Hot Topics and MS Research News for August 2014

  • Decreased sense of smell can be associated with greater disability in MS.

    Change in the ability to smell (i.e. olfactory function) is a less common symptom of MS.  It is one that has been detected in all forms of MS, but may be more common in primary progression MS according to Schmidt et al. (2012) who found olfactory dysfunction in patients with PPMS (9/10, 90%), RRMS (9/25, 36%), optic neuritis (7/12, 58%), NMO (3/7, 43%), and healthy controls (1/30, 3%). However, Silva et al. (2012) found impaired smell (hyposmia) in 11.1% of MS patients compared to 3% of healthy controls. The frequency of impairment was higher for SPMS patients (11/16, 68.8%) than RRMS patients (4/121, 3.3%) or PPMS (2/16, 12.5%). Silva et al. (2012) suggest that olfactory dysfunction may help distinguish SPMS from RRMS.  

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    In the current study, Caminiti et al. (2014) sought to objectively evaluate olfactory function using Olfactory Event Related Potentials (OERP) as results of different testing methods may be influenced by patients' response bias and clinical, demographic and cognitive features. Researchers tested the olfactory function of 30 patients with RRMS (mean age of 36.03±6.96 years) and of 30 age, sex and smoking–habit matched healthy controls by using olfactory potentials. An equal number of RRMS patients showed complete olfactory dysfunction (7/30, 23.3%) and no dysfunction (7/30, 23.3%). The remaining 16 patients (53.3%) showed some impairment with a mean value of OERP amplitude lower than the control group, who showed no impairment.

    The presence/absence of olfactory event related potentials was associated with dichotomous expanded disability status scale (p = 0.0433), as well as inversely correlated with the disease duration (r = −0.3641, p = 0.0479). Researchers conclude that unbiased olfactory dysfunction of different severity found in multiple sclerosis patients suggests an organic impairment which could be related to neuroinflammatory and/or neurodegenerative processes of olfactory networks, supporting the recent findings on neurophysiopathology of disease.

    Caminiti F, De Salvo S, De Cola MC, Russo M, Bramanti P, et al. Detection of Olfactory Dysfunction Using Olfactory Event Related Potentials in Young Patients with Multiple Sclerosis. PLoS One. 2014;9(7):e103151. doi: 10.1371/journal.pone.0103151

    Schmidt F, Goektas O, Paul F, Harms L. Olfactory Dysfunction in Different Subtypes of Multiple Sclerosis and in Neuromyelitis Optica (P07.065). Neurology. April 26, 2012; 78(Meeting Abstracts 1): P07.065. doi: 10.1212/WNL.78.1_MeetingAbstracts.P07.065

    Silva AM, Santos E, Moreira I, et al. Olfactory dysfunction in multiple sclerosis: association with secondary progression. Mult Scler. 2012 May;18(5):616-21. doi:10.1177/1352458511427156. Epub 2011 Oct 21.

    11th MS disease-modifying drug approved by the FDA in the US.

    Biogen’s newest disease-modifying therapy for relapsing forms of MS has been approved for use in the US and Europe. PlegridyTM (peginterferon beta-1a) offers less frequent dosing as compared to similar medications, Avonex and Rebif and is given by subcutaneous (under the skin) injection every two weeks. The MS community now has eleven medications in its arsenal that can be used to reduce disease progression in earlier or relapsing forms of MS. Hopefully someday there will also be effective medications available for progressive forms of the disease, in addition to treatments to repair damage to myelin caused by MS.

  • Emrich, Lisa. 11th MS Disease-Modifying Drug Approved in the US., August 18, 2014. Accessed August 26, 2014.

    Exercise is good for people with MS.

    Results from the following two studies, while not surprising, may encourage each of us to stick with a regular exercise routine to reduce symptoms and stave off disability.

    Short bouts of moderate-intensity exercise have no significant adverse effect on fatigue, pain, or function in people with MS.

    A recent pilot study was conducted to determine whether a 15-minute bout of moderate-intensity aerobic cycling exercise would affect symptoms, including pain and fatigue, and mobility function in people with MS (n=8; EDSS 5-6) or chronic fatigue syndrome (n=8), and to compare results with healthy controls (n=8). Pain, fatigue, and mobility [measured by Timed 25-Foot Walk (T25FW) and Timed Up and Go (TUG) tests] were established at baseline and 30 minutes, 2 hours, and 24 hours following an aerobic exercise session during which participants cycled for 15 minutes at 90% of their calculated anaerobic threshold.

