Multiple Sclerosis And Related Disorders[JOURNAL]
Sun
200 papers
Divergent comorbidity profiles in neuromyelitis optica spectrum disorder and multiple sclerosis: A large single-centre cohort from Turkey.
Kaya E, Caliskan C, Abasıyanık Z … +2 more , Simsek Y, Ozakbas S
Mult Scler Relat Disord · 2026 May · PMID 41861707 · Publisher ↗
BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are immune-mediated demyelinating disorders with overlapping clinical features. Comorbidities may influence diagnostic accuracy, ther...
BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are immune-mediated demyelinating disorders with overlapping clinical features. Comorbidities may influence diagnostic accuracy, therapeutic decisions, and long-term prognosis. Comparative data on comorbidity profiles in NMOSD versus MS are scarce, particularly from Middle Eastern and Mediterranean cohorts. OBJECTIVE: To compare the prevalence and distribution of systemic, metabolic, cardiovascular, and neuropsychiatric comorbidities in patients with NMOSD and MS. METHODS: We retrospectively analysed 144 patients with NMOSD and 2892 with MS followed at a neuroimmunology clinic between 2015 and 2023. Demographic, clinical, and comorbidity data were systematically extracted from electronic records. RESULTS: Comorbidity profiles differed significantly between groups. NMOSD patients more frequently had systemic lupus erythematosus (3.5% vs 0.1%, p < 0.01), diabetes mellitus (12.5% vs 4.5%, p < 0.01), and dyslipidemia (7.6% vs 3.5%, p = 0.012). A trend toward higher prevalence of Behçet's disease was observed (1.4% vs 0.2%, p = 0.052). In contrast, depression/anxiety (20.1% vs 12.5%, p = 0.025), restless legs syndrome (5.6% vs 1.4%, p = 0.029) were significantly more common in MS. CONCLUSION: NMOSD and MS differ substantially in their comorbidity signatures.
Safety and patient experiences with the natalizumab biosimilar in multiple sclerosis treatment.
Gelissen LMY, Strijbis EMM, van Oosten BW … +5 more , de Jong BA, Veldkamp AI, Rispens T, Killestein J, van Kempen ZLE
Mult Scler Relat Disord · 2026 May · PMID 41861706 · Publisher ↗
INTRODUCTION: In 2023, the natalizumab biosimilar Tyruko® was approved for relapsing-remitting multiple sclerosis. Here, we assessed patient experiences and natalizumab serum concentrations in a real-world cohort of pati...
INTRODUCTION: In 2023, the natalizumab biosimilar Tyruko® was approved for relapsing-remitting multiple sclerosis. Here, we assessed patient experiences and natalizumab serum concentrations in a real-world cohort of patients who switched from the originator, Tysabri®, to the biosimilar. Furthermore, we evaluated the consistency of the new John Cunningham virus (JCV) assay that comes with the biosimilar. METHODS: Patients, aware of the switch, completed questionnaires and had natalizumab concentrations measured during treatment with both products. Questionnaires assessed impact of MS symptoms, treatment satisfaction and wearing-off symptoms. An additional questionnaire assessed perceived differences or side effects with the biosimilar. JCV results of the new ImmunoWELL assay were analyzed over time. RESULTS: Among 83 patients, 15% reported more side effects during treatment with the biosimilar. Overall satisfaction was lower during treatment with the biosimilar compared to the originator. Other questionnaire scores and trough concentrations did not differ significantly. JCV results of the ImmunoWELL assay remained mainly consistent. CONCLUSION: While most patients perceived the biosimilar as equivalent to the originator, overall satisfaction was lower, and some reported more side effects. As these findings differ from blinded approval trials, a nocebo effect may influence patient perceptions in real-world settings when switching from originator to biosimilar natalizumab.
Beyond the 2024 McDonald criteria for defining and diagnosing multiple sclerosis.
Giovannoni G, Thompson EJ, Cutter G … +2 more , Rudick RA, Chamoun V
Mult Scler Relat Disord · 2026 May · PMID 41861705 · Publisher ↗
The multiple sclerosis community has made continuous improvements to historical diagnostic criteria by incorporating newer technology and recognising the need to diagnose MS at an early stage, when disease-modifying ther...
The multiple sclerosis community has made continuous improvements to historical diagnostic criteria by incorporating newer technology and recognising the need to diagnose MS at an early stage, when disease-modifying therapy may be more effective. Despite these improvements, we do not know how well these criteria perform in clinical practice. Therefore, a new approach may be needed going forward to incorporate lessons learned from other complex diseases to define the sensitivity and specificity of the criteria and to improve them. This is important to avoid misdiagnosis and overdiagnosis and, as a consequence, inappropriate treatment. We therefore propose a tiered process for developing and validating diagnostic criteria in the future. As part of this process, we suggest diagnostic criteria underpinned by a biological definition of MS, informed by deductive reasoning, and applying lessons learnt from other disease areas. In conclusion, we recommend that the MS community initiate a prospective international study to validate and compare MS diagnostic criteria. The ultimate aim is to facilitate the identification of individuals with early biological disease and to enhance overall diagnostic accuracy. It is important to develop a diagnostic framework for MS prevention that does not necessarily rely on clinical or radiological confirmation of MS, i.e., time to a first clinical or radiological event.
