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Applied Health Economics and Health... Oct 2016Budget impact analysis (BIA) has become an essential part of economic evaluation within health technology assessment. Several disease-modifying therapies (DMTs) are now... (Review)
Review
Paucity and Inconsistency: A Systematic Review and Critique of Budget Impact Analyses of Disease-Modifying Therapies for Multiple Sclerosis in the UK and the Implications for Policy in the UK.
BACKGROUND AND OBJECTIVES
Budget impact analysis (BIA) has become an essential part of economic evaluation within health technology assessment. Several disease-modifying therapies (DMTs) are now available for the treatment of multiple sclerosis (MS). This study sought to identify the inputs and assumptions used in existing BIAs for DMTs in the UK, and the uncertainty and variation in these, to allow critique within the context of UK policy.
METHODS
MEDLINE and the Economic Evaluations Database from the Cochrane Library were searched systematically on 15 December 2014 to identify BIAs of DMTs licensed for MS in the UK. In addition, the National Institute for Health and Care Excellence (NICE) and National Health Service (NHS) England websites were searched for relevant publications and grey literature searching was undertaken. Sources and assumptions from the included analyses were extracted, compared and critiqued.
RESULTS
The database searches produced 115 de-duplicated results. An additional 12 results were identified from the NICE and NHS England websites. No BIAs of DMTs for MS in the UK were identified in the literature. All ten included studies were from the NICE website, comprising manufacturer submissions for each DMT and corresponding NICE costing templates. There are considerable uncertainties in the inputs and assumptions used in the BIAs, but limited sensitivity analyses were undertaken.
CONCLUSIONS
Data limitations were not highlighted in the results, failing to present the uncertainty in the results to users clearly. It is to be welcomed that NICE has recently consulted on a process change to allow additional critique of the costing templates.
Topics: Budgets; Cost-Benefit Analysis; Health Expenditures; Health Policy; Humans; Multiple Sclerosis; United Kingdom
PubMed: 27130689
DOI: 10.1007/s40258-016-0244-3 -
Journal of the Neurological Sciences May 2017Multiple sclerosis (MS) is a chronic disease in the central nervous system which causes a number of physical symptoms including impairments of muscle mechanical function... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Multiple sclerosis (MS) is a chronic disease in the central nervous system which causes a number of physical symptoms including impairments of muscle mechanical function (muscle strength, muscle power and explosive muscle strength (~rate of force development, RFD)). However, a full overview of the existing knowledge regarding muscle mechanical function in persons with MS (PwMS) is still pending.
OBJECTIVES
To systematically review 1) the psychometric properties of isokinetic dynamometry testing in PwMS, and 2) studies comparing muscle mechanical function in PwMS to matched healthy controls (HC). In addition, a meta-analysis will evaluate 3) the effects of progressive resistance training on muscle mechanical function in PwMS.
METHODS
A systematic literature search was performed in eight databases. To be included in the review, the study had to 1) enroll participants with a confirmed diagnosis of MS; 2) assess muscle mechanical function 3) had undergone peer-review. The psychometric properties of isokinetic dynamometry were reviewed with respect to validity, reliability, and responsiveness. Comparison of muscle strength between PwMS and HC was performed across contraction velocities, contraction modes and muscle groups, as were the rate of force development. The effects of progressive resistance training on muscle mechanical function were evaluated in a meta-analysis using a random effects model and standardized mean difference (SMD).
RESULTS
A total of four, twenty-four, and ten studies were identified for aim 1, 2, and 3, respectively. High Intraclass correlations coefficients (range: 0.87-0.99) for isokinetic dynamometry was reported when assessing knee extensor and knee flexor muscle strength independent of contraction velocity. Compared to match HC, PwMS display impaired muscle strength, power and explosive muscle strength. Muscle strength impairments were most pronounced during maximal moderate to fast dynamic muscle contractions of the lower extremities. Progressive resistance training has a small but significant effect on muscle mechanical function in PwMS (SMD=0.45, 95% CI: 0.18-0.72, p=0.001).
