Multiple sclerosis and related disorders最新文献

{"title":"Black and Non-Hispanic White persons with multiple sclerosis: Social determinants of health and health inequities","authors":"Marta Ponzano ,&nbsp;Nicole Graziano ,&nbsp;Claire Wigley ,&nbsp;Giacomo Boffa ,&nbsp;Sylvia Klineova ,&nbsp;Maria Petracca ,&nbsp;Claire Riley ,&nbsp;Jonathan Howard ,&nbsp;Maria Pia Sormani ,&nbsp;Matilde Inglese ,&nbsp;Fred Lublin","doi":"10.1016/j.msard.2025.106935","DOIUrl":"10.1016/j.msard.2025.106935","url":null,"abstract":"<div><h3>Objective</h3><div>Distinctive differences in multiple sclerosis (MS) disease severity, progression, and mortality have been observed among different races. Social determinants of health (SDH) can contribute to such racial disparities. This study aims to: 1) compare Non-Hispanic White (NHW) and Black (Bl) persons with MS in terms of MS and SDH; 2) explore the impact of SDH-adjustment in the association between race and Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk (T25-FW), 9-Hole Peg Test (9-HPT), Symbol Digit Modalities Test (SDMT).</div></div><div><h3>Methods</h3><div>120 patients, self-identified as Bl (<em>n</em> = 60) or NHW (<em>n</em> = 60) persons, were included in this cross-sectional analysis from a prospectively enrolled cohort. We used parametric and non-parametric tests; logistic models were performed to select the most relevant SDH. Univariable linear regression models were used to explore differences in EDSS, T25-FW, 9-HPT, SDMT and models were adjusted for relevant SDH using propensity scores (PS).</div></div><div><h3>Results</h3><div>Significant racial disparities in adverse SDH were identified in Black persons with MS (BpwMS). BpwMS patients had a higher EDSS (β=0.66, <em>p</em> = 0.022), log-transformed T25-FW (β=0.16, <em>p</em> = 0.001), 9-HPT (β=2.89, <em>p</em> = 0.001) and lower SDMT (β=-5.97, <em>p</em> = 0.003); after PS-adjustment, associations were no longer significant except for T25-FW (β=0.13, <em>p</em> = 0.030) and the magnitude of all coefficients was reduced (EDSS: -27 %, T25-FW: -19 %, 9-HPT: -36 %, SDMT: -45 %).</div></div><div><h3>Interpretation</h3><div>More efforts are necessary to adequately address the SDH that distinguish Bl from NHW persons with MS; additional unknown or unmeasured variables, including biologic differences as well as other SDH, should be explored to elucidate the mechanisms behind worse MS outcomes in BpwMS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106935"},"PeriodicalIF":2.9,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788469","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}

{"title":"The effects of trunk rehabilitation on balance, gait, falls, and community mobility in patients with multiple sclerosis: A single-blind randomized controlled trial","authors":"Shatha Mukhtar ,&nbsp;Ghala Aljohani ,&nbsp;Maysam Bakkar ,&nbsp;Naseem Almutairi ,&nbsp;Aseel Mazi ,&nbsp;Lama Alsweed ,&nbsp;Majed Albadi ,&nbsp;Rawan Aldhabi ,&nbsp;Fayaz Khan","doi":"10.1016/j.msard.2025.106929","DOIUrl":"10.1016/j.msard.2025.106929","url":null,"abstract":"<div><h3>Background</h3><div>Multiple sclerosis (MS) impairs daily living and social engagement, thus reducing people’s overall quality of life. Trunk impairment in people with MS is closely linked to balance deficits, gait disturbances, and an increased risk of falls. Targeted trunk rehabilitation may improve these outcomes.</div></div><div><h3>Purpose</h3><div>This study aimed to investigate the effectiveness of dynamic trunk-focused rehabilitation in people with MS (PwMS).</div></div><div><h3>Methods</h3><div>A total of 45 PwMS were randomly assigned to either a trunk group or a core group. The trunk group received multiplanar trunk exercises on unstable surfaces combined with dual-task training, while the core group performed traditional core stability exercises. Both groups received conventional therapy in addition to their designated intervention. The primary outcome was the Trunk Impairment Scale (TIS), and secondary outcomes included the Berg Balance Scale (BBS), Timed Up and Go (TUG), Modified Falls Efficacy Scale (MFES), Modified Fatigue Impact Scale (MFIS), Hospital Anxiety and Depression Scale (HADS), and Reintegration to Normal Living Index (RNLI). A two-way mixed model ANOVA test was conducted to assess time-by-group interactions.</div></div><div><h3>Results</h3><div>The trunk group exhibited significantly greater improvements over time across all outcomes compared to the core group. Significant time-by-group interactions were observed for trunk control (TIS, <em>F</em> = 18.3, <em>P</em> ≤ 0.001), balance (BBS, <em>F</em> = 13.2, <em>P</em> ≤ 0.001), mobility (TUG, <em>F</em> = 3.9, <em>P</em> = 0.05), and community reintegration (RNLI, <em>F</em> = 7.6, <em>P</em> = 0.01). Improvements in fall prevention confidence (MFES, <em>F</em> = 16.4, <em>P</em> ≤ 0.001), fatigue reduction (MFIS, <em>F</em> = 8.3, <em>P</em> = 0.007), and psychological well-being (HADS, <em>F</em> = 4.5, <em>P</em> = 0.04) were also significantly greater in the trunk group compared to in the core group.</div></div><div><h3>Conclusion</h3><div>For PwMS, dynamic trunk-focused interventions incorporating multiplanar movements on unstable surfaces along with dual-task training offer superior benefits over standard core stability exercises. These findings support the incorporation of dynamic trunk rehabilitation as a key component of MS rehabilitation protocols.</div></div><div><h3>ClinicalTrials</h3><div>gov (NCT06447571)</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106929"},"PeriodicalIF":2.9,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788468","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}

