Multiple sclerosis and related disorders最新文献_第10页

Perceived pain during isometric exercise and neuromuscular fatigability in individuals with multiple sclerosis 多发性硬化症患者在等长运动和神经肌肉疲劳时的感知疼痛

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2025-12-20 DOI: 10.1016/j.msard.2025.106943

Mitra Rouhani , Marie K. Hoeger Bement , Sandra K. Hunter , Kathleen M. Zackowski , Ahmed Z. Obeidat , Alexander V. Ng

Among people with multiple sclerosis (PwMS), pain is a common symptom, and neuromuscular fatigability is widely reported. However, the association between pain during exercise and neuromuscular fatigability remains unclear. This study aimed to identify the association between perceived pain and neuromuscular fatigability during an exercise task in PwMS. Thirty-two PwMS (age=56.4, females=15) and 15 age- and sex-matched non-MS controls (age=57.9, females=7) participated. Disease severity was evaluated using the Expanded Disability Status Scale (median EDSS=4.0). The experimental protocol involved maximal voluntary contractions (MVCs) of the dorsiflexors, time-to-task failure (TTF) of an isometric fatiguing exercise sustained at maximal strength (neuromuscular fatigability), and a post-exercise MVC. Central and peripheral fatigability were assessed using electrical stimulation. The twitch interpolation technique quantified voluntary activation (VA), with pre-to-post exercise reductions in VA indicating central fatigability. Pre-to-post exercise reductions in resting twitch amplitude indicated peripheral fatigability. Perceived pain (0–10) was assessed at rest prior to exercise, during, and immediately post-exercise. Associations of changes in pain perception were identified using Spearman’s correlation coefficient (rho). Despite no significant differences between PwMS and controls across all outcome measures (p > 0.2), compared to controls, PwMS with higher disease severity (n = 12, EDSS≥4.5) had a significantly shorter TTF (mean difference=-38.5 s, p = 0.04), higher central fatigability (11 percentage points, p = 0.01), and lower peripheral fatigability (-20.8%, p = 0.01). Among PwMS, smaller changes in pain perception correlated with increased neuromuscular fatigability (rho=0.5, p = 0.003), higher central fatigability (rho=-0.4, p = 0.05), and lower peripheral fatigability (rho=0.4, p = 0.03). These findings suggest that perceived pain during the exercise task may be an overlooked mechanism contributing to neuromuscular fatigability in PwMS.

在多发性硬化症（PwMS）患者中，疼痛是常见的症状，神经肌肉疲劳被广泛报道。然而，运动时疼痛与神经肌肉疲劳之间的关系尚不清楚。本研究旨在确定在PwMS运动任务中感知疼痛和神经肌肉疲劳之间的关系。32名PwMS（年龄=56.4，女性=15）和15名年龄和性别匹配的非ms对照组（年龄=57.9，女性=7）参与了研究。使用扩展残疾状态量表评估疾病严重程度（中位EDSS=4.0）。实验方案包括背屈肌的最大自愿收缩（MVCs），在最大强度（神经肌肉疲劳）下持续的等长疲劳运动的任务时间失败（TTF），以及运动后的MVC。使用电刺激评估中枢和外周疲劳。抽动插值技术量化了自愿激活（VA），运动前后VA的减少表明中枢疲劳。运动前后静息抽搐幅度的减少表明周围性疲劳。感知疼痛（0-10）分别在运动前、运动中和运动后进行评估。使用Spearman相关系数（rho）确定疼痛感知变化的关联。尽管PwMS和对照组在所有结局指标上没有显著差异（p > 0.2），但与对照组相比，疾病严重程度较高的PwMS （n = 12, EDSS≥4.5）的TTF显著缩短（平均差异=-38.5 s, p = 0.04），中心疲劳程度较高（11个百分点，p = 0.01），外周疲劳程度较低（-20.8%,p = 0.01）。在PwMS中，疼痛感知的较小变化与神经肌肉疲劳增加（rho=0.5, p = 0.003）、中枢疲劳增加（rho=-0.4, p = 0.05）和外周疲劳降低（rho=0.4, p = 0.03）相关。这些发现表明，在运动任务中感知到的疼痛可能是导致PwMS神经肌肉疲劳的一个被忽视的机制。

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引用次数: 0

Brain states analysis of EEG predicts multiple sclerosis and mirrors disease duration and burden 脑状态分析的脑电图预测多发性硬化症和反映疾病的持续时间和负担

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2026-01-06 DOI: 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.

