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MS research update - More MS in town-dwelling women - 23 May 2012

In many areas of the world, the number of people with MS is going up and it seems to be going up faster in women than men. The reasons behind these increases are being investigated.

A study in Crete looked at every case of MS between 1980 and 2008. 657 people with MS (out of a population of over half a million) were identified and filled out a questionnaire. 593 people who did not have MS, but were matched for age, sex and current place of residence, were studied for comparison. The questionnaire asked about 71 different factors that might affect someone's chances of having MS.

The study found that the level of MS had gone up substantially over 30 years. This was particularly seen in women – in 1980, slightly more men than women had MS in Crete but in 2008, there were twice as many women as men.

Many people in Crete have moved from the countryside into the towns in the last thirty years and it was women living in towns, or who had moved to towns at a young age, who were most likely to have MS. In the countryside, the overall level of MS had not increased as much nor was there such an increase in MS in women relative to men.

The study examined what changes in lifestyle took place when people moved from the countryside to the towns. They found that the number of women with MS who smoked had gone up dramatically and that there was a change from using locally produced fresh goat's milk to imported cow's milk.

Women with MS were more likely to use contraceptives, were generally older when they had their first child, drank more alcohol and were more likely to take vitamins.

There was also a difference in the childhood diseases and chronic medical conditions experienced by people with MS compared to those who did not have MS.

The population was genetically stable (no major immigration or mixing of populations had taken place) so the researchers believe that the change in the level of MS across Crete, and particularly in women living in towns, is due to environmental factors.

Some factors observed in Crete, such as smoking, have already been identified as risk factors for MS. Others factors identified above may also play a part. However, more work will be needed because, in this type of epidemiological study, just because a particular factor rises in line with the level of MS, doesn't automatically mean that one causes the other. It could be coincidence or caused by something that they both have in common that is nothing to do with MS.

Kotzamani D, Panou T, Mastorodemos V, Tzagournissakis M, et al.
Rising incidence of multiple sclerosis in females associated with urbanization.
Neurology. 2012 May 16. [Epub ahead of print]

Increased risk of broken bones in MS

A study in the Netherlands followed 2,415 people with MS and over 12,000 controls who were matched for age, sex and area where they lived. During the study period 2.4% of the people with MS had a fracture (broken bone) as compared with 1.8% of the controls.

Osteoporotic fractures are those that occur in situations where healthy people would not normally break a bone. They occur because the bones are unusually fragile for some reason and are often in the spine, ribs, hips and wrists. People with MS were nearly twice (1.7 times) as likely to have an osteoporotic fracture. Of most concern, people with MS were four times more likely to break a hip.

The risk of breaking a bone was highest for people with MS who had been taking antidepressants or hypnotics/anxiolytics (drugs to help with sleep or anxiety) in the previous six months.

The researchers suggest that there should be increased awareness of the risks for people with MS of breaking bones, especially hip bones, and particularly for those on certain medications that seem to increase the risk even further.

Bazelier MT, van Staa TP, Uitdehaag BM, et al.
Risk of fractures in patients with multiple sclerosis: A population-based cohort study.
Neurology. 2012 May 16. [Epub ahead of print]

Research by topic areas...

Symptoms and symptom management

Abu-Mugheisib M, Benecke R, Zettl UK.
Management of spasticity in progressive multiple sclerosis: efficacy of repeated intrathecal triamcinolone acetonide administration.
Curr Pharm Des. 2012 May 16. [Epub ahead of print]

Vávrová J, Kemlink D, Sonka K, et al.
Restless legs syndrome in Czech patients with multiple sclerosis: An epidemiological and genetic study.
Sleep Med. 2012 May 18.[Epub ahead of print]

Tejani AM, Wasdell M, Spiwak R, et al.
Carnitine for fatigue in multiple sclerosis.
Cochrane Database Syst Rev. 2012 May 16;5:CD007280.

