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MultiplesclerosisMultiplesclerosis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Multiplesclerosis Last reviewed: February 2019 Last updated: February 2019 Summary Demyelinating central nervous system condition clinically defined by two episodes of neurological dysfunction (brain, spinal cord, or optic nerves) that are separated in space and time. Classically presents in white women, aged between 20 to 40 years (...) , but lends greater specificity when present with brain lesions. Treatment of the condition can be divided into three parts: treatment of the acute attack; prevention of future attacks by reducing triggers and use of disease-modifying therapies; and symptomatic treatments of neurological difficulties such as spasticity, pain, fatigue, and bladder dysfunction. Definition Multiplesclerosis (MS) is defined as an inflammatory demyelinating disease characterised by the presence of episodic neurological
Percutaneous venoplasty for chronic cerebrospinal venous insufficiency in multiplesclerosis P Percutaneous v ercutaneous venoplasty for chronic enoplasty for chronic cerebrospinal v cerebrospinal venous insufficiency in multiple enous insufficiency in multiplesclerosissclerosis Interventional procedures guidance Published: 30 January 2019 nice.org.uk/guidance/ipg640 Y Y our responsibility our responsibility This guidance represents the view of NICE, arrived at after careful consideration (...) 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 1 of 41 1 Recommendations Recommendations 1.1 Current evidence on percutaneous venoplasty for chronic cerebrospinal venous insufficiency in multiplesclerosis shows that there are serious complications and that it provides no benefit. Therefore, this procedure should not be used in the management of multiplesclerosis. 2 2 The condition, current treatments and procedure
Effectiveness of Exercise Interventions for Pain Reduction in People With MultipleSclerosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials To systematically review the evidence of the effect of exercise compared with passive control on pain in people with multiple sclerosis.Five electronic databases were searched for randomized controlled trials published up to March 2017 that recruited people with multiplesclerosis where exercise was the intervention and pain (...) with less pain compared with passive control groups (standardized mean difference=-.46; 95% CI, -.92 to .00). There was high between-study heterogeneity (I2=77.0%), which was not explained by the prespecified study characteristics. There was also some evidence of small study effects.This is the first systematic review of the effect of exercise interventions on pain in people with multiplesclerosis, a chronic neurological disorder that affects 2.5 million people. We found some evidence that exercise
Association of Initial Disease-Modifying Therapy With Later Conversion to Secondary Progressive MultipleSclerosis. Within 2 decades of onset, 80% of untreated patients with relapsing-remitting multiplesclerosis (MS) convert to a phase of irreversible disability accrual termed secondary progressive MS. The association between disease-modifying treatments (DMTs), and this conversion has rarely been studied and never using a validated definition.To determine the association between the use
Effect of Nonmyeloablative Hematopoietic Stem Cell Transplantation vs Continued Disease-Modifying Therapy on Disease Progression in Patients With Relapsing-Remitting MultipleSclerosis: A Randomized Clinical Trial. Hematopoietic stem cell transplantation (HSCT) represents a potentially useful approach to slow or prevent progressive disability in relapsing-remitting multiplesclerosis (MS).To compare the effect of nonmyeloablative HSCT vs disease-modifying therapy (DMT) on disease
Rehabilitation for people with multiplesclerosis: an overview of Cochrane Reviews. Multiplesclerosis (MS) is a major cause of chronic, neurological disability, with a significant long-term disability burden, often requiring comprehensive rehabilitation.To systematically evaluate evidence from published Cochrane Reviews of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS (pwMS), to improve patient outcomes (...) , and to highlight current gaps in knowledge.We searched the Cochrane Database of Systematic Reviews up to December 2017, to identify Cochrane Reviews that assessed the effectiveness of organised rehabilitation interventions for pwMS. Two reviewers independently assessed the quality of included reviews, using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool, and the quality of the evidence for reported outcomes, using the GRADE framework.Overall, we included 15 reviews published
