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Saturday, May 3, 2008

Vitamin D Impoverished Society

Leading Researchers Describe Consequences Of Vitamin D Impoverished Society

This month's online Vitamin D Council newsletter reports on the recent vitamin D symposium held in San Diego, where four leading researchers described a vitamin D impoverished American population, even in sunny areas, that suffers with excessive rates of cancer, bone problems, type-1 diabetes, multiple sclerosis, heart disease, hypertension, influenza, falls in the elderly, mental illness, and a number of other serious and potentially avoidable disorders.

(PRWEB) May 3, 2008 -- This month's online Vitamin D Council newsletter reports on the recent vitamin D symposium held in San Diego, where four leading researchers described a vitamin D impoverished American population, even in sunny areas, that suffers with excessive rates of cancer, bone problems, type-1 diabetes, multiple sclerosis, heart disease, hypertension, influenza, falls in the elderly, mental illness, and a number of other serious and potentially avoidable disorders.

The conference was sponsored by Grassroots Health (www.grassrootshealth.org), a new organization dedicated to ending the epidemic of vitamin D deficiency. The San Diego Black Nurses Association helped organize the conference, which is appropiate as death and disability from vitamin D deficiency is much higher in the black community than among whites.

Cancer data dominated the symposium because the relationship between cancer and a lack of vitamin D is striking. Apparently 30 years of scientific evidence hasn't been enough to convince health authorities that vitamin D from sunshine or dietary supplements prevents cancer. In this month's online newsletter, Dr. John Cannell, founder of The Vitamin D Council, reports on three-decades old research published by Professor Cedric Garland, University of California at San Diego epidemiologist, evidence that has gone unheeded by modern medicine.

At the seminar, Professor Robert Heaney of Creighton University attempted to field questions as to how the National Academy of Sciences established a "safe upper limit" for vitamin D by saying toxicologists dominated that decision and solely described sunlight and its hormone-like vitamin D as potentially toxic, setting the upper safe limit in foods and supplements that is equivalent to just a few minutes of summer sun. Researchers at the seminar pointed out that many people, especially African Americans, will need to take more than 2,000 IU per day, the government's upper limit, just to obtain adequate levels.

The Vitamin D Council online newsletter and website were launched five years ago to dispel many of the myths and misinformation surrounding this sunshine vitamin. To learn more visit: Vitamin D Council Newsletters (www.vitamindcouncil.org/releases.shtml).

Friday, May 2, 2008

Foot Drop

A condition of weakness in the muscles of the foot and ankle, caused by poor nerve conduction, which interferes with a person’s ability to flex the ankle and walk with a normal heel-toe pattern. The toes touch the ground before the heel, causing the person to trip or lose balance.


Thursday, May 1, 2008

MS Lifelines - Wednesdays Webevents

Webevent Wednesdays - Register Today!

Wed, May 28 - (8 PM ET)
Hit the Books! Understanding the Research Behind MS

Did you miss a previous webevent? Want to get up-to-speed?

Visit the recently updated Webevent Archives page to access archived webevents.

Wednesday, April 30, 2008


MSFocus is available on the MSF website.
This online version provides international access to the informative articles on traditional and complementary medicine, clinical trials, symptom management, quality of life issues, and much more. Many of these articles are written by renowned professionals in the MS community. Others are written by individuals with MS.

The online version of MSFocus provides an alternative to the audio version for those who are visually impaired because they can zoom in on the pages. All websites and email addresses in the magazine are hyperlinks.

Don't worry - the print edition will not change. MSFocus will continue to arrive quarterly in mailboxes across the country.

>> Click Here << To access the online version of MSFocus



MSF Newsletter - April 30th, 2008

Detailed studies of mortality in MS are limited. Studying death certificates in people known to have MS is of value in establishing mortality data and can also provide important information on the accuracy and utility of death certificates for epidemiological studies.

In 1985, a population-based survey performed in South Wales identified 441 people with MS. The Office of Population Censuses and Surveys flagged cases and death certificates were collected for more than 20 years.

Median observed survival time was 38 years from symptom onset. Mean age at death for women was 65.3 and 65.2 for men. Mean age at death from MS- related causes was 62.5. It stood at 69.3 years for unrelated deaths. Those dying of MS-related causes had a younger age at disease onset (32.5) compared to those dying of unrelated causes (36.8 years). The cause of death was related to MS in 57.9% of cases and unrelated in 42.1% of cases. In 27% of those diagnosed with MS, "MS" was absent from the death certificate. The most common cause of death was respiratory disease (47.5%).

