Multiple sclerosis and related disorders最新文献

{"title":"Progressive multifocal leukoencephalopathy associated with sphingosine-1-phosphate receptor modulators: A large case series","authors":"David Croteau ,&nbsp;Tiffany Kim ,&nbsp;Vicky Chan ,&nbsp;Jessica Stevens ,&nbsp;Daniela A. Pimentel Maldonado ,&nbsp;Laura E. Baldassari ,&nbsp;Paul R. Lee ,&nbsp;Alice Hughes ,&nbsp;Allen Brinker","doi":"10.1016/j.msard.2024.106163","DOIUrl":"10.1016/j.msard.2024.106163","url":null,"abstract":"<div><h3>Background</h3><div>Risk factors for progressive multifocal leukoencephalopathy (PML) associated with sphingosine-1-phosphate receptor (S1PR) modulators are not as well-characterized as for natalizumab. We characterized S1PR modulator-associated PML cases and risk factors for PML using spontaneous adverse event reports.</div></div><div><h3>Methods</h3><div>We reviewed case reports from the FDA Adverse Event Reporting System database and the medical literature.</div></div><div><h3>Results</h3><div>We identified 57 PML cases encompassing all marketed S1PR modulators approved for multiple sclerosis, the majority (<em>n</em> = 53) associated with fingolimod. Ten cases reported a fatal outcome. Length of S1PR modulator exposure (≥18 months) appears to be a robust risk factor for PML. Patient age ≥50 years was identified as a potential risk factor, although this may be the result of several biases. We propose that prior immunosuppressant exposure should be considered as a potential risk factor for further validation. No conclusions could be drawn regarding JC virus serology and lymphopenia severity.</div></div><div><h3>Conclusions</h3><div>Spontaneous adverse event reports support the observation that extended S1PR modulator exposure appears to be a robust PML risk factor. As a result, the U.S. Prescribing Information for each product in the S1PR modulator class was updated. Validation of other potential risk factors would support efforts to stratify and mitigate the risk of S1PR modulator-associated PML.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"92 ","pages":"Article 106163"},"PeriodicalIF":2.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early rituximab versus escalating therapy in neuromyelitis optica: A cost and quality of life analysis","authors":"Guilherme Diogo Silva ,&nbsp;Samira Luísa Apóstolos-Pereira ,&nbsp;Mateus Boaventura ,&nbsp;Renata Barbosa Paolilo ,&nbsp;Aline Matos ,&nbsp;Milena Sales Pitombeira ,&nbsp;Tarso Adoni ,&nbsp;Douglas K Sato ,&nbsp;Dagoberto Callegaro","doi":"10.1016/j.msard.2024.106160","DOIUrl":"10.1016/j.msard.2024.106160","url":null,"abstract":"<div><h3>Introduction</h3><div>Rituximab, an anti-CD20 monoclonal antibody, has shown effectiveness in reducing disease relapses and disability accrual through relapses in patients with neuromyelitis optica spectrum disorders (NMOSD). However, its higher cost compared to oral immunosuppressants raises questions about its cost-effectiveness, particularly in low and middle-income countries. This study aimed to compare the cost-effectiveness of early rituximab treatment versus escalation treatment in NMOSD patients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of NMOSD patients treated with rituximab in the first five years of disease at a hospital in São Paulo, Brazil, from 2015 to 2019. The Early Group consisted of NMOSD patients who received rituximab as a first-line treatment. The Escalating Therapy Group included patients who were prescribed rituximab after experiencing disease activity while on oral immunosuppressants, primarily azathioprine. An economic model based on Expanded Disability Status Score (EDSS) transitions was used to assess cost-effectiveness. Cost and utility data were derived from previous studies, and sensitivity analyses for different willingness to pay (WTP) thresholds and percentage of patients upscaling from oral immunossupressants to rituximab were performed.