Background: Intrathecal baclofen (ITB) is traditionally reserved for non-ambulatory patients. Objective: To investigate outcomes of ITB in ambulatory multiple sclerosis (MS) patients. Methods: Changes in outcome measures were estimated by a mixed effect model, while the complication rate was calculated using a logistic regression. Predictors of non-ambulatory status were identified by Cox model. Results: In all, 256 patients received an ITB test injection and 170 underwent ITB surgery. Aggregate Modified Ashworth Scale (MAS) scores for the ambulatory ITB cohort decreased from 13.5 ± 6.96 to 4.54 ± 4.18 at 5 years ( p < 0.001). There was no significant change in walking speed 1 year post ITB surgery (0.45 m/second ± 0.30 vs 0.38 m/second ± 0.39, p = 0.80) with 77.8% of patients remaining ambulatory which decreased to 41.7% at year 5. Longer MS disease duration (hazard ratio (HR): 1.04; 95% confidence interval (CI): 1.01–1.07; p = 0.018) and lower hip flexor strength (HR: 0.40; 95% CI: 0.27–0.57; p < 0.001) predicted non-ambulatory status after surgery. Complications were more likely in the ambulatory cohort (odds ratio (OR): 3.30, 95% CI: 2.17–5.02; p = 0.017). Conclusion: ITB is effective for ambulatory MS patients without compromising short-term walking speed, although a higher complication rate was observed in this cohort.

The coronavirus disease 2019 (COVID-19) pandemic has catalyzed the rapid adoption of telemedicine which encompasses synchronous and asynchronous interactions between patients and providers. In order to facilitate this rapid deployment, there has been numerous regulatory changes to ensure caregivers can effectively communicate with patients during this time. We illustrate a model where people, processes, and technology work together to address the comprehensive needs of multiple sclerosis (MS) patients. We provide a template for how multidisciplinary, academic practices can implement a rapid shift to virtual management during the pandemic using existing infrastructure that can be widely adopted to care for patients with chronic diseases. Telemedicine was incorporated into our entire practice, which encompasses neurology, rehabilitation, advanced practice providers, fellows, social work, and behavioral medicine. Our patient satisfaction results remained stable across almost all domains when compared to survey results from our typical, in-office visits. Our experience demonstrates telemedicine’s transformative potential in successfully managing a multidisciplinary MS clinic during the time of a pandemic and outlines a potential path for other practices to follow.

Objective. Aquaporin-4 (AQP4) serum autoantibodies are detected by a variety of methods. The highest sensitivity is achieved with cell-based assays, but the enzyme-linked immunosorbent assay (ELISA) is still commonly utilized by clinicians worldwide. Methods. We performed a retrospective review to identify all patients at the University of Utah who had AQP4 ELISA testing at ARUP Laboratories from 2010 to 2017. We then reviewed their diagnostic evaluation and final diagnosis based on the ELISA titer result. Results. A total of 750 tests for the AQP4 ELISA were analyzed, and 47 unique patients with positive titers were identified. Less than half of these patients (49%) met the clinical criteria for neuromyelitis optica spectrum disorder (NMOSD). In cases of low positive titers (3.0–7.9 U/mL, n = 19 ), the most common final diagnosis was multiple sclerosis (52.6%). In the moderate positive cohort (8.0–79.9 U/mL, n = 14 ), only a little more than half the cohort (64.3%) had NMOSD. In cases with high positives (80–160 U/mL, n = 14 ), 100% of patients met clinical criteria for NMOSD. Conclusions. Our data illustrates diagnostic uncertainty associated with the AQP4 ELISA, an assay that is still commonly ordered by clinicians despite the availability of more sensitive and specific tests to detect AQP4 autoantibodies in patients suspected of having NMOSD. In particular, low positive titer AQP4 ELISA results are particularly nonspecific for the diagnosis of NMOSD. The importance of accessibility to both sensitive and specific AQP4 testing cannot be overemphasized in clinical practice.

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A growing body of literature supports an association between long-term endurance exercise and the development of atrial fibrillation (AF). Given the benefits of lifelong exercise, a better understanding of this association is critical to allow healthcare providers to counsel aging exercisers on the proper “dose” of exercise to maximize health benefits but minimize AF risk. The current study examines the relationship between specific aspects of training volume and intensity and the occurrence of AF among older runners in order to better understand what aspects of endurance exercise may contribute to the development of AF. The study was an Internet-based survey of endurance training and health characteristics of runners 35 years of age and older. A total 2819 runners participated and 69 (2.4%) reported a current or prior diagnosis of AF. Among “traditional” risk factors, runners reporting AF were older, more likely to be male, and had higher rates of hypertension and diabetes. Among training characteristics, only accumulated years of training was associated with AF. In contrast, average weekly mileage, training pace, and days of training per week were not associated with AF. In a multivariable analysis that included chronologic age, sex, diabetes, and hypertension, accumulated years of training remained significantly associated with the report of AF. These findings suggest that the relationship between chronic endurance exercise and AF is dependent on the accumulated training duration but does not appear to be influenced by specific training characteristics such as frequency or intensity of endurance exercise. Further confirmation of these relationships may help healthcare providers counsel exercisers on optimal training habits and identify endurance athletes who are at risk for the development of AF.

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