Association of daily physical activity with brain volumes and cervical spinal cord areas in multiple sclerosis
Valerie J. BlockShuiting ChengJeremy JuwonoRichard CuneoGina KirkishAmber AlexanderMahir H. KhanAmit AkulaEduardo CaverzasiNico PapinuttoW. SternMark J. PletcherGregory M. MarcusJeffrey E. OlginStephen L. HauserJeffrey M. GelfandRiley BoveBruce CreeRoland G. Henry
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Background: Remote activity monitoring has the potential to evaluate real-world, motor function, and disability at home. The relationships of daily physical activity with spinal cord white matter and gray matter (GM) areas, multiple sclerosis (MS) disability and leg function, are unknown. Objective: Evaluate the association of structural central nervous system pathology with ambulatory disability. Methods: Fifty adults with progressive or relapsing MS with motor disability who could walk >2 minutes were assessed using clinician-evaluated, patient-reported outcomes, and quantitative brain and spinal cord magnetic resonance imaging (MRI) measures. Fitbit Flex2, worn on the non-dominant wrist, remotely assessed activity over 30 days. Univariate and multivariate analyses were performed to assess correlations between physical activity and other disability metrics. Results: Mean age was 53.3 years and median Expanded Disability Status Scale (EDSS) was 4.0. Average daily step counts (STEPS) were highly correlated with EDSS and walking measures. Greater STEPS were significantly correlated with greater C2-C3 spinal cord GM areas (ρ = 0.39, p = 0.04), total cord area (TCA; ρ = 0.35, p = 0.04), and cortical GM volume (ρ = 0.32, p = 0.04). Conclusion These results provide preliminary evidence that spinal cord GM area is a neuroanatomical substrate associated with STEPS. STEPS could serve as a proxy to alert clinicians and researchers to possible changes in structural nervous system pathology.Relapsing remitting
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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 T2-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.
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Abstract Multiple sclerosis (MS) is the most common inflammatory central nervous system (CNS) disease. Yet, clinicians should be cognizant of other demyelinating and nondemyelinating CNS inflammatory diseases, some of which mimic MS. This chapter reviews the spectrum of non-MS CNS inflammatory diseases and MS mimics.
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Introduction Multiple Sclerosis (MS) is a chronic, inflammatory and nervous autoimmune disease which influences central nervous system (CNS). MS attacks axons with Myelin in the central nervous system and this attack damages Myelin and axons. The commonest type of MS observed in 85% of those affl
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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.
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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.
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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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Background: Disease modifying drugs for multiple sclerosis have similar indications for use and at the same time, their specifics of the effect on the pathophysiological process. This complicates the choice of an optimal therapy for a given patient. Aim: To assess efficacy of treatment for multiple sclerosis with interferon beta-1b (IFN-β-1b) and natalizumab. Materials and methods: We performed an open label prospective study in 110 patients with multiple sclerosis who were followed up in the Moscow Regional Center of multiple sclerosis from 2012 to 2015. From those, 99 patients with relapsing-remitting multiple sclerosis (disease modifying drugs naïve) were treated with IFN-β-1b, 11 were non-responders to interferon (1 and more attacks for the previous year of therapy with IFN-β-1b) or had progressive course of multiple sclerosis (more than 2 attacks and an increase in the Expanded Disability Status Scale (EDSS) score by 1 and more within 1 year) and were treated with natalizumab. Analysis of treatment efficacy was performed with consideration of their past history, results of a 3-year neuromonitoring with Kurtzke EDSS and Functional System Scale, neuroophthalmologic testing with Farnsworth dichotomous test, and changes in optical coherent tomography parameters. Results: During 3 years of treatment with IFN-β-1b, the mean number of attacks decreased by over 70% (from 1.28±0.7 in the year before treatment to 0.35±0.09 in the 3rd year of treatment; p<0.05), whereas the degree of disability assessed by EDSS increased nonsignificantly by 0.44 (p>0.05). During the follow-up in the natalizumab group, the number of attacks decreased from 2.3±0.04 to 0.13±0.01 (p<0.05), and the degree of disability by EDSS decreased by 0.8 (p>0.05). There was a significant difference between changes in the thickness of peripapillar nervous fibers during 2 years of the follow up, this parameter decreasing by 2.5 mcm in patients treated with IFN-β-1b and by 0.1 mcm in those treated with natalizumab (p<0.01). Conclusion: Although the patients from natalizumab group had initial more severe course of multiple sclerosis, both agents were highly effective, with the most prominent clinical effect observed for natalizumab. The results obtained may serve as a basis for recommendation of the 2nd line disease modifying drugs for patients with aggressive course of the multiple sclerosis and failure of the 1st line disease modifying drugs. Also, we were able to demonstrate the efficacy of neuroophthalmological monitoring in the assessment of disease modifying drugs efficacy. The strict safety policy is essential while using natalizumab.
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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.)
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