Pub Date : 2026-01-13DOI: 10.1016/j.msard.2026.106997
Noah G. DuBose , Sydney R. DeJonge , Trevor B. Martin , Petra Šilić , Ariel Kidwell-Chandler , Bo Fernhall , Lara A. Pilutti , Robert W. Motl
Background
Multiple sclerosis (MS) is associated with vascular comorbidity that increases with age. Vascular function (VF) is associated with vascular comorbidity and outcomes such as cognition, fatigue, and disability in MS. Age predicts VF in the general population, yet this relationship is unknown in MS.
Objectives/Methods
This study compared MS (n=129) and controls (n=51) based on carotid-femoral pulse wave velocity (PWV) and heart rate-corrected augmentation index (AIx75) and examined age as a predictor of PWV and AIx75.
Results
The samples did not differ based on age, sex or body mass index (BMI). PWV was higher in MS than controls (7.2 m/s vs. 6.6 m/s), whereas AIx75 was not different (21.3 % vs. 18.7 %). Regression analysis indicated that after controlling for BMI and mean arterial pressure (MAP), age remained a significant predictor of PWV only in MS (β = 0.256, p<0.01). After controlling for sex, expanded disability status scale (EDSS) scores, disease duration, and MAP, age remained a significant predictor of AIx75 in MS (β = 0.371, p<0.01), as well as in controls after controlling for sex, BMI, and MAP (β = 0.347, p<0.01).
Conclusions
These results suggest that age predicts VF in MS and establish the need for future research that examines VF across the lifespan in MS.
背景：多发性硬化症（MS）与血管合并症相关，且随年龄增长而增加。血管功能（VF）与MS的血管共病和结果相关，如认知、疲劳和残疾。年龄可以预测一般人群的VF，但在MS中这种关系尚不清楚。目的/方法本研究基于颈动脉-股动脉脉搏波速度（PWV）和心率校正增强指数（AIx75）对MS （n=129）和对照组（n=51）进行比较，并检验年龄作为PWV和AIx75的预测因子。结果样本的年龄、性别和身体质量指数（BMI）没有差异。MS患者的PWV高于对照组（7.2 m/s vs. 6.6 m/s），而AIx75患者的PWV无显著差异（21.3% vs. 18.7%）。回归分析显示，在控制BMI和平均动脉压（MAP）后，年龄仍然是MS患者PWV的显著预测因子（β = 0.256, p<0.01）。在控制性别、扩展残疾状态量表（EDSS）评分、疾病持续时间和MAP后，年龄仍然是MS患者AIx75的显著预测因子（β = 0.371, p<0.01），在控制性别、BMI和MAP后，年龄仍然是对照组AIx75的显著预测因子（β = 0.347, p<0.01）。这些结果表明年龄可以预测多发性硬化症的VF，并确定了未来研究在整个生命周期中检查VF的必要性。
{"title":"Association between chronological age and vascular function in adults with and without multiple sclerosis","authors":"Noah G. DuBose , Sydney R. DeJonge , Trevor B. Martin , Petra Šilić , Ariel Kidwell-Chandler , Bo Fernhall , Lara A. Pilutti , Robert W. Motl","doi":"10.1016/j.msard.2026.106997","DOIUrl":"10.1016/j.msard.2026.106997","url":null,"abstract":"<div><h3>Background</h3><div>Multiple sclerosis (MS) is associated with vascular comorbidity that increases with age. Vascular function (VF) is associated with vascular comorbidity and outcomes such as cognition, fatigue, and disability in MS. Age predicts VF in the general population, yet this relationship is unknown in MS.</div></div><div><h3>Objectives/Methods</h3><div>This study compared MS (n=129) and controls (n=51) based on carotid-femoral pulse wave velocity (PWV) and heart rate-corrected augmentation index (AIx75) and examined age as a predictor of PWV and AIx75.</div></div><div><h3>Results</h3><div>The samples did not differ based on age, sex or body mass index (BMI). PWV was higher in MS than controls (7.2 m/s vs. 6.6 m/s), whereas AIx75 was not different (21.3 % vs. 18.7 %). Regression analysis indicated that after controlling for BMI and mean arterial pressure (MAP), age remained a significant predictor of PWV only in MS (β = 0.256, p<0.01). After controlling for sex, expanded disability status scale (EDSS) scores, disease duration, and MAP, age remained a significant predictor of AIx75 in MS (β = 0.371, p<0.01), as well as in controls after controlling for sex, BMI, and MAP (β = 0.347, p<0.01).</div></div><div><h3>Conclusions</h3><div>These results suggest that age predicts VF in MS and establish the need for future research that examines VF across the lifespan in MS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106997"},"PeriodicalIF":2.9,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1016/j.msard.2026.106993
Vihaan Sahu
{"title":"Defining highly active multiple sclerosis: Survey bias and the interpretation of clinical definitions","authors":"Vihaan Sahu","doi":"10.1016/j.msard.2026.106993","DOIUrl":"10.1016/j.msard.2026.106993","url":null,"abstract":"","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106993"},"PeriodicalIF":2.9,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: While spinal cord atrophy (SCA) is increasingly recognized as a contributor to disability in multiple sclerosis (MS), it is still unclear how spinal cord atrophy contributes to the clinical course of MS when brain atrophy is taken into account. This study aimed to characterize the longitudinal course and clinical correlates of SCA in MS patients without significant brain atrophy progression.
