Severity Of Multiple Sclerosis Symptoms Research Articles

Stress indicators in minorities with multiple sclerosis.

Black Americans with multiple sclerosis (MS) experience higher levels of disease-related disability compared to White Americans (Marrie etal., 2006). Comorbidities such as depression and anxiety, which are underdiagnosed and undertreated in this population, negatively impact quality of life and treatment outcomes for people living with multiple sclerosis (plwMS) (D'Alisa etal., 2006; Marrie etal., 2009; Stepleman etal., 2014). Acts of discrimination toward Black Americans is associated with stress, which is a contributing factor for depression (Carter,2017; Nadimpalli, 2015; Williams and Mohammed, 2009). This study compared the severity of multiple sclerosis symptoms amongst Black Americans and White Americans, and whether worsened MS symptoms in Black Americans are associated with increased experiences of discrimination. Data was analyzed from 143 plwMS in the Stress Indicators in Minorities with Multiple Sclerosis (SiMMS) study. Using the Mann-Whitney U test, significant differences were found on the NIH Emotional Distress - Anxiety measure (U=1466.500, p=0.045) and NIH Sleep Disturbance measure (U=1467.000, p=0.044) between the Black participant and the White participant groups. Discrimination was significantly correlated with both NIH Emotional Distress - Anxiety (r=0.677, p < .001) and NIH Sleep Disturbance (r=0.446, p=.007) in Black MS individuals. Additionally, several physiological condition and psychological outcome measures were correlated with the NIH Emotional Distress - Anxiety and NIH Sleep Disturbance measures. This study contributes to literature highlighting the negative impacts of discrimination and race related stress on the physical and mental health of Black Americans.

Self-efficacy trajectories of individuals newly diagnosed with multiple sclerosis.

The first year following a new multiple sclerosis (MS) diagnosis may be a critical time for individuals as they learn to manage their disease. Effective self-management of MS likely requires healthy self-efficacy levels, yet little is known about self-efficacy in the postdiagnosis period. This study aims to improve our understanding of self-efficacy in individuals newly diagnosed with MS by examining self-efficacy trajectories and identifying patient characteristics associated with trajectories in the first postdiagnosis year. Newly diagnosed adults with MS/clinically isolated syndrome (CIS) (N = 230) completed a battery of questionnaires, including the University of Washington Self-Efficacy Scale, at 1, 2, 3, 6, 9, and 12 months, postdiagnosis. Sankey diagrams characterized self-efficacy trajectories and a multiple regression model tested patient characteristics as predictors of self-efficacy change scores. Mean self-efficacy T-scores ranged from 50.79 to 52.04 (SD = 9.40 and 10.12, respectively) across the postdiagnosis year. MS diagnosis (vs. CIS), higher disability levels, and higher MS symptom severity were associated with lower self-efficacy levels at baseline. Baseline symptom severity predicted change in self-efficacy levels from baseline to month 12 (B = -0.05, p = .030). Self-efficacy remains relatively stable in the first year following a MS diagnosis, though high symptom severity is associated with decreased self-efficacy at 12-months postdiagnosis. Clinical characteristics (e.g., MS diagnosis, disability level) also appear to play a role in setting the course of self-efficacy in this postdiagnosis year. Timely interventions that enhance self-efficacy and/or improve certain clinical characteristics may promote healthy self-management of MS that carries forward in disease course. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Anti-Caspr-conjugated gold nanoparticles emergence as a novel approach in the treatment of EAE animal model.

Multiple sclerosis (MS) is a chronic autoimmune disorder of central nervous system which is increasing worldwide. Although immunosuppressive agents are used for the treatment of MS disease, nevertheless the lack of non-toxic and efficient therapeutic method is perceptible. Hence, this study aims to evaluate the effect of Contactin-associated protein (Caspr) antibody-, poly ethylene glycol (PEG)- and exosome combined gold nanoparticles (GNPs) in comparison to Glatiramer acetate as a selective treatment of MS disease in the experimental autoimmune encephalomyelitis (EAE) mouse model. EAE was induced in female C57BL/6 mice and 25-day treatment with anti-Caspr-, PEG- and exosome combined GNPs was evaluated. Histopathological examination of spinal cord, regulatory T cells as well as inflammatory pathway including IFN-ɣ and IL-17 and mir-326 were investigated. The results showed the severity of MS symptoms was significantly decreased in all treated groups. Histological examination of the spinal cord indicated the reduced demyelination and immune cell infiltration. Besides, regulatory T cells were significantly increased following all treatments. Remarkably, the cytokine levels of IFN-ɣ and IL-17 as well as mir-326 is altered in treated groups. Taken together, the obtained findings demonstrate that the administration of anti-Caspr-, PEG- and exosome combined GNPs can be considered a potential treatment in MS disease.

