Iranian Multiple Sclerosis Society Research Articles

The Experience of Living with Multiple Sclerosis during the COVID-19 Pandemic

Background: Many studies have shown that psychological distress such as worries and anxiety is one of the causes of the development, recurrence, or exacerbation of multiple sclerosis (MS). This study aimed to explore the lived experiences of patients with MS during the COVID-19 pandemic. Methods: This qualitative study was conducted using an interpretive phenomenological approach. The participants were selected from patients with MS in Tehran, Iran who were members of the Iranian MS Society in 2021. The research sample included 19 patients with MS who were selected using purposive sampling. The data were collected using semi-structured interviews until the data were saturated. The collected data were analyzed using Van Manen’s phenomenological approach, and the validity and truthfulness of the data were confirmed using the four criteria proposed by Lincoln and Guba. Results: Explication of the data revealed 22 subthemes and 5 main themes. The main themes identified were: Feeling of helplessness and fear of inadequacy in self-care, Economic concerns and financial problems, Ineffective interaction with family members, preoccupations and obsessions with the pandemic, and ambivalent and conflicting beliefs about others. Conclusion: The experiences of those affected by the pandemic were linked to personal and familial concerns, health issues, feelings of inadequacy in self-care, and economic difficulties. Additionally, participants were preoccupied with the pandemic and the social problems they faced. Gaining an understanding of these experiences can offer valuable insights to medical professionals, families of patients, and relevant organizations regarding the lived experiences of individuals with MS.

Disease-Modifying Therapy in Multiple Sclerosis: Evaluation of Patients Satisfaction in Iranian Multiple Sclerosis Population.

Medication satisfaction is a patient-reported outcome which could show medication adherence. The aim of this study was to determine Iranian MS patients' satisfaction with Disease Modifying Therapies (DMTs). A standardized questionnaire was developed using Treatment Satisfaction Questionnaire for Medication (TSQM). The online link was released on IMSS (Iranian Multiple Sclerosis Society) social media channel, accessible to 4272 MS patients totally. Three hundred and ninety-four patients participated in our survey with 324 females, 70 males and an F/M ratio of 4.6:1. The most frequent DMTs used were interferon-beta (IFNβ) followed by rituximab. The mean effectiveness and global satisfaction scores were significantly higher for injectable DMTs, while the convenience score was significantly higher for oral DMTs. Mean effectiveness and side-effect scores were significantly higher in the Tysabri group and convenience score was significantly higher in the fingolimod group while global satisfaction was higher in the IFNβ group. The global satisfaction and effectiveness were significantly higher with injectable DMTs while the convenience score was significantly higher with oral DMTs.

Multiple sclerosis projection in Tehran, Iran using Bayesian structural time series

BackgroundThe prevalence of Multiple Sclerosis (MS) has been increasing worldwide and the highest prevalence ratio among Asian countries was reported in Iran. This study aims to estimate the increase in MS occurrence during more than three decades in Tehran and forecast the future condition of the disease using time series approaches for the next ten years.MethodsThe cross-sectional study was conducted from 1999 to 2019 based on records of MS cases from Iranian MS Society (IMSS) registry system. The prevalence was estimated using population data presented by the Statistical Centre of Iran. Through Bayesian Structural Time Series (BSTS) model, we want to predict the prevalence of familial and sporadic MS in the next ten years. .ResultsAmong 22,421 cases with MS, 16,831 (75.1 %) were female and 5589 (24.9 %) were male. Female to male ratio was 3.0:1 and the number of familial MS cases were 2982 (13.3 %) of subjects. Female gender was less responsible for higher rate of MS in familial definition (beta = 0.020) in comparison to sporadic cases (beta = 0.034). Forecasting by BSTS revealed an increase in MS prevalence for the next ten years so that the prevalence rate for total, familial and sporadic MS respectively begins with 189.50 (183.94-195.14), 25.69 (24.97–26.45) and 163.74(159.06-168.57) in 2020 and ends with 220.84 (171.48-266.92), 30.79 (24.16–37.15), and 189.33(146.97-230.19) in 2029.ConclusionsAccording to the findings, MS prevalence increased during three decades and it will increase over the next ten years. Tehran province is one of the regions with highest MS prevalence in Asia. The results of present study indicated that females are at higher risk for MS than males in both sporadic and familial MS.

