To identify the risk factors associated with the relapse rate in patients with DSN-NMOSD.
Methods
This is a multicenter retrospective study of cases of DSN-NMOSD at the Mass General Brigham, the University of Sao Paulo, and Koc University. Patients were excluded if they had an alternative diagnosis. To examine the association of the different clinical and paraclinical factors on relapses, we calculated the incidence rate ratio (IRR) using a Poisson regression analysis.
Results
A total of 35 relapsing DSN-NMOSD patients were analyzed. In a univariate Poisson regression analysis, non-Caucasian patients showed a higher rate of relapse (IRR: 1.58, 95 % CI 1.06-2.32; p=0.022) and simultaneous ON and transverse myelitis (TM) at onset resulted in a lower IRR of 0.04 (95 %CI 0.010-0.13; p <0.001). After adjusting for confounding factors, sex, race, laterality of ON, and use of disease-modifying therapy, age at onset at 32 years old was associated with a higher rate of relapses (IRR 1.82, 95 % CI 1.16-2.82; p = 0.008), while initial clinical manifestations of TM only (IRR 0.41, 95 % CI 0.22-0.74; p=0.004) and simultaneous ON and TM (IRR 0.04, 95 % CI 0.01-0.15; p <0.001) were linked to low relapse rates when compared to ON only.
Conclusion
Older adult onset (>32 years old) is linked to a higher relapse rate and patients presenting with TM only and simultaneous ON and TM at onset were found to be associated with a lower relapse rate.
目的探讨与DSN-NMOSD复发率相关的危险因素。方法：这是一项多中心回顾性研究，在麻省总医院布里格姆、圣保罗大学和科克大学进行的DSN-NMOSD病例。如果患者有其他诊断则排除在外。为了检验不同临床和临床旁因素与复发的关系，我们使用泊松回归分析计算了发病率比（IRR）。结果共分析35例复发性DSN-NMOSD患者。在单变量泊松回归分析中，非高加索患者的复发率较高（IRR: 1.58, 95% CI 1.06-2.32; p=0.022），而发病时同时发生ON和横脊髓炎（TM）的IRR较低，为0.04 （95% CI 0.010-0.13; p <0.001）。在校正混杂因素、性别、种族、ON的侧侧性和疾病改善治疗的使用后，发病年龄为32岁与较高的复发率相关（IRR 1.82, 95% CI 1.16-2.82; p= 0.008），而单纯TM的初始临床表现（IRR 0.41, 95% CI 0.22-0.74; p=0.004）和同时ON和TM （IRR 0.04, 95% CI 0.01-0.15; p <0.001）与单纯ON相比复发率较低。结论年龄较大的成人发病（32岁）与较高的复发率有关，而仅出现TM且发病时同时出现ON和TM的患者复发率较低。
{"title":"Relapse risk factors in double seronegative neuromyelitis optica spectrum disorder: Insights from a multicenter study","authors":"Gerome Vallejos , Takahisa Mikami , Joao Vitor Mahler , Ahmetcan Sezen , Guilherme Diogo Silva , Marina Solti , Samira Apóstolos-Pereira , Dagoberto Callegaro , Marcelo Matiello , Ayşe Altıntaş , Michael Levy","doi":"10.1016/j.msard.2026.107123","DOIUrl":"10.1016/j.msard.2026.107123","url":null,"abstract":"<div><h3>Objective</h3><div>To identify the risk factors associated with the relapse rate in patients with DSN-NMOSD.</div></div><div><h3>Methods</h3><div>This is a multicenter retrospective study of cases of DSN-NMOSD at the Mass General Brigham, the University of Sao Paulo, and Koc University. Patients were excluded if they had an alternative diagnosis. To examine the association of the different clinical and paraclinical factors on relapses, we calculated the incidence rate ratio (IRR) using a Poisson regression analysis.</div></div><div><h3>Results</h3><div>A total of 35 relapsing DSN-NMOSD patients were analyzed. In a univariate Poisson regression analysis, non-Caucasian patients showed a higher rate of relapse (IRR: 1.58, 95 % CI 1.06-2.32; p=0.022) and simultaneous ON and transverse myelitis (TM) at onset resulted in a lower IRR of 0.04 (95 %CI 0.010-0.13; p <0.001). After adjusting for confounding factors, sex, race, laterality of ON, and use of disease-modifying therapy, age at onset at <span><math><mo>></mo></math></span>32 years old was associated with a higher rate of relapses (IRR 1.82, 95 % CI 1.16-2.82; p = 0.008), while initial clinical manifestations of TM only (IRR 0.41, 95 % CI 0.22-0.74; p=0.004) and simultaneous ON and TM (IRR 0.04, 95 % CI 0.01-0.15; p <0.001) were linked to low relapse rates when compared to ON only.</div></div><div><h3>Conclusion</h3><div>Older adult onset (>32 years old) is linked to a higher relapse rate and patients presenting with TM only and simultaneous ON and TM at onset were found to be associated with a lower relapse rate.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"109 ","pages":"Article 107123"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147387463","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 : 2026-05-01Epub Date: 2026-03-02DOI: 10.1016/j.msard.2026.107102
Charles J. Strathdee , Isabel Krug , Charles Malpas , Litza Kiropoulos
Background
Depressive, anxiety, and fatigue symptoms are highly prevalent in people with multiple sclerosis (pwMS) and have been found to co-occur. Together, these symptoms result in poorer outcomes for pwMS. However, the network topology of comorbid depression, anxiety, and fatigue in pwMS has been to be investigated.
Methods
We estimated depressive, anxiety, and fatigue symptom networks using data from the same people with multiple sclerosis at two time points: at baseline (N = 272) and at 6-months follow-up (N = 141). Expected influence (EI) centrality analyses were performed to estimate the relative influence of each symptom within the two networks. Bridge EI and community analyses were performed to identify potential bridge symptoms and densely connected symptom groups.
