3 New Insights into MS

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What follows are clinically useful insights on MS culled from 3 presentations at the 7th Joint ECTRIMS-ACTRIMS conference on multiple sclerosis.

I. DIETARY HABITS PUT PATIENTS AT RISK FOR DEMYELINATING EVENT

At the time of MS onset, patients tend to have unhealthy dietary habits.

A case-control study of dietary habits and nutritional status included 60 MS patients with a first demyelinating event who were compared with a similar number of age- and sex-matched healthy controls. Under supervision by a registered dietitian, participants completed 7-days of food recall and food frequency questionnaires for 24-hours food recall. They also had anthropometric evaluations and blood tests for nutritional status.

After 18 months of observation, a conditional logistic regression model found that low vitamin D intake, high intake of rapid absorption carbohydrates, and high omega 6/omega 3 ratio were all independently associated with a risk of diagnosis of a first demyelinating event.

Clinical Implications? 

Some known risk factors for MS include low vitamin D and low polyunsaturated fatty acids intake. This new research found high intake of rapid absorption carbohydrates and high omega 6/omega 3 ratio, which have generally been proposed as pro-inflammatory, may also play a role in MS. Results suggest the need for a dietitian consultation in MS clinics.

Dietary habits, nutritional status and risk of a diagnosis of a first demyelinating event: a single center incident case-control study
ECTRIMS Online Library. Cavalla P. Oct 27, 2017; 200658

Discussion continues on the next page.

II. NATALIZUMAB IMPROVES COGNITIVE FUNCTION IN MS

Natalizumab can significantly improve cognitive function, whether MS patients are treatment-naive or have been previously treated with other disease-modifying treatments.

A retrospective observational study included 52 MS patients--22 (42%) who had disease for up to 5 years and 30 (58%) who had disease of 6 or more years. Before starting natalizumab, 12 patients (23%) were treatment-naive and 40 (77%) were on another disease-modifying treatment.

After 2 years of natalizumab treatment, general cognitive scores improved significantly from baseline levels (median 97.9) to year 2 (median 101.2). Improvement was observed in all 7 cognitive domains from baseline through year 2.

Clinical Implications?

Cognitive impairment, which affects the majority of MS patients and is not commonly recognized or monitored, can be reduced with the high-efficacy disease-modifying treatment.

Switching to natalizumab is associated with improvements in cognitive function as measured by NeuroTrax.
ECTRIMS Online Library. Gudesblatt M. Oct 27, 2017; 200909

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III. EXPOSURE TO ENVIRONMENTAL TOXINS LINKED TO PEDIATRIC-ONSET MS

Exposure to some environmental products during early childhood appears to be linked to an increased risk of pediatric-onset MS.

An ongoing case-control study evaluated potential associations between MS onset before age 18 and history of exposure to common environmental toxic substances during childhood. The study included responses to questionnaires from 326 eligible MS cases (median age 15.7 years, 64% girls) and 506 healthy controls (median age 15.0, 57% girls).

Exposure to rodenticides and pesticides (odds ratio [OR] 1.96), weed agents (OR 1.87), products for plant/tree disease control (OR 2.03), indoor foggers, and products for insect control (OR 1.87) during childhood was significantly associated with an increased risk for pediatric-onset MS in adjusted analyses.

Clinical Implications?

The findings suggest the potential for relationships between pediatric-onset MS and environmental toxic exposures during childhood, but need to be validated in future studies.

Environmental toxic exposures are associated with risk for pediatric-onset multiple sclerosis.
ECTRIMS Online Library. Mar S. Oct 27, 2017; 200510