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Thursday, June 8, 2017

Wellness for People Living with Multiple Sclerosis Begins on Day One—With Comprehensive, Coordinated Care that is Our Shared Responsibility


                                                                  
  
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US Neurology, 2016;12(2):78–9 DOI: https://doi.org/10.17925/USN.2016.12.02.78

Abstract:

 Living well with multiple sclerosis (MS) requires the integration of neurologic and primary care, psychosocial support and wellness strategies from diagnosis onward. Promotion of healthy lifestyle behaviors and management of co-morbidities may help to improve quality of life, slow disease progression, reduce hospitalizations and prolong life. The National MS Society’s new Wellness Discussion Guide is available to facilitate conversations with patients as well as shared decision-making around wellness strategies.
Keywords: Multiple sclerosis, wellness, comorbidity, diet, exercise, mood, emotional wellness, collaborative care, smoking, quality of life
Disclosure: Rosalind Kalb has nothing to disclose in relation to this article. This article is a short opinion piece and has not been submitted to external peer reviewers. No funding was received in the publication of this article.
Received: July 19, 2016 Published Online: August 30, 2016
Correspondence: Rosalind Kalb, 290 Sabino Road, West Bath, Maine 04530, US. E: Rosalind.Kalb@nmss.org
Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit.






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Meet the Cambridge (UK) scientist on verge of curing Multiple Sclerosis


                                                                  
  
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This amazing work could literally change the world

BY

Dr Su Metcalfe is sitting quietly reading through some documents in the lobby of the Judge Business School when I arrive for our interview. It would be easy to walk right past her and not know you were in the presence of a woman who could be on the verge of curing multiple sclerosis.

MS, an auto-immune condition which affects 2.3 million people around the world, attacks cells in the brain and the spinal cord, causing an array of physical and mental side effects including blindness and muscle weakness. At the moment there’s no cure, but Su and her company, LIFNano, hope to change that.

“Some people get progressive MS, so go straight to the severe form of the disease, but the majority have a relapsing or remitting version,” she says.

“It can start from the age of 30, and there’s no cure, so all you can do is suppress the immune response, but the drugs that do that have side effects, and you can’t repair the brain. The cost of those drugs is very high, and in the UK there are a lot of people who don’t get treated at all.”

But now a solution could be in sight thanks to Su, who has married one of the body’s cleverest functions with some cutting-edge technology. The natural side of the equation is provided by a stem cell particle called a LIF.

Su was working at the university’s department of surgery when she made her big breakthrough: “I was looking to see what controls the immune response and stops it auto-attacking us,” she explains.

“I discovered a small binary switch, controlled by a LIF, which regulates inside the immune cell itself. LIF is able to control the cell to ensure it doesn’t attack your own body but then releases the attack when needed.

“That LIF, in addition to regulating and protecting us against attack, also plays a major role in keeping the brain and spinal cord healthy. In fact it plays a major role in tissue repair generally, turning on stem cells that are naturally occurring in the body, making it a natural regenerative medicine, but also plays a big part in repairing the brain when it’s been damaged.






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Physical Activity and Healthy Aging with Multiple Sclerosis— Literature Review and Research Directions


                                                                  
  
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US Neurology, 2016;12(1):29–33 DOI: http://doi.org/10.17925/USN.2016.12.01.29

Abstract:

 There is a “greying” of the population of persons with multiple sclerosis (MS) that coincides with both increased life expectancy and the shifting demographic landscape worldwide. This growing cohort of older adults with MS undergoes normal age-related declines in physical and psychologic functioning that may be compounded by the disease and its progression. Little is known about predicting and managing the progression and consequences of MS in older adults. We believe that a focus on physical activity behavior represents a novel opportunity for transformative research on healthy aging with MS. The current paper reviews existing evidence on physical activity rates, correlates, consequences, and interventions among older adults with MS, and highlights important areas for future research on physical activity and health aging with MS.
Keywords: Aging, exercise, multiple sclerosis, physical activity, sedentary behavior
Disclosure: Robert W Motl, PhD, receives research funding from Biogen Idec and Acorda Therapeutics, and provides speaking engagements for EMD Serono. Emerson SebastiĆ£o, PhD, Rachel E Klaren, BS, Edward McAuley, PhD, Elizabeth AL Stine-Morrow, PhD, and Brent Roberts, PhD, have no conflicts of interest to declare in relation to this article.
Received: November 16, 2015 Accepted November 30, 2015
Correspondence: Robert W Motl, PhD, 906 S Goodwin Ave, Urbana, IL, 61801, US. E: robmotl@illinois.edu
Support: The writing of this paper was supported by a mentor-based postdoctoral fellowship from the National Multiple Sclerosis Society (MB 0029).
Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit.
DOWNLOAD PDF for complete information




