ICYMI Multiple Sclerosis

In children with isolated optic neuritis, 3 independent biomarkers are strongly associated with progression to multiple sclerosis, according to a retrospective analysis of 357 children with the condition.

Investigators used multiple Cox proportional regressions to determine the following hazard ratios (HR):

• abnormal cranial magnetic resonance imaging (cMRI), 5.94

• the presence of cerebrosnial fluid immunoglobulin G oligoclonal bands (OCB), 3.69

• age, 1.08 per year of age

• cMRI and OCB positivity combined, 26.84

Neither sex nor laterality (unilateral or bilateral) were associated with an increased rate of disease progression to MS.

Citation: Heussinger N, Kontopantelis E, Gburek-Augustat J, et al; for GRACE-MS (German-speaking Research Alliance for ChildrEn with Multiple Sclerosis). Oligoclonal bands predict multiple sclerosis in children with optic neuritis. Ann Neurol. 2015. doi:10.1002/ana.24409.

In children with isolated optic neuritis, 3 independent biomarkers are strongly associated with progression to multiple sclerosis, according to a retrospective analysis of 357 children with the condition.

Investigators used multiple Cox proportional regressions to determine the following hazard ratios (HR):

• abnormal cranial magnetic resonance imaging (cMRI), 5.94

• the presence of cerebrosnial fluid immunoglobulin G oligoclonal bands (OCB), 3.69

• age, 1.08 per year of age

• cMRI and OCB positivity combined, 26.84

Neither sex nor laterality (unilateral or bilateral) were associated with an increased rate of disease progression to MS.

Citation: Heussinger N, Kontopantelis E, Gburek-Augustat J, et al; for GRACE-MS (German-speaking Research Alliance for ChildrEn with Multiple Sclerosis). Oligoclonal bands predict multiple sclerosis in children with optic neuritis. Ann Neurol. 2015. doi:10.1002/ana.24409.

In children with isolated optic neuritis, 3 independent biomarkers are strongly associated with progression to multiple sclerosis, according to a retrospective analysis of 357 children with the condition.

Investigators used multiple Cox proportional regressions to determine the following hazard ratios (HR):

• abnormal cranial magnetic resonance imaging (cMRI), 5.94

• the presence of cerebrosnial fluid immunoglobulin G oligoclonal bands (OCB), 3.69

• age, 1.08 per year of age

• cMRI and OCB positivity combined, 26.84

Neither sex nor laterality (unilateral or bilateral) were associated with an increased rate of disease progression to MS.

Citation: Heussinger N, Kontopantelis E, Gburek-Augustat J, et al; for GRACE-MS (German-speaking Research Alliance for ChildrEn with Multiple Sclerosis). Oligoclonal bands predict multiple sclerosis in children with optic neuritis. Ann Neurol. 2015. doi:10.1002/ana.24409.

Higher levels of education are associated with a decreased risk of multiple sclerosis (MS) independent of other established risk factors, according to the Environmental Factors in MS (EnvIMS) study. 

The case-control study of 953 MS patients and 1,717 healthy controls reported education level and history of exposure to putative environmental risk factors, including known risk factors of smoking, infective mononucleosis, vitamin D levels, and body size.

In comparison to the lowest level of education, higher levels of education was associated with a decreased MS risk odds ratio of 0.53, a risk that was only moderately reduced after adjusting for other risk factors. The study authors note this suggests factors linked to lower socioeconomic status aside from established risks may play a role in MS.

Citation: Bjørnevik K, Riise T, Cortese M, et al. Level of education and multiple sclerosis risk after adjustment for known risk factors: The EnvIMS study. Mult Scler. 2015. pii:1352458515579444.

Higher levels of education are associated with a decreased risk of multiple sclerosis (MS) independent of other established risk factors, according to the Environmental Factors in MS (EnvIMS) study. 

The case-control study of 953 MS patients and 1,717 healthy controls reported education level and history of exposure to putative environmental risk factors, including known risk factors of smoking, infective mononucleosis, vitamin D levels, and body size.

In comparison to the lowest level of education, higher levels of education was associated with a decreased MS risk odds ratio of 0.53, a risk that was only moderately reduced after adjusting for other risk factors. The study authors note this suggests factors linked to lower socioeconomic status aside from established risks may play a role in MS.

Citation: Bjørnevik K, Riise T, Cortese M, et al. Level of education and multiple sclerosis risk after adjustment for known risk factors: The EnvIMS study. Mult Scler. 2015. pii:1352458515579444.

Higher levels of education are associated with a decreased risk of multiple sclerosis (MS) independent of other established risk factors, according to the Environmental Factors in MS (EnvIMS) study. 

The case-control study of 953 MS patients and 1,717 healthy controls reported education level and history of exposure to putative environmental risk factors, including known risk factors of smoking, infective mononucleosis, vitamin D levels, and body size.

In comparison to the lowest level of education, higher levels of education was associated with a decreased MS risk odds ratio of 0.53, a risk that was only moderately reduced after adjusting for other risk factors. The study authors note this suggests factors linked to lower socioeconomic status aside from established risks may play a role in MS.

Citation: Bjørnevik K, Riise T, Cortese M, et al. Level of education and multiple sclerosis risk after adjustment for known risk factors: The EnvIMS study. Mult Scler. 2015. pii:1352458515579444.

Iron accumulation in the basal ganglia is more pronounced in the early phases of clinically isolated syndrome (CIS) and definite multiple sclerosis (MS), but short-term changes in iron concentration are not associated with disease activity or changes in disability, a longitudinal 3T MRI study of 144 patients reports.

Investigators followed patients both clinically and with 3T MRI for an average of 3 years and found:  

• Subcortical gray matter iron deposition was higher in MS than CIS at baseline.

• In CIS, R2* rates increased in the globus pallidus, putamen, and caudate nucleus, but decreased in the thalamus.

• In MS, R2* rates increased in the putamen, remained stable in the globus pallidus and caudate nucleus, and decreased in the thalamus.

Citation: Khalil M, Langkammer C, Pichler A, et al. Dynamics of brain iron levels in multiple sclerosis: A longitudinal 3T MRI study. Neurology. 2015. pii:10.1212/WNL.0000000000001679. [Epub ahead of print] 

Iron accumulation in the basal ganglia is more pronounced in the early phases of clinically isolated syndrome (CIS) and definite multiple sclerosis (MS), but short-term changes in iron concentration are not associated with disease activity or changes in disability, a longitudinal 3T MRI study of 144 patients reports.

Investigators followed patients both clinically and with 3T MRI for an average of 3 years and found:  

• Subcortical gray matter iron deposition was higher in MS than CIS at baseline.

• In CIS, R2* rates increased in the globus pallidus, putamen, and caudate nucleus, but decreased in the thalamus.

• In MS, R2* rates increased in the putamen, remained stable in the globus pallidus and caudate nucleus, and decreased in the thalamus.

