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MS research update – How does staying in hospital affect your MS? – 26 June 2017

Summary

Canadian researchers analysed details of hospital stays for a group of 2,100 people with MS attending a clinic in Calgary. Over a five year period, 23% (491 people) had been in hospital at least once, of which 29% were planned hospital stays. 7% (156 people) had been in hospital more than once. Hospital stays relating to pregnancy and childbirth were excluded.

For the whole group, the average increase in disability was 1 EDSS point every 10 years. Following hospital stays there was a sharp increase in EDSS. On average EDSS increased by 0.23 points, equivalent to approximately 2.5 years of MS progression. The effect of a second hospital stay led to a similar sharp increase in EDSS. Following hospital stays, progression continued at the previous rate.

The increase in disability was greater for unplanned, emergency stays compared to planned stays, for admission to the intensive care unit, for hospital stays not related to MS and for longer rather than shorter lengths of stay.

The results clearly show that a sudden illness requiring a stay in hospital leads to an increase in disability. Many of the reasons for admission - bladder problems like urinary tract infections, bowel problems like constipation and respiratory problems - are things which could be prevented with proactive care.


Background

A recent MS Trust report showed that an increasing number of people with MS have to go to hospital for emergency treatment. But how do these visits affect your MS? This research study has looked at the impact that sudden illness needing admission to hospital can have on disability levels in people with MS.

How this study was carried out

Canadian researchers cross-referenced two sources of data - records from an MS clinic in Calgary with a database recording details of hospital stays - to select records which included EDSS assessments together with other details. Hospital stays relating to pregnancy and childbirth were excluded.

What was found

From the two sources, the researchers identified just over 2100 people with MS. Over a five year period, 23% (491 people) had been in hospital at least once, of which 29% were planned hospital stays. 7% (156 people) had been in hospital more than once.

The underlying rate of disability progression, measured by an increase in EDSS, averaged approximately 1 EDSS point per decade. Following hospital stays there was a sharp increase in EDSS; on average EDSS increased by 0.23 points, equivalent to about 2.5 years of MS progression. The effect of a second hospital stay lead to a similar sharp increase in EDSS. Following hospital stays, disease progression continued at the previous rate.

The sharp increase was greater for unplanned, emergency stays compared to planned stays, for hospital stays that required a stay in the intensive care unit, for hospital stays not related to MS, and for longer rather than shorter lengths of stay.

What does it mean?

The results clearly show that a sudden illness requiring a stay in hospital leads to an increase in disability. More than anything else the results emphasise the importance of avoiding the need to go to hospital in the first place. Many of the reasons for admission - bladder problems like urinary tract infections, bowel problems like constipation and respiratory problems - are things which could be prevented with proactive care.

Garland A, et al.
Hospitalization is associated with subsequent disability in multiple sclerosis
Multiple Sclerosis and Related Disorders 2017; 14: 23-28
Abstract
Read the full text of this paper 

More about avoiding unplanned hospital visits

Urinary tract infections, pressure ulcers, chest infections and other complications caused by MS can be identified and addressed at an early stage, before they get to the point where someone ends up in hospital. MS specialist nurses play an important role in identifying people at risk of complications before the crisis happens and coordinating health services to provide more proactive care.  However, it is not always possible to avoid hospital stays; in the case of serious illness, hospital staff can provide expert care not available if you are treated at home.

Having MS doesn't stop people from developing other medical conditions so it's important to seek medical advice for any unexplained symptoms you might notice. Taking advantage of any health screening programmes you are offered can spot early signs of other illnesses and improve the likelihood of successful treatment. People with MS are eligible for the annual flu jab; flu can be unpleasant if you are otherwise healthy but can lead to more serious complications, such as bronchitis and pneumonia which may require hospital treatment.

Many people actively take steps to manage their MS and to live as well as possible. This can include keeping as fit and active as you can through regular exercise, maintaining a healthy weight, keeping your mind active, avoiding smoking, limiting how much alcohol you drink and continuing to take any other medicines that you doctor has prescribed.

Research by topic areas...

