We thought you might be interested in this article on Research that
was included in the Winter edition of The Sarah Matheson Trust
Newsletter. (SmarT). I scanned the document then edited it slightly
because it was columnised as in newspapers. I think it still makes
sense but you know what these medical people are like with their
jargon !!
Dave & Chris.
Research.
What comes to mind when you think about research? Images of Jerry
Lewis as the Nutty Professor or some top secret laboratory performing
amazing experiments ?
Most people realise these images are slightly fantastic. The recent
media focus on research means that most peopIe know more about the
potential medical benefits but little about the process of research.
Understanding this process is important for people whose lives are
affected by MSA and we hope the following rough guide will be useful.
Medical research can be divided into two areas, basic and clinical
research, with basic research forming the foundations of clinical
research. Basic research involves scientists working behind the
scenes in laboratories. Clinical research is the type of research
that someone with MSA may be asked to participate in..
Understanding the differences , between basic and clinical research
is important for appreciating research results. For example the
recent interest in the use of stem cells to repair nerve damage in
rats by the team at Johns Hopkins University in the USA. This small
study is an example of basic research and will need to be examined
closely by other scientists, including neurologists, to determine if
these results can be used ethically with patients. This takes time
and in research terms means several years.
There are many different types of clinical research questionnaires,
drug trials, research tests and scans, etc. All clinical research
because it involves people, must have ethical approval. This means
the researcher submitting their research plan to an ethics committee,
a group of health professionals and lay people who will consider the
purpose and value of each research plan. This ensures that no harm
will be done and that the patients, relationship with their health
care team is not compromised. It will also review all the information
given to patients. Ethical approval must be obtained before
approaching patients. When reading the results of clinical research,
either from a medical journal or the Internet, a sign of good quality
research is evidence of ethical approval.
Who does Research ?
Research is an integral part of institutions involved in medicine,
universities and hospitals. Key people within these institutions are
responsible for generating research. A hospital consultant, for
example will undertake their own research or work in collaboration
with other specialists as well as supervising junior
researchers.These junior researchers are often pre or post graduate
doctors.
,
All health professionals, to maintain good standards, use research
and you could be asked to participate in research when you see a
therapist or visit your GP.
How is Research funded?
Institutions that generate research use a percentage of their income
to fund research projects. The cost of research varies depending on
the size and scale of a study. The time needed to complete research
means that in general it doesn't come cheap. This can mean that
researchers seek alternative sources of funding. This can be from
drug companies or organisations interested in health care such as the
King's Fund or Charities.
How is research used?
Once a research study is complete, the description of the study
together with a discussion of the results is then written as a
research article. For the article to be published in a reputable
journal, it must first be peer reviewed by other experts in the
speciality area. The article may also be presented at meetings and
conferences. Vigorous discussion about research at these meetings
influences practice. At National and International conferences the
discussion can lead to a consensus on issues which may become the
accepted best practice.
How can I take part in research?
Regardless of how your care is managed you are not obliged to
participate in research. If you are interested you may see
information about research at your GP surgery or hospital. This may
be in leaflets, posters or newsletters but don't forget to let the
health professionals involved in your care know you are interested.
The best person to discuss medical research with is your consultant.
It is important that they know about any research you are taking part
in, as this may influence their management of your condition.
The researcher should provide written information for you about the
research, what it hopes to achieve, what you are required to do and
the effect this may have on you. You should also be able to discuss
with the researcher any questions you have. All research studies have
criteria for entry. If you are accepted into a research trial it
should be made clear for you that you can withdraw from the trial at
any time without any negative effect on your future care.
What research is going on in MSA?
Research into MSA is divided into different fields
What is MSA ?
A consensus statement in 1996 offered an international definition of
Multiple System Atrophy which hoped to reduce the confusion
surrounding the variety of names given to the disorder e.g. Shy
Drager. (Published in Neurology 1996;46: 1470)
Understanding the Condition
This includes the numbers of people affected, (Schrag A. Ben-Shlomo
Y. Quinn NP. ( 1999) Prevalence of progressive supranuclear palsy and
multiple system atrophy: a cross-sectional study. Lancet 354:1771-5)
as well as the most common features that aid recognition. One such
study from 1994 which also included details of the pathology (changes
in brain tissue) gives a comprehensive description of many clinical
features (Wenning GK, Ben ShlomoM et al ( 1994) Clinical features and
natural history of multiple system atrophy. Brain 117, 835-845). The
focus of the NNIPPS study hopes to obtain more information about the
progression of MSA.
How is MSA diagnosed?
