Musneckienė, Dalia

Objectives: This article presents the current structure, data collection methods, coverage, and limitations of the Lithuanian Multiple Sclerosis (MS) Registry. Materials and methods: The Lithuanian MS Registry, established by the Lithuanian Neurologists' Association, began its activities in 2013. All three national centers providing MS treatment in Lithuania have secure access to their respective patient data and can enter new clinical information into the registry. Adult individuals with a suspected or confirmed diagnosis of MS who receive care in Lithuania and provide written informed consent are eligible for inclusion in the Multiple Sclerosis Patient Surveillance System registry. For the present analysis, a dataset comprising all records from February 1, 2013, to January 1, 2024, was extracted on June 17, 2024. Results: The registry collects individual data on demographics, results from specific diagnostic procedures (such as cerebrospinal fluid analysis, evoked potentials), clinical evaluations conducted at every visit (based on the Expanded Disability Status Scale), treatment, and relapses (including their dates and whether corticosteroid treatment was administered). Currently, the registry includes 2,923 patients. Of these, 1,651 patients are classified as in active follow-up (those with at least one recorded visit since January 1, 2021) and represent less than half of the total MS population in Lithuania (47.3%). The registry covers approximately 69.5%−74.6% of all patients receiving disease-modifying therapy in the country. Conclusion: Although the registry has been operating for more than a decade, challenges remain in patient enrollment and ensuring high-quality data collection. Strengthening validation processes is essential to ensure the registry's reliability and utility in both clinical practice and research settings.

Background and Objectives: Selecting appropriate disease-modifying drugs (DMDs) is crucial for optimizing treatment and slowing disease progression in multiple sclerosis (MS). Real-world studies assess drug efficacy and usage in routine clinical practice. Therefore, the goal of this study was to determine the efficacy and safety of oral drug therapy in patients with relapsing–remitting multiple sclerosis and the particularities of adherence to the therapy. Materials and Methods: A retrospective and prospective study was conducted at the Neurology Clinic of the Kaunas Clinics of the Lithuanian University of Health Sciences. The medical records of patients with relapsing–remitting multiple sclerosis (RRMS) were reviewed. The retrospective study included 286 patients, and the prospective study included 175 patients. Results: The study population included 131 patients on teriflunomide (TFN), 53 on dimethyl fumarate (DMF), 37 on fingolimod (FTY), and 65 on cladribine (CLAD). The overall absolute reduction in the ARR over 4 years of treatment was higher in the second-line (FTY and CLAD) group (−2.00) compared with the first-line (−0.99) group (TFN and DMF). The total EDSS scores of patients who received FTY and CLAD were higher in the second (3.09, p = 0.024), third (3.94, p = 0.015), and fourth (3.6, p = 0.002) years of treatment, compared with the patients of first-line therapy. MRI revealed that the number of contrast-enhancing and new lesions was lower among patients taking second-line drugs in the second year (4.7% and 18.6%, respectively). The worst adherence to the drug therapy due to forgetfulness was observed in the DMF group (30.8%). Lymphopenia was less frequent in the TFN group (93.1%) and more frequent in the FTY group (86.5%) (p < 0.001). Conclusions: Over four years, second-line patients had greater ARR reduction, fewer MRI lesions, and higher EDSS from year two. DMF showed the lowest adherence, mainly due to patient forgetfulness, while lymphopenia occurred most frequently with FTY.

Neuromyelitis Optica Spectrum Disorder (NMOSD) is a rare inflammatory and demyelinating disease of the central nervous system affecting the optic nerves and the spinal cord. Diagnosis of NMOSD is based on the Diagnostic Criteria of the International Panel for NMOSD diagnosis (IPND). This paper introduces the case of a man who developed bilateral blindness and acute paralysis of legs. The MRI scan of the brain and spinal cord revealed lesions characteristic of transverse myelitis and bilateral optic neuritis. The serum test performed was negative for aquaporin-4-IgG (AQP4-IgG). Based on the diagnostic criteria of IPND, the patient was diagnosed with NMOSD and prescribed with immunosuppressive methylprednisolone IV once a day for five days and changed to prednisolone PO. The clinical case described here demonstrates the importance of assessing the clinical symptoms as well as brain and spinal cord images in the diagnosis of NMOSD in seronegative AQP4-IgG patients.

