Centrum komplexní neurorehabilitační péče pro nemocné s roztroušenou sklerózou, o.p.s.

O roztroušené skleróze

November 8th, 2013


Positivní účinek rehabilitace u roztroušené sklerózy mozkomíšní (dále v textu jako RS) byl prokázán u hospitalizovaných i u ambulantních pacientů; u relaps-remitentní formy, a stejně tak u progresivní formy onemocnění. Studie také prokázaly okamžité, přetrvávající a dlouhodobé účinky. Byl prokázán vliv na celou řadu sledovaných příznaků, zejména na únavu a depresi, aktivitu a kvalitu života.

Z dosavadního výzkumu však zatím nevyplývá jednoznačný konsensus, jak v různých případech (například u různých forem roztroušené sklerózy mozkomíšní (dále jen RS), v různých fázích onemocnění) postupovat. Výsledky dosavadního výzkumu se nedají zobecnit, protože jednotlivé studie jsou navzájem neporovnatelné zejména pro odlišnou definici sledovaných parametrů, obsahovou validitu.

V této sekci Vás budeme seznamovat s nejnovějšími poznatky v neurorehabilitaci RS, ale i zajímavosti týkající se vlastní nemoci



Mechanismy účinku fyzioterapie a principy, na kterých je založen současný přístup:Neurologie_pro_praxi_2013

Fyzioterapie u neurologicky nemocných  (se zaměřením na roztroušenous klerózu mozkomíšní) – brožura pro lidi s RS: fyzioterapie_2008_oprava1

Informace o funkčním neuro-stimulátoru Walkaid: článek_WA_final

Zajímavý rozhovor s Dr. Goldem na téma, zda lidé s RS mohou ovlivnit své onemocnění.

