Effectiveness of Mindfulness-Based Interventions to Reduce Stress in Patients With MS

Christopher C. Hemond, MD

In research performed through MRI, reduction in levels of stress have been associated with reduced inflammation. One intervention that shows promise for patients with multiple sclerosis (MS) is mindfulness-based stress reduction (MBSR). The therapy is a low-risk intervention that may be salubrious for systemic inflammation as well as for the debilitating “silent symptoms” of MS.

A recent study showed MBSR was associated with improvements in MS among patient-reported outcomes (PROs) for the silent symptoms in MS. The findings were presented in an abstract presentation in a platform session by lead author Christopher C. Hemond, MD, assistant professor of neurology, UMass Chan Medical School, at the 2023 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 31 to June 3, in Aurora, Colorado.¹

In the study, 23 patients with relapsing-remitting MS were offered 8 weeks of free MBSR (median age = 45 ± 11; 100% female; Expanded Disability Status Scale score = 2.0 [±1.2]). Volunteers were enrolled for pre- and post-course assessments of PROs, hair cortisol, blood-based inflammatory gene expression markers, and structural MRI. There were no reports of patients with new clinical/MRI disease activity during the 12-week observation period and 57% were on a B-cell-depleting agent. Only 91% of the patients completed the MBSR course.

During the meeting, Hemond sat down in an interview with NeurologyLive to discuss more about the findings from the study. He provided an overview of the design of the study, as well as the notable results observed. Hemond also talked about the implications of the findings regarding the management of MS and the use of mindfulness-based interventions. In addition, he spoke about the study’s limitations and what the next steps in research are in this area.

NeurologyLive: Can you provide an overview of the study design and main findings?

Christopher C. Hemond, MD: This is an unblinded, observational study of pre-post effects of mindfulness-based stress reduction on patient-reported outcome measures, structural MRI changes, and peripheral blood inflammatory markers. We found significant improvements across a wide range of patient-reported outcome measures including stress, fatigue, anxiety, depression, loneliness, and well-being. MBSR was also associated with large increases in interoceptive awareness (a perception of one's own bodily/internal state).

Secondly, most of these self-reported measures correlated highly with the Conserved Transcriptional Response to Adversity (CTRA), which is a 53-gene panel readout of peripheral white blood cell inflammation and antiviral potency. The CTRA is typically increased in conditions of environmental and social adversity.

Were there any other noteworthy findings from the study?

In preliminary structural MRI analyses limited to prespecified regions-of-interest in limbic structures, we found that MBSR is associated with a ~1% volumetric enlargement of the right hippocampus, similar to results from several other prior studies. We did not find any changes in the volume of the amygdala or its sub-structures.

What are the potential implications of these findings for the management of MS and the use of mindfulness-based interventions?

These findings further support the existing literature on the potential for MBSR to improve the challenging "silent symptoms" of MS without potential adverse effects from pharmacological intervention. Also, the Conserved Transcriptional Response to Adversity appears to be valid as a biological readout in MS, as it was highly positively correlated with multiple patient-reported measures of worsening social adversity such as loneliness, stress and anxiety.

Were there any limitations or challenges encountered during the study that may have influenced the results or interpretation?

Yes, the trial was both small with a total of 23 patients with MS as well as unblinded and observational. This trial design is susceptible to various forms of bias which reduce the generalizability of results, and increase the risk of type I statistical errors.

Based on the results of this study, what are the next steps for further research in this area? Are there any plans for conducting additional studies or investigations?

Some of the imaging data are still being processed, with the next steps including additional region-of-interest analyses including the hypothalamus and its sub-structures. Additionally, we will be assessing resting-state functional MRI connectivity measures and any changes related to MBSR. Since this is a small study, future studies will focus on both a larger sample size as well as a randomized, controlled design to reduce bias.

Click here for more coverage of CMSC 2023.

Transcript edited for clarity.

Editor’s Note: Christopher C. Hemond disclosed a consulting fee with VIVIO.

REFERENCES
1. Hemond CC, Deshpande M, Morales IB, et al. An Unblinded Observational Study of Mindfulness-Based Stress Reduction in MS: MRI and Biological Inflammatory Correlates of Patient-Reported Outcomes. Presented at CMSC 2023. IMG06.