Background: While obesity has been shown to elevate the risk of developing multiple sclerosis (MS), there is a lack of strong evidence regarding its role in the disability progression and status of MS patients. Methods: This systematic review and meta-analysis aimed to provide comparative estimates of WC and BMI in patients with MS (PwMS) and to investigate potential associations between the waist circumference (WC) and body mass index (BMI) and demographic and specific MS characteristics. Adhering to PRISMA guidelines, a detailed search of the MEDLINE PubMed, Cochrane Library, and Scopus databases was conducted. Results: A total of 16 studies were included. The pooled mean WC and BMI among PwMS was estimated to be 87.27 cm (95%CI [84.07; 90.47]) and 25.73 (95%CI [25.15; 26.31]), respectively. Meta-regression models established a significant bidirectional relationship between WC and the Expanded Disability Scale (EDSS) (p < 0.001) but not between BMI and EDSS (p = 0.45). Sensitivity analyses showed no association between WC and age (p = 0.48) and a tendency between WC and disease duration (p = 0.08). Conclusions: Although WC measurements classify PwMS as normal weight, BMI measurements classify them as overweight. Therefore, WC should complement BMI evaluations in clinical practice. Additionally, our findings highlight the significant association between abdominal fat, as indicated by WC, and disease progression. Considering the heightened risk of cardiovascular comorbidity and mortality among PwMS, we recommend integrating both WC and BMI as standard anthropometric measurements in routine clinical examinations and targeted prevention strategies for PwMS.

Background/Objectives: Myasthenia gravis (MG) comprises an autoimmune disorder marked by muscle weakness and fatigue. MG frequently coexists with other autoimmune conditions, such as diabetes mellitus, which may exacerbate the clinical burden of MG and adversely impact overall quality of life. Methods: This systematic review and meta-analysis aimed to assess the prevalence of diabetes in patients with MG. Following PRISMA guidelines, a comprehensive search was conducted in the MEDLINE PubMed, Scopus, and Google Scholar databases. Results: A total of 11 studies comprising 16,825 patients were included. The pooled prevalence of diabetes among MG patients was 15.6% (95% CI [8.4%, 24.7%]; I² = 99%, p < 0.001). Compared to healthy controls, MG patients had a 1.24-fold increased risk of developing diabetes (95% CI [1.01–1.54], p < 0.001). Meta-regression showed no association between age and diabetes prevalence, although potential publication bias was noted (Egger’s test, p = 0.72). Conclusions: This meta-analysis reveals a higher prevalence of diabetes among MG patients, with an elevated risk compared to healthy individuals. These findings suggest that the association between MG and diabetes may be mediated by corticosteroid use, genetic factors, and reduced physical activity. The main limitations of this study are the lack of reported data regarding the type of diabetes and patients’ demographic and disease characteristics (MG classification severity and duration and type of treatment). Further studies are needed to investigate the underlying causal mechanisms and to elucidate the relationship between MG and diabetes subtypes.

Introduction: Multiple Sclerosis (MS) is associated with a wide range of debilitating symptoms, and conventional therapies often fail to adequately address the disease’s multifaceted challenges. Cannabidiol (CBD) 13.0% + Delta9-tetrahydrocannabinol (THC) 9.0% (CBD13/THC9), a vaporized cannabis-based medicinal product, presents a novel therapeutic option for managing MS symptoms. Methods: This single-center longitudinal study followed 69 MS patients over a six-month period. Participants were assessed at treatment initiation and at three- and six-month intervals. Key measures included muscle spasticity, urine bladder dysfunction, and the evaluation of disability progression rate. The evaluation included the Modified Ashworth Scale (MAS), the Post Void Residual (PVR) volume, and the Expanded Disability Status Scale (EDSS). Results: Significant improvement was observed across all outcome assessments. The EDSS score was decreased over time (p = 0.009), indicating a slight reduction in disability progression rate, while MAS scores showed substantial improvement in muscle spasticity (p < 0.001). Urine bladder function improved significantly, with PVR volume showing notable improvement between baseline and the six-month assessment (p < 0.001). Correlation analyses revealed that a gradual increase in vaporized CBD13/THC9 dose was correlated with slightly lower EDSS scores, while the adverse effects were negatively associated with the frequency of cannabinoid use. Finally, patients who were smokers used CBD13/THC9 more frequently. Conclusions: The vaporized CBD13/THC9 formulation demonstrated notable efficacy in slightly improving disability progression rate via reduction in muscle spasticity and urine bladder dysfunction in MS patients. This highlights its addon therapeutic value during rehabilitation in MS patients with debilitating disability symptoms.