Citation: Khalil M, Langkammer C, Pichler A, et al. Dynamics of brain iron levels in multiple sclerosis: A longitudinal 3T MRI study. Neurology. 2015. pii:10.1212/WNL.0000000000001679. [Epub ahead of print] 

Iron accumulation in the basal ganglia is more pronounced in the early phases of clinically isolated syndrome (CIS) and definite multiple sclerosis (MS), but short-term changes in iron concentration are not associated with disease activity or changes in disability, a longitudinal 3T MRI study of 144 patients reports.

Investigators followed patients both clinically and with 3T MRI for an average of 3 years and found:  

• Subcortical gray matter iron deposition was higher in MS than CIS at baseline.

• In CIS, R2* rates increased in the globus pallidus, putamen, and caudate nucleus, but decreased in the thalamus.

• In MS, R2* rates increased in the putamen, remained stable in the globus pallidus and caudate nucleus, and decreased in the thalamus.

Citation: Khalil M, Langkammer C, Pichler A, et al. Dynamics of brain iron levels in multiple sclerosis: A longitudinal 3T MRI study. Neurology. 2015. pii:10.1212/WNL.0000000000001679. [Epub ahead of print] 

INDIANAPOLIS—Compared with interferon β-1a, daclizumab high-yield process (DAC HYP) may provide greater improvement in the patient-centered outcomes of ambulation and cognition for patients with relapsing-remitting multiple sclerosis (MS), according to data presented at the 2015 CMSC Annual Meeting.

The results come from a post hoc analysis of results from the DECIDE study. In that randomized, double-blind trial, Michael Kaufman, MD, a neurologist at Cole Neuroscience Center in Knoxville, Tennessee, and colleagues found that DAC HYP reduced clinical and radiographic disease activity in patients with relapsing-remitting MS, compared with interferon β-1a. The researchers incorporated changes in the MS Functional Composite (MSFC) and the Symbol Digit Modalities Test (SDMT) over 96 weeks as tertiary end points in the DECIDE trial to compare the effects of the two therapies on ambulation, hand and arm dexterity, and cognition.

Eligible participants were between ages 18 and 55 and had an Expanded Disability Status Scale (EDSS) score between 0 and 5. Patients were randomized to 150 mg of DAC HYP subcutaneously every four weeks or 30 mg of interferon β-1a once weekly. The study lasted for 144 weeks.

In all, 919 patients received DAC HYP, and 922 participants received interferon β-1a. Mean baseline EDSS was 2.48 for the DAC HYP group and 2.54 for the interferon β-1a group. Over 96 weeks, the median improvement from baseline in MSFC z score was 0.091 for patients receiving DAC HYP, compared with 0.055 for patients receiving interferon β-1a.

The most significant median z score change in an individual component of the MSFC was in the Nine-Hole Peg Test. This change was 0.063 for patients receiving DAC HYP and 0.017 for patients receiving interferon β-1a. Median z score change for the Timed 25-Foot Walk was 0.000 for the DAC HYP group and –0.017 for the interferon β-1a group. Median z score change for the Paced Auditory Serial Addition Test-3 was not different between groups at Week 96, but patients receiving DAC HYP showed earlier improvements in this measure. Mean change in SDMT from baseline over 96 weeks was 4.08 for the DAC HYP group, compared with 2.89 for the interferon β-1a group.

The data suggest that DAC HYP has beneficial effects for cognitive function, “which is extremely important to MS patients,” said Dr. Kaufman. The study “supports the idea that daclizumab may in the future have a place in the therapeutic armamentarium of MS,” he concluded.

—Erik Greb

INDIANAPOLIS—Compared with interferon β-1a, daclizumab high-yield process (DAC HYP) may provide greater improvement in the patient-centered outcomes of ambulation and cognition for patients with relapsing-remitting multiple sclerosis (MS), according to data presented at the 2015 CMSC Annual Meeting.

The results come from a post hoc analysis of results from the DECIDE study. In that randomized, double-blind trial, Michael Kaufman, MD, a neurologist at Cole Neuroscience Center in Knoxville, Tennessee, and colleagues found that DAC HYP reduced clinical and radiographic disease activity in patients with relapsing-remitting MS, compared with interferon β-1a. The researchers incorporated changes in the MS Functional Composite (MSFC) and the Symbol Digit Modalities Test (SDMT) over 96 weeks as tertiary end points in the DECIDE trial to compare the effects of the two therapies on ambulation, hand and arm dexterity, and cognition.

Eligible participants were between ages 18 and 55 and had an Expanded Disability Status Scale (EDSS) score between 0 and 5. Patients were randomized to 150 mg of DAC HYP subcutaneously every four weeks or 30 mg of interferon β-1a once weekly. The study lasted for 144 weeks.

In all, 919 patients received DAC HYP, and 922 participants received interferon β-1a. Mean baseline EDSS was 2.48 for the DAC HYP group and 2.54 for the interferon β-1a group. Over 96 weeks, the median improvement from baseline in MSFC z score was 0.091 for patients receiving DAC HYP, compared with 0.055 for patients receiving interferon β-1a.

The most significant median z score change in an individual component of the MSFC was in the Nine-Hole Peg Test. This change was 0.063 for patients receiving DAC HYP and 0.017 for patients receiving interferon β-1a. Median z score change for the Timed 25-Foot Walk was 0.000 for the DAC HYP group and –0.017 for the interferon β-1a group. Median z score change for the Paced Auditory Serial Addition Test-3 was not different between groups at Week 96, but patients receiving DAC HYP showed earlier improvements in this measure. Mean change in SDMT from baseline over 96 weeks was 4.08 for the DAC HYP group, compared with 2.89 for the interferon β-1a group.

The data suggest that DAC HYP has beneficial effects for cognitive function, “which is extremely important to MS patients,” said Dr. Kaufman. The study “supports the idea that daclizumab may in the future have a place in the therapeutic armamentarium of MS,” he concluded.

—Erik Greb

INDIANAPOLIS—Compared with interferon β-1a, daclizumab high-yield process (DAC HYP) may provide greater improvement in the patient-centered outcomes of ambulation and cognition for patients with relapsing-remitting multiple sclerosis (MS), according to data presented at the 2015 CMSC Annual Meeting.

The results come from a post hoc analysis of results from the DECIDE study. In that randomized, double-blind trial, Michael Kaufman, MD, a neurologist at Cole Neuroscience Center in Knoxville, Tennessee, and colleagues found that DAC HYP reduced clinical and radiographic disease activity in patients with relapsing-remitting MS, compared with interferon β-1a. The researchers incorporated changes in the MS Functional Composite (MSFC) and the Symbol Digit Modalities Test (SDMT) over 96 weeks as tertiary end points in the DECIDE trial to compare the effects of the two therapies on ambulation, hand and arm dexterity, and cognition.

Eligible participants were between ages 18 and 55 and had an Expanded Disability Status Scale (EDSS) score between 0 and 5. Patients were randomized to 150 mg of DAC HYP subcutaneously every four weeks or 30 mg of interferon β-1a once weekly. The study lasted for 144 weeks.

In all, 919 patients received DAC HYP, and 922 participants received interferon β-1a. Mean baseline EDSS was 2.48 for the DAC HYP group and 2.54 for the interferon β-1a group. Over 96 weeks, the median improvement from baseline in MSFC z score was 0.091 for patients receiving DAC HYP, compared with 0.055 for patients receiving interferon β-1a.

