MS Information Update no 38 - January 2008
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 contactinfo@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.
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1. Banwell B, Ghezzi A, Bar-Or A, et al.
Multiple sclerosis in children: clinical diagnosis, therapeutic strategies, and future directions.
Lancet Neurol 2007;6(10):887-902. [Ref. 4360]
Review recognises diagnostic challenge of differentiating acute disseminated encephalomyelitis (ADEM) from MS in children and the possibilities advanced MRI may offer. Highlights the mild cognitive changes present in children who experience minimal physical impairment and that of 50% of children with MS are expected to reach the secondary progressive phase at age 30 years. Contains tables of treatment studies in paediatric MS.
2. Brown MG, Kirby S, Skedgel C, et al.
How effective are disease modifying drugs in delaying progression in relapsing onset MS?
Neurology 2007; 69(15):1498-1507. [Ref. 4384]
Considers 'real-world' conditions in clinical practice in Nova Scotians treated with DMD's using clinic data over 20 years, where DMDs were considered together as a class. Treatment effect measured by EDSS estimated benefits greater for patients classified as relapsing at the start and end of treatment. Estimates of DMD relative treatment effect size were found to be similar to efficacy reported in pivotal trials .
3. Calabresi PA, Giovannoni G, Confavreux C, et al.
The incidence and significance of anti-natalizumab antibodies: results from AFFIRM and SENTINEL.
Neurology 2007;69(14):1391-403. [Ref. 4333]
In AFFIRM and SENTINEL studies antibodies to natalizumab were measured using ELISA. In the AFFIRM study antibodies were detected in 9% of natalizumab treated patients, 3% were transiently positive and 6% persistently positive. Reduced clinical efficacy was found in persistently positive patients with similar results in SENTINEL. Concludes that patients with suboptimal clinical response or persistant infusion related adverse events should be considered for antibody testing .
4. Casetta I, Iuliano G, Filippini G.
Azathioprine for multiple sclerosis.
Cochrane Database of Systematic Reviews 2007, Issue 4. CD003982. [Ref. 4379]
Five trials, including 698 randomised patients met inclusion criteria. Review concludes that azathioprine is an appropriate maintenance treatment for people with MS who frequently relapse and require steroids. Recommends cumulative doses of 600g should not be exceeded in relation to malignancy risk. Suggests future direct comparison between azathioprine and interferon beta would be useful .
5.Forbes A, While A, Mathes L.
Informal carer activities, carer burden and health status in multiple sclerosis.
Clin Rehabil 2007;21(6):563-575. [Ref. 4386]
Prospective postal survey of 257 caregivers to people with multiple sclerosis carried out in seven centres throughout England. Greater disease impact, lower didactic health, high care activity and greater carer burden related to level of carer related health problems. Recommends development of interventions to assess carers and reduce both subjective and objective carer burden .
6. Goodkin DS, Frohman EM, Hurwitz B, et al.
Neutralizing antibodies to interferon beta: assessment of their clinical and radiographic impact: an evidence report. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.
Neurology 2007;68(1):971-984. [Ref. 4336]
Literature review concludes that neutralizing antibody (Nab) production is probably less with interferon 1a compared to interferon 1b and that seroprevelance of Nabs to interferon 1b is affected by formulation, dose, route and frequency of administration. Suggests more information on Nab testing is required before recommendation on when to test, which test to use, how many tests may be necessary and at what titre cut off should apply can be made .
7. Gulick EE.
Postpartum functioning in mothers with multiple sclerosis.
Wes J Nurs Res 2007;29(5):589-602. [Ref 4388]
Study examined functional performance in 172 mothers with MS during the second six month postpartum period. Findings suggest the importance of continued social support during the first postpartum year and the need for healthcare providers to discuss post partum support during pregnancy with ongoing assessments throughout the first year in order to enhance well being and functioning of the mother .
8. Heesen C, Kasper J, Kopke S, et al.
Informed shared decisions making in multiple sclerosis – inevitable or impossible?
J Neurol Sci 2007;259(1-2):109-117. [Ref. 4853]
Study of 150 people with MS highlighted initial patient unfamiliarity with relative risk statements as usually presented in terms of treatment and side effects by absolute numbers. Higher risk knowledge correlated with a preference for greater autonomy but MS patients were not disturbed by evidence based balanced complex information. Recognises that not every patient wants to share decision but should make their preferred interaction model explicit and that shared decision making is based on validated evidence based information available to those who want it .
9.Houtchens M.
Pregnancy and multiple sclerosis.
Semin Neurol 2007;27(5):434-441. [Ref. 4365]
Considers symptoms such as urinary frequency and urgency, fatigue, lower extremity parethesia which may worsen during pregnancy. Contains treatment table of medication safety during pregnancy for drugs commonly used in MS .
10. Isaksson AK, Gunnarsson LG, Ahlstrom G.
The presence and meaning of chronic sorrow in patients with multiple sclerosis.
J Clin Nurs 2007;16(11):315-324 [Ref. 4387]
Of 61 patients with MS interviewed 62% reached the criteria for chronic sorrow, described as a natural response to ongoing loss or multiple losses over time. Suggests knowledge of the meaning of chronic sorrow can contribute to nurse's ability to give psychological support and promote sense of hope and control in the MS patient and complement understanding of depression .
11. Johansson S, Ytterberg C, Claesson IM, et al.
High concurrent presence of disability in multiple sclerosis. Associations with perceived health.
