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2.
Artigo em Inglês | MEDLINE | ID: mdl-33504634

RESUMO

OBJECTIVE: To investigate the incidence of coronavirus disease 2019 (COVID-19) in a single-center cohort of patients with MS and to explore the contribution of their comorbidities and therapies to the outcome. METHODS: A cross-sectional mixed-method study was conducted involving an email-based, self-administered questionnaire sent on May 21, 2020, to 586 patients with MS followed at the MS Unit of Hospital Clinic, University of Barcelona, along with telephone interview, and review of electronic medical records until June 18, 2020. The cumulative incidence of confirmed COVID-19 (positive PCR or antibody test) and all COVID-19 cases (confirmed and suspected) from the start of the pandemic was compared with the population estimates for Barcelona. RESULTS: A total of 407 patients (69.5%) completed the survey. Most of the responders (67%) were female. The responders had a median age of 48 years (range 19-86), relapsing-remitting disease (84%), at least 1 comorbidity (45%), and were on disease-modifying therapy (DMT; 74.7%). COVID-19 was confirmed in 5 patients (1.2%) and suspected in 46 (11.3%). The cumulative incidence of confirmed COVID-19 cases was similar to that of the general population but was almost 2-fold higher when all cases were considered (p < 0.001). Six patients (11.7%) were hospitalized, of which 5 had good recovery and 1 died. Hospitalized patients were more frequently male, had diabetes and had progressive forms of MS (p < 0.05). DMT was not associated with the risk of infection or the outcome. CONCLUSIONS: In the studied MS cohort, the incidence of COVID-19 was higher than that of the general population; however, most patients did not require hospitalization and had a good outcome despite the frequent presence of comorbidities and treatment with DMT.


Assuntos
/complicações , Esclerose Múltipla/complicações , Esclerose Múltipla/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antirreumáticos/efeitos adversos , Antirreumáticos/uso terapêutico , Estudos de Coortes , Comorbidade , Estudos Transversais , Registros Eletrônicos de Saúde , Feminino , Hospitalização , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/terapia , Fatores Sexuais , Espanha/epidemiologia , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
3.
Science ; 371(6525): 145-153, 2021 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-33414215

RESUMO

The ability to control autoreactive T cells without inducing systemic immune suppression is the major goal for treatment of autoimmune diseases. The key challenge is the safe and efficient delivery of pharmaceutically well-defined antigens in a noninflammatory context. Here, we show that systemic delivery of nanoparticle-formulated 1 methylpseudouridine-modified messenger RNA (m1Ψ mRNA) coding for disease-related autoantigens results in antigen presentation on splenic CD11c+ antigen-presenting cells in the absence of costimulatory signals. In several mouse models of multiple sclerosis, the disease is suppressed by treatment with such m1Ψ mRNA. The treatment effect is associated with a reduction of effector T cells and the development of regulatory T cell (Treg cell) populations. Notably, these Treg cells execute strong bystander immunosuppression and thus improve disease induced by cognate and noncognate autoantigens.


Assuntos
Efeito Espectador/imunologia , Encefalomielite Autoimune Experimental/terapia , Imunossupressão/métodos , Esclerose Múltipla/terapia , Vacinas Sintéticas/uso terapêutico , Animais , Células Apresentadoras de Antígenos , Autoantígenos/genética , Inflamação/imunologia , Camundongos , Camundongos Endogâmicos C57BL , Pseudouridina/análogos & derivados , Pseudouridina/química , RNA Mensageiro/efeitos adversos , RNA Mensageiro/química , RNA Mensageiro/genética , Linfócitos T Reguladores/imunologia , Vacinas Sintéticas/efeitos adversos
4.
Lancet Neurol ; 20(2): 136-149, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33484648

RESUMO

The field of acquired CNS neuroimmune demyelination in children is transforming. Progress in assay development, refinement of diagnostic criteria, increased biological insights provided by advanced neuroimaging techniques, and high-level evidence for the therapeutic efficacy of biological agents are redefining diagnosis and care. Three distinct neuroimmune conditions-multiple sclerosis, myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and aquaporin-4 antibody-associated neuromyelitis optica spectrum disorder (AQP4-NMOSD)-can now be distinguished, with evidence from humans and animal models supporting distinct pathobiological disease mechanisms. The development of highly effective therapies for adult-onset multiple sclerosis and AQP4-NMOSD that suppress relapse rate by more than 90% has motivated advocacy for trials in children. However, doing clinical trials is challenging because of the rarity of these conditions in the paediatric age group, necessitating new approaches to trial design, including age-based trajectory modelling based on phase 3 studies in adults. Despite these limitations, the future for children and adolescents living with multiple sclerosis, MOGAD, or AQP4-NMOSD is far brighter than in years past, and will be brighter still if successful therapies to promote remyelination, enhance neuroprotection, and remediate cognitive deficits can be further accelerated.


