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Breastfeeding, Disease Modifying Therapies (DMTs), and Postpartum Relapse in Multiple Sclerosis

Women with multiple sclerosis (MS) have higher risk of relapse during the postpartum period.  Can exclusive breastfeeding alone prevent relapses? How soon after delivery should disease modifying therapies (DMTs) be reintroduced? Are any DMTs safe to take while breastfeeding? 
 
While disease modifying therapies (DMTs) have been shown generally to reduce relapse rates, none of them are indicated for use during pregnancy and lactation. Therefore, the question of when to restart DMTs postpartum remains a difficult one for physicians counseling MS patients who wish to breastfeed their children.
 
Trying to predict the risk of relapse for any one individual is very difficult. The risk factors for postpartum attacks include ...

Rare infection occurs in patient on Tecfidera

On Tuesday 10/21/14 Biogen announced that a patient treated with Tecfidera developed a rare infection, progressive multifocal leukoencephalopathy (PML). This patient was from Europe and had been treated with Tecfidera for 54 months. For approximately 3 ½ years, this person’s lymphocyte counts were very low, in the 200-500/mm3 range. After an illness lasting about 4 months this patient died from complications of the infection.
 
PML is an infection caused by the JC virus. About half of the population has the JC virus. Once a person has the JC virus, the immune system quickly brings it under control, but the virus remains hidden in the kidneys after that. From the kidney, the virus can periodically flare up and the immune system quickly brings it under control again. There are many other viruses that have this ability to periodically flare up, for example a virus that remains hidden in the nerves of the face can periodically flare up causing fever blisters, or chicken pox virus remains hidden in the nerves and can periodically flare to cause shingles. The JC virus is fairly easy for the immune system to control, and it generally does not cause medical problems. The one exception is PML.
 
PML occurs when the JC virus flares up in a person whose immune system is not normal. In this setting the virus can spread from the kidney to the brain where it causes widespread damage and usually death. This can happen with a number of immune system diseases, or with prolonged courses of chemotherapy. In recent years PML has occurred with other medications that block the immune system.
 
Tecfidera has been a very successful medication used to treat multiple sclerosis. However, it can cause a decrease in the white blood cells and lymphocytes in the blood. This decrease is usually about 30, which is a level that would not be concerning.  About...

October Pet of the Month at the Multiple Sclerosis Center


Name:   Bootsy

Age: 6 years old

Born: Bootsy was ...

A (Slightly) New Medication for Multiple Sclerosis Comes Out in November

Interferons have been used for the treatment of multiple sclerosis (MS) since 1993. The existing line-up of interferons for MS (Avonex, Betaseron, Extavia and Rebif) will soon be joined by Plegridy, approved by the US Food and Drug Administration in August 2014. Plegridy will become commercially available in November 2014.

Plegridy is a pegylated form of interferon beta. Pegylation is a process, used by several other non-MS medications, whereby a long string of polyethylene glycol molecules is attached to the interferon beta molecule, to extend its half-life by reducing clearance via kidneys or other elimination pathways in the body. This modification allows less frequent dosing of Plegridy – once every two weeks – although it is still administered as an injection under the skin.

In the ADVANCE trial, Plegridy was ..

Getting the most out of your appointment

I was recently asked if I could provide advice on how patients could get the most out of their Swedish Multiple Sclerosis Center visits.  In reality, I think most of us have been patients at least once in our lives. The list of tips I provide is comprehensive. However, critical information may be missing.  If you notice omissions, please respond with your own advice in the comments since we can all learn from each other.
 
One of the most important MS life survival lessons is that we are all part of the same team. As a member of that team, our goal is to equip you with the knowledge and skills to live your life to the fullest. This starts with the MS Center visit. Where you go with the information, is all part of our journey together:

Just Keep Moving: Carolyn Phelps completes Ironman 70.3 in Lake Stevens

A dedicated eighth grade math teacher, wife, and mother of two, Carolyn Phelps did not exactly have the schedule to accommodate triathlon training. But after persuasion from her triathlete neighbor, Carolyn embarked on a year of intense training in order to compete in the Half Ironman in Lake Stevens, Washington this past month. Diagnosed with MS two years earlier, Carolyn made the decision to "keep moving." Competing in an Ironman event was not on her list of things to do a couple of years ago, but with her new diagnosis, she made her mind up to just move. "I don't want it to pass me by," she said. "We want to set a positive example for our children. This was a lifestyle decision, not an event," she explained.

Carolyn is the first to say she never could have succeeded without her family's support. Long runs and late night swims at the local pool caused Carolyn to commit to a tight schedule. Her husband and children were with her every step of the way "Picking up the slack," she said, "and eating peanut butter and jelly sandwiches some nights when she could not make it home for dinner." She still gets emotional about it. "I just had so much support."

In preparation for the event, Carolyn's training consisted of  ....

Gray Matter Myelin Loss Linked to Severity of Multiple Sclerosis Symptoms

In a recent collaborative study completed by the Swedish Multiple Sclerosis Center, University of Washington, and University of Wisconsin, doctors discovered through a more refined magnetic resonance imaging (MRI) process, the amount of myelin lost in the gray matter of multiple sclerosis (MS) patients’ brains may indicate a more severe form of the disease.
 
Multiple Sclerosis (MS) has long ...

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