Disability In MS Research Articles

Clinical relevance of paramagnetic rim lesion heterogeneity in multiple sclerosis.

Previous studies reveal heterogeneity in terms of paramagnetic rim lesions (PRL) associated tissue damage. We investigated the physiopathology and clinical implications of this heterogeneity. In 103 MS patients (72 relapsing and 31 progressive), brain lesions were manually segmented on 3T 3D-FLAIR and rim visibility was assessed with a visual confidence level score (VCLS) on 3D-EPI phase. Using T1 relaxation time maps, lesions were categorized in long-T1 and short-T1. Lesion age was calculated from time of first gadolinium enhancement (N = 84 lesions). Results on clinical scores were validated in an extended cohort of 167 patients using normalized T1w-MPRAGE lesion values. Rim visibility (VCLS analysis) was associated with increasing lesional T1 (P/PFDR < 0.001). Of 1680 analyzed lesions, 427 were categorized as PRL. Long-T1 PRL were older than short-T1 PRL (average 0.8 vs. 2.0 years, P/PFDR = 0.005/0.008), and featured larger lesional volume (P/PFDR < 0.0001) and multi-shell diffusion-measured axonal damage (P/PFDR < 0.0001). The total volume of long-T1-PRL versus PRL showed 2× predictive power for both higher MS disability (EDSS; P/PFDR = 0.003/0.005 vs. P/PFDR = 0.042/0.057) and severity (MSSS; P/PFDR = 0.0006/0.001 vs. P/PFDR = 0.004/0.007). In random forest, having ≥1 long-T1-PRL versus ≥4 PRL showed 2-4× higher performance to predict a higher EDSS and MSSS. In the validation cohort, long-T1 PRL outperformed (~2×) PRL in predicting both EDSS and MSSS. PRL show substantial heterogeneity in terms of intralesional tissue damage. More destructive, likely older, long-T1 PRL improve the association with MS clinical scales. This PRL heterogeneity characterization was replicated using standard T1w MRI, highlighting its potential for clinical translation.

Konectom™ cognitive processing speed test enables reliable remote, unsupervised cognitive assessment in people with multiple sclerosis: Exploring the use of substitution time as a novel digital outcome measure

Background: The Konectom™ smartphone-based cognitive processing speed (CPS) test is designed to assess processing speed and account for impact of visuomotor function on performance. Objective: Evaluate reliability and validity of Konectom CPS Test, performed in clinic and remotely. Methods: Data were collected from people with multiple sclerosis (PwMS) aged 18–64 years and healthy control participants (HC) matched for age, sex, and education. Remote test–retest reliability (intraclass correlation coefficients, ICC); correlation with established clinical measures (Spearman correlation coefficients); group analyses between cognitively impaired/unimpaired PwMS; and influence of age, sex, education, and upper limb motor function on CPS Test measures were assessed. Results: Eighty PwMS and 66 HC participated. CPS Test measures from remote tests had good test–retest reliability (ICC of 0.67–0.87) and correlated with symbol digit modalities test (highest |ρ| = 0.80, p < 0.0001). Remote measures were stable (change from baseline < 5%) and correlated with MS disability (highest |ρ| = 0.39, p = 0.0004) measured by Expanded Disability Status Scale. CPS Test measures displayed sensitivity to cognitive impairment (highest d = 1.47). Demographics and motor function had the lowest impact on CPS Test substitution time, a measure accounting for visuomotor function. Conclusion: Konectom CPS Test measures provide valid, reliable remote measurements of cognitive processing speed in PwMS.

Cognitive profile in Egyptian multiple sclerosis patients has no correlation with serum neurofilament level

BackgroundGrey matter loss is thought to be the primary reason of cognitive disability in MS, with trans-synaptic axonal degeneration acting a supportive role. This research sought to evaluate cognitive profile of Egyptian multiple sclerosis patients and find out if it has a correlation with serum neurofilament or not.MethodsThis was a cross-sectional research performed on a total of 60 patients with MS and 30 healthy controls. BICAMS battery of neuropsychological tests was used which includes SDMT, CVLT and BVMT. Serum NFLs using ELISA technique.ResultsMean ± SD of NFL in RRMS was 82.25 ± 170.9, in PPMS was 22.08 ± 7.26, in SPMS was 95.82 ± 187.5, and in control group was 56.65 ± 125.4, there was high statistical substantial variations among the different groups while there was non-statistical variation between RRMS and PPMS groups, also there was no variation between PPMS and SPMS with regard to serum level of NFL. There is no significant correlation between the NFL and different cognitive tests.ConclusionSince sNfL did not strongly connect with cognitive function in MS patients, it is possible that it cannot be used as a substitute indicator for neuropsychological state in these groups.