Results
‘Worthlessness’ and ‘anhedonia’ emerged with the highest EI at baseline and follow-up, respectively. In terms of bridging symptoms, ‘worthlessness’, ‘afraid something awful would happen’, and ‘fatigue severity’ emerged as potential bridging symptoms that clustered depressive, anxiety, and fatigue symptoms in pwMS. This changed to ‘restlessness’, ‘uncontrollable worry’, and ‘suicidal ideation’ at follow-up. Further analyses indicated that the two networks remained similar with respect to global strength (p = .97)
Conclusions
Our findings demonstrate that depressive, anxiety, and fatigue symptoms are highly interconnected in MS. Identifying bridging symptoms may allow for a renewed therapeutic focus and avenue for symptomatic improvement across board areas of psychopathology in MS.
{"title":"Bridging the gap: A symptom network analysis of depression, anxiety, and fatigue in multiple sclerosis","authors":"Charles J. Strathdee , Isabel Krug , Charles Malpas , Litza Kiropoulos","doi":"10.1016/j.msard.2026.107102","DOIUrl":"10.1016/j.msard.2026.107102","url":null,"abstract":"<div><h3>Background</h3><div>Depressive, anxiety, and fatigue symptoms are highly prevalent in people with multiple sclerosis (pwMS) and have been found to co-occur. Together, these symptoms result in poorer outcomes for pwMS. However, the network topology of comorbid depression, anxiety, and fatigue in pwMS has been to be investigated.</div></div><div><h3>Methods</h3><div>We estimated depressive, anxiety, and fatigue symptom networks using data from the same people with multiple sclerosis at two time points: at baseline (<em>N</em> = 272) and at 6-months follow-up (<em>N</em> = 141). Expected influence (EI) centrality analyses were performed to estimate the relative influence of each symptom within the two networks. Bridge EI and community analyses were performed to identify potential bridge symptoms and densely connected symptom groups.</div></div><div><h3>Results</h3><div>‘Worthlessness’ and ‘anhedonia’ emerged with the highest EI at baseline and follow-up, respectively. In terms of bridging symptoms, ‘worthlessness’, ‘afraid something awful would happen’, and ‘fatigue severity’ emerged as potential bridging symptoms that clustered depressive, anxiety, and fatigue symptoms in pwMS. This changed to ‘restlessness’, ‘uncontrollable worry’, and ‘suicidal ideation’ at follow-up. Further analyses indicated that the two networks remained similar with respect to global strength (<em>p = .</em>97)</div></div><div><h3>Conclusions</h3><div>Our findings demonstrate that depressive, anxiety, and fatigue symptoms are highly interconnected in MS. Identifying bridging symptoms may allow for a renewed therapeutic focus and avenue for symptomatic improvement across board areas of psychopathology in MS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"109 ","pages":"Article 107102"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147372971","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 : 2026-05-01Epub Date: 2026-02-28DOI: 10.1016/j.msard.2026.107101
Cato E.A. Corsten , Ana M. Marques , Yifan van Hasselt , Jeroen van Rooij , Ide Smets , Marvin M. van Luijn , Rinze F. Neuteboom , Beatrijs Wokke , Joost Smolders
Background
Multiple sclerosis (MS) susceptibility and severity are mediated by different genetic and environmental risk factors. Familial aggregation in MS is partially explained by susceptibility determinants, yet impact on early disease course after clinically isolated syndrome (CIS) is uncertain. We investigated associations of reported familial MS with genetic and environmental risk factors, and with clinical presentation and disease course after CIS.
Methods
CIS participants were included in a prospective cohort within six months after symptom onset. Family history was assessed at baseline. We evaluated weighted genetic risk scores (wGRS) for MS susceptibility, 25-hydroxyvitamin D (25(OH)D) and body mass index (BMI), and determined HLA-DRB1*15:01 and MS severity SNP rs10191329 carriership. Anti-Epstein Barr virus Nuclear Antigen-1 (anti-EBNA1) IgG antibodies and 25(OH)D levels were measured. Disease course associations were estimated with Cox regression.
Results
Family members with MS were reported by 81/415 (19.5%) CIS participants. Familial MS was associated with higher MS susceptibility wGRS (7.54 (SD1.17) vs. 7.19 (SD1.22), p=0.04) and more frequent HLA-DRB1*15:01 carriership (first-degree 66.7%, other-degree 30.2%, no 38.4%, p=0.02). Anti-EBNA1 IgG and 25(OH)D levels did not differ, yet wGRS for lower 25(OH)D and higher adult BMI characterised MS participants with first-degree MS relatives. Baseline characteristics and disease severity measures were similar between participants with and without familial MS.
Conclusion
Our results confirm that familial MS is associated with enrichment of genetic risk for MS susceptibility, low 25(OH)D and high BMI, but not with early disease course after CIS. These data support that MS susceptibility and disease course are driven by different pathophysiological processes.
