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1.
Sensors (Basel) ; 20(18)2020 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-32899946

RESUMO

Gait deterioration caused by prolonged walking represents one of the main consequences of multiple sclerosis (MS). This study aims at proposing quantitative indices to measure the gait deterioration effects. The experimental protocol consisted in a 6-min walking test and it involved nine patients with MS and twenty-six healthy subjects. Pathology severity was assessed through the Expanded Disability Status Scale. Seven inertial units were used to gather lower limb kinematics. Gait variability and asymmetry were assessed by coefficient of variation (CoV) and symmetry index (SI), respectively. The evolution of ROM (range of motion), CoV, and SI was computed analyzing data divided into six 60-s subgroups. Maximum difference among subgroups and the difference between the first minute and the remaining five were computed. The indices were analyzed for intra- and inter-day reliability and repeatability. Correlation with clinical scores was also evaluated. Good to excellent reliability was found for all indices. The computed standard deviations allowed us to affirm the good repeatability of the indices. The outcomes suggested walking-related fatigue leads to an always more variable kinematics in MS, in terms of changes in ROM, increase of variability and asymmetry. The hip asymmetry strongly correlated with the clinical disability.


Assuntos
Fadiga/fisiopatologia , Transtornos Neurológicos da Marcha/diagnóstico , Marcha/fisiologia , Esclerose Múltipla/diagnóstico , Índice de Gravidade de Doença , Caminhada/fisiologia , Adulto , Idoso , Fenômenos Biomecânicos/fisiologia , Estudos de Casos e Controles , Avaliação da Deficiência , Progressão da Doença , Teste de Esforço/métodos , Feminino , Transtornos Neurológicos da Marcha/etiologia , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/patologia , Esclerose Múltipla/fisiopatologia , Reprodutibilidade dos Testes , Projetos de Pesquisa , Fatores de Tempo
2.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(4): 524-530, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32985167

RESUMO

Failure to remyelinate and rewrap the demyelinated axons has been revealed as the major hurdle for treatment of multiple sclerosis (MS), and the bottleneck is the inability of oligodendrocyte progenitor cell (OPC) to differentiate into mature oligodendrocyte. Remyelination is a spontaneous regenerative process, which includes activation, migration and differentiation of OPC, and is believed to protect the axon and further halt neurodegeneration. In recent years, studies have identified many potential drug targets for efficiently promoting OPC differentiation in in vivo demyelination models, such as metformin, clemostine, and drug targets as myelin transcription factor 1-like protein (Myt1L), N-methyl-D-aspartic acid (NMDA) receptor, connexin 43 (Cx43), G protein coupled receptor 17 (GPR17), κ opioid receptor (KOR), sterol 14α-demethylase (CYP51), Δ14-sterol reductase (TM7SF2), emopamil-binding protein (EBP). This review summarizes the recent progress on the mechanisms underlying the activation, migration and differentiation of OPC in remyelination with special focus on studies using demyelination models of MS, which may provide insights of further exploring new therapeutic strategies for MS.


Assuntos
Esclerose Múltipla , Células Precursoras de Oligodendrócitos , Remielinização , Diferenciação Celular , Humanos , Esclerose Múltipla/fisiopatologia , Células Precursoras de Oligodendrócitos/citologia , Células Precursoras de Oligodendrócitos/metabolismo , Células Precursoras de Oligodendrócitos/patologia , Oligodendroglia/citologia , Oligodendroglia/metabolismo , Oligodendroglia/patologia
3.
PLoS One ; 15(8): e0235615, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745132

