E ISSN 2791-7851
Volume : 4 Issue : 3 Year : 2024
JOURNAL OF MULTIPLE SCLEROSIS RESEARCH - J Mult Scler Res: 4 (3)
Volume: 4  Issue: 3 - December 2024
COVER
1. Cover

Pages I - III

RESEARCH ARTICLES
2. Treatment Satisfaction of Patients Using Dimethyl Fumarate for Multiple Sclerosis: A Survey Study
Merve Turkkol, Ebru Hatun Uludasdemir, Damla Cetinkaya Tezer, Ipek Gungor Dogan, Serkan Demir
doi: 10.4274/jmsr.galenos.2024.2024-7-3  Pages 52 - 58
INTRODUCTION: Multiple sclerosis (MS) is a chronic and progressive disease that affects the central nervous system. Dimethyl fumarate (DMF) is commonly used in the treatment of MS. This study examines the relationship between treatment adherence and quality of life (QoL) in patients undergoing DMF treatment.
METHODS: The study included 227 patients using DMF. Demographic information, DMF usage duration, disease duration, and treatment adherence were obtained through surveys. Data were analyzed using the Statistical Package for the Social Sciences program. The effects of factors such as age, sex, disease duration, and treatment methods on treatment adherence and QoL were evaluated.
RESULTS: Patients who had high adherence to DMF treatment had higher QoL. Moreover, younger patients adapted to the treatment more easily and had higher QoL. Female patients had higher treatment adherence than male patients. Additionally, treatment methods had varying effects on QoL.
DISCUSSION AND CONCLUSION: DMF is an effective treatment for MS. The study results indicate that adherence to DMF treatment positively impacts patients’ QoL and that increasing this adherence is crucial. Future studies should compare different treatment methods and comprehensively examine patients’ experiences during the treatment process. Psychosocial support and education programs should be developed to enhance treatment adherence.

3. The Relationship Between Retinal Layer Thickness and Cognition in People with Multiple Sclerosis
Sinem Ozcelik, Ergi Kaya, Denizcan Ozizmirliler, Furkan Guney, Ozge Sagici, Aylin Yaman, Cavid Baba
doi: 10.4274/jmsr.galenos.2024.2024-12-1  Pages 59 - 66
INTRODUCTION: Optical coherence tomography (OCT) and OCT-angiography (OCT-A) are non-invasive techniques for investigating retinal layers and blood flow. Axonal loss in neurodegenerative disorders like multiple sclerosis (MS) can be evaluated with OCT. The retinal nerve fiber layer (RNFL) and ganglion cell inner plexiform layer (GCIPL) are mainly affected layers by MS-related axonal loss. As a result, these layers can be a biomarker of disability, cortical volume and cognition in people with MS (pwMS). This study investigates the relationship between cognition and retinal nerve layers’ thickness and retinal vessel density in pwMS.
METHODS: The participants’ OCT and OCT-A examinations were evaluated retrospectively. The participants with a history of bilateral optic neuritis and less than 12 years of education were excluded from the study. The participants were divided into the following two groups: pwMS with optic neuritis (ON+) and pwMS without optic neuritis (ON-). The unaffected eyes were evaluated in the ON+, and the mean values of eyes were evaluated in the ON- group. Demographic variables, Expanded Disability Status Scale (EDSS) and Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), which include: Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), California Verbal Learning Test-II (CVLT-II) were examined.
RESULTS: Twenty-eight participants were in the ON+ group, and 56 pwMS were in the ON- group. The thickness of GCIPL inferior and temporal quadrants exhibited a weak negative correlation with BVMT-R in the ON-group. The vessel density of optic disc inferior quadrant results showed a weak positive correlation with SDMT in the ON-group (ρ=0.329, p=0.02). The superonasal quadrant of RNFL had a moderate negative correlation with the results of CVLT-II in the ON+ group (ρ=-0.458, p=0.016). On the other hand, GCIPL, in all quadrants except the centrum, positively correlated with SDMT in the ON+ group. Similar correlation results were detected between the inferotemporal/global thickness of RNLF and SDMT in the ON+ group.
DISCUSSION AND CONCLUSION: The thicknesses of specific quadrants of RNFL and GCIPL might have a weak to moderate correlation with information processing speed, particularly in ON+ pwMS. Only inferior quadrant optic disc vessel density showed a weak correlation with information processing speed in ON- group.

