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Early-Stage Multiple Sclerosis Reversed By Stem Cell Transplant

Researchers from Northwestern University's Feinberg School of Medicine appear to have reversed the neurological dysfunction of early-stage multiple sclerosis patients by transplanting their own immune stem cells into their bodies and thereby "resetting" their immune systems.

"This is the first time we have turned the tide on this disease," said principal investigator Richard Burt, M.D. chief of immunotherapy for autoimmune diseases at the Feinberg School.

In the procedure, Burt and colleagues treated patients with chemotherapy to destroy their immune system. They then injected the patients with their own immune stem cells, obtained from the patients' blood before the chemotherapy, to create a new immune system. The procedure is called autologous non-myeloablative haematopoietic stem-cell transplantion.

"We focus on destroying only the immune component of the bone marrow and then regenerate the immune component, which makes the procedure much safer and less toxic than traditional chemotherapy for cancer," Burt said. After the transplantation, the patient's new lymphocytes or immune cells are self-tolerant and do not attack the immune system.

In previous studies, Burt had transplanted immune stem cells into late-stage MS patients. "It didn't help in the late stages, but when we treat them in the early stage, they get better and continue to get better," he said.

"What we did is promising and exciting, but we need to prove it in a randomized trial," Burt noted. He has launched a randomized national trial.

Medical News Today


Fok-I vitamin D receptor gene polymorphism (rs10735810) and vitamin D metabolism in MS.

We demonstrated the importance of the Fok-I VDRG polymorphism for vitamin D metabolism. This should be taken into account in association and ultimately intervention studies on vitamin D and MS. - J Neuroimmunol. 2009 Jan 27. [Epub ahead of print] in PubMed


Spinal cord lesions and clinical status in multiple sclerosis: A 1.5 T and 3 T MRI study.

Despite the use of higher field MRI strength, the link between spinal lesions and MS disability remains weak. The 1.5 T and 3 T protocols yielded similar results for many comparisons. - J Neurol Sci. 2009 Jan 27. [Epub ahead of print] in PubMed


Endurance exercise improves walking distance in MS patients with fatigue.

The present data confirm a strong effect of endurance exercise on maximal walking distance. Remarkably, there were no parallel improvements on the Modified Fatigue Impact Scale, the Beck Depression Inventory and the Hamburg Quality of Life Questionnaire for MS. - Acta Neurol Scand. 2009 Jan 19. [Epub ahead of print] in PubMed


Treating Relapsing Multiple Sclerosis with Subcutaneous versus Intramuscular Interferon-Beta-1a: Modelling the Clinical and Economic Implications.

The EVIDENCE trial concluded that administering high-dose/high-frequency subcutaneous (SC) interferon-beta-1a (IFNb1a) was more effective in preventing relapses among patients with relapsing multiple sclerosis (MS) than low-dose weekly intramuscular (IM) IFNb1a after 64 weeks. - Pharmacoeconomics. 2009;27(1):39-53. doi: 10.2165/00019053-200927010-00005.
in PubMed


The results of two multicenter, open-label studies assessing efficacy, tolerability and safety of protiramer...

Multiple Sclerosis, Vol. 15, No. 2, 238-243 (2009) in Sage Journals Online


Safety and immunogenicity of a new formulation of interferon β-1a (Rebif® New Formulation) in a Phase IIIb study in patients with RRMS: 96-week result

A new formulation of subcutaneous (s.c.) interferon-β-1a has been developed (Rebif® New Formulation, RNF), produced without fetal bovine serum and without human serum albumin as an excipient, with the aim of improving injection tolerability, and reducing immunogenicity. - Multiple Sclerosis, Vol. 15, No. 2, 219-228 (2009) in Sage Journals Online



Longitudinal correlates of fatigue in multiple sclerosis

Multiple Sclerosis, Vol. 15, No. 2, 258-261 (2009) - in Sage Journals Online


Earlier disability of the patients followed in MS centers compared to outpatients

The patients followed in a MS centre had earlier disability than patients managed otherwise. Analyses exclusively conducted in patients with MS supervised in specialized centers may falsely misestimate the times needed to reach major disability landmarks. - Multiple Sclerosis, Vol. 15, No. 2, 251-257 (2009) in Sage Journals Online


Holding personal information in a disease-specific register: the perspectives of people with MS and professionals on consent and access


Interferon-β bioactivity measurement in MS: feasibility for routine clinical practice

To evaluate value and feasibility of IFNβ bioactivity measurement with a single MxA mRNA measurement for screening and a second measurement before and after IFNβ administration for definite confirmation of IFNβ bioactivity status. - Multiple Sclerosis, Vol. 15, No. 2, 212-218 (2009) in Sage Journals Online


Brain atrophy evolution and lesion load accrual in MS: a 2-year follow-up study

In MS, brain atrophy occurs even after a relatively short period of time and in patients with limited progression of disability. Short-term brain atrophy progression rates differ across tissue compartments, as gray matter atrophy results more pronounced than white matter atrophy and appears to be a early phenomenon in the MS-related disease progression. - Multiple Sclerosis, Vol. 15, No. 2, 204-211 (2009) in Sage Journals Online


Cognitive functioning in children with multiple sclerosis

Verbal and non-verbal skills were equally impaired, and patients who were older at the moment of the onset of the disease had a better cognitive performance. Cognitive deficits should be regarded as a common occurrence in the course of MS in children. - Multiple Sclerosis, Vol. 15, No. 2, 266-268 (2009) in Sage Journals Online


Neuromyelitis optica and multiple sclerosis in sisters

These cases confirmed the coexistence of NMO and MS in sisters, and further studies are needed to understand the genetic linkage between these diseases. - Multiple Sclerosis, Vol. 15, No. 2, 269-271 (2009) in Sage Journals Online



[Clinical course of multiple sclerosis in patients treated with immunosuppressive drugs for cancer.]

Rev Neurol. 2009 Jan 16-31;48(2):71-4. - in PUBMED


BREAKING MEDICAL NEWS: Bone Marrow Transplant Shows Promise for MS

CHICAGO, Jan. 29 -- Patients with relapsing-remitting multiple sclerosis had significant improvement in neurologic disability after nonmyeloablative hematopoietic stem cell transplantation, investigators here reported.

After three years of follow-up, 17 of 21 patients maintained at least a one-point improvement in a standard disability scale, Richard K. Burt, M.D., of Northwestern University, and colleagues reported online in The Lancet Neurology.

All patients were progression free at last follow-up, and 16 were relapse free.

"Autologous nonmyeloabalative hematopoietic stem cell transplantation for patients with relapsing-remitting MS with active inflammatory disease and frequent exacerbations is a feasible procedure that not only seems to prevent neurological progression, but also appears to reverse neurological disability," the authors concluded.

However, they noted that "these results need to be confirmed in a randomized trial."

Hematopoietic stem cell transplantation has been evaluated throughout the world as therapy for MS. However, the trials typically involved patients with late secondary-progressive disease, and most had no improvement in neurologic disability, the authors said.

"Neurological deficits during the late secondary-progressive phase of MS are mostly caused by neurodegeneration from axonal atrophy, for which no immune-based therapy, including hematopoietic stem cell therapy, has been effective for reversing the deficits," they noted.

In contrast, they continued, demyelination associated with relapsing-remitting MS is mediated by immune cells. Therapy emphasizes immune modulation to ameliorate inflammatory processes that damage the central nervous system.

Standard therapies aim to delay disease progression. Dr. Burt and colleagues sought to reverse neurologic disability with hematopoietic stem cell transplantation in patients who had not reached the largely irreversible neurodegenerative phase of the disease process.

Their study involved patients whose disease had not responded to immune modulation but was still in an active inflammatory state. The patients' median age was 33, mean baseline expanded disability scale score (EDSS) was 3.1, and median disease duration before transplantation was five years.

The patients received a median infused dose of hematopoietic stem cells of 11·40x106 CD34+ cells per kg, mobilized with 2 g/m2 of cyclophosphamide and 10µg/kg/d filgrastim (Neupogen).

The conditioning regimen for the cells consisted of 200 mg/kg cyclophosphamide and either 20 mg alemtuzumab (Campath) or 6 mg/kg rabbit antithymocyte globulin.

The primary outcomes were progression-free survival and reversal of neurologic disability three years after transplantation.

Engraftment of white cells occurred a median of nine days after transplantation, and hospital length of stay averaged 11 days.

