Performance In Multiple Sclerosis Patients Research Articles

Can Robotic Gait Training with End Effectors Improve Lower-Limb Functions in Patients Affected by Multiple Sclerosis? Results from a Retrospective Case-Control Study.

Background: Multiple sclerosis (MS) is characterized as a neurodegenerative condition possibly triggered by autoimmune mechanisms, impacting the entire central nervous system. In this context, neurorehabilitation plays a crucial role in every phase of the disease, aiming to restore and preserve motor functions in MS patients. In particular, robotic gait training (RGT) allows intensive, repetitive, and task-oriented training, which is pivotal in boosting neuroplastic processes. Thus, the primary aim of our study is to evaluate the effectiveness of innovative robotic gait training, using the G-EO system, on gait, functional abilities, and quality of life (QoL) in patients affected by MS. Secondly, we evaluated the effect of the robotic rehabilitation on lower-limb motor functioning, balance, sensation, and joint functioning. Methods: The study involved twenty MS patients, divided into two groups with comparable medical characteristics and rehabilitation training duration. The experimental group (EG) underwent robotic gait training with the G-EO system (n. 10), while the control group (CG) received traditional rehabilitation training (n. 10). Results: Both groups exhibited improvements in disability level (Functional Independence Measure), 10 m walking distance (10MWT), gait, and balance performance (Functional Ambulation Classification, Tinetti Scale). However, the EG demonstrated a more significant improvement. The G-EO system notably reduced spasticity in the lower limbs (Modified Ashworth Scale) exclusively in the EG. Discussion: This study suggests that the G-EO system could be a valuable tool for enhancing gait functions, including lower-limb movements, functional abilities, and QoL in individuals with MS.

Influence of rehabilitation with the use of sulphide and hydrogen sulphide baths on the concentration of the brain-derived neurotrophic factor (BDNF) and selected parameters of cognitive, executive and affect functions in multiple sclerosis patients

Aim: To compare the blood serum BDNF concentration in MS patients before and after a standard three-week rehabilitation offered by the NHF. The study compared the expected growth of the BDNF concentration in a group of patients rehabilitated with the help of standard kinesiotherapy and a group of patients rehabilitated with kinesiotherapy plus sulphide and hydro sulphide baths as well as the results of the assessment of the cognitive and executive functions of MS patients in the two groups. Materials and methods: Participants in the study were divided into 3 groups of 20 people each. Group 1. MS patients rehabilitated for 3 weeks in the Day Ward of the Rehabilitation Clinic – standard kinesiotherapy. Group 2. MS patients rehabilitated for 3 weeks in the Day Ward of the Rehabilitation Clinic – kinesiotherapy with sulphide baths. Group 3. Healthy volunteers – occasional BDNF determination. In the group of MS patients the BDNF concentration was determined prior to and after the rehabilitation. Group 3 was monitored for BDNF levels initially lower than in MS patients. Results: Rehabilitation of MS patients with kinesiotherapy and sulphide baths causes a statistically higher growth of BDNF concentration than rehabilitation alone in this group of patients (p<0.001). Results of neuropsychological tests of MS patients rehabilitated with kinesiotherapy and balneotherapy elements are statistically better than of patients rehabilitated with kinesiotherapy (p<0.033). Conclusions: Research findings show that sulphide and hydro sulphuric baths seem to be a valuable supplement to MS patients’ rehabilitation.

