Isfahan Multiple Sclerosis Research Articles

Pure spinal multiple sclerosis: A case series of a possible new entity

BackgroundRecent literature describes a condition similar to multiple sclerosis (MS) but with demyelinating lesions limited to the spinal cord. This condition, referred to as “pure spinal” MS, might benefit from disease-modifying treatment (DMT). MethodsWe screened the medical records of approximately 8000 patients with demyelinating diseases at the Isfahan MS clinic in Iran. Criteria for inclusion in the case series were adults with a demyelinating disease limited to the spinal cord, positive oligoclonal IgG bands in cerebrospinal fluid (CSF), and negative results for other potential diagnoses. ResultsSeven people with pure spinal MS were identified (all women, mean age [SD]: 40.14 [6.17] years at the first visit, mean follow-up duration [SD]: 98 [39.41] months). Two had a family history of conventional MS in their siblings. All patients exhibited lower limb weakness and tested negative for anti-MOG and anti-AQP4 antibodies. They experienced relapsing-remitting partial myelitis, with new spinal cord lesions on MRI but no extraspinal CNS lesions. DMT significantly reduced relapse rates in all patients, and two showed no increase in EDSS scores. ConclusionPure spinal MS might be an atypical form of MS. Those affected may benefit from DMT; therefore, further investigation and consideration in the upcoming revisions of the McDonald criteria are recommended.

Facilitating and Inhibiting Factors regarding Quality of Life in Patients with Multiple Sclerosis: A Qualitative Study

Introduction: Multiple sclerosis (MS) is a chronic progressive disease related to the central nervous system, which affects the patients' quality of life. Several factors play the roles of facilitators and inhibitors concerning the life quality of these patients. This study aims to explain the facilitating and inhibiting factors with regard to the life quality of MS patients.
 
 Methods: The present study was conducted through a conventional content analysis approach. Through purposive sampling and semi-structured interviews, 18 MS patients referring to the Isfahan MS Association were selected. Data collection continued until data saturation was reached. For data management, MAXQDA-10 software was used.
 Results: Through content analysis of the interviews, 4 main categories and 15 sub-categories were identified. The main categories included personal facilitators (leisure time and coping strategies), interpersonal facilitators (exercise therapy, social support and social organizations), interpersonal inhibitors (physical problems, psychological disorders, uncertain future, functional limitations, losing job and poverty) ,and environmental inhibitors (disease and treatment process, caregivers' fatigue, insufficient information about MS, family tensions, and fun and entertainment).
 Conclusion: According to the results of the current research, by taking measures such as providing educational and psychological services for patients and their caregivers, appropriate insurance coverage, easy access to drugs, especially foreign ones with reasonable tariffs, social and financial support, raising the society's awareness regarding this disease and developing an appropriate urban texture can help to improve the quality of life in MS patients.

Investigating the Relationship between Perceived Social Support and Sexual Satisfaction in Patients with Multiple Sclerosis

Background and Objective: Multiple Sclerosis (MS) has many complications and consequences, one of which is the reduction of sexual satisfaction. Having the support of people around can be useful for these patients. The present study aimed to determine the relationship between perceived social support and sexual satisfaction in patients with MS in Isfahan. Materials and Methods: The present study was a descriptive-analytical study. The research community were patients with MS in Isfahan in the first half of 2021. A total of 240 eligible patients were included in the study through random sampling. To collect data, patients' demographic form, the Multidimensional Scale of Perceived Social Support (Zimet et al., 1988), and Larson sexual satisfaction questionnaire were used. Data were analyzed in SPSS software (version 16) using descriptive and inferential statistical tests. Results: The level of Perceived social support (27.35±9.06) and sexual satisfaction (88.36±13.12) was moderate. The relationship between perceived social support and patients 'sexual satisfaction (r = 0.510, P<0.001) was direct and significant, and patients' sexual satisfaction elevated with an increase in perceived social support. Conclusion: Given the importance of perceived social support in patients with MS and its relationship with sexual satisfaction, the promotion of social support for these people can be one of the effective suggestions for promoting their sexual satisfaction.

