Pub Date : 2026-01-05DOI: 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.
{"title":"Efficacy and safety of Bruton’s tyrosine kinase inhibitors compared to Teriflunomide in relapsing multiple sclerosis: A systematic review and meta-analysis","authors":"Milene Vitória Sampaio Sobral , Helen Michaela de Oliveira , Altair Pereira de Melo Neto , Thales Pardini Fagundes","doi":"10.1016/j.msard.2026.106974","DOIUrl":"10.1016/j.msard.2026.106974","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106974"},"PeriodicalIF":2.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-05DOI: 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.
{"title":"Chronic stress amplifies multidimensional disease activity in multiple sclerosis patients: A year-long within-person analysis","authors":"Omri Zveik-Lavi , Dvir Green , Ariel Rechtman , Tal Ganz , Tal Friedman-Korn , Garrick Hoichman , Lyne Shweiki , Dana Ekstein , Adi Vaknin-Dembinsky","doi":"10.1016/j.msard.2026.106965","DOIUrl":"10.1016/j.msard.2026.106965","url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106965"},"PeriodicalIF":2.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-05DOI: 10.1016/j.msard.2026.106975
Dorothy Gheorghiu , Danielle Kapustin , Monica Diaz , Robert Sharkus , Benjamin Osborne , Taegan Vinarsky , Francesca Bagnato , Michael Lutz , Suma Shah
Background and Objectives
Neuromyelitis optica (NMO) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are demyelinating autoimmune diseases that often occur in women of reproductive age. The aim of this study is to characterize pregnancy outcomes in women with NMO or MOGAD.
Methods
Retrospective chart review data were collected from four academic medical institutions in the Southeast United States using a REDCap-based tool.
Results
Data from 59 patients representing 101 NMO and 59 MOGAD pregnancies were included. The present sample showed reduced rates of spontaneous abortion (SAB) at 6.9% in patients with NMO compared to patients with MS (17.3%, p = 0.045). Intrauterine fetal demise (IUFD) was more frequent in patients with NMO (1.98%) than in the general population (0.38%, p = 0.042). Only 10.2% of MOGAD pregnancies and 20.8% of NMO pregnancies were uncomplicated. No differences between groups existed for preeclampsia or preterm delivery. This cohort demonstrated similar rates of vaginal and cesarean delivery between groups. Relapse rates were lowest during pregnancy and highest postpartum for both groups.
Discussion
Women with NMO and MOGAD had fewer spontaneous abortions than both comparison groups, but more frequent complications. Unlike prior studies evaluating MS and NMO in pregnancy, this cohort did not demonstrate higher rates of preeclampsia or preterm birth. This study observed significantly fewer relapses during pregnancy and significantly more relapses postpartum for NMO and MOGAD subgroups. Patients who received disease-modifying therapy had the fewest relapses. These data show that MOGAD and NMO have similarities with MS in terms of pregnancy outcomes but suggest differences that require tailored treatment through pregnancy.
