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Background: The mobile device diffusion has increasingly highlighted the opportunity to collect patient-reported outcomes (PROs) through electronic patient-reported outcomes measurements (ePROMs) during the clinical routine. Despite the ePROMs promises and advantages, the equivalence when a PRO measure is moved from the original paper-and-pencil to the electronic version is still little investigated. This study aims at evaluating equivalence between PROMs and ePROMs self-administration in people with multiple sclerosis (PwMS); in addition, preference of self-administration type was evaluated. Methods: The Manual Ability Measure-36 (MAM-36) and Fatigue Severity Scale (FSS) were selected for the equivalence test. The app ABOUTCOME was developed through a user-centered design approach to administer the questionnaires on tablet. Both paper-and-pencil and electronic versions were randomly self-administered. Intrarater reliability between both versions was evaluated through the intraclass correlation coefficient (ICC, excellent for values ≥ 0.75). Results: Fifty PwMS (35 females) participated to the study (mean age: 54.7±11.0 years, disease course: 27 relapsing-remitting and 23 progressive; mean EDSS: 4.7±1.9; mean disease duration: 13.3±9.5 years). No statistically significant differences were found for the means total scores of MAM-36 (p = 0.61) and FSS (p = 0.78). The ICC value for MAM-36 and FSS was excellent (0.98 and 0.94, respectively). Most of participants preferred the tablet version (84%). Conclusion: The results of the study provide evidence about the equivalence between the paper-and-pencil and electronic versions of PROs administration. In addition, PwMS prefer electronic methods rather than paper because the information can be provided more efficiently and accurately. The results could be easily extended to other MS PROs. [ABSTRACT FROM AUTHOR]

The article examines the impact of dynamic neuromuscular stabilization versus core stabilization on balance enhancement in multiple sclerosis patients. It highlights superior and enduring improvements in balance associated with dynamic neuromuscular stabilization compared to core stabilization, underscoring its potential as a more effective therapeutic intervention for managing balance impairments in this patient population.

The article discusses the efficacy of dynamic neuromuscular stabilization compared to core stabilization in improving balance among patients with multiple sclerosis. Topics include the methodology and findings of the study, emphasizing sustained benefits and superior outcomes associated with dynamic neuromuscular stabilization over time, offering significant implications for therapeutic approaches in multiple sclerosis management.

Autoimmune diseases are an important field for the development of bone marrow transplantation, or hematopoietic stem cell transplantation. In Europe alone, almost 3000 procedures have been registered so far. The Brazilian Society for Bone Marrow Transplantation (Sociedade Brasileira de Transplantes de Medula Óssea) organized consensus meetings for the Autoimmune Diseases Group, to review the available literature on hematopoietic stem cell transplantation for autoimmune diseases, aiming to gather data that support the procedure for these patients. Three autoimmune diseases for which there are evidence-based indications for hematopoietic stem cell transplantation are multiple sclerosis, systemic sclerosis and Crohn's disease. The professional stem cell transplant societies in America, Europe and Brazil (Sociedade Brasileira de Transplantes de Medula Óssea) currently consider hematopoietic stem cell transplantation as a therapeutic modality for these three autoimmune diseases. This article reviews the evidence available.

There is a gap in research on how best to support exercise in moderate to severe MS. The objective of this study is to share perspectives of people living with MS and physiotherapists on their experiences in a randomized clinical trial of online physiotherapy vs. an active comparator. Semi-structured exit interviews were conducted with volunteer participants from the online and comparator arms of the trial, and focus groups were held with study physiotherapists. Transcripts were analyzed using reflexive thematic analysis. Perspectives from participants with MS yielded three themes: usability of their program, utility of their program, and motivation to participate. Visual and dexterity impairments limited the usability of the online program. Having an opportunity "to be pushed" was valued by participants in both trial arms. Motivation to exercise was variable, and participants desired periodic face-to-face contact with their physiotherapists. Perspectives from trial physiotherapists yielded similar and complementary findings concerning usability and utility. Participants with MS and physiotherapists found the online physiotherapy platform useful for supporting exercise, yet they identified some limitations. As the appeal of online platforms has increased since the pandemic, it will be important to consider the needs of people with moderate to severe MS. NCT03039400. People with moderate-to-severe MS and physiotherapists involved in a clinical trial found online physiotherapy useful for supporting exercise. Physiotherapists and participants using the online program desired improved platform accommodations for people living with MS with visual and dexterity impairments. Physiotherapists and people living with MS from both the online exercise program and comparator groups perceived a need for more face-to-face contact and opportunities to build therapeutic alliance. Perspectives from prescribing physiotherapists and people living with MS about supporting exercise online may have practice implications during and post-pandemic. [ABSTRACT FROM AUTHOR]

