple sclerosis patients. Weight gain was reported in 40.5% of them during the outbreak. A statistically significant difference was found in the distribution of individuals’ Beck Anxiety Inventory scores for consumption of nuts/seeds, rice/pasta, cake/cookies, and water. A 1-unit increase in Beck Anxiety Inventory scores led to a 1.04 times increased consumption of bread and rice/pasta and a 1.05 times increased consumption of cake/cookies either before or after controlling for potential confounders. A 1-unit increase in Beck Anxiety Inventory scores led to a 1.06 times decreased consumption of water and a 1.04 times decreased consumption of meat and poultry, fruit (fresh), and rice/pasta, either before or after controlling for potential confounders. Conclusion During the Coronavirus disease 2019 outbreak, anxiety led to changes in multiple sclerosis patients’ nutritional habits and food preferences. The continuous surveillance of psychological consequences and nutritional counseling during outbreaks should become routine as part of preparedness efforts worldwide.

The aim of this study is to validate the speech pathology-specific questionnaire for persons with Multiple Sclerosis (SMS) in Turkish. A total of 218 participants were included in the study. The study group was composed of 104 persons diagnosed with MS, and the control group was 114 healthy participants without any neurological deficits. The translated version of the SMS was administered to all participants. Test-retest reliability, internal consistency, construct validity, floor and ceiling effects were investigated. Dysphagia in multiple sclerosis questionnaire (DYMUS) was used for criterion validity. Finally, sensitivity and specificity of the SMS-TR was calculated using a ROC curve analysis. SMS-TR has an excellent internal consistency (Cronbach’s alpha = 0.92). Item-total correlations range between 0.45 and 0.78. The intraclass correlation coefficient (ICC) obtained for the test-retest indicates a good level of reproducibility (ICC = 0.86). According to confirmatory factor analysis, the fit measures of the scale were found to be acceptable. A significant difference was found between the total SMS scores of the study group and the control group (20.6 ± 10.4 and 1.9 ± 2.8, P < 0.001, respectively). A statistically significant correlation was observed between SMS and DYMUS (r = 0.833, P < 0.001). There were no floor and ceiling effects found in the study group. According to the ROC curve analysis, the area under the curve of SMS–TR was 0.98. The optimal cut-off value was 8, with a sensitivity of 91.3% and a specificity of 95.6%. SMS-TR is a valid and reliable patient-reported outcome measure suitable for the assessment of language, speech, and swallowing disorders in persons with MS. A score >8 is an indicator of language, speech, and swallowing pathology for persons.

Giriş:Multipl Skleroz (MS) genç erişkinleri ve kadınları daha fazla etkileyen santral sinir sisteminin kronik hastalığıdır. Ölümcül bir hastalık olarak görülmemekle birlikte, gelişen tedavi seçeneklerine rağmen daha erken mortalite ile ilişkilidir.Yöntemler: Ocak 2001 ile ocak 2021 tarihleri arasında klinik kesin MS tanısı konulan, takibi yapılan hastalar çalışmaya dahil edildi. Veriler İmed veri tabanından elde edildi. Mortalite gelişen ve gelişmeyen hastalar karşılaştırıldı. Hastaların yaş, cinsiyet, yaş, hastalık başlangıç şekli, hastalık süresi, MS subtipi, toplam atak sayısı, son EDSS değeri, immünmodülatör tedavi durumları, komorbid hastalıkları ve mortalite nedenleri kaydedildi.Bulgular: Çalışmaya 2456 hasta dahil edildi. 20 yıllık takip sonucunda 26 hastada mortalite geliştiği tespit edildi. Mortalite gelişen hastaların kadın/erkek oranı 3.33’dü. Mortalite gelişmeyen hastaların ortalama yaşı 41.97±12.02, mortalite gelişen hastaların yaş ortalaması 48.57±9.91 olarak bulundu. Hastalık süresi mortalite gelişmeyen hastalarda 8.16±7.50 mortalite gelişen hastalarda 16.37±6.83 olarak bulundu. Hastalık subtipine göre değerlendirme yapıldığında mortalite gelişmeyen hastaların 1980’i (%81.5) relapsingremitting, mortalite gelişen hastalarda 13 (%50.0) RRMS hastası idi. Son EDSS değerleri ortalaması; mortalite gelişmeyen hastalarda 1.89±1.07, mortalite gelişen hastalarda 5.86±2.23 olarak bulundu. En sık mortalite nedeni %38.5 pnömoni idi. Bunu miyokard enfarktüsü, sepsis ve malignite izlemekteydi.Mortalite gelişimini etkileyen faktörler yüksek yaş, uzun hastalık süresi, progresif hastalık tipine sahip olmak ve yüksek EDSS değeri idi.Sonuç: Mortaliteye en sık sebep olan durum enfeksiyon tablolarıdır. İleri yaş, uzun hastalık süresi, progresif hastalık tipi ve yüksek EDSS seviyesi mortalitenin en fazla ilişkili olduğu durumlardır.

