Extended Disability Status Scale Research Articles

Cervical Spondylosis Severity and Its Correlation with Clinical Parameters and Cervical Lesions in Multiple Sclerosis: A Cross-Sectional MRI Study

Background: The co-occurrence of multiple sclerosis (MS) and cervical spondylosis (CS) may not only intensify symptoms but also complicate the management of these disorders. Magnetic resonance imaging (MRI) is the preferred modality for detecting spinal cord lesions; however, there is limited evidence assessing myelopathy in concurrent CS and MS. Objectives: This study aims to evaluate the association between CS and its effects on the spinal cord, as well as their impact on enhancing MS cervical lesions. Methods: This cross-sectional study was conducted on 104 MS patients between 2019 and 2021. Data collected included age, gender, duration and phenotype of MS, and the Extended Disability Status Scale (EDSS). Magnetic resonance imaging images were obtained and analyzed for the presence of cervical spondylosis and demyelinated cervical plaques (active/inactive). Multiple sclerosis plaques were evaluated based on their extension, enhancement, and cervical location. Cervical spondylosis was categorized into four grades using the Muhle scale. Additionally, the spinal cord cross-sectional area (SC - CSA) was measured at the C2 - C3 cervical spine level. Results: The severity of cervical spondylosis was associated with older age (P-value < 0.001), longer duration of MS (P-value = 0.04), more severe EDSS scores (P-value = 0.03), and a lower C2 - C3 CS-CSA (P-value < 0.001). However, no significant associations were found with gender (P-value = 0.90), MS plaques activity (P-value = 0.25), or extension (P-value = 0.13). Conclusions: The study findings indicate that the severity of CS is associated with age, MS duration, EDSS, and the C2 - C3 cervical spine cross-sectional area. However, the study did not find evidence supporting a relationship between CS and the extension or activity of MS plaques.

A phase II trial examining the safety and preliminary efficacy of repetitive transcranial magnetic stimulation (rTMS) for people living with multiple sclerosis

BackgroundMultiple sclerosis (MS) is a chronic neurological condition and the leading cause of non-traumatic disability in young adults. MS pathogenesis leads to the death of oligodendrocytes, demyelination, and progressive central nervous system neurodegeneration. Endogenous remyelination occurs in people with MS (PwMS) but is insufficient to repair the damage. Our preclinical studies in mice indicate that endogenous remyelination can be supported by the delivery of repetitive transcranial magnetic stimulation (rTMS). Our phase I trial concluded that 20 sessions of rTMS, delivered over 5 weeks, are safe and feasible for PwMS. This phase II trial aims to investigate the safety and preliminary efficacy of rTMS for PwMS.MethodsParticipants must be aged 18–65 years, diagnosed with MS by a neurologist, stable and relapse free for 6 months, have an Extended Disability Status Scale (EDSS) between 1.5 and 6 (inclusive), willing to travel to a study site every weekday for 4 consecutive weeks, and able to provide informed consent and access the internet. Participants from multiple centres will be randomised 2:1 (rTMS to sham) stratified by sex.The intervention will be delivered with a Magstim Rapid2 stimulator device and circular 90-mm coil or MagVenture MagPro stimulator device with C100 circular coil, positioned to stimulate a broad area including frontal and parietal cortices. For the rTMS group, pulse intensity will be set at 18% (MagVenture) or 25% (Magstim) of maximum stimulator output (MSO), and rTMS applied as intermittent theta burst stimulation (iTBS) (~ 3 min per side; 600 pulses). For the sham group, the procedure will be the same, but the intensity is set at 0%. Each participant will attend 20 intervention sessions over a maximum of 5 weeks.Outcome measures include MS Functional Composite Score (primary), Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Quality of Life, and Pittsburgh Sleep Quality Index/Numeric Rating Scale and adverse events (secondary) and advanced MRI metrics (tertiary). Outcomes will be measured at baseline and after completing the intervention.DiscussionThis study will determine if rTMS can improve functional outcomes or other MS symptoms and determine whether rTMS has the potential to promote remyelination in PwMS.Trial registrationRegistered with Australian New Zealand Clinical Trials Registry, 20 January 2022; ACTRN12622000064707.

