MS Information Update no 41 - September 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.
We ask for a donation of £1.00 per paper ordered to help cover the costs of the Information Service.
1. Birns J, Fitzpatrick M.
Management of spasticity: a brief overview of educational and pharmacological therapies.
Br J Neurosci Nurse 2008;4(8):370-373. [Ref. 4593]
Overview examines pathophysiology of spasticity, effect on lifestyle and methods of assessment. Multidisciplinary team involvement in setting realistic treatment goals, managing expectations, and working in partnership with the patient, family and caregivers is highlighted. The roles of non pharmacological management offered by physiotherapy and occupational therapy and pharmalogical treatments including oral medication, focal treatments, intrathecal baclofen and surgical techniques are examined.
2. Bosca I, Coret F, Valero C, et al.
Effect of relapses over early progression of disability in multiple sclerosis patients treated with beta interferon.
Mult Scler 2008;14(5):636-639. [Ref. 4571]
Observational study of 162 patients in the first two years of treatment with beta interferon found that patients with one or more relapses in the first two years of interferon treatment developed an earlier and sustained progression of disability. The main endpoint measure was defined as sustained EDSS increase.
3. Burgess M.
Development of a website for multiple sclerosis: Involving service users and providers.
Br J Neurosci Nurs 2008;4(7):316-321. [Ref. 4574]
In response to an information deficit highlighted by the Greater Manchester Multiple Sclerosis Management Audit 2006 a website for people with MS was developed in consultation with key stakeholders, health and social care professionals and service users. Article considers the extensive consultation process involved and how far the website has met the information needs of the local MS community.
4. Clarkson CJ.
The impact of national policy on palliative care on patients with neurodegenerative disease.
Br J Neurosci Nurs 2008;4(7):330-334. [Ref.4573]
Palliative care provision currently available to people with neurological conditions is examined in the context of quality requirement (QR) 9 of the NSF. The trajectory of neurodegenerative disease as compared to cancer and the relevance of palliative care from diagnosis are considered. Ways in which palliative care might best be adapted for people with neurodegenerative disease is explored.
5. DeAngelis T, Lublin F.
Multiple sclerosis: new treatment trials and emerging therapeutic targets.
Curr Opin Neurol 2008;21(3):261-271. [Ref. 4531]
Highlights the importance of risk benefit ratio and individualized treatment profiles. Examines oral therapies currently in development, monoclonal antibodies, antigen based immune therapy, repair and neuroprotection. Also considers current evidence for early initiation of existing disease modifying therapy, combination therapies and alternative dosing regimes.
6. Ennis M, Shaw P, Barnes F, et al.
Developing and auditing multiple sclerosis relapse management guidelines. .
Br J Neurosci Nurs 2008;4(6):266-271. [Ref. 4572]
Guidelines on the management of acute relapses developed and implemented in South London were followed by an audit of 47 people who had experienced relapse. 92% felt treatment had some benefit or was very effective. Considers the case for oral vs intravenous steroid treatment and includes both an algorithm for management of acute relapses and a patient information sheet for treatment of relapse.
7. Esmonde L, Long AF.
Complementary therapy use by persons with multiple sclerosis: benefits and research priorities.
Complement Ther Clin Prac 2008;14(3):176-184. [Ref. 4589]
Questionnaire study of 138 people with MS attending a UK conference found the six most used therapies to be; reflexology, massage, yoga, relaxation, acupuncture and aromatherapy with the most common benefits of relaxation, pain and spasm reduction and improved sleep. Collaborative research involving CAM practitioners, pwMS and academic researchers is suggested as a way forward to support self care in MS.
8. Forwell SJ, Brunham S, Tremlett H, et al.
Primary (PF) and non primary fatigue (NPF) in multiple sclerosis.
Int J MS Care 2008;10(1):14-20. [Ref. 4548]
Cross sectional study of 50 people with clinically definite MS attending an MS clinic were assessed using structured interview and screened for PF and NPF using the fatigue algorithm Clinical Practice Guidelines for Fatigue and Multiple Sclerosis (PVA). 72% were identified as having NPF, where the most common contributing factors were sleep problems, mobility limitations and depression. Underscores the need to identify and ameliorate treatable non primary fatigue factors.
9. Goodman S, Gulick EE.
Dietary practices of people with multiple sclerosis.
Int J MS Care 2008;10(2):47-57. [Ref. 4587]
American cross sectional observational study of 123 people with MS found fewer than 20% obtained information from a dietician. Based on BMI, one third of mild-moderately disabled participants were overweight and 17% obese; of the severely disabled group 15% were obese and 41% overweight. Suggests health care professionals should know what foods are eaten and how they are prepared by the patient and that referrals should be made to a dietician where appropriate.
10. Heesen C, Bohm J, Reich C, et al.
Patient perception of bodily functions in multiple sclerosis: gait and visual function are the most valuable.
Mult Scler 2008;14(7):988-991. [Ref. 4596]
Questionnaire study of 84 people with MS<5 years and 82 people with MS >15 years where patients graded aspects of physical function and assessed their actual disability. Walking was given the highest priority in both groups followed by vision and cognition; particularly in longer lasting MS. Concludes that walking ability is, from the participants' perspective, an important measure in clinical trials and suggests that vision should also be taken more into account.
11. Koch M, Uyttenboogaart M, van Harten A, et al.
Factors associated with the risk of secondary progression in multiple sclerosis.
