Energy cost of exercise in multiple sclerosis patients with low degree of disability

In 10 patients (five females) suffering from multiple sclerosis with mild degree of disability, (EDSS ranging from 0 to 2) and in 10 age and sex matched control subjects we investigated lung function, respiratory muscles strength and cardiorespiratory response to incremental exercise in order to assess the metabolic cost of exercise. In the absence of any impairment of lung volumes and flows and in-and expiratory maximal mouth pressures, at peak of exercise oxygen consumption (VO2max=1886 ± 145 ml/min) and workload (Wmax = 137 ± 9.8 watts) were slightly diminished in patients, as compared with controls (VO2max = 2246 ± 196 ml/min and Wmax = 164 ± 14.7 watts). These findings were associated with an increased heart rate (HR) and reduced oxygen pulse (VO2/HR) at the same workloads. During the whole exercise, however, the slope of the linear relationship between VO2 and work exhibited by the patients, amounting to 9.9 ± 0.6 ml/min/watt, was similar to that of the controls (10.9 ± 0.42 ml/min/watt). Incidentally, both at rest and during exercise, the patients showed a significantly greater minute ventilation (due to a faster respiratory rate, associated with an augmented dead space (P<0.05). We conclude that an increase of metabolic cost of exercise does not occur in multiple sclerosis patients with mild disability, suggesting a lack or a low degree of spasticity and/or ataxia elicited by the effort Thus, their exertional capacity appears to be limited mainly by a poor training. The tachypnea observed in these patients at rest and during exercise was unexpected and the reason for adopting such a pattern of breathing is unclear.

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The Assessment of Serum Concentrations of AGEs and Their Soluble Receptor (sRAGE) in Multiple Sclerosis Patients

Brain Sciences ◽

10.3390/brainsci11081021 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1021

Author(s):

Aleksandra Damasiewicz-Bodzek ◽

Beata Łabuz-Roszak ◽

Bartłomiej Kumaszka ◽

Bartosz Tadeusiak ◽

Krystyna Tyrpień-Golder

Keyword(s):

Multiple Sclerosis ◽

Stable Phase ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Healthy Controls ◽

Soluble Receptor ◽

Serum Concentrations ◽

Degree Of Disability ◽

The Mean ◽

Multiple Sclerosis Patients

Background: Advanced glycation end products (AGEs) are involved in the pathogenesis of many diseases, including neurodegenerative diseases such as multiple sclerosis (MS). The aim of the study was to determine serum concentrations of AGEs and their soluble receptor (sRAGE) in MS patients and healthy controls and to investigate their possible influence on disease activity. Methods: Serum concentrations of AGE and sRAGE in patients with MS and healthy controls were determined by enzyme-linked immunosorbent assay (ELISA). Results: The mean serum AGE concentration in patients with MS was higher than in healthy controls, whereas the mean serum sRAGE concentration was lower than in the control group. However, the differences were not statistically significant. In MS patients, serum AGE and sRAGE concentrations did not differ significantly, depending on the duration of the disease and the Expanded Disability Status Scale (EDSS) score. Conclusions: Multiple sclerosis may be accompanied by disturbances of the AGE-sRAGE axis. However, further studies are warranted to confirm it. The duration of the disease and the degree of disability do not seem to affect the progression of the glycation process, particularly in the stable phase of the disease.

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Immunisation status against major diseases preventable with vaccines in multiple sclerosis patients

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1455 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

D Bezzini ◽

M A Battaglia ◽

M Ulivelli

Keyword(s):

Multiple Sclerosis ◽

Central Italy ◽

Vaccine Safety ◽

Immunosuppressive Drugs ◽

Reproductive Age ◽

Immunization Status ◽

Lack Of Information ◽

Mild Disability ◽

Multiple Sclerosis Patients ◽

Immunisation Status

Abstract Background Multiple sclerosis (MS) patients are more susceptible to infections than the general population due to the utilization of immunosuppressive drugs (DMDs) which require particular attention to the occurrence of infectious events. So, immunisation policies are mandatory or recommended. Methods In this pilot study, subjects receiving a diagnosis of relapsing-remitting MS since 2011 at a MS center in central Italy were enrolled. The immunization status against major infectious agents and safety of most used vaccines were recorded. Results 103 patients (67% females), mean age 42 years, with no or mild disability (85%) were examined. The majority received vaccines against poliomyelitis (92%), hepatitis B (47%), tetanus and diphtheria (89%), but a small percentage got boosters every 10 years (31% for tetanus and 28% for diphtheria); other vaccines evaluated: pertussis (37%), mumps (23%), meningococcus B, C (5%), flu (1%). Evaluating immunization status due to vaccines or illnesses, a significant percentage of patients using immunosuppressive drugs was susceptible to infections, such as measles (44%), chicken pox (32%) and rubella (65%). Only 17% of patients were vaccinated after diagnosis and, regarding vaccine safety, only 1 had a relapse within 6 months following measles, mumps and rubella vaccine. Conclusions This study shows a very low number of vaccinations among patients, confirming the need of preventive information on their importance and safety for MS patients: major adverse events of therapy in MS include severe infections and the majority of patients are female in reproductive age. This pilot phase was followed by an ongoing study involving 25 Italian MS Centers and 3000 patients that will provide in 2022 useful results on vaccination policies and safety. The knowledge of immunisation status is crucial for the clinical practice in the management of DMDs, and for the public health policies for a vaccine campaign targeted to MS patients. Key messages Lack of information on vaccine safety bring to a low adherence to immunization program. The immunization status of patients is essential for a correct management of therapies.

