Multiple Sclerosis Specialists Research Articles

Multi-actor system dynamics in access to disease-modifying treatments for multiple sclerosis in Southeast Asia: A regional survey and suggestions for improvement

BackgroundDespite the global availability of multiple sclerosis (MS) treatments, accessing and financing them in Southeast Asia (SEA) remains a challenge. This descriptive survey-based study aimed to describe the current state of MS treatment access and local access dynamics within this region. MethodsThe survey questionnaire, comprising of 15 closed-ended and five open-ended questions, was developed by three neurologists with expertise in MS and routine MS patient management, or had training in neuroimmunology. Questionnaire development was guided by the recent Atlas of MS and in alignment with the Access to Treatment framework, focusing on MS diagnosis and treatment issues in SEA. Fifteen neurologists experienced in managing MS across the region were identified as key informants for this study. ResultsAll fifteen neurologists participated in the survey via email and videoconferencing between January 2020 and February 2023, which included the following countries: Brunei, Cambodia, Indonesia, Malaysia, Myanmar, Lao PDR, Philippines, Singapore, Thailand, Timor-Leste, and Vietnam. All had at least five years of experience in managing MS patients and six had previously completed a neuroimmunology fellowship programme. SEA countries showed disparities in healthcare financing, availability of neurologists, MS treatments, and investigative tools. Access to MS disease-modifying treatments (DMTs) is hindered by high cost, lack of MS specialists, and weak advocacy efforts. On-label DMTs are not listed as essential medicines regionally except for interferon beta1a and teriflunomide in Malaysia. On-label monoclonals are available only in Malaysia, Singapore, and Thailand. Generic on-label DMTs are unavailable due to lack of distributorship and expertise in using them. Off-label DMTs (azathioprine, methotrexate, and rituximab) predominate in most SEA countries. Other challenges include limited access to investigations, education, and knowledge about DMTs among general neurologists, and absence of registries and MS societies. Patient champions, communities, and MS organisations have limited influence on local governments and pharmaceutical companies. Despite its increasing prevalence, there is a lack of concerted priority setting due to MS being perceived as a rare, non-communicable disease. ConclusionThis study highlights the distinct dynamics, challenges, and research gaps within this region, and provides suggestions to improve MS diagnosis, education, and medicine access.

Time interval between the onset of symptoms and diagnosis of multiple sclerosis and the influential factors: A national registry-based study

ObjectiveThe time to diagnosis of multiple sclerosis (MS) is of great importance for early treatment, thereby reducing the disability and burden of the disease. The purpose of this study was to determine the time from the onset of clinical symptoms to the diagnosis of MS and to evaluate the factors associated with a late diagnosis in Iranian MS patients. MethodsThe present cross-sectional study was conducted on patients with MS who were registered in the National MS Registry System of Iran (NMSRI). ResultsOverall, 23291 MS patients registered in 18 provinces of Iran were included in this study. The mean (standard deviation) interval between the onset of the disease and diagnosis of MS was 13.42 (32.40) months, and the median was one month. The diagnostic interval of 41.6% of patients was less than one month, and 14.8% of them had a one-month time to diagnosis. Patients with an age of onset below 18 years and those diagnosed after the age of 50 years had a longer time to diagnosis (P<0.001). Patients with primary progressive MS (PPMS) had the longest time to diagnose and those with relapsing-remitting MS (RRMS) had the shortest time (P<0.001). The results of negative binominal regression showed that the average rate of delay in diagnosis in women was 12% less than that in men. The average delay in diagnosis in patients with a positive family history of MS was 23% more than that in others. The rate of delay in the diagnosis of patients with PPMS and secondary progressive MS was 2.22 and 1.66 times higher, respectively, compared with RRMS. ConclusionThe findings of the present study revealed that more than half of the MS patients were diagnosed within a one-month interval from the symptom onset, which is an acceptable period. More attention should be paid to patients’ access to medical facilities and MS specialists.

