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Friday, May 23, 2008

Oral prednisone taper following intravenous steroids fails to improve disability or recovery from relapses in multiple sclerosis

Oral prednisone "taper" following intravenous steroids fails to improve
disability or recovery from relapses in multiple sclerosis

Department of Neurology, Multiple Sclerosis Clinical Research Center, Wayne State University School of Medicine, Detroit & The Detroit Medical Center, Detroit, MI, USA.

Background: A short course of intravenous methylprednisolone (IVMP) followed by oral prednisone taper (OPT) is often used for the treatment of relapses in multiple sclerosis (MS). We examined the effect of IVMP plus OPT compared with IVMP only on neurologic disability 1 year after treatment of a relapse in patients with relapsing-remitting multiple sclerosis..

Methods: Two hundred eighty-five consecutive relapses were analyzed in a retrospective fashion. One hundred fifty-two patients with a total of 171 relapses received IVMP plus an OPT at the time of relapse whilst 112 patients who experienced 114 relapses received IVMP without OPT.

Results: There was no difference between the two groups in the baseline characteristics as well as the mean or categorical EDSS at baseline, at the time of relapse confirmation, and at months 3, 6 and 12 after relapse confirmation.

Conclusion: Our observations suggest that OPT following treatment with IVMP for an MS relapse does not lead to improved neurologic outcome after 12 months compared with treatment with IVMP only. Moreover, our findings raise concerns regarding the common practice of using OPT following IVMP. Further studies are indicated to validate our findings and minimize exposure to systemic corticosteroids, well known for systemic toxicity.

PMID: 18459972 [PubMed - as supplied by publisher]

Thursday, May 22, 2008

Antibodies in the brain

PHYSORG.com
Published: 14:16 EST, May 19, 2008

Antibody development: A B-cell's recognition of a target structure quickly leads to the production of numerous antibodies ready to attack this target. Memory cells ensure a quick response in case the target reappears at a later time. B-cells which don’t recognize the target (here the cells 1 and n), don’t produce antibodies. Image: Max Planck Institute of Neurobiology


Antibody development: A B-cellacutes recognition of a target structure quickly leads to the production of numerous antibodies ready to attack this target. Memory cells ensure a quick response in case the target reappears at a later time. B-cells whic ...

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Wednesday, May 21, 2008

Top 10 Sex Tips for Women with Multiple Sclerosis

Ideas to Keep the Romance Alive

By Julie Stachowiak, Ph.D., About.com

Updated: May 21, 2008

About.com Health's Disease and Condition content is reviewed by Suman Jayadev, MD

Many women with multiple sclerosis (MS) remember times when things were, well, easier. We could sprint across a parking lot on a blazing summer day, keep up with complex conversations, and jump out of bed and keep moving at a steady pace all day. Sex was like that, too. Something that you just did, carried along in the heat of the moment or in comfortable, loving companionship.

However, like pretty much everything else, sex is something that women with MS find more difficult than others to just do. It is estimated that about 75% of women with MS have some form of sexual dysfunction. What this means is that, for about a million possible reasons (including fatigue, loss of sensation, spasticity, loss of libido, etc.), sex is just not that fun.

I am going to give you 10 tips that may help you rediscover some of the fun of sex. I’m not going to tell you that you will be instantly able to recreate torrid honeymoon adventures. However, sex is an important part of a healthy adult life, especially if you are married or in a committed relationship. Given that many of our husbands or partners have to take on many “caregiving” tasks, it is crucial that we work to maintain the sexual parts of our relationships.

1. Talk With Your Partner

Open communication is essential for good sex. Talk with your partner about any sexual difficulties you might be having as a couple. Try to treat them as problems to solve and work together on finding creative solutions. Make sure that your partner knows what feels good to you and what doesn’t – these things may change with time as certain areas of your body may become numb and others may become oversensitive.

2. Lubricate

Many women with MS have trouble achieving an adequate level of vaginal lubrication naturally. This is easily fixed by using a water-based lubricant. At first, applying a lubricant for sex may seem awkward, but you and your partner will quickly become used to it and can even incorporate it into foreplay.