The Relationship Between Socioeconomic Status and Disability in MS Is Linked to Diet (P4-6.010)

The Relationship Between Socioeconomic Status and Disability in MS Is Linked to Diet (P4-6.010)

What contributes to disability in progressive MS? A brain and cervical cord–matched quantitative MRI study

Background: We assessed the ability of a brain-and-cord-matched quantitative magnetic resonance imaging (qMRI) protocol to differentiate patients with progressive multiple sclerosis (PMS) from controls, in terms of normal-appearing (NA) tissue abnormalities, and explain disability. Methods: A total of 27 patients and 16 controls were assessed on the Expanded Disability Status Scale (EDSS), 25-foot timed walk (TWT), 9-hole peg (9HPT) and symbol digit modalities (SDMT) tests. All underwent 3T brain and (C2-C3) cord structural imaging and qMRI (relaxometry, quantitative magnetisation transfer, multi-shell diffusion-weighted imaging), using a fast brain-and-cord–matched protocol with brain-and-cord–unified imaging readouts. Lesion and NA-tissue volumes and qMRI metrics reflecting demyelination and axonal loss were obtained. Random forest analyses identified the most relevant volumetric/qMRI measures to clinical outcomes. Confounder-adjusted linear regression estimated the actual MRI-clinical associations. Results: Several qMRI/volumetric differences between patients and controls were observed (p < 0.01). Higher NA-deep grey matter quantitative-T1 (EDSS: beta = 7.96, p = 0.006; 9HPT: beta = −0.09, p = 0.004), higher NA-white matter orientation dispersion index (TWT: beta = −3.21, p = 0.005; SDMT: beta = −847.10, p < 0.001), lower whole-cord bound pool fraction (9HPT: beta = 0.79, p = 0.001) and higher NA-cortical grey matter quantitative-T1 (SDMT = −94.31, p < 0.001) emerged as particularly relevant predictors of greater disability. Conclusion: Fast brain-and-cord–matched qMRI protocols are feasible and identify demyelination – combined with other mechanisms – as key for disability accumulation in PMS.

Cortical Thin Patch Fraction Reflects Disease Burden in MS: The Mosaic Approach.

GM pathology plays an essential role in MS disability progression, emphasizing the importance of neuroradiologic biomarkers to capture the heterogeneity of cortical disease burden. This study aimed to assess the validity of a patch-wise, individual interpretation of cortical thickness data to identify GM pathology, the "mosaic approach," which was previously suggested as a biomarker for assessing and localizing atrophy. We investigated the mosaic approach in a cohort of 501 patients with MS with respect to 89 internal and 651 external controls. The resulting metric of the mosaic approach is the so-called thin patch fraction, which is an estimate of overall cortical disease burden per patient. We evaluated the mosaic approach with respect to the following: 1) discrimination between patients with MS and controls, 2) classification between different MS phenotypes, and 3) association with established biomarkers reflecting MS disease burden, using general linear modeling. The thin patch fraction varied significantly between patients with MS and healthy controls and discriminated among MS phenotypes. Furthermore, the thin patch fraction was associated with disease burden, including the Expanded Disability Status Scale, cognitive and fatigue scores, and lesion volume. This study demonstrates the validity of the mosaic approach as a neuroradiologic biomarker in MS. The output of the mosaic approach, namely the thin patch fraction, is a candidate biomarker for assessing and localizing cortical GM pathology. The mosaic approach can furthermore enhance the development of a personalized cortical MS biomarker, given that the thin patch fraction provides a feature on which artificial intelligence methods can be trained. Most important, we showed the validity of the mosaic approach when referencing data with respect to external control MR imaging repositories.

Use of AI to classify MS Disability during the time of Covid

Use of AI to classify MS Disability during the time of Covid

Potential beneficial effect of IFN-β1a and ocrelizumab in people with MS during the COVID-19 pandemic.

