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1.
J Neurol ; 269(9): 4581-4603, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1971704

ABSTRACT

The SARS-CoV-2 pandemic has raised particular concern for people with Multiple Sclerosis, as these people are believed to be at increased risk of infection, especially those being treated with disease-modifying therapies. Therefore, the objective of this review was to describe how COVID-19 affects people who suffer from Multiple Sclerosis, evaluating the risk they have of suffering an infection by this virus, according to the therapy to which they are subjected as well as the immune response of these patients both to infection and vaccines and the neurological consequences that the virus can have in the long term. The results regarding the increased risk of infection due to treatment are contradictory. B-cell depletion therapies may cause patients to have a lower probability of generating a detectable neutralizing antibody titer. However, more studies are needed to help understand how this virus works, paying special attention to long COVID and the neurological symptoms that it causes.


Subject(s)
COVID-19 , Multiple Sclerosis , Antibodies, Viral , COVID-19/complications , COVID-19 Vaccines/adverse effects , Humans , Multiple Sclerosis/complications , Multiple Sclerosis/therapy , SARS-CoV-2
2.
Curr Opin Neurol ; 35(3): 259-261, 2022 06 01.
Article in English | MEDLINE | ID: covidwho-1956640
3.
PLoS One ; 17(5): e0265861, 2022.
Article in English | MEDLINE | ID: covidwho-1933213

ABSTRACT

BACKGROUND: Little is known about how people with multiple sclerosis (MS) and their families comprehend advance care planning (ACP) and its relevance in their lives. AIM: To explore under what situations, with whom, how, and why do people with MS and their families engage in ACP. METHODS: We conducted a qualitative study comprising interviews with people living with MS and their families followed by an ethical discussion group with five health professionals representing specialties working with people affected by MS and their families. Twenty-seven people with MS and 17 family members were interviewed between June 2019 and March 2020. Interviews and the ethical discussion group were audio-recorded and transcribed verbatim. Data were analysed using the framework approach. RESULTS: Participants' narratives focused on three major themes: (i) planning for an uncertain future; (ii) perceived obstacles to engaging in ACP that included uncertainty concerning MS disease progression, negative previous experiences of ACP discussions and prioritising symptom management over future planning; (iii) Preferences for engagement in ACP included a trusting relationship with a health professional and that information then be shared across services. Health professionals' accounts from the ethical discussion group departed from viewing ACP as a formal document to that of an ongoing process of seeking preferences and values. They voiced similar concerns to people with MS about uncertainty and when to initiate ACP-related discussions. Some shared concerns of their lack of confidence when having these discussions. CONCLUSION: These findings support the need for a whole system strategic approach where information about the potential benefits of ACP in all its forms can be shared with people with MS. Moreover, they highlight the need for health professionals to be skilled and trained in engaging in ACP discussions and where information is contemporaneously and seamlessly shared across services.


Subject(s)
Advance Care Planning , Multiple Sclerosis , Family , Humans , Multiple Sclerosis/therapy , Palliative Care , Qualitative Research
4.
Mult Scler ; 28(9): 1424-1456, 2022 08.
Article in English | MEDLINE | ID: covidwho-1923462

ABSTRACT

Over the recent years, the treatment of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) has evolved very rapidly and a large number of disease-modifying treatments (DMTs) are now available. However, most DMTs are associated with adverse events, the most frequent of which being infections. Consideration of all DMT-associated risks facilitates development of risk mitigation strategies. An international focused workshop with expert-led discussions was sponsored by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and was held in April 2021 to review our current knowledge about the risk of infections associated with the use of DMTs for people with MS and NMOSD and corresponding risk mitigation strategies. The workshop addressed DMT-associated infections in specific populations, such as children and pregnant women with MS, or people with MS who have other comorbidities or live in regions with an exceptionally high infection burden. Finally, we reviewed the topic of DMT-associated infectious risks in the context of the current SARS-CoV-2 pandemic. Herein, we summarize available evidence and identify gaps in knowledge which justify further research.