CONCLUSIONS
The present review showed that 1) isokinetic dynamometry has a high reliability in PwMS; 2) muscle strength, power and rate of force development is impaired in PwMS compared to HC, and muscle strength impairments are most pronounced during maximal moderate to fast dynamic muscle contractions of the lower extremities; and 3) progressive resistance training can improve muscle mechanical function in PwMS. Future studies should evaluate progressive resistance training designed to optimize maximal moderate to fast dynamic muscle contractions of the lower extremities.
Topics: Humans; Multiple Sclerosis; Muscle Strength; Muscle Strength Dynamometer; Resistance Training
PubMed: 28431618
DOI: 10.1016/j.jns.2017.03.022 -
NeuroRehabilitation 2022Multiple sclerosis (MS) is a progressive inflammatory and autoimmune neurological disease caused by inflammation and demyelination of the central nervous system. Pain is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Multiple sclerosis (MS) is a progressive inflammatory and autoimmune neurological disease caused by inflammation and demyelination of the central nervous system. Pain is a typical symptom of central nervous system demyelination, affecting 63% of adults with MS. Recently, the role of non-pharmacological pain management in patients is growing because the non-pharmacological interventions are considered safe, affordable, easy, and accessible. However, to date, no systematic reviews or meta-analyses have comprehensively examined the therapeutic effects of the variety of non-pharmacological therapeutic interventions in the management of pain in patients with MS.
OBJECTIVE
The study aimed to conduct a systematic review with meta-analysis to assess the effectiveness of the non-pharmacological rehabilitation interventions in pain management in patients with MS.
METHODS
A comprehensive search using PubMed, Cochrane, and Science Direct databases was performed and included all randomized controlled trials, randomized cross-over trials, and quasi-experimental trials assessing the effect of non-pharmacological interventions for managing pain in patients with MS. This study was conducted according to PRISMA guidelines of a systematic review and pair-wise meta-analysis. Meta-analyses were performed by calculating the standardized mean difference at a 95% confidence interval using Review Manager software.
RESULTS
Twenty-nine papers were included in the systematic review, and only 22 of them were included in the meta-analysis. The pooled analysis showed a significant effect of neuromodulation and transcranial direct current stimulation on pain intensity reduction in patients with MS (SMD -0.51, 95% CI -0.51 to -0.09, P = 0.02), (SMD -0.67, 95% CI -1.18 to -0.16 P = 0.01), respectively. The analysis showed significant improvement in pain intensity in patient with MS after mind-body therapies (SMD -0.45, 95% CI -0.82 to -0.7, P = 0.02), mindfulness (SMD -0.55, 95% CI -0.96 to -0.14, P = 0.009), hypnosis (SMD -0.88, 95% CI -1.30 to -0.46, P = 0.0001), trigger point therapies (SMD -0.83, 95% CI -1.65 to -0.01, P = 0.05) and cognitive behavioral therapy (SMD -0.64, 95% CI -1.18 to -0.11, P = 0.02). However, there is no significant effect of relaxation therapy on pain reduction in patients with MS (SMD -0.82, 95% CI -1.94 to 0.31, P = 0.15).
CONCLUSIONS
The results indicated that the majority of the non-pharmacological rehabilitation interventions showed potential therapeutic effects in reducing pain intensity in patients with MS.
Topics: Adult; Cognitive Behavioral Therapy; Humans; Multiple Sclerosis; Pain; Pain Management; Transcranial Direct Current Stimulation
PubMed: 35180138
DOI: 10.3233/NRE-210328 -
Seminars in Neurology Jun 2002Whether neuromyelitis optica (NMO), the co-occurrence of myelitis and optic neuritis, is a variant of multiple sclerosis (MS) or a unique disease is controversial.... (Review)
Review
Whether neuromyelitis optica (NMO), the co-occurrence of myelitis and optic neuritis, is a variant of multiple sclerosis (MS) or a unique disease is controversial. Distinct neuropathological features and a fulminant clinical course argue in favor of NMO as a distinct disease. However, the combination of neurological impairments of myelitis and optic neuritis occurs in patients with several inflammatory disorders, including multiple sclerosis and collagen vascular diseases. NMO is also associated with certain infectious diseases. The fact that the NMO phenotype occurs in a variety of disease states suggests that NMO does not represent a specific clinical entity. To better understand NMO and its associations with recognized diseases, a systematic review of the literature using MEDLINE was conducted. The history of NMO, its nosology, associations with other diseases, and current concepts of its pathogenesis and treatment is reviewed in this article.
