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Friday, September 6, 2019

Social Cognition: Does It Impact MS Symptoms?

SEPTEMBER 6, 2019 - BY ED TOBIAS

Feeling tired, depressed, or anxious? Maybe it has to do with your social cognition. Social cognition involves empathy and recognizing the emotions that are revealed by someone’s facial expression. That expression may show fear or disgust. Or it may warn us of danger.

Social cognition also involves the theory of mind. This has to do with beliefs, and with a person understanding that others may have beliefs and perspectives different from their own. It is considered important for daily social interactions because everyone uses it, subconsciously, to judge and understand the actions and behaviors of other people.

Social cognition and MS

There is evidence that people with MS have a hard time with social cognition. Now, a small study run by the Kessler Foundation has looked at how those social cognition problems might have an impact on some of our MS symptoms. Test subjects who performed poorly on social cognition tasks self-reported that they had worse depression, anxiety, and fatigue than those with better test scores.
But what comes first? Do social cognition problems exacerbate MS symptoms, or do the symptoms create social cognition problems?
“The nature of the relationships among these variables remains unclear,” says Helen Genova, PhD, the study’s lead writer. “We cannot say whether deficits of social cognition worsen mood condition and fatigue, or vice versa. … Poor social cognition may worsen fatigue, depression, and anxiety, leading to greater social isolation. That, in turn, may worsen social cognitive function.”
It seems to me that someone who has a hard time picking up social cues would be someone who is depressed and anxious. If you can’t easily determine the mood of another person, it is hard to make a personal connection with that person. I’d think that would lead to difficult relationships and a very small circle of friends. Genova seems to agree with my assessment.
“All of these conditions adversely affect quality of life,” she says.
So, it looks as if the best we can do is add social cognition to the list of difficulties for those of us with MS. Being aware of that may help us cope.
article source


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My Disabled Wheelchair

AUGUST 30, 2019 - BY JOHN CONNOR

Things had been going well with my electric wheelchair, but now I found myself out of control, heading toward the TV. I put my one good foot down in a feeble attempt to delay what seemed inevitable. Somehow, the foot — or perhaps sheer good luck — saved the TV. I stopped a foot away!
The left armrest of my newish ‘leccy wheelchair had just fallen off, taking the chair controls with it. I was a passenger on a runaway wheelchair! This was excitement I could do without, especially as it was late and a scream would wake the house.
I was only a yard away from my bed, but it might as well have been a mile. There was no way I’d make it. My phone and sticks were also inconveniently out of reach.
As this situation could have been a lot worse, I took a moment to calm myself.
Disabled wheelchair (Photo by John Connor)
Luckily, my trusty wheeled commode looked reachable. Before I’d gone electric, I’d actually used this as my main means of locomotion around the house for a year. I was no longer much good with a self-propelling wheelchair, but by using a stick like an oar and pushing with my left foot, I could actually get somewhere. True, I was better at going backward. Since MS has turned my life around, this seemed somehow apposite.
I managed to transfer without crashing to the floor, so that was a win.
Luckily, the wheelchair is from the NHS and there’s a service company I can call. (I’ve actually written disparagingly about this company in the past.) I sent them a late-night email and followed up with an early-morning call.
Much to my pleasant astonishment, a technician turned up about an hour after my morning call and tightened the nuts that secured both armrests to the base of the wheelchair — they had worked themselves loose. Up to now, I’d actually presumed the exaggerated in-and-out movements were just a nifty design feature. Sure, I could have read the manual in detail, but who actually does that?
The armrests are supposed to be solidly fixed. The tech said he’d seen the same thing in about five new wheelchairs of the model I use, an Invacare Bora/Spectra XTR Series.
It only took him five minutes to fix.
Crisis over? Not quite.
Within a few days, the armrests loosened again. They’re not yet as bad as they were before, but I immediately booked the technician. Since it’s not urgent this time, he’s coming around tomorrow. He did nothing wrong. He’d tightened as fast as he could without breaking the nuts.
It must be a manufacturing flaw.
Somewhat ironically, I seem to have a disabled wheelchair!
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Thursday, September 5, 2019

Assessment and Measurement of Spasticity in MS: State of the Evidence.

