The prevalence of COVID-19 infection in patients with multiple sclerosis (MS): a systematic review and meta-analysis

Neurological Sciences - The prevalence of COVID-19 is different in studies conducted in different countries. The aim of this systematic review and meta-analysis is to estimate the pooled prevalence...     

The prevalence of migraine in multiple sclerosis (MS): A systematic review and meta-analysis

ObjectivesWe designed this systematic review to estimate pooled prevalence of migraine in patients with multiple sclerosis (MS).MethodsWe searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, google scholar and gray literature including references from identified studies, conference abstracts which were published up to December 2019.The search strategy included the MeSH and text words as ((Disorder, Migraine OR Disorders, Migraine Disorder OR Migraine OR Migraines, OR Migraine Headache OR Migraine Headaches) AND (Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating).ResultsThe literature search found 2100 articles. After eliminating duplicates, 1500 articles remained. Eleven articles and twelve abstract conference papers were included for final analysis.A total of 11,372 MS cases and 2627 MS patients with migraine included in the analysis. The prevalence of migraine ranged from 2% to 67%.The pooled prevalence of migraine in included studies was 31% (95%CI: 22%–40%) (I² = 99.3%, p < 0.001). The pooled prevalence of migraine in different continents were significantly different (p < 0.001).The pooled prevalence was 24% in Asian countries, 43% in American countries, 25% in European countries and 43% in African countries.ConclusionThe results of this systematic review shows that the prevalence of migraine in MS patients is 31% while the prevalence differs significantly among residents of different continents.     

Prevalence of multiple sclerosis (MS) in Iran: a systematic review and meta-analysis

Neurological Sciences - Prevalence of multiple sclerosis (MS) is increasing world-wide. Iran is not exception. As the prevalence reported differently in various provinces, we designed this...     

Incidence of seroconversion and sero-reversion in patients with multiple sclerosis (MS) who had been treated with natalizumab: A systematic review and meta-analysis

BackgroundNatalizumab is a medication of choice for some patients with relapsing remitting (RR) form of multiple sclerosis (MS). John Cunningham virus (JCV) antibody status is important in cases who are treating with natalizumab. Different studies reported various rates of seroconversion and sero-reversion in patients who had been treated with natalizumab. As there is no systematic review reporting incidence of seroconversion and seroreversion in MS cases who were treated with natalizumab, we aimed to conduct this systematic review and meta-analysis to find pooled incidence of seroconversion and seroreversion in MS cases who were treated with natalizumab.MethodsPubMed, Scopus, EMBASE, CINAHL, Web of Science, Ovid, and google scholar were systematically searched. We also searched the gray literature including references from included studies, and conference abstracts which were published up to April 2019.ResultsThe incidence of seroconversion was reported between 6% and 41% and the incidence of seroreversion was reported between 1% and 11%.The pooled estimate of seroconversion incidence was 19% (95% CI: 13%–25%) (I² = 96.8%, P < 0.001) and the pooled estimate of seroreversion incidence was 5% (95% CI: 3%–8%) (I² = 72.2%, P < 0.001).Subgroup analysis by considering the country of the origin showed that the pooled incidence of seroconversion incidence during the studies was 6% in Asian countries and 21% in European/American countries. The incidence difference between subgroups was significant (p < 0.001).ConclusionIncidence of seroconversion in MS patients who had been treated with natalizumab is higher in European/American countries than Asian countries.     

Low back pain in patients with multiple sclerosis: A systematic review and the prevalence in a French multiple sclerosis population

PurposeThe prevalence and management of back pain in MS patients was assessed by a systematic review, and the results of a survey on the characteristics of low back pain in a sample of French MS patients are reported.MethodsA systematic search was conducted according to the PRISMA guidelines. The outcomes of interest included the prevalence of back pain, severity of pain and impact on daily activities. Moreover, the prevalence of low back pain and its consequences on daily living in a large French MS population were assessed.ResultsFourteen studies were included in the systematic review. The prevalence of back pain in MS patients ranged from 8.6 to 50%, but that of low back pain in particular ranged from 41.6 to 52.4%. Concerning the survey, 237 patients participated in the online questionnaire. The prevalence of low back pain in the French MS patients was 76.4%. The patients with chronic low back pain had more limitations in their daily life activities than those without chronic low back pain.ConclusionPatients with MS commonly suffer from low back pain, but it is still an underdiagnosed cause of pain that reduces one's ability to perform activities in daily life.     