RESUMO

No single neuroimaging technique or sequence is capable of reflecting the functional deficits manifest in MS. Given the interest in imaging biomarkers for short- to medium-term studies, we aimed to assess which imaging metrics might best represent functional impairment for monitoring in clinical trials. Given the complexity of functional impairment in MS, however, it is useful to isolate a particular functionally relevant pathway to understand the relationship between imaging and neurological function. We therefore analyzed existing data, combining multiparametric MRI and OCT to describe MS associated visual impairment. We assessed baseline data from fifty MS patients enrolled in ReBUILD, a prospective trial assessing the effect of a remyelinating drug (clemastine). Subjects underwent 3T MRI imaging, including Neurite Orientation Dispersion and Density Imaging (NODDI), myelin content quantification, and retinal imaging, using OCT. Visual function was assessed, using low-contrast letter acuity. MRI and OCT data were studied to model visual function in MS, using a partial, least-squares, regression analysis. Measures of neurodegeneration along the entire visual pathway, described most of the observed variance in visual disability, measured by low contrast letter acuity. In those patients with an identified history of ON, however, putative myelin measures also showed correlation with visual performance. In the absence of clinically identifiable inflammatory episodes, residual disability correlates with neurodegeneration, whereas after an identifiable exacerbation, putative measures of myelin content are additionally informative.


Assuntos
Esclerose Múltipla/diagnóstico por imagem , Visão Ocular , Adulto , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/patologia , Esclerose Múltipla/fisiopatologia , Bainha de Mielina/patologia , Retina/diagnóstico por imagem , Tomografia de Coerência Óptica
4.
Lancet Neurol ; 19(8): 678-688, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32702337

RESUMO

The treatment of multiple sclerosis has been transformed by the successful development of immunotherapies that efficiently reduce disease activity and related clinical relapses during the relapsing-remitting phase of the disease. However, the prevention of disability progression, which is due to axonal and neuronal damage and loss, has yet to be achieved and is therapeutically challenging, particularly during the progressive phase of the disease. One strategy to counteract neurodegeneration is to promote neuroprotection by enhancing myelin regeneration, hence restoring nerve conduction and metabolic support to the axon. Animal studies have provided targets for interventions to improve brain and spinal cord remyelination, paving the way for the translation of this research to humans. From these initial and promising forays, further problems have emerged, including questions on how best to design these clinical trials and appropriately measure the outcomes. Solving these problems will need additional work before efficacious pro-remyelination therapies will be ready for people with multiple sclerosis, but there is a real sense of hope that researchers are getting closer to a successful therapy.


Assuntos
Esclerose Múltipla/patologia , Esclerose Múltipla/fisiopatologia , Remielinização/fisiologia , Progressão da Doença , Humanos , Esclerose Múltipla/diagnóstico por imagem , Bainha de Mielina/fisiologia
5.
PLoS One ; 15(7): e0236090, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32702050

RESUMO

OBJECTIVES: To evaluate retinal axonal density and retinal capillary flow density (CFD) variations in patients affected by multiple sclerosis (MS) as documented by Optical Coherence Tomography Angiography (OCT-A). MATERIAL AND METHODS: A cross-sectional study was performed in a tertiary university eye hospital on 94 eyes from 48 MS patients compared to 37 eyes from 23 matched controls. MS patients were divided in two groups: those with previous episodes of optic neuritis (MS ON+, 71.4%) and those without any previous visual complaint (no optic neuritis group, MS ON, 28.6%). Patients underwent macular and optic nerve head OCT-A with Optovue XR Avanti (Optovue, Freemont, California) after that preliminary evaluation of the ganglion cell complex (GCC) and of the retinal nerve fiber layer (RNFL) was achieved for each single eye by SD-OCT. CFD was evaluated in three different retinal layers of MS patients and controls: superficial capillary plexus (SCP), deep capillary plexus (DCP) and the choriocapillaris layer (CL). Each layer was analyzed in 18 preset subregions automatically detected by the system. CFD values were then correlated to the RNFL thickness and GCC thickness in the groups: p values were computed by t-tests between each group of MS patients and controls. A p-value of <0.05 was considered significant. RESULTS: A significant difference in the overall CFD values was found between ON+ and ON- patients when compared to controls in 18 subregions of SCP. Furthermore, a significant difference was found between MS patients and controls in 16 subregions analyzed corresponding to the CL layer without difference between the two MS subgroups (ON+ and ON-). CONCLUSIONS: OCT-A when performed at the optic nerve head level and at the macular region is characterized by a reduction of retinal perfusion in a significant portion of MS patients independently if they had a previous history of optic nerve inflammation or not.


