MS Information Update no 37 - October 2007
The criteria for inclusion of papers in MS Information Update are relevance to MS management issues, currency and references appearing in publications to which nurses and other health professionals may not have ready access.
If you would like copies of any of these papers, please contact info@mstrust.org.uk, ring us on 01462 476700 or write to us at MS Trust, Spirella Building, Letchworth Garden City, Herts SG6 4ET quoting the Information Update number (above), the item number(s) and your postal address.
We can only accept requests from within the United Kingdom.
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1. Beal CC, Stuifenbergen A.
Loneliness in women with multiple sclerosis.
Rehabil Nurs 2007;32(4):165-171. [Ref. 4334]
In a questionnaire sample of 659 women with MS a high report of loneliness was found in those who had lower levels of social support, greater functional limitation, lower self-rated health status, greater social demands and were unmarried. The study highlights the need for health and social care professionals who interact with women to help them identify and strengthen interpersonal resources.
2. Beal CC, Stuifenbergen AK, Brown A.
Depression in multiple sclerosis: a longitudinal analysis.
Arch Psychiatr Nurs 2007;21(4):181-191. [Ref. 4338]
Questionnaire study of 607 people with MS explored the trajectory of depressive symptoms over 7 years. Younger age at onset, longer time since diagnosis, progressive disease and extent of functional limitation were predictive of depression at time 1 but only functional limitation predicted depressive symptoms over time. Women were not found to have higher rates of depression as reported in previous research. Importance of screening for depression in all people with MS is stressed.
3. de Seze M, Ruffion A, Denys P, et al.
The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines.
Mult Scler 2007;13(7):915-928. [Ref. 4344]
Literature review identifies four main risk factors of upper urinary tract damage resulting from neurogenic bladder: duration of MS, presence of indwelling catheter, permanently high detrusor pressure and high amplitude neurogenic detrusor contractions. Persons with detrusor sphinctor dyssynergia, age over 50 and male also have increased risk. Practical guidelines to diagnosis and follow up of neurogenic bladder recommended by the French Health Authorities are included.
4. Edmonds P, Vivat B, Burman R, et al.
Loss and change: experiences of people severely affected by multiple sclerosis.
Palliat Med 2007;21(12):101-107. [Ref. 4325]
Interview study of 23 people with mild to severe MS and 17 informal carers suggests the people who have lived with MS for many years continue to experience loss and change. Recommends attention be given to emotional support in three main areas for people severely affected by multiple sclerosis: physical issues, independence and relationships. Highlights palliative expertise in managing loss as an adjunct to neurological care.
5. Glass-Marmor L, Paperna T, Ben-Yosef Y, et al.
Chronotherapy using corticosteroids for multiple sclerosis relapses.
J Neurol Neurosurg Psychiatry 2007;78(8):886-888. [Ref. 4318]
Study of 17 patients treated with intravenous corticosteroids for acute MS relapse to compare outcome of day and night administration. Significantly enhanced clinical recovery and reduced mean number of side effects was reported following night time administration and patient preference was for night time treatment. Suggests benefit to implementing chronotherapy for treatment of acute MS relapses.
6. Gold R, Jawad A, Miller DH, et al.
Expert opinion: guidelines for the use of natalizumab in multiple sclerosis patients previously treated with immunomodulating therapies.
J Neuroimmunol 2007;187(1-2):156-158. [Ref. 4300]
Summary of the interdisciplinary practical recommendations made by specialists in neuroimmunology, rheumatology, transplantation medicine and clinical immunology. Highlights the need to evaluate patients to determine any evidence of an immunocompromised state before treatment with natalizumab. Considers washout intervals after immunomodulatory or immunosuppressive therapy and both clinical and laboratory parameters. Suggests that adherence to FDA patient management guidelines for treatment with natalizumab are robust.
7. Hartung HP, Polman C, Bertolotto A, et al.
Neutralising antibodies to interferon beta in multiple sclerosis – expert panel report.
