Multiple Sclerosis International The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Dealing with Chronic Illness: Experiences of Iranian Families of Persons with Multiple Sclerosis—A Qualitative Study Thu, 07 Sep 2017 00:00:00 +0000 Background. Today family members are providing care and support to each other during illness. In particular, in chronic illness, such as multiple sclerosis, the families are more involved in caring for and supporting their patients, so they use several strategies to cope with this situation. The purpose of this study was to explore the coping strategies in family caregivers of persons with multiple sclerosis in Iran. Methods. This is a qualitative study that was conducted through 18 family caregivers of persons with multiple sclerosis. A purposeful sampling method was used. Data were collected through semistructured and in-depth interviews conducted in Multiple Sclerosis Society and hospitals of Tabriz in Iran. The collected data was analyzed according to qualitative content analysis. Results. Five main categories were elicited from interviews: “using spirituality,” “living with hope,” “experiencing persistence and stability,” “seeking support,” and “seeking alternative treatments.” Conclusion. The study findings can help to inform the support given to families to help them cope with the effects of caring for someone with multiple sclerosis. Health system managers and professionals by using these results are able to support patients and their families appropriately in order to improve their quality of life and alleviate the complications of disease. Hossein Ebrahimi, Hadi Hasankhani, Hossein Namdar, Esmail Khodadadi, and Marjaneh Fooladi Copyright © 2017 Hossein Ebrahimi et al. All rights reserved. Short-Term and Long-Term Effects of an Exercise-Based Patient Education Programme in People with Multiple Sclerosis: A Pilot Study Wed, 16 Aug 2017 00:00:00 +0000 Background. Although people with Multiple Sclerosis (pwMS) benefit from physical exercise, they still show reduced physical activity and exercise behaviour. This study aimed to investigate short- and long-term effects of an exercise-based patient education programme (ePEP) that focuses on empowering pwMS to a sustainable and self-regulated exercise training management. Methods. Fourteen pwMS were randomly assigned to immediate experimental group (EG-I: ) and waitlist-control group (EG-W: ) and attended biweekly in a six-week ePEP. All participants were measured for walking ability, quality of life, fatigue, and self-efficacy towards physical exercise before and after the ePEP, after 12 weeks, and one year after baseline. Short-term effects were analysed in a randomised control trial and long-term effects of all ePEP participants (EG-I + EG-W = EG-all) in a quasi-experimental design. Results. Only functional gait significantly improved in EG-I compared to EG-W (, ). Moderate to large effects were found in EG-all for walking ability. Not significant, however, relevant changes were detected for quality of life and fatigue. Self-efficacy showed no changes. Conclusion. The ePEP seems to be a feasible option to empower pwMS to a self-regulated and sustainable exercise training management shown in long-term walking improvements. Christina Lutz, Stephanie Kersten, and Christian T. Haas Copyright © 2017 Christina Lutz et al. All rights reserved. Pharmacogenetic Biomarkers to Predict Treatment Response in Multiple Sclerosis: Current and Future Perspectives Wed, 19 Jul 2017 00:00:00 +0000 Disease-modifying therapies (DMTs) have significantly advanced the treatment of relapsing multiple sclerosis (MS), decreasing the frequency of relapses, disability, and magnetic resonance imaging lesion formation. However, patients’ responses to and tolerability of DMTs vary considerably, creating an unmet need for biomarkers to identify likely responders and/or those who may have treatment-limiting adverse reactions. Most studies in MS have focused on the identification of pharmacogenetic markers, using either the candidate-gene approach, which requires prior knowledge of the genetic marker and its role in the target disease, or genome-wide association, which examines multiple genetic variants, typically single nucleotide polymorphisms (SNPs). Both approaches have implicated numerous alleles and SNPs in response to selected MS DMTs. None have been validated for use in clinical practice. This review covers pharmacogenetic markers in clinical practice in other diseases and then reviews the current status of MS DMT markers (interferon , glatiramer acetate, and mitoxantrone). For a complex disease such as MS, multiple biomarkers may need to be evaluated simultaneously to identify potential responders. Efforts to identify relevant biomarkers are underway and will need to be expanded to all MS DMTs. These will require extensive validation in large patient groups before they can be used in clinical practice. Patricia K. Coyle Copyright © 2017 Patricia K. Coyle. All rights reserved. Depression Treatment among Adults with Multiple Sclerosis and Depression in Ambulatory Care Settings in the United States Thu, 27 Apr 2017 00:00:00 +0000 Background. There is little information regarding depression treatment patterns among adults with MS and depression in ambulatory settings at national level in the United States (US). Objectives. The objectives of this study were to identify patterns and predictors of depression treatment in ambulatory settings in US among adults with MS and depression. Methods. A cross-sectional study was conducted by pooling multiple years (2005–2011) of National Ambulatory Medical Care Survey and the outpatient department of the National Hospital Ambulatory Medical Care Survey data. The final study sample was comprised of ambulatory visits among adults with MS and depression. Dependent variable of this study was pharmacological treatment for depression