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Multiple Sclerosis: HELP
Articles from Missouri
Based on 285 articles published since 2010
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These are the 285 published articles about Multiple Sclerosis that originated from Missouri during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12
1 Guideline Interventional endovascular management of chronic cerebrospinal venous insufficiency in patients with multiple sclerosis: a position statement by the Society of Interventional Radiology, endorsed by the Canadian Interventional Radiology Association. 2010

Vedantham, Suresh / Benenati, James F / Kundu, Sanjoy / Black, Carl M / Murphy, Kieran J / Cardella, John F / Anonymous5470671 / Anonymous5480671. ·Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd., Box 8131, St. Louis, MO 63110-1076, USA. vedanthams@mir.wustl.edu ·J Vasc Interv Radiol · Pubmed #20800776.

ABSTRACT: -- No abstract --

2 Editorial Measuring disability in multiple sclerosis: Walking plus much more. 2019

Sormani, Maria Pia / Naismith, R T. ·From the Department of Health Sciences (M.P.S.), Section of Biostatistics, University of Genoa · IRCCS Ospedale Policlinico San Martino (M.P.S.), Genoa, Italy · and Department of Neurology (R.T.N.), Washington University, St. Louis, MO. ·Neurology · Pubmed #31641015.

ABSTRACT: -- No abstract --

3 Editorial Dosing interval of natalizumab in MS: Do good things come to those who wait? 2019

Clifford, David B / Tyler, Kenneth L. ·From the Department of Neurology (D.B.C.), Washington University in St Louis, MO · and Department of Medicine and Immunology-Microbiology (K.L.T.), University of Colorado School of Medicine, Aurora. ·Neurology · Pubmed #31515289.

ABSTRACT: -- No abstract --

4 Editorial The chicken or the egg dilemma: intestinal dysbiosis in multiple sclerosis. 2017

Ochoa-Repáraz, Javier / Magori, Krisztian / Kasper, Lloyd H. ·Department of Biology, Eastern Washington University, Cheney, WA, USA. · Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA. ·Ann Transl Med · Pubmed #28462225.

ABSTRACT: Recent findings suggest that the intestinal microbiota of patients suffering from relapsing remitting multiple sclerosis (MS) shows changes on the relative abundances of archaeal and bacterial genera. Although the richness and overall structure of the microbiota may be similar compared to the intestinal microbiota of healthy controls, elevated and reduced frequencies suggest a dysbiotic microbiota in MS. Over the past decade experimental evidence obtained in murine models of the disease highlighted the important relevance of the microbiota in the regulation of the immune system and in the severity of the disease. More recent findings on peripheral immune cells derived from human MS patients support the initial observations that changes in the microbiota may affect immunological pathways that could exacerbate disease. However, important questions remain to be answered. For instance, it is unclear whether dysbiosis precedes disease or, if in the contrary, an autoimmune disease such as MS can lead to gut dysbiosis. In this brief discussion, we speculate about this later possibility based on findings observed in murine models of disease. Further human studies are needed to answer the dilemma and determine specific immunomodulatory pathways that could have an impact on the therapeutic approaches to treat MS.

5 Editorial Declines in the diagnosis of primary progressive MS: A critical change in phenotype or critical measurement error? 2016

Cutter, Gary R / Salter, Amber / Marrie, Ruth Ann. ·Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA cutterg@uab.edu. · Department of Biostatistics, Washington University in St. Louis, Saint Louis, MO, USA. · Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Multiple Sclerosis Clinic, Winnipeg, MB, Canada. ·Mult Scler · Pubmed #27385768.

ABSTRACT: -- No abstract --

6 Editorial Linking Genotype to Clinical Phenotype in Multiple Sclerosis: In Search of the Holy Grail. 2016

Longbrake, Erin E / Hafler, David A. ·Department of Neurology, Yale School of Medicine, New Haven, Connecticut2Department of Neurology, Washington University in St Louis, St Louis, Missouri. · Department of Neurology, Yale School of Medicine, New Haven, Connecticut3Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut. ·JAMA Neurol · Pubmed #27244583.

ABSTRACT: -- No abstract --

7 Editorial Cortical Lesions in Multiple Sclerosis: Clinical Relevance for a Hidden Disease Burden. 2015

Naismith, Robert T. ·Department of Neurology, Washington University, St Louis, Missouri. ·JAMA Neurol · Pubmed #26191784.

