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10 results

  • Modified Mediterranean diet v. traditional Iranian diet: efficacy of dietary interventions on dietary inflammatory index score, fatigue severity and disability in multiple sclerosis patients

  • Jalal Bohlouli, Iman Namjoo, Mohammad Borzoo-Isfahani, Fariborz Poorbaferani, Amir Reza Moravejolahkami, Cain C. T. Clark, Mohammad Ali Hojjati Kermani
  • Journal:
    British Journal of Nutrition / Volume 128 / Issue 7 / 14 October 2022
    Published online by Cambridge University Press:
    16 August 2021, pp. 1274-1284
    Print publication:
    14 October 2022
    • Article
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  • Background:

    Current evidence suggests that adherence to the Mediterranean diet (MeD) can reduce inflammation in chronic diseases; however, studies pertaining to relapsing-remitting multiple sclerosis (RRMS) are limited. Therefore, the aim of this study was to investigate the potential of the modified MeD (mMeD) in improving Dietary Inflammatory Index (DII) scores, disability and fatigue severity, compared with traditional Iranian diet (TID), in RRMS patients.

    Results:

    Of the 180 patients enrolled, 147 participants were included in the final analysis (n of mMeD = 68; n of TID = 79). Self-reported adherence was good (˜81 %). Dietary intakes of forty-five food parameters were assessed through the FFQ. The mMeD significantly reduced DII scores after 6 months (2·38 ± 0·21 to −1·87 ± 0·86, P < 0·001), but TID did not elicit any changes (2·21 ± 0·44 to 2·14 ± 1·01, P = 0·771). Additionally, Modified Fatigue Impact Scale (MFIS) total score decreased significantly (72·4 ± 17·2 to 63·9 ± 14·2, P < 0·001), whereas there was no considerable improvement for Expanded Disability Status Scale (EDSS) in the mMeD group.

    Methods:

    After initial screening (n 261), 180 RRMS patients were randomised to receive mMeD or TID (as control) for 6 months. DII score, EDSS and twenty-one-item MFIS were evaluated at baseline and trial cessation. Multivariate ANCOVA was conducted and adjusted for age, gender, body weight, BMI, education level, supplement use, family history and duration of MS.

    Conclusion:

    Adherence to mMeD, for 6 months, improved dietary inflammatory status and fatigue severity in RRMS patients; however, the TID did not positively impact dietary inflammation and MFIS score.

  • Two Multiple Sclerosis Quality-of-Life Measures: Comparison in a National Sample

  • Fraser Moore, Barbara Vickrey, Kathy Fortin, Liesly Lee
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 42 / Issue 1 / January 2015
    Published online by Cambridge University Press:
    14 January 2015, pp. 55-63
    • Article
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  • Background: Multiple sclerosis (MS) has a profound impact on patients’ health-related quality of life (HRQoL). It is unclear how HRQoL can be best assessed for different purposes. This study aimed to compare two HRQoL questionnaires of differing lengths for feasibility of administration, patient perceptions and psychometric properties. Methods: This was an open-label, 24-month study in 334 patients with relapsing MS treated with subcutaneous interferon β-1a. At baseline and months 6, 12, 18 and 24, patients completed the Multiple Sclerosis International Quality of Life (MusiQoL) and Multiple Sclerosis Quality of Life-54 (MSQOL-54) questionnaires and compared them using an evaluation questionnaire. HRQoL scores over time and psychometric properties (correlations with clinical disease measures, relative validity and responsiveness to change) of the questionnaires were assessed. Results: A minority of patients had missing items on either HRQoL measure. Completion time was significantly shorter for MusiQoL versus MSQOL-54 (p<0.0001). Patients felt that MusiQoL was easier to use than MSQOL-54 but preferred MSQOL-54 in terms of thoroughness. Mean HRQoL scores increased significantly from baseline to 24 months; correlations of both measures were stronger with an anxiety and depression measure than with disability or recent relapse occurrence. Relative validity and responsiveness to change were similar for both instruments. Conclusion: The shorter MusiQoL is suitable for evaluating HRQoL in patients with MS and may be more practical to administer than the more thorough MSQOL-54.

