BackgroundInterleukin-6 (IL-6) is an important mediator in the acute phase of inflammatory diseases such as neuromyelitis optica (NMO) and multiple sclerosis (MS). The level of IL-6 is higher in ...cerebrospinal fluid and serum of NMO patients compare to MS. Vitamin D has a regulatory effect on IL-6, so it may have a negative correlation with IL-6 in the acute phase of these diseases. This study was performed to evaluate the serum levels of IL-6 and Vitamin D in NMO and MS patients at the onset of disease to find differences that may help in early diagnosis. Materials and MethodsThis case-control study was done on patients with the first episode of optic neuritis, transverse myelitis, and area postrema syndrome who were referred to Kashani MS Center in Isfahan, Iran, between January 2018 and January 2020. The serum levels of Vitamin D and IL-6 were assessed using enzyme-linked immunosorbent assay in blood sample taken at the time of first presentation in patients who had a definitive diagnosis of NMO and MS during subsequent workup. ResultsDuring a 2-year follow-up, definitive diagnosis of NMO was given in 25 cases, and they were compared with 25 cases that were randomly selected from patients with definite MS. Nineteen patients in the NMO group and 21 patients in the MS group were female. The mean age of patients in the NMO and MS groups was 29.64 ± 1.47 and 30.20 ± 1.42, respectively (P = 0.46). The mean of serum level of Vitamin D was 24.88 ± 15.2 in NMO patients and 21.56 ± 18.7 in MS patients without significant difference (P = 0.48). The mean of IL-6 was 30.1 ± 22.62 in the NMO group and 23.35 ± 18.8 in the MS group without significant difference (P = 0.28). The serum levels of Vitamin D were insufficient in both groups. No correlation between Vitamin D and IL-6 levels was found in our study (P > 0.05). ConclusionOur results showed that serum IL-6 levels were higher at the onset of NMO disease compared with MS. The serum levels of Vitamin D were low in both groups and there was no association between serum levels of Vitamin D and IL-6 in either group. Future studies with large sample size are needed to confirm these findings.
•Neuromyelitis optica spectrum disorder (NMOSD) is a rare neuroinflammatory disease characterized by recurrent relapses. The most common signs are myelitis and optic neuritis.•There are challenges in ...its diagnosis and treatment and it needed long-term follow-up studies to see the disease course over time especially in western Asian region.•An electronic registration system of NMOSD patients stablished since October 2015 to survey their disease course. This study is based on the definite NMOSD cases characteristics and clinical course during 7 years of registration.•All information such as demographic data, past history, addiction laboratory and MRI findings, disease presentation had been documented. They followed in terms of any relapse, new paraclinical tests and drug changes.•The mean age of onset is higher than multiple sclerosis (MS) patients, but there were noticeable pediatric cases too.•It is considerable that LETM can be asymptomatic at first. Brain MRI abnormalities is almost prevalent.
Neuromyelitis Optica Spectrum Disorder (NMOSD) is a rare neuroinflammatory disease characterized by recurrent relapses. The most common signs are myelitis and optic neuritis. It can also present by cerebral or brain stem syndromes. There are still many challenges in its diagnosis and treatment, and long-term follow-up studies are needed to see the disease course over time.
We established an electronic registration system of NMOSD patients starting from October 2015 in Kashani hospital, Isfahan, Iran. Every suspected patient was documented and included in the follow-up system to survey their disease course. Anti-aquaporine 4 (AQP4) antibody checked for all by cell-based assay method. All information such as demographic and clinical data and laboratory and MRI findings were documented. Participants were followed up for any relapses, new paraclinical tests and drug changes. This study is based on the definite NMOSD cases (according to the 2015 criteria) characteristics and clinical course during 7 years of registration.
The study included 173 NMOSD cases and 56 ones were seropositive for AQP4 Ab. Their mean age was 40.02±11.11 years (45.78 in the seropositive group). The mean age at disease onset was about 30.16 years. The mean time of follow-up by our registration system is 55.84 ± 18.94 months (54.82 months in seropositive ones). The annual relapse rate is estimated as 0.47±0.36. Long extended transvers myelitis (LETM) was present in the baseline MRI of 77 patients (44.5%), while 32 of them did not show any related clinical symptoms. 124 patients revealed an abnormality in the first brain MRI. 27 individuals suffer hypothyroidism as the most common comorbid disease. The disease seems to be more prevalent in the west and southwest areas of Isfahan province.
The mean age of onset is higher than Multiple Sclerosis (MS) patients, but there are notable pediatric cases too. It should also be noticed that cervical LETM can be asymptomatic at first. Brain MRI abnormalities are frequently observed. The disease is more prevalent in the geographical areas where showing high MS prevalence.
