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Family Members With Multiple Sclerosis Likely To Share Onset Age, But Not Disease Severity

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ABSTRACT OF STUDY: "Familial effects on the clinical course of multiple sclerosis" -- American Academy of Neurology: NEUROLOGY 2007;68:376-383...CLICK HERE FOR MORE

When more than one member of a family is affected by multiple sclerosis (MS), their ages at disease onset are likely to be similar, but disease severity may not be.

These new findings have important implications for counseling patients, according to a study published in the January 30, 2007, issue of Neurology®, the scientific journal of the American Academy of Neurology.

"We've known for some time that family influence plays a role in whether you are susceptible to MS, but it has not been clear whether your family influence affects the course of the disease," according to lead study author Alastair Compston, PhD, of the University of Cambridge Clinical School in Cambridge, United Kingdom.
To address the question of family influence on the course of the disease, researchers examined data on 2,310 individuals from over 1,000 families in which at least two members had MS. They examined age at onset, disability, disease severity, and other features of the disease.
The researchers found that age at onset of the disease was similar among family members, whether comparing parents to children or siblings with each other. They also found that siblings tended to have the same pattern of disease progression, while there was no correlation between the pattern in parents and children.
The study also showed there was no correlation between the severity of the disease in one family member and severity in another member, whether siblings or parent and child. "Disease progression is often considered the indicator of severity," said Compston. "But, we found no evidence that disease severity is more likely to be similar between two family members with MS than two unrelated people with MS."
The causes of the similarities in onset and progression pattern are largely unknown, as are the causes of MS itself. It is possible that genetic factors are responsible, but environmental factors shared by family members may also play a role.
Compston says the study's findings have significant implications for counseling patients. "People should not draw personal conclusions for their own MS prognosis and expected disease severity from observing the condition of their relatives with MS," he said.
: American Academy of Neurology: NEUROLOGY 2007;68:376-383


Health, disability, and life insurance experiences of working-age persons with multiple sclerosis

Working-age Americans with multiple sclerosis (MS) may face considerable financial insecurities when they become unable to work and lack the health, disability, and life insurance typically offered through employers. In order to estimate the rates of having these insurance policies, as well as how insurance status affects reports of financial stress, we conducted half-hour telephone interviews with 983 working-age persons across the US, who reported being diagnosed with MS. The interviews occurred from May through November 2005, and among the sampled individuals contacted and confirmed eligible, 93.2% completed the interview. The study population was largely female (78.9%), Caucasian (86.4%), married (68.6%), with at least some college education (71.5%), and unemployed (60.2%). Overall, 96.3% had some health insurance (40.3% with public health insurance, primarily Medicare), 56.7% had long-term disability insurance (36.4% with public programs), and 68.3% had life insurance. Notably, 27.4% indicated that, since being diagnosed with MS, health insurance concerns had significantly affected employment decisions. In addition, 16.4% reported considerable difficulty paying for health care, 27.4% put off or postponed seeking needed health care because of costs, and 22.3% delayed filling prescriptions, skipped medication doses, or split pills because of costs. Overall, 26.6% reported considerable worries about affording even basic necessities, such as food, utilities, and housing.

Fighting MS Through Reading

On Tuesday, Janet Lee elementary school students learned about multiple sclerosis through interactive demonstrations and exercises to kick off the winter session of the MS Read-A-Thon - a reading program for students between the ages of four and 14. About 35,000 students in 900 schools across Canada participate in the MS Read-A-Thon each year, raising $1.7 million through pledges. Money raised funds research and services for people with MS and their families. Pictured here, Grade 3 student Amanda Searle, with the help of Multiple Sclerosis Society of Canada MS Read-A-Thon presenter Meghan McIntosh, engages in an activity to demonstrate the difficulties people with MS can have.

Newswise | Autoimmune Disease Breakthrough Gained by Identification of 30 Errant Genes

Newswise — A report in the January issue of Nature magazine announces that one more step in understanding what may cause the body to attack itself in its war against autoimmune disease has been discovered by researchers at the Massachusetts Institute of Technology's Whitehead Institute, says the Autoimmune Related Diseases Association (AARDA), a national nonprofit patient advocacy organization.

What happens in certain cases to cause the body's immune system to go wild with an over reaction when it encounters invading viruses or bacteria, thus resulting in one or more autoimmune diseases--such as rheumatoid arthritis, lupus, multiple sclerosis, thyroid disease (Graves', Hashimoto's), juvenile (type 1) diabetes?

Researchers Richard Young and Alexander Marson, an M.D./Ph.D. student working in Young's laboratory, have reported discovering 30 genes that go awry in autoimmune diseases. According to Young, the regulatory T cells (called “T regs”) that normally control the immune system may have genetic defects. In that case, the T regs protective powers are weakened.

The "brain" of the T regs is a protein called Foxp3. It can send the message to increase or decrease the production of other genes. Dr. Marson, study lead author, said, "We identified a set of roughly 30 genes that are clearly regulated by Foxp3 and, surprisingly, a lot of them are suppressed by Foxp3." Mutation in more of the genes, PTPN22, is associated with a number of autoimmune disorders. It is speculated that altering the Foxp3 gene might be one way to reach a cure of autoimmune diseases.

Two significant implications have emerged from this research. Marson commented, "One is that we've identified this core set of genes that are probably likely to play key roles in preventing autoimmune more disease." He added, "The second implication, which is maybe more long-term, is that we hope that identifying these targets will allow us to screen for drugs to mimic the function of Foxp3 and, thus, treat autoimmune disease."

Autoimmune disease pioneer Noel R. Rose, M.D., Director of the Johns Hopkins Center for Autoimmune Disease Research, says that treating autoimmune disorders will require enhancing either the number or effectiveness of regulatory T cells. He remarked that the MIT study is "certainly important in trying to understand how these regulatory T cells work." He cautions, "Whether this will have important functional implications, only time will tell."

Commenting on the study results, Virginia Ladd, AARDA president and executive director, observes, “The discovery adds weight to the reason why autoimmune diseases should be considered a disease category similar to the way that cancer is viewed rather than as singular diseases.” She adds, “It also lends proof to the genetic connection among these diseases and an understanding as to why these diseases run in families.”

Ms. Ladd points out that the public is unaware of the genetic connection among various autoimmune diseases, and patients are seldom queried by healthcare professionals regarding the family history in autoimmune disease. AARDA is pressing for federal legislation that would bring more awareness to autoimmune diseases and the fact that collectively they affect millions of Americans.

The American Autoimmune Related Diseases Association is the only national organization dedicated to addressing the problem of autoimmunity, the major cause of chronic illness. For more information, please visit AARDA’s Web site at or call 586-776-5903 or 888-856-9433.


Los Angeles (PRWeb) January 27, 2007 -- Using laughter to help create hope and healing for individuals with disabilities, comedian Shayla Rivera, the "Puerto Rican Rocket Scientist," and other top Latino comedians, will host "Comedy Fiesta," a fundraising comedy show to benefit Familia Unida Living With Multiple Sclerosis (FULWMS), Friday, Jan. 26, 2007, at 6 p.m. at Steven's Steak House, 5332 E. Stevens Place, in Commerce.

"We're absolutely thrilled to have an all-star lineup of Latino comedians," said Irma Resendez, FULWMS founder and president, who was stricken with MS at the age of 28 and, since then, has dedicated her life to addressing the needs of people with disabilities.

"The price of admission also includes some free medical treatment," Resendez joked. "My research tells me laughter lowers blood pressure, reduces stress hormones and boosts immune function by producing disease-fighting antibodies. Personally, I have also found that laughter is healing to the heart and soul."

Rivera, who will serves as mistress of ceremony for the comedy show, hosts the Lifetime Television show, "You're Not the Man I Married." Born in Puerto Rico, Rivera studied aerospace engineering at Texas A&M University and later worked on the Space Shuttle at NASA's Johnson Space Center in Houston. She starred in the one-woman stage play, "Rocket Science and Salsa: The Shayla Rivera Story."

Rivera enlisted the support of the other comedians, who've agreed to donate their time for the charity. The talent lineup includes East L.A.'s Rudy Moreno (Showtime's "Latino Laugh Festival"), Gene Pompa (NBC's "Late Night with Conan O'Brien) and Luke Torres, who's opened for Jerry Seinfeld and Dennis Miller.

"While the comedy show promises to make us laugh, the larger event allows us to draw attention to the challenges that people with disabilities face everyday," Resendez said. "Individuals with MS and other illnesses are real people, like you and I, with hopes, fears and aspirations. As a community, we must demonstrate to these individuals that they're not alone."

In addition to the comedy show, the program will provide live music featuring La Cruda Realidad and a delicious dinner. Proceeds from the fundraising show will benefit FULWMS programs.

For more information about the "Comedy Fiesta," call Steven's Steak House at (323) 723-9856, FULWMS toll free at (877) 298-3267 or visit


UNITED PRESS INTERNATIONAL - UPDATE: No jail time for cannabis chocolate

CARLISLE, England, Jan. 27 (UPI) -- Three British citizens linked to the production of cannabis-laced chocolate for multiple sclerosis sufferers have received suspended jail sentences.

Lezley and Mark Gibson, who supplied the unusual candy through Marion Davies' Web site, were all given suspended sentences by Judge John Phillips recently, The Times of London said.

The trio previously had been found guilty, but Phillips awarded them a nine-month sentence, suspended for two years, after agreeing to the defense's claim that there were mitigating circumstances.

The group had admitted to producing more than 36,000 bars of "Canna-Biz" cannabis-laced chocolate bars to help alleviate pain for more than 1,800 victims of multiple sclerosis.

The trio had done little to mask their enterprise as well, offering advertisements in both regional and national media, and remain adamant they did nothing wrong, the newspaper said.

