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Update: Review of multiple sclerosis
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Abstracts / Journal of the Neurological Sciences 405S (2019) 116542
Introduction In CLARITY, cladribine tablets 10 mg, (cumulative dose 3.5 mg/kg [CT3.5] over 2 years [yrs]) were efficacious versus placebo in patients with relapsing multiple sclerosis (RMS). This was maintained without further treatment in CLARITY Extension. The effect of CT3.5 was evaluated in patients with RMS aged N45 and ≤ 45 yrs. Methods CT3.5 and placebo treatment groups of CLARITY were stratified according to age (≤45 and N 45 yrs). Efficacy endpoints were qualifying relapse, all relapses, and MRI parameters. Equivalent analyses were conducted for patients who received CT3.5 in CLARITY and placebo in CLARITY Extension. Results In CLARITY, 649 patients were ≤ 45 yrs. (CT3.5 N = 330; mean age 34 yrs) and 221 were N 45 yrs. (CT3.5 N = 103; mean age 52 yrs). Annualised qualifying relapse rate (ARR) comparison at Week 96 showed that CT3.5 was associated with significant relative risk reduction versus placebo in both age groups. ‘All relapse’ data were comparable for the same age groups, respectively. Numbers of cumulative new T1 Gd + lesions at Week 96 were reduced with CT3.5 compared to placebo in both age groups. Mean numbers of active T2 lesions per patient per scan at Week 96 were also significantly reduced with CT3.5 versus placebo in both age groups (≤45 yrs.: −0.667 [95%CI −0.67, −0.50], p b .0001; N45 yrs.: -0.167 [95%CI -0.33, 0.00], p b .0001), as were mean numbers of CU lesions. CLARITY Extension: mean numbers of qualifying relapses in patients ≤45 yrs. (N = 76) and N 45 yrs. (N = 22) were 0.30 and 0.09, respectively. Conclusions CT3.5 reduced relapse and MRI lesion frequency in patients aged ≤45 yrs. and N 45 yrs. The CLARITY study: NCT00213135 The CLARITY Extension study: NCT00641537 doi:10.1016/j.jns.2019.10.1122
vitamin D is 30–60 ng/ml (60–100 ng/ml for patients with multiple sclerosis). Objectives To correlate the level of serum vitamin D in multiple sclerosis patients from Benghazi Multiple Sclerosis Clinics at BMC to their score of disability using the Extended Disability Status Scale (EDSS). Methods Relying on the BMC Multiple Sclerosis Clinic Questionnaire and patient records we collected the levels of vitamin D and EDSS scores from 50 prospectively clinically reviewed patients. All the patients were taking disease modifying agents. The questionnaire has medical ethics approval. Word Excel was used for the graphs and statistical analysis. Results 39 patients were female and 11 male. Age ranged 17-63 years. The mean age was 37 years. The mean vitamin D level in both genders was 15.7 ng/ml, (females 16.1 ng/ml, and males 14.5 ng/ml). The mean EDSS score in both genders was 3.76 (females 3.71, males 3.95). Conclusion Patients in Benghazi have significantly lower than recommended levels of vitamin D, and this correlated with a significant degree of disability suggestive of secondary progressive disease. We highlight this as a target for future nationwide campaigns and recommend vitamin D supplementation added to multiple sclerosis treatment. Keywords: Vitamin D level, EDSS score, Multiple sclerosis, Benghazi, Libya doi:10.1016/j.jns.2019.10.1123
WCN19-0040 Journal of the Neurological Sciences 405S (2019) 104786
WCN19-0039 Journal of the Neurological Sciences 405S (2019) 104785 Poster Session 3 A prospective correlation study of the serum level of vitamin D to the EDSS score in patients with multiple sclerosis in Benghazi, Libya H.A. El-Zawawi Benghazi Medical Center, Neurological Medicine, Benghazi, Libya Background Vitamin D has been linked to the aetiology of several autoimmune diseases including multiple sclerosis. In 2016 all patients diagnosed with multiple sclerosis in Eastern and other parts of Libya were directed to an organized, database and treatment public sector funded central clinic at BMC. The normal range of serum levels of
Poster Session 3 Update: Review of multiple sclerosis H.A. El-Zawawi Benghazi Medical Center, Neurological Medicine, Benghazi, Libya Background Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system the aetiology of which remains so far unknown and which probably involves: genetic, immune, inflammatory, as well as environmental factors. Objectives A review of the current and past literature on multiple sclerosis to provide a concise and comprehensive educational resource. The aim being to present a simplified and clinically relevant summary of the main manifestations, and management of multiple sclerosis, with an update on current theories of pathophysiology, aetiology; and the basis behind the therapeutic agents used in current clinical practice.
