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    You are here : Home » MS Research News » New Discoveries » Technology

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    Eye-tracking glasses may change the way those with MS interact with the world

    Eye Tracking DeviceMillions of people suffering from Multiple Sclerosis, Parkinson’s, muscular dystrophy, spinal cord injuries or amputees could soon interact with their computers and surroundings using just their eyes, thanks to a new device that costs less than £40.

    Composed from off-the-shelf materials, the new device can work out exactly where a person is looking by tracking their eye movements, allowing them to control a cursor on a screen just like a normal computer mouse.

    The technology comprises an eye-tracking device and 'smart' software that have been presented today in the Journal of Neural Engineering.

    Researchers from Imperial College London demonstrated its functionality by getting a group of people to play the classic computer game Pong without any kind of handset.

    In addition users were able to browse the web and write emails 'hands-off'.

    The GT3D device is made up of two fast video game console cameras, costing less than £20 each, that are attached outside of the line of vision to a pair of glasses that cost just £3.

    The cameras constantly take pictures of the eye, working out where the pupil is pointing, and from this the researchers can use a set of calibrations to work out exactly where a person is looking on the screen.

    Even more impressively, the researchers are also able to use more detailed calibrations to work out the 3D gaze of the subjects - in other words, how far into the distance they were looking. It is believed that this could allow people to control an electronic wheelchair simply by looking where they want to go or control a robotic prosthetic arm.

    To demonstrate the effectiveness of the eye-tracker, the researchers got subjects to play the video game Pong. In this game, the subject used his or her eyes to move a bat to hit a ball that was bouncing around the screen - a feat that is difficult to accomplish with other read-out mechanisms such as brain waves (EEG).

    Dr Aldo Faisal, Lecturer in Neurotechnology at Imperial's Department of Bioengineering and the Department of Computing, is confident in the ability to utilise eye movements given that six of the subjects, who had never used their eyes as a control input before, could still register a respectable score within 20 per cent of the able bodied users after just 10 minutes of using the device for the first time.

    The commercially viable device uses just one watt of power and can transmit data wirelessly over Wi-Fi or via USB into any Windows or Linux computer.

    The GT3D system has also solved the 'Midas touch problem', allowing users to click on an item on the screen using their eyes, instead of a mouse button.

    This problem has previously been resolved by staring at an icon for a prolonged period or blinking; however, the latter is part of our natural behaviour and happens unintentionally. Instead, the researchers calibrated the system so that a simple wink would represent a mouse click, which only occurs voluntarily unlike the blink.

    Dr Faisal said: 'Crucially, we have achieved two things: we have built a 3D eye tracking system hundreds of times cheaper than commercial systems and used it to build a real-time brain machine interface that allows patients to interact more smoothly and more quickly than existing invasive technologies that are tens of thousands of times more expensive.

    'This is frugal innovation; developing smarter software and piggy-backing existing hardware to create devices that can help people worldwide independent of their healthcare circumstances.'

    See how it works.

    Source: Mail Online © Associated Newspapers Ltd 2012 (16/07/12)

    Medical device can now help diagnose and monitor disease development in MS patients

    Eyebrain LogoEyeBrain, a company developing medical devices for the early diagnosis and monitoring of neurological diseases, announces today that it is launching a new software version of its medical device, the EyeBrain Tracker.

    This means it can now contribute to the diagnosis of this pathology by confirming eye motricity impairment, which is a sensitive marker for multiple sclerosis, as well as monitoring patients’ progress and verifying the effect of therapies prescribed by practitioners.

    People with multiple sclerosis often suffer from transitory or permanent neuro-ophthalmological problems, with disruptions in eye movements affecting between 60 - 80 per cent of these patients. The most frequently observed peculiarities are alterations in saccades and pursuits (tracking movements), as well as anomalies in patients’ ability to focus and hold a look.

