ICYMI Multiple Sclerosis

The Consortium of Multiple Sclerosis Centers (CMSC) Task Force has updated its standardized MRI protocol and clinical guidelines for the diagnosis and follow-up of MS. The revision to the 2006 MRI protocols include the following changes:

• an emphasis on 3D sequences of brain MRI

• a specific monitoring protocol for progressive multifocal leukoencephalopathy (PML)

• an optional orbit MRI protocol for severe optic neuritis

Key changes to the 2006 clinical guidelines include:

• specific timing for using brain MRIs to monitor response to disease-modifying therapies

• timing of brain MRIs for PML surveillance

• inclusion of radiologic isolated syndrome

The updated guidelines also include new evidence regarding the value of MRI changes in determining treatment effectiveness.

Citation: 2015 Revised CMSC MRI Protocol and Guidelines. CMSC website. http://c.ymcdn.com/sites/www.mscare.org/resource/collection/9C5F19B9-3489-48B0-A54B-623A1ECEE07B/MRIprotocol2015.pdf. Updated April 2015. Accessed April 10, 2015.

The Consortium of Multiple Sclerosis Centers (CMSC) Task Force has updated its standardized MRI protocol and clinical guidelines for the diagnosis and follow-up of MS. The revision to the 2006 MRI protocols include the following changes:

• an emphasis on 3D sequences of brain MRI

• a specific monitoring protocol for progressive multifocal leukoencephalopathy (PML)

• an optional orbit MRI protocol for severe optic neuritis

Key changes to the 2006 clinical guidelines include:

• specific timing for using brain MRIs to monitor response to disease-modifying therapies

• timing of brain MRIs for PML surveillance

• inclusion of radiologic isolated syndrome

The updated guidelines also include new evidence regarding the value of MRI changes in determining treatment effectiveness.

Citation: 2015 Revised CMSC MRI Protocol and Guidelines. CMSC website. http://c.ymcdn.com/sites/www.mscare.org/resource/collection/9C5F19B9-3489-48B0-A54B-623A1ECEE07B/MRIprotocol2015.pdf. Updated April 2015. Accessed April 10, 2015.

The Consortium of Multiple Sclerosis Centers (CMSC) Task Force has updated its standardized MRI protocol and clinical guidelines for the diagnosis and follow-up of MS. The revision to the 2006 MRI protocols include the following changes:

• an emphasis on 3D sequences of brain MRI

• a specific monitoring protocol for progressive multifocal leukoencephalopathy (PML)

• an optional orbit MRI protocol for severe optic neuritis

Key changes to the 2006 clinical guidelines include:

• specific timing for using brain MRIs to monitor response to disease-modifying therapies

• timing of brain MRIs for PML surveillance

• inclusion of radiologic isolated syndrome

The updated guidelines also include new evidence regarding the value of MRI changes in determining treatment effectiveness.

Citation: 2015 Revised CMSC MRI Protocol and Guidelines. CMSC website. http://c.ymcdn.com/sites/www.mscare.org/resource/collection/9C5F19B9-3489-48B0-A54B-623A1ECEE07B/MRIprotocol2015.pdf. Updated April 2015. Accessed April 10, 2015.

A biomarker of Epstein-Barr virus, infectious mononucleosis, and smoking are environmental factors associated with multiple sclerosis (MS) that have the strongest consistent evidence, according to an umbrella review of 44 meta-analyses.

The review included 416 primary studies of different risk factors and MS, including vaccinations, comorbidities, surgeries, environmental agents, and biomarkers. Of those, only 3 had strong enough sample sizes to make consistent associations:

• IgG seropositivity for Epstein-Barr virus nuclear antigen (EBNA) (odds ratio [OR], 4.46)

• infectious mononucleosis (OR, 2.17)

• smoking (OR, 1.52)

The study authors conclude that more data from better-designed studies are needed to establish robust associations.

Citation: Belbasis L, Bellou V, Evangelou E, Ioannidis JP, Tzoulaki I. Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. Lancet Neurol. 2015;14(3):263-273. doi: 10.1016/S1474-4422(14)70267-4.

A biomarker of Epstein-Barr virus, infectious mononucleosis, and smoking are environmental factors associated with multiple sclerosis (MS) that have the strongest consistent evidence, according to an umbrella review of 44 meta-analyses.

