A randomized controlled study of the acute and chronic effects of cooling therapy for MS

Schwid, Steven R.; Petrie, Mary; Murray, Ronald S.; Leitch, Jennifer; Bowen, James D.; Alquist, A D; Pelligrino, Richard; Roberts, Adam; Harper-Bennie, Judith; Milan, Maria Dawn; Guisado, Raul; Luna, Bernadette; Montgomery, Leslie D.; Lamparter, R. A.; Ku, Yu-Tsuan E.; Lee, Hank; Goldwater, D. J.; Cutter, Gary; Webbon, Bruce W.; Nasa, Nasa

doi:10.1212/01.wnl.0000070183.30517.2f

Cited by 118 publications

(17 citation statements)

References 23 publications

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“…More promising may be exploration of an inflammatory etiology for MS fatigue, which is supported by a link between fatigue and inflammatory markers (tumor necrosis factor-alpha and interferon-gamma) 18 , and by the link between fatigue and elevated body temperature presented herein. Consistent with our observation linking MS fatigue and elevated body temperature, RCTs of cooling garments 19–20 and antipyretic medication (aspirin) 21 have been effective in treating MS fatigue. Our findings linking warmer body temperature and MS fatigue help explain the efficacy of cooling/antipyretic treatments, and encourage further research on such treatments for MS fatigue.…”

Section: Discussionsupporting

confidence: 89%

“…To date, fatigue in MS patients has been notoriously difficult to treat, and many patients are still prescribed stimulants (modafinal) despite several failed RCTs. 14–16 In contrast, RCTs of cooling garments 19–20 and antipyretics (aspirin) 21 have effectively reduced fatigue in MS patients. Our observation of elevated body temperature linked to worse fatigue in RRMS patients helps explain the effectiveness of previous cooling/antipyretic treatments, and encourages further research on cooling/antipyretic treatments of fatigue in RRMS.…”

Section: Discussionmentioning

confidence: 99%

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Body Temperature Is Elevated and Linked to Fatigue in Relapsing-Remitting Multiple Sclerosis, Even Without Heat Exposure

Sumowski

Leavitt²

2014

Archives of Physical Medicine and Rehabilitation

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Objective To investigate whether resting body temperature is elevated and linked to fatigue in patients with relapsing-remitting multiple sclerosis (RRMS). Design Cross-sectional study investigating (a) differences in resting body temperature across RRMS, SPMS, and healthy groups, and (b) the relationship between body temperature and fatigue in RRMS patients. Setting Climate-controlled laboratory (~22°C) within a non-profit medical rehabilitation research center. Participants Fifty patients with RRMS, 40 matched healthy controls, and 22 patients with secondary-progressive MS (SPMS). Intervention None. Main Outcome Measure(s) Body temperature was measured with an aural infrared thermometer (normal body temperature for this thermometer is 36.75°C), and differences were compared across RRMS, SPMS, and healthy persons. RRMS patients completed measures of general fatigue (Fatigue Severity Scale; FSS), as well as physical and cognitive fatigue (Modified Fatigue Impact Scale; MFIS). Results There was a large effect of group (p<.001, ηp2=.132) whereby body temperature was higher in RRMS patients (37.04°C±0.27) relative to healthy controls (36.83 ± 0.33; p = .009) and SPMS patients (36.75°C±0.39; p=.001). Warmer body temperature in RRMS patients was associated with worse general fatigue (FSS; rp=.315, p=.028) and physical fatigue (pMFIS; rp=.318, p=.026), but not cognitive fatigue (cMIFS; rp=−.017, p=.909). Conclusions These are the first-ever demonstrations that body temperature is elevated endogenously in RRMS patients, and linked to worse fatigue. We discuss these findings in the context of failed treatments for fatigue in RRMS, including several failed randomized controlled trials (RCTs) of stimulants (modafinil). In contrast, our findings may help explain how RCTs of cooling garments and antipyretics (aspirin) have effectively reduced MS fatigue, and encourage further research on cooling/antipyretic treatments of fatigue in RRMS.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Body Temperature Is Elevated and Linked to Fatigue in Relapsing-Remitting Multiple Sclerosis, Even Without Heat Exposure