Can Patient Factors Impact the Onset of Multiple Sclerosis?
Dr. Gold: Hello, this is Dr. Ralf Gold from St. Josef-Hospital/Ruhr-University Bochum, Germany. I would like to provide some highlights from one of the very interesting sessions presented at ECTRIMS 2013, discussing putative triggering factors that may lead to the development of multiple sclerosis in genetically susceptible persons.
Dr. Gold: The genes, as we learned from monozygotic twin studies, only contribute about 35% of the risk of developing multiple sclerosis; and the rest of the susceptibility is probably attributed to epigenetics or the environment. And to understand the environmental triggers which lead to an increased incidence of multiple sclerosis is really critical for us, because knowing these risk factors may help us in the future to counsel individuals who are at higher risk of developing MS.
Dr. Gold: Of course, we know the intricate association of multiple sclerosis and EBV viruses.There are good studies, especially from the Veterans Military Service in the US, a very well controlled study, showing that people who stay EBV-negative until the age of 30 or 35 and then convert to EBV-positive have a very high risk of developing MS within a short time span of 5 to 10 years. Up to 50% of these converters develop MS. However, since most of us are already EBV-positive in adulthood, probably the absolute contribution to MS in adulthood is low.It has also been shown in the paediatric population and in patients with clinically isolated syndrome that higher levels of EBV is a risk factor for MS.
Dr. Gold: In an interesting presentation, Dr. Julian Gold provided data about integration of human endogenous retrovirus into the genome of MS patients and particularly into the brain of MS patients. And the possibility remains open that the blood-brain barrier allows entry of viruses into the MS brain much more easily than in the healthy brain.Research presented by Julian Gold brought forward the question whether patients who are not responding to MS therapies could maybe better profit from antiretroviral therapy. But it’s still too early to make definite conclusions on this topic.
Dr. Gold: I think one of the strongest triggers discussed at ECTRIMS was smoking and the associated immune response of the innate immune system.When we talk about smoking, all of us think about the risk of developing lung cancer or cardiovascular disease. But we don’t often think about the fact that tar and other substances in cigarette smoke are hot, and at high concentrations these toxins enter the lung, and they have the capacity to directly stimulate the immune system via Toll-like receptors. So this is a hypothesis of how smoking may be directly associated both with the incidence and maybe even the disease course of MS. So for me, these are the most important data because they are also pathophysiologically explained.The study that was presented by Alfredsson at ECTRIMS showed that there was a correlation between the number of pack-years and the risk of developing MS, which was higher for men. So the longer you smoke and the more cigarettes you smoke per day, the higher your risk for developing MS.
Dr. Gold: The good news is that quitting does reduce MS risk. And the longer a patient has quit, the lower the risk for developing MS. In fact, if a smoker has stopped for 10 years, their risk is the same as a never-smoker—and this is very similar to the cancer risk, which also mostly disappears after 10 years of quitting smoking.So if someone has a high risk for developing MS, I would advise them to keep away from smoking.
Dr. Gold: Next, there was a Danish retrospective population study presented, looking at factors that might be associated with earlier onset of MS. So in this study, patients with MS completed a questionnaire.And what they found was that a higher body mass index at age 20 was most associated with MS onset at a younger age. There is a link between leptin—a hormone acting in our hypothalamus—and food intake. Usually if you are satiated, then leptin is high; whereas when leptin is low, we feel hunger. And it has been suggested that in MS, where levels of leptin have shown to be significantly higher than in healthy controls, leptin may have a pro-inflammatory role. So these data make sense, and actually corroborate previous data from Harvard showing a higher MS incidence in more obese young adults.Another interesting factor associated with obesity is that different kinds of fatty acids—whether they are long-chained or short-chained—may directly influence the immune system in the gut. But further studies are ongoing with regard to this subject.
Dr. Gold: Finally, we have the problem of salt and diet. And Mauricio Farez presented results from a study showing that high sodium intake correlates both with MS clinical activity and T2 lesion load on MRI. The average sodium intake is between 2 and 4.8 g/d, and for each gram of salt above this average, they saw almost 4 more T2 lesions.Now, this study is not suggesting high sodium intake as a trigger, per se, of MS, they are only showing association.
Dr. Gold: So for decades, we have known that at least 60% of the risk of developing MS must be based on nongenetic factors. And this risk contribution of putative triggers, I think, is really important. Maybe in the future, if we have risk profiles, we can avoid these triggers in people at high risk. The data that were presented at this year’s ECTRIMS suggest that modifiable risk factors such as smoking may have a strong impact, and high body weight may also have an impact. So these would be factors that we could counsel patients at high risk to avoid.EBV is not really a modifiable risk factor since we cannot directly protect from the virus, though it seems to be a clear trigger. And with the salt story, we still have to wait to see whether this is really a trigger of MS, but it certainly does seem to have an impact on basic immune parameters and also on clinical parameters, so a lower-salt diet is something we might want to recommend to our current MS patients.
For more information and resources on Multiple Sclerosis, please access the series webpage at www.peervoice.com/MSUpdates

Watch this activity on multiple sclerosis now >

Interviews are based on data presented at the 29th Congress of the European Committee for Treatment and Research in Multiple Sclerosis, October 2-5, 2013, Copenhagen, Denmark*

*PeerVoice is an independent publisher of conference news, medical education, and other learning activities.

This activity is supported by educational funding from Biogen Idec International GmbH.

PeerVoice activities are designed to fill the unmet needs of the medical community by reporting information pertaining to clinically relevant advances and developments in the science and practice of medicine. The preparation of PeerVoice activities is supported by written agreements that clearly stipulate and enforce the editorial independence of PeerVoice and the faculty presenters.

Zajímavé odkazy:

Rehabilitation in multiple sclerosis

Unie Roska – česká MS společnost

Aktivní život

Domov svatého Josefa – jako jediný v ČR poskytuje komplexní zdravotní a sociální péči výhradně nemocným roztroušenou sklerózou

Pomocné tlapky – společnost vychovávající asistenční psy

The World of Multiple Sclerosis (IFMSS), anglicky

Multiple Sclerosis World, anglicky

informační portál helpnet.cz

zdravé světlo: zdroje světla blízké slunečnímu světlu