Topics: Adult; Animals; Asia; Diagnosis, Differential; Endocrine System Diseases; Female; Humans; Japan; Male; Middle Aged; Multiple Sclerosis; Neuromyelitis Optica; Tropical Climate
PubMed: 12524556
DOI: 10.1055/s-2002-36534 -
Journal of Clinical Neuroscience :... Jan 2024Considering the different results regarding the correlation between Magnetic Resonance Imaging (MRI) structural measures and cognitive dysfunction in patients with MS,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Considering the different results regarding the correlation between Magnetic Resonance Imaging (MRI) structural measures and cognitive dysfunction in patients with MS, we aimed to perform a systematic review and meta-analysis study to investigate the correlation between T1 and T2 weighted lesions and cognitive scores to find the most robust MRI markers for cognitive function in MS population.
METHODS
The literature of this paper was identified through a comprehensive search of electronic datasets including PubMed, Scopus, Web of Science, and Embase in February 2022. Studies that reported the correlation between cognitive status and T1 and T2 weighted lesions in MS patients were selected.
RESULTS
21 studies with a total of 3771 MS patients with mean ages ranging from 30 to 57 years were entered into our study. Our analysis revealed that the volume of T1 lesions was significantly correlated with Symbol Digit Modality test (SDMT) (r: -0.30, 95 %CI: -0.59, -0.01) and Paced Auditory Serial-Addition Task (PASAT) scores (r: -0.23, 95 %CI: -0.36, -0.10). We investigated the correlation between T2 lesions and cognitive scores. The pooled estimates of z scores were significant for SDMT (r: -0.27, 95 %CI: -0.51, -0.03) and PASAT (r: -0.27, 95 %CI: -0.41, -0.13).
CONCLUSION
In conclusion, our systematic review and meta-analysis study provides strong evidence of the correlation between T1 and T2 lesions and cognitive function in MS patients. Further research is needed to explore the potential mechanisms underlying this relationship and to develop targeted interventions to improve cognitive outcomes in MS patients.
Topics: Humans; Adult; Middle Aged; Multiple Sclerosis; Cognition; Cognitive Dysfunction; Magnetic Resonance Imaging; Neuropsychological Tests
PubMed: 37952373
DOI: 10.1016/j.jocn.2023.11.014 -
Multiple Sclerosis and Related Disorders Apr 2024Fear of falling (FOF) is a common concern among persons with multiple sclerosis (MS) and affects the performance of their daily living activities. Falls may result in... (Review)
Review
BACKGROUND
Fear of falling (FOF) is a common concern among persons with multiple sclerosis (MS) and affects the performance of their daily living activities. Falls may result in FOF, leading to worsening of symptoms of MS, physical deconditioning, and exposure to future falls. This may trigger a vicious cycle between FOF and falls. A better understanding of the relationship between FOF and symptoms of MS may be helpful to develop a conceptual model to guide fall prevention interventions.
OBJECTIVE
To synthesize the correlational and predictive relationships between FOF and common symptoms of MS.
METHODS
Databases including PubMed, Embase, Web of Science, Scopus, CINHAL, PsycINFO, and SPORTDiscuss were searched from inception to October 2023. Studies examining correlations and/or predictions between FOF and common MS symptoms that include measures of gait, postural control, fatigue, cognition, pain, sleep, depression, and anxiety were identified by two independent reviewers. Both reviewers also conducted the methodological quality assessment of the included studies.
