Multiple Sclerosis Disorders Research Articles

Coexistence of epilepsy or seizure and multiple sclerosis; review of the literature with a single center experience

ObjectivesThere is evidence that the inflammatory demyelinating disorder in Multiple Sclerosis (MS) is associated with acute seizures and epilepsy. Additionally, the likelihood of developing epilepsy increases with neurodegeneration. This study aims to reveal the clinical and radiological features of MS-epilepsy/seizure coexistence. MethodsAmong all patients diagnosed with MS that we followed in our center between April 2002 and July 2023, patients with a single seizure history or diagnosed with epilepsy (MS-seizure/epilepsy) were randomized 1:1 in terms of age and gender with MS patients without a diagnosis of epilepsy or seizures. Clinical (comorbidities, annualized relapse rate, disability, seizures during attacks, initial diagnosis, disease duration, disease-modifying therapies (DMTs), refractory epilepsy, anti-seizure drugs), electroencephalography (EEG) and MRI (lesion localization and new lesion(s)) data were retrospectively evaluated. ResultsThe mean EDSS was 4.07±2.81. 29.4 % of patients had progressive MS (n = 10). Refractory epilepsy was 52.9 % (n = 18), and SE history was 14.7 % (n = 5). Pathology was detected in 69.7 % (n = 23) of patients in the EEG. The most common slow wave activation was detected in 51.5 % (n = 17). Refractory epilepsy was more common in cases under 45 and patients with lesions in thalamic localization. Lesions in the temporal and thalamic regions and cerebral atrophy were more common in the MS-seizure/epilepsy group. ConclusionPatients with demyelinating lesions in the temporal and thalamic regions should be questioned more carefully for epilepsy, and an EEG should be performed in case of clinical suspicion. Since thalamus lesions are more common in patients with refractory epilepsy, anti-seizure treatment strategies should be applied more carefully. The presence of atrophy on MRI confirms the link between neurodegeneration processes and the development of epilepsy.

Personalized therapy and its side effects in patients with multiple sclerosis with depressive disorders

Depressive disorders in multiple sclerosis are the leading syndrome, but they have not been sufficiently studied. The clinical recommendations contain only a list of medications that were previously prescribed to patients with depression. To date, there is no description of the preferred groups of drugs for the treatment of depressive disorders, the starting dosage and timing of use, as well as possible adverse reactions when prescribing therapy to multiple sclerosis patients with depression. The purpose of this study is to search for optimal therapy for the relief of depressive disorders in patients with multiple sclerosis. Patients and methods: The study involved 203 patients with a confirmed diagnosis of multiple sclerosis (MS). The age of the patients at the time of examination ranged from 15 to 60 years, with the mean age of 39.7±10.91 years. Taking into account the type of course of the disease, MS patients were distributed as follows: 179 patients with relapsing remitting multiple sclerosis (RRMS) and 24 patients with secondary progressive multiple sclerosis (SPMS). The mean age of the examined patients with RRMS was 38±10 years; the duration of the disease was on average 8.23±6.57. The mean age of the onset of the disease was 30.2±10.5. The average disability index was EDSS 2.30±1.40. The age of the examined patients with SPMS was 46±9.00 years. The average age of onset of the disease was 33.33±8.02 years, and the level of disability was EDSS 5.70±0.30. All participants received multiple sclerosis disease modifying drugs (DMDs) and signed informed consent before being included in the study. The Beck's Depression Inventory was used to identify depression. The diagnosis of depressive disorder was established in accordance with the criteria of ICD-10 by a psychiatrist. Results and discussion: The choice of an antidepressant was made taking into account the type and degree of depression. Preference was given to the group of selective serotonin reuptake inhibitors (SSRIs), since MS patients poorly tolerate drugs with a strong sedative effect. Escitalopram was more often prescribed for anxiety depression, agomelatine for melancholic and hypochondriac depression, sertraline for asthenic depression, and fluvoxamine for adynamic depression. The starting dosage of the antidepressant in MS patients was almost twice as different from the dosage in the clinical recommendations for the treatment of depressive disorder. Due to the severity of neurological disorders, in a number of MS patients with the introduction of the starting dosage of an antidepressant, signs of sensitive ataxia, increased anxiety, and headaches were noted, therefore, the administration of an antidepressant was performed with slow titration. The association of side effects with periventricular foci in the frontal and parietal lobes of the brain has been revealed, which must be taken into account when prescribing therapy. Conclusion: Starting from the period of diagnosis of multiple sclerosis, patients need to be diagnosed for affective disorders, and risk factors that can cause depression need to be identified. When prescribing antidepressant therapy, it is necessary to take into account the type of depressive disorder, as well as the dosage of the drug, in order to exclude undesirable side effects.

