Clinical, Demographic, and Radiological Characteristics of Patients Demonstrating Antibodies Against Myelin Oligodendrocyte Glycoprotein.

Background: Optic neuritis, myelitis, and neuromyelitis optica spectrum disorder (NMOSD) have been associated with antibodies against myelin oligodendrocyte glycoprotein-immunoglobulin G (anti-MOG-IgG). Furthermore, patients with radiological and demographic features atypical for multiple sclerosis (MS) with optic neuritis and myelitis also demonstrate antibodies against aquaporin-4 and anti-MOG-IgG. However, data on the diagnosis, treatment, follow-up, and prognosis in patients with anti-MOG-IgG are limited. Aims: To evaluate the clinical, radiological, and demographic characteristics of patients with anti-MOG-IgG. Study Design: Multicenter, retrospective, observational study. Methods: Patients with blood samples demonstrating anti-MOG-IgG that had been evaluated at the Neuroimmunology laboratory at Ondokuz Mayis University's Faculty of Medicine were included in the study. Results: Of the 104 patients with anti-MOG-IgG, 56.7% were women and 43.3% were men. Approximately 2.4% of the patients were diagnosed with MS, 15.8% with acute disseminated encephalomyelitis (ADEM), 39.4% with NMOSD, 31.3% with isolated optic neuritis, and 11.1% with isolated myelitis. Approximately 53.1% of patients with spinal involvement at clinical onset demonstrated a clinical course of NMOSD. Thereafter, 8.8% of these patients demonstrated a clinical course similar to MS and ADEM, and 28.1% demonstrated a clinical course of isolated myelitis. The response to acute attack treatment was lower and the disability was higher in patients aged > 40 years than patients aged < 40 years at clinical onset. Oligoclonal band was detected in 15.5% of the patients. Conclusion: For patients with NMOSD and without anti-NMO antibodies, the diagnosis is supported by the presence of anti-MOG-IgG. Furthermore, advanced age at clinical onset, Expanded Disability Status Scale (EDSS) score at clinical onset, spinal cord involvement, and number of attacks may be negative prognostic factors in patients with anti-MOG-IgG.

The role of oligoclonal band count and IgG index in treatment response and disease activity in multiple sclerosis.

BACKGROUND/AIM: Multiple sclerosis (MS) is an inflammatory demyelinating central nervous system (CNS) disease. Among the paraclinical tests, brain and spinal Magnetic Resonance Imaging (MRI) is primarily involved in the diagnosis process, and cerebrospinal fluid (CSF) analysis is fundamental in diagnosing MS and the differential diagnosis. A positive relationship was demonstrated between oligoclonal band (OCB) positivity, CSF band number and immunoglobulin G(IgG) index. The study aimed to evaluate whether the number of OCB can predict disease activity and determine a correlation with the IgG index. METHODS: Our study included 401 MS patients who had relapsing-remitting multiple sclerosis (RRMS), primary progressive multiple sclerosis (PPMS), secondary progressive multiple sclerosis (SPMS), clinic isolated syndrome (CIS), radiologic isolated syndrome (RIS), Neuromyelitis optica spectrum disorder (NMOSD) and Acute disseminated encephalomyelitis (ADEM) with OCB number groups of 2-4, 4-8, 8-12, and 12 and above. RESULTS: No significant correlation was observed between IgG index, pre-and post-treatment EDSS (Expanded Disability Status Scale Scores) and disease-modifying therapies (DMT). Drug response was better in the patient group with band number between 2 and 8 and post-treatment EDSS scores were lower (1.62±0.44). CONCLUSION: The study results suggested that band number may be as valuable as the IgG index and a predictive biomarker for disease activity.

Retinal clues for selective neuronal loss in multiple sclerosis.

