Neuromyelitis optica spectrum disorder (NMOSD) is associated with inflammatory mediators that may also trigger downstream signaling pathways leading to reduce insulin sensitivity.
We aimed to ...determine the risk association of hyperinsulinemia in NMOSD patients with seropositive AQP4-IgG and the serum levels of interleukin (IL)-6 and IL-17A compared with the control group. Serum levels of metabolic (Insulin, Fasting Blood Sugar (FBS), lipid profile) and inflammatory (IL-6 and IL-17) markers were assessed in 56 NMOSD patients and 100 controls.
Hyperinsulinemia was more prevalent in NMOSD patients independent of age, sex and body mass index (BMI) (48.2% vs. 26%, p = 0.005) compared to control group. After adjusting age, sex and BMI, there was significant association between lower insulin sensitivity (IS) and NMOSD risk (95% CI: Beta = 0.73, 0.62 to 0.86, p = 0.0001). Circulating levels of IL-6 and IL-17 were higher in NMOSD patients, and only IL-6 had an effect modifier for the association between lower insulin sensitivity and NMOSD risk.
Our data suggests that inflammatory pathogenesis of NMOSD leads to hyperinsulinemia and increases the risk of insulin resistance.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This study aimed to investigate the association between dietary acid load (DAL) and multiple sclerosis (MS), through the potential renal acid load (PRAL) and net endogenous acid production (NEAP) ...scores. In a hospital-based case-control study of 109 patients with MS and 130 healthy individuals, a validated 168-item semi-quantitative food frequency questionnaire and a logistic regression model were used to evaluate the association between the DAL and MS. After adjusting for age (years), gender (male/female), body mass index (Kg/m
), and total calories (Kcal), the MS odds were 92% lower for those in the highest tertile of total plant-based protein (OR: 0.08, 95%CI: 0.03, 0.23;
-value < 0.001) and about four times higher for those in the highest tertile of the PRAL (OR: 4.16, 95%CI: 1.94, 8.91;
-value < 0.001) and NEAP scores (OR: 3.57, 95%CI: 1.69, 7.53;
-value < 0.001), compared to those in the lowest tertile. After further adjusting for sodium, saturated fatty acid, and fiber intake, the results remained significant for total plant-based protein intake (OR: 0.07, 95%CI: 0.01, 0.38;
-value = 0.002). In conclusion, a higher NEAP or PRAL score may be associated with increased odds of MS, while a higher intake of plant-based protein instead of animal-based protein may be protective.
Objective: The prevalence of cognitive impairment in multiple sclerosis (MS) is significant and it is estimated that 40% to 70% of patients with MS suffer from this impairment. COVID-19 is also a new ...infectious disease. The symptoms of this disease, which include fever, shortness of breath, and cough, can be mild to severe and can even lead to death. Due to the use of immunosuppressive drugs by Patients with MS, they might be at greater risk of catching COVID-19. Thus, patients with MS may be more afraid of catching the virus. One of the important factors is the relationship between cognitive deficit and the increase in patients' fear of COVID-19. The aim of this study was to assess the relationship between fear of catching COVID-19 and cognitive impairment in patients with MS.
Method: This cross-sectional study was conducted at the MS Clinic, Sina hospital, Tehran University of Medical Sciences, Tehran, Iran. Our participants in this project were Patients with MS who were over 18 years old and had no history of other neurological and psychiatric diseases. In addition to obtaining demographic and clinical information, we measured the fear of catching the COVID 2019 via Fear of COVID-19 Scale (FCV-19S), which is 7-item questionnaire. We also used Multiple Sclerosis Neuro Psychological Screening Questionnaire (MSNQ) to assess memory and information processing speed in Patients with MS.
Results: After adjustment for age, gender, disease duration, highest level of education, MS type, and EDSS in linear regression model, as well as the MSNQ total score and fear score of catching coronavirus, the results demonstrated a significant positive correlation with P value of 0.00 and β: 0.024.
Conclusion: The present study showed a direct relationship between cognitive disorder and level of fear regarding COVID-19. Patients with more cognitive disorders were more afraid of COVID-19.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
To assess the opinion of patients with Multiple Sclerosis (MS) on the outcomes of COVID-19 (coronavirus disease 2019) and its effects on MS symptoms if they catch coronavirus. A cross-sectional study ...was performed.
Considering the study objectives, a questionnaire was designed and prepared as a Google Form for MS patients for one week.
A total of 148 MS patients with an average age of 35.73 years completed the questionnaire. The most important concern of the participants was "a high prevalence of COVID-19" following by the "MS symptoms worsening". Many participants (35%) believed that, if they catch COVID-19 they will be cured. However, the treatment will take more time for them in comparison with the general population. About 39.8% of the patients stated that COVID-19 infection does not affect the MS symptom, but others noted that, it can cause relapse (30.8%) or worsen MS symptoms (29.3%).