Subject(s)
COVID-19 , Multiple Sclerosis , Neuromyelitis Optica , Child , Female , Humans , Multiple Sclerosis/therapy , Neuromyelitis Optica/epidemiology , Pandemics , Pregnancy , SARS-CoV-2
5.
PLoS One ; 17(5): e0267245, 2022.
Article in English | MEDLINE | ID: covidwho-1910594

ABSTRACT

INTRODUCTION: REsilience and Activities for every DaY (READY) is an Acceptance and Commitment Therapy-based group resilience-training program that has preliminary empirical support in promoting quality of life and other psychosocial outcomes in people with multiple sclerosis (PwMS). Consistent with the Medical Research Council framework for developing and evaluating complex interventions, we conducted a pilot randomized controlled trial (RCT), followed by a phase III RCT. The present paper describes the phase III RCT protocol. METHODS AND ANALYSIS: This is a multi-centre cluster RCT comparing READY with a group relaxation program (1:1 ratio) in 240 PwMS from eight centres in Italy (trial registration: isrctn.org Identifier: ISRCTN67194859). Both interventions are composed of 7 weekly sessions plus a booster session five weeks later. Resilience (primary outcome), mood, health-related quality of life, well-being and psychological flexibility will be assessed at baseline, after the booster session, and at three and six month follow-ups. If face-to-face group meetings are interrupted because of COVID-19 related-issues, participants will be invited to complete their intervention via teleconferencing. Relevant COVID-19 information will be collected and the COVID-19 Peritraumatic Distress scale will be administered (ancillary study) at baseline and 3-month follow-up. Analysis will be by intention-to-treat to show superiority of READY over relaxation. Longitudinal changes will be compared between the two arms using repeated-measures, hierarchical generalized linear mixed models. CONCLUSION: It is expected that his study will contribute to the body of evidence on the efficacy and effectiveness of READY by comparing it with an active group intervention in frontline MS rehabilitation and clinical settings. Results will be disseminated in peer-reviewed journals and at other relevant conferences.


Subject(s)
Acceptance and Commitment Therapy , COVID-19 , Multiple Sclerosis , Clinical Trials, Phase III as Topic , Humans , Italy , Multicenter Studies as Topic , Multiple Sclerosis/psychology , Multiple Sclerosis/therapy , Quality of Life , Randomized Controlled Trials as Topic
6.
Curr Neurol Neurosci Rep ; 22(8): 537-543, 2022 08.
Article in English | MEDLINE | ID: covidwho-1885494

ABSTRACT

PURPOSE OF REVIEW: COVID-19 has posed a continuously evolving challenge for providers caring for patients with multiple sclerosis (MS). While guidelines from national and international organizations came quickly, these have required constant reassessment and modification as the pandemic has progressed. This review aims to assess the first 2 years of literature on COVID-19 relevant to the clinical management of patients with MS. In particular, we will review how MS impacts the risk of COVID-19 infection, how disease-modifying therapies may alter this risk, and explore considerations regarding disease-modifying therapy (DMT) and vaccination for COVID-19. We will also explore potential ways in which a COVID-19 infection may impact multiple sclerosis. Our goal is to provide an overarching review of the major findings at this stage of the pandemic relevant to those that care for patients with MS. RECENT FINDINGS: Over the course of the COVID-19 pandemic, providers have had to re-evaluate the priorities in the management of MS. A growing number of studies have evaluated the relevant risk factors and considerations regarding MS and particular disease-modifying therapies. The long-term impacts of the pandemic on the health of those with MS will continue to be revealed. In general, most patients with MS do not need major revisions to their treatment plan due to COVID-19 risk. However, individuals who are older, more disabled, and on more potent therapies may need to consider strategies for decreasing their overall risk. Regardless, continued improvement in our understanding of interactions between infections, disease-modifying therapy, and MS are paramount to optimizing the care of those with MS going forward.


Subject(s)
COVID-19 , Multiple Sclerosis , Humans , Multiple Sclerosis/drug therapy , Multiple Sclerosis/therapy , Pandemics/prevention & control , Risk Factors , SARS-CoV-2
7.
PLoS One ; 17(4): e0266786, 2022.
Article in English | MEDLINE | ID: covidwho-1883680

ABSTRACT

BACKGROUND: Yoga has multiple benefits for individuals living with Multiple Sclerosis (MS), including reduced pain, depression, fatigue, strength, and improved quality of life. During the COVID-19 pandemic, home-based delivery of yoga increased. However, no studies to date have explored online home-based yoga for individuals living with MS, more specifically the motivations, experiences, or the sustainability of home-based yoga practice for individuals living with MS. AIM: This study aimed to explore the facilitators and barriers of online yoga provision for individuals living with MS. METHODS: One focus group and three semi-structured interviews were carried out online via Zoom with one yoga instructor and seven yoga participants living with MS. Thematic Analysis was used to analyse this data. FINDINGS: Two themes were generated from the interviews, the environment and future provision, each with their own sub-themes. The themes reflect various facilitators and barriers of home-based yoga provision which differed depending upon the individuals home environment, social connections, physical ability, and confidence practising yoga. Furthermore, preferences of home provision fluctuated over time depending upon symptoms of MS. CONCLUSIONS: Home-based yoga practice is a viable and enjoyable option for individuals living with MS. It is recommended that yoga studios offering home-based yoga provision consider individual differences in preference, as well as fluctuations in symptoms that may create inequitable access to services and may prevent participation for some.


