Exacerbation of Symptoms Among People with Multiple Sclerosis: Impact on Sexuality and Relationships over Time

This study was designed to evaluate the impact of an exacerbation in symptoms among men and women with multiple sclerosis (MS) on sexuality and relationship satisfaction. A total of 321 people with MS (120 men, M age = 48.10 years; 201 women, M age = 45.78 years), and 239 people from the general population (79 men, M age = 53.93 years; 160 women, M age = 45.89 years) completed measures of relationship satisfaction and sexuality, and then completed these measures again 18 months later. The results demonstrated that both men and women with MS reported significantly higher levels of sexual dysfunction than did the general population. The no exacerbation group also reported significantly lower levels of sexual activity and of relationship satisfaction than the general population group over the 18-month period. Women in all groups reported significantly higher levels of sexual dysfunction but also higher levels of sexual activity than did men at each time period. They also reported significantly higher levels of sexual satisfaction at the 18-month follow up. These results suggest that men and women respond in similar ways to MS, and that people with MS do not necessarily experience poorer levels of sexual interaction or relationship quality when they experience an increase in their physical symptoms.     

The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15): Validation and Cross-cultural Adaptation of the Greek Version in MS Patients

Sexuality and Disability - Sexuality and intimate relationships are a significant part of life and well-being. The presence of a physical illness such as multiple sclerosis (MS) has the potential...     

Sexuality and Intimacy in Alzheimer's Patients and Their Partners

Geriatric Sexuality remains one of the more sensitive and controversial issues to be confronted in today's clinical setting. Research indicates that older adults continue to be sexually active well into later life. Older adults with dementing illnesses experience deleterious changes in sexual functioning that can affect their quality of life. However, few health care professionals ask older adults about their sexual functioning. This paper addresses means of fostering acceptance by professionals and families and creating an environment that nurtures sexuality in couples coping with dementia.     

The Experiences of African Americans and Euro-Americans with Multiple Sclerosis

This article summarizes the experiences of 76 Euro-Americans and 24 African Americans who have multiple sclerosis (MS), a chronic neurological disease which affects 250,000–350,000 Americans. Although the majority of people with MS are young to middle-aged women of Northern European origin, African Americans, Asian Americans, Latinos, and Native Americans also have MS. This qualitative study explores the impact of race and gender on people's initial interpretation of symptoms, access to appropriate medical care, diagnosis, and adjustment to disability.     

Reviewing the Unmet Needs of Patients with Multiple Sclerosis

Significant innovations in the treatment of patients with multiple sclerosis (MS) have primarily addressed the frequency of flare-ups in relapsing-remitting MS (RRMS). Many advances have been made in this area, and the medical community may be on the verge of a serious discussion of what constitutes a truly effective MS treatment. Certainly, it is important to further delay MS flare-ups and more effectively treat RRMS symptoms. However, great strides in reducing or preventing MS-related disability and providing neuroprotection have been elusive. Many unmet needs are still voiced by patients with MS, clinicians, and caregivers. Current information on the need for progress in various areas is reviewed in this article, including psychosocial care, treatments for progressive MS, biomarker identification, functional outcome measures, individualization of treatment, reducing side effects of medications, and improving medication adherence.     

Aphasia and Sexuality

Changes in sexuality following stroke have attracted the interest of clinical researchers, but studies seldom include aphasic individuals, who comprise almost one third of the stroke population. Studies excluded those with moderate or severe aphasia because they cannot participate in interviews or complete questionnaires used in sexuality research. This pilot study investigated how stroke changed sexuality for aphasic people and their spouses. We sought their input as to when these issues should be addressed during the process of stroke recovery, and by whom. Interviews included a structured verbal questionnaire supported by gesture, written, and pictographic materials. Responses were qualitatively analyzed. We found that aphasia affects sexuality differently than for other stroke patients. They believe that improved communication skills would help their sex life. Aphasic individuals and their spouses are open to discussing sexuality with a physician and have specific medical, physical, and psychological issues they wish to address.     

Assessing disability status: The reliability of the Multiple Sclerosis Disability Profile

The present study reports on the reliability of the Multiple Sclerosis Disability Profile. Multiple sclerosis (MS) is an enigmatic disease that affects people differently. The Disability Profile is a 68 item assessment instrument with the aim of providing a brief overview of the health status of an individual with MS. Internal consistency was assessed using the split-half technique and Cronbach's alpha. The findings demonstrated excellent internal consistency. Inter-rater reliability was assessed using Cohen's kappa. Kappa was computed with four options per item and then again with two options per item of the Disability Profile. The findings indicated that reliability was satisfactory when the responses for each item were reduced from four to two options. The recommendations are that items with poor inter-rater reliability should be reviewed and a simpler more reliable version of the Disability Profile should be adopted.     

