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Important Resources for the MS community are found on the left side of this blog.

Disclaimer: 'MS Views and News' DOES NOT endorse any products or services found on this blog. It is up to you to seek advice from your healthcare provider. The intent of this blog is to provide information on various medical conditions, medications, treatments, for your personal knowledge and to keep you informed of current health-related issues. It is not a substitute for the advice of your physician. Should you or your family members have any specific medical problem, seek medical care promptly.

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Friday, June 14, 2019

Video: SPMS Part Two: Treating Secondary Progressive MS

SPMS Part Two: Treating Secondary Progressive MS. This video is the 2nd in a two part masters class SPMS. If you're ready to learn how we TREAT SPMS, then start watching this vid right now! (And ensure you've already watched part one, link below). COMMENT with your thoughts and questions below! I look forward to reading and responding! SHARE SPMS Part One: https://youtu.be/KcRWaOjOL2I




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Video: Dr. Aaron Boster shares his thoughts on the most rare and uncommon #MultipleSclerosis symptoms

In this video I (Aaron Boster, MD) share the most rare and uncommon symptoms I've seen in clinical practice.

Want to hear about the 8 most unusual symptoms I've seen, then start watching this ideo RIGHT NOW!




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MS educational event in Rural Virginia

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Tuesday, June 11, 2019

Disease Modifying Therapies in the over 60s

Sophie McConnell

28 May 2019

Dr Jonathan White explains the results of two separate studies which looked at treatment of people over the age of 53.

In November 2017, a large-scale study was published that caused major concern and confusion amongst the MS community (1). From a meta-analysis of more than 28,000 people with MS (pwMS) taking a disease modifying treatment (DMT), researchers concluded that “after age 53…there is no predicted benefit to receiving immunomodulatory DMTs for the average MS patient
Almost immediately, OMS forums and enquiries (and I imagine Neurologists’ offices) filled with people asking questions like
“I’m 55, does that mean I should just stop my medication tomorrow?”
It remains a difficult question to answer when applied to “the real-world” person with MS (pwMS), many of whom had been taking, and remained well on medication for a lengthy period of time. It is extremely important then, that both pwMS and clinicians have as much information as possible to allow for informed decision making.

Another perspective 

A new paper may add a very valuable perspective to this particular problem (2).  Published in “Multiple Sclerosis and Related Disorders”, a team from the United States looked at pwMS over 60, and whether stopping or continuing their medications had any impact on various health-related outcomes.
This was a retrospective, observational study (looking back at results already obtained rather than setting up a new study and testing a particular intervention) including 600 pwMS who were 60 years of age or older and had been on a DMT for 2 years or more.  
The researchers focused on patient reported outcomes (PROs) and timed 25-foot walk (T25FW) test as their key outcome measures.  In simple terms, they asked the people involved a series of standardised questions to gain an understanding of their level of functioning or disability (including mobility, fatigue, cognition, bowel and bladder function, spasticity, hand function, vision and sensation) and other measures such as pain scores and levels of anxiety and depression.  They then objectively measured how long it took the pwMS to walk 25 feet.

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Warning Signs of an MS Relapse

Relapse symptoms can vary in type and intensity. Sudden or worsening weakness or tingling, double vision, and dizziness are common.

Here's what you need to know..

When you experience a multiple sclerosis relapse (also known as an exacerbation or flare-up), it's because new damage in the brain or spinal cord disrupts nerve signals. That's why you might notice new symptoms or the return of old symptoms. A true relapse lasts more than 24 hours and happens at least 30 days after any previous relapses. Relapses vary in length, severity, and symptoms. Over time, symptoms should improve. Many people recover from their relapses without treatment.

Damage to the protective covering of nerve fibers interrupts normal signals from the brain to the body. When those signals are disrupted, your body doesn't function ike it once did. Things you did easily before can seem difficult -- like opening a jar or turning a doorknob. Sudden or worsening weakness that doesn't go away could mean you're having a relapse.

continue reading 



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Monday, June 10, 2019

Video: MS Medications - Which Multiple Sclerosis Drugs Need a Washout?

In this video @AaronBosterMD teach you about washout periods for each of the MS medications.




