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

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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.

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Saturday, July 5, 2014

For Nurses and Nurse Practitioners

For Nurses and Nurse Practitioners

  1. Clinical Bulletins - Resources for healthcare professionals working with people who have multiple sclerosis.
  2. Expert Opinion Papers - Treatment recommendations from our National Clinical Advisory Board.
  3. Nurse's Quick Reference (.pdf) - A guide to nursing management in MS.
  4. Multiple Sclerosis: The Nurse Practitioner’s Handbook (.pdf) - This book was designed as a practical reference tool — offering easy access to the information you need to help your patients manage their disease, enhance their quality of life, and make healthy, informed decisions. Using the handbook: click on the Pages icon in the top left corner of the landing page to navigate directly to specific pages in the book, and the Bookmark icon to navigate directly to specific chapters.
  5. Talking with Your MS Patients about Difficult Topics- Authored by recognized MS specialists and designed to help healthcare professionals respond to their patients' questions about some of the more difficult and challenging aspects of the disease.

Source: National Multiple Sclerosis Society



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Resource Materials for Long-Term Care

Information about unique needs generated by Multiple Sclerosis 
and sophisticated resources and knowledge necessary 
to provide quality programs and services.

Serving Individuals with MS in the Home

Specific recommendations, practical tips and best practices to help home care providers, whether assigned by an agency or hired independently, to be more knowledgeable about MS and comfortable serving people living with the disease. Topics include clinical issues and symptom management, assessment, primary health care needs, daily care issues, safety, emotional and family issues, rehabilitation, and wellness and community integration.
Adult Day Programs

These guidelines will be most helpful to those day programs that have little or no experience serving people with MS. Included in the document is basic information about multiple sclerosis and specific recommendations, practical tips, and best practices as they relate to intake & assessment, clinical implications, psychosocial issues, activities & wellness, rehabilitation, and staffing & physical plant.
Assisted Living

Guidance to administrators and staff of assisted living facilities that are seeking to develop effective service plans for residents with multiple sclerosis. These guidelines address the unique set of clinical conditions of residents with MS and provide recommendations to maximize their quality of life.
Nursing Home Care

Information on clinical practice, practical tips and best practices with regard to nursing and daily care, rehabilitation, psychosocial needs and cognitive issues, assisting families with the nursing home admission process, training materials, and resources for health care professionals.
Source: National MS Society




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Friday, July 4, 2014

2014 Neurological Aspects of Multiple Sclerosis - MS Symposium Central Florida



(This video is Part 1 of 3 different videos for this program)

Program Date : June 21st, 2014
Location: Crowne Plaza downtown Orlando, Fl.

Topics and Presenters: 
In this video listen with Multiple Sclerosis Nurse-Practitioners - Plus a Q&A

Patricia Pagnotta - MSN, ARNP-C - who spoke about Emerging MS Treatments, Compliance and Switching
and

Connie Easterling - MSN, ARNP, MSCN - who discussed MS Relapse and Symptom Management





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UB Team Finds a Way to Make Stem Cells into Myelinating Cells

stem cells for mylenationStem therapy to treat multiple sclerosis may benefit greatly from a new study published in Proceedings of the National Academy of Sciences by the laboratory of Fraser Sim, Ph.D., assistant professor of Pharmacology and Toxicology at University of Buffalo’s School of Medicine and Biomedical Sciences. Dr. Fraser’s team discovered that transcription factor (proteins that induce gene expression) SOX10 is a master switch for inducing myelination in oligodendrocytes of the brain.
“Now that we have identified SOX10 as an initiator of myelination, we can work on developing a viral or pharmaceutical approach to inducing it in MS patients,” said Dr. Sim in a news release. “If we could create a small molecule drug that would switch on SOX10, that would be therapeutically important.”
Dr. Sim’s team, including lead author Jing Wang, a doctoral candidate at University of Buffalo, studied fetal brain stem cells for transcription factor expression. They identified transcription factors turned on in oligodendrocyte progenitors, but not neural progenitors. “We narrowed it down to a short list of ten transcription factors that were made exclusively by oligodendrocyte progenitor cells,” said Dr. Sim. “Among all ten transcription factors that we studied, only SOX10 was able to make the switch from neural progenitor to oligodendrocyte progenitor cell.”
Remarkably, SOX10 was capable of differentiating oligodendrocytes both on the lab bench and in a model of human leukodystrophy. These results indicate increasing SOX10 expression in stem cells will enhance the efficacy of human transplant therapy.
Read More