Gains in multiple sclerosis knowledge following completion of the Understanding Multiple Sclerosis online course are maintained six months after course completion

BackgroundParticipation in the Understanding Multiple Sclerosis (MS) massive open online course (MOOC) significantly increases MS knowledge in both people living with MS (pwMS) and not living with MS at course completion. We also observed modest increases in health literacy, self-efficacy, and quality of life. ObjectiveTo examine long-term participant knowledge retention over a six-month follow-up period following completion of the Understanding MS MOOC, a freely available six-week online health education intervention. MethodsWe conducted pre-post analysis using paired t-tests to determine the effect of the course on MS knowledge (primary outcome), health literacy, resilience, self-efficacy, quality of life, and MS symptom severity among pwMS and not living with MS. We assessed the effect of participant characteristics on the change in MS knowledge using linear regression. ResultsBoth pwMS (N=139) and not living with MS (N=164) significantly increased MS knowledge over the follow-up period. PwMS also showed increases in health literacy and self-efficacy. These increases were largely maintained from the post-course assessment. There was no effect on resilience or quality of life. ConclusionsThe Understanding MS MOOC significantly increased MS knowledge and this knowledge was maintained six months after course completion. Our results reinforce the importance and potential impact of health education in the MS community.

Superior effects of natalizumab versus other DMTs on patient-reported outcomes in people with multiple sclerosis

BackgroundLittle is known about the comparative effectiveness of multiple sclerosis (MS) disease-modifying therapies (DMTs) on patient-reported outcomes in MS. We compared the effects of natalizumab to other DMTs in relation...

Evaluating the impact of the Understanding Multiple Sclerosis online course on participant MS knowledge, health literacy, resilience, self-efficacy, quality of life, and MS symptom severity

BackgroundLittle is known about the impact of online health education on multiple sclerosis (MS)-related knowledge and other health outcomes in the MS community. ObjectivesTo estimate the impact of participating in a massive open online course (MOOC) about MS on course completer MS-related knowledge, health literacy (HL), self-efficacy, resilience, quality of life, and MS symptom severity. MethodsIn this cohort study, using a single group pre-test/post-test design (n=560), we examined the effects of MOOC participation on MS-related knowledge and other outcomes using a paired t-test. We used regression and structural equation modelling to examine the association between participant characteristics, changes in other outcomes, and changes in MS-related knowledge. ResultsWe found significant increases in MS-related knowledge for people living with MS (PwMS) (+2.13 points, p<0.001) and those without MS (+5.16 points, p<0.001), with larger effect sizes for those with higher educational levels. Among PwMS, there were also significant increases in seven HL subscales and self-efficacy, but no increase in resilience, MS symptoms severity or quality of life. Among people without MS, there were increases in two HL subscales and quality of life, but no increase in resilience or self-efficacy. Changes in MS-related knowledge were not associated with sex or changes in other study outcomes. ConclusionsThere was a significant increase in MS-related knowledge, which was unrelated to the changes in the other study outcomes, both for PwMS and for those not living with MS. Outcome-specific health educational interventions may be needed to effect change in other health outcomes.

