Health Scan: Chronotherapy: Time is of the essence for MS treatment

Taking drugs in accordance with one's biological clock can make a difference in their efficacy.

By JUDY SIEGEL-ITZKOVICH
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Taking drugs in accordance with one's biological clock can make a difference in their efficacy, according to Technion researchers who studied the benefits of multiple sclerosis treatments taken at night compared to those taken during the day. Prof. Ariel Miller, head of the MS center at Carmel Medical Center and the Technion's Rappaport Faculty of Medicine, says their new study proves victims of the neurological disease recover faster from acute attacks when they inject medication according to the principles of "chronotherapy." The study has been published in the Journal of Neurology, Surgery and Psychiatry. "It is known that the immune system functions according to body rhythms. For example, the amount of cortisone in the body is higher in the morning and lower at night. There is significance to the biological clock in autoimmune diseases such as type 1 diabetes, rheumatic disorders and MS. The Technion team injected MS patients suffering from an acute neurological attack with steroids. Some received injections between 10 a.m. and 2 p.m., while another group had theirs between 10 p.m. and 2 a.m. Those who received night-time injections recovered faster than those who had the day-time treatment. Side effects were also reduced in the night-time group. Patients have been taking MS medications depending on when they eat, as drug absorption can be disrupted by digestion. Until now, neurologists have not advised patients to get injections at specific times, but now they will advise injecting steroids late at night. SLEEP PROBLEMS & FIRST GRADERS A higher rate of sleep disorders has been found by Haifa researchers among kindergarteners who are deemed unready for first grade. Iris Afek, Oren Lamm and Giora Pillar of the University of Haifa's School of Education and the Technion's sleep lab said it is widely accepted that many children suffer from sleep disorders, and that such disorders are somehow connected to learning disabilities and behavioral problems; but most sleep disorders among children remain undiagnosed. The researchers examined 148 kindergarteners - 98 began first grade on schedule, and 50 spent an additional year in kindergarten following the recommendation of their teachers. "The children who were not ready for first grade had more fitful sleep at night," says Afek. "Their sleep patterns were less restful, and characterized by various disturbances." The study also evaluated the academic achievements of the first-grade children, and found a clear correlation between healthy sleep patterns and good grades. FOLIC ACID REDUCES CLEFT LIP Taking folic acid supplements in early pregnancy seems to substantially reduce the risk of cleft lip, and not only neural tube disorders, according to a study published in the British Medical Journal (BMJ) It has long been known that taking folic acid before getting pregnant can greatly minimize the risk of horrible neurological defects such as spina bifida and anacephaly. Some studies have suggested that the supplement may also help prevent facial clefts, but the question remained unresolved. So researchers set out to asses the possible effects of folic acid on facial clefts in Norway, which has one of the highest rates of facial clefts in Europe. They identified infants born from 1996 to 2000; 377 with cleft lip (with or without cleft palate), 196 with cleft palate only, and 763 healthy controls. All mothers were surveyed about their reproductive history, smoking, alcohol, drugs, and other exposures during early pregnancy. They were also asked to recall their diet during the first three months of pregnancy, whether they took folic acid supplements and, if so, when and how often. Women were asked similar questions about multivitamins, and the researchers then estimated each woman's total folic acid intake. After adjusting for smoking and other confounding factors, they found that daily folic acid supplementation reduced the risk of cleft lip by 40 percent. . Independent of supplements, diets rich in fruits, vegetables, and other high folate containing foods reduced the risk by 25%. The lowest risk of cleft lip was among women with folate-rich diets who also took folic acid supplements and multivitamins. Folic acid provided no protection against cleft palate alone, according to the results. The authors acknowledge that their study alone cannot show that folic acid definitely prevents cleft lip. Combined with all the previous evidence, however, their work does suggest a real preventive effect. If folic acid can prevent a major birth defect in addition to neural tube defects, this benefit should be included when considering the risks and benefits of fortifying foods with folic acid - a matter of ongoing controversy in many countries. VIAGRA FOR DIABETICS Diabetics may take erectile dysfunction drugs such as Viagra, Levitra and Cialis, according to researchers at Carmel Medical Center, whose review was published in The Cochrane Library the world's main evidence-based medicine compendium. Although diabetes can cause a variety of other chronic complications, such as heart disease and high blood pressure, PDE-5 inhibitors used in several erectile dysfunction drugs were shown not to cause many adverse reactions, said lead author Dr. Moshe Vardi of the hospital's internal medicine department. "The results of our meta-analysis are not surprising, but give strength to the general notion that this class of drugs is efficient and safe for this specific wide population," said Vardi. Reviewers analyzed eight studies that compared the effectiveness of the three PDE-5 medications to placebo. A total of 1,759 men were recruited -- with roughly half randomized to receive PDE-5 inhibitor therapy and the rest to the placebo group. Overall, 80% of the participants had type 2 diabetes and the others had type 1. As with any drug therapy, the reviewers caution that men should use PDE-5 inhibitors only as directed by their physicians.