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Ask any question you want about Multiple Sclerosis and one of our experts will answer it as soon as possible.
Q. What is your experience in switching patients from Tysabri to Tecfidera? How efficient is this in preventing relapses?
A. We do not have much experience yet with switching patients from Tysabri to Tecfidera. I suspect we will have the same problems that we have experienced with switching patients from Tysabri to other drugs. I advise following these simple rules for now:
Good luck --Dr. Kinkel Q. What is the risk of passing MS to a child if one, or both parents have MS? Can genetic counseling (or pre-implantation diagnostic) be helpful to evaluate the risk? Thank you!
A. A recent large study showed that the risk of MS in children of an MS patient is about 9.5% with no difference in the transmission rate for affected mothers or fathers. Another smaller study suggested a 9% rate if the affected parent is the mother and an 18% rate if the affected parent is the father. The discrepancy between the two studies has not been fully resolved. If both parents have MS the risk is further increased by 2% to 3%. In contrast, the risk of MS in siblings and non identical twins of MS patients is between 3% and 5 %. The risk is about 30% if you have an affected identical twin. There are other factors that may affect the risk of MS in your offspring; for instance, there is evidence that pregnancy during the winter months, presumably when vitamin D levels are lower, are associated with a higher risk of MS in offspring born in the late Spring. Since we have not identified the exact gene(s) responsible for the increased risk of MS in offspring of parents with MS, how the responsible genetic alleles from one parent interact with affected or unaffected genetic alleles of the other parent (to either increase or decrease risk) or how environmental factors modify this genetic risk, there is no way to provide further genetic counseling at this time. It seems reasonable to at least consider planning pregnancy during the spring, summer and fall and take vitamin D during pregnancy. --Dr. Kinkel The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. Q: I have had secondary progressive MS for 10 years now. I try to keep up with the latest research but find most of the information out there is on relapse remitting MS. Can you tell me if there is any promising research being done on the treatment of secondary progressive MS?
A: We have had effective MS treatments for 20 years but limited evidence that any of these treatments modify the course of secondary progressive MS in a meaningful way. During the 1990's treatments were first tested in relapsing remitting MS to determine efficacy against a placebo by using relapse rates as the outcome measure. This outcome measure for determining efficacy is easy and can detect differences between groups in a very short period of time. However, we quickly learned that effective treatments for relapsing remitting MS, at least in terms of reducing relapse rates, rarely were effective in secondary progressive MS clinical trials. Even when a benefit was observed, the clinical meaningfulness of this benefit was questionable. Gradually, we have learned that an effective treatment for secondary progressive MS may require therapies with more diverse mechanisms of action than current approved treatments. To achieve this goal will likely require treatment combinations. Effective treatments for Secondary progressive MS must do the following:
Right now we are testing therapies that may effect one or two of these mechanisms and there is a lot of hope for these treatments. Tysabri is the most effective treatment to limit the systemic inflammatory response, and if this also controls ongoing innate inflammatory responses could be effective as part of the management approach. The anti-lingo therapies in development could assist in remyelination and perhaps limit neurogeneration. Tecfidera an other drugs in development could help control ongoing neurodegeneration by modifying oxidative stress responses. Even high dose Vitamin D therapy could have protective effects. You will note that I have not mentioned stem cell therapy; it is simply too early to say what role various forms of stem cell therapy will play in our future management of secondary progressive MS. Stay tuned for future updates. They will hopefully emerge quickly in the coming years. Dr. Kinkel Q: What advice do you have for a patient who is seeing a new doctor for the first time for MS?
A: I previously wrote a blog on this issue that I encourage you to read ( http://www.healthcarejourney.com/4/post/2013/07/finding-a-doctor.html) Basically, I encourage you to prepare thoroughly for your visit by doing the following:
I hope this helps --Dr Kinkel The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. |
PLEASE NOTE: This information/opinions on this site should be used as an information source only. This information does not create any patient-HCP relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.
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