A randomized controlled study of the acute and chronic effects of cooling therapy for MS.
BACKGROUND
Cooling demyelinated nerves can reduce conduction block, potentially improving symptoms of MS. The therapeutic effects of cooling in patients with MS have not been convincingly demonstrated because prior studies were limited by uncontrolled designs, unblinded evaluations, reliance on subjective outcome measures, and small sample sizes.


OBJECTIVE
To determine the effects of a single acute dose of cooling therapy using objective measures of neurologic function in a controlled, double-blinded setting, and to determine whether effects are sustained during daily cooling garment use.


METHODS
Patients (n = 84) with definite MS, mild to moderate disability (Expanded Disability Status Scale score < 6.0), and self-reported heat sensitivity were randomized into a multicenter, sham-treatment controlled, double-blind crossover study. Patients had the MS Functional Composite (MSFC) and measures of visual acuity/contrast sensitivity assessed before and after high-dose or low-dose cooling for 1 hour with a liquid cooling garment. One week later, patients had identical assessments before and after the alternate treatment. Patients were then re-randomized to use the cooling garment 1 hour each day for a month or to have observation only. They completed self-rated assessments of fatigue, strength, and cognition during this time, and underwent another acute cooling session at the end of the period. After 1 week of rest, they had identical assessments during the alternate treatment.


RESULTS
Body temperature declined during both high-dose and low-dose cooling, but high-dose produced a greater reduction (p < 0.0001). High-dose cooling produced a small improvement in the MSFC (0.076 +/- 0.66, p = 0.007), whereas low-dose cooling produced only a trend toward improvement (0.053 +/- 0.031, p = 0.09), but the difference between conditions was not significant. Timed gait testing and visual acuity/contrast sensitivity improved in both conditions as well. When patients underwent acute cooling following a month of daily cooling, treatment effects were similar. Patients reported less fatigue during the month of daily cooling, concurrently on the Rochester Fatigue Diary and retrospectively on the Modified Fatigue Impact Scale.


CONCLUSIONS
Cooling therapy was associated with objectively measurable but modest improvements in motor and visual function as well as persistent subjective benefits.
Schwid
Steven R
SR
University of Rochester, Rochester, NY, USA.
Petrie
Mary D
MD
Murray
Ronald
R
Leitch
Jennifer
J
Bowen
James
J
Alquist
Alan
A
Pelligrino
Richard
R
Roberts
Adam
A
Harper-Bennie
Judith
J
Milan
Maria Dawn
MD
Guisado
Raul
R
Luna
Bernadette
B
Montgomery
Leslie
L
Lamparter
Richard
R
Ku
Yu-Tsuan
YT
Lee
Hank
H
Goldwater
Danielle
D
Cutter
Gary
G
Webbon
Bruce
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D003020:Clothing; D003071:Cognition; D015350:Contrast Sensitivity; D004311:Double-Blind Method; D005221:Fatigue / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000523:psychology / Q000628:therapy*; D009460:Neurologic Examination; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity