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Sullivan AB, Davis B, Kidd J, Chiong-Rivero H. Understanding Depression in People Living with Multiple Sclerosis: A Narrative Review of Recent Literature. Neurol Ther 2025; 14:681-710. [PMID: 40146488 PMCID: PMC12089588 DOI: 10.1007/s40120-025-00728-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Accepted: 03/06/2025] [Indexed: 03/28/2025] Open
Abstract
Multiple sclerosis (MS) is a chronic neurodegenerative and autoimmune disease that affects approximately 1 million adults in the US. Psychologic disorders are typical comorbidities in people with MS (pwMS), with depression being the most common. Clinical depression in pwMS can substantially impact quality of life and factor heavily in treatment adherence. Depression can surface early in MS, becoming more prevalent as the disease progresses and the severity of clinical disability increases. The etiology of comorbid depression in pwMS is not completely understood, but recent research has indicated that structural and functional brain abnormalities, along with genetic and immunologic factors, may contribute to the pathogenesis of depression in pwMS. Although depression has a significant impact on pwMS, it is often underdiagnosed and undertreated. Furthermore, the efficacy of pharmacologic and non-pharmacologic approaches for treating depression in pwMS has not been thoroughly investigated, with most studies showing minimal or no beneficial effect. Improved evaluation and diagnosis of depression and a better understanding of its pathophysiology may provide a stronger foundation for treatment and management of pwMS suffering from depression. This review discusses recent research on the potential causes of depression, the risk factors associated with developing depression, and the overall impact of depression in pwMS. It also reviews patient-reported outcomes utilized to assess depression in pwMS and the impact of disease-modifying therapies on depression in pwMS. Consideration is also given to management of depression in pwMS (both pharmacologic and non-pharmacologic) to better facilitate the patient journey.
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Affiliation(s)
| | - Bryan Davis
- Hussung Family Multiple Sclerosis Center, Norton Neuroscience Institute, Louisville, KY, USA
| | - Julie Kidd
- Roanoke Area MS Center, Salem, VA, USA
- Edward Via College of Osteopathic Medicine-Virginia Campus, Blacksburg, VA, USA
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Hosseini M, Shamsikhani S, Jadidi A, Rafiei F. The effects of Leventhal's self-regulation model-based educational intervention on stress, anxiety, and depression in women with multiple sclerosis: a randomized educational trial. Front Neurol 2025; 16:1521112. [PMID: 40417120 PMCID: PMC12098595 DOI: 10.3389/fneur.2025.1521112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Accepted: 04/24/2025] [Indexed: 05/27/2025] Open
Abstract
Background Multiple sclerosis (MS) is a long-term, progressive neurological condition that affects the myelin sheath of nerve cells in the central nervous system. Mental health concerns are often overlooked in individuals with MS, stemming from various aspects of the illness, such as its inherent characteristics and symptoms. The present research aimed to examine the impact of Leventhal self-regulation training on stress, anxiety, and depression in MS patients. Methods The current study was conducted as a randomized educational trial of 60 women referred to the MS Association in Arak City in 2024. The study implemented self-regulation training via the Leventhal model, which consisted of an initial face-to-face session to provide basic knowledge, eight offline sessions, and two online group sessions. The data were input into SPSS 26 software. Chi-square tests and Fisher's exact tests were utilized, independent t-tests, and Mann-Whitney's nonparametric equivalent. A repeated measures analysis of variance was conducted to assess the changes over three time points. Additionally, the Bonferroni post hoc correction was utilized. In the present study, data collection consisted of two parts: the demographic information form and the Depression Anxiety Stress Scale (DASS) questionnaire. The Iranian registry Clinical Trial code (IRCT) is IRCT20220703055351N3. Result The findings of this research indicated that there were no disparities in anxiety (p = 0.072), stress (p = 0.067), or depression (p = 0.170) between the control and experimental groups before the intervention. The mean (± standard deviation) anxiety, stress, and depression scores of the experimental group changed from 4.89 (4.34), 8.55 (5.57), and 6.82 (4.26) to 1.96 (2.48), 4.93 (4.55), and 4.37 (3.73) after the intervention, respectively (p < 0.05). Discussion Recent research has shown that training based on the Leventhal model is effective in reducing stress, anxiety, and depression in MS patients. Additionally, the results showed that the ability of Leventhal training to improve depression was stable for one month. Clinical trial registration https://irct.behdasht.gov.ir/, IRCT20220703055351N3.
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Affiliation(s)
- Mahsa Hosseini
- Shazand School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | | | - Ali Jadidi
- Department of Nursing, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran
| | - Fatemeh Rafiei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Pawar P, Xie SM, Varghese AR, Smith A, Gao J, Kamp EV, Kirklin K, Jones BA, Meador WR, Yuen HK. Exploring the Therapeutic Role of Coach-Guided Videoconferencing Expressive Writing in Multiple Sclerosis: A Qualitative Study. Healthcare (Basel) 2025; 13:1104. [PMID: 40427941 PMCID: PMC12111252 DOI: 10.3390/healthcare13101104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2025] [Revised: 04/28/2025] [Accepted: 05/07/2025] [Indexed: 05/29/2025] Open
Abstract
Background/Objectives: Emotional changes significantly affect people with multiple sclerosis (PwMS), often leading to negative psychological symptoms including grief. Effective management of these symptoms can foster personal growth, increase confidence, and renew hope. While expressive writing has demonstrated psychological benefits in processing trauma and chronic conditions, its effects on PwMS remain underexplored. This study aimed to address this gap by examining the experiences of PwMS who participated in a 10-week coach-guided videoconferencing expressive writing program. Methods: Twenty-five adults with MS from 10 different states across the United States participated in a 10-week coach-guided videoconferencing expressive writing program. After they completed the program, participants were interviewed individually via Zoom using a structured guide. Interviews explored participants' experiences and perceptions of the program. All interviews were audio-recorded and transcribed verbatim for analysis. Interview transcripts were analyzed using thematic analysis within a phenomenological framework. Results: Analysis revealed four themes reflecting therapeutic benefits received from the expressive writing program. These themes included Improved Emotional Processing, Promoting Healing; Therapeutic Coping; Radical Acceptance Through Deeper Understanding and Self-Forgiveness; and Empowerment Through Self-Discovery and Transformation. Conclusions: The findings highlight participants' psychological progression from emotional processing to transformation, emphasizing the program's role in guiding them through their experiences of grief and other emotions related to their MS. This process provided them with both a sense of empowerment and a renewed outlook on life. Results suggest that expressive writing is a promising intervention that offers PwMS an accessible tool for emotional well-being and self-discovery.
