www.msif.org 2010
acute febrile syndrome with fever, neutrophilia and tender erythematous plaques and papules on his upper extremities after his fifth mitoxantrone infusion with diagnosis of Sweet Syndrome. Patient was treated successfully with corticoids. Multiple Sclerosis December 9, 2010 1352458510390069 Heterogeneity at the HLA-DRB1 allelic variation locus ((DRB1*01, DRB1*03, DRB1*04, and DRB1*1501) does not influence multiple sclerosis disease severity, brain atrophy or cognition in a large, Australian, population-based cohort. They do have a relative association with decreased the age of MS onset. Multiple Sclerosis December 13, 2010, doi: 10.1177/1352458510389101 A study found that the amount of physical activity, which was measured actigraphically, decreased with disease severity (EDSS) and did not correlate with fatigue or sleepiness. Journal of Neurolology 2010 Aug 18. Researcher found that following cessation of natalizumab therapy, the disease activity rapidly returned to pre-natalizumab levels. Multiple Sclerosis December 6, 2010 A patient with established primary progressive multiple sclerosis transitions to 'secondary' relapsing- remitting disease course following a fulminant demyelinating episode. Multiple Sclerosis December 6, 2010 A clinical study found that natalizumab restores evoked potential abnormalities in patients with relapsing– remitting multiple sclerosis after 1 year of treatment. Multiple Sclerosis December 6, 2010 A large-scale study in England found that Fatigue was worse in those with progressive disease and clearly worsened once ambulation was affected. Fatigue was not related to disease duration or patient age and only had a weak correlation with anxiety and depression. There was an intimate but complex relation between fatigue and sleep. Fatigue levels were minimum at a nocturnal sleep duration of 7.5 h. Multiple Sclerosis December 6, 2010 A study found that patients were willing to continue in natalizumab and accept a higher risk of PML than neurologists. Coherent with their perception of risks and benefits, patients were also more willing to continue treatment. Open information about treatment-related risks is appreciated and might support shared decision making. Multiple Sclerosis September, 2010 A first Phase II study with the new, modified FAE BG00012/FAG-201 (BG-12) in relapsing remitting MS revealed significant effects on MRI parameters such as gadolinium-enhancing lesions after 24 weeks of treatment. The trial also underlined the safety and good tolerability of FAE. Presently, two Phase III studies are ongoing to investigate the clinical long-term efficacy of BG-12. Expert Rev Neurother. 2008 Nov;8(11):1683-90. To learn more about the enrollment criteria for this study, and to find out if you are eligible to participate, please email bg12studies@biogenidec.com, or fax to (866) 593-2271.
constipation, and support the feasibility of a substantive trial of abdominal massage for the alleviation of the symptoms of constipation in people with MS. Multiple Sclerosis Oct 12, 2010 The authors found in this study that a single relapse may not be sufficient to indicate treatment failure. However, other studies should be done to better understand the role of confounding value. Mult Scler. 2010 Aug 24. The good efficacy and the excellent safety and tolerability profiles of laquinimod 0.6 mg/day are confirmed in this extension study. In 239 patients initially randomized to 0.6 mg in LAQ/5062 the reduction of MRI activity observed in the placebo-controlled phase was maintained in the clinical study extension. The proportion of activity free detected by the MRI patients for those who switched from placebo increased from a baseline of 31% to 47% at the end of the extension phase (p = 0.01). The most prominent safety signal was elevations of liver enzymes, reversible in all cases. Multiple Sclerosis, September 8, 2010
subjects during the follow-up. Classification of evidence: This study provides Class IV evidence that natalizu 300 mg IV once every 28 days, decreased EDSS scores in pediatric patients with MS over a mean treatment peri 15.2 months. Neurology. 2010 Sep 7;75(10):912-7.