OBJECTIVE: The relationship between the cell body layer and the dendritic network layer of the retina and cognitive performance (CP) in MS patients has not been examined separately. The objective of this study is to predict cognitive impairment (CI) in RRMS patients and to examine the relationship between CP and ganglion cell layer (GCL), inner plexiform layer (IPL), and GCL divided by IPL (GCL/IPL). METHODS: Ophthalmological evaluation, retinal segmentation, and Symbol Digit Modalities Test (SDMT) were performed on 102 RRMS patients and 54 healthy subjects. The relationships of GCL, IPL, and GCL/IPL with CP in eyes without a history of optic neuritis were investigated using Spearman's correlation. Models were created by accepting 1 standard deviation less of the SDMT mean of the control group as the limit for CI. The cutoff value of the GCL/IPL variable that could predict CI was calculated by ROC analysis, and the ability to accurately predict CI was tested with binary logistic regression. RESULTS: No correlation was found between OCT parameters and CP in healthy subjects. Correlation was found between GCL thickness and GCL/IPL variable and CP in RRMS patients (r=0.235, r=0.667 respectively). A GCL/IPL value of 1.255 was able to identify CI with 81.8% sensitivity and 75.9% specificity (AUC=0.844, LR=3.38) and predicted CI with 74.5% accuracy (Nagelkerke R2=0.439). CONCLUSION: In RRMS patients, the IPL thickness is unrelated to CP. Therewithal, the GCL/IPL-CP relationship is stronger than the GCL-CP relationship and GCL/IPL can predict CI.

Erratum: Clinical and Demographic Characteristics and Two-Year Efficacy and Safety Data of 508 Multiple Sclerosis Patients with Fingolimod Treatment.

[This corrects the article on p. 23 in vol. 60, PMID: 36911568.].

Clinical and Demographic Characteristics and Two-Year Efficacy and Safety Data of 508 Multiple Sclerosis Patients with Fingolimod Treatment.

Introduction: Fingolimod is the first oral immunomodulatory treatment used as secondary care therapy in the treatment of multiple sclerosis for the last 10 years. The objective of our study is to reveal the experiences of the first generic fingolimod active ingredient treatment in different centers across Turkey. Method: The first generic fingolimod efficacy and safety data of patients followed-up in 29 different clinical multiple sclerosis units in Turkey were analyzed retrospectively. Data regarding efficacy and safety of the patients were transferred to the data system both before the treatment and on the 6th, 12th and 24th month following the treatment. The data were analyzed using the IBM SPSS 20.00. P value of <0.05 was considered to be statistically significant. Results: A total of 508 multiple sclerosis patients, 331 of whom were women, were included in the study. Upon comparing the Expanded Disability Status values before and after the treatment, a significant decrease was observed, especially at month 6 and thereafter. Since bradycardia occurred in 11 of the patients (2.3%), the first dose had to be longer than 6 hours. During the observation of the first dose, no issues that could prevent the use of the drug occured. Side effects were seen in 49 (10.3%) patients during the course of fingolimod treatment. Respectively, the most frequent side effects were bradycardia, hypotension, headache, dizziness and tachycardia. Conclusion: The observed results regarding efficacy and safety were similar to clinical trial data in the literature and real life data in terms of the first equivalent with fingolimod active ingredient.

A Rare Central Nervous System Involvement Due to CTLA-4 Gene Defect.

Cytotoxic T-lymphocyte antigen-4 (CTLA-4) haploinsufficiency is the defect of one of the checkpoint inhibitory molecules and defined as a primary immunodeficiency characterized by immune dysregulation. A 26-year-old female with a history of autoimmune hemolytic anemia, autoimmune thrombocytopenia, and hypogammaglobulinemia was admitted with an inability to walk, urinary hesitancy, and bowel incontinence. Neurological examination revealed mild weakness, pyramidal, and deep sensorial involvement of the left lower extremity. Brain MRI revealed periventricular, juxtacortical, and cerebellar inflammatory lesions. Thoracic spinal MRI showed a longitudinaly extensive cord lesion. Additionally, thoracal CT showed parenchymal opacities and bilateral hilar lymph nodes. The biopsy from mediastinal lymph nodes and lung parenchyma demonstrated a low-grade lymphoproliferation and grade 1 "Lymphomatoid granulomatosis". Detailed laboratory analyses indicated the diagnosis of ''common variable immunodeficiency''. Next-generation sequencing with primary immunodeficiency panel revealed a heterozygous mutation in CTLA-4 (c.436G>A(p.G146R)(p.Gly146Arg)). After molecular diagnosis, abatacept therapy was started as a targeted therapeutic approach with subcutaneous immunoglobulin therapy.

The course of cervical spinal cord atrophy rate and its relationship with NEDA in relapsing remitting multiple sclerosis.