Author information

1
Department of Neurology, Oregon Health & Science University, 3303 SW Sam Jackson Park Rd., L226, Portland, OR, 97239, USA. hugosc@ohsu.edu.
2
VA Portland Health Care System, 3710 SW US Veterans Hospital Rd., R&D 27, Portland, OR, 97239, USA. hugosc@ohsu.edu.
3
Department of Neurology, Oregon Health & Science University, 3303 SW Sam Jackson Park Rd., L226, Portland, OR, 97239, USA.
4
VA MS Center of Excellence-West, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd., Portland, OR, 97239, USA.

Abstract

PURPOSE OF REVIEW:

The purpose of this review is to familiarize the reader with assessments and measurement of spasticity in people with multiple sclerosis (MS). Spasticity affects 60-84% of people with MS, worsening as disability worsens and impacting activity, participation, and quality of life. Spasticity manifests in many ways, including spasms, resistance to passive stretch, pain, and perception of tightness, and can affect muscles throughout the body, making assessment and quantification of spasticity challenging but important. Assessment tools include those quantified by clinicians, instrumentation, and patients.

RECENT FINDINGS:

Most tools for measuring spasticity are based on clinician scoring, were developed many years ago, and have undergone minimal recent advances. More recent developments are patient-reported outcome measures for spasticity, including the Numeric Rating Scale for Spasticity (NRS-S) and the disease-specific Multiple Sclerosis Spasticity Scale-88 (MSSS), and, most recently, imaging through elastography. MS-related spasticity is common and often disabling. There are various spasticity measurement tools available, each with advantages and limitations. Newer tools are likely to be developed as our understanding of spasticity in MS grows.

KEYWORDS:

Assessment; Measurement; Multiple sclerosis; Outcomes; Spasticity
Source


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Computational Drug Repurposing Algorithm Targeting TRPA1 Calcium Channel as a Potential Therapeutic Solution for Multiple Sclerosis.

Author information

1
Faculty of Pharmacy, "Carol Davila" University of Medicine and Pharmacy, Traian Vuia 6, 020956 Bucharest, Romania.
2
Faculty of Pharmacy, "Carol Davila" University of Medicine and Pharmacy, Traian Vuia 6, 020956 Bucharest, Romania. george.nitulescu@umfcd.ro.
3
Center for Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstrasse 17, 1090 Vienna, Austria.

Abstract

Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system (CNS) through neurodegeneration and demyelination, leading to physical/cognitive disability and neurological defects. A viable target for treating MS appears to be the Transient Receptor Potential Ankyrin 1 (TRPA1) calcium channel, whose inhibition has been shown to have beneficial effects on neuroglial cells and protect against demyelination. Using computational drug discovery and data mining methods, we performed an in silico screening study combining chemical graph mining, quantitative structure-activity relationship (QSAR) modeling, and molecular docking techniques in a global prediction model in order to identify repurposable drugs as potent TRPA1 antagonists that may serve as potential treatments for MS patients. After screening the DrugBank database with the combined generated algorithm, 903 repurposable structures were selected, with 97 displaying satisfactory inhibition probabilities and pharmacokinetics. Among the top 10 most probable inhibitors of TRPA1 with good blood brain barrier (BBB) permeability, desvenlafaxine, paliperidone, and febuxostat emerged as the most promising repurposable agents for treating MS. Molecular docking studies indicated that desvenlafaxine, paliperidone, and febuxostat are likely to induce allosteric TRPA1 channel inhibition. Future in vitro and in vivo studies are needed to confirm the biological activity of the selected hit molecules.
PMID:
 
31480671
 
DOI:
 
10.3390/pharmaceutics11090446

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Wednesday, September 4, 2019

Aerobic Exercise Helps Multiple Sclerosis—But How and How Fast?

By Rebecca Spain, M.D., MSPH 

Rebecca Spain, M.D., MSPH
It is generally accepted that aerobic exercise is good for cardiovascular health, improving mitochondrial adenosine triphosphate (ATP) production in skeletal muscles, and reducing risks of other chronic diseases. We also know that aerobic exercise improves cognitive function and reduces fatigue—this holds true for people with multiple sclerosis (MS) who often are affected by these consequences of their disease. Less known is how quickly improvements may develop in these functions as a result of participating in aerobic physical activity, nor have the cerebral mechanisms underlying such clinical improvements been identified.

