Archive for February, 2013
Studies have shown that the popular video game, Dance Dance Revolution (DDR), which requires players to coordinate their movements to the beat of music, may help improve balance and mobility in certain patient populations. Now, researchers at The Ohio State University Wexner Medical Center are the first to test the game’s ability to help decrease the cognitive and physical effects of multiple sclerosis (MS).
An estimated 2.1 million people have multiple sclerosis (MS), an incurable inflammatory disease which progressively impairs nerve function in the brain and spinal cord. While studies with the elderly and Parkinson’s patients have shown exercise can slow cognitive decline and improve coordination, similar information is lacking for patients with MS, leaving clinicians without data to help guide prescription of exercise programs.
"The video dancing game provides a good platform for our research because it addresses multiple issues that MS clinicians and patients face. We think our data will not only help doctors and therapists make good clinical recommendations, but provide an evidence based, in-home tool for patients that helps overcome access and cost issues associated with long term physical therapy," says Anne Kloos, PhD, PT, NCS, associate clinical professor of health and rehabilitation sciences in the Ohio State College of Medicine.
Kloos became interested in DDR as a potential therapy by conducting an earlier study of individuals with Huntington’s disease. In that study, Kloos and her colleagues found that the interactive video game was a fun way to boost motivation and provide a mental and physical workout, in addition to being a convenient way to deliver physical therapy.
In early 2012, Kloos received a grant from the Ohio State Center for Clinical and Translational Science (CCTS) to examine the effects of DDR on mobility, brain plasticity and cognition in individuals with MS. In the ongoing trial, participants exercise using DDR three times a week for eight weeks. The patients’ cognitive functions are tested at the beginning and end of the trial, and functional and structural magnetic resonance imaging is used to detect brain circuitry changes.
"DDR requires a lot of cognitive processing. Players must look at a screen and time their movements to the arrows on the screen," said research team member, Nora Fritz, DPT. "Incorporating DDR into standard MS treatments has the potential to improve balance, walking, cognition and motivation."
Fritz recently received a supplementary grant from the CCTS to expand the work started by Kloos, and is being mentored by both Dr. Kloos and Deborah Larsen, PhD, PT, Director of the Ohio State School of Health and Rehabilitation Sciences. With the additional funding, Fritz will investigate the differences in dual tasking abilities between individuals with MS and healthy controls and whether playing DDR will improve dual tasking abilities.
Many people diagnosed with MS feel as though they have been given a life sentence of incapacitation. Kloos and Fritz are looking to restore hope and improve the quality of life for patients suffering from this disease, something that study participants feel they are achieving.
"Participating in the study and doing the dance program has helped me feel healthier and more independent. And that is really exciting," says Tracy Blackwell, a study participant.
The trial is still enrolling patients.
A drug that is currently used for cancer can relieve and slow down the progression of the autoimmune disease multiple sclerosis (MS) in rats, according to a new study published in PLOS ONE. The discovery, which was made by researchers at Karolinska Institutet in Sweden, might one day lead to better forms of treatment for patients with MS.
Multiple sclerosis is a disease in which the immune system attacks the spinal cord and brain, damaging nerve tissues to cause visual impairment, paralysis and other neurological disabilities. There are approximately 17,000 MS victims in Sweden, most of who develop the disease between the age of 20 and 40. The disease is currently incurable, and the treatments that are able to ameliorate the symptoms can have severe side effects.
"There is a particularly urgent need to find new, efficacious drugs with minimal adverse effects for patients with MS in the relapsing phase of the disease," says Assistant Professor Ingrid Nilsson at Karolinska Institute’s Department of Medical Chemistry and Biophysics.
The disease is caused when white blood cells attack the central nervous system. The CNS is normally protected by the blood-brain barrier, which governs what passes through the vascular walls. However, the inflammation that MS gives rise to causes the blood-brain barrier to become more permeable for immune cells to pass through.
In this present study, the research team examined the possibility of influencing the neurological symptoms by sealing the blood-brain barrier. This they did using a common rat model in which the immune defense is stimulated by an endogenous protein in the nerve tissue that triggers an autoimmune reaction, whereby white blood cells attack the protein in the CNS to create symptoms in the rat similar to those of human MS. The rats were then treated with imatinib (Gleevec®), a drug used for treating certain kinds of cancer and previously shown to reduce blood-brain barrier leakiness.
"Administering imatinib enabled us to slow down the progress of the disease and ameliorate neurological symptoms by preventing the influx of white blood cells from the blood into the nerve tissue," says Dr Nilsson.
The treatment with imatinib also suppressed the autoimmune reaction and reduced the number of white blood cells leaking through the blood-brain barrier. Since the drug is already used for cancer patients, a clinical study of the treatment could be conducted on MS patients in the near future.
"The treatment proved effective even when administered to animals that had already developed symptoms, which is very important in terms of its use in patients with multiple sclerosis," says Dr Nilsson.
