Family History Of Multiple Sclerosis Research Articles

Auto-Immune Diseases, Head and Neck Trauma, and Smoking Are Strong Predictors of Multiple Sclerosis.

Several health, environmental, and lifestyle-related factors have been separately linked to multiple sclerosis (MS) by different studies. However, these studies did not adequately account for the temporal association of these factors with MS while considering the influence of other variables in the analysis. A comprehensive investigation of these factors remains scarce. A hospital-based case-control study was carried out between Jun 2020 to Mar 2021 on 525 cases and 1050 controls frequently matched by age and sex. Cases and controls were selected at the same time and from the same centers (Motahari and Imam Reza referral centers) in Shiraz (the capital of Fars Province). Health, socio-demographic, and lifestyle status during adolescence were studied in this case-control study. The likelihood of having a history of autoimmune disease(s) (ORyes/no=15.67, P<0.001) and family history of MS (ORyes/no=11.57, P<0.001) were higher in cases. In addition, the likelihoods of reporting a history of head/neck traumas (ORhaving a history/no history=9.16, P<0.001), smoking (ORregular/other =2.24, P=0.008), and stressful events (ORyes/no=1.47, P=0.007) were higher among the case group. On the other hand, the odds of sun exposure (ORmost the time/seldom =0.14, P<0.001), physical activity (ORactive/inactive=0.45, P<0.001), and good quality sleep (OR=0.93, P<0.001) were significantly lower in the case group. This study provided a broad picture of the factors associated with MS, most of which were modifiable. Positive alterations to these factors through social and health educational programs are likely to reduce the burden of MS in Iran.

Epidemiological parameters of multiple sclerosis in Chaharmahal and Bakhtiari Province, Iran.

Background: Multiple sclerosis (MS) is a neurological disease with a high burden and disability. There are reports of various medications' side effects on patients with MS. The aim of the study is to determine the characteristics and medicine usage distribution among patients with MS in Chaharmahal and Bakhtiari Province in Iran. Methods: This registry-based cross-sectional study was performed among MS cases in Chaharmahal and Bakhtiari Province. The epidemiological data were collected from the nationwide MS registry of Iran (NMSRI) from 2019 to 2022. The information collected included age, sex, family history, type of MS, age at MS onset and diagnosis, MS symptoms, physical condition, and history of medication use. All tests were performed at a significance level of 0.05 using SPSS software. Results: A total of 416 patients included in this study. Among them, 325 individuals (78%) were women with mean ± standard deviation (SD) of age of 37.35 ± 8.51 years. No significant difference was observed between men and women in terms of age, type of MS disease, family history of MS, and physical condition (P > 0.05). The results showed that the Expanded Disability Status Scale (EDSS) score in female patients (1.41) was different from the EDSS score in male patients (1.77) (P < 0.05). Most of the patients often used interferon beta (IFN-β). Conclusion: The results provided new insight into the epidemiology and medicine patterns of patients with MS in Chaharmahal and Bakhtiari Province. The epidemiological situation of MS in this province is similar to other parts of Iran. Planning according to national programs is suggested for the management and control of MS.

Sociodemographic and Neuroimaging Evaluation of Patients with Multiple Sclerosis and Radiologically Isolated Syndrome in Isfahan, Iran

Background: Multiple sclerosis (MS) is categorized into four subtypes, including clinically-isolated syndrome (CIS), primary progressive multiple sclerosis (PPMS), secondary progressive multiple sclerosis (SPMS), and relapsing-remitting multiple sclerosis (RRMS). On the other hand, radiologically-isolated syndrome (RIS) is characterized by the imaging manifestations of MS rather than its clinical symptoms. Objectives: This study aimed to compare the sociodemographic and neuroimaging findings of different MS phenotypes and RIS. Methods: The current cross-sectional study was conducted on 3716 patients at the Multiple Sclerosis Clinic of Kashani Hospital, Isfahan, Iran, from June 2018 to April 2019. Patients presenting with RIS, CIS, and MS were included in this study. Results: The age of disease onset was remarkably lower in patients with RRMS, while the body mass index was significantly higher in RIS (P-value &lt; 0.05). Other factors, including gender, occupation, marital status, smoking, and family history of MS, showed no significant difference (P-value &gt; 0.05). Neuroimaging assessments revealed significant differences in terms of the location of the plaques, the activity of the plaques, brain atrophy, lesion load, the number of cervical plaques, and the presence of longitudinally-extended transverse myelitis (P-value &lt; 0.05), but not regarding the activity of cervical and thoracolumbar plaques and the number of thoracolumbar lesions (P-value &gt; 0.05). Conclusions: Different MS phenotypes showed variations in terms of sociodemographic and neuroimaging characteristics. Follow-up studies are recommended to determine the risk factors predicting the conversion of RIS and CIS to other MS phenotypes.

