{"title":"Pharmacogenetic Biomarkers to Predict Treatment Response in Multiple Sclerosis: Current and Future Perspectives.","authors":"Patricia K Coyle","doi":"10.1155/2017/6198530","DOIUrl":"10.1155/2017/6198530","url":null,"abstract":"<p><p>Disease-modifying therapies (DMTs) have significantly advanced the treatment of relapsing multiple sclerosis (MS), decreasing the frequency of relapses, disability, and magnetic resonance imaging lesion formation. However, patients' responses to and tolerability of DMTs vary considerably, creating an unmet need for biomarkers to identify likely responders and/or those who may have treatment-limiting adverse reactions. Most studies in MS have focused on the identification of pharmacogenetic markers, using either the candidate-gene approach, which requires prior knowledge of the genetic marker and its role in the target disease, or genome-wide association, which examines multiple genetic variants, typically single nucleotide polymorphisms (SNPs). Both approaches have implicated numerous alleles and SNPs in response to selected MS DMTs. None have been validated for use in clinical practice. This review covers pharmacogenetic markers in clinical practice in other diseases and then reviews the current status of MS DMT markers (interferon <i>β</i>, glatiramer acetate, and mitoxantrone). For a complex disease such as MS, multiple biomarkers may need to be evaluated simultaneously to identify potential responders. Efforts to identify relevant biomarkers are underway and will need to be expanded to all MS DMTs. These will require extensive validation in large patient groups before they can be used in clinical practice.</p>","PeriodicalId":46096,"journal":{"name":"Multiple Sclerosis International","volume":"2017 ","pages":"6198530"},"PeriodicalIF":2.5,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35265182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Augustine Joshua Devasahayam, Matthew Bruce Downer, Michelle Ploughman
{"title":"The Effects of Aerobic Exercise on the Recovery of Walking Ability and Neuroplasticity in People with Multiple Sclerosis: A Systematic Review of Animal and Clinical Studies.","authors":"Augustine Joshua Devasahayam, Matthew Bruce Downer, Michelle Ploughman","doi":"10.1155/2017/4815958","DOIUrl":"10.1155/2017/4815958","url":null,"abstract":"<p><strong>Introduction: </strong>Walking is of high priority for people with multiple sclerosis (PwMS). It remains unclear whether aerobic exercise can improve walking ability and upregulate neurotrophins. This review aims to consolidate evidence to develop optimal aerobic training parameters to enhance walking outcomes and neuroplasticity in PwMS.</p><p><strong>Methods: </strong>Clinical studies examining aerobic exercise for ≥3 weeks, having outcomes on walking with or without neurotrophic markers, were included. Studies utilizing animal models of MS were included if they employed aerobic exercise with outcomes on neurological recovery and neurotrophins. From a total of 1783 articles, 12 clinical and 5 animal studies were included.</p><p><strong>Results: </strong>Eleven clinical studies reported improvements in walking ability. Only two clinical studies evaluated both walking and neurotrophins, and neither found an increase in neurotrophins despite improvements in walking. Patients with significant walking impairments were underrepresented. Long-term follow-up revealed mixed results. Two animal studies reported a positive change in both neurological recovery and neurotrophins.</p><p><strong>Conclusion: </strong>Aerobic exercise improves walking ability in PwMS. Gains are not consistently maintained at 2- to 9-month follow-up. Studies examining levels of neurotrophins are inconclusive, necessitating further research. Aerobic exercise enhances both neurological recovery and neurotrophins in animal studies when started 2 weeks before induction of MS.</p>","PeriodicalId":46096,"journal":{"name":"Multiple Sclerosis International","volume":"2017 ","pages":"4815958"},"PeriodicalIF":2.5,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35643799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sandipan Bhattacharjee, Lisa Goldstone, Queeny Ip, Terri Warholak
{"title":"Depression Treatment among Adults with Multiple Sclerosis and Depression in Ambulatory Care Settings in the United States.","authors":"Sandipan Bhattacharjee, Lisa Goldstone, Queeny Ip, Terri Warholak","doi":"10.1155/2017/3175358","DOIUrl":"https://doi.org/10.1155/2017/3175358","url":null,"abstract":"<p><p><i>Background</i>. There is little information regarding depression treatment patterns among adults with MS and depression in ambulatory settings at national level in the United States (US). <i>Objectives</i>. The objectives of this study were to identify patterns and predictors of depression treatment in ambulatory settings in US among adults with MS and depression. <i>Methods</i>. A cross-sectional study was conducted by pooling multiple years (2005-2011) of National Ambulatory Medical Care Survey and the outpatient department of the National Hospital Ambulatory Medical Care Survey data. The final study