Pub Date : 2016-10-29DOI: 10.4172/2376-0389.1000186
A. Pappalardo, E. D’Amico, C. Chisari, F. Patti
Introduction: Multiple Sclerosis is the leading cause of no traumatic disability in young people. Nowadays, neurorehabilitation is commonly prescribed in patients with MS, but there are still some issues to be explored further. In this review, we discuss the following topics: 1) the neuroscientific basis of neurorehabilitation in multiple sclerosis; 2) what would be the ideal set of rehabilitative treatment: inpatients, outpatient or home-based therapy? Methods: A systematic search was made, using combination of the following terms: rehabilitation, multiple sclerosis, disability, plasticity, motor learning, cognitive rehabilitation, quality of life. Results: A growing amount of evidence suggest that motor and cognitive rehabilitation may enhance functional and structural brain plasticity in patients with multiple sclerosis. Improvement of function seems to be correlated with functional Magnetic Resonance Imaging changes in brain. Moreover, several studies show the effectiveness of cognitive rehabilitation to improve some domains of neuropsychological functions, such as attention, information processing and executive functions. Regarding the rehabilitative setting, it should be chosen taking into account the personal needs of each patient. All the studies, performed in different setting, demonstrated the effectiveness of rehabilitation in Persons affected by multiple sclerosis. Conclusion: Rehabilitation is effective in mitigating disability and improving QoL in persons with MS. Setting for rehabilitation treatment should be chosen taking into account many personal needs and desires of each patient.
{"title":"Neurorehabilitation in Persons with Multiple Sclerosis: Scientific Basis and Options of Treatment","authors":"A. Pappalardo, E. D’Amico, C. Chisari, F. Patti","doi":"10.4172/2376-0389.1000186","DOIUrl":"https://doi.org/10.4172/2376-0389.1000186","url":null,"abstract":"Introduction: Multiple Sclerosis is the leading cause of no traumatic disability in young people. Nowadays, neurorehabilitation is commonly prescribed in patients with MS, but there are still some issues to be explored further. In this review, we discuss the following topics: 1) the neuroscientific basis of neurorehabilitation in multiple sclerosis; 2) what would be the ideal set of rehabilitative treatment: inpatients, outpatient or home-based therapy? \u0000Methods: A systematic search was made, using combination of the following terms: rehabilitation, multiple sclerosis, disability, plasticity, motor learning, cognitive rehabilitation, quality of life. \u0000Results: A growing amount of evidence suggest that motor and cognitive rehabilitation may enhance functional and structural brain plasticity in patients with multiple sclerosis. Improvement of function seems to be correlated with functional Magnetic Resonance Imaging changes in brain. Moreover, several studies show the effectiveness of cognitive rehabilitation to improve some domains of neuropsychological functions, such as attention, information processing and executive functions. \u0000Regarding the rehabilitative setting, it should be chosen taking into account the personal needs of each patient. All the studies, performed in different setting, demonstrated the effectiveness of rehabilitation in Persons affected by multiple sclerosis. \u0000Conclusion: Rehabilitation is effective in mitigating disability and improving QoL in persons with MS. Setting for rehabilitation treatment should be chosen taking into account many personal needs and desires of each patient.","PeriodicalId":16369,"journal":{"name":"Journal of multiple sclerosis","volume":"17 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2016-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85104919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-27DOI: 10.4172/2376-0389.1000185
A. Bilgiç, Ü. T. Börü, M. Taşdemir, S. Alp, R. Alp, Serhan Yıldırım, A. Duman, N. Güler, J. Kurtzke
Background: In this study, the results of high dose intravenous monthly pulse CYC on patients with worsening relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) were evaluated. Methods: Fifty-six patients who presented with worsening RRMS (30) or SPMS (26) were to be treated with intravenous (IV) monthly pulse of 800 mg/m² CYC in the first year and bimonthly in the second year. We evaluated the results before treatment and after 12 and 24 months. Results: In the RRMS patients, after 2 years baseline EDSS had improved in 18, was unchanged in 5 and worse in 3. In RRMS group annual relapse rate was 0.92 at the beginning. it decreased to 0.23 in first year and to 0.23 in second year. The SPMS patients after 2 years baseline EDSS had improved in 5, was unchanged in 15 and worse in 3. In SPMS group annual relapse rate was 0.26 at the beggining. It decreased 0.13 in the first year and 0.04 in the second year. Conclusion: This study showed that high dose CYC treatment for two years was well tolerated and seemed effective for both RRMS and SPMS.