These results confirm that identifying a continuing trend based on information derived from death certificates will underestimate disease prevalence. Differences were identified between those dying from MS related causes and those dying from other causes.

"There are potential problems with this data," states Ben Thrower, M.D. "It's from 1985, a time when there were no available therapies for slowing the progression of MS. At that time, people were still arguing about whether Devic's disease was just a variant of MS or a different condition. I suspect that some Devic's cases got labeled as MS. Devic's can be aggressive and shorten life expectancy. It may also be possible that people with progressive disease are treated differently in a nationalized healthcare system as is utilized in Great Britain."


Merck Serono and ZymoGenetics Initiate Atacicept Phase 2 Clinical Trial in Relapsing Multiple Sclerosis


ZymoGenetics, Inc. (NASDAQ:ZGEN), today announced that its development partner Merck Serono, a division of Merck KGaA, Darmstadt, Germany, has initiated a Phase 2 clinical trial to evaluate the safety and efficacy of atacicept in patients with relapsing multiple sclerosis (RMS).

"Patients with multiple sclerosis need more treatment options," said Nicole Onetto, M.D., Senior Vice President and Chief Medical Officer of ZymoGenetics. "Our preclinical models have shown biological activity of atacicept in multiple sclerosis and, because of the growing body of supporting data in the literature indicating the importance of B cells and antibodies in the pathology of multiple sclerosis, we believe there is strong rationale for the clinical testing of atacicept in patients with RMS."

The four-arm randomized, double blind, placebo controlled, multicenter study will evaluate the safety and efficacy of atacicept in patients with RMS over 36 weeks of treatment. The primary objective of the study is to evaluate the efficacy of atacicept in reducing central nervous system inflammation in subjects with RMS as assessed by frequent MRI measures.

Approximately 300 RMS patients meeting the eligibility criteria will be randomly assigned to receive one of three subcutaneous doses of atacicept or placebo for 36 weeks. Patients will have follow-up visits at 48 weeks.

About Atacicept

Merck Serono and ZymoGenetics are developing atacicept (formerly referred to as TACI-Ig) as a potential treatment of autoimmune diseases, such as systemic lupus erythematosus (SLE), lupus nephritis (LN), rheumatoid arthritis and multiple sclerosis, as well as B-cell malignancies.

Atacicept contains the soluble TACI receptor that binds to the cytokines BLyS and APRIL. These cytokines are members of the tumor necrosis factor family that promote B-cell survival and autoantibody production associated with certain autoimmune diseases such as systemic lupus erythematosus. Current data indicates that levels of BLyS and APRIL are elevated in patients with rheumatoid arthritis, lupus erythematosus, B-cell malignancies and multiple sclerosis. Atacicept has been shown to affect several stages of B-cell development and may inhibit the survival of cells responsible for making antibodies.

About ZymoGenetics

ZymoGenetics creates novel protein drugs with the potential to significantly help patients fight their diseases. The Company is developing a diverse pipeline of product candidates that are moving into and through clinical development. These candidates span a wide array of clinical opportunities that include bleeding, autoimmune diseases and cancer. ZymoGenetics intends to commercialize these product candidates through internal development, collaborations with partners, and out-licensing of patents from its extensive patent portfolio. For further information, visit www.zymogenetics.com.

This press release contains "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995. These forward-looking statements are based on the current intent and expectations of the management of ZymoGenetics. These statements are not guarantees of future performance and involve risks and uncertainties that are difficult to predict. ZymoGenetics' actual results and the timing and outcome of events may differ materially from those expressed in, or implied by, the forward-looking statements because of risks associated with our unproven discovery strategy, preclinical and clinical development, regulatory oversight, intellectual property claims and litigation and other risks detailed in the company's public filings with the Securities and Exchange Commission, including the company's Annual Report on Form 10-K for the year ended December 31, 2007. Except as required by law, ZymoGenetics undertakes no obligation to update any forward-looking or other statements in this press release, whether as a result of new information, future events or otherwise.

ZymoGenetics, Inc. Investor and Media Relations: Susan W. Specht, MBA Director, Corporate Communications 206-442-6592

NEWS FROM THE American Association of Neurology ANNUAL MEETING

April 30th, 2008 - Rec'd from the MSF newsletter:

The American Academy of Neurology met in Chicago April 12 through April 19 for its 60th Annual Meeting. The following two news briefs were among the information presented.

