Multiple sclerosis and restless legs syndrome In the latest issue of the European Journal of Neurology, a foreign expert meta-analysed 24 studies published up to April 2012 and found that restless legs syndrome was more common in patients with multiple sclerosis than in those without multiple sclerosis. The prevalence ranged from 12.12% to 57.5% in different populations, while the prevalence of restless legs syndrome in non-MS patients was only 2.56% to 18.35%. Further analysis revealed that the risk of restless legs syndrome was four times higher in patients with multiple sclerosis than in those without multiple sclerosis. Note: The clinical features of restless legs syndrome are: indescribable soreness and nibbling discomfort in the legs or other parts of the body before going to sleep; improvement with activity; common in quiet resting states; and common in the evening. Reasons for discontinuation and unsuccessful medication in patients with multiple sclerosis Norwegian scholars summarized the data of 424 response surveys in patients with multiple sclerosis, of which 180 (42%) patients were still using the medication first prescribed by the physician to treat the disease, 80 (20%) patients changed to other medications at least once, 53 (12.5%) discontinued medication, and 108 (25.5%) never used medication. The analysis found that age at diagnosis, location, illness-related depression, and avoidant coping trauma increased the risk of non-use of medication. Adverse reactions after the first dose and patients who had received a higher level of education often discontinued medication. Note: In our patients, there is also a tendency to discontinue medication and to avoid medication because of concerns about the many adverse effects of the medication, somewhat of a “choking effect”. Cerebrospinal fluid oligoclonal bands and immunoglobulins in relation to disease type and disease progression The cerebrospinal fluid findings and clinical data of 1120 patients with multiple sclerosis were retrospectively analyzed to determine whether oligoclonal bands and cerebrospinal fluid parameters were associated with disease duration (relapsing-remitting versus primary-progressive) and disability progression (disability expansion expression to 6 points within 10 years of onset). The results were: oligoclonal bands were present in the cerebrospinal fluid of 72.5% of patients. Among patients with visible oligoclonal bands, 84.6% were relapsing-remitting and 15.4% were primary-progressive; among patients without visible oligoclonal bands, 89.7% were relapsing-remitting and 10.3% were primary-progressive. Both immunoglobulin and protein levels were higher in the cerebrospinal fluid of the relapsing-remitting type compared with the primary-progressive type. Disease progression appeared to be independent of oligoclonal bands. Patients who were male, had an older age of onset, relapsing-remitting type and no visual impairment were prone to undergo lumbar puncture. CONCLUSION: Positive oligoclonal bands and elevated immunoglobulin and total protein in the cerebrospinal fluid correlate with the course of relapsing-remitting disease and are not associated with disease progression; atypical clinical presentation and failure to complete the cerebrospinal fluid may produce a bias in the results. Note: If available, patients should cooperate with their physicians to complete a lumbar puncture, including immunologic testing. Cannabis-based preparations for spasticity and pain in multiple sclerosis In a new issue of the Journal of Neurological Disorders Treatment, a scholarly onset article summarizes this year’s information on the treatment of spasticity and pain with cannabis-based products. Because most patients with multiple sclerosis have bilateral lower extremity spasticity and pain, it severely affects patients’ quality of life. Randomized, double-blind, comparative studies have found that cannabis-based preparations do relieve patients’ clinical symptoms. Based on this information, a new cannabis-based product, nabiximols (Sativex), has been initiated in several countries around the world for the treatment of spasticity in multiple sclerosis. Note: Unfortunately, it is not yet available in our country.