INFORMATION WANTS AND INFORMATION SEEKING ACTIONS FROM PORTUGUESE NEUROLOGIST

Background: Medical professionals nowadays must be well-versed in the most recent, scientifically confirmed facts on illness diagnosis, treatment, and patient care. Despite the fact that there are an increasing number and variety of information sources available to physicians, many questions remain concerning the authenticity, quality, and usefulness of medical information. With the goal of improving current medical information delivery, new methodologies are needed to assess doctors’ real-life demands. Objective: The goal of this study was to explore the information requirements and seeking behaviour of Portuguese’s neurologists treating patients with multiple sclerosis (MS) and migraine. Methods: An exploratory mixed methods (quantitative and qualitative) investigation of 15 consecutive days was conducted. It was necessary to recruit a total of 50 neurologists (25 MS experts and 25 migraine specialists). An instant messaging programme built for this study was used to gather data. Personal interviews were conducted by computer at each information-seeking session, which included semi structured interviews and closed-ended questions. Content analysis was used to identify emergent themes from the mobile app interactions and physician enquiries. Results: A total of 36/20, or 71 percent, of the questions posed by neurologists were linked to treatment management and pharmacological information, followed by diagnostic techniques and procedures. Online resources were preferred by doctors (48/50, 96 percent) over offline alternatives (24/50, 47 percent) in a quantitative study. In 33% of information-seeking activities, a multi-channel strategy was used, which included using both online and offline resources to address the same demand. Neurologists were more likely to use internet resources than offline ones (F=1.7; P=.01) to get information. Compared to migraine neurologists, MS specialists were 53% more likely to participate in a single information-seeking event (risk ratio 1.54; 95% CI 1.12 to 2.05). More than two-thirds of MS specialists (28 percent [7/25] vs. 10 percent [2/25], P=.06) were interested in patient-related material, whereas migraine physicians (85% [21/25] vs. 60% [15/25], P=.05) were more inclined to seek information on treatment management. Both online and offline information searching was more difficult for migraine experts (F=12.5, P=.01) and offline channels were utilised less often (30 percent [8/25] versus 60 percent of information-seeking events, P=.02). To get information from various sources, both migraine and MS experts reported lower satisfaction rates (single source vs multiple sources P=.003). Conclusion: Portuguese MS and migraine neurologists are described in great depth in this research, including their real-life search activity as well as educational requirements and information sources they use. Neurologist information demands and information-seeking behaviour are influenced by their professional field. Identifying the temporal and context-specific demands of physicians is essential for designing a successful medical information strategy, according to these results.

Multiple sclerosis infusion service during the pandemic: service improvement

Background: Providing care to multiple sclerosis (MS) patients posed a challenge during the COVID-19 pandemic. Surge plans necessitated an abrupt change of facility for the infusion service, from an acute to a non-acute site. Aims: To assess patient satisfaction with the MS infusion service at a new location supervised by MS specialist nurses, in comparison with previous arrangements. Methods: Collection of anonymous patient surveys to assess patient demographics and levels of satisfaction across various service domains. Findings: Overall, 97% recorded a satisfaction score of ≥8/10. Key areas of improvement included difficulty parking, difficulty accessing the unit, appointment punctuality and comfort. Thematic analysis revealed several key improvement areas such as access to MS nursing knowledge, cannulation and punctuality. Conclusion: The urgently relocated service, with better access and specialist nursing input, was associated with improvements in patient experience. Despite unprecedented pressures, unique opportunities resulted in an overall improvement to the MS infusion service.

Nursing care competencies for multiple sclerosis

The UK Multiple Sclerosis Specialist Nurse Association's competency document, which was originally developed in 2008, aims to educate and increase awareness of multiple sclerosis among both specialist nurses and other non-specialist professionals. The latest document—revised in 2024—aims to showcase the most up-to-date information and serves not only as daily practice guidelines, but also promotes safe and effective practice in multiple sclerosis care.

