Showing 14 results for Multiple Sclerosis
Tayebeh Latifi, Majid Teymoori-Rad, Ahmad Nejati, Shohreh Shahmahmoodi, Farhad Rezaei, Sayed Mahdi Marashi,
Volume 0, Issue 0 (1-2024)
Abstract
Background: HERV-K env is associated with several neurological disorders, including MS. Clinical studies have demonstrated a plausible interaction between HERV-K env and other MS risk factors. The present study aimed to investigate the possible association between HERV-K18 env and TGF-β. We further assessed the in vitro effect of EBV infection on HERV-K18 env expression in the presence and absence of vitamin D in MS patients.
Methods: PBMCs from 20 MS patients and 20 healthy controls were infected with the B95.8 EBV, seeded into 24-well plates and incubated in the presence or absence of 100 nM of 1,25(OH)D3. The expression levels of HERV-K18 env and TGF-β were measured using real-time PCR.
Results: While the expression level of HERV-K18 env was significantly higher in MS patients than the healthy controls, this trend for TGF-β was significantly reverse. Interestingly, an inverse correlation was found between HERV-K18 env and TGF-β expression in MS patients, although the in vitro stimulation of PBMCs with EBV and vitamin D showed no significant differences in terms of HERV-K18 expression.
Conclusion: Our findings highlight the potential role of HERV-K18 env in MS patients.
Maryam Soleimani, Seyed Behnamedin Jameie, Mahmood Barati, Mehdi Mehdizadeh, Mahdieh Erdari,
Volume 18, Issue 4 (10-2014)
Abstract
Background: Multiple sclerosis (MS) is known as a progressive central nervous system inflammatory disease. Certain factors, such as interleukins, inflammatory cells, and oxidative stress are supposed to involve in MS etiology. Because of the important role of oxidative stress, antioxidant therapy for MS has received more attention. Although coenzyme Q10 (CoQ10) acts as an antioxidant, there is a lack of enough research on its effects on MS. Therefore, the present research was designed. Methods: C57BL/6 female adult mice (n = 30) were used in this study. The animals were randomly divided into trial and control groups. To induce MS, routine procedure for experimental autoimmune encephalomyelitis (EAE) was used, and scoring was performed based on clinical signs. By detecting score one, CoQ10 administration was started (10 mg/kg/three weeks). By using ELISA and real-time PCR, the brain levels of TNF-gamma, IL-10, IL-4, and IL-12 were studied. Statistical tests were used to analyze the data and the P value less than 0.05 was considered to be significant. Results: Clinical symptoms in EAE animals were significantly decreased (P<0.05) as compared to control ones. In addition, the level of the TNF-gamma was significantly decreased following CoQ10 administration versus IL-10. The ratio of TH1/TH2 interleukins in treated animals was significantly less than that in non-treated animals (P<0.01). Conclusion: Our findings showed that CoQ10 is capable of suppressing the inflammatory pathway of MS.
Mohsen Marzban, Kazem Mousavizadeh, Masoomeh Bakhshayesh, Nasim Vousooghi, Gelareh Vakilzadeh, Anahita Torkaman-Boutorabi,
Volume 22, Issue 5 (9-2018)
Abstract
Background: Bone marrow mesenchymal stem cells (BM-MSCs) elicit neuroprotective effects, and their repair ability has been investigated in different experimental models. We aimed to investigate the effect of multiple i.p. BM-MSCs injections in the cuprizone model of multiple sclerosis in mice. Methods: Adult male C57BL/6 mice (n = 40) were fed a regular diet or a diet containing cuprizone (0.2% w/w) for 6 six weeks. Bone marrow samples were taken from patients with spinal cord injury. BM-MSCs (2 × 106 in 1 milliliter medium) were administered intraperitoneally for two consecutive weeks at the end of the forth weeks of cuprizone administration. Animals (n = 12) were perfused with 10% paraformaldehyde at the end of sixth week. The brains were sectioned coronally in 6-8-μm thickness (-2.3 to 1.8 mm from bregma). The sections were stained by luxol fast blue-cresyl violet, and images were captured via a microscope. Demyelination ratio was estimated in corpus callosum in a blind manner. A quantitative real-time PCR was used to measure the myelin basic protein gene expression at sixth week. Results: Histologically, cuprizone induced demyelination in the corpus callosum. Demyelinated area was diminished in the corpus callosum of cell-administered group. Cuprizone could decrease myelin-binding protein mRNAs expression in corpus callosum, which was significantly recovered after BM-MSCs injections. Conclusion: Our data indicated a remyelination potency of multiple i.p. BM-MSCs in the cuprizone model of multiple sclerosis in mice.
