Multiple sclerosis and related disorders最新文献_第2页

Effects of respiratory muscle training on respiratory function, exercise capacity and quality of life in people with multiple sclerosis: a systematic review and meta-analysis 呼吸肌训练对多发性硬化症患者呼吸功能、运动能力和生活质量的影响：一项系统回顾和荟萃分析

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-02-03 DOI: 10.1016/j.msard.2026.107034

Yunji Chen , Kun Meng , Xu Xiang , Guole Jiang , Yang Liu , Qing Yi

Objective

This systematic review and meta-analysis aimed to evaluate the effects of respiratory muscle training (RMT) on respiratory function, exercise capacity, and health-related quality of life (HRQoL) in individuals with multiple sclerosis (MS).

Methods

A systematic search was conducted across eight electronic databases—Web of Science, PubMed (including MEDLINE and PubMed Central), SPORTDiscus, ScienceDirect, Scopus, Cochrane Library, Embase, and ProQuest—from their inception through September 22, 2025. Randomized controlled trials (RCTs) and quasi-RCTs that compared RMT with passive control, sham RMT, or usual care in individuals with MS were eligible for inclusion, with no restrictions on publication date. Eligible studies were required to report at least one of the following outcomes: respiratory muscle strength (e.g., maximal inspiratory pressure, MIP; maximal expiratory pressure, MEP), pulmonary function (e.g., forced expiratory volume in 1 s, FEV₁; forced vital capacity, FVC), functional exercise capacity (e.g., 6-minute walk distance, 6MWD), or HRQoL (e.g., SF-36, MSQOL-54). Two independent reviewers conducted the literature search and performed data extraction. The methodological quality and risk of bias of the included studies were assessed using the Cochrane Risk of Bias 2.0 tool (RoB2) and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.

Results

A total of 16 studies involving 542 participants were included. The meta-analysis indicated that RMT significantly improved respiratory muscle strength (MIP: Hedges’ g = 0.47; MEP: Hedges’ g = 0.28) and pulmonary function (FEV₁: Hedges’ g = 0.39; FVC: Hedges’ g = 0.24). In contrast, RMT did not significantly improve functional exercise capacity (6MWD: Hedges’ g = 0.03) or the overall physical component summary of HRQoL (Hedges’ g = 0.05). A secondary analysis of a specific quality-of-life domain, however, showed a significant effect on the SF-36 Physical Functioning subscale (Hedges’ g = 0.40, 95% CI: 0.01 to 0.80).

Conclusion

RMT effectively improves respiratory muscle strength and pulmonary function in individuals with MS, and positively impacts specific Physical Functioning domains of HRQoL. However, current evidence does not support an improvement in functional exercise capacity. Despite the limited number of included studies, RMT shows promise as an adjunctive therapy for targeted respiratory rehabilitation. This study provides a foundational evidence base to guide clinical practice and inform the design of future high-quality trials.

目的：本系统综述和荟萃分析旨在评估呼吸肌训练（RMT）对多发性硬化症（MS）患者呼吸功能、运动能力和健康相关生活质量（HRQoL）的影响。方法：系统检索了8个电子数据库——web of Science、PubMed（包括MEDLINE和PubMed Central）、SPORTDiscus、ScienceDirect、Scopus、Cochrane Library、Embase和proquest——从它们成立到2025年9月22日。将RMT与被动对照、假RMT或常规治疗进行比较的随机对照试验（rct）和准rct符合纳入条件，对发表日期没有限制。符合条件的研究需要报告以下结果中的至少一项：呼吸肌力量（如最大吸气压力，MIP；最大呼气压力，MEP）、肺功能（如1秒内用力呼气量，FEV1；用力肺活量，FVC）、功能运动能力（如6分钟步行距离，6MWD）或HRQoL（如SF-36， MSQOL-54）。两位独立审稿人进行文献检索和数据提取。采用Cochrane风险偏倚2.0工具（RoB2）和推荐、评估、发展和评价分级（GRADE）框架对纳入研究的方法学质量和偏倚风险进行评估。结果：共纳入16项研究，涉及542名受试者。meta分析显示，RMT显著改善了呼吸肌力（MIP: Hedges' g = 0.47; MEP: Hedges' g = 0.28）和肺功能（FEV1: Hedges' g = 0.39; FVC: Hedges' g = 0.24）。相比之下，RMT没有显著改善功能运动能力（6MWD: Hedges' g = 0.03）或HRQoL的整体身体成分总结（Hedges' g = 0.05）。然而，对特定生活质量领域的二次分析显示，对SF-36身体功能子量表有显著影响（Hedges' g = 0.40, 95% CI: 0.01至0.80）。结论：RMT可有效改善MS患者的呼吸肌力量和肺功能，并对HRQoL的特定生理功能域产生积极影响。然而，目前的证据并不支持功能性运动能力的改善。尽管纳入的研究数量有限，但RMT作为靶向呼吸康复的辅助治疗显示出希望。本研究为指导临床实践和指导未来高质量试验的设计提供了基础证据基础。

