Led by Monash University and published in the Medical Journal of Australia, the recommendations address the unique challenges faced by some 39,000 people living with this chronic neurological condition.

Senior author Associate Professor Mastura Monif, a neurologist and researcher from the Monash University School of Translational Medicine and head of Alfred Health’s Neuroimmunology Service, said although Australia’s Therapeutic Goods Administration (TGA) adopted an international MS guideline in 2009 (which was last updated in 2015), specific and recent consensus recommendations were needed to guide best practice on locally available therapies and local practices.

“New disease-modifying therapies are more effective and better tolerated,” says Associate Professor Monif.

“But it’s a much more complex treatment landscape than it was 20 years ago, and there is new evidence being generated all the time on many aspects of the disease.

“It is really important that the approach used is focused on both the effectiveness and safety for the individual so they can get the best possible outcome.”

Developed by more than 30 experts from the Australian and New Zealand Association of Neurologists working group — including MS specialists, nurses, allied health professionals, and patient advocacy groups — the statement covers pre-assessment, therapy selection, monitoring, symptom management, and special considerations such as pregnancy and infections.

MS Australia CEO Rohan Greenland welcomes the guidelines as an “invaluable resource, especially for generalist clinicians navigating this rapidly evolving field”.

“They provide a clear and ready reference to best-practice evidence and expert consensus – an important milestone in MS care in Australia,” he says.

First author Dr Jessica Shipley, an MS and Neuroimmunology fellow at Alfred Health, says the recommendations are for everyone involved in managing MS, regardless of healthcare setting or location.

“These recommendations will be a valuable resource for everyone from GPs,  to neurologists, doctors in training, medical students, allied health professionals, nursing staff, and consumers or patients,” says Dr Shipley.

The recommendations can be found here:

• Part 1: Consensus recommendations on MS management in Australia and New Zealand.
• Part 2: Consensus recommendations ons MS management in Australia and New Zealand.

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According to MS Australia, the number of Australians with MS rose by 30% from 2017-2021 making it more important than ever to increase awareness and funding for research into treatments and possibly a cure.

“We have advanced MS care enormously in the last 10 years. The biggest area of need is treatments for progressive MS,” says Professor Helmut Butzkueven, Monash University Central Clinical School Department of Neuroscience Head, MSBase Foundation Managing Director, and Alfred Health Director of Neurology.

“We need to unlock the huge basic research efforts in the last 10 years and turn them into new treatment trials to stop and reverse MS disability.

“To open up the trials, we need better ways of measuring MS. We need to create the right infrastructure so all people with MS who can and want to work together on this challenge are enabled and free to do so, no matter where in Australia they live.”

Associate Professor Mastura Monif, Neurologist (Alfred Health) and Monash Department of Neuroscience Senior Research Fellow and Head of the Neuroimmunology, Neuroinflammation and Neurological Diseases Group, says “MS can vary from individual to individual” with the “majority of those with MS have a relapsing-remitting type of disease”.

“This is associated with acute worsening of neurological symptoms – disease flare-ups. Currently, we do not have very accurate biomarkers to distinguish MS flare-up from remission and our team’s research focuses on that,” says Associate Professor Monif.

“We are aiming to identify markers in the blood of patients with MS during relapse that would help us distinguish relapse from remission.

“These markers once identified can assist with disease diagnosis as well as improve our knowledge for future development of targeted therapies to combat MS relapse effectively and safely.

“MS can be challenging, and some days can be harder than others for those affected by this condition.

“For us clinicians, it’s important to provide comprehensive and holistic care and to remember that MS impacts can be wide-reaching for the individual, their caregivers and the whole community.

“Our team’s research and clinical work is inspired by those affected by MS.

“Our patients with MS are the reason we work so hard to not only improve clinical care but also research in MS. Our utmost aims are to reduce the burden of disease for those affected by this condition by improving current knowledge and treatments.”

