scholarly journals Arm Ergometry to Improve Mobility in Progressive Multiple Sclerosis (AMBOS)—Results of a Pilot Randomized Controlled Trial

2021 ◽  
Vol 12 ◽  
Author(s):  
Inga Heinrich ◽  
Friederike Rosenthal ◽  
Stefan Patra ◽  
Karl-Heinz Schulz ◽  
Götz H. Welsch ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Functioning ◽  
Work Load ◽  
Progressive Multiple Sclerosis ◽  
Walking Distance ◽  
Moderate Intensity ◽  
Control Group ◽  
Walking Ability ◽  
Arm Ergometry ◽  
Maximum Work

Background: Walking disability is one of the most frequent and burdening symptoms of progressive multiple sclerosis (MS). Most of the exercise intervention studies that showed an improvement in mobility performance were conducted in low to moderately disabled relapsing–remitting MS patients with interventions using the legs. However, MS patients with substantial walking disability hardly can perform these tasks. Earlier work has indicated that aerobic arm training might also improve walking performance and could therefore be a therapeutic option in already moderately disabled progressive MS patients.Methods: Patients with progressive MS and EDSS 4–6.5 were randomized using a computer-generated algorithm list to either a waitlist control group (CG) or an intervention group (IG). The IG performed a 12-week home-based, individualized arm ergometry exercise training program. Maximum walking distance as measured by the 6-min walking test (6MWT) was the primary endpoint. Secondary endpoints included aerobic fitness, other mobility tests, cognitive functioning, as well as fatigue and depression.Results: Of n = 86 screened patients, 53 with moderate disability (mean EDSS 5.5, SD 0.9) were included and data of 39 patients were analyzed. Patients in the IG showed strong adherence to the program with a mean of 67 (SD 26.4) training sessions. Maximum work load (Pmax) increased in the training group while other fitness indicators did not. Walking distance in the 6MWT improved in both training and waitlist group but not significantly more in trained patients. Similarly, other mobility measures showed no differential group effect. Cognitive functioning remained unchanged. No serious events attributable to the intervention occurred.Conclusion: Although maximum work load improved, 3 months of high-frequency arm ergometry training of low to moderate intensity could not show improved walking ability or cognitive functioning in progressive MS compared to a waitlist CG.The study was registered at www.clinicaltrials.gov (NCT03147105) and funded by the local MS self-help organization.

Toxicity in a double-blind, placebo-controlled pilot trial with D-penicillamine and metacycline in secondary progressive multiple sclerosis

1998 ◽  
Vol 4 (2) ◽  
pp. 74-78 ◽  
Author(s):  
B Dubois ◽  
M B D'Hooghe ◽  
K De Lepeleire ◽  
P Ketelaer ◽  
G Opdenakker ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Pilot Trial ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive Multiple Sclerosis ◽  
Tissue Type ◽  
Control Group ◽  
Double Blind ◽  
Gelatinase B ◽  
Double Blind Placebo ◽  
Secondary Progressive

The serine proteinase tissue-type plasminogen activator (t-PA) and the metalloproteinase gelatinase B (MMP-9) have recently been demonstrated in MS lesions. Both enzymes are interconnected in an enzyme cascade which contributes to destruction of the blood brain barrier and demyelination and both enzymes are inhibited by D-penicillamine. Metacycline was shown in in vitro experiments to inhibit gelatinase B. The combination of peroral D-penicillamine plus metacycline was evaluated in a double-blind placebo-controlled way in two groups of 10 patients suffering from secondary progressive multiple sclerosis. The major objectives of this pilot trial were to examine the safety of this combination and the possibility of blinding, while the effect on disease progression was considered as a secondary endpoint. Over a follow-up period of 1 year and in this selected patient group, there was no significant improvement in the Expanded Disability Status Scale score (EDSS) as compared with that of the placebo-control group. Toxicity was too high to consider additional trials with this combination of metalloproteinase inhibitors. Although peroral treatment is by most MS patients acknowledged as a major improvement in treatment compliance, one has to await the development of more selective and efficaceous protease inhibitors than those used in the combination therapy described here.

scholarly journals Repeated Intrathecal Triamcinolone Acetonide Administration in Progressive Multiple Sclerosis: A Review

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Mazen Abu-Mugheisib ◽  
Reiner Benecke ◽  
Uwe K. Zettl
Keyword(s):  
Multiple Sclerosis ◽  
Triamcinolone Acetonide ◽  
Progressive Multiple Sclerosis ◽  
Intrathecal Administration ◽  
Small Sample ◽  
Walking Distance ◽  
Advantages And Disadvantages ◽  
Therapy Option ◽  
Small Sample Sizes ◽  
Selection Of

