Cannabis oral spray nabiximols found to ease spasticity in MS

 New analysis shows benefits for patients in 2 clinical trials

by Marisa Wexler, MS | May 23, 2023

Treatment with the cannabis oral spray nabiximols helped to relieve spasticity — increased muscle stiffness and spasms common in people with multiple sclerosis (MS) — among participants in two MS clinical trials, according to the results of a new analysis.

“In this analysis, nabiximols was shown to significantly [ease] spasticity across a range of outcome measures that reflect various approaches to the evaluation of spasticity in MS patients,” the researchers wrote.

“The clinically meaningful Spasticity NRS [rating scale] results are accompanied by positive findings for change in spasm count in both [the] GWSP0604 and SAVANT [clinical trials] and improvements in spastic muscle tone in SAVANT,” the team wrote, noting that Spasticity NRS “easily assesses the patients’ own daily experience, which is vital, especially for complex constructs such as spasticity.”

The study, “Efficacy of nabiximols oromucosal spray on spasticity in people with multiple sclerosis: Treatment effects on Spasticity Numeric Rating Scale, muscle spasm count, and spastic muscle tone in two randomized clinical trials,” was published in Multiple Sclerosis and Related Disorders. The work was funded by GW Pharmaceuticals, now part of Jazz Pharmaceuticals, the developer of nabiximols.

Nabiximols approved in some countries but not in US

Spasticity, in which muscles become abnormally tight over time, leading to stiffness and in some cases pain, is a common symptom of MS, affecting most people with the disease. Spasticity can be uncomfortable and make it harder to move around, and studies have suggested that MS patients who experience more spasticity tend to report poorer quality of life.

Nabiximols is approved to treat MS-related spasticity in many countries, including Canada and much of Europe, where Jazz markets the therapy under the brand name Sativex. However, the treatment is not approved for use in the U.S.

The oral spray therapy contains delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD), the two main biologically active compounds found in the cannabis plant. THC is mainly responsible for the high associated with cannabis use, while CBD is thought to have anti-inflammatory and anxiety-relieving effects on the body.

Several clinical trials have tested nabiximols in people with MS-related spasticity. Here, scientists conducted analyses from two such trials: GWSP0604 (NCT00681538), completed in 2009, and SAVANT (NCT00711646), which concluded in 2004. Most participants in both trials were also taking other anti-spasticity medications in addition to nabiximols.

Both of these studies included a run-in period in which all participants were treated with nabiximols. All self-rated their spasticity on a scale from 0 to 10 on the MS Spasticity Numerical Rating Scale (NRS), in which higher numbers reflect worse spasticity. Patients whose scores improved by at least 20% were deemed responders, and were selected to continue into the main phase of the trial, where participants were randomly assigned to receive nabiximols or a placebo.

The identification of responders to test in the main trial “was done to better reflect clinical use, since patients who do not respond to nabiximols are unlikely to remain on treatment, while those that do respond could experience substantial benefits,” the researchers wrote.

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Living with multiple sclerosis: Telling your employer

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Stu's Views on Advising a child about MS

 The information found below is an Opinion only, from Stuart Schlossman, an MS Patient

My Name: Stuart Schlossman

Age – 64

Multiple Sclerosis - RRMS

 Re: Multiple Sclerosis – description to a child  (adults can learn too)

I would begin by telling them (the children)  the basics about MS. I would ask them to imagine having a dog and this dog biting the wire and plug that connects to your television. You would see static or the picture would be lost.    The TV would be like my brain and the wire is my central nervous system that is getting damages like from the dog chewing on the wire.

 I would also ask them to twirl around and around until they got dizzy and asked them how they feel. Then I would tell them this is what happens to me when I get vertigo.

 I would ask them to run up and own on a dirt mound until their legs felt so tired it was difficult to walk and then I would tell them this is what happens to me during the day. But that some days were better than others.

I would ask them to hold a piece of plastic wrap in front of their eyes and then ask if they can see clearly. Then, I would explain to them that this view is often how I see, especially on a hot day.

