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Saturday, February 27, 2016

Stem Cell Transplant in Multiple Sclerosis: Next Steps

Caroline Helwick
February 26, 2016

NEW ORLEANS — Could stem cell transplant emerge as a reliable treatment for both relapsing and progressive forms of multiple sclerosis (MS)? Experts believe so, and they hope to prove it in clinical trials.
Andrew Goodman, MD, professor of neurology and director of the Multiple Sclerosis Center at the University of Rochester Medical Center in New York, led a discussion on the topic of stem cell transplant in MS at Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2016.
He began his presentation with a headline from The Economist(January 23, 2016): "Curing Multiple Sclerosis: Stem Cells Are Starting to Prove Their Value as Medical Treatments."
"Be aware," he said, "that this is a topic that is much in the public's mind."
The article focused on hematopoietic stem cell transplantation (HSCT), which, as he explained, is more about the reconstitution of the immune system after immunoablation than it is about the stem cells themselves. While the therapeutic element of HSCT is not actually the stem cells, "in the public's mind, that's stem cell therapy," he commented.
Other more "biologically correct" cell-based strategies are being evaluated in progressive MS, he said.
Desperate Patients
Patients with MS routinely ask about stem cell transplant, and many are hoodwinked by centers making outrageous claims, several experts noted during the session.
"Many patients come to me saying they have 'been approved' for a transplant and ask if they should go. I say, 'Approved to give them $20,000?' These are clinics with very slick websites claiming to cure everything," said Michael K. Racke, MD, professor of neurology and neuroscience at Wexner Medical Center at The Ohio State University in Columbus.
Benjamin Segal, MD, the Holtom-Garrett Professor of Neurology and director of the Multiple Sclerosis Center at the University of Michigan Medical School, Ann Arbor, added in an interview with Medscape Medical News, "Every time I'm in clinic I am asked about stem cells. There are private companies out there that exploit desperate people."
"One of my patients with progressive MS went to Germany to get some type of intrathecal embryonic stem cell injection," Dr Segal said. "A few months later, her husband informed me that she developed meningitis as a complication, and she died."
Dr Racke, Dr Segal, and other MS experts at the meeting voiced optimism, though, that research is moving in the right direction, and that stem cell transplant will some day become a treatment that professionals can embrace.
General Issues Yet to Be Settled

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Friday, February 26, 2016

Multiple Sclerosis and Depression

Many people with MS also have depression. In fact, about half of all people with multiple sclerosis will need treatment for the condition at some point.
If you have MS and you've also felt sad for a while, you don’t have to handle it alone. Talk to your doctor about how you’re feeling, and see if there are any treatments that can help you.

What’s the Link?

Anyone dealing with too much stress or a tough situation might havedepression. It’s easy to understand how MS, which takes a toll on physical health and may cause lasting problems, can bring on the mood disorder.
MS might also cause depression. The disease may destroy the protective coating around nerves that helps the brain send signals that affect mood.
Depression is also a side effect of some the drugs that treat multiple sclerosis, such as steroids or interferon.

What Are the Symptoms of Depression?

Everyone at one time or another has felt down, sad, or blue. Sometimes the feeling of sadness gets intense, lasting for a long time and keeping a person from doing what they like to do. This is depression, a mental illness that, without treatment, can get worse and go on for years. The symptoms can include:
  • Sadness
  • Loss of energy
  • Feeling hopeless or worthless
  • Not enjoying things that you used to love
  • Trouble concentrating
  • Uncontrollable crying
  • A hard time making decisions
  • Irritability
  • The urge to sleep a lot
  • Trouble falling or staying asleep at night (insomnia)
  • Aches and pains you can’t explain
  • Upset stomach and digestive problems
  • Low sex drive
  • Sexual problems
  • Headache
  • A change in appetite that causes weight loss or gain
  • Thoughts of death or suicide
  • Attempting suicide

When to Get Help

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Life on the Go With MS

You've got things to do and places to go, and no time for MS to slow you down. Check out these ideas to get comfortable and stay on the move.

Good Shoes

The right shoes can make walking a lot easier. They can help you manage symptoms like muscle stiffness, numbness, and balance problems.
"While there are plentiful options of shoes in the market, it is important to choose comfort and efficiency over style," says Nora Wagner, a physical therapist at Loyola University Health System.
Look for:
Light weight. Lighter shoes are easier on your legs and help you save energy. You'll also clear the ground more easily, which makes it less likely that you'll trip and fall.
Velcro fasteners. They're better than laces because they make it easier to put your shoes on and take them off. Adjust them for a secure, custom fit.
Wide, low heels. They make it easier for you to keep your balance. Choose one that's 1.5 inches tall or less.
Also, the bottom of your heels should be solid, not soft. Avoid flimsy shoes like flip-flops and sling-backs.
Good tread. It can help you navigate uneven surfaces like grass and gravel if you have numbness or balance problems, says Loyola University physical therapist Prem Batchu-Green.


MS and Your Social Life

Keep your social life going strong -- with a little planning and some support from your friends.
"We encourage patients to do as much as they feel comfortable doing," says Robert Bermel, MD, medical director of the Mellen Center for Multiple Sclerosis at the Cleveland Clinic. "The good news is there are no absolute avoidances," he says.
The trick to staying social is to think ahead and prepare for the unexpected.

