Multiple sclerosis and related disorders最新文献

Background: Multiple sclerosis (MS) causes immune-mediated inflammation and neurodegeneration in the central nervous system, often leading to weakness and impaired mobility. In older adults with MS, it can be challenging to distinguish MS vs. age-related contributions to weakness. Studies are needed to examine the neuromuscular mechanisms of age-related declines in muscle strength to better understand their relative contribution to weakness in older adults with MS.

Objectives: To investigate the neuromuscular mechanisms underlying age-related declines in muscle strength and their contribution to weakness in older adults with MS.

Methods: We conducted a study to determine whether older adults with MS exhibit differences in knee extensor voluntary (neural) activation, MRI-derived muscle volume, and skeletal muscle contractile quality compared to age-, sex-, and BMI-matched individuals without MS. Group comparisons were performed using nonparametric statistical analyses.

Results: In 10 older adults with MS and 10 age-, sex-, and BMI-matched controls, participants with MS had reduced isokinetic strength relative to body weight (MS 0.95 N·m/kg [0.77, 1.06], controls 1.48 N·m/kg [1.23, 1.66]) and summed torque relative to muscle volume (MS 10.31 × 10³ N·m/cm³ [8.24 × 10³, 11.84 × 10³], controls 13.32 × 10³ N·m/cm³ [12.50 × 10³, 13.59 × 10³]). In MS compared to controls, we also observed reduced peak isometric strength relative to muscle volume (MS 0.47 N·m/cm³ [0.37, 0.51], controls 0.58 N·m/cm³ [0.56, 0.63]) and reduced isokinetic strength relative to muscle volume (MS 0.37 N·m/cm³ [0.33, 0.42], controls 0.56 N·m/cm³ [0.52, 0.56]). Quadriceps muscle volume was similar in participants with MS (168.42 cm³ [158.55, 196.74]) and controls (183.26 cm³ [175.62, 202.25]). There was decreased neural activation parameters in MS including central activation ballistic torque (CAB) ratio (MS 0.31 [0.18, 0.35], controls 0.46 [0.40, 0.57]) and voluntary activation (MS 87.87% [84.09, 90.09], controls 94.82% [92.89, 95.78]). No statistically significant correlations between neuromuscular function and MS clinical outcomes were found.

Conclusion: Neuromuscular function deficits in older adults with MS are largely attributed to impaired neural activation without significant differences in muscle quality compared with controls.

Background: Findings conflict regarding the risk of peripartum mental illness in women with multiple sclerosis (MS) and how this compares to the risk among women with other chronic diseases. We compared the incidence and prevalence of peripartum mental illness among women with MS, epilepsy, inflammatory bowel disease (IBD), diabetes, and women without any of these diseases (comparators).

Methods: Using population-based Swedish administrative health data we selected women with MS, epilepsy, IBD, diabetes, and comparators who had deliveries between 2002 and 2019. Using validated case definitions for peripartum mental illness we estimated the incidence and prevalence of mental illness during the period encompassing pregnancy and the first post-partum year. We compared incidence and prevalence between cohorts using crude estimates and unadjusted Poisson regression.

Results: We included 1096,814 women (1936 MS; 7709 epilepsy; 7731 IBD; 7182 diabetes; 1072,256 comparators). Mean (SD) age at conception was 30.1 (5.1) years. Compared to comparators, mothers with MS had a higher incidence of any mental illness (incidence rate ratio [IRR] 1.36; 1.04-1.78), as did mothers with epilepsy (1.78; 1.58-2.00), IBD (1.46; 1.28-1.66) and diabetes (1.61; 1.41-1.83). Mothers with MS, epilepsy, IBD and diabetes also had a higher incidence and prevalence of depression and bipolar disorder than comparators. Mothers with epilepsy had higher incidence rates of anxiety, and higher prevalence ratios of any mental illness and anxiety than mothers with MS.