The most significant median z score change in an individual component of the MSFC was in the Nine-Hole Peg Test. This change was 0.063 for patients receiving DAC HYP and 0.017 for patients receiving interferon β-1a. Median z score change for the Timed 25-Foot Walk was 0.000 for the DAC HYP group and –0.017 for the interferon β-1a group. Median z score change for the Paced Auditory Serial Addition Test-3 was not different between groups at Week 96, but patients receiving DAC HYP showed earlier improvements in this measure. Mean change in SDMT from baseline over 96 weeks was 4.08 for the DAC HYP group, compared with 2.89 for the interferon β-1a group.

The data suggest that DAC HYP has beneficial effects for cognitive function, “which is extremely important to MS patients,” said Dr. Kaufman. The study “supports the idea that daclizumab may in the future have a place in the therapeutic armamentarium of MS,” he concluded.

—Erik Greb

INDIANAPOLIS—Most patients with relapsing-remitting multiple sclerosis (MS) remain free of new MRI activity for four years after initiating treatment with alemtuzumab, according to data presented at the 2015 CMSC Annual Meeting. Alemtuzumab also appears to slow the rate of brain volume loss, compared with interferon beta. The drug’s durable effects may result from the distinct pattern of lymphocyte depletion and repopulation that follows treatment, said Anthony Traboulsee, MD, Associate Professor of Neurology at the University of British Columbia in Vancouver.

The data result from four-year follow-up of participants in the CARE-MS II trial. In that study, patients with relapsing-remitting MS who had had an inadequate response to prior therapy (defined as at least one relapse) were randomized to alemtuzumab or subcutaneous interferon beta-1a. After two years, patients receiving alemtuzumab had a 49% decrease in annualized relapse rate and a 42% decrease in six-month sustained accumulation of disability, compared with patients who received interferon beta-1a. In addition, more patients in the alemtuzumab group were free of MRI activity, compared with the interferon group.

The open-label extension study was designed to observe the effect of alemtuzumab on MRI outcomes over four years. In this study, patients randomized to interferon had the option of receiving alemtuzumab, and patients randomized to alemtuzumab were allowed to receive additional treatment if they had breakthrough clinical or MRI activity.

About 93% of the original alemtuzumab group entered the extension study. Approximately 68% of these participants were clinically and radiologically stable and did not require further treatments during the two years of the extension. The proportion of participants receiving alemtuzumab who were free of MRI activity was 68.4% in Year 3 and 69.9% in Year 4. This proportion remained stable, compared with that of the original study. The proportion of patients receiving alemtuzumab with no evidence of disease activity (ie, clinical or MRI activity) was 52.9% at Year 3 and 54.5% at Year 4.

The median yearly loss in brain volume was smaller in Years 3 and 4 than during the original study for patients receiving alemtuzumab. Median yearly brain volume change was –0.22% at Year 2, –0.10% at Year 3, and –0.19% at Year 4. “These results reflect a reduction in focal inflammation with alemtuzumab treatment,” said Dr. Traboulsee. “Together, these findings indicate that alemtuzumab represents a novel and durable treatment approach for relapsing-remitting MS.”

—Erik Greb

INDIANAPOLIS—Most patients with relapsing-remitting multiple sclerosis (MS) remain free of new MRI activity for four years after initiating treatment with alemtuzumab, according to data presented at the 2015 CMSC Annual Meeting. Alemtuzumab also appears to slow the rate of brain volume loss, compared with interferon beta. The drug’s durable effects may result from the distinct pattern of lymphocyte depletion and repopulation that follows treatment, said Anthony Traboulsee, MD, Associate Professor of Neurology at the University of British Columbia in Vancouver.

The data result from four-year follow-up of participants in the CARE-MS II trial. In that study, patients with relapsing-remitting MS who had had an inadequate response to prior therapy (defined as at least one relapse) were randomized to alemtuzumab or subcutaneous interferon beta-1a. After two years, patients receiving alemtuzumab had a 49% decrease in annualized relapse rate and a 42% decrease in six-month sustained accumulation of disability, compared with patients who received interferon beta-1a. In addition, more patients in the alemtuzumab group were free of MRI activity, compared with the interferon group.

The open-label extension study was designed to observe the effect of alemtuzumab on MRI outcomes over four years. In this study, patients randomized to interferon had the option of receiving alemtuzumab, and patients randomized to alemtuzumab were allowed to receive additional treatment if they had breakthrough clinical or MRI activity.

About 93% of the original alemtuzumab group entered the extension study. Approximately 68% of these participants were clinically and radiologically stable and did not require further treatments during the two years of the extension. The proportion of participants receiving alemtuzumab who were free of MRI activity was 68.4% in Year 3 and 69.9% in Year 4. This proportion remained stable, compared with that of the original study. The proportion of patients receiving alemtuzumab with no evidence of disease activity (ie, clinical or MRI activity) was 52.9% at Year 3 and 54.5% at Year 4.

The median yearly loss in brain volume was smaller in Years 3 and 4 than during the original study for patients receiving alemtuzumab. Median yearly brain volume change was –0.22% at Year 2, –0.10% at Year 3, and –0.19% at Year 4. “These results reflect a reduction in focal inflammation with alemtuzumab treatment,” said Dr. Traboulsee. “Together, these findings indicate that alemtuzumab represents a novel and durable treatment approach for relapsing-remitting MS.”

—Erik Greb

INDIANAPOLIS—Most patients with relapsing-remitting multiple sclerosis (MS) remain free of new MRI activity for four years after initiating treatment with alemtuzumab, according to data presented at the 2015 CMSC Annual Meeting. Alemtuzumab also appears to slow the rate of brain volume loss, compared with interferon beta. The drug’s durable effects may result from the distinct pattern of lymphocyte depletion and repopulation that follows treatment, said Anthony Traboulsee, MD, Associate Professor of Neurology at the University of British Columbia in Vancouver.

The data result from four-year follow-up of participants in the CARE-MS II trial. In that study, patients with relapsing-remitting MS who had had an inadequate response to prior therapy (defined as at least one relapse) were randomized to alemtuzumab or subcutaneous interferon beta-1a. After two years, patients receiving alemtuzumab had a 49% decrease in annualized relapse rate and a 42% decrease in six-month sustained accumulation of disability, compared with patients who received interferon beta-1a. In addition, more patients in the alemtuzumab group were free of MRI activity, compared with the interferon group.

The open-label extension study was designed to observe the effect of alemtuzumab on MRI outcomes over four years. In this study, patients randomized to interferon had the option of receiving alemtuzumab, and patients randomized to alemtuzumab were allowed to receive additional treatment if they had breakthrough clinical or MRI activity.

About 93% of the original alemtuzumab group entered the extension study. Approximately 68% of these participants were clinically and radiologically stable and did not require further treatments during the two years of the extension. The proportion of participants receiving alemtuzumab who were free of MRI activity was 68.4% in Year 3 and 69.9% in Year 4. This proportion remained stable, compared with that of the original study. The proportion of patients receiving alemtuzumab with no evidence of disease activity (ie, clinical or MRI activity) was 52.9% at Year 3 and 54.5% at Year 4.