inflammatory disease activity. Some of these flares can be clinically severe, with a high number of contrast-enhanced lesions, suggesting a possible rebound of disease activity. Eighty-one percent (68/84) underwent a dosage interruption, and 19% (16/84) had no interruption in natalizumab treatment. Of those with a treatment interruption, 27.9% (19/68) experienced a clinical relapse within 6 months of the suspension, whereas none of the patients with ongoing treatment experienced a flare during months 12 to 18 of treatment. Ann Neurol. 2010 Sep;68(3):395-9. Scientist reported that progressive resistance training induces a compensatory increase of muscle fiber size in patients with multiple sclerosis. Multiple Sclerosis August 4, 2010 A growing body of literature indicates that the natural course of multiple sclerosis can be influenced by a number of factors. Strong evidence suggests that relapses can be triggered by infections, the postpartum period and stressful life events. Vaccinations against influenza, hepatitis B and tetanus appear to be safe. Surgery, general and epidural anaesthesia, and physical trauma are not associated with an increased risk of relapses. Factors that have been associated with a reduced relapse rate are pregnancy, exclusive breastfeeding, sunlight exposure and higher vitamin D levels. A number of medications, including hormonal fertility treatment, seem to be able to trigger relapses. Factors that may worsen progression of disability include stressful life events, radiotherapy to the head, low levels of physical activity and low vitamin D levels. Strong evidence suggests that smoking promotes disease progression, both clinically and on brain magnetic resonance imaging. There is no evidence for an increased progression of disability following childbirth in women with multiple sclerosis. Moderate alcohol intake and exercise might have a neuroprotective effect, but this needs to be confirmed. Mult Scler July 2010 vol. 16 no. 7773-785 The time period favorable to remyelination of optic nerve lesions is likely to be within the first 6 months after the attack. Mult Scler July 2010 vol. 16 no. 7786-7950
explaining respectively about 9% and 39% of the total variance. The contribution of physical fatigue to cognitive complaints was not significant. Both physical and mental fatigue did not significantly contribute to cognitive performance in terms of mental speed, attention, memory and executive functioning. Clin Rehabil. 2010 Jun 24 Patients with other inflammatory diseases have higher probabilities than patients with relapsing— remitting multiple sclerosis patients to present Epstein-Barr virus-specific antibody response in cerebrospinal fluid. Mult Scler July 2010 vol. 16 no. 7883-887 Natalizumab induces a rapid improvement of disability status and ambulation after failure of previous therapy in relapsing remitting multiple sclerosis. Eur J Neurol. 2010 Jun 16. Report of a case involving a 26-year-old woman who developed acute and progressive motor and sensory deficits and multiple treatments including corticosteroids, plasma exchange and intravenous immunoglobulin could not halt her sever clinical demyelinating disorder and radiological deterioration. She became near quadriplegic and developed motor aphasia. A diagnosis of Marburg variant MS was considered and she was given high dose cyclophosphamide (HiCy). By day 17 of treatment, she started to show a steady neurological improvement. Five months later she had minimal residual right-sided weakness and was able to ambulate without assistance. Marburg variant multiple sclerosis (MS) is an acute, fulminant and monophasic variant of MS that usually leads to death within weeks to months. No consistently successful treatment is known. J Neurol Sci. 2010 Jun 23. This is a review of osteoporosis in people with multiple sclerosis, looking at its prevalence, risk factors and possible mechanism, including management guidelines for osteoporosis in the general population and use these to propose guidelines for osteoporosis management amongst multiple sclerosis patients. They found evidence that bone mineral density is significantly reduced in multiple sclerosis patients. The most significant risk factors appear to arise from the chronic disease process of multiple sclerosis and not from glucocorticoid use. The authors propose an algorithm for the screening and treatment of osteoporosis in people with multiple sclerosis. Multiple Sclerosis 2010 June 15 Early diffuse demyelinating lesion in the cervical spinal cord predicts a worse prognosis in relapsing– remitting multiple