At the present time, anti-inflammatory, immunomodulatory, or immunosuppressive treatments of multiple sclerosis (MS) are mainly effective in the early phases of the disease but are of less advantage in progressive phases. Current therapeutic strategies of both primary and secondary progressive MS are rare. One alternative may be intrathecal application of triamcinolone acetonide (TCA). Number of papers deal with advantages and disadvantages of intrathecal administration in MS. Former trials lacked detailed selection of MS patients, with small sample sizes, low steroid dosages, and only a small number of intrathecal administration of short acting steroids. The present paper summarizes recent trials performed following a different treatment regime. They were conducted in patients with progressive MS suffering mainly from spinal symptoms and documented a significant improvement of EDSS and walking distance (WD). Intrathecal TCA administration is a proposal to take into account as one therapy option in patients with a progressive clinical course and predominantly spinal symptoms.

scholarly journals Physical Activity Behavior in Individuals With Secondary Progressive Multiple Sclerosis

2007 ◽  
Vol 9 (4) ◽  
pp. 139-142 ◽  
Author(s):  
Robert W. Motl ◽  
Erin M. Snook ◽  
Daniel Wynn
Keyword(s):  
Physical Activity ◽  
Multiple Sclerosis ◽  
Self Efficacy ◽  
Physical Activity Behavior ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive Multiple Sclerosis ◽  
Walking Ability ◽  
Activity Levels ◽  
Secondary Progressive ◽  
The Difference

This study compared the physical activity levels of individuals with secondary progressive multiple sclerosis (SPMS) with those of people with relapsing-remitting multiple sclerosis (RRMS). Symptoms, walking ability, and self-efficacy were examined as explanations for the possible difference in physical activity, after controlling for age and time since MS onset. The sample included 41 individuals with SPMS and 82 with RRMS who completed a demographics scale and self-reported measures of physical activity, self-efficacy, symptoms, and walking ability. Individuals with SPMS were older, had a longer time since MS onset, and reported less physical activity and self-efficacy and more frequent symptoms and problems with walking than those with RRMS. Self-efficacy and walking ability accounted for the difference in physical activity between the groups, and self-efficacy was the strongest correlate of physical activity in the SPMS sample. Future researchers should consider developing and testing interventions that target self-efficacy as a modifiable factor within the exercise environment to increase physical activity in people with SPMS.

scholarly journals Effect of Resistance Training with Different Intensities on Airway Resistance Indices and Fatigue and Muscular Endurance in Women with Multiple Sclerosis (MS)

Thrita ◽  
2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Ameneh Balavi ◽  
Mohsen Ghanbarzade
Keyword(s):  
Multiple Sclerosis ◽  
Resistance Training ◽  
Airway Resistance ◽  
Exercise Program ◽  
Moderate Intensity ◽  
Control Group ◽  
Moderate Intensity Exercise ◽  
Lack Of Information ◽  
Before And After ◽  
Training Exercises

Background: Airways resistance and broncho-spasm due to exercise are very common. Factors such as exercise, temperature, humidity, air pollution, and disease affect this complication. This study was performed due to the increase in physical disability of muscle weakness in patients with MS and the lack of information on the effect of different strength training exercises on air resistance. Objectives: The current study aimed to investigate the effect of resistance training with different intensities on airway resistance indices of women with MS. Methods: Thirty six women with Multiple sclerosis who had a disability criterion ranged from 1 to 4 (based on Krutzke’s disability scale) were sampled using the targeted and purposive sampling methods. They were selected based on the initial health conditions and then were randomly assigned to each of the three groups (each consisting of 12 participants). The first group received resistance training for 12 weeks, three sessions a week with intensity 60% 1RM, and the second group received resistance training for 12 weeks, three sessions a week with intensity 80% 1RM. Those in the control group didn’t have an exercise program. Results: Airway resistance indices were measured both before and after 12 weeks of resistance training, airway resistance indices in both groups was significantly decreased, and these changes were significant in both experimental groups as compared to the control group. Conclusions: According to the findings, in addition to improving balance, fatigue, and muscle endurance, high-intensity resistance training had similar effects to moderate-intensity exercise on pulmonary function indices in women with MS.

scholarly journals No Early Effect of Intrathecal Rituximab in Progressive Multiple Sclerosis (EFFRITE Clinical Trial)

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Mickael Bonnan ◽  
Sylvie Ferrari ◽  
Henri Courtade ◽  
Paul Money ◽  
Pauline Desblache ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Progressive Multiple Sclerosis ◽  
Immunosuppressive Drugs ◽  
Control Group ◽  
Csf Biomarkers ◽  
Open Label ◽  
Neurofilament Light Chain ◽  
Neurofilament Light ◽  
Early Effect ◽  
Mri Changes

