Multiple Sclerosis Journal最新文献

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: Although gastrointestinal (GI) adverse reactions (ARs) were commonly observed in registrational clinical trials of fumarate acid ester (FAE) drugs for the treatment of multiple sclerosis, serious GI reactions were uncommon.

Objective: The objective of the study is to describe the serious GI ARs that supported the post-market safety labeling change for FAE drugs.

Methods: Review of the FDA Adverse Events Reporting System (FAERS) database and published medical literature was conducted to identify cases of serious GI events in patients taking FAE drugs.

Results: Forty-nine cases of GI ARs with clinical events of perforation, ulceration, hemorrhage, or obstruction causally associated with FAE drug use were identified. Most cases occurred within 4 months of FAE drug initiation and required hospitalization. Ten of the cases required red blood cell transfusions, nine cases required surgical intervention, and two cases resulted in a fatal outcome.

Conclusion: Review of postmarketing reports supported the identification of a class association between FAE drugs and serious GI ARs. As these reactions have implications for prescribing decisions and patient management, a safety labeling change was issued to add serious GI reactions to the Warnings and Precautions section of the prescribing information for FAE drugs.

Background: Optic neuritis (ON) is a multifactorial condition with a strong association with ethnicity.

Objectives: We conducted a retrospective cohort study in a Caribbean Island, Martinique, French West Indies to assess the incidence and characteristics of ON among an Afro-descendant (AD) population.

Methods: We reviewed medical records of all patients presenting ON at the Fort de France University Hospital, Martinique between 2018 and 2022. We analysed clinical, paraclinical, and biological examinations at onset and during follow-up (6 months, 1, 2 and 3 years). ON was confirmed after a neuro-ophthalmological evaluation according to the latest criteria defined in the Lancet, 2022.

Results: Overall, 44 patients with a condition suggestive of ON were evaluated, out of which 29 fulfilled the criteria for ON. The overall incidence was 1.61 (95% CI: 1.12-2.08) per 100,000 person-years. The final diagnosis was distributed as follows: neuromyelitis optica spectrum disorder (NMOSD) (10%), myelin oligodendrocyte glycoprotein (MOG) ON (20%), multiple sclerosis (35%), single isolated ON (24%), relapsing isolated ON (7%) and (4%) unclassified diagnosis.

Conclusion: This is the first cohort study assessing the incidence of ON and its characteristics among AD. We found a high proportion of severe disease, such as NMOSD and MOG-associated disease.

Background: Multiple studies identified an association between migraines and multiple sclerosis (MS).

Objective: To investigate whether migraines increase MS risk or are part of the MS prodrome.

Methods: Incident MS cases and matched controls completed structured interviews that included a detailed headache and MS history. Participants were classified as having migraines if they fulfilled the third edition of the International Classification of Headache Disorders criteria. The association between migraine onset concurrent with or before the first MS symptom/index date was estimated using multivariable logistic regression.

Results: Among the 591 MS cases (70.6% females, 42.0% White), 21.2% developed migraines concurrent with or before the onset of MS compared to 18.7% of the 651 controls (70.4% females, 42.1% White, adjusted odds ratio (aOR) = 1.15, 95% confidence interval (CI) = 0.87-1.53). Migraine onset was more likely to occur either concurrently or 1 year before MS symptom onset/index date among MS cases (n = 18, 14.4%) than controls (n = 8, 6.6%; aOR = 2.52, 95% CI = 1.08-5.86, p = 0.032). However, not when restricted to only those with migraine onset before MS onset.

Conclusion: Migraine was associated with an increased odds of MS only when co-occurrence was considered. These findings imply that migraines are part of the constellation of MS onset symptoms rather than a risk factor for or prodromal symptom of MS.

Background: Autologous hematopoietic stem cell transplantation (AHSCT) is a therapeutic intervention for multiple sclerosis (MS) that has gained increased attention in the last decade. The impact of this intervention on the quality of life (QoL) of patients with MS remains unclear.

Objective: The aim of this study was to investigate the impact of AHSCT on QoL in patients with MS using Multiple Sclerosis Impact Scale (MSIS-29) scores.

Methods: In this observational retrospective cohort study, patients with relapsing-remitting MS treated with AHSCT in Sweden from 2004, when the first transplant was performed, until 31 December 2019, were considered for participation. Anonymized outcome data were extracted from the Swedish MS registry in May 2022.

Results: Out of 213 patients assessed for eligibility in the study, 96 were included in the final analysis. After a median follow-up of 5.2 (IQR 3.2-6.8) years, 58% improved, 14% remained unchanged and 28% worsened in the physical domain of the MSIS-29. In the psychological domain, 63% improved, 18% remained unchanged and 19% worsened. Improvements in both domains occurred early, within the first year following intervention.

Conclusions: Treatment intervention with AHSCT is associated with a clinically meaningful improvement in QoL.

Background: Mobility assessment is essential for monitoring disease progression in people with multiple sclerosis (PwMS). Technologies such as wearable sensors show potential for this purpose, but consensus is needed to optimize collection and interpretation of digital measures in PwMS.

Objective: To propose a framework for measuring and interpreting key aspects of impaired gait in PwMS using a smartphone worn at the waist level.

Methods: The framework was developed on the basis of clinical understanding and knowledge of sensor signal processing, supported by a systematic literature review (SLR). The SLR targeted articles published after 2011 that measured gait characteristics in PwMS. Findings were used to propose standardized definitions for complementary gait domains and define digital measures that should be captured for each domain.

Results: The resulting framework for PwMS recommends definitions for pace, rhythm, stability, symmetry, variability, smoothness, complexity and fatigability gait domains. For each domain, a set of digital measures is described with respect to their interpretability and associated caveats.

Conclusion: This framework provides recommendations for measuring complex gait patterns in PwMS using widely available technology. This work promotes the use of standardized gait domain definitions and harmonized descriptions of associated digital measures, paving the way for future validation efforts.

Background: People living with multiple sclerosis (PwMS) are at risk of experiencing communication difficulties that can limit their vocational outcomes.

Objective: To investigate clinical and cognitive variables that may contribute to communication restrictions in PwMS, and to evaluate how these factors affect vocational status.

Methods: In this cross-sectional study, 502 PwMS underwent clinical and cognitive assessment tasks and were administered self-reported measures assessing fatigue and mood. The communication and language assessment questionnaire for persons with multiple sclerosis (CLAMS) was also administered.

Results: Performance in information processing speed (p < 0.001), the presence of dysarthria (p < 0.001) and levels of self-reported fatigue (p < 0.001) were independent predictors of communication difficulties. Higher levels of communication difficulties were associated with a higher risk of unemployment and allowance (area under the receiver operating characteristic curve 0.649, p < 0.001 and 0.749, p < 0.001, respectively).

Conclusion: Cognitive deficits, high levels of fatigue and the presence of dysarthria may independently contribute to communication difficulties in PwMS regardless of disease type or disability levels. These factors are associated with poorer vocational outcomes, highlighting the need for targeted interventions to support effective communication and improve employment prospects for this population.