MS Speaks

The MS Association of America (MSAA) has provided highlights of the recent Consortium of Multiple Sclerosis Centers (CMSC) and Americas Committee for Treatment and Research into Multiple Sclerosis (ACTRIMS) conference. Excerpts:

CMSC and ACTRIMS Cooperative Meeting Highlights (2014)

Highlights from the Sixth Cooperative Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) and Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS), held in Dallas, Texas, May 28 through May 31, 2014
June 25, 2014

Written by Margaret M. McCormick, RN, BSN, MSCN
Reviewed by Jack Burks, MD, MSAA’s Chief Medical Officer

Edited by Susan Wells Courtney, MSAA Senior Writer and Creative Director

Introduction

The largest and most comprehensive meeting on multiple sclerosis (MS) care and research in North America took place May 28 through May 31 in Dallas, Texas, combining the 28th Annual Meeting of CMSC and the 19th Annual Meeting of ACTRIMS. This is the sixth year both organizations have met together to bring researchers and clinicians from across the spectrum of MS care to share and discuss the latest research findings in MS. This multidisciplinary approach, which brings physicians, nurses, physical and occupational therapists, psychologists, social workers, pharmacists, rehabilitation specialists, and advocacy professionals together in a single meeting, is unique and ensures that the impact of MS on the whole person is considered.

...

Quality of Life

Improved ability to cope with stressful life situations and enhanced relaxation were reported in individuals participating in a six-week program that utilized mindfulness training. Mindfulness is simply an awareness of what is occurring in the present moment with an attitude of interest and non-judgment or acceptance. The one-hour weekly program consisted of lectures, discussions, and mindfulness exercises including body awareness, breathing, progressive relaxation, meditation, visualization, and hypnosis. Decreasing the impact of stress may result in an increased quality of life for people affected by MS.

Women with MS attending an eight-week wellness training program combined with group acupuncture treatments generally agreed that the acupuncture was relaxing and the wellness classes were helpful to lifestyle management. The participants also noted that they were sleeping better and felt less fatigued. There were several reports of transient side-effects (leg twitching, leg cramps, blurred vision, and pain upon moving), but only one participant (of 14) said that acupuncture was a negative experience for her.

Most individuals with MS who prematurely leave the workforce, reduce hours, or change jobs, do so because of physical symptoms, cognitive symptoms, or both. Physical symptoms include fatigue, muscle weakness, and visual problems. Cognitive symptoms cited were problems with memory and mental agility (the ability to shift from concept to concept along the way). Fatigue was the most commonly cited reason for the change. The negative impact on mental status, family life, and financial stability should not be underestimated.

MSAA Chief Medical Officer Jack Burks, MD, notes that steps to deal with these issues should be a part of the family’s "game plan" for treating MS symptoms. Some individuals are able to extend their time in the workforce through strategies such as having accommodations made, using assistive technology, and taking advantage of vocational rehabilitation.
...



Study results presented at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) annual meeting in October 2013 support the potential negative effects of high-salt intake. One study found that people with MS who had a high-salt intake (more than 4.8 grams daily) had relapse rates that were almost four-times greater than those with salt intakes of less than 2 grams per day. Dr. Burks notes that many of the lectures at this year’s CMSC/ACTRIMS meeting mentioned the negative consequences of high salt in one’s diet as well.

In a sample of 237 women with MS, those who reported having a higher weight in early adulthood were younger at the onset of MS symptoms and at the time of MS diagnosis. Further research is needed to determine if body weight is causally linked to or a risk factor for MS. Similar to the previous study results, where salt intake is mentioned as a possible risk factor for developing or worsening MS, weight may potentially play a role as well. By examining these types of factors, researchers hope to better identify who may be at a greater risk of developing MS and potentially learn ways that the risk may be reduced – and this could potentially be found to be helpful in reducing the risk of pediatric MS.

...