Valiollah Moradi, Ebrahim Esfandiary, Mustafa Ghanadian, Nazem Ghasemi, Bahman Rashidi,
Volume 26, Issue 4 (7-2022)
Abstract
Background: Multiple sclerosis (MS) is the most prevalent neurological disability of young adults. Anti-inflammatory drugs have relative effects on MS. The anti-inflammatory and antioxidative effects of Zingiber officinale (ginger) have been proven in some experimental and clinical investigations. The aim of this study was to evaluate the effects of ginger extract on preventing myelin degradation in a rat model of MS.
Methods: Forty nine male Wistar rats were used in this study and divided into four control groups: the normal group, cuprizone-induced group, sham group (cuprizone [CPZ] + sodium carboxymethyl cellulose [NaCMC]), standard control group (fingolimod + cuprizone), including three experimental groups of CPZ, each receiving three different doses of ginger extract: 150, 300, and 600mg/kg /kg/day.
Results: Ginger extract of 600 mg/kg prevented corpus callosum from demyelination; however, a significant difference was observed in the fingolimod group (p < 0.05). Difference in the CPZ group was quite significant (p < 0.05).
Conclusion: Treatment with ginger inhibited demyelination and alleviated remyelination of corpus callosum in rats. Therefore, it could serve as a therapeutic agent in the MS.
Sara Manochehri , Zohreh Manochehri , Tayebeh Lorestani , Maryam Zamani ,
Volume 28, Issue 0 (12-2024)
Abstract
Introduction: Multiple sclerosis (MS) is a neurological disease that destroys the insulating covering of nerve cells. It is the third leading cause of disability after trauma and rheumatism. Studies have shown that the main cause of MS is not fully understood, and it is believed to be influenced by a combination of unknown genetic and environmental factors. Considering the ability of machine learning techniques, such as decision trees, to identify significant factors related to diseases, this study aimed to investigate various factors related to MS using the decision tree method.
Methods and Materials: This analytical and modeling study was conducted using the MS disease dataset. The data were obtained from the health registration system at Kermanshah University of Medical Sciences. A total of 317 individuals were studied from May 2016 to September 2017, comprising 188 individuals diagnosed with MS and 128 healthy controls. Magnetic resonance imaging was utilized for disease diagnosis. The data were processed in the R 4.0.3 software environment. The variables analyzed included gender, age, family history of MS, trauma, bowel disease, rheumatism, infectious disease, stress, depression, anxiety, migration, vitamin D deficiency, and smoking. The decision tree method and the gain ratio index were employed to assess the significance of factors influencing MS disease.
Results: According to the results, female gender, family history of MS, history of stress, vitamin D deficiency, and infectious disease with indices of 21.3, 18.94, 17.2, 15.78, and 15.21 were among the factors affecting MS disease.
Conclusion and Discussion: Three significant environmental factors associated with MS include a history of stress, a deficiency in vitamin D, and exposure to infectious diseases. Therefore, both individuals and service providers need to be aware of these factors to prevent the progression and exacerbation of its symptoms.
Mehrdad Shahrani Korrani, Negar Khalili Geshnigani, Fatemeh Azizi Farsani, Maryam Anjomshoa, Najmeh Asgharzadeh, Seyed Ali Hosseinian ,
Volume 28, Issue 0 (12-2024)
Abstract
Introduction: Multiple Sclerosis (MS) is an inflammatory autoimmune disease in which the myelin sheaths of nerve cells are damaged in the brain and spinal cord. Cognitive changes, including memory impairment, are common in MS patients, and there is still no definitive treatment available. Plants of the genus Astragalus from the legume family contain more than 900 species of annual and perennial herbaceous plants in Iran, most of which are endemic to the region. Recent studies have shown that the Astragalus has antioxidant, neuroprotective, and anticonvulsant effects. Anzerut is a species on which limited studies have been conducted. Considering the various biological effects of the Astragalus genus, we aimed to investigate the impact of Anzerut on spatial memory impairment in a rat model of MS.