High burden of poor prognostic factors at first presentation in treatment-naïve relapsing multiple sclerosis: Real-world evidence from a large Egyptian cohort.
Nasr N, Talaat F, Ramdan I … +5 more , Elsalamawy D, Nabil N, Hossam A, Galeel AA, Hamdy E
Mult Scler Relat Disord · 2026 May · PMID 41861704 · Publisher ↗
BACKGROUND: Early clinical and radiological characteristics at presentation provide important prognostic information in multiple sclerosis (MS). However, baseline disease severity in treatment-naïve patients from Middle...
BACKGROUND: Early clinical and radiological characteristics at presentation provide important prognostic information in multiple sclerosis (MS). However, baseline disease severity in treatment-naïve patients from Middle Eastern and North African populations remains scarce. OBJECTIVE: To quantify poor prognostic factors at first presentation and identify independent predictors of early disability in a large Egyptian MS cohort. METHODS: We retrospectively analyzed 1095 consecutive treatment-naïve patients with relapsing MS presenting for the first time to a tertiary referral center. Demographic, clinical, and MRI variables at baseline were collected. Established poor prognostic factors were predefined, and the cumulative burden per patient was calculated. Moderate to severe disability was defined as Expanded Disability Status Scale (EDSS) ≥3. Independent predictors were evaluated using multivariable logistic regression. RESULTS: A total of 1095 patients were analyzed (72.6% female; median age 37 years; median onset age 26 years). The median diagnostic delay was 9 years. At presentation, 39.3% had EDSS ≥3. Poor prognostic features were common, including pyramidal involvement (38.8 %), short inter-attack interval (42.0%), ≥2 relapses during the first year (34.7%), infratentorial lesions (60.1%), and spinal lesions (61.6%). Overall, 82.9% of patients exhibited ≥4 poor prognostic factors and 50.8% had ≥6. On multivariable analysis, age at onset >40 years (OR 1.04), pyramidal involvement (OR 1.72), cerebellar involvement (OR 1.81), infratentorial lesions (OR 1.49), and T1 black holes (OR 1.76) independently predicted EDSS ≥3 (all p < 0.05). Sex, smoking, relapse frequency, and gadolinium enhancement were not independently associated with disability. CONCLUSIONS: Treatment-naïve patients presenting to our tertiary MS center frequently exhibited multiple unfavorable prognostic features and substantial disability. However, the prolonged diagnostic delay observed in this cohort likely reflects referral patterns specific to this tertiary center and should not be interpreted as representative of national MS diagnostic timelines in Egypt. Early motor pathway involvement and MRI markers of tissue damage, rather than inflammatory activity alone, were the principal determinants of disability at presentation.
Do sleep interventions improve sleep in MS? A systematic review and meta-analysis of activity monitor assessed outcomes.
Jemere T, van der Mei I, Honan C … +4 more , Taylor BV, Campbell JA, Breslin M, Laslett LL
Mult Scler Relat Disord · 2026 May · PMID 41861703 · Publisher ↗
BACKGROUND: Poor sleep is common in people with multiple sclerosis (PwMS). Previous systematic reviews have evaluated intervention effectiveness to improve sleep in PwMS using questionnaires, but no review has comprehens...
BACKGROUND: Poor sleep is common in people with multiple sclerosis (PwMS). Previous systematic reviews have evaluated intervention effectiveness to improve sleep in PwMS using questionnaires, but no review has comprehensively examined whether sleep interventions improve activity monitor measured sleep outcomes in PwMS. METHODS: Adhering to the PRISMA guidelines, we searched PubMed, EMBASE, and PsycINFO databases to identify randomized controlled trials, quasi-experimental and cohort studies published from inception to October 2025. A random-effects model was used to estimate the pooled intervention effects of sleep interventions on objective sleep outcomes. RESULTS: Ten studies were included in the review for narrative synthesis, with five eligible for quantitative meta-analysis. Six sleep parameters were assessed via activity monitors: total sleep time, sleep efficiency, total time in bed, sleep onset latency, wake after sleep onset, and frequency of awakenings. Sleep interventions utilised included physical activity, mindfulness, cognitive behavioral therapy (CBT), melatonin, eszopiclone and transcranial direct current stimulation (tDCS). Only sleep efficiency improved following mindfulness interventions. The median length of actigraph wear time was 7 days (range 4 nights to 16 weeks). Study quality appraisal scores ranged from moderate to high, suggesting a low risk of bias. CONCLUSION: Activity monitors have been used to assess sleep intervention effectiveness in PwMS in studies assessing physical activity, mindfulness and CBT. Objective improvements in sleep were reported following mindfulness and only using one measure (sleep efficiency). However, the small number of included studies limits definitive conclusions. Future trials should consider a wider range of outcome measures and longer time horizons.
