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Friday, March 24, 2017

Pilot Study May Lead to Telemedicine Benefiting People with Multiple Sclerosis

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Telemedicine, which allows healthcare professionals to evaluate, diagnose and treat patients at a distance with telecommunications technology, may soon benefit people with multiple sclerosis (MS).
Elizabeth Morrison-Banks, MD, a health sciences clinical professor at the University of California at Riversi1de School of Medicine, is planning a pilot one-year study of a home-based telemedicine program for MS patients.
A $100,000 grant from Genentech is financing the project, which Morrison-Banks calls “Clinicians’ Online Neurology Network Empowering Communities through Telemedicine – Multiple Sclerosis (CONNECT-MS).”
“In 2015-2016, in collaboration with the Landon Pediatric Foundation, our research group developed a pilot telemedicine program for MS care funded by a Genentech research grant,” Morrison-Banks said in a news release. “While our preliminary data suggested that telemedicine is effective for and acceptable to patients with MS, outreach was limited by the complexity of scheduling visits to the general neurologists’ offices in coordination with simultaneous telemedicine consultations. We are therefore proposing a new home-based telemedicine program.”
As part of the project, Morrison-Banks and colleagues will randomize adults with MS to receive either telemedicine-based care or usual care.
A nurse practitioner will visit the telemedicine group’s homes, review their clinical history, and work with a neuro-immunologist who is on a telemedicine hook-up to perform a neurological analysis. The first stop at a patient’s home will be three to four weeks after the patient enrolls so the nurse can coordinate a telemedicine visit with Morrison-Banks. The privacy of such visits will be protected under the Health Insurance Portability and Accountability Act.
Researchers will compare the health of patients treated by telemedicine with those who received usual care. The variables they will examine include pain levels, fatigue, quality of life, visual impairment, sexual satisfaction, bowel control, bladder control, and mental health.
“The goal is to determine whether the home telemedicine approach works as well as usual care—that is, office visits with the neuro-immunologist,” Morrison-Banks said. “This is a pilot study and it may not be able to show whether MS telemedicine in patients’ homes is better than usual care, but if it appears to be equivalent – and if patients and families like it better because of its convenience and comfort – then the pilot study will provide useful preliminary data to guide larger research studies in the future.”

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Ocrevus and the Hope of ‘Ending MS Forever’: Interview with MS Society’s Tim Coetzee

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Ocrevus, MS and hope

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The potential approval of Ocrevus (ocrelizumab) this month supports the idea that, someday, a world free of multiple sclerosis (MS) is possible, according to Dr. Tim Coetzee, the National Multiple Sclerosis Society’s chief advocacy, services and research officer.
While Coetzee — and the society he represents — realize the potential of Ocrevus to improve MS treatment, both also acknowledge that plenty of work remains to be done to reach its goal of “ending MS forever.”
Tim Coetzee
Tim Coetzee (Courtesy, National Multiple Sclerosis Society)
Meanwhile, the society is working hard to make sure that the benefits Ocrevus may offer — if approved — will reach as many people as possible.
With the date for Ocrevus’ potential approval fast approaching, Multiple Sclerosis News Today spoke to Coetzee about how the possible therapy is viewed by the MS Society, its hopes and concerns, and work beyond Ocrevus.

Cautious optimism

“The idea of a treatment being approved for primary progressive MS is huge,” Coetzee said. Still, he and the society do not want to celebrate too soon, and are only cautiously optimistic that the U.S. Food and Drug Administration (FDA) will approve Ocrevus on March 28.
“Of course, you always have to be prepared for the unexpected — like the three-month delay in the agency’s decision late last year, but we certainly hope that doesn’t happen,” he added.
Ocrevus has been tested in three large global clinical trials: the two OPERA I and OPERA II trials (NCT01247324 and NCT01412333) in relapsing patients, and the ORATORIO (NCT01194570) study in people with primary-progressive MS. Researchers — both those involved in the trials and those not — consider the study data impressive.
Many patients also have high hopes for the treatment. According to Coetzee, relapsing MS patients are excited about the possibility of yet another, and possibly better, disease modifying treatment to choose from. And while primary progressive patients recognize that the treatment’s effect in clinical trials was modest — it is a huge step forward compared to no available treatment at all.1

“To have any option is a critical first step to addressing the challenges of treating progressive MS,” Coetzee said, but advised restrained optimism.
So while Genentech’s Dr. Peter Chin noted that Ocrevus “has the potential to change the way MS is treated,” Coetzee underscored the importance of seeing how the drug works in wider usage.

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Thursday, March 23, 2017

Trigeminal Neuralgia Often Precedes MS

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MS diagnosis also occurred at a later age in those with facial pain
Contributing Writer, MedPage Today

Trigeminal neuralgia occurred frequently in multiple sclerosis (MS) patients, and preceded the diagnosis of MS in 15% of those affected, researchers reported. 

Almost 10% of 8,590 survey respondents with MS had been diagnosed with trigeminal neuralgia (TN). Of 588 respondents who reported the year that trigeminal neuralgia was diagnosed, the latter's diagnosis preceded MS in 88 individuals, according to Ruth Ann Marrie MD, PhD, of the University of Manitoba in Winnipeg, and colleagues.

An additional 18% were diagnosed with trigeminal neuralgia and MS in the same year, they wrote in the International Journal of MS Care.
The average age at trigeminal neuralgia diagnosis was 35 for those initially diagnosed with the condition prior to MS versus 47 for individuals whose trigeminal neuralgia was diagnosed during the same year or after their MS diagnosis.
"Our findings are a reminder to neurologists that it is important to think carefully about secondary causes of trigeminal neuralgia, such as multiple sclerosis, in individuals with new onset of these symptoms, particularly if the individual is young," Marrie told MedPage Today in an email.
The study involved participants (76% female, 92% white) in the North America Research Committee on Multiple Sclerosis (NARCOMS) Registry. Average disease duration was 23 years.

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