The review included 416 primary studies of different risk factors and MS, including vaccinations, comorbidities, surgeries, environmental agents, and biomarkers. Of those, only 3 had strong enough sample sizes to make consistent associations:

• IgG seropositivity for Epstein-Barr virus nuclear antigen (EBNA) (odds ratio [OR], 4.46)

• infectious mononucleosis (OR, 2.17)

• smoking (OR, 1.52)

The study authors conclude that more data from better-designed studies are needed to establish robust associations.

Citation: Belbasis L, Bellou V, Evangelou E, Ioannidis JP, Tzoulaki I. Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. Lancet Neurol. 2015;14(3):263-273. doi: 10.1016/S1474-4422(14)70267-4.

A biomarker of Epstein-Barr virus, infectious mononucleosis, and smoking are environmental factors associated with multiple sclerosis (MS) that have the strongest consistent evidence, according to an umbrella review of 44 meta-analyses.

The review included 416 primary studies of different risk factors and MS, including vaccinations, comorbidities, surgeries, environmental agents, and biomarkers. Of those, only 3 had strong enough sample sizes to make consistent associations:

• IgG seropositivity for Epstein-Barr virus nuclear antigen (EBNA) (odds ratio [OR], 4.46)

• infectious mononucleosis (OR, 2.17)

• smoking (OR, 1.52)

The study authors conclude that more data from better-designed studies are needed to establish robust associations.

Citation: Belbasis L, Bellou V, Evangelou E, Ioannidis JP, Tzoulaki I. Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. Lancet Neurol. 2015;14(3):263-273. doi: 10.1016/S1474-4422(14)70267-4.

Psychiatric comorbidity, particularly depression and anxiety, is common in multiple sclerosis. A systematic review of 118 studies found the prevalence of psychiatric disorders as follows:

• depression, 23%

• anxiety, 22%

• alcohol abuse, 15%

• bipolar disorder, 6%

• psychosis, 4%

• substance abuse, 3%

The study authors note that developing a consistent approach to measuring psychiatric comorbidity would enhance future studies.

Citation: Marrie RA, Reingold S, Cohen J, et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: A systematic review. Mult Scler. 2015;21(3):305-317.

Commentary: Multiple sclerosis disease impact is classically gauged by physical disability characterized by neurological examination findings from EDSS. White matter disconnection impacts more than just walking, coordination, and vision, however. This very important review clearly demonstrates the high incidence of psychiatric disorders — specifically anxiety and depression — in patients with MS, not only at presentation but the increasing incidence over time. Mood can impact reported fatigue, employment, quality of life, and adherence to medications. The MS clinician no longer can entirely focus on relapse and MRI, but must evaluate and address mood-related problems in MS care to provide quality care and effective intervention of not only symptoms but long-term disease management as well.   –Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, NY

Psychiatric comorbidity, particularly depression and anxiety, is common in multiple sclerosis. A systematic review of 118 studies found the prevalence of psychiatric disorders as follows:

• depression, 23%

• anxiety, 22%

• alcohol abuse, 15%

• bipolar disorder, 6%

• psychosis, 4%

• substance abuse, 3%

The study authors note that developing a consistent approach to measuring psychiatric comorbidity would enhance future studies.

Citation: Marrie RA, Reingold S, Cohen J, et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: A systematic review. Mult Scler. 2015;21(3):305-317.

Commentary: Multiple sclerosis disease impact is classically gauged by physical disability characterized by neurological examination findings from EDSS. White matter disconnection impacts more than just walking, coordination, and vision, however. This very important review clearly demonstrates the high incidence of psychiatric disorders — specifically anxiety and depression — in patients with MS, not only at presentation but the increasing incidence over time. Mood can impact reported fatigue, employment, quality of life, and adherence to medications. The MS clinician no longer can entirely focus on relapse and MRI, but must evaluate and address mood-related problems in MS care to provide quality care and effective intervention of not only symptoms but long-term disease management as well.   –Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, NY

Psychiatric comorbidity, particularly depression and anxiety, is common in multiple sclerosis. A systematic review of 118 studies found the prevalence of psychiatric disorders as follows:

• depression, 23%

• anxiety, 22%

• alcohol abuse, 15%

• bipolar disorder, 6%

• psychosis, 4%

• substance abuse, 3%

The study authors note that developing a consistent approach to measuring psychiatric comorbidity would enhance future studies.

Citation: Marrie RA, Reingold S, Cohen J, et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: A systematic review. Mult Scler. 2015;21(3):305-317.

