MS research update - 11 December 2009
- Effects of 44mcg versus 22mcg dose of interferon beta-1a on cognition in MS
- Sensory symptoms at MS onset associated with a better outlook in primary progressive MS
- Pilot study assesses safety of vascular surgery in people with MS
Effects of 44mcg versus 22mcg dose of interferon beta-1a on cognition in MS
The aim of this study was to assess the effects of two different doses of the self-injected disease modifying drug interferon beta-1a on cognition in people with MS who have minimal disability. 459 people with MS were enrolled on the study which consisted of two treatment groups: 223 people received a 22mcg dose of interferon beta-1a; 236 people received the 44mcg dose of interferon beta-1a. The study participants underwent neuropsychological testing at study entry and throughout the three year course of the study to determine which participants were cognitively impaired, what level of cognitive impairment was present, and how levels of cognitive impairments changed throughout the course of the three year study.
The results of the study revealed that cognitive impairment at the end of 3 years was significantly higher in the group that was treated with the 22mcg dose of interferon beta-1a compared with group treated with the 44mcg dose of interferon beta 1a. The authors conclude that the cognitive benefits that people with MS who have mild disability may derive from disease modifying drug treatment may depend on the dose they receive.
Patti F, Amato MP, Bastianello S, et al.
Effects of immunomodulatory treatment with subcutaneous interferon beta-1a on cognitive decline in mildly disabled patients with relapsing remitting multiple sclerosis.
Neurology 2009; 73(22):1842-8.
Medline abstract
Sensory symptoms at MS onset associated with a better outlook in primary progressive MS
Of all MS subtypes, primary progressive MS is associated with the least favourable outcome. But research has shown that there is great variability between people with primary progressive MS and that certain characteristics may be predictive of a more favourable course.
The present study aimed to determine whether there is any link between the progression of disability and the following factors: type of symptoms experienced at onset of MS; age at onset of MS; and gender. Based on the data for 552 people with MS, the study authors investigated any apparent trends between these three factors and the time it took for people to reach EDSS 6. Point 6 on EDSS equates with the inability to walk without the support of a walking aid.
Analysis of the data revealed that sensory symptoms (such as pain, numbness, vision problems) and a younger age at MS onset were associated with a longer time to reach EDSS 6. While a younger age at MS onset was associated with a slower progression of disability, it was also associated with a younger age at which people reached EDSS 6. No associations could be drawn between gender and other types of symptoms at onset and the rate of disability progression.
Koch M, Kingwell E, Reickmann, et al.
The natural history of primary progressive multiple sclerosis.
Neurology 2009; 73(23):1996-2002.
Medline abstract
Pilot study assesses safety of vascular surgery in people with MS
It has recently been suggested that chronic cerebro-spinal venous insufficiency (CCSVI) is highly prevalent in people with MS. CCSVI is the name that has been given to a phenomenon whereby stenosis (an abnormal narrowing or obstruction) in blood vessels that take blood from the brain allows a build up of iron. One team of researchers have hypothesised that such blockages contribute to nervous system damage that occurs in MS.
This pilot study assessed the safety of a surgical technique (percutaneous transluminal angioplasty) that is used to relieve blockages in the blood vessels, in 65 people with MS who presented with CCSVI.
The study authors conclude that this procedure is safe in people with MS and was significantly associated with a reduction of relapses in people with a relapsing remitting course of MS. The authors acknowledge the limitations of the study given the small number of people involved and suggest that larger studies are necessary to establish the safety and effectiveness of this treatment for people with MS.
Further limitations of the study include the short period of follow (18 months) and the lack of a control group - a non-treatment group against which the effects seen in the treatment group might have been compared.
Zamboni P, Galeotti R, Menegatti E, et al.
A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency.
Journal of Vascular Surgery 2009; 50(6): 1348-58.
Medline abstract