Symptomatic Management in Multiple Sclerosis

Multiple sclerosis (MS) is an inflammatory, chronic, demyelinating, and neurodegenerative disorder of central nervous system, determined by an auto-immune dysfunction. Severe disability generally occurs in patients with progressive forms of MS that typically develop either after an earlier relapsing phase or less commonly from disease onset. Despite advances in research to slow the progression of MS, this condition remains a life-limiting disease with symptoms impacting negatively the lives of patients and caregivers.

To analyze the difefrent aspects of palliative cae in patients with MS.

To analyse selected literature assessing several palliative care aspects in patients with MS.

People with MS have complex symptoms and different needs. These demands include how to deal with the burden of physical disability, how to organise daily life, restructuring social roles in the family and at work, keeping self-sufficiency in personal care, and preserving personal identity and community roles.

An early palliative care approach aims to improve the palliative care skills and competencies of health professionals caring for the patients since the early stage of disease, including those who are actively undergoing disease-targeted therapies, rather than merely providing end-of-life care.

There is interest in the application of behavioral interventions based on theory for increasing physical activity among adults with multiple sclerosis (MS). To date, researchers have applied theory such as Social Cognitive Theory (SCT) for identifying correlates of physical activity that can then inform the design and delivery of behavioral interventions. Such research often has been conducted in heterogeneous samples of persons with MS without a focus on those with a specific symptom, such as fatigue, that may be targeted by physical activity behavioral interventions. To that end, this study examined SCT variables (i.e., self-efficacy, barriers, outcome expectations, goal-setting, planning, social support, and functional limitations) as correlates of physical activity in persons with MS who self-reported elevated fatigue.

Persons with MS (N=210; aged 49.6[13.2] years) who ambulated with or without assistance participated in the study. Participants completed self-report measures of fatigue, physical activity, and SCT variables and wore an ActiGraph GT3X+ accelerometer on a belt around the waist for 7 days. The accelerometer data were processed and delineated into time spent in light and moderate-to-vigorous physical activity (MVPA) based on MS-specific cut-points. We generated groups of fatigued (n=134) and non-fatigued (n=76) persons with MS based on the cut-off score of 4 for the Fatigue Severity Scale.

There were differences in physical activity and SCT variables between fatigued and non-fatigued persons with MS. Among those with fatigue, functional limitations (ρ=0.52), self-efficacy (ρ=0.31), and goal-setting (ρ=0.25) were associated with device-measured MVPA, and all SCT variables except outcome expectations were associated with self-reported physical activity. The regression analyses indicated self-efficacy, functional limitations, and goal-setting as significant correlates of MVPA in those with fatigue.

Self-efficacy, goal-setting, and social support may be important targets of SCT-based behavioral interventions for increasing physical activity among persons with MS who have fatigue.

The purpose was to investigate the effects of yoga and clinical Pilates training on walking, respiratory muscle strength, cognition, and quality of life and compare the effects of two popular exercise methods in persons with multiple sclerosis (pwMS).

Twenty-eight pwMS (Pilates group = 16, yoga group = 12) received the program once a week for eight weeks in addition to home exercises. At baseline and the end of the training, participants underwent assessments. The outcome measures were walking speed, mobility, balance confidence, respiratory muscle strength, cognition, and quality of life.

Following the program, there was no significant difference in mobility (p = 0.482), perceived walking quality (p = 0.325), respiratory muscle strength (maximum inspiratory pressure: p = 0.263, maximum expiratory pressure: p = 0.866), and cognition (Symbol Digit Modalities Test: p = 0.324, California Verbal Learning Test-II: p = 0.514, Brief Visuospatial Memory Test-Revised: p = 0.279) between the two groups. Improvements were higher in balance confidence (p = 0.006), walking speed (p = 0.004), and quality of life (p = 0.019) in the clinical Pilates group compared to the yoga group.

