risk factors

Top 10 MS stories of 2023

Throughout 2023, Multiple Sclerosis News Today brought consistent coverage to our readers of the latest scientific research, developments in treatment, and clinical trials for multiple sclerosis (MS). Here is a list of the top 10 most-read stories we published last year, along with a brief description. We look…

Expert Voices: Exploring the connection between vitamin D and MS

In this installment of our “Expert Voices” series, Multiple Sclerosis News Today asked Kassandra Munger to answer some of your questions about the connection between vitamin D levels and multiple sclerosis (MS). Munger received her bachelor’s in biology from the University of Rochester in 1997, master’s in…

Adverse Childhood Experiences Don’t Influence MS Risk: Study

Adverse childhood experiences (ACEs) did not increase the risk of multiple sclerosis (MS) development and were not associated with worse clinical outcomes, a recent study reported. These findings add to the complexity of the potential relationship between ACEs and MS that has emerged across several research studies. “Our primary…

Moderate-to-severe Bowel Problems Found in 14.5% of Patients

Moderate-to-severe bowel dysfunction was detected in 14.5% of adult people with multiple sclerosis (MS), an Italian study reports. The prevalence of bowel dysfunction was increased in women and in patients with progressive forms of MS, higher disability, older age, and longer disease duration. Despite the prevalence of bowel dysfunction…

#MSVirtual2020 – Meeting Focus Is on Advances in MS Research, Diagnostics, and Technology

The upcoming MSVirtual2020 meeting, the largest international conference dedicated to multiple sclerosis (MS) research, will focus on advances and breakthroughs made in MS causes and risk factors, diagnostic tools, treatment response biomarkers, technology, and therapies and interventions. The 8th joint meeting of the Americas Committee for Treatment and…

Unemployment Risk Factors in MS Vary with Age, Study Suggests

Physical symptoms and poorer coping mechanisms are major risk factors for unemployment in younger and older people with multiple sclerosis (MS), while psychological problems have the greatest impact in middle-aged patients’ unemployment, a study suggests. These findings highlight that unemployment risk factors vary with age and call for interventions…

Each Major Risk Factor (Like Genes, Smoking and Obesity) Can Affect Disease Course, Study Finds

Risk factors often associated with multiple sclerosis (MS), such as genetic background, obesity and smoking, contribute independently to the disease’s variability and may be an early influence on progression, a study reported. The retrospective study, “Multiple sclerosis risk factors contribute to onset heterogeneity,” was published in the journal …

Smoking Increases Relapses in RRMS Patients Receiving Interferon-beta, Study Suggests

Cigarette smoking increases the relapse rate in patients with relapsing-remitting multiple sclerosis who are being treated with interferon-beta, a study suggests. The findings suggest that RRMS patients who smoke may have fewer relapses if they quit. An article on the results, “Smoking affects the interferon beta treatment response in multiple sclerosis,” appeared in the journal Neurology. A number of studies have looked at the link between environmental and lifestyle factors and the risk of developing MS. These factors include how much sunlight and vitamin D patients get and whether they have an Epstein-Barr virus infection. Cigarette smoking is a well-documented risk factor in MS, but most of the studies on it have focused on the link between smoking and MS, or the link between smoking and the  disease's progression. “Studies that addressed the relationship between smoking and disease activity in RRMS are rarer,” the researchers wrote. The team decided to investigate whether smoking during interferon-beta treatment would affect relapse rates. Previous research had set the stage for the study by showing a link between smoking and gene mutations that make people more susceptible to developing MS. The mutations were in the HLA and NAT1 genes. The team looked at DNA from 834 RRMS patients in the Danish Multiple Sclerosis Biobank who were treated with interferon-beta. Well-known brand names of the treatment include Rebif, Avonex, and Plegridy. There are also other brand names and biosimilar drugs. Researchers also looked at patients’ medical records two years before they started on interferon-beta. Before making any conclusions on possible links between smoking and patients' relapse rate, the team adjusted for patients’ sex, age at the start of treatment, and number of relapses in the two years before treatment began. Their key conclusion was that smoking increased by more than a quarter the number of relapses in patients on interferon-beta therapy. “Each pack of cigarettes more per day during IFN-β [interferon-beta] treatment increased the number of relapses by 27%,” the team wrote. The researchers found no association among smoking, relapses, and mutations of the HLA or NAT1 genes. “Our results confirm that lifestyle factors are important in MS, suggesting that smoking cessation may be associated with a reduction in disease activity,” they wrote. “Although not formally proving that smoking cessation will decrease disease activity in RRMS, the results should encourage physicians to inform patients with MS about the harmful effect of smoking and increase focus on smoking cessation,” they observed.

