Status In Multiple Sclerosis Patients Research Articles

Female Sexual Dysfunction and Hormonal Status in Multiple Sclerosis Patients

Female Sexual Dysfunction and Hormonal Status in Multiple Sclerosis Patients

Erratum to: Effects of acute relapses on neuropsychological status in multiple sclerosis patients

Age (years) Mean ± SD 44.0 ± 7.1 42.3 ± 7.2 0.387* Gender N (%) female 35 (66.0%) 75 (65.2%) 0.917 EDSS prior to relapse Median (range) 3.0 (1.0–7.5) 2.5 (0.0–7.0) 0.717 Cerebral FS prior to relapse Median (range) 0.0 (0.0–2.0) 0.0 (0.0–2.0) 0.777 SDMT 2 visits prior to relapse Mean ± SD 52.3 ± 11.6 52.5 ± 11.3 0.937* SDMT 1 visit prior to relapse Mean ± SD 53.6 ± 10.9 53.4 ± 11.6 0.658* MSNQ 1 visit prior to relapse Mean ± SD 15.0 ± 11.2 13.0 ± 10.8 0.112* MSNQ 2 visits prior to relapse Mean ± SD 14.1 ± 10.6 13.3 ± 11.0 0.666* Corticosteroid treatment N (%) 37 (56.9%) N/A

Female Sexual Dysfunction and Hormonal Status in Multiple Sclerosis Patients

Literature holds no information on a correlation between blood hormonal levels, in particular sex hormones and the sexual response of women with multiple sclerosis (MS). To investigate a possible correlation between hormonal status and the sexual response of females with MS. The Female Sexual Function Index (FSFI) questionnaire was used to determine sexual dysfunctions (SDs). Methods for measuring blood hormones were chemiluminescence immunoassay, electrochemiluminescence immunoassay, enzyme immunoassay, and radioimmunoassay. During the screening phase, 55 women of reproductive age were recruited and completed the FSFI. In the first phase of the study females underwent a hematic hormonal evaluation on the third day of their menstrual cycle. Serum follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), thyroid stimulating hormone (TSH), cortisol, dehydroepiandrosterone sulphate (DHEA-S), androstenedione, 17[alpha]-hydroxyprogesterone, total and free testosterone, 17 beta estradiol, inhibin and sex hormone binding globulin (SHBG), and thyroid hormones (fT3 and fT4) were checked. On the day 20-21 into their menstrual cycle the progesterone hematic value was noted. Patients with amenorrhea had all hormones tested once with a random blood drawing. After a 3-month period patients began phase 2, completing the FSFI again. The same blood hormones were investigated. Fifty-four females completed the study. Thirty-one continued to manifest at least one SD: desire (57.4%) was the most common. Overall, 36.4% showed abnormal hormonal alterations. The most frequent was 40% for 17 beta-estradiol. None of the FSFI domains, including the total score, revealed any statistically significant correlation to the hormones investigated. No statistically significant clinical predictive factors for blood hormone abnormalities were detected; comparing females with and without SD, P = 0.250 using chi-squared test was reached. Notable percentages of blood hormonal alterations and SD were documented, but no significant statistical correlations were detected between hormonal status and sexual function.

A Revisited View of the Paced Auditory Serial Addition Test (PASAT) in Multiple Sclerosis

To the Editor: The Paced Auditory Serial Addition Test (PASAT) has been used since 1974 as a common research tool for different neurological disorders like multiple sclerosis. In multiple sclerosis clinics, the PASAT has been included as a major test to determine the multiple sclerosis outcome because of its sensitivity to multiple sclerosisrelated cognitive decline. PASAT is one of the major components of Multiple Sclerosis Functional Composite test. In PASAT, patients are trained to add 60 pairs of single digits so that each number is added to the one immediately preceding it. Patients report the sum orally. The digits are presented by audiotape, first at a rate of 3 seconds per digit (PASAT3), then, in a second trial, at a rate of 2 seconds per digit (PASAT2). Scores are the sums of correct responses for the 3and 2second forms of the task. We hypothesize that paying attention to the time of correct response may be valuable. For instance, in PASAT3, instead of taking into account the trueness or falseness of response, we consider the time of the patient’s reply. If he or she replies correctly, we consider the time. If he or she replies falsely, we consider 3 seconds, and if he runs out of time, we consider 3 seconds. By this approach, we have a signal: x-axis stands for 60 events (60 pairs of digits), and the y-axis stands for the time of reply. The maximum of the x-axis is 60, with steps from 1 to 60, and the y-axis maximum is 3 seconds. We believe that such a signal might give clinicians better insight into the cognitive status of multiple sclerosis patients. For instance, the mean or the standard deviation of this signal may suggest the mean attention or the degree of his or her disturbance. We think that this modified PASAT may help improve the Multiple Sclerosis Functional Composite test. Javad Razjouyan Shariar Gharibzadeh Ali Fallah Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran Abtin Khodadi Computer Science and Information Technology, Amirkabir University of Technology, Tehran, Iran

