Research Updates
STUDY REPORTS ASSOCIATION BETWEEN SMOKING AND MS
NMSS Research Update (10/27/03)
Summary: Researchers report that in a study of more than 20,000 Norwegians, the risk of developing MS was higher among smokers than in people who never smoked.
* The investigators administered questionnaires that covered current and previous smoking habits, including the age at which smoking started, as well as if and when MS symptoms first started.
* The risk of developing MS was nearly twice as high in people who were current or former smokers compared to people who had never smoked. The average duration from start of smoking to MS symptoms onset was 15.2 years.
* This was the second large, population-based study to find an association between smoking and risk of developing MS. Further study is necessary to confirm this association and to explain the underlying mechanisms for a possible link between smoking and developing MS. However, there is increasing evidence for a link between smoking and MS.
Details: Researchers report that in a study of more than 20,000 Norwegians, the risk of developing MS was higher among smokers than people who never smoked. Trond Riise, PhD (University of Bergen, Norway) and colleagues from Bergen University College and Harvard University, report their efforts in the October 28, 2003 issue of Neurology.
Background: MS is believed to occur in persons who have a genetically determined predisposition for the disease. But evidence suggests that even those who are genetically susceptible may need to encounter some other factor or factors in their environment - infectious, environmental or dietary, for example - in order for MS to develop. One environmental factor that has been investigated is smoking.
Smokers have higher rates of lung cancer, heart disease, emphysema and other respiratory problems, and infants born to smoking mothers tend to have lower birth weights than infants born to nonsmokers.
Several studies have examined the association between smoking and the risk of developing MS, with mixed results. Some smaller, hospital-based studies were negative, but a recent larger population-based study to address this question did find a statistically significant association between smoking and risk of developing MS.
Study: The authors looked at a population that had been involved in the Hordaland Health Study, a study conducted in 1997 of 22,312 people living in Hordaland, Norway. The investigators administered questionnaires and a clinical examination. Questions covered current and previous smoking habits, including the age at which smoking started, as well as if an individual had MS and if so, when MS symptoms first started. The development of other diseases with which smoking has also been connected (heart attack, angina, asthma) was also ascertained.
Results: A total of 87 people reported having MS. The risk of developing MS was nearly twice as high in people who were current or former smokers compared to people who had never smoked. The average duration from start of smoking to reported onset of symptoms was 15.2 years. Separate from MS, the risk among smokers for heart attack, angina, and asthma was also increased - which, the authors say, supports the validity of the association with MS.
Conclusion: This was the second large, population-based study to find an association between smoking and risk of developing MS. Further study is necessary to confirm this association and to explain the underlying mechanisms for a possible link between smoking and development of MS. However, there is increasing evidence for a link between smoking and MS. Although there is no evidence from this study that past or current smoking can make MS worse in a person who has the disease, smoking is known to produce shortness of breath, susceptibility to lung infections, and heartbeat irregularities in many people. These might transform a mild or moderate neurologic limitation into a severe disability.
THE IMPACT OF MOOD DISORDERS IN NEUROLOGICAL DISEASES: SHOULD NEUROLOGISTS BE CONCERNED?
Epilopsy Behav (10/3/03)
AM Kanner, JJ Barry, Department of Neurological Services, Rush Medical College, Rush Epilepsy Center, Rush-Presbyterian-St. Luke's Medical Center, 60612, Chicago, IL.
Depression is one of the most frequent comorbid psychiatric disorders identified in patients with neurological disorders. The prevalence rates range between 20 and 50% of patients with stroke, epilepsy, multiple sclerosis, and Parkinson's disease. Despite these relatively high prevalence rates, depression remains underrecognized and undertreated in these patients. And yet, depression accounts for poor quality-of-life ratings and has a negative impact on the recovery from neurological symptoms.
In this article, we review the epidemiological and clinical characteristics of mood disorders in patients with multiple sclerosis, Parkinson's disease, stroke, and epilepsy, and focus on the impact mood disorders have on the quality of life of these patients and on their recovery from their neurological deficits.
