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Khedr EM, Ahmed GK, Hassan SS, Foly MN, Attia MM, Karim AA, Haridy NA. Frequency and risk factors of sleep problems in Egyptian patients with multiple sclerosis. Front Neurol 2025; 16:1563041. [PMID: 40371079 PMCID: PMC12074942 DOI: 10.3389/fneur.2025.1563041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2025] [Accepted: 04/07/2025] [Indexed: 05/16/2025] Open
Abstract
Background Sleep problems impact over 65% of patients with multiple sclerosis (MS), a prevalence significantly greater than that observed in the general population. This study aimed to assess the frequency and risk-associated factors of sleep problems in a large MS cohort and evaluate their impact on quality of life (QoL). Methods The study included 103 participants with MS across different disease stages and 62 healthy controls. Assessment tools included the Expanded Disability Status Scale (EDSS), Pittsburgh Sleep Quality Index (PSQI), depression and fatigue scales, 9-Hole Peg Test, 25-foot walk test, cognitive function assessments, and QoL measures. Results Sleep problems were significantly more frequent in MS patients (68.9%) than in controls (30.6%). PSQI scores showed positive correlations with the number of MS relapses across the course of disease duration, walking impairment, fatigue and depression scores. Sleep problems were determined to adversely affect various domains of quality of life. Conclusion Our findings demonstrate that sleep problems are remarkably common among patients with MS. Patients experiencing poor sleep quality are typically associated with higher levels of fatigue, depression, greater difficulty with mobility, and more frequent disease relapses. These sleep problems significantly impaired the overall QoL in MS patients. A multidisciplinary approach is therefore essential for managing sleep disorders in MS.
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Affiliation(s)
- Eman M. Khedr
- Neurology and Psychiatry Department, Assiut University, Assiut, Egypt
- Neurology and Psychiatry Department, Aswan University, Aswan, Egypt
| | - Gellan K. Ahmed
- Neurology and Psychiatry Department, Assiut University, Assiut, Egypt
| | | | | | | | - Ahmed A. Karim
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
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Nezhad NN, Parnow A, Khamoushian K, Eslami R, Baker JS. Resistance training improves functional capacities in women with multiple sclerosis: a randomized control trial. BMC Neurol 2024; 24:457. [PMID: 39578772 PMCID: PMC11583674 DOI: 10.1186/s12883-024-03964-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 11/18/2024] [Indexed: 11/24/2024] Open
Abstract
PURPOSE This study aimed to investigate the effects of 12 weeks of resistance exercise training (RT) on oxidative status, muscle strength, functional capacity, quality of life (QoL), and fatigue in women with Multiple Sclerosis (MS). METHODS In this randomized control trial (ethical code: SSRI.REC-1402-101; IRCT registration code: IRCT20120912010824N3, 07.09.2023), Iran) twenty-five women with relapsing- remitting MS (aged 18-45 years and expanded disability status scale (EDSS) ≤ 4) were randomly divided in two groups MS without resistance exercise (MS + non-RT; n = 13) and with RT (12 weeks/3 times per week/ 60-80% of 1RM) (MS + RT; n = 12). "Informed" consent was obtained from all participants. Then, fifteen healthy aged-matched women participated as a control group (HCON; n = 15). Blood serum levels of oxidative stress [malondialdehyde (MDA)] and antioxidant capacity [superoxide dismutase (SOD) and glutathione peroxidase (GPx) activity] were obtained pre and post intervention. In addition, muscle strength by 5-RM test, functional capacity (for lower limb T25FWT, 2MWT, and 5STS tests and for Upper limb Manual dexterity of both hands with the (9-HPT) test and MSWS-12 questionnaire were also assessed over the same period. Also, Quality of life and fatigue were assessed pre- and post- intervention with by 31-MusiQoL questionnaire and FSMC questionnaire. RESULTS RT led to improvements in muscle strength for leg extension, lying leg curl, bench press movements (P < 0.001, P < 0.001, P < 0.001, respectively). Moreover, compared with the MS + non-RT group, RT demonstrated increased functional capacity (Timed 25 ft Walk Test, Two-Minute Walk Test, 5-Time Sit-To-Stand Test, Twelve Item MS Walking Scale (P < 0.001, P < 0.001, P < 0.001, P < 0.001, respectively). Dexterity of the left hand but not the right hand also improved (P < 0.01, P = 0.057, respectively). Improvements were also found for fatigue and QoL (P < 0.01, P < 0.05). However, the mean changes of MDA, SOD and GPx noted in RT group were not statistically significant (P˃0.05, P˃0.05, P˃0.05, respectively). CONCLUSIONS RT has positive effects on muscle strength, functional capacity, and quality of life while reducing fatigue in this population. However, markers of oxidative stress were not affected. When we consider the clear role in MS pathogenesis and progression, antioxidant increases in relation to a reduction in pro-oxidant capacity would have provided a positive and important clinical development for people with MS.