Causes of MS

Sheik-Ali S.
Infectious mononucleosis and multiple sclerosis - Updated review on associated risk.
Mult Scler Relat Disord. 2017 May;14:56-59.
abstract

Co-existing conditions

Thormann A, Sørensen PS, Koch-Henriksen N, et al.
Chronic comorbidity in multiple sclerosis is associated with lower incomes and dissolved intimate relationships.
Eur J Neurol. 2017 Jun;24(6):825-834.
abstract

Gaindh D, Kavak KS, Teter B, et al.
Decreased risk of cancer in multiple sclerosis patients and analysis of the effect of disease modifying therapies on cancer risk.
J Neurol Sci. 2016 Nov 15;370:13-17.
abstract

Diagnosis

Metz LM, Li DKB, Traboulsee AL, et al.
Trial of Minocycline in a Clinically Isolated Syndrome of Multiple Sclerosis.
N Engl J Med. 2017 Jun 1;376(22):2122-2133.
abstract

Fitzgerald KC, Munger KL, Hartung HP, et al.
Sodium intake and multiple sclerosis activity and progression in BENEFIT.
Ann Neurol. 2017 Jul;82(1):20-29.
abstract

Disease modifying drugs

Forci B, Mariottini A, Mechi C, et al.
Disease reactivation following fingolimod withdrawal in multiple sclerosis: Two case reports.
Mult Scler Relat Disord. 2017 Jul;15:24-26.
abstract

Baker D, Herrod SS, Alvarez-Gonzalez C, et al.
Both cladribine and alemtuzumab may effect MS via B-cell depletion.
Neurol Neuroimmunol Neuroinflamm. 2017 Jun 5;4(4):e360.
abstract
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Masingue M, Debs R, Maillart E, et al.
Fatigue evaluation in fingolimod treated patients: An observational study.
Mult Scler Relat Disord. 2017 May;14:8-11.
abstract

Jongen PJ.
Health-Related Quality of Life in Patients with Multiple Sclerosis: Impact of Disease-Modifying Drugs.
CNS Drugs. 2017 Jul;31(7):585-602.
abstract
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Scott TF, Kieseier BC, Newsome SD, et al.
Improvement in relapse recovery with peginterferon beta-1a in patients with multiple sclerosis.
Mult Scler J Exp Transl Clin. 2016 Nov 15;2:2055217316676644.
abstract
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Steinman L.
Induction of New Autoimmune Diseases After Alemtuzumab Therapy for Multiple Sclerosis: Learning from Adversity.
JAMA Neurol. 2017 Jun 12. [Epub ahead of print]
abstract

Baker D, Herrod SS, Alvarez-Gonzalez C, et al.
Interpreting Lymphocyte Reconstitution Data From the Pivotal Phase 3 Trials of Alemtuzumab.
JAMA Neurol. 2017 Jun 12. [Epub ahead of print]
abstract

Mehta L, Umans K, Ozen G, et al.
Immune Response to Seasonal Influenza Vaccine in Patients with Relapsing-Remitting Multiple Sclerosis Receiving Long-term Daclizumab Beta: A Prospective, Open-Label, Single-Arm Study.
Int J MS Care. 2017 May-Jun;19(3):141-147.
abstract
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D'Amico E, Ziemssen T, Cottone S.
To stop or not to stop disease modifying therapies in secondary progressive multiple sclerosis, that is the question.
Expert Rev Neurother. 2017 Jun 16:1-3. [Epub ahead of print]
abstract
Read the full text of this paper

Drugs in development

Chan D, Binks S, Nicholas JM, et al.
Effect of high-dose simvastatin on cognitive, neuropsychiatric, and health-related quality-of-life measures in secondary progressive multiple sclerosis: secondary analyses from the MS-STAT randomised, placebo-controlled trial.
Lancet Neurol. 2017 Aug;16(8):591-600.
abstract
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Filippi M, Rocca MA.
Simvastatin and cognition in multiple sclerosis.
Lancet Neurol. 2017 Aug;16(8):572-573.
abstract
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Economics

Kobelt G, Eriksson J, Phillips G, et al.
The burden of multiple sclerosis 2015: Methods of data collection, assessment and analysis of costs, quality of life and symptoms.
Mult Scler. 2017 Aug;23(2_suppl):4-16.
abstract
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Thompson A, Kobelt G, Berg J, et al.
New insights into the burden and costs of multiple sclerosis in Europe: Results for the United Kingdom.
Mult Scler. 2017 Aug;23(2_suppl):204-216.
abstract
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Other treatments

