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MRI patterns decipher between MS and VWM(23/04/15)

Researchers say they have found evidence that makes it easier to differentiate between multiple sclerosis (MS) and vanishing white matter disease (VWM) – conditions that can show considerable similarities.

According to a presentation at the American Academy of Neurology in Washington, DC, diagnosing primary and secondary progressive multiple already presents a challenge because the signs – like large and confluent lesions and multiple cavitary lesions – are rarely shown on a brain MRI. However, the comparable symptoms with VRM can cause a misdiagnosis.

“It is important to identify specific MRI findings that can be relevant diagnostic tools,” the study’s authors wrote.

Lead author Xavier Ayrignac, of the Department of Neurology in Centre Hospitalier Universitaire de Montpellier in France, and his colleagues evaluated 14 MS and 14 VWM patients to find key differences between their brain scans.

“In this context, the diagnosis of multiple sclerosis can be difficult and a diagnosis of VWM should be considered,” Ayrignac and his team determined.

When cavitary lesions show up on the MRI, it becomes more challenging to decipher between the central nervous system diseases. The researchers focused on specific features including regional atrophy, white matter and gray matter hyperintensities location and type, and posterior fossa involvement along with middle cerebellar peduncle and cerebellar white matter lesions.

While similar results were indicated between the MS and VWM patients – like focal atrophy, basal ganglia atrophy, and corpus callosum atrophy – the investigators found important individualized characteristics for the diseases:

- Cerebellum atrophy: 8 (57%) MS patients, 13 (93%) VWM patients
- Topography of the lesions (thalamus): 10 (71%) MS patients, 1 (7%) VWM patients
- Topography of the lesions (midbrain): 11 (79%) MS patients, 4 (29%) VWM patients
- Extensive juxtacortical lesions: 7 (50%) MS patients, 14 (100%) VWM patients
- Ovoid perpendicular to the ventricle: 14 (100%) MS patients, 0 VWM patients
- Corpus callosum extensive: 9 (64%) MS patients, 14 (100%) VWM patients
- Extensive lesions (external capsule): 4 (29%) MS patients, 12 (86%) VWM patients
- Perivascular cavitary lesions: 10/12 (83%) MS patients, 1/6 (17%) VWM patients
- Infratentorial symmetrical: 0 MS patients, 6/12 (50%) VWM patients
- Fluid like cavitary lesions: 3 (21%) MS patients, 9 (64%) VWM patients

“Nevertheless, our results suggest that the analysis of characteristics of MRI findings including topography and morphology of the lesions is of major diagnosis importance for the differential diagnosis of these 2 disorders,” the team concluded.

Source: MD All Specialities Copyright HCPLive 2006-2015 Intellisphere, LLC (23/04/15)

Study suggests wearables could help MS patients(15/04/15)

A three-week study by Biogen and the American patient network PatientsLikeMe claims to have found patients with multiple sclerosis can benefit from a wearable device that tracks their activity, reports the Boston Business Journal.

Biogen and the patient platform, which collects and shares patient experiences on its website, conducted the study to show the feasibility of using wearables.

“MS impairs the ability to walk for many people with MS, yet we only assess walking ability in the limited time a patient is in the doctor’s office,” said Dr. Richard Rudick, vice president of value-based medicine at Biogen.

“Consumer devices can measure number of steps, distance walked, and sleep quality on a continuous basis in a person’s home environment. These data could provide potentially important information to supplement office visit exams.”

The study found patients were receptive to wearing a device and sharing their data, and said the device helped prompt patients to be more active and helped them manage their MS.

Of the 248 PatientsLikeMe members who were provided with activity trackers, 213 activated the device and authorized PatientsLikeMe to access their data. Another 203 tracked data on the device.

Source: Boston Business Journal © 2015 American City Business Journals (15/04/15)

Australia gets cutting-edge microscope(02/02/15)

The "secrets of life" could be revealed by a powerful new microscope, the only one of its kind in Australia.

THE $5million, three-metre tall microscope, unveiled at Monash University in Melbourne, allows researchers to see molecular structures at very high resolution.