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Affiliation(s)
- Purva Pawar
- School of Public Health, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL 35294, USA;
| | - Shelly M. Xie
- UAB Arts in Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (S.M.X.); (E.V.K.); (K.K.)
| | - Angel R. Varghese
- College of Arts and Sciences, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL 35294, USA;
| | - Adrian Smith
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, SHPB 354, 1720 2nd Ave S, Birmingham, AL 35294, USA;
| | - Jie Gao
- Medical Laboratory Sciences Program, Department of Clinical and Diagnostic Science, School of Health Professions (SHP), University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Elizabeth Vander Kamp
- UAB Arts in Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (S.M.X.); (E.V.K.); (K.K.)
| | - Kimberly Kirklin
- UAB Arts in Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (S.M.X.); (E.V.K.); (K.K.)
| | - Benjamin A. Jones
- Division of Neuroimmunology and Multiple Sclerosis, Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA (W.R.M.)
| | - William R. Meador
- Division of Neuroimmunology and Multiple Sclerosis, Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA (W.R.M.)
| | - Hon K. Yuen
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, SHPB 354, 1720 2nd Ave S, Birmingham, AL 35294, USA;
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Mikuľáková W, Kendrová LD, Klímová E, Andraščiková Š, Gajdoš M. Impact of Depression, Fatigue, and Pain on Quality of Life in Slovak Multiple Sclerosis Patients. Med Sci Monit 2025; 31:e947630. [PMID: 40285337 PMCID: PMC12042709 DOI: 10.12659/msm.947630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Accepted: 02/25/2025] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, immune-mediated inflammatory disease of the central nervous system that causes demyelination and degeneration of nerve fibers. This study aimed to evaluate factors associated with quality of life, including disability status, pain, fatigue, and depression, in 176 multiple sclerosis patients in Slovakia. MATERIAL AND METHODS A cross-sectional study was conducted among a convenience sample of 176 adult MS patients (151 women, 25 men, average age 46.49 years; min-max: 21-72 years). The Expanded Disability Status Scale (EDSS) was used to determine the level of disability (mean: 4.63±1.81; min-max: 1-8). The study used standardized evaluation questionnaires: the Short Form 36 Health Subject Questionnaire for quality-of-life assessment, the Modified Fatigue Impact Scale for fatigue, the Pain Effect Scale for pain, and Zung's Self-Rating Depression Scale for depression. RESULTS Multiple regression analysis indicated that the most relevant independent predictive factors of poorer quality of life among patients with MS in our study were depression (P≤0.0001), fatigue (P≤0.0001), pain (P≤0.0001), and lack of social support (P=0.003). CONCLUSIONS The present study concludes that the quality of life of MS patients is primarily affected by clinical symptoms of the disease, such as depression, fatigue, and pain. The results suggest that social support plays an important role in the lives of patients with chronic diseases and significantly influences their subjective perception of quality of life.
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Affiliation(s)
- Wioletta Mikuľáková
- Department of Physiotherapy, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | | | - Eleonóra Klímová
- Department of Physiotherapy, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | - Štefánia Andraščiková
- Department of Midwifery, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | - Miloslav Gajdoš
- Department of Physiotherapy, Faculty of Health Care, University of Prešov, Prešov, Slovakia
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Ziaie L, Mazaheri MA, Zabihzadeh A, Etemadifar M, Shokri O, Contrada RJ. Multiple sclerosis and self-alienation: a study based on self and others representations. BMC Psychol 2024; 12:760. [PMID: 39696622 DOI: 10.1186/s40359-024-02264-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 12/05/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is an autoimmune disease of the central nervous system. MS causes many changes in the lives of its patients, forcing them to renegotiate their lives. Part of these changes are related to patients' self- and others- mental representations. Despite the importance of mental representations in changes caused by or adaptation to MS, limited research has been conducted to examine the mental representations of people with MS. METHODS This study examines the mental representations that Healthy Controls (HC) and people with MS (PWMS) have of themselves and others, including childhood and current self-images, as well as those of their mothers, love partners, and close friends. In both groups (HC (n = 82) and PWMS (n = 82)), participants completed demographic variables as well as a modified version of the comfortable interpersonal distance (CID) task in both passive (when protagonists approached them) and active modes (when participants approach protagonists). Participants estimated the point at which they felt discomforted. RESULTS The PWMS group preferred a significantly larger interpersonal distance than the HC group for both current self-image and love partner. There is no difference between the two groups in preferring interpersonal distance from their childhood self-image, mother, and friends. CONCLUSIONS Based on the research results, it seems that PWMS experience a kind of alienation at the level of self-mental representations. This research can be helpful in modifying MS interventions and increasing the engagement of support systems.