</div></div><div><h3>Results</h3><div>: Thirty NMOSD patients were included. In the Early Group, the proportion of patients reaching the highest EDSS states (6.5 or more) decreased over five years compared to baseline. In contrast, the Escalating Therapy Group experienced an increase in this proportion over the same period. Cost-effectiveness was achieved for willingness to pay (WTP) of €20–80,000 in our main analysis, sustained in our sensitivity analysis.</div></div><div><h3>Conclusion</h3><div>: Early treatment with rituximab has the potential to lower healthcare costs and enhance quality of life for NMOSD patients, supporting its early prescription for preventive treatment.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"92 ","pages":"Article 106160"},"PeriodicalIF":2.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty in multiple sclerosis: A scoping review","authors":"Nida’ Al Worikat ,&nbsp;Farzan Molaei ,&nbsp;Anna Zanotto ,&nbsp;Abbas Tabatabaei ,&nbsp;Sharon G. Lynch ,&nbsp;Bruce R. Troen ,&nbsp;Jacob J. Sosnoff ,&nbsp;Tobia Zanotto","doi":"10.1016/j.msard.2024.106157","DOIUrl":"10.1016/j.msard.2024.106157","url":null,"abstract":"<div><div>This scoping review aims to provide a comprehensive overview of frailty in multiple sclerosis (MS), building upon the increasing number of studies that have recently begun to explore the potential impact of this age-related condition on the lives of people with MS (pwMS). A systematic search was conducted on PubMed, Scopus, Embase, Ovid MEDLINE, CINAHL, CENTRAL, Web of Science, PEDRO, and clinicaltrials.gov. The search results were limited to studies published between 2000 and 2024 without language restrictions. After the screening process, 11 studies (10 original articles and one conference paper) met the inclusion criteria and were included. The scope of the included studies was mainly aimed at quantifying frailty levels and prevalence in pwMS, investigating the association between MS clinical characteristics and frailty, and exploring the relationship between frailty and adverse clinical outcomes in pwMS. All studies concluded that frailty is highly prevalent in MS, with prevalences ranging from 17 % to 66 % (ambulatory patients only) and that pwMS have an early onset of frailty compared to the general non-MS population, as the mean age of the included participants ranged from 41.2 ± 9.0 to 58.6 ± 6.0 years. Higher disability levels, disease duration, and progressive MS subtypes were commonly associated with frailty. In addition, several studies showed that frailty was strongly associated with reduced walking performance, lower sleep quality, fatigue, lower quality of life, falls, primary care visits, and mortality. In conclusion, frailty represents a common yet underinvestigated clinical concern for the MS community.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"92 ","pages":"Article 106157"},"PeriodicalIF":2.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement in depressive symptoms is associated with sustained improvement in fatigue impact in adults with multiple sclerosis","authors":"Lindsey M. Knowles ,&nbsp;Erin G. Mistretta ,&nbsp;Anne Arewasikporn ,&nbsp;Cinda L. Hugos ,&nbsp;Michelle H. Cameron ,&nbsp;Jodie K. Haselkorn ,&nbsp;Aaron P. Turner","doi":"10.1016/j.msard.2024.106158","DOIUrl":"10.1016/j.msard.2024.106158","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Fatigue is one of the most common and disabling symptoms of multiple sclerosis (MS). Behavioral interventions that target one or more behaviors such as sleep hygiene, exercise, energy management, cognitive processes, as well as mood have been shown to reduce fatigue in people with MS. Yet, little is known about mechanisms of intervention effects on MS fatigue. Research suggests that depressive symptoms may be an important intervention target for improving MS fatigue. This study examined the association between pre- to post-intervention improvement in depressive symptoms and improvement in MS fatigue impact from pre-intervention through six months post-intervention.