Assessment of Depression in Multiple Sclerosis

Signs and symptoms of multiple sclerosis (MS) may overlap with those of depression, a common comorbidity. This study explored whether inclusion of somatic items on the Beck Depression Inventory-II (BDI-II) falsely elevated scores in a clinical sample of 557 adults with MS evaluated by the health psychology service within an MS center. Our sample's BDI-II responses were subjected to exploratory factor analysis, and the results were compared with those reported in the BDI-II manual. Analyses were then conducted to compare patients who identified fatigue as their worst MS symptom with those who did not and to compare those with high and low levels of fatigue and daytime sleepiness in terms of total BDI-II score, percentage contribution of specific somatic items (ie, tiredness or fatigue) to total BDI-II score, and the sum contribution of the somatic-affective factor to the BDI-II score. Respondents who reported fatigue as their worst MS symptom and those who did not had almost identical BDI-II scores. Among patients reporting fatigue as their worst symptom, only the “loss of energy” item was significantly higher, as was the “tiredness or fatigue” item among patients with severe fatigue. Percentage contribution of the somatic-affective factor to the total BDI-II score did not differ significantly by the presence of fatigue as the worst MS symptom or level of daytime sleepiness. In conclusion, somatic items do not necessarily confound depression scores for individuals with MS and should be retained when using the BDI-II to assess depression in this population.

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Cerebrospinal fluid proteome shows disrupted neuronal development in multiple sclerosis

Scientific Reports ◽

10.1038/s41598-021-82388-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ellen F. Mosleth ◽

Christian Alexander Vedeler ◽

Kristian Hovde Liland ◽

Anette McLeod ◽

Gerd Haga Bringeland ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cerebrospinal Fluid ◽

Neural Development ◽

Transforming Growth Factor Beta ◽

Transforming Growth Factor ◽

Early Stage ◽

Retinol Binding Protein ◽

Proteomics Data ◽

Disease Heterogeneity ◽

Low Levels

AbstractDespite intensive research, the aetiology of multiple sclerosis (MS) remains unknown. Cerebrospinal fluid proteomics has the potential to reveal mechanisms of MS pathogenesis, but analyses must account for disease heterogeneity. We previously reported explorative multivariate analysis by hierarchical clustering of proteomics data of MS patients and controls, which resulted in two groups of individuals. Grouping reflected increased levels of intrathecal inflammatory response proteins and decreased levels of proteins involved in neural development in one group relative to the other group. MS patients and controls were present in both groups. Here we reanalysed these data and we also reanalysed data from an independent cohort of patients diagnosed with clinically isolated syndrome (CIS), who have symptoms of MS without evidence of dissemination in space and/or time. Some, but not all, CIS patients had intrathecal inflammation. The analyses reported here identified a common protein signature of MS/CIS that was not linked to elevated intrathecal inflammation. The signature included low levels of complement proteins, semaphorin-7A, reelin, neural cell adhesion molecules, inter-alpha-trypsin inhibitor heavy chain H2, transforming growth factor beta 1, follistatin-related protein 1, malate dehydrogenase 1 cytoplasmic, plasma retinol-binding protein, biotinidase, and transferrin, all known to play roles in neural development. Low levels of these proteins suggest that MS/CIS patients suffer from abnormally low oxidative capacity that results in disrupted neural development from an early stage of the disease.

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Fatigue at enrollment predicts EDSS worsening in the New York State Multiple Sclerosis Consortium

Multiple Sclerosis Journal ◽

10.1177/1352458518816619 ◽

2018 ◽

Vol 26 (1) ◽

pp. 99-108 ◽

Cited By ~ 4

Author(s):

Caila B Vaughn ◽

Katelyn S Kavak ◽

Michael G Dwyer ◽

Aisha Bushra ◽

Muhammad Nadeem ◽

...