Subject(s)
COVID-19 , Multiple Sclerosis , Yoga , Humans , Multiple Sclerosis/therapy , Pandemics , Quality of Life
8.
Mult Scler Relat Disord ; 63: 103913, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1867614

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has precipitated expansion of telemedicine in outpatient management of chronic diseases including multiple sclerosis (MS). Studies conducted pre-pandemic, when telehealth was an alternative to in-person consultations, represent a different setting to current practice. The aim of this study was to assess the impact of telehealth on MS outpatient care in a tertiary metropolitan hospital in Melbourne, Australia during the COVID-19 pandemic. METHOD: From March-December 2020, patients and clinicians in the MS outpatient clinic were surveyed regarding their attitudes towards telehealth. Scores on the Expanded Disability Status Scale (EDSS) from telehealth and face-to-face appointments during the study period were compared to scores from face-to-face consultations before and after this period. Medical records were reviewed to compare management decisions made during telehealth versus face-to-face consultations. Diagnoses and treatment of MS relapses were compared to 2019. RESULTS: Telehealth was used in 73% of outpatient appointments. Patient satisfaction was generally high. Patients and clinicians preferred face-to-face consultations but were willing to use telehealth longer term. Overall, there were no significant delays in identifying patients experiencing disability worsening via telehealth, but EDSS increase was recorded in more face-to-face than telehealth appointments particularly for those with lower baseline disability. Disease-modifying therapy commencement rates were similar, but symptomatic therapy initiation and investigation requests occurred more frequently in face-to-face visits. Comparable numbers of MS relapses were diagnosed and treated with corticosteroids in 2019 and 2020. CONCLUSIONS: Patient satisfaction with telehealth was high, but both clinicians and patients preferred in-person appointments. Telehealth implementation did not lead to high rates of undetected disability worsening or undiagnosed acute relapses, but telehealth-based EDSS assessment may underestimate lower scores. Treatment inertia may affect some management decisions during telehealth consultations. Telehealth will likely play a role in outpatient settings beyond the COVID-19 pandemic with further studies on its long-term impact on clinical outcomes required.


Subject(s)
COVID-19 , Multiple Sclerosis , Telemedicine , Ambulatory Care Facilities , Humans , Multiple Sclerosis/diagnosis , Multiple Sclerosis/epidemiology , Multiple Sclerosis/therapy , Pandemics , Recurrence
9.
Mult Scler Relat Disord ; 63: 103893, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1851849

ABSTRACT

INTRODUCTION: The impact of COVID-19 in patients with neuroimmunological disorders is not fully established. There is some evidence suggesting an increased risk of more severe infection associated with the use of immunosuppressors in this population. OBJECTIVE: To characterize SARS-CoV-2 infection in patients followed in the neuroimmunology outpatient clinic of a tertiary centre from the north of Portugal. METHODS: Retrospective analysis of neuroimmunological patients with PCR-proven SARS-CoV-2 infection during the observational period of 20 months. RESULTS: Ninety-one patients were infected, 68.1% female, with a mean age of 48.9±16.7 years. The median disease duration was 11.0 (IQR 6.0-19.0) years. Sixty-one patients (67.0%) had Multiple Sclerosis, of which 50 with relapsing-remitting course, 12 (13.2%) Myasthenia Gravis (MG), 6 (6.6%) Autoimmune Encephalitis and 6 (6.6%) Chronic Inflammatory Demyelinating Polyneuropathy. Seventy-six patients (83.5%) were taking disease-modifying therapy, 77.6% of which were on immunosuppressants, including anti-CD20 in 12 (13.2%). Most patients had mild COVID-19 (84.6%), with 3 cases (3.3%) of severe disease and, 7 cases (7.7%) of critical disease being reported. In total, 13 patients were hospitalized and 4 died. Patients with severe to critical disease were significantly older than patients with milder forms (69.4±21.0 versus 46.5±14.4 years, p<0.01). MG was also associated with more severe disease (p=0.02). There was no association between comorbidities or use of immunosuppressors (including anti-CD20) and COVID-19 severity. CONCLUSIONS: Greater age and MG were associated with severe or critical COVID-19. We found no association between a specific DMT, including anti-CD20, and outcome. Clinical recovery was achieved by 93.4%.


