Dual‐task difficulties as a risk factor for unemployment in people with multiple sclerosis

Background No study has investigated the impact of dual-tasking difficulties as a risk factor for unemployment in people with multiple sclerosis (pwMS). The aim was to examine the influence of dual-task performance on employment status and work difficulties and to identify the predictors of employment status in pwMS. Methods Eighty-four pwMS, including 42 employed and 42 unemployed, participated in the study. Dual-task difficulties were assessed using the Dual-task Impact on Daily-living Activities-Questionnaire (DIDA-Q), while dual-task performance was evaluated through the 30-second Walk Test and Nine-Hole Peg Test, incorporating a cognitive task. Walking and cognitive function were also measured. Results Employed pwMS had better scores in walking, cognitive function, single and dual-task performance than unemployed pwMS (p < .05). Lower scores in walking (odds ratio [OR] = 1.81, p < .001) and upper extremity-related (OR = 1.44, p = .019) dual-task performance and higher scores in the cognitive subscale of the DIDA-Q questionnaire (OR = 1.20, p = .037) were significantly associated with higher odds of being unemployed. Among employed pwMS, DIDA-Q subscales showed moderate-to-strong correlations with MSWSDQ-23 scores. The other variables showed weak-to-moderate correlations with subscale and total scores of MSWSDQ-23. Conclusion Cognitive function, as opposed to motor function, has been found to be a significant predictor of unemployment in pwMS

Natalizumab, Fingolimod and Dimethyl Fumarate Use and Pregnancy-Related Relapse and Disability in Women With Multiple Sclerosis

To investigate pregnancy-related disease activity in a contemporary multiple sclerosis (MS) cohort

Symptomatic Menagement in Multiple Sclerosis

Multiple sclerosis (MS) poses a substantial economic and social burden. Patients with MS may have many disabling symptoms that result in high emotional, psychological, and physical burden for the patients and carers. Therefore, since it can improve quality of life, the effective management of symptoms of MS is crucial; however, symptom treatment has received little attention compared with disease-modifying therapies. Although pharmacological strategies are the main component of the treatment of MS symptoms, it should be remembered that a multidisciplinary rehabilitation approach is needed for effective management. (Archives of Neuropsychiatry 2011:48 Supplement 2:83-9

Early Onset Multiple Sclerosis Has Worse Prognosis Than Adult Onset Multiple Sclerosis Based on Cognition and Magnetic Resonance Imaging

Objectives. In the present study, we aimed to compare the childhood and adult onset multiple sclerosis patients prospectively in their adulthood on the basis of clinical and magnetic resonance imaging (MRI) findings and cognitive impairment, which have not been performed before. Patients and Methods. Forty-six patients in whom the disease onset occurred before 16 years of age were included in the present study. Study subjects were compared with 64 randomly included adult onset patients. Results. Mean disease duration, clinical course, and female to male ratio did not differ in the groups. Cerebellar/brainstem and spinal involvement at onset were significantly higher in EOMS than in AOMS. Difference in MSFC between baseline and at the end of the 5th year was significantly worse in EOMS population (). The most significant difference was found in Paced Auditory Serial Addition Test (PASAT) (). Differences between baseline and at the end of the 5th year on the basis of T1 hypointense lesions were significantly higher in early onset MS than in adult onset MS patients (). Conclusions. Early onset MS seems to have worse prognosis than that of adult onset MS on the basis of clinical manifestation, cognitive impairment, and MRI parameters

Utilization of the multiple sclerosis functional composite in follow-up: relationship to disease phenotype, disability and treatment strategies

As multiple sclerosis (MS) has a dynamic process, monitoring of the disability is important in the remission period. The main aim of the present study was to investigate the usefulness of MSFC instead of EDSS in the follow-up period of MS. In addition, evaluation of the effect of immunomodulatory therapy, and the difference among the type of MS in follow-up was purposed. One hundred and eighty-three patients with definite MS were enrolled in the present study. Patients were diagnosed as having relapsing remitting (RR) MS (n=149) or secondary progressive (SP) MS (n=34). Fifty-eight out of 149 RRMS patients who bad at least two relapses in the last 2 years have received any of the immunomodulator agents. The Multiple Sclerosis Functional Composite (MSFC) and Expanded Disability Status Scale (EDSS) were performed at baseline and after 2 years to assess disability. Patients who were under disease modifying therapy were assessed before the treatment and 2 years after starting the treatment. Cross-sectional correlations between MSFC and EDSS score at baseline and follow-up were studied. Patients were divided into three subgroups: (1) RRMS patients who did not receive disease modifying therapy (DMT)-non-DMT group, (2) RRMS patients who received DMT-DMT group, (3) SPMS patients who did not receive DMT-SPMS group. EDSS and MSFC scores got worsened significantly at the end of the second year. Decreases in either EDSS or MSFC scores were more prominent in SPMS group. The most significant worsening was found in T25WT. The most prominent and significant decrease was in PASAT of SPMS group. Moderately strong cross-sectional correlations were found between MSFC and EDSS scores at baseline and follow-up. The most prominent correlation was between EDSS and T25WT scores with an excellent correlation. We concluded that the MSFC assesses aspects of neurological function not measured by the EDSS, suggesting that it is more sensitive to detect change over time and better able to demonstrate a therapeutic effect. The pattern of correlations among the MSFC, its components, and the EDSS supported the validity of MSFC. (c) 2005 Elsevier B.V. All rights reserved

