Sunday, 23 November 2014

Risk of MS maybe not based on social statratification

Goulden R, Ibrahim T, Wolfson C. Is high socioeconomic status a risk factor for multiple sclerosis? A systematic review. Eur J Neurol. 2014 Nov 5. doi: 10.1111/ene.12586. [Epub ahead of print]

High socioeconomic status (SES) is generally associated with better health outcomes, but some research has linked it with an increased risk of multiple sclerosis (MS). The evidence for this association is inconsistent and has not previously been systematically reviewed. A systematic review of cohort and case-control studies in any language was conducted looking at the association between MS and SES. MEDLINE and EMBASE were searched for articles in all languages published up until 23 August 2013. Twenty-one studies from 13 countries were included in the review. Heterogeneity of study settings precluded carrying out a meta-analysis, and a qualitative synthesis was performed instead. Five studies, all from more unequal countries, reported an association between high SES and MS. Thirteen studies reported no evidence of an association, and three studies reported an association with low SES. These 16 studies largely came from more egalitarian countries. The evidence for an association between high SES and increased MS risk is inconsistent but with some indication of a stronger effect in countries and time periods with higher inequality. Firm conclusions are hampered by the failure of most studies to control for other important risk factors for MS.

Some some argue that these is MS risk in the higher socio economic group...so is this why Pharma charge so much for their drugs:-). However, other studies argue that this is not the case, especially in more equal societies.  

ClinicSpeak: Sexual and bladder dysfunction go hand-in-hand

Sexual dysfunction in MS: how common is it? #MSBlog #MSResearch #ClinicSpeak

"The study below documents how closely related bladder and sexual dysfunction are. This should be something of a red flag for doctors and nurses seeing MSers. If an MSer complains of bladder problems we should ask about sexual problems. Why? Because we have treatments for sexual dysfunction and sexual dysfunction contributes to poor quality of life. From an anatomical perspective it is not surprising that bladder and sex go together; the neuronal pathways are both long and tend to be involved by spinal cord lesions. The following are two of the most commonly used surveys to screen men and woman for sexual dysfunction. The one for woman has been open for many months and has over 70 respondents already. It would be interesting to compare the sexes; so if  you have time could you please take a few minutes to complete one of these surveys. I am aware that these surveys are not high science, but they do highlight the how common certain problems are  in MS and the need for treatment. By completing the relevant survey you will also learn about what signs to look for and how to discuss your problems, if you have any, with your nurse of neurologist."


For males:



For females:




Epub: FragalĂ  et al. Relationship between urodynamic findings and sexual function in multiple sclerosis patients with lower urinary tract dysfunction. Eur J Neurol. 2014 Nov 19. doi: 10.1111/ene.12595.

BACKGROUND AND PURPOSE: Sexual dysfunction (SD) is prevalent in MSers and affects quality of life. Furthermore, lower urinary tract dysfunction (LUTD) is common in MSers. Our aim was to determine the relationship between urodynamic findings and SD in a cohort of MSers with LUTD.

METHODS: From January 2011 to September 2013, 135 consecutive patients with MS in remission phase and LUTD underwent a first urodynamic examination, according to the International Continence Society criteria. Neurological impairment was assessed using the Expanded Disability Status Scale and SD was investigated with the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF-15). Multivariate logistic regression analysis was performed to identify predictors of female SD (FSFI < 26.55) or moderate-severe erectile dysfunction (ED) (IIEF-EF ≤ 16), after adjusting for confounding factors including urodynamic findings.

RESULTS: Subjects with maximum detrusor pressure during involuntary detrusor contraction (PdetmaxIDC) ≥20.0 cmH2 O had lower IIEF-EF, IIEF overall satisfaction (IIEF-OS), FSFI-Arousal, FSFI-Lubrication and FSFI-Orgasm. Subjects with maximum cystometric capacity (MCC) ≥135 ml had higher IIEF-EF, intercourse satisfaction (IIEF-IS), orgasmic function (IIEF-OF), sexual desire (IIEF-SD), FSFI-Arousal, FSFI-Lubrication, FSFI-Orgasm, FSFI-Satisfaction and FSFI-Pain. On multivariate logistic regression analysis, PdetmaxIDC ≥20 cmH2 O [odds ratio (OR) 6.7; P < 0.05] and MCC <135 ml (OR 6.80; P < 0.05) were predictors of moderate-severe ED. In a model including all previous variables, compliance ≤3 ml/cmH2 O was an independent predictor of moderate-severe ED (OR 14.49; P < 0.01). No relationship was found between the previous variables and FSFI <26.55.

CONCLUSIONS: Neurogenic bladder is associated with SD in MS patients. The presence of PdetmaxIDC ≥20 cmH2 O, MCC <135 ml and compliance ≤3 ml/cmH2 O may significantly predict the presence of moderate-severe ED.

The 6th International Congress of the Lebanese Society of Neurology

My presentations from the Lebanese Society of Neurology meeting in Beirut. #MSBlog #MSResearch

"I would like to take this opportunity to thank my hosts in Lebanon for their kind invitation to speak at their congress and for their wonderful hospitality. As promised the following are my two presentations from the meeting."

"In my first talk on secondary progressive MS I presented my theory of MS being a central length-dependent axonopathy, which underpins my observations of therapeutic lag and supports the follow-on hypothesis that clinically apparent progressive MS is asynchronous in that it affects different functional systems at different rates. If I can prove the latter it opens up a new paradigm for designing clinically trials for progressive MS and explains why so many trial in progressive MS in the past have been negative."


"My second talk is based on one I originally gave at ECTRIMS 2013 about redefining MS as a dementia to focus neurologists on gray matter disease, brain volume loss and its effects on cognition. I end by suggesting that we need to go beyond NEDA and focus on trying to prevent end-organ damage in MS."



CoI: multiple (see slide 2 in both presentations)