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Multiple Sclerosis Institute
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Thursday

 

Diagnosis and Treatment of Depression Comorbid with Neurologic Disorders.

Depression is common in patients with neurologic disorders such as Alzheimer disease, stroke, Parkinson disease, and multiple sclerosis. Diagnosing depression in the context of neurologic disease is challenging, given the overlap between many signs and symptoms of depression with those of the neurologic disorders.

PMID: 18954590 [PubMed - as supplied by publisher]
PubMed - Am J Med. 2008 Nov;121(11S2):S28-S37.
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED ARTICLES

 

Endorsement of self-report neurovegetative items of depression is associated with multiple sclerosis disease symptoms.

Some researchers have suggested that general self-report depression scales may be inadequate for assessing depression among individuals with Multiple Sclerosis (MS), because many of such items represent MS disease symptoms.

PMID: 18954485 [PubMed - in process]
PubMed - J Int Neuropsychol Soc. 2008 Nov;14(6):1057-62
CLICK HERE TO READ THE FULL ABSTRACT & LINKS TO RELATED ARTICLES

 

Improving Gait in Multiple Sclerosis Using Robot-Assisted, Body Weight Supported Treadmill Training

Background: The majority of patients with multiple sclerosis (MS) develop progressive gait impairment, which can start early in the disease and worsen over a lifetime. A promising outpatient intervention to help improve gait function with potential for addressing this treatment gap is task-repetitive gait training.

Sage Journals On Line - Neurorehabilitation and Neural Repair, Vol. 22, No. 6, 661-671 (2008)

CLICK HERE TO READ THE FULL ABSTRACT & LINKS TO RELATED INFORMATION

Wednesday

 

THE FOLLOWING STORY WAS POSTED TODAY ON OUR MS NEWS CHANNEL MYSPACE BLOG

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Biogen Confirms 3rd Brain Infection - CNN MONEY

Biogen Idec confirmed late Wednesday that a third patient taking its multiple sclerosis drug Tysabri developed progressive multifocal leukoencephalopathy (PML), an often deadly brain infection.

The biotech company's shares were losing more than 15% to $35.50 in recent after-hours trading. Its partner on the drug, Elan (ELN Quote - Cramer on ELN - Stock Picks), was shedding more than 28% to $5.50

Biogen disclosed in an 8-K filing with the Securities and Exchange Commission that regulatory agencies were notified Wednesday of the new confirmed case of PML in a patient with multiple sclerosis. This patient was confirmed to have the infection after 14 injections of Tysabri and is now under the care of his or her treating physician, Biogen said.

Tysabri, a treatment for MS, was removed from the market in 2005 after being linked to PML, but has since been relaunched with information about the PML risk on its label.

In July, Biogen and Elan disclosed the first two confirmed cases of PML since the drug's relaunch. The Food and Drug Administration has since expanded the Tysabri's warning label to include the risk of the infection with the drug when it is used alone.

"We've said in the past, and the FDA has also said, as is clearly stated in our label that we've anticipated seeing additional cases of PML," Biogen Idec spokeswoman Naomi Aoki said upon the first two confirmed cases of PML three months ago.

The label currently indicates that the expected rate is 1 occurrence in 1,000 patients, which was calculated at the time of the drug's reintroduction to the market.

Biogen said last week that as of the end of September, there were more than 35,500 patients on commercial and clinical Tysabri therapy worldwide, compared with 31,800 patients on the therapy at the end of the second quarter.

Tysabri isn't alone when it comes to instances of PML.

There have been a number of other immunosuppressant drugs linked to PML, notes Summer Street's Carol Werther, including Rituxan, a drug from Genentech] and Biogen Idec. There have also been postmarketing reports of PML in patients who took Roche's CellCept and Novartis's Myfortic, drugs used to keep the body from rejecting transplant organs.

Wall Street had been watching Biogen's third quarter numbers last week to see how the two new cases might be affecting sales of the drug. Sales came in ahead of expectations, but shares declined as investors weighed comments by management regarding Biogen's goal for patients on the MS drug. The company said growth would now have to accelerate in order to reach 100,000 patients on the drug by 2010, although it was sticking to the target.

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Tuesday

 

Are "statins" beneficial or harmful in multiple sclerosis?

Patient Page:

In this issue of Neurology®, Dr. Birnbaum and co-authors study whether cholesterol medications called statins are helpful or harmful when combined with common multiple sclerosis (MS) treatments called interferons in patients who have MS.

NEUROLOGY 2008;71:e54-e56
CLICK HERE TO READ THIS & LINKS TO RELATED INFORMATION

 

Combining beta interferon and atorvastatin may increase disease activity in multiple sclerosis

Objective: To explore whether high-dose atorvastatin can be administered safely to persons with relapsing-remitting multiple sclerosis (MS) taking thrice weekly, 44 µg dose subcutaneous interferon beta-1a.

NEUROLOGY 2008;71:1390-1395
CLICK HERE TO READ THE FULL ABSTRACT & LINKS TO RELATED INFORMATION

Monday

 
The following story was posted today on our MS News Channel MySpace Blog.

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"BG-12, Biogen Idec’s Oral Compound Shown To Significantly Reduced Brain Lesions"

BG-12, Biogen Idec's Novel Oral Compound Shown To Significantly Reduced Brain Lesions In Patients With Multiple Sclerosis

Biogen Idec (NASDAQ: BIIB) today announced the publication of Phase IIb data showing that a 240 mg three-times-daily dose of the company's novel oral compound, BG-12 (BG00012, dimethyl fumarate), reduced the number of new gadolinium enhancing (Gd+) lesions by 69 percent in patients with relapsing-remitting multiple sclerosis (MS) when compared to treatment with placebo (p<0.0001).>

BG-12 is the first compound that has been shown to activate the Nrf2 transcriptional pathway, which previous studies have shown defends against oxidative-stress induced neuronal death, protects the blood-brain barrier, and supports maintenance of myelin integrity in the central nervous system.

"The effects of BG-12 on inflammatory brain lesions, together with the corresponding safety data, strongly support further research in Phase III clinical studies to define its place in the future of relapsing-remitting MS treatment," said the study's primary investigator, Professor Ludwig Kappos, acting Chair of Neurology and Research Group Leader, Department of Biomedicine, University Hospital Basel, Switzerland. "Because of BG-12's unique mechanism of action and its oral administration, it could be valuable as a therapy for many MS patients and not just those who prefer to not initiate injectable treatments."

"Enhancing the body's normal cellular protection pathways while reducing inflammation appears to be a unique approach to this disease," said Michael Panzara, MD, MPH, Vice President, Chief Medical Officer of Neurology, Biogen Idec. "At Biogen Idec, we are continuing to invest and apply our expertise in MS with new research into novel compounds such as BG-12 to further improve the lives of people with this disease."

Phase IIb Data Demonstrate Positive Efficacy and Favorable Safety Profile for BG-12

In this study, patients treated with a 240 mg three-times-daily dose of BG-12 showed a reduction in the number of new Gd+ lesions by 69 percent at weeks 12 to 24, compared to treatment with placebo (p<0.0001).>

BG-12 also significantly reduced the number of new or enlarging T2-hyperintense lesions by 48 percent versus placebo, and 63 percent of patients given BG-12 had no new T2-hyperinstense lesions, compared with 26 percent receiving placebo.

Though the study was not adequately powered to evaluate relapse endpoints, relapse rates in all BG-12 treatment groups decreased between the first and the second part of the study, which may indicate a delayed and increasing effect of BG-12 over time.

