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Babies born with low levels of vitamin D may be more likely to develop multiple sclerosis (MS) later in life than babies with higher levels of vitamin D, according to a study published in the November 30, 2016, online issue of Neurology®, the medical journal of the American Academy of Neurology.
"More research is needed to confirm these results, but our results may provide important information to the ongoing debate about vitamin D for pregnant women," said study author Nete Munk Nielsen, MD, MSc, PhD, of the State Serum Institute in Copenhagen, Denmark.
In Denmark, dried blood spots samples from newborn screening tests are stored in the Danish National Biobank. Researchers identified everyone in Denmark who was born since April 30, 1981, had onset of MS by 2012 and whose dried blood spots samples were included in the biobank. The blood from those 521 people was then compared to that of 972 people of the same sex and birthday who did not have MS. In this study, newborns with levels of vitamin D less than 30 nanomoles per liter (nmol/L) were considered born with deficient levels.
Levels of 30 to less than 50 nmol/L were considered insufficient and levels higher than or equal to 50 nmol/L were considered sufficient.
Multiple sclerosis is an autoimmune disease in which the body's immune system attacks the patient's own cells. In this case, modified T cells destroy the myelin sheath surrounding nerve cells. Myelin protects the neural pathways and is thus essential to the ability of nerve cells to transmit information. A recent study has demonstrated that a substance known as interleukin 6 (IL-6) plays an important role in instructing T cells to cause damage to myelin sheaths in the central nervous system.
Multiple sclerosis is an autoimmune disease in which the body's immune system attacks the patient's own cells. In this case, modified T cells destroy the myelin sheath surrounding nerve cells. Myelin protects the neural pathways and is thus essential to the ability of nerve cells to transmit information.
Montel Williams was once best known for his talk show, “The Montel Williams Show,” but in recent years the TV personality has become known as a vocal advocate for various causes, including veterans’ issues, multiple sclerosis awareness and medical marijuana.
Williams is also now standing up for traumatic brain injury patients in a partnership with Tackling TBI. He talked to CBS News about why the cause is important to him and how he now feels about Donald Trump, whom he once declared a “clear and present danger.”
December 2, 2016 Written By: Jack Florin, Neurologist, Headache Medicine and Multiple Sclerosis Specialist Could that same virus be the antigen that triggers the immune response in MS?
If confirmed, these observations carry monumental implications.
A recent report was published in Neurology, October 25, 2016, by lead author Lauren Bowen, MD. Five patients with HIV infection who later developed an ALS-like disease were reported. Three of the five patients who received anti-retroviral therapy within 6 months of onset had reversal of their symptoms. The other two had slow progression over several years. In 3 of the patients, blood levels for the human endogenous retrovirus K (HERV-K) were elevated. Further, those levels responded to antiviral therapy. This is an archaic virus that has been integrated into the human genome for thousands of years and, in fact, endogenous retroviruses constitute approximately 8% of the human genome. The specific HERV-K group is the most recently required of these retroviruses.
ALS associated with HIV infection has been recognized for over 15 years, but the association with HERV-K virus is new.
Regarding MS, studies are controversial, but some seem to indicate that the virus is in the brain and that it triggers the immune response, and this supports the concept that MS is “inside-out” rather than “outside-in.” This theory explains progressive MS better.
It does not take much imagination to envision patients and families of patients with ALS clamoring for treatment with anti-retroviral therapy. According to Drs Berger and Power in an editorial in the same issue, commenting upon the article by Bowen, patients with ALS that is not associated with HIV infection should receive this treatment only in a clinical trial.
Keep in mind that much is lost between the cup and the mouth
The Institute for Clinical and Economic Review (ICER) has released a Draft Evidence Report evaluating the comparative clinical effectiveness and value of disease-modifying therapies (DMTs) for patients with relapsing-remitting and primary-progressive forms of multiple sclerosis (MS).
Through Dec. 21, patients, the public, and other stakeholders can access the 82-page report and submit comments, ICER announced in a press release.
