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Thursday, August 22, 2019

DIETS & SUPPLEMENTS TO CONSIDER - Learn about certain diets from an MS neurologist

 From:  Dr. Williams—Neurologist
A well-balanced diet is important to consider when focusing on overall health. For people living with multiple sclerosis (MS), diet could potentially affect the immune system. There could be direct or indirect effects on the immune cells. There could also be effects on bacteria in the gut, which could cause inflammation or stop inflammation. Although there is no cure for MS, researchers continue to evaluate whether or not nutrition could play a larger role in the risk for MS and the course of the disease than we thought.
Remember, always talk to your doctor before making any changes to your diet, or before starting a specific diet plan.

Diet and MS

Many people have questions about the role of diet in MS. Is there a specific diet that can help? Unfortunately, there are very little data, if any, about specific diets and their role in MS. Common themes include eating more fresh and natural foods, as well as cutting down on processed foods and saturated fats.
Here are some popular diets to consider:  click here to continue

Sunday, August 18, 2019

A 3D view of The Amazing Brain: Shining a Spotlight on Individual Neurons

A major aim of the NIH-led Brain Research through Advancing Innovative Neurotechnologies® (BRAIN) Initiative is to develop new technologies that allow us to look at the brain in many different ways on many different scales. So, I’m especially pleased to highlight this winner of the initiative’s recent “Show Us Your Brain!” contest.
Here you get a close-up look at pyramidal neurons located in the hippocampus, a region of the mammalian brain involved in memory. While this tiny sample of mouse brain is densely packed with many pyramidal neurons, researchers used new ExLLSM technology to zero in on just three. This super-resolution, 3D view reveals the intricacies of each cell’s structure and branching patterns.



The group that created this award-winning visual includes the labs of X. William Yang at the University of California, Los Angeles, and Kwanghun Chung at the Massachusetts Institute of Technology, Cambridge. Chung’s team also produced another quite different “Show Us Your Brain!” winner, a colorful video featuring hundreds of neural cells and connections in a part of the brain essential to movement.
Pyramidal neurons in the hippocampus come in many different varieties. Some important differences in their functional roles may be related to differences in their physical shapes, in ways that aren’t yet well understood. So, BRAIN-supported researchers are now applying a variety of new tools and approaches in a more detailed effort to identify and characterize these neurons and their subtypes.
The video featured here took advantage of Chung’s new method for preserving brain tissue samples [1]. Another secret to its powerful imagery was a novel suite of mouse models developed in the Yang lab. With some sophisticated genetics, these models make it possible to label, at random, just 1 to 5 percent of a given neuronal cell type, illuminating their full morphology in the brain [2]. The result was this unprecedented view of three pyramidal neurons in exquisite 3D detail.
Ultimately, the goal of these and other BRAIN Initiative researchers is to produce a dynamic picture of the brain that, for the first time, shows how individual cells and complex neural circuits interact in both time and space. I look forward to their continued progress, which promises to revolutionize our understanding of how the human brain functions in both health and disease.
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Dark Rimmed Brain Lesions May Be Signal of Aggressive Disease, NIH Study Says

August 16, 2019

Brain lesions appearing as dark rimmed, “smoldering” spots on imaging scans, representing active inflammation, may be a hallmark of more aggressive and disabling forms of multiple sclerosis (MS), researchers at the National Institutes of Health(NIH) report.


Using a powerful MRI brain scanner and a 3D printer, the team visualized brain images from nearly 200 MS patients and found that these spots — identified as chronic active lesions — may be used to signal people at a higher risk of more aggressive and progressing forms of the disease.

dark-rimmed brain lesions
Dark rimmed spots on brain scans using a 7-tesla MRI may be a hallmark of more disabling MS forms. (Photo courtesy of Reich lab, NIH/NINDS)


