E ISSN 2791-7851
Volume : 1 Issue : 1 Year : 2021
JOURNAL OF MULTIPLE SCLEROSIS RESEARCH - J Mult Scler Res: 1 (1)
Volume: 1  Issue: 1 - April 2021
RESEARCH ARTICLES
1.Use of the BICAMS in Patients with Multiple Sclerosis During Attack Period: A Prospective Controlled Study
Ozan Ozturk, Bilge Piri Cinar, Serkan Ozakbas
doi: 10.4274/jmsr.galenos.2021.6-5  Pages 1 - 6
INTRODUCTION: Assessment of cognitive impairment, which cannot be evaluated with ordinary scales, in multiple sclerosis (MS) has been thought to be beneficial. MS significantly impairs the quality of life. During an MS attack, using a tool such as the brief international cognitive assessment for MS (BICAMS) battery, which can be administered quickly and applied and interpreted by individuals without neuropsychology training, provides a rapid and broad assessment of the patient’s status.
METHODS: The symbol digit modalities test (SDMT), california verbal learning test II (CVLT II), brief visuospatial memory test-revised (BVMT-R), and expanded disability status score were applied before treatment, at the end of treatment, and at the first month after treatment to evaluate mental and cognitive status in the acute period in patients with MS, who met the inclusion criteria.
RESULTS: This study enrolled 49 patients with MS (F/M, 30/19) and 25 healthy controls (F/M, 16/9). The CVLT II scores were significantly higher after treatment than at baseline evaluation (p<0.0001). However, no significant difference was observed in data obtained at the end of treatment and at the first month after treatment (p=0.517). The CVLT II scores before treatment and at the first month increased in both groups, which was significantly higher in the MS group than in the control group (p=0.002). In the MS group, a marked increase was found in the number of correctly drawn figures on the BVMT-R at the end of treatment compared with that drawn before treatment (p<0.0001). Values obtained at the first month after treatment were significantly higher than those measured before treatment (p<0.0001). In the MS group, the mean numbers of symbols drawn correctly in 90 s on the SDMT were 42.04±11.73 on the first visit and 45.40±16.32 at the end of treatment, indicating a significant improvement (p=0.003), and the mean number of symbols drawn correctly at the first month was 48.14±15.03.
DISCUSSION AND CONCLUSION: This study found that the BICAMS battery was effectively used in the acute period, the short total application period was 15 min, and a neuropsychologist was not required for application and interpretation. These results suggest the potential application of BICAMS battery in daily practice.

2.Further Validity of the Short Version of the Activities-Specific Balance Confidence Scale in Patients with Multiple Sclerosis
Zuhal Abasıyanık, Turhan Kahraman, Pinar Yigit, Cavid Baba, Ozge Ertekin, Serkan Ozakbas
doi: 10.4274/jmsr.galenos.2021.6-4  Pages 7 - 12
INTRODUCTION: There is scarce data on the utility of the short version of the Activities-specific Balance Confidence Scale in persons with multiple sclerosis (pwMS). Thus, this study aimed to expand the validity of the ABC-6 scale and compare it with the original version of the 16-item ABC scale (ABC-16) in pwMS.
METHODS: In total, 156 patients were included (median age: 35 years, 73.1% female and 26.9% male) in this study. The ABC-16 and ABC-6, timed up-and-go test (TUG), TUG-cognitive, six-minute walk test, timed 25-foot walk, MS walking scale, single-leg stance test, modified fatigue impact scale (MFIS), brief international cognitive assessment for multiple sclerosis, Beck depression inventory-II (BDI-II), and epworth sleepiness scale (ESS) were assessed. Validity was assessed in terms of criterion, convergent, discriminant, and known-group validity.
RESULTS: The correlation coefficient between the ABC-6 and ABC-16 was 0.974 (p<0.001). The ABC-16 and ABC-6 were strongly correlated with measures of the expanded disability status scale, all walking and balance tests, and physical and psychosocial subscores of MFIS (rs =-0.520 to -0.811, p<0.05). Moderate correlations were found with a cognitive subscore of fatigue, cognitive processing speed, visuospatial memory, and BDI-II (rs =-0.321 to -0.446, p<0.05). Low correlations were found in verbal memory and ESS scores (rs =-0.160 to -0.246, p<0.05). PwMS with a moderatesevere disability had significantly lower ABC-6 scores than that of patients with mild disability (p<0.001).
DISCUSSION AND CONCLUSION: The ABC-6 demonstrated high validity for measuring balance confidence in pwMS. Our findings strengthen the clinical utility of the ABC-6 in pwMS.

