Risk Factor For Multiple Sclerosis Research Articles

A novel cognitive-behavioral stress management method for multiple sclerosis. A brief report of an observational study

ABSTRACTObjectives: Psychological stress is an important risk factor for multiple sclerosis (MS) onset, relapse, neurological symptoms and psychosocial adjustment to the disease. Mounting evidence suggests that stress management could halt the disease progression and improve patients’ wellbeing. The aim of this study was to investigate the effectiveness of a novel cognitive-behavioral stress management technique (called Pythagorean Self-Awareness Intervention – PSAI) routinely used in our clinics in patients with MS.Methods: In this observational study, 148 MS patients receiving PSAI for 8-weeks were compared patients who followed only usual care. Measurements included cognitive function, psychological distress and physical fatigue. Propensity score (PS) methods (given the observational design) and linear mixed models were employed to address study’s endpoints.Results: A total of 128 (86.5%) of MS patients fulfilled the PS criteria for analyses (72 in the PSAI group and 56 in the control group). Patients of tertiary education, longer disease duration, higher cognitive score and psychological distress were more likely to choose to participate in the PSAI group. PSAI patients were found with statistical significant beneficial changes in cognitive speed processing, verbal memory, stress, anxiety, depression and fatigue. Based on the numbers-needed-to-treat of the weighted data, PSAI was particularly effective in improving cognitive speed processing (NNT = 10) and stress (NNT = 12).Discussion: PSAI can benefit cognitive function and psychological distress in MS patients. Future studies should expand these results in randomized trials and by using longer follow-up and MS activity-related endpoints.Abbreviations: BICAMS: Brief International Cognitive Assessment for Multiple Sclerosis BVMT-R: Brief Visuospatial Memory Test Revised CVLT: California Verbal Learning Test DASS: Depression Anxiety Stress Scale EDSS: Expanded Disability Status Scale MS: Multiple Sclerosis NNT: Numbers Needed to Treat PS: Propensity Score PSAI: Pythagorean Self-Awareness Intervention RR: Relapsing Remitting SDMT: Symbol Digits Modalities Test VAS-PF: Visual Analogue Scale Physical Fatigue

Season of Birth as a Risk Factor for Multiple Sclerosis in Egypt

Season of Birth as a Risk Factor for Multiple Sclerosis in Egypt

Stress-full life events and multiple sclerosis: A population-based incident case-control study

AimWhile sizeable evidence regarding the association between stressful-life events and multiple sclerosis (MS) disease activity (clinical and/or radiological) was previously documented, their relation to MS risk is controversial. We aimed to investigate the possible association of stressful-life events and multiple sclerosis risk after adjustment for relevant confounders in an Iranian population. MethodThis was a population-based incident case-control study that recruited 547 MS cases and 1057 healthy controls between August 2013 and February 2015, Tehran. The patients were identified using the Iranian MS Society based on 2010 McDonald criteria. We used standard random digit dialing protocol for control selection. Logistic regression model was applied to estimate the odds ratios (95% CI) adjusted for physical activity, age, gender, tobacco smoking, waterpipe smoking and passive smoking. ResultsWhile total life events number was not associated with risk of MS, homeless periods OR 3.85 (1.65–8.90), p = 0.002 as well as divorce OR 2.11 (1.24–3.58), p = 0.005 increased the risk of MS. However, marriage OR 0.59 (0.41–0.86), p = 0.006, death of ones' dear OR 0.60 (0.44–0.82), p = 0.002 and joblessness OR 0.61 (0.41–0.91) reduced the risk of MS. ConclusionWe could not detect a statistically significant role for the total stressful life event during the last 3 years and MS diagnosis. However, there is some evidence confirming the possible role of some individual life events, i.e. divorce and periods of homelessness as potential risk factors for MS and conversely, having married as a protective factor in MS onset.