sample was comprised of ambulatory visits among adults with MS and depression. Dependent variable of this study was pharmacological treatment for depression with or without psychotherapy. Predictors of depression treatment were determined by conducting multivariable logistic regression. <i>Results</i>. Out of all ambulatory visits involving MS diagnosis, 20.59% also involved a depression diagnosis. Depression treatment was observed in 57.25% of the study population. Fluoxetine was the most prescribed individual antidepressant. Age and total number of chronic diseases were significant predictors of depression treatment. <i>Conclusion</i>. Approximately six out of ten ambulatory visits involving MS and depression recorded some form of depression treatment. Future longitudinal studies should examine health outcomes associated with depression treatment in this population.</p>","PeriodicalId":46096,"journal":{"name":"Multiple Sclerosis International","volume":"2017 ","pages":"3175358"},"PeriodicalIF":2.5,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/3175358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35021587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lavanya Vijayasingham, Uma Jogulu, Pascale Allotey
{"title":"Work Change in Multiple Sclerosis as Motivated by the Pursuit of Illness-Work-Life Balance: A Qualitative Study.","authors":"Lavanya Vijayasingham, Uma Jogulu, Pascale Allotey","doi":"10.1155/2017/8010912","DOIUrl":"10.1155/2017/8010912","url":null,"abstract":"<p><p>Individuals with multiple sclerosis have a tendency to make early decisions for work change, even in reversible, episodic, or mild disease stages. To better understand how a multiple sclerosis (MS) diagnosis influences perceptions of work and motivations for work changes, we conducted a hermeneutic phenomenology study to explore the work lives of ten individuals with MS in Malaysia. The interpretive analysis and cumulative narratives depict an overarching change in their concept of ideal work and life aspirations and how participants make preemptive work changes to manage illness-work-life futures in subjectively meaningful ways. Discussions on their integrated pursuit of finding dynamic and subjective illness-work-life balance include reconciling the problem of hard work and stress on disease activity and progress, making positive lifestyle changes as health management behaviour, and the motivational influence of their own life and family roles: the consideration of their spouses, parents, and children. At an action level, work change was seen as moral and necessary for the management of illness futures. Our findings contribute insights on how individual perceptions and holistic life management decisions contribute to on-going and disrupted work trajectories, which can inform practice and policy on early interventions to support continued employment.</p>","PeriodicalId":46096,"journal":{"name":"Multiple Sclerosis International","volume":"2017 ","pages":"8010912"},"PeriodicalIF":2.5,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35749488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christina Lutz, Stephanie Kersten, Christian T Haas
{"title":"Short-Term and Long-Term Effects of an Exercise-Based Patient Education Programme in People with Multiple Sclerosis: A Pilot Study.","authors":"Christina Lutz, Stephanie Kersten, Christian T Haas","doi":"10.1155/2017/2826532","DOIUrl":"https://doi.org/10.1155/2017/2826532","url":null,"abstract":"<p><p><i>Background.</i> Although people with Multiple Sclerosis (pwMS) benefit from physical exercise, they still show reduced physical activity and exercise behaviour. This study aimed to investigate short- and long-term effects of an exercise-based patient education programme (ePEP) that focuses on empowering pwMS to a sustainable and self-regulated exercise training management. <i>Methods.</i> Fourteen pwMS were randomly assigned to immediate experimental group (EG-I: <i>n</i> = 8) and waitlist-control group (EG-W: <i>n</i> = 6) and attended biweekly in a six-week ePEP. All participants were measured for walking ability, quality of life, fatigue, and self-efficacy towards physical exercise before and after the ePEP, after 12 weeks, and one year after baseline. Short-term effects were analysed in a randomised control trial and long-term effects of all ePEP participants (EG-I + EG-W = EG-all) in a quasi-experimental design. <i>Results.</i> Only functional gait significantly improved in EG-I compared to EG-W (<i>p</i> = 0.008, <i>r</i> = -0.67). Moderate to large effects were found in EG-all for walking ability. Not significant, however, relevant changes were detected for quality of life and fatigue. Self-efficacy showed no changes. <i>Conclusion.</i> The ePEP seems to be a feasible option to empower pwMS to a self-regulated and sustainable exercise training management shown in long-term walking improvements.</p>","PeriodicalId":46096,"journal":{"name":"Multiple Sclerosis International","volume":"2017 ","pages":"2826532"},"PeriodicalIF":2.5,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/2826532","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35506047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Karpatkin, E. Cohen, Sarah Klein, David Park, C. Wright, Michael Zervas
