Multiple sclerosis and related disorders最新文献_第9页

Clinical and diagnostic characteristics of autoimmune, infectious, and cryptogenic central nervous system vasculitis at a tertiary care center 三级保健中心自身免疫、感染性和隐源性中枢神经系统血管炎的临床和诊断特点

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2026-01-04 DOI: 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.

背景：中枢神经系统（CNS）血管炎是一种罕见的，具有诊断挑战性的疾病，涉及大脑动脉炎症。由于非特异性的表现和有限的工具，区分感染性和自身免疫性病因是困难的。我们对三级保健中心的中枢神经系统血管炎病例进行特征分析，以确定病因的特征。方法：回顾性分析2020-2024年间哥伦比亚大学欧文医学中心ICD诊断为中枢神经系统血管炎的患者。病例根据临床、实验室、放射学和病理资料分类为感染性、自身免疫性或隐源性。采用非参数检验分析人口统计学、症状、脑脊液（CSF）检查结果、神经影像学、治疗和结果。结果：纳入病例43例，平均年龄45.7岁；51.2%男性；44.2%免疫功能低下；中位症状持续时间7天。病因为感染性（14%）、自身免疫性（30%）和隐源性（56%），明确诊断为23.3%。头痛、认知功能障碍和运动症状是常见的。各组间CSF参数无显著差异（中位蛋白53 mg/dL；葡萄糖79 mg/dL； RBC 60/µL；白细胞3/µL）。81.4%发生血管狭窄；感染性（50%）和隐源性（41.7%）比自身免疫性（0%）更常累及>2血管（p = 0.016）。隐源性病例更多表现为缺血（75%）、出血（25%）和FLAIR高信号（75%）（p < 0.010）。27.9%的患者行活检。97.4%的患者接受类固醇治疗，25.6%的患者接受疾病改善治疗。结论：尽管进行了广泛的检测，中枢神经系统血管炎的明确诊断仍然很困难。虽然临床和脑脊液特征缺乏区分价值，但血管和成像模式因病因而异，这突出了改进生物标志物和成像策略的必要性。

{"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":"2026-03-01","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}

引用次数: 0

A comparative study of gait pattern characteristics between individuals with multiple sclerosis and healthy individuals during anticipatory postural adjustment and gait initiation: A scoping review 在预期的姿势调整和步态启动过程中，多发性硬化症患者和健康人步态模式特征的比较研究：范围综述

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2025-12-29 DOI: 10.1016/j.msard.2025.106949

Narges Jahantigh Akbari , Fatemeh Ehsani , Marzieh Mortezaejad , Mohammad Yousefi , Khorshid Bijari

Individuals diagnosed with multiple sclerosis (MS) are known to face more challenging situations, such as gait initiation (GI), compared to healthy individuals. This provides a deeper insight into the mechanisms that govern dynamic postural control. A search was conducted across several databases, including PubMed, Cochrane, ScienceDirect, Web of Science, Scopus, ProQuest, and Google Scholar. Studies of any design were included if they satisfied the following criteria: the experimental group consisted of individuals with MS or clinically isolated syndrome, the control group included healthy individuals or MS patients, and the studies examined gait patterns across various parameters, such as the center of pressure (COP), center of mass, and anticipatory postural adjustments, while also assessing the gait initiation phase. Utilizing the modified Downs and Black checklist, nine articles were selected for the final analysis. The results indicated deceleration, a reduction in posterior COP displacement, and an increase in COP during anterior GI. Compared with healthy controls, individuals with MS exhibited greater instability during balance recovery and in kinetic parameters of the stance limb. Furthermore, a delay and reduction in muscle activity were noted in individuals with MS who had a history of falls, in contrast to non-falling MS patients and healthy individuals.

与健康个体相比，被诊断患有多发性硬化症（MS）的个体面临着更具有挑战性的情况，例如步态起始（GI）。这为动态姿势控制的机制提供了更深入的见解。在几个数据库中进行了搜索，包括PubMed、Cochrane、ScienceDirect、Web of Science、Scopus、ProQuest和b谷歌Scholar。只要满足以下标准，任何设计的研究都被纳入：实验组由患有多发性硬化症或临床孤立综合征的个体组成，对照组包括健康个体或多发性硬化症患者，研究检查了不同参数的步态模式，如压力中心（COP）、质心和预期姿势调整，同时也评估了步态起始阶段。利用修改后的Downs and Black检查表，选择了9篇文章进行最终分析。结果显示，在前GI过程中，减速，后部COP位移减少，COP增加。与健康对照相比，MS患者在平衡恢复和站立肢体的动力学参数方面表现出更大的不稳定性。此外，与没有跌倒的MS患者和健康个体相比，有跌倒史的MS患者肌肉活动延迟和减少。