Methods
: In this multicenter, retrospective observational study, 120 MS patients with brain MRI data acquired approximately 2 years apart were enrolled. Brain and spinal cord atrophy were quantified using SIENA/X and JIM9, respectively. Patients were stratified by evidence of disease activity and brain atrophy to evaluate SCA progression independently of inflammatory activity.
Results
: Although 64.2% of patients achieved no evidence of disease activity (NEDA) -3 and 40.8% met NEDA-4 criteria, a non-negligible degree of the SCA (−0.791 ± 1.97% / year) as well as the brain volume loss (BVL) (−0.381 ± 0.553% / year) was observed. SCA correlated weakly with BVL but not with T2 lesion volume in the brain or clinical disease activity. Among patients who fulfilled the NEDA-4 criteria, those with greater rates of SCA unexpectedly exhibited significantly smaller brain T2 lesion volumes compared to those with lower atrophy rates (p = 0.041).
Discussion
: SCA may progress independently of brain inflammation or clinical activity, potentially reflecting “pure” neurodegenerative processes. Its evaluation may provide critical insight into disease progression in MS, particularly in clinically stable patients with minimal brain atrophy or lesion burden.
{"title":"Characterizing spinal cord atrophy in multiple sclerosis patients without disease activity or brain atrophy progression","authors":"Hiroaki Yokote , Yusei Miyazaki , Juichi Fujimori , Saori Adachi , Shuta Toru , Masaaki Niino , Ichiro Nakashima , Yoshiharu Miura , Yoichiro Nishida , Sonoko Misawa","doi":"10.1016/j.msard.2026.106990","DOIUrl":"10.1016/j.msard.2026.106990","url":null,"abstract":"<div><h3>Background</h3><div><strong>:</strong> While spinal cord atrophy (SCA) is increasingly recognized as a contributor to disability in multiple sclerosis (MS), it is still unclear how spinal cord atrophy contributes to the clinical course of MS when brain atrophy is taken into account. This study aimed to characterize the longitudinal course and clinical correlates of SCA in MS patients without significant brain atrophy progression.</div></div><div><h3>Methods</h3><div><strong>:</strong> In this multicenter, retrospective observational study, 120 MS patients with brain MRI data acquired approximately 2 years apart were enrolled. Brain and spinal cord atrophy were quantified using SIENA/X and JIM9, respectively. Patients were stratified by evidence of disease activity and brain atrophy to evaluate SCA progression independently of inflammatory activity.</div></div><div><h3>Results</h3><div><strong>:</strong> Although 64.2% of patients achieved no evidence of disease activity (NEDA) -3 and 40.8% met NEDA-4 criteria, a non-negligible degree of the SCA (−0.791 ± 1.97% / year) as well as the brain volume loss (BVL) (−0.381 ± 0.553% / year) was observed. SCA correlated weakly with BVL but not with T2 lesion volume in the brain or clinical disease activity. Among patients who fulfilled the NEDA-4 criteria, those with greater rates of SCA unexpectedly exhibited significantly smaller brain T2 lesion volumes compared to those with lower atrophy rates (<em>p</em> = 0.041).</div></div><div><h3>Discussion</h3><div><strong>:</strong> SCA may progress independently of brain inflammation or clinical activity, potentially reflecting “pure” neurodegenerative processes. Its evaluation may provide critical insight into disease progression in MS, particularly in clinically stable patients with minimal brain atrophy or lesion burden.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106990"},"PeriodicalIF":2.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-10DOI: 10.1016/j.msard.2026.106966
Alexandre Bussinger Lopes, Denis Bernardi Bichuetti, Nilton Amorim de Souza, Felipe Toscano Lins de Menezes, Flavia Timbó Albuquerque, Enedina Maria Lobato de Oliveira
Background
Multiple sclerosis (MS) is a chronic demyelinating disease that often leads to disability in young adults. Among its various phenotypes, highly active MS (HA-MS) presents with frequent relapses, incomplete recovery, and a high burden of MRI lesions. Despite its clinical importance, there is no universally accepted definition of HA-MS, which complicates early identification and treatment decisions.