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This study is a secondary analysis of data from a randomized controlled trial comparing a fatigue self-management intervention to general MS education for improving fatigue in people with MS. Adults with MS (&lt;em&gt;N&lt;/em&gt; = 218) were recruited for the parent trial from the Portland, Seattle, Baltimore, and North Florida/South Georgia VA Medical Centers, affiliated academic medical centers, and surrounding communities. Both study interventions showed similar efficacy, so participants were combined into one sample for this secondary analysis. Structural equation modeling was used to examine whether clinically significant change in depressive symptoms (a 17.5 % reduction in the total Beck Depression Inventory-II score) from pre- to post-intervention, was associated with improvement in fatigue impact on the physical, cognitive, and psychosocial subscales of the Modified Fatigue Impact Scale from pre-intervention through six-month follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Participants were predominantly female (72 %), middle-aged (&lt;em&gt;M&lt;/em&gt; = 53.7 ± 10.1), and White (76 %) with a disease duration of 12.5 ± 8.4 years. Over half of the sample (58 %) had relapsing-remitting MS. Clinically significant improvement in depressive symptoms was associated with reduction in physical fatigue impact (β = -0.17, &lt;em&gt;p&lt;/em&gt; = .004, 95 % CI [-0.28, -0.05]), cognitive fatigue impact (β = -0.20, &lt;em&gt;p&lt;/em&gt; = .000, 95 % CI [-0.31, -0.10]), and psychosocial fatigue impact (β = -0.13, &lt;em&gt;p&lt;/em&gt; = .03, 95 % CI [-0.25, -0.01]) through the six-month follow-up controlling for baseline depressive symptoms and fatigue impact, MS subtype (RRMS or Progressive MS), and income level. The model demonstrated adequate fit, χ2(6) = 12.747, &lt;em&gt;p&lt;/em&gt; = .047, RMSEA = 0.072, CFI = 0.986, SRMR = 0.016, and accounted for 32 %, 39 %, and 28 % of the variance in physical, cognitive, and psychosocial fatigue impact respectively, which corresponded with large effect sizes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;These findings, building on previous research, support the importance of reducing depressive symptoms for improving fatigue impact in people with MS. Future research should examine whether explicit focus on reducing depressive symptoms or related cogniti","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"92 ","pages":"Article 106158"},"PeriodicalIF":2.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interleukin-6 inhibitors for neuromyelitis optica spectrum disorder (NMOSD): A systematic review and meta-analysis","authors":"Giovani Noll ,&nbsp;Marcos Madeira de Lima ,&nbsp;Gabriel Paulo Mantovani ,&nbsp;Felipe Gutierrez Pineda ,&nbsp;Yasmin Picanço Silva ,&nbsp;Pedro Guimarães Marcarini ,&nbsp;Lucas Gabriel Mappes Reimao Reis ,&nbsp;Viviana Regina Konzen ,&nbsp;Alessandro Finkelsztejn","doi":"10.1016/j.msard.2024.106156","DOIUrl":"10.1016/j.msard.2024.106156","url":null,"abstract":"<div><h3>Background</h3><div>Interleukin-6 (IL-6) inhibitors recently emerged as a promising therapy for neuromyelitis optica spectrum disorder (NMOSD).</div></div><div><h3>Objective</h3><div>We performed a systematic review and meta-analysis comparing IL-6 inhibitors to placebo or traditional immunosuppressants in NMOSD.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, and Cochrane Central for eligible studies. Efficacy endpoints included hazard ratio (HR) for relapse, annualized relapse ratio (ARR) and Expanded Disability Status Scale (EDSS) change over time. Safety outcomes comprised any adverse event, serious adverse events and infections. Statistical analysis was performed using RevMan Web and R studio package meta. Heterogeneity was assessed with I² statistics.