Neutropenia after ocrelizumab treatment in patients with multiple sclerosis: A single-centre case series and systematic review of literature.
Silva JA, Delgado S, Santos M … +1 more , Leitão L
Mult Scler Relat Disord · 2026 May · PMID 41850122 · Publisher ↗
INTRODUCTION: Neutropenia is a rare side effect of CD20-depleting therapy and information regarding its management is scarce. This study aims to evaluate the clinical features, management and prognosis of ocrelizumab-rel...
INTRODUCTION: Neutropenia is a rare side effect of CD20-depleting therapy and information regarding its management is scarce. This study aims to evaluate the clinical features, management and prognosis of ocrelizumab-related neutropenia in MS patients. METHODS: Retrospective single-centre case series and systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: 37 patients were included (2 from our centre, representing an incidence of 0.63% per patient-year in our cohort [N = 117]; and 35 from the systematic review). Mean age was 36.2 years (SD 8.24) and 67.6% were female. Median number of previous disease-modifying drugs was 1 (IQR 2). Neutropenia occurred in a median of two cycles (IQR 3) after the first ocrelizumab infusion and 72.5 days (IQR 75.5) after the last one. Most patients presented with late-onset neutropenia (88.9%) and had grade four neutropenia (88.9%). 73% were symptomatic and 63% required inpatient care. No deaths were reported. 89.2% of patients received treatment with granulocyte-colony stimulating factors (G-CSF), antimicrobials or both. All neutropenia events resolved in a median of 4.5 days (IQR 5). G-CSF decreased the recovery time (p < 0.001). Treatment was maintained in 72.4% (follow-up of 1-24 months). Recurrence occurred in the same ocrelizumab cycle (N = 4), in following cycles (N = 4) and after switching to ozanimod (N = 1). No clinical, demographic or treatment features influenced recurrence. CONCLUSION: Neutropenia occurred early in treatment. Most patients presented with high-grade neutropenia but experienced a mild clinical course. Ocrelizumab resumption was possible. Recurrence may happen in the same or following cycles.
Effect of Dalfampridine on cognition, gait and fatigue in patients with multiple sclerosis: a randomized placebo-controlled study.
Abdeldayem MME, Abdelnasser A, Khalil SH … +4 more , Hamid E, Abousteit AM, Abushady EM, Shalash A
Mult Scler Relat Disord · 2026 May · PMID 41850121 · Publisher ↗
BACKGROUND: Inconsistent results on dalfampridine in RRMS may reflect variability in patient characteristics. OBJECTIVE: This randomized, double-blind, placebo-controlled trial was preregistered at ClinicalTrials.gov (NC...
BACKGROUND: Inconsistent results on dalfampridine in RRMS may reflect variability in patient characteristics. OBJECTIVE: This randomized, double-blind, placebo-controlled trial was preregistered at ClinicalTrials.gov (NCT05730738), aimed to investigate the effects of dalfampridine on gait, cognition, and fatigue in patients with mild to moderate symptoms. METHODS: Patients with RRMS who had an EDSS score of ≤5.5 and a 25-Foot Walk Test (25FWT) time of ≥ 4 seconds, and who reported fatigue and cognitive impairment, were randomized to receive either dalfampridine or placebo for 3 months. Patients were assessed by the 25FWT, Berg Balance Test, Hauser Ambulation Index, the Brief International Cognitive Assessment, Montreal Cognitive Assessment, Frontal Assessment Battery, and the Modified Fatigue Impact Scale. RESULTS: Among 100 participants allocated to the study, 89 completed the follow-up. Compared with the placebo group, the dalfampridine group showed significantly lower pyramidal system impairment and disability (p = 0.006) and better cognitive performance (p = 0.04), with comparable side-effect profiles at the 3-month follow-up. There was a significant reduction in fatigue at follow-up compared to baseline (p=0.006). CONCLUSION: The current study demonstrated the positive effect of dalfampridine on cognitive impairment and fatigue in patients with mild to moderate symptoms. However, further RCTs are warranted to confirm its long-term benefits.
Targeting Epstein-Barr virus (EBV) for treatment of multiple sclerosis.
Soldan SS, Messick TE, Lieberman PM
Mult Scler Relat Disord · 2026 May · PMID 41846093 · Publisher ↗
Epstein-Barr Virus (EBV) is now recognized as an essential causal agent in the development of Multiple Sclerosis (MS). MS is a chronic autoimmune disease resulting in demyelination and neurodegeneration in the central ne...
