Ketogenic diet in relapsing multiple sclerosis: Patient perceptions, post-trial diet adherence & outcomes.

BACKGROUND: Ketogenic diets (KDs) are safe and tolerable in people with multiple sclerosis (MS). While many patient-reported and clinical benefits are noted, the sustainability of these diets outside of a clinical trial is unknown. AIMS: Evaluate patient perceptions of the KD following intervention, determine the degree of adherence to KDs post-trial, and examine what factors increase the likelihood of KD continuation following the structured diet intervention trial. METHODS: Sixty-five subjects with relapsing MS previously enrolled into a 6-month prospective, intention-to-treat KD intervention. Following the 6-month trial, subjects were asked to return for a 3-month post-study follow-up, at which time patient reported outcomes, dietary recall, clinical outcome measures, and laboratory values were repeated. In addition, subjects completed a survey to evaluate sustained and attenuated benefits following completion of the intervention phase of the trial. RESULTS: Fifty-two subjects (81%) returned for the 3-month post-KD intervention visit. Twenty-one percent reported continued adherence to a strict KD and an additional 37% reported adhering to a liberalized, less restrictive form of the KD. Those subjects with greater reductions in body mass index (BMI) and fatigue at 6-months on-diet were more likely to continue on KD following trial completion. Using intention-to-treat analysis, patient-reported and clinical outcomes at 3-months post-trial remained significantly improved from baseline (pre-KD), though the degree of improvement was slightly attenuated relative to outcomes at 6-months on KD. Regardless of diet type following the KD intervention, dietary patterns shifted toward greater protein and polyunsaturated fats and less carbohydrate/added sugar consumption. CONCLUSIONS: Following the 6-month KD intervention study, the majority of subjects elected to continue on KD, though many pursued a more liberal limit for carbohydrate restriction. Those who experienced a greater reduction in BMI or fatigue were more likely to continue with strict KD. The 6-month KD intervention induced persistent changes to dietary habits in the months following study completion. TRIAL REGISTRATION INFORMATION: Registered on Clinicaltrials.gov under registration number NCT03718247, posted on Oct 24, 2018. First patient enrollment date: Nov 1, 2018. Link: https://clinicaltrials.gov/ct2/show/NCT03718247?term=NCT03718247&draw=2&rank=1.

Socioeconomic, Clinical, and Laboratory Parameters Differentiating Pediatric Patients With MOG Antibody-Associated Disease and Multiple Sclerosis.

Studies indicate differences in the clinical phenotypes and neuroimaging of children with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) compared to multiple sclerosis; however, there are limited data assessing the socioeconomic and paraclinical differences between these distinct disorders. This retrospective study identified patients aged <18 years at time of diagnosis with MOGAD or multiple sclerosis. Demographics, birth history, socioeconomic factors (insurance type, median income, parental education level), and paraclinical features (clinical manifestations, laboratory evaluation) were recorded for eligible participants. Seventy-eight patients (28 MOGAD, 50 multiple sclerosis) met inclusion criteria. Mothers of MOGAD children were more likely to have attended college compared to the mothers of children with multiple sclerosis (80% vs 49%; P = .02). Though MOGAD patients had greater rates of day care attendance (81% vs 57%), lower rates of birth complications (7% vs 21%), and higher rates of being breastfed (65% vs 46%), these findings did not meet predefined statistical significance. Clinically, children with MOGAD exhibited a lower body mass index percentile at presentation (58th ± 27th percentile vs 83rd ± 20th percentile; P = .0001) and were younger (7.6 ± 4.1 vs 14.8 ± 1.6 years; P < .0001) and more likely to exhibit an infectious prodrome (57% vs 10%; P < .0001). MOGAD patients were less likely to have evidence of remote Epstein-Barr virus infection (29% vs 100%; P < .0001) and less likely to have ≥3 unique oligoclonal bands in the cerebrospinal fluid (5% vs 87%; P < .001). Compared with multiple sclerosis, children with MOGAD exhibit lower body mass index percentiles at presentation, are more likely to have mothers with higher education levels, and are less likely to have had prior Epstein-Barr virus infection. Our data confirm that MOGAD patients are younger, more likely to exhibit infectious prodrome, and are less likely to exhibit intrathecal synthesis of oligoclonal bands. These features provide new insights into the differentiating pathobiology of MOGAD and may be helpful in differentiating these children from multiple sclerosis early in the diagnostic evaluation.

