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Friday, June 16, 2017

Ocrevus Phase 3 Trial Will Explore How Treatment Works by Viewing Changes in Spinal Fluid

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Already an approved treatment for relapsing and primary progressive multiple sclerosis (MS), Ocrevus (ocrelizumab) is still undergoing scrutiny in several clinical trials. Most focus on the drug’s effects in specific patient groups, but one study aims to advance understanding of how Ocrevus works to harness disease.
To do so, the open-label Phase 3 trial (NCT02688985) will analyze participants’ cerebrospinal fluid, which bathes the brain and spinal cord.

Aiming to recruit 104 people with both relapsing and primary progressive disease — across 19 locations in North America, Germany, and Sweden — the study is open both to those new to disease-modifying treatment and those previously treated with interferons or Copaxone (glatiramer acetate).

Patients taking other therapies will need to stop treatment before starting Ocrevus infusions.
As in other Ocrevus trials, patients will be treated according to the drug’s prescription label. This means that the first 600-mg dose will be split into two infusions, two weeks apart. Two additional infusions, each 600-mg, will be given on weeks 24 and 48.

Brain biomarkers

Researchers will — for the first time — analyze levels of a factor called Neurofilament Light (NFL), as well as CD19+ B-cells and CD3+ T-cells, in the spinal fluid of Ocrevus-treated participants.
Changes in the fluid levels of these biomarkers will be the trial’s primary outcome measure, bringing new insights into how Ocrevus impacts MS disease processes.
For a disease involving the central nervous system, such as MS, measures of various factors in the blood do not necessarily mirror processes taking place in the brain. By analyzing factors in the cerebrospinal fluid, researchers may be better able to assess what is going on in the brain.
“This is a hypothesis-generating study to elucidate the effect of Ocrevus on biomarkers of inflammation and neurodegeneration in the CSF [cerebrospinal fluid] and peripheral blood of patients with relapsing MS and primary progressive MS, in correlation with clinical and MRI [magnetic resonance imaging] outcome measures,” Hideki Garren, Genentech’s Group Medical Director of Ocrevus, told Multiple Sclerosis News Today when asked about this company-supported trial.
But what will the factors under scrutiny tell researchers about MS disease processes and Ocrevus’ effects?
“Specifically, NFL is a marker of axonal injury,” Garren said. “And the aim of the study is to assess the potential impact of Ocrevus on this process, as well as on the inflammation,” he added, referring to measurements of B- and T-cells, which are immune system components.
Genentech scientists, in an earlier interview, said they believe that Ocrevus, through its interaction with B-cells, also has an impact on T-cells. Measuring T-cell changes in the brain can, for this reason, deepen understanding of a treatment like Ocrevus, which primarily acts to deplete CD20-type B-cells.
The study will also look for the presence of -- click here to continue reading 

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How to Manage MS Tremors

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Many people with multiple sclerosis (MS) have some form of tremor, or shaking they can’t control, in different parts of their bodies.
There are several types:
  • Postural tremors. You shake when you sit or stand, but not when you lie down.
  • Intention tremor. There’s no shaking when you’re at rest. It starts when you try to reach or grasp something or move your hand or foot to a precise spot. This is the most common form of MS tremor, and it usually causes the most problems in day-to-day life.
  • Nystagmus. This type causes jumpy eye movements.

  • What Causes Tremors in Multiple Sclerosis?
  • Tremors happen because of damage to nerves that control body movement.

