“Gait difficulties were common in both groups, with motor deficits and higher EDSS score significantly more common in patients with progressive disease,” the researchers concluded. “The MRI findings and clinical evolution were not significantly different between the two groups over the time period studied.”
—Colby Stong
Is Daycare Exposure a Protective Factor Against Neuromyelitis Optica in Children?
Early exposure to other young children may be a protective factor against the development of neuromyelitis optica, suggesting that viral infections may contribute to disease risk modification, researchers reported.
Jennifer Graves, MD, PhD, Assistant Professor of Neurology at the University of California, San Francisco, Pediatric MS Center, and colleagues sought to determine whether environmental factors known to modify the risk for multiple sclerosis (MS) were associated with the risk for neuromyelitis optica in children. The researchers used a chemoluminescence assay to measure serum 25(OH) vitamin D levels, and Epstein-Barr virus, cytomegalovirus, herpes simplex virus-1, and herpes simplex virus-2 antibody responses were determined by ELISA. The investigators also used multivariate logistic regression models to determine risk factor associations with neuromyelitis optica, including adjustments for age at sampling, sex, race, and ethnicity.
Analysis was based on 36 children with neuromyelitis optica, 491 with MS, and 224 healthy controls. Dr. Graves and colleagues found that daycare (odds ratio [OR], 0.33) and breastfeeding (OR, 0.41) were associated with lower odds of having neuromyelitis optica, compared with healthy children. “C-section tended to be associated with a twofold higher odds of neuromyelitis optica,” stated Dr. Graves. “Parental smoking was not meaningfully associated with neuromyelitis optica risk.”
A total of 34 children with neuromyelitis optica, 189 with MS, and 94 controls had serotyping. The investigators found that Epstein-Barr virus exposure “tended to be associated” with lower odds of having neuromyelitis optica, compared with children with MS. Exposure to herpes simplex virus-1 and being DRB1*15-positive were also associated with lower odds of having neuromyelitis optica.
“Unlike MS, pediatric neuromyelitis optica does not appear to be associated with exposures to common herpes viruses,” the investigators concluded.
—Colby Stong
Attitudes Toward Exercise Correlate With Perceived Autonomy and Pain Among Patients With MS
Scores on Guy’s Neurological Disability Scale (GNDS) correlate well with walking distance and presence of pain and spasticity among patients with multiple sclerosis (MS), according to researchers. In addition, the Multidimensional Outcome Expectations for Exercise Scale (MOEES) questionnaire three subscales appear valid, and self-evaluative scale scores correlate with pain scores, as well as with a physical measure. Lead author Samuel M. Bierner, MD, and colleagues said that their early analysis revealed interesting relationships between patients’ perceived autonomy and daily pain scores. Dr. Bierner is affiliated with the Department of Physical Medicine and Rehabilitation at the University of Texas Southwestern Medical Center in Dallas.
Dr. Bierner and colleagues conducted a prospective cohort study designed to assess the relationship between attitudes toward exercise and autonomy and physical measures of upper and lower body strength and exercise performed. They reported the initial results of the cohort at the time of entry into the study.
Patients from an academic MS center completed two physical measures: grip strength dynamometry and the two-minute walk test (2MWT). They also completed the GNDS, the Impact on Participation and Autonomy Questionnaire (IPA), and the MOEES, previously validated in the ambulatory MS population. A medical history relevant to MS was elicited. In the second part of the study (not reported here), the subjects completed an exercise diary for two weeks.
The initial study of 46 subjects showed a mean GNDS score of 10.7 for males and 12.1 for females, and these scores were not statistically different. Bivariate correlation analyses showed a significant relationship between GNDS and 2MWT, as well as GNDS and presence of pain or spasticity.
The IPA subscales—Autonomy Indoors scale, Family Role scale, and Autonomy Outdoors scale—showed significant correlations with average daily pain rating.
The MOEES scale data evaluated by principal components analysis showed excellent agreement with published three-subscale factor model. The Self-Evaluative subscale showed significant correlation with average daily pain rating.
Grip dynamometry results were 30.9 kg for the left hand and 32.1 kg for the right hand. Regression model showed that right-hand grip was predicted by MOEES Self-Evaluative subscale score, fatigue, and gender.
According to Dr. Bierner and colleagues, their initial study showed a relatively healthy sample, with GNDS disability scores lower than other published studies. Average grip strength was within normal limits for age and gender. The 2MWT was negatively correlated with GNDS total score and all IPA subscales. As expected, subjects who were able to walk greater distances had less perceived disability and greater autonomy and participation in their daily activities.