Depression and anxiety are common complaints in patients with multiple sclerosis (MS). The study objective was to investigate the factor structure, internal consistency, and correlates of the ...Croatian version of the Hospital Anxiety and Depression Scale (HADS) in patients with MS. A total of 179 patients with MS and 999 controls were included in the online survey. All subjects completed the HADS and self-administered questionnaires capturing information of demographic, education level, disease-related variables, and the Multiple Sclerosis Impact Scale-29 (MSIS-29). Psychometric properties were examined by estimating the validity, reliability, and factor structure of the HADS in patients with MS. The two HADS subscales (anxiety and depression) had excellent internal consistencies (Cronbach's α value 0.82-0.83), and factor analysis confirmed a two-factor structure. The convergent validity of the HADS subscales appeared to be good due to the significant correlations between HADS and MSIS-29. Receiver operating characteristic (ROC) analysis indicates that the HADS subscales have a significant diagnostic validity for group differentiation. Hierarchical regression analysis using MSIS-29 subscales as criterion variables showed consistent evidence for the incremental validity of the HADS. The HADS is a reliable and valid self-assessment scale in patients with MS and is suggested to be used in clinical monitoring of the psychiatric and psychological status of patients with MS.
Sleep disturbances and poor sleep are a common complaint in the population with multiple sclerosis (MS) disease. The most commonly reported scale is the Pittsburgh Sleep Quality Index (PSQI), ...measuring seven components of sleep quality. Yet, till today, the PSQI instrument has not been validated in people with multiple sclerosis (pwMS). The objective of our study was to add precision in sleep quality assessment by investigating the psychometric properties of PSQI (factor structure, reliability, validity based on relations with other variables, cut-off scores) in pwMS. The cross-sectional study included data on a total of 87 patients with MS and 216 control subjects. Demographic information, education level, and MS-related variables were ascertained. Psychometric properties were examined by estimating the validity, including factor structure, metric invariance, and relations with other MS- and non-MS-related variables, reliability, and discrimination ability of the PSQI. The Croatian version of the PSQI had a two-factor structure which demonstrated loading and partial intercept invariance between pwMS and the control group. The global score and both subscales had high internal consistencies (McDonald's omega and Cronbach's alpha coefficients) in pwMS and showed expected relations with demographic and MS-related variables. PwMS differed significantly in the PSQI global score from the control groups, although receiver operating characteristics (ROC) curve analysis did not indicate a clear cut-off point. The PSQI is a reliable and valid scale and can be applied in clinical settings for assessing sleep quality in pwMS.
To our knowledge, there is no study investigating whether fatigue and depression as the most commonly reported symptoms in multiple sclerosis (MS) and obstructive sleep apnea (OSA) patients have ...arisen from primary mechanisms of MS or from secondary associated conditions such as OSA in MS patients. The aim of our survey study was to determine whether depression and fatigue in MS patients were associated with clinical features of OSA or with MS. We conducted a self-administered survey using four validated questionnaires (STOP-BANG, Epworth Sleepiness Scale, Fatigue Severity Scale and The Center for Epidemiologic Studies Depression Scale-Revised) in 28 consecutive outpatients with proven MS. The prevalence of MS patients at an increased risk of OSA was 29% and age was positively correlated with this risk (p=0.019). None of the clinical features of MS patients (subtype, disability status, disease duration, modifying therapy, other medication) was correlated with depression and fatigue. On the contrary, excessive daytime sleepiness as a hallmark of OSA was significantly and positively associated with the level of depressive symptoms (p=0.004) and level of fatigue (p=0.015). Also, depression was significantly and positively correlated with the increased risk of OSA (p=0.015) and age of MS patients (p=0.016). Finally, a significant positive correlation was found between fatigue severity and level of depressive symptoms (p=0.003). OSA is a common disorder in MS patients. The clinical features and risk factors for OSA in MS patients are associated with the two most commonly reported symptoms of depression and fatigue, thus supporting the hypothesis that both symptoms are due to a secondary condition in MS.
Cognitive impairment is a common complaint in people with multiple sclerosis (pwMS). The study objective was to determine the psychometric properties of the letter digit substitution test (LDST) that ...measures information processing speed and to investigate the impact of relevant predictors of LDST achievement in pwMS. The design was cross-sectional. The study included 87 pwMS and 154 control subjects. The validity of LDST was examined, and a hierarchical regression model was used to explore relevant predictors of LDST success. The LDST had excellent construct validity, as expressed by differences between pwMS and control subjects. Convergent validity of the LDST was supported by a significant moderate correlation with the expanded disability status scale (EDSS) (ρ = -0.36;
< 0.05) and a significantly strong correlation with the multiple sclerosis impact scale (MSIS-29) physical subscale (r = -0.64;
< 0.01). The LDTS score well differentiated the pwMS considering age, education, EDSS, disease duration, comorbidity, and medication therapy. Using the LDST as a criterion variable in pwMS results showed consistent evidence for the age, education, and EDSS impact on LDST performance. The best cut-off score of ≤35 discriminated the control and MS group. LDST proved to be a valid test for assessing information processing speed in pwMS.