Commentary: Multiple sclerosis disease impact is classically gauged by physical disability characterized by neurological examination findings from EDSS. White matter disconnection impacts more than just walking, coordination, and vision, however. This very important review clearly demonstrates the high incidence of psychiatric disorders — specifically anxiety and depression — in patients with MS, not only at presentation but the increasing incidence over time. Mood can impact reported fatigue, employment, quality of life, and adherence to medications. The MS clinician no longer can entirely focus on relapse and MRI, but must evaluate and address mood-related problems in MS care to provide quality care and effective intervention of not only symptoms but long-term disease management as well.   –Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, NY

Comorbidity with multiple sclerosis can impact diagnosis, disability progression, and quality of life, but there are substantial gaps in epidemiological knowledge of comorbidities, according to a systematic review of 249 studies that found a wide variability in study designs and reporting.

Researchers quantitatively assessed population-based studies and found:

• The 5 most prevalent comorbidities were depression, anxiety, hypertension, hyperlipidemia, and chronic lung disease.

• The most prevalent autoimmune diseases were thyroid disease and psoriasis.

• The most prevalent cancers were cervical, breast, and digestive system cancers.

Citation: Marrie RA, Cohen J, Stuve O, et al. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview. Mult Scler. 2015;21(3):263-281.

Comorbidity with multiple sclerosis can impact diagnosis, disability progression, and quality of life, but there are substantial gaps in epidemiological knowledge of comorbidities, according to a systematic review of 249 studies that found a wide variability in study designs and reporting.

Researchers quantitatively assessed population-based studies and found:

• The 5 most prevalent comorbidities were depression, anxiety, hypertension, hyperlipidemia, and chronic lung disease.

• The most prevalent autoimmune diseases were thyroid disease and psoriasis.

• The most prevalent cancers were cervical, breast, and digestive system cancers.

Citation: Marrie RA, Cohen J, Stuve O, et al. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview. Mult Scler. 2015;21(3):263-281.

Comorbidity with multiple sclerosis can impact diagnosis, disability progression, and quality of life, but there are substantial gaps in epidemiological knowledge of comorbidities, according to a systematic review of 249 studies that found a wide variability in study designs and reporting.

Researchers quantitatively assessed population-based studies and found:

• The 5 most prevalent comorbidities were depression, anxiety, hypertension, hyperlipidemia, and chronic lung disease.

• The most prevalent autoimmune diseases were thyroid disease and psoriasis.

• The most prevalent cancers were cervical, breast, and digestive system cancers.

Citation: Marrie RA, Cohen J, Stuve O, et al. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview. Mult Scler. 2015;21(3):263-281.

Several factors associated with worsening in timed 25-foot walk (T25FW) scores and other clinical indicators may be used to predict clinically significant change in patients with multiple sclerosis, according to an analysis of 1,544 patients.

Investigators reviewed patients who experienced a 20% or greater worsening in T25FW, and found the following factors related to disease progression:

• lower baseline Multiple Sclerosis Performance Scales (MSPS) scores

• sex, baseline T25FW, and time since diagnosis

• Patient Health Questionaire-9 (PHQ9) scores

The disease course time to worsening was significantly shorter for secondary progressive compared to relapsing-remitting disease.

Citation: Miller DM, Thompson NR, Cohen JA, et al. Factors associated with clinically significant increased walking time in multiple sclerosis: results of a survival analysis of short-term follow-up data from a clinical database. Mult Scler. 2015;21(4):457-465. doi: 10.1177/1352458514544536.

Several factors associated with worsening in timed 25-foot walk (T25FW) scores and other clinical indicators may be used to predict clinically significant change in patients with multiple sclerosis, according to an analysis of 1,544 patients.

Investigators reviewed patients who experienced a 20% or greater worsening in T25FW, and found the following factors related to disease progression:

• lower baseline Multiple Sclerosis Performance Scales (MSPS) scores

• sex, baseline T25FW, and time since diagnosis

• Patient Health Questionaire-9 (PHQ9) scores

The disease course time to worsening was significantly shorter for secondary progressive compared to relapsing-remitting disease.

Citation: Miller DM, Thompson NR, Cohen JA, et al. Factors associated with clinically significant increased walking time in multiple sclerosis: results of a survival analysis of short-term follow-up data from a clinical database. Mult Scler. 2015;21(4):457-465. doi: 10.1177/1352458514544536.

