Multiple Sclerosis Status Research Articles

Descriptive Analysis of Health Disparities Between Black and White People With Multiple Sclerosis in the Deep South.

Black people with multiple sclerosis (MS) have a worse disease course and higher rates of progression than White people with MS. Contributing factors to health disparities are understudied. Data were collected retrospectively from the electronic medical records of 500 people with MS treated between 2013 and 2022 at a university comprehensive MS center in a southern state. Multiple logistic regression analyses were used to determine the associations between 2 disability outcomes (ie, low vs high Expanded Disability Status Score [EDSS] and ambulatory assistance [AMB] requirements) and age, sex, body mass index (BMI), MS type, disease duration, hypertension status, diabetes status, smoking status, adjusted gross income, and health insurance type for Black people with MS and White people with MS. Of the cohort, 39.2% identified as Black people with MS and the rest were White people with MS. Approximately 80% of White people with MS had relapsing MS (RMS) vs almost 90% of Black people with MS. Black people with MS were more likely to have a higher EDSS (OR 5.0, CI 3.0-8.4) and AMB (OR, 2.8; 95% CI, 1.6-4.8) than White people with MS. Among White people with MS, women (OR, 0.5; 95% CI, 0.3-0.9) and people with RMS (OR, 0.13; 95% CI 0.06-0.3) were less likely to have higher EDSS scores. Among Black people with MS, neither female sex nor RMS status was associated with a lower risk of having a higher EDSS (OR, 0.685; P = .43 and OR, 0.394; P = .29, respectively). The disparity in disability outcomes between Black people with MS and White people with MS may be driven by more disabling courses for Black people with RMS and by female sex, though further study is needed to determine causes for this outcome.

Walking and physical performance in black and white adults with multiple sclerosis controlling for social determinants of health

BackgroundThere is evidence for reduced walking and physical performance in persons with multiple sclerosis (MS) compared with healthy controls (HCs). There is further evidence suggesting increased overall mobility disability in Black persons with MS compared with White counterparts, yet little is known about the interplay of social determinants of health (SDOH) when considering differences in walking and physical performance. PurposeThis cross-sectional, comparative study examined differences in walking and physical performance in Black and White persons with MS and HCs (MS Status), statistically controlling for SDOH. MethodsThe study sample consisted of 208 persons with MS (141 White participants and 67 Black participants) and 95 HCs (59 White participants and 36 Black participants). Walking and physical function were measured using timed 25-foot walk (T25FW), six-minute walk (6MW), timed-up-and-go (TUG), and short physical performance battery (SPPB). We examined the differences in the walking and physical functions as a function of MS Status (MS vs. HCs) and Race (Black vs. White) using Multivariate Analysis of Covariance, controlling for age, sex, marital status and SDOH (i.e., education, employment, income). ResultsThere were no significant interactions between MS Status and Race on the outcomes, and the main effects of MS Status and Race remained statistically significant, controlling for SDOH and covariates. The main effects indicated significant lower T25FW (F = 34.6, p < .001, Ƞp2 = 0.11), 6MW (F = 58.5, p < .001, Ƞp2 = 0.18), TUG (F = 22.1, p < .001, Ƞp2 = 0.08), and SPPB (F = 25.2, p < .001, Ƞp2 = 0.09) performance for MS than HCs, and lower T25FW (F = 15.5, p < .001, Ƞp2 = 0.05), 6MW (F = 11.6, p < .001, Ƞp2 = 0.04), and TUG (F = 4.1, p < .05, Ƞp2 = 0.02) performance in Black than White samples. ConclusionsWe conclude that MS Status and Race independently influence walking and physical performance even after accounting for SDOH, and Black persons with MS have compromised walking and physical performance, perhaps necessitating focal rehabilitation.

