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Wednesday, July 26, 2017

How Your Genes Are Connected to Multiple Sclerosis


                                                                  
  
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July 25, 2017 

Your parents’ genes came together to create your genetic makeup, and that’s exactly what gives your body directions on how to look, both inside and out. That covers everything from your hair color to your eye color to health conditions like multiple sclerosis.
According to the MS Society, there isn’t a gene that directly causes MS, but there are certain genes that may make you more susceptible. So far, researchers have found around 110 genes that are connected to MS.
However it’s not as simple as saying if you have those genes, you’ll have MS. It depends on a variety of things, including your lifestyle and several environmental factors. If you’re never exposed to those factors, then there’s a very good chance your condition will never be triggered, even if you have the connected genes.
So, your parents may pass along the genes connected to MS, but not MS, since it isn’t caused by a single gene (or even a combination of genes). That’s not to say there won’t be more than one case of MS in a family, but it’s not likely.
Researchers are hard at work looking into the genes that are connected to the condition, as they are the best chance we have of understanding the probability of MS. Doctors will hopefully be able to use that information to create treatments that can help prevent those who are genetically predisposed to MS from developing the disease.
Many of these genes are connected to the immune system 
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Using diet to counter the effects of multiple sclerosis


                                                                  
  
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CBS NEWS :
A new study of multiple sclerosis patients examines how a strict diet may ease the symptoms of the disease.
MS, a potentially disabling disease of the central nervous system, affects about 400,000 people in the U.S., and is two to three times more common among women. Current treatments may have severe side effects, and there is no cure.
A cutting-edge, but low-tech attempt to slow the symptoms involves the diet and the microbiome -- bacteria that live mostly in our digestive tract, unique to us as a fingerprint. Research now underway at New York's Mount Sinai Hospital is studying how food might be used as medicine to combat the disease, reports Dr. Tara Narula.
Once a month this pioneering group of MS patients meets to get tips from a nutritionist and share their temptations.




"I was craving a hamburger something terrible the other night," said one patient.
"They had lobster crepes, and there was just no way I was gonna pass that off!" laughed another.

Neurologist Ilana Katz Sand is leading one of the first clinical trials to study the link between what we eat, gut bacteria, and MS symptoms.

"The gut is actually kind of a natural place to look," Dr. Katz Sand said. "And that's because the immune system, about 70 percent of it, lives inside the gut, and has far-reaching implications throughout the rest of the body."

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Ecological momentary assessment of pain, fatigue, depressive and cognitive symptoms reveals significant daily variability in multiple sclerosis


                                                                  
  
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Kratz AL, et al. Arch Phys Med Rehabil. 2017.

Abstract

OBJECTIVE: To describe the daily variability and patterns of pain, fatigue, depressed mood, and cognitive function in persons with multiple sclerosis (MS).
DESIGN: Repeated-measures observational study of seven consecutive days of home monitoring, including ecological momentary assessment (EMA) of symptoms. Multilevel mixed models were used to analyze data.
SETTING: General community.
PARTICIPANTS: Ambulatory adults (N=107) with MS recruited through [Masked] and surrounding community.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURE(S): EMA measures of pain, fatigue, depressed mood, and cognitive function rated on a 0-10 scale, collected five times a day for seven days.
RESULTS: Cognitive function and depressed mood exhibited more stable within-person patterns compared to pain and fatigue, which varied considerably within-person. All symptoms increased in intensity across the day (all p<0.02) with fatigue showing the most substantial increase. Notably, this diurnal increase varied by sex and age; women showed a continuous increase from wake to bedtime, whereas fatigue plateaued after 7PM for men (wake-bed B=1.04, p=0.004). For the oldest subgroup, diurnal increases were concentrated to the middle of the day compared to younger subgroups, which showed an earlier onset of fatigue increase and sustained increases until bed time (wake-3pm B=0.04, p=0.01; wake-7pm B=0.03, p=0.02). Diurnal patterns of cognitive function varied by education; those with advanced college degrees showed a more stable pattern across the day, with significant differences compared to those with bachelor-level degrees in the evening (wake-7pm B=-0.47, p=0.02; wake-bed B=-.45, p=0.04).
CONCLUSIONS: Findings suggest that chronic symptoms in MS are not static, even over a short time frame; rather, symptoms -fatigue and pain in particular - vary dynamically across and within days. Incorporation of EMA methods should be considered in the assessment of these chronic MS symptoms to enhance assessment and treatment strategies.
Copyright © 2017. Published by Elsevier Inc.