Assuntos
Doenças Desmielinizantes/diagnóstico por imagem , Doenças Desmielinizantes/patologia , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/patologia , Adolescente , Criança , Doenças Desmielinizantes/diagnóstico , Doenças Desmielinizantes/terapia , Humanos , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/terapia , Neuroimagem , Adulto Jovem
5.
Mult Scler Relat Disord ; 48: 102702, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33360914

RESUMO

BACKGROUND: COVID-19 pandemic has changed the way to manage MS and NMOSD, not only concerning treatment, but also regarding social distance and the increasing use of telemedicine (TM) to minimize the risk of infection. Currently, there is no data regarding TM among MS and NMOSD South American experts. OBJECTIVE: To investigate TM experiences from South American MS and/or NMOSD experts in the follow-up of their patients focusing on TM. METHODS: A cross-sectional study was performed. 141 MS and/or NMOSD experts from Argentina, Chile, Colombia and Brazil were invited to answer an web-based survey. RESULTS: A total of 129 (91.48 %) experts completed the survey. Only 19.4% had experience in TM previous COVID-19 pandemic, while 79.8% are currently using TM, most using video call (52.3%). Using TM, 44.1% of the experts were able to perform neurological examination, 85.6% believed to be able to identify a relapse, 48.6% use Patient Determined Disease Steps and 38.7% kept using the conventional Expanded Disability Status Scale. CONCLUSION: Our survey demonstrates preparedness and responsiveness among South American MS and/or NMOSD experts.  Despite scarce prior TM experience, most experts felt confident to use TM as a new tool for monitoring their patients.


Assuntos
Esclerose Múltipla/terapia , Neurologistas/estatística & dados numéricos , Neuromielite Óptica/terapia , Padrões de Prática Médica/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adulto , Argentina , Brasil , Chile , Colômbia , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade
7.
Artigo em Inglês | MEDLINE | ID: mdl-33374429

RESUMO

People with multiple sclerosis (PwMS) often experience uncertainty and fear about their futures. Partners of PwMS may share their concerns and experience fears about their own futures, limitations on their lives, ability to work, and becoming a carer. For PwMS, modification of lifestyle-related risk factors has been associated with improved health outcomes. For PwMS who attended residential lifestyle modification workshops (RLMW), sustained improved health outcomes have been demonstrated. Whether improved outcomes for PwMS who engage with lifestyle modification translate to improved partner perceptions of the future, is yet to be explored. We explored the perspectives of partners of PwMS who had attended a RLMW and the impact that the person with MS's illness and their engagement with lifestyle modification had on their partners' views of the future. Analysis of 21 semi-structured interviews used a methodology informed by Heidegger's Interpretive Phenomenology. Three themes emerged: 'uncertainty', 'planning for the future' and 'control, empowerment and confidence'. Subthemes included MS and lifestyle modification being a catalyst for positive change; developing a sense of control and empowerment; and hope, optimism and positivity. Lifestyle modification may provide benefits, not only to PwMS, but also to their partners, and should be considered part of mainstream management of MS.


Assuntos
Cuidadores/psicologia , Estilo de Vida , Esclerose Múltipla , Reabilitação Psiquiátrica , Adulto , Idoso , Terapia Comportamental , Empoderamento , Feminino , Previsões , Esperança , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/terapia , Otimismo , Educação de Pacientes como Assunto , Adulto Jovem
9.
Artigo em Inglês | MEDLINE | ID: mdl-33375123

