To evaluate the effects of spinal stabilization training (SST) combined with local vibration (LV) on postural control and to explore potential differences between LV application areas in people with ataxic multiple sclerosis (MS).
Design
Randomized controlled, assessor-blind pilot trial with three parallel groups.
Setting
Neurorehabilitation outpatient clinic.
Participants
Thirty people with MS and clinical signs of ataxia who were ambulatory were randomly allocated to three parallel groups.
Intervention
All participants received SST three times per week for 8 weeks. Two intervention groups received additional LV applied either to the gastrosoleus muscles or to the paraspinal muscles. The third group received only SST without vibration.
Main outcome and Measures
The primary outcome was balance performance measured by the Berg Balance Scale (BBS). Secondary outcomes included limits of stability, postural sways, ataxia severity, core endurance, and spatiotemporal gait parameters.
Results
All groups showed significant improvements in postural control measures (p < 0.05). Paraspinal LV was accompanied by greater improvements in balance performance, as indicated by greater increases in BBS compared to Gastrosoleus LV (p < 0.05). Gastrosoleus LV was accompanied by changes in mobility-related parameters, including improved step length, movement velocity, and reduced gait variability (p < 0.05).
Conclusion
SST appears to improve postural control in people with ataxic MS. The addition of LV may further enhance specific balance and gait parameters, with benefits varying by application site. This multimodal approach may offer clinically relevant guidance for optimizing individualized rehabilitation strategies in this population.
{"title":"Effects of spinal stabilization and local vibration on postural control in people with ataxic multiple sclerosis: An assessor-blind, randomized controlled pilot trial","authors":"Gungor Beyza Ozvar Senoz , Ozge Onursal Kilinc , Yahya Dogan , Muhammed Kilinc","doi":"10.1016/j.msard.2026.106996","DOIUrl":"10.1016/j.msard.2026.106996","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the effects of spinal stabilization training (SST) combined with local vibration (LV) on postural control and to explore potential differences between LV application areas in people with ataxic multiple sclerosis (MS).</div></div><div><h3>Design</h3><div>Randomized controlled, assessor-blind pilot trial with three parallel groups.</div></div><div><h3>Setting</h3><div>Neurorehabilitation outpatient clinic.</div></div><div><h3>Participants</h3><div>Thirty people with MS and clinical signs of ataxia who were ambulatory were randomly allocated to three parallel groups.</div></div><div><h3>Intervention</h3><div>All participants received SST three times per week for 8 weeks. Two intervention groups received additional LV applied either to the gastrosoleus muscles or to the paraspinal muscles. The third group received only SST without vibration.</div></div><div><h3>Main outcome and Measures</h3><div>The primary outcome was balance performance measured by the Berg Balance Scale (BBS). Secondary outcomes included limits of stability, postural sways, ataxia severity, core endurance, and spatiotemporal gait parameters.</div></div><div><h3>Results</h3><div>All groups showed significant improvements in postural control measures (<em>p</em> < 0.05). Paraspinal LV was accompanied by greater improvements in balance performance, as indicated by greater increases in BBS compared to Gastrosoleus LV (<em>p</em> < 0.05<strong>).</strong> Gastrosoleus LV was accompanied by changes in mobility-related parameters<strong>,</strong> including improved step length, movement velocity, and reduced gait variability (<em>p</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>SST appears to improve postural control in people with ataxic MS. The addition of LV may further enhance specific balance and gait parameters, with benefits varying by application site. This multimodal approach may offer clinically relevant guidance for optimizing individualized rehabilitation strategies in this population.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106996"},"PeriodicalIF":2.9,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030479","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 : 2026-01-13DOI: 10.1016/j.msard.2026.106992
Niclas Lange , Elisabet Tina , Olof Hultgren , Anders Svenningsson , Martin Gunnarsson
Background
Rituximab, a B-cell-depleting therapy widely used for multiple sclerosis (MS), is associated with a progressive decline in immunoglobulin G (IgG) levels, raising concerns regarding infection risk. This study evaluates IgG dynamics and antibiotic use in a real-world MS cohort.
Methods
A retrospective cohort study was conducted on MS patients treated with Rituximab over a 10-year period. Patients included had at least two infusions and a follow-up of ≥6 months after the last infusion. IgG levels and antibiotic prescriptions were registered longitudinally.