"This is one of the most exciting days of my life," said Professor James Whisstock, the Australian Research Centre's director of advanced molecular imaging.

Professor Whisstock hopes the microscope will lead to better treatments for cancer, diabetes and multiple sclerosis.

"Understanding our immune system is central to fighting cancer, infectious diseases such as malaria, and auto-immune diseases such as diabetes, rheumatism and multiple sclerosis.

"The key to understanding and treating these diseases lies in understanding how proteins and cells interact at the molecular level."

Professor Whisstock said the instrument highlights how physics and engineering together can be used to answer biological problems.

"We need physicists and engineers to be able to build these devices that can see the secrets of life."

Until now Australian scientists had to travel to Europe, the UK or the US in order to access similar microscopes.

"The problem with that is transporting biological material internationally is quite hard."

The Dutch-made Titan Krios instrument works by firing electrons through a sample.

Some of the electrons in the beam are deflected and these rays can be used to create a 2D image of the sample. Multiple 2D images can then be automatically pieced together to create 3D images of molecules.

Source: The Australian (02/02/15)

Google, Biogen team up for multiple sclerosis research(28/01/15)

Google, expanding its foray into medical research, will join Biogen Idec, maker of MS drugs, to study environmental and biological contributors to the condition’s progression.

The collaboration is the second major pharmaceutical partnership for the life science division of Google X labs, which has produced Google Glass and self-driving cars. Google X sees itself as providing the technical and innovative fire power for a “moonshot” in the health care field, said head of the division Andrew Conrad.

“Our central thesis is to change health care from being reactive to proactive,” Mr Conrad said. “We’re trying to understand condition at its onset and see if we can intervene early.”

Using sensors, software and data analysis tools, the companies will collect and sift through data from people with MS. The goal is to explain why the disease progresses differently from patient to patient, said Rick Rudick, Biogen’s vice president of development sciences.

“We used to see patients at the beginning stages of MS — two women would come in with optic neuritis, they couldn’t see out of one eye, they’d have some spots on the MRI scan, and they looked very similar,” said Rudick, who was previously director of the Cleveland Clinic’s MS program. “But as we followed them along, 10 years later, one would be a championship tennis player still and one would be in a nursing home. I never understood that.”

Biogen leads the market with five MS drugs and is using new technology to gather round-the-clock data on patients. It has run a Fitbit study to see whether fitness bands could be reliable data-gathering tools, and is developing an iPad app with the Cleveland Clinic to help physicians better assess their patients’ MS progression.

While Rudick and Conrad declined to comment on the terms of the deal, Conrad said it would probably be a multi-year effort.

MS affects 2.3 million people worldwide, according to America’s National Multiple Sclerosis Society. It causes the immune system to attack myelin, a fatty substance that coats and protects nerve fibers. Patients can experience tingling, problems with walking and degrading vision. Their symptoms get worse as MS progresses.

There are no approved cures, only drugs that help suppress the immune system or manage symptoms. Patients typically see their doctors a few times a year, meaning their day-to-day experiences aren’t catalogued.

More data may help Biogen develop more-effective drugs, or better understand which drugs should go to which patients. The experience of patients could also help Biogen prove the value of its medicine to insurers and pharmacy benefit managers, which are cracking down on high-priced drugs. MS treatments typically have wholesale prices of $50,000 a year.

After Chief Executive Officer George Scangos ran into Conrad at a digital health conference, according to Conrad. Scangos saw the opportunity to combine the search giant’s technical savvy with Biogen’s knowledge about MS.

“They bring great expertise in data analytics and technology, they’re sophisticated in their approach, they understand biology,” Scangos said, listing reasons why Biogen turned to Google instead of an academic partner.

The collaboration also deepens Google’s commitment to the health industry. Google X ventured into health care in January 2014 with the announcement of a smart contact-lens project.

The lens, developed to measure glucose in diabetes patients’ tears, was licensed by Novartis AG in July. Google X also bought health-tech startup Lift Labs, which makes cutlery that could counteract tremors experienced by people with Parkinson’s.

