•Generally similar adverse event profile with the general population.•No cases of anaphylaxis or life-threatening reactions after vaccination.•Adverse events more prevalent in those 55 years old and ...younger.•Adverse events less prevalent in mild EDSS scores.•No increase in relapse rate after vaccination was detected.
The aim of this study was to evaluate the safety of Sinofarm vaccine (BBIBP-CorV) in patients with multiple sclerosis (pwMS).
This study was conducted on pwMS patients in Isfahan, Iran. All participants received two doses of BBIBP-CorV (Sinopharm vaccine). Demographic information and data on vaccine side effects were collected after each dose using questionnaires. All patients that recorded worsening of MS symptoms were evaluated and those with true relapse were treated with IV methyl prednisolone.
Of the 1538 patients, 1151 (74.8%) were female and the mean age was 40.45 ± 9.74. The average disease duration was 10.38±6.81 years and 76.1% of participants had RRMS. 92.8% of the participants were using DMTs and mean EDSS was 2.06 ± 3.16. 54.2% (833 patient) reported at least one adverse event after the first dose of vaccine and 46.8% (720 patient) after the second dose; in both cases going away in a few days. Most prevalent adverse events after both doses were injection site pain, headache, myalgia, fever and fatigue. Adverse events were more prevalent in younger and less prevalent in mildly disabled patients. There were seven cases of Covid-19 infection between the first and second vaccination dose, and eight cases during one-month follow –up after the second dose, none of whom needed mechanical ventilation. Ten patients after first dose and thirteen patients after the second dose experienced acute relapse. A patient had two relapses, one after each vaccine dose that were clinically and radiologically confirmed. The first relapse occurred seven days after the first vaccination with hemiparesis and other relapse, 14 days after the second dose with diplopia, hemiparesis and ataxia.
Adverse events in pwMS following vaccination with Sinopharm vaccine was similar to the general population, which were more common in younger patients and less common in those with mild disability. As no increase in relapse rate after vaccination was detected, Sinopharm vaccine was safe in MS patients.
Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are associated with reduced Health Related Quality of Life (HRQOL). To the best of our knowledge, change of HRQOL in ...patients with NMOSD has not been yet measure in Iran. The objective of this study was to assess HRQOL in NMOSD and MS patients and identify related factors
A cross sectional study of 41 patients with NMOSD and 136 age and sex-match MS patients was performed. A series of questionnaires including Persian validated questionnaires on HRQOL (SF-36), fatigue (MFIS), depression (BDI-II), anxiety (HAM-A) and sleep quality (PSQI) were record. All demographic variables, socioeconomic status and clinical data were also obtained. Student's T test and Mann–Whitney U test used to compare variables between groups and multivariate regression analysis applied to assay predictor factors.
The mean scores of mental (MCS) and physical (PCS) components of QOL were statistically lower in patients with NMOSD compare with MS patients (β = −4.49, P = 0.004; β = −3.52, P = 0.015). Multivariate analysis indicated fatigue, depression and anxiety were independent, significant predictor of MCS (β = −0.229, P = 0.002; β = −0.229, P = 0.002; β = −0.258, P = 0.020 respectively). However, PCS was significantly predicted by fatigue (β = −0.258 P < 0.001), solely.
These findings indicate NMOSD patients have lower HRQOL in compare to patients with MS. Also, screening and treatment of fatigue as the most important predictor for HRQOL is necessary.
•Revise highlights to: NMOSD Patients have worse quality of life in comparison to MS patients.•NMOSD patients can be screened for fatigue, depression, and related impaired abilities with better rehabilitation strategies Fatigue is the most important variable to predict quality of life in NMOSD patients.•Healthcare policymakers in Iran and other countries should make better health and welfare service policies for NMOSD patients.
Multiple sclerosis (MS) may be affected by socioeconomic status (SES). This study aims to explore the determinants of SES among Iranian patients with MS and examine how these factors relate to ...disability and disease progression.
All patients with MS listed in the nationwide MS registry of Iran (NMSRI) until January 8, 2022, were included in this population-based study.
Among the 5153 patients, most were female (74.5%), married (70.8%), and did not hold an academic degree (53.8%). Unemployment (OR: 3.75) and being unmarried (OR: 2.60) were significantly associated with Expanded Disability Status Scale (EDSS)≥6, and the time to progression was shorter in the unemployed group (
value: 0.03). There was also a significant negative correlation between the time to progression and the age at disease onset.
The study suggests that providing financial and social support to MS patients and their families through investment could reduce both individual and societal burdens.
Rituximab associated necrosis: A case report Ashtari, Fereshteh; Hakamifard, Atousa; Hariri, Amirali ...
Multiple sclerosis and related disorders,
January 2020, 2020-Jan, 2020-01-00, Letnik:
37
Journal Article
•Rituximab has been frequently utilized for the treatment of a wide range of neurologic diseases including 'Devic's syndrome.•Previous case reports have described cases of osteonecrosis, retinal and ...nasal skin necrosis.•This case report addresses a patient with 'Devic's syndrome presented with palatal mucosal necrosis after rituximab treatment.•Due to the increasing administration of rituximab, awareness about mucosal necrosis should be raised.
Rituximab is a B-cell-depleting unconjugated monoclonal IgG1 antibody that targets the transmembrane protein CD20. This article reports on a case with the rare complication known as Rituximab-associated mucosal necrosis.
The present case report addresses, for the first time, a patient affected by Devic's syndrome presenting with oral manifestations of palatal necrosis after rituximab treatment.