The median yearly loss in brain volume was smaller in Years 3 and 4 than during the original study for patients receiving alemtuzumab. Median yearly brain volume change was –0.22% at Year 2, –0.10% at Year 3, and –0.19% at Year 4. “These results reflect a reduction in focal inflammation with alemtuzumab treatment,” said Dr. Traboulsee. “Together, these findings indicate that alemtuzumab represents a novel and durable treatment approach for relapsing-remitting MS.”

—Erik Greb

INDIANAPOLIS—A majority of patients remain stable when switching from natalizumab to dimethyl fumarate, according to data presented at the 2015 CMSC Annual Meeting. Factors such as sex, age, and duration of natalizumab treatment may predict the probability of a successful transition, reported lead author Faria S. Amjad, MD, of Georgetown University Hospital in Washington, DC, and research colleagues.

Natalizumab is a monoclonal antibody that prevents entry of leukocytes into the CNS. This mechanism of action has made it one of the most effective therapies against multiple sclerosis (MS). However, natalizumab’s use is limited by its risk of progressive multifocal leukoencephalopathy (PML). Moreover, switching from natalizumab to another therapeutic agent is made even more complex, as there is an increased risk of rebound inflammation. Dimethyl fumarate is an oral agent that offers a therapeutic alternative to patients stopping natalizumab. However, the safety and efficacy of this switch have not been studied.

To assess the stability of patients switched from natalizumab to dimethyl fumarate, Dr. Amjad and colleagues conducted a telephone survey and chart review for 66 patients with relapsing-remitting MS who had been switched from natalizumab to dimethyl fumarate. Factors analyzed included age, gender, duration on natalizumab, and duration on dimethyl fumarate.

A total of 66 patients were surveyed; 47 (71.22%) remained stable when switched to dimethyl fumarate, and 19 (28.78%) were found to be unstable on dimethyl fumarate. While the findings were not statistically significant, several trends were noted. Female patients were 2.9 times more likely to be unstable, compared with males. Patients younger than 60 were 1.8 times more likely to be unstable, compared with patients older than 60. Patients on natalizumab for less than two years were 2.4 times more likely to be unstable, compared with patients on natulizumab for more than two years. Patients who have an eight-week or less gap between natulizumab and dimethyl fumarate are just as likely to develop instability as patients with more than an eight-week gap between treatments. Patients who are on dimethyl fumarate for less than six months are 0.6 times less likely to be unstable than patients on dimethyl fumarate for longer than six months. In other words, patients on dimethyl fumarate for longer than six months are 1.7 times more likely to be unstable.

According to the researchers, an extension of this study will look at MRI changes and relapse rate after a patient has stopped natalizumab therapy and switched to dimethyl fumarate.

INDIANAPOLIS—A majority of patients remain stable when switching from natalizumab to dimethyl fumarate, according to data presented at the 2015 CMSC Annual Meeting. Factors such as sex, age, and duration of natalizumab treatment may predict the probability of a successful transition, reported lead author Faria S. Amjad, MD, of Georgetown University Hospital in Washington, DC, and research colleagues.

Natalizumab is a monoclonal antibody that prevents entry of leukocytes into the CNS. This mechanism of action has made it one of the most effective therapies against multiple sclerosis (MS). However, natalizumab’s use is limited by its risk of progressive multifocal leukoencephalopathy (PML). Moreover, switching from natalizumab to another therapeutic agent is made even more complex, as there is an increased risk of rebound inflammation. Dimethyl fumarate is an oral agent that offers a therapeutic alternative to patients stopping natalizumab. However, the safety and efficacy of this switch have not been studied.

To assess the stability of patients switched from natalizumab to dimethyl fumarate, Dr. Amjad and colleagues conducted a telephone survey and chart review for 66 patients with relapsing-remitting MS who had been switched from natalizumab to dimethyl fumarate. Factors analyzed included age, gender, duration on natalizumab, and duration on dimethyl fumarate.

A total of 66 patients were surveyed; 47 (71.22%) remained stable when switched to dimethyl fumarate, and 19 (28.78%) were found to be unstable on dimethyl fumarate. While the findings were not statistically significant, several trends were noted. Female patients were 2.9 times more likely to be unstable, compared with males. Patients younger than 60 were 1.8 times more likely to be unstable, compared with patients older than 60. Patients on natalizumab for less than two years were 2.4 times more likely to be unstable, compared with patients on natulizumab for more than two years. Patients who have an eight-week or less gap between natulizumab and dimethyl fumarate are just as likely to develop instability as patients with more than an eight-week gap between treatments. Patients who are on dimethyl fumarate for less than six months are 0.6 times less likely to be unstable than patients on dimethyl fumarate for longer than six months. In other words, patients on dimethyl fumarate for longer than six months are 1.7 times more likely to be unstable.

According to the researchers, an extension of this study will look at MRI changes and relapse rate after a patient has stopped natalizumab therapy and switched to dimethyl fumarate.

INDIANAPOLIS—A majority of patients remain stable when switching from natalizumab to dimethyl fumarate, according to data presented at the 2015 CMSC Annual Meeting. Factors such as sex, age, and duration of natalizumab treatment may predict the probability of a successful transition, reported lead author Faria S. Amjad, MD, of Georgetown University Hospital in Washington, DC, and research colleagues.

Natalizumab is a monoclonal antibody that prevents entry of leukocytes into the CNS. This mechanism of action has made it one of the most effective therapies against multiple sclerosis (MS). However, natalizumab’s use is limited by its risk of progressive multifocal leukoencephalopathy (PML). Moreover, switching from natalizumab to another therapeutic agent is made even more complex, as there is an increased risk of rebound inflammation. Dimethyl fumarate is an oral agent that offers a therapeutic alternative to patients stopping natalizumab. However, the safety and efficacy of this switch have not been studied.

To assess the stability of patients switched from natalizumab to dimethyl fumarate, Dr. Amjad and colleagues conducted a telephone survey and chart review for 66 patients with relapsing-remitting MS who had been switched from natalizumab to dimethyl fumarate. Factors analyzed included age, gender, duration on natalizumab, and duration on dimethyl fumarate.

A total of 66 patients were surveyed; 47 (71.22%) remained stable when switched to dimethyl fumarate, and 19 (28.78%) were found to be unstable on dimethyl fumarate. While the findings were not statistically significant, several trends were noted. Female patients were 2.9 times more likely to be unstable, compared with males. Patients younger than 60 were 1.8 times more likely to be unstable, compared with patients older than 60. Patients on natalizumab for less than two years were 2.4 times more likely to be unstable, compared with patients on natulizumab for more than two years. Patients who have an eight-week or less gap between natulizumab and dimethyl fumarate are just as likely to develop instability as patients with more than an eight-week gap between treatments. Patients who are on dimethyl fumarate for less than six months are 0.6 times less likely to be unstable than patients on dimethyl fumarate for longer than six months. In other words, patients on dimethyl fumarate for longer than six months are 1.7 times more likely to be unstable.

According to the researchers, an extension of this study will look at MRI changes and relapse rate after a patient has stopped natalizumab therapy and switched to dimethyl fumarate.