931Work productivity trajectories in a representative sample of Australians living with multiple sclerosis- group-based modelling

Abstract Background Studies have documented loss of work capacity and work productivity loss in multiple sclerosis (MS). Little is known about the longitudinal trajectories of work productivity in MS. Objectives To explore trajectories of work productivity in people living with multiple sclerosis (PwMS) and examine the baseline factors linked with assignment to the trajectories group. Methods Study participants were from the Australian MS Longitudinal Study (AMSLS) from 2015 to 2018 who were employed with ≥2 datapoints (n = 1205). We used group-based trajectory modelling to identify unique work productivity trajectories in PwMS. Multinomial logistic regression was used to assess associations with the work productivity trajectories. Results We identified three distinct trajectories of work productivity: ‘moderately worsened’ (16.7%) with a mean work productivity of 47.6% in 2015, ‘mildly worsened’ (50.1%) with a mean work productivity of 86.3% in 2015 and ‘normal’ (33.2%) with a mean work productivity of 99.7% in 2015. On multivariable analysis, the relative probability of being in moderately or mildly worsened work productivity trajectory were higher for baseline factors such as higher education level, longer disease duration, higher disability score, and high MS symptom severity. For example, the relative probability of being in ‘moderately worsened’ rather than ‘normal’ work productivity trajectory increased by 94% (RRR:1.94 ; 95% confidence interval:1.68 - 2.25) for each unit increase in ‘fatigue and cognitive symptoms’ cluster. Conclusion Education level, disability and MS symptom severity increased the probability of following low work productivity trajectory. Key messages Work productivity interventions should target MS symptom severity and disability reduction.

Association between MS-related knowledge, health literacy, self-efficacy, resilience, and quality of life in a large cohort of MS community members: A cross-sectional study

Background: Despite their potential importance, little is known about the associations between multiple sclerosis (MS) knowledge and other outcomes among MS community members. Objective: To examine the relationships between MS-related knowledge, health literacy, self-efficacy, resilience, quality of life (QoL), and MS symptom severity in a cohort of MS community members. Methods: In this cross-sectional study (N = 1993), we assessed a cohort of Understanding MS online course enrolees using means and standard deviations. We evaluated the impact of participant characteristics on outcomes using chi square, t-tests, and linear regression models, and assessed associations between outcomes using Pearson correlation. Results: We found that the total cohort had moderate to high scores on all outcomes. People living with MS had an above average mean MS knowledge score, but below average QoL, resilience, and health literacy scores. The association of MS status with outcome scores was supported by linear regression models. MS knowledge was not correlated with any other outcome for either people living with MS or without MS. Conclusions: MS knowledge was not associated with the other study outcomes, suggesting that educational interventions that solely aim to increase knowledge may be ineffective in improving health-related outcomes within the MS community.

Work productivity trajectories of Australians living with multiple sclerosis: A group-based modelling approach

BackgroundStudies have documented reduced work capacity and work productivity loss in multiple sclerosis (MS). Little is known about the longitudinal trajectories of work productivity in MS. ObjectivesTo examine trajectories of work productivity in people living with multiple sclerosis (PwMS) and the factors associated with the trajectories. MethodsStudy participants were employed participants of the Australian MS Longitudinal Study (AMSLS) followed from 2015 to 2019 with at least two repeated measures (n=2121). We used group-based trajectory modelling to identify unique work productivity trajectories in PwMS. ResultsWe identified three distinct trajectories of work productivity: ‘moderately reduced’ (17.0% of participants) with a mean work productivity level of 47.6% in 2015 (slope -0.97% per year (p= 0.22)), ‘mildly reduced’ (46.7%) with a mean work productivity of 86.3% in 2015 (slope 0.70% per year (p=0.12)), and ‘full’ (36.3%) with a mean work productivity of 99.7% in 2015 (slope 0.29% per year (p= 0.30)). Higher education level, higher disability, and higher MS symptom severity are associated with increased probability of being in a worse work productivity trajectory. ConclusionWe identified three distinct work productivity trajectories in PwMS which were stable over time and differentiated by their baseline level of work productivity.

