Magd Zakaria

Background: Current longitudinal real-world data on secondary progressive multiple sclerosis (SPMS) remains limited, as most studies utilize cross-sectional designs that do not combine objective metrics with patient-reported outcomes like fatigue and depression. Therefore, integrating multidimensional assessments over time is essential to accurately capture disease evolution and treatment efficacy. Objectives: To longitudinally evaluate clinical, cognitive, and functional progression in Egyptian patients with active SPMS over 12 months. Methods: This prospective study included 46 Egyptian patients with active SPMS (69.6% females; mean age 43.5 years; mean disease duration 13.9 years). Patients were evaluated at baseline and followed for 12 months at 6-month intervals using Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk Test (T25FWT), Nine-Hole Peg Test (9HPT), Symbol Digit Modalities Test (SDMT), Modified Fatigue Impact Scale (MFIS), and Beck Depression Inventory (BDI). Results: Male sex and earlier multiple sclerosis (MS) onset were associated with earlier SPMS conversion and higher early relapse rates. Over 12 months, EDSS increased significantly, with concomitant worsening in motor performance, fatigue, depression, and cognition. Faster progression was observed in patients with baseline spinal cord involvement and higher relapse frequency. Conclusion: Disease progression in SPMS is multidimensional. Integrating functional, cognitive, and patient-reported measures is crucial for comprehensive assessment and early detection of progression.

Paraclinical testing incorporated within multiple sclerosis (MS) diagnostic criteria over time have facilitated earlier diagnosis, yet global implementation is largely unknown. Lack of "specialist medical equipment or diagnostic tests" was a barrier to early diagnosis of MS endorsed by a third of 107 countries surveyed in the recent Multiple Sclerosis International Federation Atlas of MS Third Edition. This study assessed global access to paraclinical testing incorporated in MS diagnostic criteria. Survey development included stakeholders with varied expertise and perspectives from all World Health Organization regions and World Bank (WB) country economy income categories. The survey assessed availability, routine use, and barriers to routine use of MRI, CSF testing, evoked potentials, optical coherence tomography, and serum aquaporin-4 immunoglobulin G and myelin oligodendrocyte glycoprotein immunoglobulin G antibody testing. Opinions regarding anticipated 2024 criteria revisions and preferences regarding the dissemination of MS guidelines were surveyed. The survey was available from April 11, 2024, to September 2, 2024. One hundred twenty-two of 149 (82%) of country coordinators participated. No paraclinical test was available across all countries. All 10 tests were available in only 41% of countries. Availability of paraclinical testing did not guarantee routine use in the diagnostic evaluation for MS. Cost and lack of expertise for performance or interpretation were frequent barriers to routine use. Such barriers were present even in WB high-income countries, but low- and low-middle-income countries reported significantly more limited availability of paraclinical testing and significantly diminished routine use to aid diagnosis of MS. This study highlights worldwide barriers and disparities in access to paraclinical testing that can expedite the diagnosis of MS. Creative approaches are urgently needed to address cost and required expertise for these paraclinical tests to improve worldwide access. Our data suggest that targeted educational efforts surrounding 2024 McDonald criteria revisions can reduce barriers to implementation. There was enthusiasm that the incorporation of these new approaches to paraclinical testing within the criteria would improve access to early MS diagnosis. This study will provide valuable baseline data to inform future assessments of global access to paraclinical testing for the diagnosis MS.

Background: Cerebral arterial stenosis (CAS), in the absence of a structural lesion, can result in cognitive impairment that represents an ongoing contention among studies. Accordingly, we investigated cognitive functions in asymptomatic patients with CAS, using P300 which is a neurophysiological tool. We also compared cognition in intracranial stenosis (ICS) and extracranial stenosis (ECS). Methods: Asymptomatic patients with CAS (≥ 70%) in the absence of structural brain lesions were categorized into ICS and ECS groups of 15 patients each, in addition to 15 normal controls. MRI, MRA, CT angiography, P300 analysis, Mini-Mental State examination (MMSE), Wisconsin Card Sorting Test (WCST), and Wechsler Memory Scale Test-Revised (WMST) were performed to all patients. Results: Impairment on all cognitive scales ranged from 70 up to 100% among CAS group. Prolonged p300 latency and reaction time correlated with worse performance on WMST (p = 0.02), while lower amplitude and decreased accuracy correlated with more errors on WCST (p = 0.01). ICS scores on WCTS were lower than those of ECS group (p = 0.001), while ECS had a longer reaction time (p = 0.02) and lower scores on MMS and WMST than those of ICS group (p = 0.03). Conclusion: Patients with asymptomatic CAS had a high prevalence of cognitive dysfunction which places them at risk of higher morbidity. ICS group showed impairment on executive functions, while the ECS group showed predilection to memory and information processing dysfunction.

Background: Assessment of multiple sclerosis (MS) patients during the era of the coronavirus disease 2019 (COVID-19) pandemic was confronted with the overwhelmed healthcare facilities in Egypt and fear of the patients to get infected while attending the follow-up visits. This study aimed to assess the value of telephone-based assessments in the follow-up of MS patients. It includes one hundred and five patients who participated in the study and completed 3 telephone-based assessments which are the Hauser Ambulation index, Multiple Sclerosis Neuropsychology Questionnaire (MSNQ), and Symptoms of Multiple Sclerosis Scale (SMSS). Results: The Hauser Ambulation index was significantly correlated with the latest Expanded Disability Status Scale (EDSS) score done within 1 month from the telephone call (r=0.738, PP=0.016), “Often” (P=0.022), and “Always” (P=0.001). The comparison of the EDSS scores of the patients regarding the sensory-motor impairment component of SMSS showed a non-significant difference. Conclusion: The Hauser Ambulation index may be a reliable telephone-based tool for the assessment of physical disability. The MSNQ and the cognitive and psychological impairment component of SMSS can be used for the assessment of cognitive and psychological impairment among patients with MS.

Background: Approximately half of all patients with multiple sclerosis (MS) experience cognitive impairment, most commonly with regard to new learning and memory. Cognitive dysfunction is a leading cause of disability in MS and it can have profound social and economic consequences for patients and their families. Objective: This study was conducted to discover the early cognitive domains affected in multiple sclerosis patients concomitant with the postulated brain atrophy in an Egyptian sample of multiple sclerosis patients. Patients and Methods: A cross-sectional observational case-control study conducted on seventy (60) patients who came for follow-up in Ain Shams University hospitals. 40 patients were taken as cases that followed up in MS unit in Ain-Shams university hospitals. 20 participants were taken as controls taken from the general medicine clinics age and sex matched to our patient group. An informed written consent was taken from parents of each person included in the study. Results: There was a statistically significant difference between the two groups in brain volumetric changes and in the parameters of cognitive assessment Conclusion: Early detection and examination of cognitive functions is important for patient evaluation, follow up and treatment regimen used.