PMID

 28729168 [PubMed - as supplied by publisher]

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How do pain, fatigue, depressive, and cognitive symptoms relate to well-being and social and physical functioning in the daily lives of individuals with multiple sclerosis?


                                                                  
  
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Kratz AL, et al. Arch Phys Med Rehabil. 2017.

Abstract

OBJECTIVE: To examine the relative association between daily change in pain, fatigue, depressed mood, and cognitive function, and four outcomes (positive affect and well-being, ability to participate in social roles and activities, upper extremity (UE) functioning, and lower extremity (LE) functioning).
DESIGN: Repeated-measures observational study including a baseline lab visit, followed by seven days of home monitoring that included ecological momentary assessment (EMA) of symptoms (pain, fatigue, depressed mood, and cognitive function) and end-of-day diary surveys of outcomes of interest. Multilevel mixed models were used to test study hypotheses.
SETTING: General community.
PARTICIPANTS: Ambulatory adults (n=102) with MS recruited through [masked] and the surrounding community.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURE(S): Customized short-forms of the Neuro-QOL Positive Affect and Well-Being, Upper Extremity Functioning, and Lower Extremity Functioning item banks and the PROMIS Ability to Participate in Social Roles and Activity item banks, adapted for daily use and administered as end-of-day diaries.
RESULTS: Above and beyond the effects of demographic and clinical covariates, daily pain was associated with three of the four outcomes; days of higher pain were related to lower same-day social participation (B=-1.00, p=0.002), UE functioning (B=-1.04, p=0.01), and LE functioning (B=-0.71, p=0.04). Daily fatigue and depressed mood were independently related to daily positive affect and well-being; days of worse fatigue (B=-0.54, p=0.006) and depressed mood (B=-1.17, p<0.0001) were related to lower same-day well-being.
CONCLUSIONS: Results demonstrate the role of fluctuations in symptoms in daily functioning and quality of life of individuals with MS. Daily increases in pain intensity are related to social and physical functioning, whereas increases in fatigue and depressed mood is related to daily lower levels of well-being. Findings implicate a person-centered approach to monitoring and treating symptoms.
Copyright © 2017. Published by Elsevier Inc.

PMID

 28729170 [PubMed - as supplied by publisher]

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The impact of health anxiety in patients with relapsing remitting multiple sclerosis: Misperception, misattribution and quality of life


                                                                  
  
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Hayter AL, et al. Br J Clin Psychol. 2016.

Abstract

OBJECTIVES: Multiple sclerosis (MS) is a progressive disease with an unpredictable prognosis. Previous studies have reported health anxiety within the MS population. This study examines the effect of health anxiety on MS patients' quality of life (QoL) and evaluates the potential contribution of cognitive factors in maintaining health anxiety.
METHODS: A total of 84 patients with relapsing remitting multiple sclerosis (RRMS) were screened for health anxiety. From this sample, a group with relatively high and another group with low anxiety (n = 21 in each group) were identified. A further 21 healthy controls were recruited for comparison. A measure of QoL was then completed. Cognitive biases were investigated by measuring perception and attribution of common bodily symptoms as well as appraisal of performance on neuropsychological and physical fatigue tests.
RESULTS: The high health anxiety group reported poorer QoL relative to the other groups, independent of level of disability. They were also more likely to misattribute common bodily changes to MS, and perceive their (objectively intact) performance on tests of cognition and fatigue as being impaired, attributing the cause of impairment to MS.
CONCLUSION: Health anxiety may be a factor in mediating the psychosocial impact of MS. Skilled psychological treatment which changes misperception and misattribution may significantly benefit patients with MS and elevated health anxiety.
PRACTITIONER POINTS: Clinical implications Health anxiety impacts on quality of life in patients with MS even when disability and other measures of psychological distress are taken into account. High levels of health anxiety distort perceptions of symptoms in patients with MS in line with the predictions made by the cognitive model of health anxiety. Limitations of study This study is limited to patients with RRMS within the relatively early stages of their disease and is based on a small sample size. Health anxiety is correlated with measures of generalized anxiety, depression, and worry, although it is found to have a unique impact on quality of life in patients with MS.
© 2016 The British Psychological Society.

