I am blogging from the 66th Annual Meeting of the American Academy of Neurology in Philadelphia, otherwise known as the AAN meeting. The AAN features thousands of presentations on neurological diseases. I am increasingly impressed with how many of these address wellness and lifestyle in people with MS. Entire sessions are dedicated to topics such as “Diet and Hormonal Influences in MS” and “Cognition and Fatigue in MS.” We are becoming more aware of the diverse paths toward finding solutions for everyone with MS.
And even salsa dancing! Mandelbaum, Lo and colleagues (Providence, RI) reported here on a study in which they enrolled eight people with MS in a four-week salsa dance program. Individuals participated in dance sessions twice a week. Dancing resulted in significant improvements in gait and balance both right after the program and after three months of follow up. The National MS Society is now funding Dr. Lo of this team to conduct a larger study that may lead to more widespread use of dance as physical therapy for MS.
Fatigue is a significant problem that affects many people with MS – one for which we don’t yet have enough solutions. I heard a report from Dr. Barak and a team from Israel. Based on the increasing evidence that low levels of vitamin D may be a risk factor for MS, they administered a compound similar to vitamin D (alfacalcidol) or an inactive placebo to 158 people with MS once daily for six months. The treated group had significantly less fatigue, improved quality of life, and even reductions in relapses. I think this study presents a promising lead for reducing fatigue that certainly needs and warrants further study.
Another group of researchers reported on other factors that might contribute to fatigue in people with MS. They used polysomnography – advanced technology used to diagnose sleep disorders – to examine 206 people with MS who reported that they had fatigue, but who had not reported sleep problems. This test revealed that 68% actually had obstructive sleep apnea. It was great to hear that there might be a way to reduce fatigue in MS by diagnosing and addressing sleep problems.
One of the most interesting factors in the complex picture of MS, to my mind, is the growing body of research on the role of the ‘gut microbiome.’ Each of us has millions of bacteria living in our guts. Most of these bacteria are harmless as long as they remain within the inner wall of the intestine. But in MS, these bacteria may be contributing to the MS immune attack. Dr. Jhangi and colleagues at Harvard examined microorganisms in people with MS who were not on any disease modifying treatment, those on treatment, and healthy controls. Certain bacteria that are known to promote inflammation were increased in those with MS. Another type of bacteria known to block inflammation was lower in people with MS vs. controls but higher in those who were receiving one of the MS disease modifying treatments.
Inflammation occurs in MS when the body's own immune cells attack the nervous system, damaging nerve fiber-insulating myelin. Researchers are hopeful that by finding ways to reduce inflammation they may be able to limit the damaging effects of the disease. From this preliminary study, it’s too early yet to say how this emerging information might impact future treatment of MS, but it’s fascinating to think that, down the road, we might affect MS by altering our gut bacteria. This video highlights some additional work we are funding in this intriguing topic.
This is one small part of AAN reports on wellness and lifestyle in MS. I am excited about the growing prospects for improving the daily life of people with MS. You can read more by browsing through the abstracts here.