There have been no further cases of progressive multifocal leukoencephalopathy (PML) linked to Tysabri since its re-launch, Biogen Idec and Elan Corporation announced.

The companies also said clinical trials showed relapses and disability progression were significantly less likely in people taking the disease-modifying drug than in those taking placebo.

As of March, about 15,300 people in the U.S. were on the therapy, which also is now being used to treat Crohn's Disease. About 3,600 people have been on Tysabri for 18 months or longer.

Dr. Ben Thrower, medical advisor to the Multiple Sclerosis Foundation, said the updated safety information is helpful, and to a certain degree reassuring, but doesn't answer all the safety questions about Tysabri.

Previous cases of PML were seen at 18 months in people who were taking Tysabri/Avonex combination therapy. It is important to look at those who have been on the drug for that amount of time or longer, Thrower said. It is possible PML could be associated with Tysabri as a monotherapy but that it takes longer to show itself.

"Tysabri is an important drug to have in our toolbox of options," he said. "But I'm not comfortable with the idea that it is significantly more effective than other available disease-modifying drugs."

Rebif, Betaseron and Copaxone all did well during recent clinic trials, he added.

"The importance of Tysabri may not be that it is better than Avonex, Betaseron, Copaxone and Rebif, but that it is different in how it works," he said.

In the United States, Tysabri is only available at approved infusion sites to patients enrolled in the Touch Prescribing Program.

Researchers reported good results in clinical trials of the oral medication fingolimod, saying more than 67 percent of participants who took the drug for three years were relapse-free.

Of the 173 people who stayed with the trial for three years, 67 percent hadn't had a relapse at the end of the three-year period, according to a study supported by Novartis, which makes fingolimod. MRI scans showed 89 percent of the participants showed no disease activity; 75 percent of those in the clinical trial showed no new or newly enlarged lesions, according to the trial's reported results.

The drug for relapsing-remitting MS is taken once a day. Side effects seen in the trial included headache, fatigue, flu and cold symptoms.

Fingolimod, also called FTY720, is an immune-modulating drug. It binds to immune cells and keeps them in the lymph nodes.

A third phase of study on the drug is ongoing and expected to be completed in July 2009.


Vertigo in Multiple Sclerosis and how it affects me

Provided By Stuart Schlossman:

Finally, my recent flying adventure with vertigo is subsiding. Not yet fully gone as
it attacked me again just this morning.
Feeling the need for others to know more about this often disabling symptom,
continue reading to learn how I and others often get, when the Vertigo "Trip" flares it's nostrils...

Vertigo in Multiple Sclerosis - found in about.com

Vertigo is a fairly common symptom, of multiple sclerosis (MS) occurring in about 20% of people with MS at some point. It is an acute, uncomfortable sensation, making those of us who are already a little unsteady feel even more nervous about moving around. Fortunately, it is not a permanent symptom, and may not even indicate a new lesion or inflammation, as vertigo can have non-MS causes.

What Does It Feel Like?

Vertigo is a sensation of spinning, whether it feels like you are spinning or your surroundings are rotating. Think back to when you were a child and spun around and around, then stopped -– that’s pretty much the sensation of vertigo. It can feel like:

  • The ground is suddenly rushing upwards
  • The room (or surroundings) is moving continuously
  • The room only seems to rotate part of the way, return to normal, and rotate partway again

It rarely persists for a long time, but can take weeks to go away, which it does gradually.

What Causes It?

Vertigo can be caused by lesions in the cerebellum.

It can also be a result of damage to the nerves that control the vestibular functions of the ear (acoustic cranial nerve, CN VIII) in the brain stem.

However, it appears that a very common cause in people with MS is something called benign paroxysmal positioning vertigo (BPPV), rather than demyelination. This means that, just because you have MS, doesn't necessarily mean that the vertigo is a direct result of the MS disease process.

Vertigo can also be made worse by some of the drugs prescribed for MS symptoms, such as tricyclic antidepressants (such as Elavil) for neuropathic pain or Baclofen for spasticity, as these drugs can cause dizziness.

Lastly, vertigo can be caused by infections, such as the flu.

How Severe Can It Get?

It can be a very powerful feeling of movement and can cause nausea or vomiting. At its worst, it can cause difficulty standing or walking and even lead to falls.

Additional Points/Information

See an Otolaryngologist: This is a fancy name for an ear, nose and throat specialist (ENT). Otoneurologists or a neurotologists are specialists in both matters of the inner ear and neurology. I would highly recommend seeing one of these specialists to investigate the causes of any MS-related vertigo. This is important, because some causes of vertigo (such as BPPV) can be treated without medications, and you can prevent unnecessary MRI scans and drugs with side effects like fatigue.

