Multiple Sclerosis Journal最新文献

This study evaluated the association between pediatric multiple sclerosis and vaccinations within 5 years before diagnosis using German ambulatory claims data. Children with multiple sclerosis (n = 346) aged 9-17 were analyzed with logistic and Poisson regression. Control groups included children with Crohn's disease, psoriasis, and no autoimmune diseases. The results indicated a negative association between vaccinations and pediatric multiple sclerosis, with no significant risk identified. This negative relationship was consistent in sensitivity and clinically isolated syndrome analyses. Overall, the study's findings do not support the hypothesis that vaccination is a risk factor for pediatric multiple sclerosis.

Background: Women have a higher risk of developing multiple sclerosis (MS), potentially due to hormonal factors. Elevated testosterone levels, common in polycystic ovary syndrome (PCOS), might influence MS risk.

Objective: To investigate the relationship between PCOS, as a proxy for elevated testosterone levels, and MS risk through phenotypic and genomic analysis.

Methods: Cox regression models analysed the association between PCOS and MS risk. The genome-wide cross-trait analysis examined the genetic architecture.

Results: In a Swedish cohort of 1,374,529 women, 77 (0.3%) with PCOS and 3,654 (0.3%) without PCOS were diagnosed with MS. After adjusting for birth year and obesity, no association was found between PCOS and MS (HR = 0.91, 95% CI = 0.72-1.15), which was confirmed by Mendelian randomization analysis, where genetically predicted PCOS propensity, sex hormone-binding globulin (SHBG), or testosterone levels did not causally affect MS risk (all p-values > 0.05). By exploring horizontal pleiotropy, we identified shared genetic regions and 19 independent pleiotropic SNPs for SHBG with MS and 11 for testosterone with MS.

Conclusion: We did not find evidence for a causal role of PCOS, as a proxy of elevated testosterone, in reducing the risk of MS in women. The shared genetic loci between testosterone, SHBG, and MS provide biological insights.

The role of exercise as a therapeutic intervention in multiple sclerosis (MS) has shifted over time. Early views surrounding exercise in MS advocated for caution against participation. With increasing evidence, perspectives shifted to promote exercise as a therapeutic approach for symptom management. Recent efforts have focused on understanding the potential disease-modifying effects of exercise in MS, although this work is still in its infancy. While efforts continue to optimize exercise prescriptions and unravel underlying mechanisms of exercise effects, current knowledge and implementation gaps limit the accessibility of exercise as therapy for all people living with MS. This topical review is based on an invited presentation on 'Exercise as a Therapeutic Intervention in MS' delivered at the ACTRIMS Forum 2024. The review summarizes current evidence for the role of exercise as a therapeutic intervention in MS from symptomatic to disease-modifying potential. We highlight directions for future research efforts to advance our understanding of potential exercise benefits and translate findings into real-world contexts for people living with MS.

Multiple sclerosis (MS) susceptibility and prognosis vary by race and ethnicity in the USA. MS incidence is highest in Black individuals and, among individuals under the age of 35, so is the prevalence. Although MS incidence and prevalence is lower among Hispanic and particularly Asian/Pacific Islands compared to White people, among Hispanic and White people under the age of 25, the prevalence is similar. MS-related disability accrues faster, and mortality is higher at younger ages among Black compared to White people. But these differences are not due to genetics because: 1) race and ethnicity are social constructs rather than genetically or biologically distinct entities; 2) MS prognosis is not driven by genetics; 3) MS susceptibility is mostly due to environmental factors, including Epstein Barr (EBV) infection and pediatric obesity; and 4) there is a far more plausible explanation - embodied racism.

People with multiple sclerosis (PwMS) experience many barriers to accessing multiple sclerosis (MS) care that lead to diagnostic delays, delayed treatment, interrupted care, and significant economic burden. These barriers include limited geographic healthcare resources, financial burden, physical limitations, and inequities within the healthcare system. Telemedicine has the potential to reduce these barriers and improve access to care. The lack of geographic proximity to neurologists and MS Centers can be overcome by leveraging telemedicine which has been shown to significantly reduce travel burden. Furthermore, cross-sectional studies have shown telemedicine reduces indirect costs for PwMS including significantly lower mean costs in parking, gas, tolls, and wages lost compared to in-person visits. Although there has been evidence that telemedicine can reduce many barriers there is still a need to demonstrate the impact of longitudinal telemedicine care and its direct impact on access to MS care.

Randomized controlled trials (RCTs) provide the foundation of evidence-based practice for the application of rehabilitation as complementary of medications for filling in the gaps and enhancing outcomes in people with multiple sclerosis (MS). This paper identifies seven field-wide areas of relevance for RCTs of rehabilitation that are barriers for (a) knowledge translation and implementation, (b) impact among those who most need rehabilitation, and (c) the field and its value in comprehensive MS care. The seven field-wide areas include improving the quality of RCTs; implementing discovery models for informing selection of interventions; focusing on primary end-points in samples screened for presence of symptoms/dysfunction; exploring response heterogeneity as an avenue for precision medicine; quantifying adherence and compliance for guiding future prescriptions; understanding mechanisms of outcomes through experimental medicine; and extending research into under-researched populations. These field-wide areas represent unmet needs for (a) optimizing quality of life and full participation through evidence-based rehabilitation among all people with MS, (b) reducing burdens and strains among caregivers, and (c) minimizing the financial and societal impact of MS.

Background: Information on symptomatic therapy (ST) use in women of childbearing age with multiple sclerosis is sparse, and data on the impact of ST pregnancy exposure on pregnancy outcome are lacking.

Objective: To investigate (1) ST use patterns pre-conception, during pregnancy and postpartum and (2) pregnancy outcomes.

Methods: Pregnancy data from the German Multiple Sclerosis and Pregnancy Registry were analyzed for the ST use from pre-conception to postpartum. Pregnancy outcomes were compared between ST-exposed (n = 282) and matched (disease modifying therapy and age) ST-naive (n = 536) pregnancies.

Results: Of 2,449 pregnancies, 1,053 (43.0%) received ST anytime between pre-conception and postpartum, 282 (11.5%) at pre-conception and during pregnancy. The most commonly used drug classes were antidepressants (24.8%), analgetics (31.0%), and anticonvulsives (8.7%). Exposure to ST during pregnancy did not result in an increased incidence of adverse pregnancy outcomes, major congenital abnormalities, or pregnancy complications.

Conclusion: Nearly 50% of women used ST between pre-conception and postpartum, but only 12% pre-conception and during pregnancy. ST use during pregnancy did not adversely affect pregnancy outcomes in our cohort. More data are needed to analyze the effect of ST on pregnancy and fetal outcomes stratified by drug to improve recommendations for ST use in family planning.

Background: Rapidly reversible weakness with neck flexion (McArdle sign) is common in patients with multiple sclerosis (MS). The pathophysiology is unknown.

Objective: To evaluate changes in central motor conduction time (CMCT) in patients with and without McArdle sign.

Methods: We measured McArdle sign with a torque cell and CMCT with neck flexed and extended in patients with MS, other causes of myelopathy, and healthy controls.

Results: CMCT was prolonged with neck flexion disproportionately in those with MS-associated myelopathy (MSAM) with prominent McArdle sign compared to MS patients with lesser degrees of McArdle sign, and to controls.

Conclusion: McArdle sign may result from stretch-induced slowing of conduction due to demyelination.