MRI在脊髓型多发性硬化中的临床价值

目的研究核磁共振成像（MRI）在诊断脊髓型多发性硬化中的作用。方法收集10例多发性硬化患者的MRI和临床资料进行分析。结果 10例中临床诊断多发性硬化5例,其余误诊为其他疾病而最终经MRI确诊。结论磁共振成像（MRI）对脱髓鞘病灶易显示敏感,它的应用为诊断脊髓型多发性硬化提供了较为明确的依据。     

Cost-Effectiveness Analysis of Interferon Beta in Multiple Sclerosis: A Markov Process Analysis

Objective: The objective of this study was to examine the cost-effectiveness of preventive treatment with interferon beta (IFNB) versus no preventive treatment in patients with multiple sclerosis.
Methods: The setting for this study was the United Kingdom. A lifetime Markov process model was constructed to model the average quality-adjusted life years (QALYs) and the costs of both treatment strategies. Data for the construction of the model came from published literature, including large multicenter randomized clinical trials in relapsing-remitting and secondary progressive multiple sclerosis. Costs were obtained from published sources.
Results: The results of the baseline analysis from the National Health Service (NHS) perspective showed that the use of interferon beta as preventive treatment for MS increased the total average discounted cost from £51,214 to £221,436 per patient. The undiscounted effectiveness increased from 24.9 QALYs to 28.2 QALYs, resulting in an incremental cost-effectiveness ratio of £51,582 per QALY. Sensitivity analyses showed the robustness of this model for other interferons.
Conclusion: The study showed that preventive treatment with interferon beta in patients with multiple sclerosis may not be fully justified from a health-economic perspective, although interferon beta is associated with an improved effectiveness compared with no preventive treatment.     

Self-Report Assessment of Fatigue in Multiple Sclerosis: A Critical Evaluation

SUMMARY

Fatigue is among the most common and disabling symptoms of multiple sclerosis. Clinicians usually assess fatigue by asking people to describe and rate their fatigue in a self-report instrument. This paper evaluates the clinical usefulness and the scientific properties of a selection of various self-report instruments for fatigue. To be selected, instruments had to assess fatigue or a related concept, have some published information on reliability and validity, be used in at least one clinical trial of fatigue with people with multiple sclerosis, and demonstrate validity in people with MS. Five fatigue specific scales and four subscales of quality of life instruments were selected and evaluated. In occupational therapy, the fatigue subscales or items of quality of life measurements give limited information about the quality of fatigue. The selection of an instrument may depend on the clinical setting or trial design.     

Identifying Patients With Relapsing-Remitting Multiple Sclerosis Using Algorithms Applied to US Integrated Delivery Network Healthcare Data

Background

Relapsing-remitting multiple sclerosis (RRMS) has a major impact on affected patients; therefore, improved understanding of RRMS is important, particularly in the context of real-world evidence.

Dietary Patterns and Metabolic Disorders in Polish Adults with Multiple Sclerosis

Diet plays a major role in the aetiopathogenesis of many neurological diseases and may exacerbate their symptoms by inducing the occurrence of metabolic disorders. The results of research on the role of diet in the course of multiple sclerosis (MS) are ambiguous, and there is still no consensus concerning dietary recommendations for patients with MS. The aim of this study was to analyse the dietary patterns (DPs) of patients with MS and to assess the relationships between these DPs and the metabolic disorders. The study participants were comprised of 330 patients aged 41.9 ± 10.8 years. A survey questionnaire was used to collect data related to diet, lifestyle and health. The DPs were identified using a principal component analysis (PCA). Three DPs were identified: Traditional Polish, Prudent and Fast Food & Convenience Food. An analysis of the odds ratios adjusted for age, gender, smoking and education showed that a patient’s adherence to the Traditional Polish and the Fast Food & Convenience Food DPs increased the likelihood of abdominal obesity and low HDL-cholesterol concentration. Conversely, adherence to the Prudent DP was not significantly associated with any metabolic disorder. The results of this study confirmed that an unhealthy diet in patients with MS is connected with the presence of some metabolic risk factors. There is also an urgent need to educate patients with MS on healthy eating, because the appropriate modifications to their diet may improve their metabolic profile and clinical outcomes.     

The Role of Diet and Interventions on Multiple Sclerosis: A Review

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS) characterized by inflammation and neurodegeneration. The most prominent clinical features include visual loss and sensorimotor symptoms and mainly affects those of young age. Some of the factors affecting its pathogenesis are genetic and/or environmental including viruses, smoking, obesity, and nutrition. Current research provides evidence that diet may influence MS onset, course, and quality of life of the patients. In this review, we address the role of nutrition on MS pathogenesis as well as dietary interventions that show promising beneficial results with respect to MS activity and progression. Investigation with large prospective clinical studies is required in order to thoroughly evaluate the role of diet in MS.     