Estimating the Marginal Causal Effect and Potential Impact of Waterpipe Smoking on Risk of Multiple Sclerosis Using the Targeted Maximum Likelihood Estimation Method: A Large, Population-Based Incident Case-Control Study.

There are few if any reports regarding the role of lifetime waterpipe smoking in the etiology of multiple sclerosis (MS). In a population-based incident case-control study conducted in Tehran, Iran, we investigated the association between waterpipe smoking and MS, adjusted for confounders. Cases (n=547) were patients aged 15-50 years identified from the Iranian Multiple Sclerosis Society between 2013 and 2015. Population-based controls (n=1,057) were persons aged 15-50 years recruited through random digit telephone dialing. A doubly robust estimation method, the targeted maximum likelihood estimator (TMLE), was used to estimate the marginal risk ratio and odds ratio for the association between waterpipe smoking and MS. The estimated risk ratio and odds ratio were both 1.70 (95% confidence interval: 1.34, 2.17). The population attributable fraction was 21.4% (95% confidence interval: 4.0, 38.8). Subject to the limitations of case-control studies in interpreting associations causally, these results suggest that waterpipe use, or strongly related but undetermined factors, increases the risk of MS. Further epidemiologic studies, including nested case-control studies, are needed to confirm these findings.

Effectiveness of Acceptance and Commitment Therapy on Psychological Capital and Emotional Expression Styles in Women with Multiple Sclerosis

Background and Objectives: Multiple sclerosis (MS) is an unpredictable and one of the most important life-altering diseases which gradually leads to disability. This study aimed to investigate the effect of acceptance and commitment therapy (ACT) on psychological capital and emotional expression styles of female patients with MS in the Iranian MS Society during 2019-2020. Materials and Methods: The statistical population of the study consisted of all females with MS who were members of the Iranian MS Society in 2019. In total, 36 patients were selected voluntarily who were randomly divided into three groups (ACT, placebo, and control). The intervention was held in eight 90-min weekly sessions for the intervention and the placebo groups at the office of the Iranian MS Society, Tehran, Iran[A1] . All groups were re-evaluated at the end of the intervention and also two months later (i.e., follow-up stage). The obtained data were analyzed using repeated-measures analysis of variance. Results: Based on the results, ACT affected the components of hope and resilience at the significance level of 0.01 and the components of self-efficacy and optimism at the significance level of 0.05, compared to the control group. Moreover, the ACT was able to increase the components of hope and resilience at the significance level of 0.01 and the component of optimism at the significance level of 0.05 in comparison with the placebo group. Conclusion: The ACT increased psychological capital components, including hope, optimism, resilience, and self-efficacy in patients with MS.

Evidence of an increased prevalence of multiple sclerosis: a population-based study of Tehran registry during 1999\u20132018

BackgroundThe epidemiological characteristics of multiple sclerosis (MS) have been investigated in various studies, which have revealed that the prevalence of MS varies across countries. The present study was conducted to investigate the longitudinal prevalence of MS in Tehran, Iran.MethodsThe present population-based study was conducted in Tehran, the capital of Iran from 1999 to 2018 based on the annual report data provided by the Iranian MS Society (IMSS) registry system. The age-standardized and crude prevalence were estimated using population data presented by the Statistical Centre of Iran.ResultsA total of 21,580 MS cases were registered and included in the analysis. Among the participant patients, 24.99% (5393) and 75.01% (16,187) of cases were male and female, respectively. The mean age of MS onset was 28.8 years (S.D: 8.7). The age-standardized prevalence (ASP) of MS increased from 73.7 (95%CI: 72.1–75.2) per 100,000 people in 2006 to 137.6 (95% CI: 135.7–139.5) per 100,000 people in 2018. The ASP of MS in 2018 was estimated to be 67.9 (95%CI: 66.0–69.8) and 207.3 (95%CI: 204.0–210.7) per 100,000 people among males and females, respectively. The age-standardized female-to-male ratio of MS ranged from 3.7 (in 2010) to 2.06 (in 2017).ConclusionThe findings of this study suggested that the prevalence of MS in Tehran province is relatively high, and the occurrence of the disease is more common in the age groups under 40 years as compared with older-aged groups. In line with reports provided for various regions of the world, the prevalence of MS was higher among women. Similarly, the findings of this study revealed that the female-to-male ratio was 2.14 in 2018.