    Treatment for MS Tremors

    These problems are one of the hardest MS symptoms to treat. Drugs don't work well for everyone with tremors. Some people have found relief from medicines for other conditions, such as:

    Other Ways Tremors Can Affect You

    Tremors can be tough to handle in social situations. People who have them may feel they need to isolate themselves. That can lead to depression. A psychologist or counselor can help you find ways to feel more comfortable in public and keep the tremors from changing how you live your life.
    WebMD Medical Reference Reviewed by Neil Lava, MD on December 18, 2016


    © 2016 WebMD, LLC. All rights reserved.
  • THIS Is a WebMD article 

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A multiple sclerosis journey: The path to achieve wellness

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Physicians define wellness as the process of obtaining optimal health, a journey involving education, planning and action. For the more than 2,500 Southern Nevada residents living with multiple sclerosis, this journey is often filled with day-to-day obstacles. MS is an autoimmune disease in which the body’s immune system mistakenly attacks tissues, causing life-altering and debilitating symptoms. The team at the Mellen Program for MS at Cleveland Clinic Lou Ruvo Center for Brain Health strives to meet the ever-changing needs of patients by encouraging them to make health and wellness a priority.

MS is a lifelong disease with far-reaching implications causing fatigue and problems with flexibility and movement as a result of spasticity and weakness. With an MS diagnosis, the risk for becoming physically disabled increases; and factoring in poor lifestyle choices, as well as additional health disorders, can make that risk for disability even greater.

Multiple research studies have indicated that maintaining a healthy lifestyle can help improve the quality of life in patients with MS. There are many variables, including exercise, nutrition, lifestyle choices, health maintenance, sleep pattern, mental health awareness and occupational/social/intellectual health.

Exercise: Several investigations have shown that patients with MS are less physically active than the general population. This could be a result of pain or weakness, which are common symptoms, but the lack of physical activity can have wide-ranging and negative effects. Originally, exercise was thought to be unsafe in patients with MS, especially for those living in hot climates like Las Vegas, as increased heat and overexertion can temporarily increase MS-related symptoms as the core body temperature rises. However, unlike previously thought, exercise is considered safe in MS and should be implemented in weekly routines. Aerobics and muscle strengthening are recommended, as these can prevent and even improve accumulation of disability, symptoms and overall quality of life. For those living with MS in warmer climates, consider exercising in an air-conditioned room, having cold water and hand-held fans readily available, include frequent rest breaks, and employ aquatic therapy if available.

Nutrition: Those with MS should avoid food that is processed and high in saturated fats, refined sugars and salt. Instead, focus on an anti-inflammatory, plant-based diet that includes fruits and vegetables, whole grains and lean proteins. It is also important to incorporate food that is high in fiber to minimize constipation, a common symptom of MS. Additionally, several studies have shown that vitamin D deficiency is a huge risk factor for MS, which is why we recommend that those living with MS should take a vitamin D3 supplement on a daily basis. Vitamin D dosages are highly variable, so it’s important to discuss how much vitamin D3 one should take with an MS doctor and routinely monitor blood levels.

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Jamie-Lynn Sigler Opens Up About Using Walking Sticks for MS

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The Sopranos’ actress Jamie-Lynn Sigler only recently shared that she’s been living with multiple sclerosis for 15 years, choosing to remain quiet about her health out of fear that it would affect her career. Following her announcement, she won the support of multiple sclerosis sufferers all over the world and is now an advocate for the disease.

According to Self magazine, Sigler is using her social media accounts to highlight what it’s like living with the disease and recently shared that she’s now using walking sticks to get around. In an Instagram post, she admits that she hated having to buy the walking sticks, concerned that there was a stigma associated with having a disability. In a bid to overcome the stigma and to be able to enjoy her trip to Jerusalem, she proudly displayed herself with her new sticks and urged others to do whatever they needed to do to continue to enjoy life.
She also spoke of her need to better cope emotionally with having multiple sclerosis and that she was undergoing hypnotherapy. Trying to hide the disease from the public eye for so long has obviously taken its toll and she’s now ready to set herself free from the feelings of shame and embarrassment that haunted her before.

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Monday, June 12, 2017

Understanding the brain in MS: Introducing brain atrophy

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Let’s talk brain matters

When we talk about MS, we often talk about things like lesions and relapses, but you might have also heard about something called brain atrophy. Brain atrophy is being talked about more and more these days, especially by some MS experts, so what exactly is it? And why are we talking about it?
To answer these questions we need to take a few steps back. MS is a neurological disease that causes damage to the cells in the brain and spinal cord (the central nervous system). So let’s take a really quick look at how the central nervous system (CNS) works, some of the things it does and what leads to the symptoms of MS.

