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May 30 is World Multiple Sclerosis (MS) Day, an inflammatory disease and partly degenerative disease of the central nervous system (brain, optic nerves and spinal cord) of an immune-mediated nature, characterized by the involvement of myelin, the substance that surrounds the nerve fibers and which allows them to function properly. It is said ‘multiple’ because it affects different districts of the nervous system central deputies to different functions, such as visual, strength, superficial sensitivity, deep sensitivity, motor coordination, to name a few of the most common, but it can also affect the sphincter function, lead to depression and be associated with fatigue.

It typically affects young adults in their 30s, although cases with onset in children and older people are seen. Multiple sclerosis represents the most frequent cause of neurological disability among young adults, it is associated with a reduced quality of life and very high social costs.

THE IMPACT ON THE FERRARESE TERRITORY. It is calculated that in province of Ferrara, 25-30 multiple sclerosis diagnoses are made every yearwith an annual incidence of new cases around 6-7 per 100 thousand inhabitantswhile the number of subjects diagnosed with the disease in the same area to date is around 500 cases (about 140 for every 100,000 inhabitants). The female population is notoriously more affected than the male one with a ratio of 2.5-3 to 1.

To date the causes of multiple sclerosis are not identified, because the mechanisms that generate it are complex and derive from an interaction between the predisposition on a genetic basis and exposure to different environmental factors in a specific age group which precedes, in adults, by far the clinical onset and makes it difficult to find. Among the hypothesized environmental factors, however, there are some that are more probable, such as having suffered from infectious mononucleosis (‘the kissing disease’) and others that are potentially modifiable through health education programs on the general population, such as exposure to tobacco smoke cigarette (subjects who smoke or who have lived in close contact with smokers at home), obesity, low exposure to sunlight and reduced physical activity in childhood, as well as reduced levels of vitamin D in the blood. Moreover, it seems that these factors continue to play a negative role even in subjects who have developed multiple sclerosis, favoring the progression of the disease and its inflammatory activity.

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THE ROLE OF THE NEUROLOGICAL CLINIC OF S. ANNA AND THE MULTIPLE SCLEROSIS CENTER. Outpatient care activities Day Hospital and Day Service that revolve around multiple sclerosis are coordinated by Multiple Sclerosis Center of Ferrara, within the Neurological Clinic Operative Unit of the Ferrara University Hospital, directed by Maura Pugliatti, Full Professor of Neurology (in the picture). The Center, coordinated by Prof. Pugliatti together with Dr Eleonora Baldi (Operational Unit of Neurology) and to dr Caterina Ferriclinical researcher and to which a team of expert nurses contributes, follows approx 700 people with this pathology (and other diseases that can be confused with or resemble multiple sclerosis, but which are in fact different in nature and management, for example neuromyelitis optica) also coming from other Italian regions. The Center is also the venue for training activities for neurologists in training, trainees on the Medicine and Surgery degree course at the University of Ferrara and foreign universities and for other healthcare professionals. Finally, epidemiological and clinical research activities are carried out.

The MS Center of Ferrara offers the necessary services for the diagnosis of multiple sclerosis and for the differential diagnosis with other inflammatory diseases of the central nervous system. Coordinates the diagnostic-therapeutic-assistance (PDTA) “hospital-territory” path for the optimal multidisciplinary management of the person with MS, in close collaboration with Ophthalmology professionals (Dr. Joseph Lambertiprof. Marco Mura), of the Laboratory of Neurochemistry (Dr. Maximilian Castellazzi), Neuroradiology (Dr. Andrew Saletti), Rehabilitation Medicine (Dr Sofia Straudi), Neurophysiology (Dr. Jay Capone), of Neurological Intestinal Surgery (Dr Simona Ascanelli), of Gynecology (Dr Danila Morano), Psychiatry (Dr. Luigi Zerbinati, Prof. Louis Grassi) and Pediatrics (prof Agnes Suppiej). Some of the treatments – safe and in selected cases – can currently be decentralized to the patients’ territory of residence thanks to the collaboration of the Local Health Authority. Finally, the possibilities of telemedicine visits and teleconsultations are being implemented according to regional objectives.

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Multiple sclerosis – highlights Prof. Pugliatti – it is a potentially disabling and constantly growing pathology in our and other populations. However, we currently have a range of treatment strategies available that significantly modify the clinical course of this disease and prevent the accumulation of disability. There are now many immunomodulatory drugs available and many those under study and which will be available in the coming years. The MS Center of Ferrara “co-creates” the care pathway together with people with multiple sclerosis and theItalian Multiple Sclerosis Association (AISM) of Ferrara coordinated by Francesco Gattus for outreach initiatives. Finally, also thanks to the support of research funds from competitive tenders (for example, Roche studio SoMS! e PNRR studio PROMISING which I coordinate) has the development of computerized applications for the person with MS as regards the management of visits, but also information on the disease, on the pathways and the involvement of the same people in the definition of their assistance needs and for the development of prognostic support decision systems for the neurologist”.

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