Risk associated behavior in premorbid multiple sclerosis: A case-control study

The Importance of Managing Modifiable Comorbidities in People with Multiple Sclerosis: A Narrative Review

Multiple sclerosis (MS) is a chronic, inflammatory, degenerative demyelinating disease of the central nervous system (CNS) of unknown etiology that affects individuals in their early adulthood. In the last decade, life expectancy for people with MS (PwMS) has almost equaled that of the general population. This demographic shift necessitates a heightened awareness of comorbidities, especially the ones that can be prevented and modified, that can significantly impact disease progression and management. Vascular comorbidities are of particular interest as they are mostly modifiable health states, along with voluntary behaviors, such as smoking and alcohol consumption, commonly observed among individuals with MS. Vascular risk factors have also been implicated in the etiology of cerebral small vessel disease. Furthermore, differentiating between vascular and MS lesion load poses a significant challenge due to overlapping clinical and radiological features. This review describes the current evidence regarding the range of preventable and modifiable comorbidities and risk factors and their implications for PwMS.

Alcohol consumption is associated with excessive risk of multiple sclerosis: a meta-analysis observational study

BACKGROUND

There have been inconsistent results regarding the association between alcohol intake and susceptibility to multiple sclerosis.

OBJECTIVE

To assess the potential role of alcohol intake regarding the risk of multiple sclerosis by using a meta-analytic approach.

DESIGN AND SETTING

Observational meta-analysis study conducted in a hospital in China.

METHODS

The electronic databases of PubMed, EMBASE and the Cochrane library were systematically searched for eligible studies from their inception up to January 2020. The summary odds ratio (OR) with 95% confidence interval (CI) was applied to assess the association between alcohol intake and multiple sclerosis, using a random-effects model.

RESULTS

One prospective cohort study and eight case-control studies involving a total of 211,396 subjects and 10,407 cases of multiple sclerosis were selected for the final meta-analysis. From the pooled data, no significant association between alcohol intake and multiple sclerosis risk was found (OR: 0.94; 95% CI: 0.73-1.22; P = 0.668), and this conclusion was judged to be robust. Subgroup analysis found that intake of beer was associated with an increased risk of multiple sclerosis (OR: 1.58; 95% CI: 1.12-2.23; P = 0.010).

CONCLUSION

This study found that beer intake could cause an excess risk of multiple sclerosis. Further large-scale prospective studies should be conducted to verify this conclusion.

Abuse and dependence potential of sphingosine-1-phosphate (S1P) receptor modulators used in the treatment of multiple sclerosis: a review of literature and public data

Abuse and misuse of prescription drugs remains an ongoing concern in the USA and worldwide; thus, all centrally active new drugs must be assessed for abuse and dependence potential. Sphingosine-1-phosphate (S1P) receptor modulators are used primarily in the treatment of multiple sclerosis. Among the new S1P receptor modulators, siponimod, ozanimod, and ponesimod have recently been approved in the USA, European Union (EU), and other countries. This review of literature and other public data has been undertaken to assess the potential for abuse of S1P receptor modulators, including ozanimod, siponimod, ponesimod, and fingolimod, as well as several similar compounds in development. The S1P receptor modulators have not shown chemical or pharmacological similarity to known drugs of abuse; have not shown abuse or dependence potential in animal models for subjective effects, reinforcement, or physical dependence; and do not have adverse event profiles demonstrating effects of interest to individuals who abuse drugs (such as sedative, stimulant, mood-elevating, or hallucinogenic effects). In addition, no reports of actual abuse, misuse, or dependence were identified in the scientific literature for fingolimod, which has been on the market since 2010 (USA) and 2011 (EU). Overall, the data suggest that S1P receptor modulators are not associated with significant potential for abuse or dependence, consistent with their unscheduled status in the USA and internationally.

Transdiagnostic treatment of emotional disorders in people with multiple sclerosis: randomized controlled trial

BACKGROUND

Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system. MS is significantly associated with a high rate of psychological, behavioral, and emotional consequences. Despite the frequent mental disorders, high rate of psychological comorbidities, and emotional problems in people with MS (PwMS), these conditions are often underdiagnosed and undertreated. This study aimed to examine the efficacy of a group format of the unified protocol for the transdiagnostic treatment of emotional disorders in adult PwMS associated with an emotional disorder.