{"title":"Relapse activity during pregnancy and the postpartum year is associated with accelerated disability progression in multiple sclerosis","authors":"Lea I Walter ,&nbsp;Veronika Kana ,&nbsp;Sarah Hösli ,&nbsp;Michael Weller ,&nbsp;Nathalie Nierobisch ,&nbsp;Marina Herwerth ,&nbsp;Patrick Roth","doi":"10.1016/j.msard.2025.106932","DOIUrl":"10.1016/j.msard.2025.106932","url":null,"abstract":"<div><div>Management of multiple sclerosis (MS) presents unique challenges during pregnancy, particularly regarding disease-modifying therapies (DMT) and the risk of postpartum relapses. We investigated DMT exposure and further clinical and radiological parameters to identify predictors of relapse and disability progression during pregnancy and the postpartum year. We identified 112 pregnancies in 70 women with MS followed between 2010 and 2023. After excluding pregnancies lasting &lt;22 weeks, 96 pregnancies in 66 women, primarily with relapsing-remitting MS (RRMS), were included in the analysis. 77 pregnancies (80.2 %) developed during DMT exposure, with natalizumab, injectables, and fumarates being the most common. Relapse during pregnancy or the postpartum year occurred in 33 pregnancies, with 39.5 % happening during pregnancy and 60.5 % in the postpartum year, peaking in the first postpartum trimester. Women with pregnancies complicated by relapses during pregnancy or the postpartum year had lower rates of DMT exposure (66.7 % vs. 87.3 %, <em>p</em> = 0.016) and a non-significant trend toward higher baseline disability at conception. Disability progression within the first postpartum year was more frequent in the relapse group (25.8 % vs. 5.5 %, <em>p</em> = 0.010), with sustained differences in EDSS at two years postpartum. Postpartum MRI showed higher lesion load and more contrast-enhancing lesions in the relapse group. Spinal lesions at diagnosis and prior to conception were associated with significant higher risk of relapse during pregnancy and the postpartum year. Subgroup analysis of pregnant women treated with natalizumab indicated a lower relapse risk when natalizumab was continued into the third trimester. Pregnancy outcomes were mostly favorable, with 95.4 % term births and no significant differences in delivery mode or neonatal outcomes between women with versus without relapses during pregnancy.</div><div>Our findings emphasize the importance of DMT management, particularly the potential benefits of sustained natalizumab therapy for high-risk pregnancies. These results highlight the need for tailored treatment strategies to minimize postpartum relapses and long-term disability progression for women with MS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106932"},"PeriodicalIF":2.9,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788995","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}

