Vitamin D has been linked to the aetiology of several autoimmune diseases including multiple sclerosis. In 2016 all patients diagnosed with multiple sclerosis in Eastern and other parts of Libya were ...directed to an organized, database and treatment public sector funded central clinic at BMC. The normal range of serum levels of vitamin D is 30–60 ng/ml (60–100 ng/ml for patients with multiple sclerosis).
To correlate the level of serum vitamin D in multiple sclerosis patients from Benghazi Multiple Sclerosis Clinics at BMC to their score of disability using the Extended Disability Status Scale (EDSS).
Relying on the BMC Multiple Sclerosis Clinic Questionnaire and patient records we collected the levels of vitamin D and EDSS scores from 50 prospectively clinically reviewed patients. All the patients were taking disease modifying agents. The questionnaire has medical ethics approval. Word Excel was used for the graphs and statistical analysis.
39 patients were female and 11 male. Age ranged 17-63 years. The mean age was 37 years. The mean vitamin D level in both genders was 15.7 ng/ml, (females 16.1 ng/ml, and males 14.5 ng/ml). The mean EDSS score in both genders was 3.76 (females 3.71, males 3.95).
Patients in Benghazi have significantly lower than recommended levels of vitamin D, and this correlated with a significant degree of disability suggestive of secondary progressive disease. We highlight this as a target for future nationwide campaigns and recommend vitamin D supplementation added to multiple sclerosis treatment.
Although many lesion-based MRI biomarkers in multiple sclerosis (MS) patients were investigated, none of the previous studies dealt with the signal intensity variations (SIVs) of MS lesions. In this ...study, the SIVs of MS lesions on direct myelin imaging and standard clinical sequences as possible MRI biomarkers for disability in MS patients were assessed.
Twenty seven MS patients were included in this prospective study. IR-UTE, FLAIR, and MPRAGE sequences were employed on a 3T scanner. Regions of interest (ROIs) were manually drawn within the MS lesions, and the cerebrospinal fluid (CSF) and signal intensity ratios (SIR) were calculated from the derived values. Variations coefficients were determined from the standard deviations (Coeff 1) and the absolute differences (Coeff 2) of the SIRs. Disability grade was assessed by the expanded disability status scale (EDSS). Cortical/gray matter, subcortical, infratentorial, and spinal lesions were excluded.
The mean diameter of the lesions was 7.8 ± 1.97 mm, while the mean EDSS score was 4.5 ± 1.73. We found moderate correlations between the EDSS and Coeff 1 and 2 on IR-UTE and MPRAGE images. Accordingly, Pearson's correlations on IR-UTE were
= 0.51 (
= 0.007) and
= 0.49 (
= 0.01) for Coeff 1 and 2, respectively. For MPRAGE, Pearson's correlations were
= 0.5 (
= 0.008) and
= 0.48 (
= 0.012) for Coeff 1 and 2, respectively. For FLAIR, only poor correlations could be found.
The SIVs of MS lesions on IR-UTE and MPRAGE images, assessed by Coeff 1 and 2, could be used as novel potential MRI biomarkers for patients' disability.
Objective
To describe the course of disability in patients with benign multiple sclerosis—i.e., with an expanded disability status scale score < 3 10 years after disease onset—for up to 30 years ...after disease onset. We evaluated the proportion of patients remaining in the benign state on the long term and the factor associated with this favorable outcome and determined the pattern of disability course after the loss of the benign status.
Methods
Patients were selected from the ReLSEP, a French population-based registry. We studied the probability (Kaplan–Meier method) and predictors (multivariate Cox model) of remaining < 3 after year 10, and the course of disability after score 3 according to the duration of the benign phase in patients with ≥ 30 years of follow-up (graphs of the course of the mean expanded disability status scale scores in subgroups of patients).
Results
2295/3440 patients had benign multiple sclerosis (66.7%). The probability of remaining benign at year 30 was 0.26 (95% CI 0.26–0.32). A young age at disease onset and a good recovery after the first relapse were associated with remaining benign. Graphs illustrate that those who lost their benign status between years 10 and 30 follow a two-stage course. Beyond score 3, disability accumulation is similar in all but lower disability scores at advanced age are associated with longer benign periods.
