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A previously misdiagnosed cohort of aquaporin 4 antibody-positive neuromyelitis optica spectrum disorder with disease duration of >10 years in multi-ethnic Penang, Malaysia: Clinical features and disease course

Hor JY, Lim TT, Chow HB, Tan K, Cheah CF, Ching YM, et al.

Mult Scler Relat Disord, 2016 Jan;5:89-90.
PMID: 26856950 DOI: 10.1016/j.msard.2015.11.008
Matched MeSH terms: Multiple Sclerosis/diagnosis*; Multiple Sclerosis/immunology*
Does Vitamin D reduce disease activity in people with multiple sclerosis? A Cochrane Review summary with commentary

Engkasan JP

NeuroRehabilitation, 2019;45(1):135-136.
PMID: 31403951 DOI: 10.3233/NRE-189008

The aim of this commentary is to discuss in a rehabilitation perspective the recently published Cochrane Review "Vitamin D for the management of multiple sclerosis" by Jagannath et al. (2018)1 under the direct supervision of Cochrane Multiple Sclerosis and rare diseases of the CNS Group. This Cochrane Corner is produced in agreement with NeuroRehabilitation by Cochrane Rehabilitation.

Matched MeSH terms: Multiple Sclerosis*
The past, present and future of imaging in multiple sclerosis

Ramli N, Rahmat K, Azmi K, Chong HT

J Clin Neurosci, 2010 Apr;17(4):422-7.
PMID: 20167498 DOI: 10.1016/j.jocn.2009.09.014

Despite technological advances in imaging, multiple sclerosis (MS) remains a clinical diagnosis that is supported, but not replaced, by laboratory or imaging findings. However, imaging is essential in the current diagnostic criteria of MS, for prediction of the likelihood of MS for patients with clinically isolated syndromes, correlation with lesion pathology and assessment of treatment outcome. This article gives an overview of imaging in MS with particular emphasis on the role of MRI in various diagnostic imaging criteria. Novel imaging for MS using 3 Tesla field strengths, magnetization transfer imaging, diffusion tensor imaging, magnetic resonance spectroscopy and cell-specific contrast will be reviewed.

Matched MeSH terms: Multiple Sclerosis/pathology*
Fulltext Evaluation of neuroprotective effects of alpha-tocopherol in cuprizone-induced demyelination model of multiple sclerosis

Mitra NK, Xuan KY, Teo CC, Xian-Zhuang N, Singh A, Chellian J

Res Pharm Sci, 2020 Dec;15(6):602-611.
PMID: 33828603 DOI: 10.4103/1735-5362.301345

Background and Purpose: Multiple sclerosis (MS) is an autoimmune disorder characterized by demyelination and axonal loss. Quantitative estimation of behavioral, locomotor, and histological changes following the use of alpha-tocopherol (AT) in the animal model of MS have not been reported. The present study was planned to evaluate whether AT can improve sensorimotor dysfunction and reduce demyelination in the cuprizone (CPZ)-induced rat model of MS.
Experimental approach: Female Sprague-Dawley rats (8 weeks) were fed with cuprizone diet for 5 weeks followed by intraperitoneal injections of alpha-tocopherol (100 mg/Kg) or PBS for 2 weeks (groups E1 and E2, n = 8). Group C (n = 8) was fed with normal pellets followed by intraperitoneal doses of PBS. Open-field test and beam walking were carried out on every 10th day. The mean area of demyelination in the corpus callosum was quantified in Luxol® fast blue (LFB) stained histological sections of the forebrain. Qualitative grading for relative changes in the stains of myelinated fibers was also done.
Findings/Results: During withdrawal of CPZ, AT treatment increased the average speed by 22% in group E1, compared to group E2 (P < 0.05). The mean time to walk the beam was reduced in group E1 by 2.6% compared to group E2 (P < 0.05). The rearing frequency was increased in group E1 during week 6-7 compared to that in the period of CPZ treatment. The mean area of demyelination in the corpus callosum showed a 12% reduction in group E1 compared to group E2 (P < 0.05).
Conclusion and implications: Short-term AT therapy showed improvement in motor dysfunction and reduction of demyelination in the animal model of MS.