Neurofilament and Brain Atrophy and Their Association with Cognition in Multiple Sclerosis: A 10-Year Follow-Up Study

Introduction. Cognitive impairment is an important contributor to disability in multiple sclerosis (MS). Disconnection of neuronal circuits due to axonal injury is probably an important underlying mechanism for this disability. Neurofilament light chain (NfL) is a neuron-specific constituent of axons and has gained increasing attention as a biomarker of axonal injury. Objective. To assess the association between NfL in serum (sNfL) and cerebrospinal fluid (cNfL) and cognitive function over 10 years and compare these associations with volumetric brain magnetic resonance imaging (MRI) measurements. Methods. Newly diagnosed MS patients were followed prospectively with baseline NfL and MRI as well as with clinical and cognitive assessments for up to 10 years. Results. Forty-one patients were included. Baseline sNfL correlated negatively with symbol digit modalities test (SDMT) at baseline (r=−0.45, p=0.005), year 5 (r=−0.41, p=0.017), and at year 10 (r=−0.52, p=0.008). Baseline cNfL correlated with baseline SDMT (r=−0.34, p=0.030) and SDMT at year 10 (r=−0.44, p=0.037). Baseline volumes of whole brain (r=0.476, p=0.002), gray matter (r=0.467, p=0.002), T1 (r=−0.627, p<0.001), and T2 lesion volumes (r=−0.475, p=0.002) correlated significantly with baseline SDMT. Longitudinal analyses showed that both MRI volumes and EDSS were associated with the rate of SDMT decline, whereas sNfL and cNfL were not. Conclusion. NfL levels measured in serum and cerebrospinal fluid were both associated with cognitive functioning in MS patients over a 10-year period from diagnosis. However, MRI volumes correlated strongly in addition to the rate of cognitive decline.

Investigating the association between vitamin D levels and cognitive function in multiple sclerosis patients: A cross-sectional study

Investigating the association between vitamin D levels and cognitive function in multiple sclerosis patients: A cross-sectional study

Association of the BDNF rs6265 Polymorphism with Cognitive Impairment in Multiple Sclerosis: A Case-Control Study in Mexican Patients.

Cognition is a set of brain processes that allow the individual to interact with their environment. Multiple sclerosis (MS) is a chronic inflammatory disease that affects the cerebral white matter of the brain cortex and spinal cord, leading to cognitive impairment (CI) in 40-60% of the patients. Many studies have determined that CI is linked to genetic risk factors. We aimed to evaluate the association between BDNF gene rs6265 polymorphism and cognitive impairment in Mexican patients with MS by performing a case-control study. Mestizo-Mexican patients diagnosed with MS based on McDonald's criteria were enrolled. Cases were MS patients with CI (n = 31) while controls were MS patients without CI (n = 31). To measure cognitive functioning in MS patients, a neuropsychological screening battery for MS (NSB-MS) was used. Genotyping of the rs6265 gene variant was performed using quantitative real-time PCR (qPCR) with TaqMan probes. The results showed no statistically significant differences in sociodemographic and disease variables between case and control groups. qPCR analysis showed that there were 68% Val/Val wild-type homozygotes, 29% Val/Met polymorphic heterozygotes, and 3% Met/Met polymorphic homozygotes. The presence of BDNF gene rs6265 polymorphism showed an increased probability (3.6 times) of global cognitive impairment.

Assessment of Thyroid Functions in Multiple Sclerosis Patients Treated with Disease Modifying Therapies

Background:
 Multiple sclerosis is a chronic disease believed to be the result of autoimmune disorders of the central nervous system, characterised by inflammation, demyelination, and axonal transection, affecting primarily young adults. Disease modifying therapies have become widely used, and the rapid development of these drugs highlighted the need to update our knowledge on their short- and long-term safety profile.
 Objective:
 The study aim is to evaluate the impact of disease-modifying treatments on thyroid functions and thyroid autoantibodies with subsequent effects on the outcome of the disease.
 Materials and Methods:
 A retro prospective study enrolled 45 patients who were registered and diagnosed in the Multiple Sclerosis Clinic according to the revised McDonald criteria (2017). Blood samples for thyroid functions and thyroid autoantibody tests were taken before, 3 months and after 6 months from the start of disease modifying therapy. The Expanded Disability Status Scale was used to assess the severity of the disease before and after 6 months of receiving treatment.
 Results:
 45 patients with the mean age of 33.3 years, a standard deviation (SD) of ± 9.5 years were enrolled in this study. (64.4%) patients’ age was between 20 - 39 years.
 The mean free T3 decreased significantly, while the mean anti-TPO and anti-TG increased after three months compared to its baseline level.
 After six months of treatment, the mean free T4 decreased significantly, while the mean TSH increased compared to its baseline level. There were no statistically significant correlations between the baseline (EDSS) score and after 6 months of therapy.
 Conclusion
 Thyroid hormone dysfunction and thyroid autoimmune antibody levels that changed in response to interferon beta therapy in patients with multiple sclerosis may be temporary and not associated with poor outcomes.

