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Article ; Online: Serious side effects of amantadine: Rethinking the benefits and risks of medications for MS fatigue.

Nourbakhsh, Bardia

Multiple sclerosis (Houndmills, Basingstoke, England)

2021 Volume 27, Issue 14, Page(s) 2290

MeSH term(s)	Amantadine/adverse effects ; Fatigue/chemically induced ; Humans ; Multiple Sclerosis/drug therapy ; Risk Assessment
Chemical Substances	Amantadine (BF4C9Z1J53)
Language	English
Publishing date	2021-09-05
Publishing country	England
Document type	Journal Article
ZDB-ID	1290669-4
ISSN	1477-0970 ; 1352-4585
ISSN (online)	1477-0970
ISSN	1352-4585
DOI	10.1177/13524585211042341
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Article: Design recommendations for studies that evaluate multiple sclerosis fatigue interventions.

Ghajarzadeh, Mahsa / Waubant, Emmanuelle / Nourbakhsh, Bardia

Frontiers in psychiatry

2024 Volume 14, Page(s) 1287344

Language	English
Publishing date	2024-01-10
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564218-2
ISSN	1664-0640
ISSN	1664-0640
DOI	10.3389/fpsyt.2023.1287344
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Article ; Online: Association between demographics, socioeconomics, and disease-related factors and the perception of stigma in people with MS.

Ghajarzadeh, Mahsa / Fitzgerald, Kathryn C / Mowry, Ellen M / Nourbakhsh, Bardia

Multiple sclerosis (Houndmills, Basingstoke, England)

2024 Volume 30, Issue 2, Page(s) 238–246

Abstract: Background: Stigma is prevalent among individuals with chronic diseases, such as multiple sclerosis (MS) and those with comorbid mental health disorders, but its associated factors are poorly understood.: Objective: To investigate the prevalence and ... ...

Abstract	Background: Stigma is prevalent among individuals with chronic diseases, such as multiple sclerosis (MS) and those with comorbid mental health disorders, but its associated factors are poorly understood. Objective: To investigate the prevalence and correlates of stigma in people living with MS. Methods: We analyzed data from the MS Partners Advancing Technology and Health Solutions (MS PATHS) network, which collected patient information and outcomes during routine clinic visits. We used a multinomial logistic regression model to examine the cross-sectional association between stigma and demographic, socioeconomics, and MS-related factors. Results: We included 11,634 participants. The mean Neuro-QoL stigma Conclusion: Stigma remains a relevant issue for people living with MS. Factors, such as physical and cognitive disability, DMT, and employment status may influence the severity of perceived stigma.
MeSH term(s)	Humans ; Male ; Female ; Quality of Life ; Cross-Sectional Studies ; Multiple Sclerosis/complications ; Employment ; Perception
Language	English
Publishing date	2024-01-05
Publishing country	England
Document type	Journal Article
ZDB-ID	1290669-4
ISSN	1477-0970 ; 1352-4585
ISSN (online)	1477-0970
ISSN	1352-4585
DOI	10.1177/13524585231223057
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Article: Serum Sickness/Serum Sickness-like Reactions Following Ocrelizumab Infusion in 2 Patients With Multiple Sclerosis.

Rjeily, Nicole Bou / Nourbakhsh, Bardia / Mowry, Ellen M

International journal of MS care

2023 Volume 25, Issue 5, Page(s) 196–198

Abstract: Serum sickness (SS) is a rare hypersensitivity reaction that can occur with monoclonal antibodies, and only 1 case of SS has been reported with ocrelizumab. We describe 2 patients with multiple sclerosis (MS) who developed SS/SS-like reactions (SSLRs) ... ...

