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Thursday, January 8, 2015

Lifestyle Factors Contribute to Depression in Patients with Multiple Sclerosis

By Rachel Lutz | January 07, 2015


Modifiable lifestyle factors contribute to depression in multiple sclerosis (MS) patients, according to a study published in BMC Psychiatry.   Researchers from St. Vincent's Hospital Melbourne in Victoria, Australia examined nearly 2,500 MS patients in order to understand the association between lifestyle risk factors, medication, and depression risk through the analysis of self reported data. The researchers collected data about the participants' sociodemographics, diagnostic history, level of disability, comorbidities, fatigue, depression, body mass index (BMI), and an assortment of lifestyle and health behaviors. Patients were mainly female (82.4 percent) and middle aged (median age 45 years) and most patients (61.3 percent) had relapsing remitting MS. 

Most participants health either a bachelor (36.5 percent) or post graduate degrees (23.5 percent) and worked either full time (32.8 percent) or part time (21.3 percent). Diagnosis occurred at a median age of 37 years and half (45.2 percent) had been recently diagnosed within the last 5 years. Mild disability was reported in 54.8 percent of the patients.   

About a fifth of the patients (19.3 percent, 429 patients) screened positive for depression and 21.8 percent were taking prescription medication for depression. However, 10 percent of those taking medication for depression stated they did not have depression. Of patients who screened positive for depression, 92.9 percent also screened for clinically significant fatigue. The patients reported the following symptoms: - 

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Study: HPV Vaccine Doesn't Increase Risk for Multiple Sclerosis

TUESDAY, Jan. 6, 2015 (HealthDay News) -- The HPV vaccine for cervical cancer and other diseases doesn't increase the risk formultiple sclerosis or other central nervous system disorders, according to a new study.
More than 175 million doses of HPV vaccines have been distributed worldwide to girls and young women -- and more recently males -- since 2006. Unconfirmed reports in social and news media suggested the possibility of some safety concerns about the vaccine, including increased risk for multiple sclerosis and similar diseases, according to background information with the study.
To investigate this possible risk, researchers led by Nikolai Madrid Scheller, of the Statens Serum Institute in Copenhagen, Denmark, examined data on nearly 4 million Danish and Swedish girls and women from 2006 to 2013. 


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Nova Scotia First Of Canada's Atlantic Provinces To Fund Aubagio Treatment For Relapsing ...

Canada has one of the world’s highest Multiple Sclerosis (MS) prevalence rates. Some 100,000 Canadians live with the disease, and three people are newly diagnosed each day. Most people are diagnosed with relapsing MS in their twenties and thirties, and MS is the most common neurological disease affecting young adults in Canada.
Genzyme, a Sanofi company, announced January 5 that Nova Scotia has become the first of Canada’s four Atlantic Provinces to include AUBAGIO (teriflunomide) 14 mg treatment on its provincial drug formulary as a first-line oral agent for people in the province living with relapsing remitting multiple sclerosis (RRMS).
AUBAGIO was approved by Health Canada In November 2013 as monotherapy for treatment of patients with RRMS to reduce clinical exacerbation frequency and delay accretion of physical disability. The approval was based on efficacy data from two Phase III clinical trials TEMSO (TEriflunomide Multiple Sclerosis Oral) and TOWER (Teriflunomide Oral in people With relapsing remitting multiple scleRosis). In the TEMSO trial, AUBAGIO 14 mg significantly reduced the annualized relapse rate (p=0.0005) and the time to disability progression (p=0.0279) at two years versus placebo in patients with RRMS. In the TOWER trial, AUBAGIO 14 mg significantly reduced the annualized relapse rate (p=0.0001) and the time to disability progression sustained for 12 weeks (p=0.0442) was statistically significantly reduced versus placebo in patients with RRMS.


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Biogen Idec Reports Positive Top-Line Results From Phase 2 Anti-LINGO-1 Trial


By RTT News,  

Drugmaker Biogen Idec ( BIIB ) Thursday announced top-line results from the Phase 2 acute optic neuritis or AON RENEW trial in which treatment with anti-LINGO-1 showed evidence of biological repair of the visual system.
Anti-LINGO-1 demonstrated an improvement in the study's primary endpoint, recovery of optic nerve latency, relative to placebo. The study showed no effect on secondary endpoints, including change in thickness of the retinal layers and visual function.
AON damages the optic nerve, causing loss of the myelin sheath and axonal injury, and may result in loss of visual function. It is considered a good clinical model to measure the hypothesized mechanisms of action of anti-LINGO-1, remyelination and neuroprotection.
Read more 


Or read another article here: 
Biogen Idec Reports Positive Top-Line Results from Phase 2 Anti-LINGO-1 Trial in People with Acute Optic Neuritis ...



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info on Anti-LINGO-1 Remyelination ...

