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Clinical Management of Patients with Multiple Sclerosis (MS)
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Clinical Management of Patients with Multiple Sclerosis (MS)

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 15 May 2025 | Viewed by 4718

Special Issue Editor

Dr. Maddalena Sparaco

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Guest Editor
Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
Interests: multiple sclerosis; clinical care; patient-reported outcomes
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Multiple sclerosis (MS) is a disease of the central nervous system with a wide variety of symptoms and different disease courses. The comprehensive management of MS typically involves the treatment of acute relapses and of the course of the disease, symptoms management, motor and cognitive rehabilitation programs, and support in the psychosocial dimension. This Special Issue aims to comprehensively explore the world of clinical management for people with MS. It could serve as a source for in-depth clinical updates and discussions on the current challenges of MS. The themes of this Special Issue span from treatment with disease-modifying therapies to motor and cognitive rehabilitation strategies, as well as the evaluation and management of psychosocial dimensions of living with MS. Additionally, it focuses on the need for multidisciplinary approaches, favoring an interdisciplinary dialogue. Furthermore, along with other aspects, the focus on patient-reported outcomes and the use of telemedicine are useful for monitoring people with MS and for 'bringing them closer' to their neurologist. They represent essential steps towards personalized medicine and a holistic approach to MS.

Dr. Maddalena Sparaco
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • multiple sclerosis
  • clinical management
  • patient reported outcomes
  • patient-reported outcome measures
  • biomarkers
  • therapeutic approaches
  • monitoring strategies

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Published Papers (6 papers)