Assuntos
Esclerose Múltipla/diagnóstico por imagem , Tomografia de Coerência Óptica , Axônios/metabolismo , Capilares/diagnóstico por imagem , Capilares/metabolismo , Estudos de Casos e Controles , Estudos Transversais , Reações Falso-Positivas , Humanos , Esclerose Múltipla/patologia , Esclerose Múltipla/fisiopatologia , Fibras Nervosas/metabolismo , Retina/diagnóstico por imagem , Retina/fisiopatologia
6.
PLoS One ; 15(6): e0234333, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525921

RESUMO

In most cases, multiple sclerosis (MS) patients reduce physical activity with disease progression and many patients are found to be vitamin D deficient. The aim of this study was to explore correlations between daily physical activity in everyday life and 25-hydroxyvitamin-D3 (25(OH)D3) serum levels in mildly disabled patients with an Expanded Disability Status Scale (EDSS) ≤ 4. We analyzed serum 25(OH)D3 levels and recorded daily physical activity (activity duration, number of steps, distance, energy expenditure) using an activity tracker for 14-days in 25 women and 15 men. Participants recorded their daily sunlight exposure time by diary during the study period. We found a positive correlation between physical activity and 25(OH)D3 levels in both, Pearson correlation (r = 0.221) and multivariate regression analysis (ß = 0.236), which was stronger than correlation with sunlight exposure time (ß = -0.081). EDSS and physical activity were weakly correlated (r = -0.228), but no correlation between EDSS and 25(OH)D3 levels was found (r = -0.077). There were no relevant differences in physical activity (p = 0.803) and 25(OH)D3 concentrations (p = 0.385) between the EDSS groups 0 - 1.5 and 2.0 - 4.0. In conclusion, physical activity has an effect on vitamin D levels independent of sunlight exposure time in people with MS (pwMS) with low-grade disability.


Assuntos
Calcifediol/sangue , Exercício Físico/fisiologia , Esclerose Múltipla/sangue , Esclerose Múltipla/fisiopatologia , Adulto , Avaliação da Deficiência , Progressão da Doença , Feminino , Monitores de Aptidão Física , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Análise Multivariada , Estudos Prospectivos , Análise de Regressão , Luz Solar , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicações , Adulto Jovem
8.
Adv Clin Exp Med ; 29(4): 441-448, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32369275

RESUMO

BACKGROUND: Several studies have identified changes in the spinal cord DTI measurements in patients with multiple sclerosis (MS). However, correlations between changes in DTI parameters in normal appearing cervical spine and neurological findings have not been clearly established. OBJECTIVES: To determine whether diffusion tensor imaging (DTI) measurements such as fractional anisotropy (FA) and apparent diffusion coefficient (ADC) are sufficiently sensitive in detecting microstructure alterations in normal-appearing spinal cords in patients with MS and whether they reflect these patients' clinical disability. MATERIAL AND METHODS: Fifteen patients diagnosed with relapsing-remitting MS (RRMS) with normal-appearing cervical spinal cords on plain MRI and 11 asymptomatic volunteers were enrolled in the study. Overall, 75 cervical spinal segments were analyzed. The regions of interest were drawn from the entire spinal cord cross-section and in the normal-appearing white matter tracts: the superior and inferior cerebellar peduncles and the posterior limbs of the internal capsules. Neurological deficit and the level of disability were evaluated using the Expanded Disability Status Scale (EDSS), the timed 25-foot walk test (T25FW) and the 9-hole peg test (9HPT) for manual dexterity. RESULTS: A significant difference (p < 0.05) in FA values between patients with MS and the control group was found at levels C2 (p = 0.047) and C3 (p = 0.023). No significant changes in ADC values were found. There was correlation between FA and ADC values in selected white matter tracts and at particular spinal cord levels. We also observed significant correlations between diffusion tensor imaging parameters and manual dexterity. CONCLUSIONS: Our preliminary results may suggest that the spinal cord's structural loss is the dominant factor in the inflammatory/demyelinating component in patients with MS. Diffusion tensor imaging changes in the spinal cord correlate with brain DTI changes. Manual functioning seems to be more affected than walking.


