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Background: One of the most concerning features that involves 40-70% of patients with multiple sclerosis (MS) is cognitive impairment. Moreover, it affects various aspects of patients’ life. In this regard, this study was conducted to find independent predictors of cognitive function. Method: We performed a cross-sectional analysis on 92 patients chosen from MS clinic of Sina hospital, Iran. After completing a general questionnaire of demographic and various clinical features, the included participants (patients with RRMS) underwent neuropsychological assessment using Minimal Assessment of Cognitive function in Multiple Sclerosis (MACFIMS), Expanded disability Status Scale (EDSS), Beck Depression Inventory II (BDI-II), and National American Adult Reading Test (NAART). An un-weighted average of MACFIMS subscales z-scores was reported as cognitive index. In order to find the association between CI and different factors, each variable was entered in a simple regression model first. Then, a univariate multiple regression model was invoked to evaluate the predictors of cognitive index in patients. Results: Simple regression for cognitive index of 92 patients (86% female) with a mean age of 33.4±7.6 years old suffering of RRMS for 6.8±4.8 years revealed patients with history of former smoking (p=0.001), sole visual symptoms as the presentation sign of the study (β=-0.341, p=0.001), lower EDSS score (β=-0.299, p=0.005), higher NAART score (β=0.416, p≤0.0001), and college education (p=0.001), had better cognitive function in our study population. Such factors including age, educational status, BDI-II score, EDSS score, and disease duration were fixed and the other significant factors entered once separately and then simultaneously in the univariate multiple linear regression model. It was revealed that former smoking (β=-0.372, p≤0.0001), NAART (β=0.304, p=0.002), and EDSS (β= -0.185, P=0.045) are associated significantly with the cognitive function of patients with multiple sclerosis. Conclusion: This study demonstrated NAART, as a proxy of premorbid intelligence, history of former smoking, and EDSS score may have effects on cognitive function in MS. Future studies need to be invoked for the evaluation of the causality relation of these factors.

Background: Complement system activation products are present in areas of neuroinflammation, demyelination, and neurodegeneration in brains of patients with multiple sclerosis (MS). C3 is a central element in the activation of complement cascades. A common coding variant in the C3 gene (rs2230199, C3R102G) affects C3 activity. Objectives: To assess the effects of rs2230199 on MS severity using clinical, cognitive, and imaging measures. Methods: In total, 161 relapse-onset MS patients (Expanded Disability Status Scale (EDSS) ≤ 6) underwent physical assessments, cognitive tests (Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), and California Verbal Learning Test (CVLT)), and magnetic resonance imaging (MRI). Lesion volumes were quantified semi-automatically. Voxel-wise analyses were performed to assess the effects of rs2230199 genotype on gray matter (GM) atrophy ( n = 155), white matter (WM) fractional anisotropy (FA; n = 105), and WM magnetization transfer ratio (MTR; n = 90). Results: While rs2230199 minor-allele dosage (C3-102G) showed no significant effect on EDSS and Multiple Sclerosis Functional Composite (MSFC), it was associated with worse cognitive performance ( p = 0.02), lower brain parenchymal fraction ( p = 0.003), and higher lesion burden ( p = 0.02). Moreover, voxel-wise analyses showed lower GM volume in subcortical structures and insula, and lower FA and MTR in several WM areas with higher copies of rs2230199 minor allele. Conclusion: C3-rs2230199 affects white and GM damage as well as cognitive impairment in MS patients. Our findings support a causal role for complement system activity in the pathophysiology of MS.

Multiple Sclerosis is a demyelinating disease that can cause different symptoms by the autoimmune involvement of myelin. CD4+ and CD8+ T-cells as well as B-cells play important roles in MS pathophysiology. Co-existence of other autoimmune diseases and multiple sclerosis has been reported previously in the literature. It is not clear whether this co-existence may change the clinical course of MS or not. In this study we aim to evaluate the prevalence of other autoimmune diseases among patients with MS and if they may play any role in the clinical course of the patients.Twenty four patients with multiple sclerosis and another simultaneous autoimmune disease were detected among 1700 patients referred to the MS clinic of Sina Hospital during two years. Sex, age, duration of MS and the autoimmune disease as well as the type of the latter were recorded. For evaluation of disease progression a control group was randomly selected from the same patients referred to the clinic. EDSS was measured and recorded in both groups.The prevalence of concomitant autoimmune disease and multiple sclerosis was 0.014. The mean age of the patients was 35.04±6.45years. There were 18 different autoimmune diseases in the first group. The mean duration of MS and concomitant autoimmune disease were 5.91 and 9.80±7.1years respectively. The mean of EDSS in these patients was 1.62±1.12 and in the control group was 3.33±1.89. One patient had developed secondary progressive course in the first group. The statistical difference between these groups based on EDSS, was significant (P-value:0.001). The median of EDSS in the first group was 1.5 and in the second one was 2.5. The mean of annual relapse rate in the first group was 0.60 and in the second one was 0.62 (P-value: 0.71).The present study shows that several other autoimmune diseases may coexist with MS and their presence may modify the course of the disease. This should be re-evaluated in multicenter prospective long term studies.

