Literature Monitor

The specific computerized assessment battery (CAB) evaluated is valid for cognitive screening of people with multiple sclerosis (MS) and may be more likely to detect prolonged response times and impaired executive function, according to a recent study. 81 people with MS (PwMS) and 15 healthy controls (HC) completed the CAB and a set of traditional neuropsychological tests recommended for MS on the same day. Principal component factor analysis was used to assess construct validity. For criterion validity, the gold standard definition of cognitive impairment was a score of ≥1.5SD below average on at least 1 cognitive domain, based upon traditional test normative data. Researchers found:

• Traditional and computerized tests of memory, processing speed, visuospatial, and executive function converged by factor analysis.
• Computerized tests detected cognitive impairment with 85% sensitivity and 70% specificity.
• PwMS classified as impaired on only the computerized battery had significantly prolonged response times and a higher rate of unemployment compared with PwMS classified as unimpaired on both batteries.
• Poor executive function was more likely to be revealed by the CAB.

Golan D, Wilken J, Doniger GM, et al. Validity of a multi-domain computerized cognitive assessment battery for patients with multiple sclerosis. Mult Scler Relat Disord. 2019(30):154–162. doi:10.1016/j.msard.2019.01.051.

The specific computerized assessment battery (CAB) evaluated is valid for cognitive screening of people with multiple sclerosis (MS) and may be more likely to detect prolonged response times and impaired executive function, according to a recent study. 81 people with MS (PwMS) and 15 healthy controls (HC) completed the CAB and a set of traditional neuropsychological tests recommended for MS on the same day. Principal component factor analysis was used to assess construct validity. For criterion validity, the gold standard definition of cognitive impairment was a score of ≥1.5SD below average on at least 1 cognitive domain, based upon traditional test normative data. Researchers found:

• Traditional and computerized tests of memory, processing speed, visuospatial, and executive function converged by factor analysis.
• Computerized tests detected cognitive impairment with 85% sensitivity and 70% specificity.
• PwMS classified as impaired on only the computerized battery had significantly prolonged response times and a higher rate of unemployment compared with PwMS classified as unimpaired on both batteries.
• Poor executive function was more likely to be revealed by the CAB.

Golan D, Wilken J, Doniger GM, et al. Validity of a multi-domain computerized cognitive assessment battery for patients with multiple sclerosis. Mult Scler Relat Disord. 2019(30):154–162. doi:10.1016/j.msard.2019.01.051.

The specific computerized assessment battery (CAB) evaluated is valid for cognitive screening of people with multiple sclerosis (MS) and may be more likely to detect prolonged response times and impaired executive function, according to a recent study. 81 people with MS (PwMS) and 15 healthy controls (HC) completed the CAB and a set of traditional neuropsychological tests recommended for MS on the same day. Principal component factor analysis was used to assess construct validity. For criterion validity, the gold standard definition of cognitive impairment was a score of ≥1.5SD below average on at least 1 cognitive domain, based upon traditional test normative data. Researchers found:

• Traditional and computerized tests of memory, processing speed, visuospatial, and executive function converged by factor analysis.
• Computerized tests detected cognitive impairment with 85% sensitivity and 70% specificity.
• PwMS classified as impaired on only the computerized battery had significantly prolonged response times and a higher rate of unemployment compared with PwMS classified as unimpaired on both batteries.
• Poor executive function was more likely to be revealed by the CAB.

Golan D, Wilken J, Doniger GM, et al. Validity of a multi-domain computerized cognitive assessment battery for patients with multiple sclerosis. Mult Scler Relat Disord. 2019(30):154–162. doi:10.1016/j.msard.2019.01.051.

The estimated US national multiple sclerosis (MS) prevalence for 2010 is the highest reported to date and provides evidence that the north-south gradient persists, according to a recent study. A validated algorithm was applied to private, military, and public agglomerative hierarchical clustering (AHC) datasets to identify adult cases of MS between 2008 and 2010. In each dataset, researchers determined the 3-year cumulative prevalence overall and stratified by age, sex, and census region. They applied insurance-specific and stratum-specific estimates to the 2010 US Census data and pooled the findings to calculate the 2010 prevalence of MS in the US cumulated over 3 years. They also estimated the 2010 prevalence cumulated over 10 years using 2 models and extrapolated their estimate to 2017. They found:

• The estimated 2010 prevalence of MS in the US adult population cumulated over 10 years was 309.2 per 100,000, representing 727,344 cases.
• During the same time period, the MS prevalence was 450.1 per 100,000 for women and 159.7 for men (female:male ratio 2:8).
• The estimated 2010 prevalence of MS was highest in the 55- to 64-year age group.
• A US north-south decreasing prevalence gradient was identified.