{"title":"Effects of respiratory muscle training on respiratory function, exercise capacity and quality of life in people with multiple sclerosis: a systematic review and meta-analysis","authors":"Yunji Chen , Kun Meng , Xu Xiang , Guole Jiang , Yang Liu , Qing Yi","doi":"10.1016/j.msard.2026.107034","DOIUrl":"10.1016/j.msard.2026.107034","url":null,"abstract":"<div><h3>Objective</h3><div>This systematic review and meta-analysis aimed to evaluate the effects of respiratory muscle training (RMT) on respiratory function, exercise capacity, and health-related quality of life (HRQoL) in individuals with multiple sclerosis (MS).</div></div><div><h3>Methods</h3><div>A systematic search was conducted across eight electronic databases—Web of Science, PubMed (including MEDLINE and PubMed Central), SPORTDiscus, ScienceDirect, Scopus, Cochrane Library, Embase, and ProQuest—from their inception through September 22, 2025. Randomized controlled trials (RCTs) and quasi-RCTs that compared RMT with passive control, sham RMT, or usual care in individuals with MS were eligible for inclusion, with no restrictions on publication date. Eligible studies were required to report at least one of the following outcomes: respiratory muscle strength (e.g., maximal inspiratory pressure, MIP; maximal expiratory pressure, MEP), pulmonary function (e.g., forced expiratory volume in 1 s, FEV<sub>1</sub>; forced vital capacity, FVC), functional exercise capacity (e.g., 6-minute walk distance, 6MWD), or HRQoL (e.g., SF-36, MSQOL-54). Two independent reviewers conducted the literature search and performed data extraction. The methodological quality and risk of bias of the included studies were assessed using the Cochrane Risk of Bias 2.0 tool (RoB2) and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.</div></div><div><h3>Results</h3><div>A total of 16 studies involving 542 participants were included. The meta-analysis indicated that RMT significantly improved respiratory muscle strength (MIP: Hedges’ <em>g</em> = 0.47; MEP: Hedges’ <em>g</em> = 0.28) and pulmonary function (FEV<sub>1</sub>: Hedges’ <em>g</em> = 0.39; FVC: Hedges’ <em>g</em> = 0.24). In contrast, RMT did not significantly improve functional exercise capacity (6MWD: Hedges’ <em>g</em> = 0.03) or the overall physical component summary of HRQoL (Hedges’ <em>g</em> = 0.05). A secondary analysis of a specific quality-of-life domain, however, showed a significant effect on the SF-36 Physical Functioning subscale (Hedges’ <em>g</em> = 0.40, 95% CI: 0.01 to 0.80).</div></div><div><h3>Conclusion</h3><div>RMT effectively improves respiratory muscle strength and pulmonary function in individuals with MS, and positively impacts specific Physical Functioning domains of HRQoL. However, current evidence does not support an improvement in functional exercise capacity. Despite the limited number of included studies, RMT shows promise as an adjunctive therapy for targeted respiratory rehabilitation. This study provides a foundational evidence base to guide clinical practice and inform the design of future high-quality trials.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"108 ","pages":"Article 107034"},"PeriodicalIF":2.9,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146181196","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

Frailty, Disability, and Comorbidity in Multiple Sclerosis: Overlap and Distinct Associations with Quality of Life and Falls 多发性硬化症的虚弱、残疾和合并症：与生活质量和跌倒的重叠和明显关联

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-02-02 DOI: 10.1016/j.msard.2026.107043

Tobia Zanotto , Nida’ Al Worikat , Anna Zanotto , Sharon G Lynch , Jacob J Sosnoff

Background

Owing to the global aging of people with multiple sclerosis (pwMS), there is an emerging need to distinguish neurological disability from age-related conditions in this population.

Objective

To examine the overlap between frailty, disability, and comorbidity in pwMS, and their associations with quality of life (QoL) and falls.

Methods

Two hundred and three pwMS (mean age=51.8 ± 12.6 years; median Patient Determined Disease Steps (PDDS) score=1.0 [IQR=2.0]; 73.9% women) underwent established assessments of frailty (FRAIL scale, Tilburg frailty indicator, and frailty index), disability (PDDS), comorbidity (Charlson comorbidity index), QoL (MSQoL-54), and falls (12-month fall-history survey).

Results

Frailty, disability, and comorbidity were distinct but overlapping: 1.5–10.3% of participants had frailty alone, 4.4–14.3% had disability alone, and 11.8–14.3% had comorbidity alone; between 9.4% and 19.7% had all three. Multivariable quantile and logistic regression analyses revealed that all frailty measures were more strongly associated with lower QoL (median regression coefficients ≤-4.76, p-values˂0.001) and greater odds of falling (OR_s ≥1.47, p-values≤0.001) than disability or comorbidity. Participants with all three conditions had significantly worse physical QoL and a higher median number of falls than those with any one condition alone.

Conclusions

Frailty, disability, and comorbidity represent separate conditions in pwMS, as they can present in isolation, and each has distinct associations with QoL and falls. Comprehensive assessment of all three conditions may enhance risk stratification and inform individualized rehabilitation and aging support strategies.

背景：随着多发性硬化症（pwMS）患者的全球老龄化，越来越需要将这一人群的神经功能障碍与年龄相关疾病区分开来。目的探讨虚弱、残疾和合并症在pwMS中的重叠性及其与生活质量（QoL）和跌倒的关系。方法203例pwMS患者（平均年龄51.8±12.6岁），PDDS评分中位数=1.0 [IQR=2.0]；73.9%女性)接受了既定的虚弱评估（虚弱量表、Tilburg虚弱指标和虚弱指数）、残疾（PDDS）、合并症（Charlson合并症指数）、生活质量（MSQoL-54）和跌倒（12个月跌倒史调查）。结果虚弱、残疾和合并症不同但又重叠：1.5 ~ 10.3%的参与者仅虚弱，4.4 ~ 14.3%的参与者仅残疾，11.8 ~ 14.3%的参与者仅合并症；9.4%到19.7%的人三者都有。多变量分位数和逻辑回归分析显示，与残疾或共病相比，所有虚弱指标与较低的生活质量（回归系数中位数≤-4.76，p值小于0.001）和较高的跌倒几率（or≥1.47，p值≤0.001）的相关性更强。所有三种情况下的参与者的身体生活质量明显差于任何一种情况下的参与者，跌倒的中位数也高于任何一种情况下的参与者。虚弱、残疾和合并症是pwMS的独立症状，因为它们可以单独出现，并且每一种都与生活质量和跌倒有明显的关联。综合评估这三种情况可以加强风险分层，为个性化康复和老年支持策略提供信息。