Disease-modifying therapy (DMT) has led to added challenges in the management of people with multiple sclerosis (pwMS) during the COVID-19 era. It can reduce relapse in MS or slow down disease progression, but some DMTs can increased risk of infection. The aim of study was to evaluate risk and severity of COVID-19 in pwMS. The examined group of pwMS were divided in group treated with IFN-β1a, group treated with ocrelizumab and untreated group. The examination included impact of age, gender, duration of MS, type of MS, vaccination status and Expanded Disability Status Scale (EDSS) on the risk and severity of COVID-19 infection. A diagnosis of COVID-19 in pwMS was confirmed by positive polymerase-chain-reaction (PCR) or antigen test. Out of 207 pwMS, 82 patients were treated with ocrelizumab, 63 with IFN-β1a, while 62 patients were untreated pwMS. The average duration of the MS was longer in the group of patients treated with ocrelizumab than in the group treated with IFN-β1a (p < 0.05). EDSS was higher in the ocrelizumab group compared to the other two groups (p < 0.001). Untreated (more often unvaccinated) had the same COVID frequency as ocrelizumab-treated (more vaccinated, but higher EDSS). The multivariate logistic regression model indicated that administration of IFN-β1a reduces the risk of COVID-19 infection (p = 0.001, OR = 0.381, 95% CI 0.602-0.160). The use of both DMTs, driven mainly by the IFN-β1a effect, reduces the risk of moderate and severe COVID-19 (p < 0.05, OR = 0.105, 95% CI 0.011-0.968). This study provides evidence that IFN-β1a can reduce the frequency of COVID-19 infection and that two DMTs, driven mainly by the IFN-β1a effect, do not increase the risk of moderate/severe COVID-19.

Ankle dorsiflexion asymmetry and the relationship with walking performance in people with multiple sclerosis

BackgroundMultiple sclerosis (MS) is a neurological disease characterized by demyelination disrupting the central nervous system. Persons with MS may exhibit symptomatic strength asymmetry (SA) that impacts motor gait and ankle mobility. The purpose of the present study was to investigate ankle dorsiflexion SA in people with MS and its relationship to functional performance. Research QuestionIs their a difference in dorsiflexion SA in MS participants compared to healthy individuals and does it impact functional performance? Methods13 MS participants (EDSS 3.5 + 1.8) and 13 age matched NON-MS participants underwent maximal isometric (MVC) dynamometry testing for ankle dorsiflexion in both limbs to determine SA. Participants performed three functional tasks of walking performance. ResultsThere was a significant intra-limb MVC difference in the MS group, and significantly greater isometric SA (p < 0.007) and isokinetic SA (p < 0.04) in the MS group compared to healthy individuals. The MS group exhibited significant correlations between outcomes of functional walking performance with isokinetic but not isometric SA. There was no significant correlation between disability status and functional task performance. SignificanceAnkle dorsiflexion SA is negatively correlated with functional performance in MS participants. MS disability status was not a predictor of functional task performance, and symptom testing may be appropriate to assess walking ability in persons with MS.

Health behaviors of people with multiple sclerosis and its associations with MS related outcomes: a German clinical cohort.

Health behaviors in persons with multiple sclerosis (pwMS) have been associated with MS-related disease outcomes. The aim of the study was to gain knowledge about current patient health behaviors in a convenience sample representative for pwMS presenting to a large university-based outpatient clinic and to investigate associations between modifiable risk factors with physical impairment, quality of life (QoL) and cardiovascular comorbidities. A questionnaire was administered at the MS Outpatient Clinic of the University Medical Center Hamburg Eppendorf asking for health behaviors regarding dietary habits assessed with the German adaptation of the validated Spanish short Diet Quality Screener (sDQS), level of physical activity assessed with the Godin Leisure Time Questionnaire (GLTEQ) and tobacco smoking. Participants were asked to report cardiovascular comorbidities using items from the Self-Report Comorbidity Questionnaire for Multiple Sclerosis. Additionally, cardiovascular risk factors like blood pressure, height and weight (to calculate BMI) and waist circumference were measured. MS specific clinical data, e.g., disease course, duration, disability and MS-specific QoL were collected from the clinical database. Descriptive analyses were performed and multivariate regression analyses for complete cases were carried out for each of the three outcome variables including all mentioned modifiable risk factors (dietary behavior, smoking, physical activity and BMI) as independent variables. In this sample of 399 pwMS the mean age was 42 years (SD 12.8) with a mean disease duration since diagnosis of 7.4 years (SD 8.4) and a mean EDSS of 2.8 (SD 1.9). 24% were current smokers, 44% were insufficiently physically active and 54% did not follow a healthy dietary pattern. 49% of this relatively young clinical population was overweight and 27% reported one or more cardiovascular comorbidities. Most modifiable risk factors showed no convincing associations with MS-related disease outcomes in the multiple regression analyses. This clinical cohort of pwMS shows a high prevalence of critical health behaviors and comorbidities and emphasizes the need for monitoring, education and assistance for behavior change in this population.

