Please visit our MS learning channel on Youtube, which provides hundreds of topics from our education programs, that were video-recorded and archived here: www.youtube.com/msviewsandnews -- Be empowered with MS news by registering with us: www.register.msviewsandnews.org
-- Scroll left side of this blog for needed resources. Also, use our 'search by topic' tool, to find specific information.
Disclaimer: 'MS Views and News' DOES NOT endorse any products or services found on this blog. It is up to you to seek advice from your healthcare provider. The intent of this blog is to provide information on various medical conditions, medications, treatments, and procedures for your personal knowledge and to keep you informed of current health-related issues. It is not intended to be complete or exhaustive, nor is it a substitute for the advice of your physician. Should you or your family members have any specific medical problem, seek medical care promptly.
Friday, October 20, 2017
Corrona and the National Multiple Sclerosis Society announce intent to collaborate on a multiple sclerosis registry to study the comparative effectiveness and safety of approved therapies
Wednesday, October 18, 2017
Clemastine fumarate was first approved by the Food and Drug Administration (FDA) in 1977. It is an antihistamine medication for allergies and has been available over the counter since 1993. Its potential to treat MS is therefore as surprising as it is welcome.
According to principal investigator Dr. Ari Green, "To the best of our knowledge, this is the first time a therapy has been able to reverse deficits caused by MS. It's not a cure, but it's a first step toward restoring brain function to the millions who are affected by this chronic, debilitating disease."
The team studied the effects of clemastine fumarate on 50 individuals with long-standing MS over a 5-month period. Because the visual system is often one of the first to be affected, the researchers measured so-called visual evoked potentials (VEPs). This is a well-established method of assessing how quickly nerves conduct messages.
VEPs were measured by showing participants flickering patterns on a screen. Electrodes placed over the visual areas of the brain detected how long it took signals to travel from the eye to the relevant area of the brain.
For 90 days, half of the participants were given clemastine fumarate, and the other half received a placebo. Next, the groups were switched: the placebo group was given the drug and vice versa. Neither the participants nor the researchers knew which individuals were receiving the active treatments.
Consortium of Multiple Sclerosis Centers (CMSC) Updates Proposed 2017 Guidelines for Standardized Brain and Spinal Cord MRI Protocols
Tuesday, October 17, 2017
Researchers published their article in the journal Proceedings of the National Academy of Sciences.It was titled “Gut microbiota from multiple sclerosis patients enables spontaneous autoimmune encephalomyelitis in mice.”
Our gut contains millions of good bacteria, fungi, bacteria-like archaea, and viruses that we can’t live without. Although there are 300 to 1,000 species of bacteria in our gut, most of our intestines is populated with 30 or 40 species.
Recent increases in knowledge and technical advancements have made it possible for scientists to measure the equilibrium between different species in the gut, and analyze their influence on our health.
One discovery was a link between the balance of bacteria in the intestines and autoimmune diseases like MS.
A team of researchers decided to see if differences in gut microbiota play a role in MS progression and perhaps its onset.
They analyzed the feces of 34 identical twins, one of each who had MS and one of each who didn’t. They used twins to try to reduce genetic and environmental differences’ influence on the onset of the disease.
All of those with MS were Caucasian and had grown up with their healthy twin to adulthood.
Researchers analyzed the type and abundance of microorganisms in the feces of both the MS-affected and healthy twins.
They found no differences in species or amount of bacteria between siblings. What they did find was a significant increase in some types of bacteria, such as Akkermansia, in untreated twins with MS.
The team transplanted fecal samples from MS-affected and healthy twins into a mice model of MS called experimental autoimmune encephalomyelitis. These animals have an inflammatory myelin-destroying disease of the central nervous system that is comparable to human MS. Myelin is a protective coating around neurons whose loss is associated with MS.
MS twin-derived gut microbiota caused a significantly higher amount of mice to develop a relapsing–remitting autoimmunity similar to MS than healthy twin-derived microbiota.
When researchers measured the microbial profiles of the mice’s feces, they found significant differences in amounts of bacteria. The most important difference was in Sutterella, an organism that helps protect against inflammation. Sutturella levels were significantly reduced in the feces of mice transplanted with MS twin-derived microbiota compared with feces from healthy twins.
The team also measured the mice’s immune cells and the proteins they release.
They discovered that immune cells in mice with MS-twin feces transplants produced less of the anti-inflammatory factor IL-10 than immune cells from mice colonized with healthy-twin samples. IL-10, or interleukin 10, is an important immune protein.
When researchers transplanted the feces of healthy twins into the mice, then gave them an antibody that blocks the function of IL-10, they also became sick. This indicated that IL-10 may temper autoimmunity in the central nervous system.
The team then measured the twins’ immune blood components. They found that the healthy twin had higher quantities of IL-10 than the MS-affected one.
“These findings provide evidence that MS-derived microbiota contain factors that precipitate an MS-like autoimmune disease” in a mouse model, the researchers wrote.
October 17, 2017
Ocrelizumab provides greater value to relapsing forms of multiple sclerosis (RRMS) patients compared with subcutaneous interferon beta-1a (IFNβSC), according to a recent investigation. Initiating ocrelizumab at lower Expanded Disability Status Scale (EDSS) levels leads to a greater cumulative value due to slower disability progression, which extends years with higher quality-of-life.
A Markov model was developed to compare disability progression as measured by EDSS and relapse outcomes over a 30-year horizon for ocrelizumab vs IFNβSC. Direct, indirect, and informal costs (2016 US dollars) and utilities for EDSS health states were obtained from the literature. Investigators found:
Ocrelizumab was associated with an incremental gain of 0.84 quality-adjusted life years (QALYs) and cost savings of $287,713 relative to IFNβSC, resulting in an incremental net monetary benefit (INMB) of $413,611 per person over 30 years.
