1,058 research outputs found
An overview of pregnancy-related issues in patients with multiple sclerosis
No full textAlthough pregnancy in women with multiple sclerosis (MS) is not generally considered high risk, there are some associated therapeutic challenges. The pregnancy-associated reduction in the relapse rate, especially in the third trimester, is followed by a sharp increase in the first few months postpartum. Nevertheless, retrospective evidence for pregnant women with and without MS followed for up to 10 years indicates that pregnancy has no perceptible effect on long-term disease course or disability progression. Likewise, MS has no apparent effects on the pregnancy course or fetal outcomes. All disease-modifying therapies (DMTs) have potential adverse effects on fertility and pregnancy outcomes, but the level of risk varies amongst agents. There is some support for continued use of interferon-β and glatiramer acetate throughout pregnancy to reduce the risk of relapse. Use of DMTs during breastfeeding is best avoided if possible. Close evaluation of drug safety information is imperative when managing women with MS who are pregnant or wish to become pregnant. Decision-making should be a shared experience between patient and physician, and the approach must be individualized for each patient
Ponesimod to treat multiple sclerosis
No full textPonesimod (ACT-128800) is a directly bioavailable, rapidly reversible sphingosine-1-phosphate (S1P) receptor modulator, highly selective for the subtype 1 (S1P1 receptor). It acts by blocking the egress of lymphocytes from the lymphoid organs, thus limiting the entry of autoreactive cells into the central nervous system. Unlike fingolimod, ponesimod does not require monitoring of the first dose, thanks to a 14-day uptitration regimen, which markedly reduces the incidence of cardiodynamic effects related to the initiation of therapy. Results from the OPTIMUM phase III trial demonstrated the superiority of ponesimod over teriflunomide on disease activity markers, without unexpected safety concerns. Furthermore, the drug is eliminated within 1 week of discontinuation, allowing for the reversibility of its effects. Ponesimod was recently approved in both the U.S. and E.U. for the treatment of relapsing forms of multiple sclerosis. This review summarizes the pharmacological characteristics of ponesimod and the main studies that led to its approval
Sex hormones, brain damage and clinical course of Multiple Sclerosis
No full textThere is evidence that gender influences the clinical course of Multiple Sclerosis (MS). Symptom prevalence as well as characteristics differs between the sexes. These differences can be, at least partly, explained by gender differences in the characteristics of tissue damage and disease progression measured by Magnetic Resonance Imaging (MRI). The interaction between sex hormones and MS damage, supported by both MRI and clinical evidence, seems to play an important role in the clinical and sub-clinical gender bias in MS. Experimental data testing directly the effects of sex hormones on brain damage and their clinical relevance show that sex hormones have the potential of exerting anti-inflammatory and protective effects on brain tissue. Both data in experimental models and patient studies discussed in this review encourages a gender-based approach to MS. © 2009 Elsevier B.V. All rights reserved
Il ruolo della risonanza magnetica nella diagnosi e nel monitoraggio del decorso della sclerosi multipla.
No full text
Assessing walking disability in multiple sclerosis
No full textMost patients with multiple sclerosis (MS) eventually experience walking disability. The objective of this review was to evaluate the clinical utility of measures specific for walking in MS. Walking assessments had high reliability and were correlated with related measures, including the 12-item multiple sclerosis walking scale (MSWS-12). Shorter timed walking tests (Timed 25-foot Walk (T25FW), 10-metre Timed Walk, 30-metre Timed Walk) measure overall walking disability and are best suited for clinical settings, whereas longer timed or distance tests (100-metre Timed Walk, 6-minute Walk Test, 2-minute Walk Test) are better for the assessment of walking fatigability, distance limitations and functional capacity. The MSWS-12 measures different, but related, aspects of walking than the objective tests. The T25FW is the best characterised objective measure of walking disability and can be used across a wide range of walking disabilities. Additional work is needed to fully characterise the other objective walking assessments in MS
Overview of magnetic resonance imaging for management of relapsing-remitting multiple sclerosis in everyday practice
No full textAlthough the value of magnetic resonance imaging (MRI) for diagnosis/differential diagnosis of patients with clinically isolated syndromes suggestive of multiple sclerosis (MS) is widely accepted, adoption of MRI into clinical practice to monitor disease evolution remains a work in progress. However, an accumulating body of evidence points to a central role for MRI in managing patients with relapsing−remitting MS along the disease continuum. Routine MRI surveillance provides insight into disease activity that is not evident clinically and this information, in turn, can be used to inform prognosis and guide treatment decisions. In Europe, practical guidelines have been developed to reduce the heterogeneity of imaging (both intracentre and intercentre) and improve the quality of MRI assessment and interpretation. Aimed at the general neurologist, this review explores some of the issues associated with MRI and examines evidence supporting its use for routine monitoring of MS patients in everyday practice
- …