This study aimed to compare the annualized segmental cervical spinal cord atrophy rate (ASCAR) in the early and late stages of relapsing remitting multiple sclerosis (RRMS), and to investigate the relationship between ASCAR and no evidence of disease activity (NEDA) in RRMS. Participants in this study included early stage MS (EMSg) patients, late stage MS (LMSg) patients, and healthy controls. All of the included participants (n = 175 subjects) were followed up for 14 months, and an MRI was performed on each participant at the beginning and at the end of the study. Cervical spinal cord average segmental area (CSCA) was measured by a semi-automated method, and ASCAR (mm2/year) was calculated. Data from the EMSg (n = 81 subjects) and LMSg (n = 94 subjects) patient groups were compared with each other and with the control group (n = 43 subjects). Examination of the initial CSCA values revealed that the baseline CSCA of the control group was larger than that of the EMSg (p < 0.001), and the baseline CSCA of the EMSg was larger than that of the LMSg (p < 0.001). The ASCAR of the control group, LMSg, and EMSg were 0.48, 0.93, and 1.81 mm2 (p < 0.001), respectively. Regression analysis revealed that disability increase was associated with ASCAR, while MRI activity and relapse presence were unrelated to ASCAR. In both patient groups, ASCAR was slower in those who fulfilled NEDA but this relationship was not significant. Cervical spinal cord atrophy progression over time occurs at a greater rate in the early stages of RRMS disease compared to the late stages. ASCAR was unrelated to MRI activity and relapse, which are clinical markers of acute inflammation.

First measured retinal nerve fiber layer thickness in RRMS can be used as a biomarker for the course of the disease: threshold value discussions.

BACKGROUND: Peripapillary retinal nerve fiber layer thickness correlates with radiological and clinical parameters in patients with MS. OBJECTIVE: The aim of this study is to investigate the use of the first measured pRNFL thickness as a predictor of disease course in patients with RRMS. METHODS: One hundred and thirty seven RRMS patients were enrolled in the study within the first 5 years of illness. Patients were followed for 34.1 months and the EDSS was used to assess disability status to determine whether the first measured pRNFL thickness, using proportional hazards models, predicts the risk of disability worsening. RESULTS: The mean disease duration was 26.1 months. Disability worsening was detected in 36 patients. In tertile-based groups formed according to pRNFL thickness, the group with the lowest pRNFL thickness had a 2.8-fold increase in the risk of disability worsening compared to the group with the highest. The risk was higher in the first 2 years of the study (HR = 3.48; p = 0.008). CONCLUSION: The first measured pRNFL thickness in RRMS patients can predict the risk of disability worsening, and the risk of disability worsening in the early period was higher in the group with the lowest pRNFL value.

Axonal Degeneration Independent of Inflammatory Activity: Is It More Intense in the Early Stages of Relapsing-Remitting Multiple Sclerosis Disease?

BACKGROUND: This study aimed to investigate whether there are differences in the axonal degeneration rate between patients in the early years of relapsing-remitting multiple sclerosis (RRMS) disease and RRMS patients in their later years. METHODS: The early-stage RRMS patients (EMS) group had 65 patients whose duration of disease was within 3 years from the date of the first attack. The late-stage RRMS patients (LMS) group had 69 patients whose duration of disease was within the range of 3-10 years from the date of the first attack. In addition, a control group was composed of 32 healthy subjects. Peripapillary retinal nerve fiber layer (RNFL) thickness was monitored with spectral-domain OCT in all included patients for approximately 3 years. RESULTS: The annual RNFL atrophy rate (aRNFLr) in the EMS group was -1.246 ± 0.778 µm/year, the aRNFLr in the LMS group was -0.898 ± 0.536 µm/year, and the aRNFLr was -0.234 ± 0.154 µm/year in the control group (p < 0.001). The aRNFLr in the EMS group was significantly higher than the aRNFLr in the LMS group (p = 0.01). The aRNFLr was not associated with MRI activity or the condition of having an attack. There was a correlation between Expanded Disability Status Scale (EDSS) progression and aRNFLr in both the EMS and LMS patient groups (r = -0.471, p < 0.001, and r = -0.567, p < 0.001, respectively). CONCLUSION: The axonal degeneration rate is faster in RRMS patients in the first years of the disease than in later years. In addition, axonal degeneration occurs independently of inflammatory activity. Axonal degeneration is correlated with disability progression, but not with inflammatory findings, such as clinical episodes and MRI activity.

Cognitive dysfunction among patients in chronic obstructive pulmonary disease: Effects of exacerbation and long-term oxygen therapy.

