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The ongoing COVID-19 pandemic is a global health crisis. New challenges are constantly emerging especially for the healthcare system, not least with the emergence of various viral mutations. Given the variety of immunomodulatory and immunosuppressive therapies for multiple sclerosis (MS) and the immense developments in vaccine production, there is a high need of information for people with MS. The aim of this article is therefore to provide an overview of MS and COVID-19 as well as to clarify the implications for patients with MS, especially regarding vaccination and to formulate appropriate recommendations.Die aktuelle COVID-19-Pandemie stellt eine weltweite Gesundheitskrise dar. Nicht zuletzt mit dem Aufkommen diverser Virusmutationen entstehen insbesondere für das Gesundheitswesen laufend neue Herausforderungen. Angesichts der Vielfalt an immunmodulatorischen und immunsuppressiven Therapien für die Multiple Sklerose (MS) sowie der enormen Entwicklungen im Bereich der Vakzinenherstellung besteht ein hoher Informationsbedarf für Menschen mit MS. Ziel dieser Arbeit ist es daher, einen Überblick über MS und COVID-19 sowie die damit einhergehenden Implikationen für MS-Patienten, insbesondere das Impfwesen betreffend, aufzuarbeiten und entsprechende Empfehlungen auszusprechen.

Along with the challenges posed by the globally circulating COVID-19 pandemic, there have been some epochal advances in the field of vaccine technologies. In addition to the traditionally used dead, live and protein-based vaccines, vector-based and gene-based vaccines gained enormous attention in the course of this health crisis. The aim of this article is to provide an overview of multiple sclerosis (MS) and vaccination, recent advances in the SARS-CoV‑2 vaccine landscape as well as a detailed discussion of the various vaccine technologies. Finally, clear recommendations in the context of disease-modifying treatment and vaccination in MS are highlighted.Im Zusammenhang mit den Herausforderungen durch die weltweit vorherrschende COVID-19-Pandemie kam es zu teils epochalen Fortschritten im Bereich der Impfstofftechnologien. Neben den bereits langjährig eingesetzten Tot‑, Lebend- und proteinbasierten Impfstoffen gewannen im Zuge dieser Gesundheitskrise vektor- und genbasierte Impfstoffe enorm an Bedeutung. Ziel dieser Arbeit ist es daher, einen Überblick über Multiple Sklerose und Impfen, rezente Fortschritte in der SARS-CoV-2-Impfstoff-Landschaft sowie eine detaillierte Auseinandersetzung mit den verschiedenen Impfstofftechnologien zu bieten. Abschließend sollen übersichtsmäßig klare Empfehlungen im Zusammenhang mit krankheitsmodifizierenden Therapien und Impfen bei Multiple Sklerose gegeben werden.

ZusammenfassungWearables sind mit Sensoren ausgestattete Geräte oder Funktionskleidung, welche im Bereich der Multiplen Sklerose bis dato v. a. zur Messung von Bewegung in Form von Accelerometern in Verwendung sind. Im Gegensatz zu technisch aufwendigen Ganganalysesystemen und neurologischen Funktionstests können solche Wearables im Alltag einfach eingesetzt werden und bieten die Möglichkeit Ausmaß, Geschwindigkeit und Dauer von Bewegung auch über längere Zeiträume zu erfassen. Zusätzlich können auch spezifischere Parameter wie Schrittlänge, Bewegungsumfang einzelner Gelenke sowie physiologische und pathologische Bewegungsmuster dokumentiert werden. Die durch Accelerometer erhobenen Informationen korrelieren gut mit der körperlichen Aktivität im Alltag, kardiorespiratorischen Biomarkern der Bewegung, dem Ausmaß der Behinderung aber auch mit technisch aufwendigen Ganganalysen.Insofern werden Wearables in Zukunft eine immer wichtigere Rolle spielen, wenn es darum geht, die Beweglichkeit als einen der wichtigsten Faktoren der Lebensqualität von Personen mit MS im Alltag reliabel und einfach zu messen.

In the last century, several pandemics were caused by various influenza virus subtypes, with the Spanish influenza of 1918–1920 being the most severe.1 Coronaviruses were first described in humans in the 1960s, and since then seven human pathogenic coronaviruses have been described.2 The first severe outbreak was in 2002 with the severe acute respiratory syndrome coronavirus (SARS-CoV), followed by the Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in 2012.3 The current COVID-19 pandemic, which broke out in Wuhan, China, in late 2019, is caused by the highly transmissible RNA virus SARS-CoV-2.4 As of 11 June 2021, 174 439 909 COVID-19 cases and 3 768 987 deaths have been reported worldwide, according to the WHO Dashboard.5 Infectious diseases significantly contribute to morbidity in patients with multiple sclerosis (MS), since the risk of suffering from an infection is increased by MS per se and may be further enhanced by disease-modifying therapies (DMTs) and frequent comorbidities.6–9 As a result, infectious diseases may heighten the risk of disease progression in MS and result in reduced life expectancy.10–12 The COVID-19 pandemic, in particular, presents new challenges for patients with MS. Since the approval of messenger RNA (mRNA) and non-replicating vector coronavirus vaccines by the European Medicines Agency (EMA), the UK Medicines and Healthcare products Regulatory Agency (MHRA), the US Food and Drug Administration (FDA), Health Canada (HC) and the Australian Therapeutic Goods Administration (TGA), neurologists are facing an unprecedented demand for information on vaccination in MS, particularly in the context of DMTs.13–17 This review aims to provide a clinical practice-oriented approach to SARS-CoV-2 vaccination in MS in the era of the COVID-19 pandemic.18–21 COVID-19 is a disease caused by the highly contagious RNA virus SARS-CoV-2. It shares a 79% genetic match with SARS-CoV and a 50% genetic match …

