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Saturday, August 19, 2017

Evaluation of pregnancy outcomes from the Tysabri® (natalizumab) pregnancy exposure registry: a global, observational, follow-up study.


                                                                  
  
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Abstract

BACKGROUND:

Patients with multiple sclerosis (MS) or Crohn's disease (CD) being treated with natalizumab (Tysabri®, Biogen) who are planning to become pregnant or discover they are pregnant after exposure to natalizumab are currently advised to balance the potential benefits and potential risks of exposure when considering treatment options. This study was undertaken to evaluate pregnancy outcomes of women with MS or CD who were exposed to natalizumab at any time within 3 months prior to conception or during pregnancy. A pregnancy registry was created to better understand the effect of natalizumab exposure on pregnancy outcomes
The Tysabri Pregnancy Exposure Registry was a global, observational exposure registration and follow-up study. Evaluations included spontaneous abortions (<22 weeks gestational age), fetal losses (≥22 weeks gestational age), ectopic pregnancies, elective or therapeutic terminations, stillbirths, birth defects, and live births. Birth defects were reviewed and coded in accordance with the Metropolitan Atlanta Congenital Defects Program (MACDP) classification of birth defects.

RESULTS:

A total of 369 patients with MS and 7 patients with CD were enrolled prospectively, of whom 355 patients (99.4 %; 349 MS and 6 CD) had known pregnancy outcomes (including 8 twin sets). The spontaneous abortion rate was 9.0 % (n = 32; 95 % confidence interval [C. I.], 6.3-12.5 %). An independent advisory committee review determined the major birth defect rate to be 5.05 % (16 of 316 live births + 1 elective abortion; 95 % C. I., 2.9-8.1 %). The mean gestational age of the live-born infants was 38.3 weeks, and the mean birth weight was 3158.3 g.

CONCLUSIONS:

Although the overall rate of birth defects was higher than that observed by the MACDP, these registry outcomes showed no specific pattern of malformations that would suggest a drug effect, and the spontaneous abortion rate was consistent with that of the general population.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00472992 (11 May 2007).

KEYWORDS:

Fetal development; Follow-up studies; Live birth; Multiple sclerosis; Pregnancy outcome; Spontaneous abortion
PMID:
 
27552976
 
PMCID:
 
PMC4995778
 
DOI:
 
10.1186/s12883-016-0674-4
[Indexed for MEDLINE] 
Free PMC Article Source: Pubmed


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Cannabis for MS: Can it help treat symptoms?


                                                                  
  
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I've heard that cannabis can help ease symptoms of MS. Is that true?

Answers from Dean M. Wingerchuk, M.D.
Recent studies found that an extract of cannabis taken in a capsule form can help relieve multiple sclerosis (MS) symptoms, such as muscle stiffness (spasticity) and spasms, and may also reduce pain. A mixture of cannabis extracts taken in spray form possibly reduces symptoms of spasticity, pain and bladder urgency.
But the use of cannabis to treat MS symptoms is complicated.
All cannabis-based medicines have side effects, and some can be serious, including:
  • Difficulty with attention or concentration
  • Dizziness or faintness
  • Dry mouth
  • Hallucinations
  • Loss of balance and falls
  • Depression or psychosis
Cannabis is a federally controlled substance. At this time, medical marijuana can be prescribed legally in approximately 20 states and in Washington, D.C.
To date, the Food and Drug Administration has approved two synthetic forms of marijuana for medical use, dronabinol (Marinol) and nabilone (Cesamet), both available in capsule form.
Both drugs are approved for treating nausea and vomiting associated with chemotherapy that does not respond to standard treatment. Dronabinol is also approved for loss of appetite associated with weight loss in people with AIDS. At this time, the drugs are not approved for other uses.
An oral cannabis extract spray, nabiximols (Sativex), is not currently available in the U.S. Also, smoked marijuana has not been adequately studied for safety and benefit.
The role of cannabis for MS symptoms has not been fully defined. Future research will help determine the balance of benefits and risks of cannabis and compare its effects with other treatments available to treat spasticity, pain and other MS symptoms.

With
Dean M. Wingerchuk, M.D.

Article source


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Vitamin D and MS: Is there any connection?


                                                                  
  
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Is there any proof that vitamin D supplements can prevent MS or keep symptoms of MS from worsening?

Answers from Jerry W. Swanson, M.D.
A study conducted by researchers at the University of Oxford and another conducted at the New Jersey Medical School have suggested that maintaining adequate levels of vitamin D may have a protective effect and lower the risk of developing multiple sclerosis (MS).

Another study conducted at Maastricht University in the Netherlands and others suggest that for people who already have MS, vitamin D may lessen the frequency and severity of their symptoms. More research is needed to assess these findings.



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Vitamins for MS: Do supplements make a difference?


                                                                  
  
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A patient's question:

I've read that vitamin supplements could help my MS symptoms. Is that true?