RESUMO

Tailored activity pacing could help manage fatigue and improve physical activity. However, little is known about how to tailor activity pacing for people with multiple sclerosis. This study aims to evaluate the effect of a tailored activity pacing intervention on fatigue and physical activity behaviours in adults with multiple sclerosis. Twenty-one adults with multiple sclerosis, stratified by age and gender, are randomly allocated to either a tailored pacing or control group. Participants wear an accelerometer for seven days that measures physical activity behaviours, and self-report fatigue at the baseline and four-week follow-up. Physical activity behaviours are assessed by examining activity level (seven-day average activity counts per minute) and activity variability (seven-day average highest activity counts each day divided by activity counts on that day). The intervention improves activity levels (Mean difference = 40.91; 95% Confidence Interval [CI] (3.84-77.96); p = 0.03) and lessens activity variability (Mean difference = -0.63; 95% CI (-1.25-0.02); p = 0.04). No significant effect is found for fatigue (Mean difference = -0.36; 95% CI (-1.02-0.30); p = 0.27). This investigation shows that tailoring activity pacing based on physical activity behaviours and fatigue is effective in improving physical activity levels, without exacerbating fatigue symptoms.


Assuntos
Terapia por Exercício , Fadiga/prevenção & controle , Esclerose Múltipla , Acelerometria , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/terapia , Qualidade de Vida
10.
Wiad Lek ; 73(9 cz. 2): 1950-1956, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33148839

RESUMO

OBJECTIVE: The aim: Is to conduct a comparative analysis of electroneuromyographic parameters in patients with myofascial pain syndrome with multiple sclerosis under the conditions of using various means of physical therapy. PATIENTS AND METHODS: Materials and methods: 105 patients aged 21 to 54 years were examined with MPS in MS. Neurological disorders were verified according to ENMG examinations. 64 patients were enrolled in an experimental group for which a specially designed program was included, which included reflexology and exercise for stretching muscles for 30 days. The control group included 41 patients who underwent a FT course based on therapeutic massage during the same time. Analysis of global ENMG was performed according to functional tests («muscle relaxation¼ and «maximum arbitrary muscle tension¼ with m. Tibialis anterior and m. Rectus femoris), M-responses and H-reflexes, polysynaptic responses (PSV) in withdrawal from these muscles during short-term stimulation n. plantaris (number of pulses in series 10, frequency - 20 Hz, duration of a separate stimulation signal - 1 ms, intensity - double threshold of contractile response of the muscles of the sole of the foot) and residual latency as the time of motor impulse on terminal non-myelinated nerve. Testing was performed on the same muscle groups on the left and righ. RESULTS: Results: Before physical therapy during electromyographic testing, a significant decrease in the amplitude of the maximum M response, a decrease in the speed of the impulse in the proximal and distal segments of the peripheral nerve, was found to be significant compared with the control, the ratio of the proximal-distal coefficient and the residual latency index significantly increased, which indicates a demyelinating character lesions of nerve conductors. After reflexotherapy with muscle stretching in 38.0% of the patients of the experimental group, the dynamics of the amplitude of the M-answers on the left and on the right has only a tendency to further increase, while in the other 62.0% of patients, the amplitude of the M-responses increases bilaterally and is 65.7% higher than in the control group. CONCLUSION: Conclusions: The use of reflexology in conjunction with stretching leads to a reduction in muscle spasticity and pain, as evidenced by electrophysiological indicators that substantiate their feasibility in the practice of physical therapy to improve the functional status of patients with MPS in MS.


Assuntos
Esclerose Múltipla , Síndromes da Dor Miofascial , Adulto , Humanos , Massagem , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla/terapia , Contração Muscular , Síndromes da Dor Miofascial/terapia , Modalidades de Fisioterapia , Adulto Jovem
11.
BMC Psychol ; 8(1): 114, 2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33129356