Preferences and Perspectives of Specialist Multiple Sclerosis Nurses and Patients with Multiple Sclerosis Regarding the New RebiSmart® 3.0 Autoinjector versus Other Assistive Devices.

RebiSmart® is an electromechanical multidose autoinjector developed for administering subcutaneous interferon beta-1a in patients with multiple sclerosis (pwMS). This online survey aimed to understand MS nurses' and pwMS preferences and perceptions regarding the features of an upgraded version of the RebiSmart device (RebiSmart 3.0) compared to other assistive devices used for multiple sclerosis (MS) therapy. Eligible MS nurses and pwMS from Germany, Italy, and the United Kingdom completed a double-blind, 30-minute online self-administered questionnaire, including a 10-minute video describing the features of RebiSmart 3.0 and its use in administering interferon beta-1a. In total, 102 participants (MS nurses, n=52; patients, n=50) completed the survey. Overall, 70% respondents found the RebiSmart 3.0 device "very"/"extremely" appealing, 53% were "very"/"extremely" interested in learning more, and 71% stated they would be "very"/"extremely" comfortable using (pwMS) or educating (MS nurses) on it. Among current or recent RebiSmart 2.0 users (vs RebiSmart 2.0 nonusers), 67% (vs 52%) rated RebiSmart 3.0 "very" or "extremely" appealing, 52% (vs 43%) were "very" or "extremely" interested in learning more about the device, and 67% (vs 48%) stated they would be "very" or "extremely" comfortable using the RebiSmart 3.0 device. Respondents ranked customizable injection process (including injection speed, hold time, depth and rotation guide), self-injection process, and hidden needle as the most important self-assistive device features. RebiSmart 3.0 was rated higher than other self-injecting devices on all tested features. Overall, with respect to the top three features, 89% of the MS nurses and 73% of PwMS rated RebiSmart 3.0 "very good" or "excellent". After reviewing the video, 52% respondents had no questions, 67% nurses recommended providing more information on the customizable injection process feature of RebiSmart 3.0 to patients, and 88% nurses considered patient demonstration materials to be the most helpful type of information for them when initiating and educating pwMS on self-assistive devices. The overall reactions of MS nurses and pwMS to the RebiSmart 3.0 device features were positive. The incremental advances over previous versions of the device as well as in comparison with other currently available assistive devices were welcomed. The MS nurses identified key needs for patient education on the use of the device and the suitable approaches (training videos and educational leaflets) to support MS nurses and pwMS.

Awareness and Utilization of Public Physiotherapy Health Care Services to Support People With Multiple Sclerosis: A Health Care Service Audit.

To maximize functioning and well-being in people with multiple sclerosis (MS), physiotherapy consultation is recommended at the point of diagnosis and throughout the disease course. We wanted to determine whether patients with MS being managed through a large metropolitan hospital in Australia accessed physiotherapy input as part of their MS management consistent with evidence-based recommendations and to identify patients' self-reported physiotherapy requirements, including symptom management, information needs, and service delivery preferences. Surveys were sent to 597 MS clinic patients, and 160 responded. Data were analyzed using descriptive methods to derive frequencies and percentages. The survey consisted of 16 questions plus 2 optional questions related to sociodemographics (age and postcode). Of 160 respondents, 142 completed all 14 nonoptional questions. One-third of participants (n = 53) were aware of the hospital MS clinic physiotherapy services, with 21.3% (n = 34) saying that they had accessed these services. Conversely, 40.1% of respondents (n = 61) reported having consulted a private physiotherapist. Combined, 52% of respondents reported seeing a physiotherapist. There was a clear preference (94.7%; n = 144) for access to the MS clinic physiotherapy service. The presence of at least 1 current MS-related physiotherapy problem was reported by 82.2 2% of respondents (n = 125). The top ways to access MS-related information were via a specialist MS website (57.6%) and a mobile app (55.6%). There is an unmet need for physiotherapy, and many participants may have foregone services due to unawareness. Improved awareness and uptake of physiotherapy at the point of diagnosis is needed to maximize functioning and well-being in people with MS.