Several factors associated with worsening in timed 25-foot walk (T25FW) scores and other clinical indicators may be used to predict clinically significant change in patients with multiple sclerosis, according to an analysis of 1,544 patients.

Investigators reviewed patients who experienced a 20% or greater worsening in T25FW, and found the following factors related to disease progression:

• lower baseline Multiple Sclerosis Performance Scales (MSPS) scores

• sex, baseline T25FW, and time since diagnosis

• Patient Health Questionaire-9 (PHQ9) scores

The disease course time to worsening was significantly shorter for secondary progressive compared to relapsing-remitting disease.

Citation: Miller DM, Thompson NR, Cohen JA, et al. Factors associated with clinically significant increased walking time in multiple sclerosis: results of a survival analysis of short-term follow-up data from a clinical database. Mult Scler. 2015;21(4):457-465. doi: 10.1177/1352458514544536.

WASHINGTON, DC—Women with multiple sclerosis (MS) may have lower levels of important antioxidant and anti-inflammatory nutrients, such as folate from food and vitamin E, than healthy people, according to a study presented at the American Academy of Neurology’s 67th Annual Meeting.

For the study, researchers identified 27 Caucasian women with MS and compared them to 30 healthy Caucasian women between the ages of 18 and 60 and with BMI of less than or equal to 30 kg/m2. Participants reported on their diet and nutrition over the previous year prior to starting vitamin D supplementation.

On average, the women who had MS had lower levels of the following five nutrients with antioxidant or anti-inflammatory properties: food folate, vitamin E, magnesium, lutein-zeaxanthin, and quercetin. For food folate, the women with MS had average intake of 244 mg, while the healthy women had an average intake of 321 mg. The recommended daily allowance is 400 mg.

For magnesium, the women with MS had average intake of 254 mg, while the healthy women met the recommended daily allowance of 320 mg with an average of 321 mg. The women with MS also had a lower average percentage of their calories from fat than the healthy participants.

“Since MS is a chronic inflammatory disorder, having enough nutrients with anti-inflammatory properties may help prevent the disease or reduce the risk of attacks for those who already have MS,” said study author Sandra D. Cassard, ScD, of Johns Hopkins University in Baltimore. “Antioxidants are also critical to good health and help reduce the effects of other types of damage that can occur on a cellular level and contribute to neurologic diseases like MS. Whether the nutritional differences that we identified in the study are a cause of MS or a result of having it is not yet clear.”

The study was supported by the National Institute of Neurological Disorders and Stroke.

WASHINGTON, DC—Women with multiple sclerosis (MS) may have lower levels of important antioxidant and anti-inflammatory nutrients, such as folate from food and vitamin E, than healthy people, according to a study presented at the American Academy of Neurology’s 67th Annual Meeting.

For the study, researchers identified 27 Caucasian women with MS and compared them to 30 healthy Caucasian women between the ages of 18 and 60 and with BMI of less than or equal to 30 kg/m2. Participants reported on their diet and nutrition over the previous year prior to starting vitamin D supplementation.

On average, the women who had MS had lower levels of the following five nutrients with antioxidant or anti-inflammatory properties: food folate, vitamin E, magnesium, lutein-zeaxanthin, and quercetin. For food folate, the women with MS had average intake of 244 mg, while the healthy women had an average intake of 321 mg. The recommended daily allowance is 400 mg.

For magnesium, the women with MS had average intake of 254 mg, while the healthy women met the recommended daily allowance of 320 mg with an average of 321 mg. The women with MS also had a lower average percentage of their calories from fat than the healthy participants.

“Since MS is a chronic inflammatory disorder, having enough nutrients with anti-inflammatory properties may help prevent the disease or reduce the risk of attacks for those who already have MS,” said study author Sandra D. Cassard, ScD, of Johns Hopkins University in Baltimore. “Antioxidants are also critical to good health and help reduce the effects of other types of damage that can occur on a cellular level and contribute to neurologic diseases like MS. Whether the nutritional differences that we identified in the study are a cause of MS or a result of having it is not yet clear.”

The study was supported by the National Institute of Neurological Disorders and Stroke.

WASHINGTON, DC—Women with multiple sclerosis (MS) may have lower levels of important antioxidant and anti-inflammatory nutrients, such as folate from food and vitamin E, than healthy people, according to a study presented at the American Academy of Neurology’s 67th Annual Meeting.

