I am truly amazed at the breadth of research I am seeing at the AAN on restoring function to people with MS. Scientists are looking virtually everywhere for answers about how to manage symptoms and improve function through novel treatments and rehabilitation techniques.
One great aspect of attending the AAN is hearing about exciting advances in neurology in general – Dr. Albert Lo (we talked about his salsa dance program) presented promising research on rehabilitation robotics at a plenary session to thousands of neurologists. Robots can do heavy lifting for tasks like supporting a person’s weight while they walk on a treadmill, and they can be programmed to provide precise resistance and “dosages” of an exercise. A core concept of rehab is the necessity to do repetitive work. And robots are masters of repetition – an occupational therapy session may require 50 repetitions of an exercise, and robots can guide a person’s arm to do those precise repetitions. We need more proper trials, says Dr. Lo, but it was exciting to see this new frontier of rehabilitation research, which is just beginning to be applied to improving function for people with MS.
Dr. Victor Mark and colleagues from Birmingham and Philadelphia showed that a simple intervention can have dramatic results – even “rewiring” the brain to some extent. Dr. Mark is studying constraint-induced (CI) movement therapy. This has been used successfully in stroke, and involves immobilizing the arm that a person favors, and forcing the arm weakened by MS to do exercises and skilled movements to promote increasing the use of that limb in daily life. The team randomly assigned 20 people with progressive MS to a CI program or a control group involving involving activities such as aquatherapy, massage and yoga. Not only did use of the weaker arm improve, but brain tissue in the cortex (the outer layer of the brain) increased significantly in those in the CI program, but not in the control group. If the findings hold up with further study, it could produce dramatic results from a relatively simple technique.
Many studies of marijuana derivatives have produced mixed results related to improving MS symptoms. One reason for the mixed results may be that some people respond to such derivatives while others do not. I viewed a poster from Dr. J. Ruiz and a team in Spain who are taking a high-tech approach to clarifying this picture. The team used genetic techniques to screen 36 people who had participated in a trial of Sativex (a cannabinoid spray derived from marijuana available in many countries outside the U.S.) to treat spasticity. They were looking for signals that might determine what differed in the genes of people whose spasticity was helped by the treatment versus those who didn’t respond. The team detected several genetic signals in responders. These results need further study, but this is a glimpse of what the future may hold for personalizing medicine and even figuring out why treatments such as this marijuana derivative work.
People with MS often tell me that cognitive problems are some of the most troublesome symptoms they face in their daily life. A team at the Cleveland Clinic is making strides in using technology that may help improve how we approach cognitive testing and treatment. Dr. Rao and colleagues have developed an iPad-based app for testing cognition in MS. The app is part of a battery of tests that can be used to quickly and easily assess several MS symptoms. This week they reported that the iPad test works well, tapping into the same cognitive abilities as other commonly used neuropsychology tests. Also, it doesn’t require a technician to be administered, and can be programmed to automatically add the results to a person’s medical record. This tool could help us better diagnose cognitive problems and intervene earlier. It may also come in handy in future clinical trials of new therapies addressing cognition.
When cognitive problems strike kids with MS, it’s hard on everyone. This is particularly true because cognitive changes can interfere with school performance. Dr. L. Krupp and researchers from the Network of Pediatric MS Centers examined cognitive changes over two years in 67 kids with MS. The most common problems were visual or motor integration, information processing speed, and attention. The good news is that most of the kids didn’t get worse over the two years. It’s crucial for us to pinpoint these problems and address them precisely, so that we can improve the lives of this small but important population in the MS community.
The scope of this research and the increasing use of technological advances such as genetic screening and tablet computers gives me lots of hope that we are on our way to finding solutions that can improve the lives of everyone with MS.