Abstracts / Journal of the Neurological Sciences 405S (2019) 116542
Methods The standard medical texts and journals relating to MS were consulted as well as reliance on own experience of patients attending the teaching hospitals, and clinics in Benghazi Libya with a diagnosis of multiple sclerosis. Local and worldwide epidemiological published data were also reviewed. Results The incidence of multiple sclerosis varies worldwide. Eastern Libya is an area of high risk MS incidence. The importance is emerging of a genetic role in the already known immune pathogenesis of multiple sclerosis. Diet and light have regained importance in the aetiology of the disease. Investigations are advancing and help to differentiate the disease from other mimicking conditions. Biomarkers help to define diagnosis and determine prognosis. Conclusions Multiple sclerosis is an important neurological disease with protean CNS manifestations which must be considered in the differential diagnosis of neurological symptoms at all ages. Keywords: Multiple sclerosis, Pathophysiology, Clinical presentation, Management
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were associated with the presence of RBD. The most common dream phenomenon was fighting with human. The report of sleep-related injuries showed an injury to the patient was 16.3% an injury to bed partner was 6.1%. Conclusion We found that the prevalence of RBD in PD was 35% along with male gender, disease duration and disease severity may be the risk factors in our study. The dream content of RBD seemed to be passive or defending the attack rather than attack to the others. doi:10.1016/j.jns.2019.10.1125
WCN19-0077 Journal of the Neurological Sciences 405S (2019) 104788 Poster Session 3 Impact of a high fructose diet in wistar rat – Metabolic and behavioral disorders – Effect of supplementation of flaxseed
doi:10.1016/j.jns.2019.10.1124 H. Elkaoui University Ibn Tofail, Biology, Kenitra, Morocco
WCN19-0067 Journal of the Neurological Sciences 405S (2019) 104787 Poster Session 3 Rapid eye movement sleep behavior disorder in Parkinson’s disease H. Tohma-Ngee Taksin Hospital, Brain and Cerebrovascular Center, Bangkok, Thailand Objective To determine the prevalence of REM sleep behavior disorder (RBD) in patients with Parkinson’s disease and ascertain the clinical characteristics and risk factors associated with RBD. Method We enrolled subjects with Parkinson’s disease who visited in neurology clinic at Prasart neurological institute from 1st January to 31st December, 2017. Subjects and bed partner were interviewed with Mayo Sleep Questionnaire to ascertain RBD and obtained all demographic data and non-motor symptoms. The patients who were confirmed to have RBD were later interviewed regarding the dream content. Results Forty-nine patients out of 140 PD patients (35%) in our cohort were defined as RBD. Patients with RBD were male predominance (53 vs 37; p = 0.042), longer disease duration (7.4 vs 5.2; p = 0.003), higher scores of the modified H&Y stage, higher scores of the UPDRS part III (31.0 vs 18.0; P b 0.001), and higher dose of total LEDD (765.0 vs 426.0; P b 0.001). Non-motor symptoms were statistically significance in group of PD with RBD. Logistic regression analysis showed only male gender and non-motor questionnaire
Background The deregulation of the energy balance by the malnutrition leads to the dysfunction of the neuro- The metabolic mechanisms but these homeostatic problems can be corrected by nutritional supplements. In this study, we investigated the effects of flaxseed on metabolism and anxiety- depressive-like disorders in high fructosefed (23%) Wistar rat. Methods One-month-old female Wistar rats were divided into four groups of six rats: 1. Control: (30 g of standard food + 30 ml of tap water), 2. Control supplemented with flaxseed (27 g standard food + 7 g flaxseed + 30 ml tap water) 3. Fructose (30 g standard food + 23% fructose) 4. Fructose supplemented with flaxseed (23 g standard food + 7gflaxseed + 23% fructose), after two months of diet, the rats underwent a battery of tests to evaluate the affective behavior (Open Field, Elevated Plus Maze and Forced Swimming Test) and biochemical analyzes of glucose, cholesterol and triglycerides. Results High fructose diet inducesadverse metabolic effects (increases blood sugar, cholesterol, triglycerides) and behavioral ones (depression). Forflaxseed, it does not correct anxiety, but decreases depression-like and metabolic disorders. Conclusion Our results suggest that a high fructose diet induces metabolic and behavioral dysfunctions. Flaxseeds have improved these conditions. Keywords: Flaxseed, Fructose, Wistar rat, Metabolic disorders, Affective behavior
