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MSWA Bulletin Magazine Spring 2021

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What is assistive technology and how can it help you? | Good health monitoring practices | Pain and pain management series: Part 2 | Farewell Marcus Stafford

RESEARCH RESEARCH ROUND

RESEARCH RESEARCH ROUND UP SUE SHAPLAND RN, BN, MSCN GENERAL MANAGER STRATEGIC SUPPORTS AND RESIDENTIAL OPTIONS FROM MULTIPLE SCLEROSIS NEWS TODAY Read more at: multiplesclerosisnewstoday.com MS symptoms often apparent years before diagnosis; Marisa Wexler MS; June 24, 2021. A new study suggests that many people with multiple sclerosis (MS) experience symptoms several years before diagnosis. It has long been known people with MS tend to seek medical attention more frequently in the years before diagnosis than those without the disease. There has been debate as to whether this is a result of MS itself, or a prodromal phase of the disease. A team of researchers in Munich analysed data in an effort to address this question. Their findings were published in the journal Neurology, in the study, ‘Systematic Assessment of Medical Diagnoses Preceding the First Diagnosis of Multiple Sclerosis’. They reviewed medical data for 10,262 people with MS in the five years prior to diagnosis, and compared it with other groups including Crohn’s disease and psoriasis which are also autoimmune. Relative to the other groups, MS patients had significantly higher frequencies of certain medical issues. Notably, most of the issues that were more frequent among MS patients “represent symptoms suggestive of demyelinating events or other neurologic diagnoses,” the researchers wrote. The patients appear to have been experiencing MS-like symptoms years before their diagnosis. Based on this, the researchers think patients are not experiencing a distinct prodromal disease phase, but instead are dealing with symptoms of unrecognised MS. These findings may have important implications for MS diagnosis and treatment, the team said. “The sooner MS is recognised, the better we can treat the disease. We now need to take a closer look at which early symptoms of MS might be overlooked. This could allow us to recognise the disease at an earlier stage and thus enable earlier treatment initiation,” said Christiane Gasperi, physician, researcher and co-author of the study. Deep brain stimulation may help with MS-associated tremors; Marta Figueiredo PhD; October 5, 2021 A review study has found that deep brain stimulation (DBS) effectively reduces tremors in people with MS but may lead to worsening symptoms and speech problems. While these findings support the use of DBS for treating this common, disabling symptom, larger studies using standardised measures of tremors would help to assess the risk-benefit profile of DBS accurately in this patient population. The study, ‘Deep brain stimulation for multiple sclerosis tremor: A systematic review and metaanalysis’ was published in the journal Multiple Sclerosis and Related Disorders. 8

HERE WE PROVIDE SUMMARIES OF RESEARCH SOURCED FROM WEBSITES IN AUSTRALIA AND AROUND THE WORLD; WE HOPE IT’S OF INTEREST TO YOU. READ MORE AT MSWA.ORG.AU/RESEARCHUPDATE Tremors are one of the most common symptoms of MS, affecting 25% to 58% of patients, being severe in 3%–15% of cases. The arms, legs, head, trunk, and vocal cords are the most commonly affected. For many people with MS, tremors can be debilitating enough to severely impair quality of life and are challenging to treat. DBS is approved, and successful, for Parkinson’s disease and essential tremor, and has also been used for the treatment of severe MSassociated tremors when other treatments have failed. Electrodes are surgically implanted in the brain to stimulate the thalamus — an area involved in motor function — with electric impulses. The amount of stimulation is controlled by a pacemaker-like device placed under the skin, near the collarbone. A team of researchers in Iran systematically reviewed studies published up to March 2021 that investigated the effects of DBS on MS-related tremors. From a total of 1,663 studies, 17 — covering 162 MS patients — were included in the meta-analysis. Results showed that the pooled rate of tremor reduction was 73% (range of 22%–100%) and that DBS led to a significant reduction in tremor scores, by a mean of -2.9 points. One study reported improvements in quality of life among patients showing tremor reductions following DBS. “The result of this systematic review and meta-analysis demonstrates that MS-related tremor improves after DBS,” the researchers wrote. But given the high variability between studies in terms of follow-up duration and tremor assessment, as well as the low number of included patients, larger studies using standardised measures are needed to better assess the intervention’s benefits in this patient population, they added. FROM BMC NEUROLOGY Read more at: biomedcentral.com Longitudinal observational study of boxing therapy in Parkinson’s disease, including adverse impacts of the COVID-19 lockdown; Craig Horbinski, et al. Parkinson’s Disease (PD) is a highly prevalent neurodegenerative disease whose incidence is increasing with an aging population. One of the most serious manifestations is gait instability, leading to falls and subsequent complications that can be debilitating, even fatal. Boxing therapy (BT) uses gait and balance exercises to improve ambulation in people with PD, though its efficacy has not yet been fully proven. In the current longitudinal observational study, 98 participants with idiopathic PD underwent twice-weekly BT sessions. Primary outcome was self-reported falls per month; secondary outcomes were quantitative and semi-quantitative gait and balance performance evaluations. Twice per week, each participant worked with their trainer on specific boxing-related exercises aimed at improving overall coordination, gait, and balance. The program consists of hundreds of exercises/ skill sets, broken down into three main phases. At the beginning of each month, including before the very first session, each participant was asked to estimate how many falls they had experienced the prior month. The average number of self-reported falls per month per participant decreased by 87%, during BT. During the lockdown imposed by COVID-19, this increased per month. Females and those > 65 years old reported the greatest increase in falls during the lockdown period. Post-lockdown resumption of BT resulted in another decline in falls. Quantitative performance metrics, including standing from a seated position and standing on one leg, largely mirrored the pattern of falls pre-and post-lockdown; concluding that BT may be an effective option for many PD patients. 9

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