Monday, May 12

SUNDAY RECAP: 90 NEW STUDIES & STORIES WE POSTED THIS WEEK FOR NEUROLOGISTS & SAAVY MSers


Δ9-THC was not better than placebo at reducing the rates of new T1 or T2 lesions or brain atrophy in patients with progressive MS.


In this interim analysis of UK TOP results, patients treated with natalizumab had significantly improved ARRs, regardless of baseline treatment or relapse history. EDSS scores remained stable over time. Safety data were consistent with natalizumab's known safety profile. Analyses of UK TOP data over longer periods of time will further characterise the effect of natalizumab on disability, as well as on other long-term efficacy and safety parameters in a real-world setting.

Predictors of successful acceptance of home telemanagement in veterans with Multiple Sclerosis.

Time and time-frequency analysis of near-infrared signals for the assessment of ozone autohemotherapy long-term effects in multiple sclerosis.
   





Younger age, female sex, and high number of awakenings and arousals are predictive of fatigue in sleep-disordered patients. Further investigations are needed to find the pathophysiological explanation for these relationships.

The dimeric Tβ4 exhibited enhanced activity on wound healing than native Tβ4, and the purification process was simple and cost-effective. This data could be of significant benefit for the high pain and morbidity associated with chronic wounds disease. A better strategy to develop Tβ4 as a treatment for other diseases caused by injuries such as heart attack, neurotrophic keratitis, and multiple sclerosis was also described.

Internet-based FS and EDSS show good agreement with physician-measured scores. Agreement was better in patients with higher scores, indicating that internet-based assessment may be useful for patients with greater disability. Interestingly, >90% patients self-scored higher in the bowel/bladder FS than the physician-rated scores, highlighting that a web-based assessment may be useful for patient who have difficulty describing personal symptoms. Overall patient satisfaction with the web-based assessment was high. An internet-based assessment tool is likely to prove an invaluable tool in the long-term monitoring in MS; not least for those patients who have difficulty travelling to see physicians regularly due to the severity of their disease.





This study demonstrates the validity of the risk score generated, which integrates genetic and environmental risk factors. Siblings have a risk score intermediate to PwMS and HC, confirming their "at risk" position in the endophenotype construct. Much of the MS risk in siblings can be attributed to genetics, with environmental factors potentially providing the trigger for clinically apparent disease.

Our study begins to explore possible epistatic effects between genes in MS employing extremes of outcome, which increases power and may be able to detect effects that conventional models are underpowered for. Our findings suggest that interactions between antigen presenting cell activation and other components of the inflammatory cascade predispose patients to early-onset disease, and indicate a possible role for KIF21B in the onset of disease progression. We have set out a methodology for exploration of epistatic effects on MS phenotype which requires confirmation in replication studies.

The BRAIN test is a widely-available, objective test of upper limb motor function in neurological disease and can be use in the outpatient clinic, home and in clinical trials. Tapping speed is reduced in MS patients when compared to healthy controls and by a similar extent to that seen in PD. MS patients do not have prolonged dwell time when pressing keys, which is a feature of the PD patient group and perhaps extra-pyramidal slowing. This potential for the BRAIN test in differentiating pyramidal from extra-pyramidal motor dysfunction requires further study.

Assuming that reduced GM MTR implies demyelination and atrophy reflects neuronal loss, the results suggest that: (i) in progressive (SP and PP) MS there is overall more extensive GM demyelination than neuronal loss; (ii) in RRMS there is overall more extensive GM neuronal loss with less noticeable demyelination, (iii) cortical demyelination occurs in more regions in SPMS and PPMS than RRMS; (iv) demyelination and neuronal loss often occur in different locations in the cortex, and (v) co-existent demyelination and neuronal loss is most evident in the thalamus. The variation in regional abnormalities argue against a single common mechanism for demyelination and neuronal loss in MS GM.

This study demonstrates a significantly increased risk of progression from RRMS to SPMS in patients who become NAb positive. As no current disease modifying treatments are effective in this phase of the disease patients at risk should be detected early and routine NAb testing can help to inform this decision.

A DECADE OF DATA FOR THE UK MULTIPLE SCLEROSIS RISK-SHARING SCHEME.


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In addition to a prominent global influence on cognitive performance, patients with progressive MS commonly exhibit independent language and visuospatial deficits. Evaluation of these abilities should therefore be included in clinical assessment of cognition in progressive MS. The underrepresentation of frontal-executive dysfunction also seen in our study raises the possibility that language and visuospatial deficits may be characteristic of cognitive impairment in progressive MS.

