OBJECTIVE The aim of this study was to identify whether autonomic nervous system (ANS) dysfunctio... more OBJECTIVE The aim of this study was to identify whether autonomic nervous system (ANS) dysfunction identified prior to treatment initiation can predict siponimod related decrease in heart rate (HR) after treatment initiation. METHODS In 26 people with secondary progressive multiple sclerosis (SPMS) the following ANS testing protocol was applied: 10-min supine resting position, Valsalva maneuver, deep breathing test, 10 min tilt-up table test, 5-min supine resting period, ingestion of siponimod, followed by 180-min supine resting period recordings. Heart rate variability (HRV) parameters were investigated as possible predictors of decrease in HR (ΔHR) after treatment initiation. RESULTS After treatment initiation, there was a statistically significant drop in HR (71.1 ± 9.2 to 66.3 ± 8.1, p < 0.001) and elevation of systolic blood pressure (sBP) (113.2 ± 12.4 to 117.1 ± 10.8, p = 0.04). Values of the diastolic BP (dBP) followed similar trend as did sBP, however not reaching statistical significance (72.8 ± 9.6 to 74.9 ± 8.3, p = 0.13). In a multivariable regression model, disease duration and standard deviation of NN intervals (SDNN) were identified as independent predictors for ΔHR, where increase in SDNN and longer disease duration predict smaller ΔHR. CONCLUSION ANS abnormalities may predict cardiovascular abnormalities associated with treatment initiation with siponimod. SIGNIFICANCE Results of this study may help mitigate risks associated with siponimod treatment.
Multiple sclerosis (MS) is a chronic demyelinating neurologic disorder that mainly affects young ... more Multiple sclerosis (MS) is a chronic demyelinating neurologic disorder that mainly affects young individuals (aged 20 to 50 years). Approximately 85% of patients experience an initial course with relapses and remissions (relapsing-remitting multiple sclerosis). Guidelines for the management of MS should be focused on three main areas: (a) the diagnosis of MS; (b) treatment of relapses; and (c) long-term preventive treatment including clinical follow up, dose adjustment, drug switch, control of therapeutic efficacy, and disease progression. Diagnosis should be established according to clinical and paraclinical criteria. Discussion on therapeutic recommendations is focused on the disease-modifying agents in acute phases and drugs for long-term treatment and symptomatic treatment. Differential diagnoses must be taken into account on making the diagnosis of MS. Therefore, diagnosis of MS should be established on clinical and radiological diagnostic criteria, cerebrospinal fluid analysis and evoked potentials.
SUMMARY – Multiple sclerosis (MS) is a chronic demyelinating neurologic disorder that ma-inly aff... more SUMMARY – Multiple sclerosis (MS) is a chronic demyelinating neurologic disorder that ma-inly affects young individuals (aged 20 to 50 years). Approximately 85 % of patients experience an initial course with relapses and remissions (relapsing-remitting multiple sclerosis). Guidelines for the management of MS should be focused on three main areas: (a) the diagnosis of MS; (b) treatment of relapses; and (c) long-term preventive treatment including clinical follow up, dose adjustment, drug switch, control of therapeutic efficacy, and disease progression. Diagnosis should be established according to clinical and paraclinical criteria. Discussion on therapeutic recommendations is focu-sed on the disease-modifying agents in acute phases and drugs for long-term treatment and sympto-matic treatment. Differential diagnoses must be taken into account on making the diagnosis of MS. Therefore, diagnosis of MS should be established on clinical and radiological diagnostic criteria,
Objective: The aim of this study was to compare the effectiveness of different fatigue scales in ... more Objective: The aim of this study was to compare the effectiveness of different fatigue scales in patients with relapsing-remitting (RR)MS. Background: Fatigue is a common and extremely disabling symptom in patients with multiple sclerosis (MS) for which there are no adequate biomarkers. The most commonly used tool in the evaluation of fatigue are different rating scales, among which psychometrically most robust so far is Neurology Fatigue Index (NFI). Design/Methods: Twenty-five patients with RRMS, mean age of 32.04 ±7.04, and twenty-seven healthy controls (HC), mean age of 30.04 ±4.08, were enrolled in this study. Beck depression scale and Epworth Sleepiness Scale were obtained to exclude subjects with depression or sleep disorders. Each subject fulfilled following fatigue rating scales: NFI, Fatigue Severitiy Scale-9 (FSS-9) and Modified Fatigue Severity Scale (MFIS). Rasch modification of FSS-9 and MFIS scales was performed as well. Correlations between different scales and diffe...