Introduction: Over half of all patients with Multiple Sclerosis experience sleep disorders and fatigue. Awareness of this association is fundamental for prompt diagnosis and treatment. Objectives/Aims: To assess the sleep and fatigue related features in patients with relapsing-remitting multiple sclerosis (RRMS). Methods: The prospective study was conducted at the Neurology Clinic of LUHS Kaunas Hospital between June 2022 and May 2023. Fifty patients with RRMS (36 females and 14 males) (inclusion criteria: age ≧18 years, Expanded Disability Status Scale (EDSS)) ⩽ 6) were enrolled into the study, of which 18 underwent polysomnography testing. Control group consisted of 52 healthy adult individuals (36 females, 16 males) which were age and gender adjusted. The respondents completed an anonymous questionnaire containing demographic, lifestyle, sleep, and fatigue questions. The Epworth Sleepiness Scale (ESS), Modified fatigue impact scale, Visual Analog Fatigue Scale, Pittsburgh sleep quality index (PSQI), Insomnia Severity Index (ISI), Berlin Questionnaire, Beck depression inventory were provided. The statistical analysis was carried out using a statistical software package for data analysis SPSS 27.0. Results: The frequency of clinical insomnia (ISI >14) was significantly higher in RRMS patients in comparison with the control group (p = 0.02). Both total MFIS score (p < 0.001) and results of each of the subscales (physical, cognitive, and psychosocial fatigue) were significantly higher in RRMS (p < 0.001, p = 0.037, p = 0.002 respectively). MRI lesion activity significantly correlated with increased daytime sleepiness (ESS p < 0.01). The poor sleep quality (PSQI >5) was statistically more common in RRMS group with fatigue than in control group without fatigue symptoms (p = 0.02). The intensity of fatigue was also higher in respondents with poor sleep quality (p < 0.001). Polysomnography results confirmed 1 obstructive sleep apnoea, 3 periodic limb movement disorder in subjects with RRMS. Overall decreased sleep efficiency (<85%) and increased sleep latency (5-20 minutes) in 77,8% of subjects was established. Conclusion: Clinically significant insomnia is more common in subjects with RRMS and subjects with fatigue. The intensity of fatigue is higher in RRMS. Polysomnography-based sleep efficiency decreases in RRMS.

Introduction: The link between headache and multiple sclerosis (MS) has been explored in connection with various demographic and clinical characteristics such as gender, age, disease duration, and disability progression. Additionally, investigations are ongoing to establish a relationship between headache and the clinical course of MS. Literature highlights that headache may serve as an initial symptom of MS, which underscores the importance of paying attention to at-risk groups. Objectives/Aims: To determine the frequency of headache and their associations with demographic and clinical characteristics in multiple sclerosis (MS) patients. Methods: A prospective study was conducted at the Neurology Clinic of the Kaunas Clinics of the Lithuanian University of Health Sciences. A total of 99 patients with MS were surveyed. A targeted questionnaire was used to assess the prevalence and type of headache, with clinical data supplemented from medical histories. Primary headache was diagnosed according to the International Classification of Headache Disorders (ICHD-3) criteria. Results: Primary headache was observed in 48.5% of the participants, with migraine affecting 45.8%, tension-type headache 35.4%, and other types 18.8%. Migraine-type headache had a higher prevalence in women (59.7%). Before the diagnosis of MS, headache affected 31.3% of the participants. Within the headache group, 58.3% of the participants reported a relapse of headache before MS relapses, with 50% of them experiencing migraines, 28.6% tension-type headache, and 21.4% other types of headache. The mean score on the Expanded Disability Status Scale for participants experiencing headache was 4 ± 1.7 points, among those suffering from migraines, the mean score was 3.7 ± 1.6 points. Migraine was the most common headache in relapsing-remitting multiple sclerosis form and progressive form of MS. Headache was present in more than half of MS patients treated with disease-modifying therapy. Conclusion: Headache occurred in slightly less than half of the participants with multiple sclerosis. Among them, migraine-type headache and their prevalence among women were most frequently observed. Participants reported headache less frequently before the diagnosis of MS. No associations were found between types of headache, relapses before MS relapses, severity of disability, duration and clinical course of MS, and the use of disease-modifying therapy.

Kladribino tabletės – ligos eigą modifikuojantis vaistas, skirtas itin aktyviai recidyvuojančiajai remituojančiajai išsėtinės sklerozės formai gydyti. Kladribinas yra purino nukleozido adenozino analogas, selektyviai veikiantis limfocitų subpopuliacijas, dalyvaujančias išsėtinės sklerozės etiopatogenezėje, ir yra priskiriamas imuninės sistemos atkūrimo vaistų grupei. Du trumpi kladribino tablečių kursai, skiriami per dvejus metus, reikšmingai sumažina atkryčių dažnį ir negalios progresavimą. Daugumai pacientų poveikis išlieka ir trečiaisiais bei ketvirtaisiais metais. Kladribino tabletės pasižymi paprastai valdomomis saugumo savybėmis, o reikšmingiausias nepageidaujamas poveikis yra limfopenija, kuri paprastai nedidina infekcijų, išskyrus Herpes zoster, rizikos. Vis dėlto kasdienėje praktikoje iškyla nemažai klausimų, susijusių su gydymo kladribino tabletėmis taktika esant įvairioms klinikinėms situacijoms pirmaisiais–ketvirtaisiais gydymo metais, taip pat po ketvirtųjų metų. Nors kontraindikacijų skirti papildomus kladribino tablečių kursus nėra, vaistinio preparato charakteristikų santrauka nepateikia išsamių gairių dėl tolesnio šio vaisto vartojimo. Nuo vaistinio preparato registracijos praėjus daugiau nei penkeriems metams, paskelbta naujų klinikinių tyrimų rezultatų ir realaus gyvenimo duomenų (angl. Real-World Evidence) apie kladribino tablečių veiksmingumą ir saugumą, kuriais remdamosi keletas nacionalinių ir tarptautinių ekspertų komisijų, taip pat Lietuvos neurologų asociacija pateikė rekomendacijas dėl kladribino tablečių vartojimo. Atsinaujinus ligos aktyvumui, atsižvelgiant į ligos aktyvumo laipsnį, galima skirti papildomą kladribino tablečių kursą ar keisti kladribino tabletes kitais ligos eigą modifikuojančiais vaistais. Jei paciento būklė išlieka stabili po ketvirtųjų metų, tikslinga pratęsti laikotarpį, kai negydoma kladribino tabletėmis, taikant struktūrintą paciento klinikinės ligos eigos bei radiologinį stebėjimą.