During the past decades autoimmune diseases have been usually treated with immunosuppressive drugs mostly active on T-Cell mediated responses. Only in recent years, with our extended knowledge of the pathogenic mechanisms of autoreactive disorders and the tremendous development of new therapeutic monoclonal antibodies, anti-B-Cell therapies have emerged as a new option for treating autoimmune diseases. The rationale for this changeover from T-Cell to B-Cell targeted therapies resides in the recently accumulated evidence of the role of B-Cells in the pathogenesis of autoimmune diseases and in the generation of tissue damage. Targeting memory and effector BCells may then disrupt the production of pathogenic antibodies, counteract the role of B-Cells in sustaining antigen presentation to T-Cells and block the synthesis of B-Cell activation cytokines. The anti-CD20 monoclonal antibody Rituximab was first introduced more than 20 years ago for the treatment of CD20+ chronic B-lymphoproliferative disorders, and was then successfully experimented in the treatment of an ever-increasing spectrum of autoimmune diseases. Newer anti-CD20 monoclonal antibodies have been introduced more recently, which vary in their biological effects. The need for laboratory indicators that may help the rational usage and follow-up of anti-CD20 treatments has now emerged, due to the high variability of individual response, to the markedly different outcomes in the various diseases and to the controversial role of pathogenic autoantibodies as indicators of disease activity. Flow cytometric (FCM) analyses to identify and enumerate the B-cell functional subsets in the peripheral blood have been developed in recent years. They can be used to assess the degree and the persistence of memory B-Cell depletion, the quality and the timing of B-Cell reconstitution, along with the highly sensitive FCM counting technique needed for the detection of extremely low cell levels. The long-term aim of this innovative approach is to provide clinicians with a tool for a safer and more rational usage of anti-CD20 agents.

Background and Purpose: Multiple sclerosis (MS) is an unpredictable disease characterised by a highly variable disease onset and clinical course. Three main clinical phenotypes have been described. However, distinguishing between the two progressive forms of MS can be challenging for clinicians. This article examines how the diagnostic definitions of progressive MS impact clinical research, the design of clinical trials and, ultimately, treatment decisions. Methods: We carried out an extensive review of the literature highlighting differences in the definition of progressive forms of MS, and the importance of assessing the extent of the ongoing inflammatory component in MS when making treatment decisions. Results: Inconsistent results in phase III clinical studies of treatments for progressive MS, may be attributable to differences in patient characteristics (e.g., age, clinical and radiological activity at baseline) and endpoint definitions. In both primary and secondary progressive MS, patients who are younger and have more active disease will derive the greatest benefit from the available treatments. Conclusions: We recommend making treatment decisions based on the individual patient's pattern of disease progression, as well as functional, clinical and imaging parameters, rather than on their clinical phenotype. Because the definition of progressive MS differs across clinical studies, careful selection of eligibility criteria and study endpoints is needed for future studies in patients with progressive MS. [ABSTRACT FROM AUTHOR]

Highlights: We review the cell-based pathophysiology of MS to provide a firm basis for understanding of the processes involving MSCs and their exosomes in MS treatment. MS is an autoimmune neurodegenerative disease targeting the CNS. MSCs considered as promising therapeutic essence in MS with their cell-cell contact, paracrine and differentiation abilities. We review the properties of exosomes, a component of the MSC secretome. We highlight the potential of MSC-derived exosomes as a novel therapy for MS and clarify the differences between MSC-based and exosome-based therapies. Multiple sclerosis (MS) is a chronic neurodegenerative, inflammatory, and demyelinating disease of the central nervous system (CNS). Current medicines are not sufficient to control the inflammation and progressive damage to the CNS that is known in MS. These drawbacks highlight the need for novel treatment options. Cell therapy can now be used to treat complex diseases when conventional therapies are ineffective. Mesenchymal stem cells (MSCs) are a diverse group of multipotential non-hematopoietic stromal cells which have immunomodulatory, neurogenesis, and remyelinating capacity. Their advantageous effects mainly rely on paracrine, cell–cell communication and differentiation properties which introduced them as excellent candidates for MS therapy. Exosomes, as one of the MSCs secretomes, have unique properties that make them highly promising candidates for innovative approach in regenerative medicine. This review discusses the therapeutic potential of MSCs and their derived exosomes as a novel treatment for MS, highlighting the differences between these two approaches. [ABSTRACT FROM AUTHOR]

Background: While substantial progress has been made in the development of disease-modifying medications for multiple sclerosis (MS), a high percentage of treated patients still show progression and persistent inflammatory activity. Autologous haematopoietic stem cell transplantation (AHSCT) aims at eliminating a pathogenic immune repertoire through intense short-term immunosuppression that enables subsequent regeneration of a new and healthy immune system to re-establish immune tolerance for a long period of time. A number of mostly open-label, uncontrolled studies conducted over the past 20 years collected about 4000 cases. They uniformly reported high efficacy of AHSCT in controlling MS inflammatory disease activity, more markedly beneficial in relapsing-remitting MS. Immunological studies provided evidence for qualitative immune resetting following AHSCT. These data and improved safety profiles of transplantation procedures spurred interest in using AHSCT as a treatment option for MS. Objective: To develop expert consensus recommendations on AHSCT in Germany and outline a registry study project. Methods: An open call among MS neurologists as well as among experts in stem cell transplantation in Germany started in December 2021 to join a series of virtual meetings. Results: We provide a consensus-based opinion paper authored by 25 experts on the up-to-date optimal use of AHSCT in managing MS based on the Swiss criteria. Current data indicate that patients who are most likely to benefit from AHSCT have relapsing-remitting MS and are young, ambulatory and have high disease activity. Treatment data with AHSCT will be collected within the German REgistry Cohort of autologous haematopoietic stem CeLl trAnsplantation In MS (RECLAIM). Conclusion: Further clinical trials, including registry-based analyses, are urgently needed to better define the patient characteristics, efficacy and safety profile of AHSCT compared with other high-efficacy therapies and to optimally position it as a treatment option in different MS disease stages. Plain language summary: Autologous haematopoietic stem cell transplantation for multiple sclerosis Substantial progress has been made in the development of disease-modifying medications for multiple sclerosis (MS) during the last 20 years. However, in a relevant percentage of patients, the disease cannot completely be contained. Autologous haematopoietic stem cell transplantation (AHSCT) enables rebuilding of a new and healthy immune system and to potentially stop the autoimmune disease process for a long time. A number of studies documenting 4000 cases cumulatively over the past 20 years reported high efficacy of AHSCT in controlling MS inflammatory disease activity. These data and improved safety profiles of the treatment procedures spurred interest in using AHSCT as a treatment option for MS. An open call among MS neurologists as well as among experts in stem cell transplantation in Germany started in December 2021 to join a series of video calls to develop recommendations and outline a registry study project. We provide a consensus-based opinion paper authored by 25 experts on the up-to-date optimal use of AHSCT in managing MS. Current data indicate that patients are most likely to benefit from AHSCT if they are young, ambulatory, with high disease activity, that is, relapses or new magnetic resonance imaging (MRI) lesions. Treatment data with AHSCT will be collected within the German REgistry Cohort of autoLogous haematopoietic stem cell transplantation MS (RECLAIM). Further clinical trials including registry-based analyses and systematic follow-up are urgently needed to better define the optimal patient characteristics as well as the efficacy and safety profile of AHSCT compared with other high-efficacy therapies. These will help to position AHSCT as a treatment option in different MS disease stages. [ABSTRACT FROM AUTHOR]

