Work difficulties are a primary issue of multiple sclerosis (MS). This is because disease onset usually occurs during a time when establishing a career and employment is of paramount importance. The MSWDQ-23 (Multiple Sc...Work difficulties are a primary issue of multiple sclerosis (MS). This is because disease onset usually occurs during a time when establishing a career and employment is of paramount importance. The MSWDQ-23 (Multiple Sclerosis Work Difficulties Questionnaire) was developed to assess work difficulties in MS. The WORKSEP project aimed to adapt and validate the French MSWDQ-23 and develop cutoff scores through a multicentric study in 14 centers across France. Two hundred and six persons with MS were recruited: 149 with relapsing-remitting MS and 57 with progressive forms of MS. They completed the MSWDQ-23 in French, the DEX to assess the subjective cognitive executive complaint, and the SF-36 evaluating mental (MC) and physical (PC) health-related quality of life. The results indicated that the French version of MSWDQ-23 has high internal consistency (Cronbach's α: 0.93) and test-retest reliability (ICC=0.83). A confirmatory factor analysis demonstrated a scale structure identical to the original English version comprising physical barriers (PB), psychological and cognitive barriers (PCB), and external barriers (EB). The construct and convergent validity were strong. A higher level of work difficulties at PB score was related to a higher level of disability at the EDSS and lower PC quality of life, and a higher level of PCB was related to higher cognitive executive complaints and lower MC quality of life. ROC curves based on the difference between employed and unemployed patients allowed for determining cutoff values of 32 for the total score, 37 for PB, and 27 for PCB. This study allowed the validation of the MSWDQ-23 in the French language and is the first to propose a cutoff. Determining the cutoff value enables identifying patients needing intervention and targets the limitations that MS patients may encounter in the workplace. This easy-to-use instrument provides the opportunity to propose an adapted rehabilitation program or work adjustments to improve the quality of life in patients with MS.
BACKGROUND: The cerebrospinal fluid (CSF) Aβ ratio has proven to be a more reliable biomarker for amyloid pathology than CSF Aβ in Alzheimer's disease (AD), helping to correctly classify patients with positive tau biomar...BACKGROUND: The cerebrospinal fluid (CSF) Aβ ratio has proven to be a more reliable biomarker for amyloid pathology than CSF Aβ in Alzheimer's disease (AD), helping to correctly classify patients with positive tau biomarkers (T+) that would otherwise have remained outside of the AD continuum. It was shown that the Aβ ratio better captures a relative decrease of Aβ in patients with high CSF Aβ. However, whether patients with high-amyloid (HiA) AD, in whom A+ is defined by the Aβ ratio, exactly compare with their low-amyloid (LoA) counterparts, in whom A+ is defined by Aβ solely, deserves further analysis. METHODS: We retrospectively included patients with A+T+ AD and evidence of cognitive and neurodegenerative changes (N+). LoA patients were operationally defined as patients with T+N+ and low CSF Aβ, while HiA patients were defined as patients with T+N+ and normal CSF Aβ but abnormal Aβ ratio. Tau CSF biomarkers, neuropsychological profile, rates of cognitive decline, structural and metabolic imaging, ApoE genotype and brain neuropathology were compared between the HiA and LoA groups. RESULTS: At the time of the lumbar puncture, LoA patients were significantly younger than the HiA patients (68.9±8.7years vs. 71.8±9.4; P=0.0015) and had a lower Mini-Mental Status Examination (MMSE) (18.7±6.4 vs. 20.7±6.2; P=0.0005). There was no difference in the neuropsychological profile nor in the annual rates of cognitive decline between the two groups with early AD. No differences were retrieved between groups on CSF Tau and P-Tau biomarkers, atrophy and brain metabolism, distribution of the APOE4 allele and APOE4/E4 genotype, and neuropathology. CONCLUSIONS: Overall, our study supports the surrogate use of the Aβ ratio as an equivalent to Aβ to define AD. We showed that HiA CSF profiles were not associated with differences in cognition, brain structures and metabolism, APOE genotype tau CSF biomarkers or the rates of cognitive decline, but may be the associated with later-onset and early-stage AD.