One patient developed diarrhea caused by Clostridium difficile, and two patients had dermatomal zoster. Two of 17 patients treated with alemtuzumab developed late immune thrombocytopenic purpura that resolved with standard therapy.

Five patients relapsed but achieved remission again after immunosuppressive therapy.

After a mean follow-up of 37 months, 81% of patients had improved by at least one point on the EDSS.

As determined by EDSS scores, the patients had significant improvement in neurologic disability (P<0.0001).>

Significant improvement also occurred in the neurologic rating scale (P=0.0001), paced auditory serial addition test (P=0.014), 25-foot walk (P<0.0001),>P<0.0001).>

In an accompanying commentary, Gianluigi Mancardi, M.D., of the University of Genova in Italy, noted that the conditioning regimen plays a major role in the success of hematopoietic stem cell transplantation.

He noted that the regimen used by Dr. Burt and colleagues caused "modest, if not negligible" toxicity.

The fact that five patients relapsed, suggested that "nonmyeloablative conditioning regimens might not be sufficient to eradicate inflammatory activity in the long term."

Despite the relapses, Dr. Mancardi continued, "the results imply that this [conditioning regimen] is a valuable alternative to the transplant conditioning therapies used so far."

MedPage Today



Early interferon beta treatment in multiple sclerosis: nursing care implications of the BENEFIT study.

Interferon beta (IFNbeta) is a first-line treatment for relapsing forms of multiple sclerosis (MS) that can reduce the rate of clinical attacks and limit disability progression. - J Neurosci Nurs. 2008 Dec;40(6):356-61. - in PUBMED


Daclizumab treatment for multiple sclerosis.

Daclizumab may be an alternative or add-on therapy when conventional immunomodulators fail or when existing approved therapies cannot be used. Besides ongoing phase II trials, additional phase II or III trials are required to determine the extended benefits of the agent, as well as clinical outcomes. - Pharmacotherapy. 2009 Feb;29(2):227-35. in PUBMED


Age of puberty and the risk of multiple sclerosis: a population based study.

Earlier age at menarche increases the risk of MS in women. Whether this association is a surrogate for a disease causative factor or directly involved in MS disease aetiology needs to be uncovered. - Eur J Neurol. 2008 Dec 23. [Epub ahead of print] - in PUBMED


Trigeminal neuralgia and pain related to multiple sclerosis.

Pain. 2009 Jan 24. [Epub ahead of print] - in PUBMED


Omega-3 fatty acid supplementation decreases matrix metalloproteinase-9 production in relapsing-remitting multiple sclerosis(,).

Omega-3 FA significantly decreased MMP-9 levels in RRMS and may act as an immune-modulator that has potential therapeutic benefit in MS patients. - Prostaglandins Leukot Essent Fatty Acids. 2009 Jan 24. [Epub ahead of print] - in PUBMED


Use of cognitive aids and other assistive technology by individuals with multiple sclerosis.

Disabil Rehabil Assist Technol. 2009 Jan;4(1):1-8. - in PUBMED


A multiparametric evaluation of regional brain damage in patients with primary progressive multiple sclerosis.

Hum Brain Mapp. 2009 Jan 26. [Epub ahead of print] - PUBMED


Exploring the relationship between white matter and gray matter damage in early primary progressive MS: An in vivo study with TBSS and VBM

Hum Brain Mapp. 2009 Jan 26. [Epub ahead of print] - PUBMED


News & Video: Diets May Improve Memory

Reducing Calorie Intake May Be Good for Memory
Now, researchers have shown a definite link between caloric restriction (CR) and mental function, according to a study published Monday in the journal Proceedings of the National Academy of Sciences.


Economic evaluation of treating clinically isolated syndrome and subsequent MS with interferon beta-1b.

Neurol Sci. 2009 Jan 24. [Epub ahead of print] - PUBMED


Experiences of partners of people in the early stages of multiple sclerosis.

The aim of this study was to explore and describe the experiences of partners of people who are in the relatively early stages of multiple sclerosis. - Mult Scler. 2009 Jan 23. [Epub ahead of print] - PUBMED


Deep gray matter atrophy in multiple sclerosis: A tensor based morphometry.

J Neurol Sci. 2009 Jan 23. [Epub ahead of print] - PUBMED


The Prevalence of Overweight and Obesity in Veterans with Multiple Sclerosis.

Interventions to prevent and manage excessive weight in individuals with MS should be developed and evaluated. - Am J Phys Med Rehabil. 2009 Feb;88(2):83-91.



Azathioprine for multiple sclerosis.

Azathioprine (AZA) is an immunosuppressive drug widely prescribed for the treatment of multiple sclerosis (MS) until the first half of the 1990s. It could be an alternative to interferon beta because it is less expensive. - . Neurol. Neurosurg. Psychiatry, February 1, 2009; 80(2): 131-2; discussion 132. - HighWire Press Stanford University


The contribution of cerebrospinal fluid oligoclonal bands to the early diagnosis of MS.

ConclusionOB can improve overall diagnostic Accuracy by increasing Specificity and negative predictive value. - Multiple Sclerosis, January 19, 2009; - HighWire Press Stanford University


Structural equation modeling of disability in women with fibromyalgia or MS.

Social support and depressive symptoms mediated the effect of functional limitations on disability. Interventions that target modifiable characteristics, such as depression and social support, may improve outcomes such as disability. - West J Nurs Res, February 1, 2009; 31(1): 89-109. - HighWire Press Stanford University



Pedometer step counts in individuals with neurological conditions.

To examine the accuracy of measuring step counts using a pedometer in participants with neurological conditions and healthy volunteers in relation to a manual step count tally. - Clin Rehabil. 2009 Feb;23(2):171-175. - PubMed


Reflexology and progressive muscle relaxation training for people with MS: A crossover trial.

CONCLUSION: Positive effects of both treatments following sessions and over the 6 weeks of treatment are reported, with limited evidence of difference between the two treatments, complicated by ordering effects. - Complement Ther Clin Pract. 2009 Feb;15(1):14-21. Epub 2008 Oct 1. - PubMed


Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with MS

Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007256. - PubMed


Anticholinergics for urinary symptoms in multiple sclerosis.

AUTHORS' CONCLUSIONS: From the available evidence we cannot advocate the use of anticholinergics in MS. - Cochrane Database Syst Rev. 2009 Jan 21;(1):CD004193.


Interferon Beta for primary progressive multiple sclerosis.

Therapeutic trials with ss-interferon in Multiple Sclerosis (MS) have mainly focused on remitting-relapsing multiple sclerosis (RRMS), demonstrating a reduction in relapse rate. However, there is not enough evidence about their efficacy in patients with primary progressive multiple sclerosis (PPMS). - Cochrane Database Syst Rev. 2009 Jan 21;(1):CD006643.


Optic nerve diffusion changes and atrophy jointly predict visual dysfunction after optic neuritis.

Neuroimage. 2009 Jan 7. [Epub ahead of print] in PUBMED



Germany's Merck pulls ahead in race for MS pill

FRANKFURT/LONDON, Jan 23 (Reuters) - Merck KGaA pulled ahead of Novartis in the race to develop the first pill for multiple sclerosis on Friday, announcing it planned to submit its drug cladribine for approval in mid-2009.......... full story


Epstein-Barr Virus is Associated with Gray Matter Atrophy in Multiple Sclerosis

The aim was to determine whether the presence of anti-Epstein Barr virus (EBV) antibodies is associated with magnetic resonance imaging (MRI) measures of brain injury and neurodegeneration in multiple sclerosis (MS) patients. -J Neurol Neurosurg Psychiatry Online


The effect of levetiracetam on tremor severity and functionality in patients with multiple sclerosis

To investigate the effects of levetiracetam, an antiepileptic drug, on tremor severity and related functionality in MS. - Multiple Sclerosis 2009, doi:10.1177/1352458508099142
Sage Journals Online


Experiences of partners of people in the early stages of multiple sclerosis

The research illustrates the disruptive impact that MS has on partners' lives and highlights the need for support to focus on partners' needs even in early stages of the disease. -Multiple Sclerosis 2009, doi:10.1177/1352458508100048 - Sage Journals Online


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. - Journal of Child Neurology, Vol. 24, No. 1, 56-62 (2009) - Sage Journals Online


Disconnection as a mechanism for cognitive dysfunction in MS

Disconnection of cognitively important processing regions by injury to the interconnecting white matter provides a potential mechanism for cognitive dysfunction in multiple sclerosis. - Brain 2009 132(1):239-249; doi:10.1093/brain/awn275 - Brain Journal of Neurology Oxford Press



BREAKING NEWS ON: Cladribine tablets..."Merck’s Multiple Sclerosis Pill Prevents Relapses"


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Merck’s Multiple Sclerosis Pill Prevents Relapses

(Bloomberg) -- Merck KGaA, the German drugmaker seeking to be first with an oral medicine for multiple sclerosis, said its experimental pill cladribine prevented flare-ups of the debilitating neurological disease in a study.

