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People with multiple sclerosis, or MS, often have trouble swallowing, a problem called dysphagia. It can also lead to speech problems. It happens when the disease damages the nerves in the brain and spinal cord that make these tasks happen.
For some people, these problems are mild. Others have a harder time dealing with severe symptoms. But treatments and techniques can help you improve your speech and make swallowing easier.
Get a lot of lung infections, like pneumonia, that you can’t explain
When you can’t swallow properly, you might inhale food or liquids into your windpipe instead of getting them down your esophagus and into your stomach. Once in the lungs, they can cause pneumonia or abscesses. You could also be at risk for malnutrition or dehydrationbecause your food and water aren’t getting to your stomach.
Symptoms of Speech Problems
The kinds of speech problems MS causes can vary depending on which part of the brain is damaged. Someone with the disease might have mild trouble with words or severe problems that make it hard for them to speak and be understood. A problem that’s subtle in the beginning might get worse over time.
People with MS usually have a few distinctive language problems:
“Scanning" speech, when a person’s normal speech pattern is disrupted with long pauses between words or syllables
Slurring words. It usually happens because of weak tongue, lip, andmouth muscles.
Trouble changing tone of voice
Getting a Diagnosis
Your doctor will ask you about your symptoms and do a physical exam, paying attention to how well your tongue and other muscles in yourmouth and throat work.
In some cases, your doctor may recommend that you get a test called a modified barium swallow. You’ll drink a special liquid that coats your throat, stomach, and small intestine, and your doctor will give you an X-ray. The fluid makes your insides stand out on the image. The test helps your doctor pinpoint where and why you’re having trouble swallowing.
Your doctor might suggest that you see a speech therapist or a speech-language pathologist. She can figure out which part of your speech is affected and study your breathing control and way you move your lips, tongue, and other parts of your mouth.
MS Views and News, now offers the MS community a communication tool for speaking with your Neurology Healthcare provider, making it easier for you to navigate through your office visit by having a check-list to complete in advance of your appointment and bringing this form with you. On this form you will find listings of symptoms that might be affecting you. Use the form to help you to communicate with your clinician. The Land of MS Communication Tool is accessible here CLICK the document link to open the full version. We hope in the near future, to have this form available at various neurology offices, clinics and MS Centers
Representation of an enzyme (upper part of image) fixed to the tip of an atomic force microscope capturing herbicide molecules on a surface (lower part of image). The early diagnosis of certain types of cancer, as well as nervous system diseases such as multiple sclerosis and neuromyelitis optica, may soon be facilitated by the use of a nanometric sensor capable of identifying biomarkers of these pathological conditions.
The nanobiosensor was developed at the Federal University of São Carlos (UFSCar), Sorocaba, in partnership with the São Paulo Federal Institute of Education, Science & Technology (IFSP), Itapetininga, São Paulo State, Brazil. It was originally designed to detect herbicides, heavy metals and other pollutants. An article about the nanobiosensor has just been published as a cover feature by IEEE Sensors Journal.
"It's a highly sensitive device, which we developed in collaboration with Alberto Luís Dario Moreau, a professor at IFSP. "We were able to increase sensitivity dramatically by going down to the nanometric scale," said physicist Fábio de Lima Leite, a professor at UFSCar and the coordinator of the research group.
The nanobiosensor consists of a silicon nitride (Si3N4) or silicon (Si) nanoprobe with a molecular-scale elastic constant and a nanotip coupled to an enzyme, protein or other molecule.
When this molecule touches a target of interest, such as an antibody or antigen, the probe bends as the two molecules adhere. The deflection is detected and measured by the device, enabling scientists to identify the target.
"We started by detecting herbicides and heavy metals. Now we're testing the device for use in detecting target molecules typical of nervous system diseases, in partnership with colleagues at leading centers of research on demyelinating diseases of the central nervous system"
The migration from herbicide detection to antibody detection was motivated mainly by the difficulty of diagnosing demyelinating diseases, cancer and other chronic diseases before they have advanced beyond an initial stage.
The criteria for establishing a diagnosis of multiple sclerosis or neuromyelitis optica are clinical (supplemented by MRI scans), and patients do not always present with a characteristic clinical picture. More precise diagnosis entails ruling out several other diseases.
