Loss of Balance Trends in Patients With Multiple Sclerosis and Parkinson Disease

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A loss of balance (LOB) rating scale following manual perturbations was found to be reliable and reproducible among patients with multiple sclerosis (MS) and Parkinson disease, according to study findings published in NeuroRehabilitation.

Both multiple sclerosis (MS) and Parkinson disease (PD) are associated with balance dysfunction. However, it remains unclear whether these patients have similar or differential LOB reactions to everyday types of perturbations. To increase knowledge about LOB in the MS and PD context, researchers sought to systematically classify LOB trends among these populations.

Among a group of 10 healthy volunteers, physical therapists systematically applied manual perturbations in videotaped sessions and rated LOB using a Balance-Based Torso-Weighting (BBTW) assessment. Similar data collected for previous studies were rated using the same approach among healthy controls (n=32), patients with MS (n=64), and PD (n=42). LOB scores were between zero (no LOB) and three (severe LOB). LOB total scores were the sum of scores from 12 manual perturbations.

The reliability of scores across five to six reviewers had intra-class correlation coefficients between 0.56 and 0.77 and percent agreements between 81% and 94%.

Comparing upper and lower body perturbations, the magnitude and prevalence were significant among groups and types of perturbations (all P <.001). LOB was similar in severity among controls and patients with MS for both upper and lower body perturbations. Among the PD cohort, they had greater magnitude and prevalence of LOB than lower areas (all P <.017).

For anterior versus posterior perturbations, the magnitude and prevalence were significant among groups and types of perturbations (all P <.001). Control individuals and patients with MS had more severe LOB when they were nudged backward. The patients with PD had more severe LOB when they were nudged forward.

The type of perturbation had a significant prevalence (P <.05) but not magnitude (P >.05). LOB more frequently occurred in response to right-left nudges compared with anterior-posterior nudges (P <.01).

This study may have been limited by using previously collected data and not having the same clinician apply the manual perturbations.

“A clinically accessible and reliable rating scale 625 revealed differences in patterns of LOB following 626 manual perturbations in people with MS, PD, and 627 HC [healthy controls],” stated the researchers. “Clinicians may help reduce fall risk for people 628 with MS or PD more effectively if they understand 629 and address the differences in LOB following perturbations in these populations,” they concluded.

Reference

Allen DD, Gadayan J, Hughes R, et al. Patterns of balance loss with systematic perturbations in Parkinson’s disease and multiple sclerosis. NeuroRehabilitation. Published online November 10, 2021. doi:10.3233/NRE-210200

Christina Applegate Updates Fans on Her Multiple Sclerosis Diagnosis

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Watch : Christina Applegate Reveals MS Diagnosis

For Christina Applegate, the sweetest thing 2022 could bring is a cure for MS.

On Thursday, Jan. 13, the Dead to Me star—who revealed in 2021 that she’d been diagnosed with multiple sclerosis—held a Q&A on her Twitter account, discussing a variety of topics including her current favorite TV shows, her goals for the new year and her experience working alongside Selma Blair and Cameron Diaz on the 2002 film The Sweetest Thing.

Her current TV lineup? “Restaurant Startup. Before that always Below deck,” Christina, 50, wrote. “Kate and captain Lee and Ben are my buds.”

However, when asked about her 2022 goals, her answer was a bit more serious. Christina replied, “Cure for MS maybe?????”

After one fan asked about The Sweetest Thing, Christina—who is a breast cancer survivor—remarked that filming the movie was “so fun,” but that it was “sad both of us have Ms,” a reference to her co-star and close friend Selma’s own battle with multiple sclerosis, which she revealed in 2018.

Expert Voices: Complementary and Alternative Medicine for Multiple Sclerosis

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In this installment of our “Expert Voices” series, Multiple Sclerosis News Today asked Allen C. Bowling, MD, PhD, to answer some of your questions related to complementary and alternative medicine (CAM) for people with multiple sclerosis (MS).

Bowling is an internationally recognized neurologist and integrative medicine pioneer with more than three decades of clinical and research experience. He has devoted his career to developing and providing rigorous, comprehensive, and compassionate care to those with MS. Bowling is director of the NeuroHealth Institute. He also is a clinical professor of neurology at the University of Colorado.

