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Friday, August 17, 2018

MRI Can Predict Progression to MS in Patients With Clinically Isolated Syndrome

Published on: August 15, 2018

David Bai
A study recently published in Brain and Behavior has shown that certain magnetic resonance imaging (MRI) parameters correlated with a greater risk of recurrence and progression to multiple sclerosis (MS) within the first year following diagnosis of clinically isolated syndrome (CIS).
A study recently published in Brain and Behavior has shown that certain magnetic resonance imaging (MRI) parameters correlated with a greater risk of recurrence and progression to multiple sclerosis (MS) within the first year following diagnosis of clinically isolated syndrome (CIS).

CIS is a precursor to MS in many patients eventually diagnosed with the disease. However, the uncertainty of progression following the first episode of CIS, with some patients not progressing to MS until many years later, hinders decision making on the optimal time for treatment initiation in these patients. Being unable to differentiate between patients who are at higher risk of progression to MS within 1 year versus those at lower risk puts a greater strain on physicians, who have to decide whether patients require treatment shortly after their initial CIS episode.

Results from previous studies, which sought to identify key MRI and patient parameters that would predict long-term outcomes for patients after their first CIS attack, served as a baseline. However, these studies failed to analyze patient conversion to MS within the first year following CIS. The current research seeks to address this question and to help identify specific MRI parameters that correlate with progression within the first year of CIS.

Of the 46 patients who were analyzed for disease recurrence, 21 had no recurrence within the first year while 25 had another clinical episode. Lesion location, number of lesions, and lesion length were notably different between the 2 outcomes. For lesion location, the temporal lobe, occipital lobe, and the area perpendicular to the corpus callosum were significantly more involved among the 25 patients who progressed to MS. The number of lesions and lesion length were also both greater in patients who progressed compared to those who did not.

Upon further inspection of the results, researchers determined that patients with greater than 13 lesions, lesion length greater than 0.75 cm, and the presence of lesions perpendicular to the corpus callosum had a 19 times greater risk of developing a second episode.

Based on the observations following MRI imaging, several markers were identified that could predict a higher risk of recurrence within the first year. The number of lesions, lesion length, and presence of lesions perpendicular to the corpus callosum seen on the MRI scan may help physicians to recognize patients who may require earlier treatment with disease-modifying drugs.

While the low number of patients enrolled in this study warrants additional trials to validate these MRI parameters, these results established MRI as a highly valuable tool to determine the prognosis of MS throughout the duration of the disease. If MRI parameters are verified to be able to pinpoint certain high-risk patients of progressing to MS within the first year from the CIS event, it will greatly improve treatment decisions for physicians.


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Healthy Diet May Lower Risk of Developing MS, Study Finds

People who eat a healthy diet that includes foods such as vegetables, fish, eggs, poultry, and legumes may have a reduced risk of multiple sclerosis (MS), a study suggests.
Although diet may be a modifiable risk factor for MS, current evidence is mainly based on single foods and nutrients, with inconclusive results.
For example, one study found that eating fish once a week, or one to three times per month, along with taking daily fish oil supplements, may help lower the risk of developing MS. Another study showed that higher intake of antioxidant nutrients, such as vitamin C and E, does not reduce the risk of MS in women, as previously thought.
Instead, analyzing dietary patterns has advantages over the single food or single nutrient approach “by capturing information about a person’s total diet, including the interactions that may occur between food components,” the authors wrote.
Researchers at Curtin University in Australia investigated the associations between dietary patterns and the risk of a first diagnosis of central nervous system demyelination, a common precursor to MS.
“There are a number of known environmental risk factors for MS, including low vitamin D status and low sun exposure, smoking, and a history of glandular fever, and we were intrigued to see whether diet and food intake also played a significant role in this,” study lead author Lucinda Black, PhD, said in a press release.
The team collected data from the 2003-2006 Ausimmune study, a multicenter, case-control study conducted across Australia, and assessed if “a healthy diet or a western-style diet had an impact on the chances of having a demyelinating event, which involves damage to the myelin sheath that protects the nerves,” Black said.
A total of 698 participants (252 cases and 446 controls, matched in age, sex, and study region) who responded to a food frequency questionnaire concerning dietary patterns were included in the study.
Results were adjusted for body mass index, education, race, smoking habits, serum 25-hydroxyvitamin D concentrations, history of infectious mononucleosis, and dietary misreporting.
Two major dietary patterns were identified: healthy (high in poultry, fish, eggs, vegetables, and legumes) and Western (high in meat, full-fat dairy; low in wholegrains, nuts, fresh fruit, and low-fat dairy).
A healthy diet was associated with a 25% reduced risk of a first clinical diagnosis of  central nervous system demyelination. However, no statistically significant association between the Western dietary pattern and risk of a first clinical diagnosis of central nervous system demyelination was observed.
“Our results suggest that following a healthy diet characterised by poultry, fish, eggs, vegetables and legumes may lower the risk of [central nervous system demyelination],” the researchers wrote in the study.


