Multiple sclerosis and related disorders最新文献

{"title":"Cognitive performances in people with neuromyelitis optica spectrum disorder: a systematic review and meta-analysis","authors":"Mohammad Yazdan Panah ,&nbsp;Omid Mirmosayyeb ,&nbsp;Saeed Vaheb ,&nbsp;Nazanin Rafiei ,&nbsp;Elham Moases Ghaffary ,&nbsp;Farhad Mahmoudi ,&nbsp;Flavia Nelson ,&nbsp;Vahid Shaygannejad","doi":"10.1016/j.msard.2025.106921","DOIUrl":"10.1016/j.msard.2025.106921","url":null,"abstract":"<div><h3>Background</h3><div>Recent literature indicates that neuromyelitis optica spectrum disorder (NMOSD) patients commonly experience cognitive impairments (CI). This review aimed to compare cognitive functions between NMOSD patients and healthy controls (HCs) and synthesize the overall prevalence of CI in NMOSD patients.</div></div><div><h3>Method</h3><div>PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched systematically up to March 24, 2025, to identify relevant articles evaluating the cognitive functions of NMOSD patients. Meta-analysis was conducted using the random-effect model to determine a) the pooled prevalence of CI in NMOSD patients and b) the pooled standard mean difference (SMD) of cognitive performance between NMOSD patients and HC, with their 95 % confidence interval by R software version 4.4.0.</div></div><div><h3>Results</h3><div>Sixty-three studies, encompassing 3370 NMOSD patients and 4641 HCs, met the inclusion criteria. Meta-analysis revealed that the pooled prevalence of CI was 45.4 % (95 %CI; 39.6 to 51.2, I²=88 %) among NMOSD patients. The analysis demonstrated that NMOSD patients had significant poor performances on Montreal Cognitive Assessment (MoCA) (SMD=-1.53, 95 % CI: -2.03 to -1.04, <em>p</em> &lt; 0.001, I²=93 %), Brief Visuospatial Memory Test-Revised (BVMT-R) (SMD=-1.14, 95 % CI: -1.69 to -0.59, <em>p</em> &lt; 0.001, I²=86 %), Mini Mental State Examination (MMSE) (SMD=-1.1, 95 % CI: -1.65 to -0.55, <em>p</em> &lt; 0.001, I²=85 %), Symbol Digit Modalities Test (SDMT) (SMD=-1.03, 95 % CI: -1.37 to -0.69, <em>p</em> &lt; 0.001, I²=92 %) than HCs.</div></div><div><h3>Conclusion</h3><div>This comprehensive review indicated that NMOSD patients exhibited worse cognitive performance compared to healthy individuals. Additionally, CI is often a complication of NMOSD. These findings accentuate the imperative of integrating cognitive assessments into the comprehensive evaluation of these patients.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106921"},"PeriodicalIF":2.9,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788467","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":"Usage and limitations of neuroglial biomarkers NfL and GFAP in urine as non-invasive disease markers in multiple sclerosis","authors":"Konstantin Kohlhase ,&nbsp;Helai Nassir ,&nbsp;Christian Grefkes ,&nbsp;Yavor Yalachkov ,&nbsp;Ferdinand O. Bohmann ,&nbsp;Michelle Maiworm ,&nbsp;Kai Siebenbrodt ,&nbsp;Antonia Heuser ,&nbsp;Jens Göpfert ,&nbsp;Sebastian Luger ,&nbsp;Christian Foerch","doi":"10.1016/j.msard.2025.106899","DOIUrl":"10.1016/j.msard.2025.106899","url":null,"abstract":"<div><h3>Background</h3><div>NfL and GFAP in blood are emerging as important biomarkers in MS. A urine-based assay could provide a simpler, non-invasive alternative; however, limited biomarker transfer into urine may pose a major challenge. This study aimed to evaluate the detectability and diagnostic potential of urinary and serum NfL and GFAP for distinguishing MS patients from healthy controls.</div></div><div><h3>Methods</h3><div>Urine and serum samples from patients with relapsing–remitting MS (RRMS; <em>n</em> = 62) and progressive MS (PMS; <em>n</em> = 17) were analyzed alongside healthy controls (<em>n</em> = 21). NfL and GFAP concentrations were quantified using bead-based immunoassays (Simoa). Pre-analytical validation included inter-/intra-assay precision, reproducibility, and parallelism. Creatinine ratios (CRs) were calculated to adjust for urine dilution.</div></div><div><h3>Results</h3><div>Urinary NfL and GFAP concentrations were detectable but overall low and fell below the assays’ validated detection range in most samples. Analyses restricted to valid measurements, as well as sensitivity analyses including all samples, revealed no significant group differences in urinary NfL, GFAP, or their CRs. Subgroup analyses of RRMS patients with or without relapse or MRI contrast enhancement showed similar results. A weak association between serum and urinary NfL was found in univariate regression but not for GFAP. In multivariate models, urinary creatinine concentration, reflecting urine dilution, was the strongest mediator of the measured urinary biomarker levels.