scholarly journals Association of Postural Sway with Disability Status and Cerebellar Dysfunction in People with Multiple Sclerosis

2015 ◽  
Vol 17 (3) ◽  
pp. 146-151 ◽  
Author(s):  
James McLoughlin ◽  
Christopher Barr ◽  
Maria Crotty ◽  
Stephen R. Lord ◽  
Daina L. Sturnieks
Keyword(s):  
Multiple Sclerosis ◽  
Postural Sway ◽  
Balance Control ◽  
Knee Extension ◽  
Ankle Dorsiflexion ◽  
Sensory Function ◽  
Sensory Loss ◽  
Cerebellar Dysfunction ◽  
Exercise Interventions ◽  
Disability Status

Background: The aims of this study were 1) to examine postural sway in the eyes open (EO) and eyes closed (EC) conditions in people with multiple sclerosis (MS) with moderate levels of disability compared with controls and 2) to examine relationships between postural sway and total Expanded Disability Status Scale (EDSS) scores, functional system subscores, and clinical measures of strength and spasticity in the MS group. Methods: Thirty-four people with moderate MS and ten matched controls completed measures of postural sway with EO and EC, knee extension and ankle dorsiflexion isometric strength, EDSS total score and subscores, and spasticity levels. Results: Participants with MS swayed significantly more with EO and EC and had reduced knee extension and ankle dorsiflexion strength compared with controls (P < .001). In the MS group, increased sway was associated with higher total EDSS scores and cerebellar function subscores, whereas increased sway ratio (EC/EO) was associated with reduced sensory function subscores. Postural sway was not significantly associated with strength or spasticity. Conclusions: Participants with MS swayed more and were significantly weaker than controls. Cerebellar dysfunction was identified as the EDSS domain most strongly associated with increased sway, and sensory loss was associated with a relatively greater dependence on vision for balance control. These findings suggest that exercise interventions targeting sensory integration and cerebellar ataxia may be beneficial for enhancing balance control in people with MS.

scholarly journals The impact of physical functions on depressive symptoms in people with multiple sclerosis

2021 ◽  
Vol 79 (1) ◽  
pp. 44-50
Author(s):  
Carlos Bernardo TAUIL ◽  
Cintia RAMARI ◽  
Flávia Martins DA SILVA ◽  
Erica BRASIL ◽  
Ana de DAVID ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Depressive Symptoms ◽  
Perceived Exertion ◽  
Balance Control ◽  
Depression Scale ◽  
Objective Measures ◽  
Timed Up And Go ◽  
Exercise Interventions ◽  
Physical Functions ◽  
The Impact

ABSTRACT Background: Multiple sclerosis (MS) is an immune-mediated disease that affects the central nervous system. The impact of MS transcends physical functions and extends to psychological impairment. Approximately 50% of people with MS develop depressive symptoms during their lifetime and depressive symptoms may predict impairment of physical functions. However, prediction of depressive symptoms based on objective measures of physical functions is still necessary. Objective: To compare physical functions between people with MS presenting depressive symptoms or not and to identify predictors of depressive symptoms using objective measures of physical functions. Methods: Cross-sectional study including 26 people with MS. Anxiety and/or depressive symptoms were assessed by the Beck Depression Inventory-II (BDI-II) and by the Hospital Anxiety and Depression Scale (HADS). Outcomes of physical functions included: the Nnnine-hole Ppeg Ttest (NHPT), knee muscle strength, balance control, the Timed Up and Go Test (TUG), and the 6-minute walk test (6MWT). Perceived exertion was measured using the Borg scale. Results: The frequency of depressive symptoms was 42% in people with MS. Balance control during a more challenging task was impaired in people with MS who presented depressive symptoms. Balance could explain 21-24% of the variance in depressive symptoms. 6MWT and TUG presented a trend of significance explaining 16% of the variance in the BDI-II score. Conclusions: Impairment in physical functions consists in a potential predictor of depressive symptoms in people with MS. Exercise interventions aiming at the improvement of physical functions, together with the treatment of depressive symptoms and conventional medical treatment, are suggested.

