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MSWA Bulletin Magazine Spring 2020

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RESEARCH RESEARCH ROUND UP SUE SHAPLAND RN, BN, MSCN GENERAL MANAGER STRATEGIC SUPPORTS AND RESIDENTIAL OPTIONS FROM THE NEUROLOGY RESEARCH REVIEW Read more at: Association between tumor necrosis factor inhibitor exposure and inflammatory central nervous system events, Kunchok A et al. (Issue 58, 2020) A nested case-control study evaluated the association between TNF inhibitor exposure and inflammatory CNS events in patients with autoimmune disease. 106 patients with an inflammatory demyelinating or non-demyelinating CNS event were matched for age, type of autoimmune disease, and sex with 106 controls. 60% of cases and 40% of controls were exposed to TNF inhibitors. Comment: This study shows an increase of demyelinating and non-demyelinating inflammatory CNS disease in patients on TNF inhibitors; not unexpected given these drugs worsened MS when used in clinical trials. There appeared to be a greater risk of CNS disease in patients with rheumatoid arthritis. One of the factors not considered in this study is the severity of the autoimmune disease or genetic factors predisposing to autoimmune disease which might make a patient more likely to develop CNS inflammation. FROM THE PARKINSON’S DISEASE RESEARCH REVIEW Read more at: Dementia and subthalamic deep brain stimulation in Parkinson’s disease (PD), Bove F et al. (Issue 42, 2020) Dementia following bilateral STN- DBS was evaluated retrospectively in 175 patients with PD; 104 had follow-up data out to 10 years. Risk factors for dementia after STN-DBS were male sex, higher age, hallucinations, lower frontal baseline score and perioperative cerebral haemorrhage. Comment: The literature has been conflicting, but some studies have suggested a negative impact of STN-DBS on cognition, and dementia has been considered an exclusion criterion for DBS for this reason. This longitudinal study reviewed 104 PD patients, treated with STN-DBS, over 10 years. The risk of dementia was 26% after 10 years; and the incidence rate of dementia was lower than reported in other longitudinal studies of PD patients without DBS. Although direct comparison is difficult because of the differing mean ages of the cohorts; the data provided some useful statistics for counselling patients considering DBS. FROM THE MULTIPLE SCLEROSIS RESEARCH REVIEW Read more at: Use of natural medicine and dietary supplements concomitant with conventional medicine among people with multiple sclerosis, Bergien SO, et al. (Issue 49, 2020) The use of evidence-based MS therapies with conventional and alternative medicines (CAMs) is common, and natural medicine and dietary supplements (NADS) are the most frequently used. Research is important because of the potential for interactions with conventional treatments. This Danish phone survey of 384 MS patients, confirmed that 85% have used at least one CAM within the last 12 months. Even when excluding vitamin D, 78% of patients used agents including fatty acids, multivitamins, and calcium. 8

HERE WE PROVIDE SOME SUMMARIES OF RESEARCH SOURCED FROM WEBSITES IN AUSTRALIA AND AROUND THE WORLD; WE HOPE IT’S OF INTEREST TO YOU. WE HAVE INCLUDED BOTH MS SPECIFIC AND OTHER NEUROLOGICAL RESEARCH UPDATES. READ MORE AT MSWA.ORG.AU/RESEARCHUPDATE The most common reason for using CAMs was to “strengthen the body” followed by “because it was recommended”. Conclusion: The study contributes to a better understanding of NADS used among PwMS and shows that the majority of PwMS use NADS and that they use it as well as the conventional MS medicine. Furthermore, the detailed mapping of the specific types of NADS used gives a nuanced insight into the specific products of NADS used among PwMS, including different kinds of vitamins, minerals, and herbal remedies. FROM MS RESEARCH AUSTRALIA Read more at: MS Risk Increasingly Affecting Women. Why? An international group of leading women in MS, including clinicians and researchers, has compiled an extensive review of the sex effects throughout their lives on MS. Recent studies suggest that MS cases are increasing and that the increase is disproportionately affecting females. The female to male sex ratio of MS has risen in several countries in recent years, currently in Australia 75% of people diagnosed with MS are women. Sex hormones play a significant role in the risk and course of MS. Dramatic hormonal fluctuations can influence clinical, radiographic, and disabilityrelated disease parameters. The role of sex chromosomes on sex differences in MS risk and disease progression represents a new frontier for exploration. More research is needed to fully understand unique questions relating to MS and fertility, contraception, pregnancy, and reproductive aging. Positive News for Women with MS Planning Pregnancy World renowned researchers combined results from previous studies of 7,034 pregnancies of 6,430 individual mothers, to provide an updated picture of the effects of pregnancy on MS. They confirmed the historic assumption that pregnancy reduces MS relapses, although there is a slight disease ‘rebound’ after birth. Pregnant women on modern MS treatments are significantly protected from relapses compared to those in earlier decades. There were misconceptions in the past about the effects of pregnancy on MS, and some MS medications are unsafe for pregnancy, requiring careful decisions around optimising safety for mother and baby. Combined with the uncertainty MS brings, there can be significant anxiety for women with MS around having children. Two world renowned British scientists teamed up with Australian Dr Vilija Jokubaitis to investigate the effects of pregnancy on the number of relapses at different stages of pregnancy and immediately after childbirth. They combined results from 28 studies that met robust quality criteria: from 1998 to 2019. Findings: Choosing to start a family is a momentous decision and carries additional considerations for women with MS. This study confirms that pregnancy can reduce relapses, and that control of MS, including for pregnant women, has improved significantly in the last two decades. The study highlights the importance of close communication and planning between a new mother and her neurologist when planning a pregnancy, as some disease modifying therapies are unsafe during pregnancy and to ensure tailored treatment in the period immediately after childbirth. 9