The present case raises the possibility of anti-CD20 antibody contributing to the development of palatal mucosal necrosis in some patients. Given the increasing administration of rituximab as a result of its efficacy against several diseases, a report on the potential iatrogenic effects of this drug is essential.
Behavioral aspects and underlying pathology of attention deficit in multiple sclerosis (MS) remain unknown. This study aimed to clarify impairment of attention and its relationship with MS-related ...fatigue. Thirty-four relapse-remitting MS (RRMS), 35 secondary-progressive MS (SPMS) and 45 healthy controls (HC) were included. Results of psychophysics tasks (attention network test (ANT) and Posner spatial cueing test) and fatigue assessments (visual analogue scale and modified fatigue impact scale (MFIS)) were compared between groups. In ANT, attentional network effects were not different between MS phenotypes and HC. In Posner task, RRMS or SPMS patients did not benefit from valid cues unlike HC. RRMS and SPMS patients had less gain in exogenous trials with 62.5ms cue-target interval time (CTIT) and endogenous trials with 250ms CTIT, respectively. Total MFIS was the predictor of gain in 250ms endogenous blocks and cognitive MFIS predicted orienting attentional effect. Executive attentional effect in RRMS patients with shorter disease duration and orienting attentional effect in longer diagnosed SPMS were correlated with MFIS scores. The pattern of attention deficit in MS differs between phenotypes. Exogenous attention is impaired in RRMS patients while SPMS patients have a deficit in endogenous attention. Fatigue trait predicts impairment of endogenous and orienting attention in MS.
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.
Working memory (WM) is one of the most affected cognitive domains in multiple sclerosis (MS), which is mainly studied by the previously established binary model for information storage (slot model). ...However, recent observations based on the continuous reproduction paradigms have shown that assuming dynamic allocation of WM resources (resource model) instead of the binary hypothesis will give more accurate predictions in WM assessment. Moreover, continuous reproduction paradigms allow for assessing the distribution of error in recalling information, providing new insights into the organization of the WM system. Hence, by utilizing two continuous reproduction paradigms, memory-guided localization (MGL) and analog recall task with sequential presentation, we investigated WM dysfunction in MS. Our results demonstrated an overall increase in recall error and decreased recall precision in MS. While sequential paradigms were better in distinguishing healthy control from relapsing-remitting MS, MGL were more accurate in discriminating MS subtypes (relapsing-remitting from secondary progressive), providing evidence about the underlying mechanisms of WM deficit in progressive states of the disease. Furthermore, computational modeling of the results from the sequential paradigm determined that imprecision in decoding information and swap error (mistakenly reporting the feature of other presented items) were responsible for WM dysfunction in MS. Overall, this study offered a sensitive measure for assessing WM deficit and provided new insight into the organization of the WM system in MS population.
•Crude incidence rate of MS increased from 31.1 (average annual of 6.2/100,000) in 2006–2010 to 70.9/100,000 (average annual of 14.2/100,000) in 2011–2015, but it remained stable at 71.8/100,000 ...(average annual of 12 /100,000) during the period of 2016–2021.•The crude prevalence ratio of MS in 2021 was 183.9/100,000.•In 2016, the age-standardized incidence rates of POMS was 1.8/100,000, AOMS was 31.4/100,000, and LOMS was 17.5/100,000.•The female/male ratio of new cases gradually decreased from 4.7 in 1996 to a minimum of 2.6 in 2020.•The mean age of RRMS onset was 26.4 ± 8.2 between 1990 and 1999, 28.5 ± 8.3 during 2000–2009, and increased to 32.8 ± 9.6 in 2010–2019.
There has been no recent comprehensive epidemiological study on a large and stable population of multiple sclerosis (MS) in Isfahan. Therefore, we conducted this study to estimate the incidence and prevalence of MS in Isfahan province from 1996 to 2021.
In this population-based study, we utilized the dataset from the Vice-Chancellor's Office of Isfahan University of Medical Sciences, which registers all people diagnosed with MS (PDWM) in Isfahan province, excluding those residing in Kashan city. We measured crude incidence and prevalence of MS, separated by sex, and based on age of MS onset, as well as changes in age of MS onset during observation.
A total of 9,909 PDWM were included in our study. The incidence during the time period of 1996–2000 was 5.4/100,000 (1.1/100,000 per year), which subsequently increased to 14.1 (2.8/100,000 per years) and 31.1 per 100,000 (6.2/100,000 per year) during 2001–2005 and 2006–2010, respectively. There was a further increase to 70.9/100,000 (14.2/100,000 per year) in 2011–2015, but it remained stable at 71.8/100,000 (12/100,000 per year) during the period of 2016–2021. In 2016, the age-standardized incidence rates of pediatric-onset, adult-onset, and late-onset MS were 1.8/100,000, 31.4/100,000, and 17.5/100,000, respectively. The prevalence of MS in 2021 was 183.9/100,000. The female/male new case ratio was 4.5 during 1996–2000, decreasing to 4.0, 3.9, 3.9, and 2.9 in the subsequent four five-year periods. The mean age of RRMS onset was 26.3 ± 8.1 between 1990 and 1999, 28.5 ± 8.3 during 2000–2009, and increased to 32.8 ± 9.6 in 2010–2019.
This study shows that Isfahan has one of the highest incidence rate and prevalence ratio of MS in the region. We observed an increase in the incidence rate during the first decade, followed by stability in the last two five- and six-year periods. Further studies are needed to identify the reasons behind the change in incidence of MS in Iran.
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