J Neurol 2007:254(6); 767-773. [Ref. 4352]
Presence of several concurrent disabilities in sample of 219 people with MS in cognition, manual dexterity, mobility and mood. Two or more disabilities were found in 80% of people Disability regarding energy, mood and walking was associated with increase in physical impact and disability in energy and mood psychological impact. Highlights importance of systematically identifying levels of functioning and disability to improve health care .
12. Kos D, Duportail M, D'hooghe MB, et al.
Multipldisciplinary fatigue management programme in multiple sclerosis: a randomized clinical trial.
Mult Scler 2007;13(8):996-1003 [Ref. 4396]
51 subjects were randomly allocated to group A and received four weeks MFMP or group B and received placebo intervention followed by MFMP after 6 months. MFMP showed no efficacy in reducing fatigue impact compared to placebo intervention programme .
13. Miller DH, Leary SM.
Primary progressive multiple sclerosis.
Lancet Neurol 2007;6(10):903-912. [Ref. 4359]
Literature review examines natural history, genetics, pathology and pathogenisis of primary progressive MS focusing on clinical presentation and course whilst considering diagnostic criteria and management. Highlights the need for effective disease modifying treatment for progressive MS and more sensitive clinical scales such as the MS Functional Composite and MS Impact Scale .
14. Mohr DC, Hart S, Vella L.
Reduction in disability in a randomised trial of telephone administered cognitive behavioural therapy.
Health Psychol 2007;26(5):554-563 [Ref. 4348]
Randomized controlled trial comparing 16 weeks T-CTB with telephone supportive emotion focused therapy. Disability measured using Guys neurological disability scale, fatigue; Fatigue Impact Scale, depression HADS and Beck. T-CBT produced greater decreases in disability and fatigue which were related to reduction in depression. Suggests that significant reduction in disability can be achieved by reducing depression in patients with MS and that CBT specific interventions that include focus on symptoms such as fatigue management could also be beneficial .
15. Peterson EW, Cho CC, Finlayson ML.
Fear of falling and associated activity curtailment around middle aged and older adults with multiple sclerosis.
Mult Scler 2007;13(9):1168-1175. [Ref. 4382]
In telephone interviews with 1064 individuals with MS aged 45-90 years 63.5% reported fear of falling. Increased likelihood of falls was associated with being female, history of falling in the last 6 months, using a walking aid and greater MS interference in daily activities .
16. Rog DJ, Nurmikko TJ, Young CA.
Oromucosal delta9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial.
Clin Ther 2007;29(9):2068-2079. [Ref. 4395]
63 patients entered the extension phase. Most commonly reported adverse events (AEs) were dizziness 27%, nausea 18% and feelings of intoxication 11%. 17% experienced oral discomfort and tow treatment related serious AEs were reported in the same patient (ventricular bigeminy and circulatory collapse). 25% patients withdrew due to AE .
17. Solaro C, Tanganelli P, Messmer Uccelli M.
Pharmacological treatment of pain in multiple sclerosis.
Expert Rev Neurotherapeutics 2007;7(9):1165-1174. [Ref. 4358]
Review of current treatment options for pain in MS. Contains table of prevalence studies of pain in MS also table of drug categories and mechanisms of action of medications commonly used to treat pain in MS .
18. Sweetland J, Riazi A, Cano SJ, Playford ED.
Vocational rehabilitation services for people with multiple sclerosis: what patients want from clinicians and employers.
Mult Scler 2007;13(9):1183-1189. [Ref. 4380]
Four focus groups of people with MS, currently in employment, were used to examine what was needed to support people with MS in the workplace. Managing performance and managing expectations were highlighted as key areas. Performance difficulties could be managed by treating the symptoms, changing the environment or altering the demands of the job. The need to access to counseling, advocacy and support in achieving appropriate expectations from employers were highlighted .
19. Tripoliti E, Campbell C, Pring T, Taylor-Goh S.
Quality of life in multiple sclerosis: should clinicians trust proxy ratings?
Mult Scler 2007;13(9):1190-1194 [Ref. 4383]
QoL scores made by 40 people with MS were compared with scores made by a close relative on their behalf (proxy). Reasonable agreement between the scores of people with MS and their proxies was found overall but with a tendency for proxies to underestimate QoL. Results showed substantial disagreements between some people and their proxies suggesting that proxies underestimate the scores of people with a better QoL, and overestimate those with poorer QoL. These discrepancies suggest proxy ratings at clinical level should be used with caution .
20. Turpin KV, Carroll LJ, Cassidy JD, Hader WJ.
Deterioration in the health related quality of life of persons with multiple sclerosis: the possible warning signs.
Mult Scler 2007;13(8):1038-1045. [Ref. 4394]
Population based study of people with relapsing remitting MS about to begin DMT therapy found high illness intrusiveness; digestive system problems, genitourinary problems and headache were associated with poorer mental HRQoL. Physical HRQoL was found to be lower in older female patients who were not working and experienced greater fatigue and higher disability scores. Suggest findings may be used to identify patients at risk of decline of HRQoL and allow timely intervention .
21. Rudick RA, Miller D, Hass S, et al.
Health related quality of life in multiple sclerosis: effects of natalizumab.
Ann Neurol 2007;62(4):335-346. [Ref. 4393]
Using information from AFFIRM and SENTINEL studies, HRQoL data were analysed from 2113 patients where SF -36 and subject assessment visual analog scale were administered at baseline, 24, 52 and 104 weeks. Findings showed improvement of quality of life on SF-36 that was suggestive of improvement of baseline QoL rather than a slowing of HRQoL deterioration .
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.
