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A drink only occasionally may reduce the risk of dementia, perhaps because long exposure to low alcohol levels help brain cells survive other stresses

Judicious Drinking Associated with Reduced Risk of Dementia
MAYWOOD, Ill., Dec. 30 -- Having a drink only occasionally may reduce the risk of dementia, perhaps because long exposure to low alcohol levels help brain cells survive other stresses, researchers here said.
Medscape Today - Full story


Keeping Blood Sugar Low May Help Lessen Memory Loss

NEW YORK, Dec. 30 -- Lowering blood glucose levels may help lessen the cognitive decline of normal aging, even in diabetes-free patients, researchers here said.
Medscape Today - Full story



Concurrent occurrence of Multiple Sclerosis and Primary CNS Lymphoma: a case report.

We present the patient with the diagnosis of multiple sclerosis (MS), relapsing-remitting form with long lasting remission. Unexpectedly, this patient presented dramatical clinical deterioration and revealed clinical symptoms such as bradypsychia, cognitive symptoms, central vestibulare syndrome, spastic quadruparesis.
Neuro Endocrinol Lett. 2008 Dec 29;29(6). [Epub ahead of print] - PUBMED



Oral Spray Form of Zolpidem Approved for Short-Term Insomnia Treatment

December 23, 2008 — NovaDel announced yesterday that the US Food and Drug Administration (FDA) has approved an oral spray formulation of zolpidem tartrate (Zolpimist) for the short-term treatment of insomnia characterized by difficulty with sleep initiation.


Additional Cardiac Monitoring for Patients on Mitoxantrone

July 30, 2008 — The FDA has issued an alert informing healthcare professionals about additional recommendations for cardiac monitoring of patients with multiple sclerosis (MS) who are treated with mitoxantrone (marketed as Novantrone and as generics) [1].



BREAKING NEWS: Tysabri PML Patient Dies, Companies Report

December 22, 2008 — A multiple sclerosis patient treated with natalizumab (Tysabri, Biogen Idec/Élan) monotherapy who contracted progressive multifocal leukoencephalopathy (PML) earlier this year has died, the companies report. The patient, who died December 19 and had been diagnosed in October of this year, was in the United States.

Another 3 patients diagnosed with PML since reintroduction of natalizumab in 2006, including 1 announced just last week, were in Europe.

"The patient has died, and our thoughts and prayers go out to the family," Shannon Altimari, manager of public affairs for Biogen Idec, in Cambridge, Massachusetts, told Medscape Neurology & Neurosurgery.

Four Cases to Date:
On December 11, Biogen Idec and Élan reported to the United States Securities and Exchange Commission (SEC) that "relevant regulatory agencies" had been informed of another case of PML with natalizumab monotherapy in a patient with multiple sclerosis. The companies released information on their Form 8-K report to the SEC on December 15.

The case was found through surveillance, the companies noted, and the patient was stable at that time. The male patient is from Germany and had been on natalizumab monotherapy for 26 months.

The new case last week brought to 4 the number of cases that have been reported since natalizumab was reintroduced to the market in 2006; it had been withdrawn in 2005 when 3 patients developed PML during clinical trials. The drug was reintroduced with restricted distribution and risk-management programs, Tysabri Outreach: Unified Commitment to Health (TOUCH) in the United States and Tysabri Global Observational Program in Safety (TYGRIS) for the global cohort.

The newest case was found through TYGRIS. The diagnosis was made based on detection of JC virus (JCV) DNA in the cerebrospinal fluid (CSF) along with clinical signs, symptoms, and MRI findings consistent with PML, the SEC filing notes.

Cases 1 and 2 have both stabilized from their acute episode of PML and currently have "undetectable levels of JC virus in their CSF," Biogen Idec spokesperson Altimari told Medscape Neurology & Neurosurgery last week. They are both in rehabilitation and under medical care.
"Patient 3, it's still too early in her diagnosis, but she's in the acute phases of management for PML," Altimari said last week. This is the patient who subsequently died.

The 4 cases have occurred in the context of 35,500 patients who are currently on therapy, she added, "and so we still consider it a rare event, and well within the rate that's implied in the label."

Medscape Today

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Analysis of 17 autoimmune disease-associated variants in type 1 diabetes identifies 6q23/TNFAIP3 as a susceptibility locus.

As a result of genome-wide association studies in larger sample sets, there has been an increase in identifying genes that influence susceptibility to individual immune-mediated diseases, as well as evidence that some genes are associated with more than one disease.
Genes Immun. 2008 Dec 25. [Epub ahead of print] - PUBMED



Pharmacogenomics of IFN-beta in MS towards a personalized medicine approach.

Ultimately, this information will lead to a personalized form of medicine, whereby a specific therapy will be applied that is best suited to an individual patient.
Pharmacogenomics. 2009 Jan;10(1):97-108. - PUBMED


Revisiting Notch in remyelination of multiple sclerosis lesions.

Precursors of oligodendrocytes, the cells capable of myelinating axons, are preserved in demyelinating lesions; however, why these precursors do not differentiate into mature oligodendrocytes and remyelinate axons is unknown. - J Clin Invest. 2008 Dec 22. pii: 37786. doi: 10.1172/JCI37786. [Epub ahead of print] - PUBMED


Abnormal expression of TIP30 and arrested nucleocytoplasmic transport within oligodendrocyte precursor cells in multiple sclerosis.

Our results suggest that extracellular inhibitory factors as well as an intrinsic nucleocytoplasmic transport blockade within OPCs may be involved in the pathogenesis of remyelination failure in MS.
J Clin Invest. 2008 Dec 22. pii: 35440. doi: 10.1172/JCI35440. [Epub ahead of print] - PUBMED


Cognitive impairment in patients with relapsing-remitting multiple sclerosis. The correlation with MRI lesion volume.

The aim of this study was to assess cognitive impairment in patients with relapsing-remitting multiple sclerosis (RR-MS) and to evaluate the correlation of cognitive impairment with physical disability and MRI lesion volume.
Neurol Neurochir Pol. 2008 September-October;42(5):416-423. - PUBMED


Glyconanoparticles allow pre-symptomatic in vivo imaging of brain disease.

Specific visualization of the early-activated cerebral endothelium would provide a powerful tool for the presymptomatic diagnosis of brain disease and evaluation of new therapies.
Proc Natl Acad Sci U S A. 2008 Dec 23. [Epub ahead of print] - PUBMED


Clinical correlates of generalized worry in multiple sclerosis.

Anxiety disorders are common in multiple sclerosis (MS). Chronic worry is the defining feature of generalized anxiety.
J Clin Exp Neuropsychol. 2008 Dec 23:1-8. [Epub ahead of print] - PUBMED


Clinical screening of autonomic dysfunction in multiple sclerosis.

Multiple sclerosis (MS) can affect the autonomic nervous system. Although exercise may be beneficial for people with MS, those with autonomic dysfunction may have altered heart rate responses to exercise.
Physiother Res Int. 2008 Dec 23. [Epub ahead of print] - PUBMED


Is a preserved functional reserve a mechanism limiting clinical impairment in pediatric MS patients?

We evaluated the functional magnetic resonance imaging (fMRI) correlates of simple movement performance in patients with pediatric multiple sclerosis (MS) and their relation with the extent of T2 lesion volume (LV), to improve our understanding of the mechanisms leading to their short/medium term favorable clinical course.
Hum Brain Mapp. 2008 Dec 23. [Epub ahead of print] - PUBMED


Quantitative in vivo magnetic resonance imaging of multiple sclerosis at 7 Tesla with sensitivity to iron.

The purpose of this study was to quantify local field shifts in MS and to investigate their relation to disease duration and disability status.
Ann Neurol. 2008 Dec 23;64(6):707-713. [Epub ahead of print] - PUBMED


Inflammatory demyelinating events following treatment with anti-tumor necrosis factor.