Objective
This study aimed to evaluate whether Brazilian neurologists can recognize HA-MS and whether there is agreement regarding its defining characteristics. It also explored how this recognition influences treatment choices.
Methods
A cross-sectional, self-administered online survey was distributed to neurologists affiliated with the Brazilian Academy of Neurology (ABN). The questionnaire was open from March to September 2023. Responses were analyzed using descriptive statistics and chi-square or Fisher’s exact tests.
Results
A total of 206 neurologists completed the survey. Most respondents agreed that signs of high disease activity influence therapeutic decisions (98.1%). The most frequently cited indicators of HA-MS were annualized relapse rate (37.4%) and the number of gadolinium-enhancing lesions on MRI (32.0%). The Rush et al. definition was most commonly endorsed (53.9%), while Tintoré’s was least favored (85.9%). High-efficacy therapies—particularly Natalizumab, Ocrelizumab, and Alemtuzumab—were the preferred treatment options. Neuroimmunologists were significantly more likely to prescribe advanced therapies and less likely to use first-line agents compared to general neurologists.
Conclusion
Brazilian neurologists show substantial agreement in identifying clinical and radiological signs of HA-MS and favor early, high-efficacy treatment strategies. These findings highlight the need for clear, standardized criteria to guide consistent diagnosis and timely therapeutic intervention, ultimately improving patient care in MS.
{"title":"Highly active multiple sclerosis - An important, yet inaccurate concept","authors":"Alexandre Bussinger Lopes, Denis Bernardi Bichuetti, Nilton Amorim de Souza, Felipe Toscano Lins de Menezes, Flavia Timbó Albuquerque, Enedina Maria Lobato de Oliveira","doi":"10.1016/j.msard.2026.106966","DOIUrl":"10.1016/j.msard.2026.106966","url":null,"abstract":"<div><h3>Background</h3><div>Multiple sclerosis (MS) is a chronic demyelinating disease that often leads to disability in young adults. Among its various phenotypes, highly active MS (HA-MS) presents with frequent relapses, incomplete recovery, and a high burden of MRI lesions. Despite its clinical importance, there is no universally accepted definition of HA-MS, which complicates early identification and treatment decisions.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate whether Brazilian neurologists can recognize HA-MS and whether there is agreement regarding its defining characteristics. It also explored how this recognition influences treatment choices.</div></div><div><h3>Methods</h3><div>A cross-sectional, self-administered online survey was distributed to neurologists affiliated with the Brazilian Academy of Neurology (ABN). The questionnaire was open from March to September 2023. Responses were analyzed using descriptive statistics and chi-square or Fisher’s exact tests.</div></div><div><h3>Results</h3><div>A total of 206 neurologists completed the survey. Most respondents agreed that signs of high disease activity influence therapeutic decisions (98.1%). The most frequently cited indicators of HA-MS were annualized relapse rate (37.4%) and the number of gadolinium-enhancing lesions on MRI (32.0%). The Rush et al. definition was most commonly endorsed (53.9%), while Tintoré’s was least favored (85.9%). High-efficacy therapies—particularly Natalizumab, Ocrelizumab, and Alemtuzumab—were the preferred treatment options. Neuroimmunologists were significantly more likely to prescribe advanced therapies and less likely to use first-line agents compared to general neurologists.</div></div><div><h3>Conclusion</h3><div>Brazilian neurologists show substantial agreement in identifying clinical and radiological signs of HA-MS and favor early, high-efficacy treatment strategies. These findings highlight the need for clear, standardized criteria to guide consistent diagnosis and timely therapeutic intervention, ultimately improving patient care in MS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106966"},"PeriodicalIF":2.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-08DOI: 10.1016/j.msard.2026.106986
Claudia Alonso, Farren B.S. Briggs
{"title":"Letter to editor: Response to ‘psychological resilience as a mediator between depression and health-related quality of life in relapsing-remitting multiple sclerosis patients’","authors":"Claudia Alonso, Farren B.S. Briggs","doi":"10.1016/j.msard.2026.106986","DOIUrl":"10.1016/j.msard.2026.106986","url":null,"abstract":"","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106986"},"PeriodicalIF":2.9,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1016/j.msard.2026.106982
Gary Rance , Julien Zanin , Daniel Merlo , Anneke van der Walt