“A qualitative study of multiple sclerosis specialists’ experiences and perspectives in managing family planning in people with multiple sclerosis”

BackgroundManaging multiple sclerosis (MS) in people of reproductive age can be challenging as treatment decisions often need to balance efficacy, safety to reproductive health and an understanding of reproductive intentions. There has been limited examination of how family planning (FP) is approached in people with MS (pwMS) in Australia. This study aimed to explore the experiences and perspectives of Australian MS clinical specialists on managing FP in the context of MS. MethodsWe conducted one-on-one semi-structured interviews with nine neurologists and ten MS nurses across Australia who regularly provide care to pwMS of reproductive age. Interview topics examined current approaches to managing FP, availability of FP resources, and opportunities for improvement. Interview recordings were transcribed verbatim and analysed thematically. ResultsTwo main themes emerged. First, ‘inconsistent approaches in providing family planning’, where neurologists and MS nurses recognised FP provision as essential but revealed differences in the content, timing and extent of FP discussions; conflicts between reproductive considerations and DMT prescriptions according to teratogenic risk; and variable implementation of interdisciplinary approaches. Second, ‘barriers in providing family planning’ emerged which included a lack of local information resources on FP, lack of contemporary data on safety of DMTs, and a range of patient and professional factors, including time constraints. ConclusionMS clinical specialists saw FP as an essential part of the care of their patients and expressed a need for information and service provision consistency in order to improve FP and reproductive care to pwMS.

Quantifying the administration and monitoring time burden of several disease-modifying therapies for relapsing multiple sclerosis in the United Kingdom: A time and motion study

BackgroundThe treatment landscape for relapsing multiple sclerosis (MS) has changed dramatically in recent decades, including an increasing number of high-efficacy disease-modifying therapies (DMTs) with varied administration and monitoring requirements. Coupled with greater focus on earlier treatment, these factors have resulted in stretching of the capacity of MS specialist services and allied healthcare professionals (HCPs). To assist with the effective planning of MS services in the UK NHS, this study quantified the administration and monitoring time burden associated with high-efficacy DMTs (alemtuzumab, cladribine tablets, fingolimod, natalizumab, and ocrelizumab) for relapsing MS. MethodsA Time and Motion (T&M) study was conducted across four MS centres in the UK, over 3–4 months per centre (Aug 2019–Feb 2021). Time dedicated by HCPs (including but not limited to neurologists, MS specialist nurses, infusion nurses, and healthcare assistants) to pre-specified drug administration and monitoring activities, elicited during pre-study interviews at each centre, was assessed for each of the selected DMTs. Administration activities included: installing peripheral access; pre-medication administration (if needed); preparing drug for infusion; infusion initiation, monitoring, and disconnection; and patient monitoring post-infusion. Monitoring activities included: booking appointments for blood draws; blood draw; retrieval and review of blood results; maintaining blood records and follow-up with the patient; checking availability of MRI results and follow-up with the patient; booking appointments for neurologist or nurse consultations; and checking patient files prior to clinic visits. A T&M model was built using observational T&M study results, data obtained through pre-study interviews, as well as stipulated monitoring intervals from relevant Summaries of Product Characteristics for the selected DMTs, to estimate active HCP time with each DMT, extrapolated over a period of 4 years per-patient. ResultsFor oral DMTs, projected total active HCP time (monitoring only) per-patient over 4 years was 14.7 h for cladribine tablets and 19.2 h for fingolimod. For infused DMTs, total time (administration and monitoring) for alemtuzumab was 37.7 h (6.0 and 31.6 h, respectively), 48.1 h for natalizumab (17.4 and 30.8 h, respectively), and 23.5 h for ocrelizumab (6.1 and 17.4 h, respectively). ConclusionsWhile active HCP time varied across centres, infused DMTs were projected to require the greatest amount of HCP time associated with administration and monitoring over 4 years versus oral DMTs. These findings may assist MS-specific HCPs in planning and delivering the equitable provision of DMT services for patients with relapsing MS.

