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Statin Benefits Secondary Progressive MS

No treatments can currently abate the advanced stage of the disease, known as secondary progressive MS, which gradually causes patients to become more disabled. Statins are postulated to have immunomodulatory effects that appear to be independent of their effect on cholesterol. A benefit has been suggested in early multiple sclerosis (MS) based on reduction of magnetic resonance imaging brain lesions.  However, following trials have had inconsistent results.

In this multicenter, double-blind study, investigators randomized 140 participants with secondary progressive (SP) MS to 80 mg of simvastatin or placebo daily for 2 years. Participants were 18 to 65 years old, had active progression over the preceding 2 years, and had difficulties ambulating but were not wheelchair bound.  Whole brain atrophy was 43% slower annually in simvastatin recipients than in placebo recipients. The simvastatin group also had small clinical improvements over placebo on the disability scale and a patient-reported MS impact scale at 24 months.
 
These findings show that simvastatin reduced ...

Drug treatment and weight loss restores vision in a blinding disorder linked to obesity

As many as 100,000 Americans suffer from a disorder called pseudotumor cerebri or idiopathic intracranial hypertension that can cause permanent blindness and chronic headaches. The disease primarily strikes obese women of reproductive age with symptoms of daily headaches, visual symptoms including transient blurring or blindness, double vision, and pulsating noises in one’s head. Up to 5-10% of these patients may have permanent visual loss due to optic nerve damage.
 
A recent national trial funded by the National Institute of Health’s National Eye Institute has shown that a common water pill, acetazolamide, combined with a moderate but comprehensive dietary and lifestyle modification plan can restore and preserve vision in women with this disease. I was one of the local investigators for this trial along with Dr. Eugene May.
 
The symptoms of pseudotumor cerebri are thought to be due to high spinal fluid pressure around the optic nerves and brain due to impaired reabsorption of spinal fluid that is continuously being produced within the brain. This results in chronic headaches and swelling of the optic nerves that can lead to permanent blindness if left untreated. Patients typically are ...

Insufficient evidence to support complementary and alternative therapies for multiple sclerosis

A guideline was recently published about the use of complementary and alternative medicine in multiple sclerosis (MS).

The guideline process involves identifying all of the scientific articles about potential therapies and evaluating them based on their scientific merits. The evaluation process follows a strict set of requirements related to the conduct of the research.

The review included a wide variety of complementary and alternative therapies that have been proposed for MS. Not surprisingly, most therapies did not have sufficient scientific data to determine whether or not they were effective. Some cannabinoid preparations (marijuana extracts) were shown to be effective, primarily for spasticity. This reflects a relatively large number of studies done with these compounds and the availability of a commercially available extract in some countries. A handful of therapies were shown to be ineffective. Most therapies had insufficient studies to determine their effectiveness.

The importance of this review is that it ...

Physical fitness associated with improved cognition in multiple sclerosis

The benefits of exercise and being physically fit is what many people strive for.  However, a recent study added a new dimension to what exercise can do to enhance health.  In other words, exercise did more than keep a body fit.  It also made study participants think better.  You may ask, why is this new information important?  

 
Cognitive impairment is one of multiple scleroris (MS) ’s most disabling features and it can affect between 22% to 60% of people living with the disease.  Cognitive deficits may include problems with: slower information processing speed; memory impairment; difficulty with new learning and executive functioning.  Historically, medical and rehabilitation approaches to the problem have been inconsistent in improving cognition.
 
The new frontier of exercise for improved cognition provides hope. This study’s objective was to determine if there was an association between improvements in objective measures of physical fitness and performance on cognitive tests.
 
Participants were people with MS who participated in a telephone based health promotion intervention, chose to work on exercise, and who completed pre and post intervention assessments. Participants were then measured for strength, aerobic fitness, and cognition at baseline and 12 weeks later.
 
After controlling for variables such as age, gender, MS disease activity, MS type, etc. there was evidence suggesting that cognitive functioning changed over time based on level of fitness. Participants in the physically improved group showed improved performance on measures of executive functioning after 12 weeks of exercise.  The results of this study add support to the hypothesis that change in fitness is associated with improved executive functioning in people with MS. The desired outcomes are that improved cognition correlates with better quality of life, activities of daily living, vocational endeavors, and rehabilitation measures.
 
Where do we go from here? Since less is known about exercise training and cognition in MS (compared to studies demonstrating aerobic and strength training significantly improving cognitive functioning in older adults and people with mild cognitive impairment), we need more studies to examine this relationship in the MS population. 

Functional Electrical Stimulation (FES) braces improve gait

Up to 80 percent of people with multiple sclerosis (MS) have problems with walking.  The combination of weakness of the muscles of the legs, spasticity, and core weakness contributes to this.  Often, it will present with problems lifting the foot, referred to as foot drop.  This is due to weakness of the muscles that lift the foot (dorsiflexors) and spasticity or over power of the muscles that push the foot down (plantar flexors).  Traditional ankle foot orthosis have advantages over functional electrical stimulation (FES) braces in that they help with ankle stability and reduce spasticity.  Advantages of FES braces include some evidence that there may be stimulation of the cortical neurons above the stimulation area, they are less cumbersome, and more discrete to wear.

A recent study looked at ..

FDA declines approval of Lemtrada for the treatment of MS

On December 30, 2013, the US Food and Drug Administration declined to approve the use of alemtuzumab (Lemtrada) for the treatment of multiple sclerosis. The FDA stated that the manufacturer of Lemtrada “has not submitted evidence from adequate and well-controlled studies that demonstrate the benefits of Lemtrada outweigh its serious adverse effects.” This was a surprising decision to some, as only a month earlier an advisory panel of experts convened by the FDA, while raising some objections, voted to have this medicine approved. The manufacturer of Lemtrada, Genzyme, a Sanofi company, intends to appeal this decision.
 
In response, a number of MS organizations and experts have voiced their concerns that with this step, MS patients are left without a potential choice in therapy. This decision is particularly difficult for ...

FDA approves 40 mg/mL Copaxone for 3 times a week

The U.S. Food and Drug Administration (FDA) has approved the three-times-a-week COPAXONE® 40mg/mL, a new dose of COPAXONE® on Jan 28, 2014.  This new formulation will allow for a less frequent dosing regimen administered by injection for patients with relapsing forms of multiple sclerosis (MS). In addition to the newly approved dose, daily COPAXONE® 20 mg/mL will continue to be available.

The FDA approval is based on data from ...
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