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Sunday, September 23, 2018

Therapeutic potentials of ginger for treatment of Multiple sclerosis: A review with emphasis on its immunomodulatory, anti-inflammatory and anti-oxidative properties.

Review article
Jafarzadeh A, et al. J Neuroimmunol. 2018.

Abstract

Multiple sclerosis (MS) is characterized by chronic inflammatory response-induced demyelination of the neurons and degeneration of the axons within the central nervous system (CNS). A complex network of immunopathological-, inflammatory- and oxidative parameters involve in the development and advancement of MS. The anti-inflammatory, immunomodulatory and anti-oxidative characteristics of the ginger and several of its components have been indicated in some of experimental and clinical investigations. The possible therapeutic potentials of ginger and its ingredients in the treatment of MS may exert mainly through the regulation of the Th1-, Th2-, Th9-, Th17-, Th22- and Treg cell-related immune responses, down-regulation of the B cell-related immune responses, modulation of the macrophages-related responses, modulation of the production of pro- and anti-inflammatory cytokines, down-regulation of the arachidonic acid-derived mediators, interfering with the toll like receptor-related signaling pathways, suppression of the inflammasomes, down-regulation of the oxidative stress, reduction of the adhesion molecules expression, and down-regulation of the expression of the chemokines and chemokine receptors. This review aimed to provide a comprehensive knowledge regarding the immunomodulatory-, anti-inflammatory and anti-oxidative properties of ginger and its components, and highlight novel insights into the possible therapeutic potentials of this plant for treatment of MS. The review encourages more investigations to consider the therapeutic potentials of ginger and its effective components for managing of MS.

PMID

 30243185 [ - as supplied by publisher]

Full text



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The Bayesian risk estimate at onset (BREMSO) correlates with cognitive and physical disability in patients with early multiple sclerosis.

Abstract

BACKGROUND: Prevention of long-term disability is the goal of therapeutic intervention in Relapsing Remitting MS (RRMS). The Bayesian Risk Estimate for MS at Onset (BREMSO) gives an individual risk score predicting disease evolution into Secondary Progressive MS (SPMS). We investigated whether BREMSO correlates with physical disability, cognitive dysfunction, and regional brain atrophy early in MS.
METHODS: One hundred RRMS patients with at least two years of follow-up were enrolled. BREMSO score as well as Symbol Digit Modalities Test (SDMT) and Multiple Sclerosis Severity Score (MSSS), Timed 25-Foot Walk Test (T25-FW) and 9-Hole Peg Test (9-HPT), were assessed. Intracranial volume (ICV), subcortical gray matter structures and corpus callosum (CC) were automatically segmented on MRI images and their volumes measured.
RESULTS: BREMSO score correlated negatively with SDMT at visit1 (β = -0.33, p = 0.019), visit2 (β = -0.34, p = 0.017) and visit3 (β = -0.34, p = 0.014), and positively with MSSS at visit1 (r = 0.38, p = 0.006), visit2 (r = 0.47, p < 0.0001) and visit3 (r = 0.42, p = 0.002), but not with T25-FW and 9-HPT. BREMSO negatively correlated with CC volume at baseline (p < 0.03). No correlations were found with ICV and subcortical gray matter.
CONCLUSIONS: BREMSO score at onset correlated with physical disability (MSSS), cognitive function (SDMT) and CC volume measurements in patients with early MS.
Copyright © 2018. Published by Elsevier B.V.

PMID

 30243236 [ - as supplied by publisher]

Full text



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Things to Know About Flu Shots if You Have MS

The start of flu season here in the United States is just a few weeks away. It’s time for my wife and me to get our flu shots, just as we have for as long as I can remember. My neurologist and our primary care physician both recommend the shot.
Many people, particularly those of us with MS, have questions or concerns about these shots. Each year I’ve found social media forums are filled with flu shot debates. Based on what I’ve seen, some of those debates are based on facts but others will be based on unsupported, or poorly supported, opinion. Let’s talk facts.
Things to Know About Flu Shots if You Have MS

READ MORE


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Gilenya More Effective Than Avonex in Lowering Relapse Rates, New Lesions in Children with Relapsing MS, Phase 3 Trial Shows

