Bulletin Spring 2018

MS RESEARCH ROUND UP
SHARING RESEARCH UPDATES
FROM AROUND THE WORLD
SUE SHAPLAND RN, BN, Cert MS Nursing, MSCN
From the UK MS TRUST
Relapses and brain fog
Giedraitiene N, et al. Cognition during and after multiple
sclerosis relapse as assessed with the brief international
cognitive assessment for multiple sclerosis. Sci Rep. 2018
May 25;8(1):8169.
Many people with MS talk about ‘brain fog’ or ‘cog fog’ when
describing the feeling that their thinking processes are not as
organised or reliable as before. This study assessed memory
and thinking (cognition) to see how it changed during and
after a relapse.
For this study, 60 people experiencing an MS relapse, 30 with
stable MS and 30 without MS took part in this study. Cognition
was assessed using BICAMS, a quick and easy set of tests
measuring different aspects of thinking and memory. For
those experiencing a relapse, the tests were applied during
the relapse, and then one and three months after. The group
with stable MS and the group without were tested just once.
All test scores were lower in people with MS, both relapsing and
stable, vs those without MS. The test measuring information
processing speed was worse in relapsing MS than in stable
MS. Tests assessing visual and verbal memory were not
significantly different for relapsing MS and stable MS. Within
the relapsing group, scores improved one month after relapse.
The study confirms relapses can impact on cognition, with
information processing speed most affected; thus, it’s wise to
avoid making big decisions during a relapse. The good news
is that processing speed improves quite quickly and is back to
levels typical for people with MS after just one month.
The researchers commented that cognition is not often
monitored during clinic appointments and recommend
BICAMS as a quick and effective way to do this, particularly
for those having a relapse.
Intensive physiotherapy technique improves hand and
arm use.
Mark VW et al. Phase II randomized controlled trial of
constraint-induced movement therapy in multiple sclerosis.
Part 1: effects on real-world function. Neurorehabil Neural
Repair. 2018 Mar;32(3):223-232.
Constraint-induced movement therapy (CIMT) is a form of
intensive physiotherapy originally developed to help people
with one arm weaker after a stroke. It involves restricting the
use of the stronger arm and intensively training the weaker
arm and providing coaching for use in everyday life.
In this small study, researchers tested this technique with
people with MS and looked for MRI evidence of changes to brain
structures. 20 people with MS with significant weakness in one
arm received either CIMT or a package of complementary and
alternative therapies (CAM). Both groups received 3.5 hours
of direct contact therapy daily for 10 consecutive weekdays.
Eight people in each group completed treatment and returned
for follow-up assessment one year later.
Advanced MRI techniques were used to compare brain
structures in the two groups before and after treatment.
The CIMT group showed greater improvement in the everyday
use of their weaker arm than the CAM group and the
improvement was retained at the one-year follow-up.
Both groups showed improvements in speed and dexterity
of their weaker arm immediately after treatment courses. At
one-year follow-up, speed and dexterity of the weaker arm
had continued to improve in the CIMT group but was returning
to pre-treatment levels in the CAM group.
MRI results suggested that in the CIMT group there were
measurable changes in brain structures at the end of the ten
days of treatment; this was not seen in the CAM group.
The researchers conclude that the results warrant further
studies with greater numbers and longer follow-up times.
They intend to evaluate CIMT on people with MS with mobility.
Continued over
MSWA BULLETIN SPRING 2018 | 7