Patel VP, Feinstein A.
Cannabis and cognitive functioning in multiple sclerosis: The role of gender.
Mult Scler J Exp Transl Clin. 2017 Jun 8;3(2):2055217317713027.
abstract
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Ludwig MD, Turel AP, Zagon IS, et al.
Long-term treatment with low dose naltrexone maintains stable health in patients with multiple sclerosis.
Mult Scler J Exp Transl Clin. 2016 Sep 29;2:2055217316672242.
abstract
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Soheili M, Nazari F, Shaygannejad V, et al.
A comparison the effects of reflexology and relaxation on the psychological symptoms in women with multiple sclerosis.
J Educ Health Promot. 2017 Apr 19;6:11.
abstract
Read the full text of this paper

Paediatric MS

Pakpoor J, Seminatore B, Graves JS, et al.
Dietary factors and pediatric multiple sclerosis: A case-control study.
Mult Scler. 2017 Jun 1:1352458517713343. [Epub ahead of print]
abstract

Graves JS, Chitnis T, Weinstock-Guttman B, et al.
Maternal and Perinatal Exposures Are Associated With Risk for Pediatric-Onset Multiple Sclerosis.
Pediatrics. 2017 Apr;139(4). pii: e20162838.
abstract

Pathophysiology

Redondo J, Sarkar P, Kemp K, et al.
Reduced cellularity of bone marrow in multiple sclerosis with decreased MSC expansion potential and premature ageing in vitro.
Mult Scler. 2017 May 1:1352458517711276. [Epub ahead of print]
abstract
Read the full text of this paper

Prognosis

O'Gorman CM, Broadley SA.
Smoking increases the risk of progression in multiple sclerosis: A cohort study in Queensland, Australia.
J Neurol Sci. 2016 Nov 15;370:219-223.
abstract

Rehabilitation

Barr CJ, Patritti BL, Bowes R, et al.
Orthotic and therapeutic effect of functional electrical stimulation on fatigue induced gait patterns in people with multiple sclerosis.
Disabil Rehabil Assist Technol. 2017 Aug;12(6):560-572.
abstract

Leonard G, Lapierre Y, Chen JK, et al.
Noninvasive tongue stimulation combined with intensive cognitive and physical rehabilitation induces neuroplastic changes in patients with multiple sclerosis: A multimodal neuroimaging study.
Mult Scler J Exp Transl Clin. 2017 Feb 1;3(1):2055217317690561.
abstract
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Backus D, Burdett B, Hawkins L, et al.
Outcomes After Functional Electrical Stimulation Cycle Training in Individuals with Multiple Sclerosis Who Are Nonambulatory.
Int J MS Care. 2017 May-Jun;19(3):113-121.
abstract
Read the full text of this paper

Heine M, Verschuren O, Hoogervorst EL, et al.
Does aerobic training alleviate fatigue and improve societal participation in patients with multiple sclerosis? A randomized controlled trial.
Mult Scler. 2017 May 1:1352458517696596. [Epub ahead of print]
abstract
Read the full text of this paper

Blikman LJ, van Meeteren J, Twisk JW, et al.
Effectiveness of energy conservation management on fatigue and participation in multiple sclerosis: A randomized controlled trial.
Mult Scler. 2017 May 1:1352458517702751. [Epub ahead of print]
abstract

Davies BL, Arpin DJ, Liu M, et al.
Two Different Types of High-Frequency Physical Therapy Promote Improvements in the Balance and Mobility of Persons With Multiple Sclerosis.
Arch Phys Med Rehabil. 2016 Dec;97(12):2095-2101.e3.
abstract

Ortiz-Rubio A, Cabrera-Martos I, Rodríguez-Torres J, et al.
Effects of a Home-Based Upper Limb Training Program in Patients With Multiple Sclerosis: A Randomized Controlled Trial.
Arch Phys Med Rehabil. 2016 Dec;97(12):2027-2033.
abstract

Uszynski MK, Purtill H, Donnelly A, et al.
Comparing the effects of whole-body vibration to standard exercise in ambulatory people with Multiple Sclerosis: a randomised controlled feasibility study.
Clin Rehabil. 2016 Jul;30(7):657-68.
abstract

