Milestone for Cannabinoid MS Study

 

LONDON, July 21 /PRNewswire/ —

 

The CUPID (Cannabinoid Use in Progressive Inflammatory brain Disease) study at the Peninsula Medical School has reached an important milestone with the news that the full cohort of 493 patients with multiple sclerosis (MS) has been recruited to the programme.

 

CUPID is a clinical trial part-funded by the UK MS Society, which will evaluate whether tetrahydrocannabinol (THC) - the main active ingredient in the cannabis plant and one of many compounds found in the organism - is able to slow the progression of MS.

 

It is an important study for people with MS, because current treatments either target the immune system in the early stages of MS, or ease specific symptoms such as muscle spasms or bladder problems.

 

The CUPID trial follows an earlier study - Cannabinoids and Multiple Sclerosis (CAMS) - which established a link between THC and the slowing of MS. The CAMS trial saw participants take THC for a year - the CUPID trial will last for longer and aims to assess the affect of THC on progressive MS.

 

It has taken two years to recruit the 493 patients, and they will take part in the trial for three years; in some cases three and a half years. After data cleaning and analysis the results should be available by spring/early summer 2012.

 

Dr Laura Bell, research communications officer for the MS Society, said: “People affected by MS are keen to know whether there’s any truth in the suggestion that elements of the cannabis plant can help ease the symptoms and slow down progression of the condition.

 

“The MS Society is supportive of safe clinical trials investigating the medicinal properties of cannabis and it’s great news that this trial is going ahead. We look forward to the results of this exciting study.”

 

Professor John Zajicek from the Peninsula Medical School, who heads the team carrying out the CUPID study, said: “We are delighted to have achieved the correct number of patient participants for this trial. Patients have been recruited from 27 sites across the UK.

 

“If we are able to prove beyond reasonable doubt the link between THC and the slowing down of progressive MS, we will be able to develop an effective therapy for the many thousands of MS sufferers around the world.”

 

The CUPID trial is jointly funded by the MS Society, the Multiple Sclerosis Trust and the Medical Research Council.

 

    

    Notes to Editors:

 

    - The MS Society (http://www.mssociety.org.uk) is the UK’s largest

      charity dedicated to supporting everyone whose life is touched by MS,

      providing respite care, an award-winning freephone helpline 

      (0808-800-8000), specialist MS nurses and funds around 40 vital MS 

      research projects in the UK.

    - Multiple sclerosis is the most common disabling neurological

      disorder affecting young adults and an estimated 85,000 people in the 

      UK have MS.

    - MS is the result of damage to myelin - the protective sheath

      surrounding nerve fibres of the central nervous system - which 

      interferes with messages between the brain and the body.

    - For some people, MS is characterised by periods of relapse and

      remission while for others it has a progressive pattern.

    - Symptoms range from loss of sight and mobility, fatigue,

      depression and cognitive problems. There is no cure and few effective

      treatments.

 

How does a patient prepare for CT scanning, and how is it performed?

 

 

In preparation for a CT scan, patients are often asked to avoid food, especially when contrast material is to be used. Contrast material may be injected intravenously, or administered by mouth or by an enema in order to increase the distinction between various organs or areas of the body. Therefore, fluids and food may be restricted for several hours prior to the examination. If the patient has a history of allergy to contrast material (such as iodine), the requesting physician and radiology staff should be notified. All metallic materials and certain clothing around the body are removed because they can interfere with the clarity of the images.

 

Patients are placed on a movable table, and the table is slipped into the center of a large donut-shaped machine which takes the x-ray images around the body. The actual procedure can take from a half an hour to an hour and a half. If specific tests, biopsies, or intervention are performed by the radiologist during CT scanning, additional time and monitoring may be required. It is important during the CT scan procedure that the patient minimize any body movement by remaining as still and quiet as is possible. This significantly increases the clarity of the x-ray images. The CT scan technologist tells the patient when to breathe or hold his/her breath during scans of the chest and abdomen. If any problems are experienced during the CT scan, the technologist should be informed immediately. The technologist directly watches the patient through an observation window during the procedure and there is an intercom system in the room for added patient safety.

