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High unexpressed anger in MSpatients linked to nervous system damage, not disease severity1 dzień temu
 

People with multiple sclerosis (MS) feel more than twice as much withheld anger as the general population and this could have an adverse effect on their relationships and health, according to a study published in the December issue of the European Journal of Neurology.

Italian researchers assessed 195 patients with MS, using a range of scales that measure anger, depression and anxiety, and then compared them with the general population.

They were surprised by the results, which showed that while patients experienced almost twice the normal level of withheld anger and exerted low levels of control on their anger, their expressed anger levels were similar to the general population.

This, together with the fact that the elevated withheld anger levels were not related to the severity of the patients' MS, suggests that these inconsistent changes were caused by nervous system damage, rather than an emotional reaction to the stress of the disease.

"We believe that the higher levels of withheld anger shown by the study subjects is due to demyelination, loss of the substance in the white matter that insulates the nerve endings and helps people receive and interpret messages from the brain" explains lead researcher Dr Ugo Nocentini from the IRCCS S Lucia Foundation in Rome.

"The way we process anger is controlled by complex interconnections between the subcortical and cortical systems, notably the amygdale and basal ganglia and the medial prefrontal cortex. We believe that the demyelination process that causes the root symptoms of MS also disrupts the pathways that control how we deal with withheld anger."

The patients who took part in the study comprised 150 with relapsing-remitting MS and 45 with progressive MS. More than two-thirds (68 per cent) were women, the average age of the participants was 40 and the average time since diagnosis was 11 years.

Researchers evaluated the participants using the State Trait Anger Expression Inventory, the Chicago Multiscale Depression Inventory and the State Trait Anxiety Inventory.

The researchers then looked at age and sex-matched subjects in the general population and identified the levels of anger experienced by the 25 per cent of people with the highest scores.

They found that MS patients:

•Were more than twice as likely to experience high levels of withheld anger, with 60 per cent of patients recording the same high levels as the top 25 per cent of the general population.
•Exerted a low level of control on their anger, with just 11 per cent of patients reporting the same high levels of control compared to the top 25 per cent of the general population.
•Were about the same as non MS patients when it came to expressed anger, with 30 per cent of patients reporting the same high levels as the top 25 per cent of the general population.
During the study the authors also compared the anger scores against selected demographic and clinical characteristics and found they were independent of age, education, disease duration and course, disability and fatigue severity. The only notable difference was that women reported higher levels of current anxiety.

"Our findings clearly show that anger characteristics in MS patients differ from those observed in the general population and the overall results surprised the research team" concludes Dr Nocentini.

"For example, patients reported low levels of anger control and high levels of withheld anger, yet the scores for expressed anger were similar to those of the general population.

"We would have expected greater consistency between withheld and expressed anger and higher levels of expressed anger as a consequence of low anger control."

The authors conclude that damage to the fibres in the areas of the brain where anger issues are processed is the most logical explanation. They also say the findings have important implications for clinical practice.

"Anger disrupts interpersonal relationships and this is particularly true for withheld anger, which might go unrecognised by other people" says Dr Nocentini. "Witheld anger has been reported to be associated with physical problems, in particular high blood pressure and vascular disorders, and may have a negative effect on the general health of MS patients.

"Because withheld anger has no, or few, overt manifestations, and is unlikely to be recognised by clinicians or reported by patients, it is important that MS patients are asked if they experience abnormal anger."

Source: Science Daily © 1995-2009 ScienceDaily LLC (24/11/09)
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Factors from common human bacteria may trigger multiple sclerosis1 dzień temu
 
Current research suggests that a common oral bacterium may exacerbate autoimmune disease. The related report by Nichols et al, "Unique Lipids from a Common Human Bacterium Represent a New Class of TLR2 Ligands Capable of Enhancing Autoimmunity," appears in the December 2009 issue of The American Journal of Pathology.

Multiple sclerosis (MS), a disease where the immune system attacks the brain and spinal cord, affects nearly 1 in 700 people in the United States. Patients with multiple sclerosis have a variety of neurological symptoms, including muscle weakness, difficulty in moving, and difficulty in speech.