Investigating the Relationship between Perceived Social Support and Sexual Satisfaction in Patients with Multiple Sclerosis

Background and Objective: Multiple Sclerosis (MS) has many complications and consequences, one of which is the reduction of sexual satisfaction. Having the support of people around can be useful for these patients. The present study aimed to determine the relationship between perceived social support and sexual satisfaction in patients with MS in Isfahan. Materials and Methods: The present study was a descriptive-analytical study. The research community were patients with MS in Isfahan in the first half of 2021. A total of 240 eligible patients were included in the study through random sampling. To collect data, patients' demographic form, the Multidimensional Scale of Perceived Social Support (Zimet et al., 1988), and Larson sexual satisfaction questionnaire were used. Data were analyzed in SPSS software (version 16) using descriptive and inferential statistical tests. Results: The level of Perceived social support (27.35±9.06) and sexual satisfaction (88.36±13.12) was moderate. The relationship between perceived social support and patients 'sexual satisfaction (r = 0.510, P<0.001) was direct and significant, and patients' sexual satisfaction elevated with an increase in perceived social support. Conclusion: Given the importance of perceived social support in patients with MS and its relationship with sexual satisfaction, the promotion of social support for these people can be one of the effective suggestions for promoting their sexual satisfaction.

The effectiveness of Pythagorean self-awareness intervention in improving the quality of sexual life of women with multiple sclerosis

Background and aims: The present study aimed to determine the effectiveness of Pythagorean self-awareness intervention in improving the quality of sexual life of women with multiple sclerosis (MS). Methods: In this quasi-experimental study, among women with MS in Isfahan province who had medical records in Ayatollah Kashani Hospital and Isfahan MS Center, 150 female patients were enrolled by convenience sampling and screened by Sexual Quality of Life-Female (SQOL-F). After screening, 46 patients, whose quality of sexual life score was lower than the mean score of 63, were randomly assigned to experimental and control groups, each comprising 23 patients. The experimental group received the Pythagorean self-awareness intervention, while the control group received no intervention. Both groups were assessed at pre-test, post-test, and two follow-up stages. The data were analyzed by multivariate analysis of covariance (MANCOVA). Results: The results revealed that the quality of sexual life of the experimental group improved after the intervention (P<0.001). Compared to the pre-test, a significant difference was observed in its components, namely, psychosexual feelings, sexual and relationship satisfaction, self-worthlessness, and sexual repression (P<0.001). Conclusion: It seems that Pythagorean self-awareness intervention effectively improves the quality of sexual life of women with MS. In addition to the overall improvement in the quality of sexual life, a significant difference was observed in its components compared to the pre-test after the intervention. Therefore, it is essential to plan psychological interventions to improve these women’s quality of sexual life.

General knowledge and Attitudes Toward Multiple Sclerosis: A Cross-Sectional Study

Introduction: Multiple sclerosis is an inflammatory and chronic disease of the central nervous system. Lack of knowledge about the disease and its symptoms may delay early diagnosis and control of the disease. The present study aimed to investigate the general knowledge and attitude towards multiple sclerosis in Isfahan.
 Methods: This was a cross-sectional (descriptive-analytical) study conducted in 2021 in Isfahan. A researcher-made questionnaire with 22 questions was created and distributed online through social networks. Data were analyzed using independent t-test and one-way analysis of variance with SPSS software (v.24).
 Results: A total number of 480 people participated in this study. The mean scores of knowledge and attitude were 4.77±1.86 and 54±6.24, respectively. T-test results indicated that there is a significant difference between participants' knowledge and attitude scores in terms of gender and history of multiple sclerosis in those around them. Analysis of variance results also showed that there is a significant difference in the mean scores of participants' knowledge and attitude according to their education level and job status. But there was no difference in the participants' attitudes toward multiple sclerosis and patients with multiple sclerosis according to their marital status.
 Conclusion: Based on the present study findings, participants' knowledge about multiple sclerosis was moderate. Therefore, Measures must be taken in order to increase the public awareness through the mass media and health centers. It can help to early diagnose and control of the disease and correcting the people's misconceptions about patients with multiple sclerosis.

