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Thursday, August 7, 2014

Research in the News: Yale scientists track origins of multiple sclerosis

8.06.14

By Bill Hathaway - The autoimmune response that is involved in multiple sclerosis (MS) was once thought to be confined to the brain.



Yale researchers, however, have uncovered evidence that this damaging response may begin in the lymph nodes. 

The finding, reported in the issue of journal Science Translational Medicine, tracks the origin of the autoimmune response in the lymph nodes and later its arrival in the brain, where it contributes to tissue damage that results in numbness, loss of vision, and debilitating fatigue.


“This helps explain why treatments that work outside the central nervous system can ease MS symptoms and may give us clues how to develop even more effective treatments,” said neuroimmunologist Kevin O’Connor, one of the senior authors of the paper. 

Learn More, click here




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Catheter Useage





Intermittent Catheters Exclusives
August 5, 2014


Eric S. Rovner, MD
eric rovner
Quality of Life in Multiple Sclerosis Patients


Eric Rovner, MD presents the results of a study which looked at the prevalence of urinary catheterization among patients with multiple sclerosis and the impact this had on their quality of life.

Best Practices for Management
nurse and patient
Intermittent catheterization can have a significant physical and/or emotional impact on patients' lives. Clinicians need to consider the various concerns patients have in their teaching and recommend possible strategies.






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Wednesday, August 6, 2014

Using Exercise to Minimise Fatigue in MS

 mstran  -           July 21, 2014



Exercise


By Brett Drummond
Fatigue is a common symptom of multiple sclerosis (MS), that can range from creating minor difficulties to having a severe impact on quality of life. The causes of fatigue in people with MS aren’t well understood, but it is thought that many factors may contribute. Due to this, it is important to develop a strategy to minimise the levels of fatigue experienced and so lessen the impact on day to day life. One potential technique that has been investigated is the use of an exercise routine. This short review summarises the results of 10 recent studies that have all investigated the use of exercise to help manage fatigue levels in people with MS.
These trials included 233 people with MS and did not discriminate by age, gender or clinical presentation of MS. Of the 10 trials, one trial pre-screened all participants to only include those that reported experiencing constant fatigue. Many different physical activities were assessed including aquatic exercise, cycling, yoga, climbing, walking, resistance training and vestibular (head, body and eye) rehabilitation. Outcomes were measured using the fatigue-severity scale (FSS), which is a 9-item questionnaire designed to assess levels of fatigue and it’s impact on daily life. Using this measurement, 3 out of 10 trials reported effective results (associated with aquatic exercise, resistance training and vestibular rehabilitation). These results suggest that exercise may be beneficial in people with MS, however, the type of exercise undertaken and the effects observed should be evaluated individually.
Source: MSTranslate - Australia



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Tuesday, August 5, 2014

HIV drugs could help to prevent and treat Multiple Sclerosis, say scientists


HIV and multiple sclerosis

Antithesis, synthesis?

A curious observation may lead to a treatment for MS

August 5, 2014
 IN SCIENCE, as in many other walks of life, what is unexpected is often what is most interesting and important. The idea, first mooted in 2011 by Julian Gold of the Prince of Wales Hospital in Sydney, Australia, that HIV infection—or maybe the drug treatment used to fight it—might protect against multiple sclerosis (MS), was certainly unexpected. Now, in a study just published in the Journal of Neurology, Neurosurgery and Psychiatry, Dr Gold has confirmed his suspicion. That is interesting. It may also be important.

Dr Gold’s original motive for investigating the connection between the two diseases was casual observation. He treats people with HIV and has several acquaintances with MS. This led him to realise he had never come across a case of somebody with both. A literature search confirmed the lack of connection. Of the 700,000 published papers on HIV and AIDS, and the 300,000 on MS; not one referred to a patient who had the pair of them. Eventually, he tracked down a single instance—and, tellingly, that individual had started to shrug off the symptoms of MS when he began taking antiretroviral drugs to combat his HIV.