"I was devastated when we were found guilty and this decision has broken me again. I still do not think I have done anything wrong," Lezley Gibson said after the first court ruling. "How can it be wrong to try and help ill people?"



Infectious Mononucleosis Linked to Multiple Sclerosis Risk
Previous infectious mononucleosis might increase the risk for multiple sclerosis (MS), according to the results of a cohort study reported in the January issue of the Archives of Neurology.

"Infectious mononucleosis caused by the Epstein-Barr virus has been associated with increased risk of multiple sclerosis," write Trine Rasmussen Nielsen, MD, from the Statens Serum Institut in Copenhagen, Denmark, and colleagues. "However, little is known about the characteristics of this association."

This cohort study followed 25,234 Danish patients with mononucleosis who were tested serologically at Statens Serum Institut, the Danish Civil Registration System, the Danish National Hospital Discharge Register, or the Danish Multiple Sclerosis Registry. The follow-up period began on April 1, 1968, or January 1 of the year after the diagnosis of mononucleosis or after a negative Paul-Bunnell test result, respectively, whichever came last, and it ended on the date of MS diagnosis, death, emigration, or December 31, 1996, whichever came first. The primary endpoint was the standardized incidence ratio, defined as the ratio of observed to expected MS cases in the cohort.

During 556,703 person-years of follow-up, there were 104 cases of MS, yielding a standardized incidence ratio of 2.27 (95% confidence interval, 1.87 - 2.75). The risk for MS was persistently increased for more than 30 years after the diagnosis of infectious mononucleosis and uniformly distributed in all subgroups based on age and sex. The presumed severity of infectious mononucleosis did not affect the relative risk for MS.

Study limitations are that the low sensitivity of the Paul-Bunnell test can result in an underestimate of the diagnosis, compared with a possibly overestimated risk for the cohort with negative Paul-Bunnell test results.

"We observed a more than 2-fold increased risk of MS after mononucleosis apparent for up to 30 years of observation and uniformly distributed across strata of age and sex," the authors conclude. "This absence of variation in MS risk may reflect a permanent change in immunological status, which confers an excess in MS risk, a hypothesis that needs to be explored further."

The Danish Medical Research Council supported this study. The authors have disclosed no relevant financial relationships.

Arch Neurol. 2007;64:72-75.

Low impact aerobic exercise reduces fatigue in auto-immune conditions says multi-study review
Low impact aerobic exercise, such as walking and cycling, can effectively reduce fatigue in adults with chronic auto-immune conditions, according to a research review in the latest issue of the UK-based Journal of Advanced Nursing.

A team led by nurse researcher Dr Jane Neill from Flinders University in Adelaide, examined 162 research studies published between 1987 and 2006, analysing 36 in detail.

They discovered that there was evidence that people with conditions like multiple sclerosis, rheumatoid arthritis and systemic lupus erythematosus could benefit from exercise that gradually increased in intensity, duration and frequency.

“Fatigue is a major symptom in all three conditions and can cause a range of physical, psychological and social problems” says Dr Neill.

“Our review showed that aerobic exercise can significantly reduce fatigue and that some behavioural, nutritional and physiological interventions are also very effective.”

Studies reviewed by the team tested 38 interventions on more than 1,700 patients. 24 resulted in statistically reduced fatigue or increased vitality levels.

The effective aerobic exercise programmes lasted an average of 12 weeks, with participants exercising for 30 to 60 minutes, three times a week.

Group interventions involved supervised exercise classes, including warm up, low impact aerobic activity and strengthening or stretching exercises before cool down.

Home-based programmes made use of exercise bicycles, walking, cycling, jogging or swimming.

“There is good evidence that people experiencing fatigue from chronic auto-immune conditions can benefit from a range of non-medicinal interventions” concludes Dr Neill.

“Other effective strategies, apart from aerobic exercise, include health education and cognitive behavioural therapy.

“Cooling techniques and nutritional supplements such as acetyl-L-carnitine and fish oil showed a number of benefits, but need to be looked at in more detail.”

The authors suggest electro-magnetic field devices also warrant further investigation, due to promising results.

But they add that low-cost, low technology interventions that promote self-management of fatigue are probably more appropriate and feasible than those requiring specialised equipment or professional expertise.

They stress that any exercise programmes must be suitable for each individual and take account of issues that affect how people manage their conditions, like reduced mobility, pain, nausea and stress.

“Healthcare professionals should ask people about their fatigue and assess each person’s symptoms” adds Dr Neill. “People with fatigue should be encouraged to design their own exercise routines based on awareness of their individual fatigue patterns and daily priorities, while group activities must take account of the changing nature of fatigue over time.”

Previous research suggests that 70 per cent of people with multiple sclerosis suffer daily fatigue, 57 per cent of people with rheumatoid arthritis experience fatigue and 81 per cent of those with system lupus erythematosus find fatigue moderately to severely disabling.

“Any measures that can reduce people’s fatigue and improve their quality of life are to be welcomed. Our review shows that some interventions have great potential, particularly in the short term, but that more research is needed to measure their long-term effectiveness” says Dr Neill.

Respiratory Muscle Strength Training: Functional Outcomes versus Plasticity
[Department of Communication Sciences and Disorders, University of Florida, Gainesville, FL.]
Respiratory muscle strength training is a paradigm that has been used for numerous years with a variety of populations including but not limited to spinal cord injury, chronic obstructive pulmonary disease, multiple sclerosis, Parkinson's disease, voice disordered, sedentary elderly, and healthy young. The respiratory muscle strength program discussed here is an expiratory muscle strength training and uses a pressure threshold device with a regimented treatment protocol. The primary purpose of the expiratory muscle strength training program is to promote strength in the expiratory muscles. The training protocol occurs five times per day, 5 days a week, and consists of ~15-20 minutes per day of training by the user at home. The device threshold is changed weekly by a clinician to maintain a threshold load of 75% of an individual's maximum expiratory pressure. The threshold setting of the device is always based on the individual's recorded maximum expiratory pressure generated into a digital pressure gauge.

Results of 4 weeks of expiratory muscle strength training protocols indicate up to a 50% improvement for healthy subjects, those with multiple sclerosis, and those with spinal cord injury. The potential transfer of expiratory muscle strength to functional outcomes is discussed, as well as how strength-training paradigms may influence cortical plasticity.

Fatigue and sleep disturbance in multiple sclerosis
Considering the association of sleep disturbance and fatigue in multiple sclerosis (MS), we investigated the presence of sleep disturbances that may be related to fatigue by using objective and subjective measures. We included 27 MS patients with fatigue, 10 MS patients without fatigue and 13 controls. The Pittsburgh sleep quality index score showed significant differences between patient groups and controls. Beck depression inventory scores were significantly higher in fatigued than non-fatigued patients. Comparison of patient groups and controls revealed significant differences for time in bed, sleep efficiency index, sleep continuity index, wake time after sleep onset, total arousal index and periodic limb movement arousal index.

Our study confirms that MS causes sleep fragmentation in terms of both macro and microstructure. Fatigue in MS could be partially explained by disruption of sleep microstructure, poor subjective sleep quality and depression.



High serum vitamin D may protect against multiple sclerosis
The effect of geographical latitude on the incidence of multiple sclerosis led decades ago to the hypothesis that sun exposure and vitamin D protect against this debilitating disease, but this has not been confirmed by studies. A case control study nested in a cohort of more than seven million US military personnel compared serum concentrations of 25-hydroxyvitamin D in 257 people who later developed multiple sclerosis and matched controls without the disease.

In white men and women, the risk of multiple sclerosis decreased by 40% with every 50 nmol/l increase of circulating vitamin D. No such association was found in black people and Hispanics, who had lower circulating concentrations than white people. The association was particularly strong for serum vitamin D in white people under 20 years.

The authors discuss recent physiological studies that shed light on the role of vitamin D in the immune response, which could support a . . . [MORE]


Antibodies to Myelin Don't Signal MS - CME Teaching Brief
BASEL, Switzerland, Jan. 24 -- Contrary to a previous report, the presence in the blood of two types of antibodies to myelin is not diagnostic of multiple sclerosis, investigators here reported.

Although other investigators have found that the patients with serum antibodies against myelin oligodendrocyte glycoprotein and myelin basic protein were at increased risk for MS, Dr. Kuhle and colleagues could find no such link, they reported in the Jan. 25 issue of the New England Journal of Medicine

Explain to interested patients that the demyelinating disease multiple sclerosis is diagnosed according to clinical symptoms and MRI evidence of brain lesions. Contrary to findings of an earlier research group, this study suggests that the presence of antibodies to myelin are not diagnostic of MS or of MS risk,

Nor does the presence of the antibodies indicate a risk of progression to clinically definite MS, found Jens Kuhle, M.D., of University Hospital here, along with European and Canadian investigators.



BREAKING NEWS: Oral Cladribine Added-on to New Formulation of Rebif



Subject: Merck Serono S.A. Press Release Notice
Date: January 23, 2007 11:17:25 PM MST


ONWARD Phase II Trial Will Assess Therapeutic Benefit of Oral Cladribine Added-on to New Formulation of Rebif® in Multiple Sclerosis Patients

Geneva, Switzerland, January 24, 2007 - Merck Serono (virt-x: SERO and NYSE: SRA) announced today that it has begun the ONWARD (Oral Cladribine Added ON To Rebif New Formulation in Patients With Active Relapsing Disease) Phase II study. The ONWARD study will evaluate the safety, tolerability and efficacy of two dose regimens of Merck Serono's proprietary oral formulation of cladribine when added to the new formulation of Rebif® (interferon beta-1a) in multiple sclerosis (MS) patients with active disease despite treatment with Rebif®. Oral cladribine is currently also evaluated as a monotherapy in a fully enrolled Phase III pivotal trial (the CLARITY study) for first-line treatment of relapsing forms of MS. The new formulation of Rebif® is under regulatory review by the European Medicines Agency, the US Food and Drug Administration and other healthcare authorities.