Methods and Materials: In the present study, 42 male rats weighing between 230-280 g were randomly divided into six groups of seven rats each. Ethidium bromide was used to induce MS. Then, doses of 150, 450, and 800 mg/kg of Anzerut extract were administered intraperitoneally for 14 days. Behavioral testing using the Morris water maze, hippocampal malondialdehyde (MDA) level measurement, and total antioxidant capacity were evaluated. Finally, one-way ANOVA followed by Tukey's test will be used to compare the data.
Results: The injection of ethidium bromide caused a significant decrease in the time spent (p = 0.01) and distance traveled (p = 0.001) in the target quadrant on the test day compared to the control group. Treatment with Anzerut at a dose of 150 mg/kg for 14 days significantly increased the time spent and distance traveled (p = 0.05) in the target quadrant on the test day compared to the MS group. Additionally, the injection of ethidium bromide resulted in a significant increase in hippocampal MDA level and a decrease in the total antioxidant capacity of the hippocampus.
Conclusion and Discussion: The injection of ethidium bromide into the CA1 region of the hippocampus induces MS, while the administration of Anzerut extract improves learning and memory in the experimental MS model. This effect appears to be mediated through antioxidant pathways in the brain.
Mohammad Mehdi Kanani, Shahla Abolhassan, Fatemeh Nazari, Fatemeh Nabi,
Volume 28, Issue 0 (12-2024)
Abstract
Introduction: Multiple Sclerosis (MS) is currently a leading cause of neurologic disabilities, especially among young adults. Various disease-modifying drugs (DMDs) are available, aimed to slow down the progression of symptoms. Despite the success of DMDs through the last decade, treatment adherence has remained a challenge in MS care and management. Although there are self-reported, quantitative measures for treatment adherence, they cannot predict and determine the underlying causes of non-adherence. Therefore, self-reported questionnaires are more informative in clinical settings. The Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ) is the only specifically designed instrument to assess treatment adherence in MS patients. This study evaluated the validity and reliability of the Persian translation of MS-TAQ. Methods and Materials: The back-translation method was employed for proper translation with maximum precision in the first phase. In the second phase, face validity was evaluated by qualitatively distributing the questionnaire to 10 MS patients. Quantitative face validity was analyzed using the impact score. The content validity was assessed by a panel of 20 faculty members, qualitatively by interview and quantitatively using both content validity ratio and content validity index. The final validated version was given to another 10 MS patients to evaluate internal consistency by Cronbach's alpha.
Results: The Persian translation was carried out by an English translator, the backward translation to English was performed by a native English speaker who was also fluent in Persian, and a third English expert approved the original English version of MS-TAQ. In the face validity assessment, 10 MS patients were interviewed, and their comments were applied. No item was removed in face validity, as no items had an impact score of less than 1.5. The panelists' comments in the content validity assessment were also applied, with six items added in the qualitative section and five removed in the quantitative assessment. The Cronbach's alpha was 0.8 for the whole questionnaire.
Conclusion and Discussion: MS-TAQ is a reliable and validated instrument for treatment adherence assessment in Iranian MS patients. Further evidence is needed to validate the construct of MS-TAQ, which is an ongoing part of this study in selected hospitals affiliated with Isfahan University of Medical Sciences.
