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Some people with MS suffer from disabling tremor. This study asserts that improvement with medical treatment is modest, at best. They also observe stereotactic surgery targeting the vim nucleus of the thalamus (of the brain) has been successful in alleviating MS tremor. Gamma knife radiosurgery represents a minimally invasive alternative that can provide improvement.
Researchers reviewed their experience with GK thalamotomy in the management of six consecutive patients suffering from disabling MS tremor.
All patients experienced improvement in tremor after a median latency period of 2.5 months. More improvement was noted in tremor amplitude than in writing and drawing ability. In four patients, the tremor reduction led to functional improvement. One patient suffered from transient contralateral hemiparesis, which resolved after brief corticosteroid administration. No other complication was seen.
They concluded that Gamma knife radiosurgical thalamotomy is effective as a minimally invasive alternative to stereotactic surgery for the palliative treatment of disabling MS tremor.
Reference: DMathieu, D et al (2007) Gamma knife thalamotomy for multiple sclerosis tremor. Surgical Neurology 1 Oct 2007 68(4): p. 394.
Read abstract/source full text of article: http://highwire.stanford.edu/cgi/medline/pmid;17905063
About 10-15% of people with MS present with primary-progressive multiple sclerosis (PPMS).
This study suggests that compared to relapsing-remitting MS, people with PPMS are older at onset and a higher proportion are men.
They found that inflammatory white-matter lesions are less evident in PPMS, but diffuse axonal loss and microglial* activation are seen in healthy-looking white matter, in addition to demyelination of the brain’s cortex. MRI shows atrophy and intrinsic abnormalities in the grey matter and the white matter.
Spinal cord atrophy corresponds to the usual clinical presentation of progressive spastic paraplegia.
Although degeneration of the nerve axons seems to underlie PPMS, the development and the extent to which immune-mediated mechanisms operate is unclear.
They also note that MRI of the brain and spinal cord, and examination of the cerebrospinal fluid, are important investigations for diagnosis, but conventional immunomodulatory therapies, such as interferon beta and glatiramer acetate, are ineffective.
They suggest that future research should focus on the clarification of the mechanisms of axonal loss, improvements to the design of clinical trials, and the development of effective neuroprotective treatments.
* Microglia are a type of cell that act as the immune cells of the central nervous system. They are thought to be highly mobile cells that play numerous important roles in protecting the nervous system.
Reference: Miller D. and Leary S. (2007) Primary-progressive multiple sclerosis. Lancet Neurology 1 Oct 2007 6(10): p. 903.
Read abstract/source full text of article: http://highwire.stanford.edu/cgi/medline/pmid;17884680
This UK study determined whether cognitive tests predict safety to drive in people with MS.
34 participants were recruited from people referred to Derby Regional Mobility Centre for assessment of their fitness to drive. They were assessed on tests of cognitive abilities related to driving. Participants' safety to drive on the public road was tested by an approved driving instructor blind to the results of the cognitive assessment.
Safe and unsafe drivers were compared.
Significant differences were found on tests of executive function (road sign recognition), visual memory, information processing, concentration and visuo-spatial abilities.
Using a mathematical equation they have concluded that cognitive abilities were predictors of safety to drive in people with MS.
Reference: Lincoln, N. and Radford, K. (2007) Cognitive abilities as predictors of safety to drive in people with multiple sclerosis. Multiple Sclerosis 24 Sep 2007.
Read abstract/source ful ltext of article: http://highwire.stanford.edu/cgi/medline/pmid;17893114
This Irish study investigated people with optic neuritis (ON) and determined whether HLA-DRB1* genotypes are a risk factor for the development of MS.
All were Caucasian, had Irish ancestry and had MRI of brain and optic nerves within 2-3 weeks of presentation. Patients were referred to a neurologist if MRI findings were consistent with a diagnosis of MS. HLA-DRB1 allele and phenotype frequencies for 78 patients with a clinical diagnosis of acute ON were compared with those for 250 healthy bone marrow donors.
An ON/MS positive patient was 3.4 times more likely than an ON/MS negative patient to be HLA-DRB1*15 positive. No difference in age profile was detected between ON/MS positive and ON/MS negative patients or between the ON male and female subgroups. No gender or HLA-DRB1 association was identified for ON/MS negative patients. Female gender was significantly increased among ON/MS positive patients.
HLA- DRB1*15 is a significant predisposing factor for optical neuritis. This ON patient cohort has also provided an opportunity to evaluate the relationship of HLA genotype with the risk of MS development.
The findings of this study indicate that Irish individuals presenting with ON and who are HLA DRB1*15 positive have a higher risk than HLA DRB1*15 negative patients of presenting with MRI findings indicative of MS.
This study has also demonstrated that female gender is also a risk factor for developing MS in the Irish population.
* See story in Issue 20 of MSSNZ Research Roundup issued 1 June 2007 at: http://www.msnz.org.nz/research/roundups/roundup20.html#3
Reference: Tuwir, I. et al. (2007) The relationship between HLA-DRB1 alleles and optic neuritis in Irish patients and the risk of developing multiple sclerosis. British Journal of Ophthalmology1 Oct 2007 91(10): p. 1288.
Read abstract/source full text of article: http://highwire.stanford.edu/cgi/medline/pmid;17895416
This study suggests that existing data on the incidence of MS in the UK have some limitations. Few studies have reported age- and sex-specific incidence rates of MS, and none of those is based on a large sample of the general population. Further, no published reports have provided age- and sex-specific incidence rates of MS by clinical course from onset.
To estimate the age- and sex-specific incidence rate and lifetime risk of multiple sclerosis, researchers identified all new cases of MS during the period 1993-2000 in the General Practice Research Database, which includes health information on over three million Britons.