Internal comorbidities and complications of multiple sclerosis therapy - don't be caught off guard!

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system, mainly affecting young adults. Factors positively influencing its course include early antiinflammatory treatment and the influencing of other comorbidities. The most common comorbidities occurring in MS patients with a higher frequency than in the general population are neurological, psychiatric, cardiovascular, metabolic and autoimmune. Just as comorbidity compensation affects the course of MS, in some cases, MS decompensation is associated with a worse course of associated diseases. Due to common risk factors and partially shared immunopathogenesis, treatment covering multiple conditions can be used, especially for some autoimmune diseases. On the other hand, some drugs may potentiate the development of other autoimmunity or disorder. A special topic is the side effects and complications of treatment (especially infections and malignancies) of disease-modifying therapies used in patients with MS. However, the potential treatment discontinuation carries significant risks and should always be discussed with the MS specialist. Therefore, close interdisciplinary collaboration is crucial.

Iranian specialists' approach to surgery in patients with multiple sclerosis.

Background: Data on perioperative risk stratification in patients with multiple sclerosis (MS) are limited. In this regard, the present study was conducted to investigate Iranian specialists' approach to surgical counseling for patients with MS (PwMS). Methods: 21 MS specialists were asked about 11 case scenarios with different MS disease statuses, disease-modifying therapies (DMTs), and urgency of the operation. The reasons for refusing surgery or factors that have to be considered before surgery were studied. Results: Overall, Fleiss Kappa was estimated to be 0.091 [95% confidence interval (CI): 0.090-0.093, P < 0.001] indicating a very poor level of agreement among responders. Conclusion: PwMS face surgery for various reasons. Risk assessment of surgery, the effect of various drugs such as anesthetics and DMT on patients, as well as many other aspects of MS are issues challenging the practitioners. Clarifying the various dimensions of these issues requires further research.

Exploring specialist nurse clinic appointments: supporting a person with multiple sclerosis to manage spasticity and spasms

Background: Managing clinic appointments effectively and efficiently are a fundamental part of being a multiple sclerosis (MS) specialist nurse (MSSN). Opportunities to practice these skills can be limited, which can be daunting for nurses new into the speciality. Aim: This article explores the management of spasticity and spasms and how a MSSN can effectively use time in a clinic appointment to complete a holistic assessment and support people with MS (PwMS) to manage their spasticity and spasms. Method: Narrative methodology was used to synthesise insights from appointments in a specialist nurse clinic, where individuals with MS needed support to manage spasticity and spasms. The insights were constructed into a reflexive narrative and are presented in this article as one clinic appointment. Findings: Strategies for MSSNs to consider during their clinics and spasticity management practices are suggested. These include clinic preparation, verbal and physical assessments, measuring, timely referral to other multidisciplinary members and educating PwMS, such as educating them on the possible triggers that can exacerbate spasticity and spasms, the importance of exercise and stretching, and monitoring the effectiveness of symptomatic treatments, including drug interventions. Conclusion: MSSNs have a vital role in supporting PwMS to manage their spasticity and spasms throughout the disease trajectory. Developing expertise in effectively using time in clinic appointments will benefit the outcomes for PwMS, the individual nurse and the healthcare organisation.

