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Lorefice L, Ferraro E. Does menopause affect MS progression? Evidence and ongoing debates. Neurodegener Dis Manag 2025; 15:117-119. [PMID: 40194957 DOI: 10.1080/17582024.2025.2489878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2025] [Accepted: 04/02/2025] [Indexed: 04/09/2025] Open
Affiliation(s)
- L Lorefice
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, Cagliari, Italy
| | - E Ferraro
- Multiple Sclerosis Center, S. Filippo Neri Hospital, Rome, Italy
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Wu H, Gao D, Duan X, Zhang H, Ren Y, Dai Z, Song L. Construction and validation of a nomogram for predicting fatigue in climacteric women. Menopause 2025; 32:266-274. [PMID: 39998971 DOI: 10.1097/gme.0000000000002493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2025]
Abstract
OBJECTIVE The aim was to develop and validate a nomogram for evaluating the risk of fatigue in climacteric women and to assess its clinical application value. METHODS Clinical information was collected from 402 climacteric women who visited a tertiary hospital in Shanghai between November 2023 and April 2024. Network analysis methods were utilized to analyze the core symptom (fatigue). The study participants were then randomly divided into training and validation cohorts in a 7:3 ratio. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for fatigue in climacteric women. A nomogram prediction model was established based on these independent risk factors. The predictive performance of the model was evaluated using the concordance index, area under the curve, receiver operating characteristic curve, Hosmer-Lemeshow test, and calibration curve analysis. Additionally, decision curve analysis was performed to assess the model's performance in clinical applications. RESULTS Fatigue is identified as the core symptom in climacteric women. Educational level, chronic diseases, and depression status are independent influencing factors for fatigue in menopausal women. The area under the curve for the training cohort and validation cohort are 0.813 (95% CI, 0.743-0.884) and 0.759 (95% CI, 0.637-0.879), respectively, indicating that the model possesses good discriminative ability. The calibration curve shows good consistency between the predicted probabilities and actual probabilities in both the training and validation cohorts. Additionally, the P values for the Hosmer-Lemeshow test in the training and validation sets are 0.233 and 0.197, respectively, indicating good model calibration. Finally, the decision curve analysis curve demonstrates that the model has good clinical utility. CONCLUSIONS A simple nomogram based on three independent factors (educational level, chronic diseases, and depression status) can aid in clinically predicting the risk of fatigue in climacteric women.
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Affiliation(s)
| | - Danfeng Gao
- Obstetrics and Gynecology Department, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | | | | | | | - Liwen Song
- Obstetrics and Gynecology Department, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Simonsen CS, Flemmen HØ, Broch L, Myklebust H, Berg‐Hansen P, Brunborg C, Celius EG. The influence of menopause on multiple sclerosis. Eur J Neurol 2025; 32:e16566. [PMID: 39601490 PMCID: PMC11625929 DOI: 10.1111/ene.16566] [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: 03/07/2024] [Revised: 07/25/2024] [Accepted: 11/15/2024] [Indexed: 11/29/2024]
Abstract
INTRODUCTION One third of the multiple sclerosis (MS) population consists of peri- or postmenopausal women. Many symptoms of menopause overlap those of MS. Some studies show increased speed of disability progression after menopause, while others indicate an unaltered trajectory. OBJECTIVE Determine the association between menopause and MS disease course. METHODS Cohort study with clinical data collected prospectively. Self-reported age of menopause, smoking and parity collected retrospectively. RESULTS We included 559 peri-/postmenopausal women and 386 similarly aged men. There was no significant difference in EDSS progression (slope coef 0.03, 0.02-0.08, p = 0.208) or annual relapse rate (ARR) (0.10, 0.29-0.10, p = 0.324) in the 5 years before and after menopause. Women's EDSS progressed slower than men's after menopause (coef -0.02, 95% CI -0.04 to -0.002, p = 0.032), but there was no difference in ARR [coef. -0.01, 95% CI -0.04 to -0.01, p = 0.262]. Women who reached menopause before MS onset had shorter time to diagnosis than women who reached menopause after onset (3.1 years (3.1) vs. 7.4 years (8.1), p < 0.001). Women who reached menopause before diagnosis had an even longer time to diagnosis (8.8 (9.3) vs. 5.5 (6.3), p < 0.001). CONCLUSIONS There were no significant differences in EDSS progression or ARR before and after menopause. In fact, men progressed faster than women, suggesting there is no negative impact of menopause on disease progression, as measured by EDSS and relapses.