Epidemiology of MS in Tehran Province, Iran: A Population- Based Study

There is a significant increase of Multiple Sclerosis (MS) in Asia, special in Iran. Familial recurrence studies in MS are useful to identify the correlated effects in etiology of the disease. This is a cross-sectional study based on Iranian MS Society data from 1999 to 2018 with the aim of estimating incidence, prevalence and assessing associations among most important variables related to familial MS (gender, age at disease onset, types of MS and familial history). Multiple regressions were used to indicate the predictors of MS via SPSS. Among 21580 MS subjects, the crude incidence and prevalence rate was 6.93 and 151.3 per 100000 populations in 2018 respectively. Completely 16187 (75%) were female and female to male ratio was 3:1.Mean age at disease onset was 28.82 years old, 9.7% of the population had early onset MS (<=18 years old). Female gender was a strong significant predictor for onset age (p<0.001). 749 (14.4%) of male patients and 2066 (13.1%) of female patients had a history of familial MS which was significantly different between them, p value=0.017, (OR=1.11; 95% CI=1.02, 1.22). Crude odds ratio for familial recurrence of MS in first degree of relatives was significantly different among genders (OR=1.30; 95% CI=1.12, 1.5). The age standardized prevalence rate of MS was estimated 54.1 (95%CI: 53.6-54.6) among males and 174.5 (95%CI: 173.6-175.4) per 100,000 among females. Totally, 75.7% were relapsing remitting MS, 16.4% were primary progressive MS and 7.9% were secondary progressive MS. MS incidence and prevalence in Tehran has increased with a decreased female to male ratio. Despite the higher prevalence of MS amongst females, the familial recurrence was higher among males except in first degree of relatives.

Effectiveness of Unity-Oriented Psychodrama on Sense of Coherence of MS Patients

Background: Multiple sclerosis (MS) is one of the most common chronic and progressive central nervous system ailments that is considered as a disabling and traumatizing disease. Objectives: The goal of the present study was to investigate the effectiveness of psychodrama based on unity-oriented approach on the sense of coherence of MS patients. Methods: This was a quasi-experimental research, which included pre-test, post-test, and follow-up design with a control group. Using a convenience sampling method, 20 individuals were selected from among females with MS who had visited the Iranian MS Society. The subjects were randomly placed into two experiment and control groups. The experiment group participated in a 12 session unity-focused psychodrama therapy plan for six weeks, whereas the control group received no intervention. For data collection, the Flensborg-Madsen’s Sense of Coherence Questionnaire was used. The data was analyzed using ANOVA with repeated measures. Results: The results revealed that there is a significant difference between two groups’ sense of coherence scores in post-test and follow-up stages (P < 0.05). Conclusions: As seen in the findings, the unity-oriented psychodrama can be used as an effective treatment to enhance the sense of coherence among MS patients. Unity-oriented approach helps the patients integrate with the universe and define their bitter experiences. It also facilitates better patient acceptance through understanding a sense of connectivity to the coherent world and offers a sense of immorality to the MS patients.