Does COVID-19 increase the long-term relapsing-remitting multiple sclerosis clinical activity? A cohort study

BackgroundSome current evidence is pointing towards an association between COVID-19 and worsening of multiple sclerosis (MS), stressing the importance of preventing COVID-19 among people with MS (pwMS). However, population-based evidence regarding the long-term post-COVID-19 course of relapsing-remitting multiple sclerosis (RRMS) was limited when this study was initiated.ObjectiveTo detect possible changes in MS clinical disease activity after COVID-19.MethodsWe conducted an observational study from July 2020 until July 2021 in the Isfahan MS clinic, comparing the trends of probable disability progression (PDP) – defined as a three-month sustained increase in expanded disability status scale (EDSS) score – and relapses before and after probable/definitive COVID-19 diagnosis in a cohort of people with RRMS (pwRRMS).ResultsNinety pwRRMS were identified with definitive COVID-19, 53 of which were included in the final analysis. The PDP rate was significantly (0.06 vs 0.19, P = 0.04), and the relapse rate was insignificantly (0.21 vs 0.30, P = 0.30) lower post-COVID-19, compared to the pre-COVID-19 period. The results were maintained after offsetting by follow-up period in the matched binary logistic model. Survival analysis did not indicate significant difference in PDP-free (Hazard Ratio [HR] [95% CI]: 0.46 [0.12, 1.73], P = 0.25) and relapse-free (HR [95% CI]: 0.69 [0.31, 1.53], P = 0.36) survivals between the pre- and post-COVID-19 periods. Sensitivity analysis resulted similar measurements, although statistical significance was not achieved.ConclusionWhile subject to replication in future research settings, our results did not confirm any increase in the long-term clinical disease activity measures after COVID-19 contraction among pwRRMS.

Centrally-located transverse myelitis would facilitate the differentiation of NMOSD and MOG-AD from MS

ObjectivesDifferentiating neuromyelitis optica spectrum disorder (NMOSD) and Myelin oligodendrocyte glycoprotein antibody disease (MOG-AD) from multiple sclerosis (MS) is important since MS therapies might result in progression and relapse of the former diseases. Evidence of long extending transverse myelitis (LETM) in magnetic resonance imaging (MRI) is one of the requirements to make an NMOSD diagnosis. However, centrally located lesions on spinal MRI may bring higher sensitivity and specificity to the NMOSD and MOG-AD diagnosis. MethodsWe aimed to assess the association between NMOSD diagnosis and the presence of centrally located lesions at disease onset. We reviewed 102 medical records from the Isfahan MS clinic who presented with cervical cord lesions and 17 MS, 23 NMOSD, and 6 MOG-AD patients were selected. We collected demographic, clinical, and MRI data of patients who had clinical presentations of cervical cord lesion at disease onset, and the characteristics of the lesion were studied. ResultsThere was an association between NMOSD diagnosis and presence of a centrally located lesion (CLTM) (P < 0.001), presence of an LETM (P < 0.001), and an intermediate to high axial cord expansion (P < 0.001). CLTM and LETM can also be found in MOG-AD patients. The presence of CLTM (sensitivity and specificity: 95.65% and 69.56%), possessed higher sensitivity and specificity for NMO diagnosis than LETM presence (sensitivity and specificity: 78.26% and 43.47%). ConclusionA diagnostic criteria including the centrality, location, and expansion of the transverse myelitis lesions, in addition to LETM, may be more accurate in the diagnosis of NMOSD and MOG-AD and their distinction from MS.

