Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system. Vitamin D has been related to the prevention of MS and to modulating its course. Recent studies have shown ...the safety of high-dose vitamin D in MS.
This study compared the effects of high-dose vitamin D on interleukin 10 (IL-10) levels in MS patients in a double-blind, randomized clinical trial.
Ninety-four patients with relapsing remitting MS (RRMS) were randomized into a treatment and a placebo group. Both groups received conventional MS treatment. The intervention group received 50,000 IU of vitamin D every 5 days for 3 months. IL-10 was measured at baseline and after 3 months.
Serum levels of IL-10 were (median ± IQR): 12.58 ± 11.97 and 10.97 ± 9.97 pg/ml in the intervention and placebo groups, respectively, at baseline (p = 0.161); after 3 months, these levels were 13.76 ± 18.95 and 11.31 ± 19.63 pg/ml, respectively (p = 0.158). The IL-10 level increased significantly after receiving high-dose vitamin D for 3 months (β = 0.737, p = 0.015 and R2 = 0.91).
IL-10 levels increased significantly in RRMS patients after taking high-dose vitamin D3 for 3 months. High-dose vitamin D might be useful in promoting an anti-inflammatory state in RRMS patients.
Cognitive impairment is common in neuromyelitis optica spectrum disease (NMOSD) and multiple sclerosis (MS) patients. 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, a total of 49 NMOSD patients (30 patients with positive aquaporin4 antibody), 41 MS patients, and 20 control individuals were recruited. The IQ score for each patient 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 patients were lower than the control group. Relative to control, NMOSD patients reported a lower score of information as well. We found no difference between NMOSD and MS groups, except in vocabulary and similarities. No significant difference between seropositive and seronegative NMOSD patients was observed except in information and block design. In NMOSD patients, a greater EDSS score was associated with decreased scores of FSIQ, VIQ, and PIQ. Being employed and marriage were associated with greater scores of VIQ and PIQ, respectively. In both NMOSD and MS groups, advance 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 NMOSD and MS patients.
Background: Rituximab, a monoclonal antibody that targets and eliminates CD20+ B cells, has shown effectiveness in decreasing disease activity in patients with multiple sclerosis (pwMS). This study ...aimed to investigate disability, motor function, and volumetric magnetic resonance imaging (MRI) changes after one-year rituximab administration in secondary progressive MS (SPMS) patients. Methods: This longitudinal prospective study was conducted from January 2019 to October 2020 on SPMS patients undertreatment with rituximab at the Kashani MS Clinic in Isfahan, Iran. Expanded Disability Status Scale (EDSS), timed 25- feet walk test (T25-FW), and 9-hole Peg test (9-HPT) were utilized to evaluate the disability status. All patients underwent disability assessment tests and brain MRI at the baseline and after one-year rituximab treatment. MRI measurements such as lesion load, cortical atrophy, and spinal cord atrophy at C2-C3 levels were assessed with the Siemens 1.5-tesla Avanto MRI machine. The Spearman correlation was performed to determine the association between disabilities and volumetric MRI factors. Results: 31 pwMS were included (39.9±6.9 years, 64.5% females). PwMS receiving rituximab experienced stable MRI volumetric parameters, disability, and motor function. Deep white matter lesion volume was increased during follow-up (0.26±0.19 at baseline to 0.38±0.29 one year later). The mean EDSS, T25-FW, and 9-HPT did not change significantly after treatment with rituximab within 12 months (p > 0.05). Significant correlations were found between the white, gray matter volumes and the 9-HPT test of the left and right hand at follow-up (p < 0.05), as well as the T25-FW and the C1-C2 cross-sectional area at baseline (r=-0.444, p=0.016). Conclusion: As a result of the administration of rituximab, disability, brain atrophy, cervical spinal cord area, and lesion load did not change significantly during 12 months in SPMS. The role of rituximab in SPMS management needs further research with longer follow-up.
This study aims to evaluate the effect of extracorporeal shock wave therapy (ESWT) on lower limb spasticity in stroke patients.