Multiple sclerosis prevalence and its relationship with economic status in Afyonkarahisar, Turkey

BackgroundOver the past decade, the prevalence of Multiple Sclerosis (MS) has increased in Turkey. However, the prevalence of MS in Middle Anatolia, specifically Afyonkarahisar, remains unknown. Additionally, the potential link between economic status and MS has not yet been explored in Turkey. MethodsA stratified sampling method was employed to select samples from the population residing in Afyonkarahisar City Center, taking into account demographic factors such as income level, sex, and age. The sample size was calculated using the formula N = p.q.Zα2/d2, where an average prevalence rate of 70/100,000 was considered based on previous studies. The minimum sample size was 29,858. Considering incomplete, inaccurate, and low-reliability data, data were collected from 30,500 individuals and 30,408 individuals were evaluated. ResultsThe prevalence of Multiple Sclerosis in the center of Afyonkarahisar was 105.2 per 100,000 individuals. Upon investigating the association between economic status and MS prevalence, the findings revealed rates of 193.6 per 100,000 in individuals with high income, contrasting with 80.2 per 100,000 in those with low income. Notably, a heightened prevalence of MS is evident among individuals with higher income levels. ConclusionThis study revealed a significantly elevated prevalence of MS in Afyonkarahisar, the highest in Turkey. The inverse correlation between the prevalence of MS and socioeconomic status is intriguing. Possible reasons for the high prevalence include the relatively new and specific geologic and environmental conditions in the area.

35 The Association Between Social Support and Cognition in Older Adults with Multiple Sclerosis

Objective:Research has shown that social support has protective effects against cognitive decline in older adults. No study to date has examined the relationship between social support and cognition in older adults with Multiple Sclerosis (MS). Advances in treatments for MS have resulted in a growing number of aging individuals with MS, making it imperative to identify modifiable risk factors that affect cognition, such as social support. Therefore, this study was designed to examine the association between social support and cognition in older adults with MS and healthy controls.Participants and Methods:Participants were older adults with MS (N = 70; M age = 64.71, SD + 3.86 years; 62.9% female) and community-residing older adults (N = 74; M age = 68.42, SD + 5.96 years; 58.1% female). Perceived social support was assessed using the Medical Outcomes Study Modified Social Support Survey (MSSS), which measures emotional/informational support, tangible support, affectionate support, and positive social interaction. Cognition was assessed with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which measures immediate and delayed memory, attention, language, and visuospatial abilities. Linear regressions stratified by group status (MS vs. control) assessed the association between perceived social support and cognition.Results:Linear regressions controlling for age, gender, education, and medical comorbidities showed that higher total MSSS scores were related to higher RBANS scores in the MS group (β = 0.243, p = .046) and marginally in the control group (β = 0.239, p = .053). Examination of MSSS domains showed that emotional/informational support (β = 0.246, p = .044) and positive social interaction (β = 0.279, p = .023) were significant predictors of RBANS performance in the MS group. Positive social interaction (β = 0.262, p = .011) was a significant predictor of RBANS performance in the control group. Analyses that further adjusted for depression scores showed that positive social interaction remained a significant predictor of RBANS performance in the control group (β = 0.361, p = .005). In contrast, depression scores attenuated associations between all aspects of social support and RBANS performance in the MS group (p &gt; .05).Conclusions:Among older adults, the association between social support and cognition varied as a function of MS status. Overall perceived social support, emotional/informational support, and positive social interaction were significantly associated with cognition in the MS group. However, depressive symptoms attenuated these associations. In contrast, positive social interaction was the key driver of the association between social support and cognition among the healthy controls, and notably, this association remained significant even after adjusting for depressive symptoms.

Feasibility of Low-Load Resistance Training Using Blood Flow Restriction for People With Advanced Multiple Sclerosis: A Prospective Cohort Study.

