Patients with the 'aggressive' form of multiple sclerosis accrue disability at an accelerated rate, typically reaching Expanded Disability Status Score (EDSS) ≥ 6 within 10 years of symptom onset. ...Several clinicodemographic factors have been associated with aggressive multiple sclerosis, but less research has focused on clinical markers that are present in the first year of disease. The development of early predictive models of aggressive multiple sclerosis is essential to optimize treatment in this multiple sclerosis subtype. We evaluated whether patients who will develop aggressive multiple sclerosis can be identified based on early clinical markers. We then replicated this analysis in an independent cohort. Patient data were obtained from the MSBase observational study. Inclusion criteria were (i) first recorded disability score (EDSS) within 12 months of symptom onset; (ii) at least two recorded EDSS scores; and (iii) at least 10 years of observation time, based on time of last recorded EDSS score. Patients were classified as having 'aggressive multiple sclerosis' if all of the following criteria were met: (i) EDSS ≥ 6 reached within 10 years of symptom onset; (ii) EDSS ≥ 6 confirmed and sustained over ≥6 months; and (iii) EDSS ≥ 6 sustained until the end of follow-up. Clinical predictors included patient variables (sex, age at onset, baseline EDSS, disease duration at first visit) and recorded relapses in the first 12 months since disease onset (count, pyramidal signs, bowel-bladder symptoms, cerebellar signs, incomplete relapse recovery, steroid administration, hospitalization). Predictors were evaluated using Bayesian model averaging. Independent validation was performed using data from the Swedish Multiple Sclerosis Registry. Of the 2403 patients identified, 145 were classified as having aggressive multiple sclerosis (6%). Bayesian model averaging identified three statistical predictors: age > 35 at symptom onset, EDSS ≥ 3 in the first year, and the presence of pyramidal signs in the first year. This model significantly predicted aggressive multiple sclerosis area under the curve (AUC) = 0.80, 95% confidence intervals (CIs): 0.75, 0.84, positive predictive value = 0.15, negative predictive value = 0.98. The presence of all three signs was strongly predictive, with 32% of such patients meeting aggressive disease criteria. The absence of all three signs was associated with a 1.4% risk. Of the 556 eligible patients in the Swedish Multiple Sclerosis Registry cohort, 34 (6%) met criteria for aggressive multiple sclerosis. The combination of all three signs was also predictive in this cohort (AUC = 0.75, 95% CIs: 0.66, 0.84, positive predictive value = 0.15, negative predictive value = 0.97). Taken together, these findings suggest that older age at symptom onset, greater disability during the first year, and pyramidal signs in the first year are early indicators of aggressive multiple sclerosis.
Patients with pediatric-onset multiple sclerosis (POMS) typically experience higher levels of inflammation with more frequent relapses, and though patients with POMS usually recover from relapses ...better than adults, patients with POMS reach irreversible disability at a younger age than adult-onset patients. There have been few randomized, placebo-controlled clinical trials of multiple sclerosis (MS) disease-modifying therapies (DMTs) in patients with POMS, and most available data are based on observational studies of off-label use of DMTs approved for adults. We assessed the effectiveness of natalizumab compared with fingolimod using injectable platform therapies as a reference in pediatric patients in the global MSBase registry.
This retrospective study included patients with POMS who initiated treatment with an injectable DMT, natalizumab, or fingolimod between January 1, 2006, and May 3, 2021. Patients were matched using inverse probability treatment weighting. The primary outcome was time to first relapse from index therapy initiation. Secondary study outcomes included annualized relapse rate; proportions of relapse-free patients at 1, 2, and 5 years; time to treatment discontinuation; and times to 24-week confirmed disability worsening and confirmed disability improvement.
A total of 1,218 patients with POMS were included in this analysis. Patients treated with fingolimod had a significantly lower risk of relapse than patients treated with injectable DMTs (hazard ratio HR, 0.49; 95% confidence interval CI, 0.29-0.83;
= 0.008). After adjustment for prior DMT experience in the unmatched sample, patients treated with natalizumab had a significantly lower risk of relapse than patients treated either with injectable DMTs (HR, 0.15; 95% CI 0.07-0.31;
< 0.001) or fingolimod (HR, 0.37; 95% CI 0.14-1.00;
= 0.049). The adjusted secondary study outcomes were generally consistent with the primary outcome or with previous observations. The findings in the inverse probability treatment weighting-adjusted patient populations were confirmed in multiple sensitivity analyses.