Sunday

 

Results Published: Oral Drug BG00012 Reduced MRI Inflammation in Relapsing-Remitting MS During Phase 2 Trial -- Phase 3 Trials Recruiting Patients

Based on the anti-inflammatory effects seen on MRI, the sponsor is proceeding with two large-scale, Phase 3 clinical trials of BG00012 in relapsing-remitting MS. Participants are being sought for the two trials, known as the DEFINE study and the CONFIRM study.
Learn more about the possibility of participating in one of these clinical trials

National MS Society
CLICK HERE TO READ THE FULL ARTICLE & LINKS TO RELATED INFORMATION

 

Disease-responsive neural precursor cells are present in multiple sclerosis lesions.

Aims: Spontaneous tissue repair occurs in multiple sclerosis (MS), but the origin of remyelinating cells remains obscure. Here we explore the hypothesis that endogenous neural precursors are involved in MS disease processes.

PMID: 18947307 [PubMed - in process]
PubMed - Regen Med. 2008 Nov;3(6):835-47.
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

 

Effect of Exercise Training on Walking Mobility in Multiple Sclerosis: A Meta-Analysis.

OBJECTIVE: . The study used meta-analytic procedures to examine the overall effect of exercise training interventions on walking mobility among individuals with multiple sclerosis.

PMID: 18948413 [PubMed - as supplied by publisher]
PubMed - Neurorehabil Neural Repair. 2008 Oct 23. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

 

Mitoxantrone Does Not Restore the Impaired Suppressive Function of Natural Regulatory T Cells in Patients Suffering from Multiple Sclerosis.

A Longitudinal ex vivo and in vitro Study.

CD4+CD25+ regulatory T (T(reg)) cells play a major role in controlling autoimmunity by suppressing self-reactive T cells.

PMID: 18948697 [PubMed - as supplied by publisher]
PubMed - Eur Neurol. 2008 Oct 24;61(1):27-32. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

 

Pediatric multiple sclerosis: analysis of clinical and epidemiological aspects according to National MS Society Consensus 2007.

OBJECTIVE: To describe the epidemiological and clinical characteristics of child/adolescence multiple sclerosis (MS).

PubMed - Arq Neuropsiquiatr. 2008;66(3b):665-670.
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

 

Multiple sclerosis outcome and morbi-mortality of a Brazilian cohort patients.

We studied the clinical and evolution characteristics of multiple sclerosis (MS) patients followed since the onset of HUCFF/UFRJ in 1978.

PMID: 18949260 [PubMed - as supplied by publisher]
PubMed - Arq Neuropsiquiatr. 2008;66(3b):671-677.
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

 

Association of a history of varicella virus infection with multiple sclerosis.

OBJECTIVE: To analyze the association of a previous history of varicella virus infection with multiple sclerosis (MS) and its subtypes.

PMID: 18947921 [PubMed - as supplied by publisher]
PubMed - Clin Neurol Neurosurg. 2008 Oct 21. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

Saturday

 

Leukemia drug gives hopes to MS sufferers

LONDON, England -- Researchers in Britain say they have found that a drug used to treat leukemia can halt and even reverse the debilitating effects of multiple sclerosis (MS).

The findings published Thursday in the New England Journal of Medicine will bring fresh hope to the world's millions of sufferers of the the auto-immune disease.

Researchers from the University of Cambridge in eastern England found that a drug called alemtuzumab can stop the advance of MS in its early stages.

MS causes the body's immune system to attack nerve fibres in the central nervous system. Watch as drug offers hope to MS sufferers »

Symptoms of the disease can include loss of sight and mobility, depression, fatigue and cognitive problems. There is no cure, and few effective treatments. Read an explainer about MS

In trials among sufferers, alemtuzumab cut the number of attacks and helped them recover lost functions. It even apparently helped repair damaged brain tissue so individuals were less disabled than at the start of the study.

Researchers also compared the effectiveness of alemtuzumab with interferon beta-1a, a leading MS treatment.

They found patients treated with alemtuzumab were 74 percent less likely to experience relapses than those taking interferon beta-1a.

"The ability of an MS drug to promote brain repair is unprecedented," said Dr. Alasdair Coles, a lecturer at Cambridge university's department of clinical neurosciences, who worked on the study.

"We are witnessing a drug which, if given early enough, might effectively stop the advancement of the disease and also restore lost function by promoting repair of the damaged brain tissue."

CNN.com/health
CLICK HERE TO READ THE FULL ARTICLE & LINKS TO RELATED INFORMATION

 

Smoking Cessation Drug Linked to 1,001 New Serious Adverse Events

ALEXANDRIA, Va., Oct. 22 -- The smoking-cessation drug varenicline (Chantix) has been associated with 1,001 serious adverse events -- including 50 deaths -- during the first quarter of 2008, a drug-safety watchdog group said today.

Pfizer, which markets varenicline, questioned the institute's conclusions, noting that it analyzed data from the FDA's voluntary adverse event reporting system.

Those reports, the company said, were often unverifiable and lack sufficient medical information to draw any conclusions.

The institute, for its part, said its report may have undercounted the number of adverse events because the FDA's post-market surveillance system is voluntary.

The group acknowledged, however, that although "the sum totals of adverse event reports normally provide an accurate overall adverse event profile for a drug, the individual reports themselves do not prove that the drug caused the event described."

The FDA has warned of suicide ideation among patients taking varenicline and the Federal Aviation Administration banned the drug from use by pilots and air traffic controllers. (See: Pfizer Defends Beleaguered Varenicline (Chantix))

MedPage Today
CLICK HERE TO READ THE FULL ARTICLE

 

Cognitive training may improve mood as well as cognition

A short-term study of home-based cognitive training in people with MS found that not only did the training seem to improve the participants' memory and attention, but it also had positive effects on their mood. So if you're concerned about your mental function, your mood, or both, you might ask your neurologist or neuropsychologist for cognitive training recommendations. There are a number of computer-based training programs available now that you can use from home at your convenience.

MS News - News for the Multiple Sclerosis Community
CLICK HERE FOR MORE INFORMATION

 

Major new step towards treating MS

This article discusses the study results released yesterday by doctors at Cambridge University of the drug, alemtuzumab.

In the 3-year trial, patients who were given the new drug were 74% less likely to relapse and had a 71% lower risk of being disabled within three years. But most remarkably, those on the new treatment showed fewer signs of disability at the end of the trial than they began with.
The drug is a synthetic antibody that was developed at Cambridge 30 years ago as a treatment (called Campath) for leukaemia. While it is now licensed as a treatment for chronic leukaemia, scientists suspected it might also benefit MS patients because it dampens down the immune system.

MS News - News for the MS Community
CLICK HERE FOR MORE INFORMATION & LINKS TO RELATED ARTICLES

 

Webcast: Managing Your Symptoms: Spasticity, Tremors, Seizures, and Loss of Balance

Managing Your Symptoms featuring Dr. Michael Kaufman

This video webcast series will focus on:

Part 1: Spasticity

Length of program: 14 minutes
Downloads: Transcript (.pdf) Podcast (.mp3)

Topics:
Spasticity and mobility
When and where spasticity appears
Medications to treat spasticity

Part 2: Tremors, Seizures, and Loss of Balance

Length of program: 9 minutes
Downloads: Transcript (.pdf) Podcast (.mp3)

Topics:
Neurological explanation of tremors
Seizures and multiple scelrosis
Treating seizures, tremors, and loss of balance

National MS Society
CLICK HERE TO LEARN MORE ABOUT THESE WEBCASTS

 

Movement Equals Freedom: Expert Advice to Manage Mobility


LIVE WEBCAST ONE WEEK AWAY: Thursday, October 30, 2008

Walking impairment is one of the most common and disruptive consequences of MS. Is there more you could do to preserve and maintain your mobility?