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Affiliation(s)
- Leila Ziaie
- Department of Psychology, Faculty of Education & Psychology, Shahid Beheshti University, District 1, Evin, Daneshjou Boulevard, Tehran, 198396411, Iran
| | - Mohammad Ali Mazaheri
- Department of Psychology, Faculty of Education & Psychology, Shahid Beheshti University, District 1, Evin, Daneshjou Boulevard, Tehran, 198396411, Iran
| | - Abbas Zabihzadeh
- Department of Psychology, Faculty of Education & Psychology, Shahid Beheshti University, District 1, Evin, Daneshjou Boulevard, Tehran, 198396411, Iran.
| | - Masoud Etemadifar
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Omid Shokri
- Department of Psychology, Faculty of Education & Psychology, Shahid Beheshti University, District 1, Evin, Daneshjou Boulevard, Tehran, 198396411, Iran
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Doostdari F, Kianimoghadam AS, Arzpeyma M, Fatollahzadeh S, Zakibakhsh Mohammadi N, Masjedi-Arani A, Hajmanouchehri R. Alexithymia and attachment on mental health of people with multiple sclerosis: The mediating role of perceived social support and loneliness. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:444. [PMID: 39811848 PMCID: PMC11731346 DOI: 10.4103/jehp.jehp_1427_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/22/2023] [Indexed: 01/16/2025]
Abstract
BACKGROUND Multiple sclerosis and its progressive relapsing-remitting nature for MS patients is challenging and significantly affects the mental health of people with MS. We examined the direct effects of alexithymia and attachment on mental health and the indirect effect of attachment, alexithymia, loneliness, and perceived social support on the mental health of people with MS. MATERIALS AND METHODS Three hundred and forty-five diagnosed with multiple sclerosis (MS) were deemed eligible for inclusion in the study and selected through the Iranian MS Association. Measures included the Toronto Alexithymia Scale (TAS20), Attachment Style Questionnaire (ASQ), General Health Questionnaire (GHQ28), Social and Emotional Loneliness Scale for Adults (SELSA-S), and Perceived Social Support from Family and Friends Questionnaire (PSS-FA and PSS-F). The mental health of MS patients was analyzed using structural equation models (SEM), examining how alexithymia, attachment, social support, and loneliness, directly and indirectly, affect their mental health. The fit of the model to the data was analyzed using the discrepancy function divided by degrees of freedom (CMIN/DF), Normed Fit Index (NFI), Tucker-Lewis Index (TLI), Comparative Fit Index (CFI), and Root Mean Square Error of Approximation (RMSEA). RESULTS The results showed that the model fit was good. Furthermore, findings indicate that 28% (R2 = 0.28) of the mental health changes are explained via study predictors. Alexithymia and attachment directly affect mental health. Attachment style indirectly affects social support and loneliness, while loneliness and family support indirectly affect the mental health of MS patients. CONCLUSION The study findings provide valuable insights into the fundamental structures that influence the mental health of individuals with MS. Loneliness and social support are critical mediating factors that significantly impact the mental well-being of these patients. In the times ahead, healthcare professionals must prioritize attachment, alexithymia, social support, and loneliness in their medical and psychological interventions for individuals diagnosed with multiple sclerosis.
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Affiliation(s)
- Farnaz Doostdari
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Amir Sam Kianimoghadam
- Department of Clinical Psychology, Religion and Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahyar Arzpeyma
- Department of Psychology, School of Humanities, Lahijan Branch Islamic Azad University, Guilan, Iran
| | - Saina Fatollahzadeh
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | | | - Abbas Masjedi-Arani
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
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Collins J, Babenko-Mould Y, Jackson KT, Smith-Carrier T. Barriers to the health and well-being of women with multiple sclerosis in Southwestern Ontario, Canada. Nursing 2024; 54:54-61. [PMID: 39302754 DOI: 10.1097/nsg.0000000000000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
PURPOSE This study explores the lived experiences of women living with multiple sclerosis (MS) and identifies barriers to their optimal health and well-being. METHODOLOGY Using van Manen's interpretative phenomenologic analysis, the researchers conducted semistructured interviews with 23 women diagnosed with MS in Southwestern Ontario, Canada. Data were analyzed using NVivo 12 software, and themes were validated through member checking. RESULTS The study revealed a key theme of "obstacles for women with MS" and subthemes related to barriers to physical, mental, and social well-being. Participants reported experiencing feelings of health despite their MS diagnosis but identified various constraints on their optimal health and well-being, including challenges with employment, financial support, and housing security. CONCLUSION The findings highlight the need for healthcare professionals to advocate for equitable treatments, medication, and accessibility supports for women with MS, as well as for policies that address disability income support and affordable housing. Further research is recommended to explore power imbalances experienced by women with MS in precarious employment situations or living with episodic disabilities.
