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What triggers MS and MS attacks?

Blog Summary

Hi again from the American Academy of Neurology meeting in San Diego. There have been some intriguing reports from researchers looking for risk factors that contribute to making a person more likely to get multiple sclerosis, and other reports focused on factors that might trigger MS attacks or even progression. To me, this line of research is really important because it could lead to ways to take control of disease activity and even to strategies to prevent people from getting MS.

Danish researchers have noted that the incidence of MS has doubled in women in Denmark since 1970, and they’ve been working to understand what’s behind this alarming rise. The Danish MS Registry captures information on most people in their country who have MS. They found that pregnancy offered significant protection against developing MS lasting up to five years after giving birth. I’m certainly not advocating that women should get pregnant to prevent MS. But this study and others like it offer more clues that will help to determine the influence of hormones and other factors in MS.

It was also exciting to hear firsthand results from recent studies reporting that dietary salt might have a role in increasing the risk for MS. The take-home message from these studies was that higher than average physiological levels of salt can increase the aggressiveness of immune cells that are thought to play an important role in MS. They also showed that adding salt to the diet of mice led to a more severe form of an MS-like disease called experimental autoimmune encephalomyelitis. There was a lot of discussion and debate about whether the high-salt western diet might be responsible for the increased incidence of MS. We will have to just wait for more studies to know for sure, but it is probably still a good idea to keep the fast-food burgers to a minimum.

This year’s Dystel Prize winner Professor George Ebers presented his work on the influences of the environment and genes passed down through families during a special prize lecture. You can read about his work here. In a nutshell, his studies have led to the understanding that where you live, and how much sun exposure you get (and consequently how much vitamin D your body makes from the sun), are some of the key factors that influence the risk of developing MS. I’m looking forward to results from clinical trials that are testing whether vitamin D supplements can reduce disease activity in people who already have MS.

What about triggers for MS attacks? Dr. Mauricio Farez of Argentina analyzed whether common vaccinations are linked to the risk of developing MS or triggering MS attacks. He failed to find evidence that any common vaccines contribute to the risk of MS, and he confirmed previous reports suggesting that flu vaccines, including H1N1, don’t appear to trigger relapses. But the big surprise for me was his report that a less common vaccine that protects against yellow fever may substantially increase the risk of relapse. Even though this is a preliminary finding, I recommend that if you are traveling to an exotic land (luck you!) and need this vaccine, you should talk with you MS doc about how to weigh these risks.

We don’t know yet why some people’s MS progresses slowly and others experience rapid progression, but I found a small study from investigators at Louisiana State University interesting. They asked whether blood sugar is linked to levels of MS disability, and found that people with higher levels of glucose were more likely to experience progression. This needs more study, but it opens up the possibility that strategies used to treat diabetes should be tested in MS.

I’ve only scratched the surface of what’s being reported here, and I hope you’ll read the upcoming summary that will give you more details. In the meantime, summaries (abstracts) of the meeting can be viewed on the AAN Website.

The importance of exercising our bodies and minds

Blog Summary

I’m reporting again from the American Academy of Neurology meeting in San Diego. A meeting like this involves a lot of sitting, so I try to start each morning with some exercise. Turns out that emerging evidence suggests that exercise doesn’t just help keep us physically fit, but also helps our brains function better; presentations this week on exercise, rehabilitation and quality of life issues suggest this holds true for people living with MS. A small study from Society-supported scientists at the Kessler Foundation in New Jersey tested whether aerobic exercise – the kind that gets you breathing fast and your heart beat going – affects the brain. Using MRI scans and memory tests, they found hints that aerobic exercises done in 30-minute sessions, three times a week over three months improved memory and increased the volume of the hippocampus, a part of the brain involved with memory and other functions. These preliminary results are intriguing and will hopefully encourage further studies that yield more definitive conclusions and maybe even recommendations. Another study examined the potential of longer-term aerobic exercise to build endurance in people with MS. This study involved 60 people split into two groups: people with fatigue and people without. Both groups began individualized endurance (treadmill) exercise. After six months of exercise, both groups showed improved oxygen consumption, but those who started out with fatigue showed improvement in their fatigue scores, but it took at least nine months of the program to see a difference. So while you may not feel the effects at first, persistence can pay off! Some very interesting data illustrating how the brain reorganizes to adapt to MS damage was presented by a research team from the San Raffaele Hospital in Milan, Italy. This team looked at the impacts of a 12-week computer-assisted course that focused on training to increase memory and attention (the course was previously reported to improve attention and executive thinking abilities). Using functional MRI, which allows a real-time glimpse of the brain at work, they also found indicators that brain circuitry and activity had increased in specific areas. This improvement appeared to persist at least six months after the training was completed. Researchers from Milan and from Kessler also reported that people with MS with more “brain reserve” (larger brain size) and more “cognitive reserve” (higher levels of cognitive leisure activities such as playing music, writing, dancing, or painting when they were in their 20’s) were at lower risk for cognitive changes associated with brain lesions. Even when brain size is accounted for, those with more cognitive reserve appear to have lower risk for cognitive changes. There’s nothing any of us can do about the size of our brains. But growing evidence suggests that people may be able to build cognitive reserve by engaging in enrichment activities (Words with Friends anyone?). It’s exciting to think that actions we can take, such as some mental and physical training, can actually alter brain circuits, improve brain activity and possibly help slow the progression of MS. What do you do to keep your body and mind active? Summaries (abstracts) of the meeting can be viewed on the AAN Website.

Emerging therapies at the American Academy of Neurology meeting

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I’m excited to be reporting from the American Academy of Neurology (AAN) meeting in San Diego; it’s quite impressive to see large auditoriums overflowing with neurologists and other professionals attending presentations about emerging therapies in MS. Over the next few days I will share what I believe to be the most interesting MS research being presented here.One study I’m particularly intrigued by is a small trial of the blood pressure medicine, Amiloride, in 14 people with primary progressive MS. Amiloride had been shown previously to have neuroprotective properties – the study authors found that treatment resulted in a lessening of brain shrinkage associated with progressive MS. I am looking forward to seeing if this medication has similar effects in a larger study underway in the United Kingdom. Another study of over 1000 people with MS is underway – designed to determine if Gilenya can slow down disability in primary-progressive MS, compared to placebo, after 3 to 5 years of treatment. I also find it encouraging that several other large studies like this for progressive MS are currently in planning or underway. While there have been many successful new therapies introduced in the past two decades, most prove ineffective for people with progressive forms of MS. What excites me most about these studies is that they aim to bridge this gap and offer hope for real treatment options for people with progressive MS. The first results of a phase III trial of peginterferon beta-1a in relapsing MS are also being presented. The study is testing a new formulation of Avonex that should stay in the body longer than the standard treatment. Successful trial results could mean that the frequency of dosing could be extended to as long as once every four weeks – reducing the frequency of injections. I also attended presentations on various outcomes from extension trials of BG-12 and alemtuzimab. Researchers continue to add to our knowledge of the risks and benefits of these two meds currently being evaluated by the FDA for the treatment of relapsing MS. Studies are also underway on other emerging therapies for MS, including ocrelizumab and daclizumab HYP. Results will be shared on our research news as they become available. More treatment options ultimately means that people with MS have a better chance of finding a therapy that fits their specific needs and lifestyle while reducing the frequency or severity of MS attacks or disease progression. This is just a quick glimpse of some things that stood out for me so far – I will be sharing more, so stay tuned. Visit AAN’s website for brief summaries (abstracts) of the meeting.