Effect of MS14® on physical activity of multiple sclerosis patients: A randomized triple-blind placebo-controlled clinical trial.

INTRODUCTION: Multiple Sclerosis (MS) is a neurological disorder with an increasing global prevalence and severe complications. MS14® is a Persian-medicine-derived natural product with herbal and marine origin which has shown beneficial effects in the management of MS complications. In this study, its effect on physical activity of MS patients was investigated. METHODS: A triple-blind placebo-controlled clinical trial was conducted. Participants used either MS14 capsule or placebo 3 times a day for 3 weeks. At baseline and end of the study, physical activity indices were assessed using international physical activity questionnaire (IPAQ). Secondary outcome measures were Fatigue Severity Scale (FSS), timed 10 m walk, Ashworth scale, and Timed Get up and Go. RESULTS: A total number of 80 MS patients completed the study. At the end of study, improvement of general physical activity (p-value=0.047) and Timed 10 m walk index (p-value=0.003) in the MS14 group was significant when compared to placebo. No serious adverse effects were observed in this study. CONCLUSION: Considering the improvement of some physical activity indices, MS14® is seems to be a safe natural product which could be considered as a supplementary treatment in MS patients. Future larger trials are suggested to further evaluate its efficacy.

'I want to be with you, but I have MS': Challenges of interpersonal relationships from the MS patients' point of view.

Interpersonal relationships play an important role in adjustment to disease, coping and improving life quality after onset of Multiple sclerosis (MS). However, considering its specific nature, MS has a considerable effect on interpersonal relationships. Thus, this study was conducted to identify and describe effects of disease on interpersonal relationships through investigating lived experiences of patients. In this research, a total of 24 MS patients were selected through purposive sampling from individuals referred to the MS Clinic of Kashani Hospital in Isfahan, Iran, during 2016-2017, and then in-depth interviews were done with participants. After analysing interviews by Giorgi Descriptive Phenomenological Psychological Method, five main themes were obtained including 'Who is guilty?', 'The need for informed care', 'living with a secret', 'Change in relationships' and 'The Reality slap'. Content of experience for some of these themes was more influenced by nature of the disease, whereas some other themes were influenced more by patient's cultural context.

Multiple sclerosis and environmental risk factors: a case-control study in Iran.

Studies have shown an increase in the incidence of MS in Iran. The aim of our study was to evaluate the relationship between environmental exposure and MS in Iran. This case-control study was conducted on 660 MS patients and 421 controls. Many environmental factors are compared between the two groups. Our findings demonstrated that prematurity ([OR = 4.99 (95% CI 1.34-18.68), P = 0.017]), history of measles and mumps ([OR = 1.60 (95% CI 1.05-2.45), P = 0.029; OR = 1.85 (95% CI 1.22-2.78), P = 0.003, respectively]), breast feeding [OR = 2.90 (95% CI 1.49-5.65), P = 0.002], head trauma in childhood ([OR = 8.21 (95% CI 1.56-43.06), P = 0.013]), vaccination in adulthood ([OR = 4.57 (95% CI 1.14-18.41), P = 0.032, respectively]), migraine ([OR = 3.50 (95% CI 1.61-7.59), P = 0.002]), family history of MS, IBD, migraine, and collagen vascular diseases ([OR = 2.73 (95% CI 1.56-4.78), P < 0.001], [OR = 3.14 (95% CI 1.460-6.78), P = 0.004; OR = 3.18 (95% CI 1.83-5.53), P < 0.001; OR = 1.81 (95% CI 1.03-3.20), P = 0.040, respectively]), stressful events ([OR = 32.57 (95% CI 17.21-61.64), P < 0.001]), and microwave exposure ([OR = 3.55 (95% CI 2.24-5.63), P ≤0.001]) were more in the MS group. Sun exposure ([OR = 0.09 (95% CI 0.02-0.38), P = 0.001]), dairy and calcium consumption ([OR = 0.44 (95% CI 0.27-0.71), P = 0.001]), diabetes mellitus ([OR = 0.11 (95% CI 0.01-00.99), P = 0.049], and complete vaccination during childhood appeared to decreased MS risk. Our results investigated many risk factors and protective factors in Iran.