"STICKING JEWELS IN YOUR LIFE": EXPLORING WOMEN'S STRATEGIES
FOR NEGOTIATING AN ACCEPTABLE QUALITY OF LIFE WITH MULTIPLE SCLEROSIS
F. Reynolds, S. Prior Qual. Health Res. Nov. 2003; 13(9):1225-51
The authors [F. Reynolds & S. Prior from Brunel University, Isleworth, Middlesex, United Kingdom] explored women's strategies for achieving quality of life with multiple sclerosis (MS) through interviews with 27 women, most of whom had lived with MS for more than 5 years. Analysis of the semistructured interviews followed the interpretative phenomenological approach. The women portrayed living with MS as an ongoing process of negotiation and described gaining quality of life through looking after health; maintaining meaningful occupations and roles; establishing mutual relationships; clarifying beliefs, aspirations, and philosophy of life; activism on disability issues, consciously valuing positive life experiences; and finding benefits in adversity. Despite recounting resourceful strategies, many acknowledged ongoing difficulties. Some narratives suggested a mesh or tapestry of coexisting positive and negative experiences. Others portrayed an adversarial relationship, with the positive and negative forces in their lives constantly battling for supremacy. A wide array of flexible, evolving strategies was required to achieve an acceptable quality of life with MS.
CANNABINOIDS FOR TREATMENT OF SPASTICITY AND OTHER SYMPTOMS RELATED TO MULTIPLE SCLEROSIS (CAMS
STUDY): MULTICENTRE RANDOMIZED PLACEBO-CONTROLLED TRIAL
Zajicek J et al, Lancet 11/8/03
J. Zajicek, P. Fox, H. Sanders, D. Wright, J. Vickery, A. Nunn & A. Thompson, Peninsula Medical School, Plymouth, UK, in their article in Lancet, November 8, 2003, 362(9395):1517-1526.
Background: Multiple sclerosis is associated with muscle stiffness, spasms, pain, and tremor. Much anecdotal evidence suggests that cannabinoids could help these symptoms. Our aim was to test the notion that cannabinoids have a beneficial effect on spasticity and other symptoms related to multiple sclerosis.
Methods: We did a randomised, placebo-controlled trial, to which we enrolled 667 patients with stable multiple sclerosis and muscle spasticity. 630 participants were treated at 33 UK centres with oral cannabis extract (n=211), Delta(9)-tetrahydrocanna-binol (Delta (9)-THC; n=206), or placebo (n=213). Trial duration was 15 weeks. Our primary outcome measure was change in overall spasticity scores, using the Ashworth scale. Analysis was by intention to treat. Findings 611 of 630 patients were followed up for the primary endpoint. We noted no treatment effect of cannabinoids on the primary outcome (p=0.40). The estimated difference in mean reduction in total Ashworth score for participants taking cannabis extract compared with placebo was 0.32 (95% CI-1.04 to 1.67), and for those taking Delta(9)-THC versus placebo it was 0.94 (-0.44 to 2.31). There was evidence of a treatment effect on patient-reported spasticity and pain (p-0.003), with improvement in spasticity reported in 61% (n=121, 95% CI 54.6-68.2), 60% (n=108, 52.5-66.8), and 46% (n=91, 39.0-52.9) of participants on cannabis extract, Delta(9)-THC, and placebo, respectively.
Interpretation:Treatment with cannabinoids did not have a beneficial effect on spasticity when assessed with the Ashworth scale. However, though there was a degree of unmasking among the patients in the active treatment groups, objective improvement in mobility and patients' opinion of an improvement in pain suggest cannabinoids might be clinically useful.
EMERGING DISEASE MODIFYING THERAPIES FOR MULTIPLE SCLEROSIS
E. Waubant, Expert Opin Emerg Drugs 2003 May;8(1)145-61
E. Waubant, UCSF MS Center, 350 Parnassus Street, Suite 908, San Francisco, CA 94117, USA. waubante@tsa.ucsf.edu
Multiple Sclerosis (MS), the most common central nervous system (CNS) demyelinating disease, is thought to be mediated in part by CNS autoantigen-specific T cells. The aetiology of the disease is unclear, but includes genetic and environmental factors. The disease onset often occurs in young adults and is characterised by bouts of neurological symptoms such as numbness, weakness, imbalance or visual difficulties that may not be recovered from. Sometimes the course is more progressive. Since the disease can be disabling, several treatments have been developed that reduce the risk of relapse and progression of sustained disability. Although earlier treatment is encouraged, currently approved disease modifying therapies for MS are only partially effective, administered parenterally and associated with significant side effects and potential toxicities. Therefore, many promising new therapies are under development that target various goals, including immunosuppression, immunomodulation, cell traffic through the blood-brain barrier (BBB), neuroprotection and enhancement of CNS repair.