Answers from Brent A. Bauer, M.D.
Many people look to complementary and alternative therapies to treat symptoms of multiple sclerosis (MS). Among them, dietary supplements, including high-dose vitamins, are used most frequently. But will taking more than the recommended daily allowance of certain vitamins help your MS?
The question of whether larger doses of vitamins are beneficial is controversial. To be most effective, vitamins need to work in careful balance. A high concentration of one vitamin might cause a relative deficiency of another.
Vitamin D may be an exception. So far, vitamin D is one of the most intensely studied supplements for MS. For several years, there has been a growing interest in the role of low vitamin D levels and an increased risk of MS attacks or exacerbations.
Current research suggests a possible relationship between the two, although more thorough studies are needed to establish a definite link. For now, daily supplementation with up to 4,000 international units (IU) of vitamin D-3 is generally considered to be safe. Doses greater than 4,000 IU a day may sometimes be necessary in people who are vitamin D deficient, but large doses may also carry increased risks. Talk with your doctor before taking high-dose vitamin D therapy.
Fruits and vegetables contain vitamins and other nutrients in useful proportions, working together to play their role in good nutrition and disease prevention. For most people, even those with MS, the most reasonable course of action is receiving the recommended amount of vitamins from dietary sources, such as fruits and vegetables, rather than vitamin supplements.

If you have MS and are considering vitamin supplements, talk with your doctor first to determine what vitamins and doses he or she recommends.


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Friday, August 18, 2017

Catching the Flu Can Trigger an MS Relapse by Activating Glial Cells, Study Suggests


                                                                  
  
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August 2017

Coming down with the flu can provoke relapses in multiple sclerosis (MS) patients by activating glial cells that surround and protect nerve cells. In a study in mice, scientists found that activated glial cells increase the levels of a chemical messenger in the brain that, in turn, triggers an immune reaction and, potentially, autoimmune attacks.

Catching the Flu Can Trigger an MS Relapse by Activating Glial Cells, Study Suggests

The flu is caused by the human influenza virus and, despite being unpleasant, usually resolves itself within days. However, for people with MS and other neurological conditions, the flu can lead to disease relapse.
Researchers at the University of Illinois investigated what happens in the brain of MS patients during upper-respiratory viral infections, such as the flu.

“We know that when MS patients get upper respiratory infections, they’re at risk for relapse, but how that happens is not completely understood,” Andrew Steelman, an assistant professor at the university and the study’s senior author, said in a press release. “A huge question is what causes relapse, and why immune cells all of a sudden want to go to the brain. Why don’t they go to the toe?”
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University of California at San Francisco Recruiting MS Patients for Gut Bacteria Study


                                                                  
  
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August 2017
University of California at San Francisco Recruiting MS Patients for Gut Bacteria Study
University of California medical school researchers are looking for multiple sclerosis patients who want to participate in an international study of the bacteria that live in our gut.
The University of California at San Francisco team decided to study the gut microbiome after recent evidence suggested that it is critical in establishing and maintaining immune balance, according to a press release. The effort will be called the International Multiple Sclerosis Microbiome Study.
In mammals, the gut is the largest immune organ, and each person has millions of bacteria in it.
The immune system is defective in MS, turning against the body by attacking the brain and spinal cord. Knowing that the gut is involved in immune system balance, the researchers will investigate whether the microbiome can directly or indirectly impact how MS develops.
Researchers are seeking people with different types of MS. Those with primary progressive MS, or PPMS, will not need to visit the San Francisco medical center.
Those with other types of MS will have to make one visit to San Francisco, New York, Boston or Pittsburgh. The one-time visit will include cognitive and movement assessments, a neurologic examination, and questionnaires about diet.

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Children and Teens with Multiple Sclerosis consume less iron


                                                                  
  
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Children with multiple sclerosis consume less iron, which may affect their immune and nervous systems, according to a study.

Children and Teens with Multiple Sclerosis Consume Less Iron, Study Reports


Most MS cases occur between the ages of 20 and 40, but sometimes children under 18 develop it.
Pediatric-onset MS, as it’s called, is believed to account for 3 to 5 percent of cases that adults have now. Despite their low frequency, they are important because “the study of factors early in life which could affect their disease may provide important insight into the disease more generally,” the researchers from the Network of Pediatric MS Centers wrote.
One of the factors that could be important in the onset of MS is diet. But little has been known about how diet influences the risk and progression of the disease, particularly in pediatric MS.

In a study funded by the National MS Society, researchers decided to investigate the association between diet and MS in children, according to a press release.
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Thursday, August 17, 2017

Natalizumab in Multiple Sclerosis: Long-Term Management


                                                                  
  
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 2017 Apr 29;18(5). pii: E940. doi: 10.3390/ijms18050940.