Immunizations and risk of multiple sclerosis: systematic review and meta-analysis

The role of vaccinations in risk of developing multiple sclerosis (MS) or in risk of relapse has not been well established. The aim of this study was to estimate the effect of immunizations on risk of developing MS in adults as well as in subsequent risk of relapse. Systematic search for publications in MEDLINE (1966–January 2011), EMBASE (1977–January 2011) and the Cochrane Central Register of Controlled Trials (CENTRAL) (1961–January 2011). Both randomized clinical trials and non-randomized studies addressing the effect of any Center for Diseases Control (CDC) recommended vaccine for children, adults or travelers and BCG on risk of MS or disease relapse were included. Two reviewers independently extracted information from articles selected using a predefined datasheet. No significant change in the risk of developing MS after vaccination was found for BCG (OR 0.96, 95% CI 0.69–1.34), Hepatitis B (OR 1.00, 95% CI 0.74–1.37), Influenza (OR 0.97, 95% CI 0.77–1.23), Measles–Mumps–Rubella (MMR) (OR 1.02, 95% CI 0.64–1.61), Polio (OR 0.87, 95% CI 0.61–1.25) and Typhoid fever (OR 1.05, 95% CI 0.72–1.53). We found decreased risk of developing MS for Diphtheria (OR 0.60, 95% CI 0.40–0.90) and Tetanus (OR 0.68, 95% CI 0.54–0.84). Influenza immunization was also associated with no change in risk of MS relapse (RR 1.24, 95% CI 0.89–1.72). Risk of developing multiple sclerosis remained unchanged after BCG, Hepatitis B, Influenza, MMR, Polio and Typhoid fever immunization, whereas diphtheria and tetanus vaccination may be associated with a decreased risk of MS. Further research is needed for the remaining vaccines.     

Optical coherence tomography (OCT) measurements and cognitive performance in multiple sclerosis: a systematic review and meta-analysis

Journal of Neurology - Several studies report mixed associations between the retinal nerve fiber layer (RNFL) thickness with cognitive and physical disability in persons with multiple sclerosis...     

Autoimmune disease in people with multiple sclerosis and their relatives: a systematic review and meta-analysis

Additional autoimmune diseases in people with multiple sclerosis (MS) and their relatives have been studied many times. Studies have employed different designs, and yielded conflicting results. We performed a systematic review, and calculated overall risk of additional autoimmune diseases in people with MS and their first-degree relatives. PubMed and Web of Science were searched. Thyroid disease, diabetes, inflammatory bowel disease, psoriasis, rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) were studied. A generic inverse variance model was used, and subgroup analysis was used to explore heterogeneity. The OR of thyroid disease was increased in both people with MS (OR 1.66; p < 0.00001) and their relatives (OR 2.38; p < 0.00001). A similar association was seen between MS and inflammatory bowel disease (OR 1.56; p < 0.0001) and psoriasis (OR 1.31; p < 0.0001), although not in relatives. There was no increase in the rate of either SLE or RA. Studies examining diabetes showed significant heterogeneity and evidence of publication bias. There is an increase in the rate of certain autoimmune diseases in people with MS and their first-degree relatives. However, this does not extend to all conditions studied. Given the nonspecific clinical presentation of thyroid disease, it should be considered in all people with MS presenting with nonspecific symptoms.     

Global variation in prevalence and incidence of amyotrophic lateral sclerosis: a systematic review and meta-analysis

Journal of Neurology - Amyotrophic lateral sclerosis (ALS) is a global disease, which adversely affects the life quality of patients and significantly increases the burden of families and society....     

Oral and intravenous steroids for multiple sclerosis relapse: a systematic review and meta-analysis

Glucocorticoids are the standard of care for multiple sclerosis (MS) relapses, but the most desirable route of administration is still matter of debate. The aim of the study was to compare the efficacy and safety of oral versus intravenous steroids for treatment of acute relapses in patients with MS. Randomized or quasi-randomized, parallel group trials with direct comparison between oral and intravenous steroid treatment in MS patients with acute relapse were identified through a systematic literature search. Six trials were included involving 419 participants, 210 for oral, and 209 for intravenous groups, respectively. The weighted mean differences (WMDs) in the Kurtzke’s Expanded Disability Status Scale (EDSS) score reduction between the oral and intravenous groups were 0.32 [(?0.09 to 0.73); p = 0.129] and 0.11 [(?0.12 to 0.33); p = 0.355] at 1 and 4 weeks after treatment, respectively. The risk ratios (RRs) for improvement by at least one EDSS point were 0.79 [(0.37–1.68); p = 0.539] at week 1 and 0.92 (0.76–1.12); p = 0.400] at week 4. There were no differences in the relapse rate and relapse freedom at 6 months between groups. The WMDs in the mean percentage reduction of Gadolinium-enhancing lesions between oral and intravenous arms were 0.14 (?0.02, 0.29); p = 0.083] and 0.04 (?0.19, 0.28); p = 0.705] at 1 and 4 weeks from treatment. Among the adverse events, insomnia was significantly associated with the oral route of steroid administration [RR 1.25 (1.07–1.46); p = 0.005]. In adult patients with acute MS relapse, there were no clear-cut differences in the efficacy and overall tolerability between oral and intravenous steroids.     