Diagnosis is difficult to determine as the symptoms in the early
stages resemble other conditions, e.g. Parkinson's Disease. Another
consensus statement in 1999 presented international criteria on which
a diagnosis could be suggested (Gilman S, Low N, Quinn, N et al
Consensus statement on the diagnosis of MSA Journal of Neurological
Sciences 1999; 163: 94-98).
Currently there is no diagnostic test for MSA. Research to provide a
diagnostic test is ongoing. An example is the use of scanning
techniques (Burn et al The differential diagnosis of PD, MSA and PSP:
analysis of F-dopa PET data. Journal of Neurology. Neurosurgeryand
Psychiatry 1994; 57: 278-84).
What treatments are useful?
MSA, like many neurological disorders, relies on managing symptoms.
Not all treatments have been evaluated through research but examples
of those that have include; The treatment of postural hypotension
(Mathias CJ, Kimber J . Treatment of Postural Hypotension Journal of
Neurology, Neurosurgery and Psychiatry 1998; 65: 286-289). The
treatment of bladder symptoms (Beck, R. Betts, C. Fowler, C.
Genitourinary dysfunction in MSA Journal of Urology 1994; 151: 1336-
1341).
Research and Education
Some articles serve an important purpose by reviewing research
information. They provide an education tool by identifying areas
where progress is being made and areas that need more study. Many
provide a comprehensive overview for health professionals dealing
with the condition for the first time.
(Swann, L. Dupont, J. MSA Physical therapy 1999; 79: 488-494).
The references in brackets may be available through your library or
the Internet. Due to copyright restrictions the Sarah Matheson Trust
are unable to provide copies.
MSA Study Groups
Recently formed through European funding, this group will collaborate
the knowledge of the specialist centres studying MSA in Europe,
including the UK. This will enable greater sharing of information and
resources which will be more effective for time and costs. The
development of the European Study group is mirrored by the formation
of the North American MSA Study Group (including Canada). Discussion
between both groups will enhance future MSA research.
How can I find out about Research in MSA ?
Once a research study is complete (the information is collected,
analysed and written) it is submitted to be validated by experts in
the subject and then published. This is in one of a number of medical
journals e.g. The Journal of Neurology, Neurosurgery and Psychiatry.
Once published this information is accessible to all. Unless you are
a regular visitor to a library with access to medical journals
getting hold of these journals is difficult. It can be even more
difficult to understand the article once you have got it, as the
scientific style and medical language makes it heavy reading. These
problems of style and language are also present on the Internet.
The media does a better job of presenting research in a user friendly
way, the health supplements in daily newspapers and the explosion in
medical programs are testament to this. The only draw back is that
unless an expert is involved, for example Professor Winston in the
programme 'Super Human,' the style is achieved at the expense of the
content.
Natural History and Neuroprotection In Progressive Supranuclear Palsy
and Multiple Systems Atrophy (NNIPPS)
A new feature of SMarT News will be our research focus where we hope
to provide regular translations of current MSA research.
This study, which begins in January 2001, will gather information
about the natural history of two disorders, Multiple System Atrophy
(MSA) and Progressive Supranuclear Palsy (PSP) and look at the affect
of a drug called Riluzole.
Riluzole is a drug that has been used in the past with Motor Neurone
Disease (MND) and studies show that it slows down the rate of the
disease. Although MND, MSA and PSP have different symptoms, they are
all progressive neurologicat disorders. This study aims to determine
whether Riluzole will slow down the course of MSA and PSP, as well as
MND.
Patients will receive Riluzole or a placebo. Which one you receive is
decided randomly (as if by the toss of a coin). A placebo is an
inactive compound without any therapeutic benefit. This means that
half the participants in the study will receive Riluzole and half
will receive the placebo. Neither you nor your doctors will know
whether you are taking Riluzole. This is called a 'double-blind
trial.' Riluzole will not reverse your condition, i.e. it will not
make you "better".
Taking part in the study would involve seeing a neurologist every
three months for three years. During these visits participants will
be monitored for any side effects, which is routine in all drug
trials. The monitoring will include brain scans and the trial team
also hopes to undertake postmortem examinations of the nervous system
if possible.
During their visits patients will also complete a series of
questionnaires looking at different aspects of their disease. One of
the aims of the questionnaire is to establish the natural history of
the two different conditions and identify ways to diagnose each more
quickly and accurately.
This trial is being funded by a grant from the European Union and
hopes to include 800 patients from three countries (France, Germany
and the UK). Professor Nigel Leigh, at Kings College Hospital, is
coordinating this trial which will be running in several areas of the
UK.
If you are interested in knowing more about the study you can contact
Nigel Leigh or his Research Nurse Caroline Murphy on 020 7848 5172.