MS Risk in Immigrants in the McDonald Era: A Population-Based Study in Ontario, Canada

Background: Migration studies may provide insights into environmental determinants of multiple sclerosis (MS) and whether a critical window for exposure exists. We aimed to determine risk factors for MS in immigrants and compare MS risk in immigrants versus long-term residents in Ontario, Canada. Methods: We applied a validated algorithm to linked, population-based immigration and health claims data to identify incident MS cases in immigrants and long term-residents between 1994 and 2016. We conducted two multivariable Cox proportional hazards regression analyses including one limited to the immigrant cohort assessing potential risk factors for developing MS; and one comparing MS risk between immigrants and matched long-term residents (1:3 match). Results: We identified 2,304,302 immigrants for the immigrant-only analysis, of whom 1,526 (0.066%) developed MS. Younger age at migration, female sex, greater co-morbidity burden, lower neighbourhood income, and time since landing were associated with increased MS risk. Risk was greatest in those <15 years old at landing (Ref: <15 years; 16-30 years: HR 0.73, 95%CI: 0.63-0.85; 31-45 years: HR 0.55, 95%CI: 0.47-0.64). Region/country of origin was also associated with MS risk. Immigrants from the Middle East (HR 1.22, 95%CI: 1.06-1.40) were at greater risk than immigrants from Western nations; all other regions had lower MS risk (p<.0001). The matched analysis included 2,207,751 immigrants and 6,362,169 long-term residents. Immigrants were less likely to develop MS than long-term residents (p<.0001), although this lower risk was attenuated with longer residence in Canada. Interpretation: MS incidence in immigrants to Ontario, Canada varied widely by region of origin, with greatest risk seen in those from the Middle East. Although MS risk declined with increasing age at arrival, considerable risk was sustained with migration after age 15, suggesting that environmental exposures into adulthood contribute to MS risk. Funding Statement: This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Declaration of Interests: DR has received research support from the Consortium of Multiple Sclerosis Centers and from the Multiple Sclerosis Society of Canada. She has served as a consultant for Sanofi Aventis, Biogen, Novartis, EMD Serono, and Roche. RAM receives research funding from the Canadian Institutes of Health Research, Multiple Sclerosis Society of Canada, National Multiple Sclerosis Society, Research Manitoba, the Consortium of MS Centers, Crohn’s and Colitis Canada, and the Waugh Family Chair in Multiple Sclerosis. CJM has received research funding from the Canadian Institutes of Health Research, P.S.I. Foundation, MS Society of Canada, Consortium of MS Centers, MS Scientific Research Foundation, Ontario Ministry of Health and Long-Term Care-Health System Research Fund, Canadian Frailty Network, Partners for Canadian Consortium on Neurodegeneration in Aging, Network for Aging Research-University of Waterloo. She is supported by a University Research Chair at the University of Waterloo. KT receives a research scholar award from the Department of Family and Community Medicine at the University of Toronto. Ethics Approval Statement: This study was approved by the research ethics boards at St. Michael’s Hospital in Toronto, Ontario, Canada. Informed consent by participants was not required.

X linked Charcot-Marie-Tooth disease and multiple sclerosis: emerging evidence for an association

ObjectiveX linked Charcot-Marie-Tooth disease (CMTX) is a hereditary neuropathy caused by mutations in GJB1 coding for connexin-32, a gap junction protein expressed in Schwann cells, but also found in oligodendrocytes....

Retinal vascular density in multiple sclerosis: a 1-year follow-up.

Vascular pathology is increasingly acknowledged as a risk factor for multiple sclerosis (MS). Vascular density (VD) is reduced in the eyes of patients with MS on optical coherence tomography (OCT) angiography. We performed a 1-year prospective study to estimate VD variations over time and possible clinical correlates. A total of 50 patients with MS underwent spectral domain-OCT and OCT angiography at baseline and after 1-year follow-up. Mixed-effect linear regression models were used to assess variations of each OCT measure and its relation to treatment and clinical outcomes. We observed an increase in parafovea VD (coefficient, 1.147; 95% confidence interval, 0.081-2.214; P = 0.035). Reduction in parafovea VD was associated with increase in Expanded Disability Status Scale score (coefficient, -0.969; 95% confidence interval, -1.732/-0.207; P = 0.013). Retinal VD can improve over time in MS, particularly in patients experiencing disease stability. Longer follow-up, inclusion of early MS cases and combination with conventional markers of MS severity (i.e. brain atrophy) are needed to better define VD as a potential new biomarker.

On the Nature of Evidence and 'Proving' Causality: Smoking and Lung Cancer vs. Sun Exposure, Vitamin D and Multiple Sclerosis.