{"title":"A comparative study of gait pattern characteristics between individuals with multiple sclerosis and healthy individuals during anticipatory postural adjustment and gait initiation: A scoping review","authors":"Narges Jahantigh Akbari , Fatemeh Ehsani , Marzieh Mortezaejad , Mohammad Yousefi , Khorshid Bijari","doi":"10.1016/j.msard.2025.106949","DOIUrl":"10.1016/j.msard.2025.106949","url":null,"abstract":"<div><div>Individuals diagnosed with multiple sclerosis (MS) are known to face more challenging situations, such as gait initiation (GI), compared to healthy individuals. This provides a deeper insight into the mechanisms that govern dynamic postural control. A search was conducted across several databases, including PubMed, Cochrane, ScienceDirect, Web of Science, Scopus, ProQuest, and Google Scholar. Studies of any design were included if they satisfied the following criteria: the experimental group consisted of individuals with MS or clinically isolated syndrome, the control group included healthy individuals or MS patients, and the studies examined gait patterns across various parameters, such as the center of pressure (COP), center of mass, and anticipatory postural adjustments, while also assessing the gait initiation phase. Utilizing the modified Downs and Black checklist, nine articles were selected for the final analysis. The results indicated deceleration, a reduction in posterior COP displacement, and an increase in COP during anterior GI. Compared with healthy controls, individuals with MS exhibited greater instability during balance recovery and in kinetic parameters of the stance limb. Furthermore, a delay and reduction in muscle activity were noted in individuals with MS who had a history of falls, in contrast to non-falling MS patients and healthy individuals.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106949"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145940036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Early determinants of long-term outcomes in multiple sclerosis 多发性硬化症长期预后的早期决定因素。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI: 10.1016/j.msard.2025.106964

Ozan Dörtkol, Ahmed Serkan Emekli, Edis Hacılar, Sevda Öztürk Erden, Tuncay Gündüz, Murat Kürtüncü

Background

Multiple sclerosis (MS) exhibits remarkable heterogeneity in its clinical course, yet the determinants of long-term disability progression remain incompletely understood. Identifying demographic and clinical predictors of unfavorable trajectories is essential for individualized management.

Objective

To investigate demographic, clinical, and laboratory factors influencing disability progression and relapse dynamics in a large Turkish MS cohort with over two decades of follow-up.

Methods

This retrospective study included 1580 patients diagnosed with MS according to the 2017 McDonald criteria and followed between 1980 and 2020. Data on demographic, clinical, and laboratory parameters were analyzed. Survival analyses assessed time to expanded disability status scale (EDSS) 3 and 6 milestones, and logistic regression identified predictors of progressive disease.

Results

The cohort comprised 1092 females and 488 males (mean follow-up: 7.5 ± 5.7 years). Male sex and lower educational attainment were associated with faster disability accumulation (log-rank, p < 0.005 and p < 0.001, respectively). Motor, cerebellar, and spinal onset were significant predictors of a progressive phenotype, while optic neuritis, sensory, and brainstem onset indicated a relapsing–remitting course. Neither smoking, family history, nor oligoclonal band (OCB) positivity influenced disability progression. Inter-relapse intervals shortened until the fifth relapse, thereafter stabilizing, marking a potential inflection point in inflammatory activity.

Conclusion

This long-term cohort highlights distinct demographic and clinical predictors of MS progression. Early disability accumulation, particularly before reaching EDSS 3, appears critical in determining long-term outcomes. These findings emphasize the importance of early, aggressive therapeutic intervention within the initial disease phase to alter the trajectory of MS progression.

背景：多发性硬化症（MS）在临床过程中表现出显著的异质性，但长期残疾进展的决定因素仍不完全清楚。确定不利轨迹的人口统计学和临床预测因素对于个体化管理至关重要。目的：调查人口统计学、临床和实验室因素对土耳其大型MS队列残疾进展和复发动态的影响，随访超过20年。方法：本回顾性研究纳入1580例根据2017年McDonald标准诊断为MS的患者，随访时间为1980年至2020年。对人口学、临床和实验室参数的数据进行分析。生存分析评估了到达扩展残疾状态量表（EDSS） 3和6个里程碑的时间，并通过逻辑回归确定了疾病进展的预测因子。结果：女性1092人，男性488人（平均随访时间：7.5±5.7年）。男性和较低的受教育程度与更快的残疾积累相关（log-rank, p < 0.005和p < 0.001）。运动、小脑和脊柱发病是进行性表型的重要预测因子，而视神经炎、感觉和脑干发病则表明复发缓解过程。吸烟、家族史和寡克隆带（OCB）阳性均不影响残疾进展。复发间隔缩短，直至第五次复发，此后趋于稳定，标志着炎症活动的潜在拐点。结论：这项长期队列研究突出了MS进展的独特人口学和临床预测因素。早期残疾积累，特别是在达到EDSS 3之前，似乎对决定长期预后至关重要。这些发现强调了在疾病初始阶段进行早期、积极的治疗干预以改变MS进展轨迹的重要性。

{"title":"Early determinants of long-term outcomes in multiple sclerosis","authors":"Ozan Dörtkol, Ahmed Serkan Emekli, Edis Hacılar, Sevda Öztürk Erden, Tuncay Gündüz, Murat Kürtüncü","doi":"10.1016/j.msard.2025.106964","DOIUrl":"10.1016/j.msard.2025.106964","url":null,"abstract":"<div><h3>Background</h3><div>Multiple sclerosis (MS) exhibits remarkable heterogeneity in its clinical course, yet the determinants of long-term disability progression remain incompletely understood. Identifying demographic and clinical predictors of unfavorable trajectories is essential for individualized management.</div></div><div><h3>Objective</h3><div>To investigate demographic, clinical, and laboratory factors influencing disability progression and relapse dynamics in a large Turkish MS cohort with over two decades of follow-up.</div></div><div><h3>Methods</h3><div>This retrospective study included 1580 patients diagnosed with MS according to the 2017 McDonald criteria and followed between 1980 and 2020. Data on demographic, clinical, and laboratory parameters were analyzed. Survival analyses assessed time to expanded disability status scale (EDSS) 3 and 6 milestones, and logistic regression identified predictors of progressive disease.</div></div><div><h3>Results</h3><div>The cohort comprised 1092 females and 488 males (mean follow-up: 7.5 ± 5.7 years). Male sex and lower educational attainment were associated with faster disability accumulation (log-rank, <em>p</em> < 0.005 and <em>p</em> < 0.001, respectively). Motor, cerebellar, and spinal onset were significant predictors of a progressive phenotype, while optic neuritis, sensory, and brainstem onset indicated a relapsing–remitting course. Neither smoking, family history, nor oligoclonal band (OCB) positivity influenced disability progression. Inter-relapse intervals shortened until the fifth relapse, thereafter stabilizing, marking a potential inflection point in inflammatory activity.</div></div><div><h3>Conclusion</h3><div>This long-term cohort highlights distinct demographic and clinical predictors of MS progression. Early disability accumulation, particularly before reaching EDSS 3, appears critical in determining long-term outcomes. These findings emphasize the importance of early, aggressive therapeutic intervention within the initial disease phase to alter the trajectory of MS progression.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106964"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Quality of life, productivity loss, and mental health service utilization among parents of children with neuroinflammatory disorders: A cross-sectional study 神经炎性疾病患儿父母的生活质量、生产力损失和心理健康服务利用：一项横断面研究