Wallin MT, Culpepper WJ, Campbell JD, et al. The prevalence of MS in the United States. A population-based estimate using health claims data. [Published online ahead of print February 15, 2019]. Neurology. doi:10.1212/WNL.0000000000007035.

The estimated US national multiple sclerosis (MS) prevalence for 2010 is the highest reported to date and provides evidence that the north-south gradient persists, according to a recent study. A validated algorithm was applied to private, military, and public agglomerative hierarchical clustering (AHC) datasets to identify adult cases of MS between 2008 and 2010. In each dataset, researchers determined the 3-year cumulative prevalence overall and stratified by age, sex, and census region. They applied insurance-specific and stratum-specific estimates to the 2010 US Census data and pooled the findings to calculate the 2010 prevalence of MS in the US cumulated over 3 years. They also estimated the 2010 prevalence cumulated over 10 years using 2 models and extrapolated their estimate to 2017. They found:

• The estimated 2010 prevalence of MS in the US adult population cumulated over 10 years was 309.2 per 100,000, representing 727,344 cases.
• During the same time period, the MS prevalence was 450.1 per 100,000 for women and 159.7 for men (female:male ratio 2:8).
• The estimated 2010 prevalence of MS was highest in the 55- to 64-year age group.
• A US north-south decreasing prevalence gradient was identified.

Wallin MT, Culpepper WJ, Campbell JD, et al. The prevalence of MS in the United States. A population-based estimate using health claims data. [Published online ahead of print February 15, 2019]. Neurology. doi:10.1212/WNL.0000000000007035.

The estimated US national multiple sclerosis (MS) prevalence for 2010 is the highest reported to date and provides evidence that the north-south gradient persists, according to a recent study. A validated algorithm was applied to private, military, and public agglomerative hierarchical clustering (AHC) datasets to identify adult cases of MS between 2008 and 2010. In each dataset, researchers determined the 3-year cumulative prevalence overall and stratified by age, sex, and census region. They applied insurance-specific and stratum-specific estimates to the 2010 US Census data and pooled the findings to calculate the 2010 prevalence of MS in the US cumulated over 3 years. They also estimated the 2010 prevalence cumulated over 10 years using 2 models and extrapolated their estimate to 2017. They found:

• The estimated 2010 prevalence of MS in the US adult population cumulated over 10 years was 309.2 per 100,000, representing 727,344 cases.
• During the same time period, the MS prevalence was 450.1 per 100,000 for women and 159.7 for men (female:male ratio 2:8).
• The estimated 2010 prevalence of MS was highest in the 55- to 64-year age group.
• A US north-south decreasing prevalence gradient was identified.

Wallin MT, Culpepper WJ, Campbell JD, et al. The prevalence of MS in the United States. A population-based estimate using health claims data. [Published online ahead of print February 15, 2019]. Neurology. doi:10.1212/WNL.0000000000007035.

In the presence of mild levels of depression or significant fatigue in persons with multiple sclerosis (MS), subjective cognitive measures are unlikely to provide accurate estimates of objective cognitive functioning. This according to a recent study that aimed to examine the degree to which depressive symptoms and fatigue in individuals with MS are associated with discrepancies between subjective and objective cognitive impairment. 99 adults with MS completed the Patient Health Questionnaire–8 (PHQ-8), Fatigue Severity Scale (FSS), MS Neuropsychological Screening Questionnaire (MSNQ), and Brief International Cognitive Assessment for MS (BICAMS). Participants were classified as “Accurates,” “Underestimators,” or “Overestimators” based on discrepancies between their MSNQ (subjective) and BICAMS (objective) scores. Researchers found:

• The PHQ-8 (r=.58) and FSS (r=.48) significantly correlated with the MSNQ, but not with the
  BICAMS (rs<.07).
• Underestimators (ie, participants who underestimated their objective cognitive functioning) exhibited higher PHQ-8 and FSS scores compared to Accurates and Overestimators.
• Optimal cut-scores of ≥6 on the PHQ-8 and ≥36 on the FSS provided fair accuracy (78% and 74%) for identifying Underestimators.
• Identification of Underestimators based on PHQ-8 and FSS scores was not moderated by any demographic or MS clinical variables.

Hughes AJ. Depressive symptoms and fatigue as predictors of objective-subjective discrepancies in cognitive function in multiple sclerosis. [Published online ahead of print January 31, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.055.

