Clinical Presentation Of Multiple Sclerosis Research Articles

The quality of life impact of the COVID-19 pandemic and lockdowns for people living with multiple sclerosis (MS): evidence from the Australian MS Longitudinal Study

PurposePeople living with multiple sclerosis (PwMS) in metropolitan Victoria, Australia, experienced a 112-day, COVID-19-related lockdown in mid-2020. Contemporaneously, Australian PwMS elsewhere experienced minimal restrictions, resulting in a natural experiment. This study investigated the relationships between lockdowns, COVID-19-related adversity, and health-related quality of life (HRQoL). It also generated health state utilities (HSU) representative of changes in HRQoL.MethodsData were extracted from Australian MS Longitudinal Study surveys, which included the Assessment of Quality of Life-Eight Dimensions (AQoL-8D) instrument and a COVID-19 questionnaire. This COVID-19 questionnaire required participants to rank their COVID-19-related adversity across seven health dimensions. Ordered probits were used to identify variables contributing to adversity. Linear and logit regressions were applied to determine the impact of adversity on HRQoL, defined using AQoL-8D HSUs. Qualitative data were examined thematically.ResultsN = 1666 PwMS (average age 58.5; 79.8% female; consistent with the clinical presentation of MS) entered the study, with n = 367 (22.0%) exposed to the 112-day lockdown. Lockdown exposure and disability severity were strongly associated with higher adversity rankings (p < 0.01). Higher adversity rankings were associated with lower HSUs. Participants reporting major adversity, across measured health dimensions, had a mean HSU 0.161 (p < 0.01) lower than participants reporting no adversity and were more likely (OR: 2.716, p < 0.01) to report a clinically significant HSU reduction. Themes in qualitative data supported quantitative findings.ConclusionsWe found that COVID-19-related adversity reduced the HRQoL of PwMS. Our HSU estimates can be used in health economic models to evaluate lockdown cost-effectiveness for people with complex and chronic (mainly neurological) diseases.

Matrine mediated neuroprotective potential in experimental multiple sclerosis: Evidence from CSF, blood markers, brain samples and in-silico investigations

Multiple sclerosis (MS) is a debilitating, inflammatory, and demyelinating disease of the central nervous system influenced by environmental and genetic factors. Around 2.8 million people worldwide are affected by MS due to its challenging diagnosis and treatment. Our study investigates the role of the JAK/STAT and PPAR-gamma signaling pathways in the progression of multiple sclerosis. Inflammation and demyelination can be caused by dysregulation of these pathways. Modulating the STAT-3, mTOR, and PPAR-gamma signaling pathways may offer therapeutic potential for multiple sclerosis. Matrine (40 and 80 mg/kg, i.p.), a quinolizidine alkaloid derived from Sophora flavescens, has been investigated for its therapeutic potential in our laboratory. Matrine has been studied for its neuroprotective effect in neurodegenerative diseases. It inhibits inflammatory responses and promotes regeneration of damaged myelin sheaths, indicating its potential efficacy in treating multiple sclerosis. Matrine exerts its neuroprotective effect by inhibiting STAT-3 and mTOR and promoting PPAR-gamma expression.GW9662, a PPAR-gamma antagonist (2 mg/kg, i.p.), was administered to evaluate the involvement of PPAR-gamma and to compare the efficacy of matrine's potential neuroprotective effect. Matrine's interaction with the STAT-3, mTOR, and PPAR-gamma pathways in multiple Sclerosis was also validated and confirmed through insilico investigation. In addition, matrine altered the CBC profile, intensifying the clinical presentation of multiple sclerosis. In addition, we evaluated the diagnostic potential of various biological samples, including CSF, blood plasma, and brain homogenates (striatum, cortex, hippocampus, and midbrain). These samples were used to evaluate the neurochemical changes caused by neurobehavioral alterations during the progression of multiple sclerosis. These results indicate that matrine treatment ameliorated multiple sclerosis and that the mechanism underlying these effects may be closely related to the modulation of the STAT-3/mTOR/PPAR-gamma signaling pathway.

