Multiple Sclerosis Patients Research Articles

Investigation of the effects of IL-13 and IL-22 cytokine levels on disease activity, prognosis, and treatment response in multiple sclerosis patients treated with fingolimod and glatiramer acetate

Background: Multiple Sclerosis (MS) is an inflammatory, demyelinating and neurodegenerative disease. In this study, we investigated serum protein levels of Interleukin-13 (IL-13) and Interleukin-22 (IL-22) cytokines. These cytokines play an important role in the generation and regulation of the inflammatory response, which is the pathogenesis of MS, and are potential biomarkers for monitoring therapeutic response. cytokines may play a role in the development of MS lesions. Methods: The study included 66 MS patients and 22 healthy individuals. IL-13 and IL-22 cytokine protein levels were measured by ELISA from peripheral blood serum samples collected from the participants. Patient demographics and treatment history data were also collected. Results: IL-13 and IL-22 parameters were lower in MS patients compared to the control group. There was a significant difference between the patient and control groups in terms of IL-13 (p<0.001). Although the mean IL-22 level of the control group was higher than the patient group, the difference did not reach a significant level (p: 0.257). Conclusion: The results of the study suggest that IL-13 and IL-22 cytokines play an important role in the pathogenesis of MS and are affected by fingolimod and glatiramer acetate treatment.

Cardiac contractility modulation in heart failure with reduced ejection fraction patients with QRS duration 120–149 ms: Reduction in heart failure hospitalizations and improvement in functional outcome

BackgroundA subset of heart failure (HF) patients qualifies for cardiac resynchronization therapy (CRT). However, a 30% CRT nonresponder rate persists, with patients having narrower QRS durations (ie, QRSd 120–149 ms) receiving less or inconsistent benefit. Cardiac contractility modulation (CCM) may be an important alternative therapy option but has largely been evaluated only in HF patients with QRSd <120 ms. ObjectivesThe purpose of this study was to evaluate the impact of CCM on HF-related hospitalizations and on left ventricular ejection fraction (LVEF) as well as quality of life in HF patients with QRSd 120–149 ms compared to QRSd <120 ms. MethodsThe CCM-REG Registry enrolled 503 HF patients with follow-up up to 2 years. Hospitalization rates were available for 1 year preimplant. Safety was assessed by comparison of actual vs Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score– or Seattle Heart Failure Model (SHFM)–predicted mortality. ResultsAmong 111 of 455 subjects with QRSd 120–149 ms (mean QRSd 130 ± 8 ms; age 68 ± 10 years; 20% female; LVEF 29% ± 9%; 82% New York Heart Association [NYHA] class III), CCM diminished HF-related hospitalization rate by 72% (pre- vs postimplant 0.90 vs 0.25 events per patient-year over 2 years; P <.001). LVEF improved by 7% ± 8% (P = .01 vs baseline), Minnesota Living with Heart Failure Questionnaire score by 10 ± 23 points (P = .01 vs baseline), and NYHA class by 0.5 ± 0.7 classes (<0.001 vs baseline). The effect size was similar to that in QRSd <120 ms patients. Mortality within the first year was 19% in QRSd 120–149 ms patients (ie, not significantly different from the MAGGIC score or SHFM prediction). ConclusionsCCM significantly improved HF control in NYHA class III HF with reduced ejection fraction patients with moderately prolonged QRSd 120–149 ms. The effect was similar to that in patients with QRSd <120 ms.

Neurofilaments light chains as a diagnostic and predictive biomarker for Tunisian Multiple Sclerosis patients

