What is MS?

What is Trigeminal Neuralgia?

Genes and MS - What's it all about?

1. Link Between Vitamin D and MS (Posted: 1 May 2010)
2. Genetic Study of MS Among Twins (Posted: 1 May 2010)
3. Smoking, Epstein-Barr Virus and MS (Posted:9 April 2010)
4. Phase II Clinical Trial on LDN Reports (P0sted: 9 April 2010)
5. CCSVI Stent Treatment Stopped (Posted; 9April 2010)
6. Belfast Surgeon Claims Relief from MS Symptoms After CCSVI Repair (Posted: 11 Feb 2010)
7. Early Results of Buffalo Research Suggest Link between CCSVI & MS (Posted:10 Feb 2010)
8. Risk of MS Reduced for Nurses Whose Mothers Drank Vitamin D Fortified Milk During Pregnancy (Posted: 10 Feb 2010)
9. Exercises Designed for Persons with MS (Posted: 3 Feb 2010)
10. Good News on Oral Drugs (Posted: 26 Jan 2010)

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What is MS?

MS is a disease that damages nerve coverings within the central nervous system. The brain and the central nervous system control all our actions. The central nervous system sends electrical signals along nerves to various parts of the body. Nerve fibres are insulated by a fatty substance called myelin, which aids the flow of messages. MS causes unpredictable spot damage to myelin which breaks down and is replaced by scar tissue. This can interfere with the flow of messages with the result that they may be blocked, weakened or misdirected to the wrong place. Since the messages control all our movements, the effects of MS are very varied. Some have blurred or double vision. Many experience severe fatigue. Some have speech difficulties. Some may have spasms, numbness or partial paralysis of part of the body. Others experience problems with bladder or bowel control or balance. Symptoms can vary from mild to severe. Often people experience long periods of remission when symptoms diminish or even disappear completely.

The cause of MS is not known although research suggests that there may be at least two factors involved - a virus and an immune system effect. The most widely held view is that a virus or more than one virus may trigger a reaction in a person's own defence or immune system which causes it to attack its own myelin as though it was a virus. This is known as an auto-immune reaction and it is believed that people affected by MS may have a genetic susceptibility that renders them vulnerable. Research has attempted to identify viruses and genes that may be involved, but results to date, although showing promising progress, have not yet succeeded. MS is not hereditary but the genetic disposition can be with the result that the risk of contracting the disease among the descendants of a person with MS is greater than the risk among the general population.

There is no cure or preventative treatment to date for MS. However, with good care, it can be managed and many of the symptoms can be alleviated with drugs. A good diet and adequate rest are usually helpful. Physiotherapy and regular exercise can help to relieve muscle tightening and maintain muscle tone. Prompt treatment of any infection is very important. A positive attitude and a determination to maintain maximum mobility and activity appear to be important psychological factors in dealing with the symptoms. More detailed information can be accessed through the useful links page.

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• TRIGEMINAL NEURALGIA

  The trigeminal nerve (also called the fifth cranial nerve) is one of the main nerves of the face. There is one on each side. It comes through the skull from the brain, in front of the ear. It is called trigeminal as it splits into 3 main branches. Each branch divides into many smaller nerves. The nerves from the first branch go to the scalp, forehead and the area around the eye. The nerves from second branch go to the area around the cheek and upper teeth and those from the third branch go to the area around the jaw and lower teeth.

  TN involves sudden, severe, pain from one or more branches of the trigeminal nerve. The second and third branches are the most commonly affected resulting in pain around the cheek or jaw. It usually affects one side of the face and is considered to be about the most severe pain of any medical condition. It is sometimes described as like electric shocks stabbing the face. Each stab can last from a few seconds to a couple of minutes. Events such as eating, talking, brushing teeth, shaving, swallowing or a draught may trigger a pain.
  
  The cause is not known but there is a higher incidence among persons with MS than in the general population. It may be related to the formation of plaques on the trigeminal nerve. Tegretol (carbamazepine) , an anticonvulsant drug used to treat epilepsy is commonly used to treat TN because of its effect in quieting nerve impulses. Other anticonvulsant drugs such as Lamictal (lamotrigine), Neurontin (gabapentin), or Lioresal (baclofen) may also be used. Various surgical techniques may be considered if medication does not work.

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• Genes and MS - What's it all about?