The anti-TNF-alpha treatments used for RA may be associated with inflammatory demyelinating events affecting the central nervous system and may possibly aggravate known MS.
Cytokine. 2008 Dec 22. [Epub ahead of print] - PUBMED


Recovery from Chronic Demyelination by Thyroid Hormone Therapy: Myelinogenesis Induction and Assessment by Diffusion Tensor MRI

The failure of the remyelination processes in multiple sclerosis contributes to the formation of chronic demyelinated plaques that lead to severe neurological deficits.
J Neurosci. 2008 Dec 24;28(52):14189-14201. - PUBMED



Acute demyelinating disorders of the central nervous system.

Acute demyelinating disorders of the central nervous system represent some of the most formidable management and therapeutic challenges to clinicians.
Curr Treat Options Neurol. 2009 Jan;11(1):55-63. - PUBMED


[Cognitive dysfunction as a hidden multiple sclerosis related symptom relevant for an expert appraisal.]

We report on a patient with multiple sclerosis (MS), who had severe cognitive dysfunction despite only mild changes in cerebral magnetic resonance imaging (cMRI).
Fortschr Neurol Psychiatr. 2009 Jan;77(1):38-43. Epub 2008 Dec 19. - PUBMED


Gray matter atrophy correlates with MS disability progression measured with MSFC but not EDSS.

Gray matter (GM) pathology is an important component of the multiple sclerosis (MS) disease process. Accelerated gray matter atrophy has been observed in MS patients, but its relationship to neurological disability is not defined.
J Neurol Sci. 2008 Dec 18. [Epub ahead of print] - PUBMED


Radiation-induced optic neuritis after pituitary adenoma radiosurgery in a patient with MS: case report.

To our knowledge, this is the first report of radiation-induced optic neuritis after radiosurgery in a patient with multiple sclerosis.
J Neurooncol. 2008 Dec 20. [Epub ahead of print] - PUBMED


Epigenetics in multiple sclerosis susceptibility: difference in transgenerational risk localizes to the major histocompatibility complex.

Multiple sclerosis (MS) susceptibility demonstrates a complex pattern of inheritance.
Hum Mol Genet. 2009 Jan 15;18(2):261-6. - PUBMED


Autoimmune pathology accounts for common manifestations in a wide range of neuro-psychiatric disorders: The olfactory and immune system interrelations

Smell has traditionally been considered a less important sense when compared to sight or hearing, but recent research has unraveled important features inherent to the sense of smell.
Clin Immunol. 2008 Dec 17. [Epub ahead of print] - PUBMED


T-bet, pSTAT1 and pSTAT3 expression in peripheral blood mononuclear cells during pregnancy correlates with post-partum activation of MS

In pregnant women affected by multiple sclerosis (MS) we observed increased percentages of CD4(+)CD25(+)Foxp3(+) T regulatory cells at the 1st and the 2nd trimester of gestation that was associated with a decreased T-bet expression in CD4(+) T cells.
Clin Immunol. 2008 Dec 20. [Epub ahead of print] - PUBMED


Impression of Clinical Worsening Fails to Predict Interferon-beta Neutralizing Antibody Status.

The development of neutralizing antibodies (NAbs) against interferon-beta(IFNbeta) reduces clinical efficacy and markers of bioactivity in patients with multiple sclerosis (MS), although it has also been shown that a poor response to IFNbeta coincided with unexpectedly low NAb levels.
J Int Med Res. 2008 Nov-Dec;36(6):1418-25. - PUBMED


Evaluation of endocrine profile, hypothalamic-pituitary-testis axis and semen quality in MS.

Several endocrine and sexual disturbances have been demonstrated in multiple sclerosis (MS) patients of both sexes.
J Neuroendocrinol. 2008 Dec;20(12):1368-75 - PUBMED



Epigenetics in multiple sclerosis susceptibility: difference in transgenerational risk localizes to the major histocompatibility complex

Multiple sclerosis (MS) susceptibility demonstrates a complex pattern of inheritance.
Oxford Journals - Human Molecular Genetics


TWEAK is expressed at the cell surface of monocytes during multiple sclerosis

The TNF superfamily ligand, TNF-like weak inducer of apoptosis (TWEAK), regulates cellular responses ranging from proliferation to cell death in a manner highly dependent on the cell type and the microenvironmental context.
Journal of Leukocyte Biology


The complex genetics of MS: pitfalls and prospects

In this review, an attempt is made to illuminate some of the mysteries surrounding complex genetics.
Oxford Journals - Brain A Journal of Neurology



FDA Requires Warnings about Risk of Suicidal Thoughts and Behavior for Antiepileptic Medications

The U.S. Food and Drug Administration today announced it will require the manufacturers of antiepileptic drugs to add to these products' prescribing information, or labeling, a warning that their use increases risk of suicidal thoughts and behaviors (suicidality). The action includes all antiepileptic drugs including those used to treat psychiatric disorders, migraine headaches and other conditions, as well as epilepsy.

The FDA is also requiring the manufacturers to submit for each of these products a Risk Evaluation and Mitigation Strategy, including a Medication Guide for patients. Medication Guides are manufacturer-developed handouts that are given to patients, their families and caregivers when a medicine is dispensed. The guides will contain FDA-approved information about the risks of suicidal thoughts and behaviors associated with the class of antiepileptic medications.

"Patients being treated with antiepileptic drugs for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior,” said Russell Katz, M.D., director of the Division of Neurology Products in the FDA's Center for Drug Evaluation and Research. “ Patients who are currently taking an antiepileptic medicine should not make any treatment changes without talking to their health care professional.”

The FDA today also disseminated information to the public about the risks associated with antiepileptic medications by issuing a public health advisory and an information alert to health care professionals. Health care professionals should notify patients, their families, and caregivers of the potential for an increase in the risk of suicidal thoughts or behaviors so that patients may be closely observed.

The FDA's actions are based on the agency's review of 199 clinical trials of 11 antiepileptic drugs which showed that patients receiving antiepileptic drugs had almost twice the risk of suicidal behavior or thoughts (0.43 percent) compared to patients receiving a placebo (0.24 percent). This difference was about one additional case of suicidal thoughts or behaviors for every 500 patients treated with antiepileptic drugs instead of placebo.

Four of the patients who were randomized to receive one of the antiepileptic drugs committed suicide, whereas none of the patients in the placebo group did. Results were insufficient for any conclusion to be drawn about the drugs' effects on completed suicides. The biological reasons for the increase in the risk for suicidal thoughts and behavior observed in patients being treated with antiepileptic drugs are unknown.

The FDA alerted health care professionals in January 2008 that clinical trials of drugs to treat epilepsy showed increased risk of suicidal thoughts and actions. In July 2008, the FDA held a public meeting to discuss the data with a committee of independent advisors. At that meeting the committee agreed with the FDA's findings that there is an increased risk of suicidality with the analyzed antiepileptic drugs, and that appropriate warnings should extend to the whole class of medications. The panel also considered whether the drugs should be labeled with a boxed warning, the FDA's strongest warning. The advisers recommended against a boxed warning and instead recommended that a warning of a different type be added to the labeling and that a Medication Guide be developed.

Acting under the authorities of the Food and Drug Administration Amendments Act of 2007 (FDAAA), the FDA is requiring manufacturers of antiepileptic drugs to submit to the agency new labeling within 30 days, or provide a reason why they do not believe such labeling changes are necessary. In cases of non-compliance, FDAAA provides strict timelines for resolving the issue and allows the agency to initiate an enforcement action if necessary.

