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Thursday, December 23, 2010

Kids with MS need prompt treatment

Last Updated: 2010-12-13 18:43:05 -0400 (Reuters Health)

By Karla Gale

NEW YORK (Reuters Health) - About half of children with multiple sclerosis (MS) need to switch medication during their first few years of treatment because of refractory illness or poor tolerability, new study results show.

"The general rule of thumb is to wait until more than one relapse has occurred to change therapies," lead author Dr. E. Ann Yeh said. But she advises that physicians shouldn't be afraid to change treatment if the patient's disability worsens or the tempo of relapses increases.

She also recommends that pediatric MS patients be treated as soon as the diagnosis is firm, usually after two clinical episodes of central nervous system demyelination.

In an interview with Reuters Health, the researcher noted that the time to physical disability in kids with MS is longer than in adults, but they "eventually do reach the equivalent to those of adults with secondary progressive MS," and they do so at a younger age. There's also growing evidence that children develop significant cognitive difficulties within several years of diagnosis.

"So if a child is diagnosed with MS, treatment should be initiated sooner rather than later," she said. "Sometimes neurologists tend to wait and watch."

In a paper published online today in the Archives of Neurology, Dr. Yeh, from the Women and Children's Hospital of Buffalo, New York, and colleagues review records of 258 patients with pediatric-onset MS treated between 1997 and 2009 at the six Pediatric MS Centers of Excellence in the US.

The average age of onset was 13.2 years (range 2.0-17.9 years).

The patients initially received at least six months of treatment with a first-line disease-modifying therapy (DMT) - interferon beta (in 77.5%) or glatiramer acetate (in 20.5%). Five patients (1.9%) with very active acute disease were first treated with pulse cyclophosphamide or azathioprine but were later prescribed a first-line DMT.

Most patients (52.3%) continued with the first therapy prescribed throughout the observation period, which averaged 3.9 years. Therapy was changed once in 25.2%, twice in 11.2%, three times in 3.9%, and four or more times in 3.9%. Nine patients (3.5%) quit treatment.



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Angiogenesis is present in experimental autoimmune encephalomyelitis and pro-angiogenic factors are increased in multiple sclerosis lesions

Angiogenesis is a common finding in chronic inflammatory diseases; however, its role in multiple sclerosis (MS) is unclear. Central nervous system lesions from both MS and experimental autoimmune encephalomyelitis (EAE), the animal model of MS, contain T cells, macrophages and activated glia, which can produce pro-angiogenic factors.

Previous EAE studies have demonstrated an increase in blood vessels, but differences between the different phases of disease have not been reported. Therefore we examined angiogenic promoting factors in MS and EAE lesions to determine if there were changes in blood vessel density at different stages of EAE. 



Methods: In this series of experiments we used a combination of vascular casting, VEGF ELISA and immunohistochemistry to examine angiogenesis in EAE.

Using immunohistochemistry we also examined chronic active MS lesions for angiogenic factors.

Results: Vascular casting and histological examination of the spinal cord and brain of rats with EAE demonstrated that the density of patent blood vessels increased in the lumbar spinal cord during the relapse phase of the disease (p<0.05). We found an increased expression of VEGF by inflammatory cells and a decrease in the recently described angiogenesis inhibitor meteorin.

Examination of chronic active human MS tissues demonstrated glial expression of VEGF and glial and blood vessel expression of the pro-angiogenic receptor VEGFR2. There was a decreased expression of VEGFR1 in the lesions compared to normal white matter.

Conclusions: These findings reveal that angiogenesis is intimately involved in the progression of EAE and may have a role in MS.

Author: Timothy SeabrookAmanda Littlewood-EvansVolker BrinkmannBernadette PollingerChristian SchnellPeter Hiestand
Credits/Source: Journal of Neuroinflammation 2010, 7:95



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Multiple Sclerosis More Linked to Depression, in Minorities


Newswise — Multiple sclerosis (MS) can cause significant physical impairment, including fatigue, pain, muscle spasms, tremors and dizziness. For many with MS, the disease wreaks havoc with emotional well-being, too, and according to a new study, minorities might especially be at risk for developing depressive symptoms.