The study was funded by grants from the Swedish Brain Foundation/the Hållsten Research Foundation, VINNOVA (The Swedish governmental agency for innovation systems), the Swedish Association of Persons with Neurological Disabilities, among others.
Data from the largest multicenter study accessing cognitive functioning in children with multiple sclerosis (MS) reveals that one-third of these patients have cognitive impairment, according to a research paper published in the Journal of Child Neurology. Led by Lauren B. Krupp, MD, Director of the Lourie Center for Pediatric Multiple Sclerosis at Stony Brook Long Island Children’s Hospital, the study indicates that patients experience a range of problems related to cognition.
In "Cognitive Impairment Occurs in Children and Adolescents with Multiple Sclerosis: Results from a United States Network," Dr. Krupp and colleagues from Stony Brook and five other national Pediatric MS Centers of Excellence measured the cognitive functioning of 187 children and adolescents with MS, and 44 who experienced their first neurologic episode (clinically isolated syndrome) indicative of MS. They found that 35 percent of the patients with MS and 18 percent of those with clinically isolated syndrome met criteria for cognitive impairment. All patients were under age 18 with an average disease duration of about two years.
"This study is important because it represents the largest study to date to apply a comprehensive neuropsychological battery of tests to evaluate the cognitive functioning of children with MS, and the results clearly show us that cognitive issues are widespread and can occur early on in the disease course of these patients," said Dr. Krupp, also a Professor of Neurology at Stony Brook University School of Medicine. "These are critically important findings that emphasize the need for prompt recognition of our patients’ cognitive problems and for neurologists and other MS specialists to discover ways to intervene and help improve the cognitive abilities of these children while they are in school and beyond."
The authors report that the network of Pediatric MS Centers of Excellence used a comprehensive battery of 11 tests where the scores addressed cognitive domains such as general ability, reading and language, attention, working memory and speed processing, executive functioning, verbal learning and recall, visual-motor integration, and fine motor speed and coordination. The testing took approximately 2.5 hours to complete, and a participant was considered impaired when the proportion of impaired scores from the categorized tests was greater than one-third.
They found that the most frequent areas of impairment were fine motor coordination (54 percent), visual-motor integration (50 percent), and speeded information processing (35 percent). Among the various tests that showed the most frequent rate of impairment were the grooved peg board, a measure of fine motor speed and coordination, and a test for visual-motor integration, a measure that is dependent in part on fine motor coordination.
The researchers factored in clinical variables in the analysis, including disease duration, diagnosis status, age of disease onset, and disability. They found that a diagnosis of MS and overall neurologic disability were the only two independent predictors of cognitive impairment.
They also factored in sociodemographic variables such as age, gender and ethnicity, and leveraged the geographic diversity of the Pediatric Multiple Sclerosis Centers of Excellence network to create the sample. Centers participating in the study included: the Lourie Center for Pediatric Multiple Sclerosis at Stony Brook; the University of California, San Francisco; University of Alabama, Birmingham; the Jacobs Neurological Institute, SUNY Buffalo; Massachusetts General Hospital in Boston, and the Mayo Clinic in Rochester, Minn.
The authors point out that the next step for pediatric MS investigators within the network is to further the research "to develop strategies for prompt identification of children with multiple sclerosis at risk for cognitive problems so that treatment can be initiated."
The study was supported in part by the National Multiple Sclerosis Society.
Occupational exposure to magnetic fields (MF) may be associated with "moderately increased risk" of certain neurodegenerative diseases — including Alzheimer’s and amyotrophic lateral sclerosis, reports the February Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM).
But the findings are limited by variable evidence and conflicting results, according to the report by Ximena Vergara, PhD, of the Electric Power Research Institute, Palo Alto, Calif., and colleagues.
The researchers analyzed past studies on the association between MF exposure and the risk of neurodegenerative diseases such as Alzheimer’s and motor neuron disease (MND), including amyotrophic lateral sclerosis. Magnetic field exposure is common among workers in electrical occupations.
The results suggested significant but weak associations between measures of MF exposure and the risk of Alzheimer’s disease and MND. Other neurodegenerative diseases — including Parkinson’s disease and multiple sclerosis — were unrelated to MF exposure.
There were some notable inconsistencies regarding the link between MF exposure and neurodegenerative diseases. Associations for MND were stronger in studies based solely on job titles, and for Alzheimer’s disease in studies using estimated MF exposure.
Few studies included direct measurement of MF exposure or data on other potentially relevant job exposures, such as electrical shocks. There was also evidence of possible "publication bias," with studies reporting finding no link between MF and Alzheimer’s disease being less likely to be published.
Because of the weaknesses in the evidence, no "reliable inferences" can be drawn about the effects of occupational MF exposure, according to Dr Vergara and coauthors. They write, "In light of these problems we believe that conclusions about the relations of occupational MF exposure to neurologic disease will require improvement in exposure assessment, disease classification, [and] more complete reporting of results."
The above story is reprinted from materials provided by Journal of Occupational and Environmental Medicine, via Newswise.