Conclusion
The longer a patient remains in the benign state, the lower the final EDSS at advanced age.
There is wide variation in the time from the onset to secondary progressive multiple sclerosis (MS) and some controversy regarding the clinical characteristics of the courses (phenotypes) of MS. The ...present study aimed to characterize demographic and clinical factors that potentially influence long-term disability progression in the cohort of Latvian MS patients. A descriptive longitudinal incidence study was conducted using a cohort of 288 MS patients beginning in 2011 (disease duration from 1 to 51 years). Socio-demographic and clinical information from the first visit to 15/20 years was analysed in groups stratified by gender and visits at five-time points (the first visit; after a year or 2; after 5 ± 1 year; after 10 ± 2 years; after 15–20 years). Our study was dominated by patients from urban areas and non-smokers. The female/male ratio was 2.4:1; the distribution of clinical courses at the first visit was consistent with most European studies. The most common symptom at presentation in our study was optic manifestations, followed by sensory disturbances and motor deficits. In the Latvian study, gender was not a significant influencing factor on the rate of disease progression; however, patient age was statistically significantly associated with EDSS (Expanded Disability Status Scale) value at the first visit. Early clinical features of MS are important in predicting the disability accumulation of patients. Despite the small differences regarding the first MS symptoms, the disability outcomes in the cohort of Latvian patients are similar to other regions of the world.
Compared to the adult onset of multiple sclerosis (AOMS), both early-onset (EOMS) and late-onset (LOMS) are much less frequent, but are often under- or misdiagnosed. The aims of the present study ...were: 1. To compare demographic and clinical features of individuals with EOMS, AOMS and LOMS, and 2. To identify predictors for disability progression from relapsing remitting MS (RRMS) to secondary progressive MS (SPMS).
Data were taken from the Isfahan Hakim MS database. Cases were classified as EOMS (MS onset 18 years), LOMS (MS onset >50 years) and AOMS (MS >18 and 50 years). Patients' demographic and clinical (initial symptoms; course of disease; disease patterns from MRI; disease progress) information were gathered and assessed. Kaplan-Meier and Cox proportional hazard regressions were conducted to determine differences between the three groups in the time lapse in conversion from relapsing remitting MS to secondary progressive MS.
A total of 2627 MS cases were assessed; of these 127 were EOMS, 84 LOMS and 2416 AOMS. The mean age of those with EOMS was 14.5 years; key symptoms were visual impairments, brain stem dysfunction, sensory disturbances and motor dysfunctions. On average, 24.6 years after disease onset, 14.2% with relapsing remitting MS (RRMS) were diagnosed with secondary progressive MS (SPMS). The key predictor variable was a higher Expanded Disability Status Scale (EDSS) score at disease onset. Compared to individuals with AOMS and LOMS, those with EOMS more often had one or two relapses in the first two years, and more often gadolinium-enhancing brain lesions. For individuals with AOMS, mean age was 29.4 years; key symptoms were sensory disturbances, motor dysfunctions and visual impairments. On average, 20.5 years after disease onset, 15.6% with RRMS progressed to SPMS. The key predictors at disease onset were: a higher EDSS score, younger age, a shorter inter-attack interval and spinal lesions. Compared to individuals with EOMS and LOMS, individuals with AOMS more often had either no or three and more relapses in the first two years. For individuals with LOMS, mean age was 53.8 years; key symptoms were motor dysfunctions, sensory disturbances and visual impairments. On average, 14 years after disease onset, 25.3% with RRMS switched to an SPMS. The key predictors at disease onset were: occurrence of spinal lesions and spinal gadolinium-enhancement. Compared to individuals with EOMS and AOMS, individuals with LOMS more often had no relapses in the first two years, and higher EDSS scores at disease onset and at follow-up.
Among a large sample of MS sufferers, cases with early onset and late onset are observable. Individuals with early, adult and late onset MS each display distinct features which should be taken in consideration in their treatment.