Exercise modulates the levels of growth inhibitor genes before and after multiple sclerosis

Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system. The animal model of MS, experimental autoimmune encephalomyelitis (EAE), is commonly used for studies of human inflammatory demyelinating diseases and has been shown to be suitable for studying the effects of exercise on MS pathophysiology. The present study was conducted to determine the impact of forced swimming and voluntary running wheel exercises before and after the induction of EAE on expression of Nogo-A, NgR, and ROCK genes in the brain tissue. A total of 96 C57BL/6 mice were randomly divided into two groups, namely exercises before (EXb, n = 48) and after (EXa, n = 48) induction of EAE. Each group was divided into four subgroups: Forced Swimming + EAE (n = 12), Voluntary Running Wheel + EAE (n = 12), NoEX-EAE (n = 12), and Control group (n = 12). Animals performed either swimming exercise for 30 min per day or running wheel for one hour per day, five days per week for four weeks. Results of Luxal Fast Blue (LFB) staining demonstrated that the degree of demyelination was significantly less in the experimental exercised compared to NoEX-EAE groups (P < .05). Amazingly, both modes of exercise reduced the severity of MS symptoms in mice exposed to swimming and wheel running, evaluated as body weight, clinical scores, degree of demyelination, and gene expressions, regardless of whether the exercise was performed before or after EAE induction.

The frequency of bowel and bladder problems in multiple sclerosis and its relation to fatigue: A single centre experience.

BackgroundBowel and bladder problems affect more than 50% of people with Multiple Sclerosis (MS). These problems have a large impact on quality of life and place a significant burden on health systems.ObjectivesThis study aimed to ascertain the frequency of bladder and bowel problems in a select Australian MS cohort and to investigate the relationships between level of disability, bladder and bowel problems, and fatigue.MethodsQuestionnaires on the nature and severity of MS symptoms were distributed to clients attending an Australian MS centre. Log-binomial regression and multiple linear regression models were used to investigate relationships between disability, fatigue, and bladder and bowel problems.Results and conclusionsOf 167 questionnaires distributed, 136 were completed. Bladder problems were reported by 87 (74.4%) respondents, whilst 66 (48.9%) experienced functional constipation and 43 (31.9%) faecal incontinence. This frequency in our select Australian MS population is similar to that reported globally. There was a significant correlation between level of disability and: bladder problems (p = 0.015), faecal incontinence (p = 0.001), fatigue (p<0.001) and constipation (p = 0.016, relative risk: 1.16). Further investigation into the causal relationships between various MS symptoms may be beneficial in the development of novel therapeutic strategies for people with MS.

Comorbidities are prevalent and detrimental for employment outcomes in people of working age with multiple sclerosis

Background: More work is needed to understand the burden of comorbidities in people with multiple sclerosis (MS). Objective: To assess prevalence of 30 comorbidities and impacts of comorbidities on employment outcomes in a working-aged MS cohort. Methods: Participants were from the Australian MS Longitudinal Study (n = 929). Information on specific comorbidity was obtained (whether or not each was present, doctor-diagnosed, limited their activities and being treated). Results: Comorbidities most frequently reported to limit activities were osteoarthritis (51%), migraines (40%), anxiety (33%), depression (29%) and allergies (18%). Mean MS-related work productivity loss in past 4 weeks was 1.3 days for those without comorbidities and 2.5 days for those with any comorbidity. The annual population costs of work productivity loss were highest for people with depression, allergies, anxiety, migraines and osteoarthritis. Higher number of comorbidities was associated with more work productivity loss and a higher likelihood of not working. These associations were substantially reduced after adjustment for MS symptom severity. Conclusions: Comorbidities substantially impact employment outcomes and these effects were mainly mediated through MS symptom severity. This suggests that optimal and simultaneous management of comorbidities may be a viable strategy to reduce MS symptom severity, which in turn could improve employment outcomes.

Gold nanoparticles and polyethylene glycol alleviate clinical symptoms and alter cytokine secretion in a mouse model of experimental autoimmune encephalomyelitis.