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2026-01-27 DOI: 10.1016/j.msard.2026.107032

Ramesh Lamsal , E. Ann Yeh , Eleanor Pullenayegum , Wendy J. Ungar

Background

Children with neuroinflammatory disorders (NDs) require caregiving, affecting parental health and employment. This study assessed parents’ productivity losses, mental health services use, health-related quality of life (HRQoL), and care-related QoL.

Methods

This cross-sectional study enrolled children with NDs and parents at a single center. Data on productivity losses and mental health services use for both parents were collected. Respondent parents’ HRQoL and care-related QoL were measured using Health Utilities Index (HUI3) and Care-related Quality of Life (CarerQol) instrument. HUI3 scores were compared to Canadian parental norms. Annual parental costs per two-parent household and societal costs were estimated.

Results

Forty-seven parent-child dyads participated. Mean ages were 43.76 (SD 6.31) years for respondent parents and 12.00 (SD 3.34) years for children. Work and/or usual activity disruptions were reported by 86 % (31/36) of respondent parents and 78 % (28/36) of partners. Twenty-two percent (8/36) of respondent parents and 8 % (3/36) of partners used mental health services due to caregiving stress. Median (IQR) annual household costs for parents and society were CAD 2,767.87 (1,414.78–7,894.43). Mann-Whitney U test revealed no statistical difference in HUI-3 scores between parents of children with NDs (n = 46, median:0.93) and Canadian population parental norms (n = 2,799, median:0.93), W = 426434, p = 0.13. Mean CarerQol-7D and VAS scores were 85.97 (SD11.94) and 7.68 (SD1.08), respectively.

Conclusion

Parents of children with NDs reported work and/or daily activity disruptions and household costs; their HRQoL was comparable to Canadian parental norms. Larger studies with comparison groups of parents of healthy children are needed to confirm these findings.

背景：患有神经炎性疾病（NDs）的儿童需要照顾，这影响了父母的健康和就业。本研究评估了父母的生产力损失、心理健康服务的使用、健康相关生活质量（HRQoL）和护理相关生活质量。方法本横断面研究在单一中心招募NDs患儿及其父母。收集了父母双方生产力损失和心理健康服务使用情况的数据。采用健康效用指数（Health Utilities Index, HUI3）和护理相关生活质量（careqol）量表测量被调查者父母的HRQoL和护理相关生活质量。将HUI3分数与加拿大父母标准进行比较。估算了双亲家庭的年度父母成本和社会成本。结果47对亲子对参与调查。受访者父母的平均年龄为43.76岁（SD 6.31），儿童的平均年龄为12.00岁（SD 3.34）。86%（31/36）的受访者父母和78%（28/36）的受访者伴侣报告了工作和/或日常活动中断。22%（8/36）的应答父母和8%（3/36）的伴侣因照顾压力而使用心理健康服务。父母和社会的年度家庭成本中位数（IQR）为2,767.87加元（1,414.78-7,894.43）。Mann-Whitney U检验显示，NDs患儿的父母（n = 46，中位数：0.93）与加拿大人口父母标准（n = 2799，中位数：0.93）之间的HUI-3得分无统计学差异，W = 426434, p = 0.13。平均CarerQol-7D和VAS评分分别为85.97 （SD11.94）和7.68 （SD1.08）。结论NDs患儿的父母报告了工作和/或日常活动中断和家庭成本；他们的HRQoL与加拿大父母的标准相当。需要对健康儿童的父母进行更大规模的研究来证实这些发现。

