Author Of 6 Presentations
LB1152 - COVID-19 and lockdown in patients with multiple sclerosis: a descriptive study of prevalence and emotional impact (ID 954)
Abstract
Background
The SARS-Cov2 produced a world-wide health-pandemia situation where people must stay home. People with multiple sclerosis (MS) were considered one of high-risk infection population groups due to their immunological status. This situation may increase the risk of emotional unbalance and produced a high uncertainty for MS patients.
Objectives
To describe medical, demographical and emotional characteristics of a sample from our own MS Unit in a tertiary Hospital in Madrid during lockdown.
Methods
In one month we consecutively interviewed 138 MS patients, collecting information about their demographic characteristics (age, gender, years of education, house-company), their MS (physical disability, treatment, years with MS), the SARS-Cov2 (if they had it, someone living with him, the type of lockdown, protection method used outdoors) and their emotional status (previously to SARS-Cov2, compare to before, about their quality of live (QoL), coping strategies, depression and anxiety). We applied standardized questionnaires for QoL, disability related to health condition and emotion.
Results
The majority of participants were woman (69,9%) middle age (42,8) and high education (71% university), with a low disability (EDSS mode=1) after 10,3 years with MS and under treatment (97%). Smokers as frequent comorbidity (23,9%), they lived with company at home (87%) and they followed lockdown completely (61,6%), using mainly face-mask and gel as outdoors protection. Emotional situation during lockdown was described as “worse than before” in 46,4% but some patients reported feeling better (15,2%). Self-reported health was rated as 67,1 over 100 with a high EQ-5D index (M=0,73) and they were not depressed (M=4,8; SD=3,7) neither anxious (M=6,7; SD= 4,3). Infected-MS patients (only 8 cases) showed significantly higher depression (p=0,039) and lower rating in health (p=0,012) in EQ-5D than non-infected patients, using equivalent coping-strategies and rating similar physical independence.
Conclusions
Despite the immunological special status of MS patients, we found that the prevalence of SARS-Cov2 was really low, as stated in the literature. Our patients were quite responsible with lockdown rules and almost half of them confessed that lockdown affected their emotional status to the worse even though they were not infected. Interestingly, those who reported a positive lockdown indicated that not commuting, slowing down and teleworking improved their QoL significantly.
LB1166 - Risk and outcomes of COVID-19 in patients with multiple sclerosis in Madrid Spain (ID 1480)
- V. Meca-Lallana
- L. Costa-Frossard
- C. Oreja-Guevara
- C. Aguirre
- E. Alba Suárez
- M. Gómez Moreno
- L. Borrega Canelo
- J. Sabín-Muñoz
- Y. Aladro
- A. Cárcamo Fonfría
- E. Rodríguez García
- J. Cuello
- E. Monreal
- S. Sainz de la Maza
- F. Perez Parra
- F. Valenzuela
- C. Lopez De Silanes
- L. Casanova Peño
- M. Martínez-Ginés
- M. Blasco Quílez
- A. Orviz García
- L. Villar
- C. Santiuste
- M. Espiño
- G. Fernandez-Dono
- V. Elvira
- I. Moreno-Torres
Abstract
Background
Infections are an important cause of hospitalization in patients with MS. Data on outcomes of COVID-19 in patients with MS are limited
Objectives
To quantify the risks of infection, hospitalization, admission to intensive care and death due to SARS-CoV-2 infection among patients with MS relative to the general population, and to identify factors associated with risk of hospitalization
Methods
A regional registry was created to collect data on incidence, hospitalization rates, intensive care unit (ICU) admission and death in patients with MS and COVID-19. National government outcomes and seroprevalence data were used for comparison.
Results
Two-hundred nineteen patients with MS were included in the registry, 51 of whom were hospitalized. The infection incidence rate (IR) was lower in patients with MS than the general population (adjusted IR ratio 0.78; 95% confidence interval: 0.70–0.80), but hospitalization rates were higher (adjusted relative risk 6.52 [6.13–7.04]). Disease severity was generally low, with only one ICU admission and five deaths. Males with MS had higher incidence rates and risk of hospitalization than females. No association was found between the use of any disease-modifying therapy (DMT) and hospitalization risk.