Results
The study included 213 patients (72% female, mean age 40.1 ± 10.6 years). Mean IgG decreased from 11.5 ± 2.4 g/L at baseline to 9.0 ± 1.7 g/L after five years, with an average decline of 0.35 g/L/year (95% CI 0.25–0.44; p < 0.001). Hypogammaglobulinemia (<6.7 g/L) occurred in 7.5% of patients. Cumulative rituximab dose was a significant predictor of lower IgG (p < 0.001). Antibiotic prescriptions were recorded in 62% of patients (mean 2.5 per patient), most commonly for urinary (29%) and respiratory (17%) tract infections. In multivariable analysis, lower IgG levels did not significantly predict the risk of antibiotic prescription.
Conclusion
Rituximab treatment resulted in a significant, dose-dependent IgG decline. However, this decline was not associated with an increased risk of antibiotic-treated infections, suggesting a dissociation between total IgG levels and functional immune competence in this cohort. These findings support continued use of rituximab with vigilant monitoring, though dose adjustments may be warranted for patients with rapidly decreasing IgG.
背景：美罗华（Rituximab）是一种广泛用于多发性硬化症（MS）的b细胞消耗疗法，与免疫球蛋白G （IgG）水平的进行性下降有关，增加了对感染风险的担忧。本研究评估了现实世界MS队列中IgG动态和抗生素使用情况。方法：对接受利妥昔单抗治疗的MS患者进行了为期10年的回顾性队列研究。纳入的患者至少两次输注，最后一次输注后随访≥6个月。纵向记录IgG水平和抗生素处方。结果：纳入213例患者，其中女性72%，平均年龄40.1±10.6岁。平均IgG从基线时的11.5±2.4 g/L下降到5年后的9.0±1.7 g/L，平均下降0.35 g/L/年（95% CI 0.25 ~ 0.44; p < 0.001）。结论：利妥昔单抗治疗导致IgG显著的剂量依赖性下降。然而，这种下降与抗生素治疗感染的风险增加无关，这表明在该队列中，总IgG水平与功能性免疫能力之间存在分离。这些发现支持在警惕监测下继续使用利妥昔单抗，尽管对于IgG迅速下降的患者可能需要调整剂量。
{"title":"Immunoglobulin-G dynamics and relation to antibiotic prescriptions in multiple sclerosis patients treated with rituximab: a real-world cohort","authors":"Niclas Lange , Elisabet Tina , Olof Hultgren , Anders Svenningsson , Martin Gunnarsson","doi":"10.1016/j.msard.2026.106992","DOIUrl":"10.1016/j.msard.2026.106992","url":null,"abstract":"<div><h3>Background</h3><div>Rituximab, a B-cell-depleting therapy widely used for multiple sclerosis (MS), is associated with a progressive decline in immunoglobulin G (IgG) levels, raising concerns regarding infection risk. This study evaluates IgG dynamics and antibiotic use in a real-world MS cohort.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted on MS patients treated with Rituximab over a 10-year period. Patients included had at least two infusions and a follow-up of ≥6 months after the last infusion. IgG levels and antibiotic prescriptions were registered longitudinally.</div></div><div><h3>Results</h3><div>The study included 213 patients (72% female, mean age 40.1 ± 10.6 years). Mean IgG decreased from 11.5 ± 2.4 g/L at baseline to 9.0 ± 1.7 g/L after five years, with an average decline of 0.35 g/L/year (95% CI 0.25–0.44; <em>p</em> < 0.001). Hypogammaglobulinemia (<6.7 g/L) occurred in 7.5% of patients. Cumulative rituximab dose was a significant predictor of lower IgG (<em>p</em> < 0.001). Antibiotic prescriptions were recorded in 62% of patients (mean 2.5 per patient), most commonly for urinary (29%) and respiratory (17%) tract infections. In multivariable analysis, lower IgG levels did not significantly predict the risk of antibiotic prescription.</div></div><div><h3>Conclusion</h3><div>Rituximab treatment resulted in a significant, dose-dependent IgG decline. However, this decline was not associated with an increased risk of antibiotic-treated infections, suggesting a dissociation between total IgG levels and functional immune competence in this cohort. These findings support continued use of rituximab with vigilant monitoring, though dose adjustments may be warranted for patients with rapidly decreasing IgG.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106992"},"PeriodicalIF":2.9,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019109","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}