Awareness of the Saudi community toward multiple sclerosis in Al-Madinah Al- Munawarrah, Saudi Arabia

Background: Multiple sclerosis (MS) is an inflammatory neurodegenerative disease affecting the central nervous system (CNS); pathophysiological concepts revealed that exposure to some infectious agents during childhood and genetics involvement played a role. Data reported that females were more affected by MS than males due to genetic predisposition. Recent epidemiological data indicated a higher prevalence of MS in the Arabian Gulf region, with increasing incidence in the Kingdom of Saudi Arabia (KSA). Knowledge about MS shall aid in better management, diagnosis and treatment. This study aimed to assess the level of awareness about MS among participants in Al Madinah Al Munawarrah, KSA. Methods: This was a cross-sectional non-interventional observational survey questionnaire among 381 participants in Al Madinah. Results: The majority of participants were female aged more than 20 years old and high graded; 66.4% of the participants reported good awareness about MS, and 68% reported that MS impact the central nervous system, causing more illness among females aged between 20-39 years. Regarding the risk factors towards MS, Family history of MS and personal history of autoimmune diseases were on top of the list among the participants in relation to risk factors MS, with 43.3% and 38.1%, respectively. Conclusions: In summary, our study shed light on the lack of knowledge about MS among the adult population in Al Madinah AL Munawarrah, KSA. A better understanding of MS shall contribute towards better diagnosing and management.

Demographic and Clinical Characteristics of Familial and Sporadic Multiple Sclerosis Patients.

Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating, immune-mediated disease of the central nervous system. It is still unestablished whether heredity correlates with the disease's progression and severity. This study includes the patients with MS seen in the MS clinic of Kashani Hospital, affiliated with Isfahan University of Medical Sciences, from January 2019 to January 2020. We gathered data regarding the demographic and clinical characteristics, such as type of disease and family history of MS. Patients were grouped based on having relatives with MS. We compared demographic and clinical characteristics between those with a family history of MS (familial MS: FMS) and those without a family history of MS (sporadic MS: SMS). We included 2,929 MS patients, 523 (17.2%) with FMS and 2,406 (82.8%) with SMS. Patients with FMS were found to have active lesions in the thoracic spine more frequently than those with SMS (P = 0.022). We also found differences in the distribution of gender (P = 0.036) and the frequency of having active brain lesions (P = .024) among patients with FMS and SMS. No difference was found between the demographic/clinical characteristics and the number of affected relatives in the family. Significant differences were found among different groups of patients in terms of demographical and clinical characteristics.

The Assessment of the Prevalence and Disability Severity of Musculoskeletal Pain in Patients With Multiple Sclerosis in Saudi Arabia.