Single-Nucleotide Polymorphisms in Response to Interferon-Beta Therapy in Multiple Sclerosis

Interferon-beta (IFN-β) is one of the main first-line disease-modifying drugs indicated for the treatment of multiple sclerosis (MS). The drug exhibits only limited effectiveness, and does not produce clinical benefits in around 20%-50% of patients. The availability of biomarkers would be beneficial for identification of patients at high risk of treatment failure, before initiation of therapy. Over the last 5 years, the search for such biomarkers has intensified and various promising candidates have been uncovered. Here, we review the main attempts undertaken to identify polymorphic variants associated with response to IFN-β therapy in MS by means of candidate gene approaches and whole-genome association scans. Despite substantial progress made in the field, there is still a long way to go before biomarker discoveries can be incorporated into clinical practice to predict IFN-β-responder status in MS patients.

Predicting employment status in multiple sclerosis patients: the utility of the MS functional composite

As many as two-thirds of multiple sclerosis (MS) patients are unable to retain employment. Neurological and cognitive status are known to be significant predictors of unemployment, but the relationship between the two is unclear. Furthermore, the association between employment status and depression, anxiety, and personality has not been adequately explored in MS patients. This study examined the demographic, neurological, neuropsychological, and personality factors associated with unemployment in MS. We also sought to determine the utility of the Multiple Sclerosis Functional Composite (MSFC), a measure of MS-related disability incorporating physical and cognitive measures, in predicting employment status. A consecutive sample of 106 MS patients (61.3% unemployed) completed the Brief Repeatable Battery of Neuropsychological Tests (BRBN), Hospital Anxiety and Depression Scale (HADS), and NEO Five-Factor Personality Inventory. The MSFC emerged as the most robust predictor of employment status in MS patients, exceeding the predictive value of the EDSS. Together with NEO "Agreeableness" and HADS Depression subscore, the MSFC accounted for 49.8% of the variance in employment status. Unemployment was also associated with a progressive disease course, longer disease duration, and being female. While Global Cognitive Impairment did not differentiate between groups, unemployed patients scored significantly lower on three of five BRBN indices: Symbol Digit Modality Test, Paced Auditory Serial Addition Test, and Word List Generation. The findings highlight the utility of the MSFC as a predictor of unemployment in MS. Furthermore, a strong association was found between unemployment and the personality construct "Agreeableness", and severity of depression.

Perceived health status as measured by the SF‐36 in patients with multiple sclerosis: a review

This review of literature gives an overview of recent studies about perceived health status as measured by the Short-Form-36 (SF-36) Health Survey in patients with multiple sclerosis (MS). The SF-36 is one of the tools measuring health status in patients used in international research and clinical practice. It measures two main health concepts - physical and mental. The SF-36 represents a valid instrument able to detect differences in perceived health status in patients. A computer-aided search in Medline and PsycINFO resulted in 504 articles in English published from 1996 to August 2006. After the screening process on the basis of abstracts, eight articles consisting of empirical studies remained in which perceived health status was evaluated using the SF-36 Health Survey. Seven studies focused on disability and perceived health status in the SF-36. Two studies focused on the relationship between depression and perceived health status. These studies showed that MS patients with low disability and minor depression scored significantly better than patients with high disability and major depression in the SF-36 health dimensions. Gender seems to have no influence on perceived health status in MS patients. The longer the disease duration and the more severe the disease, the lower the patients scored in perceived health status. The more disabled, the more depressive and the older the patients, the poorer their perceived health status was. Health providers supporting appropriate treatment might pay more attention to more disabled and more depressive patients, with longer disease duration. Perceived health status can be a predictor of prognosis and intervention outcomes. The study shows the importance of measuring perceived health status in MS patients with implications for their quality of life and provision of care.