The objective of this study was to determine the feasibility of low-load resistance training with blood flow restriction (BFR) for people with advanced disability due to multiple sclerosis (MS). In this prospective cohort study, 14 participants with MS (Expanded Disability Status Scale [EDSS] score = 6.0 to 7.0; mean age = 55.4 [SD = 6.2] years; 71% women) were asked to perform 3 lower extremity resistance exercises (leg press, calf press, and hip abduction) bilaterally twice weekly for 8weeks using BFR. Feasibility criteria were as follows: enrollment of 20 participants, ≥80% retention and adherence, ≥90% satisfaction, and no serious adverse events related to the intervention. Other outcomes included knee extensor, ankle plantar flexor, and hip abductor muscle strength, 30-Second Sit-to-Stand Test, Berg Balance Scale, Timed 25-Foot Walk Test, 12-Item MS Walking Scale, Modified Fatigue Impact Scale, Patient-Specific Functional Scale, and daily step count. Sixteen participants consented, and 14 completed the intervention, with 93% adherence overall. All participants were satisfied with the intervention. A minor hip muscle strain was the only intervention-related adverse event. There were muscle strength improvements on the more-involved (16%-28%) and less-involved (12%-19%) sides. There were also changes in the 30-Second Sit-to-Stand Test (1.9 repetitions; 95% CI = 1.0 to 2.8), Berg Balance Scale (5.3 points; 95% CI = 3.2 to 7.4), Timed 25-Foot Walk Test (-3.3seconds; 95% CI = -7.9 to 1.3), Modified Fatigue Impact Scale (-8.8 points; 95% CI = -16.5 to -1.1), 12-Item MS Walking Scale (-3.6 points; 95% CI = -11.5 to 4.4), Patient-Specific Functional Scale (2.9 points; 95% CI = 1.9 to 3.8), and daily step count (333 steps; 95% CI = -191 to 857). Low-load resistance training using BFR in people with MS and EDSS scores of 6.0 to 7.0 appears feasible, and subsequent investigation into its efficacy is warranted. Although efficacy data are needed, combining BFR with low-load resistance training may be a viable alternative for people who have MS and who do not tolerate conventional moderate- to high-intensity training because of more severe symptoms, such as fatigue and weakness. Low-load strength training with BFR was feasible in people who have advanced disability due to MS. Using BFR may provide an alternative for people with MS who do not tolerate higher intensity training due to more severe symptoms, such as fatigue and weakness.

A - 58 Verbal Fluency Word Generation Slope among Older Adults with MS.

The decreasing rate of within-person word generation in verbal fluency (VF) tasks, here referred to as slope, is associated with mild cognitive impairment and with lower grey matter volume in select regions. While VF is sensitive to cognitive decline in Multiple Sclerosis (MS), VF slopes have yet to be assessed in older adults with MS. We, therefore, examined VF slopes in letter and category VF among dementia-free older adults with and without MS. 84 community-dwelling adults with MS (Mage = 64.7) and 86 without MS (Mage = 70.8) completed standard 60-sec letter (F, A, S) and category (fruits, vegetables, animals) VF tasks; responses were recorded in 20-sec intervals for each iteration of the task. Linear regressions showed that MS was associated with lower total word generation on category, but not letter, VF after accounting for age, sex, race, education, and health status (95% CI, [-2.27, -0.98], p < 0.001). Linear mixed effects models showed that word generation declined during the course of both tasks (all p's < 0.001) in both groups; MS status did not moderate category or letter VF slopes. Extant literature on total letter and category VF word generation in MS is mixed. The current study indicates that in community-dwelling older adults MS was associated with lower total word scores in category but not letter VF. Negative word generation slopes were documented in category and letter VF irrespective of group status. These results suggest that time effects on word generation in VF tasks were generalizable to normal aging and MS.

Premorbid Sociodemographic Status and Multiple Sclerosis Outcomes in a Universal Health Care Context

Multiple sclerosis (MS) severity may be informed by premorbid sociodemographic factors. To determine whether premorbid education, income, and marital status are associated with future MS disability and symptom severity, independent of treatment, in a universal health care context. This nationwide observational cohort study examined data from the Swedish MS Registry linked to national population registries from 2000 to 2020. Participants included people with MS onset from 2005 to 2015 and of working age (aged 23 to 59 years) 1 year and 5 years preceding disease onset. Income quartile, educational attainment, and marital status measured at 1 and 5 years preceding disease onset. Repeated measures of Expanded Disability Status Scale (EDSS) scores and patient-reported Multiple Sclerosis Impact Scale (MSIS-29) scores. Models were adjusted for age, sex, relapses, disease duration, and treatment exposure. Secondary analyses further adjusted for comorbidity. All analyses were stratified by disease course (relapse onset and progressive onset). There were 4557 patients (mean [SD] age, 37.5 [9.3] years; 3136 [68.8%] female, 4195 [92.1%] relapse-onset MS) with sociodemographic data from 1-year preonset of MS. In relapse-onset MS, higher premorbid income and education correlated with lower disability (EDSS, -0.16 [95% CI, -0.12 to -0.20] points) per income quartile; EDSS, -0.47 [95% CI, -0.59 to -0.35] points if tertiary educated), physical symptoms (MSIS-29 physical subscore, -14% [95% CI, -11% to -18%] per income quartile; MSIS-29 physical subscore, -43% [95% CI, -35% to -50%] if tertiary educated), and psychological symptoms (MSIS-29 psychological subscore, -12% [95% CI, -9% to -16%] per income quartile; MSIS-29 psychological subscore, -25% [95% CI, -17% to -33%] if tertiary educated). Marital separation was associated with adverse outcomes (EDSS, 0.34 [95% CI, 0.18 to 0.51]; MSIS-29 physical subscore, 35% [95% CI, 12% to 62%]; MSIS-29 psychological subscore, 25% [95% CI, 8% to 46%]). In progressive-onset MS, higher income correlated with lower EDSS (-0.30 [95% CI, -0.48 to -0.11] points per income quartile) whereas education correlated with lower physical (-34% [95% CI, -53% to -7%]) and psychological symptoms (-33% [95% CI, -54% to -1%]). Estimates for 5-years preonset were comparable with 1-year preonset, as were the comorbidity-adjusted findings. In this cohort study of working-age adults with MS, premorbid income, education, and marital status correlated with disability and symptom severity in relapse-onset and progressive-onset MS, independent of treatment. These findings suggest that socioeconomic status may reflect both structural and individual determinants of health in MS.