Risk factors of Multiple sclerosis and their Relation with Disease Severity: A Cross-sectional Study from Iran.

BACKGROUND: Many risk factors have been investigated in multiple sclerosis (MS); however, few studies have focused on the association between risk factors and the disease severity. The aim of our study was to evaluate the association between some of these risk factors and MS severity in a population sample of Iranian patients. METHODS: This cross-sectional study was conducted on 660 patients with MS. In addition to demographic variables, many potential risk factors were recorded. To compare the severity, progression index (PI) was calculated. This index is created by current Expanded Disability Status Scale (EDSS) /disease duration. RESULTS: Univariate analysis revealed that active smoking status is related with MS severity. (P-value = 0.012). Furthermore, our findings demonstrated that age at the disease onset [P < 0.001; OR = 1.05 (95% CI: 1.03-1.07)], female gender [P = 0.002; OR = 1.86 (95% CI: 1.24-2.77)] and marital status [P = 0.002; OR = 1.71 (95% CI: 1.21-2.41)] correlated with the severity of MS in the adjusted model. MS severity was observed to be related with high school and academic studies ([P = 0.004; OR = 0.56 (95% CI: 0.38-0.83)], [P = 0.001; OR = 0.52 (95% CI: 0.35-0.78)]) (Primary/secondary school studies are used as reference). Moreover, there was an association between MS severity and occupation (white collar, pink collar) ([P = 0.006; OR = 0.32 (95% CI: 0.14-0.73)], [P = 0.007; OR = 0.47 (95% CI: 0.27-0.81)]) (Student is used as reference). Furthermore, the results showed a significant correlation between vision and motor symptoms as an initial symptom and PI (P = 0.001, P = 0.025). CONCLUSION: Due to high cost of MS care and its moderate to severe disability, identification of factors influencing the MS severity is important. Our results demonstrated that the major modifiable factors related with MS severity in Iranian population, some protective and some promotive, were smoking, education, marital status and occupation. Prospective studies on larger scale are needed for further proof of these results.

Iranian consensus on use of vitamin D in patients with multiple sclerosis.

BACKGROUND: Accumulating evidences from experimental, epidemiologic and clinical studies support the potential linkage between poor vitamin D status and the risk of developing Multiple Sclerosis (MS), as well as, an adverse disease course. However, the results of the trials on the clinical outcomes of vitamin D supplementation in MS patients are less consistent which brought many discrepancies in routine practice. In this article we presented a summary of a symposium on vitamin D and MS. In this symposium we aim to review the current data about the relationship between vitamin D and MS, and suggest management guides for practicing neurologists. DISCUSSION: Generally, supplementation seems to be reasonable for all MS and clinically isolated syndrome (Rinaldi et al., Toxins 7:129-37, 2015) patients with serum 25(OH)D level below 40 ng/ml. In patients with vitamin D insufficiency or deficiency, a large replacing dose (e.g. 50,000 IU capsules of D per week for 8-12 week) is recommended. Panel also suggested: the checking of the serum vitamin D, and calcium level, as well as, patients' compliance after the initial phase; a maintenance treatment of 1500-2000 IU daily or equivalent intermittent (weekly, biweekly or monthly) Dose, considering the patient's compliance; routine check of serum vitamin D level at least two times a year especially at the beginning of spring and autumn; Serum vitamin D evaluation for first degree relatives of MS patients at high risk age and supplementation in case of insufficiency (25(OH)D less than 40 ng/ml); correction of vitamin D deficiency and insufficiency before pregnancy, as well as, a daily dose of 1500-2000 IU or equivalent biweekly intake in 2nd and 3rd trimesters; stopping supplementation if 25(OH)D serum level exceeds 100 ng/ml. Although the results of high power studies are not available, correcting vitamin D status seems plausible in all MS and CIS patients. Maintaining the serum 25(OH)D level between 40 and 100 ng/ml is not known to exert adverse effect. More ever, it might be associated with lower disease activity.

