Multiple Sclerosis Newsletter

Multiple Sclerosis Newsletter
Northern Colorado Edition

December 2005 - January 2006

Research Updates

SOCIAL SECURITY DISABILITY RESOURCE SITE http://www.4socialsecuritydisability.com/index.html

Do You Qualify for Disability? Disability and SSI

Applying for Social Security Benefits: Benefits Claims Process

How to appeal your Social Security Denial: The Appeals Process

Dependents Benefits: Your Spouse, Your Children

Widows, Widowers and Survivors: Disabled widow’s benefits

Workers Compensation offset: How will my Workers Compensation affect my Social Security Disability Case?

Long Term Disability: How will my Long Term Disability affect my Social Security Disability Case?

How to Hire a Lawyer: Payment of fees

Taxes and Disability Benefits: Are Disability benefits taxable?

Medical Records: What are listings and where can I find them?

Child Benefits: Applying for Child benefits

Disease Specific Information: Fibromyalgia, Multiple Sclerosis, Diabetes, Depression and Anxiety, Arthritis and Heart Disease

UNDERSTANDING MRI in MS
Multiple Sclerosis.com

Magnetic resonance imaging (MRI) techniques play an important role in the diagnosis of multiple sclerosis (MS). In addition to their role in diagnosis, MRI scans are also probably the best indicators of disease activity in relapsing forms of MS.

“In clinical practice, we use MRI to follow the MS disease process and to evaluate how somebody’s doing on disease-modifying therapy,” notes Patricia J. Coyle, MD, Director of the Stony Brook MS Comprehensive Care Center in Stony Brook, New York. “MRI techniques, particularly the newer research techniques, may help us eventually figure out why MS occurs and how to prevent it.”

An international panel of neurologists recently updated the existing guidelines for diagnosing MS, adding further importance to the role of MRI. The new criteria may allow an earlier diagnosis of MS than previous guidelines.

Eighty percent to 90% of MS brain lesions that show up on MRI scans do not seem related to clinical relapses. “This means MRI can detect ongoing disease activity of which people with MS and their physicians are not aware,” Dr. Coyle points out.

MRI Techniques Commonly Used in MS: There are currently three conventional MRI techniques used in MS: T1, T2, and contrast, or gadolinium-enhanced, MRI. On a Tl MRI scan, lesions are dark and appear as black or grey areas. Chronic lesions reflect damage caused by the loss of myelin and axons (nerve fibers). Sometimes referred to as “black holes,” these lesions usually correlate with significant tissue destruction and disease-related disability, including cognitive impairment, The darker the lesion, the more extensive the damage, explains Dr. Coyle. However, the presence of a T1 lesion does not necessarily reflect permanent damage. Some studies have shown that a large number of T1 black holes may be reversible.

T2 MRI scans are useful for detecting MS lesions in the brain and, to a lesser extent, the spinal cord. These lesions appear as bright areas that resemble white, fluffy cotton balls. Neurologists can calculate the overall volume of the lesions on a T2 MRI to get a measure of the amount of brain tissue that is involved in the disease process, says Dr. Coyle.

One drawback of the T2 MRI is that there is no way to determine the age of the lesions. Another weakness is that it doesn’t provide information about the nature of the damage within the lesion. In other words, a lesion that is caused by fluid or inflammation (both of which are reversible) will look the same on a T2 MRI scan as a lesion that is caused by a very destructive, irreversible process.

Lesions that appear on a contrast, or gadolinium-enhanced, MRI scan indicate that the MS disease process is currently active. This MRI technique uses gadolinium, a rare earth metal that is injected into the vein about 5 to 20 minutes before the image is taken. In areas where there is a breakdown of the blood-brain barrier, some of the gadolinium will appear on the scan as a bright area.

Disease-Modifying Therapy and MRI: The interferons and Copaxone (glatiramer acetate) have all been shown to be effective in reducing MRI evidence of disease activity.

