When fatigue postpartum is also prodromal.

Postpartum fatigue (PPF) is a common issue affecting mothers, characterized by reduced capacity for physical and mental activity in the weeks to months following delivery. While often attributed to the demands of infant care, severe or atypical PPF can signal an underlying medical condition, such as multiple sclerosis (MS). In this narrative review, guidance is provided to clinicians on recognizing signs of severe or atypical PPF, differentiating it from MS-associated fatigue.

Glucagon-like peptide-1 agonist safety and efficacy in a multiple sclerosis cohort.

Background: While glucagon-like peptide-1 agonist medications (GLP-1s) are on the rise, their safety and efficacy have not been studied in people with MS (PwMS).

Objective: To investigate any adverse effects of GLP-1 medications in the MS population as well as their effectiveness for weight loss and vitamin D augmentation.

Methods: We retrospectively identified PwMS who utilized a GLP-1 medication from 2006 to 2024.

Atypical disseminated herpes zoster infections in patients with demyelinating disease treated with dimethyl fumarate.

We report two patients who developed atypical, disseminated herpes zoster infections while on dimethyl fumarate (DMF) treatment, one with varicella zoster virus (VZV) encephalitis and another with herpes zoster oticus resulting in lasting motor and sensory deficits. We recommend vaccination against VZV prior to DMF initiation be incorporated as standard of care, as ensuring patients are protected against VZV before starting DMF can prevent such severe outcomes.

Multiple sclerosis treatment underutilization predicts high risk for obstructive sleep apnea in patients with multiple sclerosis.

Background: Obstructive sleep apnea (OSA) is more common in patients with multiple sclerosis (MS) than in the general population, which suggests MS may predispose patients to OSA. However, the relationships between MS treatment, disease activity, disease severity, fatigue, and OSA are unknown.

Objectives: To evaluate the connections between OSA risk, MS fatigue, and MS severity, controlling for well-established risk factors for OSA in the general population.

Worsening of lymphopenia in patients with multiple sclerosis when switched from dimethyl fumarate to diroximel fumarate.

Background: Diroximel fumarate (DRF) and dimethyl fumarate (DMF) are similar disease-modifying therapies (DMTs) that reduce disease activity in patients with relapsing-remitting multiple sclerosis (MS). We expect that patients on DRF would experience a similar incidence and severity of lymphopenia, given that it is a well-documented side effect of DMF treatment.

Methods: We utilized linear mixed-effects models to test for differences in white blood cell count (WBC), absolute lymphocyte count (ALC), absolute CD3+ count, absolute CD4+ count, and absolute CD8+ count over time in clinically stable patients with MS on DMF who switched to DRF.

Altered lymphocyte profiles and herpes zoster infections in patients with multiple sclerosis on natalizumab.

Cases of herpes zoster (HZ) in patients with MS on natalizumab (NTZ) have been documented. In this study, we assessed lymphocyte subsets in NTZ-treated patients with HZ compared to matched controls without HZ. Twenty unvaccinated patients developed HZ while on NTZ for an incidence rate of 12.

Clinical course of multiple sclerosis with comorbid endometriosis: A matched cohort study.

Background: Endometriosis (EMS) is pain syndrome in which endometrial tissue grows outside the uterus. EMS is associated with an increased risk of multiple sclerosis (MS), a demyelinating disease of the central nervous system.

Objective: To characterize clinical phenotypes of a cohort of patients with both EMS and MS compared to a cohort of matched controls with only MS.

Expanding clinical profiles and prognostic markers in stiff person syndrome spectrum disorders.

Objective: To describe the clinical features of a cohort of individuals with stiff person syndrome spectrum disorders (SPSD) and identify potential early predictors of future disability.

Background: There is a need to better understand the full spectrum of clinical and paraclinical features and long-term impact of SPSD.

Design/methods: Observational study from 1997 to 2022 at Johns Hopkins.

The many faces of gastrointestinal dysfunction in stiff person syndrome spectrum disorders.

Introduction: The effect of stiff person syndrome spectrum disorders (SPSD) on the gastrointestinal tract (GIT) is unknown. This case series aims to characterize the prevalence and types of GI dysfunction in individuals with SPSD.

Methods: A retrospective chart review included individuals diagnosed with SPSD with descriptors of GI symptoms in their medical records.

Bariatric surgery outcomes in multiple sclerosis: Interplay with vitamin D and chronic pain syndromes.

Background: Obesity and lower vitamin D levels are associated with adverse outcomes in multiple sclerosis (MS). Bariatric surgery is a safe intervention in patients with MS, although it lowers vitamin D levels in the general population.

Objective: To investigate the effects of bariatric surgery on vitamin D levels and interrogate risk factors for unsuccessful post-operative weight loss in patients with MS.

High CD4+:CD8+ ratios with herpes zoster infections in patients with multiple sclerosis on dimethyl fumarate.

Background: Dimethyl fumarate (DMF) depletes CD8+ and CD4+ T cells, and cases of herpes zoster (HZ) in patients with multiple sclerosis (MS) on DMF have been documented.

Objectives: To evaluate lymphocyte subsets in patients with MS who developed HZ on DMF (Tecfidera) compared to matched controls who did not develop HZ.

Methods: We used linear mixed-effects models to test for differences in white blood cell count, lymphocyte percentage, absolute lymphocyte count, CD3+ percentage, absolute CD3+ count, CD4+ percentage, absolute CD4+ count, CD8+ percentage, absolute CD8+ count, and CD4+:CD8+ ratio over time in HZ and non-HZ groups.

Respiratory symptoms are common in stiff person syndrome spectrum disorders and are associated with number of body regions involved.

Background And Purpose: Stiff person syndrome (SPS) spectrum disorders (SPSSD) cause spasms and rigidity throughout different body regions and can be associated with apnea and acute respiratory failure. There are limited data on the prevalence and predictors of respiratory symptoms with spasms (RSwS) in SPSSD. We sought to characterize the spirometry patterns and the frequency and predictors of RSwS in a large SPSSD cohort.