The following antiepileptic drugs are required to add warnings about the risk of suicidality:

Carbamazepine (marketed as Carbatrol, Equetro, Tegretol, Tegretol XR)
Clonazepam (marketed as Klonopin)
Clorazepate (marketed as Tranxene)
Divalproex sodium (marketed as Depakote, Depakote ER)
Ethosuximide (marketed as Zarontin)
Ethotoin (marketed as Peganone)
Felbamate (marketed as Felbatol)
Gabapentin (marketed as Neurontin)
Lamotrigine (marketed as Lamictal) Lacosamide (marketed as Vimpat)
Levetiracetam (marketed as Keppra)
Mephenytoin (marketed as Mesantoin)
Methosuximide (marketed as Celontin)
Oxcarbazepine (marketed as Trileptal)
Phenytoin (marketed as Dilantin)
Pregabalin (marketed as Lyrica)
Primidone (marketed as Mysoline)
Rufinamide (marketed as Banzel)
Tiagabine (marketed as Gabitril)
Topiramate (marketed as Topamax)
Trimethadione (marketed as Tridione)
Valproic Acid (marketed as Depakene, Stavzor Extended Release Tablets)
Zonisamide (marketed as Zonegran)

Some of these medications are also available as generics.

Health care professionals and consumers may report serious adverse events or product quality problems with the use of this product to the FDA's MedWatch Adverse Event Reporting program either online, by regular mail, fax or phone.

-- Online :

-- Regular Mail : use postage-paid FDA form 3500 available at: and mail to MedWatch, 5600 Fishers Lane , Rockville , MD 20852-9787

-- Fax: (800) FDA-0178
-- Phone: (800) FDA-1088

For more information
Information for Health Care Professionals and Public Health Advisory:

U.S. Food and Drug Administration - FDA News



Lessons from multiple sclerosis: models, concepts, observations.

Experimental autoimmune encephalomyelitis (EAE) is often termed "the" model of human multiple sclerosis (MS).
Ann Rheum Dis. 2008 Dec;67 Suppl 3:iii56-60. - PUBMED


Early treatment of multiple sclerosis to prevent neurologic damage.

However, clinical trials indicate benefits from early use of disease-modifying therapies (DMTs).
Neurology. 2008 Dec 9;71(24 Suppl 3):S3-7. - PUBMED


Disease-modifying therapy in multiple sclerosis: Update and clinical implications.

As new therapies become available for the treatment of multiple sclerosis, the relative value of established and newer disease-modifying therapies must be considered.
Neurology. 2008 Dec 9;71(24 Suppl 3):S8-S13. - PUBMED


The psychology of fatigue in patients with multiple sclerosis: A review

Conceptual issues and the relationships between MS-related fatigue and mood, anxiety, cognition, personality, and cognitive-behavioral factors are discussed, and the implications for clinical practice and research are presented.
J Psychosom Res. 2009 Jan;66(1):3-11. Epub 2008 Sep 24. - PUBMED


Negative impact of statins on oligodendrocytes and myelin formation in vitro and in vivo.

Recent studies also demonstrated anti-inflammatory and immunomodulatory properties of statins by modulating the activity of small GTPases.
J Neurosci. 2008 Dec 10;28(50):13609-14. - PUBMED


Anti-double stranded DNA and lupus syndrome induced by interferon-{beta} therapy in a patient with MS

We present a 43-year-old woman with relapsing-remitting multiple sclerosis (MS) who developed lupus syndrome after 32 months of IFN-beta-1a therapy.
Lupus. 2009;18(1):78-80. - PUBMED


The needs of carers of people with multiple sclerosis: a literature review.

The needs of carers of people with multiple sclerosis: a literature reviewPeople with multiple sclerosis depend heavily upon their families and other informal carers as they receive limited support from health-care professionals or health-care services.
Scand J Caring Sci. 2008 Dec 9. [Epub ahead of print] - PUBMED


Role of developmental inflammation and blood-brain barrier dysfunction in neurodevelopmental and neurodegenerative diseases.

The causes of most neurological disorders are not fully understood. Inflammation and blood-brain barrier dysfunction appear to play major roles in the pathology of these diseases.
Neuropathol Appl Neurobiol. 2008 Dec 11. [Epub ahead of print] - PUBMED


Role of developmental inflammation and blood-brain barrier dysfunction in neurodevelopmental and neurodegenerative diseases.

The causes of most neurological disorders are not fully understood. Inflammation and blood-brain barrier dysfunction appear to play major roles in the pathology of these diseases.
Neuropathol Appl Neurobiol. 2008 Dec 11. [Epub ahead of print] - PUBMED


The Segway for People with Disabilities: Meeting Clients' Mobility Goals.

The goal of this study was to determine how the Segway compares to clients' current method of mobility in meeting their specific mobility goals.
Am J Phys Med Rehabil. 2008 Dec 8. [Epub ahead of print] - PUBMED


Growth factor regulation of remyelination: behind the growing interest in endogenous cell repair of the CNS.

Remyelination facilitates recovery of saltatory conduction along demyelinated axons and may help prevent axon damage in patients with demyelinating diseases, such as multiple sclerosis.
Future Neurol. 2007 Nov;2(6):689-697. - PUBMED


Estimating Time to Event From Longitudinal Categorical Data: An Analysis of MS Progression.

he expanded disability status scale (EDSS) is an ordinal score that measures progression in multiple sclerosis (MS). Progression is defined as reaching EDSS of a certain level (absolute progression) or increasing of one point of EDSS (relative progression).
J Am Stat Assoc. 2007 Dec;102(480):1254-1266. - PUBMED


The role of nuclear factor-kappaB in the development of autoimmune diseases: a link between genes and environment.

Although autoimmune diseases are relatively common, mechanisms that lead to their development remain largely unknown.
Acta Biochim Pol. 2008 Dec 16. [Epub ahead of print] - PUBMED


Neuropathic pain behaviours in a chronic-relapsing model of experimental autoimmune encephalomyelitis (EAE).

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS). While the primary symptoms of MS are losses of sensory and motor functions, it is now recognized that chronic pain is also a major concern affecting between 50% and 80% of MS patients.
Pain. 2008 Dec 10. [Epub ahead of print] - PUBMED


Strabismus surgery for internuclear ophthalmoplegia with exotropia in multiple sclerosis.

Internuclear ophthalmoplegia (INO) is a disabling condition affecting up to 40% of patients with multiple sclerosis (MS).
J AAPOS. 2008 Dec 10. [Epub ahead of print] - PUBMED


Changes in quality of life and coping among people with MS over a 2 year period.

here is a need to investigate the impact of different coping strategies on quality of life (QOL) of people with multiple sclerosis (MS), in order to better inform intervention programs for this population.
Psychol Health Med. 2009 Jan;14(1):86-96. - PUBMED


Physical activity and quality of life in MS: intermediary roles of disability, fatigue, mood, pain, self-efficacy and social support.

Physical activity has been associated with a small improvement in quality of life (QOL) among those with multiple sclerosis (MS). This relationship may be indirect and operate through factors such as disability, fatigue, mood, pain, self-efficacy and social support.
Psychol Health Med. 2009 Jan;14(1):111-24. - PUBMED



Multiple Sclerosis Clue

A team of European scientists has discovered the first genetic variant for multiple sclerosis (MS) that is specifically active in neurons.
JAMA - The Journal of American Medical Association


Sclerosing skin disorders in association with multiple sclerosis. Coincidence, underlying autoimmune pathology or interferon induced?

Sclerosing skin disorders may develop in the course of MS. The relatively early age of SSc onset in patients with MS suggests a genetic predisposition and/or an IFN-associated trigger.
Annals of the Rheumatic Diseases 2009;68:47-50 - ARD Online


FDA Requires Increased Suicidality Warning on Antiepileptic Labels

ROCKVILLE, Md., Dec. 16 -- The FDA announced today it will require that all 21 antiepileptic drugs carry a label warning of an increased risk of suicidality.