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Affiliation(s)
- Nasrin Niazi Nezhad
- Bio-Sciences Department, Physical Education and Sports Sciences Faculty, Razi University, University Street, Kermanshah, Iran
| | - Abdolhossein Parnow
- Bio-Sciences Department, Physical Education and Sports Sciences Faculty, Razi University, University Street, Kermanshah, Iran.
| | - Kianoosh Khamoushian
- Department of Neurology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rasoul Eslami
- Exercise Physiology Department, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Julien S Baker
- Institute for Population Health and Medical Informatics, Hong Kong Baptist University, Kowloon Tong, Hong Kong
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Stojkovic L, Djordjevic A, Stefanovic M, Stankovic A, Dincic E, Djuric T, Zivkovic M. Circulatory Indicators of Lipid Peroxidation, the Driver of Ferroptosis, Reflect Differences between Relapsing-Remitting and Progressive Multiple Sclerosis. Int J Mol Sci 2024; 25:11024. [PMID: 39456806 PMCID: PMC11507982 DOI: 10.3390/ijms252011024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 09/27/2024] [Accepted: 10/01/2024] [Indexed: 10/28/2024] Open
Abstract
Ferroptosis, a lipid peroxidation- and iron-mediated type of regulated cell death, relates to both neuroinflammation, which is common in relapsing-remitting multiple sclerosis (RRMS), and neurodegeneration, which is prevalent in progressive (P)MS. Currently, findings related to the molecular markers proposed in this paper in patients are scarce. We analyzed circulatory molecular indicators of the main ferroptosis-related processes, comprising lipid peroxidation (malondialdehyde (MDA), 4-hydroxynonenal (4-HNE), and hexanoyl-lysine adduct (HEL)), glutathione-related antioxidant defense (total glutathione (reduced (GSH) and oxidized (GSSG)) and glutathione peroxidase 4 (GPX4)), and iron metabolism (iron, transferrin and ferritin) to estimate their contributions to the clinical manifestation of MS and differences between RRMS and PMS disease course. In 153 patients with RRMS and 69 with PMS, plasma/serum lipid peroxidation indicators and glutathione were quantified using ELISA and colorimetric reactions, respectively. Iron serum concentrations were determined using spectrophotometry, and transferrin and ferritin were determined using immunoturbidimetry. Compared to those with RRMS, patients with PMS had decreased 4-HNE (median, 1368.42 vs. 1580.17 pg/mL; p = 0.03). Interactive effects of MS course (RRMS/PMS) and disease-modifying therapy status on MDA (p = 0.009) and HEL (p = 0.02) levels were detected. In addition, the interaction of disease course and self-reported fatigue revealed significant impacts on 4-HNE levels (p = 0.01) and the GSH/GSSG ratio (p = 0.04). The results also show an association of MS course (p = 0.03) and EDSS (p = 0.04) with GSH levels. No significant changes were observed in the serum concentrations of iron metabolism indicators between the two patient groups (p > 0.05). We suggest circulatory 4-HNE as an important parameter related to differences between RRMS and PMS. Significant interactions of MS course and other clinically relevant parameters with changes in redox processes associated with ferroptosis support the further investigation of MS with a larger sample while taking into account both circulatory and central nervous system estimation.
