Changes to the septo-fornical area might play a role in the pathogenesis of anxiety in multiple sclerosis

2017 ◽  
Vol 24 (8) ◽  
pp. 1105-1114 ◽  
Author(s):  
Miklos Palotai ◽  
Andrea Mike ◽  
Michele Cavallari ◽  
Erzsebet Strammer ◽  
Gergely Orsi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Anxiety And Depression ◽  
Ultra High Field ◽  
Lesion Load ◽  
Impact Scale ◽  
Weighted Magnetic Resonance Imaging ◽  
Fatigue Impact Scale ◽  
Magnetic Resonance Imaging Mri ◽  
Post Hoc ◽  
Larger Sample

Background: Reports on the relationships between white matter lesion load (WMLL) and fatigue and anxiety in multiple sclerosis (MS) are inconsistent. Objective: To investigate the association of total and tract-specific WMLL with fatigue and anxiety. Methods: Total and regional T2 WMLL was assessed for 19 tracts in 48 MS patients (30 females). ICBM-DTI-81 Atlas-based parcellation was combined with WMLL segmentation of T2-weighted magnetic resonance imaging (MRI). Fatigue, anxiety, and depression were assessed using Fatigue Impact Scale, State Trait Anxiety Inventory, and Beck Depression Inventory, respectively. Results: Fatigue, anxiety, and depression showed significant inter-correlation. We found no association between fatigue and total or regional WMLLs, whereas anxiety was associated with total and regional WMLLs in nine tracts. After adjusting for total WMLL, age, and depression, only the column and body of the fornix (CBF) remained significantly associated with anxiety. Post hoc analyses showed no CBF lesions on T1-weighted MRI and suggested, but could not confirm, that the septum pellucidum might play a role in the pathogenesis of anxiety. Conclusion: Our results suggest that anxiety in MS patients may have a neuropathological substrate in the septo-fornical area, which requires further validation using larger sample size and ultra-high-field MRI in targeted prospective studies.

scholarly journals Fatigue in multiple sclerosis is associated with multimodal interoceptive abnormalities

2019 ◽  
Vol 26 (14) ◽  
pp. 1845-1853 ◽  
Author(s):  
Cecilia Gonzalez Campo ◽  
Paula C Salamone ◽  
Nicolás Rodríguez-Arriagada ◽  
Fabian Richter ◽  
Eduar Herrera ◽  
...  
Keyword(s):  
Machine Learning ◽  
Multiple Sclerosis ◽  
Functional Connectivity ◽  
Gray Matter Volume ◽  
Area Under The Curve ◽  
Anterior Cingulate ◽  
Impact Scale ◽  
Fatigue Impact Scale ◽  
Magnetic Resonance Imaging Mri ◽  
Interoceptive Accuracy

Background: Fatigue ranks among the most common and disabling symptoms in multiple sclerosis (MS). Recent theoretical works have surmised that this trait might be related to alterations across interoceptive mechanisms. However, this hypothesis has not been empirically evaluated. Objectives: To determine whether fatigue in MS patients is associated with specific behavioral, structural, and functional disruptions of the interoceptive domain. Methods: Fatigue levels were established via the Modified Fatigue Impact Scale. Interoception was evaluated through a robust measure indexed by the heartbeat detection task. Structural and functional connectivity properties of key interoceptive hubs were tested by magnetic resonance imaging (MRI) and resting-state functional MRI. Machine learning analyses were employed to perform pairwise classifications. Results: Only patients with fatigue presented with decreased interoceptive accuracy alongside decreased gray matter volume and increased functional connectivity in core interoceptive regions, the insula, and the anterior cingulate cortex. Each of these alterations was positively associated with fatigue. Finally, machine-learning analysis with a combination of the above interoceptive indices (behavioral, structural, and functional) successfully discriminated (area under the curve > 90%) fatigued patients from both non-fatigued and healthy controls. Conclusion: This study offers unprecedented evidence suggesting that disruptions of neurocognitive markers subserving interoception may constitute a signature of fatigue in MS.