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Video: Walking and Multiple Sclerosis: Expert advice from Neuro PT [2019]


Walking and Multiple Sclerosis: If you have questions about walking and Multiple Sclerosis, then watch this lecture! OhioHealthMS center's Jessica Petitti PT, DPT and Lauren Esposito PT, DPT, (both brilliant neuro physical therapists) who work with Dr. Boster are featured. They lectured on gait mechanics in MS during our OhioHealth MS CME 3/2019! This lecture was recorded live and delivered to an audience of MS providers.
I think the content is valuable for anyone impacted by MS. Please check it out!




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Friday, June 7, 2019

10 reasons why YOU need to see a Counselor (therapist)



By Aaron Boster, MD                                                               published 06.05.19

In this video I share 10 reasons why you need to see a counselor, therapist, or another "trained listener." Want to know why you need to see a counselor? Then start watching this vid, right now!


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Wednesday, June 5, 2019

Can MS Disease-Modifying Therapies impact depression in MS?

by Judy George, Senior Staff Writer, MedPage Today
May 31, 2019
SEATTLE -- More potent disease-modifying therapies (DMTs) were linked to fewer depressive symptoms in relapsing-remitting multiple sclerosis (MS) patients than lower-efficacy treatments, interim results of an observational study presented here suggested.
Initiating a high-efficacy DMT was tied to a significant reduction in depression severity over about a year, reported Kathryn Fitzgerald, ScD, of Johns Hopkins University School of Medicine in Baltimore, and colleagues, in a poster presentation at the annual Consortium of Multiple Sclerosis Centers meeting.
"We consider these results as preliminary, but they are consistent with some prior research studies that found a link between reduction in inflammation and downstream reduced depressive symptoms in non-MS populations," Fitzgerald told MedPage Today.
Depression affects people with MS significantly: compared with controls, MS patients have shown an elevated annual prevalence ratio of depression of 1.77. An imaging studyrecently suggested that hippocampal neuroinflammation may play a role in depression-associated in MS. In addition, DMTs may affect depression etiology and symptomatology; some lower-efficacy DMTs like interferons many increase depression risk, while higher-efficacy DMTs may exert anti-depressive properties, Fitzgerald noted.
In this study, the team examined data from MS PATHS (Multiple Sclerosis Partners Advancing Technology and Health Solutions), an ongoing 10-site longitudinal study. The investigators used the Quality of Life in Neurological Disorders (Neuro-QoL) depression subscale, a self-reported measure, to assess depression severity.
The study population consisted of patients with relapsing-remitting MS who were new initiators of higher-efficacy or lower-efficacy DMTs and who completed at least two Neuro-QoL depression scales. Natalizumab (Tysabri), rituximab (Rituxan), ocrelizumab (Ocrevus), and alemtuzumab (Lemtrada) were considered higher-efficacy DMTs. Interferons, glatiramer acetate (Copaxone), fingolimod (Gilenya), and dimethyl fumarate (Tecfidera) were classified as lower-efficacy drugs.
The sample included 400 people in the higher-efficacy group and 530 in the lower-efficacy group. In both cohorts, 77% were women. The higher-efficacy group had a mean baseline age of 42.7; their baseline Neuro-QoL scores were an average of 46.3 points, and 43.3% had a history of antidepressant use or currently were taking antidepressant drugs. The baseline age in the lower-efficacy group was 46.8; this group had a baseline Neuro-QoL of 45.6 points, and 46.7% had used or were using antidepressants.



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Tuesday, June 4, 2019

Video: Working Out and Overheating Trigger an MS Attack?

By Aaron Boster, MD

Can working out and overheating trigger an MS attack? I viewer recently asked me this. To learn the answer, start watching this video right now. COMMENT with your thoughts and questions below! I look forward to reading and responding!