    These eye movement indicators are valuable for determining the state of patients suffering from multiple sclerosis and for monitoring the development of the disease. A study carried out by Dr. E. M. Frohman, from the department of neurology at the University of Texas Southwestern, showed that oculographic techniques make it possible to detect typical eye movement anomalies in the case of multiple sclerosis more precisely than a classic visual examination carried out by a clinician. The study, which was conducted on 279 medical practitioners, showed that, in 70 per cent of cases, a clinical examination did not enable eye movement anomalies to be detected (Accuracy of clinical detection of INO in MS: corroboration with quantitative infrared oculography, by Frohman TC, Frohman EM, O’Suilleabhain P, Salter A, Dewey RB Jr, Hogan N, et al).

    From this standpoint, the EyeBrain Tracker can provide vital assistance to neurologists for monitoring patients suffering from multiple sclerosis. The EyeBrain Tracker effectively makes it possible to analyze a sensitive and quantifiable marker of anatomical function, namely eye motricity, including internuclear ophthalmoplegia. Since this marker is reproducible, it can provide quantified monitoring of the progress of the disease.

    “There is currently no tool that provides an accurate quantification of the development of multiple sclerosis,” noted the chairman of EyeBrain, Serge Kinkingnéhun. “The EyeBrain Tracker can thus be a valuable aid for neurologists in the treatment of their patients, especially regarding the choice of drugs and their dosing.”

    The upgraded version of the EyeBrain Tracker medical device for application in multiple sclerosis has been available since December. Clients who already possess the EyeBrain Tracker can upgrade it themselves with the help of the company’s after-sales service or through a maintenance visit.

    Multiple sclerosis is a chronic autoimmune neurological disease of the central nervous system. It is multifactorial and its clinical manifestations are linked to the demyelination of the nervous fibres of the central nervous system (brain, spine and optic nerve). The disease affects 80,000 people in France and more than 600,000 people in the European Union.

    About EyeBrain
    EyeBrain manufactures medical devices for the early diagnosis of neurological diseases. These devices are based on the movement of the eyes, and they make it possible to test specific regions of the brain by recording and analyzing eye movements using very sophisticated algorithms developed by the company. EyeBrain’s devices fill a gap in neurological diagnostics. For the first time, clinicians can rely on a simple set of eye movement parameters to differentiate between very similar syndromes, such as progressive supra-nuclear paralysis (PSP) and cortico-basal degeneration (CBD). The test is easy to carry out, non-invasive, and the results are available in less than 20 minutes for a small cost.

    The Mobile EyeBrain Tracker (EBT) comes as a complete solution including helmet, a computer with two screens, and stimulation and analysis software. It is already being used routinely in hospitals to help with the early characterization of Parkinsonian syndromes, to assist in the diagnosis of multiple sclerosis and to monitor the development of these pathologies. Studies are also underway to characterize the eye motricity anomalies involved in reading difficulties, such as those experienced by people with dyslexia.

    The Mobile EBT is the only device of its kind in the world to have obtained CE marking. The company has ISO 9001 and ISO 13485 certification.

    EyeBrain, which is based in the Paris suburb of Ivry-sur-Seine, was founded in 2008 and currently employs 15 people. It has raised funding of EUR 1.2 million from the CapDecisif and G1J venture capital funds and already generates revenues through the sale of the EyeBrain Tracker. It is engaged in collaborations with the French National Health and Medical Research Institute (INSERM), the French National Scientific Research Center (CNRS), Paris University Hospitals group, the University of Paris-Descartes, and the French Brain and Spinal Cord Institute.

    Source: Eyebrain (16/01/12)

    Brainsway announces interim results in Multiple Sclerosis clinical trial

    Brainsway LogoBrainsway Ltd. announced that it had received interim results with respect to 26 patients from a double-blinded clinical trial being conducted at the Charite Hospital in Berlin and at the University Medical Center Hamburg-Eppendorf in Hamburg to assess the safety and efficacy of the Company's Deep TMS device for the treatment of multiple sclerosis (MS) patients.

    The trial subjects were divided into three groups: a sham-stimulation control group, a treatment group that received high-frequency (18 Hz) left prefrontal stimulation, and an additional treatment group that received low-frequency (5 Hz) motor cortex stimulation. Each subject received a series of treatments three times per week over a period of six weeks. The effects of the treatment were evaluated over the course of the subsequent six-week period.