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Serum leptin and body mass index in a sample of Egyptian multiple sclerosis patients

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-020-00239-3 ◽

2020 ◽

Vol 56 (1) ◽

Author(s):

Mohamed A. Abd Elhafeez ◽

Dina A. Zamzam ◽

Mohamed M. Fouad ◽

Hala M. Elkhawas ◽

Hend A. Abdel Rahman

Keyword(s):

Multiple Sclerosis ◽

Body Mass Index ◽

Body Mass ◽

Clinical History ◽

Control Group ◽

Case Group ◽

Serum Leptin ◽

Disability Status ◽

Degree Of Disability ◽

Multiple Sclerosis Patients

Abstract Background The adipose tissues release pro-inflammatory cytokines such as leptin that can be considered a link between obesity and autoimmunity. This study aimed to investigate a possible correlation between BMI, serum leptin, and multiple sclerosis (MS). Methods This case-control study recruited consecutively 169 patients from our MS Unit and 50 healthy controls. Clinical history and examination with Expanded Disability Status Scale (EDSS) scoring were done for all patients. Calculation of body mass index (BMI) and measurement of serum leptin level were done for patients and controls. Results The case group had significantly higher BMI (mean of 26.85 ± 6.06 versus 19.55 ± 1.62; P < 0.001) and higher serum leptin levels (median [IQR] of 280 pgm/ml [175–525] versus 102.5 pgm/ml [80–125]; P < 0.001) compared to the control group. Serum leptin levels did not have a correlation with either disease activity or degree of disability. Conclusions MS patients had significantly higher BMI and higher serum leptin levels compared to controls.

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COVID-19 in Multiple Sclerosis Patients and Risk Factors for Severe Infection

10.1101/2020.05.27.20114827 ◽

2020 ◽

Cited By ~ 2

Author(s):

Farhan Chaudhry ◽

Helena Bulka ◽

Anirudha S. Rathnam ◽

Omar M Said ◽

Jia Lin ◽

...

Keyword(s):

Multiple Sclerosis ◽

Hospital Admission ◽

Clinical Characteristics ◽

Severe Infection ◽

Progressive Multiple Sclerosis ◽

Disease Modifying Therapy ◽

Degree Of Disability ◽

Significant Disability ◽

Disease Modifying ◽

Multiple Sclerosis Patients

AbstractImportanceMultiple sclerosis patients have been considered a higher-risk population for COVID-19 due to the high prevalence of disability and disease-modifying therapy use; however, no study has identified clinical characteristics of multiple sclerosis associated with worse COVID-19 outcomes.ObjectiveTo evaluate the clinical characteristics of multiple sclerosis, including staging, degree of disability, and disease-modifying therapy use that are associated with worse outcomes from COVID-19.DesignProspective cohort study looking at the outcomes of multiple sclerosis patients with COVID-19 between March 1st and May 18th 2020.SettingThis is a multicenter study of three distinct hospital systems within the U.S.ParticipantsThe study included 40 consecutive patients with nasopharyngeal/oropharyngeal PCR-confirmed COVID-19 infection.ExposuresMultiple sclerosis staging, severe disability (based on baseline-extended disability status scale equal to or greater than 6.0) and disease-modifying therapy.Main Outcomes and MeasureSeverity of COVID-19 infection was based on hospital course, where a mild course was defined as the patient not requiring hospital admission, moderate severity was defined as the patient requiring hospital admission to the general floor only, and most severe was defined as requiring intensive care unit admission and/or death.ResultsFor the 40 patients, the median age was 52(45.5-61) years, 16/40(40%) were male, and 21/40(52.5%) were African American. 19/40(47.5%) had mild courses, 15/40(37.5%) had moderate courses, and 6/40(15%) had severe courses. Patients with moderate and severe courses were significantly older than those with a mild course (57[50-63] years old and 66[58.8-69.5] years old vs 48[40-51.5] years old, P=0.0121, P=0.0373). There was differing prevalence of progressive multiple sclerosis staging in those with more severe courses (severe:2/6[33.3%]primary-progressing and 0/6[0%]secondary-progressing, moderate:1/14[7.14%] and 5/14[35.7%] vs mild:0/19[0%] and 1/19[5.26%], P=0.0075, 1 unknown). Significant disability was found in 1/19(5.26%) mild course-patients, but was in 9/15(60%, P=0.00435) of moderate course-patients and 2/6(33.3%, P=0.200) of severe course-patients. Disease-modifying therapy prevalence did not differ among courses (mild:17/19[89.5%], moderate:12/15[80%] and severe:3/6[50%], P=0.123).Conclusions and RelevanceMultiple sclerosis patients with more severe COVID-19 courses tended to be older, were more likely to suffer from progressive staging, and had a higher degree of disability. However, disease-modifying therapy use was not different among courses.

