The optimal time between the cessation of one disease-modifying therapy (DMT) and initiation of another in relapsing-remitting multiple sclerosis (RRMS) is incompletely understood. Lymphopenia, an adverse effect of dimethyl fumarate (DMF), may prompt a washout period prior to initiating an alternate DMT to allow absolute lymphocyte count (ALC) recovery. We hypothesized that during the DMF-DMT treatment interval, there would be disease activity, either by MRI or clinical relapses, and that lymphopenia might be a risk factor.

A retrospective chart review was conducted, collecting data on demographics and disease activity (clinical relapse or MRI with new/enlarged T2/FLAIR or gadolinium-enhancing lesions in the brain or spinal cord). The DMF-DMT interval was defined as the time in years between stopping DMF and beginning a new DMT.

Of 109 patients, 32.1% experienced disease activity during the DMF-DMT interval. ALC decreased significantly during DMF therapy but was not associated with subsequent disease activity in the DMF-DMT interval (HR 1.09 [0.62, 1.91], p = 0.77). A Kaplan–Meier curve shows that the probability of experiencing disease activity was highest within the first year of DMF discontinuation, with the median time to first relapse after stopping DMF being 0.5 years.

Disease activity was most likely to occur early after DMF cessation but was not significantly related to ALC. Our data suggest that initiating a new DMT within 6 months of DMF cessation may reduce relapse risk and lesion accumulation in RRMS patients.

Cognitive fatigability (CF), which refers to a decline in performance during sustained cognitive effort, can significantly impact people with multiple sclerosis (PwMS). This study examined the unmet needs related to perceived CF in PwMS.

One hundred PwMS completed a survey assessing factors known to contribute to CF. Participants indicated whether each factor, including CF itself, was disruptive and whether adequate support was available to address these concerns. A factor identified as disruptive and insufficiently addressed was considered an unmet need (Need Index [NI] ≥50%).

Group-level analysis revealed no significant unmet needs, although fatigue (NI = 30.23), CF (NI = 22.96) and physical activity (NI = 19.55) were more frequently reported. Individual-level analyses revealed that unmet needs varied by community setting (rural vs urban) and socioeconomic status (SES) (lower vs higher SES), with rural participants and those with lower SES reporting higher rates of unmet needs. In addition, PwMS who indicated CF was an unmet need reported more difficulties across most contributory factors, including sleep quality, fatigue, cognitive impairment, depression and contextual factors. The presence of fatigue and CF combined contributed to greater unmet needs across various domains, especially fatigue, CF and cognitive impairment, compared to fatigue alone.

Participants from rural and low socioeconomic backgrounds were more likely to have unmet needs. Notably, 36% of participants (N = 33) reported unmet needs related to perceived CF. The findings highlight the importance of tailoring future interventions to address identified needs more adequately.

Cognitive fatigue is a prevalent and disabling symptom in neurological and post-viral conditions, including multiple sclerosis (MS) and Long COVID. Assessment relies largely on self-report, and no validated objective biomarker exists, limiting reliable diagnosis and treatment monitoring. The aperiodic exponent of the Electroencephalogram (EEG) power spectrum, reflecting the excitation/inhibition (E/I) balance, is a promising candidate biomarker. We examined whether aperiodic exponent values can objectively identify pathological fatigue and assessed their classification accuracy.

We conducted a cross-sectional study, including 119 participants: 36 healthy controls, 33 with Long COVID-related fatigue (LCOF), and 50 with MS (23 fatigued and 27 nonfatigued). Resting-state EEGs were analyzed, and associations with fatigue ratings and group differences were assessed. Logistic mixed-effects regression models evaluated classification accuracy for fatigue status.

Lower frontal aperiodic exponents were associated with higher cognitive fatigue across participants. Fatigued individuals, regardless of diagnosis, showed reduced frontal exponent values compared with nonfatigued groups, while no differences emerged in occipital regions. Logistic regression confirmed that frontal exponent values significantly predicted fatigue status, improving classification accuracy beyond age and depression, with good sensitivity and specificity.

The frontal aperiodic exponent is a regionally specific biomarker of cognitive fatigue across MS and LCOF. Mechanistic interpretation suggests an altered prefrontal E/I balance, which could inform the development of targeted interventions to alleviate cognitive fatigue. It offers a clinically accessible tool to complement self-report, support trial stratification, and enable objective treatment monitoring. Importantly, its presence across distinct disorders highlights its value as a transdiagnostic marker of fatigue.

Ocrelizumab (OCR) and rituximab (RTX) are anti-CD20 monoclonal antibodies (CD20Mabs) used in the treatment of relapsing multiple sclerosis (RMS). While both are effective at reducing relapses and new MRI lesions in clinical trials, real-world data on discontinuation rates and reasons for stopping therapy are limited.