For the study, researchers identified 27 Caucasian women with MS and compared them to 30 healthy Caucasian women between the ages of 18 and 60 and with BMI of less than or equal to 30 kg/m2. Participants reported on their diet and nutrition over the previous year prior to starting vitamin D supplementation.

On average, the women who had MS had lower levels of the following five nutrients with antioxidant or anti-inflammatory properties: food folate, vitamin E, magnesium, lutein-zeaxanthin, and quercetin. For food folate, the women with MS had average intake of 244 mg, while the healthy women had an average intake of 321 mg. The recommended daily allowance is 400 mg.

For magnesium, the women with MS had average intake of 254 mg, while the healthy women met the recommended daily allowance of 320 mg with an average of 321 mg. The women with MS also had a lower average percentage of their calories from fat than the healthy participants.

“Since MS is a chronic inflammatory disorder, having enough nutrients with anti-inflammatory properties may help prevent the disease or reduce the risk of attacks for those who already have MS,” said study author Sandra D. Cassard, ScD, of Johns Hopkins University in Baltimore. “Antioxidants are also critical to good health and help reduce the effects of other types of damage that can occur on a cellular level and contribute to neurologic diseases like MS. Whether the nutritional differences that we identified in the study are a cause of MS or a result of having it is not yet clear.”

The study was supported by the National Institute of Neurological Disorders and Stroke.

Using computerized cognitive training can help to improve processing speed and working memory in patients with multiple sclerosis, according to a pilot study.

Investigators randomized subjects into 6 weeks of training in either an active or sham group, and found the active training group improved on measures of processing speed and attention, with significant improvements on measures of other domains.

The study authors noted the results provide preliminary evidence that cognitive training in multiple sclerosis patients may produce moderate improvements in select areas of cognitive functioning.

Citation: Hancock LM, Bruce JM, Bruce AS, Lynch SG. Processing speed and working memory training in multiple sclerosis: a double-blind randomized controlled pilot study. J Clin Exp Neuropsychol. 2015:1-15.

Commentary: Cognitive impairment in MS is common and can impact employment, driving, and quality of life. So often treatments require costly medications and expensive treatments. The few clinical trials to evaluate medications to improve memory in patients with MS have not demonstrated great efficacy. Information processing speed and attention are 2 cognitive domains commonly affected in MS. Computerized cognitive training might be a great opportunity and option to provide an effective treatment approach for those impacted and be delivered in a manner that could be inexpensive, easily made available, and accessible. This pilot study might provide great promise for those in need. —Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, NY.

Using computerized cognitive training can help to improve processing speed and working memory in patients with multiple sclerosis, according to a pilot study.

Investigators randomized subjects into 6 weeks of training in either an active or sham group, and found the active training group improved on measures of processing speed and attention, with significant improvements on measures of other domains.

The study authors noted the results provide preliminary evidence that cognitive training in multiple sclerosis patients may produce moderate improvements in select areas of cognitive functioning.

Citation: Hancock LM, Bruce JM, Bruce AS, Lynch SG. Processing speed and working memory training in multiple sclerosis: a double-blind randomized controlled pilot study. J Clin Exp Neuropsychol. 2015:1-15.

Commentary: Cognitive impairment in MS is common and can impact employment, driving, and quality of life. So often treatments require costly medications and expensive treatments. The few clinical trials to evaluate medications to improve memory in patients with MS have not demonstrated great efficacy. Information processing speed and attention are 2 cognitive domains commonly affected in MS. Computerized cognitive training might be a great opportunity and option to provide an effective treatment approach for those impacted and be delivered in a manner that could be inexpensive, easily made available, and accessible. This pilot study might provide great promise for those in need. —Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, NY.

Using computerized cognitive training can help to improve processing speed and working memory in patients with multiple sclerosis, according to a pilot study.

Investigators randomized subjects into 6 weeks of training in either an active or sham group, and found the active training group improved on measures of processing speed and attention, with significant improvements on measures of other domains.

The study authors noted the results provide preliminary evidence that cognitive training in multiple sclerosis patients may produce moderate improvements in select areas of cognitive functioning.

Citation: Hancock LM, Bruce JM, Bruce AS, Lynch SG. Processing speed and working memory training in multiple sclerosis: a double-blind randomized controlled pilot study. J Clin Exp Neuropsychol. 2015:1-15.

