Relapsing-remitting Type Of Multiple Sclerosis Research Articles

A review of treatment of relapsing-remitting type of multiple sclerosis (RRMS)

Introduction Multiple sclerosis (SM) is the most common chronic inflammatory-demyelinating disease of the Central Nervous System. In its course, a multifocal damage is done to a nervous tissue - myelin sheaths surrounding axons become disintegrated. This process leads to a dysfunction of the electrical impulses passage along nerve fibers which occurs as various symptoms that hinder the functioning of the patients. Aim of the study This review aims to summarize treatment methods of relapsing-remitting type of multiple sclerosis (RRMS). Following information will be presented: groups of medications, mechanism of its action, its most important side effects and its effectiveness. Material and method This review presents the current state of knowledge about relapsing-remitting type of multiple sclerosis (RRMS) treatment - it is based on Pubmed database and was carried out using keywords concerning the issues of multiple sclerosis. Cited articles were selected in order to base on up-to-date investigation results. Summary A wide range of therapeutic options let neurologists treat their patients accurately, but the basic knowledge about each substance should be assimilated to choose the best individual therapy. Patients suffering from multiple sclerosis differ from each other and a personal approach is needed to implement appropriate treatment as soon as possible. Early start allows patients to not to lose their everyday functioning areas, as the neurodegenerative process is stopped at the initial stage. If some changes in brain tissue structure are permanently done, neurologists should know the options of symptomatic treatment to alleviate a patient's suffering.

Clinical features of cognitive dysfunction in patients with relapsing-remitting type of multiple sclerosis

Background. Cognitive dysfunction in patients with multiple sclerosis is quite common, but attention is not always paid to it, since the decline of cognitive functions is often masked by motor, sensory, and visual disorders. Active patient questioning and neurocognitive screening are needed to identify cognitive impairment in patients with multiple sclerosis, even in the early stages of the disease. The goal of the study is to determine the frequency, severity, and clinical features of cognitive impairment in patients with relapsing-remitting multiple sclerosis, taking into account the duration of the disease and the level of disability of the patients. Materials and Methods. 67 patients with a diagnosis of relapsing-remitting multiple sclerosis were examined. All examined patients underwent a thorough neurological, psychometric, and instrumental examination. Patients were divided into 3 groups depending on the duration of the disease: 1st group up to 5 years (24 patients), 2nd group – from 5 to 10 years (22 patients), 3rd group more than 10 years (21 patients). The Symbol Digit Modalities Test (SDMT) and the Montreal Cognitive Function Assessment Scale (MoCA) were used to assess patients’ neuropsychological status. Results. The conducted correlation analysis showed the presence of a probable inverse relationship between the score on the EDSS scale and the scores on the SDMT and MoSA scales (r = –0.61 (p0.05); r = –0.12 (p>0.05) for scores on SDMT and MoCA scales, respectively). We also obtained a probable directly proportional correlation between the test scores on the MoСA scale and SDMT (in 1st group = 0.63, p<0.05, in 2nd group = 0.89, p<0.05, in the 3rd group r = 0.64, p<0.05) in all studied groups, i.e. for all periods of the disease duration. Conclusions. The obtained data of the correlation analysis indicate a relationship between the severity of cognitive impairment according to the test scores, the degree of disability of the patients, and the duration of the disease.

FREQUENCY AND PREDICTORS OF LHERMITTE PHENOMENON IN MULTIPLE SCLEROSIS (2-YEAR PROSPECTIVE STUDY)