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Cognitive Impairment and Multiple Sclerosis

Cognitive Impairment and MS

Cognitive impairment is an area of MS that is often overlooked, as the common deficits caused by the condition concern motor skills and vision, despite cognitive impairment showing prevalence rates of 43% to 70% at earlier and later stages of the condition. Cognitive problems can appear independently of the physical problems caused by MS, which further complicates their identification.     (continue reading below video block)

Cognitive functions affected by MS include:
  • Long-term memory
  • Attention
  • Efficiently processing information
  • Executive functioning (ability to plan and anticipate outcomes in complex goal-orientated tasks)
  • Deficits in processing speed
Processing speed, visual learning, and memory are thought to be the most commonly affected areas in MS.

Long-Term Memory

Long-term memory is most commonly impaired cognitive function in MS with rates of 40% to 65%. Recent research has shown that the main cause for long-term memory impairment is less to do with difficulties in the retrieval of information, and more to do with the initial learning of the information. Patients with MS require information to be repeated more, but once the information has been learned, they can recall the information at the same levels as patients without MS. Other factors related to learning abilities affected by MS include slow processing speeds and difficulty to disregard irrelevant information or stimuli.


The processes identified under ‘attention’ are very varied, and as such concrete conclusions about the effect of MS on attention, processes have been difficult to make. Maintaining sustained attention is typically affected, as well as the ability to multitask.
Fatigue is also a factor that can affect attention processes, in particular, the ability to hold attention for long periods of time, but is often overlooked.

Information Processing

Problems with information processing have been seen across the disease course and are one of the most commonly seen cognitive symptom of MS. The ability to maintain information for a short period of time, also known as working memory, is negatively affected by MS. Impairment in information processing is usually seen concurrently with the other cognitive deficits in MS. Processing speed can be used to predict a patient’s long-term cognitive decline and also predict their performance in everyday tasks.

Executive Functioning

Defined as the cognitive abilities necessary for goal-directed tasks and complex decision making and adaptation to changes in the environment, executive functioning is one of the less frequent deficits seen in patients with MS.
Executive tasks include:
  • Abstract and conceptual thinking.
  • Planning and organization.
  • Fluency.
  • Anticipate outcomes.
Deficits in fluency see patients struggle with both phonemic (letter and word fluency) and semantic fluency (word category fluency). Depression affects the measurement of executive functioning and should be taken into account when examining and interpreting a patient’s performance in executive functioning.

Processing Speed

A reduction in processing speed is the most common cognitive area affected by MS, and deficits are seen concurrently with other areas of decline. The effect on a patient’s working memory is less than on their processing speed there is a positive correlation between increased demand on working memory and deficits in processing speed.
A sensitive test of cognitive dysfunction is a paced auditory serial addition test (PASAT), which tests working memory that puts a high demand on a patient’s processing speed.

Treatment of Cognitive Impairments in MS


Probiotics Increase Punch of Treatments That Decrease Inflammation in MS, Study Shows

Probiotics increased the punch of treatments that decrease the inflammation associated with multiple sclerosis, a study found.
Using the supplements to add helpful bacteria to the gut may be a way to improve patients’  outcomes, researchers added.
The team from Harvard University-affiliated Brigham and Women’s Hospital did not look at whether probiotics can improve MS itself, however — only at whether it can help reduce the inflammation linked to the disease. additional studies should explore this possibility, the researchers said.
Probiotics contain live bacteria that many scientists believe improve gut health. Recent research has shown that gut microbes can affect how the immune system works. Since MS is an autoimmune disease — or one in which the immune system attacks healthy organs and tissue — this suggests the microbes could improve MS.

