April 21, 2016
Doctors have known for years that most women with multiple sclerosis (MS) feel better and have fewer relapses when they are pregnant. Researchers have speculated that fluctuating hormones may be linked to this improvement in health. But studies on MS and hormones during pregnancy have had mixed results. I’ve changed my thinking on this and I’m embarking on new research that involves microchimerism.
April 05, 2016
The Food and Drug Administration (FDA) has granted “fast track” designation for ibudilast, a medication that could help prevent damage to the brain in people with progressive multiple sclerosis.
January 08, 2016
This is the third in a series of three blog posts by James Bowen, M.D., the medical director of the Swedish Multiple Sclerosis Center, related to the International Conference on Cell-based Therapies for MS that was held in November 2015. This post discusses pleuripotent stem cells. The term “pleuripotent” means that these cells are capable of growing into any tissue in the body.
January 06, 2016
This is the second in a series of three blog posts by James Bowen, M.D., the medical director of the Swedish Multiple Sclerosis Center, related to the International Conference on Cell-based Therapies for MS that was held in November 2015. This post discusses mesenchymal stem cells. Mesenchyme refers to a type of cell that makes up much of our blood and lymphatic system as well as connective tissue.
January 04, 2016
James Bowen, M.D., medical director of the Swedish Multiple Sclerosis Center, was fortunate to be able to attend the International Conference on Cell-based Therapies for MS in November. This conference brought together about 70 of the world’s experts on using cells to treat MS. These cells are actually stem cells, and the treatments fall into three categories: hematopoietic, mesenchymal and pleuripotent stem cells. This post is Part 1 of 3, and discusses hematopoietic stem cells.
August 18, 2015
There has been debate about how to switch patients with multiple sclerosis (MS) from Tysabri to other medications. This happens most often when patients on Tysabri become positive for antibodies to the JC virus. Patients that have these antibodies are at increased risk of a serious infection called progressive multifocal leukoencephalopathy (PML).
New research has studied varying timelines for starting a new medication after Tysabri.
June 25, 2015
A recent report has generated excitement in the scientific community. This report announces the discovery of a lymphatic system in the brain.
May 26, 2015
Biotin is vitamin B7. There is a group in France studying Biotin. They published a small study a few months ago, and a larger study was presented at the AAN meeting last month. The results of the study were reported to show a benefit in patients with primary or secondary progressive MS. There were 154 patient enrolled in this study, half on biotin and half on placebo. The outcome measured was the number of people who improved on their disability at 9 months and who continued to be improved at 12 months.
April 11, 2015
We have received several inquiries about a recent report of a blood pressure medication that helps with myelin repair. This study was reported in Nature Communications: “Pharmaceutical integrated stress response enhancement protects oligodendrocytes and provides a potential multiple sclerosis therapeutic.”
This article received widespread media coverage because it involved a blood pressure medication that is already on the market.
April 04, 2015
The neurologists from the MS Center recently attended the Guthy Jackson Charitable Foundation roundtable on neuromyelitis optica (NMO) in Los Angeles. This organization is devoted to improving the care of patients with NMO and promoting research towards finding a cure.
February 06, 2015
Results were released recently from a study of a medication that may promote myelin repair. The MS Center at Swedish was one of the research sites for this study. The medication, rHIgM22, is an antibody that encouraged myelin repair in animal models. The way that it helps with myelin repair is not known. This study was a phase I study, which means that it was the first time that this medication was used in humans. Phase I studies are done to determine the safety of a medication, and also to help determine the dose of the medication.
In this study, patients ...
January 13, 2015
The MS Center at Swedish Neuroscience Institute played a major role in a research study that recently garnered national attention. This research was published in JAMA Neurology. This research investigated the effect of high dose immunosuppressive followed by hematopoietic stem cell therapy.
This therapy consists of collecting hematopoietic stem cells from patients' blood. Patients then undergo an intense course of immunosuppressive therapy with four medications. This therapy is sufficient to eliminate most of the patient’s bone marrow including white blood cells. The hematopoietic stem cells are then given back to the patient so that their bone marrow may be reconstituted. In multiple sclerosis (MS), the immune system attacks the brain. The hope is that with this therapy the reconstituted immune system will have less of a tendency to attack the br...
December 23, 2014
Traditionally, MS has been divided into four clinical courses: relapsing/remitting, primary progressive, secondary progressive and progressive relapsing. These four were intended as descriptions of the different courses that MS could take in patients, and were not based on any particular understanding of the biology of the disease, the cause of the disease, or even the prognosis of patients with the different types of MS. Over the years, our understanding of MS has improved, and these descriptions of the disease course no longer meet our needs to describe the disease.