Serum NfL and EGFR/NfL ratio mRNAs as biomarkers for phenotype and disease severity of myelin oligodendrocyte glycoprotein IgG-associated disease.

Myelin oligodendrocyte glycoprotein (MOG) IgG is frequently elevated in pediatric patients with acquired demyelinating syndrome (ADS). However, no specific biomarkers exist for phenotype classification, symptom severity, prognosis, and treatment guidance of MOG-IgG-associated disease (MOGAD). This study evaluated neurofilament light chain (NfL) and endothelial growth factor receptor (EGFR) mRNA expression levels in serum and cerebrospinal fluid (CSF) as potential biomarkers for MOGAD in Chinese children. This was a cross-sectional and single-center study. We enrolled 22 consecutive pediatric patients hospitalized with MOGAD and 20 control pediatric patients hospitalized for noninflammatory neurological diseases in Hebei Children's Hospital. Serum and CSF were collected from MOGAD patients within 3 days before immunotherapy. The mRNA levels of NfL and EGFR in serum and CSF were measured by real-time polymerase chain reaction (qPCR), and the EGFR/NfL ratio mRNA was calculated. These measurement values were then compared between disease groups and among MOGAD phenotypes. In addition, the correlations between the mRNAs of three markers (NfL, EGFR, EGFR/NfL ratio), extended disability status scale (EDSS) scores, and clinical phenotypes were analyzed. Serum and CSF NfL mRNA levels were significantly higher of acute-stage MOGAD patients than those of control patients (p< 0.05 and p< 0.01, respectively), while the mRNA levels of serum EGFR and EGFR/NfL ratio were significantly lower of MOGAD patients than those of controls (p < 0.05, p < 0.0001). Serum NfL mRNA was significantly correlated with mRNA of serum EGFR (r =0.480, p < 0.05). Serum and CSF NfL mRNA levels in MOGAD patients with the ADEM-like phenotype were also significantly higher than those in control patients (p < 0.01, p < 0.01) and optic neuritis (ON) phenotype (p < 0.05, p < 0.05). Both mRNAs of NfL in CSF and EGFR/NfL ratio in serum were correlated with EDSS scores (p < 0.05, r = 0.424; p < 0.05, r= -0.521). The mRNA levels of elevated NfL in serum and CSF as well as lower EGFR and EGFR/NfL ratio in serum could help distinguish acute-phase MOGAD. Higher mRNA levels of NfL in serum and CSF of MOGAD patients help distinguish ADEM-like phenotype. In addition, serum EGFR/NfL mRNA ratio is indicative ofdisease severity in pediatric patients with MOGAD. Further investigations arewarranted to elucidate the pathological mechanisms underlying these associations.

The relationship between melatonin level, oxidative stress, fatigue and sleep disorders in multiple sclerosis patients

Aims: Our study aimed to investigate the relationship between oxidative stress and melatonin levels, sleep disturbances and fatigue in persons with MS (pwMS).&#x0D; Methods: The study included 50 pwMS and 30 healthy controls. Levels of serum melatonin, glutathione peroxidase (GPx), superoxide dismutase (SOD), and malondialdehyde (MDA) were measured in both groups. Persons with MS (pwMS) were evaluated using the extended disability status scale (EDDS) while Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale, insomnia severity index, fatigue severity scale and Beck depression scale were used for both groups.&#x0D; Results: Persons with MS (pwMS) exhibited significantly higher sleep disturbances (p

Neutrophil–lymphocyte ratio and platelet–lymphocyte ratio as predictors of MS severity: a retrospective cohort study