{"title":"Rare demyelinating autoimmune diseases and pregnancy outcomes","authors":"Dorothy Gheorghiu , Danielle Kapustin , Monica Diaz , Robert Sharkus , Benjamin Osborne , Taegan Vinarsky , Francesca Bagnato , Michael Lutz , Suma Shah","doi":"10.1016/j.msard.2026.106975","DOIUrl":"10.1016/j.msard.2026.106975","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>Neuromyelitis optica (NMO) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are demyelinating autoimmune diseases that often occur in women of reproductive age. The aim of this study is to characterize pregnancy outcomes in women with NMO or MOGAD.</div></div><div><h3>Methods</h3><div>Retrospective chart review data were collected from four academic medical institutions in the Southeast United States using a REDCap-based tool.</div></div><div><h3>Results</h3><div>Data from 59 patients representing 101 NMO and 59 MOGAD pregnancies were included. The present sample showed reduced rates of spontaneous abortion (SAB) at 6.9% in patients with NMO compared to patients with MS (17.3%, <em>p</em> = 0.045). Intrauterine fetal demise (IUFD) was more frequent in patients with NMO (1.98%) than in the general population (0.38%, <em>p</em> = 0.042). Only 10.2% of MOGAD pregnancies and 20.8% of NMO pregnancies were uncomplicated. No differences between groups existed for preeclampsia or preterm delivery. This cohort demonstrated similar rates of vaginal and cesarean delivery between groups. Relapse rates were lowest during pregnancy and highest postpartum for both groups.</div></div><div><h3>Discussion</h3><div>Women with NMO and MOGAD had fewer spontaneous abortions than both comparison groups, but more frequent complications. Unlike prior studies evaluating MS and NMO in pregnancy, this cohort did not demonstrate higher rates of preeclampsia or preterm birth. This study observed significantly fewer relapses during pregnancy and significantly more relapses postpartum for NMO and MOGAD subgroups. Patients who received disease-modifying therapy had the fewest relapses. These data show that MOGAD and NMO have similarities with MS in terms of pregnancy outcomes but suggest differences that require tailored treatment through pregnancy.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106975"},"PeriodicalIF":2.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-05DOI: 10.1016/j.msard.2026.106973
Felipe C.D. Barros, Felipe T.L. Menezes, Natasha P.A. Bessa, Vanessa C.C. Lessa, Alexandre B. Lopes, Jessica M.D. Alencar, Denis B. Bichuetti, Nilton A. Souza, Gisele S. Silva, Enedina M.L. Oliveira
Background
Multiple sclerosis (MS) may have its prognosis affected by several cardiovascular risk factors. The Framingham Score is a systematic way to measure the biological interactions of cardiovascular risk factors and has been related to MS clinical outcomes.
Objective
assess whether the Framingham score is associated with an increased risk of MS disability, as stated by the risk of reaching an Expanded Disability Status Scale (EDSS) score of 6 during follow-up in multiethnic population in a middle-income country.
Methods
This retrospective study evaluates the relationship between the Framingham Score and the last visit EDSS score, calculated using a logistic regression model, with further adjustments for confounding risk factors and a decision tree algorithm analysis. Data was collected from a tertiary multiple sclerosis (MS) center for patients admitted between 1994 and 2019.
Results
Among 2036 medical records, we included 284 patients for final analysis. Patients who reached an EDSS of 6 or more had a mean Framingham score of 9.9 versus 5.8 among those who did not reach such EDSS. There was a positive Spearman correlation between the Framingham general cardiovascular risk score and the last-visit EDSS (rₛ = 0.414, p < 0.001). In logistic regression models using EDSS ≥ 6 as the outcome, higher Framingham scores were associated with greater odds of disability in unadjusted analyses, but this association was attenuated after adjustment for age. Among patients with baseline EDSS 0–2.5, the Framingham score significantly predicted a higher final EDSS. In this group, 25.3% of those with a score >1.91 reached EDSS ≥ 6, versus 3.9% with a score ≤1.91.
Discussion
Our study reported an association between cardiovascular risk, as measured by the Framingham score, and disability in MS, measured by the last visit EDSS score, in a middle-income MS cohort with access to DMD. Such correlation is stronger and statistically significant among patients with an EDSS between 0 and 2.5. There is an association between the Framingham score and a higher final EDSS in patients with multiple sclerosis when the cardiovascular risk factors are present in the early course of the disease.