If environmental exposures are shown to cause an adverse health outcome, reducing exposure should reduce the disease risk. Links between exposures and outcomes are typically based on ‘associations’ derived from observational studies, and causality may not be clear. Randomized controlled trials to ‘prove’ causality are often not feasible or ethical. Here the history of evidence that tobacco smoking causes lung cancer—from observational studies—is compared to that of low sun exposure and/or low vitamin D status as causal risk factors for the autoimmune disease, multiple sclerosis (MS). Evidence derives from in vitro and animal studies, as well as ecological, case-control and cohort studies, in order of increasing strength. For smoking and lung cancer, the associations are strong, consistent, and biologically plausible—the evidence is coherent or ‘in harmony’. For low sun exposure/vitamin D as risk factors for MS, the evidence is weaker, with smaller effect sizes, but coherent across a range of sources of evidence, and biologically plausible. The association is less direct—smoking is directly toxic and carcinogenic to the lung, but sun exposure/vitamin D modulate the immune system, which in turn may reduce the risk of immune attack on self-proteins in the central nervous system. Opinion about whether there is sufficient evidence to conclude that low sun exposure/vitamin D increase the risk of multiple sclerosis, is divided. General public health advice to receive sufficient sun exposure to avoid vitamin D deficiency (<50 nmol/L) should also ensure any benefits for multiple sclerosis, but must be tempered against the risk of skin cancers.

Sex-Specific Gene-by-Vitamin D Interactions Regulate Susceptibility to Central Nervous System Autoimmunity.

Vitamin D3 (VitD) insufficiency is postulated to represent a major modifiable risk factor for multiple sclerosis (MS). While low VitD levels strongly correlate with higher MS risk in white populations, this is not the case for other ethnic groups, suggesting the existence of a genetic component. Moreover, VitD supplementation studies in MS so far have not shown a consistent benefit. We sought to determine whether direct manipulation of VitD levels modulates central nervous system autoimmune disease in a sex-by-genotype-dependent manner. To this end, we used a dietary model of VitD modulation, together with the autoimmune animal model of MS, experimental autoimmune encephalomyelitis (EAE). To assess the impact of genotype-by-VitD interactions on EAE susceptibility, we utilized a chromosome substitution (consomic) mouse model that incorporates the genetic diversity of wild-derived PWD/PhJ mice. High VitD was protective in EAE in female, but not male C57BL/6J (B6) mice, and had no effect in EAE-resistant PWD/PhJ (PWD) mice. EAE protection was accompanied by sex- and genotype-specific suppression of proinflammatory transcriptional programs in CD4 T effector cells, but not CD4 regulatory T cells. Decreased expression of proinflammatory genes was observed with high VitD in female CD4 T effector cells, specifically implicating a key role of MHC class II genes, interferon gamma, and Th1 cell-mediated neuroinflammation. In consomic strains, effects of VitD on EAE were also sex- and genotype dependent, whereby high VitD: (1) was protective, (2) had no effect, and (3) unexpectedly had disease-exacerbating effects. Systemic levels of 25(OH)D differed across consomic strains, with higher levels associated with EAE protection only in females. Analysis of expression of key known VitD metabolism genes between B6 and PWD mice revealed that their expression is genetically determined and sex specific and implicated Cyp27b1 and Vdr as candidate genes responsible for differential EAE responses to VitD modulation. Taken together, our results support the observation that the association between VitD status and MS susceptibility is genotype dependent and suggest that the outcome of VitD status in MS is determined by gene-by-sex interactions.

Incorporating machine learning approaches to assess putative environmental risk factors for multiple sclerosis

BackgroundMultiple sclerosis (MS) incidence has increased recently, particularly in women, suggesting a possible role of one or more environmental exposures in MS risk. The study objective was to determine if animal, dietary, recreational, or occupational exposures are associated with MS risk. MethodsLeast absolute shrinkage and selection operator (LASSO) regression was used to identify a subset of exposures with potential relevance to disease in a large population-based (Kaiser Permanente Northern California [KPNC]) case-control study. Variables with non-zero coefficients were analyzed in matched conditional logistic regression analyses, adjusted for established environmental risk factors and socioeconomic status (if relevant in univariate screening),± genetic risk factors, in the KPNC cohort and, for purposes of replication, separately in the Swedish Epidemiological Investigation of MS cohort. These variables were also assessed in models stratified by HLA-DRB1*15:01 status since interactions between risk factors and that haplotype have been described. ResultsThere was a suggestive association of pesticide exposure with having MS among men, but only in those who were positive for HLA-DRB1*15:01 (OR pooled = 3.11, 95% CI 0.87, 11.16, p = 0.08). ConclusionsWhile this finding requires confirmation, it is interesting given the association between pesticide exposure and other neurological diseases. The study also demonstrates the application of LASSO to identify environmental exposures with reduced multiple statistical testing penalty. Machine learning approaches may be useful for future investigations of concomitant MS risk or prognostic factors.