Mult Scler 2008;14(6):799-803. [Ref. 4578]
Hospital based cohort of 571 MS patients with relapsing remitting onset found greater age at disease onset associated with shorter time to progression; gender and onset manifestation had no influence. Use of disease modifying drugs in the sample was low but suggested reduced risk of secondary progression.
12. Lee D, Newell R, Ziegler L, et al.
Treatment of fatigue in multiple sclerosis: a systematic review of the literature.
Int J Nurs Pract 2008;14(2):81-93. [Ref. 4581]
Systematic review revealed 15 intervention studies on fatigue (10 pharmacological , 5 psychological) which met inclusion criteria as being RCT, open label or cross-over trials that examined fatigue in MS as an outcome measure. Of these only two were deemed moderate to high quality. Concludes that little evidence based advice can be offered to people with MS and suggests further studies over a broad range of interventions using research addressing the methodological difficulties highlighted. Contains detailed tables of all studies included with methodologies, participants and conclusions.
13. Nielsen NM, Frisch M, Rostgaard K, et al.
Autoimmune diseases in patients with multiple sclerosis and their first-degree relatives: a nationwide cohort study in Denmark.
Mult Scler 2008;14(6):823-829. [Ref. 4576]
Using the Danish Multiple Sclerosis registers relative risk was estimated for 42 different autoimmune diseases in a population based cohort of 12 000 people with MS and 20,000 first degree relatives. Compared with the general population people with MS were found to be at increased risk of developing ulcerative colitis and pemphigoid but reduced risk of rheumatoid arthritis and temporal arteritis. First degree relatives were at increased risk of Crohn's disease, ulcerative colitis and Addison's disease. Concludes that people with MS and their first degree relatives are at increased risk of some autoimmune diseases.
14. Olsson M, Lexell J, Soderberg S.
The meaning of women's experiences of living with multiple sclerosis.
Health Care Women Int 2008;29(4):416-430. [Ref. 4591]
Qualitative study of 10 women aged 43-59 years living with secondary progressive MS. Phenomenological analysis of interviews revealed two main themes: an unrecognisable body and trying to maintain power. Study concludes that women with MS experience violated dignity and that interventions to strengthen the experience of dignity should be investigated by further research.
15. Paul L, Rafferty D, Young S, et al.
The effect of functional electrical stimulation on the physiological cost of gait in people with multiple sclerosis.
Mult Scler 2008;14(7):954-961. [Ref. 4595]
12 people with MS and 12 matched controls found wearing FES lead to improvement in walking speed and significant reduction in physiological gait. Concludes that FES offers an effective treatment option for people with MS who experience dropped foot.
16. Polman CH, Reingold SC, Barkhof F, et al.
Ethics of placebo controlled clinical trials in multiple sclerosis. A reassessment.
Neurology 2008;70(13):1134-1140. [Ref. 4510]
International group of clinicians, ethicists, regulators and pharmaceutical industry members concluded that placebo controlled trials can be carried out ethically. However in people with relapsing remitting MS where effective treatment exists this is limited to people who refuse treatment, where treatment is ineffective or unavailable for economic reasons. Guidance is given on alternative trial designs including add-on studies, active comparator arm studies and superiority studies.
17. Prunty M. Sharpe L, Butow P, et al.
The motherhood choice: themes arising in the decision making process for women with multiple sclerosis.
Mult Scler 2008;14(5):701-704. [Ref 4533]
Focus group study of 20 women with MS at varying stages in the decision making process highlighted a number of themes: concern for mother's health, child's well being, coping with parenting, societal attitudes and pressure of decision making. Concludes that information regarding the effects of MS on pregnancy and child rearing should be more accessible to women going through this decision making process.
18. Ross AP, Hackbarth N, Rohl C, et al.
Effective multiple sclerosis management through improved patient assessment.
J Neurosci Nurse 2008; 40(3):150-157. [Ref.4592]
Considers the use of questionnaires to flag issues, improve management of symptoms, highlight referral requirements, manage existing symptoms and identify new symptoms in patients attending MS outpatient clinics. Suggests that this approach can also raise patient awareness of symptoms, track progress and ultimately result in improved patient /caregiver interaction.
19. Sorensen PS, Koch-Henriksen N, Flachs EM, et al.
Is the treatment effect of IFN-beta restored after the disappearance of neutralizing antibodies?
Mult Scler 2008;14(6):837-842. [Ref.4575]
40 patients who had Nab positive status for at least 12 months followed by reversion to a Nab negative state were compared to 64 matching cases that remained Nab negative throughout. During Nab positive periods clinical effect of beta interferon was null however when the Nab negative state was regained the full effect of beta interferon was found with no negative carry over.
20. Ward-Abel N, Burgoyne T.
The importance of the immune response in multiple sclerosis, part 1: pathophysiology.
Br J Neurosci Nurse 2008;4(5):212-217. [Ref. 4594]
Article highlights the need for neurology practitioners to have a good understanding of both the immune system and the impact of immunosuppressive treatments as MS therapies develop in this arena. An overview of the immune system, immunology of MS and the processes of inflammation, remyelination and disease progression are included.
21. Wiles CM.
Physiotherapy and related activities in multiple sclerosis.
Mult Scler 2008:14(7):863-871. [Ref. 4599]
Current evidence available to support clinical referral of patients for physiotherapy treatment is considered. Includes a table of RCT's of physiotherapy and related inputs in multiple sclerosis and makes recommendations for future clinical trials including a model for trials of physiotherapy treatment in MS.
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.