doi:10.1016/j.jns.2019.10.1126
Abstracts / Journal of the Neurological Sciences 405S (2019) 116542
Introduction In CLARITY, cladribine tablets 10 mg, (cumulative dose 3.5 mg/kg [CT3.5] over 2 years [yrs]) were efficacious versus placebo in patients with relapsing multiple sclerosis (RMS). This was maintained without further treatment in CLARITY Extension. The effect of CT3.5 was evaluated in patients with RMS aged N45 and ≤ 45 yrs. Methods CT3.5 and placebo treatment groups of CLARITY were stratified according to age (≤45 and N 45 yrs). Efficacy endpoints were qualifying relapse, all relapses, and MRI parameters. Equivalent analyses were conducted for patients who received CT3.5 in CLARITY and placebo in CLARITY Extension. Results In CLARITY, 649 patients were ≤ 45 yrs. (CT3.5 N = 330; mean age 34 yrs) and 221 were N 45 yrs. (CT3.5 N = 103; mean age 52 yrs). Annualised qualifying relapse rate (ARR) comparison at Week 96 showed that CT3.5 was associated with significant relative risk reduction versus placebo in both age groups. ‘All relapse’ data were comparable for the same age groups, respectively. Numbers of cumulative new T1 Gd + lesions at Week 96 were reduced with CT3.5 compared to placebo in both age groups. Mean numbers of active T2 lesions per patient per scan at Week 96 were also significantly reduced with CT3.5 versus placebo in both age groups (≤45 yrs.: −0.667 [95%CI −0.67, −0.50], p b .0001; N45 yrs.: -0.167 [95%CI -0.33, 0.00], p b .0001), as were mean numbers of CU lesions. CLARITY Extension: mean numbers of qualifying relapses in patients ≤45 yrs. (N = 76) and N 45 yrs. (N = 22) were 0.30 and 0.09, respectively. Conclusions CT3.5 reduced relapse and MRI lesion frequency in patients aged ≤45 yrs. and N 45 yrs. The CLARITY study: NCT00213135 The CLARITY Extension study: NCT00641537 doi:10.1016/j.jns.2019.10.1122
vitamin D is 30–60 ng/ml (60–100 ng/ml for patients with multiple sclerosis). Objectives To correlate the level of serum vitamin D in multiple sclerosis patients from Benghazi Multiple Sclerosis Clinics at BMC to their score of disability using the Extended Disability Status Scale (EDSS). Methods Relying on the BMC Multiple Sclerosis Clinic Questionnaire and patient records we collected the levels of vitamin D and EDSS scores from 50 prospectively clinically reviewed patients. All the patients were taking disease modifying agents. The questionnaire has medical ethics approval. Word Excel was used for the graphs and statistical analysis. Results 39 patients were female and 11 male. Age ranged 17-63 years. The mean age was 37 years. The mean vitamin D level in both genders was 15.7 ng/ml, (females 16.1 ng/ml, and males 14.5 ng/ml). The mean EDSS score in both genders was 3.76 (females 3.71, males 3.95). Conclusion Patients in Benghazi have significantly lower than recommended levels of vitamin D, and this correlated with a significant degree of disability suggestive of secondary progressive disease. We highlight this as a target for future nationwide campaigns and recommend vitamin D supplementation added to multiple sclerosis treatment. Keywords: Vitamin D level, EDSS score, Multiple sclerosis, Benghazi, Libya doi:10.1016/j.jns.2019.10.1123
WCN19-0040 Journal of the Neurological Sciences 405S (2019) 104786
WCN19-0039 Journal of the Neurological Sciences 405S (2019) 104785 Poster Session 3 A prospective correlation study of the serum level of vitamin D to the EDSS score in patients with multiple sclerosis in Benghazi, Libya H.A. El-Zawawi Benghazi Medical Center, Neurological Medicine, Benghazi, Libya Background Vitamin D has been linked to the aetiology of several autoimmune diseases including multiple sclerosis. In 2016 all patients diagnosed with multiple sclerosis in Eastern and other parts of Libya were directed to an organized, database and treatment public sector funded central clinic at BMC. The normal range of serum levels of
Poster Session 3 Update: Review of multiple sclerosis H.A. El-Zawawi Benghazi Medical Center, Neurological Medicine, Benghazi, Libya Background Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system the aetiology of which remains so far unknown and which probably involves: genetic, immune, inflammatory, as well as environmental factors. Objectives A review of the current and past literature on multiple sclerosis to provide a concise and comprehensive educational resource. The aim being to present a simplified and clinically relevant summary of the main manifestations, and management of multiple sclerosis, with an update on current theories of pathophysiology, aetiology; and the basis behind the therapeutic agents used in current clinical practice.
