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Friday, June 15, 2018

Calorie Restriction Diets Safe, Effective for Weight Loss in Multiple Sclerosis

Patients were randomly assigned to either a control diet, a daily calorie restricted diet, or an intermittent calorie restricted diet.  Patients were randomly assigned to either a control diet, a daily calorie restricted diet, or an intermittent calorie restricted diet.
For patients with multiple sclerosis (MS), calorie restriction diets are a safe, effective way to achieve weight loss and may be associated with improved emotional health, according to results published in Multiple Sclerosis and Related Disorders.
Both daily calorie reduction and intermittent calorie reduction diets were effective for achieving weight loss.
The study included participants with MS (n=36) who were randomly assigned to 1 of 3 diets for 8 weeks: daily calorie restriction diet (22% daily reduction in energy needs), intermittent calorie restriction diet (75% reduction in energy needs, 2 days/week), or a weight-stable diet (0% reduction in energy needs).
Of the 36 participants, 86% (n=31) completed the trial, and no significant adverse events occurred.
Participants who were randomly assigned to either calorie restriction diet lost a median 3.4 kg. Participants' weight changes did not significantly differ by type of calorie restriction diet. However, participants assigned to a daily calorie restrictive diet tended to have greater weight loss (-3.6 kg) compared with intermittent calorie restriction (-3.0 kg).


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Associations Between Physiological and Perceived Fall Risk in Multiple Sclerosis

Patients with multiple sclerosis often report impaired mobility as a top concern.Patients with multiple sclerosis often report impaired mobility as a top concern.
Patients with multiple sclerosis have a disparity between their physiological risk of falling and their perceived risk of falling, both of which correspond to the risk for recurrent falls, according to a study published in Archives of Physical Medicine and Rehabilitation.
The study included 416 participants with multiple sclerosis of all subtypes. Physiological fall risk was assessed and scored using the Physiological Profile Assessment (PPA), and the perceived fall risk was assessed and scored using the Falls Efficacy Scale-international questionnaire (FESi). Retrospective assessments of fall incidence were done via interview, although prospective assessments were done using standardized daily diary sheets for recording falls.
Data analyses found that higher FESi and PPA scores increased the odds of participants being recurrent fallers [FESi odds ratio [OR] 1.05 (95% confidence interval [CI] 1.03-1.07), PPA OR 1.30 (95% CI 1.17-1.46)], with PPA being the superior predictor. In the low physiological and high perceived risk group, 37% of participants (n=63) were identified as recurrent fallers. Some of these participants may have had additional physical risk factors such as spasticity, impaired gait, and dual task interference, which are not included in the PPA, making their scores less predictive of falls.
More than half of the high physiological and low perceived risk group (10% of total participants) reported no falls,   

                      
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Correlation of Post-Void Residual Volume to Urologic Symptoms in Multiple Sclerosis

May 29, 2018

Post-void residual urine was measured by ultrasound or catheterization. Post-void residual urine was measured by ultrasound or catheterization.
A recent study published in The Journal of Urology found that post-void residual volume (PVR) is not associated with an elevated risk for recurrent urinary tract infections (UTIs), worsening incontinence, or worsening obstructive lower urinary tract symptoms in individuals with multiple sclerosis and lower urinary tract symptoms.
The study analyzed post-void residual volume in a cohort of 110 patients with multiple sclerosis and lower urinary tract symptoms to determine whether there was an association between post-void residual volume, UTIs, and self-reported urinary symptoms. Participants were included in the study if they had at least 1 post-void residual volume measure obtained by catheterization or ultrasound and a diagnosis of multiple sclerosis. Incontinence was assessed using the Michigan Incontinence Symptom Index (M-ISI), and the American Urological Association Symptom Index (AUA SI) was used for lower urinary tract symptom screening.
The average post-void residual volume for participants was 123.4 mL (range 0-650cc) and the AUA mean symptom score for participants was 19.1, with a 4.1 average bother score. Data analyses did not indicate an association between higher post-void residual volume and increased AUA symptom or bother score (=.53 and P=.44, respectively), nor any correlation between higher post-void residual volume  and history of recent recurrent UTIs (=.27). No relationship between PVR group and AUA SI or M-ISI was indicated (=.54 and P=.57, respectively).