{"title":"Frailty, Disability, and Comorbidity in Multiple Sclerosis: Overlap and Distinct Associations with Quality of Life and Falls","authors":"Tobia Zanotto , Nida’ Al Worikat , Anna Zanotto , Sharon G Lynch , Jacob J Sosnoff","doi":"10.1016/j.msard.2026.107043","DOIUrl":"10.1016/j.msard.2026.107043","url":null,"abstract":"<div><h3>Background</h3><div>Owing to the global aging of people with multiple sclerosis (pwMS), there is an emerging need to distinguish neurological disability from age-related conditions in this population.</div></div><div><h3>Objective</h3><div>To examine the overlap between frailty, disability, and comorbidity in pwMS, and their associations with quality of life (QoL) and falls.</div></div><div><h3>Methods</h3><div>Two hundred and three pwMS (mean age=51.8 ± 12.6 years; median Patient Determined Disease Steps (PDDS) score=1.0 [IQR=2.0]; 73.9% women) underwent established assessments of frailty (FRAIL scale, Tilburg frailty indicator, and frailty index), disability (PDDS), comorbidity (Charlson comorbidity index), QoL (MSQoL-54), and falls (12-month fall-history survey).</div></div><div><h3>Results</h3><div>Frailty, disability, and comorbidity were distinct but overlapping: 1.5–10.3% of participants had frailty alone, 4.4–14.3% had disability alone, and 11.8–14.3% had comorbidity alone; between 9.4% and 19.7% had all three. Multivariable quantile and logistic regression analyses revealed that all frailty measures were more strongly associated with lower QoL (median regression coefficients ≤-4.76, p-values˂0.001) and greater odds of falling (OR<sub>s</sub> ≥1.47, p-values≤0.001) than disability or comorbidity. Participants with all three conditions had significantly worse physical QoL and a higher median number of falls than those with any one condition alone.</div></div><div><h3>Conclusions</h3><div>Frailty, disability, and comorbidity represent separate conditions in pwMS, as they can present in isolation, and each has distinct associations with QoL and falls. Comprehensive assessment of all three conditions may enhance risk stratification and inform individualized rehabilitation and aging support strategies.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"108 ","pages":"Article 107043"},"PeriodicalIF":2.9,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102790","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

Multiple sclerosis and uveitis: Clinical characteristics and prognosis 多发性硬化和葡萄膜炎：临床特点和预后。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-02-02 DOI: 10.1016/j.msard.2026.107047

William GIL , Samuel CHACUN , Géraldine ANDRODIAS , Caroline VASSENEIX , Laurent KODJIKIAN , Sandra VUKUSIC , Pascal SÈVE , Thomas EL-JAMMAL

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

背景：多发性硬化症（MS）的神经预后因临床模式而异，但与葡萄膜炎的相关性尚不清楚。目的：探讨多发性硬化症相关性葡萄膜炎与非葡萄膜炎的神经预后及临床特点。方法：我们进行了一项回顾性病例对照研究，包括35例MS相关葡萄膜炎患者和102例匹配的MS对照组（1:3，年龄，性别，MS病程）。临床和神经学数据从里昂队列葡萄膜炎和EDMUS数据库中提取。主要终点是基线和最后一次随访之间扩展残疾状态量表（EDSS）的差异。结果：ms相关葡萄膜炎患者的北非血统多于对照组（48.6% vs 20.6%, p = 0.006; OR 3.51, 95% CI[1.41-8.77]）。葡萄膜炎组中位随访19年[14-26]，对照组中位随访16年[13-22]。基线EDSS在两组之间具有可比性（2.0 vs 2.0），最后随访时EDSS也具有可比性（3.0 vs 3.0）。然而，与对照组相比，bb0 ~ 32岁ms相关葡萄膜炎患者的残疾进展风险显著降低。结论：ms相关性葡萄膜炎在北非患者中更为常见，通常表现为结节病样表型。在32岁以上的患者中，它与更有利的神经预后相关。

{"title":"Multiple sclerosis and uveitis: Clinical characteristics and prognosis","authors":"William GIL , Samuel CHACUN , Géraldine ANDRODIAS , Caroline VASSENEIX , Laurent KODJIKIAN , Sandra VUKUSIC , Pascal SÈVE , Thomas EL-JAMMAL","doi":"10.1016/j.msard.2026.107047","DOIUrl":"10.1016/j.msard.2026.107047","url":null,"abstract":"<div><h3>Background</h3><div>The neurological prognosis of multiple sclerosis (MS) varies across clinical patterns but remains unclear when associated with uveitis.</div></div><div><h3>Objective</h3><div>To investigate the neurological prognosis and clinical characteristics of MS-associated uveitis compared with MS without uveitis.</div></div><div><h3>Methods</h3><div>We conducted a retrospective case-control study including 35 patients with MS-associated uveitis and 102 matched MS controls (1:3; age, sex, MS course). Clinical and neurological data were extracted from the Lyon Cohort Uveitis and the EDMUS database. The primary endpoint was the difference in Expanded Disability Status Scale (EDSS) between baseline and last follow-up.</div></div><div><h3>Results</h3><div>Patients with MS-associated uveitis were more often of North African origin than controls (48.6 % vs 20.6 %, <em>p</em> = 0.006; OR 3.51, 95 % CI [1.41–8.77]). Median follow-up was 19 years [14–26] in the uveitis group and 16 years [13–22] in controls. Baseline EDSS was comparable between groups (2.0 vs 2.0), as was EDSS at last follow-up (3.0 vs 3.0). However, patients aged >32 years with MS-associated uveitis had a significantly lower risk of disability progression compared with controls.</div></div><div><h3>Conclusions</h3><div>MS-associated uveitis was more frequent in patients of North African origin and often showed a sarcoidosis-like phenotype. In patients older than 32 years, it was associated with a more favorable neurological outcome.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107047"},"PeriodicalIF":2.9,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125964","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

No evidence of disease activity after fingolimod treatment: A three-year real-world comparison of pre- and post-treatment outcomes in multiple sclerosis 芬戈莫德治疗后无疾病活动的证据：一项为期三年的多发性硬化症治疗前后结果的真实世界比较

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-02-02 DOI: 10.1016/j.msard.2026.107044