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Affiliation(s)
- Jennifer Collins
- Jennifer Collins is an assistant professor of nursing at the Memorial University of Newfoundland, Canada. Yolanda Babenko-Mould and Kimberley T. Jackson are assistant professors at Western University, Canada. Tracy Smith-Carrier is an associate professor and Canada Research Chair at Royal Roads University, Canada
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Mikula P, Timkova V, Vitkova M, Szilasiova J, Nagyova I. Suicidal ideation in people with multiple sclerosis and its association with coping self-efficacy. Mult Scler Relat Disord 2024; 87:105677. [PMID: 38728959 DOI: 10.1016/j.msard.2024.105677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/09/2023] [Accepted: 05/06/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Chronic neurological disease such as multiple sclerosis (MS), is a significant risk factor for psychological distress, which can result in suicidal behaviour. Suicidal ideation (SI) is considered a harbinger of suicide-related mortality. However, so far, little is known about the role of protective factors against SI in MS. OBJECTIVE This study aims to assess the association between coping self-efficacy and SI when controlled for sociodemographic variables, clinical variables, sleep-related problems, and depression. METHODS The study sample consisted of 162 people with MS, was predominantly female (75.9 %), the mean age was 40.9 ± 11.4 years, the mean disease duration was 11.7 ± 7.1 years, and the mean functional disability score was 3.55 ± 1.1. We used the Coping Self-Efficacy scale (CSE), the General Health Questionnaire-28 (GHQ-28), the Expanded Disability Status Scale (EDSS), the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), and the Multidimensional Fatigue Inventory (MFI). Multiple linear regressions were utilized to statistically analyse the data. RESULTS All assessed coping self-efficacy dimensions were significantly associated with SI in MS when controlled for sociodemographic variables, clinical variables, sleep-related problems, and depression. Furthermore, all assessed coping self-efficacy dimensions were able to alleviate the negative association between income, depression and SI. CONCLUSION People with MS may significantly benefit from psychological support aimed at promoting coping self-efficacy and utilization of various coping strategies. Problem-focused coping, coping focused on getting support, and coping focused on stopping unpleasant thoughts and feelings seem to have comparable associations with SI, and thus interventions aimed at empowering any of these dimensions may be beneficial in diminishing the severity of SI.
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Affiliation(s)
- Pavol Mikula
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Slovakia
| | - Vladimira Timkova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Slovakia.
| | - Marianna Vitkova
- Department of Neurology, Faculty of Medicine, PJ Safarik University in Kosice, Slovakia
| | - Jarmila Szilasiova
- Department of Neurology, Faculty of Medicine, PJ Safarik University in Kosice, Slovakia
| | - Iveta Nagyova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Slovakia
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Dakanalis A, Tryfonos C, Pavlidou E, Vadikolias K, Papadopoulou SK, Alexatou O, Vorvolakos T, Chrysafi M, Fotiou D, Mentzelou M, Serdari A, Chatzidimitriou M, Dimoliani S, Tsourouflis G, Giaginis C. Associations between Mediterranean Diet Adherence, Quality of Life, and Mental Health in Patients with Multiple Sclerosis: A Cross-Sectional Study. J Pers Med 2024; 14:199. [PMID: 38392632 PMCID: PMC10890719 DOI: 10.3390/jpm14020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The Mediterranean diet (MD) is well-known as a diet which may exert a protective effect against neurodegenerative diseases, including multiple sclerosis (MS). To date, only a few clinical surveys have assessed the potential effects of the MD in patients with MS. The purpose of the present study is to evaluate the potential effects of MD compliance on disease disability, quality of life, physical activity, depressive symptomatology, and blood biochemical parameters related to nutritional status in MS patients, considering several socio-demographic, anthropometric, and lifestyle characteristics. METHODS This is a cross-sectional study conducted on 558 adults with MS aged 18-64 years. Relevant questionnaires were utilized to evaluate socio-demographic and anthropometric parameters, disease disability (Expanded Disability Status Scale, EDSS), multidimensional health-related quality (MS Quality of Life-54, MSQOL-54), physical activity levels (International Physical Activity Questionnaire, IPAQ), depression (Beck Depression Inventory II, BDI-II), and MD adherence (MedDietScore), while several blood biochemical parameters were retrieved from the patients' medical records. RESULTS Enhanced MD compliance was independently associated with a decreased frequency of overweight/obesity, as well as abdominal obesity, in patients suffering from MS. Elevated MD compliance was also independently associated with a decreased incidence of advanced disease disability, a higher prevalence of elevated physical activity, an improved quality of life, and lower depressive symptoms, as well as higher levels of certain blood biochemical parameters, which are effective indicators of iron deficiency and malnutrition. CONCLUSIONS The present study found that higher MD adherence may slow down disease disability, promoting a better quality of life and mental health in adults with MS. Future prospective surveys are required to obtain conclusive results.
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Affiliation(s)
- Antonios Dakanalis
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
- Department of Medicine and Surgery, University of Milan Bicocca, Via Cadore 38, 20900 Monza, Italy
| | - Christina Tryfonos
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Konstantinos Vadikolias
- Department of Neurology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Sousana K Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Olga Alexatou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Theofanis Vorvolakos
- Department of Psychiatry, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Maria Chrysafi
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Dimitrios Fotiou
- Department of Neurology, School of Medicine, Aristoteleio University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Aspasia Serdari
- Department of Psychiatry, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Maria Chatzidimitriou
- Department of Biomedical Sciences, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Sophia Dimoliani
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Gerasimos Tsourouflis
- Second Department of Surgery, Propedeutic, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Lemnos, Greece
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Bainbridge J, Barnhart R, Fuller R, Hellerslia VT, Kidd J, Merrill S, Volger E, Montgomery JH. The Role of Clinical Pharmacists in Patient-Centric Comprehensive Multiple Sclerosis Care. Int J MS Care 2024; 26:1-7. [PMID: 38213670 PMCID: PMC10779712 DOI: 10.7224/1537-2073.2022-051] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Individuals with multiple sclerosis (MS) may experience a variety of visible and invisible symptoms and, as they age, comorbidities related and unrelated to their MS. This can result in a complex medication regimen that includes disease-modifying therapies, symptom management drugs, and prescriptions for other comorbid disorders. METHODS We reviewed the existing literature to discover how to optimally integrate neurology clinical pharmacists into the MS care team and how clinical pharmacists can directly support both providers and patients through their expertise in pharmacology and medication management. RESULTS With approaches founded on a shared decision-making process alongside neurology providers, patients, and care partners, clinical pharmacists can help meet the complex challenges of MS care in a variety of ways. Especially within MS clinics, they are well positioned to enhance current neurology practices given their extensive training in comprehensive medication management and their ability to identify nuances in medication management to promote pharmacovigilance and patient-centered care. CONCLUSIONS Neurology clinical pharmacists bring multifaceted medication management and patient counseling and education skills to the MS care team and can support the shared decision-making process by serving as an accessible resource for patients and clinicians. By building trusted partnerships between neurology providers and clinical pharmacists, MS care teams can achieve effective and efficient patient care. Future research should compare clinical and patient-reported outcomes between patients receiving standard care and those receiving multidisciplinary, pharmacist-integrated care.