Background Multiple sclerosis (MS) is an autoimmune disease of the nervous system that causes chronic demyelination over time and may lead to physical disability. MS-related pain may be musculoskeletal, paroxysmal, or persistently neurogenic in nature. The most common type of pain is musculoskeletal discomfort, which is typically brought on by muscle weakening, stiffness, and generalized imbalance as the condition progresses. Pain often manifests after prolonged immobilization of muscles, tendons, and ligaments. Aim We aimed to evaluate the prevalence and severity of musculoskeletal pain (MSP) among MS patientsin Saudi Arabia. Methodology A quantitative cross-sectional study was conducted. Patients with confirmed MS in Saudi Arabia were invited to participate in the study during the duration fromApril 2022 to May 2022. Data were collected using an electronic collection tool. The study tool was checked to ensure the content validity and clarity of the Arabic and English versions. Results A total of 360 MS patients were included. Patients' ages ranged from 18 to 65 years with a mean age of 34.9±13.2 years old. Exactly 229 (63.6%) patients were females. A total of 104 (28.9%) patients complained of relapsing-remitting MS, 34 (9.4%) complained of primary progressive MS, and 16 (4.4%) complained of secondary progressive MS. A total of 138 (38.3%) patients had the disease for less than five years, and 14 (3.9%) had the disease for more than 21 years. Exactly 124 (34.4%) MS patients complained of high disability due to MSP, while 236 (65.6%) had low disability. Conclusions This study demonstrates that one out of each three patients with MS complained of pain with high disability associated with pain. Old age, comorbidities, long disease duration, and a family history of MS were significant determinants of associated disability severity.

Retrospective Evaluation of Demographic and Clinical Characteristics of Children with Multiple Sclerosis

Amaç: Bu retrospektif çalışma, multiple skleroz (MS) tanısı ile izlenen çocuk ve adölesan hastaların demografik ve klinik özelliklerini sunmak amacıyla yapılmıştır. Yöntem: Araştırma verileri, 10-25 Aralık 2021 tarihleri arasında İzmir’de bulunan üç hastanede izlenen pediatrik MS tanılı olguların, demografik verileri, başvuru yakınmaları, klinik bulguları veuygulanan tedavileri veri toplama formu ile retrospektif olarak elde edilmiştir. Bulgular: Bu retrospektif çalışmada 40 hastanın verileri incelenmiştir. Hastaların %77,5’i kız, yaş ortalaması 16 yaş ± 2,3 ve ilk atak yaş ortalaması 13,9 yaş olarak bulunmuştur. Hastaların yaklaşık yarısı interferon beta 1a subkutan, %27,5’i glatiramer asetat tedavisi aldığı ve ilaç kullanım sürelerinin ortalama 18 ay olduğu görülmüştür. Hastaların %20’si ise herhangi bir tedavi almamıştır. Tedavi alan hastaların %31,2’si ilaçtan dolayı yan etki yaşamış ve %15,6’sı yan etki nedeniyle tedaviye uyum sağlayamamıştır. Uyum sağlayamayan tüm hastaların tedavileri değiştirilmiştir. Çalışmada 3 olguda ailesel MS hastalığı öyküsü bulunmaktadır. Hastaların %72,5’i ilk ataklarında 3-10 gün intravenöz metilprednizolon tedavisi almış, tedavi alanların yarısından fazlası (%79,2) metilprednizolon tedavisi sonrası tama yakın/tamamen düzelme sağlamıştır. Hastaların %80’i relapsing-remitting MS ve %20’si klinik/radyolojik izole sendrom formundadır. Sonuç: Çocukluk çağında MS hastalığı, kızlarda daha sık ve en sık relapsing-remitting formunda görülmektedir. Çocukluk çağı MS tedavisinde büyük oranda interferon beta 1a ve glatiramer asetat kullanılmaktadır. İmmünomodülatör tedavi ile atak sayısında azalma, genişletilmiş özürlülük durum ölçeği puan ortalamasında düşme ile iyilik hali sağlanabilmektedir.

A Case of Chronic Relapsing Inflammatory Optic Neuropathy

Chronic relapsing inflammatory optic neuropathy (CRION) is a recently described form of recurrent isolated subacute optic neuropathy, with accumulating evidence that it is a nosological distinct entity. The condition is highly responsive to systemic steroid treatment and prone to relapse on steroid withdrawal. Diagnosis and management of this condition is often challenging. This 33-year-old lady with family history of multiple sclerosis (MS), with uniocular visual loss of her right eye since 2 years old without apparent cause, presented with reduction of vision and loss of colour vision in the left eye, associated with painful eye movement. There was internuclear ophthalmoplegia but slit lamp examination were unremarkable. She had no other related sensory or motor symptoms. Magnetic resonance imaging (MRI) did not reveal any features of MS. Aquaporin-4 antibody, anti-MOG and gene testing for Leber’s hereditary optic neuropathy were all negative. Metabolic, infective, and other autoimmune causes were also excluded. Visual evoked potential studies of left eye showed a mild reduction in amplitude with no prolongation of latency. Her multiple optic neuritis recurrences were treated with intravenous steroids followed by tapering regime of oral prednisolone with good effect. Knowledge of this rare condition as part of the differential diagnoses of possible aetiologies of optic neuropathy is important among Ophthalmologists, as prompt diagnosis and steroid treatment helped reduce the associated risk of blindness. Multiple relapses after initial successful treatment of inflammatory optic neuropathy should raise the suspicion of CRION.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S19