This study revealed that MS patients are more anxious about the effects of COVID-19 on their underlying disease rather than the infection itself.
Depression, fatigue, and anxiety are three common clinical comorbidities of multiple sclerosis (MS). We investigated the role of physical activity (PA) level and body mass index (BMI) as modifiable ...lifestyle factors in these three comorbidities.
A cross-sectional study was conducted in the MS specialist clinic of Sina Hospital, Tehran, Iran. Demographic and clinical data were collected. BMI was categorized in accordance with the WHO's standard classification. Physical activity (PA) level and sitting time per day were obtained using the short form of the International Physical Activity Questionnaire (IPAQ-SF). Fatigue, anxiety, and depression scores were measured using the Persian version of the Fatigue Severity Scale (FSS), Beck Anxiety Inventory (BAI), and Beck's Depression Inventory II (BDI-II) questionnaires, respectively. The correlation between the metabolic equivalent of tasks (MET), BMI, and daily sitting hours with depression, anxiety, and fatigue were checked using the linear regression test. The normal BMI group was considered a reference, and the difference in quantitative variables between the reference and the other groups was assessed using an independent sample t-test. Physical activity was classified with tertiles, and the difference in depression, anxiety, and fatigue between the PA groups was evaluated by a one-way ANOVA test.
In total, 85 MS patients were recruited for the study. The mean ± SD age of the participants was 39.07 ± 8.84 years, and 72.9% (
: 62) of them were female. The fatigue score was directly correlated with BMI (
: 0.03;
: 0.23) and sitting hours per day (
: 0.01;
: 0.26) and indirectly correlated with PA level (
< 0.01;
: -0.33). Higher depression scores were significantly correlated with elevated daily sitting hours (
: 0.01;
: 0.27). However, the correlation between depression with PA and BMI was not meaningful (
> 0.05). Higher anxiety scores were correlated with BMI (
: 0.01;
: 0.27) and lower PA (
: 0.01;
: -0.26). The correlation between anxiety and sitting hours per day was not significant (
> 0.05). Patients in the type I obesity group had significantly higher depression scores than the normal weight group (23.67 ± 2.30 vs. 14.05 ± 9.12;
: 0.001). Fatigue (32.61 ± 14.18 vs. 52.40 ± 12.42;
: <0.01) and anxiety (14.66 ± 9.68 vs. 27.80 ± 15.48;
: 0.01) scores were significantly greater among participants in the type II obesity group in comparison with the normal weight group. Fatigue (
: 0.01) and anxiety (
: 0.03) scores were significantly different in the three levels of PA, but no significant difference was found in the depression score (
: 0.17).
Our data suggest that a physically active lifestyle and being in the normal weight category are possible factors that lead to lower depression, fatigue, and anxiety in patients with MS.
Currently, multiple sclerosis (MS) lacks a definitive treatment, emphasizing the need for research that prioritizes the investigation of modifiable environmental risk factors such as diet associated ...with MS development or the manifestation of its symptoms. Therefore, we designed a narrative review to investigate the role of dietary interventions on multiple sclerosis symptoms.Swank is one of the oldest dietary interventions in MS. In 1948, swank started utilizing low fat diet, supplemented by cod liver oil. After 34 years follow-up, the survival rate was higher in swank diet group and patients were still ambulatory and otherwise healthy.Modified Paleo diet (Wahl’s protocol), recommends green leafy and sulfur-rich vegetables, as well as intensely colored fruits and vegetables, encourages eating omega-3 sources, animal and plant protein, nutritional yeast, plant-based milk, and kelp and spirulina, and excludes gluten, dairy, and eggs. A 12-month multimodal intervention it resulted in improvement in anxiety, depression, cognitive function, and executive function (self-reported).Sand et al 2019 investigated the effects of a modified Mediterranean dietary program in MS patients in a 6 months intervention. They reported a significant improvement in fatigue scores.The ketogenic diet is a high-fat and low-carbohydrate diet. Benton et al, in 2019 investigated the effects of the 6-month intervention of a modified Atkins diet as a type of ketogenic diet (KDMAD) in MS patients. No subject experienced worsening disease on diet. Body mass index and total fat mass decreased. Fatigue and depression improved and leptin declined after 3 months.Data on the effects of dietary interventions in MS is limited and the available studies are not methodologically strong. Based on the beneficial effects of some investigated diets and modifiable characteristics of diet, it seems that there is a need for more investigation with a better methodology to prove the effects of each dietary pattern.