Abstract	Serum sickness (SS) is a rare hypersensitivity reaction that can occur with monoclonal antibodies, and only 1 case of SS has been reported with ocrelizumab. We describe 2 patients with multiple sclerosis (MS) who developed SS/SS-like reactions (SSLRs) following ocrelizumab infusions. A man, aged 45 years, and a woman, aged 59 years, both with primary progressive MS, developed generalized weakness and arthralgias following their ocrelizumab infusions. Brain and spinal cord MRIs revealed no new or enhancing demyelinating lesions in both cases. They both had elevated inflammatory markers and negative infectious workups. They were subsequently treated for presumed SS with a steroid taper (and with potent anti-inflammatories in the second case), and symptoms improved dramatically after a few days. These cases suggest that SS/SSLRs should be suspected in a patient with new-onset arthralgia following ocrelizumab infusion who has an otherwise negative workup and rapid response to steroids.
Language	English
Publishing date	2023-09-14
Publishing country	United States
Document type	Journal Article
ISSN	1537-2073
ISSN	1537-2073
DOI	10.7224/1537-2073.2022-080
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Article ; Online: Low-dose ketamine infusion for the treatment of multiple sclerosis fatigue (INKLING-MS): Study protocol for a randomized, double-blind, active placebo-controlled phase II trial.

Ghajarzadeh, Mahsa / Roman, Samantha / Vega, Lauren / Nourbakhsh, Bardia

Contemporary clinical trials

2023 Volume 126, Page(s) 107106

Abstract: Background: Fatigue is one of the most common symptoms of people with Multiple Sclerosis (MS). However, currently-used medications for the treatment of fatigue probably do not work better than a placebo. In a pilot trial, we showed that one infusion of ... ...

Abstract	Background: Fatigue is one of the most common symptoms of people with Multiple Sclerosis (MS). However, currently-used medications for the treatment of fatigue probably do not work better than a placebo. In a pilot trial, we showed that one infusion of low-dose ketamine significantly improved fatigue severity measured four weeks after the infusion. Methods: The proposed study is a single-center, phase II, randomized, double-blind, parallel-group, active-placebo-controlled trial of intravenous low-dose ketamine in patients with MS fatigue. Participants will be randomized 1:1:1 into three groups: receiving either one or two infusions of ketamine (0.5 mg/kg over 40 min) or zero to one infusion of the active placebo (midazolam, 0.05 mg/kg over 40 min). Eligibility criteria include adult patients diagnosed with MS based on the latest criteria, complaining of fatigue as one of the main symptoms, and having a screening MFIS score higher than a pre-specified threshold. Results: One hundred and ten participants will be randomized over 30 months at Johns Hopkins MS Center. Complete enrollment is expected by mid-2025. The study's primary outcome will be the MFIS score at the end of week 4, comparing two-thirds of the participants who received ketamine with one-third who received midazolam. The secondary and exploratory outcomes (measured four weeks after the second infusion) will show how long the effects of a single infusion last and if two infusions of ketamine are better than one in improving MS fatigue. Conclusion: This study can show whether intervening in the glutamatergic pathways would improves MS fatigue.
MeSH term(s)	Adult ; Humans ; Ketamine ; Multiple Sclerosis/complications ; Multiple Sclerosis/drug therapy ; Midazolam/therapeutic use ; Double-Blind Method ; Fatigue/etiology ; Fatigue/chemically induced ; Treatment Outcome ; Randomized Controlled Trials as Topic ; Clinical Trials, Phase II as Topic
Chemical Substances	Ketamine (690G0D6V8H) ; Midazolam (R60L0SM5BC)
Language	English
Publishing date	2023-02-02
Publishing country	United States
Document type	Clinical Trial Protocol ; Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2182176-8
ISSN	1559-2030 ; 1551-7144
ISSN (online)	1559-2030
ISSN	1551-7144
DOI	10.1016/j.cct.2023.107106
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Article ; Online: Structural MRI measures are associated with fatigue severity and persistence in a large, real-world cohort of people with multiple sclerosis.

Simpson, Alexandra C / Hu, Chen / Mowry, Ellen M / Naismith, Robert T / Fitzgerald, Kathryn C / Nourbakhsh, Bardia

Multiple sclerosis (Houndmills, Basingstoke, England)

2024 Volume 30, Issue 6, Page(s) 738–746

Abstract: Background: Results of research on radiological hallmarks of multiple sclerosis (MS) fatigue have been conflicting.: Objective: To investigate the associations of lesion and brain compartment volumes with fatigue severity and persistence in people ... ...

