Monday, 9 April 2012

MS Research Roundup April 2012

Some more really interesting MS research projects have reported recently. It's an exciting time!

All of us with MS have probably had MRIs, for diagnosis or to check on progression. But there has always been a paradox: the number of lesions in the brain doesn't correlate with the effects of the disease.

Researchers looked at the number of lesions in different parts of the brain, and found that they could be correlated with specific symptoms. For instance, lesions in the precuneus and precentral gyrus were most predictive of mobility problems.

MRIs have poor resolution, and contrast media such as gadolinium do not necessarily measure what they aim to: they often show fluid rather than inflammation. This research could help MRIs to be used with a new precision, as a truly useful clinical tool.

We already know that many women find their MS symptoms improve during pregnancy. Now Australian researchers have found that even one pregnancy halves a woman's risk of developing MS in the future.For women who have had two or more pregnancies, the risk is a quarter. The researchers suspect this may be the reason the rate of MS in women has inched up over the last few decades, as more and more women have decided to have babies later or not at all.

An interesting study from a group of Belgian researchers. They got nearly 1400 people with relapsing remitting MS about their diet, drinking habits, and whether they smoked. They found that people who consumed alcohol, wine, fish and coffee on a regular basis took 4-7 more years to reach the point where they needed a walking aid than those who never consumed them. They didn't find the same pattern in people with progressive MS. Those who smoked cigarettes needed walking aids earlier than those who didn't.

I'll just have to hope that my intravenous coffee drip offsets my cigarettes then...

Research is continuing on various aspects of the CCSVI theory. The theory states that malformed and blocked veins in the neck lead to the deposition of iron in the brain, which in turn leads to autoimmunity and demyelination of nerve cells.

A group of American researchers tested this theory by tying mice's jugular veins shut. The mice were then observed for 6 months. There were no signs of inflammation or demyelination on CT or MRI, and no clinical change. This result strongly suggests that CCSVI is not responsible for demyelination, and therefore not responsible for MS.

We've recently seen the approval of the first oral drug for MS, Gilenya. The next to come into clinical use is likely to be BG-12, which has had extremely good results in trials. When taken three times a day, it halved the relapse rate compared to a placebo tablet.

Now the manufacturers, Biogen Idec, have applied to the FDA for approval for BG-12. They're hoping for priority processing which will shave some time off the process: if they don't get it, BG-12 should be released in the USA by the end of 2012 or early in 2013. Hopefully it'll be introduced in Europe soon afterwards, and so on around the globe.

The next study is of particular interest to me, as I've recently had this treatment myself. (Watch this space - I'm planning to post about it.)

BOTOX® is already approved in several countries including the UK and USA for the treatment of overactive bladder resulting from neurological problems such as MS and spinal cord injury. It works by relaxing the bladder muscles that were previously going into spasm, causing urgency, frequency, and possible incontinence.

Now two Phase 3 studies have shown positive results for BOTOX® for idiopathic (cause not known) overactive bladder. These results are just further confirmation of the usefulness of BOTOX® in treating overactive bladder.

Many people with MS fall: falls can result in injury, and the fear of falling can result in severely restricted mobility. American researchers asked 575 people with MS about their level of disability, how often they fell, and how afraid they were of falling. Nearly two thirds were concerned about falling, and over two thirds restricted their activities because of fear of falling. People with moderate mobility problems had the highest number of falls, and those with the worst mobility (ie non-walkers) had the fewest.

What can we do with this information? I suppose it's a question of awareness.If you know you're in the group most at risk of falls - the group with moderate mobility problems - you need to take particular care not to lean too far over, not to turn your body without moving your feet, and so on.

Researchers in Germany asked several hundred people who felt severely affected by their MS whether they wanted their doctors to talk to them about their disease progression, and about end-of-life issues.Three-quarters wanted to discuss their disease progression, but less than half were interested in talking about end-of-life issues like whether they would want to go on a life support machine or whether they would want to be resuscitated should the need arise.

These are important but very sensitive topics. Doctors must show great sensitivity when raising them.

So that's it for this research roundup.See you next time!

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