Vaccination in Individuals with Multiple Sclerosis – Part I

Multiple sclerosis (MS) is an autoimmune and demyelinating disease of the central nervous system. It is a chronic disease, and in the evaluation of all other health and vital processes, decisions should be made by considering the disease process and the drugs used by the patient. Since vaccination can be performed at every stage of life, from childhood to adulthood, immune system activity, except where it is characteristic of the vaccine, should be reviewed in patients with MS. In this review, the applications of different vaccines in individuals with MS are discussed in two separate sections

Elektrik / Manyetik transkranial kortikal stimulasyon ile tibialis anterior ve soleus kaslarından erken ve geç latanslı yanıtlar

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.SUMMARY Following transcranial magnetic or electrical motor cortex stimulation over the scalp vertex may different responses have been recorded from the healthy subjects especially the lower limb muscles. Short latency responses of about 30 msec may travel via the fastest corticospinal pathway. The later responses appearing with in 200 msec are not well understood. In this study 47 experiments were made normal subjects and 60 patients with different neurological disorders including Parkinsonizm, multiple sclerosis, vascular hemiparezis, motor neuron disorders and cervical lesion. In experiments we used Digitimer electrical and Magstim 200 magnetic coil stimulator. In all normal subjects and patient groups three experimental paradigms were performed: 1.Each subject was lied on an examination table with full relaxation. 2. Ankle was voluntary dorsiflexed at about 90* with mild voluntary contraction of TA 3. The ankle was voluntarily flexed in the planter direction at about 130* angle. Different kinds of maneuver and tests including passive dorsiflexion, jendrassik maneuver, vibration, ischemia were performed in all three paradigms. The stable late responses recorded from soleus muscle while voluntary activation of the antagonist TA muscle is called Soleus MEP-80. This response was elicited in all normal subjects. There were not a specific findings in any patients group. In conclusion the Soleus MEP-80 a polisynaptic extensor response related to postural mechanism and originated through convergence of descending motor commands and peripheral sensory feedback. 91 T.O, Yw"SElffilEETli 13 IMliiMlSTOi !Sk'ÖZET Saçlı deriden motor korteksin elektrik veya manyetik uyarımı ile sağlıklı kişilerde alt ekstremite kaslarından çok farklı yanıtlar kayıtlanmıştır. Yaklaşık 30 msn latanslı olarak saptanan kısa latanslı yanıtlar hızlı kortikospinal yola bağlı olarak ortaya çıkar. 200 msn içinde saptanan geç yanıtların kökeni ise iyi bilinmemektedir. Bu çalışmada 42 normal denek ve parkinson, MS, vaskuler hemiparezi, motor nöron hastalığı, servi kal lezyon gibi değişik nörolojik hastalıkları içeren 60 hastaya TCCS uygulanarak erken ve geç yanıtlar incelendi. TCCS için Digitimer elektrik ve Magstim 200 manyetik uyaran kullanıldı. Bütün normal denekler ve hasta grubundaki tüm deneklere üç deneysel paradigma uygulandı: 1) Denekler muayene masasına tam istirahat koşulunda yatar halde, 2) Ayak bileği 90 olacak şekilde istemli TA kasılması (dorsofleksiyon) 3) Ayak bileği 130 olacak şekilde istemli plantar fleksiyon Ayrıca pasif dorsofleksiyon, jendrassik manevrası, vibrasyon ve iskemi gibi değişik manevra ve testler bu üç deneysel paradigma kombine edildi. Bu çalışmalar sonucunda antagonist TA fasilite iken (istemli ayak dorsofleksiyonu) Soleus kasından 80-90 msn latanslı ve "Soleus MEP-80" olarak tanımlanan geç bir yanıt stabil olarak kayıtlandı. Normal deneklerde ve hasta gruplarında bu yanıtın özellikleri incelendi. Tüm normal deneklerde stabil olarak elde edilen bu yanıt hasta gruplarında değişik özellikler gösterdi, klinik tanıya spesifik bir özellik saptanmadı. Bu yanıtın periferik girdiler ve supraspinal yapıların konverjansı ile ortaya çıkan ve TCCS tetiklediği fizyolojik bir serbest kalma fenomeni olduğu kanısına varıldı. 9

Evaluating Treatment Decision for Multiple Sclerosis

PubMedWo

The Effect of Pulse Methylprednisolone Plus Theophylline Treatment on Clinical, Pulmonary and Inflammatory Markers in Relapses of Multiple Sclerosis

Objective: The aim of this study was to evaluate whether there was a relationship between severity of multiple sclerosis (MS) exacerbation and pulmonary function test (PFT) and to determine the effect of theophylline, which was added to intravenous methylprednisolone, on serum Tumor Necrosis Factor (TNF)-alpha levels and clinical scores in MS relapses. Study Design: Double blind randomized controlled trial. Material and Methods: The baseline Expanded Disability Status Scale (EDSS) score was determined, PFT was performed and blood was taken for analysis of TNF- alpha in patients with MS exacerbation. Patients were randomly divided into two groups; group 1 received intravenous methylprednisolone+IV theophylline and group 2 intravenous methylprednisolone+placebo for 5 days. PFT and EDSS score were repeated and blood was taken for TNF-alpha on the 5th and 30th days of the treatment. Results: Twenty-four patients (14 female, 10 male) were included in the study. Mean age was 32.6±9, duration of disease was 5.4±4.2 years, number of exacerbations was 5±2. There was a significant correlation between the number of exacerbations and EDSS score (p=0.000, r=1). Restrictive PFT findings were detected in 8 and decrease in carbon monoxide diffusing capacity (DLCO) in 3 cases. In within-group analysis, EDSS score was found to be decreased on day 5 and still low on day 30 in the theophylline group (baseline 3±1.3; 5th day 2.4±1.6; 30th day 2±1.7). There was no statistically significant difference in the EDSS score of the placebo group (3±1.6; 2.8±1.7; 2.4±1.9 respectively). While serum TNF-alpha level was not changed in the placebo group, there was a non-significant decrease on day 5 and increase on day 30 in the theophylline group. There was no correlation between the clinical parameters, PFT and TNF-alpha level. Conclusion: There was no correlation between severity of MS and PFT findings. It is suggested that theophylline might be effective in MS exacerbations since it caused decreases in clinical scores; studies with longer treatment duration are needed to clarify its possible anti-inflammatory effect

