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Thursday, February 14, 2013

Chronic cerebrospinal venous insufficiency in multiple sclerosis: a highly prevalent age-dependent phenomenon


Roberta LanzilloMarcello ManciniRaffaele LiuzziOrlando Di DonatoElena SalvatoreValentina Maglio,Giovanni VaccaLuca AmatoGennaro D¿AnnaArturo Brunetti and Vincenzo Brescia Morra
BMC Neurology 2013, 13:20 doi:10.1186/1471-2377-13-20
Published: 13 February 2013



Abstract (provisional)

Background

This study aimed to investigate the prevalence and clinical relevance of chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis (MS) patients and healthy controls using extra- and intracranial colour Doppler sonography.

Methods

We examined 146 MS patients, presenting with a clinically isolated syndrome, relapsing-remitting, secondary progressive, or primary progressive MS, and 38 healthy controls. Sonographic examination was performed according to Zamboni's protocol and was performed by three independent sonographers. The results of sonographic examination were compared with clinical and demographic characteristics of the patients.

Results

CCSVI, defined as the presence of at least two positive Zamboni's criteria, was found in 76% of MS patients and 16% of control subjects. B-mode anomalies of internal jugular veins, such as stenosis, malformed valves, annuli, and septa were the most common lesions detected in MS patients (80.8%) and controls (47.4%). We observed a positive correlation between sonographic diagnosis of CCSVI and the patients' age (p=0.003). However, such a correlation was not found in controls (p=0.635). Notably, no significant correlations were found between sonographic signs of CCSVI and clinical characteristics of MS, except for absent flow in the jugular veins, which was found more often in primary (p<0.005) and secondary (p<0.05) progressive patients compared with non-progressive patients. Absent flow in jugular veins was significantly correlated with patients' age (p<0.0001).

Conclusions

Sonographically defined CCSVI is common in MS patients. However, CCSVI appears to be primarily associated with the patient's age, and poorly correlated with the clinical course of the disease.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.


source: BMC Neurology


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Wednesday, February 13, 2013

OCT: A Role in Monitoring Multiple Sclerosis?


Brianne N. Hobbs, OD
DisclosuresFeb 12, 2013

Active MS Is Associated With Accelerated Retinal Ganglion Cell/Inner Plexiform Layer Thinning

Ratchford JN, Saidha S, Sotirchos ES, et al

Neurology. 2013;80:47-54.

Optical Coherence Tomography

Optical coherence tomography (OCT) has improved the ability of optometrists to detect and manage retinal pathology. It is a quick, quantitative, noninvasive imaging modality that is also relatively inexpensive. The spectral-domain OCT is capable of visualizing and quantifying specific layers of the retina with impressive precision. OCT has taken some of the guesswork out of evaluating the retinal nerve fiber layer (RNFL) in conditions such as glaucoma, but it is also useful in the management of macular pathologies such as Best disease and age-related macular degeneration.

Study Summary

In a study recently published in Neurology, a relatively new clinical application of OCT in the treatment of systemic disease was described. Multiple sclerosis (MS), a neurodegenerative demyelinating disease, affects multiple areas of the central nervous system, including the retina and optic nerve. The study by Ratchford and colleagues included 164 patients with MS and 59 healthy control patients. All 4 subtypes of MS were included: clinically isolated syndrome, relapsing-remitting MS, primary progressive MS, and secondary progressive MS.
Patients were followed for an average duration of 21.1 months and were monitored by clinical evaluation and annual brain MRI. The macula and optic disc were evaluated with spectral-domain OCT every 6 months and the ganglion cell/inner plexiform (GCIP) and RNFL layers were quantified. The investigators hypothesized that the severity and progression of systemic disease would correlate with the degree of RNFL and GCIP thinning, a plausible assumption.
The most severe thinning occurred in patients with new lesions and correlated with onset of MS within the last 5 years. Of interest, the rates of GCIP and RNFL thinning were not equal in patients with MS. The GCIP layer appeared to be more sensitive to demyelinating changes because it thinned 46% faster in MS vs control patients (-0.37 µm/year vs -0.20 µm/year). The RNFL did not thin significantly faster in patients with MS compared with control patients. New gadolinium-enhancing lesions and new T2 lesions were the factors most predictive of accelerated GCIP thinning (< .001). Relapses of nonoptic neuritis were also associated with increased rates of GCIP thinning. Overall, GCIP thinning was more indicative of the severity of the systemic disease than RNFL thinning. GCIP thinning was not associated with impaired visual function in this study, but other studies have described this relationship.[1,2] The 1.25% low-contrast acuity chart was the most sensitive to MS-related damage, a logical finding because visual function tends to be reduced in MS whereas visual acuity is relatively preserved.