{"title":"Genetic and environmental mediators of multiple sclerosis susceptibility but not early severity run in families","authors":"Cato E.A. Corsten , Ana M. Marques , Yifan van Hasselt , Jeroen van Rooij , Ide Smets , Marvin M. van Luijn , Rinze F. Neuteboom , Beatrijs Wokke , Joost Smolders","doi":"10.1016/j.msard.2026.107101","DOIUrl":"10.1016/j.msard.2026.107101","url":null,"abstract":"<div><h3>Background</h3><div>Multiple sclerosis (MS) susceptibility and severity are mediated by different genetic and environmental risk factors. Familial aggregation in MS is partially explained by susceptibility determinants, yet impact on early disease course after clinically isolated syndrome (CIS) is uncertain. We investigated associations of reported familial MS with genetic and environmental risk factors, and with clinical presentation and disease course after CIS.</div></div><div><h3>Methods</h3><div>CIS participants were included in a prospective cohort within six months after symptom onset. Family history was assessed at baseline. We evaluated weighted genetic risk scores (wGRS) for MS susceptibility, 25-hydroxyvitamin D (25(OH)D) and body mass index (BMI), and determined HLA-DRB1*15:01 and MS severity SNP rs10191329 carriership. Anti-Epstein Barr virus Nuclear Antigen-1 (anti-EBNA1) IgG antibodies and 25(OH)D levels were measured. Disease course associations were estimated with Cox regression.</div></div><div><h3>Results</h3><div>Family members with MS were reported by 81/415 (19.5%) CIS participants. Familial MS was associated with higher MS susceptibility wGRS (7.54 (SD1.17) vs. 7.19 (SD1.22), p=0.04) and more frequent HLA-DRB1*15:01 carriership (first-degree 66.7%, other-degree 30.2%, no 38.4%, p=0.02). Anti-EBNA1 IgG and 25(OH)D levels did not differ, yet wGRS for lower 25(OH)D and higher adult BMI characterised MS participants with first-degree MS relatives. Baseline characteristics and disease severity measures were similar between participants with and without familial MS.</div></div><div><h3>Conclusion</h3><div>Our results confirm that familial MS is associated with enrichment of genetic risk for MS susceptibility, low 25(OH)D and high BMI, but not with early disease course after CIS. These data support that MS susceptibility and disease course are driven by different pathophysiological processes.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"109 ","pages":"Article 107101"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378154","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 : 2026-05-01Epub Date: 2026-02-24DOI: 10.1016/j.msard.2026.107095
Alexandra C. Simpson , Jennifer Keller , Thomas Shoemaker , Julie Fiol , Michael Comisac , Daniel Becker , Sandra D. Cassard , Kathleen Zackowski , Scott D. Newsome
Background
People with secondary progressive multiple sclerosis (PwSPMS) experience symptoms impacting their ability to walk or exercise. Functional electrical stimulation (FES) cycling is a promising, safe therapeutic intervention for MS, but relatively little is known about its use in PwSPMS with moderate to severe disability.
Objective
To determine effects of active FES and passive cycling on walking speed and other disability measures in PwSPMS.
Methods
PwSPMS and Expanded Disability Status Scale (EDSS) 5.0–7.0 were randomized to a 12-week FES-assisted or passive (control) cycling intervention. The primary outcome was change in Timed 25-Foot Walk (T25FW [s]) pre-post intervention. Secondary outcomes assessed functional mobility (Timed Up and Go [TUG], 2-Minute Walk Test), strength, disability, cognition and quality of life.
Results
Fourteen participants completed the intervention (8 active FES; 6 passive). One active FES cyclist with an unrelated injury was excluded from analysis. Mean ±SD age was 54.1 ± 8.9 years and 85 % were female. Participants tolerated the intervention. No significant differences were observed between participants receiving FES compared to passive cycling in any measures. Within groups, FES cyclists trended towards but did not reach significant improvement in T25FW (10.2 to 8.4 s; p = 0.08), while passive cyclists significantly improved in TUG (12.4 to 11.6 s; p = 0.03).
Conclusion
Change in ambulatory function did not differ in participants receiving FES versus passive cycling. Within-group improvement occurred in isolated measures and no adverse events occurred, demonstrating feasibility and acceptability. Longer interventions may be necessary to demonstrate improvements beyond lack of decline, given greater baseline disability in this population.
继发性进行性多发性硬化症（PwSPMS）患者会出现影响其行走或运动能力的症状。功能性电刺激（FES）循环是一种有前景的、安全的多发性硬化症治疗干预措施，但对其在中度至重度残疾的PwSPMS中的应用知之甚少。目的探讨主动FES和被动骑行对PwSPMS患者步行速度及其他残疾指标的影响。方法spwspms和扩展残疾状态量表（EDSS） 5.0-7.0随机分为fes辅助或被动（对照）循环干预组。主要终点是干预前25英尺步行时间（T25FW [s]）的改变。次要结果评估了功能活动能力（Timed Up and Go [TUG]， 2分钟步行测试）、力量、残疾、认知和生活质量。结果14名参与者完成干预，其中主动FES 8名，被动FES 6名。一名不相关损伤的活跃FES自行车运动员被排除在分析之外。平均±SD年龄为54.1±8.9岁，85%为女性。参与者能够忍受这种干预。与被动骑车相比，接受FES的参与者在任何方面都没有显著差异。各组内，FES骑行者T25FW有改善趋势，但未达到显著改善（10.2 ~ 8.4 s, p = 0.08），而被动骑行者TUG有显著改善（12.4 ~ 11.6 s, p = 0.03）。结论接受FES和被动循环的参与者的运动功能变化无差异。孤立措施组内改善发生，无不良事件发生，证明可行性和可接受性。鉴于这一人群的基线残疾程度较高，可能需要更长时间的干预措施来证明没有下降之外的改善。
{"title":"Functional cycling ergometry with or without electrical stimulation in individuals with secondary progressive multiple sclerosis: A randomized controlled trial","authors":"Alexandra C. Simpson , Jennifer Keller , Thomas Shoemaker , Julie Fiol , Michael Comisac , Daniel Becker , Sandra D. Cassard , Kathleen Zackowski , Scott D. Newsome","doi":"10.1016/j.msard.2026.107095","DOIUrl":"10.1016/j.msard.2026.107095","url":null,"abstract":"<div><h3>Background</h3><div>People with secondary progressive multiple sclerosis (PwSPMS) experience symptoms impacting their ability to walk or exercise. Functional electrical stimulation (FES) cycling is a promising, safe therapeutic intervention for MS, but relatively little is known about its use in PwSPMS with moderate to severe disability.</div></div><div><h3>Objective</h3><div>To determine effects of active FES and passive cycling on walking speed and other disability measures in PwSPMS.