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Affiliation(s)
- Jacquelyn Bainbridge
- From the Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA (JB)
| | - Rebecca Barnhart
- University of Colorado Health, Ambulatory Care Pharmacy Services, Aurora, CO, USA (RB)
| | - Ryan Fuller
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA (RF)
| | - Van T. Hellerslia
- Temple University School of Pharmacy; Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA (VTH)
| | - Julie Kidd
- Roanoke Area MS Center, Salem, VA, USA (JK)
| | - Steven Merrill
- UCSF MS & Neuroinflammation Center, UCSF Medical Center, San Francisco, CA, USA (SM)
| | - Emily Volger
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA (EV)
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Roever L, Cavalcante BRR, Improta-Caria AC. Long-term consequences of COVID-19 on mental health and the impact of a physically active lifestyle: a narrative review. Ann Gen Psychiatry 2023; 22:19. [PMID: 37170283 PMCID: PMC10174610 DOI: 10.1186/s12991-023-00448-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/16/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Coronavirus-19 disease (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Respiratory viruses damage not only the upper respiratory tract in humans, but also several different organs such as the brain. Some of the neurological consequences of COVID-19 reported are anosmia, headache, stroke, declined cognitive function, and impaired mental health, among others. People who had COVID-19 have a higher risk of sequelae in the central nervous system (CNS). However, it is not known which are all possible sequelae and how long will last the long-term effects of the COVID-19 pandemic on behavioral patterns and quality of life. AIM We intend to address the long-term impacts of COVID-19 on mental health and the relevance of physical exercise during the pandemic. METHODS We conducted a literature search using PubMed to find the articles that were related to these themes. RESULTS We found 23,489 papers initially, and then we applied the inclusion/exclusion criteria to narrow down our search to 3617 articles and selected 1380 eligible articles after a thorough reading of titles and abstracts. The findings indicated that COVID-19 impacted general mental health and led many not only hospitalized patients to develop cognitive decline, memory impairment, anxiety, sleep alterations, and depressive-like behavior. Furthermore, the fear of vaccines and their effects had negatively affected mental health and directly impacted mortality rates in unvaccinated COVID-19 patients. CONCLUSIONS Preventive measures must be undertaken, such as the vaccination of the entire population, vaccination hesitancy discouragement by creating awareness among individuals, and people's engagement in a physically active lifestyle, since being physically active is a low-cost and effective measure to restore or inhibit the negative outcomes from COVID-19 on mental health.
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Affiliation(s)
- Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil.
| | - Bruno Raphael Ribeiro Cavalcante
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador, Brazil
- Department of Pathology and Forensic Medicine, School of Medicine, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Alex Cleber Improta-Caria
- Post-Graduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia (UFBA), Salvador, Brazil
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12
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Vesic K, Gavrilovic A, Mijailović NR, Borovcanin MM. Neuroimmune, clinical and treatment challenges in multiple sclerosis-related psychoses. World J Psychiatry 2023; 13:161-170. [PMID: 37123101 PMCID: PMC10130959 DOI: 10.5498/wjp.v13.i4.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/16/2023] [Accepted: 03/23/2023] [Indexed: 04/18/2023] Open
Abstract
In recent years, epidemiological and genetic studies have shown an association between autoimmune diseases and psychosis. The question arises whether patients with schizophrenia are more likely to develop multiple sclerosis (MS) later in life. It is well known that the immune system plays an important role in the etiopathogenesis of both disorders. Immune disturbances may be similar or very different in terms of different types of immune responses, disturbed myelination, and/or immunogenetic predispositions. A psychotic symptom may be a consequence of the MS diagnosis itself or a separate entity. In this review article, we discussed the timing of onset of psychotic symptoms and MS and whether the use of corticosteroids as therapy for acute relapses in MS is unfairly neglected in patients with psychiatric comorbidities. In addition, we discussed that the anti-inflammatory potential of antipsychotics could be useful and should be considered, especially in the treatment of psychosis that coexists with MS. Autoimmune disorders could precipitate psychotic symptoms, and in this context, autoimmune psychosis must be considered as a persistent symptomatology that requires continuous and specific treatment.