Changes in employment status over time in multiple sclerosis following a first episode of central nervous system demyelination, a Markov multistate model study.

Understanding predictors of changes in employment status among people living with multiple sclerosis (MS) can assist health care providers to develop appropriate work retention/rehabilitation programs. We aimed to model longitudinal transitions of employment status in MS and estimate the probabilities of retaining employment status or losing or gaining employment over time in individuals with a first clinical diagnosis of central nervous system demyelination (FCD). This prospective cohort study comprised adults (aged 18-59 years) diagnosed with FCD (n = 237) who were followed for more than 11 years. At each review, participants were assigned to one of three states: unemployed, part-time, or full-time employed. A Markov multistate model was used to examine the rate of state-to-state transitions. At the time of FCD, participants with full-time employment had an 89% chance of being in the same state over a 1-year period, but this decreased to 42% over the 10-year follow-up period. For unemployed participants, there was a 92% likelihood of remaining unemployed after 1 year, but this probability decreased to 53% over 10 years. Females, those who progressed to clinically definite MS, those with a higher relapse count, and those with a greater level of disability were at increased risk of transitioning to a deteriorated employment state. In addition, those who experienced clinically significant fatigue over the follow-up period were less likely to gain employment after being unemployed. In our FCD cohort, we found a considerable rate of employment transition during the early years post-diagnosis. Over more than a decade of follow-up post-FCD, we found that females and individuals with a greater disability and a higher relapse count are at higher risk of losing employment.

Sociodemographic and Neuroimaging Evaluation of Patients with Multiple Sclerosis and Radiologically Isolated Syndrome in Isfahan, Iran

Background: Multiple sclerosis (MS) is categorized into four subtypes, including clinically-isolated syndrome (CIS), primary progressive multiple sclerosis (PPMS), secondary progressive multiple sclerosis (SPMS), and relapsing-remitting multiple sclerosis (RRMS). On the other hand, radiologically-isolated syndrome (RIS) is characterized by the imaging manifestations of MS rather than its clinical symptoms. Objectives: This study aimed to compare the sociodemographic and neuroimaging findings of different MS phenotypes and RIS. Methods: The current cross-sectional study was conducted on 3716 patients at the Multiple Sclerosis Clinic of Kashani Hospital, Isfahan, Iran, from June 2018 to April 2019. Patients presenting with RIS, CIS, and MS were included in this study. Results: The age of disease onset was remarkably lower in patients with RRMS, while the body mass index was significantly higher in RIS (P-value &lt; 0.05). Other factors, including gender, occupation, marital status, smoking, and family history of MS, showed no significant difference (P-value &gt; 0.05). Neuroimaging assessments revealed significant differences in terms of the location of the plaques, the activity of the plaques, brain atrophy, lesion load, the number of cervical plaques, and the presence of longitudinally-extended transverse myelitis (P-value &lt; 0.05), but not regarding the activity of cervical and thoracolumbar plaques and the number of thoracolumbar lesions (P-value &gt; 0.05). Conclusions: Different MS phenotypes showed variations in terms of sociodemographic and neuroimaging characteristics. Follow-up studies are recommended to determine the risk factors predicting the conversion of RIS and CIS to other MS phenotypes.