Background: The adverse effect of excessive salt intake has been recognized in decades. Researchers have mainly focused on the association between salt intake and hypertension. However, studies in recent years have proposed the existence of extra‐renal sodium storage and provided insight into the immunomodulatory function of sodium. Objectives: In this review, we discuss the modulatory effects of high salt on various innate and adaptive immune cells and immune‐regulated diseases. Methods: We identified papers through electronic searches of PubMed database from inception to March 2022. Results: An increasing body of evidence has demonstrated that high salt can modulate the differentiation, activation and function of multiple immune cells. Furthermore, a high‐salt diet can increase tissue sodium concentrations and influence the immune responses in microenvironments, thereby affecting the development of immune‐regulated diseases, including hypertension, multiple sclerosis, cancer and infections. These findings provide a novel mechanism for the pathology of certain diseases and indicate that salt might serve as a target or potential therapeutic agent in different disease contexts. Conclusion: High salt has a profound impact on the differentiation, activation and function of multiple immune cells. Additionally, an HSD can modulate the development of various immune‐regulated diseases. [ABSTRACT FROM AUTHOR]

Introduction: An impaired sense of smell has a remarkable impact on the quality of life. It is seen in a variety of neurodegenerative diseases such as Parkinson disease. In this study, we assessed the olfactory function in patients with Multiple Sclerosis (MS) by Sniff Magnitude Test (SMT). Methods: A cross-sectional study was conducted on 48 patients with MS. A questionnaire, including demographic and clinical variables, was completed for each patient. The SMT was used for the evaluation of olfactory function. Results: Olfactory dysfunction was found in 14.6% of patients (8.3% hyposmia and 6.3% anosmia). Older age, longer disease duration, higher hospital admission rate, lower minimental status examination score, and secondary progressive course of MS were significantly related to olfactory dysfunction. Conclusion: Secondary progressive MS and markers of advanced disease toward neurodegenerative phase (including older age, longer disease duration, and lower cognitive function) can be associated with olfactory dysfunction in MS patients. [ABSTRACT FROM AUTHOR]

Introduction: Position sense, one of the most accurate senses in the body, makes everyone aware of the state of the body in space. This sense is an essential ability in maintaining physical health and avoiding injury. Deficits in position sense cause balance impairments in people with mild Multiple Sclerosis (MS). Position sense requires instant and coordinated communication between the central nervous system and peripheral nervous system, while in patients with MS, communication between the brain and other parts of the body is disrupted. This study aims to compare the position sense of knee joint in people with MS and healthy subjects. Materials and Methods: Ten healthy subjects with the Mean±SD age of 27.6±3.71 years and 10 persons with MS disease and the Mean±SD age of 31.40±3.50 years participated in this study. For evaluating their position sense of knee joint, they flexed their knees (from 90 to 45 degrees) four times, and then a software calculated their repositioning errors. Results: No significant changes in repositioning errors (constant, variable, absolute) were observed in MS patients, and the control group (P˃0.05). Conclusion: The results indicate that mild MS disease cannot disturb the position sense of knee joint. [ABSTRACT FROM AUTHOR]

Introduction: Dynamic Gait Index (DGI) has been used as a valid and reliable tool to assess balance performance in various populations. However, it has been translated into the Persian language and has shown perfect psychometric properties in the elderly population. The Persian version in Multiple Sclerosis (MS) population was validated, but its reliability has not been examined. The aim of the current study was to investigate the inter-rater reliability, test-retest reliability, and internal consistency of the Persian version of DGI in MS patients. Materials and Methods: A total of 62 participants took part in the reliability process. The sample included 51 females and 11 males. Inter-rater reliability was assessed by the agreement of the results obtained by two occupational therapists. We considered a 3-day interval for the first and second data collection. Test-retest and inter-rater reliability were measured with the Intraclass Correlation Coefficient (ICC2, 1) and internal consistency was evaluated with the Cronbach alpha. Results: The Persian version of DGI showed excellent inter-rater reliability (ICC for total score was 0.98 and ICC for the items ranged from 0.83 to 0.96) and test-retest reliability (ICC for the overall score was 0.97 and ICC for the items ranged from 0.82 to 0.96). The Cronbach alpha of the Persian version of DGI was 0.87. Conclusion: The Persian version of DGI can be used as a reliable tool for dynamic balance measurement of MS patients in clinical settings and research studies. [ABSTRACT FROM AUTHOR]