Neuropathic pain in multiple sclerosis can manifest itself in the form of the Lhermitte phenomenon, short-term unpleasant sensations along the spine that occur when the head is bent. The purpose of this study is to investigate the factors that act as predictors of the Lhermitte phenomenon and their frequency in multiple sclerosis. 308 patients with multiple sclerosis were involved in the study, 258 of them agreed to follow-up, of them there were 67 men (26.0%) and 191 women (74.0%), aged 21 to 60 years. Out of the total cases, 187 (72.5%) patient had the relapsing-remitting type of multiple sclerosis, 2 (0.8%) had primary progressive type, and 69 (26.7%) showed secondary progressive type. Among the 258 patients who initially agreed to participate in the study at the Centre, 18 (7.0%) individuals discontinued their involvement during the first year, and 13 (5.0%) individuals prematurely withdrew from the study during the second year due to various reasons.
 Among the characteristics of multiple sclerosis, the age of the patient when diagnosed, the duration and the type of course, and the overall assessment of neurological deficit were determined. Psychopathological and cognitive states, socio-demographic factors, and comorbid pathology were assessed using appropriate scales. Statistical research methods were employed to analyze the collected data.
 The results indicate that the risk of developing the Lhermitte phenomenon remains relatively consistent over a two-year period: 2.5% in the first year and 2.3% in the second year. Pain associated with the Lhermitte phenomenon is most commonly experienced in the neck (63.6%), followed by the upper back (54.6%), lower back (72.7%), and least frequently in the upper limbs (18.2%) and lower limbs (36.4%). The Lhermitte phenomenon typically spreads to two or three affected areas of the body in 33.3% and 48.2% of cases, respectively. The most commonly used descriptors for the Lhermitte phenomenon are "shooting" (72.7%), "tingling" (18.2%), and "crawling ants" (9.1%).
 No significant differences in social, demographic, neuropsychological, and neurocognitive characteristics were observed between patients with and without Lhermitte phenomenon. According to the results of univariate Cox regression analysis, we has found that during the 2-year period, an increase in the duration of the disease for each subsequent year is associated with a decrease in the relative risk of Lhermitte phenomenon by 1.15 times (1.02-1.29, p=0.02). In patients with multiple sclerosis, the average risk of experiencing the Lhermitte phenomenon remains consistent at approximately 2.3-2.5% per year throughout the course of the disease.
 Patients who have a short history of multiple sclerosis are a risk group for the occurrence of the Lhermitte phenomenon. It is quite difficult to explain the regularity we have identified, for its clarification a detailed study of a special additional study is necessary. But, in any case, from a practical point of view, patients in the early stages of multiple sclerosis can be considered as a group of increased risk for the occurrence of the Lhermitte phenomenon.

UCHL1, besides leptin and fibronectin, also could be a sensitive marker of the relapsing–remitting type of multiple sclerosis

Research on the markers of immunoregulatory response in multiple sclerosis (MS) is still of great importance. The aim of our study was the evaluation of leptin, fibronectin, and UCHL1 concentrations as potential biomarkers of a relapsing–remitting type of MS (RRMS). Surface Plasmon Resonance Imaging (SPRI) biosensors were used for the evaluation of proteins concentrations in 100 RRMS patients and 46 healthy volunteers. Plasma leptin, fibronectin, and UCHL1 concentrations were significantly higher in RRMS patients compared to the control group (p < 0.001, respectively). UCHL1 concentration evaluation revealed the highest diagnostic sensitivity (100%) and negative predictive value (100%) in differentiating MS patients from healthy individuals. There was no significant difference in the UCHL1 concentrations depending on the patient’s sex, the presence of relapse within the last 24 months, and the EDSS value (p > 0.05, respectively). In RRMS patients UCHL1 concentration positively correlated with fibronectin levels (r = 0.3928; p < 0.001). In the current cohort of patients plasma UCHL1 concentration was independent of the time of MS relapse and the severity of neurological symptoms. Thus current study may indicate that plasma UCHL1, besides leptin and fibronectin, also could be a promising high-sensitive potential biomarker of relapsing–remitting type of MS. However, these results should be validated with a larger group of patients, taking into account neuroimaging and cerebrospinal fluid analysis data, and by comparing them to patients with other neurological diseases as a control group.

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

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

Effectiveness of Anti-Cluster of Differentiation 20 as a Disease-Modifying Therapy in Multiple Sclerosis Across Its Different Phenotypes at the University Hospital of Caen.