The relation of sarcopenia and disability in multiple sclerosis.

The relation of sarcopenia and disability in MS is unknown. To investigate the relation of temporal muscle thickness (TMT) and disability. A cohort of 132 people who presented with a clinically isolated syndrome (CIS) suggestive of MS at a mean age of 30.0 years, were prospectively followed clinically and with MRI over 30-years. TMT and expanded disability status scale (EDSS) were assessed at baseline, one- five- ten- fourteen- twenty- and thirty-year follow-up. At 30-years, 27 participants remained classified as having had a CIS, 34 converted to relapsing remitting MS, 26 to secondary progressive MS, and 16 had died due to MS. Using linear mixed effect models with subject nested in time, greater annualized TMT-thinning was seen in individuals who developed MS (-0.04mm/a, 95%CI: -0.07 to -0.01, p=0.023). In those who converted to MS, a thinner TMT was reached at 14- (p=0.008), 20- (p=0.002) and 30-years (p< 0.001). TMT was negatively correlated with EDSS at 20-years (R=-0.18, p=0.032) and 30-years (R-0.244, p=0.005). Longitudinally, TMT at earlier timepoints was not predictive for 30-year clinical outcomes. TMT thinning is accelerated in MS and correlated with disability in later disease stages, but is not predictive of future disability.

Glial fibrillary acidic protein and multiple sclerosis progression independent of acute inflammation.

The clinical relevance of serum glial fibrillary acidic protein (sGFAP) concentration as a biomarker of MS disability progression independent of acute inflammation has yet to be quantified. To test whether baseline values and longitudinal changes in sGFAP concentration are associated with disability progression without detectable relapse of magnetic resonance imaging (MRI) inflammatory activity in participants with secondary-progressive multiple sclerosis (SPMS). We retrospectively analyzed longitudinal sGFAP concentration and clinical outcome data from the Phase 3 ASCEND trial of participants with SPMS, with no detectable relapse or MRI signs of inflammatory activity at baseline nor during the study (n = 264). Serum neurofilament (sNfL), sGFAP, T2 lesion volume, Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk (T25FW), 9-Hole Peg Test (9HPT), and composite confirmed disability progression (CDP) were measured. Linear and logistic regressions and generalized estimating equations were used in the prognostic and dynamic analyses. We found a significant cross-sectional association between baseline sGFAP and sNfL concentrations and T2 lesion volume. No or weak correlations between sGFAP concentration and changes in EDSS, T25FW, and 9HPT, or CDP were observed. Without inflammatory activity, changes in sGFAP concentration in participants with SPMS were neither associated with current nor predictive of future disability progression.

Early miR-320b and miR-25-3p miRNA levels correlate with multiple sclerosis severity at 10 years: a cohort study

