Multiple sclerosis and related disorders最新文献

{"title":"AQP4-IgG positive and AQP4-IgG–negative NMOSD: A Multicenter Latin-American Cohort vs. a Single-Center Argentine Cohort","authors":"Andrés M. Villa","doi":"10.1016/j.msard.2025.106933","DOIUrl":"10.1016/j.msard.2025.106933","url":null,"abstract":"","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106933"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145878842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-harm-related mortality among U.S. decedents with multiple sclerosis: A nationwide analysis (1999–2020)","authors":"Moaz Elsayed Abouelmagd ,&nbsp;Belal Mohamed Hamed ,&nbsp;Mostafa Meshref ,&nbsp;Devon S Conway","doi":"10.1016/j.msard.2025.106934","DOIUrl":"10.1016/j.msard.2025.106934","url":null,"abstract":"<div><h3>Objective</h3><div>Suicide risk in persons with multiple sclerosis (PwMS) exceeds that of the general population, yet national data on temporal change and demographic gradients remain limited. We conducted this study to quantify long-term trends and demographic disparities in fatal self-harm among U.S. decedents with MS.</div></div><div><h3>Methods</h3><div>We extracted Multiple Cause-of-Death records between 1999–2020 from the freely available CDC WONDER database, identifying cases in which intentional self-injury was the underlying manner of death and MS was a contributing cause. Crude mortality rates (per 100,000) overall and by sex, ten-year age group, race, and 2013 urbanization level were calculated. Log-linear and segmented regressions were used to estimate annual-percent change (APC) and join-points; rate ratios (RRs) contrasted 2020 with 1999 and each stratum with prespecified anchors.</div></div><div><h3>Results</h3><div>A total of 453 MS-related self-harm deaths yielded an overall crude rate of 0.0067 (95 % CI 0.0061–0.0073) per 100,000 per year. The APC was 0.88 % (-0.49 % to 2.27 %); a single join-point was detected in 2013. Self-harm mortality was 2.7-fold higher in non-core rural counties than large central metros, and highest in adults older than 35 years; no sex difference emerged.</div></div><div><h3>Conclusions</h3><div>Despite therapeutic advances, self-harm mortality in MS has edged upward since 2013, with pronounced rural. Tailored mental-health surveillance, particularly in remote areas, remains a critical, unmet need.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106934"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is newly diagnosed multiple sclerosis a medical emergency?","authors":"H El Mouhajir ,&nbsp;A Alrashed ,&nbsp;B Mohamed ,&nbsp;K Schmierer","doi":"10.1016/j.msard.2025.106939","DOIUrl":"10.1016/j.msard.2025.106939","url":null,"abstract":"","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106939"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145842628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived pain during isometric exercise and neuromuscular fatigability in individuals with multiple sclerosis","authors":"Mitra Rouhani ,&nbsp;Marie K. Hoeger Bement ,&nbsp;Sandra K. Hunter ,&nbsp;Kathleen M. Zackowski ,&nbsp;Ahmed Z. Obeidat ,&nbsp;Alexander V. Ng","doi":"10.1016/j.msard.2025.106943","DOIUrl":"10.1016/j.msard.2025.106943","url":null,"abstract":"<div><div>Among people with multiple sclerosis (PwMS), pain is a common symptom, and neuromuscular fatigability is widely reported. However, the association between pain during exercise and neuromuscular fatigability remains unclear. This study aimed to identify the association between perceived pain and neuromuscular fatigability during an exercise task in PwMS. Thirty-two PwMS (age=56.4, females=15) and 15 age- and sex-matched non-MS controls (age=57.9, females=7) participated. Disease severity was evaluated using the Expanded Disability Status Scale (median EDSS=4.0). The experimental protocol involved maximal voluntary contractions (MVCs) of the dorsiflexors, time-to-task failure (TTF) of an isometric fatiguing exercise sustained at maximal strength (neuromuscular fatigability), and a post-exercise MVC. Central and peripheral fatigability were assessed using electrical stimulation. The twitch interpolation technique quantified voluntary activation (VA), with pre-to-post exercise reductions in VA indicating central fatigability. Pre-to-post exercise reductions in resting twitch amplitude indicated peripheral fatigability. Perceived pain (0–10) was assessed at rest prior to exercise, during, and immediately post-exercise. Associations of changes in pain perception were identified using Spearman’s correlation coefficient (rho). Despite no significant differences between PwMS and controls across all outcome measures (<em>p</em> &gt; 0.2), compared to controls, PwMS with higher disease severity (<em>n</em> = 12, EDSS≥4.5) had a significantly shorter TTF (mean difference=-38.5 s, <em>p</em> = 0.04), higher central fatigability (11 percentage points, <em>p</em> = 0.01), and