Research news - February 2008
Open Door - February 2008 pages 4-6
- Reading improved with colour filters
- Beta interferon injections - day time or night time?
- Lamotrigine for neuropathic pain
- People with MS want to get involved!
- Sativex under investigation
- Cognitive behavioural therapy over the phone
- Epstein-Barr virus reactivation and relapses
Reading improved with colour filters
The value of tinted lenses to relieve visual stress (eye-ache and perceptual distortion) is now well-established in conditions such as migraine and dyslexia. This study tested the effect of spectral filters, sheets of coloured plastic film which are placed over a page of text, in 26 people with MS. Each participant selected a coloured filter that made text clearest and most comfortable to read. When using the filter, rate of reading and visual search accuracy improved significantly. At the end of a two week period, the reading and visual search performance of those people who had been using a grey overlay did not change, whereas the performance of those using a coloured overlay improved, both when using the overlays and also when not. When those who had been given a grey filter used their originally selected filter, their performance improved. The researchers suggest that a large proportion of people with MS may benefit from the use of spectral filters.
Newman Wright B, et al.
Spectral filters can improve reading and visual search in patients with multiple sclerosis.
Journal of Neurology 2007;254:1729-1735.
Beta interferon injections - day time or night time?
Many people inject beta interferon in the evening for convenience and to sleep through any side effects. This study compared the effects of morning (8.00 am) and evening (6.00pm) injections of beta interferon on hormone levels and side effects in 16 people. Whilst this is a small study, the results suggest that daily fluctuations in the levels of hormones may make people more susceptible to the side effects of beta interferon in the evening and that those experiencing persistent side effects from beta interferon may benefit from changing the time of injection.
Kümpfel T, et al.
Time of interferon-{beta} 1a injection and duration of treatment affect clinical side effects and acute changes of plasma hormone and cytokine levels in multiple sclerosis patients.
Multiple Sclerosis 2007;13(9):1138-1145.
Lamotrigine for neuropathic pain
Lamotrigine is an anti-epilepsy drug which has been shown to be effective in treating some types of neuropathic or nerve pain. This study looked at its effectiveness in treating neuropathic pain in MS. Twelve people received lamotrigine and placebo in two treatment periods separated by a fortnight drug-free interval. The results showed no significant differences between the lamotrigine and placebo periods for any of the measures of pain or quality of life. The researchers concluded that the trial did not support the use of lamotrigine for neuropathic pain in MS and that there was no need for a larger trial.
Breuer B, et al.
A randomized, double-blind, placebo-controlled, two-period, crossover, pilot trial of lamotrigine in patients with central pain due to multiple sclerosis.
Clinical Therapeutics 2007;29(9):2022-2230.
People with MS want to get involved!
A recent study revealed an interesting trend in the desire to participate in medical decision-making. The study used the data from six trials of different medical conditions - hypertension, depression, breast cancer, schizophrenia, MS and minor traumas. People with MS showed a significantly greater desire to participate in medical decision-making. The study concluded that the reasons for such differences remain unclear.
Hamann J, et al.
Participation preferences of patients with acute and chronic conditions.
Health Expectations 2007;10(4):358-363.
Sativex under investigation
63 people who had completed a five week placebo-controlled trial of Sativex, a cannabis based mouth spray, for neuropathic pain entered this open-label extension study to assess long-term effectiveness and adverse events.
Pain scores in the final week of the initial study were 3.8 in the treatment group and 5.0 in the placebo group. In the 28 people (44%) who completed the two year followup, the pain score in the final week was 2.9, indicating that the effectiveness of Sativex was maintained.
92% of participants experienced one or more adverse event and 17 (25%) withdrew from the trial as a result. The most common side effects were dizziness, nausea and feeling intoxicated. 11 (17%) experienced a sore mouth, four persistently. One person experienced serious cardiovascular problems which were judged to be Sativex related and which resolved after stopping treatment.
Rog DJ, et al.
Oromucosal delta9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2- year extension trial.
Clinical Therapeutics 2007; 29(9):2068-2079.
A separate study looked at eight people who had been taking Sativex for at least four weeks and who had experienced a sore mouth. All felt a stinging sensation on using the spray and four had visible lesions in the floor of the mouth which resolved or improved when they stopped using the spray. The investigators concluded that the lesions were almost certainly burns perhaps caused by the high alcohol concentration of the spray and raised concerns about longterm oral use.
Brand HS.
Adverse effects from a cannabis spray.
British Dental Journal 2007; 203(6): 336-337.
In December, the Medicines and Healthcare products Regulatory Agency (MHRA), the body that licences drugs in the UK, published its Public Information Report for Sativex. The report provides potential prescribers with information on the assessment of quality, safety and efficacy of Sativex. It details research evidence submitted by GW Pharmaceuticals, the manufacturers of Sativex, along with the outstanding issues that the MHRA feels need to be addressed before a licence might be granted.
The report is available from the MHRA website
Cognitive behavioural therapy over the phone
Cognitive behavioural therapy (CBT), which focuses on developing positive thinking, has been shown to be an effective means of treating mild to moderate depression. This study measured the impact on disability of 16 weeks of either CBT or emotional support delivered by telephone to people with MS and depression. Compared to emotional support, CBT gave significantly greater decreases in disability and fatigue which were related to reductions in depression. The results suggest that a reduction in depression leads to a reduction in fatigue which in turn resulted in a reduction in disability.
Mohr DC, et al.
Reduction in disability in a randomized controlled trial of telephoneadministered cognitive-behavioral therapy.
Health Psychology 2007;26(5):554-563.
Epstein-Barr virus reactivation and relapses
The Epstein-Barr virus, a common virus that causes glandular fever, has been proposed as a trigger for MS. Blood samples, taken from 61 people with relapsing/remitting MS at regular intervals and following relapses for one year, showed no evidence to associate a reactivation of a dormant Epstein-Barr virus infection with relapses.
Torkildsen O, et al.
Epstein-Barr virus reactivation and multiple sclerosis.
European Journal of Neurology 2007 Nov 27 [Epub ahead of print]
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