August 27, 2015
Neuromyelitis optica (NMO) is a neuroinflammatory disorder characterized by optic neuritis and extensive myelitis. Like multiple sclerosis (MS), it can have a relapsing remitting disease course. Some of the NMO patients tend to run a more aggressive disease course. Most patients with NMO have Ig G antibodies to the aquaporin-4 water channel (AQP4).
In July 2015, experts from International Panel for NMO Diagnosis (Wingerchuk DM et al. Neurology 2015 Jul 14) provided updated consensus recommendations for NMO spectrum disorders (NMOSD).
August 11, 2015
While we often counsel patients that multiple sclerosis (MS) does not often result in death, we have noticed some MS patients with aggressive disease who clearly succumb prematurely. To understand survival in the MS population with a matched cohort from the general population, a population based study is needed to evaluate the association of comorbidity with survival in both populations.
April 17, 2015
Optic neuritis is a common presentation of MS. Acute inflammation of the optic nerve can lead to transient swelling of the peripapillary retinal nerve fiber layer (pRNFL). Further injury of axons within the optic nerve may lead to degeneration of the retinal ganglion cell (RGC) layer within the macula. RGC layer thickness has been proposed as a measure of neurodegeneration because it is relatively resistant to confounding inflammation. A study was done to track the changes in the retinal layer during a 6-month period in 27 patients with acute optic neuritis to identify patterns of RGC layer changes.
February 10, 2015
Copaxone and the interferon betas (IFN-β) are both effective treatments for a relapsing form of multiple sclerosis (MS). A new study finds that MS patients followed over 10 years have similar annualized relapse rates (ARR) whether they take Copaxone or one of the interferon betas.
This recent study looked at 10 years of data on over 3,000 RRMS patients and found that Copaxone and IFN-β were similarly successful in reducing relapses. In the new study, researchers collected data on 3,326 RRMS patients who were using either IFN-β or Copaxone as their first-ever disease-modifying therapy (DMT) for at least 6 months, and had started treatment within 10 years of their first symptom. To be included in the study, patients also had to have had at least one relapse recorded during the two years leading up to the start of their initial DMT.
The researchers looked at ...
October 27, 2014
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 ...
June 11, 2014
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 simvastati...
March 15, 2014
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 ...
November 01, 2013
MS and many other autoimmune diseases are less common in men than in women. This is especially true during reproductive years. Sex hormones, including testosterone and estrogen, may be responsible for the difference. It is thought that men with multiple sclerosis may have lower testosterone levels than healthy controls.
Dr. Bove and his group assessed the prevalence and clinical associations of hypogonadism in men with recent onset relapsing multiple sclerosis. Male subjects from the Comprehensive Longitudinal Investigations of MS at the Brigham and Women's Hospital (CLIMB) cohort were included. Hormonal measures included testosterone, the testosterone: estradiol ratio, leutinizing hormone (LH), and free testosterone. Clinical outcomes were collected every 6 months for Expanded Disease Severity Scale (EDSS), and annually for Symbol Digit Modalities test (SDMT).
The analysis included 96 men with a mean age of 40 years, disease duration of 4...