 

CT scans have vastly improved the ability of doctors to diagnose many diseases earlier in their course and with much less risk than previous methods. Further refinements in CT scan technology continue to evolve which promise even better picture quality and patient safety. Newer CT scans called “spiral” or “helical” CT scans can provide more rapid and accurate visualization of internal organs. For example, many trauma centers are using these scans to more rapidly diagnose internal injuries after serious body trauma.

 

 

 

 

CT Scan At A Glance

 

 

CT scanning adds x-ray images with the aid of a computer to generate cross-sectional views of anatomy.

 

CT scanning can identify normal and abnormal structures and be used to guide procedures.

 

CT scanning is painless.

 

Iodine-containing contrast material is sometimes used in CT scanning. Patients with a history of allergy to iodine or contrast materials should notify their physicians and radiology staff.

What is a CT scan?

 

 

A computerized axial tomography scan is more commonly known by its abbreviated name, CT scan or CAT scan. It is an x-ray procedure which combines many x-ray images with the aid of a computer to generate cross-sectional views and, if needed, three-dimensional images of the internal organs and structures of the body. A CT scan is used to define normal and abnormal structures in the body and/or assist in procedures by helping to accurately guide the placement of instruments or treatments. A large donut-shaped x-ray machine takes x-ray images at many different angles around the body. These images are processed by a computer to produce cross-sectional pictures of the body. In each of these pictures the body is seen as an x-ray “slice” of the body, which is recorded on a film. This recorded image is called a tomogram. “Computerized Axial Tomography” refers to the recorded tomogram “sections” at different levels of the body.

 

Imagine the body as a loaf of bread and you are looking at one end of the loaf. As you remove each slice of bread, you can see the entire surface of that slice from the crust to the center. The body is seen on CT scan slices in a similar fashion from the skin to the central part of the body being examined. When these levels are further “added” together, a three-dimensional picture of an organ or abnormal body structure can be obtained.

 

 

 

Why are CT scans performed?

 

 

CT scans are performed to analyze the internal structures of various parts of the body. This includes the head, where traumatic injuries, (such as blood clots or skull fractures), tumors, and infections can be identified. In the spine, the bony structure of the vertebrae can be accurately defined, as can the anatomy of the intervertebral discs and spinal cord. In fact, CT scan methods can be used to accurately measure the density of bone in evaluating osteoporosis.

 

Occasionally, contrast material (an x-ray dye) is placed into the spinal fluid to further enhance the scan and the various structural relationships of the spine, the spinal cord, and its nerves. CT scans are also used in the chest to identify tumors, cysts, or infections that may be suspected on a chest x-ray. CT scans of the abdomen are extremely helpful in defining body organ anatomy, including visualizing the liver, gallbladder, pancreas, spleen, aorta, kidneys, uterus, and ovaries. CT scans in this area are used to verify the presence or absence of tumors, infection, abnormal anatomy, or changes of the body from trauma.

 

The technique is painless and can provide extremely accurate images of body structures in addition to guiding the radiologist in performing certain procedures, such as biopsies of suspected cancers, removal of internal body fluids for various tests, and the draining of abscesses which are deep in the body. Many of these procedures are minimally invasive and have markedly decreased the need to perform surgery to accomplish the same goal.

 

 

Are there risks in obtaining a CT scan?

 

 

A CT scan is a very low-risk procedure. The most common problem is an adverse reaction to intravenous contrast material. Intravenous contrast is usually an iodine-based liquid given in the vein, which makes many organs and structures, such as the kidneys and blood vessels much more visible on the CT scan. There may be resulting itching, a rash, hives, or a feeling of warmth throughout the body. These are usually self-limiting reactions and go away rather quickly. If needed, antihistamines can be given to help relieve the symptoms. A more serious reaction to intravenous contrast is called an anaphylactic reaction. When this occurs, the patient may experience severe hives and/or extreme difficulty in breathing. This reaction is quite rare, but is potentially life-threatening if not treated. Medications which may include corticosteroids, antihistamines, and epinephrine reverse this adverse reaction.