BackgroundMultiple Sclerosis (MS) course was shown to be more severe among North Africans compared to Caucasians. Validation of prognostic biomarkers of disease activity and severity is a priority in our practice. ObjectiveWe aimed to investigate the association between baseline cerebrospinal fluid (CSF) and serum NfL (sNFL) levels and disease activity and disability accrual in a cohort of Tunisian patients with MS. MethodsA cross-sectional study was conducted, in the department of Neurology of Razi Hospital, including patients diagnosed with MS. Patient's data were retrieved from our local MS database. Blood and CSF sampling were performed at the first visit. sNFL levels were measured using the Enzyme-Linked Immuno-Sorbent Assay (ELISA) sandwich technique. ResultsThree hundred MS patients were enrolled (sex-ratio= 3.05; mean age at MS onset=28.83 years+9.55, mean MS course = 10.21 years+8.96). MS phenotype was predominately relapsing (73%). CSF NfL levels were significantly correlated to the serum ones. NfL concentrations were significantly associated with MS activity (p = 0.012), disease progression (p = 0.001), and higher Multiple Sclerosis Severity Scores (MSSS) (p = 0.0017, r = 0.28). ConclusionsThese results support the value of NfL as a sensitive and clinically meaningful CSF and blood biomarker to evaluate MS activity and outcomes among Tunisian MS patients.

Determination of important predictors for the fifth-year Expanded Disability Status Scale scores of patients with multiple sclerosis using machine learning

Objectives: This study aimed to determine important predictors of fifth-year Expanded Disability Status Scale (EDSS) scores in multiple sclerosis (MS) patients using machine learning. Patients and methods: In this retrospective study, the XGBoost basic model was developed to predict five-year EDSS scores in 1,000 patients (317 males, 683 females; mean age: 43.4±10.9 years; range, 18 to 76 years) with MS between January 1999 and December 2020. Patients were categorized based on the initial symptoms of MS onset: brainstem symptoms, optic symptoms, spinal symptoms, or supratentorial symptoms. In the next stage, important predictors of fifth-year EDSS scores were determined and ranked by their importance using the SHAP (SHapley Additive exPlanations) algorithm, which is a machine learning method. Results: For patients with optic symptoms at onset, second-year EDSS scores, age, and first-year pyramidal functions were identified as the most important variables, respectively. In contrast, for those with spinal symptoms at onset, second-year pyramidal functions, age, and second-year ambulation were important predictors. In the patients with brainstem symptoms at onset, age, first-year EDSS scores, and first-year bowel and bladder functions were determined as important variables. Additionally, for patients with supratentorial symptoms at onset, second-year pyramidal functions, second-year EDSS scores, and age were the top predictors. Conclusion: The results provided valuable insights into predictors of fifth-year EDSS scores in patients with MS grouped by their initial symptoms. Our findings indicate that the ranking of importance of functional system evaluations varies among patients with MS based on their initial symptoms, with age as a significant predictor for all symptom groups.

Brain reserve and timing of clinical onset in multiple sclerosis

Background: A latent period of variable length elapses between multiple sclerosis (MS) biological onset and the occurrence of the first clinical episode reflecting a central nervous system (CNS) demyelinating event. Factors affecting the duration of such interval are unknown. Objective: To explore whether brain reserve, which moderates the impact of structural damage along MS course, could also affect the timing of MS clinical onset. Methods: We conducted a time-to-event analysis in 326 relapsing-onset multiple sclerosis patients to ascertain the effect of brain reserve, that is, larger maximal lifetime brain growth (MLBG) estimated as intracranial volume, on the risk of an earlier disease onset. For this purpose, we carried out a Cox proportional hazards regression model stratified by sex and adjusted by site and pre-morbid MS risk factors. All patients reached the event (i.e. the disease onset) with no censored case; the age (years) at disease onset was set as the main time variable. Results: We identified a protective effect of brain reserve on the time to disease onset (HR = 0.11, 95% CI = 0.02–0.83, p = 0.032), unchanged when accounting for MS risk factors. Conclusion: Brain reserve might counteract the pathological mechanisms ongoing after biological initiation, thus delaying the disease overt clinical manifestation.

Associations between the Framingham Risk Score and cognitive functions in people with multiple sclerosis