Cost of Illness of Multiple Sclerosis in Isfahan, Iran, From a Social Perspective: A Comparison of the Human-Capital and Friction-Cost Methods

ObjectivesMultiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that is characterized by demyelination and neurodegenerative changes and associated with high levels of disability. This study aimed to investigate direct and indirect costs of illness of patients with MS in Isfahan using and comparing human-capital and friction-cost methods from a societal perspective. MethodsA total of 300 patients with MS of 2 main centers of the disease in Isfahan, the MS center of Ayatollah Kashani hospital and Isfahan MS center, were included. Patient’s demographic characteristics, disease information, and annual social costs (2018-2019) were collected using data collection form. Both the human-capital and friction-cost methods were applied and compared with value indirect costs because of loss of productivity. ResultsFrom the social perspective, the average annual total cost of MS disease was estimated to be 1 441 163 710 rials (34 313 US dollar [USD]) per patient using the human-capital approach and 1 434 832 004 rials (34 162 USD) with the use of friction-cost method, from which 1 428 668 396 rials (34 016 USD) was related to direct costs. The main direct costs were related to disease-modifying therapies and referring to other physicians and hospitals. The cost of loss of production was greater with human-capital approach in comparison with friction-cost method. ConclusionsThe most prominent cost in MS disease is related to drug costs. The indirect costs were sensitive to the methods, applied in the study.

The Effect of Emotional Freedom Technique on Fatigue among Women with Multiple Sclerosis: A Randomized Controlled Trial.

Background:This study aimed to investigate the effect of Emotional Freedom Technique (EFT) on the severity of fatigue among women with Multiple Sclerosis (MS).Materials and Methods:This was a single-blind, randomized controlled trial study conducted on 50 women with MS in Isfahan, Iran. Sampling was performed using simple sampling method, then the participants were randomly divided into two groups of case and sham using the minimization method. The EFT intervention was performed on the case group, 2 sessions per week for a 4-weeks period. In the sham group, with the same psychological part of the EFT technique like case group, mild tapping was applied on false points for the same period of time. Fatigue severity score was obtained using the Fatigue Severity Scale (FSS) before and immediately and 4 weeks after the intervention in the two groups. Data analysis was conducted using descriptive and inferential statistical methods.Results:The results of the independent t-test indicated that the mean (SD) score of fatigue severity before the intervention was not significantly different between the case and sham groups 5.48 (0.75) and (5.39 (0.71) with (p = 0.67). However, this difference was significant immediately [(3.05 (0.89) and 5.15 (0.94)] and 4 weeks after the intervention 3.10 (0.81) and 5.59 (0.57) (p < 0.001).Conclusions:It seems that EFT is effective in diminishing fatigue among patients with MS and is recommended as a convenient and safe non-medicament strategy for self-management of fatigue among these patients, and can be used at the bedside by nurses.

COVID-19 infection and hospitalization rate in Iranian multiple sclerosis patients: What we know by May 2021

Background: Despite investigations on the effect of disease modifying therapies (DMTs) used in multiple sclerosis (MS) on coronavirus disease 2019 (COVID-19); there are still controversies. Objective: We designed this study to evaluate the epidemiological features of covid-19 in a large sample of people with MS (pwMS) in Isfahan, Iran, as well as the association between DMTs, risk of COVID-19 infection and hospitalization. Methods: In an observational pwMS, we interviewed subjects on their MS and COVID-19 history. Results: 3050 subjects were included (74% female) with a mean age of 41.36. 423 (13.8%) had confirmed COVID-19 which shows that pwMS are at a higher risk of infection compared to the general population, No significant relationship was observed in COVID-19 infection when individual drugs. Dimethyl fumarate and rituximab had the lowest and the highest relative risks for hospitalization rate compared to other drugs, respectively. Conclusion: We found no evidence supporting a higher prevalence of COVID-19 in pwMS compared to the general population. However, our results show pwMS to be more prone to hospitalization compared to the general population, Therefore, it is advised to use safer treatment if possible until complete vaccination, and to postpone the use of rituximab.

Epidemiological and clinical features of pediatric-onset multiple sclerosis: A population-based study in Isfahan, Iran, between 1997-2020

