Fulminant case of multiple sclerosis (marburg variant) with atypical MRI presentation

Marburg type is a rare variant of Multiple Sclerosis (MS) characterized by a severe and progressive course/evolution leading to exitus in few months. Its radiological presentation commonly raises suspicion of a malignancy, often requiring a brain biopsy for histological confirmation. Hereby we report an atypical radiological presentation and progression of a pathologically confirmed case of Marburg MS Keywords: Multiple Sclerosis; Marburg variant; Magnetic resonance imaging.

Verlaufsmodifizierende Immuntherapien bei MS-Fatigue

Zusammenfassung Obgleich sich die Zahl und die Wirkansätze der verfügbaren Immuntherapien zur Behandlung der MS in den letzten zehn Jahren deutlich vergrößert haben, ist die Datenlage zur Wirkung der verschiedenen Behandlungsformen auf Fatigue nach wie vor lückenhaft und kaum durch kontrollierte Daten belegt. Aus den in dieser Arbeit referierten Studien kann vorläufig geschlossen werden, dass von Glatirameracetat und Natalizumab am ehesten positive Auswirkungen auf das Fatigueempfinden von MS Patienten zu erwarten sind. Bei Interferonen bietet die Datenlage keine einheitliche Orientierung. Die klinische Erfahrung lehrt jedoch, dass man immer damit rechnen muss, dass eine Interferontherapie bei einzelnen Patienten zu einer Zunahme der Fatigue führt. Ein Absetzen von Interferon und ein Wechsel auf Glatirameracetat oder eines der Oralpräparate (horizontal switch) kann deshalb unter dem Aspekt der Fatigue bei Krankheitsstabilität durchaus sinnvoll sein. Die modernen Antikörpertherapien scheinen hinsichtlich einer Fatigueauslösung oder -verschlechterung eher unkritisch zu sein. Kurzfristige Schwankungen der Fatigue können aber vorkommen. Vielversprechend sehen derzeit die Daten zu Ponesimod aus, wobei es hier zu beachten gilt, dass das Messinstrument für Fatigue neu entwickelt wurde und es hierzu keinerlei Vergleichsdaten mit anderen Präparaten – abgesehen vom aktiven Komparator Teriflunomid aus der Zulassungsstudie – gibt. Hier besteht demnach wissenschaftlicher Handlungsbedarf, um zu sicherzustellen, dass es sich um eine »echte Überlegenheit« von Ponesimod in puncto Fatigue gegenüber anderen Therapien handelt. Schlüsselwörter: Multiple Sklerose, Fatigue, Therapie der Fatigue, Immuntherapien, milde bis moderate Verlaufsformen der MS, aktive bis hochaktive Verlaufsformen der MS Abstract Although the number and the mode of action of the immunotherapies available for the treatment of MS have increased significantly in the last ten years, evidence for the effect of the various forms of treatment on fatigue is still incomplete and hardly supported by controlled data. From the studies reported in this paper, it can be tentavely concluded that glatiramer acetate and natalizumab are most likely to have positive effects on the perception of fatigue in MS patients. In the case of interferons, published data do not offer a uniform orientation. However, clinical experience shows that it must always be expected that interferon therapy will lead to an increase in fatigue in individual patients. Discontinuing interferon and switching to glatiramer acetate or one of the oral drugs (horizontal switch) can therefore make sense in terms of fatigue and disease stability. Modern antibody therapies seem to be rather uncritical in terms of triggering or worsening fatigue. However, short-term fluctuations in fatigue can occur. The data on ponesimod currently look promising, although it should be noted that the measuring instrument for fatigue was newly developed and that there are no comparative data with other disease modifying therapies – apart from the active comparator teriflunomide from the registration study. There is therefore a need for scientific action here to ensure that ponesimod has a »real superiority« in terms of fatigue compared to other therapies. Keywords: multiple sclerosis, fatigue, management of fatigue, immunotherapies, mild to moderate MS, active to highly active MS

Prevalence of sexual dysfunction in men with multiple sclerosis: a systematic review and meta-analysis

Background Symptoms in multiple sclerosis (MS) can lead to different types and ranges of sexual dysfunction in MS patients. Studies in different parts of the world have reported a high range of sexual dysfunction in men with MS. This study aimed to estimate pooled prevalence of sexual dysfunction in men with MS. Methods The authors searched Web of Science, PubMed, Scopus, Embase, Magiran, SID, and Iran Medical Papers Database using the keywords “multiple sclerosis”, “sexual dysfunctions”, “men”, “prevalence”, and their synonyms systematically. Meta-analysis was performed using the random effects model with inverse variance-weighted method to estimate the overall prevalence of sexual dysfunction in men with MS. The protocol for this meta-analysis is available in PROSPERO (ID CRD42020199005). Results A total of 351 documents were identified, and 20 articles published from 1996 to 2019 were analyzed. The articles used sample sizes from 9 to 101 individuals. However, two studies conducted online used 388 and 1568 samples. Prevalence of sexual dysfunction in all studies was reported from 31 to 92%, and the pooled prevalence of sexual dysfunction in men with MS in all studies was 62.9% with a 95% confidence interval 53 to 72.7% (heterogeneity: I2 = 96.3%, Q-statistic = 12.48, P value < 0.001). According to the results of Egger’s test, there was publication bias in the current study (β = 4.55, Se = 1.38, P value = 0.004). Conclusion Sexual dysfunction is highly prevalent in men with MS. Diagnosing sexual dysfunction in MS patients in clinics by specialists have to be considered a necessity.