Smoking is associated with walking, fatigue, depression, and health-related quality of life in persons with multiple sclerosis

Aim and objective Recent studies have reported that smoking is associated with increased multiple sclerosis (MS) risk. Additionally, non-smokers have lower self-reported disability and smoking cessation resulted in the decreased risk of reaching disability milestones. Although some studies have reported that smoking is associated with anxiety and depression, little is known about other common symptoms in persons with MS (pwMS). Thus, the aim was to investigate the association between smoking and walking, fatigue, depression, and health-related quality of life in pwMS. Methods This study included 279 (199 female) pwMS. The current smoking status and pack-years of smoking were evaluated. Walking was assessed using Timed 25-Foot Walk (T25FW), Six-Minute Walk Test (6MWT), and 12-Item MS Walking Scale (MSWS-12). Fatigue, depression and health-related quality of life were assessed using Modified Fatigue Impact Scale (MFIS), Beck Depression Inventory (BDI), and MS International Quality of Life questionnaire (MusiQoL), respectively. Disability level was assessed using Expanded Disability Status Scale (EDSS). Results There were 95 (34.1%) current smokers (mean pack-years of smoking was 9.2 (SD 7.1) years). Current smokers had significantly worse MFIS (p=0.003, pη²=0.031), BDI (p=0.044, pη²=0.015), and MusiQoL (p=0.003, pη²=0.031) scores adjusting for age, gender, EDSS and disease duration compared to non-smokers. No significant difference was observed between smokers and non-smokers in walking and physical activity measures (p>0.05). Pack-years of smoking was significantly correlated with T25FW (r=0.574, p<0.001), 6MWT (r=-0.461, p<0.001), MSWS-12 (r=0.684, p<0.001), MFIS (r=0.370, p<0.001), MusiQoL (r=-0.259, p=0.012), and BDI (r=0.269, p<0.001) in smokers. Conclusions Smokers have significantly more fatigue and depression levels and less health-related quality of life compared to non-smoker pwMS. Increased pack-years of smoking is associated worse walking ability, depression, fatigue and health-related quality of life levels. Smoking cessation may reduce walking impairment as well as fatigue and depression, additionally increase health-related quality of life in pwMS

Correlations between multiple sclerosis functional composite, expanded disability status scale and health-related quality of life during and after treatment of relapses in patients with multiple sclerosis

The measurement of the clinical manifestations of multiple sclerosis (MS) is difficult. In the present study, we examined the changes in measurement of functions during and after pulse methylprednisolon (MP) treatment of MS exacerbations using the MSFC and EDSS. Correlation between multiple sclerosis quality of life (MSQoL)-54, EDSS and MSFC were studied. Thirty-six clinically definite MS patients were included in this study. Because of MSFC's repeating feature, we administered the tests to a control group to exclude practise effects. All patients received 1000-mg intravenous MP for 5 days, followed by tappering dose of 100-mg oral prednisolone. All three scales were assessed on day 0. EDSS and two components of MSFC (nine HPT and T25WT) were administered on the other days of pulse MP treatment. PASAT was not applied before the day 5 to exclude the practise effect. MSQoL-54 was assessed again on day 30. Mean EDSS values significantly decreased after the day 2. MSFC score improved from 0.03 +/- 1.71 on day 0 to 0.79 +/- 1.51 on day 5. Improvement continued on day 30. The mean physical health composite score increased from 66.50 +/- 9.3 on day 0 to 74.34 +/- 8.9 on day 30. Mental health composite had also a significant improvement on day 30. Correlation between the baseline overall MSFC and the EDSS was moderately strong. T25WT correlated most strongly with EDSS. Significant positive correlation was found between MSFC and both components of MSQoL-54. It is more prominent for the MSFC and physical health composite correlation. The same correlation was found for the EDSS and MSQoL-54 composites. Changes in EDSS and MSFC scores and MSQoL-54 were found significantly correlated for the overall score on day 30 compared with day 0. In conclusion, MSFC seems to be more sensitive in detecting changes in function than the EDSS. Hence, EDSS is still useful for daily routine practise. When these results combined with the significant correlation between MSFC and MSQoL-54 measures, which indicated the MSFC reflects the severity of MS as perceived by patients, MSFC seems to be the most useful scale for clinical trials. (C) 2003 Elsevier B.V. All rights reserved