4. Exploring the Relationship Between Sleep Quality and Fatigue, Quality of Life, Daytime Sleepiness, and Anxiety-depression Levels in Patients with Multiple Sclerosis
Asiye Tuba Ozdogar, Enes Aldemir, Pervin Yesiloglu, Vedat Cilingir
doi: 10.4274/jmsr.galenos.2024.2024-12-2  Pages 67 - 72
INTRODUCTION: Multiple sclerosis (MS) is a chronic neurological disorder often linked with fatigue and poor sleep quality, both of which significantly affect quality of life and mental health. This study aimed to explore the relationship between sleep quality and fatigue, quality of life, daytime sleepiness, and anxiety-depression in patients with MS (pwMS).
METHODS: A cross-sectional study was conducted with 52 pwMS (16 with poor sleep quality, 36 without), recruited from a neurology clinic. Sleep quality was assessed using the Pittsburgh sleep quality index (PSQI), fatigue with the modified fatigue impact scale (MFIS), daytime sleepiness with the Epworth sleepiness scale (ESS), anxiety and depression using the hospital anxiety and depression scale (HADS), and quality of life with the preference-based multiple sclerosis index (PBMSI). Participants were categorized into two groups based on PSQI scores: Those with poor sleep quality and those without. The groups were compared based on patient-reported outcomes, and correlations between these variables and clinical characteristics (e.g., expanded disability status scale scores, disease duration) were examined.
RESULTS: Participants with poor sleep quality reported higher MFIS scores across the physical, cognitive, and psychosocial domains compared to those without poor sleep quality, though these differences were not statistically significant. Anxiety was significantly higher in the poor sleep quality group (p=0.043), and there was a positive correlation between poor sleep quality and increased anxiety (r=0.336, p<0.05). No significant differences were found in ESS or PBMSI scores between the groups. Additionally, a significant correlation was observed between the number of relapses, and the MFIS-physical, MFIS-cognitive, MFIS-total scores, and the PSQI score.
DISCUSSION AND CONCLUSION: This study underscores the relationship between sleep quality, fatigue, anxiety, and the number of relapses in pwMS. Improving sleep quality may help reduce fatigue and anxiety, thereby improving overall well-being. The results suggest that these factors should be evaluated and addressed together in managing MS.

5. What is the Relationship Between Disability Level, Hip Adductor Spasticity, and Incontinence in People with Multiple Sclerosis? - A Pilot Study
Arzucan Toksal Ucar, Gungor Beyza Ozvar Senoz, Mustafa Acikgoz
doi: 10.4274/jmsr.galenos.2024.2024-12-5  Pages 73 - 78
INTRODUCTION: This study aimed to examine the relationship between disability level, hip adductor spasticity, incontinence, pelvic floor dysfunction, and quality of life in patients with multiple sclerosis (pwMS).
METHODS: Nineteen participants (11 females, 8 males) were included. Disability levels were assessed using the Expanded Disability Status Scale (EDSS). Spasticity was evaluated with the modified ashworth scale (MAS). Incontinence and pelvic floor dysfunction were assessed using the pelvic floor distress inventory-20 and its subscales [colorectal-anal distress inventory-8 (CRADI-8), urogenital distress inventory-6 (UDI-6)]. The impact on quality of life was measured with the international consultation on incontinence questionnaire-short form (ICIQ-SF), while overall health status was assessed using the king’s health questionnaire (KHQ).
RESULTS: The mean EDSS score was 2.23±1.67. No significant differences were observed between male and female participants for MAS-right, MAS-left, CRADI-8, UDI-6, ICIQ-SF, or the total KHQ score (p>0.05). A significant positive correlation was identified between disability levels and hip adductor spasticity, incontinence, pelvic floor dysfunction, and quality of life (p<0.05).
DISCUSSION AND CONCLUSION: Routine evaluation of hip adductor spasticity, incontinence, pelvic floor dysfunction, and quality of life is recommended for pwMS, regardless of disability level or gender.

