Vitamin D metabolites are associated with clinical and MRI outcomes in multiple sclerosis patients
Bianca Weinstock‐GuttmanRobert ZivadinovJun QuDiane L. CookfairXiaotao DuanE. BangNiels BergslandSara HusseinM. ChernevaLaura WillisMari Heininen‐BrownMurali Ramanathan
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We report three cases of dural arteriovenous fistula (DAVF) of the cavernous sinus treated by Onyx injection through the superior pharyngeal branch of the ascending pharyngeal artery. The treatment of choice of DAVFs of the cavernous sinus is endovascular, and it is preferentially done via transvenous occlusion of the cavernous sinus. The cavernous sinus can be reached through either the inferior petrosal sinus or the superior ophthalmic vein. When these venous routes are occluded, the first attempt is to pass through the occluded inferior petrosal sinus, but sometimes this attempt can fail. In some cases there are small transosseous feeders to the fistula arising from the superior pharyngeal branch of the ascending pharyngeal artery. When all of the more conventional approaches are unattainable, this route can be attempted. In our experience, it allowed safe and rapid occlusion of the fistula.Prevalence and risk factors for vitamin D deficiency in patientswith widespread musculoskeletal pain
Background/aim: The aim of this study was to examine the prevalence of 25-hydroxyvitamin D (25(OH) vitamin D) deficiency in patients complaining of widespread musculoskeletal pain. Materials and methods: In this cross-sectional study, 14,925 patients (13,589 females and 1336 males; mean age: 47.0 years, range: 20-99 years) were included. Serum 25(OH) vitamin D was measured by ELISA. The patients were classified into two groups: 1) patients with vitamin D deficiency (<20 ng/mL) and 2) patients without vitamin D deficiency (>20 ng/mL). Results: The prevalence of vitamin D deficiency was 73.9%. A multivariate logistic regression model showed that low 25(OH) vitamin D level was associated with sex, age, and month in which 25(OH) hypovitaminosis was determined. The risk of a low 25(OH) vitamin D was level was 1.74 times higher in female patients than in males. The risk of low 25(OH) vitamin D level was highest in March during the year. Conclusion: Our results indicate that vitamin D deficiency should be considered in patients with widespread musculoskeletal pain and some precautions, such as sunbathing during summer, should be recommended for patients with a risk of vitamin D deficiency.
Hypovitaminosis
Cross-sectional study
Sunbathing
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Sunlight
Sun Exposure
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Background: Multiple sclerosis (MS) prevalence in Iraq is 11.73/100,000 it causes disability in younger adults. Expanded Disability Status Scale (EDSS) can monitor MS disability while Visually Evoked Potentials (VEP) serves as a marker of myelination. Objectives: To explore the relationship between EDSS and VEPs in multiple sclerosis patients. Patients and Methods: A cross-sectional study was conducted in Ghazi Al- Hariri Hospital from first of Nov 2021 till the end of Jan 2022. Fifty patients with multiple sclerosis were compared to 50 healthy individuals. EDSS Data were collected using a structured questionnaire, P100 latency were measured using VEP. The Correlation was used to investigate the relationship between P100- latencies and EDSS. P value ≤0.05 was considered significant. Results: The average age of MS cases was 33.5±8.01 years, and the mean EDSS was 2.8±2.86. A significant difference in the latency period was reported. The study showed a significant positive correlation between EDSS and P100 latency period. Conclusions: Using non-invasive procedures like VEPs can help to monitor and detect deterioration and improvement in MS patients.
Positive correlation
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Introduction: Multiple sclerosis (MS) is a chronic, multifocal, inflammatory disease of the central nervous system (CNS) with an autoimmune basis. There is a strong correlation between vitamin D deficiency and the onset of multiple sclerosis and a more severe course of the disease and more severe comorbid symptoms. Many studies have investigated vitamin D supplementation to compensate for low 25(OH)D levels in MS patients.
Methods of research: A literature review was conducted based on PubMed, Google Scholar databese. Articles were researched using following keywords: multiple sclerosis; vitamin D; multiple sclerosis prevention; vitamin D deficiency.
The results: The results of these studies have provided important information on the safety and efficacy of vitamin D therapy in MS. Dietary vitamin D supplementation can therefore serve as a prevention of MS and as an adjunct to traditional MS therapy. However, it is important to emphasize the need to assess the risks and benefits individually for each patient.
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To investigate the relationship between the efficacy of interferon beta-1b (INF-β-1b) on relapsing-remitting multiple sclerosis (RRMS) and the Th17 cells in peripheral blood.Eleven RRMS patients were enrolled and treated with 250 μg INF-β-1b for 6 months. Expanded disability status scale (EDSS) scrore and T2 lesion number on MRI were examined both at baseline and at the end of the study. Flow cytometry was used to detect the number of Th17 cells in peripheral blood before the treatment.Acoording to the EDSS scores, the 11 cases of RRMS were divided into two groups: the effective group and the ineffective group.The EDSS scores and the number of lesions on T2-weighted MRI were not different significantly between the two groups (P>0.05) before the treatment. But after the treatment, compared with the ineffective group, the EDSS scores and the number of lesions on T2-weighted MRI decreased significantly in the effective group (P<0.05). Compared with the effective group, the number of Th17 cells in the ineffective group increased significantly (P<0.01) before treatment.Th17-mediated RRMS is nonresponsive to IFN-β-1b treatment.
