Medicine & Research

Taking vitamin D may benefit people with MS
 
According to researchers, led by Dr. Peter A. Calabresi, of Johns Hopkins University School of Medicine in Baltimore, taking a high dose of vitamin D3 is safe for people with multiple sclerosis and may mediate the body’s hyperactive immune response.
 
For the study, 40 people with relapsing-remitting MS received either 10,400 IU or 800 IU of vitamin D3 supplements per day for six months. The people taking the high dose had a reduction in the percentage of T cells related to MS activity. The people taking the low dose did not have any changes in their T cells.
 
Side effects from the vitamin supplements were minor and were not different between the people taking the high dose and the people taking the low dose. The people in the study taking the high dose of vitamin D reached a level that has been proposed as a target for people with MS.
 
“These results are exciting, as vitamin D has the potential to be an inexpensive, safe and convenient treatment for people with MS,” said Calabresi. “More research is needed to confirm these findings with larger groups of people and to help us understand the mechanisms for these effects, but the results are promising.”
 
The study was published in the online issue of Neurology.
 
Dr. Thrower: Multiple small and medium-sized trials of vitamin D therapy in MS have shown that getting blood levels into a mid-normal range is associated with a lower risk of relapses and fewer new lesions on MRI. This study is interesting because it sheds light on one of the ways in which vitamin D may work in MS. The majority of people with MS do have low levels of vitamin D when tested.
 
We get vitamin D both from our diet and from exposure to sunlight. Inactive forms of vitamin D are converted to the active form in the skin by sunlight. Ten to 15 minutes of sunlight daily seems to be the right amount. After that, you’re either tanning or burning. Many people with MS have good diets and get some sunlight exposure and still have low vitamin D levels. This may be due to genetic factors that regulate vitamin D metabolism.
 
So, how much vitamin D should you take? I advise that people with MS get their vitamin D levels checked with a blood test. The blood levels will guide our dosing with a goal being a 25-hydroxy vitamin D level around 50 to 70 nanograms per milliliter. People need to avoid taking massive doses of vitamin D without guidance as there may be a higher risk of kidney stones with prolonged excessive dosing.
 
Researchers pioneer new MRI technique for use in MS
 
A research team in the UK has found a way to use clinical MRI to distinguish between MS lesions and other brain white spots which are found in MS. The new study is significant because currently among patients referred to MS treatment centers with suspected MS, fewer than 50 percent are found to have it. This shows that diagnosing MS in a significant minority of cases can be challenging.
 
Researchers at the University of Nottingham and Nottingham University Hospitals NHS Trust used a clinical MRI scanner to carry out a special type of scan, called a T2-weighted imaging process, which is able to reveal lesions in the brain’s white matter that are centered on a vein — a known indicator of MS.
 
Lead researcher, Dr. Nikos Evangelou, said: “We wanted to find out whether a single brain scan in an NHS hospital scanner could also be effective in distinguishing between patients known to have MS and patients known to have non-MS brain lesions. We are excited to reveal that our results show that clinical application of this technique could supplement existing diagnostic methods for MS.”
 
Forty patients were recruited from the Neurology Outpatients’ Department of Nottingham University Hospitals NHS Trust. A test group of 10 patients with MS and 10 patients with non-MS white brain matter lesions were scanned. Scans were analyzed blinded to clinical data and simple diagnostic rules were devised. The same rules were applied to a validation group of 20 patients. Within the test group, all patients with MS had central veins in more than 45 percent of brain lesions, while the rest had central veins visible in less than 45 percent of lesions. Then, by applying the same diagnostic rules to the second group, all the remaining patients were correctly categorized into MS or non-MS, by the blinded observer, taking less than two minutes per scan.
 
The study is published in the Multiple Sclerosis Journal.
 
Dr. Thrower: In the U.S., we currently have 13 FDA-approved therapies for relapsing forms of MS. For the past 20 years, research has consistently shown that the initiation of these drugs early in the course of MS has the greatest effect. Early treatment necessitates the early diagnosis of MS. While an early diagnosis is important, an accurate diagnosis is equally important.
 
Brain MRI aids in both the diagnosis and monitoring of MS. The overwhelming majority of people with MS have “white spots” or lesions on brain MRI. Unfortunately, many other conditions can be associated with brain MRI abnormalities, including migraine headaches and small strokes.
 
This new MRI technique described may allow for the more accurate diagnosis of MS and the avoidance of mistaken diagnoses. Any research advance that allows for the more timely and accurate diagnosis of MS is a step in the right direction.
 
Infertility treatments may significantly increase MS activity
 
A new study finds that women with MS who undergo infertility treatment with assisted reproduction technology (ART) are at risk for increased disease activity. The findings suggest reproductive hormones contribute to regulation of immune responses in autoimmune diseases such as MS.
 