Assuntos
Encéfalo/diagnóstico por imagem , Medula Cervical/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Esclerose Múltipla/diagnóstico por imagem , Medula Espinal/anatomia & histologia , Medula Espinal/patologia , Anisotropia , Humanos , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Fibras Nervosas Mielinizadas/patologia
9.
PLoS One ; 15(5): e0233575, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32453803

RESUMO

The natural history of relapsing remitting multiple sclerosis (RRMS) is variable and prediction of individual prognosis challenging. The inability to reliably predict prognosis at diagnosis has important implications for informed decision making especially in relation to disease modifying therapies. We conducted a systematic review in order to collate, describe and assess the methodological quality of published prediction models in RRMS. We searched Medline, Embase and Web of Science. Two reviewers independently screened abstracts and full text for eligibility and assessed risk of bias. Studies reporting development or validation of prediction models for RRMS in adults were included. Data collection was guided by the checklist for critical appraisal and data extraction for systematic reviews (CHARMS) and applicability and methodological quality assessment by the prediction model risk of bias assessment tool (PROBAST). 30 studies were included in the review. Applicability was assessed as high risk of concern in 27 studies. Risk of bias was assessed as high for all studies. The single most frequently included predictor was baseline EDSS (n = 11). T2 Lesion volume or number and brain atrophy were each retained in seven studies. Five studies included external validation and none included impact analysis. Although a number of prediction models for RRMS have been reported, most are at high risk of bias and lack external validation and impact analysis, restricting their application to routine clinical practice.


Assuntos
Esclerose Múltipla Recidivante-Remitente/terapia , Esclerose Múltipla/terapia , Prognóstico , Tomada de Decisões , Progressão da Doença , Humanos , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla Recidivante-Remitente/epidemiologia , Esclerose Múltipla Recidivante-Remitente/fisiopatologia
10.
Occup Ther Int ; 2020: 6193938, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32425718

RESUMO

Background: Manipulative dexterity impairments affect 76% of individuals with multiple sclerosis (MS). Patients with MS can experience reduced skill when performing both basic activities of daily living and instrumental activities of daily living. Many studies consider that physical rehabilitation leads to a decrease in the level of disability, especially at the mild and moderate stages of the disease. However, most studies fail to distinguish between the different MS subtypes. Purpose: Our aims were (1) to describe the manipulative skills of people according to the different subtypes of MS, (2) to analyze the correlation between dexterity and self-perception variables, and (3) to identify possible predictors of functionality. Study Design. A descriptive cross-sectional study. Methods: 30 individuals with MS. The measurement tools used were the ABILHAND, the Purdue Pegboard Test (PPT), the Nine-Hole Peg Test, and the Box and Block Test. Results: All subtypes of MS obtained lower scores for manipulative dexterity compared to normal skill levels, with individuals with primary progressive MS displaying the lowest values. However, the analysis of differences between the different subtypes did not reveal statistically significant intragroup differences. In addition, differences were found regarding the effect size of practically all the variables analyzed for both manipulative dexterity (PPT, NHPT, and BBT) and the self-perception of ADLs (ABILHAND), for which high values (d r = 0.72) and very high values (d r = 1.46) were obtained. Conclusions: Although no significant differences were found between the different types of MS, the assessment of manual dexterity and perceived efficacy of daily activities must be considered as prognostic factors in the progression of the disease. These findings may help support further research on targeted interventions to improve dexterity deficiencies, as well as promote an improved quality of therapeutic interventions.


