Thursday, June 23, 2016

Family Planning and Multiple Sclerosis

Multiple sclerosis is often diagnosed in young adults during their prime reproductive years. So pregnancy and parenthood are common concerns for many people living with multiple sclerosis. Contrary to what physicians thought decades ago, pregnancy does not make multiple sclerosis worse. With so many treatment options, family planning is an important part of disease management for men and women with MS.

Multiple sclerosis has no significant impact on the ability to conceive, on the development of the fetus, or the mother’s ability to carry to term. MS doesn’t seem to increase the risk of spontaneous abortions, stillbirth, cesarean delivery, premature birth, or birth defects. However, a recent study suggests that MS patients may have decreased ovarian reserve, a term used to describe the ovary’s capacity to produce egg cells that can be fertilized.

Paternal MS

A recent study of men with MS who fathered children found that paternal MS had no impact on birth weight or premature birth. Researchers also determined that factors such as disease duration and disability did not impact birth outcomes. Data regarding semen quality is limited, but one study reports lower total sperm counts, reduced sperm motility, and increased percentage of abnormally formed sperm in men with MS.

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Family Planning in the Modern Day of MS

Monday, June 20, 2016

What is Advanced Multiple Sclerosis?

Rosalind Kalb of the National MS Society stated at the Consortium of MS Centers conference in June 2016 that there is no clear definition of what constitutes advanced MS. The term is used quite broadly. It may be used to describe the person with MS who is dependent upon others for assistance with personal care and daily activities, who is rarely able to leave the home, and who cannot be left alone for extended periods of time. However, the term advanced MS may also refer to a person who has more progressive disability, symptoms that interfere with activities of daily living, or safety issues that require adaptations to maintain independence and mobility.

Advanced MS does not mean 'home-bound'

My dear friend, Karen, is a person living with primary progressive MS for over 20 years who arguably has “advanced MS” but who is fiercely independent and able to stay engaged in the community with the help of specialty equipment and accommodations. She uses a rather large 350-pound electric chair, drives her own van with hand controls, and until recently was employed full time in a medical office.

Karen traveled to Chicago this summer and I accompanied her as a caregiver to be available to help manage luggage and extra equipment, make sure that she could get in and out of bed safely, and to give her the peace of mind that if anything went awry she would not have to face it alone. I’m sure that I helped Karen tremendously but one thing I learned from watching her interact with others on this trip was that a smile, patience, and clear communication had the power to overcome many hurdles that arose along the way.

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What Is Advanced MS?

Friday, June 17, 2016

The Gut and Multiple Sclerosis

Inside the digestive system is a rainforest of rich microbiota that help to process nutrients, protect us from infection, maintain protective barriers in the gut, trigger the immune system, and even communicate with the brain.

To get a sense of how bacteria does this, first understand that microbes are everywhere. They live in the soil, in water, on our skin, and inside our bodies. These tiny organisms outnumber our own cells by a ratio of 10 to one and research suggests that the human genome has incorporated bits of DNA from the genes of various microbes. There are an estimated 500,000 metabolites in our blood derived from the microbiome.

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The Gut and MS: Why What You Eat Matters

Thursday, June 16, 2016

How Men and Women Experience MS Differently

Men and women experience multiple sclerosis in different ways. While MS is not a "female disease," more than three out of four people with MS are women. Not surprisingly, few studies have been published about the management of MS in men or the experiences of men with MS. Recently I attended an entire session at the 30th Annual Consortium of MS Centers Conference held at National Harbor, Maryland, June 1-4, 2016, dedicated to men and MS.

Men tend to have a more progressive onset of disease, more rapid accumulation of disability, and need help with mobility more quickly than women do. Men with MS typically have fewer relapses, but the relapses they do have are more likely to affect motor function and less likely to be sensory in nature. However, men and women tend to reach disability milestones at overall similar ages. How MS affects the brain differs in men versus women. For example, men experience a greater ratio of T2 Gd-enhancing lesions that evolve into T1 hypointense lesions (i.e., “black holes”).

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Men Experience MS Differently Than Women Do

Monday, June 13, 2016

Is Stem Cell Therapy "The MS Cure?"

Stem cell therapy continues to show promise as an effective treatment for more advanced multiple sclerosis, albeit not without risk. Results from studies that have been ongoing for many years are slowly being published, including data from a Canadian study of immunoablation (wiping out the immune system with chemotherapy) and autologous haemopoietic stem-cell transplantation (transplantation of a patient's own bone marrow-derived stem cells), also known as IA-HSCT, for aggressive multiple sclerosis.

The Canadian study — a small phase II trial led by Drs. Mark Freedman and Harold Atkins — enrolled 24 patients with aggressive MS who underwent the chemotherapy/stem cell therapy procedure. Results demonstrated that IA-HSCT was effective in halting disease progression (no relapses and no new gadolinium-enhancing or T2 lesions) in about 67 percent of participants in the three years post-treatment. Sixteen patients experienced no increase in disability, seven patients experienced continued increase in disability, and one patient died from treatment-related complications. To date, surviving participants have been followed for four to 13 years, and 35 percent have experienced reduced disability.

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Is Stem Cell Therapy a ‘Cure’ for MS?

Thursday, June 9, 2016

Age-Related Changes in MS

As people with MS live longer, they’re now also faced with the consequences of normal aging. It can be difficult, though, to know if the cause of worsening symptoms in older MS patients are due to conditions commonly brought on by aging such as Alzheimer’s disease, Parkinson’s disease, an intensified degenerative/inflammatory process directly related to MS progression, or a combination of these factors. Here are some of the more common complications of age and MS.

Difficulties with mobility

As people age, mobility becomes more of a concern. Last year it was reported that from 2004 and 2012, the number of American adults over the age of 65 who used canes and other mobility devices increased from 16 to 24 percent.

Although MS patients of any age may require mobility aids, statistics have shown that the aging process itself may further contribute to the growing need for them. For instance, a study of 2156 people with MS, found that older persons over the age of 65 with MS had a significantly higher rate of disability compared to their younger counterparts. It also found that a higher percentage of older adults required a cane and other types of bilateral support to walk 25 feet. A higher percentage also needed a wheelchair, scooter, or were bedridden.

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Disease Comorbidity and Age-Related Changes in MS

Wednesday, June 1, 2016

Children at Higher Risk of Psychiatric Disorders When Parents With MS Have Depression

Pregnancy and new parenthood are risk factors for depression, affecting 15 - 20 percent of mothers in the first year following delivery and 10 percent of fathers. Peripartum depression — depression, anxiety, or mood disorders in the month before childbirth and year following delivery — greatly affects quality of life, may impact other members of the family, and can influence the mother-child bonding that is crucial for psychological health.

Depression and anxiety are about twice as common in people with multiple sclerosis than those without MS. Men and women with MS are equally at risk for developing peripartum depression in rates higher than individuals without MS. Researchers in British Columbia conducted a study to examine the rates of peripartum depression in parents with MS and to determine the impact of parental depression on the development of psychiatric disorders in their children.

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Depression in Parents with MS May Lead to Psychiatric Disorders in Children