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The MS Trust aims to keep you up-to-date with interesting and relevant research articles relating to multiple sclerosis. 

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MS research update - Exercise early in the course of MS and FES effects on bladder symptoms - 31 July 2018

Summary

Ideas for new research often come from unexpected and apparently random observations or a hunch which slowly develops through discussions with colleagues. Two examples cropped up in the latest batch of MS research papers.

Should we be testing the benefits of exercise earlier in the course of MS?
A group of Danish researchers has considered whether the benefits of early treatment, which are well-established for disease modifying drugs, could also be applied to exercise therapy.

They analysed studies of exercise therapy and found that none have looked at the effects of treatment any earlier than three years after diagnosis. Studies typically include people with an EDSS of at least 3, equivalent to mild to moderate disability in several functional systems. This means that the vast majority of studies have evaluated exercise therapy once someone’s MS is well established.​ However, more recent studies have shown that exercise therapy can have a direct effect on the brain, producing improvements in brain volume and cognition.

They suggest that we may have overlooked an early “window of opportunity”, starting from the first episode of neurological symptoms and continuing into the first few years following diagnosis, where exercise therapy might have the potential to modify the course of MS. They propose that studies should investigate exercise therapy as an add-on to disease modifying drugs in the early stages of MS.

Could FES improve bladder symptoms as well as walking?
People have reported unexpected improvements in bladder symptoms when they started using an FES (functional electrical stimulation) device to improve walking. A team based in London decided to check this out by gathering data from people being fitted with one of these devices.

47 people attending a clinic to set up their FES device were asked to complete a questionnaire assessing bladder symptoms at the start and after three months of using the device. For people with MS, there were improvements in both urgency and incontinence.

They suggest that further research should investigate whether this is a direct effect on the bladder with a similar mechanism to that of percutaneous tibial nerve stimulation, a recognised treatment for overactive bladder.


Background

Where do ideas for new research come from? Well, not so much from “Eureka” moments but more often from an unexpected and apparently random observation or a hunch which slowly develops through discussion with colleagues, background reading and preliminary tests. Two examples cropped up in the most recent batch of MS research papers.

  • Should we be testing the benefits of exercise earlier in the course of MS?

It is well-established that starting a disease modifying drug early in the course of relapsing MS gives greater benefits from fewer relapses and fewer new lesions, ultimately leading to less long term disability.

A group of Danish researchers wondered whether the same principle could be applied to exercise.

Exercise therapy, which covers a range of different approaches such a endurance, resistance or aerobic training, has been extensively studied in MS and has been shown to have significant beneficial effects on a variety of symptoms such as fatigue, walking, balance and depression.

The researchers analysed studies of exercise therapy and found that none have looked at the effects of treatment any earlier than three years after diagnosis. Studies typically include people with an EDSS of at least 3, equivalent to mild to moderate disability in several functional systems. This means that the vast majority of studies have evaluated exercise therapy once someone’s MS is well established.

The researchers suggest that there may be an early “window of opportunity”, starting with the first episode of neurological symptoms and continuing into the first few years after diagnosis, where exercise therapy may have the potential to modify the course of MS. They point out that recent studies have shown that exercise therapy can have a direct effect on the brain, including improvements in brain volume and cognition. They propose that studies should investigate exercise therapy as an add-on to disease modifying drugs in the early stages of MS.

Riemenschneider M, et al.
Is there an overlooked “window of opportunity” in MS exercise therapy? Perspectives for early MS rehabilitation.
Mult Scler. 2018 Jun;24(7):886-894.
Abstract

More about exercise

  • Could FES improve bladder symptoms as well as walking?

Anecdotally, people have reported unexpected improvements in bladder symptoms when they started using an FES (functional electrical stimulation) device to improve walking. A team based in London decided to check this out by gathering data from people being fitted with one of these devices.

An FES device applies small electrical charges to a muscle that has become paralysed or weakened, due to damage caused by MS in your brain or spinal cord. The electrical charge stimulates the muscle to make its usual movement. In MS, FES devices are typically fitted on the lower leg and apply electric shocks to the lower leg muscles to compensate for foot drop.

47 people attending a clinic to set up their FES device were asked to complete a questionnaire assessing bladder symptoms at the start and after three months of using the device. Of the group, 35 had MS and the remainder had other neurological conditions.

Improvement in overactive bladder symptoms was not significant for the group as a whole. But for people with MS, changes were significant, with particular improvements in urgency and incontinence. The biggest improvements in bladder symptoms were seen in those with slower initial walking speeds.

The researchers conclude that FES use does improve overactive bladder symptoms in people with MS. They suggest that further research should investigate whether this is a direct effect on the bladder with a similar mechanism to that of percutaneous tibial nerve stimulation, a recognised treatment for overactive bladder, rather than through improved mobility.