BackgroundMultiple sclerosis (MS) is a disabling immune-mediated disease of the central nervous system. Ministry of Health and Population’s statistics show that MS comprise 1.4% of all neurological diseases, putting into consideration, current economic crisis; it is needed to predict disease severity with an acceptable cost-effective method. Complete blood count (CBC) parameters are supposed to be cheap, and simple markers for the systemic inflammatory state. This study aims at evaluating role of neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) in predicting the severity of MS. Therefore, this retrospective cohort study was done on 150 MS patients attending MS clinic during year 2022. All patients were subjected to complete medical history. Estimation of the disability was done through the extended disability status scale (EDSS) and analysis of different parameters of baseline CBC before starting therapy.ResultsA cutoff value of NLR ≥ 2.95 and PLR ≥ 201.5 could predict prognosis of MS. Risk factors of sever MS are high NLR, PLR, high body mass index and absence of disease-modifying therapy.ConclusionsNeutrophil/lymphocyte ratio and platelet/lymphocyte ratio are cheap valid useful predictors of increased relapse rate and severity in MS. Highlighting the role of both ratios at time of first diagnosis helps physicians to predict prognosis of patients in context of severity. Paying special attention to those with higher ratios can lead to improve patient outcome and reducing disease burden.

Characterization of white matter lesions in multiple sclerosis using proton density and T1-relaxation measures

PurposeAlthough lesion dissemination in time is a defining characteristic of multiple sclerosis (MS), there is a limited understanding of lesion heterogeneity. Currently, conventional sequences such as fluid attenuated inversion recovery (FLAIR) and T1-weighted (T1W) data are used to assess MS lesions qualitatively. Estimating water content could provide a measure of local tissue rarefaction, or reduced tissue density, resulting from chronic inflammation. Our goal was to utilize the proton spin density (PD), derived from a rapid, multi-contrast STAGE (strategically acquired gradient echo) protocol to characterize white matter (WM) lesions seen on T2W, FLAIR and T1W data. Materials and methodsTwenty (20) subjects with relapsing-remitting MS were scanned at 3 T using T1W, T2-weighted, FLAIR and strategically acquired gradient echo (STAGE) sequences. PD and T1 maps were derived from the STAGE data. Disease severity scores, including Extended Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC), were correlated with total, high PD and high T1 lesion volumes. A probability map of high PD regions and all lesions across all subjects was generated. Five perilesional normal appearing WM (NAWM) bands surrounding the lesions were generated to compare the median PD and T1 values in each band with the lesional values and the global WM. ResultsT1W intensity was negatively correlated with PD as expected (R = −0.87, p < 0.01, R2 = 0.756) and the FLAIR signal was suppressed for high PD volumes within the lesions, roughly for PD ≥ 0.85. The threshold for high PD and T1 regions was set to 0.909 and 1953.6 ms, respectively. High PD regions showed a high probability of occurrence near the boundary of the lateral ventricles. EDSS score and nine-hole peg test (dominant and non-dominant hand) were significantly correlated with the total lesion volume and the volumes of high PD and T1 regions (p < 0.05). There was a significant difference in PD/T1 values between the high PD/T1 regions within the lesions and the remaining lesional tissue (p < 0.001). In addition, the PD values of the first NAWM perilesional band directly adjacent to the lesional boundary displayed a significant difference (p < 0.05) compared to the global WM. ConclusionLesions with high PD and T1s had the highest probability of occurrence at the boundary of the lateral ventricles and likely represent chronic lesions with significant local tissue rarefaction. Moreover, the perilesional NAWM exhibited subtly increasing PD and T1 values from the NAWM up to the lesion boundary. Unlike on the T1 maps, the perilesional band adjacent to the lesion boundary possessed a significantly higher PD value than the global WM PD values. This shows that PD maps were sensitive to the subtle changes in NAWM surrounding the lesions.

Relationship of immune cells with disability and cognitive impairment in patients with neuromyelitis optica spectrum disorder.