lower peripheral fatigability (-20.8%, <em>p</em> = 0.01). Among PwMS, smaller changes in pain perception correlated with increased neuromuscular fatigability (rho=0.5, <em>p</em> = 0.003), higher central fatigability (rho=-0.4, <em>p</em> = 0.05), and lower peripheral fatigability (rho=0.4, <em>p</em> = 0.03). These findings suggest that perceived pain during the exercise task may be an overlooked mechanism contributing to neuromuscular fatigability in PwMS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106943"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145842627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The brainstem signature of multiple sclerosis: predictable lesions, consistent syndromes","authors":"Mohammad Wafa ,&nbsp;Khalid Nuh ,&nbsp;Gavin Giovannoni ,&nbsp;Klaus Schmierer ,&nbsp;Sharmilee Gnanapavan ,&nbsp;Ruth Dobson ,&nbsp;Monical Marta ,&nbsp;Maria Papachatzaki ,&nbsp;Benjamin Turner ,&nbsp;Thomas Campion ,&nbsp;Ashok Adams ,&nbsp;Anant Krishnan ,&nbsp;Alexandros Chatzistefanou ,&nbsp;Bader Mohamed ,&nbsp;Ahmed Hashish","doi":"10.1016/j.msard.2025.106894","DOIUrl":"10.1016/j.msard.2025.106894","url":null,"abstract":"<div><h3>Background</h3><div>Integrating clinical findings with neuroradiological changes is a crucial skill in neurology, particularly for diagnosis. Multiple Sclerosis (MS) lesions in the brainstem are rarely asymptomatic, leading to unique and often localised clinical syndromes. MS lesions exhibit a characteristic perivenular distribution, which in the brainstem is imprinted by the consistent topography of the penetrating veins.</div></div><div><h3>Objective</h3><div>This review provides an integrative perspective on the anatomical patterns of MS lesions in the brainstem (midbrain, pons, and medulla). It correlates specific clinical syndromes with radiological appearances, aiding in both diagnosis and functional localisation.</div></div><div><h3>Methods</h3><div>We searched the available literature using keywords related to the three brainstem sections (midbrain, pons, medulla) and eloquent anatomical locations (<em>medial longitudinal fasciculus, cerebellar peduncle, nerve fascicle, aqueduct, area postrema</em>), aiming to correlate specific radiological patterns of MS lesions with their consistent clinical syndromes as reported in the literature.</div></div><div><h3>Summary of Key Findings</h3><div>Brainstem MS lesions often cause irritative symptoms rather than full functional loss. Unlike other conditions, visible MS lesions on MRI rarely disappear and usually remain as silent lesions following an acute event. The consistent venous architecture creates specific radiological patterns that link to distinct clinical presentations. In contrast, inflammatory disorders like NMOSD and MOGAD cause more aggressive and extensive dysfunction.</div></div><div><h3>Conclusion</h3><div>The visual details of MS brainstem lesions reflect their close relationship to venous anatomy, which can be anticipated even when the central vein sign is not directly visualised. Recognising these specific clinical-radiological syndromes provides a unique and insightful diagnostic tool for MS, underscoring the value of strong functional and radiological-anatomical interpretation skills in clinical neurology.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106894"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a short-term stress management protocol on physiologic biofeedback measures of stress and mood in people with multiple sclerosis","authors":"A.B. Sullivan ,&nbsp;G. Tworek ,&nbsp;A. Kane ,&nbsp;J. Fredieu ,&nbsp;T. Harvey","doi":"10.1016/j.msard.2026.106967","DOIUrl":"10.1016/j.msard.2026.106967","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Stress exacerbates multiple sclerosis (MS) symptoms. We report a 10-year study examining objective and subjective measures of stress and mood in people with MS (PwMS) using a shortened and more practical form of the Stress Management Therapy for MS (SMT-MS), the Stress Management Protocol (SMP).</div></div><div><h3>Methods</h3><div>We analyzed data from PwMS who underwent a 4-session SMP at Cleveland Clinic between 2012 and 2022 (<em>N</em> = 195; 90.5 % female; 68.2 % White; average age, 44.4 years; average disease duration, 12.1 years). Subjective data were collected pre-session using the Patient Health Questionaire-9 (PHQ-9) and Generalized Anxiety Disorder (GAD). Objective data, including breathing rate (breaths per minute, BPM), pulse (beats per minute, bpm), and blood oxygen saturation (%Sp02), were collected pre- and post-SMP. Statistical models assessed data differences and within-session improvement by session, as well as differences in pre- and post-session measurements .