INDIANAPOLIS—Self-reported monitoring through an automated telehealth mechanism can provide a valid assessment of disease-modifying therapy (DMT) adherence among patients with multiple sclerosis (MS), according to study findings reported at the 2015 CMSC Annual Meeting. Further, utilizing an automated electronic system reduces the time spent making phone calls and researching pharmacy refill records by healthcare providers, according to Jill R. Settle and her research colleagues. Ms. Settle is affiliated with the MS Center of Excellence at the Veterans Affairs Medical Center in Washington, DC.

DMTs for MS have been available for more than 20 years; however, adherence to DMT regimens is often poor. The most common reason cited by patients is forgetting to take their medications on the specific day they are to be administered. To address the issue of non-adherence, Ms. Settle and colleagues sought to establish the feasibility of implementing a home telehealth program to support and monitor MS medication adherence without increasing healthcare provider burden.

The researchers addressed the assessment of poor adherence using a comprehensive Home Automated Telemanagement system for MS (MS HAT). MS HAT is a home-based Internet module that supports patient self-management, patient–provider communication, and patient education.

For approximately six months, 30 study participants were randomized to either MS HAT or treatment as usual. All participants stored their interferon β-1a syringes in a clear syringe container and maintained a paper calendar of medication adherence. Pharmacy refill rates were also collected from medical records. Participants in the MS HAT study arm received text or e-mail reminders to administer their medication.

There were no significant differences in demographic variables between the two groups. Likewise, overall adherence did not differ between the two groups. MS HAT alert rates were negatively correlated with syringe counts. As alerts decreased, syringes collected increased. Syringe count was positively related to change in Morisky score for interferon β-1a. As self-reported adherence improved, the number of syringes collected also increased. Pharmacy refills were directly related to calendar reports of taking the medication and syringe counts. As pharmacy refills increased, so did calendar reports and syringes collected.

The strong correlation between self-report and objective measures of adherence suggests that the MS HAT system is effective and cost-efficient.

INDIANAPOLIS—Self-reported monitoring through an automated telehealth mechanism can provide a valid assessment of disease-modifying therapy (DMT) adherence among patients with multiple sclerosis (MS), according to study findings reported at the 2015 CMSC Annual Meeting. Further, utilizing an automated electronic system reduces the time spent making phone calls and researching pharmacy refill records by healthcare providers, according to Jill R. Settle and her research colleagues. Ms. Settle is affiliated with the MS Center of Excellence at the Veterans Affairs Medical Center in Washington, DC.

DMTs for MS have been available for more than 20 years; however, adherence to DMT regimens is often poor. The most common reason cited by patients is forgetting to take their medications on the specific day they are to be administered. To address the issue of non-adherence, Ms. Settle and colleagues sought to establish the feasibility of implementing a home telehealth program to support and monitor MS medication adherence without increasing healthcare provider burden.

The researchers addressed the assessment of poor adherence using a comprehensive Home Automated Telemanagement system for MS (MS HAT). MS HAT is a home-based Internet module that supports patient self-management, patient–provider communication, and patient education.

For approximately six months, 30 study participants were randomized to either MS HAT or treatment as usual. All participants stored their interferon β-1a syringes in a clear syringe container and maintained a paper calendar of medication adherence. Pharmacy refill rates were also collected from medical records. Participants in the MS HAT study arm received text or e-mail reminders to administer their medication.

There were no significant differences in demographic variables between the two groups. Likewise, overall adherence did not differ between the two groups. MS HAT alert rates were negatively correlated with syringe counts. As alerts decreased, syringes collected increased. Syringe count was positively related to change in Morisky score for interferon β-1a. As self-reported adherence improved, the number of syringes collected also increased. Pharmacy refills were directly related to calendar reports of taking the medication and syringe counts. As pharmacy refills increased, so did calendar reports and syringes collected.

The strong correlation between self-report and objective measures of adherence suggests that the MS HAT system is effective and cost-efficient.

INDIANAPOLIS—Self-reported monitoring through an automated telehealth mechanism can provide a valid assessment of disease-modifying therapy (DMT) adherence among patients with multiple sclerosis (MS), according to study findings reported at the 2015 CMSC Annual Meeting. Further, utilizing an automated electronic system reduces the time spent making phone calls and researching pharmacy refill records by healthcare providers, according to Jill R. Settle and her research colleagues. Ms. Settle is affiliated with the MS Center of Excellence at the Veterans Affairs Medical Center in Washington, DC.

DMTs for MS have been available for more than 20 years; however, adherence to DMT regimens is often poor. The most common reason cited by patients is forgetting to take their medications on the specific day they are to be administered. To address the issue of non-adherence, Ms. Settle and colleagues sought to establish the feasibility of implementing a home telehealth program to support and monitor MS medication adherence without increasing healthcare provider burden.

The researchers addressed the assessment of poor adherence using a comprehensive Home Automated Telemanagement system for MS (MS HAT). MS HAT is a home-based Internet module that supports patient self-management, patient–provider communication, and patient education.

For approximately six months, 30 study participants were randomized to either MS HAT or treatment as usual. All participants stored their interferon β-1a syringes in a clear syringe container and maintained a paper calendar of medication adherence. Pharmacy refill rates were also collected from medical records. Participants in the MS HAT study arm received text or e-mail reminders to administer their medication.

There were no significant differences in demographic variables between the two groups. Likewise, overall adherence did not differ between the two groups. MS HAT alert rates were negatively correlated with syringe counts. As alerts decreased, syringes collected increased. Syringe count was positively related to change in Morisky score for interferon β-1a. As self-reported adherence improved, the number of syringes collected also increased. Pharmacy refills were directly related to calendar reports of taking the medication and syringe counts. As pharmacy refills increased, so did calendar reports and syringes collected.

The strong correlation between self-report and objective measures of adherence suggests that the MS HAT system is effective and cost-efficient.

INDIANAPOLIS—Although many women with multiple sclerosis (MS) are perimenopausal, the literature contains few data about effective ways to manage these women’s symptoms, according to research presented at the 2015 CMSC Annual Meeting. The topic could be considered to inhabit an “evidence-free zone,” but general recommendations are possible, according to Riley Bove, MD, Instructor at Harvard Medical School in Boston.

During menopause, women may have vasomotor symptoms such as hot flashes, vascular instability, and rapid heartbeat. For patients with MS, these symptoms may disturb sleep, contribute to fatigue, and affect mood. Vasomotor symptoms also may cause exacerbations. Hormone replacement therapy is the most effective treatment for vasomotor symptoms. In the Women’s Health Initiative Memory Study, however, hormone replacement therapy initiated in women age 65 or older was associated with an increased risk of dementia and cognitive decline. This association should be examined in longitudinal placebo-controlled trials, said Dr. Bove.

Bladder symptoms and sleep apnea are more common during menopause and can cause frequent awakenings, which lead to mood disturbances (eg, depression or anxiety) and relational problems in patients with MS. To improve sleep, neurologists should advise their patients about good sleep hygiene. Patients should stay in bed for only a certain amount of time, use their bed for sleep or intimacy only, schedule regular wake times, and moderate caffeine intake, among other behaviors.