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Affiliation(s)
| | | | - Line Broch
- Department of NeurologyVestre Viken Hospital TrustDrammenNorway
- Department of NeurologyOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Harald Myklebust
- Department of NeurologyVestre Viken Hospital TrustDrammenNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | | | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support ServicesOslo University HospitalOsloNorway
| | - Elisabeth Gulowsen Celius
- Department of NeurologyOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
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Yi X, Zhang Y, Du Q, Kang J, Song S, Li T, Jiang Y. Global prevalence of fatigue in patients with multiple sclerosis: a systematic review and meta-analysis. Front Neurol 2024; 15:1457788. [PMID: 39416662 PMCID: PMC11479926 DOI: 10.3389/fneur.2024.1457788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 09/20/2024] [Indexed: 10/19/2024] Open
Abstract
Background Fatigue is one of the most common and burdensome symptoms for patients with multiple sclerosis (PwMS), considerably impacting their quality of life and employment. Numerous reports have described the prevalence of MS-related fatigue, but there is no global consensus on this matter. Objective To examine the global prevalence of MS-related fatigue and identify sources of heterogeneity in the published literature. Methods A systematic review and meta-analysis were conducted. A comprehensive search of the PubMed, EMBASE, Cochrane Library, Web of Science, PsycINFO, CINAHL, China National Knowledge Infrastructure (CNKI), and Wanfang database for potential literature from 2000 to January 31, 2024. A random effects model was used to calculate the prevalence of MS-related fatigue. Subgroup analyses and a meta-regression were used to explore the sources of heterogeneity. Results Sixty-nine studies from 27 countries were included. The global prevalence of MS-related fatigue was 59.1%, and it has decreased every decade since 2000. Fatigue was prevalent among females, those with lower education levels, those who were older, those with greater disability, and those with longer MS durations. The meta-regression revealed that fatigue measurement instruments were the largest source of heterogeneity. Conclusion The prevalence of MS-related fatigue is quite high. Healthcare professionals should screen for and manage fatigue for PwMS as early as possible and pay attention to populations with a high prevalence of fatigue. The high heterogeneity among the prevalence rates due to differences in the fatigue scales suggests the importance of reaching a consensus on the best screening tools for MS-related fatigue.
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Affiliation(s)
- Xiaodong Yi
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yue Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qiufeng Du
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Kang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shuang Song
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tao Li
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yunlan Jiang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Özden F. Letter to the Editor: "Concurrent multi-session anodal trans-cranial direct current stimulation enhances pelvic floor muscle training effectiveness for female patients with multiple sclerosis suffering from urinary incontinence and pelvic floor dysfunction: a randomized clinical trial study". Int Urogynecol J 2024; 35:1101-1102. [PMID: 37747551 DOI: 10.1007/s00192-023-05651-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Fatih Özden
- Köyceğiz Vocational School of Health Services, Health Care Services Department, Muğla Sıtkı Koçman University, Muğla, Turkey.
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Fernández Ó, Sörensen PS, Comi G, Vermersch P, Hartung HP, Leocani L, Berger T, Van Wijmeersch B, Oreja-Guevara C. Managing multiple sclerosis in individuals aged 55 and above: a comprehensive review. Front Immunol 2024; 15:1379538. [PMID: 38646534 PMCID: PMC11032020 DOI: 10.3389/fimmu.2024.1379538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Multiple Sclerosis (MS) management in individuals aged 55 and above presents unique challenges due to the complex interaction between aging, comorbidities, immunosenescence, and MS pathophysiology. This comprehensive review explores the evolving landscape of MS in older adults, including the increased incidence and prevalence of MS in this age group, the shift in disease phenotypes from relapsing-remitting to progressive forms, and the presence of multimorbidity and polypharmacy. We aim to provide an updated review of the available evidence of disease-modifying treatments (DMTs) in older patients, including the efficacy and safety of existing therapies, emerging treatments such as Bruton tyrosine kinase (BTKs) inhibitors and those targeting remyelination and neuroprotection, and the critical decisions surrounding the initiation, de-escalation, and discontinuation of DMTs. Non-pharmacologic approaches, including physical therapy, neuromodulation therapies, cognitive rehabilitation, and psychotherapy, are also examined for their role in holistic care. The importance of MS Care Units and advance care planning are explored as a cornerstone in providing patient-centric care, ensuring alignment with patient preferences in the disease trajectory. Finally, the review emphasizes the need for personalized management and continuous monitoring of MS patients, alongside advocating for inclusive study designs in clinical research to improve the management of this growing patient demographic.
