TMJ is More Prevalent in MS Patients with Mild or Moderate Disability
Approximately 33-86% of the world population exhibit signs and symptoms of tempororomandibular disorders (TMD), a group of conditions affecting the temporomandibular joint (TMJ), jaw muscles, and nerves on the side(s) of the head. TMD can cause pain in the jaw, face, head or neck, disconcerting joint sounds, and irregular or impaired jaw function. The pain can be severe, intermittent or constant, last for years or emerge during stressful times. (I have experienced severe jaw pain and clicking in the TMJ during stressful times when I tend to clinch my jaw constantly.) TMD have been associated with several risk factors such as depression, emotional and physical trauma, tooth damage, joint hypermobility, occlusal alterations, and pain in other parts of the body.
Multiple sclerosis can affect many structural functions in the body due to nerve damage and secondary dysfunctions. It has been hypothesized that sensory alterations and loss of muscle coordination caused by MS may contributes to the appearance of TMD symptoms. Researchers in Brazil wanted to assess the prevalence of TMD symptoms in individuals with relapsing-remitting MS compared with a control group, to examine the relationship between those symptoms and the extent of disability in patients with MS, and to assess the presence of those symptoms in both groups of participants. Sixty individuals were evaluated, including 30 patients with RRMS (mean age 42.8 years, and 66.7% female) and 30 age-matched healthy individuals.
The prevalence of TMD symptoms were more frequent in the MS group than the control group (56.7% and 16.7%, respectively), with a statistically significant difference between the groups. The reported symptoms were pain during mandibular movement (10% and 3.3%, respectively); pain in the face, temples, TMJ or maxilla (40% and 6.7%, respectively); closed lock (20% and 0%, respectively), and headache (43.3% and 16.7%, respectively).
In the MS group, 73.3% (n=22) experienced mild or moderate disability (EDSS 1.0-4.5) and 26.7% (n=8) were more severely disabled (EDSS >5.0). Of the patients with less disability, 68.2% (n=15) reported TMD symptoms, in contrast to only 25% (n=2) of the MS patients with more severe disability (EDSS >5). No correlation was found between the severity of MS disability and the prevalence of TMD symptoms.
Carvalho LS, Matta AP, Nascimento OJ, Guimarães AS, Rodrigues LR. Prevalence of temporomandibular disorders symptoms in patients with multiple sclerosis. Arq Neuropsiquiatr. 2014 Jun;72(6):422-5.
Plegridy™ Approved for Adults with RRMS in Europe
On July 23, 2014, Biogen announced that the European Commission (EC) has granted marketing authorization for Plegridy™ (pegylated interferon beta-1a) as a treatment for adults with relapsing-remitting multiple sclerosis (RRMS), the most common form of multiple sclerosis (MS). Plegridy is dosed once every two weeks and is administered subcutaneously with a prefilled syringe or a new ready-to-use autoinjector called the Plegridy Pen.
In the phase III ADVANCE study, involving more than 1500 people with RRMS, Plegridy demonstrated a reduction in relapses, disability progression, and the number of MS lesions when compared to placebo. Data from the first year of the study demonstrated that Plegridy significantly reduced annualized relapse rate (ARR) at one year by 36%, reduced the risk of 12-week confirmed disability progression by 38%, and significantly reduced the number of new or newly enlarging T2-hyperintense lesions when compared to placebo. The ADVANCE two-year data was consistent with the positive efficacy and safety results observed in year one.
The most common side effects include injection site erythema, influenza-like illness, pyrexia (fever), headache, myalgia (muscle pain), chills, injection site pain, asthenia (weakness), injection site pruritus (itching), and arthralgia (joint pain). Plegridy is developed by Biogen Idec who also markets Tecfidera, Avonex, Tysabri, Fampyra, and Rituxan.
Source: Press release
Urinary Disorders and MS: Diagnosis, Treatment, and Quality of Life
Several studies related to bladder dysfunction, urinary disorders, and multiple sclerosis were published recently. Some discussed therapeutic strategies (Denys, 2014) and drug treatments (Andersson, 2014) including botox injections (Schurch, 2014) for bladder dysfunction. One study discussed clinical and urodynamic testing for urinary disorders (Amarenco, 2014) and another investigated the usefulness of perineal electrophysiologic testing in evaluating uro-ano-genital dysfunction in MS (Podnar, 2014). Although bladder and bowel dysfunctions can interfere with quality of life, a recent study found that urinary catheterization may not adversely impact qualify of life for MS patients (James, 2014).