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Thursday, July 3, 2014

Topics: Urinary Incontinence PLUS Neuro-Psychological Testing for Multiple Sclerosis were presented at the 06.21.14 MSVN Symposium in Orlando Florida


Program Name: 2014 Neurological Aspects of Multiple Sclerosis - 
                        MS Symposium Central Florida - Part 2
Location: Orlando, Florida
Date: June 21, 2014

This video topics: Bladder Issues and Neuro-Psychological Testing information -
Christopher Walker, MD discussed the Bladder Issues with MS -
and
Justin Koenitzer, PsyD., presented on Neuro-Psych testing for Disability Claims

Plus a Q&A


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Social Security Disability (SSDI) Law discussed



Program Name: 2014 Neurological Aspects of MS
Location:            Orlando Florida
Program Date :  June 21, 2014
Presented by: Leslie D. Gaines, PA



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Wednesday, July 2, 2014

Cleveland Clinic Turns iPad Into Powerful Multiple Sclerosis Assessment Tool



Multiple sclerosis (MS) is a disease that can affect its sufferers in different ways and at different rates. Tracking how a patient progresses is a critical part of MS management, a procedure that can benefit from greater objective analysis. Turns out that today’s computer tablets feature technologies such as accelerometers, gyroscopes, and touchscreens that when combined can offer pretty good MS assessment capabilities.

Researchers at Cleveland Clinic just reported in Journal of Visualized Experiments (JoVE) that they used an Apple iPad as a tool to perform an array of performance tests relevant to MS assessment. By attaching the iPad to the back of a patient while having her walk and balance, the app within provides precise data on posture. A specially built attachment that sits on the top of the iPad’s screen allows for dexterity testing using metal pegs. The patient moves pegs between different holes as requested by a therapist and the iPad software tracks the timing of the pegs being moved, translating that into an objective evaluation of dexterity. There is also an eye test included that analyzes low contrast vision and a simple cognitive processing test to get an idea of how well the brain is working.

From the study abstract:


We report a new test, the Multiple Sclerosis Performance Test (MSPT), which represents a new approach to quantifying MS related disability. The MSPT takes advantage of advances in computer technology, information technology, biomechanics, and clinical measurement science. The resulting MSPT represents a computer-based platform for precise, valid measurement of MS severity. Based on, but extending the Multiple Sclerosis Functional Composite (MSFC), the MSPT provides precise, quantitative data on walking speed, balance, manual dexterity, visual function, and cognitive processing speed. The MSPT was tested by 51 MS patients and 49 healthy controls (HC). MSPT scores were highly reproducible, correlated strongly with technician-administered test scores, discriminated MS from HC and severe from mild MS, and correlated with patient reported outcomes. Measures of reliability, sensitivity, and clinical meaning for MSPT scores were favorable compared with technician-based testing. The MSPT is a potentially transformative approach for collecting MS disability outcome data for patient care and research.
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New study will explore potential treatment (ibudilast )for progressive MS

At this time, there is a significant gap in available treatment options for people living with progressive MS. The good news is that researchers are paying more attention to this critical area of research. In May, we told you about research being conducted on statins and how the cholesterol-lowering drugs could impact progressive MS. Now, the Rocky Mountain MS Center MS Center at Anschutz Medical Center—along with other national sites—is beginning a new study to test a drug called ibudilast.
This new study will test the safety, tolerability and activity of ibudilast in people with primary and secondary progressive multiple sclerosis. Researchers are currently looking for participants to take part in the study. 

