CMSC Meeting Focuses on Challenges, Solutions to Quality of Life Issues

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by Forest Ray PhD |

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Canadian Group MS guidelines

Nearly 3,000 multiple sclerosis (MS) healthcare providers and researchers  convened recently to share their findings regarding the latest developments in the diagnosis and treatment of MS.

However, unlike past meetings, this year’s 34th Annual Meeting of the Consortium of MS Centers (CMSC) took place online.

Virtual presentations covered the continued benefits of available therapies and long-term safety information, as well as advances in basic laboratory studies. Solutions to help those with MS live their best lives by understanding and managing symptoms received particular emphasis.

The CMSC has made the abstracts (research summaries) of the presentations available as a PDF online.

The National MS Society highlighted some of the presentations related to improvements in quality of life that it found more relevant. Topics that bore a great impact on quality of life measures included depressionexercise, culturally competent care, and abuse.

Anthony Feinstein, PhD, professor of psychiatry at the University of Toronto, Canada, presented data showing that too often depression remains underdiagnosed and undertreated in MS patients.

According to Feinstein, many patients who consider suicide frequently do not receive treatment for their underlying mental health issues despite the availability of treatments, including medication or cognitive behavioral therapy. The latter can be delivered via telemedicine.

His take-home message to healthcare providers is “Screen your patients for depression so that you do not miss the diagnosis and miss a potentially treatable disorder.”

Several presentations at CMSC focused on exercise, which is a vital aspect of MS care. One of them, by Patricia Bobryk, a physical therapist and certified MS specialist at the University of Colorado, focused on exercise and rehabilitation.

Numerous studies have shown a link between exercise and various measures of neuronal health. For instance, exercise triggers higher levels of brain-derived neurotrophic factor (BDNF), which promotes brain cell growth and survival. Exercise also reduces the levels of MMP-2, which then dials down inflammatory responses within the brain, and helps to improve communication between neurons (brain connectivity).

“Exercise, coupled with everything else that we are doing, is an important piece. The impact [of exercise] is so great, we should be thinking of it as a prescription,” Bobryk said.

On the topic of exercise, the National MS Society (NMSS) also highlighted a poster presentation (Abstract #REH27, page 75) by Tracy Fleming-Tracy, of the Tanner Center for MS, Birmingham, Alabama, seeking to compare clinic- and home-based exercise programs in rural areas. According to the NMSS, this is a particularly interesting comparison in a time of pandemic.

The research project, titled Tele-Exercise and Multiple Sclerosis (TEAMS; NCT03117881), is set to enroll up to 820 adult MS patients across three states: Alabama, Mississippi, and Tennessee. Its original goal was to meet the needs of people in rural areas.

“We have people who come from all around the state to see us because they can’t find a therapist in their area,” Tracy said. “But now, with the unprecedented time we are in, it’s even more imperative that we have this option.”

TEAMS is based on a 12-week program that combines neurorehabilitative (functional) exercise, yoga, and Pilates. Study participants receive a tablet with an exercise app installed, as well as virtual sessions with therapists.

So far, 823 participants have been enrolled in the study and 731 have been baseline tested. Participants are still being recruited in those three southern states.

In another CMSC presentation (Abstract #RHI05, page 9), Jessica Baird, PhD, of the University of Alabama at Birmingham, showed that aerobic fitness has a positive impact on physical and cognitive function in adults with MS who are 55 and older.

Results showed that higher aerobic fitness — the body’s ability to use oxygen to produce energy for muscle cells — was associated with improved walking speed, walking endurance, and cognitive function.

“Our results suggest that participation in regular physical activity may be an approach to ameliorate the consequences of aging with MS,” the team wrote.

Another presentation (Abstract #PSF09, page 62) focused on African American women with MS. Whitney McLaughlin, PhD, spoke of the need for “culturally competent care” as it relates to African American women, whose coping behaviors, emotional support needs, and mental health often go overlooked in MS literature.

McLaughlin’s research focuses on improving patients’ coping flexibility and their ability to try new coping strategies. The team is testing a Brain-Based Education and Wellness (BE WELL) intervention program that combines education about brain health with training on coping skills.

Four African American women with MS have been enrolled. Results showed positive effects of the BE WELL program in three of them.

“The customized BE WELL intervention seemed to have positive effects for each of the participants’ coping flexibility. Participant 2 was the exception as only slight effects were observed,” the team wrote.

Although this is a small study, McLaughlin emphasized the need that “healthcare providers must understand how the individual’s identity, culture and environment all impact the type and degree of stress they experience, as well as the coping resources and strategies they ultimately use.”

Abuse was another topic of interest at CMSC. A presentation (Abstract #PSF03, page 60) by Jeta Pol-Patil, at Brigham and Women’s Hospital, Boston, Massachusetts, showed data from an anonymous survey asking more than 800 women with MS about sexual, physical, verbal, and emotional abuse experiences.

In total, only 200 women (24%) completed the survey, which the researchers suggested is an indication there is potential discomfort with the topic.

Of the 200, 76 women (38%) reported having experienced abuse of some kind — a proportion higher than that reported in the general female population (29%). Among abused women, only 36 (47%) received professional help in dealing with the aftermath of the experience.

“Married women or those in domestic partnership were more likely to report any form of abuse than single patients,” the researchers wrote. “Intimate partner violence in married or partnered women with MS may be more prevalent than previously recognized.”

A presentation on voice treatment (Abstract REH03, page 69) also was featured at CMSC. Alice Estevo Dias, PhD, of the University of São Paulo, Brazil, and colleagues applied a voice treatment program used to help Parkinson’s patients toward improving speech difficulties in people with MS.

The program, called the Lee Silverman Voice Treatment (LSVT-LOUD), is “an intensive behavioral treatment program to improve overall voice and speech functions in individuals with neurologic diseases,” the researchers wrote.

In total, 34 MS patients with various speech deficits (also referred to as dysarthria, a motor speech disorder) — including slow articulation, pitch instability, short cycles of respiration, and deficient loudness control — received twice-weekly one-hour voice sessions for eight weeks.

Results showed that the program led to significant speech improvements. “In addition to conventional pharmacologic therapy, dysarthria treatment should be emphasized as part of a management plan focused on overall health and well-being, regardless of the type of MS, course of disease, and manifestation of speech and voice” symptoms, the researchers concluded.

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