Multifactorial model of predictors of the development of depressive disorders in multiple sclerosis: a prospective longitudinal study

Multifactorial model of predictors of the development of depressive disorders in multiple sclerosis: a prospective longitudinal study

Sufficiency for PSS tracking gait disorders in multiple sclerosis: A managerial perspective

This study primarily aimed to explore the capabilities of digitalisation in the healthcare context, focusing on a specific disease. In this case, the study examined the potential of remote monitoring of gait to address the sensitivity of multiple sclerosis progression to gait characteristics by adopting a non-invasive approach to remotely quantify gait disturbances in a patient's daily life. To better understand the managerial aspects associated with this approach, the researchers conducted a literature review along with a set of semi-structured interviews. The target population included MS patients as well as the key agents involved in their care: patients' family members, neurologists, MS nurses, physiotherapists, medical directors, and pharmacist. The study identifies the perceived barriers and drivers that could contribute to the successful deployment of PSS remote gait monitoring as a healthcare service: i) At mega-level governance. Implications on privacy and security data are notable barriers missing on the speech. ii) At macro level, funding is highlighted as main barrier. The cost and lack of health system subsidies may render initiatives unsustainable, as emphasised by the interviewees. iii) At meso level, useable data is recognised as a driver. The data collection process can align with diverse interests to create value and business opportunities for the ecosystem actors, enhance care, attract stakeholders, such as insurers and pharma, and form partnerships. iv) At micro-level processes, we find two potential barriers: wearable device and app usability (comfort, navigation, efficiency) and organisational/behavioural aspects (training, digital affinity, skills), which are crucial for value creation in innovation ecosystems among patients and healthcare professionals. Finally, we find an interesting gap in the literature and interviews. Stakeholders' limited awareness of technological demands, especially from information technologies, for a successful long-term service, can be consider two key barriers for PSS.

Study protocol: exercise training for treating major depressive disorder in multiple sclerosis

BackgroundMajor depressive disorder (MDD) is prevalent, yet sub-optimally treated among persons with multiple sclerosis (MS). We propose that exercise training may be a promising approach for treating depression in persons with MS who have MDD. Our primary hypothesis predicts a reduction in depression severity immediately after an exercise training intervention compared with minimal change in an attention control condition, and the reduction will be maintained during a follow-up period.MethodsThis study involves a parallel-group, assessor-blinded RCT that examines the effect of a 4-month home-based exercise training intervention on depression severity in a sample of persons with MS who have MDD based on the MINI International Neuropsychiatric Interview. The primary outcomes of depression severity are the Patient Health Questionnaire-9 and Hamilton Depression Rating Scale. Participants (N = 146) will be recruited from within 200 miles of the University of Illinois at Chicago and randomized (1:1) into either a home-based exercise training condition or control condition with concealed allocation. The exercise training and social-contact, attention control (i.e., stretching) conditions will be delivered remotely over a 4-month period and supported through eight, 1:1 Zoom-based behavioral coaching sessions guided by social-cognitive theory and conducted by persons who are uninvolved in screening, recruitment, random assignment, and outcome assessment. We will collect outcome data at 0, 4 and 8 months using treatment-blinded assessors, and data analyses will involve intent-to-treat principles.DiscussionIf successful, the proposed study will provide the first Class I evidence supporting a home-based exercise training program for treating MDD in persons with MS. This is critical as exercise training would likely have positive secondary effects on symptoms, cognition, and quality of life, and provide a powerful, behavioral approach for managing the many negative outcomes of MDD in MS. The program in the proposed research is accessible and scalable for broad treatment of depression in MS, and provides the potential for integration in the clinical management of MS.Trial registrationThe trial was registered on September 10, 2021 at clinicaltrials.gov with the identifier NCT05051618. The registration occurred before we initiated recruitment on June 2, 2023