In the presence of mild levels of depression or significant fatigue in persons with multiple sclerosis (MS), subjective cognitive measures are unlikely to provide accurate estimates of objective cognitive functioning. This according to a recent study that aimed to examine the degree to which depressive symptoms and fatigue in individuals with MS are associated with discrepancies between subjective and objective cognitive impairment. 99 adults with MS completed the Patient Health Questionnaire–8 (PHQ-8), Fatigue Severity Scale (FSS), MS Neuropsychological Screening Questionnaire (MSNQ), and Brief International Cognitive Assessment for MS (BICAMS). Participants were classified as “Accurates,” “Underestimators,” or “Overestimators” based on discrepancies between their MSNQ (subjective) and BICAMS (objective) scores. Researchers found:

• The PHQ-8 (r=.58) and FSS (r=.48) significantly correlated with the MSNQ, but not with the
  BICAMS (rs<.07).
• Underestimators (ie, participants who underestimated their objective cognitive functioning) exhibited higher PHQ-8 and FSS scores compared to Accurates and Overestimators.
• Optimal cut-scores of ≥6 on the PHQ-8 and ≥36 on the FSS provided fair accuracy (78% and 74%) for identifying Underestimators.
• Identification of Underestimators based on PHQ-8 and FSS scores was not moderated by any demographic or MS clinical variables.

Hughes AJ. Depressive symptoms and fatigue as predictors of objective-subjective discrepancies in cognitive function in multiple sclerosis. [Published online ahead of print January 31, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.055.

In the presence of mild levels of depression or significant fatigue in persons with multiple sclerosis (MS), subjective cognitive measures are unlikely to provide accurate estimates of objective cognitive functioning. This according to a recent study that aimed to examine the degree to which depressive symptoms and fatigue in individuals with MS are associated with discrepancies between subjective and objective cognitive impairment. 99 adults with MS completed the Patient Health Questionnaire–8 (PHQ-8), Fatigue Severity Scale (FSS), MS Neuropsychological Screening Questionnaire (MSNQ), and Brief International Cognitive Assessment for MS (BICAMS). Participants were classified as “Accurates,” “Underestimators,” or “Overestimators” based on discrepancies between their MSNQ (subjective) and BICAMS (objective) scores. Researchers found:

• The PHQ-8 (r=.58) and FSS (r=.48) significantly correlated with the MSNQ, but not with the
  BICAMS (rs<.07).
• Underestimators (ie, participants who underestimated their objective cognitive functioning) exhibited higher PHQ-8 and FSS scores compared to Accurates and Overestimators.
• Optimal cut-scores of ≥6 on the PHQ-8 and ≥36 on the FSS provided fair accuracy (78% and 74%) for identifying Underestimators.
• Identification of Underestimators based on PHQ-8 and FSS scores was not moderated by any demographic or MS clinical variables.

Hughes AJ. Depressive symptoms and fatigue as predictors of objective-subjective discrepancies in cognitive function in multiple sclerosis. [Published online ahead of print January 31, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.055.

Higher baseline trait conscientiousness predicts slower rates of longitudinal cognitive decline in multiple sclerosis (MS), according to a recent study. Researchers conducted a retrospective analysis of 531 patients with MS whose data were gleaned from a multi-study database, aggregated over 16 years. Linear mixed effects modeling was applied to estimate the average rate of decline on Symbol Digit Modalities Test (SDMT) performance and to predict rates of decline using baseline clinical variables. They found:

• Participants exhibited an average estimated decline of 0.22 SDMT raw-score points/year.
• There was a significant main effect of time from baseline (t = −2.78), test form (t = 2.13), disease course (t = 2.91), age (t = −2.76), sex (t = −2.71), subjective cognitive impairment (t = −2.00), premorbid verbal intelligence (t = 5.14), and trait Conscientiousness (t = 2.69).
• A significant interaction emerged for Conscientiousness and time from baseline (t = 2.57).

Fuchs TA, Wojcik C, Wilding GE, et al. Trait Conscientiousness predicts rate of longitudinal SDMT decline in multiple sclerosis. [Published online ahead of print January 7, 2019]. Mult Scler. doi:10.1177%2F1352458518820272.

Higher baseline trait conscientiousness predicts slower rates of longitudinal cognitive decline in multiple sclerosis (MS), according to a recent study. Researchers conducted a retrospective analysis of 531 patients with MS whose data were gleaned from a multi-study database, aggregated over 16 years. Linear mixed effects modeling was applied to estimate the average rate of decline on Symbol Digit Modalities Test (SDMT) performance and to predict rates of decline using baseline clinical variables. They found:

• Participants exhibited an average estimated decline of 0.22 SDMT raw-score points/year.
• There was a significant main effect of time from baseline (t = −2.78), test form (t = 2.13), disease course (t = 2.91), age (t = −2.76), sex (t = −2.71), subjective cognitive impairment (t = −2.00), premorbid verbal intelligence (t = 5.14), and trait Conscientiousness (t = 2.69).
• A significant interaction emerged for Conscientiousness and time from baseline (t = 2.57).