Keyword(s):

Multiple Sclerosis ◽

New York ◽

Proportional Hazards ◽

New York State ◽

Cox Proportional Hazards ◽

Common Symptom ◽

York State ◽

Study Enrollment ◽

Severe Fatigue ◽

Patient Reported

Background: Fatigue is one of the most common and distressing symptoms among persons with multiple sclerosis (pwMS). Objective: The aim of this study is to evaluate fatigue as a predictor for disease worsening among pwMS. Methods: In this retrospective cohort study of New York State MS Consortium (NYSMSC) registry, MS patients reporting moderate-to-severe fatigue at study enrollment ( n = 2714) were frequency matched to less-fatigued subjects ( n = 2714) on age, baseline Kurtzke Expanded Disability Status Scale (EDSS), disease duration, and MS phenotype. Change from baseline patient-reported outcomes (PROs), as measured by LIFEware™, categorized participants into two groups: those with stable/improved outcomes and those who worsened. In a subgroup of patients with longitudinal data ( n = 1951), sustained EDSS worsening was analyzed using Cox proportional hazards modeling to explore the effect of fatigue. Results: The median survival time from study enrollment to sustained EDSS worsening was 8.7 years (CI: 7.2–10.1). Participants who reported fatigue at baseline were more likely to experience sustained EDSS worsening during follow-up (HR: 1.4, 95% CI: 1.2–1.7). Patients who were fatigued at baseline were also more likely to report worsening psychosocial limitations (all ps ⩽ 0.01). Conclusion: In addition to being a common symptom of MS, severe fatigue was a significant predictor for EDSS worsening in the NYSMSC.

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Multiple Sclerosis Of The Spinal Cord: Is Gadolinium Irreplaceable In Assessing Lesion Activity?

Acta Medica Marisiensis ◽

10.2478/amma-2013-0037 ◽

2013 ◽

Vol 59 (3) ◽

pp. 158-161

Author(s):

Constantina Andrada Treabă ◽

M Buruian ◽

Rodica Bălașa ◽

Maria Daniela Podeanu ◽

I P Simu ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Magnetic Resonance ◽

Contrast Enhancement ◽

Signs And Symptoms ◽

Magnetic Resonance Images ◽

Type I ◽

Focal Lesions ◽

Spinal Cord Lesions ◽

Active Lesion

Abstract Purpose: To evaluate the relationship between the T2 patterns of spinal cord multiple sclerosis lesions and their contrast uptake. Material and method: We retrospectively reviewed the appearance of spinal cord lesions in 29 patients (with relapsing-remitting multiple sclerosis) who had signs and symptoms of myelopathy on neurologic examination and at least one active lesion visualized on magnetic resonance examinations performed between 2004 and 2011. We correlated the T2 patterns of lesions with contrast enhancement and calculated sensitivity and specificity in predicting gadolinium enhancement. Results: Only focal patterns consisting of a lesion’s center homogenously brighter than its periphery on T2-weighed images (type I) correlated significantly with the presence of contrast enhancement (p = 0.004). Sensitivity was 0.307 and specificity 0.929. In contrast, enhancement was not significantly related to uniformly hyperintense T2 focal lesions (type II) or diffuse (type III) pattern defined as poorly delineated areas of multiple small, confluent, subtle hyperintense T2 lesions (p > 0.5 for both). Conclusions: We believe that information about the activity of multiple sclerosis spinal cord lesions in patients with myelopathy may be extracted not only from contrast enhanced, but also from non-enhanced magnetic resonance images.

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Does aerobic training alleviate fatigue and improve societal participation in patients with multiple sclerosis? A randomized controlled trial

Multiple Sclerosis Journal ◽

10.1177/1352458517696596 ◽

2017 ◽

Vol 23 (11) ◽

pp. 1517-1526 ◽

Cited By ~ 20

Author(s):

Martin Heine ◽

Olaf Verschuren ◽

Erwin LJ Hoogervorst ◽

Erik van Munster ◽

Hub GA Hacking ◽

...