3. Experiment with Positions and Times

Pain, weakness or spasticity can interfere with sex. Experiment with different sexual positions, and you may find one that works better than others. Also, some MS symptoms are often less severe at certain times a day, which will vary for each person.

4. Reassure Your Partner

As I mentioned, many women with MS find themselves needing more help from their spouses or partners than they did in the past. Admittedly, some of these needs put us in “less-than-sexy” situations, such as help with injections, getting dressed, etc. It is extremely important that you let your partner know that, despite the changing roles, your romantic feelings have not disappeared.

5. Feel Beautiful

We live in a culture that has a narrow definition of beauty. As women experience the different effects of MS, they may feel less sexually attractive, which can interfere with sexual desire. Ignore messages and stereotypes from television, magazines and other media sources and embrace your body for what it can do.

Women with MS may experience a range of disabilities. They may need assistive devices to walk or a brace to hold a limb steady or need to wear an indwelling catheter if they have bladder dysfunction. These disabilities can dramatically change how a woman perceives her own attractiveness. Open communication with your partner can help reduce anxiety and negativity.

6. Take Care of Your Health

We may have MS, but don’t forget that we are also aging along with everybody else. Poor health can interfere with sex. If you have a health condition besides MS, be sure to the manage it. Follow your doctor’s orders and make the lifestyle changes you need to be healthy. Losing weight, exercising and eating well will not only improve your health, your sex life will also improve.

7. Expand Your Definition of Sex

There is a lot more to sex than intercourse. Hugging, kissing and other forms of contact are essential parts of your sex life. Simply talking to your partner about something other than health issues or other stressors may be a bridge to intimacy. We often don’t realize how just managing the “business of life” can be a full-time job, leaving no time for romantic thoughts or actions.

8. Time Your Medications

Certain medications can impair (or help) sexual functioning. For instance:
  • If you take anticholinergics for bladder dysfunction, taking these 30 minutes before sex can minimize bladder contractions during sex. These include: Propantheline (Norpanth, Pro-Banthine), Tolterodine (Detrol tablets and Detrol LA extended-release capsules), Dicyclomine (Bentyl).
  • Medications for fatigue taken one hour before sex can put you at your peak energy level. These include Provigil and Symmetrel.
  • If you take antidepressants, these may be having a negative effect on your sex drive. Talk to your doctor if you think this might be the case.
  • If you self-inject (or have your partner inject you with) one of the disease-modifying medications, coordinate the timing of your injection with any possible sexual activity. Injections may cause women so much stress or unpleasant side effects that they could not possibly enjoy sex right after a shot. On the other hand, some women may feel such a sense of pride and relief after an injection that this may be a great time for sex.

9. Talk to Your Doctor

If you are having sexual difficulties, talk to your doctor. There may be simple solutions to your problems such as changing the time of day that you take a medication or making lifestyle changes. Your doctor may be able to prescribe a medication to help your particular sexual complaint. Expect that you will have to make adjustments in your life and sexual habits as you live with MS. Your doctor can help your these adaptations go smoothly.

10. Vibrators and Masturbation

Even if you don’t have a partner at the moment, sex and orgasms bring both emotional and physical benefits. Women should not feel guilty about masturbation. Vibrators and other devices can help tremendously.

Sources:

Nancy J. Holland and June Halper. Multiple Sclerosis: A Self-Care Guide to Wellness. New York: Demos Publishing. 2005.

Allison Shadday. MS and Your Feelings. Alameda: Hunter House Publishers, 2007.

Seizures In Multiple Sclerosis

Epilepsy is three to six times more frequent in MS than in the general population. Previous studies based on conventional magnetic resonance (MR) imaging have suggested a possible correlation between cortical inflammatory pathology and epileptic seizures.

READ full synopsis


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Tuesday, May 20, 2008

Psychology Research Study (online) for The MS Patient

Tuesday, 20 May 2008 19:49
Psychology research study with MS patients -
Posted 5/20/08 8:50pm est
The Help of MS Patients will be greatly appreciated.