Viewpoint

This study exposed useful new evidence that is not intuitive. Macular GCIP thinning is more closely associated with radiologic and clinical measures of MS progression than is RNFL thinning. This finding needs to be supported by larger, longer studies, and the OCT normative database should be expanded before these results are universally applied to clinical practice. Stricter criteria for inclusion, such as excluding patients with a history of optic neuritis and minimizing the spectrum of MS subtypes, would increase uniformity and validity.
Several clinically relevant conclusions can be drawn from this study. The health of the GCIP complex is affected by MS and may be useful in monitoring the efficacy of MS treatments when other clinical signs are not sensitive enough to show low levels of inflammation. Ultimately, the patient's visual function and quality of life are the most important indicators of treatment efficacy, and if GCIP thinning is more closely correlated with these entities, it may become the preferred method of monitoring MS progression in the eye. OCT has proven its merit in daily optometric practice, but in the future it may be incorporated into the routine management of neurologic diseases.
 

Medscape Optometry © 2013  WebMD, LLC 
Article :LINK


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Teva files for Copaxone-Laquinimod patent


If a US patent is approved for the mixture of multiple sclerosis treatments, it will be valid through July 2031.

February 13, 2013

Teva Pharmaceutical Industries Ltd.  has filed for a US patent for a Copaxone-Laquinimod mixed treatment for multiple sclerosis. Copaxone, Teva's flagship branded drug had record sales of $4 billion in 2012 although sales are expected to fall slightly to $3.7-3.9 billion in 2013.
While Copaxone is administered by injection, Laquinimod is an oral drug that Teva is developing to treat multiple sclerosis. However, in 2011 in an advance Phase III trial, the clinical targets were not achieved, and the company was only able to reach the desired results after statistical corrections. Teva is preparing for an additional clinical trial which is delaying the drug's introduction to the market.
Sanford Bernstein analyst Dr. Ronny Gal said that if the patent is approved, it will be valid through July 2031. The Copaxone-Laquinimod mix would be administered as an injection and from clinical trials on mice the benefit was seen as greater than the existing treatment.


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Diagnosed with MS while serving his Country - An MS Patient's Story



In 2009, while serving as an officer on the bridge of the USS Bonhomme Richard, Donnie Horner was diagnosed with MS.
  
In this presentation Donnie Horner shares his perspective as a veteran living with MS. Read more about Donnie Horner in the Spring 2013 Issue of Momentum

Click here to view the webcast, or copy into your browser:http://www.nationalmssociety.org/multimedia-library/ms-learn-online/index.aspx   



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MS Treatments: Understanding Your Options

Information and Videos provided by : The National Multiple Sclerosis Society



MS Treatments: Understanding Your Options

Part One of One: 11 minutes
Featuring Dr. Benjamin Segal, Dr. George Kraft, Dr. Aliza Ben-Zacharia, and Dr. Susan Bennett
Downloads: Transcript (.pdf)  Podcast (.mp3)
*This video was produced prior to approval of the latest disease modifying therapy Aubagio®. To learn about
Aubagio®, please watch this video.