Amarenco G, de Sèze M, Ruffion A, Sheikh Ismael S. Clinical and urodynamic evaluations of urinary disorders in multiple sclerosis. Ann Phys Rehabil Med. 2014 Jul;57(5):277-87. doi: 10.1016/j.rehab.2014.05.006. Epub 2014 Jun 5.
Andersson KE. Current and future drugs for treatment of MS-associated bladder dysfunction. Ann Phys Rehabil Med. 2014 Jul;57(5):321-8. doi: 10.1016/j.rehab.2014.05.009. Epub 2014 Jun 2.
Denys P, Phe V, Even A, Chartier-Kastler E. Therapeutic strategies of urinary disorders in MS. Practice and algorithms. Ann Phys Rehabil Med. 2014 Jul;57(5):297-301. doi: 10.1016/j.rehab.2014.05.003. Epub 2014 Jun 4.
James R, Frasure HE, Mahaian ST. Urinary catheterization may not adversely impact quality of life in multiple sclerosis patients. ISRN Neurol. 2014 Feb 20;2014:167030. doi: 10.1155/2014/167030. eCollection 2014.
Podnar S, Vodušek DB. Place of perineal electrophysiologic testing in multiple sclerosis patients. Ann Phys Rehabil Med. 2014 Jul;57(5):288-96. doi: 10.1016/j.rehab.2014.05.005. Epub 2014 Jun 3.
Schurch B, Carda S. OnabotulinumtoxinA and multiple sclerosis. Ann Phys Rehabil Med. 2014 Jul;57(5):302-14. doi: 10.1016/j.rehab.2014.05.004. Epub 2014 Jun 5.
Other studies of interest:
Adamczyk-Sowa M, Pierzchala K, Sowa P, et al. Melatonin Acts as Antioxidant and Improves Sleep in MS Patients. Neurochem Res. 2014 Jun 30. [Epub ahead of print]
Carroll CA, Fairman KA, Lage MJ. Updated cost-of-care estimates for commercially insured patients with multiple sclerosis: retrospective observational analysis of medical and pharmacy claims data. BMC Health Serv Res. 2014 Jul 2;14(1):286. [Epub ahead of print]
Fu Y, Hao J, Zhang N, et al. Fingolimod for the Treatment of Intracerebral Hemorrhage: A 2-Arm Proof-of-Concept Study. JAMA Neurol. 2014 Jul 7. doi: 10.1001/jamaneurol.2014.1065. [Epub ahead of print]
Kalron A, Frid L, Gurevich M. Concern about falling is associated with step length in persons with multiple sclerosis. Eur J Phys Rehabil Med. 2014 Jul 1. [Epub ahead of print]
Kieseier BC. Defining a role for laquinimod in multiple sclerosis. Ther Adv Neurol Disord. Jul 2014;7(4):195-205.
Marck CH, Hadgkiss EJ, Weiland TJ, et al. Physical activity and associated levels of disability and quality of life in people with multiple sclerosis: a large international survey. BMC Neurol. 2014 Jul 12;14(1):143.
Muhlert N, Sethi V, Cipolotti L, et al. The grey matter correlates of impaired decision-making in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2014 Jul 8. pii: jnnp-2014-308169. doi: 10.1136/jnnp-2014-308169. [Epub ahead of print]
Pagathanasiou A, Messinis L, Georgeiou VL, Papathanasopoulos P. Cognitive impairment in relapsing remitting and secondary progressive multiple sclerosis patients: efficacy of a computerized cognitive screening battery. ISRN Neurol. 2014 Mar 13;2014:151379. doi: 10.1155/2014/151379. eCollection 2014.
Prévinaire JG, Lecourt G, Soler JM, Denys P. Sexual disorders in men with multiple sclerosis: Evaluation and management. Ann Phys Rehabil Med. 2014 Jul;57(5):329-36. doi: 10.1016/j.rehab.2014.05.002. Epub 2014 Jun 3.
Thaut MH, Peterson DA, McIntosh GC, Hoemberg V. Music mnemonics aid Verbal Memory and Induce Learning - Related Brain Plasticity in Multiple Sclerosis. Front Hum Neurosci. 2014 Jun 13;8:395. doi: 10.3389/fnhum.2014.00395. eCollection 2014.
Published On: July 28, 2014