{"title":"The Framingham score is a marker of early disability progression in multiple sclerosis","authors":"Felipe C.D. Barros, Felipe T.L. Menezes, Natasha P.A. Bessa, Vanessa C.C. Lessa, Alexandre B. Lopes, Jessica M.D. Alencar, Denis B. Bichuetti, Nilton A. Souza, Gisele S. Silva, Enedina M.L. Oliveira","doi":"10.1016/j.msard.2026.106973","DOIUrl":"10.1016/j.msard.2026.106973","url":null,"abstract":"<div><h3>Background</h3><div>Multiple sclerosis (MS) may have its prognosis affected by several cardiovascular risk factors. The Framingham Score is a systematic way to measure the biological interactions of cardiovascular risk factors and has been related to MS clinical outcomes.</div></div><div><h3>Objective</h3><div>assess whether the Framingham score is associated with an increased risk of MS disability, as stated by the risk of reaching an Expanded Disability Status Scale (EDSS) score of 6 during follow-up in multiethnic population in a middle-income country.</div></div><div><h3>Methods</h3><div>This retrospective study evaluates the relationship between the Framingham Score and the last visit EDSS score, calculated using a logistic regression model, with further adjustments for confounding risk factors and a decision tree algorithm analysis. Data was collected from a tertiary multiple sclerosis (MS) center for patients admitted between 1994 and 2019.</div></div><div><h3>Results</h3><div>Among 2036 medical records, we included 284 patients for final analysis. Patients who reached an EDSS of 6 or more had a mean Framingham score of 9.9 versus 5.8 among those who did not reach such EDSS. There was a positive Spearman correlation between the Framingham general cardiovascular risk score and the last-visit EDSS (rₛ = 0.414, <em>p</em> < 0.001). In logistic regression models using EDSS ≥ 6 as the outcome, higher Framingham scores were associated with greater odds of disability in unadjusted analyses, but this association was attenuated after adjustment for age. Among patients with baseline EDSS 0–2.5, the Framingham score significantly predicted a higher final EDSS. In this group, 25.3% of those with a score >1.91 reached EDSS ≥ 6, versus 3.9% with a score ≤1.91.</div></div><div><h3>Discussion</h3><div>Our study reported an association between cardiovascular risk, as measured by the Framingham score, and disability in MS, measured by the last visit EDSS score, in a middle-income MS cohort with access to DMD. Such correlation is stronger and statistically significant among patients with an EDSS between 0 and 2.5. There is an association between the Framingham score and a higher final EDSS in patients with multiple sclerosis when the cardiovascular risk factors are present in the early course of the disease.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106973"},"PeriodicalIF":2.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-04DOI: 10.1016/j.msard.2026.106970
Gerome B. Vallejos , Jackson A. Roberts , Carla Y. Kim , Kiran T. Thakur , Kathryn B. Holroyd
Background
Central nervous system (CNS) vasculitis is a rare, diagnostically challenging disorder involving inflammation of cerebral arteries. Differentiating infectious from autoimmune etiologies is difficult due to nonspecific presentations and limited tools. We characterized CNS vasculitis cases at a tertiary care center to identify distinguishing features by etiology.
Methods
Patients admitted to Columbia University Irving Medical Center between 2020–2024 with an ICD diagnosis of CNS vasculitis were reviewed. Cases were classified as infectious, autoimmune, or cryptogenic based on clinical, laboratory, radiographic, and pathologic data. Demographics, symptoms, cerebrospinal fluid (CSF) findings, neuroimaging, treatments, and outcomes were analyzed with nonparametric testing.
Results
Of 43 included cases, the mean age was 45.7 years; 51.2 % male; 44.2 % immunocompromised; median symptom duration 7 days. Etiologies were infectious (14 %), autoimmune (30 %), and cryptogenic (56 %), with definitive diagnosis in 23.3 %. Headache, cognitive dysfunction, and motor symptoms were common. CSF parameters did not significantly differ across groups (median protein 53 mg/dL; glucose 79 mg/dL; RBC 60/µL; WBC 3/µL). Vessel narrowing occurred in 81.4 %; involvement of >2 vessels was more frequent in infectious (50 %) and cryptogenic (41.7 %) vs autoimmune (0 %) cases (p = 0.016). Cryptogenic cases more often showed ischemia (75 %), hemorrhage (25 %), and FLAIR hyperintensities (75 %) (p < 0.010). Biopsy was performed in 27.9 %. Steroids were given in 97.4 % and disease-modifying therapies in 25.6 %.
Conclusions
Despite extensive testing, definitive diagnosis of CNS vasculitis remains difficult. While clinical and CSF features lacked discriminatory value, vascular and imaging patterns differed by etiology, highlighting the need for improved biomarkers and imaging strategies.
