Self-directed exercise in multiple sclerosis: Evaluation of a home automated tele-management system

2017 ◽  
Vol 24 (6) ◽  
pp. 410-419 ◽  
Author(s):  
Susan S Conroy ◽  
Min Zhan ◽  
William J Culpepper ◽  
Walter Royal ◽  
Mitchell T Wallin
Keyword(s):  
Multiple Sclerosis ◽  
Management System ◽  
Exercise Adherence ◽  
Progressive Multiple Sclerosis ◽  
Walking Ability ◽  
Control Groups ◽  
Home Based ◽  
Significant Difference ◽  
Multiple Sclerosis Patients ◽  
Minute Walk

Introduction Physical rehabilitation is one of the few non-pharmaceutical therapies for maintaining or improving walking ability for patients with multiple sclerosis. However, travel distance to rehabilitation clinics, neurological disability and insurance coverage often limit access to specialised rehabilitation services. To address these issues, we utilised a web-based system to support a home-based self-directed exercise programme. Methods Patients ( n = 24) were randomised to either routine home rehabilitation or to the multiple sclerosis home automated tele-management system for a six-month period. The study group had a mean age of 50.4 years, 56% of patients were male, and 67% had progressive multiple sclerosis with an overall mean Patient Determined Disease Steps score of 4.4 (cane or crutch required for walking). Key outcomes included the timed 25-foot-walk, six-minute-walk and the Berg Balance Scale. Results There was no statistically significant difference in the change of the primary walking outcome measure, timed 25-foot-walk, at six months between the home automated tele-management intervention and control groups ( p = 0.44). Similarly, change scores for the six-minute-walk were not significantly different between the home automated tele-management or control groups at six months. Discussion Maintaining overall gait abilities in this group of predominantly progressive multiple sclerosis patients is notable. Exercise adherence was positively associated with higher multiple sclerosis disability and self-reported walking ability. Study engagement and participation in routine home-based exercise for the entire study period was challenging. Further research using clinical video telerehabilitation techniques that optimise patient involvement warrants further study.

scholarly journals The Effect of Cannabis on the Clinical and Cytokine Profiles in Patients with Multiple Sclerosis

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Wessam Mustafa ◽  
Nadia Elgendy ◽  
Samer Salama ◽  
Mohamed Jawad ◽  
Khaled Eltoukhy
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Symptoms ◽  
Positive Impact ◽  
Control Groups ◽  
Serum Cytokines ◽  
Tnf Α ◽  
Significant Difference ◽  
Bladder Symptoms ◽  
Multiple Sclerosis Patients ◽  
And Control

Background. Multiple studies have reported that cannabis administration in multiple sclerosis patients is associated with decreased symptom severity. This study was conducted to evaluate the prevalence of cannabis abuse in multiple sclerosis cases and to evaluate the effect of cannabis on serum cytokines in such cases. Patients and Methods. A total of 150 multiple sclerosis cases along with 150 healthy controls were included during the study period. All cases were subjected to history taking, neurological examination, and routine investigations. Cases were asked about cannabis intake which was confirmed by a urine test. Serum cytokines including IL-1, IL-2, IL-4, IL-10, IL-12, IL-17, IL-22, IFN-γ, IFN-β1, and TNF-α were ordered for all cases and controls. Results. Twenty-eight cases were cannabis abusers (MS/cannabis group, 18.67%). The remaining 122 cases represented the MS group. There was no significant difference between the three groups regarding age, disease duration, or MS type. Male gender was more predominant in the MS/cannabis group, and the number of relapses was significantly lower in the same group. Fifteen cases (53.6%) reported that their symptoms were improved by cannabis. Proinflammatory cytokines were significantly elevated in the MS group compared to the MS/cannabis and control groups. Additionally, anti-inflammatory cytokines had significantly lower values in the MS group compared to the MS/cannabis and control groups. Most clinical symptoms were significantly improved in the MS/cannabis group compared to the MS group apart from sexual dysfunction, bladder symptoms, and visual disturbances. Mild side effects of cannabis were also reported. Conclusion. Cannabis may have a positive impact on the cytokine and clinical profiles in cases with multiple sclerosis.