Plan Around Your Symptoms

Keep a diary for a couple of weeks to see when your fatigue and other symptoms tend to pop up and what makes them worse.
Once you know your MS triggers and what times of day you have the most and least energy, you can schedule outings for when you feel your best. For example, if you always have more energy in the mornings, make plans early in the day.
Before you go out, prep for any MS symptom that might pop up while you're away from home:
Fatigue. To work around it, break your activities into smaller chunks of time. Instead of going to a back-to-back dinner and movie, see an early movie, go home and rest, and then go out to dinner later.
Try to take it easy until it's time to go out. "Think ahead and curtail other energy-consuming activities earlier in the course of the day so you have enough energy for later, when you've planned the social event," says Dusan Stefoski, MD, director of the Multiple Sclerosis Center at Rush University Medical Center.
Ask your doctor whether you can take a stimulant drug or other medicines that give you more energy. Or just grab a cup of coffee or tea for a quick caffeine pick-me-up before you leave.

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Incontinence & MS: 8 Tips to Tame Your Bladder

Take charge of your "urge to go" by trying some simple tips.
Don't sip. Drink a small glass of water (about 6 to 8 ounces) all at once every few hours during the day. That's better than sipping drinks constantly, which might give you the urge to pee more often. You'll know when you get enough to drink because your urine will turn light yellow.
Stop drinking before bed. Stay hydrated, but don't drink too close to bedtime or you could wake up during the night to use the bathroom. Have your last drink of water or other fluid at least 2 hours before you go to bed.
Limit caffeine and alcohol. Cut back on coffee, soda, beer, and wine. Caffeine and alcohol can irritate your bladder and increase the urge to go. Alcohol also affects the way your kidneys absorb water, and it can make your bladder fill up more quickly than usual.
Don't smoke. Nicotine is another bladder irritant. If you smoke, ask your doctor for advice on nicotine replacement products, medicines, and other methods to help you quit.
Do Kegel exercises. Just like you tone your biceps and triceps, you can strengthen the pelvic floor muscles that support your bladder. These muscles hold urine in your bladder so it won't leak when you sneeze, cough, or laugh.
To find the right muscles, squeeze like you would to stop the flow of urine, hold for about 4 seconds, then release. Do these exercises a few times each hour. You don't have to set aside a special place or time. Do them wherever and whenever you like.
If you have trouble finding your pelvic floor muscles, ask a nurse or physical therapist for help.
Retrain your bladder. Go to the bathroom on a regular schedule, such as every 2 hours. Do it even if you don't feel like you need to. That way you'll prevent your bladder from filling up too much and overflowing.

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Thursday, February 25, 2016

Healthline Natural PAIN Remedies

Pain may be unavoidable with MS, but with the right treatments, you'll likely be able to find relief. Try these five natural remedies for leg and foot pain. More »

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Sunday, February 21, 2016

Disability Accumulation Varies in Moderately Advanced MS

Caroline Helwick
February 19, 2016

NEW ORLEANS — Disability accumulation for patients with moderately advanced multiple sclerosis (MS) appears to be independent of prior disease progression, but the disease trajectory is still highly variable, an analysis of the international database MSBase has shown.
Australian investigators determined that greater relapse rates during the course of moderately advanced MS increased the probability of progression, but stronger immunomodulatory therapies appeared to mitigate the accrual of disability, said Nathaniel Lizak, a fourth-year medical student at Monash University in Clayton, Australia.
"We dispute the practice of treatment cessation on the basis of disability milestone attainment," Lizak said. "Patients should continue being treated at greater EDSS [Expanded Disability Status Scale] scores."
The investigators presented their findings at Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2016, the first meeting by ACTRIMS focused on progressive forms of MS. The study's senior investigator was Tomas Kalincik, MD, from the University of Melbourne in Australia.
Disease Trajectory After EDSS 3 Not Clear
Three large cohort studies have previously examined factors influencing disability accumulation in moderately advanced MS but reached contradictory conclusions. Their general implication has been that disease trajectories after the attainment of EDSS 3 are not modifiable, he said.

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New drug for severe form of MS generates glimmer of hope — and tempered expectations

DR. W. CRUM/TIM BEDDOW/ SCIENCE SOURCE-- MRI brain scan from a patient with multiple sclerosis.

By DAVID NATHER @DavidNather

FEBRUARY 19, 2016

There is finally some progress in the hunt for a treatment for the most difficult form of multiple sclerosis — the form that has stubbornly resisted every attempt to find a therapy.

The catch, experts say, is that people with this form of the disease should keep their expectations low, because even the new drug that’s now in the last stages of development doesn’t appear to have a big clinical impact.

The reason that the new drug is generating so much interest, though, is that it’s the first time a therapy for primary progressive MS has had any impact at all.

And it’s the first MS drug to ever receive a “breakthrough” designation from the Food and Drug Administration, which puts the experimental medicine on a fast track to get through the review process as quickly as possible. The agency granted the designation earlier this week.

Read more: Father, daughter fight different forms of MS

Primary progressive MS is a relatively rare form of the neurological disease in which a person doesn’t have severe attacks, the way people do with the more common, relapsing-remitting kind. Instead, they suffer a slow, steady physical deterioration with no hope of recovery.

The FDA has approved 13 drugs for treating relapsing-remitting MS, but none have been shown to work for people with primary progressive disease. The new “breakthrough” drug, called ocrelizumab, is one of six that are in various stages of development for this recalcitrant form, one that affects 10 to 15 percent of the estimated 400,000 Americans living with MS.

On Friday, the company behind ocrelizumab, the Roche subsidiary Genentech, will release new Phase 3 trial data at a conference of the Americas Committee for Treatment and Research in Multiple Sclerosis, which is being held in New Orleans.

Genentech has already published a first round of the results, which showed some impact on a wide range of measures for people with primary progressive MS. The new data will include more detail on how ocrelizumab affected subgroups of patients, as well as new information on how it worked in people with relapsing-remitting MS, to show whether it can also work on the more common variety of the disease.

Continuation of article found here

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