This study aimed to investigate the relationship between common clinical immune indicators, disability degree, and cognitive impairment in patients with neuromyelitis optica spectrum disorder (NMOSD). We retrospectively analyzed lymphocyte subsets and routine parameters in the peripheral blood of 55 patients with NMOSD. We assessed the degree of disability using the Extended Disability Status Scale (EDSS). The Montreal Cognitive Assessment (MoCA) scores were used to assess cognitive function. In addition, we also determined the cytokine levels in 33 patients with NMOSD. The relationships of these immunological indicators with disability and cognitive impairment were assessed using correlation and multiple linear regression analyses. The results of the multiple linear regression analysis suggested that for patients with NMOSD, the neutrophil-lymphocyte ratio (NLR) (β=0.072, p=0.034) and number of attacks (β=0.131, p=0.03) were positively correlated with EDSS scores, whereas the number of attacks was positively correlated with MoCA scores. In addition, we also collected cytokine levels in 33 of these patients. The results of the study showed a positive correlation between IL-10 and EDSS scores and a negative correlation between IL-6 and MoCA scores. Our results show that these immune cells and cytokines are, to some extent, associated with the degree of disability and cognitive impairment in patients with NMOSD. Closely monitoring these indicators may allow detecting changes in patients' disease courses and predicting the severity of their disease. In clinical practice, this may facilitate early intervention and appropriate treatment decisions, which may improve the management of patient prognosis.

No Increase in Symptoms Toward the End of the Ocrelizumab Infusion Cycle in Patients With Multiple Sclerosis: Symptom Burden on Ocrelizumab: A Longitudinal Study (SymBOLS).

Some patients with multiple sclerosis (MS) receiving ocrelizumab (OCR) report worsening symptoms toward the end of the 6-month infusion cycle ('wearing off'). The objective of our study was to comprehensively assess changes in symptom burden across 2 consecutive OCR infusion cycles. SYMptom Burden on Ocrelizumab, a Longitudinal Study (SymBOLS; NCT04855617) was an investigator-initiated, 2-center study of patients with MS starting or receiving OCR. Patients' symptoms were assessed with NeuroQoL short forms, SymptoMScreen, and Work Productivity and Activity Impairment Questionnaire at the start-cycle, mid-cycle, and end-cycle time points in each of the 2 infusion cycles. Symptom scores at the 3 time points within each cycle were compared with repeated-measures ANOVA or the Friedman rank-sum test for non-normal variables. The proportions of patients with a meaningful symptomatic change from the start to the end of each infusion cycle were calculated, and patients whose symptoms improved, worsened, and stayed the same from the start to the end of the cycle were compared with respect to demographic and clinical characteristics. One hundred three patients with MS provided longitudinal data for analyses (mean age [SD]: 46.7 [12.2] years, 68% female, 33% non-White, disease duration: 15.5 [5] years, 41% with the Extended Disability Status Scale score >3). On a group level, NeuroQoL and SymptoMScreen scores mostly remained stable or even improved slightly toward the end of each cycle. On an individual level, symptoms remained unchanged across either cycle for most patients, and meaningful symptom worsening from the start to the end of the cycle was no more common than improvement. Meaningful change in symptoms in both cycles was very rare and generally in the direction of improvement toward the end cycle. Despite the lack of evidence for symptom worsening with a longer time from infusion, 54% of patients endorsed feeling of "wearing off" at least sometimes, most commonly as an increase in fatigue. Our prospective study failed to uncover evidence for the worsening of symptoms with a longer time from OCR infusion. These findings cast doubt on the existence of wearing off as a physiologic phenomenon in OCR-treated patients with MS. The perception of wearing off is likely the result of natural fluctuations in MS symptoms and attribution bias.

Side effects following vaccination in multiple sclerosis: a prospective, multi-centre cohort study

Vaccines play a crucial role in preventing infections in patients with multiple sclerosis (MS), although concerns have been raised about potential worsening of the underlying disease. To investigate this, we conducted a prospective, multicentre, non-randomized observational study assessing changes in disease activity, safety, and clinical tolerability of vaccination in 222 MS patients on disease-modifying drugs. The majority of patients were female (76.6%) and 89.6% had relapsing–remitting MS. The vaccines administered were primarily seasonal influenza (56.3%) or tetanus-based vaccines (33.8%). Disease activity, as measured by annualized relapse rate, decreased significantly from 0.64 the year prior to vaccination to 0.38 in the following year. Moreover, the extended disability status scale remained stable within six months after vaccination in comparison to pre-vaccination values. Side effects were reported in 19.2% of vaccinated subjects, most commonly local side effects (65.2%) or flu-like symptoms (34.8%). Our findings suggest that standard non-live vaccines are safe and well-tolerated in MS patients and do not negatively impact disease activity.