“We found that it is possible to use brain scans to detect which patients are highly susceptible to the more aggressive forms of multiple sclerosis. The more chronic active lesions a patient has, the greater the chances they will experience this type of MS,” Daniel S. Reich, MD, PhD, the study’s senior author and a senior investigator at the NIH, said a news release.
“We hope these results will help test the effectiveness of new therapies for this form of MS, and reduce the suffering patients experience,” Reich added.
Previously, chronic active lesions could only be detected through an autopsy. But Reich and his team in earlier work showed that examining a living person’s brain using a highly powerful 7-tesla MRI scanner could accurately capture these lesions by their darkened, outer rims.
“Figuring out how to spot chronic active lesions was a big step, and we could not have done it without the high-powered MRI scanner provided by the NIH. It allowed us to then explore how MS lesions evolved and whether they played a role in progressive MS,” said Martina Absinta, MD, PhD, the study’s leader and a post-doctoral fellow in Reich’s lab.
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MS Therapies Among Limited Offerings Through AllianceRx Walgreens Prime




August 16, 2019


MS Therapies Among Limited Offerings Through AllianceRx Walgreens Prime

Medications for treating certain rare and chronic conditions,  including multiple sclerosis (MS), are now available from the specialty and home delivery pharmacy AllianceRx Walgreens Prime, the company announced.
The newly included specialty medications are all limited distribution drugs (LDDs), which means the drug manufacturers have signed agreements giving very few (or even just one) distributors the right to sell their products.
The newly included LDDs for MS treatment are Mayzent (siponimod) and Mavenclad (cladribine). Both of these therapies work by reducing the activity of the immune system with the goal of minimizing immune cell-mediated damage to neurons that is the defining feature of MS.
#Mayzent was approved by the U.S. Food and Drug Administration (FDA) in March for the treatment of relapsing forms of MS, including relapsing-remitting MS (RRMS), clinically isolated syndrome (CIS), and active secondary progressive MS (SPMS). Mayzent is manufactured by Novartis.
#Mavenclad, manufactured by EMD Serono (known as Merck KGaA outside the U.S. and Canada), was approved by the FDA (also in March) for RRMS and active SPMS. Because of its safety profile, Mavenclad is recommended only for MS patients who already have tried other MS therapies, but who did not have an adequate response and/or were not able to tolerate those treatments. Of note, the prescribing information for Mavenclad includes a warning that it may increase the risk of cancer, or cause harm to a developing fetus.

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Saturday, August 17, 2019

The Importance of Stretching With Multiple Sclerosis

Written by #TrevisGleason

Stretching is important when you have multiple sclerosis.
I’ve said in more than one blog that I consider myself to be a healthy person who happens to live with multiple sclerosis (MS). “Healthy,” perhaps, but lately I’ve found myself significantly out of shape.

With all that 2016 has brought upon me, I decided to ask my wife, Caryn, for help in getting onto a stretching program to help with the things that MS has thrown my way.

How to Stretch With MS
The National Multiple Sclerosis Society (NMSS) has set out the following guidelines for people with MS as we get into a stretching routine:


  • Stretch on a daily basis, as much as is possible.
  • Include muscle groups that are tight or in spasm.
  • Do slow, gentle, prolonged stretches, and go just to the point where you feel a gentle pulling, but not pain.


  • Hold stretches for 20 to 60 seconds or 5 to 10 breaths.
  • Avoid bouncing movements.
  • Use assistance as needed: a partner, towel, or strap (talk to a yoga teacher or physical therapist about what you can use to help you stretch — and how to use it).


Most of the stretching I’ve been doing has included some form of assistance — be it a chair, the wall, or often, Caryn herself. My balance has become something of an issue, so having something or someone to hold onto while stretching has been helpful.

Also helpful for when balance is even more of an issue is an illustrated, online manual from the NMSS called Stretching for People With MS.

This manual has drawings of stretches that can be done seated or lying down. It has specific stretches for some areas of spasticity and other difficulties that commonly affect people with MS.

For my own routine, I’ve dug out my physical therapist’s notes from after my hip replacement to help ease some stiffness in that area of the old body, particularly.


How My Stretching Is Paying Off

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The Line Between Self-Limitation and Self-Preservation




MS is a constant balancing act of extending yourself and protecting yourself.

How hard should you push yourself when you’re living with MS? And how do you know?