My Experience

Every other year before my MS diagnosis, for about 10 years, I would have very severe attacks of vertigo. Since it seemed to happen most often in the late winter or spring months, it was declared by doctors to be a symptom of sinusitis caused by mild respiratory infections or allergies. The docs prescribed intranasal steroids (Flonase), which I used religiously until the vertigo eventually subsided a couple of weeks later. I never had any other symptoms of sinusitis, so I have to wonder if this was an MS symptom.


Carol Turkington and Kay D. Hooper. The A to Z of Multiple Sclerosis. New York: Checkmark Books. 2005.

Randall T. Schapiro. Managing the Symptoms of Multiple Sclerosis (5th Ed.). New York: Demos Publishing. 2007.

Updated: March 16, 2008


Severe Facial Pain as a Symptom of Multiple Sclerosis

From Julie Stachowiak, Ph.D., Contributor to: ms.about.com

Trigeminal Neuralgia or Tic Doloreux and MS

Trigeminal neuralgia has to be one of the worst symptoms that people with multiple sclerosis (MS) experience. A couple of readers have written to me about this symptom and said that there were no words to describe the intensity of their pain. It is one of the types of pain described as “neurogenic pain” or “primary pain,” meaning it is the direct result of the disease process of multiple sclerosis, caused by demyelination and lesions on specific nerves.

What Does It Feel Like?

Trigeminal neuralgia, often called tic doloureux (French for “painful twitch”), is perhaps the most intensely painful MS-related symptom. It can be described most commonly as:
  • occurring in the lower part of the face (often triggered by chewing, drinking or brushing one’s teeth)
  • intense, sharp pain
  • like an electrical jolt
  • usually the most intense pain is short-lived (from a few seconds to up to two minutes), but can result in a more constant burning or aching

However, it should be noted that it can also have the following characteristics:

  • extending as far as the ear, and often mistaken for the pain of an ear infection
  • can be triggered by loud sounds

How Common Is It?

Trigeminal neuralgia is fairly rare, with only 4% of people with MS experiencing this kind of pain. However, people with MS are 400 times more likely than the general population to have an episode of trigeminal neuralgia.

What Causes It?

Trigeminal neuralgia pain can be brought on by chewing or touch. It is caused by lesions on the trigeminal nerve (the fifth cranial nerve), which is the nerve responsible for most facial sensation.

How Severe Can It Get?

Trigeminal neuralgia can get so severe and so distressing that it can require hospitalization and intravenous painkillers. It can interfere with a person’s intake of food and fluids and require that these also be supplemented intravenously. Some people may require surgery for this symptom. However, it is rare that it ever gets this severe.

Due to the intensity of this symptom, anxiety and fear about the possibility of it recurring can cause unnecessary suffering and interfere with daily life, even when the symptom is not present.

Additional Points/Information

Tends To Be Episodic: Each “bout” with trigeminal neuralgia usually lasts a couple of weeks. However, this symptom tends to recur and can happen as often as every couple of months. Some people will go years between episodes of this symptom. Unfortunately, as time passes, time between episodes gets shorter.

Hold Off On the Root Canals: Given the location and nature of the pain associated with trigeminal neuralgia, it is often mistaken for dental pain. This could lead to unnecessary (and irreversible) procedures like tooth extractions, root canals and even procedures to reposition the jaw. Make sure that you see your neurologist if you are experiencing this kind of pain, especially before undergoing any kind of drastic dental work.

Appears Early: Trigeminal neuralgia tends to be one of the first symptoms of multiple sclerosis for those who experience it.


Turkington, C. and Hooper, K. The A to Z of Multiple Sclerosis. Entry on “trigeminal neuralgia.” New York: Checkmark Books, 2005.

Updated: April 30, 2008


Tuesday, April 29, 2008

More work is needed to bridge gaps in care for MS sufferers in Scotland - where there is the highest rate of MS, in the world

Consistency needed in providing support across Lothians, says Marl Hazelwood.

THE focus of this year's Multiple Sclerosis (MS) Week which finished at the weekend was the physical, financial and emotional cost of the condition and what the MS Society Scotland can do to "put the pieces together" to help people with these costs.

MS is the most common disabling neurological condition among young adults in Scotland, affecting some 10,500 people.