Personalized, bilateral whole-body somatosensory cortex stimulation to relieve fatigue in multiple sclerosis

2017 ◽  
Vol 24 (10) ◽  
pp. 1366-1374 ◽  
Author(s):  
Andrea Cancelli ◽  
Carlo Cottone ◽  
Alessandro Giordani ◽  
Simone Migliore ◽  
Domenico Lupoi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Somatosensory Cortex ◽  
Conventional Medicine ◽  
Whole Body ◽  
Cortical Folding ◽  
Double Blind ◽  
Impact Scale ◽  
Sample Size Estimate ◽  
Fatigue Impact Scale ◽  
Magnetic Resonance Imaging Mri

Background: The patients suffering from multiple sclerosis (MS) often consider fatigue the most debilitating symptom they experience, but conventional medicine currently offers poorly efficacious therapies. Objective: We executed a replication study of an innovative approach for relieving MS fatigue. Methods: According to the sample size estimate, we recruited 10 fatigued MS patients who received 5-day transcranial direct current stimulation (tDCS) in a randomized, double-blind, Sham-controlled, crossover study, with modified Fatigue Impact Scale (mFIS) score reduction at the end of the treatment as primary outcome. A personalized anodal electrode, shaped on the magnetic resonance imaging (MRI)-derived individual cortical folding, targeted the bilateral whole-body primary somatosensory cortex (S1) with an occipital cathode. Results: The amelioration of fatigue symptoms after Real stimulation (40% of baseline) was significantly larger than after Sham stimulation (14%, p = 0.012). Anodal whole body S1 induced a significant fatigue reduction in mildly disabled MS patients when the fatigue-related symptoms severely hampered their quality of life. Conclusion: This second result in an independent group of patients supports the idea that neuromodulation interventions that properly select a personalized target might be a suitable non-pharmacological treatment for MS fatigue.

Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls

2008 ◽  
Vol 14 (3) ◽  
pp. 383-390 ◽  
Author(s):  
Myla D Goldman ◽  
Ruth Ann Marrie ◽  
Jeffrey A Cohen
Keyword(s):  
Multiple Sclerosis ◽  
Short Form ◽  
Intraclass Correlation ◽  
Rest Period ◽  
Practice Effect ◽  
Physical Component Score ◽  
Physical Fatigue ◽  
Subjective Measures ◽  
Impact Scale ◽  
Fatigue Impact Scale

Objective To assess the characteristics of the 6-min walk (6MW) in multiple sclerosis (MS) subjects of varied disability, and controls. To assess the correlation of 6MW to subjective measures of fatigue, health status and ambulation using the modified fatigue impact scale (MFIS), short form-36 Health Questionnaire physical component score and MS walking scale (MSWS). Methods Forty MS expanded disability status scale [(EDSS) 0—6.5] and 20 control subjects were recruited from a MS outpatient clinic. Subjects completed survey material and three 6MWs with 1-h interval rest in a single study visit. Results There was no practice effect or fatigability with repeat 6MW tests with a one-h rest period between test sessions. The 6MW had excellent intra-[intraclass correlation coefficient (ICC) = 0.95] and inter-rater (ICC = 0.91) reliability. MS subjects demonstrated reduced 6MW distance and speed compared with controls ( P < 0.0001). Within the MS population 6MW distance was significantly reduced with increasing disability ( P = 0.05). Compared with the EDSS, the 6MW had a stronger correlation to subjective measures of ambulation and physical fatigue: MSWS ( r = -0.81 versus 0.69) and MFISphy (0.66 versus 0.63). Conclusions The 6MW is a feasible, reproducible, and reliable measure in MS. MS subjects demonstrate motor fatigue in both 6MW distance and speed compared with controls. In MS subjects there is an inverse relationship between motor fatigue and disability. 6MW has a strong correlation to subjective measures of ambulation and physical fatigue. Multiple Sclerosis 2008; 14: 383—390. http://msj.sagepub.com

scholarly journals Assessing fatigue in multiple sclerosis: Psychometric properties of the five-item Modified Fatigue Impact Scale (MFIS-5)