For more about World MS Day, visit: worldmsday.org.

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The video, ‘What is MS?’ aims to educate the general public and people living with multiple sclerosis (MS), particularly those newly diagnosed, about the causes, different types of MS and the common symptoms associated with the condition.

MS Australia Chief Executive, Rohan Greenland says most Australians know that MS means multiple sclerosis, but don’t really have a very good understanding of what MS actually is.

“MS affects everyone differently. People living with MS will sometimes be well one day, and then be quite unwell the next,” says Mr Greenland.

“It’s really important for employers, for family, carers, and for others in the community to have a better understanding of how MS impacts people living with the condition.”

MS Australia President, Associate Professor Des Graham lives with MS and agrees that there is an inherent challenge in trying to explain to the general public what MS is.

“The public see someone with no visible symptoms and naturally struggle to understand the challenges that individual is dealing with, or incorrectly assume there’s nothing wrong with them,” says Associate Professor Graham.

Of even greater concern, Associate Professor Graham says that lack of understanding extends to areas of government support such as the NDIS (National Disability Insurance Scheme).

“Too often, people living with MS are denied the disability support they require and deserve,” he says.

“If you’ve got MS and you’re in a wheelchair, the Government may provide the support that you require, but if your symptoms are less visible, you are too often left out in the cold.”

The launch of the video comes in the wake of new prevalence data released by MS Australia in February 2023, which shows the number of Australians living with MS is increasing at a significant and accelerating rate.

The latest data shows that 33,335 Australians were living with MS in 2021, an increase of 30% over the four years since the previous update in 2017 (25,607).

Mr Greenland says that with MS on the rise, the video is equally valuable as an awareness-raising tool and a reminder to the Government of the urgent need to invest more in MS research.

Associate Professor Graham agrees and says the video also contains a strong message of hope.

“For over 50 years MS Australia has led the world in ground-breaking research to help improve the lives of Australians living with MS,” he says.

“With MS on the rise, MS Australia is now doubling its efforts to advocate for greater government investment in MS research, that will bring us closer to treatments that will slow or stop disability progression for everyone.”

To view the ‘What is MS?’ video, visit: youtu.be/iT2Vr4BLXfQ.

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The free, six-week online nutrition program will reportedly help empower people living with the complex autoimmune disease to make beneficial dietary changes that could help them manage some of their symptoms and improve their overall diet quality.

Chief Investigator Ms Rebecca Russell, a PhD student from Curtin University’s School of Population Health, says evidence shows that diet can play a significant role in managing some symptoms of MS, and people with MS want a nutrition program that is tailored to their needs.

“People with MS often turn to the internet for information about diet and MS, and they can be faced with conflicting information from the many ‘special diets’, which often exclude important food groups,” says Ms Russell.

“We know people with MS want clear information on what dietary changes they should be making.

“We have been working with them to develop this new online nutrition program that seeks to challenge the misinformation about diet and MS, and ensures they are getting the right advice.”

The research team is said to be seeking to recruit 50 people diagnosed with MS within the last five years who have internet access and are able to take part in the online program.

MS Australia Chief Executive Officer Rohan Greenland says he was delighted to support this new project because it offered a practical solution to an ongoing issue that many people with MS face.

“Currently, people with MS are advised to follow the Australian Dietary Guidelines, however, they have found this advice can be non-specific for people who have been recently diagnosed,” says Mr Greenland.

“Given the abundance of information on the internet, people with MS need advice on how to interpret what is evidence-based, and how to apply this to their own dietary preferences and living situations.

“We look forward to seeing the outcome of this exciting new program developed by Curtin researchers in collaboration with people living with MS.”

The online program will provide people with MS with the knowledge and skills to:

• Understand the evidence in the field of nutrition and MS.
• Judge the credibility of diets promoted for people with MS.
• Select, prepare, and cook nutritious foods.
• Assess the quality of their own diet.