Relapsing remitting
Clinically isolated syndrome
Interferon beta-1b
Interferon beta-1a
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Multiple sclerosis is a chronic, inflammatory, demyelinating disease which affects the central nervous system and is linked to autoimmune disorders. Although the precise causes of multiple sclerosis remain unknown, some evidence points towards hypovitaminosis D. Apart from the maintenance of calcium and phosphorus homeostasis, vitamin D also plays a major role in other aspects of human health. It is caused by the vitamin D receptor, which is present in many human organs and tissues. Vitamin D is an immunomodulating factor and accordingly has a potential to be effective in both preventing and treating autoimmune diseases, including multiple sclerosis. The aim of this review was to present up-to-date knowledge about vitamin D, especially its impact on risk of multiple sclerosis onset, relapses, and potential to modify the immune response. A further objective was to describe the role of vitamin D supplementation and its provision in the everyday diet for both prevention and treatment of multiple sclerosis.
Demyelinating disease
Hypovitaminosis
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Abstract Background Multiple sclerosis (MS) is a chronic disease characterized by demyelination, glial activation and axonal degeneration in the central nervous system. At the present, there is no certain remedy for this disease. However, available therapies often attenuate disease progress. Methods This study aims at identification of the effect of fingolimod on expanded disability status scale (EDSS) score and number of relapses in relapsing‐remitting MS (RRMS) patients in comparison with IFNβ. In the present 12‐month non‐randomized clinical trial, 55 RRMS patients aged between 18 and 45 with EDSS scores between 0 and 5.5 were divided into two groups. Twenty‐five patients received 0.5 mg oral fingolimod once a day for 12 months and 30 patients were under treatment with IFNβ. EDSS scores and number of relapses were recorded for all study participants monthly. Results No significant difference was found in age and sex of patients recruited in two study groups. EDSS score was significantly lower in treatment group in month 10, 11 and 12 after treatment compared with control group (p values of 0.004, 0.006 and 0.007 respectively). Conclusion Treated patients experienced no relapse during the study period. Fingolimod is effective in reduction of EDSS score and number of relapses in Iranian MS patients.
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Clinically isolated syndromes (CIS), such as optic neuritis, brainstem or spinal cord syndromes are frequently the first clinical presentations of multiple sclerosis. However, not all CIS patients develop multiple sclerosis and in those who do, disability is highly variable. In previous follow-up studies, brain lesions on T2-weighted MRI are associated with increased risk of multiple sclerosis and to an extent disability. We evaluated the longitudinal relationships between the MRI lesions and clinical course over a period of 20 years. CIS patients were recruited between 1984 and 1987 and previously followed up after 1, 5, 10 and 14 years. Of the 140 subjects who were initially recruited with a CIS for a baseline MRI study, we followed up 107 patients after a mean of 20.2 years (range 18-27.7). Multiple sclerosis was diagnosed as clinically definite on clinical grounds only and disability determined using the Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC) score. Clinically definite multiple sclerosis developed in 67 out of 107 (63%) overall: 60 out of 73 (82%) with abnormal and 7 out of 34 (21%) with normal baseline MRI. Multiple sclerosis was still relapsing-remitting in 39 (58%)--including 26 (39%) with a 'benign' course (EDSS < or = 3)--whilst 28 (42%) had developed secondary progression. T2 lesion volume at all time-points correlated moderately with 20-year EDSS (r(s) values 0.48 to 0.67; P < 0.001) and MSFC z-score [r(s) values (-0.50) to (-0.61); P < 0.001]. In those developing multiple sclerosis, a concurrent correlation of change in T2 lesion volume with change in EDSS was most evident in years 0-5 (r(s) = 0.69, P < 0.001). The estimated rate of lesion growth over 20 years was 0.80 cm3/year in those who retained a relapsing remitting multiple sclerosis course, and 2.89 cm3/year in those who developed secondary progressive multiple sclerosis, a difference of 2.09 cm3/year (95% CI: 0.77, 2.96; P < 0.001). This study extends previous follow-up of CIS patients and sheds new light on how the lesions evolve according to the natural history. Baseline MRI findings are predictive for development of clinically definite multiple sclerosis. Lesion volume and its change at earlier time points are correlated with disability after 20 years. Lesion volume increases for at least 20 years in relapse-onset multiple sclerosis and the rate of lesion growth is three times higher in those who develop secondary progressive than in those who remain relapsing remitting multiple sclerosis.
Optic neuritis
Clinically isolated syndrome
McDonald criteria
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A BSTRACT Background In patients with isolated syndromes that are clinically suggestive of multiple sclerosis, such as optic neuritis or brain-stem or spinal cord syndromes, the presence of lesions as determined by T 2 -weighted magnetic resonance imaging (MRI) of the brain increases the likelihood that multiple sclerosis will develop. We sought to determine the relation between early lesion volume, changes in volume, and long-term disability. Methods Seventy-one patients in a serial MRI study of patients with isolated syndromes were reassessed after a mean of 14.1 years. Disability was measured with the use of Kurtzke’s Expanded Disability Status Scale (EDSS; possible range, 0 to 10, with a higher score indicating a greater degree of disability). Results Clinically definite multiple sclerosis developed in 44 of the 50 patients (88 percent) with abnormal results on MRI at presentation and in 4 of 21 patients (19 percent) with normal results on MRI. The median EDSS score at follow-up for those with multiple sclerosis was 3.25 (range, 0 to 10); 31 percent had an EDSS score of 6 or more (including three patients whose deaths were due to multiple sclerosis). The EDSS score at 14 years correlated moderately with lesion volume on MRI at 5 years (r=0.60) and with the increase in lesion volume over the first 5 years (r=0.61). Conclusions In patients who first present with isolated syndromes suggestive of multiple sclerosis, the increases in the volume of the lesions seen on magnetic resonance imaging of the brain in the first five years correlate with the degree of long-term disability from multiple sclerosis. This relation is only moderate, so the volume of the lesions alone may not be an adequate basis for decisions about the use of disease-modifying treatment. (N Engl J Med 2002; 346:158-64.)
Optic neuritis
McDonald criteria
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