Ulvi Samadzade , Said Alizada , Can Caliskan , Orkhan Mammadov , Serkan Ozakbas

Background

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

Methods

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

Results

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

Conclusion

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

背景：芬戈莫对多发性硬化症（MS）有效性的真实数据仍然有价值，特别是在切换队列和跨表型中。方法：我们进行了一项回顾性单中心观察研究，纳入了接受芬戈莫德治疗的MS合并RRMS或SPMS患者，并有完整对称的3年治疗前和3年治疗后临床随访数据。结果包括3年前后的年复发率（ARR）和扩展残疾状态量表（EDSS）的变化，以及3年治疗期间达到NEDA-3的比例。结果：共分析657例患者（RRMS 596例，SPMS 61例）。RRMS方面，ARR由治疗前3年的0.34±0.39降至芬戈莫德治疗后3年的0.08±0.20 (p < 0.001)，平均EDSS由1.48±1.27降至1.43±1.36 （p = 0.152）。SPMS的ARR由0.61±0.52上升至0.27±0.32 (p < 0.001)， EDSS的ARR由5.08±1.01上升至6.10±1.31 （p < 0.001）。在3年的治疗期间，415/596例（69.6%）RRMS患者和10/61例（16.4%）SPMS患者达到了NEDA-3。结论：在这个现实世界的切换队列中，fingolimod与RRMS复发活动的显著降低相关，而SPMS的残疾恶化持续存在。NEDA-3率因表型而有很大差异，支持表型特异性预期和现实世界风险分层的价值。

{"title":"No evidence of disease activity after fingolimod treatment: A three-year real-world comparison of pre- and post-treatment outcomes in multiple sclerosis","authors":"Ulvi Samadzade , Said Alizada , Can Caliskan , Orkhan Mammadov , Serkan Ozakbas","doi":"10.1016/j.msard.2026.107044","DOIUrl":"10.1016/j.msard.2026.107044","url":null,"abstract":"<div><h3>Background</h3><div>Real-world data on fingolimod effectiveness in multiple sclerosis (MS) remain valuable, particularly in switch cohorts and across phenotypes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective single-center observational study including MS patients with RRMS or SPMS who received fingolimod and had complete symmetric 3-year pre- and 3-year post-treatment clinical follow-up data. Outcomes included changes in annualized relapse rate (ARR) and Expanded Disability Status Scale (EDSS) over the 3-year pre/post periods, and the proportion achieving NEDA-3 during the 3-year on-treatment period.</div></div><div><h3>Results</h3><div><strong>:</strong>A total of 657 patients were analyzed (596 RRMS; 61 SPMS). In RRMS, ARR decreased from 0.34±0.39 in the 3 years pre-treatment to 0.08±0.20 in the 3 years on fingolimod (<em>p</em> < 0.001), and mean EDSS changed from 1.48±1.27 to 1.43±1.36 (<em>p</em> = 0.152). In SPMS, ARR changed from 0.61±0.52 to 0.27±0.32 (<em>p</em> < 0.001), while EDSS increased from 5.08±1.01 to 6.10±1.31 (<em>p</em> < 0.001). NEDA-3 was achieved by 415/596 (69.6 %) RRMS patients and 10/61 (16.4 %) SPMS patients during the 3-year on-treatment period.</div></div><div><h3>Conclusion</h3><div>In this real-world switch cohort, fingolimod was associated with a marked reduction in relapse activity in RRMS, while disability worsening persisted in SPMS. NEDA-3 rates differed substantially by phenotype, supporting phenotype-specific expectations and the value of real-world risk stratification.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"108 ","pages":"Article 107044"},"PeriodicalIF":2.9,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137784","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

The high-heel sign: revisiting neurological semiology from Charcot’s era to modern patient-reported outcomes in multiple sclerosis 高跟鞋标志：回顾从夏科时代到现代多发性硬化症患者报告的结果的神经符号学。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-02-02 DOI: 10.1016/j.msard.2026.107048

Juliana Santiago-Amaral

引用次数: 0

Aging does not affect the relationship between OCT and clinical or MRI outcome measures 年龄不影响OCT和临床或MRI结果测量之间的关系。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-02-02 DOI: 10.1016/j.msard.2026.107046

S. Kaçar , Julia R. Jelgerhuis , J. Killestein , F. Barkhof , M.M. Schoonheim , B.M.J. Uitdehaag , E.M.M. Strijbis

Background

Neurodegeneration in multiple sclerosis (MS) is intertwined with normal aging. The standard approach to address this overlap is statistical correction for the confounding effects of age, but it remains unclear to what extent this successfully isolates disease-specific processes from those related to aging.

Objectives

We aimed to investigate how age influences cross-sectional associations between retinal measures—retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL)—and both MRI and clinical outcomes in MS.

Methods

We compared two MS cohorts: (1) a cohort selected on birth year (Project Y) and (2) an age-heterogeneous MS cohort (PrograMS). Multilevel linear regression models were used to assess cross-sectional associations. Models were adjusted for sex, history of optic neuritis, and disease duration. In the heterogeneous cohort, age was included as an additional covariate.

Results

In both the birth-year cohort (N = 378) and the heterogeneous cohort (N = 206), we observed significant associations between RNFL and GCIPL thickness and several MRI measures including whole brain volume, white matter volume, lesion volume, and thalamus volume, as well as clinical outcome measures, such as Expanded Disability Status Scale (EDSS), Symbol Digit Modality Test (SDMT). While effect sizes varied, the direction remained consistent. Including age as a covariate did not substantially change associations. For example, both RNFL and GCIPL thickness were associated with EDSS in the birth-year cohort (RNFL: β = -0.020, p < 0.001; GCIPL: β = -0.017, p = 0.005) and in the age-heterogeneous cohort (RNFL: β = -0.024, p = 0.010; GCIPL: β = -0.033, p < 0.001), and showed consistent directionality in their associations with MRI-derived brain volumes.