{"title":"The Effect of Maximal Strength Training on Strength, Walking, and Balance in People with Multiple Sclerosis: A Pilot Study","authors":"H. Karpatkin, E. Cohen, Sarah Klein, David Park, C. Wright, Michael Zervas","doi":"10.1155/2016/5235971","DOIUrl":"https://doi.org/10.1155/2016/5235971","url":null,"abstract":"There is little literature examining the use of maximal strength training (MST) in people with multiple sclerosis (pwMS). This pretest-posttest study examined the effects of a MST program on strength, walking, balance, and fatigue in a sample of pwMS. Seven pwMS (median EDSS 3.0, IQR 1.5) participated in a MST program twice weekly for eight weeks. Strength was assessed with 1-repetition maximum (1RM) on each leg. Walking and balance were measured with the 6-Minute Walk Test (6MWT) and Berg Balance Scale (BBS), respectively. Fatigue was measured during each week of the program with the Fatigue Severity Scale (FSS). The program was well tolerated, with an attendance rate of 96.4%. Participants had significant improvements in right leg 1RM (t(6) = −6.032, P = 0.001), left leg 1RM (t(6) = −5.388, P = 0.002), 6MWT distance (t(6) = −2.572, P = 0.042), and BBS score (Z = −2.371, P = 0.018) after the MST intervention. There was no significant change in FSS scores (F(1, 3.312) = 2.411, P = 0.092). Participants in the MST program experienced improved balance and walking without an increase in fatigue. This MST program may be utilized by rehabilitation clinicians to improve lower extremity strength, balance, and mobility in pwMS.","PeriodicalId":46096,"journal":{"name":"Multiple Sclerosis International","volume":"2016 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2016-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/5235971","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64417698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Alroughani, A. Altıntaş, M. A. Al Jumah, M. Sahraian, I. Alsharoqi, A. Altahan, A. Daif, M. Dahdaleh, D. Deleu, Ó. Fernández, N. Grigoriadis, J. Inshasi, R. Karabudak, Karim Taha, N. Totolyan, B. Yamout, M. Zakaria, S. Bohlega
{"title":"Pregnancy and the Use of Disease-Modifying Therapies in Patients with Multiple Sclerosis: Benefits versus Risks","authors":"R. Alroughani, A. Altıntaş, M. A. Al Jumah, M. Sahraian, I. Alsharoqi, A. Altahan, A. Daif, M. Dahdaleh, D. Deleu, Ó. Fernández, N. Grigoriadis, J. Inshasi, R. Karabudak, Karim Taha, N. Totolyan, B. Yamout, M. Zakaria, S. Bohlega","doi":"10.1155/2016/1034912","DOIUrl":"https://doi.org/10.1155/2016/1034912","url":null,"abstract":"The burden of multiple sclerosis (MS) in women of childbearing potential is increasing, with peak incidence around the age of 30 years, increasing incidence and prevalence, and growing female : male ratio. Guidelines recommend early use of disease-modifying therapies (DMTs), which are contraindicated or recommended with considerable caution, during pregnancy/breastfeeding. Many physicians are reluctant to prescribe them for a woman who is/is planning to be pregnant. Interferons are not absolutely contraindicated during pregnancy, since interferon-β appears to lack serious adverse effects in pregnancy, despite a warning in its labelling concerning risk of spontaneous abortion. Glatiramer acetate, natalizumab, and alemtuzumab also may not induce adverse pregnancy outcomes, although natalizumab may induce haematologic abnormalities in newborns. An accelerated elimination procedure is needed for teriflunomide if pregnancy occurs on treatment or if pregnancy is planned. Current evidence supports the contraindication for fingolimod during pregnancy; data on other DMTs remains limited. Increased relapse rates following withdrawal of some DMTs in pregnancy are concerning and require further research. The postpartum period brings increased risk of disease reactivation that needs to be carefully addressed through effective communication between treating physicians and mothers intending to breastfeed. We address the potential for use of the first- and second-line DMTs in pregnancy and lactation.","PeriodicalId":46096,"journal":{"name":"Multiple Sclerosis International","volume":"2016 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2016-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/1034912","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64200658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Effects on Balance and Walking with the CoDuSe Balance Exercise Program in People with Multiple Sclerosis: A Multicenter Randomized Controlled Trial","authors":"A. Forsberg, L. von Koch, Y. Nilsagård","doi":"10.1155/2016/7076265","DOIUrl":"https://doi.org/10.1155/2016/7076265","url":null,"abstract":"Background. Balance and walking impairments are frequent in people with multiple sclerosis (MS). Objective. The aim was to investigate the effects of a group-based balance exercise program targeting core stability, dual tasking, and sensory strategies (CoDuSe) on balance, postural sway, walking, perceived walking limitations, and balance confidence. Design. A single-blinded randomized multicenter trial. No intervention was given to controls. Participants. People with MS able to walk 100 meters but unable to maintain tandem stance ≥30 seconds. Eighty-seven participants were randomized to intervention or control. Intervention. The 60-minute CoDuSe group program, twice weekly for seven weeks, supervised by physical therapists. Measurements. Primary outcome was dynamic balance (Berg Balance Scale (BBS)). Secondary outcomes were postural sway, walking (Timed-Up and Go test; Functional Gait Assessment (FGA)), MS Walking Scale, and Activities-specific Balance Confidence (ABC) Scale. Assessments were performed before and after (week 8) the intervention. Results. 