Ailin Khosroshahi, Behnam Golabi, Hadis Razmaray, Sepideh Yasmin Moghaddam Seyedi-Sahebari, Zahra Hakimzadeh, Seyedeh Ziabari, Negar Aghaei, Sarvin Sanaie, Mahnaz Talebi, Amirreza Naseri,
Volume 28, Issue 0 (12-2024)
Abstract
Introduction: Multiple sclerosis (MS) is a disabling condition of the central nervous system. Signs and symptoms vary widely between patients. Fatigue, visual abnormalities, muscle spasms, pain, depression and anxiety, bladder problems, cerebellar dysfunction, and cognitive dysfunction are the most common presentations of MS. Sleep disturbance is a prevalent manifestation in MS patients, even in patients with a low level of disability. Poor sleep quality, and insomnia are found to be more prevalent in MS. Through this, a possible connection between sleep status and cognitive function is suggested in the literature.
Search Strategy: PubMed, Scopus, Embase, and Web of Science databases were searched. All original clinical studies delineating the relationship between sleep status and cognitive findings in MS patients were included in this systematic review. The following terms were utilized in database: “Sleep” AND “Multiple sclerosis”. Discrepancies were resolved by discussion or decided upon by a third reviewer. A data extraction table comprising authors' surname, publication date, study design, setting, sample size, age, female ratio, severity and phenotype of MS, scales about cognitive and sleep-related assessment, result and conclusion was designed.
Results: In the final review, of 1,633 screened records, 33 studies with 5,145 participants were included. Pittsburgh Sleep Quality Index , Epworth Sleepiness Scale, and polysomnography were the most common assessment tools for evaluation of sleep condition, and cognitive evaluations were conducted using the Paced Auditory Serial Addition Test, California Verbal Learning Test, Symbol Digit Modalities Test, and Brief Visuospatial Memory Test. Assessing the quality of studies showed no significant bias in most of the included articles.
Conclusion and Discussion: Only four studies found no correlation between sleep and the cognition assessment scales. We also understood that subjective assessments of sleep quality and cognitive dysfunction in MS patients do not precisely match up with their objective measurements in samples. One study concluded associations between sleep duration and cognitive performance in patients with brain injury. A review study came to the conclusion that sleep disorder is common and is a predictor of cognitive impairment in the elderly and in adults with neurodegenerative diseases.
Mehrad Amirnia, Khazar Raeisnia, Hamidreza Ashayeri, Zahra Hakimzadeh, Ehsan Nasiri, Mahnaz Talebi, Sarvin Sanaie, Amirreza Naseri,
Volume 28, Issue 0 (12-2024)
Abstract
Introduction: Multiple sclerosis (MS) is an immune-mediated disease with several etiological origins. Caffeine is an adenosine receptor antagonist in the central nervous and immune systems. Due to the pharmacologic properties of caffeine, it has neuroprotective and anti-inflammatory features. These propose a potential influence on MS risk, but the studies investigating the effect of coffee on MS development show conflicting results. This study aimed to assess existing clinical evidence on the association between caffeine consumption and the risk of MS.
Search Strategy: A comprehensive search was conducted in databases, including PubMed, Scopus, Web of Science, and Embase, to cover all articles published up to January 2024 using the following strategy for PubMed: ("Coffee" [Mesh] OR "Caffeine" [Mesh] OR Coffee OR Caffeine OR Vivarin OR Caffedrine OR Coffeinum) AND ("Multiple Sclerosis" [Mesh] OR "Multiple sclerosis"). No restriction on search date, language, or country of origin was applied during the search. Also, the reference lists and citations of the included studies and related review articles were checked.
Results: Among 604 initial records, 10 studies (eight case-control studies, one cohort, and one Mendelian randomized study) with 19,430 participants met the inclusion criteria. The included case-control studies showed an overall high quality (4 scored 100% and 4 scored 90%). Our meta-analysis showed reduced MS development in coffee consumers (OR: 0.66). The protective effects of coffee were also higher in the groups consuming at least three cups daily compared to those consuming less than three cups (OR: 0.83).
Conclusion and Discussion: The current evidence on the impact of caffeine on MS risk is inconclusive, with studies showing both protective and neutral effects. Coffee consumption, especially in high doses, may decrease the risk of MS; however, the variability in outcomes highlights the influence of study design, demographic factors, and methodological approaches in assessing dietary impacts on disease incidence. Further well-designed prospective studies are required to clarify the role of caffeine in MS pathophysiology and to explore potential protective or predisposing effects on its incidence.