MS is an autoimmune neuro-inflammatory disease of the central nervous system (CNS) that results in demyelination of axons and neurodegeneration. The underlying pathophysiology of MS is complex with inflammatory, oxidative and neurodegenerative pathologies found. MS typically starts as relapsing-remitting cycles with bouts of neurological dysfunction corresponding to CNS inflammation followed by complete or partial recovery of function. A minority of affected individuals have a progressive course from onset. MS symptoms can include weakness, sensory loss, imbalance, incoordination, vision loss, brainstem dysfunction manifesting in double vision and difficulty swallowing, muscle spasticity and neurogenic bladder. “Silent” symptoms of cognitive dysfunction and fatigue can be some of the most disabling.

While the underlying cause of MS is unknown, genetic and environmental risk factors have been identified. Comorbid conditions include obesity, hypertension, diabetes, cardiovascular disease and hyperlipidemia; these risk factors are associated with an accelerated pace of disability accumulation. The “vascular” comorbid conditions can all be prevented or improved by aerobic exercise, suggesting a contribution to disease management that is independent of the immune-mediated therapies most people with MS take. This led us to hypothesize that aerobic exercise may have a unique role in treating MS, and the mechanism may be mediated through improved ATP production.

In our study, as reported in the July 2019 issue of Medicine & Science in Sports & Exercise®, my colleagues and I demonstrated that a high-intensity aerobic exercise program in a mild-to-moderately disabled MS population typically results in rapid cardiovascular improvement and also produced expected benefits of improved V?O2max, peak work, etc. These benefits were achieved despite the subjects’ physical limitations and underlying fatigue. Further, the MS cohort (n=10) also demonstrated significant improvements in cognitive processing speed and reductions in cognitive fatigue compared to a control MS stretching group (n=7). While the exercise training was safe and well-tolerated by the subjects, a re-emergence of exercise-induced syncope served as a reminder that prudence of supervision is essential when initiating a high-intensity exercise program in patients with MS.

We used phosphorous magnetic resonance spectroscopy (31PMRS) to evaluate individual ATP peaks and the rate-constant of phosphocreatine recovery in tibialis anterior muscles. These measures were taken prior to and following the eight-week protocol. As expected, only the aerobic exercisers demonstrated improvements. When using 31PMRS for investigating ATP changes in the brain, only ATP peaks can be detected; we found no pre- to post-intervention changes for this measure in either cohort. However, a cross-sectional comparison of MS and healthy controls did show a significantly higher level of in-the-brain measures for phosphocreatine to inorganic phosphate peak in the MS group. A larger or longer exercise study will help determine if aerobic exercise increases brain ATP levels.

In sum, aerobic exercise benefits people with MS, even if only a brief high-intensity program. Such an intervention can improve cognition, reduce cognitive fatigue and promote cardiovascular benefits. 31PMRS may prove a useful technique to quantitate the benefits of aerobic effects on ATP levels, and this technology may help us design the optimal combination therapies for this complex disease. 


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Genentech to Present Pivotal Data for Satralizumab in Neuromyelitis Optica Spectrum Disorder and Six-year Ocrevus (Ocrelizumab) Data in Multiple Sclerosis at ECTRIMS