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Placebo-Controlled Trial of an Oral BTK Inhibitor in Multiple Sclerosis

Abstract

BACKGROUND

Bruton’s tyrosine kinase (BTK) regulates the functions of B cells and myeloid cells that are implicated in the pathogenesis of multiple sclerosis. Evobrutinib is a selective oral BTK inhibitor that has been shown to inhibit B-cell activation both in vitro and in vivo.
METHODS
In this double-blind, randomized, phase 2 trial, we assigned patients with relapsing multiple sclerosis to one of five groups: placebo, evobrutinib (at a dose of 25 mg once daily, 75 mg once daily, or 75 mg twice daily), or open-label dimethyl fumarate (DMF) as a reference. The primary end point was the total (cumulative) number of gadolinium-enhancing lesions identified on T1-weighted magnetic resonance imaging at weeks 12, 16, 20, and 24. Key secondary end points included the annualized relapse rate and change from baseline in the score on the Expanded Disability Status Scale (EDSS).

RESULTS

A total of 267 patients were randomly assigned to a trial group. The mean (±SD) total number of gadolinium-enhancing lesions during weeks 12 through 24 was 3.85±5.44 in the placebo group, 4.06±8.02 in the evobrutinib 25-mg group, 1.69±4.69 in the evobrutinib 75-mg once-daily group, 1.15±3.70 in the evobrutinib 75-mg twice-daily group, and 4.78±22.05 in the DMF group. The baseline adjusted rate ratios for the total number of lesions over time as compared with placebo were 1.45 in the evobrutinib 25-mg group (P=0.32), 0.30 in the evobrutinib 75-mg once-daily group (P=0.005), and 0.44 in the evobrutinib 75-mg twice-daily group (P=0.06). The unadjusted annualized relapse rate at week 24 was 0.37 in the placebo group, 0.57 in the evobrutinib 25-mg group, 0.13 in the evobrutinib 75-mg once-daily group, 0.08 in the evobrutinib 75-mg twice-daily group, and 0.20 in the DMF group. There was no significant effect of trial group on the change from baseline in the EDSS score. Elevations in liver aminotransferase values were observed with evobrutinib.

CONCLUSIONS

Patients with relapsing multiple sclerosis who received 75 mg of evobrutinib once daily had significantly fewer enhancing lesions during weeks 12 through 24 than those who received placebo. There was no significant difference with placebo for either the 25-mg once-daily or 75-mg twice-daily dose of evobrutinib, nor in the annualized relapse rate or disability progression at any dose. Longer and larger trials are required to determine the effect and risks of evobrutinib in patients with multiple sclerosis. (Funded by EMD Serono; ClinicalTrials.gov number, NCT02975349.)

See more, here



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For Yoga Lovers: Adaptive Yoga Moves Any Body

Book: Adaptive Yoga Moves Any Body
$39.95
A guide for all ages and abilities with clear instructions and hundreds of photos. Ideal for:
  • Individuals with MS, and neuromuscular conditions
  • Anybody with movement challenges
  • Individuals seeking a gentle practice
  • Caregivers of people with movement challenges
  • Individuals new to yoga
  • Experienced yogis who desire a home reference
  • Yoga instructors seeking to learn how to adapt yoga for their students
                                                                  click: 

Proceeds go to Yoga Moves MS, a non-pro t, 501(c) (3) organization dedicated to providing therapeutic yoga for individuals with MS and neuromuscular conditions.
My Yoga Moves students are the inspiration for many of the clever adaptations presented. With adaptive yoga, you can individualize the practice to your own needs and abilities.
— Mindy Eisenberg, Author
Mindy, After watching your video, and seeing the sample pages in your book, I bought! It seems to be a perfect affirmation that yoga asanas can be accessible to any-body. I wanted to share your site with friends and colleagues; your site is so easy and bright -Blessings, and Namaste.
— Barbara Ingram, Transitionsbodywork.com



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Monday, June 3, 2019

New Phase 3 Interim Results Support Safety and Efficacy of Diroximel Fumarate in Multiple Sclerosis

Interim EVOLVE-MS-1 Data Support Efficacy, Tolerability of Diroximel Fumarate in Relapsing Multiple Sclerosis

Diroximel fumarate may be an effective treatment option in both newly diagnosed and interferon/glatiramer acetate switch patients. Interim results show it significantly reduced disease activity and was well tolerated, with low rates of gastrointestinal adverse effects leading to treatment discontinuation.