Sepideh Seyedi Sahebari, Mahnaz Talebi, Amirreza Naseri, Maliheh Talebi,
Volume 28, Issue 0 (12-2024)
Abstract
Introduction: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Findings have shown that cognitive impairment in the early stages of the disease may appear as the first symptom of MS. Cognitive disorders can affect up to 70% of patients and are present in 40-20% of patients in the early stages of the disease. Memory, processing speed, attention, episodic memory, and executive functions are the cognitive domains that are primarily impaired in MS patients. In this study, we aimed to evaluate the global and domain-specific cognitive impairment in MS patients based on the Cambridge Neuropsychological Test Automated Battery (CANTAB).
Methods and Materials: In this cross-sectional study, 124 MS patients who visited the outpatient neurology clinics of Tabriz University of Medical Sciences between 2022 and 2023 were included. CANTAB was used to evaluate the patients cognitively. In addition to the Motor Screening Task, four nonverbal cognitive subtests from the CANTAB were utilized: paired-associate learning, rapid visual information processing to assess sustained attention and reaction time, and the Spatial Working Memory test, which measures participants’ ability to retain and manipulate visuospatial information. Impaired functions in at least three domains were defined as cognitive impairment. The statistical analysis was carried out through the 23rd version of SPSS. The normality of distributions was assessed using the Kolmogorov–Smirnov test, and based on the normality, numeric values were reported in mean ± SD or median (quartiles) and compared using the independent sample t-test or Mann-Whitney U test. Categorical variables were reported in number (percentage) and compared using the chi-square test.
Results: Among 124 MS patients with a median age of 31 (26.25-37.75) years, 93 (75%) were female, and 49 (39.5%) were cognitively impaired. The disease phenotype was relapsing-remitting phenotype in 112 (90.3%) patients. Regarding sex, there was not any significant difference between the two groups of cognitively impaired (females: 40 [81.6%]) and cognitively intact patients (females: 53 [70.7%]), with a p value of 0.16. There was a significant difference in age of patients between the two groups (cognitively impaired: 37 [24-44]; cognitively not impaired: 28 [24-34.5]; p = 0.01). Also, the progressive form of the disease was more frequent in the cognitively impaired group (16.3% vs. 5.3%; p = 0.04). We could not find a statistically significant difference regarding disease duration between the two study groups (cognitively impaired: 120 [36-165] months; cognitively not impaired: 48 [21-108]), with a p value of 0.08.
Conclusion and Discussion: MS who are older and have a progressive form of the disease exhibit a higher prevalence of neuropsychiatric dysfunctions. However, gender does not affect these dysfunctions. We could not find a relationship between disease duration and cognitive impairment in this study, which could be due to the small sample size.
Fatemeh Shaban, Alireza Khajehpour, Narges Safari, Mahdieh Razi,
Volume 28, Issue 0 (12-2024)
Abstract
Introduction: Multiple sclerosis (MS) is a progressive, debilitating disease that results in a variety of neurological disorders, including cognitive and motor deficits that are associated with impaired daily functioning and reduced quality of life. Rehabilitation programs can significantly improve motor and cognitive function in MS patients. Treadmill training with virtual reality (TT-VR), performed by placing the patient on a treadmill and creating a game or personalized environment, has been investigated as a new cognitive and motor rehabilitation tool. This study examines the potential role of VR in the rehabilitation of MS patients through treadmill training.
Search Strategy: A PRISMA-based search was performed using four databases: PubMed, Scopus, Web of Science, and Google Scholar. The search period was from 2015 to 2024 with keywords "treadmill training," "virtual reality," and "multiple sclerosis." In the initial search, 30 articles were found. After removing duplicates and reviewing the titles and abstracts, six articles with entry conditions, including multiple sclerosis studies, virtual reality, treadmill training and synonyms, compliance with the specified publication period, and RCTs, were included in the study. Exclusion criteria also included any violation of the input parameters.
