Multiple Sclerosis Newsletter

Multiple Sclerosis Newsletter
Northern Colorado Edition

December 2006 - January 2007

Research Updates

NEW DRUG REDUCES MS SYMPTOMS
But experts caution the findings are preliminary
HealthDay Wed. 09/13/06

Swiss researchers report that an oral drug called fingolimod was effective in preventing relapses in people with Multiple Sclerosis.

“If the phase III [clinical trial] is successful, a new once-daily oral medication could be available for treatment of relapsing MS in approximately three to four years,” said lead researcher Dr. Ludwig Kappos, head of the outpatient clinic for neurology/ neurosurgery and MS-Research Group at University Hospital in Basel.

Results of the phase II trial are published in the Sept. 14 issue of the New England Journal of Medicine.

However, Kappos, as well as authors of an accompanying editorial in the journal, cautioned that this study was small and short-term. Long-term side effects are unknown, and as with other drugs used to treat MS that suppress immune system activity, could potentially be serious.

“These are very exciting preliminary findings of an experimental drug,” said Dr. Patricia O‘Looney, director of biomedical research programs at the National Multiple Sclerosis Society. “It’s not a cure, but the results were very dramatic. The relapse rate was reduced by almost 50 percent in both treatment groups. But, there are some side effects: some upper respiratory tract infections, elevated liver enzymes, and there was some concern about heart rate changes. That’s the reason why longer-term studies are necessary.”

Multiple Sclerosis is a disease that affects the central nervous system, especially the fatty tissue – called myelin – that surrounds nerve cells. The disorder is thought to be an autoimmune disease, but its exact cause remains unknown. About 400,000 Americans have multiple sclerosis, according to the National Multiple Sclerosis Society. Many people with the disease have periods where symptoms disappear, followed by relapses or flare-ups.

Treatments are currently available to help keep symptoms at bay, but there is no cure for this disease. The most recently approved drug for MS treatment, available by infusion, is Tysabri (natalizumab). The drug was approved in November 2004, but then pulled off the market three months later because several patients developed a rare, but fatal, brain infection known as progressive multifocal leukoencephalopathy (PML). In June, 2006, the U.S. Food and Drug Administration allowed Tysabri to return to the market – under strict prescribing guidelines – because, for some people, the benefits of the medication outweigh the potential risk. No cases of PML were reported in the six-month trial of oral fingolimod.

Two hundred and fifty-five patients participated in the new trial. They were randomly assigned to one of three groups. One group took a placebo daily, while the other two groups took oral fingolimod in either a 1.25 milligram dose or a 5 milligram dose.

Using MRI scans to assess disease activity, the researchers found that the relapse rate was more than 50 percent lower for both groups taking fingolimod compared to the placebo group, according to Kappos.

Both groups on fingolimod experienced more side effects than those on a placebo, and the group taking the higher dose experienced more adverse effects than those on the lower dose, according to the study. The most frequent complaints were shortness of breath, upper respiratory infections, headaches and gastrointestinal problems.

In an accompanying editorial, Harvard researchers wrote “The results of the current proof-of-concept study by Kappos et al. are certainly promising and should provide a strong incentive for long-term follow-up trials on a large scale.”

“The results from this short-term study are very promising and fingolimod needs to be further examined,” said O’Looney. “The best news for people with MS is that there are so many clinical trials that are taking place now to try to find better therapies, and some, like fingolimod, are oral therapies. Hopefully, some of these therapies will reduce disease activity even greater than currently approved therapies.”

SCIENCE COULD POINT TO MS TREATMENTS
A protein is key to the growth of nerve coverings damaged by the disease
by Robert Preidt HealthDay News – 11/02/06

New insights into mechanisms controlling the formation of myelin – the white matter that coats all nerves – could help lead to treatments for multiple sclerosis (MS) and other myelin-related diseases and injury.