Twenty-eight eligible patients with ankle plantar flexor spasticity ...were randomly assigned to two groups. ESWT group received 1 session per week for 3 weeks of ESWT along with oral anti-spastic medications and stretching exercises. The control group received only oral anti-spastic medications and stretching exercises similar to ESWT group. At baseline, weeks 1, 3 and 12, spasticity was assessed and compared between the two groups using Modified Ashworth Scale (MAS), clonus score, passive range of motion (ROM) of joint, pain score, 3-m walk duration and lower extremity functional score (LEFS). Three patients were lost during follow-up; 25 patients completed the study and were analyzed.
After one session of ESWT treatment, MAS, pain, ROM and LEFS improved significantly compared to baseline. After three weeks of ESWT treatment, MAS, pain and 3-m walk duration improved significantly compared to week 1. At week 12, MAS, pain, ROM, 3-m walk duration and LEFS improved significantly compared to the control group after controlling baseline values. The trend of decrease in pain score and MAS was significantly different between the groups. The trend of increase in ROM and LEFS was significantly different between the groups.
ESWT significantly improved lower limb spasticity, pain, passive ROM, 3-m walk duration and LEFS immediately and 12 weeks after treatment. So, ESWT in combination with oral anti-spastic medications and stretching exercises could be useful for improvement of spasticity in stroke patients.
Background: Dysphagia is a common disorder among patients with Parkinson′s disease (PD). It occurs in up to 80% of all (PD) patients during the early stages of the disease and up to 95% in the ...advanced stages; but professionals may not hear from the patients about dysphagia symptoms until these symptoms reach an advanced stage and lead to medical complications. Materials and Methods: Thirty-three PD patients (mean age 66.09 ± 9.4 years; 24 men, nine women) participated in this study at our Neurology Institute, between April 20, 2013, and October 26, 2013. They were asked two questions; one about saliva control and the other about silent saliva penetration and aspiration. Next, they underwent the videofluoroscopic swallowing study (VFSS). Results: The Pearson Correlation coefficient between the Penetration-Aspiration Scale (PAS) scores and question 1 scores was 0.48 (P < 0.05, =0.25), and there was a significant correlation between the PAS scores and question 2 scores, and also question 1 scores + question 2 scores (r = 0.589, P < 0.05, =0 and r = 0589, P < 0.05, =0). Conclusions: This study showed a significant correlation between the questions about saliva control, silent saliva penetration, and aspiration, and laryngeal penetration and aspiration during VFSS. Therefore, by using these two questions, the potential silent laryngeal penetration and aspiration during meals could be detected before it led to aspiration pneumonia. Taking the benefit of these questions, as a part of the swallowing assessment of PD patients, is recommended.
Background: Many of the epileptic patients although are treated by multiple antiepileptic drugs but have recurrent multiple seizures. Surgery may be useful in these patients. Video-electroencephalic ...monitoring (VEM) is useful for finding epileptic focus or differentiating pseudoseizure from true seizure. This study was done in epilepsy centre of Kashani Hospital in Isfahan University of Medical Sciences to assess the clinical and paraclinical findigs of patients with intractable epilepsy. Methods: This cross-sectional study was done in epilepsy ward in Kashani hospital in 2009. Total data of admitted patients such as sex, age, type of seizure, type of medications, family history, duration of disease, and EEG findings were gathered in questionnaire forms. Data were analyzed by SPSS13 software. Finding: 101 patients were admitted in epilepsy ward of Kashani hospital in 2009. Mean age of patients was 26.8 and 50.5% (51 patients) were women. 26.7% (27 patients) had pseudoseizure and 5.9% (6 patients) had focal epileptic lesion and were candidated for surgery. Conclusion: Video-electroencephalic monitoring is necessary in patients with intractable epilepsy for confirming diagnosis and selecting the patients that surgery could help them.
