Background

Fatigue is one of the most common complaints of patients with neuromyelitis optica spectrum disorder (NMOSD). From 50 up to 71.4% of NMOSD patients reported fatigue in their daily life. Fatigue can decrease patients’ quality of life, quality of sleep and it can increase the severity of their pain.

Objectives

Ginseng has shown positive effects on decreasing fatigue in multiple sclerosis patients. Due to similar manifestations between the two diseases, this study was designed to evaluate the same effects on NMOSD.

Methods

This study was a double-blind randomized clinical trial designed and performed in Sina hospital, Tehran, Iran in 2018-2019. A total number of 58 patients were enrolled and underwent treatment with 250-mg ginseng or placebo twice daily for 3 months. Severity of fatigue was measured using the valid and reliable Farsi version of fatigue severity scale (FSS) questionnaire at the time of admission and after completing the study. Questionnaires were filled by patients and the scores were calculated and evaluated by a trained senior neurology resident.

Results

All 58 participants completed the study. Mean age was 36.84 ± 9.37, and 89.7% of patients were female. There was no difference between the study and control group regarding age, EDSS, duration of disease or types of medications used for NMOSD treatment. After administering Ginseng/placebo for 3 months there were no major side effects reported. The FSS was decreased significantly in the study group (40.21 ± 13.51 to 28.97 ± 14.18) comparing to placebo group (35.03 ± 13.51 to 38.79 ± 12.27) after treatment (p-value: <0.001).

Conclusions

This study demonstrates positive results from ginseng on relieving fatigue in NMOSD patients. No major side effects were observed after 3 months of follow-up. More studies are needed to further evaluate ginsengs’ effects and mechanisms of effects on fatigue in NMOSD.

Background

Multiple sclerosis (MS) is a chronic degenerative neurological disease that has been an increasing prevalence in many countries all over the world. Tehran province is the most populated and capital province in Iran with an increasing MS prevalence.

Objectives

The present study is conducted to estimate the prevalence and assess the epidemiology of MS including familial MS history in Tehran in 2019.

Methods

A cross-sectional study was conducted based on information taken by Iranian MS Society (IMSS) registry system from 1999 to 2019 in Tehran Province, the capital of Iran. All diagnosis approved by neurologists with MS fulfilling McDonald criteria. Individually person fills out a questionnaire relating to baseline characteristic data such as sex, age, familial history of MS and its degree of family and age at disease onset.

Results

A total of 22421 cases were registered at this study, 24.9% were male and 75.1% were female (female/male ratio = 3.016). The mean age of disease onset was 28.92 (SD=8.74). The crude prevalence of MS in 2019 in Tehran was 162.39 cases per 100000 people (244.92 per 100000 in females and 80.58 per 100000 in males). Generally, 469 (6.5%) of cases were below 18 years old, and 10903 patients (48.62%) were between 18 and 40 years old.

Totally, 2982 subjects (13.7%) had a positive family history of MS; among them, 1279 cases (42.58%) with positive family history in their first degree, 471 (15.82%) in their second degree and 896 (30.11%) subjects with positive family history in their third degree family members.

Conclusions

MS is more prevalent among female and young people.

MS prevalence in Tehran has increased (comparing to previous studies) and Tehran is one of the counties with highs prevalence in Asia.

Background

The possible protective effects of dietary supplements intake during adolescence against Multiple Sclerosis (MS) is mentioned previously. But there is no study on this context for the risk of Primary Progressive MS (PPMS) exclusively.

Objectives

We investigated the possible effects of dietary supplements intake during adolesence on the risk of PPMS subtype of MS disease.

Methods

A population-based case-control study was performed on 143 PPMS patients and 400 healthy controls, in Sina hospital and 16 Azar MS clinic, Tehran, Iran. Definite diagnosis of PPMS patients was based on 2017 McDonald Diagnostic Criteria. Data on dietary supplements consumption of participants during adolescence were obtained by the questionnaire designed for multinational case-control studies of environmental risk factors in multiple sclerosis (EnvIMS-Q). Logistic regression model adjusted for age, gender, father's ethnicity, mother's ethnicity, mother and father's educational level was applied to analyze data.