BIIB033, a monoclonal antibody targeting the LINGO-1 remyelination signaling block, passes phase 1 safety tests

A high-profile experimental treatment to repair the damaged myelin around nerves in people with multiple sclerosis (MS) has passed its first clinical testing milestone. The drug, a monoclonal antibody called BIIB033 (Biogen Idec), is safe and tolerable in people, according to the combined results of two phase 1 clinical trials that tested high doses inhealthy people and in people with MS.

“We have now reached a potential turning point in MS therapeutics,” according to an editorial published online August 27 with the phase 1 study results in the journalNeurology, Neuroimmunology & Neuroinflammation (Brugarolas et al., 2014Tran et al., 2014).

“The anti-LINGO-1 trial is likely the first of many that will test drugs that have been shown to enhance remyelination in [mouse] models,” wrote Pedro Brugarolas, Ph.D., and Brian Popko, Ph.D., of the University of Chicago, Illinois, in the editorial. “Soon we should know whether this approach will provide benefit to patients with MS, which would be the first evidence that enhancing myelin repair may alter the course of this disease.”

The antibody Li81 (BIIB033, Biogen) in hot pink binds to the signaling molecule LINGO-1 (yellow) in an unexpected four-way structure  to induce myelination, shown here in two potential configurations.  Image courtesy of Sha Mi and the <em>Journal of Pharmacology and Experimental Therapeutics</em> (Pepinsky <em>et al</em>., 2014).
The antibody Li81 (BIIB033, Biogen) in hot pink binds to the signaling molecule LINGO-1 (yellow) in an unexpected four-way structure to induce myelination, shown here in two potential configurations. Image courtesy of Sha Mi and the Journal of Pharmacology and Experimental Therapeutics (Pepinsky et al., 2014).


With no proven treatments for the progressive forms of MS that cause severe disability, attention has become riveted on ways to repair and restore the myelin that surrounds and protects axons from neurodegeneration (Franklin et al., 2014).





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Tuesday, January 6, 2015

CME event - "Clinical Challenges in MS Care: Family Planning, Pregnancy, and Disease-Modifying Therapies"

MS leaders e-mail logo header 



 
Dear Colleague,

Can you correctly answer this question:

Which one of the following statements is true and should be discussed with women of childbearing potential and MS as part of preconception counseling?

A.    Cesarean delivery is the preferred mode of delivery for all women with MS in
order to reduce the risk of postpartum relapse.
B.    The relapse rate prior to pregnancy is a good indicator of the relapse rate in
the postpartum period.
C.    Pregnancy increases the relapse rate.
D.    MS impairs fertility.

Participate in this John Hopkins educational activity to learn the answer to this and other questions related to MS therapy in women of childbearing age.

EARN CME or CNE Credit!

The Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing, in cooperation with Medical Logix, LLC, are currently offering this educational program certified for CME and CNE credit, at no charge to participants:


 Video Clinical Dialogue and eCase Challenge:



Jointly presented by the Johns Hopkins University School of Medicine and the 
Institute for Johns Hopkins Nursing

Release Date: May 7, 2014
Expiration Date: May 6, 2015


Estimated time to complete each part of this activity: 60 minutes for each of the two activities. Each part of this activity has been approved for a maximum of 1.0 AMA PRA Category 1 Credit™ and 1.0 contact hour for nurses. There are no fees or prerequisites.

Supported by independent educational grants from
EMD Serono and Genzyme, a Sanofi Company.

 
Learning Objectives
After participating in this activity, the participant will demonstrate the ability to:
  • Recognize the importance of providing preconception counseling to all patients of childbearing age in order to reduce reproductive risks.
  • Apply the most recent evidence concerning the reproductive safety of approved DMTs when counseling patients with MS who are considering pregnancy or those who are pregnant.
  • Summarize and provide context for the available data (animal and human) concerning the reproductive safety of newer and emerging DMTs.
  • Assess the available evidence regarding DMTs and male reproductive health in order to effectively communicate their potential risks to male patients with MS.
  • Discuss the evidence on the safety of DMTs used during lactation, in order to optimize outcomes for patients with MS who breastfeed their infants.
  • Implement evidence-based treatment strategies to optimize the management of postpartum relapses.
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

Statement of Need
Multiple sclerosis typically affects women of childbearing age and can influence fertility, pregnancy and decisions regarding breastfeeding. Management of a pregnant patient with MS or a patient contemplating pregnancy presents many unique issues and can be quite challenging.

The intent of this Clinical Dialogue, a video-based activity, is to review the most up-to-date evidence on MS, specifically on fertility and pregnancy outcomes, management of MS during pregnancy, the reproductive safety of DMTs, their use when breastfeeding and issues related to postpartum management. We will also address preconception issues, including pregnancy outcomes when it is the male patient who has MS. The eCase Challenge, a text-based activity, will allow the participant to apply the knowledge gained from this Clinical Dialogue in a few real-world clinical scenarios.