{"title":"Quality of life, productivity loss, and mental health service utilization among parents of children with neuroinflammatory disorders: A cross-sectional study","authors":"Ramesh Lamsal , E. Ann Yeh , Eleanor Pullenayegum , Wendy J. Ungar","doi":"10.1016/j.msard.2026.107032","DOIUrl":"10.1016/j.msard.2026.107032","url":null,"abstract":"<div><h3>Background</h3><div>Children with neuroinflammatory disorders (NDs) require caregiving, affecting parental health and employment. This study assessed parents’ productivity losses, mental health services use, health-related quality of life (HRQoL), and care-related QoL.</div></div><div><h3>Methods</h3><div>This cross-sectional study enrolled children with NDs and parents at a single center. Data on productivity losses and mental health services use for both parents were collected. Respondent parents’ HRQoL and care-related QoL were measured using Health Utilities Index (HUI3) and Care-related Quality of Life (CarerQol) instrument. HUI3 scores were compared to Canadian parental norms. Annual parental costs per two-parent household and societal costs were estimated.</div></div><div><h3>Results</h3><div>Forty-seven parent-child dyads participated. Mean ages were 43.76 (SD 6.31) years for respondent parents and 12.00 (SD 3.34) years for children. Work and/or usual activity disruptions were reported by 86 % (31/36) of respondent parents and 78 % (28/36) of partners. Twenty-two percent (8/36) of respondent parents and 8 % (3/36) of partners used mental health services due to caregiving stress. Median (IQR) annual household costs for parents and society were CAD 2,767.87 (1,414.78–7,894.43). Mann-Whitney U test revealed no statistical difference in HUI-3 scores between parents of children with NDs (<em>n</em> = 46, median:0.93) and Canadian population parental norms (<em>n</em> = 2,799, median:0.93), <em>W</em> = 426434, <em>p</em> = 0.13. Mean CarerQol-7D and VAS scores were 85.97 (SD11.94) and 7.68 (SD1.08), respectively.</div></div><div><h3>Conclusion</h3><div>Parents of children with NDs reported work and/or daily activity disruptions and household costs; their HRQoL was comparable to Canadian parental norms. Larger studies with comparison groups of parents of healthy children are needed to confirm these findings.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107032"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Development of a machine learning model to predict the expanded disability status scale in multiple sclerosis patients 开发一种机器学习模型来预测多发性硬化症患者扩展的残疾状态量表。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2025-12-18 DOI: 10.1016/j.msard.2025.106937

Asiye Tuba Ozdogar , Murat Emec , Ergi Kaya , Ela Simay Zengin , Mehmet Hilal Ozcanhan , Serkan Ozakbas

Objective

The assessment of disability in multiple sclerosis (MS) patients is crucial for treatment decisions and prognosis estimation. The Expanded Disability Status Scale (EDSS) provides a standardized way to quantify disability in MS. However, predicting EDSS scores can be challenging due to the complex and heterogeneous nature of the disease. Machine learning techniques offer a promising approach to predict EDSS scores based on various patient characteristics.

Methods

231 people with MS (pwMS) who had an assessment of physical, psychosocial, and cognitive functions in three timelines (baseline (T0), first year (T1), and second year (T2)) were enrolled. The dataset used for the study consists of 126 features. Feature selection was based on feature saliency and correlation analysis. Three machine learning models —XGBoost, Random Forest, and Linear Regression —were trained on the selected features. Hyperparameter tuning was also carried out on the models. Model performance was evaluated using standard evaluation metrics, including MAE, MSE, and R².

Results

The Machine Learning model based on the XGBoost algorithm performed best in predicting EDSS scores (T2). The MAE value obtained with the XGBoost model is 0.2361, the MSE value is 0.2408, and the R2 value is 0.9705. These results indicate that XGBoost's predictive ability on the current dataset is promising.

Conclusion

Our study demonstrates the feasibility of using machine learning techniques to predict EDSS scores in MS patients. The developed models show promising performance and have the potential to enhance clinical decision-making and patient management in MS care.

目的：评估多发性硬化症（MS）患者的残疾对治疗决策和预后评估至关重要。扩展残疾状态量表（EDSS）提供了一种标准化的方法来量化多发性硬化症的残疾。然而，由于该疾病的复杂性和异质性，预测EDSS评分可能具有挑战性。机器学习技术提供了一种很有前途的方法来预测基于各种患者特征的EDSS评分。方法：231名多发性硬化症（pwMS）患者在三个时间线(基线（T0）、第一年（T1）和第二年（T2）进行了身体、社会心理和认知功能评估。该研究使用的数据集由126个特征组成。特征选择基于特征显著性和相关性分析。三个机器学习模型——xgboost、随机森林和线性回归——在选定的特征上进行了训练。对模型进行了超参数整定。采用标准评价指标，包括MAE、MSE和R²对模型性能进行评价。结果：基于XGBoost算法的机器学习模型在预测EDSS评分（T2）方面表现最好。使用XGBoost模型得到的MAE值为0.2361，MSE值为0.2408，R2值为0.9705。这些结果表明，XGBoost在当前数据集上的预测能力是有希望的。结论：我们的研究证明了使用机器学习技术预测MS患者EDSS评分的可行性。所开发的模型显示出良好的性能，并有可能提高MS护理的临床决策和患者管理。

{"title":"Development of a machine learning model to predict the expanded disability status scale in multiple sclerosis patients","authors":"Asiye Tuba Ozdogar , Murat Emec , Ergi Kaya , Ela Simay Zengin , Mehmet Hilal Ozcanhan , Serkan Ozakbas","doi":"10.1016/j.msard.2025.106937","DOIUrl":"10.1016/j.msard.2025.106937","url":null,"abstract":"<div><h3>Objective</h3><div>The assessment of disability in multiple sclerosis (MS) patients is crucial for treatment decisions and prognosis estimation. The Expanded Disability Status Scale (EDSS) provides a standardized way to quantify disability in MS. However, predicting EDSS scores can be challenging due to the complex and heterogeneous nature of the disease. Machine learning techniques offer a promising approach to predict EDSS scores based on various patient characteristics.</div></div><div><h3>Methods</h3><div>231 people with MS (pwMS) who had an assessment of physical, psychosocial, and cognitive functions in three timelines (baseline (T0), first year (T1), and second year (T2)) were enrolled. The dataset used for the study consists of 126 features. Feature selection was based on feature saliency and correlation analysis. Three machine learning models —XGBoost, Random Forest, and Linear Regression —were trained on the selected features. Hyperparameter tuning was also carried out on the models. Model performance was evaluated using standard evaluation metrics, including MAE, MSE, and R².</div></div><div><h3>Results</h3><div>The Machine Learning model based on the XGBoost algorithm performed best in predicting EDSS scores (T2). The MAE value obtained with the XGBoost model is 0.2361, the MSE value is 0.2408, and the R2 value is 0.9705. These results indicate that XGBoost's predictive ability on the current dataset is promising.</div></div><div><h3>Conclusion</h3><div>Our study demonstrates the feasibility of using machine learning techniques to predict EDSS scores in MS patients. The developed models show promising performance and have the potential to enhance clinical decision-making and patient management in MS care.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106937"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