Objectives: It is estimated that up to 65% of pwMS (people with multiple sclerosis) experience varying degrees of cognitive impairment, the most commonly affected domain being information processing ...speed (IPS). As sleep disturbance is a predictor of detriments in IPS, we aimed to study the association between severity of restless leg syndrome (RLS) and obstructive sleep apnea (OSA) symptoms with IPS in pwMS using a language and education independent tool. Methods: In a cross-sectional study, we enrolled pwMS referred to multiple sclerosis comprehensive center of Kashani hospital in Isfahan, Iran. We used Berlin and STOP-Bang questionnaires for assessing OSA symptom severity. The International Restless Legs Syndrome Study Group scale was utilized for determining presence and severity of symptoms of restless leg syndrome. We used Integrated Cognitive Assessment (ICA) test assess visual processing speed. Results: We included 211 pwMS, with a mean age of 36.88±8.76 (82.9% female). There were significant association between RLS symptoms severity and ICA index (p=0.00), but there is no association between ICA index and OSA symptom severity using STOP-Bang scale (ICA index of 0.61±0.14 and 0.60±0.08 in low and high-risk pwMS respectively; p=0.897) and Berlin scale (ICA index of 0.61±0.14 and 0.59±0.15 in low and high-risk pwMS, respectively; p=0.384). Conclusion: We found that the severity of RLS in patients with MS can worsen information processing speed, but sleep apnea did not show any effect on this domain of cognitive dysfunction.
Background: Sleep disorders are more prevalent in people with multiple sclerosis (pwMS) than in the general population. This study aimed to examine the clinical and sociodemographic factors ...contributing to sleep disorders in pwMS. Method: The participants in this cross-sectional study were pwMS from the Isfahan Province in Iran. Sleep disorders were assessed using the Insomnia Severity Index (ISI), International Restless Legs Syndrome Study Group (IRLSSG), Berlin, and STOP-Bang questionnaires. A logistic regression model was applied to determine the accuracy of independent factors in predicting sleep impairment. A multivariate logistic regression analysis was conducted to examine the impact of multiple sclerosis (MS) types on sleep disorder severity predictability by independent variables. Result: A total of 796 pwMS were included in the current study, 693 with relapsing-remitting MS and 103 with secondary-progressive MS. Rest leg syndrome (RLS) and insomnia disorders were not present in 48.1% and 50.5% of the pwMS, respectively. According to STOP-Bang and Berlin, 87.3% and 88.4% of patients had a low-severity risk for obstructive sleep apnea (OSA), respectively. The logistic regression showed that age, gender, and Expanded Disability Status Scale (EDSS) were associated with the risk of OSA (p < 0.05). RLS severity was also correlated with age and EDSS (p < 0.05). The association between sleep disorder severity and independent variables was not affected by MS type in multivariate logistic regression. Conclusion: In this study, we found that sleep disorders such as RLS, insomnia, and OSA are common among pwMS in Iran. Sociodemographic factors, as well as disease characteristics, can have an impact on sleep disorders among pwMS.
•The scores of FSIQ, VIQ, PIQ, vocabulary, similarities, and digit-symbol in NMOSD and MS patients were lower than the control group.•There was no difference between NMOSD and MS groups in IQ scores, ...except in vocabulary and similarities subsets.•A greater EDSS score was associated with decreased scores of FSIQ, VIQ, and PIQ in NMOSD patients.
Cognitive impairment is common in people living with neuromyelitis optica spectrum disease (NMOSD) and multiple sclerosis (MS). However, there is little published data on intelligence quotient (IQ) in NMOSD patients. Therefore, we performed the present study to compare IQ scores across NMOSD, MS, and control groups.
In this cross-sectional study, 49 NMOSD (30 with positive aquaporin4 antibody), 41 MS, and 20 control individuals were recruited. The IQ score for each person was measured using Wechsler Adult Intelligence Scale-Revised (WAIS-R). Participants were reported on eleven scores of subsets, verbal IQ (VIQ), performance IQ (PIQ), and full score IQ (FSIQ).
The scores of FSIQ, VIQ, PIQ, vocabulary, similarities, and digit-symbol in NMOSD and MS individuals were lower than the control group. Relative to control, NMOSD patients reported a lower score of information. We found no difference between NMOSD and MS groups, except in vocabulary and similarities. No significant difference between seropositive and seronegative NMOSD groups was observed except for the information and block design. In NMOSD group, a greater EDSS score was associated with decreased scores of FSIQ, VIQ, and PIQ. Being employed and being married were associated with greater scores of VIQ and PIQ, respectively. In both NMOSD and MS groups, advanced education was associated with increased scores of FSIQ and VIQ.
Our study showed decreased IQ scores in NMOSD and MS. Further studies are required to examine intellectual quotient in people with NMOSD and MS.
