MS research update - 20 November 2009
- Antidepressant prevents stress-related relapses in women with MS
- Inflammation on brain MRI linked to poor cognitive performance
- MS has little impact on pregnancy outcomes
- Fluctuation in MS symptoms linked to hormonal changes during menstrual cycle
Antidepressant prevents stress-related relapses in women with MS
Previous research has suggested that there is a strong link between stressful life events and an increased risk of relapse in MS. The present study investigated the effects of a commonly prescribed antidepressant - escitalopram - on stress-related relapses in women with MS. 48 women with relapsing remitting MS who had experienced at least one MS relapse in the previous year were recruited and followed over one year. The participants were randomly divided into two equally numbered groups. One the groups were assigned to receive a daily 10mg dose of escitalopram while the second group were not assigned any treatment. Both groups kept self-report diaries recording stressful life events over the course of the year. During the study period 55 confirmed relapses occurred in 33 of the participants.
Analysis of the study revealed a significant reduction in the mean number of relapses - compared with the year prior to the study - experienced by the group receiving escitalopram. The group that did not receive anti-depressant treatment showed no significant change in the mean number of relapses experienced.
These findings suggest a potential role for antidepressant medication in reducing the risk of stress-induced relapses in women with MS. Further studies are needed to fully understand the therapeutic potential of antidepressants in MS.
Thaera GM, Wellik KE, Carter JL, et al.
Effects of escitalopram on stress-related relapses in women with multiple sclerosis: an open-label, randomized, controlled, one year follow-up study.
European Neuropsychopoharmacology 2009; [Epub ahead of print].
View abstract
Inflammation on brain MRI linked to poor cognitive performance
The term cognition refers to processes such as thinking, remembering, judgement and reasoning. Many people with MS experience cognitive problems which are most often mild and manageable. A tool that is frequently used for measuring cognitive function in MS is the Paced Auditory Serial Addition Test (PASAT). The present study recruited 75 people with relapsing remitting MS without clinical signs of a relapse to undergo brain MRI scans followed by PASAT testing at two points in time 10 weeks apart.
MRI scans were studied for the presence of gadolinium enhancing lesions. Gadolinium is an inert material used to enhance images on MRI scans and is a key marker of inflammatory activity in the brain. The participants who presented with a gadolinium enhanced lesion on MRI at one of their visits but not for the other, performed significantly better in PASAT testing at the point when no gadolinium enhancing lesions were present. The study authors concluded that inflammatory activity in the brains of people who are relapse free can detrimentally affect their cognitive performance.
Bellmann-Strobl J, Wuerfel J, Aktas O, et al.
Poor PASAT performance correlates with MRI contrast enhancement in multiple sclerosis.
Neurology 2009; 73(20): 1624-7.
Medline abstract
MS has little impact on pregnancy outcomes
A recent study has shown that having MS does not significantly influence the likelihood of a having a healthy pregnancy. Researchers analysed a large US database containing information about pregnancies and deliveries in women with MS, epilepsy, diabetes mellitus and the general healthy population. They studied information relating to the following pregnancy outcomes: length of hospital stay; high blood pressure; premature rupture of the sac surrounding the foetus; low birth weight; and caesarean section delivery. Aside from a slightly higher risk of low birth weight babies and caesarean delivery, MS was not associated with an elevated risk for any of the other pregnancy complications.
Kelly VM, Nelson LM, Chakravarty EF.
Obstetric outcomes in women with multiple sclerosis and epilepsy.
Neurology 2009; [Epub ahead of print].
Medline abstract
Fluctuation in MS symptoms linked to hormonal changes during menstrual cycle
The present study investigated the relationship between changes in MS symptoms and hormonal changes seen at various stages of a woman's menstrual cycle. 16 women with MS who were not taking oral contraception and were experiencing natural menstrual cycles and seven women with MS who were taking combined oral contraceptives monitored and scored their symptoms every day over the duration of three full cycles. The 16 women who were not using contraception, showed no significant changes in symptoms across the different stages of their menstrual cycle. However, the women who were taking the combined contraceptive pill reported significantly higher symptom score points for weakness, numbness and tiredness during the pill-free period compared to the phase during which they were taking the pill daily. The lower symptom scores during the contraceptive pill-taking phase suggests the steroid hormones present in the contraceptive pill have a beneficial effect on MS symptoms. The significance of this study is limited because of the small number of people involved but it provides an interesting hypothesis for future larger scale research into the effects of contraceptive medicines on MS symptoms.
Holmqvist P, Hammar M, Landtblom AM, et al.
Symptoms of multiple sclerosis in women in relation to cyclical hormone changes.
European Journal of contraception and Reproductive Health Care 2009; 14(5):365-70.
Medline abstract