Research news - June 2008
Way Ahead 2008;12(3):2-3
- Childhood MS affects IQ and thinking skills
- Dutch study shows antidepressant slows MS
- Alemtuzumab (Campath-1H) for aggressive relapsing remitting MS
- Delayed infusion reactions during natalizumab (Tysabri) therapy
- AAN Highlights
- Rehabilitation in MS (RIMS) Leuven, Belgium 8-10 May 2008
Childhood MS affects IQ and thinking skills
A recent study led by a team of Italian researchers concludes that in childhood and juvenile cases, MS is associated with cognitive impairment and low IQ scores. 63 children with MS took part in the study and were compared against 57 healthy controls. Participants completed a number of studies designed to measure overall intelligence, memory, language abilities, and other thinking skills. Cognitive impairment was defined by failure of three of the tests and was demonstrated by 19 (31%) children with MS, compared with less than 5% of healthy controls. The researchers also identified a significant correlation between lower IQ scores and a younger age at onset.
Amato MP, Goretti B, Ghezzi A, et al.
Cognitive and psychosocial features of childhood and juvenile MS.
Neurology 2008;70(20):1891-1897
Dutch study shows antidepressant slows MS
A small proof-of-concept study has indicated that a widely used antidepressant reduces the formation of new lesions in people with MS. 40 nondepressed people with relapsing-remitting MS were randomised to receive either oral fluoxetine (prozac) 20mg or placebo daily for 24 weeks. New lesion formation was studied by assessing the cumulative number of gadolinium-enhancing lesions on brain MRI. The scans showed that those in the fluoxetine group had fewer new areas of inflammation than those treated with placebo. At the end of the study, the group given fluoxetine had an average number of two new areas affected, while in the placebo group the average number of new areas affected was more than five. During the last 16 weeks of treatment 63% in the group given fluoxetine had no new areas of inflammation compared with 26% in the group given the placebo. Conclusions from the results must be made with caution because of the small sample size and exploratory design, but the results are sufficiently encouraging to justify further studies with fluoxetine in people with MS.
Mostert JP, Admiraal-Behloul F, Hoogduin JM et al.
Effects of fluoxetine on disease activity in relapsing multiple sclerosis: a double blind, placebo controlled, exploratory study.
J Neurol Neurosurg Psychiatry 2008;79(9):1027-1031.
Alemtuzumab (Campath-1H) for aggressive relapsing remitting MS
Researchers have recently reported on an open label study of alemtuzumab in people with relapsing remitting MS. 39 people with highly active relapsing remitting MS were followed for an average of 1.89 years. Before treatment the average number of relapses was 2.48 per year. This fell to 0.19 relapses per year after treatment. For those completing one year or more of follow-up, the average EDSS score improved by 0.15. Overall the EDSS score improved by 0.36. 83% were stable or had improved disability following treatment. Side effects were common but generally mild or easily managed; however, two people developed thyroid disease and one developed autoimmune skin disease.
Hirst CL, Pace A, Pickersgill TP, et al.
Campath 1-H treatment in patients with aggressive relapsing remitting multiple sclerosis.
J Neurol 2008;255(2):231-238.
Delayed infusion reactions during natalizumab (Tysabri) therapy
A recently published article in the Archives of Neurology suggests that delayed infusion reactions in people treated with natalizumab occur more frequently than previously thought. The monoclonal antibody is generally well tolerated and infusion reactions are typically thought to occur shortly after infusion and peak at the second infusion. The authors describe the occurrence of delayed infusion reactions in 4 out of 40 people with relapsing-remitting MS. It is also suggested that some of these infusion reactions can be treated effectively with steroids and reduction of the infusion rates. Where antibody-mediated reactions occur, treatment should be stopped immediately.
Hellwig K, Schimrigk S, Fischer M et al.
Allergic and nonallergic delayed infusion reactions during natalizumab therapy.
Arch Neurol 2008; 65 (5) 656-658
AAN Highlights
The American Academy of Neurology's 60th annual meeting was held in Chicago from April 12th -19th May 2008. The conference brought together more than 10, 000 neurologists and neuroscientists to share their latest research developments. The following data was amongst some of the most significant developments presented on MS research:
Rituximab fails to meet primary endpoint
FTY720 reduces attacks in MS
Early use of glatiramer acetate delays progression to CDMS
Cancer drug rituximab failed to slow the progressive disability that presents in primary progressive forms of MS. During the 96 week phase II/III trial, those on rituximab failed to show any improvement over those in the placebo arm.
The investigational oral therapy FTY720 (fingolimod) has proven effective in reducing the number of attacks suffered by people with MS. Significantly, almost three quarters of those taking a 5mg dose of FTY720 remained relapse free after 3 years, while 68% of those who began the trial on a 1.2mg dose remained relapse free. An ongoing blinded phase III clinical trial to further assess its safety profile is now underway.
The latest results from the PreCISe study demonstrate that early treatment with glatiramer acetate significantly reduced the risk of developing clinically definite multiple sclerosis (CDMS) by 45% compared to placebo. An application for marketing authorization in Europe to the MHRA for the extension of its indication to include the treatment of people with a first clinical event suggestive of MS, is currently under review.
Rehabilitation in MS (RIMS) Leuven, Belgium 8-10 May 2008
The 13th Annual Conference of RIMS (Rehabilitaion in Multiple Sclerosis), was recently held in Leuven, Belgium. RIMS is a multiprofessional European network of MS centres that meets annually to bring together distinguished speakers and active researchers from all over Europe. The theme for this year's conference was 'Targeting good practice in MS Care and Rehabilitation'.
The MS Trust proved successful with a poster submission demonstrating the methods that were used in producing the Young Person's Guide to MS. The MS Trust produced the publication in collaboration with MS specialist nurse Kerry Mutch from the Walton Centre, Liverpool.
The poster focused on the tools that were used in assessing and meeting the information needs of young family members of people with MS and how their input proved to be the key to meeting their needs.
Amongst other highlights of the conference was a plenary lecture presented by Dr Dirk De Ridder on Evidence based MS Urology which explored the physiological and psychological impact of first to fourth line treatments used in the treatment of bladder problems in people with MS.
Dr Vermote and Dr Van Nunen coordinated an insightful workshop on Stress reducing strategies: an introduction to mindfulness. The workshop explored the impact of stress in MS and the clinical effectiveness of a program of Mindfulness Based Strees Reduction.
MS Specialist Nurse, Bernadette Porter painted an intriguing - if somewhat daunting - picture of New ways of working - The role of Telehealth in MS. Bernie pointed to exciting developments in teleneurology and explored how new technologies might be used to improve the self management of MS.
Other speakers addressed areas such as: recent advances in MS treatment and care; the use of clinical pathways in MS rehabilitation; the cost and quality of life in MS; and employment and MS.
The RIMS General Assembly saw the appointment of three new members to the Executive Board of RIMS including MS Trust Nurse Advisor Victoria Matthews. Vicki brings to the board a wide range of professional credentials and broad experience in working with MS.
Next year's RIMS conference will take place Genoa, and represents an opportunity for people working with MS across all professions and disciplines to come together and share the latest developments and initiatives that advance rehabilitation in MS.
- For further information visit the RIMS website
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Way Ahead articles are reproduced as published. They are not updated to take account of subsequent developments. Use appropriate caution in acting on the information in any article.