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Magnetic resonance spectroscopy findings as related to fatigue and cognitive performance in multiple sclerosis patients with mild disability

Journal of the Neurological Sciences ◽

10.1016/j.jns.2014.01.013 ◽

2014 ◽

Vol 339 (1-2) ◽

pp. 35-40 ◽

Cited By ~ 11

Author(s):

Anna Pokryszko-Dragan ◽

Joanna Bladowska ◽

Anna Zimny ◽

Krzysztof Slotwinski ◽

Mieszko Zagrajek ◽

...

Keyword(s):

Multiple Sclerosis ◽

Magnetic Resonance ◽

Magnetic Resonance Spectroscopy ◽

Cognitive Performance ◽

Resonance Spectroscopy ◽

Mild Disability ◽

Multiple Sclerosis Patients

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Early Signs of Memory Impairment among Multiple Sclerosis Patients with Clinically Isolated Syndrome

Behavioural Neurology ◽

10.1155/2012/105471 ◽

2012 ◽

Vol 25 (4) ◽

pp. 311-326 ◽

Cited By ~ 14

Author(s):

Theodora Panou ◽

Vasileios Mastorodemos ◽

Efrosyni Papadaki ◽

Panagiotis G. Simos ◽

Andreas Plaitakis

Keyword(s):

Multiple Sclerosis ◽

Verbal Memory ◽

Clinically Isolated Syndrome ◽

Everyday Functioning ◽

Delayed Recall ◽

Relapsing Remitting ◽

Mild Disability ◽

Multiple Sclerosis Patients ◽

In Cis ◽

Speed Accuracy

The study investigates primary and secondary verbal memory and motor/executive functions (response inhibition and strategy shifting ability) in multiple sclerosis (MS) patients with clinically isolated syndrome (CIS). We studied 44 CIS patients and compared them to 49 patients with relapsing remitting MS (RR-MS) displaying mild disability and to a large cohort of age- and education level-matched healthy volunteers (n= 230). Results showed that both CIS and RR-MS patients evidenced a disproportionate impairment in the immediate and delayed recall of the second (as compared to the first) of two short narratives of the Logical Memory WMS-III subtest, and reduced performance on the Memory for Digits-Forward. Performance of either group on the executive tasks was not impaired, showing evidence of a reversed speed-accuracy trade-off. Illness duration emerged as a significant predictor of memory and executive task performance. Clinical, psychoemotional, and brain imaging findings were also examined as potential correlates of memory deficits and disease progression among CIS patients. These findings may signify early-onset decline of specific cognitive functions in CIS, which merits regular follow-up assessments and monitoring of psychoemotional adaptation and everyday functioning.

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Experience in Multiple Sclerosis Patients with COVID-19 and Disease-Modifying Therapies: A Review of 873 Published Cases

Journal of Clinical Medicine ◽

10.3390/jcm9124067 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4067

Author(s):

Nora Möhn ◽

Franz F. Konen ◽

Refik Pul ◽

Christoph Kleinschnitz ◽

Harald Prüss ◽

...

Keyword(s):

Multiple Sclerosis ◽

Non Invasive ◽

Disease Modifying Therapies ◽

Non Invasive Ventilation ◽

Degree Of Disability ◽

Substantial Risk ◽

Disease Modifying ◽

Anti Cd20 ◽

Severe Degree ◽

Multiple Sclerosis Patients

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic is a challenge for all participants in the healthcare system. At the beginning of the pandemic, many physicians asked themselves what risk their patients, especially those with chronic diseases, were exposed to. We present an overview of all patients with multiple sclerosis (MS) and SARS-CoV-2 infection published in the literature so far. In total, there are publications on 873 SARS-CoV-2 positive MS patients and information on the outcome can be given for 700 patients. With regard to the different disease modifying therapies (DMTs), by far the most cases were described under anti-CD20 treatment (n = 317). The mortality rate of all MS patients was 4% and a further 3% required invasive or non-invasive ventilation. When looking at the severe and fatal cases, it is particularly noticeable that patients without DMTs, with previous cardiovascular diseases, or with a severe degree of disability are at risk. Immunosuppressive therapy itself does not appear to be a substantial risk factor. Rather, it is reasonable to assume that the therapies could be protective, either directly, by mitigating the cytokine storm, or indirectly, by reducing the disease activity of MS.

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