Gilenya More Effective Than Avonex in Lowering Relapse Rates, New Lesions in Children with Relapsing MS, Phase 3 Trial Shows
Two years of treatment with oral Gilenya (fingolimod) significantly reduced the rate of relapses when compared to Avonex (interferon beta-1a) intramuscular injections in children and adolescents with relapsing forms of multiple sclerosis (RMS), according to Phase 3 clinical trial results.
Additionally, Gilenya (marketed by Novartis) decreased the number of central nervous system (CNS) lesions as observed with magnetic resonance imaging (MRI) over the same period.
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Learning to Advocate for Yourself with MS: A Guide


When you speak up or act on behalf of your rights and well-being, you’re self-advocating. If you have multiple sclerosis (MS), self-advocacy enables you to have more control over how your condition affects your life.
Self-advocacy is important in all aspects of your life. Your family, friends, healthcare team, and co-workers all need to know how they can support you and help you minimize the impact of your MS. Don’t be afraid to speak up when you need to.

At home

Your family is an important support network in your MS journey. Be clear about the support you need, but also about the ways in which you’re still independent and capable. If your MS symptoms are creating new limitations, adjust your household roles accordingly. For example, you may no longer be able to carry a basketful of laundry up the stairs, but you could take over someone else’s job of folding.
Remind family members about the invisible cognitive problems that can develop with MS. This may include problems with high-level brain functions such as memory, focus, language, or problem-solving. The next time you’re forgetful or unable to focus, your family won’t misinterpret it as a lack of caring. When you’re tired, tell them — don’t assume they already know. Make sure that you communicate clearly and regularly.
Recognize and respect that each person in your household has their own coping mechanism when faced with a challenging situation. Some might prefer to immerse themselves in learning about your condition while others would rather be distracted from thinking about it. Tailor your self-advocacy communication to the comfort level of each family member.
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More Than Just Spasms and Pain: What It's Like to Live with MS

Written by Caroline Craven on September 22, 2018

Feeling disconnected from their bodies, people with multiple sclerosis find ways to adapt.

Getty Images

Creating a sense of well-being can help mitigate the negative effects of multiple sclerosis.
That’s what researchers in the Netherlands are saying in their recent study on the debilitating disease.
With multiple sclerosis (MS), the body can start to fail and falter due to various symptoms.
Feelings of “I can” are replaced with “I might be able to.”
“I still remember the first time I experienced muscle spasms in my arm and leg. I could no longer walk or sit normally. It scared me and made me wonder whether it was really my body as I felt totally disconnected from [it],” one person with MS recalled.
As the body is able to do less, experts advise healthcare professionals and people living with MS to focus on the what the body can do.
“I would like to know whether this paper resonates with the MS community,” Hanneke van der Meide-Vijvers, one study author and a postdoctoral researcher at Tranzo Tilburg University, told Healthline. “When it comes to healthcare practice, I strongly advocate a phenomenological perspective in which we start from lived experience rather than a body-mind dualism.”

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Friday, September 21, 2018

What Do We Know About Pediatric MS?

Prevalence

Although MS occurs most commonly in adults, it is also diagnosed in children and adolescents. Estimates suggest that 8,000-10,000 children (up to 18 years old) in the United States have MS, and another 10,000-15,000 have experienced at least one symptom suggestive of MS. Studies suggest that two to five percent of all people with MS have a history of symptom onset before age 18.

Diagnosis & symptoms

Diagnosing MS in children is more challenging than in adults due to the frequency of other childhood disorders with similar symptoms and characteristics. Pediatricians may not be familiar with MS because they are not expecting to see it in children. Children with MS benefit from comprehensive carethrough multidisciplinary teams that include pediatric and adult MS experts.

Once diagnosed, almost all children are considered to have relapsing-remitting MS, with most symptoms of MS similar to those seen in adults. There are, however, symptoms experienced by children that are not typical in adults, such as seizures and mental status changes (lethargy).
  • Children often experience more frequent relapses than adults with early MS.
  • Increasing evidence suggests a slower disease course in children with MS, but significant disability can accumulate at an earlier age compared to individuals with adult onset MS.
In children and adolescents MS may affect academic performance, family relations, and can further complicate typical issues like self-image and relationships with peers. An evaluation by a trained professional can help determine appropriate interventions, and resources are  available to help you navigate the school system through the Pediatric MS Support Group.

Treating pediatric MS

In 2018 the U.S. Food and Drug Administration approved the expansion of the use of the oral MS therapy Gilenya® (fingolimod, Novartis AG) to include the treatment of children and adolescents 10 years of age or older with relapsing MS.  In addition, many of the disease modifying therapies that are FDA approved for adults are also prescribed off-label for pediatric MS.