Hare N, et al.
Improvement in overactive bladder symptoms in patients using functional electrical stimulation of the common peroneal nerve for walking.
Clin Rehabil. 2018 Jun 1:269215518780974.
Abstract

More about getting help with bladder problems

Research by topic areas...

Disease modifying drugs

Yeh EA, Chiang N, Darshan B, et al.
Adherence in youth with multiple sclerosis: a qualitative assessment of habit formation, barriers, and facilitators.
Qual Health Res. 2018 Jun 1:1049732318779039. [Epub ahead of print]
abstract

Reddel SW, Barnett MH, Riminton S, et al.
Successful implementation of an automated electronic support system for patient safety monitoring: The alemtuzumab in multiple sclerosis safety systems (AMS3) study.
Mult Scler. 2018 Jun 1:1352458518783673. [Epub ahead of print]
abstract

Sejbaek T, Nybo M, Petersen T, et al.
Real-life persistence and tolerability with dimethyl fumarate.
Mult Scler Relat Disord. 2018 Jun 2;24:42-46. [Epub ahead of print]
abstract

Freedman MS, Selchen D, Prat A, et al.
Managing multiple sclerosis: treatment initiation, modification, and sequencing.
Can J Neurol Sci. 2018 Jun 12:1-15. [Epub ahead of print]
abstract

Casanova B, Lacruz L, Villar ML, et al.
Different clinical response to interferon beta and glatiramer acetate related to the presence of oligoclonal IgM bands in CSF in multiple sclerosis patients.
Neurol Sci. 2018 Jun 7. [Epub ahead of print]
abstract

Pariani N, Willis M, Muller I, et al.
Alemtuzumab-induced thyroid dysfunction exhibits distinctive clinical and immunological features.
J Clin Endocrinol Metab. 2018 Jun 6. [Epub ahead of print]
abstract
Read the full text of this paper

Prosperini L, Lucchini M, Haggiag S, et al.
Fingolimod vs dimethyl fumarate in multiple sclerosis: A real-world propensity score-matched study.
Neurology. 2018 Jul 10;91(2):e153-e161.
abstract

Mékiès C, Heinzlef O, Jenny B, et al.
Treatment satisfaction and quality of life in patients treated with fingolimod.
Patient Prefer Adherence. 2018 May 22;12:899-907.
abstract
Read the full text of this paper

Other treatments

Rice J, Cameron M.
Cannabinoids for treatment of ms symptoms: state of the evidence.
Curr Neurol Neurosci Rep. 2018 Jun 19;18(8):50.
abstract

Ayache SS, Chalah MA.
Transcranial direct current stimulation: A glimmer of hope for multiple sclerosis fatigue?
J Clin Neurosci. 2018 Jun 15. pii: S0967-5868(18)30557-5. [Epub ahead of print]
abstract

Paediatric MS

Simone M, Viterbo RG, Margari L, et al.
Computer-assisted rehabilitation of attention in pediatric multiple sclerosis and ADHD patients: a pilot trial.
BMC Neurol. 2018 Jun 8;18(1):82.
abstract
Read the full text of this paper

Menascu S, Legarda C, Miron S, et al.
Brain lesion load and anatomic distribution in patients with juvenile clinically isolated syndrome predicts rapidly advanced to multiple sclerosis.
J Child Neurol. 2018 Jan 1:883073818774716. [Epub ahead of print]
abstract

Prognosis

Manouchehrinia A, Zhu F, Piani-Meier D, et al.
Predicting risk of secondary progression in multiple sclerosis: A nomogram.
Mult Scler. 2018 Jun 1:1352458518783667. [Epub ahead of print]
abstract

Tacchella A, Romano S, Ferraldeschi M, et al.
Collaboration between a human group and artificial intelligence can improve prediction of multiple sclerosis course: a proof-of-principle study.
F1000Res. 2017 Dec 22;6:2172.
abstract
Read the full text of this paper

Manouchehrinia A, Hedström AK, Alfredsson L, et al.
Association of pre-disease body mass index with multiple sclerosis prognosis.
Front Neurol. 2018 May 11;9:232.
abstract
Read the full text of this paper

Psychological aspects

A comparison of implicit and explicit motor sequence learning in patients with relapsing-remitting multiple sclerosis.
Sports (Basel). 2017 Jun 7;5(2). pii: E34.
abstract
Read the full text of this paper

 

Smith AD 3rd, Duffy C, Goodman AD.
Novel computer-based testing shows multi-domain cognitive dysfunction in patients with multiple sclerosis.
Mult Scler J Exp Transl Clin. 2018 Apr 27;4(2):2055217318767458.
abstract
Read the full text of this paper

Tauil CB, Grippe TC, Dias RM, et al.
Suicidal ideation, anxiety, and depression in patients with multiple sclerosis.
Arq Neuropsiquiatr. 2018 May;76(5):296-301.
abstract
Read the full text of this paper

