Telephone-based assessment of multiple sclerosis patients at Ain Shams University Hospital in the coronavirus disease 2019 pandemic.

BACKGROUND: Assessment of multiple sclerosis (MS) patients during the era of the coronavirus disease 2019 (COVID-19) pandemic was confronted with the overwhelmed healthcare facilities in Egypt and fear of the patients to get infected while attending the follow-up visits. This study aimed to assess the value of telephone-based assessments in the follow-up of MS patients. It includes one hundred and five patients who participated in the study and completed 3 telephone-based assessments which are the Hauser Ambulation index, Multiple Sclerosis Neuropsychology Questionnaire (MSNQ), and Symptoms of Multiple Sclerosis Scale (SMSS). RESULTS: The Hauser Ambulation index was significantly correlated with the latest Expanded Disability Status Scale (EDSS) score done within 1 month from the telephone call (r=0.738, P<0.001). The analysis of MSNQ scores showed that one-third of the study population had evidence of cognitive and/or neuropsychological impairment. Post hoc analysis regarding the cognitive and psychological impairment component of SMSS revealed that the patients who answered "Never" had significantly lower MSNQ scores compared to those who answered "Sometimes" (P=0.016), "Often" (P=0.022), and "Always" (P=0.001). The comparison of the EDSS scores of the patients regarding the sensory-motor impairment component of SMSS showed a non-significant difference. CONCLUSION: The Hauser Ambulation index may be a reliable telephone-based tool for the assessment of physical disability. The MSNQ and the cognitive and psychological impairment component of SMSS can be used for the assessment of cognitive and psychological impairment among patients with MS.

Serum Phosphorylated Neurofilament Heavy Chain Level in Relapsing Remitting Multiple Sclerosis in Correlation to Disease Activity and Disability.

Multiple sclerosis (MS) is a disease of clinical diagnosis. There is no single specific diagnostic test available, no single clinical feature is sufficient to diagnose MS. Hence the necessity to research the presence of new diagnostic, prognostic markers and markers of activity of the disease. As principal components of the axonal cytoskeleton, Neurofilaments (NFs) are released in the interstitial fluid after axonal injury or degeneration. NFs was detected in the serum or cerebrospinal fluid (CSF) allowing their potential use as biomarkers of neurodegeneration as well as disease activity, progression and to directly assess the efficacy of current and emerging therapies for reducing axonal injury and the likely pathological substrate of progressive neurological decline. Serum biomarker of axonal injury could prove useful as a prognostic or monitoring tool. We aimed to study the relationship between serum Phosphorylated Neurofilament Heavy Chain (pNF-H) level and clinical activity of relapsing-remitting MS (RRMS) and disability measured by EDSS score. The study included 60 patients suffering from RRMS diagnosed according to McDonald's criteria 2010 and 30 healthy controls. After verbal consent, all were subjected to detailed medical history, clinical examination using EDSS score and measurement of serum pNF-H by quantitative ELISA. Results demonstrated a significantly higher serum levels of pNF-H in MS patients than healthy controls; pNF-H was 5.02±3.25 in cases and 0.65±0.2 in controls (P < 0.05), with a calculated sensitivity and specificity of 95% and 100%, respectively, and a positive and negative predictive values of 100% and 90.9%, respectively, at a cut-off level of 1.1ng/dl. Additionally, levels of pNF-H were significantly higher among relapsing than remission groups, with 93.33% and 83.33% calculated sensitivity and specificity, respectively, and a positive and negative predictive values of 84.8 % and 92.6 %, respectively, (at that cut-off level 4 ng/dl). In conclusion, pNF-H is a promising marker of MS disease activity and disability assessment.

Clinical characteristics of patients with multiple sclerosis enrolled in a new registry in Egypt.

BACKGROUND: Epidemiological studies of multiple sclerosis (MS) are lacking in Egypt. OBJECTIVE: To study the characteristics of Egyptian patients with multiple sclerosis in a new registry in a major tertiary referral centre in Cairo, Egypt. SUBJECT AND METHODS: Patients were from the project MS database of the Multiple Sclerosis Unit at Ain Shams University Hospitals (N=950). We conducted a detailed medical history and examination including the Expanded Disability Status Scale (EDSS). RESULTS: Females represented 72% of subjects (female: male ratio 2.57:1). The mean age of disease onset was 26.1±7.6 years. Relapsing-remitting MS (RRMS) was the most common presentation (74.6%). Visual or sensory symptoms were the most common at presentation with RRMS, while motor symptoms were the most common presentation in other types of MS. Time to diagnosis was delayed up to 2 years in 27.8% of patients. The mean EDSS score was 3.6±2.1; 55% had EDSS≤3. About half (49%) received a disease-modifying drug. Progressive MS and motor presentation were associated with higher disability. CONCLUSIONS: This is the first documented MS registry from Egypt. The clinical characteristics of MS in Egypt was similar to other Arab countries and western countries. MS is more common among females in Egypt, with RRMS being the most common presentation. Visual symptoms and motor symptoms were the most common presentations in RRMS and progressive MS, respectively. Our findings also highlight the value of establishing registries in Egypt in order to be able to study, prospectively, the clinical course of the disease, the response to various DMD's and the epidemiology of MS in Egypt.