Background &amp; Objective: Cognitive impairment is common in people with multiple sclerosis (MS). The Framingham Risk Score (FRS) is an algorithm used to estimate the 10-year risk of developing cardiovascular disease (CVDr). This study aimed to evaluate the possible associations between FRS and cognitive impairment in people with MS. Methods: Demographic characteristics, laboratory parameters, clinical findings, vascular risk factors, and Brief International Cognitive Assessment for MS (BICAMS) test results, FRS and CVDr scores were recorded for 110 MS patients. Results: FRS and CVDr scores exhibited a significant negative correlation with the number of correct responses in the Symbol Digit Modalities Test (p &lt; 0.001 for all) and California Verbal Learning Test–Second UK Edition (CVLT-II) test (p &lt; 0.001 for all), and significant positive correlation with the number of incorrect responses in the CVLT-II (p &lt; 0.001 for all). The total score of the Brief Visuospatial Memory Test Revised had a negative correlation with FRS and CVDr (p &lt; 0.001 for both). BICAMS scores showed no significant correlation with smoking status, homocysteine, and uric acid levels. Conclusion: We suppose that vascular risk factors and FRS and CVDr scores may be associated with the deterioration of working memory, information processing speed, verbal learning, and memory in people with MS. Based on the potential impact of vascular risk factors on cognitive functions, our findings suggest that lifestyle changes, appropriate treatment, and using a multidisciplinary approach toward vascular risk factors during MS management may exhibit a positive effect on cognition in people with MS.

ENTIMOS: Decision Support Tool Highlights Potential Impact of Non-intravenous Therapies for Multiple Sclerosis on Patient Care via Clinical Scenario Simulation.

Administration of intravenous (IV), high-efficacy treatments (HETs) for the treatment of multiple sclerosis (MS) poses a high resourcing and planning burden on infusion centres, resulting in treatment delays that may increase the risk of breakthrough disease activity. Simulation tools can be used to systematically analyse capacity scenarios and identify and better understand constraints, therefore enabling decision-makers to optimise patient care. We have previously applied ENTIMOS, a discrete event simulation model, to assess scenarios of patient flow and care delivery using real-life data inputs from the neurology infusion suite at Charing Cross Hospital London. The model predicted that, given current capacity and projected demand, patients would experience high-risk treatment delays within 30 months. This study aimed to address key healthcare challenges for MS patient care management as seen from a neurologist's perspective. We used ENTIMOS to predict the impact of several distinct and clinically plausible scenarios on patient waiting times at the same MS infusion suite and to quantify mitigation strategies needed to assure continuity of care. We used real-world experience of an expert neurologist to identify five clinical scenarios: (1) switching patients to a subcutaneous (SC) MS treatment of the same therapeutic agent, in the same hospital setting; (2) extending opening times to the weekend; (3) reducing the number of infusion chairs (to simulate social distancing measures applied during the coronavirus disease 2019 [COVID-19] pandemic); (4) increasing demand for infusions; and (5) increasing the scheduling approval time. Patient waiting time for next due infusion and time to high-risk treatment delays (≥ 30 days) were the main analysed model outputs. Previously published base case results were used as reference. All hypothetical scenarios were run over a 3-year horizon (with the exception of scenario 1, which was run over a 3- and 5-year horizon). Strategies to mitigate treatment delays were analysed and discussed. Switching 50% of patients to SC treatment of the same therapeutic agent administered in hospital postponed the predicted high-risk treatment delays to shortly beyond the 3-year simulation timeframe (month 38). Weekend opening reduced waiting times from 20 days to 4 days and prevented treatment delays, however, at elevated labour costs. Reducing the infusion chairs increased waiting time to 53 days on average and 86 days at the end of the simulation, leading to high-risk treatment delays within 6 months. An increased demand for infusions increased waiting time to 26 days on average and 47 days at the end of the simulation, leading to high-risk treatment delays within 22 months. Prolonged scheduling approval time did not reduce the waiting time, nor postpone the high-risk treatment delays. Decision makers need transparency on capacity constraints to better plan resourcing at infusion suites and MS treatments. Our results showed that various mitigation measures, such as increasing capacity by additional infusion chairs per year and transferring patients to other infusion suites, may help prevent treatment delays. Switching patients from IV to an SC version of the same therapeutic agent reduced the waiting time moderately and postponed high-risk treatment delays. It was insufficient to prevent high-risk treatment delays in the long term.

Social determinants of health on attitudes toward childbearing among women with multiple sclerosis: A cross-sectional study.