{"title":"Long-Term Remissions With Use of High Dose Cyclophosphamide in Multiple Sclerosis","authors":"A. Bilgiç, Ü. T. Börü, M. Taşdemir, S. Alp, R. Alp, Serhan Yıldırım, A. Duman, N. Güler, J. Kurtzke","doi":"10.4172/2376-0389.1000185","DOIUrl":"https://doi.org/10.4172/2376-0389.1000185","url":null,"abstract":"Background: In this study, the results of high dose intravenous monthly pulse CYC on patients with worsening relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) were evaluated. Methods: Fifty-six patients who presented with worsening RRMS (30) or SPMS (26) were to be treated with intravenous (IV) monthly pulse of 800 mg/m² CYC in the first year and bimonthly in the second year. We evaluated the results before treatment and after 12 and 24 months. Results: In the RRMS patients, after 2 years baseline EDSS had improved in 18, was unchanged in 5 and worse in 3. In RRMS group annual relapse rate was 0.92 at the beginning. it decreased to 0.23 in first year and to 0.23 in second year. The SPMS patients after 2 years baseline EDSS had improved in 5, was unchanged in 15 and worse in 3. In SPMS group annual relapse rate was 0.26 at the beggining. It decreased 0.13 in the first year and 0.04 in the second year. Conclusion: This study showed that high dose CYC treatment for two years was well tolerated and seemed effective for both RRMS and SPMS.","PeriodicalId":16369,"journal":{"name":"Journal of multiple sclerosis","volume":"316 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2016-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75436519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-16DOI: 10.4172/2376-0389.1000187
S. Feketova
Introduction: Pain is a key symptom in patients with multiple sclerosis (MS), but the prevalence of pain in MS and its impact on quality of life of the patients is still underestimated. Objective: The aim of the study was to examine the occurrence of pain in MS patients, to identify the pain conditions and the relationship to important demographic variables (age, gender, type of MS) and to determine its impact on quality of life. Methods: Questionnaires on pain and health-related quality of life were sent to 307 patients with definitive MS diagnose. All patients with painful sensations were examined with aim to diagnose central and peripheral neuropathic and nociceptive pain. Results: Out of 220 responders 92% reported at least one type of pain or unpleasant pain sensation. Pain was more frequent in relapsing-remitting form of MS than in secondary progressive MS (p<0.0001) and less frequent in males than females (p=0,001). The ratio of different pain types was as follows: 51.38% headache, 57.94% neck or low back pain, 40.91% central neuropathic extremity and trunk pain, 5.91% trigeminal neuralgia, 34.26% Lhermitte‘s sign, 2.47% peripheral neuropathic pain. The commonest location of pain was lower extremities (84.09%) and the commonest pain quality was painful stiffness. Two and more concurrent pain locations were reported by 87.2% of patients and the total number of pain locations significantly increases with disease duration (p<0.0001). Pain limited the activities of daily living in 61.5% of patients. Conclusion: Our study confirmed the heterogenity of pain experienced in MS, the capacity to experience more than one type of pain simultaneously and inadequate pain treatment. Therefore pain is an important therapeutic target in MS.
{"title":"Pain in Multiple Sclerosis: Prevalence and Characteristics of Various Pain Conditions","authors":"S. Feketova","doi":"10.4172/2376-0389.1000187","DOIUrl":"https://doi.org/10.4172/2376-0389.1000187","url":null,"abstract":"Introduction: Pain is a key symptom in patients with multiple sclerosis (MS), but the prevalence of pain in MS and its impact on quality of life of the patients is still underestimated. \u0000Objective: The aim of the study was to examine the occurrence of pain in MS patients, to identify the pain conditions and the relationship to important demographic variables (age, gender, type of MS) and to determine its impact on quality of life. \u0000Methods: Questionnaires on pain and health-related quality of life were sent to 307 patients with definitive MS diagnose. All patients with painful sensations were examined with aim to diagnose central and peripheral neuropathic and nociceptive pain. \u0000Results: Out of 220 responders 92% reported at least one type of pain or unpleasant pain sensation. Pain was more frequent in relapsing-remitting form of MS than in secondary progressive MS (p<0.0001) and less frequent in males than females (p=0,001). The ratio of different pain types was as follows: 51.38% headache, 57.94% neck or low back pain, 40.91% central neuropathic extremity and trunk pain, 5.91% trigeminal neuralgia, 34.26% Lhermitte‘s sign, 2.47% peripheral neuropathic pain. The commonest location of pain was lower extremities (84.09%) and the commonest pain quality was painful stiffness. Two and more concurrent pain locations were reported by 87.2% of patients and the total number of pain locations significantly increases with disease duration (p<0.0001). Pain limited the activities of daily living in 61.5% of patients. \u0000Conclusion: Our study confirmed the heterogenity of pain experienced in MS, the capacity to experience more than one type of pain simultaneously and inadequate pain treatment. Therefore pain is an important therapeutic target in MS.","PeriodicalId":16369,"journal":{"name":"Journal of multiple sclerosis","volume":"9 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2016-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88954610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-17DOI: 10.4172/2376-0389.1000183