Results

Calcium supplementation was associated with 84% (95% CI: 0.03-0.85) reduced risk of PPMS. Vitamin B12 supplement intake led to 88% (95% CI: 0.02-0.61) decrease in PPMS risk. 92% (95% CI: 0.02-0.27) reduction in PPMS risk was founded in subjects who consumed vitamin C supplement during adolescence vs. participants who did not consumed. No significant association was obtained in case of fish oil, multivitamin, Iron and folic acid supplements intake (P ˃ 0.05).

Conclusions

This study emphasized the reverse association between vitamin C, B12 and Calcium supplements consumption during adolescence and risk of PPMS.

Background

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune demyelinating disease of the central nervous system that predominantly affects the spinal cord and optic nerves, caused by both genetic and environmental factors. The environmental predisposing factors are mainly indeterminate and could have happened long time before the disease presentation.

Objectives

The present study investigated the possible association of socioeconomic status (SES), stressful life events, and ethnicity with NMOSD development after adjustment for relevant confounders in an Iranian population.

Methods

This was a population-based case-control study of 153 NMOSD cases and 400 healthy controls during 2015-2019 in Tehran, Iran. Diagnosis of NMOSD was based on the 2015 International Consensus Criteria. Sex-matched controls with no history of any neurological disorders were selected through the standard method of Random Digit Dialing (RDD). Telephone interviews were administered to gather subjects’ data. Logistic regression was used to estimate adjusted and unadjusted odds ratio (OR) at 95% confidence intervals (CIs) using SPSS software.

Results

In this study NMOSD cases and controls had the mean age (SD) of 37.11 (±10.90) and 33.67 (±8.37) years, respectively (p < 0.001). Experiencing homelessness periods (OR = 4.85; 95% CI (1.24 – 18.87), p = 0.02), family disruption (OR = 12.69; 95% CI ) 3.30 – 48.73), p < 0.001), divorce (OR = 6.20; 95% CI (1.62 – 23.64), p = 0.009) and joblessness (OR = 3.83; 95% CI (1.32 – 11.15), p = 0.01) as stressful life events and positive history of depression (OR = 3.20; 95% CI (1.25 – 8.21), p = 0.01) increased NMOSD risk. Self-rated health status score was higher in controls (p < 0.001). Socioeconomic status (SES), parental ethnicity, and parental educational level during subjects’ adolescence were not associated with NMOSD development risk (P > 0.05).

Conclusions

Stressful life events including homelessness periods, family disruption, divorce, joblessness, and positive history of depression were identified as risk factors for NMOSD development, while marriage was a protective factor. Controls had higher self-rated health status score in comparison to NMOSD subjects. No evidence was found suggesting SES, ethnicity, and parental educational levels as risk factors for NMOSD in an Iranian population.

Background

Almost 10-15% of Multiple Sclerosis (MS) patients suffers from Primary Progressive (PP) subtype of MS. Until now, the possible environmental risk factors of PPMS is not well-known. Based on the modifiable nature of dietary factors, investigation on possible dietary risk factors of diseases is very valuable.

Objectives

We aimed to evaluate the role of dietary food groups intake including dairy, nuts, sea foods, fruits and vegetables during adolescence on the PPMS risk.

Methods

A case-control study was conducted in MS clinics of 16 Azar and Sina hospital which is a referral center for MS in Tehran, Iran. 143 definite PPMS patients according to 2017 McDonald Diagnostic Criteria and 400 healthy subjects were enrolled in the case and control groups, respectively. Dietary habits of participants during adolescence was collected using the questionnaire designed for multinational case-control studies of environmental risk factors in multiple sclerosis (EnvIMS-Q). Each food item converted to gram per day. The daily consumption of each food group was calculated. Food groups stratified in tertiles and logistic regression model adjusted for age, gender, father's ethnicity, mother's ethnicity, mother and father's educational level, was run.

Results

Increased amount of dairy intake (more than 477.29 g/day) in the third tertile resulted in 73% (95% CI: 0.14-0.53) decreased in PPMS risk vs. the first tertile. Sea food consumption had shown a statistically significant reverse association with PPMS risk in both second (OR: 0.48; 95% CI: 0.26-0.90) and third (OR: 0.21; 95% CI: 0.10-0.44) tertile. Higher daily intakes of nuts group in the average range of 0.43-3.86 and 3.89 < led to 72% (95% CI: 0.14-0.55) and 71% (95% CI: 0.15-0.56) reduction in PPMS risk compared with < 0.41 g in the first tertile, respectively. Elevated consumption of fruit and vegetable were associated with lower risk of PPMS. In case of vegetable group this association was founded significant in the 2^nd and 3^rd tertile with the ORs of 0.36 (95% CI: 0.19-0.69) and 0.19 (95% CI: 0.09-0.39), respectively. But for fruits group the result was just significant in the third tertile with the OR of 0.47 (95% CI: 0.22-0.99).