Sumowski

Leavitt²

2014

Archives of Physical Medicine and Rehabilitation

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“…Transient cooling of the body or of arms and legs using cold packs, cold baths or air-conditioning may improve postural stability and muscle strength of the legs (class II evidence [38]), gait (class III evidence [39]) and also fatigue (class III evidence [40]). Cooling garments may result in a better Multiple Sclerosis Functional Composite (MSFC, class II evidence [41]). It can result in a distinct reduction of fatigue and may last from 30–45 min up to several hours.…”

Section: Fatiguementioning

confidence: 99%

Symptomatic Treatment of Multiple Sclerosis

2006

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Besides immunomodulation and immunosuppression, the specific treatment of symptoms is an essential component of the overall management of multiple sclerosis (MS). Symptomatic treatment is aimed at the elimination or reduction of symptoms impairing the functional abilities and quality of life of the affected patients. Moreover, with symptomatic treatment the development of a secondary physical impairment due to an existing one may be avoided. Many therapeutic techniques as well as different drugs are used for the treatment of MS symptoms, but only a few of them have been investigated, especially in MS patients, and are approved by the national health authorities. Despite an overwhelming number of publications, only a few evidence-based studies exist and consensus reports are very rare, too. Therefore, it seemed necessary to develop a consensus statement on symptomatic treatment of MS comprising existing evidence-based literature as well as therapeutic experience of neurologists who have dealt with these problems over a long time. This consensus paper contains proposals for the treatment of the most common MS symptoms: disorders of motor function and coordination, of cranial nerve function, of autonomic, cognitive, and psychological functions as well as MS-related pain syndromes and epileptic seizures.

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“…Thus, different studies have attempted to control patients' body temperature through body cooling using either cool water [6], or cryotherapy [7,8]. One study reported a significant decrease of 0.3-0.7°C in the body temperature of patients with MS (PwMS) using cooling garments [9].…”

Section: Introductionmentioning

confidence: 99%

Effects of a Training Program Involving Body Cooling on Physical and Cognitive Capacities and Quality of Life in Multiple Sclerosis Patients: A Pilot Study

et al. 2017

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Objective: Two methods using exercise and body cooling could influence the well-being of patients with multiple sclerosis (PwMS). The aim of this study was to determine whether wearing a cooling vest during a physical training program could increase the cognitive and physical capacities and quality of life in PwMS. Methods: Eighteen PwMS (49.6 ± 8 years; Expanded Disability Status Score 5.0 ± 1.0) were randomly assigned to a cooling or control group. PwMS underwent a 7-week physical training program. In the cooling group, PwMS wore a cooling vest during each training session, whereas in the control group, PwMS wore a cotton T-shirt. Before and after the training program, both groups completed the Isaacs Set Test (IST), Trail Making Test A-B (TMT A-B), SEP-59, Multidimensional Fatigue Inventory and performed a 6-minute walk test (6MWT). Results: The cooling group showed significantly (p < 0.05) improved performance for IST, TMT A and 6MWT. Their emotional well-being and cognitive functions investigated in SEP-59 were significantly (p < 0.05) improved, and general and physical fatigue significantly (p < 0.05) decreased. Conclusions: This physical training program combined with a cooling strategy could have a significant positive influence on both cognitive and physical performances, perceived fatigue and emotional well-being in heat-sensitive PwMS.

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A randomized controlled study of the acute and chronic effects of cooling therapy for MS

Abstract: Cooling therapy was associated with objectively measurable but modest improvements in motor and visual function as well as persistent subjective benefits.

Cited by 118 publications

References 23 publications

Body Temperature Is Elevated and Linked to Fatigue in Relapsing-Remitting Multiple Sclerosis, Even Without Heat Exposure

Body Temperature Is Elevated and Linked to Fatigue in Relapsing-Remitting Multiple Sclerosis, Even Without Heat Exposure

Symptomatic Treatment of Multiple Sclerosis

Effects of a Training Program Involving Body Cooling on Physical and Cognitive Capacities and Quality of Life in Multiple Sclerosis Patients: A Pilot Study

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