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February 27, 2002

MS patients with memory deficits or cognitive impairment often have weakened central executive skills, according to research presented in Toronto at the annual meeting of the International Neuropsychological Society.
Cognitive impairment describes damage to the brain’s ability to remember, know, think and judge. Central executive skills, meanwhile, include planning, making decisions and understanding new or difficult situations.
Researchers administered two memory-related tests to 18 MS patients with cognitive impairment, 13 MS patients with no cognitive impairment and 17 otherwise healthy individuals.
MS patients with cognitive impairment performed worse on both tests than both of the other groups.
Furthermore, the scientists observed that MS patients with cognitive impairment could hear what was being said, but took significantly longer to respond to a given stimulus.
The investigators concluded that people with MS who experience cognitive impairment can receive information properly, but are unable to process or understand such information correctly, leaving them with weaker central executive skills.

The Multiple Sclerosis Foundation expanded its Homecare Assistance Program as a result of additional funding for 2002.
Funding came from a partnership the MS Foundation formed with Interim Healthcare, a national homecare provider. The partnership allows the MS Foundation to expand the availability of its program from 12 states to 46 states.
MS patients enrolled in the program receive custodial care and services such as bathing, grocery shopping, light housekeeping, meal preparation, and physical, occupational and speech therapy.
Patients can apply and are accepted on an individual basis depending upon financial need, short-term need and available funding.
For additional information, patients can call the MS Foundation at 888-MSFOCUS or visit www.msfocus.org.

MS patients with the HLA DR15 phenotype are more likely to be female and prone to an earlier disease onset, a new study suggested.
Researchers tested for the HLA DR15 phenotype in 729 patients with MS. All of the individuals were clinically assessed and their clinical records were evaluated.
Study findings showed that the presence of DR15 was associated with younger age at diagnosis and being female.
However, there was no association with disease course (relapsing-remitting or secondary-progressive versus primary-progressive type), disease outcome, specific clinical features or diagnostic certainty.
“Even though DR15 carriers are more likely to be female and prone to an earlier disease onset, the results indicate that there is no association with other specific clinical outcomes or laboratory indices examined here,” the authors concluded. “This suggests that DR15 exerts a susceptibility rather than disease-modifying effect in MS.”
The study appears in the February issue of the Journal of Neurology, Neurosurgery and Psychiatry.

Cephalon Inc.’s Provigil (modafinil), a drug currently used to treat the sleep disorder narcolepsy, may effectively improve fatigue among people with MS, according to a new study.
Included in the study were 72 individuals with MS. Patients were excluded if they were diagnosed with narcolepsy, sleep apnea or a clinically significant body-wide disease.
Those who had recently used medications affecting fatigue were also excluded.
Patients received sugar pills during the first and last two weeks of the trial. They received 200 milligrams per day of Provigil during weeks three and four and 400 mg per day of Provigil during weeks five and six. Sixty-five patients completed the study.
Compared with the sugar pill period, a significant improvement was seen for three measures of fatigue during weeks three and four. No significant difference was observed for these measures, however, during weeks five and six.
The study appears in the latest issue of Journal of Neurology Neurosurgery and Psychiatry.

Treatment with Cephalon Inc.’s Provigil (modafinil) at 200 milligrams per day significantly improves fatigue and is well-tolerated in patients with MS, new data revealed.

The nine-week study included 72 patients: 74 percent with relapsing-remitting MS, 7 percent with primary progressive MS and 19 percent with secondary progressive MS.

Patients received placebo during weeks one and two; 200 mg/day of Provigil during weeks three and four; 400 mg/day of Provigil during weeks five and six; and placebo during weeks seven and nine.

Results showed a significant improvement in fatigue after two weeks of treatment with the 200-mg dose of Provigil as compared with placebo.

However, patients’ scores on a test that measured fatigue were not significantly improved after treatment with 400 mg of Provigil compared with placebo.

The average scores on a scale that measured sleepiness improved significantly after treatment with both doses.

Investigators report the findings in the January issue of the Journal of Neurology, Neurosurgery and sychiatry.

NEW YORK (Reuters Health) Jan 16 - In patients with symptoms suggestive of multiple sclerosis (MS), brain MRI findings during the first 5 years may be able to predict long-term disability, according to a report published in the January 17th issue of the New England Journal of Medicine.

The ability to identify early correlates of future disability may have important implications for disease-modifying treatments, which may be most effective when given before irreversible changes have occurred.

Dr. David H. Miller, from the Institute of Neurology in London, and colleagues assessed the predictive value of brain MRI in 71 patients with isolated neurologic syndromes suggestive of MS. The average follow-up period was 14.1 years.

Of the 50 patients with abnormal baseline MRI results, 44 developed MS. In contrast, only 4 of the 21 patients with normal MRI results developed MS, the authors note.

On a 10-point disability scale, with 10 representing the greatest disability, MS patients achieved a median score of 3.25 at follow-up. However, nearly one third of MS patients had scores of 6 or higher, the researchers state.

MRI lesion volume at 5 years correlated moderately with the disability score at 14 years, the investigators note. An increase in lesion volume during the first 5 years was also a predictor of long-term disability.

While the current findings indicate that early MRI findings may be able to predict long-term disability, the authors caution that the correlations were only moderate. Hence, lesion volume and change on MRI probably should not be the sole determinants of whether to institute disease-modifying treatments.

In an accompanying editorial, Dr. Donald W. Paty, from Vancouver Hospital, Canada, and Dr. Douglas L. Arnold, from Montreal Neurological Hospital, suggest that "the opportunity for effective treatment may be greatest if patients are treated at the very earliest stages."

Studies such as the current one "will permit a better understanding of the impact of disease-modifying drugs on specific abnormalities in multiple sclerosis and, along with clinical examination, will provide more insight into the evolution and prognosis of the disease," the editorialists state.

N Engl J Med 2002;346:158-164, 99-200.

According to recent research, many MS patients experience loss of vision without any obvious signs or symptoms, although progression of this asymptomatic loss can occur slowly enough to escape detection during many years of follow-up.

A group of researchers conducted a two-phase study to determine how many of the channels that involve retinal and nerve activity are still functional in people with MS.

The first phase included 14 healthy control subjects and 16 MS patients who had never had optic neuritis, an inflammation of the nerve that carries the impulses responsible for sense of sight. All of these individuals were followed up for five-and-one-half to nine years.

The average percentage of functional channels at the beginning of the study was 89 percent in the MS group and 110 percent in the control group. These figures remained largely unchanged at the end of the study, with the average percentage being 87 percent for MS and 110 percent for controls.

Meanwhile, the second phase of the study, included seven people with MS or suspected MS who, as in the first phase, performed poorly on visual tests but had no symptoms of serious visual loss.

These individuals were compared with 25 MS patients who had one or more previous episodes of optic neuritis.

Compared to the controls, 80 percent of patients with no prior history of optic neuritis and 70 percent of patients who had experienced the condition still maintained functional channels.

The scientists also noted that when asymptomatic visual loss occurs in people with MS, it is usually present with the onset of MS.

The study appears in the December 2001 issue of Journal of Neurology.