Virtual reality in upper extremity rehabilitation of Multiple Sclerosis patients

Background: Virtual reality (VR) has emerged as a promising approach in the field of healthcare, particularly in the context of multiple sclerosis (MS), offering new possibilities for rehabilitation and improving the quality of life for individuals affected by this chronic neurological condition. Methods: The electronic databases PubMed, Google Scholar, and PEDro were thoroughly searched using medical subject headings and free text related to multiple sclerosis, virtual reality, upper limb, and rehabilitation. The review followed the PRISMA guidelines. Results: A total of 4 articles were included in the review. These articles examined the effects of VR in upper limb rehabilitation on patients with MS. The majority (n=2) of the studies compared VR with usual care, while one examined tele-VR and one with non-serious games. Conclusion: VR interventions have shown promise in enhancing manual dexterity, upper limb rehabilitation, and arm function in MS patients. The use of serious games for arm rehabilitation has also demonstrated potential benefits in improving functional outcomes in MS patients.

Insights into the mechanism of oligodendrocyte protection and remyelination enhancement by the integrated stress response.

central nervous system (CNS) inflammation triggers activation of the integrated stress response (ISR). We previously reported that prolonging the ISR protects remyelinating oligodendrocytes and promotes remyelination in the presence of inflammation. However, the exact mechanisms through which this occurs remain unknown. Here, we investigated whether the ISR modulator Sephin1 in combination with the oligodendrocyte differentiation enhancing reagent bazedoxifene (BZA) is able to accelerate remyelination under inflammation, and the underlying mechanisms mediating this pathway. We find that the combined treatment of Sephin1 and BZA is sufficient to accelerate early-stage remyelination in mice with ectopic IFN-γ expression in the CNS. IFN-γ, which is a critical inflammatory cytokine in multiple sclerosis (MS), inhibits oligodendrocyte precursor cell (OPC) differentiation in culture and triggers a mild ISR. Mechanistically, we further show that BZA promotes OPC differentiation in the presence of IFN-γ, while Sephin1 enhances the IFN-γ-induced ISR by reducing protein synthesis and increasing RNA stress granule formation in differentiating oligodendrocytes. Finally, pharmacological suppression of the ISR blocks stress granule formation in vitro and partially lessens the beneficial effect of Sephin1 on disease progression in a mouse model of MS, experimental autoimmune encephalitis (EAE). Overall, our findings uncover distinct mechanisms of action of BZA and Sephin1 on oligodendrocyte lineage cells under inflammatory stress, suggesting that a combination therapy may effectively promote restoring neuronal function in MS patients.

Antioxidant supplements and cognition in Multiple Sclerosis: a systematic review (P14-3.003)