Sixteen DMTs are the focus of the ICER review. All of them, the institute notes, “have an FDA indication for RRMS [relapsing-remitting MS] with the exception of ocrelizumab, which the FDA is expected to approve in December 2016 for both RRMS and PPMS [ primary-progressive MS], and rituximab, which is approved for other conditions and is used off-label for RRMS and PPMS.”
DMTs aim to decrease the frequency of MS relapses and to prevent the disability that accumulates with disease progression by modulating the immune system.
In June, the FDA granted Priority Review designation to Ocrevus (ocrelizumab) for use in PPMS. Other agents have been studied for PPMS, with Rituxan (rituximab) being of particular interest to practitioners, patients, and insurers because its mechanism of action is similar to that of Ocrevus.
There is no definitive clinical guideline to help clinicians and patients with decisions about both initial therapy and choices for subsequent therapies following treatment failure, so the ICER Report may offer important treatment recommendations.
In its conclusion graph, the report states: “DMTs of interest in this evaluation uniformly and substantially improved health outcomes compared to best supportive care, but demonstrated mixed results compared to generic glatiramer acetate. … The notable exception to this finding was alemtuzumab [Lemtrada], which consistently demonstrated improved health outcomes and good value compared to both supportive care and generic glatiramer acetate 20 mg.”
ICER is a non-profit organization that evaluates evidence on the value of medical tests, treatments, and delivery systems in order to improve the U.S. healthcare system. In developing its report, ICER researchers consulted with clinical experts, patients, manufacturers and other stakeholders. In addition, ICER accepted public comments on a Draft Scoping Document prior to conducting the review.
The Draft Evidence Report, and its accompanying voting questions, are open for comments through 5 p.m. ET on Dec. 21. Comments should be submitted by email to email@example.com. More information can be found on the ICER website. All comments will be reviewed and posted, and any necessary changes will be then included in the evidence report.
The revised voting questions will be available from Jan. 27.
The Report will then be subjected to a public meeting of the California Technology Assessment Forum (CTAF), at which a panel will vote on key questions raised, and discussions will be held to make decisions concerning recommendations to be added to the report. That public meeting will take place in Oakland, California, on Feb. 16, 2017.
Daniela holds a PhD in Clinical Psychology from The University of Edinburgh, United Kingdom, a MSc in Health Psychology and a BSc in Clinical Psychology. Her work has been focused on vulnerability to psychopathology and early identification and intervention in psychosis.
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Researchers have found neural stem cells (immature cells that can become neurons) in the meninges of the brain, a three-layer structure that protects the nervous system, according to results of a new study.
The discovery of this pool of stem cells in the adult brain opens new possibilities for the treatment of diseases that are characterized by brain damage and neuronal loss, including multiple sclerosis (MS).
The adult nervous system (brain and spinal cord) is surrounded and protected by three membranes called the meninges (dura mater, arachnoid mater, and pia mater). Neural stem cells are produced during embryonic development. According to a news release, scientists believed for decades that in the adult brain, these cells existed only within the brain tissue, making their access complicated.
Now, researchers found that the meninges also store a pool of neural stem cells, showing that these membranes can be a source of newly produced neurons in the adult brain. This finding is of great importance considering that many diseases, such as MS, result from neuronal loss, and support the idea that the adult brain has a certain capacity to regenerate and heal itself.
While the evidence is mixed, marijuana supporters say cannabis can ease symptoms for people with multiple sclerosis.
Will medical marijuana prove to be a miracle treatment for people with multiple sclerosis (MS)?
The National Multiple Sclerosis Society says there are uncertainties about how effective marijuana is in relieving MS symptoms. But the organization supports the right of patients to work with healthcare providers to access medical marijuana where legal.
Supporters of medicinal marijuana are more forceful in their advocacy.
On the website herb.com, supporters say medicinal marijuana has been “widely successful” in treating MS symptoms. They list seven ways they say cannabis eases MS symptoms.
Long history of treatment:Cannabis has been used sinceancient timesfor a variety of conditions. In 2011, a cannabis extract wasfirst approvedin Germany for the treatment of spasticity in people with MS.
Since then, only two synthetic drugs containing THC have been approved by the U.S. Food and Drug Administration (FDA). They are Marinol and Cesamet, used for treating nausea in people undergoing chemotherapy and people with HIV.