Background: Pediatric-onset multiple sclerosis (POMS) is an autoimmune demyelinating disorder of the central nervous system (CNS), affecting individuals younger than 18 years of age. We sought to characterize the epidemiological and clinical features of patients with POMS in Isfahan, Iran, from April 1997 to March 2020. Methods: The medical records of patients with POMS in the databases of Isfahan Department of Public Health and Isfahan Multiple Sclerosis Society (IMSS) were retrospectively reviewed. The 2006 and 2016 Isfahan Province population censuses were used as reference values for assessing the temporal trend of POMS. Results: From April 1997 to March 2020, 509 individuals under18 years of age were diagnosed with POMS in Isfahan. 404 of these patients (79.4%) were girls, and 105 patients (20.6%) were boys (a female to male ratio of 3.85:1). Most of the patients (83%) were monosymptomatic at onset, with optic neuritis and brainstem-cerebellar disorders being the most frequent initial presentations. Mean ± standard deviation (SD) of age at disease diagnosis was 15.8 ± 2.5 years (ranging from 3 to 18, mode = 18).From April 2019 to March 2020, the crude prevalence and the crude incidence rate of the POMS were 5.42 per 100000 and 1.86 per 100000, respectively. Poisson regression analysis revealed a 3.4% increase in the incidence rate of POMS from April 1997 to March 2020 [relative rate:1.034, 95% confidence interval (CI): 1.021-1.048]. Conclusion: The female to male ratio in our cohort was significantly higher than any other studies conducted previously. The high female to male ratio and increasing incidence of the disease suggest increasing regionalization of care.

Frequency of diencephalic syndrome in NMOSD

Diencephalic region of the brain harbors sites with a considerable amount of aquaporin-4 expression. Neuromyelitis optica spectrum disorder (NMOSD) primarily involves autoimmune processes against this molecule. However, little is known about the frequency of symptoms of diencephalic involvement in NMOSD patients. To investigate the frequency of symptoms of diencephalic involvement in NMOSD patients and describe the associated characteristics in patients presenting such symptoms. This retrospective cohort included 145 NMOSD patients (39 males and 106 females) who visited Isfahan Multiple Sclerosis Center from January 2013 to February 2020 for approximately 61months. Demographic and clinical information of patients and findings from radiological and serological investigations were retrieved. The frequency of diencephalic involvement in NMOSD patients was 3.4% (five cases). Diencephalic syndrome-associated symptoms observed in this cohort consisted of narcolepsy (n = 2; 40%), hypotension (n = 1; 20%), amenorrhea (n = 1; 20%), and syndrome of inappropriate antidiuretic hormone secretion (n = 1; 20%). These manifestations responded well to NMOSD-associated treatments, i.e., rituximab and azathioprine. Although rarely manifested through symptoms suggestive of diencephalic involvement, NMOSD should be considered when encountering patients with the diencephalic syndrome to identify the primary cause of these manifestations.

Explaining the facilitators of quality of life in patients with multiple sclerosis: a qualitative study

BackgroundIn patients with multiple sclerosis (MS), the disease’s complications and manifestations affect a person’s ability to function normally and leads to further disruptions in their education, family life, job opportunities, and daily life activities, thereby reduce their quality of life. Different factors as facilitators or inhibitors affect the quality of life in patients with MS. This study aimed to explain the facilitators of quality of life in patients with MS.MethodsThis research applied qualitative methodology, utilizing semi-structured interviews with individuals with MS and their family members/caregivers. Purposeful sampling was done among people who referred to Isfahan MS Association. Participants were selected with a maximum variation in terms of gender, age, education, occupation and marital status. Interviews were continued to reach data saturation. The gathered data were concurrently analyzed by the content analysis technique. MAXQDA software version 10 was used for data management.ResultsSaturation was reached after eighteen interviews. A total of three main categories and 8 sub-categories were extracted from the data. The identified facilitators were: personal facilitators (leisure time and coping strategies), interpersonal facilitators (exercise therapy, social support and social organizations) and needs and suggestions for improvement (family therapy, adopting urban architecture and facilities, and supportive systems).ConclusionsBased on these findings, in order to improve the quality of life in patients with MS, we should pay attention to factors such as leisure time, spirituality and positive thinking, exercise, social support and social organizations. Health professionals, the government, community and families could help to improve patients’ quality of life through adapting urban architecture, holding family therapy sessions and providing supportive systems.