Background: The prevalence of osteoporosis is reported differently. We designed this systematic review and meta-analysis to estimate pooled prevalence of osteoporosis and osteopenia in patients with MS.Methods: Independently, two researchers searched PubMed, Scopus, EMBASE, Web of Science, and google scholar along with gray literature (conference abstracts and references of the references) up to March 2021. We collected data regarding first author, country of origin, number of enrolled patients, number cases with osteoporosis/ osteopenia, mean age, F/M ratio, mean EDSS, and mean duration of the disease.Results: Literature search revealed 847 articles and 658 remained after deleting duplicates. Finally, 29 original articles and 6 conference papers remained for meta-analysis. A total of 13,906 patients were evaluated. The pooled prevalence of osteoporosis was 17% (95% CI: 14-20%) (I2 = 90.4%, p < 0.001). The pooled prevalence of osteopenia was 43% (95% CI: 35-51%) (I2 = 97.9%, p < 0.001).Conclusion: Osteoporosis/osteopenia should be considered in patients with MS. [ABSTRACT FROM AUTHOR]

Introduction: Multiple Sclerosis (MS) is a disease of central nervous system that mainly causes lesions or plaques in the spinal cord and brain. The purpose of this study was to analyze the relation between c.-813C>T (rs2070744) and c.894G>T (rs1799983) polymorphisms of NOS3 gene and MS in Iranian patients. Methods: A total of 78 patients with MS and 80 healthy controls were screened for NOS3 (rs2070744 and rs1799983) Single Nucleotide Polymorphisms (SNPs) by tetra-primer multiplex ARMS-PCR and PCR-RFLP. Results: Genotype frequencies of the c.-813C>T polymorphism in patients compared to controls were as follows: 53.8% to 80.0% for TT genotype, 41.0% to 18.8% for TC genotype, and 5.1% versus 1.2% for CC genotype (P=0.001). The frequencies of GG genotype was 57.7% and 78.8% and for GT genotype of c.894G>T polymorphism in patients compared to control subjects was 42.3% and 21.2%, respectively (P=0.004). Conclusion: Our results indicate that the studied NOS3 polymorphisms may be associated with MS in Iranian patients. [ABSTRACT FROM AUTHOR]

The article inform people with progressive multiple sclerosis and expanded disability status scale scores are at the risk of physical inactivity, face barriers to adequate physical inactivity and require ongoing intervention to sustain the benefits of increased physical activity. Topic include comparison between standing frame intervention and other interventions for people with Expanded Disability Status Scale scores of 6.5 is warranted to assess the feasibility and cost-effectiveness.

The article inform the number of enrolled participants and the percentage of those that desired to continue the intervention post-trial (70%) suggest that people with progressive multiple sclerosis are receptive to this intervention. Topic include participants were required to manoeuvre into the standing frame or need assistance from one person, limiting feasibility of this intervention for people with impairment or without an able-bodied caregiver to assist them.

Background and objectives: Treatment of spasticity poses a major challenge given the complex clinical presentation and variable efficacy and safety profiles of available drugs. We present a systematic review of the pharmacological treatment of spasticity in multiple sclerosis (MS) patients. Methods: Controlled trials and observational studies were identified. Scientific evidence was evaluated according to pre-specified levels of certainty. Results: The evidence supports the use of baclofen, tizanidine and gabapentin as first-line options. Diazepam or dantrolene could be considered if no clinical improvement is seen with the previous drugs. Nabiximols has a positive effect when used as add-on therapy in patients with poor response and/or tolerance to first-line oral treatments. Despite limited evidence, intrathecal baclofen and intrathecal phenol show a positive effect in severe spasticity and suboptimal response to oral drugs. Conclusion: The available studies on spasticity treatment offer some insight to guide clinical practice but are of variable methodological quality. Large, well-designed trials are needed to confirm the effectiveness of antispasticity agents and to produce evidence-based treatment algorithms. [ABSTRACT FROM AUTHOR]

The article comments on "Task-oriented gait training" that focuses on the safe and correct use of a walking aid that can reduce falls in people with multiple sclerosis.

The article focuses on Task-oriented gait training that focuses on the safe and correct use of a walking aid may reduce falls in people with multiple sclerosis.

The article focuses on the effectiveness of inpatient rehabilitation for improving activities and participation in patients with multiple sclerosis (MS). It mentions whilst quality of life appeared to ‘substantially' improve on all measures at discharge within the treatment group; and also mentions comprehensive description of the intervention and its context is therefore essential to reliably implement interventions shown to be useful, and replicate or build on research findings.

The article focuses on 18 to 65 years aged patients with Multiple Sclerosis (MS) who were referred for 4 weeks of inpatient rehabilitation, with an expanded disability status scale score. It mentions the treatment group received immediate admission for multidisciplinary inpatient rehabilitation; and also mentions multidisciplinary inpatient rehabilitation had small and inconsistent effects on parameters of health-related quality of life in people with MS at 6 months.

