MS Attacks Research Articles

Neutrophil-to-Lymphocyte Ratio, ESR, and CRP Have No Roles as Markers for Disease Severity and Prognosis in Patients with RRMS.

Up to now, there is no definitive prognostic factor for patients with multiple sclerosis. This study aimed to evaluate the neutrophil-to-lymphocyte ratio (N/L ratio) as a cheap, available, and noninvasive marker for disease activity and prognosis. A total of 112 patients, who were diagnosed with relapsing-remitting multiple sclerosis (RRMS), and 61 healthy controls were considered. We evaluated N/L ratio, ESR, CRP in the control, and patients in the first attack of the onset of the disease, 1 month and 6 months later during remission. All patients received interferon or Glatiramer acetate as disease-modifying therapies. The correlation of parameters with Expanded Disability Scale Score (EDSS) and Functional System (FS) involvement was evaluated. The N/L ratio was increased significantly in patients with MS in the relapse phase (mean: 2.44 ± 0.68) compared to the healthy controls (mean: 1.84 ± 0.67) (P = 0.04). Also, we found a significant increase in CRP among the aforementioned groups (P = 0.028). A significant correlation was not found between NLR, ESR, or CRP and patient's EDSS during 6 months of follow-up. For ESR and the type of functional system, a significant difference was found between favorable and unfavorable categories, while the median (IQR) of ESR in the favorable group was 7.7 (4-12) and among unfavorable ones was 13.8 (6-17.75) (P = 0.008). The results showed the effect of the innate immune system and inflammation during MS attacks. We considered that neutrophils, ESR, and CRP cannot predict disease severity or prognosis at least without a combination of other biomarkers.

Very Rare Incident of Pediatric Onset Multiple Sclerosis: A Case Report

Background: Pediatric Onset Multiple Sclerosis (POMS) is a chronic inflammatory disease in the central nervous system that affects children under 18. Children with POMS experience gradual deterioration leading to increased disability and lower life expectancy [1,2]. The Purpose of the Study: to present a rare case of POMS with an onset at 42 months, emphasizing its significance due to its infrequency in this age group. The hope is to encourage the establishment of specific diagnostic and treatment guidelines for POMS in the near future. Material and Methods: The evolution of POMS in a 3.6-year-old child who was admitted multiple times to the Hospital of Mother and Child Health Care in the Republic of Moldova during acute MS attacks. Results: In September 2022, the child received a confirmed POMS diagnosis based on McDonald’s criteria (2017), which was later confirmed in April 2023 through OCB-CSF examination. The April 2023 MRI showed changes in demyelination foci with temporary clinical improvement compared to the previous examination after the last acute attack. The child is currently undergoing five days of plasmapheresis, followed by a tapering regimen of oral steroids. Ongoing MRI monitoring is recommended, with consideration of receiving Disease-Modifying Treatments (DMTs) in Romania, where they are approved. Conclusions: This rare case highlights the importance of raising awareness about POMS in children. Early detection and intervention could lead to the development of new diagnostic and treatment guidelines. However, the lack of access to DMT drugs for POMS treatment in the Republic of Moldova results in significantly lower survival rates compared to other countries.

Very Rare Incident of Pediatric Onset Multiple Sclerosis: A Case Report

Background: Pediatric Onset Multiple Sclerosis (POMS) is a chronic inflammatory disease in the central nervous system that affects children under 18. Children with POMS experience gradual deterioration leading to increased disability and lower life expectancy [1,2]. The Purpose of the Study: to present a rare case of POMS with an onset at 42 months, emphasizing its significance due to its infrequency in this age group. The hope is to encourage the establishment of specific diagnostic and treatment guidelines for POMS in the near future. Material and Methods: The evolution of POMS in a 3.6-year-old child who was admitted multiple times to the Hospital of Mother and Child Health Care in the Republic of Moldova during acute MS attacks. Results: In September 2022, the child received a confirmed POMS diagnosis based on McDonald’s criteria (2017), which was later confirmed in April 2023 through OCB-CSF examination. The April 2023 MRI showed changes in demyelination foci with temporary clinical improvement compared to the previous examination after the last acute attack. The child is currently undergoing five days of plasmapheresis, followed by a tapering regimen of oral steroids. Ongoing MRI monitoring is recommended, with consideration of receiving Disease-Modifying Treatments (DMTs) in Romania, where they are approved. Conclusions: This rare case highlights the importance of raising awareness about POMS in children. Early detection and intervention could lead to the development of new diagnostic and treatment guidelines. However, the lack of access to DMT drugs for POMS treatment in the Republic of Moldova results in significantly lower survival rates compared to other countries.