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Research

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13 pages, 641 KiB  
Article
Migraine and Tension-Type Headache Are Associated with Multiple Sclerosis: A Case–Control Study
by Panagiotis Gklinos, Maria-Eleftheria Evangelopoulos, Georgios Velonakis and Dimos Dimitrios Mitsikostas
J. Clin. Med. 2025, 14(8), 2778; https://doi.org/10.3390/jcm14082778 - 17 Apr 2025
Viewed by 237
Abstract
Background/Objectives: Over the past few decades, there has been increased scientific interest in the prevalence of headache disorders among people with MS (pwMS). Although the latest data suggest an association between migraine and multiple sclerosis, studies have been providing inconsistent results largely [...] Read more.
Background/Objectives: Over the past few decades, there has been increased scientific interest in the prevalence of headache disorders among people with MS (pwMS). Although the latest data suggest an association between migraine and multiple sclerosis, studies have been providing inconsistent results largely due to methodological differences, including small sample sizes, lack of control groups, absence of structured headache diaries, and variability in diagnostic criteria. This study aims to address the question of whether pwMS have a higher prevalence of primary headache disorders than healthy controls (HCs) and whether MS is associated with an increased risk of headaches. Methods: In this cross-sectional, case–control study, consecutive pwMS from Eginition University Hospital, Athens, Greece, along with matched HCs, were recruited. Both groups were assessed for headache disorders, over the past 3 months from the day of recruitment, using a semi-structured questionnaire and diagnosed according to the International Classification for Headache Disorders 3 (ICHD-3) criteria. A multivariable logistic regression model adjusted for age and sex evaluated the association between MS and headache disorders. Results: Ninety-six pwMS and ninety-six matched HCs met the inclusion criteria and were enrolled in the study. A higher prevalence of primary headache disorders in pwMS (71.9%) compared to HCs (43.8%) was observed. Specifically, 28.1% of pwMS had migraine, and 38.5% had tension-type headache (TTH). PwMS were significantly more likely to be diagnosed with any primary headache disorder (OR = 4.54; 95% CI: 2.28 to 9.04; p = 1.7), migraine (OR = 2.21 95% CI: 1.05 to 4.62; p < 0.05), and TTH (OR = 2.16 95% CI: 1.16 to 4; p < 0.05) compared to HCs. Conclusions: Our study suggests that primary headache disorders are more prevalent in pwMS in a cohort recruited from the MS outpatient clinic at Eginition University Hospital in Athens, Greece, compared to the general population and highlights the need for targeted headache management within this group. Prospective longitudinal studies are needed to draw more robust conclusions on a potential association and its underlying mechanisms. Full article
(This article belongs to the Special Issue Clinical Management of Patients with Multiple Sclerosis (MS))
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11 pages, 7176 KiB  
Article
Evaluating Fundoscopy as a Screening Tool for Optic Nerve Atrophy in Multiple Sclerosis: An Optical Coherence Tomography (OCT) Comparative Study
by Vlad Constantin Donica, Ciprian Danielescu, Anisia Iuliana Alexa, Irina Andreea Pavel, Alexandra Lori Donica, Cristina Grosu, Călina Anda Sandu and Camelia Margareta Bogdănici
J. Clin. Med. 2025, 14(7), 2166; https://doi.org/10.3390/jcm14072166 - 22 Mar 2025
Viewed by 390
Abstract
Background: Multiple sclerosis (MS) is a chronic, immune-mediated disorder of the central nervous system (CNS), characterized by inflammation, demyelination, and neurodegeneration, resulting in the disruption of axonal signal conduction. Optic neuritis (ON) occurs in over 70% of MS cases, highlighting the involvement of [...] Read more.
Background: Multiple sclerosis (MS) is a chronic, immune-mediated disorder of the central nervous system (CNS), characterized by inflammation, demyelination, and neurodegeneration, resulting in the disruption of axonal signal conduction. Optic neuritis (ON) occurs in over 70% of MS cases, highlighting the involvement of the optic nerve in the progression of the disease. Optic nerve atrophy secondary to the inflammatory episode can be observed during fundoscopy as pallor in the temporal quadrant or of the entire optic disc. Our study aims to evaluate the diagnostic capacity of fundus ophthalmoscopy when compared with the temporal thickness of the pRNFL (peripapillary retinal nerve fiber layer) measured using optical coherence tomography (OCT). Methods: We analyzed 88 eyes from 44 relapsing remitting MS patients using fundus photography (FP) and OCT optic disc measurements, correlating the temporal pallor of the optic disc seen in fundus photographs (FPs) with structural parameters obtained using OCT. Results: Our analysis revealed the significant capacity of optic disc pallor grading using FPs in MS patients in order to discriminate between normal and quadrants with pallor (p = 0.006) or strong pallor (p = 0.003) and between ones with light pallor and moderate pallor (p = 0.002) or strong pallor (p = 0.001), while being unable to clearly differentiate between normal quadrants and ones with light pallor (p = 0.608) or between pallor and strong pallor (p = 0.33). Conclusions: Fundoscopy and FP are useful screening tools in evaluating optic nerve atrophy in MS patients that could be used to assess neurodegeneration because of their universal availability. With the proposed inclusion of the optic disc as the fifth part of the CNS, the optic nerve will benefit from multiple exploratory techniques in order to increase the understanding of disease progression and patient quality of life. Full article
(This article belongs to the Special Issue Clinical Management of Patients with Multiple Sclerosis (MS))
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18 pages, 1062 KiB  
Article
Unmasking the Silent Threat: Prevalence of Cardiovascular Risk Factors in MS Patients in Bucharest, Romania
by Florentina Cristina Pleșa, Elena Andreea Arsene, Andreea Pleșa, Săndica Bucurică, Daniela Anghel, Carmen Adella Sîrbu, Monica Marilena Țânțu, Alexandru Andrei Badea, Octavian Vasiliu and Alice Elena Munteanu
J. Clin. Med. 2025, 14(6), 2001; https://doi.org/10.3390/jcm14062001 - 15 Mar 2025
Viewed by 382
Abstract
Background and Objectives: This study aims to identify cardiovascular risk factors among 91 patients with multiple sclerosis in Bucharest, Romania, using data from medical records and a self-administered questionnaire. Materials and Methods: The research focuses on smoking status, body mass index, blood sugar, [...] Read more.