Gold nanoparticles (GNPs) are attractive nanoparticles with unique electronic and optical properties in the nanotechnology field and are widely used in various biomedical fields. Studies have shown that these particles also exhibit antioxidant and anti-inflammatory properties. On the other hand, polyethylene glycol (PEG) that used to stabilize GNPs also exhibits antioxidant and anti-inflammatory properties due to their membrane resealing properties. The aim of this study was to evaluate the ameliorative effect of GNPs and PEG in experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis (MS). EAE was induced in female C57BL/6 mice with injection of an emulsion of myelin oligodendrocyte glycoprotein (MOG35-55) peptide and Freund's adjuvant. GNPs measuring 25 nm were prepared, and their size was determined using transmission electron microscopy (TEM), then intraperitoneal injection of GNPs and PEG (MW 1500; 30% w/v) was initiated after immunization and continued until the day 27 postimmunization (13 injections in total). The EAE clinical scores and body weights were evaluated. We analyzed cental nervous system's cell infiltration and demyelinated lesions using hematoxylin and eosin and luxol fast blue staining, respectively. Also, interleukin-23 and interleukin-27 were examined using the ELISA technique. The severity of MS symptoms was significantly decreased in the treated groups with GNPs and PEG. Histological examination of the spinal cord showed that the number and severity of cells' infiltration and demyelinated lesions decreased significantly, and also the cytokine levels of IL-23 and IL-27 altered in treated groups. These results show that GNPs and PEG ameliorate the clinical course of EAE in mice. Our findings demonstrate proof of principle for potential of GNPs and PEG as novel agents for therapeutic approaches in the alleviated clinical symptoms of MS. © 2019 IUBMB Life, 71(9):1313-1321, 2019.

Adherence to Disease-Modifying Therapies for Multiple Sclerosis.

Multiple sclerosis (MS) is a neurological degenerative chronic condition without cure. However, long-term disease-modifying therapies (DMTs) help reduce the severity of MS symptoms. Adherence to DMTs is key to their success. Several studies have analyzed what makes patients adherent to their DMTs. As new DMTs have entered the market, few studies have analyzed factors of adherence using all currently available DMTs. To analyze different factors of adherence to DMTs for MS, in particular how the type of DMT affects adherence. This retrospective cohort study used enrollment and claims data from an upper Midwest health plan in the United States between 2011 and 2013. Patients entered the study if they had any medical claim with an MS diagnosis and used only 1 DMT during the study time frame. Medication possession ratios (MPRs) were computed as the fraction of days with medication supplied during the year; patients with MPRs of 0.8 or higher were considered adherent. Multivariate probit models with patient-specific random effects were estimated, with controls for demographic characteristics, type of DMT, health plan type, and measures of health status. Patients aged over 45 years were between 13.7 to 18.6 percentage points more likely to be adherent than younger patients. Women had a 5.5 percentage-point lower probability of being adherent than men. Patients using self-injectable DMTs with injection site reactions as the most likely side effect were 9.1 percentage points less likely to be adherent than patients using oral, infusible, and other self-injectable DMTs. Patients with depression had a 5.5 percentage-point lower probability of being adherent. These results were robust to changes in controls for type of plan and neighborhood socioeconomic characteristics. This study found statistically significant differences in adherence to DMTs by age, sex, type of DMT, and a depression diagnosis. TEVA provided funding for this study and had the option to review the manuscript. The authors retained autonomy in the determination of the final content of this work. Study concept and design were contributed by Carlin, Anderson, and Higuera. Data interpretation was primarily performed by Higuera and Carlin, along with Anderson. The manuscript was written and revised by Higuera, Carlin, and Anderson.

Latitude and HLA-DRB1*04:05 independently influence disease severity in Japanese multiple sclerosis: a cross-sectional study.

