Is Fatigue In Patients With Multiple Sclerosis Related To Autonomic Dysfunction?
Keselbrener L, Akselrod S, Ahiron A, Eldar M, Barak Y, Rotstein Z
Clin Auton Res 2000 Aug;10(4):169-75
Tel Aviv University, Abramson Center of Medical Physics, Tel Aviv, Israel
PMID# 11029013; UI# 20479984
Time-dependent frequency decomposition of fluctuations in CardioVascular signals (Heart Rate [HR], blood pressure, and blood flow) provides noninvasive and quantitative evaluation of Autonomic activity during transient and steady-state conditions.
This method was applied during a change of position from supine to standing in patients with Multiple Sclerosis (MS) who experienced unexplained Fatigue and in age-matched control subjects.
No difference in response to standing, as reflected in the time domain parameters (mean HR, mean blood pressure, and mean blood flow), was observed between patients with MS and control subjects.
Moreover, no difference was observed in very-low-frequency and low-frequency (related to Sympathetic activity) content of HR, blood pressure, blood flow, or high-frequency content of HR (related to ParaSympathetic activity).
The only Spectral estimates that showed a significant difference between groups were the ratio of low-frequency to high-frequency content of HR and low-frequency content of HR normalized to total power. Both these parameters provide an estimate of the SymPathoVagal balance.
A significant increase in these two estimates on standing was observed in control subjects only, indicating possible impairment of the SymPathoVagal balance response to standing in patients with MS who experienced Fatigue.
The authors observed a significant age dependence between close age subgroups, which occurred in the MS group only and was observed in some of the investigated Spectral estimates that reflect Vagal activity.
Therefore, the authors assumed that age-related reduction in Vagal activity occurred earlier in patients with MS who experienced Fatigue.
This reduction could also explain the lack of increase in the SymPathoVagal balance on standing.
To validate this enhanced age dependence, further investigation should be performed in a larger group of subjects with a wider age range.
A Meta-Analysis Of MethylPrednisolone In Recovery From Multiple Sclerosis Exacerbations
Miller DM, Weinstock-Guttman B, Bethoux F, Lee JC, Beck G, Block V, Durelli L, LaMantia L, Barnes D, Sellebjerg F, Rudick RA
Mult Scler 2000 Aug;6(4):267-73
Cleveland Clinic Foundation, I.H. Page Center for Health Outcomes Research, Cleveland, Ohio 44195, USA
PMID# 10962547; UI# 20420518
Despite recent advances in Multiple Sclerosis treatment, patients experience relapses for which standard treatment remains GlucoCorticoSteroids (GCS).
However, there is limited information comparing doses or routes of administration for different GCS types or the benefit of GCS compared to natural recovery.
Currently, high dose (HD) MethylPrednisolone (MP) is the preferred therapy.
We conducted meta-analyzes of published studies assessing MP at different doses and in comparison to other steroid products or no treatment.
Relevant studies were identified through predetermined processes and five articles met the inclusion criteria.
Three studies compared HD MP to placebo; two studies compared the effect of HD MP and low dose (LD) MP; only one accepted report compared HD MP to another GCS.
This report could not be included in a meta-analysis.
The meta-analysis of HD MP vsplacebo studies indicated a mean treatment difference of 0.76 in Expanded Disability Status Score (EDSS) changes from baseline.
The meta-analysis of HD and LD MP demonstrated no difference in EDSS change.
Despite these rather obvious findings, these meta-analyzes have been valuable in identifying further research questions.
We recommend studies to determine optimum benefit related to dosage, timing for starting therapy and the most appropriate GCS type.
Given the advances in MS therapeutics, these studies will have to include patients on additional disease modifying therapy.
Multiple Sclerosis (2000) 6 267 - 273
Secondary Conditions And Women With Physical Disabilities: A Descriptive Study
Coyle CP, Santiago MC, Shank JW, Ma GX, Boyd R
Arch Phys Med Rehabil 2000 Oct;81(10):1380-7
Temple University, Dept of Health Studies, Philadelphia, PA 19122, USA
PMID# 11030504; UI# 20483421
To examine secondary conditions and their relationship to life satisfaction in women with physical disabilities.
Design & Setting
Survey research at Metropolitan Philadelphia.
Women aged 18 to 65 years with self-reported functional limitations associated with Neurologic, Neuromuscular, Brain, Sensory, Arthritic, Spinal Cord, Orthopedic, or other chronic conditions.
Main Outcome Measures
Secondary conditions, health status, functional status, and life satisfaction.
In the past year, an average of 12 +/- 6.1 (SD) secondary conditions were experienced.
Fatigue, mobility, physical deconditioning, spasticity, and joint pain were reported most frequently, followed by depression, chronic pain, access problems, weight problems, and isolation.
In comparing women with Multiple Sclerosis (MS) and those with other disabling conditions, women with MS had higher Secondary Conditions Problem Index (SCPI) scores for bladder, bowel, and sexual dysfunction than women in the mixed disability group.
Other secondary conditions with the highest SCPI scores remained similar.
Self-reported emotional health status and SCPI scores were the only significant predictors of life satisfaction.
Secondary conditions influence health status and quality of life for women with physical disabilities.
Despite differences among disability groups in terms of the type of secondary conditions, common secondary conditions experienced by most women may be amenable to non-disability-specific health promotion programs.
Cost-Utility Analysis Of Interferon-ß-1b In Secondary/Progressive Multiple Sclerosis
Kobelt G, Jonsson L, Henriksson F, Fredrikson S, Jonsson B
Int J Technol Assess Health Care 2000 Summer;16(3):768-80
PMID# 11028132; UI# 20482567
Interferon-ß-1b has recently become available for the treatment of Secondary/Progressive Multiple Sclerosis (SPMS).
This study aims at estimating the cost-effectiveness of this new treatment that has been shown in a clinical trial to reduce the progression of the disease.
Effectiveness is measured as the number of quality-adjusted life-years (QALYs) gained from the reduction in progression.
Because the clinical trial period will only capture part of the treatment's effect in terms of QALYs gained, since benefits achieved during the trial will have an effect beyond it, the cost-effectiveness analysis involves modeling over the longer term using complementary data.
A Markov model with states based on disability expressed by EDSS scores was used.
Transition probabilities were calculated directly from clinical trial data for the first 3 years and then extrapolated to 10 years.
Mean costs and utilities for each Markov state were calculated from a population-based cross-sectional study in Sweden.
The incremental cost per QALY is SEK 342,700 (US $39,250; US $1 = SEK 8.73, March 10, 2000) when all costs (direct, informal care, and indirect) are included (discounted 3%).
When indirect costs are excluded, the cost per QALY is SEK 542,000 ($62,100).
Cost-effectiveness analysis in SPMS requires that the effect of treatment beyond clinical trials be included.
Also, analysis should be done from a societal perspective, since many of the costs occur outside the healthcare system.
The cost-utility ratios estimated in this analysis are at or below the mean threshold value indicated in a recent survey of health economists ($60,000).