MS is a constant balancing act of extending yourself and protecting yourself.
iStock


Many people with multiple sclerosis (MS) either goad themselves or are chided from the sidelines that they are not doing enough. But how much is enough?

Back in April, I damaged my rotator cuff — a grouping of tendons and muscles that surround the head of the shoulder joint — which had nothing to do with my MS. It was an acute injury, and I wasn’t sure at the time how bad it was … you know, other than the pain.

It was a pain that dropped me to the floor (and ground) on a number of occasions and woke me up, panting in agony.

Over time, as I waited for it to heal enough to see whether I might be able to simply rehabilitate the joint or if it might need more invasive repair, I learned the limits of movement that wouldn’t bring the white-hot knife slicing through my joint. Even in my sleep, it seems, I was aware of my limitations, as I now wake in anticipation just before I cross into the excruciating zone.

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Research on immune activity in MS

Understanding and stopping MS in its tracks requires a better understanding of the role that the immune system plays in this disease. This system is involved both in the inflammatory attacks on myelin and, very possibly, in the injury to axons (the wire-like nerve fibers) that contributes to longer-term disability. Research on the immune system includes studies on:
  • Understanding components of the immune system such as T cells, B cells, and antibodies
  • Identifying new targets for therapeutic intervention while leaving the rest of the immune system capable of fighting infections
  • Identifying substances and processes involved in the injury of axons
  • Identifying the body’s natural immune messenger molecules that can either turn on or turn off immune attacks
Much has been learned about immune system activity in the relapsing-remitting phase of MS and this knowledge has led to the development of effective disease-modifying therapies. Less understood is the relationship between initial immune activity and progressive neurodegeneration and how innate immunity participates in the progressive phase of MS. 

We’re making progress

Studies of the immune system in MS laid the groundwork for every disease-modifying therapy now available, and these studies continue to hold promise for finding ways to stop MS. Here are reports of recent progress:

Researchers co-funded by the National MS Society report study results indicating that “Tregs” – regulatory immune cells that are known to be dysfunctional in people with MS – play a role in promoting formation of new myelin following damage. If the results are confirmed through further research, these basic laboratory studies could eventually be translated to promising new therapeutic approaches to stimulating myelin repair to restore function in people with MS. Read more

Treatment with ATX-MS-1467 (Apitope) – an injected immune therapy whose early development was supported by the National MS Society through Fast Forward, the Society’s commercial research funding program – was reported to reduce disease activity on MRI scans in two small open-label studies involving people with relapsing MS. This is an approach to identify pieces of human proteins, called “peptides,” that might be able to reinstate “immune tolerance” – in effect, train immune cells to ignore myelin – to suppress MS attacks. Read more

Scientists at the University of Florida, funded in part by the National MS Society, took a novel approach to turn off immune attacks in mice with an MS-like disease. The team used a harmless virus to deliver a gene coding for a specific component of myelin, a key target of immune attacks in MS. Further research is needed to verify and refine this approach before it can be tested in people. 
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Read more about efforts to understand tissue damage in MS

Understanding the processes that lead to tissue damage in MS is crucial to our focus on reversing this damage to regain function through nervous system and myelin repair.


Overview

We pursue all promising paths to uncover solutions for EVERYONE with MS, wherever those opportunities exist, while focusing on three priority areas, including progressive MS – bringing answers and solutions where none exist today; and nervous system repair – reversing damage to regain function through nervous system and myelin repair.

Understanding the processes that lead to tissue damage in MS is crucial to these priorities. The immune attack in MS unleashes a cascade of events that damage the wire-like arms of nerve cells (axons) and the insulating tissue (myelin) that wraps around axons, disrupting nerve signal transmission.