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Affiliation(s)
- Katarina Vesic
- Department of Neurology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac 34000, Sumadija, Serbia
| | - Aleksandar Gavrilovic
- Department of Neurology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac 34000, Sumadija, Serbia
| | - Nataša R Mijailović
- Department of Pharmacy, University of Kragujevac, Faculty of Medical Sciences, Kragujevac 34000, Sumadija, Serbia
| | - Milica M Borovcanin
- Department of Psychiatry, University of Kragujevac, Faculty of Medical Sciences, Kragujevac 34000, Sumadija, Serbia
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13
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Cindik Herbrüggen ED, Özada Nazım A, Köseoğlu M, Demirkol R. Psychosocial Difficulties Experienced by MS Patients in their Quality of Life: A Comparative Study of Two Countries. Mult Scler Relat Disord 2023; 73:104604. [PMID: 37003007 DOI: 10.1016/j.msard.2023.104604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/20/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND MS is deeply impacted by social factors, such as access to health services, support from official and unofficial sources, and social welfare, which are also thought to contribute to the quality of life of MS patients. The purpose of this study is to examine the quality of life and to analyse the psychosocial challenges of MS patients in North Cyprus and Germany. METHODS This study was designed with a cross-sectional and comparative research method. The personal information form and the WHO Quality of Life Scale Short Form were used. A total sixty-eight participants joined the study: 35 German patients and 33 Turkish Cypriot patients. Researchers collected the data by face-to-face interviews between December 2021 and March 2022. The majority of MS patients were females average age was 49.48 years old. RESULTS In general, the two populations had comparable total sub-dimension scores of quality of life. However, only environment sub-dimension score has significant difference between Germany (x̄ =70.04) and North Cyprus (x̄ =55.87). Perceived opportunities for accessing medication, physiotherapy, and psychological support, as well as the opportunity to receive psychological support after the time of diagnosis were considered greater in the German group compared to the Turkish Cypriot one. CONCLUSION Findings from this cross-sectional research demonstrate significant differences in services provided, particularly in the psychosocial domain, between those in Germany and those in Cyprus. Consequently, all parties in both countries (governments, families, health workers, social workers and people with MS) should cooperate to improve social support mechanisms. Moreover, it is needed better access to health services in Northern Cyprus.
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Affiliation(s)
| | - Ayşe Özada Nazım
- Social Work Department, Cyprus International University, 99258 Nicosia, North Cyprus, Turkey
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14
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Understanding the Effect of Multiple Sclerosis on General and Dimensions of Mental Health. J Clin Med 2022; 11:jcm11247483. [PMID: 36556099 PMCID: PMC9784896 DOI: 10.3390/jcm11247483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/21/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The objective of the current study is to investigate how general and dimensions of mental health are affected by multiple sclerosis (MS). METHODS Factor analysis, generalized linear models, and one-sample t-tests were used to analyze data from 78 people with MS with a mean age of 52.19 (S.D. = 12.94) years old and 25.64% males and 38,516 people without MS with a mean age of 49.10 (S.D. = 18.24) years old and 44.27% males from Understanding Society. RESULTS The current study found that there are three underlying factors of the GHQ-12 labeled as GHQ-12A (social dysfunction and anhedonia; 6 items), GHQ-12B (depression and anxiety; 4 items), and GHQ-12C (loss of confidence; 2 items), and the general mental health, GHQ-12A (social dysfunction and anhedonia), and GHQ-12C (loss of confidence) are associated with MS. CONCLUSIONS Effective mental health management in MS patients is important given mental health in people with MS is linked to the onset of MS and exacerbating disease progression/relapses.
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15
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Freeman L, Longbrake EE, Coyle PK, Hendin B, Vollmer T. High-Efficacy Therapies for Treatment-Naïve Individuals with Relapsing-Remitting Multiple Sclerosis. CNS Drugs 2022; 36:1285-1299. [PMID: 36350491 PMCID: PMC9645316 DOI: 10.1007/s40263-022-00965-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/11/2022]
Abstract
There are > 18 distinct disease-modifying therapy (DMT) options covering 10 mechanisms of action currently approved by the US Food and Drug Administration for the treatment of relapsing-remitting multiple sclerosis (RRMS). Given the multitude of available treatment options, and recent international consensus guidelines offering differing recommendations, there is broad heterogeneity in how the DMTs are used in clinical practice. Choosing a DMT for newly diagnosed patients with MS is currently a topic of significant debate in MS care. Historically, an escalation approach to DMT was used for newly diagnosed patients with RRMS. However, the evidence for clinical benefits of early treatment with high-efficacy therapies (HETs) in this population is emerging. In this review, we provide an overview of the DMT options and MS treatment strategies, and discuss the clinical benefits of HETs (including ofatumumab, ocrelizumab, natalizumab, alemtuzumab, and cladribine) in the early stages of MS, along with safety concerns associated with these DMTs. By minimizing the accumulation of neurological damage early in the disease course, early treatment with HETs may enhance long-term clinical outcomes over the lifetime of the patient.
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Affiliation(s)
- Léorah Freeman
- Department of Neurology, Dell Medical School, The University of Texas at Austin, 1601 Trinity St, Austin, TX, 78701, USA.
| | | | - Patricia K Coyle
- Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Barry Hendin
- Banner, University Medicine Neurosciences Clinic, Phoenix, AZ, USA
| | - Timothy Vollmer
- Department of Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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16
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Seaborn K, Henderson K, Gwizdka J, Chignell M. A meta-review of psychological resilience during COVID-19. NPJ MENTAL HEALTH RESEARCH 2022; 1:5. [PMID: 37521500 PMCID: PMC9255496 DOI: 10.1038/s44184-022-00005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/17/2022] [Indexed: 11/09/2022]
Abstract
Psychological resilience has emerged as a key factor in mental health during the global COVID-19 pandemic. However, no work to date has synthesised findings across review work or assessed the reliability of findings based on review work quality, so as to inform public health policy. We thus conducted a meta-review on all types of review work from the start of the pandemic (January 2020) until the last search date (June 2021). Of an initial 281 papers, 30 were included for review characteristic reporting and 15 were of sufficient review quality for further inclusion in strategy analyses. High-level strategies were identified at the individual, community, organisational, and governmental levels. Several specific training and/or intervention programmes were also identified. However, the quality of findings was insufficient for drawing conclusions. A major gap between measuring the psychological resilience of populations and evaluating the effectiveness of strategies for those populations was revealed. More empirical work, especially randomised controlled trials with diverse populations and rigorous analyses, is strongly recommended for future research.