This finding led a Danish team to compare 5,000 HIV-positive people with a control group of 50,000 of their uninfected peers. Unfortunately (for science, if not for the individuals involved) even these large numbers did not yield enough instances of subsequent multiple sclerosis for a statistically significant result to emerge. Dr Gold therefore decided to throw the kitchen sink at the problem. He and his colleagues turned to the English Hospital Episode Statistics, which record all interactions between the people of England and hospitals belonging to their country’s National Health Service.
The team used this database to identify and track everyone in England with HIV who was discharged from hospital between 1999 and 2011, and to provide similar information on multiple sclerosis both for these people and for a group of uninfected controls. In total, Dr Gold and his colleagues found 21,207 HIV-positive individuals in the database and compared them with 5,298,496 controls of similar ages and ethnic backgrounds.
The rate of onset of MS in the controls suggested that about 18 cases should have developed among the HIV-positive patients. In fact, the team found only seven. That result was indeed statistically significant. It suggests those infected and undergoing treatment are 60% less likely to develop MS than their uninfected peers. Moreover, further analysis showed this value leapt to 80% among those who had been infected and treated for more than five years.
Dr Gold’s results do not indicate whether it is the infection or its treatment that is suppressing MS. Either sounds plausible. The immediate cause of MS’s symptoms (which range from clumsiness of movement to depression) is that the sufferer’s immune system is attacking his central nervous system—specifically, the fatty sheaths that insulate the nerve cells in it. HIV meddles with many sorts of immune-system cells and signalling pathways that are associated with multiple sclerosis, so this could be why the disease wanes in those infected with it. On the other hand, though the underlying cause of MS is unknown, many people suspect it is triggered by a yet-to-be-determined virus. If that is true, it may be that the antiviral drugs given to those with HIV are bringing relief by attacking this unknown culprit too.

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Researchers Pinpoint Signal that Triggers the Beneficial Effects of Specific Gut Bacteria in MS-Like Disease


August 4, 2014

Researchers funded by the National MS Society have pinpointed a molecular signal that triggers the beneficial effects of gut bacteria in mice with MS-like disease. This finding may set the stage for a therapeutic strategy that “resets” the immune system in MS.
Researchers funded by the National MS Society have pinpointed a molecular signal that triggers the beneficial effects of gut bacteria in mice with MS-like disease. This finding may set the stage for a therapeutic strategy that “resets” the immune system in MS.Researchers funded by the National MS Society have pinpointed a molecular signal that triggers the beneficial effects of gut bacteria in mice with MS-like disease. This finding may set the stage for a therapeutic strategy that “resets” the immune system in MS.Researchers funded by the National MS Society have pinpointed a molecular signal that triggers the beneficial effects of gut bacteria in mice with MS-like disease. If continued research confirms and extends these findings to people who have MS, the results may present a novel target for a therapeutic strategy that “resets” the immune system to stop immune attacks in MS. Yan Wang PhD, Lloyd Kasper, MD (Dartmouth College, Hanover, NH) and colleagues report their findings in Nature Communications. (2014 Jul 21;5:4432
Background: MS involves immune-system attacks against the brain and spinal cord. The gut, including the small and large intestine, is the largest immune organ in mammals. Each of us has millions of “commensal” bacteria living within our guts. Most of these bacteria are harmless as long as they remain in the inner wall of the intestine. They play a critical role in our normal physiology, and accumulating research suggests that they are critical in the establishment and maintenance of immune balance by the molecules they release. These molecules are absorbed by the complex structure of immune cells that are contained in the immune tissue associated with the gut.
Lloyd Kasper, M.D., is funded by the National MS Society, with underwriting support from the Conrad N. Hilton Foundation, to examine the effects gut commensal bacteria in MS and in mice with MS-like disease. Specifically, his team is looking at a molecule called polysaccharide A (PSA) that is released by specific species of gut bacteria (Bacteroides) that colonize almost 95% of people worldwide. Previous work in the Kasper lab (Mucosal Immunology2010 Sep;3(5):487-95) showed that PSA can reduce the effects of EAE, an animal model of MS, by stimulating the production of immune cells that regulate inflammation (known as Tregs). In this study, Dr. Kasper’s team investigated how bacterial PSA affects specific Tregs via an immune system protein (known as Toll-like receptor 2, or TLR2) in mice with EAE. 
The Study: Dr. Kasper’s team administered PSA to mice six days before inducing EAE, until nine days after EAE induction. They then analyzed which immune system signals contributed to PSA’s beneficial effects.
The results show that bacterial PSA could expand a subset of Tregs that expresses the protein CD39. This expansion was dependent on TLR2. Signals from the protein CD39 were critical for the protective effects of PSA. CD39 was essential for the function of Tregs. When CD39 was deleted from mice, PSA was not able to control inflammation, and the ability of disease-causing immune cells was enhanced.
Conclusion: This study presents exciting findings on how gut bacteria may be able to modulate the immune attack in MS. If the results are confirmed in further study, CD39 may present a possible target for treatments that can stop the immune attack and enhance the protective capability of T regs. Ultimately, this could lead to the testing of an oral treatment that provides beneficial bacteria to reset the immune system in people with MS. 
Read more about possible links between the gut, the immune system, and MS.
Source: NMSS