Discussion

Our findings reveal significant cross-sectional associations between RNFL and GCIPL thickness and several MRI and clinical measures, with consistent directionality across both cohorts, and largely independent of age.

背景：多发性硬化症（MS）的神经退行性变与正常衰老交织在一起。解决这种重叠的标准方法是对年龄的混淆效应进行统计校正，但目前尚不清楚这在多大程度上成功地将疾病特异性过程与与衰老相关的过程分离开来。目的：我们旨在研究年龄如何影响视网膜测量-视网膜神经纤维层（RNFL）和神经节细胞-内丛状层(GCIPL)-与MS的MRI和临床结果之间的横断面关联。方法：我们比较了两个MS队列：(1)根据出生年份选择的队列（Y项目）和(2)年龄异质性MS队列（program）。多水平线性回归模型用于评估横断面关联。根据性别、视神经炎病史和病程调整模型。在异质队列中，年龄作为附加协变量被纳入。结果：在出生年份队列（N = 378）和异质队列（N = 206）中，我们观察到RNFL和GCIPL厚度与全脑体积、白质体积、病变体积和丘脑体积等多项MRI测量以及扩展残疾状态量表（EDSS）、符号数字模态测试（SDMT）等临床结果测量之间存在显著相关性。虽然效应大小不同，但方向是一致的。将年龄作为协变量并没有实质性地改变相关性。例如，在出生年份队列（RNFL: β = -0.020, p < 0.001; GCIPL: β = -0.017, p = 0.005）和年龄异质性队列（RNFL: β = -0.024, p = 0.010; GCIPL: β = -0.033, p < 0.001）中，RNFL和GCIPL厚度都与EDSS相关，并且在它们与mri衍生脑容量的关联中显示出一致的方向性。讨论：我们的研究结果揭示了RNFL和GCIPL厚度以及一些MRI和临床测量之间的显著横断面关联，在两个队列中具有一致的方向性，并且在很大程度上与年龄无关。

{"title":"Aging does not affect the relationship between OCT and clinical or MRI outcome measures","authors":"S. Kaçar , Julia R. Jelgerhuis , J. Killestein , F. Barkhof , M.M. Schoonheim , B.M.J. Uitdehaag , E.M.M. Strijbis","doi":"10.1016/j.msard.2026.107046","DOIUrl":"10.1016/j.msard.2026.107046","url":null,"abstract":"<div><h3>Background</h3><div>Neurodegeneration in multiple sclerosis (MS) is intertwined with normal aging. The standard approach to address this overlap is statistical correction for the confounding effects of age, but it remains unclear to what extent this successfully isolates disease-specific processes from those related to aging.</div></div><div><h3>Objectives</h3><div>We aimed to investigate how age influences cross-sectional associations between retinal measures—retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL)—and both MRI and clinical outcomes in MS.</div></div><div><h3>Methods</h3><div>We compared two MS cohorts: (1) a cohort selected on birth year (Project Y) and (2) an age-heterogeneous MS cohort (PrograMS). Multilevel linear regression models were used to assess cross-sectional associations. Models were adjusted for sex, history of optic neuritis, and disease duration. In the heterogeneous cohort, age was included as an additional covariate.</div></div><div><h3>Results</h3><div>In both the birth-year cohort (<em>N</em> = 378) and the heterogeneous cohort (<em>N</em> = 206), we observed significant associations between RNFL and GCIPL thickness and several MRI measures including whole brain volume, white matter volume, lesion volume, and thalamus volume, as well as clinical outcome measures, such as Expanded Disability Status Scale (EDSS), Symbol Digit Modality Test (SDMT). While effect sizes varied, the direction remained consistent. Including age as a covariate did not substantially change associations. For example, both RNFL and GCIPL thickness were associated with EDSS in the birth-year cohort (RNFL: β = -0.020, <em>p</em> < 0.001; GCIPL: β = -0.017, <em>p</em> = 0.005) and in the age-heterogeneous cohort (RNFL: β = -0.024, <em>p</em> = 0.010; GCIPL: β = -0.033, <em>p</em> < 0.001), and showed consistent directionality in their associations with MRI-derived brain volumes.</div></div><div><h3>Discussion</h3><div>Our findings reveal significant cross-sectional associations between RNFL and GCIPL thickness and several MRI and clinical measures, with consistent directionality across both cohorts, and largely independent of age.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"108 ","pages":"Article 107046"},"PeriodicalIF":2.9,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146181142","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

Thirty-year trends in the prevalence and incidence of multiple sclerosis (MS) in Mazandaran Province: Application of advanced statistical methods 马赞达兰省多发性硬化症（MS）患病率和发病率的30年趋势：先进统计方法的应用

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-02-02 DOI: 10.1016/j.msard.2026.107045

Roya Nikbakht , Seyed Mohammad Baghbanian , Sharaeh Eskandarieh , Roja Nikaeen , Mohammadali Sahraian , Abolfazl Hosseinnataj

Background

Mazandaran province in Iran, identified as a high-prevalence area, has lacked comprehensive long-term studies on MS trends. This study aims to fill that gap by analyzing three decades of MS incidence and prevalence in Mazandaran using advanced statistical methods.

Methods

This longitudinal study included clinically diagnosed MS cases from the two most populous cities in Mazandaran utilizing data from the national MS registry spanning 1994 to 2023. Prevalence and age-adjusted incidence rates were calculated, and annual percentage change (APC) was assessed using joint point regression. Bayesian statistical methods were applied for comprehensive trend analysis.

Results

A total of 1333 MS patients were identified, the mean (±sd) age at diagnosis was 28.58±8.52 years. MS prevalence increased from 0.19 per 100,000 in 1994 to 127.24 per 100,000 in 2023. The age-adjusted incidence rate rose from 0.14 (95 %CI: 0–0.5) in 1994 to a peak of 10.44 (95 %CI: 7.8–13.0) in 2018, then declined to 4.39 (95 %CI: 2.7–6.1) in 2023. The APC in MS incidence was +14.1 % until 2018, followed by a -15.32 % decrease thereafter. Significant differences in mean age, Expanded Disability Status Scale (EDSS) score and MS type were observed before and after 2018. The Bayesian methods indicated that evaluated predictors were not statistically significant for MS prevalence.