Abstracts / Journal of the Neurological Sciences 405S (2019) 116542
Methods The standard medical texts and journals relating to MS were consulted as well as reliance on own experience of patients attending the teaching hospitals, and clinics in Benghazi Libya with a diagnosis of multiple sclerosis. Local and worldwide epidemiological published data were also reviewed. Results The incidence of multiple sclerosis varies worldwide. Eastern Libya is an area of high risk MS incidence. The importance is emerging of a genetic role in the already known immune pathogenesis of multiple sclerosis. Diet and light have regained importance in the aetiology of the disease. Investigations are advancing and help to differentiate the disease from other mimicking conditions. Biomarkers help to define diagnosis and determine prognosis. Conclusions Multiple sclerosis is an important neurological disease with protean CNS manifestations which must be considered in the differential diagnosis of neurological symptoms at all ages. Keywords: Multiple sclerosis, Pathophysiology, Clinical presentation, Management
179
were associated with the presence of RBD. The most common dream phenomenon was fighting with human. The report of sleep-related injuries showed an injury to the patient was 16.3% an injury to bed partner was 6.1%. Conclusion We found that the prevalence of RBD in PD was 35% along with male gender, disease duration and disease severity may be the risk factors in our study. The dream content of RBD seemed to be passive or defending the attack rather than attack to the others. doi:10.1016/j.jns.2019.10.1125
WCN19-0077 Journal of the Neurological Sciences 405S (2019) 104788 Poster Session 3 Impact of a high fructose diet in wistar rat – Metabolic and behavioral disorders – Effect of supplementation of flaxseed
doi:10.1016/j.jns.2019.10.1124 H. Elkaoui University Ibn Tofail, Biology, Kenitra, Morocco
WCN19-0067 Journal of the Neurological Sciences 405S (2019) 104787 Poster Session 3 Rapid eye movement sleep behavior disorder in Parkinson’s disease H. Tohma-Ngee Taksin Hospital, Brain and Cerebrovascular Center, Bangkok, Thailand Objective To determine the prevalence of REM sleep behavior disorder (RBD) in patients with Parkinson’s disease and ascertain the clinical characteristics and risk factors associated with RBD. Method We enrolled subjects with Parkinson’s disease who visited in neurology clinic at Prasart neurological institute from 1st January to 31st December, 2017. Subjects and bed partner were interviewed with Mayo Sleep Questionnaire to ascertain RBD and obtained all demographic data and non-motor symptoms. The patients who were confirmed to have RBD were later interviewed regarding the dream content. Results Forty-nine patients out of 140 PD patients (35%) in our cohort were defined as RBD. Patients with RBD were male predominance (53 vs 37; p = 0.042), longer disease duration (7.4 vs 5.2; p = 0.003), higher scores of the modified H&Y stage, higher scores of the UPDRS part III (31.0 vs 18.0; P b 0.001), and higher dose of total LEDD (765.0 vs 426.0; P b 0.001). Non-motor symptoms were statistically significance in group of PD with RBD. Logistic regression analysis showed only male gender and non-motor questionnaire
Background The deregulation of the energy balance by the malnutrition leads to the dysfunction of the neuro- The metabolic mechanisms but these homeostatic problems can be corrected by nutritional supplements. In this study, we investigated the effects of flaxseed on metabolism and anxiety- depressive-like disorders in high fructosefed (23%) Wistar rat. Methods One-month-old female Wistar rats were divided into four groups of six rats: 1. Control: (30 g of standard food + 30 ml of tap water), 2. Control supplemented with flaxseed (27 g standard food + 7 g flaxseed + 30 ml tap water) 3. Fructose (30 g standard food + 23% fructose) 4. Fructose supplemented with flaxseed (23 g standard food + 7gflaxseed + 23% fructose), after two months of diet, the rats underwent a battery of tests to evaluate the affective behavior (Open Field, Elevated Plus Maze and Forced Swimming Test) and biochemical analyzes of glucose, cholesterol and triglycerides. Results High fructose diet inducesadverse metabolic effects (increases blood sugar, cholesterol, triglycerides) and behavioral ones (depression). Forflaxseed, it does not correct anxiety, but decreases depression-like and metabolic disorders. Conclusion Our results suggest that a high fructose diet induces metabolic and behavioral dysfunctions. Flaxseeds have improved these conditions. Keywords: Flaxseed, Fructose, Wistar rat, Metabolic disorders, Affective behavior
doi:10.1016/j.jns.2019.10.1126