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Saturday, October 17, 2015

Mental Coaching Can Boost Multiple Sclerosis Patients' Quality of Life

Patients with multiple sclerosis (MS) can use mental visual imaging training to improve well being, according to findings published in Restorative Neurology and Neuroscience.   

Researchers from the University of Strasbourg in France studied 40 MS patients being trained in mental visual imagery programs in order to determine the effects of the program on the patients’ quality of life. Each patient was receiving regular drug therapy and was additionally being evaluated for disease progression throughout the study by clinical examination.   The patients were screened for brain abnormalities using MRI at the beginning of the study to confirm that significant signs of atrophy were acknowledged. 

The patients were coached in mental visual imagery training surrounding two primary focus points: autobiographical memory, the ability to recall personal details from a specific location and time frame, and episodic future thinking, the ability to imagine personal details as they might happen in the future.

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Q&A With Aaron Boster From OhioHealth Neurological Physicians: Videos include: Alemtuzumab and Finding the Right Chili Recipe For Treating Multiple Sclerosis

    |    Adam Hochron - 

With a wide variety of medications available and being developed for patients with multiple sclerosis the choices present different delivery options, dosing varieties, and other options. Alemtuzumab is another in this series of exciting developments in potential patient care. Aaron L. Boster, MD, From OhioHealth Neurological Physicians discussed the treatment and finding the best treatment options available to patients during the annual ECTRIMS conference in Barcelona. - 

Videos were obtained from HCP Live

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Q&A With June Halper From CMSC: Taking Global Lessons To Improve Multiple Sclerosis Care Worldwide And At Home

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Friday, October 16, 2015

Tools for Everyday Life With MS

Information provided by WebMD

Your day can go more smoothly if you take advantage of special tools that make tasks easier. Indoors or out, try these tips that help you get the job done right.

Meal Prep

Even the most seasoned cook can have trouble picking up heavy pots or chopping vegetables. A few kitchen tools make it easier to get your meal ready:
  • Cutting board with suction cups to keep it steady
  • Lightweight pots and pans
  • Forks, knives, and spoons with easy-grip handles
  • Non-slip mats to stop items from sliding on your kitchen counter
  • Stool where you can sit to cook or wash dishes
  • Kitchen fan to keep you cool while you work

Getting Dressed

Try these items that can make the morning rush to get ready go smoother:
  • Buttonhooks and zipper pulls to help you get in and out of your clothes with ease
  • Long-handled shoehorn so you can slide on your shoes without bending over

Washing Up

A few small things can make all the difference when you're at the sink or in the shower:
  • Electric soap dispenser and toothbrush
  • Lighted magnifying glass to improve your view while you shave or put on makeup
  • Long-handled brushes and combs
  • Shower chair if you need to rest while you rinse off

Working or Playing Outside

Stay active outdoors, even on warm days, by trying these:
  • Cooling vest filled with ice packs to beat the summer heat. Also try a cooling wrap that goes around your neck, wrist, or ankles.
  • Long-handled gardening tools so you don't have to bend to plant or weed
  • Wheeled cart to hold your gardening tools

Walking Aids

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Wednesday, October 14, 2015

New Analysis Confirms Brain-Loss Benefits With Teriflunomide (Aubagio)

SIENA shows the drug reduces brain shrinkage in MS over 2 years

BARCELONA -- Although earlier MRI data didn't find slowed brain volume loss with teriflunomide (Aubagio), a different analytical approach identified a beneficial effect on brain atrophy, researchers reported here.

In a post-hoc analysis of MRI data from the phase III TEMSO study, using a technique called structural image evaluation using normalization of atrophy (SIENA), brain volume loss was reduced by about 30% compared with placebo over 2 years (P=0.0001), according to Till Sprenger, MD, PhD, of University Hospital Basel.

Sprenger reported the findings during a late-breaking session at the European Committee for the Treatment and Research in Multiple Sclerosis (ECTRIMS) meeting here.

"Teriflunomide has demonstrated efficacy on annualized relapse rates, disability progression, MRI activity, and now brain volume loss, and so it remains an important once-daily oral treatment for patients with relapsing-remitting MS," Sprenger said during the presentation.

Indeed, the phase III trials TEMSO and TOWER found that teriflunomide significantly reduced the risk of disability progression in patients with relapsing MS, and researchers saw significant dose-dependent effects on brain lesions compared with placebo.


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Monday, October 12, 2015

Single drop of blood in the brain can activate autoimmune response akin to multiple sclerosis

October 12, 2015

A new study from the Gladstone Institutes shows that a single drop of blood in the brain is sufficient to activate an autoimmune response akin to multiple sclerosis (MS). This is the first demonstration that introduction of blood in the healthy brain is sufficient to cause peripheral immune cells to enter the brain, which then go on to cause brain damage.