MS Treatments: Disease Modifying Therapies, part one


Part One of Two: 12 minutes
Featuring Dr. Benjamin Segal, Dr. George Kraft, Dr. Aliza Ben-Zacharia, and Dr. Susan Bennett
Downloads: Transcript (.pdf)  Podcast (.mp3)
*This video was produced prior to approval of the latest disease modifying therapy Aubagio®. To learn about
Aubagio®, please watch this video.


MS Treatments: Disease Modifying Therapies, part two


Part Two of Two: 12 minutes
Featuring Dr. Benjamin Segal, Dr. George Kraft, Dr. Aliza Ben-Zacharia, and Dr. Susan Bennett
Downloads: Transcript (.pdf)  Podcast (.mp3)
*This video was produced prior to approval of the latest disease modifying therapy Aubagio®. To learn about
Aubagio®, please watch this video.


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What You Should Know About Aubagio®


Feature Presentations -
Treatments

What You Need To Know About Aubagio®


Source: National Multiple Sclerosis Society
 Part one of one: 12 minutes
Featuring Jim Bowen, MD and Lily Jung Henson, MD
Downloads: Transcript (.pdf)
Topics: What is Aubagio® (teriflunomide)?;
Clinical trial findings; Potential side effects



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Tuesday, February 12, 2013

Strength Training to Improve Quality of Life for People With MS


Gone are the days of doctor-placed restrictions on physical activity. New research shows that adding strength training to your exercise program can bolster your independence and improve your quality of life.

Medically reviewed by Pat F. Bass III, MD, MPH

Denise Pisciotta was diagnosed with MS in 1989. Her initial treatment plan included steroid drugs, which were commonly prescribed at the time but had the side effect of making her bones brittle. She had always been a relatively active person — tennis, running, and golf were some of her favorite activities. In 1993, one awkward step off a curb resulted in a broken femur. Her bones had been weakened so badly from the steroids that the break meant she would need to begin using a wheelchair.

denise pisciotta
Determined to remain independent, Pisciotta (pictured above) found her way to a local gym. At the time, they didn't have a staff trained about MS, but she says the personal trainers were willing to learn what they could to help her develop a workout plan that fit her abilities. She focused on developing her upper-body strength so that she wouldn’t have to rely on others to help her get in and out of her chair. She was able to maintain her upper-body strength, but her bone density continued to deteriorate and her posture was suffering from the time spent in the wheelchair.

New Outlook on Exercise

As recently as the 1980s, exercise, much less weight training, was discouraged for people with MS. There were several reasons for this thought-process, explains Nicholas G. LaRocca, PhD, vice president of health care delivery and policy research at the National Multiple Sclerosis Society. “First, the understanding of what triggers MS and MS attacks was much sketchier at that time," he notes. "Second, it was felt that exercise would worsen the fatigue that is so common in MS. Third, there was the fear that people with MS would get overheated, and their MS would get worse. And fourth, many doctors felt that exercise was a waste of time — people with MS could not benefit from exercise and, even if they did, their MS would eventually get worse anyway, and the time spent exercising would be wasted.”
Time and experience have disproved those theories. It's now known that exercise provides vast benefits. “Exercise for a person with MS can assist with achieving the highest independence possible,improve energy levels, lessen fatigue, help control spasticity, improve mood, improve the muscles that control the bowel and bladder, just to name a few,” says Nancy Dollenmeyer, MPT, MSCS, a physical therapist at Mercy Therapy Services in St. Louis, Mo.
LaRocca cites two reasons for the shift in attitude. Many people with MS, some of whom had been very athletic before their diagnosis, decided not to listen to the naysayers, followed an exercise regimen, and found it helpful for their quality of life. “However, the real turning point came with the publication of an article by Jack Petajan and colleagues at the University of Utah that examined the impact of aerobic exercise on people with MS," he says. "The study, funded by the National MS Society and published in the Annals of Neurology, found that aerobic exercise could not only improve cardiovascular fitness in people with MS, but could also improve quality of life in a variety of ways.” That opened a floodgate of research that extended beyond aerobic activity to explore the benefits of other types of exercise.