Shahla Mohamadirizi, V. Shaygannejad, S. Mohamadirizi, Marjan Mohamadirizi
Context: Social anxiety and eating disorders have demonstrated high comorbidity in a Multiple Sclerosis Clinic Population. However, social anxiety has not been directly studied with respect to eating disorders. This study, therefore, was designed to determine the relationship between social anxiety and eating disorders in a multiple sclerosis clinic population. Methods and materials: This was a cross-sectional study which was conducted in Kashani Hospital affiliated with Isfahan University of Medical Sciences, Iran, in 2013. 210 adult patients who suffered from multiple sclerosis were selected and completed the Demographic Characteristics Questionnaire, Eating Disorder Examination Questionnaire (EDE-Q) and Anxiety Disorder Inventory. SPSS Version 16 software was used to conduct statistical tests including t-test, ANOVA and Pearson correlation. Results: The results showed that mean and standard deviation of the eating disorder and social anxiety scores were 1.2 ± 0.15 and 17.9 ± 8.5, respectively. Also, 7.2% of multiple sclerosis patients had eating disorder and 39.1% social anxiety disorder. There was a significant positive correlation between the social anxiety score and eating disorder score (r=0.4, p ≤ 0.05). Conclusion: Our study indicated a significant level of social anxiety and eating disorders in people with multiple sclerosis. Eating disorders in multiple sclerosis patients was strongly related with social anxiety. The findings from this study can assist health care team to pay more attention to social anxiety and eating disorders in people with multiple sclerosis, and also consider their relationship in their evaluations.
背景:社交焦虑和饮食失调在多发性硬化症临床人群中表现出很高的合并症。然而，社交焦虑与饮食失调之间的关系尚未得到直接研究。因此，本研究旨在确定多发性硬化症临床人群中社交焦虑与饮食失调之间的关系。方法与材料:本研究为横断面研究，于2013年在伊朗伊斯法罕医科大学附属Kashani医院进行。选择210例多发性硬化症成年患者，填写人口统计学特征问卷、饮食失调检查问卷(ed - q)和焦虑障碍量表。采用SPSS Version 16软件进行统计检验，包括t检验、ANOVA和Pearson相关。结果:进食障碍和社交焦虑得分的均值和标准差分别为1.2±0.15和17.9±8.5。此外，7.2%的多发性硬化症患者有饮食障碍，39.1%的多发性硬化症患者有社交焦虑症。社交焦虑评分与饮食障碍评分呈显著正相关(r=0.4, p≤0.05)。结论:我们的研究表明多发性硬化症患者存在显著的社交焦虑和饮食失调。多发性硬化症患者饮食失调与社交焦虑密切相关。本研究的发现可以帮助医疗团队更加关注多发性硬化症患者的社交焦虑和饮食失调，并在评估时考虑两者的关系。
{"title":"Eating Disorders in a Multiple Sclerosis Clinical Population and its Association with Social Anxiety","authors":"Shahla Mohamadirizi, V. Shaygannejad, S. Mohamadirizi, Marjan Mohamadirizi","doi":"10.4172/2376-0389.1000183","DOIUrl":"https://doi.org/10.4172/2376-0389.1000183","url":null,"abstract":"Context: Social anxiety and eating disorders have demonstrated high comorbidity in a Multiple Sclerosis Clinic Population. However, social anxiety has not been directly studied with respect to eating disorders. This study, therefore, was designed to determine the relationship between social anxiety and eating disorders in a multiple sclerosis clinic population. Methods and materials: This was a cross-sectional study which was conducted in Kashani Hospital affiliated with Isfahan University of Medical Sciences, Iran, in 2013. 210 adult patients who suffered from multiple sclerosis were selected and completed the Demographic Characteristics Questionnaire, Eating Disorder Examination Questionnaire (EDE-Q) and Anxiety Disorder Inventory. SPSS Version 16 software was used to conduct statistical tests including t-test, ANOVA and Pearson correlation. Results: The results showed that mean and standard deviation of the eating disorder and social anxiety scores were 1.2 ± 0.15 and 17.9 ± 8.5, respectively. Also, 7.2% of multiple sclerosis patients had eating disorder and 39.1% social anxiety disorder. There was a significant positive correlation between the social anxiety score and eating disorder score (r=0.4, p ≤ 0.05). Conclusion: Our study indicated a significant level of social anxiety and eating disorders in people with multiple sclerosis. Eating disorders in multiple sclerosis patients was strongly related with social anxiety. The findings from this study can assist health care team to pay more attention to social anxiety and eating disorders in people with multiple sclerosis, and also consider their relationship in their evaluations.","PeriodicalId":16369,"journal":{"name":"Journal of multiple sclerosis","volume":"1 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2016-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83082752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-06DOI: 10.4172/2376-0389.1000182
G. Samantha
The projections for the rising cost of health care have spurned robust dialogue from every sector of the healthcare economy [1,2] Among the many targets for cost control are specialty drugs distinguished clinically by their route of administration, synthesis or bioengineering, mechanism of action and cost itself [2]. This terminology likely originated from payers who designate these drugs for special attention not only because of price, but also the need for distinctive handling or particular patient monitoring [3]. Although there are examples of competition emerging to tamp down prices to more acceptable levels (e.g. pharmacy benefit manager negotiations for hepatitis C drugs), stakeholders (policy-makers, insurance carriers, and non-governmental groups such as ASCO) are seeking other market-based solutions [2].