<h3>Objective:</h3> We aimed to conduct a systematic review to examine whether there is an association between antioxidants supplements and cognitive performance in MS patients. <h3>Background:</h3> Cognitive dysfunction is a debilitating characteristic of multiple sclerosis (MS) that affects approximately 60% of patients. To date, the only effective treatments for cognitive decline are cognitive rehabilitation and exercise training. While previous studies reported the beneficial effect of antioxidants on MS patients, several other studies investigated the effect of antioxidant supplements on the cognitive performance of MS patients. <h3>Design/Methods:</h3> We searched PubMed, Embase, Scopus, and Web of Science for the identification of relevant studies in November 2021. We included control trials, cohort, case-control, and cross-sectional studies which showed the effect of any type of antioxidants on cognitive performance in MS patients. <h3>Results:</h3> After screening 12 papers were included in our study. Our review included three studies that examined the effect of ginkgo Biloba on cognitive performance, two examined the Mediterranean diet, and remained studies each investigated the vitamin A, Omega 5, Omega 3, estriol, epigallocatechin-3-gallate (EGCG), Boswellia papyrifera, and paleolithic diet. Overall, it seems that there were no benefits for antioxidant administration on cognitive performance in MS patients. <h3>Conclusions:</h3> It is complicated to draw a conclusion regarding the effect of an antioxidant-containing regimen and cognitive performance in MS patients. Findings from included studies failed to unequivocally support the beneficial effect of antioxidant consumption on cognitive performance in MS patients. <b>Disclosure:</b> Mr. Nabizadeh has nothing to disclose.

Time-Varying Functional Connectivity of the Hippocampus Is Associated With Cognitive Performance in Multiple Sclerosis Patients (P10-3.014)

<h3>Objective:</h3> To explore hippocampal static (sFC) and time-varying functional connectivity (TVFC) and assess their association with cognition in multiple sclerosis (MS). <h3>Background:</h3> The hippocampus has a key role in cognition. Hippocampal TVFC in MS needs to be further explored. <h3>Design/Methods:</h3> 3T structural and resting-state (RS) functional MRI scans were acquired from 108 MS patients and 63 healthy controls (HC). Subjects underwent neuropsychological evaluation. Sliding-window correlation analysis using the left (L) and right (R) hippocampus as seed regions assessed TVFC, quantified by the standard deviation of connectivity across windows. Mean connectivity indicated sFC. <h3>Results:</h3> MS patients had decreased sFC <i>vs</i> HC between L hippocampus and temporo-parietal regions, and increased sFC between L and R hippocampus and thalamus, precuneus and superior frontal regions. TVFC was decreased in MS patients between L hippocampus and temporo-parietal regions. Conversely, TVFC was increased in MS patients between L and R hippocampus and L pre- and postcentral gyri, cuneus, orbitofrontal cortex and inferior temporal gyrus (ITG). In MS patients, better global cognition correlated with higher TVFC between L hippocampus and L pre- and postcentral gyri (r=0.21–0.28; p=0.04–0.006). Better verbal memory correlated with higher TVFC between L hippocampus and L precentral gyrus (r=0.21, p=0.03), and better visuospatial memory correlated with higher TVFC between L and R hippocampus and L cuneus, pre- and postcentral gyri and ITG (r=0.19–0.23, p=0.02–0.04). Better information processing speed correlated with higher TVFC between L hippocampus and L postcentral gyrus (r=0.21, p=0.03) and with higher sFC between R hippocampus and L superior frontal cortex (SFC) (r=0.21, p=0.03). Finally, better attention scores correlated with higher TVFC between L hippocampus and L temporal cortex (r=0.24, p=0.01) and with higher sFC between R hippocampus and L SFC (r=0.20, p=0.05). <h3>Conclusions:</h3> Increased hippocampal connectivity contributed to explain better cognitive performances in MS, with a peculiar association between higher hippocampal TVFC and better memory scores. <b>Disclosure:</b> Monica Margoni has received research support from MAGNIMS. Paola Valsasina has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for ACCMED. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol Myers Squibb . Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi Genzyme. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. Olga Marchesi has nothing to disclose. Carmen Vizzino has nothing to disclose. Damiano Mistri has nothing to disclose. Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bayer, Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme, Takeda, and Teva Pharmaceutical Industries. Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Bayer, Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme, Takeda, and Teva Pharmaceutical Industries. Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Filippi has received research support from Biogen Idec, Merck-Serono, Novartis, Roche, Teva Pharmaceutical Industries, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA). Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer, Biogen, Bristol Myers Squibb, Celgene, Genzyme, Merck Serono, Novartis, Roche, and Teva. The institution of Maria Assunta Rocca has received research support from Italian Ministry of Health, MS Society of Canada and Fondazione Italiana Sclerosi Multipla.