Williams DE, Lynch JE, Doshi V, et al.
Bruxism and temporal bone hypermobility in patients with multiple sclerosis.
Cranio. 2011 Jul;29(3):178-86.

Disease modifying treatments

Trampe AK, Hemmelmann C, Stroet A, et al.
Anti-JC virus antibodies in a large German natalizumab-treated multiple sclerosis cohort.
Neurology. 2012 May 16. [Epub ahead of print]

Bloomgren G, Richman S, Hotermans C, et al.
Risk of natalizumab-associated progressive multifocal leukoencephalopathy.
N Engl J Med. 2012 May 17;366(20):1870-80.

Other treatments

Mallory GW, Atkinson JL, Stien KJ, et al.
Outcomes after percutaneous surgery for patients with multiple sclerosis related trigeminal neuralgia.
Neurosurgery. 2012 May 15. [Epub ahead of print]

Corey-Bloom J, Wolfson T, Gamst A, et al.
Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial.
CMAJ. 2012 May 14. [Epub ahead of print]

Pryce G, Baker D.
Potential control of multiple sclerosis by cannabis and the endocannabinoid system.
CNS Neurol Disord Drug Targets. 2012 May 11. [Epub ahead of print]

Assessment tools

Yu F, Bilberg A, Dalgas U, et al.
Fatigued patients with multiple sclerosis can be discriminated from healthy controls by the recordings of a newly developed measurement system (FAMOS): a pilot study.
Disabil Rehabil Assist Technol. 2012 May 15. [Epub ahead of print]

Causes of MS

Disanto G, Morahan JM, Ramagopalan SV.
Multiple sclerosis: risk factors and their interactions.
CNS Neurol Disord Drug Targets. 2012 May 11. [Epub ahead of print]

Vitamin D

Amezcua L, Chung RH, Conti DV, et al.
Vitamin D levels in Hispanics with multiple sclerosis
J Neurol. 2012 May 16. [Epub ahead of print]

Dörr J, Ohlraun S, Skarabis H, et al.
Efficacy of vitamin D supplementation in multiple sclerosis (EVIDIMS Trial): study protocol for a randomized controlled trial.
Trials. 2012 Feb 8;13:15.

Paediatric MS

Tenembaum SN.
Ethical challenges in paediatric clinical trials in multiple sclerosis.
Ther Adv Neurol Disord. 2012 May;5(3):139-46.

Chitnis T, Tenembaum S, Banwell B, et al.
Consensus statement: evaluation of new and existing therapeutics for pediatric multiple sclerosis.
Mult Scler. 2012 Jan;18(1):116-27.

Blaschek A, Van's Gravesande KS, Heinen F, et al.
Neuropsychological aspects of childhood multiple sclerosis: an overview.
Neuropediatrics. 2012 May 17. [Epub ahead of print]

Psychological aspects

Rintell DJ, Frankel D, Minden SL, et al.
Patients' perspectives on quality of mental health care for people with MS.
Gen Hosp Psychiatry. 2012 May 14. [Epub ahead of print]

Physical activity

Kaipust JP, Huisinga JM, Filipi M, et al.
Gait variability measures reveal differences between multiple sclerosis patients and healthy controls.
Motor Control. 2012 Apr;16(2):229-44.


Kargarfard M, Etemadifar M, Baker P, et al.
Effect of aquatic exercise training on fatigue and health-related quality of life in patients with multiple sclerosis.
Arch Phys Med Rehabil. 2012 May 16. [Epub ahead of print]


Prosperini L, Fortuna D, Giannì C, et al.
The diagnostic accuracy of static posturography in predicting accidental falls in people with multiple sclerosis.
Neurorehabil Neural Repair. 2012 May 15. [Epub ahead of print]

Tremlett H, Lucas R.
The risks for falls and fractures in multiple sclerosis.
Neurology. 2012 May 16. [Epub ahead of print]

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