Fuchs TA, Wojcik C, Wilding GE, et al. Trait Conscientiousness predicts rate of longitudinal SDMT decline in multiple sclerosis. [Published online ahead of print January 7, 2019]. Mult Scler. doi:10.1177%2F1352458518820272.

Higher baseline trait conscientiousness predicts slower rates of longitudinal cognitive decline in multiple sclerosis (MS), according to a recent study. Researchers conducted a retrospective analysis of 531 patients with MS whose data were gleaned from a multi-study database, aggregated over 16 years. Linear mixed effects modeling was applied to estimate the average rate of decline on Symbol Digit Modalities Test (SDMT) performance and to predict rates of decline using baseline clinical variables. They found:

• Participants exhibited an average estimated decline of 0.22 SDMT raw-score points/year.
• There was a significant main effect of time from baseline (t = −2.78), test form (t = 2.13), disease course (t = 2.91), age (t = −2.76), sex (t = −2.71), subjective cognitive impairment (t = −2.00), premorbid verbal intelligence (t = 5.14), and trait Conscientiousness (t = 2.69).
• A significant interaction emerged for Conscientiousness and time from baseline (t = 2.57).

Fuchs TA, Wojcik C, Wilding GE, et al. Trait Conscientiousness predicts rate of longitudinal SDMT decline in multiple sclerosis. [Published online ahead of print January 7, 2019]. Mult Scler. doi:10.1177%2F1352458518820272.

The prevalence of multiple sclerosis (MS) has increased substantially in many regions around the world since 1990, according to The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). These recent findings will be useful for resource allocation and planning in health services. Researchers assessed the epidemiology of MS from 1990 to 2016. Data on prevalence and deaths are summarized in the indicator, disability-adjusted life-years (DALYs), which was calculated as the sum of years of life lost (YLLs) and years of life lived with a disability. They found:

• In 2016, there were 2,221,188 prevalent cases of MS globally, which corresponded to a 10.4% increase in the age-standardized prevalence since 1990.
• The highest age-standardized MS prevalence estimates per 100,000 persons were in high-income North America (164.6), western Europe (127.0), and Australasia (91.1), and the lowest were in eastern sub-Saharan Africa (3.3), central sub-Saharan African (2.8), and Oceania (2.0).
• There were 18,932 deaths due to MS and 1,151,478 DALYs due to MS in 2016.
• Globally, age-standardized death rates decreased significantly (change −11.5%), whereas the change in age-standardized DALYs was not significant (−4.2%,).

GBD 2016 Multiple Sclerosis Collaborators. Global, regional, and national burden of multiple sclerosis 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(3):269-285. doi:10.1016/S1474-4422(18)30443-5.

The prevalence of multiple sclerosis (MS) has increased substantially in many regions around the world since 1990, according to The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). These recent findings will be useful for resource allocation and planning in health services. Researchers assessed the epidemiology of MS from 1990 to 2016. Data on prevalence and deaths are summarized in the indicator, disability-adjusted life-years (DALYs), which was calculated as the sum of years of life lost (YLLs) and years of life lived with a disability. They found:

• In 2016, there were 2,221,188 prevalent cases of MS globally, which corresponded to a 10.4% increase in the age-standardized prevalence since 1990.
• The highest age-standardized MS prevalence estimates per 100,000 persons were in high-income North America (164.6), western Europe (127.0), and Australasia (91.1), and the lowest were in eastern sub-Saharan Africa (3.3), central sub-Saharan African (2.8), and Oceania (2.0).
• There were 18,932 deaths due to MS and 1,151,478 DALYs due to MS in 2016.
• Globally, age-standardized death rates decreased significantly (change −11.5%), whereas the change in age-standardized DALYs was not significant (−4.2%,).

GBD 2016 Multiple Sclerosis Collaborators. Global, regional, and national burden of multiple sclerosis 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(3):269-285. doi:10.1016/S1474-4422(18)30443-5.

The prevalence of multiple sclerosis (MS) has increased substantially in many regions around the world since 1990, according to The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). These recent findings will be useful for resource allocation and planning in health services. Researchers assessed the epidemiology of MS from 1990 to 2016. Data on prevalence and deaths are summarized in the indicator, disability-adjusted life-years (DALYs), which was calculated as the sum of years of life lost (YLLs) and years of life lived with a disability. They found:

• In 2016, there were 2,221,188 prevalent cases of MS globally, which corresponded to a 10.4% increase in the age-standardized prevalence since 1990.
• The highest age-standardized MS prevalence estimates per 100,000 persons were in high-income North America (164.6), western Europe (127.0), and Australasia (91.1), and the lowest were in eastern sub-Saharan Africa (3.3), central sub-Saharan African (2.8), and Oceania (2.0).
• There were 18,932 deaths due to MS and 1,151,478 DALYs due to MS in 2016.
• Globally, age-standardized death rates decreased significantly (change −11.5%), whereas the change in age-standardized DALYs was not significant (−4.2%,).