Assuntos
Destreza Motora/fisiologia , Esclerose Múltipla/fisiopatologia , Atividades Cotidianas , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/classificação , Esclerose Múltipla/psicologia , Esclerose Múltipla/reabilitação , Terapia Ocupacional , Autoimagem
11.
Neurology ; 94(24): 1088-1092, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32471886

RESUMO

The clinical courses of multiple sclerosis were defined in 1996 and refined in 2013 to provide a time-based assessment of the current status of the individual. These definitions have been successfully used by clinicians, clinical trialists, and regulatory authorities. Recent regulatory decisions produced variations and discrepancies in the use of the clinical course descriptions. We provide here a clarification of the concepts underlying these descriptions and restate the principles used in their development. Importantly, we highlight the critical importance of time framing the disease course modifiers activity and progression and clarify the difference between the terms worsening and progressing.


Assuntos
Esclerose Múltipla/diagnóstico , Progressão da Doença , Humanos , Esclerose Múltipla/fisiopatologia , Fenótipo , Resultado do Tratamento
12.
Adv Clin Exp Med ; 29(4): 469-473, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32343889

RESUMO

BACKGROUND: The effect multiple sclerosis (MS) has on the social functioning and integration of patients has been recently considered as an important factor of the disease. OBJECTIVES: To assess social participation of MS patients with regard to demographic and disease-related variables. MATERIAL AND METHODS: The study comprised 201 MS patients: 140 women, 61 men, aged 24-69 years. The World Health Organization Disability Assessment Schedule (WHODAS 2.0) was applied to assess the aspects of social functioning and the Beck Depression Inventory (BDI) was applied to evaluate the level of depression. Disease duration, degree of disability in Expanded Disability Status Scale (EDSS), most disabling symptoms and type of treatment were determined. WHODAS 2.0 scores (total and within particular domains) and their relationships with age, gender, disease-related variables and level of depression were analyzed. RESULTS: The results of WHODAS 2.0 for 27.4% of patients exceeded the 90th percentile compared to the population norms (with the highest scores for "getting around" and "participation in society" domains). The results of BDI and WHODAS 2.0 were strongly correlated (p < 0.001; ß = 0.73) and mobility impairment was related to both of them (p < 0.001; ß = -0.12 and 0.25, respectively). Other disabling symptoms were associated with scores in domains "understanding and communicating", "getting around" and "participation in society". CONCLUSIONS: Social participation of the MS patients is affected by the impact of disease and associated with depression. Particular symptoms of neurological deficit (motor and visual impairment, fatigue) influence social functioning more than general disease-related variables.


Assuntos
Depressão/diagnóstico , Depressão/psicologia , Fadiga/diagnóstico , Esclerose Múltipla/psicologia , Qualidade de Vida , Participação Social , Adulto , Idoso , Depressão/etiologia , Avaliação da Deficiência , Pessoas com Deficiência , Fadiga/etiologia , Fadiga/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/fisiopatologia , Escalas de Graduação Psiquiátrica , Perfil de Impacto da Doença , Transtornos da Visão , Adulto Jovem
13.
PLoS One ; 15(4): e0226050, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32240164

RESUMO

Autotaxin (ATX) is a secreted lysophospholipase D catalyzing the extracellular production of lysophosphatidic acid (LPA), a growth factor-like signaling lysophospholipid. ATX and LPA signaling have been incriminated in the pathogenesis of different chronic inflammatory diseases and various types of cancer. In this report, deregulated ATX and LPA levels were detected in the spinal cord and plasma of mice during the development of experimental autoimmune encephalomyelitis (EAE). Among the different sources of ATX expression in the inflamed spinal cord, F4/80+ CD11b+ cells, mostly activated macrophages and microglia, were found to express ATX, further suggesting an autocrine role for ATX/LPA in their activation, an EAE hallmark. Accordingly, ATX genetic deletion from CD11b+ cells attenuated the severity of EAE, thus proposing a pathogenic role for the ATX/LPA axis in neuroinflammatory disorders.