Commentary: Cognitive impairment in MS is common and can impact employment, driving, and quality of life. So often treatments require costly medications and expensive treatments. The few clinical trials to evaluate medications to improve memory in patients with MS have not demonstrated great efficacy. Information processing speed and attention are 2 cognitive domains commonly affected in MS. Computerized cognitive training might be a great opportunity and option to provide an effective treatment approach for those impacted and be delivered in a manner that could be inexpensive, easily made available, and accessible. This pilot study might provide great promise for those in need. —Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, NY.

Postmenopausal patients with multiple sclerosis report worsening disease severity on the Multiple Sclerosis Rating Scale (MSRS), according to an online cohort study on the PatientsLikeMe (PLM) platform.

Participants filled out a detailed reproductive history survey and linked to PLM’s prospectively collected patient-reported severity score. Of the 513 respondents:

• 55% were post-menopausal

• 54% of post-menopausal respondents reported induced menopause and were more likely to be treated with hormone replacement therapy

• median age at natural menopause was 51

Postmenopausal status, surgical menopause, and earlier age at menopause were associated with worse MSRS scores.

Citation: Bove R, Healy BC, Secor E, et al. Patients report worse MS symptoms after menopause: findings from an online cohort. Mult Scler Relat Disord. 2015;4(1):18-24. doi: 10.1016/j.msard.2014.11.009.

Postmenopausal patients with multiple sclerosis report worsening disease severity on the Multiple Sclerosis Rating Scale (MSRS), according to an online cohort study on the PatientsLikeMe (PLM) platform.

Participants filled out a detailed reproductive history survey and linked to PLM’s prospectively collected patient-reported severity score. Of the 513 respondents:

• 55% were post-menopausal

• 54% of post-menopausal respondents reported induced menopause and were more likely to be treated with hormone replacement therapy

• median age at natural menopause was 51

Postmenopausal status, surgical menopause, and earlier age at menopause were associated with worse MSRS scores.

Citation: Bove R, Healy BC, Secor E, et al. Patients report worse MS symptoms after menopause: findings from an online cohort. Mult Scler Relat Disord. 2015;4(1):18-24. doi: 10.1016/j.msard.2014.11.009.

Postmenopausal patients with multiple sclerosis report worsening disease severity on the Multiple Sclerosis Rating Scale (MSRS), according to an online cohort study on the PatientsLikeMe (PLM) platform.

Participants filled out a detailed reproductive history survey and linked to PLM’s prospectively collected patient-reported severity score. Of the 513 respondents:

• 55% were post-menopausal

• 54% of post-menopausal respondents reported induced menopause and were more likely to be treated with hormone replacement therapy

• median age at natural menopause was 51

Postmenopausal status, surgical menopause, and earlier age at menopause were associated with worse MSRS scores.

Citation: Bove R, Healy BC, Secor E, et al. Patients report worse MS symptoms after menopause: findings from an online cohort. Mult Scler Relat Disord. 2015;4(1):18-24. doi: 10.1016/j.msard.2014.11.009.

A biosocial approach including psychoeducational wellness programs for treating patients with multiple sclerosis may help to improve a patient’s overall quality of life and well-being, according to a 10-week study of the group sessions.

At baseline, 54 MS patients completed a series of self-reported questionnaires, then either attended 10, 90-minute weekly psychoeducational wellness group sessions or no interventions. The intervention was aimed at improving patients’ awareness of social, intellectual, emotional, and spiritual factors that can affect their overall well-being.

After 10 weeks study, subjects repeated the questionnaire and showed improvements in depression, anxiety, overall mental health, perceived stress, and pain, compared to the controls. No significant improvements were noted regarding social support, cognitive complaints, or fatigue.

Citation: McGuire KB, Stojanovic-Radic J, Strober L, Chiaravalloti ND, DeLuca J. Development and effectiveness of a psychoeducational wellness program for people with multiple sclerosis: description and outcomes. Int J MS Care. 2015;17(1):1-8. doi: 10.7224/1537-2073.2013-045.

A biosocial approach including psychoeducational wellness programs for treating patients with multiple sclerosis may help to improve a patient’s overall quality of life and well-being, according to a 10-week study of the group sessions.

At baseline, 54 MS patients completed a series of self-reported questionnaires, then either attended 10, 90-minute weekly psychoeducational wellness group sessions or no interventions. The intervention was aimed at improving patients’ awareness of social, intellectual, emotional, and spiritual factors that can affect their overall well-being.