The warning affects all drugs used to treat psychiatric disorders, migraine, and other conditions, in addition to epilepsy.

The FDA said the biological reasons for the increase in the risk of suicidal thoughts and behavior in patients being treated with antiepileptic drugs are unknown.

The drugs with new suicidality warning are:

  • Carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol XR)
  • Clonazepam (Klonopin)
  • Clorazepate (Tranxene)
  • Divalproex sodium (Depakote, Depakote ER, Depakene)
  • Ethosuximide (Zarontin)
  • Ethotoin (Peganone)
  • Felbamate (Felbatol)
  • Gabapentin (Neurontin)
  • Lamotrigine (Lamictal)
  • Lacosamide (Vimpat)
  • Levetiracetam (Keppra)
  • Mephenytoin (Mesantoin)
  • Methosuximide (Celontin)
  • Oxcarbazepine (Trileptal)
  • Phenytoin (Dilantin Suspension)
  • Pregabalin (Lyrica)
  • Primidone (Mysoline)
  • Tiagabine (Gabitril)
  • Topiramate (Topamax)
  • Trimethadione (Tridione)
  • Zonisamide (Zonegran)

The FDA will also require the drugs' manufacturers to submit a Risk Evaluation and Mitigation Strategy that includes a medication guide for patients.

MedPage Today



A Potentially Game-Changing MS Drug

There's a fine balance to be struck with multiple sclerosis drugs and other drugs that modulate the immune system, like Johnson & Johnson's (NYSE: JNJ) and Schering-Plough's (NYSE: SGP) rheumatoid arthritis drug, Remicade. The drugs have to stop the body from attacking itself, but not shut down the immune system too much -- it still has to be there to fight outside infections.

That's the issue that Novartis (NYSE: NVS) is having with its new multiple sclerosis drug candidate, FTY720. The drug could be a game-changer, but investors should wait for results next year before they pencil in blockbuster revenue from it.

On Friday, Novartis announced promising results from a phase 3 trial on FTY720, which sounds more like a skateboard move than a potential blockbuster drug. The drug reduced the relapse rate by 38% and 52%, compared with Biogen Idec's (Nasdaq: BIIB) Avonex at two different doses. Considering that Avonex brought in $1.6 billion in the first nine months of the year, we're talking about some serious potential revenue.

But the trial was only a year long, and FTY720 has had some issues with safety, including two fatal herpes infections, along with seven incidences of skin cancer compared with just one in the group taking Avonex. Data from two longer-term two-year trials are expected next year, and those studies are likely to determine how successful FTY720 is on the market.

Much has been made about FTY720 being administered orally versus the current drugs that are injected, like Avonex, Teva Pharmaceutical's (Nasdaq: TEVA) Copaxone, and Rebif, from EMD Serono and Pfizer (NYSE: PFE). While it's true that the drug could take a substantial piece of the market from the injected drugs, that's only going to happen if FTY720 proves to be at least as effective -- so far, so good -- with no worse side effects in the long term -- still a big unknown. If it can't do that, it'll be relegated to a second-line drug, as Biogen and Elan's (NYSE: ELN) Tysabri has mostly become.

Novartis plans to apply for marketing authorization next year. If FTY720 can stick its landing and find the sweet spot of balancing the benefits and side effects, the drug could be a blockbuster.

The Motley Fool

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Only one in 10 people with multiple sclerosis are being treated with key drug, government admits

Only around one in 10 of those who are eligible for a new drug to treat multiple sclerosis are getting it, even though it was approved a year ago for use in the NHS, the Guardian has been told.

Natalizumab, which goes by the brand name Tysabri, is the first drug that the National Institute for Clinical Excellence has approved for multiple sclerosis.

But in an answer to a parliamentary question put by the Liberal Democrat MP Paul Burstow, the government said between 100 and 300 people were getting the drug as of March this year, out of a possible 2,000 who could benefit from it.

Some delays may be due to the need to give the drug as an hour-long intravenous infusion, which means there must be a suitable place available.

The Department of Health said the choice of treatment was up to the clinician and patient. "The government has made it clear that the local NHS is required to provide funding for treatments and drugs recommended by Nice within three months of the Nice technology appraisal guidance being published," a spokesman said.




TYSABRI BREAKING NEWS - "New brain infection linked to patient who had been taking Tysabri for 26 months"

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Biogen says new brain infection linked to Tysabri [CLICK FOR FULL STORY]

NEW YORK, Dec 15 (Reuters) - Biogen Idec Inc said on Monday it notified regulators of a new case of a potentially deadly brain disease in a patient being treated with its Tysabri multiple sclerosis drug, the fourth such case reported globally this year.

The latest case of the brain infection, known as progressive multifocal leukoencephalopathy (PML), was seen in a European patient who had been taking Tysabri as a stand-alone treatment for 26 months, Biogen said in a regulatory filing.

"The patient is under physician's care," company spokeswoman Shannon Altimari said, noting it was too soon to speculate on the prognosis for the patient.

This year's four cases of affected patients, all still alive, are the first to be announced since Tysabri was withdrawn from the market in 2005 after three earlier patients developed the brain infection. Two of the earlier three patients died.

Asked why no cases were seen in 2006 or 2007, Biogen spokeswoman Naomi Aoki on Monday said, "The drug had been taken off the market for a little over a year, and returned in July 2006."

She said Biogen and Elan believe the superior effectiveness of Tysabri in preventing relapses of multiple sclerosis symptoms justifies its use, despite the relatively low risk of PML.


Aoki said more than 35,500 patients worldwide are taking Tysabri, and that the drug in clinical trials was able to produce a 68 percent reduction in relapses.

Rival drugs, by contrast, are able to reduce relapses by only about a third, she said.

Tysabri's package insert label cautions that patients taking the drug have a 1-in-1,000 risk of developing PML....

but the overall incidence of the brain infections seen so far is "still well within" that magnitude, JP Morgan analyst Geoffrey Meacham said in a research note."

Overall, we would characterize this new case as completely in line with expectations at this point," Meacham said, noting that the infrequent occurrence of PML suggests there is little risk Tysabri will again be pulled from the market.

Third-quarter sales of Tysabri rose 18 percent to $171 million, a slowdown from the 25 percent growth seen in the second quarter. Biogen said growth was tempered as doctors continue to assess the drug's risks versus its benefits.

Even so, Biogen in October reaffirmed it expects 100,000 patients to be taking Tysabri by 2010, a near tripling of the current patient roster. The company on Monday said its ambitious goal remains in place.

Autoimmune drugs work by taming the immune system, but in doing so some of them can leave the body prey to infections that rarely affect the general population.

Aoki said a handful of other drugs, including Biogen's own Rituxan treatment for cancer, carry warnings of increased risk for PML.

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BREAKING NEWS: Elan, Biogen report new Tysabri brain disease case

Elan, Biogen report 4th case of brain disease in 2008 for MS patient on Tysabri drug

NEW YORK (Associated Press) - Biotechnology companies Biogen Idec Inc. and Elan Corp. on Monday reported the fourth case this year of a deadly brain infection in a patient taking their multiple-sclerosis drug Tysabri.
The companies said they notified relevant regulatory agencies about the patient, located in the European Union, on Dec. 11. That patient has received about 26 months of Tysabri for the autoimmune condition multiple sclerosis and is being treated by a physician.
The drug has been facing pressure on the market since August, when the companies reported two new cases of the brain infection called progressive multifocal leukoencephalopathy, or PML. A third case was reported in November. More than 35,500 patients are taking the drug worldwide.
The companies have argued the risks, which are on the drug's label, are outweighed by the benefit the drug provides to multiple sclerosis patients. Tysabri was pulled from the market in 2005 after being linked to PML but reintroduced under restricted sales conditions in mid-2006.
Shares of Cambridge, Mass.-based Biogen fell 58 cents to $46.52 in morning trading. Shares of Ireland-based Elan suffered the most, shedding 27 cents, or 3.8 percent, to reach $6.92.
The new case of PML comes on top of investor calls for management change at Elan, a restructuring move by the company and a class-action lawsuit.