sclerosis. Multiple Sclerosis 2010 June 23 Low-dose naltrexone (LDN) may promote psychological well-being in autoimmune disorders. The objective of this study was to assess the effect of LDN on the Quality of Life (QoL) of patients with relapsing–remitting and secondary progressive multiple sclerosis (MS) using the MSQoL-54 questionnaire. A 17 weeks study found that LDN is a relatively safe therapeutic option in RRMS and SPMS but its efficacy is under question and probably a long duration trial is needed in the future. Multiple Sclerosis 2010 June Study finds out that MS risk is extremely low among individuals not infected with EBV, but it increases sharply in the same individuals following EBV infection. Ann Neurol. 2010 Jun;67(6):824-30 Multiple sclerosis patients lacking oligoclonal bands in the cerebrospinal fluid are less likely to develop neutralizing antibodies against interferon beta. Multiple Sclerosis June 2010 Epstein–Barr virus-specific antibody response in cerebrospinal fluid and serum of patients with multiple sclerosis does not support a direct pathogenetic role of EBV in multiple sclerosis. May 18, 2010 Early cognitive impairment in multiple sclerosis predicts disability outcome several years later. Multiple Sclerosis, Vol. 16, No. 5, 581-587 (2010) A population‐based case‐control study showed that MS may share environmental triggers, genetic susceptibilities and/or alterations in immune homeostasis with inflammatory bowel disease, uveitis, and Bell's palsy, but not with other autoimmune disorders. Mult Scler. 2010 May 12 This study confirmed the critical role of psychosocial difficulties in children and adolescents with MS. Having MS affected school activities in 28% of cases, daily living activities in 41% and social relationships in 28%. Neurol Sci. 2010 May 8. Fatigue, mood and quality of life all improved following progressive resistance training, the beneficial effect being maintained for at least 12 weeks after end of intervention. Multiple Sclerosis, Vol. 16, No. 4, 480-490 (2010) Early changes on electroencephalography in natalizumab-associated progressive multifocal leucoencephalopathy. Multiple Esclerosis 2010 May 7, 2010 Smoking appears to enhance the association between high titer of Epstein Barr (anti-EBNA) and increased multiple sclerosis (MS) risk; but the association between Epstein Barr and MS risk is independent of smoking. Further work is necessary to elucidate possible biologic mechanisms to explain this finding. Neurology (early online publication, April 7, 2010) Anti-myelin antibodies modulate clinical expression of childhood multiple sclerosis. J Neuroimmunol. 2010 Apr 8 Preliminary results suggest that dysfunctions in higher order aspects of motor control may have a role in determining fatigue in MS due to association with cortical atrophy. Arch Neurol. 2010 Apr;67(4):447-53 American Academy of Neurology(AAN)annual meeting April 2010 Below are some of the poster presentations of relevant studies about MS shown at the AAN meeting. Alzheimer's Disease risk alleles in PCDH11X and SORL1 are associated with the rate of Cognitive Decline in persons with multiple sclerosis. http://www.abstracts2view.com/aan/view.php?nu=AAN10L_S30.001 This study provides further evidence that Glatimer Acetate (GA) administered less frequently than daily may be as efficacious, and better tolerated than GA administered daily. This may have a significant impact in the clinical use of GA. Larger, multi-center studies are warranted to confirm our findings and investigate the optimal dose of GA in RRMS. http://www.abstracts2view.com/aan/view.php?nu=AAN10L_S11.002 The apparent association between breastfeeding and lower risk of post-partum relapses may be due to the higher probability that women with lower disease activity before and during pregnancy breastfeed their infants. In fact, in our sample, post-partum relapses were predicted only by previous DMDs therapy (a possible indicator of higher disease activity) and relapses before and during pregnancy. The only significant predictors of post-partum relapses were the presence of relapses in the year before pregnancy and previous treatment with DMDs. http://www.abstracts2view.com/aan/view.php?nu=AAN10L_S40.003 Pregnancy and exclusive breastfeeding are strongly associated with low 25 (OH)D levels in women with multiple sclerosis. However, these lower vitamin D levels were not associated with an increased risk of postpartum MS relapses. These data suggest that low 25(OH)D levels are not an important risk factor for postpartum MS relapses. http://www.abstracts2view.com/aan/view.php?nu=AAN10L_S40.004