BackgroundMultiple sclerosis (MS) is a chronic demyelinating autoimmune disorder which may cause long-term disability. MicroRNA (miRNA) are stable, non-coding molecules that have been identified in our Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women’s Hospital (CLIMB)-cohort, as well as other international cohorts, as potential disease biomarkers in MS. However, few studies have evaluated the association of miRNA expression early in the MS disease course with long-term outcomes. Therefore, we aimed to evaluate the potential role of three candidate serum miRNAs previously correlated with MS disability in patients with MS, miR-320b, miR-25-3p and miRNA 486-5p, as early biomarkers of MS disability at 10-year follow-up.Main bodyWe included 144 patients with serum obtained within three years of MS onset. miRNA expression was measured by RNA extraction followed by RT-PCR. Demographic, clinical, brain MRI and other biomarkers were collected. The primary outcome was the association between early miRNA expression and retaining benign MS, defined as EDSS ≤ 2 at 10-year follow-up. Among the 144 patients, 104 were benign and 40 were not benign at 10-year follow-up. 89 (62%) were women, with mean age at onset 37.7 (SD: 9.6) years. Patients who retained benign MS had lower values of miR-25-3p (p = 0.047) and higher miR-320b (p = 0.025) values. Development of SPMS was associated with higher miR-320b (p = 0.002) levels. Brain parenchymal fraction at year 10 was negatively correlated with miR-25-3p (p = 0.0004) and positively correlated with miR-320b (p = 0.006). No association was found between miR-486-5p and any outcome, and 10-year T2-lesion volume was not associated with any miRNA.ConclusionsOur results show that miR-320b and miR-25-3p expression are early biomarkers associated with MS severity and brain atrophy. This study provides class III evidence of that miR-320b and miR-25-3p are associated with long-term MS disability which may be a potential tool to risk-stratify patients with MS for early treatment decisions.

Overactive bladder and multiple sclerosis in the University Hospital of Oujda

BackgroundMultiple sclerosis (MS) is the most frequent autoimmune neurological disease in the young population. Vesico-sphincter disorders are frequent in the course of the disease; it has been reported that 90% of MS patients will develop a lower urinary tract disorder within 18 years of the diagnosis.MethodsThe aim of this study is to identify the frequency, severity, diagnosis, and treatment of overactive bladder (OAB) in MS patients at the Mohammed VI hospital university in Oujda-Morocco. It is a cross-sectional study. The population was collected in neurology department of Mohammed VI hospital university in Oujda-Morocco. The population cohort consisted of patients diagnosed with multiple sclerosis, which were invited to the urology department where they underwent urinary screening and completed a form of questions regarding the frequency and severity of OAB and its influence on quality of life.ResultIn our study, the mean age of the patients was 43 years, and our sample was composed of 48% males and 52% females, and the most frequent lower urinary tract symptom was urgency (57%), followed by urinary frequency (29%) and urge incontinence (14%). The recurrent-remittent form was the most frequent (62%), followed by the primary progressive form (24%) and the secondary progressive recurrent form (14%). Among the patients, 33% presented a mild symptomatology, 48% moderate, and 19% severe. In this study, it was found that the intensity of urinary symptoms and the MS disability score were positively correlated with quality of life and disease duration.ConclusionThe urgency was the major symptom of the lower urinary tract, and the MS disability score and the severity of OAB were associated with the quality of life of the patients. The urological evaluation of patients with multiple sclerosis should be performed routinely to identify OAB and to treat this condition appropriately.

Cognitive Processing Speed Predicts Disability Milestones in Multiple Sclerosis (P5-3.014)

Cognitive Processing Speed Predicts Disability Milestones in Multiple Sclerosis (P5-3.014)

Declines in Work Productivity in Persons With Multiple Sclerosis by PDDS Score (P13-3.005)

<h3>Objective:</h3> To describe differences in employment status and work productivity by Patient Determined Disease Steps (PDDS) score. <h3>Background:</h3> The PDDS scale measures patient-reported disability in persons with MS (pwMS). Evidence suggests that reported increases in MS symptom severity adversely impact work productivity (Glanz 2012); it is unknown how employment status varies by disability level (Bessing 2021). Examining work productivity by PDDS provides a better understanding of disease burden in pwMS. <h3>Design/Methods:</h3> The sample included all participants aged 18–62 years in the US who responded to North American Research Committee on Multiple Sclerosis survey at least once in Fall 2017–Fall 2019 and reported PDDS score and employment status. If multiple surveys were available, the most recent was analyzed. Employment outcomes in the 6 months before the survey, including employment status, hours worked per week, any cutback in hours, number of missed workdays and receipt of disability benefits, were summarized overall and by PDDS score. <h3>Results:</h3> The sample included 3870 pwMS across all PDDS scores (normal, 21%; mild, 17%; moderate, 11%; gait disability, 13%; early cane, 12%; late cane, 8%; bilateral support: 8%, wheelchair/scooter, 10%; bedridden, 1%). Overall, 47% of pwMS were employed full/part-time in the prior 6 months. The proportion of pwMS who were employed declined from 81% in pwMS with a normal PDDS score and 69% with mild disability to 12% in pwMS with wheelchair/scooter and 0% in bedridden pwMS. Among all employed pwMS, 73% worked &gt;30 hours/week, 16% cutback hours and 38% missed workdays in the prior 6 months. Receipt of disability benefits increased rapidly from 9% in pwMS with normal scores to 96% in bedridden pwMS. <h3>Conclusions:</h3> PwMS with more disability were less likely to be employed and reported lower work productivity. Interventions that can address MS disability may result in slower declines in work productivity. <b>Disclosure:</b> Dr. Geiger has received personal compensation for serving as an employee of Genentech, Inc. Dr. Geiger has stock in Moderna. Dr. Geiger has stock in Abbott Laboratories. Dr. Geiger has stock in Gilead Sciences. Dr. Geiger has stock in Amgen. Dr. Geiger has stock in Roche. Dr. Geiger has received research support from National Science Foundation. Mrs. Bonine has received personal compensation for serving as an employee of Genentech. Mrs. Bonine has stock in Genentech. Dr. Di Felice has received personal compensation for serving as an employee of Genentech. Dr. Salter 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 American Heart Association.