A break in the blood-brain barrier (BBB) allows blood proteins to leak into the brain and is a key characteristic of MS, a disabling autoimmune disease of the brain and spinal cord. However, it was unclear whether the BBB disruption caused the autoimmune response or resulted from it.
In the current study, published in Nature Communications, the scientists created a new animal model of disease to determine if BBB leakage can cause autoimmunity. They discovered that injecting just one drop of blood into the brain set off the brain's immune response, kick-starting a chain reaction that resulted in inflammation and myelin damage. Myelin is the protective sheath that insulates nerve fibers in the brain, and it is the primary site of injury in MS. What's more, the scientists were able to pinpoint a specific protein in the blood, the blood-clotting factor fibrinogen, as the trigger for the disease-causing process.

"These findings offer a completely new way of thinking about how the immune system attacks the brain--it puts the blood in the driver's seat of the onset and progression of disease," says senior author Katerina Akassoglou, PhD, a senior investigator at the Gladstone Institutes and professor of neurology at the University of California, San Francisco. "This opens up the possibility for new types of therapies that target blood coagulation factors, upstream of autoimmune processes."

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EXCLUSIVE: Top MS Researcher Gives Interview With MS News Today After Presenting New Data on Biogen’s TECFIDERA at #ECTRIMS2015

A top MS researcher for Biogen Idec answered questions in an exclusive interview with Multiple Sclerosis News Today correspondent Dr. Ana de Barros at a Satellite Symposia entitled “MS developments: transitioning evidence into clinical practice” presented by the company this morning at the 31st Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), […]
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Sunday, October 11, 2015

An MS Patient Advocate's Exclusive Interview on Primary Progressive MS ORATORIO trial results with Peter Chin, MD, Principal Medical Director for Genentech-Roche Global Neuroscience Development

Interview on the PPMS ORATORIO Study
By Laura Kolaczkowski—October 11, 2015

The interview begins below all the legalities needed

People with primary progressive multiple sclerosis (PPMS) finally have something to cheer about in a potential disease modifying therapy. Genentech and Roche pharmaceutical companies announced the results of their studies of ocrelizumab in both relapsing remitting MS (RRMS) and PPMS, at the annual conference hosted by the European committee for the treatment and research in MS. (ECTRIMS), held in Barcelona, Spain.

Dr. Peter Chin, Principal Medical Director, for Genentech-Roche Global Neuroscience Development, took time out from the ECTRIMS meetings to discuss these study results with me. To understand the questions, you might first need more background information on ocrelizumab and ORATORIO. Scroll past the background information to get to my exclusive interview with Dr. Chin.

Ocrelizumab is a humanized monoclonal antibody drug, and works by targeting B cells, which may be key to the destruction of the myelin and axonal damage experienced in MS. Ocrelizumab is a cousin of Rituximab, a drug that has quietly been used off-label for hard to treat cases of MS (think PPMS), but not so coincidentally also has a patent expiration date of 2015 (think small profit in generic drugs). Rituximab is commonly used for treating rheumatoid arthritis.

Ocrelizumab was studied in three separate trials named OPERA I, OPERA II, and ORATORIO. The OPERA studies looked at RRMS, and ORATORIO focused on PPMS. The OPERA studies showed positive results and plenty will also be written about them, but we have seen many RRMS drugs come into use over the past five years. We will take a closer look at OPERA results later – for now the spotlight should be on PPMS treatment.
What makes ORATORIO stand out is this is the first drug that has met the desired endpoints in PHASE III clinical trials for PPMS. ORATORIO was a double-blind, randomized study conducted at multiple sites around the world, and the study participants who received the real drug were given 600mg intravenously, in two separate 300mg doses, two weeks apart. There were 732 people in the trial and the study lasted 120 weeks for the subject on either Ocrelizumab or placebo.

The results of this Phase III study showed significant slowing of disease progression through an increase in walking speed, evidence on MRI with fewer lesions, and slowed brain volume loss.

The criteria for the study participants can be found through the clinical trials registry A Study of Ocrelizumab in Patients With Primary Progressive Multiple Sclerosis, but the following is a picture of the study population they used and the outcomes they hoped to meet.

