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Giovannoni G, Ford HL, Schmierer K, Middleton R, Stennett AM, Pomeroy I, Fisniku L, Scalfari A, Bannon C, Stross R, Hughes S, Williams A, Josephs S, Peel C, Straukiene A. MS care: integrating advanced therapies and holistic management. Front Neurol 2024; 14:1286122. [PMID: 38351950 PMCID: PMC10862341 DOI: 10.3389/fneur.2023.1286122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/23/2023] [Indexed: 02/16/2024] Open
Abstract
Lifestyle and environmental factors are key determinants in disease causality and progression in neurological conditions, including multiple sclerosis (MS). Lack of exercise, poor diet, tobacco smoking, excessive alcohol intake, social determinants of health, concomitant medications, poor sleep and comorbidities can exacerbate MS pathological processes by impacting brain health and depleting neurological reserves, resulting in more rapid disease worsening. In addition to using disease-modifying therapies to alter the disease course, therapeutic strategies in MS should aim to preserve as much neurological reserve as possible by promoting the adoption of a "brain-healthy" and "metabolically-healthy" lifestyle. Here, we recommend self-regulated lifestyle modifications that have the potential to improve brain health, directly impact on disease progression and improve outcomes in people with MS. We emphasise the importance of self-management and adopting a multidisciplinary, collaborative and person-centred approach to care that encompasses the healthcare team, family members and community support groups.
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Affiliation(s)
- Gavin Giovannoni
- Centre for Neuroscience, Surgery and Trauma, Faculty of Medicine and Dentistry, The Blizard Institute, Queen Mary University of London, London, United Kingdom
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Helen L. Ford
- Leeds Teaching Hospitals, University of Leeds, Leeds, United Kingdom
| | - Klaus Schmierer
- Centre for Neuroscience, Surgery and Trauma, Faculty of Medicine and Dentistry, The Blizard Institute, Queen Mary University of London, London, United Kingdom
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Rod Middleton
- Disease Registers & Data Research in Health Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Andrea M. Stennett
- Centre for Neuroscience, Surgery and Trauma, Faculty of Medicine and Dentistry, The Blizard Institute, Queen Mary University of London, London, United Kingdom
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Ian Pomeroy
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Department of Neurology, University of Liverpool, Liverpool, United Kingdom
| | - Leonora Fisniku
- Department of Neurosciences (Addenbrooke’s), Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Antonio Scalfari
- Centre of Neuroscience, Department of Medicine, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | | | - Ruth Stross
- Neurology Academy, Sheffield, United Kingdom
- Kingston Hospitals NHS Foundation Trust, Surrey, United Kingdom
| | - Sarah Hughes
- Torbay and South Devon NHS Foundation Trust, Torquay, United Kingdom
| | - Adam Williams
- Devon Partnership NHS Trust, Paignton, United Kingdom
| | | | | | - Agne Straukiene
- Torbay and South Devon NHS Foundation Trust, Torquay, United Kingdom
- University of Plymouth, Plymouth, United Kingdom
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Salavisa M, Mohamed B, Allen-Philbey K, Stennett AM, Campion T, Schmierer K. Parakinesia Brachialis Oscitans in a Patient With a First Manifestation of Multiple Sclerosis. Neurol Clin Pract 2023; 13:e200204. [PMID: 37942412 PMCID: PMC10629275 DOI: 10.1212/cpj.0000000000200204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/25/2023] [Indexed: 11/10/2023]
Abstract
Objectives Parakinesia brachialis oscitans (PBO) is the involuntary movement of an otherwise paretic upper limb triggered by yawning. We describe the first case of PBO in a patient with a first manifestation of tumefactive multiple sclerosis (MS). Methods A 35-year-old man presented to the emergency department with a first episode of generalized seizure. Neurologic examination revealed left-sided spastic hemiparesis, predominantly affecting his upper limb. Brain MRI showed a tumefactive right hemisphere lesion consistent with demyelination. CSF did not document unmatched oligoclonal bands. Results Two weeks after admission and, despite being unable to voluntarily raise his left arm, the patient noticed a repeated and reproducible involuntary raise of this limb upon yawning, consistent with PBO. In the following weeks, the phenomenon diminished both in frequency and movement amplitude alongside motor recovery. An MRI performed 2 months later showed progression of the demyelinating lesion load and confirmed a diagnosis of MS. Discussion PBO is an example of autonomic voluntary motor dissociation and reflects the interplay between loss of cortical inhibition of the cerebellum in the setting of functional spinocerebellar pathways. Clinicians should be aware of this transient phenomenon which should not be mistaken as a chronic movement disorder or focal epileptic seizures.
