Multiple Sclerosis Research Today is a free monthly online journal that collates and summarizes the latest research about Multiple Sclerosis, including details on diagnosis, symptoms, treatment, prognosis.

Redefining functionality and treatment efficacy in multiple sclerosis.

Foley JF, Brandes DW

Rocky Mountain Neurological Associates, Salt Lake City, UT, USA.

Although our understanding of multiple sclerosis (MS) has grown exponentially in the past century and a half, there is still some divergence between physicians' perceptions of effects of MS on patients and those of the patients themselves. This article examines current practices in MS assessment and clinical trial design, highlighting certain deficiencies associated with commonly used measurement techniques (e.g., the Expanded Disability Status Scale and MRI) that are reflective of these discrepancies. In particular, the authors note that there is only minimal clinical awareness of the effects of MS on patient quality of life (QoL). We posit that QoL elements including impaired cognition, fatigue, pain, a variety of visual disturbances, depression, and degrading social function may have at least as much impact on people with MS as ambulatory issues. And because QoL measures often do not correlate with Expanded Disability Status Scale or MRI findings, we recommend that QoL be assessed independently. Various validated measures do exist to assess QoL elements, which are outlined here, along with thoughts on how to incorporate these into regular patient management visits. Ultimately, we believe that expanding on the traditionally accepted definitions of "functionality" and "efficacy" will allow for the adoption of a more holistic picture of MS and its impact.

Published 9 June 2009 in Neurology, 72(23): S1-11.
Full-text of this article is available online (may require subscription).

Articles on Multiple Sclerosis published 4 June 2009:

Metformin attenuated the autoimmune disease of the central nervous system in animal models of multiple sclerosis.   J Immunol, 182(12): 8005-14.

Experimental autoimmune encephalomyelitis (EAE) is a T cell-mediated autoimmune disease of the CNS. Metformin is the most widely used drug for diabetes and mediates its action via activating AMP-activated protein kinase (AMPK). We provide evidence that metformin attenuates the induction of EAE by restricting the infiltration of mononuclear cells into the CNS, down-regulating the expression of proinflammatory cytokines (IFN-gamma, TNF-alpha, IL-6, IL-17, and inducible NO synthase (iNOS)), cell ... [Abstract] [Full-text]

Articles on Multiple Sclerosis published 1 June 2009:

Driving behaviors among community-dwelling persons with multiple sclerosis.   Arch Phys Med Rehabil, 90(6): 975-81.

OBJECTIVE: The current study examined driver behaviors and patterns among drivers with multiple sclerosis (MS) as a function of disease severity and in comparison to drivers without MS. DESIGN: Between-group comparisons of participants with and without MS and cohorts of MS groups at varying levels of severity. SETTING: All data were collected in an outpatient research setting. PARTICIPANTS: Community-dwelling persons (n=66) with clinically definite MS who were active drivers and healthy ... [Abstract] [Full-text]

Articles on Multiple Sclerosis published 21 May 2009:

Contactin-2/TAG-1-directed autoimmunity is identified in multiple sclerosis patients and mediates gray matter pathology in animals.   Proc Natl Acad Sci U S A, 106(20): 8302-7.

Gray matter pathology is increasingly recognized as an important feature of multiple sclerosis (MS), but the nature of the immune response that targets the gray matter is poorly understood. Starting with a proteomics approach, we identified contactin-2/transiently expressed axonal glycoprotein 1 (TAG-1) as a candidate autoantigen recognized by both autoantibodies and T helper (Th) 1/Th17 T cells in MS patients. Contactin-2 and its rat homologue, TAG-1, are expressed by various neuronal ... [Abstract] [Full-text]

Articles on Multiple Sclerosis published 19 May 2009:

Quality of life in multiple sclerosis is associated with lesion burden and brain volume measures.   Neurology, 72(20): 1760-5.

BACKGROUND: Health-related quality of life (HRQOL) is reduced in multiple sclerosis (MS). It is unclear whether HRQOL is associated with white matter lesion burden or measures of brain atrophy. METHODS: A cross-sectional baseline analysis of 507 patients with MS in a prospective cohort study at the University of California, San Francisco was performed. Multivariate linear regression models were used to determine whether MRI measures were associated with the Emotional Well-Being and ... [Abstract] [Full-text]

Articles on Multiple Sclerosis published 18 May 2009:

Symptomatic, radiological and pathological involvement of the hypothalamus in neuromyelitis optica.   J Neurol Neurosurg Psychiatry, 80(6): 679-82.

This study describes a young girl who presented with involuntary weight loss, spontaneous vomiting and behavioural change. Imaging confirmed hypothalamic and brainstem involvement. Routine investigations (including cerebrospinal fluid analysis and neuromyelitis optica IgG) were unhelpful. Biopsy of the hypothalamic lesion implicated an aggressive inflammatory aetiology. There was a response to conventional immunosuppression, while a further relapse responded to plasma exchange. She died 21 ... [Abstract] [Full-text]

Parity and secondary progression in multiple sclerosis.   J Neurol Neurosurg Psychiatry, 80(6): 676-8.

BACKGROUND: Pregnancy has a well-documented effect on relapses in multiple sclerosis (MS), whereas little is known about the impact of pregnancy and childbirth on the risk of secondary progression. OBJECTIVE: To investigate the association of parity and secondary progression in women with MS. METHODS: The association of the number of births and secondary progression was studied in a hospital-based cohort of 277 women with MS. Data were analysed in a multivariable logistic regression model, with ... [Abstract] [Full-text]

Epstein-Barr virus is associated with grey matter atrophy in multiple sclerosis.   J Neurol Neurosurg Psychiatry, 80(6): 620-5.

OBJECTIVE: The aim of the study was to determine whether the presence of anti-Epstein-Barr virus (EBV) antibodies is associated with MRI measures of brain injury and neurodegeneration in patients with multiple sclerosis (MS). METHODS: 135 patients with MS (86 women, 49 men) underwent brain MRI and testing for antibodies against EBV. MRI measurements included gadolinium enhancing lesion volume, T1 and T2 lesion volumes and fractions of whole brain parenchyma (BPF), white matter and grey matter ... [Abstract] [Full-text]

Current approaches to the identification and management of breakthrough disease in patients with multiple sclerosis.   Lancet Neurol, 8(6): 545-59.

Disease-modifying drugs (DMDs) for relapsing-remitting multiple sclerosis (RRMS) are only partly effective -- breakthrough disease commonly occurs despite treatment. Breakthrough disease is predictive of continued disease activity and a poor prognosis. Availability of several DMDs offers the possibility of tailoring treatment to individual patients with RRMS and altering treatment in patients with breakthrough disease. However, no biological or imaging markers have been validated to guide ... [Abstract] [Full-text]

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