The only naturally occurring THC-based drug — the oral spray Sativex — used for the treatment of spasticity in people with MS, is approved in several countries including France, Canada, and Sweden. However, it is currently not available in the United States.
An MS hug feels like a band, or girdle-like, sensation tightening around your waist. People sometimes describe it as annoying. Others say it can become quite painful.
After searching the web, I could not find statistics on the number of people with MS that experience this sensation. If it were classified in the category of pain, up to 75% of people with MS experience some type of pain.
The hug is an abnormal sensation that is caused by a lesion on the spinal cord. This neuropathic pain1 is called a “paresthesia”2. It is a result of tiny muscles (holding our ribs together) located between each rib that goes into a spasm.
The hug itself is different for everyone, and it can also differ within one person every day, week or month. It may not only occur in the stomach region, but can also occur low in the waist or high in the chest. It can give you trouble on one side of your body or both. Stress and fatigue may trigger it. It can last for minutes or years. The hug can range anywhere between a slight tickle to a stabbing pain.
Some people may experience an MS hug requiring a medical professional. Their breathing becomes painful, and mimics symptoms of a heart attack. Call the doctor immediately, or go to the nearest emergency room if this happens. Make sure to tell them you have Multiple Sclerosis.
An MRI or steroids may be prescribed if your hug is caused by an exacerbation. There are also various medications that may be prescribed. They include antispasticity medications, such as Lioresal, Valium and Xanaflex, and neuropathic pain relief medications, such as Lyrica and Neurontin.
I have heard stories from patients that tried Botox, which has been shown to be effective in the short term to relieve the MS hug. These patients have reported it as being fairly effective, yet it is not a cure.
I know from personal experience that the MS hug doesn’t necessarily mean someone is having an exacerbation. It could also be a pseudoexacerbation. My hug worsens if I’m feeling overly tired or I’m experiencing a lot of stress. What do I do to help manage it?
Meditation and deep breathing.
Cool off (sometimes with the help of cooling vests).
De-stress (I read, write, knit, watch old movies).
Spasticity is a stiffness of the limbs resulting from increased muscle tone and is common in people with MS. Spasticity results from demyelination that occurs in nerves that regulate muscle tone. It most frequently affects the group of muscles known as the antigravity or postural muscles, which include the calf muscles, thigh, buttock, groin, and back. Spasticity is often mild; however, in some cases it can be severe and painful, making normal daily activities difficult.
In some instances, people with MS who are affected by weakness in the leg muscles, may find mild stiffness helpful in standing and moving. People often experience a worsening of stiffness the more quickly they move their limbs. So, one rule of thumb with spasticity is to move slowly and steadily.
People with MS-related spasticity may occasionally develop a type of muscle spasm, called flexor spasm or extensor spasm, which are reflexes in response to the slightest of stimuli, such as when your foot rubs against a sheet during sleep. With flexor spasms, both legs pull up in a clinched position. With extensor spasms, the opposite occurs, legs extend straight and stiff. These spasms are uncontrollable and can happen so suddenly and intensely that they are capable of forcing a person out of a chair.
How is spasticity treated?
If spasticity is mild, treatment may not be necessary. However, if spasticity presents a problem, a variety of treatment options are available, including physical therapy and medication. The first approach to managing spasticity is to treat the problems that are known to increase risk for developing spasticity. These include pain of any kind, urinary tract infection and other types of infections, distended bladder or bowel, and pressure sores.
A physical therapist can recommend and offer instruction on stretching routines that involve active stretching (stretches you do on your own) and passive stretching (stretches that someone helps you to do).
Medications that may be effective in treating spasticity include Lioresal (baclofen), Zanaflex (tizanidine), Klonopin (clonazepam), Valium (diazepam), Dantrium (dantrolene), and Neurontin (gabapentin). The drug most commonly used to treat spasticity, Lioresal (baclofen), can cause you to feel weak or fatigued. The challenge with Lioresal is finding a dosage that relieves spasticity without causing excessive weakness. Another treatment option is involves injection of the drug Botox (botulinum toxin) to block nerve signaling to muscles. In some people whose spasticity is severe and does not respond to oral medication, a pump can be surgically implanted in the abdomen to deliver low doses of baclofen into the spinal canal. Intrathecal baclofen can be an effective treatment in cases of severe spasticity and the low doses of baclofen utilized limit the side effects of weakness and fatigue.