</div></div><div><h3>Conclusion</h3><div>NfL and GFAP can be detected in urine using ultra-sensitive immunoassays; however, concentrations are very low and strongly influenced by urine dilution. Consequently, urinary NfL and GFAP currently lack reliability for distinguishing MS patients from healthy controls or for monitoring disease activity.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106899"},"PeriodicalIF":2.9,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735656","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":"Is there a role of MOG antibodies in idiopathic intracranial hypertension: A comparative analysis with optic neuritis-MOG antibody associated disease","authors":"Guldeniz Cetin Erci ,&nbsp;Tugba Gencaga Atakan ,&nbsp;Mesut Yigit ,&nbsp;Ozlem Gulacti ,&nbsp;Sibel Balci ,&nbsp;Hasan Can Gudek ,&nbsp;Damla Cetinkaya Tezer ,&nbsp;Ipek Gungor Dogan ,&nbsp;Serkan Demir","doi":"10.1016/j.msard.2025.106910","DOIUrl":"10.1016/j.msard.2025.106910","url":null,"abstract":"<div><h3>Objective</h3><div>Idiopathic intracranial hypertension (IIH) is defined by elevated intracranial pressure without identifiable structural, infectious, or neoplastic cause. While the underlying pathophysiology remains unclear, emerging evidence suggests a potential role for autoimmune mechanisms, including antibodies against myelin oligodendrocyte glycoprotein (MOG). This retrospective study aimed to investigate the presence and clinical relevance of MOG-IgG antibodies in patients with IIH.</div></div><div><h3>Methods</h3><div>We included 58 consecutive patients diagnosed according to the current clinical criteria and divided them into three groups: MOG antibody-associated optic neuritis (MOG-ON, <em>n</em> = 19), MOG-positive IIH (MOG+ IIH, <em>n</em> = 10), and MOG-negative IIH (MOG-IIH, <em>n</em> = 29). MOG-IgG levels were measured using a live-cell-based assay. Clinical characteristics, cerebrospinal fluid (CSF) findings, visual assessments, cranial magnetic resonance imaging (MRI) results, and treatment responses were compared.</div></div><div><h3>Results</h3><div>MOG antibodies were detected in 25.6 % of the patients with IIH. MOG+ IIH patients were exclusively female and had higher rates of diplopia and acute symptom onset than MOG− IIH patients. MOG-ON patients had significantly lower CSF opening pressure. Visual acuity, OCT, and VEP abnormalities were more severe in the MOG-ON group, whereas there were no significant differences between MOG+ IIH and MOG− IIH. Some MRI findings related to IIH (e.g., transverse sinus stenosis) were more common in MOG− IIH.</div></div><div><h3>Conclusion</h3><div>MOG-IgG antibodies may be detected in a subset of IIH patients who exhibit distinct clinical features, suggesting a potential inflammatory or autoimmune etiology. Although a direct causal relationship could not be established, these findings support the need for further investigation into the immunological spectrum of IIH.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106910"},"PeriodicalIF":2.9,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788470","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":"Influence of FCGR2A (rs1801274) and FCGR3A (rs396991) polymorphisms on natalizumab response on multiple sclerosis","authors":"Rafaella de C Cardoso ,&nbsp;Matheus D de Matos ,&nbsp;Larissa A Duarte ,&nbsp;Bárbara D Guimenes ,&nbsp;Giovanni K Pavani ,&nbsp;Elisa Gouvea Gutman ,&nbsp;Helena França Alcaraz Ferreira ,&nbsp;Valéria Coelho Santa Rita Pereira ,&nbsp;Vinícius B Domingues ,&nbsp;João G D Farinhas ,&nbsp;Kamilla A Fernandez ,&nbsp;Felipe R Schmidt ,&nbsp;Guilherme C Montes ,&nbsp;Soniza V Alves-Leon ,&nbsp;Fabrícia L Fontes-Dantas","doi":"10.1016/j.msard.2025.106912","DOIUrl":"10.1016/j.msard.2025.106912","url":null,"abstract":"<div><h3>Background</h3><div>Genetic variants in Fc gamma receptors (FcγRs) have been implicated in the therapeutic failure of monoclonal antibodies. Natalizumab (NTZ), a monoclonal antibody widely used in the treatment of multiple sclerosis (MS), prevents immune cell migration into the central nervous system, thereby reducing inflammation and demyelination. Despite its high efficacy, a subset of patients does not respond to NTZ, with single nucleotide polymorphisms (SNPs) in FcγRs emerging as potential pharmacogenetic biomarkers.