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Affiliation(s)
- Ljiljana Stojkovic
- Laboratory for Radiobiology and Molecular Genetics, VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, P.O. Box 522, 11000 Belgrade, Serbia; (A.D.); (A.S.); (T.D.)
| | - Ana Djordjevic
- Laboratory for Radiobiology and Molecular Genetics, VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, P.O. Box 522, 11000 Belgrade, Serbia; (A.D.); (A.S.); (T.D.)
| | - Milan Stefanovic
- Laboratory for Radiobiology and Molecular Genetics, VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, P.O. Box 522, 11000 Belgrade, Serbia; (A.D.); (A.S.); (T.D.)
| | - Aleksandra Stankovic
- Laboratory for Radiobiology and Molecular Genetics, VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, P.O. Box 522, 11000 Belgrade, Serbia; (A.D.); (A.S.); (T.D.)
| | - Evica Dincic
- Clinic for Neurology, Military Medical Academy, 11000 Belgrade, Serbia;
- Medical Faculty of the Military Medical Academy, University of Defence, 11000 Belgrade, Serbia
| | - Tamara Djuric
- Laboratory for Radiobiology and Molecular Genetics, VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, P.O. Box 522, 11000 Belgrade, Serbia; (A.D.); (A.S.); (T.D.)
| | - Maja Zivkovic
- Laboratory for Radiobiology and Molecular Genetics, VINČA Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, P.O. Box 522, 11000 Belgrade, Serbia; (A.D.); (A.S.); (T.D.)
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Tayefeh-Gholami S, Akbarzadeh S, Rajabi A, Najari P, Ghasemzadeh T, HosseinpourFeizi M, Safaralizadeh R. Investigating SNHG3 and BCYRN1 lncRnas expression in the peripheral blood cells of multiple sclerosis patients. Neurol Res 2024; 46:876-882. [PMID: 38832630 DOI: 10.1080/01616412.2024.2362585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/27/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND MS (Multiple sclerosis) is a progressive neurologic disorder often appearing in the third decade of life. MS is the most frequent demyelinating disease of the central nervous system. The development of MS is influenced by environmental, genetic, and epigenetic factors. The bulk of the human transcriptome comprises lncRNAs, which play crucial regulatory roles. We aimed to assess the SNHG3 and BCYRN1 lncRNA expression in blood samples from MS patients and how these lncRNAs and disease activity are related. METHODS A total of 100 MS patients, including 8 primary progressive (PP), 82 relapsing-remitting (RR), and 10 secondary progressive (SP) MS, as well as 100 healthy controls, had their blood samples taken. Gene expression was assessed using quantitative real-time PCR. Recognizing the receiver operating characteristic (ROC) curve analysis, the diagnostic potential of lncRNA levels was evaluated. RESULTS Expressions of SNHG3 and BCYRN1 were found to have significantly increased (p < 0.0001). SNHG3 expression level showed significant differences compared to age groups and MS subtypes (p value = 0.001 and p value = 0.02).Furthermore, patients with a family history showed elevated BCYRN1 expression with a p value of 0.01. Considering the age factor, BCYRN1 exhibits altered expression levels in patient groups compared to healthy controls (p value 0.04). Additionally, the novel biomarkers SNHG3 and BCYRN1 can be used to diagnose MS (AUC = 0.97 and AUC = 0.88, respectively). DISCUSSION Increased levels of SNHG3 and BCYRN1 in the serum may serve as potential molecular biomarkers for the MS diagnosis.
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Affiliation(s)
- Samaneh Tayefeh-Gholami
- Department of Animal Biology, Faculty of Natural Science, University of Tabriz, Tabriz, Iran
| | - Sama Akbarzadeh
- Department of Biophysics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
- Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Türkiye
| | - Ali Rajabi
- Department of Animal Biology, Faculty of Natural Science, University of Tabriz, Tabriz, Iran
| | - Parisa Najari
- Department of Animal Biology, Faculty of Natural Science, University of Tabriz, Tabriz, Iran
| | - Tooraj Ghasemzadeh
- Department of Animal Biology, Faculty of Natural Science, University of Tabriz, Tabriz, Iran
| | | | - Reza Safaralizadeh
- Department of Animal Biology, Faculty of Natural Science, University of Tabriz, Tabriz, Iran
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Jiménez-Jiménez FJ, Alonso-Navarro H, Salgado-Cámara P, García-Martín E, Agúndez JAG. Oxidative Stress Markers in Multiple Sclerosis. Int J Mol Sci 2024; 25:6289. [PMID: 38927996 PMCID: PMC11203935 DOI: 10.3390/ijms25126289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/10/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
The pathogenesis of multiple sclerosis (MS) is not completely understood, but genetic factors, autoimmunity, inflammation, demyelination, and neurodegeneration seem to play a significant role. Data from analyses of central nervous system autopsy material from patients diagnosed with multiple sclerosis, as well as from studies in the main experimental model of multiple sclerosis, experimental autoimmune encephalomyelitis (EAE), suggest the possibility of a role of oxidative stress as well. In this narrative review, we summarize the main data from studies reported on oxidative stress markers in patients diagnosed with MS and in experimental models of MS (mainly EAE), and case-control association studies on the possible association of candidate genes related to oxidative stress with risk for MS. Most studies have shown an increase in markers of oxidative stress, a decrease in antioxidant substances, or both, with cerebrospinal fluid and serum/plasma malonyl-dialdehyde being the most reliable markers. This topic requires further prospective, multicenter studies with a long-term follow-up period involving a large number of patients with MS and controls.