I would ask them to ‘imagine’ grabbing a handful of tacks (yes, Only to imagine) so they could imagine the pain felt or like from grabbing a barbed-wire fence.

I can ask them to ‘Imagine’ being hit with a baseball bat in the legs so they could feel a sudden jolt of pain.  

I would then also ask them to picture someone holding a pen or a sharp stick to the front-right center of their head and pushing this or tapping it to their head so they can feel the blistering headaches I get almost everyday. Or to imagine Walking on Broken glass so they can feel the stinging pain in my feet,

Getting away from pain for a moment: 

 

 I would ask them how they might feel to have their favorite toy or game taken away from them or ask  how they would feel, if they were 'grounded' for doing something wrong. They would probably feel let down or sad.

 I would tell them that sometimes I also feel let down, (depressed), or sad..  And for many who are too fatigued to do things with friends or family, that this could be similar to a child being grounded (without being able to use their cellphones or other gadgets)..  

 I would ask that they squeeze each other tightly around the waist so they can feel an MS Hug.

 I would ask them to tie heavy sacks to their ankles and try to run and I would ask them to sit on their hands until they were tingly or Numb so I can explain how many people with MS feel this tingling sensation.

 My gosh how could I possibly tell you about the things I often forget.. Yes Little ones,, Everyday I forget to do things. But even worse is when my brain knows I want to say something but the message is not getting to my lips…

** Try this please…---------  Imagine having to  add/subtract/multiply or divide:

    2 + 6 + 5 + 10 + 7 – 3 – 1 + 4 – 6 x 2 divided by 6 = ?
I bet you got the answer of 8, right?
--  What? You think I am crazy for you to do all this math that quickly?

 
** Please know that the confusion you just had, looking at this and trying to figure this out, is very similar to my thought patterns when I am fatigued.. it can get overwhelming.

By the way, Fatigue is not the same as tired. Fatigue can be similar to a flashlight that runs low on batteries.

 >>>  When the batteries are going bad, the light is very dim. When my brain is fatigued, the shining light inside my brain gets very dim and when this happens, I cannot think clearly and so, when that happens, it is like the math problem that I gave you… Understand?  

Also Many times, people with MS, feeling like the last time they slept was three days ago. Can you imagine staying awake for three days and trying to stay focused? It is really not possible.

--- These are just a few of the things I can do with a child or children to get them to understand a bit of MS  and the symptoms which I often get and which affects many.

------------------------------

 As for Me: 

 My followers know that I do whatever I can possibly do in-spite of my condition with having Multiple Sclerosis for 25+ years. Travelling around the country on a regular basis bring needed educational programs about MS resources, medications and more, to various logistics.

I tell anybody who wants to listen that I taught my MS long ago that it needs to live my life and not the other way around. If it does not like this condition then get the Blank out of here.  Yes, I understand it will show it’s ugliness, But I will not play it’s game.

I have too much to do for others affected by MS by providing educational programs to help people learn of the many resources and information that is available so they too can adjust and live better, with their MS. For / with MS Views and News, I travel the USA providing these educational opportunities to MS patients and care partners.

My joy comes from seeing people with MS learning and living content lives. Other joys for me include my travels and what I can accomplish. As well as seeing family and friends.

Once upon a time:
I was once known as an arrogant, abrasive obnoxious salesperson.
-- These days, I am just known as an arrogant, abrasive, obnoxious HUMANITARIAN.

I hope this helped..  Thank you again!! 

 Stuart

 

Having some fun, mixed with my travels

 

Vestibular Migraine Diet - (see list of foods and beverages that can cause Migraine)

 Vestibular Migraine Diet

The causes of vestibular migraine are not completely understood, but making dietary changes through eliminating trigger foods could decrease the severity of symptoms.

By Kristen N. Smith, PhD, RDN, LD • April 27, 2023

An elimination diet is the only official dietary guidelines for vestibular migraine. You may want to begin eliminating dairy and alcohol, among other food and beverage products.