Multiple sclerosis (MS) is a common demyelinating disease of the central nervous system and is globally estimated to affect 2 new people/100.000/year. MS patients show among other symptoms mood changes including anxiety and depression. Serotonin (5-hydroxytryptamine; 5-HT) is a monoamine neurotransmitter that has been related to mood changes. We address the hypothesis that 5-HT neurotransmission may be altered in chronic MS, and for this, we evaluate the 5-HT system together with anxiety and depressive behaviors in an animal model of cuprizone (CPZ)-treated C57BL/6 mice. Animals were fed 0.2% CPZ for 5 weeks, and controls were given a standard diet. Demyelination was assessed with Luxol fast blue (LFB) stain and immunohistochemistry (IHC) with the antigens myelin proteolipid protein (PLP). 5-HT and its transporter protein (SERT) were assessed by IHC with antigens 5-HT and SERT respectively. Anxiety and depressive behaviors were assessed using the dark/light box and the forced swim tests respectively. Our findings show obvious demyelination in CPZ-treated mice together with increased 5-HT immunostaining of neurons of the dorsal and median raphe nuclei and their cortical projections. The 5-HT increase was concomitant to a decreased density of SERT fibers. Time spent in the light compartment reflecting an anxiety state, together with immobility time reflecting a depressive state were both increased in CPZ-treated mice. Our results show that exposure to CPZ for 5 weeks increases 5-HT and its cortical projections together with reduced SERT, suggesting an increased production of 5-HT and its availability. Our findings support the possible involvement of the 5-HT system in behavioral changes, demyelination and probably inflammatory processes in MS.
{"title":"Altered serotonergic system and mood behaviors in a cuprizone-induced model of demyelination","authors":"Souhoudji Themoi Demsou , Nahla Ouard , Alpha Amadou Bah , Assmaâ Tali , Rajaâ Jebbouj , Markus Kipp , Samir Ahboucha","doi":"10.1016/j.msard.2026.106991","DOIUrl":"10.1016/j.msard.2026.106991","url":null,"abstract":"<div><div>Multiple sclerosis (MS) is a common demyelinating disease of the central nervous system and is globally estimated to affect 2 new people/100.000/year. MS patients show among other symptoms mood changes including anxiety and depression. Serotonin (5-hydroxytryptamine; 5-HT) is a monoamine neurotransmitter that has been related to mood changes. We address the hypothesis that 5-HT neurotransmission may be altered in chronic MS, and for this, we evaluate the 5-HT system together with anxiety and depressive behaviors in an animal model of cuprizone (CPZ)-treated C57BL/6 mice. Animals were fed 0.2% CPZ for 5 weeks, and controls were given a standard diet. Demyelination was assessed with Luxol fast blue (LFB) stain and immunohistochemistry (IHC) with the antigens myelin proteolipid protein (PLP). 5-HT and its transporter protein (SERT) were assessed by IHC with antigens 5-HT and SERT respectively. Anxiety and depressive behaviors were assessed using the dark/light box and the forced swim tests respectively. Our findings show obvious demyelination in CPZ-treated mice together with increased 5-HT immunostaining of neurons of the dorsal and median raphe nuclei and their cortical projections. The 5-HT increase was concomitant to a decreased density of SERT fibers. Time spent in the light compartment reflecting an anxiety state, together with immobility time reflecting a depressive state were both increased in CPZ-treated mice. Our results show that exposure to CPZ for 5 weeks increases 5-HT and its cortical projections together with reduced SERT, suggesting an increased production of 5-HT and its availability. Our findings support the possible involvement of the 5-HT system in behavioral changes, demyelination and probably inflammatory processes in MS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"108 ","pages":"Article 106991"},"PeriodicalIF":2.9,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146132308","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 : 2026-01-10DOI: 10.1016/j.msard.2026.106989
Mohammad Wafa , Gavin Giovannoni
Current McDonald criteria for multiple sclerosis (MS) rely on complex statistical metaphors—dissemination in space and time—that are prone to clinical misapplication. This manuscript proposes a clinician-centred approach that simplifies diagnosis by focusing on four fundamental immunobiological pillars: confirming the condition is a chronic, inflammatory, demyelinating disease of the CNS. By reclassifying existing markers—such as the central vein sign, paramagnetic rim lesions, and neurofilaments—into these intuitive categories, the model provides clinicians greater flexibility to triangulate evidence based on available data. Crucially, this framework introduces Immunobiological MS (IBMS) (formerly Radiologically Isolated Syndrome) and Non-active CDMS as distinct diagnostic entities. These categories acknowledge the disease's biological diversity and accommodate variable treatment decisions.
