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Cannabinoids for spasticity in patients with multiple sclerosis: A systematic review and meta-analysis. 大麻素治疗多发性硬化症患者的痉挛:系统回顾和荟萃分析。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-11-05 eCollection Date: 2024-10-01 DOI: 10.1177/20552173241282379
Mohaddeseh Azadvari, Maryam Pourshams, Fatemeh Guitynavard, Seyede Zahra Emami-Razavi, Ensieh Taftian-Banadkouki, Mahsa Ghajarzade, Mohsen Rastkar

Background: One of the most disabling symptoms of patients with multiple sclerosis (MS) is spasticity which affects their quality of life. Nowadays, cannabinoids are used for spasticity control in patients with MS, while the efficacy and safety are not clearly understood. So, we designed this systematic review and meta-analysis to assess the efficacy of cannabinoids for controlling MS-related spasticity.

Methods: PubMed, Scopus, EMBASE, Web of Science, and Google Scholar were systematically searched by two independent researchers on 1 May 2023. They also searched gray literature (references of included studies, as well as conference abstracts).

Results: A literature search revealed 6552 records, 95 full-texts were evaluated, and finally, 31 studies remained for systematic review. Among included studies, six randomized trials were included. Nabiximols was the most commonly used medication for controlling MS-related spasticity. Mean Expanded Disability Status Scale ranged between 4.6 and 7. Most studies (17 studies) were done in Italy, followed by Germany (4 studies). The pooled standardized mean difference (SMD) of NRS (Numeric Rating Scale) (after-before) is estimated as -1.41 (95% confidence interval (CI): -1.65, -1.17) (I2 = 97%, p < 0.001). The pooled standardized mean difference (SMD) of Ashworth (after-before) is estimated as -0.39 (95% CI: -0.72, -0.06) (I2 = 69.9%, p = 0.005).

Conclusion: The results of this systematic review and meta-analysis showed that nabiximols was the most common cannabinoid which was used to control MS-related spasticity, and it was effective in controlling MS-related spasticity (significantly decreased SMD of NRS, and Ashworth after treatment).

背景:多发性硬化症(MS)患者最严重的致残症状之一是痉挛,这影响了他们的生活质量。如今,大麻素被用于控制多发性硬化症患者的痉挛,但其疗效和安全性尚不明确。因此,我们设计了这一系统综述和荟萃分析,以评估大麻素控制多发性硬化症相关痉挛的疗效:方法:两名独立研究人员于 2023 年 5 月 1 日对 PubMed、Scopus、EMBASE、Web of Science 和 Google Scholar 进行了系统检索。他们还检索了灰色文献(纳入研究的参考文献以及会议摘要):文献检索共发现 6552 条记录,对 95 篇全文进行了评估,最后剩下 31 篇研究进行了系统审查。在纳入的研究中,有 6 项随机试验。纳比昔莫司是控制多发性硬化症相关痉挛最常用的药物。平均残疾状况扩展量表介于 4.6 和 7 之间。大多数研究(17 项)是在意大利进行的,其次是德国(4 项)。NRS(数值评定量表)(治疗后-治疗前)的合并标准化平均差(SMD)估计为-1.41(95% 置信区间(CI):-1.65, -1.17 )(I2 = 97%,P 2 = 69.9%,P = 0.005):本次系统综述和荟萃分析的结果表明,大麻酚是用于控制多发性硬化症相关痉挛的最常见大麻类药物,而且对控制多发性硬化症相关痉挛有效(治疗后 NRS 和 Ashworth 的 SMD 显著降低)。
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引用次数: 0
Treatment effect modifiers of immunotherapies for relapsing-remitting multiple sclerosis-A systematic review and meta-analysis. 复发缓解型多发性硬化症免疫疗法的治疗效果调节剂--系统综述和荟萃分析。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-24 eCollection Date: 2024-10-01 DOI: 10.1177/20552173241274618
Christoph Heesen, Christian Röver, Susanna Salem, Judith Heinz, Declan Chard, Jordi Rio, Andrea V Fittipaldo, Thomas Lehnert, Sascha Köpke, Alessandra Solari, Maria Pia Sormani, Tim Friede, Anne C Rahn

Background: This meta-analysis aimed to assess the treatment effects of immunotherapies in subgroups of adults with clinically isolated syndrome or relapsing forms of multiple sclerosis (MS) and the effect of potential treatment effect modifiers (TEMs).

Methods: Phase 2 and 3 RCTs with a placebo comparator were analyzed. Risk of bias was assessed. Random-effects meta-analyses were conducted to summarize treatment effects within subgroups and differences in treatment effects between subgroups.

Results: Thirty-one studies were included. Age < 40 years was the strongest TEM for relapse rate across DMTs with a ratio of rate ratios (RRR) of 1.44 (95% CI 1.09-1.90; 7 studies). Disability progression was influenced by age (ratio of hazard ratios, RHR 1.59, 95% CI 1.11-2.29; 4 studies). Dichotomizing patients based on EDSS cut-offs (EDSS 2.0 and 3.0) also showed a significantly higher benefit for those less disabled for relapse rate (RRR 1.35, CI 1.03-1.76; 8 studies). Sex, baseline MRI parameters, previous immunotherapy, and clinical presentation showed no effect in this meta-analysis.

