Multiple Sclerosis International
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A Prospective Multicenter Study for Assessing MusiQoL Validity among Arabic-Speaking MS Patients Treated with Subcutaneous Interferon β-1a

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Multiple Sclerosis International publishes articles related to all aspects of multiple sclerosis, such as clinical neurology, neuroimaging, neuropathology, neuroimmunology, biomarkers, psychology and neurorehabilitation.

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Multiple Sclerosis International maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study.

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Review Article

Family Planning for People with Multiple Sclerosis in Saudi Arabia: an Expert Consensus

More than half of all patients with multiple sclerosis (MS) in the Kingdom of Saudi Arabia (KSA) are women of childbearing age. Raising a family is an important life goal for women in our region of the world. However, fears and misconceptions about the clinical course of relapsing-remitting MS (RRMS) and the effects of disease-modifying drugs (DMDs) on the foetus have led many women to reduce their expectations of raising a family, sometimes even to the point of avoiding pregnancy altogether. The increase in the number of DMDs available to manage RRMS and recent studies on their effects in pregnancy have broadened management options for these women. Interferon beta now has an indication in Europe for use during pregnancy (according to clinical need) and can be used during breastfeeding. Glatiramer acetate is a further possible option for women with lower levels of RRMS disease activity who are, or about to become, pregnant; natalizumab may be used up to 30 weeks in patients with higher levels of disease activity. Where possible, physicians need to support and encourage women to pursue their dream of a fulfilling family life, supported where necessary by active interventions for RRMS that are increasingly evidence based.

Research Article

The Effect of Cannabis on the Clinical and Cytokine Profiles in Patients with Multiple Sclerosis

Background. Multiple studies have reported that cannabis administration in multiple sclerosis patients is associated with decreased symptom severity. This study was conducted to evaluate the prevalence of cannabis abuse in multiple sclerosis cases and to evaluate the effect of cannabis on serum cytokines in such cases. Patients and Methods. A total of 150 multiple sclerosis cases along with 150 healthy controls were included during the study period. All cases were subjected to history taking, neurological examination, and routine investigations. Cases were asked about cannabis intake which was confirmed by a urine test. Serum cytokines including IL-1, IL-2, IL-4, IL-10, IL-12, IL-17, IL-22, IFN-γ, IFN-β1, and TNF-α were ordered for all cases and controls. Results. Twenty-eight cases were cannabis abusers (MS/cannabis group, 18.67%). The remaining 122 cases represented the MS group. There was no significant difference between the three groups regarding age, disease duration, or MS type. Male gender was more predominant in the MS/cannabis group, and the number of relapses was significantly lower in the same group. Fifteen cases (53.6%) reported that their symptoms were improved by cannabis. Proinflammatory cytokines were significantly elevated in the MS group compared to the MS/cannabis and control groups. Additionally, anti-inflammatory cytokines had significantly lower values in the MS group compared to the MS/cannabis and control groups. Most clinical symptoms were significantly improved in the MS/cannabis group compared to the MS group apart from sexual dysfunction, bladder symptoms, and visual disturbances. Mild side effects of cannabis were also reported. Conclusion. Cannabis may have a positive impact on the cytokine and clinical profiles in cases with multiple sclerosis.

Review Article

miRNA-Dependent CD4+ T Cell Differentiation in the Pathogenesis of Multiple Sclerosis

Multiple sclerosis (MS) is characterized by multifocal lesions, chronic inflammatory condition, and degenerative processes within the central nervous system (CNS) leading to demyelination. The most important cells involved in its pathogenesis are those which are CD4+, particularly proinflammatory Th1/Th17 and regulatory Treg. Signal cascades associated with CD4+ differentiation are regulated by microRNAs (miRNAs): short, single-stranded RNAs, responsible for negative regulation of gene expression at the posttranscriptional level. Several miRNAs have been consistently reported as showing dysregulated expression in MS, and their expression patterns may be elevated or decreased, depending on the function of specific miRNA in the immune system. Studies in MS patients indicate that, among others, miR-141, miR-200a, miR-155, miR-223, and miR-326 are upregulated, while miR-15b, miR-20b, miR-26a, and miR-30a are downregulated. Dysregulation of these miRNAs may contribute to the imbalance between pro- and anti-inflammatory processes, since their targets are associated with the regulation of Th1/Th17 and Treg cell differentiation. Highly expressed miRNAs can in turn suppress translation of key Th1/Th17 differentiation inhibitors. miRNA dysregulation may result from the impact of various factors at each stage of their biogenesis. Immature miRNA undergoes multistage transcriptional and posttranscriptional modifications; therefore, any protein involved in the processing of miRNAs can potentially lead to disturbances in their expression. Epigenetic modifications that have a direct impact on miRNA gene transcription may also play an important role.

