Research news - May 2008
Open Door - May 2008 pages 4-5
- Environmental factors and MS
- Natural history of MS
- Alemtuzumab (Campath-1H) for aggressive relapsing/remitting MS
- Cannabis and MS - effect on mental activity
- Cognitive behaviour therapy for fatigue
- Spotlight on MS
Environmental factors and MS
Studies suggest that some people have a genetic makeup that predisposes them to MS and that one or several environmental factors may act as a trigger which sets off a chain of events leading to their developing the condition.
A detailed and wide-ranging review pulls together recent research into the factors that may be responsible for susceptibility to MS. Evidence is examined from geographical distribution and migration studies, relative risks of developing MS within families, the importance of timing of exposure to environmental factors - from conception through to adulthood, the possibility of infectious causes, risks associated with latitude and sunlight exposure and the effects of these on vitamin D levels. Studies of childhood MS and the effect of evolutionary pressure are also touched on.
The author concludes that many answerable questions remain and that studies of environmental factors that could lead to prevention of MS have not received appropriate attention. He also proposes that if, as seems increasingly probable, lack of sunlight or vitamin D are major environmental risk factors, studies of disease prevention might be carried out. However, the difficulties inherent in carrying out such investigations, particularly the potentially long time interval between treatment and result, are significant.
Ebers GC.
Environmental factors and multiple sclerosis.
Lancet Neurology 2008;7:268-277.
Natural history of MS
MS is highly variable and it is impossible to predict the exact future course of the condition. Two recent studies have provided valuable information about the natural history, or untreated course of MS. Eventually, studies of this kind may enable doctors to give a clearer idea of prognosis earlier, although it is important to recognise that any predictions are based on averages only and will not be able to describe the future course of an individual's MS.
The first study compared 52 people diagnosed at 50 years or older (late-onset MS, LOMS) with 52 people diagnosed at a younger age. A picture of LOMS was built up from the predominant symptoms, MRI scans, and analysis of cerebrospinal fluid. For those who develop LOMS, a primary progressive course was frequent, with mobility problems as the major symptoms. Spinal lesions and fewer active lesions were also typical of LOMS. The researchers point out that doctors should be alert to the possible diagnosis of late onset MS as the initial symptoms are often not typical of MS.
Kis B, et al.
Clinical characteristics of patients with late-onset multiple sclerosis.
Journal Neurology 2008 Feb 19 [Epub ahead of print].
In the second study, Canadian researchers analysed data from 2,837 people, looking for any patterns in the change from relapsing/remitting (RRMS) to secondary progressive MS (SPMS). 88% of the group initially had RRMS and 58% went on to develop SPMS. On average, the relapsing/remitting phase lasted almost two decades, being shorter for men and for those older at diagnosis of MS. However, those older at onset also developed SPMS at an older age and both men and women who later became severely affected by MS did so at the same age. A longer relapsing/remitting phase was a good indicator of slower progression after developing SPMS.
Tremlett H, et al.
Natural history of secondary-progressive multiple sclerosis.
Multiple Sclerosis 2008 Jan 21 [Epub ahead of print].
Alemtuzumab (Campath-1H) for aggressive relapsing/remitting MS
Alemtuzumab is currently in clinical trials for aggressive relapsing/remitting MS. In this study, researchers reported their own open label experience of using alemtuzumab (ie both doctors and participants knew they were receiving active drug). 39 people with highly active relapsing/remitting MS were followed for an average of 1.89 years. Before treatment the average number of relapses was 2.48 per year. This fell to 0.19 relapses per year after treatment. For those completing one year or more of follow-up, the average EDSS score (measure of disability) improved by 0.15, indicating a reduction in impairment. Overall the EDSS score improved by 0.36. 83% were stable or had improved disability following treatment. Side effects were common but generally mild or easily managed; however, two people developed thyroid disease and one developed autoimmune skin disease.
Hirst CL, et al.
Campath 1-H treatment in patients with aggressive relapsing remitting multiple sclerosis.
Journal Neurology 2008 Feb 20 [Epub ahead of print].
Cannabis and MS - effect on mental activity
Ten people with MS who were current cannabis users were matched to four other people with MS who did not use cannabis. All were given tests designed to identify psychiatric illnesses (such as depression, anxiety disorders and schizophrenia) and tests to measure mental activity, including short-term memory and thinking speed. Compared to the nonusers, cannabis users were more likely to meet criteria for diagnosis of a psychiatric illness and had impaired mental activity.
The study did not look at the question of whether smoking cannabis causes long-term cognitive impairment after the drug is discontinued.
Ghaffar O, et al.
Multiple sclerosis and cannabis - cognitive and psychiatric study.
Neurology 2008 Feb 13 [Epub ahead of print].
Cognitive behaviour therapy for fatigue
Cognitive behaviour therapy (CBT) is a talking therapy which aims to change patterns of thinking or behaviour and so change the way people feel. This study examined the effectiveness of CBT for treating fatigue in MS.
72 people with fatigue were assigned to eight weekly sessions of CBT or relaxation therapy (RT). Fatigue was assessed before and after treatment and at three and six months post treatment. While both groups showed clinically significant decreases in fatigue, the CBT group reported a significantly greater reduction in fatigue across the eight months compared with the RT group.
Van Kessel K, et al.
A randomized controlled trial of cognitive behavior therapy for multiple sclerosis fatigue.
Psychosomatic Medicine 2008 Feb 6 [Epub ahead of print].
Spotlight on MS
MS makes regular appearances in storylines in television programmes with varying degrees of accuracy. Recent examples include The Bill, West Wing and Waterloo Road and an article on MS in Neighbours appears on page 10.
A recent survey of fictional portrayals of MS identified 23 films made between 1941 and 2006 in which MS appeared as a theme. The visual nature of the medium and the effects of dramatic composition have resulted in emphasis on certain symptoms such as lack of coordination, loss of mobility, blurred vision and fatigue. Sensory symptoms, bladder and sexual problems have been under-represented. Films tended to explore the impact of MS on self-image, adapting to change and relations with family and friends. Parallel with improvements in therapy and social attitudes to disability, the overriding themes of the films have progressed from earlier 'disaster' to modern 'coping' stories.
Karenberg A.
Multiple sclerosis on-screen: from disaster to coping.
Multiple Sclerosis 2008 Jan 21 [Epub ahead of print].
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