Study investigators conclude, “Elevated [post-void residual volume] was common among [multiple sclerosis] patients with [lower urinary tract symptoms] presenting to our clinic: almost half of patients met the UK guidelines for [multiple sclerosis] related urinary retention, and 10% of patients would qualify under the French consensus. However, within our sample, elevated [post-void residual volume] was not associated with worsening [lower urinary tract symptoms] as assessed by AUA [symptom score], worsening incontinence as measured by M-ISI score or increased risk of recurrent UTI.

Continue


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Test of Everyday Cognitive Ability Effectively Assesses Multiple Sclerosis-Related Impairment

June 8, 2018


For patients with multiple sclerosis (MS), the Test of Everyday Cognitive Ability (TECA) combines 10 timed instrumental activities of daily living for an assessment that includes a broad range of task difficulties, requires minimal motor involvement, and is sensitive to MS-related cognitive impairment, according to results published in Multiple Sclerosis and Related Disorders.
The items included in the TECA are finding a telephone number, making change, reading a label, finding items, reading a medicine bottle, buying grocery items, finding a name and address, finding a telephone number for a business, reviewing a shopping list, and recalling medicine bottle information.
The study included participants with MS (n=177) and healthy controls (n=49). Each participant underwent the TECA and a standard battery of neuropsychological measures.
Participants with MS had significantly worse TECA performances compared with control participants. Additionally, participants with MS who had cognitive impairment performed significantly slower compared with participants with MS without cognitive impairment.
“Administered using a standardized and portable kit, the TECA is feasible for clinical settings and across sites in clinical trials. While we have shown the TECA to be useful in MS, the items are generalizable to other disorders associated with a range of cognitive impairment, including those with only mild to moderate deficits,” the researchers wrote.




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Wednesday, June 13, 2018

Get the Facts on CBD OIL


Learn the Legalities, the Uses, 
The Oils, the Edibles and the Topicals
Read about HEMP, CBD and Endocannibinoids


"Dr. recommended CBD provided by a licensed pharmacist. 

Check it out here: 
https://www.greenroadsworld.com/?rfsn=1322192.8a2827





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Pilates Proves Beneficial to Persons with MS

Int J MS Care; 2018 Mar/Apr; Duff, et al
June 8, 2018

Pilates improved walking performance and functional ability in persons with multiple sclerosis (MS), a recent study found, and is a viable exercise option to help manage the disease. 30 individuals with MS not restricted to a wheelchair or scooter (Patient-Determined Disease Steps scale score <7) were randomized to receive Pilates (twice weekly) and massage therapy (once weekly) or once-weekly massage therapy only (control group). The Pilates was delivered in a group setting (5-10 participants per session). The primary outcome was change in walking performance (6-Minute Walk Test) after 12 weeks. Secondary outcomes included functional ability (Timed Up and Go test), balance (Fullerton Advanced Balance Scale), flexibility (sit and reach test), body composition (dual-energy X-ray absorptiometry), core endurance (plank-hold test), and muscle strength and voluntary activation (quadriceps). Researchers found:

Walking distance increased by a mean (SD) of 52.4 (40.2) meters in the Pilates group vs 15.0 (34.1) m in the control group (group × time).

Mean (SD) time to complete the Timed Up and Go test decreased by 1.5 (2.8) seconds in the Pilates group vs an increase of 0.3 (0.9) seconds in the control group (group × time).

Citation:
Duff WRD, Andrushko JW, Renshaw DW, et al. Impact of Pilates exercise in multiple sclerosis. A randomized controlled trial. Int J MS Care. 2018;20(2):92-100. doi:10.7224/1537-2073.2017-066.

Source

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Atrophied Brain Lesion Volume: New MS Biomarker

June 8, 2018

Atrophied lesion volume is a unique and clinically relevant imaging marker in multiple sclerosis (MS), with particular promise in progressive MS, according to a recent study. A total of 192 patients (18 clinically isolated syndrome, 126 relapsing‐remitting MS, and 48 progressive) received 3T magnetic resonance imaging at baseline and 5 years. Lesions were quantified at baseline, and new/enlarging lesion volumes were calculated over the study interval. Atrophied lesion volume was calculated by combining baseline lesion masks with follow‐up SIENAX‐derived cerebrospinal fluid partial volume maps. Measures were compared between disease subgroups, and correlations with disability change (Expanded Disability Status Scale [EDSS]) were evaluated. Researchers found:

Atrophied lesion volume was different between MS subtypes, and exceeded new lesion volume accumulation in progressive MS (298.1 vs 75.5 mm3).
Atrophied lesion volume was the only significant correlate of EDSS change (r = .192 relapsing, r = .317 progressive), and explained significant additional variance when controlling for brain atrophy and new/enlarging lesion volume (R2 .092 vs .045).