Radiologically isolated syndrome: A single-center, retrospective cohort study

BackgroundRadiologically Isolated Syndrome (RIS) likely represents the earliest detectable form of multiple sclerosis (MS). There are recognized risk factors for conversion of RIS to clinically definite central nervous system (CNS) demyelinating disease. We aim to characterize a new clinical cohort with RIS and to analyze previously established risk factors for conversion to clinically definite disease. MethodsA medical records search was performed for patients who were diagnosed with RIS by their treating neurologist at our institution in Boston, USA, from January 2005 to April 2020. Demographic data, clinical outcomes, and treatment courses were analyzed. The time to first clinical event representing a demyelinating disease attack or last follow up without clinically definite disease was calculated for each person. Hazard ratios (HRs) for known risk factors for the conversion of RIS to clinically definite disease were calculated using Cox proportional hazards models. ResultsOf 89 patients, the median age at RIS diagnosis was 41.0 years (76% female, 8% with a family history of MS and 16% of any autoimmune disorder, 66% never smokers, 40% BMI >30 kg/m2, 45% with spinal cord MRI lesions). Clinically definite disease was observed in 16 patients (18%) during follow-up (median time to first event 3.4 years; median follow-up duration of full cohort 3.8 years). Median EDSS for those who developed clinically definite disease was 1.25 (range: 0–4) at most recent follow up. Of 84 patients with longitudinal brain imaging, 42 (50%) had new demyelinating lesions. Gadolinium-enhancing lesions were seen in 36 patients (43%) at either baseline (n=24) or follow-up (n=12). Most patients had at least one T1-hypointense lesion (n=70, 83%). Five patients underwent ultra-high field MRI (7 Tesla); all were positive for central vein sign, two demonstrated leptomeningeal enhancement, and one was found to have cortical lesions. Out of 30 patients with susceptibility-weighted imaging acquired during routine clinical care, 8 had at least one paramagnetic rim positive lesion. Previously reported risk factors for conversion to MS were not significant: age ≤37 years HR 1.3 (95% confidence interval (CI), 0.47–3.5), male sex 1.5 (95% CI, 0.41–5.2), and spinal cord lesions 1.3 (0.47–3.4). Nearly one-third of RIS patients (n=26) took a disease modifying therapy (DMT) for MS (median total treatment duration on any DMT=2.7 years). The sub-cohort treated with a DMT had a statistically significantly greater number of recognized risk factors for conversion to clinically definite disease compared with the untreated group (p=0.028). Most patients took a DMT for MRI changes demonstrating new demyelinating disease activity (n=16). Dimethyl fumarate (n=9) and glatiramer acetate (n=7) were the most frequently prescribed DMTs. A second-line DMT was started in 10 patients. ConclusionWe characterize a new cohort of RIS patients, demonstrating time to clinically evident demyelinating disease from RIS diagnosis of approximately 3.4 years. Our data suggest that early use of a DMT in RIS may mitigate the impact of recognized risk factors on the occurrence of clinically evident disease and reduce the likelihood of conversion to clinically definite CNS demyelinating disease in high-risk individuals.