</div></div><div><h3>Methods</h3><div>PwSPMS and Expanded Disability Status Scale (EDSS) 5.0–7.0 were randomized to a 12-week FES-assisted or passive (control) cycling intervention. The primary outcome was change in Timed 25-Foot Walk (T25FW [s]) pre-post intervention. Secondary outcomes assessed functional mobility (Timed Up and Go [TUG], 2-Minute Walk Test), strength, disability, cognition and quality of life.</div></div><div><h3>Results</h3><div>Fourteen participants completed the intervention (8 active FES; 6 passive). One active FES cyclist with an unrelated injury was excluded from analysis. Mean ±SD age was 54.1 ± 8.9 years and 85 % were female. Participants tolerated the intervention. No significant differences were observed between participants receiving FES compared to passive cycling in any measures. Within groups, FES cyclists trended towards but did not reach significant improvement in T25FW (10.2 to 8.4 s; <em>p</em> = 0.08), while passive cyclists significantly improved in TUG (12.4 to 11.6 s; <em>p</em> = 0.03).</div></div><div><h3>Conclusion</h3><div>Change in ambulatory function did not differ in participants receiving FES versus passive cycling. Within-group improvement occurred in isolated measures and no adverse events occurred, demonstrating feasibility and acceptability. Longer interventions may be necessary to demonstrate improvements beyond lack of decline, given greater baseline disability in this population.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"109 ","pages":"Article 107095"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147387461","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 : 2026-05-01Epub Date: 2026-02-22DOI: 10.1016/j.msard.2026.107089
Sanaz Khodadadi , Sahar Nikkhah Bahrami , Shima Jahani , Mohammad Ali Sahraian , Andrew J. Solomon
Background
Timely diagnosis of multiple sclerosis (MS) is critical for optimal outcomes, but delays are common, particularly in resource-limited settings. This study investigates the barriers to MS diagnosis in Iran from the perspectives of neurologists.
Methods
A cross-sectional study was conducted using a questionnaire adapted from the MS International Federation (MSIF) Atlas of MS, 3rd Edition, and the 2024 Topical Survey, administered via an online platform to Iranian neurologists. Data collection occurred from April 1, 2024, to June 30, 2024.
Results
The survey received responses from 103 neurologists (34.1 % response rate), of whom 64 were general neurologists (GN) and 39 were MS specialists (NMS). Eighty percent reported at least one 'major barrier' to early MS diagnosis. These barriers included a lack of public (43.7 %) and healthcare provider (37.9 %) awareness of MS symptoms and patient reluctance to undergo testing due to social stigma (77.3 %). Access to paraclinical testing, including visual evoked potentials (VEP), optical coherence tomography (OCT), MOG-IgG, and AQP4-IgG testing, was variable. Most respondents (98.05 %) reported adherence to national guidelines, yet 4 % of NMS and 16 % of GN reported that they did not use the McDonald criteria.
Conclusions
Barriers to timely MS diagnosis in Iran are multifactorial, involving public awareness, healthcare professional education, and access to adequate resources. Addressing these issues through targeted education and improved infrastructure is essential.
{"title":"Access and barriers to diagnosis of multiple sclerosis in Iran - A clinician survey","authors":"Sanaz Khodadadi , Sahar Nikkhah Bahrami , Shima Jahani , Mohammad Ali Sahraian , Andrew J. Solomon","doi":"10.1016/j.msard.2026.107089","DOIUrl":"10.1016/j.msard.2026.107089","url":null,"abstract":"<div><h3>Background</h3><div>Timely diagnosis of multiple sclerosis (MS) is critical for optimal outcomes, but delays are common, particularly in resource-limited settings. This study investigates the barriers to MS diagnosis in Iran from the perspectives of neurologists.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted using a questionnaire adapted from the MS International Federation (MSIF) Atlas of MS, 3rd Edition, and the 2024 Topical Survey, administered via an online platform to Iranian neurologists. Data collection occurred from April 1, 2024, to June 30, 2024.</div></div><div><h3>Results</h3><div>The survey received responses from 103 neurologists (34.1 % response rate), of whom 64 were general neurologists (GN) and 39 were MS specialists (NMS). Eighty percent reported at least one 'major barrier' to early MS diagnosis. These barriers included a lack of public (43.7 %) and healthcare provider (37.9 %) awareness of MS symptoms and patient reluctance to undergo testing due to social stigma (77.3 %). Access to paraclinical testing, including visual evoked potentials (VEP), optical coherence tomography (OCT), MOG-IgG, and AQP4-IgG testing, was variable. Most respondents (98.05 %) reported adherence to national guidelines, yet 4 % of NMS and 16 % of GN reported that they did not use the McDonald criteria.</div></div><div><h3>Conclusions</h3><div>Barriers to timely MS diagnosis in Iran are multifactorial, involving public awareness, healthcare professional education, and access to adequate resources. Addressing these issues through targeted education and improved infrastructure is essential.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"109 ","pages":"Article 107089"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147387520","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 : 2026-05-01Epub Date: 2026-02-06DOI: 10.1016/j.msard.2026.107028
Xingjie Li , Xueying Kong , Aiqing Li , Xue Gong , Kundian Guo , Xu Liu , Yue Liu , Tianyu Zhang , Xiaolin Deng , Jinmei Li , Dong Zhou , Zhen Hong
Objective
To assess the neurological prognosis of patients with autoimmune encephalitis (AE) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and construct risk prediction models for a worse prognosis.
Methods
This was a prospective, multicenter, observational cohort study. Patients with AE, with or without SARS-CoV-2, were followed up every 3 months. Multivariate logistic regression was used to identify factors influencing neurological prognosis. Prediction models were created using nine machine-learning strategies.
