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Last chance to have your say on complementary and alternative therapies

source: MSIF

You have until 12 October 2009 to inform the next issue of MS in focus, on complementary and alternative medicines (CAMs) and MS, by taking part in our survey.

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Profile of the Month : January 2010

Pavel Zlobin

Country: Russia
Age: 37
Type of MS: Secondary progressive
Year of Diagnosis: 1999

"MS is still neglected as people think it is a minor problem."

Deutsch English French Italiano Русский

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Glatiramer acetate in combination with minocycline in patients with relapsing-remitting multiple sclerosis: results of a Canadian, multicenter, double-blind, placebo-controlled trial

Glatiramer acetate (GA) is one of the accepted treatments for relapsing-remitting MS. However, not all people have a satisfactory response to it. For this reason, new therapeutic approaches are being investigated. Minocycline is an oral treatment which had been previously tested in MS and shown to be effective in reducing the number of active MRI lesions, in an uncontrolled trial (without placebo group) published in 2004. The authors of this study aimed to investigate the efficacy of combined GA plus minocycline treatment in people with relapsing-remitting MS, by comparing a group receiving GA plus minocycline with another receiving GA plus placebo. They found that the group that received GA plus minocycline had a trend towards a reduction on the lesion load and number of active lesions compared to the group only receiving GA (plus placebo). The authors conclude the article suggesting the need for further study of this combination treatment.

authors: Metz LM, Li D, Traboulsee A, Myles ML, Duquette P, Godin J, Constantin M, Yong VW

source: Mult Scler. 2009 Sep 23

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A longitudinal observational study of brain atrophy rate reflecting four decades of multiple sclerosis: a comparison of serial 1D, 2D, and volumetric measurements from MRI images

MS is a chronic inflammatory-demyelinating disease of the central nervous system, which starts with a slow but continuous damage in the brain and the spinal cord, consisting of demyelination and axonal loss, which may be reflected by the presence of continuous brain volume loss. However, the exact pathological processes that occur over time and their role at explaining clinical symptoms are not yet fully understood. In this study the authors aimed to investigate the rates of brain volume loss in 37 people with MS, with different disease durations and different types of MS, in order to assess whether the rate of brain volume loss was significantly different amongst the different groups (i.e. relapsing-remitting vs. secondary progressive vs. primary progressive, and short vs. long disease duration), after following them for ten years. They did this using different parameters relating to brain volume. They found that despite the presence of different types of MS, the rate of brain volume change was not different among individuals belonging to the different groups. Although some differences in this rate of volume loss were hinted at between different disease groups at the beginning of follow-up, they disappeared as time went by, suggesting that brain volume loss may occur independently from MS disease course.

authors: Martola J, Bergström J, Fredrikson S, Stawiarz L, Hillert J, Zhang Y, Flodmark O, Lilja A, Ekbom A, Aspelin P, Wiberg MK

source: Neuroradiology. 2009 Sep 23

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Plasma exchange for acute attacks of CNS demyelination: predictors of improvement at 6 months

The most common treatment after an acute attack of central nervous system demyelination (i.e. a relapse of MS) is a high dose of intravenous steroids. However, when the attack provokes severe neurological deficits, the response to the intravenous steroids may be insufficient. In these cases, plasma exchange (PE), a measure to selectively clean the blood of antibodies (known to be related to acute demyelinating events), can have positive effects, as was shown in a double blind controlled trial published in 1999. PE has been frequently used as a treatment for these severe attacks that are unresponsive to intravenous steroids. The authors aimed to investigate the efficacy of PE and factors relating to a better outcome after PE treatment. They retrospectively studied a group of 41 people who received this treatment in a given MS centre. They found that, after PE treatment, almost 40% had an improvement during the first few weeks, which was evident from the time of discharge (one to five weeks after treatment). Interestingly, when the whole group was evaluated six months after treatment, this improvement had actually been achieved in more than 60%, revealing that a significant amount of people who had not improved at the beginning did later show improvement. Although this late improvement is encouraging and reinforces the potential role of this treatment when severe attacks unresponsive to steroids occur, the authors also found that the early improvement after the PE was the best predictor of a better late response to it.