Background. The progressive phase of multiple sclerosis (MS) is characterized by an intrathecal (IT) compartmentalization of inflammation, involving B-cells within meningeal follicles, and resisting all the available immunosuppressive treatments. A new therapeutic paradigm may be to target this inflammation by injecting immunosuppressive drugs inside the central nervous system compartment. Methods. We designed a single-center, open-label, randomized, controlled, phase II study designed to evaluate the safety and efficacy of IT rituximab in progressive MS (EFFRITE trial; ClinicalTrial Registration NCT02545959). Patients were randomized into three arms (1 : 1 : 1): control group, IT rituximab (20 mg, IT) group, and intravenous+IT (IV+IT) group. The main outcome was a change in levels of CSF biomarkers of inflammation (osteopontin). Secondary outcomes were changes in levels of CSF biomarkers of axonal loss (neurofilament light chain) and clinical and MRI changes. Results. Ten patients were included (2 : 4 : 4). No adverse event occurred. OPN level remained stable in CSF at each time point, whereas NFL had slightly decreased (-8.7%) at day 21 ( p = 0.02 ). Clinical parameters remained stable and leptomeningeal enhancements remained unchanged. Conclusion. Clinical outcome and biomarkers of inflammation were not dramatically modified after IT injection of rituximab, probably due to its limited efficiency in CSF. Drug issues for future studies are discussed.

scholarly journals Air bubble after intrathecal triamcinolone acetonide application in a progressive multiple sclerosis patient

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Thomas Müller ◽  
◽  
Sven Lütge; Gunnar Gäde ◽  
Keyword(s):  
Multiple Sclerosis ◽  
Triamcinolone Acetonide ◽  
Fold Increase ◽  
Progressive Multiple Sclerosis ◽  
Walking Distance ◽  
Air Bubble ◽  
Upper Limb Function ◽  
Repulsive Guidance Molecule ◽  
Repulsive Guidance Molecule A ◽  
Guidance Molecule

Repeated intrathecal application of the sustained release steroid Triamcinolone Acetonide (TCA) is beneficial in progressive Multiple Sclerosis (MS) patients [1]. Particularly, patients with spinal lesions often show a distinct benefit with a three fold increase of the maximum walking distance [2]. This therapy ameliorates walking distance, improves upper limb function and reduces spastic symptoms [1]. The putative regenerative effect may result from declined synthesis of the repulsive guidance molecule A [3]. Visualization of air bubbles after a TCA injection prompted this case report.

Endurance training is feasible in severely disabled patients with progressive multiple sclerosis

2013 ◽  
Vol 20 (5) ◽  
pp. 627-630 ◽  
Author(s):  
AG Skjerbæk ◽  
M Næsby ◽  
K Lützen ◽  
AB Møller ◽  
E Jensen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Heart Rate ◽  
Endurance Training ◽  
Intervention Group ◽  
Progressive Multiple Sclerosis ◽  
Drop Out ◽  
Upper Body ◽  
Control Group ◽  
Sufficient Intensity ◽  
Disabled Patients

This study tested whether upper-body endurance training (ET) is feasible and can be performed at sufficient intensity to induce cardiovascular adaptations in severely disabled patients with progressive multiple sclerosis (MS). Eleven progressive MS patients (6.5 ≤ EDSS ≤ 8.0) scheduled for a four-week inpatient rehabilitation program were randomized to a control group (CON, n = 5) that received standard individualized MS rehabilitation or an intervention group (EXE, n = 6) that in addition received 10 sessions of predominantly upper-body ET. One patient dropped out of the EXE group (drop-out rate: 1/6~17%) and no adverse events were recorded. The EXE group completed on average 9.3±0.8 sessions (~96.0±5%). During the ET sessions an average heart rate of 93.9±9.3beats*min–1 were sustained corresponding to 91.6±6.8% of the maximal pre-intervention heart rate. In the EXE group a trend toward a time*group interaction was seen for VO2peak ( p = 0.06). ET is feasible in severely disabled patients with progressive MS and it can probably be performed at sufficient intensity to induce cardiovascular adaptations.

