Staphylococcus aureus harbouring Enterotoxin A as a possible risk factor for multiple sclerosis exacerbations.

BACKGROUND: Staphylococcus aureus may produce superantigens that can non-specifically activate CD4(+) cells to potentially target the myelin basic protein. OBJECTIVE: This study examined the association between individuals with multiple sclerosis (MS) and colonization with S. aureus harbouring superantigens. METHODS: Nasal swabs were collected from non-MS subjects and patients with MS who had not experienced a relapse in the past six months (MS stable group) and who had suffered a relapse within 30 days of study recruitment (MS exacerbation group). S. aureus was isolated from the anterior nares of participants following standard procedures and staphylococcal superantigen genes (sea, seb, and tsst-1) were detected using standard laboratory PCR techniques. RESULTS: The study enrolled 204 patients, 80 in the non-MS and MS stable groups and 44 patients in the MS exacerbation group. Overall, 27.0% of patients were colonized with S. aureus with no significant differences identified between study groups. Amongst individuals colonized with S. aureus, the prevalence of sea was significantly greater in the MS exacerbation versus non-MS study group (p < 0.05; odds ratio 7.9; 95% confidence interval 1.2-49.5). CONCLUSIONS: The ability to rapidly screen patients for the presence of S. aureus producing sea may serve as a useful marker of a potential MS exacerbation.

Fatigue and cognition in patients with relapsing multiple sclerosis treated with interferon ß.

INTRODUCTION: Fatigue and cognitive deficits are common symptoms affecting patients with multiple sclerosis. METHODS: The effects of interferon beta on fatigue and cognitive deficits were assessed in 50 patients with relapsing multiple sclerosis (recruited at a single center). The pre-treatment assessments were performed on visits 1 and 2 (Months 0 and 3). Patients started treatment with subcutaneous interferon beta-1a or beta-1b, or intramuscular interferon beta-1a at Month 3, with reassessment at visits 3 and 4 (6 and 12 months, respectively). Co-primary endpoints were change in fatigue (Modified Fatigue Impact Scale) and change in cognition (Brief Repeatable Battery of Neuropsychological Tests) from pre-treatment to visits 3 and 4. Follow-up data were obtained for 40 patients. RESULTS: The pre-treatment demographic and disease characteristics did not differ between groups. Improvements in fatigue levels were reported for patients receiving subcutaneous interferon beta-1a versus patients in the intramuscular interferon beta-1a group (p = .04) and in the interferon beta-1b group (p = .09). Improvements were also reported in five out of 17 cognitive indices for all the treatment groups. CONCLUSION: The data suggest that interferon beta may reduce fatigue and cognitive deficits in patients with relapsing multiple sclerosis. Larger, randomized, and controlled studies are required to confirm our findings.

A treatment algorithm for neuropathic pain: an update.

OBJECTIVE: The purpose of this review is to provide an update of the neuropathic pain treatment algorithm previously published by Namaka et al. in 2004. This algorithm focuses on the strategic incorporation of the latest pain therapies while providing an update of any recent developments involving medications previously listed in the algorithm. DATA SOURCES: PubMed, MEDLINE, Cochrane, and Toxnet databases were used to conduct all literature searches on neuropathic pain and targeted treatment strategies. Comprehensive search efforts in the identified databases included studies published between 1980 and 2009. The search term "neuropathic pain" was used along with each of the agents outlined in this review: pregabalin, paroxetine CR, duloxetine, tramadol XL, Tramacet, Sativex, and nabilone. STUDY SELECTION: A total of 90 studies were reviewed and selected based on level 1, 2, and 3 search strategies. DATA EXTRACTION: Level 1 search strategies were initially aimed at evidence-based trials of large sample size (N > 100), with a randomized, double-blind, placebo-controlled design conducted by investigators well versed in the specialty area of interest. A level 2 search was conducted for additional trials that had many, but not all, of the desirable traits of evidence-based trials. In addition, a level 3 search strategy was conducted to compare key findings stated in anecdotal reports of very small (N < 15), poorly designed trials with the results of well-designed, evidence-based trials identified in level 1 and/or level 2 searches. DATA SYNTHESIS: Based on a thorough evaluation of the literature, pregabalin, paroxetine CR, and duloxetine have been placed in the updated algorithm as first-line agents, while tramadol XL, Tramacet, Sativex, and nabilone function primarily as adjunctive agents. CONCLUSION: The updated algorithm provides a baseline framework from which clinicians can justify the medication they prescribe.

Multiple sclerosis: etiology and treatment strategies.

OBJECTIVE: To review the etiology and treatment strategies for multiple sclerosis (MS). DATA SOURCES: Published information on MS and targeted treatment strategies extending back to 1955. The search terms multiple sclerosis and pathology, prevalence, genetics, and each of the common symptoms of MS were used. STUDY SELECTION: Seventy-two studies were reviewed based on level 1, 2, and 3 search strategies. DATA EXTRACTION: Level 1 search strategy targeted evidence-based trials of large sample size (N > 100) with a randomized, double-blind, placebo-controlled design. A level 2 search targeted additional trials with some of the traits of evidence-based trials. A level 3 search compared key findings in reports of very small (N < 15) poorly designed trials with the results of well-designed trials. DATA SYNTHESIS: MS affects each patient differently, making a definitive diagnosis and management of symptoms very difficult. Effective symptom management requires an interprofessional team approach. CONCLUSION: Despite all the research dedicated to this disease, there is still no cure. The treatments currently available function at best only to slow the disease progression and mitigate symptoms. Using the skills and knowledge available from a team of health care professionals will help patients navigate the trials and tribulations that follow throughout a life with MS.