Cannabis Use Disorder in Multiple Sclerosis: Characterization of a National Sample of Patients Seeking Treatment (P2-6.006)

Cannabis Use Disorder in Multiple Sclerosis: Characterization of a National Sample of Patients Seeking Treatment (P2-6.006)

The contribution of EEG to assess and treat motor disorders in multiple sclerosis

ObjectiveElectroencephalography (EEG) can highlight significant changes in spontaneous electrical activity of the brain produced by altered brain network connectivity linked to inflammatory demyelinating lesions and neuronal loss occurring in multiple sclerosis (MS). In this review, we describe the main EEG findings reported in the literature to characterize motor network alteration in term of local activity or functional connectivity changes in patients with MS (pwMS). MethodsA comprehensive literature search was conducted to include articles with quantitative analyses of resting-state EEG recordings (spectrograms or advanced methods for assessing spatial and temporal dynamics, such as coherence, theory of graphs, recurrent quantification, microstates) or dynamic EEG recordings during a motor task, with or without connectivity analyses. ResultsIn this systematic review, we identified 26 original articles using EEG in the evaluation of MS-related motor disorders. Various resting or dynamic EEG parameters could serve as diagnostic biomarkers of motor control impairment to differentiate pwMS from healthy subjects or be related to a specific clinical condition (fatigue) or neuroradiological aspects (lesion load). ConclusionsWe highlight some key EEG patterns in pwMS at rest and during movement, both suggesting an alteration or disruption of brain connectivity, more specifically involving sensorimotor networks. SignificanceSome of these EEG biomarkers of motor disturbance could be used to design future therapeutic strategies in MS based on neuromodulation approaches, or to predict the effects of motor training and rehabilitation in pwMS.

Myelitis associated with COVID-19: clinical, radiological, and laboratory characteristics

Aim: The current study aimed to describe various types of myelitis associated with a novel coronavirus infection [coronavirus disease 2019 (COVID-19)] as well as to analyze cytokine profiles and cerebrospinal fluid (CSF) parameters in affected patients and to compare them to patients with other immune-mediated disorders—multiple sclerosis (MS), in order to identify possible common pathogenetic pathways and consequently treatment targets. Methods: Clinical, radiological, and laboratory characteristics were studied based on patients’ history. CSF from patients with myelitis associated with COVID-19 (11 patients) was compared with CSF of healthy controls (HC) (7 patients) and patients with MS (37 patients) from the non-COVID era. CSF cytological examination, protein levels and oligoclonal bands (OCBs) evaluation, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus detection and cytokine profiling using Bio-Plex Pro Human Inflammation Panel 1, 37-Plex were performed. Results: In total 11 patients with different types of myelitis developed up to 3 months after COVID-19 were enrolled in the study. Radiological findings were diverse: short transverse myelitis (lesion of fewer than 3 segments) (n = 6), longitudinal extensive transverse myelitis (LETM) (n = 2), multifocal spinal cord lesions (n = 1), and myelitis involving dorsal and lateral columns (n = 2). The most pronounced response to treatment was observed in patients with partial transverse myelitis and patients with anti-myelin oligodendrocyte glycoprotein (MOG) antibodies (MOG Abs). Multiple comparisons have demonstrated decreased levels of interleukin-10 (IL-10), interferon-α2 (IFN-α2), IFN-β, and thymic stromal lymphopoietin (TSLP), and increased IL-19 and B cell activating factor (BAFF) in patients with COVID-19 myelitis (CM) compared to the MS group. The highest BAFF and a proliferation-inducing ligand (APRIL) concentrations were found in patients with the most profound neurological disability. Conclusions: Myelitis associated with COVID-19 is clinically and radiologically heterogeneous. Evaluation of cytokine profiles in patients with myelitis associated with COVID-19 revealed their relative similarity with ones of MS patients, except for a few cytokines. BAFF/APRIL system as well as IL-10 is well-known for the role in the development and progression of autoimmune diseases, however, their links with COVID-19 and effects on the development of immune-mediated central nervous system (CNS) disorders after SARS-CoV-2 remain to be further studied.

