Improvement in strength following resistance training in MS patients despite varied disability levels.

Strength and endurance data from 67 participants with multiple sclerosis (MS) were compared before, during and after a 6-month program of standardized resistance training. The hypothesis was that a standardized, structured resistance training exercise program improves strength in MS patients with different levels of disability. The range of EDSS scores was 1-8: (40% - EDSS of 1-4.5), (35% - EDSS of 5-7) (25% - EDSS of 7.5 or higher). This unique study evaluated patients with differing levels of disability for a change in strength and endurance following a 6-month training program. Data were analyzed by repeat measures and analysis of variables using Proc GLM in SAS to account for variability between subjects, and within subjects, due to repeated measures at 3 time points. Each treatment was blocked by disability class. Every within-treatment analysis was significant. Each exercise showed significant improvement in strength for participants, despite disability levels. Increases in strength followed parallel improvement pathways, at all disability levels. All but one treatment displayed highly significant improvement (p-value < 0.0001). The results demonstrated that all individuals with MS, despite disability levels, show parallel improvement in strength and endurance. This study supports the use of exercise, including resistance programs, for all MS patients.

A randomized open label study of pain medications (naproxen, acetaminophen and ibuprofen) for controlling side effects during initiation of IFN beta-1a therapy and during its ongoing use for relapsing-remitting multiple sclerosis.

Multiple sclerosis (MS) patients initiating IFN beta-1a, Avonex, therapy (Group 1, n = 30) or experiencing side effects after 6 months on therapy (Group 2, n = 30) were randomized for 5 weeks open label adjunct therapy to naproxen (Aleve), acetaminophen (Tylenol) or ibuprofen (Advil). Our hypothesis was that non-prescription pain medications are effective in decreasing or alleviating the side effects associated with IFN beta-1a therapy. Contrary to the hypothesis, most patients in both groups continued to report side effects on all pain medications. After 5 weeks, headache, fever, chills and injection site pain were low in < or = 50% of patients. Moderate to significant fatigue, muscle or joint pain continued in most patients. As a quality of life measure, the Modified Fatigue Impact Scale (mFIS) improved for Group 1 on naproxen or ibuprofen with greatest improvement in physical subset (P = 0.002 for naproxen and P<0.01 for ibuprofen). Total mFIS for Group 1 on acetaminophen improved (P = 0.04) due to improved cognitive subset rather than physical subset. Group 2, with side effects initially, reported less significant fatigue (severity 5-10) but more moderate fatigue (severity 2-4) at study end for all three medications. All medications improved cognitive subset (P = 0.05). Physical mFIS subset did not improve for Group 2 on acetaminophen, but did with naproxen (P = 0.05) or ibuprofen (P = 0.03). Naproxen and ibuprofen were more effective than acetaminophen in minimizing physical side effects of IFN beta-1a. None of the three pain medications tested were as effective as hypothesized for minimizing fatigue or muscle and joint pain.

Discordant functional and inflammatory parameters in multiple sclerosis patients after autologous haematopoietic stem cell transplantation.

This article describes outcomes in four patients with advanced multiple sclerosis up to two years after autologous haematopoietic stem cell transplantation using a total-body irradiation-based preparative regimen. MRI and CSF analyses demonstrated clear suppression of the inflammatory processes. The results demonstrate however, a dissociation of inflammation parameters and functional disability findings raising questions about optimal future stem cell transplantation strategies for this disease.