Epstein-Barr Virus (EBV) is now recognized as an essential causal agent in the development of Multiple Sclerosis (MS). MS is a chronic autoimmune disease resulting in demyelination and neurodegeneration in the central nervous system (CNS). EBV is a ubiquitous human γ-herpesvirus that establishes long-term latent infection in a small subpopulation of memory B-lymphocytes. While EBV and B-lymphocytes are known to be drivers of MS autoimmune disease, it remains enigmatic how a small population of EBV-infected cells trigger and drive MS pathogenesis in some individuals. In this review, we discuss the known biology of EBV and its role in MS and other disease, including cancers, where EBV is an essential driving factor in disease progression. We review some of the conditions and cofactors that increase the risk of EBV infection leading to MS and the potential of pharmacological, biologic and vaccine approaches to more selectively target EBV to treat MS.
Prevalence and clinical implications of abnormal autoantibodies in Omani patients with multiple sclerosis: A retrospective cross-sectional study.
Al-Maskari M, Al-Asmi A, Islam MM … +5 more , Al-Hidabi R, Elyas M, AlShekaili J, Al-Kindi M, Rashed SS
Mult Scler Relat Disord · 2026 May · PMID 41833243 · Publisher ↗
BACKGROUND AND PURPOSE: Non-organ-specific autoantibodies-including antinuclear antibodies (ANA), extractable nuclear antigens (ENA), and antiphospholipid antibodies (APLA)-are reported in some patients with multiple scl...
BACKGROUND AND PURPOSE: Non-organ-specific autoantibodies-including antinuclear antibodies (ANA), extractable nuclear antigens (ENA), and antiphospholipid antibodies (APLA)-are reported in some patients with multiple sclerosis (MS). This study assessed the prevalence and predictors of ANA, ENA, and APLA among Omani people with MS (PwMS). METHODS: This retrospective cross-sectional study reviewed records of 215 Omani PwMS between 2017 and 2022. Demographics, clinical features, and ANA, ENA, and APLA profiles were analyzed. RESULTS: Women comprised 66.5 % of the total patients, and most patients had relapsing-remitting MS (82.3 %). ANA positivity was 34.4 % and was significantly associated with MS duration (p = 0.021). ENA positivity was present in 31.7 % patients, mainly anti-SSA (63.2 %). APLA was detected in 17 % and was associated with female sex, brainstem or cerebral presentations, and cardiovascular comorbidity. None of the autoantibodies showed meaningful associations with MS subtype, expanded disability status scale (EDSS) score, or relapse rate. CONCLUSION: ANA and ENA are relatively common in Omani PwMS, whereas APLA is less frequent. However, autoantibody positivity showed limited clinical relevance, indicating the need for cautious interpretation and additional regional research to clarify the diagnostic implications of autoantibodies in MS.
Multiple sclerosis in the All of Us Research Program: Prevalence and associated demographic and geographic characteristics.
Peltz-Rauchman CD, Meng Z, Ma L … +11 more , Yeh HH, Joseph CL, Chesla D, Epstein M, Garber L, Stevens A, Waring SC, Ziegenfuss J, Cerghet M, Ahmedani B, Johnson CC
Mult Scler Relat Disord · 2026 May · PMID 41833242 · Publisher ↗
Multiple sclerosis is a chronic disease with a great burden not only in healthcare costs but to a person's quality of life. The All of Us Research Program's large, diverse and broadly accessible data resource could be ex...
Multiple sclerosis is a chronic disease with a great burden not only in healthcare costs but to a person's quality of life. The All of Us Research Program's large, diverse and broadly accessible data resource could be extremely useful to multiple sclerosis researchers, allowing them to consider individual differences in lifestyle, socioeconomic factors, environmental, genetic and other biological characteristics to advance precision prevention, diagnosis and treatment. The objective of this analysis was to demonstrate the richness of the All of Us data in prevalence, demographic and geographic distribution of participants reporting a history of multiple sclerosis either by electronic health record data, survey data or both. The prevalence of multiple sclerosis within the All of Us population was higher than most previous reports, overall and within demographic and geographic categories. Differences were also seen in prevalence by the type of data provided, with lowest prevalence in those who had both medical record and self-reported multiple sclerosis. These findings, along with the diversity of data types available in this cohort, may make it an ideal place for MS researchers to conduct studies, particularly etiologic and translational research. The ability to link participant reported survey data with electronic health record data, genetic and biospecimen data could allow for new studies that could not only improve our understanding of the disease, but present opportunities to develop personalized multiple sclerosis preventive interventions and treatments in the future.
Access and barriers to diagnosis of multiple sclerosis in Iran - A clinician survey.