ABSTRACT: -- No abstract --

8 Editorial Multiple sclerosis, immunomodulation, and immunizations: balancing the benefits. 2015

Goldman, Myla D / Naismith, Robert T. ·From the Department of Neurology (M.D.G.), University of Virginia, Charlottesville · and the Department of Neurology (R.T.N.), Washington University, St. Louis, MO. ·Neurology · Pubmed #25636716.

ABSTRACT: -- No abstract --

9 Editorial Antisense therapy: potential tool to reduce activity in MS via protein expression inhibition. 2014

Naismith, Robert T / Cross, Anne H. ·From the Department of Neurology (R.T.N., A.H.C.) and Hope Center for Neurological Disorders (A.H.C.), Washington University School of Medicine, St. Louis, MO. · From the Department of Neurology (R.T.N., A.H.C.) and Hope Center for Neurological Disorders (A.H.C.), Washington University School of Medicine, St. Louis, MO. crossa@neuro.wustl.edu. ·Neurology · Pubmed #25239837.

ABSTRACT: -- No abstract --

10 Editorial Active and progressive: a new duality of MS classification. 2014

Cross, Anne H / Wingerchuk, Dean M / Weinshenker, Brian G. ·From the Department of Neurology (A.H.C.), Washington University School of Medicine, St. Louis, MO · the Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ · and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN. ·Neurology · Pubmed #24928117.

ABSTRACT: -- No abstract --

11 Editorial Natalizumab to fingolimod washout in patients at risk of PML: when good intentions yield bad outcomes. 2014

Giovannoni, Gavin / Naismith, Robert T. ·From the Queen Mary University of London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK · and the Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO. ·Neurology · Pubmed #24610331.

ABSTRACT: With more choices for multiple sclerosis (MS) disease-modifying therapies, data are urgently required to support clinical decisions regarding safe transitioning and sequencing of therapies. With more than 7 years of clinical experience, natalizumab has been confirmed as highly effective in reducing MS disease activity. However, natalizumab carries a risk of progressive multifocal leukoencephalopathy (PML),(1) with more than 400 cases of natalizumab-related PML to date.(2) Because 2 of the 3 initial natalizumab-associated PML cases were on the combination natalizumab plus interferon, the concern was that combining agents led to a heightened risk of infectious complications. In these early times, uncertainty revolved around 2 points: the theoretical risk of PML if natalizumab was transiently combined with another immune-altering agent and the value of transiently "reconstituting" CNS immune surveillance by washout of natalizumab in an effort to clear theoretical subclinical JC virus within the CNS.(3) The optimal length of natalizumab washout became the subject of intense consternation and debate, with no clear guidelines to inform practice. However, upon withdrawing natalizumab, resumption of disease activity was soon observed, beginning 3-4 months after the last dose of natalizumab.(4-10) Postnatalizumab return of disease raised concern that the washout may harm the patient by a severe relapse with incomplete recovery.

12 Editorial Themes from the special issue on neurodegenerative diseases: what have we learned, and where can we go from here? 2014

Foster, Erin R. ·Erin R. Foster, OTD, MSCI, OTR/L, is Assistant Professor, Program in Occupational Therapy, Departments of Neurology and Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO 63110; erfoster@wustl.edu. ·Am J Occup Ther · Pubmed #24367948.

ABSTRACT: -- No abstract --

13 Editorial BCG vaccine for clinically isolated syndrome and MS: infections and protective immunity. 2014

Bourdette, Dennis / Naismith, Robert T. ·From the Department of Neurology (D.B.), Oregon Health & Science University and Multiple Sclerosis Centers of Excellence-West, Veterans Affairs Medical Center, Portland · and the Department of Neurology (R.T.N.), Washington University, St. Louis, MO. ·Neurology · Pubmed #24306000.

ABSTRACT: -- No abstract --

14 Review Neuroinflammation and neurodegeneration in human brain at single-cell resolution. 2020

Colonna, Marco / Brioschi, Simone. ·Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA. mcolonna@wustl.edu. · Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA. ·Nat Rev Immunol · Pubmed #31844328.