Quality of life, disability level and nutritional status among Multiple sclerosis patients

Background: The most severe form of nervous dysfunction among young individuals is Multiple sclerosis (MS). Symptoms usually appear at (15–40) years of age.MS is identified as an affective disorder in patients for a long time, characterized by current nervous system (NS) injury structure and rising accumulative damage.Recent years have seen a rise in the number of MS. This affects more than two million individuals every year in the world. Methods: Ethical approval for this study was granted by the Ethics Committee for the Medical Research/University of Mosul. This was a retrospective and a hospital-based study performed. In the latter, MS patients' medical records fulfilling the McDonald diagnostic criteria were analyzed, and both demographics and clinical characteristics were reviewed. We did exclude patients with neuromyelitis optica and isolated transverse myelitis. A retrospective study design was applied in Ibn-Sina Teaching Hospital, City of Mosul, Iraq. Results:This section summarizes the main findings of this research. Identified 500 patients who fulfilled our criteria for having MS. The crude estimated Prevalence of MS in the Mosul population was thus 50/100,000. The research population's demographic and clinical characteristics were identified and found a positive first or second-degree family history of MS at least 11.4% of Mosul patients. Conclusion:Based on the assumptions and previous studies that patients with multiple sclerosis in Mosul suffer from milder disease severity than those in western countries, it was surprising that half of the patients suffer from gait disability.

Awareness of Saudi community toward multiple sclerosis in Qassim Region, Saudi Arabia.

Objectives:To evaluate the awareness of Saudis in Qassim region, Saudi Arabia on multiple sclerosis (MS).Methods:A cross-sectional study was conducted on 350 Saudis in Qassim, Saudi Arabia between January 2019 and June 2019 using a pre-designed questionnaire including socio-demographic data and questions evaluating knowledge about MS.Results:The majority of studied participants were adult females (74%), between 20-30 year-old (45.1%) and with high education level or above (80.6%). Nearly one third of the studied group had good knowledge regarding MS (31.7%). Half of the studied group knew that central nervous system (CNS) is the system affected by MS, 52% reported that vitamin D deficiency, family history of MS, personal history of autoimmune disease, viruses, and obesity are the factors which increase the risk of developing MS. Approximately, 62.9% knew that blurred and double vision, numbness, paralysis or weakness and difficulty in concentration and memorizing are symptoms of MS. Female participants and those knowing someone having MS had a significant good knowledge level regarding MS than others. Getting knowledge from combined sources from internet or social media; family, friends or neighbors and health workers was significantly more prevalent among those with good knowledge.Conclusion:Most of the study participants had limited knowledge regarding MS. Planning health education programs for the public is essential.

Assessment of delayed diagnosis and treatment in multiple sclerosis patients during 1990-2016.

Multiple sclerosis (MS) is the most common inflammatory demyelinating disease in the central nervous system. It is one of the major causes of disability in young adults. Early diagnosis and treatment of this disease could decrease later disability and additional costs. In this cross-sectional analytical study, a total of 351 patients were selected from among the multiple sclerosis patients that went to MS clinic or neurologic clinic in 1990-2016. Data were collected and analysed by SPSS v16. This study was conducted on 82.6% females and 17.4% males. Family history of MS was positive in 12.8% of cases. Mean time of onset of symptoms till first medical visit was 3.25months. Mean time from first medical visit to diagnosis was 14.98months. Mean time from onset of symptoms till diagnosis was 18.01months and the mean time from onset of symptoms till initiation of treatment was 18.73months. Also, 29.3% of cases had delay in first medical visit and 42.2% of cases had delay in diagnosis of MS more than 6weeks from first medical visit. Overall, delay in first medical visit and diagnosis of MS has decreased over the years. However, there is still delay in diagnosis of MS. Factors associated with delay are low education, male gender, living in rural areas, primary progressive MS, age at MS diagnosis and first clinical symptoms.

A matched case-control study of risk factors associated with multiple sclerosis in Kuwait