Conrad has 150 scientists working for him, including astrophysicists, theoretical mathematicians, oncologists, immunologists, electrical engineers and computer scientists.

“What I think and hope we’re good at,” he said, “is trying to do this moonshot, innovative thinking, where it’s OK to fail, and we’re looking for partners to join in these endeavours.”

Source: SFGate (28/01/15)

Novel brain measurement software used in major MS study(22/12/14)

Icometrix, a biotechnology company focused on unique projects for diagnosing and treating multiple sclerosis (MS) patients, has designed new software for the measurement of brain lesions and brain volumes and their changes over time. MS, a chronic and neurological condition that affects about 2.5 million people throughout the world, is often first detected in patients at a young age, and the company expects to improve diagnosis and treatment options with the measurements.

Icometrix expects its new software to be able to help MS patients who need to keep track of their brain volume and brain lesions with their physicians, since the two characteristics are directly connected to patients’ physical and cognitive capacities, which are progressively affected as the disease progresses.

“Complementary to the evaluation by the radiologist, we perform calculations on MRI scans of the brain, which most people with MS already undergo regularly,” explained the co-founder and Chief Business Officer of icometrix, Ir. Wim Van Hecke. “We are the first to calculate brain volume with such accuracy that it can be used in clinical practice. It is great that we can introduce this in 2014, which was launched as the ‘Year of the Brain,’ by the European Brain Council.”

The brain volume measurements will be used for assessment within the major, multi-center project organized by the Belgian Study Group for Multiple Sclerosis, which has been working for 50 years since its foundation to enhance both research and treatment of MS in Belgium. The group gathers the most recognised Belgian MS neurologists as well as MS investigators. In the case of this study, 12 Belgian hospitals and MS centres and one other hospital in Luxembourg will participate in order to assess brain scans of more than 200 MS patients.

“Neurologists are very interested in reliable measures that can tell us something about the state of the brain of an MS patient,” stated the head of Neurology of the National MS Center in Melsbroek, Prof. Guy Nagels. “We believe this information can help us take better decisions for our patients,” Prof. Nagels stated. “The potential of these measures also goes beyond MS. In the future it might benefit patients with Alzheimer’s disease, epilepsy, or other neurological conditions.”

Wim Van Hecke emphasised the company’s excitement about the project, but noted that despite the high level of morale among the research team, the work will not end with this Belgium-based study, since he believes the measurements may be able to help patients and research worldwide. “Pilot studies are coming up and will start in the beginning of 2015 in The Netherlands, France, Italy, Germany and the US. In addition, we are very close to obtaining our CE and FDA approval, which means that our software is approved for clinical practice. And this is an important milestone for both icometrix and MS patients worldwide,” he added.

Source: Multiple Sclerosis News Today © BioNews-tx.com 2014 (22/12/14)

Study tests whether vibrating insoles improve MS balance(17/12/14)

A new Multiple Sclerosis pilot study was awarded a $39,000 grant by the US National Multiple Sclerosis Society to investigate how patients’ sensation in their feet while standing impacts balance and whether their ability to walk is improved through the use of vibrating insoles.

Multiple Sclerosis is characterised by the destruction of the inner layer of nerve cells, mainly composed of myelin. This destruction is thought to occur either by patients’ own immune systems attacking the central nervous system, specifically myelin, or by cells failing to produce this component. Currently without any cure, MS affects over 2.3 million people throughout the world, leading to a diverse symptomatic disease, impacting visual, sensory, and motor capabilities. As a consequence, MS patients exhibit major limitations, notably fatigue and balance impairments.

In this study, a team of researchers at the University of Massachusetts Amherst will evaluate the sensation in patients’ feet soles (analysing two different areas) and compare their results with healthy subjects. The analysis will be performed while sitting and standing up to determine how this impacts patients’ balance. The project introduces a new focus, since the majority of previous reports only determine patients’ parameters while lying down. Introducing a new standing parameter will allow determining how weight bearing impacts MS patients’ balance.