{"title":"Real World Evidence and the Behavioral Economics of Physician Prescribing","authors":"G. Samantha","doi":"10.4172/2376-0389.1000182","DOIUrl":"https://doi.org/10.4172/2376-0389.1000182","url":null,"abstract":"The projections for the rising cost of health care have spurned robust dialogue from every sector of the healthcare economy [1,2] Among the many targets for cost control are specialty drugs distinguished clinically by their route of administration, synthesis or bioengineering, mechanism of action and cost itself [2]. This terminology likely originated from payers who designate these drugs for special attention not only because of price, but also the need for distinctive handling or particular patient monitoring [3]. Although there are examples of competition emerging to tamp down prices to more acceptable levels (e.g. pharmacy benefit manager negotiations for hepatitis C drugs), stakeholders (policy-makers, insurance carriers, and non-governmental groups such as ASCO) are seeking other market-based solutions [2].","PeriodicalId":16369,"journal":{"name":"Journal of multiple sclerosis","volume":"28 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2016-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81272332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-10DOI: 10.4172/2376-0389.1000180
Hunter Sf
CCR7: C-C Chemokine Receptor Type 7; CNS: Central Nervous System; S1P: Sphingosine 1-Phosphate; S1P1: Sphingosine 1-Phosphate Receptor Subtype 1; TN: Naïve T Cell Knowledge of the immunopathology of multiple sclerosis (MS) within the central nervous system (CNS) continues to evolve and has been enhanced greatly by an understanding of the mode of action and effects of disease modifying therapies (DMTs). It is widely accepted that T cells play a critical role in the pathogenesis of MS, and immune cell infiltrates found in active CNS lesions are dominated by T cells and antigen-presenting cells [1,2]. Auto reactive T cells that migrate across the blood–brain barrier (BBB) are activated locally by immune cells in the CNS (microglia and astrocytes), leading to CNS inflammation (Figure 1) [3,4]. Indeed, the approved high-efficacy DMTs natalizumab and fingolimod exert effects on T cells by targeting facets of T-cell migration [5].
{"title":"The Effects of Fingolimod on T Cells and the Central Nervous System in the Pathogenesis of Multiple Sclerosis","authors":"Hunter Sf","doi":"10.4172/2376-0389.1000180","DOIUrl":"https://doi.org/10.4172/2376-0389.1000180","url":null,"abstract":"CCR7: C-C Chemokine Receptor Type 7; CNS: Central Nervous System; S1P: Sphingosine 1-Phosphate; S1P1: Sphingosine 1-Phosphate Receptor Subtype 1; TN: Naïve T Cell Knowledge of the immunopathology of multiple sclerosis (MS) within the central nervous system (CNS) continues to evolve and has been enhanced greatly by an understanding of the mode of action and effects of disease modifying therapies (DMTs). It is widely accepted that T cells play a critical role in the pathogenesis of MS, and immune cell infiltrates found in active CNS lesions are dominated by T cells and antigen-presenting cells [1,2]. Auto reactive T cells that migrate across the blood–brain barrier (BBB) are activated locally by immune cells in the CNS (microglia and astrocytes), leading to CNS inflammation (Figure 1) [3,4]. Indeed, the approved high-efficacy DMTs natalizumab and fingolimod exert effects on T cells by targeting facets of T-cell migration [5].","PeriodicalId":16369,"journal":{"name":"Journal of multiple sclerosis","volume":"60 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2016-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90853328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-31DOI: 10.4172/2376-0389.1000181
P. Petrou, T. Ben-Hur, A. Vaknin-Dembinsky, O. Abramsky, D. Karussis
Background: Plasma-exchange/plasmapheresis (PLEX) is an efficient treatment for several immune mediated diseases. In addition to its known efficacy in myasthenia gravis and Gulliain Barre syndrome, it has been also shown to be effective in certain patients with MS and other CNS demyelinating disorders, during an acute/sub-acute deterioration of the disease. Aims and methods: We report the results of an open prospective study with PLEX in 36 patients with progressive forms of multiple sclerosis (either secondary progressive or relapsing-progressive) and 12 patients with NMO-spectrum disease. All patients had experienced a significant clinical deterioration in the year prior to inclusion (0.5-1 degree or more, in the EDSS scale or a severe relapse from which they did not fully recover) and responded partially or not at all to steroidal treatment. The mean EDSS score at inclusion was 5.91 ± 1.46. The mean EDSS for the MS subgroup was 5.95 ± 1.3 and for the NMO subgroup, 5.6 ± 1.4. The mean duration of the disease was 11.4 ± 7.8 years (12 ± 7.6 for the MS and 5.75 4.59 for the NMO). All patients were treated with 5 courses of PLEX in 2 weeks, followed by a monthly course for one year. Results: Twenty eight of the 48 patients (58.3 %) improved significantly in the EDSS score at year one post initiation of PLEX. The mean EDSS score declined from 5.91 ± 1.46 at inclusion, to 5.41 ± 1.8 at year one. This improvement was more pronounced in the NMO group: Ten out of twelve patients with NMO (83%) improved and their mean EDSS score was reduced from 5.6 ± 1.4 before the treatment to 4.7 ± 1.5 EDSS score post PLEX. In the whole group there were 16 patients with over imposed relapses (relapsing-progressive course) with a total of 26 relapses in the year prior to the inclusion; the number of relapses during the year following PLEX was reduced from 26 to 4. In general patients with prominent myelitic involvement had the most impressive response to the treatment. Five patients suffered from minor infections and one was admitted with sepsis. No other major side effects were observed. Conclusion: PLEX may benefit some patients with progressive MS and NMO and thus may represent an alternative second line treatment modality for such patients with highly active disease, especially those with myelitic forms, and recent deterioration that did not respond to steroids. Larger, controlled studies are warranted to confirm the efficacy of PLEX in these subgroups of MS.
{"title":"Clinical Efficacy of Plasma-Exchange in Patients with Progressive forms of Multiple Sclerosis and NMO-Spectrum Disease","authors":"P. Petrou, T. Ben-Hur, A. Vaknin-Dembinsky, O. Abramsky, D. Karussis","doi":"10.4172/2376-0389.1000181","DOIUrl":"https://doi.org/10.4172/2376-0389.1000181","url":null,"abstract":"Background: Plasma-exchange/plasmapheresis (PLEX) is an efficient treatment for several immune mediated diseases. In addition to its known efficacy in myasthenia gravis and Gulliain Barre syndrome, it has been also shown to be effective in certain patients with MS and other CNS demyelinating disorders, during an acute/sub-acute deterioration of the disease. Aims and methods: We report the results of an open prospective study with PLEX in 36 patients with progressive forms of multiple sclerosis (either secondary progressive or relapsing-progressive) and 12 patients with NMO-spectrum disease. All patients had experienced a significant clinical deterioration in the year prior to inclusion (0.5-1 degree or more, in the EDSS scale or a severe relapse from which they did not fully recover) and responded partially or not at all to steroidal treatment. The mean EDSS score at inclusion was 5.91 ± 1.46. The mean EDSS for the MS subgroup was 5.95 ± 1.3 and for the NMO subgroup, 5.6 ± 1.4. The mean duration of the disease was 11.4 ± 7.8 years (12 ± 7.6 for the MS and 5.75 4.59 for the NMO). All patients were treated with 5 courses of PLEX in 2 weeks, followed by a monthly course for one year. Results: Twenty eight of the 48 patients (58.3 %) improved significantly in the EDSS score at year one post initiation of PLEX. The mean EDSS score declined from 5.91 ± 1.46 at inclusion, to 5.41 ± 1.8 at year one. This improvement was more pronounced in the NMO group: Ten out of twelve patients with NMO (83%) improved and their mean EDSS score was reduced from 5.6 ± 1.4 before the treatment to 4.7 ± 1.5 EDSS score post PLEX. In the whole group there were 16 patients with over imposed relapses (relapsing-progressive course) with a total of 26 relapses in the year prior to the inclusion; the number of relapses during the year following PLEX was reduced from 26 to 4. In general patients with prominent myelitic involvement had the most impressive response to the treatment. Five patients suffered from minor infections and one was admitted with sepsis. No other major side effects were observed. Conclusion: PLEX may benefit some patients with progressive MS and NMO and thus may represent an alternative second line treatment modality for such patients with highly active disease, especially those with myelitic forms, and recent deterioration that did not respond to steroids. Larger, controlled studies are warranted to confirm the efficacy of PLEX in these subgroups of MS.","PeriodicalId":16369,"journal":{"name":"Journal of multiple sclerosis","volume":"11 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2016-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79061129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-30DOI: 10.4172/2376-0389.1000179
Shahla Mohamadirizi