Patients who took the pill suffered 55 to 58 percent fewer relapses, depending on the dose, than those who took a placebo during the two-year study, the Darmstadt, Germany-based company said today.

The German drugmaker said it is on track to submit an application for approval to European and U.S. regulators by the middle of this year. Merck shares climbed 5.53 euros, or 8.6 percent, to 69.89 euros in Frankfurt.

Cladribine tablets are among several oral medications for multiple sclerosis now in the final stage of clinical testing.

Used to treat leukemia since the 1990s, the drug reduces the number of lymphocytes, white blood cells believed to be linked to multiple sclerosis, a disease in which the body’s immune system attacks the central nervous system. Side effects of headaches and cold symptoms were comparable in the dummy pill and cladribine patient groups, Merck said today.

Merck and Swiss drugmaker Novartis AG have said they will ask regulators in the U.S. and Europe this year to approve pills to treat the disease. Novartis released preliminary results last month showing its pill, known as fingolimod, cut relapse rates as much as 52 percent more than a standard therapy.

Side Effects
Merck already makes Rebif, one of the three beta interferons now commonly prescribed for multiple sclerosis. The injected drug, which will begin to lose patent protection in 2012, had 1.22 billion euros ($1.68 billion) in sales in 2007.

Patient advocates will be watching the long-term side effects of cladribine, which was given over a shorter time period to leukemia patients than it likely will be to multiple sclerosis sufferers, said Dr. Doug Brown, research manager for the Multiple Sclerosis Society in London, before today’s results were released. Brown said they will also want to see whether the oral medicines slow progression of the disease.

Merck and Novartis have said they will present full clinical trial results for their experimental pills at medical conferences later this year. Merck said the new study, which it funded, followed about 1,300 patients.



BREAKING NEWS: "FDA allows first test of human stem cell therapy"


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FDA allows first test of human stem cell therapy

WASHINGTON (Reuters) - The U.S. Food and Drug Administration has cleared the way for the world's first study of human embryonic stem cell therapy, Geron Corp said on Friday.

The California biotechnology company plans to start a clinical trial to try to use the stem cells to regrow nerve tissue in patients with acute spinal cord injury.

"This marks the beginning of what is potentially a new chapter in medical therapeutics -- one that reaches beyond pills to a new level of healing: the restoration of organ and tissue function achieved by the injection of healthy replacement cells," Geron Chief Executive Thomas Okarma said in a statement.

Shares of Geron rose nearly 30 percent to $6.75 in premarket electronic trading on Nasdaq.

The FDA rejected his company's first request to conduct the trial of GRNOPC1, Oligodendroglial Progenitor Cells. It put the trial on hold in May."

If GRNOPC1 eventually does become the first human Embryonic Stem Cell drug to receive an approved Biologic License Application it could be as important to drug therapy as the discovery of Salvarsan or penicillin," drug analysts Stephen Brozak and Daniel Mallin of WBB Securities LLC said in a statement.

Salvarssan was the first modern drug, used to treat syphilis early in the last century.

Joel Sendek of Lazard Capital Markets was cautious, saying he was recommending a hold in Geron shares. "Cellular-based therapies carry substantially more regulatory risk than do traditional small-molecule drugs or protein therapeutics," he said.

Former President George W. Bush had been at odds with Congress, researchers and advocates for years over the issue and by executive order restricted federal funding of work involving human embryonic stem cells.

President Barack Obama, who succeeded Bush on Tuesday, had been widely expected to rescind that directive. Although the FDA says it does not make decisions based on politics, the company made the decision public just days after Obama was sworn into office.

Stem cells are the body's master cells, giving rise to all the tissues, organs and blood. Embryonic stem cells are considered the most powerful kinds of stem cells, as they have the potential to give rise to any type of tissue.

But they are difficult to make, requiring the use of an embryo or cloning technology. Geron and some other companies have been pursuing the goal without the use of federal funds.

Advocates say stem cell-related research could lead to a whole new field of regenerative medicine, in which patients could get transplants and treatments for Parkinson's, juvenile diabetes, cancer, injuries and a range of other ills.

"If safe and effective, the therapy would provide a viable treatment option for thousands of patients who suffer severe spinal cord injuries each year," Richard Fessler, professor of neurological surgery at the Feinberg School of Medicine at Northwestern University said in a statement.



A clinically isolated syndrome: A challenging entity : Multiple sclerosis or collagen tissue disorders: Clues for differentiation.

J Neurol. 2008 Nov;255(11):1625-35. Epub 2009 Jan 21.


[Dynamic stabilometry as a monitoring of movement and coordination disorders in the rehabilitation of patients with multiple sclerosis.]

The results of the study may provide further determination of the approaches to the development of rehabilitation stabilometric algorithms. - Zh Nevrol Psikhiatr Im S S Korsakova. 2009;109(1):35-39. - PUBMED


[Pathology of the thyroid gland and multiple sclerosis: a possible influence on efficacy and tolerability of treatment.]

This paper reviews the literature and own data on prevalence of thyroid diseases in patients with multiple sclerosis (MS). It has been shown that 20-25% of untreated MS patients have autoimmune thyroiditis (AIT) and/or subclinical hypothyroidism. - Zh Nevrol Psikhiatr Im S S Korsakova. 2009;109(1):10-15. - PUBMED


Treadmill exercise in early multiple sclerosis: a case series study.

The effect of specific exercise therapy programs on the management of balance and walking disorders in multiple sclerosis (MS) patients have not been fully explained yet. - Eur J Phys Rehabil Med. 2009 Jan 21. [Epub ahead of print] - PUBMED


Electrodiagnostic assessment in optic nerve disease.

Electrophysiology, combined with clinical and imaging investigations, is a powerful diagnostic and monitoring tool. Macular dysfunction can mimic optic nerve disease in the absence of fundus abnormality. - Curr Opin Neurol. 2009 Feb;22(1):3-10. - PUBMED


Peripheral nerves are progressively involved in MS - A hypothesis from a pilot study of temperature sensitized electroneurographic screening.

Multiple sclerosis (MS) is primarily a disease of the central nervous system. Although the involvement of the peripheral nervous system in MS was suggested over 100 years ago, the issue is still controversial, and it is generally accepted that except for the optic nerve the peripheral nerves are left unaffected by the disease. - Med Hypotheses. 2009 Jan 18. [Epub ahead of print] - PUBMED


Personality traits in women with multiple sclerosis: Discrepancy in patient/partner report and disease course.

Patients diagnosed with multiple sclerosis (MS) are believed to undergo personality changes, which could have implications for how they perceive themselves and are perceived by others. - J Psychosom Res. 2009 Feb;66(2):147-54. Epub 2008 Nov 22 - PUBMED


Personality traits in women with multiple sclerosis: Discrepancy in patient/partner report and disease course.

Patients diagnosed with multiple sclerosis (MS) are believed to undergo personality changes, which could have implications for how they perceive themselves and are perceived by others. - J Psychosom Res. 2009 Feb;66(2):147-54. Epub 2008 Nov 22 - PUBMED



Soluble IL-2RA Levels in Multiple Sclerosis Subjects and the Effect of Soluble IL-2RA on Immune Responses

Multiple sclerosis (MS) is an organ-specific autoimmune disorder that is in part genetically determined. The gene encoding the -chain of the IL-2 receptor, IL2RA, harbors alleles associated with risk to MS and other autoimmune diseases.
The Journal of Immunology, 2009, 182: 1541-1547.


Serum vitamin B12, folate, and homocysteine levels and their association with clinical and electrophysiological parameters in MS.

Patients with multiple sclerosis (MS) may have low serum vitamin B12 and folate levels and high levels of homocysteine. We aimed to evaluate serum vitamin B12, folate, homocysteine, mean corpuscular volume (MCV), hemoglobin (Hb), and hematocrit (Hct) levels in patients with MS. - J Clin Neurosci. 2009 Jan 17. [Epub ahead of print] - PubMed


Coping strategies, psychological variables and their relationship with quality of life in MS.