BACKGROUND: Memory deficits are a major burden in temporal lobe epilepsy (TLE), contributing to the impaired quality of life of patients. Short- and long-term efficacy of memory remediation in TLE is still debated. The a...BACKGROUND: Memory deficits are a major burden in temporal lobe epilepsy (TLE), contributing to the impaired quality of life of patients. Short- and long-term efficacy of memory remediation in TLE is still debated. The aim of our study was to assess the short- and long-term efficacy of a cognitive remediation program, COMETE (COgnitive Rehabilitation of MEmory in Temporal Epilepsy), targeting specifically episodic memory in patients with TLE. METHODS: In this prospective randomized single-blinded trial, patients from different French epilepsy centers were randomly assigned in a 2:4 ratio, via a computer-generated code, to receive remediation intervention or no intervention between neuropsychological assessments. Neuropsychologists assessing the cognitive performance at baseline, at immediate follow-up (3months after baseline) and in long-term follow-up (10 to 12months after baseline) were blinded to the intervention allocation. RESULTS: Sixty out of 66 included patients were randomized. Patients in the Remediation group significantly improved their performances in the subtests addressed by the program (verbal and non-verbal memory; P<0.001 at 3months and P<0.001 at 10/12months) while patients in the Control group did not. In verbal memory, 56% of the patients in the Remediation group normalized their performance in verbal memory learning score while 7% of the patients in the Control group did. CONCLUSIONS: Cognitive remediation targeting memory is efficient at short and long term in temporal lobe epilepsy patients.
BACKGROUND AND PURPOSE: Incidence of stroke among young adults is on the rise worldwide. Inequities remain among minorities and little is known about stroke characteristics among young Pacific patients. French Polynesia...BACKGROUND AND PURPOSE: Incidence of stroke among young adults is on the rise worldwide. Inequities remain among minorities and little is known about stroke characteristics among young Pacific patients. French Polynesia (FP), located in the middle of the South Pacific Ocean, could provide insight into this problem. METHODS: Patients aged 18-54years consecutively treated for first-ever acute ischemic stroke in Tahiti, FP, from January 2022 to December 2023 were compared to a reference cohort enrolled from January 2017 to July 2021 in Toulouse, France. Patients' characteristics were recorded and cause of stroke was classified using the ASCOD (A: atherosclerosis; S: small vessel disease; C: cardiac pathology; O: other causes; D: dissection) classification system. RESULTS: In total, 187 patients were included in Tahiti (Polynesians) and compared to 743 patients in Toulouse (mainland French [MF]). Median age was 47years old in both groups. Hypertension, diabetes, hyperlipidemia, obesity, atrial fibrillation and mechanical valve were significantly higher in Polynesian patients, whereas MF patients were more likely to be men, tobacco users, and to have a stroke related to a foramen oval with atrial septal aneurysm (all P<0.05). Multivariate analysis revealed higher prevalence of grade 1 (potentially causal) atherothrombotic (adjusted OR [aOR]: 1.775; 95% CI: 1.117-2.820; P=0.015) and cardio-embolic stroke in Tahiti (aOR: 2.966; 95% CI: 1.956-4.496; P<0.001), and higher rate of dissections in Toulouse (aOR: 4.545; 95% CI: 1.616-12.821; P=0.004). Cervical atherosclerosis was significantly associated with MF patients (aOR: 5.587; 95% CI: 2.326-13.514; P<0.001), and intracranial atherosclerosis with Polynesian patients (aOR: 3.257; 95% CI: 1.364-7.778; P=0.008). CONCLUSION: Polynesian and MF young adults with stroke appeared to have widely different characteristics and cause of stroke. These disparities underscore the necessity for tailored prevention programs and therapeutic approaches that address the unique risk profile and etiological patterns observed in Pacific Islanders.