Association of Blood Levels of Vitamin D and Its Binding Protein with Clinical Phenotypes of Multiple Sclerosis.

Low vitamin D levels may synergize with changing levels of the vitamin D binding protein (DBP) to precipitate in the development and clinical progression of multiple sclerosis (MS). In this study, this hypothesis was explored in groups of Kuwaiti healthy controls and patients with different clinical phenotypes of MS. Fasting serum concentrations of 25-hydroxyvitamin D [25(OH)D] and DBP were measured in 146 healthy controls and 195 patients with MS. The latter were classified according to the duration, type, and onset of the disease and the mode of treatment. Factors such as relapse/remitting, and the use of nutritional supplements were also considered. The DBP levels were significantly lower in the patients than in the controls. This was more evident in newly diagnosed drug-naïve patients than in those patients with more established MS. MS status and severity were negatively impacted by concurrently low levels of 25(OH)D and DBP. This was most clearly expressed in drug-naïve patients and in those with a disease in relapse. It was also established that the 25(OH)D level had a significant positive correlation with the duration of the disease. Lower levels of 25(OH)D and DBP appear to have a synergistic effect on MS status. This was most clearly demonstrated in patients who were newly diagnosed (drug-naïve) and in those patients who were in relapse.

Physical function across the lifespan in adults with multiple sclerosis: An application of the Short Physical Performance Battery.

Multiple sclerosis (MS) typically has its onset in early and middle adulthood, but the population is steadily becoming more dominated by older adults. One of the primary consequences of both MS and aging involves declines of lower extremity physical function and mobility. This cross-sectional study compared physical function status based on Short Physical Performance Battery (SPPB) summary and component scores between persons with MS and healthy controls across 6 age groups. We further examined associations between SPPB summary scores and component scores as well as associations between summary scores and measures of physical and cognitive function for identifying the strongest correlates of SPPB summary scores. The study involved secondary analysis of cross-sectional data from multiple studies. Ambulatory adults with MS who were relapse-free for the last 30 days were recruited, and controls were recruited based on similar criteria to adults with MS except without the diagnosis of MS or relapses. The sample of 345 persons with MS and 174 controls completed questionnaires regarding demographic and clinical information and underwent assessments of physical and cognitive function including the SPPB, 6-Minute Walk, Timed 25-Foot Walk, Symbol Digit Modalities Test, California Verbal Learning Test-Second Edition, and Brief Visuospatial Memory Test-Revised. The two-way ANOVA indicated a main effect of MS status (F(5,500)=34.74, p<.01, η2=0.065), a main effect of age (F(1,500)=3.88, p<.01, η2=0.037), and no MS status by age interaction (F(5,500)=1.20, p=.31, η2=0.012) on SPPB scores. The bivariate correlation analysis indicated that summary SPPB scores were associated with component SPPB scores in the overall samples of persons with MS (rs=0.71 to 0.83) and controls (rs=0.42 to 0.91) as well as within most age groups of MS (rs=0.63 to 0.91) and controls (rs=0.34 to 1.00). The associations between SPPB scores and physical function outcomes were larger in the sample of persons with MS (rs=-0.72 to 0.76) than controls (rs=-0.47 to 0.48). SPPB scores were further significantly associated with scores on cognitive outcomes in persons with MS (rs=0.31 to 0.43), whereas these associations were weaker in controls (rs=0.09 to 0.32). Overall, the associations between SPPB scores and physical function outcomes were stronger than the associations between SPPB scores and cognitive function outcomes. Overall, MS status and aging have additive effects on physical function, and the summary SPPB score may be driven by a specific component within each age group. SPPB scores may be driven more by mobility rather than cognition, and are consistent with cognitive-motor coupling in MS. The novelty of this study provides evidence of worsening physical function based on the application of the SPPB and its scores across the lifespan in persons with MS and controls, and this has important implications particularly given the increasing prevalence of older adults with MS.

The effect of exercise on cognitive function in people with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.