A Controlled Clinical Trial on the Effects of Exercise on Cognition and Mobility in Adults With MultipleSclerosis. The aim of the study was to investigate the effects of a 6-mo exercise program on cognition and mobility in participants with multiple sclerosis.This is a prospective, single-blind, controlled clinical trial.A community rehabilitation program within a large metropolitan health service.Twenty-eight patients with multiplesclerosis were referred for outpatient (...) did not have significant changes in cognition scores after 6 mos of follow-up and had a worse performance in mobility tests.Six months of exercise provided benefits to cognition and mobility in adults with multiplesclerosis. This trial was registered prospectively with the Brazilian Clinical Trials Register, ID: RBR-9gh4km (http://www.ensaiosclinicos.gov.br/rg/?q=RBR-9gh4km).Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon
Non-pharmacological interventions for chronic pain in multiplesclerosis. Chronic pain is common and significantly impacts on the lives of persons with multiplesclerosis (pwMS). Various types of non-pharmacological interventions are widely used, both in hospital and ambulatory/mobility settings to improve pain control in pwMS, but the effectiveness and safety of many non-pharmacological modalities is still unknown.This review aimed to investigate the effectiveness and safety of non
Ocrelizumab (Ocrevus) - relapsing forms of multiplesclerosis 1 Published 10 December 2018 1 SMC2121 ocrelizumab 300mg concentrate for solution for infusion (Ocrevus®) Roche Products Ltd Resubmission 9 November 2018 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHSScotland. The advice is summarised as follows: ADVICE: following a resubmission ocrelizumab (Ocrevus® (...) ) is accepted for restricted use within NHSScotland. Indication under review: The treatment of adult patients with relapsing forms of multiplesclerosis (RMS) with active disease defined by clinical or imaging features. SMC restriction: Treatment of relapsing remitting multiplesclerosis (RRMS) in adults with active disease defined by clinical or imaging features who are contra-indicated or otherwise unsuitable for alemtuzumab. Two phase III studies identified superiority of ocrelizumab when compared
MultipleSclerosis-Associated Changes in the Composition and Immune Functions of Spore-Forming Bacteria Multiplesclerosis (MS) is an autoimmune disease of the central nervous system characterized by adaptive and innate immune system dysregulation. Recent work has revealed moderate alteration of gut microbial communities in subjects with MS and in experimental, induced models. However, a mechanistic understanding linking the observed changes in the microbiota and the presence of the disease
Fampridine (Fampyra) - multiplesclerosis 1 Published 12 November 2018 1 SMC2107 fampridine 10mg prolonged-release tablet (Fampyra®) Biogen Idec Ltd Resubmission 05 October 2018 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHSScotland. The advice is summarised as follows: ADVICE: following a resubmission fampridine (Fampyra ® ) is not recommended for use within (...) NHSScotland. Indication under review: For the improvement of walking in adult patients with multiplesclerosis with walking disability (EDSS [expanded disability status scale] 4-7). In double-blind phase III studies fampridine, compared with placebo, improved walking ability in adults with multiplesclerosis and walking impairment. The submitting company did not present a sufficiently robust economic analysis to gain acceptance by SMC. Chairman Scottish Medicines Consortium www.scottishmedicines.org.uk 2
ADSTEP: Preliminary Investigation of a Multicomponent Walking Aid Program in People With MultipleSclerosis To evaluate the effect of the Assistive Device Selection, Training and Education Program (ADSTEP) on falls and walking and sitting activity in people with multiplesclerosis (PwMS).Randomized controlled trial.Veterans affairs medical center.PwMS (N=40) using a walking aid at baseline who had fallen in the previous year.Participants were randomly assigned to ADSTEP or control. ADSTEP had 6 (...) Technologies, MultipleSclerosis Walking Scale-12, Activities-Specific Balance Confidence Scale, and MultipleSclerosis Impact Scale-29. Effect on these outcomes was estimated by a 2-by-2 repeated measures general linear model.Fewer ADSTEP than control participants fell (χ2=3.96, P<.05. number needed to treat =3.3). Time spent sitting changed significantly differently with ADSTEP than with control from baseline to intervention completion (F=11.16, P=.002. ADSTEP: reduced 87.00±194.89min/d; control
Information provision for people with multiplesclerosis. People with multiplesclerosis (MS) are confronted with a number of important uncertainties concerning many aspects of the disease. These include diagnosis, prognosis, disease course, disease-modifying therapies, symptomatic therapies, and non-pharmacological interventions, among others. While people with MS demand adequate information to be able to actively participate in medical decision making and to self manage their disease, it has (...) to promote informed choice and improve patient-relevant outcomes, Further objectives were to evaluate the components and the developmental processes of the complex interventions used, to highlight the quantity and the certainty of the research evidence available, and to set an agenda for future research.For this update, we searched the Cochrane MultipleSclerosis and Rare Diseases of the Central Nervous System Group Specialised Register, which contains trials from CENTRAL (the Cochrane Library 2017