•The largest ambispective study from a developing country on natalizumab and multiple sclerosis.•Natalizumab was found to be highly effective in Indian patients with MS.•Patients with RRMS and SPMS ...improved in relapse rate while EDSS improvement was observed only in the RRMS cohort.•The risk-benefit ratio appears highly favorable with no reports of PML.
Natalizumab (NTZ) is increasingly being used in Indian multiple sclerosis (MS) patients. There are no reports on its safety and efficacy, especially with respect to the occurrence of progressive multifocal leukoencephalopathy (PML).
To describe the patient characteristics, treatment outcomes, and adverse events, especially the occurrence of PML in NTZ-treated patients.
A multicentre ambispective study was conducted across 18 centres, from Jan 2012 to Dec 2021. Patients at and above the age of 18 years treated with NTZ were included. Descriptive and comparative statistics were applied to analyze data.
During the study period of 9 years, 116 patients were treated with NTZ. Mean age of the cohort was 35.6 ± 9.7 years; 83/116 (71.6%) were females. Relapse rate for the entire cohort in the year before NTZ was 3.1 ± 1.51 while one year after was 0.20±0.57 (p = 0.001; CI 2.45 -3.35). EDSS of the entire cohort in the year before NTZ was 4.5 ± 1.94 and one year after was 3.8 ± 2.7 (p = 0.013; CI 0.16–1.36). At last follow up (38.3 ± 22.78 months) there were no cases of PML identified.
Natalizumab is highly effective and safe in Indian MS patients, with no cases of PML identified at last follow up.
To investigate the associations between hypovitaminosis D and disease activity in a cohort of relapsing remitting multiple sclerosis (RRMS) and clinically isolated syndrome (CIS) patients.
In 51 RRMS ...and 2 CIS patients on stable interferon-β-1b (IFN-β-1b) treatment recruited to the EVIDIMS study (Efficacy of Vitamin D Supplementation in Multiple Sclerosis (NCT01440062) baseline serum vitamin D levels were evaluated. Patients were dichotomized based on the definition of vitamin D deficiency which is reflected by a < 30 vs. ≥ 30 ng/ml level of 25-hydroxyvitamin D (25(OH)D). Possible associations between vitamin D deficiency and both clinical and MRI features of the disease were analyzed.
Median (25, 75% quartiles, Q) 25(OH)D level was 18 ng/ml (12, 24). Forty eight out of 53 (91%) patients had 25(OH)D levels < 30 ng/ml (
< 0.001). Patients with 25(OH)D ≥ 30 ng/ml had lower median (25, 75% Q) T2-weighted lesion counts 25 (24, 33) compared to patients with 25(OH)D < 30 ng/ml 60 (36, 84),
= 0.03; adjusted for age, gender and disease duration:
< 0.001. Expanded disability status scale (EDSS) score was negatively associated with serum 25(OH)D levels in a multiple linear regression, including age, sex, and disease duration (adjusted:
< 0.001).
Most patients recruited in the EVIDIMS study were vitamin D deficient. Higher 25(OH)D levels were associated with reduced T2 weighted lesion count and lower EDSS scores.
Background and purpose
The cervical and thoracic cross‐sectional spinal cord area (CS‐SCA) in multiple sclerosis (MS) correlates with disability, whilst such a correlation remains to be established ...in neuromyelitis optica spectrum disorder (NMOSD). Our aim was to clarify differences between MS and NMOSD in spinal cord segments where CS‐SCA is associated with disability.
Methods
The CS‐SCA at C2/C3, C3/C4, T8/T9 and T9/T10 vertebral disc levels was measured in 140 MS patients (111 with relapsing–remitting MS and 29 with progressive MS) and 42 NMOSD patients with anti‐aquaporin‐4 immunoglobulin G. Disability was evaluated by Expanded Disability Status Scale (EDSS) scores. Multivariate associations between CS‐SCA and disability were assessed by stepwise forward multiple linear regression.
