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Thursday, November 21, 2013

MS Treatment and Research Update

By Patricia K. Coyle, MD

The 29th Congress of the European Committee for the Treatment and Research in MS (ECTRIMS) was held in Copenhagen, Denmark from October 2-4, 2013. There were over 1,000 formal presentations..

There were a number of presentations relating to environmental factors that appear to influence MS. Smoking not only increases risk for developing MS, but there is a dose response curve.

The longer the duration of smoking, and the greater the intensity of smoking (packs per day), the higher the risk for MS. This is regardless of age at exposure, so this increased risk is present in young and middle aged smokers.

Increased salt intake in the diet of MS patients is connected with increased attack rate, and increased rate of new brain MRI lesions.

 Teenage obesity and alcohol use (from the ages of 15 to 19), and developing clinical mononucleosis, resulted in an earlier age of onset of MS.

Other presentations focused on first attack MS patients with a clinically isolated syndrome. Low vitamin D levels predicted these patients would have greater clinical and MRI disease activity. Abnormal spinal fluid, and more than 9 brain MRI lesions, were also associated with increased future disease activity.

Hormonal states such as pregnancy have a profound impact on MS, but very little is known about what happens at menopause. A study of MS menopausal patients found that 48% reported worsening of MS symptoms (depression, fatigue, bladder, sexual dysfunction, cognitive issues).

In a study that used MRI to evaluate MS patients with depression or fatigue, they showed more signs of microscopic injury to their brain tissue than MS patients without these symptoms, implicating injury to specific brain pathways. This would support trying to minimize brain injury to decrease these major MS symptoms.

There is increasing evidence that physical exercises can change the brain. MS patients who went through balance training with a Wii board showed both clinical improvement (better balance), and brain MRI changes on diffusion tensor imaging, consistent with the exercise program causing microscopic changes.

Newer MRI techniques are being developed to evaluate the brain in MS. Lesions within the cortex can be identified and followed, and there are ways to tell if these lesions repair (remyelinate) over time. This might be a way to study potential repair therapies for MS.

In secondary progressive MS patients, autopsied brain studies indicated that diffuse inflammation was associated with active lesion damage. This raises the hope that anti-inflammatory agents, if they are able to get into the CNS, might be helpful for progressive MS.

There is an increasing focus on identifying gender based differences in MS. It is known that MS is more common in women, and men have a poorer prognosis than women. In a large MS database study, women with relapsing MS showed higher attack rates than men. Relapses fell over time. This was related more to age than duration of MS. Relapse rate may be another gender-based difference in MS.


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