Results
SARS-CoV-2 infection was noted in 241 of 308 patients. Multivariate logistic regression showed inactivated immunizations plus recombinant or adenovirus vector vaccines protected against SARS-CoV-2 infection (odds ratio [OR] 0.05, 95% confidence interval [CI] 0.01–0.52, p = 0.01). Three months after infection, 12.4% of patients with stable AE had a worse neurological prognosis, 6.2% failed to recover their working conditions. Pre-infection modified Rankin Scale (mRS) = 1 (OR 4.06, 95% CI 1.11–14.91, p = 0.04) and mRS > 1 (OR 13.4, 95% CI 3.31–54.02, p < 0.01), immunotherapy during infection (OR 5.1, 95% CI 1.65–15.79, p = 0.01), and SARS-CoV-2-related drowsiness (OR 19.5, 95% CI 5.42–70.34, p < 0.01) and gastrointestinal symptoms (OR 4.4, 95% CI 1.58–11.96, p < 0.01) were identified as risk factors for worse prognosis. The ranger model(https://xingjieli1999.shinyapps.io/clinical_prediction_app/) using these four parameters showed a discrimination accuracy of 0.96 (95% CI 0.94–0.99).
Conclusions
Patients with AE could experience exacerbated neurological symptoms following SARS-CoV-2 infection. Machine-learning algorithms showed feasibility of predicting prognoses based on clinical information in patients with AE.
目的：评价自身免疫性脑炎（AE）患者感染严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）后的神经系统预后，并建立预后不良的风险预测模型。方法：这是一项前瞻性、多中心、观察性队列研究。AE患者，不论有无SARS-CoV-2，每3个月随访一次。采用多因素logistic回归分析确定影响神经系统预后的因素。使用九种机器学习策略创建了预测模型。结果：308例患者中有241例出现SARS-CoV-2感染。多因素logistic回归显示，灭活免疫加重组或腺病毒载体疫苗可预防SARS-CoV-2感染（优势比[or] 0.05, 95%可信区间[CI] 0.01 ~ 0.52, p = 0.01）。感染3个月后，12.4%的稳定AE患者神经系统预后较差，6.2%的患者无法恢复工作状态。感染前改良Rankin量表(mRS) = 1 （OR 4.06, 95% CI 1.11-14.91, p = 0.04）和mRS bbb1 （OR 13.4, 95% CI 3.31-54.02, p < 0.01）、感染期间免疫治疗（OR 5.1, 95% CI 1.65-15.79, p = 0.01）、sars - cov -2相关嗜睡（OR 19.5, 95% CI 5.42-70.34, p < 0.01）和胃肠道症状（OR 4.4, 95% CI 1.58-11.96, p < 0.01）被确定为预后不良的危险因素。游侠模型（https://xingjieli1999.shinyapps）。io/clinical_prediction_app/)使用这四个参数的识别准确率为0.96 （95% CI 0.94-0.99）。结论：AE患者感染SARS-CoV-2后可出现神经系统症状加重。机器学习算法显示了基于AE患者临床信息预测预后的可行性。
{"title":"Machine learning model predicts prognosis in SARS-CoV-2-infected autoimmune encephalitis patients","authors":"Xingjie Li , Xueying Kong , Aiqing Li , Xue Gong , Kundian Guo , Xu Liu , Yue Liu , Tianyu Zhang , Xiaolin Deng , Jinmei Li , Dong Zhou , Zhen Hong","doi":"10.1016/j.msard.2026.107028","DOIUrl":"10.1016/j.msard.2026.107028","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the neurological prognosis of patients with autoimmune encephalitis (AE) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and construct risk prediction models for a worse prognosis.</div></div><div><h3>Methods</h3><div>This was a prospective, multicenter, observational cohort study. Patients with AE, with or without SARS-CoV-2, were followed up every 3 months. Multivariate logistic regression was used to identify factors influencing neurological prognosis. Prediction models were created using nine machine-learning strategies.</div></div><div><h3>Results</h3><div>SARS-CoV-2 infection was noted in 241 of 308 patients. Multivariate logistic regression showed inactivated immunizations plus recombinant or adenovirus vector vaccines protected against SARS-CoV-2 infection (odds ratio [OR] 0.05, 95% confidence interval [CI] 0.01–0.52, <em>p</em> = 0.01). Three months after infection, 12.4% of patients with stable AE had a worse neurological prognosis, 6.2% failed to recover their working conditions. Pre-infection modified Rankin Scale (mRS) = 1 (OR 4.06, 95% CI 1.11–14.91, <em>p</em> = 0.04) and mRS > 1 (OR 13.4, 95% CI 3.31–54.02, <em>p</em> < 0.01), immunotherapy during infection (OR 5.1, 95% CI 1.65–15.79, <em>p</em> = 0.01), and SARS-CoV-2-related drowsiness (OR 19.5, 95% CI 5.42–70.34, <em>p</em> < 0.01) and gastrointestinal symptoms (OR 4.4, 95% CI 1.58–11.96, <em>p</em> < 0.01) were identified as risk factors for worse prognosis. The ranger model(<span><span>https://xingjieli1999.shinyapps.io/clinical_prediction_app/</span><svg><path></path></svg></span>) using these four parameters showed a discrimination accuracy of 0.96 (95% CI 0.94–0.99).</div></div><div><h3>Conclusions</h3><div>Patients with AE could experience exacerbated neurological symptoms following SARS-CoV-2 infection. Machine-learning algorithms showed feasibility of predicting prognoses based on clinical information in patients with AE.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"109 ","pages":"Article 107028"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147321847","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 : 2026-05-01Epub Date: 2026-03-03DOI: 10.1016/j.msard.2026.107110
İlknur Özkan , Seçil Taylan , Cansu Polat Dünya
Background
Women with Multiple Sclerosis (MS) face significant challenges in their sexual life, including physical limitations and emotional barriers. The PLISSIT model offers a structured framework for counselors to address these issues effectively. This study aimed to investigate the effects of counseling interventions based on the PLISSIT model on the sexual life of women with MS through randomized controlled trials.
