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Friday, March 9, 2018

Video: Multiple Sclerosis (MS) Has Changed





Originally Published in 2017

Intro to CMSC 2017 lecture. Boster narrates discussion about how everything in MS had changed...our diagnostic criteria, our tools to diagnose and monitor, our available MS drugs, our goals of therapy...Everything has changed it would seem, except the way in which we see patients. We have yet to update the way we approach and help patients and families. It's time we update that too!

Click video


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Thursday, March 8, 2018

Video: Is there still a role for COPAXONE in Multiple Sclerosis in 2018?

By Aaron Boster, MD



I was recently asked this provocative question and my answer is.... both yes and no! In the video I review my opinion that there are certain circumstances when Copaxone is our goto drug. There are many situation, however, when I would NOT want to use this product. Importantly I'm talking about when I am helping choose a DMT for a person with MS in 2018. Not talking about switching a super responder to any of the given DMTs. I'm not suggesting someone who is doing well stop and switch. I I am, however, sharing my personal opinion that in 2018, if I"m picking a new drug, I'm unlikely to reach for copaxone. If I could predict that someone would be a super responder to a given DMT I'd want to use that. But given that I can't predict that ahead of time, and given that breakthrough disease has significant down stream consequences, I would rather start with a higher efficacy drug. There are several situations where I feel Copaxone IS the best option: 1. A person who values safety of DMT over other factors may be the right fit for this very safe therapy. 2. This drug is a polypeptide (building block of protein). It doesn't interact with other therapies, nor get processed by kidney or liver. As such it's a goto drug when someone with MS has a co-morbid condition such as MS and cancer, MS and immunodeficiency, MS and liver transplant, etc. 3. Copaxone is increasingly being considered, albeit off label, during attempts at conception. This must be sorted out with a given woman with MS and her MS provider, but it's a place we see it used more and more. 4. Lastly, Copaxone may have a role as a person transitions between two high efficacy DMTs during a needed washout period. 5. Lastly, as my friend Chris LaGanke says, "every drug has knocked it out of the park at least once!" If someone is responding most awesomely to a given DMT, I would not want to change that! Please leave your comments and questions below. What do YOU think?



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Video: Multiple Sclerosis, MRI And Claustrophobia

Multiple Sclerosis and MRI Claustrophobia: How to beat MRI Claustrophobia




Are You Claustrophobic in the MRI scanner? Here is a tip to make the scan more tolerable. Note: SOME ONE ELSE MUST DRIVE YOU TO AND FROM YOUR MRI. Also make sure this tip has been ok'd by your prescribing clinician. Lastly, this video is only for educational purposes. Step One: Make yourself exhausted the night before. Literally limit your sleep to less than three hours. (remember: someone must drive you to your scan the next morning) Step Two: Take 5mg tab of valium (your provider must prescribe this for this purpose before the scan. Only do this under their direction and supervision). Step Three: when you lay down on the MRI gantry, CLOSE YOUR EYES and DON'T RE-OPEN THEM for any reason! The result of no sleep, valium and laying down flat with eyes closed...is often a nap and an easy MRI scan! What works for you? Might your try this? Share your comments and please leave your questions below! #WeHave MS. NOTE: this video was for educational purposes only.



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Video: How to Prepare for your upcoming MS Clinic Visit: 9 Tips

Published: March 4, 2018



How to Prepare for your upcoming MS Clinic Visit: 9 Tips You are the head of your MS village. Your MS provider is a key village member. Since you only see each other a few times a year, you want to make sure you get the most out of village meeting! Clinics can move fast and if you don't PREPARE for the visit things might get lost, forgotten, or pushed to the side.

Here are 9 tips to help ensure you get the most out of your next clinic visit!



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MS Views and News is MAKING an IMPACT for those, affected by Multiple Sclerosis
MS Views and News provides Multiple Sclerosis education, information, resources and services that will benefit many affected by MS. 
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Understanding MS in children

There are several Pediatric MS centers of Excellence in the USA . The information showing below pertains to one of these.

Although multiple sclerosis (MS) most commonly affects people who are ages 20 to 40, as many as 5 percent of MS patients develop symptoms during childhood. Yet many features of the natural history of pediatric MS, as well as best practices for diagnosing and treating the disease, are not fully understood.
Mayo Clinic in Rochester, Minn., has been recognized by the National Multiple Sclerosis Society as a "pediatric MS center of excellence." The multidisciplinary practice focuses on evaluating and treating children with MS and other central nervous system (CNS) disorders. In conjunction with five similarly designated centers, Mayo researchers also are enrolling patients in a database to support studies on the causes and management of these CNS disorders in children.
"Our goal is to learn more about pediatric MS so we can establish treatment guidelines and standards and be in a leading position to offer the best care for these patients," says Jan-Mendelt Tillema, M.D., a pediatric neurologist at Mayo Clinic in Rochester, Minn.