This observational retrospective chart review included patients from two MS clinics in British Columbia, Canada. RMS patients treated with at least one infusion of OCR or RTX between January 2017 and March 2023 were included. Primary outcomes were reasons for discontinuation and discontinuation rates, with a secondary outcome of time to discontinuation.

In total, 881 RMS patients were included, with 478 on OCR and 403 on RTX. A total of 16.9% of patients on OCR and 14.9% on RTX discontinued therapy over 1643 and 694 patient-years, respectively (p = 0.46). Reasons for discontinuation included: side effects (33.3%), insurance coverage (17.0%) and clinical or radiological disease activity (11.3%). Discontinuation rates at 12, 24 and 36 months were 3.5%, 8.2% and 12.5% for OCR, and 6.4%, 14.8% and 22.2% for RTX, respectively (p = 0.0089). Median time to discontinuation was 21 months on OCR and 11.5 months on RTX (p < 0.0001). On Cox regression analysis, treatment with RTX was the only variable associated with discontinuation (hazard ratio 1.72, 95% CI 1.20–2.45).

Discontinuation rates of CD20Mabs were low, and the most common reason for stopping was side effects. Although not designed for comparison, our study suggests RMS patients may persist longer on OCR than RTX.

The aim of this study was to investigate the effects of central vestibular dysfunction on physical functionality and cognitive function in individuals with multiple sclerosis (MS).

Fifty-two fully ambulatory individuals with MS (Expanded Disability Status Scale [EDSS] ≤ 4) were included and divided into two groups: those with central vestibular involvement (Group 1; n = 25) and those without (Group 2; n = 27). Central vestibular involvement was assessed using videonystagmography. Physical and cognitive functions were evaluated in all participants using the Glittre Activities of Daily Living (ADL) test, Godin Leisure-Time Exercise Questionnaire (GLTEQ), and the physical dimension of the MSQoL-54 for physical functionality, and the BICAMS, Trail Making Test (TMT), Word List Generation test and the cognitive dimension of the MSQoL-54 for cognitive function.

According to the physical functionality assessment results, the time required to complete the Glittre ADL test was longer in group 1 than in group 2 (p = 0.01). The score for the physical dimension of the MSQoL-54 was lower in group 1 (p = 0.045). In the BICAMS Symbol Digit Modalities Test, Group 1 scored lower than Group 2 (p = 0.013). A significant difference between the groups was also observed in the time taken to complete the TMT (p = 0.017). Additionally, Group 1 exhibited lower scores on the cognitive dimension of the MSQoL-54 (p = 0.012).

Physical functionality and specific cognitive domains differed between MS participants with and without central vestibular involvement. It should be considered that vestibular dysfunction may adversely impact cognitive and physical functionality, even in low-moderate disability level.

Multiple sclerosis (MS) is a chronic, auto-immune, neurodegenerative condition with increasing global prevalence. People living with MS (plwMS) have reported limited guidance relating to nutrition information. Paired with varied health literacy levels, this makes plwMS susceptible to nutrition misinformation.

A cross-sectional online social network analysis (SNA) examining nutrition information for MS.

A systematic SNA using Twitter/X and YouTube platforms using NodeXL to summarise metrics. Quality was assessed using the QUEST tool. Content analysis of YouTube videos was synthesised into themes for misinformation.

Online publicly available social media user posts and video content.

Twitter/X SNA revealed keywords used most by an account representing 72·8 % of the user network with common diet mentions including Wahls (57 times), paleo (15 times) and ketogenic (11 times). ‘Favourite count’ metrics were strongly correlated with ‘repost count’ (r = 0·83, P = 0·000). Videos which endorsed a diet were more likely to have a lower QUEST score. User engagement metrics were higher for lower quality videos. The quality of online nutrition information relating to MS was moderate (61 %). Physicians were the most likely source of nutrition information endorsing a diet for MS. The content analysis identified a knowledge gap for both medical professionals and plwMS.

Nutrition misinformation for MS occurs on social media and information quality is variable. Audiences need to be cautioned about users with large followings and evaluate the credibility of all information. This study reiterates the importance of evidence-based information for the MS community.

Cognitive impairment is a common feature of multiple sclerosis (MS), and its severity may be influenced by several factors, such as biological sex and levels of cognitive reserve (CR). The relationship between sex, CR, and cognition has not yet been fully investigated. Therefore, the present study aimed to explore sex differences in CR building and the effect of sex and CR on cognitive performance in MS.

233 participants underwent the Brief Repeatable Battery of Neuropsychological Tests (BRB-N), the Stroop test, and the Cognitive Reserve Scale. The t-test was performed to compare sociodemographic variables, Italian adaptation of the Cognitive Reserve Scale, and cognitive test scores between sexes. To evaluate the effect of CR and sex and their interaction on cognitive performance several models of multivariate analyses of covariance were performed (dependent variables: all subtests of Brief Repeatable Battery of Neuropsychological Tests and Stroop scores; independent variables: sex and CR). Covariates included age, Expanded Disability Status Scale, and BDI-II scores.