Tune in to our webcast, brought to you by MoveOverMS, a website sponsored by Acorda Therapeutics, on October 30. MS experts will explain what they mean by "mobility impairment" and explore what causes it. You'll learn about physical problems such as weakness and balance trouble as well as other limitations like fatigue and depression. Experts will explain the importance of discussing concerns about walking impairment with your doctors early and often, and you'll learn about simple strategies you can incorporate in your daily life that may help you make the most of your existing mobility. Plus, real MS patients will share their stories, strategies and experiences.

And, as always, you'll have a chance to ask the experts your questions.

BONUS: Attend the live webcast for your chance to win one of three iPod nanos. Use your nano to download the latest MS podcasts now available at HealthTalk.com! (Drawing open to U.S. residents only.)

Date: Thursday, October 30, 2008
Time: 5:30 p.m. PDT / 6:30 p.m. MDT / 7:30 p.m. CDT / 8:30 p.m. EDT
Location: On the phoneOn the Internet

How to participate: It's okay if you haven't registered prior to the webcast – we'd still love for you to attend. There are two ways you can tune in:

On the phone: On Thursday, October 30 about 10 minutes prior to show time, call 1-877-795-3635 on a touch-tone telephone. An operator will greet you and transfer you into the show.

On the Internet: On Thursday, October 30 about 10 minutes prior to show time, go to this Web address from any computer:


Be sure to install Adobe Flash Player and test it before the webcast. Find easy download instructions at


Thank you for tuning in! We wish you and your family the best of health, The HealthTalk Multiple Sclerosis Team

P.S. For even more tips and advice for living well with MS, visit
IMPORTANT NOTE: THIS PODCAST IS SPONSORED BY ACORDA THERAPEUTICS, INC.
*DISCLAIMER FROM MSNEWSCHANNEL: The views and opinions expressed in this podcast may not be the views of MSNewsChannel. Information provided is not intended as a substitute for advice, prescription or recommendation from a physician or other healthcare professional. For specific, personalized information, consult your healthcare provider. MSNewsChannel does not approve, endorse or recommend specific products or services, but provides information to assist people in making their own decisions.

 

[Cognitive impairment in the early phase of multiple sclerosis and its relationship with mood, demographic and clinical variables.]

Cognitive impairment in the early phase of multiple sclerosis and its relationship with mood, demographic and clinical variables. Our aim was to study cognitive performance in the early phase of MS.

PubMed - Psicothema. 2008 Nov;20(4):583-8
CLICK HER FOR FULL ABSTRACT & RELATED INFORMATION

 

Treatment of restless legs syndrome: An evidence-based review and implications for clinical practice.

Only in the last three decades, the restless legs syndrome (RLS) has been examined in randomized controlled trials.

PubMed - Mov Disord. 2008 Oct 16. [Epub ahead of print]
CLICK HERE FOR FULL ABSTRACT & LINKS TO RELATED INFORMATION

 

Changes in matrix metalloproteinases and their inhibitors during interferon-beta treatment in multiple sclerosis.

Matrix metalloproteinases (MMPs) and tissue inhibitors (TIMPs) play a key role in the pathogenesis of multiple sclerosis (MS) and have been proposed as biomarkers of response to therapy.

PubMed - Clin Immunol. 2008 Oct 20. [Epub ahead of print]
CLICK HERE FOR FULL ABSTRACT & LINKS TO RELATED INFORMATION

 

Posterior Reversible Encephalopathy Syndrome after Intravenous Caffeine for Post-Lumbar Puncture Headaches.

A 33-year-old woman developed severe post-lumbar puncture headaches in the course of work-up for multiple sclerosis.

PubMed - AJNR Am J Neuroradiol. 2008 Oct 22. [Epub ahead of print]
CLICK HERE FOR FULL ABSTRACT & LINKS TO RELATED INFORMATION

 

Disconnection as a mechanism for cognitive dysfunction in multiple sclerosis

Disconnection of cognitively important processing regions by injury to the interconnecting white matter provides a potential mechanism for cognitive dysfunction in multiple sclerosis.

OxFord Journals - BRAIN A Journal of Neurology
CLICK HERE FOR FULL ABSTRACT & LINKS TO RELATED INFORMATION

 

Survival and cause of death in multiple sclerosis: results from a 50-year follow-up in Western Norway

Survival time among patients with multiple sclerosis (MS) has varied considerably according to previous reports.

Sage Journals On Line
Multiple Sclerosis, Vol. 14, No. 9, 1191-1198 (2008)
CLICK HERE FOR FULL ABSTRACT & LINKS TO RELATED INFORMATION

 

Cognitive impairments in relapsing-remitting multiple sclerosis: a meta-analysis

There is debate in the literature regarding the magnitude, nature, and influence of cognitive impairment in individuals with relapsing-remitting multiple sclerosis (RRMS).

Sage Journals On Line
CLICK HERE FOR FULL ABSTRACT & LINKS TO RELATED INFORMATION

 

Movement disorders in multiple sclerosis: causal or coincidental association?

Despite the relatively frequent involvement of the basal ganglia and subthalamic nucleus by multiple sclerosis (MS) plaques, movement disorders (MD), other than tremor secondary to cerebellar or brainstem lesions, are uncommon clinical manifestations of MS.

Sage Journals On Line - Multiple Sclerosis, Vol. 14, No. 9, 1284-1287 (2008)
CLICK HERE FOR FULL ABSTRACT & LINKS TO RELATED INFORMATION

 

Natalizumab disproportionately increases circulating pre-B and B cells in multiple sclerosis.

BACKGROUND: Natalizumab, a humanized anti-alpha4 integrin monoclonal antibody, reduces relapses and disease progression in patients with multiple sclerosis (MS).

HighWire Press Stanford University - Neurology, October 21, 2008; 71(17): 1350-4.
CLICK HERE FOR FULL ABSTRACT & RELATED INFORMATION

 

Multiple Sclerosis in Childhood: Clinical and Radiological Features.

We analyzed the medical records and cerebral imaging of 30 children with early onset multiple sclerosis to compare the clinical and neuro-radiological features with acute demyelinating encephalomyelitis and adult multiple sclerosis.

HighWire Press Stanford University - J Child Neurol, October 21, 2008;
CLICK HERE FOR FULL ABSTRACT & LINKS TO RELATED INFORMATION

 

CSF anti-myelin antibodies are related to MR measures of disease activity in multiple sclerosis.

OBJECTIVE: Recent studies reported contrasting results with respect to the presence of anti-myelin protein antibodies in Multiple Sclerosis (MS) and their relation with disease activity.

HighWire Press Stanford University - J. Neurol. Neurosurg. Psychiatry, October 17, 2008;
CLICK HERE FOR FULL ABSTRACT & LINKS TO RELATED INFORMATION

 

Smoking-cessation drug Chantix associated with 50 deaths during the first quarter of 2008

The following story was posted today on our MS News Channel MySpace Blog.

It is one of 4,613 stories on our MySpace Blog! Our 3,300 MySpace Friendshave made 29,896 Comments & 42,234 Kudos on the 4,613 stories!

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Smoking Cessation Drug Linked to 1,001 New Serious Adverse Events

Published: October 22, 2008
ALEXANDRIA, Va., Oct. 22 -- The smoking-cessation drug varenicline (Chantix) has been associated with 1,001 serious adverse events -- including 50 deaths -- during the first quarter of 2008, a drug-safety watchdog group said today.

The Institute for Safe Medication Practices said that total put varenicline at the top of its list of drugs associated with serious injuries during the quarter. Heparin was second.

