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Neurology International
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Advances in Multiple Sclerosis
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Advances in Multiple Sclerosis

A special issue of Neurology International (ISSN 2035-8377).

Deadline for manuscript submissions: closed (31 March 2022) | Viewed by 20427

Special Issue Editor

Dr. Marcello Moccia

E-Mail Website
Guest Editor
Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, 80131 Naples, Italy
Interests: multiple sclerosis; biomarkers; neurorehabilitation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Over recent years, we have reshaped multiple sclerosis (MS) management thanks to advances in clinical, epidemiology, and biomarker studies. Clinical trials, epidemiological studies, real-world experiences, and case reports have shed light on different aspects of the disease burden, and have showed therapeutic potential (and side effects) of both novel and already existing medications, targeting both disease symptoms and its pathology mechanisms. A number of biomarkers have been developed, tested, and validated in clinical, laboratory, neuroimaging, and neurophysiology studies, including cognitive tests, neuroimmunology measures, and conventional and advanced MRI methods, and have been a milestone in better understanding and treating MS. Not least of which, in light of such advances, costs for MS management are now very much of interest for both national healthcare systems and insurance companies.

This Special Issue aims to contribute to filling knowledge gaps in the MS field. Reviews, full papers, short communications, and case reports are equally welcome, if providing readers with novel insights on MS clinical features, treatments, epidemiology, pharmacoeconomics, and biomarkers (e.g., laboratory, neuroimaging, neurophysiology).

Dr. Marcello Moccia
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Neurology International is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Multiple sclerosis
  • Clinical
  • Treatment
  • Cognition
  • Biomarkers
  • Neuroimmunology
  • Neuroimaging

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Published Papers (6 papers)

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Research

Jump to: Review, Other

10 pages, 301 KiB  
Article
Examining the Clinical Utility of Selected Memory-Based Embedded Performance Validity Tests in Neuropsychological Assessment of Patients with Multiple Sclerosis
by John W. Lace, Zachary C. Merz and Rachel Galioto
Neurol. Int. 2021, 13(4), 477-486; https://doi.org/10.3390/neurolint13040047 - 23 Sep 2021
Cited by 1 | Viewed by 3161
Abstract
Within the neuropsychological assessment, clinicians are responsible for ensuring the validity of obtained cognitive data. As such, increased attention is being paid to performance validity in patients with multiple sclerosis (pwMS). Experts have proposed batteries of neuropsychological tests for use in this population, [...] Read more.
Within the neuropsychological assessment, clinicians are responsible for ensuring the validity of obtained cognitive data. As such, increased attention is being paid to performance validity in patients with multiple sclerosis (pwMS). Experts have proposed batteries of neuropsychological tests for use in this population, though none contain recommendations for standalone performance validity tests (PVTs). The California Verbal Learning Test, Second Edition (CVLT-II) and Brief Visuospatial Memory Test, Revised (BVMT-R)—both of which are included in the aforementioned recommended neuropsychological batteries—include previously validated embedded PVTs (which offer some advantages, including expedience and reduced costs), with no prior work exploring their utility in pwMS. The purpose of the present study was to determine the potential clinical utility of embedded PVTs to detect the signal of non-credibility as operationally defined by below criterion standalone PVT performance. One hundred thirty-three (133) patients (M age = 48.28; 76.7% women; 85.0% White) with MS were referred for neuropsychological assessment at a large, Midwestern academic medical center. Patients were placed into “credible” (n = 100) or “noncredible” (n = 33) groups based on a standalone PVT criterion. Classification statistics for four CVLT-II and BVMT-R PVTs of interest in isolation were poor (AUCs = 0.58–0.62). Several arithmetic and logistic regression-derived multivariate formulas were calculated, all of which similarly demonstrated poor discriminability (AUCs = 0.61–0.64). Although embedded PVTs may arguably maximize efficiency and minimize test burden in pwMS, common ones in the CVLT-II and BVMT-R may not be psychometrically appropriate, sufficiently sensitive, nor substitutable for standalone PVTs in this population. Clinical neuropsychologists who evaluate such patients are encouraged to include standalone PVTs in their assessment batteries to ensure that clinical care conclusions drawn from neuropsychological data are valid. Full article
(This article belongs to the Special Issue Advances in Multiple Sclerosis)
8 pages, 280 KiB  
Article
Cognitive Dysfunction in Multiple Sclerosis: Educational Level as a Protective Factor
by Mar Estrada-López, Sheila García-Martín and Isabel Cantón-Mayo
Neurol. Int. 2021, 13(3), 335-342; https://doi.org/10.3390/neurolint13030034 - 22 Jul 2021
Cited by 6 | Viewed by 2674
Abstract
Most people with MS experience cognitive deficits especially in attention, memory, information processing, and executive functions, negatively impacting on their quality of life. Cognitive variables of short-term memory, logical memory, and verbal fluency in 65 patients with multiple sclerosis (MS) were analysed in [...] Read more.
Most people with MS experience cognitive deficits especially in attention, memory, information processing, and executive functions, negatively impacting on their quality of life. Cognitive variables of short-term memory, logical memory, and verbal fluency in 65 patients with multiple sclerosis (MS) were analysed in conjunction with sociodemographic variables such as sex, age, and educational level that might influence disease progression. We found that psychoeducational variables exerted a significant effect on the cognitive status of patients with MS. Thus, when considering sex, age, educational level, and type of MS (SPMS or RRMS), tests for between-subject effects revealed statistically significant differences in all three cognitive variables. In addition, we found that the type of MS and time since onset also generated significant cognitive differences. Our study shows that educational achievement or level is a protective factor against the disease, acting as a source of intellectual enrichment that promotes cognitive reserve in patients with MS. Further longitudinal studies assessing disease progression and prognosis in patients with MS would be useful in order to determine the specific importance of these variables in such patients and in strategies that could enhance their performance in neuropsychological assessment tasks. Full article
(This article belongs to the Special Issue Advances in Multiple Sclerosis)