{"title":"Feasibility and efficacy of peak-velocity interval training vs. moderate-intensity walking training in people with multiple sclerosis with severe fatigue and walking impairment: A pilot randomized controlled trial","authors":"Brice Thomas Cleland ,&nbsp;Brenda Jeng ,&nbsp;Natalya Brown ,&nbsp;Robert W. Motl ,&nbsp;Sangeetha Madhavan","doi":"10.1016/j.msard.2025.106930","DOIUrl":"10.1016/j.msard.2025.106930","url":null,"abstract":"<div><h3>Introduction</h3><div>High-intensity interval training (HIIT) may yield greater improvements in walking and fatigue for people with multiple sclerosis (MS) than moderate-intensity, continuous training (MICT). This pilot project established the feasibility of peak velocity interval walking training (PVIT, a novel form of HIIT) in people with MS who had elevated fatigue and walking dysfunction and determined initial efficacy on fitness, walking, fatigue, and cognition.</div></div><div><h3>Methods</h3><div>Twelve people with MS [49.3 (7.4) years of age; 9 female; 1–34 years post diagnosis; Fatigue Severity Scale Score &gt;4; Patient-Determined Disease Steps score 3–6] were randomly assigned into PVIT (<em>n</em> = 7) or MICT (<em>n</em> = 5) and completed 12 sessions of training up to 40 min. Feasibility was measured throughout as rates of recruitment, randomization, retention, adherence, and compliance. Pre- and post-assessments included peak oxygen consumption, walking performance, fatigue severity, and cognition.</div></div><div><h3>Results</h3><div>All participants who enrolled were successfully randomized and completed all sessions (100 % retention) with no adverse events. Adherence was high (86 %) as was intensity compliance (100 %) and did not differ between groups. PVIT resulted in greater walking velocity (relative to maximal overground velocity, 95 % vs. 70 %) and heart rate reserve (93 % vs. 55 %) than MICT. Peak oxygen consumption improved more in the PVIT than MICT condition (14 % vs. 1 % improvement, <em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Initial results suggest that PVIT as a form of HIIT is safe, feasible, and may improve aerobic fitness more than MICT in people with MS who have elevated fatigue and impaired walking function.</div></div><div><h3>Clinical trial registration</h3><div>ClinicalTrials.gov: NCT06264336</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106930"},"PeriodicalIF":2.9,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788996","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}

{"title":"Discriminative ability of the six-minute walk distance in identifying fallers in multiple sclerosis","authors":"Cemile Bozdemir ,&nbsp;Ebru Turan Kızıldogan ,&nbsp;Gulnur Tekgol Uzuner","doi":"10.1016/j.msard.2025.106931","DOIUrl":"10.1016/j.msard.2025.106931","url":null,"abstract":"<div><h3>Background</h3><div>Falls are a common clinical problem in individuals with multiple sclerosis (MS).</div></div><div><h3>Objective</h3><div>This study aimed to investigate the discriminative ability of the six-minute walk distance (6MWD), widely used to assess walking endurance in individuals with MS, in determining fall status.</div></div><div><h3>Methods</h3><div>The sixty-seven patients diagnosed with MS (EDSS = 3.05 ± 0.89) were included in a cross-sectional study. Falls and fall status were retrospectively recorded for the past three months. Clinic variables were evaluated. Walking endurance was assessed using the 6MWT (Six-minute walk test). The discriminative ability of 6MWD to determine fall status was defined using a receiver operating characteristic (ROC) curve analysis.</div></div><div><h3>Results</h3><div>The 6MWD was lower in the faller group compared to non-fallers (212.74 ± 98.32 m vs 343 ± 92.55 m; Cohen’s <em>d</em> = 1.36, <em>p</em> &lt; 0.001). A 1-meter increase in 6MWD was associated with a 1.5 % decrease in the odds of having fallen in the last 3 months (odds ratio: 0.985; 95 % CI: 0.973–0.993; <em>p</em> &lt; 0.001). The optimal cut-off point for identifying increased fall risk was ≤299 meters in 6MWD (AUC:0.824, sensitivity: 80.00 %, specificity: 71.87 %; AUC:0.94; 95 % CI 0.712 to 0.906; <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The 6MWD is a valuable tool for distinguishing fallers from non-fallers among individuals with MS. It may provide useful information not only to assess walking capacity and fatigability but also to identify individuals at increased risk of falls. Prospective monitoring is needed to validate its predictive value in clinical practice.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106931"},"PeriodicalIF":2.9,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788997","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}