Background: Haematopoietic stem cell transplantation (HSCT) has been tried in the last 15 years as a therapeutic option in patients with poor-prognosis autoimmune disease who do not respond to conventional treatments. Worldwide, more than 600 patients with multiple sclerosis (MS) have been treated with HSCT, most of them having been recruited in small, single-centre, phase 1–2 uncontrolled trials. Clinical and magnetic resonance imaging outcomes from case series reports or Registry-based analyses suggest that a major response is achieved in most patients; quality and duration of response are better in patients transplanted during the relapsing–remitting phase than in those in the secondary progressive stage.Objectives: An interdisciplinary group of neurologists and haematologists has been formed, following two international meetings supported by the European and American Blood and Marrow Transplantation Societies, for the purpose of discussing a controlled clinical trial, to be designed within the new scenarios of evolving MS treatments.Conclusions: Objectives of the trial, patient selection, transplant technology and outcome assessment were extensively discussed. The outcome of this process is summarized in the present paper, with the goal of establishing the background and advancing the development of a prospective, randomized, controlled multicentre trial to assess the clinical efficacy of HSCT for the treatment of highly active MS. [ABSTRACT FROM AUTHOR]

Multiple sclerosis is a complex, autoimmune-mediated disease of the central nervous system characterized by inflammatory demyelination and axonal/neuronal damage. The approval of various disease-modifying therapies and our increased understanding of disease mechanisms and evolution in recent years have significantly changed the prognosis and course of the disease. This update of the Multiple Sclerosis Therapy Consensus Group treatment recommendation focuses on the most important recommendations for disease-modifying therapies of multiple sclerosis in 2021. Our recommendations are based on current scientific evidence and apply to those medications approved in wide parts of Europe, particularly German-speaking countries (Germany, Austria, and Switzerland). [ABSTRACT FROM AUTHOR]

Background: Multiple Sclerosis (MS) is affected by cognitive and emotional factors. The aim of this study was to investigate the relationship between sensitivity to anxiety and executive functions and the Quality of Life (QoL) of MS patients using path analysis. Methods: This descriptive correlational research was done on all patients with MS in Gorgan MS Association in 2020. The sample size was considered to be 290 people according to the sample selection formula and based on the values obtained from the previous study selected by simple random sampling. To collect data, the Executive Functions Questionnaire of Nejati (2013), QoL questionnaire of McGuigan & Hutchinson (2004), and Sensitivity to Anxiety Questionnaires of Taylor and Cox (1998) were used. Path analysis with SPSS v. 18 and AMOS v. 23 software was used to analyze the data. Results: The results showed that the executive functions had a positive relationship with QoL in MS patients and sensitivity to anxiety had a negative relationship with QoL in MS patients. Also, mediating role of the anxiety sensitivity variable in the relationship between executive functions with QoL in MS patients was confirmed (P≤0.01). Conclusion: The present study indicated the importance of cognitive factors, such as executive functions, and emotional factors, such as sensitivity to anxiety in explaining the QoL in MS patients. [ABSTRACT FROM AUTHOR]

Cognitive impairment in multiple sclerosis (MS) is common, debilitating and burdensome. Key evidence from trials was reviewed to enable recommendations to be made to guide clinical practice and research. Behavioural and pharmacological interventions on cognition reported in published studies were reviewed. Most studies evaluating behavioural treatment for impairment in learning and memory, deficits of attention and executive function have demonstrated some improvement. Controlled studies in relapsing remitting MS indicate interferon (IFN) β-1b and IFN β-1a were associated with modest cognitive improvement. The effects of symptomatic therapies such as modafinil and donepezil are inconsistent. Most studies yielding positive findings have significant methodological difficulties limiting the confidence in making any broad treatment recommendations. There are no published reports of glatiramer acetate, natalizumab and fingolimod being effective in improving cognition in controlled trials. The effects of disease modifying therapies in other forms of MS and clinically isolated syndrome have not yielded positive results. Data linking behavioural therapy, symptomatic treatment or disease modifying treatment, to either reducing cognitive decline or improving impaired cognition are limited and inconsistent. The treatment and prevention of cognitive impairment needs to remain a key research focus, identifying new interventions and improving clinical trial methodology. [ABSTRACT FROM AUTHOR]

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Ankylosing spondylitis (AS) is a chronic inflammatory arthritis that predominantly affects the axial skeleton in adolescent patients. The natural history of the disease remains poorly characterized. In this study, we combined GC–MS and LC–MS techniques to evaluate the major metabolic changes in the plasma of AS patients in view of metabonomics. Univariate and multivariate analysis were employed for altered metabolite comparison and pattern recognition. Application of supervised partial least-squares discrminant analysis to either GC–MS or LC–MS data allowed accurate discrimination of AS patients from normal controls, demonstrating its potential diagnostic utilization. In addition, AS patients presented elevated plasma concentrations of proline, glucose, phosphate, urea, glycerol, phenylalanine and homocysteine but reduced levels of phosphocholines, tryptophan and a bipeptide – phenylalanyl-phenylalanine. In the context of their involved metabolic pathways, the identified metabolites were discussed accordingly. This investigation primarily proved that integrated chromatography–mass spectrometry and integrated uni- and multi-variate statistical analysis facilitated metabonomics to be a more promising tool in disease research. [ABSTRACT FROM AUTHOR]

