The effects of relaxation on the psychological symptoms in women with multiple sclerosis

Background and aims: Multiple sclerosis (MS) patients compared to healthy subjects have much higher levels of psychological disorders such as depression, anxiety and stress that greatly affect their quality of life and significant role in stimulating the onset of MS, worsening symptoms and increasing fatigue. Relaxation in complementary medicine is the most common treatments with low cost. This study aimed to determine the effects of relaxation on depression, anxiety, stress and in women suffering of MS. Methods: This study is a randomized clinical trial that was carried out on 50 patients with MS referred to MS Clinic of Kashani Hospital in Isfahan, Iran. After simple non-random sampling, participants were randomly assigned by minimization method to three groups: Reflexology, relaxation, and control groups. In the experimental group was performed relaxation intervention within 4 weeks, twice a week for 40 min and the control group were received care and routine medical treatment as directed by a doctor? Data were collected through DASS-21 questionnaire before, immediately and 2 months after interventions in two groups. Data analysis was performed by SPSS using descriptive and inferential statistics. Results: Mean scores of stress, anxiety, and depression before the intervention showed no significant difference in the two groups (P>0.5), but immediately after the intervention, independent t-test showed significant difference between mean scores of stress (P=0.001), anxiety (P=0.02) and depression (P=0.02) between groups while two months after the intervention there was only a significant difference between the mean score of stress in the two groups (P=0.003). Also, findings obtained from repeated measures analysis of variance showed that the severity stress, anxiety and depression during the different times in experimental group had significant difference (P0.05). Conclusion: It seems that relaxation technique as intervention in reducing stress, anxiety and depression is effective in women with MS. However, the technique has long-term effects on stress. So, this method as effective technique can be recommended

Effects of Adjunct Low-Dose Vitamin D on Relapsing-Remitting Multiple Sclerosis Progression: Preliminary Findings of a Randomized Placebo-Controlled Trial

The aim of this preliminary study was to evaluate the effect of low-dose oral vitamin D in combination with current disease-modifying therapy on the prevention of progression of relapsing-remitting multiple sclerosis (RRMS). A phase II double-blind placebo-controlled randomized clinical trial conducted between October 2007 and October 2008 included 50 patients with confirmed RRMS aged 25 to 57 years and normal serum 25-hydroxyvitamin D. They were randomly allocated to receive 12 months of treatment with either escalating calcitriol doses up to 0.5 μg/day or placebo combined with disease-modifying therapy. Response to treatment was assessed at eight-week intervals. In both groups, the mean relapse rate decreased significantly (P < 0.001). In the 25 patients treated with placebo, the mean (SD) Expanded Disability Status Scale (EDSS) increased from 1.70 (1.21) at baseline to 1.94 (1.41) at the end of study period (P < 0.01). Average EDSS and relapse rate at the end of trial did not differ between groups. Adding low-dose vitamin D to routine disease-modifying therapy had no significant effect on the EDSS score or relapse rate. A larger phase III multicenter study of vitamin D in RRMS is warranted to more assess the efficacy of this intervention

Modeling the Number of Attacks in Multiple Sclerosis Patients Using Zero-Inflated Negative Binomial Model

Background and aims: Multiple sclerosis (MS) is an inflammatory disease of the central nervous system. The impact of the number of attacks on the disease is undeniable. The aim of this study was to analyze the number of attacks in these patients. Methods: In this descriptive-analytical study, the registered data of 1840 MS patients referred to the MS clinic of Ayatollah Kashani hospital in Isfahan were used. The number of attacks during the treatment period was defined as the response variable, age at diagnosis, sex, employment, level of education, marital status, family history, course of disease, and expanded disability as the explanatory variables. The analysis was performed using zero-inflated negative binomial model via Bayesian framework in OpenBUGS software. Results: Age at diagnosis (CI: -0.04, -0.20), marital status (CI: -0.56, 0.002), level of education (CI: -0.81, -0.26), Job (CIHousewives vs Employee=[0.04, 0.64], CIUnemployee vs Employee=[-1.10,0.008])), and course of disease (CI: -0.51, -0.08) had a significant effect on the number of attacks. In relapsing-remitting patients, the number of attacks was partial significantly affected by expanded disability status scale (EDSS) (CI: -0.019, 0.16). Conclusion: Aging, being single (never married), high education, and not having a job decrease the number of attacks; therefore, lower age, being married, primary education, and being a housewife increase the number of attacks. An interventional or educational program is suggested in order to prevent the occurrence of further attacks in high-risk groups of patients and to increase their chances of recovery. Keywords: Multiple sclerosis Attack Negative binomial Zero-inflated Markov chain Monte Carl

Biased Treg/Th17 balance away from regulatory toward inflammatory phenotype in relapsed multiple sclerosis and its correlation with severity of symptoms

