Predictors of relapse severity in multiple sclerosis

BACKGROUND

The severity of relapses is one of the determinants of residual disability in multiple sclerosis (MS), contributing to the final progressive state. However, the factors that predict the severity of relapses are not fully understood.

AIM

To predict relapse severity in MS and investigate the relationship between relapse severity and the degree of improvement in physical, cognitive, and social tests.

METHODS

This observational single-center study prospectively assesses relapse severity in patients with MS. Relapses were classified as mild, moderate, and severe. Before relapse treatment and 1 month into remission four physical tests, four cognitive tests, and six surveys were performed. Multinomial regression analyses were applied to predict relapse severity.

RESULTS

A total of 126 relapses were studied prospectively. Twenty-two were lost to follow-up. Multiple sclerosis International Quality of Life (MusiQol) questionnaire (r = 0.28, p = 0.006) and Symbol Digit Modalities Test (SDMT, r = 0.23, p = 0.022) improvement statuses were correlated with the severity of the relapse. Higher cases with improvement were observed in the severe relapse group on both MusiQol and SDMT, but no difference for those with a mild relapse. In the predictive model, only disease duration [Odds Ratio (OR) 0.808 95% confidence ınterval (CI) 0.691 to 0.945; p = 0.008] and Body Mass Index (BMI, OR 1.148 95% CI 1.018 to 1.294; p = 0.024) were associated with relapse severity.

CONCLUSION

Only disease duration was found to be predictive of relapse severity among disease-related variables. On the other hand, BMI may be a modifiable patient-related factor to consider in the management of exacerbations in MS.

Dual-task difficulties as a risk factor for unemployment in people with multiple sclerosis

BACKGROUND

No study has investigated the impact of dual-tasking difficulties as a risk factor for unemployment in people with multiple sclerosis (pwMS). The aim was to examine the influence of dual-task performance on employment status and work difficulties and to identify the predictors of employment status in pwMS.

METHODS

Eighty-four pwMS, including 42 employed and 42 unemployed, participated in the study. Dual-task difficulties were assessed using the Dual-task Impact on Daily-living Activities-Questionnaire (DIDA-Q), while dual-task performance was evaluated through the 30-second Walk Test and Nine-Hole Peg Test, incorporating a cognitive task. Walking and cognitive function were also measured.

RESULTS

Employed pwMS had better scores in walking, cognitive function, single and dual-task performance than unemployed pwMS (p < .05). Lower scores in walking (odds ratio [OR] = 1.81, p < .001) and upper extremity-related (OR = 1.44, p = .019) dual-task performance and higher scores in the cognitive subscale of the DIDA-Q questionnaire (OR = 1.20, p = .037) were significantly associated with higher odds of being unemployed. Among employed pwMS, DIDA-Q subscales showed moderate-to-strong correlations with MSWSDQ-23 scores. The other variables showed weak-to-moderate correlations with subscale and total scores of MSWSDQ-23.

CONCLUSION

Cognitive function, as opposed to motor function, has been found to be a significant predictor of unemployment in pwMS.

The Preference-Based Multiple Sclerosis Index: an assessment of its psychometric properties and translation into Turkish

PURPOSE

To translate Preference-Based Multiple Sclerosis Index (PBMSI) into Turkish, investigate its psychometric properties and differences between its two scoring algorithms: PBMSI-Rating Scale (PBMSI-RS) and PBMSI-Standard Gamble (PBMSI-SG).

METHODS

An expert committee supervised the translation process. Psychometric properties were evaluated in 104 people with multiple sclerosis. Exploratory common factor analysis was used to investigate structural validity. Convergent validity was assessed by formulating hypotheses about correlations between PBMSI and other HRQL measures, disability level, walking-related measures, and MS symptoms. Known-groups validity was assessed against different measures of disability and walking capacity. Test-retest reliability was assessed by calculating the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC95%).

RESULTS

Factor analysis revealed one factor (Eigenvalue = 2.46). PBMSI-RS and PBMSI-SG correlated significantly with other measures (p < .001). Both could differentiate between individuals with different levels of disability and walking capacity (p < .05, d  ≥  0.50). Relative test-retest reliability was moderate for PBMSI-RS (ICC = 0.75) and good for PBMSI-SG (ICC = 0.83). SEM and MDC95% values were 0.16 and 0.44 for PBMSI-RS and 0.10 and 0.28 for PBMSI-SG, respectively.