    The effects of the treatment on subjects' fatigue levels were assessed using standard fatigue rating scales such as the Fatigue Severity Scale (FSS), the Modified Fatigue Impact Scale (MFIS) and the Visual Analogue Scale (VAS); and its effects on subjects' depression levels were assessed using the Hamilton Rating Scale for Depression, the Beck Depression Inventory (BDI) and the Positive and Negative Affect Scale (PANAS).

    Analysis of fatigue rating scale results revealed a significant improvement in FSS scores in the motor cortex stimulation treatment group, as well as a tendency towards significant improvement in the left prefrontal stimulation treatment group. A non-significant improvement in VAS scores was observed in the left prefrontal stimulation group, and both treatment groups also displayed non-significant improvement in MFIS scores. The control group showed either no improvement or only non-significant improvement on fatigue rating scales.

    As for the treatment's effect on depression, a significant improvement on the BDI and the PANAS was observed in the motor cortex stimulation group, while the other groups' scores on these depression rating scales did not change significantly.

    The principle investigator commented, "These results indicate that Deep TMS therapy with Brainsway's device is safe and effective for the treatment of MS patients, and that it may even alleviate these patients' fatigue symptoms. Of note, the treatment's effects on metabolic and neural activity have not yet been investigated, and will be addressed in future studies."

    Source: Market Watch Copyright © 2011 MarketWatch, Inc (30/12/11)

    Brainsway reports positive results in MS study

    Brainsway LogoBrainsway Ltd. has reported positive results in a safety and efficacy trial of its non-invasive proprietary coil to stimulate the motor cortex for the lower limbs in patients with advanced multiple sclerosis.

    The double blind trial was conducted by Advanced Technologies Innovation Distribution SrL on 23 patients at INSPE Medical Center in Milan. Half the patients were treated by the device over three weeks, and half received a placebo.

    Success was measured as the ability to walk ten meters in six minutes, a standard measurement under the Modified Ashworth Scale (MAS). The patients who received the treatment showed a clear statistical improvement compared with the patients who received the placebo. No side effects were recorded.

    The researchers cautioned that the results must be confirmed in a larger multicenter trial.

    Source: Globes © © Globes 2011 All rights reserved.(24/10/11)

    MS could be diagnosed early with ‘electronic nose’
    MS DiagnosisThe “electronic nose,” developed by a young chemical engineer and his colleagues at the Technion-Israel Institute of Technology, has been proven to detect lung and other cancers from breath. It has also succeeded in diagnosing in the same way multiple sclerosis.

    The non-invasive technique using sensors, which has been called a “breakthrough” in early diagnosis of the disease that first appears in young adults, was reported in the latest issue of the journal ACS Chemical Neuroscience.

    Prof. Hossam Haick, who still in his 30s has received numerous prestigious scientific awards, developed the electronic sensor in the Technion’s chemical engineering faculty and the Russell Berrie Institute for Nanotechnology Research, together with Prof. Ariel Miller of the Technion’s Rappaport Medical Faculty and Carmel Medical Center in Haifa.

    While no cure has yet been found for MS, in which the immune system of the body mistakenly regards the myelin coating of nerves as a “stranger” and attacks it, a number of medications – most of them, like Copaxone, developed in Israel – can slow and reduce the neurological attacks that can cause loss of muscle function, paralysis and pain.

    Conventional diagnosis of MS, which first appears as numbed nerves, has been via expensive MRI scanning and the examination of spinal fluid. But in their first clinical study, Haick and Miller identified organic compounds in the breath that are a sign of MS. They developed nanometric sensors and tested them on 34 MS patients and 17 normal volunteers. The results were found to be accurate.

    The researchers predicted that MS could be diagnosed at an early stage and non-invasively using the sensors.

    “It is a very early stage, and the research will continue with the aim of developing speedy diagnosis for MS and other chronic neurological diseases. The sensors could also detect neurological attacks after the disease is diagnosed so treatment to halt the attacks can be given.”

    Haick is the founder and chief scientific officer of the Nanose Ltd., a leading developer of advanced nanotechnology for cancer detection by breath analysis.

