Serkan Ozakbas

Izmir University of Economics Medical Point · Faculty of Medicine

Background The relationship between coronavirus disease 2019 (COVID-19) infection and multiple sclerosis (MS) relapse and disease progression remains unclear. Previous studies are limited by small sample sizes and most lack a propensity-matched control cohort. Objective To evaluate the effect of COVID-19 infection on MS disease course with a large...

Objectives To investigate the effect of telerehabilitation-based graded motor imagery (MI,GMI) training on pain and pain-related factors in people with multiple sclerosis (MS). Design Randomized controlled, assessor-blind pilot trial with repeated measure design. Setting Neurology outpatient clinic. Participants Thirty-two people with MS were rando...

Background and Objectives Women with multiple sclerosis (MS) are at risk of disease reactivation in the early postpartum period. Ocrelizumab (OCR) is an anti-CD20 therapy highly effective at reducing MS disease activity. Data remain limited regarding use of disease-modifying therapies (DMTs), including OCR, and disease activity during peripregnancy...

Introduction: The assessment of disability in multiple sclerosis (MS) patients is crucial for treatment decisions and prognosis estimation. The Expanded Disability Status Scale (EDSS), a widely accepted clinical measure, provides a standardized way to quantify disability in MS. However, predicting EDSS scores can be challenging due to the complex a...

Spinal cord lesions in multiple sclerosis (MS) have considerable impact on disability. High-efficacy disease-modifying treatments (hDMTs) are associated with greater reduction of relapses and new brain lesions compared to low-efficacy treatments (lDMTs). Knowledge on the impact of DMTs on cord lesion formation is limited as these outcome measures w...

Background Neuromyelitis optica spectrum disorder (NMOSD) can be categorised into aquaporin-4 antibody (AQP4-IgG) NMOSD or seronegative NMOSD. While our knowledge of AQP4-IgG NMOSD has evolved significantly in the past decade, seronegative NMOSD remains less understood. This study aimed to evaluate the predictors of relapses and treatment responses...

Background Distance walking fatigability (DWF) in people with multiple sclerosis (pwMS) is defined as a decrease in the distance walking over time. However, declines in gait quality (i.e., gait quality fatigability- GQF) may occur independently or alongside DWF. Objective i) to investigate how walking fatigability manifests and its prevalence in pw...

Background/Objectives The COVID-19 pandemic raised concern amongst clinicians that disease-modifying therapy (DMT), particularly anti-CD20 monoclonal antibodies (mAB) and fingolimod, could worsen COVID-19 in people with multiple sclerosis (pwMS). This study aimed to examine DMT prescribing trends pre- and post-pandemic. Methods A multi-centre long...

Background Late-onset multiple sclerosis (LOMS or L; MS) and early-onset MS (EOMS or E) are less common, and their prognosis can be different. To characterize the demographic and clinical features, and clinical outcomes of LOMS and EOMS patients, comparing them to adult-onset MS (AOMS or A) patients. Methods The study was conducted as a secondary...

Background Comparisons between cladribine and other potent immunotherapies for multiple sclerosis (MS) are lacking. Objectives To compare the effectiveness of cladribine against fingolimod, natalizumab, ocrelizumab and alemtuzumab in relapsing-remitting MS. Methods Patients with relapsing-remitting MS treated with cladribine, fingolimod, natalizu...

Background Multiple sclerosis (MS) is commonly associated with work difficulties. This study aimed to examine the relationship between work difficulties and physical disability, cognitive and social cognitive impairment, and subcortical gray matter (scGM) atrophy in pwMS. Methods Thirty-three employees with MS underwent assessments with Multiple Sc...

Background The COVID-19 pandemic raised concern amongst clinicians that disease-modifying therapies (DMT), particularly anti-CD20 monoclonal antibodies (mAb) and fingolimod, could worsen COVID-19 in people with multiple sclerosis (pwMS). This study aimed to examine DMT prescribing trends pre- and post-pandemic onset. Methods A multi-centre longitu...

Theory of Mind (ToM) is understanding others' minds. Empathy is an insight into emotions and feelings of others. Persons with multiple sclerosis (pwMS) may experience impairment in ToM and empathy. To investigate ToM, empathy, and their relationship with neuroimaging, neuropsychological, and neuropsychiatric data. 41 pwMS and 41 HC were assessed us...