BackgroundMultiple sclerosis is a chronic, demyelinating disorder occurring primarily as two main forms of relapsing-remitting multiple sclerosis (RRMS) found predominantly in women, and primary progressive multiple sclerosis (PPMS) occurring predominantly in men. In this retrospective single-center study, we aimed to explore the effects of anti-cluster of differentiation (CD)20 treatment for both relapsing-remitting and primary progressive forms of multiple sclerosis (MS) in a population-based cohort treated at the university hospital. MethodologyThe diagnostic factors being assessed were forms of multiple sclerosis (MS), age at first relapse, whereas therapeutic factors were age at first disease-modifying therapy (DMT), age at starting anti-CD20, reason to switch to anti-CD20 and the duration of anti-CD20 treatment. Primary outcomes measured were number of relapses and progression in disability as measured by the Expanded Disability Status Scale, while secondary outcomes measures being assessed number of cerebral lesions on MRI and level of IgG at the beginning and end of the 12-month treatment.ResultsTreatment with anti-CD20 demonstrated a reduction in number of relapses 12 months after treatment, no change in the progression of disability in RRMS type, but an increase in PPMS type. No change was observed in cerebral MRI lesions at the end of treatment after 12 months. A statistically significant reduction in serum IgG value was observed after 12 months from the start of treatment, where only one out of 26 (3.8%) patients developed hypogammaglobulinemia with IgG less than 6 g/L but none developed hypogammaglobulinemia of less than 5 g/L.ConclusionAnti-CD20 antibodies as disease-modifying therapy can profoundly impact the course and progression of MS in both its forms if utilized at an earlier stage in patients and therefore greatly improve the quality of life in patients living with multiple sclerosis.

Clinical and neurophysiological patterns of impairments to emotion attention and empathy in multiple sclerosis.

Patients suffering from multiple sclerosis experience various cognitive and affective impairments, resulting in a negative impact on social behavior and personal independence to differing degrees. According to these often clinically subtle but conflicting cognitive-affective impairments, recordings of these socially relevant issues are still of demand to stratifying clinical and social support in a sophisticated way. Therefore, we studied specific cognitive and affective capacities in eleven patients with a predominant relapsing-remitting type of multiple sclerosis by applying paradigms of event-related potentials and a well-selected neuropsychological test protocol. Thus far, distinct cognitive disturbances of executive and attentional domains and the Wechsler Memory Test's four memory indices were found in multiple sclerosis patients. Concerning affective domains, patients showed discrete impairments of affect discrimination and affected naming as proved by specific testing (Tuebinger Affect Battery). Neurophysiologically, event-related potentials recordings in multiple sclerosis patients, were associated with decreased implicit emotion processing to cues of different emotion arousal at the early processing stage depending on attentional capacities and alterations of implicit emotion modulation at late processing stages. These clinical neurophysiological and neuropsychological data were correlated in part to quantitative magnetic resonance imaging brain lesions. Summarizing our data, our data indicate certain neurocognitive and neuroaffective dysfunctions in patients with multiple sclerosis, thus highlighting the validity of sensitive recording of less apparent neurologic disturbances in multiple sclerosis for optimizing the individual care management in patients.

The effect of aerobic exercise on Neurofilament light chain and glial Fibrillary acidic protein level in patients with relapsing remitting type multiple sclerosis

Background Multiple sclerosis (MS) is an autoimmune and neurodegenerative disease of the central nervous system in which disease activity can be monitored with some biomarkers. The aim of our study was to investigate serum Glial Fibrillary Acidic Protein (GFAP) and Neurofilament Light Chain (NFL) in relapsing-remitting MS (RRMS) patients after the aerobic exercise.Methods A total of 38 participants with RRMS (Expanded Disability Status Scale: 1.0 – 4.5) were randomized to a study group (3 × /week for 8 weeks at 60 – 70 % of maximal aerobic capacity (VO2max) + home exercises) and a control group (were given home exercises programme 3 times a week for 8 week). Serum NFL and GFAP levels were analyzed using enzyme-linked immunosorbent analysis method before and at the end of 8 weeks.Results: NFL and GFAP levels were statistically lower in the study group at the end of the study than before the study. In the control group, no significant changes were observed in serum NFL and GFAP levels. ΔNFL levels were significantly higher in the study group than control group.Conclusion It was shown, for the first time that serum GFAP and NFL levels (%10 and % 32, respectively) in RRMS patients decreased after aerobic exercise. Our study is important in terms of investigating the effects of aerobic exercise in individuals with RRMS and elucidating the underlying measurable biomarkers. The significant reduction of NFL and GFAP, which have an important role in the pathology associated with nervous system damage in MS, with aerobic exercise may be promising in understanding the regulation of disease activity in MS patients.