Orienting therapeutic interventions, to oppose depression and anxiety and to favour more appropriate coping strategies can improve the patients' QoL. - Neurol Sci. 2009 Jan 20. [Epub ahead of print] - PubMed


Effects of infectious mononucleosis and HLA-DRB1*15 in multiple sclerosis.

Both human leukocyte antigen (HLA)-DRB1*15 and Epstein-Barr virus infection presenting as infectious mononucleosis (IM) are recognized as risk factors for multiple sclerosis (MS). - Mult Scler. 2009 Jan 19. [Epub ahead of print] - PubMed


Motor evoked potentials in clinically isolated syndrome suggestive of multiple sclerosis.

This study demonstrates that MEP, especially the AR, is sensitive to motor pathway dysfunction right from the early stages of MS. Mult Scler. 2009 Jan 19. [Epub ahead of print] - PubMed


The burden of mental comorbidity in multiple sclerosis: frequent, underdiagnosed, and undertreated.

Mental comorbidity remains underdiagnosed and undertreated in MS. Patients of lower socioeconomic status bear a disproportionate share of the burden of depression. - Mult Scler. 2009 Jan 19. [Epub ahead of print] - PubMed



Association of alpha-Synuclein Immunoreactivity With Inflammatory Activity in Multiple Sclerosis Lesions.

Multiple sclerosis (MS) has neurodegenerative features including neuronal and axonal loss and widespread atrophy of the brain and spinal cord. The cause of this neurodegeneration has been largely attributed to inflammation, but other mechanisms, including those associated with classic neurodegenerative diseases such as the alpha-synucleinopathies, might also be involved in MS pathogenesis. - J Neuropathol Exp Neurol. 2009 Jan 15. [Epub ahead of print] - PubMed


Structural Equation Modeling of Disability in Women with Fibromyalgia or Multiple Sclerosis.

Structural equation modeling (SEM), a popular statistical technique for analysis of multivariate data in the social sciences, is increasingly being used in the behavioral and clinical sciences. -West J Nurs Res. 2009 Feb;31(1):89-109. - PubMed


Structural Equation Modeling of Disability in Women with Fibromyalgia or Multiple Sclerosis.

Structural equation modeling (SEM), a popular statistical technique for analysis of multivariate data in the social sciences, is increasingly being used in the behavioral and clinical sciences. -West J Nurs Res. 2009 Feb;31(1):89-109. - PubMed


Azathioprine for multiple sclerosis.

Azathioprine (AZA) is an immunosuppressive drug widely prescribed for the treatment of multiple sclerosis (MS) until the first half of the 1990s. It could be an alternative to interferon beta because it is less expensive. Concerns about its safety, mainly a possible increased risk of malignancy, have been raised. This systematic review aimed to determine the trade off between the benefits and risks of azathioprine in MS. - J Neurol Neurosurg Psychiatry. 2009 Feb;80(2):131-132.



Lessons from multiple sclerosis: models, concepts, observations.

Experimental autoimmune encephalomyelitis (EAE) is often termed "the" model of human multiple sclerosis (MS). This is, however, an oversimplification. MS is a multifaceted disorder, with no single experimental model representing the entire complexity of the human disease.
Ann Rheum Dis, December 1, 2008; 67 Suppl 3: iii56-60. - HighWire Press Stanford University


Angiotensin-converting enzyme (ACE) and ACE2 levels in the cerebrospinal fluid of patients with multiple sclerosis.

Multiple Sclerosis, January 9, 2009; . - HighWire Press Stanford University


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

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, January 1, 2009; 18(1): 78-80. - HighWire Press Stanford University


Daclizumab in treatment of multiple sclerosis patients

Our aim was to assess its safety and tolerability in our patient population. -Multiple Sclerosis, January 9, 2009; - HighWire Press Stanford University


Women Coping Successfully With Multiple Sclerosis and the Precursors of Change.

In this qualitative study, we explored the question of why some women with progressive forms of multiple sclerosis (MS) cope successfully in spite of disease progression.
Qual Health Res, December 17, 2008; . - HighWire Press Stanford University


Can rate of brain atrophy in multiple sclerosis be explained by clinical and MRI characteristics?

We concluded that variance in brain atrophy rates can partially be explained by clinical and MRI measures of disease. Future atrophy rates in individual MS patients are difficult to predict even when including previous atrophy rates. -Multiple Sclerosis, December 17, 2008; - HighWire Press Stanford University


Oral fingolimod (FTY720) in multiple sclerosis: two-year results of a phase II extension study.

Once-daily oral treatment with FTY720, 1.25 or 5.0 mg, for up to 2 years, was well tolerated and was associated with low relapse rates and lesion activity.
Neurology, January 6, 2009; 72(1): 73-9. - HighWire Press Stanford University


Increased relapse rate in pediatric-onset compared with adult-onset multiple sclerosis.

To investigate whether or not the disparity in disease progression in those with pediatric-onset compared with adult-onset multiple sclerosis (MS) is due to differences in relapse rates. - Arch Neurol, January 1, 2009; 66(1): 54-9. - HighWire Press Stanford University


Imaging correlates of leukocyte accumulation and CXCR4/CXCL12 in MS.

Arch Neurol, January 1, 2009; 66(1): 44-53. - HighWire Press Stanford University


FDA Says Avoid All Products Containing Peanut Butter

ROCKVILLE, Md., Jan. 19 -- Consumers should not eat products containing peanut butter until they can be cleared of a connection to the ongoing nationwide salmonella outbreak, the FDA warned.

The recommendation does not apply to name-brand jars of peanut butter available in grocery stores, which have not been implicated in the rash of infections.

The following recalls have been announced:
Kellogg Company recalled certain Austin and Keebler brand peanut butter sandwich crackers and some snack-size packages of Famous Amos and Keebler peanut butter cookies.

Hy-Vee Inc. recalled its Peanut Butter Cookies, Monster Cookies, Peanut Butter Reese's Pieces Cookies, Peanut Butter Chocolate Chip Cookies, Lunchbox Reese's Pieces Cookies, Lunchbox Peanut Butter Cookies, People Chow Party Mix, and Assorted Truffle Fudge.

Perry's Ice Cream recalled select ice cream products sold under the brand names Perry's, Shurfine, and Wegmans that contain peanut butter sauce.

McKee Foods Corporation recalled all sizes of Little Debbie Peanut Butter Toasty sandwich crackers and Little Debbie Peanut Butter Cheese sandwich crackers.

The South Bend Chocolate Company recalled several varieties of chocolate containing peanut butter.

Ralcorp Frozen Bakery Products recalled several varieties of peanut butter cookies, including some of those sold under the Wal-Mart Bakery and Food Lion Bake Shop brands.

The FDA will keep track of these and other related recalls at the following Web site: Salmonella Typhimurium Outbreak.

"In terms of food products that contain peanut butter but have not yet been recalled," Dr. Sundlof said, "we urge consumers to postpone eating these products until further information becomes available about whether that product may be affected."

The more severe illnesses have involved older and very young individuals, as well as those with weakened immune systems. - Full Story in Medpage Today



Management strategies for improving the tolerability of interferons in the treatment of MS.

Interferon beta therapies for multiple sclerosis (MS) are well tolerated during long-term use, but the first year of treatment is a critical risk period for nonadherence and discontinuation. Some of the most common reasons for discontinuation include adverse effects (including flu-like symptoms and injection site reactions). Minimizing the impact of adverse effects is crucial in helping patients adhere to their treatment regimens, and improving their chances of better health over the longer term. Can J Neurosci Nurs. 2008;30(4):18-25. - PUBMED


First Clinical Study on Ultra-High-Field MR Imaging in Patients with MS: Comparison of 1.5T and 7T.

Ultra-high-field imaging of patients with MS at 7T was well tolerated and provided better visualization of MS lesions in the gray matter and demonstrated structural abnormalities within the MS lesions themselves more effectively. AJNR Am J Neuroradiol. 2009 Jan 15. [Epub ahead of print] - PUBMED



The multiple sclerosis severity score (MSSS) predicts disease severity over time.

The MSSS may allow the prediction of disease severity over time, and is consistent with the lack of a major impact of disease-modifying drugs upon disease severity as measured by the MSSS. These results need to be verified in a larger cohort of patients. - J Neurol Sci. 2009 Jan 10. [Epub ahead of print] PUBMED


Imaging correlates of leukocyte accumulation and CXCR4/CXCL12 in multiple sclerosis.