Conclusion

This study demonstrates a marked increase in MS incidence in Mazandaran province until 2018, followed by a subsequent decline. The rising prevalence and decreasing mean age at diagnosis underscore the need for continued surveillance and further research to determine whether the recent decline in incidence will persist.

背景伊朗mazandaran省被确定为多发性硬化症高流行地区，缺乏对多发性硬化症趋势的全面长期研究。本研究旨在通过使用先进的统计方法分析Mazandaran三十年的MS发病率和患病率来填补这一空白。方法本纵向研究纳入马赞达兰两个人口最多城市的临床诊断多发性硬化症病例，利用1994年至2023年国家多发性硬化症登记处的数据。计算患病率和年龄调整后的发病率，并使用关节点回归评估年百分比变化（APC）。采用贝叶斯统计方法进行综合趋势分析。结果共确诊MS患者1333例，诊断时平均（±sd）年龄为28.58±8.52岁。多发性硬化症患病率从1994年的0.19 / 10万上升到2023年的127.24 / 10万。年龄调整后的发病率从1994年的0.14 （95% CI: 0-0.5）上升到2018年的峰值10.44 (95% CI: 7.8-13.0)，然后下降到2023年的4.39 （95% CI: 2.7-6.1）。到2018年，MS发病率的APC为+ 14.1%，此后下降- 15.32%。2018年前后的平均年龄、扩展残疾状态量表（EDSS）评分和多发性硬化症类型存在显著差异。贝叶斯方法表明，评估的预测因子对MS患病率无统计学意义。该研究表明，直到2018年，马赞达兰省的MS发病率显著增加，随后下降。患病率的上升和平均诊断年龄的下降强调需要继续监测和进一步研究，以确定最近发病率的下降是否会持续下去。

{"title":"Thirty-year trends in the prevalence and incidence of multiple sclerosis (MS) in Mazandaran Province: Application of advanced statistical methods","authors":"Roya Nikbakht , Seyed Mohammad Baghbanian , Sharaeh Eskandarieh , Roja Nikaeen , Mohammadali Sahraian , Abolfazl Hosseinnataj","doi":"10.1016/j.msard.2026.107045","DOIUrl":"10.1016/j.msard.2026.107045","url":null,"abstract":"<div><h3>Background</h3><div>Mazandaran province in Iran, identified as a high-prevalence area, has lacked comprehensive long-term studies on MS trends. This study aims to fill that gap by analyzing three decades of MS incidence and prevalence in Mazandaran using advanced statistical methods.</div></div><div><h3>Methods</h3><div>This longitudinal study included clinically diagnosed MS cases from the two most populous cities in Mazandaran utilizing data from the national MS registry spanning 1994 to 2023. Prevalence and age-adjusted incidence rates were calculated, and annual percentage change (APC) was assessed using joint point regression. Bayesian statistical methods were applied for comprehensive trend analysis.</div></div><div><h3>Results</h3><div>A total of 1333 MS patients were identified, the mean (±sd) age at diagnosis was 28.58±8.52 years. MS prevalence increased from 0.19 per 100,000 in 1994 to 127.24 per 100,000 in 2023. The age-adjusted incidence rate rose from 0.14 (95 %CI: 0–0.5) in 1994 to a peak of 10.44 (95 %CI: 7.8–13.0) in 2018, then declined to 4.39 (95 %CI: 2.7–6.1) in 2023. The APC in MS incidence was +14.1 % until 2018, followed by a -15.32 % decrease thereafter. Significant differences in mean age, Expanded Disability Status Scale (EDSS) score and MS type were observed before and after 2018. The Bayesian methods indicated that evaluated predictors were not statistically significant for MS prevalence.</div></div><div><h3>Conclusion</h3><div>This study demonstrates a marked increase in MS incidence in Mazandaran province until 2018, followed by a subsequent decline. The rising prevalence and decreasing mean age at diagnosis underscore the need for continued surveillance and further research to determine whether the recent decline in incidence will persist.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"108 ","pages":"Article 107045"},"PeriodicalIF":2.9,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190769","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

Reduced retinal neuronal injury as a consequence of high efficacy DMT treatment: an OCT study 高效DMT治疗减少视网膜神经元损伤：一项OCT研究。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-02-02 DOI: 10.1016/j.msard.2026.107049

Antonio Francesco Vacca , Su-Chun Huang , Elisa Idini , Giancarlo Coghe , Marzia Fronza , Lorena Lorefice , Eleonora Cocco , Christian Cordano , Jessica Frau

Objective

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

Methods

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

Results

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

Conclusions

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

目的：探讨疾病改善治疗对视网膜神经节细胞-内丛状层（GCIPL）厚度的影响。方法：我们分析了90例MS患者（男女比3:1，平均年龄39.3岁，中位EDSS 2.0，平均病程8.1年）的174张视网膜光学相干断层扫描（OCT）。2017年至2023年间，使用光谱域OCT （Spectralis, Heidelberg Engineering, Germany）在基线和随访时获得双侧黄斑扫描。将患者分为中效组（ME-DMT, N = 34）和高效组（HE-DMT, N = 56）。主要测量指标是全球GCIPL厚度，通过独立t检验和混合线性回归模型进行分析，以确定GCIPL的年化变化。结果：HE-DMT组GCIPL年萎缩率（0.07±0.38µm/年）明显低于ME-DMT组（0.64±0.86µm/年，p < 0.0001）。混合线性回归证实了这些发现，并考虑了协变量和基线特征。结论：HE-DMTs可减缓GCIPL萎缩，提示其具有潜在的神经保护作用。这些结果强调了视网膜成像在跟踪MS治疗效果和神经变性方面的价值。