ADC restriction is not associated with clinical response to plasma exchange following a cerebral attack of multiple sclerosis.

MS is the most common CNS inflammatory demyelinating disease. Plasma exchange (PLEX) has well-demonstrated efficacy in acute corticosteroid-refractory attacks of demyelination but identifying the factors that predict favorable PLEX response remains elusive. We aimed to determine if apparent diffusion coefficient (ADC) restriction on brain MRI predicts clinical response to PLEX in individuals with an acute cerebral attack of MS. Retrospective chart review of individuals with a cerebral attack of MS who underwent PLEX at Mayo Clinic. We identified 34 individuals who fulfilled the inclusion criteria.Twenty-seven (79%) responded to plasma exchange, with 16/34 (47%) having moderate and 11/34 (32%) marked improvement. Twenty-three (68%) people had ADC restriction on brain MRI prior to PLEX. ADC restriction did not predict response (p=0.51). Several other pre-PLEX factors, including sex, Expanded Disability Status Scale (EDSS) at initial attack, time to PLEX, and concurrent spinal cord attack, also failed to predict response. Plasma-exchange responders had less disability at 6-month follow-up compared to non-responders (median EDSS 2.5 (range 1.0-10.0) vs. 7.5 (5.5-10.0), p<0.001). Acute cerebral attacks of MS have a high rate of plasma exchange response resulting in a lower EDSS at 6-months. ADC restriction does not predict response to plasma exchange.

Analysis of determinants of treatment change in adult paediatric-onset MS patients.

Paediatric-onset multiple sclerosis (POMS) is increasing worldwide and represents approximately 5% of all MS cases. Although this patient group has similar characteristics to the adult group, it is important for this patient group to receive effective treatment due to the early onset of cognitive involvement, higher lesion burden, and secondary progression at an earlier age than adults. In this study, we aimed to evaluate the factors that cause treatment change in POMS patients. Adult patients with a first MS attack at age 18 years or younger who were followed up with the diagnosis of MS at the Clinical Neuroimmunology and Demyelinating Diseases outpatient clinic of Cerrahpaşa Medical School between 1987 and 2020 were included in our study. Patient files were reviewed retrospectively, and demographic and clinical characteristics, imaging, first attack characteristics, and treatment change were noted. We included 269 patients with a definite diagnosis of MS in the study, and these patients were evaluated in two groups: negative for treatment change and positive for treatment change. Multifocal involvement was detected more frequently in the group with treatment change (p=0,049). Cerebellar involvement as a first attack symptom was more common in male patients (p=0,023) The age at first MS attack was found to be younger (p=0,006), and the disease duration was longer in the positive for treatment change group (p=0,003). Spinal cord involvement was more common in the positive for treatment change group (p=0,016). Abnormal VEP findings were observed more frequently in the group without treatment change (p=0.018). In multivariant analysis, spinal cord involvement, younger age at first attack, and abnormal VEP findings in the group without treatment change were found to be significant. Among the reasons for treatment change, the most common reason was radiological and clinical progression. The higher inflammatory load in POMS patients compared with adults necessitates early initiation of treatment in this group and timely treatment change to prevent disability. Furthermore, this patient group should be followed closely and receive effective treatment.

Metabolomics of Cerebrospinal Fluid in Multiple Sclerosis Compared With Healthy Controls: A Pilot Study.

BackgroundMultiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS) leading to the loss of myelin and axons. Diagnosis is based on clinical findings, MRI, and analysis of cerebrospinal fluid (CSF). CSF is an ultrafiltrate of plasma and reflects inflammatory processes in the CNS. The aim of this study was to perform metabolomics analysis of CSF in patients after the first attack of MS and healthy controls and try to find new specific analytes for MS including those potentially predicting disease activities at the onset.MethodsWe collected CSF from 19 patients (16 females, aged 19–55 years) after the first attack of clinical symptoms who fulfilled revised McDonald criteria of MS and CSF of 19 controls (16 females, aged 19–50 years). Analyses of CSF samples were provided using the high-performance liquid chromatography system coupled with a mass spectrometer with a high-resolution detector (TripleTOF 5600, AB Sciex, Canada).ResultsApproximately 130 selected analytes were identified, and 30 of them were verified. During the targeted analysis, a significant decrease in arginine and histidine and a less significant decrease in the levels of asparagine, leucine/isoleucine, and tryptophan, together with a significant increase of palmitic acid in the patient group, were found.ConclusionWe observed significant differences in amino and fatty acids in the CSF of newly diagnosed patients with MS in comparison with controls. The most significant changes were observed in levels of arginine, histidine, and palmitic acid that may predict inflammatory disease activity. Further studies are necessary to support these findings as potential biomarkers of MS.

Availability of Fibrinogen/Albumin ratio in MS attack

Background/AimMultiple sclerosis (MS) is a chronic central nervous system inflammatory disease. Fibrinogen/Albumin ratio (FAR) has been studied as an inflammatory marker in the past, and its significant relationship with inflammation has been shown. In our study, we examined serum levels of albumin, fibrinogen and FAR in patients presenting with MS attack. We investigated its usability in the diagnosis and management of MS attacks. Materials and methodsThis retrospective study included 40 patients admitted to hospital with MS attack and 40 control patients. All patients’ demographics, medical history, the mean Expanded Disability Status Scale (EDSS), imaging findings and laboratory tests were extracted from medical records. Patients’ fibrinogen, albumin levels were recorded in the blood tests performed before steroid administration, and FAR values were calculated. The patients’ and controls’ results were compared. ResultsFibrinogen and FAR values were significantly higher in the patient group (p<0.001 in both). There was no difference between the patient and control groups in terms of albumin (p = 0,16). No significant relationship was found between parameters such as EDSS, disease duration, smoking status and FAR value (p>0.05 in all). ConclusionSerum fibrinogen and FAR levels in the patients presenting with an attack were significantly higher than the control group. FAR value did not vary with disease duration and EDSS score. Based on this information, FAR may be a useful indicator for MS attack regardless of EDSS and disease duration.

Assessment of serum zonulin as a marker of altered intestinal permeability in patients with multiple sclerosis

Abstract Background Here we enrolled patients into 3 groups: Relapsing remittent MS in relapse (RRMS) [N = 26], progressive MS (progressive) [N = 19] and relapsing remittent MS in remission (remission) [N = 18] Control group matching age and sex [N = 20] P-Value was &amp;lt;0.001, which is significant in RRMS group in relation to progressive, remission and control groups. P-Value was 0.849, which is insignificant in progressive group in relation to remission group. P-Value was 0.584, which is insignificant in progressive group in relation to control group. P-Value was 0.973, which is insignificant in remission group in relation to control group. Aim of the Work To investigate the possible association between IP changes and MS through measurement serum zonulin in different population of MS for possible implication on treatment. Patients and Methods A. Subjects Type of the Study A case control observational cross sectional study Study Setting The Neurology department of Ain Shams University hospitals. Study Period 6 months to 1 year Study Population This study will enroll 92 subjects who will be divided into 4 groups; group 1 including 24patients with the diagnosis of relapsing remittent MS (RRMS) who are in relapse phase within one week from the time of sample withdrawal, group 2 including 24 patients with the diagnosis of RRMS who are in remission phase, group 3 including 24 patients with secondary progressive MS (SPMS) and group 4 including 20 age- and sex-matched healthy controls. Results In the RRMS group of this study, serum Zonulin varying between (12_ 93) with mean 28.692 and +\-22.894 SD. In the progressive group of this study, serum Zonulin varying between (2_ 18) with mean 8.021 and +\-3.866 SD. In the remission group of this study, serum Zonulin varying between (1.5_ 11) with mean 4.522 and +\-3.026 SD. In the control group of this study, serum Zonulin varying between (1.3_ 6) with mean 2.690 and +\-1.292 SD. P-Value was &amp;lt;0.001, which is significant in RRMS group in relation to progressive, remission and control groups. P-Value was 0.849, which is insignificant in progressive group in relation to remission group. P-Value was 0.584, which is insignificant in progressive group in relation to control group. P-Value was 0.973, which is insignificant in remission group in relation to control group. Conclusion this study included 62 patients diagnosed as multiple sclerosis that are divided into 3 groups and serum Zonulin level was assessed in each group and the results were significant in the relapse group which indicates autoimmune theory of MS and link between gut barrier and CNS also illustrated the role of gut microbiota in the MS. It also supported disintegration of intestinal barrier during the attack of MS for further work up studies regarding oral medication in the acute attack of MS.