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Investor asks Elan board to remove CEO, executives

CrabTree Partners wants Elan to remove CEO and executives, citing poor management

NEW YORK (Associated Press) - Elan Corp. investor CrabTree Partners called for the removal of Chief Executive Kelly Martin and key changes in management and structure Friday because of what it called "gross incompetence."
In a letter to Ireland-based Elan's board of directors, CrabTree co-founder Jack Schuler said the biotechnology company's performance has been unacceptable. American Depository Shares have fallen about 67 percent since the beginning of 2008. Schuler, who is also a former president of Abbott Laboratories, blames management for a failure to gain ground in the multiple sclerosis and Crohn's disease market with the company's key drug Tysabri.
Tysabri sales have been hurt by cases of multiple-sclerosis patients with a brain infection called progressive multifocal leukoencephalopathy, or PML. Regardless of the PML cases, Schuler said, Tysabri should be gaining ground in its respective markets.
Elan and partner Biogen Idec Inc. reported two cases of PML in August and a third case in November. The risks, though, were already on the drug's label, as it had been pulled from the market in 2005 after being linked to PML, then reintroduced under restricted sales conditions in mid-2006.
He would also like to see better management of company funds and took issue with the CEO's use of a corporate jet.
"I know of no other biotech company that has corporate jets, yet alone a small, struggling one," Schuler said in his letter to the board. Top of page

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MRI as an outcome in multiple sclerosis clinical trials

MRI measures widely used in trials of relapsing-remitting and progressive multiple sclerosis add little if anything independently to the clinically relevant relapse and disability outcomes. These results reemphasize the importance of validating potential surrogate markers against clinical measures and highlight the need for better MRI markers of disease activity and progression.


Disability in optic neuritis correlates with diffusion tensor–derived directional diffusivities

To determine the potential of directional diffusivities from diffusion tensor imaging (DTI) to predict clinical outcome of optic neuritis (ON), and correlate with vision, optical coherence tomography (OCT), and visual evoked potentials (VEP).


MRIs Showing MS Pathology Even in Asymptomatic Patients

SAN FRANCISCO, Dec. 10 -- Widespread use of MRI for conditions like migraine and head trauma is turning up what looks like evidence of multiple sclerosis -- even if patients have no symptoms of the disease, researchers said here.

Nearly a third of these patients develop MS within about five years, Darin T. Okuda, M.D., of the University of California San Francisco, and colleagues reported online in Neurology.

The researchers have dubbed the condition "radiologically isolated syndrome" (RIS), which describes the incidental white matter image findings that are suggestive of MS pathology.

"More research is needed to fully understand the risk of developing MS for people with these brain abnormalities, but it appears that this condition may be a precursor to MS," Dr. Okuda said.

"This study sets the stage for establishing a process for evaluating these patients and following them to help determine the risk of developing MS," Dr. Bourdette said. "For now, it's best to remember the wise advice that we 'treat the patient, not the MRI scan.'"
MedPage Today



Elan closing New York, Tokyo offices; cutting jobs

Elan shutting down 2 offices, cutting jobs as it realigns operations to focus on research

NEW YORK (Associated Press) - Biotechnology firm Elan Corp. said Friday it is closing its offices in New York and Tokyo during the first quarter as it realigns operations.

Elan said it will eliminate an unspecified number of positions and revise its marketing activities for Tysabri as a treatment for Crohn's disease.

CNN Money



Video Games May Improve Cognition in the Older Population

URBANA, Ill., Dec. 11 -- Older individuals may be able to stem the age-related decline in cognitive function by playing video games, researchers here found.

Nearly two dozen hours of playing a strategic video game over several weeks led to increased performance on four out of six tests of executive function, Arthur Kramer, Ph.D., of the University of Illinois at Urbana-Champaign, and colleagues reported in the December issue of Psychology and Aging.

"Whether similar transfer effects would be observed with video-game-based training to everyday cognition in older adults is a both theoretically as well as practically important question, especially given the rapid expansion of commercial products and computer programs touted to improve the cognitive abilities of older adults," the researchers said.

Previous studies have shown that training individuals in a particular cognitive task can enhance performance on that specific task, the researchers said.

But opinions are mixed on whether training can result in improvements in an array of cognitive skills, they said.

Participants' cognitive skills -- including tasks of executive control and visuospatial skills -- were tested before, during, and at the end of the study.

The authors acknowledged that the study was limited by the fact that the control group did not play a video game.

Future studies should evaluate whether the improvements in laboratory-based measurements of cognitive function translate into everyday activities like driving a car or working in a busy office, they said.

MedPage Today


Novartis MS Drug Reduces Relapses

Novartis(NVS Quote - Cramer on NVS - Stock Picks) announced Friday late-stage results from a clinical study that showed its experimental daily pill for multiple sclerosis was more effective than a currently approved injectable drug sold by Biogen Idec(BIIB Quote - Cramer on BIIB - Stock Picks).

The Swiss-based drug maker said it intends to seek regulatory approval for the drug, FTY720, in the U.S. and Europe by the end of the year. If approved, FTY720 would offer patients with relapsing-remitting multiple sclerosis, the most common form of the disease, the convenience of an oral treatment for the first time.

The "Transforms" study reported by Novartis Friday was the first head-to-head comparison of FTY720, taken as a daily pill, against Biogen Idec's leading multiple sclerosis drug Avonex, which is administered via a weekly injection.

The results showed that MS patients treated with FTY720 experienced significantly fewer disease relapses than patients taking Avonex. The annualized relapse rate after one year of treatment with FTY720 was reduced by 52% at the low dose and 38% at the high dose compared with Avonex patients, according to Novartis. The results from both doses of FTY720 compared with Avonex were statistically significant.

Overall, Novartis said that 87% of FTY720 patients completed the one-year study. The discontinuation rate for FTY720 was 10% for the low-dose patients and 15% for the high-dose patients compared with 12% for Avonex patients.

Novartis is conducting two additional phase III studies of FTY720 in MS patients, both comparing the drug to placebo after two years of treatment. Data from these studies, which will be required for the drug's approval, are expected to be released in 2009.




Impact of specialty drugs on the use of other medical services.

Given the high cost of many specialty drugs, health plans may rightly focus on making sure only patients who will most benefit receive them. But once such patients are identified, it makes little sense to limit coverage.
Am J Manag Care. 2008 Dec;14(12):821-8. - PubMed


The Onset Location of Multiple Sclerosis Predicts the Location of Subsequent Relapses.

We sought to determine if initial clinical demyelinating event (IDE) location predicts subsequent clinical relapse locations in early RRMS.
J Neurol Neurosurg Psychiatry. 2008 Dec 9. [Epub ahead of print] - PubMed


Elevated ATG5 expression in autoimmune demyelination and multiple sclerosis.

Together these data suggest that increased T cell expression of Atg5 may contribute to inflammatory demyelination in MS.
Autophagy. 2009 Feb 5;5(2). [Epub ahead of print] - PubMed


Neuropsychiatric disorders related to interferon and interleukins treatment.

The presence of such an imbalance in patients being treated with cytokines and in patients with psychiatric disorders and the possible consequence of those changes on the neuroprotective function in the brain are discussed in this review.
Metab Brain Dis. 2008 Dec 10. [Epub ahead of print] - PubMed


TYSABRI NEWS - Pressure rises on Elan board from upset investors

BOSTON, Dec 10 (Reuters) - Some major investors in Irish drugmaker Elan Corp Plc are unhappy at the company's direction and want to see change at the top.