Stress-full life events and multiple sclerosis: A population-based incident case-control study

AimWhile sizeable evidence regarding the association between stressful-life events and multiple sclerosis (MS) disease activity (clinical and/or radiological) was previously documented, their relation to MS risk is controversial. We aimed to investigate the possible association of stressful-life events and multiple sclerosis risk after adjustment for relevant confounders in an Iranian population. MethodThis was a population-based incident case-control study that recruited 547 MS cases and 1057 healthy controls between August 2013 and February 2015, Tehran. The patients were identified using the Iranian MS Society based on 2010 McDonald criteria. We used standard random digit dialing protocol for control selection. Logistic regression model was applied to estimate the odds ratios (95% CI) adjusted for physical activity, age, gender, tobacco smoking, waterpipe smoking and passive smoking. ResultsWhile total life events number was not associated with risk of MS, homeless periods OR 3.85 (1.65–8.90), p = 0.002 as well as divorce OR 2.11 (1.24–3.58), p = 0.005 increased the risk of MS. However, marriage OR 0.59 (0.41–0.86), p = 0.006, death of ones' dear OR 0.60 (0.44–0.82), p = 0.002 and joblessness OR 0.61 (0.41–0.91) reduced the risk of MS. ConclusionWe could not detect a statistically significant role for the total stressful life event during the last 3 years and MS diagnosis. However, there is some evidence confirming the possible role of some individual life events, i.e. divorce and periods of homelessness as potential risk factors for MS and conversely, having married as a protective factor in MS onset.

Estimating the Marginal Causal Effect of Fish Consumption during Adolescence on Multiple Sclerosis: A Population-Based Incident Case-Control Study

Background: Adolescence is considered as a critical time period in multiple sclerosis (MS) etiology. Nonetheless, there are insufficient reports regarding the potential role of fresh and canned fish consumptions during adolescence in MS etiology. The authors investigated the association between fresh and canned fish consumptions and MS. Methods: This was a population-based incident case-control study conducted in Tehran. Cases (n = 547) identified from Iranian Multiple Sclerosis Society between August 7, 2013, and November 17, 2015 were included in the study. Population-based controls (n = 1,057) were recruited by random digit telephone dialing without any matching. Inverse-probability-of-treatment weighing (IPTW) using 2 sets of propensity scores and model-based standardization were used to separately estimate the marginal odds ratio between fresh and canned fish consumptions in adolescence and MS. Results: The marginal OR for fresh fish was 0.72 (95% CI 0.58–0.90; p = 0.005) in both IPTW analyses. Similarly, the marginal OR for canned fish consumption was 0.75 (95% CI 0.60–0.95; p = 0.014).The model-based standardized OR was 0.72 (95% CI 0.58–0.91; p = 0.008) for fresh and 0.73 (95% CI 0.59–0.94; p = 0.006) for canned fish consumption in adolescence. Discussion: Subject to limitation of case-control studies in interpreting associations causally, this study suggests that both fresh and canned fish consumptions in adolescence can decrease the risk of MS.

Estimation of the marginal effect of regular drug use on multiple sclerosis in the Iranian population.

There are only few reports regarding the role of lifetime drug or substance use in multiple sclerosis (MS) etiology. In this study, we investigated the potential effect of drug or substance exposure on the onset of MS diagnosis. We conducted a population-based incident case control study in Tehran. Cases (n = 547) were 15–50 years old persons with MS identified from the Iranian Multiple Sclerosis Society (IMSS) register during August 7, 2013, and November 17, 2015. Population-based controls (n = 1057) were 15–50 years old and were recruited by random digit telephone dialing. Inverse-probability-of-treatment weighing (IPTW) using two sets of propensity scores (PSs) was used to estimate marginal incidence odds ratios (ORs) for MS contrasting pre-specified substance use. The estimated marginal OR was 6.03 (95% confidence interval: 3.54;10.3, using trimmed weights at the 95th percentile of the stabilized weight distribution) in both IPTW analyses comparing lifetime substance use (opioids, cannabis, inhalants, hallucinogens and stimulants) for at least one time monthly during a six-months or longer period vs. no such history of drug use. Subject to limitation of causal claims based on case-control studies, this study suggests that monthly drug or substance use for a period of at least six consecutive months, may increase the risk of MS by factor 3.5 or higher.