Keyword(s):

Multiple Sclerosis ◽

Aerobic Training ◽

Controlled Trial ◽

Post Intervention ◽

Intensity Control ◽

Control Intervention ◽

Severe Fatigue ◽

Disability Status ◽

Checklist Individual Strength ◽

Societal Participation

Background: Evidence supporting the effectiveness of aerobic training, specific for fatigue, in severely fatigued patients with multiple sclerosis (MS) is lacking. Objective: To estimate the effectiveness of aerobic training on MS-related fatigue and societal participation in ambulant patients with severe MS-related fatigue. Methods: Patients ( N = 90) with severe MS-related fatigue were allocated to 16-week aerobic training or control intervention. Primary outcomes were perceived fatigue (Checklist Individual Strength (CIS20r) fatigue subscale) and societal participation. An improvement of ⩾8 points on the CIS20r fatigue subscale was considered clinically relevant. Outcomes were assessed by a blinded observer at baseline, 2, 4, 6 and 12 months. Results: Of the 89 patients that started treatment (median Expanded Disability Status Scale (interquartile range), 3.0 (2.0–3.6); mean CIS20r fatigue subscale (standard deviation (SD)), 42.6 (8.0)), 43 received aerobic training and 46 received the control intervention. A significant post-intervention between-group mean difference (MD) on the CIS20r fatigue subscale of 4.708 (95% confidence interval (CI) = 1.003–8.412; p = 0.014) points was found in favour of aerobic training that, however, was not sustained during follow-up. No effect was found on societal participation. Conclusion: Aerobic training in MS patients with severe fatigue does not lead to a clinically meaningful reduction in fatigue or societal participation when compared to a low-intensity control intervention.

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Delivering an NHS Health Psychology service for patients with eye cancer

10.4324/9781003120469-4 ◽

2021 ◽

pp. 42-59

Author(s):

Laura Hope-Stone

Keyword(s):

Health Psychology ◽

Psychology Service

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Ion Currents and Axonal Oscillators: A Possible Biophysical Basis for Positive Signs and Symptoms in Multiple Sclerosis

Multiple Sclerosis As A Neuronal Disease ◽

10.1016/b978-012738761-1/50010-9 ◽

2005 ◽

pp. 131-143 ◽

Cited By ~ 1

Author(s):

Mark D. Baker

Keyword(s):

Multiple Sclerosis ◽

Signs And Symptoms ◽

Ion Currents

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Assessment and Treatment of Sexual Dysfunction in Multiple Sclerosis

10.1093/med/9780199341016.003.0016 ◽

2016 ◽

Author(s):

Frederick W. Foley

Keyword(s):

Multiple Sclerosis ◽

Sexual Dysfunction ◽

Patient Population ◽

Behavioral Interventions ◽

Treatment Strategies ◽

Signs And Symptoms ◽

Assessment And Treatment ◽

Pharmacologic Agents

This chapter discusses the signs and symptoms of sexual dysfunction that are common in persons with multiple sclerosis. The epidemiology of sexual dysfunction in this patient population is presented, along with techniques and instruments for screening for sexual dysfunction. Definitions of primary, secondary, and tertiary sexual dysfunction are reviewed, and a detailed discussion of treatment strategies is presented, including pharmacologic agents, devices, and behavioral interventions.

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Sleep in chronic renal insufficiency

10.1093/med/9780199682003.003.0043 ◽

2017 ◽

Author(s):

Giorgos K. Sakkas ◽

Christoforos D. Giannaki

Keyword(s):

Sleep Disorders ◽

Daytime Sleepiness ◽

Burden Of Illness ◽

Public Health Problem ◽

Premature Mortality ◽

Signs And Symptoms ◽

Poor Sleep ◽

Disturbed Sleep ◽

Nocturnal Hemodialysis

Chronic kidney disease is a significant and growing medical and public health problem, responsible for a substantial burden of illness and premature mortality. Renal disease has a dramatic impact on patients’ quality of life (QoL), with sleep disorders contributing significantly and 80% of the renal population reporting symptoms of disturbed sleep, including insomnia, sleep apnea, restless legs syndrome, daytime sleepiness, and fatigue. Many patients with sleep disorders remain underdiagnosed, since many of the signs and symptoms related to poor sleep are thought to be an unavoidable consequence of renal failure or inadequate dialysis. Effective management of sleep disorders could improve patients’ QoL and mortality. A growing body of evidence suggests significant advantages of nocturnal hemodialysis for control of uremia and therefore for improving sleep quality and daytime sleepiness.

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