'treatment' Neuroscience (SNI) posts

The last 20 years have held significant gains for people living with multiple sclerosis (MS). Thanks to new studies and a full pipeline of those to come, our understanding of the disease and promises for future remedies grows rapidly.

Dr. James Bowen, Medical Director and neurologist at the MS Center at Swedish, wrote an article on this progress n Scientific American MIND. "Solving the Mystery of MS" unpacks the history of MS treatments, from breakthrough treatments to rethinking the disease origin, and offers a comprehensive view of what we know now as well as what lays ahead.

One year ago today, the first patients visited the brand new Multiple Sclerosis (MS) Center at Swedish Neuroscience Institute. The 11,700-square-foot facility was designed around the patient experience as part of the MS Center’s commitment to treating the whole person and addressing each patient’s individual emotional, psychological, social and physical needs in a supportive environment.

Since we opened our doors on April 9, 2012, we’ve hit a few new milestones:

• More than 5,400 total patients, including 620 new faces, from around the world received care from our comprehensive treatment team in the last 12 months.

• We welcomed three new providers: neurologist Peiqing Qian, M.D.; physical therapist Kim Kobata, PT; and neuro-psychiatrist Lina Fine, M.D., M.Phil.

• We completed the Pigott Terrace. The 1,500-square-foot outdoor therapy terrace includes a one-of-a-kind system that enables patients to ...

On March 27, the U.S. Food and Drug Administration approved the newest treatment in the increasing number of disease modifying therapies (DMTs) available to treat multiple sclerosis. Tecfidera (BG-12) is an oral capsule to treat adults with relapsing forms of MS. Research participants at the MS Center at Swedish participated in clinical trials for Tecfidera.

The trials reported that people taking Tecfidera had fewer relapses and less frequent worsening of disability compared to people taking a placebo. There were also fewer and less-severe side effects with Tecfidera than other treatments.

The studies found that ...

A small pilot study from the University of Southern California suggests a pulse adrenocorticotropic hormone (ACTH) therapy could be effective in patients with breakthrough multiple sclerosis attacks while on beta-interferon. “Breakthrough” attacks that occur after starting a disease modifying therapy (DMT).

The study compared the safety and benefits of monthly pulse ACTH to monthly methylprednisone (MP) pulse in patients on beta-interferon. Over 15 months, researchers found that those treated with ACTH had fewer relapses and fewer psychiatric side effects. ACTH gel is currently used to treat MS relapses, but researchers note it may be able to alter the body’s immune responses beyond producing steroids.

As I discussed with the Medscape reporter, Megan Brooks, last week, the results of this study are ....

Increased dietary salt was reported to increase the immune attack on myelin in three studies this week. All three were published in the journal Nature.

1. A study by Kleinewietfeld, et al, looked at TH17 cells, which is a type of lymphocyte that is highly inflammatory and that causes substantial tissue damage. These cells were grown in cultures in the lab. Some had normal and others high salt levels in their cultures. Those grown in a high salt environment had increased markers for inflammation. This seemed to be due to activation of one particular set of chemical signals in the cell, called the p38/MAPK pathway. They also looked at mice with an MS-like disease called experimental allergic encephalomyelitis (EAE). Mice fed a high salt diet had worse EAE than those fed a normal diet.
2. A study by Wu, et al, also looked at TH17 cells. An analysis was done on genes associated with activation of TH17 cells, and SGK1 was identified as an important protein in this process. The SGK1 pathway was found to be more active if cells were cultured in a high salt environment. This was then studied in mice with EAE. Mice fed a high salt diet had more severe EAE. Blocking the SGK1 pathway seemed to reverse the effect of the high salt diet on the EAE.
3. A study by Yosef, et al, also looked a the genes associated with activation of TH17 cells. They identified 22 sets of related genes that increased TH17 cell activity and 5 that decreased activity.

TH17 cells are highly inflammatory and likely contribute to the severe damage done to tissues in a number of diseases. Their precise role in MS is not fully understood, but it is believed that ...

Tremor is a normal physiologic reaction to anxiety or stress, but it is not normal to have a tremor when performing typical daily activities.

People who develop a tremor while eating, drinking, writing or doing other common activities may have a movement disorder called Essential Tremor. This is actually the most common movement disorder, and can affect up to 4% of people over age 40. People who have this disorder can take medications to help minimize the tremor, but they don't often reduce the tremor by more than about half. Deep brain stimulation (DBS) is an excellent treatment option for people with severe tremor, and can nearly eliminate the tremor in many patients. Many patients aren't sure when their tremor is severe enough to warrant surgery, and much of our conversation in the office is to help answer this question.

There is no one answer that is right for everyone, but for me it has to do with how well someone is actually doing in their daily life:

It is well documented that exercise is beneficial for the body and mind because it promotes strength, endurance, flexibility, range of motion, mood, and a general sense of health and well-being. All these “perks” improve function in our daily lives. Add music to the aerobics routine and the soul is uplifted. After all, music can calm or energize the spirit and often allows us to move more freely.

The MS Center at Swedish offers free aerobics classes to the MS community for the joy of movement and music. In contrast to the typical dance-like moves that might come to mind when you think of aerobics, the exercises in Aerobics for MS are designed to increase strength and mobility for functional movements part of everyday life. Most of all, they’re meant to be fun! Classes take place in a supportive and relaxed environment, and all abilities are invited.

For more information about MS aerobics classes...