Khodadadi S, Bahrami SN, Jahani S … +2 more , Sahraian MA, Solomon AJ
Mult Scler Relat Disord · 2026 May · PMID 41832843 · Publisher ↗
BACKGROUND: Timely diagnosis of multiple sclerosis (MS) is critical for optimal outcomes, but delays are common, particularly in resource-limited settings. This study investigates the barriers to MS diagnosis in Iran fro...
BACKGROUND: Timely diagnosis of multiple sclerosis (MS) is critical for optimal outcomes, but delays are common, particularly in resource-limited settings. This study investigates the barriers to MS diagnosis in Iran from the perspectives of neurologists. METHODS: A cross-sectional study was conducted using a questionnaire adapted from the MS International Federation (MSIF) Atlas of MS, 3rd Edition, and the 2024 Topical Survey, administered via an online platform to Iranian neurologists. Data collection occurred from April 1, 2024, to June 30, 2024. RESULTS: The survey received responses from 103 neurologists (34.1 % response rate), of whom 64 were general neurologists (GN) and 39 were MS specialists (NMS). Eighty percent reported at least one 'major barrier' to early MS diagnosis. These barriers included a lack of public (43.7 %) and healthcare provider (37.9 %) awareness of MS symptoms and patient reluctance to undergo testing due to social stigma (77.3 %). Access to paraclinical testing, including visual evoked potentials (VEP), optical coherence tomography (OCT), MOG-IgG, and AQP4-IgG testing, was variable. Most respondents (98.05 %) reported adherence to national guidelines, yet 4 % of NMS and 16 % of GN reported that they did not use the McDonald criteria. CONCLUSIONS: Barriers to timely MS diagnosis in Iran are multifactorial, involving public awareness, healthcare professional education, and access to adequate resources. Addressing these issues through targeted education and improved infrastructure is essential.
Bile acids as candidate therapies for multiple sclerosis: inverse signal analysis using the FDA adverse event reporting system and preclinical validation.
Asada M, Aizawa F, Mikami T … +7 more , Goda M, Sonoda Y, Niimura T, Zamami Y, Chuma M, Uesawa Y, Ishizawa K
Mult Scler Relat Disord · 2026 May · PMID 41832842 · Publisher ↗
BACKGROUND: Alterations in bile acid metabolism have been observed in individuals with multiple sclerosis (MS), yet the therapeutic implications of bile acid supplementation remain uncertain. METHODS: We conducted a two-...
BACKGROUND: Alterations in bile acid metabolism have been observed in individuals with multiple sclerosis (MS), yet the therapeutic implications of bile acid supplementation remain uncertain. METHODS: We conducted a two-stage study integrating pharmacovigilance analysis with preclinical validation to evaluate bile acid derivatives as candidate therapies for MS. A disproportionality analysis of the FDA Adverse Event Reporting System (FAERS; Q4/2003-Q2/2025) was performed to identify inverse associations between MS and bile acid preparations. The effects of ursodeoxycholic acid (UDCA) and obeticholic acid (6-ECDCA) were evaluated in a therapeutic experimental autoimmune encephalomyelitis (EAE) model, with treatment initiated after disease onset. RESULTS: Among 13,734,539 FAERS reports, 75,659 involved MS. Inverse associations were identified for UDCA (odds ratio [OR]: 0.197, 95% confidence interval [CI]: 0.117-0.333) and 6-ECDCA (OR: 0.128, 95% CI: 0.041-0.396). In the EAE model, UDCA was associated with lower clinical scores at the peak (day 18) and late phases (days 26-28), whereas 6-ECDCA showed only a non-significant trend toward improvement at day 28. CONCLUSION: This two-stage investigation highlights the potential utility of pharmacovigilance-guided approaches for identifying therapeutic candidates. Bile acid derivatives, particularly UDCA, are biologically plausible candidates meriting further investigation in the context of MS.
Perceived value of physiotherapy and occupational therapy among people with multiple sclerosis: insights from a qualitative interview study.
Beckerman H, Coppers JP, Eijssen IC
Mult Scler Relat Disord · 2026 May · PMID 41832841 · Publisher ↗
OBJECTIVE: While physiotherapy, occupational therapy and Cesar/Mensendieck exercise therapy are considered essential in the management of multiple sclerosis (MS), little is known about how people with MS (PwMS) value the...
OBJECTIVE: While physiotherapy, occupational therapy and Cesar/Mensendieck exercise therapy are considered essential in the management of multiple sclerosis (MS), little is known about how people with MS (PwMS) value these therapies across the disease course. This study explores the lived experiences and values of PwMS regarding these therapies during the lifespan with MS. METHODS: In-depth interviews were conducted with a purposive sample of 23 PwMS (15 females, 8 males; median age 50 years, range 32-79; median disease duration 13 years, range 2-32). The sample size ensured a broad range of experiences with the therapies, so that in-depth and detailed meanings could be obtained for interpretative phenomenological analysis, coloured by contextual factors. RESULTS: PwMS highly value continuous physiotherapy and occupational therapy, especially when tailored to personal needs and disease progression. Only 7 PwMS had experiences with Cesar/Mensendieck therapy. Five key themes emerged: values related to the patient, the therapist, the patient-therapist relationship, the therapy itself, and collaboration among healthcare providers. These values are dynamic, multifaceted and interwoven, underpinning positive therapy experiences. Personal needs, goals, and the role of the therapist evolve over time, and therapies shift from general orientation to tailored interventions, empowering PwMS to make increasingly autonomous and confident decisions. CONCLUSION: Continuous, individualized physiotherapy and occupational therapy are highly valued by PwMS. Adapting therapy to their interwoven values, evolving needs and circumstances, is considered essential for optimal MS care.