</div></div><div><h3>Methods</h3><div>In this study, we evaluated patients with relapsing-remitting MS diagnosed according to the McDonald criteria and treated with NTZ. Genotyping of <em>FCGR2A</em> (rs1801274) and <em>FCGR3A</em> (rs396991) was performed using TaqMan-PCR allelic discrimination. Cytokine levels were quantified using x-MAP technology.</div></div><div><h3>Results</h3><div>Of the 116 patients analyzed, 13 were classified as non-responders. Logistic regression adjusted for sex and age revealed that the <em>FCGR2A</em> AG genotype was significantly associated with a reduced risk of therapeutic failure (OR = 0.044; <em>p</em> = 0.014), while for <em>FCGR3A</em>, the AC genotype was also associated with a protective effect (OR = 0.077; <em>p</em> = 0.025). No significant effects of age or sex were observed in either model. Receiver Operating Characteristic (ROC) analysis showed that the <em>FCGR2A</em> rs1801274 GG genotype had weak predictive value for therapeutic failure, whereas <em>FCGR3A</em> rs396991 AA had modest discriminatory power. Additionally, these genotypes were associated with reduced levels of specific pro-inflammatory cytokines.</div></div><div><h3>Conclusion</h3><div>The <em>FCGR2A</em> AG and <em>FCGR3A</em> AC genotypes were associated with a lower risk of NTZ treatment failure, suggesting that FcγR polymorphisms may serve as biomarkers for therapeutic response in MS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106912"},"PeriodicalIF":2.9,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735659","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":"Employment status in people with multiple sclerosis: Profile, dynamic changes and determinants over time","authors":"Carolyn A Young ,&nbsp;David Rog ,&nbsp;Radu Tanasescu ,&nbsp;Basil Sharrack ,&nbsp;Seema Kalra ,&nbsp;Roger Mills ,&nbsp;Alan Tennant ,&nbsp;TONiC study group","doi":"10.1016/j.msard.2025.106911","DOIUrl":"10.1016/j.msard.2025.106911","url":null,"abstract":"<div><h3>Aim</h3><div>In a large UK multiple sclerosis (MS) cohort, we examined work status and how it changed over follow-up, identifying demographic, clinical and other factors associated with these transitions.</div></div><div><h3>Methods</h3><div>Participants of the Trajectories of Outcome in Neurological Conditions-MS study completed questionnaires on demographics, work instability, disability, fatigue, mood and quality of life at baseline and follow-up to explore work disability (stopping), discontinuity (retiring early) and drift (downgrading). Regression and Classification and Regression Tree (CART) analysis examined predictive factors.</div></div><div><h3>Results</h3><div>Among 1035 subjects aged 20–60 years in paid work at baseline with mean follow-up 22.7 months, net annual increases were 4.0 % for work disability, 3.1 % for discontinuity and 1.8 % for drift. Risk of work disability was increased by age, work instability and for part-time work, female sex. The risk of drift was 3.9 times higher for females; work instability increased drift for all subjects. Reverse work disability and drift were also observed, <em>i.e.</em> returning to employment or upgrading work. Discontinuity was influenced by secondary progressive subtype, impaired cognition, more comorbidities, and reduced by disease modifying therapy use. CART analysis showed that risk of job loss could be predicted using age, EDSS and sickness absence information, and of medical retirement using the above three factors and MS subtype.</div></div><div><h3>Conclusions</h3><div>Screening for people with MS at greater risk of losing employment could be readily done in clinical practice, facilitating further discussion with the multidisciplinary team and referral to support services as appropriate.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106911"},"PeriodicalIF":2.9,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788472","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":"Investigating the causality and pathogenesis of multiple sclerosis in breast cancer via bioinformatics analysis","authors":"Yanfeng Wang ,&nbsp;Haitao Ji ,&nbsp;Huxia Wang ,&nbsp;Zhangjun Song","doi":"10.1016/j.msard.2025.106898","DOIUrl":"10.1016/j.msard.2025.106898","url":null,"abstract":"<div><h3>Background</h3><div>Breast cancer (BC) is one of the most prevalent cancers among women in the worldwide. Multiple sclerosis (MS) plays an important role not only in pathogenesis but also in the antitumour response. Therefore, we investigated the causal relationship and pathogenesis between BC and MS via integrated Mendelian randomization (MR) and bioinformatics analysis.