Background/Objectives: Neuropsychological impairment (NI) is common in newly diagnosed patients with multiple sclerosis (pwMS). This study has two main objectives; the systematic review aims to describe the relationship between NI and molecular biomarkers in newly diagnosed pwMS, and the meta-analysis aims to explore the relationship between NI, age, disability status, and disease duration in this patient group. Methods: We conducted a systematic review, with 20 studies meeting the inclusion criteria. Out of these, 12 studies were included in the meta-analysis. We analyzed three key cognitive measures—the Symbol Digit Modalities Test (SDMT), the Paced Auditory Serial Addition Test (PASAT), and the Selective Reminding Test–long-term storage (SRT-LTS)—in relation to demographic and MS-related characteristics. Results: Neurofilament light chain (NfL) levels were consistently associated with NI, especially a slower information processing speed (IPS). Other biomarkers, including chitinase 3-like 1 (CHI3L1), brain-derived neurotrophic factor (BDNF), apolipoprotein E4 allele (APOE4), and vitamin D, also showed promising correlations with NI. A meta-regression analysis of 2380 pwMS indicated a negative association between SDMT score and disability status (p = 0.01). No significant associations were found for the PASAT with age, disability status, or disease duration (p > 0.05). Conclusions: These findings highlight the role of NfL as a biomarker related to NI in newly diagnosed pwMS and the association between IPS and disability status. Further research is needed with more homogeneous samples in terms of the disease duration, along with standardized cognitive assessments and a broader range of biomarkers, to improve our understanding and management of cognitive difficulties in the early stages of MS.

Background/Objectives: The majority of stroke survivors undergo physical therapy rehabilitation to regain functionality and improve their overall quality of life. Given the wide range of physical therapy modalities and approaches in post stroke cardiovascular fitness rehabilitation, this systematic review and meta-analysis (SR-MA) aims to assess their efficacy as measured by peak oxygen consumption (VO2peak). Methods: Adhering to PRISMA guidelines; a detailed search of the MEDLINE PubMed; Cochrane Library; and Scopus databases was conducted. Results: Thirty-seven studies with a total of 1310 post-stroke patients were included. The aggregated mean VO2 pre-intervention was 15.30 mL/kg/min ([14.09, 16.51], I² = 99.7%), increasing to 17.10 mL/kg/min post-intervention ([15.73, 18.46], I² = 99.8%). The standardized mean difference in VO2 was 1.76 ([1.20, 2.31], I² = 96.9%). Sensitivity analyses in a subset of RCTs revealed that cardiorespiratory rehabilitation demonstrates a statistically significant improvement in VO2peak levels compared to conventional physical therapy. There was a high degree of heterogeneity among included studies (potentially due to the lack of standardized protocols) while Egger’s test (β = 0.32, p = 0.72) and funnel plot inspection were indicative of moderate publication bias with small study effects. Conclusions: Based on the results of this meta-analysis, the increase in VO2peak levels post-interventions ranged from 0.28 to 3.36 mL/kg/min, depending on intervention type. The ideal time to commence aerobic training rehabilitation was found to be six months post-stroke. According to previous studies on cardiovascular diseases, VO2peak can potentially act as a predictor of (a) the efficacy of intervention and (b) the patient’s risk of stroke-recurrence and disability progression.

Stavrogianni K, et al. J Clin Neurol. 2024 Nov;20(6):591-598. https://doi.org/10.3988/jcn.2024.0149