Driving solutions

Research focusing on understanding the extent and causes of damage to the nervous system in MS is driving progress that will help us find ways to protect the brain and stop disease progression. Current research approaches funded by the Society's research programs include:
  • Investigating whether debris from damage caused by the immune attack causes further damage to nerve cells during the course of MS.
  • Exploring how alterations in the myelin coating after immune attacks affect the health and behavior of nerve fibers.
  • Identifying processes that contribute to the loss of myelin and ways to restore myelin to protect nerves and their function.
  • Seeking ways to diagnose MS earlier to enable earliest treatment as the best insurance against future damage.
  • Developing high-powered imaging as a window to seeing how MS causes damage and as a tool for tracking the success of treatments.
Past Success
The MS Lesion Project was a major collaboration of investigators worldwide who sought to understand the damage MS does to the nervous system and ultimately improve its treatment. This large-scale project was funded through the Society’s Promise: 2010 Initiative.

investigators sought to understand patterns of MS damage in lesions—spots of brain tissue where myelin has been stripped from nerve fibers. Claudia F. Lucchinetti, MD, with collaborators in the U.S., Germany and Austria, launched the most extensive attempt ever to map and understand the meaning of MS damage in the brain. They amassed an unprecedented collection of tissue samples from more than 1,000 people with MS, obtained from brain biopsies (a rare procedure) or autopsies. By identifying four distinct kinds of lesion patterns, the collaborators: 
  • changed the way researchers think about MS
  • discovered that unique antibody patterns are associated with different lesion patterns, which could lead to a blood test to help inform treatment decisions
  • made significant gains in understanding when lesions form and how tissue is damaged, opening up new possibilities for strategies to stop that damage
An additional grant from the National Institutes of Health is making it possible for these investigators to continue making discoveries about tissue damage in MS that may ultimately drive treatment decisions.

We are making progress


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Researchers Identify Nerve Cells That Are Vulnerable to Damage in MS

July 18, 2019
Findings contribute to efforts to stopping MS progression

SUMMARY
  • Collaborators in Cambridge and San Francisco used advanced technology to evaluate genetic instructions within single brain cells in specific areas of brain tissues from people who had MS in their lifetimes, before there were disease-modifying therapies.
  • They report that a specific type of nerve cell called “projection neurons” – which normally facilitate communication between different areas of the brain – are especially vulnerable to damage in the cortex (the outer region of the brain, associated with disease progression and cognitive impairment).
  • They also confirmed the role of immune B cells in this type of damage.
  • This study yields important new information about how MS may progress and why certain symptoms worsen. If confirmed, it is likely to contribute to efforts to develop better, more targeted ways to stop the disease, protect the nervous system from further injury, and slow down MS progression.
  • This study was funded by the National MS Society and the National Institutes of Health, among others.
  • The team published their findings in Nature (Published: 17 July 2019)
 
DETAILS
Background: MS occurs when the immune system attacks the brain and spinal cord. Disease  progression is associated with damage in the cortex, the outer region of the brain, which is responsible for directing cognitive functions.
 
The Study: Investigators at the University of Cambridge and the University of California, San Francisco looked at tissue obtained from 12 people with MS via autopsy (who had never received modern disease-modifying therapies) and from 9 controls without the disease. They used single-nucleus RNA sequencing, a novel technology which allowed them to isolate many types of cells in the cortex, evaluate the genetic instructions and compare different populations of cells.
 
The researchers pinpointed a striking reduction of one cell type in the brain tissue obtained from people with MS – so called “projection neurons.” These are nerve cells involved in communicating information between distant areas of the brain. Further results showed that immune B cells were increased in areas with more damage to those projection neurons, highlighting the role of this immune cell type.
 
This work, by Drs. David Rowitch, Lucas Schirmer and others, was funded by the National MS Society and the National Institutes of Health, among others. Dr. Schirmer was a postdoctoral fellow of the Society, funded by the Dave Tomlinson Research Fund. The team published their findings in Nature (Published: 17 July 2019)

Conclusions: This study yields important new information about how MS may progress and why certain symptoms worsen. If confirmed, it is likely to contribute to efforts to develop better, more targeted ways to stop the disease, protect the nervous system from further injury, and slow down MS progression.