Background The use of non-specific immunosuppressants (NSIS) to treat multiple sclerosis (MS) remains prevalent in certain geographies despite safety concerns, likely due to resource limitations. Objective To use MSBase registry data to compare real-world outcomes in adults with relapsing-remitting MS (RRMS) treated with dimethyl fumarate (DMF) or...

Background Exergaming has been suggested as a rehabilitation method since it is more motivational for people with multiple sclerosis (MS, pwMS). However, the major disadvantage of this method is the lack of specific scenarios designed for pwMS. Objectives This study aims to assess the feasibility of exergaming, which was developed for pwMS. Methods...

Objective: This study aims to investigate the relationship between disease-modifying therapies (DMTs) used in people with MS (pwMS) and the risk of COVID-19 infection. Methods: This longitudinal cohort study included the MS cohort of 3402 people followed for COVID-19 infection. The whole MS cohort was interviewed at least once for information about...

Background The risk of hepatitis B virus (HBV) reactivation remains unclear in people with multiple sclerosis (MS) receiving ocrelizumab. We aimed to assess HBV seroprevalence and reactivation risk in MS patients on ocrelizumab and to evaluate the effectiveness of antiviral prophylaxis against HBV reactivation. Methods In this single-center, cross...

Background Balance confidence is an essential component of fall risk assessment in persons with multiple sclerosis (pwMS). Aims The aims of this cross-sectional study were to 1) investigate the ability of the 16-item Activities-specific Balance Confidence scale (ABC-16), 6-item Activities-specific Balance Confidence scale (ABC-6), and each item of...

Background Ongoing controversy exists regarding optimal management of disease modifying therapy (DMT) in older people with multiple sclerosis (pwMS). There is concern that the lower relapse rate, combined with a higher risk of DMT-related infections and side effects, may alter the risk-benefit balance in older pwMS. Given the lack of pwMS above age...

Background and objectives: Patients with pediatric-onset multiple sclerosis (POMS) typically experience higher levels of inflammation with more frequent relapses, and though patients with POMS usually recover from relapses better than adults, patients with POMS reach irreversible disability at a younger age than adult-onset patients. There have be...

Objectives and aims Neuromyelitis Optica Spectrum Disorder (NMOSD) is a disabling autoimmune disease of the central nervous system that requires immunosuppressants to control the relapses. The latter puts them at risk for more severe COVID-19 infection. Vaccines are an effective way to control the pandemic. However, we do not know how effective the...

Objectives Some disease-modifying therapies (DMTs) have been associated with COVID-19 severity in people with MS. Comprehensive exploration of these relationships in large international samples is needed. Methods Clinician-reported demographic/clinical data from 27 countries were aggregated into a dataset of 5,648 patients with suspected/confirmed...

Objective: Cognitive changes are commonly seen in patients with multiple sclerosis (MS), which is a chronic autoimmune, demyelinating disease. The Clock Drawing Test (CDT) is an easy to use and highly reliable cognitive assessment tool that evaluates planning, visuospatial abilities, and abstract thinking. In this study, the CDT was scored with the...

Background To mimic as closely as possible a randomised controlled trial (RCT) and calibrate the real-world evidence (RWE) studies against a known treatment effect would be helpful to understand if RWE can support causal conclusions in selected circumstances. The aim was to emulate the TRANSFORMS trial comparing Fingolimod (FTY) versus intramuscula...

The severity of relapses is one of the determinants of residual disability in multiple sclerosis (MS), contributing to the final progressive state. However, the factors that predict the severity of relapses are not fully understood. To predict relapse severity in MS and investigate the relationship between relapse severity and the degree of improve...

Objective To investigate the relationship between coping mechanisms in people with multiple sclerosis (MS, pwMS) and cognitive, physical, and psychosocial factors such as socio-demographic characteristics, disability, personality, stigma, quality of life, depression, and anxiety. Method One hundred and two pwMS were enrolled in this cross-sectional...

Aim To evaluate the real-world comparative effectiveness and the cost-effectiveness, from a UK National Health Service perspective, of natalizumab versus fingolimod in patients with rapidly evolving severe relapsing-remitting multiple sclerosis (RES-RRMS). Methods Real-world data from the MSBase Registry were obtained for patients with RES-RRMS wh...

Background Treatment switching is a common challenge and opportunity in real-world clinical practice. Increasing diversity in disease-modifying treatments (DMTs) has generated interest in the identification of reliable and robust predictors of treatment switching across different countries, DMTs, and time periods. Objective The objective of this r...

