MS research update - 18 September 2009
- Individual programmes boost physical health whilst group programmes boost mental health
- Tysabri activates virus that causes PML
- Lesions in specific areas of the brain linked to cognitive problems in MS
- Causes and management of seizures in MS
Individual programmes boost physical health whilst group programmes boost mental health
Fifty people with MS took part in this study which compared the effect of individual versus group-based interventions to promote health and physical activity. Participants were divided into two groups; the first group received four one-on-one physical rehabilitation sessions and three personalised phone calls whilst the second group attended seven group-based education sessions. Questionnaires, physical fitness assessments, and physical activity diaries were used to measure the effect of the two programs on the participants. At the end of the eight-week study it was found that both groups had improved in terms of general health and physical activity. However, the group that had received individual therapy sessions showed a greater improvement in physical health whilst the group receiving group-based therapy showed greater improvements in their mental health. The study authors suggest that future research should investigate the benefits to be gained from combining individual physical rehabilitation with group-based therapy in improving both physical and mental wellbeing in people with MS.
Plow MA, Mathiowetz V, Lowe DA.
Comparing individualized rehabilitation to a group wellness intervention for persons with multiple sclerosis.
American Journal of Health Promotion 2009; 24(1):23-6.
Medline abstract
Tysabri activates virus that causes PML
The JC virus, thought to be present but dormant in a large proportion of the general population, causes infections that are usually of little consequence in healthy individuals. However, for people with compromised immune systems the JC virus can lead to the development of a potentially deadly brain infection known as progressive multifocal leukoencephalopathy or PML. The present study monitored 19 people with relapsing remitting MS who received the disease modifying drug natalizumab (Tysabri) over an 18 month period to determine whether the JC virus was present in the blood or the urine. Samples were taken at 6, 12 and 18 months and it was found that levels of the JC virus increased in the blood and the urine. Furthermore, researchers discovered that the JC virus underwent changes that enabled it to evade the immune system and increased the likelihood of it infecting the brain. The significance of this study is that it offers further clues or 'markers' that might allow for better monitoring of people who are at greater risk of developing PML. The publication of this study coincides with reports of two further cases of PML in people taking Tysabri, bringing the total of PML cases to date to 13. These new cases do not change the estimated risk of developing PML whilst on the drug which remains below 1 in 1000.
Chen Y, Bord E, Tompkins T, et al.
Asymptomatic reactivation of JC virus in patients treated with natalizumab.
New England Journal of Medicine 2009; 361(11): 1067-74.
Medline abstract
Lesions in specific areas of the brain linked to cognitive problems in MS
The term cognition refers to processes such as thinking, remembering, judgement and reasoning. Many people with MS experience cognitive problems which are most often mild and manageable. The present study investigates the link between areas of demyelination and tissue loss in a specific region of the brain - the cerebal cortex - and cognitive impairment. The cerebral cortex is the region of the brain associated with functions such as voluntary movement, coordination of sensory information, learning and memory, and the expression of individuality. Imaging techniques were used to measure the number of lesions and extent of tissue loss in this area of the brain in 70 people with relapsing remitting MS. A series of neuropsychological tests (tests which measure different aspects of cognition) were used to identify cognitively impaired and cognitively unimpaired participants. It was found that the cognitively impaired participants had a higher number of lesions (areas of demyelination) and greater level of tissue loss in the cerebral cortex than the participants who were not cognitively impaired.
Calabrese M, Agosta F, Rinaldi F, et al.
Cortical lesions and atrophy associated with cognitive impairment in relapsing remitting multiple sclerosis.
Archives of Neurology 2009; 66(9): 1144-50
Medline abstract
Causes and management of seizures in MS
A seizure may be described as a sudden surge of electrical activity in the brain that usually affects how a person feels or acts for a short time. Though seizures are not recognized as a common symptom of MS, previous studies have suggested that they are more common in the MS population than in the general healthy population. This article explores a number of theoretical explanations for the increased frequency of seizures in people with MS and suggests that inflammation and demyelination in specific regions of the brain could be responsible for the occurrence of seizures. With no clear guidelines on how seizures in people with MS should be managed, the authors also emphasise the importance of an individualised approach to treatment.
Kelley BJ, Rodriguez M.
Seizures in patients with multiple sclerosis: epidemiology, patholophysiology, and management.
CNS Drugs 2009; 23 (10):805-15
Medline abstract