Multiple sclerosis is an inflammatory autoimmune disease characterized by focal destruction of myelin within the central nervous system. Auditory deficits are a relatively frequent, but often underdiagnosed symptom. This study examined sound detection threshold and functional hearing ability in a cohort of patients with multiple sclerosis.
Thirty adults with relapsing-remitting multiple sclerosis and 30 age, gender and hearing-level matched controls underwent peripheral and central auditory assessments. These included audiometric (sound detection threshold) measurement, binaural speech perception, spatial hearing (Listening in Spatialized Noise test) and self-perceived hearing/communication disability rating (Speech, Spatial and Qualities of Hearing Questionnaire). Correlations with neurological disability, white matter lesion count, lesion volume and whole brain volume were evaluated.
Average sound detection levels for individuals with multiple sclerosis were abnormal in one or both ears for 18/30 participants and outside age-based population norms in 17/60 ears. Binaural speech perception was significantly poorer (P<.001) in listening conditions requiring localization of sound sources and participants rated their everyday hearing/communication ability lower than matched controls (P=.001). Importantly, peripheral hearing loss did not account for the observed speech deficits. Rather, poorer speech perception moderately correlated with greater disability and lower brain volume, and poorer binaural processing was strongly correlated with increased lesion and lower brain volumes.
The findings of this study are consistent with disruption of auditory neural activity occurring as a result of demyelination in the central pathways and global neurodegeneration. Clinicians should be aware that both peripheral- and central deficits severe enough to affect the quality of life of patients are common in multiple sclerosis.
{"title":"Binaural hearing, neurological disability and brain imaging in Multiple Sclerosis","authors":"Gary Rance , Julien Zanin , Daniel Merlo , Anneke van der Walt","doi":"10.1016/j.msard.2026.106982","DOIUrl":"10.1016/j.msard.2026.106982","url":null,"abstract":"<div><div>Multiple sclerosis is an inflammatory autoimmune disease characterized by focal destruction of myelin within the central nervous system. Auditory deficits are a relatively frequent, but often underdiagnosed symptom. This study examined sound detection threshold and functional hearing ability in a cohort of patients with multiple sclerosis.</div><div>Thirty adults with relapsing-remitting multiple sclerosis and 30 age, gender and hearing-level matched controls underwent peripheral and central auditory assessments. These included audiometric (sound detection threshold) measurement, binaural speech perception, spatial hearing (Listening in Spatialized Noise test) and self-perceived hearing/communication disability rating (Speech, Spatial and Qualities of Hearing Questionnaire). Correlations with neurological disability, white matter lesion count, lesion volume and whole brain volume were evaluated.</div><div>Average sound detection levels for individuals with multiple sclerosis were abnormal in one or both ears for 18/30 participants and outside age-based population norms in 17/60 ears. Binaural speech perception was significantly poorer (P<.001) in listening conditions requiring localization of sound sources and participants rated their everyday hearing/communication ability lower than matched controls (P=.001). Importantly, peripheral hearing loss did not account for the observed speech deficits. Rather, poorer speech perception moderately correlated with greater disability and lower brain volume, and poorer binaural processing was strongly correlated with increased lesion and lower brain volumes.</div><div>The findings of this study are consistent with disruption of auditory neural activity occurring as a result of demyelination in the central pathways and global neurodegeneration. Clinicians should be aware that both peripheral- and central deficits severe enough to affect the quality of life of patients are common in multiple sclerosis.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106982"},"PeriodicalIF":2.9,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1016/j.msard.2026.106984
Jessica Podda , Federica Di Antonio , Ludovico Pedullà , Erica Grange , Mario Alberto Battaglia , Andrea Tacchino , Giampaolo Brichetto
Background
The Paced Auditory Serial Addition Test (PASAT) is widely used to assess cognitive functioning and fatigability in people with Multiple Sclerosis (PwMS). However, its poor acceptability and high refusal rates may limit its clinical interpretability, while potentially conveying meaningful information beyond test performance.