DNA methylation as a mediator of HLA-DRB1*15:01 and a protective variant in multiple sclerosis

The human leukocyte antigen (HLA) haplotype DRB1*15:01 is the major risk factor for multiple sclerosis (MS). Here, we find that DRB1*15:01 is hypomethylated and predominantly expressed in monocytes among carriers of DRB1*15:01. A differentially methylated region (DMR) encompassing HLA-DRB1 exon 2 is particularly affected and displays methylation-sensitive regulatory properties in vitro. Causal inference and Mendelian randomization provide evidence that HLA variants mediate risk for MS via changes in the HLA-DRB1 DMR that modify HLA-DRB1 expression. Meta-analysis of 14,259 cases and 171,347 controls confirms that these variants confer risk from DRB1*15:01 and also identifies a protective variant (rs9267649, p < 3.32 × 10−8, odds ratio = 0.86) after conditioning for all MS-associated variants in the region. rs9267649 is associated with increased DNA methylation at the HLA-DRB1 DMR and reduced expression of HLA-DRB1, suggesting a modulation of the DRB1*15:01 effect. Our integrative approach provides insights into the molecular mechanisms of MS susceptibility and suggests putative therapeutic strategies targeting a methylation-mediated regulation of the major risk gene.

Environmental exposures and the risk of multiple sclerosis in Saudi Arabia

BackgroundMultiple sclerosis (MS) is the most common non-traumatic condition that leads to disability among young individuals. It is associated with demyelination, inflammation, and neurodegeneration within the central nervous system. Information on risk factors of multiple sclerosis is crucial for the prevention and control of the disease. The aim of this study was to determine risk factors of MS among adults in Saudi Arabia.MethodsA matched multicenter case-control study, including 307 MS patients and 307 healthy controls, was conducted in MS clinics and wards in 3 main cities of Saudi Arabia. Age, gender, and hospital were matched. Information on demographics, family history of MS, past medical and family history, sun exposure at different age periods, tobacco use, diet, consanguinity, and coffee consumption was obtained from self-administered questionnaires. ORs and 95% confidence intervals (CIs) were calculated. A conditional logistic regression model was used to control for potential confounding factors.ResultsThe conditional logistic regression adjusted for age and gender showed that being the first child in the family (Adjusted Odds Ratio (AOR) 1.68, 95% CI: 1.03–2.74), having a family history of MS (AOR 5.83, 95% CI: 2.83–12), eating fast food ≥5 times weekly (AOR 2.05, 95% CI: 1.03–4.08), and having had measles (AOR 3.77, 95% CI: 2.05–6.96), were independently associated with an increased risk of MS.In contrast, eating ≥5 servings of fruit per week (AOR 0.25, 95% CI: 0.16–0.38), drinking coffee daily (AOR 0.46, 95% CI: 0.31–0.68), and having a high level of sun exposure at the primary school level and university level (AOR 0.57, 95% CI: 0.38–0.85 and AOR 0.48, 95% CI: 0.30–0.76, respectively) were independently associated with a decreased risk of MS.ConclusionsOur study suggested that high levels of sun exposure during primary school and university, consumption of fruits and drinking coffee protect against MS. In contrast, eating fast food was associated with an increased risk of the disease. Encouraging outdoor activity and healthy diets in school, especially for females, is highly recommended.

Onset Symptoms, Tobacco Smoking, and Progressive-Onset Phenotype Are Associated With a Delayed Onset of Multiple Sclerosis, and Marijuana Use With an Earlier Onset.