authors: Llufriu S, Castillo J, Blanco Y, Ramió-Torrentà L, Río J, Vallès M, Lozano M, Castellà MD, Calabia J, Horga A, Graus F, Montalban X, Saiz A

source: Neurology. 2009 Sep 22;73(12):949-53

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Vitamins E and D3 attenuate demyelination and potentiate remyelination processes of hippocampal formation of rats following local injection of ethidium bromide

MS is an inflammatory-demyelinating disease of the central nervous system of autoimmune origin. It is also considered a degenerative disease, because after onset, slow but continuous demyelinating changes, amongst other pathological changes, occur in the brain and the spinal cord. Though the ideal treatment would be to stop the demyelinating process and regenerate the damaged tissue, the currently available treatments only slow down this process. Some “antioxidant” vitamins such as vitamin D have the ability to ameliorate clinical symptoms in animal models of MS. Others such as vitamin E can prevent the neural tissue from being damaged as a result of different oxidative processes, known to be present in degenerative diseases including MS. The authors aimed to investigate the ability of vitamins D and E to regenerate the myelin content of the central nervous system in an animal model of MS, the rat. After provoking a demyelinating stimulus in the brain of the rat (artificial brain damage), they divided the rats into three groups and injected them with vitamin D, vitamin E or a placebo. They compared the groups and found that the groups which had received vitamin D or vitamin E for at least four weeks after the demyelinating brain damage, had significantly lower level of demyelination and higher level of remyelination (restoration of myelin content) in the brain than the rats that received the placebo. Though further studies with humans are needed to understand better the role of these vitamins in MS, this study supports their suggested beneficial effects and sheds light on the pathogenesis of the disease.

authors: Goudarzvand M, Javan M, Mirnajafi-Zadeh J, Mozafari S, Tiraihi T

source: Cell Mol Neurobiol. 2009 Sep 19

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Efficacy and safety of mitoxantrone, as an initial therapy, in multiple sclerosis: experience in an Indian tertiary care setting

Mitoxantrone is an accepted treatment for MS, used when first line treatments such as interferon beta and glatiramer acetate fail. Over recent years its use has been reduced because of the risk of potentially life-threatening side effects and also due to introduction of natalizumab as an accepted drug for MS. However, mitoxantrone is still a therapeutic option for some people with MS. In this study the authors investigated a group of 23 people with MS or neuromyelitis optica, (an inflammatory-demyelinating disease of the central nervous system, like MS) whose first therapeutic option was mitoxantrone. In people who completed a two-year period of treatment, the authors reported a significant reduction in their relapse rate and levels of disability, when pre and post treatment values were compared. However, in three people the treatment with mitoxantrone had to be discontinued due to cardiotoxicity and reduction of white blood cell count.

authors: Singhal BS, Geeta S, Hundalani SG, Menon S

source: Neurol India. 2009 Jul-Aug;57(4):418-23

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Agrupación Chile founder wins Woman of 2009 competition

source: Agrupación de Enfermos de Esclerosis Múltiple, Chile

On 22 September 2009, Claudia Opazo Ossandon, founder and spokesperson for the Chilean MS group Agrupación de Enfermos de Esclerosis Múltiple, was declared winner of the Chilean Terra media network’s online Woman of 2009 competition.

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ECTRIMS announce Research Fellowship Exchange Programme

source: ECTRIMS

The European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) has announced its Research Fellowship Exchange Programme for young European postdoctoral neuroscientists.

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UK MS Society comments on new assisted suicide guidance

source: MS Society UK

The UK MS Society has commented on new guidance issued to clarify the law on assisted suicide in England and Wales.

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Therapeutic strategies for MS and more highlighted at ECTRIMS conference

source: US National MS Society

MS clinicians and investigators convened to present findings and develop collaborations at the 25th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), September 9-12, 2009, in Düsseldorf, Germany.

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