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MS research update - Natural improvements in MS disability - 04 July 2012

MS is a complex condition with a wide range of possible symptoms which can go up and down in severity with time. Increasing disability is a major concern but improvements do occur. These may be in the short term, for example when recovering after a relapse or because of treatment, or they could occur independently.

This study examined whether people with MS experience natural improvements, where levels of disability decrease over one or two years. The researchers used the British Columbian MS database where data could be retrieved about people with MS between 1980 and 2009 who were not receiving any disease modifying treatment at the time they were assessed.

The EDSS score, a commonly used measure of disability in MS, was available for 2,961 people with MS with one year between assessments and for 2,382 people with a two year gap between assessments. As several assessments over time were often available for the same person, this amounted to a very large amount of data: 7,653 yearly intervals and 5,845 two year intervals.

Looking at the yearly intervals, about one in seven (15%) showed an improvement of at least half a point on the EDSS scale, one in 12 (8%) showed an improvement of at least one point and one in 45 (2.2%) showed an improvement of at least two points on the scale. The results looking at a two year interval were very similar. Almost half of those experiencing an improvement remained improved over a longer period.

The people who experienced an improvement were more likely to belong to one or more of the following groups: women, younger age, relatively recent disease onset, relapsing onset MS , moderate disability (as compared with either mild or advanced levels of disability), and a previous worsening of disability that was not associated with a relapse.

Almost a quarter (24%) of people with primary progressive MS experienced improvements over one or two years and half of these experienced a longer improvement.

The researchers concluded that improvements in MS are not unusual although the majority of people in the study showed no change in their level of disability over one or two years. They suggest that these improvements are most likely due to the body's natural ability to repair itself although it was possible that treatments for particular symptoms played a part.

This study provides some welcome encouragement for people with MS, including people with primary progressive MS, as the focus of research is often on disability rather than improvement.

Tremlett H, Zhu F, Petkau J, et al.
Natural, innate improvements in multiple sclerosis disability.
Mult Scler. 2012 Jun 26. [Epub ahead of print]


How MS affects the mouth and face

This study looked at the different ways that MS can affect the mouth and face and how often this occurred.

500 people with MS aged between 11 and 69 underwent a standard neurological examination. The researchers were particularly looking for:

  • trigeminal neuralgia (an intense stabbing and burning sensation down the side of the face)
  • facial palsy (the muscles of the face are affected due to damage to the facial nerve)
  • temporomandibular disorders (problems affecting the jaw joint)
  • visual complications (problems with eye sight)
  • dysphagia (problems with swallowing)
  • dysarthria (speech problems caused by weakness or lack of coordination in the muscles used in speaking)

In total, about nine out of ten participants experienced orofacial (mouth and face) symptoms. The most common were problems with vision (80%) followed by temporomandibular disorders (58%), dysarthria (42%), dysphagia (27%), facial palsy (19%), and trigeminal neuralgia (8%). Those who had MS for longer were more likely to have these symptoms.

The researchers suggest that people should make their dentists aware of any of these symptoms so that the dentist can take these issues into account and suggest the best dental treatment.

Danesh-Sani SA, Rahimdoost A, Soltani M, et al.
Clinical assessment of orofacial manifestations in 500 patients with multiple sclerosis.
J Oral Maxillofac Surg. 2012 Jun 26. [Epub ahead of print]

Disease modifying treatments

Rossi S, Motta C, Studer V, et al.
Effect of glatiramer acetate on disease reactivation in MS patients discontinuing natalizumab.
Eur J Neurol. 2012 Jun 28. doi: 10.1111/j.1468-1331.2012.03794.x. [Epub ahead of print]

David OJ, Ocwieja M, Meiser K, et al.
Pharmacokinetics of fingolimod (FTY720) and a combined oral contraceptive coadministered in healthy women: drug-drug interaction study results.
Int J Clin Pharmacol Ther. 2012 Jun 26. [Epub ahead of print]

Assessment tools

Kieseier BC, Pozzilli C.
Assessing walking disability in multiple sclerosis.
Mult Scler. 2012 Jul;18(7):914-24.

Ontaneda D, Larocca N, Coetzee T, et al.
Revisiting The Multiple Sclerosis Functional Composite: proceedings from the National Multiple Sclerosis Society (NMSS) Task Force on Clinical Disability Measures.
Mult Scler. 2012 Jun 27. [Epub ahead of print]

Quality of life

Benito-León J, Mitchell AJ, Rivera-Navarro J, et al.
Impaired health-related quality of life predicts progression of disability in multiple sclerosis.
Eur J Neurol. 2012 Jun 28. doi: 10.1111/j.1468-1331.2012.03792.x. [Epub ahead of print]

Causes of MS

Pakpoor J, Disanto G, Gerber JE, et al.
The risk of developing multiple sclerosis in individuals seronegative for Epstein-Barr virus: a meta-analysis.
Mult Scler. 2012 Jun 11. [Epub ahead of print]

Vitamin D

Weinstock-Guttman B, Mehta BK, Ramanathan M, et al.
Vitamin D and multiple sclerosis.
Neurologist. 2012 Jul;18(4):179-83.

Psychological aspects

Stepanov II, Abramson CI, Hoogs M, et al.
Overall memory impairment identification with mathematical modeling of the CVLT-II learning curve in multiple sclerosis.
Mult Scler Int. 2012;2012:312503.

Moss-Morris R, Dennison L, Landau S, et al.
A randomized controlled trial of cognitive behavioral therapy (CBT) for adjusting to multiple sclerosis (the SAMS trial): does CBT work and for whom does it work?
J Consult Clin Psychol. 2012 Jun 25. [Epub ahead of print]


Heisen M, Treur M, Van der Hel W, et al.
Fingolimod reduces direct medical costs compared to natalizumab in patients with relapsing-remitting multiple sclerosis in the Netherlands.
J Med Econ. 2012 Jun 28. [Epub ahead of print]


Tutuncu M, Tang J, Zeid NA, et al.
Onset of progressive phase is an age-dependent clinical milestone in multiple sclerosis.
Mult Scler. 2012 Jun 26. [Epub ahead of print]

Pregnancy and childbirth

Borisow N, Döring A, Pfueller CF, et al.
Expert recommendations to personalization of medical approaches in treatment of multiple sclerosis: an overview of family planning and pregnancy.
EPMA J. 2012 Jun 22;3(1):9. [Epub ahead of print]

McCombe PA, Greer JM.
Female reproductive issues in multiple sclerosis.
Mult Scler. 2012 Jun 25. [Epub ahead of print]

Bone health

Dobson R, Ramagopalan S, Giovannoni G.
Bone health and multiple sclerosis.
Mult Scler. 2012 Jun 27. [Epub ahead of print]


Kuehn BM.
FDA warns about the risks of unproven surgical therapy for multiple sclerosis.
JAMA. 2012 Jun 27;307(24):2575-6.

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