The authors are recruiting both patients with Multiple Sclerosis and healthy subjects aged between 21 and 65 years old. Notably, all the participants have to be able to walk and stand up without assistance. Participants’ ability to be enrolled in the study will be determine by different tests including, muscle strength and the 25-foot walk; additionally, patients will be analysed for skin sensation (pressure and vibration), standing balance and posture evaluation.

With all parameters evaluated, the project will determine the effect of a vibrant sole to be administered in patients’ feet while vibrating at low, undetectable frequencies. This will be achieved by small devices – “factors” — introduced in patients’ shoe soles in the areas previously assessed as the most sensitive. Patients will then be evaluated in a blind test, consisting of five different postures in five-minute intervals before repetition, during which patients will not know whether the “factors” are being used.

In a final phase of the study, these results will allow the researchers to test how these factors help Multiple Sclerosis patients in the presence of an unexpected balance challenge, such as standing on a platform that without notice moves 3 inches (8 cm).

The researchers highlight that the study will uncover the potential use of vibrating shoe soles in patients with balance impairments.

Stephanie Jones in the department of kinesiology at UMass Amherst commented, “There is a lot of evidence that the somatosensory system, that is the skin’s sensation and body awareness or proprioception, is affected in people with MS, who often report peripheral sensory loss, for example. This method exploits the phenomenon of stochastic resonance of the nervous system. It applies a kind of ‘noise’ that can enhance a person’s skin sensation. If we identify this mechanism of somatosensory impairment in MS, perhaps we can develop other interventions to try to do more.”

Source: Multiple Sclerosis News Today © Copyright 2014 BioNews Services, LLC (17/12/14)

Could multiple sclerosis be treated with video games?(15/12/14)

A team of researchers from Ohio State University received a $44,000 grant from the National Multiple Sclerosis Society to fund the development and testing of an interactive video game designed to promote and supplement physical therapy among patients suffering from multiple sclerosis (MS), an autoimmune disease of the motor neurons that is estimate to affect over 2.3 million people across the globe. The NMSS Pilot Research Grant will be used to fund a clinical trial to assess the efficacy of the video game, which will be funded for a year.

The interdisciplinary team of scientists is led by Computer Science and Engineering (CSE) Associate Professor Roger Crawfis, together with Assistant Professor of Physical Medicine and Rehabilitation Lynne Gauthier, and CSE grad student David Maung.

The game, “Recovery Rapids,” was originally conceptualised and programmed for stroke patients in need of rehabilitation for upper extremity motor impairment, which is also a common challenge in MS. Previous studies have shown the many benefits of promoting and maintaining physical activity and movement in managing the debilitating symptoms of MS, which the researchers believe can be more easily managed through a more engaging, fun approach.

All that is needed to play the game is a Microsoft Xbox Kinect body action sensor, which would allow the MS patient to engage in constraint-induced (CI) movement therapy usually conducted in the clinic. Recovery Rapids is a fun way to encourage physical activity and rehabilitative movement in that it requires the player to propel and steer a kayak and interact with items in the game environment, all in the comfort and convenience of home.

Professor Crawfis said that CI therapy has been proven to be a reliable method for motor rehabilitation for MS patients and that players of Recovery Rapids may gain the same hand and arm strengthening effects from the game as in-clinic CI therapy sessions.

Lynn Gauthier said that access to regular rehabilitation can be a challenge to many MS patients as transportation to the clinic can be quite tiring and limited for them. The researchers are hopeful that their “gamified” version can help make MS patients’ lives easier.

Source: Multiple Sclerosis News Today © Copyright 2014 BioNews Services, LLC (15/12/14)

Cambridge scientist awarded £150k for ground-breaking MS trials(02/10/14)

Treatment for multiple sclerosis (MS) patients could be revolutionised in ground-breaking trials planned by a Cambridge scientist.

Dr Su Metcalfe, a University of Cambridge senior research associate based at Addenbrooke’s, has won a £150,000 award which will enable her team to proceed to pre-clinical trials in Nanotechnology.

The award is one of only five given out this year worldwide from major pharmaceutical company, Merck Serono, and the first to a UK scientist.