    He received his BSc. from Ben-Gurion University of the Negev and completed his PhD in chemical engineering at the Technion in 2002. After a two-year period at the Weizmann Institute of Science, he went to the California Institute of Technology-Caltech for postdoctoral research and returned to the Technion in 2006. He has received a Fulbright fellowship, the Science and Technology Ministry award, Prof. Avrahami prize, and CNR-IMIP prize.

    Source: The Jerusalem Post © The Jerusalem Post 1995 - 2011 (17/10/11)

    Tongue stimulation study shows promise in helping MS patients

    Tongue StimulationKurt Shafer is walking stronger and more confidently than he has in years, and he credits an experimental electronic device he uses five times a day.

    "The fact that I have improved is really the hope that people need to go on living," said Shafer.

    Diagnosed with multiple sclerosis six years ago, Shafer recently enrolled in a clinical study at the University of Wisconsin, Madison.

    MS is an autoimmune disorder which damages the nervous system and interrupts signals between the brain and the muscles.

    "The thing about MS is, there's no cure for it. They do have drugs that help you go downhill slower, but there was nothing to help you improve," Shafer said.

    Several times a day, while exercising, reading or writing, Shafer places an electronic device in his mouth. It rests on his tongue and emits low grade vibrations.

    "It feels like Pop Rocks on my tongue," he said.

    The vibrations stimulate the cranial nerve in the tongue, sending new pathways around damaged areas of the brain. Preliminary data from the Wisconsin study shows the device has tremendous potential for resolving balance problems seen in patients with MS.

    Shafer more than doubled his walking ability, though he navigates with ski poles as a safeguard against tripping. He makes light of his gait, but he's completely mobile.

    "It looks like I went to the Frankenstein school of walking. But I'm a lot better and there are so many people that could get better too," Shafer said.

    His wife, Mary Shafer said the device has changed their lives, allowing them freedom to leave the house without the constant worry of Kurt falling.

    "Within two weeks, everything had turned around. We saw life opening up again. And having hope is an amazing thing," said Mary.

    Shafer was so pleased with his improvement, he's working to help replicate the study in Omaha to push the device closer to getting FDA approval.

    "He's not only given us dollars but he's shared his passion with us," said Melanie Welsh, director of development at the University of Nebraska Foundation.

    Shafer personally wrote a cheque to the NU Foundation to start a research fund called "Train the Brain" so that The University of Nebraska Medical Center's Munroe-Meyer Institute could replicate the study in Omaha.

    The foundation is still seeking funding for the project which will cost $250,000. Welsh said the study will rely on the support of private donations and they'll seek funding from the National Institute of Health.

    Welsh said the device could have huge implications in the treatment of Alzheimer's disease, autism, traumatic brain injury and even Parkinson's disease.

    Dr. Max Kurz, a researcher with Munroe-Meyer Institute, will run the study. His team was the first to test the brain device to help resolve balance issues in children.

    Mary said she's proud of the way her husband has dealt with MS.

    "He has absolutely taken the attitude that there must be some reason I got MS, some reason I got into this study and if I can send this out to other people, some of this makes sense," said Mary.

    Source: KETV Omaha © 2011, Hearst Properties Inc. (01/07/11)

    Radiation therapy improves painful MS symptom

    Stereotactic RadiationStereotactic radiation is an effective, long-term treatment for trigeminal neuralgia: a painful condition that occurs with increased frequency in patients with multiple sclerosis (MS).

    Radiation is noninvasive and has less negative side effects than other treatments, according to the longest follow-up in a study of its kind presented October 31, 2010, at the 52nd Annual Meeting of the American Society for Radiation Oncology (ASTRO).

    Multiple sclerosis is a progressive neurological disease affecting about 400,000 Americans where the body’s immune system attacks its own nerve cells, affecting the ability of the brain to communicate with the spinal cord. Trigeminal neuralgia is an intensely painful condition caused by dysfunction of the trigeminal nerve, which is one of the nerves that innervates the face. People living with MS see a significantly increased incidence of this problem.

    “We studied patients for a median of five years after treatment, which is the longest period of follow-up ever completed,” Tejan Diwanji, lead author of the study at the University of Maryland, School of Medicine in Baltimore, said “Our study shows that radiosurgery using Gamma Knife is a proven alternative to surgery or anti-epileptic drugs."