</div></div><div><h3>Results</h3><div>Subjective and objective scores improved significantly after Session 1. Significant intrasession improvements were observed, especially during the initial sessions. Significant overall improvements were observed in PHQ-9, GAD-7, and pre-session BPM and %SpO₂. Greatest improvements in PHQ-9 and BPM were observed in patients completing 3 sessions and that %Sp0₂ were observed in patients completing 4 sessions.</div></div><div><h3>Discussion</h3><div>PwMS who participated in the SMP showed considerable improvement in outcomes within and across sessions. Our results show that a brief, 4-session SMP can improve both subjective and objective measures of stress and mood in PwMS and that PwMS are able to utilize the SMP/biofeedback tools outside of therapy, in a real-world environment.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106967"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of Bruton’s tyrosine kinase inhibitors compared to Teriflunomide in relapsing multiple sclerosis: A systematic review and meta-analysis","authors":"Milene Vitória Sampaio Sobral ,&nbsp;Helen Michaela de Oliveira ,&nbsp;Altair Pereira de Melo Neto ,&nbsp;Thales Pardini Fagundes","doi":"10.1016/j.msard.2026.106974","DOIUrl":"10.1016/j.msard.2026.106974","url":null,"abstract":"<div><h3>Introduction</h3><div>Traditional disease-modifying therapies (DMTs) reduce relapse frequency in relapsing–remitting multiple sclerosis (MS) but have a limited impact on relapse-independent progression, underscoring the need for novel therapies. Bruton’s tyrosine kinase inhibitors (BTKis), with dual immunomodulatory effects and central nervous system penetration, offer a promising alternative for comparison with established agents such as teriflunomide.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase, and Cochrane CENTRAL up to June 2025 for randomized controlled trials (RCTs) comparing BTKis with teriflunomide in patients with relapsing MS. The primary outcome was confirmed disability worsening (CDW) at 3 and 6 months. Secondary outcomes included annualized relapse rate (ARR), magnetic resonance imaging (MRI) lesion activity, and adverse events. Random-effects meta-analyses were performed using hazard ratios (HRs), rate ratios, risk ratios, and mean differences, as appropriate.</div></div><div><h3>Results</h3><div>Four RCTs with 4136 participants were included. ARR was similar between the groups (Rate Ratio: 1.03; 95% CI: 0.90–1.19). BTK inhibitors reduced the risk of 3-month CDW compared with teriflunomide (HR: 0.81; 95% CI: 0.67–0.97) but not 6-month CDW (HR: 0.88; 95% CI: 0.63–1.24). The slight but significant difference in new T1 gadolinium-enhancing lesions favored teriflunomide (MD: 0.20; 95% CI: 0.15–0.25), whereas no difference was found in new or enlarging T2 lesions (MD:0.07; 95% CI:0.85 to 0.71). The incidence of serious adverse events was comparable between the groups (RR: 1.13; 95% CI: 0.92–1.40).</div></div><div><h3>Conclusion</h3><div>Compared with teriflunomide, BTK inhibitors were associated with a reduced risk of short-term disability progression, whereas no differences were observed in relapse rates, MRI activity, or safety outcomes.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106974"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurological and paraclinical features differentiating Systemic lupus erythematosus, Sjögren’s disease, and neuromyelitis optica spectrum disorders","authors":"Ivna Lacerda Pereira Nóbrega ,&nbsp;Melissa Macedo Peixoto Nascimento ,&nbsp;Igor Bessa Santiago ,&nbsp;Jozélio Freire de Carvalho ,&nbsp;Milena Sales Pitombeira ,&nbsp;Carlos Ewerton Maia Rodrigues","doi":"10.1016/j.msard.2026.106972","DOIUrl":"10.1016/j.msard.2026.106972","url":null,"abstract":"<div><h3>Purpose of Review</h3><div>To compare and elucidate the distinguishing clinical, laboratory, and imaging features of neuromyelitis optica spectrum disorder (NMOSD) when it occurs alone and when it coexists with systemic lupus erythematosus (SLE) or Sjögren’s disease (SjD).</div></div><div><h3>Recent Findings</h3><div>NMOSD is a chronic inflammatory autoimmune astrocitophaty that causes multifocal central nervous system involvement, primarily affecting the optic nerves and spinal cord. Serological testing for AQP4-IgG is the hallmark of NMOSD diagnosis. These antibodies are highly specific for NMOSD and are essential for differentiating it from SLE and SS, which usually test negative for this marker. Around 20–30% of NMOSD patients have associated autoimmune comorbidities, most commonly SLE and SjD, suggesting shared underlying autoimmune mechanisms. In SLE with NMOSD, central nervous system events are more frequent, while SjD often presents with predominant peripheral nervous system involvement.</div></div><div><h3>Summary</h3><div>Patients with NMOSD and concurrent SLE or SjD have higher morbidity, with increased risk of complications such as paraplegia and seizures, and longer hospital stays compared to those without these comorbidities. NMOSD represents a distinct disease process rather than a neurological complication of SLE or SjD. Identifying distinguishing clinical, laboratory, and imaging features is crucial for accurate diagnosis, guiding treatment strategies, and improving outcomes.