Multiple sclerosis was the focus of a joint meeting of the Consortium of Multiple Sclerosis Centers (CMSC) and the Americas Committee on Treatment and Research in Multiple Sclerosis (ACTRIMS), held May 28 to May 31 in Dallas, Texas. Summaries of presentations (abstracts) from both meetings are available online (.pdf).
The meeting focused on providing MS healthcare professionals with the most up-to-date information impacting the care of people with MS, and featured numerous presentations on research aimed at stopping the effects of MS and MS progression, and restoring function to people with MS using various wellness and rehabilitation approaches. In most cases, study results presented at meetings are considered preliminary. Many of the results will be analyzed more thoroughly, and then published in peer-reviewed medical journals. Confidence in a study’s findings grows when it is repeated by others, with similar results.
Restoring Function – Wellness and Rehabilitation Approaches
Pilot Yoga Study Shows Benefits – Dr. Evan Cohen (Rutgers, The State University of New Jersey) and colleagues tested a yoga program in 14 women with MS and moderate disability. The 8-week program included two classes each week, teaching yoga philosophy, breathing, postures, relaxation, and meditation. Significant improvements, compared to individual results before the program, were found in tests that measured mobility, leg function, upper extremity function, fatigue, mental health, and social function. The results of this pilot study warrant confirmation in a study with a comparison group, to determine if indeed yoga can help people with MS to live their best lives. Read more about yoga for MS. (Abstract #SX02)
Mind Over MS - Carrie L. Sammarco and colleagues (NYU Langone Medical Center, New York) reported very early results from The Mindfulness in MS program, a weekly program designed to reduce stress and enhance quality of life in 10 people with MS through mindfulness-based techniques, such as body awareness, breathing, progressive relaxation, meditation, visualization, and hypnosis. Participants are given educational material and are encouraged to practice during the week. Anecdotally, patients have reported improved ability to cope with stressful life situations and enhanced relaxation. They are being followed over six months, and results will be assessed via clinical measures of quality of life. (Abstract #CG14)
Physical Therapy Collaboration in the Carolinas – The Division of Physical Therapy at the University of North Carolina and the National MS Society’s Greater Carolinas Chapter reported on an evaluation of MS STEP UP, a program to educate physical therapy students to become MS-Certified Specialists. Participants tailored class assignments to focus on MS, observed MS-specialized therapists and neurologists, and participated in National MS Society events, board meetings, fundraisers, and self-help groups. Eight students who completed the program indicate that their MS-specific knowledge and skills changed from “below” to “above” average. Future research will evaluate effects on patient outcomes. (Abstract #RH38)
Service Dogs to Help Ambulation – Dr. Cecilie Fjeldstad and colleagues (MS Center of Excellence, Oklahoma City) studied whether walking speed in 36 people with MS and mobility issues (but who were not using a walking aid) improved with the assistance of a certified service dog. Participants were asked to perform a walking test with and without a service dog. The researchers found that walking speed improved significantly with the aid of a service dog. (Abstract #RH07)
Video-Chatting Increases Exercise and Much More – Dr. Lara Pilutti and colleagues (University of Illinois at Urbana-Champaign) were funded by a National MS Society grant to examine whether video-chat sessions with a behavior change coach could improve the results of a 6-month physical activity program. The researchers had shown improvements in increasing physical activity and in reducing fatigue and depression at last year’s CMSC meeting. This year, they report improvements in bone health and body composition among the video-chatting group (Abstract #RH24), as well as improvements in cognitive function in those with mild disability (Abstract #CG12). This team also analyzed the results of 12 previous trials examining whether exercise improved depression, and found significant improvement. (Abstract#RH19). Read more about rehabilitation research.
Aquatic Exercise – Dr. Yasser Salem (University of North Texas Health Science Center) examined the effects of a 10-week aquatic training program on mobility function, strength, fatigue, and quality of life in 10 people with MS, compared with a control group of 10 people with MS. Participants in the exercise program improved in walking speed, balance, grip strength, fatigue, and quality of life significantly more than participants in the control group. This study shows the potential of aquatic training to restore function in people with MS. (Abstract #RH42) Read more about aquatic therapy.