Arch Neurol. 2009 Jan;66(1):44-53. PubMed


Continued disease activity in a patient with multiple sclerosis after allogeneic hematopoietic cell transplantation.

Despite high-dose, cytotoxic, immunosuppressive therapy and exchange of a presumed autoreactive immune system with a healthy immune system, MS in this patient continued to be active. - Arch Neurol. 2009 Jan;66(1):116-20. PubMed


Idiopathic chiasmal neuritis: clinical features and prognosis.

The demographic and clinical features of idiopathic chiasmal neuritis resemble those of idiopathic optic neuritis. Visual prognosis is excellent. In this series, 40% of patients subsequently developed multiple sclerosis. - Arch Ophthalmol. 2009 Jan;127(1):76-81.
in PubMed


Increased relapse rate in pediatric-onset compared with adult-onset multiple sclerosis.

Relapses are more frequent in patients with pediatric-onset compared with adult-onset MS in the disease-modifying treatment era. This finding suggests that patients with pediatric-onset MS experience a more inflammatory disease course than patients with adult onset of the disease.
Arch Neurol. 2009 Jan;66(1):54-9. - PUBMED



Daclizumab in treatment of multiple sclerosis patients.

Our aim was to assess its safety and tolerability in our patient population.
Mult Scler. 2009 Jan 9. [Epub ahead of print] - PubMed


"Do Patients Trust Doctors Too Much?" -The New York Times


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Do Patients Trust Doctors Too Much?

When a doctor friend of mine recently heard a radio ad for a Web site where patients could rate their doctors, he almost drove off the road.

“I can’t believe they’ve added doctors to the list,” he said of the site, Angie’s List, perhaps best known for its user-generated report cards on local contractors.

“Why do patients want to assess my relationship with them in the same way they evaluate a roofing job?” he asked, shaking his head over what he interpreted to be more evidence of the disintegrating doctor-patient relationship.

I agreed with my friend and, not long after our conversation, curiosity piqued, I paid for a subscription to the site.

The pages seemed to overflow with information. There were reviews of roofers, childcare providers, dog walkers and tattoo and piercing shops. One of the newest and most popular categories was doctors, where reviewers could grade their doctors by answering the site’s specific questions and elaborate with additional comments.

Doctors, like every other business, service, and facility listed, were evaluated using the same generic report card. Everyone received a grade for each of five categories — price, quality, responsiveness, punctuality, and professionalism — as well as an answer to the all-important bottom line question: Hire again?

So much for Marcus Welby, I thought, after going through a couple of the reviews.

But the more I read, the more I realized that there was a correlation between good grades and attentiveness. Reviewers gave less-than-passing, and even failing, grades to those physicians who seemed rushed, brusque or distracted; and they uniformly gave “A’s” and “B’s” to doctors who were warm, concerned and focused.

Even more could be gleaned from what went unsaid. Amongst the many comments I read, I found almost no mention of a doctor’s actual medical skill.

That was not the case with roofers, for example, where in addition to grades, reviewers’ comments offered great specifics — and even photographs — regarding the quality of the handiwork, the types of supplies used and the aesthetics of the finished product. All the detailed commentaries fleshed out each company’s final grades, and it was easy to get a pretty good sense of an individual roofer’s skill and craftsmanship.

With doctors, however, there were no detailed descriptions of medical skill beyond the overall grade. Instead, the playing field seemed oddly level.

One surgeon, it appeared, could operate much like another; pediatricians and internists could diagnose and manage with similar abilities; and obstetricians could deliver babies regardless of shape, size, or form.

All doctors, whatever their grades, seemed to possess similar and interchangeable skills that they could then apply to you. You just might not like the way they treated you in the process.

I found this extraordinary degree of trust astonishing. When I look for a doctor, of course I am concerned about how that doctor relates to me as a patient. But there are a whole host of other issues I consider as well, such as the physician’s training, board certification, experience, membership in a respected professional society, safety records and hospital affiliations. And I admit that I don’t feel comfortable as a patient in another doctor’s hands until I learn the answers to at least some of my questions.

But as it turns out, most patients don’t feel the same way. And many of them are just as trusting when it comes to treatment specifics.

Earlier this year, the American College of Surgeons, the national scientific and educational organization of surgeons, conducted a nationwide survey that found that the average patient devotes an hour or less to researching his or her surgery or surgeon. While prospective patients worry about the costs or complications of an operation, they don’t necessarily look for information that would address their concerns.

In fact, more than a third of patients who had an operation in the last five years never reviewed the credentials of the surgeon who operated.

Patients are more likely to spend time researching a job change (on average, about 10 hours) or a new car (8 hours) than the operation they are about to submit to or the surgeon who wields the knife.

And many patients are satisfied with the answers they receive from their surgeon or primary care doctor, whoever those individuals happen to be.

I was intrigued by the survey, so I called Dr. Thomas Russell, executive director of the American College of Surgeons. “There is a tendency, probably more so now than in the era of Marcus Welby, for patients not to get particularly involved and not to feel compelled to look into their surgery or surgeons,” he told me.

There are consequences to that kind of blind trust. “Today, medicine and surgery are really team sports,” Dr. Russell continued, “and the patient, as the ultimate decision maker, is the most important member of the team. Mistakes can happen, and patients have to be educated and must understand what is going on.”

Dr. Russell has made it part of his personal mission to educate patients and recently wrote a book, “I Need an Operation...Now What? A Patient’s Guide to a Safe and Successful Outcome,” as a response to the survey. ”Patients and their families need to be armed with the fortitude and the right questions in order to find the best doctors for their problems,” he said.

In other words, a healthy doctor-patient relationship does not simply entail good bedside manners and responsible office management on the part of the doctor. It also requires that patients come to the relationship educated about their doctors, their illnesses and their treatment.



BREAKING NEWS: "Early Biogen Drug Seeks To Repair MS Damage"


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IN THE PIPELINE: Early Biogen Drug Seeks To Repair MS Damage

NEW YORK -(Dow Jones)- Reversing the damage done by multiple sclerosis would be a dream come true for patients of the debilitating disease, and there is some promising research working toward that goal.

The condition is thought to occur when the body literally attacks itself and current therapies only seek to slow or stop that situation. But Biogen Idec Inc. (BIIB) is developing a drug that may repair the damage to the nervous system from the disease, a prospect that could also aid victims of other neurological conditions.

"This is the first entry into our clinical pipeline, or really in anyone else's pipeline that we are aware of, for a truly restorative therapy for MS," said Ken Rhodes, vice president of discovery neurobiology at Biogen.

Though the Cambridge, Mass., biotech company is hopeful for the drug's development, it is yet to be tested in humans and, assuming success, it wouldn't be available to patients for many years.

Much remains unknown about multiple sclerosis, but it is thought to be an autoimmune disease that occurs when the body attacks myelin, the protective insulation surrounding the nerve fibers called axons in the central nervous system. The myelin damage can distort or block messages carried by the axons and result in a wide variety of symptoms such as vision problems, limb numbness and paralysis.

Though the cause is a mystery, MS is thought to develop from some degree of genetic predisposition working in combination with environmental triggers earlier in the life. It is more common in women and tends to develop between the ages of 20 and 50, according to the National Multiple Sclerosis Society.

Current treatments for the disease all involve trying to alter the immune system's ability to attack the nervous systems, notes John Richert, executive vice president of research and clinical programs for the MS Society.

A popular group of drugs are the beta-interferons, which reduce disease flare ups and are similar to proteins that play a role in the immune system. Those are Biogen's Avonex, Bayer AG's (BAY.XE) Betaseron, and Rebif, marketed by Pfizer Inc. (PFE) and Germany's Merck KGaA (MRK.XE).

Teva Pharmaceuticals Industries Inc. (TEVA) makes Copaxone, which seems to fight the nerve-attacking immune cells by acting as a myelin decoy. Biogen and partner Elan Plc (ELN) also sell Tysabri, which prevents those immune cells leaving the blood stream so that they can't get to the brain or spinal cord.

Early Success

The focus of much of Biogen's current discovery research in MS is focused on restorative therapy, but its most advanced program is led by biologist Sha Mi, who joined the company in 2000 and studied why the axons in MS lesions weren't generating new myelin.

Research found that cells called oligodendrocytes were being prevented from undergoing the needed differentiation for them to build new myelin.