Usefulness of the Beck depression inventory in the diagnosis of depressive disorders in multiple sclerosis

Depression is one of the most prevalent psychiatric conditions in adulthood, reaching figures of around 20%. The methodologies used to study depression are varied, and range from a self-administered test to structured psychiatric assessment. Several studies of patients with multiple sclerosis (MS) have been conducted in the last 20 years, and figures of around 35% have been found for depressive symptoms, while depressive disorders are less frequent, at approximately 21%. The aim of this study is to evaluate the usefulness of patient self-reported scales such as the Beck depression inventory (BDI) for identifying depressive symptoms in patients with MS, and to analyse their correlation with the diagnosis of clinical depression or depressive disorder using the psychiatric clinical interview based on the criteria of the Diagnostic and statistical manual of mental disorders, fifth edition. This is a multicentre descriptive cross-sectional study of patients with MS and depressive symptoms. The BDI and the Hamilton depression rating scale (HDRS) were used, and the patients with the highest scores underwent psychiatric assessment. A total of 191 patients were included; 81 of these (40.5%) had depressive symptomatology in the pathological range according to the BDI (cut-off point of 14), and 20 had a severe score (above 28). Nineteen patients with severe depressive symptoms according to both scales were selected and finally evaluated by a psychiatrist, who also assessed five patients who according to the neurologist had severe depressive symptoms despite a BDI score of almost 28, but did not reach that level. The suspected major depressive disorder was confirmed in only four (21%) cases with BDI scores indicative of severe symptoms. There is no correlation between the severity score as evidenced by the BDI and the psychiatric assessment. A major depressive disorder was diagnosed in 16 (66.6%) of the 24 patients with BDI > 26 evaluated by psychiatry. A score above 26 on the BDI enables identification of 75% of cases of depressive disorder without subtyping. The correlation between the HDRS and the BDI was statistically significant (r = 0.8; p < 0). The BDI is a useful screening test for identifying patients with depressive symptoms; in specific terms, a score above 26 is probably indicative of a depressive disorder that may benefit from psychiatric assessment.

Immersive virtual reality to improve functional capabilities in people with multiple sclerosis disorder

Multiple Sclerosis, also called MS, is an autoimmune disease and a chronic neurological condition resulting from a malfunction of tissue in the brain and spinal cord. Physical rehabilitation is one procedure that has been demonstrated to offer several advantages, though these treatments, which are centered on repetitive physical acts, can be discouraging for sufferers. This study investigates the use of Immersive Virtual Reality (IVR) as a non-pharmacological therapeutic intervention to enhance functional capabilities in individuals with MS. The primary objective is to determine the feasibility and efficacy of an IVR-based exercise program in improving physical function, reducing fall risk, and increasing personal autonomy among people with MS (pwMS). The idea is that an exergame strategy using Immersive Virtual Reality (IVR) is practical for people with a history of multiple sclerosis (pwMS) and may enhance their movement through more motivational sessions. This paper outlines the procedures for a single-blind randomized experimental examination that investigates the feasibility and effectiveness of an 8-week IVR intervention (ExeRVIEM program) in pwMS. Equilibrium, posture, risk of falling, movement efficiency, lower limb durability, fatigue, handgrip endurance, and reaction speed will be measured.