The INMB increased by $151,763 for those initiating ocrelizumab at EDSS level 1 vs level 4.
Influential parameters were QALY value, treatment costs, and disability progression; however, all sensitivity analyses indicated that the INMB for ocrelizumab relative to IFNβSC was ≥$300,000 per person.
Frasco MA, Shih T, Incerti D, Espinosa OD, Vania DK, Thomas N. Incremental net monetary benefit of ocrelizumab relative to subcutaneous interferon β-1a. J Med Econ. 2017;20(10):1074-1082. doi:10.1080/13696998.2017.1357564.
October 17, 2017
Transcranial direct current stimulation (tDCS) is a promising option for fatigue reduction in multiple sclerosis (MS), according to 2 recent studies. Dorsolateral prefrontal cortex left anodal tDCS was administered using a remotely supervised (RS)-tDCS protocol, paired with 20 minutes of cognitive training. Study 1 delivered 10 open-label tDCS treatments (1.5 mA; n=15) compared to a cognitive training only condition (n=20). Study 2 was a randomized trial of active (2.0 mA, n=15) or sham (n=12) delivered for 20 sessions. Fatigue was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS)—Fatigue Short Form. Researchers found:
In Study 1, there was modest fatigue reduction in the active group (−2.5 ± 7.4 vs −0.2 ± 5.3).
However, in Study 2 there was statistically significant reduction for the active group (−5.6 ± 8.9 vs 0.9 ± 1.9).
Charvet LE, Dobbs B, Shaw MT, Bikson M, Datta A, Krupp LB. Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: Results from a randomized, sham-controlled trial. [Published online ahead of print September 22, 2017]. Mult Scler. doi:10.1177/1352458517732842.
Arch Phys Med Rehab; ePub 2017 Sep 25; Goverover, et al
Substantial progress has been made in regard to the identification of effective treatments for cognitive impairments in persons with multiple sclerosis (MS), according to a recent updated literature review from 2007 through 2016. Searches of literature were conducted using combinations of the following terms: attention, awareness, cognition, cognitive, communication, executive, executive function, language, learning, memory, perception, problem solving, reasoning, rehabilitation, remediation, training, processing speed, and working memory. 129 articles were identified and underwent initial screening; 59 articles were selected for inclusion after initial screening; 19 studies were excluded after further detailed review; and 40 studies were fully reviewed and evaluated. Investigators found:
The review yielded 6 class I studies, 10 class II studies, and 24 class III studies.
1 intervention in the area of verbal learning and memory received support for a practice standard, 2 computer programs received support as practice guidelines (in the area of attention and multi-cognitive domains), and several studies provided support for 5 practice options in the domains of attention and learning and memory.
Goverover Y, Chiaravalloti ND, O’Brien A, DeLuca J. Evidenced based cognitive rehabilitation for persons with multiple sclerosis: An updated review of the literature from 2007-2016. [Published online ahead of print September 25, 2017]. Arch Phys Med Rehab. doi:10.1016/j.apmr.2017.07.021.
Stereotactic radio surgery (SRS) and radiofrequency rhizotomy (RFR) provide effective pain relief for trigeminal neuralgia (TN) in the setting of multiple sclerosis (MS), according to a recent study. While initial surgical cost of RFR and SRS were different, subsequent and total cost of the 2 modalities were not significantly different. Researchers evaluated patients with TN and MS (n=17) who were treated since 1997. Patients either underwent SRS (n=7) or RFR (n=10) as their index procedure and were evaluated as a group based on this first procedure. The median age of patients at first operation in each group was 58.5 ± 10.9 and 63.5 ± 7.5 for SRS and RFR, respectively. They found:
Overall, 71% of patients had an excellent or good initial pain outcome.
Over time, 60% of RFR and 29% of SRS patients required additional procedures to obtain satisfactory pain relief.
The patients who underwent RFR as their index procedure required a significantly higher number of procedures to achieve adequate pain relief (RFR=2.7 vs SRS=2.0).
Holland MT, Teferi N, Noeller J, et al. Stereotactic radio surgery and radio frequency rhizotomy for trigeminal neuralgia in multiple sclerosis: A single institution experience. [Published online ahead of print September 7, 2017]. Clin Neurol Neurosurg. doi:10.1016/j.clineuro.2017.09.004.
Monday, October 16, 2017
By the time multiple sclerosis (MS) is diagnosed in children, it may be difficult to prevent the disabilities and relapses that come with the disease. In a new Yale School of Medicine study, researchers examined MRI brain scans to identify children at high risk of developing MS before symptoms appear, which may lead to earlier diagnosis and treatment.
Published in the November issue of the journal Neurology: Neuroimmunology & Neuroinflammation, the study of 38 children at 16 sites in six countries showed that the MRIs can reveal changes in the brain associated with MS before the clinical symptoms of the disease appear in children.
The children in the study all underwent MRI scans for other reasons, most commonly headache, but the MRIs unexpectedly revealed signs of MS. Having MRI findings of MS without any symptoms of the disease has been termed radiologically isolated syndrome (RIS) and previously had only been seen in adults.
"For the first time we have proposed a definition of RIS in children," said lead author Naila Makhani, M.D., assistant professor of pediatrics and neurology at Yale School of Medicine. "Children with RIS may represent a high-risk group of children that needs to be followed more closely for the later development of clinical multiple sclerosis."
Approximately 42% of children in the study with MRI findings of MS developed the first clinical symptoms of the disease about two years after the abnormal MRI, which shows a faster development of the disease than has been reported in adults. Children who had a specific marker in spinal fluid or who had MRI changes in the spinal cord, were at greatest risk of developing the clinical symptoms of MS.