Furthermore, Mi found that the so-called LINGO molecule was inhibiting that differentiation and that using an antibody to block LINGO's function could allow myelin to regenerate.

"When we block LINGO function, we can see robust oligodendrocyte differentiation, and they interact with the axon for remylination," said Mi.

The antibody has been shown to be effective in mouse models that are accepted as being useful for mimicking the properties of MS.

The antibody helped the mice grow new myelin, and it also helped with the integrity of the nerve fibers, in comparison to untreated mice, thus aiding nerve function. More myelin growth occurred closer to the site of the antibody application, also suggesting its responsibility for the effects.

The research showed that the antibody didn't prevent the loss of myelin in an animal model, but it did reduce the effects of disease progression.

Though the development is clearly exciting, the antibody is only in toxicity studies that are expected to be completed later this year.

Biogen expects to file an Investigational New Drug application with Food and Drug Administration in the fourth quarter and begin human studies starting shortly thereafter.

Rhodes noted that the next goal is to conduct proof-of-concept studies to determine if the drug inhibits LINGO function in humans with the same positive effects.

Hopeful Future

The possibility of repairing damage done by MS and reducing symptoms of the disease would be revolutionary for MS patients, but Dr. Richert believes that currently used therapies are likely to continue as the best treatment for new patients who may not have a lot of nerve damage.

Regeneration would be used on patients who already have neurological deficits, he said, as well as those whose disease continues to progress regardless of treatment.

In order to provide the best benefit, Dr. Rhodes said that the anti-LINGO antibody would likely be used in combination with one of the more traditional immunosupressive approaches.

"As you dampen the immune response, you treat with anti-LINGO to try and actually facilitate recovery and repair," he said.

If successful, the antibody could have a future in treating other neurological disease such as Parkinson's, or even help repair damage done to the spinal cord.

Biogen has a number of programs to explore the antibody's use in other diseases but is cautious on any of those prospects.

"The preclinical data supporting the utility of those indications isn't as well developed yet as it is with MS," Dr. Rhodes said.

Last year, research was published on another Biogen pipeline product, a protein called neublastin, that promoted the regeneration of damaged sensory nerve cells in order to restore sensory and motor function. The drug is being studied to treat peripheral nervous system diseases.

full story - CNN Money

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Video Presentations from the 2008 Rare Neuroimmunologic Disorders Symposium

Acute Therapies: Steroids, IVIG, Plasmaexchange and Cyclophosphamide, Benjamin M. Greenberg, MD, MHS, Johns Hopkins University, Baltimore, MD

Choosing a Treatment for New Diagnosis of Multiple Sclerosis, Kathleen M. Costello, MS, CRNP, University of Maryland Medical Center, Baltimore, MD

Future Immunotherapies and Neuroprotective therapies ,Mariko Kita, MD, Virginia Mason MS Center, Seattle, Washington

Fatigue in Autoimmune Neurological Diseases, Kathleen M. Costello, MS, CRNP, MRCP (UK), MSCN, University of Maryland Medical Center, Baltimore, MD

Demoralization, Depression and Cognitive Impairment in MS, TM NMO & Other CNS Autoimmune Diseases, Adam I. Kaplin, MD, PhD, Johns Hopkins University, Baltimore, MD

Medical and interventional approaches to Neuropathic Pain and Paresthesias, Denise Taylor, MD, University of New Mexico, Albuquerque, NM

Sexual Dysfunction in Multiple Sclerosis and other Demyelinating Diseases, Bobbie Severson, ARP, MS Center at Evergreen, Kirkland, WA

Bladder Dysfunction and Management, Claire C. Yang, MD, University of Washington, Seattle, WA

Spasticity Management, Frank Pidcock, MD, Kennedy Krieger Institute, Baltimore, MD

Patient Centered Care: The Role of Self-management, Stephen Wegener, PhD, Johns Hopkins University, Baltimore, MD

Self advocacy and employment with disabilities, Sandy Hanebrink, OTR/L

Obstetric Issues in Women with Demyelinating Disease, Benjamin M. Greenberg, MD, MHS & Donna Chattin, BSN, RN

The Genetics of Autoimmunity, Benjamin M. Greenberg, MD, MHS

High Dose Cyclophosphamide (HiCy) in Multiple Sclerosis, Chitra Krishnan, MHS, Adam I. Kaplin, MD, PhD, Johns Hopkins University, Baltimore, MD

Hematopoietic Stem Cell Transplantation in Multiple Sclerosis, James Bowen, MD, MS Center at Evergreen, Kirkland, WA

Optical Coherence Tomography (OCT) and neuroprotection, Laura J. Balcer, MD,University of Pennsylvania, Philadelphia, PA

Neurorehabilitation - now and the future, Kathleen M. Zackowski, PhD, OT, Kennedy Krieger Institute, Baltimore, MD

Stem Cells and Neuroregeneration – The Future, Douglas A. Kerr, MD, PhD, Johns Hopkins University, Baltimore, MD


Audio Presentation - 2008 World Congress for the Treatment and Research of Multiple Sclerosis (WCTRMS 2008):

New Data From the World Congress: First-Line Therapy, Modified Treatment, and Emerging Options in Multiple Sclerosis CME/CE Bruce A. Cree, MD, PhD, MCR, University of California San Francisco San Francisco, California

Updates in Multiple Sclerosis: New Data on First-Line Therapy, Modified Treatment, and Emerging Options CME/CE Barry A. Singer, MD, Missouri Baptist Medical Center, St. Louis, Missouri

Improving Outcomes in Newly Diagnosed Relapsing-Remitting MS: Focus on Early Intervention and Long-Term Treatment CME/CE Timothy Vollmer, MD, University of Colorado, Denver, Colorado

Should We "Mess With Success?" Evaluating Modified Treatments and Dosing in Multiple Sclerosis CME/CE Timothy Vollmer, MD, University of Colorado, Denver, Colorado

Emerging Strategies in Multiple Sclerosis: Innovative Agents and New Treatment Approaches CME/CE Bruce A. Cree, MD, PhD, MCR, University of California San Francisco, San Francisco, California

Doctor's Guide Publishing


VIDEO - Researchers From UT Southwestern are Studying a Drug that May Help Spasticity -- a Common Side Effect for Patients With MS

Attacking Multiple Sclerosis


New Interferon Formulations Promise To Eliminate Injections In MS Treatment

Nerveda Inc. and Aegis Therapeutics LLC today announced preclinical results from their joint collaboration aimed at developing non-injectable formulations of the beta-interferons. The beta interferons, beta-1a (tradename Rebif(R)), and beta 1b (tradenames Betaseron(R) and Betaferon(R)) are closely related injectable protein drugs in the interferon family that are used to treat both the relapsing-remitting and secondary-progressive forms of multiple sclerosis (MS). The beta interferons are currently administered by subcutaneous injection and have been proven clinically to slow the advance of multiple sclerosis and reduce the frequency of attacks. Current worldwide combined annual sales of Rebif(R), Betaseron(R) and Betaferon(R) are approximately $4 Billion.

Because proteins are large and fragile molecules, they cannot be administered orally and are typically administered by injection. They are often subject to instability due to aggregation of the protein molecules -- particularly upon storage and handling at non-refrigerated temperatures. The resulting protein aggregates are more poorly absorbed into the blood stream upon injection due to their increased size, and induce development of circulating antibodies to interferon in patients that reduce the effectiveness of the drug over time.

Leading medical scientists at Johns Hopkins University, expert in the treatment of neurological diseases, in collaboration with Nerveda and Aegis have applied Aegis' Intravail(R) transmucosal absorption enhancement, and ProTek(R) protein stabilization technologies to address these problems and have demonstrated for the first time that the beta interferons can be administered intranasally to prevent nerve damage in preclinical animal models of multiple sclerosis. In addition, the new formulations were shown to reduce or eliminate the immunogenicity of Betaseron(R) and Rebif(R), administered either by injection or intranasally, while substantially increasing stability in a stress test involving constant agitation at elevated temperatures for extended periods of time.

Dr. Edward Maggio, Ph.D., CEO of Aegis Therapeutics, who participated in the research, said, "since interferons will continue to be the foundation of MS therapy, it is critical that non-invasive delivery options for patients be developed." Maggio also indicated, "the reduction in immunogenicity and the increase in stability also address a significant unmet need of the currently available beta-interferon therapies."

Nerveda plans to begin testing the new formulation in clinical trials in early 2009 in collaboration with clinicians and scientists at John Hopkins University Medical Center and other sites.