Background The multiple sclerosis (MS) landscape has changed over the past two decades across the world and in the Middle East. The Middle East is an ethnically diverse region located between 12 degrees and 42 degrees of latitude and 35 degrees and 54 degrees of longitude and varying altitudes. The magnitude of the shifts observed in the epidemiology and management of MS differ in each region and from country to country. Objectives The aim of this study was to provide a clinicodemographic overview of the cohorts of patients contributed to MSBase, a large international MS registry, in the Middle East and describe disease-modifying treatment (DMT) utilization in the different countries within the region. Understanding the differences between these cohorts is integral to interpretation of the studies conducted using registry data and provides insight into clinical practice in these cohorts. Methods The MSBase registry was searched for patients with MS or clinically isolated syndrome from the Middle Eastern countries with data captured between 2009 and 2018. In 2-year epochs, and with special focus on the most recent epoch (2017-2018), we explored the demographic, clinical characteristics and treatment exposures of the studied cohorts and reported the results using standard descriptive statistics. Results Over the 10-year study period, 13,356 patients from 17 centers in 8 Middle Eastern countries fulfilled the inclusion criteria. The represented countries were Egypt, Iran, Kuwait, Lebanon, Oman, Saudi Arabia, Turkey and the United Arab Emirates. Overall, the represented cohort was young (median 36 years, quartiles 29-45) and captured relatively early after the onset of MS (median disease duration < 10 years, quartiles 3-12). The relapsing-remitting phenotype was the most prevalent phenotype in all countries (73-97%) and the highest proportion of progressive MS was reported in Saudi Arabia (12%). Median Expanded Disability Status Scale (EDSS) ranged from 0 to 3, depicting a mildly disabled cohort, with the exception of Saudi Arabia where the median EDSS was 4 (quartiles 1.5-6.5). The median relapse frequency was highest in Lebanon (median 1.03, 95% CI 0.94-1.16) followed by Egypt (median 1.02, 95% CI 0.89-1.24) and lowest in Saudi Arabia (median 0.70, 95% CI 0.58-0.95) and Kuwait (median 0.75, 95% CI 0.71-0.80). The treatment landscape greatly varied between different countries. Platform injectable therapies were mostly utilized in Egypt, Iran and Turkey (86%, 79% and 53%, respectively), while oral therapies and monoclonal antibodies were more commonly used in Kuwait, Lebanon and the United Arab Emirates (87.2%, 67.3% and 58.7%, respectively). Conclusion Patients in the Middle East enrolled in a large multinational registry are representative of the general MS population. The spectrum of therapies used in the individual countries, however, is highly variable. Further studies that include rural and non-academic practices are needed to enhance our understanding of the MS cohorts in the Middle East.