Fatigue is common in MS, and its severity and frequency tend to increase during menopause. Neurologists should rule out additional contributors to fatigue, such as thyroid disease. Patients should be advised to arrange their daily schedule so that work routines are spaced out. They should take intermittent rest breaks and try to concentrate their activity in the morning when it is cooler. Relaxation and meditation practices can reduce stress and decrease fatigue. Drugs such as modafinil and amantadine can promote wakefulness, and methylphenidate can be used as a stimulant.

Pain tolerance may decrease during menopause, and patients with MS often have cervical and lumbar spondylosis, joint immobility, spasticity, and deconditioning. Baclofen, diazepam, dantrolene, and tizanidine may be effective for pain resulting from spasticity. Phenytoin, carbamazepine, and tricyclic antidepressants can alleviate neuropathic pain and paresthesias. Neurologists also might recommend weight loss or exercise or refer a patient to a pain center for an integrated approach to the condition.

Mood disorders are common among patients with MS, and mood fluctuations may accompany menopause. In response to this problem, a neurologist may recommend psychotherapy to help optimize the patient’s coping abilities. Spousal and interpersonal support also are important for the patient. Antidepressants such as fluoxetine, sertraline, escitalopram, and citalopram can be effective if drug therapy is warranted. Support groups also may help stabilize the patient’s mood.

—Erik Greb

INDIANAPOLIS—Although many women with multiple sclerosis (MS) are perimenopausal, the literature contains few data about effective ways to manage these women’s symptoms, according to research presented at the 2015 CMSC Annual Meeting. The topic could be considered to inhabit an “evidence-free zone,” but general recommendations are possible, according to Riley Bove, MD, Instructor at Harvard Medical School in Boston.

During menopause, women may have vasomotor symptoms such as hot flashes, vascular instability, and rapid heartbeat. For patients with MS, these symptoms may disturb sleep, contribute to fatigue, and affect mood. Vasomotor symptoms also may cause exacerbations. Hormone replacement therapy is the most effective treatment for vasomotor symptoms. In the Women’s Health Initiative Memory Study, however, hormone replacement therapy initiated in women age 65 or older was associated with an increased risk of dementia and cognitive decline. This association should be examined in longitudinal placebo-controlled trials, said Dr. Bove.

Bladder symptoms and sleep apnea are more common during menopause and can cause frequent awakenings, which lead to mood disturbances (eg, depression or anxiety) and relational problems in patients with MS. To improve sleep, neurologists should advise their patients about good sleep hygiene. Patients should stay in bed for only a certain amount of time, use their bed for sleep or intimacy only, schedule regular wake times, and moderate caffeine intake, among other behaviors.

Fatigue is common in MS, and its severity and frequency tend to increase during menopause. Neurologists should rule out additional contributors to fatigue, such as thyroid disease. Patients should be advised to arrange their daily schedule so that work routines are spaced out. They should take intermittent rest breaks and try to concentrate their activity in the morning when it is cooler. Relaxation and meditation practices can reduce stress and decrease fatigue. Drugs such as modafinil and amantadine can promote wakefulness, and methylphenidate can be used as a stimulant.

Pain tolerance may decrease during menopause, and patients with MS often have cervical and lumbar spondylosis, joint immobility, spasticity, and deconditioning. Baclofen, diazepam, dantrolene, and tizanidine may be effective for pain resulting from spasticity. Phenytoin, carbamazepine, and tricyclic antidepressants can alleviate neuropathic pain and paresthesias. Neurologists also might recommend weight loss or exercise or refer a patient to a pain center for an integrated approach to the condition.

Mood disorders are common among patients with MS, and mood fluctuations may accompany menopause. In response to this problem, a neurologist may recommend psychotherapy to help optimize the patient’s coping abilities. Spousal and interpersonal support also are important for the patient. Antidepressants such as fluoxetine, sertraline, escitalopram, and citalopram can be effective if drug therapy is warranted. Support groups also may help stabilize the patient’s mood.

—Erik Greb

INDIANAPOLIS—Although many women with multiple sclerosis (MS) are perimenopausal, the literature contains few data about effective ways to manage these women’s symptoms, according to research presented at the 2015 CMSC Annual Meeting. The topic could be considered to inhabit an “evidence-free zone,” but general recommendations are possible, according to Riley Bove, MD, Instructor at Harvard Medical School in Boston.

During menopause, women may have vasomotor symptoms such as hot flashes, vascular instability, and rapid heartbeat. For patients with MS, these symptoms may disturb sleep, contribute to fatigue, and affect mood. Vasomotor symptoms also may cause exacerbations. Hormone replacement therapy is the most effective treatment for vasomotor symptoms. In the Women’s Health Initiative Memory Study, however, hormone replacement therapy initiated in women age 65 or older was associated with an increased risk of dementia and cognitive decline. This association should be examined in longitudinal placebo-controlled trials, said Dr. Bove.

Bladder symptoms and sleep apnea are more common during menopause and can cause frequent awakenings, which lead to mood disturbances (eg, depression or anxiety) and relational problems in patients with MS. To improve sleep, neurologists should advise their patients about good sleep hygiene. Patients should stay in bed for only a certain amount of time, use their bed for sleep or intimacy only, schedule regular wake times, and moderate caffeine intake, among other behaviors.

Fatigue is common in MS, and its severity and frequency tend to increase during menopause. Neurologists should rule out additional contributors to fatigue, such as thyroid disease. Patients should be advised to arrange their daily schedule so that work routines are spaced out. They should take intermittent rest breaks and try to concentrate their activity in the morning when it is cooler. Relaxation and meditation practices can reduce stress and decrease fatigue. Drugs such as modafinil and amantadine can promote wakefulness, and methylphenidate can be used as a stimulant.

Pain tolerance may decrease during menopause, and patients with MS often have cervical and lumbar spondylosis, joint immobility, spasticity, and deconditioning. Baclofen, diazepam, dantrolene, and tizanidine may be effective for pain resulting from spasticity. Phenytoin, carbamazepine, and tricyclic antidepressants can alleviate neuropathic pain and paresthesias. Neurologists also might recommend weight loss or exercise or refer a patient to a pain center for an integrated approach to the condition.

Mood disorders are common among patients with MS, and mood fluctuations may accompany menopause. In response to this problem, a neurologist may recommend psychotherapy to help optimize the patient’s coping abilities. Spousal and interpersonal support also are important for the patient. Antidepressants such as fluoxetine, sertraline, escitalopram, and citalopram can be effective if drug therapy is warranted. Support groups also may help stabilize the patient’s mood.

—Erik Greb

INDIANAPOLIS—Early detection of progressive multifocal leukoencephalopathy (PML) may improve outcomes, according to an update presented at the 2015 CMSC Annual Meeting. When PML results from reversible immunosuppression, as in patients with multiple sclerosis (MS) who are receiving monoclonal antibodies, the immediate cessation of the offending agent is recommended.

The pathogenesis of PML is not well understood, but the initial infection may be oropharyngeal or respiratory, said Joseph R. Berger, MD, Professor of Neurology at the Hospital of the University of Pennsylvania in Philadelphia. The infection spreads to sites of latency and may be re-expressed with circulation in B cells before entering the CNS.

