Aquatic Therapy Improves MS Fatigue, MS Disease Pathology Not Defined by Courses, Rituximab Shows Positive Effect in Myasthenia Gravis

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Welcome to this special edition of Neurology News Network. I’m Marco Meglio.

Findings from a meta-analysis of trials that assessed long-term aquatic exercise training in multiple sclerosis (MS) suggest that this type of therapeutic approach has positive effects on fatigue and balance, and could be a potentially effective strategy in occupational therapy of patients with MS.Led by Brandon S. Shaw, PhD, executive director, University of Essex, a total of 16 trials comprising of 794 participants met the eligibility criteria and were further analyzed. Trials were either experimental, such as case-control studies, randomized and non-randomized controlled trials, and case series. The studies included adults aged 19 years and older with MS, had a land-based therapy, control, conventional therapy, or other intervention as the comparison separate from aquatic therapy, and reported on balance, fatigue, and motor function outcomes. Using the Modified Fatigue Impact Scale (MFIS), 4 trials spanning 163 patients demonstrated improved physical fatigue to a greater extent with aquatic therapy than control group. Similarly, investigators also found that using aquatic therapy significantly improves cognitive function compared with controls on MFIS.

For years, multiple sclerosis (MS) has been defined by 3 clinical courses: relapsing-remitting, primary progressive, and secondary progressive. Now, though, a newly published paper from the International Advisory Committee on Clinical Trials in Multiple Sclerosis suggests that patients with MS share qualitatively similar pathology features independent of clinical course, and that disability progression is neither dichotomous nor genetically determined, ultimately implying the need for a new framework from which to view the disease. Notably, the authors acknowledged that until the underlying mechanisms of the disease are better clarified, any new view of MS disease course will be flexible, and the adoption of biologically based definitions will present operational challenges, "as the existing descriptors are deeply embedded in clinical research and health-care systems" as well as in regulatory processes.

Data from the RINOMAX randomized clinical trial showed that a single dose of 500 mg of rituximab, a medication traditionally used as a third-line option for refractory generalized myasthenia gravis (MG), was associated with a greater probability of minimal MG manifestations and reduced need of rescue medications compared with placebo.The primary outcome, minimal disease manifestations at week 16 defined as a Quantitative Myasthenia Gravis (QMG) score of 4 or less with prednisolone, 10 mg or less daily, and no rescue treatment, was achieved by 71% (17 of 24) in the rituximab group vs 29% (6 of 21) on placebo. The proportions fulfilling the same criteria at week 24 (tertiary end points) and weeks 36 and 48 similarly favored active treatment over placebo. In a related editorial, Miguel Chuquilin, MD, and Richard Barohn, MD, wrote, "The reason for a better clinical response in patients with new-onset AChR gMG may be related to the reduction of formation of long-lived plasma cells responsible for antibody secretion.

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