Now that the dust from this year’s ECTRIMS meeting has finally settled, I’ve had the chance to sit back and reflect on my experiences at the meeting and the interesting research that was presented.. As the largest conference singularly devoted to MS in the world, ECTRIMS takes the pulse of MS research and, through the convergence of accumulated data and new ideas, sets the foundation for future advances in our understanding of MS and finding new, effective therapies.
This year’s conference left no stone unturned, covering topics ranging from new diagnostic/prognostic tools and risk factors to cutting-edge treatments and rehabilitation strategies. To summarize the full-range high-quality research studies at ECTRIMS spread across over 1,500 oral and poster presentations would be an impossible feat; instead, over the next few posts I’ll be leaving you with some highlights, including key areas in the research landscape that are up-and-coming over the next few years. The next few posts are inspired by Dr. J Sastre Garriga (Multiple Sclerosis Centre of Catalonia, Barcelona, Spain) and Dr. Heinz Wiendl (Universitätsklinikum Münster, Münster, Germany), who combed through all of the seminars and posters and presented their top highlights at the closing session.
While ECTRIMS 2015 was defined by a number of ground-breaking clinical findings that made waves throughout the MS research community, one thing that struck me was the surge in research on wellness and societal aspects of MS compared to just a few years ago. Here are some of the studies that caught my eye this year:
Wellness
- Easy-to-use and access technologies have been increasingly investigated as potential tools to correct balance problems in people living with MS. Dr. Francesca Tona (Sapienza University, Rome, Italy) and her team demonstrated that high intensity training over 12 weeks using a Nintendo Wii balance board can significantly improve balance impairment in people living with MS, and also mapped out the formation of new functional connections in the brain’s cerebellum (centre in the brain that coordinates balance, posture, and coordination) in response to balance training.
- Based on evidence that physical activity can provide benefits to fatigue, cognition and depression, MS Society of Canada-funded doctoral candidate Stephanie Grover (The Hospital for Sick Children, Toronto, ON) investigated physical activity in children and adolescents living with both MS and monophasic acquired demyelinating syndrome (mono-ADS; a potential precursor to MS). She found that youth with MS generally participate in less strenuous exercise than those with mono-ADS, and that depression and fatigue were less common in those who undertook more strenuous levels of physical activity.
- Loss of skeletal muscle mass and function is a common problem in MS. Dr. Ulrik Dalgas (Aarhus University, Aarhus, Denmark) presented data showing that high intensity training – highly intense spurts of physical activity separated by periods of rest – in MS participants over 12 weeks resulted in an increase in the molecular components necessary to repair and build new muscle.
- Since participating in physical activity and getting to a gym can be a challenge for people living with MS, there is a need for more effective approaches for promoting physical activity. A controlled trial conducted by Dr. Mathias Mäurer (Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany) showed that internet-based interventions (including online consultations, web-based consultations and online therapeutic software) improved muscle strength, physical activity and fitness, although feelings of fatigue and health-related quality of life were unaffected.
- An Amsterdam-based research group led by Dr. Jeroen Geurts examined the effects of sleep disturbance on brain activity and cognition in people with MS. Results of the study, presented at ECTRIMS by Dr. Quinten van Geest, shows that sleep disturbance didn’t affect cognition as seen on MRI, but were related to subjective cognitive problems, meaning people felt that issues with sleep affected their ability to think and perform tasks. They also found that sleep disturbances impacted functioning of the thalamus – the central neurological hub carrying important sensory and motor signals throughout the brain. He notes that sleep therapy might help to improve the quality of life in people with MS, and that identifying and validating measures of sleep disturbances should be a priority.
- Data from a small randomized controlled trial presented by Dr. Markus Bock (Max Delbrück Center for Molecular Medicine, Berlin, Germany) showed evidence that both a prolonged (7-day) fasting diet or a ketogenic diet (high-fat, low-carbohydrate) may have beneficial effects on health-related quality of life in people living with relapsing remitting MS. He proposes that these types of diets produce byproducts from fat breakdown called ketone bodies that are thought to help protect the brain from damage
Social and economic outcomes
- MS Society-funded doctoral candidate Neda Razaz (University of British Columbia, Vancouver, BC) conducted a detailed analysis into rates and determinants of mental health disorders in children with a parent living with MS. She found that children with a mother living with MS had an overall higher rate of mental health disorders like anxiety and depression, particularly if the mother also had a mental health disorder. These findings underline the importance of providing appropriate support to the person living with MS and their children to manage the risk of negatively affecting childhood development.
- Dr. Michael Wiberg (Karolinska Institutet, Stockholm, Sweden) presented data analyzing participation in the workforce and income security over time among people living with MS in Sweden. His study compared the distribution of earnings among people with MS and healthy controls across education levels and occupation types, and found that work capacity gradually decreased in people with MS following diagnosis. Fine-grained analysis such as this is important for informing policies about disability and income supports.
- In a study led by Dr. Nancy Sicotte (Cedars-Sinai Medical Center in California), a total of 105 participants underwent a neuropsychological and cognitive assessments, in addition to MRI scans in order to identify a potential link between depression as a co-morbidity (co-existing condition) in MS and major depressive disorder. The MRI revealed that people with MS who are also affected by depression experience significant cognitive impairment and have a smaller hippocampi (the part of the brain that controls emotion, memory and navigation). Interestingly, they found some similarities on MRI between depression in people with MS and major depressive disorder, although they still appeared to be distinct conditions which suggests different mechanisms.
Stay tuned for part 2 where I review some of the studies on genetic and environmental risk factors. In the meantime, leave any comments or questions below.