Background: Age at symptom onset (ASO) is a prognostic factor that could affect the accrual of disability in multiple sclerosis (MS) patients. Some factors are known to influence the risk of multiple sclerosis (MS), but their influence on the ASO is less well-investigated.Objective: Examine the associations between known or emerging MS risk factors and ASO.Methods: This was a multicenter study, incident cases (n = 279) with first clinical diagnosis of demyelinating event aged 18–59 years recruited at four Australian centres (latitudes 27°-43°S), from 1 November 2003 to 31 December 2006. Environmental/behavioral variables and initial symptoms were recorded at baseline interview. Linear regression was used to assess the association between risk factors and ASO.Results: Five factors were significantly associated with ASO: a history of tobacco smoking was associated with 3.05-years later ASO (p = 0.002); a history of marijuana use was associated with 6.03-years earlier ASO (p < 0.001); progressive-onset cases had 5.61-years later ASO (p = 0.001); an initial presentation of bowel & bladder and cerebral dysfunctional were associated with 3.39 (p = 0.017) and 4.37-years (p = 0.006) later ASO, respectively. Other factors, including sex, offspring number, latitude of study site, history of infectious mononucleosis, HLA-DR15 & HLA-A2 genotype, 25(OH)D levels, and ultraviolet radiation exposure were not associated with ASO. Including all five significant variables into one model explained 12% of the total variance in ASO.Conclusion: We found a novel association between a history of tobacco smoking and later onset, whereas marijuana use was associated with earlier onset. Behavioral factors seem important drivers of MS onset timing although much of the variance remains unexplained.

Effects of vitamin D on axonal damage during de- and remyelination in the cuprizone model

Vitamin D deficiency is a risk factor for multiple sclerosis and associated with higher disease activity. The aim of this study was to investigate the effects of cholecalciferol and calcitriol on axonal damage during de- and remyelination in the cuprizone model. We found significantly less reduction of neurofilament immunopositive axons in the high vs. low cholecalciferol group, while high dose calcitriol, given during remyelination, did not influence axonal regeneration. Our results indicate that high dose vitamin D could protect against axonal loss in an experimental model for demyelination, if given before and during the demyelination.

Editors' note: 25-Hydroxyvitamin D deficiency and risk of MS among women in the Finnish Maternity Cohort

Dr. Braillon raises several concerns regarding the methodology and conclusions found in the study “25-Hydroxyvitamin D (25[OH]D) deficiency and risk of MS among women in the Finnish Maternity Cohort,” including the jump from association to causality and the lack of data related to smoking history. He likens the current state of 25(OH)D and multiple sclerosis (MS) research to that of 25(OH)D and cancer, in which, he states, there is a continuous flow of flawed positive studies despite several large negative trials. Authors Munger et al. maintain that there is enough affirmative evidence to conclude that low vitamin D level is a risk factor for MS and even to support causality. The authors agree that the lack of smoking data in the Finnish Maternity Cohort was a limitation of their study, but when they excluded women with positive serum cotinine (a biomarker for nicotine metabolism), their results were unchanged. Dr. Braillon raises several concerns regarding the methodology and conclusions found in the study “25-Hydroxyvitamin D (25[OH]D) deficiency and risk of MS among women in the Finnish Maternity Cohort,” including the jump from association to causality and the lack of data related to smoking history. He likens the current state of 25(OH)D and multiple sclerosis (MS) research to that of 25(OH)D and cancer, in which, he states, there is a continuous flow of flawed positive studies despite several large negative trials.

Association between high fat consumption, myelin loss, and mitochondrial dynamics