Gait Dysfunction Interventions

The assistance of a certified service dog can result in improved walking speed in people with MS. Participants in this study were individuals with MS who had a gait abnormality secondary to MS, but did not require an assistive device. The results showed a significant difference (improvement) in the Timed 25-Foot Walk in individuals who were accompanied by a service dog compared to the same individual without such assistance. The authors believe that this is the first study to evaluate the effectiveness of a service animal to improve walking in MS. These results are encouraging as they may present another option for some individuals as part of their treatment plan to improve walking speed.

...

Drug Therapy

An observational study of individuals with MS who were newly prescribed dalfampridine extended release (D-ER) demonstrated significant improvement in functional tasks of both the arms and legs. This was observed even among those who did not improve on the traditional Timed 25-Foot Walk test.

This medication, with the brand name Ampyra™, is an oral, timed-release medication developed to improve the conduction of impulses between damaged nerves of the central nervous system (CNS). Phase III clinical trials showed that a greater number of individuals with MS experienced improvement in walking speed when taking Ampyra, compared to when taking a placebo. Ampyra was granted approval in 2010 to improve walking speed in individuals with MS.

While the indication for this medication is to improve walking speed in individuals with MS, this study suggests that it may have additional benefits to both lower and upper extremities. The latter includes potential improvement in arm and hand function, as shown by improved performance on the Nine-Hole Peg Test.

Patient adherence to recommended safety monitoring with Gilenya and Aubagio is poor. A retrospective chart review of the first six months of therapy of all patients who received Gilenya® (fingolimod, FTY720) or Aubagio® (teriflunomide) at one MS center revealed that only 38 percent of Gilenya patients received the recommended eye examination at month four to rule out macular edema (a condition that has the potential to negatively affect vision). The review also found that 58 percent of patients taking Aubagio received three or fewer of the required six monthly blood tests to check for liver damage.

Despite having been educated on the risks and benefits of the drug, as well as receiving written instructions and prescriptions regarding the required testing, these patients did not follow through with the recommendations of their healthcare providers. Failure to comply with the recommended monitoring can lead to serious, even life-threatening complications. This reinforces the need for increased patient education and awareness, along with closer monitoring by the patient’s healthcare team.

An Overview of CMSC/ACTRIMS Sessions from MSAA’s Chief Medical Officer

MSAA’s Chief Medical Officer Dr. Jack Burks explains, "In addition to the abstracts noted above, I would like to provide a quick overview of some of the sessions that I attended at the CMSC/ACTRIMS meeting. In general, I found the information presented at this year’s conference to be extremely positive, with much reaffirming data on the presently approved disease-modifying therapies (DMTs) and many new potential treatments on the horizon.

"For instance, 20 years of treatment with the injectable DMTs have established their long-term safety and effectiveness for individuals with relapsing forms of MS. Tysabri continues to greatly impact disease activity, while initial and periodic blood testing and close monitoring help protect people from developing progressive multifocal leukoencephalopathy (PML), a rare but potentially fatal brain infection. The three oral DMTs are also doing very well in terms of safety and effectiveness, along with their convenient administration. Nonetheless, doctors and patients need to follow monitoring recommendations closely to stay apprised of potential side effects.
"In terms of new treatments on the horizon, we see positive data on Plegridy, Lemtrada, daclizumab, laquinimod, ocrelizumab, ofatumumab, ibudilast, anti-LINGO antibody to increase myelin repair, stem cells, and many others. These new (unapproved) treatments, some of which are already under consideration by the United States Food and Drug Administration (FDA), would give the MS community several additional treatment options. We are also very encouraged by the fact that several trials in progressive MS are currently underway. Results from some of these studies may be known by the end of 2014.

"Regarding patient care, we’re seeing a great deal of study in the areas of fatigue, cognition, depression, mobility, and quality-of-life issues. In addition to medications, organized and supervised exercise programs, which include activities such as swimming and dance, can lead to increased strength and stamina, along with improvements in cognition and depression. MS centers continue to report that a team approach for treating the entire patient results in improved function, a greater quality of life, and better adherence to disease-modifying therapies."