Depression, anxiety, and fear of COVID-19 in patients with multiple sclerosis in pandemic era: a cross-sectional study.

BackgroundDepression and anxiety are the two important factors determining quality of life of patients with multiple sclerosis (PWMS). In COVID-19 pandemic era, several factors can provoke mental issues of people and patients. In this cross-sectional study, we aim to estimate the new prevalence of anxious and depressive symptoms and their relating factors in PWMS.MethodsIn this cross-sectional study, we include PWMS who are recruited in the MS clinic of Sina Hospital, Tehran, and are joined in our channel of Telegram media. A self-designed online questionnaire consisted of 4 parts handed out between patients: demographic and clinical data, Beck depression inventory, Beck anxiety inventory, and Fear of COVID-19 Scale. Univariate and multiple logistic regression analyses were performed to find the relating factors of expression of depressive and anxious symptoms in PWMS.ResultsOf a total of 282 participants with the mean age of 35.66 (30.75–40) years, had been suffering from multiple sclerosis for 7.36 (3–10) years, 81.7% were women and 69.1% classified as relapsing–remitting MS. Mean score of BDI was 17.13 ± 11.51 which is classified as minimal-moderate depressive symptoms. 48.6% of patients did not express depressive symptoms (BDI-II ≤ 14) and the others reported some degrees of depression. In the univariate analysis employment (p = 0.015), marital status (p = 0.022), level of education (p = 0.004), number of hospitalization due to MS attacks (p = 0.048), and fear of COVID-19 (p ≤ 0.0001) associated significantly with presence of depressive symptoms. After entering these factors in a binary logistic regression model, level of education (p = 0.019), marital status (p = 0.044), number of hospital admissions due to MS relapses (β = 1.10, p = 0.02), and fear of COVID-19 (β = 1.07, p ≤ 0001) remained significant as relating factors. Mean score of the anxiety calculated 14.54 ± 9.75 and just 3.2% of patients had severe anxiety. Employment (p = 0.045), EDSS score (p = 0.004), and fear of COVID-19 (p ≤ 0.0001) reported relating to anxious symptoms significantly in the univariate analysis. After entering in the logistic regression analysis, EDSS (β = 1.30, p = 0.001) and fear of COVID-19 (β = 1.13, p ≤ 0.0001) remained as significant relating factors of anxious symptoms.ConclusionThe overall prevalence of depressive symptoms in PWMS in our MS clinic is 51.4% which is obviously higher than other world’s centers which could be due to fear of COVID-19. In addition to fear of COVID-19, presence of depressive symptoms in PWMS is related significantly with level of education, number of hospital admissions due to MS relapses, and marital status. Other side, the patients classified as suffering from anxious symptoms had more severe problems on fear of COVID-19. But it is recommended for future studies to compare patients score in the COVID-19 era with their score before this pandemic.