Development of novel biomechanical outcomes using motion capture to characterize hand function in multiple sclerosis.
Rai SM, Du M, Johnston J … +3 more , Briggs FBS, Alberts J, McGinley M
Mult Scler Relat Disord · 2026 May · PMID 41832840 · Full text
BACKGROUND: Nine-Hole Peg Test (9HPT) is limited to a single outcome and can be insensitive to impairment in people with MS (PwMS). OBJECTIVES: To develop novel biomechanical outcomes that better characterize upper extre...
BACKGROUND: Nine-Hole Peg Test (9HPT) is limited to a single outcome and can be insensitive to impairment in people with MS (PwMS). OBJECTIVES: To develop novel biomechanical outcomes that better characterize upper extremity function in PwMS. METHODS: 16 PwMS and 16 healthy controls (HC) completed the manual dexterity test (MDT, an iPad adaptation of 9HPT). A Kinect® device was used to capture bilateral 3-dimensional, multi-joint hand motion and an advanced mathematical model was constructed to yield novel outcomes. Cross-sectional associations between the MDT outcomes and clinical characteristics (arm spasticity, dysmetria, upper extremity weakness) were evaluated and effect size calculated. RESULTS: 16 PwMS (mean age 55.91 years, disease duration 13.90 years) and 16 HC (mean age 40.45 years) completed the study. The novel measure of Time to Grab had a large effect size for dominant hand (η²p 0.23) and non-dominant hand (η²p 0.17). Several other novel measures (Actual Distance-xy (Insertion to Removal), Time to Grab, Time to Lift, Movement Delay (PiH), Movement Time (PiH), Movement Time (EH), and Abnormal Records of Local Maxima (Insertion to Removal)) and the traditional outcome of MDT total time had a large effect size for the non-dominant hand (η²p 0.25, 0.17, 0.17, 0.32, 0.23, 0.17, 0.20, 0.15, respectively). CONCLUSIONS: MDT Total Time showed an ability to discriminate PwMs from HCs supporting the continued use as a conventional measure. Several novel measures were also identified that demonstrated potential to discriminate PwMS from HCs and correlated with various clinical measures that the traditional measure did not.
Cognitive-Motor dual-task assessments in people with multiple sclerosis: A scoping review.
Sinaei E, Costello M, Arie L … +2 more , Snow J, Plummer P
Mult Scler Relat Disord · 2026 May · PMID 41832839 · Publisher ↗
BACKGROUND: Dual-task paradigms are increasingly recognized as critical measures of functional impairment in people with multiple sclerosis (PwMS). Although dual-task assessments offer valuable insights into real-life fu...
BACKGROUND: Dual-task paradigms are increasingly recognized as critical measures of functional impairment in people with multiple sclerosis (PwMS). Although dual-task assessments offer valuable insights into real-life functioning, methodological inconsistencies limit their interpretability and clinical applicability. This scoping review systematically mapped cognitive-motor dual-task assessments used in MS research to identify methodological trends and gaps and guide future research and clinical practice. METHODS: We conducted a scoping review following Arksey and O'Malley's framework, searching PubMed, CINAHL, PEDro, and PsycINFO databases from inception to June 1, 2025. Included studies employed performance-based dual-task paradigms involving walking or standing tasks in PwMS. Data were extracted regarding study design, participant characteristics, cognitive and motor tasks, single-task assessments, task prioritization instructions, and dual-task interference calculations. Results were synthesized descriptively. RESULTS: Of the 493 initially identified records, 128 studies involving 5944 PwMS met the inclusion criteria. Walking-based tasks predominated, with standard and complex gait assessments widely used. Cognitive tasks frequently included serial subtraction, verbal fluency, and alphabet recitation. Only 39 % of studies assessed both cognitive and motor single-task performance, highlighting the extent of shortcomings in the accurate interpretation of cognitive-motor dual-task interference in PwMS. Standardized dual-task tools were seldom used, and task prioritization instructions were inconsistently reported. CONCLUSION: There is substantial variability and methodological inconsistency in current cognitive-motor dual-task assessments in MS research. Future research should standardize dual-task protocols and measure single-task performance of both tasks. Improved rigor in dual-task assessment will enhance the validity and comparability of dual-task assessments, benefiting intervention strategies and outcome assessment for PwMS.
