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Latest & greatest articles for multiple sclerosis
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on multiple sclerosis or other clinical topics then use Trip today.
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Multiplesclerosis. Multiplesclerosis continues to be a challenging and disabling condition but there is now greater understanding of the underlying genetic and environmental factors that drive the condition, including low vitamin D levels, cigarette smoking, and obesity. Early and accurate diagnosis is crucial and is supported by diagnostic criteria, incorporating imaging and spinal fluid abnormalities for those presenting with a clinically isolated syndrome. Importantly (...) , there is an extensive therapeutic armamentarium, both oral and by infusion, for those with the relapsing remitting form of the disease. Careful consideration is required when choosing the correct treatment, balancing the side-effect profile with efficacy and escalating as clinically appropriate. This move towards more personalised medicine is supported by a clinical guideline published in 2018. Finally, a comprehensive management programme is strongly recommended for all patients with multiplesclerosis, enhancing
Siponimod versus placebo in secondary progressive multiplesclerosis (EXPAND): a double-blind, randomised, phase 3 study. No treatment has consistently shown efficacy in slowing disability progression in patients with secondary progressive multiplesclerosis (SPMS). We assessed the effect of siponimod, a selective sphingosine 1-phosphate (S1P) receptor1,5 modulator, on disability progression in patients with SPMS.This event-driven and exposure-driven, double-blind, phase 3 trial was done at 292 (...) hospital clinics and specialised multiplesclerosis centres in 31 countries. Using interactive response technology to assign numbers linked to treatment arms, patients (age 18-60 years) with SPMS and an Expanded Disability Status Scale score of 3·0-6·5 were randomly assigned (2:1) to once daily oral siponimod 2 mg or placebo for up to 3 years or until the occurrence of a prespecified number of confirmed disability progression (CDP) events. The primary endpoint was time to 3-month CDP. Efficacy
2018LancetControlled trial quality: predicted high
Exploring cued and non-cued motor imagery interventions in people with multiplesclerosis: a randomised feasibility trial and reliability study Motor imagery (MI) is increasingly used in neurorehabilitation to facilitate motor performance. Our previous study results demonstrated significantly improved walking after rhythmic-cued MI in people with multiplesclerosis (pwMS). The present feasibility study was aimed to obtain preliminary information of changes in walking, fatigue, quality of life (...) ). Descriptive statistics were reported for all outcomes. Primary outcomes were walking speed (Timed 25-Foot Walk) and walking distance (6-Minute Walk Test). Secondary outcomes were recruitment rate, retention, adherence, acceptability, adverse events, MI ability (Kinaesthetic and Visual Imagery Questionnaire, Time-Dependent MI test), fatigue (Modified Fatigue Impact Scale) and QoL (MultipleSclerosis Impact Scale-29). The reliability of a gait analysis system used to assess gait synchronisation with music
EMA urgently reviewing multiplesclerosis medicine Zinbryta following cases of inflammatory brain disorders EMA urgently reviewing multiplesclerosis medicine Zinbryta following cases of inflammatory brain disorders | European Medicines Agency Search Search Menu EMA urgently reviewing multiplesclerosis medicine Zinbryta following cases of inflammatory brain disorders Press release 02/03/2018 Medicine to be voluntarily withdrawn from the market by the company The European Medicines Agency (EMA (...) ) has started an urgent review of the multiplesclerosis medicine Zinbryta (daclizumab) following 7 cases of serious inflammatory brain disorders in Germany, including encephalitis and meningoencephalitis, and one case in Spain. In parallel to the start of the review, the company that markets Zinbryta (Biogen Idec Ltd) has informed EMA of its intention to voluntarily withdraw the medicine's . Doctors in the EU will be contacted directly in the coming days with further information. Until then EMA
EMA recommends immediate suspension and recall of multiplesclerosis medicine Zinbryta EMA recommends immediate suspension and recall of multiplesclerosis medicine Zinbryta | European Medicines Agency Search Search Menu EMA recommends immediate suspension and recall of multiplesclerosis medicine Zinbryta Press release 07/03/2018 Evidence indicates risk of serious inflammatory brain disorders The European Medicines Agency (EMA) has recommended the immediate suspension and recall (...) of the multiplesclerosis medicine Zinbryta (daclizumab beta) following 12 reports of serious inflammatory brain disorders worldwide, including encephalitis and meningoencephalitis. Three of the cases were fatal. A preliminary review of the available evidence indicates that immune reactions observed in the reported cases may be linked to the use of Zinbryta. Zinbryta may also be linked to severe immune reactions affecting several other organs. To protect patients' health, EMA is recommending the immediate