SPHERES: innovative registry addressing the new era of neuromyelitis optica spectrum disorders (NMOSD) therapy SPHERES：解决视神经脊髓炎频谱障碍（NMOSD）治疗新时代的创新注册。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2025-12-19 DOI: 10.1016/j.msard.2025.106940

Jeffrey L. Bennett , Nicole Middaugh , Michael R. Yeaman , Terry J. Smith , Megan K. Behne , Margaux Crabtree , Robert R. McLean , Dimitros A. Pappas , Michael Levy

Neuromyelitis Optica Spectrum Disorders (NMOSD) are rare, autoimmune disorders of the central nervous system (CNS) that affect optic nerves and spinal cord. The SPHERES (Synergy of Prospective Health & Experimental Research for Emerging Solutions) Registry for NMOSD, a prospective observational cohort of adult patients in the United States, established in June 2021, was designed to gather robust and high-quality longitudinal data to facilitate knowledge of NMOSD and better understand the newly approved therapeutics. The objective of this study was to detail the SPHERES Registry features and characterize the SPHERES population in aggregate and stratified by serostatus at registry enrollment. Registry questionnaires were completed by clinicians and patients at enrollment and at routine clinical visits occurring at ∼6-month intervals, with additional data collection between visits. At enrollment into SPHERES, mean age of the first 350 patients enrolled was 50.1 years, 84 % of the cohort was female, 66 % had anti-AQP4+ NMOSD, and 71 % reported use of a biologic therapy. A number of demographic and disease characteristics and disease activity measures varied by serostatus, including mean durations since symptom onset and diagnosis and mean EDSS score. Patient-reported outcome measures were generally similar across serostatus groups. This analysis of the initial SPHERES patients provides valuable insights into the ability of the Registry to capture the natural history, real-world effectiveness, therapeutic utilization and safety in treating NMOSD.

视谱神经脊髓炎（NMOSD）是一种罕见的中枢神经系统（CNS）自身免疫性疾病，影响视神经和脊髓。NMOSD的SPHERES（新兴解决方案前瞻性健康与实验研究协同）登记处是一项针对美国成年患者的前瞻性观察队列，于2021年6月成立，旨在收集可靠和高质量的纵向数据，以促进对NMOSD的认识，并更好地了解新批准的治疗方法。本研究的目的是详细描述SPHERES登记的特征，并根据登记入组时的血清状态对SPHERES人群进行总体和分层。注册问卷由临床医生和患者在入组时以及每隔6个月的常规临床就诊时完成，并在两次就诊之间收集额外的数据。在入组SPHERES时，前350名患者的平均年龄为50.1岁，84%为女性，66%有抗aqp4 + NMOSD， 71%报告使用了生物治疗。许多人口统计学和疾病特征以及疾病活动性测量因血清状态而异，包括自症状出现和诊断以来的平均持续时间以及平均EDSS评分。不同血清状态组患者报告的结果通常相似。对最初的SPHERES患者的分析提供了宝贵的见解，使其能够了解治疗NMOSD的自然历史、现实世界的有效性、治疗利用率和安全性。

{"title":"SPHERES: innovative registry addressing the new era of neuromyelitis optica spectrum disorders (NMOSD) therapy","authors":"Jeffrey L. Bennett , Nicole Middaugh , Michael R. Yeaman , Terry J. Smith , Megan K. Behne , Margaux Crabtree , Robert R. McLean , Dimitros A. Pappas , Michael Levy","doi":"10.1016/j.msard.2025.106940","DOIUrl":"10.1016/j.msard.2025.106940","url":null,"abstract":"<div><div>Neuromyelitis Optica Spectrum Disorders (NMOSD) are rare, autoimmune disorders of the central nervous system (CNS) that affect optic nerves and spinal cord. The SPHERES (Synergy of Prospective Health & Experimental Research for Emerging Solutions) Registry for NMOSD, a prospective observational cohort of adult patients in the United States, established in June 2021, was designed to gather robust and high-quality longitudinal data to facilitate knowledge of NMOSD and better understand the newly approved therapeutics. The objective of this study was to detail the SPHERES Registry features and characterize the SPHERES population in aggregate and stratified by serostatus at registry enrollment. Registry questionnaires were completed by clinicians and patients at enrollment and at routine clinical visits occurring at ∼6-month intervals, with additional data collection between visits. At enrollment into SPHERES, mean age of the first 350 patients enrolled was 50.1 years, 84 % of the cohort was female, 66 % had anti-AQP4+ NMOSD, and 71 % reported use of a biologic therapy. A number of demographic and disease characteristics and disease activity measures varied by serostatus, including mean durations since symptom onset and diagnosis and mean EDSS score. Patient-reported outcome measures were generally similar across serostatus groups. This analysis of the initial SPHERES patients provides valuable insights into the ability of the Registry to capture the natural history, real-world effectiveness, therapeutic utilization and safety in treating NMOSD.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106940"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2026-02-02 DOI: 10.1016/j.msard.2026.107047