Weight Training: More Promising Results

A recent study, published in the Adaptive Physical Activity Quarterly, found that resistance training in particular improved the walking ability of people with MS and their overall quality of life. “When participants were interviewed, most indicated improvements in walking endurance and performance during daily living," says study author Lesley J. White, PhD, FACSM. "Together, these findings suggest that physical function may improve with program participation and suggest that deficits in physical function due to MS may be partially reversible.” Along with walking, many participants found that they could stand for longer periods, had better muscle endurance to do more and not tire as quickly, better balance with more confidence climbing stairs, and added strength for tasks like outdoor chores and getting in and out of the car. “Some also mentioned that being able to do more gave them more confidence,” White adds.
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Researchers are optimistic about the progress toward finding an MS cure.


Medically reviewed by Lindsey Marcellin, MD, MPH



If you're living with multiple sclerosis, there's reason to be hopeful that more effective treatments — even an MS cure — are on the horizon. That's because researchers and doctors who are working to understand the underlying causes of multiple sclerosis and to develop effective MS treatments are optimistic too.
Someone asks me in every clinic if we are close to a cure,” says neurologist Khurram Bashir, MD, MPH, associate professor of neurology and director of the University of Alabama at Birmingham Multiple Sclerosis Center. “I am optimistic, but it’s hard to know if a cure will come in the next five years or longer. Science moves forward in small steps.” Current MS treatments are more and more effective, says Dr. Bashir. A quarter-century ago, no treatments existed. Today, nine MS drug treatments have been approved by the Food and Drug Administration, with two more anticipated in the next year and manyothers working their way through the pipeline.
However, says Jack Burks, MD, chief medical officer of the Multiple Sclerosis Association of America, based in Cherry Hill, N.J., “the cure will most likely come from new scientific information into the yet unknown cause of MS."

Multiple Sclerosis Cure: Signs of Progress

Since no MS cure has been developed so far, today's MS medications are aimed at "disease modifying" instead of curing, which means they slow the progression of multiple sclerosis and reduce the severity of MS symptoms. The most recent generation of drugs suppresses the immune response that may contribute to multiple sclerosis. Other drugs in the pipeline (yet to be approved) may help regenerate some lost myelin (the sheath that protects neurons). These drugs have some limitations, points out Bashir, because they cannot repair scar tissue or long-term injury to neural networks. Nonetheless, they offer some hope for protecting function and ability.

Multiple Sclerosis Cure: Focus on Slowing Progression

The current focus of MS treatments is on slowing the progression toward disability. Even with the number of medications available, it can be challenging to find the best medication for a given patient’s individual experience of multiple sclerosis. Without a good understanding of what causes MS or biomarkers that can suggest which medications could work most effectively, doctors and patients may be working on a trial-and-error basis to manage the condition.

Multiple Sclerosis Cure: Genetics May Be Key

Understanding the mechanisms that cause complex diseases such as MS can help researchers develop strategies for prevention or even an MS cure. Genetic risk is one avenue of research that could yield some of the answers researchers are seeking.
Research published in PloS One found that there are more than 50 genetic locations that could be involved in an individual’s MS risk, and researchers expect there are even more genetic keys yet to be discovered.
The exact cause of MS remains unknown, but researchers have used genetic information to prevent the development of MS in genetically altered mice, a finding that suggests that a gene-based vaccine may be a possibility for multiple sclerosis in the not-too-distant future.

Multiple Sclerosis Cure: Stem Cell Research

Included among the many possible cures for MS is the use of stem cell transplants. Animal studies have shown promise in using stem cells to replace lost myelin, a protective covering over nerves in the body that is damaged or destroyed by multiple sclerosis.