Mastery, functional disability and perceived health status in patients with multiple sclerosis

Multiple sclerosis (MS) is a chronic disease that is difficult to predict and to cope with. Mastery refers to the extent to which patients see themselves as being in control of the forces that affect their lives. It may play an important role in perceived health status and well-being. The purpose of this study was to clarify whether mastery is associated with functional disability and perceived health status in MS patients and how such an association might function. Two hundred and three MS patients completed the Short-Form-36 Health Survey as well as the Pearlin-Schooler Mastery Scale. Functional disability was assessed using the Kurtzke Expanded Disability Status Scale. Hierarchical multiple linear regression analyses were performed on the data from two MS age groups: <45 and > or =45 years of age. Functional disability was negatively associated with perceived physical health status in both age groups and with perceived mental health status in younger age group. Mastery was positively associated with perceived health status in older age group. The findings confirm that mastery might be helpful for older MS patients. Education strategies for MS patients aimed at personal empowerment for the maintaining of physical and mental well-being may be important.

Caractéristiques des personnes atteintes d’une sclérose en plaques selon la situation professionnelle

Aim To describe the health and professional status of multiple sclerosis patients of working age and to compare a group of patients in work (group T1) with a group of unemployed patients (group T2). Materials and methods A case-controlled study was performed. In the course of a specific consultation with a neurologist, demographic, medical and professional data were gathering using a questionnaire. Descriptive and comparative statistical analyses were then performed. Results A total of 76 patients were included in the study: 54 were in work (group T1) and 22 were unemployed (group T2). Hence, the employment rate was 71%, with an average time since disease onset of nine years at the time of the study. Low educational level ( p = 0.02), disease progression ( p = 0.0001), the presence of motor symptoms ( p = 0.01), cerebellar symptoms ( p = 0.02) or cognitive symptoms ( p = 0.03), a worse EDSS ( p = 0.0001) and a job requiring force ( p = 0.05) or manual dexterity ( p = 0.05) were found to be negative factors. Employment in the public sector ( p = 0.003) or large companies ( p = 0.03) were found to be protective factors. Access to the workplace was better for currently employed patients ( p = 0.03). Conclusion This study shows that differences exist within the MS patient population according to the professional situation. It underlines the importance of clinical and demographics variables as determinants of differences in employment status. Not surprisingly, unemployed patients are more likely to have been classified as handicapped workers. Factors linked to work-induced constraints did not emerge from the survey because the questionnaire items were not appropriate for addressing this latter issue.

Social support as a predictor of perceived health status in patients with multiple sclerosis

Objective The main aim of this study was to investigate whether different levels of perceived social support are associated with different levels of perceived health status in multiple sclerosis (MS) patients. Methods Two hundred and seven MS patients (38.4 ± 10.6 years, 66.2% female) completed the Short-Form-36 Health Survey (SF-36) as the measure for perceived health status, and the perceived social support scale (PSSS) as the measure for social support. Functional disability was assessed using Kurtzke's expanded disability status scale (EDSS). The contribution of EDSS and PSSS for explaining the variance in SF-36 was investigated with multiple linear regression analysis. Results Demographic variables and EDSS explained 44% of the variance of the physical health summary scale in the SF-36. Demographic variables, EDSS and PSSS from family and friends explained 24% of the variance in mental health summary scale in the SF-36. Results varied according to the multiple linear regression analyses of predictors of variance in the eight dimensions of the SF-36. Conclusion PSSS from significant others was positively associated with general health dimension of perceived physical health status, while PSSS from family and friends was positively associated with perceived mental health status in MS patients. Practice implications The results show the importance of supporting social ties and relationships between MS patients and others.