The influence of personality traits and coping strategies on the quality of life of patients with relapsing-remitting type of multiple sclerosis

Background/Aim. Multiple sclerosis (MS) is a chronic, progressive autoimmune disease of the central nervous system, that can reduce quality of life. Personality traits and coping strategies are significant factors in interpersonal variance regarding quality of life. The aim of this study was to examine relations between personality traits and coping strategies in patients with relapsing-remitting (RR) type of MS, and to examine relations of personality traits, coping strategies, and quality of life in patients with RR type of MS. Methods. This observational cross-sectional study included 66 patients (34 female, 32 male) with clinically definitive MS, based on the McDonald criteria. The following clinical scales were used to examine personality traits, coping strategies, and quality of life: Revised NEO Personality Inventory (NEO-PI-R), Coping Strategies Inventory (CSI), and Multiple Sclerosis Quality of Life (MSQOsL-54). Results. The average age of the patients was 41.6 ? 7.1 years. The Pearson?s correlation coefficient showed that with regards to coping strategies, the only positive correlation existed with neuroticism (r = 0.502). The correlation was negative between neuroticism and physical (r = -0.284, p &lt; 0.05) and mental health (r = - 0.289, p &lt; 0.05), as well as between passive coping strategies and mental health (r = -0.358, p &lt; 0.05), meaning that the patients with a higher level of neuroticism, and who relied on passive coping strategies, had a lower quality of life. Conclusion: This research showed the importance of personality traits and coping strategy assessment in patients with RR-type MS. Participation in cognitive-behavioral therapy, with emphasis on active coping strategies, can improve the quality of life in patients with MS.

FEATURES OF LOCAL IMMUNE REACTIONS IN SKIN WITH UNDERLYING SOFT TISSUES IN PATIENTS WITH MULTIPLE SCLEROSIS

The aim of the study is to identify the peculiarities of local immune reactions in the skin with underlying soft tissues in patients with different variants of the multiple sclerosis' course. Material and methods: The study included 35 patients, hospitalized in the neurological department of the Communal Nonprofit Enterprise of Kharkiv Regional Council «Regional Clinical Hospital» with the established diagnosis of multiple sclerosis. The patients were divided into three study groups, based on different variants of this pathology's course. Group 1 included 16 patients with relapsing-remitting type of multiple sclerosis. Group 2 included 11 patients with a secondary-progressive type of multiple sclerosis course. Group 3 included 8 patients with a primary progressive type of multiple sclerosis. Patients of all groups underwent a biopsy of the skin with underlying soft tissues in the lower third of the inner surface of the right lower leg. The comparison group (group 4) was represented by 10 autopsy cases (7 women and 3 men) conducted on the basis of the pathological anatomy department of the Communal Nonprofit Enterprise of Kharkiv Regional Council «Regional Clinical Hospital». There were no signs of the nervous system's pathology during life in all cases of this group. The cause of death was a dislocation of the brain stem or hematocephaly and the main disease was arteriovenous malformation or congenital aneurysm of the cerebral vessels. The material for the morphological study was skin with underlying soft tissues. Microspecimens stained with histological and immunohistochemical methods were studied, using an Olympus BX-41 microscope. The obtained data were statistically processed, using Statistica 6.0 and Microsoft Excel 2003 programs. Results: Survey microscopy showed that in groups 1-3 in comparison with group 4 immune cell infiltrations were more pronounced in the skin with underlying hypodermis. Significantly larger mean values of the absolute number of CD 3-, CD 20- and CD 68-positive cells were revealed immunohistochemically in groups 1-3 compared with group 4. Thus, it was found in patients with multiple sclerosis the activation of T-cell immunity, B-cell immunity and macrophage system with the development of an immune imbalance between them. Our results allow us to think about the participation of all the above immune cells in the pathogenesis of multiple sclerosis development. The revealed disorders of local immune reactions in the skin with underlying hypodermis in patients with multiple sclerosis are less pronounced in the remitting-recurrent variant of the course of the disease, more pronounced in the secondary-progressing and, especially, primary-progressing variants. Conclusions: In patients with multiple sclerosis in the skin with underlying hypodermis activation of T-cell immunity, B-cell immunity and the macrophage system is observed with the development of an immune imbalance between them, characterized by the prevalence of the absolute number of macrophages among all immune cells. Less pronounced violations of local immune reactions in the skin with underlying hypodermis are noted in remitting-relapsing variant of multiple sclerosis course, more pronounced in a secondary-progressing and, especially, primary-progressing variants.