The opposing immune functions of Treg and Th17 lymphocytes and the plasticity of Treg/Th17 differentiation, has led us to investigate the effects of their fluctuations and counterbalance in autoimmune condition of multiple sclerosis (MS). Evaluation of Treg and Th17 frequency in peripheral blood of a group of relapsed MS patients, showed a decrease in Treg/Th17 ratio compared to that of healthy controls. A reverse correlation between these subsets was observed in controls but not in patient groups. Both Treg frequency and Treg/Th17 ratio were negatively correlated with severity of symptoms. There was shown to be an enduring increase in Treg frequency associated with MS disease

Is Chiari malformation a cause of systemic hypertension and sinus bradycardia? A case report and literature review

Abstract A middle aged woman, having a history of diastolic hypertension and sinus bradycardia since one year ago, was referred to our center with a sudden occipital headache after shouting. To evaluate the cause of headache the brain MRI was performed reporting a slight cerebellar tonsillar herniation of about one centimeter below the foramen magnum. After the patient was diagnosed to have type I Chiari malformation, a surgery procedure was done and the symptoms were recovered after that. Type I Chiari malformation is a disease mostly caused by congenital displacement of cerebellar tonsils through the foramen magnum. The most common symptom is headache, rarely reported with hypertension or sinus bradycardia

Comparison of prevalence rates of restless legs syndrome, self-assessed risks of obstructive sleep apnea, and daytime sleepiness among patients with multiple sclerosis (MS), clinically isolated syndrome (CIS) and Neuromyelitis Optica Spectrum Disorder (NMOSD)

Prevalence rates for restless legs syndrome (RLS) and risk of Obstructive Sleep Apnea (OSA) in individuals with Neuromyelitis Optica Spectrum Disorder (NMOSD) and Clinically Isolated Syndrome (CIS) are unknown. The aims of the present study were to assess symptoms of RLS and self-assessed risks of OSA in individuals with NMOSD and CIS, to compare these prevalence rates with those of persons with multiple sclerosis (MS), and to associate RLS and OSA with expanded disability status scale (EDSS) scores, daytime sleepiness, fatigue, paresthesia, and medication.; A total of 495 individuals (mean age = 34.92 years, 84.9% females) were assessed. Of these, 24 had NMOSD, 112 had CIS and 359 had MS. Trained neurologists ascertained individuals' neurological diagnoses, assessed their EDSS scores, and conducted a clinical interview to assess RLS. Additionally, participants completed questionnaires covering sociodemographic information, risks of snoring and OSA, daytime sleepiness, fatigue, paresthesia and medication.; Prevalence rates of RLS were 45.8% in NMOSD, 41.1% in CIS, and 28.7% in MS. Prevalence rates of self-assessed risks of OSA were 8.3% in NMOSD, 7.7% in CIS, and 7.8% in MS; these rates were not significantly different. Across the entire sample and within the diagnostic groups, RLS and OSA scores were unrelated to EDSS, daytime sleepiness, fatigue or medication.; Individuals with NMOSD, CIS and MS have high prevalence rates for RLS and self-assessed risks of obstructive sleep apnea syndrome (OSAS), which are unrelated to EDSS, daytime sleepiness, fatigue, paresthesia, or medication. Sleep issues should be monitored during routine check-ups for individuals with NMOSD and CIS

Toll like receptor 2 and 4 expression in peripheral blood mononuclear cells of multiple sclerosis patients

Background: Multiple sclerosis (MS) is a T cell mediated autoimmune disease with unknown etiology. Appropriate MS therapeutic strategies need thorough understanding of both disease etiology and pathogenesis mechanisms. Ligation of TLR-2 and TLR-4 stimulates the production of several cytokines leading to CNS autoimmunity and neurodegenerative diseases. Objective: To find a relationship between MS disability and TLR-2 and TLR-4 expression on mononuclear cells in the blood of MS patients. Methods: Forty-five new case (NC) MS patients (33 females and 12 males) and 45 age and gender-matched healthy controls (HC) were recruited to the study. PBMCs were prepared and the expressions of TLR-2 and TLR-4 were assessed by flowcytometry technique using appropriate monoclonal antibodies. Results: Our results showed that the expression of TLR-2 and TLR-4 proteins in the patients group was significantly higher than that of healthy controls. TLR-2 but not TLR-4 was correlated with expanded disability status scale (EDSS) scores. Conclusion: High expressions of TLR-2 and TLR-4 may represent a state of innate immune activation in patients with MS. © 2014, Shiraz University of Medical Sciences

Sociodemographic and Illness-Related Indicators to Predict the Status of Neuromyelitis Optica Spectrum Disorder (NMOSD) Five Years after Disease Onset