Sexual dysfunction (SD) in people with multiple sclerosis (pwMS) has a detrimental impact on individual health-related quality of life (HRQoL). It is not clear whether SD in multiple sclerosis (MS) is an independent symptom or merely a byproduct of other symptoms such as depression or anxiety. This cross-sectional study of 93 pwMS determines risk factors for SD in MS based on prevalence, HRQoL, and associated disease outcomes. Diagnosis of SD was determined based on the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) and correlated with physical disability (measured by Expanded Disability Status scale, EDSS), depression and anxiety [Hospital Anxiety and Depression Scale (HADS)], and HRQoL [Multiple Sclerosis Quality of Life-54 (MSQoL-54)]. Multivariate regression models were performed to determine independent risk factors for SD in pwMS. Almost half of the participants in this study (46%) reported SD. HRQoL was significantly poorer in patients with MS suffering from SD (median [IQR] MSQoL-54 scores: physical subscale 52 [41–68] vs. 81 [69–89], p < 0.001; mental subscale 50 [38–82] vs. 86 [70–89], p < 0.001). In the multivariate model, EDSS was the only independent risk factor for SD (OR 18.1 for EDSS ≥4 [95% CI 3.3–31.4, p < 0.001]), while depression and anxiety were not. We conclude that the risk for SD is growing with increasing EDSS and is independent of depression or anxiety. Screening for SD becomes particularly relevant in patients with growing disability.

BACKGROUND Treatment and monitoring decisions in people with multiple sclerosis (MS) are based commonly on clinician-reported outcomes. These reflect physical and radiological disease activity and are the most relevant endpoints in clinical trials. Over the past few years, the number of studies evaluating so-called patient-reported outcomes (PROs) has been increasing. PROs are reports from patients concerning their own health perception. They are typically obtained by means of questionnaires and aim to quantify symptoms such as fatigue, depression, and sexual dysfunction. The emergence of PROs has made a tremendous contribution to understanding the individual impact of disease in people with MS and their health-related quality of life. However, the assessment of PROs consumes resources, including time and personnel. Thus, useful ways to conveniently introduce PROs into clinical practice are needed. OBJECTIVE We aim to provide a rationale and pilot study protocol for a mobile health (mHealth) solution named “haMSter” that allows for remote monitoring of PROs in people with MS. METHODS The core function of haMSter is to provide three scientifically validated PRO questionnaires relevant to MS for patients to fill out at home once a month. Thereby, longitudinal and remote documentation of PROs is enabled. A scoring algorithm graphically plots PRO scores over time and makes them available at the next visit. RESULTS The pilot study is currently ongoing and will evaluate adherence to this mHealth solution in 50 patients over a period of 6 months. Results from the haMSter pilot study are expected in 2021. CONCLUSIONS haMSter is a novel mHealth-based solution for modern PRO research, which may constitute the first step in achieving the ability to integrate PROs in clinical practice. This allows for a more problem-oriented approach in monitoring visits, which addresses patient needs and ultimately saves time. CLINICALTRIAL ClinicalTrials.gov NCT04555863; https://clinicaltrials.gov/ct2/show/NCT04555863 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/25011

Background Treatment and monitoring decisions in people with multiple sclerosis (MS) are based commonly on clinician-reported outcomes. These reflect physical and radiological disease activity and are the most relevant endpoints in clinical trials. Over the past few years, the number of studies evaluating so-called patient-reported outcomes (PROs) has been increasing. PROs are reports from patients concerning their own health perception. They are typically obtained by means of questionnaires and aim to quantify symptoms such as fatigue, depression, and sexual dysfunction. The emergence of PROs has made a tremendous contribution to understanding the individual impact of disease in people with MS and their health-related quality of life. However, the assessment of PROs consumes resources, including time and personnel. Thus, useful ways to conveniently introduce PROs into clinical practice are needed. Objective We aim to provide a rationale and pilot study protocol for a mobile health (mHealth) solution named “haMSter” that allows for remote monitoring of PROs in people with MS. Methods The core function of haMSter is to provide three scientifically validated PRO questionnaires relevant to MS for patients to fill out at home once a month. Thereby, longitudinal and remote documentation of PROs is enabled. A scoring algorithm graphically plots PRO scores over time and makes them available at the next visit. Results The pilot study is currently ongoing and will evaluate adherence to this mHealth solution in 50 patients over a period of 6 months. Results from the haMSter pilot study are expected in 2021. Conclusions haMSter is a novel mHealth-based solution for modern PRO research, which may constitute the first step in achieving the ability to integrate PROs in clinical practice. This allows for a more problem-oriented approach in monitoring visits, which addresses patient needs and ultimately saves time. Trial Registration ClinicalTrials.gov NCT04555863; https://clinicaltrials.gov/ct2/show/NCT04555863 International Registered Report Identifier (IRRID) DERR1-10.2196/25011