"We have an opportunity, by studying this novel molecule, to add to the growing body of research, and potentially have an impact, on progressive disease," said Dr. John Corboy.
This study is being conducted at 28 sites across the country through a consortium called NeuroNEXT (The Network for Excellence in Neuroscience Clinical Trials). Participation in the study is not limited to Colorado residents – study sites are located nationwide. NeuroNEXT studies are funded by the National Institutes of Health (NIH) and are designed to create increased efficiency in neurological research trials. The University of Colorado Denver is one of 25 NeuroNEXT sites.
More about ibudilast
Ibudilast is an oral medication that is approved in Japan for post-stroke use and asthma. In a 2010 Dutch study on relapsing forms of MS, ibudilast showed no beneficial effect on newly active lesions and relapses. The preliminary evidence, however, suggested that ibudilast may act in a neuroprotective way. Neuroprotection simply means that it protects neurons that have been damaged, and therefore helps preserve brain function. This is likely because ibuldilast is a phosphodiesterase (PDE) inhibitor, which means it influences inflammation and neurodegeneration.
Study details
People with primary or secondary progressive multiple sclerosis are eligible for the study only if they are not currently on a disease modifying treatment (DMT), or are currently taking Copaxone, Avonex, Rebif or any other formulation of an Interferon Beta. The study will be stratified by disease status and by current use of a DMT.


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Tuesday, July 1, 2014

How Do Multiple Sclerosis (MS) Relapses Impact Disability?

Early relapses indicate greater likelihood of progression to SPMS

Created June 30, 2014



The symptoms that accompany a multiple sclerosis (MS) relapse are usually dramatic and debilitating – I have completely lost vision in one eye with optic neuritis, I have gone from being able to walk quickly to having to clutch furniture or another person to get across the room, and I have had such intense pain from the "MS hug" that I could not sleep. These symptoms came on quickly and intensified within a day or two.
During the relapse period, there are two main questions that consume me: 1) When will these immediate symptoms be gone? 2) What effect will this relapse have long-term? While my immediate symptoms responded well to a course of Solu-Medrol, I still wonder what kind of impact the relapse had on my future disability.
I was lucky enough to attend a session at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2012 called "Controversies in the Natural History of MS," where Antonio Scalfari from the Division of Neuroscience of Imperial College in London presented data on the relationship between relapses and sustained disability, using information from different databases of MS patients.
Typically, relapsing-remitting MS begins with a higher number of relapses at the beginning of the onset of the disease. Turns out that the relapses that people have in the first year or two may be the most important relapses in terms of telling us what our disease course may be.
How do relapses predict long-term disability?
  • Overall, people with more early relapses in the first two years after diagnosis have a shorter time to diagnosis of secondary progressive MS. Those that had 3 or more relapses in that time are almost 3 times more likely to progress to SPMS than those who only had one relapse.
  • One study showed that people who had one relapse in the first 2 years took an average of 22.7 years to reach a score of 6 of the Expanded Disability Status Scale – EDSS (the point when assistance, such as a cane, is needed to walk), while those people who had 3 or more relapses in the first two years reached EDSS of 6 in 15.1 years.
  • However, the time from EDSS 3 (the average EDSS score when SPMS is diagnosed) to EDSS 6 is not affected by early relapses.
  • Additionally, the number of relapses a person has after the first two years has little effect on progression to SPMS.
Turns out the most important factor in predicting progression to EDSS 6 is time to reach SPMS. Once SPMS is reached, relapse history does not matter, as disability accumulates with pretty much the same speed.
What does this mean for individuals with MS?
  • Remember that not everyone with relapsing-remitting MS will convert to SPMS.
  • Although it is still not entirely clear whether disease-modifying therapies have an impact on long-term disability, it is important to delay progression to SPMS, to slow disability accumulation. Since early relapses tend to speed time to SPMS conversion, it is important that therapy be started early to attempt to prevent relapses early in the disease process.
source: AboutMS.com



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VIDEO of Man Who Has Cerebral Palsy and Multiple Sclerosis Says Medical Marijuana Changed His Life