RESULTS
Twenty-three studies with a total of 2819 participants were included in the review. Correlational findings indicated that increased FOF was significantly associated with greater walking deficits (lower gait speed, smaller steps), reduced mobility, and poorer balance. Increased FOF was also significantly correlated with higher cognitive impairments, more fatigue, sleep disturbances, and depression. Decreased gait parameters, reduced balance, lower physical functions, cognitive impairments, and sleep deficits were found as significant predictors of increased FOF.
CONCLUSION
Evidence indicates significant correlational and bidirectional predictive relationships exist between FOF and common MS symptoms. A comprehensive conceptual framework accounting for the interaction between FOF and MS symptoms is needed to develop effective falls prevention strategies.
Topics: Humans; Multiple Sclerosis; Depression; Fear; Cognition; Fatigue; Postural Balance
PubMed: 38422635
DOI: 10.1016/j.msard.2024.105506 -
Journal of Neurology May 2013Additional autoimmune diseases in people with multiple sclerosis (MS) and their relatives have been studied many times. Studies have employed different designs, and... (Meta-Analysis)
Meta-Analysis Review
Additional autoimmune diseases in people with multiple sclerosis (MS) and their relatives have been studied many times. Studies have employed different designs, and yielded conflicting results. We performed a systematic review, and calculated overall risk of additional autoimmune diseases in people with MS and their first-degree relatives. PubMed and Web of Science were searched. Thyroid disease, diabetes, inflammatory bowel disease, psoriasis, rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) were studied. A generic inverse variance model was used, and subgroup analysis was used to explore heterogeneity. The OR of thyroid disease was increased in both people with MS (OR 1.66; p < 0.00001) and their relatives (OR 2.38; p < 0.00001). A similar association was seen between MS and inflammatory bowel disease (OR 1.56; p < 0.0001) and psoriasis (OR 1.31; p < 0.0001), although not in relatives. There was no increase in the rate of either SLE or RA. Studies examining diabetes showed significant heterogeneity and evidence of publication bias. There is an increase in the rate of certain autoimmune diseases in people with MS and their first-degree relatives. However, this does not extend to all conditions studied. Given the nonspecific clinical presentation of thyroid disease, it should be considered in all people with MS presenting with nonspecific symptoms.
Topics: Autoimmune Diseases; Databases, Bibliographic; Family; Humans; Multiple Sclerosis
PubMed: 23315260
DOI: 10.1007/s00415-012-6790-1 -
Multiple Sclerosis and Related Disorders May 2016To investigate the association between Helicobacter pylori infection and multiple sclerosis. (Meta-Analysis)
Meta-Analysis Review
AIM
To investigate the association between Helicobacter pylori infection and multiple sclerosis.
METHODS
A comprehensive search of the databases including PubMed/MEDLINE and EMBASE was performed from their dates of inception to January 2016. Inclusion criteria were the observational studies in adult assessing the association between Helicobacter pylori infection and multiple sclerosis. The main outcome was the prevalence of Helicobacter pylori infection comparing between participants with multiple sclerosis and controls. The between-study heterogeneity of effect-size was quantified using the Q statistic and I(2).
RESULTS
The initial search yielded 103 articles. Seventeen articles underwent full-length review and data was extracted from six observational studies involving 1902 participants. There was a statistically significant lower odds Helicobacter pylori infection in multiple sclerosis with pooled odds ratio of 0.59 (95% CI: 0.37-0.94, P=0.03, I(2)=71%). We conducted a univariate meta-regression analysis to assess potential source of heterogeneity. Age of patient and age of onset of multiple sclerosis were significant predictors of association between Helicobacter pylori infection and multiple sclerosis (beta-coefficient =-0.23, SE=0.10, p=0.02 and beta-coefficient =-0.34, SE=0.17, p=0.04, respectively).
CONCLUSIONS
We demonstrate a significant lower prevalence of Helicobacter pylori infection in patients with multiple sclerosis. This pathogen might be a protective factor for developing multiple sclerosis.