{"title":"Clinical and diagnostic characteristics of autoimmune, infectious, and cryptogenic central nervous system vasculitis at a tertiary care center","authors":"Gerome B. Vallejos , Jackson A. Roberts , Carla Y. Kim , Kiran T. Thakur , Kathryn B. Holroyd","doi":"10.1016/j.msard.2026.106970","DOIUrl":"10.1016/j.msard.2026.106970","url":null,"abstract":"<div><h3>Background</h3><div>Central nervous system (CNS) vasculitis is a rare, diagnostically challenging disorder involving inflammation of cerebral arteries. Differentiating infectious from autoimmune etiologies is difficult due to nonspecific presentations and limited tools. We characterized CNS vasculitis cases at a tertiary care center to identify distinguishing features by etiology.</div></div><div><h3>Methods</h3><div>Patients admitted to Columbia University Irving Medical Center between 2020–2024 with an ICD diagnosis of CNS vasculitis were reviewed. Cases were classified as infectious, autoimmune, or cryptogenic based on clinical, laboratory, radiographic, and pathologic data. Demographics, symptoms, cerebrospinal fluid (CSF) findings, neuroimaging, treatments, and outcomes were analyzed with nonparametric testing.</div></div><div><h3>Results</h3><div>Of 43 included cases, the mean age was 45.7 years; 51.2 % male; 44.2 % immunocompromised; median symptom duration 7 days. Etiologies were infectious (14 %), autoimmune (30 %), and cryptogenic (56 %), with definitive diagnosis in 23.3 %. Headache, cognitive dysfunction, and motor symptoms were common. CSF parameters did not significantly differ across groups (median protein 53 mg/dL; glucose 79 mg/dL; RBC 60/µL; WBC 3/µL). Vessel narrowing occurred in 81.4 %; involvement of >2 vessels was more frequent in infectious (50 %) and cryptogenic (41.7 %) vs autoimmune (0 %) cases (<em>p</em> = 0.016). Cryptogenic cases more often showed ischemia (75 %), hemorrhage (25 %), and FLAIR hyperintensities (75 %) (<em>p</em> < 0.010). Biopsy was performed in 27.9 %. Steroids were given in 97.4 % and disease-modifying therapies in 25.6 %.</div></div><div><h3>Conclusions</h3><div>Despite extensive testing, definitive diagnosis of CNS vasculitis remains difficult. While clinical and CSF features lacked discriminatory value, vascular and imaging patterns differed by etiology, highlighting the need for improved biomarkers and imaging strategies.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106970"},"PeriodicalIF":2.9,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-04DOI: 10.1016/j.msard.2026.106977
Yunier Broche-Pérez , Rodneys M. Jiménez-Morales
{"title":"Psychological resilience as a dynamic process in relapsing-remitting multiple sclerosis: A response to Alonso and Briggs","authors":"Yunier Broche-Pérez , Rodneys M. Jiménez-Morales","doi":"10.1016/j.msard.2026.106977","DOIUrl":"10.1016/j.msard.2026.106977","url":null,"abstract":"","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106977"},"PeriodicalIF":2.9,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-04DOI: 10.1016/j.msard.2026.106971
Patrick Emanuell Mesquita Sousa-Santos, Fernando Coronetti Gomes da Rocha
The 2024 revision of the McDonald criteria for multiple sclerosis (MS) has recently been published. This update introduces several important advances aimed at achieving an earlier and more specific diagnosis, particularly through the inclusion of new biomarkers and neuroimaging findings. However, while the criteria have become more comprehensive, their complexity and practical application have also increased.
We therefore propose a visual reinterpretation of the 2024 McDonald criteria, presented as a point-based schematic, to facilitate their interpretation. In this model, a total score of four points or higher supports the diagnosis of MS, provided that no better explanation exists. We believe that this visual approach may enhance understanding and applicability of the new criteria, especially among non-specialists in neuroimmunology and neurology trainees.