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106972"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain states analysis of EEG predicts multiple sclerosis and mirrors disease duration and burden","authors":"István Mórocz ,&nbsp;Mojtaba Jouzizadeh ,&nbsp;Amir Hossein Ghaderi ,&nbsp;Hamed Cheraghmakani ,&nbsp;Seyed Mohammad Baghbanian ,&nbsp;Reza Khanbabaie ,&nbsp;Andrei Mogoutov","doi":"10.1016/j.msard.2026.106981","DOIUrl":"10.1016/j.msard.2026.106981","url":null,"abstract":"<div><h3>Background:</h3><div>Any treatment of multiple sclerosis should preserve mental function, considering how cognitive deterioration interferes with quality of life. However, mental assessment is still realized with neuro-psychological tests without monitoring cognition on neurobiological grounds whereas the ongoing neural activity is readily observable and readable.</div></div><div><h3>Objective:</h3><div>The proposed method deciphers electrical brain states which as multi-dimensional cognetoms quantitatively discriminate normal from pathological patterns in an EEG.</div></div><div><h3>Method:</h3><div>Baseline recordings from a prior EEG study of 88 subjects, 36 with MS, were analyzed. Spectral bands served to compute cognetoms and categorize subsequent feature combination sets.</div></div><div><h3>Result:</h3><div>The brain states predictor correlates with disease burden and duration. Using cognetoms and spectral bands, a cross-sectional comparison separated patients from controls with a precision of 85% while using bands alone arrived at 79%.</div></div><div><h3>Conclusion:</h3><div>We demonstrate the efficiency of the quantitative data-driven method based on brain states analysis by contrasting EEG data of patients with MS and healthy subjects. The congruity with disease severity and duration is a neurophysiological indicator for disease accumulation over time. We discuss potential applications of the approach for the monitoring of disease time course and treatment efficacy in longitudinal clinical studies in psychiatry and neurology.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106981"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic stress amplifies multidimensional disease activity in multiple sclerosis patients: A year-long within-person analysis","authors":"Omri Zveik-Lavi ,&nbsp;Dvir Green ,&nbsp;Ariel Rechtman ,&nbsp;Tal Ganz ,&nbsp;Tal Friedman-Korn ,&nbsp;Garrick Hoichman ,&nbsp;Lyne Shweiki ,&nbsp;Dana Ekstein ,&nbsp;Adi Vaknin-Dembinsky","doi":"10.1016/j.msard.2026.106965","DOIUrl":"10.1016/j.msard.2026.106965","url":null,"abstract":"<div><h3>Background</h3><div>Chronic psychological stress is suspected to intensify disease activity in multiple sclerosis (MS), yet longitudinal real-world evidence remains limited. This study aims to determine whether the first year of the war in Israel during 2023-2024, a period of sustained nationwide stress, was associated with increased composite evidence of disease activity (EDA-3) in people with MS (pwMS).</div></div><div><h3>Methods</h3><div>We conducted a retrospective case-control study of 930 pwMS followed at Hadassah Medical Center who had ≥1 annual visit across three consecutive years. Within-person comparisons were made between the war year (P3, 07/10/2023-06/10/2024) and the preceding year (P2). The primary outcome was EDA-3 (clinical relapse, confirmed EDSS worsening, or magnetic resonance imaging [MRI] activity). Each component of EDA-3, as well as treatment modifications, was also evaluated independently.</div></div><div><h3>Results</h3><div>EDA-3 prevalence was significantly higher during the war year (17.42%, 162/930) than pre-war (13.87%, 129/930; odds ratio [OR]=1.34, 95%-confidence interval [CI]: 1.02-1.76, p=0.034). Effects were more pronounced in males (OR=1.72, 95%-CI: 1.07-2.83; p=0.024) and in patients with EDSS≥4 (OR=1.77, 95%-CI: 1.20-2.63; p=0.0034). MRI activity increased from 11.77% to 17.54% (OR=1.83, 95%-CI: 1.14-2.98; p=0.011). Annualized relapse rate (ARR) showed a non-significant increase (p=0.068), and treatment modification rates were stable (switches: p=0.92; escalations: p=0.42). Results persisted after excluding pre-war DMT switchers (OR=1.55, 95%-CI: 1.147-2.122; p=0.004).</div></div><div><h3>Conclusion</h3><div>Sustained war-related stress coincided with clinically significant, multidimensional increases in MS disease activity, predominantly driven by MRI activity, with disproportionate impacts on males and higher-disability patients. These findings position chronic stress as a modifiable risk factor, advocating for integrated stress mitigation and proactive enhanced monitoring in MS care during prolonged crises.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106965"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}