{"title":"Lost in space, lost in time: A clinician’s proposed approach to the diagnosis of multiple sclerosis","authors":"Mohammad Wafa , Gavin Giovannoni","doi":"10.1016/j.msard.2026.106989","DOIUrl":"10.1016/j.msard.2026.106989","url":null,"abstract":"<div><div>Current McDonald criteria for multiple sclerosis (MS) rely on complex statistical metaphors—dissemination in space and time—that are prone to clinical misapplication. This manuscript proposes a clinician-centred approach that simplifies diagnosis by focusing on four fundamental immunobiological pillars: confirming the condition is a chronic, inflammatory, demyelinating disease of the CNS. By reclassifying existing markers—such as the central vein sign, paramagnetic rim lesions, and neurofilaments—into these intuitive categories, the model provides clinicians greater flexibility to triangulate evidence based on available data. Crucially, this framework introduces Immunobiological MS (IBMS) (formerly Radiologically Isolated Syndrome) and Non-active CDMS as distinct diagnostic entities. These categories acknowledge the disease's biological diversity and accommodate variable treatment decisions.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106989"},"PeriodicalIF":2.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034585","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}
: While spinal cord atrophy (SCA) is increasingly recognized as a contributor to disability in multiple sclerosis (MS), it is still unclear how spinal cord atrophy contributes to the clinical course of MS when brain atrophy is taken into account. This study aimed to characterize the longitudinal course and clinical correlates of SCA in MS patients without significant brain atrophy progression.
Methods
: In this multicenter, retrospective observational study, 120 MS patients with brain MRI data acquired approximately 2 years apart were enrolled. Brain and spinal cord atrophy were quantified using SIENA/X and JIM9, respectively. Patients were stratified by evidence of disease activity and brain atrophy to evaluate SCA progression independently of inflammatory activity.
Results
: Although 64.2% of patients achieved no evidence of disease activity (NEDA) -3 and 40.8% met NEDA-4 criteria, a non-negligible degree of the SCA (−0.791 ± 1.97% / year) as well as the brain volume loss (BVL) (−0.381 ± 0.553% / year) was observed. SCA correlated weakly with BVL but not with T2 lesion volume in the brain or clinical disease activity. Among patients who fulfilled the NEDA-4 criteria, those with greater rates of SCA unexpectedly exhibited significantly smaller brain T2 lesion volumes compared to those with lower atrophy rates (p = 0.041).
Discussion
: SCA may progress independently of brain inflammation or clinical activity, potentially reflecting “pure” neurodegenerative processes. Its evaluation may provide critical insight into disease progression in MS, particularly in clinically stable patients with minimal brain atrophy or lesion burden.
{"title":"Characterizing spinal cord atrophy in multiple sclerosis patients without disease activity or brain atrophy progression","authors":"Hiroaki Yokote , Yusei Miyazaki , Juichi Fujimori , Saori Adachi , Shuta Toru , Masaaki Niino , Ichiro Nakashima , Yoshiharu Miura , Yoichiro Nishida , Sonoko Misawa","doi":"10.1016/j.msard.2026.106990","DOIUrl":"10.1016/j.msard.2026.106990","url":null,"abstract":"<div><h3>Background</h3><div><strong>:</strong> While spinal cord atrophy (SCA) is increasingly recognized as a contributor to disability in multiple sclerosis (MS), it is still unclear how spinal cord atrophy contributes to the clinical course of MS when brain atrophy is taken into account. This study aimed to characterize the longitudinal course and clinical correlates of SCA in MS patients without significant brain atrophy progression.</div></div><div><h3>Methods</h3><div><strong>:</strong> In this multicenter, retrospective observational study, 120 MS patients with brain MRI data acquired approximately 2 years apart were enrolled. Brain and spinal cord atrophy were quantified using SIENA/X and JIM9, respectively. Patients were stratified by evidence of disease activity and brain atrophy to evaluate SCA progression independently of inflammatory activity.</div></div><div><h3>Results</h3><div><strong>:</strong> Although 64.2% of patients achieved no evidence of disease activity (NEDA) -3 and 40.8% met NEDA-4 criteria, a non-negligible degree of the SCA (−0.791 ± 1.97% / year) as well as the brain volume loss (BVL) (−0.381 ± 0.553% / year) was observed. SCA correlated weakly with BVL but not with T2 lesion volume in the brain or clinical disease activity. Among patients who fulfilled the NEDA-4 criteria, those with greater rates of SCA unexpectedly exhibited significantly smaller brain T2 lesion volumes compared to those with lower atrophy rates (<em>p</em> = 0.041).