Methods
This was a systematic review and meta-analysis study. Databases such as Google Scholar, OpenAIRE, Web of Science, Social Sciences Citation Index, Academic Search Ultimate, Complementary Index, Scopus, CINAHL Complete, MEDLINE, and PubMed were searched for English-language studies without year restrictions up to February 2024. The PRISMA guidelines were followed. Comprehensive Meta-Analysis 3 software was used for data analysis. Two researchers independently assessed the quality of the included studies using the Cochrane Collaboration tool.
Results
Three randomized controlled trials with a total of 232 participants were included in this study. Counseling based on the PLISSIT model was found to have a high and positive effect on the sexual life of women with MS (Hedges' g = 0.927, 95 % CI = -1.122 to 2.976, p = 0.375).
Conclusions
This meta-analysis suggests that sexual counseling based on the PLISSIT model may have a positive impact on the sexual life of women with MS, although statistically significant results were not obtained. Future research with larger sample sizes and more homogeneous study groups may provide clearer results.
患有多发性硬化症（MS）的女性在性生活中面临着巨大的挑战，包括身体限制和情感障碍。PLISSIT模型为辅导员有效地解决这些问题提供了一个结构化的框架。本研究旨在通过随机对照试验，探讨基于PLISSIT模型的咨询干预对MS女性性生活的影响。方法采用系统综述和荟萃分析研究。在谷歌Scholar、OpenAIRE、Web of Science、Social Sciences Citation Index、Academic Search Ultimate、Complementary Index、Scopus、CINAHL Complete、MEDLINE和PubMed等数据库中检索了截至2024年2月的无年份限制的英语研究。遵循了PRISMA准则。采用综合Meta-Analysis 3软件进行数据分析。两位研究者使用Cochrane协作工具独立评估纳入研究的质量。结果本研究共纳入3项随机对照试验，共232名受试者。基于PLISSIT模型的咨询对MS女性的性生活有很高的积极影响（Hedges’g = 0.927, 95% CI = -1.122 ~ 2.976, p = 0.375）。结论本荟萃分析表明，基于PLISSIT模型的性咨询可能对MS女性的性生活有积极影响，尽管没有统计学上显著的结果。未来有更大样本量和更均匀的研究小组的研究可能会提供更清晰的结果。
{"title":"The impact of PLISSIT model-based counseling on the sexual life of women with multiple sclerosis: A systematic review and meta-analysis","authors":"İlknur Özkan , Seçil Taylan , Cansu Polat Dünya","doi":"10.1016/j.msard.2026.107110","DOIUrl":"10.1016/j.msard.2026.107110","url":null,"abstract":"<div><h3>Background</h3><div>Women with Multiple Sclerosis (MS) face significant challenges in their sexual life, including physical limitations and emotional barriers. The PLISSIT model offers a structured framework for counselors to address these issues effectively. This study aimed to investigate the effects of counseling interventions based on the PLISSIT model on the sexual life of women with MS through randomized controlled trials.</div></div><div><h3>Methods</h3><div>This was a systematic review and meta-analysis study. Databases such as Google Scholar, OpenAIRE, Web of Science, Social Sciences Citation Index, Academic Search Ultimate, Complementary Index, Scopus, CINAHL Complete, MEDLINE, and PubMed were searched for English-language studies without year restrictions up to February 2024. The PRISMA guidelines were followed. Comprehensive Meta-Analysis 3 software was used for data analysis. Two researchers independently assessed the quality of the included studies using the Cochrane Collaboration tool.</div></div><div><h3>Results</h3><div>Three randomized controlled trials with a total of 232 participants were included in this study. Counseling based on the PLISSIT model was found to have a high and positive effect on the sexual life of women with MS (Hedges' <em>g</em> = 0.927, 95 % CI = -1.122 to 2.976, <em>p</em> = 0.375).</div></div><div><h3>Conclusions</h3><div>This meta-analysis suggests that sexual counseling based on the PLISSIT model may have a positive impact on the sexual life of women with MS, although statistically significant results were not obtained. Future research with larger sample sizes and more homogeneous study groups may provide clearer results.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"109 ","pages":"Article 107110"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147387375","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 : 2026-05-01Epub Date: 2026-03-02DOI: 10.1016/j.msard.2026.107107
Murat Emec , Said Alizada , Yasemin Simsek , Ulvi Samadzade , Mehmet Hilal Ozcanhan , Serkan Ozakbas
Background
Pregnancy represents a unique immunological state in women with multiple sclerosis (MS), and postpartum disease reactivation is a major concern. While pregnancy outcomes have been extensively described, the long-term effects of reproductive and obstetric variables on disability progression remain poorly elucidated.
Objective
To predict postpartum EDSS-based disability change based on pregnancy-related clinical and demographic variables in women with MS, using validated machine learning models.
Methods
This retrospective real-world study included 662 women contributing 909 pregnancies. Engineered features included pre- and post-pregnancy Expanded Disability Status Scale (EDSS) scores, disease duration, maternal age, postpartum relapse, and obstetric variables. Regression and classification models (Random Forest, XGBoost, Elastic Net, Support Vector Classifier) were trained on an 80/20 train–test split with five-fold cross-validation. Model performance was assessed using R², mean absolute error (MAE), accuracy, and F1 score.
Results
Classification models achieved superior generalization performance (test accuracy 85–88%, F1 0.84–0.87) compared to regression models (test R² 0.31–0.39, MAE 0.41–0.48). Postpartum relapse was the strongest predictor of disability change, followed by disease duration and age at pregnancy. Predictive performance was highest among women with multiple pregnancies, suggesting that cumulative reproductive history carries prognostic value. Obstetric variables such as delivery type and breastfeeding contributed secondary but clinically relevant effects.