3.Challenges of Patients with Neuromyelitis Optica Spectrum Disorder During COVID-19 Pandemic
Serkan Ozakbas, Cavid Baba, Pelin Hancer, Ozge Sagici, Asiye Tuba Ozdogar, Zuhal Abasıyanık, Seda Dastan
doi: 10.4274/jmsr.galenos.2021.6-1  Pages 13 - 16
INTRODUCTION: At present, millions of people have been infected and hundreds of thousands are falling dead because of Coronavirus disease-2019.
People with neuromyelitis optica spectrum disorder (NMOSD) are among patients who use immunosuppressive drugs.
METHODS: Registered patients with NMOSD were contacted via phone during the three-months of pandemic.
RESULTS: Information from 45 patients was gathered, and three (8.57%) of them stopped their treatment due to fear for immunosuppression. All
three were on rituximab treatment.
DISCUSSION AND CONCLUSION: Infusion therapy was assumed to pose more fear in terms of immunosuppression on patients compared with noninfusion route of
treatment.

4.Relationship between Physical Disability and Black Holes in Multiple Sclerosis: Upper Extremity Functions - an Important Parameter
Bilge Piri Cinar, Gulcan Kalaycı, Mustafa Acikgoz, Serkan Ozakbas
doi: 10.4274/jmsr.galenos.2021.6-2  Pages 17 - 21
INTRODUCTION: Typical lesion locations in multiple sclerosis (MS) and hypointense lesions that persist >6 months on T1-weighted magnetic resonance imaging (MRI) are known as black holes. This study aimed to investigate the potential relationship between brain MRI lesion localization and the presence of black holes and upper extremity function in patients with MS in remission.
METHODS: Materials and Methods: The nine-hole peg test (NHPT), timed 25-foot walk test (T25FWT), and expanded disability status scale (EDSS) scores were calculated with neurological examinations in the period when MRI was performed (±1 week).
RESULTS: Results: This study included 47 patients diagnosed with MS. The mean patient age was 34.24±8.38 (19-54) years. The mean EDSS score of the study group was 1.7±0.85 (0-3). The mean NHPT time was 17.27±2.70 s (13.74-27.23 s). The mean T25FWT time of the study group was 4.35±0.62 s (3.30- 6.05 s). Juxtacortical lesions were present in 46 (97.0%) patients, cortical lesions in 2 (4.3%), brain stem lesions in 38 (80.9%), and cerebellar lesions in 16 (34%). Permanent black holes were found in 37 (78.7%) patients, with more than one black holes being detected in 33 of these patients. The mean NHPT time was significantly longer in patients with permanent black holes detected by MRI of the brain than in those without black holes (p=0.034). A weak correlation was found between the EDSS score and NHPT time (r=0.192, p=0.046).
DISCUSSION AND CONCLUSION: Conclusion: The presence and number of permanent black holes can be used as a marker of disability. Upper extremity functions may well represent disability, especially in patients with low EDSS scores.

5.The Relationship Between Fatigue and Lower Extremity Function in People with Multiple Sclerosis with the Absence of Clinical Disability
Asiye Tuba Ozdogar, Seda Dastan, Ozge Ertekin, Cavid Baba, Serkan Ozakbas
doi: 10.4274/jmsr.galenos.2021.6-3  Pages 22 - 26
INTRODUCTION: Impairment in the lower extremity function and mobility is a symptom often among people with multiple sclerosis (pwMS), even in the absence of clinical disability. Fatigue is one of the most common symptoms reported by at least 80% of pwMS during any disease. This study investigated the relationship between fatigue and lower extremity function, which is assessed by the Six Spot Step test (SSST) in pwMS with the absence of clinical disability.
METHODS: A total of 477 pwMS with an Expanded Disability Status scale (EDSS) score of ≤1.5 were included in the study. The SSST was used to evaluate the complex sensorimotor function of lower extremity function, such as lower extremity muscle strength, coordination, and balance. Participants with SSST performance above 8 seconds were classified as impaired. In addition, a Modified Fatigue Impact scale-5- item version was used to evaluate perceived fatigue. Demographic (gender, age) and clinical data (disability level and disease duration) of the participants were obtained from interviews and medical records.
RESULTS: Impairment in SSST performance was detected in 171 (35.85%) pwMS. Univariate regression analysis revealed that fatigue was significantly associated with the SSST (p<0.001). Furthermore, fatigue was still an associated factor in the multivariate regression analysis after adjusting for age, gender, and disability level (p<0.001).
DISCUSSION AND CONCLUSION: This study showed that even in the absence of disability, fatigue could be related to impairment in SSST performance. Considering the reflection of SSST performance on functional mobility, ambulation, and daily life in pwMS, it is essential to include the fatigue in the evaluation and treatment of pwMS with the absence of clinical disability.

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