Results: The included studies demonstrate that TT-VR significantly enhances walking speed, kinematics, and kinetics, indicating increased functional abilities. Furthermore, TT-VR improves walking performance when crossing obstacles and complex conditions and spatiotemporal parameters of walking and balance. It also positively influences multiple aspects of cognitive function and mental health, improving learning and educational outcomes. This exercise is also safe and applicable for MS patients who have moderate disability.
Conclusion and Discussion: Creating a personalized environment, enhancing patient adherence to the rehabilitation process, and facilitating functional and cognitive aspects can make TT-VR a valuable addition to the rehabilitation environment. Nevertheless, further studies with more extended follow-up periods are necessary to ascertain the efficacy of this exercise in mitigating the disease process (either by reducing its severity or even reversing it).
Zahra Sabahi, Amirreza Naseri, Malihe Talebi, Mahnaz Talebi, Sina Ranjbar Gharajeh,
Volume 28, Issue 0 (12-2024)
Abstract
Introduction: Multiple sclerosis (MS) is a demyelinating, central nervous system inflammatory disease. Optic neuritis (ON) is inflammation of the optic nerve and occurs in 20% of patients at disease onset and up to 80% throughout the disease. This cross-sectional study aimed to investigate the association between visual evoked potentials (VEP) and performance on the Cambridge Neuropsychological Test Automated Battery (CANTAB) in relapsing-remitting MS (RRMS) patients.
Methods and Materials: 133 RRMS patients were recruited from an MS cognition clinic in Tabriz, Iran, between 2022 and 2023. Participants underwent VEP testing and based on the rapid visual information processing (RVP) subtest of CANTAB, patients were divided into two groups (impaired [RVP-I] and non-impaired [NI-RVP]), and VEP outcomes were compared between the groups of the study. All statistics were applied using the 27th version of SPSS. Considering the lack of normal distributions based on the Kolmogorov–Smirnov test, numeric values are presented in median [IQR], and non-parametric tests (Mann-Whitney U test and Spearman correlation) were utilized. Categorical variables were compared using the Chi-Square.
Results: Of 133 included participants in the total sample, 99 (74.4%) were female, and 34 (25.6%) were male. Fifty-seven patients (42.8%) had CI, and 76 (57.1%) were in the NCI group. VEP left latency (RVP-I: 116.68 [26.95], RVP-NI: 112.32 [13.40]; p = 0.02) was significantly higher in the RVP-I group, and VEP left latency118 was more prevalent in RVP-I group (47.5% vs. 30.2%; p = 0.047). There was no significant difference between the groups regarding the VEP correct latency (RVP-I: 116.20 [22.23], RVP-NI: 113.00 [16.45]; p = 0.18), VEP amplitudes (data are not presented; p = 0.05). There was a positive correlation between the RVP and VEP Left Latency (Correlation r = 0.227, p = 0.010). Conclusion and discussion Our findings revealed a relationship between optic neuritis and visual information processing speed in RRMS.
Zahra Abdi, Amirreza Naseri, Reza Mosaddeghi Heris, Hanie Karimi, Anahita Najafi, Mir Sobhan Mousavi, Mahnaz Talebi, Sarvin Sanaie, Wolfgang Marx, Sanaz Hamedyazdan, Mostafa Araj Khodaei,
Volume 28, Issue 0 (12-2024)
Abstract
Introduction: Multiple sclerosis (MS) is a chronic and progressive disease of the central nervous system characterized by chronic inflammation, myelin degradation of nerve cells by the immune system, and the formation of plaques in the nervous system. Fatigue is one of the significant issues for patients with MS, but usually, it gets neglected. This study aimed to determine the effect of hydroalcoholic extract of flaxseed and Nigella sativa herbal plants on the fatigue status of MS patients.
Methods and Materials: In this clinical trial study, relevant questionnaires were completed to select the patients who meet the study criteria. Inclusion criteria required a diagnosis of RRMS, an EDSS score of less than 4, age 18 or older, and informed consent. Exclusion criteria included inability to access health information, recent disease relapse, substance abuse, smoking, alcohol use, recent vitamin D supplements, pregnancy, specific medication use, and dissatisfaction with participation. After the initial assessment, 50 patients were ultimately included in the study. These participants were divided into two groups: one group receiving hydroalcoholic extracts of flaxseed and Nigella sativa herbal plants (25 patients) and the other group receiving the placebo (25 patients). Following the intervention period, patients who did not follow up 3 months after receiving the intervention were excluded from the analysis. This led to a final inclusion of 36 patients, with 17 patients from the intervention group and 19 from the control group. Data were analyzed using SPSS 22, employing descriptive statistics and analytical methods such as t-test, Mann-Whitney U-test, and Chi-square.