BACKGROUND: We investigated the association between cognitive dysfunction (CD) and chronic obstructive pulmonary disease (COPD) during exacerbation and compare with stable COPD patients and control subjects. Also, we compared the cognitive function of long-term oxygen therapy (LTOT) dependent patients and not receiving LTOT. METHODS: The 121 people included in the study. They were divided into three groups: exacerbation of COPD (COPD-E), stable COPD (COPD-S) and control groups. Also, COPD patients were divided into two groups, non-user LTOTD-COPD and regular-user LTOTD-COPD. The patients were asked in their native language by exact conversion of the questions of MMSE (Mini Mental State Examination). RESULTS: The mean age of patients was 67 and ratio of patients with MMSE results below 24 was 41.6%. MMSE score was 18.9 in patient with exacerbation and 25.7 in stable COPD. Age average was higher and MMSE was lower in COPD-E group. Low educational degree was predicting factor for CD in COPD-E group. Low MMSE was related with decreased FEV1%, pO2 and sO2 values, increased pCO2 values, low educational level and increased comorbidity. MMSE score was 18.8 in reguler-user LTOTD COPD and 24.9 in nonuser LTOTD-COPD. Regular-user LTOTD-COPD groups exacerbation rate was higher than nonuser LTOTD-COPD group. CONCLUSION: MMSE scores was low in COPD-E group and regular-user LTOTD-COPD group. This is important because MMSE identifies clinically significant CD. This suggests that the CD may be linked to the causes of severe exacerbations. Clinicians need to look for CD, because cognitive function needs to be taken into account in their management of the patient.

Effects of omalizumab therapy on peripheral nerve functions: short observational study.

INTRODUCTION: Peripheral neuropathy (PN) is a common neurological condition causing symmetrical and diffuse damage in nerves. The etiology of PN includes systemic diseases, toxic exposure, medications, infections, and hereditary diseases. Omalizumab is a humanized monoclonal anti-IgE antibody that exerts its activity by binding to free IgE in circulation. AIM: To investigate the relationship between omalizumab and peripheral neuropathy. MATERIAL AND METHODS: The study included 30 patients who underwent omalizumab therapy (Xolair) due to the diagnosis of chronic urticaria. A detailed neurological and physical examination was performed in each patient both before and 3 months after the therapy. Electrophysiological examination was also performed using a Medelec Synergy instrument. RESULTS: The 30 patients included 8 (26.7%) men and 22 (73.3%) women with a mean age of 37.5 ±14.14 years. No serious side effect of the medication was detected in any patient although local wound irritation occurred in 3 (10%) patients. Moreover, no change occurred in the pre-treatment Neuropathy Symptom Score (NSS) or Neurological Disability Score (NDS) of the patients and no pathological values that could result in neuropathy were observed during motor/sensory nerve conduction. However, significant changes were detected in the sensory and motor components of the nerves with regards to pre- and post-treatment values. CONCLUSIONS: Omalizumab therapy caused no peripheral neuropathy in any of our patients but altered the latency, amplitude, and velocity values of the peripheral nerves.

Ultrasonic Elastography Evaluation in Optic Neuritis.

PURPOSE: In the present study, we attempted to determine whether ultrasonic elastography (USE) evaluation can be used in a diagnosis of optic neuritis (ON). MATERIALS AND METHODS: Thirteen patients who each had one normal eye and one eye with a diagnosis of ON were included in the study. Ultrasonography (US) and USE examinations were performed on the affected and non-affected eyes of all participants. Optic nerve and adjacent fat tissue regions at the same depth were selected, and USE measurements were obtained. The optic nerve diameter was measured in both normal and affected eyes. RESULTS: The mean USE values for the optic nerve were 2.58 ± 0.50 m/s in ON eyes and 1.91 ± 0.39 m/s in normal eyes (p = 0.001). The mean USE values for the optic-nerve adjacent tissue were 2.26 ± 0.45 m/s in ON eyes and 1.77 ± 0.22 m/s in normal eyes (p = 0.001). The mean optic-nerve diameter was 3.80 ± 1.09 mm in ON eyes and 3.28 ± 0.98 mm in normal eyes (p = 0.005). CONCLUSIONS: USE may be considered an accessible, safe technique for the detection of significant optic-nerve tissue stiffness in ON and may be used an adjunctive tool for confirming this diagnosis.