Do cardiovascular disease comorbidities affect the cognitive function of Multiple Sclerosis patients?

IntroductionCognitive impairment is a core symptom of multiple sclerosis, leading to disability in 40–70% of patients. The most common cognitive domains affected by MS are information processing speed, complex attention, executive functions and less frequently, episodic declarative memory. Cardiovascular disease comorbidities have been shown to increase the decline rate in many neurological conditions. Our study aims to examine the possible impact of CVD risk factors in the cognitive decline rate of PwMS. MethodsOver the course of a year, 248 PwMS with and without Cardiovascular comorbidity were cognitively evaluated using the written version of SDMT and the MoCA. ResultsCompared to control, MS patients with comorbid CVD had greater general cognitive decline and decreased processing speed. Patients with comorbid diabetes and dyslipidemia had the highest impairment, followed by those with hypertension, compared to the control group and those patients with a high BMI. ConclusionThe presence of cardiovascular comorbidities and especially dyslipidemia increases the rate of cognitive decline in MS patients. In such cases, patients should be evaluated every 6 months instead of a year and the use of the SDMT is advised since it’s time efficient,it requires minimal training and correlates with MRI findings.

The effect of exercise on cognitive function in people with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.

A growing body of research examining the effect of exercise on cognitive function in people with multiple sclerosis (MS), while findings of available studies were conflicting. We aimed to explore the effect of exercise on cognitive function in MS patients. For this systematic review and meta-analysis, we searched PubMed, Web of Science, EBSCO, Cochrane, and Scopus electronic databases, through July 18, 2022. Cochrane risk assessment tool was used to evaluate the methodological quality of the included literature. Twenty-one studies with a total of 23 experimental groups and 21 control groups met the inclusion criteria. There was a significant effect of exercise on improving cognitive function in MS patients, while the effect size was small (Cohen's d = 0.20, 95% CI 0.06-0.34, p < 0.001, I2 = 39.31%). Subgroup analysis showed that exercise significantly improved memory (Cohen's d = 0.17, 95% CI 0.02-0.33, p = 0.03, I2 = 7.59%). In addition, multicomponent training, exercise conducted 8weeks and 10weeks, up to 60min per session, 3 times or more per week, 180min or more per week increased cognitive function significantly. Furthermore, a worse basal MS status (defined by the Expanded Disability Status Scale) and an older age were associated with greater improvement in cognitive function. MS patients are recommended to participate in at least three multicomponent training sessions per week, with each session lasting up to 60min, and the exercise goal of 180min per week can be achieved by increasing the frequency of exercise. Exercise lasting 8 or 10weeks is best for cognitive function improvement. Additionally, a worse basal MS status, or the older the age, the greater effect on cognitive function.

Dual Role of B Cells in Multiple Sclerosis.

B cells have emerged as an important immune cell type that can be targeted for therapy in multiple sclerosis (MS). Depleting B cells with anti-CD20 antibodies is effective in treating MS. Yet, atacicept treatment, which blocks B-cell Activating Factor (BAFF) and A Proliferation-Inducing Ligand (APRIL), two cytokines important for B cell development and function, paradoxically increases disease activity in MS patients. The reason behind the failure of atacicept is not well understood. The stark differences in clinical outcomes with these therapies demonstrate that B cells have both inflammatory and anti-inflammatory functions in MS. In this review, we summarize the importance of B cells in MS and discuss the different B cell subsets that perform inflammatory and anti-inflammatory functions and how therapies modulate B cell functions in MS patients. Additionally, we discuss the potential anti-inflammatory functions of BAFF and APRIL on MS disease.