Objective To determine the impact of multiple sclerosis (MS) on patient attendance at dental practices and maintenance of oral health.Design A cross-sectional postal questionnaire-based study.Setting Leicestershire, United Kingdom.Subjects and methods People with MS in Leicestershire identified from local health authority records (n = 476).Main outcome measures Number registered at dental practice, frequency of attendance, issues and perspectives relating to attendance and maintenance of oral health.Results A response rate of 61% (n = 289) was obtained. When compared to the general population, a higher number of people with MS were registered with a dentist (49%:88%) and displayed more frequent practice attendance (71%:81%) in the past year. People with MS reported difficulties in attending a dentist and maintaining oral health, which were exacerbated by deterioration in general health. Problems relating to reduced personal mobility had the greatest impact on attendance.Conclusions MS has a negative impact on perceived patient attendance and maintenance of oral health. Patients with a progressive disability could benefit greatly from the provision of preventive oral health care. The importance of seeking care earlier rather than later needs to be emphasised to both professionals and patients alike. Further efforts are required to increase awareness of the importance of oral health to the quality of life of people with MS and ensure that individuals with physical disabilities receive the same access to dental services as the able-bodied. [ABSTRACT FROM AUTHOR]

The article focuses on the "Best Clinical Paper of 2013" that entitled ""Improved ability to work after one year of natalizumab treatment in multiple sclerosis. Analysis of disease-specific and work-related factors that influence the effect of treatment" Study found various points including beneficial effects of natalizumab on clinical outcomes, short disease duration and minimal physical disability and impact of natalizumab.

The article examines the antimuscarinic therapies in remyelination among patients with multiple sclerosis (MS). It notes that some significant inhibitory signals in inflammatory demyelination prevent necessary oligodendrocyte differentiation in initiating recovery. It points out the relevance of evaluating the potential of antimuscarinic in treating MS patients.

Macrophage M2 (MP2)‐based cell therapy is a novel medicinal treatment for animals with Experimental Autoimmune Encephalomyelitis (EAE) as an experimental model of multiple sclerosis (MS). This systematic review and meta‐analysis study was designed to assess the overall therapeutic effects of MP2 cell therapy on Clinical Score and motor impairment in EAE‐induced animals. All experiments on MP2 cell therapy in animals with EAE were gathered (by October 2, 2022) from English (PubMed, Scopus, WoS, Science Direct, and ISC) and Persian (MagIran and SID) databases. The searching strategy was designed using "Experimental Autoimmune Encephalomyelitis," "Multiple Sclerosis," and "Macrophage M2" keywords. Following primary and secondary screenings, eligible papers were selected based on the PRISMA 2020 guideline, and the study quality was assessed using the Animal Research: Reporting of In Vivo Experiments (ARRIVE) checklist. The difference in means of Clinical Score (score 0–5) as the effect size (ES) was analyzed based on the random effect model (CMA software, v.2). Subgrouping (EAE phases of Onset, Peak, and Recovery) was applied, and I2 index was used to assess the heterogeneity index. Publication bias and sensitivity indices were also evaluated. P < 0.05 was considered significant, and the confidence interval (CI) was determined 95%. Among 22 gathered papers, medium to high quality studies were selected for meta‐analysis. Difference in means, P value, and I2 for Onset, Peak, and Recovery phases were 0.082 (CI95%: −0.323–0.159, P value: 0.504, I2: 67.961%), −0.606 (CI95%: −1.518 to −0.305, P value: 0.192, I2: 96.070%), and −1.103 (CI95%: −1.390 to −0.816, P value: 0.000, I2: 30.880%), respectively and Overall Effect was found −0.509 (CI95%: −0.689 to −0.328, P value < 0.001). Also, P value (two‐tailed) indices for publication bias were 0.366 and 0.583 for Egger's regression intercept and Begg rank correlation, respectively. The P value for sensitivity was detected 0.003. Cell therapy procedure using MP2 can potentially alleviate the Clinical Scores Index and correct the motor defects in Recovery phase of EAE animals. In healthy mice, the brain and myelin surrounding neurons are in a healthy and physiological state (1). To evaluate MS in humans, it is necessary to model this type of disease in animals using EAE procedure through subcutaneous injection of CFA, MOG35–55, MT, and Pert. Thus, inflammation and autoimmunity occur, which finally lead to myelin destruction and motor symptoms (2). By aspiration of progenitor cells available in bone marrow, the MP2 can be isolated and cultured. By activation of these types of cells, a rich collection of MP2 can be prepared for the cell‐therapy process (3). After injection through the tail vein or intra‐peritoneal procedure, these cells can be located in CNS through crossing from the BBB. They begin their anti‐inflammatory activities and help repair the damaged myelin (4). Eventually, the clinical symptoms can be modified considerably, and the animal motor function improves (5). CFA, complete Freund's adjuvant; MOG35–55, myelin oligodendrocyte glycoprotein; MT, Mycobacterium tuberculosis; Pert, pertussis; EAE, Experimental Autoimmune Encephalomyelitis; BM, bone marrow; MP2, macrophage M2; and BBB, blood brain barrier. [ABSTRACT FROM AUTHOR]