ABSTRACT: -- No abstract --

15 Review An overview of the current state of evidence for the role of specific diets in multiple sclerosis. 2019

Evans, Emily / Levasseur, Victoria / Cross, Anne H / Piccio, Laura. ·Former Multiple Sclerosis Fellow, Washington University in St. Louis, Current Neurologist, Mercy MS Care, St. Louis MO, USA. Electronic address: Emily.evans2@mercy.net. · Neurology Resident, Washington University in St. Louis, USA. Electronic address: vlevasseur@wustl.edu. · The Manny and Rosalyn Rosenthal - Dr. John Trotter MS Chair in Neuroimmunology, Professor of Neurology, Washington University in St. Louis, USA. Electronic address: crossa@wustl.edu. · Associate Professor of Neurology, Washington University in St. Louis, USA; Brain and Mind Centre, University of Sydney, Australia. Electronic address: picciol@wustl.edu. ·Mult Scler Relat Disord · Pubmed #31574403.

ABSTRACT: BACKGROUND: Surveys of people with multiple sclerosis (MS) report that most are interested in using dietary modifications to potentially reduce the severity and symptoms of their disease. This review provides an updated overview of the current state of evidence for the role of specific diets in MS and its animal models, with an emphasis on recent studies including efficacy and safety issues related to dietary manipulations in people with MS. METHODS: Studies were identified using a PubMed search for each diet in both MS and experimental autoimmune encephalomyelitis, by review of the reference list of papers identified in the search process, and by searching clinicaltrials.gov for ongoing studies. Each study was evaluated and the data was summarized. Each diet was assigned a level of evidence for its use in MS based on the Quality Rating Scheme for Studies and Other Evidence. RESULTS: Several diets have been explored in people with MS and animal models of MS. Most human trials have been small and non-blinded, limiting their generalizability. Many have also been of short-duration, potentially limiting their ability to find clinically meaningful changes. Presently, insufficient evidence exists to recommend the routine use of any specific diet by people with MS. Clinical trials are ongoing or planned for many diets including the Swank Diet, Wahl's diet, McDougall diet, Mediterranean diet, and intermittent fasting. Results of these studies may help guide clinical recommendations. CONCLUSION: There is insufficient evidence to recommend the routine use of any specific diet by people with MS. Some diets touted for MS may have potential negative health consequences. It is important that clinicians inquire regarding dietary manipulations, so they can educate patients on any known efficacy data and potential adverse effects of individual diets. Consultation with a registered dietician is recommended for patients undertaking restrictive diets.

16 Review Acute Disseminated Encephalomyelitis in Children: An Updated Review Based on Current Diagnostic Criteria. 2019

Cole, Jordan / Evans, Emily / Mwangi, Martin / Mar, Soe. ·Pediatric Multiple Sclerosis and Demyelinating Diseases Center, Washington University in St. Louis, St. Louis, Missouri. Electronic address: jordan.cole@wustl.edu. · Pediatric Multiple Sclerosis and Demyelinating Diseases Center, Washington University in St. Louis, St. Louis, Missouri. ·Pediatr Neurol · Pubmed #31371120.

ABSTRACT: Acute disseminated encephalomyelitis is an inflammatory disorder of the central nervous system. Uniform diagnostic criteria for acute disseminated encephalomyelitis did not exist until publication of expert-defined consensus definitions by the International Pediatric Multiple Sclerosis Society Group in 2007, with updates in 2013. In the expanding field of pediatric neuroimmunology, consistent diagnostic criteria are essential to correctly categorize patients as increasing information regarding prognosis and management becomes available. Scientific literature is relatively lacking in review articles on International Pediatric Multiple Sclerosis Society Group-defined acute disseminated encephalomyelitis. This review focuses primarily on references applying the International Pediatric Multiple Sclerosis Society Group criteria for acute disseminated encephalomyelitis presenting specific, up-to-date, and translatable information regarding the epidemiology, pathophysiology, clinical features, diagnosis, management, and prognosis of acute disseminated encephalomyelitis in the pediatric population.

17 Review Advances in the Understanding and Management of Chronic Pain in Multiple Sclerosis: a Comprehensive Review. 2019

Urits, Ivan / Adamian, Leena / Fiocchi, Jacob / Hoyt, Dylan / Ernst, Carly / Kaye, Alan D / Viswanath, Omar. ·Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. iurits@bidmc.harvard.edu. · Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA. · A T Still University, Kirksville College Of Osteopathic Medicine, Kirksville, MO, USA. · Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA. · Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA. · Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA. · Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA. ·Curr Pain Headache Rep · Pubmed #31342191.