Bowling lectures extensively and is actively engaged in the ongoing clinical care of people with MS. He incorporates the approaches outlined in writing and speaking in his clinical practice, Neurology Care, in Englewood, Colorado.

He is a summa cum laude graduate of Yale, where he also obtained his MD and PhD degrees. He completed his neurology residency training at the University of California, San Francisco, and his fellowship training at Massachusetts General Hospital-Harvard Medical School.

What misunderstandings about complementary and alternative medicine would you like to dispel in regards to MS?

Allen C. Bowling, MD, PhD, is a neurologist specializing in integrative medicine for MS. (Photo courtesy of Allen C. Bowling)

I think a major misunderstanding is with the term itself, “complementary and alternative medicine.” This misunderstanding is of concern, especially for those with MS, because CAM is actually somewhat limiting in the therapies that it offers. Technically, CAM refers to therapies that are “unconventional.” For those who want to consider all available therapies, which is the majority of those with MS, a much broader and more helpful term is “integrative medicine.” This refers to an approach that combines conventional medicine, unconventional medicine (or CAM), and lifestyle medicine, which includes lifestyle practices such as diet and physical activity.

It’s important to recognize that with integrative medicine in MS, including CAM, there is a lot of misinformation, some of which is marketing for sales purposes. This is confusing, unfair, and potentially dangerous to those with MS. Some of these approaches are low risk and potentially beneficial, but others are dangerous and/or ineffective. It’s essential for people with MS who have an interest in this area to distinguish between potentially helpful and harmful approaches by first obtaining objective, evidence-based information.

In addition, people with MS need to recognize that integrative medicine has a few important distinctions from conventional medicine. First, integrative medicine, like conventional medicine, aims to treat disease. But it is also very much directed at maintaining health and preventing disease. Also, integrative medicine should be pursued with clinicians who have expertise in this area and are able to provide a relationship that is supportive of this approach.

Generally, what’s your thought process for deciding what treatment might be best for a patient to try?

When applying integrative medicine to MS, I think of seven “steps” that all people with MS should pursue:

conventional, FDA-approved medications symptom management, which should include the use of conventional medication but also lifestyle and unconventional medication exercise diet, including food, dietary supplements, and weight management e motional health decreasing t obacco and alcohol use maintaining the health of the rest of the body

Practical, evidence-based information about all of the above approaches may be found on my website and in a book that I’ve written, “Optimal Health with Multiple Sclerosis: A Guide to Integrating Lifestyle, Alternative, and Conventional Medicine.”

Are there CAM trends you’d like to warn against?

As I’ve mentioned, I think misinformation is rampant in the CAM field, and this is dangerous because some CAM approaches are excessively costly, dangerous, and/or ineffective. People with MS need to talk with their healthcare providers and do their own “homework” to obtain objective safety and effectiveness information about complementary and alternative medicine.

One area in which there is a lot of MS misinformation is dietary supplements. Supplements are often marketed specifically to people with MS even though many may do more harm than good. There are actually more than 200 supplements that should be avoided or used with caution by people with MS.

An area of frequent confusion is with products that activate the immune system. These are often marketed to those with MS because MS is an immune condition. MS is, in fact, an immune condition, but it is characterized by excessive immune system activity. As a result, supplements that activate the immune system could actually be harmful because they could worsen MS or inhibit the therapeutic effects of MS medications. Examples of immune-stimulating supplements include many herbs, such as the popular Ayurvedic herb Ashwagandha, and antioxidant vitamins.

Are there generally helpful and safe forms of complementary and alternative medicine you tend to recommend to MS patients?

I work with my patients to rigorously follow the seven steps that I’ve outlined above. Importantly, no one does these steps perfectly, and the best ways to pursue each step may change over time, so it’s always a “work in progress.”

Do you have any thoughts about medical marijuana’s use in MS treatment?

Medical marijuana has been of much interest to me for more than three decades. There is quite good evidence that it relieves MS-associated pain and spasticity. As with most medications, however, it has potential adverse effects and drug interactions, some of which are significant in MS. It is a disservice to people with MS that medical marijuana programs in the U.S. do not readily provide objective, MS-relevant information about the effectiveness, safety, and drug interactions of marijuana. I have compiled this information, and it is available on my website through this link.