The development of nanodevices will be of assistance in identifying these diseases and reducing the chances of false diagnosis.
The procedure can be as simple as placing a drop of the patient's cerebrospinal fluid on a glass slide and observing its interaction with the nanobiosensor.
Once-daily oral tablet to be reimbursed for first-line use through exception process
MISSISSAUGA, ON, June 24, 2015 /CNW/ - Genzyme Canada announced today that Health Canada has approved AUBAGIO™ (teriflunomide) 14 mg as an expedited exception benefit product through the Non-Insured Health Benefits (NIHB) Program of Health Canada for eligible First Nations people and Inuit as a first-line oral tablet for relapsing remitting multiple sclerosis (RRMS).
AUBAGIO is a once daily oral tablet indicated as monotherapy for the treatment of RRMS to reduce the frequency of clinical exacerbations and to delay the accumulation of physical disability.
"Aubagio with its combination of efficacy, safety, convenience and tolerability is an excellent first line choice for many patients with RRMS, said Dr. Daniel Selchen, Chief, Neurology, and Consultant, MS Clinic, St. Michael's Hospital in Toronto, Ontario.
"The NIHB approval of AUBAGIO represents a step forward in the management of MS," says Dr.Virginia Devonshire, Clinical Assistant Professor Neurology, University of British Columbia, and Director, MS Clinic, University Hospital of Northern BC. "AUBAGIO is a safe and effective oral treatment choice for relapsing MS."
"We are pleased that Health Canada has been responsive in listing another disease-modifying therapy option for those with multiple sclerosis who are eligible for the Non-Insured Health Benefits (NIHB) for First Nations people and Inuit," says Sylvia Leonard, National Vice President, Talent, Programs and Services, MS Society of Canada. "This responsiveness means that Canadians with MS have greater access to treatments to manage the effects of their disease. For individuals with MS who are interested in exploring treatment options, we encourage them to consult with their healthcare team to find the course that is most appropriate for them."
About MS in CanadaWith 100,000 Canadians living with MS and three people newly diagnosed every day, Canada has one of the highest prevalence rates in the world. As most people are diagnosed with relapsing MS in their twenties and thirties, MS is the most common neurological disease affecting young adults in Canada.
"We applaud Health Canada for making AUBAGIO available to First Nations people and Inuit suffering from RRMS who meet appropriate criteria through the expedited exception process. With its once-a-day oral regimen, this will provide eligible patients an important alternative to injectable treatments," said Peter Brenders, General Manager, Genzyme Canada.
(MS).LINDA CHION KENNEY Daisy Vega, at a Greater Brandon Chamber of Commerce luncheon,
shows her use of the WalkAide device to offset the foot drop she suffers as a result of her
BY Linda Chion Kenney
Published: June 24, 2015
RIVERVIEW — Ask Daisy Vega what it’s like to live with multiple sclerosis and she’ll talk about the blessings of life and the brilliance of the WalkAide System that allows her to counter the foot drop associated with her condition.
“Imagine yourself with a 50-pound foot,” said Vega, a Riverview resident and member of the Kiwanis Club of Greater Brandon, among her many other community associations. “You’re trying to lift this foot up to take your next step. You’re trying to remember to walk and balance yourself at the same time. People with foot drop have to be careful with balance.”
Balance is a good word to use in describing Vega’s outlook for living a life with MS, an autoimmune condition that affects the central nervous system, causing problems with vision, balance, muscle control and other basic body functions. For 20 years she felt numbness in her feet and a tingling in her hands. She went blind temporarily in each eye
at different times. Many times she couldn’t walk, the pain too great in her spine.
Not until 2001 would a doctor confirm her suspicions, that she had MS, and her reaction was one of relief.
“My doctor told me he wished every person he diagnosed with MS had my spirit,” Vega said. “I told him, you know, I’ve had this for 20 years so God has used me to be strong about this. And now I have the opportunity to educate other people about MS.”
Soon that turned into a mission to spread the word about a device that helps people with foot drop walk a more normal life. With determination, and a deep-rooted faith, Vega set about to ensure that anyone who needs one can secure a WalkAid device of their own.