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Validation of Mood Measures for People with Multiple Sclerosis

Tessa M. WatsonDClinPsyEmma FordBScEsme WorthingtonPhDNadina B.LincolnPhD

Background: Valid assessments are needed in order to identify anxiety and depression in people with multiple sclerosis (MS). The objective of this study was to assess the validity of questionnaire measures of mood in people with MS.
Methods: People with MS were recruited from a clinic database and asked to complete and return a questionnaire containing the Beck Anxiety Inventory (BAI), Beck Depression Inventory–II (BDI-II), and Hospital Anxiety and Depression Scale (HADS). Those who returned the questionnaire were invited to complete a structured clinical interview, which was blind to the results of the questionnaire.
Results: The BDI-II and HADS were both found to be valid measures to detect depression and anxiety in people with MS. An optimum cutoff score of 23 for the BDI-II yielded high sensitivity (85%) and high specificity (76%). An optimum cutoff score of 11 for the HADS demonstrated high sensitivity and specificity for both the Anxiety subscale (sensitivity 90%, specificity 92%) and the Depression subscale (sensitivity 77%, specificity 81%). The BAI had high sensitivity (80%) but poor specificity (46%) for detecting anxiety.
Conclusion: The BDI-II and HADS can be used to identify mood disorders in people with MS.
From the Institute of Work, Health and Organisations, University of Nottingham, Nottingham, UK.
Correspondence: Nadina B. Lincoln, PhD, Institute of Work, Health and Organisations, University of Nottingham, International House, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, United Kingdom; e-mail:.

Complete article found here

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Short-Term Effect of Aerobic Exercise on Symptoms in Multiple Sclerosis and Chronic Fatigue Syndrome - A Pilot Study

Yvonne C. LearmonthPhDLorna PaulPhDAngus K. McFadyenPhDRebeccaMarshall-McKennaPhDPaul MattisonMDLinda MillerMPhilNiall G. McFarlane,PhD

Background: This pilot study was conducted to determine whether a 15-minute bout of moderate-intensity aerobic cycling exercise would affect symptoms (pain and fatigue) and function (Timed 25-Foot Walk test [T25FW] and Timed Up and Go test [TUG]) in people with multiple sclerosis (MS) or chronic fatigue syndrome (CFS), and to compare these results with those of a healthy control group.
Methods: Eight people with MS (Expanded Disability Status Scale score 5–6; Karnofsky score 50–80), eight people with CFS (Karnofsky score 50–80), and eight healthy volunteers participated in the study. Pain and fatigue levels and results of the T25FW and TUG were established at baseline as well as at 30 minutes, 2 hours, and 24 hours following a 15-minute stationary cycling aerobic exercise test. Repeated-measures analysis of variance (ANOVA) and covariance (ANCOVA) were used to analyze the findings over time.
Results: At baseline there were statistically significant differences between groups in fatigue (P = .039), T25FW (P = .034), and TUG (P = .010). A significant group/time interaction emerged for fatigue levels (P= .005). We found no significant group/time interaction for pain levels or function.
Conclusions: Undertaking 15 minutes of moderate-intensity aerobic cycling exercise had no significant adverse effects on pain or function in people with MS and CFS (with a Karnofsky score of 50–80) within a 24-hour time period. These initial results suggest that people with MS or CFS may undertake 15 minutes of cycling as moderate aerobic exercise with no expected negative impact on pain or function.
Complete article found here