Aberrant expression of β-catenin in CD4+ T cells isolated from primary progressive multiple sclerosis patients

2017 ◽  
Vol 653 ◽  
pp. 159-162 ◽  
Author(s):  
Sabrina Giacoppo ◽  
Oxana Bereshchenko ◽  
Stefano Bruscoli ◽  
Carlo Riccardi ◽  
Placido Bramanti ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
T Cells ◽  
Cd4 T Cells ◽  
Progressive Multiple Sclerosis ◽  
Primary Progressive Multiple Sclerosis ◽  
Aberrant Expression ◽  
Primary Progressive ◽  
Multiple Sclerosis Patients

Agreement analysis comparing iPad LCVA and Sloan testing in multiple sclerosis patients

2017 ◽  
Vol 24 (8) ◽  
pp. 1126-1130 ◽  
Author(s):  
Neda Sattarnezhad ◽  
Samantha Farrow ◽  
Dorlan Kimbrough ◽  
Bonnie Glanz ◽  
Brian Healy ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Visual Acuity ◽  
T Test ◽  
Computerized Testing ◽  
Low Contrast ◽  
Significant Difference ◽  
Increased Sensitivity ◽  
The Right ◽  
Multiple Sclerosis Patients ◽  
Paired T Test

Background: Visual symptoms are common in multiple sclerosis (MS). Low-contrast visual acuity (LCVA) testing using Sloan charts has demonstrated increased sensitivity for visual deficits compared to high-contrast acuity testing. Computerized testing of visual acuity may facilitate use in the clinic setting. Objectives: To evaluate the agreement between an iPad-based and Sloan testing of LCVA in a cohort of MS patients. Methods: A total of 38 patients with relapsing-remitting MS were enrolled after providing informed written consent at Partners MS Center, Brigham and Women’s hospital. Monocular LCVA was measured using retroilluminated Sloan chart and iPad-based LogMAR chart. Number of correct letters and agreement between two measurements were assessed for each eye using Bland–Altman analysis and paired t-test. Results: For both eyes, there was no significant difference in number correct between the two measurements using a paired t-test, and there was high correlation between two measurements (oculus dextrus (OD) r = 0.89, p < 0.001; oculus sinister (OS) r = 0.78, p < 0.001). The limits of agreement were −7.9 to +8.5 letters for the right eye and −10.9 to +11.2 letters for the left eye. Conclusion: An iPad-based LCVA test shows good agreement with Sloan testing in MS patients.

scholarly journals Monitoring cognitive change in multiple sclerosis using a computerized cognitive battery

2018 ◽  
Vol 4 (4) ◽  
pp. 205521731881551 ◽  
Author(s):  
L De Meijer ◽  
D Merlo ◽  
O Skibina ◽  
EJ Grobbee ◽  
J Gale ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Change ◽  
Progressive Multiple Sclerosis ◽  
Healthy Controls ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Serial Addition ◽  
Multiple Sclerosis Patients ◽  
Relapsing Remitting Multiple Sclerosis ◽  
Cognitive Monitoring

Background Cognitive monitoring that can detect short-term change in multiple sclerosis is challenging. Computerized cognitive batteries such as the CogState Brief Battery can rapidly assess commonly affected cognitive domains. Objectives The purpose of this study was to establish the acceptability and sensitivity of the CogState Brief Battery in multiple sclerosis patients compared to controls. We compared the sensitivity of the CogState Brief Battery to that of the Paced Auditory Serial Addition Test over 12 months. Methods Demographics, Expanded Disability Status Scale scores, depression and anxiety scores were compared with CogState Brief Battery and Paced Auditory Serial Addition Test performances of 51 patients with relapsing–remitting multiple sclerosis, 19 with secondary progressive multiple sclerosis and 40 healthy controls. Longitudinal data in 37 relapsing–remitting multiple sclerosis patients were evaluated using linear mixed models. Results Both the CogState Brief Battery and the Paced Auditory Serial Addition Test discriminated between multiple sclerosis and healthy controls at baseline ( p<0.001). CogState Brief Battery tasks were more acceptable and caused less anxiety than the Paced Auditory Serial Addition Test ( p<0.001). In relapsing–remitting multiple sclerosis patients, reaction time slowed over 12 months ( p<0.001) for the CogState Brief Battery Detection (mean change –34.23 ms) and Identification (–25.31 ms) tasks. Paced Auditory Serial Addition Test scores did not change over this time. Conclusions The CogState Brief Battery is highly acceptable and better able to detect cognitive change than the Paced Auditory Serial Addition Test. The CogState Brief Battery could potentially be used as a practical cognitive monitoring tool in the multiple sclerosis clinic setting.

scholarly journals Clinical and neurophysiological findings in oligoclonal band negative multiple sclerosis patients