Conclusion: Age < 40 is a robust TEM for a lower relapse rate as well as less disability progression across six MS immunotherapies. Additionally, a lower baseline EDSS was predictive of the relapse rate.

背景:这项荟萃分析旨在评估免疫疗法对临床孤立综合征或复发性多发性硬化症(MS)成人亚组的治疗效果以及潜在治疗效果调节剂(TEM)的影响:方法:分析了带有安慰剂参照物的2期和3期RCT。对偏倚风险进行了评估。进行随机效应荟萃分析,总结亚组间的治疗效果以及亚组间治疗效果的差异:结果:共纳入 31 项研究。年龄 结论年龄
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引用次数: 0
Cesarian sections in women with multiple sclerosis: A Canadian prospective pregnancy study. 多发性硬化症妇女的剖腹产:加拿大前瞻性妊娠研究。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-08 eCollection Date: 2024-10-01 DOI: 10.1177/20552173241285546
Dessa Sadovnick, Maria Criscuoli, Irene Yee, Robert Carruthers, Virginia Devonshire, Penelope Smyth, Kristen M Krysko

Background: An increasing number of women with multiple sclerosis (wMS) are considering pregnancy. Prior studies suggest increased rate of elective cesarian sections (C-sections) in wMS.

Methods: The Canadian Multiple Sclerosis Pregnancy Study (CANPREG-MS) is a prospective study on pregnant wMS. This report shows comparisons between (i) CANPREG-MS wMS delivered by C-section and the general population and (ii) C-section and vaginal deliveries in this study cohort.

Results: CANPREG-MS has resulted in 170 deliveries with 63 by C-section. The proportion with C-sections in CANPREG-MS (37.1%) was significantly higher than that for the Canadian population (28%) (p = .0085). The majority (66.7%) of C-sections were not planned, and typically were performed for obstetrical indications. C-sections were performed at an earlier gestational age than vaginal deliveries, although birthweight did not differ by mode of delivery in wMS. MS relapses (3.2%) and pseudo-relapses (3.2%) were rare in the first month after C-section deliveries, regardless of disease modifying therapy decisions during gestation and postpartum.

Conclusions: C-sections were more common in wMS than the general population, but few were because of maternal MS. CANPREG-MS provides informative data for pregnancies in wMS with well-managed and relatively mild disease. This information is helpful to obstetrical and MS healthcare providers.

背景:越来越多的多发性硬化症(multiple sclerosis,wMS)女性患者考虑怀孕。先前的研究表明,女性多发性硬化症患者选择剖腹产(C-sections)的比例增加:加拿大多发性硬化症妊娠研究(CANPREG-MS)是一项针对妊娠妇女的前瞻性研究。本报告显示了(i) CANPREG-MS 中剖腹产孕妇与普通人群之间的比较,以及(ii) 该研究队列中剖腹产与阴道分娩之间的比较:结果:CANPREG-MS 共导致 170 例分娩,其中 63 例为剖腹产。在 CANPREG-MS 中,剖腹产的比例(37.1%)明显高于加拿大人口(28%)(p = .0085)。大多数(66.7%)剖腹产并非计划内的,通常是出于产科指征。与阴道分娩相比,剖腹产的胎龄更早,但出生体重并没有因分娩方式的不同而有所差异。多发性硬化症复发(3.2%)和假性复发(3.2%)在剖腹产后的第一个月很少见,与妊娠期和产后的疾病调整治疗决定无关:结论:与普通人群相比,产妇多发性硬化症患者的剖腹产率更高,但很少有产妇是因为多发性硬化症而剖腹产。CANPREG-MS为病情控制良好且相对较轻的多发性硬化症患者的妊娠提供了信息数据。这些信息对产科和多发性硬化症医疗服务提供者很有帮助。
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引用次数: 0
Exploring the relationship between neurologists and older persons with multiple sclerosis through the lens of social support theory. 从社会支持理论的角度探讨神经科医生与多发性硬化症老年人之间的关系。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-03 eCollection Date: 2024-10-01 DOI: 10.1177/20552173241281458
Mina Stanikić, Felix Gille, Jonas Schlomberg, Paola Daniore, Susanne Kägi, Andrew Chan, Christian P Kamm, Chiara Zecca, Pasquale Calabrese, Patrick Roth, Claudia Baum, Irene Rapold, Milo A Puhan, Viktor von Wyl

Background: Although healthcare practitioners (HCPs) are a valuable source of social support, research on support provided by neurologists to older persons with multiple sclerosis (pwMS) remains limited.

Objectives: To explore expectations of pwMS aged 55 years or older regarding MS care and to identify support types, met and unmet needs within their relationship with neurologists.

Methods: Utilizing a mixed-methods approach, we analyzed survey data from Swiss Multiple Sclerosis Registry participants. Quantitative data included Likert scales gauging the importance of various aspects of MS care for pwMS both in and out of neurological care. Qualitative data were derived from three open-ended questions, focusing on neurologist-provided support for pwMS in neurological care. Data underwent descriptive and deductive thematic analysis, using Cutrona and Suhr framework for coding social support.

