Swedish Multiple Sclerosis Blog

Swedish Multiple Sclerosis Blog

Insufficient evidence to support complementary and alternative therapies for multiple sclerosis

James D. Bowen, MD

A guideline was recently published about the use of complementary and alternative medicine in multiple sclerosis (MS).

The guideline process involves identifying all of the scientific articles about potential therapies and evaluating them based on their scientific merits. The evaluation process follows a strict set of requirements related to the conduct of the research.

The review included a wide variety of complementary and alternative therapies that have been proposed for MS. Not surprisingly, most therapies did not have sufficient scientific data to determine whether or not they were effective. Some cannabinoid preparations (marijuana extracts) were shown to be effective, primarily for spasticity. This reflects a relatively large number of studies done with these compounds and the availability of a commercially available extract in some countries. A handful of therapies were shown to be ineffective. Most therapies had insufficient studies to determine their effectiveness.

The importance of this review is that it ...

National Stress Awareness Month-Managing stress with multiple sclerosis

Michelle T. Toshima

April is National Stress Awareness Month so it seems appropriate to look at the impact of stress on people living with MS and to become more aware of what one can do to better manage one’s reaction to the inevitable stressors in life.
 
There is a growing body of research that suggests there is an association between stress and an increased risk of MS exacerbations and the development of new lesions in patients with MS.  A group of Dutch researchers followed 73 patients with RRMS and found that those patients who reported a major stressful event were 2.2 times more likely to have an MS exacerbation in the following four weeks.  In 2006, a group of U.S. researchers followed 36 people with MS and found that after experiencing a major life stress, those MS patients were 1.6 times more likely to develop a new lesion in the next eight weeks.2  The same group of researchers reported that the MS patients with good coping strategies could reduce this risk.
 
The exact mechanism by which stress increases the risk of MS exacerbations and the development of new brain lesions is not entirely clear, but what is known is that stress affects the body’s ability to regulate the inflammatory response, and in patients with MS and other autoimmune disorders, inflammation occurs when  ...

Physical fitness associated with improved cognition in multiple sclerosis

Bobbie (Barbara) J. Severson, ARNP

Bobbie (Barbara) J. Severson, ARNP
ARNP, Swedish Multiple Sclerosis Center

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

Alan Wittenberg, MSW

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

Angeli Mayadev, MD

Angeli Mayadev, MD
Physical Medicine & Rehabilitation, Swedish Multiple Sclerosis Center

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

Pavle Repovic, MD, PhD
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

Peiqing Qian

Peiqing Qian
Neurologist, Swedish Multiple Sclerosis Center

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 ...
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Top Authors

Kate Floyd

Kate Floyd
Education Coordinator, Swedish MS Center

James D. Bowen, MD
Jessica Bratrude, RD

Jessica Bratrude, RD
Nutritionist, Swedish Multiple Sclerosis Center

Bobbie (Barbara) J. Severson, ARNP

Bobbie (Barbara) J. Severson, ARNP
ARNP, Swedish Multiple Sclerosis Center

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