Abstract

Natalizumab is a monoclonal antibody highly effective in the treatment of relapsing remitting multiple sclerosis (RRMS) patients. Despite its effectiveness, there are growing concerns regarding the risk of progressive multifocal leukoencephalopathy (PML), a brain infection caused by John Cunningham virus (JCV), particularly after 24 doses and in patients who previously received immunosuppressive drugs. Long-term natalizumab treated, immunosuppressive-pretreated, and JCV antibody-positive patients are asked to rediscuss natalizumab continuation or withdrawal after 24 doses. Until now, there has not been a clear strategy that should be followed to avoid PML risk and in parallel reduce clinical and radiological rebound activity. In this review, we analyzed the results of clinical trials and case reports in relation to the following situations: natalizumab continuation, natalizumab discontinuation followed by full therapeutic suspension or switch to other first or second line MS treatments. Quitting all MS treatment after natalizumab increases MS activity occurrence. The results regarding the therapeutic switch are not homogeneous, so at the moment there are no established guidelines regarding natalizumab treatment after 24 administrations; the choice is currently based on the professional experience of the neurologist, and on patients' clinical features and preferences.
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Wednesday, August 16, 2017

How MS Affects the Entire Family


                                                                  
  
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Open communication and mutual support help patients, parents, spouses and kids.


By Lisa Esposito, Staff Writer 

There's something about multiple sclerosis, or MS, that disrupts families at every level. "I've often talked about it as the uninvited guest," says Rosalind Kalb, vice president for health care information and resources at the National Multiple Sclerosis Society. "This disease shows up in your household, moves in, spreads its junk all over and doesn't leave. It means everyone has to develop a relationship with this intruder."
MS is a progressive disease of the central nervous system that affects the brain, spinal cord and optic nerves. Multiple sclerosis causes multiple symptoms – from blurred vision to blindness; mobility issues ranging from poor balance and coordination to paralysis; slurred speech, tremors and severe fatigue; and problems with memory and concentration.
A family sits on a hospital bed.
Keeping the lines of communication open can help families offer support and information. (GETTY IMAGES)
There's no cure for MS, and it's unpredictable. People with relapsing/remitting MS, the most common form, experience periodic flare-ups that come and go. About two-thirds of cases occur in women. First symptoms – often visual – most commonly happen between ages 20 and 40, according to the Centers for Disease Control and Prevention, although children and older adults can be diagnosed, too.
When you put those risk factors together, "Women of childbearing age, who are starting careers and families, are the folks who seem to be most often at risk," says Kalb, a clinical psychologist and the author of "Multiple Sclerosis For Dummies."
Shifting Family Shoulders



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Disproven Theories About the Causes of MS and Its Flare-ups


                                                                  
  
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Science may get closer to actual causes when it learns what doesn't trigger the disease.


By Heidi Godman, Contributor | March 24, 2017

A home heathcare nurse exchanges a smile with her patient. The patient, receiving nutrition from a feeding tube, has advanced Multiple Sclerosis (MS).
While some multiple sclerosis causes have been nixed, smoking and Vitamin D deficiency are both still associated with the risk for developing MS. (GETTY IMAGES)
 You may hear about a lot of potential causes of multiple sclerosis, the progressive, incurable disease that damages the brain, spinal cord and optic nerves. Theories have ranged from genetic to environmental triggers, some as simple as living with a pet.

In reality, it's difficult to say exactly what causes the condition. "If there were just one thing that caused MS, I believe we would have figured it out by now," says Dr. Robert Shin, a professor of neurology at MedStar Georgetown University Hospital.
Understanding MS
MS starts when the body's immune system mistakenly attacks the nerves and their protective covering. "I use the analogy of friendly fire. It's like we have soldiers in the field fighting the enemy. Sometimes they can get confused and accidentally shoot allies," Shin says.
The damage interrupts the signals being transmitted throughout the body, resulting in symptoms ranging from numbness and tingling in the extremities to vision problems, muscle weakness, trouble walking and even paralysis.

The disabling nature of the condition has motivated scientists to try to pinpoint why the immune system takes aim at a healthy central nervous system. Researchers are also seeking to understand what causes people with the most common type of MS – called relapsing-remitting MS – to experience symptom flare-ups periodically.
Eliminating MS Causes
It was only the 1960s when scientists began unraveling how the MS disease process works, according to the National Institutes of Health. In the six decades since, researchers have studied many potential causes of MS, and come up with few answers.
Scientists are at least beginning to understand what doesn't lead to MS onset. For example, scientists suspected for years that a virus carried by dogs, called canine distemper, was associated with the onset of MS in dog owners. A 1982 New York Times article recounts how two neurologists made the connection after three sisters developed MS in 1974, not long after the family's dog contracted distemper.
But there has not been enough clinical evidence to support a link between MS and canine distemper, reports the National Multiple Sclerosis Society.
The group notes that there is also a lack of evidence supporting an association between MS and:
  • Environmental allergens (allergies).
  • Exposure to the heavy metals mercury, lead or manganese.
  • Consumption of the artificial sweetener aspartame.
Nixed Relapse Triggers
When Dr. Colin Bamford began researching MS in 1976, scientists already knew the immune system was involved in the development of MS. But it wasn't clear what triggered MS relapses or the progression of disability.
One question, Bamford recalls, was whether physical trauma could lead to deterioration. 

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