Increasing prevalence of familial recurrence of multiple sclerosis in Iran: a population based study of Tehran registry 1999\u20132015

BackgroundTehran is the capital of Iran with an increasing multiple sclerosis (MS) prevalence. A retrospective population-based study was conducted to evaluate the trends of MS prevalence in Tehran.MethodsA population-based survey was conducted for the period 1999 to 2015, based on Iranian MS Society (IMSS) registry system of Tehran, the capital city of Iran. Point regression analysis was applied on MS trend data to find annual percent change (APC).The logistic regression analysis was used to estimate the odds ratio (OR) for individual variables in order to assess factors associating with familial recurrence of MS. P values < 0.05 were considered significant.ResultsMS prevalence has significantly increased during the study period from 1999 to 2015 (56.22 per 100,000). Total point prevalence of MS was 115.94 per 100,000 persons in 2015 compared to general population. Positive family history of MS was observed among 12.4% of patients. The strongest association amongst first-degree relatives was found in siblings, p value ≤ 0.001.ConclusionMS prevalence is rising in Tehran and this city is one of the regions with highest MS prevalence in Asia. In this sample, the largest proportion of relatives with MS were found among first-degree relatives, particularly siblings. Familial recurrence correlated with relative type.

Parental ethnicity associated with risk for multiple sclerosis: A population-based incident case–control study in Iran

BackgroundThe epidemiology of multiple sclerosis (MS) includes a consideration of geography and population ethnicity. To determine whether there is any association between ethnicity and risk of MS in a multiethnic, population-based case–control study. MethodsWe conducted a population-based case–control of 547 incident MS cases and 1057 healthy controls between August 2013 and February 2015, Tehran, a multi-ethnic city. The patients were identified and enrolled through the Iranian MS Society. Case status was confirmed by a panel of MS specialists beside of 2010 McDonald criteria. Controls were selected through random digit dialing. A logistic regression model was applied to estimate the odds ratios (95%CI) adjusted for age, sex, tobacco smoking and socioeconomic status. ResultsThe risk of MS for Kurd, Turk and Fars ethnicities was apparently smaller compared to one specific ethnic background (Lor); OR 0.36 (0.15–0.86) for Kurd, OR 0.42 (0.24–0.74) for Turk and OR 0.53 (0.31–0.89) for Fars. Heterogeneity in parental ethnicity of common ethnic groups was significantly associated with increased risk of MS OR 1.61 (1.13–2.29). All associations remained after adjustment for relevant confounders. ConclusionsMS was unequally distributed in the ethnic groups. Moreover, heterogeneity in parental ethnicity seems to be a risk factor for MS.

Qualitative analysis of the process of restoring social esteem by the women with multiple sclerosis

The present study has been conducted with the purpose of analyzing the process of restoring the social esteem of the women with multiple sclerosis (MS) in the Iranian society through the approach of grounded theory. To this end, a number of 10 women with MS who had referred to Sina Hospital and Iranian MS Society were selected through theoretical sampling. The data collection was conducted through semi-structured interview, on-field note taking, investigating the documents, and memoing. Based on analyzing data, six processes emerged which, according to the order of occurrence, are: (1) seeking and finding treatment, (2) change of the perceived social esteem, (3) struggle to preserve or regain possessions, (4) seeking support and sponsorship, (5) attempt to achieve a desirable consistency, and ultimately, (6) restoring social esteem. The results obtained from this study indicated that though a considerable number of the cases feel changes in their social esteem due to rejection, being abandoned by their spouses, emergence of a co-wife, feeling of burden, financial shortages, and divorce, depending on interventional and contextual conditions including belief in spirituality and supernatural, patient and society’s awareness of the nature of the disease, and the extent of social support, they have experienced varied circumstances. Ultimately, a central level titled “repeated and recurring adjustment of goals” was proposed to reflect the process of restoring the social esteem of the women with MS in Iran.