</div></div><div><h3>Methods</h3><div>We performed MR analyses to investigate the potential causal relationship between BC and MS via the IEU database. A comprehensive strategy among least absolute shrinkage and selection operator regression, support vector machine, univariate and multivariate Cox regression analysis, time ROC regression, and survival analysis was adopted to construct and validate the prognostic model. Immune cell infiltration and chemotherapy sensitivity were used to evaluate the prognostic model.</div></div><div><h3>Results</h3><div>MR analysis revealed that MS was causally associated with the incidence risk of BC. Patients in the high-risk group were related to worse survival, immune infiltration, and increased sensitivity to paclitaxel, methotrexate, doxorubicin, gemcitabine, and sunitinib. Furthermore, KLRC1 was expressed at low levels in BC tissues and correlated with poor prognosis and immune cell infiltration.</div></div><div><h3>Conclusions</h3><div>Our findings suggest a potential causal association between MS and BC. KLRC1 is a robust and promising biomarker for predicting the prognosis of patients with MS and BC.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106898"},"PeriodicalIF":2.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788474","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":"Nutritional status and taste impairment in adult patients with multiple sclerosis and dysphagia. A pilot study","authors":"N.V. Franchina-Vergel ,&nbsp;J. Molina-López ,&nbsp;E. Planells","doi":"10.1016/j.msard.2025.106909","DOIUrl":"10.1016/j.msard.2025.106909","url":null,"abstract":"<div><h3>Introduction</h3><div>Multiple sclerosis (MS) is a chronic, inflammatory, autoimmune, and demyelinating disease of the central nervous system. Disease progression increases dysphagia, raising risks of malnutrition, dehydration, and respiratory complications, directly impacting nutrition management.</div></div><div><h3>Objectives</h3><div>(I) To analyse the anthropometric profiles and body composition of adults with MS; (II) to determine the prevalence of dysphagia according to disease duration; (III) to examine dietary intake and eating habits; (IV) to identify potential alterations in taste perception.</div></div><div><h3>Methodology</h3><div>A descriptive-analytical study included 14 MS patients (7 women, 7 men; median age 46.9 ± 13.5 years) from Granada. Anthropometry and body composition were assessed using bioelectrical impedance analysis (TANITA). Dysphagia risk was evaluated using the Yale Swallow protocol, TWST, and TOMASS protocols, and basic taste perception was examined. Dietary intake was recorded over 3-day (24-hour recall) and food frequency questionnaire (FFQ); data were processed with Dietowin® software.</div></div><div><h3>Results</h3><div>A total of 66.7 % presented with overweight or obesity (median BMI 28.1 kg/m²). The prevalence of mixed dysphagia was 71.4 %, with no significant differences according to disease duration, except for mixed dysphagia (<em>p</em> = 0.018). Over 70 % of patients had insufficient intake of energy, fibre, and micronutrients (calcium, iron, potassium, magnesium). Taste alterations were observed in 57.1 % of patients, particularly in the perception of sweetness (78.6 %).</div></div><div><h3>Conclusions</h3><div>Patients with MS and dysphagia exhibit a high prevalence of overweight, inadequate dietary intake, and taste alterations. These findings highlight the need for comprehensive, multidisciplinary interventions involving speech therapy and nutritional support, to optimise nutritional status and quality of life.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106909"},"PeriodicalIF":2.