Fatigue is a very common symptom in MS, sometimes associated with sleep disorders, depressive symptoms or anxiety. The treatable causes of fatigue in MS such as sleep and mood disturbances should be identified and treated.

213 www.journals.viamedica.pl/neurologia_neurochirurgia_polska Agata Czarnowska et al., SARS-CoV-2 infection in MS patients treated with disease-modifying therapies

lethal and highly pathogenic coronavirus known as SARS -CoV -2 has been reported in China. 5 The first cases of the new coronavirus infection were observed in Wuhan City, Hubei Province, China, in December 2019. Furthermore, a cluster of cases with a clinical presentation of viral pneumonia was also noted. 6 The assessment of the lower respiratory tract samples confirmed the presence of the novel coronavirus, which was contagious among humans. Terms such as "Wuhan coronavirus" or "the new coronavirus" (2019 -nCoV) were commonly used until January 2020. The official name, ie, SARS -CoV -2, which was based on taxonomic designation, appeared on February 11, 2020. At the same time, World Health Organization termed the disease "COVID -19." 7 The recent pneumonia outbreak was associated with a large animal and seafood market. However, the investigations are ongoing Introduction Coronaviruses represent a large group of positive -strand RNA viruses, genetically classified into 4 major genera, ie, alpha-, beta-, gamma-, and deltacoronaviruses. They mainly cause respiratory and enteric diseases in animals and humans. 1 So far, 6 subtypes of human coronaviruses have been recognized, namely, human coronavirus NL63 (HCoV -NL63), human coronavirus 229E (HCoV -229E), human coronavirus OC43 (HCoV -OC43), human coronavirus HKU1 (HCoV -HKU1), severe acute respiratory syndrome coronavirus (SARS -CoV), and Middle East respiratory syndrome coronavirus (MERS--CoV). 2 Although human coronaviruses were first identified in the 1960s, 3 only the SARS -CoV epidemic in 2003 followed by the MERS -CoV epidemic in 2013 drew the attention of researchers worldwide. 4 While the clinical implications of the MERS -CoV epidemic are still noticeable, another

Cel pracyBól jest jednym z najczęściej zgłaszanych objawów stwardnienia rozsianego (SR). Wpływa na codzienne funkcjonowanie chorych, ogranicza zdolność do pracy, zmniejsza radość życia. Celem pracy była analiza wpływu dolegliwości bólowych na jakość życia oraz występowanie objawów lękowych i depresyjnych u chorych na SR.MetodaBadaniem objęto 144 osoby (110 kobiet i 34 mężczyzn) z rozpoznanym na podstawie kryteriów Mc Donalda (2005) SR. Badanie przeprowadzono na podstawie autorskiej ankiety dotyczącej aktualnych i przebytych dolegliwości bólowych, kwestionariusza EuroQol 5D samooceny jakości życia chorych oraz szpitalnej skali oceny lęku i depresji (HADS).WynikiWśród wszystkich badanych, aktualne dolegliwości bólowe zgłaszało 117 osób (81,3%), natomiast 120 osób (83,3%) deklarowało występowanie dolegliwości bólowych w przeszłości. Aktualnie chorzy zgłaszali: bóle kończyn –79 osób (54,9%), bóle głowy i twarzy –72 (50%), bóle kręgosłupa –72 (50%), bolesne kurcze mięśni –54 (38,6%), ból w gałce ocznej –37 (25,7%), objaw Lhermitte’a –32 (22,2%). Nasilenie objawów lękowych i depresyjnych było istotnie statystycznie wyższe u osób zgłaszających dolegliwości bólowe w porównaniu z chorymi bez tego typu dolegliwości (HADS-L: 8,0±4,3 vs 5,1±4,3; p<0,01; HADS-D: 6,0±4,2 vs 3,4±3,7; p<0,01), zaś jakość życia była istotnie niższa (EQ 5D: 8,1±1,9 vs 6,3±1,4; p<0,0001). Stwierdzono związek pomiędzy występowaniem bólu a płcią (p<0,01), wiekiem (p<0,05), stopniem niesprawności (p<0,05), wykształceniem (p<0,001) i pracą zawodową (p<0,01).WnioskiBól u chorych na SR wiąże się z wyższym nasileniem objawów lęku i depresji oraz niższą jakością życia. Płeć żeńska, starszy wiek, niższe wykształcenie, większa niesprawność oraz brak pracy zawodowej predysponują do występowania dolegliwości bólowych u chorych na SR.

(1) Background: To report and analyze the presence of residual symptoms after SARS-CoV-2 infection among Polish patients with multiple sclerosis (MS) treated with different disease-modifying therapies (DMTs). (2) Methods: The study included 426 individuals with MS treated with DMTs and confirmed SARS-CoV-2 infection from 12 Polish MS centers. The data were collected through to 31 May 2021. The information included demographics, specific MS characteristics, course of SARS-CoV-2 infection, and residual (general and neurological) symptoms lasting more than four and 12 weeks after the initial infection. The results were obtained using maximum likelihood estimates for odds ratio and logistic regression. (3) Results: A total of 44.84% patients with MS reported symptoms lasting between four and 12 weeks after the initial infection; 24.41% people had symptoms that resolved up to 12 weeks, and 20.42% patients had symptoms that lasted over 12 weeks. The most common symptoms were: fatigue, disturbance of concentration, attention, and memory, cognitive complaints, and headache. None of the DMTs were predisposed to the development of residual symptoms after the initial infection. A total of 11.97% of patients had relapse three months prior or after SARS-CoV-2 infection. (4) Conclusion: Almost half of individuals with MS treated with different DMTs had residual symptoms after SARS-CoV-2 infection. None of the DMTs raised the probability of developing post-acute COVID symptoms.

