Self-assessment of people with relapsing-remitting and progressive multiple sclerosis towards burden of disease, progression, and treatment utilization-Results of a large-scale cross-sectional online survey (MS Perspectives)

Prevalence of epsilon toxin-producing Clostridium perfringens isolates among patients with multiple sclerosis and neuromyelitis optica spectrum disorder in Iran

BACKGROUND

Clostridium perfringens epsilon toxin (ETX) is a potent neurotoxin that crosses the blood-brain barrier (BBB), and has been suggested to be involved in demyelinating CNS disorders. Here, we investigated the prevalence of C. perfringens and anti-ETX immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody levels in stool and sera of patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) compared to healthy controls.

METHODS

Between September 2019 and June 2020, 43 stool and 43 sera specimens were collected from MS (n = 33) and NMOSD (n = 10) patients, and 49 samples from healthy subjects. Stool samples were cultured for the presence of C. perfringens and PCR was used to detect etx-encoding gene. The level of serum IgG and IgM against ETX was examined using competitive ELISA. The predictive value of sex, age, ETX IgG and IgM levels, and C. perfringens was assessed using multivariable prediction models, with all models trained on the full set of variables. Independent contributions were evaluated separately using logistic regression (LR) analysis.

RESULTS

Totally, 11 C. perfringens were isolated from MS (n = 4), NMOSD (n = 2), and healthy (n = 5) subjects. The etx gene was detected in 1/4 (25%) isolates from MS and 2/2 (100%) from NMOSD patients, while none of the isolates from healthy subjects carried the gene. The analysis of serum IgG and IgM level against ETX showed no significant difference between patients and healthy subjects. Among the prediction models used, LR and Naïve Bayes (NB), trained on all predictor variables, exhibited the highest statistical accuracy for MS diagnosis, with AUC = 0.71 and AUC = 0.93, respectively. Among individual parameters, sex (AUC = 0.63) and IgG level (AUC = 0.57) were the most reliable predictors. The nomogram prediction demonstrated that the probability of patients' risk of developing MS and NMOSD can be predicted using these predictors.

CONCLUSIONS

Our findings indicate a potential association between ETX-producing C. perfringens strains and MS/NMOSD diseases, as its presence was detected in a subset of patient samples. However, no significant differences in anti-ETX antibody levels were observed between control and patients. Our prediction models highlighted key demographic and serological factors that may contribute to MS diagnosis. These results highlight the need for further research to meticulously decipher the biological interplay of C. perfringens and its ETX toxin with the development of MS and NMOSD.

PERSIMS: Comparing doctors and patients PERSpectives on quality of life In Multiple Sclerosis

BACKGROUND

Advances in Multiple Sclerosis (MS) therapy have improved prognosis, but significant disability can still occur. Understanding the perspectives of doctors and patients on how MS and its treatment impact quality of life (QoL) is crucial. We aimed to explore the perceptions of MS patients and neurologists on MS symptoms, treatment, and their impact on QoL.

METHODS

A cross-sectional online survey was conducted, targeting adult patients with MS and physicians experienced in MS care. Patients' quality of life (QoL) was assessed using the MS Quality of Life (MSQOL-54) scale.

RESULTS

252 patients and 53 doctors completed the survey. Relapses in the previous year were associated with lower physical (p = 0.026) and mental (p = 0.022) health scores. Being satisfied with disease-modifying treatment (DMT) and being involved in its choice were also associated with higher physical (both p < 0.001) and mental (p = 0.024 and p = 0.002, respectively) health scores; these scores were not different in patients under moderate versus high-efficacy DMTs (physical p = 0.582 and mental p = 0.180). Patients' and doctors' perspectives differ in what they value for QoL. Patients prioritized mental health (p = 0.024), while doctors focused on the impact of physical aspects on QoL (p = 0.030 and p = 0.004). Patients valued information about social support (p < 0.001) more than doctors and considered fatigue more challenging to discuss (p = 0.039), whereas doctors highlighted sexual dysfunction as difficult to address (p < 0.001). Doctors prioritized workplace adaptations (p = 0.041), while patients preferred faster access to healthcare to improve QoL (p < 0.001).

CONCLUSION

Incorporating patient-reported outcomes in MS care is essential to align treatment plans with patients' priorities and improve their QoL.

Smouldering-Associated Worsening in Multiple Sclerosis: An International Consensus Statement on Definition, Biology, Clinical Implications, and Future Directions

Despite therapeutic suppression of relapses, multiple sclerosis (MS) patients often experience subtle deterioration, which extends beyond the definition of "progression independent of relapsing activity." We propose the concept of smouldering-associated-worsening (SAW), encompassing physical and cognitive symptoms, resulting from smouldering pathological processes, which remain unmet therapeutic targets. We provide a consensus-based framework of possible pathological substrates and manifestations of smouldering MS, and we discuss clinical, radiological, and serum/cerebrospinal fluid biomarkers for potentially monitoring SAW. Finally, we share considerations for optimizing disease surveillance and implications for clinical trials to promote the integration of smouldering MS into routine practice and future research efforts. ANN NEUROL 2024;96:826-845.

Large-scale cross-sectional online survey on patient-neurologist communication, burden of disease assessment and disease monitoring in people with multiple sclerosis

Background

Management of multiple sclerosis (MS) requires a high level of communication between health care professionals (HCPs) and people with MS (pwMS) including profound investigation and discussion of symptoms to identify therapeutic needs. For treatment decisions, monitoring of disease activity is important, in this respect self-monitoring devices and apps, as well as magnetic resonance imaging are important tools.

Methods

MS Perspectives is a cross-sectional online survey conducted in Germany which was designed to collect data, among others, on the communication between pwMS and HCPs regarding treatment goals, symptom assessment, usage of devices and apps to self-monitor health functions, as well as to identify patients' attitude toward the role of magnetic resonance imaging (MRI). Between December 2021 and February 2022, 4,555 pwMS completed the survey.

Results

In total, 63.7% of participants reported that treatment goals have been discussed with their HCPs. Symptoms worsening in the past 12 months independent of relapses was more often reported by pwMS than inquired by HCPs, according to patients' report. Devices or apps for health monitoring were used by less than half of participants. Frequency of MRI controls was much lower in participants with longer compared to shorter disease duration (47.5 vs. 86.3%). The proportion of patients with annual or semiannual scans was highest among pwMS receiving infusion therapy (93.5%), followed by oral medication (82.5%) and injectables (73.4%), and lowest for pwMS without immunotherapy (58.2%).

Conclusion

MS Perspectives identified a rather low patient involvement regarding treatment goals and symptom assessment in clinical practice. Regarding this and our findings for health self-monitoring and MRI usage, strategies for improving patient-HCP communication and disease monitoring may be considered.