 

Toxicity to the kidneys which can result in kidney failure is an extremely rare complication of the intravenous contrast used in CT scans. Diabetics, dehydrated individuals, or patients who already have impaired kidney function are most prone to this reaction. Newer intravenous contrast agents have been developed, such as Isovue, which have nearly eliminated this complication.

 

The amount of radiation a person receives during a CT scan is minimal. In men and non-pregnant women, it has not been shown to produce any adverse effects. If a woman is pregnant, there may be a potential risk to the fetus, especially in the first trimester of the pregnancy. If a woman is pregnant, she should inform her doctor of her condition and discuss other potential methods of testing, such as an ultrasound, which are not harmful to the fetus.

Definition

 

Evoked potential studies are a group of tests of the nervous system that measure electrical signals along the nerve pathways.

 

Purpose

 

Nerves convey information to the body by sending electrical signals down the length of the nerve. These signals can be recorded by wires placed over the nerves on the surface of the skin, in a procedure called an evoked potential (EP) study. The person conducting the test evokes the patient’s neural activity by visual or auditory stimulation or using a mild electrical shock. This causes changes in the electrical potential in the nerves. Analysis of the signals can provide information about the condition of nerve pathways, especially those in the brain and spinal cord. They can indicate the presence of disease or degeneration, and can help determine the location of nerve lesions.

 

There are three major types of EP studies used regularly:

 

• Visual evoked potentials are used to diagnose visual losses due to optic nerve damage, especially from multiple sclerosis. They are also useful to diagnose “hysterical blindness,” in which loss of vision is not due to any nerve damage.
• Auditory evoked potentials are used to diagnose hearing losses. They can distinguish damage to the acoustic nerve (which carries signals from the ear to the brain stem) from damage to the auditory pathways within the brainstem. Most auditory EPs record activity from the brainstem, and are therefore called “brainstem auditory evoked potentials.” Disorders diagnosed with auditory EPs include acoustic neuroma (tumors of the inner ear) and multiple sclerosis (chronic disease in which nerves lose patches of their outer covering). They may also be used to assess high frequency hearing ability, to determine brain death, and to monitor brainstem function during surgery
• Somatosensory evoked potentials record transmission of nerve impulses from the limbs to the brain, and can be used to diagnose nerve damage or degeneration within the spinal cord or nerve roots from multiple sclerosis, trauma, or other degenerative disease. Somatosensory EPs can be used to distinguish central versus peripheral nerve disease, when combined with results from a nerve conduction velocity test, which measures nerve function in the extremities.

Precautions

 

Evoked potential studies are painless, non-invasive, and without any significant risk. Somatosensory EP tests involve very mild electric shocks, usually felt as a tingling.

 

Description

 

The person performing the test locates and marks specific spots on the patient’s head for placement of electrodes. These spots are cleaned, and an adhesive conducting paste is applied. Cup electrodes are attached. For somatosensory EP, spots on the arm or leg are also marked and cleaned; electrodes may be taped in place. The patient sits or reclines in a chair throughout the tests.

 

For a visual EP, the patient focuses on a TV screen which displays a checkerboard pattern. The eye not being tested is covered with a patch. For children or others whose attention may wander, goggles are used which show the pattern to one eye at a time. Each eye is usually tested twice, and the entire procedure takes approximately 30-45 minutes.

 

For auditory EP, headphones are used to deliver a series of clicks to one ear at a time. A masking or static sound is played into the other ear. Each ear is usually tested twice, and the entire procedure takes approximately 30-45 minutes.

 

For somatosensory EP, mild electrical shocks are delivered to the arm or leg. This may cause some twitching and tingling. The stimulus lasts for about two minutes at a time, and the entire procedure takes approximately 30 minutes.

 

After the tests, the electrodes are removed with acetone and the scalp is cleaned.

 

Preparation

 

Hair must be clean, dry, and free of any braids, pins, or jewellery. The patient should shampoo before the test, and must not use any hair spray, gel, or other hair care products after shampooing. Clothing should be loose and comfortable. The patient may eat and take some medications as usual before the test, although sedative medications should be avoided on the day of the test, if possible. It is best to check with the physician supervising the test for specific instructions.

