Harmonizing Definitions for Progression Independent of Relapse Activity in Multiple Sclerosis

JAMA Neurology, Journal Year: 2023, Volume and Issue: 80(11), P. 1232 - 1232

Published: Oct. 2, 2023

Emerging evidence suggests that progression independent of relapse activity (PIRA) is a substantial contributor to long-term disability accumulation in relapsing-remitting multiple sclerosis (RRMS). To date, there no uniform agreed-upon definition PIRA, limiting the comparability published studies.

Language: Английский

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Is Aerobic or Resistance Training the Most Effective Exercise Modality for Improving Lower Extremity Physical Function and Perceived Fatigue in People With Multiple Sclerosis? A Systematic Review and Meta-analysis

Archives of Physical Medicine and Rehabilitation, Journal Year: 2021, Volume and Issue: 102(10), P. 2032 - 2048

Published: April 24, 2021

ObjectiveThe purpose of this systematic review was to investigate whether aerobic training (AT) or resistance (RT) is most effective in terms improving lower limb physical function and perceived fatigue persons with multiple sclerosis (PwMS).Data SourcesNine databases (MEDLINE, EMBASE, Cumulative Index Nursing Allied Health, Complementary Medicine Database, Physiotherapy Evidence SPORTDiscus, PsycINFO, Web Science, Scopus) were electronically searched April 2020.Study SelectionIncluded studies randomized controlled trials (RCTs) involving PwMS attending 1 2 exercise interventions: AT RT. Studies had include at least objective self-reported outcome extremity and/or fatigue.Data ExtractionData extracted using a customized spreadsheet, which included detailed information on patient characteristics, interventions, outcomes. The methodological quality the independently assessed by reviewers Tool for Assessment Study Quality Reporting Exercise rating scale.Data SynthesisTwenty-seven articles reporting data from 22 RCTS (AT=14, RT=8) including 966 PwMS. modalities found be equally short walk test (AT: effect size [ES]=0.33 [95% confidence interval (CI), −1.49 2.06]; RT: ES=0.27 CI, 0.07-0.47]) long performance ES=0.37 −0.04 0.78]; ES=0.36 −0.35 1.08]), as well reducing ES=−0.61 −1.10 −0.11]; ES=−0.41 −0.80 −0.02]). Findings other functional mobility tests along walking sparse inconclusive.ConclusionsAT RT appear highly Clinicians can thus use either modality target impairments these In future perspective, head-to-head are warranted. Future MS further encouraged adapt consensus “core battery” facilitate comparison results across modalities.

Language: Английский

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Secondary Progressive Multiple Sclerosis

Neurology Neuroimmunology & Neuroinflammation, Journal Year: 2022, Volume and Issue: 10(1)

Published: Nov. 22, 2022

Many challenges exist in the precise diagnosis and clinical management of secondary progressive multiple sclerosis (SPMS) because lack definitive clinical, imaging, immunologic, or pathologic criteria that demarcate transition from relapsing-remitting MS to SPMS. This review provides an overview diagnostic criteria/definition heterogeneity associated with different SPMS patient populations; it also emphasizes importance available prospective/retrospective tools identify patients earlier disease course so approved disease-modifying therapies nonpharmacological strategies will translate into better outcomes. Delivery such interventions necessitates evolving patient-clinician dialog within context a multidisciplinary team.

Language: Английский

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Defining progression independent of relapse activity (PIRA) in adult patients with relapsing multiple sclerosis: A systematic review✰

Multiple Sclerosis and Related Disorders, Journal Year: 2023, Volume and Issue: 78, P. 104899 - 104899

Published: July 20, 2023

Language: Английский

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Early use of high-efficacy therapies in multiple sclerosis in the United States: benefits, barriers, and strategies for encouraging adoption

Journal of Neurology, Journal Year: 2024, Volume and Issue: 271(6), P. 3116 - 3130

Published: April 14, 2024

Abstract Multiple sclerosis (MS) is characterized by progressive neuroinflammation and neurodegeneration from disease onset that, if left untreated, can result in the accumulation of irreversible neurological disability. Early intervention with high-efficacy therapies (HETs) increasingly recognized as best strategy to delay or mitigate progression earliest stages prevent long-term neurodegeneration. Although there growing clinical real-world evidence supporting early HET intervention, foregoing this favor a traditional escalation approach prioritizing lower-efficacy disease-modifying remains common practice. This review explores potential health care professional- patient-related barriers use HETs patients MS United States. Barriers include regulatory reimbursement restrictions; knowledge gaps safety concerns among professionals; various individual, cultural, societal factors affecting patients. Potential strategies for overcoming these encouraging are proposed.