This paper proposes a new model of stress that integrates earlier models and adds insights from developmental psychology. Previous models describe the behavioral and physical effects of stress events, but have not explained the translation of experiences into stress itself. The Developmental Model of Stress shows how psychosocial developmental challenges in childhood create persistent negative beliefs and behaviors that increase threat perception and maladaptive stress responses. These developmental challenges produce early psychological and physiological predispositions for increased stress responses over time. Ongoing stress leads to dysregulation of physical stress-response systems (allostatic load), which is associated with multiple diseases. High allostatic load provides the necessary preconditions for the diathesis-stress model, which says the addition of an acute stressor to a weakened or predisposed system can lead to disease development. The paper also documents the evolving measurement of stress to better understand the stress-disease relationship, helping to resolve conflicting results between studies. The Developmental Model of Stress was combined with clinician insight and patient reports to build an integrative framework for understanding the role of stress in the development and progression of multiple sclerosis (MS). It includes the first mapping of maladaptive beliefs and behaviors arising from developmental challenges that are common to people with MS. An initial comparison shows these may be distinct from those of people with other chronic diseases. These beliefs and behaviors form the predisposing factors and contribute to the triggering factors, which are the acute stressors triggering disease onset. These often took two forms, a prolonged incident experienced as feeling trapped or stuck, and threat of a breach in a relationship. The reinforcing factors add the stress of a chronic disease with a poor prognosis and seemingly random symptom fluctuation, still managed with the same beliefs and behaviors developed in childhood, increasing physiological dysregulation and symptom severity. A pilot study is described in which these three categories of stress factors in MS were explicitly addressed. This study noted clinically important improvements in physical and mental well-being, providing preliminary support for the Developmental Model. Future research might expand on the pilot using a more robust sample and design. [ABSTRACT FROM AUTHOR]

Background: Multiple Sclerosis (MS) affects various aspects of a patient's life. This study aimed to investigate the effect of positive thinking training on the quality of life and emotion regulation among patients with MS. Methods: This research was a quasi-experimental study conducted on a sample of 40 patients selected by convenience sampling method. Eight 90-minute sessions of positive thinking training were held for the experimental group for two months. The Post-test and follow-up were conducted at the end of the sessions and a month later, respectively. Ware and Sherbourne Quality of Life Questionnaire (1999) and Ibanez et al. Self-Regulation Scale (2005) were used for collecting the data. The data analyses were conducted using the analysis of covariance. The inclusion criteria were suffering from MS and being able to read and write. The exclusion criteria were having mental disorders, cognitive disorders, a history of substance addiction, and other neurological disorders. Results: The results demonstrated a significant difference between the scores obtained by the groups with regard to emotion regulation (Eta-squared=0.62, P<0.001). Besides, considering physical health, there was a significant difference between the scores obtained by the groups (Eta-squared=0.53, P<0.001), and considering mental health, there was a significant difference between the scores obtained by the groups (Eta-squared=0.74, P<0.001). Conclusion: These results indicated that positive thinking training was effective in improving emotion regulation and promoting quality of life in pre-test, post-test, and follow-up. Authorities are recommended to conduct programs based on positive thinking training to promote emotion regulation and increase MS patients' quality of life. It is recommended that training positive thinking skills be conducted as a regular program at associations and organizations, which support MS patients to promote the levels of quality of life and emotion regulation among these patients. [ABSTRACT FROM AUTHOR]

Background: Walking impairment is one of the most reported symptoms of Multiple Sclerosis (MS). The documentation of gait impairments is important for indexing disease progression and rehabilitation in MS. By measuring and comparing relevant parameters based on the Center of Pressure (COP) patterns, this study aimed to characterize the execution of the gait task and to identify the relationship between these parameters and the level of Expanded Disability Status Scale (EDSS). Methods: Ten women with MS, with an average EDSS score of 2.4, and 10 healthy women were tested using a force plate and motion capture system during the transition from standing to gait posture. The time series of COP were acquired and processed to extract the trajectory-related parameters followed by the COP. Results: The correlation analysis underlined that the progressive alteration of the task execution is directly related to the increase in the EDSS score. These findings suggest that most of the impairments found in people with MS originate from the first part of the COP pattern: the anticipatory postural adjustments (APAs). Before every voluntary movement, the central nervous system performs APAs to minimize the balance perturbation due to the movement itself. Conclusion: Gait initiation APAs play a role in some contractions of ankle muscles and induce a backward COP shift to the swing limb. Our analysis highlighted that patients who affected by MS have a reduced posterior COP shift that reveals the impairment of the anticipatory mechanism. [ABSTRACT FROM AUTHOR]

This study analyses the research output in Covid-19 and Neurosciences during the period 2020-2021 and the analyses included global publications' share, citation impact, the share of countries, and patterns of research communication in most productive journals. It also analyses the characteristics of most productive institutions, authors, and high-cited papers. The most contributed countries are: the USA with 1307 publications followed far by the UK with 571, Italy with 541, China with 372, Germany with 286, India with 285, Canada with 272, Spain with 260, France with 212 and Brazil with 196 articles, etc. the prolific organizations are: Harvard Medical School from the USA (with 124 papers) and received 1200 Citations, followed by INSERM, France (with 87 papers) and received 881 Citations, University of Toronto, Canada (with 86 papers) and received 1720 Citations, King's College London, UK (with 77 papers), University College London with 64, the University of Oxford with 64, Massachusetts General Hospital with 54. The most preferred journals are Psychiatry Research with 270 articles followed by Frontiers In Neurology with 155, Lancet Psychiatry with 149, Brain Behavior And Immunity with 136, Journal Of Neurology with 135, Peerj with 132, and Multiple Sclerosis And Related Disorders with 119. There is an urgent need to substantially increase the research activities in the field of Covid-19 and Neurosciences during the pandemic period. [ABSTRACT FROM AUTHOR]