J Neurol 2007;254(7):827-837. [Ref. 4324]
Expert panel recommends NAB testing as critical. As NAB positivity at 1 year is predictive of future NAB status the panel recommend NAB test at 4 or 6 months after initiation of treatment and at 1 year. Assay testing should be carried out in a specialist laboratory, as standardisation remains problematic. Optimal NAB testing methods, clinical relevance of NAB titres and treatment recommendations for patients who develop NAB are highlighted as areas for future research.
8. Khan F, Pallant J, Brand C.
Caregiver strain and factors associated with caregiver self-efficacy and quality of life in a community cohort with multiple sclerosis.
Disabil Rehabil 2007;29(16):1241-1250. [Ref. 4342]
Community sample of 62 informal caregivers and 101 people with MS took part in structured interviews. Study found caregivers who reported higher levels of strain and lower QoL were caring for person with MS who also reported lower QoL and high levels of depression and anxiety. Highlights the importance of identifying caregivers at risk of strain and implementation of strategies targeting their needs.
9. Kappos L, Freedman MS, Polman CH, et al.
Effect of early versus delayed interferon beta 1b treatment on disability after a first clinical event suggestive of multiple sclerosis: a 3-year follow up analysis of the BENEFIT study.
Lancet 2007;370(9585):389-397. [Ref. 4329]
Analysis of 392 people completing post randomisation follow up of the placebo controlled double-blinded BENEFIT (Betaferon in newly emerging multiple sclerosis for initial treatment) study. 37% patients in the early treatment group developed clinically definite MS compared to 51% in the delayed treatment group. Over 3 years 16% of patients in the early treatment group and 24% in the delayed treatment group had confirmed EDSS progression, early treatment reduced risk for progression of disability by 40% compared with delayed treatment. However whilst statistically significant the magnitude of benefit was clinically small. Concludes that these findings support the use of interferon beta 1b after the first manifestation of relapsing remitting MS.
10. Lima FS, Simionia S, Bruggimann L, et al.
Perceived behavioural changes (PBC) in early multiple sclerosis.
Behav Neurol 2007;18(2):81-90. [Ref.4343]
88 early MS patients EDSS<=2.5 and 48 controls with comparable progressive inflammatory conditions not involving the CNS were assessed. PBCs most frequently recorded in both groups were: lack of stamina, liability/moodiness, anxiety, vulnerability to stress, and irritability. Similarity with control group suggests early changes are not related to MS pathology although marginally more PBCs were noted in MS patients with cognitive deficit. Behavioural modification such as apathy, disinhibition and dysexecutive syndrome were perceived more intensely by people with MS than by relatives.
11. Lode K, Larsen JP, Bru E, et al.
Patient information and coping styles in multiple sclerosis.
Mult Scler 2007;13(6):792-799. [Ref. 4345]
Questionnaire study 86 people with MS to examine the correlation between quality of disease information and subsequent coping. Patients satisfied with information at disease onset reported more use of problem solving strategies such as planning and seeking social support later in disease course. Concludes that optimising the information process in the early disease phase may result in coping styles that produce better adaptation for living with MS.
12. Marrie RA, Cutter G, Tyry T, et al.
Disparities in the management of multiple sclerosis related bladder symptoms.
Neurology 2007;68(23):1971-1978. [Ref. 4336]
Questionnaire study of 9,688 patients from the NARCOMS registry in the US highlighted UTI infection as representing a substantial morbidity and found many patients remained significantly affected by bladder symptoms despite available treatments. Ethnicity and socioeconomic status impacted on treatment and further investigation is recommended in this area.
13. Newman MA, Dawes H, van den Berg M, et al.
Can aerobic treadmill training reduce the effort of walking and fatigue in people with multiple sclerosis: a pilot study.
Mult Scler 2007;13(1):113-119. [Ref. 4335]
16 people with MS able to walk 10 metres in< 60 seconds took part in 12 sessions of up to 30 minutes of treadmill training. Results showed reduction in resting metabolism, increased walking endurance, more normal gait pattern and decreased walking effort but no impact on fatigue was reported. Suggests that similar programmes could readily be implemented in community fitness centres.
14. O'Leary S, Beavin J, Bishop C, et al.
Practical guidelines for administering natalizumab: a nursing perspective.