</div></div><div><h3>Discussion</h3><div><strong>:</strong> SCA may progress independently of brain inflammation or clinical activity, potentially reflecting “pure” neurodegenerative processes. Its evaluation may provide critical insight into disease progression in MS, particularly in clinically stable patients with minimal brain atrophy or lesion burden.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106990"},"PeriodicalIF":2.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978466","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 : 2026-01-10DOI: 10.1016/j.msard.2026.106966
Alexandre Bussinger Lopes, Denis Bernardi Bichuetti, Nilton Amorim de Souza, Felipe Toscano Lins de Menezes, Flavia Timbó Albuquerque, Enedina Maria Lobato de Oliveira
Background
Multiple sclerosis (MS) is a chronic demyelinating disease that often leads to disability in young adults. Among its various phenotypes, highly active MS (HA-MS) presents with frequent relapses, incomplete recovery, and a high burden of MRI lesions. Despite its clinical importance, there is no universally accepted definition of HA-MS, which complicates early identification and treatment decisions.
Objective
This study aimed to evaluate whether Brazilian neurologists can recognize HA-MS and whether there is agreement regarding its defining characteristics. It also explored how this recognition influences treatment choices.
Methods
A cross-sectional, self-administered online survey was distributed to neurologists affiliated with the Brazilian Academy of Neurology (ABN). The questionnaire was open from March to September 2023. Responses were analyzed using descriptive statistics and chi-square or Fisher’s exact tests.
Results
A total of 206 neurologists completed the survey. Most respondents agreed that signs of high disease activity influence therapeutic decisions (98.1%). The most frequently cited indicators of HA-MS were annualized relapse rate (37.4%) and the number of gadolinium-enhancing lesions on MRI (32.0%). The Rush et al. definition was most commonly endorsed (53.9%), while Tintoré’s was least favored (85.9%). High-efficacy therapies—particularly Natalizumab, Ocrelizumab, and Alemtuzumab—were the preferred treatment options. Neuroimmunologists were significantly more likely to prescribe advanced therapies and less likely to use first-line agents compared to general neurologists.
Conclusion
Brazilian neurologists show substantial agreement in identifying clinical and radiological signs of HA-MS and favor early, high-efficacy treatment strategies. These findings highlight the need for clear, standardized criteria to guide consistent diagnosis and timely therapeutic intervention, ultimately improving patient care in MS.
{"title":"Highly active multiple sclerosis - An important, yet inaccurate concept","authors":"Alexandre Bussinger Lopes, Denis Bernardi Bichuetti, Nilton Amorim de Souza, Felipe Toscano Lins de Menezes, Flavia Timbó Albuquerque, Enedina Maria Lobato de Oliveira","doi":"10.1016/j.msard.2026.106966","DOIUrl":"10.1016/j.msard.2026.106966","url":null,"abstract":"<div><h3>Background</h3><div>Multiple sclerosis (MS) is a chronic demyelinating disease that often leads to disability in young adults. Among its various phenotypes, highly active MS (HA-MS) presents with frequent relapses, incomplete recovery, and a high burden of MRI lesions. Despite its clinical importance, there is no universally accepted definition of HA-MS, which complicates early identification and treatment decisions.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate whether Brazilian neurologists can recognize HA-MS and whether there is agreement regarding its defining characteristics. It also explored how this recognition influences treatment choices.</div></div><div><h3>Methods</h3><div>A cross-sectional, self-administered online survey was distributed to neurologists affiliated with the Brazilian Academy of Neurology (ABN). The questionnaire was open from March to September 2023. Responses were analyzed using descriptive statistics and chi-square or Fisher’s exact tests.