Results: Among the 286 participants (median age 61.0 years, interquartile range (IQR) 57.0-66.0; median disease duration 23.5 years, IQR 15.0-31.0), 84.6% (N = 244) were under neurological care. Quantitative findings highlighted the significance of HCP expertise and consultation time. Qualitative analysis identified all social support domains in the neurologist-pwMS relationship, with informational support being most prevalent, followed by emotional support. Neurologists' expertise, availability, comprehensive advising, listening, and validation emerged as key themes. Unmet needs were relatively infrequent and concerned insufficient information on complementary medicine, empathy, and understanding of symptoms like fatigue.

Conclusions: Older pwMS see neurologists as adequate providers of comprehensive support and particularly value neurologists' sufficient availability, informational and emotional support. Areas for improvement include attention to complementary medicine and empathy.

背景:尽管医疗保健从业人员(HCPs)是社会支持的重要来源,但有关神经科医生为老年多发性硬化症患者(pwMS)提供支持的研究仍然有限:目的:探讨 55 岁或以上的多发性硬化症老年患者对多发性硬化症护理的期望,并确定支持类型、他们与神经科医生关系中已满足和未满足的需求:我们采用混合方法分析了瑞士多发性硬化症登记参与者的调查数据。定量数据包括李克特量表,用于衡量神经科护理内外的多发性硬化症患者对多发性硬化症护理各方面的重要性。定性数据来自三个开放式问题,重点是神经科医生在神经科护理中为患者提供的支持。采用 Cutrona 和 Suhr 的社会支持编码框架,对数据进行了描述性和演绎性主题分析:在 286 名参与者(中位年龄 61.0 岁,四分位数间距 (IQR) 57.0-66.0;中位病程 23.5 年,IQR 15.0-31.0)中,84.6%(N = 244)接受了神经科治疗。定量分析结果强调了保健医生专业知识和会诊时间的重要性。定性分析确定了神经科医生与患儿关系中的所有社会支持领域,其中信息支持最为普遍,其次是情感支持。神经科医生的专业知识、可用性、综合建议、倾听和验证成为关键主题。未满足的需求相对较少,主要涉及补充医学信息不足、换位思考以及对疲劳等症状的理解:结论:老年患者认为神经科医生能够提供足够的全面支持,尤其看重神经科医生的充分可用性、信息和情感支持。需要改进的方面包括对辅助药物和同理心的关注。
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引用次数: 0
Illness representation in patients with multiple sclerosis: A preliminary narrative medicine study. 多发性硬化症患者的疾病表征:叙事医学初步研究
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-24 eCollection Date: 2024-07-01 DOI: 10.1177/20552173241271755
T Paolucci, M Reho, C Ciacchella, G Veneziani, I Santoro, G Fiorentino, F Galli, C Lai

Background: The development of personalized interventions aimed at coping with multiple sclerosis is enriched by the understanding of patients' representations of the illness.

Objective: The aim of this study was to investigate the association between patients' illness representations versus contextual factors (i.e. presence/absence and type of caregiver, engagement, frequency and type of rehabilitation), fatigue, pain, and neurological impairment.

Methods: Interviews of 28 patients were analysed through an automated text analysis procedure. After a systematic labelling procedure four illness representations were identified: daily life, search for meaning of the disease, relationship to people and the diagnosis, coping and physical growth.

Results: Findings showed that the representation of the relational aspects of the illness was associated with the caregiver's presence, while the representation related to coping and growth tended to be associated with participation in rehabilitation programs. Moreover, the representation related to daily life was associated with lower levels of fatigue compared to the representation related to coping and growth, and with higher levels of neurological impairment compared to the representations related to coping and growth and the relational aspects of the illness.

Conclusion: Exploring illness representations is a key step that can help health professionals to get an integrated perspective that could be useful in designing and calibrating interventions according to specific patient needs.