A growing body of research examining the effect of exercise on cognitive function in people with multiple sclerosis (MS), while findings of available studies were conflicting. We aimed to explore the effect of exercise on cognitive function in MS patients. For this systematic review and meta-analysis, we searched PubMed, Web of Science, EBSCO, Cochrane, and Scopus electronic databases, through July 18, 2022. Cochrane risk assessment tool was used to evaluate the methodological quality of the included literature. Twenty-one studies with a total of 23 experimental groups and 21 control groups met the inclusion criteria. There was a significant effect of exercise on improving cognitive function in MS patients, while the effect size was small (Cohen's d = 0.20, 95% CI 0.06-0.34, p < 0.001, I2 = 39.31%). Subgroup analysis showed that exercise significantly improved memory (Cohen's d = 0.17, 95% CI 0.02-0.33, p = 0.03, I2 = 7.59%). In addition, multicomponent training, exercise conducted 8weeks and 10weeks, up to 60min per session, 3 times or more per week, 180min or more per week increased cognitive function significantly. Furthermore, a worse basal MS status (defined by the Expanded Disability Status Scale) and an older age were associated with greater improvement in cognitive function. MS patients are recommended to participate in at least three multicomponent training sessions per week, with each session lasting up to 60min, and the exercise goal of 180min per week can be achieved by increasing the frequency of exercise. Exercise lasting 8 or 10weeks is best for cognitive function improvement. Additionally, a worse basal MS status, or the older the age, the greater effect on cognitive function.

Vitamin D genetic risk scores in multiple sclerosis

BackgroundLow serum 25(OH)D3 (vD) is an environmental risk factor for multiple sclerosis (MS). Lower vD levels during early disease may be associated with long-term disability. Determinants of serum vD levels in healthy individuals include supplementation behaviour and genetic factors. These determinants have been less well studied in people with MS (pwMS).MethodsWe developed a vD-weighted genetic risk score (GRS) and validated this in 373,357 UK Biobank participants without MS. We measured serum 25(OH)D3 and genotyped six vD-associated SNPs (rs12785878, rs10741657, rs17216707, rs10745742, rs8018720, rs2282679) in a cohort of pwMS (n = 315) with age and geographically matched controls (n = 232). We then assessed predictors of serum vD concentration in this cohort.ResultsThe GRS was strongly associated with vD status in the Biobank cohort (p < 2 × 10–16). vD supplementation, having MS, lower BMI, increased age and supplementation dose were associated with higher vD levels (false discovery rate, FDR < 5%). In multivariable models adjusting for supplementation, BMI, age, sex, and MS status, the GRS was strongly associated with vD level (p = 0.004), but not in those who supplemented (p = 0.47).ConclusionsOur findings suggest that vD supplementation is the major determinant of vD level in pwMS, with genetic determinants playing a far smaller role.

Multiple sclerosis diagnosis and phenotype identification by multivariate classification of in vivo frontal cortex metabolite profiles

Multiple sclerosis (MS) is a heterogeneous autoimmune disease for which diagnosis continues to rely on subjective clinical judgment over a battery of tests. Proton magnetic resonance spectroscopy (1H MRS) enables the noninvasive in vivo detection of multiple small-molecule metabolites and is therefore in principle a promising means of gathering information sufficient for multiple sclerosis diagnosis and subtype classification. Here we show that supervised classification using 1H-MRS-visible normal-appearing frontal cortex small-molecule metabolites alone can indeed differentiate individuals with progressive MS from control (held-out validation sensitivity 79% and specificity 68%), as well as between relapsing and progressive MS phenotypes (held-out validation sensitivity 84% and specificity 74%). Post hoc assessment demonstrated the disproportionate contributions of glutamate and glutamine to identifying MS status and phenotype, respectively. Our finding establishes 1H MRS as a viable means of characterizing progressive multiple sclerosis disease status and paves the way for continued refinement of this method as an auxiliary or mainstay of multiple sclerosis diagnostics.

MR imaging in children with transverse myelitis and acquired demyelinating syndromes