Published: Sep 04, 2019

Logo
Sept. 4, 2019 05:00 UTC
  • Investigational medicine satralizumab significantly reduces the risk of relapse in pivotal SAkuraStar monotherapy study for neuromyelitis optica spectrum disorder (NMOSD)
  • New data provide insights into neurofilament light chain (NfL) levels as a potential biomarker for predicting multiple sclerosis (MS) disability progression; new longer-term Ocrevus data of more than six years show reduction of disability progression in relapsing and primary progressive MS
  • Breadth of data reinforce Genentech's commitment to following the science to gain a better understanding of complex nervous system disorders
SOUTH SAN FRANCISCO, Calif.--(BUSINESS WIRE)-- Genentech, a member of the Roche Group (SIX: RO, ROG; OTCQX: RHHBY), announced today that new data across its neuroscience portfolio will be presented at the 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) from September 11-13 in Stockholm. Presentations include complete Phase III results from the SAkuraStar study investigating satralizumab for the treatment of neuromyelitis optica spectrum disorder (NMOSD), and new multiple sclerosis (MS) research, which provides insights into disease progression, including data from Ocrevus®(ocrelizumab) trials that advance understanding of neurofilament light chain (NfL) levels as a potential biomarker for predicting disability outcomes. Additionally, longer-term data of more than six years to be presented continue to show consistent safety and efficacy outcomes for patients treated with Ocrevus earlier.
“Disorders of the nervous system are some of the most complex and difficult to treat, and we have increased our commitment in neuroscience to advance care and scientific understanding for conditions such as multiple sclerosis and neuromyelitis optica spectrum disorder. Data being presented at ECTRIMS include positive Phase III results for satralizumab as a monotherapy, taking a novel approach to treating neuromyelitis optica spectrum disorder, and new insights using biomarkers to identify disease progression in multiple sclerosis,” said Sandra Horning, M.D., chief medical officer and head of Global Product Development. “Similar to our approach with Ocrevus in multiple sclerosis, targeting B cells as a key driver of disease, we aim to offer satralizumab as a highly effective treatment option in neuromyelitis optica spectrum disorder, targeting the interleukin-6 receptor.”
About neuromyelitis optica spectrum disorder (NMOSD)
Complete pivotal data from the SAkuraStar study investigating satralizumab as a subcutaneous monotherapy compared to placebo for the treatment of NMOSD will be presented. The primary and subgroup analyses show that satralizumab significantly reduces the risk of relapse in patients who were seropositive for aquaporin-4 auto-antibodies (AQP4-IgG), as well as the overall intention-to-treat (ITT) population representative of NMOSD patients. Satralizumab also demonstrates a similar safety profile compared to placebo.
NMOSD is a rare, lifelong and debilitating autoimmune disease of the central nervous system commonly misdiagnosed as MS. It is associated with pathogenic AQP4-IgG auto-antibodies that target and damage a specific cell type, called astrocytes, resulting in inflammatory lesions of the optic nerve(s), spinal cord and brain. Through the use of a diagnostic biomarker test, the majority of people with NMOSD are identified as AQP4-IgG seropositive and tend to experience a more severe disease course; however, as many as one-third of those with NMOSD are AQP4-IgG seronegative. At ECTRIMS, two analyses of U.S. healthcare insurance claims databases will be presented that reflect the low utilization of AQP4-IgG diagnostic testing and the subsequent frequency of misdiagnosis of NMOSD patients.
Additionally, two pre-clinical in-vitro models will be presented that show satralizumab reduces the degradation of the blood brain barrier, supporting evidence of its multi-faceted mechanism of action.

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Tuesday, September 3, 2019

Medical Marijuana (Cannabis) FAQs

#MedicalMarijuana


What is cannabis?

Cannabis is a flowering plant with fibrous stalks. The leaves, flowers, and roots are used for medicinal purposes. On the mature plant, the leaves and flowers are covered with trichomes - tiny glands of resinous oil containing cannabinoids and terpenes that, when consumed, can provide physical and psychoactive effects.
 

What is medical cannabis?

Also called “medical marijuana,” medical cannabis is cannabis and cannabinoids (chemical compounds in the plant) that can be medically recommended to treat certain conditions and symptoms, such as nausea and vomiting associated with chemotherapy, and pain that can be associated with numerous conditions.
 

What are cannabinoids?

Cannabinoids are the chemical compounds secreted by cannabis flowers. There are also compounds called terpenes – chemical compounds that give cannabis its unique aroma. The concentrations and combinations of the cannabinoids and terpenes vary from plant to plant and among the different strains of cannabis. When inhaled, consumed as an edible, or used on the skin as a topical preparation, the cannabinoids bind to cannabinoid docking sites or receptors in the human body and alter nerve transmission in the brain.


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Monday, September 2, 2019

Join us (in Columbus, OH) for a Special Roundtable discussion: "MS Conversations NOW" , with Aaron Boster, MD and an MS Patient Advocate

REGISTRATION NOW open for MS event called "MS Conversations NOW"

RSVP for this Special RoundTable discussion with two special people (both quite involved in the MS Community). 

Event taking place in Columbus, OH on Thursday - Dec 5th.. –
Aaron Boster, MD and I (Stuart Schlossman), will compassionately face-off with each other in a new styled round table discussion. 

Listen as they discuss hot MS topics that affect so many, including what patients need to know more, from their neuro teams and what the Neurologists need to learn more, from the MS patient community, during their short office visits so that needs can be met. 