Subject(s)
COVID-19 , Multiple Sclerosis , Adult , Aged , Antigens, CD20 , Female , Humans , Male , Middle Aged , Multiple Sclerosis/therapy , Portugal/epidemiology , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers
10.
Mult Scler Relat Disord ; 63: 103843, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1821420

ABSTRACT

BACKGROUND: COVID-19 pandemic has affected people with multiple sclerosis (PwMS) on various levels. Pandemic lockdown influenced the access to typical measures of physical activity such as out-door training or gym exercises. METHODS: We performed a survey assessing physical activity during pandemic lockdown among PwMS treated in our MS center. The questionnaire encompassed questions regarding physical activity before and during lockdown, including the employment of online technologies. RESULTS: The survey was completed by 262 PwMS. Physical activity before lockdown was declared by 74.4% of PwMS, regular exercises were declared by 30.9% of participants. Among physically active PwMS 50.5% limited their physical activity during the COVID-19 lockdown. The decrease in physical activity was reported more frequently by PwMS with higher levels of disability, particularly declaring regular exercises before lockdown. In the opinion of 39,7% of PwMS online training could replace standard exercises, however only 19,9% of PwMS were actively looking for online training during the lockdown. The interest in online exercise was greatest in the group ≤30 years of age and EDSS ≤2. Synchronous exercises were the preferred online training, particularly among PwMS with EDSS≥4. CONCLUSION: Our findings indicate a need for systematic educational and organizational measures, promoting physical activity among PwMS and acknowledging pandemic conditions.


Subject(s)
COVID-19 , Multiple Sclerosis , Communicable Disease Control , Exercise , Humans , Multiple Sclerosis/therapy , Pandemics
11.
BMC Neurol ; 22(1): 144, 2022 Apr 18.
Article in English | MEDLINE | ID: covidwho-1808348

ABSTRACT

BACKGROUND: As a chronic, disabling disease, multiple sclerosis (MS) has challenged healthcare systems in many ways. MS adversely affects patients' quality of life and self-efficacy and results in psychological stress. The present study was conducted to investigate the effect of peer education based on Pender's health promotion model on the quality of life, stress management, and self-efficacy of patients with MS in the south of Iran. METHODS: The present study was a randomized controlled clinical trial. A total of 90 patients were divided into group A intervention group 45 patients) and group B (control group 45 patients). The intervention was peer education based on Pender's health promotion model. Data were collected using the MS Quality of Life Scale, the Self-efficacy Scale, and the Stress Management Scale. Data analyses were conducted using SPSS version 22. To analyze the data, we used descriptive statistics. Thus, inferential statistics applied included Chi-square, independent-samples t-test, and Repeated measures (ANOVA). The significance level was considered p < 0.05. RESULTS: The quality of life, self-efficacy, and stress management mean scores of the intervention group as measured immediately and 3 months after intervention were significant (p < 0.05). As for the control group, however, the difference was not significant. CONCLUSION: Peer education based on Pender's health promotion model improves patients' quality of life, stress management, and self-efficacy with multiple sclerosis. Nursing managers and health system policymakers can use this educational approach for patients with other chronic diseases to enhance their quality of life and self-efficacy. TRIAL REGISTRATION: Iranian Registry of Clinical Trials: IRCT registration number: IRCT20190917044802N3 .


Subject(s)
Multiple Sclerosis , Quality of Life , Health Promotion , Humans , Iran/epidemiology , Multiple Sclerosis/therapy , Self Efficacy
12.
Mult Scler Relat Disord ; 62: 103799, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1778382