We recently demonstrated that high dietary fat (HFD) consumption results in a dramatic loss of myelinating cells and their progenitors in the adult CNS (Yoon et al., 2016). However, the mechanism(s) by which HFD drives dysmyelination are unknown. Since epidemiological studies indicate that metabolic syndrome is a key risk factor for multiple sclerosis (MS), a better understanding of how HFD contributes to oligodendrocyte loss and the capacity for myelin regeneration has the potential to highlight new treatment targets.In mice fed HFD, we found significant decreases in vertical activity by 4 wk and significant changes in ambulatory and stereotypy movements by 12 wk in the Open Field Test. HFD‐fed mice also spent less time in the center of the field as opposed to the perimeter, indicating an anxious phenotype. Mitochondrial isolated from the spinal cord of mice consuming HFD for 4 wk had significantly higher state 3 and state 4 respiration as determined by high‐resolution respirometry. However, by 12 wk, state 4 mitochondrial respiration was significantly less in the HFD group. Targeted LC‐LC‐mass spectroscopy approaches demonstrated that Citric Acid Cycle intermediates are also depleted in the spinal cord of mice consuming HFD for 12 wk compared to controls. Changes in genes related to mitochondrial morphology, quality control processes, and oxidative stress response were also found. In addition, there were significantly fewer Olig2+ cells and increased signs of lipid peroxidation products (4‐Hydroxynonenal‐immunoreactivity) in the corpus callosum of HFD consuming mice compared to those fed a regular diet.Supporting in vivo findings that oligodendrocytes are reduced in the spinal cord of mice consuming HFD, we observed increased mitochondrial fragmentation and a reduced oxygen consumption rate in oligodendrocyte precursors cultured with palmitic acid. Astrocytes however, significantly increased oxygen consumption following exposure to palmitic acid.Together, these findings suggest that changes in the adult spinal cord in response to HFD consumption creates an environment that is less conducive to neural repair by impacting mitochondria function and morphology and impairing oligodendrocyte function. To determine any impact of HFD on myelin regeneration, studies are ongoing to examine myelin regeneration using a murine model of Cuprizone‐mediated demyelination. Neurobehavioral assessments to date reveal significant interactions between HFD and myelin injury and repair. Understanding the cellular environment in response to dietary factors such as HFD consumption can help to guide care for individuals with MS and other conditions in which myelin loss plays a pathological role and has potential to identify new targets for intervention.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

A Comparison between Vitamin D Level in Multiple Sclerosis and Non-Multiple Sclerosis Patients

Background: Multiple sclerosis (MS) is a demyelinating disease of the nervous system. Its etiology is still not well understood. Lately, attention has been increased for the relation between MS and vitamin D deficiency. Objectives: This study aims to compare vitamin D level between MS and non-MS patients looking for any significant difference. Methods: This is a retrospective cohort study held at a tertiary hospital. It compares vitamin D level between MS and non-MS patients in the period from 2010 to 2017. Vitamin D level 50nmoI/L was labelled as normal. The means of the vitamin D level were compared using the independent t-test with a p-value of 0.05 for significance level. Results: Out of the 96 MS patients, only 72 patients had their vitamin D level measured. (51 females, mean age 34.62). In comparison with 97 non-MS patients were included in the study (65 females, mean age 37.32). Vitamin D level mean values in the MS and non-MS patients were calculated as 38.63 and 44.09 respectively. Comparing the means showed a p-value of 0.266. Conclusion: Despite that vitamin D deficiency is known as one of the risk factors for MS, with the high prevalence of vitamin D deficiency in this region, the development of MS can be attributed to more relevant contributing factors and further studies regarding MS risk factors for our population are needed to be sought.

Lifestyle factors and multiple sclerosis: A population-based incident case-control study

ObjectiveAlthough low sun exposure, low vitamin D, and smoking are established risk factor of multiple sclerosis (MS), there is less evidence on the role of the other lifestyle factors. We examined the association of sun exposure, physical activity, drug abuse, and alcohol intake with MS. Materials and methodsThis was population-based incident case-control study in Iran with 547 incident cases and 1057 general population controls (7/8/2013–17/2/2015). Logistic regression was used to analyse the data. ResultsHigher sun exposure during adolescence was associated with a reduced risk of MS, both in summer (test for trend p < 0.001) and winter (P < 0.001), while physical activity was not associated with MS (test for trend p = 0.712). Lifetime drug abuse (OR for ever use 2.93 (1.83–4.70)), with a dose-response association (test for trend p < 0.001), and alcohol intake (OR for ever use 1.49 (1.05–2.12)) was significantly associated with an increased risk of MS. ConclusionIn a middle-eastern setting, we found that sun exposure during adolescence, drug abuse, and alcohol use were all associated with MS. Increasing sun exposure and reducing drug abuse and the use of alcohol through educational programs is likely to reduce the rate of MS.