Pregnancy and motherhood are very valuable but challenging for women with multiple sclerosis (MS). Given that there are limited studies in this field, this study aimed to determine the social determinants of health on attitudes toward childbearing among women with MS. We conducted a cross-sectional study on 206 women with MS in Alborz province, Iran, from February to June 2023 using convenience sampling. The data were collected using the questionnaire, and a linear regression analysis was applied. The mean age of the participants was 36.80±6.50 years. Participants' Attitudes toward Fertility and Childbearing (PAFC) had a positive significant association with social support (B=.10, SE=.04, p=.023) and a significant negative association with the total score of depression, anxiety, and stress scale (B=-.13, SE=.06, p=.047) and depression (B=-.40, SE=.18, p=.023). However, the association between anxiety (B=-.25, SE=.20, p=.211), stress (B=-.36, SE=.18, p=.050), MS severity (B=.04, SE=.30, p=.890), and socioeconomic status scale (SES) (B=-.08, SE=.32, p=.806) was nonsignificant with PAFC. Our results showed that factors, including social support and mental health especially depression, can affect PAFC in women with MS. Therefore, it is necessary to determine specific strategies for policymakers to help MS patients manage pregnancy and motherhood.

Disability independent of cerebral white matter demyelination in progressive multiple sclerosis

The pathogenic mechanisms contributing to neurological disability in progressive multiple sclerosis (PMS) are poorly understood. Cortical neuronal loss independent of cerebral white matter (WM) demyelination in myelocortical MS (MCMS) and identification of MS patients with widespread cortical atrophy and disability progression independent of relapse activity (PIRA) support pathogenic mechanisms other than cerebral WM demyelination. The three-dimensional distribution and underlying pathology of myelinated T2 lesions were investigated in postmortem MCMS brains. Postmortem brain slices from previously characterized MCMS (10 cases) and typical MS (TMS) cases (12 cases) were co-registered with in situ postmortem T2 hyperintensities and T1 hypointensities. T1 intensity thresholds were used to establish a classifier that differentiates MCMS from TMS. The classifier was validated in 36 uncharacterized postmortem brains and applied to baseline MRIs from 255 living PMS participants enrolled in SPRINT-MS. Myelinated T2 hyperintensities in postmortem MCMS brains have a contiguous periventricular distribution that expands at the occipital poles of the lateral ventricles where a surface-in gradient of myelinated axonal degeneration was observed. The MRI classifier distinguished pathologically confirmed postmortem MCMS and TMS cases with an accuracy of 94%. For SPRINT-MS patients, the MRI classifier identified 78% as TMS, 10% as MCMS, and 12% with a paucity of cerebral T1 and T2 intensities. In SPRINT-MS, expanded disability status scale and brain atrophy measures were similar in MCMS and TMS cohorts. A paucity of cerebral WM demyelination in 22% of living PMS patients raises questions regarding a primary role for cerebral WM demyelination in disability progression in all MS patients and has implications for clinical management of MS patients and clinical trial outcomes in PMS. Periventricular myelinated fiber degeneration provides additional support for surface-in gradients of neurodegeneration in MS.

Training Artificial Neural Networks to Detect Multiple Sclerosis Lesions Using Granulometric Data from Preprocessed Magnetic Resonance Images with Morphological Transformations

The symptoms of multiple sclerosis (MS) are determined by the location of demyelinating lesions in the white matter of the brain and spinal cord. Currently, magnetic resonance imaging (MRI) is the most common tool used for diagnosing MS, understanding the course of the disease, and analyzing the effects of treatments. However, undesirable components may appear during the generation of MRI scans, such as noise or intensity variations. Mathematical morphology (MM) is a powerful image analysis technique that helps to filter the image and extract relevant structures. Granulometry is an image measurement tool for measuring MM that determines the size distribution of objects in an image without explicitly segmenting each object. While several methods have been proposed for the automatic segmentation of MS lesions in MRI scans, in some cases, only simple data preprocessing, such as image resizing to standardize the input dimensions, has been performed before the algorithm training. Therefore, this paper proposes an MRI preprocessing algorithm capable of performing elementary morphological transformations in brain images of MS patients and healthy individuals in order to delete undesirable components and extract the relevant structures such as MS lesions. Also, the algorithm computes the granulometry in MRI scans to describe the size qualities of lesions. Using this algorithm, we trained two artificial neural networks (ANNs) to predict MS diagnoses. By computing the differences in granulometry measurements between an image with MS lesions and a reference image (without lesions), we determined the size characterization of the lesions. Then, the ANNs were evaluated with the validation set, and the performance results (test accuracy = 0.9753; cross-entropy loss = 0.0247) show that the proposed algorithm can support specialists in making decisions to diagnose MS and estimating the disease progress based on granulometry values.