背景：考虑到认知退化对生活质量的影响，任何多发性硬化症的治疗都应该保持精神功能。然而，心理评估仍然是通过神经心理测试来实现的，没有基于神经生物学的认知监测，而正在进行的神经活动是容易观察和可读的。目的：提出了一种定量解读脑电图中作为多维认知体的脑电状态的方法。方法：对88名受试者（其中36名患有多发性硬化症）先前EEG研究的基线记录进行分析。光谱带用于计算认知集并对随后的特征组合集进行分类。结果：脑状态预测因子与疾病负担和病程相关。使用认知图和光谱带，横断面比较将患者与对照组分开，精确度为85%，而单独使用光谱带的准确率为79%。结论：通过对比MS患者和健康人的脑电图数据，证明了基于脑状态分析的定量数据驱动方法的有效性。与疾病严重程度和持续时间的一致性是疾病随时间积累的神经生理指标。我们讨论了该方法在精神病学和神经病学纵向临床研究中监测疾病病程和治疗疗效的潜在应用。

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引用次数: 0

Chronic stress amplifies multidimensional disease activity in multiple sclerosis patients: A year-long within-person analysis 慢性压力放大了多发性硬化症患者的多维疾病活动：一项为期一年的个人分析

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI: 10.1016/j.msard.2026.106965

Omri Zveik-Lavi , Dvir Green , Ariel Rechtman , Tal Ganz , Tal Friedman-Korn , Garrick Hoichman , Lyne Shweiki , Dana Ekstein , Adi Vaknin-Dembinsky

Background

Chronic psychological stress is suspected to intensify disease activity in multiple sclerosis (MS), yet longitudinal real-world evidence remains limited. This study aims to determine whether the first year of the war in Israel during 2023-2024, a period of sustained nationwide stress, was associated with increased composite evidence of disease activity (EDA-3) in people with MS (pwMS).

Methods

We conducted a retrospective case-control study of 930 pwMS followed at Hadassah Medical Center who had ≥1 annual visit across three consecutive years. Within-person comparisons were made between the war year (P3, 07/10/2023-06/10/2024) and the preceding year (P2). The primary outcome was EDA-3 (clinical relapse, confirmed EDSS worsening, or magnetic resonance imaging [MRI] activity). Each component of EDA-3, as well as treatment modifications, was also evaluated independently.

Results

EDA-3 prevalence was significantly higher during the war year (17.42%, 162/930) than pre-war (13.87%, 129/930; odds ratio [OR]=1.34, 95%-confidence interval [CI]: 1.02-1.76, p=0.034). Effects were more pronounced in males (OR=1.72, 95%-CI: 1.07-2.83; p=0.024) and in patients with EDSS≥4 (OR=1.77, 95%-CI: 1.20-2.63; p=0.0034). MRI activity increased from 11.77% to 17.54% (OR=1.83, 95%-CI: 1.14-2.98; p=0.011). Annualized relapse rate (ARR) showed a non-significant increase (p=0.068), and treatment modification rates were stable (switches: p=0.92; escalations: p=0.42). Results persisted after excluding pre-war DMT switchers (OR=1.55, 95%-CI: 1.147-2.122; p=0.004).

Conclusion

Sustained war-related stress coincided with clinically significant, multidimensional increases in MS disease activity, predominantly driven by MRI activity, with disproportionate impacts on males and higher-disability patients. These findings position chronic stress as a modifiable risk factor, advocating for integrated stress mitigation and proactive enhanced monitoring in MS care during prolonged crises.

慢性心理压力被怀疑会加剧多发性硬化症（MS）的疾病活动，但纵向现实证据仍然有限。本研究旨在确定以色列战争的第一年（2023-2024年），一个持续的全国性压力时期，是否与多发性硬化症（pwMS）患者疾病活动的综合证据（EDA-3）增加有关。方法对在哈达萨医疗中心连续3年每年访视≥1次的930例pwMS患者进行回顾性病例对照研究。对战争年（P3, 207/10/23 - 2024年6/10/06）和前一年（P2）进行了面对面的比较。主要预后指标为EDA-3（临床复发、确认EDSS恶化或磁共振成像活性）。EDA-3的每个成分以及治疗修改也被独立评估。结果战争年tsa -3患病率（17.42%,162/930）明显高于战前（13.87%,129/930），优势比[OR]=1.34, 95%可信区间[CI]: 1.02 ~ 1.76, p=0.034)。在男性（OR=1.72, 95%-CI: 1.07-2.83; p=0.024）和EDSS≥4的患者（OR=1.77, 95%-CI: 1.20-2.63; p=0.0034）中效果更为明显。MRI活度从11.77%增加到17.54% （OR=1.83, 95% ci: 1.14-2.98; p=0.011）。年化复发率（ARR）无显著增加（p=0.068），治疗改良率稳定（转换：p=0.92；升级：p=0.42）。排除战前DMT转换者后，结果仍然存在（OR=1.55, 95%-CI: 1.147-2.122; p=0.004）。结论：持续的战争相关应激与临床显著的多发性硬化症疾病活动性多维度增加相吻合，主要由MRI活动驱动，对男性和高残疾患者的影响不成比例。这些发现将慢性压力定位为一个可改变的风险因素，提倡在长期危机期间对MS护理进行综合压力缓解和主动加强监测。