STUDYING PRIMARY-PROGRESSIVE MS
Nat. M.S. Soc. (10/31/03)
In the Keynote Address, Jerry Wilinsky, MD (The University of Texas Health Sciences Center) reviewed data from the PROMISE trial, a study of Copaxone (glatiramer acetate) aimed at slowing progression of disability in people with primary-progressive MS (PP MS, which slowly but nearly continuously worsens from onset). An interim analysis of results showed no possibility of demonstrating a treatment effect, perhaps because the untreated placebo group did not progress significantly over the time of study, and the study was therefore discontinued in late 2002.
The investigators decided to review all data to evaluate if there might have been a subgroup of individuals in the study who showed greater progression, and who thus might have been a better group to test in this trial. Dr. Wolinsky and colleagues analyzed the results from this trial involving 943 patients, identifying several clinical and imaging factors might have enabled the investigators to identify more clearly disease progression. If these results are verified, such study "enrichment" factors may prove invaluable in planning future studies to evaluate treatment success in people with primary-progressive MS, a type of MS for which there is as yet no approved treatment.
CAN THE IMMUNE SYSTEM PROTECT THE NERVOUS SYSTEM IN MS?
Nat. M.S. Soc. (10/31/03)
MS occurs when the immune system attack the grain and spinal cord. The inflammatory events are generally considered to be uniformly damaging to nervous system tissues. However, Michal Schwartz, PhD (The Weizmann Institute of Science, Rehovot, Israel) is focused on inflammatory and other immune events that might be "protective" as well as destructive in diseases like MS. Her team has shown that immune T cells programmed to attack the central nervous system may also hone in to the site of damage and help brain cells to reduce nerve degeneration. To study this, the team injected immune cells activated against a myelin protein up to 12 days after spinal cord injury on rats. The "vaccinated" animals experienced significant and pronounced recovery from injury. Dr. Schwartz noted efforts underway to develop a vaccine with such myelin proteins that could establish a protective autoimmune response without bringing on autoimmune disease.
MORE IMAGING FINDINGS FROM ESTRIOL TRIAL IN WOMEN WITH MS
Nat. M.S. Soc. (10/31/03)
Nancy L. Sicotte, MD, a Harry Weaver Neuroscience Scholar of the National MS Society, and colleagues (University of California, Los Angeles) extended the findings of a small-scale, early-phase trial of the hormone estriol, a form of estrogen, in which women with relapsing-remitting MS showed decreases in areas of myelin damage (lesions) and immune responses during treatment. Dr. Sicotte reported that the rate of severe "black holes" detected with magnetic resonance imaging - dark areas that indicate nerve tissue damage - appeared to slow during estriol treatment, and areas of myelin damage identified during the study did not evolve into severe black holes. These results suggest that the hormone therapy might have an impact on the development of brain lesions that are considered to be the hallmark of MS. The team is hoping to conduct a larger, longer-term trial of estriol in MS.
A NEW TARGET FOR MS TREATMENT
Nat. M.S. Soc. (10/31/03)
Heiki Wulff, PhD (University of California, Davis) and colleagues have found a striking difference in the patterns of ion channels - tiny pores - on immune T cells for people with MS and people without MS. They have also shown that a protein that blocks these pores can prevent MS-like disease in rats. In a new study using T cells that react to myelin, taken from people with MS, the group reported that one particular ion channel may be repeatedly stimulated throughout the course of disease. Wtih funding from a Society Pilot Research Award, Dr. Wulff and colleagues are now developing a compound to inhibit this ion channel in hopes of stopping MS-like disease in animal models, a first step in applying such approaches as a treatment for MS itself.
MS MYTH-BUSTER
Nat. M.S. Soc. (Fall 2003)
Myth: MS is fatal.
Fact: It isn't.
There is still a lot to learn about multiple sclerosis (MS). That it is fatal is one widely held misconception that needs to be corrected. In fact, statistics show that most people diagnosed with MS have a near-normal life span. Most deaths associated with MS are due to complications in advanced, progressive stages of the disease. Effective early treatment of MS should help to prevent those complications. In very rare cases, MS is malignantly progressive and may be fatal.
