MS Information Update no 39 - March 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 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. Alonso A, Jick SS, Olek MJ, et al.
Incidence of multiple sclerosis in the United Kingdom, findings from a population based cohort.
J Neurol 2007;254(12):1736-1741. [Ref. 4451]
Population based study using the General Practice Research Database (GPRD) that identified all cases of MS recorded between 1993 and 2000 in the UK. Age adjusted incident rate of relapsing remitting MS was found to be 2.5 times higher among women than men. Incidence peaked at 30-35 years for relapsing remitting MS and 10 years later for primary progressive. Lifetime risk for relapsing remitting MS for women was found to be 5 per 1,000 and 2.1 per 1000 for men, primary progressive 0.5 per 1000 in women and 0.4 per 1000 in men.
2. Ciccone A, Beretta S, Brusaferri F, et al.
Corticosteroids for the long term treatment in multiple sclerosis (Review).
Cochrane Database of Systematic Reviews 2008, Issue 1. CD006264. [Ref. 4446]
Review considered three trials all with a high risk of bias. Concluded that there is not enough evidence that long term corticosteroid treatment delays progression of disability in people with MS. However suggests a high powered RCT should investigate pulsed high dose iv MP in RRMS. NICE guidelines currently do not recommend corticosteroids in long term treatment.
3. Cohen BA, Rieckmann P.
Emerging oral therapies for multiple sclerosis.
Int J Clin Practice 2007;61(11):1922-1930. [Ref. 4407]
The limitations of currently available injected treatments for MS are considered, including needle phobia, injection site reactions and the intrusiveness of self-injection. Considers how optimal adherence might be achieved with reference to appropriate expectations and perceived value. Suggests alternative treatment routes may improve adherence and examines oral drugs that are in Phase III development including Cladribine, Fingolimod and Teriflouromide. Suggests that different modes of administration may facilitate combination treatments.
4. Dalgas U, Stenager E, Ingemann-Hansen T.
Multiple sclerosis and physical exercise: recommendations for the application of resistance, endurance and combined training.
Mult Scler 2008;14(1):35-53. [Ref. 4426]
Literature review of exercise in MS. Goes on to recommend participation in endurance training at low to moderate intensity and resistance training at moderate intensity. Highlights that existing evidence is limited as effects of exercise have only been studied in moderately impaired people with EDSS < 7 and recommendations regarding MS prescription for exercise in more advanced MS are not yet possible.
5. Embrey N.
Exploring the lived experience of palliative care for people with MS. 1: A literature review.
Br J Neurosci Nurs 2008;4(1):9-16. [Ref. 4336]
Review of palliative care services for non-cancer patients that highlights the unmet needs of people in advanced stages of MS. Palliative care and supportive care are defined. The importance of partnership between patient, carer and health professionals in addressing the patient's psychological, physiological, social and spiritual needs is stressed. Suggests that a supportive care pathway could reduce variations in current poorly organized and coordinated care services, improve fundamental partnership working, flexible service delivery and collaborative working with existing services.
6. Finlayson M, Garcia JD, Preissner K.
Development of an educational programme for caregivers of people aging with multiple sclerosis.
Occ Ther Int 2008;15(1):4-17. [Ref. 4445]
Describes the process of using literature review and empirical data to inform the development process of an educational programme and to support clinical practice. Evidence based on telephone interviews with 302 caregivers of people with MS.
7. Fry DK, Pfalzer LA, Chokshi AR, et al.
Randomised control trial of effects of a 10 week inspiratory muscle training (IMT) program on measures of pulmonary function in persons with multiple sclerosis.
J Neurol Phys Ther 2007;31(4):162-172. [Ref. 4455]
Community based trial of 46 ambulatory persons with MS found that IMT significantly increased inspiratory muscle strength. Highlights the morbidity and mortality associated with pulmonary impairment and suggests that pulmonary function should be tested in all persons with MS, with respiratory muscle training instigated in therapy programmes where pulmonary function is impaired.
8. Giovannoni G, Kinkel P, Vartanian T.
Treating multiple sclerosis in the natalizumab era: risks, benefits, clinical decision making, and a comparison between North American and European Union practices.
Rev Neurol Dis 2007;4(4):184-193. [Ref. 4450]
Reviews evidence and argument for early treatment of MS, considers when a particular DMT may be deemed insufficient or a treatment failure, what should follow such failure and what risks might be reasonable to assume. It is suggested that licensing indications for use of natalizumab in the United States and EU are currently a compromise between regulation and meeting the unmet need for more effective therapy.
9. Ingram C, Knowles V, Beety D.
Filling the void: how real life health information builds better services.
Br J Neurosci Nurs 2007;3(12):575-578. [Ref 4424]
Literature review highlights the ad hoc basis of service development in the UK.and suggests that commissioning organisations are data rich but information poor. Questions how the NSF for long term conditions can be implemented when the target population remains unknown. Describes how a Marketing Analysis Project (MAP) carried out by Sue Ryder has resulted in a detailed report about each strategic health authority and states that changes at Government and commissioner level are essential to develop and used data better to build services.
10. Lienau FS, Fullgraf H, Moser A, et al.
Why do cannabinoids not show consistent effects as analgetic drugs in multiple sclerosis?
Eur J Neurol 2007;14(10):1162-1169. [Ref. 4453]
Overview of pain in MS with a review of clinical trials that examine the effects of cannibinoids in MS to date. Considers the possible mechanisms of action of cannabinoids in central and neuropathic pain and includes the interaction between exogenously administered CB and endocannibinoids. Concludes that studies are needed to differentiate the origin of clinically presented pain in MS and identification of MS lesions associated with pain through MRI techniques.