with or without psychotherapy. Predictors of depression treatment were determined by conducting multivariable logistic regression. Results. Out of all ambulatory visits involving MS diagnosis, 20.59% also involved a depression diagnosis. Depression treatment was observed in 57.25% of the study population. Fluoxetine was the most prescribed individual antidepressant. Age and total number of chronic diseases were significant predictors of depression treatment. Conclusion. Approximately six out of ten ambulatory visits involving MS and depression recorded some form of depression treatment. Future longitudinal studies should examine health outcomes associated with depression treatment in this population. Sandipan Bhattacharjee, Lisa Goldstone, Queeny Ip, and Terri Warholak Copyright © 2017 Sandipan Bhattacharjee et al. All rights reserved. The Prevalence of Anti-Aquaporin 4 Antibody in Patients with Idiopathic Inflammatory Demyelinating Diseases Presented to a Tertiary Hospital in Malaysia: Presentation and Prognosis Thu, 19 Jan 2017 00:00:00 +0000 Background. There have been inconsistent reports on the prevalence and pathogenicity of anti-Aquaporin 4 (AQP4) in patients presented with idiopathic inflammatory demyelinating diseases (IIDDs). Objective. To estimate the prevalence of anti-AQP4 antibody in patients with IIDDs presented to University Malaya Medical Centre in terms of patients’ clinical and radiological presentations and prognoses. Methods. Retrospective data review of IIDDs patients presented from 2005 to 2015. Patients were classified into classical multiple sclerosis (CMS), opticospinal (OS) presentation, optic neuritis (ON), transverse myelitis (TM), brainstem syndrome (BS), and tumefactive MS. Anti-Aquaporin 4 antibody was tested using the Indirect Immunofluorescence Test (IIFT) cell-based assay. Statistical analysis was done using the SPSS version 20. Results. Anti-AQP4 antibody was detected in 53% of patients presented with IIDDs. CMS was more common in the seronegative group, 27/47 (57.45%; ). Conversely, OS involvement was more common in the seropositive group, 26/53 (49.06%; ). Longitudinally extensive spinal cord lesions (LESCLs) on MRI were also more common in the seropositive group, 29/40 (72.50%; ). Only 2/40 (5.00%) had MRI evidence of patchy or multiple short-segment spinal cord lesions in the AQP4-positive group (). The relapse rate and Expanded Disability Status Scale (EDSS) were also higher in the seropositive group (5.43 versus 3.17, ; 4.07 versus 2.51, , resp.). Typical clinical presentations that defined NMO were also seen in the seronegative patients, but in a lower frequency. Conclusion. Our cohort of patients had a higher prevalence of seropositivity of anti-AQP4 antibody as compared to those in Western countries. This was also associated with a more typical presentation of opticospinal involvement with LESCLs on MRI, a higher rate of relapse, and EDSS. S. Abdullah, W. F. Wong, and C. T. Tan Copyright © 2017 S. Abdullah et al. All rights reserved. Free Light Chains and Intrathecal B Cells Activity in Multiple Sclerosis: A Prospective Study and Meta-Analysis Wed, 28 Dec 2016 12:56:43 +0000 Background. The presence of CSF oligoclonal bands (OBs) is an independent prognostic factor for multiple sclerosis (MS), but the difficulties in the standardization of the test and the interlaboratory variation in reporting have contributed to its limited use in the diagnosis of the disease. Standard nephelometric assays to measure free light chains (FLC) levels have been recently developed and the test may improve the detection of intrathecal B cells activity. Methods. The presence of OBs, kappa and lambda FLC levels, and standard indices of intrathecal inflammation were assessed in 100 consecutive patients, including patients with MS, clinically isolated syndromes (CIS), other inflammatory diseases of the CNS, and other noninflammatory diseases. Results. Both KFLC and LFLC correlated strongly with the presence of OCBs and with all common tests for intrathecal inflammation ( for all comparisons). KFLC and LFLC were significantly different in patients with MS and CIS compared to the other groups ( and , resp.) and had a better diagnostic accuracy than all the other tests (area under the curve 82.3 % for KFLC index and 79.3 % for LFLC index). Conclusion. Nephelometric assays for KFLC in CSF reliably detect intrathecal immunoglobulin synthesis and discriminate MS patients. Gabriella Passerini, Gloria Dalla Costa, Francesca Sangalli, Lucia Moiola, Bruno Colombo, Massimo Locatelli, Giancarlo Comi, Roberto Furlan, and Vittorio Martinelli Copyright © 2016 Gabriella Passerini et al. All rights reserved. The Effect of Maximal Strength Training on Strength, Walking, and Balance in People with Multiple Sclerosis: A Pilot Study Mon, 26 Dec 2016 15:32:33 +0000 There is little literature examining the use of maximal strength training (MST) in people with multiple sclerosis (pwMS). This pretest-posttest study examined the effects of a MST program on strength, walking, balance, and fatigue in a sample of pwMS. Seven pwMS (median EDSS 3.0, IQR 1.5) participated in a MST program twice weekly for eight weeks. Strength was assessed with 1-repetition maximum (1RM) on each leg. Walking and balance were measured with the 6-Minute Walk Test (6MWT) and Berg Balance Scale (BBS), respectively. Fatigue was measured during each week of the program with the Fatigue Severity Scale (FSS). The program was well tolerated, with an attendance rate of 96.4%. Participants had significant improvements in right leg 1RM (, ), left leg 1RM (, ), 6MWT distance (), and BBS score (, ) after the MST intervention. There was no significant change in FSS scores (, ). Participants in the MST program experienced improved balance and walking without an increase in fatigue. This MST program may be utilized by rehabilitation clinicians to improve lower