The institute's drug-safety watchers include Curt D. Furberg, M.D., Ph.D., of Wake Forest.Since varenicline was approved in 2006, there have been 3,325 reported serious injuries in the U.S., including 112 deaths, the institute said.

Pfizer, which markets varenicline, questioned the institute's conclusions, noting that it analyzed data from the FDA's voluntary adverse event reporting system.

Those reports, the company said, were often unverifiable and lack sufficient medical information to draw any conclusions.

The institute, for its part, said its report may have undercounted the number of adverse events because the FDA's post-market surveillance system is voluntary.

The group acknowledged, however, that although "the sum totals of adverse event reports normally provide an accurate overall adverse event profile for a drug, the individual reports themselves do not prove that the drug caused the event described."

The FDA has warned of suicide ideation among patients taking varenicline and the Federal Aviation Administration banned the drug from use by pilots and air traffic controllers. (See: Pfizer Defends Beleaguered Varenicline (Chantix))

But it wasn't just varenicline that was targeted by the institute.

Overall, the group said there were a "record number of deaths and serious injuries associated with drug therapy" during the first quarter of 2008, with 20,745 injuries and 4,824 deaths. The adverse event rate was 2.4-fold higher than the last quarter of 2007.

Medication errors accounted for 7.1% of all serious injuries, the group said.


 

Influence of anxiety and reported stressful life events on relapses in multiple sclerosis"

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Influence of anxiety and reported stressful life events on relapses in multiple sclerosis: a prospective study

Department of Neurology, University of Athens School of Medicine, Unit of Demyelinating Diseases, Eginition Hospital, Athens, Greece

Objective: Self-reported stressful life events and infections have been associated with relapses in multiple sclerosis. Also, anxiety has been reported to influence other diseases of unpredictable course. To study relation of self-reported stressful life events, levels of anxiety, and episodes of infection, with relapses of the disease in women with multiple sclerosis.

Methods: This is a one-year prospective study. Thirty seven women with multiple sclerosis were regularly seen every four weeks, for one year. They were keeping diaries of events they considered stressful. These events were ranked according to the Holmes and Rahe Social Readjustment Rating Scale. Their anxiety levels were assessed with the Hamilton rating scale for anxiety. Relapses and episodes of infection were verified at additional visits. Results were studied using a survival analysis model adapted for several recurrent events.

Results: A total of 291 stressful events, 37 episodes of infection, and 48 relapses, were registered. High level of anxiety were stongly related to the number and the severity of reported stressful events during the preceding period and with the advent of a relapse in the following period (Hamilton score greater than 18 is associated with 4.2 times the rate of relapsing and three or more reported stressful events with 5.7 times the rate of relapsing).

Conclusions: Anxiety and self-reported stressful events may in fact be two measures of the same underlying emotional factor, which plays an important role on the course of the disease, in addition to episodes of infection.

Friday

 

"Survey: Half of US doctors use placebo treatments"

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Survey: Half of US doctors use placebo treatments

About half of American doctors in a new survey say they regularly give patients placebo treatments - usually drugs or vitamins that won't really help their condition. And many of these doctors are not honest with their patients about what they are doing, the survey found.


That contradicts advice from the American Medical Association, which recommends doctors use treatments with the full knowledge of their patients.


"It's a disturbing finding," said Franklin G. Miller, director of the research ethics program at the U.S. National Institutes Health and one of the study authors. "

There is an element of deception here which is contrary to the principle of informed consent."


The study was being published online in Friday's issue of BMJ, formerly the British Medical Journal.


Placebos as defined in the survey went beyond the typical sugar pill commonly used in medical studies. A placebo was any treatment that wouldn't necessarily help the patient.


Scientists have long known of the "placebo effect," in which patients given a fake or ineffective treatment often improve anyway, simply because they expected to get better.


"Doctors may be under a lot of pressure to help their patients, but this is not an acceptable shortcut," said Irving Kirsch, a professor of psychology at the University of Hull in Britain who has studied the use of placebos.


Researchers at the NIH sent surveys to a random sample of 1,200 internists and rheumatologists - doctors who treat arthritis and other joint problems. They received 679 responses. Of those doctors, 62 percent believed that using a placebo treatment was ethically acceptable.


Half the doctors reported using placebos several times a month, nearly 70 percent of those described the treatment to their patients as "a potentially beneficial medicine not typically used for your condition." Only 5 percent of doctors explicitly called it a placebo treatment.


Most doctors used actual medicines as a placebo treatment: 41 percent used painkillers, 38 percent used vitamins, 13 percent used antibiotics, 13 percent used sedatives, 3 percent used saline injections, and 2 percent used sugar pills.


In the survey, doctors were asked if they would recommend a sugar pill for patients with chronic pain if it had been shown to be more effective than no treatment. Nearly 60 percent said they would.
Smaller studies done elsewhere, including Britain, Denmark and Sweden, have found similar results.

Jon Tilburt, the lead author of the U.S. study, who is with NIH's bioethics department, said he believes the doctors surveyed were representative of internists and rheumatologists across the U.S. No statistical work was done to establish whether the survey results would apply to other medical specialists, such as pediatricians or surgeons.


The authors said most doctors probably reasoned that doing something was better than doing nothing.


In some cases, placebos were given to patients with conditions such as chronic fatigue syndrome. Doctors also gave antibiotics to patients with viral bronchitis, knowing full well that a virus is impervious to antibiotics, which fight bacteria. Experts believe overuse of antibiotics promotes the development of drug-resistant strains of bacteria.


Some doctors believe placebos are a good treatment in certain situations, as long as patients are told what they are being given. Dr. Walter Brown, a professor of psychiatry at Brown and Tufts universities, said people with insomnia, depression or high blood pressure often respond well to placebo treatments.


"You could tell those patients that this is something that doesn't have any medicine in it but has been shown to work in people with your condition," he suggested.


However, experts don't know if the placebo effect would be undermined if patients were explicitly told they were getting a dummy pill.


Brown said that while he hasn't prescribed sugar pills, he has given people with anxiety problems pills that had extremely low doses of medication. "The dose was so low that whatever effect the patients were getting was probably a placebo effect," he said.


Kirsch, the psychologist, said it might be possible to get the psychological impact without using a fake pill. "If doctors just spent more time with their patients so they felt more reassured, that might help," he said.
Some patients who had just seen their doctors at a clinic in London said the truth was paramount.

Thursday

 

"a drug originally developed to treat leukaemia can halt and even reverse the effects of MS"


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Hi Stan... a friend sent this to me... i didn't know if you or the angels would be interested in reading it... either way... here:


LONDON (AFP) – Researchers at the University of Cambridge said Thursday they have found that a drug originally developed to treat leukaemia can halt and even reverse the debilitating effects of multiple sclerosis (MS).

In trials, alemtuzumab reduced the number of attacks in sufferers and also helped them recover lost functions, apparently allowing damaged brain tissue to repair so that individuals were less disabled than at the start of the study.

"The ability of an MS drug to promote brain repair is unprecedented," said Dr Alasdair Coles, a lecturer at Cambridge university's department of clinical neurosciences, who coordinated many aspects of the study."

We are witnessing a drug which, if given early enough, might effectively stop the advancement of the disease and also restore lost function by promoting repair of the damaged brain tissue."

The MS Society, Britain's largest support charity for those affected by the condition, said it was "delighted" at the trial's results, which must be followed up with more research before the drug can be licensed."

This is the first drug that has shown the potential to halt and even reverse the debilitating effects of MS and this news will rightly bring hope to people living with the condition day in, day out," said head of research Lee Dunster.