Language: Английский

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The need for a strategic therapeutic approach: multiple sclerosis in check

Therapeutic Advances in Chronic Disease, Journal Year: 2022, Volume and Issue: 13

Published: Jan. 1, 2022

Multiple sclerosis (MS) is the most common chronic autoimmune neurological disease. Its therapeutic management has drastically evolved in recent years with development of specific disease-modifying therapies (DMTs). Together established injectables, oral and intravenous alternatives are now available for MS patients significant benefits to modulate disease course. Certain drugs present a higher efficacy than others, profiles frequencies adverse events differentiate as well. Thus due several different treatment alternatives, approach adopted by neurologists requires tactical focus targeted, timed, meaningful decision. An integration rational emotional control proper communication skills necessary shared decision-making patients. In this perspective paper, we reinforce concept strategic using all based on scientific evidence current experience. We apply didactic analogy game chess. The opening oriented attack (i.e. already early stages clinical isolated syndrome), correct choice chess pieces move among DMTs), re-assessment reaction scenarios (e.g. sustained activity, events, family planning) advantage real-world data discussed try best ultimately successfully personalized treatment.

Language: Английский

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The association between brain volume loss and disability in multiple sclerosis: A systematic review

Multiple Sclerosis and Related Disorders, Journal Year: 2023, Volume and Issue: 74, P. 104714 - 104714

Published: April 9, 2023

Language: Английский

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Disability patterns in multiple sclerosis: A meta-analysis on RAW and PIRA in the real-world context

Multiple Sclerosis Journal, Journal Year: 2024, Volume and Issue: 30(10), P. 1309 - 1321

Published: July 31, 2024

To summarize the current evidence on relapse-associated worsening (RAW) and progression independent of relapse activity (PIRA) through a quantitative synthesis real-world studies.

Language: Английский

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A Digital Patient Portal for Patients With Multiple Sclerosis

Frontiers in Neurology, Journal Year: 2020, Volume and Issue: 11

Published: May 22, 2020

Background: Multiple Sclerosis is a chronic inflammatory disease of the central nervous system that requires complex, differential, and lifelong treatment strategy, which involves high monitoring efforts accumulation numerous medical data. A fast broad availability care, as well patient-relevant data stronger integration patients participating care providers into complex process desirable. The aim ERDF-funded project "Integrated Care Portal Sclerosis" (IBMS) was to develop pathway-based model corresponding patient portal for MS health professionals (HCPs) digital tool deliver model. Methods: created according patient-centered design approach both patients' professionals' view. Buurmann's five iterative phases were integrated science research process. problem analysis focusing on functions user interfaces conducted through surveys workshops with HCPs. Based this, refined prototype implemented using an agile software development strategy. Results: HCPs already use hardware are open new technologies. Nevertheless, they desire improved (digital) communication coordination between providers. Both groups require number portal, in prototype. Usability tests planned consider whether deemed usable, acceptable functional prepare any needed ameliorations. Discussion: After testing usability, acceptability, functionality, it will most likely be useful high-quality electronic (eHealth) management from day telerehabilitation. It implements clinical pathways manner comprehensible patients. Future developments modules could include additional diseases, quality privacy tools, artificial intelligence personalize strategies.

Language: Английский

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Data Collection in Multiple Sclerosis: The MSDS Approach

Frontiers in Neurology, Journal Year: 2020, Volume and Issue: 11

Published: June 16, 2020

Multiple sclerosis (MS) is a frequent chronic inflammatory disease of the central nervous system which affects patients for decades. As monitoring and treatment multiple get more personalized complex, individual assessment collection different parameters ranging from clinical assessments via laboratory imaging data to patient-reported are necessary in an innovative patient management MS. These points predestine electronic processing use MS documentation. Such technologies enable rapid exchange health information between patients, practitioners caregivers, regardless time location. In this perspective paper, we introduce our digital strategy Dresden develop constantly Sclerosis Documentation System (MSDS) into eHealth platform can be used purpose. Different user cases presented implementing software providing important future. The holistic will have impact on other fields care as eg. neurorehabilitation.

Language: Английский

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