extremity strength, balance, and mobility in pwMS. Herb I. Karpatkin, Evan T. Cohen, Sarah Klein, David Park, Charles Wright, and Michael Zervas Copyright © 2016 Herb I. Karpatkin et al. All rights reserved. Pregnancy and the Use of Disease-Modifying Therapies in Patients with Multiple Sclerosis: Benefits versus Risks Sun, 18 Dec 2016 13:47:45 +0000 The burden of multiple sclerosis (MS) in women of childbearing potential is increasing, with peak incidence around the age of 30 years, increasing incidence and prevalence, and growing female : male ratio. Guidelines recommend early use of disease-modifying therapies (DMTs), which are contraindicated or recommended with considerable caution, during pregnancy/breastfeeding. Many physicians are reluctant to prescribe them for a woman who is/is planning to be pregnant. Interferons are not absolutely contraindicated during pregnancy, since interferon-β appears to lack serious adverse effects in pregnancy, despite a warning in its labelling concerning risk of spontaneous abortion. Glatiramer acetate, natalizumab, and alemtuzumab also may not induce adverse pregnancy outcomes, although natalizumab may induce haematologic abnormalities in newborns. An accelerated elimination procedure is needed for teriflunomide if pregnancy occurs on treatment or if pregnancy is planned. Current evidence supports the contraindication for fingolimod during pregnancy; data on other DMTs remains limited. Increased relapse rates following withdrawal of some DMTs in pregnancy are concerning and require further research. The postpartum period brings increased risk of disease reactivation that needs to be carefully addressed through effective communication between treating physicians and mothers intending to breastfeed. We address the potential for use of the first- and second-line DMTs in pregnancy and lactation. Raed Alroughani, Ayse Altintas, Mohammed Al Jumah, Mohammadali Sahraian, Issa Alsharoqi, Abdurahman AlTahan, Abdulkader Daif, Maurice Dahdaleh, Dirk Deleu, Oscar Fernandez, Nikolaos Grigoriadis, Jihad Inshasi, Rana Karabudak, Karim Taha, Natalia Totolyan, Bassem I. Yamout, Magd Zakaria, and Saeed Bohlega Copyright © 2016 Raed Alroughani et al. All rights reserved. Effects on Balance and Walking with the CoDuSe Balance Exercise Program in People with Multiple Sclerosis: A Multicenter Randomized Controlled Trial Wed, 30 Nov 2016 14:03:18 +0000 Background. Balance and walking impairments are frequent in people with multiple sclerosis (MS). Objective. The aim was to investigate the effects of a group-based balance exercise program targeting core stability, dual tasking, and sensory strategies (CoDuSe) on balance, postural sway, walking, perceived walking limitations, and balance confidence. Design. A single-blinded randomized multicenter trial. No intervention was given to controls. Participants. People with MS able to walk 100 meters but unable to maintain tandem stance ≥30 seconds. Eighty-seven participants were randomized to intervention or control. Intervention. The 60-minute CoDuSe group program, twice weekly for seven weeks, supervised by physical therapists. Measurements. Primary outcome was dynamic balance (Berg Balance Scale (BBS)). Secondary outcomes were postural sway, walking (Timed-Up and Go test; Functional Gait Assessment (FGA)), MS Walking Scale, and Activities-specific Balance Confidence (ABC) Scale. Assessments were performed before and after (week 8) the intervention. Results. 73 participants fulfilled the study. There were significant differences between the intervention and the control groups in change in the BBS and in the secondary measures: postural sway with eyes open, FGA, MS Walking Scale, and ABC scale in favor of the intervention. Conclusions. The seven-week CoDuSe program improved dynamic balance more than no intervention. Anette Forsberg, Lena von Koch, and Ylva Nilsagård Copyright © 2016 Anette Forsberg et al. All rights reserved. EVASEP: A Noninterventional Study Describing the Perception of Neurologists, Patients, and Caregivers on Caregivers’ Role in the Support of Patients Suffering from Multiple Sclerosis Treated with Subcutaneous Interferon Beta 1a Mon, 01 Aug 2016 14:34:04 +0000 Background. The perception of the role of caregivers for people with multiple sclerosis (MS) is important but poorly studied, particularly in patients with low levels of disability. Objectives. To describe the perceptions of the role of caregivers from the perspective of the caregiver, the patient, and neurologists. Methods. This observational study was conducted in France on patients with relapsing remitting MS treated with subcutaneous (SC) interferon-β-1a (IFN-β-1a) for more than 24 months. Results. Caregiver, patients, and neurologists all considered providing moral support and fighting against the disease as the most important role of the care provider. Moral support was considered significantly more important by caregivers than the patients and neurologists () and caregivers considered their role in helping patients to fight disease more important than did the neurologists (). Knowledge of disease and available treatments were less important among support providers than patients ( and ). Conclusion. There are many unmet needs in the perception of the role of caregivers for people with MS which need to be addressed to deliver the most effective care package for patients and to support the needs of the support provider. Cécile Donzé, Bruno Lenne, Anne-Sophie Jean Deleglise, Christian Kempf, Yasmine Bellili, and Patrick Hautecoeur Copyright © 2016 Cécile Donzé et al. All rights reserved. Retracted: Consensus Guidelines for CSF and Blood Biobanking for CNS Biomarker Studies Tue, 26 Jul 2016 08:16:52 +0000 Multiple Sclerosis International Copyright © 2016 Multiple Sclerosis International. All rights reserved. Healthy Aging from the Perspectives of 683 Older People with Multiple Sclerosis Mon, 18 Jul 2016 15:56:20 +0000 Purpose. The aim of this study was to determine what factors most greatly contributed to healthy aging with multiple sclerosis (MS) from the perspective of a large sample of older people with MS. Design and Methods. Participants (; >55 years of age with symptoms >20 years) provided answers to an open-ended question regarding healthy aging and were categorized into three groups, 55–64 (young), 65–74 (middle), and 75 and over (oldest old). Sociodemographic actors were compared using ANOVA. Two independent raters used the framework method of analyzing qualitative data. Results. Participants averaged 64 years of age with MS symptoms for 32.9 years . 