Research news - August 2007
Open Door - May 2007 pages 4-5
- Exercise is good for you!
- Depression and MS
- AAN Annual Meeting
- Testosterone treatment for men
- Restless legs
1. Exercise is good for you!
Several new studies have looked at the value of aerobic exercise for people with mild to moderate MS.
In one study, researchers looked at various clinical measures to see if treadmill training could reduce the effort of walking. 16 people with MS took part in 12 sessions of up to 30 minutes treadmill walking at a comfortable walking speed. Treadmill training resulted in a reduction in resting metabolism, an increase in walking endurance, improved walking gait, increased walking speed and a decrease in walking effort. Self-reported fatigue was not significantly different.
Newman MA, et al.
Can aerobic training reduce the effort of walking and fatigue in people with multiple sclerosis: a pilot study.
Multiple Sclerosis 2007;13(1);113-119.
In another study, participants took part in an eight week aerobic training programme. Walking distances and speeds were significantly improved, as were several physiological measures taken during exercise tests. The people who were most disabled tended to benefit more from aerobic training. There was no difference in effect on fatigue.
Rampello A, et al.
Effect of aerobic training on walking capacity and maximal exercise tolerance in patients with multiple sclerosis: a randomized crossover controlled study.
Physical Therapy 2007;87(5):545-555.
A third study reported on the potential for cycle training to reduce the risk of coronary artery disease (CAD). 11 people with MS and 11 matched controls took part in aerobic cycle training (three 30 minutes sessions per week for eight weeks). Participants were assessed for CAD risk factors, based on guidelines of the American Heart Association, before and after training. The investigators found that both groups reduced their level of CAD risk and improved their aerobic fitness. They concluded that people with mild to moderate MS were able to take part in exercise to a level that reduced their risk of CAD.
Patel D, et al.
Aerobic exercise influence on coronary artery disease risk factors in multiple sclerosis.
FASEB Journal 2007:21:765.1.
2. Depression and MS
495 people with MS completed questionnaires about depression at the start of this study and again at one and two years. If a completed questionnaire indicated that the participant might be depressed, a letter was sent recommending that they contact their GP. Despite a high prevalence of depression, few participants sought treatment, even when prompted to do so. Where treatment was sought, most were treated by their GP and less than 20% referred to a psychologist, psychiatrist or counsellor. The study found no significant change in depressive symptoms over time between those who reported having received treatment and those who did not. The investigators conclude that further research is needed to consider why the majority of people with MS do not seek treatment for depression and why treatments do not seem to be effective.
Sollom AC, et al.
Treatment of depression in people who have multiple sclerosis.
Multiple Sclerosis 2007; 13: 632-635.
3. AAN Annual Meeting
The American Academy of Neurology (AAN) Annual Meeting is one of the world's largest gatherings of neurology professionals and is one of the major events for sharing new research. This year's meeting took place in Boston from 28 April to 5 May.
Highlights from the meeting included:
Alemtuzumab (Campath)
Results from the first two years of a phase II study were presented. Compared with the beta interferon Rebif, Campath demonstrated a marked reduction in risk of relapses and risk of increased disability in relapsing/remitting MS.
Two serious consequences which have previously been reported following Campath treatment were covered in separate sessions.
Idiopathic thrombocytopenic purpura (ITP), a disorder that prevents blood from clotting properly, was fatal in one case. Details were presented of a safety programme for early detection and management of ITP; a further five cases have now been identified and successfully treated.
A higher incidence of thyroid-related side effects was found (11% of those on Campath vs 2% on Rebif) and this was mirrored by a higher level of abnormal thyroid function (but not sufficient to produce side effects) in the Campath group. Overall the rates of thyroid disorders were lower than those reported in previous studies.
Changes in sex ratio
The incidence of MS appears to be increasing in women compared to men. US figures indicate an increase from approximately 2:1 in 1940 to over 4:1 in 2000. Reasons for this increase are not clear.
Risk tolerance in MS patients
Some of the emerging MS treatments appear to be very effective but carry significant risk of serious side effects. A telephone survey of 125 people with MS revealed that they would accept a relatively high level of risk; factors influencing this included increased disability, reduced quality of life and absence of dependents in the home.
Fampridine and walking
A phase III study of 283 people with MS concluded that a significant proportion (34.8% vs 8.3% on placebo) of those treated with fampridine experienced improved walking speed during 14 weeks of treatment.
4. Testosterone treatment for men
Men are less susceptible to many autoimmune diseases, including MS. Possible causes for this include sex hormones. While testosterone has been shown to be effective in animal models of MS, the effect of testosterone on men with MS is not known. In this pilot study, 10 men with relapsing/remitting MS were studied during a six month pre-treatment period followed by a 12 month period of daily treatment with a testosterone gel. There was an improvement in cognitive performance and a slowing of brain atrophy but no significant effect on MRI-detected lesions. These preliminary findings suggest that testosterone treatment may have neuroprotective effects in men with relapsing/remitting MS.
Sicotte NL, et al.
Testosterone treatment in multiple sclerosis: a pilot study.
Archives of Neurology 2007;64(5):683-688.
5. Restless legs
This study looked at the prevalence of restless legs syndrome (RLS) in 156 people with MS. 51 (32.7%) met the criteria for RLS. In a few (8.5%) RLS preceded the onset of MS; in the remainder RLS followed or developed at the same time as their MS. No correlation was found between RLS and gender, time since diagnosis and preferred sleeping habits. The primary progressive MS course was more represented in the RLS group.
Manconi M, et al.
High prevalence of restless legs syndrome in multiple sclerosis.
European Journal of Neurology 2007;14(5):534-539.
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