MS is an auto-immune disease that affects millions of people worldwide, including almost 100,000 in Britain and 400,000 in the United States.

It is caused by the body's immune system attacking nerve fibres in the central nervous system, and can lead to loss of sight and mobility, depression, fatigue and cognitive problems. There is no cure, and few effective treatments.

In the trial, 334 patients diagnosed with early-stage relapsing-remitting MS who had not previously been treated were given alemtuzumab or interferon beta-1a, one of the most effective licensed therapies for similar MS cases.

After three years, alemtuzumab was found to reduce the number of attacks the patients suffered by 74 percent over the other treatment, and reduce the risk of sustained accumulation of disability by 71 percent over interferon beta-1a.

Many individuals who took alemtuzumab also recovered some of their lost functions, becoming less disabled by the end, while the disabilities of the other patients worsened, the study in the New England Journal of Medicine said.

Alastair Compston, professor of neurology and head of the clinical neurosciences department at Cambridge, said alemtuzumab was the "most promising" experimental drug for the treatment of MS.
He expressed hope that further trials "will confirm that it can both stabilise and allow some recovery of what had previously been assumed to be irreversible disabilities".

Alemtuzumab was developed in Cambridge and has been licensed for the treatment of chronic lymphocytic leukaemia.

 

Alemtuzumab vs. Interferon Beta-1a in Early Multiple Sclerosis

Background: Alemtuzumab, a humanized monoclonal antibody that targets CD52 on lymphocytes and monocytes, may be an effective treatment for early multiple sclerosis.

Method; In this phase 2, randomized, blinded trial involving previously untreated, early, relapsing–remitting multiple sclerosis, we assigned 334 patients with scores of 3.0 or less on the Expanded Disability Status Scale and a disease duration of 3 years or less to receive either subcutaneous interferon beta-1a (at a dose of 44 μg) three times per week or annual intravenous cycles of alemtuzumab (at a dose of either 12 mg or 24 mg per day) for 36 months. In September 2005, alemtuzumab therapy was suspended after immune thrombocytopenic purpura developed in three patients, one of whom died. Treatment with interferon beta-1a continued throughout the study.

Result: Alemtuzumab significantly reduced the rate of sustained accumulation of disability, as compared with interferon beta-1a (9.0% vs. 26.2%; hazard ratio, 0.29; 95% confidence interval [CI], 0.16 to 0.54; P<0.001) and the annualized rate of relapse (0.10 vs. 0.36; hazard ratio, 0.26; 95% CI, 0.16 to 0.41; P<0.001). The mean disability score on a 10-point scale improved by 0.39 point in the alemtuzumab group and worsened by 0.38 point in the interferon beta-1a group (P<0.001). In the alemtuzumab group, the lesion burden (as seen on T2-weighted magnetic resonance imaging) was reduced, as compared with that in the interferon beta-1a group (P = 0.005). From month 12 to month 36, brain volume (as seen on T1-weighted magnetic resonance imaging) increased in the alemtuzumab group but decreased in the interferon beta-1a group (P = 0.02). Adverse events in the alemtuzumab group, as compared with the interferon beta-1a group, included autoimmunity (thyroid disorders [23% vs. 3%] and immune thrombocytopenic purpura [3% vs. 1%]) and infections (66% vs. 47%). There were no significant differences in outcomes between the 12-mg dose and the 24-mg dose of alemtuzumab.

Conclusions: In patients with early, relapsing–remitting multiple sclerosis, alemtuzumab was more effective than interferon beta-1a but was associated with autoimmunity, most seriously manifesting as immune thrombocytopenic purpura. The study was not powered to identify uncommon adverse events. (ClinicalTrials.gov number, NCT00050778.)

The New England Journal of Medicine
Volume 359:1786-1801 October 23, 2008
Number 17

Wednesday

 

Alemtuzumab Results Published: Reduced MS Relapses and Accumulation -- Phase 3 Trials Recruiting Patients

Treatment with alemtuzumab (Genzyme Corporation) reduced the accumulation of disability and the frequency of relapses in people with early relapsing-remitting MS, compared to Rebif® (interferon beta-1a, EMD Serono, Inc. and Pfizer, Inc.). Those taking alemtuzumab had a 74% reduction in the risk of MS relapse compared with those on Rebif, and a 71% reduction in the risk for sustained accumulation of disability. Those on alemtuzumab, an immune-suppressing monoclonal antibody, experienced adverse events more frequently, including immune thrombocytopenic purpura (a serious bleeding disorder), thyroid adverse events, and infections. The results, originally reported at medical meetings, have now been published (New England Journal of Medicine 2008 359;17: 30-45), and two Phase 3 trials are currently recruiting participants with relapsing-remitting MS.

Comment: “We are pleased to see potential new treatment options move positively through the MS pipeline,” said John R. Richert, MD, executive vice president for research and clinical programs at the National MS Society. “We look forward to results from the Phase 3 studies now getting underway, which will help determine if this treatment can be used safely and effectively in people with MS.”

Two Phase 3 trials of alemtuzumab, supported by Genzyme Corporation and Bayer Healthcare Pharmaceuticals, are currently recruiting participants.

National Multiple Sclerosis Society
CLICK HERE TO READ THE FULL ARTICLE & LINKS TO RELATED INFORMATION

Labels:


 

Yesterday, Today, and Tomorrow: Diagnostic and Treatment Strategies for Patients With Progressive MS

Aaron Miller, MD, Moderator and Chair; Robert P. Lisak, MD; Steven R. Schwid, MD; Jerry S. Wolinsky, MD Author Information and Disclosures

Release Date: October 15, 2008; Valid for credit through October 15, 2009

Credits Available
Physicians - maximum of 1.75 AMA PRA Category 1 Credit(s) for physicians;
Nurses - 1.5 ANCC contact hours (None of these credits is in the area of pharmacology)

To participate in this internet activity: (1) review the target audience, learning objectives, and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation; (4) view/print certificate View details.

This CME activity is based on transcripts and slides from presentations as delivered by the faculty at the "Yesterday, Today, and Tomorrow: Diagnostic and Treatment Strategies for Patients With Progressive MS" symposium originally presented at Hyatt Regency, Denver, Colorado, on May 28, 2008.

Contents of This CME/CE Activity

  1. IntroductionAvailable As: Slides/Audio | Slides/Transcript

    Part I - Laying the Groundwork
  2. Pathogenesis of Multiple SclerosisAvailable As: Slides/Audio | Slides/Transcript
  3. Diagnostic and Management Challenges of Progressive DiseaseAvailable As: Slides/Audio | Slides/Transcript
  4. Current and Emerging Therapies for the Treatment of Progressive DiseaseAvailable As: Slides/Audio | Slides/Transcript

    Part 2 - Practical Applications
  5. Case Study 1
    Available As: Slides/Audio | Slides/Transcript
  6. Case Study 2
    Available As: Slides/Audio | Slides/Transcript
  7. Questions and AnswersAvailable As: Slides/Audio | Slides/Transcript

Legal Disclaimer

The material presented here does not necessarily reflect the views of Medscape or companies that support educational programming on www.medscape.com. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

Copyright © 2008 Institute for Continuing Healthcare Education (the Institute). All rights reserved. No part of this publication may be reproduced or transmitted in any other form or by any means -- electronic or mechanical -- without first obtaining written permission from the Institute.

Medscape Today

CLICK HERE TO ACCESS THIS CME/CE ACTIVITY FOR MED STUDENTS

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Tuesday

 

Short-latency afferent inhibition predicts verbal memory performance in patients with multiple sclerosis.