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145763393","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":"Towards practical management of the Marburg variant of multiple sclerosis","authors":"Mašan Sredanović ,&nbsp;Branka Bunoza ,&nbsp;Ivan Lehman ,&nbsp;Maja Jurin ,&nbsp;Nataša Nenadić Baranašić ,&nbsp;Gabriela Plosnić ,&nbsp;Petra Grđan Stevanović ,&nbsp;Miroslav Weiss ,&nbsp;Ivan Jovanović ,&nbsp;Ivana Brnadić ,&nbsp;Katarina Tešija ,&nbsp;Ernest Bilić ,&nbsp;Daniel Turudić ,&nbsp;Magdalena Krbot Skorić ,&nbsp;Mario Habek","doi":"10.1016/j.msard.2025.106908","DOIUrl":"10.1016/j.msard.2025.106908","url":null,"abstract":"<div><h3>Objectives</h3><div>The Marburg variant of multiple sclerosis (MvMS) is a rare, rapidly progressive demyelinating disorder characterized by an acute, monophasic onset with early, severe disability or death within weeks to months. In this systematic review, we aimed to: (I) describe patient characteristics and therapies used; (II) categorize outcomes; and (III) synthesize therapy–outcome relationships to guide practical management.</div></div><div><h3>Methods</h3><div>We performed a PRISMA-guided systematic review of published MvMS cases reporting treatment and outcomes, and present an illustrative pediatric case from our center.</div></div><div><h3>Results</h3><div>Across databases, 144 records were identified (PubMed 34; Scopus 74; WoS 36), out of which 22 articles met inclusion criteria. Among the 23 patients synthesized (22 published cases plus our pediatric case), median age was 32 years (range 14–63), with a female predominance (78 %). Nearly all patients received high-dose corticosteroids (22/23; 96 %). Additional therapies were common and variably combined: plasma exchange (14/23; 61 %), IVIg (8/23; 35 %), cyclophosphamide (10/23; 43 %), mitoxantrone (7/23; 30 %), any cytotoxic (cyclophosphamide and/or mitoxantrone) (15/23; 65 %), B-cell–depleting therapy (rituximab/ocrelizumab) (4/23; 17 %), alemtuzumab (1/23; 4 %), and natalizumab (1/23; 4 %); doses were inconsistently reported across studies, and order/timing of therapies varied widely. Overall outcomes were death in 6/23 (26 %), stable deficit in 4/23 (17 %), improvement in 9/23 (39 %), and near-complete recovery in 4/23 (17 %). We also propose a set of pragmatic, evidence-based diagnostic criteria. These criteria classify cases as Definite, Probable, or Possible Marburg variant MS based on fulminant clinical course, characteristic MRI patterns, CSF/serologic exclusion of mimics, and—when available—pathological confirmation.</div></div><div><h3>Conclusion</h3><div>While no single regimen was uniformly effective, our three-group analysis suggests a stepwise strategy: steroids ± plasma exchange alone were often insufficient; adding a cytotoxic agent with dual B- and T-cell activity (cyclophosphamide or mitoxantrone) was associated with more frequent improvement; and the highest proportion of improvement occurred when dual-arm cytotoxic therapy was combined with a B-cell–directed/lymphocyte-depleting agent.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"106 ","pages":"Article 106908"},"PeriodicalIF":2.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712429","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":"Expert consensus on the clinical use of cladribine tablets for treating relapsing multiple sclerosis in the asia-pacific region","authors":"Ho Jin Kim ,&nbsp;Suzanne J. Hodgkinson ,&nbsp;Long-Sun Ro ,&nbsp;Rocksy Fransisca V Situmeang ,&nbsp;Sasitorn Siritho ,&nbsp;Kevin Tan ,&nbsp;Hoang Tien Trong Nghia ,&nbsp;Shanthi Viswanathan ,&nbsp;Lau Yuk Lun Alexander ,&nbsp;Hannah Loke ,&nbsp;Ru Jin Tay ,&nbsp;Karim Taha ,&nbsp;Maya Zeineddine ,&nbsp;Bassem Yamout","doi":"10.1016/j.msard.2025.106897","DOIUrl":"10.1016/j.msard.2025.106897","url":null,"abstract":"<div><h3>Background</h3><div>Cladribine Tablets (CladT) have emerged as a potent disease-modifying therapy (DMT) for relapsing multiple sclerosis (Pittock et al., 2019. While their efficacy and safety profiles have been well-documented in Western populations, there is a paucity of region-specific guidelines for their use in the Asia-Pacific context. This manuscript presents a consensus developed by Asia-Pacific experts, aiming to provide practical recommendations for the clinical application of CladT in this region.</div></div><div><h3>Methods</h3><div>A steering committee (SC) comprising four multiple sclerosis (<span><span>Pittock et al., 2019</span></span>one international and three from the APAC region—led an advisory board and developed 16 clinical questions regarding the practical use of CladT. To address these questions, statements were formulated based on available evidence, expert insights, and perspectives from the SC, along with input from an extended faculty of six MS experts representing in total nine APAC countries. Consensus on the recommendations was established when at least 75 % of respondents rated their agreement between 7 and 9 on a 9-point scale.