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

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

{"title":"Multiple sclerosis and uveitis: Clinical characteristics and prognosis","authors":"William GIL , Samuel CHACUN , Géraldine ANDRODIAS , Caroline VASSENEIX , Laurent KODJIKIAN , Sandra VUKUSIC , Pascal SÈVE , Thomas EL-JAMMAL","doi":"10.1016/j.msard.2026.107047","DOIUrl":"10.1016/j.msard.2026.107047","url":null,"abstract":"<div><h3>Background</h3><div>The neurological prognosis of multiple sclerosis (MS) varies across clinical patterns but remains unclear when associated with uveitis.</div></div><div><h3>Objective</h3><div>To investigate the neurological prognosis and clinical characteristics of MS-associated uveitis compared with MS without uveitis.</div></div><div><h3>Methods</h3><div>We conducted a retrospective case-control study including 35 patients with MS-associated uveitis and 102 matched MS controls (1:3; age, sex, MS course). Clinical and neurological data were extracted from the Lyon Cohort Uveitis and the EDMUS database. The primary endpoint was the difference in Expanded Disability Status Scale (EDSS) between baseline and last follow-up.</div></div><div><h3>Results</h3><div>Patients with MS-associated uveitis were more often of North African origin than controls (48.6 % vs 20.6 %, <em>p</em> = 0.006; OR 3.51, 95 % CI [1.41–8.77]). Median follow-up was 19 years [14–26] in the uveitis group and 16 years [13–22] in controls. Baseline EDSS was comparable between groups (2.0 vs 2.0), as was EDSS at last follow-up (3.0 vs 3.0). However, patients aged >32 years with MS-associated uveitis had a significantly lower risk of disability progression compared with controls.</div></div><div><h3>Conclusions</h3><div>MS-associated uveitis was more frequent in patients of North African origin and often showed a sarcoidosis-like phenotype. In patients older than 32 years, it was associated with a more favorable neurological outcome.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107047"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Real-world evidence of clinical outcomes and adherence to ofatumumab in the UK and the impact of a patients support programme: A retrospective, non-interventional cohort study ofatumumab在英国临床结果和依从性的真实证据以及患者支持计划的影响：一项回顾性，非介入性队列研究

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2026-01-27 DOI: 10.1016/j.msard.2026.107030

David Paling , David Cottrell , Ruth Hamlin , Colin O’Leary , Owen Pearson , Agne Straukiene , Pyry Kivi , Wendy Rice , Sarah Al-Azki , Nazanin Kondori

Background

Ofatumumab is the only anti-CD20 monoclonal antibody disease modifying therapy available for self- administration for adults with active relapsing remitting multiple sclerosis (RMS). This study aimed to investigate real-world adherence and clinical outcomes of ofatumumab-treated patients in the UK and looked at the impact of a patient support program called Kesimpta Connect (KC PSP) on these outcomes.

Methods

This retrospective observational cohort study examined adherence to ofatumumab in 155 RMS patients recruited from six UK MS centres. The primary objective of the study was to describe the medication possession ratio (MPR) adherence of ofatumumab treated patients over a 13-month period. The study also looked at clinical effectiveness measures, including change in annualized relapse rates (ARR). Safety and secondary-care use was also assessed in this study.

Results

103 patients had data available to be assessed for adherence and clinical effectiveness. 87 % (n=90) of patients had an MPR adherence of 0.80 or greater and higher proportion of non-KC PSP users reported adherence of greater than 0.80 than KC PSP users (98.4 % vs 69.2 %). The total ARR decreased during the follow-up period from 0.33 (95 % CI 0.23-0.40) prior to ofatumumab initiation to 0.06 (95 % CI 0.01-0.11) 12-months after initiation. In terms of safety, 38.1 % (n=59/155) patients reported experiencing an adverse event during the follow-up period; one was reported to be severe. However, no patients reported discontinuing ofatumumab during the study follow-up period.

Conclusion

This study provides evidence of good adherence for RMS patients using ofatumumab. Further, there is evidence of clinical effectiveness based on reduction in ARR post-ofatumumab initiation, as well as tolerability and a favourable safety profile. The results of this study support the continued use of ofatumumab in providing effective RMS disease management in the UK NHS.

背景：dofatumumab是唯一一种抗cd20单克隆抗体疾病修饰疗法，可用于成人活动性复发缓解型多发性硬化症（RMS）患者的自我给药。本研究旨在调查英国ofatumumab治疗患者的现实依从性和临床结果，并研究了称为Kesimpta Connect （KC PSP）的患者支持计划对这些结果的影响。方法：本回顾性观察队列研究调查了来自英国6个多发性硬化症中心的155名RMS患者对ofatumumab的依从性。该研究的主要目的是描述13个月期间ofatumumab治疗患者的药物占有比（MPR）依从性。该研究还考察了临床有效性指标，包括年化复发率（ARR）的变化。本研究还评估了安全性和二级保健使用情况。结果103例患者有可用于依从性和临床疗效评估的数据。87% （n=90）患者的MPR依从性为0.80或更高，非KC PSP使用者报告的MPR依从性大于0.80的比例高于KC PSP使用者（98.4% vs 69.2%）。在随访期间，总ARR从ofatumumab开始治疗前的0.33 （95% CI 0.23-0.40）下降到开始治疗后12个月的0.06 （95% CI 0.01-0.11）。在安全性方面，38.1% （n=59/155）的患者报告在随访期间出现不良事件；据报道，其中一人伤势严重。然而，在研究随访期间，没有患者报告停止使用阿图单抗。本研究为RMS患者使用ofatumumab提供了良好的依从性证据。此外，有证据表明临床有效性基于ofatumumab启动后ARR的降低，以及耐受性和良好的安全性。本研究结果支持继续使用ofatumumab在英国NHS提供有效的RMS疾病管理。