2019 ◽  
Vol 5 (4) ◽  
pp. 205521731988798 ◽  
Author(s):  
Virginia Meca-Lallana ◽  
María Brañas-Pampillón ◽  
Yolanda Higueras ◽  
Antonio Candeliere-Merlicco ◽  
Yolanda Aladro-Benito ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Psychometric Properties ◽  
Impact Scale ◽  
Fatigue Impact Scale

scholarly journals Brain and Spinal Cord MRI in Multiple Sclerosis: an Update

2017 ◽  
Vol 01 (04) ◽  
pp. E294-E306 ◽  
Author(s):  
Mike Wattjes ◽  
Peter Raab
Keyword(s):  
Multiple Sclerosis ◽  
Quantitative Mri ◽  
Central Vein ◽  
Resonance Imaging ◽  
Ultra High Field ◽  
Important Differential Diagnosis ◽  
Magnetic Resonance Imaging Mri ◽  
Near Future ◽  
Brain And Spinal Cord

AbstractMagnetic resonance imaging (MRI) plays an important role in the diagnosis of multiple sclerosis and has been incorporated into the McDonald diagnostic criteria for MS. In particular, for the exclusion of important differential diagnosis and comorbidities, new MRI markers have been established such as the “central vein sign”. In addition to diagnostic purposes, the role of MRI in MS monitoring is becoming increasingly important, particularly for pharmacovigilance. This includes treatment efficacy monitoring, prediction of treatment response and safety monitoring. Quantitative MRI methods and ultra-high-field MRI offer the opportunity for the quantitative assessment of damage in normal-appearing brain tissue. However, the standardization of these techniques with the goal of implementation in clinical routine will be one of the major challenges in the near future.

scholarly journals Efficacy of Cladribine Tablets in high disease activity subgroups of patients with relapsing multiple sclerosis: A post hoc analysis of the CLARITY study

2018 ◽  
Vol 25 (6) ◽  
pp. 819-827 ◽  
Author(s):  
Gavin Giovannoni ◽  
Per Soelberg Sorensen ◽  
Stuart Cook ◽  
Kottil W Rammohan ◽  
Peter Rieckmann ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Activity ◽  
High Disease Activity ◽  
Study Entry ◽  
T2 Lesions ◽  
Relapsing Remitting ◽  
Study Population ◽  
Magnetic Resonance Imaging Mri ◽  
Post Hoc ◽  
Relapsing Remitting Multiple Sclerosis

Background: In the CLARITY (CLAdRIbine Tablets treating multiple sclerosis orallY) study, Cladribine Tablets significantly improved clinical and magnetic resonance imaging (MRI) outcomes (vs placebo) in patients with relapsing-remitting multiple sclerosis. Objective: Describe two clinically relevant definitions for patients with high disease activity (HDA) at baseline of the CLARITY study (utility verified in patients receiving placebo) and assess the treatment effects of Cladribine Tablets 3.5 mg/kg compared with the overall study population. Methods: Outcomes of patients randomised to Cladribine Tablets 3.5 mg/kg or placebo were analysed for subgroups using HDA definitions based on high relapse activity (HRA; patients with ⩾2 relapses during the year prior to study entry, whether on DMD treatment or not) or HRA plus disease activity on treatment (HRA + DAT; patients with ⩾2 relapses during the year prior to study entry, whether on DMD treatment or not, PLUS patients with ⩾1 relapse during the year prior to study entry while on therapy with other DMDs and ⩾1 T1 Gd+ or ⩾9 T2 lesions). Results: In the overall population, Cladribine Tablets 3.5 mg/kg reduced the risk of 6-month-confirmed Expanded Disability Status Scale (EDSS) worsening by 47% vs placebo. A risk reduction of 82% vs placebo was seen in both the HRA and HRA + DAT subgroups (vs 19% for non-HRA and 18% for non-HRA + DAT), indicating greater responsiveness to Cladribine Tablets 3.5 mg/kg in patients with HDA. There were consistent results for other efficacy endpoints. The safety profile in HDA patients was consistent with the overall CLARITY population. Conclusion: Patients with HDA showed clinical and MRI responses to Cladribine Tablets 3.5 mg/kg that were generally better than, or at least comparable with, the outcomes seen in the overall CLARITY population.