</div></div><div><h3>Results</h3><div>Four studies involving 361 patients (228 treated with IL-6 inhibitors) were included. IL-6 inhibitors significantly reduced HR for relapse (HR 0.35; 95 % CI 0.23, 0.55); p &lt; 0.00001; I² = 0 %) and ARR (mean difference -0.79 relapses/year; 95 % CI -1.54, -0.03; p = 0.04; I² = 96 %) compared to placebo or traditional immunosuppressants. No significant differences were observed in EDSS change over 24 weeks of follow-up (mean difference -0.18; 95 % CI -0.41, 0.05; p = 0.93; I² = 0 %), adverse events (odds ratio (OR) 1.59; 95 % CI 0.45, 5.63; p = 0.48; I² = 48 %), serious adverse events (OR 0.76; 95 % CI 0.40, 1.44; p = 0.50; I² = 0 %) and infection rates (OR 1.10; 95 % CI 0.67, 1.79; p = 0.71; I² = 0 %).</div></div><div><h3>Conclusion</h3><div>IL-6 inhibitors demonstrate superior efficacy in preventing relapses in NMOSD compared to placebo or traditional immunosuppressants, without a notable increase in safety risks.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"92 ","pages":"Article 106156"},"PeriodicalIF":2.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of disease modifying therapies in late-onset multiple sclerosis: A Portuguese multicentric characterization study","authors":"Patrícia Faustino ,&nbsp;Diana Marques Cruz ,&nbsp;Catarina Fernandes ,&nbsp;Andressa Pereira ,&nbsp;Roberto Franco ,&nbsp;Sara Costa ,&nbsp;Sara Matos ,&nbsp;Armando Morganho ,&nbsp;Carla Fraga ,&nbsp;Ernestina Santos ,&nbsp;Filipa Ladeira ,&nbsp;Mónica Santos ,&nbsp;Pedro Abreu ,&nbsp;Sónia Batista ,&nbsp;José Vale ,&nbsp;Maria José Sá ,&nbsp;Mariana Santos","doi":"10.1016/j.msard.2024.106153","DOIUrl":"10.1016/j.msard.2024.106153","url":null,"abstract":"<div><h3>Introduction</h3><div>Knowledge about the effect of disease modifying treatment (DMT) in late-onset multiple sclerosis (LOMS, onset ≥50 years-old) is scarce. This study aims to evaluate the association between DMT use and multiple sclerosis (MS) evolution in a LOMS cohort.</div></div><div><h3>Methods</h3><div>This multicentre, retrospective and observational study included LOMS patients with ≥2 years of follow-up. Data on demographics, clinical/paraclinical (baseline and follow-up), DMT and adverse events were collected. Primary outcomes were irreversible EDSS 4.0 and 6.0 achievement and first year ARR. Univariate and multivariate regression models were conducted, with treated and/or relapsing phenotypes (RMS) subgroups analyses.</div></div><div><h3>Results</h3><div>We included 232 patients (53.4 % with RRMS phenotype; 84.9 % submitted to DMT; median follow-up time of 141.5 (IQR 92.7–193.1) months). Treatment versus non-treatment did not affect EDSS milestones in multivariate analysis (adjusted to phenotype, baseline EDSS, age, and ARR), but initially receiving monoclonal antibodies (MAbs) was associated with lower odds of EDSS 4.0 (OR 0.13). In treated patients, starting with high efficacy DMT (HE-DMT) was related to a lower chance of EDSS 4.0 (OR 0.05) and 6.0 (OR 0.26) compared with being exclusively treated with moderate efficacy DMT (ME-DMT), with similar results when analysing the subgroup of RMS treated patients. In multivariate models, initial treatment with MAbs (vs. non-treatment) and with HE-DMT (vs. ME-DMT) were related to a lower first year ARR; when considering only RMS patients, every DMT class analysed reduced first year ARR vs. non-treatment. During DMT, we documented a rate of 0.6 % serious infections, 0.07 % opportunistic infections and 0.7 % neoplasm diagnosis per patient year.</div></div><div><h3>Conclusion</h3><div>DMT type and therapeutic strategy influenced LOMS disability accumulation and relapses in our cohort. Our findings support the importance of investment in LOMS treatment optimization.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"92 ","pages":"Article 106153"},"PeriodicalIF":2.