Context: Multiple Sclerosis and its treatments have been shown to have a negative psychological effect on many MS patients. Infact living with a chronic disease with an unpredictable outcome may cause psychiatric symptoms such as Obsessive-Compulsive disorder and serious impairment in eating attitudes Therefore, this study was designed with the aim of determinating of Obsessive-Compulsive Disorder Symptoms in patients with Multiple Sclerosis and its association with eating attitudes. Methods: This was a descriptive correlational study which was conducted in MS clinic located at the Ayatollah Kashani Hospital affiliated to Isfahan University of Medical Sciences, Iran, in 2013. Of MS patients in remitting course that referred to MS clinic Two hundred and ten patients were selected and completed Demographic characteristic questionnaire, Eating Disorder Examination Questionnaire (EDE-Q) and Maudsley Obsessive- Compulsive Questionnaire. The SPSS software, version11, was used to conduct statistical tests including t-test, ANOVA and Pearson correlation. Results: The mean scores of age, body mass index (BMI) and duration of illness were (33.96 ± 9.5) Years (21.6 ± 3.6) Kg.m2 and (24.3 ± 6.3) months, respectively. Most patients were married (66.1%), without university education (62.8%) and with moderate incomes (63%). Majority of the patients had received beta-interferon) (65%) as their main treatment. In addition, mean ± SD of eating disorder and Obsessive-Compulsive disorder scores were 4.9 ± 0.8and17.6 ± 4.5, respectively. Also 48.1 % of MS patients had the Obsessive-Compulsive disorder symptoms and 19.1% showed eating disorder. There was a significant positive correlation between the Obsessive-Compulsive score and eating disorder scores(r=0.32, p ≤ 0.05). Conclusion: The findings of this study showed that majority of the patients with MS had experienced symptoms of eating disorders and Obsessive-Compulsive disorder. The findings of this study can assist health care team in order to pay more attention to eating disorders and Obsessive-Compulsive disorder in patients with multiple sclerosis and also considering nutritional problems during disease in their evaluations. Furthermore there was correlation between the Eating Disorder Symptoms and Obsessive Compulsive in MS patients. Also patient education by nurses regarding nutritional problems in during disease can be effective in early diagnosing and identifying such disorders.
{"title":"The Survey of Obsessive-Compulsive Disorder Symptoms in Patients with Multiple Sclerosis and Its Association with Eating Attitudes","authors":"Shahla Mohamadirizi","doi":"10.4172/2376-0389.1000179","DOIUrl":"https://doi.org/10.4172/2376-0389.1000179","url":null,"abstract":"Context: Multiple Sclerosis and its treatments have been shown to have a negative psychological effect on many MS patients. Infact living with a chronic disease with an unpredictable outcome may cause psychiatric symptoms such as Obsessive-Compulsive disorder and serious impairment in eating attitudes Therefore, this study was designed with the aim of determinating of Obsessive-Compulsive Disorder Symptoms in patients with Multiple Sclerosis and its association with eating attitudes. Methods: This was a descriptive correlational study which was conducted in MS clinic located at the Ayatollah Kashani Hospital affiliated to Isfahan University of Medical Sciences, Iran, in 2013. Of MS patients in remitting course that referred to MS clinic Two hundred and ten patients were selected and completed Demographic characteristic questionnaire, Eating Disorder Examination Questionnaire (EDE-Q) and Maudsley Obsessive- Compulsive Questionnaire. The SPSS software, version11, was used to conduct statistical tests including t-test, ANOVA and Pearson correlation. Results: The mean scores of age, body mass index (BMI) and duration of illness were (33.96 ± 9.5) Years (21.6 ± 3.6) Kg.m2 and (24.3 ± 6.3) months, respectively. Most patients were married (66.1%), without university education (62.8%) and with moderate incomes (63%). Majority of the patients had received beta-interferon) (65%) as their main treatment. In addition, mean ± SD of eating disorder and Obsessive-Compulsive disorder scores were 4.9 ± 0.8and17.6 ± 4.5, respectively. Also 48.1 % of MS patients had the Obsessive-Compulsive disorder symptoms and 19.1% showed eating disorder. There was a significant positive correlation between the Obsessive-Compulsive score and eating disorder scores(r=0.32, p ≤ 0.05). Conclusion: The findings of this study showed that majority of the patients with MS had experienced symptoms of eating disorders and Obsessive-Compulsive disorder. The findings of this study can assist health care team in order to pay more attention to eating disorders and Obsessive-Compulsive disorder in patients with multiple sclerosis and also considering nutritional problems during disease in their evaluations. Furthermore there was correlation between the Eating Disorder Symptoms and Obsessive Compulsive in MS patients. Also patient education by nurses regarding nutritional problems in during disease can be effective in early diagnosing and identifying such disorders.","PeriodicalId":16369,"journal":{"name":"Journal of multiple sclerosis","volume":"32 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2016-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86122028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-15DOI: 10.4172/2376-0389.1000e108