Muliple Sclerosis, Corpus Callosum &amp; Epilepsy

There is a difference in prevalence of Epilepsy in General population &amp; MS patients. Interical Epileptiform Discharges (IED) positivity in EEG is also different in the above two populations. Demyelination slows down the conduction speed of axons and author is proposing that different speed of conduction in adjacent axons can generate re-entrant circuits. If the reentrant circuits involve Corpus callosum (CC) fibers, seizure activities of MS can be triggered. DBS applied to CC can terminate the seizure attack of MS like Vagal Nerve Simulator (VNS) in terminating seizure in general population.

The Epidemiology of COVID-19 and MS-Related Characteristics in a National Sample of People With MS in China.

Few studies have focused on immune status and disease activity in MS patients during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study is to investigate immune status, COVID-19 infection, and attacks in MS patients during the pandemic. An online questionnaire about COVID-19 infection, MS attack, and MS treatment during the pandemic was administered to all 525 MS patients registered in our hospital database from January 1, 2011, to June 1, 2020. Only 384 responded, of which 361 patients could be included in the final analysis. During the pandemic, 42.1% of the 361 patients and 65.0% of the 234 patients on immunotherapies were exposed to teriflunomide. Compared to patients who didn't receive treatment, patients exposed to DMTs had significantly lower levels of neutrophils (P < 0.01) and immunoglobulin G (P < 0.01), and patients exposed to immunosuppressants had significantly lower levels of immunoglobulin G (P < 0.05). Over 80% of our patients followed effective protective measures and none of the 361 MS patients in our cohort contracted COVID-19. Patients whose treatment was disrupted had a significantly higher annualized relapse rate (ARR) during than before the pandemic (P < 0.01), while the ARR of patients with continuous treatment or without treatment remained unchanged. During the pandemic, the risk of MS attack due to treatment disruption possibly outweighs the risk of COVID-19 infection under preventive measures, and MS treatment maintenance might be necessary.

COVID-19 and the Risk of Relapse in Multiple Sclerosis Patients: A Fight with No Bystander Effect?

BackgroundCOVID-19 is speculated to increase the likelihood of relapsing-remitting multiple sclerosis (RRMS) exacerbation. ObjectiveTo investigate the association between contraction of COVID-19 and incidence of acute MS attacks in RRMS patients six months post-infection. MethodsThis retrospective cohort study compares the risk of relapse in RRMS patients with (n=56) and without COVID-19 (n=69). Incidence of relapse was recorded for six-month following contraction of COVID-19. Incidence of RRMS exacerbation in patients with COVID-19 was compared to patients without COVID-19 (the independent control group) and the same patients six months prior to the COVID-19 pandemic. ResultsA lower incidence rate of RRMS exacerbation was observed in patients that contracted COVID-19 than in patients who did not contract COVID-19 (incidence rate ratio: 0.275; p=0.026). Self-controlled analysis showed no significant difference in relapse rates before the COVID-19 pandemic and after contracting COVID-19 (p=0.222). The relapse risk was not different between patients who had been hospitalized due to COVID-19 severity and those who had not (p=0.710). ConclusionCOVID-19 contraction may not increase the risk of acute MS attacks shortly following contraction. We hypothesize that COVID-19-associated lymphopenia may partly preclude the autoreactive memory cells from expansion and initiating relapses through a so-called bystander effect of COVID-19 infection.

Low serum Α-SYNUCLEIN and oligomer Α-SYNUCLEIN levels in multiple sclerosis patients

