Clinical and demographic characteristics of late-onset multiple sclerosis: LOMS-TR study.

OBJECTIVES: Multiple sclerosis (MS), which is known as a young-adult age disease, is called late-onset MS (LOMS) when it occurs at the age of 50 and older. In our study, we aimed to analyse the clinical and demographic characteristics, comorbidities, diagnostic and treatment challenges and prognosis of LOMS. METHODS: In a retrospective analysis of 136 patients diagnosed with multiple sclerosis (MS) after the age of 50, based on the 2017 McDonald criteria, and who were under observation in eight distinct MS centers across Turkey; demographic information, clinical characteristics of the disease, oligoclonal band (OCB) status, initial and current Expanded Disability Status Scale (EDSS) values, administered treatments, and the existence of spinal lesions on magnetic resonance imaging (MRI) were investigated. RESULTS: The mean age of the 136 patients was 60.96±6.42 years (51-79), the mean age at diagnosis was 54.94±4.30 years, and 89 (65.4 %) of the patients were female. Most of the cases, 61.1 % (83) had at least one comorbidity. In 97 patients who underwent lumbar puncture (LP), OCB positivity was observed in 63.6 %. In 114 patients (83.8 %), spinal lesions were detected on MRI. Eighty-seven patients had relapsing-remitting MS (RRMS) (64 %), 27 patients had secondary progressive MS (SPMS) (19.9 %), and 22 patients had primary progressive MS (PPMS) (16.2 %). The mean EDSS at the time of diagnosis was 2.44±1.46, and the mean current EDSS was 3.15±2.14. CONCLUSIONS: In LOMS patients, the rates of delay in the diagnostic process, treatment disruption and progressive disease are higher than in the general MS population. The high rates of LP applying and OCB positivity of this study may indicate the habit of looking for clear evidences in advanged age in our country. This situation and comorbidities may cause a delay in diagnosis and eliminates the window of opportunity for early diagnosis. Although the high number of spinal lesions is a known marker for progressive disease, it is an issue that needs to be discussed whether the increased frequency of progressive course at older ages is due to the nature of the disease or immune aging itself.

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.

Restless legs syndrome/Willis-Ekbom disease in multiple sclerosis: a contributing factor for anxiety, disability, sleep disorder, and quality of life.

BACKGROUND: Restless legs syndrome (RLS) is one of the most common and burdensome sleep disorders in the course of multiple sclerosis (MS). OBJECTIVE: To evaluate common MS-related symptoms and consequences between groups with and without RLS and further assess the association of quality of life determinants with RLS symptom severity. METHODS: According to their RLS status, 46 relapsing-remitting MS patients were divided into MS-RLS+ (n=19) and MS-RLS- groups (n=27). Specific questionnaires were administered to assess the patients' health-related quality of life (HRQoL), fatigue levels, sleep quality, daily sleepiness, anxiety, and depression symptoms. Functional capacity was examined using the Expanded Disability Status Scale (EDSS). RESULTS: The prevalence of RLS was 41.3%. Compared to the MS-RLS- group, those with RLS had higher EDSS scores, more cranial and spinal lesions, longer disease duration, and were older. In the MS-RLS+ group, symptom severity scores were positively correlated with higher anxiety and poorer sleep quality. The symptom severity score was negatively correlated with mental HRQoL and pain scores. CONCLUSION: In conclusion, the findings of the current study indicate the negative impact of RLS on functional capacity, anxiety, sleep quality, and mental HRQoL of MS patients. Further studies using more accurate diagnostic strategies for identifying RLS and other sleep disorders are necessary to clarify the association of MS with RLS and explore relevant clinical implications.

Restless legs syndrome/Willis-Ekbom disease in multiple sclerosis: a contributing factor for anxiety, disability, sleep disorder, and quality of life / Síndrome de las piernas inquietas/enfermedad de Willis-Ekbom en la esclerosis múltiple: un factor que contribuye a la ansiedad, la discapacidad, los trastornos del sueño y la calidad de vida

ABSTRACT Background: Restless legs syndrome (RLS) is one of the most common and burdensome sleep disorders in the course of multiple sclerosis (MS). Objective: To evaluate common MS-related symptoms and consequences between groups with and without RLS and further assess the association of quality of life determinants with RLS symptom severity. Methods: According to their RLS status, 46 relapsing-remitting MS patients were divided into MS-RLS+ (n=19) and MS-RLS- groups (n=27). Specific questionnaires were administered to assess the patients' health-related quality of life (HRQoL), fatigue levels, sleep quality, daily sleepiness, anxiety, and depression symptoms. Functional capacity was examined using the Expanded Disability Status Scale (EDSS). Results: The prevalence of RLS was 41.3%. Compared to the MS-RLS- group, those with RLS had higher EDSS scores, more cranial and spinal lesions, longer disease duration, and were older. In the MS-RLS+ group, symptom severity scores were positively correlated with higher anxiety and poorer sleep quality. The symptom severity score was negatively correlated with mental HRQoL and pain scores. Conclusion: In conclusion, the findings of the current study indicate the negative impact of RLS on functional capacity, anxiety, sleep quality, and mental HRQoL of MS patients. Further studies using more accurate diagnostic strategies for identifying RLS and other sleep disorders are necessary to clarify the association of MS with RLS and explore relevant clinical implications.

RESUMEN Antecedentes: El síndrome de piernas inquietas (SPI) es uno de los trastornos del sueño más comunes y onerosos en el curso de la esclerosis múltiple (EM). Objetivo: El objetivo de este estudio fue evaluar los síntomas y las consecuencias comunes asociados con la EM entre los grupos con y sin SPI y evaluar aún más la asociación de los determinantes de la calidad de vida con la gravedad de los síntomas del SPI. Métodos: De acuerdo con su estado de SPI, 46 pacientes con EM recurrente-remitente se dividieron en los grupos EM-SPI+ (n=19) y EM-SPI- (n=27). Se utilizaron cuestionarios específicos para evaluar la calidad de vida relacionada con la salud (CVRS), los niveles de fatiga, la calidad del sueño, la somnolencia diaria, la ansiedad y los síntomas de depresión de los pacientes. La capacidad funcional se examinó mediante la escala ampliada del estado de discapacidad (Expanded Disability Status Scale — EDSS). Resultados: La prevalencia de SPI fue del 41,3%. Em comparación com el grupo EM-SPI-, aquellos com SPI tenían púntuaciones más altas em la EDSS, más lesiones craneales y espinales, mayor duración de la enfermedad y eran mayores. Los puntajes de gravedad de los síntomas em el grupo EM-SPI+ se correlacionaron positivamente con una mayor ansiedad y una peor calidad del sueño. Se observaron correlaciones negativas entre la puntuación de gravedad de los síntomas y la CVRS mental y los puntajes de dolor. Conclusiones: En conclusión, el estudio actual indica el impacto negativo del SPI en la discapacidad funcional, la ansiedad, la calidad del sueño y la CVRS mental de los pacientes con EM. Se necesitan más estudios que utilicen estrategias de diagnóstico más precisas para identificar el SPI y otros trastornos del sueño para aclarar la asociación de la EM con el SPI y para explorar implicaciones clínicas relevantes.