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引用次数: 0

The brainstem signature of multiple sclerosis: predictable lesions, consistent syndromes 多发性硬化症的脑干特征：可预测的病变，一致的症状。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2025-12-03 DOI: 10.1016/j.msard.2025.106894

Mohammad Wafa , Khalid Nuh , Gavin Giovannoni , Klaus Schmierer , Sharmilee Gnanapavan , Ruth Dobson , Monical Marta , Maria Papachatzaki , Benjamin Turner , Thomas Campion , Ashok Adams , Anant Krishnan , Alexandros Chatzistefanou , Bader Mohamed , Ahmed Hashish

Background

Integrating clinical findings with neuroradiological changes is a crucial skill in neurology, particularly for diagnosis. Multiple Sclerosis (MS) lesions in the brainstem are rarely asymptomatic, leading to unique and often localised clinical syndromes. MS lesions exhibit a characteristic perivenular distribution, which in the brainstem is imprinted by the consistent topography of the penetrating veins.

Objective

This review provides an integrative perspective on the anatomical patterns of MS lesions in the brainstem (midbrain, pons, and medulla). It correlates specific clinical syndromes with radiological appearances, aiding in both diagnosis and functional localisation.

Methods

We searched the available literature using keywords related to the three brainstem sections (midbrain, pons, medulla) and eloquent anatomical locations (medial longitudinal fasciculus, cerebellar peduncle, nerve fascicle, aqueduct, area postrema), aiming to correlate specific radiological patterns of MS lesions with their consistent clinical syndromes as reported in the literature.

Summary of Key Findings

Brainstem MS lesions often cause irritative symptoms rather than full functional loss. Unlike other conditions, visible MS lesions on MRI rarely disappear and usually remain as silent lesions following an acute event. The consistent venous architecture creates specific radiological patterns that link to distinct clinical presentations. In contrast, inflammatory disorders like NMOSD and MOGAD cause more aggressive and extensive dysfunction.

Conclusion

The visual details of MS brainstem lesions reflect their close relationship to venous anatomy, which can be anticipated even when the central vein sign is not directly visualised. Recognising these specific clinical-radiological syndromes provides a unique and insightful diagnostic tool for MS, underscoring the value of strong functional and radiological-anatomical interpretation skills in clinical neurology.

背景：将临床表现与神经影像学改变相结合是神经病学的一项关键技能，尤其是在诊断方面。多发性硬化症（MS）病变在脑干很少是无症状的，导致独特的，往往是局部临床综合征。多发性硬化症病变表现为特征性的静脉周围分布，其在脑干中表现为穿透静脉的一致地形。目的：本文综述了多发性硬化症脑干（中脑、脑桥和脑髓）病变的解剖学模式。它将特定的临床综合征与影像学表现联系起来，有助于诊断和功能定位。方法：以脑干3个部位（中脑、脑桥、脑髓）及相关解剖部位（内侧纵束、小脑脚、神经束、输水管、后脑区）为关键词，检索相关文献，将MS病变的特定影像学表现与文献报道的一致临床症状联系起来。主要发现总结：脑干MS病变通常引起刺激症状，而不是完全功能丧失。与其他疾病不同，MRI上可见的MS病变很少消失，通常在急性事件后保持沉默。一致的静脉结构创造了特定的放射学模式，与不同的临床表现相联系。相比之下，炎性疾病如NMOSD和MOGAD会导致更严重和广泛的功能障碍。结论：MS脑干病变的视觉细节反映了其与静脉解剖的密切关系，即使没有直接看到中央静脉征象，也可以预见到这一点。认识到这些特定的临床-放射学综合征为MS提供了独特而深刻的诊断工具，强调了临床神经病学中强大的功能和放射-解剖解释技能的价值。