Objectives
To determine whether PASAT rejection at the first assessment represents a clinically meaningful marker of overall vulnerability in PwMS, reflected by a tendency toward worsening across demographic, disease-related and clinical domains, using both patient-reported and clinician-assessed outcomes.
Methods
One-way ANOVAs or non-parametric equivalents were run to compare different groups defined by baseline PASAT performance (missing, low, high) in terms of demographic, disease-related and clinical variables.
Results
Retrospective data from 1154 PwMS were analyzed. Participants with missing PASAT (N=224) were significantly older (60.1±13.5 years), had longer disease duration (18.9±12.2 years), higher EDSS (6.1±2.0), lower educational level (9.9±3.9 years), poorer cognitive performances on the Montreal Cognitive Assessment (MoCA) and Symbol Digit Modalities Test (SDMT) (respectively, 17.4±6.5, 22.5±13.6), and higher level of required assistance in daily functioning as measured by the Functional Independence Measure (FIM) (91.1±29.3), compared with both low and high PASAT groups (all ps < 0.05).
Conclusions
PASAT rejection at first assessment identifies a subgroup of older PwMS with higher disability, lower education, and more pronounced cognitive and functional impairments, suggesting that test refusal may serve as a clinically relevant marker of overall vulnerability in MS.
{"title":"Revealing the clinical significance of PASAT rejection in multiple sclerosis: Insights from patient-reported and clinician-assessed outcomes","authors":"Jessica Podda , Federica Di Antonio , Ludovico Pedullà , Erica Grange , Mario Alberto Battaglia , Andrea Tacchino , Giampaolo Brichetto","doi":"10.1016/j.msard.2026.106984","DOIUrl":"10.1016/j.msard.2026.106984","url":null,"abstract":"<div><h3>Background</h3><div>The Paced Auditory Serial Addition Test (PASAT) is widely used to assess cognitive functioning and fatigability in people with Multiple Sclerosis (PwMS). However, its poor acceptability and high refusal rates may limit its clinical interpretability, while potentially conveying meaningful information beyond test performance.</div></div><div><h3>Objectives</h3><div>To determine whether PASAT rejection at the first assessment represents a clinically meaningful marker of overall vulnerability in PwMS, reflected by a tendency toward worsening across demographic, disease-related and clinical domains, using both patient-reported and clinician-assessed outcomes.</div></div><div><h3>Methods</h3><div>One-way ANOVAs or non-parametric equivalents were run to compare different groups defined by baseline PASAT performance (missing, low, high) in terms of demographic, disease-related and clinical variables.</div></div><div><h3>Results</h3><div>Retrospective data from 1154 PwMS were analyzed. Participants with missing PASAT (N=224) were significantly older (60.1±13.5 years), had longer disease duration (18.9±12.2 years), higher EDSS (6.1±2.0), lower educational level (9.9±3.9 years), poorer cognitive performances on the Montreal Cognitive Assessment (MoCA) and Symbol Digit Modalities Test (SDMT) (respectively, 17.4±6.5, 22.5±13.6), and higher level of required assistance in daily functioning as measured by the Functional Independence Measure (FIM) (91.1±29.3), compared with both low and high PASAT groups (all ps < 0.05).</div></div><div><h3>Conclusions</h3><div>PASAT rejection at first assessment identifies a subgroup of older PwMS with higher disability, lower education, and more pronounced cognitive and functional impairments, suggesting that test refusal may serve as a clinically relevant marker of overall vulnerability in MS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106984"},"PeriodicalIF":2.9,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1016/j.msard.2026.106981
István Mórocz , Mojtaba Jouzizadeh , Amir Hossein Ghaderi , Hamed Cheraghmakani , Seyed Mohammad Baghbanian , Reza Khanbabaie , Andrei Mogoutov
Background:
Any treatment of multiple sclerosis should preserve mental function, considering how cognitive deterioration interferes with quality of life. However, mental assessment is still realized with neuro-psychological tests without monitoring cognition on neurobiological grounds whereas the ongoing neural activity is readily observable and readable.
