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Physical fitness associated with improved cognition in multiple sclerosis

The benefits of exercise and being physically fit is what many people strive for.  However, a recent study added a new dimension to what exercise can do to enhance health.  In other words, exercise did more than keep a body fit.  It also made study participants think better.  You may ask, why is this new information important?  

 
Cognitive impairment is one of multiple scleroris (MS) ’s most disabling features and it can affect between 22% to 60% of people living with the disease.  Cognitive deficits may include problems with: slower information processing speed; memory impairment; difficulty with new learning and executive functioning.  Historically, medical and rehabilitation approaches to the problem have been inconsistent in improving cognition.
 
The new frontier of exercise for improved cognition provides hope. This study’s objective was to determine if there was an association between improvements in objective measures of physical fitness and performance on cognitive tests.
 
Participants were people with MS who participated in a telephone based health promotion intervention, chose to work on exercise, and who completed pre and post intervention assessments. Participants were then measured for strength, aerobic fitness, and cognition at baseline and 12 weeks later.
 
After controlling for variables such as age, gender, MS disease activity, MS type, etc. there was evidence suggesting that cognitive functioning changed over time based on level of fitness. Participants in the physically improved group showed improved performance on measures of executive functioning after 12 weeks of exercise.  The results of this study add support to the hypothesis that change in fitness is associated with improved executive functioning in people with MS. The desired outcomes are that improved cognition correlates with better quality of life, activities of daily living, vocational endeavors, and rehabilitation measures.
 
Where do we go from here? Since less is known about exercise training and cognition in MS (compared to studies demonstrating aerobic and strength training significantly improving cognitive functioning in older adults and people with mild cognitive impairment), we need more studies to examine this relationship in the MS population. 

Personal grants for people with multiple sclerosis

Personal grants are available from a variety of MS organizations and offer assistance for everything from mobility equipment to financial support. With summertime fast approaching, grants for cooling equipment for those that are heat sensitive are also available. Check out the links below to learn more about these opportunities.

Functional Electrical Stimulation (FES) braces improve gait

Up to 80 percent of people with multiple sclerosis (MS) have problems with walking.  The combination of weakness of the muscles of the legs, spasticity, and core weakness contributes to this.  Often, it will present with problems lifting the foot, referred to as foot drop.  This is due to weakness of the muscles that lift the foot (dorsiflexors) and spasticity or over power of the muscles that push the foot down (plantar flexors).  Traditional ankle foot orthosis have advantages over functional electrical stimulation (FES) braces in that they help with ankle stability and reduce spasticity.  Advantages of FES braces include some evidence that there may be stimulation of the cortical neurons above the stimulation area, they are less cumbersome, and more discrete to wear.

A recent study looked at ..

FDA declines approval of Lemtrada for the treatment of MS

On December 30, 2013, the US Food and Drug Administration declined to approve the use of alemtuzumab (Lemtrada) for the treatment of multiple sclerosis. The FDA stated that the manufacturer of Lemtrada “has not submitted evidence from adequate and well-controlled studies that demonstrate the benefits of Lemtrada outweigh its serious adverse effects.” This was a surprising decision to some, as only a month earlier an advisory panel of experts convened by the FDA, while raising some objections, voted to have this medicine approved. The manufacturer of Lemtrada, Genzyme, a Sanofi company, intends to appeal this decision.
 
In response, a number of MS organizations and experts have voiced their concerns that with this step, MS patients are left without a potential choice in therapy. This decision is particularly difficult for ...

FDA approves 40 mg/mL Copaxone for 3 times a week

The U.S. Food and Drug Administration (FDA) has approved the three-times-a-week COPAXONE® 40mg/mL, a new dose of COPAXONE® on Jan 28, 2014.  This new formulation will allow for a less frequent dosing regimen administered by injection for patients with relapsing forms of multiple sclerosis (MS). In addition to the newly approved dose, daily COPAXONE® 20 mg/mL will continue to be available.

The FDA approval is based on data from ...

Weak link between epsilon toxin and MS

A recent article has been published suggesting that MS may be caused by a bacterial toxin. The bacteria is Clostridium Perfringens, a common bacteria found in soil and a cause of food poisoning. This bacteria can produce a number of toxins, one of which is the epsilon toxin.

This study found that about 10% of people with multiple sclerosis (MS) had antibodies to the epsilon toxin, compared to 1% of people without MS. In pathology specimens from mice, the epsilon toxin was found to bind to blood vessels in the retina of the eye, and to myelin in the brain. The authors also reported a single case of a woman with MS who was infected with Clostridium Perfringens and that was producing the epsilon toxin.

Though this study has been widely discussed online, I think that it is unlikely that this will be the answer to the MS problem. This study was primarily in pathology tissue, which found that the toxin was able to bind to myelin. Many more studies will be needed to determine whether this toxin is capable of causing damage to myelin of the type that is seen in MS. There are many other known toxins to myelin, but so far none seem to be the cause of MS.

They tried to show that ..

Swedish MS Center design recognized

Less than two years old, the Swedish Multiple Sclerosis Center has already received an overwhelming amount of praise from patients and physicians alike for its holistic approach to world class care.

Now we can add one more accolade to the list.

Healthcare Design magazine recently recognized the MS Center’s patient and family waiting area as a finalist in the Family Spaces category of its Healthcare Design Remodel Renovation Competition.The entire piece beautifully encapsulates the approach, design and ultimately the quality of care that the MS Center strives to deliver. Here is an excerpt of one of the judge’s comments:

“The entire design is a phenomenal reflection of a deep understanding of the unique needs of patients with multiple sclerosis. It is apparent the design team did their research, listened to the voice of the patient and caregivers, and integrated evidence-based design principles….”

That’s high praise, and it is rewarding to know that the attention we paid to every detail — from furniture and flooring to treatment and waiting areas — was noticed. But it is even more rewarding to know that the center has become an incredible resource in treating those diagnosed with MS, a degenerative disease that strikes the central nervous system.

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