Background The COVID-19 outbreak, which has caused great fear and has affected many aspects of life even in healthy individuals, could become more threatening for people with multiple sclerosis (PwMS). Aim The aim of the present study was to evaluate depression, sleep and quality of life before and one year after the COVID-19 pandemic in PwMS and the association between the fear of COVID-19 and these parameters. Methods A total of 89 PwMS and 262 healthy controls were included in this descriptive cross-sectional study. The study compared the data collected before the pandemic with the data collected online approximately one year after the onset of the pandemic. The Fear of COVID-19 Scale (FCV-19S), the Worry and Anxiety Questionnaire (WAQ), the Beck Depression Inventory (BDI), the Pittsburgh Sleep Quality Index (PSQI) and the MS Quality of Life Scale (MSQoL-54) were used as data collection tools. Results The mean age of the patients was 41.08 (±10.2) years; 62% were female and half (50.6%) of the patients were not working. The mean EDSS and the mean duration of diagnosis were found to be 1.33(±1.6) and 7.73(±6.1), respectively. The mean age of the control group was 38.08 (±11.4) and 51.5% were female. In both groups, social (PwMS 79.8% vs HC 89.3%) and psychological (PwMS 61.8% vs HC 51.9%) fields were found to have been affected by the COVID-19 pandemic most. Of the patients, 19% reported that the frequency of exacerbations increased during the pandemic. In the patient group, the fear of coronavirus (p=0.808) and the sleep quality (p=0.906) were found not to be different to those in control group; however, the anxiety (p=0.001) and depression (p=0.001) levels were determined to be significantly higher. Compared to the pre-pandemic period, the sleep quality of the patients was seen to be impaired during the pandemic (p0.05). Although there were improvements in energy/vitality (p0.05). Conclusion It was determined that PwMS and were psychosocially affected by the COVID-19 pandemic, and had a significant deterioration in sleep quality at the end of a year spent with the pandemic. In addition, there was a deterioration in depression scores, although it was not statistically significant. Considering the fact that many subdimensions of quality of life, especially those associated with mental health, were impaired, it can be said that providing psychosocial support to patients is an important necessity.

PURPOSE This study aimed to examine the effects of a psychoeducational program on the cognitive emotion regulation levels of individuals with multiple sclerosis (MS). DESIGN AND METHOD This study followed a randomized, controlled quasi-experimental design. A questionnaire including descriptive characteristics and disease-related characteristics and the Cognitive Emotion Regulation Questionnaire were used in the data collection. FINDINGS The difference between the pretest-posttest and follow-up test mean scores of the patients in the experimental group was significant (p

International audience; Background: Ofatumumab, a subcutaneous anti-CD20 monoclonal antibody, selectively depletes B cells. Teriflunomide, an oral inhibitor of pyrimidine synthesis, reduces T-cell and B-cell activation. The relative effects of these two drugs in patients with multiple sclerosis are not known.Methods: In two double-blind, double-dummy, phase 3 trials, we randomly assigned patients with relapsing multiple sclerosis to receive subcutaneous ofatumumab (20 mg every 4 weeks after 20-mg loading doses at days 1, 7, and 14) or oral teriflunomide (14 mg daily) for up to 30 months. The primary end point was the annualized relapse rate. Secondary end points included disability worsening confirmed at 3 months or 6 months, disability improvement confirmed at 6 months, the number of gadolinium-enhancing lesions per T1-weighted magnetic resonance imaging (MRI) scan, the annualized rate of new or enlarging lesions on T2-weighted MRI, serum neurofilament light chain levels at month 3, and change in brain volume.Results: Overall, 946 patients were assigned to receive ofatumumab and 936 to receive teriflunomide; the median follow-up was 1.6 years. The annualized relapse rates in the ofatumumab and teriflunomide groups were 0.11 and 0.22, respectively, in trial 1 (difference, -0.11; 95% confidence interval [CI], -0.16 to -0.06; P

This study was conducted as a randomized controlled study to evaluate the effect of self-acupressure on fatigue in patients with Multiple Sclerosis (MS).The sample of the study consisted of 123 patients (41 in the experiment group, 40 in the sham group, and 42 controls) who were admitted to a neurology clinic in a university hospital. To collect data a patient information form, Fatigue Severity Scale (FSS), Expanded Disability Status Scale (EDSS), and Mini-Mental Status Examination were used. Depressive mood and sleep quality, which may affect fatigue, were evaluated using the Beck Depression Scale (BDI-II) and Pittsburg Sleep Quality Index (PSQI), respectively. The patients in the experimental group were applied acupressure by use of LI4 (He Gu), SP6 (San Yin Jiao) and ST36 (Zu San Li) points.The majority of patients were female (67.5%) and the mean age was 41.18. In addition, the mean BDI-II score of the patients was found to be 15.54, and the mean score of PSQI was 6.78 and the mean scores of these scales were similar in all groups. When the baseline FSS score means were examined, there was no significant difference among the groups (Acupressure:5.54 ± 0.87, Control:5.40 ± 0.92, and Sham:5.50 ± 0.99; p = 0.816). In the 4th week, there was a significant decrease in the mean score of fatigue of the experimental group compared to the other two groups (Acupressure:4.15 ± 1.09, Control:5.47 ± 1.11, Sham:5.34 ± 1.14, p 0,001).Our results suggest that acupressure might be an effective method to reduce fatigue in patients with MS.