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Robotics and the future of rehabilitation for multiple sclerosis

I am pleased to write some of my thoughts after attending the International Conference on Rehabilitation Robotics (ICORR) in June. This bi-annual meeting brings together biomedical, design, and mechanical engineers as well as providers that work in the field of rehabilitation robotics.

Robotic devices are part of the future of neuro-rehabiltation for multiple sclerosis (MS) patients.  ICORR displayed designs and prototypes of upper extremity devices and lower extremity gait orthosis devices that hold promise for MS patients.

Using these devices in clinical rehabilitation practice would improve patients’ ability to perform the frequent, repetitive movements that we know are essential for the brain to adapt to change, re-grow myelin and build connections between neurons (all parts of healthy neuroplasticity). It would also help address ....

MS Research Roundup: Cannabinoids and new trials for progressive MS

A couple recent announcements may be of interest to people living with multiple sclerosis. Read the articles below and click through the links for more information about the individual studies.

Trial shows no benefit of cannabinoid in slowing multiple sclerosis progression

A UK trial of dronabinol (delta-9-THC) in 498 patients did not slow the progression of multiple sclerosis (MS) compared to placebo. Critics will point out that this is only one of many cannabinoids found in marijuana; and that the placebo arm did better than expected (thus limiting the ability to detect the effects of the drug). Nonetheless, the result is the strongest argument yet against the neuroprotective effects of THC in MS population.

New trials in progressive MS are coming

Later this year, two trials will ...

Can Botox help paraspinal muscle spasticity in multiple sclerosis?

This post is jointly written with Alika Ziker, Swedish Neuroscience Institute research intern.

Botulinum toxin type-A (Botox) is a naturally occurring toxic substance best known for its use in cosmetics.  It is taken from certain bacteria and works by preventing the target muscle from contracting.

Over the last 15 years, several studies have emerged supporting the idea that Botox is also an effective and safe therapy for people who suffer from a loss of muscle control, lower back pain and even migraines. Because multiple sclerosis (MS) is a disease that attacks the central nervous system, many MS patients suffer from those same conditions, as well as weakness and spasticity.  Depending on the individual, the affected muscles may be ....

Do injectable therapies benefit progressive forms of MS?

The American Academy of Neurology (AAN) recently published their Top Five Recommendations in the Choosing Wisely Campaign in promoting high value neurological care. This was done in collaboration with the American Board of Internal Medicine Foundation and Consumer Reports to reduce ineffective and costly care.

One of the AAN’s recommendations was to stop prescribing interferon-beta and glatiramer acetate to people who have progressive, non-relapsing forms of multiple sclerosis (MS).

The AAN made clear that  the recommendations were intended to promote discussion between patients and their providers about the value of these therapies, not to completely stop the use of specific treatments.

The recommendation to stop prescribing interferon-beta and glatiramer acetate is not unanimously supported by all MS neurologists, many of whom feel that this was an oversimplification.

People with ...

Multiple sclerosis MRI technique can spot tissue damage months before an MS attack

A study published in this week’s Neurology found that a relatively new MRI technique could spot changes in the brain up to three months before inflammation causes a multiple sclerosis (MS) attack.

Traditionally, we have viewed MS as a disease where the immune system attacks the brain, causing the abrupt onset of inflammation (measured by gadolinium enhancement). This inflammation causes damage to the brain, which causes symptoms.

The new technique, called susceptibility-weighted imaging, allows researchers to see that tissue damage is happening up to three months prior to the inflammation.

Susceptibility-weighted imaging measures the amount of magnetic susceptibility of tissues aligned in different directions. The amount of alignment in different directions is called the phase image. In tissues like myelin, the magnetic susceptibility lines up with the direction of the myelin because molecules can move alongside the myelin more easily than they can move across it.

When myelin is damaged, the tissue becomes disorganized and magnetic susceptibility changes from aligning primarily in one direction to alignment in many different directions. The phase image can be used to measure the degree of myelin damage.

In this study, 20 patients ...

Vision Problems with MS: Can AP-4 (Ampyra) help?

Each optic nerve contains approximately one million nerve cells (neurons) that connect the eye to the brain. Inflammation from multiple sclerosis (MS) can affect the optic nerves. Therefore, it is very common for people with MS to have vision problems.

When MS inflammation affects optic nerve neurons, they may lose their protective myelin coating, a process called demyelination. This caused signals through the neurons to slow down, resulting in blurred vision.

Medications may repair myelin, but studies are limited.

4-aminopyridine (4-AP) is a medicine used to treat symptoms of MS caused by demyelination. It stabilizes movement of potassium ions through the surface of demyelinated neurons, making it easier for them to conduct signals.

Historically, 4-AP has only been available through compounding pharmacies, so studies of its use have been ...

MS Research Update: Safety of oral MS medication with effective birth control

Teriflunomide (Aubagio) is a once daily oral disease modifying therapy approved for treating patients with relapsing forms of multiple sclerosis (MS). One of the limitations of its use is its black box warning for potential fetal harm due to birth defects noted in rats and rabbits. Women who are of childbearing age who are not using reliable birth control are advised to not use teriflunomide.

At the Consortium of Multiple Sclerosis Centers annual meeting on May 30, I presented a poster describing 81 pregnancies in female patients and 20 pregnancies in partners of male patients in nine teriflunomide clinical studies. Of these pregnancies, none of the 20 babies born to female patients and 12 live births in partners of male patients had any structural or functional problems. The mean known birth weight and mean gestational age were normal, as was the miscarriage rate.

These findings are consistent with ..

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