</div></div><div><h3>Results</h3><div>A total of 206 neurologists completed the survey. Most respondents agreed that signs of high disease activity influence therapeutic decisions (98.1%). The most frequently cited indicators of HA-MS were annualized relapse rate (37.4%) and the number of gadolinium-enhancing lesions on MRI (32.0%). The Rush et al. definition was most commonly endorsed (53.9%), while Tintoré’s was least favored (85.9%). High-efficacy therapies—particularly Natalizumab, Ocrelizumab, and Alemtuzumab—were the preferred treatment options. Neuroimmunologists were significantly more likely to prescribe advanced therapies and less likely to use first-line agents compared to general neurologists.</div></div><div><h3>Conclusion</h3><div>Brazilian neurologists show substantial agreement in identifying clinical and radiological signs of HA-MS and favor early, high-efficacy treatment strategies. These findings highlight the need for clear, standardized criteria to guide consistent diagnosis and timely therapeutic intervention, ultimately improving patient care in MS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106966"},"PeriodicalIF":2.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978568","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 : 2026-01-08DOI: 10.1016/j.msard.2026.106987
Mulan Jiang, Anastasia Vishnevetsky, Mattia Wruble Clark, Monique Anderson, Takahisa Mikami, Rebecca Gillani, Fabian Murillo, Joao Vitor Mahler Ferreira Oliveira, Rebecca Salky, Gabriela Romanow, Michael Levy, Philippe A. Bilodeau
{"title":"Lack of external validity of the MOG-AR score in a North American cohort","authors":"Mulan Jiang, Anastasia Vishnevetsky, Mattia Wruble Clark, Monique Anderson, Takahisa Mikami, Rebecca Gillani, Fabian Murillo, Joao Vitor Mahler Ferreira Oliveira, Rebecca Salky, Gabriela Romanow, Michael Levy, Philippe A. Bilodeau","doi":"10.1016/j.msard.2026.106987","DOIUrl":"10.1016/j.msard.2026.106987","url":null,"abstract":"","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106987"},"PeriodicalIF":2.9,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078580","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 : 2026-01-08DOI: 10.1016/j.msard.2026.106988
Christopher H Hawkes , Gavin Giovannoni , Jeanette Lechner-Scott , Michael Levy , Ann Yeh
{"title":"Why don’t all adults get multiple sclerosis?","authors":"Christopher H Hawkes , Gavin Giovannoni , Jeanette Lechner-Scott , Michael Levy , Ann Yeh","doi":"10.1016/j.msard.2026.106988","DOIUrl":"10.1016/j.msard.2026.106988","url":null,"abstract":"","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106988"},"PeriodicalIF":2.9,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023117","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 : 2026-01-08DOI: 10.1016/j.msard.2026.106980
Mohamed Ezzat M. Mansour , Omar Kassar , Khalid Radwan Alsaadany , Mohamed Awad E. Ahmed , Mufreh Amin , Mohamed H. Khalil , Yomna Emad Abdalla
Introduction
Smoking is a common factor that contributes to the development of Multiple sclerosis during embryogenesis. Several studies found a correlation between maternal or paternal smoking and the development of Multiple sclerosis in offspring. Given inconclusive findings from recent studies, we aim to conduct a systematic review and meta-analysis of the relation between parental tobacco smoking and the risk of Multiple sclerosis in offspring.
Methods
We systematically conducted comprehensive search screening including (PubMed, Scopus, Web of Science, Embase, and Cochrane Library) until July 2025. This study aimed to assess the relation between exposure to tobacco smoke during pregnancy (maternal and paternal smoking) and the risk of Multiple sclerosis in offspring. Pooled estimates were calculated using a random-effects model. The PROSPERO registration is CRD420251117243.
Results
This study included nine studies involving 1,405,641 participants, including 5,452 Multiple sclerosis patients. We did not find a correlation between maternal smoking during and before pregnancy and risk of Multiple sclerosis in offspring (OR = 1.13, 95% CI [0.9, 1.43], P-value= 0.30, I2= 53.7%), (OR = 1.11, 95% CI [0.83, 1.48], P-value= 0.48, I2 = 0%) respectively. We found a statistically significant association between paternal smoking and the risk of Multiple sclerosis in offspring (OR 1.62, 95% CI [1.24; 2.11], P-value= 0.00036, I2= 0%).
Conclusion
These findings highlight a complex relationship between parental smoking and offspring risk of MS. We observed no clear association for maternal smoking, whereas paternal smoking was associated with an increased risk in offspring. However, neither result is definitive, and further well-designed prospective studies are required to confirm these associations and clarify underlying mechanisms.