Of study participants with the neurological condition, 44.2 percent of Latinos and 45.8 percent of African-Americans reported at least mild depression, compared with 38.7 percent of whites with MS. However, more Latinos never received mental health care, compared to whites or African-Americans with MS, according to lead study author Robert Buchanan, Ph.D.
Buchan is a professor in the department of political science and public administration at Mississippi State University. For the study in the December 2010 issue of the journal Ethnicity & Disease, authors used data from a registry of 26,967 white, 715 Latino and 1,313 African- American MS patients.
“Depression is even more common in people with MS,” said Staley Brod, M.D., director of the Multiple Sclerosis Research Group Clinic at the University of Texas-Houston. “In general it is a treatable problem and, in most cases, the neurologist that’s seeing the patient can deal with it effectively,” he said.
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Wednesday, December 22, 2010

ABOUT Caregivers and Emotional Support


Caregivers

A caregiver is someone who can provide you with support and encouragement to help you live well with multiple sclerosis (MS). It could be your spouse, parent, other family member or good friend. Regardless of who it is, it's important for the two of you to talk openly and honestly about your needs and wants. Some people with MS need more physical and practical assistance; others want more emotional support. Often it's a combination of both. You and your caregiver should work together to find the most effective ways you can support each other. In doing so, you may discover a deeper level of understanding and closeness in your relationship.

Emotional support

MS affects both you and your loved one. It can help to lean on each other for support. Your caregiver can help motivate you to stay on therapy and can help you make decisions about medical, financial and other issues. You can support your caregiver by showing him or her special appreciation and listening to his or her concerns. And you and your caregiver should talk openly together, empathize with one another and provide support through difficult emotional times.
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Tuesday, December 21, 2010

European Neurologists Expect Significant Increases in the Use of Both Tysabri and Extavia in Their Multiple Sclerosis Patients the Next Six Months

Yahoo Finance Press Release -  Source: BioTrends Research Group, Inc. On Tuesday December 21, 2010,



EXTON, Pa.Dec. 21, 2010 /PRNewswire/ -- BioTrends Research Group, Inc. finds that while neurologists in the EU tend to prescribe the established interferon betas as their first line disease modifying agents (DMAs) for the treatment of multiple sclerosis (MS) patients, they are most satisfied with Biogen/Elan's Tysabri. Prescribing of both Tysabri and Novartis's recently launched DMA, Extavia, is anticipated to increase over the next six months with Bayer's Betaferon suffering the most in terms of market share loss. Despite these expected changes, neurologists clearly associate most of the DMAs with a certain MS patient type and their reported prescribing reflects these preference patterns.
The recently released TreatmentTrends®: Multiple Sclerosis in the European Union report finds that neurologists in the U.K. have less clinical experience with many of the DMAs, prescribe DMAs to a smaller percentage of their MS patients, and are detailed less than their counterparts in FranceGermanyItaly andSpain. In line with these regional differences, neurologists in the U.K. report relying on different attributes when making their DMA prescribing decisions and identify different unmet needs for DMAs in development compared to neurologists from the other EU regions.




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Beyond the Immune System?


Beyond the Immune System?
Gilenya is the first oral MS drug available and it was approved to treat relapsing forms of MS, the most common initial presentation of the debilitating and potentially deadly disease. The understanding among biomedical researchers has been that, like all other primary MS therapies, Gilenya acts on a patient’s malfunctioning immune system to prevent the attack on the brain that causes the disease.
This was a logical conclusion. Among other important effects in the immune system, researchers have well documented that after Gilenya goes through a transformation in the body called phosphorylation, it binds with molecular receptors known as S1Preceptors (S1PRs) found on the surfaces of certain cells. “Then it does something weird,” says Chun.
This binding causes the cell to internalize the receptor and ultimately destroy it. In the case of immune system cells, one subtype of receptors, called “S1P1“are critical in the release of white blood cells (lymphocytes), from lymphoid organs, which in MS patients can damage nervous system cells. So the hypothesis was that this receptor destruction pathway gives the drug its positive MS results.
But the Scripps Research team suspected the drug might also have important effects within the CNS. Fifteen years ago, Chun’s group was the first to discover the family of receptors that includes the S1P receptors (S1PRs). Many receptors from this family are expressed in the brain, suggesting that a drug tied to the receptors might well have important activity in the brain.
Intriguing Brain Activity
To test this hypothesis, the researchers genetically altered mice so that they lacked S1P1“only within the CNS. S1P1 in immune system cells remained intact.
“If there was purely an immunologic effect, if the CNS was just a bystander, then there should be no effect from removing those CNS receptors,” says Chun.
But that’s not what the researchers found.
Knocking out the nervous system S1PRs decreased the severity of a mouse disease analogous to MS (experimental autoimmune encephalomyelitis). And when the team administered Gilenya to these mice, it had very no effect, while it continued to affect the immune system.
All told, these results strongly suggested that Gilenya’s main disease-fighting properties must be centered within the CNS.
“It’s a surprising result especially considering the purely immunological focus of current MS therapies as well as many under development. That you can alter the course of this disease through S1PR signaling in the CNS points to new ways to treat MS,” says Chun.
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Find a doctor specializing in spasticity management

To find a doctor specializing in spasticity management, click here and enter your zip code to Find a Doctor in your area who offers a full range of treatment options for spasticity.




Source for the information found above, is MS World, Inc
MSWorld, Inc. does not endorse or recommend any of the physicians listed through the links above.






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