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Treatment Satisfaction in Multiple Sclerosis

Bonnie I. GlanzPhDAlexander MusallamMPHDavid J. RintellEdDTanuja Chitnis,MDHoward L. WeinerMDBrian C. HealyPhD

Background: Disease-modifying therapies (DMTs) for the treatment of multiple sclerosis (MS) are associated with inconvenient methods of administration, significant side effects, and low adherence rates. This study was undertaken to compare treatment satisfaction in MS patients treated with interferon beta-1a intramuscular (IFNβ-1a IM), interferon beta-1a subcutaneous (IFNβ-1a SC), glatiramer acetate (GA), and natalizumab (NTZ), and to examine the associations between treatment satisfaction ratings and adherence to therapy.
Methods: Two hundred twenty-six treated MS patients completed the Treatment Satisfaction Questionnaire for Medicine. Multivariable models were used to compare treatment satisfaction across groups.
Results: There were no statistically significant differences in overall treatment satisfaction. The NTZ group reported greater satisfaction with the ability of the medication to treat or prevent MS than the IFNβ-1a IM group. The NTZ group also reported higher overall convenience scores than the IFNβ-1a IM group and greater satisfaction with ease of use of the medication than the interferon and GA groups. Patients in the IFNβ-1a IM group reported less satisfaction with ease of planning when to use the medication than those in the other groups. Convenience was associated with adherence in IFNβ-1a SC- and GA-treated patients, with lower convenience scores associated with lower adherence.
Conclusions: These results may be useful to MS patients and health-care providers facing decisions about DMT use.

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Monday, August 4, 2014

Effects of Functional Electrical Stimulation on Gait Function and Quality of Life for People with Multiple Sclerosis on Ampyra

Lori MayerMSN, MSCN, CCRPTina WarringPTStephanie AgrellaANP-BC, MSCN;Helen L. RogersPT, PhDEdward J. FoxMD, PhD
From the MS Clinic of Central Texas, Central Texas Neurology Consultants, Round Rock, TX, USA (LM, TW, SA, EJF); and Innovative Neurotronics, Austin, TX, USA (HLR).
Background: Multiple sclerosis (MS) can adversely affect gait, causing gait slowing, loss of balance, decreased functional mobility, and gait deficits such as footdrop. Current treatments for gait dysfunction due to MS are pharmacologic, using Ampyra (dalfampridine), or orthotic, using an ankle-foot orthosis (AFO). Functional electrical stimulation (FES) to the fibular nerve stimulates active dorsiflexion and provides an alternative treatment for gait dysfunction caused by footdrop. The objective of this study was to determine the effect of FES on gait function and the impact of MS on walking and quality of life (QOL) for people with MS on a stable Ampyra dosage.
Methods: Subjects demonstrating gait slowing and footdrop completed the Timed 25-Foot Walk (T25FW) test, 6-Minute Walk (6MW) test, GaitRite Functional Ambulation Profile (FAP), Multiple Sclerosis Walking Scale–12 (MSWS-12), and SF-36 at screening without FES; the measures were repeated with FES at baseline, 1 month, and 3 months.
Results: Twenty subjects (8 male, 12 female) completed this unblinded case series study. The mean age, duration of MS, and time on Ampyra were 51.7, 15.8, and 1.4 years, respectively. Changes from screening to baseline and screening to 3 months were analyzed. Significant improvement was noted from screening to baseline for the MSWS-12 (P = .024) and SF-36 Physical Function domain (P = .028) and from screening to 3 months for the T25FW (P = .015), MSWS-12 (P = .003), and SF-36 Physical Function (P = .032) and Role Limitation–Physical Health domains (P = .012).
Conclusions: Improvements, above those induced pharmacologically, suggest that FES can augment pharmacologic intervention and significantly improve gait function, decrease the impact of MS on walking, and improve QOL for people with MS.
Published Online: July 14, 2014
Correspondence: Helen L. Rogers, PT, PhD, 2014 Sydnor Lane, Galveston, TX 77554; e-mail: .