The effects of ginseng on fatigue have been proven in patients with multiple sclerosis (MS), which have several similar manifestations to neuromyelitis optica spectrum disorder (NMOSD) patients. This ...study was designed to evaluate the effects of ginseng on fatigue in NMOSD patients.
In this double-blinded randomized controlled clinical trial, 64 patients were recruited and were allocated into two study groups (ginseng or placebo) via block randomization. The participants received either 250-mg ginseng or placebo twice daily for a 3-month period. Also, the measurement of outcome was performed using the valid and reliable Persian version of fatigue severity scale (FSS) questionnaire, which was filled by patients once after enrollment in the study and once at the end of the study post-intervention.
In total, 58 patients finished the study with no major side effects. There were no significant differences in demographic, clinical, as well as FSS between two study groups (p>0.05). Ginseng supplementation significantly reduced fatigue (40.21±13.51 vs. 28.97±14.18; p˂0.01), while patients in the placebo group showed significantly higher fatigue score after 3 months post-intervention (35.03±13.51 vs. 38.79±12.27; P: 0.02). The extent of changes in the fatigue score in the ginseng group was significantly greater than in the placebo group (p ˂0.01).
This study revealed positive effects of ginseng on reducing fatigue in NMOSD patients with no major side effects. In this regard, further studies are warranted to evaluate and clarify the effects of ginseng on fatigue in NMOSD.
Studies show that nutritional factors have an effect on both the incidence and symptoms as well as progression of multiple sclerosis (MS). We reviewed nutritional recommendations in MS. ...Unfortunately; there is currently no proven beneficial diet for MS patients. However, having a healthy diet to get adequate amount of nutrients and weight control can be beneficial for MS patients. Diets characterized by elevated consumption of fruits, vegetables, whole grains, and lean sources of protein, while concurrently restricting intake of processed foods, sugar, and saturated fats, demonstrate advantageous due to their antioxidative and anti-inflammatory properties. Fortunately, in most MS patients, the disease is mild and moderate. However, in the advanced stages of the disease, there is a possibility of needing nutritional support, and the progress of the disease is associated with dysphagia, so it is necessary to adjust the consistency of food, transfer from solid food to puree, and concentrate liquids. Neurogenic bowel in these patients or drug side effects can lead to constipation or diarrhea, so the prevalence of constipation in these patients is high and its control is recommended through consumption of fluids, fibers and increased physical activity. Neurogenic bladder is also common in MS patients, which leads to frequent urination, urinary incontinence and urinary infection. Therefore, distribution of liquid consumption during waking hours and minimizing liquid consumption before going to sleep can minimize problems and complications. The expansion of following the western dietary pattern (food pattern including high amounts of animal fat, red meat, fried foods, sweetened and high sugar drinks, high salt amounts) and its subsequent results such as obesity is one of the risk factors for MS, and following A healthy non-western diet can help control MS. The Mediterranean dietary pattern is known as an anti-inflammatory pattern. The beneficial effects of this diet are related to the presence of large amounts of polyphenols, flavonoids and tannins. Due to the inflammatory nature of MS, this diet has been of great interest. Several studies have shown the role of following this diet in reducing the risk of MS. A pilot RCT study showed the role of following a Mediterranean dietary pattern on reducing fatigue, disease symptoms and EDSS in MS patients. Another cohort study has also shown its role in less disability in MS patients .
The first appearance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) named coronavirus disease 2019 (COVID-19) was reported from Wuhan in December 2019. While this virus displays ...several respiratory manifestations such as severe pneumonia and acute respiratory distress syndrome, there are several reports of nervous system involvement in the affected patients. Currently, there is a growing number of cases with central nervous system (CNS) autoimmune diseases (ADs) including autoimmune encephalitis (AE), neuromyelitis optica spectrum disorder (NMOSD), CNS vasculitis, acute disseminated encephalomyelitis (ADEM), and multiple sclerosis (MS) secondary to COVID-19 infection. Symptoms of these diseases vary from mainly drowsiness, delirium, and motor deficits in ADEM, MS, and AE and also visual impairment, and sensory problems in NMOSD and transverse myelitis patients. The severity of COVID-19 symptoms was also different from disease to disease. Based on the previous studies moderate corticosteroid therapy or other medication such as intravenous human immunoglobulins (IVIG), and plasma exchange (PLEX) is suggested for the treatment of CNS ADs in COVID patients. Also, patients with a previous history of ADs and other comorbidities such as hypertension, diabetes mellitus, hypercholesterolemia, and ischemic heart disease are at greater risk to develop severe complications of COVID compared to other patients. Current pieces of evidence demonstrated that CNS ADs can occur due to COVID-19 infection and the healthcare system should attention to CNS ADs as a complication of COVID-19. However, further investigations are strongly needed to confirm these findings.
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