Investigating the potential disease-modifying and neuroprotective efficacy of exercise therapy early in the disease course of multiple sclerosis: The Early Multiple Sclerosis Exercise Study (EMSES).

BACKGROUND: Potential supplemental disease-modifying and neuroprotective treatment strategies are warranted in multiple sclerosis (MS). Exercise is a promising non-pharmacological approach, and an uninvestigated 'window of opportunity' exists early in the disease course. OBJECTIVE: To investigate the effect of early exercise on relapse rate, global brain atrophy and secondary magnetic resonance imaging (MRI) outcomes. METHODS: This randomized controlled trial (n = 84, disease duration <2 years) included 48 weeks of supervised aerobic exercise or control condition. Population-based control data (Danish MS Registry) was included (n = 850, disease duration <2 years). Relapse rates were obtained from medical records, and patients underwent structural and diffusion-kurtosis MRI at baseline, 24 and 48 weeks. RESULTS: No between-group differences were observed for primary outcomes, relapse rate (incidence-rate-ratio exercise relative to control: (0.49 (0.15; 1.66), p = 0.25) and global brain atrophy rate (-0.04 (-0.48; 0.40)%, p = 0.87), or secondary measures of lesion load. Aerobic fitness increased in favour of the exercise group. Microstructural integrity was higher in four of eight a priori defined motor-related tracts and nuclei in the exercise group compared with the control (thalamus, corticospinal tract, globus pallidus, cingulate gyrus) at 48 weeks. CONCLUSION: Early supervised aerobic exercise did not reduce relapse rate or global brain atrophy, but does positively affect the microstructural integrity of important motor-related tracts and nuclei.

[Natalizumab can induce progressive multifocal leucoencephalopathy].

A 41-year-old woman with relapsing-remitting multiple sclerosis came to the outpatient-clinic, prior to a scheduled infusion with natalizumab. She had been treated with natalizumab for four years. Prior to treatment she did not wish to have her John Cunningham virus status tested. At the consultation she appeared disoriented and answered questions inadequately. An MRI was consistent with progressive multifocal leucoencephalopathy, and treatment with plasmapheresis was startet immediatly. The patient deceased four months later.

[Neuromyelitis optica--an important differential diagnosis for multiple sclerosis]. / Neuromyelitis optica-- en vigtig differentialdiagnose til multipel sklerose.

Neuromyelitis optica (Devic's disease) is a rare autoimmune neuroinflammatory disease. The disease can often be difficult to distinguish from multiple sclerosis. It is important to be familiar with the disease because of the risk of rapid progression to disability or even death. We describe a 15-year-old woman with onset of a typical relapsing-remitting course. The case includes the diagnostic tests and effected treatment.