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Affiliation(s)
- Katie Seaborn
- Department of Industrial Engineering and Economics, Tokyo Institute of Technology, Tokyo, Japan
| | - Kailyn Henderson
- Department of Mechanical and Industrial Engineering, The University of Toronto, Toronto, ON Canada
| | - Jacek Gwizdka
- School of Information, The University of Texas at Austin, Austin, TX USA
| | - Mark Chignell
- Department of Mechanical and Industrial Engineering, The University of Toronto, Toronto, ON Canada
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17
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Zarobkiewicz MK, Morawska I, Kowalska W, Halczuk P, Roliński J, Bojarska-Junak AA. PECAM-1 Is Down-Regulated in γδT Cells during Remission, but Up-Regulated in Relapse of Multiple Sclerosis. J Clin Med 2022; 11:3210. [PMID: 35683597 PMCID: PMC9181399 DOI: 10.3390/jcm11113210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction. PECAM-1 and NKRP1A are both involved in the vascular transmigration of T lymphocytes. Vascular transmigration is a crucial process in multiple sclerosis pathogenesis. Methods and aim. The current paper presents an analysis of PECAM-1 and NKRP1A expression on γδ T cells. Expression of PECAM-1 and NKRP1A on subsets of γδ T cells was performed with flow cytometry. Results. Based on the flow cytometry data, PECAM1 was slightly differentially modulated on γδ T cells-it was up-regulated during relapse, but down-regulated during remission. Moreover, a significant downregulation of CD3 expression was noted on γδ T cells from MS patients, most notably during relapse. Conclusions. This may be a sign of the overall activation of γδ T cells in the course of multiple sclerosis.
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Affiliation(s)
- Michał K. Zarobkiewicz
- Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (W.K.); (J.R.)
| | - Izabela Morawska
- Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (W.K.); (J.R.)
| | - Wioleta Kowalska
- Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (W.K.); (J.R.)
| | - Paweł Halczuk
- Department of Neurology, Medical University of Lublin, 20-090 Lublin, Poland;
- Department of Histology and Embryology with Experimental Cytology Unit, Medical University of Lublin, 20-080 Lublin, Poland
| | - Jacek Roliński
- Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (W.K.); (J.R.)
| | - Agnieszka A. Bojarska-Junak
- Department of Clinical Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (W.K.); (J.R.)
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18
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Zaratin P, Banwell B, Coetzee T, Comi G, Feinstein A, Hyde R, Salvetti M, Smith K. Researching COVID-19 in progressive MS requires a globally coordinated, multi-disciplinary and multi-stakeholder approach-perspectives from the International Progressive MS Alliance. Mult Scler J Exp Transl Clin 2022; 8:20552173221099181. [PMID: 35530174 PMCID: PMC9073122 DOI: 10.1177/20552173221099181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/21/2022] [Indexed: 12/01/2022] Open
Abstract
Background The COVID-19 pandemic has reinforced the importance of research for the health of our society and highlighted the need for stakeholders of the health research and care continuum to form a collaborative and interdependent ecosystem. Objective With the world still reeling from waves of the COVID-19 pandemic and adapting to the vaccine rollout at widely different rates, the International Progressive MS Alliance (hereafter Alliance) organized a meeting (April 2021) to consider how the Covid-19 pandemic impacts the health and well-being of people with progressive Multiple Sclerosis (MS). Methods We invited the Alliance stakeholders and experts to present what they have learned about SARS-CoV-2 infection and progressive MS and to define future scientific priorities. Results The meeting highlighted three priorities for additional focus: (1) the impact of Disease Modifying Therapies (DMTs) on the risk of COVID-19 and on the efficacy of COVID-19 vaccines in people with progressive MS; (2) the long-term impact of COVID-19 and COVID-19 vaccines on the biology of progressive MS; and (3) the impact on well-being of people with progressive MS. Conclusion This paper's calls to action could represent a path toward a shared research agenda. Multi-stakeholder and long-term investigations will be required to drive and evolve such an agenda.
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Affiliation(s)
| | - Brenda Banwell
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Anthony Feinstein
- Sunnybrook Research Institute and University of Toronto, Toronto, Canada
| | - Robert Hyde
- Biogen International GMBH, International Progressive MS Alliance Industry Forum representative, Zürich, Switzerland
| | - Marco Salvetti
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Kathryn Smith
- International Progressive MS Alliance, Lyme, CT, USA
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19
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Ghadiri F, Naser Moghadasi A, Sahraian MA. Telemedicine as a strategic intervention for cognitive rehabilitation in MS patients during COVID-19. Acta Neurol Belg 2022; 122:23-29. [PMID: 35094365 PMCID: PMC8801040 DOI: 10.1007/s13760-022-01875-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/17/2022] [Indexed: 12/27/2022]
Abstract
The recent COVID-19 pandemic has taken the lives of nearly 5.2 million up to now. With no definite treatment and considering close contact as the primary mode of transmission, telemedicine has emerged as an essential medical care platform. Virtual medical communications have offered clinicians the opportunity to visit and follow up on patients more efficiently during the lockdown. Not only has telemedicine improved multiple sclerosis (MS) patients’ health and quality of life during the pandemic, but it could also be used as a cost-effective platform for physical and cognitive MS rehabilitation programs. Cognitive impairment is a common problem among MS patients even at the initial phases of the disease. Rehabilitation training programs such as RehaCom, BrainHQ, Speed of Processing Training (PST), and COGNI-TRAcK have made great strides in improving a wide range of cognitive functions that MS patients are challenged with. Regarding the impact of COVID-19 on the cognitive aspects of MS patients, efforts to implement rehabilitation training applications have been increased. Web-based mobile applications, virtual visits, and telephone follow-ups are examples of such efforts. Having said that, limitations such as privacy, socioeconomic disparities, e-health literacy, study settings, and challenges of neurologic examinationss have been raised. Since most MS patients are young, all the beneficiaries are encouraged to embrace the research in the field to pave the road for more feasible and efficient ways of cognitive enhancement in MS patients.