Myelin plays an important role in the overall health and function of the nervous system. MS and other diseases or injuries that damage myelin result in serious problems including uncoordinated movements, neuropathic pain and paralysis.

Researchers at the University of Southern California (USC) and the Institut de Reserches Cliques de Montreal in Canada found that a protein called Par-3 plays an important role in the formation of myelin during nerve development.

Par-3 acts like a “molecular scaffold” to set up an “organizing center” that brings together proteins essential for the formation of myelin, the researchers said. They found that when they disrupted this “organizing center,” cells could not form myelin normally.

The findings, which appear in the Nov. 3 issue of the journal Science, open the way to new research to identify other components that are recruited when Par-3 sets up the “organizing center,” said researcher Jonah Chan, assistant professor of cell and neurobiology at USC’s Keck School of Medicine. This line of research could help scientists find ways to manipulate the Par-3 pathway in order to promote remyelination of diseased or damaged nerves.

NINDS M.S. INFORMATION PAGE
National Institute of Neurological Disorders and Stroke

What is Multiple Sclerosis?
An unpredictable disease of the central nervous system, multiple sclerosis (MS) can range from relatively benign to somewhat disabling to devastating, as communication between the brain and other parts of the body is disrupted. Many investigators believe MS to be an autoimmune disease – one in which the body, through its immune system, launches a defensive attack against its own tissues. In the case of MS, it is the nerve-insulating myelin that comes under assault. Such assaults may be linked to an unknown environmental trigger, perhaps a virus.

Many people experience their first symptoms of MS between the ages of 20 and 40; the initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye. Most MS patients experience muscle weakness in their extremities and difficulties with coordination and balance. These symptoms may be severe enough to impair walking or even standing. In the worst case, MS can produce partial or complete paralysis. Most people with MS also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling, or “pins and needles” sensations. Some may also experience pain. Speech impediments, tremors, and dizziness are other frequent complaints. Occasionally, people with MS have hearing loss. Approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked. Depression is another common feature of MS.

Is There Any Treatment?
There is as yet no cure for MS. Many patients do well with no therapy at all, especially since many medications have serious side effects and some carry significant risks. However, three forms of beta interferon (Avonex, Betaseron, and Rebif) have now been approved by the Food and Drug Administration for treatment of relapsing-remitting M.S. Beta interferon has been shown to reduce the number of exacerbations and may slow the progression of physical disability. When attacks do occur, they tend to be shorter and less severe. The FDA also has approve a synthetic form of myelin basic protein, called copolymer 1 (Copaxone), for the treatment of relapsing remitting MS. Copolymer 1 has few side effects, and studies indicate that the agent can reduce the relapse rate by almost one third. An immunosuppressant treatment, Novantrone (mitoxantrone), is approved by the FDA for the treatment of advanced or chronic MS.

While steroids do not affect the course of MS over time, they can reduce the duration and severity of attacks in some patients. Spasticity, which can occur either as a sustained stiffness caused by increased muscle tone or as spasms that come and go, is usually treated with muscle relaxants and tranquilizers such as baclofen, tizanidine, diazepam, clonazepam, and dantrolene. Physical therapy and exercise can help preserve remaining function, and patients may find that various aids – such as foot braces, canes, and walkers – can help them remain independent and mobile. Avoiding excessive activity and avoiding heat are probably the most important measures patients can take to counter physiological fatigue. If psychological symptoms of fatigue such as depression or apathy are evident, antidepressant medications may help. Other drugs that may reduce fatigue in some, but not all, patients include amanytadine (Symmeytrel), permoline (Cylert) and the still-experimental drug aminopyridine. Although improvement of optic symptoms usually occurs even without treatment, a short course of treatment with intravenous methylprednisolone (Solu-Medrol) followed by treatment with oral steroids is sometimes used.