11. Lincoln NB, Radford KA.
Cognitive abilities as predictors of safety to drive in people with multiple sclerosis.
Mult Scler 2008;14(1):123-128. [Ref. 4427]
34 people with MS who had been referred to a driving mobility centre took part in the study. Cognitive tests were carried out and safety to drive assessed by a blinded driving instructor. Assesment of cognitive abilities related to safe driving included Stroke Drivers Screening Assessment, Paced Auditory Serial Addition Test, Stroop, Test of Motor Impersistence and Adult Memory and Information Processing Battery. Significant differences in tests of executive function, visual memory, information processing and visuospatial abilities between safe and unsafe drivers were found. Highlights the need for consideration of cognitive abilities when considering safety to drive.
12. McCabe MP, McDonald E.
Perceptions of relationship and sexual satisfaction among people with multiple sclerosis and their partners.
Sex Disabil 2007;25(4):179-188. [Ref. 4452]
Study of 45 heterosexual people with MS their partners and 32 heterosexual people from general population and partners found that people with MS experienced more problems in the relationship and sexual functioning but not in sexual satisfaction. Partners of people with MS were most likely to feel MS had a negative impact on physical and emotional aspect of the relationship and considers implications in terms of support for partners and impact over time.
13. McCullagh R, Fitzgerald AP, Murphy RP.
Long term benefits of exercising on quality of life (QoL) and fatigue in multiple sclerosis patients with mild disability.
Clin Rehabil 2008;22(3):206-214. [Ref. 4448]
Randomised controlled trial of 30 independently mobile people with MS assigned to either exercise classes twice weekly and independent exercise once weekly for three months or control. The programme improved participants' exercise capacity, QoL and fatigue with improvements in QoL and fatigue lasting beyond the programme. Concludes that these findings offer the only evidence to date of the longer term benefit of exercise and that intervals of exercise training rather than continuous exercise management benefit people with MS.
14. McHugh JC, Galvin PL Murphy RP.
Retrospective comparison of the original and revised McDonald criteria in a general neurology practice in Ireland.
Mult Scler 2008;14(1):81-85. [Ref. 4428]
Highlights a considerable gap between clinical diagnosis in a general neurology setting and compliance with the McDonald criteria in the retrospective study of 62 patients. 47% fulfilled the 2001 criteria and 49% the revised criteria. Of those not fulfilling the revised criteria 21% went on to meet these over a 23 month follow up. . The failure to perform follow up MRI on patients with clinically isolated syndrome (CIS) was seen to represent a diagnostic gap however; practical differences between the original and revised criteria appeared to be small.
15. Mills RJ, Young CA.
A medical definition of fatigue in multiple sclerosis.
Q J Med 2008;101(1): 49-60. [Ref. 4449]
Qualitative study of forty unselected people with MS attending outpatients at the Walton Centre using structured interviews from which a definition of fatigue was drawn - reversible motor and cognitive impairment with reduced motivation and desire to rest, either appearing spontaneously or brought on by mental or physical activity, humidity, acute infection and food ingestion and is relieved by daytime sleep or rest. Article suggests that clinical trials have thus far been limited by the lack of a well validated definition of fatigue.
16. Newman Wright B, Wilkins AJ, Zoukos Yl.
Spectral filters can improve reading and visual search in patients with multiple sclerosis.
J Neurol 2007;254(12):1729-1735. [Ref. 4405]
26 people with multiple sclerosis selected a coloured overlay and 25 reported fewer symptoms of visual stress, 50% read more quickly Findings suggest that a large proportion of patients with multiple sclerosis may benefit from use of spectral overlay.
17. Pakenham KI.
Making sense of illness or disability: the nature of sense making in multiple sclerosis.
J Health Psychol 2008;13(1):93-105. [Ref. 4447]
Postal survey of 408 people with MS found half the sample generated sense making explanations for their illness. On analysis 16 sense making themes were revealed and related to lower disability and disease severity. Sense making was seen to have a beneficial direct effect on positive adjustment outcomes and depression after controlling for illness and religious spiritual belief. Analysis concludes that practitioners need to listen actively to patients sense making and identify early negative explanations.
18. Siegle SD, Turner AP, Haselkorn JK.
Adherence to disease modifying therapy in MS. Does caregiver social support matter?
Rehabil Psychol 2008;53(1):73-79. [Ref. 4454]
Telephone survey of 54 people with MS currently prescribed DMT therapy who identified a primary caregiver. DMT adherence was assessed by missed doses in the past month. Study concluded that supportive qualities of the caregiver - recipient relationship represent an important predictor of adherence and could be considered a potential target in adherence based interventions.
19. Stevenson VL, Playford ED.
Rehabilitation and MS.
Int MS J 2007;14(3):85-92. [Ref. 4423]
Considers the role of neurological rehabilitation in managing MS and highlights the contribution of multidisciplinary team members. Explains the four stages of the rehabilitation process, assessment; goal setting; treatment and evaluation and considers these in the context of the evolution of the individuals MS, during relapse, symptom management, moderate and severe disability. Highlights the individualized approach required at all stages across primary and secondary care and effective communication and co ordination of management and services across health and social care.
20. Yates A.
Continence management in multiple sclerosis - the Cardiff experience.
Scottish Nurse 2007;10(11):20-21. [Ref 4391]
Article describes the evolution of services to improve continence care for patients with MS in Cardiff and Vale. Includes analysis of referral patterns, audit and patient evaluation and how increased communication has been achieved between MS service and the continence team.
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.