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20
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Hynes SM, O'Keeffe F, Bane E, Oglesby MH, Dwyer CP, Joyce R, Klein OA. Assessment and Management of Cognitive and Psychosocial Difficulties for People with Multiple Sclerosis in Ireland: A National Survey of Clinical Practice. Int J Clin Pract 2022; 2022:3232076. [PMID: 36340964 PMCID: PMC9616662 DOI: 10.1155/2022/3232076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A recent survey of 109 healthcare professionals explored how UK healthcare professionals typically assess and treat multiple sclerosis (MS)-related cognitive impairment. Little is currently known about what constitutes usual care for cognitive impairment and psychosocial care for people with MS in Ireland. AIM The aim of the current research was to survey healthcare professionals (HCPs) who work with people with MS, to understand current assessment and management of cognition and psychosocial care in people with MS in the Republic of Ireland. METHODS A cross-sectional survey design was used. Data were collected online through Microsoft forms and through postal responses. The original UK questionnaire was adapted, piloted, and distributed to Irish HCPs. Participants were qualified HCPs who work clinically with people with MS in the Republic of Ireland. RESULTS Ninety-eight HCPs completed the survey. Only 34% of those surveyed reported routine screening of cognition for people with MS within their services; approximately, 36% HCPs reported that they did not provide information or services in relation to cognition to people with MS and 39% reported not referring elsewhere when cognitive difficulties were suspected. Out of the 98 HCPs, 47% reported assessing mood difficulties as part of their services, with 14% unsure. In total, 70% of participants reported onward referral took place if mood difficulties were identified. The Montreal Cognitive Assessment was the most commonly administrated cognitive assessment. Cognitive intervention choices were found to be guided by clinical judgement in 75.5% of cases. Discussion. Despite the high importance placed on cognitive and psychosocial care, there is very little consistency in treatment and assessment across services for people with MS in Ireland.
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Affiliation(s)
- Sinéad M. Hynes
- Discipline of Occupational Therapy, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | | | - Eimear Bane
- Discipline of Occupational Therapy, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Megan H. Oglesby
- Discipline of Occupational Therapy, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Christopher P. Dwyer
- School of Social Science, Technological University of the Shannon IE, Athlone, Ireland
| | - Robert Joyce
- Discipline of Occupational Therapy, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Olga A. Klein
- German Center for Neurodegenerative Diseases, Rostock, DE, Germany
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21
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Lakin L, Davis BE, Binns CC, Currie KM, Rensel MR. Comprehensive Approach to Management of Multiple Sclerosis: Addressing Invisible Symptoms-A Narrative Review. Neurol Ther 2021; 10:75-98. [PMID: 33877583 PMCID: PMC8057008 DOI: 10.1007/s40120-021-00239-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the central nervous system, leading to neurodegeneration and manifesting as a variety of symptoms. These can include "invisible" symptoms, not externally evident to others, such as fatigue, mood disorders, cognitive impairments, pain, bladder/bowel dysfunction, sexual dysfunction, and vision changes. Invisible symptoms are highly prevalent in people living with MS, with multifactorial etiology and potential to impact the disease course. Patient experiences of these symptoms include both physical and psychosocial elements, which when unaddressed negatively influence many aspects of quality of life and perception of health. Despite the high impact on patient lives, gaps persist in awareness and management of these hidden symptoms. The healthcare provider and patient author experiences brought together here serve to raise the profile of invisible symptoms and review strategies for a team-based approach to comprehensive MS care. We summarize the current literature regarding the prevalence and etiology of invisible symptoms to convey the high likelihood that a person living with MS will contend with one or more of these concerns. We then explore how open communication between people living with MS and their care team, stigma mitigation, and shared decision-making are key to comprehensive management of invisible symptoms. We recommend validated screening tools and technological advancements that may be incorporated into MS care to regularly monitor these symptoms, offering insight into how healthcare providers can both educate and listen to patients, with the goal of improved patient quality of life. By pairing clinical knowledge with an understanding and consideration of the patient perspective, providers will be equipped to foster a patient-centered dialogue that encourages shared decision-making. Invisible symptoms of MS.
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Affiliation(s)
- Lynsey Lakin
- The Neurology Group, 9120 Haven Ave, Rancho Cucamonga, CA, USA
- Comprehensive MS Center, The University of California Riverside, 3390 University Ave, Suite 100, Riverside, CA, USA
| | - Bryan E Davis
- Comprehensive MS Center, The University of California Riverside, 3390 University Ave, Suite 100, Riverside, CA, USA
| | - Cherie C Binns
- Accelerated Cure Project/iConquerMS, 187 Robinson Street, Wakefield, RI, USA
| | - Keisha M Currie
- Currie Consultancy Agency LLC., 11 M. R. Watson Court, Eastover, SC, USA
| | - Mary R Rensel
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
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