 

Aftercare

 

This test is painless and has no residual effects. The patient may return to work or other activities immediately afterward.

 

Normal results

 

EP test results are displayed as jagged electrical tracings (wave forms), which have characteristic shapes, heights, and lengths, indicating the speed and intensity of signal transmission. Results are read by someone trained in evoked potential studies.

 

Abnormal results

 

Changes in the electrical tracings may indicate damage to or degeneration of nerve pathways to the brain from the eyes, ears, or limbs. Absence of any activity may mean complete loss of nerve function in that pathway. Other changes may provide evidence of the type and location of nerve damage.

 

Key Terms

 

Nerve conduction velocity test

 

A test of the speed of conduction of nerves, performed on the nerves in the arm and leg.

 

For Your Information

 

Resources

 

Books

 

• Samuels, Martin, and Seven Feske, editors. Office Practice of Neurology. New York: Churchill Livingstone, 1996.

 

 

 

 

 

Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group The Essay Author is Richard Robinson.

 

 The Awful Neurological Diagnosis

 

After years of experiencing those illusive symptoms I started to feel like a hypochondriac.  After all, my doctor knew I was only seeking attention, so why shouldn’t I start to realize that my symptoms were mere phantoms.  I had completely stopped mentioning any health difficulty that could not be quantified by myself first.

          

Then came a time when everything changed.  I had an appointment to see my regular general practitioner when an intern was doing preliminary examinations for my own doctor.  As I was talking to the intern she actually witnessed me experiencing the lighting bolts of pain.  There was no ignoring or disguising the pain I felt at that time.  It was so sudden and so very, very intense.  She explained to me that this was called trigeminal neuralgia which involves a malfunction of one of the major facial nerves.

 

The intern had taken a class on MS the day before and was eager to practice what she had learned.  After a thorough examination she reported what she had observed to my doctor.  I was then referred to a neurologist.  Just like that, I was finally seeing a neurologist.  I did not realize until years later that I could have requested an appointment with a neurologist and my GP would have had to refer me.  (At least in Canada, I am not sure how things are done in other countries.  In Canada we cannot see a specialist unless we are referred by our GPs.)

 

On the first visit with the neurologist he calmly said, “Yes, you probably have MS, but I want to do some simple tests first.”  One of these tests was a Magnetic Resonance Imaging (MRI), the other test is a Spinal Tap.

 

 

The Day of Discovery

 

The day I found out that I had MS was a gray, dismal day.   The neurologist walked into the examination room, perched on the edge of his desk, slapped my chart down, and said, “You have MS”. 

 

After a lengthy stunned pause he continued, “There is nothing I can do for you unless you have $17,000 a year to spend on medicine!”  He allowed a short pause before he asked, “Do you have that amount of money?”  I numbly answered in the negative.  He stood up and walked out; flippantly and callously, saying, “Have a good day.”

 

I was numb with shock.  I made my way to the waiting room and my daughter was. We left.  To her question of the diagnosis, I numbly replied, “Yes, I have MS”. 

 

When we got to the street the sky had opened up and the rain was pouring down.  We had several blocks to walk.  I started  crying.  We were both very quiet, with our own private thoughts. 

 

Nature plastered us with drenching water, running down our faces.  No one on the street, even noticed that I was crying.  After a few block I started to pray.  I gave myself, and my MS, completely over to the care of God. 

 

By the time we got to the car I knew that God was in control and my life could be very good, even with MS.  I wasn’t relieved.  I wasn’t accepting.  I wasn’t understanding.  But, I did know that I didn’t have to do this alone.

 

To many, I may appear to be healthy.  I may appear to have no difficulty with balance, vision, speech, muscle spasms, tremors, cognitive abilities, or fatigue.  Many do not see the emotional and physical pains that I experience because of MS.  MS is not always a visible disease. 

 

For most MS patients, MS is a:  silent, invisible, chronic, progressive, sometimes devastating disease.  MS can attack any part of the central nervous system, including: the brain, spinal cord, and optic nerve.  It is believed that our body’s immune system is attacking itself.

 

 

Bonnie