Conclusions: Women with MS, epilepsy, IBD and diabetes have a similarly elevated incidence and prevalence of peripartum mental illness as compared to mothers without these conditions.

Background: The neurological prognosis of multiple sclerosis (MS) varies across clinical patterns but remains unclear when associated with uveitis.

Objective: To investigate the neurological prognosis and clinical characteristics of MS-associated uveitis compared with MS without uveitis.

Methods: We conducted a retrospective case-control study including 35 patients with MS-associated uveitis and 102 matched MS controls (1:3; age, sex, MS course). Clinical and neurological data were extracted from the Lyon Cohort Uveitis and the EDMUS database. The primary endpoint was the difference in Expanded Disability Status Scale (EDSS) between baseline and last follow-up.

Results: Patients with MS-associated uveitis were more often of North African origin than controls (48.6 % vs 20.6 %, p = 0.006; OR 3.51, 95 % CI [1.41-8.77]). Median follow-up was 19 years [14-26] in the uveitis group and 16 years [13-22] in controls. Baseline EDSS was comparable between groups (2.0 vs 2.0), as was EDSS at last follow-up (3.0 vs 3.0). However, patients aged >32 years with MS-associated uveitis had a significantly lower risk of disability progression compared with controls.

Conclusions: MS-associated uveitis was more frequent in patients of North African origin and often showed a sarcoidosis-like phenotype. In patients older than 32 years, it was associated with a more favorable neurological outcome.

Background: Real-world data on fingolimod effectiveness in multiple sclerosis (MS) remain valuable, particularly in switch cohorts and across phenotypes.

Methods: We conducted a retrospective single-center observational study including MS patients with RRMS or SPMS who received fingolimod and had complete symmetric 3-year pre- and 3-year post-treatment clinical follow-up data. Outcomes included changes in annualized relapse rate (ARR) and Expanded Disability Status Scale (EDSS) over the 3-year pre/post periods, and the proportion achieving NEDA-3 during the 3-year on-treatment period.

Results: A total of 657 patients were analyzed (596 RRMS; 61 SPMS). In RRMS, ARR decreased from 0.34±0.39 in the 3 years pre-treatment to 0.08±0.20 in the 3 years on fingolimod (p < 0.001), and mean EDSS changed from 1.48±1.27 to 1.43±1.36 (p = 0.152). In SPMS, ARR changed from 0.61±0.52 to 0.27±0.32 (p < 0.001), while EDSS increased from 5.08±1.01 to 6.10±1.31 (p < 0.001). NEDA-3 was achieved by 415/596 (69.6 %) RRMS patients and 10/61 (16.4 %) SPMS patients during the 3-year on-treatment period.

Conclusion: In this real-world switch cohort, fingolimod was associated with a marked reduction in relapse activity in RRMS, while disability worsening persisted in SPMS. NEDA-3 rates differed substantially by phenotype, supporting phenotype-specific expectations and the value of real-world risk stratification.

Objective: To assess the impact of disease-modifying treatments (DMTs) on retinal ganglion cell-inner plexiform layer (GCIPL) thickness.

Methods: We analyzed 174 retinal optical coherence tomography (OCT) scans from 90 MS patients (female-to-male ratio 3:1; mean age 39.3 years; median EDSS 2.0; mean disease duration 8.1 years). Bilateral macular scans were obtained at baseline and follow-up using spectral-domain OCT (Spectralis, Heidelberg Engineering, Germany) between 2017 and 2023. Patients were divided into moderate-efficacy (ME-DMT, N = 34) and high-efficacy (HE-DMT, N = 56) groups. The primary measure was global GCIPL thickness, with analysis conducted via independent t-tests and a mixed linear regression model to determine annualized GCIPL change.

Results: The HE-DMT group had a significantly lower annual GCIPL atrophy rate (0.07 ± 0.38 µm/year) compared to the ME-DMT group (0.64 ± 0.86 µm/year, p < 0.0001). Mixed linear regression confirmed these findings, accounting for covariates and baseline characteristics.