Results: The results of the study showed that there was no significant difference in physical function (EDSS before:1.5[2.8] vs. 1[1], p = 0.08 and EDSS after: 1.5[2.9] vs. 1[2], p = 0.22) and cognitive function (SDMT before: 50[38] vs 47[35], p = 0.98 and SDMT after:60[39] vs 51[25], p = 0.42) between the two groups before and after the treatment period, indicating the ineffectiveness of the supplement in improving the fatigue status and overall health of the patients. The only difference between the study groups was the overall fatigue status of the patients (90[40] vs 60[80], p = 0.03), which was also observed before the intervention (90[35] vs 65[70], p = 0.03). The study groups had no significant difference in pain, stress, anxiety, sleep problems, nutrition problems, and walking difficulties (p = 0.05).
Conclusion and Discussion: The results of this study showed that a 3-month consumption of hydroalcoholic extract of flaxseed and Nigella sativa herbal plants did not significantly improve the fatigue status of MS patients.
Sina Pakkhesal, Amirreza Naseri, Amir Mohammad Sharafi, Rasa Beheshti, Saman Baharomid, Zahra Koochaki, Fatemeh Amiri, Mahnaz Talebi, Sarvin Sanaei,
Volume 28, Issue 0 (12-2024)
Abstract
Introduction: Cognitive impairment, as a common symptom of multiple sclerosis (MS), significantly impacts the quality of life of MS patients. In this context, cannabis-based medications (CBMs) have been investigated as a therapeutic option for managing various symptoms of MS, including cognitive dysfunction. Previous systematic reviews provided limited conclusions regarding cognitive outcomes. The present study aimed to provide an updated systematic review and meta-analysis of the existing clinical evidence on the effects of CBMs on cognitive functions in individuals with MS.
Search Strategy: A comprehensive literature search was conducted in May 2024 in major electronic databases, including Web of Science, Embase, Scopus, PubMed, and clinicaltrials.gov, with no time limit. A search strategy based on the terms of randomized-controlled trials (RCTs) evaluating the impact of CBMs on cognitive outcomes/adverse effects in MS patients was considered. Risk-of-bias was assessed using the Cochrane RoB2 tool. Meta-analysis was conducted using Comprehensive Meta-Analysis v3, and a fixed-effects model was used to estimate the pooled effect size. The whole process was according to PRISMA.
Results: From 1,274 primary results, 10 RCTs were included in the qualitative review, and 13 RCTs were included in test-based (331 patients) and event-based (1,232 patients) analyses. The event-based meta-analysis of the attention disturbances showed a significant decline among MS patients receiving CBMs compared to the placebo group (odds-ratio = 2.853, CI 95%: [1.41, 5.77], p = 0.004, I2 = 0.00). The test-based meta-analysis of the Paced Auditory Serial-Addition Test (PASAT) showed a significant difference between CBM and placebo (standardized-mean-difference = 0.387, 95% CI: [0.17, 0.61], p = 0.001, I2=38.87), favoring placebo. Five studies reported no significant effects on processing speed, executive function, and measures of attention and concentration. In contrast, one study observed reduced complex attention and processing speed after acute cannabis administration. Regarding psychomotor skills, three studies indicated impairment. At the same time, the results for multiple domain screenings were mixed, with one study showing a reduction in Short-Orientation-Memory-Concentration Test with THC and another finding no differences between groups.
Conclusion and Discussion: This study suggests that CBM may have adverse effects on attention and processing speed in MS patients; however, overall cognitive impacts of CBM appear to be complex and dependent on factors such as dosage, duration of exposure, and the specific cognitive domains being assessed.
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