{"title":"Real-world evidence of clinical outcomes and adherence to ofatumumab in the UK and the impact of a patients support programme: A retrospective, non-interventional cohort study","authors":"David Paling , David Cottrell , Ruth Hamlin , Colin O’Leary , Owen Pearson , Agne Straukiene , Pyry Kivi , Wendy Rice , Sarah Al-Azki , Nazanin Kondori","doi":"10.1016/j.msard.2026.107030","DOIUrl":"10.1016/j.msard.2026.107030","url":null,"abstract":"<div><h3>Background</h3><div>Ofatumumab is the only anti-CD20 monoclonal antibody disease modifying therapy available for self- administration for adults with active relapsing remitting multiple sclerosis (RMS). This study aimed to investigate real-world adherence and clinical outcomes of ofatumumab-treated patients in the UK and looked at the impact of a patient support program called Kesimpta Connect (KC PSP) on these outcomes.</div></div><div><h3>Methods</h3><div>This retrospective observational cohort study examined adherence to ofatumumab in 155 RMS patients recruited from six UK MS centres. The primary objective of the study was to describe the medication possession ratio (MPR) adherence of ofatumumab treated patients over a 13-month period. The study also looked at clinical effectiveness measures, including change in annualized relapse rates (ARR). Safety and secondary-care use was also assessed in this study.</div></div><div><h3>Results</h3><div>103 patients had data available to be assessed for adherence and clinical effectiveness. 87 % (n=90) of patients had an MPR adherence of 0.80 or greater and higher proportion of non-KC PSP users reported adherence of greater than 0.80 than KC PSP users (98.4 % vs 69.2 %). The total ARR decreased during the follow-up period from 0.33 (95 % CI 0.23-0.40) prior to ofatumumab initiation to 0.06 (95 % CI 0.01-0.11) 12-months after initiation. In terms of safety, 38.1 % (n=59/155) patients reported experiencing an adverse event during the follow-up period; one was reported to be severe. However, no patients reported discontinuing ofatumumab during the study follow-up period.</div></div><div><h3>Conclusion</h3><div>This study provides evidence of good adherence for RMS patients using ofatumumab. Further, there is evidence of clinical effectiveness based on reduction in ARR post-ofatumumab initiation, as well as tolerability and a favourable safety profile. The results of this study support the continued use of ofatumumab in providing effective RMS disease management in the UK NHS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107030"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Post-infusion observation of patients with multiple sclerosis receiving natalizumab: Is it necessary? 多发性硬化症患者接受纳他珠单抗输注后观察：有必要吗？

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2026-01-13 DOI: 10.1016/j.msard.2026.106995

Melika Arab Bafrani, Negar Sadat Ahmadi, Fateme Zahra Idjadi, Sanaz Bordbar, Shima Jahani, Rayhane Montazeri, Sara Kamali Zonouzi, Mahsa Mohammadi Lapevandani, Zahra Ebadi, Samira Navardi, Hora Heidari, Amirreza Azimi, Abdorreza Naser Moghadasi, Mohammad Ali Sahraian

Background/Objective

Natalizumab (Tysabri ®), the first monoclonal antibody approved for treatment of relapsing-remitting Multiple Sclerosis (RRMS), can significantly reduce exacerbations and active brain lesions. Due to concerns on infusion-related reactions (IRRs) patients should be observed during the infusions and one hour after the completion of the infusions for signs and symptoms of hypersensitivity reactions, especially in the first 12 doses. This study was conducted to see if one-hour post-infusion observation is necessary in all patients receiving natalizumab or can be wavied in some stable patients.

Method

In this cross-sectional study, one-hour post-infusion observation was not conducted in patients who had previously received three doses of natalizumab without any history of moderate to severe or life-threatening IRRs based on the Common Terminology Criteria for Adverse Events (CTCAE) definition. Patient demographics and clinical characteristics were recorded by a trained physician in a questionnaire coupled with an emergency hotline provided for IRRs. In case of a modere to sever or life-threatening reaction during the ifusion the patient excluded from the study. Phone follow-up was done after an hour by the same medical doctor.

Result

424 patients with MS were enrolled in this study. Fatigue (10.8%), headache (4.5%), and cough (2.8%) were the most prevalent symptoms after 1 hour from the infusions. No life-threatening complications happened for the patients. There was no significant relationship between age, gender, the interval between doses, the number of total infusions, and disease duration with the incidence of side effects.

Conclusion

Early discharge without one hour post-infusion monitoring can be considered for patients without any moderate to sever adverse reaction in the fisrt three infusion of natalizumab.This sterategy may reduce the costs and save the time of infusion for these patients.