2003 ◽  
Vol 131 (3-4) ◽  
pp. 122-126 ◽  
Author(s):  
Sarlota Mesaros ◽  
Jelena Drulovic ◽  
Zvonimir Levic
Keyword(s):  
Multiple Sclerosis ◽  
Statistical Significance ◽  
Progression Rate ◽  
Positive Group ◽  
Clinical Difference ◽  
Initial Symptoms ◽  
Significant Difference ◽  
Intrathecal Igg Synthesis ◽  
Edss Score ◽  
Multiple Sclerosis Patients

Besides magnetic resonance imaging, the presence of locally produced oligoclonal IgG bands (OCB) in the cerebrospinal fluid (CSF) is the most consistent laboratory abnormality in patients with multiple sclerosis (MS). The most sensitive method for the detection of CSF OCB is isoelectric focusing (IEF) [6]. Occasional patients with clinically definite MS lack evidence for intrathecal IgG synthesis [7, 8]. This study was designed to compare clinical data and evoked potential (EP) findings between CSF OCB positive and OCB negative MS patients. The study comprised 22 OCB negative patients with clinically definite MS [11] and 22 OCB positive controls matched for age, disease duration, activity and course of MS. In both groups clinical assessment was performed by using Expanded Disability Status Scale (EDSS) score [12] and progression rate (PR). All patients underwent multimodal EP: visual (VEPs), brainstem auditory (BAEPs) and median somatosensory (mSEPs). The VEPa were considered abnormal if the P100 latency exceeded 117 ms or inter-ocular difference greater than 8 ms was detected. The BAEPs were considered abnormal if waves III or V were absent or the interpeak latencies I-III, III-V, or I-V were increased. The mSEPs were considerd abnormal when N9, N13 and N20 potentials were absent or when increased interpeak latencies were recorded. The severity of the neurophysiological abnormalities was scored for each modality as follows normal EP score 0; every other EP abnormality except the absence of one of the main waves, score 1; absence of one or more of the main waves, score 2 [13]. Both mean EDSS score (4.0 vs. 3.5) and PR (0.6 vs. 0.5) were similar in OCB positive and OCB negative group, (p>0.05). In the first group males were predominant, but without statistical significance (Table 1). Disease started more often with the brainstem symptoms in the OCB positive than in OCB negative MS group (p=0.028), while there was no differences in other initial symptoms between the groups (Graph 2). The frequency of (multimodal) EP abnormalities was higher in the OCB positive group but the differences were not statistically significant, except for bilateral SEP abnormalities (p=0.012). The severity of the AEPs abnormalities was similar in both groups while for the VEPs and SEPs abnormalities were more pronounced in the OCB positive group but not significantly (Table 2). The male preponderance of OCB negative MS patients in our study is in accordance with previous studies [14, 15]. This finding could be potentially ascribed to the well known gender-related differences in both humoral and cellular immune responses [17]. We found no statistically significant differences in either disability or PR between the two patient groups, although OCB negative MS patients had lower EDSS score and PR than OCB positive cases. In accordance with these findings, Fukazawa et al. also failed to show differences in disability between OCB negative and positive MS patients. On the other hand, few studies reported that OCB negative MS patients have a better prognosis [16 18]. The only clinical difference between two groups of patients that we found was that the disease more often started with brainstem symptoms in OCB positive MS patients (p=0.028). OCB positive MS patients had more often bilateral SEPs abnormalities (p=0.012). There was no statistically significant differences between two groups of patients in the severity of trimodal EPs abnormalities and the frequency of BAEPs and VEPs abnormalities although OCB negative patients had trend towards less pronounced EP disturbancies. In conclusion, our results did not reveal significant difference in clinical and neurophysiological(y) parameters between two groups of patients. However, they indicate a trend towards better prognosis of the disease in OCB negative MS patients.

scholarly journals Onset of secondary progressive multiple sclerosis is not influenced by current relapsing multiple sclerosis therapies

2018 ◽  
Vol 4 (2) ◽  
pp. 205521731878334 ◽  
Author(s):  
Francisco Coret ◽  
Francisco C Pérez-Miralles ◽  
Francisco Gascón ◽  
Carmen Alcalá ◽  
Arantxa Navarré ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive Multiple Sclerosis ◽  
Secondary Progressive ◽  
Disease Modifying Therapies ◽  
Relapsing Remitting ◽  
Disease Modifying ◽  
Remitting Multiple Sclerosis ◽  
Multiple Sclerosis Patients ◽  
Relapsing Remitting Multiple Sclerosis

