Stress relief may slow multiple sclerosis lesions
NEW YORK (Reuters Health) - Stress management therapy may help curb some of the brain inflammation seen in multiple sclerosis (MS) -- at least for a time, researchers reported Wednesday.
Stress management counseling designed specifically for MS has been shown to help people feel better. But the new study is the first to show that there may be detectable effects on the brain.
In a study of 121 MS patients, researchers found that those given six months of stress management sessions were less likely to develop new brain lesions -- patches of inflammation in the protective sheath that surrounds nerve fibers.
It's too early to recommend stress management for slowing the progression of MS, the study's lead researcher said. For one, the brain benefits disappeared once people stopped going to therapy.
Plus, it's not clear what the effects might be on people's actual MS symptoms. Brain lesions are considered a marker of MS "activity," but they do not necessarily correlate well with symptoms.
"This is really the first time a behavioral intervention has been shown to have an effect on MS disease activity," said lead researcher David C. Mohr, a professor at Northwestern University School of Medicine in Chicago.
That's "good news," according to an editorial published with the study in the journal Neurology.
But the "bad news" was that the effects on brain lesions vanished in the six months after patients stopped stress management therapy, write Dr. Christoph Heesen and Stefan M. Gold of the University Medical Center Eppendorf in Hamburg, Germany.
MS is thought to arise when the immune system mistakenly attacks the protective sheath around nerve fibers in the brain and spine. The symptoms vary based on which nerve fibers are affected, but can include muscle weakness, numbness, vision problems and difficulty with balance and coordination.
No one knows what triggers the abnormal immune response.
COUNSELING CAN BE COSTLY
For the new study, Mohr's team tested a stress management therapy designed specifically for people with MS. Research had already shown that this particular therapy can help patients' mood, fatigue and quality of life.
But no one had known whether it affects brain lesions.
So Mohr's team randomly assigned patients to either have 16 one-on-one sessions with a psychologist over 24 weeks or go on a wait-list.
Using MRI scans, the researchers found that more of the stress management patients remained free of new lesions. After 24 weeks, 77 percent had no new "gadolinium-enhancing" lesions in their brains. That compared with 55 percent of the wait-listed patients.
But the advantage disappeared in the 24 weeks after therapy ended. During that period, 69 percent of therapy patients and 61 percent of wait-list patients had no new lesions.
Mohr said that longer-term help might be needed. But, he said, "with one-on-one counseling, that's difficult. It's hard for people to keep up, and it gets costly."
That cost varies place to place, but a typical one-on-one session would run about $100 an hour.
A potential answer, according to Mohr, might be to offer therapy over the phone or online. Other research, he said, has suggested that telephone stress management counseling can be as effective as face-to-face.
STRESS AND INFLAMMATION
And why would the therapy have an effect on MS brain lesions? It's not fully clear, Mohr said. The theory is essentially that stress can exacerbate inflammation, and reducing stress may, therefore, lessen inflammation.
But there are many questions left.
"It's premature to recommend this therapy for managing MS progression," Mohr said.
Nor does he see it as a potential alternative to the so-called disease-modifying drugs used to treat MS. In this study, patients stuck with any medications they were already using.
Still, the program used in the study may help with problems like depressed mood and fatigue. And it's available in manual form for therapists to use, according to Mohr.
But outside of urban areas, he noted, it might be hard to find a therapist with specific experience in MS.
People who are interested in stress management could ask their doctor or consult the National MS Society to find out what's in their area, Mohr said.
SOURCE: http://bit.ly/N2DcLw Neurology, online July 11, 2012.
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