6. Qualitative Insights into the Diagnosis, Treatment, and Socioeconomic and Psychological Challenges of Patients with Multiple Sclerosis in a Turkish Public Hospital
Aysenur Sandal Kilic, Seyhan Hidiroglu, Murat Tugberk Bakar, Basak Oyku Gulkac, Burak Mert Saracoglu, Ayse Esin Kay, Alper Uzum, Macide Nur Kaymak, Melda Karavus, Kadriye Agan, Dilek Ince Gunal, Gulin Sunter
doi: 10.4274/jmsr.galenos.2025.2024-5-1  Pages 79 - 88
INTRODUCTION: Objective of the study is to qualitatively evaluate challenges multiple sclerosis (MS) patients faced during diagnosis, treatment, and social life.
METHODS: Population of our qualitative study consisted MS patients with expanded disability status scale score ≤5 (19-50 years of age) who were admitted to a public university hospital neurology department. Semi-structured question guide were applied via in-depth face-to-face interviews. Interviews wereaudio-recorded after permission. Twelve participants agreed to participate voluntarily, the recordings were transcribed, thematic analysis was conducted.
RESULTS: “Attitude of family members and social circle”, “problems came across” and “worries and coping mechanisms” were the most significant themes. Participants had anxiety after diagnosis because of fear of death, probabilityof losing functions and having no clue about what MS willbring in the future. Their families started to act more sensitively and with understanding after the diagnosis. While this situation was welcomed by some of the participants, some perceived this situation negatively a triggering factor for their feeling of insufficiency. Participants were exposed to stigma. One participant narrated he faced stigmatization due to his gait. Their educational lifeadversely affected. Participants faced situations such as not being hired or termination of employment. Probability of attacks to ocur at work could become an obstacle. Some participants stated it would be difficult to carry their responsibilities due to MS and start a family, so they would have difficulties in establishing romantic relationships. Some emphasized the disease would not cause a problem, but their partners’ approach to MS was important. They were worried that their families would experience sadness and anxiety, that they would not be able to support their spouses and children if their disease progressed, they were also worried about risk of transmitting MS to their children. They developed coping strategiessuch as avoidance, religion, self-soothing.
DISCUSSION AND CONCLUSION: Participants’ knowledge about MS is limited. Families have a supportive attitude towards patients and takes teps to make participants’ lives easier. Studies developing scales such as quantitatively measuring stigma or perceived empathy in MS patients can be recommended.

7. Correlation of Breastfeeding with Disease Development and Progression in Patients with Multiple Sclerosis
Nuray Bilge, Yildiz Dagci, Filiz Demirdogen, Fatma Simsek
doi: 10.4274/jmsr.galenos.2025.2024-12-3  Pages 89 - 94
INTRODUCTION: Breastfeeding during infancy has been shown to be protective against autoimmune diseases. This study aimed to determine the correlation between breastfeeding during infancy and disease development and progression in patients with multiple sclerosis (MS).
METHODS: This study included 180 participants, comprising 90 patients with MS and a control group of 90 healthy individuals. Demographic characteristics, duration of disease, age of onset, number of attacks, annual relapse rate, expanded disability status scale (EDSS) scores, and duration of breastfeeding of patients with MS were recorded.
RESULTS: No significant difference was found between the two groups; the duration of breastfeeding was 13.67±9 months in the MS group and 14.3±9.4 months in the control group. Furthermore, there was no statistically significant difference in age of onset, annual relapse rate, number of attacks, or EDSS values between groups with ≤4 months and >4 months of breastfeeding and between ≤6 months and >6 months of breastfeeding.
DISCUSSION AND CONCLUSION: According to the results of this study, breastfeeding duration was not significantly correlated with disease development, age of onset, or disease progression in patients with MS. However, further studies with a larger sample group are required to validate the findings.

CASE REPORT
8. Area Postrema Syndrome: A Rare Presentation of Neurosarcoidosis
Abdulkadir Tunc, Omer Elci, Beyzanur Bozkurt, Samet Oncel
doi: 10.4274/jmsr.galenos.2024.2024-10-3  Pages 95 - 98
This case report describes a rare occurrence of neurosarcoidosis presenting as area postrema syndrome, marked by severe nausea and vomiting. A woman in her 30s developed persistent symptoms following a cesarean section. Diagnostic investigations, including magnetic resonance imaging and cerebrospinal fluid analysis, confirmed the diagnosis of neurosarcoidosis. Treatment with prednisolone resulted in substantial symptom relief. This case emphasizes the need to consider neurosarcoidosis in the differential diagnosis of unexplained gastrointestinal symptoms and highlights the diagnostic challenges associated with such atypical presentations.

INDEX
9. 2024 Referee Index

Page E1
Abstract |Full Text PDF

10. 2024 Author Index

Page E2
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11. 2024 Subject Index

Page E3
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