BackgroundGenetic and environmental factors seem to have etiologic roles in multiple sclerosis (MS). Kuwait is regarded as medium to high risk country for MS. However, there is a paucity of published data on the risk factors for MS in Kuwait. Therefore, this matched case-control study examined the association between various factors including family history, stressful life events, exposure to tobacco smoke, vaccination history, comorbidities and MS risk in Kuwait.MethodsConfirmed 110 MS cases and age (± 5 years), gender and nationality matched controls (1:1) were enrolled. A pre-tested structured questionnaire was used to collect the data through face-to-face interviews both from cases and controls. Conditional logistic regression was used to analyze the data.ResultsAmong both cases and controls, majority were Kuwaiti (82.7%), and female (76.4%). Multivariable model showed that cases compared to controls were significantly more likely to have had a family history of MS (adjusted matched odds ratio (mORadj) = 5.1; 95% CI: 2.1–12.4; p < 0.001) or less likely to have been vaccinated against influenza A and B viruses before MS onset (mORadj = 0.4; 95% CI: 0.2–0.8; p = 0.010). None of the other variables considered were significantly related to MS status in this study.ConclusionsFamily history of MS had significantly direct, whereas, vaccination against influenza A and B viruses had inverse associations with MS status. Future studies may contemplate to verify the observed results.

European Respiratory Journal, list of peer reviewers 2019.

<h3>Objective:</h3> To investigate the role of known multiple sclerosis (MS)-associated genetic variants in MS familial aggregation, clinical expression, and accuracy of disease prediction in sporadic and familial cases. <h3>Methods:</h3> A total of 1,443 consecutive patients were screened for MS and familial autoimmune history in a hospital-based Italian cohort. Among them, 461 sporadic and 93 familial probands were genotyped for 107 MS-associated polymorphisms. Their effect sizes were combined to calculate the weighted genetic risk score (wGRS). <h3>Results:</h3> Family history of MS was reported by 17.2% of probands, and 33.8% reported a familial autoimmune disorder, with autoimmune thyroiditis and psoriasis being the most frequent. No difference in wGRS was observed between sporadic and familial MS cases. In contrast, a lower wGRS was observed in probands with greater familial aggregation (&gt;1 first-degree relative or &gt;2 relatives with MS) (<i>p</i> = 0.03). Also, female probands of familial cases with greater familial aggregation had a lower wGRS than sporadic cases (<i>p</i> = 0.0009) and male probands of familial cases (<i>p</i> = 0.04). An inverse correlation between wGRS and age at onset was observed (<i>p</i> = 0.05). The predictive performance of the genetic model including all known MS variants was modest but greater in sporadic vs familial cases (area under the curve = 0.63 and 0.57). <h3>Conclusions:</h3> Additional variants outside the known MS-associated loci, rare variants, and/or environmental factors may explain disease occurrence within families; in females, hormonal and epigenetic factors probably have a predominant role in explaining familial aggregation. The inclusion of these additional factors in future versions of aggregated genetic measures could improve their predictive ability.

Prevalence of Multiple Sclerosis (MS) in Zanjan Province of Iran.

Background:The prevalence of multiple sclerosis (MS) varies in different geographical regions and has dramatically increased in Iran. Revealing the high prevalence rate draws the attention of policymakers and helps them allocate necessary resources. The aim of this study is to determine the prevalence of MS in Zanjan province of Iran.Methods:We included all registered residents of Zanjan province with MS on the prevalence day (July 31, 2019). All cases met the McDonald criteria. All registered cases in Zanjan MS society were identified as index cases. Data regarding patient's national code, gender, age, age at the first symptom onset, city of residence, marital status, education level, occupation, ethnicity, family history of MS and the time span between symptom's onset and disease diagnosis were recorded.Results:We identified 758 patients, 551 of whom (72.7%) were female. The mean age at the first symptom onset was 28.9 ±8.7 years old. The crude prevalence was 71.6 per 100,000 population (95% CI 66.6–76.9). The disease was most prevalent in Zanjan city (100.5 per 100,000). The gender-specific prevalence per 100,000 population was 105.4 for women (95% CI: 96.8–114.6) and 38.7 for men (95% CI: 33.6–44.1), with female to male ratio of 2.6. The standardized mortality ratio (SMR) was calculated as expected/observed for both men and women as 2.3 (207/88.2) (551/234.1).Conclusions:Our data confirm that the MS prevalence rate is high in Zanjan province of Iran.

