Iranian specialists' approach to treatment escalation in multiple sclerosis patients with cognitive impairment

Fereshteh Ghadiri; Elnaz Asadollahzadeh; Zahra Ebadi; Mohammad Ali Sahraian; Amirreza Azimi; Samira Navardi; Hora Heidari; Zohreh Abna; Marzieh Aboutorabi; Iman Adibi; Seyed Mohammad Baghbanian; Sepideh Paybast; Maryam Poursadeghfard; Samaneh Hosseini; Sareh Shahmohammadi; Mehran Ghaffari; Hamidreza Ghalyanchi-Langroodi; Masoud Ghiasian; Hoda Kamali; Ebrahim Kouchaki; Farzad Mahrabi; Ehsan Mohammadianinejad; Mohammad Ali Nahayati; Abdorreza Naser Moghadasi

doi:10.18502/cjn.v22i1.12610

Iranian specialists' approach to treatment escalation in multiple sclerosis patients with cognitive impairment

Curr J Neurol. 2023 Jan 5;22(1):1-7. doi: 10.18502/cjn.v22i1.12610.

Authors

Fereshteh Ghadiri¹, Elnaz Asadollahzadeh¹, Zahra Ebadi¹, Mohammad Ali Sahraian¹, Amirreza Azimi¹, Samira Navardi¹, Hora Heidari¹, Zohreh Abna¹, Marzieh Aboutorabi², Iman Adibi^{3

4}, Seyed Mohammad Baghbanian⁵, Sepideh Paybast¹, Maryam Poursadeghfard⁶, Samaneh Hosseini⁷, Sareh Shahmohammadi¹, Mehran Ghaffari⁸, Hamidreza Ghalyanchi-Langroodi⁹, Masoud Ghiasian¹⁰, Hoda Kamali¹¹, Ebrahim Kouchaki¹², Farzad Mahrabi¹³, Ehsan Mohammadianinejad¹, Mohammad Ali Nahayati¹⁴, Abdorreza Naser Moghadasi¹

Affiliations

¹ Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
² Department of Neurology, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
³ Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
⁴ Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
⁵ Department of Neurology, Booalicina Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
⁶ Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
⁷ Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
⁸ Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁹ Center for Clinical Research and Development, Ghaem International Hospital, Rasht, Iran.
¹⁰ Department of Neurology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
¹¹ Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran.
¹² Department of Neurology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.
¹³ Department of Neurology, Imam Reza Hospital, AJA University of Medical Sciences, Tehran, Iran.
¹⁴ Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Background: People with multiple sclerosis ‎(MS) and their physicians recognize cognitive retention as an important desired outcome of disease-modifying therapies (DMTs). In this study, we attempted to gather the opinions of Iranian MS experts regarding the treatment approach toward clinical cases with different physical and cognitive conditions. Methods: Opinions of 20 MS specialists regarding the best approach to 6 case scenarios (with different clinical, cognitive, and imaging characteristics) were gathered via a form. Results: The estimated kappa of 0.16 [95% confidence interval (CI): 0.159-0.163; P < 0.001] suggested a poor degree of agreement on the treatment choice among the professionals. Conclusion: Although most specialists agreed with treatment escalation in cases with cognitive impairment, there was no general agreement. Furthermore, there was not enough clinical evidence in the literature to develop consensus guidelines on the matter.

Keywords: Cognitive Dysfunction; Iran; Multiple Sclerosis; Specialist; Treatment Escalation.