Conclusions

Our data suggested the possible protective role of higher consumption of dairy, sea foods, nuts, fruits and vegetables against PPMS risk.

Background

Multiple sclerosis (MS) is a chronic degenerative neurological disease that has been an increasing prevalence in many countries all over the world. Tehran province is the most populated and capital province in Iran with an increasing MS prevalence.

Objectives

The present study is conducted to estimate the prevalence and assess the epidemiology of MS including familial MS history in Tehran in 2019.

Methods

A cross-sectional study was conducted based on information taken by Iranian MS Society (IMSS) registry system from 1999 to 2019 in Tehran Province, the capital of Iran. All diagnosis approved by neurologists with MS fulfilling McDonald criteria. Individually person fills out a questionnaire relating to baseline characteristic data such as sex, age, familial history of MS and its degree of family and age at disease onset.

Results

A total of 22421 cases were registered at this study, 24.9% were male and 75.1% were female (female/male ratio = 3.016). The mean age of disease onset was 28.92 (SD=8.74). The crude prevalence of MS in 2019 in Tehran was 162.39 cases per 100000 people (244.92 per 100000 in females and 80.58 per 100000 in males). Generally, 469 (6.5%) of cases were below 18 years old, and 10903 patients (48.62%) were between 18 and 40 years old.

Totally, 2982 subjects (13.7%) had a positive family history of MS; among them, 1279 cases (42.58%) with positive family history in their first degree, 471 (15.82%) in their second degree and 896 (30.11%) subjects with positive family history in their third degree family members.

Conclusions

MS is more prevalent among female and young people.

MS prevalence in Tehran has increased (comparing to previous studies) and Tehran is one of the counties with highs prevalence in Asia.

Background

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune demyelinating disease of the central nervous system that predominantly affects the spinal cord and optic nerves, caused by both genetic and environmental factors. The environmental predisposing factors are mainly indeterminate and could have happened long time before the disease presentation.

Objectives

The present study investigated the possible association of socioeconomic status (SES), stressful life events, and ethnicity with NMOSD development after adjustment for relevant confounders in an Iranian population.

Methods

This was a population-based case-control study of 153 NMOSD cases and 400 healthy controls during 2015-2019 in Tehran, Iran. Diagnosis of NMOSD was based on the 2015 International Consensus Criteria. Sex-matched controls with no history of any neurological disorders were selected through the standard method of Random Digit Dialing (RDD). Telephone interviews were administered to gather subjects’ data. Logistic regression was used to estimate adjusted and unadjusted odds ratio (OR) at 95% confidence intervals (CIs) using SPSS software.

Results

In this study NMOSD cases and controls had the mean age (SD) of 37.11 (±10.90) and 33.67 (±8.37) years, respectively (p < 0.001). Experiencing homelessness periods (OR = 4.85; 95% CI (1.24 – 18.87), p = 0.02), family disruption (OR = 12.69; 95% CI ) 3.30 – 48.73), p < 0.001), divorce (OR = 6.20; 95% CI (1.62 – 23.64), p = 0.009) and joblessness (OR = 3.83; 95% CI (1.32 – 11.15), p = 0.01) as stressful life events and positive history of depression (OR = 3.20; 95% CI (1.25 – 8.21), p = 0.01) increased NMOSD risk. Self-rated health status score was higher in controls (p < 0.001). Socioeconomic status (SES), parental ethnicity, and parental educational level during subjects’ adolescence were not associated with NMOSD development risk (P > 0.05).

Conclusions

Stressful life events including homelessness periods, family disruption, divorce, joblessness, and positive history of depression were identified as risk factors for NMOSD development, while marriage was a protective factor. Controls had higher self-rated health status score in comparison to NMOSD subjects. No evidence was found suggesting SES, ethnicity, and parental educational levels as risk factors for NMOSD in an Iranian population.