How about acupuncture?

Acupuncture is one component of a comprehensive treatment approach known as traditional Chinese medicine. For people with MS, I think of acupuncture as a low-risk, potentially beneficial therapy. It is widely known that it may relieve pain. Other MS symptoms that could possibly be eased with acupuncture include bladder difficulties, anxiety, fatigue, and insomnia.

Are any important nutrients or vitamins often overlooked for people with MS?

I think the most important vitamin to be aware of with MS is vitamin D. In some studies, low levels or low intake of vitamin D have been associated with increased risk for MS attacks and disability.

The other vitamin that is important to be mindful of is vitamin B12. People with MS may be at risk for low vitamin B12 levels, and low vitamin B12 levels may produce many of the same neurological symptoms that are caused by MS. Levels of vitamin D and vitamin B12 are measured with routine blood testing — if levels are low, then supplements may be needed.

Expert Voices is a monthly series involving a Q&A with an expert in the MS space about a specific topic. These topics and questions are curated from a survey in which we ask readers what they want to learn more about from experts. If you’d like to submit topics or questions for consideration in a future installment of the series, click here to take the survey.

Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Trial of Cannabidiol-derived EHP-101 for Relapsing MS Enrolling Soon

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Emerald Health Pharmaceuticals will soon begin enrollment in a Phase 2a clinical trial investigating its cannabidiol-derived therapy EHP-101 in relapsing forms of multiple sclerosis (MS).

The trial (NCT04909502) aims to recruit 50 patients, ages 18-55, with relapsing-remitting MS (RRMS) and active secondary progressive MS (SPMS). It follows the clearance of the company’s investigational new drug application by the U.S. Food and Drug Administration (FDA).

Enrollment is expected to take place at about 30 locations in the European Union, the U.S., and Australia. More information on contacts and locations will be available here.

“The absence of therapeutic options that go beyond treating symptoms, inflammation and reducing the incidence of relapses represents a significant unmet need for multiple sclerosis patients,” Jim DeMesa, MD, CEO of Emerald Health, said in a press release.

EHP-101 is an oral therapy whose active ingredient is derived from cannabidiol or CBD — the most well-known non-psychoactive component of the cannabis or marijuana plant. It has various biological activities that may be beneficial for patients with MS, without inducing the “high” associated with tetrahydrocannabinol (THC), the other better-known component of cannabis.

Preclinical studies in MS mouse models showed that EHP-101 can reduce inflammation in the brain and promote remyelination — the regeneration of the myelin sheath that covers nerve fibers and is progressively damaged in MS.

The treatment also was found to be safe and well-tolerated in a Phase 1 clinical trial (NCT03745001), completed in 2019, involving more than 100 healthy volunteers. Only mild to moderate adverse events were reported in that study.

“Our preclinical studies of EHP-101 demonstrated a promising effect on disease progression by preventing demyelination of the neurons, the major issue associated with MS, but also by stimulating their remyelination or regeneration of new myelin, in several multiple sclerosis animal models,” DeMesa said.

The upcoming Phase 2a trial will further evaluate the safety and tolerability of EHP-101 in people with relapsing forms of MS, in which active inflammation mainly contributes to disease progression.

In the trial, participants will receive ascending doses of EHP-101, given once or twice a day, for 24 weeks (about six months). After an initial screening period of up to four weeks, patients will start with a 25 mg dose of EHP-101, once or twice a day, which will be increased to 50 mg (also once or twice daily) after another four weeks.

The main goal of this trial is to determine the safety and efficacy of EHP-101 in MS patients. Secondary efficacy measures include changes in brain lesion activity on MRI scans, as well as changes in disability status and neurological impairment, time to first relapse, and relapse rates.

Other measures include changes in neurofilament light chain in the blood — a well-known biomarker of nerve cell damage — and structural assessments of the brain to identify remyelination.

“We look forward to assessing some of the early indicators of activity of EHP-101 in this Phase 2a study of patients suffering from relapsing forms of MS, the most common disease course,” DeMesa said.