Characterising executive functioning in the chronic phase of autoimmune encephalitis: A study by the Australian autoimmune encephalitis consortium.
Ko KY, Seery N, Griffith S … +23 more , Kazzi C, Wesselingh R, Rushen T, Tan TH, Ford H, Meade C, O'Shea MF, Forcadela M, Duncan A, Butler EG, Van Der Walt A, D'Souza W, Seneviratne U, Buzzard K, Macdonell R, Ramanathan S, Reddel SW, Hardy TA, Butzkueven H, O'Brien TJ, Alpitsis R, Malpas CB, Monif M
Mult Scler Relat Disord · 2026 May · PMID 41832838 · Publisher ↗
BACKGROUND AND OBJECTIVES: This study investigated executive functioning in patients with autoimmune encephalitis (AE) in the chronic phase of the illness. Relationships between Behavior Rating Inventory of Executive Fun...
BACKGROUND AND OBJECTIVES: This study investigated executive functioning in patients with autoimmune encephalitis (AE) in the chronic phase of the illness. Relationships between Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) scores and clinical outcomes-including AE subtype, time since disease onset, and scores on the modified Rankin Scale (mRS) and Clinical Assessment Scale in Autoimmune Encephalitis (CASE)-were also examined. METHODS: Sixty-six AE patients (50% female, Mage=55.71, SDage=17.26) from the Australian Autoimmune Encephalitis Consortium Project completed BRIEF-A questionnaires, time-matched to their CASE and/or mRS scores within six months. RESULTS: On average, assessments occurred 12 months post-onset. Median CASE and mRS scores were 2, with 66.67% of patients having mRS ≤2. Self- and informant-reported BRIEF-A scores were significantly elevated across domains, indicating substantial executive dysfunction, particularly in Emotional Control and Working Memory, where patients reported worse outcomes than informants. Patients with seronegative AE reported the most severe dysfunction, especially in emotional and behavioural regulation. Psychiatric comorbidities and seizures were associated with poorer executive functioning, while disease duration showed no significant impact. Dichotomising mRS at ≤1 vs. >1 better captured executive dysfunction, with patients in the >1 group showing significantly greater executive dysfunction than those classified as mRS >2. mRS scores significantly predicted executive dysfunction (28-43% variance); the inclusion of the CASE score did not improve these models. DISCUSSION: AE patients in the chronic stage of the illness exhibit significant executive dysfunction. Combining self- and informant reports offers a comprehensive approach to assess executive dysfunction and guide personalised treatment strategies.
Neurocognitive performance in myelin oligodendrocyte glycoprotein antibody-associated disease: A systematic review and meta-analysis.
Filho HNF, Furtado JFCU, Eulálio EC … +5 more , Ribeiro PVC, Dias FC, Paiva LMA, Torres JPV, Neto EB
Mult Scler Relat Disord · 2026 May · PMID 41831288 · Publisher ↗
INTRODUCTION: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a demyelinating disorder of the central nervous system. Although motor and visual outcomes are established, cognitive effects remai...
INTRODUCTION: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a demyelinating disorder of the central nervous system. Although motor and visual outcomes are established, cognitive effects remain unclear. This systematic review and meta-analysis assessed standardized neuropsychological tests to define the cognitive profile of MOGAD. METHODS: A comprehensive search of PubMed, Embase, and Web of Science up to August 15, 2025, identified 11 observational studies including 507 patients (68 pediatric, 439 adults). Extracted data included patient characteristics, treatments, and outcomes from validated cognitive instruments such as the Montreal Cognitive Assessment (MoCA), Paced Auditory Serial Addition Test (PASAT-2 and PASAT-3), Symbol Digit Modalities Test (SDMT), and the Wechsler Intelligence Scale for Children - Fifth Edition (WISC-V). RESULTS: Adults with MOGAD showed mild global cognitive impairment, with pooled MoCA scores of 24.69 (95 % CI: 23.31-26.07). Processing speed and working memory were consistently affected, with pooled PASAT-3 means of 39.14 (95 % CI: 35.68-42.61), PASAT-2 of 30.91 (95 % CI: 28.08-33.75), and SDMT of 44.47 (95 % CI: 41.73-47.20). In pediatric cohorts, WISC-V scores suggested relative preservation of most domains (VCI: 95.57, VSI: 98.31, FRI: 106.14, WMI: 97.44, PSI: 96.66, FSIQ: 98.93). CONCLUSION: This meta-analysis shows that cognitive impairment is a heterogeneous but relevant feature of MOGAD, most evident in processing speed and working memory. Standardized cognitive testing should be integrated into care, and longitudinal studies are needed to clarify long-term outcomes.