Seth Green, whose multiple debilitating conditions prevented him from living a "normal" life, finally found a solution.
The 23-year-old says in the video above that medical cannabis has helped mitigate the panic attacks, depression and anxiety he experiences due to cerebral palsy, a congenital disorder that affects his muscle and cognitive functioning. Medicinal marijuana has also helped him cope with multiple sclerosis, an autoimmune disease that affects the central nervous system. Green, who is both a patient and an activist, also suffers from scoliosis and seizures.
"I want to be a normal man in society -- or close to it," Green, who lives in Tennessee, says in the video. "I don't want to draw an SSI check each month and live broke. I want to get out and be productive and either help people or, if that is not my choosing, work for a living. I don't want to just sit home."
Green has become an advocate for medicinal marijuana, sharing the story of his struggles through the nonprofit Healthy Hopes, which helps patients legally obtain medical cannabis. Green's ailments are listed as qualifying medical conditions in most states' medical marijuana regulations.
The outspoken activist has held a rally to support Tennessee's 2014 Herbal Bill, which attracted more than 300 people. He also testified at the state Capitol in Nashville on the same bill in front of the House Health Committee. And he says he doesn't plan to stop there.
In an email to The Huffington Post, Green said that after he moves to a state such as California, where medical marijuana is legal, he plans to run for a state representative position. Ultimately, he said he hopes to curb government regulation and special interest groups that back major pharmaceutical companies, which he believes offer poor long-term solutions such as pain pills.
Recent research from the American Academy of Neurology indicates that medical marijuana does ease muscle spasms and pain in patients who have multiple sclerosis. 
READ MORE found here


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Genzyme’s Lemtrada Approved in Argentina for Treatment of Multiple Sclerosis

CAMBRIDGE, Mass., Jun 30, 2014 (BUSINESS WIRE) -- Genzyme, a Sanofi company , announced today that Argentina’s National Administration of Drugs, Food and Medical Technology (ANMAT) has approved LemtradaTM (alemtuzumab) for adult patients with relapsing remitting multiple sclerosis (RRMS) with active disease defined by clinical or imaging features.
“The Lemtrada clinical trial data demonstrating the treatment’s positive impact on relapse rates and disability progression support its potential as a transformational new treatment for relapsing-remitting multiple sclerosis,” said Norma Deri, M.D., Hosptial Fernandez, Buenos Aires, Argentina. “The approval of Lemtrada is good news for people living with active MS, who are in need of additional treatment options that may offer greater efficacy.”
Lemtrada is supported by a comprehensive and extensive clinical development program that involved nearly 1,500 patients and 5,400 patient-years of follow-up. In addition to Argentina, Lemtrada is approved in the European Union, Australia, Canada, Mexico, Brazil and Guatemala. Lemtrada is currently not approved in the United States. Genzyme recently announced that the U.S. Food and Drug Administration (FDA) has accepted for review the company’s resubmission of its application seeking approval of Lemtrada. Genzyme expects FDA action on the application in the fourth quarter.
More than 2.3 million people worldwide have been diagnosed with MS, including approximately 8,000 people in Argentina.
Lemtrada 12 mg has a novel dosing and administration schedule of two annual treatment courses. The first treatment course of Lemtrada is administered via intravenous infusion on five consecutive days, and the second course is administered on three consecutive days, 12 months later.
"We are pleased by the continued global support for Lemtrada," said Genzyme President and CEO, David Meeker. "We are launching the treatment in more than 30 countries this year, and look forward to additional approvals where Lemtrada is still under review."




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BREAKDOWN OF THE BLOOD-BRAIN BARRIER PRECEDES SYMPTOMS AND OTHER MRI SIGNS OF NEW LESIONS IN MULTIPLE SCLEROSIS PATHOGENETIC AND CLINICAL IMPLICATIONS


Summary

From an extensive serial magnetic resonance imaging (MRI) study in multiple sclerosis (MS) we have identified 4 cases in which disruption of the blood-brain barrier, as detected by gadolinium-DTPA enhancement, preceded other MRI abnormalities and in 1 case clinical evidence of the new lesion. This supports the view that a defect in the blood-brain barrier, and therefore inflammation, is an early and possibly crucial event in the pathogenesis of the new lesion in MS. These cases showed a marked discrepancy between MRI abnormality and symptoms. The mechanisms contributing to this disparity are discussed, and it is concluded that far from being surprising it is to be expected.