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Affiliation(s)
- Manuel Salavisa
- Centre for Neuroscience (MS, BM, KA-P, KS), Surgery and Trauma, The Blizard Institute, Queen Mary University of London; Clinical Board Medicine (Neuroscience) (MS, BM, KA-P, AMS, TC, KS), The Royal London Hospital, Barts Health NHS Trust, United Kingdom; and Neurology Department (MS), Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal
| | - Bader Mohamed
- Centre for Neuroscience (MS, BM, KA-P, KS), Surgery and Trauma, The Blizard Institute, Queen Mary University of London; Clinical Board Medicine (Neuroscience) (MS, BM, KA-P, AMS, TC, KS), The Royal London Hospital, Barts Health NHS Trust, United Kingdom; and Neurology Department (MS), Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal
| | - Kimberley Allen-Philbey
- Centre for Neuroscience (MS, BM, KA-P, KS), Surgery and Trauma, The Blizard Institute, Queen Mary University of London; Clinical Board Medicine (Neuroscience) (MS, BM, KA-P, AMS, TC, KS), The Royal London Hospital, Barts Health NHS Trust, United Kingdom; and Neurology Department (MS), Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal
| | - Andrea M Stennett
- Centre for Neuroscience (MS, BM, KA-P, KS), Surgery and Trauma, The Blizard Institute, Queen Mary University of London; Clinical Board Medicine (Neuroscience) (MS, BM, KA-P, AMS, TC, KS), The Royal London Hospital, Barts Health NHS Trust, United Kingdom; and Neurology Department (MS), Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal
| | - Thomas Campion
- Centre for Neuroscience (MS, BM, KA-P, KS), Surgery and Trauma, The Blizard Institute, Queen Mary University of London; Clinical Board Medicine (Neuroscience) (MS, BM, KA-P, AMS, TC, KS), The Royal London Hospital, Barts Health NHS Trust, United Kingdom; and Neurology Department (MS), Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal
| | - Klaus Schmierer
- Centre for Neuroscience (MS, BM, KA-P, KS), Surgery and Trauma, The Blizard Institute, Queen Mary University of London; Clinical Board Medicine (Neuroscience) (MS, BM, KA-P, AMS, TC, KS), The Royal London Hospital, Barts Health NHS Trust, United Kingdom; and Neurology Department (MS), Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal
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Ryan JM, Stennett AM, Peacock S, Baker G, Norris M. Associations between activity and participation in adults with multiple sclerosis: a cross sectional study. Physiotherapy 2018; 105:453-460. [PMID: 30876719 DOI: 10.1016/j.physio.2018.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 11/04/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The aim of this study was to determine the association between walking ability in a clinical setting (activity capacity), walking ability in a person's daily environment (activity capability) and walking performance in daily life (activity performance), and the contribution of each activity construct to participation among people with multiple sclerosis (MS). DESIGN Cross-sectional study. SETTING Five MS therapy centres in England. PARTICIPANTS Fifty-two adults (13 males) with MS who were independently ambulatory with or without a walking aid (mean (SD) age 55.4 (9.1) year). INTERVENTIONS No intervention. MAIN OUTCOME MEASURES Activity capacity, capability, and performance were assessed using the Six Minute Walk Test (6MWT), Twelve Item MS Walking Scale (MSWS-12), and steps/day measured using a pedometer worn for 6 days, respectively. Participation was assessed using the Impact on Participation and Autonomy questionnaire (IPA). RESULTS Distance walked on the 6MWT was associated with MSWS-12 score (β=-0.56, 95% CI -0.87 to -0.22) and steps/day (β=129.49, 95% CI 48.48 to 207.57). MSWS-12 score was also associated with step count (β=-87.35, 95% CI -172.29 to -15.71). 6MWT distance was associated with the autonomy indoors subscale of the IPA (β=-0.02, 95% CI -0.04 to -0.01). No other activity measure was associated with participation. CONCLUSIONS Findings suggest that while activity capacity, capability and performance are related, activity is a poor predictor of participation. The strength of associations between constructs of activity, and activity and participation, however, are often small with wide confidence intervals, indicating that there is considerable uncertainty associated with effect estimates.
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Affiliation(s)
- Jennifer M Ryan
- Department of Clinical Sciences, Brunel University London, United Kingdom; Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Andrea M Stennett
- Department of Clinical Sciences, Brunel University London, United Kingdom
| | - Sarah Peacock
- Department of Clinical Sciences, Brunel University London, United Kingdom
| | - Gayle Baker
- Department of Clinical Sciences, Brunel University London, United Kingdom
| | - Meriel Norris
- Department of Clinical Sciences, Brunel University London, United Kingdom
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