Mom's Story, A Child Learns About MS

Mom's Story, A Child Learns About MS
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Tuesday, March 27, 2012

National MS Society-funded study suggests balance/ eye movement training improves fatigue, balance and other symptoms in people with MS

A recent controlled study suggests that a 6-week balance and eye movement-focused exercise program improved balance, reduced fatigue, and reduced disability due to dizziness or disequilibrium in a group of people with MS, lasting for at least 4 weeks following supervised training. Larger and longer studies are needed to determine how long the benefits last, and which people with MS would be most likely to respond to the training program. The study, by Jeffrey Hebert, PT, PhD (University of Colorado, Aurora) and colleagues, was reported in the journal Physical Therapy in August, 2011 and was partially funded by a pilot research grant from the National MS Society.

Background: Fatigue and impaired balance are two common and troublesome symptoms experienced by people with MS. Current treatments vary greatly in effectiveness. This study is the first to examine the effects of an exercise program involving balance and eye movement training – or “vestibular rehabilitation” -- in people with MS to see if it improves both fatigue and balance.

The study: For this controlled study, 38 people with MS were divided into three groups: one group did not participate in an exercise program and only received normal MS medical care; one group participated in a general exercise program involving endurance and stretching; and one group participated in the vestibular rehabilitation program specifically designed to improve balance. The endurance and stretching exercises included bicycle riding and exercise designed to stretch various muscles. The vestibular rehabilitation program included balance exercises on various surfaces (firm surface, foam cushion, trampoline, tiltboard), arm movements while kneeling, head movements on a trampoline and while fixating on different objects, ball catching while walking. The vestibular rehabilitation program also included 3 types of eye movement exercises. Both exercise programs were performed for 60 minutes twice a week in the clinic. A daily home exercise program, consisting of a subset of exercises performed in the clinic, was also assigned to each participant. The exercise training programs lasted for 6 weeks.

Effects on balance, fatigue, dizziness/equilibrium, depression, and walking ability were examined at the end of the 6 weeks and also 4 weeks after the exercise program had ended. At the end of the 6-week period, the group that underwent the vestibular rehabilitation program showed improved balance, reduced fatigue, and reduced disability due to dizziness or disequilibrium. Depression and walking ability were minimally improved. Neither of the control groups showed improvement in balance, fatigue, or dizziness/disequilibrium disability. Four weeks after the exercise program ended, those in the vestibular rehabilitation program group continued to show benefit.

It should be noted that in this study, the bicycle riding was not designed as an aerobic exercise, and thus these findings do not counter prior research studies that have shown benefits of aerobic exercise on MS fatigue. In their paper, the researchers suggest that the vestibular rehabilitation program reteaches the brain how to maintain balance when performing activities during standing or walking, after such abilities are impaired by MS, leading to improved balance, fatigue and dizziness.

Future studies should include more participants and a longer follow-up to determine how long the benefit lasts and which people with MS would most likely respond to this program. Proposals for these investigations are underway.

Based on these preliminary results, balance and eye movement training may help people with MS who are experiencing fatigue and balance problems. Those wishing to explore this option should consult with their neurologists, local rehabilitation facilities or hospitals to see whether this type of training is available.

Sunday, March 11, 2012

Study: Woman’s Risk of Having a First Neurologic Event, Which Often Leads to MS, Decreased with Increased Number of Pregnancies

Women’s risk for developing clinically isolated syndrome, which often leads to multiple sclerosis, was shown to decrease with increased number of pregnancies in a comprehensive study undertaken in Australia. Clinically isolated syndrome (CIS) is a first neurologic episode caused by inflammation or damage to nerve fiber-insulating myelin in the brain or spinal cord. Although the results of this Ausimmune Study need to be confirmed, the findings encourage further exploration of potential treatments such as sex hormones, which may mimic pregnancy’s benefits in women with MS. The sex hormone estriol is currently in clinical trials, supported by the National MS Society and the National Institutes of Health, to treat women MS.

Anne-Louise Ponsonby, PhD (Murdoch Childrens Research Institute, Melbourne) and colleagues across Australia report their findings in Neurology (2011;76:540-548). This study was supported by a research grant from the National MS Society to Anthony McMichael, PhD, the National Health and Medical Research Council of Australia, and MS Research Australia.

Background: Before 1950, most women with MS were counseled to avoid pregnancy because of the belief that it might make their MS worse. Over the past 40 years, studies in hundreds of women with MS have almost all reached the opposite conclusion: that pregnancy reduces the number of MS exacerbations, especially in the second and third trimesters.

The Ausimmune Study was undertaken to investigate whether increased exposure to sunlight and vitamin D may be protective against MS in people who had not yet been diagnosed with MS, but who had experienced a CIS. Read more about previously released findings. In the current study, the team used this unique population to study whether the number of pregnancies or offspring affects the risk for developing a CIS.

The Study: Investigators looked at the records of 282 men and women who had developed a CIS, and compared the number of children – and in women, the number of pregnancies – with controls who did not develop CIS.

Women who had one pregnancy were nearly half as likely to develop CIS, and those with three or more pregnancies had more than one fourth the risk of developing CIS compared with controls. Other factors considered – such as sun exposure and immune-system-related genes associated with MS – did not otherwise explain these associations. There was no association between risk of CIS and the number of children in men.

Comment: In an accompanying editorial, Martin Daumer, PhD, Brian G. Weinshenker, MD, and Rhonda Voskuhl, MD, comment that these findings need to be replicated in other countries to be validated, and caution that the study does not address whether pregnancy affects the long-term course of MS or development of disability.

Even with these caveats, the editorial authors say that because of studies such as this one, there is a compelling need for research to develop therapeutic approaches that mimic pregnancy’s benefits in women with MS. Dr. Voskuhl is now leading a team of investigators at seven medical centers to conduct a two-year, controlled clinical trial of estriol – a sex hormone that is increased during pregnancy – added to standard therapy to treat MS in 150 women with relapsing-remitting MS. This study recently completed enrollment.

This study provides additional evidence of a link between gender and autoimmunity. Read more about the Society’s efforts to study this link for clues to stopping MS in its tracks and ending it forever.