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Herpes virus ‘one of main causes of MS’

Tackling Epstein-Barr virus (EPV) – one of the most common viruses in humans – could lead to MS prevention, researchers say

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A herpes virus has been found to be a leading cause of Multiple Sclerosis (MS) in a new study. 

MS affects 2.8million people worldwide, and one of its causes has been found to be the Epstein-Barr virus (EBV), which is one of the most common viruses among humans. 

“The hypothesis that EBV causes MS has been investigated by our group and others for several years, but this is the first study providing compelling evidence of causality,” said Professor Alberto Ascherio, professor of epidemiology and nutrition at Harvard Chan School and senior author of the study. 

“This is a big step because it suggests that most MS cases could be prevented by stopping EBV infection, and that targeting EBV could lead to the discovery of a cure for MS.”

MS is a chronic inflammatory disease of the central nervous system that attacks the myelin sheaths protecting neurons in the brain and spinal cord. Its cause is not known, yet one of the top suspects is EBV, a herpes virus that can cause infectious mononucleosis and establishes a latent, lifelong infection of the host. 

Establishing a causal relationship between the virus and the disease has been difficult because EBV infects approximately 95 per cent of adults, but MS is a relatively rare disease and the onset of MS symptoms begins about ten years after EBV infection. 

To determine the connection between EBV and MS, the researchers conducted a study among more than 10 million young adults on active duty in the US military and identified 955 who were diagnosed with MS during their period of service.

The team analysed serum samples taken biennially by the military and determined the soldiers’ EBV status at time of first sample and the relationship between EBV infection and MS onset during the period of active duty. 

In this cohort, the risk of MS increased 32-fold after infection with EBV but was unchanged after infection with other viruses. Serum levels of neurofilament light chain, a biomarker of the nerve degeneration typical in MS, increased only after EBV infection. 

The findings cannot be explained by any known risk factor for MS and suggest EBV as the leading cause of MS.

Prof Ascherio says that the delay between EBV infection and the onset of MS may be partially due to the disease’s symptoms being undetected during the earliest stages and partially due to the evolving relationship between EBV and the host’s immune system, which is repeatedly stimulated whenever latent virus reactivates.

“Currently there is no way to effectively prevent or treat EBV infection, but an EBV vaccine or targeting the virus with EBV-specific antiviral drugs could ultimately prevent or cure MS,” said Prof Ascherio.

MS

VR ‘could improve traditional rehab for MS patients’

VR may increase the effectiveness of traditional cognitive rehabilitation and exercise training, say scientists

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Virtual reality (VR) technology could strengthen the effects of traditional rehabilitation for people living with multiple sclerosis (MS), new research has found. 

By increasing sensory input and promoting multi-sensory processing, VR may increase the effectiveness of traditional cognitive rehabilitation and exercise training in individuals with MS, according to Kessler Foundation researchers. 

Kessler Foundation scientists are advocates for the incorporation of VR technology in cognitive rehabilitation research in MS. 

They presented a conceptual framework supporting VR as an adjuvant to traditional cognitive rehabilitation and exercise training for MS, theorising that VR could strengthen the effects of traditional rehabilitative therapies by increasing sensory input and promoting multi-sensory integration and processing.

Current pharmacological therapies for MS are not effective for cognitive dysfunction, a common consequence of MS that affects the daily lives of many individuals. 

This lack of efficacy underscores the need to consider other approaches to managing these disabling cognitive deficits.

The inclusion of VR technology in rehabilitation research and care for MS has the potential not only to improve cognition, but to facilitate the transfer of those cognitive gains to improvements in everyday function, according to Dr Brian Sandroff, senior research scientist in the Center for Neuropsychology and Neuroscience Research at Kessler Foundation. 

It also builds on previous Kessler Foundation research which highlighted the positive impact of VR in stroke recovery.

“With VR, we can substantially increase engagement and the volume of sensory input,” he said.

“And by promoting multi-sensory integration and processing, VR can augment the effects of the two most promising non-pharmacological treatments – cognitive rehabilitation and exercise.”

Virtual environments are flexible and varied, enabling investigators to control the range and progression of cognitive challenges, with the potential for greater adaptations and stronger intervention effects. 

VR also allows for the incorporation of cognitive rehabilitation strategies into exercise training sessions, which may support a more direct approach to improving specific cognitive domains through exercise prescriptions.

The application of VR to stroke research has shown more improvement in motor outcomes compared with traditional therapy, as well as greater neural activation in the affected area of the brain, suggesting that greater gains may persist over time.

Dr. Sandroff emphasised the largely conceptual advantages for the use of VR to treat cognitive dysfunction in individuals with MS. 