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Affiliation(s)
- Félix Javier Jiménez-Jiménez
- Section of Neurology, Hospital Universitario del Sureste, Arganda del Rey, E-28500 Madrid, Spain; (H.A.-N.); (P.S.-C.)
| | - Hortensia Alonso-Navarro
- Section of Neurology, Hospital Universitario del Sureste, Arganda del Rey, E-28500 Madrid, Spain; (H.A.-N.); (P.S.-C.)
| | - Paula Salgado-Cámara
- Section of Neurology, Hospital Universitario del Sureste, Arganda del Rey, E-28500 Madrid, Spain; (H.A.-N.); (P.S.-C.)
| | - Elena García-Martín
- University Institute of Molecular Pathology Biomarkers, Universidad de Extremadura, E-10071 Cáceres, Spain; (E.G.-M.); (J.A.G.A.)
| | - José A. G. Agúndez
- University Institute of Molecular Pathology Biomarkers, Universidad de Extremadura, E-10071 Cáceres, Spain; (E.G.-M.); (J.A.G.A.)
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Razmaray H, Nasiri E, Vakilipour P, Morsali S, Moradi A, Ebrahimian A, Rashidi S, Mosaddeghi-Heris R, Sadigh-Eteghad S, Naseri A. The effects of melatonin supplementation on neurobehavioral outcomes and clinical severity in rodent models of multiple sclerosis; a systematic review and meta-analysis. Inflammopharmacology 2024; 32:927-944. [PMID: 38252220 DOI: 10.1007/s10787-023-01414-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Through the antioxidant and anti-inflammation pathways, melatonin is proposed as a safe and effective intervention in neurological diseases. This study aims to evaluate the effects of melatonin supplementation on the neurobehavioral and clinical outcomes in animal models of multiple sclerosis (MS). METHODS This study was conducted following the PRISMA statement. Animal studies that reported the effects of melatonin in preclinical MS models, including the experimental autoimmune encephalomyelitis (EAE) and cuprizone model for demyelination are included in this study. A systematic search in PubMed, Web of Science, Embase, and Scopus up was conducted in April 2023. The collaborative Approach to Meta-Analysis and Review of Animal Experimental Studies (CAMARADES) critical appraisal tool was used for the quality assessment of the studies and the quantitative synthetizes were conducted using the comprehensive meta-analysis software. RESULTS Out of 542 studies, finally 21 studies, including 14 studies in the EAE model and 7 studies of the toxic demyelination method with cuprizone were included. The route of administration was intraperitoneal in 18 studies, oral in 2 studies, and subcutaneous in 1 study. The quantitative synthesis of the EAE clinical severity scale was associated with significant differences (standardized mean difference [SDM]: - 2.52; - 3.61 to - 1.42; p value < 0.01). In subgroup analyses, the difference was statistically significant in the mouse subgroup (SMD: - 2.60; - 3.74 to - 1.46; p value < 0.01). DISCUSSION This study encountered that melatonin may be associated with improved behavioral and cognitive outcomes of preclinical models of MS with acceptable safety profiles. FUNDING The research was supported by the Student Research Committee, Tabriz University of Medical Sciences (grant number: 71005).