© Drazen Zigic | Getty Images

If you’ve ever suffered from headaches, you’re well aware how disruptive they can be. When they strike, they might inconvenience an hour, wipe out an entire day, or in cases of migraine, especially vestibular migraine, they can negatively impact quality of life. More than 17 percent of women and nearly six percent of men suffer from migraines, and about three percent of adults experience the less common, but no less severe, vestibular migraine. Symptoms may not resemble typical migraine headache, such as moderate to severe pounding or throbbing. In fact, it may not involve headaches at all, but rather vestibular (affecting one’s sense of balance) symptoms, such as vertigo, imbalance, nausea, and vomiting. Many of the triggers, including dietary triggers, for migraine headaches can also cause vestibular migraines. Some research suggests dietary changes, such as following what has come to be called a vestibular migraine diet, may help reduce frequency and severity of vestibular symptoms.

The causes of migraine, including vestibular migraine, are not completely understood and symptoms can vary greatly. Evidence suggests that dietary factors may play a role in several of the triggering mechanisms. According to a review of studies, the most commonly reported foods and drinks that have been identified as migraine triggers include chocolate, cheese, nuts, citrus fruits, processed meats, monosodium glutamate (MSG), aspartame, fatty foods, coffee, and alcohol. While it is generally accepted that migraines are sensitive to diet and that diet may trigger migraine attacks, there is no definitive list of these foods. 

According to a study published in the journal Nutrients, the following foods have been noted in the scientific literature as potential contributors to migraine:

• Chocolate
• Citrus fruits
• Nuts
• Ice cream
• Tomatoes
• Onions
• Dairy products
• Alcoholic beverages
• Coffee
• Caffeine
• Monosodium glutamate (MSG): commonly found in fast food, chips and snack foods, seasoning blends, frozen meals, canned soups and soup and noodle mixes, processed meats, and condiments
• Histamine: found in alcohol and other fermented beverages and foods, like yogurt and sauerkraut, dried fruits, avocados, eggplant, spinach, processed meats, shellfish, aged cheese
• Tyramine: found in aged cheese, cured meats like salami and pepperoni, pickled and fermented foods, dried fruits, alcoholic beverages
• Phenylethylamine: found in chocolate, wine, natto, eggs, some nuts and seeds like almonds, walnuts, and flaxseeds, and some beans like soybeans, lentils, chickpeas, and green peas.
• Nitrites: added to foods such as cured deli meats, bacon, and sausage.
• Aspartame: artificial sweetener added to some sugar-free sodas, ice cream, gum, yogurts, dressings, etc.
• Sucralose: sweetener that may be found in packaged baked goods, beverages, chewing gum, frozen dairy desserts, etc.
• Gluten: found in beer, breads, cakes, candies, cereals, cookies, crackers, muffins, pancakes, etc.

Research has also suggested that it can take high amounts of some of these foods to trigger a headache, withdrawal from some of these foods, notably caffeine, or fasting. According to one systematic review, fasting was shown to be a migraine trigger for 44 percent of people. In addition, some diets, such as Atkins, Mediterranean, ketogenic, low-sodium, and low-fat have been reported to reduce migraine attacks.

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What Happens if Multiple Sclerosis Goes Untreated?

 Multiple sclerosis drugs have been proved to reduce relapses. But some with MS still say no to treatment.

By Becky UphamMedically Reviewed by Samuel Mackenzie, MD, PhD

In active MS, lesions form in the brain and sometimes the spinal cord.Getty Images

In many chronic conditions, the way the disease will progress over months or years is relatively predictable. That’s not the case with multiple sclerosis (MS); while some people with the disease may be only mildly impacted over years or even decades, others may lose their ability to walk, speak, or swallow over time. And many are affected cognitively, meaning their ability to think, focus, and remember may be impaired, making it difficult to hold down a job.

Because the course of MS can vary dramatically from person to person, it’s hard to know with absolute certainty what the prognosis will be for an individual who doesn’t get treatment. But that lack of predictability doesn’t mean a “wait and see” approach is a good idea, says Justin Abbatemarco, MD, a neurologist at the Cleveland Clinic who specializes in treating multiple sclerosis.

