MS curiosities in a curious time


The following are some of the novelties, oddities and curiosities recently published in the multiple sclerosis literature.

HSCT and COVID-19: There is a new report of four MS patients who were diagnosed with COVID-19 in the 6-31 months after receiving autologous hematopoietic stem cell transplant (Gazca et al. Hematology 2020;25:320). Subjects (3F, 1M) were aged 39-54 years. Three contracted COVID-19 from a family member. Only 1 of 4 patients was hospitalized but did not require an ICU stay. No neurological complications of COVID-19 infection were reported.

Sex and CSF: An analysis of CSF samples obtained from 1,252 patients aged 18-89 years found sex-based differences (Castellazzi et al. Clin Chem Lab Med 2020; epublished August 20, 2020). Median CSF total protein content was significantly higher in males compared to females (46 vs. 37 mg/dL [0.46 vs. 0.37 mg/mL]; “normal” range 0.15-0.60 mg/mL); differences remained significant after adjusting for age and diagnosis. Throughout the age range, total protein was consistently 8.5 mg/dL (0.085 mg/mL) higher in males. One consequence: lab reports were more likely to report “elevated CSF total protein content” in men. 

COVID and PPMS: A multicentre study (which included Sunnybrook HSC, Toronto) examined the effect of the COVID-19 pandemic on mood and quality of life in patients with primary-progressive MS (Chiaravalloti et al. J Neurol 2020; epublished August 19, 2020). Patients enrolled in a rehabilitation study that was suspended due to the pandemic were surveyed. Overall, there were no significant changes in anxiety, depression or QoL after lockdown.

NMO and Native Americans: A genome-wide association study in Mexico reported that patients with neuromyelitis optica (NMO) were more likely to have Native American ancestry than controls (68.1% vs. 58.6%) (Romero-Hidalgo et al. Sci Rep 2020;10:13706). All of the NMO-associated alleles in the HLA region were of Native American origin. This is the first report of higher NMO susceptibility in an aboriginal population. A separate study a few years ago found that Hispanic MS patients with Native American ancestry were more likely to present with optic neuritis (odds ratio 2.35 for highest vs. lowest native ancestry quartile), suggestive of a more opticospinal presentation (Amezcua et al. Ann Clin Transl Neurol 2018;5:1362-1371). A B.C. study reported that MS characteristics (% female, age of onset, % with RRMS) was similar in aboriginal Canadians compared to non-Native populations (Saeedi et al. Mult Scler 2012;18:1239-1243). However, aboriginal patients demonstrated more rapid progression to EDSS 6.

Financial toxicity the new AE: “Financial toxicity” is a term that emerged almost a decade ago in the oncology literature to describe the adverse effects on health associated with out-of-pocket expenses, such as delayed treatment, distress (for oneself and family) and poorer QoL (Zafar et al. Oncology 2013;27:80-81). An 11-item patient-reported outcome measure, called COST (COmprehensive Score for financial Toxicity), was soon developed (de Souza et al. Cancer 2014;120:3245-3253). That tool has now been applied to the MS population (Sadigh et al. Mult Scler 2020; epublished August 18, 2020). A lower COST score (indicating greater toxicity) was correlated with worse QoL. Of note: 34.7% of MS patients reported that they were non-adherent to care because of a financial burden.

High risk of relapse: There is a case report of a U.S. Air Force serviceman with MS who experienced a relapse after a day spent ascending and descending Mount Fuji (Hsieh et al. Mil Med 2020;185:e1322-e1325). It is the first case of high-altitude climbing as a possible trigger of MS relapse.

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