Porphyromas gingivalis, a common oral bacterium in humans, produces a unique type of lipid, phosphorylated dihydroceramides (DHCs), which enhance inflammatory responses. These lipids are also likely produced by bacteria found in other parts of the body including the gastrointestinal tract. To determine if these lipids accentuate immune-mediated damage in autoimmune disease, researchers led by Robert B. Clark and Frank C. Nichols of the University of Connecticut Health Center administered phosphorylated DHCs in a mouse model of MS.

The severity of disease was significantly enhanced by the addition of these lipids in a manner that was dependent on activation of the immune system. These data suggest that phosphorylated DHCs from bacteria commonly found in humans may trigger or increase the severity of autoimmune diseases such as multiple sclerosis.

The authors state that "while it is clear that the immune system in most individuals has the potential to attack self-tissues, the "tipping" factors that initiate and propagate autoimmune diseases such as multiple sclerosis in only a subset of individuals remain unknown. Overall, [their] results represent the first description that phosphorylated DHCs derived from common human bacteria are capable of enhancing autoimmune disease." Thus, these lipids may function as "tipping" factors, playing a previously unrecognized role in initiating or exacerbating human autoimmune diseases.

In future studies, Dr. Clark and colleagues plan to characterize the effects of phosphorylated DHCs on specific cells of the immune system and to identify how and where these lipids are deposited in tissues throughout the body. In addition to the role of these lipids in triggering and worsening MS, the authors believe that phosphorylated DHCs may have the potential to serve both as new markers of MS disease activity and as new targets for therapeutic intervention.

Source: Scinece Codex (24/11/09)
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Multiple Sclerosis progress slowed by giving birth, Belgian doctors say1 dzień temu
 
Giving birth seems to slow the progression of multiple sclerosis (MS), Belgian and Dutch researchers say.

The researchers tracked 330 women with MS for 18 years and found that among those who had children, severe disability took longer to develop.

Writing in the Journal of Neurology, Neurosurgery and Psychiatry, they say previous studies have suggested a worsening of MS just after birth.

But the MS Society said the study was flawed and further research was needed.

MS is a long-term inflammatory condition of the central nervous system.

It affects the transfer of messages from the nervous system to the rest of the body.

Women are twice as likely to develop MS as men and many of the new cases will be among women of childbearing age.

The researchers from Belgium and the Netherlands said all the women had been referred to one specialist centre and had had their first symptoms from the ages of 22 to almost 38.

Nearly a quarter of the women (24%) were childless; 170 had given birth before their symptoms developed (52%); 61 had their children after their symptoms developed (18%); and 19 had had children both before and afterwards (6%).

'Speed of progression'

The researchers used the Kurtzke Expanded Disability Status Scale (EDSS) which runs from one to 10, where 10 is death from MS and six is when an individual needs a cane, a crutch or a brace to walk 100m.

After an average of 18 years living with MS, over half the women (55%) were categorised as EDSS six.

They found that both the likelihood and speed of progression were affected by childbirth.

Women who had given birth to one or more children at any point before or after the start of MS symptoms were 34% less likely to progress to EDSS six than childless women.

Women whose children had been born after their MS began were 39% less likely to progress to EDSS six than women who had not had children.

They said this held true even after taking account of the age at which symptoms began.

Women who had no children after their MS symptoms started progressed to EDSS six within 13 to 15 years on average.

But women who did have children took an average of 22 to 23 years to reach this stage.

'Beneficial effect'

Dr Maria D'hooghe, from the National MS Centre in Melsbroek, Belgium, which co-ordinated the study, said it had shown for the first time the long-term effects of having a baby if you have MS.

She said: "It's possible that the hormones released in pregnancy are having a beneficial effect on the immune system.

"Certainly, animal studies show that pregnancy can lead to less damage in their brains.

"The other possibility is that it is lifestyle changes caused by having a baby that are delaying the effects of MS perhaps through increased activity or changes in the way we deal with stress."

But Dr Susan Kohlhaas, research communications officer for the MS Society, said it was a small study and they had not taken account of the fact that women with more severe MS may choose not to get pregnant because they are worried about a relapse or about taking care of a baby during a relapse.