Conclusions
Patients with MS do not appear to have greater risks of SARS-CoV-2 infection or severe COVID-19 outcomes compared with the general population. The decision to start or continue DMT should be based on a careful risk-benefit assessment.
P0796 - Cognitive differences in aging patients with multiple sclerosis compared to healthy controls (ID 1851)
Abstract
Background
It´s stated that as we get older, cognitive processes change. Healthy control (HC) and people with multiple sclerosis (MS) share a decrement in speed of processing with age. Nevertheless, demyelinating and neurodegenerative characteristics of MS may implicate neuropsychological differences when analyzing aging.
Objectives
To study the differences in cognitive processes between MS patients and HC when considering two age groups: yound adults and older ones.
Methods
We had two groups: MS from 45 to 55 years old (MS1) and from 56 to 70 (MS2) and a HC group (HC1 and HC2) paired in age and years of education (YoE). We applied a neuropsychological comprehensive battery including Symbol Digit Modality Test (SDMT), PASAT 3”, Spanish California Verbal Learning Test (TAVEC), Spatial Recall Test (SPART), Brief Visual Memory Test (BVMT-R), Five Digit Test (5DT), WAIS-Digits and Corsi and verbal fluency (letter, category and exclusion). Mild (MCI) and moderated (ModCI) cognitive impairment was based on Z scores for the following cognitive domains: speed of processing (SP), attention, working memory, verbal and visual memory and executive functions.
Results
We assessed 137 MS patients, 62,7% women with a mean age of 52.7, secondary education (M=14.3) with a mean Expanded Disability Status Scale (EDSS) of 3.3 (Mode=6), relapsing-remitting MS (82,5%) after a mean of 14,3 years having MS. We also evaluated 34 matching HC. MS patients were MCI (43.1%) followed by no impairment (33.6%) and they were equivalent in age, YoE or EDSS. When comparing groups, HC1 scored higher than HC2 in SDMT (p<0.001), SPART-recall (p=0.21) and they retrieved more words in TAVEC when cued were offered short-term (p=0.024), long-term (p=0.034) and free long-term recall (p=0.043). When MS group was analyzed, MS1 performed better than MS2 in SDMT (P=0.004), total learning in TAVEC (p=0.026 list A and p=0.004 list B), hits and dyads in PASAT (p=0.004 and P=0.01), digits-forward (p=0.035) and exclusion fluency (p=0.014). When comparing the same age group, MS1 scored lower in SMDT, SPART learning and recall compared to HC1. In older group, MS2 showed less hits and dyads in PASAT with higher interference errors and less fluency in exclusion trial compared to HC2.
Conclusions
Cognitive ageing for MS patients is different: as HC, they get slower when processing information but they also perform worse in verbal and visual learning tasks together with executive functioning, whereas for HC the cognitive deficit is more memory-specific related. When younger, MS were equal to HC but slower. When older, MS displayed dysexecutive aspects instead of mainly amnesic ones. The added cognitive features of the older MS group support the idea of an added subcortical damage, responsible of a frontal-like neuropsychological profile.
P0801 - Default Mode Network functioning and Multiple Sclerosis: the importance of phenotypes and cognition (ID 1661)
Abstract
Background
There is controversial data on the differential activity of the default mode network (DMN) in patients with Multiple Sclerosis (MS), and how it is linked to cognitive status. For some authors, there could be an initial hypercompensation, followed by a late exhaustion of the DMN. More research is needed to clarify how those changes may be related to cognition and the different phenotypes of MS.
Objectives
To evaluate the functional connectivity of DMN of MS patients with different phenotypes (relapsing-remitting (RR), clinically isolated syndrome (CIS) and primary progressive (PP) compared to healthy controls (HC).