Vaccines and multiple sclerosis: a systematic review

Vaccinations are often the most effective tool against some disease known to mankind. This study offers a literature review on the role of vaccines regarding the risk of developing multiple sclerosis (MS) and MS relapse. The method used in this study is a systematic literature review on the database PubMed. The study found no change in risk of developing multiple sclerosis (MS) after vaccination against hepatitis B virus, human papillomavirus, seasonal influenza, measles–mumps–rubella, variola, tetanus, Bacillus Calmette-Guérin (BCG), polio, or diphtheria. No change in risk of relapse was found for influenza. Further research is needed for the potential therapeutic use of the BCG vaccine in patients in risk of developing MS and for the preventive potential of the tetanus and diphtheria vaccine.     

Risk factors for unprovoked epileptic seizures in multiple sclerosis: a systematic review and meta-analysis

The role of different factors in influencing the risk of seizures during multiple sclerosis (MS) is not known. To perform a systematic review and meta-analysis of risk factors for epilepsy during MS. Pubmed, Google scholar, and Scopus databases were searched. Articles published in English (1986–2016) were included. Nine studies were included (3 retrospective cohort and 6 case–control) enrolling 2845 MS patients (217 with epilepsy; 7.6%). MS patients with epilepsy had a younger age at onset compared to MS patients without seizures (difference in means = ?5.42 years, 95% CI ?7.19 to ?3.66, p < 0.001). Mean EDSS value at inclusion tended to be higher in patients with epilepsy, without reaching statistical significance (difference in means = 0.45, 95% CI ?0.01 to 0.91, p = 0.054). No differences were observed in sex distribution (OR = 0.94, 95% CI 0.51–1.72, p = 0.83) and clinical form (OR = 1.03, 95% CI 0.33–3.21, p = 0.96). Two studies evaluated presence and number of cortical lesions as a risk factor for epilepsy in MS using different MRI techniques: in one study, cortical lesions were more frequently observed in patients with epilepsy (OR = 7.06, 95% CI 2.39–20.8; p < 0.001). In the other, cortico-juxtacortical lesions were more frequently observed in patients with epilepsy (OR = 2.6, 95% CI 1.0–6.5; p = 0.047). Studies about risk factors for epilepsy during MS are heterogeneous. Compared to MS patients without seizures, patients with epilepsy have an earlier MS onset and a higher EDSS score after similar disease duration. Clinical form of MS and sex do not predict the appearance of seizures.     

Effect of exercise therapy on quality of life of patients with multiple sclerosis in Iran: a systematic review and meta-analysis

Multiple sclerosis (MS) is a chronic and progressive disease charachterized by disabilities which adversely affect individuals’ quality of life (QOL). In the present study, the effect size of exercise therapy on patients’ QOL in both physical and mental dimensions were investigated and the moderator effect of a number of selected theoretical and significant practical variables were assessed. Relevant studies, published before July 2015, were identified by searching PubMed, Scopus, Google scholar, and Persian medical databases including IranMedex, Irandoc, Magiran, Scientific Information Database (SID), and Medlib. Supplementary searches were also performed manually by reviewing the reference lists of the relevant articles. Next, using a randomized controlled trial (RCT) design, English and/or Persian-language articles conducted in Iran and evaluating the effect of exercise therapy on physical and/or mental aspects of QOL of MS patients were pooled. Afterwards, two competent reviewers in the field extracted the required data and rated the quality of the studies. Twenty-one journal articles were identified and reviewed, but only 13 of them contained the as much data as required to serve the purpose of the study. The mean effect size of exercise therapy on mental, physical, and overall QOL of the patients were 1.021 (95%CI 0.712–1.331, P < .001), 1.040 (95%CI 0.730–1.349, P < .001), and 0.846 (95%CI 0.508–1.184, P < .001), respectively. Based on the investigated Iranian studies, there is strong evidence confirming the effect of exercise therapy on QOL of patients with MS; there, however, exists a need for more studies to identify and establish effective exercise programs due to the heterogeneity of the studies conducted in this area.     

Chronic cerebrospinal venous insufficiency (CCSVI) and multiple sclerosis (MS): a critical review

Multiple sclerosis (MS) is a chronic disease of the central nervous system with not yet completely understood pathogenesis. The so called "chronic cerebrospinal venous insufficiency (CCSVI) theory" has recently emerged, supporting the concept of a cerebrospinal venous drainage impairment as the cause of MS. Since the first publication on this topic with a claimed 100% specificity and sensitivity of the condition for MS diagnosis, CCSVI theory has generated a scientific and mass media debate with a great hope for the miracle of a new possible endovascular treatment of MS ("liberation procedure"). We critically summarize the available evidence on CCSVI discussing inconsistent and incomplete replication of the original results by different groups, methodological limitations and potential therapeutic implications. We conclude that the available data are insufficient to establish conclusively a clear relationship between MS and CCSVI and do not support the role of CCSVI as the primary cause of MS. Until credible scientific evidence replicates the original results, any proposed invasive treatments of CCSVI should be discouraged.