Further verification of the test will be required.  If you do not have antibodies to the virus, your PML risk should be extremely low if the preliminary result hold true.  There have been 31 cases of PML reported in over 48,000 currently treated patients.

Biogen Idec Inc. at JPMorgan Healthcare Conference Tuesday, January 12, 2010 http://investor.biogenidec.com

The U.S. Food and Drug Administration approved Ampyra (dalfampridine) extended release tablets to improve walking in patients with multiple sclerosis.  In clinical trials, patients treated with Ampyra ( pronounced am-PEER-ah) had faster walking speeds than those treated with an inactive pill (placebo).

Ampyra is a compound that blocks potassium channels which allows nerves to transmit impulses better.  Two phase III trials of Amprya 10 mg twice a day showed benefits in some people with MS on their ability to walk 25 feet. 

In the first study, 72 patients were treated with placebo and 228 patients were treated with Ampyra over 14 weeks.  Of the 35% of patients who responded to Ampyra, the average change in walking speed increased 25%.

In the second study, 119 patients were treated with placebo and 120 patients were treated with Ampyra over 8 weeks.  43% of treated patients responded.   Ampyra worked in all MS types including relapsing remitting, secondary progressive and primary progressive disease.

The side effects of Amprya include dizziness, trouble sleeping, headache and fatigue.  Although these two trials did not report any seizures, seizures have been reported in people on higher doses of the same active chemical also called 4-aminopyridine.  One seizure can legally prevent you from driving for 6 months in some states.  4-aminopyridine capsules can be made at some compounding pharmacies, but Ampyra will soon be widely available.

Goodman AD. AAN 5/1/07; ECTRIMS 9/20/08 P909.

Zamboni performed a trial of opening of the vein blockages with angioplasty in 65 MS patients.  Patients had less relapses and MRI activity after treatment, but there was no comparison group that got a fake “sham” procedure.  Previous trials of patients on no treatment (placebo group) show less relapses and MRI activity over time naturally so follow-up larger studies are needed to see if this treatment is really effective.   There also has been reports of a fatal brain bleed after stenting and a stent moving into the heart so trials will be necessary to see if stenting works if indeed people with MS have more frequent vein blockages.

Overall, an intriguing observation that needs to be verified at other centers.  Is the vein blockages causing MS or simply the result of MS inflammation on the veins?    Further research is needed!

Extavia is interferon beta-1b.  Interferon beta-1b was the first FDA-approved treatment in 1993.   The version of interferon beta-1b available for the past 16 years has been Betaseron.  Novartis, who temporarily owned the plant making interferon beta-1b,  has made an arrangement with Bayer, makers of Betaseron, to brand and market their version Extavia.  Now we have two names for the same medicine made in the same plant!

The key will be support for those living with MS:   injection training, nursing support, reimbursement specialists and out-of-pocket costs.   Novartis is committed to MS and working on additional treatments including the daily oral experimental medication FTY720 that will likely go to the FDA for review before the end of 2009.

Oral Cladribine reduced relapses by 58% vs. placebo based on the lower of two doses.  The CLARITY trial studied 1326 MS patients over two years.  More patients were relapse free (80%) on treatment with the lower dose than on placebo (61%).  The patients on the low dose of cladribine were 33% less likely to progress in disability.  T1 contrast lesions dropped 86-88% on treatment.  Side effects included low white counts (22-32%), shingles (2%), and some hair loss (3.5%).  One treated patient died with tuberculosis.

FTY720 oral daily treatment compared to Avonex injections reduced relapses 52%  on  the lower dose of FTY720.  The TRANSFORMS  trial studied 1292 patients for 1 year.  More patients were relapse free (83%) on FTY720 than on Avonex (69%).  Side effects and risks included transient slowing of  heart rate and 8 cases of back of the eye swelling (macular edema).  Three cases of melanoma skin cancer were discovered on first dermatology evaluation as part of the trial monitoring.  One death from severe chicken pox in someone also receiving steroids who was never vaccinated or exposed as a child.  One death from herpes encephalitis with a delay of 1 week of diagnosis and treatment.  The MS Center for Innovations in Care was a trial site for this international study.

Rituximab antibody treatment was not helpful in primary progressive MS  overall based on a study of 439 patients.  Rituximab seemed to be effective in the 25% of patients with T1 Contrast lesions on their baseline scan, which is a marker of ongoing active brain inflammation.   

Ginseng, unfortunately, wasn’t very effective for fatigue in a small trial. 

Namenda, an Alzhemier’s medication, did not help thinking in people with MS.

Smoking before age 17 can increase the risk of developing MS 2.7 times.

ATL-TV1102 is a treatment that binds to DNA strands.  The treatment affects a molecule important for white blood cells to cross into the brain. The cumulative number of T1 contrast brain lesions dropped 67% over 12 weeks on treatment.