RESUMO

BACKGROUND: Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system. MS is significantly associated with a high rate of psychological, behavioral, and emotional consequences. Despite the frequent mental disorders, high rate of psychological comorbidities, and emotional problems in people with MS (PwMS), these conditions are often underdiagnosed and undertreated. This study aimed to examine the efficacy of a group format of the unified protocol for the transdiagnostic treatment of emotional disorders in adult PwMS associated with an emotional disorder. METHODS: Seventy adult PwMS were randomized using an internet-based computer system to either the unified protocol (n = 35) or treatment as usual condition. The assessment protocol included semi-structured clinical interviews and self-reports evaluating diagnostic criteria, depression, anxiety and worry symptoms, emotional dysregulation, and affectivity. RESULTS: The parametric test of analysis of covariance, followed the intent to treat analyses, revealed the unified protocol significantly changed depression symptoms (Cohen's d = 1.9), anxiety symptoms (Cohen's d = 2.16), worry symptoms (Cohen's d = 1.27), emotion dysregulation (Cohen's d = 0.44), positive affect (Cohen's d = 1.51), and negative affect (Cohen's d = 1.89) compared with the control group. The unified protocol also significantly improved outcome scores at the end of treatment relative to baseline (p < .001). CONCLUSION: The findings support that the unified protocol could be an additional efficient psychological treatment for PwMS. Trial registration IRCT, number: IRCT20190711044173N1. Registered 31october 2019, https://en.irct.ir/user/trial/40779/view .


Assuntos
Transtornos do Humor/complicações , Transtornos do Humor/terapia , Esclerose Múltipla/complicações , Esclerose Múltipla/psicologia , Adulto , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Depressão/complicações , Depressão/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/terapia , Resultado do Tratamento , Adulto Jovem
12.
Molecules ; 25(21)2020 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-33105830

RESUMO

Inflammation is a biological response to the activation of the immune system by various infectious or non-infectious agents, which may lead to tissue damage and various diseases. Gut commensal bacteria maintain a symbiotic relationship with the host and display a critical function in the homeostasis of the host immune system. Disturbance to the gut microbiota leads to immune dysfunction both locally and at distant sites, which causes inflammatory conditions not only in the intestine but also in the other organs such as lungs and brain, and may induce a disease state. Probiotics are well known to reinforce immunity and counteract inflammation by restoring symbiosis within the gut microbiota. As a result, probiotics protect against various diseases, including respiratory infections and neuroinflammatory disorders. A growing body of research supports the beneficial role of probiotics in lung and mental health through modulating the gut-lung and gut-brain axes. In the current paper, we discuss the potential role of probiotics in the treatment of viral respiratory infections, including the COVID-19 disease, as major public health crisis in 2020, and influenza virus infection, as well as treatment of neurological disorders like multiple sclerosis and other mental illnesses.


Assuntos
Infecções por Coronavirus/terapia , Influenza Humana/terapia , Transtornos Mentais/terapia , Esclerose Múltipla/terapia , Pneumonia Viral/terapia , Probióticos/uso terapêutico , Infecções Respiratórias/terapia , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/patogenicidade , Betacoronavirus/fisiologia , Encéfalo/imunologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/microbiologia , Infecções por Coronavirus/virologia , Microbioma Gastrointestinal/imunologia , Trato Gastrointestinal/imunologia , Trato Gastrointestinal/microbiologia , Humanos , Imunomodulação , Influenza Humana/imunologia , Influenza Humana/microbiologia , Influenza Humana/virologia , Pulmão/imunologia , Transtornos Mentais/imunologia , Transtornos Mentais/microbiologia , Consórcios Microbianos/imunologia , Esclerose Múltipla/imunologia , Esclerose Múltipla/microbiologia , Orthomyxoviridae/efeitos dos fármacos , Orthomyxoviridae/patogenicidade , Orthomyxoviridae/fisiologia , Pandemias , Pneumonia Viral/imunologia , Pneumonia Viral/microbiologia , Pneumonia Viral/virologia , Infecções Respiratórias/imunologia , Infecções Respiratórias/microbiologia , Simbiose/imunologia
13.
Lancet Neurol ; 19(10): 860-871, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32949546

RESUMO

Multiple sclerosis is a chronic, demyelinating disease of the CNS. Cognitive impairment is a sometimes neglected, yet common, sign and symptom with a profound effect on instrumental activities of daily living. The prevalence of cognitive impairment in multiple sclerosis varies across the lifespan and might be difficult to distinguish from other causes in older age. MRI studies show that widespread changes to brain networks contribute to cognitive dysfunction, and grey matter atrophy is an early sign of potential future cognitive decline. Neuropsychological research suggests that cognitive processing speed and episodic memory are the most frequently affected cognitive domains. Narrowing evaluation to these core areas permits brief, routine assessment in the clinical setting. Owing to its brevity, reliability, and sensitivity, the Symbol Digit Modalities Test, or its computer-based analogues, can be used to monitor episodes of acute disease activity. The Symbol Digit Modalities Test can also be used in clinical trials, and data increasingly show that cognitive processing speed and memory are amenable to cognitive training interventions.