Matched MeSH terms: Multiple Sclerosis
Fulltext Foot reflexology therapy for non-specific low back pain condition : a protocol for a randomized controlled trial

Nor Dalila Marican, Rozita Hod, Nadiah Wan-Arfah, Azmi Hassan

Int J Public Health Res, 2018;8(1):933-938.
MyJurnal

Introduction Non-specific low back pain is one of the most common physical ailments
affecting millions of people worldwide. This condition constitutes a
significant public health problem and was listed as a prevalent health
complaint in most societies. Even though there are many anecdotal claims
for reflexology in the treatment of various conditions such as a migraine,
arthritis and multiple sclerosis, but very little clinical evidence exists for
reflexology on the management of low back pain per se. This study aims to
evaluate the effects of foot reflexology therapy as an adjunctive treatment to
the Malaysian low back pain standard care in relieving pain and promoting
health-related quality of life among people with non-specific low back pain.
Methods This is a parallel randomized controlled trial with pre and post-treatment
study design. The study setting for the intervention located at Penawar
Reflexology Center, Kuala Terengganu, Malaysia. A total of 100
participants with non-specific low back pain will be allocated to one of two
groups, using a randomization computer program of Research Randomizer.
The control group will receive low back pain standard care, while the
intervention group will receive standard care plus eight sessions of foot
reflexology therapy. The pain intensity and health-related quality of life
scores will be measured using Visual Analogue Scale and Euro-quality of
life scale respectively in both groups. The study was approved by the
Human Research Ethics Committee of University Sultan Zainal Abidin
(UHREC/2016/2/011). The study protocol was registered at
ClinicalTrials.gov, with the ID number of NCT02887430.
Measurements Outcome measures will be undertaken at pre-intervention (week 1), postintervention
(week 6) and follow-up (week 10).
Conclusions This will be the first trial to compare the foot reflexology therapy with
control group among people who medically diagnosed with non-specific low
back pain in Malaysia. The result of this study will contribute to better
management of this population, especially for Malaysia healthcare setting.

Study site: Penawar Reflexology Center, Kuala Terengganu, Malaysia

Matched MeSH terms: Multiple Sclerosis
Multiple sclerosis. The neuropathology of a case with a plea

Arumugasamy N

Med J Malaya, 1969 Sep;24(1):45-8.
PMID: 4243843
Matched MeSH terms: Multiple Sclerosis/pathology*
Different pathological processes for acute white matter lesions in multiple sclerosis

Alturkustani M, Bahakeem B, Zhang Q, Ang LC

Malays J Pathol, 2020 Aug;42(2):187-194.
PMID: 32860370

INTRODUCTION: Multiple sclerosis (MS) has variable clinical presentations, prognoses, pathogeneses, and pathological patterns. We conducted a pathological review of acute MS-associated lesions that focused on the degree of axonal injury, myelin loss, and glial reaction to determine whether the observed demyelination was of the primary or secondary type.
MATERIALS AND METHODS: After searching the records for a 15-year period at the London Health Sciences Centre Pathology Department, we identified 8 cases of surgical acute lesion biopsies in which clinical MS diagnoses were made before or after the biopsy.
RESULTS: The white matter pathologies in these cases could be sorted into 3 morphological patterns. The first pattern, which represents typical demyelinated plaques, was observed in 4 cases and was characterised by nearly complete demyelination accompanied by variable degrees of axon preservation and axonal swelling. The second pattern was observed in 3 cases and was characterised by demyelinating lesions containing variable numbers of myelinated axons mixed with a few demyelinated axons and variable numbers of axonal swellings. The myelinated axons ranged from scattered fibres to bands of variable thickness, and the demyelination was a mixture of primary and secondary demyelination. The third pattern was observed in 1 case and was characterised by well-demarcated areas of reduced myelin staining and numerous apoptotic nuclei. Axonal staining revealed many fragmented axons with reduced myelin staining but no definitely demyelinated axons.
CONCLUSIONS: This report shows that the predominant pathology underlying acute MS-related lesions is not limited to demyelination but can include axonal degeneration alone or in combination with primary demyelination which reflect different pathogenesis for these acute lesions.

Matched MeSH terms: Multiple Sclerosis/pathology*
Fulltext Economic burden of multiple sclerosis on Kuwait health care system

Alowayesh MS, Ahmed SF, Al-Hashel J, Alroughani R

PLoS One, 2019;14(5):e0216646.
PMID: 31086393 DOI: 10.1371/journal.pone.0216646

BACKGROUND: Multiple Sclerosis (MS) is a chronic neurological disease with heavy economic and social burdens resulting in significant disability.
OBJECTIVE: This study aims to (1) measure the cost of health resources utilization by MS patients and (2) to examine the difference in utilization and its attributed costs amongst patients who may have a different course of MS and expanded disability status scale (EDSS) scores.
METHODS: A cross-sectional study using Kuwait National MS registry was conducted to estimate the costs of utilization of resources from 2011 to 2015.
RESULTS: Between the period 2011-2015, 1344 MS patients were included in the registry. The average annual cost per MS patient has increased from $10,271 in 2011 to $17,296 in 2015. Utilization of disease-modifying therapies (DMTs) was the main driver of costs reaching 89.9% in 2015. Throughout the five-year period, the occurrence of relapses decreased from 21.8% to 12.2% (p <0.0001). During this same period, ambulatory relapse treatment increased by 5.8% while hospitalizations decreased by 2.6%. Patients with a moderate EDSS score (3.5-6) had the highest average cost (p<0.0001) compared to mild and severe EDSS scores.
CONCLUSIONS: Multiple sclerosis has been a significant economic burden on the Kuwait healthcare system. DMTs are the main driver of cost.