Hello,
I am a researcher at the University of Southern California. I am currently conducting a short online survey about how people think about and cope with illness. It is hoped the results of this study will improve understanding of how people deal with illness and assist the medical profession in improving their support of future patients. I am especially interested in having people with multiple sclerosis take part in the study. People who have already taken part in the study have reported the study to be interesting. Typically, people have mentioned that the study encouraged them to think about their illness and that this reflective thinking was helpful to them.
If you wish to learn more about this study, which takes about 20 minutes to complete, please click on the link at the bottom of this message. Everyone who takes part in the study will be entered in a lottery; the winner of this lottery will receive a check for $200. We are expecting about 500 people to complete the study. Therefore your chances of winning the prize are 1/500.

READ Complete Request, found on the bottom of this homepage

.



UK- Embryo bill decision offers hope to multiple sclerosis sufferers

Embryo bill decision offers hope to multiple sclerosis sufferers

Published: Monday, 19-May-2008 - News-Medical.net

The MS Society (UK) welcomes the decision by MPs to allow scientists to use 'hybrid' human - animal embryos in research into conditions such as multiple sclerosis (MS).

Jayne Spink, Director of Policy and Research at the MS Society, said: "This really is a victory for common sense.

"Allowing scientists to further explore this avenue of research may prove to be hugely beneficial not just to the 85,000 people with multiple sclerosis (MS), but to the hundreds of thousands of people living with debilitating, degenerative and life limiting conditions.

"The MS Society believes it is essential to keep all possible avenues of research open and supports the use of the best technology available to achieve its goals of finding effective treatments for people with MS."

  • The MS Society (http://www.mssociety.org.uk) is the UK's largest charity dedicated to supporting everyone whose life is touched by MS, providing respite care, an award-winning freephone helpline (0808-800-8000), specialist MS nurses and funds around 40 vital MS research projects in the UK.
  • Multiple sclerosis is the most common disabling neurological disorder affecting young adults and an estimated 85,000 people in the UK have MS.
  • MS is the result of damage to myelin - the protective sheath surrounding nerve fibres of the central nervous system - which interferes with messages between the brain and the body.
  • For some people, MS is characterised by periods of relapse and remission while for others it has a progressive pattern.
  • Symptoms range from loss of sight and mobility, fatigue, depression and cognitive problems. There is no cure and few effective treatments.

http://www.mssociety.org.uk/

Inflammatory bowel disease (IBD) may share an underlying pathogenesis with other autoimmune diseases

Pre-Published by Pubmed for 2008 Jun;14(6):738-43.

Autoimmune disease concomitance among inflammatory bowel disease patients in the United States, 2001-2002.

University of Chicago Hospital, Chicago, Illinois.

Background: Recent studies suggest that inflammatory bowel disease (IBD) may share an underlying pathogenesis with other autoimmune diseases.

Methods: Two United States data sets with patient-level medical and drug claims were used to explore the occurrence of autoimmune diseases in patients with IBD, particularly Crohn's disease (CD) and ulcerative colitis (UC), with that in controls.

From 2001 to 2002 IBD patients were identified using International Classification of Diseases, 9th revision, diagnosis codes in the IMS Health Integrated Administration Claims Database and the Market Scan Commercial Claims and Encounters Database. Controls were selected by matching on sex, age, Census Bureau region, and length of previous medical insurance coverage. Odds ratios (ORs) evaluated the risk relationship between IBD patients and controls within an estimated Mantel-Haenszel 95% confidence interval. Sensitivity analysis tested the case identification method used to select IBD patients.

Results: The risk for ankylosing spondylitis (AS) was substantially increased across both data sets: OR (95% confidence interval [CI]) of 7.8 (5.6-10.8) in IMS Health and 5.8 (3.9-8.6) in MarketScan.

The risk for rheumatoid arthritis (RA) was 2.7 (2.4-3.0) and 2.1 (1.8-2.3), respectively; for multiple sclerosis (MS); the ORs were 1.5 (1.2-1.9) and 1.6 (1.2-2.1), respectively.

There was no increased risk for type 1 diabetes mellitus, and the results for psoriatic arthritis (PsA) were inconsistent. The sensitivity analysis supported these findings.

Conclusions: A much higher risk for RA, AS, PsA, and MS was observed in IBD patients compared with controls. Prospective epidemiologic studies are needed to confirm these findings and explore the pathogenic mechanism of this relationship.(Inflamm Bowel Dis 2008).