ABSTRACT: PURPOSE OF REVIEW: Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system that can lead to severe physical, cognitive, and neurological deficits that often manifest in young adults. Central neuropathic pain is a common presenting symptom, often prompting patients to seek treatment with opioids, NSAIDS, antiepileptics, and antidepressants despite minimal effectiveness and alarming side-effect profiles. Additionally, spasticity occurs in more than 80% of MS patients and is an important consideration for further study in treatment. RECENT FINDINGS: Related to inconsistencies in pain presentation and clinical reporting, current studies continue to investigate clinical patient presentation to define chronic pain characteristics to optimize treatment plans. Although often neuropathic in origin, the complex nature of such pain necessitates a multimodal approach for adequate treatment. While psychiatric comorbidities typically remain unchanged in their severity over time, physical conditions may lead to worsening chronic pain long-term, often due to decreased quality of life. The prevalence of neuropathic pain is ~ 86% in patients with multiple sclerosis and most commonly presents as extremity pain, trigeminal neuralgia, back pain, or headaches. As MS symptoms are frequently unremitting and poorly responsive to conventional medical management, recent attention has been given to novel interventions for management of pain. Among these, medicinal cannabis therapy, targeted physical therapy, and neuromodulation offer promising results. In this review, we provide a comprehensive update of the current perspective of MS pathophysiology, symptomatology, and treatment.

18 Review Clinical trials in multiple sclerosis: potential future trial designs. 2019

Manouchehri, Navid / Zhang, Yinan / Salter, Amber / Hussain, Rehana Z / Hartung, Hans-Peter / Hemmer, Bernhard / Linker, Ralf / Segal, Benjamin M / Cutter, Gary / Stüve, Olaf. ·Department of Neurology and Neurotherapeutics, The University of Texas Southwestern Medical Center, Dallas, TX. · Division of Biostatistics, Washington University School of Medicine, St. Louis, MO. · Department of Neurology, UKD and Center for Neurology and Neuropsychiatry, LVR Klinikum, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany. · Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany. · Department of Neurology, University of Regensburg, Germany. · Department of Neurology, University of Michigan, Ann Arbor, MI. · Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL. · Neurology Section, VA North Texas Health Care System, Medical Service, 500 South Lancaster Rd., Dallas, TX 75216, USA Department of Neurology and Neurotherapeutics, The University of Texas Southwestern Medical Center, Dallas, TX Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany. ·Ther Adv Neurol Disord · Pubmed #31205492.

ABSTRACT: Clinical trials of new treatments in multiple sclerosis (MS) currently require large sample sizes and long durations in order to yield reliable results. The differential responses of an already heterogeneous population of MS patients to individual disease-modifying therapies (DMTs) will further complicate future trials. MS trials with smaller samples and faster outcomes are conceivable through the substitution of current clinical and MRI outcomes with objectively measureable genomic and proteomic biomarkers. Currently, biomarkers that could be utilized for diagnosis and monitoring of MS disease activity are in the early validation phase. The power of single biomarkers or multiple correlated biomarkers to predict prognosis and response to treatment could initially be compared with currently accepted methods. These prospectively validated disease biomarkers could then be used to subcategorize the spectrum of MS patients into a finite number of endophenotypes with demonstrable different molecular pathogeneses and DMT response profiles. Newly developed DMT could potentially be assessed within specific endophenotypes and compared with pharmacogenomically relevant active comparator DMT. This approach may increase the efficiency of MS trials through homogenization of patient population and minimization of nonresponders in study groups, providing the potential for the development of targeted therapies.

19 Review Differential Diagnosis of Pediatric Multiple Sclerosis. 2019

Galardi, Maria Milagros / Gaudioso, Cristina / Ahmadi, Saumel / Evans, Emily / Gilbert, Laura / Mar, Soe. ·Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA. mmgalardi@wustl.edu. · Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA. gaudioso@wustl.edu. · Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA. saumel@wustl.edu. · Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA. eevans23@wustl.edu. · Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA. l.gilbert@wustl.edu. · Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA. mars@wustl.edu. ·Children (Basel) · Pubmed #31163654.