Meet the central nervous system

The CNS is the body’s main control centre. Even when you’re chilling out watching TV, your CNS controls your breathing, your temperature and the muscles helping you stay upright. It makes sense of the moving images you’re seeing, the sounds you’re hearing and all while forming new memories too. Pretty exhausting when you think about it, right?
The cells in the CNS making all of this possible are called neurons (sometimes called nerve cells). They form connections and networks along which messages can travel. Neurons are strange looking cells made up of a cell body and a long fibre called an axon, which carries messages. The axon is coated in the fatty substance called myelin that protects the axon and helps signals to travel efficiently.

So what happens in MS?

The cause of MS is still unknown but we do know that the immune system is involved. Our immune system is vital for our survival, protecting us from harmful things. But in MS, the immune system mistakenly sees myelin as a foreign material, and attacks it.

When myelin is damaged, the signals can’t travel as fast. And once the myelin around the nerve is completely destroyed, the signal may become blocked altogether, resulting in a broken connection.

What about brain atrophy?

Brain atrophy is something that happens to absolutely everyone, not just if you have MS. In fact, it’s a normal part of ageing. Our brains keep growing until we are in our very late teens and then very slowly start to shrink. This process can also be called brain volume loss, or brain shrinkage. But the damage caused by MS can make this happen a little bit faster.
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Induction and escalation therapies in multiple sclerosis

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Multiple sclerosis (MS) is a chronic demyelinating disease affecting the central nervous system. Pharmacological therapy of MS includes symptomatic drugs, treatment for relapses (corticosteroid and intravenous immunoglobulin) and disease modifying drugs (DMDs) defined as pharmacological agents that have an impact on relapse rate, disability accumulation and radiological outcomes. Two different therapeutic approaches are widely used in MS: escalation and induction therapy. 
Escalation therapy consists of an early start with first line DMDs (beta interferon, glatiramer acetate, teriflunomide, dimethyl fumarate) and if DMDs are ineffective or partially effective, switching to second line drugs (mitoxantrone, natalizumab, fingolimod). Induction therapy consists of the early use of immunosuppressant drugs followed by long-term maintenance treatment, generally with immunomodulatory agents. 
While the use of natalizumab and fingolimod as first line drugs is indicated for aggressive forms of MS, the indication for mitoxantrone as an induction treatment arises from randomized studies demonstrating that induction therapy with mitoxantrone followed by DMD maintenance is more effective than monotherapy with beta interferon. 
However, the safety profile of induction drugs indicates this is not an acceptable therapeutic strategy for all MS patients in all phases of the disease. The upcoming challenge is to identify patients at high risk of disability development from their clinical characteristics, radiological findings or biomarkers. 
Furthermore, future studies to establish an individual safety profile stratification are needed.


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MS Views and News is now collaborating with iConquerMS

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DEAR MS Friends,

I’m excited to announce MS Views and News is collaborating with the good people at iConquerMS to promote more ways that those of us affected by MS can work together find a cure for this disease.  

How can you do that? It’s simple – follow this link and enroll as a member of iConquerMS

Once you are registered you can securely share your information about living with MS, suggest research topics, and have opportunities to weigh in on research study designs. 

The information you provide, without your personal information, of course, is combined with the information from over 4,000 other people world-wide so that researchers can study MS more effectively and efficiently. Learn more about this special group at their website –

Don’t delay – do this today and help iConquerMS to move forward.

Best Regards,

Stuart C. Schlossman
President and MS Patient
MS Views and News, Inc.
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Our Mission: MS Views and News (MSVN), is dedicated to the global collection and distribution of information concerning Multiple Sclerosis (MS). Through partnering relationships, MSVN provides education, advocacy and service to empower and enhance the quality of life of the MS community.

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