ABSTRACT

BACKGROUND: The impact of the COVID-19 pandemic on physical therapy services for people with multiple sclerosis (pwMS) is unknown. Therefore, the Special Interest Group for Mobility (SIG Mobility) of the European Network for Best Practice and Research in Multiple Sclerosis Rehabilitation (RIMS) has undertaken the initiative to examine the impact of the COVID-19 outbreak on physical therapy services and physical activity participation in pwMS across Europe, Israel and Australia. OBJECTIVE: To describe the impact of the COVID-19 outbreak on physical therapy practice from the perspective of the therapist. METHODS: An online survey was developed and conducted from December 2020 to July 2021. The survey (50 questions), included multiple-choice questions and open-ended responses. RESULTS: In total, 215 physical therapists (PT's) from 9 countries (Australia, Belgium, the Czech Republic, Ireland, Israel, Italy, Norway, Spain, and Turkey) participated in the study. The therapy most affected during the pandemic was aerobic training/conditioning exercises; 33.5% reported that these activities were either reduced or unavailable. In contrast, 15% of the PTs reported increased use of relaxation/mind body techniques and/or fatigue management programs during the pandemic. PTs reported a mixture of positive and negative feelings about the therapeutic sessions offered during the pandemic. Most reported positive feelings included "positive" (26.5%), and "optimistic" (24.7%). Negative feelings most frequently reported included "worried" (30.7%), and "hesitant" (20.9%). The PTs reported a 10% decrease in the use of hands-on techniques and a 10% increase in the use of oral instructions when treating moderately and severely pwMS during as compared to before the pandemic. CONCLUSION: The COVID-19 pandemic has affected physical therapy services in pwMS internationally in terms of content, frequency of use and format.


Subject(s)
COVID-19 , Multiple Sclerosis , Humans , Multiple Sclerosis/rehabilitation , Multiple Sclerosis/therapy , Pandemics , Physical Therapy Modalities , Surveys and Questionnaires
13.
J Clin Neurosci ; 99: 311-316, 2022 May.
Article in English | MEDLINE | ID: covidwho-1773525

ABSTRACT

A cross-sectional hospital records-based study was conducted to evaluate the prevalence, severity, outcomes, and identify demographic and clinical risk factors of coronavirus disease (COVID-19) in patients with MS. The study was conducted at multiple clinics in Oman, Kuwait, and the United Arab Emirates (UAE) from March 2020 to February 2021. The association of patient demographics, MS disease characteristics, and use of disease-modifying therapies with outcomes of COVID-19 illness were evaluated using odds ratio. A total of 134 MS patients with COVID-19 (prevalence rate of 3.7%) having a median age of 35.5 years were analyzed in the study. A majority (126 [94.0%]) of patients had mild COVID-19 illness and 122 (91.0%) made a full recovery, while 1 (0.7%) patient died. The median EDSS score reported in the study was low (1.0). Univariate regression analysis showed high EDSS scores, progressive MS disease, and use of anti-CD20 therapy such as rituximab as risk factors for moderate to severe COVID-19 requiring hospitalization. Comorbidities were associated with a higher risk of non-recovery from COVID-19 in both univariate and multivariate analyses. Age, sex, smoking history, and duration of MS did not show a significant association with severity or adverse COVID-19 disease outcome. Identification of risk factors can aid in improving the treatment and monitoring of pwMS and COVID-19.


Subject(s)
COVID-19 , Multiple Sclerosis , Adult , COVID-19/epidemiology , Cross-Sectional Studies , Humans , Multiple Sclerosis/complications , Multiple Sclerosis/epidemiology , Multiple Sclerosis/therapy , Prevalence , Risk Factors , SARS-CoV-2
14.
Int J Environ Res Public Health ; 19(6)2022 03 08.
Article in English | MEDLINE | ID: covidwho-1760572

ABSTRACT

PURPOSE: The Comprehensive assessment of Acceptance and Commitment Therapy (ACT) processes (CompACT) is a 23-item self-report questionnaire assessing psychological flexibility, which is the overarching construct underpinning the ACT framework. We conducted a two-phase project to develop validated versions of the CompACT in three languages: phase 1-cross-cultural adaptation; and phase 2-psychometric validation of the questionnaire for use in Italy, Germany and Spain. This article focuses on the first phase. METHODS: We translated and culturally adapted the CompACT in the three target languages, following the ISPOR TCA Task Force guidelines. The process was overseen by a translation panel (three translators, at least two multiple sclerosis (MS) researchers and a lay person), ACT experts and clinicians from the research team of each country and the original CompACT developers. We debriefed the new questionnaire versions via face-to-face interviews with a minimum of four adults from the general population (GP) and four adults with MS in each country. RESULTS: The translation-adaptation process went smoothly in the three countries, with some items (7 in Italy, 4 in Germany, 6 in Spain) revised after feedback from ACT experts. Cognitive debriefing showed that the CompACT was deemed easy to understand and score in each target country by both GP and MS adults. CONCLUSIONS: The Italian, German and Spanish versions of the CompACT have semantic, conceptual and normative equivalence to the original scale and good content validity. Our findings are informative for researchers adapting the CompACT and other self-reported outcome measures into multiple languages and cultures.


