Hot Topics and MS Research News for April 2014
Evidence-based guidelines for complementary and alternative medicine (CAM) in MS issued by American Academy of Neurology (AAN).
This guideline addresses the following questions: In patients with MS,
1. do CAM therapies reduce specific symptoms and prevent relapses or disability?
2. can CAM use worsen MS or cause serious adverse effects (SAEs)?
3. can CAM use interfere with MS disease-modifying therapies?
Highlights of the recommendations include possible effectiveness of different forms of cannabis extracts or synthetic cannabinoids for spasticity symptoms, pain, and urinary frequency; magnetic therapy and ginkgo biloba for fatigue; and reflexology for paresthesia. Cannabinoids are likely ineffective for short-term spasticity, tremor, and urinary incontinence. Magnetic therapy is probably ineffective for depression and ginko biloba is ineffective for cognition. Fish oil and bee sting therapies are probably ineffective for relapses, disability, fatigue, MRI lesions, and health-related quality of life (QOL).
Evidence was insufficient to support or refute the effectiveness of the following therapies in MS: acetyl-L-carnitine, acupuncture, biofeedback, carnitine, chelation therapy, Chinese medicine, chiropractic medicine, creatine monohydrate, dental amalgam replacement, glucosamine sulfate, hippotherapy, hyperbaric oxygen, inosine, linoleic acid, low-dose naltrexone, massage therapy, mindfulness training, music therapy, naturopathic medicine, neural therapy, Padma 28, progressive muscle relaxation therapy, tai chi, threonine, transdermal histamine, and yoga. Data also were insufficient to determine whether any CAM therapies worsen MS or interfere with disease-modifying therapies.
Yadav V, Bever C, Bowen J, et al. Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2014 Mar 25;82(12):1083-92. doi: 10.1212/WNL.0000000000000250.
Fox RJ. Complementary and alternative medicine in multiple sclerosis. Neurology. 2014 Mar 25;82(12):e103-7. doi: 10.1212/WNL.0000000000000307.
Poor sleep quality is associated with MS-related fatigue.
A recent study shows that, for many individuals with MS, fatigue is associated with poor sleep quality. Fatigue is among the most common symptoms of MS, affecting up to 80% of those diagnosed with the disease. Several factors may contribute to the connection between poor sleep quality and fatigue. Increased levels of inflammatory cytokines or lesions in the brain may disrupt pathways involved with sleep and daytime alertness. Sleep apnea, which is common in people with MS, may also result in both fatigue and sleep disruption. The use of MS disease modifying therapies, particularly beta interferons, may contribute to both fatigue and sleep disturbance. Although depression was associated with both sleep disturbance and fatigue in this study, authors note that exclusion of patients with severe depression and the low incidence of depression in the study participants limits their ability to evaluate a possible connection.
MS-related fatigue is often treated with medication, exercise, and energy management strategies. However, healthcare providers may not routinely ask patients about their sleep habits when fatigue is reported. Authors of the study recommend that clinicians assess sleep in people with MS and fatigue by asking about subjective sleep quality, sleep duration, and daytime dysfunction, as well as consider a formal sleep study (polysomnography) to assess for sleep apnea or related dysfunction.
Cameron MH, Peterson V, Boudreau EA, et al. Fatigue Is Associated with Poor Sleep in People with Multiple Sclerosis and Cognitive Impairment. Mult Scler Int. 2014;2014:872732. doi: 10.1155/2014/872732. Epub 2014 Mar 5.
Neuromuscular electrical stimulation cycling benefits people with advanced MS.
Patients with advanced MS and increased disability may find it difficult to exercise. In a study of eight women with secondary progressive MS (SPMS), a training program utilizing neuromuscular electrical stimulation (nMES) cycling resulted in several real and perceived benefits. Using electrodes which are placed on the quadriceps, hamstrings, and gluteal muscles of each leg, nMES cycling exercise allows persons with paralyzed legs to exercise on a stationary recumbent bicycle. A computer reads the position of the pedals on the cycle and controls a muscle stimulator to generate appropriately timed nMES-induced muscle contractions to drive the pedals and producing cycling exercise.
The goal of this study was to investigate the feasibility of adapting nMES cycling to suit the needs of persons with MS. Adaptations included a slower pedaling cadence (at a speed of 10 revolutions/minute) which produces greater muscle forces and a slow, gradual increase in stimulation intensity (pulse amplitude) during the first 20 minutes of each exercise session as patients adjusted to the uncomfortable stimulation. By the sixth of 18 sessions, all participants were performing 40 minutes of nMES exercise. Study outcomes included the stimulation intensity tolerated, thigh circumference changes, and power output and cardiorespiratory response during cycling.
Modifying neuromuscular electrical stimulation cycling allowed persons with advanced multiple sclerosis to tolerate greater stimulation intensities and exercise their muscles more intensely than previous studies. Measurable increases in thigh volume were noted. Participants also reported a number of perceived benefits including improvements in transfer ability, leg circulation, spasticity and strength.
Ché F, Phu H. Neuromuscular Electrical Stimulation Cycling Exercise for Persons with Advanced Multiple Sclerosis. J Rehabil Med. 2014 Apr 22. doi: 10.2340/16501977-1792. [Epub ahead of print].
Other studies of interest:
Carrillo-Salinas FJ, Navarrete C, Mecha M, Feliu ́ A, Collado JA, et al. A Cannabigerol Derivative Suppresses Immune Responses and Protects Mice from Experimental Autoimmune Encephalomyelitis. PLoS One. 2014 Apr 11;9(4):e94733. doi: 10.1371/journal.pone.0094733. eCollection 2014.
Gironi M, Borgiani B, Mariani E, et al. Oxidative Stress Is Differentially Present in Multiple Sclerosis Courses, Early Evident, and Unrelated to Treatment. J Immunol Res. 2014;2014:961863. doi: 10.1155/2014/961863. Epub 2014 Mar 26.
Jahromi SR, Sahraian MA, Ashtari F, et al. Islamic fasting and multiple sclerosis. BMC Neurol. 2014 Mar 22;14:56. doi: 10.1186/1471-2377-14-56.
Raz E, Loh JP, Saba L, et al. Periventricular Lesions Help Differentiate Neuromyelitis Optica Spectrum Disorders from Multiple Sclerosis. Mult Scler Int. 2014;2014:986923. doi: 10.1155/2014/986923. Epub 2014 Feb 9.
Sandroff BM, Klaren RE, Pilutti LA, Motl RW. Oxygen Cost of Walking in Persons with Multiple Sclerosis: Disability Matters, but Why? Mult Scler Int. 2014;2014:162765. doi: 10.1155/2014/162765. Epub 2014 Mar 6.
Tanasescu R, Ionete C, Chou IJ, Constantinescu CS. Advances in the Treatment of Relapsing-Remitting Multiple Sclerosis. Biomed J. 2014 Mar-Apr;37(2):41-9. doi: 10.4103/2319-4170.130440.