She said: "It is difficult to form any meaningful conclusions from this research given the small size of the study and its flaws, but further studies will hopefully clarify the effects of pregnancy in women with MS."

Source: BBC News © British Broadcasting Corporation 2009 (24/11/09)
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MS Society of Canada announces request for research operating grants related to CCSVI and MS1 dzień temu
 
The Multiple Sclerosis Society of Canada announced it will request research operating grants related to chronic cerebrospinal venous insufficiency (CCSVI) and MS.

A recent study released by Dr. Paulo Zamboni, University of Ferrara, Italy, describes CCSVI as a disruption of blood flow in which the venous system is not able to efficiently remove blood from the central nervous system resulting in increased pressure in the veins of the brain and spinal cord which in turn results in damage to these areas.

“These early results are encouraging and show that this warrants more study,” said Yves Savoie, MS Society President and CEO. “This is truly a new avenue to explore in MS research, and we want to be a part of furthering this investigation.”

The MS Society of Canada will issue an invitation for research operating grant proposals on CCSVI related to multiple sclerosis from qualified investigators based in Canadian institutions. Proposals will be evaluated for their scientific merit and relevance to the field of MS.

The competition will open on December 9, 2009, and the deadline for applications will be January 22, 2010.

“There has been tremendous interest and excitement about this study from people with MS, supporters, volunteers and staff across the country. While we acknowledge that the concept of CCSVI as a cause of MS needs to be replicated and validated in larger well-designed studies, the Society looks forward to contributing to this body of work,” said Savoie.

While excited about the potential of the CCSVI study, the findings are preliminary. Thus the MS Society advises that while further research is underway people follow their physician's recommendations and continue their current course of therapies.

Source: Multiple Sclerosis Society of Canada (24/11/09)

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Warning on cancer risk from stem cell therapy2 dni temu
 
Experts fear that a Victorian man with leukaemia may be the first Australian ''infected'' with cancer after treatment at a private overseas stem cell therapy centre.

Stem cell specialists and patient support groups are calling for more public education about the dangers of such services, saying they get hundreds of calls a year from people considering using them - and the numbers are rising.

The companies advertise on the internet and via local information sessions, offering injections of foetal stem cells and stem cells extracted from the patient's spinal cord. They claim to treat conditions such as Alzheimer's, multiple sclerosis, diabetes, autism and spinal injury.

Private, largely unregulated clinics in Asia and Europe charge tens of thousands of dollars plus travel costs. However few have published, clinical proof of their efficacy, relying instead on slick websites and individual testimonies.

Advocacy groups for people targeted as possible clients will meet in Canberra today to discuss how to protect people from being emotionally and financially exploited.

The stem cell treatments ranged in quality and safety but very few, if any, offered genuine hope, said Dr Kirsten Herbert, a hematologist at the Peter MacCallum Cancer Centre and clinical adviser to the Australian Stem Cell Centre (ASCC).

''One man in Queensland paid $40,000 for a treatment [at a private German clinic] and was told he needed two or three more [visits] for a treatment that I cannot imagine, even with the most blue-sky open mind, could have helped him,'' she said.

''But they will take his money and not do anything to look after him when he leaves. If we practised a treatment like that we would be disbarred.''

Dr Herbert plans next month to investigate the case of a Victorian man being treated for leukaemia, which was diagnosed after his recent return from overseas stem cell therapy.

She said it was difficult to prove a link, but there was an international precedent: in February the journal PLoS Medicine reported the case of a teenage Israeli boy who developed brain tumours from experimental stem cell injections at a Russian clinic. Dr Herbert said cancer was a rare but possible side-effect of experimental stem cell therapy. ''Most stem cells grow in a culture that is exposed to proteins and hormones that encourage growth, and cancer is out-of-control growth, so these cells have a greater potential to cause cancer,'' she said.

Other risks included contamination from animal products used in laboratory processing of the stem cells, which could introduce Creutzfeldt-Jakob disease. Some clinics also instructed patients to go on medication to suppress their immune systems, with potentially dangerous side-effects. ''They don't follow these patients up,'' Dr Herbert said. ''They prescribe and wave goodbye without any duty of care.''