Conclusion
Machine learning models integrating pregnancy-related variables can provide clinically informative predictions regarding postpartum EDSS-based disability change in women with MS. Postpartum relapse remains the dominant driver of disability change, while reproductive and obstetric factors provide additional prognostic information. These findings highlight the postpartum period as a critical therapeutic window and support incorporating reproductive variables into individualized prognostic frameworks for women with MS.
{"title":"Integrating Reproductive and Clinical Variables to Predict Postpartum Disability Outcomes in Multiple Sclerosis Using Machine Learning","authors":"Murat Emec , Said Alizada , Yasemin Simsek , Ulvi Samadzade , Mehmet Hilal Ozcanhan , Serkan Ozakbas","doi":"10.1016/j.msard.2026.107107","DOIUrl":"10.1016/j.msard.2026.107107","url":null,"abstract":"<div><h3>Background</h3><div>Pregnancy represents a unique immunological state in women with multiple sclerosis (MS), and postpartum disease reactivation is a major concern. While pregnancy outcomes have been extensively described, the long-term effects of reproductive and obstetric variables on disability progression remain poorly elucidated.</div></div><div><h3>Objective</h3><div>To predict postpartum EDSS-based disability change based on pregnancy-related clinical and demographic variables in women with MS, using validated machine learning models.</div></div><div><h3>Methods</h3><div>This retrospective real-world study included 662 women contributing 909 pregnancies. Engineered features included pre- and post-pregnancy Expanded Disability Status Scale (EDSS) scores, disease duration, maternal age, postpartum relapse, and obstetric variables. Regression and classification models (Random Forest, XGBoost, Elastic Net, Support Vector Classifier) were trained on an 80/20 train–test split with five-fold cross-validation. Model performance was assessed using R², mean absolute error (MAE), accuracy, and F1 score.</div></div><div><h3>Results</h3><div>Classification models achieved superior generalization performance (test accuracy 85–88%, F1 0.84–0.87) compared to regression models (test R² 0.31–0.39, MAE 0.41–0.48). Postpartum relapse was the strongest predictor of disability change, followed by disease duration and age at pregnancy. Predictive performance was highest among women with multiple pregnancies, suggesting that cumulative reproductive history carries prognostic value. Obstetric variables such as delivery type and breastfeeding contributed secondary but clinically relevant effects.</div></div><div><h3>Conclusion</h3><div>Machine learning models integrating pregnancy-related variables can provide clinically informative predictions regarding postpartum EDSS-based disability change in women with MS. Postpartum relapse remains the dominant driver of disability change, while reproductive and obstetric factors provide additional prognostic information. These findings highlight the postpartum period as a critical therapeutic window and support incorporating reproductive variables into individualized prognostic frameworks for women with MS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"109 ","pages":"Article 107107"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147387462","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 : 2026-05-01Epub Date: 2026-02-17DOI: 10.1016/j.msard.2026.107084
Ariel Kidwell-Chandler, Brenda Jeng, Robert W. Motl
Background
Obesity is cited as a relevant factor in multiple sclerosis (MS). To date, there is inconsistent evidence regarding the relationship between total body fat and frequently studied outcomes in MS. Body fat distribution, or the location of adipose tissue and depots within the body, may represent a biologically meaningful correlate of MS-related outcomes.
Purpose
This exploratory study assessed whether dual-energy X-ray absorptiometry (DXA)-based body fat distribution metrics were associated with performance-based and self-reported outcomes of MS.
Methods
Fifty-seven ambulatory adults with MS underwent DXA to quantify visceral and subcutaneous adipose tissue; android- and gynoid- % fat mass; and android/gynoid ratio. Outcomes included performance-based (Timed Up and Go, Timed 25-Foot Walk, Six-Minute Walk) and self-reported assessments (Hospital Anxiety and Depression Scale anxiety and depression [HADS-D] sub-scales), Multiple Sclerosis Impact Scale physical [MSIS Physical] and psychological domains, Fatigue Severity Scale, and the short form of the McGill Pain Questionnaire). Spearman correlation assessed bivariate and partial (controlling for sex and age) associations.
Results
Correlations between body fat distribution metrics and performance-based and self-reported outcomes were generally small and not statistically significant. Gynoid % fat mass correlated with depressive symptoms (HADS-D: rs = –.28, p = .033) and physical health-related quality of life (MSIS Physical: rs = –.31, p = .018), but partial correlations were not statistically significant.
Conclusion
Our results did not support an association between body fat distribution and frequently studied MS-related outcomes. This aligns with research suggesting a limited role of adiposity and MS-related outcomes.
