ObjectiveTo address the disability impact on fine hand motor functions in patients with Multiple Sclerosis (MS) by quantitatively measuring finger opposition movements, with the aim of providing a new “score” integrating current methods for disability assessment.Methods40 MS patients (Expanded Disability Status Scale (EDSS): 0–7) and 80 healthy controls (HC) performed a repetitive finger-to-thumb opposition sequence with their dominant hand at spontaneous and maximal velocity, and uni- and bi-manually metronome-paced. A sensor-engineered glove was used to measure finger motor performance. Twenty-seven HC were tested twice, one month apart, to assess test-retest reliability.ResultsThe motor parameters showed a good reproducibility in HC and demonstrated significantly worse performance in MS patients with respect to HC. A multivariate model revealed that rate of movement in the spontaneous velocity condition and inter-hand interval (IHI), indicating bimanual coordination, contributed independently to differentiate the two groups. A finger motor impairment score based on these two parameters was able to discriminate HC from MS patients with very low EDSS scores (p<0.001): a significant difference was already evident for patients with EDSS = 0. Further, in the MS group, some motor performance parameters correlated with the clinical scores. In particular, significant correlations were found between IHI and EDSS (r = 0.56; p<0.0001), MS Functional Composite (r = −0.40; p = 0.01), Paced Auditory Serial Addition (r = −0.38; p = 0.02). No motor performance parameter correlated with Timed 25-Foot Walk.ConclusionsA simple, quantitative, objective method measuring finger motor performance could be used to define a score discriminating healthy controls and MS patients, even with very low disability. This sensitivity might be of crucial importance for monitoring the disease course and the treatment effects in early MS patients, when changes in the EDSS are small or absent.
ObjectiveTo study the effect of natural menopause on multiple sclerosis clinical course.MethodsThis was an observational, retrospective, multicentre, cohort study. Menopause onset was defined by the final menstrual period (FMP) beyond which no menses occurred for 12 months. We included multiple sclerosis (MS) patients with FMP occurred after 2005 and a recorded follow-up of at least 2 years pre-FMP and post-FMP. We excluded patients with primary progressive course, iatrogenic menopause and with other confounders that could mask menopause onset. We compared relapse-rate and expanded disability status scale (EDSS) scores pre-FMP and post-FMP, searching for possible interactions with age, disease duration, cigarette smoking and nulliparity status.Results148 patients were included (mean observation: 3.5 years pre-FMP and post-FMP). Most patients (92%) received disease-modifying therapies, mainly first-lines. After menopause the annualised relapse rate (ARR) significantly decreased (from 0.21±0.31 to 0.13± 0.24; p=0.005), while disability worsened (increase of mean 0.4 vs 0.2 points after menopause; p<0.001). Older age and long-lasting disease were associated with ARR reduction (p=0.013), but not with disability worsening. Cigarette smokers showed a trend to a higher disability accumulation after menopause (p=0.059).ConclusionNatural menopause seems to be a turning point to a more progressive phase of MS. Relapse rate is also reduced after menopause, but this effect could be driven most by ageing and shifting to progressive phase in patients with long-lasting disease. Cigarette smoking could speed up disability progression after menopause.
Highlights 1 patient was diagnosed with COVID-19 after PCR execution. 5.4% of MS patients fulfilled defined criteria for COVID-19-suspect group. No patient required hospitalization, ICU care or intubation.
Despite a few initial reports [1-5], the risk and course of COVID-19 in patients with multiple sclerosis (MS) is still unclear. Although neurological disability and comorbid conditions may be important factors, the role played by immune-based disease-modifying therapies (DMTs) in patients with MS has attracted the most attention in this regard [6]. Patients with MS have a generally increased risk of infections [7], particularly those with more severe disability or significant co-morbidities, with evidence for a role for infections in triggering MS relapses or worsening preexisting MS symptoms [8]. MS patients are generally twice as likely to be hospitalized for infections than the general population [9]. Recently, Maghzi et al. [10] reported in this journal a case series of five teriflunomide-treated MS patients who developed COVID-19 infection and continued their therapy with a self-limiting infection and without any relapse. The authors hypothesized that the immune-biologic mechanisms pertaining to teriflunomide have a potential role in favoring a COVID-19-positive outcome.
Our data suggest that isolated ToM deficits could represent an at-risk situation for the development of future prefrontal dysfunction and bvFTD. ToM evaluation should be included in neuropsychological protocols aimed to evaluate the early phases of dementia.
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