Multiple Sclerosis Patients Age Research Articles

Investigating the volume of hippocampus and corpus callosum in Iranian multiple sclerosis patients using magnetic resonance imaging: a retrospective study

Multiple Sclerosis (MS) is one of the most common forms of the acquired autoimmune demyelinating disorder affecting the brain. The neurological symptoms of MS are often presented in a relapsing-remitting manner. This study aims to investigate volume changes in the hippocampus and Corpus Callosum (CC). A cross-sectional study was conducted on 200 MS patients, 100 males and 100 females, aged 20-56 years. According to McDonald’s 2017 criteria,100 patients were in the MS group, and 100 were in the control group. This study assessed volume changes in the hippocampus and CC with ITK-SNAP 4.0 software. Our study revealed that the volumes of the right Hippocampus (P<0.0001), left Hippocampus (P<0.05), and corpus callosum (P<0.001), were significantly decreased in MS group compared to control group, regardless of the sex of the patients. Additionally, our results showed that the volume of these three areas has no significant difference with the age of MS patients. This research shows that some brain regions, including the hippocampus and corpus callosum, can be essential landmarks in determining MS disease.

DEPRESSION AND FATIGUE ARE DUE TO OBSTRUCTIVE SLEEP APNEA IN MULTIPLE SCLEROSIS.

To our knowledge, there is no study investigating whether fatigue and depression as the most commonly reported symptoms in multiple sclerosis (MS) and obstructive sleep apnea (OSA) patients have arisen from primary mechanisms of MS or from secondary associated conditions such as OSA in MS patients. The aim of our survey study was to determine whether depression and fatigue in MS patients were associated with clinical features of OSA or with MS. We conducted a self-administered survey using four validated questionnaires (STOP-BANG, Epworth Sleepiness Scale, Fatigue Severity Scale and The Center for Epidemiologic Studies Depression Scale-Revised) in 28 consecutive outpatients with proven MS. The prevalence of MS patients at an increased risk of OSA was 29% and age was positively correlated with this risk (p=0.019). None of the clinical features of MS patients (subtype, disability status, disease duration, modifying therapy, other medication) was correlated with depression and fatigue. On the contrary, excessive daytime sleepiness as a hallmark of OSA was significantly and positively associated with the level of depressive symptoms (p=0.004) and level of fatigue (p=0.015). Also, depression was significantly and positively correlated with the increased risk of OSA (p=0.015) and age of MS patients (p=0.016). Finally, a significant positive correlation was found between fatigue severity and level of depressive symptoms (p=0.003). OSA is a common disorder in MS patients. The clinical features and risk factors for OSA in MS patients are associated with the two most commonly reported symptoms of depression and fatigue, thus supporting the hypothesis that both symptoms are due to a secondary condition in MS.

Health care resource utilization and disease modifying treatment use in multiple sclerosis patients by age and insurance type

Objective The objective of this study was to describe and compare health care resource utilization (HCRU) and disease modifying treatment (DMT) use among US adults <65 years with multiple sclerosis (MS), across commercial and Medicare Advantage plans. Methods Medical and pharmacy claims data from commercial and Medicare Advantage with Part D (MAPD) plans were extracted for MS patients age 18 − 64 identified between 1 January 2014 and 31 May 2017. Comparisons were made between commercial and MAPD enrollees for all-cause HCRU and DMT use over 1 year, overall and by 5 year age groups. Results A total of 28,427 MS patients were identified; two-thirds (67%) had commercial coverage. MAPD patients had statistically significantly higher mean counts of all-cause inpatient, emergency room (ER) and ambulatory visits compared to commercial patients. The significant differences were evident in all age groups ≥30 years, except for ER visits in the 40–44 and 60–64 age groups. MAPD patients had statistically significantly lower prevalence of DMT use compared to commercial patients in all age groups starting at ≥35 years. Conclusion MAPD patients had a higher burden of medical HCRU compared to their commercially insured counterparts, most likely due primarily to their more advanced disease state and higher level of MS-related disability. Reasons for lower prevalence of DMT use among MAPD patients may include their more advanced disease state, older age and higher prevalence of comorbid conditions compared with commercially insured patients, as well as more restrictive formularies for MAPD vs. commercial plans. These findings suggest that there may be an opportunity for recently approved DMTs indicated for active secondary progressive MS to fulfill an unmet need for treatment among MS patients <65 years without contraindicated comorbid conditions who are enrolled in MAPD plans. Novel therapies under development to delay progression may help keep MS patients of working age in the work force.