Objective:
The proposed method deciphers electrical brain states which as multi-dimensional cognetoms quantitatively discriminate normal from pathological patterns in an EEG.
Method:
Baseline recordings from a prior EEG study of 88 subjects, 36 with MS, were analyzed. Spectral bands served to compute cognetoms and categorize subsequent feature combination sets.
Result:
The brain states predictor correlates with disease burden and duration. Using cognetoms and spectral bands, a cross-sectional comparison separated patients from controls with a precision of 85% while using bands alone arrived at 79%.
Conclusion:
We demonstrate the efficiency of the quantitative data-driven method based on brain states analysis by contrasting EEG data of patients with MS and healthy subjects. The congruity with disease severity and duration is a neurophysiological indicator for disease accumulation over time. We discuss potential applications of the approach for the monitoring of disease time course and treatment efficacy in longitudinal clinical studies in psychiatry and neurology.
{"title":"Brain states analysis of EEG predicts multiple sclerosis and mirrors disease duration and burden","authors":"István Mórocz , Mojtaba Jouzizadeh , Amir Hossein Ghaderi , Hamed Cheraghmakani , Seyed Mohammad Baghbanian , Reza Khanbabaie , Andrei Mogoutov","doi":"10.1016/j.msard.2026.106981","DOIUrl":"10.1016/j.msard.2026.106981","url":null,"abstract":"<div><h3>Background:</h3><div>Any treatment of multiple sclerosis should preserve mental function, considering how cognitive deterioration interferes with quality of life. However, mental assessment is still realized with neuro-psychological tests without monitoring cognition on neurobiological grounds whereas the ongoing neural activity is readily observable and readable.</div></div><div><h3>Objective:</h3><div>The proposed method deciphers electrical brain states which as multi-dimensional cognetoms quantitatively discriminate normal from pathological patterns in an EEG.</div></div><div><h3>Method:</h3><div>Baseline recordings from a prior EEG study of 88 subjects, 36 with MS, were analyzed. Spectral bands served to compute cognetoms and categorize subsequent feature combination sets.</div></div><div><h3>Result:</h3><div>The brain states predictor correlates with disease burden and duration. Using cognetoms and spectral bands, a cross-sectional comparison separated patients from controls with a precision of 85% while using bands alone arrived at 79%.</div></div><div><h3>Conclusion:</h3><div>We demonstrate the efficiency of the quantitative data-driven method based on brain states analysis by contrasting EEG data of patients with MS and healthy subjects. The congruity with disease severity and duration is a neurophysiological indicator for disease accumulation over time. We discuss potential applications of the approach for the monitoring of disease time course and treatment efficacy in longitudinal clinical studies in psychiatry and neurology.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106981"},"PeriodicalIF":2.9,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1016/j.msard.2026.106976
Daniel Selchen , Rebecca Grant , Claire Magnussen , Jillian Murray , Calum S Neish
Background
In multiple sclerosis, disease-modifying therapies aim to reduce relapse rate and slow disease progression. An important component of successful disease control is treatment persistence, which is the time a patient remains on a therapy. The primary objective of this study was to examine persistence with ofatumumab in a real-world setting.
Methods
This was a retrospective cohort study using data from the Patient Support Program (clinicaltrials.gov number NCT06854341). Adults diagnosed with relapsing remitting multiple sclerosis who initiated ofatumumab were included. Persistence, defined as the number of days from ofatumumab initiation until discontinuation, was assessed from April 2021 to May 2024. Ofatumumab persistence was quantified by Kaplan-Meier estimates for discontinuation probabilities with corresponding 95% confidence intervals at 12, 24 and 36 months. Secondary objectives included a descriptive analysis of patients’ baseline demographic and clinical characteristics, and their association with discontinuation.