Odnos između mineralne gustine kostiju I kratkoročne terapije visokim dozama kortikosteroida kod pacijenata sa multiplom sklerozom

Introduction: Previous studies were reported that osteoporosis and bone fracture occurs more frequently among Multiple sclerosis patients than the general population. The aim of this study to investigate the effects of total doses of short-term, high dose corticosteroids on bone mineral density and other affecting factors for bone mineral density in Relapsing-remitting type Multiple Sclerosis patients. Material and methods: Fifty-four patients (37 females, 17 males) with relapsing-remitting type Multiple Sclerosis who filled the diagnostic criteria according to McDonald criteria were included in the study. Femoral and lumbar bone mineral density were measured using dual energy X-ray absorptiometry. Expanded Disability Status Scale, disease duration, number of attacks, cumulative corticosteroid dose were recorded. Serum calcium, potassium, phosphorus, vitamin D, parathormone and osteocalcin levels were measured. Patients were divided into two groups: patients who have received at least 20 g intravenous metilprednisolone (Group I) and patients who have received less than 20 g intravenous metilprednisolone (Group II). We analysed association between cumulative corticosteroid dose and each parameters. Results: Osteopenia was present in 46.2% and osteoporosis in 5.5% of the study population according to femoral neck bone mineral density. Femoral bone mineral density was significantly lower among patients. There was no correlation between cumulative dose of corticosteroid and bone mineral density. Conclusion: Low bone mineral density and osteoporosis are common in Multiple sclerosis patients. High-dose steroid therapy is not be the primary cause of osteoporosis in patients with multiple sclerosis.

Features of the visual analyzer change in the primary progressive type of multiple sclerosis

The article deals with the features of visual disturbances in patient with primary progressive type of multiple sclerosis (MS). On the basis of clinical observations, it was found that, in contrast to the relapsing-remitting type of MS, the visual disturbances are accompanied by a rapidly progressive decrease in visual and oculomotor functions. The process of development of descending partial atrophy of the optic nerve with primary progressive type of MS is symmetric, in contrast to the relapsing-remitting type of the course of MS and is determined by the increase in the severity of brain structures atrophy according to MRI.

The physical and occupational activity of patients with multiple sclerosis depending on the form of clinical disease

&lt;br/&gt;&lt;b&gt;Introduction:&lt;/b&gt; The progressive nature of multiple sclerosis (MS) is associated with numerous neurological deficits, leading gradually to deteriorating health and to disability. &lt;br/&gt;&lt;b&gt;Purpose:&lt;/b&gt; The aim of this study was a subjective assessment of the physical and occupational activity of individuals with MS depending on the clinical form of the disease. &lt;br/&gt;&lt;b&gt;Materials and methods:&lt;/b&gt; We used the original to conduct the research, with 28 closed questions. The study was carried out from December 1, 2018, to January 31, 2019, following approval by the Bioethics Committee of the Medical University of Bialystok, among persons belonging to the Association for Helping Sick People for Multiple Sclerosis in Białystok and patients of the Neurology Department of the University Clinical Hospital in Bialystok. The study sample comprised 50 people diagnosed with MS, 41 women and 9 men. &lt;br/&gt;&lt;b&gt;Results:&lt;/b&gt; The most frequently occurring clinical form of MS was relapsing-remitting (68%). In this form, most participants had good physical fitness (44%). In those with the progressive-recurrent form (50%), very poor physical fitness was subjectively noted. Of those with the relapsing-remitting type of MS, 50% were professionally active, while none of the participants with the progressive-recurrent form were. Both the physical and occupational activities of MS patients were frequently limited by fatigue, balance disturbances, and movement difficulties. Fatigue was the most common symptom for most individuals with MS (82%). &lt;br/&gt;&lt;b&gt;Conclusion:&lt;/b&gt; MS has a significant impact on both the physical activity and occupational functioning of patients. In the clinical form of MS, relapsing-remitting, patients’ physical fitness was better.