After 10 weeks study, subjects repeated the questionnaire and showed improvements in depression, anxiety, overall mental health, perceived stress, and pain, compared to the controls. No significant improvements were noted regarding social support, cognitive complaints, or fatigue.

Citation: McGuire KB, Stojanovic-Radic J, Strober L, Chiaravalloti ND, DeLuca J. Development and effectiveness of a psychoeducational wellness program for people with multiple sclerosis: description and outcomes. Int J MS Care. 2015;17(1):1-8. doi: 10.7224/1537-2073.2013-045.

A biosocial approach including psychoeducational wellness programs for treating patients with multiple sclerosis may help to improve a patient’s overall quality of life and well-being, according to a 10-week study of the group sessions.

At baseline, 54 MS patients completed a series of self-reported questionnaires, then either attended 10, 90-minute weekly psychoeducational wellness group sessions or no interventions. The intervention was aimed at improving patients’ awareness of social, intellectual, emotional, and spiritual factors that can affect their overall well-being.

After 10 weeks study, subjects repeated the questionnaire and showed improvements in depression, anxiety, overall mental health, perceived stress, and pain, compared to the controls. No significant improvements were noted regarding social support, cognitive complaints, or fatigue.

Citation: McGuire KB, Stojanovic-Radic J, Strober L, Chiaravalloti ND, DeLuca J. Development and effectiveness of a psychoeducational wellness program for people with multiple sclerosis: description and outcomes. Int J MS Care. 2015;17(1):1-8. doi: 10.7224/1537-2073.2013-045.

Lower urinary tract symptoms (LUTS) are common among patients with multiple sclerosis, however they remain largely untreated, according to an online, cross-sectional survey of 1,052 individuals with MS.

One or more lower urinary tract symptoms were present in 92% of subjects with the most common as follows:

• Post-micturition dribble (64.9%)

• Urinary urgency (61.7%)

• Feeling of incomplete emptying (60.7%)

• Some type of UTI (79%)

Of those with symptoms, 70% previously discussed it with a health care provider, however, only 32% had seen a health care provider in the past year. Patients were more likely to seek treatment for urgency, intermittent urine stream, and urgency urinary incontinence.

Citation: Khalaf KM, Coyne KS, Globe DR, Armstrong EP, Malone DC, Burks J. Lower urinary tract symptom prevalence and management among patients with multiple sclerosis. Int J MS Care. 2015;17(1):14-25. doi: 10.7224/1537-2073.2013-040.

Lower urinary tract symptoms (LUTS) are common among patients with multiple sclerosis, however they remain largely untreated, according to an online, cross-sectional survey of 1,052 individuals with MS.

One or more lower urinary tract symptoms were present in 92% of subjects with the most common as follows:

• Post-micturition dribble (64.9%)

• Urinary urgency (61.7%)

• Feeling of incomplete emptying (60.7%)

• Some type of UTI (79%)

Of those with symptoms, 70% previously discussed it with a health care provider, however, only 32% had seen a health care provider in the past year. Patients were more likely to seek treatment for urgency, intermittent urine stream, and urgency urinary incontinence.

Citation: Khalaf KM, Coyne KS, Globe DR, Armstrong EP, Malone DC, Burks J. Lower urinary tract symptom prevalence and management among patients with multiple sclerosis. Int J MS Care. 2015;17(1):14-25. doi: 10.7224/1537-2073.2013-040.

Lower urinary tract symptoms (LUTS) are common among patients with multiple sclerosis, however they remain largely untreated, according to an online, cross-sectional survey of 1,052 individuals with MS.

One or more lower urinary tract symptoms were present in 92% of subjects with the most common as follows:

• Post-micturition dribble (64.9%)

• Urinary urgency (61.7%)

• Feeling of incomplete emptying (60.7%)

• Some type of UTI (79%)

Of those with symptoms, 70% previously discussed it with a health care provider, however, only 32% had seen a health care provider in the past year. Patients were more likely to seek treatment for urgency, intermittent urine stream, and urgency urinary incontinence.

Citation: Khalaf KM, Coyne KS, Globe DR, Armstrong EP, Malone DC, Burks J. Lower urinary tract symptom prevalence and management among patients with multiple sclerosis. Int J MS Care. 2015;17(1):14-25. doi: 10.7224/1537-2073.2013-040.