Linda Morgante

Fatigue therapy in multiple sclerosis Results of a double‐blind, randomized, parallel trial of amantadine, pemoline, and placebo

Objective To determine the relative efficacy of amantadine, pemoline, and placebo in treatment of multiple sclerosis (MS)-related fatigue. Background Fatigue is a complication of MS. Both pemoline and amantadine have been used to treat MS fatigue, but their relative efficacy is not known. Methods Amantadine, pemoline, and placebo were compared in a randomized, double-blind, placebo-controlled study using a parallel-group design. Ninety-three ambulatory MS patients completed the study. Primary outcome measures were the fatigue seventy scale (FSS); the MS-specific fatigue scale (MS-FS); and subjective response determined by verbal self-report. Secondary outcome measures consisted of assessments of sleep, depression, and vitality. Repeated-measures analysis of variance with planned post-hoc contrasts and Fishers exact test were used to compare treatment response. Results Amantadine-treated patients showed a significantly greater reduction in fatigue, as measured by the MS-FS, than did patients treated with placebo (p = 0.04). By verbal report at the end of the study, 79% of patients treated with amantadine versus 52% treated with placebo and 32% treated with pemoline preferred drug therapy compared with no treatment (p = 0.03). No significant differences in any primary outcome measures were noted between pemoline and placebo. Neither amantadine nor pemoline affected sleep or depression relative to placebo. Conclusion Amantadine was significantly better than placebo in treating fatigue in MS patients, whereas pemoline was not. The benefit of amantadine was not due to changes in sleep, depression, or neurologic disability.

The Goldman Consensus statement on depression in multiple sclerosis

Background. In January 2002 the New York City Chapter of the National Multiple Sclerosis Society convened a panel of experts to review the issue of depressive affective disorders associated with multiple sclerosis (MS). This Consensus Conference was supported by a grant from the Goldman family of New York City. Results. The panel reviewed summaries of current epidemiologic, neurobiologic, and therapeutic studies having to do with depressive disorders among MS patient populations. Depressive disorders occur at high rates among patients with MS, and there is reason to believe that the immunopathology of the disease is involved in the clinical expression of affective disorders. The depressive syndromes of MS have a major, negative impact on quality of life for MS sufferers, but are treatable. At the present time, most MS patients with depression do not receive adequate recognition and treatment. Conclusions. The Goldman Consensus Conference Study Group provides recommendations for improved screening, diagnosis, and clinical management for depressive affective disorders among patients suffering from MS.

A multicenter, randomized, double-blind, placebo-controlled trial of influenza immunization in multiple sclerosis

Article abstract-We determined the effect of influenza vaccine in patients with relapsing/remitting MS. Considerable controversy surrounds the question of whether to administer influenza vaccines to MS patients. Prevention of a febrile viral illness is clearly desirable in MS, and previous studies suggest that immunization is safe. Despite this, many clinicians avoid vaccination because they fear precipitating an MS exacerbation. We conducted a multicenter, prospective, randomized, double-blind trial of influenza immunization in patients with relapsing/remitting MS. In the autumn of 1993, 104 patients at five MS centers received either standard influenza vaccine or placebo. Patients were followed for 6 months for evaluation of neurologic status and the occurrence of influenza. Influenza was operationally defined as fever >or=to 38 degrees C in the presence of coryza, cough, or sore throat at a time when the disease was present in the community. Attacks were defined in the standard manner, requiring objective change in the examination. Patients were examined at 4 weeks and 6 months after inoculation and were contacted by telephone at 1 week and 3 months. They were also examined at times of possible attacks but not when they were sick with flu-like illness. Three vaccine patients and two placebo patients experienced attacks within 28 days of vaccine (no significant difference). Exacerbation rates in the first month for both groups were equal to or less than expected from published series. The two groups showed no difference in attack rate or disease progression over 6 months. Influenza immunization in MS patients is neither associated with an increased exacerbation rate in the postvaccination period nor a change in disease course over the subsequent 6 months. NEUROLOGY 1997;48: 312-314