{"title":"Reduced retinal neuronal injury as a consequence of high efficacy DMT treatment: an OCT study","authors":"Antonio Francesco Vacca , Su-Chun Huang , Elisa Idini , Giancarlo Coghe , Marzia Fronza , Lorena Lorefice , Eleonora Cocco , Christian Cordano , Jessica Frau","doi":"10.1016/j.msard.2026.107049","DOIUrl":"10.1016/j.msard.2026.107049","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the impact of disease-modifying treatments (DMTs) on retinal ganglion cell-inner plexiform layer (GCIPL) thickness.</div></div><div><h3>Methods</h3><div>We analyzed 174 retinal optical coherence tomography (OCT) scans from 90 MS patients (female-to-male ratio 3:1; mean age 39.3 years; median EDSS 2.0; mean disease duration 8.1 years). Bilateral macular scans were obtained at baseline and follow-up using spectral-domain OCT (Spectralis, Heidelberg Engineering, Germany) between 2017 and 2023. Patients were divided into moderate-efficacy (ME-DMT, <em>N</em> = 34) and high-efficacy (HE-DMT, <em>N</em> = 56) groups. The primary measure was global GCIPL thickness, with analysis conducted via independent <em>t</em>-tests and a mixed linear regression model to determine annualized GCIPL change.</div></div><div><h3>Results</h3><div>The HE-DMT group had a significantly lower annual GCIPL atrophy rate (0.07 ± 0.38 µm/year) compared to the ME-DMT group (0.64 ± 0.86 µm/year, <em>p</em> < 0.0001). Mixed linear regression confirmed these findings, accounting for covariates and baseline characteristics.</div></div><div><h3>Conclusions</h3><div>HE-DMTs appear to slow GCIPL atrophy, suggesting a potential neuroprotective effect. These results underscore the value of retinal imaging in tracking MS treatment efficacy and neurodegeneration.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"108 ","pages":"Article 107049"},"PeriodicalIF":2.9,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142979","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

Efficacy of traditional swallowing therapy plus neuromuscular electrostimulation in multiple sclerosis: A randomized controlled trial 传统吞咽疗法加神经肌肉电刺激治疗多发性硬化症的疗效：一项随机对照试验

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-02-02 DOI: 10.1016/j.msard.2026.107042

Maria Grazia Grasso , Giampaolo Brichetto , Marco Rovaris , Roberta Beccari , Davide Cattaneo , Alessandro Cuccaro , Rachele Di Giovanni , Shara De Santi , Giulia Fusari , Carla Giudice , Erica Grange , Katia Inglese , Daniele Martinelli , Elisa Monti , Margherita Monti Bragadin , Federico Masserano Zoli , Giulia Musto , Giorgia Presicce , Arianna Servetto , Marilia Simonelli , Claudio Solaro

Background

Dysphagia is a common and potentially life-threatening complication in people with multiple sclerosis (pwMS), even in early disease stages. Although compensatory strategies may reduce aspiration risk, they do not restore normal swallowing. Neuromuscular Electrical Stimulation (NMES) has shown promise in dysphagic populations, but evidence in pwMS is scarce. Objectives: This double-blind, randomized, placebo-controlled trial aimed to evaluate the feasibility and added benefit of NMES combined with standard swallowing therapy in pwMS with dysphagia.

Results

Of 151 dysphagic pwMS screened, 101 were enrolled and randomized to receive NMES plus conventional swallowing exercises (TST-NMES) (n = 52) or sham stimulation with the same therapy (TST-S) (n = 49).

Both groups improved in dysphagia disturbances over time. However, when we analysed the two groups according to disease severity, significantly greater ASHA score gains were observed in severely disabled patients (EDSS ≥7) receiving NMES. Baseline ASHA predicted outcomes, while EDSS influenced only controls. At follow-up, no adverse effects were reported, confirming treatment safety and tolerability.

Conclusion

NMES combined with standard swallowing therapy appears to be a feasible and effective intervention for dysphagia in pwMS, especially in more disabled people. These results support further investigation in larger randomized trials.

吞咽困难是多发性硬化症（pwMS）患者常见且可能危及生命的并发症，即使在疾病的早期阶段也是如此。虽然代偿策略可以降低误吸风险，但不能恢复正常吞咽。神经肌肉电刺激（NMES）在吞咽困难人群中显示出希望，但在pwMS中的证据很少。目的：这项双盲、随机、安慰剂对照试验旨在评估NMES联合标准吞咽疗法治疗伴有吞咽困难的pwMS的可行性和额外益处。结果在筛选的151例吞咽困难pwMS中，101例被纳入并随机分配接受NMES +常规吞咽练习（TST-NMES）（n = 52）或假性刺激治疗（TST-S）（n = 49）。随着时间的推移，两组的吞咽困难症状都有所改善。然而，当我们根据疾病严重程度对两组进行分析时，在接受NMES的严重残疾患者（EDSS≥7）中观察到明显更大的ASHA评分增加。基线ASHA预测预后，而EDSS仅影响对照组。在随访中，无不良反应报告，证实了治疗的安全性和耐受性。结论nmes联合标准吞咽治疗是治疗pwMS患者吞咽困难的一种可行且有效的干预措施，尤其是对更多的残疾人。这些结果支持在更大的随机试验中进一步研究。