Other hot topics being discussed from the Physician standpoint and the Patient's perspective, include Disease Progression, MRI, MS Relapse, Symptoms, and others topics as showing in the banner seen below.

If you are in the Central Ohio area, we hope you can join us on 12/5 for this dinner event.
 Rsvp here: www.events.msvn.org, for MS Conversations Now.

During this roundtable discussion we will also be asking the audience for their feedback, opinions and questions, with the intent on getting many attendees included into our discussion. 

Yes, Join us for "MS Conversations NOW" in Columbus, on December 5th, 2019.  Click here to view the program Flyer. 
Then RSVP by clicking the link showing on that flyer or simply by clicking here (then scrolling down on page) 





If you plan to attend, and want to be involved in the dialogue, 
send an email to: info@msviewsandnews.org

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Sunday, September 1, 2019

AAN issues guideline on vaccines and MS

source: MS Foundation


August 29, 2019
Can a person with multiple sclerosis get regular vaccines? According to a new guideline, the answer is yes. The guideline, developed by the American Academy of Neurology, recommends that people with MS receive recommended vaccinations, including yearly flu shots. The guideline is endorsed by the Consortium of Multiple Sclerosis Centers.

In addition, the guideline recommends that people with MS should make sure their doctor or care team knows what MS medications they are using before receiving vaccinations. There is some evidence that shows that certain vaccinations may not work as well with certain MS medications. Clinicians should recommend against using live-attenuated vaccines in people with MS receiving ISIM therapies.

The guideline recommends that people experiencing an MS flare consult their doctor before receiving vaccinations. They may want to consider waiting until the flare has passed before receiving vaccinations.

Finally, the guideline states that some vaccines might not work well enough to prevent infection for some people with MS who take certain MS medications. However, it is recommended that people still work with their care team to maintain their regular recommended vaccinations, including the flu shot.

The guideline is published in Neurology, the medical journal of the AAN.
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Infusion Treatments: Benefits and Side Effects


Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system (CNS).
With MS, your immune system mistakenly attacks your nerves and destroys myelin, their protective coating. If left untreated, MS can eventually destroy all of the myelin surrounding your nerves. Then it may start to harm the nerves themselves.
There’s no cure for MS, but there are several types of treatments. In some cases, treatment can slow the pace of MS. Treatment can also help ease symptoms and reduce potential damage done by MS flare-ups. Flare-ups are the periods when you have symptoms.
However, once an attack has started, you may need another type of medication called a disease modifier. Disease modifiers can change how the disease behaves. They can also help slow the progression of MS and reduce flare-ups.
Some disease-modifying therapies come as infused medications. These infusion treatments may be especially helpful to people with aggressive or advanced MS. Read on to learn more about these medications and how they help treat MS.
Q&A: Administering infusion treatments

Q: How are infusion treatments given?

A: These drugs are injected intravenously. This means you receive them through your vein. However, you don’t inject these medications yourself. You can only receive these drugs from a healthcare provider in a healthcare facility.

The Healthline Medical Team

Infusion treatment drugs

Today there are four infusible drugs available to treat MS. However, we are only showing three as the fourth is not used any longer (being a dangerous chemo-therapy drug)

Alemtuzumab (Lemtrada)

Doctors give alemtuzumab (Lemtrada) to people who haven’t responded well to at least two other MS medications.
This drug works by slowly reducing your body’s number of T and B lymphocytes, which are types of white blood cells (WBCs). This action may reduce inflammation and damage to nerve cells.
You receive this drug once per day for five days. Then one year after your first treatment, you receive the drug once per day for three days.

Natalizumab (Tysabri)

Natalizumab (Tysabri) works by stopping the damaging immune cells from entering your brain and spinal cord. You receive this drug once every four weeks.

Ocrelizumab (Ocrevus)

Ocrelizumab is the newest infusion treatment for MS. It was approved by the Food and Drug Administration (FDA) in 2017.
Ocrelizumab is used to treat relapsing or primary progressive forms of MS. In fact, it’s the first drug approved to treat primary progressive MS (PPMS).
This medication is thought to work by targeting the B lymphocytes that are responsible for myelin sheath damage and repair.
It’s initially given in two 300-milligram infusions, separated by two weeks. After that, it’s given in 600-milligram infusions every six months. 
Side effects of the infusion process



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