Coagulation status and biochemical and inflammatory markers in multiple sclerosis

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system and is the most common cause of neurologic disability in young adults. In this study, the coagulation status and biochemical and non-specific inflammatory markers in patients with MS were investigated. Plasma prothrombin time, activated partial thrombin time, fibrinogen, D-dimer, serum high sensitive C-reactive protein, homocysteine, blood urea nitrogen, creatinine, calcium, total protein, albumin, total cholesterol, vitamin B12, folate levels and erythrocyte sedimentation rate were measured in 42 patients with MS and 31 healthy subjects as a control group. There was a positive correlation between homocysteine and D-dimer levels ( r = 0.84, p < 0.01). However, there was no significant correlation between homocysteine, vitamin B12 ( r = 0.18) and folate ( r = 0.23) levels. Serum total protein, albumin and calcium levels of MS patients were lower than the control group. There are some alterations in the coagulation and biochemical status in MS patients. These findings may contribute to better understanding of the etiopathogenesis and clinical characteristics of this disease.

Multiple Sclerosis: Relapses and Timing of Remissions

Background: Relapse is a relatively sudden worsening of neurological status in multiple sclerosis patients. The aim of this paper is to describe the frequency and timing of the subsequent clinical remission, and factors linked to a possible lack of recovery. Methods: Two hundred and twenty-three relapses in 62 multiple sclerosis patients were examined retrospectively. Kurtzke’s Expanded Disability Status Scale (EDSS) scores were calculated every 3 months from 1 year before to 1 year after. Remission was defined as improvement vs. the EDSS as scored during the relapse. Recovery was defined as return to the EDSS as scored before the relapse. Results: The frequency of improvement was 78% at 3 months, 86% at 6, and lower in males (65 vs. 81%). The frequency of recovery was 55% at 3 months, 71% at 6. Kaplan-Meier curves showed stabilization after 6 months, with improvement in 90% of patients, 100% without further relapses. Relapses without recovery were only 30%; 15% excluding short-term relapses. Conclusions: Incomplete remissions do not appear to be linked to the evolution of the relapse, but to further relapses in the following months; in other words, to the short-term relapse rate.

Predicting gadolinium enhancement status in MS patients eligible for randomized clinical trials

Gadolinium enhancement is often used in randomized clinical trials to evaluate the efficacy of new drugs in multiple sclerosis (MS). Knowledge about predictors of enhancement status is important for the selection of patients for MRI monitored trials. Data from 17 trials were available in anonymized format through the Sylvia Lawry Centre for MS Research. In an open part containing 1,328 (non primary progressive) patients, two logistic regression analyses were explored, including demographic, clinical, and MRI predictors. The authors examined the area under the curve (AUC) and the increase in positive predictive value (PPV). The final selection of models was validated in a closed part of 848 comparable patients. Age at onset, disease duration, and disease course (CIS/RR/SP) were important predictors from the multivariate models. Further, a multivariate model including T2 burden of disease was more predictive than one with only clinical predictors (AUC 0.719 vs 0.625, p < 0.001). For the model with T2 burden of disease, the PPV was 66.8%, compared to 58.5% for the model without (a priori chance 46.4%). These findings were unequivocally confirmed in the closed part of the database. Gadolinium status can be predicted by a set of baseline variables, certainly when T2 burden of disease is included. These findings may benefit the design and statistical power of future randomized clinical trials.

Human herpesvirus 6 and multiple sclerosis: a study of T cell cross-reactivity to viral and myelin basic protein antigens.

Several reports have suggested an association of human herpesvirus 6 (HHV‐6) with multiple sclerosis. Autoreactive T lymphocytes directed against myelin components seem to contribute to the pathogenesis of the disease. It has been suggested that molecular mimicry between viral and self‐antigens might be one of the mechanisms that determine the onset of several autoimmune diseases. Following this hypothesis, the purpose of the present study was to evaluate if HHV‐6 could play a role in activating T cells capable of cross‐reaction with an important myelin component, the myelin basic protein. T cell lines were established from 22 multiple sclerosis patients and from 16 healthy controls, and their capability to react to both virus and myelin basic protein antigens was compared. The analysis of T cell cross‐reactivity in patients and controls did not show significant differences in the HHV‐6 ability to activate myelin basic protein‐reactive T cells. Similarly, the evaluation of the humoral immune response to HHV‐6 in patients and controls did not mirror any abnormality in the HHV‐6 status in multiple sclerosis patients. Therefore, although the findings of activity in vitro of T cell lines with dual specificity are consistent with the hypothesis of molecular mimicry, the lack of differences in cross‐reactivity between patients and controls do not support molecular mimicry as an important mechanism in the physiopathology of this disease. J. Med. Virol. 68: 268–272, 2002. © 2002 Wiley‐Liss, Inc.