Research Article

Teriflunomide Safety and Efficacy in Advanced Progressive Multiple Sclerosis

Objectives. To explore the safety and efficacy profile of teriflunomide in progressive multiple sclerosis. Methods. We conducted a single-center retrospective observational analysis of a progressive multiple sclerosis population, assessing safety and efficacy in patients treated at least one year with teriflunomide or glatiramer acetate. Sustained progression of expanded disability status scale and sustained worsening of timed 25-foot walk were compared using a Cox proportional hazards model. Results. Teriflunomide group () mean characteristics: years (), years (), (), and months (). Glatiramer acetate group () mean characteristics: years (), years (), (), and months (). Both treatments were well tolerated without serious side effects. After adjustment for age, sex, and baseline expanded disability status score, sustained expanded disability status score progression did not differ between groups (; 95% confidence interval: 0.45, 3.08; ). Sustained timed 25-foot walk worsening after adjustment also did not differ (; 95% confidence interval: 0.2, 1.53; ). Conclusion. In an advanced progressive multiple sclerosis population, no substantial differences in tolerability, safety, sustained EDSS progression, or sustained T25FW worsening over time were observed between glatiramer acetate and teriflunomide-treated groups. The small sample precluded definitive determination.

Research Article

Backward Walking and Dual-Task Assessment Improve Identification of Gait Impairments and Fall Risk in Individuals with MS

Background. Individuals with multiple sclerosis (MS) experience deficits in motor and cognitive domains, resulting in impairment in dual-task walking ability. The goal of this study was to compare performance of forward walking and backward walking in single- and dual-task conditions in persons with MS to age- and sex-matched healthy controls. We also examined relationships between forward and backward walking to cognitive function, balance, and retrospective fall reports. Methods. All measures were collected in a single session. A mixed model ANOVA was used to compare differences in forward and backward walking in single- and dual-task conditions between MS and healthy controls. Spearman correlations were used to examine relationships between gait and cognitive function, falls, and balance. Results. Eighteen individuals with relapsing-remitting MS and 14 age- and sex-matched healthy controls participated. Backward walking velocity revealed significant differences between groups for both single-task () and dual-task () conditions. Persons with MS demonstrated significant differences between single- and dual-task forward and backward walking velocities (; ), whereas this difference was only apparent in the backward walking condition for healthy controls (). In persons with MS, there were significant differences in double support time between single- and dual-task conditions in both backward () and forward () directions. More falls at six months were significantly associated with shorter backward dual-task stride length (; ) and slower velocity (; ). Conclusion. Differences in MS and age- and sex-matched healthy controls are more pronounced during backward compared to forward walking under single- and dual-task conditions. Future work with a larger sample size is needed to validate the clinical utility of backward walking and dual-task assessments and mitigate the limited sensitivity of the current dual-task assessments that primarily rely upon forward walking.

Research Article

Evaluation of Lower Urinary Tract Dysfunction Impact on Quality of Life in Multiple Sclerosis Patients: Russian Translation and Validation of SF-Qualiveen

The Short Form Qualiveen (SF-Qualiveen) is an 8-item version of the Qualiveen questionnaire used to evaluate the impact of urinary symptoms on the quality of life in patients with urological dysfunction due to neurological disorders. The questionnaire was never available in the Russian language before. The study is aimed at providing the translation, cultural adaptation, and validation of a Russian version of the SF-Qualiveen for the use in patients with multiple sclerosis (MS). Materials and Methods. The original English language version of the SF-Qualiveen was translated into Russian according to the cultural and linguistic adaptation algorithm. The participants (50 MS patients with neurogenic bladder and 10 relatively healthy volunteers) filled out the finalized Russian version of the SF-Qualiveen and the Neurogenic Bladder Symptom Score (NBSS) twice, 2 weeks apart. The data obtained was used to determine the internal consistency (Cronbach’s alpha), external validity (the Spearman correlation), and test-retest reliability (intraclass correlation coefficient (ICC)) of the questionnaire. Results. The mean SF-Qualiveen total score was in patients with a neurogenic bladder and in the control group (). Cronbach’s alpha exceeded 0.9 indicating an excellent internal consistency of the questionnaire. The retest did not reveal any significant differences between the findings. The test-retest reliability was good for all items and domains (ICC 0.81-0.89). The total score demonstrated the highest ICC (0.89). The external validity was verified by a strong correlation demonstrated between the SF-Qualiveen and NBSS scores. Conclusions. The Russian SF-Qualiveen questionnaire is a reliable, valid, and consistent tool for the assessment of a urinary disorder impact on the quality of life in patients with MS.

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