[S23.007] Randomized Controlled Trial of CI Therapy for Progressive MS: Increased Real-World Function and Neuroplasticity on MRI

Victor Mark,1Edward Taub,1Gitendra Uswatte,1Gary Cutter,1David Morris,1Staci McKay,1Mary Bowman,1Michelle Haddad,1Tyler Rickards,1Chelsey Sterling2
1Birmingham, AL, USA, 2Philadelphia, PA, USA


OBJECTIVE: Evaluate Constraint-Induced Movement therapy (CI therapy) for real-world function and neuroplasticity in progressive MS.
BACKGROUND: Progressive MS lacks an established effective treatment. CI therapy has shown efficacy for arm use in stroke and cerebral palsy in clinical trials, but its efficacy for MS is undetermined. However, pilot findings were positive (Mark et al, Mult Scler 2008). Therefore, we conducted a randomized trial for MS. Because CI therapy has increased neuroplasticity in stroke and cerebral palsy, we also evaluated changes on cortical structure in MS.
DESIGN/METHODS: 20 adults with chronic progressive MS were randomized to 35 hours of either CI therapy or Complementary & Alternative Medicine (CAM) treatments (aquatherapy, massage, yoga). Both groups had identical expectations to improve. Outcomes were post-treatment changes in real-world arm use on the Motor Activity Log (MAL) and cortical grey matter structure from brain MRI at 3T on voxel-based morphometry.
RESULTS: The MAL significantly improved after CI therapy (mean 2.7 points) compared to CAM (0.5 points), p = 0.0005. The Effect Size for CI therapy was 3.9 (very large), while for CAM it was 0.5 (moderate). There were no adverse events or patient dropouts. The CI therapy patients also had significantly increased cortical grey matter over bilateral sensorimotor areas after treatment (p<0.02), unlike the CAM patients.
CONCLUSIONS: CI therapy appears to be efficacious for improving real-world arm use in progressive hemiparetic MS and significantly increases cortical grey matter structural plasticity. Together, these findings suggest that CI therapy, but not CAM, can counteract the progressive functional loss and CNS degeneration of progressive MS.
Supported by: National MS Society grant RG 4221 and NIH grant HD061767.
Category - MS and CNS Inflammatory Disease: Clinical Science

Tuesday, April 29, 2014 4:45 PM

S23: Platform Session: MS and CNS Inflammatory Disease: Novel Therapeutics (3:15 PM-5:00 PM)

 

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