Background Little is known on how to address sexuality in clinical care for patients with multiple sclerosis (pwMS). Aim To describe and contrast the perception of sexuality and associated aspects of communication in pwMS and their treating neurologists (“MSologists”) and provide a standard of care. Methods Patients were surveyed using a 13-item questionnaire investigating perception on their own sexuality and opinions on communication about sexuality in context with MS. Certified MSologists in Austria received an 18-item survey regarding their approach to taking a sexual history of their patients. Outcomes We report the frequency of answers given in this survey and propose a possible standard of care how sexuality could be addressed in clinical routine. Results Ninety-three pwMS (mean age 39 ± 11 years, 57% female) and 75 MSologists (mean age 43 ± 9 years, 63% male) completed this survey. Seventy-six percent of patients report their own sexuality as being (very) important to them and 95% think that sexual dysfunction would influence their quality of life. 84% would like to be asked about their sexuality by their MSologist. In contrast, only 15% of MSologists reported discussing sexuality with every patient. The most common reason for not doing so was a fear of crossing personal borders (34%). There is a strong desire for further medical education on this subject (76%). Clinical implications Discussing sexuality is important to pwMS and MSologists should consider their patients’ wishes and needs to talk about it. Strengths & Limitations This is the largest survey contrasting the views of patients and their treating physicians on the topic of communication about sexuality. The use of an empirical unvalidated questionnaire may have introduced bias. Moreover, patients that are open to talk about their sexuality may be potentially overrepresented in this study. Conclusion MSologists should offer their patients an open opportunity and appropriate framework to discuss their sexuality during a consultation. Altmann P, Leithner K, Leutmezer F, et al. Sexuality and Multiple Sclerosis: Patient and Doctor Perspectives. J Sex Med 2021;18:743-749.

Introduction Treatment with disease-modifying therapies (DMT) in patients with clinically isolated syndrome (CIS) represents standard care in multiple sclerosis (MS) patients nowadays. Since a proportion of patients may show no evidence of disease activity (NEDA) after some time of treatment, the question might arise about the risks of stopping DMT. Methods We present a cohort of 49 patients who started DMT immediately after CIS and had no evidence of disease activity (NEDA-3) for at least five years before discontinuation of therapy. Thereafter, patients underwent clinical and MRI follow-up for at least five consecutive years. Results Of 49 patients discontinuing DMT, 53% (n = 26) had NEDA for at least further five years, while 47% (n = 23) showed either a relapse/disease progression (18.4%, n = 9), MRI activity (14.3%, n = 7) or both (14.3%, n = 7). The main predictive factor for sustained NEDA was age at DMT termination. Patients aged > 45 years had a significantly lower risk of disease reactivation (13% vs. 54% in patients aged p Discussion In CIS patients with immediate DMT after their first clinical episode, older age at the time of DMT discontinuation is the main predictive factor for sustained NEDA status.

Previous studies suggested an association between MS and Restless Legs Syndrome (RLS). Data on the prevalence of RLS in Austrian MS patients and on the influence of disease-modifying therapies (DMT) on RLS are lacking.To investigate (1) the prevalence of RLS in Austria compared to control persons (CP), (2) risk factors for RLS in MS, and (3) influence of DMTs on RLS prevalence and/or severity.Adult MS patients and CP were screened for RLS by face-to-face interviews, including questionnaires for RLS severity, sleep quality and daytime sleepiness.23.9% of MS patients (n=117) had RLS compared to 3.4% (p0.001) of CP (n=119). The MS+RLS group (n=28) had a higher rate of sleep impairment (78.6% vs 21.3%, p0.001) and excessive daytime sleepiness (32.1% vs 15.7%, p=0.045) compared to the MS-RLS group. Multivariate regression analysis revealed higher Expanded Disability Status Scale and spinal lesions in MRI as risk factors for RLS in MS, while DMTs had no impact on RLS.Roughly a quarter of MS patients suffers from RLS, significantly impacting quality of life by poor sleep quality and excessive daytime sleepiness. RLS risk increases with physical disability and spinal lesions but is independent of DMT.