Over the past couple of years, there has been a revision of our classification of MS, resulting in a publication in July 2014. The recommendations of this revision have been ..
November 21, 2014
On November 14, 2014, the U.S. Food and Drug Administration (FDA) approved Lemtrada (alemtuzumab) for the treatment of patients with relapsing forms of multiple sclerosis (MS) who have responded inadequately to two or more MS drugs. Lemtrada is already approved in over 40 countries around the globe including the EU, Canada and Australia.
The FDA approval of Lemtrada is a significant milestone for people living with relapsing MS. Lemtrada demonstrated superior efficacy over Rebif on annualized relapse rates in two pivotal randomized Phase III open-label rater-blinded studies in patients with relapsing remitting MS which were the basis for approval. The clinical development program for Lemtrada involved nearly 1,500 patients including patients at the Swedish MS Center with more than ...
October 24, 2014
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 r...
June 04, 2014
A recent study addressed the outcomes of pregnancy in women with MS who were taking fingolimod (Gilenya). Of 66 pregnancies on the medication, 41 attempted to carry the pregnancy to term. 26 of the 41 had healthy newborns. There were, 9 miscarriages, 24 elective abortion, 4 ongoing pregnancies and 1 with an unknown outcome. Of the elective abortions, four were for fetal malformations. There were 5 cases with abnormal fetal development in the 66 pregnancies. Poor fetal outcomes were found in 14.6% of the pregnancies. This contrasts with a 3% rate of poor outcomes for most pregnancies.
This paper highlights the importance of care in planning pregnancies in MS. It is now known that women with MS have ...
April 19, 2014
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 thera...
March 08, 2014
A recent article has been published suggesting that MS may be caused by a bacterial toxin. The bacteria is Clostridium Perfringens, a common bacteria found in soil and a cause of food poisoning. This bacteria can produce a number of toxins, one of which is the epsilon toxin.
This study found that about 10% of people with multiple sclerosis (MS) had antibodies to the epsilon toxin, compared to 1% of people without MS. In pathology specimens from mice, the epsilon toxin was found to bind to blood vessels in the retina of the eye, and to myelin in the brain. The authors also reported a single case of a woman with MS who was infected with Clostridium Perfringens and that was producing the epsilon toxin.
Though this study has been widely discussed online, I think that it is unlikely that...
January 28, 2014
Less than two years old, the Swedish Multiple Sclerosis Center has already received an overwhelming amount of praise from patients and physicians alike for its holistic approach to world class care.
Now we can add one more accolade to the list.
Healthcare Design magazine recently recognized the MS Center’s patient and family waiting area as a finalist in the Family Spaces category of its Healthcare Design Remodel Renovation Competition.The entire piece beautifully encapsulates the approach, design and ultimately the quality of care that the MS Center strives to deliver. Here is an excerpt of one of the judge’s comments:
“The entire design is a phenomenal reflection of a deep understandin...
January 17, 2014
Now that flu season is upon us, we are getting a lot of questions about the relationship between MS and infections, including influenza. MS does not impair the ability to fight off infections. Likewise, most of the treatments for MS do not impair the ability to fight infections, though there are a few exceptions to this. Most people with MS will therefore not be at any higher risk of colds or flu than the general population. However, infections may affect the MS. People with MS have an increased risk of having an MS attack at the time of infections, including colds, flu, pneumonia, bladder infections, etc. Some have estimated that about 1 out of 10 infections will be accompanied by an MS attack. Likewise, for every MS attack about 1 in 10 will be preceded by an infection. This means that about 90% of MS attacks occur in the absence of an infection.
Another important question is the role of vaccination in MS. In general, vaccinations do not seem to cause MS attacks. Because the vaccination...
December 02, 2013
All are invited to attend the presentation, “Multiple Sclerosis in the Pacific Northwest,” on Monday, Dec. 9 at 7 p.m. in Kirkland. I'll discuss multiple sclerosis as a disease, trends, changes in its distribution around the world, and how it uniquely impacts our region. The presentation is free and is open to all ages. Click here for more information.