“More clinical research is needed to explore the efficacy of combining VR with cognitive rehabilitation and/or exercise training, and the impact on everyday functioning on individual with MS,” he said. 

“The conceptual framework we outline includes examples of ways immersive and interactive VR can be incorporated into MS clinical trials that will form the basis for larger randomised clinical trials.” 

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MS

Support for MS symptoms ‘must be offered at diagnosis’

Non-pharmaceutical help from clinicians should not be delayed, new research recommends

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Clinicians should offer non-pharmaceutical help for symptoms like pain, fatigue, depression or anxiety at the time of diagnosis for patients with multiple sclerosis (MS), rather than wait, new research has recommended. 

A new study has shown that clinically-significant levels of pain,  experienced by 50 per cent of patients; fatigue for 60 per cent; depression for 47 per cent; and anxiety for 39 per cent were regularly seen for patients within the first year after diagnosis. 

“The take home was that we found these symptoms, pain, fatigue, depression and anxiety quite prevalent at the point of diagnosis,” said Dr Kevin Alschuler, principal investigator of the UW Medicine study. 

“We want to address this immediately, rather than five or 10 years down the road.”

The findings also indicated that prompt screening was necessary if quality of life was to be maintained and optimised.

Globally, more than 2.3million people have been diagnosed with MS, a disease for which there is no cure and results from the body’s immune system attacking the brain and spinal cord, damaging the myelin which disrupts signals to and from the brain. 

In a further study from UW Medicine, the quality of life for MS patients was explored immediately after, at two months, three months, six months, nine months and then a year after diagnosis. 

The results of the study showed that, on average, quality of life was largely stable throughout the year – a finding that surprised researchers.

“Patients who are newly diagnosed have to deal with the emotional impact of the diagnosis, as well as numerous tests and treatment decision-making,” noted Dr Alschuler, who was lead author on the study.

“Results showed that, on average, if they came in and were doing great at diagnosis, they had a tendency to stay that way throughout the first year.

“If they were struggling, they also tended to stay that way.”

Many times, patients had been dealing with the symptoms years before a formal diagnosis, both noted.

“Through symptom self-management, including cognitive behavioral therapy, we help patients become empowered with coping skills, especially in the areas of fatigue and pain,” said Dr Dawn Ehde, a co-author on the quality of life study.

“We teach them how to use strategies such as relaxation or mindfulness meditation techniques, as well as how to pace themselves to decrease fatigue and better manage stress. 

“Patients who learn these skills often find that not only do their pain and fatigue go down, they are able to do more of what is important to them despite their MS.”

The next step for the team is to explore options for early interventions to help newly diagnosed patients.

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MS

‘Promote aquatic exercise for MS patients’

Barriers to participation must be reduced to ensure the wellbeing of people with Multiple Sclerosis, a report recommends

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Barriers to exercise – and particularly aquatic exercise – for patients living with Multiple Sclerosis (MS) should be reduced, a study concluded. 

Many people with MS report difficulties engaging in traditional land-based physical activity due to heat sensitivity and physical disability, meaning aquatic exercise is often a suitable alternative. 

In new Kessler Foundation research, 100 per cent of people with MS who had tried aquatic exercise said they preferred it to land-based alternatives. 

However, their participation has been impacted by the COVID-19 pandemic. 

The study found that while 56 per cent of people participated in exercise during the restrictions, only seven per cent took part solely in aquatic exercise. 

Although that was the preferred option by individuals with experience with this type of exercise, lack of access to pools and the costs associated with access were significant barriers.

Now, as we move on from the pandemic, the study’s authors have urged barriers to be removed from MS patients’ participation in aquatic exercise. 

“Clinicians should encourage their patients with MS to resume exercising as pandemic restrictions ease,” said Dr Helen Genova. 

“Given the benefits of aquatic exercise for people with MS, and the finding that it was preferred, it is worthwhile to look at reducing barriers to this type of exercise. 

“Encouraging community organisations and health and wellness programs to sponsor affordable aquatic exercise activities for people with MS would lower the barriers for participation, especially for the economically disadvantaged.”

Available treatments for MS have limitations in terms of symptomatic relief of the array of physical and cognitive symptoms experienced by many individuals, which has spurred interest in the role of health-related behaviours in minimising MS-related disability. 

As a health-related behaviour with known benefits on gait, balance, mood, and fatigue, exercise is a key topic in providing some antidote. 

In the study, researchers conducted an online survey of 179 individuals with MS about their exercise activities from October 2020 to April 2021, which established a general decrease in levels of activity, but also highlighted the importance of water-based activity in people’s lives. 

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