Other oral therapies for MS, including dimethyl fumarate (Tecfidera®) and teriflunomide (Aubagio®), are currently under study in clinical trials for the treatment of pediatric MS.  An observational study of natalizumab showed that the safety and efficacy in children were similar to that in the adult MS population.  Smaller retrospective studies, case studies and unblinded controlled trials have demonstrated safety and efficacy of the self-injected MS disease modifying therapies.

In addition to the FDA approved therapies used for pediatrics, another treatment, that is not FDA approved for MS, known as rituximab (Rituxan®), has been studied in small trials of pediatric patients and showed that it was safe and effective.

Ultimately, starting or switching a disease modifying therapy in children and adolescents requires that the provider, child and family have an in-depth discussion. This discussion should include the goals and expectations of the child and family, how the drug is expected to control the MS, the side effects, the risks and any monitoring (blood tests, MRI and other tests) after the therapy is started. In this way, providers, patients and families can participate in a shared decision-making process to determine the therapy that best meets individual needs.

The International Pediatric MS Study Group has written a series of articles, highlighting the advances, unanswered questions and challenges in diagnosing and treating MS in children. These articles have been published in a supplement to the journal Neurology. A publication from the Multiple Sclerosis International Federation (MSIF) summarizes the key points from each of these articles.

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Thursday, September 20, 2018

Trial of fingolimod vs interferon beta-1a in pediatric multiple sclerosis

New England Journal of Medicine — Chitnis T, et al. | September 14, 2018

In this phase 3 trial, researchers compared fingolimod with interferon beta-1a in patients younger than 18 years of age with multiple sclerosis. Compared to interferon beta-1a, fingolimod had a lower rate of relapse and less accumulation of lesions on magnetic resonance imaging (MRI) over a 2-year period but was related to a higher rate of serious adverse events (infection, leukopenia) among pediatric patients with relapsing multiple sclerosis.

Methods

  • For this investigation, researchers randomly assigned subjects 10 to 17 years of age with relapsing multiple sclerosis in a 1:1 ratio to receive oral fingolimod at a dose of 0.5 mg per day (0.25 mg per day for patients with a body weight of ≤40 kg) or intramuscular interferon beta-1a at a dose of 30 μg per week for up to 2 years.
  • The annualized relapse rate was the primary end point.

Results

  • According to the findings obtained, out of 215 patients, 107 were assigned to fingolimod and 108 to interferon beta-1a; 15.3 years was the mean age of the patients.
  • It was observed that there was a mean of 2.4 relapses during the preceding 2 years among all patients.
  • Findings revealed that the adjusted annualized relapse rate was 0.12 with fingolimod and 0.67 with interferon beta-1a (absolute difference, 0.55 relapses; relative difference, 82%; P < 0.001).
  • Researchers found that the key secondary end point of the annualized rate of new or newly enlarged lesions on T2-weighted magnetic resonance imaging (MRI) was 4.39 with fingolimod and 9.27 with interferon beta-1a (absolute difference, 4.88 lesions; relative difference, 53%; P < 0.001).
  • Excluding relapses of multiple sclerosis, adverse events occurred in 88.8% of patients who received fingolimod and 95.3% of those who received interferon beta-1a.
  • They observed that serious adverse events occurred in 18 subjects (16.8%) in the fingolimod group and included infection (in 4 patients) and leukopenia (in 2 patients); convulsions were noted in six patients.
  • They discovered that serious adverse events occurred in 7 subjects (6.5%) in the interferon beta-1a group and included infection (in 2 patients) and supraventricular tachycardia (in 1 patient).
Read the full article on New England Journal of Medicine





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Tuesday, September 18, 2018

This Is What Excites Me About Remyelination Therapy Research

SEPTEMBER 17, 2018 -- BY DEBI WILSON

This Is What Excites Me About Remyelination Therapy Research


Remyelination therapies are on the horizon as an innovative multiple sclerosis (MS) treatment, according to my neurologist. These therapies have been on my radar the last few years, but to hear my neurologist say they could soon be a reality makes me hopeful of the possibilities.

To offer a clear description of what remyelination therapies are and what they mean for those of us with MS, I first need to explain what MS is.