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Affiliation(s)
- Hadis Razmaray
- Student Research Committee, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, 5166/15731, East Azerbaijan, Iran
| | - Ehsan Nasiri
- Student Research Committee, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, 5166/15731, East Azerbaijan, Iran
| | - Pouya Vakilipour
- Student Research Committee, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, 5166/15731, East Azerbaijan, Iran
| | - Soroush Morsali
- Student Research Committee, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, 5166/15731, East Azerbaijan, Iran
| | - Afshin Moradi
- Student Research Committee, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, 5166/15731, East Azerbaijan, Iran
| | - Asal Ebrahimian
- Student Research Committee, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, 5166/15731, East Azerbaijan, Iran
| | - Sahel Rashidi
- Faculty of Medicine, Dokuz Eylül University, Izmir, Türkiye
| | - Reza Mosaddeghi-Heris
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Golgasht Street, Tabriz, 5166/614756, East Azerbaijan, Iran
| | - Saeed Sadigh-Eteghad
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Golgasht Street, Tabriz, 5166/614756, East Azerbaijan, Iran.
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, 5166/15731, East Azerbaijan, Iran.
- Research Center for Evidence-Based Medicine, Center of Excellence, Iranian EBM Centre: A Joanna Briggs Institute (JBI), Tabriz University of Medical Sciences, Tabriz, Iran.
- Tabriz USERN Office, Universal Scientific Education and Research Network (USERN), Tabriz, Iran.
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Morsali S, Sabahi Z, Kakaei J, Hakimzadeh Z, Hamidi S, Gholipour-Khalili E, Sanaie S, Talebi M, Naseri A. Clinical efficacy and safety of melatonin supplementation in multiple sclerosis: a systematic review. Inflammopharmacology 2023; 31:2213-2220. [PMID: 37429996 DOI: 10.1007/s10787-023-01271-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/10/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Melatonin is a neurohormone secreted predominantly by the pineal gland that is demonstrated to be associated with the pathogenesis of multiple sclerosis (MS). This research desires to evaluate the tolerability and beneficial effects of exogenous melatonin supplementations in patients with MS. METHODS This study was executed following the PRISMA 2020 statement. Both observational and interventional studies which reported the clinical effectiveness and/or safety of melatonin supplementation in patients with MS were included in this systematic review. Ovid, PubMed, Scopus, Embase, and Web of Science databases were searched and the risk of bias in included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools based on study design. RESULTS Out of 1304 results of database searches, finally, 14 articles, including 7 randomized controlled trials (RCTs), 6 case-control studies, and one quasi-experimental study, were included based on the full-text review. Included phenotypes of MS were mostly relapsing-remitting MS (RRMS) (in 11 studies); it was secondary progressive MS (SPMS) in only one study, and two other studies had a mixture of the different phenotypes. The course of treatment with melatonin supplementation was between 2 weeks and 12 months. There were no substantial safety issues. Although melatonin was associated with enhanced oxidative stress and inflammation status, concerning the clinical benefits, limited studies suggested improvements in sleep conditions, cognitive outcomes, and fatigue in MS. DISCUSSION There are insufficient data to support the regular melatonin prescription in MS. Limitations such as the small number of included studies, the diversity of the dosage, route, and duration of melatonin administration, and the diversity of assessment tests lead to unconvincing findings in this study. There is a need for future studies to achieve a comprehensive judgment on this subject.
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Affiliation(s)
- Soroush Morsali
- Student Research Committee, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, 5166/15731, East Azerbaijan, Iran
| | - Zahra Sabahi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Kakaei
- Zanjan Branch (IAUZ), Islamic Azad University, Zanjan, Iran
| | - Zahra Hakimzadeh
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, 5166/15731, Iran
| | - Sana Hamidi
- Student Research Committee, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, 5166/15731, East Azerbaijan, Iran
| | | | - Sarvin Sanaie
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, 5166/15731, Iran
| | - Mahnaz Talebi
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, 5166/15731, Iran.
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, 5166/15731, East Azerbaijan, Iran.
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.
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The association of apolipoprotein E (ApoE) genotype and cognitive outcomes in multiple sclerosis; a systematic review and meta-analysis. Mult Scler Relat Disord 2022; 65:104011. [DOI: 10.1016/j.msard.2022.104011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/11/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022]
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