{"title":"Therapeutic challenges in patients with multiple sclerosis and ankylosing spondylitis: A case series","authors":"Lucas P. Garfinkel ,&nbsp;Judy Diep ,&nbsp;Anjela Anand ,&nbsp;Katherine Stankevich ,&nbsp;Emily Lai ,&nbsp;Hala M. Eid ,&nbsp;Mary Penckofer ,&nbsp;Manisha Koneru ,&nbsp;Aswathi Sajeendran ,&nbsp;Alison Riggs ,&nbsp;Marina Santos de Sousa ,&nbsp;Donald Barone ,&nbsp;Jesse M. Thon ,&nbsp;Cris S. Constantinescu ,&nbsp;Olga R. Thon","doi":"10.1016/j.msard.2025.106926","DOIUrl":"10.1016/j.msard.2025.106926","url":null,"abstract":"<div><h3>Background</h3><div>Multiple Sclerosis (MS) is a chronic immune-mediated disease affecting &gt;2 million people worldwide. Coexistence with other autoimmune disorders, such as systemic lupus erythematosus (SLE), has been reported. However, reports of MS patients concurrently diagnosed with ankylosing spondylitis (AS) are rare, likely due to their differing immunogenic pathways. Management of patients with both MS and AS presents a clinical challenge, particularly due to the contraindication of TNF-α inhibitors (TNFi) in MS.</div></div><div><h3>Methods</h3><div>We present three patients with coexisting MS and AS. We characterize this population as well as provide an updated review of the literature detailing case reports with clinical information about patients diagnosed with both diseases, focusing on therapeutic challenges.</div></div><div><h3>Results</h3><div>Among the 18 total cases from case reports of MS patients with AS (15 published and 3 from this study), where clinical details are available, relapsing remitting MS was the most common MS subtype, and typical presentations included sensory deficits, spastic paraparesis, and optic neuritis. CSF oligoclonal bands were positive in 11 of the 13 cases where lumbar puncture results were reported. TNFi were used in eight patients for AS and were discontinued in all eight due to concern for demyelination. Diagnosis of MS in these patients happened after the TNFi treatment. In contrast, secukinumab, an IL-17A inhibitor, was well tolerated and effective in controlling AS symptoms without worsening MS in the five reported patients who received it. One of our cases illustrates the potential for secukinumab to be used alongside modern MS therapies such as dimethyl fumarate and ocrelizumab. Another case also highlights the complexity of treatment planning in the context of pregnancy.</div></div><div><h3>Conclusions</h3><div>Patients with concurrent MS and AS may have a specific clinical and laboratory profile. In instances where one disease process is more active than the other, a single immunotherapy agent targeting that condition may be favored, whereas using dual immunosuppression can be reserved for those with both highly active MS and AS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106926"},"PeriodicalIF":2.9,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735657","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}

{"title":"The effect of dietary interventions on peripheral markers of inflammation among people with multiple sclerosis: A systematic review and meta-analysis of randomized controlled trials","authors":"Wade R. Pingel ,&nbsp;Tyler J. Titcomb ,&nbsp;Solange M. Saxby ,&nbsp;Farshad Arsalandeh ,&nbsp;Asma Salari-Moghaddam ,&nbsp;Ashutosh Mangalam ,&nbsp;Linda G. Snetselaar ,&nbsp;Terry L. Wahls ,&nbsp;Farnoosh Shemirani","doi":"10.1016/j.msard.2025.106913","DOIUrl":"10.1016/j.msard.2025.106913","url":null,"abstract":"<div><h3>Background</h3><div>Multiple sclerosis (MS) is characterized by neuroinflammation and peripheral immune dysregulation, with circulating cytokines and systemic markers implicated in disease activity and progression. Emerging evidence suggests that diet influences inflammation, yet the impact of diet on inflammatory markers in MS remains unclear.</div></div><div><h3>Methods</h3><div>PubMed, Web of Science, Scopus, Embase, and Cochrane library (Central) were searched for randomized controlled trials (RCTs) evaluating dietary interventions versus control on peripheral inflammatory biomarkers, from inception through February 2025. Pooled effects were estimated using random-effects meta-analysis. The certainty of the evidence was assessed using the NutriGRADE scoring system. The study was registered in PROSPERO (CRD42023425961).</div></div><div><h3>Results</h3><div>Thirteen RCTs (<em>n</em> = 891) met inclusion criteria. Seven assessed dietary effects on C-reactive protein (CRP), with five showing reductions, particularly in Mediterranean, plant-based, and calorie-restricted diets, and two showing no between-group differences. The largest improvements occurred in trials lasting six months or longer. Meta-analyses of leptin (WMD: 0.95; 95 % CI: –2.80 to 4.69) and adiponectin (WMD: 480; 95 % CI: –152 to 1112) revealed no significant effects of calorie restriction. Data for other markers were insufficient for pooling. NutriGRADE evidence was rated low due to small sample sizes, and studies with a high or some concerns risk of bias.</div></div><div><h3>Conclusions</h3><div>Several dietary interventions may reduce systemic inflammation in PwMS, with greater effects in longer-duration interventions. Calorie-restricted diets did not significantly alter adipokines. Given the limited number and heterogeneity of studies, larger and longer RCTs using comparable dietary interventions are needed to confirm these findings.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106913"},"PeriodicalIF":2.9,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788564","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}