Clinical Presentation Of Multiple Sclerosis In A Tertiary Health Care Centre, Abuja

Clinical Presentation Of Multiple Sclerosis In A Tertiary Health Care Centre, Abuja

Initial clinical presentation of multiple sclerosis with concurrent COVID-19 infection: Case report and literature review.

The Article Abstract is not available.

Uveitis prior to clinical presentation of Multiple Sclerosis (MS) is associated with better MS prognosis.

ObjectiveAn association between uveitis and multiple sclerosis (MS) is well-established, but the actual nature of that association remains poorly understood. We sought to determine the association between the presence of a uveitis diagnosis prior to an MS diagnosis compared to no pre-existing uveitis diagnosis in MS patients.MethodsPatients in whom the presentation of uveitis preceded the presentation of MS (study group) and patients with MS and no uveitis (control group) were randomly selected at a ratio of 1:3 from the Sheba Multiple Sclerosis Center computerized database.ResultsEleven patients presented with uveitis prior to MS diagnosis (study group), and 31 randomly selected patients had MS without uveitis (control group). Only one patient in the study group deteriorated to EDSS 3 during the follow-up period, compared to 15 patients in the control group (9.1% vs 48.4%, P = 0.049). None of the patients in the study group reached EDSS 6 during the 10 years of follow-up compared to 6 (19.4%) patients in the control group (P = 0.194).ConclusionsMS patients who presented with uveitis that preceded their neurological symptoms of MS demonstrated a clinically significant better neurological prognosis, than our MS patients with no uveitis.

Newly Diagnosed Multiple Sclerosis Presenting as Brown-Séquard Syndrome: A Case Report.

IntroductionBrown-Séquard syndrome is a rare neurological disorder due to hemisection of the spinal cord that can occur from a variety of causes, most commonly trauma.Case ReportWe present a case of a 25-year-old woman presenting with Brown-Séquard syndrome as her first clinical presentation of multiple sclerosis.ConclusionThis case highlights the need to have demyelinating disease on the differential as an exceedingly rare, but important, possible cause of Brown-Séquard syndrome.

Diagnostic relevance of free light chain indices and their relation to the clinical presentation of multiple sclerosis

Purpose: Cerebrospinal fluid (CSF) free light chains (FLC) are of promising diagnostic importance in patients with multiple sclerosis (MS). However, research is required to confirm their utility as part of the diagnostic criteria for MS. In addition, very few publications can be found addressing the relationship of FLCs to the clinical presentation at the onset of MS. We aimed to evaluate the diagnostic performance of the FLC kappa and lambda indices, and explored their relationship to the number and type of functional systems (FS) involved.&#x0D; Methods: FLC indices were determined in paired CSF and serum samples from 71 patients with noninflammatory neurological diseases (non-MS, n = 29) and new-onset MS (MS, n = 42). The latter were further divided into two groups with mono- and polysymptomatic presentation. FS involvement was evaluated in accordance with the Expanded Disability Status Scale (EDSS).&#x0D; Results: Using both FLC indices along with the age and sex of patients, the diagnostic accuracy of MS was higher (AUC, 0.991; sensitivity, 95.5%; specificity, 95.8%) than that observed when using either the lambda index (AUC, 0.677; sensitivity, 68.0%; specificity, 60.0%) or kappa index (AUC, 0.957; sensitivity, 88.5%; specificity, 88.0%) alone. No differences were observed in the lambda (U = 78.0; p = 0.749) or kappa indices (U = 82.0; p = 0.885) between mono- and polysymptomatic patients. Nor was a correlation found between FLC indices and EDSS scores.&#x0D; Conslusion: FLC indices could be useful diagnostic markers for MS. However, such indices do not differentiate between clinical presentations at disease onset and are not correlated with baseline EDSS scores.

