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Tuesday, December 6, 2016

Factors Associated with Employment Status in Individuals with Multiple Sclerosis


                                                                  
  

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Margaret CaddenMSPeter ArnettPhD

From the Psychology Department, The Pennsylvania State University, University Park, PA, USA.
Correspondence: Margaret Cadden, MS, The Pennsylvania State University, 372 Moore Bldg., University Park, PA 16802; e-mail: .
Background: Unemployment is common in individuals with multiple sclerosis (MS) and is associated with substantial socioeconomic burden. Several MS-related factors have been found to be associated with employment status, including fatigue, depression, cognitive problems, and motor difficulties. However, few studies have examined these factors collectively in predicting employment. The present study aimed to explore these variables together in predicting employment status in MS.
Methods: Fifty-three individuals with MS participating in a research study of cognitive, emotional, and social factors related to MS were examined. Composite scores were created using factor analysis that represented cognition, fatigue, depression, and motor function. These composite scores, along with the Expanded Disability Status Scale score, were explored as predictors of employment status (working, not working) via logistic regression. Models of mediation were also investigated.
Results: A model including composite scores of motor function, cognition, depression, and fatigue significantly distinguished those who are unemployed versus employed. However, only the cognitive, motor, and fatigue composite scores were found to be significantly associated with unemployment individually. Results of a mediation analysis using 1000 bootstrap samples indicated that the cognitive and fatigue composite scores significantly mediated the effect of disability on work status.
Conclusions: Cognitive function and fatigue mediate the effect of MS disability on employment status. Interventions targeting cognitive difficulties and fatigue in MS may be effective in helping individuals maintain employment.
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Effects of Single Bouts of Walking Exercise and Yoga on Acute Mood Symptoms in People with Multiple Sclerosis


                                                                  
  

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Ipek EnsariEdMBrian M. SandroffMSRobert W. MotlPhD

From the Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
Correspondence: Robert W. Motl, PhD, University of Illinois at Urbana-Champaign, 906 S. Goodwin Ave., Urbana, IL 61801; e-mail: .
Background: Little is known about the acute or immediate effects of walking exercise and yoga on mood in people with multiple sclerosis (MS). Such an examination is important for identifying an exercise modality for inclusion in exercise-training interventions that yields mood benefits in MS. We examined the effects of single bouts of treadmill walking and yoga compared with a quiet, seated-rest control condition on acute mood symptoms in MS.
Methods: Twenty-four participants with MS completed 20 minutes of treadmill walking, yoga, or quiet rest in a randomized, counterbalanced order with 1 week between sessions. Participants completed the Profile of Mood States questionnaire before and immediately after each condition. Total mood disturbance (TMD) and the six subscales of the Profile of Mood States were analyzed using repeated-measures analysis of variance and paired-samples t tests.
Results: There was a significant condition × time interaction on TMD scores (ηp2= 0.13). Walking and yoga conditions yielded comparable reductions in TMD scores. There was a significant condition × time interaction on vigor (ηp2 = 0.23) whereby walking but not yoga yielded an improvement in vigor. There was a significant main effect of time on anger, confusion, depression, and tension (P < .05) but not on fatigue.
Conclusions: Walking and yoga yielded similar improvements in overall acute mood symptoms, and walking improved feelings of vigor. These effects should be further investigated in long-term exercise-training studies.


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Individual and Co-occurring SNAP Risk Factors: Investigation of Smoking, Nutrition, Alcohol Consumption, and Physical Activity in Persons with Multiple Sclerosis


                                                                  
  