I spend a lot of time outdoors in the summer, despite the impact of the heat on my multiple sclerosis. I love the warmth and the brightness. So, I lather up with sunscreen and I figure that, at least for me, the rewards of being in the sun outweigh the risks.
So, I was very interested when I came across a study that concludes insufficient sun exposure should be considered an “emerging health problem” in the United States. In their paper, The Risks and Benefits of Sun Exposure 2016, the authors make the case that health officials are delivering only a negative message to the public about sun exposure — that is, sun exposure is bad for you. Because of this, they say, Americans aren’t reaping the health benefits they should be getting from the sun.
Program Date: November 1, 2016
Location: Jacksonville, Fl.
Presenters and Topics:
Ali Kasraeian, MD Urology
To Discuss: Impacts of symptom management in relation to bladder on overall health and wellness. Bladder issues, continence, spasticity and symptom management options
Followed by: Megan Weigel, DNP, ARNP-C, MSCN
Megan discusses: The importance of understanding your MS and treatment options upon diagnosis. A look at current and newly emerging therapies for MS- how they work, options, safety and side-effects. Compliance and adherence to MS Therapies and its impacts on health and wellness. PLUS: Understanding Disease Management, how health & wellness can impact quality of life
Plenty of information for the people watching this video. Pause when you wish and then restart.
An overwhelming majority of individuals with multiple sclerosis (MS) are not meeting nutrition guidelines, according to a recent study, and more than 90% with 2 or more risk factors reported the co-occurrence of poor diet and insufficient levels of physical activity. 69 participants with MS completed self-reported measures of smoking status, nutrition, alcohol use, physical activity levels, and sociodemographic and clinical characteristics. Researchers found:
Poor diet was the most common risk factor, with 85.5% of the sample not meeting dietary guidelines.
LONDON—High-dose vitamin D as an add-on therapy may improve MRI outcomes in patients with relapsing-remitting multiple sclerosis (MS), according to a study presented at the 32nd Congress of the European Committee for Treatment and Research in MS.
“Vitamin D is the precursor of a potent immunoregulatory molecule. However, whether supplementation of it improves outcomes is uncertain, since existing medical evidence is contradictory and involves small patient numbers,” said Raymond Hupperts, MD, PhD, Professor of Neurology at Maastricht University in the Netherlands.
Previous studies have found an association between low serum levels of vitamin D and a greater risk of developing MS and poor MS outcomes. As a result, Dr. Hupperts and colleagues conducted the SOLAR (Supplementation of VigantOL Oil Versus Placebo as Add-on in Patients With Relapsing Remitting MS Receiving Rebif Treatment) study to investigate the effects of vitamin D as add-on therapy in patients receiving subcutaneous interferon beta-1a.
The SOLAR study included 229 patients who were stratified by serum vitamin D level and randomized to vitamin D or placebo. READ MORE
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Click here to receive MS news via e-mail LONDON—Evaluation of cortical lesions improves the specificity of the diagnostic criteria for multiple sclerosis (MS), according to research presented at the 32nd Congress of the European Committee for Treatment and Research in MS (ECTRIMS). Assessment of cortical lesions, in concert with current McDonald criteria, also preserved a high level of diagnostic sensitivity and accuracy in a multicentric cohort of patients with clinically isolated syndrome, reported Paolo Preziosa, MD, Neuroimaging Research Unit at the Institute of Experimental Neurology and Division of Neuroscience at San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy, and his research colleagues. Since the publication of the 2010 revised McDonald criteria, new data regarding the application of MRI for the diagnosis of MS have become available. In a single-center study, adding the assessment of cortical lesions was shown to modify the diagnostic algorithm, resulting in higher specificity.
In the present study, Dr. Preziosa and colleagues sought to test the performance of different sets of imaging criteria, including the assessment of cortical lesions, for the development of MS in a multicentric cohort of patients with clinically isolated syndrome.