"Multiple sclerosis patients with signs of active disease while on treatment with a disease modifying drug may benefit from adding another agent with a different mechanism of action, to complement and increase the overall efficacy while maintaining an acceptable safety and tolerability profile," said Bruno Musch, Merck Serono's Head of Neurology Clinical Development. "The different mechanism of action and the oral intermittent administration of oral cladribine make it a potentially useful add-on therapy to Rebif® at a critical time of disease progression."

"Oral cladribine is currently being evaluated as a monotherapy in the CLARITY Phase III pivotal study and is on track to become the first oral therapy for first-line treatment of multiple sclerosis", said Franck Latrille, Merck Serono's Head of Product Development.

"We are now initiating the ONWARD study as we believe that oral cladribine also has a great potential as an add-on therapy, for patients who have signs of active relapsing disease while on a treatment."

The ONWARD study is a two-year (96 weeks), randomized, double-blind, placebo-controlled, international trial. The trial will be conducted in 40 sites located in the United States and in Europe. It will involve 260 MS patients who have experienced at least one relapse while taking Rebif® during the year prior to study enrollment. Study participants will be randomized in one of the three arms of the study to receive one of two different dose regimens of oral cladribine or matching placebo tablets, in addition to the new formulation of Rebif® 44 micrograms subcutaneous three times a week. In the study, oral cladribine is given in two or four treatment cycles in the first year, with each cycle consisting of daily administration for four or five consecutive days, which means study patients take oral cladribine therapy for only 8 to 20 days during that year. In the second year, two treatment cycles are administered in all dose regimens.

The primary safety endpoints of the ONWARD study consist of a wide range of safety and tolerability parameters measured during 96 weeks of treatment. The primary efficacy endpoint is the mean change in the number of new T1 gadolinium-enhanced lesions per subject per magnetic resonance imaging (MRI) scan from baseline to 96 weeks.

About oral cladribine

Merck Serono's proprietary oral formulation of cladribine is currently being evaluated in Phase III as a treatment for patients with relapsing forms of multiple sclerosis (MS). Cladribine is a small molecule that interferes with the behavior and the proliferation of certain white blood cells, particularly lymphocytes, which are involved in the pathological process of MS. Through its differentiated mechanism of action, oral cladribine may offer a safe and effective new option to patients with MS.

About Rebif®

Rebif® (interferon beta-1a) is a disease-modifying drug used to treat relapsing forms of multiple sclerosis (MS) and is similar to the interferon beta protein produced by the human body. Interferon helps modulate the body's immune system, fight disease and reduce inflammation.
Rebif®, which was approved in Europe in 1998 and in the US in 2002, is registered in more than 80 countries worldwide. In the United States, Rebif® is co-marketed by EMD Serono, Inc. (the US affiliate of Merck Serono) and Pfizer Inc. Rebif® has been proven to delay the progression of disability, reduce the frequency of relapses and reduce MRI lesion activity and area1. Rebif® is not approved for treatment of chronic progressive MS. Rebif® is available in a 22 mcg and 44 mcg ready-to-use pre-filled syringe and a titration pack, and can be stored at room temperature for up to 30 days if a refrigerator is not available.

Most commonly reported side effects are injection site disorders, flu-like symptoms, elevation of liver enzymes and blood cell abnormalities. Patients, especially those with depression, seizure disorders, or liver problems, should discuss treatment with Rebif® with their doctors.

1The exact correlation between MRI findings and the current or future clinical status of patients, including disability progression, is unknown.



When the Body Attacks Itself.
Scientists link 30 genes to multiple sclerosis and other autoimmune diseases

Jan. 21, 2007 - The immune system is what keeps most people's bodies healthy and free of disease, but for as many as 23 million Americans, it is a cause of disease, too. In autoimmune disorders, the system goes haywire, mistaking the body's own tissues for foreign invaders and destroying them. Drugs for these conditions, which include type 1 diabetes, multiple sclerosis and lupus, have been elusive. But on Sunday, scientists are reporting in the journal Nature that they have found a set of 30 genes that go awry in autoimmune disorders—and that could be potential targets for cures. NEWSWEEK's Mary Carmichael spoke with two of the discoverers, Richard Young, a biologist at the Massachusetts Institute of Technology's Whitehead Institute, and Alexander Marson, an M.D./Ph.D. student in Young's lab.


NEWSWEEK: What do these 30 genes normally do in a healthy person's body?

Richard Young: There was a very, very important discovery made about a decade ago, which was that a specialized class of "regulatory T cells" was controlling the immune system's arms of attack. Now, the million-dollar question is why this wonderful system that keeps you healthy might turn against you and begin to attack your own body. And it turns out that in these autoimmune disorders, there are genetic defects in the regulatory T cells, which would otherwise be a check on the rest of the immune system.

These regulatory T cells can't keep the system in line, and it starts attacking things it shouldn't?

Alexander Marson: Yes. In mice, if you remove all the regulatory T cells, what you see is a massive, multiorgan autoimmune disease. In some common human autoimmune disorders, like multiple sclerosis, there's not a total lack of these cells, but there's a subtler dysfunction. The regulatory T cells are present, but they don't work as well at turning off the other immune cells and preventing them from attacking the body.

Young says the discovery will give drug makers 'a real leg up' in curing autoimmune diseases
What exactly is wrong with the genes in these regulatory T cells? What are they doing that they shouldn't be doing?

Young: In autoimmune disorders, most of these genes are less active than they normally would be. What Alex and his colleagues discovered is that this turns the regulatory T cells' activities down, so they're not as aggressive or powerful as they normally would be. Now, it was only three years ago that scientists discovered the "brain" of the regulatory T cells, or the gene that tells them how to do their job. This is a gene called Foxp3.

So Foxp3 is the immune system's big boss, and the 30 genes you've found inside the regulatory T cells are the middle managers?

Young: Right. Until now, it was not known exactly how Foxp3 was giving these T cells directions—which genes it was controlling in order to do that.


Amazing Story of Perseverance: St. Peters woman copes with her MS and that of her father

ST. PETERS — Dealing with the frustration of multiple sclerosis is a way of life for Julie Stanglein, who was diagnosed with the degenerative neurological disorder last year. Her father, Ted Gauble, 56, discovered 16 years ago that he had MS.

Stanglein and her husband, David Stanglein, are caretakers for Gauble, who lives in an apartment the couple built on their home in St. Peters. Stanglein's concerns carry over into her job. She is a part-time care coordinator for the Gateway Chapter of the Multiple Sclerosis Society in St. Louis County.

MS is a chronic neurological illness that affects the central nervous system. It has no known cause or cure, and the prognosis varies widely from individual to individual. Stanglein prefers to be optimistic, saying that "God has opened doors for me before I needed to go through them, and for that I'm grateful."

Still, she pulls no punches as she describes the devastating effects of MS on both the afflicted and their families.

"I live with it. I breathe it. I work with people who have it every day of my life," she said.

Gauble was forced to retire on disability from his job as a Home Depot manager when he was 40. He was plagued with fatigue and with mobility and vision problems — symptoms he had experienced for six years before diagnosis.

Stanglein's parents were divorced after her father was diagnosed — not unusual in MS families, she said.

The care of their father fell to Stanglein and her sister, Jennifer Hope of north St. Louis County. Gauble uses a wheelchair and is assisted by an aide every morning. The Stangleins take the evening shift. David Stanglein has a flexible schedule as a manager of a Walgreens in Wentzville.

They operate as a team in every way, Julie Stanglein said.

"Without my husband, I wouldn't be able to care for my dad on a daily basis, and as for my sister — we couldn't exist without each other. We do everything for Dad together," she said.

Stanglein (pronounced stang-line) said her children, Eva, 7, and Kurt, 6, had been sensitized to people with disabilities.

"They know that Mommy takes shots every day, and they help with Grandpa," she said.

Family friends participate in a variety of MS Society fundraisers, including the annual MS Walk, Challenge Walk and 150 Bike Tour.

Stanglein graduated from high school in Gainesville, Ga., and from Newberry College in South Carolina, where she majored in social work. She received a master's degree in that discipline from Washington University and worked as an oncology social worker at St. Luke's Hospital in St. Louis County. After her father was diagnosed with MS, she changed her focus from children's issues to the health-care field.

Stanglein recalled that her symptoms surfaced when she was pregnant with her son. She suffered facial neuralgia, vertigo, memory loss and vision problems. She went from doctor to doctor until a specialist ordered an MRI.

"I wanted an MRI before that, but my HMO physician wouldn't prescribe it," she said. "This man was seasoned and very caring. His first words to me when he got the results were, 'Did you bring anyone with you?' With my medical background, I knew what those words meant, and I did tear up."

Stanglein said the diagnosis for her and most MS patients brought a measure of relief because the diagnostic process was lengthy and complex. The disease is so individualized and the symptoms so random that the prognosis is uncertain, she said.

"There is no way to predict a person's symptoms, unlike other diseases like tumors, where you can see what's happening in the body," she said. "With MS there is no indicator for what's going on in the body."

Stanglein is a member of Zion Lutheran Church in St. Charles County, where singing in the choir is one of her biggest pleasures. Her mother was a church organist, she said, who made music a part of her life.

She said that her father's initial response to her diagnosis was denial but that slowly he had accepted the fact that his daughter had the dreaded disease.

Stanglein described herself as a Type-A personality who had learned to set limits on family activities.