Diagnosis and treatment

For physicians, the challenges of pediatric MS begin with diagnosis. Magnetic resonance imaging (MRI) plays a large role, as it does in adults. "But magnetic resonance imaging of children can be much more difficult to interpret," Dr. Tillema says. For example, lesions may be less sharply demarcated. Distinguishing between MRI patterns in MS and acute disseminated encephalomyelitis (ADEM) — which occurs more frequently in children and adolescents than does MS — can be challenging, particularly after a single episode of signs and symptoms.

Following subsequent attacks, MRI often can show clearer evidence of disease, which is required to make the diagnosis of MS. Dr. Tillema notes that research studies with a small number of patients suggest MS attacks tend to occur more frequently in the initial phase of the disease in children than in adults — a feature he has witnessed in his own practice. "It's not uncommon for kids to have a few attacks within a year or two, whereas in adults it is more often — but not always — the case that episodes are spread out over several years," he says.
Treatment for pediatric MS relies on the same medications used in adults, although randomized controlled trials needed for Food and Drug Administration approval of such medications have not included pediatric patients. One of the major goals of the pediatric centers of excellence is to facilitate large-scale research initiatives.

"There is increasing experience in using MS medications in kids. Based on studies of these cases, we know more about the similarities and differences in both efficacy and side effect profiles in children," Dr. Tillema says. "The future target is to find the safest and best drugs to treat MS in children, rather than extrapolating that information from adult studies."

Read More



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MS Views and News is MAKING an IMPACT for those, affected by Multiple Sclerosis
MS Views and News provides Multiple Sclerosis education, information, resources and services that will benefit many affected by MS. 
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Tuesday, March 6, 2018

Biomarkers: The Future of MS Treatment?

Research is showing how biomarkers can be used to identify MS in individuals, pinpoint the type of MS someone has, and even provide direction in treatment

Ancestry information, products for gut health, paternity tests.
One can pretty much mail order anything these days.
There are even companies that will analyze your blood without a doctor’s order. They provide blood chemistry and wellness tests based on the results. 
How long before a blood sample can provide information on what type of multiple sclerosis (MS) someone has, and also how to best treat it? 
Not long if clinical studies continue to show positive results with biomarkers and the potential benefits for people with MS.

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MS Views and News is MAKING an IMPACT for those, affected by Multiple Sclerosis
MS Views and News provides Multiple Sclerosis education, information, resources and services that will benefit many affected by MS. 
SUBSCRIBE to our MS Learning Channel on YouTube: www.youtube.com/msviewsandnews
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Monday, March 5, 2018

Utilizing Rehabilitation Professionals in Recovery of an MS Relapse

Posted on 
Many of you have read my previous article about how a denied insurance authorization led me to an MS relapse, rendering me nonfunctional on my right side. As it turned out, MRI studies revealed that I had two new active lesions on my brain and one on the right side of my cervical spine that was 4mm in width and 3cm in length stretching from C2 to C4.
The symptoms of this relapse were tragic. They affected my cognitionspeech,swallowing, function of my right arm and hand, and drop foot on my right side. From a cognitive standpoint, I was having trouble with my word recollection and memory. The cognitive deficits affected my ability to perform at my usual level at my job and, all of a sudden, it changed conversations about me at the office. I typically travel to meet with clients and go to the home office. Once my disability became apparent, I was asked to stay home. This caused unnecessary fear and anxiety that my MS was going to cost me my full-time employment. The stress and worry of this situation spilled over to my family relationships and my condition was making my wife and my two small boys worry as well.Utilizing Rehabilitation Professionals in Recovery of an MS Relapse
From a physical standpoint, side effects were even worse. Walking was dangerous. I am well known for my dog story and how when I lost my ability to walk with Transverse Myelitis in 2005, the gift of a puppy helped to get me up on my feet and out walking every day. It had been like that for the past 11 years until this relapse in March. While I was still trying to walk, the drop foot was making it dangerous to do so. I did not have the strength or speed to keep up with my 11 year old dog. Negotiating sidewalk curbs was an adventure that almost caused several falls. My right knee was weak and gave out on me every other step. I was shifting all of my weight to my left side causing friction and stress on those muscles to compensate for my right side deficits. This led to soreness and pain in the left side, while creating risk of injury on my right side that was numb.
Losing the use of my right arm and hand was also severely debilitating. I could not raise or lower my arm without assistance. I could not grab anything with my hand, including eating utensils, keys, phones or any small tool that assists you with the tasks of everyday living. I could not dress or bath myself independently, nor apply deodorant properly. Even using the bathroom became a daunting chore. The lesion on my spine felt as if it was pressing on my cervical fusion causing intense pain in my neck. I couldn’t sleep and was having trouble swallowing. It felt like food was continually stuck in my esophagus.
All aspects of my life were spiraling out of control. As I completely lost my independence, I felt embarrassed and ashamed. So, where was I to turn to for help?


