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MSWA Bulletin Magazine Summer 17

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ROUND-UP OF RESEARCH AND

ROUND-UP OF RESEARCH AND OTHER ITEMS OF INTEREST SUE SHAPLAND RN, BN From the UK MS Trust: Could computer games help with MS symptoms? Mii-vitaliSe: a pilot randomised controlled trial of a home gaming system (Nintendo Wii) to increase activity levels, vitality and well-being in people with multiple sclerosis. (Ref: BMJ Open 2017; 7(9): e016966.) This study had 30 participants split into two groups; one group had training and used the Wii for 12 months whilst the other waited 6 months before starting. Physiotherapists provided two training sessions giving background information on exercising and using the Wii, installed the equipment and developed a personalised exercise program. They provided regular ongoing support and encouragement either by telephone or home visits. Participants kept a daily log of Wii use and completed questionnaires on their physical and mental health. Balance, walking style, mobility and hand dexterity were assessed at the start and at six and 12 months. Participants reported a wide range of benefits related to both physical and mental health, including physical activity, improved mood, better sleep, improved balance, strength and posture and relief of symptoms such as pain and fatigue. For some, use of the Wii acted as a ‘gateway’ to other physical activities and to greater self-confidence. Researchers found that Mii-vitaliSe was well received by most participants and acceptable to the physiotherapists delivering it. Overall, findings are promising and support proceeding to a full-scale trial of effectiveness and cost-effectiveness. They felt this work has relevance for the development and evaluation of other interventions that incorporate technology and personalised support to enhance physical activity levels in long-term conditions. The researchers also commented that, with technology moving so fast other alternative systems could be developed. Do men and women experience ageing with MS differently? Women’s and Men’s Differing Experiences of Health, Lifestyle, and Aging with Multiple Sclerosis. Ploughman M, Collins K, Wallack EM, Monks M, Mayo N; Health, Lifestyle, and Aging with MS Canadian Consortium. Data was obtained from a postal survey involving 743 Canadians older than 55 years with MS for at least 20 years. Sex differences in health, lifestyle, mood, and socioeconomics were examined using analysis of variance. The study found that despite no differences in age, years with MS, disability, fatigue, or social support, older men (n = 166) experienced lower perceived health and lower resilience and participated less in life roles than older women (n = 577). Men experienced more depressive symptoms whilst women reported more anxiety. Depression was the strongest predictor of health perception in both women and men ( = -2.40 and -5.19, respectively, for each 3-point increase in depressive symptoms). Other contributors included household participation, fatigue, resilience, and disability in women, and physical activity, financial flexibility, and alcohol use in men. This study concluded that older men exhibit poorer adaptation to ageing with MS than older women. From National MS Society: www.nationalmssociety.org Antihistamine Shows Evidence of Stimulating Myelin Repair in Small Phase II MS Study - More studies needed before benefits and risks are verified. In a small phase II clinical trial of an oral antihistamine, Clemastine improved transmission of electrical signals in the optic nerve of people with MS with optic nerve damage. The improved transmission indicates that nerve-insulating myelin was repaired along the nerve pathways. Clemastine is an over-the-counter allergy medication but doses used in this trial exceeded the maximum recommended for over-the-counter use, which does carry a risk of side effects. 50 participants received the drug or a placebo twice daily for 150 days. 8 | MSWA BULLETIN SUMMER 2017

Read more at: mswa.org.au/researchupdate The researchers stressed that more research is needed, with larger numbers of participants, before it can be considered as a treatment. Bruce Bebo, PhD, Executive Vice President, Research at the National MS Society commented that “This is a significant step forward in one of many different approaches being taken to find a way to repair the nervous system damage caused by MS and research to restore function to people with MS is a very high priority.” Clinical trial of the experimental oral therapy siponimod (BAF312) The Phase III clinical trial of Siponimod by Novartis Pharmaceuticals AG, involving 1,651 people with secondary progressive MS, met its primary endpoint of reducing the risk of disability progression compared with inactive placebo. Secondary endpoints suggested that those on active therapy had less decrease of brain tissue volume. From multiplesclerosisnewstoday.com High MS risk children identified by MRI scans. A study at Yale University School of Medicine suggests that brain scans of children could reveal changes associated with multiple sclerosis before any symptoms are developed. The findings suggest that brain and spinal cord scans can identify children at high risk for developing MS. Children with signs of antibodies in their spinal fluid or lesions in the spinal cord were more likely to develop MS symptoms, researchers found. The study participants had what is called radiologically isolated syndrome (RIS), which are MRI lesions that indicate a loss of myelin. RIS has been studied in adults, and researchers know that about one-third of adults with these lesions eventually develop MS symptoms. This is the first study of RIS in children. The study, of 38 children with two thirds of them girls, demonstrated that children with RIS share many of the same characteristics as adults with the syndrome. Because spinal cord lesions were linked to symptom development, the team argued that all children with RIS should have spinal cord MRI scans to identify those in need of closer follow-up. Naila Makhani, MD lead researcher, said “We hope that our work will help inform expert guidelines for how to follow up children with RIS and help us accurately inform families of the risk of later developing multiple sclerosis, something we were previously unable to do.” From MS International Federation. New evidence of potential role of gut bacteria in MS. There is a growing interest in the role of gut bacteria in inflammatory disorders such as MS. Gut bacteria, also called our microbiome, play a crucial role in our digestive tracts by assisting with digestion of food and producing beneficial chemicals for the body to use. This may just be the tip of the iceberg and the complete and complex picture of the role that gut bacteria play, is only beginning to be revealed. Previously, it was shown that there are potential differences in gut bacteria between those with MS and those without it. Two studies published by two collaborating groups in the prestigious journal Proceedings of the National Academy of Sciences, have revealed more about the link between gut bacteria and MS. One German study reviewed 34 pairs of identical twins, each with one with MS and one without, and when comparing the gut bacteria, they identified obvious differences between the siblings. In fact, there were greater differences between different families than between each twin pair, highlighting the stronger influence of diet and geography in influencing our gut bacteria. The results suggest there are some differences in gut bacteria in those with MS, and these bacteria can influence the immune system in a way that promotes MS-like inflammation. The second study was in the USA, involving 71 people with MS and 712 without, and the team examined the gut bacteria of all participants. While their study showed some similar findings to the German group, they did find a couple of specific bacterial families that were altered in people with MS. In both studies the scientists transplanted gut bacteria from people with or without MS into mice that had an MS-like disease; they found that the bacteria from people with MS led to a more severe disease. There is great interest in how we may be able to manipulate our gut microbiome to treat or prevent disease. This research shows there is still a way to go before we have a complete picture of how much influence our microbiome may have in MS, and how this information may be used to treat MS. MSWA BULLETIN SUMMER 2017 | 9