Hepatic encephalopathy (HE) is a brain dysfunction caused by liver failure. Clinically, it can manifests as a wide spectrum of neurological or psychiatric abnormalities. This report presents a case ...of a 43-year-old male with HE and asymmetric kinetic, postural and resting tremor of upper extremities. Magnetic resonance imaging (MRI) of the brain showed signal abnormalities in numerous areas. The patient underwent liver transplantation and six months after normalization of liver function, tremor as well as brain MRI abnormalities almost completely regressed. This case re-port presents the asymmetric and reversible kinetic, postural and resting tremor of upper extremities as part of the spectrum of neurological abnormalities in HE.
To our knowledge, there is no study investigating whether fatigue and depression as the most commonly reported symptoms in multiple sclerosis (MS) and obstructive sleep apnea (OSA) patients have ...arisen from primary mechanisms of MS or from secondary associated conditions such as OSA in MS patients. The aim of our survey study was to determine whether depression and fatigue in MS patients were associated with clinical features of OSA or with MS. We conducted a self-administered survey using four validated questionnaires (STOP-BANG, Epworth Sleepiness Scale, Fatigue Severity Scale and The Center for Epidemiologic Studies Depression Scale-Revised) in 28 consecutive outpatients with proven MS. The prevalence of MS patients at an increased risk of OSA was 29% and age was positively correlated with this risk (p=0.019). None of the clinical features of MS patients (subtype, disability status, disease duration, modifying therapy, other medication) was correlated with depression and fatigue. On the contrary, excessive daytime sleepiness as a hallmark of OSA was significantly and positively associated with the level of depressive symptoms (p=0.004) and level of fatigue (p=0.015). Also, depression was significantly and positively correlated with the increased risk of OSA (p=0.015) and age of MS patients (p=0.016). Finally, a significant positive correlation was found between fatigue severity and level of depressive symptoms (p=0.003). OSA is a common disorder in MS patients. The clinical features and risk factors for OSA in MS patients are associated with the two most commonly reported symptoms of depression and fatigue, thus supporting the hypothesis that both symptoms are due to a secondary condition in MS. Key words: Depression; Fatigue; Multiple sclerosis; Obstructive sleep apnea Sukladno na?im saznanjima nema studije koja je istra?ivala nastaju li umor i depresija kao najucestaliji simptomi kod bolesnika s multiplom sklerozom (MS) i opstrukcijskom apnejom tijekom spavanja (OSA) primarnim mehanizmima MS ili iz sekundarnih povezanih stanja kao ?to je OSA kod bolesnika s MS. Cilj na?e anketne studije bio je utvrditi jesu li depresija i umor u bolesnika s MS povezani s klinickim obilje?jima OSA ili MS. Proveli smo anketu pomocu cetiri validirana upitnika (STOP-BANG, Epworthova ljestvica pospanosti, ljestvica te?ine umora i revidirana ljestvica depresije Centra za epidemiolo?ke studije) u 28 uzastopnih ambulantnih bolesnika s klinicki i paraklinicki dokazanom MS. Ucestalost bolesnika s MS s povecanim rizikom od nastanka OSA bila je 29%, a dob je bila u pozitivnoj korelaciji s tim rizikom (p=0,019). Nijedna od klinickih znacajka bolesnika s MS (podtip, status invaliditeta, trajanje bolesti, modificirajuca terapija, drugi lijekovi) nije bila u korelaciji s depresijom i umorom. Naprotiv, pretjerana pospanost tijekom dana kao obilje?je OSA bila je znacajno i pozitivno povezana s razinom simptoma depresije (p=0,004) i razinom umora (p=0,015). Takoder, depresija je znacajno i pozitivno korelirala s povecanim rizikom od OSA (p=0,015) i dobi bolesnika s MS (p=0,016). Konacno, utvrdena je znacajna pozitivna korelacija izmedu te?ine umora i simptoma depresije (p=0,003). OSA je cest poremecaj kod bolesnika s MS. Klinicke znacajke i cimbenici rizika za OSA u bolesnika s MS povezani su s dva najce?ce prijavljivana simptoma depresije i umora, podupiruci tako hipotezu da su oba simptoma posljedica sekundarnog stanja u MS. Kljucne rijeci: Depresija; Umor; Multipla skleroza; Opstrukcijska apneja tijekom spavanja
•Validation of FSS in people with multiple sclerosis (MS) in Croatia.•Factor analysis demonstrated a unidimensional structure.•Significant correlations were shown between FSS and MSIS-29 scale.•The ...best cut-off score for differentiating MS and control group is between 4 and 5.•The Croatian FSS version is a reliable and valid scale in people with MS.
Fatigue is a common symptom in people with multiple sclerosis (MS) and is evaluated and monitored with self-report questionnaires. The objective of this study was to determine the psychometric properties of the Croatian version of the Fatigue Severity Scale (FSS) in people with MS.
This is a retrospective cohort study conducted as an online survey from December 16, 2020, until January 13, 2021. A total of 179 people with MS and 999 control subjects completed FSS and self-administered questionnaires capturing information of demographic, education level, disease-related variables (duration of the disease, MS type, the expanded disability status scale (EDSS), and Multiple Sclerosis Impact Scale-29 (MSIS-29). Psychometric properties were examined by estimating the validity, reliability, and factor structure of the FSS scale in people with MS.
