Multiple sclerosis: new treatment trials and emerging therapeutic targets.
This review gives an overview of the up-to-date therapeutic strategies and the new drugs which are currently studied in clinical trials.
authors: Deangelis T, Lublin F.
source: Curr Opin Neurol. 2008 Jun;21(3):261-71.
Simvastatin Inhibits IL-17 Secretion by Targeting Multiple IL-17-Regulatory Cytokines and by Inhibiting the Expression of IL-17 Transcription Factor RORC in CD4+ Lymphocytes.
The authors investigated the immunomodulatory role of simvastatin, a medication which is used as cholesterol-lowering agent, in people with MS. They found that this drug can interfere in the autoimmune response, but further studies are needed to assess its clinical benefit.
authors: Zhang X, Jin J, Peng X, Ramgolam VS, Markovic-Plese S.
source: J Immunol. 2008 May 15;180(10):6988-96.
Ireland: new, nationwide programme for people with MS
"Getting The Balance Right" is MS Ireland’s first-ever nationwide exercise, health promotion and research programme for people with MS, and will be delivered across the country in a variety of venues and settings.
On 16 September 2008, MSIF and the MS Society of Canada will be holding Montréal08 - Living with MS: Global Perspectives on Current Issues in Montréal, Quebec, Canada.
Summaries of all the latest research findings on MS selected by a team based at the Institute of Neurology, London. Identification of internuclear ophthalmoplegia signs in multiple sclerosis patients : Saccade test analysis.
Eye movement disorders, particularly internuclear ophthalmoplegia (INO), are common in people with MS. The authors found that the saccade test analysis which is part of the electrooculographic evaluation, is useful for identifying subclinical INO signs in people with MS.
authors: Jozefowicz-Korczynska M, Lukomski M, Pajor A.
source: J Neurol. 2008 May 2 [Epub ahead of print]
Does high field MRI allow an earlier diagnosis of multiple sclerosis?
The authors investigated whether high field MRI (i.e. 3 Tesla scanner) can provide an earlier diagnosis of definite MS compared with 1.5 Tesla. They concluded that, although it showed a higher detection rate of inflammatory brain lesions, high field MRI cannot lead to a earlier diagnosis of lesion dissemination in time and therefore definite MS.
authors: Wattjes MP, Harzheim M, Lutterbey GG, Hojati F, Simon B, Schmidt S, Schild HH, Barkhof F.
source: J Neurol. 2008 May 2 [Epub ahead of print]
MS neurologist and researcher, Montreal Neurological Institute, QC
What are the criteria used in defining or diagnosing a Clinically Isolated Syndrome (CIS)? Is it possible to receive a diagnosis of CIS while still meeting the McDonald criteria for probable MS?
CIS (Clinically Isolated Syndrome), a term coined by the MS community, refers to any neurological episode that involves central nervous system (CNS) dysfunction, has characteristics of an inflammatory demyelinating process (meaning neurological symptoms tends to come on subacutely and typically gets at least partially better with or without treatment), and for which there is no evidence for other explanation (infection, trauma, etc). Since involvement can be in any CNS pathway, there are many possible presentations of CIS, including an episode of optic neuritis, myelitis, etc.
An important point is that CIS, by definition, refers to an isolated event, which means the person has never experienced another event in the past that may be due to inflammatory CNS demyelination, nor has the person experienced any further events since the CIS episode. If you consider all individuals who have experienced CIS, a proportion of these individuals, but not all of them, will end up with the diagnosis of MS. A brain MRI and a few other tests performed around the time of the CIS episode can help predict which patients with CIS are more or less likely to have diagnosis of MS.
To establish the diagnosis of MS in someone who has had CIS, there needs to be some evidence of new activity in the CNS developing over time. If someone with CIS has another clinical attack sometime later, or if they show clearly new lesions on repeat brain MRI, they can qualify for the diagnosis of MS. Therefore, anyone with CIS is considered as being at greater risk (than the general population) of developing the diagnosis of MS. They can be thought of as having 'possible MS'.
The notion of 'probable MS' is more of a 'statistical' concept. For example, if a patient with CIS has a brain MRI at the time, which shows no lesions at all, the likelihood he/she will develop the diagnosis of MS in the future is considered quite low (around 20% or less). On the other hand, a patient with CIS (who may clinically have the exact episode as the patient above) whose brain MRI at the time showed many lesions, is quite likely to eventually have an MS diagnosis (probably 80% or more). Such patients may be considered to have a high enough likelihood of MS that they can be offered some of the approved MS therapies.
So, anyone with an episode of CIS could be considered as someone who may possibly end up with an MS diagnosis. Some of these individuals with CIS may be more or less likely to do so. The MRI as noted above can help but is also not perfect. For patients with CIS, for whom the decision is not to initiate an MS therapy, the general approach is to follow them in an 'active' way, with repeat MRI and neurological exams at reasonable intervals, so that if new activity is identified, treatment discussion can be revisited.
5/13/2008 4:26:16 PM
More answers from Dr. Amit Bar-Or
More answers in the category: Diagnosis and Types of MS
DISCLAIMER: Please be aware that this information does not necessarily represent the opinion of the MS Society of Canada, and is not intended as medical advice. For specific advice and opinion, always consult a physician.
Using your head: Gairdner Award winner Dr. Sam Weiss and his discovery that the adult brain produces stem cells to fix itself.