Our analyses of relapse risk suggest that natalizumab is more effective than fingolimod in the control of relapses in this population with high rates of new inflammatory activity, consistent with previous studies of natalizumab and fingolimod in adult-onset patients and POMS. In addition, both fingolimod and natalizumab were more effective than first-line injectable therapies.
This study provides Class II evidence that patients with POMS treated with natalizumab had a lower risk of relapse than those with fingolimod.
Purpose
This study aimed to examine the effects of a psychoeducational program on the cognitive emotion regulation levels of individuals with multiple sclerosis (MS).
Design and Method
This study ...followed a randomized, controlled quasi‐experimental design. A questionnaire including descriptive characteristics and disease‐related characteristics and the Cognitive Emotion Regulation Questionnaire were used in the data collection.
Findings
The difference between the pretest–posttest and follow‐up test mean scores of the patients in the experimental group was significant (p < 0.05).
Conclusion
The psychoeducation program based on the rational emotional behavioral approach increased the use of cognitive emotion regulation strategies in individuals with MS.
Whether progression independent of relapse activity (PIRA) heralds earlier onset of secondary progressive multiple sclerosis (SPMS) and more rapid accumulation of disability during SPMS remains to be ...determined. We investigated the association between early PIRA, relapse-associated worsening (RAW) of disability and time to SPMS, subsequent disability progression and their response to therapy.
This observational cohort study included patients with relapsing-remitting multiple sclerosis (RRMS) from the MSBase international registry across 146 centres and 39 countries. Associations between the number of PIRA and RAW during early multiple sclerosis (MS) (the initial 5 years of MS onset) were analysed with respect to: time to SPMS using Cox proportional hazards models adjusted for disease characteristics; and disability progression during SPMS, calculated as the change of Multiple Sclerosis Severity Scores over time, using multivariable linear regression.
10 692 patients met the inclusion criteria: 3125 (29%) were men and the mean MS onset age was 32.2 years. A higher number of early PIRA (HR=1.50, 95% CI 1.28 to 1.76, p<0.001) and RAW (HR=2.53, 95% CI 2.25 to 2.85, p<0.001) signalled a higher risk of SPMS. A higher proportion of early disease-modifying therapy exposure (per 10%) reduced the effect of early RAW (HR=0.94, 95% CI 0.89 to 1.00, p=0.041) but not PIRA (HR=0.97, 95% CI 0.91 to 1.05, p=0.49) on SPMS risk. No association between early PIRA/RAW and disability progression during SPMS was found.
Early disability increase during RRMS is associated with a greater risk of SPMS but not the rate of disability progression during SPMS. The deterioration associated with early relapses represents a potentially treatable risk factor of SPMS.
Australian New Zealand Clinical Trials Registry (ACTRN12605000455662).
Health-related quality of life shows how a person is affected physically, emotionally perceptually and socially by the disease, the consequent disability and treatment and rehabilitation processes. ...It is important to evaluate the quality of life of patients and their caregivers with generic or specific scales during the diagnosis, treatment, and follow-up stages of neurological diseases. In studies conducted in our country scales with Turkish validity and reliability must be used. Additionally it should be noted that quality-of-life scales do not measure every parameter with the same sensitivity. Keywords: Generic scales, neurological diseases, quality of life, specific scales. Saglikla ilgili yasam kalitesi, kisinin hastaliktan, onun yarattigi engellilikten, tedavi ve rehabilitasyon süreçlerinden bedensel, duygusal, algisal ve sosyal olarak nasil etkilendigini gösterir. Nörolojik hastaliklarin tani, tedavi ve takip asamalarinda, hastalarin ve bakim verenlerin yasam kalitesinin jenerik veya özgül ölçeklerle degerlendirilmesi önemlidir. ?lkemizde yapilan çalismalarda, mutlaka Türkçe geçerlik ve güvenirligi yapilmis ölçekler kullanilmalidir. Ayrica, yasam kalitesi ölçeklerinin her parametreyi ayni hassasiyetle ölçmedigi unutulmamalidir. Anahtar sözcükler: Jenerik ölçekler, nörolojik hastaliklar, yasam kalitesi, özgün ölçekler.