531 participants were female (78%). The majority of participants lived in their own home () with a spouse or partner (). Participants described seven themes: social connections, attitude and outlook on life, lifestyle choices and habits, health care system, spirituality and religion, independence, and finances. These themes had two shared characteristics, multidimensionality and interdependence. Implications. Learning from the experiences of older adults with MS can help young and middle aged people with MS plan to age in their own homes and communities. Our data suggests that older people with MS prioritize factors that are modifiable through targeted self-management strategies. Elizabeth M. Wallack, Hailey D. Wiseman, and Michelle Ploughman Copyright © 2016 Elizabeth M. Wallack et al. All rights reserved. The Incidence of Euphoria in Multiple Sclerosis: Artefact of Measure Mon, 13 Jun 2016 07:56:25 +0000 Background. A subgroup of MS patients present with “euphoria.” Classical authors describe this symptom as the predominant mood state of these patients, while contemporary authors regard it as rare. Objective. This study aimed to address these discrepancies and investigate the contributions made by varying operational definitions and measurement instruments. Methods. One hundred MS patients and 100 matched controls completed the classical interview of Cottrell and Wilson and the modern Neuropsychiatric Inventory in a once-off interview. Results. The MS group demonstrated high frequencies of euphoria using the classical measure but low frequencies using the contemporary measure and definition. The matched control group demonstrated significantly higher rates than the MS group using the classical measure and lower rates than the MS group using the contemporary measure. Conclusion. The discrepancies in incidence rates of euphoria noted in the literature do not reflect a change in the incidence of euphoria in MS, but rather in the definition and operationalisation of “euphoria.” Furthermore, these results highlight the importance of characterising what represents pathological euphoria as well as the need for better definitions and instruments of measure. Amy Duncan, Susan Malcolm-Smith, Ozayr Ameen, and Mark Solms Copyright © 2016 Amy Duncan et al. All rights reserved. The Efficacy of Functional Electrical Stimulation of the Abdominal Muscles in the Treatment of Chronic Constipation in Patients with Multiple Sclerosis: A Pilot Study Wed, 20 Apr 2016 07:01:20 +0000 Chronic constipation in patients with multiple sclerosis (MS) is common and the current methods of treatment are ineffective in some patients. Anecdotal observations suggest that functional electrical stimulation (FES) of the abdominal muscles may be effective in the management of constipation in these patients. Patients and Methods. In this exploratory investigation we studied the effects of FES on the whole gut transit time (WGTT) and the colonic transit time (CTT). In addition, we evaluated the treatment effect on the patients’ constipation-related quality of life and on the use of laxatives and the use of manual bowel evacuation. FES was given for 30 minutes twice a day for a period of six weeks. Four female patients were studied. Results. The WGTT and CTT and constipation-related quality of life improved in all patients. The patients’ use of laxatives was reduced. No adverse effects of FES treatment were reported. Conclusion. The findings of this pilot study suggest that FES applied to the abdominal muscles may be an effective treatment modality for severe chronic constipation in patients with MS. Christine Singleton, Abdel Magid Bakheit, and Carla Peace Copyright © 2016 Christine Singleton et al. All rights reserved. Management of Multiple Sclerosis in the Breastfeeding Mother Thu, 04 Feb 2016 08:21:29 +0000 Multiple Sclerosis (MS) is an autoimmune neurological disease characterized by inflammation of the brain and spinal cord. Relapsing-Remitting MS is characterized by acute attacks followed by remission. Treatment is aimed at halting these attacks; therapy may last for months to years. Because MS disproportionately affects females and commonly begins during the childbearing years, clinicians treat pregnant or nursing MS patients. The intent of this review is to perform an in-depth analysis into the safety of drugs used in breastfeeding women with MS. This paper is composed of several drugs used in the treatment of MS and current research regarding their safety in breastfeeding including immunomodulators, immunosuppressants, monoclonal antibodies, corticosteroids, and drugs used for symptomatic treatment. Typically, some medications are large polar molecules which often do not pass into the milk in clinically relevant amounts. For this reason, interferon beta is likely safe for the infant when given to a breastfeeding mother. However, other drugs with particularly dangerous side effects may not be recommended. While treatment options are available and some data from clinical studies does exist, there continues to be a need for investigation and ongoing review of the medications used in breastfeeding mothers. Saneea Almas, Jesse Vance, Teresa Baker, and Thomas Hale Copyright © 2016 