A systematic review of the effects of modifiable risk factor interventions on the progression of multiple sclerosis

2017 ◽  
Vol 23 (4) ◽  
pp. 513-524 ◽  
Author(s):  
Susanne Hempel ◽  
Glenn D Graham ◽  
Ning Fu ◽  
Elena Estrada ◽  
Annie Y Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Vitamin D ◽  
Risk Factor ◽  
Vitamin D Supplementation ◽  
Dietary Interventions ◽  
Exercise Interventions ◽  
Disability Status ◽  
Mean Differences

Background: Several risk factors are associated with multiple sclerosis (MS) progression and may be amenable to intervention. Objective: To systematically review the evidence for interventions targeting risk factors for MS progression. Methods: We searched six databases and existing reviews till March 2015 and consulted with experts to identify randomized controlled trials (RCTs) of interventions targeting MS risk factors (PROSPERO 2015:CRD42015016461). Results: In total, 37 RCTs met inclusion criteria. Expanded Disability Status Scale (EDSS) scores after exercise interventions did not differ compared with untreated controls (standardized mean differences (SMDs): 0.02; confidence interval (CI): −0.40, 0.44; I2: 0%; seven RCTs; very low quality of evidence (QoE)). Dietary interventions did not show a statistically significant effect on the relative risk (RR) of progression (RR: 0.86; CI: 0.67, 1.05; I2: 0%; four RCTs; moderate QoE) compared to placebo. EDSS scores after vitamin D supplementation were not significantly different from placebo (SMD: −0.15; CI: −0.33, 0.02; I2: 0%; five RCTs; very low QoE). Conclusion: We did not identify any risk factor interventions with significant effects on MS progression, but the overall QoE was limited. More adequately powered trials are needed on vitamin D supplementation, long-term exercise, and smoking cessation.

scholarly journals Relationship between Expanded Disability Status Scale scores and the presence of temporomandibular disorders in patients with multiple sclerosis

2018 ◽  
Vol 12 (01) ◽  
pp. 144-148 ◽  
Author(s):  
Lucas Senra Correa Carvalho ◽  
Osvaldo José Moreira Nascimento ◽  
Luciane Lacerda Franco Rocha Rodrigues ◽  
Andre Palma Da Cunha Matta
Keyword(s):  
Multiple Sclerosis ◽  
Temporomandibular Disorders ◽  
Control Group ◽  
Expanded Disability Status Scale ◽  
Exact Test ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Scale Scores ◽  
Axis I ◽  
Relapsing Remitting Multiple Sclerosis

ABSTRACTObjectives: The objectives of this study were to assess the prevalence of temporomandibular disorders (TMDs) in patients with relapsing-remitting multiple sclerosis (MS) and to investigate whether an association exists between the presence of TMD symptoms and the degree of MS-related disability. Materials and Methods: In all, 120 individuals were evaluated: 60 patients with a diagnosis of relapsing-remitting MS and 60 age- and sex-matched controls without neurological impairments. A questionnaire recommended by the European Academy of Craniomandibular Disorders for the assessment of TMD symptoms was administered. For those who answered affirmatively to at least one of the questions, the RDC/TMD Axis I instrument was used for a possible classification of TMD subtypes. The Expanded Disability Status Scale (EDSS) was the measure of the degree of MS-related disability. Statistical Analysis Used: Fisher’s exact test was used to analyze the data. ANOVA was used to detect significant differences between means and to assess whether the factors influenced any of the dependent variables by comparing means from the different groups. Results: The prevalence of TMD symptoms in patients with MS was 61.7% versus 18.3% in the control group (CG). A diagnosis of TMD was established for 36.7% in the MS group and 3.3% in the CG (P = 0.0001). There were statistically significant differences between degrees of MS-related disability and the prevalence of TMD (P = 0.0288). Conclusions: The prevalence of both TMD and TMD symptoms was significantly greater in the MS group. EDSS scores and TMD prevalence rates were inversely related.

scholarly journals Determinants of therapeutic lag in multiple sclerosis

2021 ◽  
pp. 135245852098130
Author(s):  
Izanne Roos ◽  
Emmanuelle Leray ◽  
Federico Frascoli ◽  
Romain Casey ◽  
J William L Brown ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Expanded Disability Status Scale ◽  
Disability Progression ◽  
Delayed Onset ◽  
Disease Characteristics ◽  
Disability Status ◽  
Male Sex ◽  
Pre Treatment ◽  
Patient Subgroups