    The study was designed to determine the long-term effectiveness of treating trigeminal neuralgia in MS patients with Gamma Knife radiosurgery.

    Stereotactic radiation is a specialized type of external beam radiation therapy that uses focused radiation beams to target a well-defined area. It is most often used for tumors of the brain, but in this case, doctors targeted a nerve root, relying on detailed imaging and computerized three-dimensional planning to deliver the radiation dose with extreme accuracy while sparing the surrounding tissue to reduce side effects.

    Stereotactic radiation therapy, sometimes called radiosurgery, refers to a single or several treatments to the brain. Doctors in this study used GammaKnife. Other brand names for stereotactic radiation include Axesse, CyberKnife, Novalis, Primatom, Synergy, X-Knife, TomoTherapy or Trilogy.

    The study involved 13 MS patients with trigeminal neuralgia who were treated with radiosurgery at the University of Maryland between 1998 and 2001 and were followed for a median of five years after treatment.

    “We need more long-term studies to confirm the positive and lasting outcomes of radiosurgery, then it could become the treatment of choice for MS patients afflicted with trigeminal neuralgia,” Diwanji, said. “I encourage people with MS suffering from trigeminal neuralgia to talk to their doctor about consulting a radiation oncologist to see if they would be good candidates for radiosurgery.”

    Source: Newswise ©2010 Newswise, Inc (26/10/10)

    Driving simulator to be tested on Multiple Sclerosis patients

    Driving SimulatorThe Medical College of Georgia has received a one-year grant to determine the usefulness of using a simulator-based driving training program to improve fitness-to-drive in multiple sclerosis patients.

    Fifty participants, recruited for the study through the MCG Multiple Sclerosis Center, will receive driving training at the MCG Driving Simulation Laboratory under the direction of Dr. Abiodun Akinwuntan, associate professor of physical therapy, graduate studies and neurology. The study is funded by the Consortium for Multiple Sclerosis Centers.

    "An extensive study using the same driving training program with stroke survivors showed tremendous difference in putting participants back behind the wheel," said Akinwuntan. With cognitive training, stroke survivors improved their chances of returning to driving from 30 percent to 41 percent. By adding simulator training, the odds increased to 73 percent.

    An ongoing MCG study with Parkinson's disease patients shows signs of comparable outcomes. "We hope patients with multiple sclerosis will also derive visual, cognitive, perceptual and physical benefits necessary for safe driving from the training program," Akinwuntan said.

    Another study goal is to eliminate redundant testing of multiple sclerosis patients to determine their driving safety.

    "The medical community has a laundry list of tests, about 25 in all, to evaluate the driving ability of patients with multiple sclerosis," said Akinwuntan. "We believe that not all of these tests are necessary." The study hopes to determine which three to five tests are most likely to give an accurate assessment in order to reduce cost, time and manpower.

    Drs. Gregory Lee, Lara Stepleman and Mitzi Williams are co-investigators on the study.

    The Driving Simulation Laboratory also has expanded services to accommodate other physically challenged drivers.

    Eighteen-year-old Todd Goldberg and his twin brother, Keith, who have hereditary spastic paraplegia, have been coming to the lab for several months to "drive" in preparation for their driver's licenses.

    The Lakeside High School seniors' limited lower-body strength necessitates hand controls when driving. Local driving schools' vehicles lack such equipment, so the twins call the MCG lab a perfect supplement to their father's adapted GMC Savana conversion van.

    "The first time I did the simulator I did pretty good, except for turning," Todd said. "After that, I've done really well. It's helped me with power and control. Because we have such strong upper-body strength, the slightest touch can send the car up to the highest speed. Now I'm more comfortable."

    Keith's first reaction to the simulator was a sense of familiarity from years of playing video games. That's not surprising, since driving simulators were developed from Atari games.

    "The differences between video games and this simulator are primarily the types of traffic events and the turn capability," Akinwuntan said. "The simulated traffic closely resembles typical real-life traffic situations in a city like Augusta, Ga. The turn capability of the simulator is limited in precision, but it turns up to 360 degrees and backs up."