Medical evidence shows sex hormones and those involved in ovulation play an important role in the development of autoimmune disorders. A group of researchers, with the Raúl Carrea Institute for Neurological Research in Buenos Aires, analyzed clinical, radiological, and immune response data in 16 MS patients who were subject to 26 ART cycles. The team recruited 15 healthy volunteers and 15 MS patients in remission not receiving ART to serve as controls.
 
Results show that 75 percent of MS patients experienced disease exacerbation following infertility treatment. Relapses were reported in 58 percent of the cycles during the three-month period following ART treatment. Furthermore, ART was associated with a seven-fold increase in risk of MS exacerbation and a nine-fold increase of greater disease activity on MRIs. The authors found that 73 percent of exacerbations were new symptoms and 27 percent were attributed to a worsening of pre-existing symptoms.
 
The study was published in Annals of Neurology.
 
Dr. Thrower: MS is most commonly diagnosed in young adults, with women outnumbering men by about a 3-1 ratio. Family planning is of great importance to many of these young women. Discussions about the effect of pregnancy, breastfeeding, and the effects of medications on both of these, are part of comprehensive MS management. The authors of this study took a look at a less commonly discussed topic. While further research is needed, this study shows a fairly high risk of relapse with infertility treatment. Hopefully, further research will include information on relapse rates and types of treatment in women undergoing infertility management.
 
Studies of women with MS have shown that the person’s pre-pregnancy MS activity (relapse rate, MRI activity) may help predict the risk of a post-partum relapse. In addition, stopping MS medications, especially Tysabri, which may be associated with a higher risk of relapses, regardless of pregnancy/infertility issues.
 
Brain-training video games may help MS patients
 
A new study suggests that playing a certain kind of video game strengthens neural connections in the brains of people with multiple sclerosis, actually improving cognitive abilities. Researchers hope to study whether the plasticity induced by video games is linked to improvements in other aspects of the daily lives of those with MS. They also plan to look at how the video game can be integrated into a rehabilitation program.
 
Researchers from the Department of Neurology and Psychiatry at Sapienza University in Rome, studied the effects of a video game-based cognitive rehabilitation program on the thalamus in MS patients. They used a collection of Nintendo games, called Dr. Kawashima’s Brain Training, which trains the brain using puzzles, word, memory, and other mental challenges.
 
Twenty-four MS patients with cognitive impairment were randomly assigned to either take part in an eight-week, home-based rehabilitation program – consisting of 30-minute gaming sessions, five days per week – or be put on a wait list, serving as the control group. Patients were evaluated by cognitive tests and by 3-Tesla resting state functional MRI at baseline and after the eight-week period. At follow-up, the 12 patients in the video-game group had significant increases in thalamic functional connectivity in brain areas corresponding to the posterior component of the default mode network, which is one of the most important brain networks involved in cognition.
 
The modifications in functional connectivity, shown in the video game group after training, corresponded to significant improvements in test scores assessing sustained attention and executive function. The results suggest that video-game-based brain training is an effective option to improve cognitive abilities of patients with MS.
 
The study was published online in the journal Radiology.
 
Dr. Thrower: As a parent, I’m always trying to limit the time my son spends on video games. As it turns out, not all video games are bad. This study shows how the use of brain-training games may be used like a form of physical therapy to improve cognition. People with MS using the brain-training games showed improvements on functional MRI and on cognitive test scores. Let’s not let our kids see this study.
 
Study finds greater role for environment in MS
 
According to early research, led by Queen Mary University of London and Barts Health NHS Trust, environmental factors may be playing a much greater role in the onset of MS than previously realized. The theory is based on new findings showing that black people and South Asians in east London have a higher prevalence of MS compared to those groups in their ancestral countries, indicating a strong environmental influence on the disease that could be driving higher MS rates in London.
 
The researchers used electronic records from general practices in four East London boroughs which were reviewed for the number of MS-diagnosed patients, grouped by ethnicity. What they found was that MS appeared to be several times more prevalent among African people and South Asians living in London compared to those groups living in their ancestral territory. While prevalence differences could be explained by fewer MS diagnoses occurring in less resourced countries, the authors said it is unlikely to explain the disparity in prevalence between these territories. They said that an alternative or additional explanation would be increased exposure, in the UK, to environmental agents or behaviors that facilitate the development of MS.
 
The study was published in Multiple Sclerosis Journal.
 
Dr. Thrower: MS results from a complicated dance between genetic and environmental factors. More than 60 genes have been identified that play a role in the risk for developing MS. Environmental risk factors include low vitamin D levels, tobacco smoking, obesity, and the exposure to certain viruses. The role of dietary factors, such as sodium and diets higher in animal fats, is still being sorted out. Traditionally, certain parts of the world and certain racial groups have a low risk for developing MS. These include parts of Asia and Africa. This study suggests that environmental factors can shift a seemingly lower MS risk group into a higher MS risk group.