Exercise for People Using Wheelchairs – Dr. Yvonne Learmonth and colleagues (University of Illinois at Urbana-Champaign) were funded by the National MS Society to explore the motivations and barriers related to physical activity and exercise in 15 people with MS who use wheelchairs. Many participants acknowledged improvement in fatigue, strength, mobility, everyday function, self-control and mood. Common barriers reported were symptoms, lack of motivation, the environment, and lack of professional guidance. The researchers recommend that physical activity and exercise interventions for those with advanced MS should be symptom-appropriate, include behavior management strategies, be undertaken in appropriate environments, and be delivered with professional interaction. (Abstract #RH44) Read more about incorporating exercise into life with MS.
Finding solutions for mobility impairment – Several teams reported on novel approaches to improving mobility. Dr. Francois Bethoux and colleagues (Cleveland Clinic) demonstrated that rhythmic auditory stimulation (using rhythmic cues to facilitate movement) significantly improved walking cadence, and increased brain activation when participants engaged in mental imagery of walking. (Abstract #RH15) Herbert I. Karpatkin and colleagues (Hunter College, New York) tested a technique in which people take breaks during walking rather than walking continuously, and showed significant walking improvement in six people with MS. (Abstract #RH17) Read more about walking and MS.
Stopping MS Symptoms and Progression, and Improving Care
“Telemedicine” Improves Communication – Dr. Jazmin Torres and colleagues (VA Health Care System, East Orange, NJ) tested “My Health eVet.” This free, online personal health record for veterans features a system for non-urgent communication with the healthcare team. All 28 veterans with MS reported increased communication with providers, increased quality of care, and found the website easy to use. They were able to order medications and review test results from home. All five providers who participated in the study reported that the technology was not burdensome, and helped to address patients’ needs in a more timely fashion. This small study points to the potential of telemedicine to improve access to care. (Abstract #CC10)
Less Medicine, Better Behavior – Cindy Walsh of The Boston Home, a residence for
adults with advanced MS, sought to reduce the use of antipsychotic medication in people with cognitive impairments secondary to MS who exhibited behaviors that were difficult for caregivers to manage. The home incorporated a behavior management technique called “OASIS” into the role of all caregivers, which involves looking for triggers of behaviors and modifying the triggers, rather than reacting to the behavior itself. The use of antipsychotics decreased by 28% overall, and by 100% for individuals without psychiatric diagnoses. This training is now a standard component of the employee orientation. (Abstract #CG15) Read more about cognitive and emotional changes that can affect people with MS.
Are People Complying with Safety Monitoring for Oral MS treatments? Blood monitoring is recommended by the FDA for people taking Aubagio® (teriflunomide, Sanofi Aventis), or Gilenya® (fingolimod, Novartis), along with eye examinations for Gilenya. Dr. Jeffrey English (MS Center of Atlanta) and colleagues reviewed medical charts to see who complied with these recommendations. For Gilenya, 81% of patients received the required blood testing, and 38% received follow-up eye examinations. For Aubagio, 42% of patients received over half of six required blood tests, whereas 58% performed three or fewer. The researchers concluded that adherence to monitoring was “poor,” which could increase risks for those not receiving recommended safety monitoring. (Abstract #DX33) The Society helps people with MS work with their healthcare teams to make treatment decisions that fit their lifestyles. Read more.
Marriage and MS Progression – Marriage has been associated with less severe disease progression in people with dementia and rheumatoid arthritis, so Dr. Jill Suttle (MS Center of Excellence, Washington, DC) and colleagues investigated whether marriage influences MS progression, with funding from the National MS Society. They analyzed the marital status and disease course of a group of 2,631 Gulf War–era veterans. Over a follow-up period of about six years, married veterans progressed significantly more slowly on a clinical scale measuring disability progression than those who remained single. Further research is needed to understand the mechanism by which marital status may influence MS progression or by which progression influences marital status. (Abstract #EP07)
Early Awareness of Bladder Problems – Tracy Flemming Tracy and colleagues (Tanner Center for MS, Birmingham) sought to determine the presence of bladder dysfunction in 34 people diagnosed with MS within the past year, and to assess any connections with disability level. Thirteen people (38%) had abnormalities on bladder ultrasound, and all 13 subjects had early indicators of possible walking impairment. These findings suggest the need for early detection and intervention to address bladder dysfunction, as well as monitoring for disease activity that may increase concurrently. (Abstract #SX22) Read more about bladder dysfunction.
Download summaries presented at the meeting.