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

Fereshteh Ghadiri Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Elnaz Asadollahzadeh Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Zahra Ebadi Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Mohammad Ali Sahraian Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Amirreza Azimi Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Samira Navardi Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Hora Heidari Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Zohreh Abna Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Marzieh Aboutorabi Department of Neurology, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Iman Adibi Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Seyed Mohammad Baghbanian Department of Neurology, Booalicina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
Sepideh Paybast Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Maryam Poursadeghfard Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Samaneh Hosseini Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Sareh Shahmohammadi Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Mehran Ghaffari Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Hamidreza Ghalyanchi-Langroodi Center for Clinical Research and Development, Ghaem International Hospital, Rasht, Iran
Masoud Ghiasian Department of Neurology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
Hoda Kamali Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
Ebrahim Kouchaki Department of Neurology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
Farzad Mahrabi Department of Neurology, Imam Reza Hospital, AJA University of Medical Sciences, Tehran, Iran
Ehsan Mohammadianinejad Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Mohammad Ali Nahayati Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
Abdorreza Naser Moghadasi Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/cjn.v22i1.12610

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

Abstract

Background: People with multiple sclerosis ‎(MS) and their physicians recognize cognitive retention as an important desired outcome of disease-modifying

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.