IntroductionMultiple sclerosis (MS) is an autoimmune, inflammatory, demyelinating neurodegenerative disease progressing with attacks. Alpha-synuclein (α-Syn), a neuronal protein, has been previously associated with the inflammation and development of neurodegenerative diseases. Although the cause of neurodegeneration in multiple sclerosis is mainly associated with inflammation, α-Syn may play a role in the pathogenesis of MS, as in other classical neurodegenerative diseases such as synucleinopathies. In multiple sclerosis, α-Syn has been directly studied in central nervous system lesions and cerebrospinal fluid (CSF). However, there are few studies approaching variations in peripheral α-Syn in MS. The aim of our study was to investigate the correlation between disease progression and other clinical parameters by measuring serum α-Syn and oligomer α-Syn levels in MS patients. Material and methodThe study included 60 MS patients aged 18 years or older who were admitted to the Department of Neurology between 01.02.2020–01.04.2020 and diagnosed with MS according to the 2010 MC Donald criteria, and 60 age- and sex-matched healthy controls. Those who were in the MS attack period and received cortisone treatment in the past three months were excluded from the study. The serum α-Syn and oligomer α-Syn levels of the individuals in both groups were measured. The correlation between the serum α-Syn, oligomer α-Syn, oligomer α-Syn/α-Syn ratio levels of the MS patients and their age, disease duration, number of attacks, annualized relapse rate (ARR), disease type, EDSS scores and immunomodulatory drug type used was investigated. Statistical analysis was performed using the SPSS 22.0 software. ResultsIn our study, 73.3% of the MS patients were female and the mean age of the patients was 36.18 ± 9.5 years. The most common MS disease type was RRMS with 83.3%. Serum α-Syn (79.52 ± 34.81) and oligomer α-Syn (18.79 ± 10.48) levels were significantly lower in the MS patients compared to the control group (p < 0.001). Serum oligomer α-Syn/α-Syn ratio was higher in the MS patients compared to the control group and in SPMS compared to RRMS, but was not statistically significant. There was no significant correlation between the serum α-Syn, oligomer α-Syn and oligomer α-Syn/α-Syn ratio ratio of the MS patients and their age, disease duration, disease type, EDDS, ARR and immunomodulatory treatments. There was a significant positive correlation between α-Syn and oligomer α-Syn in MS patients (r: 0.29, p: 0.02). ConclusionIn our study, serum α-Syn and oligomer α-Syn levels were lower in the MS patients compared to the control group. Low levels of α-Syn in MS may play a role in the development of neuroinflammation and may be a result of the diffuse neuronal and synaptic loss. There is a need for further studies on this subject.

Location of first attack predicts the site of subsequent relapses in multiple sclerosis

Predictors of attack location in relapsing-remitting multiple sclerosis (RRMS) are poorly known. It has been suggested that the site of the first relapse may influence the location of the subsequents. We aimed to ascertain this hypothesis in a sample of patients consecutively recruited in two Italian MS Centres, with at least two MS attacks. The following data were collected from medical records: demographic data, locations involved in the first two (or three) MS attacks (optic nerve, spinal cord, brain stem/cerebellum, cerebral hemispheres, according to symptoms presented), time elapsed between relapses and onset of disease-modifying treatment (DMT). We enrolled 199 patients (67% females; MS onset age 30.0 ± 8.69 years), in 148 of whom we could define the precise attack location. In 70/148 patients (47%) the second attack involved exactly the same location as the first. There was an increased risk of relapsing in the same location of the first attack when this involved the optic nerve (OR 4.5, 95% CI 2.2–9.2, p < 0.0001), the brainstem/cerebellum (OR 3.5, 95% CI 1.7–6.9, p < 0.0001), or the spinal cord (OR 3.0, 95% CI 1.5–5.9, p = 0.001). The location of third relapse (N = 90) was equally influenced by the site of first attack. In 24 patients with optic neuritis in both the two first attacks, the side coincided in 50% of cases. The location of first attack has a major role in influencing the site of subsequent ones in RRMS.

Approach to multiple sclerosis associated uveitis: 3 case reports

Background: Uveitis which is known as inflammation in adjacent ocular structures can be one of the ocular manifestations of multiple sclerosis. It is shown that the prevalence of uveitis in patients suffering from MS is more than the normal population. This case report encompasses the association between the two diseases. The diagnostic and approaching the patients to both disorders are fully discussed. Case presentation: 3 patients with definite MS and uveitis are reported. The first and second patients have the feature of intermediate uveitis and the third one has sclerouveitis. Each patient has a negative laboratory test for inflammatory and infectious diseases. Conclusion: Uveitis can be considered as an attack of MS, therefore this eye impairment should be managed by an ophthalmologist and then refer back to the neurologist for further MS treatment and management.

