Multiple sclerosis : clinical and laboratory research
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Randomized Controlled Trial Comparative Study
Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis.
The object of this study was to monitor the safety and efficacy of long-term use of an oromucosal cannabis-based medicine (CBM) in patients with multiple sclerosis (MS). A total of 137 MS patients with symptoms not controlled satisfactorily using standard drugs entered this open-label trial following a 10-week, placebo-controlled study. Patients were assessed every eight weeks using visual analogue scales and diary scores of main symptoms, and were followed for an average of 434 days (range: 21 -814). ⋯ Twenty-two (88%) patients re-started CBM treatment. We conclude that long-term use of an oromucosal CBM (Sativex) maintains its effect in those patients who perceive initial benefit. The precise nature and rate of risks with long-term use, especially epilepsy, will require larger and longer-term studies.
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Grey matter hypointensity on T2-weighted magnetic resonance imaging (MRI) scans, suggesting iron deposition, has been described in multiple sclerosis (MS) and is related to physical disability, disease course and brain atrophy. We tested the hypothesis that subcortical grey matter T2 hypointensity is related to cognitive impairment after adjusting for the effect of MRI lesion and atrophy measures. We studied 33 patients with MS and 14 healthy controls. ⋯ Basal ganglia T2 hypointensity and BPF demonstrated the strongest associations with cognitive impairment on individual cognitive subtests. Subcortical grey matter T2 hypointensity is related to cognitive impairment in MS, supporting the clinical relevance of T2 hypointensity as a biological marker of MS tissue damage. These data implicate a role for basal ganglia iron deposition in neuropsychological dysfunction.
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Comparative Study
Nursing home residents with multiple sclerosis and dementia compared to other multiple sclerosis residents.
Cognitive impairment may be a significant symptom in multiple sclerosis (MS), affecting about one half of MS patients in study samples similar to the general MS population. An interesting question is what role dementia, of any aetiology, plays in the cognitive ability of people with MS. The objective of this research is to learn more about nursing home residents with MS and dementia, identifying how they differ from other residents with MS. ⋯ Nursing home residents with MS and dementia are admitted to nursing facilities at an older age and seem less likely to have physical impairments but more mood and behaviour problems than other MS residents at admission. A cortical variant of MS may be more prevalent than previously suspected and may be a factor responsible leading to nursing home admission in this subgroup of patients. Further clinical analysis of this subgroup would be necessary to support this contention.
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This study used reliable and validated instruments to compare pain severity in multiple sclerosis (MS) to that in other chronic painful conditions, and to examine relationships between chronic pain in MS and health-related quality of life (HRQOL). ⋯ Chronic pain in MS is as severe as pain in arthritic conditions and is associated with reduced HRQOL. Thus, pain can be a significant symptom for MS patients and the need for treatment may be underestimated.
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Randomized Controlled Trial Clinical Trial
A double-blind, randomized, controlled study of oral pirfenidone for treatment of secondary progressive multiple sclerosis.
Currently, there are no approved treatments for secondary progressive multiple sclerosis (MS) that stabilize or reverse the neurological disabilities associated with this disease. Oral pirfenidone was found to stabilize and overcome the disabilities in two published independent open-label studies in secondary progressive MS. This led us to study pirfenidone in a phase II double-blind, randomized and controlled, clinical trial in patients with advanced secondary progressive MS for 12 months. ⋯ Expanded Disability Status Scale scores and MRI lesion count were not significantly different in the placebo and pirfenidone groups. These findings indicate a significant effect of pirfenidone on clinical disability and bladder function for secondary progressive MS patients. A major multicentre, double-blind, randomized, controlled trial is justified.