{"title":"A practical guide for rapid disease modifying therapy initiation and maintenance in aquaporin-4 positive neuromyelitis optica","authors":"Gandelman S ,&nbsp;Nussenzweig PM ,&nbsp;Yawetz S ,&nbsp;Bhattacharyya S","doi":"10.1016/j.msard.2025.106914","DOIUrl":"10.1016/j.msard.2025.106914","url":null,"abstract":"","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106914"},"PeriodicalIF":2.9,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735658","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}

{"title":"Ramadan fasting in multiple sclerosis: A systematic review","authors":"Ahad Nourmohammad ,&nbsp;Meysam Zorriyeh-Sheikhali ,&nbsp;Sarvin Sanaie ,&nbsp;Amirreza Naseri","doi":"10.1016/j.msard.2025.106920","DOIUrl":"10.1016/j.msard.2025.106920","url":null,"abstract":"<div><h3>Background and aims</h3><div>During Ramadan, the ninth month of the Islamic calendar, Muslims should abstain from eating, drinking, smoking, and sexual activity from sunrise to sunset. The possible effects of Ramadan observance in patients with multiple sclerosis (MS) is a challenging concern which is addressed in this systematic review.</div></div><div><h3>Methods</h3><div>Following the JBI and PRISMA methods, a broad search was conducted in PubMed, Scopus, Embase, and Web of Science databases, and clinical evidence regarding the probable effects of Ramadan fasting in MS patients was collected. Reviews, case reports, animal studies, editorials, letters, conference abstracts and commentaries were not included. The risk of bias was assessed using the JBI critical appraisal tools.</div></div><div><h3>Results</h3><div>The initial search yielded 48 articles, of which four reports (total n= 481; 426 fasting and 55 non-fasting patients), were found to meet the eligibility criteria. The study settings were Iran (two studies) and Egypt; and one multicenter study was conducted in Egypt, Morocco, and Saudi Arabia. Ramadan fasting was not found to be associated with increasing frequency of MS relapsing or worsening of disability. Also, evidence suggests benefits regarding the quality of life and cognitive domain score of modified fatigue impact scale; however, a higher level of disability and longer disease duration are found to increase the risk of MS activation during Ramadan.</div></div><div><h3>Discussion</h3><div>Based on the limited available evidence, Ramadan fasting, especially in patients with mild levels of disability, can be associated with improvements in the quality of life with no considerable negative effects. Reported outcomes in this investigation should be interpreted with circumspection as these effects were observed only in small studies, all in the Eastern Mediterranean Region.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106920"},"PeriodicalIF":2.9,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735661","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}

{"title":"Efficacy of caffeine supplementation on fatigue in patients with multiple sclerosis: A randomized double-blind placebo-controlled trial","authors":"Seyed Mohammad Baghbanian ,&nbsp;Aida Gharanjik ,&nbsp;Monireh Ghazaeian ,&nbsp;Atieh Bakhshi ,&nbsp;Abolfazl Hosseinnataj","doi":"10.1016/j.msard.2025.106923","DOIUrl":"10.1016/j.msard.2025.106923","url":null,"abstract":"<div><h3>Background</h3><div>Fatigue represents a significant clinical challenge in patients with multiple sclerosis (MS). Existing pharmacological interventions often demonstrate limited efficacy and may be associated with adverse effects. This study investigates the potential of caffeine to mitigate fatigue and enhance quality of life (QoL) in individuals diagnosed with MS.</div></div><div><h3>Methods</h3><div>In a randomized, double-blind, placebo-controlled study, individuals with multiple sclerosis and self-reported fatigue were administered either 100 mg of oral caffeine daily or a placebo over 12 weeks. The primary endpoint was the severity of fatigue, as assessed by the Multidimensional Fatigue Inventory (MFI-20). Secondary endpoints included quality of life, as measured by the SF-36, and the monitoring of adverse events throughout the study duration.</div></div><div><h3>Results</h3><div>A clinical trial involving sixty participants was conducted. The group administered caffeine exhibited a statistically significant decrease in MFI-20 scores relative to baseline (P &lt; 0.001) and compared to the placebo group (Mean difference of -8.55, P &lt; 0.009). Furthermore, statistically significant improvements were noted across multiple domains of the SF-36, specifically in vitality, pain, emotional well-being, and physical functioning (P&lt;0.05). Caffeine was well-tolerated among participants, with no serious adverse events reported.</div></div><div><h3>Conclusion</h3><div>Caffeine supplementation results in a significant reduction in fatigue and an improvement in quality of life and mood among patients with MS, with a favorable safety profile. These results suggest that caffeine may be a practical, readily available, and cost-effective therapeutic option for fatigue associated with MS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106923"},"PeriodicalIF":2.9,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145775006","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}