Pourcher V, Boudot de La Motte M, Touat M
… +10 more, Deschamps R, Dehais C, Houillier C, Domont F, Bonnin S, Le Stang MB, Rodriguez C, Eloit M, Peytavin G, Maillart E
BACKGROUND AND PURPOSE: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headaches and segmental vasoconstriction of cerebral arteries resolutive within three months. However...BACKGROUND AND PURPOSE: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by recurrent thunderclap headaches and segmental vasoconstriction of cerebral arteries resolutive within three months. However, two case reports in the literature revealed diffuse cerebral vasodilatation rather than vasoconstriction at the early phase of RCVS (Kobayashi, 2016; Oikawa et al., 2017). This study aims at reporting the occurrence of diffuse cerebral vasodilatation at the initial stage of RCVS and at analyzing the clinical and prognostic characteristics of patients with diffuse vasodilatation. MATERIALS AND METHODS: Patients with RCVS were retrospectively gathered from medical files. Initial and follow-up vascular imaging were compared to assess vasodilatation and vasoconstriction for each segment of the circle of Willis on the initial angiogram. Diffuse vasodilatation was defined as dilatation of four or more of the circle of Willis arteries both in the anterior and posterior circulations, without previously described "string of beads" appearance of cerebral arteries. Patients were split into two groups based on the presence of diffuse cerebrovascular dilatation for comparison. RESULTS: Among 148 patients with RCVS, 45 patients (30%) had diffuse cerebral vasodilatation. Diffuse vasodilatation was proved to occur at the early phase of RCVS (mean delay between thunderclap headache onset and initial imaging of 2.25days versus 7.63days, P=0.047) and mainly affected the first and second segments of major cerebral arteries. It was significatively associated with distal vasoconstriction (44.44% versus 25.24%, P=0.033). Patients with diffuse cerebral vasodilatation had a greater risk of hemorrhage (15.56% for subarachnoid hemorrhage versus 3.88%, P=0.035; 8.89% for intracranial hemorrhage versus 0.97%, P=0.03). Vasodilatation was more frequent in women (71.11% versus 41.75%, P=0.001). Secondary forms of RCVS were associated with diffuse vasodilatation (51% versus 27%, P=0.008). CONCLUSION: The early cerebral angiogram may reveal diffuse cerebrovascular dilatation in patients with RCVS. Vasodilatation might have a pathophysiological implication in RCVS with clinical and prognostic consequences for patients.
CONTEXT: Delays in cancer management have been reported during the COVID-19 pandemic. Neuro-oncology patients represent a real challenge as their disease can progress rapidly without appropriate care. However, data avail...CONTEXT: Delays in cancer management have been reported during the COVID-19 pandemic. Neuro-oncology patients represent a real challenge as their disease can progress rapidly without appropriate care. However, data available for these patients over this period is scarce. OBJECTIVE: Therefore, the aim of this study was to examine the impact of the COVID-19 pandemic on therapeutic care within a specific population at a French institute. A retrospective descriptive study was conducted using electronic medical records. All patients who underwent surgery for glioma in a neurosurgery unit between January 1st, 2019 and December 31st, 2020 were included. RESULTS: A total of 114 patients were operated for a glioma; 70 patients in 2019 (before the pandemic) and 44 in 2020 (during the pandemic). Among these patients, 89% were diagnosed with a high-grade glioma, including 81% with glioblastoma. The mean time between first symptoms and imaging process increased from 35days in 2019 to 40days in 2020. However, in the subsequent steps of the care pathway, timelines improved at each stage with a reduction up to four days. The time reduction was statistically significant for two specific stages of care: (i) the interval between the surgery and the histomolecular diagnosis, with a reduction of two days, and (ii) the period between the histomoleculardiagnosis and the consultation for results announcement, with a reduction of three days. In summary, on average, the first treatment was initiated 49 days post-surgery in 2019 and 36days post-surgery in 2020. CONCLUSION: This study showed that the COVID-19 outbreak positively impacted the therapeutic care pathway of patients with glioma at a French institute. Although the improvement can be measured in days, this acceleration of care was nonetheless crucial for the population studied.
BACKGROUND: Health disparities along the rural-urban spectrum are a growing concern. The objective of this study was to determine whether in France, clinical profile, care and outcome after ischemic stroke differed betwe...BACKGROUND: Health disparities along the rural-urban spectrum are a growing concern. The objective of this study was to determine whether in France, clinical profile, care and outcome after ischemic stroke differed between patients affiliated to the statutory health insurance system dedicated to the agricultural economic sector (i.e., Mutualité Sociale Agricole [MSA]) and all other patients. METHODS: Data on all patients aged≥20 years hospitalized for ischemic stroke in mainland France in 2018 were extracted from the French National Health Insurance Data System. Age-standardized percentages were used to compare the care accessed by MSA versus other stroke patients. Associations between health insurance scheme and case fatality were assessed using Poisson regression. RESULTS: Of 87,864 stroke cases 7928 (9%) were MSA patients. MSA patients were more often rural dwellers (75.4 versus 32%) and older (median age: 84 versus 76 years). In the 12 months prior to the stroke, access to general practitioner (GP) was similar, but MSA patients were less likely to have an appointment with a cardiologist. Pre-stroke drug prescriptions suggested a better cardiovascular profile in male MSA patients (e.g., antidiabetics: 18.1 versus 21.5%). A part from a lower access to stroke unit (e.g., women: 55.3 versus 59%) other acute care indicators, including reperfusion therapy, were comparable. The crude 7-day case fatality was higher for MSA patients (Relative Risk [RR]: 1.44, 95% CI [1.32-1.57]), but this disadvantage reduced to non-significant level after adjustment for age, comorbidities and stroke management (adjusted RR: 1.07 95% CI [0.98-1.18]) CONCLUSIONS: For the mostly farming, rural, MSA population, pre-stroke, acute and post-stroke care did not differ markedly from that provided to other patients. The lower density of GP in rural areas and the remoteness from specialized center did not result in less access to preventive and acute stroke care for MSA patients in 2018.