The demographic characteristics of the White MS patients in our cohort are very similar to those recently described in another UK-based geographically-linked MS cohort of 620 patients in Wales which was 97% White (J Neurol, Neurosurg & Psychiatry 80 (4):386-391). They described a mean age of 51, a female:male ratio of 2.4:1, and a prevalence of 146 per 100,000. However, what is unique to our cohort is its ethnic diversity, allowing us to show prevalences for ethnic minorities. What is more, when data coding is complete, we will be able to conduct further epidemiological studies, including migration studies, treatment effectiveness studies, and case-control studies of risk factors.






Splenectomy may increase the risk for the development of natalizumab-associated PML via effects on the B cell compartment. It may be regarded as a risk factor in MS patients independent from the duration of disease.
 

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Medscape Education for Neurologist: 2013 Insomnia Update: A Focus on Clinical Pathways and Why They Matter

Evidence-based patient information program in early multiple sclerosis: a randomised controlled trial

 Elan Announces Webcast of Third Quarter 2013 Financial Results - 4:16pm EDT

Characterizing aggressive multiple sclerosis

A DECADE OF DATA FOR THE UK MULTIPLE SCLEROSIS RISK-SHARING 

LATE-ONSET MULTIPLE SCLEROSIS  

MOST NEUROLOGISTS IN SCOTLAND DO NOT USE THE MCDONALD 2010 CRITERIA TO DIAGNOSE MULTIPLE SCLEROSIS

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Neuropsychological, balance and mobility risk factors for falls in people with multiple sclerosis: a prospective cohort study.
The study reveals important balance, coordination and cognitive determinants of falls in PwMS. These should assist the development of effective strategies for prevention of falls in this high-risk group

Postural control, falls and fear of falling in people with multiple sclerosis without mobility aids.

Characterising aggressive multiple sclerosis


Decreased NAA in Gray Matter is Correlated with Decreased Availability of Acetate in White Matter in Postmortem Multiple Sclerosis Cortex.

Depressive syndromes in neurological disorders.

Maintenance percutaneous posterior nerve stimulation for refractory lower urinary tract symptoms in patients with multiple sclerosis.
Prolonged PTNS treatment leads to a persistent improvement of LUTS in MS patients.

Cell-Based Reparative Therapies for Multiple Sclerosis.

Astrocytic A20 ameliorates experimental autoimmune encephalomyelitis by inhibiting NF-κB- and STAT1-dependent chemokine production in astrocytes.

Pivotal role of augmented αB-crystallin in tumor development induced by deficient TSC1/2 complex.

False positive radiographical evidence of pump catheter migration into the spinal cord.

Environmental factors acting during development to influence MS risk: insights from animal studies.

Defective sphingosine 1-phosphate receptor 1 (S1P1) phosphorylation exacerbates TH17-mediated autoimmune neuroinflammation.

Analysis of immune-related loci identifies 48 new susceptibility variants for multiple sclerosis.

TNF Receptor 2 protects oligodendrocyte progenitor cells against oxidative stress.

Targeting Interleukin-6 in Inflammatory Autoimmune Diseases and Cancers.

Review of the pharmacoeconomics of early treatment of multiple sclerosis using interferon beta.

The usefulness of brain MRI at onset in the differentiation of multiple sclerosis and seropositive neuromyelitis optica spectrum disorders.

 Dalfampridine improves walking speed, walking endurance, and community participation in veterans with multiple sclerosis: a longitudinal cohort study

Evidence-based patient information programme in early multiple sclerosis: randomised controlled trial

Evidence-based patient information programme in early multiple sclerosis: a randomised controlled trial

Characterising aggressive multiple sclerosis

Disease modification in multiple sclerosis: an update

Early White Matter Changes in Childhood Multiple Sclerosis: A Diffusion Tensor Imaging Study

Compliance to GILENYA (fingolimod) and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study.
Fingolimod initiators were more compliant, less likely to discontinue treatment, and discontinued later than patients who initiated self-injected DMT.


[Is MRI monitoring useful in clinical practice in patients with relapsing-remitting multiple sclerosis? Yes.]

Visualization of inflammation and demyelination in 2D2 transgenic mice with rodent MRI.

25-hydroxyvitamin D3 Concentration in Serum and Cerebrospinal Fluid of Patients with Remitting-relapse Multiple Sclerosis.

Adipocytokine Profile, Cytokine Levels and Foxp3 Expression in Multiple Sclerosis: a Possible Link to Susceptibility and Clinical Course of Disease.

Progression, Symptoms and Psychosocial Concerns among Those Severely Affected by Multiple Sclerosis: A Mixed-Methods Cross-Sectional Study of Black Caribbean and White British People.

Tumefactive multiple sclerosis and fingolimod: Immunotherapies and unintended consequences.

The neuropathology of obesity: insights from human disease.

Alterations of brain eicosanoid synthetic pathway in multiple sclerosis and in animal models of demyelination: Role of cyclooxygenase-2.

Cell therapy for multiple sclerosis: an evolving concept with implications for other neurodegenerative diseases.