Six-Minute Walk as a Measure of Walking Capacity and Endurance in Patients With Pediatric-Onset Multiple Sclerosis.

BACKGROUND: Despite low levels of disability, youth with pediatric-onset MS (POMS) engage in less physical activity compared to peers. The contribution of walking capacity, endurance, behavior, and MS co-morbidities remain relatively undefined and may provide valuable insights into the limitations toward physical activity in youth with MS. OBJECTIVE: Investigate differences in walking capacity, endurance and real-world behaviors of daily activity between youth with POMS and controls. DESIGN/METHODS: Youth diagnosed with MS prior to 18 years and aged ≤21 years were recruited in addition to healthy controls. Subjects completed questionnaires to quantify fatigue, depression, and physical activity levels and the timed 2- and 6-minute walk (2MW, 6MW) as an assessment of walk capacity and endurance. Subjects were sent home with a waist-worn accelerometer to assess real-world walking behavior. RESULTS: Forty-five POMS and 85 control subjects were enrolled. The POMS cohort had a mean age of 16.9±2.7 years with a mean disease duration of 2.8±2.6 years. A greater proportion of the POMS cohort was overweight/obese compared to controls (60% versus 33%). Subjects with MS walked a significantly shorter distance in 6 minutes compared to controls (1848 feet vs 2134 feet, p<0.0001) and, unlike controls, were unable to accelerate to their peak speed at the end of the 6MW. BMI category and MS disease significantly impacted 6MW performance. Using continuous accelerometry, subjects with MS spent less time in moderate-to-vigorous physical activity compared to controls (20.4 minutes/day vs 35.4 minutes/day, p=0.0003). The POMS cohort reported significantly higher levels of depression and fatigue, but self-reported similar levels of daily physical activity as controls. CONCLUSIONS: Youth with POMS exhibit slower 6MW performance and less daily engagement in moderate-to-vigorous physical activity, suggesting limitations in functional walking capacity, endurance, and daily activity behavior. Limitations in walking endurance and capacity are most prominent in those youth who are overweight/obese and living with MS. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that, compared to healthy controls, patients with pediatric-onset MS walk shorter distances on the 6 minute walk test, are less able to accelerate to peak speed at the end of the test, and are less physically active.

Crowdsourcing Medical Costs in Dermatology: Cross-sectional Study Analyzing Dermatologic GoFundMe Campaigns.

BACKGROUND: Crowdfunding for medical costs is becoming increasingly popular. Few previous studies have described the fundraising characteristics and qualities associated with success. OBJECTIVE: This study aimed to characterize and investigate the qualities associated with successful dermatological fundraisers. METHODS: This cross-sectional study of dermatological GoFundMe campaigns collected data, including demographic variables, thematic variables using an inductive qualitative method, and quantitative information. Linear regression examined the qualities associated with success, which are defined based on funds raised when controlling for campaign goals. Logistic regression was used to examine qualities associated with extremely successful campaigns, defined as those raising >1.5 times the IQR. Statistical significance was set at P<.05. RESULTS: A total of 2008 publicly available campaigns at the time of data collection were evaluated. Nonmodifiable factors associated with greater success included male gender, age 20-40 years, and White race. Modifiable factors associated with success included more updates posted to the campaign page, non-self-identity of the campaign creator, mention of a chronic condition, and smiling in campaign profile photographs. CONCLUSIONS: Understanding the modifiable factors of medical crowdfunding may inform future campaigns, and nonmodifiable factors may have policy implications for improving health care equity and financing. Crowdfunding for medical disease treatment may have potential implications for medical privacy and exacerbation of existing health care disparities. This study was limited to publicly available GoFundMe campaigns. Potential limitations for this study include intercoder variability, misclassification bias because of the data abstraction process, and prioritization of campaigns based on the proprietary GoFundMe algorithm.