  Recent discovery of a link between two genes and a genetic susceptibility for MS has attracted media attention. The discovery has been hailed as the first for over thirty years. Every discovery of this kind is to be welcomed. The recent discovery is particularly of interest because the two genes involved are outside the HLA group of genes that have been linked to MS for over thirty years.

  The recent studies suggest that variations in these newly linked genes increases the susceptibility to MS by less than one percent whereas variations in genes within the HLA group are believed to account for nearly 50% susceptibility.

  The HLA cluster of genes includes over 200 genes. The detail is very complex and it is believed a considerable number of these genes may play a part in MS. The following is a simplified account of the role of the HLA genes.

  The cells of the body carry protein markers that allow the immune system to identify them . Tissue not marked as belonging to the body is seen as foreign and is normally attacked by the immune system. Viruses and bacteria are identified in this way and a healthy immune system attacks them. The white blood cells are the main component of the immune system. Unless compatible with the body's own tissue, transplanted tissue will also be attacked. Only tissue from an identical twin is fully compatible and drugs are normally used to dampen down the immune system during transplant surgery. After a period, the immune system comes to 'recognise' the new tissue as the body's own.

  Variations in some of the HLA genes result in the immune system not recognising certain cells as the body's own cells and they are attacked. In the case of MS, the protective myelin covering round the nerve cells of the central nervous system are attacked and the resulting damage interferes with the messages between the brain and the muscles. Similar mechanisms are involved in other auto-immune conditions.

  It is to be hoped that the increasing understanding of the human genetic make-up, generally known as the human genome, which contains about 25000 genes, will eventually lead to effective preventative measures against MS and other auto-immune diseases.

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Items posted 2010

1. Link Between Vitamin D and MS

   An Australian study published yesterday has shed further light on the correlation between vitamin D and MS. The study, published in the British Medical Journal, shows that people born after the vitamin D-scarce winter months are about 30 per cent more likely to go on to develop MS later in life compared with those born after the summer months. View the MS Society report at this link.

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2. Genetic Study of MS Among Twins

   A pilot study published yesterday in the journal, Nature, has thrown new light on the question of whether the risk of developing MS is genetic. The complete genome of one set of twins and 99% of the genomes of two other sets were examined by Sergio Baranzini, Associate professor of Neurology at the University of California, and his team. One twin in each case had MS.

   They reported that they were unable to uncover any significant genetic variations that could account for the fact that one twin developed MS and the other didn't. This led them to conclude that the trigger for MS must lie in environmental factors although their research did not rule out the possibility of a genetic factor that renders a person susceptible to MS.

   There has long been an established view that there is a genetic susceptibility to MS and an environmental trigger. A number of possible triggers have been suggested by different studies such as low childhood exposure to sunlight resulting in low levels of vitamin D, childhood exposure to Epstein-Barr virus or smoking. This study, although a pilot study, does not confirm or refute the possibility of a genetic susceptibility but it adds considerable weight to the theory of one or more trigger factors in the environment. The main evidence for the existence of a genetic factor is based on epidemiological studies that suggest that a twin of a person with MS has a 25% higher risk of developing the disease.

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3. Smokers, Epstein-Barr Virus & MS

   Epstein-Barr virus (EBV), also called human herpesvirus 4 (HHV-4), is very common and infects a majority of young persons without any serious illness. Those infected normally develop antibodies. Research suggests that the presence of high levels of the antibodies increase the risk of developing MS. Research also suggests an increased risk of MS among persons who smoke.

   A new study suggests that persons with high levels of the antibodies who also smoke have nearly double the risk of developing MS.

   The researchers analysed the results of three major studies, a large American Nurses' Health Study, a Tasmanian MS Study in Australia and a Swedish MS study.

   Although the researchers noted the difficulties of coordinating the results of three disparate studies, they suggested that the outcome was so definitive that it was unlikely to be a chance effect. They called for further research.

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4. LDN Phase II Clinical Trial Reports

   There are widespread anecdotal claims that LDN can benefit persons with MS. The results of a phase II clinical trial have benn published recently and, according to a report on the MS Society website at MS Society item on LDN , the results of the study suggest that LDN is safe and may have positive effects on the mental quality of life in people with MS, but no effect on a patient's physical quality of life.