medicine are responsible for the discovery of incidentally identified anomalies within the CNS now called RIS or Radiologically Isolated Syndrome. In addition to the identification of brain MRI abnormalities that may be highly suggestive of demyelinating disease, asymptomatic spinal cord lesions are periodically identified. The presence of asymptomatic spinal cord lesions place RIS subjects at substantial risk for clinical conversion to CIS, a risk that is independent of brain lesions on MRI. http: //www.abstracts2view.com/aan/view.php?nu=AAN10L_S10.007 44 cases of Leukemia secondary to mitoxantrone therapy may be a significant risk factor for patients with MS. Although a definitive estimate of the risk may be difficult and no clear dose dependence was observed, the possibility of this adverse event warrants ongoing investigation and monitoring of patients receiving mitoxantrone for MS. http://www.abstracts2view.com/aan/view.php?nu=AAN10L_P01. 170 Lymphopenia is a serious side effect from fingomiloid. This study followed up the patients that had developed lymphopenia and discovered that peripheral lymphocyte counts remained depressed beyond the currently expected time period in a few patients following cessation of long-term FTY720 therapy. http://www.abstracts2view.com/aan/view.php?nu=AAN10L_PD5.006 Response to Treatment with Dalfampridine Extended Release Tablets in Patients with Multiple Sclerosis Is Independent of sex, type of MS, EDSS score and concomitant Immunomodulator Therapy. http: //www.abstracts2view.com/aan/view.php?nu=AAN10L_P06.136 This study explored the use of the Bayesian Risk Estimate for MS (BREMS) within the first year of disease as a simple tool for early prediction of unfavorable evolution of multiple sclerosis (MS). They concluded that BREMS score may be useful to identify patients who are candidates for early or more aggressive therapies and was useful to identify patients with high risk of reaching secondary progression. http://www.abstracts2view.com/aan/view.php?nu=AAN10L_P01.183
other disability in the group that had been overlooked. They followed 43 patients for around 11 years. Only ten patients (23%) maintained an EDSS < 3, and showed no changes in MRI, cognitive tests and EDSS (74% of the patients presented changes in MRI studies, showing increase in the number of gadolinium enhancing lesions, new or enlarging T2 lesions or increase in the number of black holes, 47% presented cognitive impairment, and 37% exhibited significant changes in EDSS). They concluded that the definition of benign MS should be reviewed to include disease-related cognitive impairment, social aspects, and MRI changes observed in this population. http://www.abstracts2view.com/aan/view.php?nu=AAN10L_P01.188 Scientist confirm that cervical spinal cord atrophy most strongly correlates with physical disability in MS compared to other central nervous system measures of lesions and atrophy, including thoracic or whole spinal cord volume, and cerebral gray, white or whole brain volume. The weak relationship between spinal cord and brain atrophy suggests that they progress rather independently in patients with MS. http://www.abstracts2view.com/aan/view.php?nu=AAN10L_P03.113 On a double-blind, placebo-controlled randomized Phase II study of two doses of CDP323 in subjects with relapsing forms of multiple sclerosis over 24 weeks was found that oral CDP323 did not provide the level of efficacy expected for an 4 integrin inhibitor. http://www.abstracts2view.com/aan/view.php?nu=AAN10L_S21.002 In RRMS studies, oral teriflunomide 7 or 14mg/day was well tolerated and reduced MRI activity relative to placebo in monotherapy for 36-weeks (both doses>61%) and when added to interferon-beta for 24- weeks (7mg: 56% and 14mg: 81%). Adding teriflunomide 7 and 14mg daily to patients on glatimer acetate showed acceptable safety and improved disease control as evaluated by MRI activity over 24- weeks compared to glatimer acetate alone. Further data are required to establish clinical benefit and safety. http://www.abstracts2view.com/aan/view.php?nu=AAN10L_S21.001