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Taking A Closer Look at Your MS Treatment Plan


                                                                  
  
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Every MS patient is different, and no single treatment plan works for everyone. Learn more about what to consider as you evaluate your own MS treatment plan.

MS involves gradual, unpredictable damage to the myelin of the CNS. This damage causes nerve signals to slow down, stutter, and distort. The nerves themselves may also suffer damage. This can cause MS symptoms such as numbness, loss of vision, difficult speaking, slow thinking, or even inability to move (paralysis).

Learn more about what to consider when you evaluate your MS treatment plan.
Continue reading from here





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Management of Children with Multiple Sclerosis


                                                                  
  
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Published June 7, 2017
by Jon Shepheard, Key Account Director
US Neurology

The care of children and adolescents with multiple sclerosis (MS) requires appreciation of the impact of the disease on the developing brain and, in particular, the risk for cognitive impairment and academic challenges. Relapse rates in the first three years from onset are high, with an average of 1.5 relapses per year, and often require hospitalization for acute corticosteroid therapy. 

Disease modulatory therapies are typically prescribed, although formal clinical trials in the pediatric MS population are only just now being realized. In this review, we discuss strategies to optimize therapy for an individual child or teenager, including utilization of a multidisciplinary approach to care.
Yeshokumar A.K. Banwell B. Management of Children with Multiple Sclerosis. US Neurology, 2017;13(1):42–6 DOI: https://doi.org/10.17925/USN.2017.13.01.42
For the open access PDF of the full article please go to the following link to download: http://www.touchneurology.com/articles/management-children-multiple-sclerosis

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Wednesday, June 7, 2017

MS-Related Dizziness and Neck Spasms


                                                                  
  
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Multiple sclerosis is so weird. Sometimes I just put up with a strange sensation or painful problem because I do not know how to describe it to the doctor without sounding crazy.
I hope the problems will just go away, and sometimes they do. Maybe I am a little gun-shy from the year prior to my diagnosis, when each symptom I complained about just brought me a new antidepressant.
A couple of years ago, after suffering in silence for many months, I scheduled an appointment with a neurologist. Waiting in the exam room, symptom list in hand, I worried. My new sensation was causing problems, but I did not know how to describe it. The kind (and unusually personable, for a neurologist) doctor greeted me warmly. We covered the usual suspects — fatigue, paresthesia, foot drop. He asked if there was anything else.
“Well, sometimes I get a really weird sensation in my head,” I stammered. He asked questions: Was it painful? No, not really, just very uncomfortable. Where did I feel it? Sort of in my neck and the base of my skull. Could I describe it?  The words finally tumbled out of me, in an awkward rush of pent-up stress.
“This will sound weird, but it feels like a giant hand is grabbing my head and squeezing the back of it. Or like I’m in a pressurized room, and my head is being squished. My neck gets really tight and I get kind of dizzy and sometimes it’s like the floor or the walls tilt. If I’m standing I sort of lose my balance, and if I’m sitting it feels like my head jerks to one side, but I don’t know if it really does.”
Thankfully, the kind doctor did not call for a priest to perform an exorcism. He asked about neck spasms and felt along my shoulders, neck and skull. He gently reminded me that I have lesions in my cervical spine and explained that this was likely a type of vertigo caused by neck spasms and my damaged nervous system. A prescription for Baclofen was sent to the pharmacy.
I have since sought additional ways to minimize this sensation, otherwise known as cervicogenic dizziness.

Good posture

  • Make sure any screen (computer, phone, TV) is at eye level
  • Get up and move around, don’t sit in one position too long
  • Shoulders down and back, sit up straight
  • Pilates lessons have helped with my posture and overall muscle spasms

Stretching




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Multiple Sclerosis Video: MS Has Changed - produced by Aaron Boster, MD


                                                                  
  
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Published on Jun 2, 2017

Aaron Boster, MD narrates discussion about how everything in MS had changed...except the way in which we see patients. 