Results
The PSP included a total of 6377 patients, of which 5436 patients met the inclusion criteria and had information to assess discontinuation. Persistence probability with ofatumumab was 96.94% at 12-months, 95.02% at 24-months, and 92.26% at 36-months post index. During this period, 167 patients (3.1%) discontinued ofatumumab. The most common reasons for discontinuation included side effects (0.9%), trying to conceive/pregnancy (0.5%), and patient request (0.5%).
Conclusion
This study provides insights into real-world ofatumumab utilization among patients with multiple sclerosis and demonstrates that persistence with ofatumumab remained high over 3 years. These results complement data from controlled clinical trials and suggest that patients persist with ofatumumab.
{"title":"A real-world study on persistence with ofatumumab in Canadian patients with multiple sclerosis","authors":"Daniel Selchen , Rebecca Grant , Claire Magnussen , Jillian Murray , Calum S Neish","doi":"10.1016/j.msard.2026.106976","DOIUrl":"10.1016/j.msard.2026.106976","url":null,"abstract":"<div><h3>Background</h3><div>In multiple sclerosis, disease-modifying therapies aim to reduce relapse rate and slow disease progression. An important component of successful disease control is treatment persistence, which is the time a patient remains on a therapy. The primary objective of this study was to examine persistence with ofatumumab in a real-world setting.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study using data from the Patient Support Program (clinicaltrials.gov number NCT06854341). Adults diagnosed with relapsing remitting multiple sclerosis who initiated ofatumumab were included. Persistence, defined as the number of days from ofatumumab initiation until discontinuation, was assessed from April 2021 to May 2024. Ofatumumab persistence was quantified by Kaplan-Meier estimates for discontinuation probabilities with corresponding 95% confidence intervals at 12, 24 and 36 months. Secondary objectives included a descriptive analysis of patients’ baseline demographic and clinical characteristics, and their association with discontinuation.</div></div><div><h3>Results</h3><div>The PSP included a total of 6377 patients, of which 5436 patients met the inclusion criteria and had information to assess discontinuation. Persistence probability with ofatumumab was 96.94% at 12-months, 95.02% at 24-months, and 92.26% at 36-months post index. During this period, 167 patients (3.1%) discontinued ofatumumab. The most common reasons for discontinuation included side effects (0.9%), trying to conceive/pregnancy (0.5%), and patient request (0.5%).</div></div><div><h3>Conclusion</h3><div>This study provides insights into real-world ofatumumab utilization among patients with multiple sclerosis and demonstrates that persistence with ofatumumab remained high over 3 years. These results complement data from controlled clinical trials and suggest that patients persist with ofatumumab.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106976"},"PeriodicalIF":2.9,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-05DOI: 10.1016/j.msard.2025.106964
Ozan Dörtkol, Ahmed Serkan Emekli, Edis Hacılar, Sevda Öztürk Erden, Tuncay Gündüz, Murat Kürtüncü
Background
Multiple sclerosis (MS) exhibits remarkable heterogeneity in its clinical course, yet the determinants of long-term disability progression remain incompletely understood. Identifying demographic and clinical predictors of unfavorable trajectories is essential for individualized management.
Objective
To investigate demographic, clinical, and laboratory factors influencing disability progression and relapse dynamics in a large Turkish MS cohort with over two decades of follow-up.
Methods
This retrospective study included 1580 patients diagnosed with MS according to the 2017 McDonald criteria and followed between 1980 and 2020. Data on demographic, clinical, and laboratory parameters were analyzed. Survival analyses assessed time to expanded disability status scale (EDSS) 3 and 6 milestones, and logistic regression identified predictors of progressive disease.
Results
The cohort comprised 1092 females and 488 males (mean follow-up: 7.5 ± 5.7 years). Male sex and lower educational attainment were associated with faster disability accumulation (log-rank, p < 0.005 and p < 0.001, respectively). Motor, cerebellar, and spinal onset were significant predictors of a progressive phenotype, while optic neuritis, sensory, and brainstem onset indicated a relapsing–remitting course. Neither smoking, family history, nor oligoclonal band (OCB) positivity influenced disability progression. Inter-relapse intervals shortened until the fifth relapse, thereafter stabilizing, marking a potential inflection point in inflammatory activity.