(1) Background: The present study aims to report the side effects of vaccination against coronavirus disease 2019 (COVID-19) among patients with multiple sclerosis (MS) who were being treated with disease-modifying therapies (DMTs) in Poland. (2) Methods: The study included 2261 patients with MS who were being treated with DMTs, and who were vaccinated against COVID-19 in 16 Polish MS centers. The data collected were demographic information, specific MS characteristics, current DMTs, type of vaccine, side effects after vaccination, time of side-effect symptom onset and resolution, applied treatment, relapse occurrence, and incidence of COVID-19 after vaccination. The results were presented using maximum likelihood estimates of the odds ratio, t-test, Pearson’s chi-squared test, Fisher’s exact p, and logistic regression. The statistical analyses were performed using STATA 15 software. (3) Of the 2261 sampled patients, 1862 (82.4%) were vaccinated with nucleoside-modified messenger RNA (mRNA) vaccines. Mild symptoms after immunization, often after the first dose, were reported in 70.6% of individuals. Symptoms included arm pain (47.5% after the first dose and 38.7% after the second dose), fever/chills/flu-like symptoms (17.1% after the first dose and 20.5% after the second dose), and fatigue (10.3% after the first dose and 11.3% after the second dose). Only one individual presented with severe side effects (pro-thrombotic complications) after vaccination. None of the DMTs in the presented cohort were predisposed to the development of side effects. Nine patients (0.4%) had a SARS-CoV-2 infection confirmed despite vaccination. (4) Conclusions: Vaccination against SARS-CoV-2 is safe for people with MS who are being treated with DMTs. Most adverse events following vaccination are mild and the acute relapse incidence is low.

Introduction and objectivesThe purpose of this study was to evaluate the concentration of 25-hydroxycholecalciferol and parameters of calcium–phosphate metabolism at different periods of relapsing–remitting multiple sclerosis (RRMS).Materials and methodsForty-five patients, residents of Poland (49°–50°, N), were enrolled in the study, i.e. 15 immediately after the diagnosis of RRMS, 15 at the early stage and 15 at the advanced stage of RRMS. The results were compared to values obtained in 20 age- and sex-matched controls.ResultsLower serum concentrations of 25-hydroxycholecalciferol and ionised calcium were found in patients compared to the control group. In patients with the disease duration of 5–6 years, concentrations of 25-hydroxycholecalciferol and ionised calcium were lower than in patients in the earlier period of RRMS. The inverse and clearer direction of changes was found in parathormone serum concentration in patients compared to the controls. In patients with a longer disease duration, a significantly lower 25-hydroxycholecalciferol concentration was found in female patients compared to male patients. In patients, more frequent 25-hydroxycholecalciferol and unsaturated fatty acids’ supplementation was observed compared to the controls.ConclusionsIn RRMS patients, calcium–phosphate metabolism is disturbed which increases during disease progression.

Background: It is suspected that patients with multiple sclerosis (MS) are at greater risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection due to disability and immunotherapy. The relationship between MS and coronavirus disease 2019 (COVID-19) is uncertain. The aim of the study was to collect and analyze this relationship. Methods: All MS patients of the Neurological Outpatient Clinic in Zabrze, Poland, were regularly questioned for the symptoms of COVID-19 and contact with an infected person. Patients that presented with COVID-19 symptoms or confirmed contact with an infected person were referred for the COVID-19 test. All patients with confirmed SARS-CoV-2 infection (n=41) were included in the analysis. Medical records of the study group were analyzed. Patient condition was monitored in the outpatient clinic after recovery. In 26 subjects, additional examinations, including brain magnetic resonance imaging (MRI), electroneurography (ENG), electroencephalography (EEG), color duplex Doppler (CDD), visual evoked potentials (VEPs), brainstem auditory evoked potentials (BAEPs) and psychological assessment were performed following recovery. Results: Only one patient required hospitalization during COVID-19 infection, whereas 87.80% of patients did not require treatment for COVID-19. In all patients, C-reactive protein (CRP) levels were below 10 mg/L. In 2.44% of patients, oxygen partial pressure was below 95%. In most MS patients, the results of further examinations after COVID-19 infection were similar to those prior to infection. Psychological assessment revealed that anxiety was found in 42.31% of patients. Conclusions: A mild course of COVID-19 in MS patients seems common despite disease-modifying drug treatment and disability. Self-isolation is recommended to reduce the number of infected patients. COVID-19 infection did not worsen the course of MS in most subjects. Patients with MS may require additional psychological support during the pandemic due to their susceptibility to anxiety.