Research news - May 2007
Open Door - May 2007 pages 4-5
- Infections and MS
- Sativex for spasticity
- Pregnancy, childbirth and urinary disorders
- Sexual problems under-reported
- Family effects in MS
- Oral health in people with MS
1. Infections and MS
The debate continues on the role of infections as a cause of MS. Several recent studies have shed further light on the subject.
In one study, the researchers looked for evidence of viral infections in the spinal fluid of people with MS, with other neurological diseases or with no neurological disease.
The spinal fluid from people with no neurological disease had no markers of viral infections. Markers for several viruses (human herpes simplex viruses, Epstein-Barr virus, JC virus) were found in both people with MS and people with other neurological diseases. Varicella zoster virus (chickenpox) was found more frequently in the MS group, particularly those with relapsing/remitting MS, compared to those with other neurological conditions. These results suggest that, rather than a specific viral infection acting as a trigger, it may be a more general response to any viral infection in those who are susceptible that triggers off a chain of events resulting in MS.
Mancuso R, et al.
Increased prevalence of varicella zoster virus DNA in cerebrospinal fluid from patients with multiple sclerosis.
Journal of Medical Virology 2007; 79(2):192-199.
The Epstein-Barr virus, a common virus that causes glandular fever (infectious mononucleosis), has been proposed as a trigger for MS. In a separate study, 25,234 Danish patients with mononucleosis were checked for the diagnosis of MS after infection. The results suggested that the risk of developing MS is increased in people with prior infectious mononucleosis, regardless of sex, age, time since infection, or severity of infection and that this effect persists for at least 30 years after the infection.
Nielsen TR, et al.
Multiple sclerosis after infectious mononucleosis.
Archives of Neurology 2007;64(1):72-75.
Chlamydia pneumoniae is a common cause of pneumonia and has been theoretically associated with several chronic conditions, including multiple sclerosis. Antibiotics might therefore be expected to result in an improvement in symptoms of MS. In this study, which investigated this hypothesis, 28 people with MS received several courses of the antibiotic roxithromycin or placebo over a 12 month period. No significant differences were found in disability scales or relapse rate when comparing roxithromycin and placebo. The investigators conclude that a causative connection between bacterial infections with C. pneumoniae and MS seems unlikely.
Woessner R, et al.
Long-term antibiotic treatment with roxithromycin in patients with multiple sclerosis.
Infection 2006; 34(6): 342-344.
2. Sativex for spasticity
Cannabis has long been proposed as an antispasmodic and muscle relaxant. This study examined the efficacy, benefits and adverse effects of Sativex, a cannabis based spray, in people with spasticity due to MS. In a six week, double blind study, 189 people received either Sativex (124) or placebo (65) in addition to any preexisting treatments. Based on the participants' own daily scoring of spasticity, Sativex was significantly better than placebo. 40% of subjects achieved greater than 30% benefit. Although these effects were modest, the researchers argue that relatively small changes may represent significant improvements in quality of life. Clinician measures of spasticity indicated that Sativex was better than placebo but the change was not statistically significant.
Collin C, et al.
Randomised controlled trial of cannabis based medicine in spasticity caused by multiple sclerosis.
European Journal of Neurology 2007;14(3):290-296.
3. Pregnancy, childbirth and urinary disorders
The incidence of urinary problems was compared in women with MS who had had one or more pregnancies with women with MS who had had none. Urinary disorders were mostly linked to the duration and severity of MS and not to pregnancy or method of delivery (caesarean or vaginal delivery). The researchers conclude that pregnancy and childbirth do not increase the incidence of urinary problems in women with MS and that there is no clear argument for routinely performing caesarean section in women with MS. Decisions about caesarean section should be made on the same grounds as for women who do not have the condition.
Durufle A, et al.
Effects of pregnancy and childbirth on the incidence of urinary disorders in multiple sclerosis.
Clinical and Experimental Obstetrics & Gynecology 2006; 33(4): 215-218.
4. Sexual problems under-reported
Sexual problems are under-diagnosed symptoms of MS. 98 people with MS were asked to complete a questionnaire and their answers compared with documented discussions of sexual problems in their medical records. While only 6% had reference to sexual problems in their records, 33% reported sexual problems in their questionnaire. Fewer patients had been asked about sexual problems than about urinary or bowel problems. The investigators suggest that the low detection rate of sexual problems may be improved by a patient-completed questionnaire.
O'Sullivan SS, Hardiman O.
Detection rates of sexual dysfunction amongst patients with multiple sclerosis in an outpatient setting – can this be improved?
Irish Medical Journal 2006; 100(9):304-306.
5. Family effects in MS
It is well established that there is an increased, if still small, risk of developing MS if a first degree relative has MS, but it is not known whether a family history of MS has other effects on the clinical course of the condition. This study looked at more than 1000 families where there were two or more first degree relatives with MS. Age at onset of the disease was similar among family members - the similar year of onset among siblings suggesting that some factor in the shared environment could have contributed to MS. Siblings tended to have the same pattern of disease progression, but there was no such correlation between parents and children. However, the study also showed there was no pattern in the severity of MS in one family member and severity in another.
Hensiek AE et al.
Familial effects on the clinical course of multiple sclerosis.
Neurology 2007; 68(5): 376-383.
6. Oral health in people with MS
A questionnaire was sent to people with MS identified from inpatient records held by Leicestershire Health Authority. 289 questionnaires were returned (61% response rate). Deteriorating health and personal mobility both resulted in reduced attendance for people with MS. In addition, many people with MS were unaware of facilities such as community dental services (which provide dental care for people who are unable to obtain treatment from a family dentist) and many did not consider the possibility that their dentist may offer home visits. The researchers conclude that initiatives are required to increase awareness of and ensure access to dental services for people with MS.
Baird WO, et al.
Factors that influence the dental attendance pattern and maintenance of oral health for people with multiple sclerosis.
British Dental Journal 2007;202(1):E4.
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