DEMOGRAPHIC, CLINICAL AND PARACLINICAL CHARACTERISTICS OF A SAMPLE OF EGYPTIAN MULTIPLE SCLEROSIS (MS) PATIENTS ATTENDING MS CLINIC IN AL-AZHAR UNIVERSITY HOSPITALS

Background: Multiple sclerosis is an autoimmune inflammatory demyelinating disorder, affecting people in the most productive period in their lives with more predilection to affect females more than males, many demographic studies of multiple sclerosis had been done in many western countries, in the middle east particularly in Arabic countries multiple sclerosis now being heavily studied in all aspects ofthe disorder after the incidence of multiple sclerosis has been increased. Objective: The aim of this work was to study the clinical and paraclinical characteristics of patients with multiple sclerosis (MS) attending Al-azhar university hospitals, (Al-Hussein and Bab-El-Sherya) along the time of the study (from April 2017 to April 2019) aiming for better management and rehabilitation of Multiple sclerosis patients to improve their quality of life. Patients and Methods: This was a cross sectional descriptive study carried on 400 definite multiple sclerosis patients who were recruited from Al-Azhar university hospitals diagnosed according to revised McDonald's criteria 2017. Results: The current study included 400 MS patients, 113 were males and 287 were females, the main age of disease onset was 28.42±8.48, the motor manifestations was the most common presenting manifestation, followed by optic neuritis then the sensory manifestations, the relapsing remitting phenotype was the commonest phenotype, the family history of MS was positive in 2% in the current study, we observed a statistically significant difference between MS patients as regard MS phenotype and the sex of the patient, age and the total EDSS, first clinical symptoms and the total EDSS, time to 2nd clinical event and the total EDSS and the lesions in the spinal cord and the total EDSS. Conclusion: The first clinical presentation of MS affects the patient EDSS, patients with visual and sensory presentation had commonly lower EDSS, compared to patients with motor presentation had commonly higher EDSS.

Multiple sclerosis national registry system in Iran: Validity and reliability of a minimum data set

BackgroundAs the prevalence and incidence of Multiple Sclerosis (MS) are increasing remarkably in Iran, gathering standardized information regarding the individual's diagnosis, care, and outcomes through a uniform registry system would enable policy-makers to systematically plan for care quality improvements. ObjectiveTo design a valid and reliable Persian version of a minimum data set to be utilized and integrated into the national MS registry system of Iran. MethodThe minimum data set consisted of six domains including patient identification, family history of MS, diagnosis, disease course, disability status, and medications. The content validity was assessed based on 27 experts’ opinions. Item-Content Validity Index (I-CVI) and Scale-Content Validity Index (S-CVI) were used to assess the questions and their validities. Reliability was evaluated using the intra-class correlation coefficient (ICC) of the test-retest results. ResultsFor validity appraisal, 27 experts reviewed the developed minimum data set. All the items had I-CVI values higher than the critical value of 0.78 in terms of relevance, clarity, and simplicity, except for “medication start date” and “medication end date” in relevance (I-CVI = 0.75 and 0.73, respectively) and “MS type” in simplicity (I-CVI = 0.76). The total S-CVI scores for relevance, clarity, and simplicity were higher than 0.9. In reliability assessment, 27 patients (out of 74 interviewed patients) were re-interviewed to assess the test-retest reliability. All ICCs were higher than the critical value of 0.7 (in 14 items out of 16), except for “progression to secondary-progressive MS” with the ICC = 0.68 and “the reason for medication discontinuance” with the ICC = 0.64. ConclusionThe use of standardized validated minimum data set has the potential to enable the researchers and policy-makers to systematically compare and analyze patient information. The Persian version of the minimum data set found to be valid and reliable in Iran.

Association Between Exposure of Ipratropium and Salmeterol and Diagnosis of Multiple Sclerosis: A Matched Case–control Study