The WalkAide online is billed as a “revolutionary, FDA-cleared medical device that leverages functional electrical stimulation to improve (the) walking ability of people living with foot drop.” The device, worn right below the knee, is reported to be beneficial for people with foot drop resulting from brain or spinal diseases or trauma, such as stroke, multiple sclerosis, spinal cord injury, traumatic brain injury or cerebral palsy.
Generics for other diseases have upended formularies, but the effect of generic Copaxone may be limited. - Thomas Reinke
The multiple sclerosis medications, a specialty class of therapy that costs $5,000 to $6,000 a month, is about to get its first generic. In April the FDA approved a knockoff of the class-leading, disease-modifying agent Copaxone, which has annual sales of more than $3 billion.
When generic versions of such class leaders as Lipitor and Nexium came out, they turned formulary design on its head and put a real dent in drug expenditures. But that won’t happen in MS. The factors that allowed generics to completely dominate branded drugs in other classes simply don’t exist in MS.
Moreover, experts say that while health plans and PBMs will need to figure out how generic Copaxone fits in, they should also focus on broader issues in MS therapy.
MS is an autoimmune disease that attacks the myelin sheaths of the nerves of the central nervous system. Between 250,000 and 400,000 Americans have the disease, which is the leading cause of permanent disability among young adults.
The generic name for Copaxone is glatiramer acetate. It is a synthetic protein that is antigenically similar to myelin basic protein, a component of the myelin sheath that protects nerves. Copaxone works by blocking T cells that damage myelin. How it does so is uncertain.
One reason generic Copaxone will have a limited impact is the lack of branded me-too agents for MS, all with the same mechanism of action. When a generic comes along for a disease with lots of branded copycat drugs, it has ample opportunity to knock out some of those copycats. Copaxone doesn’t have copycats, so the pickings won’t be so easy for generic Copaxone.
Another factor is the lack of strong treatment guidelines for MS that would give a particular drug—or drugs sharing the same mechanism of action—a dominant position in the armamentarium. As a result, clinicians take many different approaches to treating MS, and some of those approaches don’t include Copaxone—or, presumably, the newly available generic, explains Atheer Kaddis, PharmD, a senior vice president at Diplomat Pharmacy, a specialty pharmacy in Flint, Mich.
New formulary designs may be developed because of generic Copaxone, says Atheer Kaddis, PharmD, of Diplomat Pharmacy.
The new generic kid on the block, from Sandoz, also faces some stiff competition. Teva saw the patent expiration coming, so it rolled out a patented 40-mg version that reduces the frequency of injections from daily to three times per week. The FDA approved Teva’s formulation in March 2014. Since then, the company has shifted more than 60% of its volume to the three-days-a-week version, according to Kaddis.
A market for generic Copaxone
The formularies for MS agents often include Copaxone as a preferred agent, so now it is a question of whether the generic version will get listed instead.
Annual sales and total prescriptions for leading MS drugs
Source: IMS National Sales Perspectives
Currently, in highly managed formularies there is usually a preferred interferon, Copaxone, one or more of newer oral agents, and natalizumab (Tysabri), a monoclonal antibody with a unique mechanism of action, according to Kaddis. For less-managed formularies, there may be two interferons, perhaps two orals, Copaxone, and natalizumab.
Rebates are offered by pharmaceutical manufacturers for the brand-name MS therapies, Kaddis explains. The rebates are typically market-share based so additional rebates are offered if greater market share is driven toward formulary preferred therapies.
Kaddis expects there to be a solid market for generic Copaxone. An increasing number of physicians are taking on risk by participating in ACOs and other value-based care. In some of those arrangements pharmacy costs are measured, and physicians are rewarded for reducing them. Even if 60% of Copaxone sales have moved to the new three-days-a-week formulation, 40% of the volume is still open to the generic. That can result in a considerable cost savings, notes Kaddis.
Moreover, new formulary designs may be developed because of generic Copaxone, says Kaddis: “There’s the potential for health plans to implement step therapy or to provide incentives such as a fixed copay in place of a percentage coinsurance.”
