The 20-year history: Change of multiple sclerosis patient profile over 20 years

Background: Patients attending multiple sclerosis (MS) clinics experience less disability compared to previous years

The effect of the gender factor on multiple sclerosis and autoimmunity

Samsun Eğitim ve Araştırma Hastanesi, Nöroloji Kliniğiİzmir Üniversitesi Hastanesi, Medikal Park, Nöroloji KliniğiBergama Devlet Hastanesi, Nöroloji KliniğiOtoimmün bir hastalık olan multipl sklerozun (MS) etyopatogenezi tam aydınlatılamamış olsa da T ve B lenfositlerin, doğal öldürücü (NK) hücrelerin, makrofajların ve sitokinlerin atak-remisyon dönemlerinde ve progresyonda önemli rolü olduğu bilinmektedir. Kadınlarda otoimmün hastalık gelişme riski erkeklere oranla daha fazladır. Multipl sklerozda yardımcı T 1 hücre (Th1) aktivitesi ön plandadır ve kadınlarda Th1 hücre yanıtı erkeklerden daha baskındır. Bu durum MS gibi diğer otoimmün hastalıkların kadınlarda neden daha sık olduğunu kısmen açıklamaktadır. Düşük östrojen düzeyleri Th1 tipi proenflamatuar yanıtı artırırken, yüksek östrojen ve progesteron düzeyleri Th2 tipi yanıtı artırır. Kadınlarda menstrüasyon döneminden önce MS ataklarında alevlenme olduğu ve östrojen ve progesteron düzeylerinin çok düşük olduğu saptanmıştır. Progesteron ve östrojenin çok yüksek olduğu gebeliğin son trimesterinde atak oranı anlamlı olarak azalırken, doğum sonrası dönemde atak sıklığı ve şiddeti artmaktadır. Progestreron reaktif gliozisi düşürür, remiyelinizasyonu artırır ve mikroglial enflamatuar aktivasyonu azaltır. Östrojen proenflamatuar sinyalleri azaltmaktadır. Kadınlarda, tekrarlayan ve düzelen MS tipi daha sık görülmekle birlikte, erkeklerde daha ciddi düzeyde disabilite ve daha kısa sürede progresif forma geçiş saptanmaktadır. Manyetik rezonans görüntülemelerde erkeklerde daha az enflamatuvar aktivite gözlenirken, aksonal kayıp ve nörodejenerasyonun göstergesi olan kara delik görüntüsüne daha sık rastlanmaktadır. Bu klinik ve radyolojik farklılıklar, seks hormonlarının MS patolojisi üzerine olan etkisi olduğu düşüncesini desteklemektedir.Although the etiopathogenesis of multiple sclerosis (MS), as an autoimmune disease, is still unclear, T and B lymphocytes, natural killer (NK) cells, macrophages and cytokines are known to play an important role in attack-remission periods and in progression. The risk of developing an autoimmune disease is greater in women than in men. T helper 1 (Th1) cell activity is in the forefront in MS, and Th1 cell response in women is more dominant than in men. This partly explains why MS and the like autoimmune diseases are more prevalent in women. Low estrogen levels increase Th1-type pro-inflammatory response, while high estrogen and progesterone levels increase Th2-type response. Flare-ups in MS attacks before menstruation and very low estrogen and progesterone levels have been determined in women. The level of attacks decreases significantly in the third trimester of pregnancy during which the progesterone and estrogen are very high, while the incidence and severity of attacks increase in the postnatal period. Progesterone reduces reactive gliosis, increases remyelination and lowers microglial inflammatory activation. Estrogen reduces pro-inflammatory signals. Relapsing remitting MS is more common in women, while more serious disability and a more rapid transition to the progressive form are observed in men. Less inflammatory activity is observed at magnetic resonance imaging in men, while black hole, an indicator of axonal loss and neurodegeneration, more frequently, is more commonly encountered. These clinical and radiological variations support the idea of sex hormones to have an affect on the pathology of MS

Self-injectable DMTs in relapsing MS: NEDA assessment at 10 years in a real-world cohort

Background Multiple sclerosis (MS) is an immune-mediated disorder of the central nervous system. DMTs effectively reduce the annual relapse rate-thus reducing disease activity-and, to a lesser extent, some DMTs prevent disease progression in some people with MS. Monitoring the efficacy of DMTs with no evidence disease activity (NEDA) provides an objective perspective for evaluating treatment success. Objective Our goal is to detect the prevalence of NEDA-3 in people with MS treated with self-injectable DMTs at two years and 10 years in a retrospective study. Methods The treatment continuation rates and NEDA-3 parameters in the 2nd and 10th years were evaluated. Results A total of 1032 patients diagnosed with RRMS were included in the study, and 613 patients (59.3%) continued with treatment after 10 years. In the first two years, NEDA-3 was detected in 321 patients (52.4%), and 112 of the 613 patients continued with self-injectable DMTs at the end of 10 years (18.3%). The rate of NEDA-3 in patients starting treatment over the age of 35 was 15.1% compared to that in the patient group starting treatment aged 34 or less at 20.2% (p = .004). Conclusion Our study includes the most comprehensive NEDA-3 data from real world evidence and supports the idea that NEDA-3 can be an effective early predictor of progression-free status at treatment follow-up of up to 10 years

Cognitive involvement in clinically isolated syndrome and relationship with fatigue

Purpose: The cognitive profile in clinically isolated syndrome (CIS) is frequently characterized by deficit in processing speed and working memory. In this study, we aimed to investigate the characteristics and frequency of cognitive impairment in patients with CIS by comparing with healthy controls