The financial and emotional risks to patients were just as great, Dr Herbert said. ''Most likely, the treatment you are going to receive is not going to work.'' It was important not to demonise people who sought these cures, but instead to help them find the right advice.

Patient advocacy groups are meeting stem cell experts in Canberra today to discuss a co-ordinated approach to public education on overseas experimental treatments.

The ASCC is about to release a patient handbook to help people critically analyse stem cell treatments. It has a list of questions to ask before signing up.

Source: The Age.com.au © 2009 Fairfax Digital (23/11/09)
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The present efficacy of multiple sclerosis therapeutics: Is the new 66% just the old 33%?2 dni temu
 
Many authorities, and of course the drug companies responsible, promote Tysabri as being more effective than standard disease modifying drugs (DMDs) like Betaferon (Betaseron) and Copaxone.

Klawiter and Cross, in the journal Neurology, argue that the risk of progressive multifocal leukoencephalopathy (PML) with Tysabri means that we have to examine this much more rigorously.

In their paper, entitled 'The present efficacy of multiple sclerosis therapeutics: is the new 66% just the old 33%?' (referring to the supposed better performance of Tysabri in relapse rate reduction than standard DMDs), they argue that because patient populations were markedly different in the trials, with patients with more benign illness in the Tysabri trials, the improved performance of Tysabri may be just an illusion, and it may in fact be comparable in efficacy with the DMDs.

ABSTRACT
A challenge for the clinician treating patients with multiple sclerosis (MS) is to determine the most
effective treatment while weighing the benefits and risks. Results of the phase 2 and phase 3
studies on natalizumab were received with great interest, in part due to the “improved” risk reduction
for relapse rate, disease progression, and MRI metrics observed in comparison to results in
trials of beta-interferon and glatiramer acetate. However, comparison across trials is invalid, in
large part due to differences in the study populations. The increased efficacy observed in more
recent trials has also been attributed to a fundamental change in subjects with MS enrolled in
recent trials compared with the prior decade. In this article, we debate the relative efficacy of
natalizumab vs the older injectable therapies.

Eric C. Klawiter, MD; Anne H. Cross, MD; Robert T. Naismith,MD

Sources: Neurology® 2009;73:984–990 & Taking Control Of Multiple Sclerosis (23/11/09)
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Vitamin D - the missing link for multiple sclerosis sufferers3 dni temu
 
Scientists have uncovered increasing evidence of the significance of Vitamin D in the development of multiple sclerosis. Now, Australian researchers have found that Vitamin D may actually reduce its symptoms.

Professor Bruce Taylor, a principal research fellow at the Menzies Institute in Hobart, studied 145 patients in southern Tasmania and tracked their seasonal susceptibility to the disease. He looked at how Vitamin D levels influenced their risk of having an attack of MS.

'We found that the higher your Vitamin D level, the lower your chance of relapse, and for each ten nanomole [a standard measure of concentration of Vitamin D in the blood] increase in Vitamin D, you can reduce your risk of having an attack of MS by about ten per cent. Doubling your Vitamin D will reduce your risk by up to 50 per cent - a major result.'

Helen Yates, the Multiple Sclerosis Resource Centre's chief executive, says: 'It has long been believed that Vitamin D has a role to play in the risk of developing MS but this new research opens up the strong possibility that this vitamin could impact on relapse rates.'

The MS Society's research communications officer, Dr Susan Kohlhaas, says: 'These results are very early-stage and need to be reviewed and validated before we draw any firm conclusions.'

It has been known for many years that the further you live from the Equator, the more likely you are to develop MS. For example, Malaysia has hardly any sufferers but in Scotland and Scandinavia MS is relatively common.

It is believed this is due to a shortage of Vitamin D; countries far from the Equator, such as those in Northern Europe, enjoy less sunshine, the main source of Vitamin D.

Research has shown that babies born in May - who developed in the womb during the Vitamin D-scarce winter months - are the most likely to get MS in later life, while those born in November are at much lower risk.

Another study this year found evidence that Vitamin D deficiency during pregnancy and infancy could increase a child's risk of developing MS in later life. The researchers concluded that taking Vitamin D supplements during these times could reduce the risk, although this has yet to be proven.

Source The Mail Online © 2009 Associated Newspapers Ltd (22/11/09)
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Researcher's labour of love leads to breakthrough in treating Multiple Sclerosis3 dni temu
 

“ I am confident that this could be a revolution for the research and diagnosis of multiple sclerosis ”
— Dr. Paolo Zamboni


Elena Ravalli was a seemingly healthy 37-year-old when she began to experience strange attacks of vertigo, numbness, temporary vision loss and crushing fatigue. They were classic signs of multiple sclerosis, a potentially debilitating neurological disease.

It was 1995 and her husband, Paolo Zamboni, a professor of medicine at the University of Ferrara in Italy, set out to help. He was determined to solve the mystery of MS – an illness that strikes people in the prime of their lives but whose causes are unknown and whose effective treatments are few.

What he learned in his medical detective work, scouring dusty old books and using ultra-modern imaging techniques, could well turn what we know about MS on its head: Dr. Zamboni's research suggests that MS is not, as widely believed, an autoimmune condition, but a vascular disease.

More radical still, the experimental surgery he performed on his wife offers hope that MS, which afflicts 2.5 million people worldwide, can be cured and even largely prevented.

“I am confident that this could be a revolution for the research and diagnosis of multiple sclerosis,” Dr. Zamboni said in an interview.

Not everyone is so bullish: Skeptics warn the evidence is too scant and speculative to start rewriting medical textbooks. Even those intrigued by the theory caution that MS sufferers should not rush off to get the surgery – nicknamed the “liberation procedure” – until more research is done.

U.S. and Canadian researchers are trying to test Dr. Zamboni's premise.

For the Italian professor, however, the quest was both personal and professional and the results were stunning.

Fighting for his wife's health, Dr. Zamboni looked for answers in the medical literature. He found repeated references, dating back a century, to excess iron as a possible cause of MS. The heavy metal can cause inflammation and cell death, hallmarks of the disease. The vascular surgeon was intrigued – coincidentally, he had been researching how iron buildup damages blood vessels in the legs, and wondered if there could be a similar problem in the blood vessels of the brain.

Using ultrasound to examine the vessels leading in and out of the brain, Dr. Zamboni made a startling find: In more than 90 per cent of people with multiple sclerosis, including his spouse, the veins draining blood from the brain were malformed or blocked. In people without MS, they were not.

He hypothesized that iron was damaging the blood vessels and allowing the heavy metal, along with other unwelcome cells, to cross the crucial brain-blood barrier. (The barrier keeps blood and cerebrospinal fluid separate. In MS, immune cells cross the blood-brain barrier, where they destroy myelin, a crucial sheathing on nerves.)

More striking still was that, when Dr. Zamboni performed a simple operation to unclog veins and get blood flowing normally again, many of the symptoms of MS disappeared. The procedure is similar to angioplasty, in which a catheter is threaded into the groin and up into the arteries, where a balloon is inflated to clear the blockages. His wife, who had the surgery three years ago, has not had an attack since.

The researcher's theory is simple: that the underlying cause of MS is a condition he has dubbed “chronic cerebrospinal venous insufficiency.” If you tackle CCSVI by repairing the drainage problems from the brain, you can successfully treat, or better still prevent, the disease.

“If this is proven correct, it will be a very, very big discovery because we'll completely change the way we think about MS, and how we'll treat it,” said Bianca Weinstock-Guttman, an associate professor of neurology at the State University of New York at Buffalo.

The initial studies done in Italy were small but the outcomes were dramatic. In a group of 65 patients with relapsing-remitting MS (the most common form) who underwent surgery, the number of active lesions in the brain fell sharply, to 12 per cent from 50 per cent; in the two years after surgery, 73 per cent of patients had no symptoms.

Augusto Zeppi, a 40-year-old resident of the northern Italian city of Ferrara, was one of those patients. Diagnosed with MS nine years ago, he suffered severe attacks every four months that lasted weeks at a time – leaving him unable to use his arms and legs and with debilitating fatigue. “Everything I was dreaming for my future adult life, it was game over,” he said.