The Spectrum of Clinical Presentation of Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder in Young Patients of Our Community.

BackgroundNeuromyelitis optica spectrum disorder (NMOSD) is an inflammatory, demyelinating syndrome of the central nervous system (CNS) which affects the spinal cord and optic nerves. The aim of our study was to evaluate the clinical appearance of multiple sclerosis and neuromyelitis optica spectrum disease in young children in our communityMaterials and methodsThis cross-sectional study was done in the neurology departments of the Combined Military Hospital & Pak Emirates Military Hospital Rawalpindi for six months from April 2020 to September 2020. Eighty people between the ages of 18 and 45 with Guillain-Barre syndrome (GBS), multiple sclerosis (MS), and neuromyelitis optica spectrum disorder participated in this prospective research. The patient's demographic profile includes information such as age, gender, length and kind of sickness, and symptoms. The relationship of socio-demographic factors was assessed with the involvement of more than one organ system at the time of presentation.ResultsThe final study comprised of 80 patients of whom 31 (38.5 percent) were men and 49 (61.25%) were women. Fifty-four (67.5%) patients were diagnosed with multiple sclerosis while 26 (32.5%) had neuromyelitis optica spectrum disorders. Most of the patients presented with sensory symptoms followed by visual disturbances. Twenty-nine (37%) had involvement of more than one system while 51 (63%) had involvement of only one system at the time of presentation. Female gender and having a diagnosis of multiple sclerosis had a statistically significant relationship with involvement of one than one system.ConclusionsIn individuals with MS and NMO, motor, sensory, and visual symptoms were often observed at the time of presentation. Involvement of one than one system at the time of presentation was fairly common among these patients and females and patients having a diagnosis of multiple sclerosis were more at risk of involvement of more than one system.

Clinically detectable structural abnormalities in pediatric‐onset multiple sclerosis: A large‐scale magnetic resonance imaging analysis

AbstractBackgroundMultiple Sclerosis is characterized by neural demyelination. Structural magnetic resonance imaging (MRI) provides soft tissue contrast, which forms the basis of techniques for extracting regional biomarkers across a participant's brain.ObjectivesTo investigate the clinical presentation of multiple sclerosis in a large‐scale MRI analysis that includes thorough consideration of extractable structural measurements (average and variability of regional cortical thicknesses, cortical surface measurements, and volumes).MethodsWe performed a large‐scale retrospective analysis of 370 T1 structural volumetric MRIs from 64 participants with multiple sclerosis and compared them with a large cohort of neurotypical participants, consisting of 993 MRIs from 988 participants. Regionally distributed measurements of cortical thickness (average and standard deviation) were extracted along with surface area, surface curvature, and volumetric measurements.ResultsThe largest observed finding involved regionally distributed reductions in average cortical thickness, with the parahippocampal region exhibiting the largest effect size, a finding that may be linked with known hippocampal atrophy in multiple sclerosis. Group‐wise differences were also observed in terms of distributed volume, surface area, and surface curvature measurements.ConclusionsParticipants with pediatric‐onset multiple sclerosis present clinically with a variety of structural abnormalities, including perirhinal cortex thickness abnormalities not previously reported in the literature.

Treatment with Delta-9-tetrahydrocannabinol/cannabidiol in Multiple Sclerosis: Influence on the Autonomy Profile according to the International Classification of Functioning, Disability and Health.

The clinical presentation of multiple sclerosis (MS) is heterogeneous but very often lower limb spasticity leads to severe disability.The use of nabiximols improved spasticity control and motor performance in walking, and also had a larger effect in improving activity and participation in personal relationships.Appropriate assessment of MS cases, through the ICF framework, may demonstrate further effects of nabiximols on patient capacity and performance.