Read more on this subject and relating articles






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Monday, June 30, 2014

The Burden of MS on Our Military

Published Jun 30, 2014

In the summer of 1977, when I enlisted in the U.S. Marine Corps (USMC), I had to endure the 105-110 degree heat of boot camp in Parris Island, South Carolina. Weeks of humidity and drills in unbearable heat were grueling, but as a young man, not even 20 years old, I became used to the endless days and limited sleep. When I look back at a time in my life 37 years ago when MS was just two letters in the alphabet with no other meaning, it seemed like someone else’s life.
For the past eight years of living with the two letters that now mean multiple sclerosis, I have come to appreciate the time in my life when I was able to endure the heat, run drills, climb ropes, and, well…just feel my limbs and coordinate them. I no longer take for granted the health of my youth or the ability to conquer the hardest task put in front of me. Those two little letters ‒ MS ‒ have changed my life forever.
Last week I began to wonder, when I put on my USMC cap and headed to the gym to coordinate myself through another workout, how many Marines and other military men and women suffer from MS. How many war veterans who have served our country with honor and bravery now deal with the numbness of MS and its multitude of symptoms? How many military careers have been cut short by this debilitating disease? So, I began to do my research and found some disturbing facts.

MS and the Military: ‘Service-Connected’ Evidence

Information from the U.S. Department of Veterans Affairs (VA) states that more than 28,000 veterans are receiving care annually for MS in the VA system. That is just the number that is being reported to the VA. I am sure that many thousands of MS diagnoses in the military are unreported.
I found, through information at the National Multiple Sclerosis Society, that a February 2008 Congressional briefing examined MS among veterans. Two U.S. veterans living with MS and a neurologist with the VA’s MS Centers of Excellence testified on Capitol Hill. Legislators and staff came together and examined the increased risk and prevalence of the disease among U.S. veterans and explored the need for increased federal funding in MS research.
New evidence at the time showed a potential link between the incidence of MS and combat service. A study published in the Annals of Neurology in 2004 identified 5,345 cases of MS among U.S. veterans that were deemed “service-connected.”
One of the veterans who testified, Dr. David Gustavison, a U.S. Army Medical Corps veteran whoserved in the Gulf War and lives with MS, shared his views as a medical doctor with complete knowledge of the disease. “I believe there is a relationship between military service and MS,” Dr. Gustavison said. “Myself and three other physicians in the same command were diagnosed with MS in approximately a two-year time period. Two of us were deployed to the Gulf. All three had the same pre-deployment vaccinations. And all three worked with the same command and visited the same installations. I have had symptoms of MS since 1994.”
Bob Wolz, another U.S. Army veteran who served in the Gulf War, also testified by sharing his story of life with MS. He considers MS a wound that does not heal from his first tour of duty. The stories go on and on about veterans who suffer from MS and I wanted to speak to one of these MS warriors.

U.S. Army Veteran With MS: ‘Never Stop…Never Quit’

Kevin Byrne on recumbant bikeSo, in my search to learn more about MS and the soldiers afflicted by this disease, I found Kevin Byrne (pictured, left), a veteran army helicopter pilot. Kevin is very vocal about his battle with MS, and I knew I had to reach out to him and get his story firsthand. I spoke to Kevin on the phone, and he is an amazing man who has a heart to help others with MS.
Kevin’s personal mantra is very similar to my “Never Quit”: “Never Stop…Never Quit!” He says, “I always want to do it all, but some years, my body just will not let me.”
Kevin reflects that, “I was overseas with the Army Cavalry when I was first diagnosed with multiple sclerosis in 1999. Although my Army career ended in a flash, my physical recovery has taken much longer. I have been able to fight back, though. Through the amazing medical treatment that I receive from my doctors at the VA Hospital, my health is ‘stable.’ Through the constant love and guidance from my friends and family, I have been able to maintain my daily life.”
As a West Point graduate, Kevin entered military service strong minded and physically fit with the dream that anything is possible. He served as a captain in Army aviation, flying helicopters. His life changed in 1999, when he started experiencing vision problems and numbness in his arms.
Kevin says, “I like to think of myself as a strong person. I’m the one who stands straight when dealing with adversity, there to support the ones who ‘really need the help.’ My MS proves that’s not true. It reminds me how much I lean on others and how much others carry me, support me, and give me the strength to keep moving forward.”
I had the pleasure of asking Kevin a few questions:



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