Scans showed that his two jugular veins were blocked, 60 and 80 per cent respectively. In 2007, he was one of the first to undergo the experimental surgery to unblock the veins. He had a second operation a year later, when one of his jugular veins was blocked anew.

After the procedures, Mr. Zeppi said he was reborn. “I don't remember what it's like to have MS,” he said. “It gave me a second life.”

Buffalo researchers are now recruiting 1,700 adults and children from the United States and Canada. They plan to test MS sufferers and non-sufferers alike and, using ultrasound and magnetic resonance imaging, do detailed analyses of blood flow in and out of the brain and examine iron deposits.

Another researcher, Mark Haacke, an adjunct professor at McMaster University in Hamilton, is urging patients to send him MRI scans of their heads and necks so he can probe the Zamboni theory further. Dr. Haacke is a world-renowned expert in imaging who has developed a method of measuring iron buildup in the brain.

“Patients need to speak up and say they want something like this investigated … to see if there's credence to the theory,” he said.

MS societies in Canada and the United States, however, have reacted far more cautiously to Dr. Zamboni's conclusion. “Many questions remain about how and when this phenomenon might play a role in nervous system damage seen in MS, and at the present time there is insufficient evidence to suggest that this phenomenon is the cause of MS,” said the Multiple Sclerosis Society of Canada.

The U.S. society goes further, discouraging patients from getting tested or seeking surgical treatment. Rather, it continues to promote drug treatments used to alleviate symptoms, which include corticosteroids, chemotherapy agents and pain medication.

Many people with multiple sclerosis, though, are impatient for results. Chatter about CCSVI is frequent in online MS support groups, and patients are scrambling to be part of the research, particularly when they hear the testimonials.

Kevin Lipp, a 49-year-old resident of Buffalo, was diagnosed with MS a decade ago and has suffered increasingly severe attacks, especially in the heat. (Heat sensitivity is a common symptom of MS.) His symptoms were so bad that he was unable to work and closed his ice-cream shop.

Mr. Lipp was tested and doctors discovered blockages in both his jugular and azygos veins. In January of this year, he travelled to Italy for surgery, which cleared five blockages, and he began to feel better almost immediately.

“I felt good. I felt totally normal. I felt like I did years ago,” he said. He has not had an attack since.

As part of the research project, Mr. Lipp's siblings have also been tested. His two sisters, both of whom have MS, have significant blockages and iron deposits, while his brother, who does not have MS, has neither iron buildup nor blocked arteries.

While it has long been known that there is a genetic component to multiple sclerosis, the new theory is that it is CCSVI that is hereditary – that people are born with malformed valves and strictures in the large veins of the neck and brain. These problems lead to poor blood drainage and even reversal of blood flow direction that can cause inflammation, iron buildup and the brain lesions characteristic of multiple sclerosis.

It is well-established that the symptoms of MS are caused by a breakdown of myelin, a fatty substance that coats nerve cells and plays a crucial role in transmitting messages to the central nervous system. When those messages are blurred, nerves malfunction, causing all manner of woes, including blurred eyesight, loss of sensation in the limbs and even paralysis.

However, it is unclear what triggers the breakdown of myelin. There are various theories, including exposure to a virus in childhood, vitamin D deficiency, hormones – and now, buildup of iron in the brain because of poor blood flow.

While he is convinced of the significance of his discovery, Dr. Zamboni recognizes that medicine is slow to accept new theories and even slower to act on them. Regardless, he can take satisfaction in knowing that the woman who inspired the quest, and perhaps a dramatic breakthrough, has benefited tremendously.

Dr. Zamboni's wife, Elena, has undergone a battery of scans and neurological tests and her multiple sclerosis is, for all intents and purposes, gone.

“This is probably the best prize of the research,” he said.

Source: The Globe & Mail © Copyright 2009 CTVglobemedia Publishing Inc (22/11/09)

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Fifty percent of MS patients avoid treatment over injectable delivery fears5 dni temu
 
Around half of all multiple sclerosis (MS) patients that are eligible for treatment do not receive it and one in five of those patients that do begin therapy, delay doing so because of fear and anxiety over the treatment process, and not fear and anxiety about the disease.