背景:通过了解患者对疾病的表述,可以丰富旨在应对多发性硬化症的个性化干预措施的开发:本研究旨在调查患者的疾病表征与环境因素(即护理者的存在/不存在及类型、参与情况、康复频率及类型)、疲劳、疼痛和神经功能损伤之间的关联:通过自动文本分析程序对 28 名患者的访谈进行分析。经过系统标签程序,确定了四种疾病表征:日常生活、寻找疾病的意义、与人和诊断的关系、应对和身体成长:研究结果表明,疾病关系方面的表征与照顾者的存在有关,而与应对和成长有关的表征往往与参与康复计划有关。此外,与应对和成长相关的表征相比,与日常生活相关的表征与较低程度的疲劳相关,与应对和成长相关的表征以及与疾病关系相关的表征相比,与较高程度的神经损伤相关:探索疾病表征是一个关键步骤,可以帮助医疗专业人员获得综合视角,有助于根据患者的具体需求设计和调整干预措施。
{"title":"Illness representation in patients with multiple sclerosis: A preliminary narrative medicine study.","authors":"T Paolucci, M Reho, C Ciacchella, G Veneziani, I Santoro, G Fiorentino, F Galli, C Lai","doi":"10.1177/20552173241271755","DOIUrl":"https://doi.org/10.1177/20552173241271755","url":null,"abstract":"<p><strong>Background: </strong>The development of personalized interventions aimed at coping with multiple sclerosis is enriched by the understanding of patients' representations of the illness.</p><p><strong>Objective: </strong>The aim of this study was to investigate the association between patients' illness representations versus contextual factors (i.e. presence/absence and type of caregiver, engagement, frequency and type of rehabilitation), fatigue, pain, and neurological impairment.</p><p><strong>Methods: </strong>Interviews of 28 patients were analysed through an automated text analysis procedure. After a systematic labelling procedure four illness representations were identified: <i>daily life, search for meaning of the disease, relationship to people and the diagnosis, coping and physical growth</i>.</p><p><strong>Results: </strong>Findings showed that the representation of the relational aspects of the illness was associated with the caregiver's presence, while the representation related to coping and growth tended to be associated with participation in rehabilitation programs. Moreover, the representation related to daily life was associated with lower levels of fatigue compared to the representation related to coping and growth, and with higher levels of neurological impairment compared to the representations related to coping and growth and the relational aspects of the illness.</p><p><strong>Conclusion: </strong>Exploring illness representations is a key step that can help health professionals to get an integrated perspective that could be useful in designing and calibrating interventions according to specific patient needs.</p>","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"10 3","pages":"20552173241271755"},"PeriodicalIF":2.5,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11425788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142350458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effectiveness of cognitive rehabilitation in comparison with routine rehabilitation methods in patients with multiple sclerosis: A systematic review and meta-analysis. 认知康复与常规康复方法对多发性硬化症患者的疗效比较:系统回顾与荟萃分析。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-12 eCollection Date: 2024-07-01 DOI: 10.1177/20552173241272561
Seyed Mansoor Rayegani, Saeed Heidari, Maryam Seyed-Nezhad, Narges Kiyani, Mohammad Moradi-Joo

Introduction: Cognitive rehabilitation includes a set of programs to train the brain, which leads to the improvement of mental and neuro-psychological functions. This meta-analysis was conducted with the aim of investigating the effectiveness of cognitive rehabilitation in comparison with routine rehabilitation methods in patients with multiple sclerosis (MS).

Methods: The Cochrane Library, ProQuest, PubMed, PsycINFO, and Web of Science databases were searched from inception to August 2022. Google Scholar was used to find relevant sources and complete the search coverage. Two authors independently selected studies based on predefined inclusion criteria. Data analysis was performed using RevMan (version 5.3).

Results: Out of the 578 studies found, 20 studies were finally included in this review. The results of the meta-analysis on four outcomes (Paced Auditory Serial Addition Test (PASAT), Brief Visuospatial Memory Test (BVMT), MS Neuropsychological Screening Questionnaire (MSNQ), and Beck Depression Inventory (BDI)) indicated that the outcome was significant in favor of the cognitive rehabilitation group. However, for five outcomes (Controlled Oral Word Association Test (COWAT), California Verbal Learning Test (CVLT), Everyday Memory Questionnaire (EMQ), Symbol Digit Modalities Test (SDMT), and Expanded Disability Status Scale (EDSS)), the differences between the two groups were not significant.

Conclusion: The results of this meta-analysis showed that cognitive rehabilitation has an effect on improving the performance of patients with MS. However, further studies with more accurate methodologies are required to determine which of the outcomes cognitive rehabilitation has a greater effect on.