High-dose, more frequently administered interferons such as Betaseron and Rebif have been shown to reduce a greater percentage of lesions as seen on MRI compared with a low dose, once-weekly interferon such as Avonex. For example, in the INCOMIN (Independent Comparison of Interferon) study, which involved patients with relapsing forms of MS, a significantly higher proportion of those taking Betaseron had no new development of T2 lesions and no gadolinium-enhanced lesions compared with those taking Avonex.

Researchers are further studying the relationship between dose and effectiveness in MS disease-modifying agents. MRI results offer a means of measuring and comparing a drug’s effectiveness with other agents or to different doses of the same drug. One example involves the results of the first phase of the BEYOND (Betaseron Efficacy Yielding Outcomes of a New Dose) study, which tested the safety and effectiveness of doubling the dose of Betaseron. Results showed that both Betaseron 250 mcg (currently approved dose) and the increased dose (Betaseron 500 mcg) were safe and well tolerated. In addition, no new or unpredicted side effects were reported in those taking the higher dose.

When it came to MRI measures, both doses of Betaseron produced a marked reduction in the number of gadolinium-enhancing lesions at 12 weeks. However, Betaseron 500 mcg showed a greater decrease in both the number and volume of enhancing and T2 lesions. “Studies such as these showed that the most important measures of MS disease activity (MRI) is markedly improved in patients taking higher doses of disease-modifying drugs, with no significant increase in side effects,” remarks Dr. Coyle.

Advanced MRI Techniques: More advanced MRI techniques can detect damage in the brain and spinal cord that is not detected by routine MRI techniques. These newer techniques include magnetic transfer imaging, diffusion-weighted and diffusion-tension MRI, and high-magnet MRI scans. They are currently used as research tools, however, and are not routinely available in clinical settings.

According to Dr. Coyle, in the next few years some of these newer MRI techniques may be used to help follow response to therapy and to gain better insight into the MS disease process.

NEUROLOGISTS REFINE MULTIPLE SCLEROSIS DIAGNOSTIC CRITERIA
MultipleSclerosis.com

An international panel of neurologists has updated the current guidelines for diagnosing multiple sclerosis (MS), strengthening the role of magnetic resonance imaging (MRI). The guidelines, published online November 10, 2005 in the Annals of Neurology, update the “McDonald criteria,” created 5 years ago and named after the chair of the previous panel, Prof. W. Ian McDonald of the Institute of Neurology in London.

“We hope, and trust, that these revisions will allow an even earlier diagnosis of MS, without any loss of diagnostic accuracy,” said Chris H. Polman, MD, of the Free University Medical Center in Amsterdam, The Netherlands, and chair of the current panel.

“The changes in diagnostic criteria for primary progressive multiple sclerosis is particularly helpful,” said Robert P. Lisak, MD, of Wayne State University in Detroit, Michigan, and chair of the American Neurological Association’s public information committee. “The ability to make the diagnosis of multiple sclerosis early and accurately is important for both patient care and for clinical research including clinical trials of new treatments.” There is increasing evidence that MS drugs such as interferon beta and glatiramer acetate are most effective when started early in the disease course.

The original McDonald Criteria were the first to incorporate MRI testing into the traditional tool kit of neurological history and examination, along with various laboratory exams. Brain imaging can show physicians the damaged sites (termed “lesions”) in the brain and spinal cord.

“A series of studies performed during the last few years, with improved techniques for spinal cord MRI, shows that it is a powerful tool not only to demonstrate MS lesions, but also to exclude alternative diagnoses,” said Dr. Polman.

The new criteria also conclude that only two separate MRI scans, rather than three, are needed to evaluate whether the disease is progressing.

WHAT CAUSES MS?
MSActiveSource

Despite a great deal of research, we still do not know what causes MS. In general, it is thought that MS is caused by a combination of factors. It is likely that people with MS are, to a certain extent, prone to develop the disease (that is, something that they inherit). Then some unknown environmental factor may trigger the immune system to attack the white matter of the CNS. Environmental Factors Climate: MS does not occur as frequently in every country throughout the world. MS most commonly affects Caucasians, particularly in North America, Europe, and Australia. The differences are not as great as we used to think. We do know, however, that in both the northern and southern hemisphere, MS is more frequent the farther away a country is from the equator. This applies to regions within a country itself. For example, in the US, the incidence of MS is much higher in northern states with temporate climates (seasonal changes) than in warmer southern states.