"My husband and I have found a balance. I used to be able to say yes to everything, but that has changed over the course of several years. Being super mom and housework have gone to the bottom of the priority list," she said.

VIDEO: High Five Goes to Man who Serves, Despite MS

(KSL News) This morning, Sylvia Webber wanted to publicly recognize her brother for the way he handles his multiple sclerosis. So, our Coco Warner surprised him with a High 5.

Eric Glade was diagnosed with MS when he was 15. Now he's 34 years old and in a wheelchair. Yet, Sylvia says he's the one who is constantly helping other people, especially residents of the assisted living center, where he lives.

Sylvia Galde-Webber, Nominated brother: "Eric, I nominated you because of your selfless acts you do to help other people. I'm very impressed. You never complain about your disability, and you're always looking for ways to help other people."

Eric Glade, Nominated by sister: "I am super surprised. This is my wonderful sister. She does really good. She's got a big heart. So, I just want to tell her thank you very much."


Lewistown MS rate high: Residents attribute above-average figure to sludge from Chicago - Journal Star News
Tuesday, January 23, 2007


LEWISTOWN - The city's rate of multiple sclerosis exceeds the national average, according to figures released Monday night in Lewistown.

Health Research Systems of the University of Illinois College of Medicine at Rockford identified nine people with MS living in Lewistown during the study period - 1998 to 2002.

The city's prevalence rate was determined to be 222 cases per 100,000 people. The National Health Interview Survey average is 85 cases per 100,000.

Lewistown, the Fulton County seat, has about 2,500 residents.

People who were willing to disclose information about their medical, residential and occupation history and allow their medical records to be reviewed became part of the study.

The study was done in response to residents' concerns about perceived excessive cases of MS in the Illinois communities of DePue, Morrison, Paw Paw and Savanna as well as Lewistown.

Some Lewistown residents believed their higher rate of MS could be attributed to sludge from the Chicago Metropolitan Sanitary District sprayed on area fields and strip mines.

Monica Smith, a Lewistown resident diagnosed with MS about four years ago, said she was not at all surprised by the results of the study.

"It pretty much showed what I thought it would," Smith said. "I knew it was high."

Smith helped make the study possible by contacting Joel Cowan, principal investigator for Health Systems Research. He said genetic factors are thought to play a role in determining who develops MS. Cowan said he believes genetics is the main factor contributing to MS.

"We do believe attention to ancestry, especially that of women is important," Cowan said.

Of the 37 participants in all five communities, 11 had blood relatives with MS.

The study also determined there was a significantly higher proportion of females with MS. Of the 37 participants with MS, 34 were female.

"I don't know of any other study in the literature that has come up with a ratio this high," Cowan said.

Cowan also said MS is five times more prevalent in temperate climates, like the northern United States and is more common among people of Northern European Ancestry.

All 9 persons verified with MS in Lewistown listed at least one northern European ancestry.

MORE: Lewistown MS rate high: Residents attribute above-average figure to sludge from Chicago - Journal Star News


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GREAT VIDEO: Stem Cell Summit Aims To Help MS Patients -
Dr. Douglas Kerr is a neurologist at Johns Hopkins. He led a team of scientists there, turning embryonic stem cells of mice into motor neurons in rats, allowing paralyzed rats to walk again by reconnecting the spinal cord with muscle. It's the kind of stem cell research being shared at this summit in San Francisco.

Douglas Kerr, M.D., Ph.D., Johns Hopkins, Dept. of Neurology: "There are stem cell biologists, and we have meetings, but you never interact with clinicians, people who think about changing this into a clinical trial or a clinical therapy."

John Richert, M.D., National MS Society, VP Research: "The field has come along to a point where many things that we thought were science fiction just a few years ago, now look like they may well be doable."

That's why the National Multiple Sclerosis Society is hosting this summit, bringing together world renowned researchers to help strategize how to move stem cell therapy forward in the treatment of MS.

Dr. Hans Keirstead: "I think we're going to see a consensus view that oligodendrocytes and glea that are made from human embryonic stem cells and other stem cell types are extremely useful for drug development and basic research."

The spinal cord research of Dr. Hans Keirstead and his team at UCI is expected to lead to the first clinical trial in North America using embryonic stem cells.

Dr. Hans Keirstead: "We take human embryonic stem cells, push them to become high purity populations of one spinal cord cell type, an oligodendrocyte."

Right now, he's successfully implanted those cells in paralyzed rats.

Dr. Hans Keirstead: "What happens is the insulators are restored and the ability of the animals to walk again is also restored."

Scientists will be sharing data and research for the next two days. On Friday they'll meet in groups to hammer out some specific recommendations for the MS Society, helping nail down how stem cell research could eventually help repair the nervous system or immune system of MS patients.CLICK HERE TO WATCH VIDEO -


Pharmos Announces Clinical Data from Phase 2a Trial of Cannabinor for Capsaicin-induced Pain

Pharmos Corp. today announced preliminary results from its Phase 2a study evaluating intravenous (i.v.) cannabinor, a CB2-selective synthetic cannabinoid compound, in a capsaicin-induced pain model. The drug candidate did not meet the primary endpoint defined by analgesic effects compared to placebo, but confirmed safety and tolerability observed in previous studies. All subjects completed the treatment with no serious adverse events or significant cardiovascular effects.

The randomized, double-blinded, two-way crossover study enrolled 24 healthy male volunteers to compare 48mg of cannabinor delivered intravenously versus placebo on capsaicin-evoked allodynia (pain resulting from a non- noxious stimulus to the skin) and hyperalgesia (abnormally increased pain sense).

"While we are disappointed that cannabinor did not show efficacy in this pain model, we have a newly developed oral formulation of cannabinor targeting chronic neuropathic pain with repeated administration," said Dr. Haim Aviv, Chairman & CEO. "We plan to move forward with the program for orally administered cannabinor, and our next step is to conduct a Phase I safety trial in healthy volunteers. Based on preclinical results of oral cannabinor, its prospects as a potential treatment for neuropathic pain are promising." Pharmos recently completed preclinical toxicology and safety pharmacology studies of oral cannabinor, the data from which support initiation of Phase 1 testing... (MORE)


An Everett medical marijuana advocate is outraged that drug agents served a search warrant on his home, confiscated hundreds of marijuana plants, and took computers and other records.

Steve Sarich said those records contained personal information of about 200 people associated with his organization CannaCare.

The raid was Friday at his north Everett home, where he runs the organization. He gives marijuana starter plants to people eligible to use medical marijuana under state law.

"We don't sell any pot," Sarich said. "What they were doing is harassing us to get patient names. It was a political assassination."

Sarich has openly promoted marijuana use for medical purposes under the 1998 state initiative. The law allows patients to get a doctor recommendation for marijuana to ease pain or to aid them for a variety of illnesses, such as glaucoma, cancer and multiple sclerosis.

Those patients are allowed to grow or possess a 60-day supply of marijuana, under the law.
The federal government doesn't recognize laws in 11 states that allow the use of medical marijuana.

Members of the Kitsap County-based West Sound Narcotics Enforcement Team and federal Drug Enforcement Administration agents Friday served a search warrant at Sarich's home.
Simultaneously, a second warrant was served at the Renton home of Sarich associate John Worthington.

West Sound Sgt. Carlos Rodriguez said officers confiscated more than 1,500 marijuana plants, computers and plant-growing equipment from Sarich's residence. Six plants and some papers were taken from the Worthington home, according to search warrant documents.

Sarich said only a few ounces of marijuana were found at his home, and most of the items seized were cuttings and starter plants. Agents also took $1,020 that Sarich said was set aside to pay his Snohomish County PUD bill.

Worthington and Sarich accused the Kitsap County officers of retaliating for information that Worthington sent to the Legislature last week. Worthington has accused the Kitsap drug unit of circumventing the state medical marijuana law by turning marijuana cases over to federal authorities.

Kitsap officials wrote in court documents that they had a lead and a belief that they would find a large number of marijuana plants in the raids. Rodriguez said the case is still under investigation and he declined to comment further on it.

There have been no arrests, and no charges have been filed...(MORE)



Man's inhumanity to man is only surpassed by his cruelty to animals. I was never so sickened as when I read of David Waitzman's primate project at the University of Connecticut Health Center [Page 1, Jan. 12, "Primate Lab Violations End Project At UConn"]. My only question is: Who was minding the candy store when the keys were given out?

Mr. Waitzman's project should not just have been suspended, he should have been charged with animal cruelty, a felony. And with regard to UConn student and animal activist Justin Goodman, thank God there are caring individuals who will take a stand, regardless of any consequences, to protect our animal companions.

Julie Nelson: New Britain

As a person who has multiple sclerosis, peripheral neuropathy and Marfan syndrome - all incurable diseases and all with no or limited treatments available - I experience intense pain on a near daily basis that cannot be controlled with conventional pain medications. I am losing my mobility, cognition, bladder control, eyesight and hearing. My thoughts have turned toward finding cures through research for incurable diseases for our next generation: our children.

I have been under the medical care of Dr. David Waitzman for several years. Dr. Waitzman is the most brilliant person I have ever encountered. He has a very compassionate nature and an intense interest in helping his patients. Dr. Waitzman has dropped everything on his schedule to stop to help me when I have medical crises.

The Courant's Jan. 12 article portrayed Dr. Waitzman as an irresponsible scientist. He is not. He is a devoted and responsible physician and researcher pursuing answers and help for people who are suffering from diseases and disorders that medicine knows too little about... (MORE)


BioMS Medical Corp (TSX: MS), a leading developer of products for the treatment of multiple sclerosis (MS), announced today that it has received clearance from the United States Food and Drug Administration (FDA) of its Investigational New Drug Application (IND) for the initiation of a pivotal phase III clinical trial to investigate the use of MBP8298 as a treatment for patients with secondary progressive MS.