{"title":"The brainstem signature of multiple sclerosis: predictable lesions, consistent syndromes","authors":"Mohammad Wafa , Khalid Nuh , Gavin Giovannoni , Klaus Schmierer , Sharmilee Gnanapavan , Ruth Dobson , Monical Marta , Maria Papachatzaki , Benjamin Turner , Thomas Campion , Ashok Adams , Anant Krishnan , Alexandros Chatzistefanou , Bader Mohamed , Ahmed Hashish","doi":"10.1016/j.msard.2025.106894","DOIUrl":"10.1016/j.msard.2025.106894","url":null,"abstract":"<div><h3>Background</h3><div>Integrating clinical findings with neuroradiological changes is a crucial skill in neurology, particularly for diagnosis. Multiple Sclerosis (MS) lesions in the brainstem are rarely asymptomatic, leading to unique and often localised clinical syndromes. MS lesions exhibit a characteristic perivenular distribution, which in the brainstem is imprinted by the consistent topography of the penetrating veins.</div></div><div><h3>Objective</h3><div>This review provides an integrative perspective on the anatomical patterns of MS lesions in the brainstem (midbrain, pons, and medulla). It correlates specific clinical syndromes with radiological appearances, aiding in both diagnosis and functional localisation.</div></div><div><h3>Methods</h3><div>We searched the available literature using keywords related to the three brainstem sections (midbrain, pons, medulla) and eloquent anatomical locations (<em>medial longitudinal fasciculus, cerebellar peduncle, nerve fascicle, aqueduct, area postrema</em>), aiming to correlate specific radiological patterns of MS lesions with their consistent clinical syndromes as reported in the literature.</div></div><div><h3>Summary of Key Findings</h3><div>Brainstem MS lesions often cause irritative symptoms rather than full functional loss. Unlike other conditions, visible MS lesions on MRI rarely disappear and usually remain as silent lesions following an acute event. The consistent venous architecture creates specific radiological patterns that link to distinct clinical presentations. In contrast, inflammatory disorders like NMOSD and MOGAD cause more aggressive and extensive dysfunction.</div></div><div><h3>Conclusion</h3><div>The visual details of MS brainstem lesions reflect their close relationship to venous anatomy, which can be anticipated even when the central vein sign is not directly visualised. Recognising these specific clinical-radiological syndromes provides a unique and insightful diagnostic tool for MS, underscoring the value of strong functional and radiological-anatomical interpretation skills in clinical neurology.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106894"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834171","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}

引用次数: 0

Baseline severe disability as a predictor of treatment escalation to rituximab in AQP4-IgG–positive NMOSD patients: A retrospective cohort study 基线严重残疾作为aqp4 - igg阳性NMOSD患者升级到利妥昔单抗治疗的预测因素：一项回顾性队列研究

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2026-01-18 DOI: 10.1016/j.msard.2026.107022

Chayangkoon Siripornmongkol, Metha Apiwattanakul, Saharat Aungsumart

Introduction

Azathioprine and mycophenolate mofetil remain widely used as first-line immunosuppressive therapies for neuromyelitis optica spectrum disorder (NMOSD) in resource-limited settings. However, a subset of patients experience ongoing disease activity or treatment intolerance requiring escalation to rituximab. Identification of clinical factors associated with treatment escalation may improve treatment strategies.

Objectives

To identify clinical factors associated with escalation from azathioprine and mycophenolate mofetil to rituximab in AQP4-IgG–positive NMOSD patients.

Methods

We conducted a retrospective cohort study of AQP4-IgG–positive NMOSD patients treated at the Neurological Institute of Thailand between 2019 and 2024. Patients initially treated with azathioprine or mycophenolate mofetil were followed until escalation to rituximab or last follow-up. Baseline demographic, clinical, and laboratory variables were analyzed using logistic regression to identify factors associated with treatment escalation.

Results

Among 173 patients, 35 (20.23%) required escalation to rituximab. In multivariable analysis, baseline severe disability (EDSS ≥6 prior to first-line therapy) was independently strongly associated with treatment escalation to rituximab (OR 18.19, 95% CI 2.22–148.95; p=0.007). Other demographic and laboratory variables were not independently associated.

Conclusion

Baseline severe disability was strongly associated with subsequent escalation to rituximab. Early identification of high-risk patients may support more individualized treatment strategies and inform future policy decisions in resource-limited healthcare systems.