The effect of cognitive performance on self-management behavior of multiple sclerosis patients

Background: Difficulties of self-management in people with MS (pwMS) is considered as one of the most important factors contributing to low rehabilitation efficacy, more severe long-term complications and increase in healthcare costs. Despite the emergence of research in the last decade documenting causes, types, and course of cognitive difficulties in MS disease subtypes, limited evidence is available in the literature for direct comparison of self-management and cognitive deficits. In this study we aimed to investigate the relationship between cognitive performance and self-management in pwMS. Methods: PwMS who applied to neurology out-patient clinics of seven different centers were included into study. Multiple Sclerosis Self-Management Scale- Revised (MSSM-R) was used for the assessment of self-management behaviors and Multiple Sclerosis inventory cognition scale (MUSIC) was used for the assessment of cognitive performance and fatigue. Results: In this study, 194 (144 female and 50 male) pwMS participated (mean age = 38.9 years). The course of the disease was RRMS in 173 patients and mean EDSS was 2.0. 68.5% of the participants were married, 32.5% were employed, and 57.2% had secondary education. The MSSM-R mean score of the study group was 42.6 +/- 10.4 (1-81). There was a positive correlation between MSSM-R and MUSIC-cog scores (r = 0.21, p = 0.003). A hierarchical multiple regression revealed that income level (beta = 0.196, t = 2.692, p = 0.008) and cognitive performance (beta = 0.167, t = 2.063, p = 0.041) together with control variables (gender, age, educational status, employment status, duration of disease, EDSS and fatigue) explained 5.5% of the variance in self-management. Conclusion: Cognitive performance is a predictor of self-management in pwMS. Better self-management behavior is also related with employment and income level in pwMS. Studies evaluating patients' cognitive abilities and evaluating the effectiveness of adapted self-management training programs are needed

Differences Between General Neurologists and Multiple Sclerosis Specialists in the Management of Multiple Sclerosis Patients: A National Survey

Introduction: The management of multiple sclerosis (MS) has become more complicated after the introduction of new diagnostic and treatment options. Despite the abundance of guidelines, the experience of physicians still plays a major role in the management of patients. This study aimed to define differences in behavior patterns between general neurologists (GNs) and MS specialists (MSSs)

The comparative effectiveness of fingolimod, natalizumab, and ocrelizumab in relapsing-remitting multiple sclerosis

© 2023, Fondazione Società Italiana di Neurologia.Background: Fingolimod, natalizumab, and ocrelizumab are commonly used in the second-line treatment of relapsing-remitting multiple sclerosis (RRMS). However, these have only been compared in observational studies, not in controlled trials, with limited and inconclusive results being reported. A comparison of their effect on relapse and disability in a real-world setting is therefore needed. Objectives: The objective of this study was to compare the efficacy of fingolimod, natalizumab, and ocrelizumab in reducing disease activity in RRMS. Methods: This multicenter, retrospective observational study was carried out with prospectively collected data from 16 centers. All consecutive RRMS patients treated with fingolimod, natalizumab, and ocrelizumab were included. Data for relapses, Expanded Disability Status Scale (EDSS) scores, and brain magnetic resonance imaging (MRI) scans were collected. Patients were matched using propensity scores. Annualized relapse rates (ARR), time to first relapse, and disability accumulation were compared. Results: Propensity score matching retained 736 patients in the fingolimod versus 370 in the natalizumab groups, 762 in the fingolimod versus 434 in the ocrelizumab groups, and 310 in the natalizumab versus 310 in the ocrelizumab groups for final analyses. Mean ARR decreased markedly from baseline after treatment in all three treatment groups. Mean on-treatment ARR was lower in natalizumab-treated patients (0.09, 95% confidence interval (CI), 0.07–0.12) than in those treated with fingolimod (0.17, 0.15–0.19, p<0.001), ocrelizumab (0.08, 0.06–0.11), and fingolimod (0.14, 0.12–0.16, p=0.001). No significant difference was observed in mean on-treatment ARR between patients treated with natalizumab (0.08, 0.06–0.11) and ocrelizumab (0.09, 0.07–0.12, p=0.54). Compared to fingolimod, the natalizumab and ocrelizumab groups exhibited a higher percentage of relapse-free patients and a lower percentage of MRI-active patients at year 1. No significance differences in disability accumulation were determined between the therapies. Conclusion: Natalizumab and ocrelizumab exhibited similar effects on relapse control, and both were associated with better relapse control than fingolimod. The effects of the three therapies on disability outcomes were similar

Vaccination in Individuals with Multiple Sclerosis – Part II Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II

Multiple sclerosis (MS) is an autoimmune and demyelinating disease of the central nervous system. It is a chronic disease, and in the evaluation of all other health and vital processes, decisions about vaccination should be made considering the disease process and the medications used by the patient. Since vaccination can be performed at any stage of life, immune system activity should be reviewed in patients with MS except where it is characteristic of the vaccine. In this review, the applications of different vaccines in patients with MS are discussed in two separate sections (part 1 was published in the previous issue)