Personal Income Before and After Diagnosis of Multiple Sclerosis

Background

Multiple sclerosis (MS) is associated with serious morbidity and labor force absenteeism, but little is known of the long-term impact of the disease on personal income.

Estimating a Preference-Based Index for an Eight-Dimensional Health State Classification System for Multiple Sclerosis

BackgroundCondition-specific measures are frequently used to assess the health-related quality of life of people with multiple sclerosis (MS). Such measures are unsuitable for use in economic evaluations that require estimates of cost per quality-adjusted life-year because they are not based on preferences.ObjectivesTo report the estimation of a preference-based single index for an eight-dimensional instrument for MS, the Multiple Sclerosis Impact Scale – Eight Dimensions (MSIS-8D), derived from an MS-specific measure of health-related quality of life, the 29-item Multiple Sclerosis Impact Scale (MSIS-29).MethodsWe elicited preferences for a sample of MSIS-8D states (n = 169) from a sample (n = 1702) of the UK general population. Preferences were elicited using the time trade-off technique via an Internet-based survey. We fitted regression models to these data to estimate values for all health states described by the MSIS-8D. Estimated values were assessed against MSIS-29 scores and values derived from generic preference-based measures in a large, representative sample of people with MS.ResultsParticipants reported that the time trade-off questions were easy to understand. Observed health state values ranged from 0.08 to 0.89. The best-performing model was a main effects, random effects model (mean absolute error = 0.04). Validation analyses support the performance of the MSIS-8D index: it correlated more strongly than did generic measures with MSIS-29 scores, and it discriminated effectively between subgroups of people with MS.ConclusionsThe MSIS-8D enables health state values to be estimated from the MSIS-29, adding to the methods available to assess health outcomes and to estimate quality-adjusted life-years for MS for use in health technology assessment and decision-making contexts.     

Mapping the Literature on Diet and Multiple Sclerosis: A Data-Driven Approach

Multiple sclerosis (MS) is a chronic neurological disease of the central nervous system that is currently incurable. Diet may influence the onset and progression of MS. A variety of literature reviews have been conducted in the field of diet and MS. However, conventional reviews mostly focus on specific topics rather than delivering a holistic view of the literature landscape. Using a data-driven approach, we aimed to provide an overview of the literature on diet and MS, revealing gaps in knowledge. We conducted citation network analysis to identify clusters of all available publications about diet and MS over the past 50 years. We also conducted topic analysis of each cluster and illustrated them in word clouds. Four main clusters were identified from 1626 publications: MS risk and symptom management; mouse models of MS; gluten sensitivity; and dysphagia. Citation network analysis revealed that in this emerging field, articles published after 1991 were more likely to be highly cited. Relatively few studies focused on MS disease progression compared to risk factors, and limited evidence was available for many foods and nutrients in relation to MS. Future studies could focus on filling these identified knowledge gaps.     

The Distribution of the Cost of Multiple Sclerosis in the UK: How Do Costs Vary by Illness Severity?

ObjectiveTo derive robust estimates for the cost of multiple sclerosis (MS) based on a variety of cost factors across a number of different cost perspectives. This is essential to perform credible pharmacoeconomic evaluations of alternative MS therapies.MethodsHere we present a detailed analysis of previously published MS cost data for the UK to which we fit a seemingly unrelated regression. This allows us to assess the size and significance of different cost factors, and account for the covariance between cost perspectives.ResultsWe show that disability severity, disease type, relapse status, treatment type and time of treatment, sex, age, educational status, and time since diagnosis, are significant cost factors, with the significance of each dependent on the cost perspective chosen.ConclusionThis analysis provides a statistical model that may be used to better estimate individual patient costs across a range of demographic and cost perspectives, for use by health planners and in pharmacoeconomic evaluations.     

多发性硬化影像学诊断价值

多发性硬化（multiple sclerosis,MS）是最常见的中枢神经系统白质脱髓鞘疾病,以病灶多发、病程缓解与复发交替为特征。CT显示MS斑的阳性率仅为MRI的54.6%,在小脑、脑干及胼胝体上更低。MRI对MS诊断的敏感性比CT高,很多CT阴性者常能在MRI上显示病灶,特别是对后颅窝和脊髓病灶,MRI更优于CT。常规MRI技术检查局部白质病灶有极高的灵敏度,新的定量MRI技术对正常脑白质轻微改变的灵敏度增高以及对MS不均一性的病理学变化特异性增加。磁化传递成像、弥散加权成像、弥散张量成像（MTI、DWI、DTI）细胞特异性成像能够提供关于T2可见病灶内外细胞和结构改变的信息。常规和新的MRI技术的广泛应用将会提高对MS的诊断。