Conclusion
This long-term cohort highlights distinct demographic and clinical predictors of MS progression. Early disability accumulation, particularly before reaching EDSS 3, appears critical in determining long-term outcomes. These findings emphasize the importance of early, aggressive therapeutic intervention within the initial disease phase to alter the trajectory of MS progression.
背景：多发性硬化症（MS）在临床过程中表现出显著的异质性，但长期残疾进展的决定因素仍不完全清楚。确定不利轨迹的人口统计学和临床预测因素对于个体化管理至关重要。目的：调查人口统计学、临床和实验室因素对土耳其大型MS队列残疾进展和复发动态的影响，随访超过20年。方法：本回顾性研究纳入1580例根据2017年McDonald标准诊断为MS的患者，随访时间为1980年至2020年。对人口学、临床和实验室参数的数据进行分析。生存分析评估了到达扩展残疾状态量表（EDSS） 3和6个里程碑的时间，并通过逻辑回归确定了疾病进展的预测因子。结果：女性1092人，男性488人（平均随访时间：7.5±5.7年）。男性和较低的受教育程度与更快的残疾积累相关（log-rank, p < 0.005和p < 0.001）。运动、小脑和脊柱发病是进行性表型的重要预测因子，而视神经炎、感觉和脑干发病则表明复发缓解过程。吸烟、家族史和寡克隆带（OCB）阳性均不影响残疾进展。复发间隔缩短，直至第五次复发，此后趋于稳定，标志着炎症活动的潜在拐点。结论：这项长期队列研究突出了MS进展的独特人口学和临床预测因素。早期残疾积累，特别是在达到EDSS 3之前，似乎对决定长期预后至关重要。这些发现强调了在疾病初始阶段进行早期、积极的治疗干预以改变MS进展轨迹的重要性。
{"title":"Early determinants of long-term outcomes in multiple sclerosis","authors":"Ozan Dörtkol, Ahmed Serkan Emekli, Edis Hacılar, Sevda Öztürk Erden, Tuncay Gündüz, Murat Kürtüncü","doi":"10.1016/j.msard.2025.106964","DOIUrl":"10.1016/j.msard.2025.106964","url":null,"abstract":"<div><h3>Background</h3><div>Multiple sclerosis (MS) exhibits remarkable heterogeneity in its clinical course, yet the determinants of long-term disability progression remain incompletely understood. Identifying demographic and clinical predictors of unfavorable trajectories is essential for individualized management.</div></div><div><h3>Objective</h3><div>To investigate demographic, clinical, and laboratory factors influencing disability progression and relapse dynamics in a large Turkish MS cohort with over two decades of follow-up.</div></div><div><h3>Methods</h3><div>This retrospective study included 1580 patients diagnosed with MS according to the 2017 McDonald criteria and followed between 1980 and 2020. Data on demographic, clinical, and laboratory parameters were analyzed. Survival analyses assessed time to expanded disability status scale (EDSS) 3 and 6 milestones, and logistic regression identified predictors of progressive disease.</div></div><div><h3>Results</h3><div>The cohort comprised 1092 females and 488 males (mean follow-up: 7.5 ± 5.7 years). Male sex and lower educational attainment were associated with faster disability accumulation (log-rank, <em>p</em> < 0.005 and <em>p</em> < 0.001, respectively). Motor, cerebellar, and spinal onset were significant predictors of a progressive phenotype, while optic neuritis, sensory, and brainstem onset indicated a relapsing–remitting course. Neither smoking, family history, nor oligoclonal band (OCB) positivity influenced disability progression. Inter-relapse intervals shortened until the fifth relapse, thereafter stabilizing, marking a potential inflection point in inflammatory activity.</div></div><div><h3>Conclusion</h3><div>This long-term cohort highlights distinct demographic and clinical predictors of MS progression. Early disability accumulation, particularly before reaching EDSS 3, appears critical in determining long-term outcomes. These findings emphasize the importance of early, aggressive therapeutic intervention within the initial disease phase to alter the trajectory of MS progression.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106964"},"PeriodicalIF":2.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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