Background Disease-modifying therapies are thought to reduce the conversion rate to secondary progressive multiple sclerosis. Objective To explore the rate, chronology, and contributing factors of conversion to the progressive phase in treated relapsing–remitting multiple sclerosis patients. Methods Our study included 204 patients treated for relapsing–remitting multiple sclerosis between 1995 and 2002, prospectively followed to date. Kaplan–Meier analysis was applied to estimate the time until secondary progressive multiple sclerosis conversion, and multivariate survival analysis with a Cox regression model was used to analyse prognostic factors. Results Relapsing–remitting multiple sclerosis patients were continuously treated for 13 years (SD 4.5); 36.3% converted to secondary progressive multiple sclerosis at a mean age of 42.6 years (SD 10.6), a mean time of 8.2 years (SD 5.2) and an estimated mean time of 17.2 years (range 17.1–18.1). A multifocal relapse, age older than 34 years at disease onset and treatment failure independently predicted conversion to secondary progressive multiple sclerosis but did not influence the time to reach an Expanded Disability Status Scale of 6.0. Conclusions The favourable influence of disease-modifying therapies on long-term disability in relapsing–remitting multiple sclerosis is well established. However, the time to progression onset and the subsequent clinical course in treated patients seem similar to those previously reported in natural history studies. More studies are needed to clarify the effect of disease-modifying therapies once the progressive phase has been reached.

Practice Effects in Mobile Tests of Cognition, Dexterity & Mobility in Multiple Sclerosis Patients: Data Analysis of a Smartphone–Based Observational Study (Preprint)

2021 ◽  
Author(s):  
Tim Woelfle ◽  
Silvan Pless ◽  
Andrea Wiencierz ◽  
Ludwig Kappos ◽  
Yvonne Naegelin ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Neurological Diseases ◽  
Clinical Manifestations ◽  
Practice Effect ◽  
Practice Effects ◽  
Linear Phase ◽  
Multiple Sclerosis Patients ◽  
Personalized Health ◽  
Changes Over Time ◽  
Minute Walk

BACKGROUND Smartphones and their inbuilt sensors allow for the collection of a wealth of data about their owners. While passively collected data such as step counts can already provide meaningful insights, active tests allow for measuring function in more specific tasks. This could improve disease characterization and monitoring and could potentially support treatment decisions in multiple sclerosis (MS), a multifaceted chronic neurological disease with highly variable clinical manifestations. One challenge that has to be overcome in the assessment of changes over time is the analysis and interpretation of practice effects. OBJECTIVE In this study, we aimed to identify practice effects in active tests for cognition, dexterity, and mobility in user–scheduled, high–frequency, smartphone–based testing. METHODS We analyzed data from 251 self–declared persons with MS with a minimum of 5 weeks of follow–up and at least 5 tests per domain in the Floodlight Open study, a self–enrolment study accessible by smartphone owners from 16 countries. The collected data are openly available for scientists. Using bounded growth mixed models and quantile regression, we characterized practice effects for three different tests: Symbol Digit Modalities Test (SDMT) for cognition, Finger Pinching for dexterity, and Two Minute Walk for mobility. RESULTS Strong practice effects were found for N=4388 SDMT and N=17945 Finger Pinching tests with modelled boundary improvements of 39.6% (38.6%–40.9%) and 85.9% (83.2%–88.9%) over baseline, respectively. Half of the practice effect was reached after 9 repetitions for SDMT and 27 repetitions for Finger Pinching, 90% were reached after 31 and 89 repetitions, respectively. While baseline performance levels were highly variable across participants, no significant differences between the practice effects in low–performers (5th and 25th percentile), median performers and high performers (75th and 95th percentile) were found for SDMT (β = 1.0–1.2 additional correct responses per repetition in the linear phase). Only small differences were observed for Finger Pinching (β = 0.3–0.7 additional successful pinches per repetition in the linear phase). For N=12997 Two Minute Walk tests, no practice effects were observed at all. CONCLUSIONS Smartphone–based tests promise to help monitor disease trajectories of MS and other chronic neurological diseases. Our findings suggest that strong practice effects in cognitive and dexterity functions have to be accounted for in order to identify disease–related changes in these domains, especially in the context of personalized health and in studies with no comparator arm. In contrast, changes in mobility may be more easily interpreted due to the absence of practice effects.

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