Study Identifies MS Patients at Risk of Severe Disease Reactivation After Gilenya Is Discontinued

Multiple sclerosis patients with high relapse rates but less physical impairment before starting on  Novartis’ Gilenya (fingolimod) are likely to experience a surge in disease activity if they stop the treatment, researchers in Turkey report. The study, which dealt with patients with relapsing forms of MS, referred to the surge as "severe disease reactivation," or SDR. Researchers published their article, “Factors Predictive of Severe Multiple Sclerosis Disease Reactivation After Fingolimod Cessation,” in the journal The Neurologist. Studies have shown that Gilenya, which the U.S. Food and Drug Administration approved in 2010, can benefit adults with relapsing MS. It reduces annualized relapse rates and prevents more brain lesions from forming, compared with standard interferon treatments. Lesions are damaged nerve cell areas. Despite its benefits, Gilenya is not recommended for patients with heart or liver problems, low levels of white blood cells, severe herpes virus infections or other infections. Also, patients who do not respond to Gilenya and women who are planning to become pregnant are advised to stop the treatment. Discontinuing Gilenya can lead to a return to pretreatment disease activity, or severe disease reactivation, in some patients. It is unclear why this happens and why it affects only some patients. To better understand what risk factors could be associated with reactivation, a team at Istanbul University compared the demographic and disease features of patients who developed SDR after stopping treatment with Gilenya. SDR was defined as including these elements within 6 months of Gilenya discontinuation: more than 5 gadolinium-enhanced lesions or a tumefactive demyelinating lesion detectable by magnetic resonance imaging, the disease progressing to the point that additional treatment with methylprednisolone or plasma exchange was required, and progressive physical disability reflected by a 1-point or more increase in patients' scores on the Expanded Disability Status Scale, or EDSS, Thirty-one patients at the university’s MS clinic who had discontinued Gilenya were included in the study. Eight experienced SDR and 11 relapses. The mean time for SDR patients' reactivation to occur was 2.6 months, researchers said. Patients had significantly higher levels of lymphocytes — white blood cells involved in autoimmunity — than during Gilenya treatment. When the team compared the disease features of SDR and non-SDR patients, they found that SDR patients had significantly higher annualized relapse rates before starting Gilenya and lower EDSS scores. “A higher ARR [annualized relapse rate] is the major contributory factor toward development of SDR,” the researchers wrote. “Patients who had higher ARRs before fingolimod [Gilenya] treatment must be closely followed up both clinically and radiologically in terms of the early signs of severe reactivation,” they wrote. About 38 percent of the SDR patients failed to respond to steroid treatment. They received a plasma exchange, which led to moderate improvement in their condition. Based on this finding, the researchers suggested that “plasmapheresis [plasma exchange] must be considered in patients exhibiting steroid-refractory SDR.” "In conclusion, SDR may be observed within the first 3 months after cessation of fingolimod," the team wrote. "This may be explained by the rapid influx of lymphocytes into the CNS [central nervous system]. Patients with higher annualized relapse rates and lower Expanded Disability Status Scale scores before commencing fingolimod treatment were more likely to exhibit SDR."  

