Introduction Gait dysfunction is a common impairment in people with multiple sclerosis (PwMS), contributing to falls, reduced mobility, and lower quality of life. Functional electrical stimulation (FES) can address gait challenges but remains underutilized in MS care. This feasibility study evaluated the immediate effects of a novel multimuscle FES sleeve on spatiotemporal gait parameters in PwMS experiencing walking difficulties. Methods Twenty adults with MS participated completed preferred- and fast-speed walking trials on an instrumented walkway with and without a wearable lower-extremity FES sleeve in a single-session study. Usability rating was assessed via survey. Spatiotemporal gait metrics were compared between conditions. Results Responses indicated strong usability: 85% found the FES useful for self-management of walking symptoms; 95% agreed that FES would positively impact quality of life; 75% found it easy to use. FES use was associated with immediate improvements in gait stability, including reduced stride width variability and step length asymmetry, and increased walk ratio during preferred-speed walking. Reduced stride width variability was also observed during fast walking. Conclusions This multimuscle wearable FES sleeve was highly acceptable to PwMS and demonstrated immediate improvements in their gait stability. Longitudinal studies are needed to evaluate long-term effectiveness and impact on mobility and participation.
Background Progression independent of relapse and/or MRI activity (PIRA/PIRMA) is now understood to drive progression in persons with MS (PwMS). Worsening of cognition over time, cognitive PIRA or PIRMA, is understudied. Objective Examine change in cognition over 2 years in PwMS without relapse and/or MRI activity. Methods This study was a retrospective analysis of a prospective cohort assessing subjects at baseline and 2 years later; Symbol Digit Modalities Test (SDMT) and MRI were performed at both visits. PwMS aged ≥ 18 years were recruited consecutively, from November 2020 to August 2022. We identified subjects who did not experienced a relapse and/or new lesions on MRI yet demonstrated worsened on SDMT over time (cognitive PIRA and/or PIRMA). Results One hundred subjects completed the baseline visit, 95 subjects completed year 2. Four subjects had relapses. 29 (31.9%) had any decrease on SDMT: 17 (18.7%) decrease of ≥ four points; 6 (6.6%) a decrease of ≥ eight points. An additional 11 subjects had new lesions on MRI. In this remaining cohort, 25 (31.3%) had a decrease on SDMT: 14 (17.5%) ≥ four points; 4 (5.0%) ≥ eight points. Conclusion Cognitive PIRA/PIRMA is common in PwMS. More studies are needed to better understand this phenomenon.
Objectives To compare MSDA Score and pathway scores between patients treated with ocrelizumab and natalizumab in real-world MS population. Methods We conducted a cross-sectional observational study of patients treated with ocrelizumab or natalizumab at a tertiary MS center between June 2023 and February 2025. Octave MSDA results were linked to clinical and MRI data from electronic health records. Group differences in MSDA composite and pathway scores were evaluated using ordinal regression models adjusted for demographic and disease-related covariates. Results A total of 152 patients were included (105 ocrelizumab, and 47 natalizumab). Except for two natalizumab-treated patients (≥ 4 months), all patients had been on their current DMT for at least 6 months. Patients treated with ocrelizumab were significantly more likely to have low MSDA scores (MSDA ≤ 4) compared to those treated with natalizumab (98.1% vs. 66%), despite similar clinical and MRI outcomes. Patients on ocrelizumab also had lower scores in three biological pathways, including neuroinflammation (p < 0.001), immunomodulation (p < 0.001), and myelin biology (p = 0.002). Conclusions Ocrelizumab-treated patients showed significantly lower Octave MSDA composite scores compared with natalizumab, independent of clinical and MRI findings, highlighting the importance of considering DMT mechanisms when interpreting serum biomarker profiles.
Background Disease-modifying therapies (DMTs) for multiple sclerosis (MS) can be either high- or low-intensity. This study aims to examine predictors associated with high-intensity MS treatment strategies using commercial claims data. Methods We used Merative MarketScan commercial and Medicare supplemental databases to examine patients with: outpatient MS diagnosis (ICD-9/-10: 340.xx, G35.xx); DMT fill; no DMTs 1 year prior to MS diagnosis through DMT fill; and 6 months continuous database enrollment. The first DMT filled was classified as either high- (natalizumab, alemtuzumab, ocrelizumab, rituximab, ofatumumab, cladribine) or low-intensity (interferon, glatiramer acetate, teriflunomide, dimethyl fumarate, diroximel fumarate, fingolimod, ponesimod, siponimod, ozanimod). We used logistic regression to examine factors associated with high-intensity first-line MS treatments, and multilevel modelling to characterize provider-level variance. Results A total of 16,405 patients met the study criteria, and they were 48 years old on average (SD = 12), and 75% female. High-intensity first-line DMT was used in 3%, increasing from <1% in 2012 to 13% in 2021. Provider type was most commonly neurologist (49%) or MS specialist (36%). Provider-level effect accounted for 17% of variance. Discussion The minority of MS patients initiated high-intensity treatment although this proportion increased over time, and later years were predictive of high-intensity treatment. Providers had a significant role in the approach selected.
Background A risk of disease reactivation has been clearly identified after natalizumab cessation in patients with multiple sclerosis (MS). Several studies have demonstrated a low risk of reactivation or rebound in patients switching to anti-CD20, but limited data are available concerning ofatumumab. Objective In the present study, we evaluated a cohort of 61 MS patients who switched from natalizumab to ofatumumab. Results After a mean follow-up of 2.4 years (range: 6 months to 4 years), none of the patients had experienced any clinical relapse or magnetic resonance imaging reactivation. Conclusion We confirm that ofatumumab is likely an effective option, using a short washout period following natalizumab discontinuation.