引言认知康复包括一套训练大脑的方案,可改善精神和神经心理功能。本荟萃分析旨在研究认知康复与常规康复方法相比,对多发性硬化症(MS)患者的疗效:方法:检索了从开始到 2022 年 8 月的 Cochrane Library、ProQuest、PubMed、PsycINFO 和 Web of Science 数据库。使用谷歌学术(Google Scholar)查找相关资料并完成搜索范围。两位作者根据预定义的纳入标准独立筛选研究。数据分析使用 RevMan(5.3 版)进行:在找到的 578 项研究中,最终有 20 项研究被纳入本综述。对四项结果(步调听觉连续加法测验(PASAT)、简明视觉空间记忆测验(BVMT)、多发性硬化症神经心理筛查问卷(MSNQ)和贝克抑郁量表(BDI))的荟萃分析结果表明,认知康复组的结果显著。然而,对于五项结果(控制性口语单词联想测试(COWAT)、加利福尼亚言语学习测试(CVLT)、日常记忆问卷(EMQ)、符号数字模型测试(SDMT)和残疾状况扩展量表(EDSS)),两组之间的差异并不显著:这项荟萃分析的结果表明,认知康复对改善多发性硬化症患者的表现有一定作用。然而,要确定认知康复对哪种结果的影响更大,还需要采用更准确的方法进行进一步研究。
{"title":"Effectiveness of cognitive rehabilitation in comparison with routine rehabilitation methods in patients with multiple sclerosis: A systematic review and meta-analysis.","authors":"Seyed Mansoor Rayegani, Saeed Heidari, Maryam Seyed-Nezhad, Narges Kiyani, Mohammad Moradi-Joo","doi":"10.1177/20552173241272561","DOIUrl":"https://doi.org/10.1177/20552173241272561","url":null,"abstract":"<p><strong>Introduction: </strong>Cognitive rehabilitation includes a set of programs to train the brain, which leads to the improvement of mental and neuro-psychological functions. This meta-analysis was conducted with the aim of investigating the effectiveness of cognitive rehabilitation in comparison with routine rehabilitation methods in patients with multiple sclerosis (MS).</p><p><strong>Methods: </strong>The Cochrane Library, ProQuest, PubMed, PsycINFO, and Web of Science databases were searched from inception to August 2022. Google Scholar was used to find relevant sources and complete the search coverage. Two authors independently selected studies based on predefined inclusion criteria. Data analysis was performed using RevMan (version 5.3).</p><p><strong>Results: </strong>Out of the 578 studies found, 20 studies were finally included in this review. The results of the meta-analysis on four outcomes (Paced Auditory Serial Addition Test (PASAT), Brief Visuospatial Memory Test (BVMT), MS Neuropsychological Screening Questionnaire (MSNQ), and Beck Depression Inventory (BDI)) indicated that the outcome was significant in favor of the cognitive rehabilitation group. However, for five outcomes (Controlled Oral Word Association Test (COWAT), California Verbal Learning Test (CVLT), Everyday Memory Questionnaire (EMQ), Symbol Digit Modalities Test (SDMT), and Expanded Disability Status Scale (EDSS)), the differences between the two groups were not significant.</p><p><strong>Conclusion: </strong>The results of this meta-analysis showed that cognitive rehabilitation has an effect on improving the performance of patients with MS. However, further studies with more accurate methodologies are required to determine which of the outcomes cognitive rehabilitation has a greater effect on.</p>","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"10 3","pages":"20552173241272561"},"PeriodicalIF":2.5,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11406612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142291536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of race and socioeconomic deprivation on clinical outcomes and healthcare utilization in pediatric multiple sclerosis. 种族和社会经济贫困对小儿多发性硬化症临床结果和医疗保健利用率的影响。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-08-26 eCollection Date: 2024-07-01 DOI: 10.1177/20552173241274586
Kelsey E Poisson, Stacey S Cofield, Jayne M Ness

Background: Health disparities in adult-onset multiple sclerosis have been identified in the Black/African American (AA) population. A higher relapse rate has been suggested in Black/AA patients with pediatric-onset MS (POMS), but little work explores healthcare utilization and social determinants of health (SDOH).

Objective: To evaluate racial, ethnic, and socioeconomic disparities in POMS outcomes.

Methods: Retrospective chart review identified 31 eligible patients diagnosed with POMS at Children's of Alabama between 2013 and 2023. Demographics, outcomes, and healthcare utilization over 2 years from diagnosis were collected. Patient addresses were connected to SDOH measures from the US Census. Bivariate analysis was performed using Fisher's Exact Test, Wilcoxin Test, and 2-sided t-test.

Results: Black/AA children had a higher Expanded Disability Status Scale (EDSS) at first presentation (p = 0.0276) and were more likely to initiate fingolimod vs. glatiramer acetate (p = 0.0464). Living further from Children's of Alabama was associated with a higher most recent EDSS (p = 0.0301) and fewer neurology appointments (p = 0.0167). Families living in more socioeconomically deprived census tracts had significantly more hospital admissions.

Conclusion: Black/AA POMS patients had a more severe initial presentation and were started on higher efficacy medication. We identified disparities in EDSS and healthcare utilization based on SDOH data linked to a child's home address.

背景:在黑人/非裔美国人(AA)人群中,已发现成人发病型多发性硬化症存在健康差异。有研究表明,黑人/非裔美国人小儿多发性硬化症(POMS)患者的复发率较高,但很少有研究探讨医疗保健利用率和健康的社会决定因素(SDOH):评估 POMS 结果中的种族、民族和社会经济差异:回顾性病历审查确定了 2013 年至 2023 年期间在阿拉巴马州儿童医院确诊的 31 名符合条件的 POMS 患者。收集了患者的人口统计学特征、治疗效果以及诊断后两年内的医疗保健使用情况。患者地址与美国人口普查中的 SDOH 指标相关联。使用费雪精确检验、Wilcoxin 检验和双侧 t 检验进行双变量分析:结果:黑人/亚裔儿童首次就诊时的残疾状况扩展量表(EDSS)较高(p = 0.0276),且更有可能开始使用芬戈莫德(fingolimod)而非醋酸格拉替雷(glatiramer acetate)(p = 0.0464)。居住地距离阿拉巴马州儿童医院较远的家庭最近的 EDSS 值较高(p = 0.0301),神经内科就诊次数较少(p = 0.0167)。居住在社会经济条件较差的人口普查区的家庭入院次数明显较多:结论:黑人/非裔美国人POMS患者的初始症状更为严重,开始接受的药物疗效更高。根据与儿童家庭住址相关联的 SDOH 数据,我们确定了 EDSS 和医疗保健利用率方面的差异。
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引用次数: 0
Glial fibrillary acidic protein and neurofilament light chain as biomarkers in pediatric multiple sclerosis. 胶质纤维酸性蛋白和神经丝轻链作为小儿多发性硬化症的生物标记物。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-08-26 eCollection Date: 2024-07-01 DOI: 10.1177/20552173241274567
Laura Saucier, Brian C Healy, Shrishti Saxena, Eunnindy Sanon, Tanuja Chitnis

