Saturday, 28 July 2012

Stress management on trial as a DMT

Epub: Mohr et al. A randomized trial of stress management for the prevention of new brain lesions in MS. Neurology. 2012 Jul.


OBJECTIVES: This trial examined the efficacy of a stress management program in reducing neuroimaging markers of MS disease activity.


METHODS: A total of 121 MSers with relapsing forms of MS were randomized to receive stress management therapy for MS (SMT-MS) or a wait-list control condition. SMT-MS provided 16 individual treatment sessions over 24 weeks, followed by a 24-week post-treatment follow-up. The primary outcome was the cumulative number of new gadolinium-enhancing (Gd+) brain lesions on MRI at weeks 8, 16, and 24. Secondary outcomes included new or enlarging T2 MRI lesions, brain volume change, clinical exacerbation, and stress.


RESULTS: SMT-MS resulted in a reduction in cumulative Gd+ lesions (p = 0.04) and greater numbers of participants remained free of Gd+ lesions during the treatment (76.8% vs 54.7%, p = 0.02), compared to participants receiving the control treatment. SMT-MS also resulted in significantly reduced numbers of cumulative new T2 lesions (p = 0.005) and a greater number of participants remaining free of new T2 lesions (69.5% vs 42.7%, p = 0.006). These effects were no longer detectable during the 24-week post-treatment follow-up period.


CONCLUSIONS: This trial indicates that SMT-MS may be useful in reducing the development of new MRI brain lesions while patients are in treatment. This benefit was not sustained beyond 24 weeks, and there were no clinical benefits .Trial registration:ClinicalTrials.gov, number NCT00147446.


"Interesting? Who would have thought that reducing stress would have had an impact on MS disease activity? These results would need to be reproduced; the trial is relatively small (121 MSers) and could be a false positive. Nevertheless this is something that needs to be looked into in more detail. Who is up for stress management therapy?"

11 comments:

  1. I am sure some of the CCSVI community might suggest that raised stress = raised blood pressure... you know the rest.

    But perhaps stress and EBV play a link here?

    http://www.sciencedirect.com/science/article/pii/0889159191900186: "One of the factors thought to be associated with the reactivation of latent herpesviruses is psychological stress."

    Interesting, too, is the possible use of an anti-depressant, Fluoxetine, in MS.

    Is the mechanism here one of a chemical impact of the drug? Or does it just reduce stress and as such reduce MS impact?

    Perhaps anti-depressants and CBT should be used as an adjunct to MS treatment? We know that many suffer from depression.

    Here is one small study:

    http://jnnp.bmj.com/content/79/9/1027.short which concluded that "the number of patients without enhancing lesions was 63% in the fluoxetine group versus 26% in the placebo group"

    And here is another:

    http://www.sciencedirect.com/science/article/pii/S0304394006003156

    Axonal degeneration in multiplesclerosis (MS) may be caused by mitochondrial dysfunction and is associated with decreased levels of N-acetylaspartate (NAA) as measured with 1H-magnetic resonance spectroscopy (MRS). Fluoxetine stimulates astrocytic glycogenolysis, which serves as an energy source for axons. Eleven patients with MS received fluoxetine orally 20 mg a day during the first week, and 40 mg a day during the second week. The mean NAA/Creatine ratio in cerebral white matter of the MS patients increased from 1.77 at baseline to 1.84 at the end of the second week (p = 0.007). These findings show evidence for a reversible axonal dysfunction in patients with MS and provide a rationale for investigating whether fluoxetine has neuroprotective effects in MS.

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  2. I would be the first to sign up - have been saying for years that stressful childhood events and continuous stress are the main reasons for my MS (alongside an indoor-lifestyle=lack of VitD and wrong diet)

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  3. And i'd be the second! Have always thought that stressful events may have had an impact on the onset and development of my ms.

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  4. I think it would be a good idea to do a survey about how much stress MSers are having (or have had e.g. traumatic childhood, sustained bullying or mobbing, bitter divorce etc.) in order to valide those first studies, what do you think Team G?

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  5. I think you'll find that many MSers (me included) are acutely aware of the (-ve) effect of stress on MS/relapses etc - I could tell you almost down to the minute... the exact events and the effects. These stresses were not those mentioned in previous posts, I think everyone has different stressors that they react to - not easy to design a study to examine this.

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  6. I don't think it's difficult to measure - stress is stress no matter what kind - for some it may be a divorce for others a ride on a crowded bus - what counts is the negative effect on the brain which then sets off a negative chain reaction leading to nerve loss.

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  7. "SMT-MS may be useful in reducing the development of new MRI brain lesions while patients are in treatment..."

    I don't know exactly what the program tested was, but I suspect it was not something that cost tens of thousands of dollars and had minimal side effects. And it also reduced development of new brain lesions? Wow, why don't we all jump on this train and take it to where it promises to go? I have used my own stress management techniques to, I believe, great effect, but to find scientific validation is wonderful news.

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  8. "Who would have thought that reducing stress would have had an impact on MS disease activity?"

    No, who would have thought that lifestyle changes to improve overall health would actually have a positive impact on a chronic disease like MS??

    Many of us have been doing that for years.
    overcomingmultiplesclerosis.org/

    guys, its time for you to get your heads out of the petri dishes

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  9. Re: "guys, its time for you to get your heads out of the petri dishes."

    I agree; I need a stress-free holiday with lots of sleep.

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  10. Re: "I think it would be a good idea to do a survey about how much stress MSers are having!"

    Will do; we will start with a short poll and take it from there if it looks like a big problem.

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  11. Re: "Who is up for stress management therapy?" Yes please. This sounds a great idea. I study Ayurveda and I have RRMS. Yoga is great and my local MS treatment centre does classes including seated yoga. I massage my legs, arms and shoulders with oil such as almond oil, it helps wth stiffness in my calf muscles.

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