A preliminary study into the dental health status of multiple sclerosis patients.

Multiple sclerosis (MS) is an inflammatory disease of unknown etiology involving the central nervous system. Since MS affects the whole body, orofacial aspects of the disease must be expected, particularly since loss of muscular coordination may result in a diminished ability to maintain oral hygiene. This preliminary study examined the dental health status of 22 volunteer MS patients. A questionnaire collected data regarding medical and dental histories and socio-demographic information. Extra- and intra-oral examinations were carried out on all subjects to determine the particular dental treatment needs of this special group. The DMFT and CPITN scores for this group did not indicate that MS patients were more susceptible to dental caries or periodontal disease. However, the prevalence of trigeminal neuralgia and symptoms of TMJ dysfunction in the group studied indicated that these conditions may be manifest in MS patients and warrant further investigations.

Implicit Memory in Multiple Sclerosis

A number of neuropsychological studies have revealed that memory problems are relatively common in patients with multiple sclerosis (MS). It may be useful to compare MS with conditions such as Huntington's disease (HD), which have been referred to as subcortical dementia. A characteristic of these conditions may be an impairment in implicit (unconscious) memory, but not in explicit (conscious) memory. The present study examined the functioning of explicit and implicit memory in MS. Results showed that implicit memory was not significantly impaired in the MS subjects, and that they were impaired on recall but not recognition. A correlation was found between implicit memory performance and disability status in MS patients. Findings also suggest the possibility of long-term priming of implicit memory in the control subjects. The implications of these results are discussed.

Implicit memory in multiple sclerosis.

A number of neuropsychological studies have revealed that memory problems are relatively common in patients with multiple sclerosis (MS). It may be useful to compare MS with conditions such as Huntington's disease (HD), which have been referred to as subcortical dementia. A characteristic of these conditions may be an impairment in implicit (unconscious) memory, but not in explicit (conscious) memory. The present study examined the functioning of explicit and implicit memory in MS. Results showed that implicit memory was not significantly impaired in the MS subjects, and that they were impaired on recall but not recognition. A correlation was found between implicit memory performance and disability status in MS patients. Findings also suggest the possibility of long-term priming of implicit memory in the control subjects. The implications of these results are discussed.

Cell-mediated immunological status in multiple sclerosis patients.

In vitro lymphocyte proliferation in response to allogeneic pooled cells, mitogens (PHA, Con A and PWM), and PPD was measured in 67 patients with clinically definite MS and in 67 age and sex-matched controls. Overall, dose-response curves in the two groups were similar, but response to PHA and PWM was significantly greater among patients, and a greater percentage of patients failed to respond to peak and suboptimal PPD concentrations. There was a reduced response to allogeneic pooled cells in Dw2 positive controls, and, in both patients and controls, a tendency towards a higher PPD response in Dw2 positive males. The results suggest that there is some alteration of balance of immune regulation in MS, which is slightly affected by Dw2 status.

An assessment of the reliability of three methods used in evaluating the status of multiple sclerosis patients

The reliability of three different evaluation methods used in a cooperative clinical trial of the efficacy of ACTH in multiple sclerosis patients was evaluated in a uniformity study that used an efficient statistical design requiring only 10 patients and 5 examiners. The methods were the standard neurologic examination, a scoring system for functional grades and disability status, and a 7-day symptom score. Each patient was examined only 3 times at the beginning of the study and 3 more times 6 days later. No significant differences among the 5 examiners were observed on 82 of the 87 items used to measure neurologic function. With the exception of 1 variable, there were no significant differences among the average values of the sequence of the 3 examinations, nor among the average increments of change in the numerical scores between the first and second trials. In an additional examination in which all 5 examiners simultaneously evaluated 3 patients 1 at a time, it was found that the 5 examiners observed uniformly in all of the neurologic tests. The results of this study indicate that, by and large, the three evaluation methods appear to be reliable in the evaluation of neurologic status when used in a cooperative clinical trial where several investigators contribute data. Furthermore, investigations of reliability in cooperative studies can be performed with the use of efficient statistical designs such as the incomplete Latin-square design.