MSWA Bulletin Magazine Spring 17_WEB

ROUND-UP OF RESEARCH
AND OTHER ITEMS OF INTEREST
SUE SHAPLAND RN, BN
From the UK MS Trust site:
www.mstrust.org.uk/research/research-updates
MS research update – How does
staying in hospital affect your MS?
Canadian researchers reviewed
details of hospital stays for 2,100
people with MS, over a 5-year
period. 23% had been in hospital at
least once and 7% more than once.
It was found that following hospital
stays there was a sharp increase in EDSS and on average
that was equivalent to 2.5 years of progression. The increase
in disability was greater for unplanned, emergency stays
compared to planned stays, for admission to the intensive care
unit, for hospital stays not related to MS and for longer rather
than shorter lengths of stay.
The results indicated that a sudden illness requiring a stay in
hospital leads to an increase in disability. Many of the reasons
for admission – bladder problems like urinary tract infections,
bowel problems like constipation and respiratory problems –
could be prevented with proactive care.
Can we predict benign multiple sclerosis? Results of a 20-
year long-term follow-up study. Sartori et al. Journal of
Neurology 2017; 264:1068-1075.
Canadian researchers wanted to see whether people
considered to have benign MS (ie very mild relapses and low
levels of disability some years after diagnosis) would still meet
the definition after 10 years. They were also interested to know
if it was possible to predict those people who were destined to
have a benign course of MS as this would help identify people
who might not need to take one of the disease modifying drugs.
175 people, from 5000 on the Ottawa MS clinic database,
were identified as having an EDSS 3 or less 10 years after
diagnosis; of these 63% remained benign at 20 years.
The researchers commented that since none of the early
clinical indicators could predict future course, they concluded
that benign MS can only be used to describe someone’s
experience of MS. The researchers did recognise there were
several problems with the methods they used.
They considered delaying disease modifying drugs (DMDs) in
the hope of someone having and maintaining a benign status
is risky, particularly as once it is clear that someone is no
longer benign, they may have progressed to the point where
DMDs are no longer effective.
Tracking daily fatigue fluctuations in multiple sclerosis:
ecological momentary assessment provides unique insights.
Powell DJH, et al Journal of Behavioural Medicine 2017
Mar 9. [Epub ahead of print]
Fatigue is one of the most common MS symptoms but the
causes are not well understood. A wide range of factors
contribute to fatigue, including low mood and stress at work
or in personal relationships. The combination of contributing
factors means that fatigue levels can vary from day to day and
within a day, making it particularly hard to cope with.
This UK study believed to be a first of its kind, sought to get
a better picture of how fatigue levels vary from moment-tomoment
and day-to-day whilst capturing details of people’s
mood and their stress levels and recent physical activity.
76 participants – 38 with RRMS and 38 without MS – recorded
fatigue levels over 4 week days, together with details of their
mood, exposure to stress and what they were doing at six
time points during the day. At the start of the day, they were
asked to rate the quality of the previous night’s sleep and in
the evening, to score their overall fatigue level for the day.
There were substantial moment-to-moment and day-to-day
fluctuations in fatigue in people with RRMS. On average, their
fatigue levels started higher and remained higher throughout
the day, increasing more rapidly in the earlier part of the day,
peaking in late afternoon then leveling off in the evening.
In both groups, greater exposure to stress and low mood
were associated with higher fatigue levels, positive mood
with lower fatigue levels. Increased fatigue was associated
with recent physical activity in people with MS but not in
those without MS. Surprisingly, a poor night’s sleep did not
affect the next day’s fatigue levels in people with MS but did
increase fatigue levels in people without MS.
Findings: This research highlights the individual variation in
fatigue experienced by people with MS and reinforces the
need for personalised approaches for effective management.
Future studies of MS fatigue could explore ways to improve
positive mood and respond to stress arising from personal
relationships and the work environment. Ways to manage
peak fatigue in the afternoon and after physical activity could
also be explored.
8 | MSWA BULLETIN SPRING 2017