“After an MS diagnosis is confirmed, we usually would initiate or recommend some form of treatment, just because we know the outcome for most patients who remain untreated,” says Dr. Abbatemarco.

“There is evidence that patients [with relapsing-remitting MS (RRMS)] who remain off MS disease-modifying therapies will have more frequent relapses and more frequent disability accrual, and they’ll have a higher chance for developing secondary-progressive multiple sclerosis (SPMS),” Abbatemarco says.

SPMS is generally regarded as a stage of MS that follows RRMS, during which there is a steady progression of symptoms and disability, without noticeable periods of remission.

On the other hand, a study published in January 2019 in the Journal of the American Medical Association provides some evidence that treatment with more highly effective MS therapies soon after diagnosis is associated with a lower risk of transitioning to SPMS.

Disease Course of MS Is Unpredictable

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12 Ways to Fight MS Fatigue

 For many people, fatigue is the most troubling of all MS symptoms. These expert tips may help to boost your energy level.

Regularly practicing a mindful form of exercise, such as tai chi, can help to reduce MS fatigue.

Rob And Julia Campbell/Stocksy

The majority of people living with multiple sclerosis (MS) — a chronic autoimmune disease affecting the central nervous system — say that fatigue is their most prominent symptom, according to the National Multiple Sclerosis Society (NMSS).

Research published in March 2021 in Multiple Sclerosis Journal confirms this finding: In a Norwegian study of nearly 1600 people with MS, researchers found that 81 percent of respondents experienced fatigue.

"Other MS symptoms may come and go, but fatigue seems to be a constant, no matter what stage of MS they’re in," says neurologist Jeffrey Cohen, MD, director of the Cleveland Clinic's Mellen Center for Multiple Sclerosis Treatment and Research in Ohio.

For many people living with MS, however, the word “fatigue” doesn’t quite capture the feeling of being completely depleted.

“I’ve always wished there was another to term to describe MS ‘fatigue,’” says Michael Wentink, a 42-year-old writer with MS who lives in San Antonio, Texas, with his wife and two children. “When people hear fatigue as a symptom of MS, they often think, ‘Oh, sure, I’m tired, too,’ but it’s not at all the same feeling,” he says.

“I remember what it was like to feel tired or fatigued before I had MS, and this is totally different,” says Wentink.

The kind of fatigue that comes with MS isn’t the kind that comes from exertion, Wentink explains. “I can wake up from a night of sleep and feel fatigued. After my shower and shaving, sometimes I literally need to go lie down on the bed for a little bit afterward to recover.”

What Causes MS Fatigue?

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How I told my children about my MS

 written by Angela

Angela is a child therapist, but talking to her daughters about her MS was still a challenge.

I work as a counsellor in primary schools. I first started noticing something was wrong during the school holidays two years ago. I was unbelievably tired – and it didn’t get better, no matter how much I rested.

Over the next few weeks, my face went numb, and my balance was all over the place. My legs became so weak, I would stumble and fall when I went out.

Coming to terms with my MS diagnosis

I went to the GP, and was referred to hospital, where I was admitted. Two days, an MRI and a lumbar puncture later, I was diagnosed with MS.

I knew I needed to tell my daughters, who were 10 and 14 at the time. But I was still getting my head around the diagnosis. I remember being in hospital, crying, thinking ‘How am I going to tell the girls?’ I support children emotionally for a living, but it was still hard.

Avoiding information overload

My husband and I decided to wait a day or two, until I was back home and settled. Then we sat the girls down and told them the news.

We kept it simple, just telling them the basics about what MS is. We didn’t want to frighten them with lots of information. We warned them against googling MS, because we knew they might find some scary stories online. We showed them some good websites, like the MS Society and the MS Trust.

We talked a lot about the uncertainty – how we didn’t know if or when I would have another relapse, or if I would be permanently disabled. We decided we had to focus on managing things now, and not think too much about the future.

Sharing our experiences of MS

We’ve always been an organised family, planning trips and holidays in advance. Now we have to be more spontaneous and flexible.