Bridging perspectives on comorbidities in multiple sclerosis: A pilot study with individuals with lived experience and healthcare professionals.
Karim ME, Sage O, Thandi M … +8 more , Frank HA, Marrie RA, Tremlett H, McKay K, Cox S, Lix L, Zhu F, Yusuf F
Mult Scler Relat Disord · 2026 May · PMID 41830893 · Publisher ↗
OBJECTIVE: This qualitative study explored the impact of comorbidities on multiple sclerosis (MS) management, integrating perspectives from individuals with lived MS experience and healthcare professionals who have direc...
OBJECTIVE: This qualitative study explored the impact of comorbidities on multiple sclerosis (MS) management, integrating perspectives from individuals with lived MS experience and healthcare professionals who have direct experience in treating and managing MS. METHODS: Semi-structured interviews were conducted with five individuals living with MS and five clinicians recruited through professional networks and advocacy groups. Interviews were conducted online between February 26th to March 15th, 2024. A thematic analysis was used to identify the main themes emerging from the interviews, focusing on the influence of comorbidities on MS progression, treatment decisions, and daily experiences. RESULTS: Comorbidities were found to significantly complicate MS management by exacerbating symptoms and influencing clinical decision-making. Individuals with lived MS experience and clinicians emphasized the need for enhanced coordination between healthcare providers and more comprehensive, interdisciplinary care models. Additionally, participants highlighted gaps in existing research on the relationship between comorbidities such as insomnia and substance use and their effects on MS outcomes. CONCLUSIONS: Comorbidities add a significant layer of complexity to MS management, both for individuals living with the disease and for clinicians providing care. Our findings suggest a need for integrated care models that address the unique needs of individuals with MS and comorbidities. Enhanced communication between specialists, comprehensive education for the individuals living with MS, and research that further explores the links between MS and comorbidities are critical steps toward improving outcomes. TRIAL REGISTRATION: Not applicable.
The case for seronegative MOG antibody syndrome (SMOGAS).
Levy M, Lechner-Scott J, Hawkes CH … +2 more , Ann Yeh E, Giovannoni G
Mult Scler Relat Disord · 2026 Apr · PMID 41825975 · Publisher ↗
Abstract loading — click title to view on PubMed.
Determinants of change in disease-modifying drugs in patients with multiple sclerosis: A registry-based study.
Ezabadi SG, Ebrahimitirtashi A, Salehi Z … +9 more , Khodaie F, Kasbi NA, Naghizadeh MM, Aliyari S, Beladi-Moghadam N, Nabavi SM, Harirchian MH, Sahraian MA, Eskandarieh S
Mult Scler Relat Disord · 2026 Apr · PMID 41825974 · Publisher ↗
BACKGROUND: Multiple sclerosis (MS) is the most prevalent neuroinflammatory disorder significantly impacting patients' health outcomes and economic burden. The increasing incidence of MS in Tehran, Iran, underscores the...
BACKGROUND: Multiple sclerosis (MS) is the most prevalent neuroinflammatory disorder significantly impacting patients' health outcomes and economic burden. The increasing incidence of MS in Tehran, Iran, underscores the urgent need for effective patient care and management. While disease-modifying drugs (DMDs) play a crucial role in enhancing patient quality of life and reducing disease progression, they also contribute substantially to healthcare expenditures. Understanding the factors influencing changes in DMDs is essential for optimizing treatment strategies and managing costs effectively. OBJECTIVE: This study aims to elucidate the underlying reasons for DMD changes among patients with MS (PwMS) in Tehran, Iran and to identify associated demographic and clinical factors. METHODS: A registry-based cross-sectional study was conducted involving 2,771 PwMS who altered their DMD regimen within five years prior to October 15, 2023. Data were sourced from the National Multiple Sclerosis Registry of Iran (NMSRI) and analyzed using descriptive and inferential statistics with a significance level set at P < 0.05. The primary outcome focused on the reasons for DMT changes, while secondary outcomes included disease severity metrics, initial symptoms, and treatment history. RESULTS: Among the participants, 70.3% reported a change in their DMD regimen. The primary reasons for these alterations included inadequate disease control or relapse (62.3%), adverse drug reactions (30.7%), and non-adherence (11.3%). Notably, demographic factors such as gender and age did not significantly correlate with changes in DMDs. Patients with progressive forms of MS exhibited a higher frequency of DMT modifications compared to those with non-progressive forms. Additionally, initial symptoms such as motor dysfunction significantly influenced the likelihood of changing therapies. CONCLUSION: The findings underscore that inadequate disease control and adverse drug reactions are significant determinants driving DMT modifications among MS patients in Tehran. The higher rates of changes observed in patients with progressive forms of MS reflect the need for more effective treatment strategies tailored to individual clinical presentations. Overall, this study highlights the importance of personalized care approaches that consider disease severity and symptomatology to optimize therapeutic outcomes for patients with MS.
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