Assuntos
Encefalomielite Autoimune Experimental/genética , Lisofosfolipídeos/genética , Esclerose Múltipla/genética , Diester Fosfórico Hidrolases/genética , Animais , Antígeno CD11b/genética , Sistema Nervoso Central/metabolismo , Sistema Nervoso Central/patologia , Encefalomielite Autoimune Experimental/sangue , Encefalomielite Autoimune Experimental/fisiopatologia , Deleção de Genes , Expressão Gênica/genética , Humanos , Lisofosfolipídeos/biossíntese , Macrófagos/metabolismo , Macrófagos/patologia , Camundongos , Microglia/metabolismo , Microglia/patologia , Esclerose Múltipla/sangue , Esclerose Múltipla/fisiopatologia , Transdução de Sinais/genética , Medula Espinal/metabolismo , Medula Espinal/fisiopatologia
14.
Semin Ophthalmol ; 35(2): 103-115, 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32228341

RESUMO

Multiple sclerosis (MS) is an acquired demyelinating and inflammatory neurodegenerative disease affecting the central nervous system (CNS). Clinical and subclinical ocular disturbances occur in almost all patients with MS. The objective of this narrative review was to collect and summarize the available scientific information on oculomotor, accommodative and binocular alterations that have been reported in MS. A systematic search strategy with the following descriptors was carried out: multiple sclerosis, ocular motility disorders, internuclear ophthalmoplegia, nystagmus, vergences, fixation, pupil reflex, accommodation and stereopsis. According to the search, some oculomotor alterations were found to be commonly reported in MS, such as alterations in saccades and nystagmus. In contrast, accommodative, vergence and stereopsis alterations have not been comprehensively studied despite their relevance, with only minimal evidence showing a potential negative impact of the disease on these aspects. In conclusion, oculomotor impairment is a common component of disability in MS patients and should be considered when managing this type of patients. More research is still needed to know the real impact of this disease on binocular vision and accommodation.


Assuntos
Acomodação Ocular/fisiologia , Esclerose Múltipla/fisiopatologia , Transtornos da Motilidade Ocular/fisiopatologia , Visão Binocular/fisiologia , Percepção de Profundidade/fisiologia , Humanos , Movimentos Sacádicos/fisiologia
15.
NeuroRehabilitation ; 46(3): 333-341, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32250329

RESUMO

BACKGROUD: Patients with MS, regardless of the complexity of the activity or sensory conditions, commonly present a significant postural control deficit compared to healthy subjects. OBJECTIVE: To investigate which postural self-correction strategies are adopted by patients with Multiple Sclerosis versus a group of healthy-subjects and how self-correction can influence the control of postural balance. METHODS: A case-control prospective observational study was conducted. Person with Multiple Sclerosis and a group of healthy volunteers were enrolled. Patients included were instructed with vocal commands, to reach a self-correction posture, and they were compared to healthy subjects. Clinical assessments including Balance, Stabilometry and Postural evaluation of the spine were performed. RESULTS: Sixty patients (30: control-group; 30: treatment-group) were enrolled. In the treatment group, the analysis reported a significant statistical difference between path length and center of pressure speed in self-correction posture with closed-eyes (p = 0,049; 0,047) and an improvement in C7 and L3 levels in self-correction posture (p < 0,01-C7; p < 0,01-L3). There are significant statistical differences about path length between the two groups in all examined conditions (p = 0,0001). At sagittal plane evaluation, results show an increase of all measurements in both posture (C7-neutral posture p = 0,0001; L3-neutral posture p = 0,0001; C7-self-correction posture p = 0,0001; L3-self-correction posture p = 0,0001). CONCLUSION: Further study should investigate dynamic situations and different Multiple Sclerosis forms to complete balance analysis and to establish a correct rehabilitative program with self-correction exercise as powerful focus.