It is important to emphasize that the questions and answers discussed in this program must be individualized to the specific circumstances of each patient and their acceptance of risk.

Johns Hopkins Chair and Course Director:
Jack N. Ratchford, MD
Assistant Professor of Neurology
Johns Hopkins University School of Medicine
Baltimore, MD

Faculty:
Moderator
Jack N. Ratchford, MD
Assistant Professor of Neurology
Johns Hopkins University School of Medicine
Baltimore, MD

Patricia K. Coyle, MD
Professor and Vice Chair
Department of Neurology
Director, Multiple Sclerosis Comprehensive Care Center
SUNY at Stony Brook University Medical Center
Stony Brook, NY

Lynn Stazzone, RN, MSN, NP, MSCN
Nurse Practitioner
Partners MS Center
Brigham and Women's Hospital
Boston, MA

Intended Audience
Healthcare professionals, specifically, neurologists, internists, family practice physicians, nurse practitioners, physician assistants, registered nurses and other providers involved in the care of patients with multiple sclerosis.










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Sunday, January 4, 2015

ClinicSpeak: reconnecting MSers and the medical profession

Jan 4, 2015


How do we prevent and treat social isolation in MSers? #ClinicSpeak #MSBlog #MSResearch

"Yesterday I did a post on the disconnect between what the medical profession require medical students to know about MS and what MSers would like doctors to know. It set me off thinking is there something that we can do to change this. I came across this article on using personal narratives or autobiographies to teach medical students about MS. This is good way to explain to them the impact that having MS can have on an individual living in modern society."

"It reminds me of someone in our neighbourhood who has MS. I have been living in this area for 13 years and when I first met him he as mobile and fully functional. He is not aware that I am an MS expert and is managed by a very good MS unit locally. I have gradually watched him go from being independently mobile to needing a walking stick, then two sticks, a walking frame and now a wheelchair. I have seen him fall many times and have helped him up on several occasions; I have bought him drinks and generally being very friendly to him; but not friendly enough. In the beginning I would frequently see him in one of our village eateries with friends and family, laughing and having a good time. The only person I see him with now is one of his carers who take him out for daily walks. His carers always seem to change; I wonder how this affects the quality of his care? Carer churn is a big problem in the UK; carers in London tend to be poorly paid and are often foreigners on short-term contracts from a local agency."

"This short narrative highlights one of the biggest blights in modern society; the social isolation that frequently awaits people with chronic disabling disease. How do we prevent it? I think history judges successful societies on how they look after their elderly and infirm; we are not doing very well in this domain. Sociologists lament at the demise of the extended family; the claim the nuclear family and now on-demand technology is breaking down our social capital further. The question I have is what can we do as a community to teach medical students about social isolation, social capital and how important the latter is as part of the holistic management of someone with MS."

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Exercise Video for Multiple Sclerosis Patients and others


However MS affects you, there are exercises that can be helpful to stay as healthy and fit as possible and to improve some of your symptoms and their effects.
People taking part in an exercise class
This page covers:
For more information, download our MS Essentials publication on exercise and physiotherapy.

Benefits of exercise

Exercising regularly will keep your body working to its full potential. To make it easier, it is important to find exercise that suits you – something you enjoy and find worthwhile.
Exercise can:
  • improve the overall health of people with milder MS
  • help people with more severe MS to stay as mobile and active as possible
  • help some people manage MS symptoms and decrease the risk of heart disease
  • improve muscle strength and fitness, helping with mobility or weakness problems
  • help manage weight control, especially when combined with a healthy, well-balanced diet
By finding the right exercises, perhaps with the help of a physiotherapist, you can stop problems becoming worse than they need to be.
Getting fit and keeping fit helps the body and mind to stay as healthy as possible. 

Relapses and exercising

There is no evidence that exercise makes MS worse in the long-term, or that exercising causes relapses.
However, if you're having a relapse you shouldn’t try to carry on exercising until after symptoms have ‘levelled out’ and you have completed any steroid treatment. A physiotherapist can help with getting you back into a routine as you recover from the relapse, through rehabilitation.

Types of exercise 

There is no single exercise that could be called an ‘MS exercise’. MS affects people in different ways, so what’s suitable will vary from person to person.
Exercises might include:
  • Strengthening exercises
  • Aerobic exercises (such as cycling, running or rowing)
  • Stretching (helps keep muscles supple and relaxed)
  • Range-of-motion (moving the arms, legs, wrists and ankles in wide reaching circular patterns.)
  • Passive stretching (involves a physiotherapist or carer helping to move your arms or legs to create a stretch and move the joints).
  • Posture exercises help keep your feet, knees, pelvis, shoulders and head properly aligned, to reduce strain on the muscles and bones in the body.

Continue Reading this article on Exercise



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