GBD 2016 Multiple Sclerosis Collaborators. Global, regional, and national burden of multiple sclerosis 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(3):269-285. doi:10.1016/S1474-4422(18)30443-5.

Contrary to recent reports, resting core temperature is not elevated in patients with relapsing-remitting multiple sclerosis (RRMS) compared to healthy controls when measured using precision thermometry, according to a recent study. Furthermore, no association was observed between resting rectal temperature (T_re) and any subjective measures of fatigue in a subset of participants with MS. Across 2 international data collection sites (Sydney and Dallas), 28 RRMS patients and 27 aged-matched controls (CON) were exposed to either 30°C, 30% relative humidity (RH) (Sydney) or 25°C, 30% RH (Dallas). Resting T_re and esophageal (T_eso) temperature and resting oxygen consumption (VO₂) was measured in MS (n=28) and CON (n=27) groups who completed the 25°C and 30°C trials. Tympanic membrane (T_tym) temperature was measured in MS (n=16) and CON (n=15) groups in the 30°C condition. A modified fatigue impact scale (MFIS) questionnaire was used to assess subjective measures of psychosocial, physical, and cognitive fatigue in the 30°C condition. Researchers found:

• Irrespective of ambient temperature, no group differences were observed for T_re, T_eso, or resting VO₂.
• Similarly, no group differences were observed for T_tym in the 30°C condition.

Chaseling GK, Allen DR, Vucic S, et al. Core temperature is not elevated at rest in people with relapsing-remitting multiple sclerosis. [Published online ahead of print January 3, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.013.

Contrary to recent reports, resting core temperature is not elevated in patients with relapsing-remitting multiple sclerosis (RRMS) compared to healthy controls when measured using precision thermometry, according to a recent study. Furthermore, no association was observed between resting rectal temperature (T_re) and any subjective measures of fatigue in a subset of participants with MS. Across 2 international data collection sites (Sydney and Dallas), 28 RRMS patients and 27 aged-matched controls (CON) were exposed to either 30°C, 30% relative humidity (RH) (Sydney) or 25°C, 30% RH (Dallas). Resting T_re and esophageal (T_eso) temperature and resting oxygen consumption (VO₂) was measured in MS (n=28) and CON (n=27) groups who completed the 25°C and 30°C trials. Tympanic membrane (T_tym) temperature was measured in MS (n=16) and CON (n=15) groups in the 30°C condition. A modified fatigue impact scale (MFIS) questionnaire was used to assess subjective measures of psychosocial, physical, and cognitive fatigue in the 30°C condition. Researchers found:

• Irrespective of ambient temperature, no group differences were observed for T_re, T_eso, or resting VO₂.
• Similarly, no group differences were observed for T_tym in the 30°C condition.

Chaseling GK, Allen DR, Vucic S, et al. Core temperature is not elevated at rest in people with relapsing-remitting multiple sclerosis. [Published online ahead of print January 3, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.013.

Contrary to recent reports, resting core temperature is not elevated in patients with relapsing-remitting multiple sclerosis (RRMS) compared to healthy controls when measured using precision thermometry, according to a recent study. Furthermore, no association was observed between resting rectal temperature (T_re) and any subjective measures of fatigue in a subset of participants with MS. Across 2 international data collection sites (Sydney and Dallas), 28 RRMS patients and 27 aged-matched controls (CON) were exposed to either 30°C, 30% relative humidity (RH) (Sydney) or 25°C, 30% RH (Dallas). Resting T_re and esophageal (T_eso) temperature and resting oxygen consumption (VO₂) was measured in MS (n=28) and CON (n=27) groups who completed the 25°C and 30°C trials. Tympanic membrane (T_tym) temperature was measured in MS (n=16) and CON (n=15) groups in the 30°C condition. A modified fatigue impact scale (MFIS) questionnaire was used to assess subjective measures of psychosocial, physical, and cognitive fatigue in the 30°C condition. Researchers found:

• Irrespective of ambient temperature, no group differences were observed for T_re, T_eso, or resting VO₂.
• Similarly, no group differences were observed for T_tym in the 30°C condition.

Chaseling GK, Allen DR, Vucic S, et al. Core temperature is not elevated at rest in people with relapsing-remitting multiple sclerosis. [Published online ahead of print January 3, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.013.