Background: Serum neurofilament light chain (sNfL) is a marker of neuroaxonal injury, and serum glial fibrillary acidic protein (sGFAP) reflects reactive astrogliosis. In adult multiple sclerosis (MS), sNfL correlates with relapsing disease activity while sGFAP correlates with progressive disease.

Objectives: We evaluate sNfL and sGFAP as biomarkers in pediatric-onset MS (POMS) compared to pediatric healthy controls (PHC), and correlations with the disease course.

Methods: In this single-center observational cross-sectional study, we extracted data from a longitudinal database and measured NfL and GFAP from bio-banked serum using single-molecule array technology.

Results: The analysis included 61 POMS patients and 45 PHC. Controlling for age and BMI, sNfL was 414% higher and sGFAP was 42.3% higher in POMS. Disability (EDSS) is associated with higher sNfL (β = 0.32, p = 0.002) and higher sGFAP (β = 0.11, p = 0.03). sNfL is associated with MRI lesion burden, recent disease activity (β =0.95, p < 0.001), and untreated status (β = 0.5, p = 0.006).

Conclusion: sNfL and sGFAP are elevated in POMS compared to PHC. Both biomarkers are associated with clinical disability. Elevated sGFAP may reflect early neurodegeneration in POMS, while sNfL reflects disease activity and DMT response. Elevated sNfL among some clinically and radiographically stable POMS patients suggests ongoing neuroaxonal injury with a potential role for sNfL monitoring disease stability.

背景:血清神经丝蛋白轻链(sNfL)是神经轴突损伤的标志物,而血清胶质纤维酸性蛋白(sGFAP)反映了反应性星形胶质细胞增多。在成人多发性硬化症(MS)中,sNfL 与复发性疾病活动相关,而 sGFAP 与进展性疾病相关:我们评估了作为生物标记物的 sNfL 和 sGFAP 在小儿多发性硬化症(POMS)中与小儿健康对照组(PHC)的比较,以及与疾病进程的相关性:在这项单中心观察性横断面研究中,我们从纵向数据库中提取了数据,并使用单分子阵列技术测量了生物库血清中的NfL和GFAP:分析包括61名POMS患者和45名PHC患者。在控制年龄和体重指数的情况下,POMS 患者的 sNfL 高出 414%,sGFAP 高出 42.3%。残疾(EDSS)与较高的sNfL(β = 0.32,p = 0.002)和较高的sGFAP(β = 0.11,p = 0.03)相关。sNfL与MRI病变负荷、近期疾病活动(β = 0.95,p < 0.001)和未治疗状态(β = 0.5,p = 0.006)相关。这两种生物标志物都与临床残疾有关。sGFAP的升高可能反映了POMS的早期神经变性,而sNfL则反映了疾病的活动性和DMT反应。在一些临床和影像学表现稳定的POMS患者中,sNfL的升高表明神经轴突损伤仍在持续,sNfL在监测疾病稳定性方面具有潜在的作用。
{"title":"Glial fibrillary acidic protein and neurofilament light chain as biomarkers in pediatric multiple sclerosis.","authors":"Laura Saucier, Brian C Healy, Shrishti Saxena, Eunnindy Sanon, Tanuja Chitnis","doi":"10.1177/20552173241274567","DOIUrl":"10.1177/20552173241274567","url":null,"abstract":"<p><strong>Background: </strong>Serum neurofilament light chain (sNfL) is a marker of neuroaxonal injury, and serum glial fibrillary acidic protein (sGFAP) reflects reactive astrogliosis. In adult multiple sclerosis (MS), sNfL correlates with relapsing disease activity while sGFAP correlates with progressive disease.</p><p><strong>Objectives: </strong>We evaluate sNfL and sGFAP as biomarkers in pediatric-onset MS (POMS) compared to pediatric healthy controls (PHC), and correlations with the disease course.</p><p><strong>Methods: </strong>In this single-center observational cross-sectional study, we extracted data from a longitudinal database and measured NfL and GFAP from bio-banked serum using single-molecule array technology.</p><p><strong>Results: </strong>The analysis included 61 POMS patients and 45 PHC. Controlling for age and BMI, sNfL was 414% higher and sGFAP was 42.3% higher in POMS. Disability (EDSS) is associated with higher sNfL (<i>β</i> = 0.32, <i>p</i> = 0.002) and higher sGFAP (<i>β</i> = 0.11, <i>p</i> = 0.03). sNfL is associated with MRI lesion burden, recent disease activity (<i>β</i> =0.95, <i>p</i> < 0.001), and untreated status (<i>β</i> = 0.5, <i>p</i> = 0.006).</p><p><strong>Conclusion: </strong>sNfL and sGFAP are elevated in POMS compared to PHC. Both biomarkers are associated with clinical disability. Elevated sGFAP may reflect early neurodegeneration in POMS, while sNfL reflects disease activity and DMT response. Elevated sNfL among some clinically and radiographically stable POMS patients suggests ongoing neuroaxonal injury with a potential role for sNfL monitoring disease stability.</p>","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"10 3","pages":"20552173241274567"},"PeriodicalIF":2.5,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Quality of life is impaired in myelin oligodendrocyte glycoprotein antibody associated disease. 髓鞘少突胶质细胞糖蛋白抗体相关疾病患者的生活质量受到影响。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-08-23 eCollection Date: 2024-07-01 DOI: 10.1177/20552173241274605
Yana Said, Dimitrios C Ladakis, Julia M Lefelar, Jenny M Khazen, Jennifer Gould, Kathryn C Fitzgerald, Elias S Sotirchos

