Medicine In Multiple Sclerosis Research Articles

A first step towards preventive medicine in multiple sclerosis.

A first step towards preventive medicine in multiple sclerosis.

Complementary and alternative medicine in multiple sclerosis: a questionnaire-based study.

To assess the prevalence and characteristics of complementary and alternative medicine (CAM) use among multiple sclerosis (MS) patients in Poland. Multiple sclerosis (MS) is a chronic, progressive and disabling neurological disease with significant impact on quality of life. Although the efficacy and safety of complementary and alternative medicine (CAM) has not been scientifically confirmed, many patients use CAM as a complement or an alternative to conventional therapy. Data was collected via a self-designed survey consisting of 33 questions. The questionnaire was distributed among MS patients hospitalised during 2016 in the MS Unit at the Department of Neurology, Medical University of Warsaw, Poland. The study group consisted of 75 patients (47 females, 28 males, mean age 44.6 ± 12.5 years) with clinically defined MS. According to the questionnaire, 48 patients (64%) had used CAM at least once. Most of the patients declared that CAM had a possible (58%) or a marked (43.7%) positive effect. 61.4% of CAM users reported reduced fatigue and 33.3% improved mood. There were significant correlations between CAM use and lower social and professional status (p < 0.04), disease progression (p < 0.03), and lack of efficacy of disease-modifying therapies (p < 0.04). There were no significant correlations between CAM usage and sex, habitation, education, marital or professional status. The most frequently used CAMs were vitamins (48%), and polyunsaturated fatty acids (36%); psychophysical methods (44%) included manual therapies (24%) and relaxation techniques (17.3%) as well as herbal medicine (29.3%). Physicians were considered to be the most reliable authority in both conventional treatment (97.3%) and CAM (67%). Complementary and alternative medicine users significantly more often discussed this issue with their doctors (56%) compared to patients who did not use alternative medicine (p < 0.05). However, 54% of patients did not inform their physician about CAM use. Responders said that physicians did not initiate discussion about it (55.9%), but 44% of patients would like to have the possibility of talking to a doctor about CAM. Although CAM efficacy and safety is not confirmed, one should keep in mind that most MS patients use alternative methods, especially those individuals with a more severe phenotype. Physicians are mostly perceived as reliable authorities and therefore they should discuss this issue with patients in order to eliminate drug interactions and to improve compliance.

Analysis of patients’ access to reimbursed biotechnological medicines for multiple sclerosis in Bulgaria and Greece

ABSTRACT Objective The goal is to perform a comparative analysis of multiple sclerosis patients’ access to medicines in Bulgaria and Greece. Materials and methods A comparative analysis of pharmaceutical legislation of Bulgaria and Greece focusing on medicines for multiple sclerosis (MS) was performed. Patients’ access to therapy is assessed through the guideline compliance index (GCI) and availability index. Results The procedures for marketing authorization, pricing and reimbursement, and inclusion of medicines in the positive drug list (PDL) are identical in both European Union member states. Almost all MS medicines authorized for sale in the European Union are included in the Bulgarian and Greek PDL. In both PDLs are included medicines from different groups: immunostimulants, other immunostimulants, immunosuppressors, selective immunosuppressors, and other immunosuppressors. All medicines are fully paid by the health insurance funds in both countries. The average time for inclusion of medicines for MS in the PDL of Bulgaria after their marketing authorization is 3 years. The analysis of pharmacotherapeutic guidelines showed high GCI as it is higher for Bulgaria: 0.846 vs. 0.769 out of 1. Conclusion The existing legislative measures at the national level of Bulgaria and Greece ensure adequate and timely access of patients with MS to treatment.

Mechanism of sphingosine 1-phosphate clearance from blood.