Persons with multiple sclerosis (MS) who have greater disability exhibit higher body fat and lower bone tissue content and density than those with mild disability, a recent study found. Researchers conducted a cross-sectional investigation of 47 ambulatory persons with relapsing remitting MS who were grouped by Expanded Disability Status Scale (EDSS) scores as having mild (1.0‒4.0; n=26) or moderate (4.5‒6.5; n=21) disability. Main outcome measures were whole-body and regional soft tissue composition (%body fat [BF], fat mass [FM], and fat-free soft tissue mass [FFM]), bone mineral content (BMC), and bone mineral density (BMD). Other outcomes included physical fitness, mobility, cognitive processing speed, symptoms, and health-related quality of life (HRQOL). They found:

• Whole-body and regional %BF and FM were significantly higher, and whole-body and appendicular BMC and BMD were significantly lower in participants with moderate disability than those with mild disability.
• There were no significant differences in whole-body or regional FFM by disability status.
• In the overall sample, body fat correlated significantly with cardiorespiratory fitness, pain symptoms, and psychological HRQOL.
• FFM and BMC correlated primarily with measures of muscular strength.

Pilutti LA, Motl RW. Body composition and disability in people with multiple sclerosis: A dual-energy x-ray absorptiometry study. [Published online ahead of print January 3, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.009.

Persons with multiple sclerosis (MS) who have greater disability exhibit higher body fat and lower bone tissue content and density than those with mild disability, a recent study found. Researchers conducted a cross-sectional investigation of 47 ambulatory persons with relapsing remitting MS who were grouped by Expanded Disability Status Scale (EDSS) scores as having mild (1.0‒4.0; n=26) or moderate (4.5‒6.5; n=21) disability. Main outcome measures were whole-body and regional soft tissue composition (%body fat [BF], fat mass [FM], and fat-free soft tissue mass [FFM]), bone mineral content (BMC), and bone mineral density (BMD). Other outcomes included physical fitness, mobility, cognitive processing speed, symptoms, and health-related quality of life (HRQOL). They found:

• Whole-body and regional %BF and FM were significantly higher, and whole-body and appendicular BMC and BMD were significantly lower in participants with moderate disability than those with mild disability.
• There were no significant differences in whole-body or regional FFM by disability status.
• In the overall sample, body fat correlated significantly with cardiorespiratory fitness, pain symptoms, and psychological HRQOL.
• FFM and BMC correlated primarily with measures of muscular strength.

Pilutti LA, Motl RW. Body composition and disability in people with multiple sclerosis: A dual-energy x-ray absorptiometry study. [Published online ahead of print January 3, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.009.

Persons with multiple sclerosis (MS) who have greater disability exhibit higher body fat and lower bone tissue content and density than those with mild disability, a recent study found. Researchers conducted a cross-sectional investigation of 47 ambulatory persons with relapsing remitting MS who were grouped by Expanded Disability Status Scale (EDSS) scores as having mild (1.0‒4.0; n=26) or moderate (4.5‒6.5; n=21) disability. Main outcome measures were whole-body and regional soft tissue composition (%body fat [BF], fat mass [FM], and fat-free soft tissue mass [FFM]), bone mineral content (BMC), and bone mineral density (BMD). Other outcomes included physical fitness, mobility, cognitive processing speed, symptoms, and health-related quality of life (HRQOL). They found:

• Whole-body and regional %BF and FM were significantly higher, and whole-body and appendicular BMC and BMD were significantly lower in participants with moderate disability than those with mild disability.
• There were no significant differences in whole-body or regional FFM by disability status.
• In the overall sample, body fat correlated significantly with cardiorespiratory fitness, pain symptoms, and psychological HRQOL.
• FFM and BMC correlated primarily with measures of muscular strength.

Pilutti LA, Motl RW. Body composition and disability in people with multiple sclerosis: A dual-energy x-ray absorptiometry study. [Published online ahead of print January 3, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.01.009.

The prevalence of pseudobulbar affect (PBA) in multiple sclerosis (MS) is low, according to a recent study, but similar symptoms may co-occur or overlap with depression, highlighting the importance of concomitant assessment of mood when evaluating potential PBA. Furthermore, PBA may be associated with cognitive impairment in people with MS. North American Research Committee on MS (NARCOMS) registry participants completed the Center for Neurologic Study-Lability Scale (CNS-LS), a validated 7-question self-report measure of PBA. Researchers categorized individuals as PBA-positive (PBA[+]) if they had a composite score ≥17 without current depression. Participants also reported their demographic characteristics and their clinical characteristics using Patient-Determined Disease Steps and Performance Scales. They found:

• Of the 8,136 responders, 574 (7%) had scores ≥17 on the CNS-LS; however, only 200 (2.5%) individuals had scores ≥17 without comorbid depression, of whom only 22 (11%) reported a diagnosis of PBA.
• PBA(+) individuals tended to be younger (mean [SD] 53.4 [11.0] vs 57.2 [10.3] years), non-white (13% vs 9%), and have lower socioeconomic status (≤$30,000 annual income: 28% vs 22%).
• In multivariable models, PBA(+) was associated with increased odds of more severe cognitive impairment.