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Affiliation(s)
- Óscar Fernández
- Departament of Pharmacology, Faculty of Medicine; Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, Malaga, Spain
- Department of Pharmacology and Pediatry, Faculty of Medicine, University of Malaga, Malaga, Spain
| | - Per Soelberg Sörensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Copenhagen and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giancarlo Comi
- Department of Neurorehabilitation Sciences, Multiple Sclerosis Centre Casa di Cura Igea, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Patrick Vermersch
- Univ. Lille, Inserm U1172 LilNCog, CHU Lille, FHU Precise, Lille, France
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Brain and Mind Center, University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Palacky University Olomouc, Olomouc, Czechia
| | - Letizia Leocani
- Department of Neurorehabilitation Sciences, Multiple Sclerosis Centre Casa di Cura Igea, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Bart Van Wijmeersch
- University MS Centre, Hasselt-Pelt, Belgium
- Rehabilitation and Multiple Sclerosis (MS), Noorderhart Hospitals, Pelt, Belgium
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clínico Universitario San Carlos, IdISSC, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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Shahraki Z, Rastkar M, Rastkar E, Mohammadifar M, Mohamadi A, Ghajarzadeh M. Impact of menopause on relapse rate and disability level in patients with multiple sclerosis (MS): a systematic review and meta-analysis. BMC Neurol 2023; 23:316. [PMID: 37667181 PMCID: PMC10476298 DOI: 10.1186/s12883-023-03332-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/15/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Menopause is a physiologic phase in women's lives. Findings regarding multiple sclerosis (MS) course through menopause are diverse. So, we designed this systematic review and meta-analysis to estimate the impact of menopause on relapse rate, and disability status in women with MS. METHODS PubMed, Scopus, EMBASE, Web of Science, and google scholar were systematically searched by two independent researchers on January 1st, 2023. They also evaluated conference abstracts, and references of the included studies. In addition, data regarding the total number of participants, name of the first author of the publication, publication year, country of origin, disease duration, disease type, annual relapse rate, and Expanded Disability Status Scale (EDSS) before and after menopause were recorded. RESULTS A literature search revealed 1024 records. Twenty-one full texts were evaluated, and finally, four studies were included for meta-analysis. Mean ARR before menopause ranged between 0.21 and 0.37, and after menopause ranged between 0.13 and 0.08. The SMD of mean ARR ranged between - 1.04, and - 0.29, while the pooled SMD was estimated as -0.52(95% CI: -0.88, -0.15) (I2 = 73.6%, P = 0.02). The mean EDSS before menopause ranged between 1.5 and 2, and after menopause ranged between 2 and 3.1. The SMD of EDSS ranged between 0.46, and 0.71. The pooled SMD of EDSS change (after menopause-before menopause) estimated as 0.56(95% CI: 0.38, 0.73)(I2 = 0, P = 0.4). CONCLUSION The result of this systematic review and meta-analysis show that menopause can be associated with relapse rate reduction, unlike increase in disease-related disability in women with MS.
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Affiliation(s)
| | - Mohsen Rastkar
- Student's Scientific research center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elnaz Rastkar
- Faculty of Medicine, Tabriz University of Medical Science, Tabriz, Iran
| | - Mehdi Mohammadifar
- Multiple Sclerosis Research Group (MSRG), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Mohamadi
- Multiple Sclerosis Research Group (MSRG), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Ghajarzadeh
- Multiple Sclerosis Research Group (MSRG), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran.
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
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Lorefice L, Fenu G, Fronza M, Murgia F, Frau J, Coghe G, Barracciu MA, Atzori L, Angioni S, Cocco E. Menopausal transition in multiple sclerosis: relationship with disease activity and brain volume measurements. Front Neurol 2023; 14:1251667. [PMID: 37602270 PMCID: PMC10434500 DOI: 10.3389/fneur.2023.1251667] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Background Recent evidence has shown a significant association between menopause and multiple sclerosis (MS) progression. This study investigated the possible role of menopause in influencing MS from clinical and neuroradiological perspectives. Notably, the possible association between menopause and brain atrophy has been evaluated. Materials and methods This study included women with MS whose ages ranged from 45 to 55 years. Demographic and clinical characteristics were collected, and the reproductive phase was defined as non-menopausal or menopausal based on the final menstrual period. Thus, MS activity over the past year was reported as the annualised relapse rate (ARR), and MRI activity (defined as new T2 lesions and/or the presence of gadolinium-enhancing lesions at the last MRI assessment in comparison with the MRI performed within the previous 12 months) were compared between non-menopausal women (non-MW) and menopausal women (MW). Volume measurements of the whole brain (WB), white matter (WM), grey matter (GM), and cortical GM were estimated using the SIENAX software, and the possible relationship with menopausal status was assessed by regression analysis. Results The study included 147 women with MS. Eighty-four (57.1%) were MW, with a mean age of 48.5 ± 4.3 years at menopause onset and a mean duration of menopause of 4.1 ± 1.1 years. When compared for ARR, MW reported a lower rate than the non-MW (ARR of 0.29 ± 0.4 vs. 0.52 ± 0.5; p < 0.01). MRI activity was observed in 13.1% of MW and 20.6% of non-MW (p = 0.03). Lower cortical GM volumes (578.1 ± 40.4 mL in MW vs. 596.9 ± 35.8 mL in non-MW; p < 0.01) have also been reported. Finally, multivariate analysis showed a significant association of lower ARR (p = 0.001) and cortical GM volume (p = 0.002) with menopausal status after correction for chronological age and other variables. Discussion Menopause may be an adverse prognostic factor of MS. Our preliminary results suggest that menopause may facilitate cortical GM atrophy, probably due to a decline in the neuroprotective effects of estrogen, with negative effects on MS evolution.
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Affiliation(s)
- Lorena Lorefice
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
| | - Giuseppe Fenu
- Department of Neurosciences, ARNAS Brotzu, Cagliari, Italy
| | - Marzia Fronza
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
| | - Federica Murgia
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Jessica Frau
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
| | - Giancarlo Coghe
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
| | | | - Luigi Atzori
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
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