The new program has been funded as part of MS Australia’s 2021 incubator grant round.

MS Australia is the national peak body for people affected by MS and is dedicated to advocacy, communications, education, funding and coordinating MS research, as part of the worldwide effort to solve MS.

It is estimated that more than 25,600 Australians currently live with MS.

Anyone interested in taking part in the program should contact the research team by email at MSDietProject@curtin.edu.au or by phone (Andrea Begley, research project supervisor) on 08 9266 2773.

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The reason behind this is that due to being a disorder where the immune system attacks itself, MS leaves the patient vulnerable to all kinds of infections.

“Determining immunisation status when commencing [immunosuppressive] DMTs [disease-modifying therapies] is key, as is an individualised approach to risk-benefit assessment when considering vaccinations,” wrote the authors, led by Dr Cassie Nesbitt, a neurologist at Alfred Health in Melbourne.

“MS is an autoimmune disorder treated with DMTs. Immunosuppression predisposes [patients with MS] to infection risk, including opportunistic infections – a higher long-term risk of some infection-related malignancies is also likely.

“Infections in patients with MS may result in increased relapses, functional decline and pregnancy complications,” continues Dr Nesbitt.

Dr Nesbitt and colleagues recommend that “a full course of vaccinations should be considered for non-immune patients before commencing a DMT” and add that “this is sometimes forgotten in the urgency of managing a new MS diagnosis”.

They add that “immunisations administered in accordance with local guidelines are considered the best strategy for minimising the risk of infections that could trigger MS relapses”.

However, they caution that “in patients experiencing clinically significant relapses, delaying vaccine administration has been suggested until patients have stabilised and show signs of improvement (typically four to six weeks)”.

“Additional consideration is required for women with MS who are planning a pregnancy,” they write.

“Women should receive live vaccinations before conception to prevent adverse pregnancy outcomes. However, DMT cessation to allow vaccination before conception is often feasible. Vaccination should therefore be explored as early as possible, preferably before commencement of DMT, as it may represent a one-off opportunity.”

While considering vaccinations is important, the authors conclude that this should be a consideration made before the commencement of DMT, as “live vaccinations are contraindicated in patients once they have commenced a DMT”.

“Although we consider it safe to combine non-live vaccinations with DMTs, data are limited regarding their efficacy and durability,” they write.

For more information and to read the article, visit: onlinelibrary.wiley.com/doi/10.5694/mja2.51012

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This grant is to investigate and develop drugs that can better treat multiple sclerosis (MS).

“Current treatments for MS are limited to immunosuppressive drugs that suppress autoimmunity and inflammation,” says Associate Professor Don.

“There is a pressing need for a new approach – for an effective drug that can both protect existing myelin and stimulate myelin repair, as this will open up the possibility for functional recovery in people with MS.

“This grant supports a project operating at the very forefront of MS research and that could lead to the development of a new therapeutic approach to improve outcomes for people with MS.”

The project

Associate Professor Don will be investigating a group of drugs known as sphingosine-1-phosphate receptor agonists (S1Ps), which mimic the signals produced by the naturally occurring hormone-like molecule sphingosine 1-phosphate (S1P) in the body.

“Our current research suggests that S1P is essential in myelin regeneration,” he explains.

“We will be determining if these S1P enhancing drugs are indeed myelin protective, if they promote the formation of myelin and the processes by which this may happen.”

Dr Julia Morahan, Head of Research, MS Research Australia adds: “This innovative research proposal addresses the urgent need for therapies to stimulate myelin repair in MS.

“While remyelination or myelin repair is important for all types of MS, it is extremely important in tackling the lack of treatment options for those people with progressive MS.

“We look forward to seeing the outcomes of this study.”

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The expert collaboration, involving clinicians, researchers, allied health professionals, neurologists and the MS community, have built the guidelines to equip people with MS and health professionals with tools that support priority lifestyle changes that will improve the condition by reducing relapses, disability and improving quality of life.