What is the prognosis?
A physician may diagnose MS in some patients soon after the onset of the illness. In others, however, doctors may not be able to readily identify the cause of the symptoms, leading to years of uncertainty and multiple, diagnoses punctuated by baffling symptoms that mysteriously wax and wane. The vast majority of patients are mildly affected, but in the worst cases, MS can render a person unable to write, speak, or walk. MS is a disease with a natural tendency to remit spontaneously, for which there is no universally effective treatment.

What research is being done?
The National Institute of Neurological Disorders and Stroke (NINDS) and other instituted of the National Institutes of Health (HIH) conduct research in laboratories at the NIH and also support additional research through grants to major medical institutions across the country. Scientists continue their extensive efforts to create new and better therapies for MS. One of the most promising MS research areas involves naturally occurring antiviral proteins known as interferons. Beta interferon has been shown to reduce the number of exacerbations and may slow the progression of physical disability. When attacks do occur, they tend to be shorter and less severe. In addition, there are a number of treatments under investigation that may curtail attacks or improve function. Over a dozen clinical trials testing potential therapies are underway, and additional new treatments are being devised and tested in animal models.

Announcing the Rocky Mountain MS Center’s Individualized, Integrated Education Program (IIEP)
Allen Bowling, M.D., Ph.D., Thomas Stewart, M.S., J.D., PA-C
InforMS, Vol. 22, No. 4, Fall 2006

For the past eight years, the Rocky Mountain MS Center has been a pioneer in exploring complementary and alternative medicine (CAM) in MS. We have done this both through our own research and by compiling and evaluating the research done by others in a form that is accessible to people with MS, meticulous, and written in an easy-to-understand style. Our Complementary and Alternative Medicine Program is known throughout many parts of the world for these activities.

We are pleased to announce an important expansion of our CAM Program. Beginning in December, 2006, we will begin widely offering our Individualized Integrated Education Program (IIEP) to people with MS. The IIEP is designed to help you combine the best of conventional and non-conventional medicine. Through one-on-one educational consultations, participants will learn about mind-body medicine, exercise, diet and dietary supplements, and other therapies that may help you to manage your symptoms better.

The IIEP was made possible, in part, through a generous grant from the Multiple Sclerosis Foundation, a non-profit organization located in Florida. Because of this grant, we will provide the first 200 IIEP consultations FREE of charge. We thank the MSF for their support. After these 200 consultations, we will charge $50 for IIEP consultations.

Participants will receive three brochures written by Allen Bowling, M.D., Ph.D. and Thomas Stewart, M.S., J.D., PA-C. One of these brochures describes the Five-Step Model, which is a broad approach to developing an integrated care plan. The second brochure describes a practical approach to using diet and dietary supplements in a way that may improve outcomes in MS, and the third describes an approach for evaluating claims about CAM. Participants will also meet individually with Tom Stewart for a one-hour appointment to facilitate the development of an integrated plan of care that accounts for each participant’s unique clinical background and interests.

What is Integrative Medicine?
Numerous surveys have shown that people with MS use both conventional approaches and non-conventional approaches to minimize the effects of disease and to optimize health. Given that MS is a chronic disease with only partially-effective, expensive therapies, such an approach makes perfect sense, depending on how it is done. Ideally, conventional and non-conventional approaches to health and the management of MS should be blended using as much science and attention to safety as possible. Such a blend is often referred to as integrative medicine.

In addition to being based on the best available science, an integrative approach should also be individualized. In other words, an integrative treatment plan should accommodate your unique medical considerations, symptoms, abilities, and preferences. It is not possible to write a specific, one-size-fits-all approach to integrative care. For this reason, we have instead developed an organizational framework along with some specific ideas that, we hope, will empower you to develop your own thoughtful integrated treatment plan in consultation with your physician or other conventional health care practitioner. We refer to this approach as our “Five-step Model.”

News | Information / Subscriptions
Programs | Smile | Archive |Contact Us

FortNet Home

*This material is provided as general medical information and is not intended as advice for individual patients;
please contact your physician for specific recommendations.

Web site design by Mes Bijoux Ltd