As of March 3, 2015, 541 cases of PML have been reported in patients receiving natalizumab. Of these patients, 538 had MS. The patients’ mean duration of treatment with natalizumab was 42 months. Approximately 8% of patients were a-symptomatic at the time of diagnosis. Data have suggested that exposure to John Cunningham virus (JCV), prior immunosuppressive therapy, and longer treatment duration are risk factors for PML.

Since 2013, New England Journal of Medicine has published three case reports of PML in patients receiving dimethyl fumarate. In one of the cases, the drug had been manufactured by a compounding pharmacy. The literature also contains two cases of PML in patients receiving fingolimod.

To date, 160 cases of PML have been reported in patients receiving rituximab, but none of these cases occurred in patients with MS. Almost all cases of PML related to rituximab were in patients with chronic lymphocytic leukemia or other lymphoproliferative diseases. The drug has a black box warning, but the risk of PML for patients receiving this therapy probably is “vanishingly low,” said Dr. Berger.

A total of 57 patients receiving alemtuzumab have developed PML. Fifty-five of these individuals had chronic lymphocytic leukemia, and two developed PML after a lung transplant. Alemtuzumab depletes B cells, which recover in 27 months, and T cells, which recover in 61 months.

Diagnosis of PML depends on neuropathologic demonstration of demyelination, bizarre astrocytes, and enlarged oligodendroglial nuclei. The presence of JCV also must be established by polymerase chain reaction. A two-step Enzyme Linked Immunosorbent Assay can detect JCV antibodies, but it has a significant risk of false seronegativity, said Dr. Berger.

On CT imaging, PML manifests as hypodense lesions and, in less than 10% of cases, as contrast enhancement. PML is visible as hypointense lesions on T1 MRI and as increased signal on T2 MRI and FLAIR. PML is not associated with mass effect on MRI and often affects parieto-occipital and frontal lobes. The condition may affect atypical locations such as the cerebellum, brainstem, basal ganglia, or temporal lobe.

—Erik Greb

INDIANAPOLIS—Early detection of progressive multifocal leukoencephalopathy (PML) may improve outcomes, according to an update presented at the 2015 CMSC Annual Meeting. When PML results from reversible immunosuppression, as in patients with multiple sclerosis (MS) who are receiving monoclonal antibodies, the immediate cessation of the offending agent is recommended.

The pathogenesis of PML is not well understood, but the initial infection may be oropharyngeal or respiratory, said Joseph R. Berger, MD, Professor of Neurology at the Hospital of the University of Pennsylvania in Philadelphia. The infection spreads to sites of latency and may be re-expressed with circulation in B cells before entering the CNS.

As of March 3, 2015, 541 cases of PML have been reported in patients receiving natalizumab. Of these patients, 538 had MS. The patients’ mean duration of treatment with natalizumab was 42 months. Approximately 8% of patients were a-symptomatic at the time of diagnosis. Data have suggested that exposure to John Cunningham virus (JCV), prior immunosuppressive therapy, and longer treatment duration are risk factors for PML.

Since 2013, New England Journal of Medicine has published three case reports of PML in patients receiving dimethyl fumarate. In one of the cases, the drug had been manufactured by a compounding pharmacy. The literature also contains two cases of PML in patients receiving fingolimod.

To date, 160 cases of PML have been reported in patients receiving rituximab, but none of these cases occurred in patients with MS. Almost all cases of PML related to rituximab were in patients with chronic lymphocytic leukemia or other lymphoproliferative diseases. The drug has a black box warning, but the risk of PML for patients receiving this therapy probably is “vanishingly low,” said Dr. Berger.

A total of 57 patients receiving alemtuzumab have developed PML. Fifty-five of these individuals had chronic lymphocytic leukemia, and two developed PML after a lung transplant. Alemtuzumab depletes B cells, which recover in 27 months, and T cells, which recover in 61 months.

Diagnosis of PML depends on neuropathologic demonstration of demyelination, bizarre astrocytes, and enlarged oligodendroglial nuclei. The presence of JCV also must be established by polymerase chain reaction. A two-step Enzyme Linked Immunosorbent Assay can detect JCV antibodies, but it has a significant risk of false seronegativity, said Dr. Berger.

On CT imaging, PML manifests as hypodense lesions and, in less than 10% of cases, as contrast enhancement. PML is visible as hypointense lesions on T1 MRI and as increased signal on T2 MRI and FLAIR. PML is not associated with mass effect on MRI and often affects parieto-occipital and frontal lobes. The condition may affect atypical locations such as the cerebellum, brainstem, basal ganglia, or temporal lobe.

—Erik Greb

INDIANAPOLIS—Early detection of progressive multifocal leukoencephalopathy (PML) may improve outcomes, according to an update presented at the 2015 CMSC Annual Meeting. When PML results from reversible immunosuppression, as in patients with multiple sclerosis (MS) who are receiving monoclonal antibodies, the immediate cessation of the offending agent is recommended.

The pathogenesis of PML is not well understood, but the initial infection may be oropharyngeal or respiratory, said Joseph R. Berger, MD, Professor of Neurology at the Hospital of the University of Pennsylvania in Philadelphia. The infection spreads to sites of latency and may be re-expressed with circulation in B cells before entering the CNS.

As of March 3, 2015, 541 cases of PML have been reported in patients receiving natalizumab. Of these patients, 538 had MS. The patients’ mean duration of treatment with natalizumab was 42 months. Approximately 8% of patients were a-symptomatic at the time of diagnosis. Data have suggested that exposure to John Cunningham virus (JCV), prior immunosuppressive therapy, and longer treatment duration are risk factors for PML.

Since 2013, New England Journal of Medicine has published three case reports of PML in patients receiving dimethyl fumarate. In one of the cases, the drug had been manufactured by a compounding pharmacy. The literature also contains two cases of PML in patients receiving fingolimod.

To date, 160 cases of PML have been reported in patients receiving rituximab, but none of these cases occurred in patients with MS. Almost all cases of PML related to rituximab were in patients with chronic lymphocytic leukemia or other lymphoproliferative diseases. The drug has a black box warning, but the risk of PML for patients receiving this therapy probably is “vanishingly low,” said Dr. Berger.

A total of 57 patients receiving alemtuzumab have developed PML. Fifty-five of these individuals had chronic lymphocytic leukemia, and two developed PML after a lung transplant. Alemtuzumab depletes B cells, which recover in 27 months, and T cells, which recover in 61 months.

Diagnosis of PML depends on neuropathologic demonstration of demyelination, bizarre astrocytes, and enlarged oligodendroglial nuclei. The presence of JCV also must be established by polymerase chain reaction. A two-step Enzyme Linked Immunosorbent Assay can detect JCV antibodies, but it has a significant risk of false seronegativity, said Dr. Berger.

On CT imaging, PML manifests as hypodense lesions and, in less than 10% of cases, as contrast enhancement. PML is visible as hypointense lesions on T1 MRI and as increased signal on T2 MRI and FLAIR. PML is not associated with mass effect on MRI and often affects parieto-occipital and frontal lobes. The condition may affect atypical locations such as the cerebellum, brainstem, basal ganglia, or temporal lobe.