PMID

 26806805 [PubMed - indexed for MEDLINE]

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Tracking daily fatigue fluctuations in multiple sclerosis: ecological momentary assessment provides unique insights


                                                                  
  
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Powell DJ, et al. J Behav Med. 2017.

Abstract

Studies investigating the prevalence, cause, and consequence of multiple sclerosis (MS) fatigue typically use single measures that implicitly assume symptom-stability over time, neglecting information about if, when, and why severity fluctuates. We aimed to examine the extent of moment-to-moment and day-to-day variability in fatigue in relapsing-remitting MS and healthy individuals, and identify daily life determinants of fluctuations. Over 4 weekdays, 76 participants (38 relapsing-remitting MS; 38 controls) recruited from multiple sites provided real-time self-reports six times daily (n = 1661 observations analyzed) measuring fatigue severity, stressors, mood, and physical exertion, and daily self-reports of sleep quality. Fatigue fluctuations were evident in both groups. Fatigue was highest in relapsing-remitting MS, typically peaking in late-afternoon. In controls, fatigue started lower and increased steadily until bedtime. Real-time stressors and negative mood were associated with increased fatigue, and positive mood with decreased fatigue in both groups. Increased fatigue was related to physical exertion in relapsing-remitting MS, and poorer sleep quality in controls. In relapsing-remitting MS, fatigue fluctuates substantially over time. Many daily life determinants of fluctuations are similar in relapsing-remitting MS and healthy individuals (stressors, mood) but physical exertion seems more relevant in relapsing-remitting MS and sleep quality most relevant in healthy individuals.

PMID

 28281106 [PubMed - as supplied by publisher]

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Evaluation of the Impact of Cognitive Training on Quality of Life in Patients with Multiple Sclerosis.


                                                                  
  
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Grasso MG, et al. Eur Neurol. 2017.

Abstract

OBJECTIVE: The aim of this study was to evaluate the effectiveness of cognitive rehabilitation in a group of multiple sclerosis (MS) patients.
METHODS: Thirty-four patients were included in this study and randomly allocated either to treatment with multidisciplinary rehabilitation plus cognitive training or to treatment with multidisciplinary rehabilitation alone.
RESULTS: After 3 months of cognitive treatment, the patients assigned to the rehabilitation plus cognitive training group displayed an improvement in the cognitive test of executive function and a marked improvement in quality of life (QoL). The patients treated with multidisciplinary rehabilitation without cognitive training improved in the physical composite score alone. Both groups of patients displayed an improvement in depression, though the improvement was confirmed at the 6-month follow-up examination (p = 0.036) only in patients treated with multidisciplinary rehabilitation plus cognitive training.
CONCLUSIONS: Our results indicate that the multidisciplinary rehabilitation treatment is the best approach to treat MS. The specific effect of each treatment needs to be assessed to be able to determine its role within a multidisciplinary approach. Cognitive rehabilitation is an important aspect of this multidisciplinary approach insofar as it may improve the QoL of MS people.
© 2017 S. Karger AG, Basel.

PMID

 28738376 [PubMed - as supplied by publisher]

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A randomized controlled trial to examine the impact of aquatic exercise training on functional capacity, balance, and perceptions of fatigue in female patients with multiple sclerosis.


                                                                  
  
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Kargarfard M, et al. Arch Phys Med Rehabil. 2017.

Abstract

OBJECTIVE: To assess the effects of 8-weeks aquatic exercise training program on functional capacity, balance, and perceptions of fatigue in women with multiple sclerosis (MS).
DESIGN: A randomized controlled design.
SETTING: Referral center of a multiple sclerosis society.
PARTICIPANTS: Women (age: 36.4 ±8.2) diagnosed with relapsing-remitting (RR-type) MS. After undergoing baseline testing by a neurologist, participants were allocated to either an intervention (aquatic training program) or a control group.
INTERVENTIONS: The intervention consisted of an 8-week aquatic training program (3 supervised training sessions per week; session duration; 45-60 min; 50-75% estimated maximum heart rate).
MAIN MEASURES: Six-minute walk test (6-MWT); balance (Berg Balance Scale; BBS), and perceptions of fatigue (Modified Fatigue Impact Scale; MFIS), at baseline and after an 8 week intervention. Differences over time between the experimental and control groups were assessed by a 2x2 (group by time) repeated measures analysis of variance (ANOVA).
RESULTS: 32 women completed the 8-week aquatic training intervention (experimental group, n=17; controls, n = 15). All outcome measures improved in the experimental group; 6-MWT performance (451±58 m to 503±57 m; P<0.001); BBS (pre-test mean, 53.59±1.70; post-test mean, 55.18±1.18; P<0.001), and in the MFIS (pre-test mean, 43.1±14.6, post-test mean, 32.8 ±5.9;P<0.01). A significant group-by-time interaction was evident between the experimental and controls groups for 6-MWT:P<0.001, ηp(2)=0.551; BBS:P<0.001, ηp(2)=0.423; and MFIS: P<0.001, ηp(2)=0.679.
CONCLUSIONS: Aquatic exercise training improved functional capacity, balance, and perceptions of fatigue in women with MS.
Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