CONCLUSION

Turkish version of PBMSI has good psychometric properties to assess health-related quality of life in people with multiple sclerosis. PBMSI-SG should be preferred over PBMSI-RS.IMPLICATIONS FOR REHABILITATIONHealth-related quality of life is often used as a primary or secondary endpoint in multiple sclerosis research.The Preference-Based Multiple Sclerosis Index is the first preference-based health-related quality of life measure developed in multiple sclerosis using patient preferences.Preference-Based Multiple Sclerosis Index was translated to Turkish and demonstrated good psychometric properties, including structural, convergent, known-groups validity, internal consistency, and test-retest reliability.Professionals working in the field of multiple sclerosis research and rehabilitation may benefit from using the Preference-Based Multiple Sclerosis Index as it is a short and psychometrically robust instrument.

Epstein-Barr virus antibody in newly diagnosed multiple sclerosis patients and its association with relapse severity and lesion location

BACKGROUND

Epstein-Barr virus is considered a risk factor for the development of multiple sclerosis, and recent findings reveal infected plasma -cells in meningeal ectopic lymphoid deposits. Activation of the dormant virus could be responsible for the multiple sclerosis exacerbation AIMS: To compare Epstein-Barr nuclear IgG (EBNA IgG) titer in newly diagnosed treatment-naive multiple sclerosis patients regarding the diagnoses date, clinical and radiological activity.

METHODS

Treatment-naive multiple sclerosis patients were divided into two groups according to Poser (late group) and McDonald2017(early group) diagnostic criteria. EBNA IgG, EDSS, physical (Timed 25 Foot Walk test, Nine-hole Peg test), and cognitive tests (Brief International Cognitive Assessment for Multiple Sclerosis) were done before the methylprednisolone infusion. The lesion location was evaluated by an MRI. Myelitis was considered a severe attack, and optic neuritis a mild relapse.

RESULTS

In total, 69 patients were enrolled. 44 (63.8%) of them were diagnosed by McDonald2017, and 25 (36.2%) were diagnosed with Poser criteria. There was a significant difference (p = 0.049) between the EBNA IgG titer of the late (median:238 U/ml, IQR: 154-362) and early (median: 154 U/ml, IQR:100.25-293.25). Severe relapse, having a spinal cord lesion, and not being treated with methylprednisolone was associated with higher EBNA IgG titer.

CONCLUSION

Study results show that EBNA IgG was significantly associated with disease activity regarding relapse severity and lesion location and could be a potential biomarker for predicting disease exacerbation.

Challenges of persons with multiple sclerosis on ocrelizumab treatment during COVID-19 pandemic

Background

Coronavirus disease of the 2019 pandemic caused much fear among people with chronic diseases and those on immunosuppressant treatment because of spreading knowledge that the infection has a fatal course in these populations. People with Multiple Sclerosis on ocrelizumab treatment share this fear too. We aimed to investigate treatment and lifestyle changes of people with multiple sclerosis on ocrelizumab treatment during the lockdown.

Methods

We surveyed 199 of our registered multiple sclerosis patients on ocrelizumab treatment by phone.

Results

In this survey, delays in treating 22 (11%) patients were not caused by fear of immunosuppressive drug use but rather by the general fear of contracting a fatal disease, which is the case during traveling and hospital visits. There was a positive correlation between living alone and treatment delay (P = .029), emphasizing the role of family support or just the presence of another person during the pandemic.

Conclusion

Vaccines might soon solve the pandemic's issue, which is not the case with multiple sclerosis progression, so we should think twice before discontinuing the treatment.

Systematic evaluation of the guidelines for rehabilitation in multiple sclerosis patients: an overview according to ICF functioning domains