BackgroundTransverse myelitis (TM) occurs isolated or within other acquired demyelinating syndromes (ADS) such as neuromyelitis optica spectrum disorders (NMOSD), multiple sclerosis (MS) or myelin oligodendrocyte glycoprotein antibody associated disorders (MOGAD). ObjectiveTo describe and compare clinical and MRI features of children with ADS presenting with TM grouped according to antibody status and diagnosis of MS and NMOSD. Patients and methodsChildren with TM, radiological involvement of the myelon, MOG and aquaporin-4 antibody status were elegible. Results100 children were identified and divided into MOGAD (n=33), NMOSD (n=7), double seronegative TM (n=34), and MS (n=26). MOGAD children had mainly acute disseminated encephalomyelitis + TM/ longitudinally extensive TM (LETM) (42%) or isolated LETM (30%). In MOGAD, LETM was present in more than half of all children (55%) with predominant involvement of only the grey matter (73%). Leptomeningeal enhancement was highly predictive of MOGAD (16/30; p=0.003). In MS patients spinal MRI showed single (50%) or multiple short lesions (46%) with involvement of grey and white matter (68%). Double seronegative children presented with LETM (74%) and brain lesions were less frequent compared to the other groups (30%). ConclusionChildren with ADS presenting with TM reveal important radiological differences such as LETM with predominant involvement of spinal grey matter and leptomeningeal enhancement in MOGAD.

Do device-measured physical activity and sedentary behavior differ by depression symptom status in persons with multiple sclerosis?

BackgroundDepression is highly prevalent and impactful in persons with multiple sclerosis (MS). There are data indicating that the volume of physical activity behavior differs by depression symptom status in MS, yet less is known about the volume of sedentary behavior and its relationship with depression. We further know little about physical activity patterns and sedentary behavior and depression in MS. ObjectivesThis study examined differences in the volume (i.e., minutes/day) and pattern (i.e., bouts/day or bout length) of device-measured sedentary behavior and physical activity as a function of depression symptom status in persons with MS. MethodsThe sample of adults with MS (N=441) completed the Hospital Anxiety and Depression Scale (HADS) and wore a waist-mounted ActiGraph GT3X+ accelerometer during waking hours for 7 days. Participants were divided into subgroups of elevated (n=127) or non-elevated (n=314) depression symptoms based on a cut-point for the HADS scores (i.e., 8+ as indicative of elevated depressive symptoms). We examined the effect of depression group status differences on volume and pattern of sedentary behavior and light (LPA) and moderate-to-vigorous (MVPA) physical activity between subgroups using multivariate analyses of variance (MANOVA) and then multivariate analysis of covariance (MANCOVA) controlling for demographic/clinical variables that differed between the elevated and non-elevated depression groups. ResultsResults of the MANOVA indicated an overall difference between subgroups in the volume, but not pattern, of physical activity and sedentary behavior. The non-elevated depression group had a significantly greater amount of steps/day (mean [M]=4584.3, standard deviation [SD]=2821.3), than the elevated depression group ([M]=3729.6, [SD]=2576.3, F=8.7; p=.003). Results of the MANCOVA revealed there was no statistically significant difference between the elevated and non-elevated depression groups in measures of volume of physical activity, and the difference in steps/day became non-significant F(1,438)= 2.13, p=.146), after controlling for disability, age, disease duration, and educations years. ConclusionsThis study observed no differences in sedentary behavior and physical activity as a function of depression symptom status in persons with MS, yet there was a difference in steps/day initially. Results demonstrated that when disability, age, disease duration, and years of education are included in the MANCOVA, the difference in depression groups is no longer significant. This suggests that steps/day could be an important target of health promotion interventions among persons with MS who have higher disability and elevated depression symptoms.

Seroprevalence of SARS-CoV-2 in a Cohort of Patients with Multiple Sclerosis under Disease-Modifying Therapies.

Background: Disease-modifying therapies (DMTs) used to treat multiple sclerosis (MS) alter the immune system and therefore increase the risk of infection. There is growing concern about the impact of COVID-19 on patients with MS (pwMS), especially those treated with DMTs. Methods: This is a single-center prospective observational study based on data from the Esclerosis Múltiple y COVID-19 (EMCOVID-19) study. Demographic characteristics, MS history, laboratory data and SARS-CoV-2 serology, and symptoms of COVID-19 in pwMS treated with any DTM were extracted. The relationship among demographics, MS status, DMT, and COVID-19 was evaluated. Results: A total of 259 pwMS were included. The administration of interferon was significantly associated with the presence of SARS-CoV-2 antibodies (26.4% vs. 10.7%, p = 0.006). Although patients taking interferon were significantly older (49.1 vs. 43.5, p = 0.003), the association of interferon with the presence of SARS-CoV-2 antibodies was still significant in the multivariate analysis (OR 2.99 (1.38; 6.36), p = 0.006). Conclusions: According to our data, pwMS present a higher risk of COVID-19 infection compared with results obtained from the general population. There is no evidence of a worse COVID-19 outcome in pwMS. DMTs did not significantly change the frequency of COVID-19, except for interferon; however, these findings must be interpreted with caution given the small sample of pwMS taking each DMT.