Influence of Instantaneous Compression on Recognition of Speech in Noise with Temporal Dips.

In listening environments with background noise that fluctuates in level, listeners with normal hearing can "glimpse" speech during dips in the noise, resulting in better speech recognition in fluctuating noise than in steady noise at the same overall level (referred to as masking release). Listeners with sensorineural hearing loss show less masking release. Amplification can improve masking release but not to the same extent that it does for listeners with normal hearing. The purpose of this study was to compare masking release for listeners with sensorineural hearing loss obtained with an experimental hearing-aid signal-processing algorithm with instantaneous compression (referred to as a suppression hearing aid, SHA) to masking release obtained with fast compression. The suppression hearing aid mimics effects of normal cochlear suppression, i.e., the reduction in the response to one sound by the simultaneous presentation of another sound. A within-participant design with repeated measures across test conditions was used. Participants included 29 adults with mild-to-moderate sensorineural hearing loss and 21 adults with normal hearing. Participants with sensorineural hearing loss were fitted with simulators for SHA and a generic hearing aid (GHA) with fast (but not instantaneous) compression (5 ms attack and 50 ms release times) and no suppression. Gain was prescribed using either an experimental method based on categorical loudness scaling (CLS) or the Desired Sensation Level (DSL) algorithm version 5a, resulting in a total of four processing conditions: CLS-GHA, CLS-SHA, DSL-GHA, and DSL-SHA. All participants listened to consonant-vowel-consonant nonwords in the presence of temporally-modulated and steady noise. An adaptive-tracking procedure was used to determine the signal-to-noise ratio required to obtain 29% and 71% correct. Measurements were made with amplification for participants with sensorineural hearing loss and without amplification for participants with normal hearing. Repeated-measures analysis of variance was used to determine the influence of within-participant factors of noise type and, for participants with sensorineural hearing loss, processing condition on masking release. Pearson correlational analysis was used to assess the effect of age on masking release for participants with sensorineural hearing loss. Statistically significant masking release was observed for listeners with sensorineural hearing loss for 29% correct, but not for 71% correct. However, the amount of masking release was less than masking release for participants with normal hearing. There were no significant differences among the amplification conditions for participants with sensorineural hearing loss. The results suggest that amplification with either instantaneous or fast compression resulted in similar masking release for listeners with sensorineural hearing loss. However, the masking release was less for participants with hearing loss than it was for those with normal hearing.

Evaluation of Antiserum Level of EBV-VCA Antibodies in Acute Attack in Patients with Multiple Sclerosis

Introduction: MS is considered as one of the most common causes of disability among young people. As no definite treatment has been recognized for this disease yet, the patients are confused due to the life struggles with regard to the chronic clinical conditions, influencing their quality of life and health. Thus, finding the factors exacerbating the MS and trying to eliminate these factors are crucial. Thus, this research was conducted to evaluate the antiserum level of EBV-VCA antibodies in acute attack in patients with multiple sclerosis. Method and materials: In this descriptive, cross-sectional research, 30 patients with multiple sclerosis admitted to neurologic clinic due to acute MS, were included. Anti-serum level of EBV-VCA antibodies was measured by ELISA method. Results: The research results revealed that out of total 30 patients, 3 patients (10%) had positive serum EBV-VCA IgM, 5 suspected cases (16.7%) were doubtful and 22 patients (73.3%) were negative in this regard. No significant relationship was found between serum level of EBV-VCA IgG and acute MS attack (P>0.05). Conclusion: The results of the research and comparison of these results with those of some other studies suggest that there is no significant relationship between serum level of IgM EB-VCA and acute attack of multiple sclerosis.

Real-world validation of the 2017 McDonald criteria for pediatric MS.