Saneea Almas et al. All rights reserved. Lack of Association between Pulse Steroid Therapy and Bone Mineral Density in Patients with Multiple Sclerosis Thu, 04 Feb 2016 06:41:40 +0000 Multiple sclerosis (MS) has been associated with reduced bone mineral density (BMD). The purpose of this study was to determine the possible factors affecting BMD in patients with MS. We included consecutive 155 patients with MS and 90 age- and sex-matched control subjects. Patients with MS exhibited significantly lower T-scores and Z-scores in the femoral neck and trochanter compared to the controls. Ninety-four (61%) patients had reduced bone mass in either the lumbar spine or the femoral neck; of these, 64 (41.3%) had osteopenia and 30 (19.4%) had osteoporosis. The main factors affecting BMD were disability, duration of MS, and smoking. There was a negative relationship between femoral BMD and EDSS and disease duration. No association with lumbar BMD was determined. There were no correlations between BMD at any anatomic region and cumulative corticosteroid dose. BMD is significantly lower in patients with MS than in healthy controls. Reduced BMD in MS is mainly associated with disability and duration of the disease. Short courses of high dose steroid therapy did not result in an obvious negative impact on BMD in the lumbar spine and femoral neck in patients with MS. Serap Zengin Karahan, Cavit Boz, Sevgi Kilic, Nuray Can Usta, Mehmet Ozmenoglu, Vildan Altunayoglu Cakmak, and Sibel Gazioglu Copyright © 2016 Serap Zengin Karahan et al. All rights reserved. Stride-Time Variability and Fall Risk in Persons with Multiple Sclerosis Wed, 30 Dec 2015 11:28:21 +0000 Gait variability is associated with falls in clinical populations. However, gait variability’s link to falls in persons with Multiple Sclerosis (PwMS) is not well established. This investigation examined the relationship between stride-time variability, fall risk, and physiological fall risk factors in PwMS. 17 PwMS ( years) and 17 age-matched controls ( years) performed the 6-minute walk test. Stride-time was assessed with accelerometers attached to the participants’ shanks. Stride-time variability was measured by interstride coefficient of variation (CV) of stride-time. The participant’s fall risk was measured by the short form physiological profile assessment (PPA). A Spearman correlation analysis was used to determine the relationship between variables. Increased fall risk was strongly associated with increased stride-time CV in both PwMS (, ) and the controls (, ). Fall risk was not correlated with average stride-time (). In PwMS, stride-time CV was related to postural sway (, ) while in the control group, it was related to proprioception (, ) and postural sway (, ). Current observations suggest that gait variability is maybe more sensitive marker of fall risk than average gait parameters in PwMS. It was also noted that postural sway may be potentially targeted to modify gait variability in PwMS. Yaejin Moon, Douglas A. Wajda, Robert W. Motl, and Jacob J. Sosnoff Copyright © 2015 Yaejin Moon et al. All rights reserved. The Therapeutic Potential of the Ketogenic Diet in Treating Progressive Multiple Sclerosis Tue, 29 Dec 2015 11:39:23 +0000 Until recently, multiple sclerosis has been viewed as an entirely inflammatory disease without acknowledgment of the significant neurodegenerative component responsible for disease progression and disability. This perspective is being challenged by observations of a dissociation between inflammation and neurodegeneration where the neurodegenerative component may play a more significant role in disease progression. In this review, we explore the relationship between mitochondrial dysfunction and neurodegeneration in multiple sclerosis. We review evidence that the ketogenic diet can improve mitochondrial function and discuss the potential of the ketogenic diet in treating progressive multiple sclerosis for which no treatment currently exists. Mithu Storoni and Gordon T. Plant Copyright © 2015 Mithu Storoni and Gordon T. Plant. All rights reserved. The Communication of Multiple Sclerosis Diagnosis: The Patients’ Perspective Tue, 15 Dec 2015 11:05:16 +0000 Background. Multiple sclerosis (MS) is the leading cause of nontraumatic neurological disability in young adults in Europe and in the United States. The uncertainty regarding its evolution makes the diagnosis disclosure a difficult process. Objective. The aim of the study was to provide patients’ global perspective towards MS diagnosis communication. Methods. 150 consecutive patients, recently diagnosed with CIS or MS, were asked to complete a 17-item questionnaire assessing factors influencing their satisfaction with the information provided. Results. Eighty-six patients fulfilled diagnostic criteria for MS and 64 for CIS. Diagnosis disclosure took place in a private setting and required in most cases (87.3%) less than 30 minutes. Most patients reported being moderately or highly satisfied with the information provided (75%). The degree of satisfaction seems significantly related to patients’ younger age, a longer time dedicated to disclose the diagnosis, a CIS diagnosis, and, above all, tailored information and an adequate emotional support. Conclusion. Most patients reported a good degree of satisfaction about the communication of MS or CIS diagnosis. A fruitful relationship between patient and neurologist is essential to obtain a better acceptance of the disease, patients’ compliance with chronic treatments and to improve patients’ quality of life. Maria Josè Messina, Gloria Dalla Costa, Mariaemma Rodegher, Lucia Moiola, Bruno Colombo, Giancarlo Comi, and Vittorio Martinelli Copyright © 2015 Maria Josè Messina et al. All rights reserved. Comparing Three Dual-Task Methods and the Relationship to Physical and Cognitive Impairment in People with Multiple Sclerosis and Controls Mon, 23 Nov 2015 