Source
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Friday, August 16, 2019

X-chromosome gene may explain why women are more prone to autoimmune diseases

Newswise | August 15, 2019

Findings

A gene on the X-chromosome may help explain why more women than men develop autoimmune diseases, including multiple sclerosis (MS). Researchers found that a gene known as Kdm6a was expressed more in the immune cells of women compared to men, and female mice compared to male mice. Additionally, when the Kdm6a gene was eliminated in mice specially bred to mimic a disease like MS, they had improved symptoms, reduced inflammation, and less damage to their spinal cords.

Background

Women are known to have about a threefold higher risk of developing MS than men, and also to have stronger immune responses in general. Previous research has suggested that this gender difference may be due to sex hormone and/or chromosome differences between men and women. Since women have two X chromosomes, they get a “double dose” of genes on the X chromosome; despite a natural mechanism to silence the extra genes, some genes elude this inactivation. The current study set out to determine which X-chromosome genes may “slip by” and show increased expression in females’ immune systems, and whether they may underlie the increased female susceptibility to autoimmune disease.

Method

The team first used RNA sequencing to determine which X-chromosome genes were expressed more in the T cells of female vs male immune systems. After finding that a gene known as Kdm6a showed the greatest sex difference, the team bred mice that lacked it—mice that were from a strain destined to develop an MS-like autoimmune disease. The specially bred mice without the Kdm6a gene had reduced clinical symptoms of the disease compared to their counterparts who had intact Kdm6a.
The researchers next inspected the animals’ spinal cords to assess damage that’s characteristic of MS. In mice lacking the Kdm6a gene, there was evidence of reduced autoimmune activity in spinal cord cells, reduced damage to the cells’ axons (the long extensions through which neural communication occurs, and which undergo deterioration in MS), and greater numbers of intact axons. The results suggest that deleting the Kdm6a gene has protective effects.
    Finally, the team was also able to identify the molecular changes that are triggered by the deletion of the gene. In mice lacking Kdm6a, they found evidence of increased activity of multiple genes involved in healthy immune activity, and reduced activity of genes involved in neuroinflammation.

    Impact

    The results help explain why females are more prone to developing autoimmune disease and suggest that modulating the activity Kdm6a in T cells might be a potential therapeutic target for MS and other autoimmune diseases. The findings suggest that drugs like metformin, a diabetes treatment that has been shown to alter Kdm6a activity, might also deserve further study.

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Research shows that treatment at the first sign of disease may be best for most patients with Multiple Sclerosis


Our experts explain why and describe some exceptions.


Sheila Halloran Skowyra was coming up on one of her busiest weeks at work when she woke up with numbness in her legs and feet. "It was more like pins and needles. I could walk around fine, so I figured it was just a pinched nerve," says Skowyra, 37, an assignment editor at a Boston TV station and mother of two young children.
Illustration by Jorge Colombo
The symptoms persisted, but Skowyra powered through, overseeing coverage of the Boston Marathon and celebrating Easter and her younger daughter's fourth birthday. When she went to the doctor's office midweek, an exam and bloodwork found nothing alarming.
But by the following Monday, Skowyra could barely walk and felt like she had a band wrapped around her waist. She dropped her children off at school and headed straight to the hospital.
A subsequent MRI showed she had multiple lesions on her spinal cord, as well as older-looking lesions on her brain—telltale signs of multiple sclerosis (MS). Although Skowyra had worked on some stories about MS, she knew few specifics of the disease. She was soon to learn that MS is a chronic condition in which the immune system produces inflammation in the central nervous system, resulting in damaged nerves, potentially significant disability, and increased risk of mortality.
Disease severity and symptoms vary from person to person, but MS commonly causes problems with vision, walking, and balance, as well as unusual fatigue, pain, muscle weakness or spasms, numbness and tingling, bladder or bowel dysfunction, and cognitive and emotional changes such as depression and anxiety.
Skowyra was told she had relapsing-remitting MS (the most common form of the disease), in which attacks, or flare-ups, can occur at any time, followed by periods of partial or complete remission. "I was worried about the effect it would have on my children if I became immobile or disabled," Skowyra says. That concern informed her decisions when it came time to pick a medication.
Her neurologist recommended two disease-modifying therapies (DMTs): a daily pill that has been around for about nine years and a newer drug that is administered twice a year through intravenous infusions. Skowyra chose the latter because it had proved highly effective in clinical trials at preventing attacks and seemed like it would suit her busy schedule. She had her first infusion in June. "I wanted to get ahead of this [disease] and treat it aggressively," Skowyra says. "I wasn't willing to wait and see if I had another attack."
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Vitamin D for the management of multiple sclerosis.