Topics: Disease Susceptibility; Helicobacter Infections; Helicobacter pylori; Humans; Multiple Sclerosis; Observational Studies as Topic
PubMed: 27237767
DOI: 10.1016/j.msard.2016.03.013 -
Multiple Sclerosis and Related Disorders May 2023Neuromyelitis optica spectrum disorders (NMOSD) is considered a complex multifactorial disorder. Most cases are sporadic, and familial NMOSD is assumed as a rare...
BACKGROUND
Neuromyelitis optica spectrum disorders (NMOSD) is considered a complex multifactorial disorder. Most cases are sporadic, and familial NMOSD is assumed as a rare occurrence. However, few studies reported familial aggregation of the disorder.
OBJECTIVES
To report familial NMOSD cases in Thailand and conduct a systematic review of familial NMOSD.
METHODS
A retrospective chart review of familial NMOSD patients at the university hospital was performed. Articles related to "genetic" and "NMOSD" were systematically searched and reviewed. We included NMOSD patients whose one or more relatives were diagnosed with the same disease or multiple sclerosis (MS). Data regarding demographics, clinical features, disease outcomes, and genetic testing were collected and analyzed using descriptive statistics.
RESULTS
We identified 6 familial cases from 165 NMOSD cases (3.6%) at our hospital and gathered 77 cases from a systematic review, totaling 83 cases from 40 families. The mean (SD) age at onset was 37.2 (18.0) years. Familial NMOSD involved 1-2 generations with mainly 2 affected individuals. The most common kinship pattern was siblingship in 21 families (52.5%). Initial syndromes were mostly optic neuritis and transverse myelitis. Serum aquaporin-4 IgG was positive in 79.7% of cases. Median number of relapses was 3 (range 1-26). Median expanded disability status scale in the last visit was 2 (range 0-8). Reported human leukocyte antigens (HLA) alleles shared between familial cases were HLA-A*01 and HLA-DRB1*03.
CONCLUSION
Familial clustering of NMOSD is more common than would be expected in the general population. The demographic, clinical, and outcome profiles of familial cases were not different from sporadic cases. Certain specific HLA haplotypes were shared among familial cases. Our systematic review highlighted complex genetic predisposition to NMOSD.
Topics: Humans; Adult; Neuromyelitis Optica; Retrospective Studies; Autoantibodies; Neoplasm Recurrence, Local; Aquaporin 4
PubMed: 37015139
DOI: 10.1016/j.msard.2023.104627 -
Multiple Sclerosis and Related Disorders Jan 2022The prevalence of Trigeminal Neuralgia (TN) in patients diagnosed with multiple sclerosis (MS) is insufficiently understood and controversially reported. This study... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The prevalence of Trigeminal Neuralgia (TN) in patients diagnosed with multiple sclerosis (MS) is insufficiently understood and controversially reported. This study focused on providing a better understanding of the prevalence of TN in MS patients.
METHOD
We systematically searched PubMed, Scopus, EMBASE, Web of Science, and Google Scholar to identify studies published from January 1, 1990, to December 30, 2020. We included studies reporting the TN prevalence among MS patients and exclude case reports/series and editorial studies, review studies, and non-English written articles. We used pooled prevalence estimates to determine the TN prevalence among MS patients.
RESULTS
Pooled overall TN prevalence among 19 studies and 30,348 MS patients was estimated as 3.4% (95% CI: 1.5%-5.9%) with a high level of heterogeneity among studies (I2=98.92%; p<0.001). The pooled prevalence of TN in male and female patients across 9 surveys was 2.4% (95% CI: 0.5%-5.4%) and 3.8% (95% CI: 0.8%-8.7%), respectively. No heterogeneity between the two groups was observed (p = 0.558). A meta-regression was performed to explore the source of the heterogeneity. None of the candidate covariates, including the year of a study publication, the sample size, the average age of patients, and the disease duration, were significant in the model.
CONCLUSION
Our results showed that TN is a common problem among patients with MS, predominantly male patients. Future studies should target the general prevalence of pain in MS patients.
Topics: Female; Humans; Male; Multiple Sclerosis; Pain; Prevalence; Trigeminal Neuralgia
PubMed: 34986455
DOI: 10.1016/j.msard.2021.103472