MS Wrap-up: Suboptimal Cognitive Performance, Postpregnancy Relapse Protection, and More

Here are some of the latest developments in multiple sclerosis (MS) from our sister publication, NeurologyLive®.

Understanding Cognitive Performance in MS

Results of a recent study found the mechanisms underlying suboptimal cognitive performance among patients with MS remain a mystery, according to an article published by NeurologyLive®. Although the analysis found the condition is frequent among patients, no satisfactory explanation for it exists. Authors suggested suboptimal cognitive performance should be considered in the interpretation of cognitive complaints.

A total of 99 patients were analyzed in an outpatient setting and were classified as invalid or valid based on performance validity tests (PVTs). Of these patients, 20% scored below the PVT cutoff, although the performers did not differ in demographic, disease-related, and patient-related outcomes.

"Even though it remains difficult to grasp the underlying reasons of suboptimal performance, absence of PVTs may result in invalid interpretations of cognitive test results and consequently in less relevant patient education and counseling,” authors wrote.

Minimizing Postpartum, Pregnancy MS Relapses

New data suggest natalizumab could be an effective treatment option for minimizing the risk of postpartum relapses among pregnant women with MS who stopped disease-modifying therapy (DMT) during pregnancy, NeurologyLive® reports. Reinitiation of DMT with natalizumab protected women against postpartum relapse. Findings also showed continuing natalizumab into pregnancy reduced the odds of relapse during pregnancy.

The research revealed those who breastfed were less likely to experience MS relapse. A total of 1998 pregnancies from 1619 women were included in the analysis.

“For women of child-bearing age, our data inform DMT use that best controls disease activity during and after pregnancy as part of prepregnancy counseling. In women considered at high relapse risk or those with poor prognostic factors, high-efficacy therapy continuation in pregnancy attenuates the risk of relapse and disability accrual peri-pregnancy,” researchers said.

Impact of MRI Consensus Guidelines

In an interview, Scott D. Newsome, DO, and David Li, MD, FRCPC, underscored the importance of the first North American and European MRI consensus guidelines for MS. These new recommendations, developed in response to technological advancements, new safety data, and clinical advancements, will allow for a more unified approach to MS diagnosis and treatment.

“I applaud the last 20-plus years…This has not been an insignificant amount of work and number of people that have been involved, where we now finally have a consensus amongst experts, not just here in the Americas, but worldwide,” said Newsome, who is the president of the Consortium of Multiple Sclerosis Centers, director of the Neurosciences Consultation and Infusion Center at Green Spring Station, and an associate professor of neurology at Johns Hopkins Medicine

“The key to be able to diagnose MS as well as to monitor treatment is really being able to see those lesions and the changes that occur from one scan to the next,” added Li, a professor of radiology, associate member in neurology, and director of the Multiple Sclerosis/MRI Research Group at the University of British Columbia.