BackgroundHigher latitude and human leukocyte antigen (HLA)-DRB1*04:05 increase susceptibility to multiple sclerosis (MS) in the Japanese population, but their effects on disease severity are unknown. We aimed to clarify the effects of latitude and the HLA-DRB1 and HLA-DPB1 genes on disease severity in Japanese patients with MS.MethodsWe enrolled 247 MS patients and 159 healthy controls (HCs) from the northernmost main island of Japan, Hokkaido Island (42–45° north), and 187 MS patients and 235 HCs from the southern half (33–35° north) of the Japanese archipelago (33–45° north). We genotyped HLA-DRB1 and HLA-DPB1 alleles, compared demographic features, and analyzed factors contributing to differences in clinical and laboratory findings between MS patients from southern and northern Japan. The Multiple Sclerosis Severity Score (MSSS), which adjusts the Kurtzke’s Expanded Disability Status Scale score according to disease duration, was used to estimate disease severity.ResultsThe HLA-DRB1*04:05 and DRB1*15:01 alleles conferred susceptibility to MS in our Japanese population (pcorr = 0.0004 and pcorr = 0.0019, respectively). Southern patients had higher MSSS scores than northern patients (p = 0.003). Northern patients had higher frequencies of brain lesions meeting the Barkhof criteria (Barkhof brain lesions) and cerebrospinal fluid (CSF) IgG abnormalities than southern patients (p = 0.0012 and p < 0.0001, respectively). DRB1*04:05-positive MS patients had lower MSSS scores and lower frequencies of Barkhof brain lesions and CSF IgG abnormalities than DRB1*04:05-negative MS patients (p = 0.0415, p = 0.0026, and p < 0.0001, respectively). Multivariate analyses revealed that latitude and DRB1*04:05 were independently associated with the lowest quartile of MSSS and that latitude was positively associated with Barkhof brain lesions and CSF IgG abnormalities. DRB1*04:05 was negatively associated with these parameters. MSSS was decreased by 0.57 per DRB1*04:05 allele (p = 0.0198).ConclusionsLiving at a higher latitude and carrying the DRB1*04:05 allele independently lessens MS symptom severity as defined by MSSS. However, these factors influence the frequency of Barkhof brain lesions and CSF IgG abnormalities in opposite ways; higher latitude increases the frequency of Barkhof brain lesions and CSF IgG abnormalities, whereas DRB1*04:05 decreases them.Electronic supplementary materialThe online version of this article (doi:10.1186/s12974-016-0695-3) contains supplementary material, which is available to authorized users.

Non-Oral Poster 30

OBJECTIVES: To determine the impact of overactive bladder (OAB) symptoms and treatments on quality of life (QoL) measures in patients with multiple sclerosis (MS). MATERIALS AND METHODS: After obtaining IRB approval, results from the Fall 2005 North American Research Committee On Multiple Sclerosis (NARCOMS) survey were reviewed, including the Urogenital Distress Inventory (UDI-6) with an additional question regarding nocturia, the SF-12 (mental and physical scores), and the Patient Determined Disease Steps (PDDS), a subjective measure of MS symptom severity (scored 0 to 8). A total OAB symptom score was created by summing individual responses to the frequency, urgency, small leakage and nocturia questions, resulting in a possible score of 0 to 12. Data were analyzed using descriptive statistics, the chi-square and Student's t-tests, analysis of variance, and multivariate logistic regression. RESULTS: Of 16,858 surveys mailed, 9702 (58%) complete responses were returned (75.4% females and 24.6% males). Participants with a surgically altered bladder were excluded (N = 21). At least one moderate to severe urinary symptom (score >1) was reported by 6263 (65%) respondents. The median OAB symptom score for all respondents was 5.1. A significant correlation between increasing OAB symptom score and increasing disability as gauged by PDDS score was noted (r = 0.291, P < 0.001). Quality of life assessments based on SF-12 scores were adversely impacted by increasing OAB symptom and PDDS scores (P < 0.001). Among respondents with at least one OAB symptom score >1, significant reductions in SF-12 physical (PCS-12) and mental (MCS-12) scores in all domains were noted (all P < 0.001). When disability was controlled for, reduced physical and mental QoL were correlated with increasing OAB symptom scores (PCS-12 r = 0.17; MCS-12 r = 0.16; both P < 0.001). Among respondents with an OAB symptom score >4, only 2361 (51.3%) had been treated with an anti-cholinergic medication. No significant difference in QoL measures based on the MCS-12 were noted between patients treated [44.65 (SD = 11.78)] or not treated [44.21 (SD = 11.67)] with anti-cholinergic medications (P = 0.142). However, lower median PCS-12 scores were noted among anti-cholinergic medication treated patients [32.84 (SD = 9.85)] versus untreated patients [36.34 (SD = 11.47); P < 0.001]. Respondents who utilized any form of urinary catheterization reported greater disability and reduced QoL (both P < 0.001). When compared, catheterizing respondents reported lower mean (SD) MCS-12 score of 44.1 (12.2), PCS-12 score of 30.5 (9.2) and PDDS score of 5.4 (2.0) versus mean MCS-12 score of 45.7 (11.5), PCS-12 score of 38.1 (11.8), and PDDS score of 3.2 (2.3) (t = 4.9, 23.9, 35.6 respectively, all P < 0.001) in non-catheterizing respondents. CONCLUSION: Overactive bladder symptoms have a significant negative impact on the QoL of MS patients. Although greater reductions in QoL are noted in patients treated with anti-cholinergic medications or catheterization for OAB symptoms, these differences may be secondary to increased physical disability associated with more severe disease.