ADAR Expression and Single Nucleotide Variants in Multiple Sclerosis Patients Affect the Response to Interferon Beta Therapy.

Interferon (IFN)-β is the first-line disease management choice in multiple sclerosis (MS) with profound effects; however, in up to 50% of patients, clinical response does not occur. Ascertaining the responding state, need a long-term clinical follow-up, and this may lead to delay in use of other effective medications. IFN-induced cascade and its regulation is considered to play a major role in MS. Adenosine deaminase, RNA-specific (ADAR) dysregulation is important to IFN signaling pathway as an activity suppressor. Hence, we investigated the expression of ADAR and its single nucleotide variants of rs2229857 association with response to IFN-β in relapsing-remitting MS patients. mRNA levels and genotyping of rs2229857 in 167 MS patients were investigated via SYBR Green real-time (RT)-quantitative polymerase chain reaction and high-resolution melting RT PCR, respectively. The allele-A in rs2229857 and higher expression of ADAR were associated with poor response to IFN-β. Two response groups were significantly different in terms of annualized relapse rate, first symptoms, first extended disability status scale (EDSS), current EDSS, and the MS severity score. According to this study's findings, assessment of transcript levels and also variants in ADAR may be useful in identifying patients' response to IFN-β before starting treatment. Further investigations are needed to determine the potency of ADAR to be a predictive biomarker in drug responsiveness.

Letter to the editor on "new algorithmic approach for easier and faster extended disability status scale calculation".

Letter to the editor on "new algorithmic approach for easier and faster extended disability status scale calculation".

Letter to the editor on "new algorithmic approach for easier and faster extended disability status scale calculation".

Letter to the editor on "new algorithmic approach for easier and faster extended disability status scale calculation".

ESTIMATION OF EDSS FROM EEG SIGNALS OF MULTIPLE SCLEROSIS PATIENTS

Multiple sclerosis (MS) is an autoimmune, neurodegenerative, chronic disease that affects the central nervous system and manifests itself with attacks. Although there is no definite cure for the disease, it is possible to control these attacks. Follow-up of the disease has great importance in terms of disability. An Extended Disability Status Scale (EDSS) is used to show how much the disease affects. This score is determined by specialized clinicians. In this study, the EDSS score, previously determined by neurologists, was attempted to be estimated using the EEG signals. 32-channel EEG signals were recorded while 17 MS patients with EDSS 1.0, 1.5, and 2.0 were performing a working memory task. Using the band power of these 6-minute EEG signals, EDSS estimation was performed with the Decision Tree Regressor, resulting in a Mean Absolute Error (MAE) of 0.088. With the Leave One Out Cross-Validation, 17 trees were extracted and 12 were found to be identical. As a result, the band power features of F7 and CP2 EEG channels were found to be successful in predicting 3-level EDSS scores with a decision tree regressor with 0.0 MAE. Additionally, the relationship between the scores obtained in the working memory task and the EDSS scores of MS patients was statistically calculated with One-way ANOVA. There was no significant difference between the EDSS score and the task scores (p&amp;gt;.05).

Relationship between astrocyte damage and different levels of cerebrospinal fluid markers and prognosis in patients with subarachnoid hemorrhage.