Background: Neuromyelitis Optica Spectrum Disorder (NMOSD) is an autoimmune demyelinating disease of the central nervous system. Currently, no factors have been identified to predict the long-term course of NMOSD. To counter this, we analyzed data of 58 individuals with NMOSD at disease onset and about five years later. Methods: Medical records of 58 individuals with NMOSD (mean age: 31.13 years at disease onset; 86.2% female) were retrospectively analyzed. At baseline, a thorough medical and disease-related examination was performed; the same examination was repeated about five years later at follow-up, including treatment-related information. Mean outcome measure was the difference in EDSS (Expanded Disease Severity Scale) scores between baseline and follow-up. Results: Mean disease duration was 4.67 years. Based on the differences of the EDSS scores between baseline and follow-up, participants were categorized as improving (n = 39; 67.2%), unchanged (n = 13; 22.4%) and deteriorating (n = 6; 10.3%). Deteriorating was related to a higher progression index, and a higher number of attacks, while the annualized relapse rate reflecting the number of attacks per time lapse did not differ between the three groups. Improving was related to a higher intake of rituximab, and to a higher rate of seropositive cases. Unchanged was related to a lower rate of seropositive cases. Factors such as age, gender, somatic and psychiatric comorbidities, symptoms at disease onset, relapse rates, number and location of cervical plaques, or brain plaques and thoracolumbar plaques at baseline did not differ between those improving, deteriorating or remaining unchanged. Conclusions: Among a smaller sample of individuals with NMOSD followed-up about five years later, individuals deteriorating over time reported a higher progression index, while the annualized relapse rate was unrelated to the progress of disease. Overall, it appears that the course of NMOSD over a time lapse of about five years after disease onset is highly individualized. Accordingly, treatment regimen demands a highly individually tailored approach

Clinical Characteristics and Disability Progression of Early- and Late-Onset Multiple Sclerosis Compared to Adult-Onset Multiple Sclerosis

Compared to the adult onset of multiple sclerosis (AOMS), both early-onset (EOMS) and late-onset (LOMS) are much less frequent, but are often under- or misdiagnosed. The aims of the present study were: 1. To compare demographic and clinical features of individuals with EOMS, AOMS and LOMS, and 2. To identify predictors for disability progression from relapsing remitting MS (RRMS) to secondary progressive MS (SPMS).; Data were taken from the Isfahan Hakim MS database. Cases were classified as EOMS (MS onset 18 years), LOMS (MS onset >50 years) and AOMS (MS >18 and 50 years). Patients' demographic and clinical (initial symptoms; course of disease; disease patterns from MRI; disease progress) information were gathered and assessed. Kaplan-Meier and Cox proportional hazard regressions were conducted to determine differences between the three groups in the time lapse in conversion from relapsing remitting MS to secondary progressive MS.; A total of 2627 MS cases were assessed; of these 127 were EOMS, 84 LOMS and 2416 AOMS. The mean age of those with EOMS was 14.5 years; key symptoms were visual impairments, brain stem dysfunction, sensory disturbances and motor dysfunctions. On average, 24.6 years after disease onset, 14.2% with relapsing remitting MS (RRMS) were diagnosed with secondary progressive MS (SPMS). The key predictor variable was a higher Expanded Disability Status Scale (EDSS) score at disease onset. Compared to individuals with AOMS and LOMS, those with EOMS more often had one or two relapses in the first two years, and more often gadolinium-enhancing brain lesions. For individuals with AOMS, mean age was 29.4 years; key symptoms were sensory disturbances, motor dysfunctions and visual impairments. On average, 20.5 years after disease onset, 15.6% with RRMS progressed to SPMS. The key predictors at disease onset were: a higher EDSS score, younger age, a shorter inter-attack interval and spinal lesions. Compared to individuals with EOMS and LOMS, individuals with AOMS more often had either no or three and more relapses in the first two years. For individuals with LOMS, mean age was 53.8 years; key symptoms were motor dysfunctions, sensory disturbances and visual impairments. On average, 14 years after disease onset, 25.3% with RRMS switched to an SPMS. The key predictors at disease onset were: occurrence of spinal lesions and spinal gadolinium-enhancement. Compared to individuals with EOMS and AOMS, individuals with LOMS more often had no relapses in the first two years, and higher EDSS scores at disease onset and at follow-up.; Among a large sample of MS sufferers, cases with early onset and late onset are observable. Individuals with early, adult and late onset MS each display distinct features which should be taken in consideration in their treatment

Cytokine gene expression in newly diagnosed multiple sclerosis patients

Multiple Sclerosis (MS) is characterized by multiple areas of inflammation, demyelination and neurodegeneration. Infiltrating Th1 CD4+ T cells secrete proinflammatory cytokines. They stimulate the release of some cytokines, expression of adhesion molecules and these cytokines may cause damage to the myelin sheath and axons. In this study, we analyzed plasma levels and gene expressions of five important cytokines in the new diagnosed MS Patients by ELISA and Real time PCR. PCR amplifications were performed to determine the IL-17, IL-23, IL-10, IL-27 and TGF-β mRNA expression levels using the SYBR Green PCR Kit. Our results showed significant decrease in IL-10, IL-27 and TGF-β but there was no significant difference in the IL-17 and IL-23 between patients and healthy controls. Altogether, our results indicated that dysregulation of cytokines, mainly increased expression of pro-inflammatory cytokines and decreased expression of inhibitory cytokines occurred in MS patients. This study may shed light to the probable role of these cytokines in neurodegeneration mechanism and current or future use of cytokines in managing and treatment of multiple sclerosis