73 participants fulfilled the study. There were significant differences between the intervention and the control groups in change in the BBS and in the secondary measures: postural sway with eyes open, FGA, MS Walking Scale, and ABC scale in favor of the intervention. Conclusions. The seven-week CoDuSe program improved dynamic balance more than no intervention.","PeriodicalId":46096,"journal":{"name":"Multiple Sclerosis International","volume":"2016 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/7076265","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64504748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Efficacy of Functional Electrical Stimulation of the Abdominal Muscles in the Treatment of Chronic Constipation in Patients with Multiple Sclerosis: A Pilot Study.","authors":"Christine Singleton, Abdel Magid Bakheit, Carla Peace","doi":"10.1155/2016/4860315","DOIUrl":"https://doi.org/10.1155/2016/4860315","url":null,"abstract":"<p><p>Chronic constipation in patients with multiple sclerosis (MS) is common and the current methods of treatment are ineffective in some patients. Anecdotal observations suggest that functional electrical stimulation (FES) of the abdominal muscles may be effective in the management of constipation in these patients. Patients and Methods. In this exploratory investigation we studied the effects of FES on the whole gut transit time (WGTT) and the colonic transit time (CTT). In addition, we evaluated the treatment effect on the patients' constipation-related quality of life and on the use of laxatives and the use of manual bowel evacuation. FES was given for 30 minutes twice a day for a period of six weeks. Four female patients were studied. Results. The WGTT and CTT and constipation-related quality of life improved in all patients. The patients' use of laxatives was reduced. No adverse effects of FES treatment were reported. Conclusion. The findings of this pilot study suggest that FES applied to the abdominal muscles may be an effective treatment modality for severe chronic constipation in patients with MS. </p>","PeriodicalId":46096,"journal":{"name":"Multiple Sclerosis International","volume":"2016 ","pages":"4860315"},"PeriodicalIF":2.5,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/4860315","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34566505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elizabeth M Wallack, Hailey D Wiseman, Michelle Ploughman
{"title":"Healthy Aging from the Perspectives of 683 Older People with Multiple Sclerosis.","authors":"Elizabeth M Wallack, Hailey D Wiseman, Michelle Ploughman","doi":"10.1155/2016/1845720","DOIUrl":"https://doi.org/10.1155/2016/1845720","url":null,"abstract":"<p><p>Purpose. The aim of this study was to determine what factors most greatly contributed to healthy aging with multiple sclerosis (MS) from the perspective of a large sample of older people with MS. Design and Methods. Participants (n = 683; >55 years of age with symptoms >20 years) provided answers to an open-ended question regarding healthy aging and were categorized into three groups, 55-64 (young), 65-74 (middle), and 75 and over (oldest old). Sociodemographic actors were compared using ANOVA. Two independent raters used the framework method of analyzing qualitative data. Results. Participants averaged 64 years of age (±6.2) with MS symptoms for 32.9 years (±9.4). 531 participants were female (78%). The majority of participants lived in their own home (n = 657) with a spouse or partner (n = 483). Participants described seven themes: social connections, attitude and outlook on life, lifestyle choices and habits, health care system, spirituality and religion, independence, and finances. These themes had two shared characteristics, multidimensionality and interdependence. Implications. Learning from the experiences of older adults with MS can help young and middle aged people with MS plan to age in their own homes and communities. Our data suggests that older people with MS prioritize factors that are modifiable through targeted self-management strategies. </p>","PeriodicalId":46096,"journal":{"name":"Multiple Sclerosis International","volume":"2016 ","pages":"1845720"},"PeriodicalIF":2.5,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/1845720","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34740531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}