Randomized Controlled Trial to Examine the Impact of Aquatic Exercise Training on Functional Capacity, Balance, and Perceptions of Fatigue in Female Patients With MultipleSclerosis To assess the effects of an 8-week aquatic exercise training program on functional capacity, balance, and perceptions of fatigue in women with multiplesclerosis (MS).Randomized controlled design.Referral center of an MS society.Women (N=32; mean age ± SD, 36.4±8.2y) with diagnosed relapsing-remitting MS. After
Evidenced-Based Cognitive Rehabilitation for Persons With MultipleSclerosis: An Updated Review of the Literature From 2007 to 2016 To update the clinical recommendations for cognitive rehabilitation of people with multiplesclerosis (MS), based on a systematic review of the literature from 2007 through 2016.Searches of MEDLINE, PsycINFO, and CINAHL were conducted with a combination of the following terms: attention, awareness, cognition, cognitive, communication, executive, executive function
Efficacy of Balance and Eye-Movement Exercises for Persons With MultipleSclerosis (BEEMS) To determine whether a multifaceted vestibular-related rehabilitation program (Balance and Eye-Movement Exercises for Persons with MultipleSclerosis; BEEMS) improves balance in persons with MS and whether there are differences in outcomes based on brainstem/cerebellar lesion involvement.A 2-arm, examiner-blinded, stratified (involvement vs no involvement of brainstem/cerebellar structures), randomized (...) , p < 0.0001), SF-36 Mental (3.9, 0.70-7.16, p = 0.02), and SF-36 Physical (3.2, 0.79-5.62, p = 0.01) scores. From baseline to 6 weeks, BEEMS participants with brainstem/cerebellar lesion involvement experienced greater improvements compared to those without in CDP-SOT composite (5.26, 0.34-10.2, p = 0.04) and MFIS total (-7.6, -14.0 to -1.33, p = 0.02) scores.BEEMS improved multiple outcomes regardless of whether brainstem/cerebellar lesions were present, supporting the generalizability of BEEMS
Cladribine (Mavenclad) - for the treatment of adult patients with highly active relapsing multiplesclerosis (MS) Cost-effectiveness of cladribine (Mavenclad®) for the treatment of adult patients with highly active relapsing multiplesclerosis (MS) as defined by clinical or imaging features The NCPE has issued a recommendation regarding the cost-effectiveness of cladribine (Mavenclad®). Following assessment of the applicant’s submission, the NCPE recommends that cladribine (Mavenclad® (...) who has a responsibility for commissioning or providing healthcare, public health or social care services. National Centre for Pharmacoeconomics July 20182 Summary In December 2017, Merck Serono Europe Ltd submitted a dossier of clinical, safety and economic evidence in support of cladribine (Mavenclad®) for the treatment of adult patients with highly active relapsing multiplesclerosis (MS) as defined by clinical or imaging features. This includes both relapsing remitting MS (RRMS) and secondary
Ocrelizumab (Ocrevus) for the treatment of adult patients with relapsing forms of multiplesclerosis (RMS) Cost-effectiveness of ocrelizumab (Ocrevus®) for the treatment of adult patients with relapsing-remitting multiplesclerosis (RRMS) The NCPE has issued a recommendation regarding the cost-effectiveness of Ocrelizumab (Ocrevus) for the treatment of relapsing – remitting multiplesclerosis (RRMS). Following assessment of the applicant’s submission, the NCPE recommends that ocrelizumab (...) , safe and value for money treatments for patients. Our advice is for consideration by anyone who has a responsibility for commissioning or providing healthcare, public health or social care services. National Centre for Pharmacoeconomics August 20182 Summary Roche Products Ireland Ltd submitted an economic dossier on the cost-effectiveness of ocrelizumab (Ocrevus®) for the treatment of adult patients with relapsing-remitting multiplesclerosis (RRMS) on the 16 th March 2018. Ocrelizumab
Ocrelizumab (Ocrevus) for the treatment of adult patients with early primary progressive multiplesclerosis (PPMS) Cost-effectiveness of ocrelizumab (Ocrevus®) for the treatment of adult patients with early primary progressive multiplesclerosis (PPMS) The NCPE has issued a recommendation regarding the cost-effectiveness of ocrelizumab (Ocrevus®) for the treatment of adult patients with early primary progressive multiplesclerosis (PPMS). Following assessment of the applicant’s submission (...) primary progressive multiplesclerosis (PPMS) in terms of disease duration and level of disability, and with imaging features characteristic of inflammatory activity. Ocrelizumab is a humanised monoclonal antibody that selectively targets CD20 a cell surface antigen expressed on B cells but not on lymphoid stem cells or plasma cells. It was granted regulatory approval from the European Medicines Agency (EMA) on the 8 th January 2018. The formulation is ocrelizumab 300mg concentrate for solution