Explaining the burden of cultural factors on MS disease: a qualitative study of the experiences of women with multiple sclerosis

BackgroundMultiple sclerosis (MS) is a debilitating, non-traumatic disease that is common among young adults. Cultural factors, as background factors, can affect how patients adapt and their quality of life. This study aimed to explain the burden of cultural factors on Multiple sclerosis.MethodsThis study was conducted with a qualitative approach and conventional content analysis among women with Multiple sclerosis in Mashhad. The data were collected through semi-structured interviews with women with MS. Fifteen patients with Multiple sclerosis were selected using purposeful sampling. The Graneheim and Lundman method was used to analyze the collected data. The transferability of the study was evaluated using the Guba and Lincoln criteria. MAXQADA 10 software was used to manage and analyze the data.ResultsIn explanation of the cultural factors of patients with Multiple sclerosis, one category (cultural tensions) and five subcategories (forced communication with spouse’s family, definition of women’s role in society, people’s behavior, social beliefs and isolation of the patient) were extracted.ConclusionThe results obtained in this study show that female MS patients face various concerns. Overcoming these challenges require a change in the attitude of people in the society towards women with MS, which is important in the context of formulating practical policies to create a suitable culture. Adopted policies should aim to internalize the culture of changing society’s views of female MS patients. Therefore, the authors argue that there is a need for cultural policies, followed by the systems implementing these policies to consider the challenges mentioned in this study as a priority for MS patients.

Effects of disease-modifying therapies on remyelination in multiple sclerosis; evaluation via visual evoked potential test

BackgroundAssessment of the visual pathway, which is frequently affected by MS, provides the opportunity to measure the remyelination of acute and chronic MS lesions in vivo and non-invasively. VEP can be used in this context. Amplitude is a parameter of axonal loss, whereas latency is an in vivo biomarker of myelin repair. This study aimed to evaluate DMT's neuroprotective and pro-remyelinating potential by evaluating VEP latency and amplitude in MS patients. Materials and methodsA total of 74 patients with relapsing MS who had no evidence of optic neuritis were included in the study. Patient data were retrospectively analyzed and recorded. In the VEP test, latency above 118 ms and amplitude below 5.0 μV were considered abnormal. Classified according to DMTs (injectables, teriflunomide, dimethyl fumarate, fingolimod, cladribine, and alemtuzumab). Visual evoked potential tests, clinical features, and cerebrospinal fluid examinations were evaluated by three independent neurologists and one clinical neurophysiologist. ResultsThe mean age at diagnosis was 29.2 ± 9.01, and the mean age at first VEP was 34.97 ± 10.64. In women, latency was lower, and amplitude was higher. The mean differences in latency and amplitude were, respectively, latency prolonged by 0.7 ms on the right and 0.5 ms on the left, and amplitude increased by 0.6 μV on the right and 0.37 μV on the left. However, these changes were not statistically significant. Latency worsening was more prominent in those with longer disease duration (p = 0.011). Those with amplitude or latency worsening had higher EDSS (p = 0.016 and 0.013, respectively). DMTs did not affect these changes. ConclusionProlonged latency is associated with a long disease duration. Deterioration in both amplitude and latency is evident in high EDSS. These results may be an indirect consequence of axonal degeneration dominating remyelination. DMTs do not ameliorate impaired remyelination and neurodegeneration but seem to be sufficient for short-term maintenance of the current state.

Targeting Oligodendrocyte Dynamics and Remyelination: Emerging Therapies and Personalized Approaches in Multiple Sclerosis Management.