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin D and cardiovascular outcomes in multiple sclerosis","authors":"Madeleine France-Ratcliffe ,&nbsp;Stephanie L. Harrison ,&nbsp;Leona A. Verma ,&nbsp;Azmil H. Abdul-Rahim ,&nbsp;Linsay McCallum ,&nbsp;Carolyn A. Young ,&nbsp;Garry McDowell ,&nbsp;Benjamin JR Buckley","doi":"10.1016/j.msard.2024.106155","DOIUrl":"10.1016/j.msard.2024.106155","url":null,"abstract":"<div><h3>Background</h3><div>Vitamin D (25(OH)D) deficiency is linked to increased cardiovascular disease (CVD) risk in the general population, but its implications for people with multiple sclerosis (pwMS) remain unexplored. This study aimed to evaluate the association of 25(OH)D with long-term CVD outcomes in pwMS and the impact of vitamin D supplementation.</div></div><div><h3>Methods</h3><div>This observational cohort study analysed anonymised medical records from 70 healthcare organisations following pwMS for 5-years (2019–2024). PwMS and deficient or inadequate 25(OH)D levels were 1:1 propensity-score matched with pwMS and adequate 25(OH)D levels, for demographics, comorbidities, and cardiovascular care. Cox proportional hazard models analysed the incidence of all-cause mortality, stroke, acute myocardial infarction, heart failure, angina, atrial fibrillation/flutter, and a composite measure of major adverse cardiovascular events (MACE). Propensity-matched pwMS who had deficient or inadequate 25(OH)D levels taking cholecalciferol were compared to pwMS and adequate 25(OH)D levels (not taking supplementation).</div></div><div><h3>Results</h3><div>Amongst 74,372 pwMS, 9 % had deficient 25(OH)D levels, 18 % inadequate, and 73 % adequate. Deficient, or inadequate 25(OH)D levels were associated with an increased rate of MACE (HR, 1.32 [95 % CI: 1.19, 1.46], HR, 1.29 [95 % CI: 1.20, 1.40], respectively) compared to those with adequate levels. Cholecalciferol supplementation in pwMS and deficient or inadequate 25(OH)D levels did not alleviate the higher CVD rate (HR, 1.39 [95 % CI: 1.21,1.60], HR, 1.31 [95 % CI: 1.17, 1.47], respectively) in comparison to those with adequate 25(OH)D levels taking no vitamin D supplementation.</div></div><div><h3>Conclusions</h3><div>Deficient or inadequate 25(OH)D levels in pwMS were associated with an increased rate of MACE, which may not be mitigated by vitamin D supplementation.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"92 ","pages":"Article 106155"},"PeriodicalIF":2.9,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing and tailoring predictive equations of VO2max for women with multiple sclerosis with mild to moderate disability","authors":"Marco Morrone ,&nbsp;Anna Boi ,&nbsp;Lucia Ventura ,&nbsp;Gianluca Martinez ,&nbsp;Elena Aiello ,&nbsp;Franca Deriu ,&nbsp;Andrea Manca","doi":"10.1016/j.msard.2024.106154","DOIUrl":"10.1016/j.msard.2024.106154","url":null,"abstract":"<div><h3>Background</h3><div>Established equations to predict peak oxygen uptake (VO₂max) in healthy subjects are not directly applicable to patient populations, including people with multiple sclerosis (PwMS). PwMS, who commonly exhibit impaired cardiorespiratory and neuromuscular function, often require tailored predictive models. This study aimed at (1) testing the validity, reliability, and accuracy of four widely used formulae, developed in healthy populations, to estimate VO₂max in mildly to moderately disabled women with MS, and (2) develop adjusted formulae tailored on MS features.</div></div><div><h3>Methods</h3><div>Fifty-one mildly to moderately disabled women (mean age 46, median EDSS 3.5) with relapsing-remitting multiple sclerosis (RRMS) underwent incremental cardiopulmonary exercise testing (CPET) using cycle ergometry. Gas exchanges were analyzed by open-circuit spirometry. Four commonly employed predictive equations (ACSM, Storer's, Uth's, and Myers’) were tested for reliability and accuracy against measured VO₂max. Regressions were performed to identify significant VO₂max predictors and to introduce adjustments to develop gender-specific equations aimed at estimating cardiorespiratory fitness with varying degrees of exercise involvement.