OBJECTIVE The aim of this study was to identify whether autonomic nervous system (ANS) dysfunctio... more OBJECTIVE The aim of this study was to identify whether autonomic nervous system (ANS) dysfunction identified prior to treatment initiation can predict siponimod related decrease in heart rate (HR) after treatment initiation. METHODS In 26 people with secondary progressive multiple sclerosis (SPMS) the following ANS testing protocol was applied: 10-min supine resting position, Valsalva maneuver, deep breathing test, 10 min tilt-up table test, 5-min supine resting period, ingestion of siponimod, followed by 180-min supine resting period recordings. Heart rate variability (HRV) parameters were investigated as possible predictors of decrease in HR (ΔHR) after treatment initiation. RESULTS After treatment initiation, there was a statistically significant drop in HR (71.1 ± 9.2 to 66.3 ± 8.1, p < 0.001) and elevation of systolic blood pressure (sBP) (113.2 ± 12.4 to 117.1 ± 10.8, p = 0.04). Values of the diastolic BP (dBP) followed similar trend as did sBP, however not reaching statistical significance (72.8 ± 9.6 to 74.9 ± 8.3, p = 0.13). In a multivariable regression model, disease duration and standard deviation of NN intervals (SDNN) were identified as independent predictors for ΔHR, where increase in SDNN and longer disease duration predict smaller ΔHR. CONCLUSION ANS abnormalities may predict cardiovascular abnormalities associated with treatment initiation with siponimod. SIGNIFICANCE Results of this study may help mitigate risks associated with siponimod treatment.
Multiple sclerosis (MS) is a chronic demyelinating neurologic disorder that mainly affects young ... more Multiple sclerosis (MS) is a chronic demyelinating neurologic disorder that mainly affects young individuals (aged 20 to 50 years). Approximately 85% of patients experience an initial course with relapses and remissions (relapsing-remitting multiple sclerosis). Guidelines for the management of MS should be focused on three main areas: (a) the diagnosis of MS; (b) treatment of relapses; and (c) long-term preventive treatment including clinical follow up, dose adjustment, drug switch, control of therapeutic efficacy, and disease progression. Diagnosis should be established according to clinical and paraclinical criteria. Discussion on therapeutic recommendations is focused on the disease-modifying agents in acute phases and drugs for long-term treatment and symptomatic treatment. Differential diagnoses must be taken into account on making the diagnosis of MS. Therefore, diagnosis of MS should be established on clinical and radiological diagnostic criteria, cerebrospinal fluid analysis and evoked potentials.
SUMMARY – Multiple sclerosis (MS) is a chronic demyelinating neurologic disorder that ma-inly aff... more SUMMARY – Multiple sclerosis (MS) is a chronic demyelinating neurologic disorder that ma-inly affects young individuals (aged 20 to 50 years). Approximately 85 % of patients experience an initial course with relapses and remissions (relapsing-remitting multiple sclerosis). Guidelines for the management of MS should be focused on three main areas: (a) the diagnosis of MS; (b) treatment of relapses; and (c) long-term preventive treatment including clinical follow up, dose adjustment, drug switch, control of therapeutic efficacy, and disease progression. Diagnosis should be established according to clinical and paraclinical criteria. Discussion on therapeutic recommendations is focu-sed on the disease-modifying agents in acute phases and drugs for long-term treatment and sympto-matic treatment. Differential diagnoses must be taken into account on making the diagnosis of MS. Therefore, diagnosis of MS should be established on clinical and radiological diagnostic criteria,
Objective: The aim of this study was to compare the effectiveness of different fatigue scales in ... more Objective: The aim of this study was to compare the effectiveness of different fatigue scales in patients with relapsing-remitting (RR)MS. Background: Fatigue is a common and extremely disabling symptom in patients with multiple sclerosis (MS) for which there are no adequate biomarkers. The most commonly used tool in the evaluation of fatigue are different rating scales, among which psychometrically most robust so far is Neurology Fatigue Index (NFI). Design/Methods: Twenty-five patients with RRMS, mean age of 32.04 ±7.04, and twenty-seven healthy controls (HC), mean age of 30.04 ±4.08, were enrolled in this study. Beck depression scale and Epworth Sleepiness Scale were obtained to exclude subjects with depression or sleep disorders. Each subject fulfilled following fatigue rating scales: NFI, Fatigue Severitiy Scale-9 (FSS-9) and Modified Fatigue Severity Scale (MFIS). Rasch modification of FSS-9 and MFIS scales was performed as well. Correlations between different scales and diffe...
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Papers by Tereza Gabelić