For more information about Aegis, please visit the Aegis website at: Therapeutics LLC

For full story - Medical News Today

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WEBCAST - Managing the Consequences of MS: A Multidisciplinary Approach to Improving the Quality of Life

Click for webcast : Managing the Consequences of Multiple Sclerosis: A Multidisciplinary Approach to Improving the Quality of Life

Faculty: Francois Bethoux, MD Susan E. Bennett, PT, EdD, NCS Patricia Kennedy, RN, CNP, MSCN Randall T. Schapiro, MD
CME Credit hour: 1.0

This program focuses on the signs and symptoms of multiple sclerosis, its affect on quality of life, and current pharmacologic and rehabilitation treatment options. The program also contains an interesting case study.



Biogen Says No New Brain Infections In First Tysabri Update

By Thomas Gryta Of DOW JONES NEWSWIRES NEW YORK -(Dow Jones)- Biogen Idec Inc. (BIIB) reported that there were no new cases of a rare brain infection in users of its multiple sclerosis drug Tysabri in the first of its planned weekly Web-based updates on Friday.

The Cambridge, Mass., biotech, which sells Tysabri with Ireland's Elan Plc (ELN), will post the updates in an effort to more consistently disclose incidences of the often fatal condition.

A suspected link to progressive multifocal leukoencephalopathy, or PML, led to Tysabri being pulled from the market for 18 months beginning in 2005. Since the relaunch, the company has reported that four people had confirmed cases of PML, with one dying.

This past summer marked the two-year anniversary of Tysabri's re-launch, raising Wall Street's anxiety over PML-related news. The timeline is important because two patients with PML in 2005 were using the drug for more than two years.

Biogen will post an update of PML cases on the investor relations section of its Web site every Friday at 4:30 p.m. EST and will continue to do so until July 24, which is the third anniversary of the drug's relaunch.

"I think it is going to provide a lot of clarity and almost realtime information to the market to really make decisions and evaluate the situation," said Citigroup analyst Yaron Werber.

Werber has criticized Biogen's former policy of disclosing new cases through 8-K filings with the Securities and Exchange Commission as making investors nervous and pressuring the company's shares.

Biogen's stock, which closed up 30 cents, or 0.6%, at $48.25, is down 17% for the last 12 months.

Elan closed Friday down 31 cents, or 3.6%, at $8.39 and is down 67% in the last year. Tysabri is Elan's biggest seller, making it more sensitive to related news, plus it was hurt by disappointing data over the summer from an Alzheimer's disease drug in development with Wyeth (WYE).

Werber expects the regular updates to help ease of the "fear of the unexpected" in Biogen shares. He agrees with stopping the disclosures in late July, when a clear picture of the PML risk in Tysabri should be firmly established. "

At some point they would be wise to cut this off," he said. "Because this sort of information is going to be very good for the competition. You can't go on marketing a product in this situation forever."


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WEBCAST - 2008 World Stem Cell Summit - Spinal cord injury and multiple sclerosis

Advocate: Sabrina Cohen, Sabrina Cohen Foundation for Stem Cell Research
Foundation: Timothy Coetzee, Fast Forward, LLC
Scientist: Ian Duncan, University of Wisconsin-Madison
Scientist: Hans Kierstead, University of California-Irvine
Scientist: Wise Young, Rutgers University
Moderator: Su Chun Zhang, University of Wisconsin-Madison
2008 World Stem Cell Summit Web Seminar


Webcast - How to setup an MS Center and make it pay

If you enjoyed hearing Dr. Rick Munschauer lecture at the annual meeting 2008, this podcast is an opportunity to revisit the concepts and evolution of his system for making an MS center profitable. Practical and timely suggestions abound in this interesting and engaging session. And, for audio and powerpoint slides from the original workshop given with Anne Dunne, please click here.
Consortium of Multiple Sclerosis Centers - CMSC Online



2008 CMSC Annual Meeting Audio Slides: Neuromyelitis Optica


AUDIO WEBCAST - Top Ten Things to Look for on an MRI in the Workup of CIS

Experience the excellent lecture of Dr. Traboulsee through this podcast as he shares his expertise in the fields of MRI, image analysis, functional MRI, MR spectroscopy and magnetic transfer. Be informed of the step-wised approach in dealing with MS by going over his audio and web slides presentations during the 2008 Annual Meeting. Click here for the complete preview.
The Consortium of Multiple Sclerosis Centers


Video Presentation - Spasticity in Multiple Sclerosis

The Consortium of Multiple Sclerosis Centers presents a special Web-based Video Presentation
Evaluation and Management of Spasticity in Multiple Sclerosis with the spasticity management team from the Mellen Center for MS Treatment and Research at The Cleveland Clinic in Cleveland, Ohio
Consortium of Multiple Sclerosis Centers (CMSC)


VIDEO PODCAST - Maryland Health Today - Multiple Sclerosis Update

Dr. Walter Royal, director of the Maryland Center for MS at the University of Maryland Medical Center. Dr. Royal is also an associate professor of neurology at the University of Maryland School of Medicine.

This interview covers the symptoms, diagnosis and latest treatments for MS, as well as some recent advances and research initiatives that offer hope to people who have MS.

Video Podcast from the University of Maryland - Part 1 & Part 2


VIDEO - New hope for multiple sclerosis sufferers

A drug which was developed in Cambridge and initially designed to treat a form of leukemia has also proven effective against combating the debilitating neurological disease multiple sclerosis (MS). The study, led by researchers from the University of Cambridge, has found that alemtuzumab not only stops MS from advancing in patients with early stage active relapsing-remitting multiple sclerosis (RRMS) but may also restore lost function caused by the disease.
University of Cambridge - News Video


VIDEO - Progressive MS: Potential New Therapeutic Target

A new Mayo Clinic study found that two particular enzymes were elevated in patients with progressive multiple sclerosis (MS). The levels of these enzymes also were associated with the patients’ levels of disability. This gives researchers new hope in developing a therapy for patients with progressive MS.

Watch Mayo Clinic neuroscientist Isobel Scarisbrick, Ph.D., discuss multiple sclerosis and the results of a study that identified a potential new therapy for progressive multiple sclerosis on YouTube.



Unbiased treatment effect estimates by modeling the disease process of multiple sclerosis.

Gadolinium-enhancing lesions in the brain are commonly used as a primary outcome measure of disease activity in phase I/II clinical trials in multiple sclerosis (MS). - J Neurol Sci. 2008 Dec 31. [Epub ahead of print] - PubMed


Prospects for Antigen-Specific Tolerance Based Therapies for the Treatment of MS.

A primary focus in autoimmunity is the breakdown of central and peripheral tolerance resulting in the survival and eventual activation of autoreactive T cells. - Results Probl Cell Differ. 2009 Jan 8. [Epub ahead of print] - PubMed


NF-kappaB, a potential therapeutic target for the treatment of multiple sclerosis.

Herein, the role of NF-kappaB in MS will be reviewed and its potential as a new therapeutic target in MS will be considered and compared with existing treatments. - CNS Neurol Disord Drug Targets. 2008 Dec;7(6):536-57. - PubMed


Chronic myeloid leukaemia in two multiple sclerosis patients on interferon beta-1a.

Haematological problems are commonly associated with use of beta-interferon in multiple sclerosis (MS) patients. However these problems are usually benign and are reversible when the drug is stopped. - J Clin Pharm Ther. 2009 Feb;34(1):125-7. - PubMed


The Multiple Sclerosis Risk Sharing Scheme Monitoring Study - early results and lessons for the future.

This study aimed to assess the feasibility of risk sharing schemes, looking at long term clinical outcomes, to determine the price at which high cost treatments would be acceptable to the NHS.
BMC Neurol. 2009 Jan 6;9(1):1. [Epub ahead of print] - PubMed


Desensitization in Interferon-beta1a Allergy: A Case Report.

We report a 41-year-old patient with multiple sclerosis (MS) who was successfully desensitized after she developed non-injection-site urticaria and angioedema due to interferon (IFN)-beta1a.
Int Arch Allergy Immunol. 2009 Jan 6;149(2):178-180. [Epub ahead of print] - PubMed


Negative affect predicts subsequent cognitive change in MS.

Baseline predictors of cognitive change were explored in a sample of persons with multiple sclerosis (MS). Potential predictors included demographic features, baseline clinical characteristics, and psychological state. - J Int Neuropsychol Soc. 2009 Jan;15(1):53-61.