Brief review of HLA profile and clinical presentation of multiple sclerosis in Iran

HLA typing, the natural course and clinical findings of 79 and 200 definite MS cases in Iran was respectively reviewed [1,2]. Results drawn from our 79 Iranian MS patients revealed an association between MS and HLA types A 24, DR 2, and DR 15, each with a relative risk of 1.9 times of controls.

The Patterns of Clinical Presentation of Multiple Sclerosis in Patients Admitted to the National Center of Neurological Sciences, Khartoum, Sudan 2018

Multiple sclerosis (MS) is an immune- mediated inflammatory disease that attacks myelinated axons in the central nervous system leading to significant disability. This study is a descriptive cross-sectional study conducted at the national center for neurological sciences (NCNS), Khartoum Sudan, over 3 years period from August 2015 to April 2018. The diagnosis was performed based on Poser & Mackdonalds criteria. Data was collected using Questionnaire. The diagnosis was confirmed by brain and cervical spine magnetic resonance imaging (MRI) with sagittal FLAIR, serum and cerebrospinal fluid (CSF) oligoclonal band. Sixty-five patients were enrolled. The majority (90.8%) of them were females. 38.4% were within the age group from 21-30 years and 95.4% had no family history of MS. 18 patients (27.6%) had decreased visual acuity, 13 patients (20%) had ataxia, and 33 patients (50.7%) had a past history of similar condition. 64.6% out of 65 patients had more than two lesions detectable in their brain MRI. Only 18.4% of the patients were examined for CSF analysis. Oligoclonal band was found positive in all of them. Females predominated in 91% of the patients. The most affected age group was ranging between 21-30 years. Relapsing-remitting type was the most common disease course. Oligoclonal band was detected in all of the patients. Azathioprine was found to be very effective.

Blood transcriptome profiling captures dysregulated pathways and response to treatment in neuroimmunological disease.

Blood transcriptome profiling captures dysregulated pathways and response to treatment in neuroimmunological disease.

The Patterns of Clinical Presentation of Multiple Sclerosis in Patients Admitted to the National Center of Neurological Sciences, Khartoum, Sudan 2018

Background: Multiple sclerosis (MS) is an immune- mediated inflammatory disease that attacks myelinated axons in the central nervous system leading to significant disability. Worldwide, approximately 2.1 million peoples around the world are affected by MS. MS is often recognizable clinically by different patterns: Relapsing and remitting, MS (80–90%) primary progressive MS (10–20%) secondary progressive MS.

Commentary on Al Hussona et al. ‘New-onset seizures as a sole clinical presentation of multiple sclerosis’

Despite the now significant contribution of magnetic resonance imaging, the accurate and timely diagnosis of multiple sclerosis (MS) is still clinically challenging. Al Hussona et al., with their case series, highlight the complexities of attributing paroxysmal, and in particular cortical, symptoms such as epileptic seizures to inflammatory demyelinating lesions, and establishing a diagnosis of MS based on them. In such circumstances an MS diagnosis is likely to be more tentative than for more typical MS presentations, and treatment choices should be weighed accordingly.

The Patterns of Clinical Presentation of Multiple Sclerosis in Patients admitted to the National Center of Neurological Sciences, Khartoum, Sudan 2018

