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Editorials
Recognized experts in the field of Multiple Sclerosis discuss current topics in Multiple Sclerosis assessment, treatment, and care.
The Movement Toward a Multidisciplinary Approach to MS Care: From Crisis Management to Health Maintenance
Amy Perrin Ross, APN, MSN, CNRN, MSCN
February - 2010
The care and treatment of patients with MS has changed dramatically in the past few decades. A Consortium of Multiple Sclerosis Centers Statement Paper reminds us of the not-so-distant past of MS care...
Read MoreComplementary and Alternative Medicine in MS: Guiding Our Patients
Mark C. Cascione, MD
October - 2009
A review of the literature shows that many patients with multiple sclerosis (MS) have turned to the use of complementary and alternative medicines (CAM).1-3 As a neurologist who specializes in the treatment of patients with MS, I receive frequent questions about alternative therapies from many of the patients I treat. As healthcare providers, we have a responsibility to guide our patients; however, most of us know little or nothing about CAM therapies. This makes sense, since there are few randomized controlled trials (RCTs) of CAM therapies in MS....
Read MoreTreating MS: Is Earlier Always Better?
Fred D. Lublin, MD
August - 2009
There is little doubt that the early diagnosis of MS has made a positive impact on the outcomes of those with the disease. Major clinical studies have borne out that the earlier patients receive disease-modifying therapy (DMT), the better they do. The successful clinical trial results of patients with clinically isolated syndrome (CIS) with current first-line DMTs led to new indications for the treatment of CIS for intramuscular interferon beta-1a, interferon beta-1b, and, most recently, glatiramer acetate.1-3 ...
Read MoreSmoking and MS: Making the Connection
Mark C. Cascione, MD
June - 2009
The evidence is mounting—we can most likely add smoking to the list of environmental risk factors for MS. Or, put another way, MS may be added to the list of diseases for which smoking represents a risk factor, ie, cancer, cardiovascular disease, and rheumatoid arthritis. ...
Read MoreFampridine—A New Era in the Symptomatic Treatment of MS
Amy Perrin Ross, APN, MSN, CNRN, MSCN
May - 2009
The availability of disease-modifying therapies (DMTs) has greatly increased the outlook for patients with multiple sclerosis (MS). However, MS patients face a multitude of symptoms throughout the disease course, making symptomatic treatment important in all phases of the disease.1 According to recent studies, between 64% and 85% of MS patients experience impaired walking ability.2,3 Seventy percent of people with MS reported that walking disability is the most challenging aspect of their disease.2 There is currently no pharmaceutical treatment for this symptom....
Read MoreSwitching From First-Line Disease-Modifying Therapy in Patients With a Suboptimal Response
Amy Perrin Ross, APN, MSN, CNRN, MSCN
April - 2009
During the first few years of treatment with a disease-modifying therapy (DMT), at least 30% of multiple sclerosis (MS) patients may experience a suboptimal response.1,2 DMTs appear to be most effective in the earlier stages of MS, when suppression of inflammatory events will most likely help to delay or prevent axonal loss and decline in neurologic function. For this reason, it is important to identify patients who have a suboptimal response as early as possible. Several studies suggest that switching from one first-line DMT to another is a safe and effective strategy in such cases. This editorial will look at some of these studies and their outcomes, with a critical eye toward the study design (all are open label or prospective), safety, and criteria used to determine a suboptimal response or treatment failure....
Read MoreAn Update on Oral MS Therapies
Fred D. Lublin, MD
December - 2008
In the near future we can expect oral therapies to enter the marketplace, and I am taking the opportunity in this editorial to provide updates on the progress of several oral compounds. Until the phase 3 programs are completed, we can only speculate how the oral therapies will be used clinically. Annualized relapse rate has been the benchmark for the approval of new therapies; however, in many of these early trials, MRI outcomes are primary measures of disease activity. This approach allows a quick means of assessing a compound’s potential and helps the manufacturer to determine whether the drug is worth the investment in a phase 3 trial. We will have to wait to pass judgment, though, until phase 3 trials and better efficacy metrics are completed....
Read MoreThinking About Cognitive Dysfunction
Amy Perrin Ross, APN, MSN, CNRN, MSCN
November - 2008
At least half of all patients with multiple sclerosis (MS) will develop cognitive dysfunction during their lifetimes.1-3 Learning and memory, information processing, working memory and multitasking, and executive function are the most commonly affected processes, and dysfunction in these areas can eventually translate to difficulties at work, loss of independence, and degradation in quality of life. Despite the effects cognitive difficulties have on patients with MS, research in this area has been limited....
Read MoreNo excuse for relying on marketing materials when selecting a DMT
Faculty Author: Mark C. Cascione, MD
August - 2008
At regional neurology meetings we often ask how attendees go about guiding patients’ selection of a disease-modifying therapy (DMT). Surprisingly, too many participants believe the best means of including patients in this decision is to send them home with all four or five company-supplied patient information kits. It isn’t even clear if the prescribing healthcare provider has viewed all of the DVDs provided. This practice shifts the basis of the choice from medical information to the emotional reactions brought on by marketing tools....
Read MoreWhen and Whom to Treat? The Ongoing Dilemma over Early Treatment with Disease-Modifying Therapies (DMTs)
Faculty Author: Amy Perrin Ross, APN, MSN, CNRN, MSCN
June - 2008
The National Multiple Sclerosis Society Disease Management Consensus Statement recommends treatment for patients “following a definite diagnosis of MS with active disease”, and for patients who have had a clinically isolated syndrome (CIS) and “are at high risk of MS.”1 However, these guidelines do not assist the clinician in determining which patients have active disease or are at risk for MS after a CIS. On the one hand, effective treatments for early MS are available, and these treatments may be less effective later in the disease course. On the other hand, not all patients are thought to accrue disability and develop a secondary progressive course (SPMS) over the long-term. Given the cost and adverse effects associated with DMTs, clinicians must determine who should receive treatment and when treatment should be initiated....
Read MoreBEYOND the Data REGARDing DMTs: Interpreting Findings From the Comparative Trials
Faculty Author: Fred D. Lublin, MD
April - 2008
IFN β-1b was first shown to alter the disease course of relapsing and remitting multiple sclerosis (RRMS) in 1993. This was followed by the advent of IFN β-1a and glatiramer acetate (GA) several years later. However, data from head-to-head comparison studies of these agents have only recently started to emerge.1 This editorial will examine the results from the completed trials and discuss their implications for the treatment of MS....
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