The aim of the study was to explore the relationship between astrocyte damage and different levels of cerebrospinal fluid markers and prognosis in patients with subarachnoid hemorrhage (SAH). A total of 168 SAH patients diagnosed and treated in the emergency department of our hospital during the period October 2019 to February 2022 were randomly selected as the study subjects. The severity of these patients' condition was evaluated by Hunt-Hess grading and these subjects were graded as the low-level group (78 patients) and high-level group (90 patients) according to the evaluation results. The Extended Disability Status Scale (EDSS) score was employed to evaluate the astrocyte damage. The content of atypical chemokine receptor 3 (ACKR3), Connexin 43 (Cx43), oxygenated hemoglobin (HbO 2 ), and endothelin (ET) in cerebrospinal fluid was measured. The relationship between the content of ACKR3, Cx43, HbO 2 , and ET in cerebrospinal fluid with EDSS score was analyzed through Pearson correlation analysis. Multivariate logistic regression analysis was adopted to analyze the risk factors. ACKR3 was mainly expressed in the cytoplasm of cerebrospinal fluid monocytes, and Cx43 was mainly expressed in the cell membrane and cytoplasm. Patients in the high-level group had markedly higher expression rates of ACKR3 and Cx43 positive cells in cerebrospinal fluid than those in the low-level group ( p < 0.05). Patients in the high-level group had higher content of HbO 2 and ET in cerebrospinal fluid and EDSS score than patients in the low-level group ( p < 0.05). The content of ACKR3, Cx43, HbO 2 , and ET in cerebrospinal fluid of SAH patients was positively correlated with EDSS scores ( p < 0.05). Systolic blood pressure, Hunt-Hess grade, rebleeding, emotional control, EDSS score, ACKR3, Cx43 positive cell rate, and HbO 2 and ET expression levels were independent risk factors for the prognosis of SAH patients ( p < 0.05). Astrocyte damage in SAH patients was positively correlated with the content of ACKR3, Cx43, HbO 2 , and ET in cerebrospinal fluid. These indicators increased significantly with the increasing severity of the disease, and had certain value in reflecting the patient's condition. Astrocyte damage combined with cerebrospinal fluid markers had potential value in evaluating the severity and prognosis of patients.

New algorithmic approach for easier and faster extended disability status scale calculation.

The traditional paper and pencil method for EDSS calculation (pEDSS) is the cornerstone of multiple sclerosis practice; however, it requires an expert for an accurate calculation, and it takes a lot of time to perform the function scores. A new algorithmic approach (aEDSS) has been developed for easier and faster assessment. To determine if using aEDSS can achieve good inter-rater agreement and save time compared to pEDSS. This study was conducted on 200 MS patients; EDSS was performed twice for each patient by two neurologists on the same day; one used the pEDSS, and the other used the aEDSS in a random order to test the inter-rater agreement regarding functional system scores and the final EDSS score and to detect the difference in the time needed for calculation between both methods. The new algorithmic approach achieved excellent agreement with the traditional method (Kappa > 0.81) with a shorter calculation time (16 ± 2.67 min for aEDSS vs 31 ± 4.3 min for pEDSS, P < 0.0001). The new algorithmic approach could represent a suitable alternative to the traditional method, making EDSS calculation easier and faster.

The Use of Clinimetrics in the Practice of a Neurosurgical Nurse. Preliminary Reports

Introduction. Clinimetrics is a field of medical knowledge aimed at developing and using measuring tools (scales) to assess the condition of a patient. Using clinimetric scales, a nurse, based on her/his knowledge, skills and experience, is able to determine the patient’s condition, potential health problems and establish a care plan based on a nursing diagnosis.&#x0D; Aim. The main aim of the research was to analyse the use of measurement tools in the practice of a neurosurgical nurse.&#x0D; Material and Methods. The study was conducted on a group of 93 nurses employed in 6 neurosurgical centres located in the Kuyavian-Pomeranian voivodeship. The study used the diagnostic survey method, using the survey technique. In order to obtain an answer to the main objective of the research, a questionnaire was constructed consisting of a general part (demographic data) and a detailed part (data concerning measurement tools).&#x0D; Results. It was found that 68 (73%) neurosurgical nurses use measuring tools (scales) to assess the condition of the patient in their professional practice. The most popular scales are: Glasgow Coma Scale — GCS (93 — 100% of responses), Barthel Index — BI (56 — 60% of responses), Kurtzke Extended Disability Status Scale (43 — 46% of responses) and Mini Mental State Examination (MMSE) (38 — 40% of responses). A statistically significant relationship was found between the use of measuring tools (scales) and education (&lt; 0.0001) and specialization by nurses (&lt; 0.0001). There was no dependence on age (p &lt; 0.05) and seniority (p &lt; 0.05) of nurses.&#x0D; Conclusions. More than half of the surveyed neurosurgical nurses use measuring tools (scales) in their professional practice to assess the patient’s condition. The most popular measuring tool (scale) is the Glasgow Coma Scale (GCS). A relationship was observed between education and specialization and the use of measuring tools (scales) to assess the condition of a patient in professional practice. (JNNN 2022;11(3):124–129)