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Julia M. Balto BSIpek Ensari PhDElizabeth A. Hubbard MSNaiman Khan PhD, RDJennifer L. Barnes PhD, RDRobert W. Motl PhD
From the Department of Kinesiology and Community Health (JMB, IE, EAH, NK, RWM) and Division of Nutritional Sciences (NK), University of Illinois at Urbana-Champaign, Urbana, IL, USA; Department of Family and Consumer Sciences, Illinois State University, Bloomington, IL, USA (JLB); and Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA (RWM).
Correspondence: Robert W. Motl, PhD, Department of Physical Therapy, University of Alabama at Birmingham, School of Health Professions 336, Birmingham, AL; e-mail: 
Background: Smoking, poor nutrition, excess alcohol consumption, and insufficient physical activity underlie most preventable causes of morbidity in the general population and are possibly associated with co-morbidities and health outcomes in MS. However, the frequency of co-occurrence of these risk factors among people with MS remains unclear.
Methods: Sixty-nine participants with MS completed self-report measures of smoking status, nutrition, alcohol use, physical activity levels, and sociodemographic and clinical characteristics. The data were analyzed using ttests and χ2 analyses in SPSS Statistics 22.0.
Results: Poor diet was the most common risk factor, with 85.5% of the sample not meeting dietary guidelines. Of participants with two or more risk factors, 90.3% were not meeting dietary and physical activity guidelines. There were differential rates of meeting physical activity guidelines between men and women (χ2 = 7.5, P = .01) such that 73% of women were not meeting physical activity guidelines compared with 38% of men. There were further differential rates of the most commonly co-occurring risk factors, insufficient physical activity and poor nutrition by sex (χ2 = 4.2, P = .05), such that 65% of women reported the co-occurrence of insufficient physical activity and poor diet compared with 38% of men.
Conclusion: Our results indicate that: a) an overwhelming 85.5% of the sample was not meeting nutrition guidelines; b) 90.3% of participants with two or more risk factors reported the co-occurrence of poor diet and insufficient levels of physical activity; and c) physical activity levels and the total number of SNAP risk factors varied across sex.
© 2016 Consortium of Multiple Sclerosis Centers.

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Antidepressant Treatment in Association with Multiple Sclerosis Disease-Modifying Therapy: Using Explorys in the MS Population


                                                                  
  

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Matthew M. MirskyMSRuth Ann MarrieMD, PhDAlexander Rae-GrantMD, FRCPC
From the Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (MMM, ARG); and the Departments of Internal Medicine (Neurology) and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnepeg, Manitoba, Canada (RAM).

Correspondence: Alexander Rae-Grant, MD, FRCPC, Cleveland Clinic Main Campus, Mail Code U2-315, 9500 Euclid Ave., Cleveland, OH 44195; e-mail: .
Background: Explorys Enterprise Performance Management (EPM) is a HIPAA-compliant database containing de-identified clinical data totaling 50 million patients. MS disease-modifying therapies (DMTs), specifically interferon beta treatments, may potentiate depression. There has been conflicting data, and a large-scale claims-based study by Patten et al. did not support such an association. This study serves to compare results of Patten et al., “Anti-depressant Use in Association with Interferon and Glatiramer Acetate Treatment in Multiple Sclerosis,” using EPM while investigating other DMTs.
Methods: EPM “power searches” were built to test the relationship between antidepressant and DMT use in the MS population. Searches were built to produce a cohort of individuals diagnosed with MS in the past 3 years, on a specific DMT, who were then placed on any antidepressant. The antidepressant prevalence was tested in the MS population on the following DMTs: interferon beta-1a, interferon beta-1b, combined interferon beta as “IFN,” glatiramer acetate, natalizumab, fingolimod, and dimethyl fumarate. These data were further analyzed by age and sex.
Results: In patients with MS the rate of antidepressant use in those on MS DMTs ranged from 40.60% to 44.57%. The rate of antidepressant use among IFN DMTs was 41.61%. The rate of antidepressant use in males ranged from 31.25% to 39.62%, while in females it ranged from 43.10% to 47.33%. Antidepressant use peaked in the 45–54 age group in five of six MS DMTs studied.
Conclusions: We found no association between IFN treatment and antidepressant use in the MS population when compared to other DMTs. The EPM database has been validated against Patten et al. data for future use in the MS population.
© 2016 Consortium of Multiple Sclerosis Centers.