By: Jenna Payesko
Published: May 30, 2019

At the 2019 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) held in Seattle, Washington, May 28–June 1, Biogen presented new interim data from the ongoing open-label, pivotal phase 3 EVOLVE-MS-1 (NCT02634307) safety study indicating that diroximel fumarate significantly reduced disease activity in patients newly diagnosed with relapsing-remitting multiple sclerosis and those previously treated with interferons or glatiramer acetate, and was well tolerated with low rates of gastrointestinal adverse effects leading to treatment discontinuation.1

The investigational, novel, oral fumarate candidate, which is in development with Alkermes, is currently under review with the FDA and has a Prescription Drug User Fee Act (PDUFA) target action date in the fourth quarter of 2019. The new drug application was accepted February 2019 through the 505(b)(2) pathway and references the dimethyl fumarate data, with the application including findings from the EVOLVE-MS-1 study. If diroximel fumarate is approved by the FDA, Biogen intends to market it under the brand name Vumerity.

"Diroximel fumarate is a novel oral fumarate candidate with a distinct chemical structure that is in development for the treatment of relapsing forms of MS. Diroximel fumarate is designed to rapidly convert to monomethyl fumarate in the body and it is hypothesized that it may offer differentiated gastrointestinal (GI) tolerability compared to dimethyl fumarate. The data we are presenting at CMSC broaden the body of evidence supporting the tolerability of diroximel fumarate," Bernd Kieseier, MD, global head of multiple sclerosis, Biogen, told NeurologyLive. "The data presented at CMSC are consistent with previous results we’ve shared on the potential safety and effectiveness of diroximel fumarate in relapsing MS, particularly in newly diagnosed patients. We look forward to learning more about the GI tolerability profile of diroximel fumarate, which is being evaluated in the ongoing EVOLVE-MS-2, a head-to-head study versus dimethyl fumarate, with results expected later this year."

The single arm, 96-week, phase 3 trial will enroll approximately 1000 patients with relapsing-remitting multiple sclerosis. The interim results, which were presented in a safety and efficacy analyses at the CMSC meeting, includes 696 subjects treated with diroximel fumarate for a median of approximately 1 year.

The efficacy of diroximel fumarate, explored in a sub-group analysis of EVOLVE-MS-1, included participants naïve to prior disease-modifying therapy treatment or those previously treated with interferon or glatiramer acetate.

As of March 2018, the results demonstrated significant improvements in radiologic and clinical endpoints over 1 year compared to baseline. The annualize relapse rate at week 48 versus the previous 12 months was 0.20 vs 1.1 (82% reduction; n=82) in newly diagnosed and 0.19 versus 0.6 (68% reduction; n=361) in those who switched from interferons or glatiramer acetate. A reduction in the mean number of gadolinium-enhancing lesions was observed for both participants newly diagnosed (baseline, 2.2 [6.2]; week 48, 0.1 [0.38]; 96% reduction; P = .0051; n=70) and those who switched from interferons or glatiramer acetate (baseline, 1.1 [3.17]; week 48, 0.4 [2.18]; 64% reduction; P <.0001; n=242). Based on the results of this analysis, investigators concluded that diroximel fumarate may be an effective therapy in both newly diagnosed patients and interferons or glatiramer acetate switchers.3

"Results show that in these interferons/glatiramer acetate switch patients, diroximel fumarate was associated with significant improvements in radiological and clinical endpoints over one year compared to baseline, and annualized relapse rate was reduced by 72% with diroximel fumarate at week 48 compared to baseline," Kieseier explained. "Additionally, the mean number of gadolinium-enhancing (Gd+) lesions was reduced by 64% with diroximel fumarate compared to baseline, and the percentage of patients with no Gd+ lesions at week 48 was 89% compared to 74% at baseline. These data are consistent with additional results we’ve previously shared demonstrating the effectiveness of diroximel fumarate in relapsing MS, including in specific patient populations such as newly diagnosed patients and early switch patients."



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Multiple Sclerosis Vlog: Decoding the JC Virus Antibody Test

Published on Jun 2, 2019
In this video I teach you how to understand the JC virus antibody test.To learn how to decode JCV antibody testing, start watching this video!



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