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..

Tele-rehabilitation Improves Cognitive Function in MS


                                                                  
  
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PLOS One; ePub 2017 May 11; Charvet, et al
June 6, 2017

Adaptive, computer-based cognitive remediation accessed from home can improve cognitive functioning in multiple sclerosis (MS), according to a recent study. Researchers hypothesized that training at home with an adaptive online cognitive training program would have greater cognitive benefit than ordinary computer games in cognitively-impaired adults with MS and conducted a double-blind, randomized, active-placebo-controlled trial. Participants with MS were recruited and randomly assigned to either the adaptive cognitive remediation (ACR) program or active control of ordinary computer games for 60 hours over 12 weeks. They found:
  • Participants in the ACR (n=74) vs active control (n=61) training program had significantly greater improvement in the primary outcome of cognitive functioning, despite greater training time in the active control condition.
  • Furthermore, this telerehabilitation approach allowed for rapid recruitment and high compliance, and can be readily applied to other neurological conditions associated with cognitive dysfunction.
Citation:
Charvet LE, Yang J, Shaw MT, et al. Cognitive function in multiple sclerosis improves with telerehabilitation: Results from a randomized controlled trial. [Published online ahead of print May 11, 2017]. PLOS One. doi:10.1371/journal.pone.0177177.
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Memory Deficits Examined Across Stages of MS


                                                                  
  
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Mult Scler; ePub 2017 May 18; Sumowski, et al
June 6, 2017

Neuroanatomical correlates of memory deficits differ across disease stages in multiple sclerosis (MS), a recent study found. Memory deficits due to MS have been variably linked to lower subcortical grey matter (SCGM) and mesial temporal lobe (MTL) volumes. Researchers investigated which is the better predictor and whether this changes across disease stages. Magnetic resonance imaging (MRI) measured volumes of total brain, grey matter, white matter, MTL (hippocampus, amygdala) and SCGM (thalamus, caudate) in 315 patients. They found:
  • MTL predicted memory in the total sample and in patients with earlier (<10 years) or later (≥10 years) relapsing disease.
  • SCGM (specifically thalamus) predicted memory in progressive patients.
Citation:
Sumowski JF, Leavitt VM, Rocca, et al. Mesial temporal lobe and subcortical grey matter volumes differentially predict memory across stages of multiple sclerosis. [Published online ahead of print May 18, 2017]. Mult Scler. doi:10.1177/1352458517708873.
Source



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Depression and Anxiety Under-diagnosed in MS


                                                                  
  
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Int J MS Care; ePub 2017 May 18; Marrie, et al
June 6, 2017


Depression and, to a greater extent, anxiety remain underdiagnosed and undertreated in multiple sclerosis (MS), according to a recent study, and both substantially contribute to reduced health-related quality of life (HRQOL) in MS. Researchers linked clinical and administrative data for 859 participants with MS; HRQOL was measured by the Health Utilities Index (Mark III). They classified participants as depressed or anxious using administrative data, self-reported physician diagnoses, and the Hospital Anxiety and Depression Scale (HADS). They found:
  • Lifetime prevalence estimates for depression were approximately 30% regardless of methods used, but 35.8% with current depressive symptoms were not captured by either method.
  • Prevalence estimates of anxiety ranged from 11% to 19%, but 65.6% with current anxiety were not captured by either method.
  • Prior diagnoses did not decrease HRQOL after accounting for current symptoms.

Citation:
Marrie RA, Patten SB, Berrigan LI, et al. Diagnoses of depression and anxiety versus current symptoms and quality of life in multiple sclerosis. [Published online ahead of print May 18, 2017]. Int J MS Care. doi:10.7224/1537-2073.2016-110.
Source

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Torso-Weighting Improved Balance, Reduced Falls


                                                                  
  
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Int J MS Care; ePub 2017 May 22; Horn, et al
June 6, 2017


During a single testing session, torso-weighting produced significant improvements in postural stability and fall reduction during the Sensory Organization Test (SOT) for multiple sclerosis (MS), but no change in healthy controls (HC), a recent study found. As part of a more extensive single-session clinical study, 60 people with MS and 10 bin-matched HCs completed the SOT with no weights (NW), and again while weighted (WT), using the Balance-Based Torso-Weighting assessment method. SOT composite scores, equilibrium scores, and number of falls occurring across the 6 SOT conditions were compared between and within groups. Researchers found:

A statistically significant increase in composite score of 9.14 points NW to WT occurred in MS but not HC groups.