The risk factors of neuropathic pain in neuromyelitis optica spectrum disorder: a retrospective case-cohort study

BackgroundNeuropathic pain is a common complication in neuromyelitis optica spectrum disorder (NMOSD), which seriously affects the quality of life of NMOSD patients, with no satisfactory treatment. And risk factors of neuropathic pain are still uncertain.ObjectiveTo investigate the risk factors of neuropathic pain in a NMOSD cohort.Materials and methodsOur study was a retrospective case-cohort study, the patients diagnosed with NMOSD in the Department of Neurology from the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2011 to October 2021 were screened. Inclusion criteria were: (1) patients diagnosed as NMOSD according to the International Panel for NMO Diagnosis (IPND) criteria, (2) the aquaporin-4 immunoglobulin G antibodies (AQP4-IgG) test was performed. Patients without AQP4-IgG antibody were excluded. Clinical data, including sex, age of the first onset, symptoms of the first episode including neuropathic pain and attack types, localization of lesions of the first episode on Magnetic Resonance Imaging (MRI), Extended disability status Scale (EDSS) of the first onset, treatment of immunosuppression in the first acute phase, disease modifying therapy (DMT), treatment of neuropathic pain and APQ4-IgG status were collected from the hospital system database. Neuropathic pain was defined according to the International Association for the Study of Pain criteria and was described as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system”.ResultsOne hundred nineteen patients were screened and finally 86 patients fulfilling the inclusion and exclusion criteria were enrolled in our study. The prevalence of neuropathic pain in patients with NMOSD was 43.0%. Univariate analysis showed that the factors associated with neuropathic pain were the age at the onset, the attack type of optic neuritis, the attack type of myelitis, length of spinal cord involvement, localization of thoracic lesion, optic lesion, upper thoracic lesions, lower thoracic lesions, extended spinal cord lesions (≥ 3 spinal lesions), extended thoracic lesions (≥ 4 thoracic lesions), intravenous immunoglobulin and mycophenolate mofetil. Multivariate regression analysis showed that extended thoracic lesions (OR 20.21 [1.18–346.05], P = 0.038) and age (OR 1.35 (1–1.81) P = 0.050) were independently associated with neuropathic pain among NMOSD patients and that gender (OR 12.11 (0.97–151.64) P = 0.053) might be associated with neuropathic pain among NMOSD patients.ConclusionExtended thoracic lesions (≥ 4 thoracic lesions), age and gender might be independent risk factors of neuropathic pain among patients with NMOSD. However, with a small sample size and predominantly female, caution must be applied and these results need validating in further cohorts.

Perivascular space is associated with brain atrophy in patients with multiple sclerosis.