Growing evidence from epidemiological and clinical research demonstrates the significant potential for modifiable lifestyle factors to change MS outcomes.

MS Research Australia identified this as an area of high interest among the community, as it provides a mechanism for people with MS to be empowered to take control and minimise the impact of MS on their lives.

The assessment, undertaken by the expert team, was conducted over the past 18 months and evaluated the latest scientific evidence on nine lifestyle factors to understand how they impact MS: smoking, physical activity and exercise, diet and nutrition, gut health and microbiome, supplements, vitamin D and sun exposure, weight and obesity, other medical conditions in addition to MS and lipid profiles.

“While exercise, diet and weight management are a focus on most of the general population’s ‘To Do’ lists – particularly during Covid-19 – these lifestyle measures were formally confirmed by the experts building this guide as very important ‘Must Dos’ for those living with MS,” says Associate Professor Yasmine Probst, Dietitian and Nutritionist at the University of Wollongong, and The Illawarra Health and Medical Research Institute.

The guidelines ‘Modifiable Lifestyle Factors and MS: A guide for Health Professionals’ can be found online here: msra.org.au/modifiable-lifestyle-guide-2020/health-professionals/

The patient guide ‘Adapting your lifestyle – a guide for people with MS’ can be found online here: msra.org.au/modifiable-lifestyle-guide-2020/for-people-with-ms/

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A report released in the science journal Nutritional Neuroscience said the researchers had failed to find solid clinical evidence for vitamin D as a protective neurological agent.

“Our work counters an emerging belief held in some quarters suggesting that higher levels of vitamin D can impact positively on brain health,” lead author and University of Adelaide PhD candidate Krystal Iacopetta said.

Ms Iacopetta investigated the role of vitamin D across a wide range of neurodegenerative diseases, based on a systematic review of more than 70 pre-clinical and clinical studies.

She said results of the in-depth review and an analysis of all the scientific literature indicated there was “no convincing evidence supporting vitamin D as a protective agent for the brain”.

Professor Mark Hutchinson of the University of Adelaide, Director of the ARC Centre of Excellence for Nanoscale BioPhotonics, worked with Ms Iacopetta on the research and findings.

“This outcome is important and is based on an extremely comprehensive review and analysis of current data and relevant scientific publications,” he said.

“We’ve broken a commonly held belief that vitamin D resulting from sun exposure is good for your brain.”

Interestingly, Professor Hutchinson notes that there may be evidence that UV light from sun exposure could impact the brain beneficially in ways other than that related to levels of vitamin D.

“There are some early studies that suggest that UV exposure could have a positive impact on some neurological disorders such as multiple sclerosis,” he said. “We have presented critical evidence that UV light may impact molecular processes in the brain in a manner that has absolutely nothing to do with vitamin D.”

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The company has released details of a collaboration with Shift.ms, a social network for people with MS, who will be executive producers of a new documentary film featuring unique perspectives and real-world stories from the MS community. The film will premiere at the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis in Berlin in October.

In addition, for every use of the hashtag #MSInsideOut on Twitter until June 8, Merck will donate $1.30 (up to $30,000) towards a research fellowship program overseen by the MS International Federation.

In Australia, Merck has again agreed to be a major supporter of PACTRIMS, the Asia-Pacific scientific meeting for MS, which this year is being held in Sydney from November 1. The company also provides ongoing support for initiatives conducted by MS Australia, MS Research Australia, the Trish MS Research Foundation and Carers Australia.

Merck has two registered products for the treatment of relapsing-remitting MS, Rebif (interferon beta-1a) and Mavenclad (cladribine tablets).

“As well as providing medicines for the treatment of MS, Merck remains dedicated to supporting patients and their families and carers through a range of valuable initiatives,” Merck Australia Managing Director Drew Young said. “Better understanding of the disease and its impact, along with support for clinical research, remain firm priorities for Merck.”

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