This means that Scotland has the highest rate of MS in the world. MS is a disease of the central nervous system. There is no cure, but treatments and specialists can help manage many symptoms well.

It is estimated that more than 1500 people across Edinburgh and the Lothians have MS, meaning that thousands more family and friends are affected.

The MS Society Scotland campaigns for better services for people affected by MS, and services in the area have undoubtedly got better in recent years. There are now two MS specialist nurses and a specialist physiotherapist at NHS Lothian who provide excellent care and support, while access to neurologists has also improved.

But social care provision remains inconsistent, with people affected by MS sometimes having to fight for what they need. Social care covers a wide range of services such as aids and adaptations to the home, personal care, respite and residential care. It is a vital element in supporting people with MS to live as independently as possible.

Respite care allows both the person with MS and their carer an essential break. Leuchie House, the MS Society's respite care centre at North Berwick, is well used by local people, with around 50 people staying there each year. It relies on the generosity of the public to provide highly specialised short breaks. Last year the society also awarded more than £40,000 of grant support to people in the Lothians to support them with essentials such as purchasing equipment, making home adaptations or accessing respite breaks. These awards very often "top-up" local authority or other public funding.

This highlights where gaps remain in the services and support that are available to people with MS in the Lothians.

For example, the financial support for respite care that the four local authorities provide varies considerably from person to person. The experience of people before and after diagnosis can also still vary considerably in different areas, often according to how much a GP or other primary care professionals knows about the condition. That is one of the reasons why the MS Society offers training to health and social care professionals.

The services available for people affected by MS locally have certainly come a long way over the last few years. But there is much more that can be done and the MS Society will be at the forefront of working for the necessary changes.

Marl Hazelwood is director of MS Society Scotland.

Monday, April 28, 2008

Neuroscience researcher working toward a cure for MS

Univ of Connecticut "Advance"

by Chris DeFrancesco - April 28, 2008

If finding a way to restore nerve cells’ protective coating were the only challenge, multiple sclerosis would be a more manageable disease.

But researchers at the UConn Health Center say MS also takes it toll on axons, the nerve cell extensions that carry nerve impulses.

The devastation hinders the ability of neurons to communicate with each other, resulting in debilitating neurodegenerative disease.

“The long-term disability of MS is caused by degeneration of axons that have lost their myelin sheath – their protective coating,” says Rashmi Bansal, an associate professor of neuroscience.

Bansal recently won a grant from the National Multiple Sclerosis Society for her research focusing on a specific protein and its role in MS.

In MS patients and mouse models, this protein, called fibroblast growth factor, increases in areas of the nervous system where the myelin is missing.

“There’s got to be an important connection of this observation with the disease scenario,” Bansal says.

Signals from these growth factors regulate the biology of cells called oligodendrocytes, which produce myelin in the central nervous system.

Fibroblast growth factors bind and signal to oligodendrocytes through three different receptors, which are the docking sites for these growth factors. Bansal’s previous research found this interaction varied depending on the receptor involved.

“Stimulation of one receptor versus the other led to different responses,” Bansal says. “And interestingly, we found that in oligodendrocytes, while one response was positive, the other was a negative pathological one.

So that raises the question of what the fibroblast growth factor is doing. Is it good or bad to have a lot of it in MS lesions?”

Bansal’s grant, more than $600,000 over three years, is for the next step. She and her research team, including postdoctoral fellow Miki Furusho, are working with mice that are missing the gene for one or more of the fibroblast growth factor receptors.

“We want to know, what’s the outcome of getting rid of this gene? It would give us a handle on what each receptor is doing for normal myelination in the animal,” Bansal says.

“But what would be really interesting and important for MS research will be to know the function of these receptors in myelin disease and recovery.”

Bansal says initial studies with these mice have given indications of defects in oligodendrocyte development and myelination, “but how it’s going to play out in the disease scenario, we don’t know yet. In this grant we have proposed experiments that will allow us to address these questions.”

In addition to her own research projects, Bansal is committed to carrying on the work of professor of neuroscience Steven Pfeiffer, a colleague who died last year.

During his 38 years at the Health Center, Pfeiffer developed an international reputation as a biomedical scientist working toward a cure for MS.

“He and I worked together on various aspects of MS research ever since I joined the University,” Bansal says.

Bansal says MS research at UConn is embracing modern scientific advances such as proteomic analysis, an approach aimed at discovering new proteins.

Bansal and her team, including postdoctoral fellow Akahiro Ishii, will continue the pursuit of the proteins in human myelin, which was a major focus of Pfeiffer’s research.