Perivascular space (PVS) is associated with neurodegenerative and neuroimmune diseases. Multiple sclerosis (MS) is traditionally a neuroimmune disease. However, studies show neurodegeneration also plays a vital role in MS. At present, most studies conclude severer PVS in MS is an imaging marker of neuroinflammation, while a 7T MRI study suggests that PVS in MS is associated with neurodegeneration. In this study, 82 MS patients (n=82) and 32 healthy controls (n=32) were enrolled. The following indexes were measured: the number, size and distribution of PVS, the PVS score, corpus callosum index (CCI), corpus callosum area (CCA), the ratio of the corpus callosum to the cranium (CCR), aligned third ventricle width (a3VW), and unaligned third ventricle width (u3VW). The PVS score (4 vs. 3, P=0.041), PVSs number (103.280±45.107 vs. 87.625±30.139, P=0.035), and enlarged perivascular spaces (EPVSs) number (9 vs. 1, P<0.001) of MS patients were significantly higher than in the healthy controls. PVSs number (23.5 vs. 13) and EPVSs number (1 vs. 0) in the basal ganglia (BG), and EPVSs number (3 vs. 0) in centrum semiovale (CSO) of MS patients were significantly higher than in the healthy controls, P<0.001. In MS patients, PVS was correlated with age and hypertension but not to the extended disability status scale (EDSS) score and other clinical data. In MS patients, PVS score was correlated with CCA (rs=0.272; P=0.013) and the CCR (rs=0.219; P=0.048), and PVSs number was correlated with CCA (rs=0.255; P=0.021), the correlation disappeared after adjusting hypertension and age. In MS patients in remission, PVSs number was correlated with CCA (rs=0.487; P=0.019), CCR (rs=0.479; P=0.021), and PVS score was correlated with CCA (rs=0.453; P=0.03). After adjustment of hypertension and age, the total number of PVSs was correlated with CCA (rs=0.419; P=0.049). The PVS load in MS patients was heavier than healthy people, especially in BG and CSO. PVS was not correlated with EDSS in MS patients. The PVS of MS patients was associated with CCA and CCR, and PVSs number was independently related with CCA in MS patients in remission.

Therapeutics of integrative medicine ameliorate immunological disorders of the nervous system: A meta-analysis

Objective: The objective of the study is to evaluate the therapeutic efficacy of integrative medicine in the treatment of immunological disorders of the nervous system. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were adopted to conduct this study, which included randomized controlled trials with a confirmed diagnosis of multiple sclerosis (MS), myasthenia gravis (MG), and Guillain–Barre syndrome (GBS), all of which were treated with integrative medicine. The effective rate, recurrent frequency, and disease score were used as the markers of outcome variables for the meta-analysis. Results: A total of 48 randomized control trials were included. The effective rates of treatment with integrative medicine were noticeably higher than those with Western medicine alone for the three diseases. The recurrence frequency for MS and the recurrence rate for MG treated with integrative medicine were reduced more than those with Western medicine alone. The Extended Disability Status Scale, acetylcholine receptor antibody, and Hughes scores for MS, MG, and GBS, respectively, treated with integrative medicine were significantly lower than those with Western medicine alone. The risks of bias in the literature evaluation showed that the quality of the included studies was not high. Conclusions: Compared to treatment with Western medicine alone, integrative medicine might ameliorate immunological disorders of the nervous system.

Therapeutics of integrative medicine ameliorate immunological disorders of the nervous system: A meta-analysis

Objective: The objective of the study is to evaluate the therapeutic efficacy of integrative medicine in the treatment of immunological disorders of the nervous system. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were adopted to conduct this study, which included randomized controlled trials with a confirmed diagnosis of multiple sclerosis (MS), myasthenia gravis (MG), and Guillain–Barre syndrome (GBS), all of which were treated with integrative medicine. The effective rate, recurrent frequency, and disease score were used as the markers of outcome variables for the meta-analysis. Results: A total of 48 randomized control trials were included. The effective rates of treatment with integrative medicine were noticeably higher than those with Western medicine alone for the three diseases. The recurrence frequency for MS and the recurrence rate for MG treated with integrative medicine were reduced more than those with Western medicine alone. The Extended Disability Status Scale, acetylcholine receptor antibody, and Hughes scores for MS, MG, and GBS, respectively, treated with integrative medicine were significantly lower than those with Western medicine alone. The risks of bias in the literature evaluation showed that the quality of the included studies was not high. Conclusions: Compared to treatment with Western medicine alone, integrative medicine might ameliorate immunological disorders of the nervous system.