Citation:
Dwyer MG, Bergsland N, Ramasamy DP, Jakimovski D, Weinstock-Guttman B, Zivadinov R. Atrophied brain lesion volume: A new imaging biomarker in multiple sclerosis. [Published online ahead of print June 1, 2018]. J Neuroimaging. doi:10.1111/jon.12527.

source


                      
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Why You Need to Get Enough Sleep


Can’t focus? It’s hard to do when you haven’t slept. You’ll also have trouble learning new stuff. And when you do, you’ll need some shut-eye to remember it. Doctors call this consolidation -- sleep strengthens the links between brain cells that form memories. That’s what makes learning stick.

Sleepy drivers cause at least 100,000 highway crashes a year. Nodding off at the wheel isn’t the only problem. A lack of rest can lead to a drop in what doctors call mental performance. You’re less motivated, focused, and happy. And you don’t think as clearly. This doesn’t just apply to road warriors. One study showed hospitals could cut mistakes by more than a third if they gave doctors more time to sleep.

tired dad

Do you get a little snippy when you’re short on sleep? That’s normal. Just one bad night can make you sad, stressed, angry, and tired. If the trouble lasts, you may start to feel worse about your life. You might not want to hang out with friends and family. Over time this can lead to mood disorders like depression or anxiety. A better sleep routine is the answer. Talk to your doctor if it doesn’t help or if your symptoms get in the way of your life.
Sleep less than 6 hours a night? You’re more likely to get heart disease. Doctors aren’t sure how it works, but they know lack of sleep raises blood pressure, stokes your stress, and boosts adrenaline. Each can take a toll on your ticker.

READ MORE


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MS Care Professionals Need Better Understanding of Medical Marijuana to Address Patient Demand

Patricia K. Coyle, MD“Eighty-nine percent of residents and fellows are not prepared to recommend cannabis use to patients, and 33% are not at all prepared to answer any questions about the plant,” said Allen Bowling, MD, PhD, during a lecture at the Consortium of Multiple Sclerosis Centers’ (CMSC) 32nd Annual Meeting on Wednesday, May 30. “In addition, 80% of dispensary staff have no medical or scientific training, yet 94% are providing advice about specific products.”
“There are 3 Cannabis universes: medical, pharmaceutical, and recreational use,” said Dr. Bowling. Although recreational is still the biggest of the three, medical marijuana use by patients is expanding rapidly, especially since it is now legal in most states for medical treatment of multiple sclerosis (MS). He added that there is a huge demand among the general public and people with MS for scientifically accurate information on the use of medical marijuana.
A leading expert on the use of alternative medicine in MS, Dr. Bowling stressed that healthcare professionals need a greater understanding of the effects of delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), synthetic THC, and other cannabinoids in order to provide patients with sufficient information to make informed decisions. “Cannabis is an umbrella term," he said, but cannabis does not necessarily equate to marijuana. "There is some debate, but many botanists will agree there is only one species of cannabis with many different subspecies and varieties,” Dr. Bowling told the packed lecture room. Different parts of the plant can have different levels of THC, but the psychoactive ingredient is most concentrated in the sticky resin located in the flower head.
Although there are a myriad of studies discussing the safety and effectiveness of marijuana in MS, these findings do not necessarily apply to the specific Cannabis products sold in U.S. dispensaries, Dr. Bowling noted. He urged attendees to learn more about marijuana use in general and the substances that their patients are able to obtain locally.

Source


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A review on stem cell therapy for multiple sclerosis: special focus on human embryonic stem cells

Source

Geeta Shroff

Department of Stem Cell Therapy, Nutech Mediworld, New Delhi, India

Abstract: Multiple sclerosis (MS), a complex disorder of the central nervous system (CNS), is characterized with axonal loss underlying long-term progressive disability. Currently available therapies for its management are able to slow down the progression but fail to treat it completely. Moreover, these therapies are associated with major CNS and cardiovascular adverse events, and prolonged use of these treatments may cause life-threatening diseases. Recent research has shown that cellular therapies hold a potential for CNS repair and may be able to provide protection from inflammatory damage caused after injury. Human embryonic stem cell (hESC) transplantation is one of the promising cell therapies; hESCs play an important role in remyelination and help in preventing demylenation of the axons. In this study, an overview of the current knowledge about the unique properties of hESC and their comparison with other cell therapies has been presented for the treatment of patients with MS.