Background: A delayed onset of treatment effect, termed therapeutic lag, may influence the assessment of treatment response in some patient subgroups. Objectives: The objective of this study is to explore the associations of patient and disease characteristics with therapeutic lag on relapses and disability accumulation. Methods: Data from MSBase, a multinational multiple sclerosis (MS) registry, and OFSEP, the French MS registry, were used. Patients diagnosed with MS, minimum 1 year of exposure to MS treatment and 3 years of pre-treatment follow-up, were included in the analysis. Studied outcomes were incidence of relapses and disability accumulation. Therapeutic lag was calculated using an objective, validated method in subgroups stratified by patient and disease characteristics. Therapeutic lag under specific circumstances was then estimated in subgroups defined by combinations of clinical and demographic determinants. Results: High baseline disability scores, annualised relapse rate (ARR) ⩾ 1 and male sex were associated with longer therapeutic lag on disability progression in sufficiently populated groups: females with expanded disability status scale (EDSS) < 6 and ARR < 1 had mean lag of 26.6 weeks (95% CI = 18.2–34.9), males with EDSS < 6 and ARR < 1 31.0 weeks (95% CI = 25.3–36.8), females with EDSS < 6 and ARR ⩾ 1 44.8 weeks (95% CI = 24.5–65.1), and females with EDSS ⩾ 6 and ARR < 1 54.3 weeks (95% CI = 47.2–61.5). Conclusions: Pre-treatment EDSS and ARR are the most important determinants of therapeutic lag.

scholarly journals A Pilot Study of 24-h Motor Activity Patterns in Multiple Sclerosis: Pre-Planned Follow-Up at 2 Years

2021 ◽  
Vol 3 (3) ◽  
pp. 366-376
Author(s):  
Lorenzo Tonetti ◽  
Federico Camilli ◽  
Sara Giovagnoli ◽  
Vincenzo Natale ◽  
Alessandra Lugaresi
Keyword(s):  
Multiple Sclerosis ◽  
Motor Activity ◽  
Activity Pattern ◽  
Activity Patterns ◽  
Expanded Disability Status Scale ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Edss Score ◽  
Activity Prognosis

Early multiple sclerosis (MS) predictive markers of disease activity/prognosis have been proposed but are not universally accepted. Aim of this pilot prospective study is to verify whether a peculiar hyperactivity, observed at baseline (T0) in early relapsing-remitting (RR) MS patients, could represent a further prognostic marker. Here we report results collected at T0 and at a 24-month follow-up (T1). Eighteen RRMS patients (11 females, median Expanded Disability Status Scale-EDSS score 1.25, range EDSS score 0–2) were monitored at T0 (mean age 32.33 ± 7.51) and T1 (median EDSS score 1.5, range EDSS score 0–2.5). Patients were grouped into two groups: responders (R, 14 patients) and non-responders (NR, 4 patients) to treatment at T1. Each patient wore an actigraph for one week to record the 24-h motor activity pattern. At T0, NR presented significantly lower motor activity than R between around 9:00 and 13:00. At T1, NR were characterized by significantly lower motor activity than R between around 12:00 and 17:00. Overall, these data suggest that through the 24-h motor activity pattern, we can fairly segregate at T0 patients who will show a therapeutic failure, possibly related to a more active disease, at T1. These patients are characterized by a reduced morning level of motor activation. Further studies on larger populations are needed to confirm these preliminary findings.

Test–Retest Reliability of the Mini-BESTest in People With Mild to Moderate Multiple Sclerosis

2021 ◽  
Author(s):  
A Wallin ◽  
M Kierkegaard ◽  
E Franzén ◽  
S Johansson
Keyword(s):  
Multiple Sclerosis ◽  
Measurement Errors ◽  
Balance Control ◽  
Intraclass Correlation ◽  
Repeated Measurements ◽  
Minimal Detectable Change ◽  
Detectable Change ◽  
Limits Of Agreement ◽  
Retest Reliability ◽  
Test Retest Reliability