The technology developed for treatment of MS - an incurable autoimmune disease that attacks the central nervous system - by Dr Metcalfe uses tiny ‘smart’ nanoparticles that act as magic bullets to deliver powerful factors known to increase repair of damaged myelin. The key factor is “LIF”, a stem cell protein.

The money from the Merck-Serono’s “Grants for Multiple Sclerosis International” (GMSI) scheme will fund preclinical trials of Metcalfe’s nano-therapeutic device that taps into the body’s natural mechanisms for repair and avoids use of drugs.

“Nanotechnology is now recognised as a key platform for healthcare,” said Dr Metcalfe. “Our ‘smart’ technology allows us to target delivery of molecules able to repair myelin and also reduce inflammation.

“By using a nanoparticle platform where the safety in humans is already confirmed, a hugely important feature for rapid progress towards the clinic, we can now expect to move to clinical trials within three to five years.”

Multiple sclerosis commonly affects young adults and in the UK alone, more than 100,000 people have MS with 2,500 being diagnosed each year.

The disease causes damage to the nerve sheaths, or myelin, which normally insulate the electrical activity of nerve fibres in the brain and spinal cord.

Specific nerves become inflamed and lose function and this disrupts messages from the brain to parts of the body, resulting in early symptoms of MS, such as impaired vision.

The award will link a small team of experts including bioengineer Dr Tarek Fahmy of Yale University who prepares the smart nanoparticles, Professors David Baker and Gavin Giovannoni who lead preclinical and clinical trials in MS at Queen Mary’s University of London, and Dr Anna Williams who works on progressive MS at the University of Edinburgh.

This GMSI project exploits nanotechnology to harness the power of Leukaemia Inhibitory Factor (LIF), a potent stem cell cytokine able to both oppose inflammatory immunity and promote myelin repair - both highly relevant to treatment of MS.

Source: CambridgeNewsUK Copyright © 2014 Local World (02/10/14)

Study suggests playing video game may help MS patients' balance(27/08/14)

An exercise component of the popular Nintendo Wii video game may help multiple sclerosis patients improve their balance by rewiring their brains, a new study suggests.

No medications exist to preserve balance in MS patients, and some drugs make balance worse, said study lead author Dr. Luca Prosperini, a neurologist at Sapienza University in Rome, Italy.

It appears that patients who use the Wii Balance Board five days a week -- moving to snowboarding or dance games, for example -- may help reduce their risk of falls and boost certain brain connections, possibly because they're coordinating their movements with a figure on a screen, Prosperini said.

There are caveats to the research, however. The study was small, and there's a risk that patients could hurt themselves by falling, although they can play seated rather than stand on the balance board.

"Patients with MS should be encouraged to start using this system only under supervision," Prosperini said. "Once well-trained, they may use it at home."

Multiple sclerosis is a nerve disorder that affects how the brain communicates with the body.

"Balance problems are quite common and arise due to the effects of MS on a number of functions that are important for balance," said Nicholas LaRocca, vice president for health care delivery and policy research with the National Multiple Sclerosis Society. Among other things, MS can disrupt vision, coordination and the body's balancing mechanism, he said.

Patients turn to a variety of strategies to support balance, he said. Canes and orthotic devices (shoe inserts) help some people, and rehabilitation can build strength and coordination. Some patients try electrical muscle stimulation to maintain or regain control of their muscles, he said.

Prosperini was inspired to study a video game treatment for MS when he saw patients in rehabilitation using a balance-boosting system that reminded him of an old Atari video game. Then a commercial about the Wii Balance Board caught his attention. The balance board, shaped a bit like a weight scale, detects a person's movements and allows them to be translated into action on a TV screen.

Prosperini tried to get a grant from Nintendo to support research. The company wasn't interested, he said, but he obtained funding from the Italian MS Society.

His previous research has supported the idea that patients regain balance when they use the Wii Balance Board. The new study aimed to understand what's happening in their brains.