“The clearance to proceed with a phase III trial in the U.S. is a significant step towards bringing MBP8298 to the worldwide market,” said Kevin Giese, President and CEO of BioMS Medical. “There are approximately 400,000 Americans with MS and close to 50% of patients have secondary progressive MS. Between the U.S. initiative and the on-going pivotal phase III trial in Canada and Europe , we are successfully executing our global development plan for MBP8298.”

The IND allows the commencement of a pivotal phase III secondary progressive MS clinical trial in the US and has been granted on the basis of satisfying FDA criteria regarding preclinical, chemistry, manufacturing and safety data from the completed and ongoing clinical studies for MBP8298.

MAESTRO-03 Phase III US Trial

The pivotal phase III clinical trial in the US, named MAESTRO-03 (A Double-blind, Placebo Controlled Multi-center Study to Evaluate the Efficacy and Safety of MBP8298 in subjects with Secondary Progressive Multiple Sclerosis), will be evaluating MBP8298 for the treatment of secondary progressive multiple sclerosis (SPMS). The trial is a randomized, double-blind study enrolling approximately 510 patients who will be administered either MBP8298 or placebo intravenously every six months for a period of two years. The primary clinical endpoint for the trial is defined as a statistically and clinically significant increase in the time to progression of the disease as measured by the Expanded Disability Status Scale (EDSS), in patients with HLA-DR2 and/or HLA-DR4 immune response genes (up to 75% of all MS patients are HLA-DR2 and/or HLA-DR4 positive).

About MBP8298 - Novel Mechanism of Action
In MS patients, the body's immune system inappropriately attacks the myelin coating around the nerves in the brain and spinal column, whereas healthy people are otherwise “tolerant” of such common body components. The proposed mechanism of action of MBP8298 is, by design, to re-introduce such a state of “tolerance” to a critical portion of the nerve's Myelin Basic Protein that is an immunological site of attack in many MS patients. This is accomplished by the I.V. injection of MBP8298 every six months.

Phase II and long-term follow-up treatment of MS patients with MBP8298, recently published in the European Journal of Neurology showed that MBP8298 safely delayed the median time to disease progression for five years in progressive MS patients with HLA-DR2 or HLA-DR4 immune response genes. MORE: NEW DRUG FOR SECONDARY PRPGRESSIVE MS

Senate looks to expand Rx marijuana bill: "After 1996, when he was diagnosed with multiple sclerosis after two years of symptoms, Mark Tucci of Manchester began taking a bunch of heavy duty medications.

But those medications came with their own problems and side effects.

Then he began smoking marijuana. Tucci says his use of the drug has helped him to cut in half the number of prescription medicines he takes, and his illness is not progressing as rapidly as was expected. He has written a book for patients growing marijuana.

'Not only does smoking slow down the degenerative progress of my disease, you can see that, but I don't have to take the 17 narcotics I did have to take,' Tucci, 50, said by telephone Friday.

He spoke the same day the state Senate Judiciary Committee voted 4-1 to advance a bill expanding the state's medical marijuana statute, which became law in 2004.

The concerns of law enforcement officials helped persuade members of the committee to stop short of giving advocates for medical marijuana everything they wanted, said Sen. Richard Sears, D-Bennington, the committee chairman. Police and prosecution officials testified earlier this month that there was a chance changing the law could contribute to an increase in drug crimes, or that patients might be targeted for theft.

'We listened to law enforcement and their concerns,' Sears said.

The bill, which now moves to the Health and Welfare Committee in the Senate, would expand Vermont's marijuana program significantly.

If it becomes law, sufferers of chronic illnesses that are progressive and debilitating – but not life-threatening – will be able to legally possess and grow limited amounts of the drug. In the past, access was restricted to deadly diseases like cancer, AIDs and multiple sclerosis.

Patients would be able to have four mature marijuana plants and 10 immature plants, as long as they registered the plants with state police and had the approval of their doctors.

However, patients still would be restricted to possessing two ounces of marijuana. And strict rules about how the drugs are grown, and requirements about registration by patients, would remain in place, lawmakers said.

'The testimony we received was that it was working well for the people already on the registry,' Sears said.

So far, Vermont's law has not run afoul of federal authorities. Vermont's law protects patients from prosecution by state and local authorities, but not under federal drug laws.

However, Vermont's medical marijuana law is significantly more restrictive than those in other states, like California, where federal authorities have stepped in to enforce U.S. laws, Sears said.

'We still believe that is unlikely to happen in Vermont,' Sears said.

He said it's important for Vermont to expand the list of ill patients who are eligible for medical use of the drug, and to increase the number of plants patients can grow for their own use. Otherwise, patients — whose diseases may have weakened them financially as well as physically — may be purchasing them much more expensively on the black market.

'Some of these people are just struggling to get by,' Sears said.....MORE"

Nick Coleman: Two wheels, five days, 273 miles, one great cause
This will mark the 18th installment of TRAM, which used to stand for "The Ride Across Minnesota" but has morphed into The Ride AROUND Minnesota, without a manic need to cross a monumental state from border to border, as we used to do at the beginning. Begun in 1990 (I was along for the first five rides and returned last year), TRAM has piled up impressive numbers:

Since 1990, more than 20,000 riders have pedaled more than 6 million miles and raised more than $10 million for the Minnesota chapter of the National Multiple Sclerosis Society.

Your turn to crank.

TRAM is a well-organized, family-friendly, extremely fun and occasionally challenging way to see Minnesota from the vantage point of your handlebars, not from behind a bug-spattered windshield.

TRAMsters get up close and personal with the wildlife.

It is only from a bike seat that you get to hear a loon calling from a lake or smell the blossoms of high summer as you make your way to a hot meal and a hot shower at the end of the trail each day.

This is called sweat-equity tourism, and when you invest 55 miles a day in your beloved home state, you will treasure it in a way you never have before. And you will be proud of what you have accomplished, both for yourself and your fellow citizens in need, especially those who suffer from MS.

That's why the Star Tribune and I are inviting you to get out your calendars and get on your exercise bike. Get ready for the Star Tribune MS TRAM, and get ready to work your rear end off while laughing it off, too.

Here are some highlights to expect on TRAM 2007


Viragen Announces That OVA(TM) System Results are Published in Leading U.S. Scientific Journal

Viragen Announces That OVA(TM) System Results are Published in Leading U.S. Scientific Journal
Viragen, Inc.
(Amex: VRA; VRA.U; VRA.WS) and its collaborative partners in the field of
avian transgenics, Roslin Institute and Oxford Biomedica Plc (LSE: OXB),
today announced that the Proceedings of the National Academy of Sciences of
the United States of America (PNAS), a leading scientific journal, has
published an article profiling the OVA(TM) System's ability to express two
therapeutic proteins in the whites of eggs of transgenic hens. The OVA(TM)
System is being developed as a novel, large-scale biomanufacturing
alternative capable of cost-effectively expressing many types of
therapeutic proteins.

The article, entitled, "Oviduct-specific expression of two therapeutic
proteins in transgenic hens," reports on the production of two protein drug
candidates: a humanized monoclonal antibody being developed by Viragen for
advanced malignant melanoma; and interferon beta-1a, which is currently
marketed under two competing brand names for the treatment of Multiple
Sclerosis (MS), as Avonex(R)* (Biogen Idec) and Rebif(R)** (Serono).

Article Summary:
Recent advances in avian transgenesis have led to the possibility of
utilizing the laying hen as a production platform for the large-scale
synthesis of pharmaceutical proteins. Ovalbumin constitutes more than half
of the protein in the white of a laid egg, and expression of the ovalbumin
gene is restricted to the tubular gland cells of the oviduct. Here we
describe the use of lentiviral vectors to deliver transgene constructs
comprising regulatory sequences from the ovalbumin gene designed to direct
synthesis of associated therapeutic proteins to the oviduct. We report the
generation of transgenic hens that synthesize functional recombinant
pharmaceutical protein in a tightly regulated tissue-specific manner,
without any evidence of transgene silencing after germ-line transmission.

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Uric acid may treat spinal cord injuries - Rutgers University
University researchers led by Professor Bonnie Firestein may have found a treatment for spinal cord injuries by using uric acid.

Firestein, an associate professor of cell biology and neuroscience, and her team have published their findings in the early online copy of the research journal Glia.

Humans produce only small quantities of uric acid naturally, but past research indicated the human body is very sensitive to uric acid blood concentration. Gout, an extreme form of arthritis, results from an excess of uric acid, leading to the formation of uric acid crystals in the cartilage and tendons of joints. These crystals result in tremendously painful inflammation.

However, recent research points to the detrimental effects of low blood uric acid concentration.

"In the literature, there's a lot of data on uric acid as a protective agent in multiple sclerosis and Parkinson's disease," Firestein said. In fact, people suffering from gout rarely develop multiple sclerosis or Parkinson's disease.

Therefore, scientists proposed that a dearth of uric acid may promote certain neurological problems in the body.

Firestein's laboratory initiated the study of uric acid's effects on the central nervous system because cypin, a protein Firestein researched for years, is involved in the production of uric acid.

"We first wanted to reveal a possible relationship between cypin, uric acid and the neuronal protection," said Dr. Yangzhou Du, a research associate in Firestein's laboratory and the first author on the paper.

The lab's findings point to an intricate interaction between glia cells and uric acid to prevent damage to neurons.

There are two types of nerve cells in the central nervous system: neurons and glia. Neurons were previously thought to be the most important cells in the nervous system; much research has been done on them. Glia cells, though they outnumber the neurons in a ten to one ratio, were dubbed as "supporting cells," said Firestein.

