Stress Management for Patients With Multiple Sclerosis

Multiple Sclerosis Clinical Trial

Official title:

Phase II Study of the Effects of Stress Management on Neuroimaging, Clinical, Immune and Psychosocial Outcomes

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00147446
• Other study ID #: SIMS
• Secondary ID: R01HD043323
• Status: Completed
• Phase: Phase 2
• First received: September 2, 2005
• Last updated: September 6, 2013
• Start date: May 2005
• Est. completion date: January 2009

Study information

• Verified date: September 2013
• Source: Northwestern University
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Federal GovernmentUnited States: Institutional Review Board
• Study type: Interventional

Clinical Trial Summary

There is a growing body of literature showing that stressful life events can increase the risk of developing exacerbations and new brain lesions among people with multiple sclerosis. The purpose of this study is to examine the hypothesis that stress management programs can reduce the occurrence of new brain lesions and exacerbations. We will also examine potential immune and neuroendocrine pathways.

Description:

MS is a frequently disabling autoimmune disease affecting approximately 350,000 people in the United States. More than two decades of research has consistently shown a relationship between stressful life events (SLEs), in particular non-traumatic family and work stressors, and subsequent clinical exacerbation. Furthermore, we have shown that non-traumatic SLEs increase the risk of the subsequent appearance of new gadolinium enhancing (Gd+) magnetic resonance imaging (MRI) brain lesions, an early marker of MS inflammation and blood-brain barrier (BBB) breakdown. The purpose of this study is to determine the efficacy of cognitive behavioral stress management for MS (CBSM-MS) in reducing the occurrence of new brain lesions in people with relapsing forms of MS. Patients must have a documented new Gd+ MRI brain lesion or clinical exacerbation within the previous 12 months to be enrolled. One hundred and twelve patients will be enrolled for 12 months. Patients will be randomly assigned to either an intensive CBSM-MS program, consisting of 16 individual meetings with a behavioral medicine specialist, or a condensed CBSM-MS program, consisting of a one-day workshop offered after the 10th month of participation. Outcomes include MRI, clinical neurological end-points, and psychosocial functioning. We will also enhance our understanding of mechanisms by examining potential psychosocial, immune, and endocrine mediators of the relationship between SLEs and clinical and neuroimaging markers of MS inflammation.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 121
• Est. completion date: January 2009
• Est. primary completion date: January 2009
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Confirmed diagnosis of MS

• New Gd+ MRI brain lesion or clinically diagnosed exacerbation within the previous 12 months.

• Able to speak english.

• Age 18 or over.

• Able to give informed consent.

• Patients taking the drug glatiramer acetate must have been on the drug for at least 6 months prior to their Gd+ MRI brain lesion and/or exacerbation.

• Patients taking an interferon beta drug must have been on the drug for at least 1 month prior to their Gd+ MRI brain lesion and/or exacerbation.

• Patients not on disease modifying treatment are not planning to initiate treatment.

Exclusion Criteria:

• Meets criteria for dementia by scoring below the 5th percentile in 3 or more of 6 areas of neuropsychological functioning or as determined by study neuropsychologist.

• Severe psychiatric pathology, including schizophrenia, bipolar disorder, current alcoholism or substance abuse, or other severe psychiatric disorder for which this intervention would be inappropriate.

• Active and severe suicidal ideation.

• Endocrine or metabolic disorder.

• Currently in psychotherapy.

• Initiated antidepressant therapy within the past 4 weeks.

• Received corticosteroid treatment within the past 28 days.

• Pregnant or planning pregnancy in the next 12 months.

• Has any non-removable metal or medical device in the body for which an MRI could pose a danger.

• Has any risk factors for developing nephrogenic systemic fibrosis (NSF) or is allergic to Gadolinium.

• Currently uses a Baclofen pump.

• Has an Expanded Disability Status Scale score greater than 6.5.

• Recently begun relaxation, meditation, yoga, or similar form of disease management course within the past 3 months.

• Treatment with Chemotherapy.

• Treatment with Tysabri.

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Prevention

Related Conditions & MeSH terms

• Multiple Sclerosis
• Sclerosis

Intervention

Behavioral:
• Individual Stress Management
Stress management therapy for multiple sclerosis (SMT-MS) is a manualized, validated, published stress management program designed for patients with MS. Participants met with a therapist for 16 individual 50-minute sessions conducted over 20-24 weeks. The first 6 sessions focused on teaching problem solving skills, relaxation, increasing positive activities, cognitive restructuring, and enhancement of social support. Participants were able to tailor the treatment to meet their needs using optional treatment modules including communication and assertiveness training, fatigue management, anxiety reduction, pain management, management of cognitive problems, insomnia treatment, and management of sexual dysfunction.

Other:
• Wait List Control
Wait List Control provided treatment as usual for the first 10+ months of participation. A 5-hour workshop was provided after the 10th month. This allowed at least 2 post-treatment MRI evaluation that were not contaminated by the workshop.

Locations

Country	Name	City	State
United States	Northwestern University, Department of Preventive Medicine	Chicago	Illinois
United States	MS Center at Evergreen Medical Center	Kirkland	Washington
United States	UCSF Behavioral Medicine Research Center	San Francisco	California

Sponsors (2)

Lead Sponsor	Collaborator
Northwestern University	Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Country where clinical trial is conducted

United States, 

References & Publications (1)

Mohr DC, Lovera J, Brown T, Cohen B, Neylan T, Henry R, Siddique J, Jin L, Daikh D, Pelletier D. A randomized trial of stress management for the prevention of new brain lesions in MS. Neurology. 2012 Jul 31;79(5):412-9. doi: 10.1212/WNL.0b013e3182616ff9. Epub 2012 Jul 11. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	No.of Gd+ Lesions From Week 8 to Week 24	Gd+ is Gadolinium-enhancing MRI brain lesion, A marker of the opening of the blood-brain barrier and is typically used as a primary endpoints in phase II trials because of its high sensitivity to ongoing MS disease activity and its association with clinical exacerbation. The single value was calculated by summing up the lesions from week 8 to week 24.	week 8 to week 24	No
Secondary	No.of New or Enlarged T2 Lesions From Week 8 to Week 24	T2-weighted MRI is commonly used in phase II trials to identify more permanent lesions. The single value was calculated by summing up the lesions from week 8 to week 24.	week 8 to week 24	No