Background No study has investigated the impact of dual‐tasking difficulties as a risk factor for unemployment in people with multiple sclerosis (pwMS). The aim was to examine the influence of dual‐task performance on employment status and work difficulties and to identify the predictors of employment status in pwMS. Methods Eighty‐four pwMS, incl...

Objective The study aimed to examine the demographic, clinical and therapeutic characteristics of people with neuromyelitis optica spectrum disorders (NMOSD, pwNMOSD) during the coronavirus disease 2019 (COVID‐19) pandemic. Methods This was an observational study of pwNMOSD at a tertiary care clinic. Data on COVID‐19 infection were collected betwe...

It is unknown whether the currently known risk factors of multiple sclerosis reflect the etiology of progressive-onset multiple sclerosis (POMS) as observational studies rarely included analysis by type of onset. We designed a case–control study to examine associations between environmental factors and POMS and compared effect sizes to relapse-onse...

Introduction: Coronavirus disease 2019 (COVID-19) is the biggest health challenge of recent times. Studies so far reveal that vaccination is the only way to prevent this pandemic. There may be factors that decrease or increase vaccine effectiveness. In multiple sclerosis (MS), some of these factors may cause changes in the effectiveness of the vac...

Introduction: Neuromyelitis optica spectrum disorders (NMOSD) is an autoimmune, inflammatory disease of the central nervous system affecting the optic nerves and spinal cord. Most NMOSD patients have autoantibodies against the astrocyte water channel protein aquaporin-4 (AQP4). Eculizumab treatment is used effectively and safely in AQP4-IgG+ NMOSD...

Background Simultaneous comparisons of multiple disease-modifying therapies for relapsing-remitting multiple sclerosis (RRMS) over an extended follow-up are lacking. Here we emulate a randomised trial simultaneously comparing the effectiveness of six commonly used therapies over 5 years. Methods Data from 74 centres in 35 countries were sourced fr...

Background Whether progression independent of relapse activity (PIRA) heralds earlier onset of secondary progressive multiple sclerosis (SPMS) and more rapid accumulation of disability during SPMS remains to be determined. We investigated the association between early PIRA, relapse-associated worsening (RAW) of disability and time to SPMS, subseque...

Geographical variations in the incidence and prevalence of multiple sclerosis have been reported globally. Latitude as a surrogate for exposure to ultraviolet radiation but also other lifestyle and environmental factors are regarded as drivers of this variation. No previous studies evaluated geographical variation in the risk of secondary progressi...

Importance: Ocrelizumab, a humanized monoclonal antibody targeted against CD20+ B cells, reduces the frequency of relapses by 46% and disability worsening by 40% compared with interferon beta 1a in relapsing-remitting multiple sclerosis (MS). Rituximab, a chimeric monoclonal anti-CD20 agent, is often prescribed as an off-label alternative to ocrel...

Background and purpose: Urinary incontinence is a common symptom in people with multiple sclerosis. The primary aim was to investigate feasibility of telerehabilitation-based pelvic floor muscle training (Tele-PFMT) and compare its effects on leakage episodes and pad usage with home exercise-based pelvic floor muscle training (Home-PFMT) and contr...

What is this summary about?: Patient registries contain anonymous data from people who share the same medical condition. The MSBase registry contains information from over 80,000 people living with multiple sclerosis (MS) across 41 countries. Using information from the MSBase registry, the GLIMPSE (Generating Learnings In MultiPle SclErosis) study...

Importance: Natalizumab cessation is associated with a risk of rebound disease activity. It is important to identify the optimal switch disease-modifying therapy strategy after natalizumab to limit the risk of severe relapses. Objectives: To compare the effectiveness and persistence of dimethyl fumarate, fingolimod, and ocrelizumab among patient...

Importance Autologous hematopoietic stem cell transplant (AHSCT) is available for treatment of highly active multiple sclerosis (MS). Objective To compare the effectiveness of AHSCT vs fingolimod, natalizumab, and ocrelizumab in relapsing-remitting MS by emulating pairwise trials. Design, Setting, and Participants This comparative treatment effec...

The course of pediatric-onset multiple sclerosis and adult multiple sclerosis shows some clinical differences. The rate of having a second attack after the first clinical event is 80% in children and around 45% in adults but the time to the second event is similar in all age groups. The pediatric group usually has a more aggressive onset than adult...

