The Latest Articles on Multiple Sclerosis
Our staff editors continue to share exciting, interesting, and thought-provoking reading material in the recommended articles series.
This week, we would like to share several latest articles on Multiple Sclerosis.
Title: Cognitive impairment, fatigue and depression in multiple sclerosis: is there a difference between benign and non-benign MS?
Authors: H Bogaardt., D Golan, MA Barrera, S Attrill, O Kaczmarek, M Zarif, B Bumstead, MJB Buhse, J Wilken, GM Doniger, LM Hancock, IK Penner, J Halper, SA Morrow, T Covey, M Gudesblatt
Type: Research Article
Abstract:
Introduction
Multiple Sclerosis (MS) is a chronic inflammatory and degenerative disease of the central nervous system (CNS). The severity of disability in people with MS (PwMS) is generally measured with the Expanded Disability Status Scale (EDSS). A variant of MS known as ‘benign MS’ (BMS) has been defined as an EDSS score of 3 or lower, combined with a disease duration of 10 years or longer; however, there is disagreement in the field about whether BMS really exists. Given that the EDSS does not capture cognitive issues, communication dysfunction, fatigue, depression, or anxiety properly, its ability to accurately represent disability in all PwMS, including BMS, remains questionable.
Methods
In this study, 141 persons with BMS (PwBMS) were included, consisting of 115 females (82%) and 26 males (18%) with a mean age of 50.8 (± 8.68). A computerized test battery (NeuroTrax) was used to assess cognition, covering seven cognitive domains (memory, executive function, visual-spatial processing, verbal function, attention, information processing, and motor skills). Fatigue was measured using the Fatigue Severity Scale (FSS). The Beck Depression Inventory (BDI) was used to assess symptoms of depression. Cognitive impairment was defined for this study as when someone has a score lower than 85 in at least two subdomains of the cognitive test battery. Rates of impairment were compared to 158 persons with non-benign MS (PwNBMS; with a disease duration of 10 years and longer and an EDSS score higher than 3) and 487 PwMS with a disease duration of fewer than 10 years.
Results
Cognitive impairment was found in 38% of PwBMS and in 66% of PwNBMS (p < 0.001). In PwBMS, the lowest rate of impairment was found in the verbal function domain (18%) and the highest rate of impairment in the domain of information processing (32%). Fatigue and depression were found in 78% and 55% of all PwBMS, with no difference in these rates between PwBMS and PwNBMS (p = 0.787 and p = 0.316 resp.)
Conclusion
Cognitive impairment, fatigue and depression are common among people with an EDSS-based definition of benign MS. These aspects should be incorporated into a new and better definition of truly benign MS
Access this article: https://doi.org/10.1016/j.msard.2023.104630
Title: Neuroprotective influence of macular xanthophylls and retinal integrity on cognitive function among persons with multiple sclerosis
Authors: Jonathan Cerna, Caitlyn G. Edwards, Shelby Martell, Nikta S. Athari Anaraki, Anne D.M. Walk, Connor M. Robbs, Brynn C. Adamson, Isabel R. Flemming, Leanne Labriola, Robert W. Motl, Naiman A. Khan
Type: Research Article
Abstract:
Background
No studies to date have examined if macular xanthophyll accumulation and retinal integrity are independently associated with cognitive function in individuals with Multiple Sclerosis (MS). This study explored whether macular xanthophyll accumulation and structural morphometry in the retina were associated with behavioral performance and neuroelectric function during a computerized cognitive task among persons with MS and healthy controls (HCs).
Methods
42 HCs and 42 individuals with MS aged 18–64 years were enrolled. Macular pigment optical density (MPOD) was measured using heterochromatic flicker photometry. Optic disc retinal nerve fiber layer (odRNFL), macular retinal nerve fiber layer, and total macular volume were assessed via optical coherence tomography. Attentional inhibition was assessed using an Eriksen flanker task while underlying neuroelectric function was recorded using event-related potentials.
Results
Persons with MS had a slower reaction time, lower accuracy, and delayed P3 peak latency time during both congruent and incongruent trials compared with HCs. Within the MS group, MPOD explained variance in incongruent P3 peak latency, and odRNFL explained variance in congruent reaction time and congruent P3 peak latency.
Conclusions
Persons with MS exhibited worse attentional inhibition and slower processing speed, yet higher MPOD and odRNFL levels were independently associated with greater attentional inhibition and faster processing speed among persons with MS. Future interventions are necessary to determine if improvements in these metrics may promote cognitive function among persons with MS.
Access this article: https://doi.org/10.1016/j.ijpsycho.2023.03.002
Title: Spinal cord and brain corticospinal tract lesions are associated with motor progression in tumefactive multiple sclerosis
Authors: Caitlin S. Jackson-Tarlton, B. Mark Keegan, Mahboubeh Fereidan-Esfahani, Benan O. Barakat, Paul A. Decker, Claudia F. Lucchinetti, Jeanette Eckel-Passow, W. Oliver Tobin
Type: Research Article
Abstract:
Background
Spinal cord lesions have been associated with progressive disease in individuals with typical relapsing remitting MS (RRMS).