Matched MeSH terms: Multiple Sclerosis/economics*; Multiple Sclerosis/epidemiology
Chronic illness and sustainable careers: How individuals with multiple sclerosis negotiate work transitions in a middle-income country

Vijayasingham L, Jogulu U, Allotey P

Soc Sci Med, 2020 01;245:112699.
PMID: 31785425 DOI: 10.1016/j.socscimed.2019.112699

Reports of work change and transitions are common amongst individuals with chronic illnesses such as multiple sclerosis (MS). However, there is little research on the lived experience of these work transitions. The scarcity of this research is particularly evident within low-and-middle-income countries, where protection laws and resources such as anti-discrimination laws and reasonable work modifications may not exist or be well enforced. In this paper, we explore how and why individuals with MS seek and achieve work transitions in the structural context of Malaysia. We interviewed ten working individuals with MS (July-december 2015) using a joint hermeneutic phenomenology and constructivist grounded theory approach. Using a broad conceptual lens of 'sustainable careers', we examine their careers as a series of experiences, decisions, and events, paying attention to the influences of context, time, their personal levels of agency and sense of meaning. Participants described work transitions as early as within the first year of diagnosis, that were prompted by voluntary, involuntary and semi-voluntary reasons. Key aspects of the process of seeking new roles included an exploration of alternative roles and paths, and then acquiring, trialing/adapting and remaining engaged in their new roles. Participants identified the perception and experience of 'being unemployable', based on how their diagnosis and short-term symptoms were responded to by employers. Nevertheless, participants used various strategies and career resources to obtain and maintain meaningful work roles. However, success in obtaining or maintaining new roles were not equally achieved. This research draws attention to the cumulative economic disadvantage of a chronic illness diagnosis, even at milder and episodic stages. Furthermore, it reiterates the need for cohesive structural protection in low-and-middle-income countries to facilitate a more equal ability to remain economically resilient and capable of engaging in meaningful long-term careers when living with a chronic illness.

Matched MeSH terms: Multiple Sclerosis
Glutamate receptors and transporters as comparative cues to the glutamatergic circuits of the avian and mammalian brain

Islam, M.R., Muzaimi, M., Abdullah, J.M.

Orient Neuron Nexus, 2011;2(1):2-9.
MyJurnal

Glutamate is the principal excitatory neurotransmitter in the central nervous system, and plays important roles in both physiological and pathological neuronal processes. Current understanding of the exact mechanisms involved in glutamate-induced neuronal excitotoxicity, in which excessive glutamate causes neuronal dysfunction and degeneration, whether acute or chronic, remain elusive. Conditions, due to acute insults such as ischaemia and traumatic brain injury, and chronic neurodegenerative disorders such as multiple sclerosis and motor neuron disease, suffer from the lack of translational neuroprotection in clinical setting to tackle glutamate excitotoxicity despite steady growth of animal studies that revealed complex cell death pathway interactions. In addition, glutamates are also released by non-neuronal cells including astrocytes and oligodendroglia. Thus, attempts to elucidate this complexity are closely related to our understanding of the glutamatergic circuitry in the brain. Neuronal cells develop a glutamatergic system at glutamatergic synapses that utilise glutamate as an intercellular signaling molecule to characterise the output, input, and termination of this signaling. As to signal input, various kinds of glutamate receptors have been identified and characterized. Na+-dependent glutamate transporters at the plasma membrane are responsible for the signal termination through sequestration of glutamate from the synaptic cleft. The signal output systems comprise vesicular storage and subsequent exocytosis of glutamate by using vesicular glutamate transporters. Similar to the mammalian brain, the regional differences of glutamatergic neurons and glutamate receptor neurons suggest many glutamatergic projections in the avian brain, as supported by recent evidence of glutamate-related genes distribution. Glutamatergic target areas are expected to show high activity of glutamate transporters that remove released glutamate from the synaptic clefts. This review summarises and compares glutamatergic circuits in the avian and mammalian brain, particularly in the olfactory pathway, the paffial organization of glutamatergic neurons and connection with the striatum, hippocampal-septal pathway, visual and auditory pathways, and granule cell-Purkinje cell pathway in the cerebellum. Comparative appreciation of these glutamatergic circuits, particularly with the localisation and/or expression of specific subtypes of glutamate transporters, would provide the morphological basis for physiological and pharmacological designs that supplement existing animal studies of the current proposed mechanisms that underlie glutamate-induced neuronal excitotoxicity.

Matched MeSH terms: Multiple Sclerosis