The Croatian version of the FSS had excellent internal consistency (Cronbach's α value 0.93). Factor analysis demonstrated a unidimensional structure. The concurrent validity of the FSS appeared to be satisfactory due to the significant differences between people with MS and control subjects (p < .05). The correlations between FSS and MSIS-29 physical (r = 0.60) and psychological (r = 0.50) subscale results confirmed the convergent validity of the FSS scale. Results also indicated that the best cut-off score is between 4 and 5 with a relatively high sensitivity and specificity.
The Croatian version of FSS was shown to have excellent psychometric properties in people with MS and can be used in the research and clinical settings evaluating fatigue in people with MS in Croatia.
Background and purpose: Inevitable lockdown scenario during the first wave of COVID-19 pandemic led to different approaches of medical care system worldwide. During this period, health care services ...faced theproblem of time, place and human resources management. However, in spite of redirecting health forces to fight this new and unknown virus in all countries, the need of routine treatment of all the other emergencies according to the guidelines remained present. The aim of our study was to analyse the acute stroke care in Croatia during first wave of Covid pandemic.Materials and methods: In order to achieve the rate of stroke patients admitted to hospital care in dedicated hospital stroke units and centers, we have gathered the data from four Croatian University Hospitals. We analyzed the number of hospitalized stroke patients from 1th of February to 1th of May 2020 and the proportions of patients treated with recanalization therapy.Results: Our results showed a slight decrease of number of all neurological patients who arrived to the Emergency Unit. In 2019 recanalization therapy was given to 158 patients (19%) vs 177 (26%) in 2020. Thrombolysis alone was given to 72 (9%) of patients in 2019 and to 68 (10%) of patients in 2020, while thrombectomy (with or without thrombolysis) has been performed to 86 (10%) vs 109 (16%) patients in 2019 and 2020 respectively.Conclusion: In conclusion, we did not notice less severe stroke patients or lower level of stroke care in University Hospitals.
Untreated multiple sclerosis (MS) irretrievably leads to severe neurological impairment. In European health care systems, patient access to disease modifying therapies (DMT) is often confined to more ...advanced stages of the disease because of restrictions in reimbursement. A discrepancy in access to DMTs is evident between West and East European countries. In order to improve access to DMTs for people with MS (pwMS) living in Croatia, the Croatian Neurological Society issued new recommendations for the treatment of relapsing MS. The aim of this article is to present these recommendations. The recommendations for platform therapies are to start DMT as soon as the diagnosis is made. If poor prognostic criteria are present (greater than or equal to 9 T2 or FLAIR lesions on the initial brain and spinal cord magnetic resonance imaging MRI or greater than or equal to 3 T1 lesions with postcontrast enhancement on the initial brain and spinal cord MRI or Expanded Disability Status Scale after treatment of the initial relapse greater than or equal to 3), high-efficacy DMT should be initiated. If pwMS experience greater than or equal to 1 relapse or greater than or equal to 3 new T2 lesions while on platform therapies, they should be switched to high-efficacy DMT. Further efforts should be made to enable early and unrestricted access to high-efficacy DMT with a freedom of choice of an appropriate therapy for expert physicians and pwMS. The improvement of access to DMT achieved by the implementation of national treatment guidelines in Croatia can serve as an example to national neurological societies from other Eastern European countries to persuade payers to enable early and unrestricted treatment of pwMS.
The aim of this study was to examine the impact of intravenous methylprednisolone therapy (IVMP) on the recovery of walking ability in patients experiencing multiple sclerosis (MS) relapses, to ...compare the responsiveness of walking-based measures, and to estimate the impact of different walking-based measures responsiveness on clinical trials.
The study included 49 consecutive patients with relapsing-remitting MS who received Solu-Medrol 1000 mg/day over 3 days for relapse with difficulties in walking. The following walking-based measures were administered before and a month after IVMP: the Multiple Sclerosis Walking Scale-12 (MSWS-12), the Expanded Disability Status Scale (EDSS), the 2-minute timed walk (2-minTW), the 25-foot walk test (25FWT), the Six Spot Step Test (SSST). All patients had worn the step activity monitor accelerometer (SAM) 1 week prior to IVMP was applied and wore it again the fourth week upon the corticosteroid therapy was completed. The SAM analysis utilized the average daily step count and data regarding frequency and intensity of walking over a continuous time interval. We examined: (1) the impact of IVMP on the recovery of walking ability; (2) the responsiveness of each walking-based measure; (3) the relative responsiveness of competing walking-based measures; and (4) the impact of different walking-based measures responsiveness on clinical trials.
All walking-based measures showed significant improvement of walking ability 1 month after the IVMP. The most responsive were MSWS-12 and EDSS. Different responsiveness implied a greater than 6-fold impact on sample size estimates.
All applied walking-based measures showed significant improvement of walking ability 1 month after the IVMP. Responsiveness of various walking-based measures notably differ, thus affecting sample size calculations.
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