Early-onset multiple sclerosis: Reports of 300 patients from Iran

Background:The epidemiologic data on demographic features of early-onset multiple sclerosis (EOMS) are rare in the Middle East, and no previous study has explored it. We aim to perform a neuroepidemiologic analysis to emphasize on the demographic features of EOMS in Tehran, Iran, during 2005–2015.Materials and Methods:Our study was performed in Tehran, Iran; the research included patients with EOMS who had experienced their first symptoms before the age of 18 years and those who were referred to Iranian Multiple Sclerosis Society in Tehran during 2005–2015. A total of 300 patients were contacted and filled the checklists by themselves or the physician. The checklist contained data about gender, age at the onset, the first symptom, time interval between the first presentation and the diagnosis, clinical course, family history of MS, and history of smoking in parents.Results:Among the patients with EOMS, 78% were female and 22% were male. Average age of disease onset was 15.6 years (standard deviation, 2.6 years), mean time interval between the first symptoms and disease diagnosis was 16.8 months, the shortest time interval measured was 0.1 month, and the longest time interval was 144 months. The first symptom at the onset of the disease was ocular in 140 patients and sensory in 82 patients. Approximately 16.7% of the patients had a positive family history for MS. The most common clinical course of disease was relapsing-remitting MS (RRMS). Parental smoking history was negative in 63.3% of the patients.Conclusion:In our study, the EOMS was higher in females. Despite the earlier studies, it was found that the polysymptomatic onset was not very common. Optic neuritis was the most initial presentation and RRMS was the most frequent course.

Comparing epidemiology and baseline characteristic of multiple sclerosis and neuromyelitis optica: A case-control study

BackgroundAutoimmune syndromes such as Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO) are chronic, demyelinating diseases of the central nervous system which usually affect young adults. Both environmental risk factors and genetic susceptibility have been proposed to explain the etiology of these diseases. The aim of this study was to compare epidemiology and possible risk factors in MS and NMO in Tehran, Iran. MethodA population-based incident case-control study was performed in Tehran based on a study conducted on1513 MS patients from Iranian MS Society registry center of Tehran, from 2014 to 2015, and 83 NMO patients diagnosed with NMO in 2015 at Sina hospital, a tertiary care referral center in Tehran. The random digit dialing (RDD) methods were established to select 400 population-based controls. A checklist was designed to cover the epidemiological variables to estimate the possible risk factors for MS and NMO based on a questionnaire designed for multinational case-control studies of environmental risk factors in multiple sclerosis. Structured face to face interviews with cases, and telephone interviews with controls were conducted by trained interviewers to collect data. The multiple logistic regression analysis was done via SPSS package. ResultsThe adjusted odds ratio (OR) estimate of MS for females compared to males was (OR =1.47; 95% CI: 1.12, 1.95), and it was (OR=1.54; 95% CI: 1.17, 2.02) for people aged 18–27 years compared to younger ones aged 28–37 years. The adjusted OR estimate of NMO for people aged over 48 years compared to those aged 28–37 years was (OR=3.49; 95% CI: 1.59, 7.64).The point estimates were greater than eight-fold increased risk associated with MS among patients with a positive familial history 8.80 (95% CI: 4.10, 18.90). ConclusionThe results of this study reveal that the risk of MS is significantly higher in female and younger people in comparison to NMO. Having positive family history of MS can increase the risk of MS substantially. The findings of the study indicated that factors that predict susceptibility to MS, including a positive history of MS in relatives, do not appear to have any association with NMO.

Improvement in Activity of Daily Living and Fatigue in Multiple Sclerosis Patients: the Impact of Nutrition Education

Abstract Background: Fatigue is one of the most common complications of Multiple Sclerosis (MS). However, a few studies are available on the effect of nutrition education on fatigue and Activities of Daily Living (ADL) in patients with MS. Objectives: This study aimed to assess the effect of nutrition education on fatigue and ability to perform ADL in patients with MS. Methods: This quasi-experimental one group, pretest and posttest study was performed on 40 patients with MS, who were conveniently recruited among patients, registered at the Iranian MS Society. Data were collected through a demographic questionnaire, the Fatigue Severity Scale (FSS), a standard ADL scale, and a 24-hour food recall for two days. The instruments were completed at the start and two months after the intervention. Descriptive statistics and paired t test were used to analyze the data. Results: Sixty percent of the patients had severe fatigue before the intervention while, 90% of them reported mild fatigue after the intervention. The mean posttest ADL was increased by 12.45 units after the intervention when compared with the pretest value (P<0.001). Moreover, the daily intake of vitamin D and E, calcium and omega3 were lower than 75% of the Dietary Reference Intake (DRI) in most of the patients. Conclusions: The present study showed the beneficial effects of nutritional training on fatigue and ADL in patients with MS. Therefore, nurses and dietitians should regularly assess the patients’ dietary pattern and train them and their families about appropriate diet. Keywords: Quality of Life, Fatigue, Multiple Sclerosis, Nutrition Education