specially if the disease became unbearable. http://www.abstracts2view.com/aan/view.php? nu=AAN10L_P02.158 In a 3-year Phase 2 trial, alemtuzumab patients developed autoimmune disease (thyroid dysfunction 23% and immune thrombocytopenia 3%) at a greater rate than interferon beta 1a patients. But those patients who develop those diseases still experience efficacy effects comparable to those observed with alemtuzumab treated patients. Efforts to characterize and predict the development of autoimmune abnormalities related to alemtuzumab treatment are ongoing. http://www.abstracts2view.com/aan/view. php?nu=AAN10L_P03.114 Alemtuzumab- a new iv treatment for MS has proved to keep the patient free of relapses and disease progression when compared to interferon beta 1a after two years. In the long-term results of the CAMMS223 study, they found that compared to thrice weekly interferon beta 1a, 2 annual cycles of alemtuzumab provide positive efive effects on diverse neurological functions for as much as 2 years after last exposure.http://www.abstracts2view.com/aan/view.php?nu=AAN10L_P05.042 During the first part of the CAMMS223 study on alemtuzumab, a serious side effect cutaneous symptoms of ITP went unrecognized in the 1st case until onset of a fatal cerebral hemorrhage. Five other cases were subsequently diagnosed. ITP onset occurred between 1.5 and 16 months after alemtuzumab. A long-term follow-up of those patients found that at 35 to 48 months post ITP diagnosis, all 5 surviving patients have normal platelet counts with no sequelae. No additional cases of ITP have been identified from CAMMS223. http://www.abstracts2view.com/aan/view.php? nu=AAN10L_P05.036 When researchers evaluated the association between Vitamin D metabolites levels versus clinical and brain MRI injury parameters in 237 multiple sclerosis (MS) patients, they found that low levels of Vitamin D had significant associations with disability and MRI measures in MS. http://www.abstracts2view.com/aan/view.php?nu=AAN10L_PD5.009 Researcher found that vitamin D insufficiency is more frequent in patients with MS when compared with patients without MS in southeastern Michigan. http://www.abstracts2view.com/aan/view.php?nu=AAN10L_P01.196 Tovaxin an autologous T-cell immuno treatment showed potential benefit in clinical, MRI and immunological measures. The annual rate of relapse of the Tovaxin treated patients at 52 weeks was 42% lower than that of placebo. The percentage of patients with stable or improved EDSS at week 52 was 73% for the Tovaxin treated patients and 61% for placebo. http://www.abstracts2view.com/aan/view.php?nu=AAN10L_P04.211 __________
and having disease activity were administered one of two doses of daclizumab (Biogen Idec and Facet Biotech Corp.) or placebo – show that the higher dose reduced disease activity on MRI scans by 72% and the lower dose by 25%. http://www.nationalmssociety.org/news/news-detail/index.aspx?nid=2727 Fingolimod will have a speedy revision by the FDA in its approval process. If there is no mayor problem found, it can be in the market in less than 6 months as the first oral pill for MS. Its commercial name will be Gilenia. http://www.nationalmssociety.org/news/news-detail/index.aspx?nid=2758 Disease-modifying therapy is ineffective in patients (Expanded Disability Status Scale [EDSS] > 6.5) with secondary progressive multiple sclerosis (MS) without relapses, or in primary progressive MS. An epidemiological study in Ireland questioned neurologist and persons with progressive disease on the use of the therapy. A significant proportion considered to be receiving therapy without benefit. They concluded that the costs of disease-modifying therapies in this group (>170,000 euro dollars yearly) could be re-directed towards development of neurology services to optimize their management. Mult Scler. 2009 Dec;15(12):1528-31, Scientists speculate that the occurrence of melanoma during natalizumab treatment in multiple sclerosis is purely a coincidence. They considered that at the moment the incidence of melanoma is estimable as about 5 per 100,000 multiple sclerosis person-years treated with natalizumab, and in the general population, the incidence of melanoma per 100,000 person-years is more than 10. Mult Scler. 2009 Dec;15(12):1532-3. In a double blind randomized sham-controlled trial on reflexology for the treatment of pain in people with MS it was found that precision reflexology was not superior to sham, however, both treatments offer clinically significant improvements for MS symptoms fatigue, depression, disability, spasm and quality of life via a possible placebo effect or stimulation of reflex points in the feet using non-specific massage. Mult Scler. 2009 Nov;15(11):1329-38 The results of a single center randomized, double-blind, placebo-controlled, parallel group trial of memantine in adults with multiple sclerosis and spasticity did not demonstrate efficacy in treatment of spasticity in this 12-week small exploratory study. Mult Scler. 2010 Feb;16(2):248-51 |
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