The interplay of sphingosine 1-phosphate (S1P) synthetic and degradative enzymes as well as S1P exporters creates concentration gradients that are a fundamental to S1P biology. Extracellular S1P levels, such as in blood and lymph, are high relative to cellular S1P. The blood-tissue S1P gradient maintains endothelial integrity while local S1P gradients influence immune cell positioning. Indeed, the importance of S1P gradients was recognized initially when the mechanism of action of an S1P receptor agonist used as a medicine for multiple sclerosis was revealed to be inhibition of T-lymphocytes’ recognition of the high S1P in efferent lymph. Furthermore, the increase in erythrocyte S1P in response to hypoxia influences oxygen delivery during high altitude acclimatization. However, understanding of how S1P gradients are maintained is incomplete. For example, S1P is synthesized but is only slowly metabolized by blood yet circulating S1P turns over quickly by an unknown mechanism. Prompted by the counterintuitive observation that blood S1P increases markedly in response to inhibition S1P synthesis (by sphingosine kinase 2 (SphK2)), we studied mice wherein several tissues were made deficient in either SphK2 or S1P degrading enzymes. Our data reveal a mechanism whereby S1P is de-phosphorylated at the hepatocyte surface and the resulting sphingosine is sequestered by SphK phosphorylation and in turn degraded by intracellular S1P lyase. Thus, we identify the liver as the primary site of blood S1P clearance and provide an explanation for the role of SphK2 in this process. Our discovery suggests a general mechanism whereby S1P gradients are shaped.

A proof-of-concept application of a novel scoring approach for personalized medicine in multiple sclerosis

Background: Stratified medicine methodologies based on subgroup analyses are often insufficiently powered. More powerful personalized medicine approaches are based on continuous scores. Objective: We deployed a patient-specific continuous score predicting treatment response in patients with relapsing-remitting multiple sclerosis (RRMS). Methods: Data from two independent randomized controlled trials (RCTs) were used to build and validate an individual treatment response (ITR) score, regressing annualized relapse rates (ARRs) on a set of baseline predictors. Results: The ITR score for the combined treatment groups versus placebo detected differential clinical response in both RCTs. High responders in one RCT had a cross-validated ARR ratio of 0.29 (95% confidence interval (CI) = 0.13–0.55) versus 0.62 (95% CI = 0.47–0.83) for all other responders (heterogeneity p = 0.038) and were validated in the other RCT, with the corresponding ARR ratios of 0.31 (95% CI = 0.18–0.56) and 0.61 (95% CI = 0.47–0.79; heterogeneity p = 0.036). The strongest treatment effect modifiers were the Short Form-36 Physical Component Summary, age, Visual Function Test 2.5%, prior MS treatment and Expanded Disability Status Scale. Conclusion: Our modelling strategy detects and validates an ITR score and opens up avenues for building treatment response calculators that are also applicable in routine clinical practice.

Traditional Chinese Medicine in Multiple Sclerosis: Theory and Practice

Multiple sclerosis (MS) is a disease with complex etiology and pathophysiology. Approved drugs for MS treatment are only partly effective, and some of them show obvious side effects and resistance. In this review, we will discuss the philosophy and advantages of traditional Chinese medicine (TCM) as a complementary and alternative therapy for MS treatment. The purpose of this review is to provide novel insights and directions for MS management. TCM is an empirical medical system which has established its own unique method of diagnosis and therapy for over thousands of years. The concept of holism and yin-yang balance are its core theories. From TCM perspective, syndrome differentiation, deficiency tonification, stasis removal, and detoxication are the four main principles of MS treatment. Clinical trials have shown that TCM is effective to alleviate symptoms, prevent recurrence, and delay disease progression in MS patients. Experimental evidences also have confirmed the effect of TCM in experimental autoimmune encephalomyelitis (EAE), which is in the multitarget and multicomponent pattern. TCM maximize therapeutic efficacy by facilitating synergistic actions, exhibiting various biological activities including anti-inflammatory, anti-oxidative, immune-regulatory, and neuro-protective effects in MS and EAE. Treatment with TCM alone or combined with western medicine can greatly improve the body’s resistance and reduce side effects of the treatment. Integrating TCM with Western medicine have great promise for inspiring new ideas and therapies for prevention and treatment of MS. The appropriate combination can improve efficacy, reduce toxicity, and make the best benefits in MS patients.

Personalized medicine in multiple sclerosis.