The association between retinal nerve fibre layer thickness and corpus callosum index in different clinical subtypes of multiple sclerosis.

The objective of this paper is to evaluate the association between physical disability in multiple sclerosis (MS) patients, the thickness of the retinal nerve fibre layer (RNFL) and corpus callosum volumes, as expressed by the corpus callosum index (CCI). This study was based on a cohort of 212 MS patients and 52 healthy control subjects, who were age and gender matched. The MS patients included 144 women and 177 relapsing-remitting MS (RRMS) patients. Peripapillary and volumetric optical coherence tomography (OCT) scans of the macula were performed using spectral-domain OCT technology. All magnetic resonance imaging (MRI) scans were performed using 1.5-T systems. CCI and RNFL were lower in MS than healthy control subjects (0.341 versus 0.386, p < 0.01 and 92.1 versus 105.0, p < 0.01). In addition, CCI correlated with RNFL (r = 0.464, p < 0.01). This was also true for the subgroup of patients with no history of optic neuritis (ON). There is a correlation between the thickness of the RNFL and CCI values in MS patients with no history of ON, which suggests that OCT might be a suitable marker for neurodegeneration in MS clinical trials.

Dissociative experiences in patients with epilepsy.

A few studies have explored dissociative experiences in epilepsy patients. We investigated dissociative experiences in patients with epilepsy using the dissociative experiences scale (DES). Ninety-eight patients with epilepsy and sixty healthy controls were enrolled in this study. A sociodemographic questionnaire and the Dissociative Experiences Scale (DES), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were administered to the participants. The DES scores were significantly higher for the patients with epilepsy than the healthy individuals. The number of individuals with pathological dissociation (DES ≥ 30) was higher in the epilepsy group (n = 28) than in the control group (n = 8). Also, higher levels of dissociation were significantly associated with frequency of seizures, but were not associated with duration of epilepsy and age at onset of the disorder. These findings demonstrate that patients with epilepsy are more prone to dissociation than controls. The high rate of dissociative experiences among patients with epilepsy suggest that some epilepsy-related factors are present.

Dissociative experiences in patients with epilepsy / Experiências dissociativas em pacientes com epilepsia

ABSTRACT A few studies have explored dissociative experiences in epilepsy patients. We investigated dissociative experiences in patients with epilepsy using the dissociative experiences scale (DES). Ninety-eight patients with epilepsy and sixty healthy controls were enrolled in this study. A sociodemographic questionnaire and the Dissociative Experiences Scale (DES), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were administered to the participants. The DES scores were significantly higher for the patients with epilepsy than the healthy individuals. The number of individuals with pathological dissociation (DES ≥ 30) was higher in the epilepsy group (n = 28) than in the control group (n = 8). Also, higher levels of dissociation were significantly associated with frequency of seizures, but were not associated with duration of epilepsy and age at onset of the disorder. These findings demonstrate that patients with epilepsy are more prone to dissociation than controls. The high rate of dissociative experiences among patients with epilepsy suggest that some epilepsy-related factors are present.

RESUMO Poucos estudos exploraram as experiências dissociativas em pacientes com epilepsia. Investigamos as experiências dissociativas em pacientes com epilepsia através da Escala de Experiências Dissociativas (EED). Noventa e oito pacientes com epilepsia e 60 controles saudáveis foram incluídos neste estudo. Um questionário sócio-demográfico, a EED, o Beck Depression Inventory (BDI) e o Beck Anxiety Inventory (BAI) foram administrados aos participantes. Os valores de EED foram significativamente maiores nos pacientes com epilepsia em relação aos controles saudáveis. O número de indivíduos com doença dissociativa (EED ≥ 30) foi maior no grupo de epilepsia (n = 28) todo que no grupo controle (n = 8). Além disto, altos níveis de dissociação estavam associados à frequência de crises epilépticas, mas não à duração da epilepsia ou idade de início da doença. Estes achados demonstram que pacientes com epilepsia são maus susceptíveis à dissociação do que os controles. O alto índice de experiências dissociativas entre os pacientes com epilepsia sugere que alguns fatores específicos da epilepsia possam estar relacionados aos achados.

Serum antioxidant enzymes activities and oxidative stress levels in patients with acute ischemic stroke: influence on neurological status and outcome.