Based on 642 incident cases, incidence rates of MS adjusted to the world population were 7.2 in women and 3.1 in men. The incidence of MS with relapsing-remitting onset was higher in women than in men, but there were no sex differences for primary-progressive MS. The estimated lifetime risk from birth of receiving an MS diagnosis was 5.3 per 1,000 in women and 2.3 per 1,000 in men.
These results confirm the relatively high incidence of MS in the UK and show marked differences in the sex-specific pattern of MS incidence by clinical course from onset.
Reference: Alonso, A. et al. (2007) Incidence of multiple sclerosis in the United Kingdom : Findings from a population-based cohort. Journal of Neurology 1 Oct 2007.
Read abstract/source full text of article: http://highwire.stanford.edu/cgi/medline/pmid;17896096
Relapse is a relatively sudden worsening of neurological status in people with MS. The aim of this study was to describe the frequency and timing of the subsequent clinical remission, and factors linked to a possible lack of recovery.
223 relapses in 62 people with MS were examined retrospectively. Kurtzke's Expanded Disability Status Scale (EDSS) scores were calculated every 3 months from 1 year before to 1 year after. Remission was defined as improvement vs. the EDSS as scored during the relapse. Recovery was defined as return to the EDSS as scored before the relapse.
The frequency of improvement was 78% at 3 months, 86% at 6 months, but lower in males (65%). The frequency of recovery was 55% at 3 months and 71% at 6 months. Other measures showed stabilisation after 6 months, with improvement in 90%, plus 100% without further relapses.
They concluded that incomplete remissions do not appear to be linked to the evolution of the relapse, but to further relapses in the following months.
Reference: Iuliano, G. , Napoletano, R. and Esposito, A. (2007) Multiple Sclerosis: Relapses and Timing of Remissions. European Neurology, 4 Oct 2007 59(1-2): p. 44.
Read abstract/source full text of article: http://highwire.stanford.edu/cgi/medline/pmid;17917457
This Danish study observes that the triggering-off agent for MS, despite intensive epidemiological and biomedical research, is still unknown. They say the disease is typically diagnosed in reproductive age and acknowledge that recent findings have suggested that MS could be a sexually transmitted disease.
So, they aimed to assess the influence of different sexual practices in young age on the risk of developing MS, and specifically to explore the possible impact of oral sex and oral sperm exposure on this risk.
Danish women under 40 with a first time MS diagnosis up to 2005 participated in the study together with an age and geographically-matched control group.
They found no difference between women with and without MS in regard to years of schooling, oral herpes infections, genital herpes, blood transfusions, age at sexual debut, age at coital debut and in regard to various sexual behaviours and sexually transmitted diseases.
They concluded that for any sexual activity looked at in the study, none had any association to the risk of later developing MS.
This study does not support the hypothesis that MS is a sexually transmitted or acquired disease.
Reference: Lidegaard, O and Svendsen, A. (2007) Sexual habits before multiple sclerosis: a National case control study. Multiple Sclerosis 24 Sep 2007.
Read abstract/source ful ltext of article: http://highwire.stanford.edu/cgi/medline/pmid;17893111
This study suggests that in MS, autologous hematopoietic stem cell transplantation* (AHSCT) profoundly suppresses activity and MR imaging-detectable inflammation, but it may also be associated with a rapid brain volume loss in the months subsequent to treatment. In this regard, the study set out to assess how AHSCT affects the medium-term evolution of brain atrophy in MS.
They analysed MR imaging scans of the brain from 14 patients with rapidly evolving secondary-progressive MS, obtained 3 months before and every year after AHSCT for 3 years.
The median decrease of brain volume was 1.92% over the first year after AHSCT and then declined to 1.35% at the second year and to 0.69% at the third year.
They concluded that after AHSCT, the rate of brain tissue loss in patients with MS declines dramatically after the first 2 years.
* cells from the patient’s own bone marrow
Reference: Rocca, M. et al. (2007) A Three-Year Study of Brain Atrophy after Autologous Hematopoietic Stem Cell Transplantation in Rapidly Evolving Secondary Progressive Multiple Sclerosis. American Journal of Neuroradiology 20 Sep 2007.
Read abstract/source full text of article: http://highwire.stanford.edu/cgi/medline/pmid;17885242
Development of neutralising antibodies (NAbs) against interferon-beta (IFNb) is a known clinical problem in the treatment of MS.
This study observes that there are several methods are available to assess NAbs, but there is lack of consensus on how the different NAb levels can interfere with the efficacy of the drug, especially in the individual patient.
They identified levels of NAbs at which the IFNb biological activity was reduced or abrogated.
Those with NAb titers* up to 150 TRU/ml still had retained IFNb bioactivity, whereas greatly reduced levels of IFNb bioactivity were found in those with NAbs between 150 and 600 TRU/ml. Titers above 600 TRU/ml were associated with loss of IFNb bioactivity.
They concluded that there is a stepwise loss of IFNb bioactivity with increasing levels of neutralising antibodies. They suggest it is possible to identify functionally critical NAb levels that are useful as a support in treatment decisions for the individual patient on interferon treatment.
* A measurement of the amount or concentration of a substance— usually referring to the amount of medicine or antibodies found in a person’s blood.
Reference: Sominanda, A., Hillert, J. and Fogdell-Hahn, A. (2007) In vivo bioactivity of interferon beta in multiple sclerosis patients with neutralising antibodies is titer dependent. Journal of Neurology, Neurosurgery and Psychiatry 2 Oct 2007.
Read abstract/source full text of article: http://highwire.stanford.edu/cgi/medline/pmid;17911184