</div></div><div><h3>Results</h3><div>A total of 16 clinical statements were drafted, and consensus was reached on 15 of them. The recommendations covered key aspects of CladT use, including indications for treatment initiation in both treatment-naïve and previously treated patients, strategies for managing disease activity over time, long-term safety considerations, and the role of CladT in special populations. CladT were recognized as an effective high-efficacy therapy for both highly and moderately active RMS, with robust long-term efficacy and safety profiles. It was also identified as a suitable option for patients requiring minimal hospital visits and those with limited access to healthcare facilities. While there was strong agreement on its use in treatment-naïve and early MS patients as well as a switch therapy, no consensus was reached on using CladT as a first-switch option for patients experiencing breakthrough disease on high-efficacy therapies. Recommendations also emphasized the importance of lymphocyte monitoring, appropriate patient selection, and the possibility of additional treatment courses beyond Year 5 in selected cases.</div></div><div><h3>Conclusion</h3><div>The consensus encompasses patient selection criteria, therapeutic strategies, monitoring protocols, and safety considerations, tailored to the unique demographic and healthcare landscapes of APAC countries.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"105 ","pages":"Article 106897"},"PeriodicalIF":2.9,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733464","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 brainstem signature of multiple sclerosis: predictable lesions, consistent syndromes","authors":"Mohammad Wafa ,&nbsp;Khalid Nuh ,&nbsp;Gavin Giovannoni ,&nbsp;Klaus Schmierer ,&nbsp;Sharmilee Gnanapavan ,&nbsp;Ruth Dobson ,&nbsp;Monical Marta ,&nbsp;Maria Papachatzaki ,&nbsp;Benjamin Turner ,&nbsp;Thomas Campion ,&nbsp;Ashok Adams ,&nbsp;Anant Krishnan ,&nbsp;Alexandros Chatzistefanou ,&nbsp;Bader Mohamed ,&nbsp;Ahmed Hashish","doi":"10.1016/j.msard.2025.106894","DOIUrl":"10.1016/j.msard.2025.106894","url":null,"abstract":"<div><h3>Background</h3><div>Integrating clinical findings with neuroradiological changes is a crucial skill in neurology, particularly for diagnosis. Multiple Sclerosis (MS) lesions in the brainstem are rarely asymptomatic, leading to unique and often localised clinical syndromes. MS lesions exhibit a characteristic perivenular distribution, which in the brainstem is imprinted by the consistent topography of the penetrating veins.</div></div><div><h3>Objective</h3><div>This review provides an integrative perspective on the anatomical patterns of MS lesions in the brainstem (midbrain, pons, and medulla). It correlates specific clinical syndromes with radiological appearances, aiding in both diagnosis and functional localisation.</div></div><div><h3>Methods</h3><div>We searched the available literature using keywords related to the three brainstem sections (midbrain, pons, medulla) and eloquent anatomical locations (<em>medial longitudinal fasciculus, cerebellar peduncle, nerve fascicle, aqueduct, area postrema</em>), aiming to correlate specific radiological patterns of MS lesions with their consistent clinical syndromes as reported in the literature.</div></div><div><h3>Summary of Key Findings</h3><div>Brainstem MS lesions often cause irritative symptoms rather than full functional loss. Unlike other conditions, visible MS lesions on MRI rarely disappear and usually remain as silent lesions following an acute event. The consistent venous architecture creates specific radiological patterns that link to distinct clinical presentations. In contrast, inflammatory disorders like NMOSD and MOGAD cause more aggressive and extensive dysfunction.</div></div><div><h3>Conclusion</h3><div>The visual details of MS brainstem lesions reflect their close relationship to venous anatomy, which can be anticipated even when the central vein sign is not directly visualised. Recognising these specific clinical-radiological syndromes provides a unique and insightful diagnostic tool for MS, underscoring the value of strong functional and radiological-anatomical interpretation skills in clinical neurology.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106894"},"PeriodicalIF":2.9,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834171","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}