What we learned on Thursday (26 October) at ECTRIMS–ACTRIMS
When the Eiffel Tower was planned, it was mocked as ‘useless and monstrous’
The Eiffel Tower was planned to be the entrance to the 1889 World’s Fair, but as the foundations were being laid, outraged French intellectuals and artists protested ‘against the construction in the very heart of our capital of the useless and monstrous Eiffel Tower’, and campaigned to have the plans for the tower abolished. 123 years later, the Eiffel Tower is a national icon and undergoing a €30 million refurbishment.
Solar panels and glass floors: it's a €30m refit for the Eiffel Tower, The Guardian, 5 October 2014
Presence of oligoclonal bands is now included in the diagnostic criteria for MS
The International Panel on Diagnosis of MS has made five revisions to the McDonald diagnostic criteria. The revisions represent a compromise between sensitivity (to facilitate efficient diagnosis now that earlier treatment exists) and specificity (to lessen the risk of misdiagnosis). The first revision now allows oligoclonal bands to be considered in diagnosis of MS: in a patient with typical CIS and MRI dissemination in space (DIS) and no better clinical explanation, the presence of CSF-specific oligoclonal bands allows diagnosis to be revised to MS.
Time is of the essence
A new study by Brownlee et al. showed that time influences the performance of diagnostic criteria for multiple sclerosis. The specificity and accuracy of the McDonald 2010 criteria for a diagnosis of clinically definite MS (CDMS) improved over time, as did the positive predictive value for a diagnosis of CDMS (while the negative predictive value decreased). The duration of follow-up is an important factor to consider when the performance of MRI criteria is evaluated.
Miscarriage induces reactivation of inflammation in RRMS
Like pregnancy, miscarriage affects the disease course of MS and can cause disease reactivation. A study by Landi et al. suggested that this may occur through recovery of immunocompetence. There was an inverse correlation between pregnancy length and the occurrence of new Gd+ lesions after a miscarriage. These may occur as a result of pro-inflammatory processes (essential for implantation and pregnancy maintenance) and low production of oestriol at a very early pregnancy stage.
Psychiatric illness can be a warning of future MS
In MS, psychiatric comorbidity is more prevalent and has a higher incidence than in the general population. A study by Marrie et al. showed that there was a higher incidence of depression, anxiety and bipolar disorder as early as 5 years before diagnosis of MS. The increased incidence rates before MS diagnosis might be the reflection of inflammation or neurodegeneration.
DICAM is a potential new therapeutic target for MS treatment
Dual Ig-domain-containing Cell Adhesion Molecule (DICAM) is expressed on the surface of potentially encephalitogenic TH17 lymphocytes and regulated by IL-23, IL-1b and IL-6 – cytokines that play a role in CNS autoimmune diseases. Grasmuck et al. showed that the proportion of DICAM+ CD4+ lymphocytes was higher in MS patients compared with healthy controls. The interaction between TH17 lymphocytes and blood–brain barrier via DICAM might be important in the pathology of MS and may provide a new therapeutic target.
If you eat more fish, you reduce your risk of MS
A study by Langer Gould et al. showed that fresh fish consumption was associated with a lower risk of MS that was independent of vitamin D status and consistent across ethnic groups. Future studies should find out whether specific components of fish (e.g. omega-3 PUFAs) are protective or whether these results are simply due to the fish substituting other potentially detrimental foods from the diet.
Breathing polluted air is particularly damaging for people with MS
It is essentially unknown what triggers MS relapses, but the incidence of relapses varies across seasons, which suggests that season-dependent factors may be involved. One of these factors, air pollution, is of growing interest in the aetiology of neurological diseases. In a time-stratified case-crossover study, Jeanjean et al. showed that levels of ambient air pollution (e.g., NO2, PM10 and O3) were associated with the occurrence of MS relapses. These results have significant implications on the aetiology of neurological diseases.
Smokers with MS may be at increased risk of relapse
Smoking was associated with an increased relapse rate in natalizumab-treated patients with RRMS. This study further exemplifies the deleterious effects of smoking on MS patients.
In MS, laughing matters
A study of 172 patients showed that individuals with high use of humour reported greater psychological well-being (PWB), physical health, general and MS self-efficacy, self-efficacy/locus of control (LOC) and social support. They also seemed to have lower levels of depression and anxiety.