Smoking Increases Relapse Rate in RRMS Patients on Tysabri, Study Suggests

 August 7, 2018
Smoking increases the relapse rate in patients with relapsing-remitting multiple sclerosis being treated with Tysabri , an observational study suggests.
Multiple sclerosis is a multifactorial disease associated with both genetic and environmental risk factors. Smoking, in particular, has been linked to numerous aspects of MS, including its development and progression.
(continue reading below photo)
Tysabri and smoking
In a previous study, the research team looked at how smoking influences the relapse rate in RRMS patients being treated with interferon beta. From more than 800 patients, they found that smoking one pack per day (about 20 cigarettes) essentially interfered with the positive effect of the IFN-beta treatment and increased the relapse rate by 27%.
The researchers then questioned whether the same was true for other treatments.
Tysabri, developed by Biogen, is a monoclonal antibody that targets the alpha-4 integrin protein. By interfering with this molecule, the therapy prevents white blood cells from moving into the central nervous system, suppressing the immune reaction that contributes to MS symptoms.
In the study, 355 Tysabri-treated RRMS patients from the Danish Multiple Sclerosis Centre were assessed. To gather information on smoking habits and body mass index, the patients filled out a 100-question survey. Data was collected between the start of the treatment and a two-year follow-up visit.
Results showed that smoking one pack of cigarettes per day increases the relapse rate by 38% in RRMS patients on Tysabri.
This increase in relapse rate takes into account both sex and age at the start of treatment, since age can affect the relapse rate. For example, an increase in age by one year raises the number of relapses by 2%.
The researchers also looked at the relationship between smoking and the presence of two immune-related alleles: HLA-DRB1*15:01 and HLA-A*02:01. Previous studies showed that HLADRB1*15:01 is associated with an increased risk of developing MS, while HLA-A*02:01 is linked to a decreased risk.
Although previous studies reported a link between smoking and these two alleles in MS patients, the current study did not find an association between smoking and carrying either of these alleles.
Based on the results, the researchers concluded that smoking significantly increases the relapse rate in RRMS patients receiving Tysabri.
According to the team, the results "add important information that hopefully will sharpen the focus on the overall harmful effects of smoking in MS patients."


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Quanterix’s Simoa Assay May Make Neurofilament Light Chain Useful Blood Biomarker of MS and Its Likely Progression

August 8, 2018

Quanterix’s ultra-sensitive Simoa assay has the potential to open new uses for the brain biomarker known as neurofilament light chain, including the possibility to detect early evidence of neurological diseases like multiple sclerosis (MS), Parkinson’s, and Alzheimer’s, and ably evaluate efforts to treat and prevent them, the company reports in a press release.
A hallmark of MS is the progressive degeneration of brain cells. As these cells are damaged, a protein called neurofilament light chain, or NfL, is released into cerebral spinal fluid and blood.
Studies have suggested that blood levels of NfL provide a reliable picture of MS activity, and could also be used to monitor disease progression, instead of magnetic resonance imaging scans of the brain. However, NfL’s use as a diagnostic marker for MS and other neurological disorders was limited due to lack of sensitive and reliable methods to assess it.


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Long-term DMT Use Seen to Lower Likelihood of RRMS Progressing to SPMS in Study

Long-term treatment with disease-modifying therapies (DMTs) appears to lessen the risk of disease worsening in relapsing-remitting multiple sclerosis (RRMS) patients, an 18-year follow-up study suggests.
But these therapies were not seen to benefit those who had progressed to secondary progressive multiple sclerosis (SPMS).
Disease-modifying therapies (DMTs) are treatments that aim to reduce MS progression from relapsing–remitting forms of the disease to SPMS.
Researchers conducted a retrospective analysis of 1,709 patients registered at the Group for Research and Treatment of Multiple Sclerosis (GITEM) Registry in Valencia, Spain.
Out of the initial 1,709 patients, 225 were clinically diagnosed with MS and 204 received treatment with first-line DMTs — interferon beta (Biogen‘s Avonex, among other brand names) or glatiramer acetate (sold as Teva‘s Copaxone).
Treatment with DMTs began when patients experienced at least one relapse in the previous year or two relapses within the previous three years. RRMS patients were followed for a median of 18.1 years.
Patients who failed to respond to treatment were given second-line therapies, namely the immune suppressants Novantrone (mitoxantrone), cyclophosphamide, or selective second-line DMTs, such as Tysabri (natalizumab) or Gilenya (fingolimod).
Study participants were evaluated regularly — every three to six months — for changes in their Expanded Disability Status Scale (EDSS) scores, relapse rates, and for side effects or decisions to stop treatment.
Progression to SPMS was confirmed “when patients with a previous EDSS score of 3.0 or greater experienced a six-month worsening to EDSS 4.0 or greater without evidence of relapse,” the researchers wrote.


