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MS research update - Migraine and MS: the effect of disease in modifying treatments - 12 April 2012

Migraines are severe recurring headaches, usually affecting only one side of the head, characterized by sharp pain and often accompanied by nausea, vomiting, and visual disturbances. Migraines affect one in seven adults in the UK, with women being three times more likely to get them than men. Migraines are more common in some families than others.

Many people who have migraines find that they are triggered or made worse by certain changes or events and that avoiding these triggers improves their quality of life.

This research paper looked at the effect of taking disease modifying treatment (beta interferon or natalizumab) on people with MS who also had migraines. They looked at how often migraines occurred and how disabling they were. Two groups of people with MS were compared: 33 people who had previously had beta interferon and then switched to natalizumab (Tysabri) and 30 people who had remained on beta interferon.

They found that people who had switched to natalizumab had significantly fewer migraines per month – down from an average of over 8 days a month to about 5 days a month. The severity of the migraines was also reduced.

Previous work had suggested that beta interferon made migraines worse so it seems that natalizumab does not have this effect. This may be an important factor to consider for people who have both MS and migraine when deciding on which disease modifying treatment to try.

Villani V, Prosperini L, De Giglio L, et al.
The impact of interferon beta and natalizumab on comorbid migraine in multiple sclerosis.
Headache. 2012 Apr 5. doi: 10.1111/j.1526-4610.2012.02146.x. [Epub ahead of print]

Does taking oral contraceptives (The Pill) affect MS?

It is already known than sex hormone levels affect MS, for example, MS is more common in women than men. Also, relapses are often less frequent during pregnancy but can be more frequent in the six months after giving birth and this is thought to be related to hormone changes.

This study looked at the effect on women with MS of taking oral contraceptives (commonly known as The Pill), which are manufactured versions of the naturally occurring female hormones.

132 women were divided into three groups depending on their use of oral contraceptives: (1) women who had never used oral contraceptives; (2) women who had used them in the past but had stopped before their MS began and (3) women who used them after their MS began.

They found that women who used oral contraceptives after their MS began were more likely to have benign MS (a few, very mild attacks separated by long periods with no symptoms) and to have lower EDSS scores reflecting lower levels of disability.

The researchers suggest that using oral contraceptives (The Pill) may be associated with a milder disease course for women with MS.

Sena A, Couderc R, Vasconcelos JC, et al.
Oral contraceptive use and clinical outcomes in patients with multiple sclerosis.
J Neurol Sci. 2012 Mar 27. [Epub ahead of print]

Research by topic areas...

Symptoms and symptom management

Krishnan V, Kanekar N, Aruin AS.
Feedforward postural control in individuals with multiple sclerosis during load release.
Gait Posture. 2012 Apr 4. [Epub ahead of print]

Williams D.
Management of bladder dysfunction in patients with multiple sclerosis.
Nurs Stand. 2012 Feb 22-28;26(25):39-46.

Disease modifying treatments

Penner IK, Stemper B, Calabrese P, et al.
Effects of interferon beta-1b on cognitive performance in patients with a first event suggestive of multiple sclerosis.
Mult Scler. 2012 Apr 4.[Epub ahead of print]

Roskell N, Zimovetz E, Rycroft C, et al.
Annualized relapse rate of first-line treatments for multiple sclerosis: a meta-analysis, including indirect comparisons versus fingolimod.
Curr Med Res Opin. 2012 Apr 2. [Epub ahead of print]

Goodin DS, Jones J, Li D, et al.
Establishing long-term efficacy in chronic disease: use of recursive partitioning and propensity score adjustment to estimate outcome in MS.
PLoS One. 2011;6(11):e22444.

Assessment tools

Vereecken M, Vanderstraeten G, Ilsbroukx S.
From "Wheelchair Circuit" to "Wheelchair Assessment Instrument for People with Multiple Sclerosis": Reliability and Validity Analysis of a Test to Assess Driving Skills in Manual Wheelchair Users With Multiple Sclerosis.
Arch Phys Med Rehabil. 2012 Apr 2. [Epub ahead of print]

Quality of life

Sweetland J, Howse E, Playford ED, et al.
A systematic review of research undertaken in vocational rehabilitation for people with multiple sclerosis.
Disabil Rehabil. 2012 Apr 3. [Epub ahead of print]

Psychological aspects

Rendell PG, Henry JD, Phillips LH, et al.
Prospective memory, emotional valence, and multiple sclerosis.
J Clin Exp Neuropsychol. 2012 Apr 4. [Epub ahead of print]

Physical activity

Freeman JA, Fox E, Gear M, et al.
Pilates based core stability training in ambulant individuals with multiple sclerosis: Protocol for a multi-centre randomised controlled trial.
BMC Neurol. 2012 Apr 5;12(1):19. [Epub ahead of print]

Hale LA, Smith C, Mulligan H, et al.
"Tell me what you want, what you really really want….": asking people with multiple sclerosis about enhancing their participation in physical activity.
Disabil Rehabil. 2012 Apr 5. [Epub ahead of print]

Motl RW, Sandroff BM, Suh Y, et al.
Energy Cost of Walking and Its Association With Gait Parameters, Daily Activity, and Fatigue in Persons With Mild Multiple Sclerosis.
Neurorehabil Neural Repair. 2012 Mar 30. [Epub ahead of print]

Kamm CP, Heldner MR, Vanbellingen T, et al.
Limb apraxia in multiple sclerosis: prevalence and impact on manual dexterity and activities of daily living.
Arch Phys Med Rehabil. 2012 Mar 28. [Epub ahead of print]

Balantrapu S, Sandroff BM, Sosnoff JJ, et al.
Perceived impact of spasticity is associated with spatial and temporal parameters of gait in multiple sclerosis.
ISRN Neurol. 2012;2012:675431.

Provision of care

Buecken R, Galushko M, Golla H, et al.
Patients feeling severely affected by multiple sclerosis: How do patients want to communicate about end-of-life issues?
Patient Educ Couns. 2012 Apr 3. [Epub ahead of print]


Artemiadis AK, Vervainioti AA, Alexopoulos EC, et al.
Stress management and multiple sclerosis: a randomized controlled trial.
Arch Clin Neuropsychol. 2012 Apr 3. [Epub ahead of print]

Bone health

Bazelier MT, Bentzen J, Vestergaard P, et al.
The risk of fracture in incident multiple sclerosis patients: The Danish National Health Registers.
Mult Scler. 2012 Apr 3. [Epub ahead of print]

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