Sclerosis, Volume 1, Issue 3 (December 2023) – 3 articles

The aim of this study was to investigate signal patterns and parameters of digital biomarkers in the assessment of mobility in individuals with multiple sclerosis, captured through motion sensors. This is an integrative literature review based on the PRISMA recommendations, which included studies that used wearable technology, such as accelerometers, wearable sensors or inertial sensors, and analyzed mobility/gait-related parameters, such as speed, step count, rhythm, balance, duration and intensity of activity. A total of 1602 studies were identified, of which only 21 were included in the final qualitative synthesis. The main digital biomarkers identified presented signal patterns and parameters captured through different wearable devices, including triaxial accelerometers, inertial sensors, smartphones or smartwatches. The studies employed different objective biomarker reference measures, such as walking speed and step count, and subjective biomarker reference measures, such as fatigue and quality of life assessment scales, for a comprehensive assessment of the participants’ health and mobility. It was found that digital biomarkers play a fundamental role in any individual’s health assessment and protocols. However, it is essential to understand these signals and standardize the choice of the best method to capture signals of high quantity and quality, especially for individuals affected by some neurological pathology. Full article

Lower urinary tract dysfunction is frequently observed in individuals with multiple sclerosis (MS), significantly impacting their quality of life and increasing the risk of upper urinary tract (UUT) damage. Magnetic resonance imaging (MRI) serves as the gold standard imaging technique for identifying demyelinating lesions and aiding in the clinical diagnosis of MS. However, despite its diagnostic utility, the precise relationship between MRI lesions and bladder dysfunction remains poorly established. We aimed to examine the correlation between MRI lesion localizations and both urodynamic parameters and risk factors for UUT damage. In this retrospective study, we conducted a comprehensive review of 201 patients diagnosed with MS who were referred for primary neurourological evaluation, including a videourodynamic study (VUDS). To explore potential significant relationships between the independent variable of MRI lesion localization and the dependent outcome variables, we conducted a multivariate analysis of variance (MANOVA) regression. A significant correlation was observed between the presence of a brainstem lesion and specific urodynamic parameters, including lower maximum cystometric bladder capacity and higher bladder compliance. Similarly, an increased number of diverse MRI lesion localizations demonstrated a significant correlation with these urodynamic parameters. In conclusion, MRI findings did not exhibit a significant association with urodynamic risk factors for UUT damage, thereby limiting their utility in stratifying MS patients for subsequent neurourological assessment and treatment. Full article

Multiple sclerosis (MS) is an autoimmune, neurological, and demyelinating disease of unknown etiology. Neuroinflammation caused by the disease has been associated with air pollution as well as bioclimatic conditions. The aim of this study was to investigate the impacts of air pollution and human thermal discomfort on hospitalizations for multiple sclerosis in Sao Paulo, Brazil, from 2008 to 2015. Generalized Additive Model for Location Scale and Shape (GAMLSS) with Zero Inflated Poisson was used to relate multiple sclerosis hospitalizations in three age groups (less than 30 years old, between 30 and 50 years old, and more than 50 years old) and gender (female and male) with atmospheric pollutants PM₁₀, SO₂, NO₂, NO, and NO_x and thermal discomfort. The results showed that the exposure to an increase of 1 µg/m³ in SO₂ concentration is highly associated with a 10% increase of the risk of MS hospitalization (95% CI: 2–21%) in female patients and a 7.5% (95% CI: 1.5–16%) increase in male patients. PM₁₀ and NO were associated with increased MS risk only for female patients, mainly aged between 30 and 50 years old (2% and 1% increase in hospitalizations, respectively). The cold discomfort was also associated with MS hospitalization, mainly in males (2% increase in hospitalizations; 95% IC: 1–3%). These results are important, since there are few studies that relate air pollution and thermal discomfort with hospitalizations for multiple sclerosis in Brazil. Full article