Elan's stock has fallen more than 80 percent over the past five months amid concern over the safety of its multiple sclerosis drug Tysabri and disappointing results from a trial of its experimental Alzheimer's vaccine.

Elan says it is aware of the discontent, but does not believe it is justified. It is looking into ways to cut costs, and may close two locations. It also hopes to raise up to $500 million in cash within the next six to eight months by licensing the rights to some of its products.

Still, another big shareholder who declined to be named citing company policy, said more experience and oversight are needed at the board level, and he would like to see a shake-up.

Investors have seen Elan shares go into free fall before.

Now some investors want change, and even Armen, architect of Elan's previous turnaround, says dramatic action is needed if the company is to thrive.

Elan is not putting Tysabri on the block. It is Elan's most important product, with sales of $236 million in the third quarter and Wall Street views it will reach a $1 billion a year. Elan splits the profit on Tysabri with its partner, Biogen Idec Inc.

Elan's plan, instead, is to sell its drug technology unit, valued at about $1 billion. So far, it has not found a buyer.

"Elan remains committed to its focus as a neuroscience-based company," said spokeswoman Stutts.

One reason is the products. Many hopes still ride high on Tysabri. And if the Alzheimer's drug called bapineuzumab, which it is developing with Wyeth, does end up on the market, it could eventually be one of the most lucrative drugs in the world with sales that may top $13 billion.

"There is plenty of risk as to whether the stock can get there, but we are willing to accept the risk to achieve that number." (Reporting by Toni Clarke)
Guardian News:



Genomic NGFB variation and multiple sclerosis in a case control study.

Nerve growth factor beta (NGFB) is involved in cell proliferation and survival, and it is a mediator of the immune response. ProNGF, the precursor protein of NGFB, has been shown to induce cell death via interaction with the p75 neurotrophin receptor.
BMC Med Genet. 2008 Dec 8;9(1):107. [Epub ahead of print] - PubMed


MR Relaxation in Multiple Sclerosis.

This article provides an overview of relaxation times and their application to normal brain and brain and cord affected by multiple sclerosis.
Neuroimaging Clin N Am. 2009 Feb;19(1):1-26. - PubMed


Proton magnetic resonance spectroscopy in multiple sclerosis.

Proton magnetic resonance spectroscopy ((1)H-MRS) provides tissue metabolic information in vivo.
Neuroimaging Clin N Am. 2009 Feb;19(1):45-58. - PubMed


Functional MR Imaging in Multiple Sclerosis.

A variable effectiveness of reparative and recovery mechanisms following tissue damage is among the factors that might contribute to explaining resolution of symptoms and maintenance of a normal level of function in patients who have multiple sclerosis (MS).
Neuroimaging Clin N Am. 2009 Feb;19(1):59-70. - PubMed


Nonconventional optic nerve imaging in multiple sclerosis.

Conventional MR imaging is, at present, the most important paraclinical modality for assessing the risk of MS in patients with acute demyelinating ON and for monitoring the progression of disease.
Neuroimaging Clin N Am. 2009 Feb;19(1):71-9. - PubMed


Spinal-Cord MRI in Multiple Sclerosis: Conventional and Nonconventional MR Techniques.

Multiple sclerosis is a diffuse disease of the central nervous system, and MRI of the spinal cord is highly recommended in the clinical evaluation of patients suspected of having multiple sclerosis.
Neuroimaging Clin N Am. 2009 Feb;19(1):81-99. - PubMed


Brain imaging of multiple sclerosis: the next 10 years.

MR imaging has had a major impact on understanding the dynamic neuropathologic findings of multiple sclerosis (MS), early diagnosis of the disease, and clinical trial conduct.
Neuroimaging Clin N Am. 2009 Feb;19(1):101-12. - PubMed


High-field magnetic resonance imaging.

This article explores the role of high-field (HF) MR imaging in medicine. It analyzes advantages of HF MR imaging in application to human subjects and how best they can be used to unravel the secrets of diseases, such as multiple sclerosis.
Neuroimaging Clin N Am. 2009 Feb;19(1):113-28. - PubMed


Natalizumab use in pediatric multiple sclerosis.

Natalizumab treatment was effective and well tolerated in our pediatric patients with RRMS who did not respond to initial immunomodulatory treatments. Therefore, it is a promising second-line therapy for pediatric patients with RRMS.
Arch Neurol. 2008 Dec;65(12):1655-8. - PubMed



Courage award for carer, aged 7

A seven-year-old boy from Swansea who cares for his mother who has multiple sclerosis has rubbed shoulders with Prince Harry and the Prime Minister.

William John from Loughor picked up a Young Carer award at the Woman's Own Children of Courage Awards in London.

William's mother Wendy, who separated from his father when he was two, said she could not get by without him.

His mother was diagnosed with MS 10 years ago.

She said: "All the things I can no longer do, William does - he's always there making my life easier. He has been incredible."

She has trouble getting out of bed, dressing and carrying things - all jobs William has taken.

His mother said he was constantly striving to help, even when it meant missing out on things other boys his age enjoy, such as rugby practice.

"I'm always falling over which must be very frightening for William but he takes it in his stride and helps me get up," she added.

"One day I didn't wake up at all - my body had shut down from exhaustion. Despite being terrified, he phoned his nan and stayed calm until help arrived.

"If it wasn't for William I might not be here today. I honestly don't think I could live without him."

Williams is one of 10 winners from all over the UK to be recognised at the awards, now in its 35th year.

Woman's Own editor, Karen Livermore, said: "All our winners have shown tremendous courage and huge determination and we're delighted to give them the recognition they truly deserve."

BBC News



Only Half of Patients With MS Respond to Interferon Treatment

Regular magnetic resonance imaging (MRI) evaluations show that only about half of patients with multiple sclerosis achieve and sustain a response to treatment with interferon beta over three years, according to a study posted online today that will appear in the January 2009 print issue of Archives of Neurology, one of the JAMA/Archives journals.
Scientific Frontline


Central Nervous System Immune Surveillance

On Natalizumab, Dendritic Cells, and Dangerous Immune Privilege
Arch Neurol. 2008;65(12):1566-1567.


Natalizumab Use in Pediatric Multiple Sclerosis

To determine the safety, effectiveness, and tolerability of natalizumab use in pediatric patients with MS.
Arch Neurol. 2008;65(12):1655-1658.


Decrease in the Numbers of Dendritic Cells and CD4+ T Cells in Cerebral Perivascular Spaces Due to Natalizumab

Our observations may explain the differential and prolonged effects of natalizumab therapy on leukocyte numbers in the cerebrospinal fluid.
Arch Neurol. 2008;65(12):1596-1603.


Impaired hypothalamic-pituitary-adrenal axis activity in patients with multiple sclerosis

To investigate hypothalamic-pituitary-adrenal axis activity in well-defined multiple sclerosis (MS) patient subgroups.
NEUROLOGY 2008;71:1948-1954


Expression and regulation of IFN/β receptor in IFNβ-treated patients with MS

Findings show that interferon-/β receptor (IFNAR)-2 isoforms are important regulators of the responsiveness to endogenous and systemically administered interferon beta (IFNβ).
NEUROLOGY 2008;71:1940-1947


Tolerability, adherence, and patient outcomes

Providing optimal patient care in multiple sclerosis (MS) is dependent on both the patient and the healthcare system.
NEUROLOGY 2008;71:S21-S23


Identification, causation, alleviation, and prevention of complications (ICAP)

An approach to symptom and disability management in multiple sclerosis
NEUROLOGY 2008;71:S14-S20


Disease-modifying therapy in multiple sclerosis

Update and clinical implications
NEUROLOGY 2008;71:S8-S13


Early treatment of multiple sclerosis to prevent neurologic damage

...approach requires the ability to recognize clinically isolated syndrome features that indicate a diagnosis of MS.
NEUROLOGY 2008;71:S3-S7


Neuroimaging in Multiple Sclerosis.