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5. CCSVI Stent Treatment Halted

   A team at Stanford University started testing the CCSVI theory by treating the blocked veins. They inserted stents into the blockakes to open the veins. One of the participants died of a brain haemorrhage. Another had to have emergency surgery because the stent had become dislodged and had moved down into the heart. The treatment has now been stopped. This was a recognised risk as the veins involved feed directly into the heart.

   See the two items immediately following.

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6. Belfast Surgeon Claims Relief from MS Symptoms After CCSVI Repair

   The BBC today carried a report of an interview with an Italian heart surgeon who has MS and who works in Belfast. The Surgeon underwent a repair of his CCSVI condition in Italy a couple of years ago and, according to the report, experienced immediate improvement to his MS symptoms. Last year his condition worsened again and he discovered his veins had again narrowed. He had a repair again in October and claims his symptoms have again improved. Read the BBC report at BBC Report.

   This is an interesting report but must be treated with caution. Aristotle is believed to have coined the phrase ’one swallow doesn't make a Spring‘ and it has frequently applied to claims of cures for MS. Nevertheless, the research reported in the item below is welcome and, hopefully, will speedily establish whether there may be a causal link between CCSVI and MS.

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7. Early Results of Buffalo Research Suggest Link between CCSVI and MS.

   Early Results of the 1st phase of a preliminary study at the University of Buffalo in New York suggest a link between MS and CCSVI.

   In a news bulletin issued today (10 Feb 2010), the university published preliminary results of a study of 500 persons over half of whom had MS. They reported that 56.4% of persons with MS had CCSVI compared with 22.4% of healthy controls. This is not evidence that CCSVI is a cause of MS but merely confirms a significant link between the two and the researchers plan to extend the study to a further 500 persons. Detailed results of the preliminary study are to be presented at an American Academy of Neurology meeting in April.

   Earlier items posted on this site can be viewed at Bucket of Cold Water Thrown on CCSVI Theory (Posted:04 Dec 2009) & Possible New Cause for MS under Investigation (posted: 29 Oct 2009).

   The News release can be viewed at Buffalo News Release.

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8. Risk of MS Reduced for Nurses Whose Mothers Drank Vitamin D Fortified Milk During Pregnancy

   Results of a 16 year study involving 35,794 nurses whose mothers completed a questionnaire in 2001 about their experiences and diet during pregnancy with their nurse-daughter will be reported to the April meeting of the American Academy of Neurology. Of the nurses studied, 199 women developed MS over the 16-year period.

   The researchers from the Harvard School of Public Health in Boston found that the risk of MS among nurses whose mothers had a high intake of milk or dietary vitamin D during pregnancy was lower than those whose mothers had a low intake. They report that the risk of MS among daughters whose mothers consumed four glasses of milk per day was 56 percent lower than daughters whose mothers consumed less than three glasses of milk per month. These results add to the growing evidence of a link between MS and vitamin D

   Fatty fish such as salmon and exposure to sunlight are sources of vitamin D.

   Note: UK milk is not fortified with vitamin D and does not contribute to the level of vitamin D in the system.

   
   
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9. Exercises Designed for Persons with MS

   The MS Trust has launched a new exercise resource for persons with MS on its website based on its popular 2004 book. The resource consists of a series of website pages, each of which can be downloaded in PDF format. The complete resource, including general posture and fitness advice and each of the colourfully illustrated exercises can be accessed on MS Trust Exercise Resource. If you only want the exercises go directly to MS Trust Exercises. (Image courtesy of the MS Trust)
   

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10. Good News on Oral Drugs

    The New Year has brought a number of reports of advances in development of MS drug therapies. Currently the recognised treatments such as interferon beta are administered by injection. Two orally administered drugs, cladibrine and fingolimod, are therefore of great interest to the MS community . Both of these reported very positive results in earlier trials last year and further trails were published online in the New England Journal of Medicine on 20 January this year.

    During the last year a double blind clinical trail found fingolimod to be superior to interferon beta-1a in respect of relapse rates and MRI results. However further trials will be necessary to establish safety factors as two participants developed herpes zoster infections and died.

    In the other trial, cladibrine was also found to be very effective in reducing relapses but there was also evidence of increased rates of herpes zoster infection. Cladibrine is already used to treat a type of leukemia.

    Both of the developing companies are submitting applications for licences in the UK and in America. There is a real prospect of the drugs being approved for MS within the next two to three years.

    More detailed information on these trials is available on the MS UK website.