Multiple Sclerosis Journal最新文献

Background: Seizures are associated with reduced cognition in the general population and worse outcomes in people with multiple sclerosis (pwMS). Yet, it remains unclear whether seizures are linked to cognitive dysfunction in pwMS.

Objectives: To evaluate the connection between seizure history and poorer cognition in pwMS.

Methods: A consecutive sample of 803 pwMS reported any prior seizures. Covariates included age, sex, Wechsler Test of Adult Reading scores, educational years, Expanded Disability Status Scale (EDSS) scores, disease duration, disease subtype, high-efficacy disease-modifying therapy use, Hospital Anxiety and Depression Scale scores for anxiety and depression and Modified Fatigue Impact Scale scores. Linear regression analyses, controlling for covariates, were undertaken to predict Minimal Assessment of Cognitive Function in MS scores from seizure history.

Results: Mean age was 44.01 years (SD = 11.58), 76.84% were female, and median EDSS was 2.0 (interquartile range (IQR) = 1.5-3.5). Accounting for covariates, people with seizures (n = 43, 5.35%) performed worse than those without (n = 760) on Judgement of Line Orientation (β = -0.09, p < 0.01), California Verbal Learning Test-II learning (β = -0.08, p < 0.01) and memory (β = -0.10, p < 0.01), Brief Visuospatial Memory Test-Revised learning (β = -0.08, p = 0.01) and memory (β = -0.07, p = 0.05), Symbol Digit Modalities Test (β = -0.06, p = 0.04), Paced Auditory Serial Addition Test (β = -0.10, p < 0.01) and Delis-Kaplan Executive Function System (β = -0.07, p = 0.02).

Conclusions: A seizure history independently predicts reduced cognition in pwMS.

Background: Smoking and vascular risk factors (VRFs) are reported to have adverse effects in multiple sclerosis but data are limited in aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD). This study aimed to measure their impact on disability.

Methods: Smoking status was defined as never, past or current smokers and VRF comprised of ⩾1: hypertension, dyslipidemia, high body mass index or diabetes. Logistic regression models were fitted to predict their influence on recovery from onset attack and first optic neuritis (ON) attack.

Results: A total of 442 patients were included. Current MOGAD smokers had a higher risk of disability from onset attack and first ON attack than never smokers (odds ratio (OR) 2.9, 95% confidence interval (CI) 1.3-6.9; OR 3.3, 95% CI 1.4-7.8). VRF in MOGAD was not predictive of disability. Current AQP4-NMOSD smokers and VRFs had a higher risk of residual disability from onset attacks (OR 7.5, 95% CI 2.1-27.7; OR 1.9, 95% CI 1.0-3.4). VRF was associated with higher risk of visual disability (OR 2.6, 95% CI 1.08-6.46) while smoking status was not.

Conclusions: Current smoking status detrimentally influenced onset attack recovery in AQP4-NMOSD and MOGAD patients, including visual recovery in MOGAD. Non-smoking VRFs influenced clinical and visual outcomes in AQP4-NMOSD.

Background: The complement system has been suspected to play a role in multiple sclerosis (MS) due to presence of complement activation products in MS lesions.

Objective: We sought to understand whether variation in the complement component 4 (C4) gene is associated with MS.

Methods: Here we used next-generation sequencing and our novel bioinformatics tool, C4Investigator, to interrogate C4 copy number variation in MS.

Results: We found higher overall copy number of C4 in controls (p < 10^-16, odds ratio (OR) = 0.43, 95% confidence interval (CI): 0.37-0.49) compared to MS patients with European ancestry.

Conclusion: This finding suggests that lower C4 copies confer risk for MS, similar to associations seen in other autoimmune disorders.

Background: Sacral neuromodulation (SNM) is commonly used in the treatment of overactive bladder, but few studies have evaluated its efficacy in patients with multiple sclerosis (MS).

Objectives: To assess the efficacy of SNM in the treatment of neurogenic overactive bladder (nOAB) in patients with MS.

Methods: All MS patients that underwent a two-stage SNM to treat nOAB between 2013 and 2023 in four university hospitals were considered eligible. The primary outcome was clinical efficacy, defined as the implantation of an implantable pulse generator (IPG). Secondary outcome included the Patient Global Impression of Improvement (PGI-I), the 3-day bladder diary parameters and the maintenance of efficacy within 5 years.

Results: A total of 38 patients were included. The IPG was implanted in 33 patients (87%). The median daily (9.0 to 7.0; p < 0.001) and nocturnal (2.5 to 1.0; p < 0.01) number of micturition/clean self-intermittent catheterization (CISC), the presence of urinary urgency (97% vs 58%; p < 0.01) and urinary incontinence (84% vs 25%, p < 0.001) significantly decreased at the end of the test phase. Efficacy was maintained at 5 years in 46% of cases.

Conclusions: In MS patients with nOAB, SNM exhibits clinical efficacy comparable to that observed in the non-neurological population.

Background: Vaccination in patients with multiple sclerosis (PwMS) presents unique challenges. Disease-modifying therapies (DMTs) can increase infectious risks, though these are largely preventable through immunizations. However, DMTs can also reduce vaccine efficacy.

Aims: This study aimed to identify challenges in achieving effective immunization for PwMS and explore strategies to optimize vaccination practices.

Methods: Recent guidelines and studies on vaccination in PwMS were reviewed to pinpoint challenges, unmet needs, and opportunities for improvement.

Results: Early immunization before DMT initiation is vital for optimal responses, coordinating vaccinations with DMTs' presents challenges. Strategies to enhance vaccine efficacy, such as bridging therapies or more immunogenic formulations, may benefit highly active patients requiring immediate DMT initiation. Although live-attenuated vaccines pose challenges for those on immunosuppressive therapies, emerging evidence suggests safe administration in select cases. Overcoming vaccine hesitancy demands targeted education, personalized counseling, and improved access to services, especially in low- and middle-income countries. Inclusivity is crucial, particularly for groups, such as pediatric, pregnant, and elderly PwMS.

Conclusion: A multifaceted approach is essential to addressing vaccination challenges in PwMS. Collaborative efforts involving multiple stakeholders are crucial for overcoming these obstacles and generating robust evidence. We propose an integrated strategy to ensure effective immunization while maintaining timely DMT administration.

Radiologically isolated syndrome (RIS) is the earliest documented stage in the disease continuum of multiple sclerosis (MS). It is discovered incidentally in individuals who are asymptomatic but have typical lesions in the brain or spinal cord suggestive of autoimmune inflammatory demyelination. The revised 2023 RIS criteria aim to secure an accurate and timely diagnosis due to the presence of imaging mimics. These criteria require having at least one T2-weighted hyperintense lesion in one of the four suggestive MS locations along with two of the following three features: spinal cord lesion, cerebrospinal fluid (CSF)-restricted oligoclonal bands, or new T2 or gadolinium-enhancing lesion observed on a subsequent magnetic resonance imaging (MRI) study. Once the diagnosis is confirmed, established risk factors, including age, lesion location and CSF, significantly improve prognostic stratification, which is crucial for immunoactive interventions. Recent clinical trials have shown that oral disease-modifying treatments can delay or prevent the first clinical event in RIS patients. Consulting with an MS team for each RIS case is strongly recommended to enhance care and disease surveillance. The revised 2024 McDonald criteria will classify individuals with additional CSF and advanced MRI biomarkers as having preclinical MS, highlighting the importance of vigilance in this area.