Abstract	Background: Results of research on radiological hallmarks of multiple sclerosis (MS) fatigue have been conflicting. Objective: To investigate the associations of lesion and brain compartment volumes with fatigue severity and persistence in people with multiple sclerosis (PwMS). Methods: The Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) network collects standardized data during routine care of PwMS from 10 healthcare institutions. Magnetic resonance imaging (MRI) predictors included baseline brain parenchymal (BPF) and gray matter fractions (GMF) and T2 lesion volume (T2LV). The Quality of Life in Neurological Disorders (Neuro-QOL) fatigue subscore was analyzed linearly and categorically using T-score cutpoints, with a period of elevated symptoms defined as T-score ⩾ mean + 0.5 SD over follow-up. Results: At baseline, of 4012 participants (average age: 45.6 ± 11.8 years; 73% female; 31% progressive MS), 2058 (51%) had no fatigue, 629 (16%) had mild fatigue, and 1325 (33%) had moderate-to-severe fatigue. One SD greater baseline BPF and GMF were associated with 0.83 ( Conclusion: Baseline lesion burden and lower generalized whole-brain volumes were associated with MS fatigue in cross-sectional and longitudinal analyses in a large, real-world cohort of PwMS.
MeSH term(s)	Humans ; Female ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Fatigue/etiology ; Fatigue/diagnostic imaging ; Adult ; Multiple Sclerosis/diagnostic imaging ; Multiple Sclerosis/pathology ; Multiple Sclerosis/complications ; Severity of Illness Index ; Brain/diagnostic imaging ; Brain/pathology ; Gray Matter/diagnostic imaging ; Gray Matter/pathology ; Cohort Studies ; Quality of Life
Language	English
Publishing date	2024-03-25
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	1290669-4
ISSN	1477-0970 ; 1352-4585
ISSN (online)	1477-0970
ISSN	1352-4585
DOI	10.1177/13524585241239473
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Article: The Role of Remote Monitoring in Evaluating Fatigue in Multiple Sclerosis: A Review.

Block, Valerie J / Bove, Riley / Nourbakhsh, Bardia

Frontiers in neurology

2022 Volume 13, Page(s) 878313

Abstract: Fatigue is one of the most common multiple sclerosis (MS) symptoms. Despite this, monitoring and measuring fatigue (subjective lack of energy)- and fatigability (objectively measurable and quantifiable performance decline)- in people with MS have ... ...

Abstract	Fatigue is one of the most common multiple sclerosis (MS) symptoms. Despite this, monitoring and measuring fatigue (subjective lack of energy)- and fatigability (objectively measurable and quantifiable performance decline)- in people with MS have remained challenging. Traditionally, administration of self-report questionnaires during in-person visits has been used to measure fatigue. However, remote measurement and monitoring of fatigue and fatigability have become feasible in the past decade. Traditional questionnaires can be administered through the web in any setting. The ubiquitous availability of smartphones allows for momentary and frequent measurement of MS fatigue in the ecological home-setting. This approach reduces the recall bias inherent in many traditional questionnaires and demonstrates the fluctuation of fatigue that cannot be captured by standard measures. Wearable devices can assess patients' fatigability and activity levels, often influenced by the severity of subjective fatigue. Remote monitoring of fatigue, fatigability, and activity in real-world situations can facilitate quantifying symptom-severity in clinical and research settings. Combining remote measures of fatigue as well as objective fatigability in a single construct, composite score, may provide a more comprehensive outcome. The more granular data obtained through remote monitoring techniques may also help with the development of interventions aimed at improving fatigue and lowering the burden of this disabling symptom.
Language	English
Publishing date	2022-06-27
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2022.878313
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Article ; Online: Multiple Sclerosis Risk Factors and Pathogenesis.

Nourbakhsh, Bardia / Mowry, Ellen M

Continuum (Minneapolis, Minn.)

2019 Volume 25, Issue 3, Page(s) 596–610

Abstract: Purpose of review: This article summarizes recent advances in the identification of genetic and environmental factors that affect the risk of developing multiple sclerosis (MS) and the pathogenic processes involved in acute relapses and relapse- ... ...

