Background: People with multiple sclerosis (PwMS) suffer from some comorbidities, including physical and psychiatric disorders, low quality of life (QoL), hormonal dysregulation, and hypothalamic-pituitary-adrenal axis dysfunction. The current study aimed to investigate the effects of eight weeks of tele-yoga and tele-Pilates on the serum levels of prolactin and cortisol and selected physical and psychological factors. Methods: Forty-five females with relapsing remitting multiple sclerosis, based on age (18–65), expanded disability status scale (0–5.5), and body mass index (20–32), were randomly assigned to tele-Pilates, tele-yoga, or control groups (n = 15). Serum blood samples and validated questionnaires were collected before and after interventions. Results: Following online interventions, there was a significant increase in the serum levels of prolactin (p = 0.004) and a significant decrease in cortisol (p = 0.04) in the time × group interaction factors. In addition, significant improvements were observed in depression (p = 0.001), physical activity levels (p < 0.001), QoL (p ≤ 0.001), and the speed of walking (p < 0.001). Conclusion: Our findings suggest that tele-yoga and tele-Pilates training could be introduced as patient-friendly, non-pharmacological, add-on therapeutic methods for increasing prolactin and decreasing cortisol serum levels and achieving clinically relevant improvements in depression, walking speed, physical activity level, and QoL in female MS patients.

Introduction: Multiple sclerosis (MS) is an inflammatory disease in which the myelin sheaths of the nerve cells in the brain and spinal cord, which are responsible for communication, are destroyed and cause physical signs and symptoms. According to studies, anti-CD20 monoclonal antibodies have significant results in the treatment of this disease. Thus, the aim of the present study was to determine the cost-effectiveness of rituximab against natalizumab in the patients with RRMS in southern Iran in 2020. Methods: This is an economic evaluation including cost-effectiveness analysis in which the Markov model with a lifetime horizon was used. The study sample consisted of 120 patients randomly selected from among those referred to the MS Association and the Special Diseases Unit of Shiraz University of Medical Sciences. In this study, the costs were collected from a societal perspective, and the outcomes were obtained in the form of Quality Adjusted Life Years (QALY) and the mean relapse rate. The TreeAge pro 2020 and Excel 2016 software were used for data analysis. Results: The comparative study of rituximab and natalizumab showed that the patients receiving rituximab had lower costs ($ 58,307.93 vs. $ 354,174.85) and more QALYs (7.77 vs. 7.65). In addition, the incidence of relapse by rituximab was lower compared to natalizumab (1.15 vs. 2.57). The probabilistic one-way sensitivity analysis showed the robustness of the results. The scatter plots also showed that rituximab was more cost-effective for the patients in 100% of the simulations for the threshold of < $ 37,641. Discussion and conclusion: According to the results of this study, rituximab had higher cost-effectiveness than natalizumab. Therefore, it could be a priority for RRMS patients compared to natalizumab because it reduced treatment costs and increased effectiveness.

Background: Neurological disability associated with multiple sclerosis and immunosuppressive or immunomodulatory therapy which is administered for it may increases the risk of SARS-CoV-2 infection and its morbidity/mortality. Objective: In this study, we evaluated the infection rate and the severity of SARS-CoV-2 infection in patients with multiple sclerosis (MS) Methods: One thousand and three hundred and sixty one MS patients from Fars province, south of Iran, were interviewed by phone from April 3 to June 20, 2020. Basic demographic data, information about MS disease and any symptoms or laboratory results relevant to COVID-19 were gathered and reviewed by treating neurologist and MS nurses. SPSS version 22 was used for data analysis. Results: 68 (5%) of MS patients were suspected cases and 8 (0.58%) of all patients with positive real-time reverse transcription polymerase chain reaction (RT-PCR) or chest CT were in the confirmed group. 5 cases of the confirmed group needed hospitalization. Two patients died while both of them had PPMS and were taking rituximab. The frequency rate of suspected cases with RRMS was 57 (87.7%), followed by PPMS 5 (7.7%) and CIS 2(3.1%). In the confirmed group 37.5% had RRMS, 50% had PPMS, 25% use corticosteroid drug, and 50% were on rituximab. 62.5% of confirmed cases had high disability level and need assistance to walk. 36.8% of suspected and 25% of the confirmed cases were on IFN-β1; eventually all of them recovered well from COVID-19 infection. Conclusion: The present study showed that rate of developing COVID-19 in MS patients are similar to the general population and the frequency of PPMS phenotype, rituximab therapy and corticosteroid therapy were higher in the confirmed group.

Genetics plays a significant role in Multiple Sclerosis (MS), with approximately 12.6% of cases occurring in familial form. While previous studies have demonstrated differences in disease progression and MRI findings between familial and sporadic MS, there has been no comparison of cognitive impairment between them. In this study, we evaluated cognitive performance among patients with sporadic and familial MS, along with a healthy control group. A total of 130 individuals, matched for age, sex, and education, were recruited for each group. The mean age of participants was 37.8 ± 9.8 years, and 77.6% of them were female. Cognitive performance was assessed using the Brief International Cognitive Assessment for MS (BICAMS) across the three groups. Both familial and sporadic MS patients showed poorer cognitive performance in the Symbol Digit Modalities Test (SDMT) (Familial: 46.96 ± 12.59, Sporadic: 45.88 ± 14.13, Normal: 56.48 ± 11.89), California Verbal Learning Test (CVLT) (Familial: 66.90 ± 14.01, Sporadic: 68.19 ± 16.49, Normal: 75.18 ± 13.02), and the Brief Visuospatial Memory Test-Revised (BVMT-R) (Familial: 24 (12), Sporadic: 24 (12), Normal: 35 (4)) compared to healthy controls. Meanwhile, no significant differences in cognitive impairment were observed between the familial and sporadic MS groups in the SDMT (p = 1.000), CVLT (p = 0.775), and BVMT-R (p = 0.733). Furthermore, this study found significant relationships between education, depression, age, and sex with different aspects of cognitive performance in MS. Overall, both familial and sporadic MS patients demonstrated similar levels of cognitive impairment.