The therapeutic approach in multiple sclerosis (MS) requires a personalized medicine frame beyond the precision medicine concept, which is not currently implementable due to the lack of robust biomarkers and detailed understanding of MS pathogenesis. Personalized medicine demands a patient-focused approach, with disease taxonomy informed by characterization of pathophysiological processes. Important questions concerning MS taxonomy are: when does MS begin? When does the progressive phase begin? Is MS really two or three diseases? Does a therapeutic window truly exist? Newer evidence points to a disease spectrum and a therapeutic lag of several years for benefits to be observed from disease-modifying therapy. For personalized treatment, it is important to ascertain disease stage and any worsening of focal inflammatory lesions over time.

Exercise as Medicine in Multiple Sclerosis—Moving Beyond Compensatory Benefits

Many studies have shown that physical exercise improves multiple sclerosis (MS) symptoms, including cognition, fatigue, bowel and bladder function, depression, and overall quality of life. However, the pathophysiologic mechanisms responsible for these symptomatic changes remain elusive. Exercise offers a likely path for addressing progressive MS, nervous system repair, and as a wellness approach for people with MS. We as a community need to work toward gaining information to establish an evidence-based exercise prescription for people living with MS.

Exercise as Medicine in Multiple Sclerosis—Moving Beyond Compensatory Benefits

Many studies have shown that physical exercise improves multiple sclerosis (MS) symptoms, including cognition, fatigue, bowel and bladder function, depression, and overall quality of life. However, the pathophysiologic mechanisms responsible for these symptomatic changes remain elusive. Exercise offers a likely path for addressing progressive MS, nervous system repair, and as a wellness approach for people with MS. We as a community need to work toward gaining information to establish an evidence-based exercise prescription for people living with MS.

Precision medicine in multiple sclerosis: biomarkers for diagnosis, prognosis, and treatment response.

This article highlights recent studies on MRI and body fluid molecular biomarkers with potential implications in diagnosis, prognosis, and response to treatment in patients with multiple sclerosis (MS). In the MS diagnostic process, a reappraisal of well known MRI findings, including symptomatic and spinal cord lesions, and incorporation of newer, more specific, features of MS lesions, such as detection of central veins, are in a testing phase aiming to increase diagnostic accuracy. Lesion counts on T2-weighted scans and gadolinium uptake on postcontrast T1-weighted scans are well established prognostic brain MRI biomarkers. Evidences supporting the implementation of brain volume measures for disease and treatment monitoring are increasing, maybe within a 'zero tolerance' scheme in the overarching no evidence of disease activity concept. Cerebrospinal fluid (CSF) chitinase 3-like 1 and the light subunit of neurofilaments are consolidating their prognostic role in patients with clinically isolated syndrome. Blood CD62L and CSF IgM oligoclonal bands may become clinically useful biomarkers for progressive multifocal leukoencephalopathy risk stratification in MS patients treated with natalizumab. Although more studies are needed, current and emerging imaging and molecular biomarkers in MS may contribute to outline the concept of precision medicine in MS.

Experimental research of integrative Chinese medicine in multiple sclerosis

Experimental research of integrative Chinese medicine in multiple sclerosis

Decade in review-multiple sclerosis: new drugs and personalized medicine for multiple sclerosis.

The past decade of multiple sclerosis research has been marked by important advances in understanding the disease, a dramatic increase in the range of treatment options and a new spirit of data sharing in research for patient benefit. This progress has made personalized medicine in multiple sclerosis a realistic possibility.

The Impact of Social Media on Dissemination and Implementation of Clinical Practice Guidelines: A Longitudinal Observational Study.