BACKGROUND : The pathogenesis of cognitive deficits in multiple sclerosis (MS) patients is the subject of debate.

PubMed - J Neurol. 2008 Oct 7. [Epub ahead of print]

CLICK HERE TO READ THE FULL ABSTRACT & LINKS TO RELATED INFORMATION

 

Clustering of organ-specific autoimmunity: a case presentation of multiple sclerosis and connective tissue disorders.

We further discuss the immunopathogenetic mechanisms for a possible association between MS and autoimmune disorders.

PubMed - Neurol Sci. 2008 Oct 14. [Epub ahead of print]

CLICK HERE TO READ THE FULL ABSTRACT & LINKS TO RELATED INFORMATION


 

Neurogenic continence. Part 1: pathophysiology and quality of ilfe.

There are a number of neurological conditions that cause bladder and bowel problems in the form of neurogenic bladder and bowel dysfunction. Both have a considerable impact on a person's quality of life.

Br J Nurs. 2008 Jul 10-23;17(13):836-41.

CLICK HERE TO READ THE FULL ABSTRACT & LINKS TO RELATED INFORMATION


 

Pain in women with relapsing-remitting multiple sclerosis and in healthy women: a comparative study.

The purpose of this study was to examine multidimensional aspects of pain in women with relapsing-remitting multiple sclerosis (RRMS) and in healthy women.
J Neurosci Nurs. 2008 Oct;40(5):262-8.
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION


 

Cladribine tablets' potential in multiple: sclerosis treatment.

Cladribine tablets now are undergoing phase III development for the treatment of relapsing forms of MS. With the advent of new MS agents such as cladribine tablets, nurses will be critical in monitoring these new therapies.

J Neurosci Nurs. 2008 Oct;40(5):275-80.

CLICK HERE TO READ THE FULL ABSTRACT & LINKS TO RELATED INFORMATION


 

Impact of co-prescribed glatiramer acetate and antihistamine therapy on the likelihood of relapse among patients with multiple sclerosis.

We conducted a retrospective database study to examine the risk of relapse among patients with multiple sclerosis (MS) who were simultaneously prescribed glatiramer acetate (GA) and antihistamine (AH) therapy.

J Neurosci Nurs. 2008 Oct;40(5):281-90.

CLICK HERE TO READ THE FULL ABSTRACT & LINKS TO RELATED INFORMATION



 

Chronic sorrow in next of kin of patients with multiple sclerosis.

The aim of this qualitative study was to explore the presence and meaning of chronic sorrow in a group of next of kin of patients with MS.

PubMed - J Neurosci Nurs. 2008 Oct;40(5):304-11.
CLICK HERE TO READ THE FULL ABSTRACT & LINKS TO RELATED INFORMATION


 

Correlates of sexual dysfunction in men and women with multiple sclerosis.

Sexual dysfunction (SD) is an often overlooked disability in multiple sclerosis (MS).

PubMed - J Neurosci Nurs. 2008 Oct;40(5):312-7.
CLICK HERE TO READ THE FULL ABSTRACT & LINKS TO RELATED INFORMATION


 

The antidepressant venlafaxine ameliorates murine experimental autoimmune encephalomyelitis by suppression of pro-inflammatory cytokines.

In this study, we examined the immunomodulatory properties of venlafaxine, a selective serotonin/norepinephrine reuptake inhibitor (SNRI), in murine experimental autoimmune encephalomyelitis (EAE), a T-cell-mediated CNS demyelinating disease model of multiple sclerosis.

Int J Neuropsychopharmacol. 2008 Oct 16:1-12. [Epub ahead of print]
CLICK HERE TO READ THE FULL ABSTRACT & LINKS TO RELATED INFORMATION

Sunday

 

Quercetin and interferon-beta modulate immune response(s) in peripheral blood mononuclear cells isolated from multiple sclerosis patients.

Department of Neurology, Baird MS Center, Jacobs Neurological Institute, Buffalo, NY, United States.

The study is aimed to determine the role of quercetin (3,3'4',5,7-pentahydroxy flavone), alone and in combination with human interferon-beta (IFN-beta), in modulating the immune response(s) of peripheral blood mononuclear cells (PBMC) isolated from multiple sclerosis (MS) patients and from normal healthy subjects.

PMID: 18926575 [PubMed - as supplied by publisher]
J Neuroimmunol. 2008 Oct 14. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

The persistency of high levels of pSTAT3 expression in circulating CD4+ T cells from CIS patients favors the early conversion to clinically defined MS

Not all patients with clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS) develop clinically defined MS (CDMS).

J Neuroimmunol. 2008 Oct 14. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

Management of optic neuritis and impact of clinical trials: An international survey.

OBJECTIVE: 1) To evaluate the management of acute isolated optic neuritis (ON) by ophthalmologists and neurologists; 2) to evaluate the impact of clinical trials; 3) to compare these practices among 7 countries.

J Neurol Sci. 2008 Oct 14. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

[Translational research in multiple sclerosis.]

Translational research has become a challenge for the health care administration and Neurology Departments.

Neurología 2008;23(9):543-545.
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

[Is fibromyalgia a neurological disease?]

The key feature of fibromyalgia is a chronic pain picture located in different structures of the musculoskeletal system, but without any evidence of disease in them.

PMID: 18925441 [PubMed - in process
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

TYSABRI - Fred Baron, a prominent political donor linked to the John Edwards mistress scandal...

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Ailing Democratic donor obtains experimental drug (Washington Post)

Friday, October 17, 2008; 4:58 AM

DALLAS -- An ailing Democratic fundraiser has obtained an experimental cancer-fighting drug through the Mayo Clinic, according to his son, despite the drug maker's refusal to sanction the treatment.

Fred Baron, a prominent political donor linked to the John Edwards mistress scandal, received the drug Tysabri after a "legal basis" for its use was found, his son Andrew Baron said in an e-mail to The Associated Press. He didn't elaborate.

Baron has described Tysabri as a "last chance effort for life" in his 61-year-old father's battle with late-stage multiple myeloma. Doctors last week gave Fred Baron only days to live, his son said.

Tysabri is approved for people with multiple sclerosis or Crohn's disease, but is only in the early clinical trial stage for multiple myeloma.

Patients can seek to use drugs outside the authorized use under what the Food and Drug Administration calls single-patient investigations. But permission must ultimately come from the drug manufacturer, said Judy Leon, an FDA spokeswoman.

Biogen Idec Inc., which manufactures Tysabri, didn't grant permission to treat Fred Baron with the drug, company spokeswoman Naomi Aoki said late Thursday. Biogen has maintained the regulatory risks of giving him special access to Tysabri are too great.

The company stood by its decision despite appeals from such prominent figures as former President Bill Clinton and cyclist Lance Armstrong.

Andrew Baron said the Mayo Clinic, working with the FDA, found a legal basis for using Tysabri on his father.

Mayo Clinic spokesman John Murphy said he had no information about the case. Leon said the FDA could not comment on individual cases, but said no preferential treatment had been given to Baron.

The FDA approved about 250 single-patient investigations in 2007, Leon said.Fred Baron has bankrolled millions for Democrats in Texas. He made headlines this summer when he acknowledged sending money to Edwards' former mistress. Baron has said Edwards had no involvement with the payments, which were used to resettle Rielle Hunter, Edwards' former mistress, in California.

Aoki has said there is no data showing Tysabri would work in Fred Baron's case. He was turned down for the company's clinical trial, but Aoki said she could not say why.