In spinal cord injuries, the spinal cord suffers two forms of damage. Mechanical damage results from the physical impact on neurons, and chemical damage results from "neurons [that] release glutamate in an injury, which can kill neurons at high amounts," Firestein said.

Du's team simulated a spinal cord injury in the laboratory by adding glutamate to neurons and glia grown on a plate, he said.

He explained that when exposed to uric acid, one type of glia cell called astroglia expresses an elevated level of a glutamate transporter called EAAT-1. The astroglia are then able to reduce neurons' access to glutamate, protecting them from further damage.

Uric acid was also shown to protect neurons even when it is added after glutamate. "This points to therapeutic potential," Du said.

However, prescribing uric acid may not be the best avenue for treatment against glutamate toxicity, Firestein said. Though uric acid can be administered through local injections or with an oral supplement called inosine that is internally degraded to uric acid, Firestein said high uric acid concentrations may be toxic to the heart and kidneys.

Firestein is now collaborating with researchers from the University of Rochester and Baylor College of Medicine to "develop astroglia from stem cells that express high levels of the glutamate transporter." These modified astroglia will be transplanted into rats with a spinal cord injury to see if they will ameliorate their conditions.
MORE: Rutgers University

ABC News crew to visit family
A scholarship essay written during Marilyn Wilhelm's senior year at Paulding High School has led to a national television appearance for her family.

Wilhelm, a first-year nursing student at Ohio State University, was one of 942 applicants for a multiple sclerosis scholarship program, which required writing an essay. A program for children of parents who have MS, $442,000 was awarded to 204 students. Wilhelm, who graduated fourth in her high school class, plans to continue on to medical school with an emphasis on neurological diseases.

The essay was passed onto the Wall Street Journal by the MS Society. As a result, the family of K. Paul and Sue Wilhelm, Marilyn's parents, became part of a comprehensive look at the lives of children who are an integral part of an ill parent's ongoing care that was detailed in an article published Jan. 5. And apparently, that story led to an ABC News crew's plan to visit the Wilhelms on Thursday.

The Wall Street article by Clare Ansbury chronicled the daily life of Jordon, the Wilhelms' youngest child, and other teens with ill or physically disabled parents. A high school senior at Paulding High School, Jordon has stepped up to the plate, taking over tasks that fell to each of his sisters, Marilyn and Valerie, until they left for college.

According to the article, a study carried out by the National Alliance for Caregiving and the United Hospital Fund Foundation reports well over 60 percent of the children who help with a parent's care, carry out tasks of daily living such as bathing, dressing and feeding. This number was applied to more than one million children in the U.S. between the ages of 8 and 18.

According to Sue Wilhelm, seeing to Paul's care is a juggling act that requires the efforts of everyone, including extended family on either side.

The Wilhelms' story struck a chord across the country and now ABC News will be visiting the family.

"They said something about covering 'a day in the life,' " Sue says. "They don't know yet what program the story will be on, Good Morning America or the evening news."

Paul was diagnosed with MS so many years ago that the children don't remember their father as a healthy person. Despite years of physical degeneration, Paul and his family are upbeat and have retained their senses of humor. The Wilhelm children have always been high achievers and managed a variety of activities and part-time jobs in addition to helping care for their father.

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(photo: Steve Sarich, executive director of CannaCare, says he's no drug dealer and that his group's funds support medical marijuana users)
Agents raid medical marijuana advocacy office IN Washington - Plants, computers and cash seized in Everett
Drug enforcement agents raided the Everett headquarters of an advocacy group for medical marijuana patients, confiscating what police documents say was more than 1,000 plants and computers that the owners say contain personal information of about 200 men and women authorized to use the drug for medicinal purposes.

So far, no one has been arrested or charged with a crime.

Fearful of potential repercussions and unsure of the officers' ultimate aim, patients in the CannaCare network of marijuana users have been "laying low," said one, terrified that they may be prosecuted for using a substance authorized by their physicians.

"Who knows what they're doing with our information?" said Steve Newman, who has multiple sclerosis and has been using marijuana, obtained through CannaCare, for two years. "It makes me concerned -- really, really concerned. But we're pretty helpless. Nobody can say much about it."

A detective assigned to the federally funded West Sound Narcotics Enforcement Team, which launched Friday's raid, scoffed at the notion that CannaCare -- run out of the home of medical marijuana advocate Steve Sarich -- was anything other than a drug-dealing enterprise.

Detective Roy Alloway said it was "absurd" to think that the number of plants Sarich was tending would be covered by his medical authorization.

"It's clear that Sarich is a guy that's selling drugs," said Alloway, who noted that state law allows no more than a 60-day supply of marijuana for medical use.

The amount found in Sarich's home, he said, was "not even close."

Long a thorn in the side of law enforcement for his vocal, thumb-in-the-eye advocacy style, Sarich, 56, insists that the government is merely harassing patients -- himself included -- who have a legitimate right to use the drug for managing pain due to MS, cancer and a host of other illnesses.

Washington voters approved the use of marijuana for certain medical conditions through a citizens initiative in 1998.
click for full story

"NEW TWIST... samurai sword slaying" -

Though she denies any role in the samurai sword slaying of her husband, Laura Nager's attorney says she is prepared to be arrested soon

On the day that Zachary Gibian was sentenced for the samurai sword murder he blamed on his mother, she appeared to move closer to arrest, her attorney said.

Although she never appeared in court during her son's six-week trial - nor at his sentencing yesterday - Laura Nager, widow of victim Scott Nager and mother of Gibian, has remained a central figure in the bizarre murder case. Now her arrest is imminent, her attorney, Steven Wilutis of Miller Place, said yesterday.

"I was told to have her ready to surrender, and she's ready. I'm just waiting for the D.A. to notify me," Wilutis said outside the Suffolk criminal courthouse, where Gibian was sentenced to 25 years to life in prison. "I've been waiting for weeks. I assume something will happen now. "

Later yesterday, in the messy living room where her husband was nearly decapitated, Laura Nager insisted, "I didn't have anything to do with it. "

Although Wilutis said Assistant District Attorney John Scott Prudenti and District Attorney Thomas Spota both recently told him that Laura Nager would be arrested "soon," prosecutors yesterday disputed ever telling him that.

"The investigation into those who may have been complicit in Scott Nager's death is continuing," said John Collins, chief of homicide for the district attorney's office. "I am not aware of any conversation with Mr. Wilutis advising him to have his client ready to surrender. "

Collins said last month that prosecutors were considering whether to seek an indictment against Laura Nager.

Wilutis said he expected his client, who suffers from multiple sclerosis, to be arrested within the next two weeks, and said she could be charged with anything from conspiracy to second-degree murder, under the theory that she helped Gibian carry out the February 2005 slaying of Scott Nager.

Laura Nager acknowledged that she was concerned about her own criminal charges.

"I don't think I would do very well in prison," said Nager, who added that she was on several medications for her illness and in a lot of pain. "I'm not well. "

In bombshell testimony during his trial, Gibian said his mother was the real killer, enraged after catching her husband sexually abusing her son.

Prosecutors have dismissed the story, but from early on in the case have called Laura Nager a "person of interest. "

They have noted that she has sued to collect a $2-million life insurance policy left by her husband. They also say she may have misled police to cover up the murder, including by lying in a 911 call hours after the slaying. She claimed then that her husband was killed in a burglary.

Yesterday, Laura Nager stuck to that story.

"I think there was a third party involved. Zachary didn't do it," Nager said.


Parasite Infection Might Ease Multiple Sclerosis
Parasitic infections may actually benefit people with multiple sclerosis (MS), suggests a study by researchers in Argentina.


These infections may affect the body's immune response in a way that changes the course of the disease.

Previous studies found that parasite infection could affect the course of autoimmune diseases in animals. This is the first study to examine the relationship between parasite infections and MS in humans.

The study included 12 MS patients with a parasite infection and 12 MS patients who were parasite-free. The patients in both groups had a similar disease course. The patients were followed for an average of 4.6 years.

During the study period, there were three clinical relapses of MS among patients infected with a parasite, compared to 56 relapses in the group of uninfected MS patients. Patients in the infected group were less likely to suffer increased disability due to MS.

The researchers also found that infected patients had much higher numbers of cells that produce cytokine suppressants. MS involves an inflammatory response associated with the production of cytokines, which are regulatory proteins.

The findings provide evidence to support the idea that an autoimmune response caused by a parasite infection can decrease the normal inflammatory response associated with MS, the study authors suggested.

The study appears in the January issue of the Annals of Neuro


"Oral Cladribine on Track to Become First Oral Disease Modifying Treatment for Multiple Sclerosis" - Merck Serono - Press Release

Geneva, Switzerland, January 16, 2007 - Merck Serono (virt-x: SEO and NYSE: SRA) announced today that patient enrollment has been completed in the CLARITY (CLAdRIbine Tablets Treating MS OrallY) study, a Phase III pivotal clinical trial evaluating the efficacy and safety of Merck Serono’s proprietary oral formulation of cladribine for the treatment of relapsing forms of multiple sclerosis (MS).
“The completion of patient enrollment into the CLARITY pivotal trial is a major milestone in the development program of oral cladribine,” said Franck Latrille, Merck Serono’s Head of Product Development. “It brings us one step closer to our objective of offering patients the first oral therapy for first line treatment of multiple sclerosis, with the convenience of short courses of therapy given intermittently.”
The CLARITY study is a two-year (96 weeks), randomized, double-blind, placebo-controlled, international trial. It enrolled more than 1,300 patients and will provide data on key endpoints including clinical relapses, disability progression and magnetic resonance imaging (MRI). Study participants have been enrolled in one of the three arms of the study to receive one of two different dose regimens of oral cladribine or matching placebo tablets. In the study, oral cladribine is given in two or four treatment cycles in the first year, with each cycle consisting of daily administration for five consecutive days, which means study patients take oral cladribine therapy for only 10 or 20 days during the year. In the second year, two treatment cycles are administered.