PURPOSE: Taking into account the experience of patients living with chronic diseases, like multiple sclerosis (MS), in the assessment of the quality of their care pathway contributes significantly to improve these qualit...PURPOSE: Taking into account the experience of patients living with chronic diseases, like multiple sclerosis (MS), in the assessment of the quality of their care pathway contributes significantly to improve these quality and their own state of health. This challenge requires better identification of the determinants of this experience. The study aimed to explore the determinants of the experience of MS patients in France concerning their care pathway quality. PATIENT AND METHODS: This study was based on a dedicated cross-sectional national survey that took place in 2021. Teams from regional MS networks and MS unit at the hospital, as well as patients' associations, invited patients to participate throughout France. Patients' experience was assessed using the Musicare questionnaire. The determinants explored concerned their sociodemographic characteristics, quality of life and disease characteristics. To explore association between MusiCare questionnaire dimension scores and these determinants, bivariate and multivariate analysis were performed. RESULTS: Data were exploitable for 1971 patients living throughout France. Multivariate analysis identified significant relationships between all but one of the Musicare dimensions and several of the determinants considered in this study. The presence of a supportive caregiver, better quality of life scores, receiving specialized follow-up for MS, being a male patient and long-term illness significantly improves patient experience on one or more dimensions of the Musicare questionnaire. CONCLUSION: Some of these results are consistent with those of previous studies on other chronic diseases. They require confirmation, but they pave the way for targeted interventions for these patients in France.
BACKGROUND: Secondary cases of trigeminal autonomic cephalalgia have been described, most commonly following tumor, trauma, or vascular causes. CASES: We report a series of 6 patients who experienced ipsilateral headache...BACKGROUND: Secondary cases of trigeminal autonomic cephalalgia have been described, most commonly following tumor, trauma, or vascular causes. CASES: We report a series of 6 patients who experienced ipsilateral headache responding to the International Headache Society criteria for cluster headache, hemicrania continua or probable hemicrania continua. It occurred immediately or in the following days or weeks after cataract or glaucoma surgery. We complete these descriptions with 4 cases from a literature review of trigeminal autonomic cephalalgia attributed to non-destructive eye surgery. CONCLUSION: We report the largest series of patients who developed TAC after ocular surgery, supplemented by 4 cases from the literature. For many of these patients, TAC treatments can be effective either as a preventive or as an attack.
BACKGROUND: Acute myelitis is a neurological entity, often posing the problem of etiology. The two main causes are infectious or autoimmune. French Guyana is a region of the world where infectious etiologies are multiple...BACKGROUND: Acute myelitis is a neurological entity, often posing the problem of etiology. The two main causes are infectious or autoimmune. French Guyana is a region of the world where infectious etiologies are multiple, in particular human immunodeficiency virus infection, and autoimmune diseases appear to be emerging. The aim of our study was firstly to determine the proportion of each etiology of acute myelitis in French Guyana, and secondly to describe the clinical, paraclinical and epidemiological characteristics of autoimmune myelitis in French Guyana, with particular reference to neuromyelitis optica spectrum disorder (NMOSD). METHODS: This retrospective, observational study included all patients who presented with acute myelitis between January 2015 and August 2023 at Cayenne Hospital Center. Each patient's chart was reviewed and patients were classified according to etiology. Demographic and clinical data were collected, as well as blood, lumbar puncture, and cerebral and spinal cord magnetic resonance imaging results. RESULTS: Of the 40 patients included, immune etiology was found in 74%, including 49% with NMOSD (37% with positive anti-aquaporin-4 antibodies) compared with three patients with infectious etiology. There was no statistically significant difference in complementary examinations between immune and infectious etiologies. The prevalence of NMOSD in French Guyana was estimated at 8/100,000 (6/100,000 for patients with positive anti-aquaporin-4 antibodies). No significant difference in the geographic distribution of patients with NMOSD in French Guyana was demonstrated. CONCLUSIONS: Our results show a high proportion of autoimmune etiology of acute myelitis in French Guyana, and more particularly of NMOSD. There is a high prevalence of NMOSD, the second highest in the world after the French West Indies. Given this high proportion of autoimmune myelitis, several hypotheses can be put forward, with genetic and environmental factors in the foreground. For patients with acute myelitis in French Guyana, an immune cause is the most likely. It is therefore important to think about this and look for NMOSD in particular, without ignoring an infectious etiology.
INTRODUCTION: Prehospital identification of stroke patients with large vessel occlusion (LVO) is crucial to optimize transport to an endovascular thrombectomy (EVT)-capable center. Existing scores require medical or para...INTRODUCTION: Prehospital identification of stroke patients with large vessel occlusion (LVO) is crucial to optimize transport to an endovascular thrombectomy (EVT)-capable center. Existing scores require medical or paramedical expertise and specific teachings. We aimed to validate a simple prehospital phone-based score for LVO identification. METHODS: First, the Stroke Triage Alpha Rescue Score (STARS) was designed among a retrospective cohort of 3452 stroke alerts from the Emergency Medical Dispatch Centers (EMDC) registry. Phone-based neurological assessment, characteristics, final diagnosis, and brain imaging were analyzed. The items weighting was based on odds ratios (ORs) of significant variables after multivariate analysis. Secondly, STARS was assessed by dispatchers for all suspected strokes in a prospective cohort. Receiver operating curve (ROC) and predictive performances were calculated for the external validation. RESULTS: In the retrospective cohort, the best balance between specificity and sensitivity was obtained with a combination of six items (presence or absence of: upper, lower limbs motor deficits, language impairment, facial palsy, consciousness disorder, smoking). Each item value was determined according to their respective OR to obtain a total STARS between 0 and 13, with the most favorable cut-off higher or equal to 7 points. Then, STARS was prospectively assessed in 799 stroke alerts between March 2021 and March 2022. LVO was finally detected in 63 of 653 patients (9.6%). The area under the ROC was 0.83 [95% CI: 0.78; 0.88]. STARS≥7 had 0.83 accuracy, 0.65 sensitivity, and 0.85 specificity for detecting LVO. CONCLUSION: STARS is a simple and accurate phone-based score, without specific teaching, to detect LVO in prehospital network. STARS correctly classified 83% of stroke alerts and could be useful to identify patients with LVO eligible for EVT.
BACKGROUND: Although the literature suggests high prevalences of sensory impairments after stroke, the independent contribution of sensory modalities to functionality needs further investigation. OBJECTIVE: To identify t...BACKGROUND: Although the literature suggests high prevalences of sensory impairments after stroke, the independent contribution of sensory modalities to functionality needs further investigation. OBJECTIVE: To identify the prevalence and characterize the sensory impairment in adults with stroke and to verify the contribution of proprioceptive and exteroceptive impairments to their functional disability. METHODS: Exploratory cross-sectional study conducted in a hospital stroke unit. Sensory impairments were measured by the sensation subscale of the Fugl-Meyer Assessment, and the exteroception and proprioception data were used for analysis. The modified Rankin Scale was used to measure functional disability. Stepwise multiple linear regression analysis was used to evaluate the relative contribution of proprioceptive and exteroceptive sensory impairments to functional disability. RESULTS: Two thousand and five hundred sixty-six individuals were recruited. The prevalence of sensory impairments was 57%, with exteroceptive impairment (48%) being more prevalent than proprioceptive impairment (42%). The palm was the region most affected by the loss of exteroception, and the hallux was the region most affected by the loss of proprioception. The sensory impairments could explain 14% of the variance for functional disability. Alone, proprioceptive impairment explained 13%. The exteroceptive impairment added 1% of explanatory power to the model. CONCLUSIONS: Sensory impairments were highly prevalent. Proprioceptive impairment was the main contributor to functional disability. Investigating and proposing interventions for sensory impairments may result in a more efficient rehabilitation process.