Assuntos
Terapia por Exercício/métodos , Esclerose Múltipla , Equilíbrio Postural/fisiologia , Postura/fisiologia , Estudos de Casos e Controles , Humanos , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/reabilitação , Estudos Prospectivos
16.
NeuroRehabilitation ; 46(3): 321-331, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32250333

RESUMO

BACKGROUND: An intensive task-oriented circuit training (TOCT) provides a valid approach in improving motor function in Multiple Sclerosis (MS). OBJECTIVE: We aimed at testing the efficacy of TOCT on gait kinematics in MS patients with mild-moderate disability. METHODS: Nineteen MS patients able of independent walking performed 3-D Gait Analysis before (T0) and after (T1) a two-week TOCT program. Patients were clustered in two different subgroups, according to clinical neurological impairments assessed with specific functional system of Expanded Disability Status Scale (EDSS): pyramidal (Group 1) and cerebellar (Group 2) subjects. Spatio-temporal and kinematic data were compared before and after the TOCT intervention in the total sample of patients and in the two selected subgroups at two time intervals. RESULTS: Data obtained revealed increased dynamic ROM at knee joint after training in the whole study sample. Of note, knee dynamic excursion improved significantly in Group 1 but not in Group 2 patients after TOCT. Moreover, sagittal plane kinematics revealed significant modifications on knee and ankle biomechanics in Group 1 after rehabilitation. CONCLUSIONS: These data point out the benefits of the task specific training on gait dynamics in mild impaired MS subjects, linking to treatment opportunity in patients with a prevalent pyramidal impairment.


Assuntos
Exercícios em Circuitos/métodos , Terapia por Exercício/métodos , Marcha/fisiologia , Esclerose Múltipla , Fenômenos Biomecânicos/fisiologia , Análise da Marcha , Humanos , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/reabilitação
17.
NeuroRehabilitation ; 46(3): 343-353, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32310197

RESUMO

BACKGROUND: Exercise training has positive effects on motor and cognitive performance which deteriorates over time in patients with Multiple Sclerosis (MS). The effects of task-oriented circuit training (TOCT) on motor and cognitive performance in patients with MS are not yet clear. OBJECTIVE: The aims of this study are to investigate the effects of TOCT on balance, walking, manual dexterity, cognitive performance, and to determine the extent to which patients are able to transfer changes in their performance to activities of daily living. METHODS: Twenty patients with MS (EDSS: 2-5.5), were randomly assigned to two groups; the task-oriented circuit training group (TOCTG, n:10) and the control group (CG, n:10). The TOCTG received TOCT twice a week for six weeks while the CG performed the relaxation exercises at home. All patients were assessed by using Modified Sensory Organization Test, Berg Balance Scale, Activities-specific Balance Confidence, Timed Up and Go, Functional Gait Assessment, 12-item Multiple Sclerosis Walking Scale, Nine-Hole Peg Test, Brief Repeatable Battery of Neuropsychological Tests, Multiple Sclerosis Neuropsychological Questionnaire. RESULTS: Balance and walking performance were improved after TOCT (p < 0.05), whereas manual dexterity and cognitive performance except for verbal memory did not change significantly (p > 0.05). The CG showed no changes in any measurements (p > 0.05). CONCLUSIONS: TOCT is quite effective to improve balance and walking in patients with MS. However, further studies are needed to determine the effect of TOCT on cognitive performance.


Assuntos
Exercícios em Circuitos/métodos , Cognição/fisiologia , Terapia por Exercício/métodos , Esclerose Múltipla , Humanos , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/psicologia , Esclerose Múltipla/reabilitação , Testes Neuropsicológicos
18.
J Clin Neurosci ; 75: 181-187, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32247741

RESUMO

Pattern reversal visual evoked potentials have been used to study optic neuritis. Although smaller check size in the central fields are more sensitive, larger check sizes can be advantageous for patient fixation and in poor vision. We compared sectorial central and peripheral hemisurround stimulus with commonly used full- and half- field stimulus using large check sizes (65') in the context of optic neuritis and multiple sclerosis. Of 19 female and 16 male control subjects studied, females had shorter P100 latencies and larger amplitudes than males. In 9 of the 18 patients with VEP abnormalities, the central field abnormalities were greater than those recorded with the full field response. The results confirm for the first time that central field stimulation using large checks can show a greater extent of abnormality than can be appreciated with large check full field stimulation alone, and could be commonly employed to improve yield in the investigation of optic neuritis. The data suggest that it is necessary to collect separate gender-specific laboratory normal values using this check size.