Characterization of Jc Virus Dna Amplified from Urine of Chronic Progressive Multiple Sclerosis Patients

1996 ◽  
Vol 1 (4) ◽  
pp. 193-199 ◽  
Author(s):  
Gerald L Stoner ◽  
Hansjürgen T Agostini ◽  
Caroline F Ryschkewitsch ◽  
Robert W Baumhefner ◽  
Wallace W Tourtellotte
Keyword(s):  
Multiple Sclerosis ◽  
Jc Virus ◽  
Pcr Amplification ◽  
Treated Group ◽  
Progressive Multiple Sclerosis ◽  
Control Group ◽  
Cell Extracts ◽  
Chronic Progressive Multiple Sclerosis ◽  
Multiple Sclerosis Patients

Thirty-seven chronic progressive multiple sclerosis (MS) patients, 20 of whom were taking cyclosporine, were examined for excretion of JC virus (JCV) in the urine. Polymerase chain reaction (PCR) amplification of DNA in urinary cell extracts detected JCV in 30% of the MS urines. In the cyclosporine treated group four of 20 (20%) excreted JCV, whereas in the untreated group seven of 17 (41%) excreted JCV. Thus, cyclosporine treatment did not enhance urinary excretion of the virus. A control group consisting of an unselected series of 89 patients donating urine in a general medical clinic and 16 healthy volunteers showed 41% with detectable urinary JCV. Thirty-three percent of the control females excreted JCV (18154), as did 49% of the control males (25151). Although the percentage of MS patients excreting detectable virus was not increased compared to the control group, the presence of JCV in the urine provides or convenient source of the virus for further characterization. Genotyping of DNA fragments amplified from the VPI region indicates mainly the presence of JCV Type 1 in these chronic progressive MS patients. This is also the type that predominates in the control group. An apparent recombinant between Type 1 and Type 3 (African) within the VPI region, tentatively designated Type 113 (or Type 4), was found in both the MS group and the controls. A larger series of MS patients that includes relapsing/remitting disease will be required to determine whether the genotype profile of JCV excreted in the urine of MS patients differs significantly from controls.

The unique impact of changes in normal appearing brain tissue on cognitive dysfunction in secondary progressive multiple sclerosis patients

2004 ◽  
Vol 10 (6) ◽  
pp. 626-629 ◽  
Author(s):  
Darcy Cox ◽  
Daniel Pelletier ◽  
Claude Genain ◽  
Sharmila Majumdar ◽  
Ying Lu ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Cognitive Functioning ◽  
Brain Tissue ◽  
Cognitive Dysfunction ◽  
Progressive Multiple Sclerosis ◽  
Resonance Spectroscopy ◽  
Lesion Load ◽  
T1 And T2 ◽  
Multiple Sclerosis Patients

Objective: The purpose of this study was to examine the relationships between cognitive functioning, whole brain magnetic transfer ratio (MTR) imaging, supratentorial 1H-magnetic resonance spectroscopy imaging (1HMRSI), and conventional T1 and T2 imaging in a homogenous sample of SPMS patients. Methods: Nineteen patients underwent a single 90-min imaging session that obtained T1-and T2-weighted images and MTR. 1HMRSI was obtained on 14 of these patients. Patients underwent a neuropsychological battery, which was used to create an integrated measure of cognitive impairment. Cognitive impairment was the dependent variable in two hierarchical multiple regression analyses in which T2 lesion load, T1 lesion load, and MTR or NAA/Cr were entered sequentially. Results: MTR was significantly related to cognitive functioning (ΔR2= 0.22, P= 0.02) after accounting for T2 lesion load (ΔR2=0.33, P= 0.01) and T1 lesion load (ΔR2= 0.00, P=0.98). NAA/Cr was not significantly related to cognitive functioning. Conclusions: Cognitive dysfunction may act as a clinical marker of normal appearing brain tissue pathology in multiple sclerosis.

scholarly journals CXCL13 CSF level inversely correlates with duration of disease in primary progressive multiple sclerosis

2016 ◽  
Vol 85 (4) ◽  
pp. 302-304
Author(s):  
Jacek Losy ◽  
Piotr Iwanowski ◽  
Elżbieta Kaufman ◽  
Marlena Wójcicka
Keyword(s):  
Multiple Sclerosis ◽  
Serum Levels ◽  
Progressive Multiple Sclerosis ◽  
Control Group ◽  
Primary Progressive Multiple Sclerosis ◽  
Primary Progressive ◽  
Cxcl13 Level ◽  
Relapsing Remitting ◽  
Duration Of Disease ◽  
And Control

Chemokines are important factors in the immunopathogenesis of multiple sclerosis. The objective of the study was to examine the CSF and serum levels of CXCL13 and CCL5 chemokines in primary progressive MS, compare results with relapsing remitting MS and control group with other noninflammatory neurological disorders. The levels of chemokines was measured by ELISA method. The CXCL13 CSF levels in PP and RR MS were higher in comparison with control group, without significant differences between these podgroups. Additionally CXCL13 level in PP MS inversely correlated with duration of the disease. CCL5 CSF level was also significantly higher in PP MS in comparison with control group. The results demonstrate involvement of CXCL13 and CCL5 chemokines in the immunopathogenetic mechanisms of primary progressive MS.

Sign in / Sign up

Export Citation Format

Share Document