在资源有限的情况下，硫唑嘌呤和霉酚酸酯仍被广泛用作治疗视神经脊髓炎谱系障碍（NMOSD）的一线免疫抑制疗法。然而，一部分患者经历持续的疾病活动或治疗不耐受，需要升级到利妥昔单抗。确定与治疗升级相关的临床因素可以改善治疗策略。目的探讨aqp4 - igg阳性NMOSD患者从硫唑嘌呤和霉酚酸酯向利妥昔单抗升级的相关临床因素。方法对2019年至2024年在泰国神经病学研究所接受治疗的aqp4 - igg阳性NMOSD患者进行回顾性队列研究。患者最初用硫唑嘌呤或霉酚酸酯治疗，直到升级到利妥昔单抗或最后一次随访。使用逻辑回归分析基线人口统计学、临床和实验室变量，以确定与治疗升级相关的因素。结果173例患者中，35例（20.23%）需要升级至利妥昔单抗。在多变量分析中，基线严重残疾（一线治疗前EDSS≥6）与治疗升级为利妥昔单抗独立强相关（OR 18.19, 95% CI 2.22-148.95; p=0.007）。其他人口统计学和实验室变量没有独立关联。结论：基线严重残疾与随后升级使用利妥昔单抗密切相关。在资源有限的卫生保健系统中，早期识别高风险患者可能支持更个性化的治疗策略，并为未来的政策决策提供信息。

{"title":"Baseline severe disability as a predictor of treatment escalation to rituximab in AQP4-IgG–positive NMOSD patients: A retrospective cohort study","authors":"Chayangkoon Siripornmongkol, Metha Apiwattanakul, Saharat Aungsumart","doi":"10.1016/j.msard.2026.107022","DOIUrl":"10.1016/j.msard.2026.107022","url":null,"abstract":"<div><h3>Introduction</h3><div>Azathioprine and mycophenolate mofetil remain widely used as first-line immunosuppressive therapies for neuromyelitis optica spectrum disorder (NMOSD) in resource-limited settings. However, a subset of patients experience ongoing disease activity or treatment intolerance requiring escalation to rituximab. Identification of clinical factors associated with treatment escalation may improve treatment strategies.</div></div><div><h3>Objectives</h3><div>To identify clinical factors associated with escalation from azathioprine and mycophenolate mofetil to rituximab in AQP4-IgG–positive NMOSD patients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of AQP4-IgG–positive NMOSD patients treated at the Neurological Institute of Thailand between 2019 and 2024. Patients initially treated with azathioprine or mycophenolate mofetil were followed until escalation to rituximab or last follow-up. Baseline demographic, clinical, and laboratory variables were analyzed using logistic regression to identify factors associated with treatment escalation.</div></div><div><h3>Results</h3><div>Among 173 patients, 35 (20.23%) required escalation to rituximab. In multivariable analysis, baseline severe disability (EDSS ≥6 prior to first-line therapy) was independently strongly associated with treatment escalation to rituximab (OR 18.19, 95% CI 2.22–148.95; p=0.007). Other demographic and laboratory variables were not independently associated.</div></div><div><h3>Conclusion</h3><div>Baseline severe disability was strongly associated with subsequent escalation to rituximab. Early identification of high-risk patients may support more individualized treatment strategies and inform future policy decisions in resource-limited healthcare systems.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107022"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034515","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}

引用次数: 0

Impact of a short-term stress management protocol on physiologic biofeedback measures of stress and mood in people with multiple sclerosis 短期压力管理方案对多发性硬化症患者压力和情绪生理生物反馈测量的影响

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2026-01-02 DOI: 10.1016/j.msard.2026.106967

A.B. Sullivan , G. Tworek , A. Kane , J. Fredieu , T. Harvey

Background and objectives

Stress exacerbates multiple sclerosis (MS) symptoms. We report a 10-year study examining objective and subjective measures of stress and mood in people with MS (PwMS) using a shortened and more practical form of the Stress Management Therapy for MS (SMT-MS), the Stress Management Protocol (SMP).

Methods

We analyzed data from PwMS who underwent a 4-session SMP at Cleveland Clinic between 2012 and 2022 (N = 195; 90.5 % female; 68.2 % White; average age, 44.4 years; average disease duration, 12.1 years). Subjective data were collected pre-session using the Patient Health Questionaire-9 (PHQ-9) and Generalized Anxiety Disorder (GAD). Objective data, including breathing rate (breaths per minute, BPM), pulse (beats per minute, bpm), and blood oxygen saturation (%Sp02), were collected pre- and post-SMP. Statistical models assessed data differences and within-session improvement by session, as well as differences in pre- and post-session measurements .