Multiple sclerosis [MS] is a progressive autoimmune condition that primarily affects young people and is characterized by demyelination and neurodegeneration of the central nervous system [CNS]. This in-depth review explores the complex involvement of oligodendrocytes, the primary myelin- producing cells in the CNS, in the pathophysiology of MS. It discusses the biochemical processes and signalling pathways required for oligodendrocytes to function and remain alive, as well as how they might fail and cause demyelination to occur. We investigate developing therapeutic options that target remyelination, a fundamental component of MS treatment. Remyelination approaches promote the survival and differentiation of oligodendrocyte precursor cells [OPCs], restoring myelin sheaths. This improves nerve fibre function and may prevent MS from worsening. We examine crucial parameters influencing remyelination success, such as OPC density, ageing, and signalling pathway regulation [e.g., Retinoid X receptor, LINGO-1, Notch]. The review also examines existing neuroprotective and antiinflammatory medications being studied to see if they can assist oligodendrocytes in surviving and reducing the severity of MS symptoms. The review focuses on medicines that target the myelin metabolism in oligodendrocytes. Altering oligodendrocyte metabolism has been linked to reversing demyelination and improving MS patient outcomes through various mechanisms. We also explore potential breakthroughs, including innovative antisense technologies, deep brain stimulation, and the impact of gut health and exercise on MS development. The article discusses the possibility of personalized medicine in MS therapy, emphasizing the importance of specific medicines based on individual molecular profiles. The study emphasizes the need for reliable biomarkers and improved imaging tools for monitoring disease progression and therapy response. Finally, this review focuses on the importance of oligodendrocytes in MS and the potential for remyelination therapy. It also underlines the importance of continued research to develop more effective treatment regimens, taking into account the complexities of MS pathology and the different factors that influence disease progression and treatment.

Dermatological Neoplastic Diseases Complicating Treatment with Monoclonal Antibodies for Multiple Sclerosis.

Background: Over the past 20 years, the treatment scenario of multiple sclerosis (MS) has radically changed, and an ever-increasing number of disease-modifying treatments has emerged. Among high-efficacy treatment agents, monoclonal antibodies (mAbs) have become a mainstay in a MS patient's treatment due to their targeted mechanism, high efficacy, and favorable risk profile. The latter varies from drug to drug and a skin cancer warning has emerged with sphingosine 1-phosphate receptor inhibitors. Several cases of skin malignancy in people with MS (pwMS) undergoing therapy with mAbs have also been described, but dermatological follow-up is not currently indicated. Objectives: The aim of this review is to investigate cases of cutaneous malignancy during mAb therapy and to explore possible pathophysiological mechanisms to evaluate the potential need for regular dermatological follow-ups in pwMS treated with mAbs. Methods: A literature search for original articles and reviews in PubMed was conducted with no date restrictions. Results: A total of 1019 results were retrieved. Duplicates were removed using Endnote and manually. Only peer-reviewed studies published in English were considered for inclusion. At the end of these screening procedures, 54 studies published between 2001 and 2024 that met the objectives of this review were selected and reported. Conclusions: The available data do not show a clear link between monoclonal antibody (mAb) treatment in pwMS and the risk of skin cancer. At present, these treatments remain contraindicated for people with cancer. Dermatological screening is advisable before starting mAb treatment in pwMS, and subsequent follow-ups should be individualized according to each patient's risk profile.

Association of chronotype and timing of interferon injection with severity of IFNβ-induced flu-like syndrome in Multiple sclerosis (MS) patients

BackgroundAlthough Interferon-beta (IFNβ) has long been approved as a disease-modifying therapy (DMT) for Multiple sclerosis (MS), flu-like syndrome (FLS) persists as a common adverse effect of interferon therapy. Given the importance of circadian rhythm in regulating physiological processes, we aimed to assess the relationship between patient’s chronotype and time of interferon injection with FLS score in MS patients receiving IFNβ. MethodsA cross-sectional study was conducted on 118 MS patients who were referred to the clinic of neurology of Zanjan Vali-e-Asr Hospital for interferon injection. The included were invited to complete a morningness-eveningness questionnaire (MEQ) assessing patients’ chronotype. The following data were extracted from patients’ record: age, gender, duration of interferon treatment, type of interferon taken, time of interferon injection (morning/evening), FLS score, MS subtype, and usage of pain killers. All data found were imported and statistically analyzed in SPSS ver.26. ResultsAccording to the patients’ record, 114 (96.6%) patients had experienced post-interferon injection FLS with different severities. Statistical analysis revealed no significant relationship between the patient’s chronotype and FLS score. Nevertheless, the FLS score was significantly higher in those who had evening injections. ConclusionsTime of interferon injection was significantly associated with FLS score, with higher FLS score following evening injection. However, no significant relationship was found between the FLS score and the patient’s chronotype. It is recommended that further studies assessing circadian rhythm using laboratory tests such as melatonin measurement need to be undertaken to investigate the association of circadian rhythm with post-interferon injection FLS.