ABSTRACT: The differential diagnosis of pediatric multiple sclerosis (MS) can be broad and pose diagnostic challenges, particularly at initial presentation. Among demyelinating entities, neuromyelitis optica spectrum disorders (NMOSD), myelin oligodendrocyte glycoprotein antibodies (MOG-ab) associated disorders, and acute disseminated encephalomyelitis (ADEM) are now well-known as unique disease processes and yet continue to overlap with MS in regards to clinical presentation and imaging. In non-inflammatory entities, such as metabolic disorders and leukodystrophies, an erroneous diagnosis of MS can be made even while applying appropriate diagnostic criteria. Knowing the epidemiology, typical clinical presentation, diagnostic criteria, and ancillary test results in each disease, can aid in making the correct diagnosis by contrasting these features with those of pediatric MS. Determining the correct diagnosis early, allows for efficient and effective treatment as well as appropriate prognostication.

20 Review Evolution of clinical trials in multiple sclerosis. 2019

Zhang, Yinan / Salter, Amber / Wallström, Erik / Cutter, Gary / Stüve, Olaf. ·Department of Neurology and Neurotherapeutics, the University of Texas Southwestern Medical Center, Dallas, TX, USA. · Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA. · Sanofi Genzyme, Neuro and Gene Therapy, Cambridge, MA, USA. · Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA. · Neurology Section, VA North Texas Health Care System, Medical Service, 4500 South Lancaster Rd., Dallas, TX 75216, USADepartment of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany. ·Ther Adv Neurol Disord · Pubmed #30833985.

ABSTRACT: Clinical trials have advanced the treatment of multiple sclerosis (MS) by demonstrating the safety and efficacy of disease-modifying therapies (DMTs). This review discusses major changes to MS clinical trials in the era of DMTs. As treatment options for MS continue to increase, patients in modern MS trials present earlier and with milder disease compared with historic MS populations. While placebo-controlled trials for some questions may still be relevant, DMT trials in relapsing-remitting MS (RRMS) are no longer ethical. The replacement of the placebo arm by an active comparator arm in trials have raised the cost of trials by requiring larger sample sizes to detect on-study changes in treatment effects. Efforts to improve trial efficiency in RRMS have focused on exploring adaptive designs and relying on sensitive magnetic resonance imaging measures of disease activity. In trials for progressive forms of MS (PMS), the lack of sensitive outcome measures that can be used in shorter-term trials have delayed the development of effective treatments. Recent shifting of the focus to advancing trials in PMS has identified paraclinical outcome measurements with improved potential, and the testing of agents for neuroprotection and remyelination is in progress.

21 Review Misdiagnosis of multiple sclerosis: Impact of the 2017 McDonald criteria on clinical practice. 2019

Solomon, Andrew J / Naismith, Robert T / Cross, Anne H. ·From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at The University of Vermont, University Health Center, Burlington · and Department of Neurology (R.T.N., A.H.C.), Washington University in St. Louis, MO. ·Neurology · Pubmed #30381369.

ABSTRACT: Misdiagnosis of multiple sclerosis (MS) (the incorrect assignment of a diagnosis of MS) remains a problem in contemporary clinical practice. Studies indicate that misdiagnosed patients are often exposed to prolonged unnecessary health care risks and morbidity. The recently published 2017 revision of the McDonald criteria for the diagnosis of MS provides an opportunity to consider the effect of these revisions on the problem of MS misdiagnosis. The 2017 McDonald criteria include several new recommendations to reduce potential for misdiagnoses. The criteria should be used for the types of patients in which validation studies were performed, specifically those patients who present with typical demyelinating syndromes. MRI lesion characteristics were defined for which McDonald criteria would be expected to perform with accuracy. However, 2017 revisions, which now include assessment for cortical lesions, and the inclusion of symptomatic lesions and positive oligoclonal bands for the fulfillment of diagnostic criteria, may have the potential to lead to misdiagnosis of MS if not applied appropriately. While the 2017 McDonald criteria integrate issues relating to MS misdiagnosis and incorporate specific recommendations for its prevention more prominently than prior criteria, the interpretation of clinical and radiologic assessments upon which these criteria depend will continue to allow misdiagnoses. In patients with atypical clinical presentations, the revised McDonald criteria may not be readily applied. In those situations, further evaluation or monitoring rather than immediate diagnosis of MS is prudent.

