High-Dose Intravenous Steroid Treatment Seems to Have No Long-Term Negative Effect on Bone Mineral Density of Young and Newly Diagnosed Multiple Sclerosis Patients: A Pilot Study.

High-dose intravenous steroid treatment (HDIST) represents the first choice of treatment for multiple sclerosis (MS) relapses. Chronic oral glucocorticoid (GC) administration correlates with bone loss whereas data regarding HDIST in MS are still conflicting. Twenty-five newly diagnosed MS patients (NDMSP) (median age: 37 years) were prospectively studied for the effects of HDIST on bone mineral density (BMD) and bone metabolism. Patients received 1000 mg methylprednisolone intravenously every day for 5 days followed by oral prednisolone tapering over 21 days. Bone metabolism indices were determined prior to GC, on days 2, 4, 6, and 90, and at months 6, 12, 18, and 24 post GC therapy. Femoral, lumbar-spine BMD, and whole-body measurement of adipose/lean tissue were assessed prior to GC-administration and then every six months. Ten patients completed the study. N-terminal-propeptide-procollagen-type-1 and bone-specific alkaline phosphatase showed a significant increase at day-90 (p < 0.05). A transient non-significant fall of BMD was observed at 6 months after GC-administration, which subsequently appeared to be restored. We conclude that HDIST seems not to have long-term negative effects on BMD, while the observed transient increase of bone formation markers probably indicates a high bone turnover phase to GC-administration. Additional prospective studies with larger sample size are needed.

Massage therapy as a complementary treatment for Parkinson's disease: A Systematic Literature Review.

OBJECTIVE: There is no definite cure for Parkinson's disease (PD); therefore, the goals for symptomatic treatment are to improve quality of life and manage the motor and non-motor symptoms of the disease. Although massage is the one of the commonest used forms of complementary and alternative medicine (CAM), there is no systematically-oriented review focusing specifically on the efficacy of the different massage techniques on PD.Aim of this review was to evaluate the quality of evidence referring to massage therapy for PD. DESIGN: A systematic search was conductedin the MEDLINE database to identify the efficacy of massage on PD between 01/01/1970 and 06/12/2019. RESULTS: A total of 12 studies were analyzed in this systematic review. Massage therapy seems to induce relaxation in most cases, which is accompanied by biological measures involving urine stress hormones. Quality of life has been shown to be improved upon various therapeutic massage styles, involving classical whole-body therapeutic massage and reflexology. Non-motor symptoms, such as sleep disturbances, pain, fatigue, anxiety and depressive symptoms have been demonstrated to be improved upon different massage techniques, including classical deep therapeutic massage, Traditional Japanese (Anma) massage, Thai massage, neuromuscular therapy and Yin Tui Na massage. Regarding motor symptoms, classical therapeutic massage, Traditional Japanese (Anma) massage, Thai massage, and neuromuscular therapy seemed to improve motor symptoms, whereas Yin Tui Na technique combined with acupuncture was associated with worse motor scores. CONCLUSIONS: Despite the methodological concerns regarding the existing evidence, there is a wide range of safe massage techniques with beneficial effects on both motor and non-motor symptoms of PD. Longitudinal studies are needed to justify the introduction of massage therapy into clinical practice.

The role of melatonin in Multiple Sclerosis.

Melatonin is a neurohormone mainly produced by the pineal gland following a circadian rhythm. It is characterized as a pleiotropic factor because it not only regulates the wake-sleep rhythm but also exerts antinociceptive, antidepressant, anxiolytic, and immunomodulating properties. Recent studies suggest that dysregulation of melatonin secretion is associated with the pathogenesis of various autoimmune diseases, such as, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and multiple sclerosis (MS). MS is an autoimmune disorder characterized by an abnormal immune response directed against the myelin sheath in the central nervous system, demyelination, oligodendrocyte death, and axonal degeneration. Recent evidence reveals that melatonin secretion is dysregulated in MS patients, suggesting that melatonin could be a potential target for therapeutic intervention. Here, we summarize the available literature regarding the role of melatonin in immune processes relevant for experimental autoimmune encephalomyelitis (EAE), MS, and the current clinical trials of melatonin supplementation in MS patients.

Stress management and multiple sclerosis: a randomized controlled trial.

There is a well-established adverse reciprocal relationship between stress and multiple sclerosis (MS). However, stress management in these patients has been parsimoniously studied. In this parallel randomized controlled trial, relapsing-remitting MS patients were randomly assigned to undergo either an 8-week stress management program (n=31; relaxation breathing and progressive muscle relaxation, twice a day) or not (n=30). Self-reported validated measures were used to evaluate perceived stress, health locus of control, anxiety, and depression. Daily diaries of MS symptoms were also kept by patients. In patients in the intervention group, perceived stress and symptoms of depression were significantly decreased after 8 weeks of relaxation. Repeated measures analyses showed significant group-by-time interactions for both the number of weekly symptoms and the mean intensity per symptom. No other significant change was reported. We deem that our results should encourage future studies that will incorporate more objective clinical and laboratory outcomes.