Multiple sclerosis (Houndmills, Basingstoke, England)最新文献

{"title":"Gynecological health: A missing link in comprehensive treatment monitoring for multiple sclerosis.","authors":"Melika Arab Bafrani, Viviana Rios, Min Ji Kim, Ayushi Balan, Riley Bove","doi":"10.1177/13524585251346371","DOIUrl":"https://doi.org/10.1177/13524585251346371","url":null,"abstract":"<p><p>Safety monitoring of disease-modifying therapies (DMTs) used to treat multiple sclerosis (MS) has largely overlooked the domain of gynecological health. This topical review aims to provide MS clinicians with an overview of the three categories of complications described to date, as well as risk mitigation strategies. These are increased risk of human papilloma virus (HPV) positivity and related cervical dysplasia/cancers; inflammatory and infectious vaginitis and susceptibility to bacterial vaginosis (BV); and herpesvirus infections, including genital Herpes Simplex Virus (HSV). Current knowledge may be biased due to limited studies and lack of gynecological focus in neurological encounters. Risk mitigation strategies include promoting HPV vaccination, following guidance for immune compromised individuals relating to cervical cancer screening and antiviral suppression, and proactive communication with patients about gynecological health when starting DMTs. Together, these might improve gynecological health and thereby quality of life in females with neuroinflammatory diseases.</p>","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251346371"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with delay to diagnosis of multiple sclerosis in Zambia.","authors":"Malya Sahu, Mashina Chomba, Dominique Mortel, Sarah Braun, Lorraine Chishimba, Frighton Mutete, Naluca Mwendaweli, Coolwe Namangala, Stanley Zimba, Deanna Saylor","doi":"10.1177/13524585251344832","DOIUrl":"https://doi.org/10.1177/13524585251344832","url":null,"abstract":"<p><strong>Background/objectives: </strong>Delays to diagnosis of multiple sclerosis (MS) are largely unknown in sub-Saharan Africa. This study utilizes a quantitative approach to determine factors independently associated with delays to diagnosis among a cohort of Zambian people with MS.</p><p><strong>Methods: </strong>This cross-sectional study enrolled people with a confirmed diagnosis of MS at a public outpatient neurology clinic in Lusaka, Zambia. Standardized surveys were administered. Diagnostic delay was categorized into patient delay, health-system delay, and all delay. A multivariable linear regression model was used to determine factors independently associated with time to diagnosis.</p><p><strong>Results: </strong>A total of 22 participants had a confirmed diagnosis of MS. Median all delay from symptom onset to MS diagnosis was 11.4 months (interquartile range (IQR) = 4-35.5), with health-system delay accounting for the majority. Asian race correlated with a decrease in all delay, while evaluation outside of Zambia was associated with a decrease in patient delay and birthplace outside of Zambia correlated with decreased health-system delay.</p><p><strong>Conclusion: </strong>Black African people born in Zambia and evaluated in Zambia experienced prolonged diagnostic delays when compared to non-black Zambians born and/or evaluated outside Zambia, likely due to a combination of health system and patient factors, which necessitate further study to shorten time to diagnosis.</p>","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251344832"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kappa free light chain index predicts long-term disease activity and disability accrual in multiple sclerosis.","authors":"Klaus Berek, Martin Schmidauer, Gabriel Bsteh, Michael Auer, Robert Barket, Thomas Berger, Franziska Di Pauli, Astrid Ellen Grams, Michaela Hassler, Lukas Lenhart, Dejan Milosavljevic, Anne Zinganell, Janette Walde, Florian Deisenhammer, Harald Hegen","doi":"10.1177/13524585251344807","DOIUrl":"https://doi.org/10.1177/13524585251344807","url":null,"abstract":"<p><strong>Background: </strong>The prognostic value of κ-free light chain (κ-FLC) index over the long term is unknown.</p><p><strong>Objectives: </strong>The objective of the study was to determine whether κ-FLC index determined at disease onset predicts relapse activity and disability accrual during long-term follow-up.