In the new study, published online Aug. 26 in Radiology, 27 MS patients were split into two groups. One group spent three months doing nothing special while the other group played with the Wii Balance Board for 30 to 40 minutes daily, five days a week. Then the groups reversed roles: Those who had done nothing special used the balance board for three months, while the others stopped using it.

Another 15 healthy people tried the system, too.

All participants had specialised MRI scans to detect any physiological changes in the brain.

The researchers found that patients regained some balance, presumably by using the board, and their brains actually changed. Using the video game was tied to improvements in the protective sheath around nerves, leading to better conduction of impulses between the body and brain, Prosperini said.

It's not clear if other kinds of training might also help MS patients regain balance, he said. But video games like those that use the balance board might have similar benefits because they require patients to mimic movements that they see on screen, potentially providing an extra brain boost.

LaRocca, of the MS Society, said the study is valid but has limitations. For one, it's difficult to interpret what the brain changes mean, he said. Also, he added, the research suggests that the improvements in balance aren't permanent, requiring patients to keep at it to make the benefits last.

"Training needs to be ongoing, just like any other form of exercise," LaRocca said.

While the study found an association between the video-game balance board and balance-enhancing brain changes, it did not establish a cause-and-effect relationship. Prosperini said more research is needed, especially since the study was so small.

"There is increasing evidence of the clinical benefit of playing with the balance board, and more in general with highly interactive video games," he said. But researchers don't know enough about why the patients are getting better, he added.

Souce: healthfinder.gov Copyright © 2014 HealthDay (27/08/14)

iPad performance testing in MS(17/06/14)

In the not-too-distant future, patients with multiple sclerosis (MS) may simply strap on an iPad to complete their balance and walking tests, without the need for a technician.

The test results would be automatically uploaded to a clinical or research database, eliminating the chance of human error.

And patients may be doing the tests in the comfort of their own home, eliminating the need to visit a clinic, a boon to those living in rural areas or with mobility issues.

"It's an entirely new way of measuring the clinical impact of MS," said Richard A Rudick, MD, who recently left the Cleveland Clinic Mellen Center for Multiple Sclerosis Treatment and Research in Ohio to become vice president, development sciences, Value-Based Medicine, Biogen Idec."The bottom line on this is a new method to collect, display, aggregate, and analyse neurological performance data that has potential to have a major impact in MS patient care and research."

Dr. Rudick was addressing the 6th Cooperative Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) and the Americas Committee for Treatment and Research In Multiple Sclerosis (ACTRIMS).

Major Impact

The iPad is designed to simulate the standard tests administered by a technician: for example, the analogous test for the Timed 25-Foot Walk is the Walking Speed Test on the iPad, the 9-Hole Peg Test is called the Manual Dexterity Test, the Sloan Low Contrast Visual Acuity Test translates to the Low Contrast Visual Acuity, and the Symbol Digit Modalities Test to the Processing Speed Test.

The iPad is attached to a belt clip worn by the patient. A specially engineered device that sits on top of the iPad and is connected to it collects the relevant data, said Dr. Rudick.

He and his team performed a validation study that included 51 patients with MS and 49 healthy controls. Over and over, they found that the 2 methods were similar. For example, the test-retest reliability for various dimensions, including the T25FW and the 9 HPT, was "very good," said Dr. Rudick. "The correlations were mostly above .9, showing that it's highly reliable whether the technician does it or the iPad does it."

As for sensitivity to MS with tests of manual dexterity, visual acuity, and other tests, again, "what you see is that all of these tests, whether the technician or the iPad does them, distinguish MS patients from healthy controls," said Dr. Rudick.

Results were "very similar" for progressive versus relapsing types of MS, he added.

In some instances, the device was superior to a human tester. For example, with respect to how well a test distinguishes MS from healthy control, "for virtually every case, except the visual test, the iPad actually does a little bit better than the technician," said Dr. Rudick.

As for how well iPad or the technician measurements correlated with patient reports, that seemed to depend on the dimension. There was some correlation with certain lower-extremity patient reports, but not some upper-limb reports.