Fitzgerald KC, Salter A, Tyry T, Fox RJ, Cutter G, Marrie RA. Pseudobulbar affect.

Prevalence and association with symptoms in multiple sclerosis. Neurol Clin Pract. 2018;8(6):472-481. doi:10.1212/CPJ.0000000000000523.

The prevalence of pseudobulbar affect (PBA) in multiple sclerosis (MS) is low, according to a recent study, but similar symptoms may co-occur or overlap with depression, highlighting the importance of concomitant assessment of mood when evaluating potential PBA. Furthermore, PBA may be associated with cognitive impairment in people with MS. North American Research Committee on MS (NARCOMS) registry participants completed the Center for Neurologic Study-Lability Scale (CNS-LS), a validated 7-question self-report measure of PBA. Researchers categorized individuals as PBA-positive (PBA[+]) if they had a composite score ≥17 without current depression. Participants also reported their demographic characteristics and their clinical characteristics using Patient-Determined Disease Steps and Performance Scales. They found:

• Of the 8,136 responders, 574 (7%) had scores ≥17 on the CNS-LS; however, only 200 (2.5%) individuals had scores ≥17 without comorbid depression, of whom only 22 (11%) reported a diagnosis of PBA.
• PBA(+) individuals tended to be younger (mean [SD] 53.4 [11.0] vs 57.2 [10.3] years), non-white (13% vs 9%), and have lower socioeconomic status (≤$30,000 annual income: 28% vs 22%).
• In multivariable models, PBA(+) was associated with increased odds of more severe cognitive impairment.

Fitzgerald KC, Salter A, Tyry T, Fox RJ, Cutter G, Marrie RA. Pseudobulbar affect.

Prevalence and association with symptoms in multiple sclerosis. Neurol Clin Pract. 2018;8(6):472-481. doi:10.1212/CPJ.0000000000000523.

The prevalence of pseudobulbar affect (PBA) in multiple sclerosis (MS) is low, according to a recent study, but similar symptoms may co-occur or overlap with depression, highlighting the importance of concomitant assessment of mood when evaluating potential PBA. Furthermore, PBA may be associated with cognitive impairment in people with MS. North American Research Committee on MS (NARCOMS) registry participants completed the Center for Neurologic Study-Lability Scale (CNS-LS), a validated 7-question self-report measure of PBA. Researchers categorized individuals as PBA-positive (PBA[+]) if they had a composite score ≥17 without current depression. Participants also reported their demographic characteristics and their clinical characteristics using Patient-Determined Disease Steps and Performance Scales. They found:

• Of the 8,136 responders, 574 (7%) had scores ≥17 on the CNS-LS; however, only 200 (2.5%) individuals had scores ≥17 without comorbid depression, of whom only 22 (11%) reported a diagnosis of PBA.
• PBA(+) individuals tended to be younger (mean [SD] 53.4 [11.0] vs 57.2 [10.3] years), non-white (13% vs 9%), and have lower socioeconomic status (≤$30,000 annual income: 28% vs 22%).
• In multivariable models, PBA(+) was associated with increased odds of more severe cognitive impairment.

Fitzgerald KC, Salter A, Tyry T, Fox RJ, Cutter G, Marrie RA. Pseudobulbar affect.

Prevalence and association with symptoms in multiple sclerosis. Neurol Clin Pract. 2018;8(6):472-481. doi:10.1212/CPJ.0000000000000523.

Altered thalamo-hippocampal resting state functional brain connectivity may serve as a biomarker to signal treatment resistance in patients with temporal lobe epilepsy (TLE) suggests a recent study of 286 patients with epilepsy.

• Researchers from Rockefeller University reviewed data from a database that included resting state functional MRI readings.
• The analysis included seizure characterization, EEG indications of lateralization, and localization of seizure foci.
• The investigators compared records from patients with well-controlled TLE to those with treatment resistant disease and healthy controls.
• Treatment resistant patients had a significant bilateral decrease in thalamo-hippocampal functional connectivity.

Pressl C, Brandner P, Schaffelhofer S, et al. Resting state functional connectivity patterns associated with pharmacological treatment resistance in temporal lobe epilepsy. Epilepsy Res. 2019;149:37-43.