Influenza virus vaccination of patients with multiple sclerosis

Prior to vaccination with a trivalent influenza vaccine (AT/Texas, AB/Beijing, and BP/Panama), sera from 19 MS patients had a significantly higher mean level of antibody than 9 normal subjects to AT strain of influenza, but not to AB or BP strains. After Flu vaccination, the mean anti-AT and anti-AB antibody titers significantly increased 4-fold in I I MS patients and 9 normal subjects. The ratio of MS responders (6II1), however, was lower than normal (8/9). The mean PBL proliferative response to the Flu antigens increased after vaccination significantly more in MS patients than in normal subjects, and increased in 9 of I I MS patients and 3 of 9 normal subjects. Although MS patients responded to Flu antigens with higher antibody levels and proliferative responses of PBL, than normal subjects, a clinical protective effect of the vaccine against Flu was not dearly demonstrated in these patients, and vaccination did not cause or protect against exacerbation of MS.

Rethinking cognitive function in multiple sclerosis: a nursing perspective.

&NA; Cognitive impairment is a common problem in multiple sclerosis (MS); up to 65% of patients exhibit some neuropsychological dysfunction during the course of their disease. It is a major contributing factor to unemployment, accidents, impairment of daily functioning, and loss of social activity in those affected by MS. The areas of cognition typically impaired are memory, attention, information processing, executive functions, and visuospatial skills. Cognitive dysfunction is independent of disease duration and level of disability; cognitive decline may begin in the earliest stages of MS before patients become even mildly, disabled. Structural brain imaging studies show a positive correlation between the extent of brain atrophy and cognitive dysfunction. Despite its prevalence in MS, cognitive dysfunction often goes undiagnosed or is misdiagnosed as depression, stress, stubbornness, lack of intelligence, or psychosis. Because nurses play such an important role in the care of patients with MS, they are in a position to identify patients with cognitive dysfunction, educate patients and their families on ways to cope with cognitive deficits, and counsel patients on available treatment options. Practical guidelines help nurses identify and care for cognitively impaired MS patients.

Decision Making in Multiple Sclerosis: Theory to Practice

Multiple sclerosis (MS) is an uncertain disease that manifests itself in neurological symptoms unique to each individual. People with MS and their families experience the day-to-day variability of the disease and often face difficult decisions regarding their care. Decisions include opting for a disease-modifying therapy soon after the diagnosis of MS is confirmed, choosing various pharmaceutical and nonpharmaceutical treatments for managing the symptoms that result, changing therapies and selecting alternatives when prescribed treatments are not successful, and determining whether to enter a clinical trial of a promising medication. When new therapies become available, nurses are faced with the important task of clarifying expectations, helping patients understand the risks and benefits of the new agent and, if appropriate, the rationale for continuing on their current regimen rather than switching therapies. Patients should be taught to appraise how they are doing on their current treatment and then wei...

Influenza immunization in multiple sclerosis

Reply from the Authors: We appreciate the comments by Salvetti et al. regarding our paper1 on influenza vaccination in patients with relapsing-remitting multiple sclerosis (MS). We are pleased that they agree with our conclusion that such immunization can be recommended for MS patients. The correspondents have raised a note of caution because …

Developing Proposals for Nursing Research

A nursing specialty research panel was assigned the task of developing research questions pertinent to the issue of bladder management and skin integrity in multiple sclerosis. Review of the literature highlighted a gap in nursing research specific to nursing practice. Surveying colleagues at other multiple sclerosis centers revealed an inconsistent practice pattern. We believe that urinary tract infections can lead to worsening of MS symptoms and that urinary retention is a common cause of urinary tract infections. The technique of intermittent-self-catheterization is taught to patients to decrease urinary retention. The first research question addresses recommendations for catheter reuse. Additionally, skin breakdown is frequently referred to as a complication of MS. We do not know the incidence and prevalence of skin breakdown in this population. Moreover, we do not know the specific risk factors for skin breakdown in MS clients. The Braden scale has been utilized to predict pressure ulcer risk in the geriatric population. The pressure ulcer study being planned by the MS nursing specialty panel intends to examine the utility of the Braden scale to predict skin breakdown in MS patients. Both studies will include patients with clinically definite multiple sclerosis from MS centers within the Consortium of Multiple Sclerosis Centers.