Click here to go to the Washington Post for the full story

Labels:


 

Two interesting articles on Myelin


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Multiple Sclerosis Discovery Sheds Light On Unravelling Of Nerves' Protective Myelin Sheath

ScienceDaily (Sep. 15, 2004) — Santa Barbara, CA -- Scientists at the University of California, Santa Barbara have made an important discovery that will increase the understanding of multiple sclerosis, a debilitating disease of the central nervous system in which the myelin sheath, an insulating membrane surrounding the nerve cells in the brain and spinal cord, start to unravel for reasons as yet unknown.

In a paper appearing in today's issue (Sept. 14) of the Proceedings of the National Academy of Science, several UC Santa Barbara researchers describe the results of a study that shows why the unraveling occurs.

The myelin sheath is made up of a lipid bilayer (similar to those making up the cell membrane) wrapped many times around the nerve axon -- the part of a nerve cell through which impulses travel away from the cell body.One specific protein, called myelin basic protein, acts to hold the myelin sheath together tightly around the axon. The axons serve as the electrical wires that connect the nerve cells, and the myelin serves as the insulation to keep the electrical impulses flowing quickly and reliably.

http://www.msplinks.com/MDFodHRwOi8vd3d3LnNjaWVuY2VkYWlseS5jb20vcmVsZWFzZXMvMjAwNC8wOS8wNDA5MTUxMTE2NDMuaHRt
Physical Decline Caused By Slow Decay Of Brain's Myelin

ScienceDaily (Oct. 18, 2008) — During this year's baseball playoffs, Chicago White Sox outfielder Ken Griffey Jr., 38, threw a picture-perfect strike from center field to home plate to stop an opposing player from scoring. The White Sox ultimately won the game by a single run and clinched the division title.

Had Griffey been 40, it could be argued, he might not have made the throw in time. That's because in middle age, we begin to lose myelin — the fatty sheath of "insulation" that coats our nerve axons and allows for fast signaling bursts in our brains.

Reporting in the online version of the journal Neurobiology of Aging, Dr. George Bartzokis, professor of psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior at UCLA, and his colleagues compared how quickly a group of males ranging in age from 23 to 80 could perform a motor task and then correlated their performances to their brains' myelin integrity. The researchers found a striking correlation between the speed of the task and the integrity of myelination over the range of ages. Put another way, after middle age, we start to lose the battle to repair the myelin in our brain, and our motor and cognitive functions begin a long, slow downhill slide.


Saturday

 

4-Aminopyridine toxicity with unintentional overdose in four patients with multiple sclerosis.

Aminopyridine has been shown to improve spasticity and ambulatory speed in patients with multiple sclerosis (MS), spinal cord injuries, and neuromuscular diseases.1-4 Four-aminopyridine (4-AP) selectively blocks fast, voltage-gated potassium channels in excitable tissues and increases the influx of calcium at nerve terminals, thereby enhancing neuromuscular transmission.1 It is this mechanism of action, however, that predispose to adverse events, specifically seizures.1,2,5

Given the prevalence of MS in North America and the sizable proportion of patients with progressive ambulatory decline, the use of the aminopyridines is likely to increase. An error in formulation, as occurred in Ontario, has the potential to seriously harm a considerable number of patients. Despite this, aminopyridines have shown effectiveness in patients with MS and spinal cord injury, a population of patients with limited treatment options. When used properly, these medications are beneficial with an acceptable safety profile. However, when morbidity from toxicity is so great and the eligible population so large, preparation by the pharmaceutical industry with the infrastructure, resources, and budget to implement high standards and quality assurance may be the best method to safeguard against such medication errors.

Discussion. The potential for seizure and other severe adverse events with aminopyridine overdose has been recognized in animal and human subjects for decades.1 There are multiple case reports of patients with MS developing seizure activity.1 Although more commonly associated with overdose, seizure events can occur at the recommended dose of 4-AP and with both immediate and extended release formulations. 2,5 In a recent meta-analysis of minopyridine trials, up to 3% of patients experienced adverse events, including seizure and confusion while taking both 4-AP (at doses ranging from 40 mg to 100 mg/day) and 3,4-diaminopyridine.

HighWire Press Stanford University

Excerpts from Neurology ISSN: 0028-3878
CLICK HERE TO READ FULL ARTICLE

 

Anti-GM1 antibodies are not associated with cerebral atrophy in patients with multiple sclerosis.

Objectives: The aim of this study was to correlate the brain atrophy with serum levels of anti-GM1 antibodies in patients with relapsing-remitting multiple sclerosis (RRMS).

HighWire Press Stanford University
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

Switching first-line disease-modifying therapy after failure: impact on the course of relapsing-remitting multiple sclerosis.

Switching first-line DMT in patients with RRMS failing initial therapy may be effective in many cases.

HighWire Press Stanford University
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

Patient education program to enhance decision autonomy in multiple sclerosis relapse management: a randomized-controlled trial.

Background: Contrary to strong recommendations for high-dose intravenous corticosteroid treatment for relapses in multiple sclerosis (MS), uncertainty remains about most aspects of relapse management.

HighWire Press Stanford University
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

Sensory impairments in quiet standing in subjects with multiple sclerosis.

Balance disorders and falls are frequently observed in subjects with multiple sclerosis (MS).

HighWire Press Stanford University
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

Cognitive functioning in children with multiple sclerosis.

Objective: To examine the cognitive functioning of children with multiple sclerosis (MS).

HighWire Press Stanford University
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

High frequency of adverse health behaviors in multiple sclerosis.

Background: Health behaviors influence chronic disease risks in the general population, and may influence health outcomes independently of comorbid diseases.

HighWire Press Stanford University
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

Neuromyelitis optica and multiple sclerosis in sisters.

We report two Venezuelan Caucasian sisters with human leukocyte antigen (HLA) typing.

HighWire Press Stanford University
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

Validation of the Multiple Sclerosis Neuropsychological Screening Questionnaire in Argentina.

Considering the lack of screening technology that would permit neurologists to identify patients who may benefit from formal or more comprehensive assessment of neuropsychological status in patients with multiple sclerosis (MS) in Argentina, we felt the need to validate the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ) developed by Benedict, et al.

HighWire Press Stanford University
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

FTY720 therapy exerts differential effects on T cell subsets in multiple sclerosis.

BACKGROUND: The oral immunomodulator FTY720 has shown efficacy in patients with relapsing multiple sclerosis (MS).

HighWire Press Stanford University
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

Friday

 

Clustering of organ-specific autoimmunity: a case presentation of multiple sclerosis and connective tissue disorders.

Multiple sclerosis (MS) is the most common demyelinating disease caused by an autoimmune inflammatory process in the central nervous system (CNS) and is associated with aberrant immune response to myelin selfantigens.

PubMed - Neurol Sci. 2008 Oct 14. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT

 

How effective is intravenous immunoglobulin for the treatment of relapsing-remitting multiple sclerosis?

Several studies indicate that the benefits of IVIg with respect to relapses and MRI lesion activity compare favorably with those of interferon beta and glatiramer acetate in relapsing-remitting multiple sclerosis (RRMS) or clinically isolated syndromes.

PubMed - Nat Clin Pract Neurol. 2008 Oct 14. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT

Thursday

 

Pro-drugs for indirect cannabinoids as therapeutic agents.

Medicinal cannabis, cannabis extracts, and other cannabinoids are currently in use or under clinical trial investigation for the control of nausea, emesis and wasting in patients undergoing chemotherapy, the control of neuropathic pain and arthritic pain, and the control of the symptoms of multiple sclerosis.

PubMed - Curr Drug Deliv. 2008 Oct;5(4):243-7.
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

Glatiramer acetate-associated, CD30+, primary, cutaneous, anaplastic large-cell lymphoma.

