Impact of an adaptive program for cognitive and emotional deficits (ADACOG program) in multiple sclerosis patients with cognitive impairments.

BACKGROUND: Cognitive impairment is frequent in multiple sclerosis (MS), affecting approximately 40 to 70% of patients. We developed a psycho-educational program (ADACOG program) to allow patients to cope with cognitive deficits. The purpose of this exploratory study was to investigate the impact of the ADACOG program on subjective self-reported cognitive impairments, quality of life, anxiety, depression and self-esteem in MS patients. METHODS: ADACOG program is a psycho-educational program focusing on cognitive and emotional dysfunctions in MS consisting of three modules in small groups lasting two hours every two weeks. Forty-five MS patients with self-reported cognitive impairments and objective cognitive deficits were enrolled consecutively in two groups: (i) the ADACOG group (N=24) and (ii) the control group (N=21). Both groups of patients completed questionnaires evaluating self-reported cognitive impairments (Multiple Sclerosis Neuropsychological Screening Questionnaire), quality of life (Multiple Sclerosis Impact Scale), anxiety and depression (Hospital Anxiety and Depression Scale, HAD) and self-esteem (Rosenberg Scale) at inclusion (M0), one month later (M1) and seven months after inclusion (M7). The evolution of outcomes within ADACOG group and between both groups was analyzed. RESULTS: The analyses within the ADACOG group showed that patients reported better quality of life and fewer anxiety symptoms at M1 compared to M0 (respectively P=0.03 and P=0,04). Moreover, patients presented less subjective self-reported cognitive deficits at M7 compared to M0 (P=0.003). Score evolution for HAD depression and self-esteem were not significant within the ADACOG group. The change M1-M0 for MSIS-29 and HAD anxiety scores was significantly different between both groups (respectively P=0.04 and P=0.008), with improvement of quality of life and anxiety in the ADACOG group. The evolution of scores between groups was not significant for the other outcomes. DISCUSSION: This study showed a small effect of a psycho-educational program focusing on cognitive and emotional disorders in MS patients with subjective self-reported cognitive deficits and objective cognitive deficits. Interest of psycho-education focusing on cognition in MS patients is discussed.

[Hearing loss in multiple sclerosis: clinical, electrophysiologic and radiological study]. / Surdité et sclérose en plaques: étude clinique, électrophysiologique et radiologique.

Clinical presentation of multiple sclerosis (MS) is highly heterogeneous. Deafness is considered to be rare. The aim of this study was to determine the frequency of acute deafness in MS and to evaluate prognosis. The occurrence of acute deafness was systematically noted in a cohort of 400 consecutive clinically definite MS patients. Acute deafness was observed in 14 patients (3.5 p. cent) with a mean age of 28 years (15 to 48) and after a mean of 2.3 years (0 to 10) of disease duration. In all but two patients, deafness was associated with disease exacerbations, highly suggestive of infratentorial lesions. MRI showed hyperintensities in the pons or the midbrain in 11 cases. Deafness disappeared in all cases excepted for one patient. After a mean follow-up of 7.2 years (1 to 17), all the patients remain in the relapsing-remitting form of the disease with a mean EDSS of 2.4 (0 to 4.5). Acute deafness is observed in 3.5 p. cent of MS cases and occurs more frequently during the first years of the disease. Although follow-up of a larger cohort is necessary, deafness could be of good prognostic factor in MS.

[Current treatment of multiple sclerosis]. / Actualités thérapeutiques de la sclérose en plaques.

Since commercialisation of the first immunomodulatory drug (IMD) for multiple sclerosis (subcutaneous interferon beta-1b) in 1995, three new IMD have been on the market: two interferons (intramuscular interferon beta-1a and subcutaneous interferon beta-1a) and glatiramer acetate. These four immunomodulatory drugs have a similar efficiency: they reduce by about 30% the relapse rate of treated patients compared to untreated patients. Their effect on disability is moderate mainly due to the reduced relapse rate. Lately, in 2002, mitoxantrone was approved for aggressive relapsing-remitting MS and in 2007 the first monoclonal antibody (natalizumab) was approved for active relapsing-remitting MS.