Hot Topics and MS Research News for October 2014

  • Psychiatric disorders may precede MS diagnosis.

    Psychiatric disorders, such as depression or anxiety disorders, are common with multiple sclerosis. Several studies focus on the prevalence of depression or anxiety in patients diagnosed with MS. However, fewer studies focus on the diagnosis of psychiatric disorders years before MS is finally diagnosed in patients. This case report describes 51-year-old woman who had been treated for depression, severe anxiety, and behavioral disorders for 14 years before the onset of MS neurological symptoms, including vision problems, jerky movement in each of her limbs, weakness down the right side of her body, urinary dysfunction, speech problems, and short-term memory impairment. Not all symptoms occurred at once but in episodes over the past 6 years. Clinical and MRI examinations were consistent with MS. The psychotic episodes during the initial 14 years appear to have been signs of MS-related events.

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    Combining this case study with evidence from prior studies, authors conclude that there appears to be an important relationship between chronic psychiatric disorders and later MS onset, which may be due to disconnection in the white matter of the brain. They suggest that patients with psychiatric symptoms should receive a full neurological assessment, including brain imaging investigations. Doing so would allow for better understanding of any psychiatric disorders occurring before and/or during MS onset, and would provide patients with a better quality of life. The EDSS score reached 7.5 before this patient was finally diagnosed with MS.

    Sennou AS, Boujraf S, Belahsen MF, Messouak O. Psychiatric disorders revealing multiple sclerosis after 20 years of evolvement. J Neurosci Rural Pract. 2014 Oct;5(4):420-2. doi: 10.4103/0976-3147.140009.

    Non-drug therapies are more effective in combating MS-related fatigue.

    Fatigue is a complex, highly subjective, and frequently reported symptom of MS. Methods to improve fatigue in people with MS include both pharmacological (drug) and non-pharmacological interventions, each with varying levels of evidence for their effectiveness. In this systematic review, it becomes evident that the effect of fatigue-management approaches vary considerably and their benefit was modest at best and/or has yet to be established. Authors did note that non-pharmacological interventions (both exercise and psychological/educational interventions) appear to have a stronger and more significant favorable effect on reducing the impact or severity of fatigue compared to commonly prescribed pharmacological agents such as amantadine, modafinil, or pemoline (Cylert). The findings from this review suggest that non-drug approaches used alone and/or in combination with drug therapy should be the mainstay of the management of fatigue in people with MS. Further high-quality research studies are warranted.

    Khan F, Amatya B, Galea M. Management of Fatigue in Persons with Multiple Sclerosis. Front Neurol. 2014; 5: 177. Prepublished online 2014 August 26. Published online 2014 September 15. doi: 10.3389/fneur.2014.00177.


  • Reasons why people with MS fall more frequently.

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    The circumstances, consequences, causes, and risk of falls are different for people with MS than for healthy people of the same age and gender. People with MS fall more, are more likely to be injured by a fall, and often fall indoors. People with MS, but not their healthy counterparts, frequently fall because they are distracted, fatigued, or hot.

    Mazumder R, Murchison C, Bourdette D, Cameron M. Falls in people with multiple sclerosis compared with falls in healthy controls. PLoS One. 2014 Sep 25;9(9):e107620. doi: 10.1371/journal.pone.0107620. eCollection 2014.

    Treatment updates: Alemtuzumab, Plegridy, Copaxone, and a discussion of the role of immune cells in MS.

    Bridel C, Lalive PH. Update on multiple sclerosis treatments. Swiss Med Wkly. 2014 Sep 23;144:w14012. doi: 10.4414/smw.2014.14012. eCollection 2014.

    Hartung HP, Aktas O, Boyko AN. Alemtuzumab: A new therapy for active relapsing-remitting multiple sclerosis. Mult Scler. 2014 Oct 24. pii: 1352458514549398. [Epub ahead of print]

    Høglund RA, Maghazachi AA. Multiple sclerosis and the role of immune cells. World J Exp Med. 2014 Aug 20;4(3):27-37. doi: 10.5493/wjem.v4.i3.27. eCollection 2014.

    Hu X, Cui Y, White J, et al. Pharmacokinetics and Pharmacodynamics of Peginterferon Beta-1a in Patients with Relapsing-Remitting Multiple Sclerosis in the Randomised ADVANCE Study. Br J Clin Pharmacol. 2014 Sep 29. doi: 10.1111/bcp.12521. [Epub ahead of print]

    Ireland SJ, Guzman aA, O’Brien DE, et al. The Effect of Glatiramer Acetate Therapy on Functional Properties of B Cells From Patients With Relapsing-Remitting Multiple Sclerosis. JAMA Neurol. 2014 Sep 29. doi: 10.1001/jamaneurol.2014.1472. [Epub ahead of print]

    Other studies of interest:

    Reynard AK, Sullivan AB, Rae-Grant A. A systematic review of stress-management interventions for multiple sclerosis patients. Int J MS Care. 2014 Fall;16(3):140-4. doi: 10.7224/1537-2073.2013-034.

    Severijns D, Lamers I, Kerkhofs L, Feys P. Hand grip fatigability in persons with multiple sclerosis according to hand dominance and disease progression. J Rehabil Med. 2014 Sep 30. doi: 10.2340/16501977-1897. [Epub ahead of print]

    Williams AE, Vietri JT, Isherwood G, Flor A. Symptoms and Association with Health Outcomes in Relapsing-Remitting Multiple Sclerosis: Results of a US Patient Survey. Mult Scler Int. Vol. 2014, Article ID 203183, 8 pages, 2014. doi:10.1155/2014/203183

    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: October 28, 2014