Wednesday, 4 March 2015

CrowdSpeak: vote on the name for the study to crowdfunded

You didn't like HEART; you now have a vote to choose your name! #CrowdSpeak #MSBlog #MSResearch

"Thank you for your very creative responses in proposing several names for the study formerly known as the HEART study. The following is a list of 16 crowd-sourced acronyms." 

  1. ARTEMIS - Anti-Retroviral Treatment for Epstein-Barr Virus in MultIple Sclerosis
  2. ARTS - Anti-ebv and Anti-Retroviral Therapy in mS Trial
  3. BARTS - Barts Anti-ebv and Anti-Retroviral Therapy in mS Trial
  4. BEAT-MS - Barts anti-Ebv and Anti-retroviral Therapy in MS Trial
  5. CARE - ChaRcot Anti-bv and anti-Retroviral thErapy trial 
  6. CATT - Charcot Anti-ebv and anti-reTroviral Therapy in MS Trial
  7. Charcot 2 trial - CHARCOT anti-Ebv and anti-tetroviral Therapy in MS
  8. CHANT - CHarcot anti-ebv and ANti-retroviral Therapy Trial 
  9. CHART - CHarcot anti-ebv and Anti-Retroviral Therapy Trial
  10. CHEARS - CHarcot anti-Ebv and Anti-Retroviral therapy Trial in MS
  11. CHEAT-MS - CHarcot anti-Ebv and Anti-retroviral therapy Trial
  12. CHEERY - CHarcot anti-Ebv and anti-Retroviral therapy Trial
  13. CREATE - ChaRcot anti-Ebv and Anti-retroviral ThErapy trial
  14. ERASE MS - Eliminating Retroviruses And Simultaneously EBV as a driver of MS
  15. HEART - cHarcot anti-Ebv and Anti-Retroviral Therapy Trial
  16. HEART-MS - cHarcot anti-Ebv and Anti-Retroviral Therapy in MS Trial

Please vote for the name you like best?"

"The survey is still open and we have expanded the number of questions we are asking; we need more responses in relation to the type of funding model and whether or not you you understand what we are trying to do."

"Please note although we are going with the Charcot 2 Project we are still working on the  HSCT vs. Alemtuzumab or the ZEUS study. At the moment we are engaging with Dr Paolo Muraro's group at Imperial who will need to lead on this." 

"This remains a community project so please feel free to comment. Thank you."

CoI: multiple

ClinicSpeak: pelvic floor excercises

Did you know pelvic floor exercises help with sexual dysfunction? #MSBlog #MSResearch #ClinicSpeak

"I am attending our annual UK MS Debating Society Meeting this week and I need your help. I have been asked to debate on the benefits of pelvic floor exercises in MSers with bladder and/or sexual dysfunction."

Debate: Pelvic floor exercises should be recommended to all patients with bladder and/or sexual dysfunction. 

For: Prof Gavin Giovannoni /  Against: Dr James Overell.

"There is an emerging literature on the subject. Do any of you have experience with this form or therapy? I would appreciate it if you could let me know via this short survey if you have heard of this treatment or not? Have you been offered it or not? If you have has it been of benefit or not? I have been researching the issue and it occurred to me that everyone with MS should be made aware of this topic and sex, a form of exercise, could be defined as part of a pelvic floor exercise programme. This topic falls into my holistic approach to MS very well. "

Aims: Evaluate the role of Pelvic Floor Muscle Training (PFMT) on the treatment of Lower Urinary Tract Dysfunction (LUTD) in Multiple Sclerosis (MS) patients.

Methods: In this randomized controlled trial, twenty seven female patients with a diagnosis of MS and LUTD complaints were randomized, in two groups: Treatment group (GI) (N = 13) and Sham group (GII) (N = 14). Evaluation included urodynamic study, 24-hr Pad testing, three day voiding diary and pelvic floor evaluation according to PERFECT scheme. Intervention was performed twice a week for 12 weeks in both groups. GI intervention consisted of PFMT with assistance of a vaginal perineometer. GII received a sham treatment consisted on the introduction of a perineometer inside the vagina with no contraction required.