Background Many patients with multiple sclerosis (MS) endure cognitive impairment, which affects their everyday life and lowers their life quality. It has been demonstrated that obesity can result in poor cognitive performance in healthy individuals through various mechanisms. Therefore, we aimed at assessing the association between body mass index (BMI) and cognitive function in MS patients, using minimal assessment of cognitive functions in MS (MACFIMS) battery. Method This study included eighty-one patients with relapsing-remitting MS (RRMS). After collecting the demographic data, patients’ height and weight were measured in order to calculate BMI. Then, MACFIMS battery was administered in one session, after obtaining information using expanded disability status scale (EDSS). Results Paced Auditory Serial Addition Test (PASAT) and Symbol Digit Modalities Test (SDMT) scores were negatively correlated with BMI (P values are equal to 0.005 and 0.037, respectively). PASAT score correlated with BMI after controlling for sex, age, and EDSS, but SDMT score did not correlate. Nevertheless, no significant variation was observed in the BMI level among individuals having MS with or without cognitive deficit. Conclusion We have shown that, BMI is associated with poor cognitive performance in some tests which, MACFIMS battery was included. This could suggest that obesity might be an important factor, which have effect on the cognitive performance.

Mesenchymal stem cells (MSCs) are a potential therapy for various diseases. Here, the results of intrathecal injection of MSCs in multiple sclerosis (MS) patients are reported.Four patients were enrolled in the study. Three were male and one was female. There were three secondary-progressive MS patients and one relapsing-remitting MS patient. An amount of 50-80 ml of bone marrow was collected from the patients. MSC cultures were collected for each microbiological examination at each change of medium and passage as well as at the time of sample injection. Then, MSCs were injected into the patients by the intrathecal method. In two patients, the injection was replicated in 1 year.All the patients were followed up for 2 years. Three patients who had secondary progression did not show disease progress after the injection, and the disease entered a stable state. A degree of recovery was observed in two patients. The relapsing-remitting patient suffered an attack that led to corticosteroid injection. None of the patients reported side effects. In terms of magnetic resonance imaging, there were no new plaques or enhanced plaques.This study suggests that injection of MSC can be a suitable method, especially for secondary-progressive patients. It seems that reinjection of these stem cells can be safe and sustaining it positively increases the effects of this therapeutic approach.

Introduction Neuromyelitis optica is a demyelinating disease of the central nervous system with various patterns of brain lesions. Corpus callosum may be involved in both multiple sclerosis and neuromyelitis optica. Previous case reports have demonstrated that callosal lesions in neuromyelitis optica are usually large and edematous and have a heterogeneous intensity showing a “marbled pattern” in the acute phase. Their size and intensity may reduce with time or disappear in the chronic stages. Case presentation In this report, we describe a case of a 25-year-old Caucasian man with neuromyelitis optica who presented clinically with optic neuritis and myelitis. His brain magnetic resonance imaging demonstrated linear enhancement of the corpus callosum. Brain images with contrast agent added also showed linear ependymal layer enhancement of the lateral ventricles, which has been reported in this disease previously. Conclusions Linear enhancement of corpus callosum in magnetic resonance imaging with contrast agent could help in diagnosing neuromyelitis optica and differentiating it from other demyelinating disease, especially multiple sclerosis.

Introduction Several cases of sarcoidosis following treatment with interferon-α have been reported in the literature, but those following interferon-β are very rare. We report the case of a patient with multiple sclerosis who developed pulmonary and cutaneous sarcoidosis following treatment with Betaseron® (interferon-β-1b). Case presentation A 33-year-old Caucasian woman with a history of multiple sclerosis, treated with interferon-β-1b for 2.5 years developed erythema nodosum in her lower limbs, a breast abscess, and unilateral adenopathy of her left lung. A skin biopsy confirmed sarcoidosis. After the discontinuation of interferon-β-1b and treatment with indomethacin and prednisolone, she recovered. Conclusions Sarcoidosis is considered one of the most common multiple sclerosis imitators with involvement of the central nervous system. However, although rare, sarcoidosis can develop following treatment with interferon-β-1b and should be considered in patients with multiple sclerosis treated with beta-interferons who develop pulmonary or extra-pulmonary manifestations of sarcoidosis. Interferon-β-1b discontinuation is the first and most important step in the treatment of such cases followed by treatment with corticosteroids.

Objectives Several studies have reported reduced quality of life (QOL) scores in patients with multiple sclerosis (MS) even in absence of physical disability. Thus QOL measures could be served as an adjunct endpoints for clinical trials. In this study we assessed the relationship between QOL scores and brain structures' volume and magnetization transfer ratio (MTR) in patients with MS. Design and methods One hundred and twenty two patients with relapse-onset MS were recruited in the study. They underwent clinical examination and structural magnetic resonance imaging (MRI). QOL was evaluated using SF-36 questionnaire. Brain structure segmentation on lesion-filled T1-weighted images was performed using a multi-atlas algorithm, MAGeT Brain. Correlation between SF-36 physical and mental scores and expanded disability status scale (EDSS), brain structures' volumes (adjusted to intracranial volume) and MTR were assessed using general linear model (GLM) with age and gender as covariate. Results SF-36 physical score (PCS) was negatively correlated with EDSS (P>0.001), cerebellar (P=0.020) and pyramidal (P=0.001) Kurtzke functional system scores and multiple sclerosis functional composite (MSFC) score (P=0.006). Physical and mental Scores of SF-36 showed no significant correlation with total brain volume, volume of right and left thalamus, hippocampus, right and left hemispheres of cerebellum, corpus medullare of cerebellum and lesion load. The correlation between physical and mental subscores of SF-36 and MTR of corona radiate, internal capsule and corpus callosum were also non-significant. Conclusion Clinical measures predicted physical components of QOL. Neither clinical nor radiological measures of MS severity contribute significantly to mental QOL.