Review

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10 pages, 274 KiB  
Review
Multiple Sclerosis Treatment in the COVID-19 Era: A Risk-Benefit Approach
by Paolo Immovilli, Nicola Morelli, Chiara Terracciano, Eugenia Rota, Elena Marchesi, Stefano Vollaro, Paola De Mitri, Domenica Zaino, Veronica Bazzurri and Donata Guidetti
Neurol. Int. 2022, 14(2), 368-377; https://doi.org/10.3390/neurolint14020030 - 15 Apr 2022
Cited by 6 | Viewed by 3016
Abstract
The COVID-19 pandemic poses an ongoing global challenge, and several risk factors make people with multiple sclerosis (pwMS) particularly susceptible to running a severe disease course. Although the literature does report numerous articles on the risk factors for severe COVID-19 and vaccination response [...] Read more.
The COVID-19 pandemic poses an ongoing global challenge, and several risk factors make people with multiple sclerosis (pwMS) particularly susceptible to running a severe disease course. Although the literature does report numerous articles on the risk factors for severe COVID-19 and vaccination response in pwMS, there is a scarcity of reviews integrating both these aspects into strategies aimed at minimizing risks. The aim of this review is to describe the risk of vulnerable pwMS exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the issues related to the SARS-CoV-2 vaccine and to evidence possible future strategies in the clinical management of pwMS. The authors searched for papers on severe COVID-19 risk factors, SARS-CoV-2 vaccination and people with multiple sclerosis in support of this narrative literature review. We propose a multilevel strategy aimed at: the evaluation of risk factors for severe COVID-19 in people with multiple sclerosis, identifying the most appropriate vaccination schedule that is safe for people on disease-modifying drugs (DMDs) and a strict follow-up of high-risk people with multiple sclerosis to allow for the prompt administration of monoclonal antibodies to manage COVID-19 risks in this patient population. Full article
(This article belongs to the Special Issue Advances in Multiple Sclerosis)
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Other