The increased convenience resulting from the oral intermittent administration of oral cladribine has the potential to address an important unmet medical need in patients with MS.

Oral cladribine was designated a Fast Track product by the US Food and Drug Administration (FDA) in September 2006. Under Fast Track designation, oral cladribine is eligible for Priority Review and the FDA may consider portions of the marketing application for review before the New Drug Application (NDA) is completed.

About oral cladribine
Merck Serono’s proprietary oral formulation of cladribine is currently being evaluated in Phase III as a treatment for patients with relapsing forms of multiple sclerosis (MS). Cladribine is a small molecule that interferes with the behavior and the proliferation of certain white blood cells, particularly lymphocytes, which are involved in the pathological process of MS. Through its differentiated mechanism of action, oral cladribine may offer a safe and effective new option to patients with MS.
MORE - Merck Serono - Press Release


Sears: Allow sick to grow more pot - Bennington Banner:
"BENNINGTON — A Manchester resident testified before the Senate Judiciary Committee Thursday in support of a new medical marijuana bill.

Mark Tucci, 49, who suffers from multiple sclerosis, told the committee the state should revise a law passed in 2004 to allow approved patients to grow more marijuana for medical use. Tucci's testimony Thursday was in support of S.07, a bill proposed by Sen. Dick Sears, D-Bennington, last month.

"A lot of people have asked me why I've introduced this bill, and Mark is the reason. ... That's the way legislation works in Vermont because we're a small state and you really do hear from your constituents," said Sears.
MORE - Bennington Banner:

The bill seeks to raise the amount of marijuana a registered patient can possess to six mature plants, 18 immature plants and four ounces of usable marijuana. Current law allows for one mature plant, two immature plants and two ounces of usable marijuana. In addition, the registration fee for patients would be reduced from $100 to $50.

Sears' bill also expands the number of conditions that would qualify for medical marijuana. In addition to ailments such as cancer, AIDS and "Overall ... the program works. A very small group of the sickest Vermonters with AIDS, cancer and multiple sclerosis now have a very important tool to help them where nothing else seemed to or where the side effects from the real drugs were too debilitating to handle," he said.

However, it is time the state expand the law to allow patients to grow more, said Tucci. He said the plants he is allowed to grow often die or do not yield a sufficient amount of marijuana, causing Tucci to spend $400 to $500 dollars of his $850 monthly disability check purchasing marijuana on the black market.

"I smoke roughly two ounces a month. At present, I can grow about two ounces in a three to four-month period. That means two thirds of my meds have to be bought on the black market. ... The unknown strain and unknown growing conditions pretty much guarantee that the quality won't be the same," Tucci told the committee.

By purchasing marijuana on the street, Tucci said he is unintentionally encouraging recreational use of the drug. He said Sears' law could change that.

"By going out into the black market, I'm breaking the laws that our officers are sworn to uphold. ... The way to end all this is to let me grow enough medicine."

Tucci's testimony details the need for the bill, said Sears. "

MS hits North Africans harder than Europeans - Scientific
Multiple sclerosis (MS) follows a more severe course in North Africans than Europeans, a new study from France shows.

MS is fairly common in France, which is considered to be a relatively high-risk country. It is much more common in France, striking more than 100 people for every 100,000 citizens, than in North African countries, where the prevalence is 15 per 100,000 people, Dr. Marc Debouverie of the Central Hospital in Nancy and colleagues note.

The variable prevalence of MS throughout the world is thought to be related to the effects of genetic make-up, environmental factors, or both, the researchers add in the January issue of Neurology.

France has many North African residents, and due a high volume of immigration in the 1950, it also has a large number of second-generation North Africans.
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The researchers compared how MS manifested itself in North Africans who emigrated to France, evaluating 211 North Africans and 2,945 Europeans.

The disease struck the North Africans at an earlier age, about 30 years old compared to about age 33 for Europeans, the researchers found. The most severe form of MS, known as primary progressive disease, was more common among North Africans, with 15.6% having this type of MS, compared twin 11.7% of Europeans.

North Africans were also less likely to have a complete recovery from their first bout with the illness, had a shorter average time before relapses; had more relapses in the first five years of having the disease; and became disabled more quickly. For example, North Africans started requiring a cane for walking an average of 10 years earlier than Europeans.

MS also developed earlier in French-born North Africans earlier than those who emigrated to the country, which was the only difference between the two groups in terms of the disease course.

Given that all of the study participants shared the same environment, the findings suggest that the differences in MS course between North Africans and Europeans are genetically based, Debouverie and colleagues conclude.

SOURCE: Neurology, January 2, 2007.

MS in focus English Issue nine cover

CLICK HERE FOR FREE DOWNLOAD: "Issue nine - January 2007
Caregiving and MS"

Issue nine - January 2007

Caregiving and MS

The English-language edition of the nineth issue of MS in focus magazine is now available for download.

This issue of MS in focus features articles from leading authors on caregiving and provides important practical information for carers of people with MS, healthcare professionals and people with MS.

The magazine will also be available online in German and Spanish shortly.

MS victim says it `enriched my life'- : "For a woman who has lived with multiple sclerosis for 22 years, Carrie Schulman does not view her disease as a burden.

Instead, the 53-year-old Plantation woman finds it has given her added purpose.

''It's enriched my life. It's not taken away from my life,'' Schulman said.

Shortly after she was diagnosed with the disease, the mother of two began to turn a negative into a positive by getting involved with the South Florida Chapter of the National Multiple Sclerosis Society.

Since then, she has been a lead player in the fight to raise both awareness and money for research.

This year, her husband, David, surprised her by making their company, DBS Financial Group, the lead sponsor for the event Carrie has worked on for 15 years.MORE"



Honorary dinner raises awareness, funds for MS - Ft. Collins, CO.
: "im Dunlap has a message for the community and for those suffering with multiple sclerosis: Multiple sclerosis is very difficult to deal with, but it's not the end of the world.

He also wants to raise community awareness that some people with MS, like himself, may look fine on the outside but be suffering from such things as extreme fatigue, vision problems, cognitive issues or weakness.


Dunlap, along with Mark and Neyla Driscoll, will be honored at the 2008 Dinner of Champions, which honors a community leader and a person with disease.

The Dinner of Champions is the largest fundraiser of the year for the Northern Colorado Chapter of the MS...MORE"

BRITISH scientists have unveiled a genetically modified super-chicken capable of laying eggs rich in cancer-fighting drugs. The breed is also being hailed as providing a major breakthrough in the battle against several other lifethreatening diseases such as multiple sclerosis.

A 500-strong flock of the ISA Brown hens has been created at the Roslin Institute near Edinburgh responsible for creating Dolly the cloned sheep. By mass-producing the drugs at a low cost it is hoped the eggs will save the NHS thousands of pounds a year for every patient treated. The NHS's annual bill for prescription drugs exceeded GBP8billion last year an increase of 46 per cent since the turn of the millennium. Each hen had human genes introduced to the make-up of its DNA, allowing them to produce complex medicinal proteins that secrete into the egg white. Through a relatively simple process, the protein can be separated from the egg and used in the production of valuable drugs. Researchers have achieved a world first by creating a "true breed" to ensure the human genes pass down through generations. Scientists introduced human interferon, commonly used to battle multiple sclerosis, into one of the lines, with a potential worldwide market value in excess of hundreds of millions of pounds. Arthritis and skin cancer sufferers are also set to benefit from the breakthrough after the antibody miR24 was introduced into a separate line.
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The Pharmacological Management of Spasticity

Source: Journal of Neuroscience Nursing

By Saulino, Michael; Jacobs, Beth W

Spasticity is formally defined as a velocity-dependent increase in resistance to passive range of motion. It is a hallmark of neurological diseases that affect the central nervous system, including conditions that are congenital (e.g., cerebral palsy), acquired (traumatic brain injury), static (stroke), and progressive (multiple sclerosis). Spasticity results in involuntary contractions of synergistic muscles in the extremities, which are clinically manifested as flexor or extensor spasms (Mayer & Esquenazi, 2003; Meythaler, 2001).

Spasticity can be both beneficial and deleterious. Therefore, clinicians who care for such patients must consider all aspects of a patient's spasticity before embarking on a treatment plan. Spasticity beneficially contributes to assistance with mobility, maintenance of posture, vascular circulation, preservation of muscle mass and bone mineral density, prevention of venous thrombosis, and reflexive bowel and bladder function. Conversely, spasticity can interfere with positioning, mobility, comfort, and hygiene. Impaired dexterity can be observed in individuals with both spasticity and some voluntary muscle movement. Ambulatory patients can benefit from formal gait analysis to precisely assess the impact of hypertonitity on locomotion. Spasticity has also been linked to increased metabolic demands in patients who are not adequately nourished (Saulino, Kancherla, & Phillips, 2004). Spontaneous spasms can interfere with sleep or duration of wheelchair use. Spasms can also lead to skin breakdown because of shearing effects or to impaired healing of surgical wounds due to tension along suture lines (Satkunam, 2003).

The relationship of spasticity to pain is complex. Spasticity can limit the range of motion around a joint and result in musculoskeletal pain. Reduction of spasticity may reduce the pain associated with biomechanical problems. However, central nervous system disease can also produce neuropathic pain. Modulation of spasticity may not be effective in reducing neuropathic pain (Ward & Kadies, 2002).