Introduction: Exergaming has been suggested as a rehabilitation method since it is more motivational for people with multiple sclerosis (MS, pwMS). However, the major disadvantage of this method is the lack of specific scenarios designed for pwMS. This study aims to assess the feasibility of exergaming, which was developed for pwMS.

Background: COVID-19 vaccines are recommended for people with multiple sclerosis (pwMS). Adequate humoral responses are obtained in pwMS receiving disease-modifying therapies (DMTs) after vaccination, with the exception of those receiving B-cell-depleting therapies and non-selective S1P modulators. However, most of the reported studies on the immu...

Background Some studies comparing primary and secondary progressive multiple sclerosis (PPMS, SPMS) report similar ages at onset of the progressive phase and similar rates of subsequent disability accrual. Others report later onset and/or faster accrual in SPMS. Comparisons have been complicated by regional cohort effects, phenotypic differences in...

Background: The prognostic significance of non-disabling relapses in people with relapsing-remitting multiple sclerosis (RRMS) is unclear. Objective: To determine whether early non-disabling relapses predict disability accumulation in RRMS. Methods: We redefined mild relapses in MSBase as 'non-disabling', and moderate or severe relapses as 'di...

Background: In the absence of evidence from randomised controlled trials, observational data can be used to emulate clinical trials and guide clinical decisions. Observational studies are, however, susceptible to confounding and bias. Among the used techniques to reduce indication bias are propensity score matching and marginal structural models....

Background: This study assessed the effect of patient characteristics on the response to disease modifying therapy (DMT) in in multiple sclerosis (MS). Methods: We extracted data from 61,810 patients from 135 centres across 35 countries from the MSBase registry. The selection criteria were: clinically isolated syndrome or definite MS; follow-up...

Background Fingolimod, natalizumab, and ocrelizumab are commonly used in the second-line treatment of relapsing-remitting multiple sclerosis (RRMS). However, these have only been compared in observational studies, not in controlled trials, with limited and inconclusive results being reported. A comparison of their effect on relapse and disability i...

Background: Patients with relapsing-remitting multiple sclerosis (RRMS) who experience relapses on a first-line therapy (interferon, glatiramer acetate, dimethyl fumarate, or teriflunomide; collectively, "BRACETD") often switch to another therapy, including natalizumab or fingolimod. Here we compare the effectiveness of switching from a first-line...

Background Restless legs syndrome (RLS) is a sensory-motor disorder characterized by an uncomfortable sensation in the lower extremity, triggered by sitting and lying positions and release with motion. There is strong evidence that RLS prevalence is higher in persons with multiple sclerosis (MS, pwMS) than in the general population. Current literat...

Background: Effectiveness of cladribine tablets, an oral disease-modifying treatment (DMT) for multiple sclerosis (MS), was established in clinical trials and confirmed with real-world experience. Objectives: Use real-world data to compare treatment patterns and clinical outcomes in people with MS (pwMS) treated with cladribine tablets versus ot...

Background To compare the effectiveness and treatment persistence of ocrelizumab, cladribine and natalizumab in patients with relapsing–remitting multiple sclerosis switching from fingolimod. Methods Using data from MSBase registry, this multicentre cohort study included subjects who had used fingolimod for ≥6 months and then switched to ocrelizum...

Background and Objectives Patients with pediatric-onset multiple sclerosis (POMS) typically experience higher levels of inflammation with more frequent relapses and reach irreversible disability at a younger age than adult-onset patients. There have been few randomized placebo-controlled clinical trials of multiple sclerosis (MS) disease-modifying...

Background Early recognition of markers of faster disability worsening in paediatric-onset multiple sclerosis (MS) is a key requisite of personalised therapy for children with MS at the earliest possible time. Objective To identify early predictors of rapid disability accrual in patients with paediatric-onset MS. Methods Using the global MSBase r...

Background and objectives: Certain demographic and clinical characteristics, including the use of some disease-modifying therapies (DMTs), are associated with severe acute respiratory syndrome coronavirus 2 infection severity in people with multiple sclerosis (MS). Comprehensive exploration of these relationships in large international samples is...

Objectives To evaluate the rate of return of disease activity after cessation of multiple sclerosis (MS) disease-modifying therapy. Methods This was a retrospective cohort study from two large observational MS registries: MSBase and OFSEP. Patients with relapsing-remitting MS who had ceased a disease-modifying therapy and were followed up for the...