Multiple Sclerosis Cure: Toward Understanding MS

Multiple sclerosis remains something of a mystery, even as researchers continue to pursue new, more effective, ways to treat the condition and manage symptoms. And in a way, the more researchers know about treating MS, the more they don’t know.
More technologies are needed, argues Thomas P. Leist, MD, PhD, associate professor of neurology, chief of the division of clinical neuroimmunology, and director of the Comprehensive Multiple Sclerosis Center at Thomas Jefferson University in Philadelphia.
“It has been recognized in recent years that there is significant injury in the gray matter structures of the brain,” he explains. But, says Dr. Leist, imaging technologies don’t tell physicians much about that damage. Better imaging technologies, tests to determine which treatment works best, and a deeper understanding of what causes multiple sclerosis in different people are necessary to move toward an MS cure.
“I think MS is a syndrome. I don’t think that everybody with MS has MS for the same reasons,” he says. And he waits, with hope, as do patients all over the country, for a critical mass of information that can explain MS and point toward a cure.
Last Updated: 11/08/2012

Source: Everyday Health
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Coping With MS and a Secondary Disease


People living with MS often find themselves coping with a second or third health condition at the same time. But with a positive attitude and the right planning, it's possible to manage multiple diseases.

Medically reviewed by Lindsey Marcellin, MD, MPH


Being diagnosed with multiple sclerosis (MS) can feel overwhelming.  Some people become so caught up in managing their MS that they stop getting routine health screenings and believe that nothing worse can happen to them, says Rosalind Kalb, PhD, vice president of the Professional Resource Center for the National Multiple Sclerosis Society. This can have dire consequences.
Kalb points out that having a diagnosis for one disease will not prevent you from ending up with a second disease or even a third. “Get preventative care so that you are better prepared to handle other health conditions as they arise,” she suggests.
It's also important to notice when a new symptom appears or a “normal” symptom suddenly changes. Don’t assume it’s being caused by your MS, and if the symptom persists mention it to your neurologist. He or she will be able to determine if the symptom is aside effect of new medications or treatments you're trying.

And If your neurologist determines the symptom isn’t caused by MS, it’s time to visit your primary care doctor to locate the source.Migraine headaches and MS are a frequently seen combination, and secondary autoimmune disorders like rheumatoid arthritis aren’t uncommon.

Create the Best Medical Team

Because MS can be an all-consuming disease that requires frequent visits with a neurologist, some people come to rely heavily on that one specialist, mistakenly believing they no longer need a primary care physician. This is not the case, cautions Kalb, because "your primary care doctor watches all different aspects of your health.” And when you have more than one health condition, it’s even more imperative to have a primary care doctor helping to coordinate care with your neurologist and other specialists. For example, you'll need to see a rheumatologist if you develop rheumatoid arthritis
Zoe Koplowitz can vouch for the necessity of a well-coordinated medical team. Diagnosed with MS in her twenties, Koplowitz is now 64 and thriving thanks in large part to her medical team — a primary care physician, neurologist, rheumatologist, internist, and endocrinologist. They work together to help manage symptoms of MS and her two other conditions, diabetes and Sjogren’s syndrome, another autoimmune disorder characterized by chronic dry eyes and dry mouth.
Many hospitals and doctor's offices have electronic medical records stored in a central computer system that enables medical providers to easily communicate with one another and track patients’ treatment plans. If your health care providers are not electronically connected, you need to make sure you report each and every medication and treatment to all of your doctors or follow up to make sure the information is passed along among offices. Ask your primary care doctor to help you and your providers stay up-to-date.
Keep track of all symptoms and any over-the-counter medications you take and provide all of this information to your doctors as well. Koplowitz uses e-mail to make sure her team has all pertinent data — one group e-mail and the information gets where it needs to be.
If managing multiple health conditions becomes overwhelming, consider hiring a professional care manager as a team coordinator. A care manager is a health professional who coordinates care between your medical team, pharmacists, and even your insurance company. Ask your health care provider or insurance company to see if this is an option.

Create a Triage System for Care

“What will this do to my MS?” is a common reaction after being diagnosed with a secondary disease, even one as serious as cancer, says Kalb. It is important to remember that MS is rarely life-threatening, so you want to prioritize your health concerns and treat them accordingly. Your medical team should direct a treatment plan so that the most serious conditions are taken care of first. If none of your conditions are life-threatening, your medical team will work with you to prioritize the symptoms that should be treated first.