Background and Objectives: This study aims to identify cardiovascular risk factors among 91 patients with multiple sclerosis in Bucharest, Romania, using data from medical records and a self-administered questionnaire. Materials and Methods: The research focuses on smoking status, body mass index, blood sugar, cholesterol, triglycerides, blood pressure, and renal function. The average age of the patients was 42.90 ± 10.60 years, and 74.73% were female. The average BMI was 23.89 kg/m2 ± 4.74 kg/m2 (lower than in the general population), with 41.76% of patients having a BMI outside normal limits. The majority were former smokers (35.87%), followed by non-smokers (28.26%), and the fewest were smokers of more than 20 cigarettes/day (7.61%). The average total cholesterol was 198.48 ± 38.56 mg/dL, triglycerides were 114.22 mg/dL ± 76.2281 mg/dL, and blood glucose was 97.54 ± 36.58 mg/dL. While 25.27% of the patients had fasting blood glucose > 126 mg/dL, only five patients were diagnosed with DM. The average blood pressure was 137.5165 ± 19.5047 mmHg, with only 11 patients diagnosed with HTA. Results: The study found an average cardiovascular risk of 6.6133% ± 7.1412%, with higher values among males, rural patients, those with secondary-progressive MS, and those with a disease progression >10 years (after age adjustment). Conclusions: The study underscores the importance of identifying and combating cardiovascular risk factors in patients with multiple sclerosis. Full article
(This article belongs to the Special Issue Clinical Management of Patients with Multiple Sclerosis (MS))
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11 pages, 247 KiB  
Article
Exploring the Role of Positive Body Image, Depression Symptoms, Disability and Age in Acceptance of Illness in People with Multiple Sclerosis
by Edyta Matusik, Barbara Lewicka, Kamila Czepczor-Bernat, Katarzyna Maciejowska and Paulina Kowalcze
J. Clin. Med. 2025, 14(3), 724; https://doi.org/10.3390/jcm14030724 - 23 Jan 2025
Viewed by 655
Abstract
Background: Multiple sclerosis (MS) is a chronic, neurodegenerative disease leading to a progressive disability that can affect not only the physical but also the mental state of patients. The psychological adaptation to the illness plays an important role in the general effectiveness of [...] Read more.
Background: Multiple sclerosis (MS) is a chronic, neurodegenerative disease leading to a progressive disability that can affect not only the physical but also the mental state of patients. The psychological adaptation to the illness plays an important role in the general effectiveness of treatment. The study aimed to determine modifiable and nonmodifiable correlates of acceptance of illness. Methods: A total of 139 Caucasian people with MS (pwMS) (106 females) were included. The Acceptance of Illness Scale (AIS), the Body Appreciation Scale (BAS-2) and the Depression, Anxiety and Stress Scale—21 items (DASS-21), together with sociodemographic and clinical data, including the Expanded Disability Status Scale (EDSS), were used. Results: Pearson correlation analysis showed that all variables (disability status of pwMS, intensity of depression symptoms and positive body image) are significantly related to acceptance of illness. After including all the predictors in the regression analysis, all the correlations turned out to be significant (except for multiple sclerosis disability rating). Both age and the severity of depressive symptoms decrease the level of acceptance of the disease. An increase in the level of positive body image positively affects the level of acceptance of the disease. Conclusions: The acceptance of the disease is correlated with both modifiable and nonmodifiable factors. The work on modifiable factors should be taken into account to create a complex program of rehabilitation and treatment for MS patients. Full article
(This article belongs to the Special Issue Clinical Management of Patients with Multiple Sclerosis (MS))
13 pages, 833 KiB  
Article
Percutaneous Tibial Nerve Stimulation’s Impact on Sexual Function in Female Patients with Neurogenic Detrusor Overactivity, Sexual Dysfunction, and Multiple Sclerosis
by Athanasios Zachariou, Ioannis Giannakis, Aris Kaltsas, Athanasios Zikopoulos, Charikleia Skentou, Sofoklis Stavros, Anastasios Potiris, Dimitrios Zachariou, Dimitrios Baltogiannis, Cam Hoang Nguyen Phuc, Bou Sopheap, Dung Mai Ba Tien and Nikolaos Sofikitis
J. Clin. Med. 2024, 13(20), 6042; https://doi.org/10.3390/jcm13206042 - 10 Oct 2024
Cited by 1 | Viewed by 1592
Abstract
Background/Objectives: Multiple sclerosis (MS) frequently results in both urinary and sexual dysfunction, which significantly impairs quality of life. Conventional treatments for bladder dysfunction often prove insufficient, leading to the exploration of alternative therapies such as percutaneous tibial nerve stimulation (PTNS). This study aimed [...] Read more.
Background/Objectives: Multiple sclerosis (MS) frequently results in both urinary and sexual dysfunction, which significantly impairs quality of life. Conventional treatments for bladder dysfunction often prove insufficient, leading to the exploration of alternative therapies such as percutaneous tibial nerve stimulation (PTNS). This study aimed to assess the impact of PTNS on sexual function and bladder symptoms in female MS patients with neurogenic detrusor overactivity (NDO) and female sexual dysfunction (FSD). Methods: A total of 65 female MS patients with NDO were evaluated and underwent 12 weeks of standardized PTNS treatment. Sexual function was assessed using the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R), while bladder symptoms were evaluated using the OAB-v8 questionnaire. Participants were grouped based on the presence of sexual dysfunction and distress and compared to a control group of 20 patients who declined PTNS. Results: Significant improvements were observed in FSFI scores across multiple domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) in the treatment groups (p < 0.05). Additionally, 58.46% of patients showed positive responses to PTNS regarding overactive bladder symptoms (OAB-v8 score), while the control group showed no significant changes. Conclusions: PTNS appears to be an effective therapeutic option for improving sexual function and urinary symptoms in female MS patients with NDO and FSD, offering a promising non-invasive alternative for managing these conditions. Full article
(This article belongs to the Special Issue Clinical Management of Patients with Multiple Sclerosis (MS))
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Review