#MSParis2017 – Quitting Smoking, Boosting Vitamin D Reduces MS Healthcare Costs, Improves Outcomes

People with multiple sclerosis (MS) who quit smoking have better health outcomes than those who continue. Therefore, MS-related costs can be reduced by encouraging smokers to quit. Similar results were observed in MS patients with healthy vitamin D levels, Maura Pugliatti, from the University of Ferrara, in Italy, said Friday in a presentation at the…

National MS Society Among Groups Promoting Sept. 22 as Falls Prevention Awareness Day

Today is Falls Prevention Awareness Day, an annual campaign that occurs every Sept. 22 to encourage multiple sclerosis patients and others prone to falls to give a little extra thought on how to identify factors for falls. The event, coordinated by the National Council on Aging, will be the 10th in an annual series that has taken place since 2007. The National Multiple Sclerosis Society is contributing to the event by presenting research into MS-related falls, as well as resources to identify risk factors of falling. Research shows that 50 to 70 percent of MS patients report falling at least once over a six-month period, with about 30 percent falling several times. Many people with MS also get injured when they fall, adding significantly to the burden of MS. Studies show that typical MS symptoms, such as poor gait and balance, or the loss of proprioception — the perception of where body parts are in a space — contribute to falls in MS, which typically occur while doing everyday activities at home. To better understand why people with MS fall, and how to best prevent it, current research focuses on better detection of falls. One approach is to use automatic fall detection devices, which patients can wear. A 2015 symposium on gait and balance in MS focused specifically on falls. The meeting concluded that although knowledge and prevention strategies have improved, much remains to be done. In that regard, the International MS Fall Prevention Research Network helps researchers collaborate on falls research. But neurological symptoms are not the only factors at play. Psychological issues make up another area in the risk spectrum, says the NMSS. Fear of falling or overconfidence both contribute, as does inactivity. Besides the guide, the NMSS has also developed the Free From Falls program, containing eight modules with webinars, downloadable educational material and video-guided exercises. These materials teach patients about biological, behavioral and environmental risk factors for falling, while also offering tips and strategies that may reduce the risk of falls.

MS Symptoms, Coupled with Poor Self-Esteem, Can Lead to Serious Depression, Study Says

Fatigue, limited mobility, and poor self-esteem or resiliency were found to be associated with periods of serious depression among multiple sclerosis patients, according to a recent study. Previous research has suggested that MS patients are at risk of major depression, with potentially profound impact on their quality of life. But only a few studies have addressed the incidence of depression among MS patients or the risk factors that may underlie its occurrence. Researchers in Canada enrolled 188 MS patients being treated an Alberta clinic, who were interviewed to assess potential risk factors for depression: namely, socioeconomic status, disease-related factors, childhood risk factors, psychosocial factors, and health behaviors. Participants were also asked to complete the Patient Health Questionnaire every two weeks for six months to identify depressive symptoms in real-time. Over a six-month follow-up, 36 cases of depression were reported among the group of MS patients analyzed. The incidence of depression was 0.019 for women, but higher — 0.044 — for men. Importantly, several factors seemed to be associated with depression in these patients — fatigue, limited mobility, and low resiliency, self-esteem, and self-efficacy, as well as poor coping skills. Results also showed that gender and income were associated with depression. Overall, the researchers concluded that "depression in MS exhibits a risk factor profile similar to that of depression in the general population, with the additional impact of MS illness-related factors. Potentially modifiable risk factors, such as coping with stress and resiliency, present opportunities for focus of further research in depression in MS treatment and prevention efforts." Concerning treatment, the team also emphasized that "while there is evidence in the clinical context that supports the efficacy for pharmacologic and non-pharmacologic treatments for depression in the general population, there is currently insufficient evidence to support/or refute the efficacy of depression treatment for individuals with MS ... Clearly this is an area that requires additional research."