Vaccinations and MS

Some studies show that viral infections can increase MS relapse rate, presumably by activating the immune system. New information, presented by Dr Patricia Coyle at the 2014 Meeting of CMSC and ACTRIMS, confirms that nearly all vaccinations are safe for patients with MS. The seasonal flu vaccine is well studied, and the killed virus is considered safe. Similarly, vaccines for hepatitis B, varicella (shingles), tetanus, and HPV are accepted as safe. Killed vaccines rather than live should be used whenever possible.

Disease-modifying drugs, including beta interferons, Copaxone, Tysabri, and Aubagio do not affect the body’s immune responses to vaccines. There are no data about Tecfidera’s effect on vaccine responses, and administrating live vaccines to patients on this drug is not recommended. Fingolimod may have some effect. Patients should be checked for previous infections to zoster (chicken pox) before starting the drug. If these are not found, patients should be vaccinated, and starting therapy should be delayed for a month. Live vaccines should not be given to patients on this drug.

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Dr. Jack Florin
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Treating Restless Legs Syndrome May Improve Sleep and Reduce Pain

If a patient presents with rheumatoid arthritis or fibromyalgia, the physician should screen the patient for restless legs syndrome. First-line therapies are dopamine agonists, including Neupro Patch, Requip, Mirapex. Next class is based on gabapentin-type medications. Lyrica is in that class. It is effective but it does not have FDA approval for this indication. Unlike dopamine agonists, Lyrica was not associated with impulse control problems or augmentation.

According to Dr Alon Avidan, physicians should always ask patients about difficulties with insomnia, snoring, an urge to move the legs, or unusual movements at night. Because sleep and pain are bidirectional, the treatment of the pain and the underlying sleep symptoms can be very rewarding. This was presented at the 66th Annual Meeting of the American Academy of Neurology.

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Exciting Research in Migraine

Monoclonal antibodies are the most important new experimental treatment for migraine. They target the calcitonin gene-related peptide (CGRP). When a migraine patient is having an attack, this compound is increased in the blood and not so between attacks. Injecting this compound into a migraine patient always triggers an attack.

There are 3 monoclonal antibodies to CGRP being tested. Preliminary results seem positive and side effects very low. Our center is currently recruiting for a trial of the compound termed LY2951742. This is a phase II trial, but there are already plans for a phase III trial with the hope of obtaining FDA indication and making this medication available to all migraine patients.

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How Effective Is Marijuana For MS?

About 46% of MS patients smoke marijuana for pain, tremor, insomnia, bladder symptoms, spasticity. Oral sprays probably have fewer risks.

Nabiximols may soon receive FDA approval. They are a liquid extract of 2 strains of cannabis formulated as an oral mucosal spray containing tetrahydrocannabinol (THC) and cannabidiol (CBD) in a 1-to-1 ratio. THC is psychoactive and CBD counteracts that effect. Several trials have shown that the drug is effective for pain within 4 weeks. There was no tolerance or withdrawal when stopping. About 30% had dizziness. Less than 1% of patients had a cannabis high. The drug is approved for MS-related spasticity and pain in the UK, Canada, New Zealand, and 8 European countries.

In contrast, smoked cannabis, though reducing pain by about 30%, causes significant cognitive symptoms in at least a third of patients and drug dependence and withdrawal in about 1 in 10.

Oral cannabis is least popular among patients because of low bioavailability in that it is metabolized in the liver. Dronabinol is a synthetic THC that is available in the US and has an analgesic effect similar to codeine. It is approved for chemotherapy related and AIDS-related nausea, vomiting and weight loss.

A study performed in 2012 sponsored by the Consortium of Multiple Sclerosis Centers of 493 British patients concluded that THC does not slow the progression of primary or secondary progressive MS. The medication was given in an oral capsule, based on weight. About 60% of patients had dizziness and about half had thought or perception changes but fewer patients seemed to develop pain or urinary tract infections.

The American Academy of Neurology issued a practice parameter in 2014 and concluded that Nabiximols and THC are “probably effective” for spasticity, central pain or painful spasms, overactive bladder symptoms, and are probably ineffective for tremor.

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Fullerton Neurology and Headache Center

A Surprising Survey of High School Football Players and Neurocognitive Function

The survey was presented in the 2014 annual meeting of the American Academy of Orthopaedic Surgeons based on studying over 1200 high school football players, utilizing neuropsychological tests to look for an association with years of participation in football, age, concussion history. Mean age was 16, mean time of playing football was 4-1/2 years, and 4% had a concussion. Surprisingly, there was no significant association between years of football participation and neurocognitive function. The implication is that the playing of football is not in and of itself detrimental. Nevertheless, several recent research studies have found a link between subconcussive head blows in football and neurocognitive decline in adolescents.

Fullerton Neurology And Headache Center

New Migraine Drugs Target CGRP

There are currently 3 drugs being studied that target CGRP. One drug showed a reduction of 66% compared to a 52% placebo group reduction in migraine days. Sixteen percent were headache-free while none of the placebo patients were. The second drug had a 63% reduction compared to 42% in placebo group. No safety issues were noted.

Our center is a site in a research study with a third drug, which is a monoclonal antibody directed against CGRP, a pain transmitter critical in the migraine process.

For more information about CGRP or to schedule an appointment, call us at (714) 738-0800 or visit our website.