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MS research update - Alcohol and caffeine - no link to causing MS - 06 June 2012

On being diagnosed with MS, many people ask why did it happened to them, or their loved one, and whether anything could have been done to prevent it.

So far, the cause of MS is unknown although there is increasing evidence that several factors have to come together to trigger the disease. These factors can be genetic or environmental, and there is substantial evidence that being exposed to a virus or lack of vitamin D plays a part.

The cause of MS is a very active area of research and one aspect that is being investigated is lifestyle factors. In this study, the amounts of alcohol and caffeine in someone's diet were examined as possible risk factors because they are both known to affect the nervous system.

In some studies, people with MS are asked to look back and say what their diet was like. This relies on them being able to remember accurately what they ate and drank, in general terms, often many years before. This can be quite difficult and can make the research less reliable.

In comparison, this study was able to follow a very large number of people (over 180,000) for up to 24 years, record their diet and then see who developed MS and whether this seemed to relate to the intake of particular food items over the previous years.

Two large groups of women in the USA were followed either from 1980 to 1994 (The Nurses' Health Study with 92,275 women) or from 1991 to 2005 (Nurses' Health Study II with 95,051 women). They answered questionnaires about their diet when they began the study and then every four years. Participants were asked about 130 different food items.

282 women were diagnosed with MS, with symptoms only beginning after they entered the study. The researchers found that there was no relationship between having MS and either the total amount of alcohol consumed or the amount of beer, wine or spirits when considered separately. There was also no relationship between the amount of caffeine consumed, mostly as coffee, tea or cola, and the risk of getting MS.

Massa J, O'Reilly E, Munger K, et al.
Caffeine and alcohol intakes have no association with risk of multiple sclerosis.
Mult Scler. 2012 May 28. [Epub ahead of print]

Reorganising the brain to maintain ability

It is known that the brain can change the way it works for certain tasks if it needs to get round areas that are damaged by neurodegeneration, including due to MS. In this way, the brain compensates for the damage and can still carry out its functions. This means that symptoms, including cognitive problems, may not show up to begin with because the brain has found another way of working.

This study looked at two aspects of this in people with MS. Hyperactivation is when an area of the brain is used more intensely than before. Functional reorganisation is changing to using different parts of the brain, often in addition to using the usual areas which may not be working well enough to perform the task efficiently.

In MS, three times more women are affected than men and there is some evidence that the disease progresses differently in the two sexes. Also, the structure of the brain and the way it works show some differences between men and women in the general population. Consequently, this study looked to see if there were any differences in how the brain reorganised itself in women compared to men with MS.

30 people with MS in the Netherlands (an equal number of men and women) were matched for sex, age, education and IQ (intelligence quotient) with 30 controls. Male and female patients were matched for level of disability (although this was generally low), disease duration and white matter lesion load.

All the participants had an MRI scan and performed neuropsychological tests for visuospatial memory and processing speed. The MRI scans were analysed to work out the level of communication between 88 areas of the brain.

The researchers found that women with MS performed as well as male and female controls in the neuropsychological tasks. However, men with MS did not perform as well and this was due to a decrease in the functional connectivity of the brain which affected visuospatial memory.

They suggest that this difference could explain why men often have a faster clinical progression than women. In addition. they believe that these differences in brain organisation should be taken into account when designing therapies to improve cognitive function in men and women with MS.

Schoonheim MM, Hulst HE, Landi D, et al.
Gender-related differences in functional connectivity in multiple sclerosis.
Mult Scler. 2012 Feb;18(2):164-73.


Khanna S, Sharma A, Huecker J, et al.
Magnetic resonance imaging of optic neuritis in patients with neuromyelitis optica versus multiple sclerosis.
J Neuroophthalmol. 2012 May 31. [Epub ahead of print]

Symptoms and symptom management

Romberg A, Ikonen A, Ruutiainen J, et al.
The effects of heat stress on physical functioning in persons with multiple sclerosis.
J Neurol Sci. 2012 May 28. [Epub ahead of print]

Grau-López L, Sierra S, Martínez-Cáceres E, et al.
Analysis of the pain in multiple sclerosis patients.
Neurologia. 2011 May;26(4):208-13.

Disease modifying treatments

Bergamaschi R, Quaglini S, Tavazzi E, et al.
Immunomodulatory therapies delay disease progression in multiple sclerosis.
Mult Scler. 2012 May 31. [Epub ahead of print]

Johnston J, So TY.
First-line disease-modifying therapies in paediatric multiple sclerosis: a comprehensive overview.
Drugs. 2012 May 29. doi: 10.2165/11634010-000000000-00000. [Epub ahead of print]

Horga A, Tintoré M.
Natalizumab for relapsing-remitting multiple sclerosis.
Neurologia. 2011 Jul-Aug;26(6):357-68.


D'hooghe MB, De Keyser J.
Associations of alcohol consumption with clinical and MRI measures in multiple sclerosis.
Expert Rev Neurother. 2012 Jun;12(6):657-60.

Co-existing conditions

Villani V, De Giglio L, Sette G, et al.
Determinants of the severity of comorbid migraine in multiple sclerosis.
Neurol Sci. 2012 May 27. [Epub ahead of print]

Assessment tools

Sonder JM, Bosma LV, van der Linden FA, et al.
Proxy measurements in multiple sclerosis: agreement on different patient-reported outcome scales.
Mult Scler. 2012 Feb;18(2):196-201.

Psychological aspects

Bensa C, Bodiguel E, Brassat D, et al.
Recommendations for the detection and therapeutic management of cognitive impairment in multiple sclerosis.
Rev Neurol (Paris). 2012 Jun 1. [Epub ahead of print]

Askey-Jones S, Silber E, Shaw P, et al.
A nurse-led mental health service for people with multiple sclerosis.
J Psychosom Res. 2012 Jun;72(6):463-5.

Guimarães J, Sá MJ.
Cognitive dysfunction in multiple sclerosis.
Front Neurol.2012;3:74.

Physical activity

Learmonth YC, Marshall-McKenna R, Paul L, et al.
A qualitative exploration of the impact of a 12-week group exercise class for those moderately affected with multiple sclerosis.
Disabil Rehabil. 2012 Jun 2. [Epub ahead of print]


Karampampa K, Gustavsson A, Miltenburger C, et al.
Treatment experience, burden and unmet needs (TRIBUNE) in MS study: results from five European countries.
Mult Scler. 2012 Jun;18(2 Suppl):7-15.

Fattore G, Lang M, Pugliatti M.
The treatment experience, burden, and unmet needs (TRIBUNE) study - measuring the socioeconomic consequences of multiple sclerosis.
Mult Scler. 2012 Jun;18(2 Suppl):5-6.


Conway DS, Miller DM, O'Brien RG, et al.
Long term benefit of multiple sclerosis treatment: an investigation using a novel data collection technique.
Mult Scler. 2012 May 31. [Epub ahead of print]


Baracchini C, Valdueza JM, Del Sette M, et al.
CCSVI and MS: a statement from the European Society of neurosonology and cerebral hemodynamics.
J Neurol. 2012 May 31. [Epub ahead of print]

Vera C, Herr A, Mandato K, et al.
Internet-based social networking and its role in the evolution of chronic cerebrospinal venous insufficiency.
Tech Vasc Interv Radiol. 2012 Jun;15(2):153-7.

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