22 Review The Gut Microbiome in Multiple Sclerosis: A Potential Therapeutic Avenue. 2018

Kirby, Trevor O / Ochoa-Repáraz, Javier. ·Department of Biology, Eastern Washington University, 258 Science Building, Cheney, WA 99004, USA. trevor.kirby@eagles.ewu.edu. · Department of Biology, Eastern Washington University, 258 Science Building, Cheney, WA 99004, USA. jochoareparaz@ewu.edu. ·Med Sci (Basel) · Pubmed #30149548.

ABSTRACT: Recently, there has been a substantial increase in the number of studies focused upon connecting the gut microbiome with cases of central nervous system (CNS) autoimmunity. Multiple sclerosis (MS) is a neurodegenerative autoimmune disorder of the CNS. Recent experimental and clinical evidence suggests the presence of microbial imbalances in the gut of MS sufferers. The gut microbiome is defined as the summation of all the microbial entities as well as their genes, proteins, and metabolic products in a given space and time. Studies show the MS gut microbiome as having general alterations in specific taxa, some associated with the promotion of inflammatory cytokines and overall inflammation. In conjunction with these findings, experimental models of the disease have reported that T regulatory (Treg) cells have deficits in their function as a result of the aberrant gut microbiota composition. The findings suggest that the interactions between the host and the microbiota are reciprocal, although more extensive work is required to confirm this. Moreover, evidence indicates that changes in microbiota composition may result in imbalances that could result in disease, with the gut as a potential novel therapeutic avenue. By understanding the biological effects of aberrant gut microbiome composition, it is possible to contemplate current therapeutic options and their efficacy. Ultimately, more research is necessary in this field, but targeting the gut microbiota may lead to the development of novel therapeutic strategies.

23 Review Clinical trials in multiple sclerosis: milestones. 2018

Zhang, Yinan / Salter, Amber / Cutter, Gary / Stuve, Olaf. ·Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA. · Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA. · Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA. · Neurology Section, VA North Texas Health Care System, Medical Service, 4500 South Lancaster Rd, Dallas, TX 75216, USA. ·Ther Adv Neurol Disord · Pubmed #30034537.

ABSTRACT: The achievements in multiple sclerosis (MS) therapeutics are founded on the outcomes of clinical trials that demonstrate quantifiable results in treating a disease with an unpredictable course. Much has changed since the early trials in MS from the mid-20th century that compared a potential therapeutic agent with a placebo and measured outcomes based on patients' subjective reports. Advancements over the past decades have simplified diagnosis of the disease and allowed for more quantitative monitoring of its progression alongside support from paraclinical studies. Further collaborative efforts have led to pivotal meetings that steered the direction of future trials and the creation of patient databases that provided important epidemiologic information on trial subjects. These innovations and changes have improved MS clinical trials but challenge future trials to create more efficient designs lest the pace of progress necessarily slows because of the increased time to conduct such studies. As treatment options for MS broaden, clinical trials will continue to incorporate new strategies to identify novel therapies and pathways of intervention.

24 Review Use of Vitamins and Dietary Supplements by Patients With Multiple Sclerosis: A Review. 2018

Evans, Emily / Piccio, Laura / Cross, Anne H. ·Department of Neurology, Neuroimmunology Section, Washington University in St Louis, St Louis, Missouri. ·JAMA Neurol · Pubmed #29710293.

ABSTRACT: Importance: Surveys of patients with multiple sclerosis report that most are interested in modifying their diet and using supplements to potentially reduce the severity and symptoms of the disease. This review provides an updated overview of the current state of evidence for the role that vitamins and dietary supplements play in multiple sclerosis and its animal models, with an emphasis on recent studies, and addresses biological plausibility and safety issues. Observations: Several vitamins and dietary supplements have been recently explored both in animal models and by patients with multiple sclerosis. Most human trials have been small or nonblinded, limiting their generalizability. Biotin and vitamin D are currently being tested in large randomized clinical trials. Smaller trials are ongoing or planned for other supplements such as lipoic acid and probiotics. The results of these studies may help guide clinical recommendations. Conclusions and Relevance: At the present time, the only vitamin with sufficient evidence to support routine supplementation for patients with multiple sclerosis is vitamin D. Vitamin deficiencies should be avoided. It is important for clinicians to know which supplements their patients are taking and to educate patients on any known efficacy data, along with any potential medication interactions and adverse effects of individual supplements. Given that dietary supplements and vitamins are not subject to the same regulatory oversight as prescription pharmaceuticals in the United States, it is recommended that vitamins and supplements be purchased from reputable manufacturers with the United States Pharmacopeia designation.