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Clinical Significance of Gastrointestinal and Flushing Events in Patients with Multiple Sclerosis Treated with Delayed-Release Dimethyl Fumarate


                                                                  
  

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J. Theodore PhillipsMD, PhDKrzysztof SelmajMD, PhDRalf GoldMDRobert J.FoxMDEva HavrdovaMDGavin GiovannoniMBBCh, PhDHeather Abourjaily,PharmDAmy PaceScDMark NovasMDChristophe HotermansMD, PhDVissiaVigliettaMD, PhDLeslie MeltzerPhD
From the Multiple Sclerosis Program, Baylor Institute for Immunology Research, Dallas, TX, USA (JTP); Medical University of Lodz, Lodz, Poland (KS); St. Josef Hospital, Ruhr University, Bochum, Germany (RG); Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA (RJF); Department of Neurology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic (EH); Queen Mary University of London, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK (GG); and Biogen, Cambridge, MA, USA (HA, AP, MN, CH, VV, LM).
Correspondence: J. Theodore Phillips, MD, PhD, Multiple Sclerosis Program, Baylor Institute for Immunology Research, 3434 Live Oak St., Dallas, TX 75204; e-mail: .
Background: In the phase 3 DEFINE and CONFIRM trials, flushing and gastrointestinal (GI) events were associated with delayed-release dimethyl fumarate (DMF; also known as gastroresistant DMF) treatment in people with relapsing-remitting multiple sclerosis (MS). To investigate these events, a post hoc analysis of integrated data from these trials was conducted, focusing on the initial treatment period (months 0−3) with the recommended DMF dosage (240 mg twice daily).
Methods: Eligibility criteria included age 18 to 55 years, relapsing-remitting MS diagnosis, and Expanded Disability Status Scale score 0 to 5.0. Patients were randomized and received treatment with placebo (n = 771) or DMF (n = 769) for up to 2 years. Adverse events were recorded at scheduled clinic visits every 4 weeks.
Results: The incidence of GI and flushing events was highest in the first month of treatment. In months 0 to 3, the incidence of GI events was 17% in the placebo group and 27% in the DMF group and the incidence of flushing and related symptoms was 5% in the placebo group and 37% in the DMF group. Most GI and flushing events were of mild or moderate severity and resolved during the study. The events were temporally associated with the use of diverse symptomatic therapies (efficacy not assessed) and infrequently led to DMF discontinuation.
Conclusions: This integrated analysis indicates that in a clinical trial setting, GI and flushing events associated with DMF treatment are generally transient and mild or moderate in severity and uncommonly lead to treatment discontinuation.

When choosing among treatments for relapsing-remitting multiple sclerosis (MS), health-care providers and patients must weigh factors such as efficacy, safety, tolerability, and convenience. Newer therapeutics are attractive owing to their convenience, but the current lack of long-term experience with these agents may limit their use compared with traditional agents with well-established safety and tolerability profiles.

Delayed-release dimethyl fumarate (DMF; also known as gastroresistant DMF) is one of the newest oral therapeutics. In the phase 3 DEFINE (Determination of the Efficacy and Safety of Oral Fumarate in Relapsing-Remitting MS)1 and CONFIRM (Comparator and an Oral Fumarate in Relapsing-Remitting Multiple Sclerosis)2 trials, DMF 240 mg twice daily and three times daily demonstrated efficacy on clinical and neuroradiologic measures across diverse subgroups of patients.3,4 The most common adverse events associated with DMF treatment were flushing and gastrointestinal (GI) events, including abdominal pain, nausea, vomiting, and diarrhea. Other safety signals of note included decreases in mean white blood cell and lymphocyte counts and transient elevations in mean liver enzyme levels. There was no overall increased risk of infections, serious infections, opportunistic infections, or malignancies in DMF-treated patients.
Flushing and GI events are likely to be of concern when considering treatment with DMF. To further investigate the incidence, severity, duration, management, and outcome of these events as recorded by investigators at monthly clinic visits, a post hoc analysis of integrated data from DEFINE and CONFIRM was conducted. The analysis focused on the initial treatment period (months 0−3) with the recommended dosing regimen of DMF (240 mg twice daily).