Comparative Effectiveness of Autologous Hematopoietic Stem Cell Transplant vs Fingolimod, Natalizumab, and Ocrelizumab in Highly Active Relapsing-Remitting Multiple Sclerosis

Autologous hematopoietic stem cell transplant (AHSCT) is available for treatment of highly active multiple sclerosis (MS). To compare the effectiveness of AHSCT vs fingolimod, natalizumab, and ocrelizumab in relapsing-remitting MS by emulating pairwise trials. This comparative treatment effectiveness study included 6 specialist MS centers with AHSCT programs and international MSBase registry between 2006 and 2021. The study included patients with relapsing-remitting MS treated with AHSCT, fingolimod, natalizumab, or ocrelizumab with 2 or more years study follow-up including 2 or more disability assessments. Patients were matched on a propensity score derived from clinical and demographic characteristics. AHSCT vs fingolimod, natalizumab, or ocrelizumab. Pairwise-censored groups were compared on annualized relapse rates (ARR) and freedom from relapses and 6-month confirmed Expanded Disability Status Scale (EDSS) score worsening and improvement. Of 4915 individuals, 167 were treated with AHSCT; 2558, fingolimod; 1490, natalizumab; and 700, ocrelizumab. The prematch AHSCT cohort was younger and with greater disability than the fingolimod, natalizumab, and ocrelizumab cohorts; the matched groups were closely aligned. The proportion of women ranged from 65% to 70%, and the mean (SD) age ranged from 35.3 (9.4) to 37.1 (10.6) years. The mean (SD) disease duration ranged from 7.9 (5.6) to 8.7 (5.4) years, EDSS score ranged from 3.5 (1.6) to 3.9 (1.9), and frequency of relapses ranged from 0.77 (0.94) to 0.86 (0.89) in the preceding year. Compared with the fingolimod group (769 [30.0%]), AHSCT (144 [86.2%]) was associated with fewer relapses (ARR: mean [SD], 0.09 [0.30] vs 0.20 [0.44]), similar risk of disability worsening (hazard ratio [HR], 1.70; 95% CI, 0.91-3.17), and higher chance of disability improvement (HR, 2.70; 95% CI, 1.71-4.26) over 5 years. Compared with natalizumab (730 [49.0%]), AHSCT (146 [87.4%]) was associated with marginally lower ARR (mean [SD], 0.08 [0.31] vs 0.10 [0.34]), similar risk of disability worsening (HR, 1.06; 95% CI, 0.54-2.09), and higher chance of disability improvement (HR, 2.68; 95% CI, 1.72-4.18) over 5 years. AHSCT (110 [65.9%]) and ocrelizumab (343 [49.0%]) were associated with similar ARR (mean [SD], 0.09 [0.34] vs 0.06 [0.32]), disability worsening (HR, 1.77; 95% CI, 0.61-5.08), and disability improvement (HR, 1.37; 95% CI, 0.66-2.82) over 3 years. AHSCT-related mortality occurred in 1 of 159 patients (0.6%). In this study, the association of AHSCT with preventing relapses and facilitating recovery from disability was considerably superior to fingolimod and marginally superior to natalizumab. This study did not find evidence for difference in the effectiveness of AHSCT and ocrelizumab over a shorter available follow-up time.

Challenges of patients with multiple sclerosis in receiving health care services in Iran.

Background: Multiple sclerosis (MS) is a debilitating, non-traumatic, neurological disorder in young adults and can reduce quality of life (QoL) by interfering with the ability to work, leisure activities, and routine living tasks. Various studies have shown the dissatisfaction of people with MS in different areas of care services. Regarding the patients' weakness with care and services, we sought to identify the challenges for patients with MS in receiving care and services in Iran. Methods: This cross-sectional study was conducted in 2016-2018 using a researcher-made questionnaire (designed by MS Specialists in an MS research center). The questionnaire examined the care challenges in four areas: 1) costs of medication, hospitalization, and rehabilitation services, 2) family support, insurance system, and job protection, 3) access to transportation system and treatment team, 4) quality of the provided care and services. Results: Completed questionnaires were received from 945 respondents. The mean age of responders was 35.92 years. In total, 731 (77.8) participants were women and 208 (22.2) were men. Academic education was reported among 615 (65.3) participants and 367 (40.2) were employed during the study, while 99 (10.5) of the subjects were not able to walk a minimum of 20 meters. The prioritization of care services challenges was as follows: the cost of pharmaceutical services (49.1), lack of telephone counseling (47.4), uninsured home rehabilitation (44.7), lack of qualified care centers (41.2), and rehabilitation costs (40.2). Conclusion: We found that patients who could not walk at least 20 meters and unemployed individuals had more problems and lower QoL. The patients who had non-academic education had more challenges with the cost of medication, transportation, and lack of familial support. This study shows the challenges of MS patients in receiving health care in Iran that vary in age, education, employment, and ability to walk. As the abovementioned challenges are of great importance in determining the QoL of people with MS, an appropriate solution is provided in this study to overcome these challenges.