Dysregulation of NF-κB-Associated lncRNAs in Multiple Sclerosis Patients.

Long non-coding RNAs (lncRNAs) have been reported to participate in the pathogenesis of several complex disorders such as immune-related disorders. Multiple sclerosis (MS) as an inflammatory disorder of the central nervous system has been associated with aberrant expression of several lncRNAs. In the current study, we assessed expression of NF-κB-, autophagy-, and obesity-associated lncRNAs/genes and two inflammatory cytokines in the peripheral blood of MS patients and healthy controls. LNC-MKI67IP was down-regulated in total MS patients compared with total controls (P value < 0.0001). However, when comparing its expression in a gender-based manner, no significant difference was found between patients and controls. Expression of HNF1A-AS1 was significantly lower in total MS patients and patients of both sexes when compared with the matched controls (P value < 0.0001; P value = 0.03; P value = 0.004, respectively). Expression of LINC00305 had a similar pattern to HNF1A-AS1 (P value < 0.0001; P value = 0.005; P value < 0.0001, respectively). Expressions of other assessed NF-κB associated lncRNAs were not different between cases and controls. Expression of IL-1B was significantly lower in total MS patients compared with total controls (P value < 0.0001). Such decreased expression was detected in female patients compared with female controls as well (P value < 0.0001). Expression of IL-6 was not different between cases and controls. Expression of CEBPA was higher in total MS patients compared with controls (P value = 0.047). However, when dividing study participants into male and female subgroups, no significant difference was detected between cases and gender-matched controls. There were no significant difference in the expression of any assessed autophagy-associated lncRNAs between cases and controls. ATG5, CEBPA, HNF1A-AS1, IL-1B, LINC00305, and LNC-MKI67IP could differentiate disease status with diagnostic power values of 0.781, 0.582, 0.744, 0.76, 0.926, and 0.703, respectively. Expression levels of ADINR and CHAST were correlated with age of MS patients and disease duration, respectively (r = 0.33, P < 0.0001; r = 0.34, P < 0.0001, respectively). The present study highlighted the role of a number lncRNAs in the pathogenesis of MS and supported the previous data regarding aberrant expression of these transcripts in this immune-related disorder.

Abstract P206: Multiple Sclerosis Risk Factors Improved With Residential Lifestyle Intervention

Rationale: Previous research suggest that lipids, which are important elements in healthy myelin sheaths, could play a role in multiple sclerosis (MS). This study evaluate the effect on lipids of a medical 18-day lifestyle program. Methods: The program is summarized in the word NEWSTART acronym of (N)utrition (vegan diet), (E)xercise, (W)ater, (S)unshine (proper exposure), (T)emperance (proper use of good things and avoiding harmful things), (A)ir (breathing exercises), (R)est, (T)rust in rational, spiritual, and psychological aspects. Patients were seen by certified physicians, nutritionists, and chaplaincy. They received physician consultations, plant-based diet, massage, hydrotherapy and exercise therapy among other modalities. Results: Out of 2081 patients that completed the program in an 11 year period, n=10 had a diagnosis of MS. Only n=9 of the n=10 patients had complete laboratories. Average age of MS patients was 51 (SD 15), 89% were female. At baseline, the average of cholesterol, triglycerides, HDL, and LDL (listed in the same order) was 196, 141, 59, and 100, with an SD of 47.7, 84.3, 10.1, 35.6, minimum of 126, 68, 50, 75, maximum 276, 304, 70, 141 and median 203, 100, 58, 85. On completion of the 18-day program, the average of cholesterol, triglycerides, HDL, and LDL was 174, 129, 49, and 99, SD was 27.4, 64.3, 18.0, 30.1, minimum 139, 64, 28, 69, maximum 214, 270, 87, 147, median 175, 115, 47, 88, t-test values 2.6, 1.2, -.2, 2.9, significant change? ( Yes(p&lt;.02), Yes(p&lt;.2), No(p&lt;.8), Yes(p&lt;0.1). Conclusions: The program is effective in improving lipids of MS patients. The risk factors cholesterol, triglycerides and LDL responded very well to the intervention. HDL decreased a few point but the change was not significant. Patients seem to benefit from the intervention.

MRI correlates of cognitive impairment in childhood-onset multiple sclerosis.