Objective
In the current study, we aimed to determine if progressive disease is associated with spinal cord lesions in those with tumefactive multiple sclerosis (MS).
Methods
Retrospective chart review of individuals presenting to Mayo Clinic with tumefactive MS with spinal cord MRIs available (n = 159). Clinical data were extracted by chart review. Brain and spinal cord MRIs were reviewed to characterize the tumefactive demyelinating lesion(s) and assess the burden of spinal cord disease.
Results
A total of 69 (43%) had spinal cord lesions. Progressive demyelinating disease was documented in 13 (8%); the majority (11/13) with secondary progressive disease. The method of progression was myelopathic in 8/13 (62%), cognitive in 3/13 (23%), motor from a supratentorial lesion in 2/13 (16%). EDSS at last follow-up was higher in those with progression than those without (median 6.0 (2.0-10.0) vs. 2.5 (0-10.0), p = < 0.001). Progressive demyelinating disease occurred in a minority.
Conclusions
Patients with progression typically experienced progressive motor impairment, and this occurred exclusively in individuals with lesions in the corticospinal tracts of the brain and/or the spinal cord.
Access this article: https://doi.org/10.1016/j.msard.2023.104614
Title: The National Multiple Sclerosis Registry System of Iran (NMSRI): aspects and methodological dimensions
Authors: Saeideh Ayoubi, Hassan Asadigandomani, Melika Arab Bafrani, Aryan Shirkoohi, Mohamadreza Nasiri, Mohammad Ali Sahraian, Sharareh Eskandarieh
Type: Research Article
Abstract:
Introduction
Multiple Sclerosis (MS) as one of the most common causes of disability around the world requires a uniform standardized information registry system to help policy-makers systematically plan for care quality improvements. The aim of this study is to verify aspects and methodological scopes of MS registry system in Iran.
Methods
The National MS Registry System in Iran (NMSRI) is a population-based registry system that systemically identifies and collects all MS patients' data in a specific geographical area. It supports 22 medical science universities and 13 MS societies in 18 provinces of Iran. The information items taken from each patient to collect the data set and data are gathered from all available sources including public and private hospitals, clinics, neurologists' offices, and all MS societies. They are recorded in District Health Information System 2 (DHIS2) software.
Discussion
The NMSRI is a successful system of collecting MS patients’ data. It can lead to positive results, such as updating patients' data to receive new treatments, fair allocation of treatment budgets, and providing researchers with novel ideas to carry out research projects.
Access this article: https://doi.org/10.1016/j.msard.2023.104610
Title: Neural bases of motor fatigue in multiple sclerosis: A multimodal approach using neuromuscular assessment and TMS-EEG
Authors: Giorgio Leodori, Marco Mancuso, Davide Maccarrone, Matteo Tartaglia, Antonio Ianniello, Francesco Certo, Viola Baione, Gina Ferrazzano, Leonardo Malimpensa, Daniele Belvisi, Carlo Pozzilli, Alfredo Berardelli, Antonella Conte
Type: Research Article
Abstract:
Motor fatigue is one of the most common symptoms in multiple sclerosis (MS) patients. Previous studies suggested that increased motor fatigue in MS may arise at the central nervous system level. However, the mechanisms underlying central motor fatigue in MS are still unclear.
This paper investigated whether central motor fatigue in MS reflects impaired corticospinal transmission or suboptimal primary motor cortex (M1) output (supraspinal fatigue). Furthermore, we sought to identify whether central motor fatigue is associated with abnormal M1 excitability and connectivity within the sensorimotor network.
Twenty-two patients affected by relapsing-remitting MS and 15 healthy controls (HCs) performed repeated blocks of contraction at different percentages of maximal voluntary contraction with the right first dorsal interosseus muscle until exhaustion. Peripheral, central, and supraspinal components of motor fatigue were quantified by a neuromuscular assessment based on the superimposed twitch evoked by peripheral nerve and transcranial magnetic stimulation (TMS). Corticospinal transmission, excitability and inhibition during the task were tested by measurement of motor evoked potential (MEP) latency, amplitude, and cortical silent period (CSP). M1 excitability and connectivity was measured by TMS-evoked electroencephalography (EEG) potentials (TEPs) elicited by M1 stimulation before and after the task.
Patients completed fewer blocks of contraction and showed higher values of central and supraspinal fatigue than HCs. We found no MEP or CSP differences between MS patients and HCs. Patients showed a post-fatigue increase in TEPs propagation from M1 to the rest of the cortex and in source-reconstructed activity within the sensorimotor network, in contrast to the reduction observed in HCs. Post-fatigue increase in source-reconstructed TEPs correlated with supraspinal fatigue values.
To conclude, MS-related motor fatigue is caused by central mechanisms related explicitly to suboptimal M1 output rather than impaired corticospinal transmission. Furthermore, by adopting a TMS-EEG approach, we proved that suboptimal M1 output in MS patients is associated with abnormal task-related modulation of M1 connectivity within the sensorimotor network. Our findings shed new light on the central mechanisms of motor fatigue in MS by highlighting a possible role of abnormal sensorimotor network dynamics. These novel results may point to new therapeutical targets for fatigue in MS.
Access this article: https://doi.org/10.1016/j.nbd.2023.106073
