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MSWA Bulletin Magazine Summer 2022

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Keeping your cool this summer | Welcome Melanie Kiely CEO | MSWA Stationary Cycle results | Pain and pain management series: Part 3

RESEARCH RESEARCH ROUND

RESEARCH RESEARCH ROUND UP SUE SHAPLAND RN, BN, MSCN GENERAL MANAGER STRATEGIC SUPPORTS AND RESIDENTIAL OPTIONS FROM MS AUSTRALIA Read more at: msaustralia.org.au Could time outdoors reduce MS development in children? January 18, 2022. The causes of adult-onset MS are thought to be a combination of genetic factors, infectious exposures, and other environmental factors such as low sun exposure, low UVR exposure and low vitamin D levels. This current research study is believed to be the first to explore environmental factors that may contribute to the development of MS, specifically in children. Children with MS across the USA were recruited to this study exploring links between time spent outdoors, ultraviolet radiation (UVR) exposure and sun protection usage in the first year after birth and the year before the first demyelinating event of MS. The researchers found spending more than 30 minutes outdoors during weekends and holidays in summer, and residing in a sunnier location, were associated with a reduced risk of developing MS in children. What did the study investigators do? Many prominent paediatric neurologists specialising in MS were involved, together with researchers from the Australian National University (ANU) in Canberra, collecting data from 16 centres spread all over the USA. The study results of 332 children diagnosed with MS or experiencing a first demyelinating event before 18 years were compared against 534 controls (children without MS) recruited from the same hospitals as the children with MS, either as siblings, or attending the same hospital for other reasons. Both the patients and the control cases were also sex and age-matched and exposed to the same sun and UVR conditions. A survey completed by the parents determined time spent outdoors in various months in the first year of life and at specific ages until the child’s diagnosis. The use of sun protection was also recorded, along with the ambient UVR dose based on their home latitude and longitude over their lifetime, vitamin D levels and other variables such as exposure to tobacco smoke, race, obesity, sun sensitivity and antibody levels to the Epstein-Barr virus (EBV). The ANU researchers used a complex, but robust statistical package, led by Australian Professor Robyn Lucas to explore variables independently and against each other to determine the impact of the sun and UVR exposure. Study results. The average time from diagnosis to study recruitment for children with MS was just over seven months. Children with MS were compared against the healthy controls using the variables described above. Results showed that children with MS were more likely to have been exposed to tobacco smoke in their first year of life than in control cases. They were also more likely to have been overweight at some stage of their childhood, which is consistent with recent research suggesting that childhood obesity and smoking contribute to the development and progression of MS in adults. 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 Children with MS were more likely to have spent less time outside during the summer weekends and holidays than healthy controls. Blood levels of vitamin D were higher in the MS group, most likely because they were given vitamin D supplements following diagnosis. For analysis purposes, time spent outdoors in the year after birth and the year prior to MS diagnosis was categorised. The researchers found a dose-dependent response to sun exposure to be protective against the development of MS. How does this study help our understanding of environmental risk factors in MS? Given that MS in children under 18 years is not common, the large study group of 332 children diagnosed with MS provides a contextually significant study in history. The researchers stopped short of making recommendations on optimal sun exposure and the use of sunscreen, as ambient UVR doses vary so much in relation to a person’s location of residence and the time of the year. However, they have suggested that investigating these factors in paediatric MS offers a valuable opportunity to understand the contributing factors to the development of MS, particularly environmental exposures, primarily because the window between exposure and disease onset is significantly narrower in children than in adults. The researchers suggest that regular time in the sun of at least 30 minutes daily during summer and using sun protection as needed, might be a worthwhile intervention to reduce the incidence of paediatric-onset MS, particularly in first degree relatives (parents, offspring and siblings) of people with MS. FROM MS NEWS TODAY Read more at multiplesclerosisnewstoday.com An Epstein-Barr virus primer for MS patients; Ed Tobias, January 21, 2022. Research has recently been published about the Epstein-Barr virus (EBV) and MS. The Harvard T.H. Chan School of Public Health study reports that being infected by EBV increases the risk of developing MS by 32 times. The researchers reviewed 20 years of data covering more than 10 million U.S. military members. “This is a big step because it suggests that most MS cases could be prevented by stopping EBV infection, and that targeting EBV could lead to the discovery of a cure for MS,” the study’s senior author, Alberto Ascherio, MD, said. Several studies over the past few years suggested an EBV-MS connection, and that link might be in memory B-cells. When EBV is in the body in its dormant form, it situates itself inside those B-cells. Some of our disease-modifying therapies are designed to target B-cells, reducing their numbers or preventing them from traveling into the central nervous system. The Harvard researchers wrote: “The extremely low MS risk in EBVnegative individuals suggests that, by far, most MS cases are caused by EBV and could thus potentially be prevented by a suitable vaccine.” An EBV vaccine in the works: Moderna, the company that produces one of the mRNA-based COVID-19 vaccines, has started a clinical trial for a possible EBV vaccine, using the same mRNA technology. Researchers hope to enrol about 270 participants across 15 sites in the U.S. Vitamin D supplements may improve MS quality of life; Steve Bryson PhD, December 30, 2021. Because vitamin D deficiency is common in MS patients, these findings suggest that “supplementation should be applied at least in a dose that covers the recommended intake,” the researchers wrote. The review study, “Vitamin D Supplementation and Mental Health in Multiple Sclerosis Patients: A Systematic Review,” was published in the journal Nutrients. Low levels of vitamin D are associated with an increased risk of MS. In the early stages of the disease, it is also a strong risk factor for longterm activity and progression. Although several studies have concluded that vitamin D supplementation has no significant effect on disability progression or MS relapse rate, others suggest vitamin D treatment may improve mental health, such as reducing the risk of depression or negative emotions. Scientists at the Warsaw University in Poland systematically reviewed the medical literature to determine if treatment with vitamin D supplements affected the mental health of people with MS. 9