Abstract Objective The mini-BESTest is a balance measure for assessment of the underlying physiological systems for balance control in adults. Evaluations of test–retest reliability of the mini-BESTest in larger samples of people with multiple sclerosis (MS) are lacking. The purpose of this study was to investigate test–retest reliability of the mini-BESTest total and section sum scores and individual items in people with mild to moderate overall MS disability. Methods This study used a test–retest design in a movement laboratory setting. Fifty-four people with mild to moderate overall MS disability according to the Expanded Disability Status scale (EDSS) were included, with 28 in the mild subgroup (EDSS 2.0–3.5) and 26 in the moderate subgroup (EDSS 4.0–5.5). Test–retest reliability of the mini-BESTest was evaluated by repeated measurements taken 1 week apart. Reliability and measurement error were analyzed. Results Test–retest reliability for the total scores were considered good to excellent, with intraclass correlation coefficients of .88 for the whole sample, .83 for the mild MS subgroup, and .80 for the moderate MS subgroup. Measurement errors were small, with standard error of measurement and minimal detectable change of 1.3 and 3.5, respectively, in mild MS, and 1.7 and 4.7, respectively, in moderate MS. The limits of agreement were − 3.4 and 4.6. Test–retest reliability for the section scores were fair to good or excellent; weighted kappa values ranged from .62 to .83. All items but 1 showed fair to good or excellent test–retest reliability, and percentage agreement ranged from 61% to 100%. Conclusions The mini-BESTest demonstrated good to excellent test–retest reliability and small measurement errors and is recommended for use in people with mild to moderate MS. Impact Knowledge of limits of agreement and minimal detectable change contribute to interpretability of the mini-BESTest total score. The findings of this study enhance the clinical usefulness of the test for evaluation of balance control and for designing individually customized balance training with high precision and accuracy in people with MS.

scholarly journals Efficacy and Safety of Teriflunomide in Multiple Sclerosis across Age Groups: Analysis from Pooled Pivotal and Real-world Studies

2021 ◽  
Vol 13 ◽  
pp. 117957352110287
Author(s):  
Jiwon Oh ◽  
Sandra Vukusic ◽  
Klaus Tiel-Wilck ◽  
Jihad Said Inshasi ◽  
David Rog ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Real World ◽  
Age Groups ◽  
Phase Iii ◽  
Efficacy And Safety ◽  
Additional Group ◽  
Disability Status ◽  
Scale Scores ◽  
Post Hoc ◽  
Phase Ii And Iii

Background: Evidence suggests that efficacy and safety of disease-modifying treatments for multiple sclerosis may differ with age. We evaluate efficacy and safety of teriflunomide across age subgroups of patients from pooled clinical trials and real-world studies. Methods: Post hoc analyses of patients who received teriflunomide 14 mg in the pooled phase II and III TEMSO, TOWER, TENERE, and TOPIC core and extension studies (n = 1978), and the real-world Teri-PRO (n = 928) and TAURUS-MS I (n = 1126) studies were conducted. Data were stratified by age at study entry: ⩽25, >25 to ⩽35, >35 to ⩽45, and >45 years. In Teri-PRO and TAURUS-MS I, an additional group, >55 years, was assessed. Results: In the pooled core studies, teriflunomide reduced annualized relapse rate (ARR) versus placebo across all ages. Unadjusted ARRs remained low across age groups in pooled extensions (0.18-0.30), Teri-PRO (0.10-0.35), and TAURUS-MS I (0.14-0.35). Baseline Expanded Disability Status Scale scores were higher with age, but stable through core and extension studies (mean increases over 7 years: ⩽25 years, +0.59; >25 to ⩽35 years, +0.46; >35 to ⩽45 years, +0.35; >45 years, +0.81). Across age groups, adverse event (AE) incidences were 78.4% to 90.7% in pooled core and extension studies and Teri-PRO, and 29.2% to 37.7% in TAURUS-MS I; serious AE incidences were ⩽21.3% in all studies. In pooled phase III and Teri-PRO studies, lymphocyte count decreases over 1 year after initiating teriflunomide, and proportions of patients developing lymphopenia, were small across age groups. Conclusions: Teriflunomide efficacy was demonstrated regardless of age. Safety was generally consistent across age groups.

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