There may be instances when medications for MS should not be taken if you are on drugs for another health condition. For example, prednisone, taken to relieve the inflammation of MS, makes it more difficult to manage blood sugar and weight — side effects make it harder for Koplowitz to control her diabetes.

Koplowitz depends on her medical team to identify these types of interactions. She also uses one pharmacy for all medications because its database will alert the pharmacist if there's a potential interaction that she should be aware of. Any time she starts a new medication, she takes it separately, at a different time of day than her other medications — something that she says helps her to identify any changes in symptoms or side effects that she needs to report to her medical team.

Stay Positive No Matter What

When Koplowitz was first diagnosed with MS in 1973, she thought it would eventually kill her. She was prepared for defeat from the beginning. Her outlook changed when she choked on a pill one day and had the realization that, even with MS, she was subject to the same randomness as everyone else. She thought of activities that seemed impossible for someone with MS to accomplish and set out to do them.

Since then, Koplowitz has completed 25 New York City marathons, finishing last every time, but finishing. She has also gone snorkeling and parasailing. She sets goals for herself and figures out how to make them happen using modifications and sheer determination. Planning ahead (while staying flexible), being prepared, and maintaining a positive attitude keep her moving forward and actively participating in life. “Don’t cash in your chips,” she says. “You can either have a disease or be one.” 

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Antisense Therapeutics granted U.S. patent for multiple sclerosis treatment

(MENAFN - ProactiveInvestors - Australia) Antisense Therapeutics (ASX: ANP) has been granted a U.S. patent covering its ATL1102 drug in the treatment of multiple sclerosis.

The patent extends coverage of the ATL1102 compound for the treatment of relapsing-remitting multiple sclerosis patients until 2029 with the potential for up to a five year extension to 2034.

Antisense also has patent applications under examination in Europe, Japan, Canada, and Australia.

Additional patent protection in relation to the antisense technology and manufacturing is also provided internationally for ATL1102 by Antisense's technology partner Isis Pharmaceuticals.

A previous phase two study has confirmed the drug's activity in potently suppressing brain lesions in relapsing-remitting multiple sclerosis patients.

There are significant commercial deals taking place in the multiple sclerosis space including Biogen Idec's purchase of Elan's stake in Tysabri, and Merck Serono's option over Opexa's Tcelna therapy, a multiple sclerosis treatment entering phase IIb trials.


Move towards phase IIb study

Testing of the ATL1102 formulated material for suitability for use in a chronic toxicology study has now confirmed the material's suitability for its intended application.

The material will be shipped to China for use in the toxicology study that is designed to support a potential future phase IIb study of ATL1102 in multiple sclerosis patients.

Antisense and Chinese partner Tianjin International Joint Academy of Biotechnology and Medicine (TJAB) are in discussions regarding the commencement of the toxicology study ahead of establishing the joint venture.

TJAB was established as part of an initiative of the Chinese Government and State Food and Drug Administration to accelerate economic growth and develop the country's biotech industry.

Potential applications for ATL1102 include the areas of multiple sclerosis, stem cell mobilisation and asthma.
 
Source: MenaFN

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Nerve Stimulation Cuts Down on Migraines

By Crystal Phend, Senior Staff Writer, MedPage Today
Published: February 11, 2013
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

A noninvasive device that electrically stimulates the trigeminal nerve prevented migraines for patients whose episodes were not well controlled by medication alone, a trial showed.
The number of days with a migraine dropped significantly by about two per month in the supraorbital transcutaneous stimulation group, without a change in the sham control group, Jean Schoenen, MD, PhD, of Belgium's Liège University, and colleagues found.
While the difference between the two didn't reach statistical significance, the coprimary endpoint showed three times more responders with at least a 50% drop in migraine days with neurostimulation (38% versus 12%, P=0.023), the group reported in the Feb. 19 issue of Neurology.
"The therapeutic gain (26%) is within the range of those reported for other preventive drug and nondrug anti-migraine treatments," they wrote.

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