Brain MRI measures were correlated with neuropsychological function in 35 pediatric-onset multiple sclerosis (MS) patients and 33 age- and sex-matched healthy controls. Mean age of MS patients was 16.3 ± 2.3 years with average disease duration of 4.3 ± 3.1 years. Cortical gray matter, thalamic, and global brain volumes were calculated for all participants using a scaling factor computed using normalization of atrophy method to normalize total and regional brain volumes for head size. T1- and T2-weighted lesion volumes were calculated for MS patients. Cognitive impairment (CI) was identified in 29% of the MS cohort. Cognitive deficits predominantly involved attention and processing speed, expressive language, and visuomotor integration. Relative to controls, the MS group showed significantly lower thalamic volume (p < .001), total brain volume (p < .008), and gray matter volume (p < .015). Corpus callosum area and thalamic volume differentiated patients identified as having CI from those without CI (p < .05). Regression models controlling for disease duration and age indicated that thalamic volume accounted for significant incremental variance in predicting global IQ, processing speed, and expressive vocabulary (ΔR2 ranging from .43 to .60) and was the most robust MRI predictor of cognition relative to other MRI metrics. The robust association between cognitive function and reduced size of thalamus and global brain volume in pediatric-onset MS patients implicate neurodegenerative processes early in the disease course, and suggest that plasticity of an immature central nervous system is not sufficient to protect patients from the deleterious consequences of MS on cognitive neural networks. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Comment on Shuhaibar et al.: Favourable effect of immunomodulator therapy on bone mineral density in multiple sclerosis

Dear Editor, The study by Shuhaibar et al. [1] caught our attention because we have collected bone mineral density (BMD) data from multiple sclerosis (MS) patients recently. The authors report z scores significantly higher than zero in MS patients receiving immunomodulatory treatment (IMT) and conclude that IMT may have a favourable effect on bone in patients with MS. They did not compare their measurements in 37 MS patients receiving IMT with patients not receiving such treatment nor with healthy controls. We have measured BMD at, amongst other sites, the lumbar spine and proximal femur in 86 ambulant MS patients age 19–50 [40.1 ± 7.0 (mean ± SD) years]. A total of 39 patients (45%) were on IMT with interferon beta-1a (31), interferon beta-1b (4) or glatiramer acetate (3). Mean duration of treatment with the current IMT was 3.7 ± 2.4 years. Comparing patients on IMT with those not receiving IMT, there were no statistically significant differences between groups in age, duration of MS, EDSS, body mass index (BMI) or proportion treated with pulsed intravenous methylprednisolone. We have performed BMD measurements on a Lunar prodigy densitometer. Z scores are calculated using scanner software. The population the reference database is based on differs between manufacturers and may differ from the population studied. In northern Norway, we found mean z scores significantly lower than zero in both the IMT group (one-sample t test lumbar spine: P = 0.021, total hip: P = 0.011) and in the group not receiving IMT (total hip: P = 0.015, lumbar spine: ns). Measured z scores did not differ between IMT-treated and untreated patients (twosample t test lumbar spine: P = 0.653, total hip: P = 0.944). We do not wish to publish detailed data at this point. Our IMT-treated group is comparable with the patients studied by Shuhaibar et al. regarding most variables, except that our patients had longer duration of MS from first relapse (9.7 ± 7.0 vs. 5.8 ± 3.7 years) and slightly lower EDSS (median 2.5, mean 2.6 ± 1.2 vs. 3.1 ± 1.9). Fewer patients in our study had been treated with pulsed intravenous methylprednisolone (46 vs. 81%) and none had ever received long-term steroid treatment. Shuhaibar et al. do not provide information on BMI in their patients, although it is known that BMI has a strong positive association with BMD. Median BMI in our study was 25 for women and 27 for men. Minor differences in patient characteristics between the two studies are not a likely explanation for the conflicting results, whereas the densitometer software used might play a role. Shuhaibar et al. present the intriguing hypothesis that IMT treatment for MS may offer an unexpected benefit in terms of preventing osteoporosis, which they argue is biologically plausible. Our findings do not support this prediction. Based on our understanding of the literature and our own preliminary results, we consider it likely that MS is a cause of secondary osteoporosis and that there is no association between IMT and BMD. More research is definitely warranted in this area. M. T. Kampman (&) Department of Neurology, University Hospital of North Norway, P.O. Box 33, 9038 Tromso, Norway e-mail: margitta.kampman@unn.no