Iranian specialists' approach to treatment escalation in multiple sclerosis patients with cognitive impairment.

Background: People with multiple sclerosis ‎(MS) and their physicians recognize cognitive retention as an important desired outcome of disease-modifying therapies (DMTs). In this study, we attempted to gather the opinions of Iranian MS experts regarding the treatment approach toward clinical cases with different physical and cognitive conditions. Methods: Opinions of 20 MS specialists regarding the best approach to 6 case scenarios (with different clinical, cognitive, and imaging characteristics) were gathered via a form. Results: The estimated kappa of 0.16 [95% confidence interval (CI): 0.159-0.163; P < 0.001] suggested a poor degree of agreement on the treatment choice among the professionals. Conclusion: Although most specialists agreed with treatment escalation in cases with cognitive impairment, there was no general agreement. Furthermore, there was not enough clinical evidence in the literature to develop consensus guidelines on the matter.

Comparative Analysis of Diagnostic Criteria for Radiologically Isolated Syndrome (S31.009)

<h3>Objective:</h3> This study aimed to analyze the factors that predict the conversion of radiologically isolated syndrome (RIS) patients to multiple sclerosis (MS), and the validity of the two RIS diagnostic criteria. <h3>Background:</h3> Okuda et al. introduced the RIS criteria for the first time in 2009. In 2018, the MAGNIMS group proposed less stringent criteria. There are no studies comparing these two criteria. <h3>Design/Methods:</h3> All participants with suspected demyelinating brain MRI lesions were included in this study. Patient data was collected including demographics, clinical and cerebrospinal fluid (CSF) parameters, and MRI lesion characteristics. All MRI images were reevaluated by two MS specialists and a neuroradiologist. Multi-parameter Cox-regression method was used during the analyses. <h3>Results:</h3> A total of 130 patients (30 mRIS, 65 Okuda and mRIS, 35 nonRIS) from seven centers were included into the study. Fifty percent of the patients converted into MS after 8.59 years (95% CI: 3.95–13.22). The conversion rate of the three groups were comparable (p=0.18). Presence of oligoclonal bands in the CSF (OCB) (HR=0.09, p=0.02), elevated IgG index (HR=0.08, p=0.02), and presence of spinal MRI lesion (HR= 0.23, p=0.001) predicted conversion to MS. Male gender (HR=1.05, p=0.89) and age less than 37 (HR=0.56, p=0.21) were not predictive of conversion to MS. <h3>Conclusions:</h3> Our findings indicates that baseline spinal lesions, an elevated IgG index, and OCB are the best predictors of conversion to MS. Considering conversion to MS, we found no difference between patients who fulfilled the Okuda or modified RIS criteria. It is necessary to explore new parameters that will improve the sensitivity and specificity of the present diagnostic criteria for RIS. <b>Disclosure:</b> Tuncay Gunduz has nothing to disclose. Dr. Ciftci has nothing to disclose. Bilge Piri Cinar has nothing to disclose. Mr. Baba has nothing to disclose. MERAL SEFEROGLU has nothing to disclose. Dr. SIVACI has nothing to disclose. Dr. Cilingir has nothing to disclose.ÖZLEM ETHEMOGLU has nothing to disclose. LEVENT OCEK, 4284 has nothing to disclose. Dr. Barburoglu has nothing to disclose. Dr. Ozakbas has nothing to disclose. Dr. Eraksoy has nothing to disclose. Dr. Kurtuncu has nothing to disclose.

