Background

Neuromyelitis optica spectrum disorder is an inflammatory astrocytopathy disorder of the central nervous system (CNS) which the interaction between T cells and B cells is suggested for its development. Interleukin 17 (IL-17) is one of the pro-inflammatory cytokines that could affect T cells activity. But there is a limited data on the serum levels of IL-17 in NMOSD patients.

Objectives

In this study we aimed to compare the serum levels of IL-17 as a pro-inflammatory factor in NMOSD patients and healthy subjects.

Methods

A population-based case-control study was conducted on 56 NMOSD patients and 100 healthy controls. NMOSD patients were selected from NMOSD specialist clinic of Sina hospital, which is a referral center for NMOSD in Tehran, Iran. NMOSD diagnosis was based on the 2015 international consensus criteria and only patients with NMO-IgG seropositive status were included in the study. Age and sex matched controls were gathered from healthy population from all municipality zones of Tehran. Serum levels of participants were assessed by the enzyme-linked immunosorbent assay (ELISA) test. The difference between the serum levels of IL-17 in case and control groups were evaluated by independent samples T-test and univariate model adjusted for age, gender and body mass index (BMI). Data distribution was not normal, so IL-17 levels are reported as Ln.

This study was supported by the National Institute for Medical Research Development (NIMAD) [grant number 973227].

Results

89.3% of participants in case group and 93.0% in control group were women. The mean (SD) ages of subjects in case and control groups were 35.89 (9.39) and 37.40 (6.68) years old, respectively (P: 0.29). No significant differences was found regarding BMI between study groups (BMI in case group: 26.61 ± 5.15; in control group: 26.82 ± 5.45 Kg/m² (P: 0.81)).

The mean (SD) levels of Ln serum IL-17 in NMOSD patients was 2.01 (1.18) pg/mL which was significantly higher than control group with the mean Ln serum levels of 1.11 (0.81) pg/mL (P <0.001). This difference was also significant in univariate model adjusted for age, gender and BMI (P <0.001).

Conclusions

This investigation suggested the possible role of IL-17 in NMOD development and also elevated serum level of IL-17 as a diagnostic criteria for NMOSD.

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

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.