Multiple sclerosis (MS) is an inflammatory disease damaging the myelin sheath in the central and peripheral nervous system in the brain and spinal cord. Optic Neuritis (ON) is one of the most ...prevalent ocular demonstrations of MS. The current diagnosis protocol for MS is MRI, but newer modalities like Optical Coherence Tomography (OCT) are already of interest in early detection and progression analysis. OCT reveals the symptoms of MS in the Central Nervous System (CNS) through cross-sectional images from neural retinal layers. Previous works on OCT were mostly focused on the thickness of retinal layers; however, texture features seem also to have information in this regard. In this research, we introduce a new pipeline that constructs layer-stacked (LS) images containing data from each specific layer. A variety of texture features are then extracted from LS images to differentiate between healthy controls and ON/None-ON MS cases. Furthermore, the definition of texture extraction methods is tailored for this application. After performing a vast survey on available texture analysis methods, a treasury of powerful features is collected in this paper. As a primary work, this paper shows the ability of such features in the diagnosis of HC and MS (ON and None-ON) cases. Our findings show that the texture features are powerful to diagnose MS cases. Furthermore, adding information of conventional thickness values to texture features improves considerably the discrimination between most of the target groups including HC vs. MS, HC vs. MS-None-ON, and HC vs. MS-ON.
•Patients with a history of psychiatric disorder are more prone to depression during the COVID-19 pandemic.•Older patients are more susceptible to anxiety during the COVID-19 pandemic.•The patients ...who are diagnosed with MS at older ages experience more anxiety during the current pandemic in comparison to those with younger ages at the disease onset.•MS patients with academic degree experience less anxiety during the COVID-19 pandemic.
There are reports that stress-related disorders are increasing during coronavirus disease 2019 (COVID-19) pandemic. Patients with Multiple Sclerosis (MS) are at higher risk of developing psychiatric disorders, which result in worsening of their disability. There are concerns about the mental health of MS patients during this pandemic.
We aimed to evaluate the prevalence of anxiety, depression, and levels of fear about Corona in MS patients during the COVID-19 pandemic.
This was a cross-sectional study on MS patients who were admitted to the MS clinics affiliated with Isfahan University of medical sciences from May to June 2020. Anxiety and depression were evaluated according to the Hospital Anxiety and Depression Scale (HADS). The Corona Fear Questionnaire developed by Ahorsu et al. was applied to evaluate the state of fear about COVID-19. Chi-square tests were used to compare depression and anxiety between different groups, Kruskal-Wallis was used for fear scores, Spearman correlation coefficient was also reported for correlations.
410 MS patients with a mean age of 38.6 years (±10.35) were enrolled in the study. Among those patients who answered the HADS questionnaire completely (n=399, n=388, for anxiety and depression subscales respectively) the prevalence of anxiety and depression were 31.2% (n=128) and 39.3% (n=161), respectively. There was no significant relationship between anxiety and depression with any of the following variables: sex, marital status, history of drug abuse, smoking, duration of taking psychiatric medication, being tested for COVID-19, being quarantined. Regarding fear about COVID-19, patients with depression or anxiety showed higher scores on the fear questionnaire (p-value=0.03, p-value=0.008 respectively).
The prevalence of anxiety and depression in MS patients was higher than previously reported. Fear about COVID-19 was correlated with anxiety and depression. Multicenter studies are required to develop specific recommendations for screening mental health problems in MS patients during COVID pandemic.
Objectives: The purpose of this study was to compare the relative efficacy of acetylsalicylic acid (ASA) and amantadine for the treatment of fatigue in multiple sclerosis (MS).
Methods: A 10-week, ...randomized double-blind crossover clinical trial conducted from October 2009 to September 2010. Fifty-two patients with MS presenting fatigue at 21 to 53 years of age were randomly allocated to the two treatment groups. The first group received amantadine (100 mg twice daily) for a total of 4 weeks. The second group received ASA (500 mg once daily) for four weeks. After a 2-week washout period, they crossed over to the alternative treatment for 4 weeks. Patients were rated at baseline and the end of each phase with the Fatigue Severity Scale (FSS).
Results: ASA appeared to be equivalent in efficacy and safety to amantadine. A significant decrease in FSS occurred in both groups. Of the 26 patients treated with amantadine, the mean (SD) of FSS decreased from 4·8 (1·4) to 4·0 (1·4) (P<0·001). In the 26 patients treated with ASA, the mean (SD) of FSS decreased from 4·6 (1·4) to 3·5 (1·5) (P<0·001).
Discussion: This study demonstrates that both ASA and amantadine significantly reduce MS-related fatigue. Both ASA and amantadine have previously been shown to reduce fatigue, and we postulate that treatment with ASA and amantadine may have similar benefits.
PDF