Influence of Sociodemographic Characteristics on cognitive Functions in Multiple Sclerosis Patients

Background: Multiple sclerosis is a a complex diesase that may be presented by different neurological symptoms causing impairment of physical, psychological and cognitive functions. Objective: The aim of the study was to evaluate the influence of sociodemographic characteristics on cognitive functions in multiple sclerosis patients. Methods: This study included 60 MS patients treated at the Department of Neurology, Clinical Center University of Sarajevo. Inclusion criteria were clinically definite diagnosis of multiple sclerosis, 18 years of age or older and were able to give written informed consent. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCa) screening test. Mann-Whitney and Kruskal-Wallis test were used for comparisons between sociodemographic characteristics and MoCa test scores. Results: 76.66% were female patients. Average age of patients was 44.5 years. 70% of patients were married. 73,33% of patients had a high school degree, 20% had a college degree while only 6,66% had primary education. 38,33% of patients were employed, 33,33% were unemployed and 28,33% retired. 88.33% of patients had cognitive impairment, 68.33% having mild cognitive impairment. Executive functions (53,66%) and delayed recall (28,33%) were rated the worst. The median value of the Naming and Language MoCa domains of cognition showed statistical significant correlation with level of education (p&lt;0.05; p&lt;0.01).The mean value of the Language variable was statistically significantly lower in respondents aged 35 and over compared to respondents younger than 35 years (p=0,003;p&lt;0,01), Statistically significant correlation was found between the level of education and cognitive status (rho=0,276,p&lt;0,05), while the other variables (gender, age, marital status and employment ) did not show a statistically significant corellation. Conclusion: High perecentage of MS patients has cognitive impairment. Executive functions are rated the worst. Education is the major factor that contribute to better cognitive functioning in MS patients independent of age or employment status. The highest correlation is found between language and naming domains of cognition. Gender did not prove to be predictive factor of cognition in multiple sclerosis patients at any domain.

Cognitive Imapirment in Multiple Sclerosis: Relation to Dysability, Duration and Type of Disease

Background: Cognitive dysfunctions are often presented as a symptom in multiple sclerosis which is associated with both structural and functional imapirments of neuronal networks in the brain. Objective: The aim of the study was to evaluate the influence of dysability, duration and type of disesase on cognitive functions in multiple sclerosis patients. Methods: This study included 60 MS patients treated at the Department of Neurology, Clinical Center University of Sarajevo. Inclusion criteria were clinically definite diagnosis of multiple sclerosis, 18 years of age or older and were able to give written informed consent. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCa) screening test. Mann-Whitney and Kruskal-Wallis test were used for comparisons between clinical characteristics and MoCa test scores. Results: Out of 63.33% of patients had EDSS &lt;=4.5. Disease lasted longer than 10 years in 30% of patients. 80% had relapsing-remitting MS and 20% had secondary progressive MS. 84,2 % of patients with EDSS ≤ 4.5 had cognitive dysfunction. Higher disability (rho=0,306, p&lt;0,05), progressive type of disease (rho=0,377, p&lt; 0,01) and longer disease duration (rho=0,282, p&lt;0,05) were associated with worse overall cognitive functions. Level of disability showed statistical significant correlation with the executive functions and language domains of cognition (p&lt;0.01). Longer disease duration was significant correlated with executive functions (p&lt;0,01) and language domains (p&lt;0,01), while progressive type of disease was signifacant correlated only with executive functions domain (p&lt;0,01). MoCa score variables did not show a statistically significant difference in relation to the number of relapses per year and the use of imunoterapy. Statistically significant negative correlation was obtained between executive functions domain and level of disability, disease duration and progressive type of disease, while language domain significantly correlated only with disability level and progressive type of disease. Conclusion: High percentage of MS patients has cognitive impairment. Patients with higher disability were presented with lower cognitive abilities, especially in executive functions and language domains. Higher frequency of cognitive impairment were presented in progessive forms of disaese and longer disease duration with strong influence on executive functions domains of cognition.