Results

Subjective and objective scores improved significantly after Session 1. Significant intrasession improvements were observed, especially during the initial sessions. Significant overall improvements were observed in PHQ-9, GAD-7, and pre-session BPM and %SpO₂. Greatest improvements in PHQ-9 and BPM were observed in patients completing 3 sessions and that %Sp0₂ were observed in patients completing 4 sessions.

Discussion

PwMS who participated in the SMP showed considerable improvement in outcomes within and across sessions. Our results show that a brief, 4-session SMP can improve both subjective and objective measures of stress and mood in PwMS and that PwMS are able to utilize the SMP/biofeedback tools outside of therapy, in a real-world environment.

背景与目的压力会加重多发性硬化症（MS）的症状。我们报告了一项为期10年的研究，研究了MS （PwMS）患者的压力和情绪的客观和主观测量，使用了MS压力管理疗法（SMT-MS）的缩短和更实用的形式，即压力管理方案（SMP）。方法：我们分析了2012年至2022年间在克利夫兰诊所接受4期SMP治疗的PwMS患者的数据（N = 195, 90.5%为女性，68.2%为白人，平均年龄44.4岁，平均病程12.1年）。在会前使用患者健康问卷-9 （PHQ-9）和广泛性焦虑障碍（GAD）收集主观数据。客观数据，包括呼吸频率（每分钟呼吸数，BPM）、脉搏（每分钟心跳数，BPM）和血氧饱和度（%Sp02），均收集于smp前后。统计模型评估了数据差异和每次治疗期间的改善，以及治疗前和治疗后测量的差异。结果第一阶段后主观和客观评分均有显著提高。观察到重大的休会期间改善，特别是在最初的会议期间。在PHQ-9、GAD-7、会前BPM和%SpO2中观察到显著的总体改善。在完成3个疗程的患者中观察到PHQ-9和BPM的最大改善，在完成4个疗程的患者中观察到%Sp02的改善。参加SMP的pwms在会议内和会议间的结果都有相当大的改善。我们的研究结果表明，一个简短的4期SMP可以改善PwMS的主观和客观压力和情绪测量，并且PwMS能够在治疗之外，在现实环境中利用SMP/生物反馈工具。

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引用次数: 0

Efficacy and safety of Bruton’s tyrosine kinase inhibitors compared to Teriflunomide in relapsing multiple sclerosis: A systematic review and meta-analysis 布鲁顿酪氨酸激酶抑制剂与特立氟米特治疗复发性多发性硬化症的疗效和安全性：一项系统评价和荟萃分析

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI: 10.1016/j.msard.2026.106974

Milene Vitória Sampaio Sobral , Helen Michaela de Oliveira , Altair Pereira de Melo Neto , Thales Pardini Fagundes

Introduction

Traditional disease-modifying therapies (DMTs) reduce relapse frequency in relapsing–remitting multiple sclerosis (MS) but have a limited impact on relapse-independent progression, underscoring the need for novel therapies. Bruton’s tyrosine kinase inhibitors (BTKis), with dual immunomodulatory effects and central nervous system penetration, offer a promising alternative for comparison with established agents such as teriflunomide.

Methods

We systematically searched PubMed, Embase, and Cochrane CENTRAL up to June 2025 for randomized controlled trials (RCTs) comparing BTKis with teriflunomide in patients with relapsing MS. The primary outcome was confirmed disability worsening (CDW) at 3 and 6 months. Secondary outcomes included annualized relapse rate (ARR), magnetic resonance imaging (MRI) lesion activity, and adverse events. Random-effects meta-analyses were performed using hazard ratios (HRs), rate ratios, risk ratios, and mean differences, as appropriate.

Results

Four RCTs with 4136 participants were included. ARR was similar between the groups (Rate Ratio: 1.03; 95% CI: 0.90–1.19). BTK inhibitors reduced the risk of 3-month CDW compared with teriflunomide (HR: 0.81; 95% CI: 0.67–0.97) but not 6-month CDW (HR: 0.88; 95% CI: 0.63–1.24). The slight but significant difference in new T1 gadolinium-enhancing lesions favored teriflunomide (MD: 0.20; 95% CI: 0.15–0.25), whereas no difference was found in new or enlarging T2 lesions (MD:0.07; 95% CI:0.85 to 0.71). The incidence of serious adverse events was comparable between the groups (RR: 1.13; 95% CI: 0.92–1.40).