The ORATORIO study was designed with these measures as their benchmarks for success:
“Primary Outcome Measures:
  • Efficacy: Time to onset of sustained disability progression, defined as an increase in Expanded Disability Status Scale (EDSS) score that is sustained for at least 12 weeks [ Time Frame: up to 5.5 years ]
Secondary Outcome Measures:
  • Time to sustained disability progression, defined as an increase in EDSS score that is sustained for at least 24 weeks [ Time Frame: up to 5.5 years ]
  • Change in timed 25-foot walk [ Time Frame: from baseline to Week 120 ]
  • Change in total volume of T2 lesions on magnetic resonance imaging (MRI) scans of the brain [ Time Frame: from baseline to Week 180 ]
  • Safety and tolerability: Incidence of adverse events [ Time Frame: up to 5.5 years ]
Inclusion Criteria:
  • Adult patients, 18-55 years of age
  • Primary Progressive Multiple Sclerosis (according to revised McDonald criteria)
  • Expanded Disability Status Scale (EDSS) 3 to 6.5 points
  • Disease duration from onset of MS symptoms < 15 years if EDSS > 5.0, < 10 years if EDSS >/= 5.0
Sexually active male and female patients of reproductive potential must use two methods of contraception throughout the study treatment phase and for 48 weeks after the last dose.”1

According to the official release from Genentech:
“The ORATORIO study met its primary endpoint, showing treatment with ocrelizumab significantly reduced the risk of progression of clinical disability sustained for at least 12 weeks by 24 percent compared with placebo, as measured by the EDSS (p=0.0321). Additionally, ocrelizumab was superior to placebo in significantly reducing the risk of progression of clinical disability for at least 24 weeks by 25 percent (p=0.0365) and the time required to walk 25 feet (Timed 25-Foot Walk, or T25-FW) over 120 weeks by 29 percent (p=0.0404). Ocrelizumab decreased the volume of hyperintense T2 lesions by 3.4 percent over 120 weeks, compared to placebo which increased T2 volume by 7.4 percent (p<0.0001). Ocrelizumab reduced the rate of whole brain volume loss over 120 weeks by 17.5 percent compared to placebo (p=0.0206).”

Exclusive Interview on Primary Progressive MS ORATORIO trial results

Peter Chin, MD, is Principal Medical Director for Genentech-Roche Global Neuroscience Development, and integral to the design and study of Ocrelizumab in both the OPERA and ORATORIO trials for the use of this drug in treating multiple sclerosis. Dr. Chin has treated people with MS where he learned more about the impact of this disease and its various stages. He took time from the proceedings of the ECTRIMS 2015 Congress to answer my questions.

Q: When will the results of the study ORATORIO be made available through formal papers so we might see all the results of this study?

CLICK HERE to see this answer as well as more questions and answers on the primary topic of this publication

Our thanks to Laura Kolaczkowski for sharing this information

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Latest research on cognitive dysfunction in Multiple Sclerosis patients, an eye opener

In a paper published in Nature Reviews Neurology, researchers at Monash University have revealed that eye movement measures can help identify the presence and progression of Multiple Sclerosis (MS).
MS is a chronic disease of the central nervous system in which the immune system eats away at the protective covering of nerves. Patients experience a broad range of physical and cognitive problems, depending on the location and frequency of repeated immune-related attacks on the system. These can include loss of balance, slurred speech, tremors, problems with memory and concentration, paralysis, and blindness. Unlike the physical problems, which are easily recognised and monitored, the cognitive issues are less clear and changes may go unnoticed.
By following simple visual commands, movement of the eye has been shown to reflect our cognitive or thought processes. 
“Over the past 10 years, our studies have shown that eye movement measures can reveal abnormal cognitive processes in MS patients, at all stages of the disease, even where a diagnosis is only suspected. Further, we have been able to show that the degree of abnormality increases with disease duration,” commented Dr Joanne Fielding from the School of Psychological Sciences at Monash University.
The ability to monitor the various symptoms of the disease is crucial for patient management, specifically for determining whether the disease is progressing or that a particular treatment is stalling disease progression. According to Dr Fielding, the primary advantage of these measures lies in their sensitivity, especially in the earliest stages of the disease, and in their ease of use. 
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Teriflunomide (AUBAGIO) Slows Brain Atrophy in Relapsing Multiple Sclerosis

Oct 9, 2015

BARCELONA — A reanalysis of phase III data on teriflunomide (Aubagio) shows that both doses of the drug result in significant reduction of brain volume loss vs. placebo in patients with relapsing multiple sclerosis (RMS).

Ludwig Kappos, MD, of the University Hospital of Basel in Basel, Switzerland, and fellow researchers presented the data at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress in Barcelona.

For this study, Professor Kappos and colleagues analyzed changes in brain volume from MRI data from the TEMSO study using the SIENA methodology in patients treated with Aubagio 14 mg or 7 mg or placebo. Previously, Aubagio 14 mg was found to significantly reduce the risk of disability progression in patients with RMS.