Background: There is a paucity of studies examining quality of life (QoL) in people with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).

Methods: A cross-sectional, online, self-administered survey was distributed. Data elements included demographic and clinical characteristics, and QoL in Neurological Disorders (Neuro-QoL) short form questionnaires. Neuro-QoL domain scores were compared to reference populations, yielding standardized T-scores. Symptom severity was categorized as mild, moderate, or severe, using standard Neuro-QoL cut points.

Results: A total of 259 participants completed the survey. Neuro-QoL domain impairment was present in a significant proportion of respondents (anxiety: 58.1%, depression: 30.7%, stigma 29.8%, cognition: 58.5%, social function: 57.7%). T-scores were significantly worse than the reference population for anxiety (p<0.001), stigma (p=0.005), cognitive function (p<0.001) and social interactions (p<0.001). There was no clear association between QoL domains and demographics, disease-modifying therapy class, or type of clinical presentation. A relapsing vs monophasic disease course was associated with worse anxiety, stigma, cognition, and social interactions (p<0.05).

Conclusion: People with MOGAD may exhibit impairment in multiple domains of QoL. Practicing clinicians should be aware of this burden in MOGAD. Further research is needed to better understand factors associated with QoL impairment in MOGAD.

背景:关于髓鞘少突胶质细胞糖蛋白抗体相关疾病(MOGAD)患者生活质量(QoL)的研究很少:有关髓鞘少突胶质细胞糖蛋白抗体相关疾病(MOGAD)患者生活质量(QoL)的研究很少:发放了一份横断面在线自填调查问卷。数据元素包括人口统计学特征、临床特征和神经系统疾病 QoL(Neuro-QoL)简表问卷。将神经-QoL 领域得分与参考人群进行比较,得出标准化的 T 值。症状严重程度采用标准的神经-QoL切点分为轻度、中度和重度:共有 259 人完成了调查。结果:共有 259 名受访者完成了调查。相当一部分受访者存在神经-QoL 领域障碍(焦虑:58.1%;抑郁:30.7%;耻辱感:29.8%;认知:58.5%;社交功能:30.7%):58.5%,社会功能:57.7%):57.7%).在焦虑方面,T 值明显低于参照人群(p 结论:患有 MOGAD 的人可能会在多个 QoL 领域表现出损害。执业临床医生应了解 MOGAD 患者的这一负担。要更好地了解与 MOGAD 患者 QoL 受损相关的因素,还需要进一步的研究。
{"title":"Quality of life is impaired in myelin oligodendrocyte glycoprotein antibody associated disease.","authors":"Yana Said, Dimitrios C Ladakis, Julia M Lefelar, Jenny M Khazen, Jennifer Gould, Kathryn C Fitzgerald, Elias S Sotirchos","doi":"10.1177/20552173241274605","DOIUrl":"10.1177/20552173241274605","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of studies examining quality of life (QoL) in people with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).</p><p><strong>Methods: </strong>A cross-sectional, online, self-administered survey was distributed. Data elements included demographic and clinical characteristics, and QoL in Neurological Disorders (Neuro-QoL) short form questionnaires. Neuro-QoL domain scores were compared to reference populations, yielding standardized T-scores. Symptom severity was categorized as mild, moderate, or severe, using standard Neuro-QoL cut points.</p><p><strong>Results: </strong>A total of 259 participants completed the survey. Neuro-QoL domain impairment was present in a significant proportion of respondents (anxiety: 58.1%, depression: 30.7%, stigma 29.8%, cognition: 58.5%, social function: 57.7%). T-scores were significantly worse than the reference population for anxiety (p<0.001), stigma (p=0.005), cognitive function (p<0.001) and social interactions (p<0.001). There was no clear association between QoL domains and demographics, disease-modifying therapy class, or type of clinical presentation. A relapsing vs monophasic disease course was associated with worse anxiety, stigma, cognition, and social interactions (p<0.05).</p><p><strong>Conclusion: </strong>People with MOGAD may exhibit impairment in multiple domains of QoL. Practicing clinicians should be aware of this burden in MOGAD. Further research is needed to better understand factors associated with QoL impairment in MOGAD.</p>","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"10 3","pages":"20552173241274605"},"PeriodicalIF":2.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142054142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The positive predictive value of MOG-IgG testing based on the 2023 diagnostic criteria for MOGAD. 基于 2023 年 MOGAD 诊断标准的 MOG-IgG 检测的阳性预测值。
IF 2.5 Q2 CLINICAL NEUROLOGY Pub Date : 2024-08-14 eCollection Date: 2024-07-01 DOI: 10.1177/20552173241274610
Linda Nguyen, Sumit Singh, Fabricio S Feltrin, Lauren M Tardo, Rebekah L Clarke, Cynthia X Wang, Benjamin M Greenberg