Overuse and over-reliance on MRI by clinicians sometimes can occur, and careful interpretation and clinical judgment remain essential in the care of multiple sclerosis.
Neurol Clin. 2009 Feb;27(1):203-219. - PubMed



Immune Ablation Using Cyclophosphamide without Stem Cell Rescue for Intractable MS and Its Variants

To assess the safety and efficacy of immunoablation using CTX without hematologic stem cell rescue for intractable relapsing progressive multiple sclerosis failing standard immune modulation or immune suppression.
Blood (ASH Annual Meeting Abstracts) 2008 112: Abstract 4903


Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis

The extracranial venous outflow routes in clinically defined multiple sclerosis (CDMS) have never been investigated.
J Neurol Neurosurg Psychiatry


Long Term Outcomes of Autologous Hematopoietic Stem Cell Transplantation in Progressive Multiple Sclerosis

Progressive multiple sclerosis (MS) is going with continuously disability and unresponsive to high dose steroid and immunomodulation. The autologous hematopoietic stem cell transplantation (ASCT) has been introduced in treatment of the forms of multiple sclerosis.
Blood (ASH Annual Meeting Abstracts) 2008 112: Abstract 4438


Four Strategies of Autologous Hematopoietic Stem Cell Transplantation for MS Treatment

Conventional therapies do not provide satisfactory control of multiple sclerosis (MS) due to their inability to eradicate self-specific T cell clones. During the last decade high-dose immunosuppressive therapy (HDIT) with autologous haematopoietic stem cell transplantation (AHSCT) has been used with increasing frequency as a therapeutic option for MS patients.
Blood (ASH Annual Meeting Abstracts) 2008 112: Abstract 4432


Mini-Autologous Hematopoietic Stem Cell Transplantations as a New Treatment Modality for MS Patients

Conventional therapies do not provide satisfactory control of multiple sclerosis (MS) due to their inability to eradicate self-specific T cell clones.
Blood (ASH Annual Meeting Abstracts) 2008 112: Abstract 4454



Obliterating intracranial vasculopathy mimicking multiple sclerosis.

The first ever diagnosis of multiple sclerosis (MS) requires consideration of both diagnostic criteria and differential diagnosis. Clinicians are particularly challenged by rare conditions which may mimic MS symptoms and relapses.
Acta Neurol Scand. 2008 Nov 24. [Epub ahead of print]



Ouch! My employees' drug therapy costs how much?

In the United States today, most citizens receive their health care through programs sponsored and financed by their employers rather than through primarily government-based funding.
Benefits Q. 2008;24(4):16-24.


A systematic review of the epidemiology of multiple sclerosis in South America.

Hundreds of publications dealing with the prevalence of multiple sclerosis (MS) throughout the world exist, but little data have been published from South America.
Eur J Neurol. 2008 Dec;15(12):1273-8.


Informed shared decision making about immunotherapy for patients with multiple sclerosis (ISDIMS): a randomized controlled trial.

To evaluate the effects of an evidence-based patient decision aid (DA) on multiple sclerosis (MS) immunotherapy.
Eur J Neurol. 2008 Dec;15(12):1345-52.


Prospective combined brain and spinal cord MRI in clinically isolated syndromes and possible early MS: impact on dissemination in space and time.

The diagnosis of multiple sclerosis (MS) is based on dissemination in space (DIS) and time (DIT). The aim of the study was to assess the impact of spinal cord (SC) imaging on the evidence of DIS and DIT.
Eur J Neurol. 2008 Dec;15(12):1359-64


Maternal smoking during pregnancy and multiple sclerosis amongst offspring.

An association between parental smoking and multiple sclerosis (MS) in offspring has been reported. This study examined whether maternal smoking during pregnancy is associated with MS in offspring.
Eur J Neurol. 2008 Dec;15(12):1395-9.


Decreased intrathecal synthesis of prostaglandin D(2) synthase in the cerebrospinal fluid of patients with acute inflam.demyelinating polyneuropathy

Prostaglandin D(2) synthase (PGDS) is the most abundant brain protein in cerebrospinal fluid (CSF) and is tied closely with inflammatory processes.
J Neuroimmunol. 2008 Dec 1. [Epub ahead of print]


Role of sildenafil in neurological disorders.

Sildenafil, a phosphodiesterase-5 inhibitor commonly used for erectile dysfunction, may also have a beneficial therapeutic effect in the treatment of stroke, subarachnoid hemorrhage, dementia, learning, and neurodegenerative disorders by enhancing angiogenesis and neurogenesis.
Clin Neuropharmacol. 2008 Nov-Dec;31(6):353-62


Brain antigens in functionally distinct antigen-presenting cell populations in cervical lymph nodes in MS and EAE.

Drainage of central nervous system (CNS) antigens to the brain-draining cervical lymph nodes (CLN) is likely crucial in the initiation and control of autoimmune responses during multiple sclerosis (MS).
J Mol Med. 2008 Dec 3. [Epub ahead of print]


As someone living with MS, you may be interested to hear about the important results from a long-term follow-up study of once-weekly AVONEX therapy.

In a follow-up study called ASSURANCE, people completed questionnaires, and those currently taking AVONEX for up to 15 years reported better overall results in key areas compared with patients not currently taking AVONEX.

On average, people taking AVONEX:

And AVONEX is the only once-a-week MS therapy shown to reduce flare-ups, slow down physical disability, and reduce the number of brain lesions and rate of brain shrinkage.

*Based on a 2-year study and a patient-reported follow-up at 15 years.
FDA-approved labeling includes up to 3 years of clinical data.

At Biogen Idec, the maker of AVONEX, we're here to help. Call a Personal Support Specialist at 1-800-456-2255, Monday to Friday, 8:30 AM to 8:00 PM (ET) or log on to


AVONEX is approved by the FDA to treat relapsing forms of Multiple Sclerosis (MS) to decrease the number of flare-ups and slow the occurrence of some of the physical disability that is common in people with MS. AVONEX is approved for use in people who have experienced a first attack and have lesions consistent with MS on their MRI.

Important Safety Information

AVONEX can cause serious side effects, so before you start taking AVONEX, you should talk with your doctor about the possible benefits of AVONEX and its possible side effects to decide if AVONEX is right for you.

Sometimes interferons, including AVONEX, make people feel sad. If you are taking AVONEX, and feel unusually sad, you should tell a family member or friend right away and call your doctor as soon as possible.

Some people have had severe allergic reactions, a drop in their red or white blood cell levels, a drop in the cells that help to form blood clots, heart problems, changes in their thyroid function, or seizures.

Your liver may be affected by taking AVONEX and a few patients have developed severe liver injury. Your healthcare provider may ask you to have regular blood tests to make sure that your liver is working properly. If your skin or the whites of your eyes become yellow or if you are bruising easily, you should call your doctor immediately.

AVONEX has not been studied in pregnant women. If you become pregnant while taking AVONEX, you should stop taking AVONEX immediately, tell your doctor, and consider enrolling in the AVONEX Pregnancy Registry by calling 1-800-456-2255.

Most people who take AVONEX have flu-like symptoms (fever, chills, sweating, muscle aches, and tiredness) early during the course of therapy. For many people, these symptoms lessen or go away over time. Talk to your doctor if these symptoms continue longer than the first few months of therapy, or if they are difficult to manage.