Antioxidant supplements and cognition in Multiple Sclerosis: a systematic review

Background: Cognitive dysfunction is a debilitating characteristic of multiple sclerosis (MS) that affects approximately 60% of patients. To date, the only effective treatments for cognitive decline are cognitive rehabilitation and exercise training. While previous studies reported the beneficial effect of antioxidants on MS patients, several other studies investigated the effect of antioxidant supplements on the cognitive performance of MS patients. We aimed to conduct a systematic review to examine whether there is an association between antioxidants supplements and cognitive performance in MS patients.Methods: We searched PubMed, Embase, Scopus, and Web of Science for the identification of relevant studies in November 2021. We included control trials, cohort, case-control, and cross-sectional studies which showed the effect of any type of antioxidants on cognitive performance in MS patients.Results: After screening 12 papers were included in our study. Our review included three studies that examined the effect of ginkgo Biloba on cognitive performance, two examined the Mediterranean diet, and remained studies each investigated the vitamin A, Omega 5, Omega 3, estriol, epigallocatechin-3-gallate (EGCG), Boswellia papyrifera, and paleolithic diet. Overall, it seems that there were no benefits of antioxidant administration on cognitive performance in MS patients.

The effectiveness of anodal tDCS and cognitive training on cognitive functions in multiple sclerosis; a randomized, double-blind, parallel-group study

BackgroundForty to 70% of patients with multiple sclerosis (MS) suffer from cognitive impairment during their illness. Only a few studies have examined the effects of anodal transcranial direct current stimulation (a-tDCS) along with cognitive training on cognitive performance in MS patients. This study aims to determine whether multi-session a-tDCS with or without cognitive training impacts cognitive performance in MS. MethodsEighty MS patients received a-tDCS, cognitive training, a-tDCS plus cognitive training, and sham for ten consecutive daily sessions. Cognitive function (including episodic memory, attention, and inhibitory control, working memory, and visuospatial skill) was measured at baseline, week 4, and week 12 after the intervention. ResultsAll cognitive functions significantly improved after the intervention compared to the sham condition. This effect also showed persistence during follow-up for some cognitive tasks in the a-tDCS and a-tDCS combined cognitive training groups. Although the cognitive training group experienced an immediate improvement in attention and inhibitory control, the difference was not significant at follow-up. Also, there were no significant differences between these three groups in cognitive scores after the intervention. Conclusiona-tDCS alone and a-tDCS paired with or without cognitive training as compared to sham appears to be a promising therapeutic option for cognitive performance in MS patients.

Altered bladder-related brain network in multiple sclerosis women with voiding dysfunction.

A number of neurourology imaging studies have mainly focused on investigating the brain activations during micturition in healthy and neuropathic patients. It is, however, also necessary to study brain functional connectivity (FC) within bladder-related regions to understand the brain organization during the execution of bladder function. This study aims to identify the altered brain network associated with bladder function in multiple sclerosis (MS) women with voiding dysfunction through comparisons with healthy subjects via concurrent urodynamic study(UDS)/functional magnetic resonance imaging(fMRI). Ten healthy adult women and nine adult ambulatory women with clinically stable MS for ≥6 months and symptomatic voiding phase neurogenic lower urinary tract dysfunction (NLUTD) underwent UDS/fMRI evaluation with a task of bladder filling/emptying that was repeated three to five times. We quantitatively compared their FC within 17 bladder-related brain regions during two UDS phases: "strong desire to void" and "(attempt at) voiding initiation." At "strong desire to void," the healthy group showed significantly stronger FC in regions involved in bladder filling and suppression of voiding compared to the patient group. These regions included the bilateral anterior cingulate cortex, right supplementary motor area, and right middle frontal gyrus. During "(attempt at) voiding initiation," healthy subjects exhibited stronger FC in the right inferior frontal gyrus compared to MS patients. Our study offers a new way to identify alterations in the neural mechanisms underlying NLUTD and provides potential targets for clinical interventions (such as cortical neuromodulation) aimed at restoring bladder functions in MS patients.