Conclusion

Compared with teriflunomide, BTK inhibitors were associated with a reduced risk of short-term disability progression, whereas no differences were observed in relapse rates, MRI activity, or safety outcomes.

传统的疾病改善疗法（dmt）降低了复发缓解型多发性硬化症（MS）的复发率，但对复发无关性进展的影响有限，这强调了对新疗法的需求。布鲁顿酪氨酸激酶抑制剂（BTKis）具有双重免疫调节作用和中枢神经系统穿透性，为与特立氟米特等现有药物进行比较提供了一个有希望的替代方案。方法：我们系统地检索PubMed、Embase和Cochrane CENTRAL截至2025年6月的随机对照试验（rct），比较BTKis和teri氟米特在复发性ms患者中的疗效，主要结局是在3个月和6个月时确认残疾恶化（CDW）。次要结局包括年复发率（ARR）、磁共振成像（MRI）病变活动性和不良事件。随机效应荟萃分析采用风险比（hr）、比率比、风险比和平均差异进行。结果共纳入4项随机对照试验，共4136名受试者。两组间ARR相似（率比：1.03;95% CI: 0.90-1.19）。与特里氟米特相比，BTK抑制剂降低了3个月CDW的风险（HR: 0.81; 95% CI: 0.67-0.97），但没有降低6个月CDW的风险（HR: 0.88; 95% CI: 0.63-1.24）。在新发T1钆增强病变中有轻微但显著的差异（MD: 0.20; 95% CI: 0.15-0.25），而在新发或扩大的T2病变中没有发现差异（MD:0.07; 95% CI:0.85 - 0.71）。两组间严重不良事件发生率具有可比性（RR: 1.13; 95% CI: 0.92-1.40）。结论：与特立氟米特相比，BTK抑制剂与短期残疾进展风险降低相关，而在复发率、MRI活性或安全性结果方面没有观察到差异。

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引用次数: 0

Neurological and paraclinical features differentiating Systemic lupus erythematosus, Sjögren’s disease, and neuromyelitis optica spectrum disorders 鉴别系统性红斑狼疮、Sjögren病和视神经脊髓炎的神经学和临床旁特征。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI: 10.1016/j.msard.2026.106972

Ivna Lacerda Pereira Nóbrega , Melissa Macedo Peixoto Nascimento , Igor Bessa Santiago , Jozélio Freire de Carvalho , Milena Sales Pitombeira , Carlos Ewerton Maia Rodrigues

Purpose of Review

To compare and elucidate the distinguishing clinical, laboratory, and imaging features of neuromyelitis optica spectrum disorder (NMOSD) when it occurs alone and when it coexists with systemic lupus erythematosus (SLE) or Sjögren’s disease (SjD).

Recent Findings

NMOSD is a chronic inflammatory autoimmune astrocitophaty that causes multifocal central nervous system involvement, primarily affecting the optic nerves and spinal cord. Serological testing for AQP4-IgG is the hallmark of NMOSD diagnosis. These antibodies are highly specific for NMOSD and are essential for differentiating it from SLE and SS, which usually test negative for this marker. Around 20–30% of NMOSD patients have associated autoimmune comorbidities, most commonly SLE and SjD, suggesting shared underlying autoimmune mechanisms. In SLE with NMOSD, central nervous system events are more frequent, while SjD often presents with predominant peripheral nervous system involvement.

Summary

Patients with NMOSD and concurrent SLE or SjD have higher morbidity, with increased risk of complications such as paraplegia and seizures, and longer hospital stays compared to those without these comorbidities. NMOSD represents a distinct disease process rather than a neurological complication of SLE or SjD. Identifying distinguishing clinical, laboratory, and imaging features is crucial for accurate diagnosis, guiding treatment strategies, and improving outcomes.

综述目的：比较和阐明视神经脊髓炎光谱障碍（NMOSD）单独发生和与系统性红斑狼疮（SLE）或Sjögren病（SjD）共存时的临床、实验室和影像学特征。最近发现：NMOSD是一种慢性炎症性自身免疫性星形腹肌病，可引起多灶中枢神经系统受累，主要影响视神经和脊髓。AQP4-IgG的血清学检测是诊断NMOSD的标志。这些抗体对NMOSD具有高度特异性，是将其与SLE和SS区分开来的必要条件，SLE和SS通常对该标志物检测呈阴性。约20-30%的NMOSD患者有相关的自身免疫性合并症，最常见的是SLE和SjD，提示有共同的潜在自身免疫性机制。在合并NMOSD的SLE中，中枢神经系统事件更为频繁，而SjD通常以周围神经系统受累为主。总结：与没有这些合并症的患者相比，NMOSD合并SLE或SjD的患者发病率更高，截瘫和癫痫发作等并发症的风险增加，住院时间更长。NMOSD代表一个独特的疾病过程，而不是SLE或SjD的神经系统并发症。鉴别临床、实验室和影像学特征对于准确诊断、指导治疗策略和改善预后至关重要。