Background: Myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD) is a relatively new disease entity in the field of demyelinating disorders. Its first diagnostic criteria have recently been published.

Objectives: We evaluated the positive predictive value (PPV) for MOG-IgG testing and report the clinical and radiologic features with respect to the recently published criteria.

Methods: A retrospective study was conducted at three centers in Dallas, Texas. Patients with positive MOG-IgG testing on cell-based assays at any time were included. Positive cases were reviewed by at least two neuroimmunologists for fulfillment of the criteria.

Results: We included 235 patients. The PPV of seropositivity at any time was 78.3% overall, 52.6% for low titer, and 90.1% for high titer. Children had a higher PPV than adults (93.9% versus 67.2%). Positive predictive value was 6.3% in those without a core clinical demyelinating attack. Children more often have the typical imaging features of MOGAD in optic neuritis than adults.

Conclusions: We report a PPV of 78.3% for MOG-IgG testing using the 2023 MOGAD diagnostic criteria. Children had higher PPV and frequency of supporting imaging features. Careful consideration is necessary when assigning patients with no core demyelinating event and low titers a MOGAD diagnosis.

背景:髓鞘少突胶质细胞糖蛋白抗体相关疾病(MOGAD)是脱髓鞘疾病领域中一种相对较新的疾病实体。其首个诊断标准已于近期公布:我们评估了 MOG-IgG 检测的阳性预测值 (PPV),并根据最近公布的标准报告了临床和放射学特征:德克萨斯州达拉斯市的三个中心开展了一项回顾性研究。方法:德克萨斯州达拉斯市的三家中心开展了一项回顾性研究,纳入了在任何时间通过细胞检测获得 MOG-IgG 阳性的患者。阳性病例至少由两名神经免疫学家进行复查,以确定是否符合标准:我们共纳入了 235 名患者。任何时候血清阳性的PPV总体为78.3%,低滴度为52.6%,高滴度为90.1%。儿童的 PPV 值高于成人(93.9% 对 67.2%)。在没有核心脱髓鞘临床发作的患者中,阳性预测值为 6.3%。与成人相比,儿童更常具有视神经炎 MOGAD 的典型影像学特征:我们报告了使用 2023 年 MOGAD 诊断标准进行 MOG-IgG 检测的 PPV 为 78.3%。儿童的 PPV 值更高,支持影像学特征的频率也更高。在对无核心脱髓鞘事件且滴度较低的患者进行 MOGAD 诊断时,有必要慎重考虑。
{"title":"The positive predictive value of MOG-IgG testing based on the 2023 diagnostic criteria for MOGAD.","authors":"Linda Nguyen, Sumit Singh, Fabricio S Feltrin, Lauren M Tardo, Rebekah L Clarke, Cynthia X Wang, Benjamin M Greenberg","doi":"10.1177/20552173241274610","DOIUrl":"10.1177/20552173241274610","url":null,"abstract":"<p><strong>Background: </strong>Myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD) is a relatively new disease entity in the field of demyelinating disorders. Its first diagnostic criteria have recently been published.</p><p><strong>Objectives: </strong>We evaluated the positive predictive value (PPV) for MOG-IgG testing and report the clinical and radiologic features with respect to the recently published criteria.</p><p><strong>Methods: </strong>A retrospective study was conducted at three centers in Dallas, Texas. Patients with positive MOG-IgG testing on cell-based assays at any time were included. Positive cases were reviewed by at least two neuroimmunologists for fulfillment of the criteria.</p><p><strong>Results: </strong>We included 235 patients. The PPV of seropositivity at any time was 78.3% overall, 52.6% for low titer, and 90.1% for high titer. Children had a higher PPV than adults (93.9% versus 67.2%). Positive predictive value was 6.3% in those without a core clinical demyelinating attack. Children more often have the typical imaging features of MOGAD in optic neuritis than adults.</p><p><strong>Conclusions: </strong>We report a PPV of 78.3% for MOG-IgG testing using the 2023 MOGAD diagnostic criteria. Children had higher PPV and frequency of supporting imaging features. Careful consideration is necessary when assigning patients with no core demyelinating event and low titers a MOGAD diagnosis.</p>","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"10 3","pages":"20552173241274610"},"PeriodicalIF":2.5,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11325327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Multiple Sclerosis Journal - Experimental, Translational and Clinical
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