Effects of Acupuncture on Gait of Patients with Multiple Sclerosis

Multiple sclerosis is considered a complex and heterogeneous disease. Approximately 85% of patients with multiple sclerosis indicate impaired gait as one of the major limitations in their daily life. Acupuncture studies found a reduction of spasticity and improvement of fatigue and imbalance in patients with multiple sclerosis, but there is a lack of studies regarding gait. We designed a study of acupuncture treatment, according to the Heidelberg model of Traditional Chinese Medicine (TCM), to investigate if acupuncture can be a useful therapeutic strategy in patients with gait impairment in multiple sclerosis of relapsing-remitting type. The sample consisted of 20 individuals with diagnosis of multiple sclerosis of relapsing-remitting type. Gait impairment was evaluated by the 25-foot walk test. The results showed differences in time to walk 25 feet following true acupuncture. In contrast, there was no difference in time to walk 25 feet following sham acupuncture. When using true acupuncture, 95% of cases showed an improvement in 25-foot walk test, compared with 45% when sham acupuncture was done. Our study protocol provides evidence that acupuncture treatment can be an attractive option for patients with multiple sclerosis, with gait impairment.

1457 – Multiple sclerosis, psychosis and the use of interferon beta 1a: a rare clinical case

Introduction Multiple Sclerosis (MS) is an inflammatory demyelinating disease that affects the white matter of the central nervous system. It’s more frequent in women. The disease has clinical heterogeneity, but initial neuropsychiatric symptoms are common (60%). If these symptoms are not present at the onset, they will certainly develop throughout the course of the disease. Objectives To describe the case of a central hospital psychiatric inpatient and it’s comparison with the international available literature. Methods Retrospective analysis of the clinical process. Case report Woman, 51 years old, functioning until 3 months ago. Hospitalized for behavioral changes with heteroaggressiveness (verbal and physical) and psychomotor agitation. History of relapsing-remitting type MS with 10 years of evolution, treated with 44μg Interferon beta 1a (subcutaneous). To the mental examination she presented with uncooperative and suspicious attitude, dysphoric and delusional mood, changes in thought content with auto-referential/persecutory delusions and delusional interpretations. The extended analytical study, CE-CT and MRI were not altered, as were the Internal Medicine and Neurology evaluations. There was complete regression of symptoms after Interferon beta 1a suspension and maintenance of low-dose neuroleptic. Conclusion This is a rare case of psychotic disorder secondary to the use of interferon beta 1a in patients with MS. The rarity of this case is well patented as there is no published report of psychosis secondary to use of subcutaneous formulation, although it is known that psychiatric symptoms may occur in less than 1% of patients using this drug.

Incidence and prevalence of multiple sclerosis in southeastern Iran

BackgroundBased on data available, Iran is located in a low risk area for multiple sclerosis (MS). The objective of the current study is to determine the age and sex adjusted prevalence and incidence of MS in southeastern Iran. MethodsThis cross-sectional case register study was conducted from January to August 2010. Considering that MS affects people aged between 16 and 50 years, we intended to find the incidence and prevalence of MS during this age range. Since all cases in this area are referred to our university hospital for confirmation of diagnosis, misdiagnosis is rare. Population data, based on the censuses carried out in 1996 and 2006, were obtained from the Iranian Bureau of Statistics to determine the number of people at risk. ResultsTotally 206 patients were identified according to the McDonald criteria. In 2009 the age-adjusted prevalence and incidence rates of MS for 16–50 year-old adults were 13.96 and 2.67 per 100,000 persons, respectively. Based on those values; the female to male ratio was 2.18. Between 2006 and 2009, the incidence rates increased 2.4 and 2.7 times in women and men, respectively. In 2009, the prevalence rates among the age ranges of <15, 16–35, 36–50 and ≥51 years were 1.44, 14.34, 12.24 and 1.45 per 100,000 persons, respectively, and the relapsing-remitting type of MS was the most prevalent form (65.8%). ConclusionAccording to the Kurtzke geographical distribution, the authors conclude that the prevalence of MS in southeastern Iran is in the intermediate range, and the incidence rate is showing a faster growth rate, compared to previous years.

The economic burden of Medicare-eligible patients by multiple sclerosis type

Objective Although the global rate of multiple sclerosis (MS) is low, a few studies have documented high costs. Costs are highly variable depending on MS stage. This study was designed to assess the economic burden of Medicare-eligible patients by MS type in the United States using a claims-based classification algorithm to examine cost variation by disease stage. Methods A sample of 2003 to 2006 Medicare patients was selected. Cases were classified as pre-existing progressive MS or pre-existing relapsing-remitting MS (RRMS); the latter were further subdivided into relapsing, remitting, or stable. Results The sample had 5044 MS subjects, of whom 34.4% had prevalent progressive MS and 65.6% had prevalent RRMS. There were many chronic, comorbid conditions. The mean all-cause Medicare expenditures (not including self-administered medications) per person-year for MS in 2006 were $23,630 for prevalent progressive patients and $5887 for prevalent RRMS patients. Within the RRMS type, Medicare expenditures per person per month in 2006 were $1418 for relapsing patients, $608 for remitting patients, and $331 for stable patients. Conclusions There are substantial cost advantages to Medicare for keeping RRMS patients in a stable health state and in keeping them from advancing in disability severity. The overall cost advantage would be diminished by the large cost burden of comorbidity, which would likely remain fixed with improved MS therapies.