10:00:11 +0000 Dual-tasking (DT) is a measure to detect impairments in people with multiple sclerosis (MS). We compared three DT methods to determine whether cognitive (Montreal Cognitive Assessment (MoCA)) or physical disability (Expanded Disease Severity Scale; EDSS) was related to DT performance. We recruited MS participants with low disability (<3 EDSS, ) and high disability (≥3 EDSS, ) and matched controls (). Participants walked at self-selected (SS) speed on an instrumented walkway (Protokinetics, Havertown, USA), followed by DT walks in randomized order: DT ABC (reciting every second letter of the alphabet), DT 7 (serially subtracting 7’s from 100), and DT 3 (counting upwards, leaving out multiples and numbers that include 3). DT 7 resulted in the most consistent changes in performance. Both MS and control groups reduced velocity and cadence and shortened step length during DT with no significant differences between groups. Control subjects widened stride width by about 1 cm while MS subjects (collapsed as one group) did not. MS subjects with higher disability significantly increased percentage time in double support during DT compared to SS (, ). The change in DS was related to cognitive and not physical disability (,). Megan C. Kirkland, Elizabeth M. Wallack, Samantha N. Rancourt, and Michelle Ploughman Copyright © 2015 Megan C. Kirkland et al. All rights reserved. Adipsin Is Associated with Multiple Sclerosis: A Follow-Up Study of Adipokines Sun, 08 Nov 2015 12:28:40 +0000 Background and Objective. The role of adipokines in regulation of immune responses has been recognized, but very little is known about their impact on multiple sclerosis (MS). In this study, we analysed whether the major adipokines are differentially expressed in plasma of patients with different MS subtypes and clinically isolated syndrome (CIS) and explored their association with major disease characteristics. Methods. The levels of adiponectin, adipsin, leptin, and resistin in the plasma of 80 patients with different subtypes of MS and CIS were followed up annually over the two years. The data obtained were correlated with disease activity, EDSS and volumes of T1-weighted lesions (T1-LV), and fluid attenuation inversion recovery lesions (FLAIR-LV) on MRI. Results. In MS group, a correlation was found between the level of adipsin and EDSS score at baseline (, ). In RRMS, the levels of adipsin correlated with EDSS scores (, ), T1-LV (, ), and FLAIR-LV (, ) at baseline and an increase in the T1-LV over the follow-up (, ). Associations with other adipokines were not detected. Conclusion. Our exploratory study provides novel insights on the impact of adipokines in MS and suggests that adipsin exerts predictive potential as a biomarker of neurodegeneration. Renuka Natarajan, Sanna Hagman, Mari Hämälainen, Tiina Leppänen, Prasun Dastidar, Eeva Moilanen, and Irina Elovaara Copyright © 2015 Renuka Natarajan et al. All rights reserved. Neuroimaging of Natalizumab Complications in Multiple Sclerosis: PML and Other Associated Entities Mon, 21 Sep 2015 12:00:37 +0000 Natalizumab (Tysabri) is a monoclonal antibody (α4 integrin antagonist) approved for treatment of multiple sclerosis, both for patients who fail therapy with other disease modifying agents and for patients with aggressive disease. Natalizumab is highly effective, resulting in significant decreases in rates of both relapse and disability accumulation, as well as marked decrease in MRI evidence of disease activity. As such, utilization of natalizumab is increasing, and the presentation of its associated complications is increasing accordingly. This review focuses on the clinical and neuroimaging features of the major complications associated with natalizumab therapy, focusing on the rare but devastating progressive multifocal leukoencephalopathy (PML). Associated entities including PML associated immune reconstitution inflammatory syndrome (PML-IRIS) and the emerging phenomenon of rebound of MS disease activity after natalizumab discontinuation are also discussed. Early recognition of neuroimaging features associated with these processes is critical in order to facilitate prompt diagnosis, treatment, and/or modification of therapies to improve patient outcomes. Justin M. Honce, Lidia Nagae, and Eric Nyberg Copyright © 2015 Justin M. Honce et al. All rights reserved. Fingolimod Treatment in Relapsing-Remitting Multiple Sclerosis Patients: A Prospective Observational Multicenter Postmarketing Study Wed, 22 Jul 2015 11:24:23 +0000 Objective. The aim of this prospective observational multicenter postmarketing study was to evaluate fingolimod efficacy in a real world clinical setting. Methods. One hundred forty-two subjects with relapsing-remitting multiple sclerosis (RRMS) were enrolled in three multiple sclerosis centers throughout Central and Southern Italy between January 2011 and September 2013. After enrollment, regular visits and EDSS assessment were scheduled every 3 months, and MRI scan was obtained every 12 months. Patients were followed up from 1 to 33 months (mean 14.95 ± 9.15 months). The main efficacy endpoints included the proportion of patients free from clinical relapses, from disability progression, from magnetic resonance imaging activity, and from any disease activity. Results. Out of 142 patients enrolled in the study, 88.1% were free from clinical relapse and 69.0% were free from disability progression; 68.5% of patients remained free from new or newly enlarging T2 lesions and 81.7% of patients were free from gadolinium enhancing lesions. Overall the proportion of patients free from any disease activity was 41.9%. Conclusions. Our data in a real world cohort are consistent with previous findings that yield convincing evidence for the efficacy of fingolimod in patients with RRMS. Rocco Totaro, Caterina Di Carmine, Gianfranco Costantino, Roberta Fantozzi, Paolo Bellantonio, Aurora