Assuntos
Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/psicologia , Gerenciamento Clínico , Imagem por Ressonância Magnética/métodos , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/psicologia , Adolescente , Idoso de 80 Anos ou mais , Disfunção Cognitiva/terapia , Feminino , Humanos , Esclerose Múltipla/terapia
14.
Neurology ; 95(16): 733-744, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-32907966

RESUMO

Specific therapies targeting B lymphocytes in multiple sclerosis (MS) have demonstrated reductions in disease activity and disability progression. Several observational studies have also shown the effects of targeting B lymphocytes in other rare CNS inflammatory diseases, such as neuromyelitis optica spectrum disorder (NMOSD) and autoimmune encephalitis (AE). However, some drugs targeting cytokine receptors involved in B-lymphocyte maturation and proliferation resulted in negative outcomes in MS. These apparently conflicting findings have stimulated research on the pathophysiologic mechanisms of B lymphocytes in CNS inflammatory diseases. It has been demonstrated that B lymphocytes participate in the pathogenesis of these conditions as antigen-presenting cells, producing proinflammatory cytokines that induce Th1 and Th17 responses and producing antibodies. However, they are also able to produce anti-inflammatory cytokines, such as interleukin-10, functioning as regulators of autoimmunity. Understanding these diverse effects is essential for the development of focused treatments. In this review, we discuss the possible mechanisms that underlie B-lymphocyte involvement in MS, NMOSD, and AE and the outcomes obtained by treatments targeting B lymphocytes.


Assuntos
Linfócitos B/imunologia , Encefalite/imunologia , Doença de Hashimoto/imunologia , Esclerose Múltipla/imunologia , Neuromielite Óptica/imunologia , Animais , Autoimunidade , Encefalite/terapia , Doença de Hashimoto/terapia , Humanos , Mediadores da Inflamação/imunologia , Esclerose Múltipla/terapia , Neuromielite Óptica/terapia
15.
Nat Commun ; 11(1): 3871, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32747712

RESUMO

Relapses in multiple sclerosis can result in irreversible nervous system tissue injury. If these events could be detected early, targeted immunotherapy could potentially slow disease progression. We describe the use of engineered biomaterial-based immunological niches amenable to biopsy to provide insights into the phenotype of innate immune cells that control disease activity in a mouse model of multiple sclerosis. Differential gene expression in cells from these niches allow monitoring of disease dynamics and gauging the effectiveness of treatment. A proactive treatment regimen, given in response to signal within the niche but before symptoms appeared, substantially reduced disease. This technology offers a new approach to monitor organ-specific autoimmunity, and represents a platform to analyze immune dysfunction within otherwise inaccessible target tissues.


Assuntos
Encefalomielite Autoimune Experimental/terapia , Imunoterapia/métodos , Monitorização Fisiológica/métodos , Esclerose Múltipla/terapia , Animais , Modelos Animais de Doenças , Progressão da Doença , Encefalomielite Autoimune Experimental/genética , Encefalomielite Autoimune Experimental/imunologia , Feminino , Expressão Gênica/genética , Expressão Gênica/imunologia , Perfilação da Expressão Gênica/métodos , Humanos , Camundongos Endogâmicos , Esclerose Múltipla/genética , Esclerose Múltipla/imunologia , Recidiva , Resultado do Tratamento
16.
Mult Scler ; 26(10): 1163-1171, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32772807

RESUMO

BACKGROUND: People with multiple sclerosis (MS) may be at higher risk for complications from the 2019 coronavirus (COVID-19) pandemic due to use of immunomodulatory disease modifying therapies (DMTs) and greater need for medical services. OBJECTIVES: To evaluate risk factors for COVID-19 susceptibility and describe the pandemic's impact on healthcare delivery. METHODS: Surveys sent to MS patients at Cleveland Clinic, Johns Hopkins, and Vall d'Hebron-Centre d'Esclerosi Múltiple de Catalunya in April and May 2020 collected information about comorbidities, DMTs, exposures, COVID-19 testing/outcomes, health behaviors, and disruptions to MS care. RESULTS: There were 3028/10,816 responders. Suspected or confirmed COVID-19 cases were more likely to have a known COVID-19 contact (odds ratio (OR): 4.38; 95% confidence interval (CI): 1.04, 18.54). In multivariable-adjusted models, people who were younger, had to work on site, had a lower education level, and resided in socioeconomically disadvantaged areas were less likely to follow social distancing guidelines. 4.4% reported changes to therapy plans, primarily delays in infusions, and 15.5% a disruption to rehabilitative services. CONCLUSION: Younger people with lower socioeconomic status required to work on site may be at higher exposure risk and are potential targets for educational intervention and work restrictions to limit exposure. Providers should be mindful of potential infusion delays and MS care disruption.