Leclaire K, Cecil A, LaRussa A, et al.
Short report: a pilot study of a group positive psychology intervention for patients with multiple sclerosis.
Int J MS Care. 2018 May-Jun;20(3):136-141.
abstract
Read the full text of this paper

Grech LB, Kiropoulos LA, Kirby KM, et al.
Target coping strategies for interventions aimed at maximizing psychosocial adjustment in people with multiple sclerosis.
Int J MS Care. 2018 May-Jun;20(3):109-119.
abstract
Read the full text of this paper

Crescentini C, Matiz A, Cimenti M, et al.
Effect of mindfulness meditation on personality and psychological well-being in patients with multiple sclerosis.
Int J MS Care. 2018 May-Jun;20(3):101-108.
abstract
Read the full text of this paper

Strober LB.
Quality of life and psychological well-being in the early stages of multiple sclerosis (MS): Importance of adopting a biopsychosocial model.
Disabil Health J. 2018 May 31. pii: S1936-6574(18)30084-0. [Epub ahead of print]
abstract

Malivoire BL, Hare CJ, Hart TL.
Psychological symptoms and perceived cognitive impairment in multiple sclerosis: The role of rumination.
Rehabil Psychol. 2018 May;63(2):286-294.
abstract

Rehabilitation

Peters S, Wilkinson A, Mulligan H.
Views of healthcare professionals on training for and delivery of a fatigue self-management program for persons with multiple sclerosis.
Disabil Rehabil. 2018 Jun 17:1-7. [Epub ahead of print]
abstract

Uszynski MK, Casey B, Hayes S, et al.
Social Cognitive theory correlates of physical activity in inactive adults with multiple sclerosis.
Int J MS Care. 2018 May-Jun;20(3):129-135.
abstract
Read the full text of this paper

Rice LA, Isaacs Z, Ousley C, et al.
Investigation of the feasibility of an intervention to manage fall risk in wheeled mobility device users with multiple sclerosis.
Int J MS Care. 2018 May-Jun;20(3):121-128.
abstract
Read the full text of this paper

Goverover Y, DeLuca J.
Assessing everyday life functional activity using actual reality in persons with MS.
Rehabil Psychol. 2018 May;63(2):276-285.
abstract

Symptoms and symptom management

Corfield F, Langdon D.
A Systematic review and meta-analysis of the brief cognitive assessment for multiple sclerosis (BICAMS).
Neurol Ther. 2018 Jun 19. [Epub ahead of print]
abstract
Read the full text of this paper

Tornic J, Sartori AM, Gajewski JB, et al.
Catheterization for treating neurogenic lower urinary tract dysfunction in patients with multiple sclerosis: A systematic review. A report from the Neuro-Urology Promotion Committee of the International Continence Society (ICS).
Neurourol Urodyn. 2018 Jun 19. [Epub ahead of print]
abstract

Adamec I, Crnošija L, Junaković A, et al.
Progressive multiple sclerosis patients have a higher burden of autonomic dysfunction compared to relapsing remitting phenotype.
Clin Neurophysiol. 2018 Aug;129(8):1588-1594.
abstract

Chinnadurai SA, Gandhirajan D, Pamidimukala V, et al.
Analysing the relationship between polysomnographic measures of sleep with measures of physical and cognitive fatigue in people with multiple sclerosis.
Mult Scler Relat Disord. 2018 May 23;24:32-37. [Epub ahead of print]
abstract

Valvano AK, Rollock MJD, Hudson WH, et al.
Sexual communication, sexual satisfaction, and relationship quality in people with multiple sclerosis.
Rehabil Psychol. 2018 May;63(2):267-275.
abstract

Cotter J, Vithanage N, Colville S, et al.
Investigating domain-specific cognitive impairment among patients with multiple sclerosis using touchscreen cognitive testing in routine clinical care.
Front Neurol. 2018 May 11;9:331.
abstract
Read the full text of this paper

Vitamin D

DeLuca HF, Plum L.
UVB radiation, vitamin D and multiple sclerosis.
Photochem Photobiol Sci. 2017 Mar 16;16(3):411-415.
abstract

Work

Chen J, Taylor BV, Blizzard L, et al.
Effects of multiple sclerosis disease-modifying therapies on employment measures using patient-reported data.
J Neurol Neurosurg Psychiatry. 2018 Jun 19. pii: jnnp-2018-318228. [Epub ahead of print]
abstract

Chen J, Taylor B, Palmer AJ, et al.
Estimating MS-related work productivity loss and factors associated with work productivity loss in a representative Australian sample of people with multiple sclerosis.
Mult Scler. 2018 Jun 1:1352458518781971. [Epub ahead of print]
abstract

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