Tysabri vs. Gilenya: Studies Conflict on Which Is Superior

Is natalizumab better than fingolimod? Flip a coin

BARCELONA -- Results from two European cohort studies provide no clear answers on whether natalizumab (Tysabri) or fingolimod (Gilenya) offers better efficacy, researchers reported here.

One study from France found relapse rates to be lower with natalizumab, while another from Denmark revealed similar relapse rates in both groups. Both were reported during an oral session at the European Committee for Treatment and Research in Multiple Sclerosis meeting here.

Both drugs are approved for relapsing-remitting MS patients. They're two of the spate of treatments for MS that have been approved in recent years, and clinicians and patients would naturally like guidance on whether any are clearly to superior to the others. But few head-to-head comparisons and no randomized controlled comparisons of the safety and efficacy of these drugs have been done.

There have been some observational data, but the findings are mixed. Indeed, two other recent studies -- one by Braune et al. in the Journal of Neurology in 2013 and the other by Kalincik et al. in Annals of Neurology this year -- came to similarly conflicting results. The Braune trial found no difference between the two drugs over one year, while the Kalincik paper found higher relapse rates with fingolimod.


Vitamin D Supplements Improve Cognition in Patients With MS

BARCELONA — Patients with multiple sclerosis (MS) given vitamin D supplements showed improved cognition at 3 months, a new study shows.
The results suggest that patients with MS should get their vitamin D levels checked and, if deficient, take vitamin D supplements, said Hala Darwish, PhD, a neuroscience expert whose research at the American University of Beirut (AUB) focuses, among other things, on cognitive and inflammatory changes associated with aging.
"I'm one of those who believes that MS patients should take supplements," Dr Darwish told Medscape Medical News.
She presented results of the study here at the Congress of the European Committee for Treatment and Research in MS (ECTRIMS) 2015.
Brain Receptors
Vitamin D, which can be obtained through exposure to the sun or fortified foods, plays a role in the pathogenesis of MS, said Dr Darwish. It has been shown to improve physical function and decrease inflammation. Evidence also links vitamin D to cognitive performance in older adults.
That vitamin D affects cognition makes some biological sense, "We know there are vitamin D receptors in the brain" of both animals and humans, said Dr Darwish. "This suggests a function in cognition."
For the study, researchers recruited adult patients with MS from the AUB center who were being treated with interferon β. From blood tests, they determined that 88 patients qualified for inclusion in that they had normal serum 25-hydroxyvitamin D (25[OH]D) levels (>35 μg/mL) or were vitamin D deficient (<25 μg/mL).
Researchers collected demographic data, health history, and information on lifestyle habits. They assessed depression and anxiety using the Arabic-Hopkins Symptoms Checklist.
The low and normal vitamin D groups were similar in terms of marital status, income, and employment level. Dr Darwish noted that both groups were highly educated, with many having at least a college degree.
As for lifestyle, those with low vitamin D engaged in less physical activity than the normal vitamin D group, and they smoked more and drank more alcohol. This low vitamin D group also tended to participate in fewer leisure activities.
Disease duration did not differ between the groups, but there was a significant difference on the Expanded Disability Status Scale (EDSS), with those in the low vitamin D group having a higher mean score (1.6 vs 1.1; P = .04).
This, said Dr Darwish, might explain their differences in physical activity and being less involved in playing online video games.
Cognitive Tests
Study patients were given a battery of cognitive tests, including the Montreal Cognitive Assessment; Symbol Digit Modalities Test (SDMT); Stroop test; and Brief Visuospatial Memory Test Revised (BVMT-R), immediate (10 and 30 seconds), and delayed recall (DR) (20 minutes).
All the cognitive tests were short and altogether took about 45 minutes to complete. In some cases, researchers used the Arabic version of these tests for the first time.
At baseline, the low vitamin D group scored lower on all cognitive tests except the Stroop test. The difference was significant for SDMT and BVMT-DR.
The low vitamin D group was given high doses of vitamin supplements (10,000 IU daily or 50,000 IU per week) for 3 months. The normal vitamin D group received usual care.
Read complete article here