Dr. Rudick noted that the processing speed test correlated with just about everything except cognition. "MS patients don't recognise their cognitive dysfunction as a symptom they would call a cognitive problem," he explained. He added that the literature shows that cognition correlates better with depression than actual cognitive performance.

Easy to Use

The technology was well accepted. Patients found the applications were easy to understand and to use. "They said that completing the test on the iPad using a touch screen was easy, and they didn't have difficulty wearing the iPad for balance and walking," said Dr. Rudick.

Patients with MS, however, were more likely than healthy controls to find that the testing caused fatigue. "The way I interpret this is that it just reflects that patients have fatigue and can only tolerate so much testing," said Dr. Rudick.

The technology has several implications. The data can be transferred wirelessly to the "cloud" and scored instantly, enabling automatic entry into research and clinical databases. "You could theoretically send this right to the doctor at the time of the testing so he or she can see it, and at the same time send it to a research database," said Dr. Rudick.

This should reduce errors because there's no transcription of data, he added. "Whenever a human transcribes data there will be some error rates" which are estimated at about 1% or 2%.

The iPad data collection could lower costs of testing, too, because it lessens the need for extensive quality control of data and for human input. "If this can be transformed into a completely self-administered test, which we're working on right now, you don't need the technician," said Dr. Rudick.

"Nobody has the money for a technician to test their patients in practice," Dr. Rudick added in an interview with Medscape Medical News. "Also, a single technician can test a single patient, one at a time; with the iPad, several patients could test themselves simultaneously."

The technology could be adapted for "nontraditional" settings, such as rural areas, said Dr. Rudick. Because data could be collected at home, collection could be done more often, allowing for "trend analysis" over time, he said. Another implication, he noted, is that it allows researchers to develop a patient "profile" to determine how a patient is doing relative to healthy matched controls. "You can immediately grasp what is going on with patients over time." The technology also allows for input of additional tests the clinician might find useful, said Dr. Rudick.

The advantage of this technology, Dr. Rudick told Medscape Medical News, is that "walking speed, manual dexterity, vision function, and cognitive function information can be available to the neurologist." This, he said, "would allow the neurologist to track his or her patient over time, monitor the impact of medication, and make data-driven treatment decisions after discussion with the patient."

The technology still needs some tweaking. "We have to solve issues such as data transfer and integration with medical records, and we have to start building some databases from this," said Dr. Rudick. He said he hopes the technology will be available for widespread dissemination in about a year.

Work to Be Done

Asked for a comment, Robert P. Lisak, MD, professor and chair, Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, and the new president of CMSC, said the study is very interesting and promising.

"It's nice to see modern electronics and computer technology applied to the practice of medicine in a useful manner that has the potential to enhance care and cut costs but not cut costs by reducing the amount and quality of care," Dr. Lisak told Medscape Medical News.

However, he added that "there is still some work to be done on some of the measures, and we need to see if this approach can be confirmed and validated at other centers."

The validation study was supported by Novartis Pharmaceuticals. Dr. Rudick is an employee of Biogen Idec. Dr. Lisak has disclosed no relevant financial relationships.

6th Cooperative Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) and the Americas Committee for Treatment and Research In Multiple Sclerosis (ACTRIMS). Symposium: iTechnology in MS: Transformation or Chaos? Presented May 29, 2014.

Source: Medscape Multispeciality Copyright © 1994-2014 by WebMD LLC (17/06/14)

Unique solutions for MS gait problems(03/06/14)

With impaired walking ability generally considered the number one functional problem for multiple sclerosis (MS) patients, new approaches to assistive devices were described here, ranging from the mechanical to the furry.

In the former category, PhD student Morgan Boes and colleagues at the University of Illinois in Urbana-Champaign (UIUC) have designed a self-contained, pneumatic-powered ankle-foot orthosis (AFO) aimed at boosting a patient's ability to push off while walking or climbing stairs.

In the latter category is Bamse, a 6-year-old boxer dog trained by Cecilie Fjeldstad, PhD, of the Oklahoma Medical Research Foundation in Oklahoma City, to provide both physical and psychological support to moderately disabled MS patients as they walk.