“Myelin composition is well known to have some major proteins,” Bansal says.

“This proteomic analysis allows us to determine the minor components – and minor doesn’t mean unimportant: the smallest components could be the ones that are the most important. This study will provide us with several novel targets to go after and will form a valuable foundation for understanding the molecular mechanism of myelination and the pathogenesis of human myelin disease such as MS.”

The MS Society also awarded Bansal two other grants since 1999, and she has won funding from the National Institutes of Health over that same period.

“Our goal – like many researchers – is that somehow in our lifetime we’ll be able to see our research from the bench get into the clinics and help the people with multiple sclerosis,” Bansal says.

“That’s the main ambition and dream for us.”

Accessible Travel info

The info found below was provided by my mother for me, and each of you:

Click here: Welcome to Access-Able Travel Source

Click here: Disabled Travelers.com - Resource for accessible and disability travel information

I hope that you benefit from the info found in the links found above.

Keeping you entertained with Laughter -

Funniest DUI Video


A Great MS Medication --- "LAUGHTER"

Remembering that Laughter is Great Medicine, here is an oldie that many of you will remember the faces..

From an old version of the Johnny Carson Show.

See what Dean Martin is doing, towards the end of this hilarious video

I hope you enjoyed this form of medicine

Sunday, April 27, 2008

Back from my New England excursion..

I am back from my trip to New England.
Able to have a great time due to a new appendage, a CANE...
Yes, me with a cane.. Un-believable!
My wife bought it for me just one day before we left on our excursion. She wanting me to be able to feel more comfortable and balanced.
How cool it was while in the casino, that people gave up a seat fro me when they saw me approaching a card table with cane-in-hand. Or allowing me to get thru lines more swiftly while awaiting the buffet or while at tourist attractions.
Okay - yes, I would like to not have the need for a cane, but for now, while I do, than I guess that using it and enjoying life, is better than not using it and having to remain home!!
New topics will soon be posted again to this site.
I hope all are doing okay and remembering to take your medications...



Using Visualization to Reduce Stress When Injecting

In the Spotlight - from about.com

Using Visualization to Reduce Stress When Injecting
I'm bringing you another tip that may be helpful to get past some of the hurdles and just unpleasant moments connected with injecting yourself with one of the disease-modifying therapies for multiple sclerosis (MS).

Visualization is a technique that is used by professional athletes, fighter pilots and award-winning actors to achieve success at their craft. It is also used by many people as a stress management technique in the form of guided imagery, whereby people are taught to imagine a relaxing place or situation and pull this up whenever they are overwhelmed or experiencing stress.

Visualization can be used very effectively to help you give yourself injections with minimal stress. It uses the natural learning processes of the brain to rehearse situations before they happen in order to perform them better in the future.

Read the full article: Using Visualization To Reduce Stress When Injecting

Contribution of relapses to disability in multiple sclerosis

2008 Feb;255(2):280-7. Epub 2008 Jan 23.

Helen Durham Neuro-inflammatory Centre, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff, UK. Clairehirst_uk@yahoo.co.uk

The impact of relapses on long-term disability in multiple sclerosis remains unclear; however some evidence suggests that relapses play an important role in determining subsequent prognosis. We report on outcome, prognostic factors for recovery and the contribution of relapses to the accumulation of fixed disability in a large series of patients with documented relapses. Two hundred and seventy-nine relapses in 182 patients were assessed before, during and after relapse by expanded disability status scale and data analysed to assess degree of recovery. Factors affecting outcome were considered including sex, age and site of relapse.

Mean EDSS prior to relapse was 3.73, during relapse 5.18 and post relapse 4.23. Mean interval to post relapse assessment was 127 days post relapse. Mean residual change in EDSS score (pre to post relapse) was 0.50 points. Overall 49.4 % of patients had a residual increase in disability post relapse of at least 0.5 EDSS points and 32.7 % had an increase of at least 1 point. No significant difference was observed in mean residual EDSS for sex, site of relapse or age at relapse or in the proportion of patients with a residual increase in disability of > or = 1 EDSS point post relapse. 14.4 % of patients had no increase in EDSS score during relapse compared to pre relapse.

These results suggest that acute relapses are commonly associated with an objective worsening of disability in the majority of patients with MS and that recovery is incomplete in approximately half and not influenced by gender, age or site of lesion. Therapies which reduce relapse frequency and/or severity might therefore be expected to slow or prevent worsening of disability if initiated prior to the onset of more permanent damage.