Effect of Tai Chi Chuan on balance in women with multiple sclerosis

ObjectiveTo examine the effect of Tai Chi Chuan on balance in women with multiple sclerosis in Iran. Design36 women with multiple sclerosis who were members of the Iranian Multiple Sclerosis Society participated in this study. 18 participants were allocated to the intervention group and 18 allocated to the control group. The intervention consisted of Yang style Tai Chi Chuan exercise sessions twice a week for 12 weeks. Main outcome measuresThis study used a demographic questionnaire and the Berg Balance Scale (BBS) to collect data. ResultsAfter 12 weeks, the mean score of the BBS in the intervention group demonstrated a statistically significant improvement in comparison with baseline status. ConclusionsThe results suggest that Tai Chi Chuan could be used as a safe complementary intervention to increase balance in patients with multiple sclerosis.

Sexual Problems and Quality of Life in Women with Multiple Sclerosis

Sexual problems (SP) are often experienced by people with multiple sclerosis (MS) and severely affect their quality of life. The aim of this study is to investigate the relationship between sexual problems and quality of life subscales. 132 women with MS from Iranian MS Society completed demographic and medical history questionnaire. Quality of life was measured by Multiple Sclerosis Quality of Life-54 (MSQoL-54) and sexual problems were quantified by MSISQ-19 which includes items for primary, secondary and tertiary causes of sexual problems. The data was analyzed by using SPSS-18 and Pearson’s correlation coefficients were used to examine relationships between sexual problems and quality of life subscales. Statistically significant correlation was found between sexual problems and quality of life subscales. Physical and mental components of MSQoL-54 were strongly correlated with secondary level of SP (p < 0.001, r = 0.702 and p < 0.001, r = 0.470 respectively). Of primary SP items decreased libido showed highly significant correlation with physical and mental components of MSQoL-54 (p < 0.001, r = 0.629 and p < 0.001, r = 0.499 respectively). Sexual problems such as decreased libido are highly correlated with quality of life in women with MS. Secondary SP had most correlations with quality of life subscales. Evaluation and appropriate management of sexual problems in MS patients can lead to improving their quality of life.

A 20-Year Incidence Trend (1989–2008) and Point Prevalence (March 20, 2009) of Multiple Sclerosis in Tehran, Iran: A Population-Based Study

Background: The frequency of multiple sclerosis (MS) is still undetermined in Tehran. We conducted this survey to assess the incidence trend and point prevalence of MS on March 20, 2009, in Tehran province, Iran. Methods: Data for patients with a definite diagnosis of MS were obtained from the Iranian MS Society (IMSS). The annual incidence rates were calculated based on year of diagnosis. The prevalence and annual incidence rates were standardized using the WHO (2000–2025) population as a standard. Results: We detected 8,026 definite MS cases that had been registered by the IMSS till the prevalence day. The age- and sex-adjusted incidence rates increased significantly from 0.68/100,000 in 1989 to 2.93/100,000 in 2008 with its peak (4.58) in 2005. On March 20, 2009, we identified 7,896 prevalent cases (5,888 females and 2,008 males) yielding an age-adjusted prevalence rate of 50.57/100,000 (females: 77.24 and males: 25.54). The female-to-male ratio was 3.11 (95% confidence interval: 2.95–3.27). The age-specific prevalence showed a peak in the group aged 35–39 years in females and in that of 40–44 years in males with a mean (±SD) age of 35.48 (±9.9) years for females and 36.98 (±10.5) years for males. Conclusion: Tehran is a high-risk area for MS disease, and the incidence has dramatically increased over the last 20 years.