Keywords: multiple sclerosis, stem cells, human embryonic stem cells, remyelination, axonal loss, neurological disorder
Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.
Download Article [PDF]  View Full Text [HTML][Machine readable]

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MS NEURO TV: Pain Management in Multiple Sclerosis

MS NEURO TV "Pain Management in Multiple Sclerosis" 
with Megan Weigel, DNP, ARNP-C, MSCN (June 2018 webinar) 

Learn about types of pain related to MS, 

CLICK HERE













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A new APP - Helping MS providers and patients navigate the complexity of MS decision-making and treatment.





CLICK BOX to learn More of this App


Significant advancements in multiple sclerosis care, including the arrival of new therapies, have made treatment decision-making and navigating health insurance requirements increasingly complex for patients and their providers. To simplify the process, PRIME worked in partnership with the CMSA and the Academy of Managed Care Pharmacy (AMCP) Foundation to develop myMS.care, a new online tool featuring 2 complimentary web apps. The web apps – a CarePath for patients, and a CareNavigator for providers – are tethered to facilitate shared decision-making and help guide critical conversations between those receiving care and those delivering it. Aligning preferences and goals to ensure patients and providers are on the same page often leads to greater satisfaction and improves the patient experience throughout the course of the MS journey. By offering specific tips on efficiently navigating the insurance process, the web apps are instrumental in avoiding unnecessary delays in treatment. Additionally, patients using the web app are able to print a customized “care guide” to take with them to their medical appointments. The care guide, which includes a list of the patient’s preferences, key concerns, and questions, serves as an important resource and reference tool when patients are deciding on a care plan with their providers.

Access the website here:  https://www.myms.care/s/msvn




Sunday, June 10, 2018

20 Tips & Tricks to Tackle Depression in Multiple Sclerosis






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Lhermitte Phenomenon ( L'hermitte's Sign or Syndrome) in Multiple Sclerosis



Click above to learn from Dr. Boster 


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Comparisons of therapies in different scenarios help complete the puzzle

Escalation of therapy is the most widely used strategy for managing active relapsing-remitting multiple sclerosis. The difficulty in tailoring the choice of treatment to the needs of patients with multiple sclerosis reflects the complexity of the underlying decision matrix, which consists of factors such as treatment goals, available therapies, route of administration, family planning, safety and efficacy, in the context of individual disease severity.

Thus, the choice of the right treatment for a concrete patient at a given time depends on multiple circumstances – including prior treatment history, disease activity and personal preference. From the article by Dr Lorscheider and colleagues, published in this issue of Multiple Sclerosis Journal,1 we learn that while both fingolimod and natalizumab are associated with substantial reduction in relapse frequency, natalizumab offers superior control of relapse activity and improved chance of recovery from previously accrued disability when compared to fingolimod, if used in patients who have experienced relapses despite being treated with platform injectable therapies (interferon β or glatiramer acetate) during the preceding 1 year. This study, which utilised the data from the Swiss Federation of Common tasks of Health Insurances, used methodology that is the gold standard for assessing treatment effectiveness in observational data sets. The authors studied 358 patients, matched closely on a propensity score that was derived from a comprehensive list of potential confounders, in order to minimise inclusion bias. They used paired analyses and pairwise censoring of follow-up to eliminate attrition bias. Lorscheider et al. have chosen robust disability endpoints, including 12 month confirmed improvement in Extended Disability Status Scale score, and have applied internal processes to ensure data quality and completeness. The source data set represents 65% of the Swiss multiple sclerosis population. Although the study did not estimate the vulnerability of its outcomes to potential unmeasured confounders (such as magnetic resonance imaging (MRI) activity), the authors assure us about the validity of their results through a number of converging sensitivity analyses, including analyses using different matching strategies and different definitions of prior disease activity.