Background: Multiple sclerosis (MS) is an immunemediated inflammatory disease that attacks myelinated axons in the central nervous system leading to significant disability. Worldwide, approximately 2.1 million peoples around the world are affected by MS. MS is often recognizable clinically by different patterns: relapsing and remitting, MS (80-90%) primary progressive MS (10-20%) secondary progressive MS. Objectives: To study the patterns of clinical presentation of MS in Sudanese patients. Methods: This study is descriptive cross-sectional study conducted at the national center for neurological sciences (NCNS), Khartoum Sudan, conducted for 3 years period from August 2015 to April 2018. The diagnosis was done based on Poser & Mackdonalds criteria two or more clinical attacks with Objective clinical evidence in examination of 2 or more lesions, in patients with two or more attacks with objective clinical evidence of 1 lesion dissemination in space demonstrated by MRI. Sixty-five patients were enrolled. Data was collected using Questionnaire. The diagnosis was confirmed by MRI brain with sagittal FLAIR&MRI cervical spine, serum & CSF oligoclonal band. Results: Females were (90.8%) the majority of them 25 (38.4%) were within the age group from 21-30 years, most of the patients 62 (95.4%) had no family history, 18 patients (27.6%) had decreased visual acuity 13 patients (20%) had ataxia, 33 patients (50.7%) had past history of similar condition, most of the patients 40 (64.6%) had more than two lesions detectable in their brain MRI, 12 (18.4%) patients were examined for CSF analysis, Oligoclonal band was found in all of them. Conclusion: Females predominated in 91% of the patients, the most affected age group was ranging between 21-30 years. Relapsing Remitting type was predominating. Oligo-clonal band was detected in all of the patients. Azathioprine was found to be very effective.

Puberty Does Not Affect Clinical Presentation of Multiple Sclerosis in Adolescent (P1.381)

Puberty Does Not Affect Clinical Presentation of Multiple Sclerosis in Adolescent (P1.381)

Puberty does not affect clinical presentation of multiple sclerosis in children

Puberty does not affect clinical presentation of multiple sclerosis in children

Novel approaches in the treatment of multiple sclerosis

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system, which usually affects young adults. The most common clinical course of the disease is the relapsing-remitting form of multiple sclerosis (RRMS). Although there is no causative therapy, treatment outcomes in patients with RRMS have been significantly improved with the introduction of disease modifying therapy (DMT), which decreases disease activity and delays progression of disability. Drugs used as DMT are immune modulator and immunosuppressive drugs. The conventional immunomodulatory drugs, interferons (IFN-β 1b and IFN-β 1a) and glatiramer acetate, applied parenterally, have been the first line therapy for many years in patients with RRMS. IFN-β and GA are generally safe and well-tolerated. However, due to the heterogeneity of the pathophysiology and clinical presentation of MS, their efficacy is modest, which requires substitution of IFN-β with GA or the use of certain novel immunomodulatory therapies: monoclonal antibodies, alemtuzumab and natalizumab, (parenteral administration) or teriflunomide, dimethyl-fumarate and fingolimod (peroral administration). The antineoplastic agent, mitoxantrone, is used for the treatment of aggressive forms of MS. The overall benefit/risk ratio for novel approaches in the treatment of MS has yet to be determined.

Transcriptomic Profile Reveals Gender-Specific Molecular Mechanisms Driving Multiple Sclerosis Progression

BackgroundAlthough the most common clinical presentation of multiple sclerosis (MS) is the so called Relapsing-Remitting MS (RRMS), the molecular mechanisms responsible for its progression are currently unknown. To tackle this problem, a whole-genome gene expression analysis has been performed on RRMS patients.ResultsThe comparative analysis of the Affymetrix Human Gene 1.0 ST microarray data from peripheral blood leucocytes obtained from 25 patients in remission and relapse and 25 healthy subjects has revealed 174 genes altered in both remission and relapse, a high proportion of them showing what we have called “mirror pattern”: they are upregulated in remission and downregulated in relapse or vice versa. The coexpression analysis of these genes has shown that they are organized in three female-specific and one male-specific modules.ConclusionsThe interpretation of the modules of the coexpression network suggests that Epstein-Barr virus (EBV) reactivation of B cells happens in MS relapses; however, qPCR expression data of the viral genes supports that hypothesis only in female patients, reinforcing the notion that different molecular processes drive disease progression in females and males. Besides, we propose that the “primed” state showed by neutrophils in women is an endogenous control mechanism triggered to keep EBV reactivation under control through vitamin B12 physiology. Finally, our results also point towards an important sex-specific role of non-coding RNA in MS.