Research from IJMSC November 2024

Here's the latest multidisciplinary multiple sclerosis (MS) research from the International Journal of MS Care.

Our CE article for November/December, highlights the complexity of fall situations among people with MS, emphasizing the influence of direct, indirect, and circumstantial factors. Preceding activities, such as physical exertion or illness, can significantly narrow the margin for maintaining balance, necessitating personalized fall-prevention strategies. Environmental adjustments, coping strategies, and proactive measures are necessary as falls frequently occur during outdoor activities or everyday tasks. Incorporating individual factors, such as emotional state and self-confidence, into clinical discussions can enhance awareness and reduce fall risk.

Frail older adults with MS had worse cognitive performance overall, though visuospatial memory deficits remained significant after controlling for age and disability. The prevalence of frailty (57.7%) in this cohort aligns with general older populations but varies compared to prior MS-specific studies, reflecting differences in measurement tools. The findings underscore the importance of addressing frailty as a reversible state through multidisciplinary interventions, particularly physical activity, which can improve both physical and cognitive aspects of frailty.

Objective processing speed and subjective cognitive perceptions independently contribute to illness intrusiveness for individuals with MS. While slower processing speed, measured via the Symbol Digit Modalities Test, was linked to greater intrusiveness, subjective cognitive concerns also played a significant role, underscoring the importance of patient-reported experiences. Resilience did not moderate the cognition-intrusiveness relationship but directly reduced illness intrusiveness, highlighting its potential as a treatment focus.

Abrupt cessation of fingolimod in patients with MS led to significantly higher relapse rates (81%) and was also associated with more severe relapses and slower recovery. Fingolimod withdrawal disrupts immune balance by releasing autoreactive T cells and inflammatory mediators, which may contribute to rebound activity. While MRI findings revealed new lesions in 19% of patients post-washout, no difference was observed between abrupt and gradual discontinuation groups. Risk factors for relapse included a high baseline annualized relapse rate, prior disease breakthrough on fingolimod, and female sex, though low lymphocyte counts at cessation were also implicated.

Come back next month for more research from the IJMSC community or check out our website for the latest at any time.