Women showed higher levels of CR, particularly in daily activities (t = −5.848, p<.001), hobbies (t = −2.591, p = .010), and social life (t = −2.362, p = .011). Sex differences were noted in verbal memory and fluency (with women outperforming men) and processing speed (with men performing better than women). Multivariate analyses revealed a nonsignificant interaction between CR and sex on cognition (Λ=.950, F(10,260)=.813, p = .617, ηp2 = .050).

CR and sex seemed to affect cognitive performance independently in pwMS. This highlights the importance of considering both factors in cognitive assessment, and that both sexes may benefit from specific psychoeducational training aimed at increasing CR levels.

Cognitive impairment is prevalent, disabling, and poorly managed in multiple sclerosis (MS). Physical activity, often expressed as steps/day, has been associated with cognitive function in this population. This brief report examined the possibility of a (1) steps/day threshold associated with absence of cognitive impairment or (2) dose-response relationship between steps/day and cognitive function in MS.

The sample included 358 persons with MS who provided demographic (age, sex, race) and clinical (MS type, disease duration, disability status) information, and completed the Symbol Digit Modalities Test (SDMT) and California Verbal Learning Test-Second Edition (CVLT-II). Participants wore an ActiGraph GT3X+ accelerometer above the non-dominant hip during waking hours of the day over a 7-day period for measuring steps/day.

The receiver operating characteristic (ROC) curve analysis did not identify a steps/day threshold associated with cognitive impairment on SDMT (area under the curve [AUC] ranged between 0.606 and 0.691). The ROC curve analysis further did not identify a threshold of steps/day associated with cognitive impairment based on CVLT-II (AUC range 0.606 to 0.691). The regression analysis indicated significant linear relationships between steps/day and SDMT (R2 = .06; β=.251; p < .001) and CVLT-II (R2 = .06; β=.247; p < .001) z-scores.

The observed linear relationship suggests that focusing on increasing steps/day across all levels of physical activity might have benefits for cognitive function in MS.

Limited access to multiple sclerosis (MS)-focused care in rural areas can decrease the quality of life in individuals living with MS while influencing both physical and mental health.

The objectives of this research were to compare demographic and clinical outcomes in participants with MS who reside within urban, semi-urban and rural settings within Newfoundland and Labrador. All participants were assessed by an MS neurologist, and data collection included participants’ clinical history, date of diagnosis, disease-modifying therapy (DMT) use, measures of disability, fatigue, pain, heat sensitivity, depression, anxiety and disease activity.

Overall, no demographic differences were observed between rural and urban areas. Furthermore, the categorization of primary residence did not demonstrate any differences in physical disability or indicators of disease activity. A significantly higher percentage of participants were prescribed platform or high-efficacy DMTs in semi-urban areas; a higher percentage of participants in urban and rural areas were prescribed moderate-efficacy DMTs. Compared to depression, anxiety was more prevalent within the entire cohort. Comparable levels of anxiety were measured across all areas, yet individuals in rural settings experienced greater levels of depression. Individuals living with MS in either an urban or rural setting demonstrated clinical similarities, which were relatively equally managed by DMTs.

Despite greater levels of depression in rural areas, the results of this study highlight that an overall comparable level and continuity of care is provided to individuals living with MS within rural and urban Newfoundland and Labrador.

The outcomes of radiosurgery for trigeminal neuralgia (TN) in patients with multiple sclerosis (MS) are not as extensively assessed as those for idiopathic or classical TN cases.

Evaluate the safety and efficacy of radiosurgery for TN in MS patients and identify potential predictors of successful outcomes.

A retrospective single-institution cohort study with patients treated between 2009 and 2022 was performed. Fifty patients were included, and a total of 68 radiosurgical interventions were delivered. Outcomes included the maintenance of pain relief assessed using Kaplan–Meier curves and treatment-related complications. Cox regression analyses were used to identify potential predictors of better pain relief.

Following the first radiosurgical treatments, the initial pain relief rate was 86% after a median latency period of 14 days. Adequate pain relief rates at 6, 12, 36 and 60 months were 86%, 52%, 35% and 24%, respectively. Adequate pain relief was sustained for an actuarial median of 12.7 months. After initial relief, pain recurrence occurred in 68% of patients. No statistical difference was seen in the duration of pain relief after initial or repeat radiosurgery (p = 0.368). The most frequent complication was facial hypesthesia (Barrow Neurological Institute facial hypesthesia scale grade II: 10%; III: 6%; IV: 0%). Ipsilateral vascular compression was predictive of better efficacy (p = 0.024).

Radiosurgery for TN in patients with MS appears to be safe and to provide effective pain relief. Notably, radiological identification of vascular compression may predict more sustained pain relief.