Fuiani, Ciro Mundi, Stefano Ruggieri, Carmine Marini, and Antonio Carolei Copyright © 2015 Rocco Totaro et al. All rights reserved. Prevalence of Depression and Anxiety among Patients with Multiple Sclerosis Attending the MS Clinic at Sheikh Khalifa Medical City, UAE: Cross-Sectional Study Thu, 09 Jul 2015 11:42:22 +0000 Depression and anxiety are reported to be prevalent in patients with MS, with prevalence rates ranging from 20% to 50%. Unfortunately, the rates, patterns, and risk factors are not well studied in our Middle East region, and, to our knowledge, not at all in UAE. Using standardized screening tools, we observed that 17% and 20% of 80 patients seen in MS clinic had scores consistent with major depression and anxiety disorders, respectively, at a rate that was not statistically different when compared to age and sex matched controls. None of the studied variables including duration of the disease, EDSS scores, age, gender, and the level of education had any significant correlation with the rates of both disorders. Almost two-thirds of the patients with scores consistent with major depression and anxiety were not on antidepressant and antianxiety medications. Taoufik Alsaadi, Khadija El Hammasi, Tarek M. Shahrour, Mustafa Shakra, Lamya Turkawi, Abdulla Mudhafar, Lina Diab, and Mufeed Raoof Copyright © 2015 Taoufik Alsaadi et al. All rights reserved. EDSS Change Relates to Physical HRQoL While Relapse Occurrence Relates to Overall HRQoL in Patients with Multiple Sclerosis Receiving Subcutaneous Interferon β-1a Sun, 05 Jul 2015 09:49:20 +0000 Objective. To compare patterns of associations of changes in mental and physical health dimensions of health-related quality of life (HRQoL) over time with relapse occurrence and changes in Expanded Disability Status Scale (EDSS) scores in patients with relapsing multiple sclerosis (RMS). Methods. This 24-month, phase IV, observational study enrolled 334 patients with RMS who received interferon β-1a 44 μg or 22 μg subcutaneously three times weekly. At each 6-month visit, patients completed the Multiple Sclerosis Quality of Life-54 (MSQOL-54) and site investigators assessed EDSS and recorded relapse occurrence. A generalized linear model procedure was used for multivariable analyses (per protocol) that explored unique associations of EDSS score change and relapse occurrence with MSQOL-54 physical health composite score (PCS) and mental health composite score (MCS). Results. HRQoL improved over 2 years among those who completed the study. Occurrence of ≥1 relapse was significantly associated with lower MSQOL-54 PCS and MCS. Changes in EDSS score were significantly associated with MSQOL-54 PCS, but not MCS. Conclusions. HRQoL assessments, particularly those that examine mental health, may provide information on the general health status of patients with RMS that would not be recognized using traditional clinician-assessed measures of disease severity and activity. This trial is registered with; identifier: NCT01141751. Barbara G. Vickrey, Liesly Lee, Fraser Moore, and Patrick Moriarty Copyright © 2015 Barbara G. Vickrey et al. All rights reserved. Antiepileptic and Antidepressive Polypharmacy in Patients with Multiple Sclerosis Mon, 29 Jun 2015 09:42:19 +0000 Objective. Patients with multiple sclerosis (MS) are often suffering from neuropathic pain. Antiepileptic drugs (AEDs) and tricyclic antidepressants (TCAs) are commonly used and are susceptible to be involved in drug interactions. The aim of this retrospective study was to investigate the prevalence of use of antiepileptic and antidepressive drugs in MS patients and to discuss the theoretical potential for interactions. Methods. Review of the medical records from all patients treated at a dedicated MS rehabilitation centre in Norway between 2009 and 2012. Results. In total 1090 patients attended a rehabilitation stay during the study period. Of these, 342 (31%; 249 females) with mean age of 53 (±10) years and EDSS 4.8 (±1.7) used at least one AED (gabapentin 12.7%, pregabalin 7.7%, clonazepam 7.8%, and carbamazepine 2.6%) or amitriptyline (9.7%). Polypharmacy was widespread (mean 5.4 drugs) with 60% using additional CNS-active drugs with a propensity to be involved in interactions. Age, gender, and EDSS scores did not differ significantly between those using and not using AED/amitriptyline. Conclusion. One-third of MS patients attending a rehabilitation stay receive AED/amitriptyline treatment. The high prevalence of polypharmacy and use of CNS-active drugs calls for awareness of especially pharmacodynamic interactions and possible excessive adverse effects. Georg Anton Giæver Beiske, Trygve Holmøy, Antonie Giæver Beiske, Svein I. Johannessen, and Cecilie Johannessen Landmark Copyright © 2015 Georg Anton Giæver Beiske et al. All rights reserved. Development of Activity-Related Muscle Fatigue during Robot-Mediated Upper Limb Rehabilitation Training in Persons with Multiple Sclerosis: A Pilot Trial Sun, 24 May 2015 10:13:22 +0000 Robot-assisted rehabilitation facilitates high-intensity training of the impaired upper limb in neurological rehabilitation. It has been clinically observed that persons with Multiple Sclerosis (MS) have difficulties in sustaining the training intensity during a session due to the development of activity-related muscle fatigue. An experimental observational pilot study was conducted to examine whether or not the muscle fatigue develops in MS patients during one session of robot-assisted training within a virtual learning environment. Six MS patients with upper limb impairment (motricity index ranging from 50 to 91/100) and six healthy persons completed five training bouts of three minutes each performing lifting tasks, while EMG signals of anterior deltoid and lower trapezius muscles were measured and their subjective perceptions on muscle fatigue were registered. Decreased performance and higher