Switching to Second-Line Therapies in Interferon-Beta-Treated Relapsing-Remitting MS Patients.

Our study highlights the role of disability and high relapse rate in the first 2 years of treatment in predicting long-term response and the switching to second-line therapies. - Eur Neurol. 2009 Jan 8;61(3):177-182. [Epub ahead of print] in PubMed


BREAKING NEWS: "FDA Approves Tramadol Extended-Release Formulation for Chronic Pain"


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


FDA Approves Tramadol Extended-Release Formulation for Chronic Pain

January 6, 2009 — Labopharm announced that the Food and Drug Administration (FDA) has approved an extended-release once-daily formulation of tramadol (Ryzolt) for the management of moderate to moderately severe chronic pain.

The new formulation of tramadol uses the company's proprietary controlled-release technology (Contramid) for oral administration of existing solid-dosage medications and is the first approval in the United States obtained by Labopharm for 1 of these compounds.

A statement from the company announcing the approval on December 31 notes that the formulation is "composed of a dual-matrix delivery system with both immediate-release and extended-release characteristics." Labopharm and marketing partner in the United States, Purdue Pharma, anticipate launching the product in 100-mg, 200-mg, and 300-mg dosage strengths in the second quarter of 2009, the statement adds.

"In a society where people with pain are increasingly demanding simplified dosing regimens, this once-daily formulation of tramadol should be embraced by physicians and patients alike," Nicholas J. Messina III, MD, from Vista Medical Research, in Mesa, Arizona, principal investigator of the US clinical studies of Ryzolt, said in the company release.


Testes stem cell can change into other body tissues, Stanford/UCSF study shows

STANFORD, Calif. — Scientists at the Stanford University School of Medicine and at UC-San Francisco have succeeded in isolating stem cells from human testes. The cells bear a striking resemblance to embryonic stem cells — they can differentiate into each of the three main types of tissues of the body — but the researchers caution against viewing them as one and the same....full news release in Stanford School of Medicine


Elan shares soar over Pfizer takeover rumour

Speculation that Pfizer is looking at acquiring Elan Corp has seen the Irish drugmaker’s stock leap 45% this week, and analysts have been weighing up whether such a deal would make sense.....full story in PharmaTimes


Deep Brain Stimulation Bests Medical Therapy for Advanced Parkinson's Disease

January 8, 2009 — Results of a randomized trial show that compared with best medical therapy, deep brain stimulation (DBS) increased "on" time without dyskinesias and improved motor function as well as quality of life at 6 months in patients with moderate to severe Parkinson's disease (PD), but at the cost of increased serious adverse events (SAEs).....full story in Medscape Today


Facet Biotech to lay off 78

Daclizumab and volociximab are being developed in collaboration with Biogen Idec Inc., the former employer of Facet President and CEO Faheem Hasnain, while elotuzumab is in development with Bristol-Myers Squibb Co.
San Francisco Business Times



Alert The Elanians: A Bull's On The Loose

Don't look now, but in the first week of the new year shares of Elan are up 30 percent. ELN stock lost nearly three-quarters of its value last year on safety concerns about the multiple sclerosis drug Tysabri, which it shares with Biogen Idec, and efficacy concerns over the Alzheimer's drug it's developing with Wyeth.
Pharma's Market - CNBC



Osteoporosis treatment puts brakes on bone loss

Osteoporosis treatment may involve medication along with lifestyle change. A Mayo Clinic specialist answers some of the most common questions about osteoporosis treatment.
The Mayo Clinic


Slide show: Exercises for osteoporosis

Don't let osteoporosis rob your bones of their strength. Here are some exercises to prevent or treat this common bone disease.
The Mayo Clinic


Immunomodulation and postpartum relapses in patients with MS

Multiple sclerosis (MS) mainly affects young women during a life period with desire for children. Relapse rate decreases during pregnancy and rises after delivery. Therefore, studies on satisfactory postpartum relapse prevention and its efficacy are essential.
Therapeutic Advances in Neurological Disorders, Vol. 2, No. 1, 7-11 (2009)
Sage Journals Online


Review: Psychopathology in MS: diagnosis, prevalence and treatment

Demyelinization of nerve fibres not only affects the motor and sensory systems functionally, but may also cause psychopathological signs and symptoms. -Therapeutic Advances in Neurological Disorders, Vol. 2, No. 1, 13-29 (2009) - Sage Journals Online





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STANFORD, Calif. — On his first day as attending physician at Stanford, Abraham Verghese, MD, suggested to the ward team that they leave the "bunker" and head out to their patients' bedsides.

"They probably felt that everything I would need to get up to speed on our patients — the necessary images, the laboratory results — was right there in the team room," Verghese wrote in an essay in the Dec. 25 issue of the New England Journal of Medicine. "From my perspective, the most crucial element wasn't."

Verghese makes it quite clear in his journal article: the "chart-as-surrogate-for-the-patient" approach to medical care is no replacement for the skilled, hands-on physical exam.

The advent of computerized medical records and easy availability of diagnostic tests has led to physicians getting to meet the "iPatient" — the virtual construct of a patient based on all the lab tests and imaging — even before they meet the real live human version waiting nearby in a hospital bed.

Speaking about this virtual entity, he writes, "The iPatient's blood counts and emanations are tracked and trended like a Dow Jones Index…. The real patients keep the beds warm and ensure that the folders bearing their names stay alive on the computer."

Describing his article as a reflective essay and a "manifesto for what we are trying to do here," Verghese writes about the new push at Stanford to emphasize and improve bedside examination skills in students and residents in internal medicine, and calls for a similar national effort at all medical schools.

Long a champion of hands-on medicine, Verghese, a best-selling author, arrived at the Stanford University School of Medicine in December 2007 to serve as professor of medicine and senior associate chair for a new program in the theory and practice of medicine. Board-certified in three specialties — internal medicine, pulmonary diseases and infectious diseases — he is widely published in scientific literature and is also a bestselling author. His next book, the novel Cutting for Stone, is due out this month.

In his article, Verghese describes a dialectic tension between the two approaches to patient care. In the first, the traditional or old-school method, the patient's body tells the story. The doctor works as "bedside-sleuth" using inspection and palpitation along with the help of technology to determine a treatment course. Well-trained in the use of tuning forks, stethoscopes and knee hammers, he or she can detect disease in the appearance, in the gait, in a pulse, well before the relevant test might even be ordered.

"I truly believe that good bedside skills make residents more efficient," Verghese wrote. Doctors who rely on hands-on skills tend to order tests more judiciously, reducing the number of unnecessary and expensive trips to the radiology department, he said.

"In a health care system in which our menu has no prices, we can order filet mignon at every meal," Verghese warned.

The hands-on approach also inspires patient confidence in physicians — a difficult-to-measure commodity that many health-care advocates warn has long been in decline. "There's a reason people seek out alternative medicine in droves," Verghese said in an interview. "Those people put hands on a patient."

The growing trend toward the second method — one that focuses on the "iPatient" — parallels the recent explosion in medical technology, Verghese wrote. While not formally taught, "residents seem to have learned it no matter where in the United States they trained."

It's a simple case of putting the cart before the horse.

Today's doctors spend an "astonishing among of time in front of the monitor" charting in the electronic medical record, moving patients through the system, examining tests results. And medical students learn through example. "In short, bedside skills have plummeted in inverse proportion to the available technology," he wrote.

But Verghese doesn't blame technology for this trend. Instead, he turns his attention toward medical education and educators like himself. "How did we reach this state of affairs?" he wrote. "The fault is ours as teachers of medicine."

Today's routine graduation of medical students without serious testing of physical exam skills is akin to licensing pilots without "ever having been in the air with a seasoned examiner," he wrote. "The public would be scandalized."

Verghese suggested U.S. medical schools "might take a lesson from Canada," where physicians are required to pass bedside examination skills tests. And he emphasized the importance of role-modeling by teachers.

At Stanford, the internal medicine department has instituted regular bedside rounds and faculty-development sessions showcasing good bedside technique as a step in that direction, he wrote.

"What is tragic about tending to the iPatient," Verghese wrote, "is that it can't begin to compare with the joy, excitement, intellectual pleasure, pride, disappointment, and lessons in humility that trainees might experience by learning from the real patient's body examined at the bedside."

Stanford University Medical Center integrates research, medical education and patient care at its three institutions — Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital at Stanford. For more information, please visit the Web site of the medical center's Office of Communication & Public Affairs at

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