INTRODUCTION: It has been reported that estrogen may affect T helper (Th) 1 and Th-2 lymphocytes and the ratio of Th-1 to Th-2, which play an essential role in the immunopathogenesis of multiple sclerosis (MS). Therefore, hormonal changes during transitional periods, such as pregnancy and menopause, may affect the activity of the disease at different phases of the menstrual cycle. This study aimed to determine the association of MS in women with variables, such as menarche age, menstrual order, menopausal age, and disease-related factors, such as disability level and the number of relapses.
METHODS: This descriptive study enrolled 281 women with MS. The participants were evaluated using a simple and short survey by the researchers. A neurologist evaluated the Expanded Disability Status Scale (EDSS) score, the number of attacks, and disease duration.
RESULTS: Sixty-seven (23.8%) of 281 patients had entered menopause. There was no significant difference in the EDSS score of women with MS with or without menopause (p>0.05). Sixty patients (21.4%) had children after MS. There was no significant difference between the number of relapses before (1.87±1.46) and after having a child (3.15±3.59) (p>0.05). Additionally, the last EDSS score (2.46±2.07) was not different from the EDSS score after having a child (2.35±1.81) (p>0.05). It was found that 80.4% of the patients had a regular menstrual cycle, whereas 19.6% of them had an irregular cycle. The EDSS score was significantly higher in women with irregular menstrual cycles than in women with regular menstrual cycles (p<0.05). The age at menarche in the study group (13.07) was found to be earlier than the average age at menarche in Turkey (13.3) (p<0.05).
DISCUSSION AND CONCLUSION: This study suggested that menopause and childbearing may not affect disability level or the number of attacks in women with MS. Additionally, women with MS have an earlier age at menarche compared with the general population. Future studies should investigate earlier age at menarche as a possible risk factor in MS.

INTRODUCTION: The methods used in monitoring the progression of multiple sclerosis (MS) and evaluating the effectiveness of disease-modifying treatments are insufficient. Data obtained from the expanded disability status scale (EDSS), annual relapse rate, or magnetic resonance imaging methods lead to the understanding of symptoms such as cognitive involvement only in the late disease phase. Therefore, this study aimed to compare the relationship between a tool that also evaluated cognitive involvement, such as the multiple sclerosis functional composite (MSFC), which is not widely used in every MS clinic, and a traditional method such as the EDSS.
METHODS: A total of 121 patients with relapsing-remitting MS [female, n=82 (67.8%); male, n=39 (32.2%)] were included in the study. Three (baseline, year 1, and year 2)-year changes in the EDSS scores of these patients within 1 year were visually categorized as both ≥0.5 or ≥1.0. Changes in MSFC components were recorded numerically. The relationship between the changes in 1 year and the EDSS categories was analyzed by repeated-measures analysis of variance (ANOVA). P values <0.05 were considered significant.
RESULTS: According to the results of repeated measures ANOVA, timed 25-foot walk (T25-FW) values were significantly correlated with EDSS changes of ≥1.0 point between both baseline to year 1 [F (1,118) = 6.532; p=0.012] and year 1 to year 2 [F (1,118)=10.222; p=0.002]. When the 3-year change between the baseline and year 2 was considered, the paced auditory serial addition test (PASAT) 3” was found to be significantly correlated with EDSS changes of ≥1.0 points [F (2,118) = 4.204; p=0.043].
DISCUSSION AND CONCLUSION: MSFC results demonstrated disease progression in line with the EDSS categories designed for the study. T25-FW is effective in predicting changes of ≥1.0 points in the EDSS at 1-year intervals. The PASAT 3” was effective in predicting changes of ≥0.5 points and ≥1.0 points, considering the 2-year change. Accordingly, MSFC components can be used in clinics as an alternative method to determine the treatment endpoint and to monitor cognitive involvement.