Multiple sclerosis in Iran: An epidemiological update with focus on air pollution debate’

Multiple sclerosis (MS), as the most common neurologic disorder of the central nervous system, with growing incidence and prevalence worldwide and in the Middle East. This article aimed to find out the potential relationship between MS and air pollution in Iran. By assessing the published articles on MS and air pollution in Iran, the situation of MS as well as air/soil pollution in Iran was clarified. Then, studies on air pollution and its potential effect on Iranian MS patients were checked until 2020. The MS prevalence is distributed across Iran Provinces with highest rates in Isfahan, located in the center of Iran. The higher rates of MS in Isfahan and Tehran (the Metropolitan) might be due to industrial pollution of these cities, but this hypothesis is not true for non-industrial provinces. Based on the published atlas of MS in Iran, it seems that there is a high-risk "belt" from northwest to southeast. There are many risk factors of MS in Iran including age, gender, Vitamin D deficiency, smoking, and air pollution. The potential main risk factor of MS might be air pollution considering Isfahan and Tehran provinces. However, Chahar Mahal and Bakhtiary Province, with non-industrial nature, has the second highest MS rates which does not follow this hypothesis. By finding the air pollution as the main potential risk factor of MS in big provinces including Isfahan and Tehran, its effect of this factor can also be considered during diagnosis and treatment.

Outcome of COVID-19 infection in multiple sclerosis patients receiving disease-modifying therapies.

Background:With the spread of COVID-19, treatment of diseases such as multiple sclerosis (MS) should be resumed with caution due to the disease-modifying therapies (DMTs) used in this subset of patients and the immunoregulatory effects of these drugs. We aim to assess the outcome of COVID-19 infection in MS patients receiving DMTs.Materials and Methods:This is a cross-sectional study involving 45 COVID-19-infected patients previously diagnosed with MS. The data regarding their MS status and the type of DMT taken by the patients were extracted from the Isfahan MS Institute registry and were summarized. Diagnosis of MS was based on the 2017 McDonald Criteria, and the diagnosis of COVID-19 was based on computed tomography scan and polymerase chain reaction of nasopharyngeal swabs.Results:Out of the 45 MS patients infected with COVID-19, 5 had unfavorable outcomes. Two patients deceased and the other three had persistent respiratory complications on the 4-week follow-up visit. Hypertension, diabetes, seizures, and rheumatoid arthritis were among the comorbidities that the patients reported. Both patients who died received rituximab as part of their MS treatment. All other patients recovered completely.Conclusion:Each different drug category may possess a distinct risk for infection, therefore until robust evidence are available, the safest drug should be utilized or the therapy should be postponed, if possible, to minimize patient risk. Disease-modifying therapy use in MS patients should be cautiously applied as their effect on COVID-19 infection prognosis is not yet studied.

"NMDA receptor spectrum disorder" in the differential diagnosis of demyelinating disorders of the CNS: optic neuritis and myelitis.

The aim of this study was to investigate the frequency of anti-N-methyl-D-aspartate receptor (anti-NMDAR) antibody positivity in patients presenting with transverse myelitis (TM) and/or optic neuritis (ON), to describe their neurologic and radiological characteristics, and to compare these characteristics with those reported in previous studies. This study included 179 patients (ON: 96, TM: 74, ON and TM: 9) who visited Isfahan Multiple Sclerosis Center from January 2017 to September 2019, for approximately 32months. The respective neurological examinations were performed. Demographic data of the patients, as well as findings from radiological and serological investigations were obtained. Frequencies of anti-NMDAR seropositivity in patients with TM, ON, and concurrent TM and ON were approximately 3.4%, 1.4%, and 11.1%, respectively. None exhibited any psychiatric symptoms. Based on the frequency of seropositivity for anti-NMDAR antibody in our patients, positivity for this antibody appears to be more frequent than previously anticipated in patients presenting with these conditions. We recommend that the anti-NMDAR antibody presence in CSF/serum be checked and considered in addition to the routine examinations performed upon confronting demyelinating conditions such as TM and ON. We suggest considering the term "NMDAR spectrum disorder" to more clearly distinguish the potentially overlapping conditions with different etiologies in patients with CNS disorders.

