Sexual Health

Positive Clinical Trial Results Take Center Stage At American Academy Of Neurology Meeting

noted for those on active treatment. (Abstract S11.002). A related study by National MS Society Sylvia Lawry Fellow Lahar Mehta, MD, and colleagues at the University of Rochester also found no benefit in the use of memantine for the treatment of MS-related spasticity (Abstract P07.138) MS in Children - Antibodies: The presence of immune antibodies in the spinal fluid is among signs doctors look for when they are diagnosing MS, but not everyone who has MS has these antibodies, which are called "oligoclonal bands." In their first platform presentation as research collaborators, Dorothee Chabas, MD, PhD, and other members of the National MS Society"s six Pediatric MS Centers of Excellence shared results of a study comparing spinal fluid characteristics of 82 children diagnosed with MS before and after age 11. The spinal fluid was analyzed within the first three months of disease onset. The investigators found that a significantly lower proportion of those with onset before age 11 had oligoclonal bands in their spinal fluid, and tended to have lower amounts of a key antibody (IgG) than those who were older at disease onset. They also found higher levels of white blood cells called neutrophils. The team points out that these features, which are less like MS in adults, should be taken into consideration when children are being diagnosed. (Abstract S01.003) MS Risk Factors - Smoking: Joseph Finkelstein, MD, PhD (Johns Hopkins) and colleagues, in collaboration with the Baltimore VA"s MS Center of Excellence, reported on a study using the 2002 National Health Interview Survey of over 30,000 households. A small proportion of those surveyed told interviewers that they had been diagnosed with MS. The cigarette smoking history of these 87 people was compared to that of 435 matched controls who did not have MS. The investigators found that people who had started smoking early (prior to age 17) were 2.7 times more likely to develop MS, versus those who started smoking later or never smoked. It is not clear whether other behavioral factors contributed to the increased risk of MS in this relatively small sample of individuals. This study adds to the growing body of information related to cigarette smoking and its apparent contributions to MS susceptibility and progression. (Abstract S01.001) - Breastfeeding and MS: A quandary facing women with MS and their doctors relates to a crucial time period after giving birth, when there is a higher risk for relapse, and many women are advised to go back on their disease-modifying therapies as soon as possible. Since there is insufficient evidence to support the safety of breastfeeding while using any of these therapies, most babies born to moms with MS are bottle fed, despite known health benefits of breastfeeding for infants. Annette Langer-Gould, MD, PhD (Stanford University) and colleagues conducted a pilot study in which they followed 32 pregnant women with MS and a matched set of pregnant women without MS, assessing their disease and breastfeeding status at intervals out to 12 months after giving birth. In this small sample, they found that women who breastfed their babies exclusively (without giving supplemental bottles) for at least the first two months post-partum were five times less likely to have an MS relapse than those who did not breastfeed or who did not breastfeed exclusively during the first two months. The investigators suggest that the results may be biased because women in their study with more severe MS were less likely to breastfeed, while those with milder MS were more likely to breastfeed. Nevertheless, this study points to the importance of this issue; more research is needed to help guide postpartum treatment decisions. (Abstract S01.006) Genes Influencing MS Progress in understanding the influence of genes on MS susceptibility and disease course was apparent from several platform and poster presentations. - MS susceptibility genes: Trevor Kilpatrick, MB, BS, PhD, FRACP (University of Melbourne) reported on a large-scale gene scan supported by MS Research Australia and the Australian Research Council. They compared genetic material from 3,874 people with MS and 5,723 people without MS in search of gene variations that appeared to make people more susceptible to developing the disease. They confirmed 6 gene variations that had been previously identified, and found 15 variations not previously reported. These include a region on Chromosome 12 that has also been associated with autoimmune diseases such as rheumatoid arthritis and type 1 diabetes, further confirmation that at least some of the same gene variations may be at work in MS and other immune diseases. (Late Breaking Abstract LBS.003) - Protective genes: Gabriele DeLuca, MD, PhD (University of Oxford) and international collaborators presented results suggesting that a specific gene variation may confer protection against severe MS. The investigators explored genetic material from 241 individuals who had experienced only one symptom - visual loss (due to optic neuritis) - but never went on to develop definite MS. They compared their genes to those of hundreds of individuals who had definite MS, including some with either benign or severe disease courses. Among their findings, their study confirmed that significantly fewer people who had a severe course had a previously identified MS gene (HLA-DRB1*01) related to immune activity, suggesting it is protective against the development of MS. The investigators note that research into its protective mechanism may provide important new avenues for treatment. (Abstract S17.002) Clues from Imaging Studies - Role of glutamate: A large study supports the possibility that excess amounts of glutamate in the brain may contribute to progressive tissue damage in MS. Glutamate helps excite nerve cells, and some research suggests that too much glutamate may contribute to tissue damage in MS. In a study funded by the National MS Society to test the relationship of this chemical to tissue loss, Daniel Pelletier, MD (University of California, San Francisco) and colleagues did annual MRS (magnetic resonance spectroscopic) scans in 265 people with early or established relapsing-remitting or secondary-progressive MS. MRS can detect quantities of chemicals in different parts of the brain; one chemical called NAA is considered a marker that goes down as nerve tissue is injured. The researchers found that, in the gray matter of the brain where nerve cell bodies reside, the higher the level of glutamate, there was a corresponding loss of NAA, indicating nerve damage. This was not observed in the white matter, which contains the nerve fibers that are covered by myelin. These findings provide further evidence of a link between glutamate and nerve tissue loss in MS. (Abstract S31.002) - Predicting progression: Having better tools that can help measure the effectiveness of new therapies and help predict whether MS will progress over time is an important goal of clinical researchers. To help address this need, Elizabeth Fisher, PhD (Cleveland Clinic) and colleagues conducted a study, supported by the National Institutes of Health, that used MRI measures to follow the course of 63 individuals with relapsing-remitting or secondary-progressive MS for an average of 6.5 years. They compared their imaging findings to clinically measured disease progression using MSFC, a scale used to test physical and cognitive functions. They reported that MRI measures of brain shrinkage, or atrophy, were the best predictors of future clinical worsening measured by the MSFC, but they did not correlate with changes in the more traditional measure of disease progression, the EDSS. Work is underway to further enhance the MSFC as a sensitive measure of disability. (Abstract S31.004) National MS Society

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