Extract from Cannabis sativa (spasticity due to multiplesclerosis) - Benefit assessment according to §35a Social Code Book V (expiry of the decision) Extract 1 Translation of the executive summary of the dossier assessment Extrakt aus Cannabis sativa (Spastik aufgrund von multipler Sklerose) – Nutzenbewertung gemäß § 35a SGB V (Ablauf Befristung) (Version 1.0; Status: 26 July 2018). Please note: This document was translated by an external translator and is provided as a service by IQWiG (...) to English-language readers. However, solely the German original text is absolutely authoritative and legally binding. IQWiG Reports – Commission No. A18-27 Extract from Cannabis sativa (spasticity due to multiplesclerosis) – Benefit assessment according to §35a Social Code Book V 1 (expiry of the decision) Extract of dossier assessment A18-27 Version 1.0 Extract from Cannabis sativa (spasticity due to multiplesclerosis) 26 July 2018 Institute for Quality and Efficiency in Health Care (IQWiG) - i
Multiplesclerosis: Tizanidine Tizanidine | Prescribing information | Multiplesclerosis | CKS | NICE Search CKS… Menu Tizanidine Multiplesclerosis: Tizanidine Last revised in October 2019 Tizanidine What doses of tizanidine are indicated for spasticity? The dose of tizanidine often needs adjustment for each person, but a typical regimen is: Initial dose: 2 mg as a single daily dose. Titration: gradually increase the dose at intervals of at least 3–4 days in steps of 2 mg daily (and taken
Multiplesclerosis: Scenario: General management Scenario: General management | Management | Multiplesclerosis | CKS | NICE Search CKS… Menu Scenario: General management Multiplesclerosis: Scenario: General management Last revised in October 2019 Scenario: General management From age 18 years onwards. How should I manage someone with confirmed multiplesclerosis? If the diagnosis of multiplesclerosis (MS) is confirmed: The person should be under the care of a consultant neurologist (...) for Health and Care Excellence (NICE) guideline Multiplesclerosis: management of multiplesclerosis in primary and secondary care [ ]. The recommendation about smoking is in keeping with studies that have shown that smoking roughly doubles the risk of developing MS, and may adversely affect the disease course [ ; ; ]. The NICE guideline also states 'offer people suspected of having MS information about support groups and national charities.' Comprehensive annual review The recommendation about an annual
Multiplesclerosis: Scenario: Managing relapse Scenario: Managing a relapse | Management | Multiplesclerosis | CKS | NICE Search CKS… Menu Scenario: Managing a relapse Multiplesclerosis: Scenario: Managing relapse Last revised in October 2019 Scenario: Managing relapse From age 18 years onwards. How should I manage a person having a relapse? If you suspect that a person is having a : Rule out infection , particularly urinary tract and respiratory infections, and other that can (...) be misdiagnosed as a relapse. Consider hospital admission if the relapse is severe or if it is difficult for the person to meet their care needs at home. If hospital admission is not indicated , communicate promptly with the person's multiplesclerosis specialist team to discuss management. Offer steroid treatment, if appropriate. Not all relapses require steroid treatment (ie mild relapses). Standard treatment is oral methylprednisolone 0.5 g daily for five days, regardless of the person's weight. If you
Multiplesclerosis: How should I confirm a diagnosis of multiple slcerosis? Confirming the diagnosis | Diagnosis | Multiplesclerosis | CKS | NICE Search CKS… Menu Confirming the diagnosis Multiplesclerosis: How should I confirm a diagnosis of multiple slcerosis? Last revised in October 2019 How should I confirm a diagnosis of multiple slcerosis? If a person has suggestive of multiplesclerosis (MS): Refer the person promptly to a consultant neurologist, as early diagnosis and treatment may (...) sedimentation rate or C-reactive protein. Liver function tests. Renal function tests. Calcium. Glucose / HbA1c. Thyroid function tests. Vitamin B12. HIV serology. However, awaiting the results of blood tests should not delay urgent referral if that is required on clinical grounds. There is no single test that can diagnose multiplesclerosis (MS). A consultant neurologist may request tests such as an MRI scan to provide support for the diagnosis, but MS should not be diagnosed on the basis of MRI findings