Objectives and aims : Disease modifying therapies used in multiple sclerosis can decrease humoral response after COVID-19 vaccines. This problem must be adequately addressed because new variants evolve, and COVID-19 still poses a risk to patients with comorbidities and immunosuppression. We aimed to evaluate the antibody response after the third do...

Background Epstein-Barr virus is considered a risk factor for the development of multiple sclerosis, and recent findings reveal infected plasma -cells in meningeal ectopic lymphoid deposits. Activation of the dormant virus could be responsible for the multiple sclerosis exacerbation Aims To compare Epstein-Barr nuclear IgG (EBNA IgG) titer in newl...

Background Interferon-β, a disease-modifying therapy (DMT) for MS, may be associated with less severe COVID-19 in people with MS. Results Among 5,568 patients (83.4% confirmed COVID-19), interferon-treated patients had lower risk of severe COVID-19 compared to untreated, but not to glatiramer-acetate, dimethyl-fumarate, or pooled other DMTs. Conc...

Background Natalizumab and fingolimod are used as high-efficacy treatments in relapsing–remitting multiple sclerosis. Several observational studies comparing these two drugs have shown variable results, using different methods to control treatment indication bias and manage censoring. The objective of this empirical study was to elucidate the impac...

Background There is no information about the effects and usability of rehabilitation during corticosteroid treatment. This randomized clinical trial was conducted to evaluate and compare the effects and safety of exergaming and conventional rehabilitation (CR) on persons with multiple sclerosis (MS, pwMS) during corticosteroid treatment. Methods Th...

Background: Prevention of disability over the long-term is the main treatment goal in multiple sclerosis (MS), however, randomized clinical trials evaluate only short-term treatment effects on disability. This study aimed to define criteria for 6-month confirmed disability progression events of MS with a high probability of resulting in sustained...

Background and Objectives The severity of multiple sclerosis (MS) varies widely among individuals. Understanding the determinants of this heterogeneity will help clinicians optimize the management of MS. The aim of this study was to investigate the association between latitude of residence, ultraviolet B radiation exposure (UVB) and the severity of...

Purpose To translate Preference-Based Multiple Sclerosis Index (PBMSI) into Turkish, investigate its psychometric properties and differences between its two scoring algorithms: PBMSI-Rating Scale (PBMSI-RS) and PBMSI-Standard Gamble (PBMSI-SG). Methods An expert committee supervised the translation process. Psychometric properties were evaluated i...

Background The MSBase prediction model of treatment response leverages multiple demographic and clinical characteristics to estimate hazards of relapses, confirmed disability accumulation (CDA), and confirmed disability improvement (CDI). The model did not include Multiple Sclerosis Severity Score (MSSS), a disease duration-adjusted ranked score of...

Background Even though the prevalence of restless leg syndrome in multiple sclerosis (MS) is known to vary between 12.5% and 60%, the underlying pathophysiological mechanism remains unclear. Aim This study aims to investigate the relationship between spinal cord lesions and restless leg syndrome in MS. Materials and Methods In total, 959 persons wi...

Background: Multiple sclerosis (MS) is an immune-mediated disorder of the central nervous system. DMTs effectively reduce the annual relapse rate-thus reducing disease activity-and, to a lesser extent, some DMTs prevent disease progression in some people with MS. Monitoring the efficacy of DMTs with no evidence disease activity (NEDA) provides an...

Background: Disease-modifying therapy could weaken the immune system and decrease the immune response to vaccines. It is essential to know which vaccine is more protective against SARS-CoV-2 in the multiple sclerosis population. Objective: To assess immune response after messenger RNA BNT162b2 (Pfizer/BioNTech) and inactivated Sinovac vaccines in p...

Background Examining leisure-time physical activity in people with multiple sclerosis (PwMS) from different environmental backgrounds might increase understanding and awareness of inactivity in PwMS. Therefore, the study objective was twofold; to compare the level of physical activity in PwMS in Israel and Turkey and to examine the relationship bet...

Objective: Previous studies have reported that people with obesity have slower walking speed, poor balance control, and more energy expenditure during gait than patients without obesity. However, little is known about the effect of obesity on walking and balance control in people with multiple sclerosis (MS). This study aimed to investigate the ass...