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10 pages, 6231 KiB  
Case Report
Neuroimaging and CSF Findings in Patients with Autoimmune Encephalitis: A Report of Eight Cases in a Single Academic Center
by Hongyan Wu, Hongxuyang Yu, Joe Joseph, Shruti Jaiswal, Shreya R. Pasham and Shitiz Sriwastava
Neurol. Int. 2022, 14(1), 176-185; https://doi.org/10.3390/neurolint14010014 - 28 Jan 2022
Cited by 4 | Viewed by 4616
Abstract
Autoimmune Encephalitis (AIE) is a rare and complex group of disorders wherein the body’s immune system attacks and causes inflammatory changes in the central nervous system (CNS). It presents with altered mental status and a diverse range of typical and atypical symptoms and [...] Read more.
Autoimmune Encephalitis (AIE) is a rare and complex group of disorders wherein the body’s immune system attacks and causes inflammatory changes in the central nervous system (CNS). It presents with altered mental status and a diverse range of typical and atypical symptoms and neuroimaging and cerebrospinal fluid (CSF) findings. The objective of this article is to highlight the importance of early identification of neurological symptoms, prompt diagnosis with neuroimaging and CSF findings, and timely management for early and complete resolution of the disease and long-term benefits. We report eight AIE cases from a single academic center confirmed by the presence of specific serum and CSF autoantibodies. The patients were mostly women, with imaging findings showing T2-weighted (T2), fluid-attenuated inversion recovery (FLAIR), hyperintensities/changes in cortical/mesio-temporal regions on a magnetic resonance imaging (MRI), and delta brush wave patterns or epileptogenic patterns on an electroencephalogram (EEG). Among the antibodies, the N-methyl-D-aspartate receptor (NMDA-R) antibody (AB) was most frequently identified, and CSF lymphocytosis and elevated CSF glucose were found in majority of the cases, CSF pleocytosis and elevated protein only in a minority of patients, and oligoclonal bands (OCBs) only in NMDA-R encephalitis. Early treatment with intravenous immune globulin (IVIG), steroids, plasmapheresis (PLEX), and rituximab was started in most cases, and all of them responded well and survived, but some had residual symptoms or relapses. Full article
(This article belongs to the Special Issue Advances in Multiple Sclerosis)
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6 pages, 634 KiB  
Case Report
Clinical Onset and Multiple Sclerosis Relapse after SARS-CoV-2 Infection
by Antonia Pignolo, Maria Aprile, Cesare Gagliardo, Giovanni Maurizio Giammanco, Marco D’Amelio, Paolo Aridon, Giuseppe La Tona, Giuseppe Salemi and Paolo Ragonese
Neurol. Int. 2021, 13(4), 695-700; https://doi.org/10.3390/neurolint13040066 - 6 Dec 2021
Cited by 17 | Viewed by 3141
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with several neurological disorders including headache, facial palsy, encephalitis, stroke, demyelinating disorders. The present report will discuss cases of multiple sclerosis (MS) onset and relapse both beginning early after SARS-CoV-2 infection. In [...] Read more.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with several neurological disorders including headache, facial palsy, encephalitis, stroke, demyelinating disorders. The present report will discuss cases of multiple sclerosis (MS) onset and relapse both beginning early after SARS-CoV-2 infection. In both cases, magnetic resonance imaging (MRI) showed widespread bilateral subcortical and periventricular active lesions. Serum IgG against SARS-CoV-2 Spike antigens confirmed seroconversion with titers that are considered not definitely protective against possible reinfection. We hypothesize that SARS-CoV-2 infection, as previously reported for other viruses, could drive an active inflammatory response that can contribute either to the onset of MS or its relapse. The presented data further support the importance of vaccination in individuals with MS. Full article
(This article belongs to the Special Issue Advances in Multiple Sclerosis)
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11 pages, 2033 KiB  
Case Report
Walking with UAN.GO Exoskeleton: Training and Compliance in a Multiple Sclerosis Patient
by Gianluca Sesenna, Cecilia Calzolari, Maria Paola Gruppi and Gianluca Ciardi
Neurol. Int. 2021, 13(3), 428-438; https://doi.org/10.3390/neurolint13030042 - 23 Aug 2021
Cited by 2 | Viewed by 2711
Abstract
Background: Multiple sclerosis is a progressive neurodegenerative disease that affects myelin in the central nervous system. It is complex and unpredictable and occurs predominantly in young adults, causing increasing disability and a significantly lower quality of life. Recent studies investigated how rehabilitation training [...] Read more.
Background: Multiple sclerosis is a progressive neurodegenerative disease that affects myelin in the central nervous system. It is complex and unpredictable and occurs predominantly in young adults, causing increasing disability and a significantly lower quality of life. Recent studies investigated how rehabilitation training through the use of a robotic exoskeleton can influence walking recovery in patients with a serious neurological disease. Aim: The purpose of this study was to analyze the first approach of a multiple sclerosis patient to a robotic exoskeleton for the lower limbs, in order to assess the effectiveness of the protocol on walking ability, adaptability of the device, level of appreciation, variations in parameters related to walking, and fatigue perception. Methods: This study was conducted on a 71-year-old male diagnosed with primary progressive multiple sclerosis since 2012, with an EDSS score of 6. The patient underwent a cycle of 10 sessions of treatment with the exoskeleton for the lower limbs, the UAN.GO, lasting 1 h 30 min. Pre- and post-treatment evaluations were carried out with the 6 min walking test, the Fatigue Severity Scale, the Short Form-36 Health Survey, and a Likert scale for review. During each session, blood pressure, heart rate, and peripheral saturation were monitored; in addition, the perception of fatigue by the Borg scale was studied. Result: A comparison between the initial and final evaluations showed improvements in the walked distance at 6 MWT (T0 = 53 m/T1 = 61 m). There was a positive trend in saturation and heart rate values collected during each session. Further improvements were found by the Borg scale (T0 = 15/T1 = 11). Discussion: The data collected in this case report show promising results regarding the treatment of multiple sclerosis patients with the UAN.GO exoskeleton, with benefits on both motor performance and vital parameters. Full article
(This article belongs to the Special Issue Advances in Multiple Sclerosis)
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