Hot Topics and MS Research News for June 2014

  • How common is sexual dysfunction in women with MS?

    Sexual dysfunction is very common in MS but it is not highly discussed.  Studies report that up to 84.6% of women with MS experience at least one sexual dysfunction.  Approximately 34.8% of MS women experience 5 or more sexual dysfunctions while 12.9% experience 10 or more.  Symptoms include lower sex drive, decreased lubrication, poor clitoral erection, and lack of orgasm.  Other MS symptoms, such as bladder and bowel dysfunction, spasticity, pain, fatigue, depression, anxiety, and side effects of medication often contribute to sexual dysfunction.  More research is needed, but drugs such as sildenafil (a and alpha-blockers may improve lubrication.  Water-based lubricants and estrogen therapy may help with vaginal dryness, burning, and painful intercourse.  As antidepressants can interfere with orgasm, lower doses or a change of medication may be recommended.  Because of physical limitations of MS, women with MS may be advised to plan ahead for sex to manage timing, positioning, and fatigue, as well as prevent unwanted urinary or fecal incontinence.  Sex aids and extra-genital stimulation can provide erotic sensations.  Counseling can also help couples improve communication skills and increase sexual satisfaction (Cordeau, 2014).

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    Cordeau D, Courtois F. Sexual disorders in women with MS: Assessment and management. Ann Phys Rehabil Med. 2014 Jun 5. pii: S1877-0657(14)01727-8. doi: 10.1016/j.rehab.2014.05.008. [Epub ahead of print]

    Anti-seizure drug may be effective against pseudobulbar affect (PBA)

    Pseudobulbar affect (PBA), also known as emotional incontinence, is a neurological disorder characterized by involuntary or uncontrollable episodes of laughing and/or crying.  It can occur in patients with an underlying neurological disease such as MS, Alzheimer’s, Parkinson’s, stroke, or traumatic brain injury.  Patients with PBA have an impaired ability to control their emotional reactions.  Very few studies have been published on PBA in people with MS and reported prevalence estimates range from 6.5 to 95%.  Dextromethorphan plus quinidine (Nuedexta) is the only FDA approved treatment for PBA.  A recent case report describes a 60 year old woman with MS who experienced incessant crying.  A brain MRI showed a new lesion next to her corpus callosum.  Her symptoms resolved within 3 days after doctors prescribed valproic acid (Depakote), but did not respond to Nuedexta (Johnson, 2014).

    Johnson B, Nichols S. Crying and suicidal, but not depressed. Pseudobulbar affect in multiple sclerosis successfully treated with valproic acid: Case report and literature review. Palliat Support Care. 2014 Jun 11:1-5. [Epub ahead of print]

     

    Do you want to know more about how the oral drugs for MS work?  

    You can find out in the article, “Molecular pharmacodynamics of new oral drugs used in the treatment of multiple sclerosis,” published in the journal, Drug Design, Development and Therapy.  This article discusses the mechanism of action of each of the oral MS drugs, approved and still in development: fingolimod (Gilenya, Novartis), dimethyl fumarate (Tecfidera, Biogen Idec), teriflunomide (Aubagio, Genzyme), and laquinimod (Nerventra, Teva, not yet approved for use).  It also discusses the effects of each drug on the immune system, permeability of the blood-brain-barrier, and CNS cells (di Nuzzo, 2014).


  • di Nuzzo L, Orlando R, Nasca C, Nicoletti F. Molecular pharmacodynamics of new oral drugs used in the treatment of multiple sclerosis. Drug Des Devel Ther. 2014 May 19;8:555-68. doi: 10.2147/DDDT.S52428. eCollection 2014.

     

    How are disease activity and disability measured in MS clinical trials?

    Determining the effectiveness of MS disease-modifying drugs is a challenge due to the nature of the disease, as recovery from relapses and rates of disability vary considerably among patients.  Before starting a clinical trial, researchers must choose primary, secondary, and surrogate endpoints.  The method of measuring outcomes in MS trials has evolved over time.  The current review defines the outcome measures and endpoints used in MS clinical trials from the 1980’s to the present date.  This article is an excellent read if you are interested in learning more about how disease activity and disability are measured in adult and pediatric trials (Lavery, 2014).

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    Lavery AM, Verhey LH, Waldman AT. Outcome Measures in Relapsing-Remitting Multiple Sclerosis: Capturing Disability and Disease Progression in Clinical Trials. Mult Scler Int, vol. 2014, Article ID 262350, 13 pages, 2014. doi:10.1155/2014/262350

    Stimulating cranial nerves during exercise improves walking ability in MS

    Gait disturbance, a common problem for people with MS, is currently managed through exercise, pharmacology, functional electrical stimulation, compensatory strategies, use of assistive devices, and implanted electrical devices.  In a small pilot randomized controlled trial in people with MS (n=20) with impaired gait, participants who received tongue-based cranial nerve non-invasive neuromodulation (CN-NINM) combined with targeted exercise therapy experienced greater improvements in walking ability after 14 weeks than the control group.  Improvements were both clinically and statistically significant.  Electrical stimulation to the tongue was delivered by a device, held in place by the lips and teeth, that has a rectangular tab covered in 144 exposed gold-plated circular electrodes.  Subjects controlled the intensity of the stimulation.  Results of this study suggest that tongue-based neurostimulation may amplify the benefits of exercise for people with chronic MS.

    Tyler ME, Kaczmarek KA, Rust KL, et al. Non-invasive neuromodulation to improve gait in chronic multiple sclerosis: a randomized double blind controlled pilot trial. J Neuroeng Rehabil. 2014 May 1;11(1):79. doi: 10.1186/1743-0003-11-79.

    Other studies of interest:

    Gandolfi M, Geroin C, Picelli A, et al. Robot-assisted vs. sensory integration training in treating gait and balance dysfunctions in patients with multiple sclerosis: a randomized controlled trial. Front Hum Neurosci. 2014 May 22;8:318. doi: 10.3389/fnhum.2014.00318. eCollection 2014.

    Gordon LK, Goldstein DA. Gender and Uveitis in Patients with Multiple Sclerosis. Journal of Ophthalmology, vol. 2014, Article ID 565262, 5 pages, 2014. doi:10.1155/2014/565262


  • Hadgkiss EJ, Jelinek GA, Weiland TJ, et al. The association of diet with quality of life, disability, and relapse rate in an international sample of people with multiple sclerosis. Nutr Neurosci. 2014 Mar 17. [Epub ahead of print]

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    Pecori C, Giannini M, Portaccio E, et al. Paternal therapy with disease modifying drugs in multiple sclerosis and pregnancy outcomes: a prospective observational multicentric study. BMC Neurol. 2014 May 26;14(1):114. doi: 10.1186/1471-2377-14-114.

    Razaz N, Nourian R, Marrie RA, et al. Children and adolescents adjustment to parental multiple sclerosis: a systematic review. BMC Neurol. 2014 May 19;14(1):107. doi: 10.1186/1471-2377-14-107.

    Straudi S, Martinuzzi C, Pavarelli C, et al. A task-oriented circuit training in multiple sclerosis: a feasibility study. BMC Neurol. 2014 Jun 7;14(1):124. doi: 10.1186/1471-2377-14-124.

     

    Lisa Emrich is author of the blog Brass and Ivory: Life with MS and RA and founder of the Carnival of MS Bloggers.

Published On: June 27, 2014