The role of stem cell therapy in multiple sclerosis: An overview of the current status of the clinical studies.

The complexity of multiple sclerosis (MS) and the incompetence of a large number of promised treatments for MS urge us to plan new and more effective therapeutic approaches that aim to suppress ongoing autoimmune responses and induction of local endogenous regeneration. Emerging data propose that hematopoietic, mesenchymal, and neural stem cells have the potential to restore self-tolerance, provide in situ immunomodulation and neuroprotection, as well as promote regeneration. Thus, in this article, we will first provide an overview of the cell sources for proposed mechanisms that contribute to the beneficial effects of stem cell transplantation, the ideal route and/or timing of stem cell-based therapies for each main stem cell group, and finally, an overview of the current status of stem cell research in clinical trial stages in MS by comparable and healthy therapeutic effects of different stem cell therapies for MS patients.

A double-blind, placebo-controlled trial of adding erythropoietin to intravenous methylprednisolone for the treatment of unilateral acute optic neuritis of unknown or demyelinative origin.

PURPOSE: To compare the effect of adding recombinant human erythropoietin (rhEPO) to intravenous methylprednisolone for the treatment of unilateral acute optic neuritis of unknown or demyelinative origin on the logarithm of the minimum angle of resolution (logMAR), perimetric variables [mean deviation (MD) and pattern standard deviation (PSD)], and retinal nerve fiber layer (RNFL) thickness in optical coherence tomography (OCT). METHODS: Thirty patients (15 patients in each group) diagnosed with unilateral acute optic neuritis of unknown or demyelinative origin were included. All patients received 1, 000 mg intravenous methylprednisolone per day for 3 days. One intravenous bullous dose of rhEPO with the dose of 33,000 IU was administered at days 1-3 for the patients in group 2. One intravenous bullous dose of 0.9 % normal saline was administered at days 1-3 for group 1 patients. At 6 months post-intervention, in the involved eye, logMAR, MD, PSD, and mean RNFL thickness in each of four quadrants and post-intervention changes in each of the variables were compared between group 1 and group 2. RESULTS: The amount of MD improvement after the intervention (difference of pre- and post-intervention MDs) was significantly higher in the group 2 patients (p = 0.04). The other post-intervention variables, including post-intervention PSD, amount of PSD improvement, and total and four-quadrant post-intervention RNFL thickness and RNFL loss (difference of pre- and post-intervention RNFL thicknesses), demonstrated no significant differences between group 1 and group 2. CONCLUSION: Until more controlled studies are available, the rhEPO is not recommended as an add-on treatment for optic neuritis.

Seizure in Iranian patients with multiple sclerosis.

BACKGROUND: There is a broad variation in reported frequencies of seizure in multiple sclerosis (MS). In this study, the seizure and its characteristics analyzed among a large group of patients with MS. PATIENTS AND METHODS: We reviewed the medical records of all definite MS patients referred to the MS Clinic of Kashani hospital, Isfahan, Iran, between 2007 and 2011. RESULTS: Altogether, 34 cases with seizure activity identified among the 920 definite MS subjects (3.69%). Five excluded due to the other probable etiologies rather than MS. In the remained 29 patients (3.15%), the type of seizure was mostly generalized (79.3%); interictal electroencephalography showed an abnormal pattern in 84.6%, brain magnetic resonance imaging revealed subcortical white mater lesions in 84.6% of patients. The mean duration of MS onsets was 8.17 years and the mean interval between MS onset and the first seizure occurrence was 3.7 years. In general, response to antiepileptic treatment was excellent. CONCLUSION: Seizures can occur at any stage during the course of MS, but it is more common during the early stages.