The objective of the research work is to accurately segment multiple sclerosis (MS) lesions in brain Magnetic Resonance Imaging (MRI) of varying sizes and also to classify its types. Designing effective automatic segmentation and classification tool aid the doctors in better understanding MS lesion progressions. In meeting research challenges, this paper presents Noise Invariant Convolution Neural Network (NICNN). The NICNN model is efficient in the detection and segmentation of MS lesions of varying sizes in comparison with standard CNN-based segmentation methods. Further, this paper introduced a new cross-validation scheme to address the class imbalance issue by selecting effective features for classifying the type of MS lesion. The experiment outcome shows the proposed method provides improved Dice Similarity Coefficient (DSC), Positive Predicted Value (PPV), and True Positive Rate (TPR) value compared to the state-of-art CNN-based MS lesion segmentation method. Further, achieves better accuracy in classifying MS lesion types compared to standard MS lesion type classification models. [ABSTRACT FROM AUTHOR]

Background: This study aimed to develop a Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) tablet application, "iCAMS," and examine equivalency between the original paper-based and the tablet-based assessments. Methods: This study enrolled 100 participants with physician-confirmed multiple sclerosis (MS). Interrater reliability, parallel forms reliability, and concurrent validity were evaluated by incorporating two test administrators in each session: one scoring participant responses with the original paper assessments and the other with iCAMS. Although the participant was exposed to the material only once, responses were recorded on both administration methods. In addition to the standard test procedures, each research assistant used a stopwatch to measure the amount of time required to administer and score each version of BICAMS. Results: Pearson correlation coefficients (r) revealed strong and significant correlations for all three tests. Excellent agreement was observed between iCAMS and paper versions of the BICAMS tests, with all intraclass correlation coefficients exceeding 0.93. The scores from all the cognitive tests were not statistically significantly different, indicating no proportional bias. Including scoring, administration of the iCAMS application saved approximately 10 minutes over the paper version. Conclusions: Preliminary findings suggest that the tablet application iCAMS is a reliable and fast method for administering BICAMS. [ABSTRACT FROM AUTHOR]

Wearable sensor technologies are becoming increasingly relevant in health research, particularly in the context of chronic disease management. They generate real-time health data that can be translated into digital biomarkers, which can provide insights into our health and well-being. Scientific methods to collect, interpret, analyze, and translate health data from wearables to digital biomarkers vary, and systematic approaches to guide these processes are currently lacking. This paper is based on an observational, longitudinal cohort study, BarKA-MS, which collected wearable sensor data on the physical rehabilitation of people living with multiple sclerosis (MS). Based on our experience with BarKA-MS, we provide and discuss ten lessons we learned in relation to digital biomarker development across key study phases. We then summarize these lessons into a guiding framework (DACIA) that aims to informs the use of wearable sensor data for digital biomarker development and chronic disease management for future research and teaching. [ABSTRACT FROM AUTHOR]

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The neuro-immune axis has a crucial function both during physiological and pathological conditions. Among the immune cells, myeloid-derived suppressor cells (MDSCs) exert a pivotal role in regulating the immune response in many pathological conditions, influencing neuroinflammation and neurodegenerative disease progression. In chronic neuroinflammation, MDSCs could lead to exacerbation of the inflammatory state and eventually participate in the impairment of cognitive functions. To have a complete overview of the role of MDSCs in neurodegenerative diseases, research on PubMed for articles using a combination of terms made with Boolean operators was performed. According to the search strategy, 80 papers were retrieved. Among these, 44 papers met the eligibility criteria. The two subtypes of MDSCs, monocytic and polymorphonuclear MDSCs, behave differently in these diseases. The initial MDSC proliferation is fundamental for attenuating inflammation in Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis (MS), but not in amyotrophic lateral sclerosis (ALS), where MDSC expansion leads to exacerbation of the disease. Moreover, the accumulation of MDSC subtypes in distinct organs changes during the disease. The proliferation of MDSC subtypes occurs at different disease stages and can influence the progression of each neurodegenerative disorder differently. [ABSTRACT FROM AUTHOR]

This paper presents three cases of the Zhang’s Cupping Triple Therapy, an innovative approach in traditional Chinese medicine that integrates modern technology with ancient healing techniques. The therapy, designed for pain management, particularly in the back, lumbar, and sacral regions, combines electrical cupping, targeted acupuncture along the spine, and infrared lamp radiation. Each component contributes synergistically to the overall therapeutic effect, enhancing blood flow, reducing inflammation, and promoting relaxation. The paper showcases three illustrative case studies, each addressing a different complex medical condition: ankylosing spondylitis and endometriosis, multiple sclerosis, and rheumatoid arthritis. These cases demonstrate the therapy’s versatility and efficacy in providing significant pain relief, improving joint mobility, and enhancing the overall quality of life. The treatment outcomes highlight the potential of Zhang’s Cupping Triple Therapy in managing chronic conditions and underscore the value of integrating traditional therapies with modern medical practices. The paper presents strong cases for the recognition of alternative therapies like the Zhang’s Cupping Triple Therapy in mainstream healthcare, emphasizing the importance of a holistic approach to patient care and the potential for improved health outcomes in chronic condition management. [ABSTRACT FROM AUTHOR]