Cyclophosphamide Versus Rituximab in Progressive Forms of Multiple Sclerosis

This study aimed to compare the efficacy of rituximab versus Cyclophosphamide on active secondary progressive multiple sclerosis (SPMS). The randomized clinical trial was performed from 2015 to 2017 in multiple sclerosis (MS) clinics affiliated to Isfahan MS society (IMSS). Patients were randomized to two groups, and one of them received Rituximab that was repeated every six months in case of medical indication. The other one received a monthly pulse of methylprednisolone plus cyclophosphamide (Endoxan, Baxter, UK) until two years. Expanded disabilities status scale (EDSS), clinical, and MRI findings were assessed every six months. Statistical analysis was performed using SPSS software. 39 patients in the Rituximab group and 30 in the Cyclophosphamide group with similar age and gender distribution were entered for analysis. At baseline, the mean number of attacks in the Rituximab group was significantly more than the Cyclophosphamide group (P=0.0001). After 6, 12, and 18 months of treatment, the rate of attacks was similar between groups although it increased significantly in the Rituximab group (P=0.030) after 24 months of treatment. EDSS was increased in the Rituximab group more than the other group at the end of the study. Both drugs were well-tolerated by patients. The EDSS was increased in the Rituximab group but the disability score did not worsen in the Cyclophosphamide group. Both therapies were associated with a reduction in disease attacks and improvement in radiologic findings in a two-year period of follow-up. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(8):484-491.

An 8-year study of people with multiple sclerosis in Isfahan, Iran: Association between environmental air pollutants and severity of disease

The evidence for an impact of ambient air pollution on the incidence and severity of multiple sclerosis (MS) is still limited. In the present study, we assessed the association between daily air pollution levels and MS prevalence and severity in Isfahan city, Iran. Data related to MS patients has been collected from 2008 to 2016 in a referral university clinic. The air quality index (AQI) data, were collected from 6 monitoring stations of Isfahan department of environment. The distribution map presenting the sites of air pollution monitoring stations as well as the residential address of MS patients was plotted on geographical information system (GIS).An increase in AQI level in four areas of the city (north, west, east and south) was associated with higher expanded disability status scale (EDSS) of MS patients[logistic regression odds ratio = 1.01 (95% CI = 1.008,1.012)]. Moreover, significant inverse association between the complete remission after the first attack with AQI level in total areas [logistic regression odds ratio = 0.987 (95% CI = 0.977, 0.997)] was found in crude model. However, after adjustment for confounding variables through multivariate logistic regression, AQI level was associated with degree of complete remission after first attack 1.005 (95% CI = 1.004, 1.006). The results of our study suggest that air pollution could play a role in the severity and remission of MS disease. However, more detailed studies with considering the complex involvement of different environmental factors including sunlight exposure, diet, depression and vitamin D are needed to determine the outcome of MS.

Multiple sclerosis among Afghan immigrants in Isfahan, Iran

BackgroundMultiple sclerosis is a central nervous system demyelinating disease with unknown etiology. However, it is believed to be a multifactorial disease resulting from an interaction of genetic and environmental factors. Immigrant studies have been performed to provide a better view of the pattern of this interaction. We aimed to report the prevalence of MS Afghan immigrants of Isfahan, a population who share the same environment as Isfahan residents but with different genetic backgrounds. Patients and methodsMedical documents of 4536 patients registered by Isfahan Multiple Sclerosis Society (IMSS), the only MS registry in the province of Isfahan, were reviewed for Afghan patients and the demographic and clinical characteristics. The information on the current population of Afghans residing in the province was gathered through Bureau for Aliens and Foreign Immigrants Affairs (BAFIA). ResultsSix Afghan cases were identified among 4536 patients registered by IMSS. Current population of Afghans in the province was 123,578 people (65,041 male and 58,537 female). One of the cases was male and the other five were females with a female/male ratio of 5:1. Sex-adjusted prevalence for males and females was 1.53 and 8.54 per 100,000, respectively. The overall crude prevalence for Afghan population of Isfahan is 4.85 per 100,000. ConclusionThis study shows a lower prevalence of MS among Afghan residents of Isfahan compared to the overall prevalence of the province. Our result could be implying a stronger bond between genetic factors and developing MS, rather than the environmental factors.