</div></div><div><h3>Results</h3><div>ACSM and Storer's equations underestimated VO₂max (-6.09 %, <em>Z</em> = -3.22, <em>p</em> = 0.001; and -21.74 %, <em>Z</em> = -5.02, <em>p</em> &lt; 0.001, respectively) whereas Uth's and Myers’ equations overestimated it (+20.19 %, <em>Z</em> = -5.92, <em>p</em> &lt; 0.001; and +19.31 %, <em>Z</em> = -6.19, <em>p</em> &lt; 0.001, respectively). Regressions for adjusted equations revealed work rate/bodyweight (WR/BW) (β = 0.867, <em>p</em> &lt; 0.001) for ACSM adjusted; age (β = -0.275, <em>p</em> = 0.004), BW (β = -0.658, <em>p</em> &lt; 0.001) and peak Watts (β = 0.485, <em>p</em> &lt; 0.001) for Storer's adjusted; heart rate ratio (β = 0.512, <em>p</em> &lt; 0.001) for Uth's adjusted, and age (β = -0.492, <em>p</em> &lt; 0.001), BW (β = -0.483, <em>p</em> &lt; 0.001) and EDSS (β = -0.211, <em>p</em> = 0.046) for Myers’ adjusted as predictors of VO₂max.</div></div><div><h3>Conclusions</h3><div>VO₂max can be validly estimated in women with MS using established formulae, provided that specific adjustments are introduced to account for their signature functional impairments. The models proposed in this study enable reliable assessment of cardiorespiratory fitness with protocols at different levels of exercise involvement, making them practical for clinical and everyday use. This approach supports a translationally driven bench-to-bedside perspective, allowing for patient VO₂max assessment in virtually all settings.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"92 ","pages":"Article 106154"},"PeriodicalIF":2.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Step to the beat: Auditory-motor coupling during walking to higher and lower tempi with music and metronomes in progressive multiple sclerosis: An observational study","authors":"Nele Vanbilsen ,&nbsp;Lousin Moumdjian ,&nbsp;Fenne Kinnaert ,&nbsp;Birte Degens ,&nbsp;Bart Moens ,&nbsp;Mieke Goetschalckx ,&nbsp;Daphne Kos ,&nbsp;Bart Van Wijmeersch ,&nbsp;Marc Leman ,&nbsp;Peter Feys","doi":"10.1016/j.msard.2024.106152","DOIUrl":"10.1016/j.msard.2024.106152","url":null,"abstract":"<div><h3>Background</h3><div>Many persons with multiple sclerosis (MS) are confronted with fatigue and difficulties with walking and even more so in persons with progressive subtypes of MS. Task-oriented training, and more specifically in the form of auditory-motor coupling, where persons are asked to synchronise their steps to beats in music and metronomes, is promising. However, it is currently not known whether persons with progressive MS (PwPMS) can synchronise their steps to beats in music and metronomes and if they can adapt their gait to slower and higher tempi.</div></div><div><h3>Methods</h3><div>The study is a case control study where participants with progressive MS (PwPMS) and healthy controls (HCs) were asked to synchronise their steps during overground walking to beats in music and metronomes at five different tempi, ranging from slow (-8%, -4%), baseline (0%) and high (4%, 8%) while synchronisation, spatiotemporal parameters and gait dynamics were recorded. Mixed model analyses were performed on synchronisation outcome measures and spatiotemporal gait parameters. Additionally, a regression analysis was performed to identify clinical factors such as cognition and motor function influencing synchronisation consistency.</div></div><div><h3>Results</h3><div>In total, 18 PwPMS (mean age = 52.4, median EDSS = 4.24) and 16 healthy controls (HCs) (mean age = 56.5) were included in the study. Results show that both groups were able to synchronise their steps to beats in music and metronomes, but highest synchronisation consistency was reached for metronome conditions compared to music conditions and for HCs compared to persons with progressive MS. Highest synchronisation consistency for persons with progressive MS was found at -4% and 0%. Additionally, more variability in inter-step-intervals and thus a more anti-persistent gait pattern was found for metronome compared to music conditions. Last, lower performance on the Timed Up &amp; Go Test negatively impacted synchronisation consistency.