25 Review Comprehensive systematic review summary: Disease-modifying therapies for adults with multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. 2018

Rae-Grant, Alexander / Day, Gregory S / Marrie, Ruth Ann / Rabinstein, Alejandro / Cree, Bruce A C / Gronseth, Gary S / Haboubi, Michael / Halper, June / Hosey, Jonathan P / Jones, David E / Lisak, Robert / Pelletier, Daniel / Potrebic, Sonja / Sitcov, Cynthia / Sommers, Rick / Stachowiak, Julie / Getchius, Thomas S D / Merillat, Shannon A / Pringsheim, Tamara. ·From the Department of Neurology (A.R.-G.), Cleveland Clinic, OH · Department of Neurology (G.S.D.), Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University in St. Louis, MO · Department of Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada · Department of Neurology (A.R.), Mayo Clinic, Rochester, MN · UCSF Weill Institute for Neurosciences, Department of Neurology (B.A.C.C.), University of California, San Francisco · Department of Neurology (G.S.G.), Kansas University Medical Center, Kansas City · Department of Neurology, School of Medicine (M.H.), University of Louisville, KY · Consortium of Multiple Sclerosis Centers (J.H.), Hackensack, NJ · Department of Neuroscience (J.P.H.), St. Luke's University Health Network, Bethlehem, PA · Department of Neurology (D.E.J.), University of Virginia, Charlottesville · Consortium of Multiple Sclerosis Centers (R.L.), Hackensack, NJ · Department of Neurology, School of Medicine (R.L.), Wayne State University, Detroit, MI · Department of Neurology, Keck School of Medicine (D.P.), University of Southern California, Los Angeles · Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser, Los Angeles · National Multiple Sclerosis Society (C.S.), Arlington, VA · National Multiple Sclerosis Society (R.S.), New York, NY · Santa Fe (J.S.), NM · Heart Rhythm Society (T.S.D.G.), Washington, DC · American Academy of Neurology (S.A.M.), Minneapolis, MN · and Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, Cumming School of Medicine (T.P.), University of Calgary, Alberta, Canada. ·Neurology · Pubmed #29686117.

ABSTRACT: OBJECTIVE: To review evidence on starting, switching, and stopping disease-modifying therapies (DMTs) for multiple sclerosis (MS) in clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), and progressive MS forms. METHODS: Relevant, peer-reviewed research articles, systematic reviews, and abstracts were identified (MEDLINE, CENTRAL, EMBASE searched from inception to November 2016). Studies were rated using the therapeutic classification scheme. Prior published Cochrane reviews were also used. RESULTS: Twenty Cochrane reviews and an additional 73 full-text articles were selected for data extraction through an updated systematic review (completed November 2016). For people with RRMS, many DMTs are superior to placebo (annualized relapses rates [ARRs], new disease activity [new MRI T2 lesion burden], and in-study disease progression) (see summary and full text publications). For people with RRMS who experienced a relapse on interferon-β (IFN-β) or glatiramer acetate, alemtuzumab is more effective than IFN-β-1a 44 μg subcutaneous 3 times per week in reducing the ARR. For people with primary progressive MS, ocrelizumab is probably more effective than placebo (in-study disease progression). DMTs for MS have varying adverse effects. In people with CIS, glatiramer acetate and IFN-β-1a subcutaneous 3 times per week are more effective than placebo in decreasing risk of conversion to MS. Cladribine, immunoglobulins, IFN-β-1a 30 μg intramuscular weekly, IFN-β-1b subcutaneous alternate day, and teriflunomide are probably more effective than placebo in decreasing risk of conversion to MS. Suggestions for future research include studies considering comparative effectiveness, usefulness of high-efficacy treatment vs stepped-care protocols, and research into predictive biomarkers.

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