Methods
Sixty-two participants (16 HC, 16 RR, 15 CIS and 14 PP) were evaluated with a neuropsychological battery to establish their cognitive profile. A functional magnetic resonance (fMRI) with a seed-to-voxel approach was performed to study the DMN, as defined by the Human Connectome Project. We selected four regions of interest: Posterior cingulated cortex (PCC); Medial prefrontal cortex (MPFC); Lateral parietal cortex Left (L-LPC) and Lateral parietal cortex Right (R-LPC). Correlation of their functional connectivity was analyzed considering different groups according to the MS phenotype.
Results
MS patients and HC were equivalent in age, years of education and gender. A 35,5% of MS patients were cognitively preserved, whereas 24(64,5%) had cognitive impairment: 12 were mild(MCI) and 12 moderate(ModCI). RR patients were significantly younger (M=37,9 old; SD=7,3) compared to CIS (M=40,8; SD=9,9) and PP (M= 49,4; SD=7,8). CIS patients had a shorter duration of MS (M=4,3 years; SD=3,9; p=0,013) compared to RR (age M=9,5; SD=5,6) and PP (M=9,9; SD=6,9). Groups were not homogeneous in terms of physical disability, being PP the most disabled (Mode=6) vs RR (Mode=2) or CIS (Mode=0). Regarding global DMN connectivity, no differences were found between HC and MS patients. However, when focusing on phenotypes, we found that CIS had a trend to a higher connectivity than HC and that connectivity steadily decreased though RR to PP, so that PP activity was significantly lower than that of CIS (p=0,019). No differences were found based on cognitive impairment. Antero-posterior connectivity was significantly higher for CIS than RR (p=0,017) and PP (p=0,018); and in cognitively preserved vs ModCI (p=0,03).
Conclusions
Our data supports the dynamic theory for functional connectivity that suggests an initial overcompensation followed by a gradual decline, which is elicited by studying MS phenotypes. Within the DMN, anterior-posterior connectivity was related to a worse cognitive performance.
P0939 - Antibody titters against EBV and HHV-6A/B and expression of MSRV ENV in the serum of pregnant multiple sclerosis patients (ID 1197)
Abstract
Background
Pregnancy is a special period within the clinical course of multiple sclerosis (MS), characterized by a reduction in the relapse rate and slower disease progression. On the contrary, during puerperium, relapse rate increases again. Viruses have been related to the etiopathogenesis of the disease, especially with disease activity.
Objectives
To analyse the serum antibody titters against Epstein-Barr virus (EBV) (EBNA-1 and VCA) and human herpesvirus 6 A/B (HHV-6A/B), as well as the expression of the envelope protein of the MS-associated retrovirus (MSRV ENV) in pregnant MS patients during pregnancy and postpartum. To study their possible relationship with the disease activity during pregnancy and postpartum, as well as their potential role in predicting the risk of relapses.
Methods
Serum samples were collected from 71 pregnant women, 50 with MS and 21 healthy controls, at every trimester of pregnancy and in the postpartum. Antibody titters against the above mentioned viruses were analysed by ELISA commercial kits, following manufacturer instructions; gene expression of MSRV ENV was analysed by qRT-PCR.
Results
IgM titres against HHV-6A/B were higher in MS patients than in healthy controls in the three trimesters of pregnancy and in the postpartum period (U-Mann Whitney): p =0.00001 for the first trimester; p=0.021 for the second trimester; p = 0.000005 for the third trimester; p =0.001, for the postpartum period). Furthermore, IgM titres against HHV-6A/B in the first trimester were higher in patients with relapses (U Mann Whitney, p = 0.052). Regarding the expression of MSRV ENV, the percentage of positivity during the first trimester was significantly higher in MS patients with relapses during pregnancy compared to those who did not (Fisher, p = 0.038).
Conclusions
High IgM titters against HHV-6A/B and the expression of MSRV ENV during the first trimester of pregnancy could act as predictors of relapse risk during pregnancy / postpartum. Although further studies are needed to validate these results, this study support the relation between viruses and relapses in pregnant MS patients.