Subject(s)
Acceptance and Commitment Therapy , Multiple Sclerosis , Adult , Humans , Language , Multiple Sclerosis/therapy , Psychometrics , Reproducibility of Results , Surveys and Questionnaires , Translating , Translations
15.
Mult Scler Relat Disord ; 59: 103557, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1730004

ABSTRACT

Thermoregulation is a homeostatic mechanism that is disrupted in some neurological diseases. Patients with multiple sclerosis (MS) are susceptible to increases in body temperature, especially with more severe neurological signs. This condition can become intolerable when these patients suffer febrile infections such as coronavirus disease-2019 (COVID-19). We review the mechanisms of hyperthermia in patients with MS, and they may encounter when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Finally, the thermoregulatory role and relevant adaptation to regular physical exercise are summarized.


Subject(s)
COVID-19 , Multiple Sclerosis , Nervous System Diseases , Exercise , Humans , Multiple Sclerosis/complications , Multiple Sclerosis/therapy , SARS-CoV-2
17.
Mult Scler Relat Disord ; 60: 103719, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1712889

ABSTRACT

The impaired ability to mount an effective immune response to vaccination leaves immunosuppressed patients at higher risk of severe COVID-19 infection. This retrospective study aimed to evaluate COVID-19 seroconversion and antibody titers for patients on immune modulating therapies compared to those not on disease modifying therapy (DMT). As expected, individuals on B-cell depletion therapies (BCDT) and those on sphingosine 1-phosphate (S1P) modulators had an impaired humoral response to mRNA vaccination. We observed variable seroconversion depending on the type of B-cell depleting medication, with a smaller percentage of seroconversion in patients on infused BCDT (iBCDT, ocrelizumab and rituximab) compared to ofatumumab. The humoral response to vaccination was not impaired for individuals on natalizumab or for untreated MS patients. These observations may influence DMT selection during the COVID-19 era.


Subject(s)
COVID-19 , Multiple Sclerosis , COVID-19/prevention & control , COVID-19 Vaccines , Humans , Multiple Sclerosis/therapy , Retrospective Studies , SARS-CoV-2 , Seroconversion , Vaccination
18.
JCI Insight ; 7(4)2022 02 22.
Article in English | MEDLINE | ID: covidwho-1701616

ABSTRACT

BACKGROUNDVaccine-elicited adaptive immunity is a prerequisite for control of SARS-CoV-2 infection. Multiple sclerosis (MS) disease-modifying therapies (DMTs) differentially target humoral and cellular immunity. A comprehensive comparison of the effects of MS DMTs on SARS-CoV-2 vaccine-specific immunity is needed, including quantitative and functional B and T cell responses.METHODSSpike-specific Ab and T cell responses were measured before and following SARS-CoV-2 vaccination in a cohort of 80 study participants, including healthy controls and patients with MS in 6 DMT groups: untreated and treated with glatiramer acetate (GA), dimethyl fumarate (DMF), natalizumab (NTZ), sphingosine-1-phosphate (S1P) receptor modulators, and anti-CD20 mAbs. Anti-spike-Ab responses were assessed by Luminex assay, VirScan, and pseudovirus neutralization. Spike-specific CD4+ and CD8+ T cell responses were characterized by activation-induced marker and cytokine expression and tetramer.RESULTSAnti-spike IgG levels were similar between healthy control participants and patients with untreated MS and those receiving GA, DMF, or NTZ but were reduced in anti-CD20 mAb- and S1P-treated patients. Anti-spike seropositivity in anti-CD20 mAb-treated patients was correlated with CD19+ B cell levels and inversely correlated with cumulative treatment duration. Spike epitope reactivity and pseudovirus neutralization were reduced in anti-CD20 mAb- and S1P-treated patients. Spike-specific CD4+ and CD8+ T cell reactivity remained robust across all groups, except in S1P-treated patients, in whom postvaccine CD4+ T cell responses were attenuated.CONCLUSIONThese findings from a large cohort of patients with MS exposed to a wide spectrum of MS immunotherapies have important implications for treatment-specific COVID-19 clinical guidelines.FUNDINGNIH grants 1K08NS107619, K08NS096117, R01AI159260, R01NS092835, R01AI131624, and R21NS108159; NMSS grants TA-1903-33713 and RG1701-26628; Westridge Foundation; Chan Zuckerberg Biohub; Maisin Foundation.


