Understanding multiple sclerosis as a disease spectrum: above and below the clinical threshold

Current Opinion in Neurology, Год журнала: 2024, Номер 37(3), С. 189 - 201

Опубликована: Март 27, 2024

Research in multiple sclerosis (MS) has long been predicated on clinical groupings that do not reflect the underlying biologic heterogeneity apparent within patient populations. This review explicates various levels of explanation through which spectrum disease is described and investigated both above below threshold detection, as framed by topographical model MS, to help advance a cogent mechanistic framework.

Язык: Английский

---

Treatment of Patients with Multiple Sclerosis Transitioning Between Relapsing and Progressive Disease

CNS Drugs, Год журнала: 2023, Номер 37(1), С. 69 - 92

Опубликована: Янв. 1, 2023

Multiple sclerosis (MS) is a chronic autoimmune demyelinating and neurodegenerative disease of the central nervous system with wide variety clinical phenotypes. In spite phenotypic classification MS patients, current data provide evidence that diffuse neuroinflammation neurodegeneration coexist in all forms, latter gaining increasing relevance progressive phases. Given transition phase relapsing-remitting (RRMS) to secondary (SPMS) not well defined, widely accepted criteria for SPMS are lacking, randomised controlled trials (RCTs) specifically designed have been conducted. This review summarizes primary analyses reports derived from III prospective RCTs listed PubMed compounds authorised through European Medicines Agency (EMA) US Food Drug Administration (FDA) treatment MS. The best available interferon beta-1a (IFNb-1a) subcutaneous (s.c.), IFNb-1b s.c., mitoxantrone siponimod, being most modern compound likely risk-to-effect ratio. Moreover, there labels discrepancy many disease-modifying treatments (DMTs) between FDA EMA, which be taken into consideration when opting specific DMT.

Язык: Английский

---

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

Therapeutic Advances in Chronic Disease, Год журнала: 2022, Номер 13

Опубликована: Янв. 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.

Язык: Английский

---

MSProDiscuss™ Clinical Decision Support Tool for Identifying Multiple Sclerosis Progression

Journal of Clinical Medicine, Год журнала: 2022, Номер 11(15), С. 4401 - 4401

Опубликована: Июль 28, 2022

This article describes the rationale for development of MSProDiscuss™ clinical decision support (CDS) tool, its development, and insights into how it can help neurologists improve care patients with multiple sclerosis (MS). MS is a progressive disease characterized by heterogeneous symptoms variable course. There growing consensus that exists on continuum, overlap between relapsing-remitting secondary phenotypes. Evidence demonstrates neuroaxonal loss occurs from outset, progression occur independent relapse activity, continuous underlying pathological processes may not be reflected inflammatory activity indicative patient's immune response. Early intervention benefit patients, there need tool assists physicians in rapidly identifying subtle signs progression. MSProDiscuss, developed facilitates structured approach to patient consultations. It analyzes multidimensional data via an algorithm estimate likelihood (the MSProDiscuss score), contribution various symptoms, impact daily living, enabling more personalized treatment management. Data CDS tools such as offer new course facilitate informed decision-making holistic care.

Язык: Английский

---

Enhancing Nurse–Robot Engagement: Two-Wave Survey Study

Journal of Medical Internet Research, Год журнала: 2022, Номер 25, С. e37731 - e37731

Опубликована: Сен. 16, 2022

Robots are introduced into health care contexts to assist professionals. However, we do not know how the benefits and maintenance of robots influence nurse-robot engagement.This study aimed examine nurses' personal innovativeness impact attitudes engagement.Our adopted a 2-wave follow-up design. We surveyed 358 registered nurses in operating rooms large-scale medical center Taiwan. The first-wave data were collected from October November 2019. second-wave December 2019 February 2020. In total, 344 participated first wave. used telephone follow up with them successfully followed-up 331 second wave.Robot positively related engagement (β=.13, P<.05), while robot requirements negatively (β=-.15, P<.05). Our structural model fit acceptably (comparative index=0.96, incremental nonnormed index=0.95, root mean square error approximation=0.075).Our is assistive them. found that on outweighs requirements. Hence, makers should consider emphasizing design communication context.

Язык: Английский

---

VISIBL-MS: A bilingual educational framework to increase awareness of early multiple sclerosis

Multiple Sclerosis Journal, Год журнала: 2024, Номер 30(4-5), С. 585 - 593

Опубликована: Фев. 15, 2024

Background: Despite advancements in treatments of multiple sclerosis (MS), there is a lack awareness early MS symptoms, especially students and the public, contributing to delays diagnosis treatment. This review aims identify gaps tools increase provide bilingual framework facilitate recognition symptoms. Methods: We performed literature determine use English Spanish mnemonics education for medical patients. Results: There no educational tool help remember signs at present. Here we present encompassed VISIBLY (English) VISIBLE (Spanish). stands (1) Vision changes: Painful vision loss, loss color or double vision; (2) Belly Back numbness Balance issues; (3) Limb weakness Numbness; (4), Young people. version included manuscript. Conclusion: posit that VISIBL-MS provides addresses interconnection between language, culture, health literacy, outcomes can be useful tackle effects literacy on diverse communities.