{"title":"A visual reinterpretation of the 2024 McDonald criteria for multiple scleroris","authors":"Patrick Emanuell Mesquita Sousa-Santos, Fernando Coronetti Gomes da Rocha","doi":"10.1016/j.msard.2026.106971","DOIUrl":"10.1016/j.msard.2026.106971","url":null,"abstract":"<div><div>The 2024 revision of the McDonald criteria for multiple sclerosis (MS) has recently been published. This update introduces several important advances aimed at achieving an earlier and more specific diagnosis, particularly through the inclusion of new biomarkers and neuroimaging findings. However, while the criteria have become more comprehensive, their complexity and practical application have also increased.</div><div>We therefore propose a visual reinterpretation of the 2024 McDonald criteria, presented as a point-based schematic, to facilitate their interpretation. In this model, a total score of four points or higher supports the diagnosis of MS, provided that no better explanation exists. We believe that this visual approach may enhance understanding and applicability of the new criteria, especially among non-specialists in neuroimmunology and neurology trainees.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106971"},"PeriodicalIF":2.9,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1016/j.msard.2026.106969
Sina Pakkhesal , Sarvin Sanaie , Amirreza Naseri
{"title":"Letter to the editor on “efficacy of caffeine supplementation on fatigue in patients with multiple sclerosis: A randomized double-blind placebo-controlled trial”","authors":"Sina Pakkhesal , Sarvin Sanaie , Amirreza Naseri","doi":"10.1016/j.msard.2026.106969","DOIUrl":"10.1016/j.msard.2026.106969","url":null,"abstract":"","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106969"},"PeriodicalIF":2.9,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 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.
{"title":"Impact of a short-term stress management protocol on physiologic biofeedback measures of stress and mood in people with multiple sclerosis","authors":"A.B. Sullivan , G. Tworek , A. Kane , J. Fredieu , T. Harvey","doi":"10.1016/j.msard.2026.106967","DOIUrl":"10.1016/j.msard.2026.106967","url":null,"abstract":"<div><h3>Background and objectives</h3><div>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).</div></div><div><h3>Methods</h3><div>We analyzed data from PwMS who underwent a 4-session SMP at Cleveland Clinic between 2012 and 2022 (<em>N</em> = 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 .</div></div><div><h3>Results</h3><div>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 %SpO<sub>2</sub>. Greatest improvements in PHQ-9 and BPM were observed in patients completing 3 sessions and that %Sp0<sub>2</sub> were observed in patients completing 4 sessions.</div></div><div><h3>Discussion</h3><div>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.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106967"},"PeriodicalIF":2.9,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-02DOI: 10.1016/j.msard.2025.106953
Yunji Chen , Kun Meng , Guole Jiang , Xu Xiang , Yang Liu , Qing Yi
Objective
To evaluate the effects of respiratory muscle training (RMT) on respiratory function and fatigue in individuals with multiple sclerosis (MS).
Methods
In accordance with the PRISMA 2020 guidelines, a systematic search was conducted across five electronic databases (PubMed/MEDLINE, Web of Science, Cochrane Library, SPORTDiscus, Scopus) from inception through 31 August 2025. Randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) that enrolled adults with MS who underwent isolated RMT (inspiratory, expiratory, or combined) for a duration of ≥ 4 weeks were included. Primary outcomes included respiratory function (e.g., maximal inspiratory pressure [MIP], maximal expiratory pressure [MEP], forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC]) and fatigue (evaluated using the Fatigue Severity Scale [FSS] or Modified Fatigue Impact Scale [MFIS]). Data were synthesized using random- or fixed-effects models, with results expressed as standardized mean differences (SMDs) and 95% confidence intervals (CIs).