Materials and Methods
Patients and Study DesignMethodological details of the phase 3 DEFINE (NCT00420212) and CONFIRM (NCT00451451) studies have been described previously.1,2 Briefly, eligible patients were aged 18 to 55 years, had a diagnosis of relapsing-remitting MS per the McDonald criteriaand an Expanded Disability Status Scale (EDSS) score6 of 0 to 5.0, and had either 1 or more clinically documented relapses within 1 year before randomization and a previous cranial magnetic resonance image showing lesions consistent with MS or a brain magnetic resonance image obtained within 6 weeks before randomization showing at least one gadolinium-enhancing lesion.

DEFINE and CONFIRM were 2-year, multicenter, randomized, double-blind, placebo-controlled clinical trials. In DEFINE, patients were randomized 1:1:1 to receive placebo, DMF 240 mg twice daily, or DMF 240 mg three times daily (408, 410, and 416 patients, respectively, in the safety population, defined as patients who received at least one dose of study treatment) for up to 96 weeks. In CONFIRM, patients were randomized 1:1:1:1 to receive treatment with placebo, DMF 240 mg twice or three times daily, or glatiramer acetate (a reference comparator; safety population = 363, 359, 344, and 351 patients, respectively) for up to 96 weeks.

All patients provided written informed consent. The studies were approved by central and local ethics committees and were conducted in accordance with the International Conference on Harmonization Guidelines for Good Clinical Practice 7 and the Declaration of Helsinki.8

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Associations Between Bladder Dysfunction and Falls in People with Relapsing-Remitting Multiple Sclerosis


                                                                  
  

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Jaime E. ZelayaPhDCharles MurchisonMSMichelle CameronMD, PT
From the School of Medicine (JEZ) and Department of Neurology (CM, MC), Oregon Health & Science University; and VA Multiple Sclerosis Center of Excellence–West, VA Portland Health Care System, Portland, OR, USA (MC).

Correspondence: Michelle Cameron, MD, PT, Department of Neurology, Oregon Health & Science University, 3710 SW US Veterans Hospital Rd., Mail Code P3NEUR, Portland, OR 97239; e-mail: .
Background: Bladder dysfunction and falls are common in multiple sclerosis (MS), but associations between these problems are unclear. The purpose of this study was to clarify the association between specific types of bladder dysfunction (urinary urgency, frequency, and incontinence) and prospectively recorded falls in people with MS.
Methods: Fifty-one people aged 18 to 50 years with relapsing-remitting MS and mild-to-moderate disability (Expanded Disability Status Scale [EDSS] score ≤6.0) completed a self-report questionnaire regarding urinary incontinence, urgency, and frequency at baseline and then prospectively recorded their falls daily for 3 months using fall calendars. Participants were classified as recurrent fallers (≥2 falls) or nonrecurrent fallers (<2 falls) for one regression model, and then as fallers (≥1 fall) or nonfallers (0 falls) for another regression model. Associations between baseline bladder dysfunction and faller status were assessed using logistic regression, adjusted for potential confounders of age, gender, and disability.
Results: Fifteen subjects were recurrent fallers, 36 were nonrecurrent fallers, 32 were fallers, and 19 were nonfallers. After adjusting for age, gender, and disability, there was only a significant association between urinary urgency with incontinence and recurrent falls in the following 3 months (OR: 57.57; 95% CI: 3.43–966.05; P =.005).
Conclusions: Urinary urgency with incontinence is associated with recurrent falls in the following 3 months in people with relapsing-remitting MS with mild-to-moderate disability. Further research is needed to better understand mechanisms underlying this association and to evaluate the impact of bladder management programs on falls.
© 2016 Consortium of Multiple Sclerosis Centers. click



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Sunday, December 4, 2016

Multiple sclerosis can be isolating. Rambler the dog is changing that for one Kingsburg man Read more here: http://www.fresnobee.com/living/liv-columns-blogs/carmen-george/article118500333.html#storylink=cpy


                                                                  
  

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Rambler the service dog can do a lot – open elevator doors, turn on lights, pull people in wheelchairs – but it’s a far simpler skill – kissing – that his humans love best of all.
Multiple sclerosis has left Morten Johnson defenseless against these slobbery sieges, but the Kingsburg man doesn’t mind.
“He’s like an answer to prayers,” Johnson said of the black Labrador and golden retriever mix. “He’s mine, and he accepts me for what I am and doesn’t judge me.”