I’ve recovered enough to go back to work part time. I work in the mornings, and keep my afternoons free in case I’m fatigued. It gives me a chance to recharge before the girls come home from school.

I’ve written a book, based on our experience, to help families talk about MS. It’s a story that takes you through diagnosis, treatment and how MS affects the whole family. I hope that by creating characters that parents and children can identify with, they’ll find it easier to talk about their own experiences.

Download our support booklet for family and friends

#LetsTalkMS

This MS Awareness Week (19-25 April 2021) we’re saying #LetsTalkMS. MS can be tough, and for many people talking about it can be challenging. Help start a conversation about MS – share your story

Ways to talk MS

Our online sessions and webinars are a great way to connect online. You can also join the conversation at Facebook, Instagram and Twitter. And our MS Helpline is here for you, offering emotional support and information. 

Information obtained from MS Society UK website.

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Mavenclad benefits for MS sustained up to 15 years after last treatment

 More than half who received it in clinical trials didn't need further DMTs

by Steve Bryson, PhD | April 11, 2023

The benefits of Mavenclad (cladribine) were sustained for up to 15 years after its last treatment course in people with relapsing multiple sclerosis (MS), according to real-world data from the CLASSIC-MS study.

More than half of those who received the oral therapy in the clinical trials that supported its approval no longer needed further disease-modifying therapies (DMTs) and twice as many continued relapse-free over a median of 10.9 years compared with those never given it.

The real-world study, “Long-term follow-up of patients with relapsing multiple sclerosis from the CLARITY/CLARITY Extension cohort of CLASSIC-MS: An ambispective study,” was published in the Multiple Sclerosis Journal.

Mavenclad, marketed by EMD Serono, is a short-course oral DMT approved for relapsing forms of MS, including relapsing-remitting MS (RRMS) and active secondary progressive MS (SPMS). It works by lowering the number of immune cells circulating in the bloodstream that drive inflammation and nerve damage in MS.

Its approval was supported by data from three Phase 3 clinical trials — CLARITY (NCT00213135), the CLARITY extension study (NCT00641537), and ORACLE-MS (NCT00725985), all of which demonstrated Mavenclad’s efficacy compared with a placebo.

Long-term outcomes with Mavenclad

The now completed Phase 4 trial CLASSIC-MS (NCT03961204) trial — conducted post-approval in a real-world setting — evaluated the long-term durability of Mavenclad for up to 15 years beyond the two-year regimen of the three Phase 3 trials.

The analysis focused on the long-term outcomes of 435 CLASSIC-MS patients, ages 32-79, who previously participated in CLARITY with or without enrolling in the extension study. All eligible CLASSIC-MS participants had received at least one course of Mavenclad tablets or a placebo in the previous studies.

A total of 394 (90.6%) patients were previously treated with Mavenclad and 160 of them completed the two-year regimen. The time since the last Mavenclad dose ranged from 9.3 to 14.9 years, with a median of 10.9 years.

Meeting its primary long-term mobility goal, CLASSIC-MS demonstrated that significantly more Mavenclad-treated patients weren’t using a wheelchair or weren’t confined to bed compared with those given a placebo in CLARITY (90% vs. 77.8%). Compared with those never treated with Mavenclad, those who received the two full years of treatment were 48% less likely to require a wheelchair or be bedridden when they entered CLASSIC-MS.

The trial also met its secondary long-term disability objective by showing that patients who received the therapy were more likely to not need walking assistance compared with those given a placebo (81.2% vs. 75.6%).

Mavenclad reduces need for subsequent DMTs

In a four-year responder analysis, more Mavenclad-treated patients didn’t need subsequent DMTs relative to a placebo (66.2% vs. 36.6%). No disease reactivation was seen in more of those exposed to the medicine than a placebo (50.3% vs. 26.8%).

The team also noted that participants with high relapse activity responded well to Mavenclad treatment.

Over the 10.9-year median follow-up, more than half (53.1%) of the CLASSIC-MS patients didn’t further use DMTs. Most of those who used other DMTs were treated with immune-modulating interferons (68.6%).