ObjectiveTo compare the diagnostic accuracy of the McDonald 2017 vs the McDonald 2010 criteria to predict a second attack of MS (clinically definite MS [CDMS]) at the first attack of acquired demyelinating syndromes (ADS).MethodsOne hundred sixty-four children (aged <18 years) with an incident attack of ADS were included in a prospective multicenter study between June 2006 and December 2016. Brain (and spinal if available) MRI was performed ≤3 months after symptom onset. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were compared at baseline between the 2010 and 2017 criteria.ResultsAmong the 164 patients, 110 patients (67%) presented without encephalopathy (ADS–, female 63%; median age 14.8 years, IQR 11.3–16.1years) and 54 (33%) with encephalopathy (acute disseminated encephalomyelitis [ADEM], female 52%; median age 4.0 years, IQR 2.6–6.1 years). Of the 110 ADS– patients, 52 (47%) were diagnosed with CDMS within a median follow-up of 4.5 years (IQR 2.6–6.7 years). The sensitivity was higher for the 2017 criteria than for the 2010 criteria (83%; 95% CI 67–92, vs 49%; 95% CI 33–65; p < 0.001), but the specificity was lower (73%; 95% CI 59–84 vs 87%; 95% CI 74–94, p = 0.02). At baseline, 48 patients fulfilled the 2017 criteria compared with 27 patients when using the 2010 criteria. The results for children aged <12 years without encephalopathy were similar. In patients with ADEM, 8% fulfilled the 2010 criteria and 10% the 2017 criteria at baseline but no patient fulfilled the criteria for CDMS.ConclusionsThe McDonald 2017 criteria are more sensitive than the McDonald 2010 criteria for predicting CDMS at baseline. These criteria can also be applied in children aged <12 years without encephalopathy but not in children with ADEM.Classification of evidenceThis study provides Class II evidence that in children with ADS, the 2017 McDonald criteria are more sensitive but less specific than the 2010 McDonald criteria for predicting CDMS.

Headache in Multiple Sclerosis From a Different Perspective: A Prospective Study

Objective: It is known that patients with multiple sclerosis have a high incidence of headache. Although there is increasing evidence to suggest that periaqueductal gray matter (PAG) plays a role in the pathophysiology of migraine headache, it is not known whether the type of headache may be a predictor of a MS relapse. Patients and Methods: The study enrolled 100 patients (68 females, 32 males) with clinically confirmed MS diagnosis established by McDonald diagnostic criteria. The type and duration of MS, MRI localization of lesions and cognitive status were recorded for all patients. Patients were questioned whether they experience headache during MS attacks. Results: Sixty-eight percent of the patients had headache and 32% of the patients were free of headache. Of the patients with headache, 16% had tension –type headache (TTH), 14% had migraine, 11% had primary stabbing headache (PSH), 8% had TTH+ migraine, 6% had PSH+ migraine, 6% had medication overuse headache , 2% had medication overuse headache + migraine, 2% had paroxysmal hemicrania, 1% had cervicogenic headache, 1% had chronic TTH, and 1% had unclassified headache. There was a statistically significant relationship between the presence of headache and MS relapse (p<0.001). We found a statistically significant relationship between the type of headache and the localization of plaques in all MS patients in a statistical analysis using chi-square test, (p<0.001). Conclusion: Headache may be the only symptom of a flare-up in MS patients. The relationship between stabbing headache and MS relapses merits further investigation.

Serum soluble Talin-1 levels are elevated in patients with multiple sclerosis, reflecting its disease activity

Previously, we identified anti-Talin-1 antibodies in the serum of MS. In this case, we measured the serum soluble Talin-1 (sTalin-1) levels by enzyme-linked immunosorbent assay. The serum sTalin-1 levels were significantly higher in 40 patients with MS than in 43 normal controls and in the acute phase of disease than in the remission phase. Interestingly, serum sTalin-1 levels were associated with a sustained increase in disability after MS attack but not with serum anti-Talin-1 antibody levels. sTalin-1 may be a biomarker for the acute phase of MS and may be used for the short-term prognosis of MS.