Results
Fifteen RCTs, comprising a total of 433 participants, were included. Meta-analysis revealed that RMT significantly enhanced respiratory muscle strength (MEP: SMD = 0.24, 95% CI: 0.03 to 0.45, p = 0.03; MIP: SMD = 0.45, 95% CI: 0.25 to 0.65, p < 0.001) and pulmonary function (FEV1: SMD = 0.37, 95% CI: 0.17 to 0.58, p < 0.001; FVC: SMD = 0.24, 95% CI: 0.04 to 0.43, p = 0.02). Significant reductions in fatigue were observed across all subscales of the MFIS (physical: SMD = -1.00, 95% CI: -1.53 to -0.46, p < 0.001; cognitive: SMD = -0.54, 95% CI: -1.05 to -0.03, p = 0.04; psychosocial: SMD = -0.88, 95% CI: -1.41 to -0.35, p < 0.001; total: SMD = -0.98, 95% CI: -1.52 to -0.43, p < 0.001). However, no significant improvement was observed on the FSS (SMD = -0.39, 95% CI: -1.10 to 0.33, p = 0.29).
Conclusion
RMT may serve as an effective intervention for improving respiratory muscle strength, pulmonary function, and functional fatigue in individuals with MS. Nonetheless, its effect on perceived fatigue severity appears limited. These findings support the incorporation of RMT into MS rehabilitation programs. Further robust studies with standardized training protocols are warranted to confirm its long-term benefits.
{"title":"Effects of Respiratory Muscle Training on Respiratory Function and Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis","authors":"Yunji Chen , Kun Meng , Guole Jiang , Xu Xiang , Yang Liu , Qing Yi","doi":"10.1016/j.msard.2025.106953","DOIUrl":"10.1016/j.msard.2025.106953","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effects of respiratory muscle training (RMT) on respiratory function and fatigue in individuals with multiple sclerosis (MS).</div></div><div><h3>Methods</h3><div>In accordance with the PRISMA 2020 guidelines, a systematic search was conducted across five electronic databases (PubMed/MEDLINE, Web of Science, Cochrane Library, SPORTDiscus, Scopus) from inception through 31 August 2025. Randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) that enrolled adults with MS who underwent isolated RMT (inspiratory, expiratory, or combined) for a duration of ≥ 4 weeks were included. Primary outcomes included respiratory function (e.g., maximal inspiratory pressure [MIP], maximal expiratory pressure [MEP], forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC]) and fatigue (evaluated using the Fatigue Severity Scale [FSS] or Modified Fatigue Impact Scale [MFIS]). Data were synthesized using random- or fixed-effects models, with results expressed as standardized mean differences (SMDs) and 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Fifteen RCTs, comprising a total of 433 participants, were included. Meta-analysis revealed that RMT significantly enhanced respiratory muscle strength (MEP: SMD = 0.24, 95% CI: 0.03 to 0.45, <em>p</em> = 0.03; MIP: SMD = 0.45, 95% CI: 0.25 to 0.65, <em>p</em> < 0.001) and pulmonary function (FEV1: SMD = 0.37, 95% CI: 0.17 to 0.58, <em>p</em> < 0.001; FVC: SMD = 0.24, 95% CI: 0.04 to 0.43, <em>p</em> = 0.02). Significant reductions in fatigue were observed across all subscales of the MFIS (physical: SMD = -1.00, 95% CI: -1.53 to -0.46, <em>p</em> < 0.001; cognitive: SMD = -0.54, 95% CI: -1.05 to -0.03, <em>p</em> = 0.04; psychosocial: SMD = -0.88, 95% CI: -1.41 to -0.35, <em>p</em> < 0.001; total: SMD = -0.98, 95% CI: -1.52 to -0.43, <em>p</em> < 0.001). However, no significant improvement was observed on the FSS (SMD = -0.39, 95% CI: -1.10 to 0.33, <em>p</em> = 0.29).</div></div><div><h3>Conclusion</h3><div>RMT may serve as an effective intervention for improving respiratory muscle strength, pulmonary function, and functional fatigue in individuals with MS. Nonetheless, its effect on perceived fatigue severity appears limited. These findings support the incorporation of RMT into MS rehabilitation programs. Further robust studies with standardized training protocols are warranted to confirm its long-term benefits.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106953"},"PeriodicalIF":2.9,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939981","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号