Being in- or out-of-sync: Couples' adaptation to change in multiple sclerosis

Purpose. To examine how couples adapt to the challenges of multiple sclerosis (MS) and to identify possible risk factors for relational stress.Method. Semi-structured interviews were conducted with eight couples to explore how participants defined and identified the strengths and challenges in their relationship, negotiated role changes and received external support. Conceptual frameworks on how families adapt to chronic illness guided within and across case analyses. We identified patterns in the couples' current responses to the demands and stressors of MS.Results. Two patterns of adaptation to MS were identified as being ‘in-sync’ or ‘out-of-sync’. Characteristics of the four couples currently in-sync included having a relapsing-remitting type of MS, which proceeded at a pace that enabled both partners to maintain their social roles and identity, and a collaborative problem solving style. The four couples currently out-of-sync had a rapid progression of MS, loss of employment before retirement age, differences in personal styles that shifted from being complementary to oppositional in the face of increased demands and struggles with parenting adolescent children.Conclusions. Clinicians can use these data to assess possible relational strain in couples with MS and identify families who might benefit from referrals to family therapy or other relational support.

Clinical characteristics of multiple sclerosis and associated optic neuritis in Korean children

To study the clinical characteristics of multiple sclerosis and associated optic neuritis in Korean children. A retrospective analysis was performed on 10 patients with an onset of multiple sclerosis before age 16. Information on sex, age of onset, clinical course, laboratory findings, and clinical characteristics of optic neuritis was obtained. The mean age at presentation was 7.31 +/- 2.99 years, and the mean duration of observation was 36.2 +/- 26.1 months. No female predilection (50%) was observed. The disease presented as relapsing-remitting type multiple sclerosis in all patients and transited to secondary progressive type in two cases (20%). No oligoclonal bands were found in any patient. Optic neuritis occurred in eight patients (80%); five (62.5%) of these had optic neuritis at the first multiple sclerosis attack, with all five manifesting bilateral simultaneous optic neuritis. Visual acuity recovered to > or =20/40 in 8 of 15 eyes (53.3%), but in 2 eyes (13.3%) visual acuity remained at < or =20/200. In the patients with optic neuritis, the patients who showed optic neuritis at initial presentation had a worse visual prognosis (p = 0.030, Mann-Whitney U-test). In Korean children with multiple sclerosis, age of onset was younger than reported in other countries, and there was no female predominance. The prognosis for good visual acuity was worse in patients who initially presented with optic neuritis.

The effects of interferon‐β on interleukin‐10 in multiple sclerosis patients

The incidence of the neuropathological lesions and the severity of the clinical symptoms in multiple sclerosis (MS) are correlated with the amount of the transferred autoreactive T cells. The balance between the T helper 1 (Th1) and T helper 2 (Th2) cytokine phenotypes may affect the activity of the disease in MS patients. Interleukin-10 (IL-10) is a cytokine secreted by Th2 cells. Thus, it has been thought that inducing IL-10 may have therapeutic effects in the treatment of MS patients. In this study, in order determine whether different types of prophylaxis change the secretion of IL-10, we measured the levels of IL-10 in relapsing-remitting type multiple sclerosis (RRMS) patients receiving interferon-beta 1b (IFN-beta 1b) or azathioprine (AZA). Our study consisted of RRMS patients (n=45) and healthy subjects (n=15) as control group. Patients were categorized into three groups as those receiving either IFN-beta 1b or AZA and those not receiving prophylaxis. Each group was compared with the control group. Serum IL-10 levels were determined using ELISA method. IL-10 levels of those receiving IFN-beta 1b were found to be significantly higher than that of other groups. These results support that the ability of inducing anti-inflammatory cytokine IL-10 plays a role in the clinical advantage of IFN-beta 1b in MS treatment.