PMID

 28735720 [PubMed - as supplied by publisher]

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Neuropsychological rehabilitation does not improve cognitive performance but reduces perceived cognitive deficits in patients with multiple sclerosis: a randomised, controlled, multi-centre trial


                                                                  
  
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Randomized controlled trial
Mäntynen A, et al. Mult Scler. 2014.

Abstract

BACKGROUND: There is preliminary evidence on the positive effects of neuropsychological rehabilitation on cognition in multiple sclerosis (MS), but the generalisability of the findings is limited by methodological problems.
OBJECTIVE: The aim of the present study was to determine the effects of strategy-oriented neuropsychological rehabilitation on MS.
METHODS: A total of 102 relapsing-remitting MS patients with subjective and objective attentional deficits were randomised into an intervention and a control group. Neuropsychological assessments were performed at baseline, at three months immediately after the intervention, and at six months. Patients in the intervention group received neuropsychological rehabilitation once a week in 60-minute sessions for 13 consecutive weeks. The control group received no intervention.
RESULTS: Neuropsychological rehabilitation including computer-based attention and working memory retraining, psychoeducation, strategy learning and psychological support did not improve cognitive performance but had a positive effect on perceived cognitive deficits. The intervention group perceived significantly fewer deficits than the control group both immediately after the intervention and at six months. The personal rehabilitation goals were also well achieved.
CONCLUSIONS: Strategy-oriented neuropsychological rehabilitation did not improve cognitive performance but reduced perceived cognitive deficits in MS.

PMID

 23804555 [PubMed - indexed for MEDLINE]

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Memory rehabilitation for the working memory of patients with multiple sclerosis (MS).


                                                                  
  
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Mousavi S, et al. J Clin Exp Neuropsychol. 2017.

Abstract

OBJECTIVE: The main cognitive impairments in multiple sclerosis (MS) affect the working memory, processing speed, and performances that are in close interaction with one another. Cognitive problems in MS are influenced to a lesser degree by disease recovery medications or treatments,but cognitive rehabilitation is considered one of the promising methods for cure. There is evidence regarding the effectiveness of cognitive rehabilitation for MS patients in various stages of the disease. Since the impairment in working memory is one of the main MS deficits, a particular training that affects this cognitive domain can be of a great value. This study aims to determine the effectiveness of memory rehabilitation on the working memory performance of MS patients.
METHOD: Sixty MS patients with cognitive impairment and similar in terms of demographic characteristics, duration of disease, neurological problems, and mental health were randomly assigned to three groups: namely, experimental, placebo, and control. Patients' cognitive evaluation incorporated baseline assessments immediately post-intervention and 5 weeks post-intervention. The experimental group received a cognitive rehabilitation program in one-hour sessions on a weekly basis for 8 weeks. The placebo group received relaxation techniques on a weekly basis; the control group received no intervention.
RESULTS: The results of this study showed that the cognitive rehabilitation program had a positive effect on the working memory performance of patients with MS in the experimental group. These results were achieved in immediate evaluation (post-test) and follow-up 5 weeks after intervention. There was no significant difference in working memory performance between the placebo group and the control group.
CONCLUSIONS: According to the study, there is evidence for the effectiveness of a memory rehabilitation program for the working memory of patients with MS. Cognitive rehabilitation can improve working memory disorders and have a positive effect on the working memory performance of these patients.

PMID

 28737452 [PubMed - as supplied by publisher]


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