Effect of comorbidity on mortality in multiple sclerosis

Objective: We aimed to compare survival in the multiple sclerosis (MS) population with a matched cohort from the general population, and to evaluate the association of comorbidity with survival in both populations.
Methods: Using population-based administrative data, we identified 5,797 persons with MS and 28,807 controls matched on sex, year of birth, and region. We estimated annual mortality rates. Using Cox proportional hazards regression, we evaluated the association between comorbidity status and mortality, stratifying by birth cohort, and adjusting for sex, socioeconomic status, and region. We compared causes of death between populations.
Results: Median survival from birth in the MS population was 75.9 years vs 83.4 years in the matched population. MS was associated with a 2-fold increased risk of death (adjusted hazard ratio 2.40; 95% confidence interval: 2.24–2.58). Several comorbidities were associated with increased hazard of death in both populations, including diabetes, ischemic heart disease, depression, anxiety, and chronic lung disease. The magnitude of the associations of mortality with chronic lung disease, diabetes, hypertension, and ischemic heart disease was lower in the MS population than the matched population. The most common causes of death in the MS population were diseases of the nervous system and diseases of the circulatory system. Mortality rates due to infectious diseases and diseases of the respiratory system were higher in the MS population.
Conclusion: In the MS population, survival remained shorter than expected. Within the MS population, comorbidity was associated with increased mortality risk. However, comorbidity did not preferentially increase mortality risk in the MS population as compared with controls.
READ complete article found here





Multiple Sclerosis B Cell and T Cell Image

B and T cells have a significant role in MS pathogenesis and are key drivers of disease activity.

Learn More


Tried-and-True Antibiotic May Block Conversion to MS

Minocycline seemed to reduce progression to multiple sclerosis after first demyelinating event

BARCELONA -- After a first demyelinating event, a broad-spectrum tetracycline antibiotic may prevent conversion to multiple sclerosis (MS), researchers reported here.

In a phase III multicenter Canadian study, patients randomized to minocycline had a significant 44.6% relative risk reduction in progressing to MS over 6 months, reported Luanne Metz, MD, of the University of Calgary, at the European Committee for the Treatment and Research in Multiple Sclerosis meeting.

"We feel that this should be considered a treatment for MS," Metz said. "If you treat people with a simple prescription, you don't need to do complex paperwork or get insurance going. It's a well tolerated drug that requires no safety monitoring whatsoever."

She said she believes a typical regimen of the drug would cost $500 to $600 annually in Canada (about $387 to $460 U.S).

Current therapies work better if they're given to patients soon after their first clinical demyelinating event. However, insurance coverage for therapies varies by country and region, which may result in treatment delays until patients have a second clinical attack.

In addition, currently available oral therapies may not be ideal because of safety concerns.

Minocycline is an oral antibiotic with a recognized safety profile, widely available, and can be obtained in a lower-cost generic formulation, Metz said. It has many immune-modulating properties, including blocking the transmigration of leukocytes and reducing the activity of activated microglia, she noted.


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'Every Day We Are So Grateful That We Are Not in This Race'

Ann Romney, wife of former Republican presidential candidate Mitt Romney, speaks at a rally in St. Augustine, Florida in October 2012. In her new book, Romney bares her soul about her struggles with multiple sclerosis.BRIAN BLANCO/REUTERS

“If she can do it, I can do it.” To 27-year-old Grafton Pritchartt, Ann Romney is an inspiration.
Like Romney, Pritchartt was diagnosed with multiple sclerosis (MS), a relatively unexplained neurological condition in which the immune system attacks healthy nerve-cell coverings. She got the news last November, when she was 26. Her form of the disease, like Romney’s, is currently in remission.

“You think, ‘She was diagnosed, she had a family, she was supporting a husband with huge aspirations, she traveled the nation doing a campaign,’” Pritchartt, deputy director of a political action committee in Washington, D.C., said.
This week, she got to meet Romney in Arlington, Virginia, at a book signing for In This Together, a book Romney says is intended for those who are suffering.
In This Together marks Romney’s third foray into publishing. She previously released Whatever You Want to Be, a book of advice for young men and women, and The Romney Family Table, an anecdote-filled cookbook.
Those works don't take readers deep into the “very dark, very lonely” days right before and directly after Romney’s MS diagnosis, nor her decades of work to stay healthy and raise money for a disease that threatened her ability to get out of bed in the morning.
“I wanted the book to be as honest as I could make it so that [readers] would be able to understand how difficult this is to go through,” Romney says, referring to her 1998 diagnosis. “And so I intentionally, you know, bared my soul a little bit.”
Bare her soul she did: The book covers everything from the moment directly after his wife’s diagnosis that a devastated Mitt Romney asked doctors how the pair might remain intimate to the angst caused by a Christmas season with her children and grandchildren that Ann—who describes forgoing a career to be the ultimate stay-at-home mom—essentially had to skip out on due to exhaustion.
“[I want people to know] it’s OK to go through those feelings. It’s OK to feel the despair and the discouragement,” she says. “But then you have to realize that we are all in this together, and there is hope.”
Continue reading from Newsweek