Association of body mass index and physical activity with fatigue, depression, and anxiety among Iranian patients with multiple sclerosis.

Depression, fatigue, and anxiety are three common clinical comorbidities of multiple sclerosis (MS). We investigated the role of physical activity (PA) level and body mass index (BMI) as modifiable lifestyle factors in these three comorbidities. A cross-sectional study was conducted in the MS specialist clinic of Sina Hospital, Tehran, Iran. Demographic and clinical data were collected. BMI was categorized in accordance with the WHO's standard classification. Physical activity (PA) level and sitting time per day were obtained using the short form of the International Physical Activity Questionnaire (IPAQ-SF). Fatigue, anxiety, and depression scores were measured using the Persian version of the Fatigue Severity Scale (FSS), Beck Anxiety Inventory (BAI), and Beck's Depression Inventory II (BDI-II) questionnaires, respectively. The correlation between the metabolic equivalent of tasks (MET), BMI, and daily sitting hours with depression, anxiety, and fatigue were checked using the linear regression test. The normal BMI group was considered a reference, and the difference in quantitative variables between the reference and the other groups was assessed using an independent sample t-test. Physical activity was classified with tertiles, and the difference in depression, anxiety, and fatigue between the PA groups was evaluated by a one-way ANOVA test. In total, 85 MS patients were recruited for the study. The mean ± SD age of the participants was 39.07 ± 8.84 years, and 72.9% (n: 62) of them were female. The fatigue score was directly correlated with BMI (P: 0.03; r: 0.23) and sitting hours per day (P: 0.01; r: 0.26) and indirectly correlated with PA level (P < 0.01; r: -0.33). Higher depression scores were significantly correlated with elevated daily sitting hours (P: 0.01; r: 0.27). However, the correlation between depression with PA and BMI was not meaningful (p > 0.05). Higher anxiety scores were correlated with BMI (P: 0.01; r: 0.27) and lower PA (P: 0.01; r: -0.26). The correlation between anxiety and sitting hours per day was not significant (p > 0.05). Patients in the type I obesity group had significantly higher depression scores than the normal weight group (23.67 ± 2.30 vs. 14.05 ± 9.12; P: 0.001). Fatigue (32.61 ± 14.18 vs. 52.40 ± 12.42; P: <0.01) and anxiety (14.66 ± 9.68 vs. 27.80 ± 15.48; P: 0.01) scores were significantly greater among participants in the type II obesity group in comparison with the normal weight group. Fatigue (P: 0.01) and anxiety (P: 0.03) scores were significantly different in the three levels of PA, but no significant difference was found in the depression score (P: 0.17). Our data suggest that a physically active lifestyle and being in the normal weight category are possible factors that lead to lower depression, fatigue, and anxiety in patients with MS.

2023 and beyond

As the British Journal of Neuroscience Nursing enters it's third year of publishing a supplement dedicated to multiple sclerosis (MS), Paru Naik gives thanks to the readers and contributors of the journal. Additionally, Paru reflects on the different ways that the MS Trust are helping to tackle the tremendous pressures that MS Specialist nurses are currently facing.

Discussing treatment choices in multiple sclerosis

A popular and useful publication returns to print this month in a revised and improved format. The Multiple Sclerosis (MS) Trust worked with the MS community, including people with MS and MS specialist clinicians, to redevelop their flagship resources on disease modifying drugs with the aim of better meeting the needs of patients and healthcare professionals.

The role of the advanced multiple sclerosis champion: executive summary of the pilot programme

As a result of the changing workloads of multiple sclerosis (MS) teams across the country, people with advanced MS are less likely to be seen by MS specialist services. The MS Trust, with support from NHS England and the Optimum Care Pathway for MS, introduced a pilot programme that established the role of six advanced MS champions in different sites across the UK. By working solely with people with advanced MS, the aim is for this role to address the health inequalities and ensure every person with MS receives access to the specialist care they need.