This study replicates the results of a number of other studies, which showed superior effect of natalizumab on relapse incidence and some of them also on improvement of disability in patients with previously active disease. These include studies completed in the French Observatoire Français de la Sclérose en Plaques (OFSEP) cohort,2 a two-centre study in northern Italy,3 a multicentre Italian study4 and a study from the global MSBase registry.5 In contrast, a study conducted in the population-based Danish National Multiple Sclerosis Registry did not find any differences in relapse and disability outcomes among 928 matched patients treated with fingolimod or natalizumab.6
The differences in the results of observational studies may in some readers raise doubts about the validity of real-world evidence. In fact, validity of such evidence strongly depends on the quality of the underlying data and on the used statistical methodology. Reassuringly, the common denominator of the studies cited above as well as the study published in the issue of Multiple Sclerosis Journal is the high degree of rigour applied to study designs and analyses. Before the reader sets out on a journey to explore the differences in their statistical methodologies, we should contemplate the different contexts in which natalizumab and fingolimod had been compared. An interesting pattern emerges. The Danish study enrolled patients with variable disease and treatment histories, including patients with relatively low prior relapse frequency and limited treatment possession. On the other hand, the studies that showed superiority of natalizumab over fingolimod were all enriched for patients with previously high disease activity, and several of these studies even required recent failure of injectable platform therapies for patient inclusion.

In summary, the currently available literature suggests that the magnitude of the difference observed between therapies of unequal anti-inflammatory potential is determined by the degree of previous inflammatory activity experienced by the studied patients. Therefore, the choice of natalizumab or fingolimod should, in addition to safety and convenience considerations, be guided by prior disease activity and treatment history. Treatment-naïve patients or those with previously stable disease may equally benefit from treatment with fingolimod or natalizumab. In contrast, patients with a relatively active disease and a history of suboptimal treatment response should opt for the more potent treatment option without hesitation. Such hypothesis is intuitive and reflects the approach already practised by many neurologists. However, conclusive evidence that will confirm that treatment escalation strategies should be driven by prior disease activity is still needed.




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Detection and clinical correlation of leukocortical lesions in pediatric-onset multiple sclerosis on multi-contrast MRI

To determine the frequency of cortical lesions (CLs) in patients with pediatric-onset multiple sclerosis (POMS) using multi-contrast magnetic resonance imaging (MRI), and the relationship between frontal CL load and upper limb dexterity assessed with the Nine-Hole Peg Test (9-HPT).
Participants completed the 9-HPT and were imaged on a 3T MRI scanner to collect T1-weighted three-dimensional (3D) magnetization prepared rapid gradient echo (MPRAGE), proton density–weighted, T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. CLs were manually segmented using all MRI contrasts.
We enrolled 24 participants with POMS (mean (standard deviation) age at first symptom: 13.3 (±2.7) years; mean age at scan: 18.8 (±3) years; mean disease duration of 5 (±3.2) years). A total of 391 CLs (mean, 16.3 ± 27.2; median, 7) were identified in 19 of 24 POMS patients (79%). The total number of CLs was positively associated with white matter lesion volume (p = 0.04) but not with thalamic volume, age at the time of the scan, or disease duration. The number of frontal CLs was associated with slower performance on the 9-HPT (p = 0.05).
Multi-contrast 3T MRI led to a high rate of CL detection, demonstrating that cortical pathology occurs even in pediatric-onset disease. Frontal lobe CL count was associated with reduced manual dexterity, indicating that these CLs are clinically relevant.





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Skin Tone, Race May Be Associated With Multiple Sclerosis Diagnosis

A study has shown that children with acquired demyelinating syndromes (ADSs) who report a lighter skin tone and a non-white race are more likely to receive a diagnosis of MS, though this effect is likely due to factors other than UV absorption. This research was presented at the 32nd Annual Meeting of the Consortium of Multiple Sclerosis Centers, held May 30-June 2, 2018, in Nashville, Tennessee.
Research took place at multiple sites in Canada from 2004 to 2017. Between 2010 and 2017, the study researchers assessed skin tone by studying an area of the upper inner arm that did not receive significant sun exposure. 
The MS and monophasic ADS groups were compared using quantified melanin measurements via the DSM II Colorimeter; self-reported skin tones of fair, medium, olive, or dark; a self-reported race; and skin tone, which was self-reported using 10 numerical panels of color. The study researchers used Fisher's exact tests, χ2 tests, and Kruskal-Wallis or Wilcoxon tests to compare between groups.
The study researchers included 107 children in this study, 42 of whom had MS and 65 of whom had monophasic ADS. The groups did not differ significantly by melanin measurements (=.98) or self-reported skin tones (=.25). There was a higher number of children who reported a non-white race in the MS group (=.03). There was also a difference in self-reported skin tone, with an interquartile range (IQR) of 5 (4-8) in the MS group and an IQR of 6 (4-7) in the monophasic ADS group (=.01). In this last metric, lower numbers correspond with lighter skin tones.


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