Read more here: http://www.fresnobee.com/living/liv-columns-blogs/carmen-george/article118500333.html#storylink=cpy


See a slide show and learn more of Rambler - a Service Dog
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Lemtrada Lessens MS Disability in People Who Respond Poorly to Other Therapies, Study Says


                                                                  
  

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Data from the CARE-MS II clinical trial showed that Lemtrada(alemtuzumab) can lessen pre-existing disabilities in patients with relapsing-remitting multiple sclerosis (RRMS) who failed to respond adequately to previous disease-modifying therapies, according to a study of the trial’s data. The treatment was evaluated against Rebif(interferon beta-1a) therapy.
A major aim of multiple sclerosis (MS) treatment is limiting patients’ disability, an outcome usually measured by the delay in confirmed disability worsening (CDW). However, interest in growing in efforts to reach confirmed disability improvement (CDI), a higher standard of therapeutic efficacy than that of slowing disability accumulation.
CDI is believed to reflect durable and clinically meaningful Expanded Disability Status Scale (EDSS) score changes. EDSS is a standard method of quantifying disability in MS.
In this study, the researchers’ objective was to characterize the effects of Lemtrada treatment on measures of disability improvement in patients with RRMS whose response to other treatments was found to be inadequate (relapsing at least once). Lemtrada is a humanized monoclonal antibody capable of remodeling the immune responses of innate immune cells in patients with RRMS.




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Saturday, December 3, 2016

Newborns with low levels of vitamin D may more likely develop multiple sclerosis in later life


                                                                  
  

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Nov 30, 2016

Babies born with low levels of vitamin D may be more likely to develop multiple sclerosis (MS) later in life than babies with higher levels of vitamin D, according to a study published in the November 30, 2016, online issue of Neurology®, the medical journal of the American Academy of Neurology.
"More research is needed to confirm these results, but our results may provide important information to the ongoing debate about vitamin D for pregnant women," said study author Nete Munk Nielsen, MD, MSc, PhD, of the State Serum Institute in Copenhagen, Denmark.

In Denmark, dried blood spots samples from newborn screening tests are stored in the Danish National Biobank. Researchers identified everyone in Denmark who was born since April 30, 1981, had onset of MS by 2012 and whose dried blood spots samples were included in the biobank. The blood from those 521 people was then compared to that of 972 people of the same sex and birthday who did not have MS. In this study, newborns with levels of vitamin D less than 30 nanomoles per liter (nmol/L) were considered born with deficient levels. 

Levels of 30 to less than 50 nmol/L were considered insufficient and levels higher than or equal to 50 nmol/L were considered sufficient.








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Multiple sclerosis: Newly discovered signal mechanism causes T cells to turn pathogenic


                                                                  
  

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Date: December 1, 2016
Source:
Technical University of Munich (TUM)
Summary:
Multiple sclerosis is an autoimmune disease in which the body's immune system attacks the patient's own cells. In this case, modified T cells destroy the myelin sheath surrounding nerve cells. Myelin protects the neural pathways and is thus essential to the ability of nerve cells to transmit information. A recent study has demonstrated that a substance known as interleukin 6 (IL-6) plays an important role in instructing T cells to cause damage to myelin sheaths in the central nervous system.
Multiple sclerosis is an autoimmune disease in which the body's immune system attacks the patient's own cells. In this case, modified T cells destroy the myelin sheath surrounding nerve cells. Myelin protects the neural pathways and is thus essential to the ability of nerve cells to transmit information.
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