High-quality clinical practice guidelines (CPGs) can provide evidence-based recommendations for optimizing care on managing multiple sclerosis (MS). There is currently no review that compiles recommendations of high-quality CPGs to guide decision-making for MS rehabilitation. The aim was to identify evidence-based recommendations in high-quality multidisciplinary English CPGs for rehabilitation in MS. CPGs published in the last 10 years (2009-2019) that described recommendations on rehabilitation were searched in PubMed, Turning Research into Practice database, International Guideline databases, National Guideline databases and websites of MS organizations. Quality assessment of CPGs was conducted by two evaluators using the Appraisal of Guidelines for Research and Evaluation II instrument. Recommendations were classified according to the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Health Intervention (ICHI) and documented in terms of strength of recommendation and level of evidence. Five CPGs satisfied the inclusion criteria. Of 120 recommendations, 38 had a strong level with moderate to low level of evidence, 61 were of weak strength and 18 were formulated by the consensus of experts. Recommendations were categorized into 12 domains and 1 chapter on the body function level, 1 chapter on activity level and 2 domains on external factors. The existing CPGs demonstrated more than 100 evidence level recommendations to be followed at the clinical practice, most in body functions of the ICF. Developing up-to-date CPGs with more focus on activity and participation domains for countries with various healthcare backgrounds may be useful for a best clinical practice.

Associations between smoking and walking, fatigue, depression, and health-related quality of life in persons with multiple sclerosis

Smoking is associated with increased multiple sclerosis (MS) risk. In addition, some studies have reported that smoking is associated with anxiety and depression. However, the associations between smoking, walking, and fatigue are needed to be investigated. The objective was to investigate the associations between cigarette smoking and walking, fatigue, depression symptom severity, and health-related quality of life in persons with MS. Two hundred seventy-nine persons with MS were evaluated in this cross-sectional study. Study outcomes were neurological disability level, walking speed, walking endurance, perceived walking impact of MS, fatigue, depression symptom severity, and health-related quality of life. There were 95 (34.1%) current smokers who had significantly higher fatigue (p = 0.003, pη² = 0.031) and depression (p = 0.044, pη² = 0.015), and lower health-related quality of life (p = 0.003, pη² = 0.031) after adjusting for age, gender, neurological disability level, and disease duration compared to non-smokers (n = 184). There was no significant difference between smokers and non-smokers in walking measures (p > 0.05). Smoking intensity was significantly correlated with age (r = 0.487), neurological disability level (r = 0.227), disease duration (r = 0.30), walking speed (r = 0.574), walking endurance (r =  - 0.461), perceived walking impact of MS (r = 0.684), fatigue (r = 0.370), health-related quality of life (r =  - 0.259), and depression (r = 0.269) in current smokers. Cigarette smokers with MS had significantly more fatigue and depression symptom severity and less health-related quality of life compared to non-smokers. Increased pack-years of cigarette smoking was associated with worse walking ability and health-related quality of life, and greater depression symptom severity and fatigue.

Validity and reliability of "Cognitive Reserve Index Questionnaire" for the Turkish Population

BACKGROUND

Cognitive reserve (CR) is the ability to counteract brain damage through differential recruitment of brain networks. Besides, it has also been observed that lifetime intellectual enriching skills reduce the effect of disease burden on cognitive status. The Cognitive Reserve Index questionnaire (CRIq), which is a method for the quantitative measurement and comprehensive evaluation of the CR, that individuals have accumulated throughout their lifetimes. The present study aimed to adapt CRIq to the Turkish population.

METHODS

CRIq is a 20-item questionnaire consisting of 3 sub-scales (CRI-Education, CRI- Working Activity, CRI-Leisure Time). 271 females and 228 males, a total of 499 healthy volunteers participated in the study (mean age: 39.54±14.05, mean education years 13.14±4.84). Participants were evaluated with the "Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS)" and CRIq was applied. BICAMS was used to determine the validity of the CRIq. To determine the reliability, the questionnaire was applied again two weeks after the first application. Internal consistency and test-retest reliability were measured for reliability analysis. Independent sample t-test was conducted to observe the difference between genders.

RESULTS

The Cronbach alpha coefficient of the questionnaire was 0.78, and the reliability of the questionnaire was acceptable. The findings showed that inter-rater reliability was quite high (ICC:0.95, 95% CI=1.000, n=36). The correlation between the first and second application of the questionnaire was found to be acceptable for both the sub-scales and the whole questionnaire. The highest CRIq scores were shown for young adults in CRI-Education and CRI-LeisureTime, for the middle-aged in CRIq-WorkingActivity, no significant differences in total CRIq scores. The males scored significantly higher in CRIq total scores than females, but there was not a significant difference in CRI-LeisureTime between genders.

CONCLUSION

The Turkish version of CRIq was found to be a valid and reliable method for evaluating cognitive reserve in healthy individuals.