Quantification of Autoreactive Antibodies in Mice upon Experimental Autoimmune Encephalomyelitis.

Experimental autoimmune encephalomyelitis (EAE) is a disease model that recapitulates the autoimmune disorder multiple sclerosis (MS) at histopathological and molecular levels. EAE is induced by immunizing experimental animals via subcutaneous injection of short myelin peptides together with specific adjuvants to boost the immune response. Like the human counterpart, EAE mice develop demyelinating lesions, immune cell infiltration into the central nervous system (CNS), glia activation and neuronal injury. A consistent body of evidence also supports a mechanistic role for B cell dysfunction in the etiology of both MS and EAE. B cells can serve as antigen-presenting cells as well as a primary source of pro-inflammatory cytokines and autoantibodies. In EAE, antibodies are generated against the myelin peptides that were employed to induce the disease. Such autoantibodies have been shown to mediate either myelin loss or pathogenic T cell reactivation into the CNS. This article describes an efficient ELISA-based protocol to quantify autoantibodies in the serum of C57BL/6J mice immunized with the myelin oligodendrocyte glycoprotein 35-55 (MOG35-55) peptide. The proposed method serves as a powerful tool to investigate the specificity and magnitude of the aberrant humoral response in the context of autoimmune demyelination.

Rehabilitation of Gate and Balance Disorders in Multiple Sclerosis using Progressive Resistance Power Training: a Randomized Controlled Study

INTRODUCTION. Progressive resistance training (PRT) has been recognized as an effective tool in the rehabilitation of patients with multiple sclerosis (MS), however its comparative efficacy remains has yet to be determined. AIM. In this study, we aimed to evaluate the efficacy and safety of the self-guided in-patient progressive resistance power training (PRT) program for improving gait and balance in patients with MS compared with the standard rehabilitation program. MATERIALS AND METHODS. 60 patients with MS were equally randomized into control group (CG) and the PRT group (PG). Training was performed 5 times/week, for 4 weeks in both groups. The primary endpoint was the percentage of patients with improvement in the 6-minute walking test above a minimal clinically significant difference in both groups. Tests of walking speed and balance (Timed 25-foot walking test (T25FW), Timed up-and-go (TUG) test, walking speed), mean voluntary muscle contraction on dominant and non-dominant legs as well as quality of life tests (cognitive and physical domains) at week 4 were used as secondary endpoints. RESULTS. In PG, 17/27 (63 %) patients reached the primary endpoint compared to 11/23 (48 %) in KG, which did not make a statistically significant difference (p = 0.89). Patients showed significant improvement in the T25FW test and TUG test in PG, but not in CG one. Muscle strength improved in both groups, however patients in PG showed mostly improvement in non-dominant leg and more on knee flexors and feet extensors, while patients in the CG showed improvement in hip flexors on both legs. Quality of life parameters improved in both groups. There were no statistically significant differences between the groups at all the endpoints studied at week 4. DISCUSSION. In both groups, significant increases in distance and walking speed prevented reaching the primary endpoint. PRT has been shown to provide a statistically significant improvement in short-distance walking speed, which may have been due to a positive effect on the rate of force development, increasing walking speed and improving walking balance. The increase in muscle strength occurred in trained muscle groups and had differences between the study groups. This result could be obtained both due to the direct training of certain muscle groups, and due to the phenomenon of contralateral transfer. CONCLUSION. Progressive resistance training may have some beneficial differences compared to non-progressive training that need to be elucidated further.