Conclusions: HE-DMTs appear to slow GCIPL atrophy, suggesting a potential neuroprotective effect. These results underscore the value of retinal imaging in tracking MS treatment efficacy and neurodegeneration.

Background: Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are chronic demyelinating diseases of the central nervous system frequently associated with cognitive impairment (CI). Although both disorders share overlapping neurological manifestations, they differ substantially in underlying pathophysiology and disease course. Despite the clinical relevance of personality traits and cognition in chronic neurological disorders, the relationship between cognitive function and the five major personality domains remains insufficiently characterized in MS patients. Moreover, this relationship has not yet been adequately investigated in NMOSD patients. This study aimed to explore the associations between personality traits and cognitive function in MS patients and NMOSD patients.

Methods: This cross-sectional study incorporated 100 MS patients and 53 NMOSD patients between March and November 2024 in Isfahan, Iran. The Symbol Digit Modalities Test (SDMT) and Mini-Mental State Examination (MMSE) were used to assess cognitive performance. Personality traits were evaluated using the NEO Five-Factor Inventory (NEO-FFI). Hierarchical regression models determined significant predictors of cognitive performance.

Results: In multivariable analyses, Conscientiousness was significantly associated with cognitive performance in both groups. In MS patients, Conscientiousness was independently associated with higher SDMT (B = 0.25, p = 0.003). Among NMOSD patients, Conscientiousness was significantly associated with higher SDMT (B = 0.45, p < 0.001) and MMSE (B = 0.09, p = 0.035). Additionally, Agreeableness was inversely associated with SDMT in NMOSD patients (B = -0.38, p = 0.009).

Conclusion: These findings indicate that some personality traits, particularly Conscientiousness, are associated with cognitive performance in MS and NMOSD. While these associations have been identified in MS, they are preliminary findings in NMOSD and highlight the clinical relevance of personality traits in interpreting cognitive assessments and supporting more personalized approaches to cognitive care.

Purpose: This pilot randomized controlled trial (RCT) evaluated the efficacy of a behavioral intervention grounded in the Capability-Opportunity-Motivation-Behavior (COM-B) model delivered via online coaching and newsletters for promoting physical activity (PA) in people newly diagnosed with multiple sclerosis (PNDwMS).

Methods: This unblinded, parallel-group, RCT included 50 PNDwMS (disease duration ≤ 2 years) who were randomized into either PA intervention (n = 25) or waitlist control (WLC) (n = 25) conditions. The intervention was delivered over 16 weeks by a researcher uninvolved in randomization. Data were collected pre- and post-intervention. Primary outcomes included device-measured (steps/day, light PA [LPA], moderate-to-vigorous PA [MVPA]) and self-reported PA (Godin Leisure-Time Exercise Questionnaire [GLTEQ] and International Physical Activity Questionnaire [IPAQ]). Secondary outcomes included fatigue, depression, anxiety, and health-related quality of life (HRQOL). Data were analyzed (intent-to-treat) using condition-by-time mixed-effects ANOVA.

Results: There were significant condition-by-time interactions on device-measured (MVPA) and self-reported (IPAQ) PA as well as depression and mental HRQOL (all p ≤ .05). There were moderate and significant improvements in MVPA (Δ11.2 min/day, 95% CI: 8.8, 13.7, d = 0.5) and IPAQ (Δ11.4 units, 95% CI: 10.4, 12.3, d = 0.7), HADS-D (Δ1.4 units, 95% CI: 1.3, 1.5, d = 0.5), and SF-12 MCS (Δ5.6 units, 95% CI: 5.1, 6.1, d = 0.6) scores in the PA intervention condition, but not in the WLC condition.

Conclusion: These findings provide preliminary evidence for the efficacy of the COM-B-based behavioral intervention for increasing PA and improving mental health outcomes in PNDwMS.