Comparing Individualized Rehabilitation to a Group Wellness Intervention for Persons with Multiple Sclerosis

2009 ◽  
Vol 24 (1) ◽  
pp. 23-26 ◽  
Author(s):  
Matthew A. Plow ◽  
Virgil Mathiowetz ◽  
Dawn A. Lowe
Keyword(s):  
Mental Health ◽  
Multiple Sclerosis ◽  
Physical Health ◽  
Preliminary Evidence ◽  
Effect Sizes ◽  
Future Research ◽  
Impact Scale ◽  
Sf 36 ◽  
Fatigue Impact Scale ◽  
Wellness Intervention

Purpose. Compare the efficacy of two interventions designed to promote health and physical activity (PA). Design. This study was a randomized clinical trial using a time series design. Subjects were randomized into individualized physical rehabilitation (IPR) and group wellness intervention (GWI). Primary questionnaires were administered twice preintervention and twice postintervention. Physical fitness and PA frequency were assessed preintervention and postintervention. Setting. Clinic based in a metropolitan area. Subjects. Fifty volunteers with multiple sclerosis. Interventions. IPR consisted of four physical therapy sessions plus three telephone calls. GWI consisted of seven educational sessions. Measures. Primary: SF-36 Health Survey, Modified Fatigue Impact Scale, Mental Health Inventory. Secondary: physical assessment, PA frequency. Analysis. Stability of primary questionnaires between the two pretests was examined. Efficacy of interventions was evaluated by multivariate analysis of variance (MANOVA) and effect sizes. Results. Primary measures were stable between pretests. MANOVA showed nonsignificant differences between interventions. Eight weeks postintervention, both groups had improved PA, fatigue, resting heart rate, and strength. Effect sizes suggested that IPR had a greater effect on preventing decline of physical health, whereas GWI had a greater effect on improving mental health. Conclusion. Preliminary evidence indicated that health and PA improved in both groups. Effect sizes suggested that participants benefited more physically from IPR and more mentally from GWI. Future research should determine whether combining therapeutic exercise with group education improves both mental and physical health.

Comparison of the influence of different rehabilitation programmes on clinical, spirometric and spiroergometric parameters in patients with multiple sclerosis

2006 ◽  
Vol 12 (2) ◽  
pp. 227-234 ◽  
Author(s):  
K Rasova ◽  
E Havrdova ◽  
P Brandejsky ◽  
M Zálišová ◽  
B Foubikova ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Aerobic Training ◽  
Combined Therapy ◽  
Bicycle Ergometer ◽  
Beck Depression Inventory Score ◽  
Impact Scale ◽  
Fatigue Impact Scale ◽  
Training Programmes

Purpose The aim of this study was to compare the effect of four different programmes on spiroergometric, spirometric and clinical parameters in multiple sclerosis (MS) patients.Methods One hundred and twelve MS patients were divided into four groups. The first group underwent neurophysiologically based physiotherapy, the second aerobic training, the third combined therapy (neurophysiologically based physiotherapy and aerobic training) and the fourth did not change any habits. Seventeen patients did not finish the study. Patients were examined on impairment (Expanded Disability Status Scale), disability (Barthel Index), handicap (Environment Status Scale), quality of life (Multiple Sclerosis Quality of Life), fatigue (Modified Fatigue Impact Scale), depression (Beck Depression Inventory Score), respiratory function (spirometric parameters on spirometry) and physical fitness (spiroergometric parameters on a bicycle ergometer).Results The patients who participated in one of our training programmes showed a significant improvement of the examined parameters in comparison to those who did not change their present habits. Each of the four training programmes had a different impact on the parameters, which means that each of them had a different effect. The neurophysiologically based physiotherapy had the greatest impact on impairment, and the aerobic training on spirometric and spiroergometric parameters. All methods (the neurophysiologically based physiotherapy, the aerobic training and the combined programme) had an impact on fatigue.

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