Sreeram Ramagopalan, PhD

Scientists are studying the underlying causes of epilepsy and the seizures that occur after brain trauma, stroke, and brain tumors, says the NIH. Ongoing research is focused on developing new model systems to more quickly screen potential new treatments. Identification of genetic information that may cause epilepsy may help doctors prevent the disorder or predict which treatments will be most beneficial.Recent epilepsy study findings -- highlighted in these slides -- include:
• About one-fifth of patients with epilepsy have ADHD, which is associated with lower quality of life.
• Social deprivation appears to be a cause of epilepsy.
• The risk of venous thromboembolism is higher in patients with epilepsy.

Slideshows

ADHD lowers the quality of life in adults with epilepsy; epilepsy is associated with social deprivation and increased risk of venous thromboembolism: details of these recent findings in this slide show. 

3 New Findings on Epilepsy

Natalizumab is a highly effective therapy for relapsing-remitting multiple sclerosis. However, its efficacy in the context of other more recently available treatments needs to be assessed. Further, hampering the long-term of use of natalizumab is the association of treatment with a risk of progressive multifocal leukoencephalopathy (PML).The slides above highlight findings of 3 new studies of natalizumab.Â Â Â 

Three brand new studies shed light on use of natalizumab in relapsing-remitting multiple sclerosis.

MS and Natalizumab: 3 New Findings

The use of acupuncture to treat patients with multiple sclerosis (MS) is fairly common, but little literature exists about studies of its effectiveness. The purpose of this study was to review the literature on the use of acupuncture to treat patients with MS.

In performing a literature search, the researchers identified 12 peer-reviewed articles on the subject that examined the use of acupuncture to manage MS-related quality of life, fatigue, spasticity, and pain. They found that many studies showed a positive effect of acupuncture in patients with MS.

However, most of the studies were poorly designed without control groups, patient randomization, or patient and assessor blinding. In addition, description of the subjects, interventions, and outcome measures often was lacking or minimal as was statistical analysis.

In conclusion, although many of the studies suggested that acupuncture is successful in improving MS-related symptoms, poor study design makes it difficult to draw any robust conclusions about the true effectiveness of this intervention. Further studies with more rigorous designs and analysis are needed before accurate claims can be made as to the effectiveness of acupuncture in patients with MS.

The findings of this review on acupuncture treatment in MS are clearly disappointing, and unsurprising. The researchers found that the body of published literature on the effectiveness of acupuncture for MS-related symptoms is poor. However, further studies will be hard to do-it is very difficult, if not impossible, to blind acupuncture studies or to use a placebo.

1. Karpatkin HI, Napolione D, Siminovich-Blok B. 

Acupuncture and multiple sclerosis: a review of the evidence. 

 2014;2014:972935. doi: 10.1155/2014/972935. Epub 2014 Jun 18.

Articles

Studies suggest that acupuncture can improve MS-related symptoms, but poor design makes it difficult to draw robust conclusions.

Acupuncture and MS: The Literature Is Lacking

Primary progressive multiple sclerosis (PPMS), the least common MS disease course, carries the worst prognosis. In this study,

 researchers investigated factors associated with disability accumulation in PPMS.

The researchers identified 500 patients with PPMS in their patient database in Canada. They investigated the influence of sex, age at disease onset, and onset symptoms on time to, and age at, Expanded Disability Status Scale (EDSS) 4 and 6, as well as the time from EDSS 4 to 6 in patients with PPMS using standard survival methods. Median times to EDSS 4 and EDSS 6 were found to be 5 and 9 years. The median ages at EDSS 4 and EDSS 6 were 51 years and 55 years, respectively.

Older age at onset and bilateral motor onset symptoms were independently associated with a shorter time to both EDSS 4 and EDSS 6. Only age at onset was significantly associated with the time from EDSS 4 to EDSS 6.

In conclusion, age at disease onset is the most important predictor of disability accumulation in PPMS. Bilateral motor onset symptoms also were associated with quicker disease progression.

The above paper demonstrates that the prognosis for PPMS is poor and that age at disease onset is the most important risk factor predicting outcome. More than 50% of patients with PPMS need a walking stick within 10 years of disease onset. Treatments are urgently needed to prevent or delay the rapid disease progression in these patients. Age predicting disease progression is now a common theme in MS and needs future research attention.

1. Koch MW, Greenfield J, Javizian O, et al. 

The natural history of early versus late disability accumulation in primary progressive MS. 

2014 Aug 4. pii: jnnp-2014-307948. doi: 10.1136/jnnp-2014-307948.

This, the least common MS disease course, carries the worst prognosis. Treatments are urgently needed to prevent or delay the rapid disease progression.

Sreeram Ramagopalan, PhD

Articles

3 New Findings on Epilepsy

MS and Natalizumab: 3 New Findings

Acupuncture and MS: The Literature Is Lacking

Age at Onset Predicts Disease Progression in MS