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19 pages, 1039 KiB  
Review
Clinical Insights and Radiological Features on Multiple Sclerosis Comorbid with Migraine
by Maddalena Sparaco and Simona Bonavita
J. Clin. Med. 2025, 14(2), 561; https://doi.org/10.3390/jcm14020561 - 16 Jan 2025
Viewed by 827
Abstract
Background: Multiple sclerosis (MS) and migraine are neurological diseases, affecting young women. Migraine is the most prevalent type of headache in people with MS (pwMS). Objectives: The aim of this review is to describe the clinical, radiological, and therapeutic features of MS and [...] Read more.
Background: Multiple sclerosis (MS) and migraine are neurological diseases, affecting young women. Migraine is the most prevalent type of headache in people with MS (pwMS). Objectives: The aim of this review is to describe the clinical, radiological, and therapeutic features of MS and migraine comorbidity. The clinical section focuses on the characteristics of migraine in pwMS and of MS in co-occurrence with migraine, and on the presence of other possible comorbidities. The radiological section deals with the differential diagnosis of white matter lesions and changes in connectivity patterns on brain magnetic resonanceto investigate a possible link between MS and migraine. The therapeutic section evaluates the effects of MS-disease-modifying therapies on migraine and of prophylactic migraine treatments on MS. Methods: The literature search was conducted using PubMed as an electronic database. The papers that reported relevant clinical, radiological and therapeutic findings were selected. Results: Among 1351 results retrieved, at the end of screening procedures, 34 studies were selected. Migraine can impact the perception of some symptoms and the presence of some comorbidities, particularly relevant in MS. Furthermore, migraine and MS share some radiological features, leading to diagnostic challenges, however identifying some lesion characteristics and changes in the connectivity pathway may be supportive. Medications for migraine and MS should be administered considering both the adverse events and multiple drug interactions. Conclusions: The data emerging from this review illustrate the research efforts aimed at providing valuable insights into accurate diagnosis, effective clinical management, and the definition of targeted treatment schedules that could improve the quality of life for pwMS with migraine. Full article
(This article belongs to the Special Issue Clinical Management of Patients with Multiple Sclerosis (MS))
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