subjective fatigue perception were present in the MS group. Increased mean EMG amplitudes and subjective perception levels on muscle fatigue were observed in both groups. Muscle fatigue development during 15′ training has been demonstrated in the arm of MS patients, which influences the sustainability of training intensity in MS patients. To optimize the training performance, adaptivity based on the detection of MS patient’s muscle fatigue could be provided by means of training program adjustment. Johanna Renny Octavia, Peter Feys, and Karin Coninx Copyright © 2015 Johanna Renny Octavia et al. All rights reserved. Applying an Open-Source Segmentation Algorithm to Different OCT Devices in Multiple Sclerosis Patients and Healthy Controls: Implications for Clinical Trials Mon, 18 May 2015 12:34:13 +0000 Background. The lack of segmentation algorithms operative across optical coherence tomography (OCT) platforms hinders utility of retinal layer measures in MS trials. Objective. To determine cross-sectional and longitudinal agreement of retinal layer thicknesses derived from an open-source, fully-automated, segmentation algorithm, applied to two spectral-domain OCT devices. Methods. Cirrus HD-OCT and Spectralis OCT macular scans from 68 MS patients and 22 healthy controls were segmented. A longitudinal cohort comprising 51 subjects (mean follow-up: 1.4 ± 0.9 years) was also examined. Bland-Altman analyses and interscanner agreement indices were utilized to assess agreement between scanners. Results. Low mean differences (−2.16 to 0.26 μm) and narrow limits of agreement (LOA) were noted for ganglion cell and inner and outer nuclear layer thicknesses cross-sectionally. Longitudinally we found low mean differences (−0.195 to 0.21 μm) for changes in all layers, with wider LOA. Comparisons of rate of change in layer thicknesses over time revealed consistent results between the platforms. Conclusions. Retinal thickness measures for the majority of the retinal layers agree well cross-sectionally and longitudinally between the two scanners at the cohort level, with greater variability at the individual level. This open-source segmentation algorithm enables combining data from different OCT platforms, broadening utilization of OCT as an outcome measure in MS trials. Pavan Bhargava, Andrew Lang, Omar Al-Louzi, Aaron Carass, Jerry Prince, Peter A. Calabresi, and Shiv Saidha Copyright © 2015 Pavan Bhargava et al. All rights reserved. The Lived Experience of Multiple Sclerosis Relapse: How Adults with Multiple Sclerosis Processed Their Relapse Experience and Evaluated Their Need for Postrelapse Care Wed, 13 May 2015 09:50:15 +0000 Background. Multiple sclerosis (MS) relapses can take a toll on individuals’ health and quality of life. Given such consequences of relapses, postrelapse care beyond pharmacological approaches may play an important role in recovery. Nevertheless, how individuals with MS process their relapse experience and manage the consequences is still uncertain. Purpose. We conducted a qualitative study to understand relapse experiences and postrelapse care need from perspectives of adults with MS and identify relapse management patterns. Methods. We interviewed 17 adults with MS. Results. By examining combinations of three categories related to relapse experience, we identified four relapse management patterns: (i) Active Relapse Manager, (ii) Early-Stage Proactive Relapse Monitor, (iii) Adapted Passive Relapse Manager, and (iv) Passive Relapse Monitor. The relapse management patterns appear to associate strongly with the appraisal of the experience. Conclusions. The results of this study suggest the importance of understanding each patient beyond their functional limitations and the potential need for multidisciplinary postrelapse care which goes past restoring functional limitations at the acute phase. Future research to further understand the relapse management process at all stages of the healthcare continuum is a crucial step toward developing strategies to advance the current postrelapse care and to facilitate optimal recovery. Miho Asano, Karli Hawken, Merrill Turpin, Abby Eitzen, and Marcia Finlayson Copyright © 2015 Miho Asano et al. All rights reserved. Does Self-Efficacy Affect Cognitive Performance in Persons with Clinically Isolated Syndrome and Early Relapsing Remitting Multiple Sclerosis? Wed, 29 Apr 2015 09:35:51 +0000 In persons with multiple sclerosis (MS) a lowered self-efficacy negatively affects physical activities. Against this background we studied the relationship between self-efficacy and cognitive performance in the early stages of MS. Thirty-three patients with Clinically Isolated Syndrome (CIS) and early Relapsing Remitting MS (eRRMS) were assessed for self-efficacy (MSSES-18), cognition (CDR System), fatigue (MFIS-5), depressive symptoms (BDI), disease impact (MSIS-29), and disability (EDSS). Correlative analyses were performed between self-efficacy and cognitive scores, and stepwise regression analyses identified predictors of cognition and self-efficacy. Good correlations existed between total self-efficacy and Power of Attention (; ), Reaction Time Variability (; ), and Speed of Memory (; ), and between control self-efficacy and Reaction Time Variability (; ). Total self-efficacy predicted 40% of Power of Attention, 34% of Reaction Time Variability, and 40% of Speed of Memory variabilities. Disease impact predicted 65% of total self-efficacy and 58% of control self-efficacy variabilities. The findings may suggest that in persons with CIS and eRRMS self-efficacy may positively affect cognitive performance and that prevention of disease activity may preserve self-efficacy. Peter Joseph Jongen, Keith Wesnes, Björn van Geel, Paul Pop, Hans Schrijver, Leo H. Visser, H. Jacobus Gilhuis, Ludovicus G. Sinnige, and Augustina M. Brands Copyright © 2015 Peter Joseph Jongen et al. All rights reserved.