OBJECTIVE: To report the association of the development of a primary, cutaneous, anaplastic large-cell lymphoma after initiation of glatiramer acetate treatment of a patient with relapsing-remitting multiple sclerosis. .

PubMed - Arch Neurol. 2008 Oct;65(10):1378-9
CLICK HERE TO READ FULL ABSTRACT

Wednesday

 

Single brain cell can reactivate paralysed limbs: study


One tiny brain cell is all it takes to restore voluntary movement of paralysed muscles, scientists in the United States reported Wednesday.

In experiments pointing to new treatments for paralysis caused by spinal cord injury or stroke, monkeys learned within minutes to harness the power of a single neuron to activate muscles immobilised by drugs.

There are some 100 billion neurons in the human brain, and the study suggests an unsuspected degree of flexibility in the kinds of tasks they can perform.

"Nearly every neuron we tested could be used to control this type of stimulation," Chet Moritz, lead author and a researcher at the University of Washington, told journalists in a conference call.

If a monkey can do it, a human should be able to do it even better, he said.

Clinical trials, however, are at least several years away, perhaps longer, Moritz added.

Several obstacles remain, however, before this new technique can be tested in humans, he said.

Breitbart.com

CLICK HERE TO READ FULL STUDY & RELATED INFORMATION


Tuesday

 

A role for CB2 receptors in anandamide signalling pathways involved in the regulation of IL-12 and IL-23 in microglial cells.

Together, our results provide the first demonstration of a role of AEA in inhibiting IL-12p70/IL-23 axis in human and murine microglial cells via the CB2 receptor and suggest that the pharmacological manipulation of the endocannabinoid system is a potential tool for treating brain inflammatory and autoimmune diseases, like MS.

PubMed - Biochem Pharmacol. 2008 Sep 20. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

Subdural intrathecal catheter placement: experience with two cases.

Two cases of sudural placement of intrathecal catheters are presented.

PubMed - Pain Physician. 2008 Sep-Oct;11(5):677-80.
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

The association of nocturnal serum melatonin levels with major depression in patients with acute multiple sclerosis.

The association of nocturnal serum melatonin levels was investigated in acute multiple sclerosis (MS) patients with major depression (MD).

PMID: 18848732 [PubMed - as supplied by publisher]
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

 

Invited Article: Professionalism in neurology: The role of law SYMBOL

Professionalism may be defined as the obligation of the physician to uphold the primacy of patients’ interests, to achieve and maintain medical competency, and to abide by high ethical standards.

Neurology - Volume 71(16), 14 October 2008, pp 1283-1288
CLICK HERE TO READ FULL ABSTRACT

Monday

 

Fampridine for MS responders SYMBOL: Clinically relevant or hypothesis generating?

In an article published in this issue, Goodman et al.1 conducted a randomized clinical trial to compare three doses of fampridine (10, 15, and 20 mg twice daily) to placebo for treating multiple sclerosis (MS). Although the trial results were negative, the investigators discovered an innovative method for identifying consistent responders to the drug, providing clinicians with a promising tool for treating a subset of MS patients. Is this a true positive finding or an example of data massaging?

Results of the planned portions of the trial were negative. Comparison of each dose group with placebo yielded nonsignificant results on the primary endpoint (percent change in walking speed on the timed 25-foot walk) as well as on seven of the eight secondary endpoints, despite the fact that the sample size was increased from 38 to a minimum of 50 per dose group to meet the requirements of the US Food and Drug Administration (FDA) on the issue of preserving the type I error rate when comparing multiple doses with placebo.

The only endpoint attaining significance was the change from baseline in lower extremity strength, which showed an improvement of roughly 15% over placebo in both the 10- and 15-mg dose groups. These analyses, however, are based on the mean change or mean percent change from baseline averaged over all patients receiving the same treatment. It is possible that the drug could benefit individual patients, which leads to the clinically appealing concept of a responder analysis.

In light of the nonsignificant Clinician Global Impression, these issues surrounding the responder analysis should be addressed to evaluate the clinical impact of using fampridine to treat MS patients.

Neurology Volume 71(15), 7 October 2008, pp 1130-1131

CLICK HERE TO READ FULL ABSTRACT


Saturday

 

A GREAT VIDEO ABOUT THE 2008 NOBEL PEACE PRIZE WINNERS: "Growing Nerve Cells"

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http://www.youtube.com/watch?v=n0UzdYRnMtY



 

Stress and MS: THE CLEVELAND CLINIC

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Stress and MS: THE CLEVELAND CLINIC

Stress refers to two different things: situations that trigger a reaction (physical and/or emotional) and the response to those triggers. Each individual's experience of stress depends on the nature of the stressor and how the stressor is perceived.

Having a chronic illness can cause and influence stress. MS is no exception. Individuals with MS have the difficult challenge of dealing with:
* The uncertainty of diagnosis (before MS diagnosis, living with symptoms, and no diagnosis)
* The unpredictability of the disease
* The emergence of symptoms (having visible signs of the disease, such as the need for a cane or wheelchair)
* Concerns about finances and job situation
* Dependence on others and not being able to care for others (such as a spouse and children) as before
* The need to modify activities and surroundings to accommodate changes due to MS
* Symptoms that are unexplainable and not understandable

What are the warning signs of stress?
Responses to stressors include physical changes, and emotional and behavioral responses.

Emotional warning signs
* Anger
* Inability to concentrate
* Unproductive worry
* Sadness
* Frequent mood swings

Physical warning signs
* Stooped posture
* Sweaty palms
* Chronic fatigue
* Weight gain or lossBehavioral warning signs
* Over-reacting
* Acting on impulse
* Using alcohol or drugs
* Withdrawing from relationships

What can I do to reduce stress?
* Keep a positive attitude.
* Accept that there are events that you cannot control.
* Be assertive instead of aggressive. "Assert" your feelings, opinions, or beliefs instead of becoming angry, combative, or passive.
* Learn relaxation techniques.
* Exercise regularly. Your body can fight stress better when it is fit.
* Eat well-balanced meals.
* Rest and sleep. Your body needs time to recover from stressful events.
* Don't rely on alcohol or drugs to reduce stress.

How can I learn to relax?
There are a number of exercises that you can do to relax. These exercises include breathing, muscle and mind relaxation, relaxation to music, and biofeedback. A few that you can try are listed below. First, be sure that you have:

1. A quiet location that is free of distractions
2. A comfortable body position (Sit or recline on a chair or sofa.)
3. A good state of mind (Try to block out worries and distracting thoughts.)

Relaxation exercises
* 2-Minute relaxation — Switch your thoughts to yourself and your breathing. Take a few deep breaths, exhaling slowly. Mentally scan your body. Notice areas that feel tense or cramped. Quickly loosen up these areas. Let go of as much tension as you can. Rotate your head in a smooth, circular motion once or twice. (Stop any movements that cause pain.) Roll your shoulders forward and backward several times. Let all of your muscles completely relax. Recall a pleasant thought for a few seconds. Take another deep breath and exhale slowly. You should feel relaxed.
* Mind relaxation — Close your eyes. Breathe normally through your nose. As you exhale, silently say to yourself the word "one," a short word such as "peaceful" or a short phrase such as "I feel quiet." Continue for 10 minutes. If your mind wanders, gently remind yourself to think about your breathing and your chosen word or phrase. Let your breathing become slow and steady.
* Deep breathing relaxation — Imagine a spot just below your navel. Breath into that spot and fill your abdomen with air. Let the air fill you from the abdomen up, then let it out, like deflating a balloon. With every long, slow breath out, you should feel more relaxed. MORE: THE CLEVELAND CLINIC


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