  • 43 - Sex hormones and other pregnancy-related factors with therapeutic potential in multiple sclerosis

  • from Section III - Clinical trials of multiple sclerosis therapies
  • Edited by Jeffrey A. Cohen, Richard A. Rudick
  • Book:
    Multiple Sclerosis Therapeutics
    Published online:
    05 December 2011
    Print publication:
    20 October 2011, pp 498-507

  • Summary

    Laquinimod is rapidly absorbed following oral administration with bioavailability of 82%-95%. Two Phase 2 clinical trials were conducted with laquinimod. Both demonstrated a reduction in the frequency of gadolinium (Gd)-enhancing lesions and relapses in patients with relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS). Laquinimod was well tolerated in both Phase 2 trials with few side effects. There was no difference in the overall number of adverse events (AEs) or serious adverse events (SAEs) between the placebo and laquinimod groups. Laquinimod effectively ameliorates both acute and chronic experimental autoimmune encephalomyelitis (EAE) decreasing both demyleination and axonal loss. Laquinimod may have protective effects on axonal integrity beyond that associated with decreased inflammation. Laquinimod has no immuno suppressive effects in animal models or in human studies, and does not decrease the ability of animals to mount a cellular or humeral immune response. The safety profile of laquinimod appears quite favorable.

  • 40 - Statins in multiple sclerosis

  • from Section III - Clinical trials of multiple sclerosis therapies
  • Edited by Jeffrey A. Cohen, Richard A. Rudick
  • Book:
    Multiple Sclerosis Therapeutics
    Published online:
    05 December 2011
    Print publication:
    20 October 2011, pp 465-471

  • Summary

    Dimethyl fumarate (DMF) is an oral therapy in development for multiple sclerosis (MS). Fumaric acids were first studied in MS in a Phase 1, open-label, baseline-controlled trial using the combination fumaric acid ester preparation Fumaderm. Based upon the encouraging Phase 1 results, Fumapharm partnered with Biogen Idec to conduct a Phase 2 trial of DMF in relapsing-remitting multiple sclerosis (RRMS). The use of DMF in autoimmune diseases arose from a personal view of the immune system, whereby autoimmunity is caused by disruption in the Krebs's cycle. The Phase 2 trial found that 720 mg/d of BG00012 reduced active inflammation. The Phase 3 trials provide pivotal and definitive evidence regarding the safety and efficacy of BG00012 in MS. Ongoing laboratory studies and advanced imaging studies in the Phase 3 trials are evaluating the neuroprotective effects of BG00012. Fumaric acids such as BG00012 are an exciting new class of potential MS treatment.

  • 60 - Assessment and treatment of pain disorders in multiple sclerosis

  • from Section IV - Therapy in clinical practice
  • Edited by Jeffrey A. Cohen, Richard A. Rudick
  • Book:
    Multiple Sclerosis Therapeutics
    Published online:
    05 December 2011
    Print publication:
    20 October 2011, pp 707-713

  • Summary

    Disease modifying therapy (DMT) with one of the approved agents should be considered in all patients with active relapsing-remitting multiple sclerosis (RRMS) once the diagnosis of MS is confirmed and in selected patients with a clinically isolated demyelinating syndrome (CIS). Interferon beta modulates T-cell and B-cell function, decreases expression of matrix metalloproteinases reversing blood-brain barrier disruption, and alters expression of cytokines. A series of double-blind, placebo-controlled Phase 3 trials in RRMS supported the benefit of interferon in reducing relapses, disability progression, and MRI lesion activity and accrual. All of the available agents have been reported to reduce relapse rate, magnetic resonance imaging (MRI) lesion activity, and accumulation of disability in RRMS. Patients need to be seen on a regular basis after starting treatment to address potential side effects. This chapter discusses treatment of acute relapses, progressive multiple sclerosis and treatment in special populations including children.

  • 32 - Alemtuzumab to treat multiple sclerosis

  • from Section III - Clinical trials of multiple sclerosis therapies
  • Edited by Jeffrey A. Cohen, Richard A. Rudick
  • Book:
    Multiple Sclerosis Therapeutics
    Published online:
    05 December 2011
    Print publication:
    20 October 2011, pp 393-398

  • Summary

    In vitro, two different classes of antibodies are recognized according to the assay used to identify them: binding antibodies (BAbs) and neutralizing antibodies (NAbs). There is emerging agreement that NAbs are correlated with reduced therapeutic efficacy of IFNβ. None of the pivotal trials in relapsing-remitting multiple sclerosis (MS) showed an effect of NAbs on disease progression. Among the therapeutic monoclonal antibodies natalizumab, alemtuzumab, and daclizumab are humanized monoclonal antibodies, whereas rituximab is a mouse-human chimeric antibody. NAbs are associated with reduction of the therapeutic effect of IFNβ, and patients with persistent high titers of NAbs should be switched to an alternative therapy. Patients with low or intermediate titers should have their IFN bioactivity measured with an in vivo mRNA MxA induction test. Patients with repeated abrogation of the mRNA MxA response to IFN injections should be switched to another therapy.