INTRODUCTION: This study aimed to assess the effects of sexual dysfunction, fatigue, and depression of women with multiple sclerosis (MS) on their quality of life (QoL).
METHODS: The study included 30 women with MS, and 60 healthy women who presented to the outpatient clinics of Hafsa Sultan Hospital, Celal Bayar University, with simple complaints without a chronic disease. The sociodemographic form, fatigue severity scale (FSS), Arizona sexual experiences scale (ASES), Beck Depression scale (BDS), and Health-Related QoL Short Form-36 (SF-36) were administered to the patients with MS and patients in the control group. While patients with MS were assigned to the experimental group, other patients were assigned to the control group.
RESULTS: In both groups, the mean age of the patients was 34 (minimum=24, maximum=40) years. A significant statistical difference was found between the two groups in terms of the mean scores they obtained from the FSS (p<0.05). In our study, the mean scores of the participants in the experimental and control groups obtained from the overall BDS were 16.00±7.96 and 2.10±2.62, respectively. Of the participants in the experimental group, 9 experienced moderate depression and 2 had severe depression. Of the participants, 29 women in the experimental group and 10 women in the control group had sexual dysfunction. In terms of the mean scores they obtained from the ASES, a significant difference was found between the participants in the experimental and control groups (p<0.01).
DISCUSSION AND CONCLUSION: Women with MS had higher levels of fatigue, sexual dysfunction, and depression than did the healthy controls, which explains the decrease in their QoL. The comparison of the participants in both groups in terms of their QoL revealed that the women with MS had a lower level of QoL than did the women in the control group.

INTRODUCTION: Physical disability is a fact of some neurologic disorders, such as multiple sclerosis. One of the treatments for such disability is routine physical exercises, or “rehabilitation”. However, rehabilitation in hospitals is often unattractive to patients. Another difficulty is objectively assessing the final effect of rehabilitation on disabilities, as assessment often depends on the subjective opinion of the physician. In the present study, we offer exergaming rehabilitation at home (telerehabilitation) and an objective method for measuring the physical performance of people with multiple sclerosis using a virtual reality tool to assist the decision of whether improvement, no change, or deterioration in the patient’s health status has occurred.
METHODS: Telerehabilitation is provided by custom-made exergames specifically designed for patients with upper extremity disabilities. Our performance measurement method records the time taken by a patient to finish a physical test and measures the angles of interest between predetermined upper extremities. The measurements are recorded and saved for future determinations of patient progress. Thus, improvement-deterioration-no change decisions can depend less on subjective opinions. Preliminary performance experimentation was conducted before and after participants played our virtual reality exergames.
RESULTS: The results reveal that our method is capable of measuring angles with an error margin of 6.44%. The accuracy of our method is 86.00%. The sensitivity, i.e., ability to detect improvements in patient performance, of our method is higher at 88.24%. The specificity, i.e., correct determination of no change in performance, is lower at 82.25%. The time taken to finish a physical test could not be evaluated due to a lack of real patients in our engineering laboratories.
DISCUSSION AND CONCLUSION: The impact of our telerehabilitation exergaming solution on patient performance requires prolonged use by patients and future analysis of accumulated medical opinions. Our proposal is the first step toward exergaming and digital performance determination.

Multiple sclerosis (MS) is a chronic, autoimmune, neurodegenerative disease of the central nervous system, with inflammation and loss of myelin in axons. Fingolimod is the first oral disease-modifying agent approved for the treatment of relapsing-remitting MS. Here we aimed to present a patient with MS who developed human papillomavirus (HPV)-associated anal and genital intraepithelial neoplasia while on fingolimod treatment. A 19-year-old female patient presented with the complaint of diplopia. The diagnosis of MS was made based on imaging and cerebrospinal fluid results. She was treated first with beta-interferon 1a, then methotrexate, and finally fingolimod. While the patient was being followed without attack under fingolimod treatment, HPV-associated genital, and further, anal warts developed. This is a rare case that developed both cervical dysplasia and anal Condyloma acuminatum due to the HPV that developed after fingolimod treatment in a patient with MS. In conclusion, fingolimod treatment increases the risk of cervical HPV infection and related cancer in patients with MS.