October 25, 2013
Our bodies are made of billions of cells. However, the cells in our bodies are far outnumbered by the bacteria that cover our skin and inhabit our gut. These bacteria are now increasingly recognized to have an important role in maintaining our health. For example, skin bacteria help protect us from more dangerous bacteria that could invade us. Gut bacteria help digest our food. There are suggestions that changes in these bacteria, particularly those in the gut, might play a role in several diseases.
October 21, 2013
The 29th Congress of the European Committee for the Treatment and Research in MS (ECTRIMS) and the 18th Annual Conference on Rehabilitation in MS (RIMS) were held on October 2-5 in Copenhagen, Denmark. These two meetings are the largest scientific meetings on MS and rehabilitation in MS, with over 8,000 people attending this year.
The MS Center at Swedish was well-represented with five people attending. The meeting consisted of educational courses, symposia and scientific research presentations. The scientific presentations included over 1200 posters describing recent research in MS. There were also over 200 oral scientific research presentations. Upcoming blog posts will cover some of the reports that were of most interest to us.
September 24, 2013
A recent study published in the journal PLOS ONE found differences in protein levels of cerebrospinal fluid (CSF) among people with relapsing-remitting multiple sclerosis (RRMS) and clinically isolated syndrome (CIS).
Using the relatively new field of proteomics, researchers were able to identify each individual protein in cerebrospinal fluid (CSF)—86 total—and compares their levels among people with relapsing MS, clinically isolated syndrome (CIS) and healthy individuals. People with RRMS had different levels of 20 proteins compared to people with CIS. Seventy five percent of those proteins related to neurons (rather than myelin). Changes were particularly notable f...
July 23, 2013
Help us thank and congratulate them Sunday, August 4. Photo from Diane Mattens.
More than 30 bike riders will arrive at the MS Center at Swedish on the afternoon of Sunday, August 4 to celebrate their cross-country bike ride and to make a contribution in support of the Center. We are seeking MS Center patients and friends to help us welcome the riders, including Swedish patient, Diane Mattens, and to thank them for their generous support.
July 15, 2013
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 al...
April 22, 2013
There are many studies that show that the risks for getting multiple sclerosis (MS) vary according to the month a person is born. However, the differences between the months of birth are slight.
For example, a 2005 study of people with MS living in northern latitudes found that more people (9.1%) had a birthday in May and significantly less (8.5%) were born in November. The opposite pattern is seen in the southern hemisphere. Thus, worldwide there is a slight increase in MS risk in those born in the spring and a decrease in those born in the winter.
The cause of this has not been determined. Some ideas include differences in:
March 28, 2013
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 ...
March 13, 2013
After working in the field of neuromodulation for the past 25 years, I have seen many advances in the field; both in our understanding of the nervous system, and new technology designed to target specific neuronal pathways that will offer the best outcome for patients. It is an exciting field with new investigations that lead to ever expanding knowledge. However, what really keeps me interested in the field after all these years is the opportunity and privilege to be a part of our patients lives on a daily basis. The picture and comment shared below from a grateful patient who had DBS with us two years ago says it all…
"I look back on my experience at Swedish with a grateful heart... thankful for every day I've been given.."
March 11, 2013
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.
- 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.
- 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...
May 12, 2011
Once again, multiple sclerosis patients’ area buzz over a new theory and treatment for the disease. The theory is called chronic cerebrospinal venous insufficiency (CCSVI); and, this time, social media is driving the patient excitement.
CCSVI is based on a controversial idea that impaired venous drainage of the brain due to blockage in venous structures causes MS. Increase in venous pressure promotes leakage of blood across capillaries, with inflammation resulting from the iron deposition into the brain. In 2009 Paolo Zamboni, M.D., reported that virtually all MS patients in a study had abnormalities in the jugular or azygous veins, whereas no control patients had such findings. The Zamboni, or Liberation, procedure involves either angioplasty or stenting of the abnormal vein. Many MS patients are understandably enthusiastic about this theory and treatment.
November 15, 2010
The Multiple Sclerosis Center continues to grow. We have added an additional MS nurse, Reiko Aramaki, RN. Reiko joined us from the Evergreen MS Center. She is certified by the International Order of MS Nurses and will expand our ability to respond to patient’s needs.
Outreach programs also continue. Dr. Bowen was recently interviewed by Kathi Goertzen from KOMO TV4 regarding CCSVI. This interview can be seen at http://www.komonews.com/home/video/106166123.html.
Also, Chaz Gilbert, a patient care coordinator won the Seattle Verizon Urban Challenge on 10/30/10, racing through 12 checkpoints in their city using only clues, their feet and public transit.