Assuntos
Potenciais Evocados Visuais/fisiologia , Esclerose Múltipla/fisiopatologia , Neurite Óptica/fisiopatologia , Estimulação Luminosa/métodos , Campos Visuais/fisiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico , Neurite Óptica/diagnóstico , Adulto Jovem
19.
Autoimmun Rev ; 19(5): 102512, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32173519

RESUMO

A proper clinical evaluation of patients with Multiple Sclerosis (MS) is of great importance to detect MS progression. It provides important data for physicians on their daily practice as well as with scientific purpose, especially useful with the development of newer therapeutic options in MS. Clinical outcome measures (COMs) are instruments that enable a standardized characterization of the patient's clinical disease status. A proper COM should have - among other psychometric characteristics - a good validity, reliability and responsiveness. For MS disability, the Expanded Disability Status Scale (EDSS) is currently the most frequently used scale. However, different less known COMs are also available and could be implemented on clinical practice. We review the most frequently used COMs of MS progression including their operationalization and statistical considerations, as well as newer composite COMs and digital tools on development. We focus on their responsiveness or capacity to detect clinically relevant changes to identify progression or transition to progressive forms of the disease, as well as therapeutic response.


Assuntos
Esclerose Múltipla/diagnóstico , Esclerose Múltipla/terapia , Avaliação da Deficiência , Progressão da Doença , Humanos , Esclerose Múltipla/fisiopatologia , Avaliação de Resultados em Cuidados de Saúde , Reprodutibilidade dos Testes
20.
Value Health ; 23(2): 242-250, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32113630

RESUMO

BACKGROUND: A major debate in the quality-adjusted life-year (QALY) literature concerns whose preferences should be used to estimate health state values (HSVs) and to calculate QALYs. OBJECTIVES: This study explores differences between public and patient values for multiple sclerosis (MS) health states, described using an MS-specific classification system (Multiple Sclerosis Impact Scale-8 Dimensions [MSIS-8D]). METHODS: The MSIS-8D is an existing preference-based measure of health-related quality of life in MS, which has 2 tariffs of HSVs, based on the preferences of a representative sample of the UK general population (n = 1702) and of people with MS living in the United Kingdom (n = 1635), elicited using the time trade-off technique. Here, we explore differences between HSVs by sample type, using descriptive statistics and multivariate regression methods. RESULTS: Overall, the survey of people with MS produced significantly higher HSVs; estimated values ranged from 0.079 to 0.883 for the general population survey and from 0.138 to 0.894 for the MS survey. Differences in HSVs were more pronounced for severe health states. The difference between patient and public values varied across the dimensions of the MSIS-8D. People with MS placed greater importance on cognition than the general population, leading to lower HSVs when impairment was at a worse level; the reverse was true for the daily activities, fatigue, and depression dimensions. CONCLUSIONS: We identified significant differences in HSVs by sample type. Using patient rather than public values may influence the results of economic evaluations, depending on the dimensions of health-related quality of life affected by the intervention being assessed, and may therefore have important consequences for reimbursement decisions.


Assuntos
Indicadores Básicos de Saúde , Nível de Saúde , Esclerose Múltipla/diagnóstico , Preferência do Paciente , Opinião Pública , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Atividades Cotidianas , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Efeitos Psicossociais da Doença , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/psicologia , Índice de Gravidade de Doença , Fatores de Tempo , Reino Unido , Adulto Jovem
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