</p><p><strong>Methods: </strong>Patients with a first demyelinating event of the central nervous system who had cerebrospinal fluid and serum sampling were eligible for inclusion. At baseline, demographics, clinical data, number of T2 hyperintense (T2L) and contrast-enhancing lesions (CEL) on MRI were assessed. During follow-up occurrence of relapses, Expanded Disability Status Scale (EDSS) scores and disease-modifying treatments (DMT) were registered. κ-FLC was measured by nephelometry and κ-FLC index calculated as (CSF κ-FLC/serum κ-FLC)/albumin quotient.</p><p><strong>Results: </strong>Sixty-four patients with a median age at onset of 32 years (25th-75th percentile: 27-39) and a female predominance of 75% were followed over a median of 113 (90-129) months. Forty-six (72%) patients experienced relapse, 30 (47%) showed disability accrual. Multivariable Cox regression analysis adjusted for age, sex, disease duration, T2L, CEL and DMT revealed that κ-FLC index independently predicts time to relapse (per increase of 10: hazard ratio (HR) = 1.04, lower limit (LL)-confidence interval (CI) = 1.001, <i>p</i> = 0.044) and disability accrual (per increase of 10: HR = 1.05, LL-CI = 1.009, <i>p</i> = 0.022).</p><p><strong>Conclusions: </strong>κ-FLC index predicts long-term disease activity independently of other risk factors.</p>","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251344807"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Should natalizumab be used despite JC virus positivity? Yes'.","authors":"William M Carroll","doi":"10.1177/13524585251346374","DOIUrl":"https://doi.org/10.1177/13524585251346374","url":null,"abstract":"","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251346374"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive reserve in multiple sclerosis: The role of depression and fatigue.","authors":"Clara Stein, Fiadhnait O'Keeffe, Méadhbh Brosnan, Claire Flynn, Christopher McGuigan, Jessica Bramham","doi":"10.1177/13524585251338757","DOIUrl":"10.1177/13524585251338757","url":null,"abstract":"<p><strong>Background: </strong>Several reports suggest that cognitive reserve (CR) may protect against cognitive impairment in MS. Fatigue and depression are common in MS. Yet, their influence on engagement with activities that build CR is unclear.</p><p><strong>Objectives: </strong>This study aimed to achieve a better understanding of CR-building in MS, by examining how CR differs in people with MS (pwMS) compared with neurologically healthy individuals and by investigating how common MS symptoms interact with CR-building.</p><p><strong>Methods: </strong>In total, 206 pwMS and 150 age- and gender-matched controls participated in this cross-sectional study. Participants completed self-report measures of CR accumulated in early life and across the lifespan (including education, occupation, cognitively enriching leisure activities), and of cognitive functioning, fatigue, depression, anxiety and MS-impact on everyday life.</p><p><strong>Results: </strong>PwMS' recent engagement in cognitively enriching leisure activities was negatively associated with self-reported cognitive difficulties (rho = -0.31, <i>p</i> < 0.001). However, after controlling for fatigue and depression, this association was no longer present. Correspondingly, we observed that higher levels of depression were associated with lower engagement in cognitively enriching leisure activities (<i>B</i> = -0.41 (95% confidence interval (CI): -0.61 to -0.22), <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Our results highlight the importance of addressing depression and fatigue in the context of lifestyle recommendations.</p>","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251338757"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical commentary to gender-affirming interventions and prognosis in multiple sclerosis.","authors":"Marcello Moccia","doi":"10.1177/13524585251341177","DOIUrl":"https://doi.org/10.1177/13524585251341177","url":null,"abstract":"","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251341177"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender-affirming interventions and prognosis in multiple sclerosis.","authors":"Nur Neyal, Nabeela Nathoo, Elizabeth J Cathcart-Rake, Orhun H Kantarci, Burcu Zeydan","doi":"10.1177/13524585251341174","DOIUrl":"https://doi.org/10.1177/13524585251341174","url":null,"abstract":"<p><strong>Background: </strong>Gender-affirming hormone therapy (GAHT) may increase multiple sclerosis (MS) risk, yet MS disease course among transgender and gender-diverse (TGD) individuals remains understudied. We aimed to evaluate the disease course in TGD individuals with MS (TGD-MS).</p><p><strong>Methods: </strong>Seventeen TGD-MS were identified. Ten TGD-MS on GAHT (five transgender women with MS (TW-MS) and five transgender men with MS (TM-MS)) were investigated further for MS outcomes of symptomatic (clinical)/asymptomatic (radiological) disease activity and progressive MS (PMS) onset.