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Stratton C, Vassilopoulos A, Brenton JN, Potter K, Vargas W, Rumm H, Bartels A, Bailey M, Odonkor C, Stoll S, Zempsky EWT, Yeh EA, Makhani N. Interim guidelines for the assessment and treatment of pain in children with multiple sclerosis. Front Neurosci 2023; 17:1235945. [PMID: 37781253 PMCID: PMC10536169 DOI: 10.3389/fnins.2023.1235945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Pain in multiple sclerosis (MS) is common, but literature on pain in children with MS remains scarce. Pain has physical, psychological, and social implications in MS, and both comprehensive assessment and interdisciplinary management approaches are needed. We sought to develop an interdisciplinary interim guideline for the assessment and management of pain in children with MS. Methods and materials We convened a modified Delphi panel composed of 13 experts in pediatric and adult MS neurology, physiotherapy, pain, patient lived-experience, advanced practice nursing, psychology, physiatry, and MS research. A survey was sent to panelists for anonymous completion. The panel discussed survey themes extracted by the panel chair. The process was repeated twice. Results Thirteen assessment and treatment recommendations were produced regarding pain in children with MS. Discussion Future studies will assess implementation of these pain assessment and treatment guidelines in the clinical setting.
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Affiliation(s)
- Catherine Stratton
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Areti Vassilopoulos
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - J. Nicholas Brenton
- Division of Pediatric Neurology, Department of Neurology, University of Virginia Medical Center, Charlottesville, VA, United States
| | - Kirsten Potter
- Department of Physical Therapy, Tufts University, Medford, MA, United States
| | - Wendy Vargas
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Department of Neurology, New York-Presbyterian NYP/Columbia University Irving Medical Center, New York, NY, United States
| | - Heather Rumm
- Connecticut Chapter, National Multiple Sclerosis Society, Hartford, CT, United States
| | - Andrea Bartels
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Mary Bailey
- Trinity Health of New England, Hartford, CT, United States
| | - Charles Odonkor
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States
- Yale New Haven Health Old Saybrook Medical Center, Old Saybrook Medical Center, New Haven, CT, United States
| | - Sharon Stoll
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
- Yale MS Center, North Haven, CT, United States
| | - E. William T. Zempsky
- Division of Pain & Palliative Medicine, Connecticut Children’s Medical Center, Hartford, CT, United States
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, United States
| | - E. Ann Yeh
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Neuroscience and Mental Health, Department of Paediatrics (Neurology), Hospital for Sick Children, SickKids Research Institute, Toronto, ON, Canada
| | - Naila Makhani
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
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Mirmosayyeb O, Naderi M, Raeisi S, Ebrahimi N, Ghaffary EM, Afshari-Safavi A, Barzegar M, Shaygannejad V. Hearing loss among patients with multiple sclerosis (PwMS): A systematic review and meta-analysis. Mult Scler Relat Disord 2022; 62:103754. [DOI: 10.1016/j.msard.2022.103754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/18/2022] [Accepted: 03/18/2022] [Indexed: 01/10/2023]
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Hearing abnormalities in multiple sclerosis: clinical semiology and pathophysiologic mechanisms. J Neurol 2022; 269:2792-2805. [PMID: 34999960 DOI: 10.1007/s00415-021-10915-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/14/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
Auditory manifestations from multiple sclerosis (MS) are not as common as the well-recognized sentinel exacerbations of optic neuritis, partial myelitis, motor weakness, vertiginous episodes, heat intolerance, and eye movement abnormalities. This paper discusses four cases of auditory changes, secondary to MS, and describes the first case, to our knowledge, of palinacousis, the perseveration of hearing, despite cessation of the sound stimulus. For each we characterize the initial complaint, the diagnostic work up, and ultimately, underscore the individualized treatment interventions, that allowed us to achieve a remission in all four cases. Individually codifying the treatment regimens served to mitigate, if not to abolish, the clinical derangements in hearing. Special attention is focused upon examination of the clinical manifestations and the pathophysiologic mechanisms which are responsible for them. We further emphasize the differential diagnostic considerations, and physical exam findings, along with the results of laboratory testing, neuro-imaging sequences, and lesion localization. Taken together, such information is germane to organizing cogently coherent strategic treatment plan(s). We believe that this small case series represents a clinically pragmatic example of 'precision medicine'; a principal theme and goal throughout this paper, the achievement of such in MS, but also as an illustration for the assessment and management schema for neuroimmunologic disorders in general.
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Taylor K, Muscal E, Van Mater H. The Role of Pediatric Rheumatologists in Autoimmune Brain Disease. Rheum Dis Clin North Am 2021; 48:343-369. [PMID: 34798957 DOI: 10.1016/j.rdc.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The spectrum of autoimmune and inflammatory brain diseases continues to evolve with medical advances facilitating both the detection of inflammation of the central nervous system and the discovery of novel disease mechanisms. The clinical overlap of these disorders with primary rheumatic diseases and the efficacy of immunotherapy have led to strong partnerships between pediatric rheumatologists, neurologists, psychiatrists, and other providers in the care of children with these conditions. Early diagnosis and initiation of targeted therapy improve clinical outcomes, highlighting the importance of interdisciplinary collaborative care.
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Affiliation(s)
- Kathryn Taylor
- Pediatrics, Division of Neurology, Duke University, Durham, NC, USA.
| | - Eyal Muscal
- Division of Rheumatology and Co-appointment in Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Heather Van Mater
- Pediatrics, Division of Rheumatology, Duke University, Durham, NC, USA
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