Introduction. During the pandemic, vaccination against COVID-19 has become one of the most important ways to prevent severe infection. However, a lack of trust in vaccines among the population, including people with multiple sclerosis (MS) has been identified. In Lithuania, the specific reasons for vaccine hesitancy among people with MS have not been described. We conducted a survey to determine the attitude of people with MS towards vaccination against COVID-19 infection. Methods. An original anonymous questionnaire was created. The survey included the following aspects: patient demographics, MS exacerbation, COVID-19 vaccination status, and attitudes towards the vaccination process. The survey was conducted between November 2021 and February 2022. Data were analyzed using IBM SPSS Statistics 27.0 with Chi-square and Mann-Whitney U tests and p-value (statistically significant at <0.05) for each hypothesis. Results. Of the 80 MS patients, 82.5% (n=66) were vaccinated and only 17.5% (n=14) were not vaccinated. The most popular positive opinions about vaccination were: “COVID-19 vaccines have more benefits than harm” (71.6%) and “the desire to prevent severe symptoms/hospitalization caused by COVID-19 infection” (79.1%), while mostly agreed negative opinion was “fear of side effects of the vaccine” (84.6%). Intended uptake of COVID-19 vaccines was strongly associated with younger age (p=0.021), higher education level (p=0.008), and employment status (p=0.028). There was no further link between other demographic factors such as gender, residency, and even exacerbation of MS between January 1, 2020 and February 1, 2022 (p>0.05). Conclusion. Although there was some hesitancy about the COVID-19 vaccination, people with MS were more likely to take the COVID-19 vaccine due to their positive attitude towards the process.

Nuo 2019 m. gruodžio mėnesio dėl COVID-19 infekcijos visame pasaulyje buvo įvestas karantinas, siekiant sustabdyti žmonių kontaktavimą ir apriboti ligos plitimą. Tačiau, sumažėjus kontaktų ir apsilankymų pas gydytojus, iškilo kita problema, su kuria susidūrė lėtinėmis ligomis, ypač išsėtine skleroze, sergantys pacientai. Tai neuropsichologinės būklės blogėjimas, pasireiškiantis depresija, padidėjusiu stresu, nemiga ir sumažėjusiu fiziniu aktyvumu. Šiame straipsnyje apžvelgsime kitų autorių atliktus mokslinius darbus, nagrinėjančius COVID-19 pandemijos įtaką išsėtine skleroze sergančių pacientų neuropsichologinei būklei ir galimus šios problemos sprendimo būdus.

Background: Fingolimod is associated with an increased risk of developing progressive multifocal leukoencephalopathy (PML); however, its discontinuation may cause severe immune reconstitution inflammatory syndrome (IRIS). As both of these conditions (especially fingolimod induced PML) are rarely described in medical case reports distinguishing between PML-IRIS and MS-IRIS may be diagnostically challenging. Case presentation: We report a patient with severe clinical decline (Expanded Disability Status Scale (EDSS) increasing from 3.5 to 7.5) and multiple, large, contrast-enhancing lesions on brain magnetic resonance imaging (MRI) a few months after fingolimod withdrawal. The diagnostic possibilities included IRIS due to fingolimod withdrawal versus PML-IRIS. The JC virus (JCV) antibody index was positive (2.56); however, cerebrospinal fluid (CSF) JCV real-time polymerase chain reaction (JCV-PCR) was negative and brain biopsy was not performed. After a long course of aggressive treatment (several pulsed methylprednisolone infusions, plasmapheresis, intravenous dexamethasone, oral mirtazapine) the patient gradually recovered (EDSS 2.5) and MRI lesions decreased.Conclusions: This case report demonstrates the importance of monitoring patients carefully after the discontinuation of fingolimod for PML-IRIS and rebound MS with IRIS as these conditions may manifest similarly.