METHODS

Seventy adult PwMS were randomized using an internet-based computer system to either the unified protocol (n = 35) or treatment as usual condition. The assessment protocol included semi-structured clinical interviews and self-reports evaluating diagnostic criteria, depression, anxiety and worry symptoms, emotional dysregulation, and affectivity.

RESULTS

The parametric test of analysis of covariance, followed the intent to treat analyses, revealed the unified protocol significantly changed depression symptoms (Cohen's d = 1.9), anxiety symptoms (Cohen's d = 2.16), worry symptoms (Cohen's d = 1.27), emotion dysregulation (Cohen's d = 0.44), positive affect (Cohen's d = 1.51), and negative affect (Cohen's d = 1.89) compared with the control group. The unified protocol also significantly improved outcome scores at the end of treatment relative to baseline (p < .001).

CONCLUSION

The findings support that the unified protocol could be an additional efficient psychological treatment for PwMS. Trial registration IRCT, number: IRCT20190711044173N1. Registered 31october 2019, https://en.irct.ir/user/trial/40779/view .

Transdiagnostic treatment of emotional disorders in people with multiple sclerosis: randomized controlled trial

Background

Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system. MS is significantly associated with a high rate of psychological, behavioral, and emotional consequences. Despite the frequent mental disorders, high rate of psychological comorbidities, and emotional problems in people with MS (PwMS), these conditions are often underdiagnosed and undertreated. This study aimed to examine the efficacy of a group format of the unified protocol for the transdiagnostic treatment of emotional disorders in adult PwMS associated with an emotional disorder.

Methods

Seventy adult PwMS were randomized using an internet-based computer system to either the unified protocol (n = 35) or treatment as usual condition. The assessment protocol included semi-structured clinical interviews and self-reports evaluating diagnostic criteria, depression, anxiety and worry symptoms, emotional dysregulation, and affectivity.

Results

The parametric test of analysis of covariance, followed the intent to treat analyses, revealed the unified protocol significantly changed depression symptoms (Cohen’s d = 1.9), anxiety symptoms (Cohen’s d = 2.16), worry symptoms (Cohen’s d = 1.27), emotion dysregulation (Cohen’s d = 0.44), positive affect (Cohen’s d = 1.51), and negative affect (Cohen’s d = 1.89) compared with the control group. The unified protocol also significantly improved outcome scores at the end of treatment relative to baseline (p < .001).

Conclusion

The findings support that the unified protocol could be an additional efficient psychological treatment for PwMS.

Trial registration IRCT, number: IRCT20190711044173N1. Registered 31october 2019, https://en.irct.ir/user/trial/40779/view.

Intrathecal immunoreactivity in people with or without previous infectious mononucleosis

OBJECTIVES

The risk of developing multiple sclerosis (MS) increases (OR: 3.1) after infectious mononucleosis (IM). However, the nature of this link is obscure. We tested the hypothesis that IM might incur long-term sequelae, including low-key inflammatory activity, with characteristics of an MS endophenotype (or presymptomatic trait) and that assays of MS-relevant cyto-/chemokines in the cerebrospinal fluid (CSF) post-IM may show a trend in this direction.

MATERIALS AND METHODS

We selected seven CSF cytokines (IL-1b, IL-6, YKL-40, TNF-alpha) or chemokines (IL-8, CCL2, IP-10), representing pro-inflammatory factors previously associated with MS. We assayed the CSF levels of these seven cyto-/chemokines in healthy individuals with a median follow-up time of 10 years after serologically confirmed IM (post-IM group, n = 22), and in healthy controls without a history of IM (n = 19). A group of MS patients (n = 23) were included as reference.