These observations are according to Patricia Kennedy, a nurse practitioner and consultant at Can Do Multiple Sclerosis, formerly The Heuga Center for MS, US, who presented at the 2nd Vetter Drug Management Leadership Conference in Germany.

“If the injectable therapies that we have available today are good for MS, good for patients, and good for the future, why aren’t patients taking them?” questioned Kennedy. “It is important for industry to be aware of MS patients’ reasons for avoiding treatment and what they go through when facing the disease,” she added. She then urged delivery-device manufacturers to consider patient behaviour and feelings when developing new devices in order to increase a patient’s chances of initiating therapy and complying with long-term treatment.

According to Kennedy, healthcare professionals face a number of challenges when dealing with MS patients, with those who are eligible for therapy opting out of treatment for a number of reasons, including: lack of belief that it is needed; fear of needles; the constant reminder of the disease each time they need to inject; lack of family support; and the financial burden of treatment.

“Even in those patients that do begin treatment, it’s another challenge to keep them on it,” admitted Kennedy. She also advised of the problems that US healthcare systems currently face with disposal of syringes and sharp objects; this is a particular problem in more populated regions in the US.

Education of patients and their support networks is incredibly important to help with patient compliance and disease management. However, Kennedy also provided advice to industry on how new device development might help MS patients to manage and control their disease since injection-related issues are still a primary cause for patient’s fear of starting therapy and is the main reason for lack of compliance.

What can industry do?
“The easier we can make it for a patient to administer treatment, the more likely it is that the medication is going to be used,” explained Kennedy. “In most cases, the smaller the needle, the better. Although a 29-gauge needle might be easier to use than a 30-gauge needle, and although both are small, the patient will opt for the slimmer 30-gauge every time. Psychologically, that’s what they want,” she added.

According to Kennedy, patients want titrated, prefilled syringes that are marked clearly. Not only does this avoid any issues of efficient mixing and incorrect dosing, but MS patients often have vision problems. Kennedy also emphasized the importance of travel devices, such as pens. “Patients want devices that are easy to travel with because we live in a mobile society, and if we provide the option of transporting less bulky injections devices whilst they’re away from home, patients are more likely to comply with their medication,” she advised.

In general, Kennedy also believes that injection devices could help patients immensely. “Most patients like injectors; even if the needle is a 30-gauge needle, patient’s don’t want to see it. So if you can hide the injector, then that’s good. It’s psychological,” she said. Injection devices not only help overcome the psychological barrier to injections, but they are also easier to use than syringes, which is especially beneficial for those patients that suffer from tremors. In addition, they help patients to obtain a consistent depth of injection and thus reduce the number of injection-related side effects.

“I also believe that needless devices would help improve patient compliance with drug therapy,” added Kenney.

The bottom-line for patients, according to Kennedy, is to provide them with delivery devices that are easy to use, offer choice and flexibility, with increased comfort.

“What patients really want, first of all, is control over their MS — easily-injectable systems can help with that. They want to be self-effective, they want a medication that’s easy to use because then they’re not reminded about their MS, and if they’re reminded less often then life goes on and they’re able to pursue other things.

“So in the future, I would urge industry to continue to make injectable devices that are more patient-friendly. We need to work together to decrease the number of non-users; let’s raise that 50% to 75%,” she insisted. “I doubt we’ll ever make 100%, but we can lessen the impact of MS on a person’s life by giving them maximum control and letting them get on with their life. If we treat people early with the medications, we already have available to us today, and treatment is consistent and easy to administer, it gives them hope for the future,” she concluded.

Source: Pharmatech.com © 2009 Advanstar Communications, Inc (20/11/09)
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Drug studied as possible treatment for spinal injuries might also treat Multiple Sclerosis5 dni temu
 
Researchers have shown how an experimental drug might restore the function of nerves damaged in spinal cord injuries by preventing short circuits caused when tiny "potassium channels" in the fibers are exposed.