Assuntos
Infecções por Coronavirus/epidemiologia , Emprego , Fatores Imunológicos/uso terapêutico , Esclerose Múltipla/terapia , Terapia Ocupacional , Modalidades de Fisioterapia , Pneumonia Viral/epidemiologia , Classe Social , Adulto , Fatores Etários , Betacoronavirus , Comorbidade , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde , Gerenciamento Clínico , Suscetibilidade a Doenças , Escolaridade , Feminino , Comportamentos Relacionados com a Saúde , Acesso aos Serviços de Saúde , Terapia por Infusões no Domicílio , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Obesidade/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Fatores de Risco , Espanha/epidemiologia , Estados Unidos/epidemiologia
17.
Medicine (Baltimore) ; 99(34): e21646, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846775

RESUMO

INTRODUCTION: People with multiple sclerosis (PwMS) experience a wide range of disabilities which negatively impact their quality of life (QOL). Several interventions have been used in PwMS such as medication, physical therapy exercises and stem cell therapy to improve their QOL. However, there is a limited evidence on the benefits of combining interventions. The purpose of this study is to explore the effect of combining physical therapy exercises (PTE) and Wharton Jelly mesenchymal stem cell (WJ-MSCs) injections on motor and non-motor symptoms versus each intervention alone in PwMS. METHODS: Sixty PwMS will be allocated to either PTE, WJ-MSCs, or a combined group, followed up for 12 months and examined using a comprehensive battery of measures. Participants in the PTE group will receive 2 sessions per week of a supervised exercise program for 6 months followed by a home exercise program for another 6 months. The WJ-MSCs group will receive 3 WJ-MSCs injections in the first 6 months then they will be encouraged to follow an active life style. The third group will receive both interventions. DISCUSSION: This study will aid in a better understanding of the combined effect of physical therapy and mesenchymal stem cell therapy. The results from this proposed study may reduce disability, improve QOL in PwMS, and consequently, reduce the cost associated with the life-time care of these individuals worldwide. TRIAL REGISTRATION NUMBER: NCT03326505.


Assuntos
Terapia por Exercício , Transplante de Células-Tronco Mesenquimais , Esclerose Múltipla/terapia , Terapia Combinada , Humanos , Injeções , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego
18.
Neurology ; 95(8): e1114-e1116, 2020 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-32839302
20.
Artigo em Inglês | MEDLINE | ID: mdl-32630765

RESUMO

Goal setting is a core component of physical therapy in multiple sclerosis (MS). It is unknown whether and to what extent goals are set at different levels of the International Classification of Functioning, Disability and Health (ICF), and whether, and to which, standardized outcome measures are used in real life for evaluation at the different ICF levels. Our aim was to describe the real-world use of goal setting and outcome measures in Europe. An online cross-sectional survey, completed by 212 physical therapists (PTs) specialized in MS from 26 European countries, was conducted. Differences between European regions and relationships between goals and assessments were analyzed. PTs regularly set goals, but did not always apply the Specific, Measurable, Achievable, Realistic, Timed (SMART) criteria. Regions did not differ in the range of activities assessed, but in goals set (e.g., Western and Northern regions set significantly more goals regarding leisure and work) and outcome measures used (e.g., the Berg Balance Scale was more frequently used in Northern regions). Quality of life was not routinely assessed, despite being viewed as an important therapy goal. Discrepancies existed both in goal setting and assessment across European regions. ICF assists in understanding these discrepancies and in guiding improved health-care for the future.


Assuntos
Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Esclerose Múltipla/terapia , Modalidades de Fisioterapia , Estudos Transversais , Avaliação da Deficiência , Europa (Continente) , Objetivos , Humanos , Avaliação de Resultados em Cuidados de Saúde , Inquéritos e Questionários
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