Abstract	Purpose of review: This article summarizes recent advances in the identification of genetic and environmental factors that affect the risk of developing multiple sclerosis (MS) and the pathogenic processes involved in acute relapses and relapse-independent disability progression. Recent findings: The number of single-nucleotide polymorphisms associated with increased risk of MS has increased to more than 200 variants. The evidence for the association of Epstein-Barr virus infection, vitamin D deficiency, obesity, and smoking with increased risk of MS has further accumulated, and, in cases of obesity and vitamin D deficiency, the evidence for causal association has strengthened. Interactions between genetic and environmental factors have been studied more extensively. Dietary factors and changes in the gut microbiota are emerging as possible modulators of the disease risk. Several processes important to MS pathogenesis have been newly investigated or investigated more comprehensively, including the role of B cells, innate immune cells, meningeal inflammation, cortical and gray matter demyelination, and early axonal and neuronal loss. Summary: MS is a complex disease in which the interaction between genetic and environmental factors causes a cascade of events, including activation of the adaptive and innate immune system, blood-brain barrier breakdown, central nervous system demyelination, and axonal and neuronal damage with variable degrees of repair. These events manifest as potentially reversible focal neurologic symptoms or progressive nonremitting physical and cognitive disability, or both. Advances in the understanding of the risk factors and pathogenic mechanisms of MS have resulted in improved therapeutic strategies. The results of ongoing or future studies are needed to successfully and fully translate these advances into clinical practice.
MeSH term(s)	Adult ; Disease Progression ; Epstein-Barr Virus Infections/cerebrospinal fluid ; Epstein-Barr Virus Infections/diagnosis ; Epstein-Barr Virus Infections/genetics ; Female ; Humans ; Multiple Sclerosis/cerebrospinal fluid ; Multiple Sclerosis/diagnostic imaging ; Multiple Sclerosis/genetics ; Multiple Sclerosis, Relapsing-Remitting/cerebrospinal fluid ; Multiple Sclerosis, Relapsing-Remitting/diagnostic imaging ; Multiple Sclerosis, Relapsing-Remitting/genetics ; Obesity/cerebrospinal fluid ; Obesity/diagnosis ; Obesity/genetics ; Risk Factors ; Vitamin D Deficiency/cerebrospinal fluid ; Vitamin D Deficiency/diagnosis ; Vitamin D Deficiency/genetics
Language	English
Publishing date	2019-06-20
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ISSN	1538-6899
ISSN (online)	1538-6899
DOI	10.1212/CON.0000000000000725
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Article ; Online: B-cell depleting therapies may affect susceptibility to acute respiratory illness among patients with multiple sclerosis during the early COVID-19 epidemic in Iran.

Safavi, Farinaz / Nourbakhsh, Bardia / Azimi, Amir Reza

Multiple sclerosis and related disorders

2020 Volume 43, Page(s) 102195

Abstract: Objective: To determine whether the course of COVID-19 is more severe in patients with MS and if MS disease-modifying treatments (DMTs) affect the risk of contracting the disease.: Methods: In a cross-sectional survey, data were collected by sending ... ...

