MS research update - 28 August 2009
- Evidence supports early use of disease modifying drugs
- Effects of disease modifying drugs in pregnant women
- Effectiveness of CBT compared with supportive listening in helping adjustment to MS
- Botox injections improve symptoms of overactive bladder in people with MS
Evidence supports early use of disease modifying drugs
Clinically isolated syndrome (CIS) is an individual's first neurologic episode lasting at least 24 hours. It is caused by inflammation or damage to the covering of nerve in one or more sites in the central nervous system (CNS). Not everyone who experiences CIS will go on to develop MS and for some there may be no further symptoms. Current evidence supports early treatment of clinically isolated syndrome with disease modifying drugs to delay progression to MS in people at high risk. However, weighing the benefits of delaying the potential onset of definite MS, against the drawbacks of treating unnecessarily in cases where MS would not have emerged, is a point of some contention. The present article reviews all the available evidence to support the use of interferon-beta in reducing the risk of developing clinically definite MS. The article considers the rationale of early treatment within the paradigms of diagnostic criteria, pathological evidence, MRI evidence, clinical trial evidence and tolerability.
Comi G.
Shifting the paradigm toward earlier treatment of multiple sclerosis with interferon beta.
Clinical Therapeutics 2009;31(6):1142-57.
Medline abstract
Effects of disease modifying drugs in pregnant women
Because of the lack of available data there is still uncertainty about how women exposed to disease modifying drugs ought to be managed. The present prospective observational study (a study whereby participants were identified and then followed forward in time to assess outcomes) sought to determine the safety of interferon beta-1a, interferon beta 1b and glatiramer acetate for treatment of MS during pregnancy. Spontaneous abortions were within the normal range for all study groups. There were two serious birth defects in the glatiramer acetate group (club feet and a complex heart defect). Premature births were not significantly different to the rate of premature births seen in the healthy particpants. The study authors conclude that although their findings suggest that neither interferon-beta nor glatiramer acetate pose a major risk to unborn babies, further research is needed to prove the safety of their use during pregnancy.
Weber-Schoendorfer C, Schaefer C.
Multiple sclerosis, immunomodulators, and pregnancy outcome: a prospective observational study.
Multiple Sclerosis 2009; (9):1037-42.
Medline abstract
Effectiveness of CBT compared with supportive listening in helping adjustment to MS
Accepting and adjusting to a diagnosis of MS along with the uncertainty and unpredictability the condition often represents, poses unique challenges to every individual. MS can have a profound impact on people's lives and for some people it poses huge challenges in terms of psychological adjustment. This paper describes how a study will compare the effectiveness of cognitive behavioural therapy (CBT) with supportive listening in helping people adjust to MS. 122 people will be randomly allocated to receive either cognitive behavioural therapy or supportive listening. Eight one hour sessions of therapy (delivered over a period of ten weeks) will be delivered by general nurses trained in both treatments. Self-report questionnaires will be completed by participants at various stages throughout and after the study and will be designed to capture levels of distress and MS-related social and role impairment. The study authors point to the uniqueness of the study in terms of its aim to aid adjustment to MS in a broad sense. They also highlight that the use of nurses as therapists makes the intervention potentially viable in terms of being rolled out in the NHS.
Moss-Morris R, Dennison L, Yardley L, et al.
Protocol for the saMS trial (supportive adjustment for multiple sclerosis): A randomized controlled trial comparing cognitive behavioral therapy to supportive listening for adjustment to multiple sclerosis.
BioMedCentral Neurology 2009; 9(1):45.
Medline abstract
Botox injections improve symptoms of overactive bladder in people with MS
Neurogenic bladder is a dysfunction that results from interference with the normal nerve pathways associated with urination. It occurs in people with conditions relating to the nervous system such as multiple sclerosis and spinal cord injury. Neurogenic detrusor (bladder muscle) overactivity is characterised by uncontrolled, frequent voiding of urine from the bladder. The present study assessed the effectiveness of botulinum toxin A injections in a group of people presenting with overactive bladder due to different conditions including multiple sclerosis. 214 people took part in the study and significant improvements in rates of urinary tract infections and incontinence episodes were reported. There was also a significant reduction in the use of continence aids after treatment. The study authors point to the clinical benefits and the cost effectiveness of botox in the treatment of overactive bladder in a range of conditions.
Wefer B, Ehlken B, Bremer J, et al.
Treatment outcomes and resource use of patients with neurogenic detrusor overactivity receiving botulinum toxin A (BOTOX) therapy in Germany.
World Journal of Urology 2009; [Epub ahead of print] .
Medline abstract