A
new study shows that taking part in a stress management program may help people
with multiple sclerosis (MS) prevent new disease activity. The study is
published in the July 11, 2012, online issue of Neurology, the
medical journal of the American Academy of Neurology.
A weekly stress management program for patients with
multiple sclerosis (M.S.) prevented the development of new brain lesions, a
marker of the disease's activity in the brain, according to new Northwestern
Medicine research. Brain lesions in M.S. often precede flare-ups of symptoms
such as loss of vision or use of limbs or pain.
"This is the first time counseling or
psychotherapy has been shown to affect the development of new brain
lesions," said David Mohr, principal investigator of the study and
professor of preventive medicine at Northwestern University Feinberg School of
Medicine. "In M.S., the prevention of new brain lesions is an important
marker used to judge how effective medications are."
"The new finding is an important step and the
strongest evidence we have to date that stress is involved in M.S.," Mohr
added.
The results indicate that stress management therapy
may be a useful adjunct treatment with drug therapy for M.S., but a larger
clinical trial is needed to confirm this, Mohr said.
The study is published in the July 11, 2012 issue of Neurology,
the medical journal of the American Academy of Neurology.
Mohr's previous research showed a connection between
psychological distress and the development of new brain lesions. Stress is one
of many factors, he said, that influence whether the underlying M.S. disease
processes escalate to the point of a new lesion or a relapse. Mohr has spent
more than a decade studying the link between emotional distress, including a
study on depression, and M.S.
For an event to be stressful, a person has to feel it
is a threat to something important, and that he or she doesn't have any control
over it.
"We taught patients strategies to evaluate how
much of a threat something truly is," Mohr said. "When people
overestimate the threat of an event or underestimate their ability to manage
it, we teach them how to evaluate their own thinking about the stress and how
to challenge and change that thinking to a more realistic and helpful appraisal
of the actual threat. That often leads to improved ability to manage stressful
events."
Patients also were taught how to calm their physical
reactions to stress through relaxation and meditation to cope with stressful
events that couldn't be avoided.
In the national clinical trial, 121 patients were
randomized to receive stress management therapy for M.S. or be in a control
group. Those in the therapy group received 16 sessions over a 24-week period
during which they were taught coping skills to enhance their ability to prevent
stressful events from occurring and to improve their capacity to manage their
responses to stressful events that did arise. They also received a 24-week
post-treatment follow-up. Two-thirds of the patients were women, who have a higher
incidence of M.S.
MRI neuroimaging showed the stress management therapy
reduced two types of new brain lesions common in multiple sclerosis.
The first type, gadolinium-enhancing brain lesions,
indicates a breakdown of the blood-brain barrier, allowing the immune system
access to attack and damage brain cells. Gadolinium is injected into an M.S.
patient during the MRI and can be observed passing through the blood-brain
barrier, if these types of lesions are present. These lesions may disappear
over time or may leave more permanent damage in the brain.
The second type, a T2 brain lesion, is a more global
marker of the effect of M.S. on the brain and is a more permanent lesion. These
markers are commonly used in evaluating M.S. medications in Phase II trials. If
the lesions are decreased, the implication is the drug is working.
Among patients who received stress management therapy,
55 percent had a new gadolinium-enhancing brain lesion during the treatment
period, compared to 77 percent of those in the control group. Similarly, 43
percent receiving stress management therapy had a new T2 brain lesion during
the treatment period, compared to 70 percent in the control group. The stress
reduction prevented new lesions whether or not the patients were taking M.S.
disease-modifying medications (e.g., beta-interferons or glatiramer acetate).
But the improvement in brain lesions didn't last after
the stress management program ended.
"This suggests that we will need to develop
treatments that are more sustainable over longer periods of time," Mohr
said. "It's difficult for people to come in for treatment once a week over
long periods of time, due both to cost and time constraints. We are looking at
telemedicine programs that can be delivered via a computer or a smartphone to
people in their environment at much lower costs than traditional therapy."
The study did not show a statistical difference in the
rate of clinical M.S. symptoms, but Mohr said he didn't expect one in such a
small number of participants. The outcome goal of this trial was only to see if
the stress reduction affected the brain lesions.
While the results are positive, Mohr said, it's
premature to make recommendations for patients regarding use of stress
management therapy. "I don't want to see patients decide not to take their
medication and use this instead," he emphasized.
Provided by American
Academy of Neurology
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