MS Information Update no 54 - January 2012
The criteria for inclusion of papers in MS Information Update are relevance to MS management issues, currency and references appearing in publications to which nurses and other health professionals may not have ready access.
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1. Bogosian A, Moss-Morris R, Bishop FL, et al.
How do adolescents adjust to their parent's multiple sclerosis? An interview study.
Br J Health Psychol 2011;16(2):430-444. [Ref. 5078]
This study comprised interviews with 15 teenagers who described both positive and negative experiences of having a parent with MS. Benefits included having greater empathy for others and becoming more independent. Negative aspects included family tension, less time to spend with friends and worries about the future. The severity and progression of the parent's symptoms, support from the other partner, siblings or friends, and extra responsibilities towards their parents all played a role in adjustment. The study highlighted the importance of the family environment and the researchers suggested that supporting families to improve communications may benefit adolescents who are finding it hard to cope.
2. Casserly C, Ebers GC.
Relapses do not matter in relation to long-term disability: Yes.
Mult Scler 2011;17(12):1412-1414. [Ref. 5092]
Authors highlight that the progressive phase of MS determines long-term outcome and that location of relapse in the central nervous system, severity and recovery do not influence time to long-term disability endpoint. Studies implicate axonal degeneration in cerebrospinal tracts in progressive MS as independent of plaque location or burden. Authors suggest that targeting early relapse may be relevant if it proves to delay or arrest the progressive phase but that the target of research should be to characterise and treat progressive MS to prevent long-term disability.
3. Feinstein A.
Multiple sclerosis and depression.
Mult Scler 2011;17(11):1276-1281. [Ref. 5100]
Review highlights the lifetime prevalence of depression as 50% for people with MS. The difficulty of diagnosis in the context of other MS symptoms is explored and the independent predictors of depression: emotion based coping, uncertainty, loss of hope and degree of physical disability, are considered. Feinstein highlights the data showing that, in the neurological setting, depression is often overlooked and under treated but that anti depressant medication, cognitive behavioral therapy and mindfulness therapy can all be successful treatment approaches.
4. Fowler CJ.
Systematic review of therapy for neurogenic detrusor overactivity (NDO).
Can Urol Assoc J 2011;5(5 Suppl 2):S146-148. [Ref. 5105]
The lack of robust evidence to support the use of antimuscarinic medications as first line treatment for neurogenic detrusor overactivity is highlighted, the Cochrane review of 2009 being unable to support the use of antimuscarinic medications in MS. Examines the evidence for use of desmopressin and cannabinoids and concludes that evidence of efficacy of detrusor injections of Botuinum Toxin A is already Level 1, suggestive of a highly effective treatment for NDO but that this carries with it a need for clean intermittent self-catheterisation.
5. He D, Zhou H, Guo D, Wu B.
Pharmacologic treatment for memory disorder in multiple sclerosis (Review).
Cochrane Database of Syst Rev 2011, Issue 10:CD008876. [Ref. 5094]
Data on the use of donepezil, Ginkgo biloba extracts, memantine and rivastigmine, either orally or parenterally in the context of treating memory disorder in MS was examined. The aim of the review was to assess the efficacy, tolerability and safety of these treatments in adult people with all types of MS. Only four studies comprising a total of 291 participants met the inclusion criteria and the quality of the included studies was low. The authors did not find convincing evidence for these interventions as effective treatments for memory disorder in MS.
6. Higginson IJ, Costantini M, Silber E, et al.
Evaluation of a new model of short-term palliative care for people severely affected with multiple sclerosis: a randomised fast-track trial to test timing of referral and how long the effect is maintained.
Postgrad Med J 2011;87(1033):769-775. [Ref. 5096]
52 people severely affected by MS (average EDSS 7.7) were randomised to receive palliative care immediately (fast track) or after 12 weeks (control). Palliative care treatment was from a multidisciplinary team that provided three visits per week with all care completed by six weeks. Higher rate of improvement was found in the fast track group with effects maintained at 12 but not 24 weeks following withdrawal of treatment. Authors conclude that earlier palliative care has a similar effect on symptom reduction but greater effect on reducing care giver burden.
7. Jafari N, Hintzen RQ.
The association between cigarette smoking and multiple sclerosis.
J Neurol Sci 2011;311(1-2):78-85. [Ref. 5102]
Review of the 14 major studies on MS and smoking which suggests that whilst a recent meta-analysis demonstrated a link between cigarette smoking and MS susceptibility, the effect on disease progression is less certain. The importance of passive exposure to tobacco smoke has not been considered or that of other lifestyle risk factors such as alcohol intake or body mass index.