The chemical compound also might be developed as a treatment for multiple sclerosis.

Because nerves usually are not severed in a common type of spinal cord trauma, called "compression" injuries, the drug offers hope as a possible treatment, said Riyi Shi, a professor in Purdue University's Department of Basic Medical Sciences, School of Veterinary Medicine, Center for Paralysis Research and Weldon School of Biomedical Engineering.

"Compression is responsible for most spinal cord injuries, including many resulting in paralysis," Shi said. "Since the nerves are not severed, this type of drug represents a potential golden opportunity to treat spinal cord injuries."

The experimental compound, 4-aminopyridine-3-methyl hydroxide, has been shown to restore function to damaged axons, slender fibers that extend from nerve cells and transmit electrical impulses in the spinal cord.

Findings, based on experiments with guinea pig spinal cord tissue, appeared online in the Journal of Neurophysiology. The work was led by Department of Basic Medical Sciences doctoral student Wenjing Sun.

Shi said the findings were made possible by the interdisciplinary nature of the work, which also involves researchers Richard Borgens, director of Purdue's Center for Paralysis Research and the Mari Hulman George Professor of Neurology in the School of Veterinary Medicine; Stephen Byrn, the Charles B. Jordan Professor of Medicinal Chemistry, and Daniel Smith, a research assistant professor, both in the Department of Industrial and Physical Pharmacy; and Ji-Xin Cheng, an associate professor in the Weldon School of Biomedical Engineering and Department of Chemistry.



Researchers have shown how an experimental drug might restore the function of nerves damaged in spinal cord injuries by preventing short circuits caused when tiny "potassium channels" in the fibers are exposed by trauma. The compound also might be developed as a treatment for multiple sclerosis. This diagram illustrates how the drug functions as a "channel blocker," meaning it permits the conduction of signals even though the protective myelin insulation has been damaged.

(Photo Credit: Purdue University, Department of Basic Medical Sciences)

The researchers subjected spinal cord tissue to stresses that mimic what happens in a compression injury, which stretches nerves. Then they treated the damaged axons with 4-aminopyridine-3-methyl hydroxide.

The compound is a derivative of the drug 4-aminopyridine, used primarily as a research tool and also to manage symptoms of multiple sclerosis.

The axons of each nerve are sheathed in a thick insulating lipid layer, called myelin, which enables the transmission of signals without short circuiting, much like the insulation surrounding electrical wires. Spinal cord trauma damages the myelin sheath, exposing "fast potassium channels" that are embedded in the axons and are critical for transmitting nerve impulses.

The researchers confirmed previous circumstantial evidence suggesting injury causes the myelin insulation to recede, exposing the channels and impairing signal transmission. Laboratory and imaging techniques revealed the exposed channels in damaged axons.
The researchers also discovered that 4-aminopyridine-3-methyl hydroxide is a "potassium channel blocker," using a sophistic laboratory technique called "patch clamp" to measure signal conduction. Findings confirmed that the compound prevents the exposed channels from leaking electrical current and enhances nerve conduction in segments of the damaged spinal cord.

The compound could make it possible to sidestep spinal cord damage by enabling axons to transmit signals as though they were still sheathed in myelin, Shi said.

Nerves transmit signals through a series of rapid electrical pulses, or "action potentials." For proper nerve function, the time gap between pulses must be as brief as possible. However, 4-aminopyridine has been shown to lengthen the gap, or "refractory period," between pulses. The researchers found that 4-aminopyridine-3-methyl hydroxide restores function without affecting the refractory period. As a result, the damaged nerves perform more like healthy nerves than those treated with other drugs, he said.

Another key advantage of the new compound is that it's about 10 times more potent than 4-aminopyridine, meaning lower doses can be used to reduce the likelihood of serious side effects.

Because myelin also is damaged in multiple sclerosis, the same drug might be used to restore nerve function in people stricken with the disease, Shi said. Since the newer drug can be used in lower doses, it might be more effective than 4-aminopyridine in treating multiple sclerosis, which affects more than 350,000 people in the United States and 2.5 million worldwide, he said.

Source: Science Codex (20/11/09)
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