Because the effects of spasticity can be complex, the goal of treatment may not be its complete elimination but rather titration to maximize the risk-benefit ratio. Traditionally, this syndrome is managed in a sequential fashion. However, most practitioners currently apply a more synergistic approach to reducing spasticity. Regardless of the approach, any anti-spasticity regimen must be tailored to the patient.

Nonpharmacological Treatment

The two mainstays of nonpharmacological spasticity management are the removal of noxious stimuli that can drive hypertonicity and the application of physical modalities. Comorbidities of neurological dis ease can act as noxious stimuli that trigger increased spasticity. Examples include urinary tract infections, bladder distention, urolithiasis, bowel impaction, decubitus ulcers, and osteomyelitis. Such problems should be treated before beginning pharmacological treatment for spasticity. As patients become more aware of their reactions to such triggers, they can help the healthcare professional with the ongoing management of their spasticity.

Physical measures can also modulate spasticity. Stretching of the involved muscles is often helpful. Continuous or static stretching is preferred to short-duration or ballistic stretching (Gracies, 2001a). Longduration stretching techniques can be applied manually or by means of adaptive equipment such as casts or splints. Application of heat and cold has been reported to reduce spasticity. Cryotherapy has the more extensive history; methods for oyotherapy include cooling sprays, cold packs, and cooling garments. Other potential modalities for moderating spasticity include ultrasound and short-wave diathermy, microwave irradiation, and transcutaneous electrical nerve stimulation (TENS; Grades, 2001b).

Surgical interventions are the most invasive nonpharmacological interventions for spasticity management. Muscle-tendon lengthening can decrease spasticity by altering the tension-to-length relationship of contracting muscle. Techniques for destroying nerves, such as neurectomy, rhizotomy, and myelotomy, can also be used to control hypertonicity, but these are typically reserved for the most recalcitrant cases (Smyth & Peacock, 2000).

Pharmacological Approaches

Three medications have spasticity reduction as their primary indication: baclofen (Lioresal), dantrolene (Dantrium), and tizanidine (Zanaflex). These drugs represent the mainstays of pharmaceutical treatment for hypertonicity. Table 1 summarizes their important features. The decision process for pharmacological intervention should integrate several factors. The course of neurological dysfunction can influence the choice of modality. A progressive disease such as multiple sclerosis might be better managed using an intervention that can escalate as the disease advances, such as an intrathecal baclofen pump. The areas of the body affected by the neurological disease can dictate treatment. For example, a focal intervention such as a botulinum toxin injection might benefit a stroke patient with focal hypertonicity but would not be appropriate for a patient with global hypertonicity resulting from a traumatic spinal cord injury. Concurrent medical problems should also be considered in the decision process. For patients with known liver dysfunction, medications that are known to affect hepatic function should be avoided. Similarly, for a patient who is chronically colonized by microbial agents, the use of implanted devices must be approached with caution, given the possibility that infectious agents could directly infect the device. For example, infection of an implanted intrathecal pump can lead to meningitis. Such problems are becoming more common (Teddy, Jamous, Gardner, Wang, & Silver, 1992).

Baclofen is a classic medication for spasticity management. It exerts its clinical effects by interacting with neurons that use gamma aminobutyric acid (GABA) as a neurotransmitter. It acts both pre- and postsynaptically to inhibit spinal reflexes. Baclofen is rapidly and completely absorbed following enterai administration. It has a mean half-life of 3.5 hours. Baclofen is metabolized by the liver and eliminated by renal excretion. Because baclofen readily crosses the blood-brain barrier, sedation, fatigue, dizziness, lowering of the seizure threshold, and cognitive dysfunction are common adverse effects. The typical starting dose is 5-10 mg two or three times per day, and the dosage can be increased by 5-10 mg per week. Although 80 mg per day is a commonly accepted maximum, dosing up to 200 mg per day has been used safely and effectively. A badofen withdrawal syndrome can occur with rapid cessation of usage. Withdrawal symptoms include a rebound increase in spasticity, fever, altered mental status, seizures, malignant hyperthermia, and, very rarely, death. Badofen withdrawal is typically treated by gradual reinstitution of oral baclof en. In the case of serious withdrawal, intravenous benzodiazepines can be used. Baclofen overdose syndrome can also occur. It is characterized by sedation, depressed arousal, and respiratory suppression and is treated by temporarily stopping or tapering off baclofen. Intravenous physostigmine, flumazenil, or both may be used in severe cases. Repeated dosing may be needed, because these agents have a shorter half-life than baclofen.

Dantrolene is unique among the oral agents in that its site of action is the peripheral muscle rather than the central neurotransmitter systems. This medication inhibits the release of calcium from the sarcoplasmic reticulum during muscle contraction. The usual starting dose is 25 mg twice per day, and it can be increased by 25-50 mg per day per week. The commonly accepted maximum dosage is 400 mg per day, although use of as much as 800 mg per day has been reported. The halflife of oral dantrolene is 15 hours. Liver abnormalities can be seen with this agent; thus, liver enzymes must be monitored periodically. Abnormal liver enzymes are observed in approximately 2% of patients, with fatal hepatic failure seen in 0.3% of cases. Hepatotoxicity can usually be reversed by ceasing treatment. Laboratory monitoring of liver enzymes (i.e., AST, ALT) is recommended at the initiation of treatment and periodically thereafter. Other reported adverse effects of dantrolene include weakness, nausea, diarrhea, and paresthesias. Dantrolene is the initial medication of choice for spasticity of cerebral origin, because it acts at the level of the peripheral muscle with minimal untoward central effects.

The newest drug for spasticity modulation is tizanidine. This agent is chemically similar to the antihypertension medication clonidine. It acts through agonist effects on the alpha-2 adrenergic system at both the spinal and supraspinal levels to reduce spasm. Peak plasma levels occur 1 hour after oral administration, with a half-life of 2.5 hours. The typical starting dose is 1-4 mg as a single dose at bedtime. The typical maximum daily dosage is 36 mg. This drug is extensively metabolized by the liver to inactive compounds and is then excreted by the kidneys. As with dantrolene, liver function should be monitored during treatment, although no cases of hepatic failure have been reported with tizanidine. Common adverse effects of this agent include sedation, di\zziness, hypotension, nausea, and dry mouth. Some studies have suggested that tizanidine has pain relief properties in addition to its antispasticiry effects (Elovic, 2001).

Several other agents, while not carrying primary indications for spasticity reduction, are occasionally used in appropriate patients. These agents include gabapentin (Neurontin), tiagabine (Gabitril), diazepam (Valium), and clonidine (Catapres). Gabapentin exerts its therapeutic effects by binding to a calcium channel receptor that resides on neurons. Tiagabine and diazepam similarly exert their effects through interactions on the GABA neurotransmitter systems (Francisco, Kothari, & HuIs, 2001). Clonidine, a well-known antihypertension medication, is an agonist to the alpha2 adrenergic system. Its effects are similar to those of tizanidine. The centrally acting muscle relaxants, such as cyclobenzaprine (Flexeri), carisoprodol (Soma), methocarbamol (Robaxin), metaxalone (Skelaxin), and chlorzoxazone (Parafon Forte), are more commonly used to treat painful musculoskeletal conditions rather than spasticity. Their mechanisms of action are poorly understood. All of these medications are considered second-line agents and are valuable treatment options (Kita & Goodkin, 2000).

Alternative techniques for administering oral medications can be quite useful in the appropriate patient setting. Both diazepam and dantrolene have intravenous formulations that can be effectively substituted while a patient is temporarily unable to use oral medication (e.g., during a hospitalization or prolonged procedure). Intravenous diazepam can also be useful in managing baclofen withdrawal. Clonidine is available as a transdermal patch that is applied every 3 days. The long duration of action and continuous administration also can be useful for patients with limited personal assistance or limited hand function. Both baclofen and clonidine can be delivered directly to the nervous system via implanted intrathecal pump. Intrathecal baclofen therapy is indicated for patients with severe spasticity who have not responded to conservative procedures or cannot tolerate other spasticity interventions or who require the precise dosing administration that the pump system affords (Ivanhoe, Tilton, & Francisco, 2001; Remy- Neris, Tiffreau, Bouillard, & Bussel, 2003).

Invasive Pharmacological Treatment Options

The two major invasive interventions for managing spasticity are administration of intravenous and intrathecal medication (discussed above) and chemodenervation. Before using invasive treatment, clinicians should consider the same issues as for oral medications. These treatments can be used in combination with oral agents.

Chemodenervation is the injection of a chemical into a neural structure to decrease excitability within the target. It is an excellent technique for areas of focal spasticity, such as a clenched-fist deformity; the technique may not be as beneficial for global or multifocal hypertonicity. Neural areas that are amenable to chemodenervation include peripheral muscle, motor points, or peripheral nerves. Electrodiagnostic techniques should be used to locate the appropriate neural target for denervation (Childers, 2003). Temporary effects can be obtained by using anesthetic agents such as lidocaine or procaine; relatively permanent effects are obtained by using ethanol or phenol to denature the proteins of the neural structures. The main adverse effects of these agents are dysesthesia of the selected nerve and excessive focal weakness.

Another agent used for denervation is botulinum toxin. Currently, two toxins are commercially available: type A (Botox) and type B (Myobloc). The toxins exert their effect by inhibiting the release of acetylcholine into the neuromuscular junction. Cost is a major concern in the use of botulinum toxin. A typical treatment can cost hundreds of dollars, and repetition may be necessary, because the effect is often temporary.


The spectrum of antispasticity therapies is fairly broad. Familiarity with the various therapies will enable a nurse involved in the care of neurological patients to deliver the effective treatment and minimize adverse events. Referral to specialty care centers may be appropriate for selected patients who require more complex interventions for spasticity control.

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