Medication usage and falls in people with multiple sclerosis

Comber, Laura; Quinn, Gillian; McGuigan, Chris; Galvin, Rose; Coote, Susan

doi:10.1177/1352458517731912

Cited by 11 publications

(17 citation statements)

References 8 publications

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“…18 Indeed, pwMS are particularly prone to falls and have an elevated risk of potentially life-threatening infections, possibly due to physical disability as well as immunosuppressive treatments. 7,34 In other words, ageing pwMS are at higher risk to be frail.…”

Section: Discussionmentioning

confidence: 99%

“…2–4 Despite recent progress characterized by the advent of new disease-modifying therapies resulting in a better, although partial, control of the early inflammatory phase of the disease, pwMS still show an increased risk of accidents and falls, a higher utilization of acute and chronic healthcare facilities and, ultimately, a younger age at death compared to the general population. 5–9…”

Section: Introductionmentioning

confidence: 99%

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Frailty in ageing persons with multiple sclerosis

et al. 2020

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Background: Recent progress in multiple sclerosis (MS) management has contributed to a greater life expectancy in persons with MS. Ageing with MS comes with unique challenges and bears the potential to greatly affect quality of life and socioeconomic burden. Objectives: To compare frailty in ageing persons with multiple sclerosis (pwMS) and controls; to correlate frailty with MS clinical characteristics. Methods: PwMS and controls over 50 years old were recruited in a cross-sectional study. Two validated frailty measures were assessed: the frailty index and the Fried’s phenotype. Several multiple linear regressions accounting for demographic and clinical characteristics were performed. Results: Eighty pwMS (57 females, mean age 58.5 ± 6 years old) and 37 controls (24 females, mean age 61 ± 6.5 years old) were recruited. Multivariable analysis identified significantly higher frailty index in pwMS (0.21 ± 0.12 vs 0.11 ± 0.08, p < 0.0001). Similarly, according to Fried’s phenotype, a significantly higher percentage of pwMS were frail compared to controls (28% vs 8%). In pwMS, frailty index was independently associated with expanded disability status scale (EDSS), comorbidities, education level and disease duration. Conclusion: Our results suggest that frailty can be routinely assessed in pwMS. Increased frailty in MS patients suggests that, along with MS therapeutics, a tailored multidisciplinary approach of ageing pwMS is needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Frailty in ageing persons with multiple sclerosis

et al. 2020

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“…Similar to the literature in elderly populations, medications, in terms of quantity and class, are associated with higher falls rates in most studies published on this topic. 51,52 During the last decade a wide variety of disease modifying drugs (DMD's) have been introduced in MS. The challenge is to examine whether immunomodulatory drugs differ when examining falls in the MS community.…”

Section: O N L I N E F I R S Tmentioning

confidence: 99%

“…The challenge is to examine whether immunomodulatory drugs differ when examining falls in the MS community. This issue was partly addressed by Comber et al 52 who investigated the effect of medication usage on falls in MS. They reported that participants taking medications categorised as genitourinary and sex hormones or centrally acting muscle relaxant medications had increased odds of being a faller.…”

Section: O N L I N E F I R S Tmentioning

confidence: 99%

Falls in People with Multiple Sclerosis

Coote¹,

Comber²,

Quinn³

et al. 2020

International Journal of MS Care

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Falls are highly prevalent for people with Multiple Sclerosis (MS) and result in a range of negative consequences such as injury, activity curtailment, reduced quality of life, increased need for care and time off work. This narrative review aims to summarise key literature and to discuss future work needed in the area of falls prevention for people with MS. The incidence of falls is estimated to be over 50%; similar to the rate of falls in adults over 80 years. The consequences of falls are considerable as rate of injury is high, and fear of falling and low self-efficacy are significant problems that lead to activity curtailment. A wide range of physiological, personal and environmental factors have been highlighted as potential risk factors and predictors of falls. Falls are individual and multifactorial, and hence approaches to interventions will likely need to adopt a multi-factorial approach. However, the literature to date has largely focused on exercise-based interventions, with newer more comprehensive interventions using both education and exercise showing promising results. Several gaps remain in the topic of falls in MS and in particular the lack of standardisation of definitions and outcome measures to enable data pooling and comparison. In future, the involvement of people with MS in the design and evaluation of programmes is essential, as are approaches to intervention development that consider implementation from the outset.

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“…Furthermore, some drugs that are broadly used in neurologic setting may even worsen gait and balance of patients with MS, including antidepressants (selective serotonin reuptake inhibitor and serotonin and norepinephrine reuptake inhibitor), centrally acting muscle relaxants, genitourinary medications and sex hormones ( Table 3 ). 73 , 74 If there is also a dose-dependent effect of the aforementioned classes of medications on the risk of accidental falls is still controversial. 22 , 75 , 76 …”

Section: Introductionmentioning

confidence: 99%

Spotlight on postural control in patients with multiple sclerosis

Prosperini

Castelli²

2018

DNND

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Multiple sclerosis (MS) is a disease that heavily affects postural control, predisposing patients to accidental falls and fall-related injuries, with a relevant burden on their families, health care systems and themselves. Clinical scales aimed to assess balance are easy to administer in daily clinical setting, but suffer from several limitations including their variable execution, subjective judgment in the scoring system, poor performance in identifying patients at higher risk of falls, and statistical concerns mainly related to distribution of their scores. Today we are able to objectively and reliably assess postural control not only with laboratory-grade standard force platform, but also with low-cost systems based on commercial devices that provide acceptable comparability to gold-standard equipment. The sensitivity of measurements derived from force platforms is such that we can detect balance abnormalities even in minimally impaired patients and predict the risk of future accidental falls accurately. By manipulating sensory inputs (dynamic posturography) or by adding a concurrent cognitive task (dual-task paradigm) to the standard postural assessment, we can unmask postural control deficit even in patients at first demyelinating event or in those with a radiologic isolated syndrome. Studies on neuroanatomical correlates support the multifactorial etiology of postural control deficit in MS, with the association with balance impairment being correlated with cerebellum, spinal cord, and highly ordered processing network according to different studies. Postural control deficit can be managed by means of rehabilitation, which is the most important way to improve balance in patients with MS, but there are also suggestions of a beneficial effect of some pharmacologic interventions. On the other hand, it would be useful to pay attention to some drugs that are currently used to manage other symptoms in daily clinical setting because they can further impair postural controls of patients with MS.

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Medication usage and falls in people with multiple sclerosis

Cited by 11 publications

References 8 publications

Frailty in ageing persons with multiple sclerosis

Frailty in ageing persons with multiple sclerosis

Falls in People with Multiple Sclerosis

Spotlight on postural control in patients with multiple sclerosis

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