MS is a relentlessly devastating immune-mediated disorder of the central nervous system. In MS, the body turns on itself. It attacks and damages the myelin sheath, which covers axons, or long, threadlike nerves of the central nervous system. The result of these attacks is damage and exposure of the myelin and the axons. This invasion leaves behind a disrupted connection between the brain and the spinal cord.
The disconnection creates an array of varied debilitating and painful symptoms. What symptoms occur depends on where the damage is located on the spine and the brain. The cause of MS is unknown, although many theories exist. No cure has been discovered yet.
The hope for remyelination is that through drug therapy, myelin and axons can be repaired and replenished where damage has occurred. This treatment could greatly impact those with MS. If we were able to regain even a small portion of what we have lost, it would be life-changing!
A study abstract published in Nature Reviews Drug Discovery, titled “Remyelination therapies: a new direction and challenge in multiple sclerosis,” states that current therapies for MS are “predominantly immune-modulating and do not directly promote repair.” It adds: “White matter regeneration, or remyelination, is a new and exciting potential approach to treating multiple sclerosis, as remyelination repairs the damaged regions of the central nervous system.”
Continue Reading

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What Triggers Your Sensory Overload?

Stu's Views ---   DANG - do I surely know of this issue...  

a Healthline.com EMPOWERING article
“Noise in closed areas, such as parties, classrooms, malls, stores, etc. As long as I can leave the environment, I will be OK.” — Esther D., living with MS
“Noise! I can feel like my head is collapsing.” — Rhonda L., living with MS
“Noise of any sort. My cat meowing at me can freak me out at times." — Amy M., living with MS

ms voices


“The common one is when the work environment gets loud and busy, but the newest, and one that seems the strangest, is any warehouse type store. The extremely tall and long aisles, even when they're practically empty.” — Amy L., living with MS
“Large crowds. Bright big stores. Sometimes I go to the store, walk in, say ‘nope,’ and go home.” — Bonnie W., living with MS
“The grocery store and heavy traffic. Makes me feel scatterbrained and ‘lost.’” — Amber A., living with MS
ms voices

Unfamiliar spaces

“An environment I'm not used to, physically and/or mentally. Still don't know how to deal with them.” — Rona M., living with MS
“Being away from home too long. I get very anxious.” — Sherri H., living with MS

Fatigue

“Being tired can trigger it, real bright lights, a lot of motion, lights, noise at the same time, trying to listen and talk in a setting with other input.” — Kelly H., living with MS
“Fatigue is probably the number one cause of my sensory overload, but it's not always the culprit. If there are too many noises at once, they all seem to be competing to be the loudest, resulting in complete overload. In turn, I become a complete wreck. Tremors, feeling extremely uneasy, and anxious. All this holds true with an overload of any other sensual stimulus or combination of sensory overload events.” — Gail F., living with MS
“Someone who sits next to me and talks nonstop, especially in the late afternoon when extra fatigued, or just loud people with lots of energy … I'm like chocolate on a hot pavement … I melt down to a mess.” — Lisa F., living with MS

Restaurants

“In restaurants, I request not to be seated directly under a speaker. Music, combined with people's voices and kitchen clatter, drives me crazy.” — Connie R., living with MS
“Dinner at Texas Roadhouse with all the birthdays and singing and celebrations. Just gets to be too much!” — Judy C., living with MS
ms voices
“Noise coming from multiple directions and high-pitched sounds like the clanking of dishes and silverware together, or children screeching. Restaurants with high ceilings and open kitchens are the worst for me because every sound just feels multiplied.” — Erin H., living with MS

Crowds

“Being in a crowd or a loud room where I'm unable to tune some of the noise out. Hustling and bustling crowds are the worst between the sounds, the people, and my balance issues.” — Cindi P., living with MS
“Too many voices at once.”— Robin G., living with MS

Too many things to count

“Bright lights, too loud, children screeching, hot with odd smells, some industrial sounds, sometimes even reading can be too much if the lights are wrong or the setting is overwhelming.” — Alysin P., living with MS
“Going to the grocery store, being tired, the doctors telling me too much all at once, restaurants, people who don’t control their screaming, running kids.” — Stacy N., living with MS
“Large stores with a lot of color and visual stimulation; flashing or strobe lights especially in the dark; too much, too loud, or specific types of noise such as screeching or sirens; crowds or fast-paced and bustling activity.” — Polly P., living with MS
SOURCE: HEALTHLINE