PMID: 18300281 [PubMed - in process]

Cortical pathology in multiple sclerosis - The Grey Matter is also affected

Pre-Released from PubMed - Due for distribution: 2008 Jun;21(3):229-34

Cortical pathology in multiple sclerosis.

aInstitute of Neuropathology, University Medical Centre, Göttingen, Germany bDepartment of General Neurology, University of Tübingen, Tübingen, Germany.

PURPOSE OF REVIEW: Multiple sclerosis is the most common chronic, disabling central nervous system disease in young adults, characterized by inflammatory demyelinating white matter lesions with glial scar formation and axonal loss. Lately, evidence has accumulated that large areas of grey matter are affected in multiple sclerosis patients.

RECENT FINDINGS: Findings in post-mortem brain tissue support the notion that cortical demyelination is frequent and extensive, especially in patients with chronic multiple sclerosis. Cortical lesions differ from white matter lesions with respect to inflammatory cell infiltration, gliosis, and remyelination. Thus, differences in cortical and white matter lesion pathogenesis have been proposed. Experimental models suggest a decisive role for antimyelin antibodies in cortical demyelination. Topical studies focus on damage to neurons, dendrites, and synapses in cortical multiple sclerosis lesions. Improved imaging techniques for the detection of cortical lesions are currently developed and will provide the basis for future clinicopathological correlative studies.

SUMMARY: In summary, recent years have opened our eyes to the extensive grey matter involvement in multiple sclerosis. Studies on the pathogenesis of cortical demyelination, cortical damage, and repair will elucidate basic principles of multiple sclerosis lesion formation. However, more sensitive imaging tools are required to study the impact of cortical lesions on clinical symptoms, disability, and disease progression.

PMID: 18451703 [PubMed - in process]

Monday, May 19, 2008

Glatiramer acetate after induction therapy with mitoxantrone in relapsing multiple sclerosis.

obtained from an MSnews@acceleratedCure.org News Bulletin
2008 Apr 18 - pubMed

Barrow Neurological Institute, Phoenix, AZ, USA.

Forty relapsing multiple sclerosis patients with 1-15 gadolinium (Gd)-enhancing lesions on screening brain magnetic resonance imaging (MRI) and Expanded Disability Status Scale (EDSS) scores 0-6.5 were randomized to receive short-term induction therapy with mitoxantrone (three monthly 12 mg/m(2) infusions) followed by 12 months of daily glatiramer acetate (GA) therapy 20 mg/day subcutaneously for a total of 15 months (M-GA, n = 21) or daily GA 20 mg/day for 15 months (GA, n = 19). MRI scans were performed at months 6, 9, 12 and 15. The primary measure of outcome was the incidence of adverse events; secondary measures included number of Gd-enhanced lesions, confirmed relapses and EDSS changes. Except age, baseline demographic characteristics were well matched in both treatment arms. Both treatments were safe and well tolerated. M-GA induction produced an 89% greater reduction (relative risk (RR) = 0.11, 95% confidence interval (CI): 0.04-0.36, p Gd-enhancing lesions at months 6 and 9 and a 70% reduction (RR = 0.30, 95% CI: 0.11-0.86, p relapse rates were 0.16 and 0.32 in the M-GA and GA groups, respectively. Short-term immunosuppression with mitoxantrone followed by daily GA for up to 15 months was found to be safe and effective, with an early and sustained decrease in MRI disease activity.

PMID: 18424479 [PubMed - as supplied by publisher]

Sunday, May 18, 2008

Bayer Schering Pharma Starts Global Awareness Campaign - Mastering MS

Medical News Today
17 May 2008

The results of an international survey presented by Bayer Schering Pharma shows that many people face the same fears and concerns when they are first diagnosed with multiple sclerosis (MS). In the survey, 71 percent of people with MS had at least one concern about how the disease would affect their relationships; 64 percent said being diagnosed had a negative impact on their career. To address these concerns, Bayer Schering Pharma launched Mastering MS today. This global public awareness program provides insight into the lives of people with MS, offering tools and expert advice that can help anyone facing a chronic disease lead a physically and emotionally fulfilling life.

Mastering MS highlights inspirational stories of people who have mastered living with MS whether as a spouse, parent, child, friend or co-worker, like 36-year old Dane Betina.

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