Results: At the end of the treatment GI was complaining less about storage and voiding symptoms than GII. Furthermore, differences found between groups were: reduction of pad weight (P = 0.00) (Mean: 87,51 grams initial and 6,03 grams final in GI. 69,46 grams initial and 75,88 grams final in GII), number of pads (P = 0.01) (Mean: 3,61 initial and 2,15 final in GI. 3,42 initial and 3,28 final in GII) and nocturia events (P < 0.00) (Mean: 2,38 initial and 0,46 final in GI. 2,55 initial and 2,47 final in GII) and improvements of muscle power (P = 0.00), endurance (P < 0.00), resistance (P < 0.00) and fast contractions (P < 0.00), domains of PERFECT scheme.

Conclusions: PFMT is an effective approach to treat LUTD in female with MS.

Paper 2

OBJECTIVE: To compare pelvic floor muscle training and a sham procedure for the treatment of lower urinary tract symptoms and quality of life in women with multiple sclerosis. 

METHODS: Thirty-five female patients with multiple sclerosis were randomized into two groups: a treatment group (n = 18) and a sham group (n = 17). The evaluation included use of the Overactive Bladder Questionnaire, Medical Outcomes Study Short Form 36, International Consultation on Incontinence Questionnaire Short Form, and Qualiveen questionnaire. The intervention was performed twice per week for 12 weeks in both groups. The treatment group underwent pelvic floor muscle training with assistance from a vaginal perineometer and instructions to practice the exercises daily at home. The sham group received a treatment consisting of introducing a perineometer inside the vagina with no exercises required. Pre- and post-intervention data were recorded. 

RESULTS: The evaluation results of the two groups were similar at baseline. At the end of the treatment, the treatment group reported fewer storage and voiding symptoms than the sham group. Furthermore, the differences found between the groups were significant improvements in the following scores in the treatment group: Overactive Bladder Questionnaire, International Consultation on Incontinence Questionnaire Short Form, and the General Quality of Life, and Specific Impact of Urinary Problems domains of the Qualiveen questionnaire. 

CONCLUSIONS: The improvement of lower urinary tract symptoms had a positive effect on the quality of life of women with multiple sclerosis who underwent pelvic floor muscle training, as the disease-specific of quality of life questionnaires demonstrated. This study reinforces the importance of assessing quality of life to judge the effectiveness of a treatment intervention.

Paper 3

Vahtera et al. Pelvic floor rehabilitation is effective in patients with multiple sclerosis. Clin Rehabil August 1997 vol. 11 no. 3 211-219.

Objective: To determine the effect of pelvic floor muscle exercises combined with electrical stimulation of pelvic floor on lower urinary tract dysfunction in MSers with near normal (<100 ml) postvoid residual volumes.

Design: Open, controlled, randomized study in two parallel groups.

Setting: Rehabilitation centre for MSers.

Subjects: Fifty women and 30 men with definite MS and current symptoms of lower urinary tract dysfunction.

Outcome: The muscle activity of the pelvic floor muscles was tested using surface EMG. Subjective urinary symptoms were assessed using a questionnaire.

Interventions: Pelvic floor muscles were stimulated using electrical stimulation at six sessions. During and after the final session the MSers were taught to exercise their pelvic floor muscles and advised to continue these exercises regularly for at least six months. The control group was not treated.

Results: The maximal contraction power and endurance of the pelvic floor muscles increased after six sessions of electrical stimulation with interferential currents. Symptoms of urinary urgency, frequency and incontinence were significantly less frequent in the treated group than in the untreated subjects. Male MSers appeared to respond better to the treatment than female MSers. Compliance with the pelvic floor exercises was over 60% at the end of a follow-up for six months. Most drop-outs were due to the disappearance of urinary tract symptoms or to severe relapses in MS.

Conclusions: The present study indicates that pelvic floor muscle exercises combined with electrical stimulation of the pelvic floor constitute an effective treatment for lower urinary tract dysfunction at least in male MSers with MS.