Effects of traditional Chinese exercises on physical and psychological health of patients with multiple sclerosis: A systematic review and meta-analysis

Background and purposePhysical exercise improves physical and psychological health. However, information on the quantitative impact of Traditional Chinese Exercise (TCE) on physical and psychological health remains limited. Therefore, this systematic review and meta-analysis aimed to quantitatively explore the effects of TCE on the physical and psychological health of patients with multiple sclerosis (MS). MethodsA comprehensive search was conducted across seven electronic databases (PubMed, SCOPUS, CINAHL, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and Wanfang) from their inception to March 7, 2024 using the terms, Taiji, Tai Chi, Tai Chi Chuan, Qigong, Baduanjin, Wuqinxi, Yijinjing, multiple sclerosis, and disseminated sclerosis. Randomized controlled trials (RCTs) and non-RCTs reporting the effects of TCE on physical function or psychological health outcomes in MS patients were included. A random-effects model and 95 % confidence intervals (95 % CI) were used to compute the effect sizes. ResultsEleven studies, including 461 subjects with MS, were included in this meta-analysis. TCE significantly increased balance (d = 0.88, 95 % CI [0.45, 1.31], p < 0.001, I2 = 39.26 %), activities of daily living (d = 1.17, 95 % CI [0.30, 2.04], p < 0.001, I2 = 89.15 %), Multiple Sclerosis Impact Scale (MSIS) scores (d = 0.53, 95 % CI [0.12, 0.93], p = 0.01, I2 = 0 %), depression (d = 0.66, 95 % CI [0.003, 1.32], p = 0.049, I2 = 62.97 %), and Activities-Specific Balance Confidence (ABC) scores (d = 1.30, 95 % CI [0.41, 2.18], p < 0.001, I2 = 0 %) compared with control conditions. ConclusionsThis meta-analysis suggests the efficacy of TCE in improving balance, activities of daily living, MSIS scores, depression, and ABC scores in MS patients. However, further high-quality research is warranted to investigate these findings.

Assessment of the life quality of patients with multiple sclerosis using the SF-36 scale

The prevalence of multiple sclerosis (MS) is steadily increasing not only due to rising incidence, but also due to improvements in diagnosis and treatment. Accordingly, there is growing interest in improving the quality of life (QL) of chronic patients, for the assessment of which general scales are used, as well as scales developed specifically for MS. In this work, we analyzed publications devoted to assessing the quality of life of MS patients using the nonspecific SF-36 scale for the period from 2018 to 2023. Data were assessed on all eight scales: physical functioning, role functioning, bodily pain, general health, vitality, social functioning, emotional state and mental health. The usefulness of the SF-36 questionnaire has been shown in the management of patients with MS by a general practitioner for a comprehensive assessment of QL dynamics during treatment and in planning of further treatment and rehabilitation measures. However, the ambiguity of numerous QL studies results in MS obtained using the SF-36 questionnaire requires continued research and improvement of the instrument itself.

Multi-omics profiling reveals peripheral blood biomarkers of multiple sclerosis: implications for diagnosis and stratification.