  • 37 - Use of immunosuppressants to treat multiple sclerosis

  • from Section III - Clinical trials of multiple sclerosis therapies
  • Edited by Jeffrey A. Cohen, Richard A. Rudick
  • Book:
    Multiple Sclerosis Therapeutics
    Published online:
    05 December 2011
    Print publication:
    20 October 2011, pp 436-443

  • Summary

    In the Mitoxantrone in Multiple Sclerosis (MIMS) study, patients were enrolled between 1993 and 1997 at 17 centers in Belgium, Germany, Hungary, and Poland, and randomly assigned to treatment with mitox. Cardiac monitoring, electrocardiography (ECG), and left ventricular ejection fraction (LVEF) assessed by echocardiography or radionuclide scan, was performed before treatment. The comparative study of mitox efficacy profile in relapsing-remitting multiple sclerosis (RRMS) and secondary-progressive multiple sclerosis (SPMS) evaluated the clinical and neuroradiological response to mitox. Substantial tolerability data are available from oncology studies in which mitox was generally used in combination with cyclophosphamide, luorouracil, mitomycin, methotrexate, and radiotherapy for leukemia, non-Hodgkin's lymphoma and solid tumors, and from MS studies in which mitox was used as monotherapy. The available data from studies in patients with MS suggest that mitox may have a role to play in the management of aggressive disease, as an induction therapy.

  • 42 - B-cell-based therapies for multiple sclerosis

  • from Section III - Clinical trials of multiple sclerosis therapies
  • Edited by Jeffrey A. Cohen, Richard A. Rudick
  • Book:
    Multiple Sclerosis Therapeutics
    Published online:
    05 December 2011
    Print publication:
    20 October 2011, pp 483-497

  • Summary

    In the first of two studies reported by Rose and coworkers, patients with relapsing-remitting multiple sclerosis (RRMS) or secondary-progressive multiple sclerosis (SPMS) were initiated on daclizumab with the same dose. A positive effect on relapses was observed. Safety data coming from daclizumab's regulatory-approved indication in renal transplantation suggest that the drug is overall safe and well tolerated. However, safety data from other of-label indications, such as uveitis, seem to confirm safety concerns regarding a mild increase in infection rate as well as skin reactions. Daclizumab is a novel and promising therapy for MS patients now being tested as monotherapy in a large Phase 3 trial using an active comparator arm. Daclizumab's mechanism of action is not fully understood, but an increase in regulatory immune cells has been related to clinical response and is now thought to play a more important role than direct anti-inflammatory effects derived from IL-2 blockade.

  • Information processing deficits in multiple sclerosis: A matter of complexity

  • BRETT A. PARMENTER, JANET L. SHUCARD, DAVID W. SHUCARD
  • Journal:
    Journal of the International Neuropsychological Society / Volume 13 / Issue 3 / May 2007
    Published online by Cambridge University Press:
    20 March 2007, pp. 417-423

  • This study examined the relationship between processing speed (PS) and working memory (WM), as measured by performance on an n-back task, in relapsing-remitting multiple sclerosis (RRMS) patients. Simple PS was defined as reaction time (RT) on the 0-back task and complex PS was defined as RT on both the 1-back and 2-back tasks. Participants were administered all three n-back tasks (0-, 1-, and 2-back). Total correct responses, total dyads, and RTs were recorded. As expected, RT for all participants slowed as WM load increased. MS patients had slower RTs than controls across all tasks, and the difference between groups for RT was greatest during the 2-back task. When RT for simple PS (0-back) was parsed from the 1- and 2-back tasks, MS patients still showed impaired complex PS compared to controls. MS patients also made significantly fewer total correct responses and had fewer dyads than controls only on the 2-back task. These findings suggest that both WM and PS deficits are present in RRMS, and that as WM demand increases (from 1- to 2-back) both PS and WM deficits become more prominent. (JINS, 2007, 13, 417–423.)