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    by Dr. Randall (Randy) Schapiro, M.D., FAAN, Can Do MS Programs Consultant and Board Member

    Updates from the American Academy of Neurology

    Dr. Randall (Randy) Schapiro, M.D., FAAN, Can Do MS Programs Consultant and Board Member

    As the roving reporter for Can Do MS at the American Academy of Neurology Meeting in Toronto, I could not help but notice how large and spacious the Convention Center of Toronto is.  Anyone attending the meeting had to lose 5 pounds simply by walking between the sessions!  Around 10,000 neurologists from all over the world attended.   The Europeans (thanks to Iceland volcanoes) had an extra long visit. 

    The meeting drew the interest of the attendees to multiple sclerosis with the sessions requiring the largest rooms in the convention center.  There were not a lot of ground breaking accomplishments announced.  We are in a phase where research studies which are important involving many new agents are in progress and not ready for further analysis.  Some are working their way to the FDA and others are not that far along but none are ready for “prime time” as yet. 

    FTY 720 (Fingolimod) was updated by reports about their studies in the relapsing form of MS.  This oral treatment is a novel approach to slowing the immune system’s attack on the nervous system.  The treatment appears to work by trapping certain immune cells within the body’s lymph nodes and preventing their escape.  If they do not escape they cannot get into the nervous system to attack.  It appears quite clear from the results presented that this approach decreases the attacks and the damage as evidenced by the MRI significantly.  The obvious question left is the long term safety of this approach.  That question cannot be answered without more time but thus far the issues raised include infections and cancer and the numbers look hopeful.  Time will tell and time is needed.  One study compares the effect of Fingolimod versus low dose IM interferon beta 1a.  The study indicates a favorable effect for this oral agent with the appearance of it being twice as effective as the once a week shot.  We need to watch and wait and keep our concern about risk versus benefit at the forefront.

    Cladribine, another new oral agent, was discussed with analysis of data done in the studies that are being used for FDA submission.  Again the effect looks to be optimistic in terms of decreasing relapses and slowing the MRI activity.  Like other new oral agents the long term safety continues to be the looming question.  This is a chemotherapy agent which goes after lymphocytes (cells of the immune system) and by decreasing them keeps them from attacking the nervous system.  It is taken only twice a year so is really different from what has been available in the past.

    A new theory in MS was discussed at the meeting.  This theory involves the veins carrying blood from the brain back to the body.  The theory involves a narrowing of these vessels potentially increasing the pressure in the system and preventing the flow of substances and blood from the brain back to the body.  The thought is the pressure increases and thus this is called chronic cerebrospinal venous insufficiency.  It is being promoted by a vascular surgeon from Italy and a MRI specialist from Buffalo, NY (Drs. Zamboni and Zvadinov).  On the surface it makes little sense and the data appear to be looking less impressive as analysis continues.  Nonetheless interest is present, albeit controversial.  The studies continue and will become public as they conclude.  If positive, a surgical approach toward increasing blood flow in those veins would become a treatment for MS. 

    This is the roving reporter for Can Do MS signing off for now!

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