For more information, refer to the patient Medication Guide in the full product information. This information is not intended to replace discussions with a healthcare provider.

Please see full Prescribing Information, including the patient Medication Guide. Call 1-800-456-2255 or visit
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Optical coherence tomography: a window into the mechanisms of multiple sclerosis.

The pathophysiology of multiple sclerosis (MS) is characterized by demyelination, which culminates in a reduction in axonal transmission. Axonal and neuronal degeneration seem to be concomitant features of MS and are probably the pathological processes responsible for permanent disability in this disease.
Nat Clin Pract Neurol. 2008 Dec;4(12):664-675.


A salmon based diet protects mice from behavioural changes in the cuprizone model for demyelination.

Although many patients with multiple sclerosis (MS) use special diets, the data available at present are insufficient to assess any potential benefit of diet modification.
Clin Nutr. 2008 Nov 28. [Epub ahead of print]


N-(4-pyridyl) methyl carbamate inhibits fast potassium currents in guinea pig dorsal root ganglion cells.

Axonal demyelination is a critical pathological phenomenon associated with spinal cord injury and multiple sclerosis (MS).
J Neurol Sci. 2008 Nov 28. [Epub ahead of print]


The intrathecal, polyspecific antiviral immune response: Specific for MS or a general marker of CNS autoimmunity?

80-100% of patients with multiple sclerosis (MS) display a polyspecific, intrathecal humoral immune response against a broad panel of viral agents including antibodies to measles, rubella and varicella zoster virus as its three most abundant components (called MRZ reaction [MRZR]).
J Neurol Sci. 2008 Nov 26. [Epub ahead of print]


Early Recovery of CD4 T Cell Receptor Diversity after "Lymphoablative" Conditioning and Autologous CD34 Cell Transplantation.

T cell diversity posttransplantation is thought to be severely restricted, based on T cell receptor beta-chain immunophenotyping or spectratyping.
Biol Blood Marrow Transplant. 2008 Dec;14(12):1373-9.


Attentional lapses, emotional regulation and quality of life in multiple sclerosis.

We investigated the role of attentional lapses and emotion regulation in predicting multiple aspects of Quality of Life (QoL) in MS.
Br J Clin Psychol. 2008 Nov 26. [Epub ahead of print]


Complement in multiple sclerosis: its role in disease and potential as a biomarker.

Multiple sclerosis (MS) is a common inflammatory disease of the central nervous system with a poorly defined and complex immunopathogenesis.
Clin Exp Immunol. 2008 Nov 24. [Epub ahead of print]


Lamotrigine in the treatment of pain syndromes and neuropathic pain.

Anti-epileptic drugs are increasingly used in the treatment of pain syndromes and neuropathic pain.
Bratisl Lek Listy. 2008;109(9):421-4


[Change of CCR7 and CD45RA after blocking of Kv1.3 potassium channel of CD4+ T lymphocytes in MS]

To investigate the changes of CCR7 and CD45RA expression after blocking of the potassium channel Kv1.3 in myelin specific CD4 T lymphocytes and the relation thereof with multiple sclerosis(MS).
Zhonghua Yi Xue Za Zhi. 2008 Jul 15;88(27):1896-9



Novel Insomnia Drug Shows Promise for Jet Lag

BOSTON, Dec. 1 -- An investigational drug to combat insomnia helped people cope with disrupted sleep-wake cycles, as are found with jet lag or rotating work shifts, said researchers here.

Significant improvements in all major sleep outcomes were seen with tasimelteon compared with placebo in separate phase II and phase III studies, reported Elizabeth B. Klerman, M.D., Ph.D., of Brigham and Women's Hospital, and colleagues online in The Lancet.

The studies of the melatonin receptor agonist involved healthy individuals who were told to go to sleep five hours earlier than normal at a sleep clinic.

Because the study took place in an unfamiliar environment, participants were also expected to have transient insomnia known as the "first-night effect."

Dr. Klerman and colleagues found that tasimelteon improved sleep efficiency, total sleep time, wake time after sleep onset, latency to sleep onset, and latency to persistent sleep compared with placebo.

Adverse events did not differ between the active drug and placebo and were uncommon, except for pain, irritation, and bruising related to venipunctures for blood sampling.

"By simultaneously improving sleep latency and sleep maintenance with a shift in circadian rhythms, tasimelteon has the potential for the treatment of patients with transient insomnia associated with circadian rhythm sleep disorders, including people affected by jet lag, or those who work at night, and early-riser workers," Dr. Klerman and colleagues wrote.

Ramelteon is approved for treating primary insomnia but not specifically for sleep problems associated with circadian disruptions.

Melatonin itself does not make a practical drug for treating circadian rhythm-associated insomnias because of its pharmacokinetic properties.

Drs. Cardinali and Golombek said the pharmacokinetics of tasimelteon deserved closer scrutiny, because of the relatively high doses needed to reduce insomnia in the Lancet studies.

Its sponsor, Vanda Pharmaceuticals, announced in late October that it was suspending "all commercial and development activities," after the FDA rejected its marketing application for another product, the anti-psychotic drug iloperidone.

Vanda has since filed a revised application for iloperidone, but has not indicated its plans for tasimelteon or other programs.

MedPage Today


RSNA: Exercise May Prevent Loss of Small Blood Vessels in the Brain

CHICAGO, Dec. 1 -- Older adults who exercise regularly may have increased cerebral blood flow and a greater number of small blood vessels in the brain, researchers here said.

This could be the mechanism by which exercise prevents cognitive decline in the elderly, Feraz Rahman, M.S., a medical student at Jefferson Medical College in Philadelphia, told attendees at the Radiological Society of North America meeting.

"Aerobic exercise improves cognitive function … and counteracts the effects of aging on the brain," Rahman said. "That may be due to blood flow and vasculature."

Previous research has shown that exercise reverses small vessel disease elsewhere in the body, and increases brain volume and cognitive function in the elderly.

Rahman concluded that the findings of this study show that "exercise is a vital part of healthy aging and might slow the loss of small vessels."

MedPage Today



Role of MRI in the differentiation of ADEM from MS in children.

MRI diagnostic criteria are proposed that may be useful in differentiating children experiencing the first attack of multiple sclerosis from those with monophasic acute disseminated encephalomyelitis.
Neurology. 2008 Nov 26. [Epub ahead of print]


MRI in the diagnosis of pediatric multiple sclerosis.

MRI diagnostic criteria have not yet been adopted for pediatric multiple sclerosis (MS). MRI plays a pivotal role in supporting the diagnosis of MS in adults. We sought to quantitatively define the MRI features of pediatric MS, to determine features that distinguish MS from nondemyelinating relapsing childhood neurologic disorders, and to propose MRI criteria for lesion dissemination in space in children with MS.
Neurology. 2008 Nov 26. [Epub ahead of print]


Results of a phase IIa clinical trial of an anti-inflammatory molecule, chaperonin 10, in multiple sclerosis.

Chaperonin 10 (Cpn10) is a mitochondrial molecule involved in protein folding. The aim of this study was to determine the safety profile of Cpn10 in patients with multiple sclerosis (MS).MethodsA total of 50 patients with relapse-remitting or secondary progressive MS were intravenously administered 5 mg or 10 mg of Cpn10 weekly for 12 weeks in a double-blind, randomized, placebo controlled, phase II trial.
Mult Scler. 2008 Nov 27. [Epub ahead of print]


What insights have new imaging techniques given into aggressive forms of MS - different forms of MS or different from MS?

"Aggressive" multiple sclerosis (MS) is still a challenging diagnosis, in spite of the relevant progresses concerning the comprehension of the disease mechanisms, especially through pathology studies and the advent of conventional magnetic resonance imaging (MRI).
Mult Scler. 2008 Nov 27. [Epub ahead of print]

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