—Erik Greb

INDIANAPOLIS—Smoked cannabis may compromise cognitive function in patients with multiple sclerosis (MS), according to an overview presented at the 2015 Consortium of MS Centers Annual Meeting. Evidence does not support the hypothesis that cannabis affects mood or causes anxiety or psychosis, however. Clinicians should weigh the potentially harmful effects of cannabis on cognition against the drug’s possible benefits for pain, spasticity, and urinary problems.

Between 40% and 70% of people with MS have cognitive dysfunction, which may include deficits in information processing speed, working memory, visuospatial memory, or executive function, said Anthony Feinstein, MD, PhD, Professor of Psychiatry at the University of Toronto. Approximately 40% of patients with MS have used cannabis, and Dr. Feinstein studies the drug’s effects on cognition among patients with MS.

In 2008, he and his colleagues interviewed 140 consecutive patients with MS with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Axis I disorders. The researchers assessed cognition using the Neuropsychological Battery for MS, supplemented with the Symbol Digit Modalities Test (SDMT). When the investigators compared 10 current cannabis users with 40 matched controls with MS, they found that cannabis users had a slower mean performance time on the SDMT and a different pattern of response, compared with the matched controls.

In 2011, Dr. Feinstein and colleagues compared 25 patients with MS who smoked cannabis with 25 patients with MS who did not smoke cannabis. Participants underwent the Minimal Assessment of Cognitive Function in MS battery of neuropsychologic tests, the Hospital Anxiety and Depression Scale (HADS), and the Structured Clinical Interview for the DSM-IV Axis I Disorders. The two patient groups were matched for demographic and disease variables. Cannabis users were more likely to be unemployed than nonusers and also had more cognitive deficits, including in visuospatial perception, executive function, and information processing speed, compared with nonusers. The researchers found no differences between groups in depression or anxiety, however.

Finally, in 2014, Dr. Feinstein and colleagues performed a cross-sectional study of 20 patients with MS who smoked cannabis and 19 patients with MS who did not. Participants underwent fMRI while completing the N-Back test of working memory. Spatial memory and Paced Auditory Serial Addition Test scores were lower among patients who smoked cannabis. These patients also had slowed responses and more errors on the N-Back test, compared with cannabis nonusers. During this test, cannabis users also had increased activation in parietal and anterior cingulate regions implicated in working memory, compared with nonusers.

—Erik Greb

INDIANAPOLIS—Smoked cannabis may compromise cognitive function in patients with multiple sclerosis (MS), according to an overview presented at the 2015 Consortium of MS Centers Annual Meeting. Evidence does not support the hypothesis that cannabis affects mood or causes anxiety or psychosis, however. Clinicians should weigh the potentially harmful effects of cannabis on cognition against the drug’s possible benefits for pain, spasticity, and urinary problems.

Between 40% and 70% of people with MS have cognitive dysfunction, which may include deficits in information processing speed, working memory, visuospatial memory, or executive function, said Anthony Feinstein, MD, PhD, Professor of Psychiatry at the University of Toronto. Approximately 40% of patients with MS have used cannabis, and Dr. Feinstein studies the drug’s effects on cognition among patients with MS.

In 2008, he and his colleagues interviewed 140 consecutive patients with MS with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Axis I disorders. The researchers assessed cognition using the Neuropsychological Battery for MS, supplemented with the Symbol Digit Modalities Test (SDMT). When the investigators compared 10 current cannabis users with 40 matched controls with MS, they found that cannabis users had a slower mean performance time on the SDMT and a different pattern of response, compared with the matched controls.

In 2011, Dr. Feinstein and colleagues compared 25 patients with MS who smoked cannabis with 25 patients with MS who did not smoke cannabis. Participants underwent the Minimal Assessment of Cognitive Function in MS battery of neuropsychologic tests, the Hospital Anxiety and Depression Scale (HADS), and the Structured Clinical Interview for the DSM-IV Axis I Disorders. The two patient groups were matched for demographic and disease variables. Cannabis users were more likely to be unemployed than nonusers and also had more cognitive deficits, including in visuospatial perception, executive function, and information processing speed, compared with nonusers. The researchers found no differences between groups in depression or anxiety, however.

Finally, in 2014, Dr. Feinstein and colleagues performed a cross-sectional study of 20 patients with MS who smoked cannabis and 19 patients with MS who did not. Participants underwent fMRI while completing the N-Back test of working memory. Spatial memory and Paced Auditory Serial Addition Test scores were lower among patients who smoked cannabis. These patients also had slowed responses and more errors on the N-Back test, compared with cannabis nonusers. During this test, cannabis users also had increased activation in parietal and anterior cingulate regions implicated in working memory, compared with nonusers.

—Erik Greb

INDIANAPOLIS—Smoked cannabis may compromise cognitive function in patients with multiple sclerosis (MS), according to an overview presented at the 2015 Consortium of MS Centers Annual Meeting. Evidence does not support the hypothesis that cannabis affects mood or causes anxiety or psychosis, however. Clinicians should weigh the potentially harmful effects of cannabis on cognition against the drug’s possible benefits for pain, spasticity, and urinary problems.

Between 40% and 70% of people with MS have cognitive dysfunction, which may include deficits in information processing speed, working memory, visuospatial memory, or executive function, said Anthony Feinstein, MD, PhD, Professor of Psychiatry at the University of Toronto. Approximately 40% of patients with MS have used cannabis, and Dr. Feinstein studies the drug’s effects on cognition among patients with MS.

In 2008, he and his colleagues interviewed 140 consecutive patients with MS with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Axis I disorders. The researchers assessed cognition using the Neuropsychological Battery for MS, supplemented with the Symbol Digit Modalities Test (SDMT). When the investigators compared 10 current cannabis users with 40 matched controls with MS, they found that cannabis users had a slower mean performance time on the SDMT and a different pattern of response, compared with the matched controls.

In 2011, Dr. Feinstein and colleagues compared 25 patients with MS who smoked cannabis with 25 patients with MS who did not smoke cannabis. Participants underwent the Minimal Assessment of Cognitive Function in MS battery of neuropsychologic tests, the Hospital Anxiety and Depression Scale (HADS), and the Structured Clinical Interview for the DSM-IV Axis I Disorders. The two patient groups were matched for demographic and disease variables. Cannabis users were more likely to be unemployed than nonusers and also had more cognitive deficits, including in visuospatial perception, executive function, and information processing speed, compared with nonusers. The researchers found no differences between groups in depression or anxiety, however.

Finally, in 2014, Dr. Feinstein and colleagues performed a cross-sectional study of 20 patients with MS who smoked cannabis and 19 patients with MS who did not. Participants underwent fMRI while completing the N-Back test of working memory. Spatial memory and Paced Auditory Serial Addition Test scores were lower among patients who smoked cannabis. These patients also had slowed responses and more errors on the N-Back test, compared with cannabis nonusers. During this test, cannabis users also had increased activation in parietal and anterior cingulate regions implicated in working memory, compared with nonusers.

—Erik Greb