Patricia Jm, I. Sz
To bring new drugs and therapies to the clinic, preclinical studies are mandated to establish the efficacy and possible mechanism of action. For the best results, animal models that closely mimic the target disease are required. Prior to initiating large-scale multi-centered clinical trials, the Food and Drug Administration in the United States often dictates that the efficacy and safety of new drugs need to be demonstrated in two animal models, and not just two different strains of mice. This set of rules has not always been followed when testing drugs for autoimmune diseases. Given that many of these diseases, including fibromyalgia, multiple sclerosis, arthritis, and even autism fall into spectrums of disorders, determining an appropriate animal model is complicated. With regard to multiple sclerosis, the primary animal model is experimental autoimmune encephalomyelitis (EAE) [1,2]. In mouse or rat models of EAE, there are several ways to induce the disorder including viral infection, genetic or adoptive transfer of activated T cells, or chemical/antibody producing systemic injections [1-5]. These models have been described by numerous investigators with each pointing out the strengths and weaknesses [2,6,7]. However, less attention is paid to the major form of MS which is a relapsingremitting form, and few animal models of EAE provide a reliable and consistent profile of this disease. Viral infection and adoptive transfer result in a progressive form of EAE – most likely mimicking chronic progressive MS. However, chronic progressive MS only affects 15% of the population, leaving a majority of the people with relapsingremitting MS at onset without a reasonable animal model.
为了将新的药物和疗法推向临床，临床前研究的任务是确定疗效和可能的作用机制。为了获得最佳结果，需要密切模仿目标疾病的动物模型。在开始大规模的多中心临床试验之前，美国食品和药物管理局(Food and Drug Administration)经常规定，新药的有效性和安全性需要在两种动物模型上进行验证，而不仅仅是在两种不同的小鼠身上进行验证。在检测自身免疫性疾病的药物时，并不总是遵循这一套规则。考虑到许多这些疾病，包括纤维肌痛、多发性硬化症、关节炎，甚至自闭症都属于疾病谱系，确定一个合适的动物模型是很复杂的。对于多发性硬化症，主要的动物模型是实验性自身免疫性脑脊髓炎(EAE)[1,2]。在小鼠或大鼠EAE模型中，有几种诱导疾病的方法，包括病毒感染，活化T细胞的遗传或过继转移，或产生化学/抗体的全身注射[1-5]。这些模型已经被许多研究者描述过，每个研究者都指出了它们的优缺点[2,6,7]。然而，很少有人关注MS的主要形式，即复发缓解型，并且很少有EAE的动物模型提供该疾病的可靠和一致的特征。病毒感染和过继性转移导致EAE的进行性形式-很可能模仿慢性进行性MS。然而，慢性进行性MS仅影响15%的人群，使得大多数发病时复发缓解型MS的患者没有合理的动物模型。
{"title":"Importance of the Non-responder in Deciphering Animal Behavior of Experimental Autoimmune Encephalomyelitis","authors":"Patricia Jm, I. Sz","doi":"10.4172/2376-0389.1000e108","DOIUrl":"https://doi.org/10.4172/2376-0389.1000e108","url":null,"abstract":"To bring new drugs and therapies to the clinic, preclinical studies are mandated to establish the efficacy and possible mechanism of action. For the best results, animal models that closely mimic the target disease are required. Prior to initiating large-scale multi-centered clinical trials, the Food and Drug Administration in the United States often dictates that the efficacy and safety of new drugs need to be demonstrated in two animal models, and not just two different strains of mice. This set of rules has not always been followed when testing drugs for autoimmune diseases. Given that many of these diseases, including fibromyalgia, multiple sclerosis, arthritis, and even autism fall into spectrums of disorders, determining an appropriate animal model is complicated. With regard to multiple sclerosis, the primary animal model is experimental autoimmune encephalomyelitis (EAE) [1,2]. In mouse or rat models of EAE, there are several ways to induce the disorder including viral infection, genetic or adoptive transfer of activated T cells, or chemical/antibody producing systemic injections [1-5]. These models have been described by numerous investigators with each pointing out the strengths and weaknesses [2,6,7]. However, less attention is paid to the major form of MS which is a relapsingremitting form, and few animal models of EAE provide a reliable and consistent profile of this disease. Viral infection and adoptive transfer result in a progressive form of EAE – most likely mimicking chronic progressive MS. However, chronic progressive MS only affects 15% of the population, leaving a majority of the people with relapsingremitting MS at onset without a reasonable animal model.","PeriodicalId":16369,"journal":{"name":"Journal of multiple sclerosis","volume":"16 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2016-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74524481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-30DOI: 10.4172/2376-0389.1000178