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Multiple Sclerosis (MS) SYMPTOMS - Learn to recognize and manage the possible symptoms of MS, which range from mild to severe.

MS symptoms are variable and unpredictable. No two people have exactly the same symptoms, and each person’s symptoms can change or fluctuate over time. One person might experience only one or two of the possible symptoms while another person experiences many more.
Explore the list (via the link showing below) to find more information about the symptoms you or someone you care about is experiencing. Most of these symptoms can be managed very effectively with medication, rehabilitation and other management strategies.
See the MS Symptoms list and learn, by clicking here


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Hearing Loss with MS

Hearing loss is an uncommon symptom of MS. About 6 percent of people who have MS complain of impaired hearing; hearing loss may take place during an acute exacerbation.
  • In very rare cases, hearing loss has been reported as the first symptom of the disease.
  • Deafness due to MS is exceedingly rare, and most acute episodes of hearing deficit caused by MS tend to improve.
Hearing loss is usually associated with other symptoms that suggest damage to the brainstem — the part of the nervous system that contains the nerves that help to control vision, hearing, balance and equilibrium.
Hearing deficits caused by MS are thought to be due to inflammation and/or scarring around the eighth cranial nerve (the auditory nerve) as it enters the brainstem, although plaques (abnormal areas that develop on nerves whose myelin has been destroyed) at other sites along the auditory pathways could also contribute to hearing problems.

Because hearing deficits are so uncommon in MS, people with MS who do develop hearing loss should have their hearing thoroughly evaluated to rule out other causes.
Information showing above was obtained from the NMSS website


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Speech Problems with MS

Overview

Speech disorders are fairly common in MS. Speech patterns are controlled by many areas in the brain, especially the brainstem. Lesions (damaged areas) in different parts of the brain can cause several types of changes in normal speech patterns. They range from mild difficulties to severe problems that make it difficult to speak and be understood. Medically, speech disorders are called dysarthrias.
  • One pattern that is commonly associated with MS is so-called scanning speech. Scanning dysarthria produces speech in which the normal "melody" or speech pattern is disrupted, with abnormally long pauses between words or individual syllables of words.
  • People with MS may also slur words. This is usually the result of weakness and/or incoordination of the muscles of the tongue, lips, cheeks and mouth.
  • Other speech problems include nasal speech, which sounds as though the person has a cold or nasal obstruction.
Dysarthrias are commonly associated with other symptoms caused by lesions in the brainstem. These include tremor, head shaking or incoordination.

Treating speech problems

Many people can be aided by a speech/language pathologist, who can evaluate and help to improve speech patterns, enunciation and oral communication in general.

If a person with MS becomes unable to speak, there are many assistive devices available. These range from alphabet cards to hand-held communicators that print out a tape, to computers that respond to eyeblinks.
Many persons with dysarthria also have dysphagia (difficulty in swallowing). Speech therapists are trained to evaluate, diagnose and relieve these problems.
Information showing above was made possible by the National Multiple Sclerosis Society found here



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Sunday, August 3, 2014

Nanotechnology a Possible Future Solution for Multiple Sclerosis


By Rachel Lutz | August 02, 2014

A University of Southern California (USC) PhD student has announced plans to develop a model of a human brain that can mimic the electrical circuit pathways of multiple sclerosis (MS) and other neurological diseases that can affect patients’ brains. The team he is working with hopes the brain model can lead to better treatment options, implementation plans, and the true pathology of various neurological diseases.   “There is no known cure for many of the most debilitating neural diseases,” Kun Yue, a doctoral student in the USC Viterbi Ming Hsieh Department of Electrical Engineering, said in a statement. “New technology can ease people's suffering.”   -

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