Equilibrium scores were significantly higher with WT in MS but not HC.
Falls during the SOT were reduced by 35% with WT in the MS group compared to NW, with the greatest number of falls occurring in SOT conditions 5 and 6.

Citation:
Horn KK, Allen DD, Gibson-Horn C, Widener GL. Torso-weighting produces improved standing balance and reduced falls during the Sensory Organization Test in people with multiple sclerosis. [Published online ahead of print May 22, 2017]. Int J MS Care. doi:10.7224/1537-2073.2015-090.

Source: Neurology Reviews


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Top 50 Symptoms of Multiple Sclerosis


                                                                  
  
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Here are 50 of the most common MS symptoms:
Sensory problems
  • Abnormal sensations (dysesthesias)
  • Numbness, tingling, burning, or tightness
  • Pins and needles
  • Severe itchiness (pruritus)
  • Hypersensitivity to touch
  • Pain - acute or chronic, mild to severe
  • Loss of proprioception (sense of body position in space)
  • Inability to detect vibrations
  • Impaired sense of taste or smell
  • Trigeminal neuralgia - stabbing pain in the face
  • L’Hermitte’s sign - electrical shock-like sensation running down the spine and into the limbs when you bend your neck forward or backward
  • The MS hug
Motor problems
  • Loss of strength or muscle weakness
  • Loss of muscle tone (hypotonicity) or increased muscle tone (hypertonicity)
  • Spasticity - continuously contracted muscles and/or muscle spasms
  • Myoclonus - sudden involuntary muscle contractions
  • Tremor
  • Foot drop
  • Problems walking, impaired gait, or mobility problems
  • Paralysis
  • Loss of balance
  • Loss of coordination (ataxia)
Cerebellar ataxia can cause:
  • Gait ataxia - uncoordinated walking
  • Nystagmus - jittery eye movements
  • Intention tremor - shaking when attempting fine motor movements
  • Hypotonia - inability to maintain a steady posture
  • Dysdiadochokinesia - inability to maintain a steady rhythm
  • Dysmetria - reduced control of range of movement resulting in over- or under-shooting limb movements
  • Dysarthria - changes in speech production, including slurring, unclear articulation of words, and difficulty controlling loudness
  • Dysphonia - changes in voice quality, including hoarseness, breathiness, nasal tone, and poor control of pitch
  • Dysphagia - difficulty swallowing
Vestibular ataxia can cause:
  • Loss of balance
  • Vertigo - dizziness, nausea and vomiting
  • Nystagmus - jittery eye movements
Sensory ataxia results in:
  • Loss of body position sense (proprioception)
  • Inability to detect vibrations
  • Romberg’s sign
Vision problems
  • Optic neuritis - loss of vision, eye pain, diminished color vision
  • Diplopia - double vision
  • Blurred vision
  • Flashes of light in peripheral vision
Hearing problems
  • Hearing loss
  • Tinnitus - ringing in the ears
  • Hyperacusis - abnormal sensitivity or intolerance to everyday sound levels or noise
Cognitive changes
  • Short and long-term memory problems
  • Attention difficulties
  • Slower speech or information processing speed
  • Problems with abstract conceptualization
  • Difficulty finding the right words
  • Confusion or sensory overload
Emotional changes
Bladder, bowel, or sexual problems
  • Urinary incontinence, hesitancy, urgency, frequency, retention, or leakage
  • Constipation, diarrhea or bowel incontinence
  • Impotence, reduced libido, or inability to achieve orgasm
  • Reduced genital sensation or vaginal dryness
Sleep disorders
  • Insomnia
  • Narcolepsy
  • Restless leg syndrome (RLS) or nocturnal movements
  • Sleep disordered breathing
Other symptoms
information written and provided by Lisa Emrich
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