This study showed positive effects in walking and respiratory aspects in pwMS who received yoga and clinical Pilates training. Pilates training was superior in improving walking speed, quality of life, and balance confidence compared to yoga training.

Co-occurring walking and cognitive performance deficits are debilitating consequences of multiple sclerosis (MS) that worsen with age. However, it is unknown if fatigability influences such age-related worsening of walking and cognitive performance.

This cross-sectional study examined possible age-related differences in walking-related motor fatigability (incremental six-minute-walk (6MW) performance) and cognitive fatigability (incremental Symbol Digit Modalities Test (SDMT) performance) in adults with MS.

196 adults with MS were categorized into age-groups: younger (20–39 years; n = 53), middle-aged (40–59 years; n = 89), and older (60–79 years; n = 54), and completed the 6MW and SDMT. Age-group differences in incremental 6MW and SDMT performance, controlling for disability status, were examined using separate, mixed-factor ANCOVAs.

There were no statistically significant age-group-by-time interactions on walking-related motor or cognitive fatigability when controlling for disability. However, there were significant main effects of time on incremental 6MW (p = 0.01) and SDMT (p < 0.01) performance indicating the presence of walking-related motor and cognitive fatigability, respectively, collapsed across age-groups.

Fatigability does not exert a primary influence on age-related worsening of walking and cognitive neuroperformance outcomes among adults with MS. This suggests that walking-related motor fatigability and cognitive fatigability may not be optimal targets for mitigating age-related declines in ambulation and cognition among adults with MS.

Persons with multiple sclerosis(MS) engage in substantially more sedentary behavior than adults from the general population.

Hypothesis: This preliminary, cross-sectional study examined social-cognitive theory(SCT) variables as correlates of sedentary behavior in MS. We hypothesized that scores from SCT variables for sedentary behavior change would correlate with scores from self-reported and device-measured volumes of sedentary behavior in MS. We further hypothesized that the correlations would be stronger for self-reported than device-measured sedentary behavior, and that the primary correlate of sedentary behavior would be self-efficacy.

We recruited participants through a random sample of 1,000 persons enrolled in the North American Research Committee on MS registry, and 275 of the 296 persons who underwent screening volunteered for the study. Participants wore an ActiGraph accelerometer on a belt around the waist for measuring minutes per day of sedentary behavior. Participants further completed a newly-created, study-specific measure of SCT variables for reducing sedentary behavior(i.e., self-efficacy, outcome expectations, barriers, goal setting, & planning) and the abbreviated International Physical Activity Questionnaire as a self-report measure of sitting time.

Self-reported sedentary behavior was associated with self-efficacy(r = −0.47), goal setting(r = −0.31), planning(r = −0.35), and barriers(r = 0.39) for reducing sedentary behavior. Device-measured sedentary behavior was associated with self-efficacy(r = −0.32), goal setting(r = −0.21), planning(r = −0.18), and barriers(r = 0.20). Self-efficacy(β = −0.29), barriers(β = 0.26), and planning(β = −0.24) independently explained variance in self-reported sedentary behavior(R² = 0.33). Only self-efficacy(β = −0.32) independently explained variance in device-measured sedentary behavior(R² = 0.10).

SCT constructs might be reasonable targets of a behavioral intervention for reducing sedentary behavior in MS.

Multiple sclerosis (MS) has been estimated to affect 450,000 persons in the United States and 2.3 million worldwide. The peak incidence is age 30 and it appears up to three times more often in women as compared to men. It affects Caucasians more frequently than other races. There are four common clinical courses in MS: clinically isolated syndrome, relapsing-remitting MS, secondary progressive MS, and primary progressive MS. MS can be diagnosed if there is evidence of two attacks disseminated in time and space with clinical, laboratory, or imaging evidence of at least two lesions in the brain or spinal cord. Symptoms of MS involve multiple systems including musculoskeletal, bowel and bladder, visual, and cognitive, leading to varied and extensive functional limitations. The patient may require involvement of a comprehensive multidisciplinary rehabilitation team.