Abstract

BACKGROUND:

This review is an update of a previously published review, "Vitamin D for the management of multiple sclerosis" (published in the Cochrane Library; 2010, Issue 12). Multiple sclerosis (MS) is characterised by inflammation, demyelination, axonal or neuronal loss, and astrocytic gliosis in the central nervous system (CNS), which can result in varying levels of disability. Some studies have provided evidence showing an association of MS with low levels of vitamin D and benefit derived from its supplementation.

OBJECTIVES:

To evaluate the benefit and safety of vitamin D supplementation for reducing disease activity in people with MS.

SEARCH METHODS:

We searched the Cochrane Multiple Sclerosis and Rare Diseases of the CNS Specialized Register up to 2 October 2017 through contact with the Information Specialist with search terms relevant to this review. We included references identified from comprehensive electronic database searches and from handsearches of relevant journals and abstract books from conferences.

SELECTION CRITERIA:

We included randomised controlled trials (RCTs) and quasi-RCTs that compared vitamin D versus placebo, routine care, or low doses of vitamin D in patients with MS. Vitamin D was administered as monotherapy or in combination with calcium. Concomitant interventions were allowed if they were used equally in all trial intervention groups.

TO SEE FULL REPORT on PubMed - CLICK HERE

AUTHORS' CONCLUSIONS:

To date, very low-quality evidence suggests no benefit of vitamin D for patient-important outcomes among people with MS. Vitamin D appears to have no effect on recurrence of relapse, worsening of disability measured by the Expanded Disability Status Scale (EDSS), and MRI lesions. Effects on health-related quality of life and fatigue are unclear. Vitamin D₃ at the doses and treatment durations used in the included trials appears to be safe, although available data are limited. Seven ongoing studies will likely provide further evidence that can be included in a future update of this review.

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Thursday, August 15, 2019

MS and Comorbidities

Healthcare news from The Accelerated Cure Project

The majority of people with MS have other diseases to manage.  These other illnesses, called comorbidities, have been shown to impact MS diagnosis, treatment and disease course.  In case you missed it, our July newsletter focuses on the potential impact of comorbidities on people with MS.  Our first article sheds light on which other health conditions are most common in people with MS and how they may affect those living with the disease.




It’s important for people with MS to assemble a healthcare team with the appropriate specialists to manage the many facets of MS and any comorbidities they may have.  Learn more about managing MS and other maladies and some simple strategies to help people with MS achieve the best outcomes and quality of life possible.


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Actress Selma Blair Undergoing Stem Cell Treatment for Multiple Sclerosis (MS)

  • Selma Blair revealed via Instagram that she is undergoing a stem cell treatment called hematopoietic stem cell transplantation (HSCT) to slow down her multiple sclerosis.
  • This experimental treatment uses chemotherapy to reset and rebuild a patient’s immune system.
  • The therapy includes many of the risks and side effects of traditional chemotherapy, including hair loss.
  • In recent phase 2 clinical trials, HSCT showed promise in slowing the progression of relapsing-remitting MS compared to existing disease-modifying drugs.
In a recent Instagram post, actress Selma Blair showed off her newly shaven head and announced she “did HSCT” in an effort to slow down the progression of her multiple sclerosis.
This left many in the MS community wondering about the specifics of this new and relatively unknown treatment for MS.
Hematopoietic stem cell transplantation (HSCT) is a complicated and still experimental therapy that uses mild to stronger forms of chemotherapy to reset a patient’s immune system, erasing the memory of MS.
MS is largely recognized as an autoimmune condition, where the body’s natural defenses become confused and attack healthy tissues in the central nervous system.
HSCT carries many of the side effects associated with traditional chemotherapy, including hair loss, which likely explains Blair’s social media posts.
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