Язык: Английский

---

Scoping review of clinical decision support systems for multiple sclerosis management: Leveraging information technology and massive health data

European Journal of Neurology, Год журнала: 2024, Номер unknown

Опубликована: Июнь 11, 2024

Abstract Background and purpose Multiple sclerosis (MS) is a complex autoimmune disease of the central nervous system, with numerous therapeutic options, but lack biomarkers to support mechanistic approach precision medicine. A computational medicine could proceed from clinical decision systems (CDSSs). They are digital tools aiming empower physicians through applications information technology massive data. However, process their development still maturing; we aimed review it in field MS. Methods For this scoping review, screened systematically PubMed database. We identified 24 articles reporting 14 CDSS projects compared technical software aspects. Results The position themselves various contexts usage algorithmic approaches: expert systems, CDSSs based on similar patients' data visualization, model‐based implementing mathematical predictive models. So far, no project has completed its up certification for use global release. Some have been replaced at subsequent iterations. most advanced did not necessarily report every step dedicated article (proof concept, offline validation, refined prototype, live evaluation, comparative prospective evaluation). seek different distribution options integrate into health care: internal usage, “peer‐to‐peer,” marketing distribution. Conclusions This illustrates potential MS management helps clarify roadmap future as multidisciplinary multistep process.

Язык: Английский

---

Development and usability testing of your MS questionnaire: A patient-based digital tool to monitor symptoms of multiple sclerosis

Digital Health, Год журнала: 2023, Номер 9

Опубликована: Янв. 1, 2023

We describe the development of Your Multiple Sclerosis Questionnaire and present real-world usability testing results Questionnaire.The tool was developed in four stages to collect feedback from people living with MS (plwMS), patient organizations, clinicians on content, format, applicability. To assess its usability, 13 across 7 countries completed an online survey after using plwMS a total 261 consultations September, 2020 July, 2021.The initial version based findings previous research developing MSProDiscuss™, clinician-completed tool. Subsequently, insights obtained during cognitive debriefing, councils advisory boards led changes including addition mood sexual problems definition relapse. All individual survey, whereas 10 final survey. Clinicians "strongly agreed" or "agreed" that easy use understand (98.5%; 257/261 consultations). The were willing again same (98.1%; 256/261 who (100%; 10/10) reported have positive influence their clinical practice, helped patients engage MS, facilitated discussion patients, complemented neurological assessment.Your benefits both by facilitating structured engaging self-monitor self-manage. is compatible telemedicine practice integration into electronic health records would enable tracking disease evolution monitoring symptoms over time.

Язык: Английский

---

Data on Ocrelizumab Treatment Collected by MS Patients in Germany Using Brisa App

Journal of Personalized Medicine, Год журнала: 2024, Номер 14(4), С. 409 - 409

Опубликована: Апрель 12, 2024

Background: With a rising number of multiple sclerosis (MS) cases and increasing pressure on health systems, digital companion apps like Brisa, designed specifically for people with MS, can play an important role in the patient journey. These enable collection real-time longitudinal data that are critical to our understanding pathophysiology progression MS. Methods: This retrospective, descriptive analysis consists from Brisa users who registered between 6 August 2021 8 September 2022. Of unique users, 37.7% (n = 1593) fulfilled inclusion criteria including information about medication demographics tracked one or more symptoms and/or patient-reported outcomes. Users were classified as moderate-efficacy treatment high-efficacy ocrelizumab reporting frequency scores outcomes analyzed. Results: The largest cohort (405) reported mostly diagnosed 2–5 years before survey. most MS similar OUs (ocrelizumab users), HETUs (high-efficacy users) METUs (moderate-efficacy users). average answered questionnaires frequently. Baseline similar, whereas baseline slightly lower comparison. In further OUs, disability increased age; aged 26–45 had higher pain than 18–25-year-olds. No significant differences found quality life, bowel control vision age groups. Conclusion: findings show characteristics results other studies registries provide representative overview everyday disease management. Thereby, these bridge gap clinical research real experience, but they also raise new questions, such how often hard-and-early therapy approach is already used whether reasons choosing particular contribute different over time. Answering questions requires analysis.

Язык: Английский

---

A Clinical Care Algorithm for Detecting Progression in Multiple Sclerosis: RetratEMos Project

Cureus, Год журнала: 2024, Номер unknown

Опубликована: Ноя. 19, 2024

The diagnosis of secondary progressive multiple sclerosis (SPMS) is often established retrospectively leading to a delay in detection. This work presents clinical care algorithm that aims facilitate the recognition phase disease, analyzing its usefulness and feasibility implementation routine practice.

Язык: Английский

---