A prospective study of cellular immune response to booster COVID-19 vaccination in multiple sclerosis patients treated with a broad spectrum of disease-modifying therapies

BackgroundMost people with Multiple Sclerosis (pwMS) are subjected to immunomodulatory disease-modifying treatments (DMTs). As a result, immune responses to COVID-19 vaccinations could be compromised. There are few data on cellular immune responses to the use of COVID-19 vaccine boosters in pwMS under a broad spectrum of DMTs.MethodsIn this prospective study, we analysed cellular immune responses to SARS-CoV-2 mRNA booster vaccinations in 159 pwMS with DMT, including: ocrelizumab, rituximab, fingolimod, alemtuzumab, dimethyl fumarate, glatiramer acetate, teriflunomide, natalizumab and cladribine.ResultsDMTs, and particularly fingolimod, interact with cellular responses to COVID-19 vaccination. One booster dose does not increase cellular immunity any more than two doses, except in the cases of natalizumab and cladribine. SARS-CoV-2 infection combined with two doses of vaccine resulted in a greater cellular immune response, but this was not observed after supplementary booster jabs. Ocrelizumab-treated pwMS who had previously received fingolimod did not develop cellular immunity, even after receiving a booster. The time after MS diagnosis and disability status negatively correlated with cellular immunity in ocrelizumab-treated pwMS in a booster dose cohort.ConclusionsAfter two doses of SARS-CoV-2 vaccination, a high response yield was achieved, except in patients who had received fingolimod. The effects of fingolimod on cellular immunity persisted for more than 2 years after a change to ocrelizumab (which, in contrast, conserved cellular immunity). Our results confirmed the need to find alternative protective measures for fingolimod-treated people and to consider the possible failure to provide protection against SARS-CoV-2 when switching from fingolimod to ocrelizumab.

Cholesterol pathway associated with MS disability.

Cholesterol pathway associated with MS disability.

Ten years of monoclonals in MS have not made an obvious dent in disability progression

We audited the clinical characteristics of 327 patients with MS and clinical onset with either a transverse myelitis (TM) or optic neuritis (ON) at our two MS specialist centres. We compared those diagnosed in 2000–2010 and 2010–2020 to determine if MS disability progression is being altered by the use of mono- clonal disease modifying treatments. Our hypothesis was that TM onset disease might no longer carry a worse clinical prognosis.More patients are being treated with monoclonals first line in the last decade (TM 12% to 27%, ON 7% to 11%). The time to MS diagnosis is shorter (5 months for TM and 25 months for ON), as was the time to treatment (4 years for both TM and ON). Contrary to our expectations, patients presenting with ON or TM during 2010–20 did not have a reduced risk of reaching EDSS 4.0. In fact, those with TM onset MS diagnosed in the last decade performed the worst overall, with 50% of the cohort reaching EDSS 4.0 within four years. Our study suggests that the effect of monoclonals is not as positive as widely assumed and pragmatic randomised trials are needed to test their real value in clinical practice.christopher.allen@nottingham.ac.uk

Functional analysis of validated miRNAs associated with MS disability (P2-4.005)

Functional analysis of validated miRNAs associated with MS disability (P2-4.005)