The lived experiences of people diagnosed with multiple sclerosis in relation to exercise

The purpose of this study was to examine the lived experiences of people diagnosed with Multiple Sclerosis (MS). Seven active exercisers with MS participated in semi-structured interviews regarding their exercise experiences since diagnosis. Data were analysed using Interpretative Phenomenological Analysis (IPA; Smith & Osborn, 2003). Interpretive Phenomenological Analysis. The results and interpretations of narratives revealed a number of functional limitations due to the severity of MS symptoms, which were found to have a major effect on the ability of the participants to exercise. Furthermore, psychological problems and the heightened behavioural adjustments to the progressive disability led to re-appraisal of ability to exercise. Previous, relevant exercise experience made participants more determined to continue to be able to exercise after diagnosis. The wider exercise experience narratives were related to concerns about safety, dependability on others to overcome the challenges, and potential environmental hazards. The loss of spontaneous opportunities to exercise because of these actual and perceived barriers was key to this population. This research highlighted the need to rethink the health and social service arrangements in relation to exercise provision for individuals with MS.

Female sex steroids: effects upon microglial cell activation

Multiple sclerosis occurs more commonly in females than males. However, the mechanisms resulting in gender differences in multiple sclerosis are unknown. Activated microglia are believed to contribute to multiple sclerosis pathology, perhaps in part due to production of nitric oxide (NO) and TNF-α, molecules which can be toxic to cells including oligodendrocytes. The current study demonstrates that the female sex steroids estriol, β-estradiol and progesterone inhibit lipopolysaccharide (LPS) induction of nitric oxide (NO) production by primary rat microglia and by the mouse N9 microglial cell line. These hormones act by inhibiting the production of inducible nitric oxide synthase (iNOS) which catalyses the synthesis of NO. Estriol likely inhibits iNOS gene expression since the hormone blocks LPS induction of iNOS RNA levels. The pro-inflammatory cytokines IFN-γ and TNF-α are believed to be important modulators of multiple sclerosis. Here, we demonstrate that estrogens and progesterone also inhibit NO production by microglial cells activated in response to these cytokines. Activated microglia elicit TNF-α in addition to NO and we further demonstrate that estrogens and progesterone repress TNF-α production by these cells. Finally, estriol and progesterone, at concentrations consistent with late pregnancy, inhibit NO and TNF-α production by activated microglia, suggesting that hormone inhibition of microglial cell activation may contribute to the decreased severity of multiple sclerosis symptoms commonly associated with pregnancy.

Assistance arrangements and use of services among persons with multiple sclerosis and their caregivers.

A large population-based survey of persons with multiple sclerosis (MS) and their caregivers was conducted in Ontario using self-completed mailed questionnaires. The objectives included describing assistance arrangements, needs, and use of and satisfaction with services, and comparing perceptions of persons with MS and their caregivers. Response rates were 83% and 72% for those with MS and caregivers, respectively. Based on 697 respondents with MS whose mean age is 48 years, 70% are female, and 75% are married. While 24% experience no mobility restrictions, the majority require some type of aid or a wheelchair for getting around. Among 345 caregivers, who have been providing care for 9 years on average, the majority are spouses. Caregivers report providing more frequent care than do persons with MS report receiving it, particularly for the following activities of daily living: eating, meal preparation, and help with personal finances. Caregivers also report assistance of longer duration per day than do care recipients with MS. Frequency and duration of assistance are positively associated with increased MS symptom severity and reduced mobility. Generally there is no rural-urban disparity in service provision, utilization or satisfaction, and although there is a wide range of service utilization, satisfaction is consistently high. Respite care is rarely used by caregivers. Use of several services is positively associated with increased severity of MS symptoms and reduced mobility. Assistance arrangements and use of services, each from the point of view of persons with MS and their caregivers, must be taken into account in efforts to prolong home care and to postpone early institutionalization of persons with MS.