</p><p><strong>Results: </strong>TW-MS (mean = 54.5 years, range = 35.1-66.3) were older than TM-MS (39.2 years, range = 29.6-47.2) at last follow-up. MS onset was later in TW-MS (31.5 years, range = 25.1-39.1) than in TM-MS (21.0 years, range = 15.0-29.8). Three patients (one TW-MS, two TM-MS) experienced symptomatic activity after GAHT initiation (8-10 months); in two patients (one TW-MS, one TM-MS), this marked symptomatic MS onset. Seven patients (four TW-MS, three TM-MS) had ⩾1 clinical/radiological disease activity. Four had PMS; all were TW-MS. In three, GAHT initiation preceded PMS onset (1-5 years). Disability was higher in TW-MS than in TM-MS.</p><p><strong>Conclusion: </strong>MS disease course may be modified by GAHT and may differ between TW-MS and TM-MS, highlighting the need for larger long-term studies to overcome disparities in MS care. Comprehensive GAHT history, timely management, and closer follow-up are warranted in TGD-MS.</p>","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251341174"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiologically isolated syndrome: How could we accurately diagnose a subclinical period of multiple sclerosis?","authors":"Andreu Vilaseca, Angela Vidal-Jordana, Sofia Sceppacuercia, Willem Calderon, Georgina Arrambide, Jordi Rio, Carmen Tur, Breogan Rodriguez-Acevedo, Helena Ariño, Ana Zabalza, Alvaro Cobo-Calvo, Neus Mongay-Ochoa, Pere Carbonell-Mirabent, Agustín Pappolla, René Carvajal, Joaquín Castilló, Ingrid Galan, Luciana Midaglia, Luca Bollo, Javier Villacieros-Álvarez, Cristina Auger, Jaume Sastre-Garriga, Mar Tintoré, Manuel Comabella, Àlex Rovira, Xavier Montalban","doi":"10.1177/13524585251332115","DOIUrl":"10.1177/13524585251332115","url":null,"abstract":"<p><strong>Background: </strong>Radiologically isolated syndrome (RIS) represents a subclinical period of multiple sclerosis (MS).</p><p><strong>Objectives: </strong>We aimed to characterize and identify risk factors for developing MS in an RIS cohort and to assess various proposed RIS definitions for their predictive value in MS development.</p><p><strong>Methods: </strong>This cohort study included all patients with at least one typical inflammatory-demyelinating lesion suggestive of MS on brain and/or spinal cord magnetic resonance imaging (MRI). The development of MS symptoms and new T2 lesions were the primary and secondary outcomes, respectively. Cox regression was used to identify risk factors, and diagnostic performance was assessed.</p><p><strong>Results: </strong>Eighty-eight patients were included, with 25.0% developing MS symptoms over a mean 55.1-month follow-up. Younger age and spinal cord and cortico-/juxtacortical lesions were associated with worse outcomes. The 2017 McDonald dissemination in space (DIS) criteria and 2023 Lebrun RIS definition, which correspond to either the 2005 McDonald DIS criteria or one brain inflammatory-demyelinating lesion associated with two among oligoclonal bands, a spinal cord lesion and dissemination in time during radiological follow-up, showed high sensitivity (0.82 and 0.94, respectively). However, the sensitivity decreased (0.79) when only the baseline characteristics of the 2023 Lebrun RIS definition were considered. Combining the 2017 McDonald DIS criteria with positivity for oligoclonal bands or contrast-enhancing lesions on baseline MRI, which are the current McDonald MS criteria, improved the specificity (to 0.64 and 0.90, respectively).</p><p><strong>Conclusions: </strong>Our findings support the utility of the current DIS component of the 2017 McDonald MS criteria for RIS patients.</p>","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"771-781"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should disease-modifying therapy be discontinued in older patients with stable MS after long-term clinical and radiological stability? Yes.","authors":"Géraldine Androdias, Bruno Stankoff","doi":"10.1177/13524585251344792","DOIUrl":"10.1177/13524585251344792","url":null,"abstract":"","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"764-765"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should disease-modifying therapy be discontinued in older patients with stable MS after long-term clinical and radiological stability? Commentary.","authors":"Anna Karin Hedström","doi":"10.1177/13524585251344786","DOIUrl":"10.1177/13524585251344786","url":null,"abstract":"","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"769-770"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}