8. Khan F, Amatya B, Turner-Stokes L.
Symptomatic therapy and rehabilitation in primary progressive multiple sclerosis.
Neurol Res Int 2011; 2011:740505. [Ref. 5084]
Article explores the multidisciplinary approach to treatment, highlighting evidence for MS rehabilitation, the role of a neuropalliative approach to primary progressive MS and the interface between neurology, rehabilitation and palliative care in this context. The principles of goal setting in rehabilitation to maximise function and safety and minimise complications resulting from decreased mobility with improved quality of life are highlighted.
9. Kasper J, Heesen C, Kopke S, et al.
Patients' and observers' perceptions of involvement differ. Validation study on inter-relating measure for shared decision making.
PLos ONE 2011;6(10):e26255. [Ref. 5101]
Evaluation of four methods to indicate patient involvement in decision making using a cohort of 79 people already enrolled in a study evaluating the effectiveness of a decision aid. All participants agreed to video recording of the consultation with the physician as a sample of communication behavior. OPTION scale, Shared Decision Making Questionnaire, Control Preference Scale and Decisional Conflict Scale
10. Killestein J, Rudick RA, Polman CH.
Oral treatment for multiple sclerosis.
Lancet Neurol 2011;10(11):1026-1034. [Ref. 5080]
This review covers mechanism of action, safety and efficacy found in results of trials of the oral drugs fingolimod, teriflunomide, laquinimod and dimethyl fumarate (BG-12) over the last two years. Authors consider the challenges in MS treatment that these new therapies might bring including how treatment choice might be made particularly for patients not currently using DMTs, those using first line injectable therapies and those using natalizumab. Highlights the need for careful monitoring of long-term safety data and concludes that whilst significant interest in oral drugs has been generated this does not necessarily make for harmless and convenient treatment.
11. Koch-Henriksen N, Sorensen PS.
Why does the north-south gradient of incidence of multiple sclerosis seem to have disappeared in the Northern hemisphere?
J Neurol Sci 2011;311(1-2):58-63. [Ref. 5093]
Meta-analysis encompassing studies over five decades indicates that whilst incidence and prevalence of MS have increased, particularly in women, recent literature fails to confirm the previously reported latitudinal gradient in the Northern hemisphere. Authors postulate this may be due to environmental factors such as lifestyle habits as well as errors in previous interpretations and suggest a need for epidemiological studies that focus on changes of female lifestyle.
12. Laupacis A, Lille E, Dueck A, et al.
Association between chronic cerebrospinal venous insufficiency and multiple sclerosis: a meta-analysis.
CMAJ 2011;183(16):1203-1212. [Ref. 5104]
Meta-analysis commissioned by the Canadian Institutes of Health Research examined eight studies that evaluated the association between chronic cerebrospinal venous insufficiency and multiple sclerosis. The studies included a total of 664 patients with MS and an equal number of controls (136 of whom had neurological conditions other than MS). The authors found that CCSVI was more frequent among people with MS than amongst healthy controls. However the prevalence of CCSVI in people with MS varied widely and authors concluded that this meta-analysis cannot differentiate between causal and non-causal associations.
13. Lincoln NB, Yuill F, Holmes J, et al.
Evaluation of an adjustment group for people with multiple sclerosis and low mood: a randomized controlled trial.
Mult Scler 2011;17(10):1250-1257. [Ref. 5052]
151 people with MS and low mood as assessed with Hospital Anxiety and Depression Scale (HAD) were assigned to an adjustment group (n=72) or waiting list control (n=79). The intervention was six, two hour group treatment sessions based on cognitive behavioral therapy (CBT). Outcomes were assessed at four and eight months after randomisation. Authors conclude that group treatment was effective for reducing low mood in people with MS; that CBT approaches are useful and that group intervention is beneficial.
14. Lublin F.
Relapses do not matter in relation to long-term disability: No (they do).
Mult Scler 2011:17(12);1415-1416. [Ref. 5091]
Highlights that higher rate of relapse leads to shorter time to disability milestones and onset of secondary progressive MS and suggests that there is a general underestimation of physical, emotional and economic consequences of relapse. That in early disease relapse is responsible for the majority of worsening, once the progressive phase sets in this is most important.
15. Moore K, Tawadros C, Betts C.
Multiple sclerosis and bladder dysfunction.
Br J Neurosci Nurs 2011;7(5):645-654. [Ref. 5108]
Overview of bladder dysfunction and its management in MS. The impact of this symptom on quality of life and activities of daily living are highlighted and investigations and treatments explored. The importance of regular review by the multidisciplinary team is stressed, particularly in the context of progressive disease.