Quality of life and experience with the national multiple sclerosis society strategic plan priorities for people with multiple sclerosis: Findings from a path analysis.

The National Multiple Sclerosis Society (NMSS) strives to ensure that people affected by multiple sclerosis (MS) can live their best lives. This mission is reflected in the Society's strategic plan, which establishes the roadmap for the Society's continued commitment to a world free of MS. The purpose of this article is to add to the understanding of both the scope and complexity of the impact of MS and MS-related supports on quality of life (QOL). A national sample of people with MS (n = 748) participated in the study by completing validated surveys assessing their QOL, physical and mental health, MS self-efficacy, resilience, participation in NMSS, perceived stress, emotional support, and social roles and activities. A path model was used to examine how the frequently identified MS QOL predictors, including demographic, MS, psychosocial, and physical functional status variables relate to each other and to QOL. The model exhibited reasonable model fit with hypothesized paths being statistically significant and in the hypothesized direction. Findings revealed that the relationships among mental health, demographic factors, overall MS experiences, QOL, NMSS participation, and resonance with the mission of the NMSS are complex, highly nuanced, and yet strongly correlated. More importantly, the study highlights the strong influence of variables that are more readily amenable to change through programmatic and clinical intervention, and active self-management and participation.

Reliability of televisits for patients with mild relapsing\u2013remitting multiple sclerosis in the COVID-19 era

BackgroundEvidence of the cost-effectiveness of telemedicine (TM) for the management of Multiple Sclerosis (MS) has been provided recently. However, some doubts persist about the accuracy of neurological examinations performed remotely.ObjectivesThis study investigated the reliability of neurological evaluations performed through TM in mild MS patients as compared with standard in-person visits.MethodsIn total, 76 patients with relapsing–remitting MS and Expanded Disability Status Scale (EDSS) ≤ 3.5 were consecutively recruited. Of them, 40 patients (52.6%) accepted to undergo both in-person and TM evaluations with independent examiners within 48 h. We alternatively asked patients to assure or not the presence of a caregiver during TM visits. A satisfaction questionnaire was administered to all participants.ResultsThe inter-rater agreement attributed by two independent neurologists during TM visit was high (κ > 0.80) for EDSS and Functional Systems (FS) scores. Moderate agreement between TM and in-person evaluations emerged for pyramidal (κ = 0.57; p < 0.001), brainstem (κ = 0.57; p < 0.001), bowel and bladder (κ = 0.54; p < 0.001) and sensory (κ = 0.51; p < 0.001) FS scores, higher in patients providing the support of a caregiver. A good reliability was reported for EDSS scores computed during remote and in-person visits (ICC = 0.83; 95% CI 0.70–0.91; p < 0.001).ConclusionsDespite the complexity of neurological examination, TM could be useful in monitoring MS patients with low disability.

Evaluating Course Completion, Appropriateness, and Burden in the Understanding Multiple Sclerosis Massive Open Online Course: Cohort Study.

BackgroundMassive open online course (MOOC) research is an emerging field; to date, most research in this area has focused on participant engagement.ObjectiveThe aim of this study is to evaluate both participant engagement and measures of satisfaction, appropriateness, and burden for a MOOC entitled Understanding Multiple Sclerosis (MS) among a cohort of 3518 international course participants.MethodsWe assessed the association of key outcomes with participant education level, MS status, caregiver status, sex, and age using summary statistics, and 2-tailed t tests, and chi-square tests.ResultsOf the 3518 study participants, 928 (26.37%) were people living with MS. Among the 2590 participants not living with MS, 862 (33.28%) identified as formal or informal caregivers. Our key findings were as follows: the course completion rate among study participants was 67.17% (2363/3518); the course was well received, with 96.97% (1502/1549) of participants satisfied, with an appropriate pitch and low burden (a mean of 2.2 hours engagement per week); people living with MS were less likely than those not living with MS to complete the course; and people with a recent diagnosis of MS, caregivers, and participants without a university education were more likely to apply the material by course completion.ConclusionsThe Understanding MS MOOC is fit for purpose; it presents information in a way that is readily understood by course participants and is applicable in their lives.