RESULTS

The CSF levels of IP-10, YKL-40, and CCL-2 were higher in the post-IM group than in our IM unexposed controls (P = .021, .049, .028). Seven of seven cyto-/chemokine assays showed a trend in the predicted direction (P of binomial ratio = .008). However, this trend was non-significant in a multivariate test (P = .22). A power analysis indicated that similar studies including a larger cohort would be numerically realistic.

CONCLUSIONS

These results do not reject the hypothesis that the established epidemiological association between IM and MS results from a stepwise inflammatory propagation from IM sequelae to an MS endophenotype (or presymptomatic trait) in a proportion of IM patients, pending confirmation with adequate power.

Estimation of the marginal effect of regular drug use on multiple sclerosis in the Iranian population

There are only few reports regarding the role of lifetime drug or substance use in multiple sclerosis (MS) etiology. In this study, we investigated the potential effect of drug or substance exposure on the onset of MS diagnosis. We conducted a population-based incident case control study in Tehran. Cases (n = 547) were 15-50 years old persons with MS identified from the Iranian Multiple Sclerosis Society (IMSS) register during August 7, 2013, and November 17, 2015. Population-based controls (n = 1057) were 15-50 years old and were recruited by random digit telephone dialing. Inverse-probability-of-treatment weighing (IPTW) using two sets of propensity scores (PSs) was used to estimate marginal incidence odds ratios (ORs) for MS contrasting pre-specified substance use. The estimated marginal OR was 6.03 (95% confidence interval: 3.54;10.3, using trimmed weights at the 95th percentile of the stabilized weight distribution) in both IPTW analyses comparing lifetime substance use (opioids, cannabis, inhalants, hallucinogens and stimulants) for at least one time monthly during a six-months or longer period vs. no such history of drug use. Subject to limitation of causal claims based on case-control studies, this study suggests that monthly drug or substance use for a period of at least six consecutive months, may increase the risk of MS by factor 3.5 or higher.

Lifestyle factors and multiple sclerosis: A population-based incident case-control study

OBJECTIVE

Although low sun exposure, low vitamin D, and smoking are established risk factor of multiple sclerosis (MS), there is less evidence on the role of the other lifestyle factors. We examined the association of sun exposure, physical activity, drug abuse, and alcohol intake with MS.

MATERIALS AND METHODS

This was population-based incident case-control study in Iran with 547 incident cases and 1057 general population controls (7/8/2013-17/2/2015). Logistic regression was used to analyse the data.

RESULTS

Higher sun exposure during adolescence was associated with a reduced risk of MS, both in summer (test for trend p < 0.001) and winter (P < 0.001), while physical activity was not associated with MS (test for trend p = 0.712). Lifetime drug abuse (OR for ever use 2.93 (1.83-4.70)), with a dose-response association (test for trend p < 0.001), and alcohol intake (OR for ever use 1.49 (1.05-2.12)) was significantly associated with an increased risk of MS.

CONCLUSION

In a middle-eastern setting, we found that sun exposure during adolescence, drug abuse, and alcohol use were all associated with MS. Increasing sun exposure and reducing drug abuse and the use of alcohol through educational programs is likely to reduce the rate of MS.

Targeting Epstein-Barr virus infection as an intervention against multiple sclerosis

We here review contemporary data on genetic and environmental risk factors, particularly Epstein-Barr virus infection, for multiple sclerosis. There is an important immunogenetic etiological factor for multiple sclerosis. However, a general assumption is that immune defense genes are activated by the environment, basically by infections. We contend that the relationship between infectious mononucleosis and multiple sclerosis cannot be completely explained by genetics and inverse causality. Epstein-Barr infection as indicated by positive serology is an obligatory precondition for multiple sclerosis, which is a stronger attribute than a risk factor only. Data on events in the early pathogenesis of multiple sclerosis are cumulating from bio-banks with presymptomatic specimens, but there is only little information from the critical age when Epstein-Barr infection including infectious mononucleosis is acquired, nor on the detailed immunological consequences of this infection in individuals with and without multiple sclerosis. We discuss how focused bio-banking may elaborate a rationale for the development of treatment or vaccination against Epstein-Barr virus infection. A cohort in which intervention against Epstein-Barr infections was performed should be the object of neurological follow-up.