Improving Sleep among Adults with Multiple Sclerosis using Mindfulness plus Sleep Education.

We explored the feasibility of a mindfulness plus sleep education intervention, SleepWell!, delivered via videoconference compared to onsite among adults with MS. A non-randomized wait-list control design was used. Participants wore actigraphy watches and kept sleep diaries for seven days pre- and post intervention. Questionnaires were completed pre-intervention, post-intervention, and three months post-intervention. One group was conducted onsite. Three groups participated via videoconference. Attrition among videoconference groups was 23% compared to 57% in the onsite group. Within group analysis showed moderate-to-large effect sizes on sleep efficiency (d=0.78) and total sleep time (d=0.54) in the videoconference groups. One-way repeated measures ANOVA post-hoc analysis suggested small-to-medium effect over three months on sleep quality (ηp2 =0.28), physical health quality of life (ηp2 =0.42), mental health quality of life (ηp2 =0.13), and mindfulness (ηp2 =0.29). Results indicate feasibility of providing our intervention via videoconferencing. Preliminary analysis suggests that SleepWell! improves sleep and mindfulness among adults with MS.

Rituximab-induced serum sickness in multiple sclerosis patients.

Rituximab is a chimeric anti-CD20 monoclonal antibody that is an effective therapy for multiple sclerosis. Rituximab has been associated with the development of serum sickness (type III hypersensitivity) characterized by arthralgia, fever, and rash during the treatment of other conditions, such as rheumatoid arthritis. Here we describe serum sickness associated with rituximab in multiple sclerosis patients and discuss both the management of serum sickness itself and implications for utilizing alternative anti-CD20 monoclonal antibodies for disease management in this patient population.

Efficacy and tolerability of dimethyl fumarate in White-, African- and Hispanic- Americans with multiple sclerosis.

BACKGROUND: Dimethyl fumarate (DMF) was approved by the US Food and Drug Administration (FDA) for treatment of relapsing-remitting multiple sclerosis (RRMS) based on two phase III randomized clinical trials (RCTs). There were not enough non-White patients enrolled in these RCTs to allow for subgroup analysis based on race. Efficacy and tolerability of DMF therapy across various racial groups is unknown. METHODS: Retrospective chart review was performed on all patients with RRMS who were started on DMF in two tertiary multiple sclerosis (MS) clinics. Efficacy and tolerability of DMF was compared across three self-identified racial groups: White-American (WA), African-American (AA) and Hispanic-American (HA). RESULTS: A total of 390 RRMS patients were included in the study: 261 (66.9%) WA, 69 (17.7%) AA and 52 (13.3%) HA. When comparing 'pre-DMF' (1 year) and 'on DMF' (mean follow up of 14 months) periods, statistically significant reduction in rates of annualized relapses (WA from 0.44 to 0.19, AA from 0.39 to 0.15, and HA from 0.39 to 0.14; no differences between groups), new T2 lesions (WA from 45% to 23%, AA from 39% to 23%, HA from 52% to 26%; no difference between groups), and Gd+ lesions (WA from 25% to 13%, AA from 24% to 7%, HA from 23% to 12%; no difference between groups) were seen. DMF was relatively well tolerated across all groups, with an overall discontinuation rate of 20% (no difference between the three groups). CONCLUSION: Efficacy of DMF in our clinic population did not differ across three major ethnic groups, WA, AA and HA, and was comparable with results observed in the pivotal studies. These 'real-life' data suggest that race is not a factor that needs to be taken into account when initiating DMF.

Clinically isolated syndrome and multiple sclerosis: rethinking the arsenal.

Until the end of the past century, a diagnosis of multiple sclerosis (MS) was often accompanied by a sense of apprehension, fueled primarily by the lack of available therapies and failed attempts with numerous agents. The modern era of MS therapeutics introduced in the past 20 years has helped to assuage the previous belief that little could be done to treat MS. The advent of disease-modifying treatments such as interferons and glatiramer acetate has had a notable impact on the course of MS. Numerous trials have demonstrated the clear benefit of initiating therapy in patients with a diagnosis of MS, but more importantly, they have shown that early initiation of treatment can delay progression to clinically definite MS in patients with clinically isolated syndrome who have concurrent changes on MRI. As newer agents become available, trials to assess their efficacy and tolerability are under way in an effort to expand the arsenal of available treatments. However, questions constantly resurface about the effect of treatments on disability, the safety of combination therapies, the role in neuroprotection, and other aspects. Moreover, recent attention regarding a radiologic and clinical dissociation, best illustrated by the anecdotally termed "radiologically isolated syndrome," highlights the frustrations facing clinicians when they try to predict disease course and the role of medications, if any.Despite the need for clear answers to these questions, the current practice is to initiate the available treatments early in patients with relapsing-remitting multiple sclerosis, in order to reduce the severity and frequency of clinical relapses. Treatment should also be initiated early in patients with clinically isolated syndrome because they are at high risk for developing clinically definite multiple sclerosis.