The management of MS has been substantially advanced by the availability of several disease-modifying drugs. A number of positive outcomes have been demonstrated in people with relapsing-remitting disease: reduction in the frequency and severity of relapses, reduction of brain lesion development, as evidenced by magnetic resonance imaging (MRI), and the possibility of reduction of future disability.
To be better informed about MS and to clear up some of the misconceptions, we recommend you explore the "9 Myths About MS" section on the National MS Society's Web site: nationalmssociety.org
NEW YEAR START FOR NEW NATIONAL MS SOCIETY LEARN ONLINE PROGRAMMING FOR PEOPLE WITH MS
Nat. MS Soc. (11/14/2003)
The National MS Society will launch an exciting new series of MS Learn Online programs via its national website www.nationalmssociety.org beginning January 15, 2004. Targeted toward people with MS and their families, the series features experts speaking on pertinent topics for approximately ten minutes at a time. A different program will debut the first and third Thursday of each month throughout the year.
Topics scheduled include: "MS Facts" (1/15), "MS Courses," (2/5) "MS Treatments," (2/19) and "Ask the Experts," (3/4) with Loren Rolak, MD, Director Division of Neuroscience, the Marshfield MS Center, Marshfield, Wisconsin; "Evaluating Progression" (3/18), "Demyelination," (4/8), "Treatments for Progressive MS" (4/22), and "Ask the Experts," speaker to be announced; "Fatigue" (5/20), "Tremors and Balance" (6/3), "Gait and Spasticity" (6/17) and "Dizziness and Vertigo" with Randall Schapiro, MD, Director Fairview MS Center, Minneapolis, Minnesota. In the fall there will be a series of webcasts on "Common Concerns in MS" featuring more informative topics and presenters.
An invaluable resource for people with MS as well as their friends and families, MS Learn Online presentations can be accessed anytime from the National MS Society website (nationalmssociety.org). Interested individuals can also join the MS Learn Online mailing list by e-mailing MSLearnOnline@ nmss.org. To access the programs, go to the Society's website and select "Living With MS" then "Webcasts and Conference." Free software to view and listen to these programs can be downloaded from the site's Technical Support section in "Webcasts and Conferences."
Since its funding in 1946, the National MS Society has funded more MS research and served more people with MS than any national voluntary MS organization in the world. The National MS Society is proud to lead the way in providing information about multiple sclerosis, which has been diagnosed in more than 400,000 Americans. To find out more about the programs and resources of the National Multiple Sclerosis Society, and to find the chapter nearest you, call 1.800.FIGHT MS or log onto www.nationalmssociety.org.
LIVING WITH MS
Nat. M.S. Soc. (Fall 2003)
This seminar features special guest, Oscar-nominated actress and MS LifeLines Ambassador Teri Garr, who will share her story about motherhood, career and living with MS. Learn. It's the best thing you can do for yourself when you have multiple sclerosis. Did you know there's a therapy that may help you? One that was so successful in a clinical trial that it made history? The most widely used therapy for relapsing forms of MS outside the U.S. is worth knowing about. Especially since it's the most recently approved, fastest growing MS therapy within the U.S. You owe it to yourself to learn all you can about treatment options. The sooner, the better. MS LifeLines, an educational support service for people living with MS and their families, invites you to a free seminar where a doctor will explain the latest research findings and where you can hear from an MS LifeLines Ambassador, like Michelle or Rick. You can also ask questions and meet others taking an active role in their treatment. Don't miss this important event!
Living with MS
Ronald S. Murray, M.D.
Neurologist
Brian Hutchinson
Special Host
President, The Heuga Center
Edwards, Colorado
Saturday, December 6, 2003
Registration & Continental Breakfast
9:30 am - 10:30 am
Seminar 10:30 am - 1:00 pm
MS LifeLines Wellness Center
1:00 pm - 2:00 pm
Denver Marriott South East
6363 E. Hampden Avenue
Denver, Colorado
To register, simply visit www.MSLifeLines.com or call toll free 1.877.267.4662.
As a service and courtesy to you, the National Multiple Sclerosis Society wants to inform you of this educational opportunity. However, we want to be clear that the NMSS, Colorado Chapter, has had no role in developing the content or choosing speakers for this program. To register, please use the number provided above.
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