{"title":"Efficacy of traditional swallowing therapy plus neuromuscular electrostimulation in multiple sclerosis: A randomized controlled trial","authors":"Maria Grazia Grasso , Giampaolo Brichetto , Marco Rovaris , Roberta Beccari , Davide Cattaneo , Alessandro Cuccaro , Rachele Di Giovanni , Shara De Santi , Giulia Fusari , Carla Giudice , Erica Grange , Katia Inglese , Daniele Martinelli , Elisa Monti , Margherita Monti Bragadin , Federico Masserano Zoli , Giulia Musto , Giorgia Presicce , Arianna Servetto , Marilia Simonelli , Claudio Solaro","doi":"10.1016/j.msard.2026.107042","DOIUrl":"10.1016/j.msard.2026.107042","url":null,"abstract":"<div><h3>Background</h3><div>Dysphagia is a common and potentially life-threatening complication in people with multiple sclerosis (pwMS), even in early disease stages. Although compensatory strategies may reduce aspiration risk, they do not restore normal swallowing. Neuromuscular Electrical Stimulation (NMES) has shown promise in dysphagic populations, but evidence in pwMS is scarce. <strong>Objectives</strong>: This double-blind, randomized, placebo-controlled trial aimed to evaluate the feasibility and added benefit of NMES combined with standard swallowing therapy in pwMS with dysphagia.</div></div><div><h3>Results</h3><div>Of 151 dysphagic pwMS screened, 101 were enrolled and randomized to receive NMES plus conventional swallowing exercises (TST-NMES) (<em>n</em> = 52) or sham stimulation with the same therapy (TST-S) (<em>n</em> = 49).</div><div>Both groups improved in dysphagia disturbances over time. However, when we analysed the two groups according to disease severity, significantly greater ASHA score gains were observed in severely disabled patients (EDSS ≥7) receiving NMES. Baseline ASHA predicted outcomes, while EDSS influenced only controls. At follow-up, no adverse effects were reported, confirming treatment safety and tolerability.</div></div><div><h3>Conclusion</h3><div>NMES combined with standard swallowing therapy appears to be a feasible and effective intervention for dysphagia in pwMS, especially in more disabled people. These results support further investigation in larger randomized trials.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"108 ","pages":"Article 107042"},"PeriodicalIF":2.9,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190770","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

Incident and prevalent peripartum mental illness in mothers with multiple sclerosis and other chronic diseases in Sweden 瑞典患有多发性硬化症和其他慢性病的母亲围产期精神病的发生率和流行率。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-01-31 DOI: 10.1016/j.msard.2026.107041

Ruth Ann Marrie , Colleen J Maxwell , James M. Bolton , Jonas Söderling , Charles N Bernstein , Kristen M Krysko , Kyla A McKay , Dalia Rotstein , Karma Deakin-Harb , Neda Razaz

Background

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

Methods

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

Results

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

Conclusions

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

背景：关于多发性硬化症（MS）妇女围产期精神疾病的风险，以及如何将其与其他慢性疾病妇女的风险进行比较，研究结果相互矛盾。我们比较了患有多发性硬化症、癫痫、炎症性肠病（IBD）、糖尿病和没有这些疾病的女性围生期精神疾病的发病率和患病率。方法：使用基于人群的瑞典行政健康数据，我们选择了2002年至2019年间分娩的MS、癫痫、IBD、糖尿病和比较者。使用围产期精神疾病的有效病例定义，我们估计了怀孕期间和产后第一年精神疾病的发病率和流行程度。我们使用粗略估计和未经调整的泊松回归比较了队列之间的发病率和患病率。结果：我们纳入了1096814名女性（多发性硬化症1936例；癫痫7709例；IBD 7731例；糖尿病7182例；比较者1072256例）。平均（SD）受孕年龄为30.1（5.1）岁。与比较组相比，患有MS的母亲有更高的精神疾病发病率（发病率比[IRR] 1.36; 1.04-1.78），患有癫痫（1.78;1.58-2.00）、IBD（1.46; 1.28-1.66）和糖尿病（1.61;1.41-1.83）的母亲也是如此。患有多发性硬化症、癫痫、IBD和糖尿病的母亲患抑郁症和双相情感障碍的发生率和患病率也高于对照组。结论：与没有这些疾病的母亲相比，患有多发性硬化症、癫痫、IBD和糖尿病的母亲围产期精神疾病的发病率和患病率相似地升高。

{"title":"Incident and prevalent peripartum mental illness in mothers with multiple sclerosis and other chronic diseases in Sweden","authors":"Ruth Ann Marrie , Colleen J Maxwell , James M. Bolton , Jonas Söderling , Charles N Bernstein , Kristen M Krysko , Kyla A McKay , Dalia Rotstein , Karma Deakin-Harb , Neda Razaz","doi":"10.1016/j.msard.2026.107041","DOIUrl":"10.1016/j.msard.2026.107041","url":null,"abstract":"<div><h3>Background</h3><div>Findings conflict regarding the risk of peripartum mental illness in women with multiple sclerosis (MS) and how this compares to the risk among women with other chronic diseases. We compared the incidence and prevalence of peripartum mental illness among women with MS, epilepsy, inflammatory bowel disease (IBD), diabetes, and women without any of these diseases (comparators).</div></div><div><h3>Methods</h3><div>Using population-based Swedish administrative health data we selected women with MS, epilepsy, IBD, diabetes, and comparators who had deliveries between 2002 and 2019. Using validated case definitions for peripartum mental illness we estimated the incidence and prevalence of mental illness during the period encompassing pregnancy and the first post-partum year. We compared incidence and prevalence between cohorts using crude estimates and unadjusted Poisson regression.</div></div><div><h3>Results</h3><div>We included 1096,814 women (1936 MS; 7709 epilepsy; 7731 IBD; 7182 diabetes; 1072,256 comparators). Mean (SD) age at conception was 30.1 (5.1) years. Compared to comparators, mothers with MS had a higher incidence of any mental illness (incidence rate ratio [IRR] 1.36; 1.04–1.78), as did mothers with epilepsy (1.78; 1.58–2.00), IBD (1.46; 1.28–1.66) and diabetes (1.61; 1.41–1.83). Mothers with MS, epilepsy, IBD and diabetes also had a higher incidence and prevalence of depression and bipolar disorder than comparators. Mothers with epilepsy had higher incidence rates of anxiety, and higher prevalence ratios of any mental illness and anxiety than mothers with MS.</div></div><div><h3>Conclusions</h3><div>Women with MS, epilepsy, IBD and diabetes have a similarly elevated incidence and prevalence of peripartum mental illness as compared to mothers without these conditions.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107041"},"PeriodicalIF":2.9,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119526","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