Abstract	Objective: To determine whether the course of COVID-19 is more severe in patients with MS and if MS disease-modifying treatments (DMTs) affect the risk of contracting the disease. Methods: In a cross-sectional survey, data were collected by sending a questionnaire to 2000 patients with a demyelinating disease through an online portal system. Collected data included the current MS DMT and patient-reported disability level, history of recent sick contact, recent fever, respiratory symptoms, diagnosis with COVID-19, and the disposition after the diagnosis. We defined a COVID-19-suspect group as patients having fever and cough or fever and shortness of breath, or a presumptive diagnosis based on suggestive chest computed tomography. We calculated the proportion of COVID-19-suspect patients and compared their demographics, clinical characteristics, and DMT categories with the rest of survey-responders, using univariable and multivariable models. Results: Out of 712 patients, 34 (4.8%) fulfilled our criteria for being in the COVID-19-suspect group. Only two patients required hospitalization. No patient required intensive care. In a multivariable model, disease duration (p-value=0.017), DMT category (p-value=0.030), and history of sick contact (p-values<0.001) were associated with the risk of being in the COVID-19-suspect group. Being on B-cell depleting antibodies (as compared to non-cell depleting, non-cell trafficking inhibitor DMTs) was associated with a 2.6-fold increase in the risk of being in the COVID-19-suspect group. (RR: 3.55, 95%CI: 1.45, 8.68, p-value=0.005). Conclusions: The course of infection in patients with MS suspected of having COVID-19 was mild to moderate, and all patients had a full recovery. B-cell depleting antibodies may increase the susceptibility to contracting COVID-19.
MeSH term(s)	Adult ; Antibodies, Monoclonal, Humanized/therapeutic use ; B-Lymphocytes/immunology ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/epidemiology ; Coronavirus Infections/immunology ; Coronavirus Infections/physiopathology ; Cough ; Cross-Sectional Studies ; Crotonates/therapeutic use ; Dimethyl Fumarate/therapeutic use ; Disease Susceptibility ; Dyspnea ; Epidemics ; Female ; Fever ; Fingolimod Hydrochloride/therapeutic use ; Glatiramer Acetate/therapeutic use ; Hospitalization/statistics & numerical data ; Humans ; Immunocompromised Host/immunology ; Immunologic Factors/therapeutic use ; Intensive Care Units/statistics & numerical data ; Interferons/therapeutic use ; Iran/epidemiology ; Lung/diagnostic imaging ; Lymphocyte Depletion ; Male ; Multiple Sclerosis/complications ; Multiple Sclerosis/drug therapy ; Multiple Sclerosis, Chronic Progressive/drug therapy ; Multiple Sclerosis, Chronic Progressive/epidemiology ; Multiple Sclerosis, Relapsing-Remitting/drug therapy ; Multiple Sclerosis, Relapsing-Remitting/epidemiology ; Natalizumab/therapeutic use ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/immunology ; Pneumonia, Viral/physiopathology ; Rituximab/therapeutic use ; SARS-CoV-2 ; Severity of Illness Index ; Toluidines/therapeutic use ; Tomography, X-Ray Computed
Chemical Substances	Antibodies, Monoclonal, Humanized ; Crotonates ; Immunologic Factors ; Natalizumab ; Toluidines ; teriflunomide (1C058IKG3B) ; Rituximab (4F4X42SYQ6) ; Glatiramer Acetate (5M691HL4BO) ; Interferons (9008-11-1) ; ocrelizumab (A10SJL62JY) ; Dimethyl Fumarate (FO2303MNI2) ; Fingolimod Hydrochloride (G926EC510T)
Keywords	covid19
Language	English
Publishing date	2020-05-13
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2645330-7
ISSN	2211-0356 ; 2211-0348
ISSN (online)	2211-0356
ISSN	2211-0348
DOI	10.1016/j.msard.2020.102195
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Article ; Online: Ethical considerations in the treatment of multiple sclerosis fatigue.

Nourbakhsh, Bardia / Waubant, Emmanuelle / Evers, Andrea W M / Solomon, Andrew J

Multiple sclerosis and related disorders

2021 Volume 54, Page(s) 103129

Abstract: Fatigue is the most common symptom and a leading cause of disability multiple sclerosis (MS). Despite the lack of evidence, several medications are frequently prescribed by physicians to ameliorate fatigue in patients with MS. However, a recent study ... ...

Abstract	Fatigue is the most common symptom and a leading cause of disability multiple sclerosis (MS). Despite the lack of evidence, several medications are frequently prescribed by physicians to ameliorate fatigue in patients with MS. However, a recent study demonstrated that improvement in fatigue severity with these medications appears to be due to placebo effect and is also is associated with more frequent adverse events than the placebo. These findings raise ethical concerns surrounding the initiation and discontinuation of these treatments for fatigue in MS. Starting these medications for the treatment of MS fatigue for their placebo effect may not be justified. However, stopping the medications in patients who report symptomatic benefits and have no side effects may also not be ethical. In MS care non-pharmacological approaches for fatigue treatment, such as exercise and cognitive behavioral therapy, should now be prioritized. Novel study designs may be necessary to address placebo response in future clinical trials evaluating interventions for fatigue in MS.
MeSH term(s)	Cognition ; Exercise ; Fatigue/drug therapy ; Fatigue/etiology ; Humans ; Multiple Sclerosis/complications ; Multiple Sclerosis/drug therapy ; Physicians
Language	English
Publishing date	2021-07-03
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2645330-7
ISSN	2211-0356 ; 2211-0348
ISSN (online)	2211-0356
ISSN	2211-0348
DOI	10.1016/j.msard.2021.103129
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