Psychological symptoms in Multiple Sclerosis and the role of marital status: results from a retrospective single-center study

BackgroundMarried people have, on average, better mental health than no married people. Psychological symptoms as anxiety and depression occur frequently in patients with multiple sclerosis (MS), increasing the severity of neurologic disability. The aim of this retrospective study was to investigate the relationship between functional disability and psychological symptoms differentiating by marital status. MethodsIn this study 150 MS outpatients without a history of psychological disorders were selected from the hospital database. The outpatient procedure for all patients includes the administration of the Expanded Disability Status Scale and the questionnaire Symptoms Checklist-90-Revised (SCL-90-R) a multidimensional self-report inventory, consisting of 90 items covering nine clinical dimensions: somatization (SOM), obsessive-compulsive (OC), interpersonal sensitivity (IS), depression (DEP), anxiety (ANX), hostility (HOS), phobic anxiety (PHOB), paranoid ideation (PAR), psychoticism (PSY), and three global indices of distress: global severity index (GSI), positive symptoms total (PST) and positive symptom distress index (PSDI). According to marital status, subjects were subdivided in single, married (including cohabitants), and divorced (including separated). A nonparametric group comparisons analysis was performed, as well as multivariate analysis which included generalized linear regression models. ResultsRegression results showed that functional disability was a significant predictor for all SCL- 90-R subscales. Moreover, it would seem that the single condition might be a protective factor for the development of psychological symptoms in SM patients. Notably, findings showed that younger subjects were predominantly single and had less psychological symptoms, whereas patients with greater psychological alterations were older in a stable affective couple relationship, presenting an elevation in depression, anxiety, somatization and compulsive, and obsessive scales. ConclusionNumerous factors contribute to the onset of psychological disorders in multiple sclerosis. Marriage does not represent a protective factor for the development of psychological symptoms in SM patients. Future investigation is needed to ascertain the prevalence and underlying causes of psychological symptoms.

BMAL1 loss in oligodendroglia contributes to abnormal myelination and sleep

Myelination depends on the maintenance of oligodendrocytes that arise from oligodendrocyte precursor cells (OPCs). We show that OPC-specific proliferation, morphology, and BMAL1 are time-of-day dependent. Knockout of Bmal1 in mouse OPCs during development disrupts the expression of genes associated with circadian rhythms, proliferation, density, morphology, and migration, leading to changes in OPC dynamics in a spatiotemporal manner. Furthermore, these deficits translate into thinner myelin, dysregulated cognitive and motor functions, and sleep fragmentation. OPC-specific Bmal1 loss in adulthood does not alter OPC density at baseline but impairs the remyelination of a demyelinated lesion driven by changes in OPC morphology and migration. Lastly, we show that sleep fragmentation is associated with increased prevalence of the demyelinating disorder multiple sclerosis (MS), suggesting a link between MS and sleep that requires further investigation. These findings have broad mechanistic and therapeutic implications for brain disorders that include both myelin and sleep phenotypes.

Objective assessment of dysarthric disorders in patients with multiple sclerosis depending on sex, age, and type of text read.

To assess dysarthric disorders in multiple sclerosis (MS) patients in comparison with healthy individuals and MS patients without dysarthria depending on the patient's sex, age, and the type of text read using an objective tool. The study was carried out in a group of 72 persons, including 24 with MS presenting dysarthria (study group) and 24 healthy individuals (healthy control group), and 24 with MS without dysarthria (MS control group). Performance (reading) time was evaluated by means of an objective tool created for the purpose of the analysis. The study showed significant statistical differences in the analyzed performance time of: poetry reading, prose reading, and completing a diction exercise, among persons with MS from the study group presenting dysarthria and both control groups (p < 0.05). It took more time to read the poem, and prose and to perform a diction exercise in the study group with dysarthria than in both control groups (with no significant differences between the two) Similarly, the comparison between the groups in terms of sex and age showed disturbances in the above-mentioned parameter in the study group. What was not demonstrated were significant differences in the evaluated speech parameters depending on both sex and age separately in the group of MS patients with dysarthria, and both control groups (p < 0.05). The objective tool created for the purpose of speech analysis is useful in detecting discrepancies in performance (reading) time among MS patients with dysarthria, and healthy individuals, as well as patients with MS without dysarthria and can be used in clinical practice for diagnostic purposes, however, further research is essential to complete its validation.

