Friday, June 27, 2014

June 2014 Round-Up of MS News and Research

How common is sexual dysfunction in women with MS?
Sexual dysfunction is very common in MS but it is not highly discussed.  Studies report that up to 84.6% of women with MS experience at least one sexual dysfunction.  Approximately 34.8% of MS women experience 5 or more sexual dysfunctions while 12.9% experience 10 or more.  Symptoms include lower sex drive, decreased lubrication, poor clitoral erection, and lack of orgasm.  Other MS symptoms, such as bladder and bowel dysfunction, spasticity, pain, fatigue, depression, anxiety, and side effects of medication often contribute to sexual dysfunction.  More research is needed, but drugs such as sildenafil (a and alpha-blockers may improve lubrication.  Water-based lubricants and estrogen therapy may help with vaginal dryness, burning, and painful intercourse.  As antidepressants can interfere with orgasm, lower doses or a change of medication may be recommended.  Because of physical limitations of MS, women with MS may be advised to plan ahead for sex to manage timing, positioning, and fatigue, as well as prevent unwanted urinary or fecal incontinence.  Sex aids and extra-genital stimulation can provide erotic sensations.  Counseling can also help couples improve communication skills and increase sexual satisfaction (Cordeau, 2014).

Anti-seizure drug may be effective against pseudobulbar affect (PBA)
Pseudobulbar affect (PBA), also known as emotional incontinence, is a neurological disorder characterized by involuntary or uncontrollable episodes of laughing and/or crying.  It can occur in patients with an underlying neurological disease such as MS, Alzheimer’s, Parkinson’s, stroke, or traumatic brain injury.  Patients with PBA have an impaired ability to control their emotional reactions.  Very few studies have been published on PBA in people with MS and reported prevalence estimates range from 6.5 to 95%.  Dextromethorphan plus quinidine (Nuedexta) is the only FDA approved treatment for PBA.  A recent case report describes a 60 year old woman with MS who experienced incessant crying.  A brain MRI showed a new lesion next to her corpus callosum.  Her symptoms resolved within 3 days after doctors prescribed valproic acid (Depakote), but did not respond to Nuedexta (Johnson, 2014).

Do you want to know more about how the oral drugs for MS work?  
You can find out in the article, “Molecular pharmacodynamics of new oral drugs used in the treatment of multiple sclerosis,” published in the journal, Drug Design, Development and Therapy.  This article discusses the mechanism of action of each of the oral MS drugs, approved and still in development: fingolimod (Gilenya, Novartis), dimethyl fumarate (Tecfidera, Biogen Idec), teriflunomide (Aubagio, Genzyme), and laquinimod (Nerventra, Teva, not yet approved for use).  It also discusses the effects of each drug on the immune system, permeability of the blood-brain-barrier, and CNS cells (di Nuzzo, 2014).

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Hot Topics and MS Research News for June 2014

Tuesday, June 24, 2014

Cancer Mistaken For RA in Children

Musculoskeletal pain and nonspecific symptoms are often the initial signs of cancer in about 20% of children who develop pediatric leukemia.  Because of similar symptoms, childhood leukemia can masquerade as juvenile idiopathic arthritis, osteomyelitis, transient synovitis, or septic arthritis, resulting in delayed treatment.

What is leukemia?
Leukemia is a type of cancer that causes bone marrow to produce large numbers of abnormal white blood cells that enter the bloodstream and do not function properly.  Leukemia accounts for 33-41% of all malignancies in children under 15 years of age with approximately 3250 children diagnosed each year in the United States.

Each type of leukemia is named for the blood cell that’s affected.  The four most common types of leukemia are acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML), and chronic lymphocytic leukemia (CLL).  Acute lymphoblastic leukemia (ALL) represents about 75-85% of all cases of childhood leukemia and is the form which is known to mimic arthritis.  Symptoms are often vague and nonspecific.

Common leukemia signs and symptoms include:
    •    Fever or chills
    •    Persistent fatigue, weakness
    •    Frequent or severe infections
    •    Losing weight without trying
    •    Swollen lymph nodes, enlarged liver or spleen
    •    Easy bleeding or bruising
    •    Recurrent nosebleeds
    •    Tiny red spots in your skin (petechiae)
    •    Excessive sweating, especially at night
    •    Bone pain or tenderness
    •    Hematological abnormalities (anemia, low white blood cell count, low platelet count, circulating blasts)

How does leukemia look like juvenile arthritis?
Musculoskeletal symptoms are the primary complaint in 14% to 30% of pediatric ALL cases, sometimes before changes in peripheral blood are evident.  Several case reports exist in the medical literature discussing patients who are initially (mis)diagnosed with juvenile idiopathic arthritis (JIA) due to bone pain and joint swelling, often in the lower extremities (ankle, knee, hip), to later be diagnosed with ALL.  About 7% of children with ALL who initially have musculoskeletal manifestations meet diagnostic criteria for JIA.

What are the best ways to distinguish leukemia from arthritis in children?
Studies have identified three important features that predict a diagnosis of ALL and differentiate it from JIA, including:
    •    Low white blood cell count (leukopenia)
    •    Low-normal platelet count (thrombocytopenia)
    •    Nocturnal pain

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Childhood Leukemia Mistaken for Juvenile Rheumatoid Arthritis