D. Johannes, K. Martin, Olga, S. Makbule, R. Daniela, F. Panteha, H. Anna, E. Sonja, F. Tanja, T. Daniela, G. Regina, J. Sarah, S. Joachim, Albert Cl, T. Hayrettin
Abstract Objective: Immunoadsorption (IA) is increasingly recognized as a promising and low-risk therapy option in a variety of autoimmune neurologic disorders. Along with plasma exchange (PE) it is considered as a second line therapy in multiple sclerosis (MS) and optic neuritis (ON) and usually regarded as a therapy option in case of steroid-refractory relapse in most guidelines. However, systematic prospective data is missing, especially regarding modern efficient adsorber systems with regenerating columns. The aim of this study was to provide efficacy and tolerability data in patients with steroid-refractory multiple sclerosis and optic neuritis. Methods: We prospectively investigated the clinical course of 25 patients with steroid-refractory relapse of MS or ON who were treated with IA using regenerating protein A columns. IA was performed on 5 consecutive days, and 2- to 2.5-fold plasma volumes were processed each day. As objective outcome parameters, Expanded Disability Status Scale (EDSS) and visual acuity measurement were conducted before as well as on day 5 of IA and 14 days after treatment. Additionally, adverse events and laboratory data were collected. Results: After 14 days, mean EDSS improved from 3.4 ± 2.0 to 2.3 ± 2.0 (p=0.001), and visual acuity improved from 0.39 ± 0.33 to 0.66 ± 0.36 (p=0.01). Response rate was 64%. No relevant adverse events were observed. IA was effective even in patients with long latency since relapse, defined as a time of >6 weeks between first symptoms and treatment. Interpretation: Our data provide preliminary evidence that immunoadsorption with regenerating columns is an effective and well-tolerated treatment option for steroid-refractory MS and ON and might even be considered for patients with long latency since relapse. However, our results have to be confirmed by a randomized controlled trial with a higher number of subjects, and additional studies are needed to compare efficacy of IA and PE.
{"title":"Immunoadsorption with Regenerating Columns in Treatment of Steroid-Refractory Relapse in Multiple Sclerosis and Optic Neuritis","authors":"D. Johannes, K. Martin, Olga, S. Makbule, R. Daniela, F. Panteha, H. Anna, E. Sonja, F. Tanja, T. Daniela, G. Regina, J. Sarah, S. Joachim, Albert Cl, T. Hayrettin","doi":"10.4172/2376-0389.1000178","DOIUrl":"https://doi.org/10.4172/2376-0389.1000178","url":null,"abstract":"Abstract \u0000 Objective: \u0000Immunoadsorption (IA) is increasingly recognized as a promising and low-risk therapy option in a variety of autoimmune neurologic disorders. Along with plasma exchange (PE) it is considered as a second line therapy in multiple sclerosis (MS) and optic neuritis (ON) and usually regarded as a therapy option in case of steroid-refractory relapse in most guidelines. However, systematic prospective data is missing, especially regarding modern efficient adsorber systems with regenerating columns. The aim of this study was to provide efficacy and tolerability data in patients with steroid-refractory multiple sclerosis and optic neuritis. \u0000Methods: We prospectively investigated the clinical course of 25 patients with steroid-refractory relapse of MS or ON who were treated with IA using regenerating protein A columns. IA was performed on 5 consecutive days, and 2- to 2.5-fold plasma volumes were processed each day. As objective outcome parameters, Expanded Disability Status Scale (EDSS) and visual acuity measurement were conducted before as well as on day 5 of IA and 14 days after treatment. Additionally, adverse events and laboratory data were collected. \u0000Results: \u0000After 14 days, mean EDSS improved from 3.4 ± 2.0 to 2.3 ± 2.0 (p=0.001), and visual acuity improved from 0.39 ± 0.33 to 0.66 ± 0.36 (p=0.01). Response rate was 64%. No relevant adverse events were observed. IA was effective even in patients with long latency since relapse, defined as a time of >6 weeks between first symptoms and treatment. \u0000Interpretation: \u0000Our data provide preliminary evidence that immunoadsorption with regenerating columns is an effective and well-tolerated treatment option for steroid-refractory MS and ON and might even be considered for patients with long latency since relapse. However, our results have to be confirmed by a randomized controlled trial with a higher number of subjects, and additional studies are needed to compare efficacy of IA and PE.","PeriodicalId":16369,"journal":{"name":"Journal of multiple sclerosis","volume":"3 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2016-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89923508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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