</div></div><div><h3>Conclusion</h3><div>PwPMS are able to synchronise steps to beats in music and metronomes. Overall, more consistent synchronisation is seen for metronome conditions. All participants are able to adapt their cadence to all tempi, yet, PwPMS struggle to adapt gait speed to high tempi. Noteworthy, participants walk with more random inter-step-interval fluctuations when walking to metronome compared to music conditions. Last, dynamic balance significantly impacted synchronisation consistency. These results show the potential of using auditory-motor coupling for walking related rehabilitation for PwPMS, however, tempo and auditory stimulation should be carefully considered.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"92 ","pages":"Article 106152"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement of fatigue, depression, and processing speed two weeks post Natalizumab infusion in Multiple Sclerosis: No difference between standard and extended interval dosing schedules","authors":"Giorgio Leodori ,&nbsp;Marco Mancuso ,&nbsp;Davide Maccarrone ,&nbsp;Matteo Tartaglia ,&nbsp;Antonio Ianniello ,&nbsp;Viola Baione ,&nbsp;Gina Ferrazzano ,&nbsp;Leonardo Malimpensa ,&nbsp;Daniele Belvisi ,&nbsp;Alfredo Berardelli ,&nbsp;Carlo Pozzilli ,&nbsp;Antonella Conte","doi":"10.1016/j.msard.2024.106146","DOIUrl":"10.1016/j.msard.2024.106146","url":null,"abstract":"<div><h3>Background</h3><div>Fatigue, depression and slow processing speed are debilitating symptoms in people with Relapsing-Remitting Multiple Sclerosis (RRMS) that significantly impacts on the quality of life. Natalizumab, a disease-modifying treatment, improves clinical symptoms but questions remain about the comparative efficacy between its standard interval dosing (SID) and extended interval dosing (EID) schedules.</div></div><div><h3>Objective</h3><div>To examine the impact of short term natalizumab dosing schedules—SID versus EID—on the so called “invisible symptoms”, specifically focusing on symptom exacerbation during the 'wearing-off' phase before infusion and the subsequent relief post-infusion.</div></div><div><h3>Methods</h3><div>Forty-two RRMS patients were assessed one week before (T0) and two weeks after pre-and post-natalizumab infusion (T1) for fatigue symptoms using the Fatigue Scale for Motor and Cognitive Functions (FSMC), the Modified Fatigue Impact Scale (MFIS), and the Fatigue Symptoms and Impacts Questionnaire–Relapsing Multiple Sclerosis (FSIQ-RMS). Processing speed and depression were measured by the symbol digit modality test (SDMT), and the Beck Depression Inventory-II (BDI-II). Participants were categorized into either the SID or EID dosing schedules of natalizumab, and their outcomes were compared.</div></div><div><h3>Results</h3><div>Forty-two patients (21 SID; 21 EID) completed the study. Fatigue severity scales, SDMT, and BDI-II scores improved from T0 to T1. No significant differences in fatigue symptoms were found between the SID and EID groups, whether during the \"wearing-off\" period (T0) or post-infusion (T1).</div></div><div><h3>Conclusions</h3><div>Both SID and EID dosing regimens of natalizumab are similarly effective in reducing fatigue symptoms, depression and improving processing speed in individuals with RRMS, with no observed differences during the \"wearing-off\" periods or after re-infusion.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"92 ","pages":"Article 106146"},"PeriodicalIF":2.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590023","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}