Prevalence of and risk factors for cognitive impairment in patients with relapsing-remitting multiple sclerosis: Multi-center, controlled trial

BackgroundCognitive impairment (CI) is a common problem in multiple sclerosis (MS), may occur either in early or late phase of the disease, and impairs quality of life. ObjectivesThis study aimed to determine the prevalence of CI and related risk factors in relapsing-remitting MS (RRMS) patients in Turkey. MethodsThe present cross-sectional, multi-center, and nationally representative study included RRMS patients. Sociodemographic characteristics, cognitive functions and additional outcomes were compared between patients with and without CI. ResultsThe analyses included 487 RRMS patients. According to the BRB-N battery results, CI prevalence was 53.7%. There was a negative significant correlation of BRB-N subtests with age, disease duration, and EDSS and MSNQ-patient rated scores. On the logistic regression analysis, increased age, living in village/rural area, high income level, and high EDSS score were significant increasing risk factors in the development of CI. ConclusionsThis is the first national cognitive data obtained from MS in Turkey, which is a country between Europe and Asia and thus has characteristics of both continents. The similarity of the results of the present study obtained from Turkey to the Western-based data indicates that CI is universal in MS and the main factors affecting CI have not changed.

Neuritis óptica en pediatría: experiencia en 27 años y protocolo de actuación

Introduction and objectiveIn this article, we present our experience on optic neuritis (ON) and provide a diagnostic/therapeutic protocol, intended to rule out other aetiologies (particularly infection), and a fact sheet for parents. Material and methodsWe conducted a descriptive, retrospective study of patients with ON over a 27-year period (1990-2017). A review of the available scientific evidence was performed in order to draft the protocol and fact sheet. ResultsOur neuropaediatrics department has assessed 20,744 patients in the last 27 years, of whom 14 were diagnosed with ON: 8 had isolated ON, 1 had multiple sclerosis (MS), 1 had clinically isolated syndrome (CIS), 3 had acute disseminated encephalomyelitis, and 1 had isolated ON and a history of acute disseminated encephalomyelitis one year previously. Patients’ age range was 4-13 years; 50% were boys. Eight patients were aged over 10: 7 had isolated ON and 1 had MS. Nine patients had bilateral ON, and 3 had retrobulbar ON. MRI results were normal in 7 patients and showed involvement of the optic nerve only in 2 patients and optic nerve involvement + central nervous system demyelination in 5. Thirteen patients received corticosteroids. One patient had been vaccinated against meningococcus-C the previous month. Progression was favourable, except in the patient with MS. A management protocol and fact sheet are provided. ConclusionsON usually has a favourable clinical course. In children aged older than 10 years with risk factors for MS or optic neuromyelitis (hyperintensity on brain MRI, oligoclonal bands, anti-NMO antibody positivity, ON recurrence), the initiation of immunomodulatory treatment should be agreed with the neurology department. The protocol is useful for diagnostic decision-making, follow-up, and treatment of this rare disease with potentially major repercussions. The use of protocols and fact sheets is important.

Complementary and Alternative Medicine Usage by Multiple Sclerosis Patients: Results from a Prospective Clinical Study.

To investigate the factors associated with complementary and alternative medicine (CAM) usage by multiple sclerosis (MS) patients. Design, Setting/Location: Single-center, prospective clinical study at an academic MS center in the northeastern United States. This study included CAM data from 524 MS patients and 304 healthy controls (HC) enrolled in a prospective study of clinical, neuroimaging, and environmental risk factors in MS at an academic MS Center. Clinical, neuroimaging, and disease-modifying treatment data were obtained. In addition, data on usage of CAM modalities, including acupuncture, aromatherapy, Ayurveda, Chinese herbal medicine, chiropractor, electromagnetic therapy, homeopathy, hypnosis, massage, naturopathy, Qi gong, Reiki, therapeutic touch, and bee stings were collected in an in-person interview. The percentages of HC reporting usage of any CAM (32%) was similar to that in MS patients after diagnosis (30.5%). The usage of any CAM was higher in MS patients after MS diagnosis compared to before MS diagnosis (p < 0.001). The three most frequently used CAM for MS patients after MS diagnosis and HC were chiropractor, massage, and acupuncture. The most frequent reasons for CAM use were MS symptom relief, back problems, and pain. In multivariate analysis, female gender, higher education level, MS disease course, and not currently on disease-modifying therapies (DMT) treatment status were associated with CAM usage. Gender, education level, DMT treatment status, and MS disease course are associated with CAM usage in MS patients. Ever-CAM usage patterns in MS patients are similar to those in HC.