BackgroundEvidence-based clinical practice guidelines (CPGs) are statements that provide recommendations to optimize patient care for a specific clinical problem or question. Merely reading a guideline rarely leads to implementation of recommendations. The American Academy of Neurology (AAN) has a formal process of guideline development and dissemination. The last few years have seen a burgeoning of social media such as Facebook, Twitter, and LinkedIn, and newer methods of dissemination such as podcasts and webinars. The role of these media in guideline dissemination has not been studied. Systematic evaluation of dissemination methods and comparison of the effectiveness of newer methods with traditional methods is not available. It is also not known whether specific dissemination methods may be more effectively targeted to specific audiences.ObjectiveOur aim was to (1) develop an innovative dissemination strategy by adding social media-based dissemination methods to traditional methods for the AAN clinical practice guidelines “Complementary and alternative medicine in multiple sclerosis” (“CAM in MS”) and (2) evaluate whether the addition of social media outreach improves awareness of the CPG and knowledge of CPG recommendations, and affects implementation of those recommendations.MethodsOutcomes were measured by four surveys in each of the two target populations: patients and physicians/clinicians (“physicians”). The primary outcome was the difference in participants’ intent to discuss use of complementary and alternative medicine (CAM) with their physicians or patients, respectively, after novel dissemination, as compared with that after traditional dissemination. Secondary outcomes were changes in awareness of the CPG, knowledge of CPG content, and behavior regarding CAM use in multiple sclerosis (MS).ResultsResponse rates were 25.08% (622/2480) for physicians and 43.5% (348/800) for patients. Awareness of the CPG increased after traditional dissemination (absolute difference, 95% confidence interval: physicians 36%, 95% CI 25-46, and patients 10%, 95% CI 1-11) but did not increase further after novel dissemination (physicians 0%, 95% CI -11 to 11, and patients -4%, 95% CI -6 to 14). Intent to discuss CAM also increased after traditional dissemination but did not change after novel dissemination (traditional: physicians 12%, 95% CI 2-22, and patients 19%, 95% CI 3-33; novel: physicians 11%, 95% CI -1 to -21, and patients -8%, 95% CI -22 to 8). Knowledge of CPG recommendations and behavior regarding CAM use in MS did not change after either traditional dissemination or novel dissemination.ConclusionsSocial media-based dissemination methods did not confer additional benefit over print-, email-, and Internet-based methods in increasing CPG awareness and changing intent in physicians or patients. Research on audience selection, message formatting, and message delivery is required to utilize Web 2.0 technologies optimally for dissemination.

Uses of Complementary and Alternative Medicine in Multiple Sclerosis

Multiple sclerosis (MS) is a chronic, disabling, recurrent demyelination of the central nervous system (CNS). It could affect different regions in the brain and spinal cord, and according to the domain which is affected, it could cause different symptoms such as motor, sensory, or visual impairment; fatigue; bowel, bladder, and sexual dysfunction; cognitive impairment; and depression. MS patients also face reduced quality of life. Drugs that are used in MS are not fully efficient and patients suffer from many symptoms and adverse effects. Today there is an increasing trend of using complementary and alternative medicine (CAM). People are more likely to use this type of treatment. Using appropriate lifestyle and CAM therapy can subside some of the symptoms and could improve the quality of life in these patients. Many people with MS explore CAM therapies for their symptoms. This review is aimed to introduce CAM therapies that could be used in MS patients.

Guidelines on Complementary and Alternative Medicine in Multiple Sclerosis

Sponsoring Organization: American Academy of Neurology Target Population: Neurologists, patients, other clinicians seeing patients with multiple sclerosis (MS) Background and Objective Numerous disabling and painful symptoms of multiple sclerosis are inadequately addressed by our medication arsenal. Many patients with MS seek alternate therapies to help improve their quality of life. Key Points A panel of MS experts reviewed the evidence on 29 alternative approaches. They found the evidence sufficient to comment on only 7 of them and derived the following statements:

Complementary and alternative medicine in multiple sclerosis: Payment policy perspectives.

This article identifies payment policy perspectives of the American Academy of Neurology's guideline on complementary and alternative medicine (CAM) in multiple sclerosis (MS). The guideline is a reliable repository of information for advocating or not recommending certain CAM treatments in MS. It eases the burden of searching for information on each separate CAM treatment. It frequently emphasizes the need for patient counseling. To provide such generally undervalued, but needed, cognitive services, neurologists could use advanced practice providers and patient-friendly visual aids during or between visits. They should also rely on evaluation and management codes that recognize time spent predominantly on counseling or coordination of care. The guideline's categorization of probable effectiveness of certain therapies will not influence coverage decisions because payers do not generally cover CAM therapies.

Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis

To develop evidence-based recommendations for complementary and alternative medicine (CAM) in multiple sclerosis (MS). We searched the literature (1970-March 2011; March 2011-September 2013 MEDLINE search), classified articles, and linked recommendations to evidence. Clinicians might offer oral cannabis extract for spasticity symptoms and pain (excluding central neuropathic pain) (Level A). Clinicians might offer tetrahydrocannabinol for spasticity symptoms and pain (excluding central neuropathic pain) (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity (short-term)/tremor (Level B) and possibly effective for spasticity and pain (long-term) (Level C). Clinicians might offer Sativex oromucosal cannabinoid spray (nabiximols) for spasticity symptoms, pain, and urinary frequency (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity/urinary incontinence (Level B). Clinicians might choose not to offer these agents for tremor (Level C). Clinicians might counsel patients that magnetic therapy is probably effective for fatigue and probably ineffective for depression (Level B); fish oil is probably ineffective for relapses, disability, fatigue, MRI lesions, and quality of life (QOL) (Level B); ginkgo biloba is ineffective for cognition (Level A) and possibly effective for fatigue (Level C); reflexology is possibly effective for paresthesia (Level C); Cari Loder regimen is possibly ineffective for disability, symptoms, depression, and fatigue (Level C); and bee sting therapy is possibly ineffective for relapses, disability, fatigue, lesion burden/volume, and health-related QOL (Level C). Cannabinoids may cause adverse effects. Clinicians should exercise caution regarding standardized vs nonstandardized cannabis extracts and overall CAM quality control/nonregulation. Safety/efficacy of other CAM/CAM interaction with MS disease-modifying therapies is unknown.

Complementary and alternative medicine in multiple sclerosis

Although it is sometimes hard to define, complementary and alternative medicine (CAM) refers to health care approaches that are developed outside of mainstream and conventional medicine.1 “Complementary” and “alternative” are often used interchangeably, but there are some differences. “Complementary medicine” generally refers to using a nonmainstream approach together with conventional medicine. “Alternative medicine” refers to using a nonmainstream approach in place of conventional medicine. The boundaries between complementary and conventional medicine can overlap and even change with time. Most CAM therapies are not regulated by the US Food and Drug Administration, which means the quality and purity of CAM therapies may vary significantly.

Solving the Mystery of MS

New medicines for multiple sclerosis have made a big difference in patients' lives, but a breakthrough in therapy may require rethinking the origins of the disease

A Multicentre, Double-Blind, Randomised, Parallel-Group, Placebo-Controlled Study of Effect of Long-Term Sativex® Treatment on Cognition and Mood of Patients with Spasticity Due to Multiple Sclerosis

Objective: When Sativex ®THC:CBD cannabinoid-based oromucosal spray was first approved as a prescription medicine for multiple sclerosis (MS) spasticity, there was some concern about its possible long-term impact on cognition and mood. The objective of this study was therefore to assess the long-term impact of Sativex on cognitive function and mood in MS patients with spasticity. Methods: 121 patients were randomly assigned Sativex or placebo in a double-blind manner. Patients self-administered treatment daily for 48 weeks while maintaining anti-spasticity therapy. The primary endpoint was the difference between treatments in Paced Auditory Serial Addition Test (PASAT) score from baseline to end of treatment. Secondary measures included Beck Depression Inventory-II (BDI-II), Subject-, Physician- and Caregiver Global Impression of Change, and Columbia-Suicide Severity Rating Scale. Results: 62 patients were randomised to Sativex and 59 to placebo. There was no difference in the effect of Sativex on PASAT and BDI-II scores compared with placebo. Subject-, Physician- and Caregiver-rated improvements in spasticity with Sativex were all statistically significant. The mean daily dose of Sativex declined gradually to 6.4 sprays per day. Conclusion: Long-term treatment with Sativex was not associated with cognitive decline or significant changes in mood in this prone population sample. Sativex was efficacious and well tolerated across the study period and no new safety concerns were identified.