INTRODUCTION: Neuropsychiatric symptoms are highly prevalent in Parkinson's disease (PD) and significantly affect the quality of life of patients and their significant others. The aim of this work is to describe typical...INTRODUCTION: Neuropsychiatric symptoms are highly prevalent in Parkinson's disease (PD) and significantly affect the quality of life of patients and their significant others. The aim of this work is to describe typical neuropsychiatric symptoms and their treatment. METHODS: This is a narrative opinion paper, illustrated by a fictional case report. The most common neuropsychiatric symptoms such as depressive symptoms, anxiety, apathy, psychotic symptoms, impulse control disorders, as well as cognitive impairment are discussed in the context of prodromal stage, early stage, fluctuations stage, post-surgical intervention, and late stage of PD. RESULTS: Multiple factors such as pathophysiology, dopaminergic medication, deep brain stimulation, personality traits and individual life circumstances influence neuropsychiatric symptoms. Since the complexity and causes of neuropsychiatric symptoms can change, management strategies have to be adapted and individualised throughout the disease trajectory. DISCUSSION: Recognising neuropsychiatric symptoms within the framework of the disease stage and identifying their potential causes is pivotal to provide adequate interventions.
PURPOSE: Primary central nervous system lymphoma (PCNSL) mainly affects the brain (>90% cases); there are very little data pertaining to PCNSL involving the spinal cord. METHODS: We retrospectively selected from the Fren...PURPOSE: Primary central nervous system lymphoma (PCNSL) mainly affects the brain (>90% cases); there are very little data pertaining to PCNSL involving the spinal cord. METHODS: We retrospectively selected from the French LOC network database adult immunocompetent patients diagnosed with PCNSL involving the spinal cord between 2011 and 2022. RESULTS: Of the 2043 patients records retrieved from the database, 16 patients (median age: 62.5 years, median Karnofsky performance status: 40) satisfied our study's selection criteria. The median diagnostic delay was 97 days. Upon diagnosis, 10 patients could not walk, and seven had an indwelling urinary catheter. All of the patients had undergone MRI that revealed expansive lesion(s) with homogeneous contrast enhancement. Brain lesions were found in nine patients and CSF IL-10 was increased in 9 of 10 patients. The diagnosis of PCNSL was made based on brain biopsy (n=6), spinal cord biopsy or surgery (n=6) or cytologic analysis of CSF (n=4). All the patients were treated with high-dose methotrexate-based chemotherapy, followed by spinal cord irradiation (n=1) or autograft (n=4). The median PFS and OS were 29 and 51 months, respectively. Among the responders, 33% remained in a wheelchair, and only 25% regained the ability to walk without assistance. CONCLUSION: Considering the high risks associated with a spinal cord biopsy, the rarity of the disease and the lack of specificity of its clinicoradiological presentation, the diagnosis of spinal cord lymphoma is often delayed. Searching for other lymphomatous locations or assaying CSF IL-10 may be helpful in this disease, which can cause irreversible handicap.
BACKGROUND: Vascular diseases (VDs) are increasingly studied in multiple sclerosis (MS) due to their significant impact on disability and mortality. Our aim was to evaluate VD incidence rates and determine the prevalence...BACKGROUND: Vascular diseases (VDs) are increasingly studied in multiple sclerosis (MS) due to their significant impact on disability and mortality. Our aim was to evaluate VD incidence rates and determine the prevalence of VD-related mortality. MATERIAL AND METHODS: Our study followed the PRISMA 2020 guidelines. We searched PubMed, Google Scholar, Europe PMC, and Web of Science from the inception up to April 30th, 2024. Data analysis was performed using the R statistics package program. Sensitivity analysis, subgroup analysis, and meta-regression were conducted for significant heterogeneity. RESULTS: We collected 23 studies. Patients with MS exhibited significantly higher rates of VD compared with controls. Patients with MS showed a significantly higher rate of heart failure (HF), venous thromboembolism (VTE), peripheral vascular disease (PVD), and stroke, although the incidence rate of atrial fibrillation/flutter was significantly lower compared with controls. High blood pressure tended to be lower compared with controls. The highest rate of VD was within the first 10years of follow-up, significantly for myocardial infraction, VTE, and stroke, compared with controls. Regarding mortality, the prevalence of VD-related mortality among deceased individuals with MS was 16.7% [95% CI 11.8;22.0]. CONCLUSION: Our meta-analysis revealed a significant dynamic nexus between MS and VD. MS may act as an independent risk factor for certain VDs, yet it could also be a protective factor against others. Physicians should consider VD and mortality related to VD when managing patients with MS.