16. Pakenham KI, Fleming M.
Relations between acceptance of multiple sclerosis and positive and negative adjustments.
Psychol Health 2011;26(10):1292-1309. [Ref. 5103]
Study examined the relationship between acceptance as defined in Acceptance and Commitment Therapy (ACT) and adjustment to multiple sclerosis. The MS Acceptance Questionnaire (MSAQ) was developed to assess adjustment in MS. 128 people with MS, all parents of children aged between 10 and 20 years, completed measures of demographics, illness and adjustment at initial assessment and measures of acceptance and adjustment 12 months later. Greater acceptance (as defined by ACT) was related to better adjustment and authors suggest that this provides a first step for further investigation of acceptance in MS.
17. Ploughman M, Austin MW, Murdoch M, et al.
Factors influencing healthy aging with multiple sclerosis: a qualitative study.
Disabil Rehabil 2012;34(1):26-33. [Ref. 5090]
18 participants (14 women, 4 men) over 55 years of age with MS for more than 20 years were selected from an MS clinic and outpatient rehabilitation visits. Semi-structured face-to-face interviews were used to explore perspectives on aging, health and lifestyle. Financial planning was found to be crucial in allowing people to remain active, mobile, adapt homes and pay for additional care and services. Mental health, resilience and cognition were important factors for healthy aging with MS.
18. Pucci E, Giuliani G, Solari A, et al.
Natalizumab for relapsing remitting multiple sclerosis (Review).
Cochrane Database of Syst Rev 2011;10:CD007621. [Ref. 5099]
This review examined three clinical trials of natalizumab involving over 2,000 people with MS. The review concluded that taking natalizumab for two years lowers the number of relapses and progression of disability in people with relapsing remitting MS and that the drug was well tolerated. Current significant safety concerns due to cases of PML (progressive multifocal leukoencephalopathy) associated with taking natalizumab, particularly if taken for more than two years were noted but authors were unable to comment on this risk as the trials included in the review only lasted a maximum of two years.
19. Riazi A, Porter B, Chataway J, et al.
A tool to measure the attributes of receiving IV therapy in a home versus hospital setting: the Multiple Sclerosis Relapse Management Scale (MSRMS).
Health Qual Life Outcomes 2011;9(1):80. [Ref. 5106]
Article explains the development of the MSRMS, a 42 item scale with four subscales covering access to care, information, coordination of care and interpersonal care. Results identified this as a valid and reliable measure of patient experience of relapse management that could have a valuable role in determining which services should be developed and commissioned.
20. Rosti-Otajärvi EM, Hämäläinen PI.
Neuropsychological rehabilitation for multiple sclerosis (Review).
Cochrane Database Syst Rev 2011;11:CD009131. [Ref. 5098]
14 studies (770 MS patients) fulfilled the inclusion criteria. Low level evidence was found that neuropsychological rehabilitation reduces cognitive symptoms in MS and that cognitive training was found to improve memory span, working memory and immediate visual memory.
21. Scalfari A, Neuhause A, Daumer M, et al.
Age and disability accumulation in multiple sclerosis.
Neurology 2011;77(13):1246-1252. [Ref. 5095]
Data from 1,023 people with MS in the London, Ontario database was analysed. Older age at relapsing remitting onset was associated with higher risk of reaching advanced EDSS, independent of early relapse frequency. Onset of MS at age forty doubled the risk of developing secondary progressive MS and at age 50 tripled this risk compared to onset at age 20. Authors conclude that development of secondary progressive MS is the major determinant of long- term prognosis. This is independent of disease duration and previous relapse frequency.
22. Sosnoff JJ, Socie MJ, Boes MK, et al.
Mobility balance and falls in persons with multiple sclerosis.
PLoS ONE 2011;9(11):e28021. [Ref. 5107]
52 people with MS provided fall history over a 12 month period. EDSS, walking speed, coordination, endurance and postural control were assessed. Authors conclude that older people, those who walk more slowly, have lower walking endurance and worse balance are at greater risk of falling. The importance for health professionals of monitoring people with MS who demonstrate these risk factors for future falls is noted.
23. Young CA.
Factors predisposing to the development of multiple sclerosis.
Q J Med 2011;104(5):383-386. [Ref. 5097]
Overview of MS risk factors for both development of MS, and disease severity within the condition. Genetic and migration data, environmental risk factors and the possible protective effect of vitamin D are explored.