High hopes for monoclonal antibodies
Generic Copaxone is entering the market as treatment of MS is changing and is more likely to involve fairly aggressive treatment with the goal of preventing relapse and slowing long-term disease progression. Kaddis says part-and-parcel of a more aggressive approach to treatment is greater attention to the diagnosis of the disease and recognition of clinically isolated syndrome (CIS), the appearance of single or multiple neurologic symptoms such as an attack of optic neuritis or weakness on one side. If CIS is confirmed through MRI or other means, doctors nowadays may prescribe MS drugs to head off a full-blown exacerbation of the disease.
The treatment of MS is also characterized by a willingness—even eagerness—on the part of physicians and patients to try new agents, partly because there’s no surefire treatment strategy for MS. Open-mindedness is also part of the MS treatment mindset because how patients respond to MS drugs varies so much.
Doctors and patients, to say nothing of biotech companies, have high hopes for monoclonal antibodies improving the treatment of MS in a meaningful way. Tysabri is gaining acceptance. Alemtuzumab (Lemtrada) was approved in November 2014, and, in April, Biogen and AbbVie announced the FDA’s acceptance of their application for daclizumab (Zinbryta).
Cost of FDA-approved drugs for relapsing multiple sclerosis
glatiramer acetate (Copaxone)
20 mg once daily
40 mg 3x/week
interferon beta-1a pegylated (Plegridy)
dimethyl fumarate (Tecfidera)
*Approximate WAC for one year of treatment at the usual dosage. WAC=wholesaler acquisition cost or manufacturer’s published price to wholesalers. Source: Adapted with permission from The Medical Letter on Drugs and Therapeutics, May 11, 2015; Vol. 57 (1468):68.
While they are more effective than other medications at slowing relapses, the monoclonal antibodies can have alarming side effects, albeit in a very small number of patients. Tysabri has been linked to progressive multifocal leukoencephalopathy, and Lemtrada to serious autoimmune conditions. The monoclonal antibodies are also extremely expensive. Lemtrada’s price has been reported at $158,000 for two courses of therapy, although they are taken a year apart.
The National Multiple Sclerosis Society says that in many cases, health plans and PBMs focus too much on controlling costs instead of accommodating current treatment philosophies. The counterargument is that payers serve the important function of holding down costs that, ultimately, makes treatment more accessible.
There are 12 disease-modifying therapies. Often formulary designs with a limited number of drugs in preferred tiers do not allow switching among medications without incurring high copayment or coinsurance costs, says Tim Coetzee, MD, chief officer for advocacy, services and research for the MS Society.
“Relapsing patients or those with new lesions may need to switch medicines and the hurdles are significant,” he continues. “People are not switching their medications out of convenience; they are trying to control their disease activity.
“High cost share can really wreak havoc on people with MS,” Coetzee continues. “It’s not like they are shopping for a blood pressure medicine. They are trying to get their immune system under control and minimize brain damage.”
June 22, 2015 -- Every year, John Thyfault snaps the same photo, and it makes him a little sad.
Thyfault, PhD, is an associate professor at Kansas University Medical Center, where he studies the health effects of exercise. Each year, he travels to the American Diabetes Association’s annual scientific sessions. The meeting attracts roughly 18,000 people and is held in massive convention centers that span the distances of several football fields, their floors connected by long staircases and humming escalators.
Conference organizers pick a prominent set of stairs and lay down a decal with the logo for their “Stop Diabetes” campaign -- a hand with a drop of blood on the fingertip. It’s meant to remind attendees to take the stairs instead of riding the escalator.
Each time they put the sign up, Thyfault stands at the foot of the stairs and whips out his smartphone. The stairs are nearly empty, but the escalator is packed. To him, it’s a picture worth a thousand pills.
“Exercise and physical activity is not something that you just do extra in your life to get extra healthy. Rather, it’s something that’s absolutely necessary for normal function,” he says.
Thyfault hopes to make more people aware that exercise benefits the body in ways that go far beyond muscle tissue and burning fat.
“We were meant to exercise quite a bit every day to survive, and now we’ve taken it away, and we’re actually causing dysfunction,” he says.
Exercise and Blood Sugar
He’s passionate about exercise because his research has shown again and again how critical it is to health. He says when he’s tried to cause disease, for example, by feeding rats or mice high-fat diets, he can’t do it as long as the animals are exercising.
“Inactivity is the foundational piece that has to be there for these diseases to develop,” he says.