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MS Research Spotlight: Comorbidities, Disability Milestones & More

MS Research Spotlight covers key research news from the past two weeks.


Comorbidity in MS: Past, present and future (1)

MARCH 23, 2019 || Clinical and Investigative Medicine

It’s widely accepted that comorbidities, or co-occurring health conditions, are common in people with MS, but research over the last 20 years has not looked more closely at how these conditions can affect people also living with MS.

Dr. Ruth Ann Marrie recently reviewed and published the results of observations linking comorbidities to MS in subjects with multiple sclerosis. In the abstract to her research, she writes that “Broadening our perspective by better understanding the effects of comorbidity on an individual with a particular chronic disease offers us an opportunity to improve understanding of prognosis, personalize disease management, develop new therapeutic approaches and illuminate the pathophysiology of disease.”

Looking at incidence, prevalence and outcomes related to comorbidities in her research subjects, Dr. Marrie found a wide variety of health problems among those with MS, such as depression, anxiety, hypertension, hyperlipidemia, diabetes, and chronic lung disease. The study’s findings suggest an “urgent need to determine how to best prevent and treat comorbidity in MS.”1

Changes in the risk of reaching MS disability milestones(2)

MARCH 18, 2019 || JAMA Neurology

“Disability milestones” refers to specific changes in the severity of one’s disability as measured by the Expanded Disability Status Scale (EDSS).2,3

People with MS who experience limitations may be scored on the EDSS and receive a rating between 0.0 and 10.0 which categorizes how severely disabled they are by their disease. A measure of 0.0 to 5.0 shows little to no apparent physical disability, while 6.0 to 10.0 shows the range from having trouble walking to becoming fully bedridden.

Recent research in Sweden suggests that the risk of reaching major disability milestones (namely 6.0 to 10.0) has significantly decreased in the last decade in a survey of nearly 7500 patients with MS.

The researchers believe that the increased use of “more efficacious disease-modifying treatments” for those with relapsing-remitting disease could be to credit for this positive change.

Meanwhile, results for patients with progressive forms of the illness did not change, and the researchers suggest this is due to the “absence of efficacious treatment option in this group.”2

Remote monitoring devices to measure walking ability in people with MS

MARCH 15, 2019 || JAMA Network Open

It can be difficult to capture and measure the variability in walking ability in people with MS. New research studied 95 people with varying forms of MS whose gait and walking behaviors were monitored remotely, by way of a wrist-worn accelerometer, in their natural environment for one year.

The researchers found that measuring the ambulatory disability of subjects with MS through this wearable device was both valid and feasible, and that the data captured by the device revealed clinically relevant information not obtained through conventional metrics. The study authors concluded that using these easy-to-wear remote monitoring devices could greatly enhance research data in the future.4

Role of cerebral hypoperfusion in MS

MARCH 14, 2019 || BMC Trials Journal

Cerebral hypoperfusion describes a condition in which the brain does not receive an adequate blood supply. Recent research has focused on how cerebrovascular factors, such as cerebral hypoperfusion, might play a role in neurodegenerative and cognitive impairment related to conditions such as MS.5,6

A study published in the Journal of Cerebral Blood Flow & Metabolism in 2015 sought to analyze this relationship, finding that “perfusion-weighted imaging studies have demonstrated that there is a widespread cerebral hypoperfusion in patients with MS, which is present from the early beginning to more advanced disease stages,” and that “evidence is evolving that cerebral hypoperfusion in MS is associated with chronic hypoxia, focal lesion formation, diffuse axonal degeneration, cognitive dysfunction, and fatigue. Restoring CBF may, therefore, emerge as a new therapeutic target in MS.”7

A new European study is looking into restoration of CBF through short-term dosages of bosentan, a dual endothelin receptor antagonist used in the treatment of pulmonary artery hypertension. The ongoing ROCHIMS study is a “proof-of-concept double-blind randomized clinical trial” which researchers hope to demonstrate a “global increase of CBF in the individuals treated with bosentan.”8 They will also be looking at multiple parameters, such changes in fatigue, cognition, motor function, depression, and brain volume.

Recruitment for the trial ends in April 2019.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Marrie RA. Comorbidity in multiple sclerosis: Past, present and future. Clinical and Investigative Medicine. 2019 Mar 23;42(1):E5-E12. doi: 10.25011/cim.v42i1.32383.
  2. Beiki O, Frumento P, Bottai M, Manouchehrinia A, Hillert J. Changes in the Risk of Reaching Multiple Sclerosis Disability Milestones In Recent Decades: A Nationwide Population-Based Cohort Study in Sweden. JAMA Neurol. Published online March 18, 2019. doi:10.1001/jamaneurol.2019.0330
  3. Kurtzke Expanded Disability Status Scale. US Department of Veterans Affairs. https://www.va.gov/MS/Professionals/Diagnosis/Kurtzke_Expanded_Disability_Status_Scale.asp. Updated August 3, 2018. Accessed April 18, 2019.
  4. Block VJ, Bove R, Zhao C, et al. Association of Continuous Assessment of Step Count by Remote Monitoring With Disability Progression Among Adults With Multiple Sclerosis. JAMA Netw Open. 2019;2(3):e190570. doi:10.1001/jamanetworkopen.2019.0570
  5. Hostenbach S, Pauwels A, et al. Role of cerebral hypoperfusion in multiple sclerosis (ROCHIMS): study protocol for a proof-of-concept randomized controlled trial with bosentan. March 14, 2019. ttps://doi.org/10.1186/s13063-019-3252-4
  6. Duncombe J, Kitamura A, Hase Y, et al. Chronic cerebral hypoperfusion: a key mechanism leading to vascular cognitive impairment and dementia. Closing the translational gap between rodent models and human vascular cognitive impairment and dementia. Clinical Science. September 28, 2017. DOI: 10.1042/CS20160727
  7. D'haeseleer M, Hostenbach S, Peeters I, et al. Cerebral hypoperfusion: a new pathophysiologic concept in multiple sclerosis?. J Cereb Blood Flow Metab. 2015;35(9):1406–1410. doi:10.1038/jcbfm.2015.131
  8. UZ Brussel. Does cerebral hypoperfusion play a role in reduced axonal metabolism and clinical disability in patients with multiple sclerosis? EudraCT Number: 2017-001253-13. Start dateL August 23, 2017. Accessed April 18, 2019.

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