February Round-Up: MS News and Hot Topics

Relapse risk after switching from natalizumab (Tysabri) to fingolimod (Gilenya):

In another study, researchers collected data from patients with MS (n=333) who were switching from natalizumab (Tysabri) to fingolimod (Gilenya) after a mean of 31 natalizumab infusions (female to male ratio, 2.36; mean age, 41 years; 71% were JCV positive).  Data was collected regarding treatment with Tysabri, the duration and management of the washout period (WP) after stopping Tysabri, and any relapses or adverse events occurring during the WP and during the 6 months after patients started Gilenya. 

During the washout period, 27% of patients relapsed.  The risk for relapse was 3.2 times higher for patients who stopped natalizumab because of poor tolerance or lack of efficacy.  Washout periods shorter than 3 months were associated with 77% lower risk of relapse during the WP, but also with less disease activity before natalizumab treatment.  Twenty percent (20%) of patients relapsed during the first 6 months of treatment with fingolimod, while 3% stopped fingolimod due to issues with efficacy, tolerance, or compliance.  Researchers found that the occurrence of relapse during the WP was the only significant prognostic factor for relapse during fingolimod therapy (odds ratio, 3.80; P = .05). They also recommend that washout periods should be shorter than 3 months (Cohen, 2014).


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Hot Topics and MS Research News: February 2014

Simple Taco Salad

The key to this salad is the cooked kidney bean and vegetable mixture.  A few years ago in the frozen food section, I discovered Hanover Latino Blend Vegetables (16 oz. bag) which includes corn, black beans, onions, green peppers, and red peppers.  This combination of vegetables is perfect for a taco salad.  Cooking/frying the kidney beans in salt and pepper changes the flavor in a way that compliments the salad.

The following recipe usually feeds 3 people in our household.  The kidney beans are high in fiber.  The romaine lettuce, tomatoes, and mixed vegetables are low in calories.  The cumin enhances the mexican flavor, as does the salsa and cheddar jack cheese.  The optional honey french dressing adds a little sweetness to accompany the salty of the kidney beans.

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Favorite Recipe: Taco Salad with Kidney Beans, Latino Vegetables, and Salsa

Newly Diagnosed with MS? What should you do?

As you begin to learn how MS affects you personally, you will discover what strategies help you feel your best.  From day one, you can focus on staying healthy through diet and exercise.  Eating high-quality food, such as cold-water fish (e.g. salmon), fresh fruits and vegetables, nuts, and whole grains, while avoiding highly processed foods will provide your body with quality nutrients.  Supplements, such as Vitamin D, can be helpful in combating MS.  Discuss all supplements and medications you take with your neurologist.

Exercise, which can reduce fatigue and help you maintain strength, does not need to be strenuous.  Moderate-intensity aerobic exercise in short sessions, such as five 3- or 4-minute bursts of exercise with 2-minute rest periods in between, can improve fatigue and health-related quality of life (Carter, 2014).  Exercising past the point of fatigue may actually prevent you from sticking with an exercise routine.  Working with a physical therapist who specializes in neurological disorders can be helpful.

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What to do when newly diagnosed with MS

Stress and MS

When living with MS, we may experience physical stress, emotional stress, social stress, economic stress, and cognitive distress. 

The physiological changes caused by MS, such as weakness, spasticity, imbalance or loss of coordination, can increase physical demands on the body.  It is important to be aware of physical changes caused by MS and to work to combat them so that the changes themselves do not create additional problems.  Staying active and working with a physical therapist or trainer are ways you can reduce the physical stress caused by MS. 

Regular exercise reduces the effects of stress hormones on the body and can help prevent physical de-conditioning.  Strength training helps to build and maintain muscle strength with is necessary with you live with MS. Working with a healthcare provider to learn how to adjust to changing abilities and properly use assistive devices can be invaluable.

Emotional stress can be caused by the uncertainty and unpredictable nature of the disease.  It can also result from physical changes occurring in the brain due to neurological damage.  Common symptoms of MS include depression, anxiety, and cognitive dysfunction.  When you are feeling emotionally stressed, it doesn’t take much to trigger a physical reaction.  However, there is no clear evidence that stress can trigger exacerbations.


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Identifying the Effects of Stress on MS

Subtle Signs of an MS Relapse

While symptoms of a relapse may be dramatic, they can also be more subtle. Numbness, tingling, or other altered sensations are very common MS symptoms which you might notice much of the time. However, numbness that begins to spread or becomes more intense over the course of a day or two may indicate an impending relapse. Loss of sensation can be more than annoying, it can become dangerous. Call the doctor when you notice new or worsening numbness that doesn’t go away.

Foot drop is a common symptom of MS that involves weak ankle muscles which make it hard to flex the foot. Foot drop may cause you to trip as the toes of the foot drag or get caught on surfaces as you walk. People with MS who experience foot drop may develop an exaggerated gait to avoid tripping. Working with a physical therapist who may prescribe a specially designed ankle brace can be helpful. If you develop a new case of foot drop, call your doctor.


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MS Relapses: Causes, Symptoms, and Treatments

Medical Marijuana and MS Symptoms

A number of studies have indicated improvement in MS symptoms, particularly for muscle stiffness and spasms, neuropathic pain and sleep and bladder disturbance, in patients with MS treated with cannabinoids. Trials evaluating other symptoms such as tremor and nystagmus have not demonstrated any beneficial effects of cannabinoids. Safety profiles of cannabinoids seem acceptable, although a slow prolonged period of titration improves tolerability. No serious safety concerns have emerged (Zajicek, 2011).

Recent case reports included in a German study indicate that THC:CBD oromucosal spray is useful in individual patients with moderate to severe spasticity resistant to existing therapies. Researchers were excited to note that improvements in Quality of Life and Activities of Daily Living in some patients with resistant MS spasticity allowed them to engage back in physical and social activities (Koehler, 2014).

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Can Medical Marijuana Help Control MS Symptoms?: A HealthCentral Explainer