Altered thalamo-hippocampal resting state functional brain connectivity may serve as a biomarker to signal treatment resistance in patients with temporal lobe epilepsy (TLE) suggests a recent study of 286 patients with epilepsy.

• Researchers from Rockefeller University reviewed data from a database that included resting state functional MRI readings.
• The analysis included seizure characterization, EEG indications of lateralization, and localization of seizure foci.
• The investigators compared records from patients with well-controlled TLE to those with treatment resistant disease and healthy controls.
• Treatment resistant patients had a significant bilateral decrease in thalamo-hippocampal functional connectivity.

Pressl C, Brandner P, Schaffelhofer S, et al. Resting state functional connectivity patterns associated with pharmacological treatment resistance in temporal lobe epilepsy. Epilepsy Res. 2019;149:37-43.

Altered thalamo-hippocampal resting state functional brain connectivity may serve as a biomarker to signal treatment resistance in patients with temporal lobe epilepsy (TLE) suggests a recent study of 286 patients with epilepsy.

• Researchers from Rockefeller University reviewed data from a database that included resting state functional MRI readings.
• The analysis included seizure characterization, EEG indications of lateralization, and localization of seizure foci.
• The investigators compared records from patients with well-controlled TLE to those with treatment resistant disease and healthy controls.
• Treatment resistant patients had a significant bilateral decrease in thalamo-hippocampal functional connectivity.

Pressl C, Brandner P, Schaffelhofer S, et al. Resting state functional connectivity patterns associated with pharmacological treatment resistance in temporal lobe epilepsy. Epilepsy Res. 2019;149:37-43.

Delaying the first dose of antiseizure medication in children with status epilepticus will likely prolong the condition, according a report published in Epilepsy Research.

• Investigators from the Division of Child Neurology at Children’s National Health System in Washington, DC, evaluated the timing and selection of antiseizure medication in children presenting at a pediatric emergency department.
• Among 141 patients with status epilepticus (SE), median age 45 months, SE lasted 61.5 min (median).
• Median time to receipt of the first dose of antiseizure drug was 25 min.
• Ninety two percent of patients received a benzodiazepine as the first drug.
• A benzodiazepine was the second dose antiseizure medication in 95% of patients.
• Among patients who received the first dose of medication in less than 5 minutes, seizures lasted 59.5 min (median) while children who did not receive their first dose for an hour or more after seizure experienced a duration of 151.5 min.

Cohen NT, Chamberlain JM, Gaillard WD. Timing and selection of first antiseizure medication in patients with pediatric status epilepticus. Epilepsy Res. 2019;149:21-25.

Delaying the first dose of antiseizure medication in children with status epilepticus will likely prolong the condition, according a report published in Epilepsy Research.

• Investigators from the Division of Child Neurology at Children’s National Health System in Washington, DC, evaluated the timing and selection of antiseizure medication in children presenting at a pediatric emergency department.
• Among 141 patients with status epilepticus (SE), median age 45 months, SE lasted 61.5 min (median).
• Median time to receipt of the first dose of antiseizure drug was 25 min.
• Ninety two percent of patients received a benzodiazepine as the first drug.
• A benzodiazepine was the second dose antiseizure medication in 95% of patients.
• Among patients who received the first dose of medication in less than 5 minutes, seizures lasted 59.5 min (median) while children who did not receive their first dose for an hour or more after seizure experienced a duration of 151.5 min.

Cohen NT, Chamberlain JM, Gaillard WD. Timing and selection of first antiseizure medication in patients with pediatric status epilepticus. Epilepsy Res. 2019;149:21-25.

Delaying the first dose of antiseizure medication in children with status epilepticus will likely prolong the condition, according a report published in Epilepsy Research.

• Investigators from the Division of Child Neurology at Children’s National Health System in Washington, DC, evaluated the timing and selection of antiseizure medication in children presenting at a pediatric emergency department.
• Among 141 patients with status epilepticus (SE), median age 45 months, SE lasted 61.5 min (median).
• Median time to receipt of the first dose of antiseizure drug was 25 min.
• Ninety two percent of patients received a benzodiazepine as the first drug.
• A benzodiazepine was the second dose antiseizure medication in 95% of patients.
• Among patients who received the first dose of medication in less than 5 minutes, seizures lasted 59.5 min (median) while children who did not receive their first dose for an hour or more after seizure experienced a duration of 151.5 min.

Cohen NT, Chamberlain JM, Gaillard WD. Timing and selection of first antiseizure medication in patients with pediatric status epilepticus. Epilepsy Res. 2019;149:21-25.