Impact of Dimethylfumarate on Sleep in Multiple Sclerosis Patients: An Actigraphic Study.

Sleep disorders in multiple sclerosis (MS) patients are common. Dimethylfumarate is an oral disease-modifying drug (DMT), whose impact on sleep is unknown. The aim of this study was to characterize actigraphic patterns in MS patients treated with dimethylfumarate. Twenty relapsing-remitting MS patients with low to a mild disability, aged 20-50y, treated with dimethylfumarate for more than 6 months, were enrolled. All subjects had no history of sleep disorders. Actigraphy was used to study sleep patterns during a seven-day period. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Twenty healthy subjects served as controls. Our results showed statistically significant differences between some actigraphic patterns in MS patients treated with dimethylfumarate and healthy subjects, but the values for patients were still within normal limits. PSQI score was higher in MS patients compared to controls. Our findings suggest that dimethylfumarate, an oral DMT with a favourable benefit-risk profile, does not strongly alter sleep patterns in MS patients with low to mild disability and with no history of sleep disorders. Actigraphy is a simple diagnostic tool, able to support an objective measure of sleep parameters. The simplicity of application may allow considering its use for a screening of sleep disorders in MS patients.

Investigating the Prevalence of Psychiatric Disorders in Multiple Sclerosis with Autoimmune Comorbidities (P5-3.008)

Investigating the Prevalence of Psychiatric Disorders in Multiple Sclerosis with Autoimmune Comorbidities (P5-3.008)

Autonomic nervous system disorders in multiple sclerosis.

Multiple sclerosis (MS) is a chronic progressive demyelinating disease of the central nervous system (CNS), which also affects the autonomic nervous system (ANS). Manifestations of MS in the ANS include urological, sexual, gastrointestinal, cardiovascular, and thermoregulatory disorders as well as increased fatigue. These problems are common yet are often underestimated due to the non-specificity of the symptoms and the limited evaluation of the ANS in the usual clinical practice. Most of these symptoms seem to be related to localized lesions in the CNS. However, the mechanisms by which these disorders are caused in MS have not been fully investigated, thus preventing any focused etiological treatment. The most common disorders of the ANS in MS represent a challenge for clinicians due to the variability of the clinical picture and our minimal data on their diagnosis and treatment. Early diagnosis and initiation of individualized treatment regimens, often in need of multiple approaches, seem to yield the best results in managing ANS dysfunction in MS patients.

Autonomic Disorders in Multiple Sclerosis

Autonomic Disorders in Multiple Sclerosis

Ocular motor impairment in early-stage multiple sclerosis: a video-oculography assessment

BackgroundEye movement disorders in multiple sclerosis (MS) are frequently misdiagnosed and frequently overlooked during clinical examinations. Even at a preclinical state, these defects frequently cause impairment and weariness.MethodsWe conducted a cross-sectional observational study including 20 individuals with a confirmed MS diagnosis. The inclusion criteria were an EDSS score of 4 or less and a 6-month interval between the last relapse and enrolment. As part of the MS assessment, a routine ORL, neurology exam, eye exam, assessment of eye movement using Ulmer’s videonystagmography battery tests, and routine brain MRI were performed on the patient.ResultsA total of 75% of the patients in our series are female, with a mean age of 39 years and a range of 24 to 59 years. The average age of MS onset is 32 years. The relapsing-remitting type of multiple sclerosis (RRMS) accounts for 95% of all cases. There is only a single case of secondary progressive disease course (SPMS). Principal VNG manifestations are related to subclinical eye movements abnormalities. Rotatory vertigo caused by vestibular dysfunction was less prevalent than other balance disorders. There were found to be two types of nystagmus: pendular and central positional nystagmus.Discussion and conclusionVNG is sensitive for detecting vestibular system dysfunction in MS patients. It is also beneficial for diagnosing subtle eye movement abnormalities that are usually overlooked.