Compared with a placebo, Mavenclad treatment during CLARITY lowered the likelihood of further DMT use after the last CLARITY dose, with 55.8% of patients exposed to Mavenclad versus 26.8% in the never-exposed group receiving no subsequent DMTs.

Likewise, fewer Mavenclad-exposed patients received a second subsequent DMT than never-exposed patients (14.2% vs. 29.2%), as well as those who were given a third DMT (4.6% vs. 7.3%). The estimated median time until the first subsequent DMT after the last CLARITY dose was longer with Mavenclad than with a placebo (12 vs. 2.8 years).

Among the 200 patients who didn’t have a relapse since their last dose, about twice as many treated with Mavenclad were relapse-free relative to those given a placebo (48.0% vs. 26.8%). This finding was reflected in the annualized relapse rate for Mavenclad against a placebo (0.12 vs. 0.23 relapses per year).

Finally, at the beginning of CLASSIC-MS, the proportion of patients in active employment was higher among those exposed to Mavenclad in CLARITY compared to the never-exposed group (51% vs. 27.5%).

“Together, these findings support previous studies that have reported on the sustained efficacy of [Mavenclad] tablets following treatment,” the researchers said.

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EBViously Announces First Details of Its EBV-001 Vaccine Candidate for the Prevention of Epstein-Barr Virus (EBV)-Induced Diseases

• Presentation at the World Vaccine Congress 2023
• EBV-infections associated with many cancers and multiple sclerosis

Munich, Germany, April 3, 2023 – EBViously, a start-up developing novel vaccines based on next-generation virus-like particles, will present its approach and technology at the upcoming World Vaccine Congress 2023 (April 4-6, 2023) in Washington, DC (USA). The presentation will take place on Wednesday, April 5, 2023, at 2:55 p.m. EST in Room 201 of the Walter E. Washington Convention Center in Washington, DC.

EBViously, a spin-off from Helmholtz Munich (HMGU), is led by world-leading experts in Epstein-Barr virus biology, genetics, and immunity and was founded to develop a safe and highly effective preventive vaccine against a range of diseases caused by Epstein-Barr virus (EBV), including various cancers, immune disorders, and multiple sclerosis.

The first candidate, named EBV-001, is based on non-infectious EBV-derived virus-like particles (VLPs). It is a highly immunogenic, multi-antigen vaccine that mimics the original viral pathogen and its complexity, delivering more than 50 viral antigens in their native conformation. EBViously has generated positive preclinical proof-of-concept data on the immunogenicity of the vaccine candidate. Moreover, the induction of a broad humoral and cellular immune response has already been demonstrated in animal models, reflecting the spectrum of antiviral immunity in humans.

VLPs resemble actual virus particles, but do not contain any viral genetic material. With the authentic structure of the virus, these empty shells signal an EBV infection to the immune system and elicit a highly specific immune response from both the humoral and the cellular parts of the immune system.

“Based on our very favorable preclinical proof-of-concept data regarding the immunogenicity of the vaccine, we are confident that EBV-001 can effectively prevent the development of infectious mononucleosis and the often associated chronic fatigue syndrome,” said Axel Polack, M.D., designated CEO of EBViously. “A GMP process has been established by a commercial CMO and our goal is to begin clinical trials in 2024.”

“As a primary indication, we are targeting the prevention of infectious mononucleosis, also known as kissing disease or glandular fever, and post-infectious fatigue/chronic fatigue (ME/CFS), a common, long-COVID-like protracted disease following infectious mononucleosis,” said Prof. Wolfgang Hammerschmidt, designated CSO of EBViously. “Other potential indications include the prevention of post-transplant lymphoproliferative disease (PTLD) and EBV-associated cancers. As infectious mononucleosis is a known risk factor for multiple sclerosis, there is great hope that our vaccine may also reduce the incidence of this chronic neurodegenerative autoimmune disease.”