Both researchers described their progress to date with their respective approaches at the joint meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis (CMSC-ACTRIMS).

Pneumatic Powered AFO

Boes, who is completing her doctoral studies in the UIUC lab of Robert Motl, PhD, showed her device's design at two CMSC-ACTRIMS poster sessions.

It's powered by bottled CO2 gas worn on a belt, which is connected to an AFO that includes positional and force sensors and a pneumatic actuator that flexes the foot while increasing joint stability and motion control.

The primary goal, Boes explained, is to provide "directional powered assistance during each phase of the gait."

Passive AFOs are already widely available to support the foot and ankle in MS patients and others with weakened lower-extremity muscle function. A common problem in MS is drop foot -- impairment in the strength of ankle-foot flexion, depriving patients of the power needed to move forward while walking.

These devices stabilize the joint and hold the foot in a neutral position, which helps patients with drop foot to walk but cannot provide an actual strength boost.

The UIUC device provides up to 100 lbs per square inch (PSI) of force during three of the four gait stages: initial contact when the foot strikes the ground (stage 1), forward propulsion (stage 3), and leg advancement (stage 4). No power is delivered at the second stage, known as loading response, when the weakened foot is flat on the ground and the walker has not yet begun to push off on it.

Pilot studies with healthy people in the lab have indicated that it should perform more or less as desired, but testing in MS patients has not yet begun. Boes's group is gearing up for a trial with planned enrollment of about 30 patients already using an AFO or for whom it has been recommended. The trial will use the 6-minute walk test as the primary endpoint.

Boes admitted that the prototype's design was somewhat awkward looking (although when this was suggested to her, she laughed and said it was "sleek" relative to an earlier model). But she pointed out that it was constructed from readily available and inexpensive components and the pneumatic system was known to be both robust and safe. She said her group had considered an electromechanical design and decided it would have more minuses than pluses.

Service Dog for Walking Assistance

Fjeldstad reported on an initial trial with Bamse (Norwegian for "stuffed teddy bear," she explained, pronouncing it as "bom-suh") in 36 patients with pronounced walking impairment but who did not currently require an assistive device such as a cane or walker.

She personally trained the animal (already a certified therapy dog) to walk beside a person without pulling ahead or lagging behind, and designed a special harness with a flexible handle. Hence, the patient cannot and should not lean on the dog like a cane.

The intent is similar to that of a guide dog for the blind, Fjeldstad indicated. The person may gain some physical steadying from having a hand on the dog's harness, but the support is primarily psychological in giving the patient more confidence in walking.

In the trial, the 36 patients underwent a total of four timed 25-foot walk (T25W) tests with Bamse -- an unassisted walk followed 3 minutes later with a second walk with Bamse. After a 15-minute rest, each patient then repeated the two T25W tests but in reverse order (assisted followed by unassisted).

The mean unassisted time to complete the 25-foot walks was 9.3 seconds (SD 0.4), well in excess of the 8-second threshold for substantial impairment proposed in a Neurology paper last year by several researchers including Motl.

Bamse's assistance improved the T25W times only a little -- to a mean of 8.7 second (SD 0.3), which was statistically significant at P=0.014 -- but then, the participants had not trained with the dog before and one might expect that the confidence boost would increase with practice.

Fjeldstad said that these results should encourage more research into the use of service animals as an aid to ambulation in MS patients.

The study by Boes' group was supported by the CMSC Foundation and the National Science Foundation Research Center for Compact and Efficient Fluid Power.

The study by Fjeldstad's group had no external funding.

Authors of both studies declared they had no relevant financial interests.

Primary source: CMSC-ACTRIMS
Source reference: Boes M, et al. "Evaluation of a portable powered ankle-foot orthosis on gait function in persons with multiple sclerosis" CMSC-ACTRIMS 2014.

Additional source: CMSC-ACTRIMS
Source reference:Fjeldstad C, et al. "Does using a service dog help ambulation in MS individuals with gait dysfunction?" CMSC-ACTRIMS 2014; Abstract RH07.

Source: MedPage Today © 2014 MedPage Today, LLC (03/06/14)