Innovations In Clinical Neuroscience

HOTTOP Multiple Sclerosis DEC 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Page 8 of 27

9 Hot Topics in Multiple Sclerosis [December 2017] Updates in Clinical Practice Updates on research and products in the field of multiple sclerosis COGNITIVE IMPAIRMENT AND TREATMENT It's Time for Combination Therapies in Multiple Sclerosis. Even as medicine for multiple sclerosis (MS) continues to grow, including B-cell depleting monoclonal antibodies (mAbs), these treatments are often unable to cross the blood-brain barrier (BBB). Therefore, additional treatment is needed to provide complete care for patients with MS. This challenge persists especially in patients with relapsing-remitting MS (RRMS), which can ultimately evolve into secondary progressive MS (SPMS). One study recommends combination therapies to fully treat the disorder. By combining a BBB-crossing molecule with an mAb, the mAB has the chance to completely stop the progression of the disease. One drug in particular that the study mentions is ocrelizumab, which was found to be more effective in patients with RRMS than interferon beta-1a. It also resulted in a 24-percent reduced clinical disability risk than patients who received a placebo. Other positive effects included improved 25-foot walk times, decreased chronic inflammatory brain lesion volume, and reduced rate of brain volume loss. The researchers involved in the study suggest that a drug like cyclophosphamide could aid in therapy for patients with MS because of its ability to cross the BBB, but no randomized, controlled trials have studied this as of now. Laquinimod was also suggested as a possible BBB-crossing drug, but clinical trials found that a dose of 1.2mg/day resulted in cardiotoxicity, and no additional clinical trials related to its combination with mAbs to treat MS have not been conducted. However, the idea of combination therapy itself is not a new idea in MS, especially for patients with RRMS who have problems with improving symptoms. * Access the full study The Turkish Validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) Battery. Cognitive impairment affects the majority of patients in the world with multiple sclerosis (MS) and up to 60 percent of patients with secondary progressive MS (SPMS). Researchers aimed to validate the Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS) in Turkish. There are many batteries that are meant to measure cognitive ability in patients with MS, such as the Brief Repeatable Battery of Neuropsychological tests (BRB-N) and the Minimal Assessment of Cognitive Function in MS (MACFIMS), but they take 45 to 90 minutes to finish and are not often clinically viable. BICAMS takes much faster to complete and has been deemed applicable in many different countries and languages worldwide. The researchers also aimed to measure how cognitive impairment affects quality of life via the Modified Fatigue Impact Scale (MFIS) and the Multiple Sclerosis International Quality of Life (MUSIQoL) questionnaire. Overall, 173 patients with MS and 153 healthy controls completed the study. There was no previously determined threshold for cognitive impairment on the BICAMS, so researchers defined it as scoring below the fifth percentile on more than one test in the battery. Cognitive impairment was found in 78 of the 173 patients (45.1%) in the MS group. They also found a significant negative correlation between cognitive ability and fatigue, according to the MFIS. In general, the researchers involved in this study were able to replicate the results of the BICAMS in the Turkish version; thus the researchers concluded that the Turkish version is reliable as the English version. * Access the full study Disease Modifying Treatments and Symptomatic Drugs for Cognitive Impairment in Multiple Sclerosis: Where Do We Stand? New developments in treatments for patients with multiple sclerosis (MS) have continued to help people worldwide, but it's still unclear how the drugs could be helping cognitive impairment. Cognitive impairment can be a symptom of any form of MS, including relapsing-remitting MS (RRMS) and primary progressive MS (PPMS). In general, disease-modifying treatments (DMTs) can improve cognitive performance, and in the case of MS, they can decrease the Click * to access the full study.

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