Within the framework of the European year of the brain, the Austrian Society of Neurology is intensifying its public relations with information on neurological diseases and the achievements of the Austrian neurology. On the occasion of the World MS Day, MS experts reported on research activities that may have an impact on the diagnosis or therapy of multiple sclerosis.
Prof F. Fazekas, head of the Department of Neurology, University of Graz, pointed out that Austrian neurology successfully contributes to the international MS research in various fields. Fazekas cited as an example that Austrian researchers recently found increased iron deposition in the brain of MS patients. Whereas the significance of this finding remains yet unclear, it shows that the Austrian neurology is an important player in MS-research.
Promoting cognitive reserves: Research demonstrated that higher education moderates the effect of T2 lesion load and third ventricle width (suggestive of thalamic atrophy) on cognitive performance in a large sample of MS patients (n=137)1. D. Pinter, a neuropsychologist at the Medical University of Vienna, who published this data, concludes that cognitive training and leisure activities that are cognitive demanding a combination with disease-modifying drugs may help to reduce the cognitive impairment in MS patients.
Rehabilitation in MS: S. Salhofer-Polany, Department of Neurology, Medical University of Vienna, pointed out that rehabilitation is often recommended in MS patients, whereas data on its efficacy is limited. A recently published study showed that an inpatient multidisciplinary rehabilitation programme improves mean change scores of Timed 50 Meter Walk, walking speed and 6-Minute Walk compared to MS patients without rehabilitation2.
Is iron in the brain a MS-specific marker? Whereas MS is said to be an inflammatory disease, there are indications of a neurodegenerative component in MS, which are of interest regarding the progression of this chronic disease and the development of permanent tissue injury and disability. M. Khalil, Department of Neurology, Medical University of Graz, emphasised that the trace element iron may play an important role because of its involvement in maintaining normal brain metabolism, in the transport of oxygen, the synthesis of neurotransmitters and the production of myelin. Above that, iron is said to be related to oxidative stress, which might damage brain parenchyma. New developments in magnetic resonance imaging (MRI) make it possible to detect deposits of iron directly and noninvasively. High iron deposits have been shown to be a marker in MS patients compared to healthy controls. Besides that there seems to be a relation between elevated iron deposits and increased disease duration and disease severity. A long-term study shows that iron deposits progress rapidly in the brain of MS patients, specifically in the early phase of the disease. The impact of the latter finding on the course of the disease is still unclear, said Khalil.
H. Lassmann and S. Hametner, Medical University of Vienna, reported that iron is released by dying myelin cells in MS. The released iron is absorbed by other brain cells which cause oxidative stress through cell degradation. These findings support the perception that iron is released by the destruction of myelin cells during the first „wave“ of the MS associated attacks on the nervous system3,4. Fazekas pointed out that further studies and subgroup analyses will show if iron is possibly a marker for neurodegeneration and disease progression.
Task force on neuromyelitis optica
For a long time, neuromyelitis optica (NMO) was regarded a special form of MS. Since the demonstration of a specific antibody in NMO patients, NMO is viewed as an independent illness that needs a specific treatment.
In 2008, the Austrian NMO task force started under the guidance of Aboulenein-Djamshidian, Department of Neurology, SMZ Ost, Vienna. The aim of this task force is to identify all NMO patients in Austria and to analyse the course of the disease and the efficacy of the treatment. In the research laboratory of the Department of Deurology, Medical University of Innsbruck, in 1957 serum assays were analysed. Of these serum assays 71 NMO patients were identified5. Fazekas pointed out that the mentioned data provides a perfect base for further studies and international cooperation with the aim to better understand this rare disease and to treat it adequately.
Austrian MS register
In 2006, the Austrian MS register on MS therapies was established. All Austrian MS-centres participate in the register with the aim of optimising the treatment of MS by systematically gathering data on MS therapies. T. Berger, Department of Neurology, Medical University of Innsbruck, pointed out that the analysis of the long-term benefits and the risk factors of MS therapies are part of a quality management that provides important evidence of the real-life-treatment of MS patients. At the moment Natalizumab, Fingolimod and Alemtuzumab are part of the register.
This article is a summary of a report published in neurologisch 2/2014, p. 8–9 www.medmedia.at/medien/neurologisch/
1Pinter D et al., Higher education moderates the effect of T2 lesion load and third ventricle width on cognition in multiple sclerosis. PLOS One 2014 Jan 27; 9(1):e87567
2Salhofer-Polany S et al., Benefits of inpatient multidisciplinary rehabilitation in multiple sclerosis; NeuroRehabilitation 2013; 33(2):285–92
3Khalil M et al., Cerebrospinal fluid transferrin levels are reduced in patients with early multiple sclerosis; Mult Scler 2014 April 28
4Hametner S et al., Iron and Neurodegeneration in the Multiple Sclerosis Brain. Ann Neurol 2013; 74(6):848–61
5Aboul-Enein F et al., Neuromyelitis Optica in Austria in 2011: To Bridge the Gap between Neuroepidemiological Research and Practice in the Study Population of 8.4 Million People: PLOS One Nov 5; 8(11):e79649