Stem cells

Muraro PA, Martin R, Mancardi GL, et al.
Autologous haematopoietic stem cell transplantation for treatment of multiple sclerosis.
Nat Rev Neurol. 2017 Jul;13(7):391-405.
abstract

Cull G, Hall D, Fabis-Pedrini MJ, et al.
Lymphocyte reconstitution following autologous stem cell transplantation for progressive MS.
Mult Scler J Exp Transl Clin. 2017 Mar 23;3(1):2055217317700167.
abstract
Read the full text of this paper

Symptoms and symptom management

Oliveria SF, Rodriguez RL, Bowers D, et al.
Safety and efficacy of dual-lead thalamic deep brain stimulation for patients with treatment-refractory multiple sclerosis tremor: a single-centre, randomised, single-blind, pilot trial.
Lancet Neurol. 2017 Jun 19. pii: S1474-4422(17)30166-7. [Epub ahead of print]
abstract

Soh D, Fasano A.
Multiple sclerosis tremor: are technical advances enough?
Lancet Neurol. 2017 Jun 19. pii: S1474-4422(17)30198-9. [Epub ahead of print]
abstract

Bartnik P, Wielgoś A, Kacperczyk J, et al.
Sexual dysfunction in female patients with relapsing-remitting multiple sclerosis.
Brain Behav. 2017 Apr 14;7(6):e00699.
abstract
Read the full text of this paper

Afrasiabifar A, Karami F, Najafi Doulatabad S.
Comparing the effect of Cawthorne-Cooksey and Frenkel exercises on balance in patients with multiple sclerosis: a randomized controlled trial.
Clin Rehabil. 2017 Jun 1:269215517714592. [Epub ahead of print]
abstract

Silverman EP, Miller S, Zhang Y, et al.
Effects of expiratory muscle strength training on maximal respiratory pressure and swallow-related quality of life in individuals with multiple sclerosis.
Mult Scler J Exp Transl Clin. 2017 May 29;3(2):2055217317710829.
abstract
Read the full text of this paper

Hugos CL, Bourdette D, Chen Y, et al.
A group-delivered self-management program reduces spasticity in people with multiple sclerosis: A randomized, controlled pilot trial.
Mult Scler J Exp Transl Clin. 2017 Mar 23;3(1):2055217317699993.
abstract
Read the full text of this paper

Atula S, Sinkkonen ST, Saat R, et al.
Association of multiple sclerosis and sudden sensorineural hearing loss.
Mult Scler J Exp Transl Clin. 2016 May 31;2:2055217316652155.
abstract
Read the full text of this paper

Hoogerwerf AEW, Bol Y, Lobbestael J, et al.
Mindfulness-based cognitive therapy for severely fatigued multiple sclerosis patients: A waiting list controlled study.
J Rehabil Med. 2017 Jun 28;49(6):497-504.
abstract
Read the full text of this paper

Dibley L, Coggrave M, McClurg D, et al.
It's just horrible": a qualitative study of patients' and carers' experiences of bowel dysfunction in multiple sclerosis.
J Neurol. 2017 Jul;264(7):1354-1361.
abstract

van den Akker LE, Beckerman H, Collette EH, et al.
Cognitive behavioral therapy positively affects fatigue in patients with multiple sclerosis: Results of a randomized controlled trial.
Mult Scler. 2017 May 1:1352458517709361. [Epub ahead of print]
abstract

Brucker BM, Nitti VW, Kalra S, et al.
Barriers experienced by patients with multiple sclerosis in seeking care for lower urinary tract symptoms.
Neurourol Urodyn. 2017 Apr;36(4):1208-1213.
abstract

Vitamin D

Pierrot-Deseilligny C, Souberbielle JC.
Vitamin D and multiple sclerosis: An update.
Mult Scler Relat Disord. 2017 May;14:35-45.
abstract

Work

Meide HV, Gorp DV, van der Hiele K, et al.
"Always looking for a new balance": toward an understanding of what it takes to continue working while being diagnosed with relapsing-remitting multiple sclerosis.
Disabil Rehabil. 2017 Jun 22:1-8. [Epub ahead of print]
abstract

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