Multiple sclerosis (MS), a chronic autoimmune disorder marked by demyelination in the central nervous system, is exceptionally uncommon in China, and remains poorly understood in terms of its peripheral blood manifestations. We conducted a cohort study comprising 39 MS patients and 40 normal controls (NC). High-dimensional mass cytometry, protein arrays, and targeted metabolomics were utilized to profile immune subsets, proteins, and metabolites in blood. Differences in multi-omics signatures were scrutinized across varying MS subtypes. Immune profiling demonstrated an elevation in various B cell subsets and monocytes, alongside a reduction in dendritic cells among MS patients. Proteomic data revealed a downregulation in neurotrophic and tissue repair proteins. Metabolomic assessment showed a noted decrease in anti-inflammatory molecules and sphingolipids. Integrated analysis identified distinct molecular patterns distinguishing MS from controls. Additionally, multi-omics differences among different MS subtypes were uncovered. Notably, hippuric acid levels was consistently lower in MS subgroups with greater disease severity. This study represents the pioneering exploration of multi-omics in Chinese MS patients, presenting a comprehensive view of the peripheral blood changes in MS. Our study underscores the robust capability of multi-omics assessments in identifying peripheral blood biomarkers that delineate the varied clinical presentation, and facilitates future development of biomarkers and targeted therapeutic interventions in MS.

Investigating the State of Sleep Disorders and the Factors Affecting Them in Patients with Multiple Sclerosis: Cross-Sectional Study

Background: Multiple sclerosis (MS) is a chronic disease that leads to non-traumatic disability and is influenced by both hereditary and environmental factors. Objectives: This study aims to investigate the state of obstructive sleep apnea (OSA) syndrome and the factors affecting it in patients with multiple sclerosis. Methods: This cross-sectional and descriptive study included 180 patients, selected based on previous studies on MS patients and the prevalence of sleep apnea syndrome. The STOP-BANG questionnaire, Epworth Sleepiness Scale (ESS), and Fatigue Severity Scale (FSS) were used for data collection. Additionally, a demographic profile form was utilized to gather information on age, sex, marital status, education level, and income status of the patients. Data were analyzed using SPSS 16 software, employing mean and standard deviation, chi-square test, ANOVA, correlation coefficient, and one-way analysis of variance. Results: The results showed that among patients with a low risk of OSA, 87.3% were female, whereas among those with a high risk of OSA, 71.4% were male. This indicates that the risk of OSA is higher in men than in women with MS. Additionally, the mean ± SD of the Epworth score in high-risk individuals was 16.41 (1.56), compared to 14.27 (1.78) in low-risk individuals, indicating poorer Epworth scores in those at high risk of OSA. Conclusions: The prevalence of OSA and other sleep disorders among patients with MS in Ilam was found to be high. Therefore, it is recommended that necessary therapeutic and rehabilitation interventions be implemented to reduce OSA and improve the sleep quality of these patients.

Enhanced and cross-reactive in vitro memory B cell response against Epstein-Barr virus nuclear antigen 1 in multiple sclerosis.

Multiple sclerosis (MS) is a prototypical autoimmune disease of the central nervous system (CNS). In addition to CD4+ T cells, memory B cells are now recognized as a critical cell type in the disease. This is underlined by the fact that the best-characterized environmental risk factor for MS is the Epstein-Barr virus (EBV), which can infect and persist in memory B cells throughout life. Several studies have identified changes in anti-EBV immunity in patients with MS. Examples include elevated titers of anti-EBV nuclear antigen 1 (EBNA1) antibodies, interactions of these with the MS-associated HLA-DR15 haplotype, and molecular mimicry with MS autoantigens like myelin basic protein (MBP), anoctamin-2 (ANO2), glial cell adhesion molecule (GlialCAM), and alpha-crystallin B (CRYAB). In this study, we employ a simple in vitro assay to examine the memory B cell antibody repertoire in MS patients and healthy controls. We replicate previous serological data from MS patients demonstrating an increased secretion of anti-EBNA1380-641 IgG in cell culture supernatants, as well as a positive correlation of these levels with autoantibodies against GlialCAM262-416 and ANO21-275. For EBNA1380-641 and ANO21-275, we provide additional evidence suggesting antibody cross-reactivity between the two targets. Further, we show that two efficacious MS treatments - natalizumab (NAT) and autologous hematopoietic stem cell transplantation (aHSCT) - are associated with distinct changes in the EBNA1-directed B cell response and that these alterations can be attributed to the unique mechanisms of action of these therapies. Using an in vitro system, our study confirms MS-associated changes in the anti-EBNA1 memory B cell response, EBNA1380-641 antibody cross-reactivity with ANO21-275, and reveals treatment-associated changes in the immunoglobulin repertoire in MS.