Objective: To determine the contribution of gait analysis to the differentiation and diagnosis of these diseases by examining the walking videos of individuals diagnosed with multiple sclerosis (MS) ...and Parkinson's disease (PD) using the deep learning method. Materials and Methods: A hybrid system based on Convolutional Neural Networks was developed for the detection of MS and PD based on gait analysis. The patients were walked on a flat surface of approximately 14 meters and video recordings were taken from the front, back and both sides during walking. Videos of a total of 28 patients, 12 PD and 16 MS patients, were used in the study. Results: In the study, the data was analyzed using machine learning techniques and the best accuracy score was obtained as 87.5%. Conclusion: The accuracy rate of machine learning models in the diagnosis, follow-up and treatment process of patients such as MS, PD and other neurological diseases has been examined and it has been concluded that it is inevitable that these methods will be used much more over time. Keywords: Machine learning, neurological diseases, gait analysis, kinetic analysis, kinematic analysis Amac: Derin ogrenme yontemi kullanilarak multipl skleroz (MS) ve Parkinson hastaligi (PH) tanisi alan bireylere ait yurume videolari incelenerek, yurume analizinin bu hastaliklarin birbirinden ayirimina ve taniya olan katkisinin belirlenmesidir. Gerec ve Yontem: Yurume analizine dayali MS ve PH'lerin tespiti icin Evrisimsel Sinir Aglarina dayali hibrit bir sistem gelistirilmistir. Hastalar yaklasik 14 metrelik duz bir zeminde yurutulmus ve yuruyus esnasinda on, arka ve her iki yanlardan video kayitlari alinmistir. Calismada 12 PH ve 16 MS hastasi olmak uzere toplam 28 hastaya ait videolar kullanilmistir. Bulgular: Calismada makine ogrenimi teknikleri kullanilarak veriler analiz edilmis ve en iyi dogruluk skoru %87,5 olarak elde edilmistir. Sonuc: MS, PH gibi hasta gruplarinda ve diger norolojik hastaliklarda hastalarinin tani, takip ve tedavi surecinde makine ogrenmesi modellerinin dogruluk orani incelenmis ve zamanla bu yontemlerden cok daha fazla yararlanilacaginin kacinilmaz oldugu gorusmustur. Anahtar Kelimeler: Makine ogrenimi, norolojik hastaliklar, yurume analizi, kinetik analiz, kinematik analiz
The multiple sclerosis (MS) landscape has changed over the past two decades across the world and in the Middle East. The Middle East is an ethnically diverse region located between 12° and 42° of ...latitude and 35° and 54° of longitude and varying altitudes. The magnitude of the shifts observed in the epidemiology and management of MS differ in each region and from country to country.
The aim of this study was to provide a clinicodemographic overview of the cohorts of patients contributed to MSBase, a large international MS registry, in the Middle East and describe disease-modifying treatment (DMT) utilization in the different countries within the region. Understanding the differences between these cohorts is integral to interpretation of the studies conducted using registry data and provides insight into clinical practice in these cohorts.
The MSBase registry was searched for patients with MS or clinically isolated syndrome from the Middle Eastern countries with data captured between 2009 and 2018. In 2-year epochs, and with special focus on the most recent epoch (2017-2018), we explored the demographic, clinical characteristics and treatment exposures of the studied cohorts and reported the results using standard descriptive statistics.
Over the 10-year study period, 13,356 patients from 17 centers in 8 Middle Eastern countries fulfilled the inclusion criteria. The represented countries were Egypt, Iran, Kuwait, Lebanon, Oman, Saudi Arabia, Turkey and the United Arab Emirates. Overall, the represented cohort was young (median 36 years, quartiles 29-45) and captured relatively early after the onset of MS (median disease duration < 10 years, quartiles 3-12). The relapsing-remitting phenotype was the most prevalent phenotype in all countries (73-97%) and the highest proportion of progressive MS was reported in Saudi Arabia (12%). Median Expanded Disability Status Scale (EDSS) ranged from 0 to 3, depicting a mildly disabled cohort, with the exception of Saudi Arabia where the median EDSS was 4 (quartiles 1.5-6.5). The median relapse frequency was highest in Lebanon (median 1.03, 95% CI 0.94-1.16) followed by Egypt (median 1.02, 95% CI 0.89-1.24) and lowest in Saudi Arabia (median 0.70, 95% CI 0.58-0.95) and Kuwait (median 0.75, 95% CI 0.71-0.80). The treatment landscape greatly varied between different countries. Platform injectable therapies were mostly utilized in Egypt, Iran and Turkey (86%, 79% and 53%, respectively), while oral therapies and monoclonal antibodies were more commonly used in Kuwait, Lebanon and the United Arab Emirates (87.2%, 67.3% and 58.7%, respectively).
Patients in the Middle East enrolled in a large multinational registry are representative of the general MS population. The spectrum of therapies used in the individual countries, however, is highly variable. Further studies that include rural and non-academic practices are needed to enhance our understanding of the MS cohorts in the Middle East.
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