PurposeIpratropium and salmeterol were found to stimulate oligodendrocyte differentiation in a high-throughput drug screening assay; thus, they may play a role in the risk reduction of multiple sclerosis (MS). So far, they have not been examined in any clinical data. This study aims at investigating the association between ipratropium and salmeterol and reduced diagnosis of MS with the use of real-world clinical data. MethodsWe conducted a 1:10 matched case–control study that compared the exposure of ipratropium and salmeterol between patients with MS and control patients over the past 2 years, using the MS Flowsheet Registry of OSF HealthCare Saint Francis Medical Center. Cases were matched to control patients, based on service year/quarter, age, sex, race, and payer type. The relationship was examined with a Poisson regression model and a generalized structural equation model. FindingsThe sample in our analysis included 217 patients with MS and 2164 matched control patients. The mean (SD) age for both patients with MS and control patients was 41 (11.8) years with a range of 18 to 75 years. The MS group had consistently less prescriptions of ipratropium and salmeterol than the control group in the past 1, 2, and 3 years before the index date. Our multivariable analysis found that the control group had 3.2 more prescriptions (95% CI, 1.4–7.1; P = 0.006) of either ipratropium or salmeterol in the past 2 years than the MS group, even if controlling for other confounders. In the generalized structural equation model, we found that use of ipratropium and salmeterol was significantly associated with reduced diagnosis of MS (P = 0.036), whereas smokers and people with family history of MS were more likely to have a diagnosis of MS (P < 0.001). ImplicationsThe observed association between ipratropium and salmeterol use and reduced diagnosis of MS indicates that they might potentially serve as agents in the treatment of MS.

Characteristics of pediatric multiple sclerosis: The Turkish pediatric multiple sclerosis database.

To document the clinical and paraclinical features of pediatric multiple sclerosis (MS) in Turkey. Data of MS patients with onset before age 18 years (n=193) were collected from 27 pediatric neurology centers throughout Turkey. Earlier-onset (<12 years) and later-onset (≥12 years) groups were compared. There were 123 (63.7%) girls and 70 (36.3%) boys aged 4-17 years, median 14years at disease onset. Family history of MS was 6.5%. The first presentation was polysymptomatic in 55.4% of patients, with brainstem syndromes (50.3%), sensory disturbances (44%), motor symptoms (33.2%), and optic neuritis (26.4%) as common initial manifestations. Nineteen children had facial paralysis and 10 had epileptic seizures at first attack; 21 (11%) were initially diagnosed with acute disseminated encephalomyelitis (ADEM). Oligoclonal bands were identified in 68% of patients. Magnetic resonance imaging revealed periventricular (96%), cortical/juxtacortical (64.2%), brainstem (63%), cerebellum (51.4%), and spinal cord (67%) involvement. Visual evoked potentials (VEP) were abnormal in 52%; serum 25-hydroxyvitamin D levels were low in 68.5% of patients. The earlier-onset group had a higher rate of infection/vaccination preceding initial attack, initial diagnosis of ADEM, longer interval between first 2 attacks, and more disability accumulating in the first 3 years of the disease. Brainstem and cerebellum are common sites of clinical and radiological involvement in pediatric-onset MS. VEP abnormalities are frequent even in patients without history of optic neuropathy. Vitamin D status does not appear to affect the course in early disease. MS beginning before 12 years of age has certain characteristics in history and course.

The First Hospital-Based Registry of Patients with Multiple Sclerosis in Croatia.

The first hospital-based registry of patients with multiple sclerosis (MS) was established at the University Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia, in 2014. The aim of the registry was to continuously provide data on the number of hospital-managed MS patients, patterns of disease progression, predictors of disability progression, changes in lifespan and long-term outcomes. Relevant medical data included age and gender of MS patients, family history of MS, data on previous immunization, disease course, Expanded Disability Status Scale (EDSS) score, cerebral magnetic resonance imaging (MRI) lesion load quantification, and cerebrospinal fluid analysis. Lifestyle habits in MS patients including smoking and alcohol consumption were also analyzed. All data were obtained from primary medical records between January 1, 2014 and January 1, 2015, and entered into the database. Data were evaluated retrospectively according to age and gender differences. Results showed that the majority of patients enrolled in the registry had the remitting relapsing course of disease, with low EDSS score indicating no disability or minimal disability. Cerebrospinal fluid analysis showed that oligoclonal bands were present in the majority of MS patients, with affected blood-brain-barrier permeability. According to the remitting relapsing course of the disease, cerebral MRI quantitative analysis demonstrated a significant lesion load in the majority of patients. When stratified by lifestyle habits, smokers and alcohol consumers were more prevalent among male patients. Our hospital-based registry might be considered as a prototype for the national MS registry and should be improved for reliable statistical analysis.