Subject(s)
Antibodies, Viral/biosynthesis , COVID-19 Vaccines/immunology , Multiple Sclerosis/therapy , SARS-CoV-2/immunology , T-Lymphocytes/immunology , Antibodies, Viral/immunology , Humans , Multiple Sclerosis/immunology
19.
Mult Scler Relat Disord ; 60: 103693, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1693089

ABSTRACT

BACKGROUND: Lifestyle modifications (physical activity and diet) are among the most promising strategies in multiple sclerosis (MS) rehabilitation. This study aimed to investigate the effects of combined home-based AT and Vit D on the neurotrophins level and biomarker of inflammation in MS patients during COVID-19 outbreak. METHODS: In this randomized, single-blinded, placebo-controlled trial, 38 females with MS having EDSS: 3-5 (aged 20-40 years with body mass index [BMI] of 25-30 kg/m2) were randomly assigned into four groups: AT+Vit D (n = 10), AT (n = 9), Vit D (n = 9), and Control (C n = 10). The AT program consisted of 50-70% of HRMax, 25-40 min/day, three days/wk for eight weeks. Participants in the Vit D group consumed 50,000 IU of Vit D supplement capsules per week for eight weeks. The data were analyzed through paired t-test and one-way analysis of variance and Tukey's post hoc test at the signification level of P<0.05. RESULTS: AT+Vit D, AT, and Vit D compared to the control, increased BDNF and NGF, and downregulated CRP, TNF-a, IL-6, and IL-1ß in MS patients. Additionally, the AT+Vit D group showed significantly lower CRP, TNF-a, IL-6, and IL-1ß levels and significantly higher BDNF and NGF levels compared to the AT and Vit D groups. Also, the results of this study showed significant differences between AT and Vit D groups in the variable mentioned above. CONCLUSIONS: These findings suggest that AT+Vit D improves neurotrophin and inflammatory biomarker levels in female MS patients more effectively than AT or Vit D alone.


Subject(s)
Exercise Therapy , Multiple Sclerosis , Vitamin D , Adult , Biomarkers , Brain-Derived Neurotrophic Factor , Female , Humans , Interleukin-6 , Multiple Sclerosis/therapy , Nerve Growth Factors , Vitamin D/pharmacology , Young Adult
20.
Mult Scler Relat Disord ; 60: 103701, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1693085

ABSTRACT

BACKGROUND: Many persons with multiple sclerosis (MS) have difficulties engaging in traditional land-based physical activity due to heat sensitivity and physical disability. Aquatic exercise may be a suitable alternative for these individuals, preventing overheating and enabling a range of movements that were otherwise difficult on land. The objective of the current study was to understand why some persons with MS prefer aquatic exercise while others prefer non-aquatic exercise, which will inform recommendations. METHODS: A total of 179 persons with MS completed a brief online survey (∼10 min) about their exercise routines between October 2020 and April 2021. RESULTS: Fifty-sex percent of respondents reported that they only engaged in non-aquatic exercise (i.e., land-based activities such as jogging), followed by 36% of respondents who reported that they engaged in both aquatic and non-aquatic exercise, and 7% of respondents who participated in aquatic exercise only. The most frequently reported barriers for aquatic exercise were lack of access to pools and its associated expense. Among individuals who had tried aquatic exercise, aquatic exercise was preferred over non-aquatic exercise, and 100% reported that they would recommend aquatic exercise to other persons with MS. Finally, the majority of respondents reported exercising less during the coronavirus disease 2019 (COVID-19) pandemic. CONCLUSION: Aquatic exercise is well liked among persons with MS who have tried it; however, it may not be feasible for economically disadvantaged persons with MS. Local charities and health organizations may consider financially sponsoring aquatic exercise programs to encourage participation in physical activity for the MS population. Due to the negative impact of the pandemic on exercise routines, MS clinicians should encourage their patients to resume their exercise routines once the pandemic subsides.


Subject(s)
COVID-19 , Multiple Sclerosis , Exercise , Exercise Therapy , Humans , Multiple Sclerosis/therapy , Patient Reported Outcome Measures
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