背景/目的：Natalizumab （Tysabri®）是首个被批准用于治疗复发-缓解型多发性硬化症（RRMS）的单克隆抗体，可以显著减少恶化和活动性脑病变。考虑到输注相关反应（IRRs），应在输注期间和输注完成后1小时观察患者的过敏反应体征和症状，特别是在前12次剂量。本研究旨在确定是否所有接受natalizumab的患者都需要输注后1小时的观察，或者在一些稳定的患者中是否可以不进行观察。方法：在这项横断面研究中，根据不良事件通用术语标准（CTCAE）的定义，没有任何中度至重度或危及生命的不良反应史的患者接受过三剂natalizumab，输注后1小时未进行观察。病人的人口统计资料和临床特征由训练有素的医生记录在一份调查问卷中，同时为内审人员提供紧急热线。如果在输液过程中出现严重或危及生命的反应，则将患者排除在研究之外。一小时后，同一名医生进行了电话随访。结果：424例MS患者纳入本研究。疲劳（10.8%）、头痛（4.5%）和咳嗽（2.8%）是输液1小时后最常见的症状。没有发生危及生命的并发症。年龄、性别、给药间隔、总输注次数、病程与不良反应发生率无显著关系。结论：对于前三次输注natalizumab无中重度不良反应的患者，可考虑不进行输注后1小时监测而提前出院。这种策略可以降低这些患者的输注成本，节省输注时间。

{"title":"Post-infusion observation of patients with multiple sclerosis receiving natalizumab: Is it necessary?","authors":"Melika Arab Bafrani, Negar Sadat Ahmadi, Fateme Zahra Idjadi, Sanaz Bordbar, Shima Jahani, Rayhane Montazeri, Sara Kamali Zonouzi, Mahsa Mohammadi Lapevandani, Zahra Ebadi, Samira Navardi, Hora Heidari, Amirreza Azimi, Abdorreza Naser Moghadasi, Mohammad Ali Sahraian","doi":"10.1016/j.msard.2026.106995","DOIUrl":"10.1016/j.msard.2026.106995","url":null,"abstract":"<div><h3>Background/Objective</h3><div>Natalizumab (Tysabri ®), the first monoclonal antibody approved for treatment of relapsing-remitting Multiple Sclerosis (RRMS), can significantly reduce exacerbations and active brain lesions. Due to concerns on infusion-related reactions (IRRs) patients should be observed during the infusions and one hour after the completion of the infusions for signs and symptoms of hypersensitivity reactions, especially in the first 12 doses. This study was conducted to see if one-hour post-infusion observation is necessary in all patients receiving natalizumab or can be wavied in some stable patients.</div></div><div><h3>Method</h3><div>In this cross-sectional study, one-hour post-infusion observation was not conducted in patients who had previously received three doses of natalizumab without any history of moderate to severe or life-threatening IRRs based on the Common Terminology Criteria for Adverse Events (CTCAE) definition. Patient demographics and clinical characteristics were recorded by a trained physician in a questionnaire coupled with an emergency hotline provided for IRRs. In case of a modere to sever or life-threatening reaction during the ifusion the patient excluded from the study. Phone follow-up was done after an hour by the same medical doctor.</div></div><div><h3>Result</h3><div>424 patients with MS were enrolled in this study. Fatigue (10.8%), headache (4.5%), and cough (2.8%) were the most prevalent symptoms after 1 hour from the infusions. No life-threatening complications happened for the patients. There was no significant relationship between age, gender, the interval between doses, the number of total infusions, and disease duration with the incidence of side effects.</div></div><div><h3>Conclusion</h3><div>Early discharge without one hour post-infusion monitoring can be considered for patients without any moderate to sever adverse reaction in the fisrt three infusion of natalizumab.This sterategy may reduce the costs and save the time of infusion for these patients.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106995"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders

Pub Date : 2026-03-01 Epub Date: 2026-01-31 DOI: 10.1016/j.msard.2026.107041

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

Background

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

Methods

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

Results

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

Conclusions

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

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

{"title":"Incident and prevalent peripartum mental illness in mothers with multiple sclerosis and other chronic diseases in Sweden","authors":"Ruth Ann Marrie , Colleen J Maxwell , James M. Bolton , Jonas Söderling , Charles N Bernstein , Kristen M Krysko , Kyla A McKay , Dalia Rotstein , Karma Deakin-Harb , Neda Razaz","doi":"10.1016/j.msard.2026.107041","DOIUrl":"10.1016/j.msard.2026.107041","url":null,"abstract":"<div><h3>Background</h3><div>Findings conflict regarding the risk of peripartum mental illness in women with multiple sclerosis (MS) and how this compares to the risk among women with other chronic diseases. We compared the incidence and prevalence of peripartum mental illness among women with MS, epilepsy, inflammatory bowel disease (IBD), diabetes, and women without any of these diseases (comparators).</div></div><div><h3>Methods</h3><div>Using population-based Swedish administrative health data we selected women with MS, epilepsy, IBD, diabetes, and comparators who had deliveries between 2002 and 2019. Using validated case definitions for peripartum mental illness we estimated the incidence and prevalence of mental illness during the period encompassing pregnancy and the first post-partum year. We compared incidence and prevalence between cohorts using crude estimates and unadjusted Poisson regression.</div></div><div><h3>Results</h3><div>We included 1096,814 women (1936 MS; 7709 epilepsy; 7731 IBD; 7182 diabetes; 1072,256 comparators). Mean (SD) age at conception was 30.1 (5.1) years. Compared to comparators, mothers with MS had a higher incidence of any mental illness (incidence rate ratio [IRR] 1.36; 1.04–1.78), as did mothers with epilepsy (1.78; 1.58–2.00), IBD (1.46; 1.28–1.66) and diabetes (1.61; 1.41–1.83). Mothers with MS, epilepsy, IBD and diabetes also had a higher incidence and prevalence of depression and bipolar disorder than comparators. Mothers with epilepsy had higher incidence rates of anxiety, and higher prevalence ratios of any mental illness and anxiety than mothers with MS.</div></div><div><h3>Conclusions</h3><div>Women with MS, epilepsy, IBD and diabetes have a similarly elevated incidence and prevalence of peripartum mental illness as compared to mothers without these conditions.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107041"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0