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Thursday, August 16, 2018

Number, Location, Size of Lesions on MRI Can Predict Progression to MS, Study Shows

MS lesions

The number, location, and size of lesions can help predict the risk of progression from clinically isolated syndrome (CIS) to multiple sclerosis(MS) within one year, a new study shows.

Most patients diagnosed with MS initially present with CIS. In 50-70% of patients, magnetic resonance imaging (MRI) is taken at the time of CIS diagnosis, and it usually reveals multiple white matter brain lesions that suggest the presence of demyelination (or myelin loss, the process that underlies the pathology of MS).

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This College Cheerleader Won’t Let MS Stop Her from Being an Athlete

  Sterling, to the left of the duck mascot, has been the University of Miami cheer captain for three years, despite being told by a doctor that cheerleading — let alone going to college — would be a stretch. 
Image courtesy of Sidney Sterling

When Sidney Sterling started experiencing a slight tingling and numbing sensation in her right arm, she figured she slept wrong and went about her activity at an elite summer cheer camp — one she’d dreamed about attending since she was a kid. At age 16, she felt like everything seemed to be falling into place.
As the cheerleading camp went on, Sterling says the tingling and numbness traveled up her arm and into her back, and she knew it was time to say something. “Once I got back to Miami, my parents immediately brought me to the emergency room,” Sterling tells Healthline.
After an MRI of her brain and spinal cord, a spinal tap, and three full days of observation in the hospital, the doctors determined she had contracted a bacterial infection.
After settling into her junior year of high school, Sterling noticed that day-to-day tasks like school work, homework, extracurricular activities, and cheerleading practice were daunting and physically exhausting.
After expressing how she felt to her parents, Sterling’s mom and dad took her to see a pediatric neurologist.
And that is the moment her life changed.
“The pediatric neurologist reviewed the results from my trip to the hospital four months prior,” says Sterling. “But instead of thinking I had a bacterial infection, this doctor gave me a different diagnosis: multiple sclerosis.”

What it’s like to get an MS diagnosis as a teen

Most teenagers aren’t thinking too seriously about the future of their health. This was certainly the case for Sterling.
“I don’t think I understood the severity or the impact this diagnosis would have on my life,” Sterling says. “I was both anxious and relieved: anxious for the future but relieved that my health would finally improve and I could resume regular activity,” she explains.


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Horseback Riding May Help People with MS

Researchers say therapeutic horseback riding, or hippotherapy, can improve balance, fatigue, and pain in people with multiple sclerosis.

Full width image

Could horseback riding help ease multiple sclerosis symptoms?
One study out of Germany concluded that a horseback riding therapy known as hippotherapy along with standard care significantly improved balance, fatigue, motor function, and spasticity in people with multiple sclerosis (MS).
The primary outcome of the study was the change in the Berg Balance Scale (BBS).
The BBS is a widely used clinical test of a person’s balance abilities, with additional measures including fatigue, pain, quality of life, and spasticity.
The research was initiated by Marion Drache, chair of the executive board of Zentrum für Therapeutisches Reiten Johannisberg e.V., which is a nonprofit organization for hippotherapy focused on high-level scientific studies on therapeutic riding since 2004.
“Hippotherapy is different than regular horseback riding,” Drache told Healthline.
She explained hippotherapy is a physiotherapy treatment based on a neurophysiological approach. It works by “transmitting the three-dimensional movements generated by the horse’s slow gait (walk) to the patient,” she said.

How the riding works

Specially trained horses are guided in a large circle in slow, rhythmic, and methodical gaits as the hippotherapists use the horses’ energy and movement to work with each patient. 

Continue reading


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