简介：吸烟是导致胚胎发育过程中多发性硬化症发生的一个常见因素。几项研究发现，母亲或父亲吸烟与后代患多发性硬化症之间存在相关性。鉴于最近的研究结果不确定，我们的目标是对父母吸烟与后代多发性硬化症风险之间的关系进行系统回顾和荟萃分析。方法：我们系统地进行了全面的检索筛选，包括（PubMed、Scopus、Web of Science、Embase和Cochrane Library），截止到2025年7月。本研究旨在评估怀孕期间暴露于烟草烟雾（母亲和父亲吸烟）与后代多发性硬化症风险之间的关系。汇总估计使用随机效应模型计算。普洛斯彼罗的注册号是CRD420251117243。结果：本研究包括9项研究，涉及1,405,641名参与者，包括5,452名多发性硬化症患者。我们没有发现孕期和孕前吸烟与后代多发性硬化症风险之间的相关性（OR = 1.13, 95% CI [0.9, 1.43]， p值= 0.30,I2= 53.7%）， （OR = 1.11, 95% CI [0.83, 1.48]， p值= 0.48,I2= 0%）。我们发现父亲吸烟与后代患多发性硬化症的风险有统计学意义的关联（OR 1.62, 95% CI [1.24; 2.11]， p值= 0.00036,I2= 0%）。结论：这些发现强调了父母吸烟与后代ms风险之间的复杂关系。我们没有观察到母亲吸烟与ms风险之间的明确关联，而父亲吸烟与后代ms风险增加有关。然而，这两个结果都不是决定性的，需要进一步精心设计的前瞻性研究来证实这些关联并阐明潜在的机制。
{"title":"Exposure to tobacco smoke during pregnancy and the risk of multiple sclerosis in offspring: A systematic review and meta-analysis","authors":"Mohamed Ezzat M. Mansour , Omar Kassar , Khalid Radwan Alsaadany , Mohamed Awad E. Ahmed , Mufreh Amin , Mohamed H. Khalil , Yomna Emad Abdalla","doi":"10.1016/j.msard.2026.106980","DOIUrl":"10.1016/j.msard.2026.106980","url":null,"abstract":"<div><h3>Introduction</h3><div>Smoking is a common factor that contributes to the development of Multiple sclerosis during embryogenesis. Several studies found a correlation between maternal or paternal smoking and the development of Multiple sclerosis in offspring. Given inconclusive findings from recent studies, we aim to conduct a systematic review and meta-analysis of the relation between parental tobacco smoking and the risk of Multiple sclerosis in offspring.</div></div><div><h3>Methods</h3><div>We systematically conducted comprehensive search screening including (PubMed, Scopus, Web of Science, Embase, and Cochrane Library) until July 2025. This study aimed to assess the relation between exposure to tobacco smoke during pregnancy (maternal and paternal smoking) and the risk of Multiple sclerosis in offspring. Pooled estimates were calculated using a random-effects model. The PROSPERO registration is CRD420251117243.</div></div><div><h3>Results</h3><div>This study included nine studies involving 1,405,641 participants, including 5,452 Multiple sclerosis patients. We did not find a correlation between maternal smoking during and before pregnancy and risk of Multiple sclerosis in offspring (OR = 1.13, 95% CI [0.9, 1.43], P-value= 0.30, I<sup>2</sup>= 53.7%), (OR = 1.11, 95% CI [0.83, 1.48], P-value= 0.48, I<sup>2</sup> = 0%) respectively. We found a statistically significant association between paternal smoking and the risk of Multiple sclerosis in offspring (OR 1.62, 95% CI [1.24; 2.11], P-value= 0.00036, I<sup>2</sup>= 0%).</div></div><div><h3>Conclusion</h3><div>These findings highlight a complex relationship between parental smoking and offspring risk of MS. We observed no clear association for maternal smoking, whereas paternal smoking was associated with an increased risk in offspring. However, neither result is definitive, and further well-designed prospective studies are required to confirm these associations and clarify underlying mechanisms.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106980"},"PeriodicalIF":2.9,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019124","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 : 2026-01-08DOI: 10.1016/j.msard.2026.106986
Claudia Alonso, Farren B.S. Briggs
{"title":"Letter to editor: Response to ‘psychological resilience as a mediator between depression and health-related quality of life in relapsing-remitting multiple sclerosis patients’","authors":"Claudia Alonso, Farren B.S. Briggs","doi":"10.1016/j.msard.2026.106986","DOIUrl":"10.1016/j.msard.2026.106986","url":null,"abstract":"","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106986"},"PeriodicalIF":2.9,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952657","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}
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