###

About EBViously

EBViously specializes in novel vaccines based on next-generation virus-like particles. The Company is a spin-off from Helmholtz Munich (HMGU) and is led by a group of renowned experts in the field of Epstein-Barr virus research. EBViously has so far received €9.6 million in funding from Helmholtz Validierungs Fonds (HVF) and the German Center for Infection Research (DZIF). Additional collaboration partners are Ludwig-Maximilians-Universität München (LMU) and University Hospital rechts der Isar (TUM MRI).

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Ten (10) ways to Preserve Brain Health if you have MS or other conditions

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By Quinn Phillips - Reviewed: May 4, 2023

Medically Reviewed by Michael R. Yochelson, MD, MBA

Activities like guided meditation may help to improve your cognitive abilities in the long term.

Tom Merton/Getty Images

From getting enough sleep to doing brain exercises, there are steps you can take to preserve and possibly improve your cognitive health.

If you have multiple sclerosis (MS), you’re probably aware of the wide range of symptoms that could develop over the course of your disease. Some, such as fatigue, spasticity, and walking difficulties, are well-known, whereas others, such as cognitive issues, are less commonly discussed.

Over half of all people with MS will develop problems with cognition at some point, according to the National Multiple Sclerosis Society. Usually, but not always, these changes are mild, and they don’t necessarily correspond to how severe your physical symptoms are. They can occur in anyone who has MS but are more common in people who have had the disease a long time.

As you might expect, cognitive changes are associated with the number and location of brain lesions seen on an MRI, as well as brain atrophy (shrinkage). These changes may become noticeable in different ways, such as:

• Trouble finding or remembering words
• Forgetting what to do in your home or work routine
• Trouble making decisions or judgments
• General difficulty with your job or school performance

There’s a widespread but mistaken belief that not much can be done about cognitive changes in MS. There are many things you can do to potentially improve your cognitive health.

Most of the actions you can take won’t interrupt or slow the disease process that’s contributing to your symptoms, but your brain is a complex organ that’s affected by numerous processes in your body, and changing any one of these can have an impact on your brain health.

Here are 10 steps you can take to preserve — or even improve — your brain health when you have MS.

1. Get Enough Sleep

Research shows that too little sleep is linked to worsening cognitive performance in people with MS, according to Meghan L. Beier, PhD, a neuropsychologist and assistant professor of physical medicine and rehabilitation at Johns Hopkins Medicine in Baltimore. “We know that people who get less than seven hours of sleep tend to have worse cognition,” she says.

A study published in March 2023 looked at 524 women with MS who were part of the much larger Nurses’ Health Study, a survey of more than 60,000 women on a range of health topics. The MS-focused report found a strong connection between cognitive impairment and sleep challenges like obstructive sleep apnea, insomnia, and sleepiness.

The research reflected the findings of an earlier study, from 2016, which looked at people with MS who slept poorly because of obstructive sleep apnea. That study found that less overall sleep and greater sleep fragmentation were both independently and significantly associated with deficits in visual and verbal memory, attention, executive function (the ability to plan and focus on tasks), and processing speed, accounting for 27 and 18 percent of the measured cognitive changes, respectively.

2. Work to Manage Fatigue

Fatigue can be a major factor in worsened cognitive performance in people with MS, according to Dr. Beier. “Fatigue management is really helpful,” she says. “We also know that things in the environment can have an effect on cognition, like heat. So when you’re doing something cognitively taxing, try to be in an environment that’s going to help cognition,” such as somewhere cool and relaxing.

Generally speaking, Beier says, fatigue management means planning out your days so that you don’t need to do anything physically or mentally demanding when you’re most likely to be exhausted.

3. Get Enough Physical Exercise

The right kind of exercise can help your brain function at its best, especially executive functioning, Beier notes. Some studies suggest that doing something cognitively challenging while exercising — having an in-depth conversation, doing math problems — enhances the benefits.

In a study published in 2018, researchers compared a high-intensity interval training program with a standard exercise program in 60 participants with MS. While both groups saw improvement in executive functioning, such as the ability to plan and prioritize tasks, the group that did interval training also saw improvements in their verbal memory.

4. Take Your Medication    

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