Integrated Cognitive Rehabilitation Home-Based Protocol to Improve Cognitive Functions in Multiple Sclerosis Patients: A Randomized Controlled Study.

Cognitive impairment (CI) occurs in about 40–65% of people with multiple sclerosis (MS) during the disease course. Cognitive rehabilitation has produced non-univocal results in MS patients. Objective: The present study aimed to evaluate whether an Integrated Cognitive Rehabilitation Program (ICRP) in MS patients might significantly improve CI. Methods: Forty patients with three phenotypes of MS were randomly assigned into two groups: the experimental group (EG, n = 20), which participated in the ICRP for 10 weeks of training; and the control group (CG, n = 20). All participants’ cognitive functions were assessed at three timepoints (baseline, post-treatment, and 3-month follow-up) with the California Verbal Learning (CVLT), Brief Visuospatial Memory (BVMTR), Numerical Stroop, and Wisconsin tests. Results: When compared to CG patients, EG patients showed significant improvements in several measures of cognitive performance after ICRP, including verbal learning, visuospatial memory, attention, and executive functions. Conclusions: Home-based ICRP can improve cognitive functions and prevent the deterioration of patients’ cognitive deficits. As an integrated cognitive rehabilitation program aimed at potentiation of restorative and compensatory mechanisms, this approach might suggest an effective role in preserving neuronal flexibility as well as limiting the progression of cognitive dysfunction in MS.

Relaxation-Compensated Chemical Exchange Saturation Transfer MRI in the Brain at 7T: Application in Relapsing-Remitting Multiple Sclerosis.

Chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI) can probe tissue biochemistry in vivo with high resolution and sensitivity without requiring exogenous contrast agents. Applying CEST MRI at ultrahigh field provides advantages of increasing spectral resolution and improving sensitivity to metabolites with faster proton exchange rates such as glutamate, a critical neurotransmitter in the brain. Prior magnetic resonance spectroscopy and CEST MRI studies have revealed altered regulation of glutamate in patients with multiple sclerosis (MS). While CEST imaging facilitates new strategies for investigating the pathology underlying this complex and heterogeneous neurological disease, CEST signals are contaminated or diluted by concurrent effects (e.g., semi-solid magnetization transfer (MT) and direct water saturation) and are scaled by the T1 relaxation time of the free water pool which may also be altered in the context of disease. In this study of 20 relapsing-remitting MS patients and age- and sex-matched healthy volunteers, glutamate-weighted CEST data were acquired at 7.0 T. A Lorentzian fitting procedure was used to remove the asymmetric MT contribution from CEST z-spectra, and the apparent exchange-dependent relaxation (AREX) correction was applied using an R1 map derived from an inversion recovery sequence to further isolate glutamate-weighted CEST signals from concurrent effects. Associations between AREX and cognitive function were examined using the Minimal Assessment of Cognitive Function in MS battery. After isolating CEST effects from MT, direct water saturation, and T1 effects, glutamate-weighted AREX contrast remained higher in gray matter than in white matter, though the difference between these tissues decreased. Glutamate-weighted AREX in normal-appearing gray and white matter in MS patients did not differ from healthy gray and white matter but was significantly elevated in white matter lesions. AREX in some cortical regions and in white matter lesions correlated with disability and measures of cognitive function in MS patients. However, further studies with larger sample sizes are needed to confirm these relationships due to potential confounding effects. The application of MT and AREX corrections in this study demonstrates the importance of isolating CEST signals for more specific characterization of the contribution of metabolic changes to tissue pathology and symptoms in MS.