Results
Thoracic CS‐SCA was significantly smaller in NMOSD patients than in MS patients even after adjusting for age, sex and disease duration (P = 0.002 at T8/T9), whilst there was no difference in cervical CS‐SCA between the two diseases. Cervical and thoracic CS‐SCA had a negative correlation with EDSS scores in MS patients (P < 0.0001 at C3/C4 and P = 0.0002 at T8/T9) whereas only thoracic CS‐SCA correlated with EDSS scores in NMOSD patients (P = 0.0006 at T8/T9). By multiple regression analyses, predictive factors for disability in MS were smaller cervical CS‐SCA, progressive course, older age and a higher number of relapses, whilst those in NMOSD were smaller thoracic CS‐SCA and older age.
Conclusions
Thoracic CS‐SCA is a useful predictive marker for disability in patients with NMOSD whilst cervical CS‐SCA is associated with disability in patients with MS.
The current study aims to compare injectable and oral first-line disease-modifying therapies (DMTs) for time to first relapse, time to confirmed disability progression (CDP), and time to ...discontinuation using a cohort of relapsing remitting multiple sclerosis (RRMS) patients, with data extracted from the Italian MS Register. This multicenter, observational, retrospectively acquired, and propensity-adjusted cohort study utilized RRMS-naïve patients from the Italian MS Register who started either injectable or oral first-line DMTs between January 1, 2010, and December 31, 2017, to evaluate the impact on disability outcomes in patients. Enrolled patients were divided into two groups, namely the injectable group (IG) and the oral group (OG). Of a cohort of 11,416 patients, 4602 were enrolled (3919 in the IG and 683 in the OG). The IG had a higher rate of women (67.3% vs 63.4%,
p
< 0.05) and a lower mean age (36.1 ± 10.9 vs 38.9 ± 11.8,
p
< 0.001). The event time to first relapse demonstrated a lower risk in the OG (HR = 0.58; CI 95% 0.48–0.72,
p
< 0.001). However, no differences were found between the two groups with respect to the risk of CDP (HR = 0.94; CI 95% 0.76–1.29,
p
= 0.941), while a lower risk of DMT was found in the OG (HR = 0.72; CI 95% 0.58–0.88,
p
= 0.002) for the event time to discontinuation. Real-world data from the Italian MS Register suggests that first-line oral DMTs are associated with a lower risk of experiencing a new relapse and of therapy discontinuation compared to injectable DMTs.
Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy, a newly defined autoimmune encephalitis, is an antibody-mediated meningoencephalomyelitis. The pathogenesis of the disease is still ...unclear. Nod-like receptor protein 3 (NLRP3) inflammasome is a complex composed of a variety of proteins that recognizes a variety of ligands and ultimately leads to the development of inflammatory responses. This is important for infectious, inflammatory, and immune diseases. The aims of this study were to detect levels of cerebrospinal fluid (CSF) NLRP3 inflammasome and inflammatory factors in autoimmune GFAP astrocytopathy patients and to study the relationships between these profiles. Twenty autoimmune GFAP astrocytopathy patients, 17 viral meningoencephalitis (VM) patients, and 16 controls (CTLs) were recruited. The levels of NLRP3 inflammasomes, interleukin (IL)-1β, IL-6, and IL-17 were measured by enzyme-linked immunosorbent assay (ELISA). The Expanded Disability Status Scale (EDSS) score was used to assess the severity of clinical manifestations. The results showed that the levels of NLRP3 inflammasome and inflammatory cytokines (IL-1β, IL-6, IL-17) were significantly more elevated in CSF of patients with autoimmune GFAP astrocytopathy than that in CTLs. When compared with VM patients, significantly elevated NLRP3 inflammasome was found in GFAP astrocytopathy patients, while the levels of IL-1β, IL-6, and IL-17 were not different between the two groups. Significant positive correlations were found between NLRP3 inflammasome and inflammatory cytokines and they were all positively related to the severity of the disease. Moreover, we found that patients with positive anti-GFAP antibodies had higher levels of NLRP3 and inflammatory factors. And the severity of the disease was positively correlated with GFAP antibody titers. Taken together, the results suggested that NLRP3 inflammasome was involved in the pathogenesis of autoimmune GFAP astrocytopathy. It can be used to assess the severity of the disease or act as a new target for the therapy.
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