BACKGROUND: Oxidative stress is well believed to play a role in the pathogenesis of acute ischemic stroke. Reports on antioxidant enzyme activities in patients with stroke are conflicting. Therefore, the aim of this study was to investigate serum antioxidant enzyme activities and oxidative stress levels in patients with acute ischemic stroke within 1st, 5th, and 21st day after stroke onset and also the relationship between these results and the clinical status of patients. METHODS: The current study comprised 45 patients with acute ischemic stroke and 30 healthy controls. Serum malondialdehyde (MDA) levels, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase activities were measured spectrophotometrically. RESULTS: Serum MDA levels were significantly higher in acute ischemic stroke patients within 24 h after stroke onset than controls (p < 0.05), whereas serum catalase activity was significantly lower (p < 0.05). There were no significant differences in GSH-Px and SOD activities. Serum catalase and SOD activities were significantly lower in fifth day than those of controls (both, p < 0.05) but GSH-Px activity and MDA levels did not change (p > 0.05). Serum SOD activity was significantly lower in 21st day compared to SOD activity of controls (p < 0.05) but MDA levels, GSH-Px, and CAT activities did not change significantly. CONCLUSIONS: Our study demonstrated that acute ischemic stroke patients have increased oxidative stress and decreased antioxidant enzymes activities. These findings indicated that an imbalance of oxidant and antioxidant status might play a role in the pathogenesis of acute ischemic stroke.

Dyke-Davidoff-Masson Syndrome With Cerebral Hypometabolism and Unique Crossed Cerebellar Diaschisis in 18F-FDG PET/CT.

A 23-year-old man with Dyke-Davidoff-Masson syndrome (DDMS) was admitted to the hospital with increasing frequency of epileptic seizures. Physical examination revealed mental retardation, left facial asymmetry, and left-sided spastic hemiparesis. Dysdiadochokinesia on the left upper limb was detected, and there was no dysmetria. MRI confirmed the well-known radiological features of DDMS. PET/CT demonstrated cerebral and contralateral cerebellar hypometabolism. We present DDMS with crossed cerebellar diaschisis, which was demonstrated by PET/CT.

Relations between mood characteristics, circadian preferences, and functionality in multiple sclerosis.

OBJECTIVE: Multiple sclerosis (MS) is a progressive disorder that results in demyelinization of the nerve fibers of the central nervous system. We aimed to determine chronobiological and mood features in patients with MS. METHODS: The sample comprised 75 patients with MS (54 women and 21 men) and 50 healthy individuals (38 women and 12 men). Sixty-three patients were relapsing-remitting MS and twelve patients had secondary progressive-type MS. Mood characteristics were assessed using subscales of the Profile of Mood States (POMS). Chronotypical characteristics were determined by the Morningness-Eveningness Questionnaire (MEQ). Univariate and structural equation modeling was applied to untangle the possible connections between variables. RESULTS: Both relapsing-remitting and secondary progressive patients scored higher on the depression-dejection and fatigue-inertia scales of the POMS than healthy individuals. Circadian preferences did not differ significantly between these groups. Patients using glatiramer acetate and other types of drugs had greater severity of functional impairment measured relative to interferon-beta treatment group. Glatiramer acetate had more negative effects on mood than interferon-beta therapy. This finding may be the result of significantly higher duration of disease and higher symptom severity scores in glatiramer acetate group. CONCLUSIONS: In the structural equation model, gender was found to be predictive for characteristics of mood.

Coping strategies and mood profiles in patients with multiple sclerosis.

OBJECTIVE: The aim of the present study was to investigate the coping strategies, mood characteristics and the association between these aspects in patients diagnosed with multiple sclerosis and healthy subjects. METHOD: Fifty consecutive patients who were diagnosed with multiple sclerosis according to McDonald criteria and thirty-one healthy subjects were included in the study. In addition to the sociodemographic form, Expanded Disability Status Scale (EDSS), Coping Orientation for Problem Experiences Scale (COPE), and Profile of Mood States (POMS) tests were applied to the participants. RESULTS: Non-functional coping strategies were significantly higher in the secondary-progressive type (p≤0.05). Depression-dejection, fatigue-inertia and total POMS scores were significantly higher in the secondary-progressive type (p≤0.05). CONCLUSION: The results of our study demonstrate the importance of rehabilitation programs that encourage exercise among patients with multiple sclerosis to increase vigor-activity levels.