An Integrative Review of Causes, Manifestations and Evaluation of Cognitive Fatigue among Persons with Multiple Sclerosis

Background: Fatigue is the most distinguishing symptom for patients with Multiple Sclerosis (MS) and for some of these patients it can be quite disabling. Studies exploring MS-related fatigue have differentiated this into various dimensions: motor, cognitive, physical, psychosocial, performance, and subjective. It is the cognitive dimension that can have serious consequences such as loss of vocation, independence, and possibly, more relapses or worsening of the disease. Objective: The aims of this integrative review were to explore the advances in understanding cognitive fatigue in MS, as well as its causes and manifestations, and to identify the objective methodologies that best measure cognitive fatigue in MS. Methodology: An integrative review of the scientific literature was performed using methods and criteria following the PRISMA-P2015 guidelines for data extraction. The studies were critically appraised using the Rapid Critical Appraisal and the qualitative study method of Constant Comparison. Results: Twenty-three studies (2010-2019) were identified from the United States and other countries. The majority of articles were published within the last three years. Evaluation of outcomes from these studies was conducted through self-reporting. Cognitive fatigue may result in more relapses among those with relapsing and remitting MS and from those with secondary progressive MS. Cognitive fatigue and physical fatigue should be considered distinct domains. Conclusion and Recommendations: An increasing number of studies focused on cognitive fatigue, however, there is no standard definition or conceptual framework available to understand this phenomenon. Various methodologies were identified to evaluate cognitive fatigue. Additionally, there should be a valid, reliable, and readily available instrument for use in the clinical setting. Keywords: Multiple Sclerosis, Cognitive Fatigue, Fatigue, Integrative Review

The effectiveness of rehabilitation of patients with multiple sclerosis in virtual reality

Objectives - to review the results of the use of virtual reality for the rehabilitation of patients with multiple sclerosis. Material and methods. А bibliographic review of the PubMed database was conducted using the keywords "multiple sclerosis" and "virtual reality". The review was performed in accordance with the recommendations of the "Preferred Reporting Items for Systematic reviews and Meta-analysis" (PRISMA). Results. The analysis included 45 articles. Only 10 articles were subjected to final analysis. Conclusion. Virtual reality is a potentially effective alternative to traditional motor rehabilitation for patients with multiple sclerosis.

Healthcare and Rehabilitation Needs of Individuals with Multiple Sclerosis

There is little research delineating the healthcare and rehabilitation needs of individuals with multiple sclerosis (MS) that is based on the perspectives of those individuals themselves. The medical community is largely well-informed about disease progression, symptoms, and treatment of MS, but little is known regarding the barriers and unmet needs that individuals with MS experience in their interaction with healthcare and rehabilitation systems and providers, and in their efforts to maintain healthy, productive, and participatory lives. In this article, we provide a comprehensive summary of the most frequently identified healthcare and rehabilitation needs of individuals with MS based on a review of over 500 articles, from which 29 articles were selected for inclusion as they specifically addressed the needs or unmet healthcare and rehabilitation needs of people with MS. Based on our review, we identified 11 categories of needs, which we discuss in the context of three broad categories, including (a) emotional and psychological support, (b) healthcare and rehabilitation, and (c) transportation, home care, and financial needs. Keywords: multiple sclerosis, health care, priorities, needs, expectations

A Propósito do Artigo: “O Tratamento da Esclerose Múltipla com Natalizumab: Análise de uma Coorte Hospitalar”

Keywords: Multiple Sclerosis; Natalizumab; Treatment Outcome; Antibodies, Monoclonal, Humanized/ adverse effects; Leukoencephalopathy, Progressive Multifocal/chemically induced.

Supplementation and therapeutic use of vitamin D in patients with multiple sclerosis: Consensus of the Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology

Multiple sclerosis (MS) is an inflammatory, autoimmune, demyelinating, and degenerative central nervous system disease. Even though the etiology of MS has not yet been fully elucidated, there is evidence that genetic and environmental factors interact to cause the disease. Among the main environmental factors studied, those more likely associated with MS include certain viruses, smoking, and hypovitaminosis D. This review aimed to determine whether there is evidence to recommend the use of vitamin D as monotherapy or as adjunct therapy in patients with MS. We searched PUBMED, EMBASE, COCHRANNE, and LILACS databases for studies published until September 9 th , 2013, using the keywords “multiple sclerosis”, “vitamin D”, and “clinical trial”. There is no scientific evidence up to the production of this consensus for the use of vitamin D as monotherapy for MS in clinical practice.