Some studies suggest that there may be a connection between where a person lived for about the first 15 years of his or her life and the incidence of MS. For example, children up to age 15 who move to another area where there is a higher or lower risk for MS become as likely to get MS as people who have always lived in that area. But people older than 15 who move remain as likely to get MS as if they had not moved.

Viruses: A great deal of research has investigated the links between MS and all kinds of viruses. As yet there has been no reliable proof of any specific virus being responsible for MS. A likely possibility is that MS is the result of a response to several outside factors, such as viral infections, in a person who may be susceptible to MS based on his or her genetic makeup.

Hereditary Factors: We know that MS is hereditary to a limited extent. The results of studies of identical twins have mainly brought this to light. If a sickness is completely hereditary it should always affect not just one of the twins, but the other as well. The chances of this happening with MS are not 100% but about 30%. Family members of someone with MS have a somewhat higher risk of contracting the disease than someone who does not have a family member with MS. In addition, MS most commonly affects Caucasians. This could also point to a hereditary factor among the causes of MS.

At the moment, we know that, for some hereditary diseases, it is possible to point to the exact place where the hereditary factor can be found in our genetic material, the chromosomes. Unfortunately, researchers have not yet found the location of the hereditary factors involved in MS.

Autoimmune Disease: It is clear, however, that a fourth factor is important: our body’s defense system, the immune system. The immune system is designed to protect us from outside enemies, such as viruses or bacteria that cause illness. Generally speaking, inflammatory reactions only occur when the immune system reacts to these viruses and bacteria. But, in exceptional cases, an inflammatory reaction can be caused against our own body parts or tissues. Diseases in which this process occurs are called “autoimmune” diseases (“auto” means “self”). It is believed that MS is such an autoimmune disease: people with MS are thought to have inflammatory reactions against the myelin in their own brain and spinal cord.

Further evidenced that MS is an autoimmune disease is the observation that it is possible to cause a condition resembling MS in laboratory animals by giving them an injection of brain tissue that activates their immune system. In addition, autoimmune diseases such as rheumatoid arthritis, lupus, and diabetes, are more common in women than in men; this is also true of MS.

Generally speaking, it is thought that MS does not have a single cause, but that a combination of a number of factors is likely to be responsible for causing the disease.

MEDITATE ON THIS: BUDDHIST TRADITION THICKENS PARTS OF THE BRAIN
LifeScience.com Fri Nov 11, 2005

Meditation alters brain patterns in ways that are likely permanent, scientists have known. But a new study shows key parts of the brain actually get thicker through the practice. Brain imaging of regular working folks who meditate regularly revealed increased thickness in cortical regions relate to sensory, auditory and visual perception, as well as internal perception – the automatic monitoring of heart rate for breathing, for example. This study also indicates that regular meditation may slow age-related thinning of the frontal cortex.

“What is most fascinating to me is the suggestion that meditation practice can change anyone’s gray matter,” said study team member Jeremy Gray, an assistant professor of Psychology at Yale. “The study participants were people with jobs and families. They must mediate on average 40 minutes each day. You don’t have to be a monk.” The research was led by Sara Lazar, assistant in psychology at Massachusetts General Hospital. It is detailed in the November issue of the journal NeuroReport. The study involved a small number of people, just 20. All had extensive training in Buddhist Insight mediation. But the researchers say the results are significant.

Most of the brain regions identified to be changed through meditation were found in the right hemisphere, which is essential for sustaining attention. And attention is the focus of the meditation. Other forms of yoga and meditation likely have a similar impact on brain structure, the researchers speculate, but each tradition probably has a slightly different pattern of cortical thickening based on the specific mental exercises involved.

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*This material is provided as general medical information and is not intended as advice for individual patients;
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