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    Although researchers anticipated an immediate (within 24 hours) negative impact of exercise on symptoms and mobility in people with MS and CFS, they found that for people with MS there was no increase in fatigue levels or decrease in function following the exercise test; fatigue levels appeared to increase for those with CFS (Learmonth, 2014). Additionally, there was a slight trend toward increased pain levels in both the MS and CFS groups. Results from this pilot study showed that 15 minutes of moderate-intensity aerobic cycling exercise had no significant adverse effect on pain or function in people with MS or CFS.

    Learmonth YC, Paul L, McFadyen AK, et al. Short-Term Effect of Aerobic Exercise on Symptoms in Multiple Sclerosis and Chronic Fatigue Syndrome: A Pilot Study. Int J MS Care. 2014;16:76–82.

    Combination exercise improves MS symptoms and quality of life, but must be continued to maintain benefit.

    Researchers in Iran investigated the short-term and long-term effects of a period of combination exercise therapy on walking distance, balance, fatigue and quality of life in multiple sclerosis patients (n=59) referred to the physiotherapy clinic of Iran's Multiple Sclerosis Society in 2013. Patients were randomized into the intervention (n=39) and control (n=20) groups. The intervention group received 10 weeks of combination therapy including aerobic, strengthening, balancing and stretching exercises. All participants were assessed for disability (EDSS), balance, walking (6-minute walking test), fatigue intensity, and quality of life one week before and one week after the exercise phase and again nine months later.

    The results indicated significant improvements in MS symptoms in the intervention group as compared to the control group during the exercise phase of the study in all areas measured except disability. However, the benefit seemed to dissipate in absence of specific exercise guidance after nine months, as test scores returned to baseline. Researchers conclude that rehabilitation can be crucially important in keeping MS patients capable of doing their daily activities (Sangelaji, 2014). The return of symptoms and disabilities following the cessation of exercise emphasizes the necessity of doing exercises regularly and continuously to maintain beneficial effects. Further research is warranted.

  • Sangelaji B, Nabavi SM, Estebsari F, et al. Effect of Combination Exercise Therapy on Walking Distance, Postural Balance, Fatigue and Quality of Life in Multiple Sclerosis Patients: A Clinical Trial Study. Iran Red Crescent Med J. 2014 Jun;16(6):e17173. doi: 10.5812/ircmj.17173. Epub 2014 Jun 5.

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    Other Studies of Interest:

    Farez MF, Crivelli L, Leiguarda R, Correale J. Decision-making impairment in patients with multiple sclerosis: a case-control study. BMJ Open. 2014 Jul 29;4(7):e004918. doi: 10.1136/bmjopen-2014-004918.

    Gold J, Goldacre R, Maruszak H, Giovannnoni G, et al. HIV and lower risk of multiple sclerosis: beginning to unravel a mystery using a record-linked database study. J Neurol Neurosurg Psychiatry. 2014 Aug 4. pii: jnnp-2014-307932. doi: 10.1136/jnnp-2014-307932. [Epub ahead of print]

    Goodin DS, Corwin M, Kaufman D, et al. Causes of Death among Commercially Insured Multiple Sclerosis Patients in the United States. PLoS One. 2014 Aug 21;9(8):e105207. doi: 10.1371/journal.pone.0105207. eCollection 2014.

    Karpatkin HI, Napolione D, Siminovich-Blok B. Acupuncture and multiple sclerosis: a review of the evidence. Evid Based Complement Alternat Med. 2014;2014:972935. doi: 10.1155/2014/972935. Epub 2014 Jun 18.

    Milanlioglu A, Ozdemir PG, Cilingir V, et al. Coping strategies and mood profiles in patients with multiple sclerosis. Arq Neuropsiquiatr. 2014 Jul;72(7):490-5.

    Suppiej A, Cainelli E. Cognitive dysfunction in pediatric multiple sclerosis. Neuropsychiatr Dis Treat. 2014; 10: 1385–1392. Published online 2014 July 23. doi: 10.2147/NDT.S48495

    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: August 27, 2014