Saturday, 6 July 2013

MS disease trajectory

MS and ageing: nobody wants to get old. #MSBlog #MSResearch

Epub: Bove et al. No sex-specific difference in disease trajectory in multiple sclerosis patients before and after age 50. BMC Neurol. 2013 Jul 3;13(1):73.

BACKGROUND: The disease course in MS is influenced by many factors, including age, sex, and sex hormones. Little is known about sex-specific changes in disease course around age 50, which may represent a key biological transition period for reproductive aging.

METHODS: Male and female subjects with no prior chemotherapy exposure were selected from a prospective MS cohort to form groups representing the years before (38-46 years, N=351) and after (54-62 years, N=200) age 50. Primary analysis assessed for interaction between effects of sex and age on clinical (Expanded Disability Status Scale, EDSS; relapse rate) and radiologic (T2 lesion volume, T2LV; brain parenchymal fraction, BPF) outcomes. Secondarily, we explored MSers or patient-reported outcomes (PROs).

RESULTS: As expected, there were age- and sex- related changes with male and older cohorts showing worse disease severity (EDSS), brain atrophy (BPF), and more progressive course.There was no interaction between age and sex on cross-sectional adjusted clinical (EDSS, relapse rate) or radiologic (BPF, T2LV) measures, or on 2-year trajectories of decline.There was a significant interaction between age and sex for a physical functioning PRO (SF-36): the older female cohort reported lower physical functioning than men (p=0.002). There were no differences in depression (Center for Epidemiological Study  Depression, CES-D) or fatigue (Modified Fatigue Impact Scale, MFIS) scores.

CONCLUSIONS: There was no interaction between age and sex suggestive of an effect of reproductive aging on clinical or radiologic progression. Prospective analyses across the menopausal transition are needed.   

"MS predisposes the brain to premature ageing. The healthier you keep your brain the better you age. How do MSers keep their brain healthy? That's a story for another day."

3 comments:

  1. Prof G,

    You've said that time is brain, so I'd really like to know how to keep my brain as healthy as possible. Is this research telling us that if we get to an oldish age we're going to be in a pretty bad state - mentally and physically?

    Given all the recent bad news posts, are there many diseases which are worse than mS?

    Given all the recent bad news posts, i'm advising friends to buy shares in Dignitas. Very depressing disease with a depressing looking future. When I was dx my neuro's advice was to not visit ms websites. I now know why. Reading some of the posts over recent months, I have little hope for th future. At one point, I thought I'd be in th generation who might get a cure for this disease. I just hope the next generation gets a better deal.

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  2. I echo this. On the one hand, it has definitely helped to feel in control of things by keeping informed, but as there's no likelihood of being able to access second line DMDs, it IS depressing. I now don't look at this site every day because I daren't let myself get into a downward spiral. Mind you, I shall be asking my neuro quite a few hard questions this time round! This said, I am deeply grateful that Prof G spends the time he does reaching out to the MS community. We owe him a lot.

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  3. If I'm honest, all the reaching out to the MS community can never achieve what I want from MS researchers / neurologists = to get back to full health, or to at least get some of the deficits back. I had high hope for Team G and got a great buzz from attending the research days. But I now need to see all this effort convert into real treatments. Promise 2010 has yet to deliver for MSers. We have no neuroprotective agents and no neuro restorative agents. At the very least, as someone who has done some crazy things for raising money for MS research, I want some ball park estimate of when I might get some real benefits from all this research. I'm very grateful to the two Profs for all their work on the blog, but am less convinced that I'm going to benefit from th research ring undertaken. Is there a lesson to learn from the two Cs in Cambridge? Focus on one potential treatment and push it through. Team G seems to be involved in so much research that it's a quantity v quality issue. Is this why many grant applications gt turned down? Prof G works his socks off bt perhaps is stretching himself too thinly. I'd focus on the Charcot project and the most promising neuroprotective agent. Further work for pharma should be rejected. A change of strategy like this will give Prof G a better work life balance and deliver some tangible results ie real treatments which MSers can benefit from.

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