Diagnostic and Clinical Utility of the GAD-2 for Screening Anxiety Symptoms in Individuals With MultipleSclerosis To assess the diagnostic and clinical utility of the 2-item Generalized Anxiety Disorder Scale (GAD-2) for screening anxiety symptoms in individuals with multiplesclerosis (MS).Cross-sectional.University-affiliated MS neurology and rehabilitation center.The sample comprised adults (N=99) (ages 19-72; mean ± SD=46.2±13.0; 75% women) with a physician-confirmed MS diagnosis who were
Discriminative ability and clinical utility of the Timed Up and Go (TUG) in identifying falls risk in people with multiplesclerosis: a prospective cohort study To investigate discriminative ability and clinical utility of the Timed Up and Go under single- and dual-task conditions between fallers and non-fallers in multiplesclerosis (MS).Prospective cohort study.Neurology service in a tertiary hospital.Participants were 101 people with MS and Expanded Disability Status Scale score of 3-6.5 (...) -Cognitive in distinguishing fallers (person with ⩾1 fall) from non-fallers are 0.60 and 0.57, respectively, and in distinguishing multiple fallers (⩾2 falls) the values are 0.46 and 0.43. A Timed Up and Go score of ⩾9 seconds has a sensitivity of 0.82 and a specificity of 0.34 to identify fallers and a sensitivity of 0.79 and a specificity of 0.27 to identify multiple fallers. A Timed Up and Go-Cognitive score of ⩾11 seconds has a sensitivity of 0.77 and a specificity of 0.30 to identify fallers
Relationship Between Physiological and Perceived Fall Risk in People With MultipleSclerosis: Implications for Assessment and Management This study evaluated the relationship between physiological and perceived fall risk in people with multiplesclerosis (MS).Secondary analysis of data from prospective cohort studies undertaken in Australia, the United Kingdom, and the United States.Community.Ambulatory people with MS (N=416) (age 51.5±12.0 years; 73% female; 62% relapsing-remitting MS; 13.7
Vitamin D for the management of multiplesclerosis. This review is an update of a previously published review, "Vitamin D for the management of multiplesclerosis" (published in the Cochrane Library; 2010, Issue 12). Multiplesclerosis (MS) is characterised by inflammation, demyelination, axonal or neuronal loss, and astrocytic gliosis in the central nervous system (CNS), which can result in varying levels of disability. Some studies have provided evidence showing an association of MS with low (...) levels of vitamin D and benefit derived from its supplementation.To evaluate the benefit and safety of vitamin D supplementation for reducing disease activity in people with MS.We searched the Cochrane MultipleSclerosis and Rare Diseases of the CNS Specialized Register up to 2 October 2017 through contact with the Information Specialist with search terms relevant to this review. We included references identified from comprehensive electronic database searches and from handsearches of relevant
Trial of Fingolimod versus Interferon Beta-1a in Pediatric MultipleSclerosis. Treatment of patients younger than 18 years of age with multiplesclerosis has not been adequately examined in randomized trials. We compared fingolimod with interferon beta-1a in this population.In this phase 3 trial, we randomly assigned patients 10 to 17 years of age with relapsing multiplesclerosis in a 1:1 ratio to receive oral fingolimod at a dose of 0.5 mg per day (0.25 mg per day for patients with a body (...) ; relative difference, 82%; P<0.001). The key secondary end point of the annualized rate of new or newly enlarged lesions on T2-weighted magnetic resonance imaging (MRI) was 4.39 with fingolimod and 9.27 with interferon beta-1a (absolute difference, 4.88 lesions; relative difference, 53%; P<0.001). Adverse events, excluding relapses of multiplesclerosis, occurred in 88.8% of patients who received fingolimod and 95.3% of those who received interferon beta-1a. Serious adverse events occurred in 18
Phase 2 Trial of Ibudilast in Progressive MultipleSclerosis. There are limited treatments for progressive multiplesclerosis. Ibudilast inhibits several cyclic nucleotide phosphodiesterases, macrophage migration inhibitory factor, and toll-like receptor 4 and can cross the blood-brain barrier, with potential salutary effects in progressive multiple sclerosis.We enrolled patients with primary or secondary progressive multiplesclerosis in a phase 2 randomized trial of oral ibudilast (≤100 mg (...) less brain-tissue loss with ibudilast over a period of 96 weeks. Adverse events with ibudilast included gastrointestinal symptoms, headache, and depression.In a phase 2 trial involving patients with progressive multiplesclerosis, ibudilast was associated with slower progression of brain atrophy than placebo but was associated with higher rates of gastrointestinal side effects, headache, and depression. (Funded by the National Institute of Neurological Disorders and Stroke and others; NN102/SPRINT