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引用次数: 0

AQP4-IgG positive and AQP4-IgG–negative NMOSD: A Multicenter Latin-American Cohort vs. a Single-Center Argentine Cohort AQP4-IgG阳性和AQP4-IgG阴性NMOSD：多中心拉丁美洲队列vs单中心阿根廷队列

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2025-12-15 DOI: 10.1016/j.msard.2025.106933

Andrés M. Villa

引用次数: 0

Real-world detection of paramagnetic rim lesions and their association with disease burden in multiple sclerosis 多发性硬化症中顺磁边缘病变的真实世界检测及其与疾病负担的关系。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2026-01-16 DOI: 10.1016/j.msard.2026.107012

Olavi Misin , Anni Piispanen , Markus Matilainen , Riitta Parkkola , Mikko Nyman , Teija Sainio , Jussi Hirvonen , Laura Airas

Background

Paramagnetic rim lesions (PRLs) are an emerging MRI biomarker in multiple sclerosis (MS). On susceptibility-sensitive MRI, PRLs are characterized by a paramagnetic shift at the lesion rim corresponding to iron-laden macrophages and microglia, and PRL detection can hence be viewed as a proxy for lesion-associated smoldering inflammation in MS brain. The aim of this study was to identify PRLs in a standard university hospital setting to explore the associations between PRL burden and MS-related clinical and paraclinical parameters.

Methods

We retrospectively reviewed all 3T brain MRI studies performed as part of MS patient management at a tertiary university hospital in Finland between September 2021 and December 2023. PRLs were visually identified on filtered phase images from susceptibility-weighted imaging (SWI) sequences. Brain volumetric data were extracted from post-contrast 3D T1-weighted images using an automated quantification tool (cNeuro® cMRI). Clinical and laboratory variables were obtained by manual chart review from electronic medical records.

Results

The final cohort included 206 patients. 34% of patients had at least one PRL (the PRL1+ group). The median number of PRLs in the PRL1+ group was 2 and the maximum number was 11. Within the PRL1+ group, PRL count correlated positively with Expanded Disability Status Scale (EDSS), Multiple Sclerosis Severity Score (MSSS) and T2 lesion volume. Patients with PRLs had significantly smaller thalami compared to those without PRLs.

Discussion

Our real-world data reinforce evidence that PRLs are linked to more severe disease and demonstrate that PRL identification using manufacturer-reconstructed SWI filtered phase images provides a feasible imaging parameter to assess progression-associated pathology in MS in a standard clinical setting.

背景：顺磁边缘病变（prl）是多发性硬化症（MS）的一种新兴MRI生物标志物。在敏感MRI上，PRL的特征是病变边缘的顺磁移位，与铁负载巨噬细胞和小胶质细胞相对应，因此PRL的检测可以被视为MS脑病变相关的阴燃炎症的代理。本研究的目的是在一个标准的大学医院环境中识别PRL，探讨PRL负担与ms相关的临床和临床参数之间的关系。方法：我们回顾性回顾了2021年9月至2023年12月期间芬兰一家三级大学医院作为MS患者管理一部分进行的所有3T脑MRI研究。利用加权成像（SWI）序列滤波后的相位图像进行prl的视觉识别。使用自动量化工具（cNeuro®cMRI）从对比后的3D t1加权图像中提取脑容量数据。临床和实验室变量通过手工图表审查电子病历获得。结果：最终队列包括206例患者。34%的患者至少有一个PRL （PRL1+组）。PRL1+组prl中位数为2个，最大值为11个。在PRL1+组中，PRL计数与扩展残疾状态量表（EDSS）、多发性硬化严重程度评分（MSSS）和T2病变体积呈正相关。与没有prl的患者相比，prl患者的丘脑明显更小。讨论：我们的真实世界数据强化了PRL与更严重疾病相关的证据，并证明使用制造商重建的SWI滤波相位图像识别PRL为在标准临床环境中评估MS进展相关病理提供了可行的成像参数。

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引用次数: 0