P1138 - short-chain fatty acid during pregnancy in multiple sclerosis: a prospective cohort study (ID 1801)
Abstract
Background
Objective: Pregnancy reduces the annualized relapse rate (ARR) in multiple sclerosis (MS). However it is temporarily increased at puerperium. The exact mechanism underlying this clinical observation remains unknown.
Objectives
We aimed to explore the changes of the short-chain fatty acids (SCFAs) profiles in MS patients and healthy women (HCW) during pregnancy, and to assess any potential biomarker predicting the appearance of relapses during pregnancy and postpartum.
Methods
Methods: We included 53 pregnant MS patients and 21 HCW followed at Hospital Universitario Gregorio Marañón between 2007 and 2018. Patients were evaluated at every trimester of pregnancy and in the puerperium. Serum SCFAs were measured by liquid chromatography-mass spectrometry
Results
Results: Seventeen patients (32%) experienced relapses during pregnancy or puerperium (ACT group) and 37(68%) did not (NO-ACT group). We did not found differences in clinical characteristics or treatment status between the two groups. We observed differences in the SCFAs profile between ACT:NO-ACT groups during pregnancy and puerperium. Acetate levels were higher during the pregnancy-puerperium period in MS patients, regardless of clinical activity, compared to HCW (p: 0.0001). Interestingly, levels of propionate and butyrate below 1,985 μM (1,283 - 3.55) and 0.515 μM (0.01-2.943) respectively during the first trimester were associated with relapses during the pregnancy-puerperium period (p: 0.0001). The ACT group had a lower ratio of propionate/acetate and butyrate/acetate during pregnancy compared to NO-ACT group (<0.0001). The ROC curve showed that a propionate/acetate ratio of 0.36 (AUC 0.96, sensitivity 94%, specificity 92%;) has an OR=165 [CI: 10.2-239.4], p <0.0001) to predict relapses during pregnancy-puerperium.
Conclusions
Conclusions: SCFA levels during pregnancy may be associated with clinical activity in MS, and that their measurement could be useful in predicting the occurrence of relapses during this pregnancy-puerperium period
Presenter Of 1 Presentation
P1138 - short-chain fatty acid during pregnancy in multiple sclerosis: a prospective cohort study (ID 1801)
Abstract
Background
Objective: Pregnancy reduces the annualized relapse rate (ARR) in multiple sclerosis (MS). However it is temporarily increased at puerperium. The exact mechanism underlying this clinical observation remains unknown.
Objectives
We aimed to explore the changes of the short-chain fatty acids (SCFAs) profiles in MS patients and healthy women (HCW) during pregnancy, and to assess any potential biomarker predicting the appearance of relapses during pregnancy and postpartum.
Methods
Methods: We included 53 pregnant MS patients and 21 HCW followed at Hospital Universitario Gregorio Marañón between 2007 and 2018. Patients were evaluated at every trimester of pregnancy and in the puerperium. Serum SCFAs were measured by liquid chromatography-mass spectrometry
Results
Results: Seventeen patients (32%) experienced relapses during pregnancy or puerperium (ACT group) and 37(68%) did not (NO-ACT group). We did not found differences in clinical characteristics or treatment status between the two groups. We observed differences in the SCFAs profile between ACT:NO-ACT groups during pregnancy and puerperium. Acetate levels were higher during the pregnancy-puerperium period in MS patients, regardless of clinical activity, compared to HCW (p: 0.0001). Interestingly, levels of propionate and butyrate below 1,985 μM (1,283 - 3.55) and 0.515 μM (0.01-2.943) respectively during the first trimester were associated with relapses during the pregnancy-puerperium period (p: 0.0001). The ACT group had a lower ratio of propionate/acetate and butyrate/acetate during pregnancy compared to NO-ACT group (<0.0001). The ROC curve showed that a propionate/acetate ratio of 0.36 (AUC 0.96, sensitivity 94%, specificity 92%;) has an OR=165 [CI: 10.2-239.4], p <0.0001) to predict relapses during pregnancy-puerperium.
Conclusions
Conclusions: SCFA levels during pregnancy may be associated with clinical activity in MS, and that their measurement could be useful in predicting the occurrence of relapses during this pregnancy-puerperium period