{"title":"Cross sectional analyses indicated that body fat distribution was not associated with performance-based and self-reported outcomes among ambulatory people with multiple sclerosis","authors":"Ariel Kidwell-Chandler, Brenda Jeng, Robert W. Motl","doi":"10.1016/j.msard.2026.107084","DOIUrl":"10.1016/j.msard.2026.107084","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is cited as a relevant factor in multiple sclerosis (MS). To date, there is inconsistent evidence regarding the relationship between total body fat and frequently studied outcomes in MS. Body fat distribution, or the location of adipose tissue and depots within the body, may represent a biologically meaningful correlate of MS-related outcomes.</div></div><div><h3>Purpose</h3><div>This exploratory study assessed whether dual-energy X-ray absorptiometry (DXA)-based body fat distribution metrics were associated with performance-based and self-reported outcomes of MS.</div></div><div><h3>Methods</h3><div>Fifty-seven ambulatory adults with MS underwent DXA to quantify visceral and subcutaneous adipose tissue; android- and gynoid- % fat mass; and android/gynoid ratio. Outcomes included performance-based (Timed Up and Go, Timed 25-Foot Walk, Six-Minute Walk) and self-reported assessments (Hospital Anxiety and Depression Scale anxiety and depression [HADS-D] sub-scales), Multiple Sclerosis Impact Scale physical [MSIS Physical] and psychological domains, Fatigue Severity Scale, and the short form of the McGill Pain Questionnaire). Spearman correlation assessed bivariate and partial (controlling for sex and age) associations.</div></div><div><h3>Results</h3><div>Correlations between body fat distribution metrics and performance-based and self-reported outcomes were generally small and not statistically significant. Gynoid % fat mass correlated with depressive symptoms (HADS-D: <em>r<sub>s</sub></em> = –.28, <em>p</em> = .033) and physical health-related quality of life (MSIS Physical: <em>r<sub>s</sub></em> = –.31, <em>p</em> = .018), but partial correlations were not statistically significant.</div></div><div><h3>Conclusion</h3><div>Our results did not support an association between body fat distribution and frequently studied MS-related outcomes. This aligns with research suggesting a limited role of adiposity and MS-related outcomes.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"109 ","pages":"Article 107084"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147308263","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 : 2026-05-01Epub Date: 2026-02-16DOI: 10.1016/j.msard.2026.107076
Mette Louise Andersen , Line Riis Jølving , Maria Iachina , Egon Stenager , Torben Knudsen , Bente Mertz Nørgård
Objective
Cesarean section (CS) rates are increased in women with multiple sclerosis (MS). It is unknown whether CS in women with MS constitutes a risk of maternal postpartum infection compared to vaginal delivery.
Methods
We used the Danish national health registers to establish a cohort of all live births by women with MS in Denmark from 1995 to 2023. We estimated the risk of maternal postpartum infections according to the mode of delivery in women with MS using logistic regression models adjusted for confounders such as age, body mass index, and comorbidity.
Results
Overall, 872 women with MS gave birth to their child by CS, and 2542 women with MS had a vaginal birth. Within the postpartum period of 42 days, 21.0% with CS and 14.1% with vaginal birth had an infectious complication. The overall risk of infections among women with MS giving birth by CS, relative to those with vaginal delivery, was an adjusted odds ratio (aOR) of 1.54, 95% confidence interval (95% CI 1.18–2.01). The risk of mild to moderate infections (prescriptions of antibiotics) was aOR 1.60 (95% CI 1.24–2.08), and the risk of severe infections (hospital-diagnosed) was aOR 1.55 (95% CI 0.82–2.94).
Conclusion
Women with MS who give birth by CS have an increased risk of postpartum infection compared to women with MS who give birth vaginally. This is important to be aware of since infection can cause worsening of neurological symptoms or trigger a new relapse in patients with MS.
目的：多发性硬化症（MS）妇女剖宫产（CS）率增高。与阴道分娩相比，MS妇女的CS是否构成产妇产后感染的风险尚不清楚。方法：我们使用丹麦国家健康登记册建立了一个1995年至2023年丹麦MS妇女的所有活产队列。我们根据MS妇女的分娩方式，使用调整了混杂因素（如年龄、体重指数和合并症）的logistic回归模型来估计产妇产后感染的风险。结果：总体而言，872名MS女性通过CS分娩，2542名MS女性通过阴道分娩。产后42天，CS组有21.0%发生感染并发症，顺产组有14.1%发生感染并发症。经阴道分娩的MS妇女感染的总风险，相对于阴道分娩的妇女，调整后的优势比（aOR）为1.54,95%可信区间（95% CI 1.18-2.01）。轻度至中度感染（抗生素处方）的风险为aOR 1.60 (95% CI 1.24-2.08)，严重感染（医院诊断）的风险为aOR 1.55 （95% CI 0.82-2.94）。结论：与顺产的MS妇女相比，CS分娩的MS妇女产后感染的风险增加。意识到这一点很重要，因为感染会导致神经症状恶化或引发多发性硬化症患者的新复发。
{"title":"Risk of postpartum infection after cesarean section in women with multiple sclerosis: A population-based cohort study","authors":"Mette Louise Andersen , Line Riis Jølving , Maria Iachina , Egon Stenager , Torben Knudsen , Bente Mertz Nørgård","doi":"10.1016/j.msard.2026.107076","DOIUrl":"10.1016/j.msard.2026.107076","url":null,"abstract":"<div><h3>Objective</h3><div>Cesarean section (CS) rates are increased in women with multiple sclerosis (MS). It is unknown whether CS in women with MS constitutes a risk of maternal postpartum infection compared to vaginal delivery.</div></div><div><h3>Methods</h3><div>We used the Danish national health registers to establish a cohort of all live births by women with MS in Denmark from 1995 to 2023. We estimated the risk of maternal postpartum infections according to the mode of delivery in women with MS using logistic regression models adjusted for confounders such as age, body mass index, and comorbidity.</div></div><div><h3>Results</h3><div>Overall, 872 women with MS gave birth to their child by CS, and 2542 women with MS had a vaginal birth. Within the postpartum period of 42 days, 21.0% with CS and 14.1% with vaginal birth had an infectious complication. The overall risk of infections among women with MS giving birth by CS, relative to those with vaginal delivery, was an adjusted odds ratio (aOR) of 1.54, 95% confidence interval (95% CI 1.18–2.01). The risk of mild to moderate infections (prescriptions of antibiotics) was aOR 1.60 (95% CI 1.24–2.08), and the risk of severe infections (hospital-diagnosed) was aOR 1.55 (95% CI 0.82–2.94).</div></div><div><h3>Conclusion</h3><div>Women with MS who give birth by CS have an increased risk of postpartum infection compared to women with MS who give birth vaginally. This is important to be aware of since infection can cause worsening of neurological symptoms or trigger a new relapse in patients with MS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"109 ","pages":"Article 107076"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147321839","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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