Int J MS Care 2007;9:1-8. [Ref.4298]
Guidelines for administration of natalizumab infusions are reviewed and different clinical settings considered. Includes a table of adverse and serious adverse events from the AFFIRM study.
15. Patti F, Pozzilli C, Montanari E, et al.
Effects of education level and employment status on HRQoL in early relapsing-remitting multiple sclerosis.
Mult Scler 2007;13(6):783-791 [Ref. 4349]
648 patients with relapsing remitting multiple sclerosis, no experience of disease modifying therapies and EDSS between 1 and 5.5 were evaluated using the MSQoL-54 questionnaire. The importance of sustaining employment after recent diagnosis of MS was highlighted and higher educational level was also found to impact positively on quality of life. Concludes that health professionals should discourage patients from leaving their usual activity and stress those patients who continue working or studying experience a better quality of life
16. Ramsaransing GS, De Keyser J.
Predictive value of clinical characteristics for 'benign' multiple sclerosis.
Eur J Neurol 2007;14(8):885-889. [Ref. 4343]
Cohort of 496 people with MS found 151 had benign MS as defined by EDSS<=3 after 10 years. Age at onset, gender, symptoms and recovery at first relapse, time between first and second relapse, use of immunomodulatory therapy and EDSS scores at 2, 5 and 10 years were considered. Relapsing remitting course, low EDSS score and low number of relapses were predictive of benign MS at 5 years. 69% of the cohort with benign MS at 10 years remained so at 20. Concludes that disease course, EDSS score and relapse rate at 5 years are predictors for a benign disease at 10.
17. Rog DJ, Nurmikko TJ, Friede T, et al.
Validation and reliability of the neuropathic pain scale (NPS) in multiple sclerosis.
Clin J Pain 2007;23(6):473-481.[Ref. 4333]
Study of 141 patients with MS concludes that the NPS is valid and reliable when administered face to face, by post or serially and is a useful tool in assessment of neuropathic pain in MS that could be used to measure outcomes of therapeutic interventions. NPS captures a large proportion of the patient's own descriptors eg itchy, dull, unpleasant and shows convergent and discriminant validity with other commonly used scales including Short form McGill and HADS.
18. Rogers JM, Panegyres PK.
Cognitive impairment in multiple sclerosis: evidence based analysis and recommendations.
J Clin Neurosci 2007;14(10)919-927. [Ref. 4339]
Considers factors influencing cognitive dysfunction in MS including fatigue, disease duration, medication and affective disturbance. Considers instruments available for screening for early cognitive impairment in MS and recommends the Symbol Digit Modalities Test (SDMT) as a tool for rapid screening and elucidating the effects of disease modifying or symptom specific treatment. Highlights the relatively mild cognitive difficulties that can result in significant functional disability.
19. Solari A, Acquarone N, Pucci E, et al.
Communicating the diagnosis of multiple sclerosis – a qualitative study.
Mult Scler 2007;13(6):763-769. [Ref. 4346]
Italian study using focus groups to explore experiences of both receiver and giver of the MS diagnosis. Communication process was found to be stressful for both patient and health professional and lack of training support for health professionals in this area was noted. Tailoring of information and structural and organisational requirements are noted.
20. Yap L, Kouyialis A, Varama RK.
Stereotactic neurosurgery for disabling tremor in multiple sclerosis: thalotomy or deep brain stimulation?
Br J Neurosurg 2007;21(4):349-354. [Ref. 4330]
Systematic literature review assessing the role, efficacy and safety of thalotomy and deep brain simulation (DBS) in treatment of tremor in MS. Found initial tremor suppression in 93.8% of patients following thalotomy and 96% with DBS, whilst functional improvement was seen in 47.8% of thalotomy patient compared to 85.2% undergoing DBS. Highlights a lack of standardized outcome measures in trials and concludes that both procedures are comparable with attendant side effects.
If you would like copies of any of these papers, please contact info@mstrust.org.uk, ring us on 01462 476700 or write to us at MS Trust, Spirella Building, Letchworth Garden City, Herts SG6 4ET.