Cardiovasular risks and MS

Kappus N, Weinstock-Guttman B, Hagemeier J, Kennedy C, Melia R, Carl E, Ramasamy DP, Cherneva M, Durfee J, Bergsland N, Dwyer MG, Kolb C, Hojnacki D, Ramanathan M, Zivadinov R.
J Neurol Neurosurg Psychiatry. 2015 Cardiovascular risk factors are associated with increased lesion burden and brain atrophy inmultiple sclerosis.Feb 26. pii: jnnp-2014-310051. doi: 10.1136/jnnp-2014-310051. [Epub ahead of print]

BACKGROUND: Cardiovascular (CV) risk factors have been associated with changes in clinical outcomes in patients with multiple sclerosis (MS).
OBJECTIVES: To investigate the frequency of CV risks in patients with MS and their association with MRI outcomes.
METHODS: In a prospective study, 326 patients with relapsing-remitting MS and 163 patients with progressive MS, 61 patients with clinically isolated syndrome (CIS) and 175 healthy controls (HCs) were screened for CV risks and scanned on a 3T MRI scanner. Examined CV risks included hypertension, heart disease, smoking, overweight/obesity and type 1 diabetes. MRI measures assessed lesion volumes (LVs) and brain atrophy. Association between individual or multiple CV risks and MRI outcomes was examined adjusting for age, sex, race, disease duration and treatment status.
RESULTS:Patients with MS showed increased frequency of smoking (51.7% vs 36.5%, p=0.001) and hypertension (33.9% vs 24.7%, p=0.035) compared with HCs. In total, 49.9% of patients with MS and 36% of HCs showed ≥2 CV risks (p=0.003), while the frequency of ≥3 CV risks was 18.8% in the MS group and 8.6% in the HCs group (p=0.002). In patients with MS, hypertension and heart disease were associated with decreased grey matter (GM) and cortical volumes (p<0.05), while overweight/obesity was associated with increased T1-LV (p<0.39) and smoking with decreased whole brain volume (p=0.049). Increased lateral ventricle volume was associated with heart disease (p=0.029) in CIS.
CONCLUSIONS: Patients with MS with one or more CV risks showed increased lesion burden and more advanced brain atrophy.

So this study suggests that MSers have cardiovascular co-morbidities, which comes first co-morbidity and MS or MS an then the co-morbidity,many of these problems come with age as does brain atrophy.

Peoples Strictly- Vote Trishna

#MS Research Vote #Trisha @ #Peoples Strictly

You only come here for the Research News, you cam skip this piece on Peoples Strictly.

Whilst all the contestants deserve heaps of praise, lets get behind Trishna, She contributes to TeamG activities including being one of our Expert MSers, who is embedded in our teaching, clinical and research activities. She also runs Asian MS, which is associated with the MS Society 

You must now realise that Trishna was not featured on last weeks show. So tonight's the night.

Six inspirational but everyday heroes and heroines have been confirmed to take part in BBC One’s The People’s Strictly for Comic Relief and fulfil every Strictly fan’s dream.

Each contestant has been paired with a professional dancer from the Strictly Come Dancing family. They have spent five weeks being immersed in the Strictly experience, as they prepare to become the new stars of the ballroom. Aljaž Skorjanec is Trishna's Dancing Partner [Pronounced AlyArge SkorYanEtz (E as e in Jet. tz as tz in Tzar]  

Today is the second episode introducing Trishna and other contestants

The third episode tomorrow (5th march) will continue to follow their training and preparation as they get ready for their ballroom debut in front of the nation.

Episode four (11th March) will see all six contestants compete on the famous Strictly Come Dancing ballroom, as they vie for the judges’ scores and viewers’ votes. The judges’ scores will be for guidance only, and the public will have the deciding vote.

The Training is gruelling and fingers crossed the Fatigue and Stress is not good for MS.

Voting lines will open once all couples have danced and the winner of the public vote will then be crowned The People’s Strictly champion as part of the live Comic Relief show on BBC One on Friday 13 March 2015. 

You can watch starting Today BBC1 (British Broadcasting Corporation) at 21.00 and who knows who else you may see:-). 

I've been at a meeting so if your reading mum, set the video:-). I know all you techies can get it on iplayer.