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MS Views and News is MAKING an IMPACT for those, affected by Multiple Sclerosis
MS Views and News provides Multiple Sclerosis education, information, resources and services that will benefit many affected by MS. 
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Sunday, March 4, 2018

Living Well with MS Round Table discussion from Augusta, GA

RSVP Required - see information showing below please

Program Date: May 2nd 2018 - in Augusta, GA

Click below or click here  for more information and to RSVP to attend



Healthy Diet Tied to Less MS Disability

NARCOMS data support nonpharmacologic intervention


Healthy eating appears to be linked with reduced disability in people with all types of MS, according to analysis of their self-reported dietary habits and disability levels, researchers found.
A large cross sectional survey of almost 8,000 people with MS in the North American Research Committee on MS (NARCOMS) Registry found that, compared to people with the least healthy diet, those with the healthiest eating habits had 20% lower risk for severe versus mild disability (P=0.002 for trend), according to Kathryn C. Fitzgerald, ScD, of Johns Hopkins School of Medicine in Baltimore, and colleagues.
The researchers also found 18% lower risk for severe versus mild depression after adjusting for disability status (P=0.01 for trend), they reported online in Neurology.
Respondents were divided into five groups based on their 2015 responses on the dietary screener questionnaire (DSQ). The healthiest diet included more fruits, vegetables, legumes and whole grains, less sugar in desserts and drinks, and less red meat and processed meat. Dairy was not included due to its differing health effects, due for instance to saturated fat content. Results were significant after controlling for health-related factors such as age, MS duration, body mass index, income, and smoking.
Past or current exposure to any of 19 special diets, including MS-specific (Swank, Wahls) and popular diets (Mediterranean, Paleo, gluten-free) was associated with a modest 11% reduction in the odds of increasing disability (P=0.009).
"People with MS often ask if there is anything they can do to delay or avoid disability, and many people want to know if their diet can play a role, but there have been few studies investigating this," said Fitzgerald.



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MS Views and News is MAKING an IMPACT for those, affected by Multiple Sclerosis
MS Views and News provides Multiple Sclerosis education, information, resources and services that will benefit many affected by MS. 
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Omega-3s Linked to Lower MS Risk

Fatty acid biosynthesis may play a protective role

by Judy George, Contributing Writer, MedPage Today
March 01, 2018

LOS ANGELES -- Omega-3 fatty acids may play an important role in lowering the risk of developing multiple sclerosis (MS), researchers suggested.
Consuming fish at least once a week -- or at least once a month with regular fish oil use -- was associated with a 44% reduced risk of MS or its precursor, clinically isolated syndrome (CIS), reported Annette Langer-Gould, MD, PhD, of Kaiser Permanente Southern California in Pasadena, CA, and co-authors, in an early-release abstract from the American Academy of Neurology annual meeting, to be held here in April.
"These findings provide more evidence that a diet rich in fish and omega-3 polyunsaturated fatty acids has health benefits," Langer-Gould said. "In addition to promoting improved cardiovascular health, a high fish or seafood diet may also reduce the risk of developing MS."
A marine diet is the best source of omega-3 polyunsaturated fatty acids (PUFAs), she noted. High fish intake has been associated with a lower risk of MS, but it's unclear whether this is due to PUFAs or other nutrients.
Single nucleotide polymorphisms (SNPs) in the fatty acid desaturase (FADS) gene cluster that modulate fatty acid levels have been associated with cognition, cardiovascular disease, and inflammation, she noted, but whether they're associated with MS also is unknown.
For this study, Langer-Gould and colleagues examined the diets of 1,153 people from the MS Sunshine Study, a multi-ethnic, matched case-control cohort of incident MS or CIS recruited from Kaiser Permanente Southern California, to determine the association of fish consumption and 13 tag SNPs in FADS1, FADS2, and ELOV2 with the risk of MS. The researchers defined high fish intake as eating fish at least once a week or more, or one to three servings per month plus fish oil supplements, and adjusted findings for age, sex, smoking, genetic ancestry, and the HLADRB1*15:01 allele.

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