A future mono vaccine may have a shot at defeating multiple sclerosis, a new study suggests

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A study provides the strongest evidence to date suggesting the Epstein-Barr virus may lead to multiple sclerosis .

. Scientists disagree about whether EBV definitively causes MS.

Scientists have found the strongest evidence to date that an infection from the Epstein-Barr virus could significantly increase the risk of developing multiple sclerosis, a degenerative disease, new research suggests.

“Our data strongly suggest EBV is the leading cause of MS,” Dr. Kjetil Bjornevik, a research scientist at Harvard T.H. Chan School of Public Health and lead author of the study, which was published in the journal Science on Thursday, told STAT News.

The findings offer hope that a vaccine or early treatment of the virus could one day help prevent multiple sclerosis, Alberto Ascherio, an author of the study and epidemiology professor at the Harvard T.H. Chan School of Public Health, told Insider.

But experts unaffiliated with the study say there’s still uncertainty about whether the virus causes MS.

The study suggests a much higher MS risk after infection

Multiple sclerosis, a progressive disease that affects the brain and spinal cord, is caused by inflammation that attacks myelin, the fatty tissue surrounding the nerves, according to the National Institutes of Health. In 2020, there were 2.8 million people living with multiple sclerosis worldwide.

When myelin degrades, it’s more difficult for the nerves to send messages to the brain, causing blurred vision, weak limbs, tingling sensations, unsteadiness, and fatigue, according to the Multiple Sclerosis International Federation. In advanced cases, patients can have muscle weakness in their arms and legs, making it difficult to walk or stand.

To determine the link between an EBV infection and MS, scientists analyzed samples from the Department of Defense Serum Repository, a collection of more than 60 million blood samples taken from more than 10 million active and reserve duty members every few years.

The scientists compared blood samples of 1,566 service members who didn’t develop MS to samples from 801 service members who received an MS diagnosis during the course of the study. Of those individuals, 107 members of the control group and 35 members of the group that subsequently developed MS started off without an EBV infection.

By the end of the study, 34 of the 35 people who developed MS had been infected with EBV at some point during the study. In these cases, the infection always preceded the diagnosis.

In other words, all but one person in the study who developed MS had a previous EBV infection — and having that infection increased the likelihood of getting MS later in life by 32-fold in the study, the scientists found.

Jury’s still out on whether EBV definitively causes MS, some experts say

It’s difficult to definitively prove that EBV, which is also the virus behind mononucleosis, causes MS.

Although it’s the most authoritative study to date, the way the study is designed means scientists can’t know with absolute certainty that the virus causes the disease, Alan Thompson, dean of the Faculty of Brain Sciences from University College London and a peer reviewer on the new paper, told Insider.

It’s possible that the virus does cause the disease, Thompson added, scientists just aren’t 100% sure.

“We do need to be a little cautious about getting too excited,” Catherine Godbold, research communications manager for the MS Society, a charity in the UK, said of the study results.

The gold standard would be to do a randomized controlled trial, but that’s impractical as well as unethical, Godbold explained, because it would involve infecting half of study participants with EBV. The current study design is the next best thing, she added.

While the study did not directly investigate how EBV could potentially cause multiple sclerosis, previous research may provide clues.

Some research groups have suggested that the virus carried a molecule at its surface that looks like myelin, confusing immune system, which sees it as a foreign invader to attack, causing inflammation, according to STAT News . Different researchers theorize that immune cells, called B cells, may turn against the body when infected by EBV, STAT reported.

iStock / Getty Images Plus

A vaccine offers hope, but may take decades

While there’s currently no treatment or vaccine against EBV, the pharmaceutical company Moderna is in the early stages of developing an EBV vaccine, using similar technology to current mRNA COVID-19 vaccines.

Using existing technology may quicken the availability of EBV vaccines, by shortening the timeline from decades to years, Thompson said.

Most people catch EBV during their lifetimes, usually during childhood, but the vast majority don’t develop multiple sclerosis, so it’s also important to figure out what other factors are at play. Genetics, vitamin D deficiency, and childhood obesity are all risk factors associated with multiple sclerosis.

Aschiero is hopeful: “If you could prevent infection, we should be able to prevent the large majority of MS cases.”