    The brothers also had to get used to the difference between the simulator car, a 1991 Plymouth Acclaim, and actual street driving.

    "When you apply gas to go faster, our car has more vibration," Keith said. "Applying speed to it is different than in the simulator."

    Nevertheless, "what you learn in the simulator does translate to real driving," Akinwuntan said. "The simulated drive is programmed so that challenges will come just when the driver needs to attend and react to other traffic events on the road, forcing him to prioritize. Todd and Keith see real accident situations and learn how to react to them without panicking. They get feedback when they do the wrong thing without the consequence of damages."

    "This is a great learning tool, a real plus," said Peter Goldberg, the twins' father, who has the same condition as his sons and recently switched to hand controls for driving. "If we want to have people who are physically challenged in the working world and paying taxes, they need a way of getting there. If they want to get independent, then they have to learn to drive."

    Source; Medical News Today © 2010 MediLexicon International Ltd (06/09/10)

    Rhythmic auditory stimulation and walking in MS

    Rhythmic auditory stimulationA Home-Based Walking Program Using Rhythmic Auditory Stimulation Improves Gait Performance in Patients With Multiple Sclerosis: A Pilot Study

    Abstract

    Background. Few interventions have been successful in improving gait dysfunction in patients with multiple sclerosis (MS). Rhythmic auditory stimulation (RAS) has demonstrated positive results on gait performance in other neurologically impaired populations.

    Objective. To measure the effects of RAS on quantitative walking parameters in ambulatory patients with MS.

    Methods. Ten MS patients with gait disturbance were randomly assigned to receive RAS versus no intervention for 2 weeks. All participants received RAS for another 2 weeks. Between weekly clinic visits, they were provided with MP3 players containing songs whose tempo was 10% above the participant’s spontaneous cadence and were instructed to walk to the music 20 minutes daily. Quantitative gait parameters were measured using the GAITRite system.

    Results. A statistically significant decrease between groups was found for change in double-support time (left, P = .0176; right, P = .0247), whereas trends with medium to high effect sizes were found for other gait parameters, including walking speed. A pooled within-group analysis showed significant improvement of cadence, stride length, step length, velocity, and normalized velocity after 1 week of treatment. Satisfaction level with RAS was high.

    Conclusions. These results in a convenience sample of MS patients demonstrate the feasibility and safety of RAS when used at home and suggest a potential benefit on gait parameters.

    Conklyn D, Stough D, Novak E, Paczak S, Chemali K, Bethoux F., Neurorehabil Neural Repair. 2010 Jul 19.

    Source: Sage Journals Online © 2010 by American Society of Neurorehabilitation (06/08/10)

    Adaptive robot training for the treatment of incoordination in MS

    Robotic ManipulandumCerebellar symptoms are extremely disabling and are common in Multiple Sclerosis (MS) patients.

    In this feasibility study, we developed and tested a robot therapy protocol, aimed at the rehabilitation of incoordination in MS subjects.

    Methods: Eight subjects with clinically defined MS performed planar reaching movements while grasping the handle of a robotic manipulandum, which generated forces that either reduced (error-reducing, ER) or enhanced (error-enhancing, EE) the curvature of their movements, assessed at the beginning of each session.

    The protocol was designed to adapt to the individual subjects' impairments, as well as to improvements between sessions (if any). Each subject went through a total of eight training sessions.

    To compare the effect of the two variants of the training protocol (ER and EE), we used a cross-over design consisting into two blocks of sessions (four ER and four EE; 2 sessions/week), separated by a 2-week wash-outperiod. The order of application of ER and EE exercises was randomized across subjects.

    The primary outcome measure was the modification of the Nine Hole Peg Test (NHPT) score. Other clinical scales and movement kinematics were taken as secondary outcomes.

    Results: Most subjects revealed a preserved ability to adapt to the robot-generated forces.

    No significant differences were observed in EE and ER training. However over sessions, subjects exhibited an average 24 % decrease in their NHPT score.

    The other clinical scales showed small improvements for at least some of the subjects. After training, movements became smoother, and their curvature decreased significantly over sessions.

    Conclusions: The results point to an improved coordination over sessions, and suggest a potential benefit of a short-term, customized, and adaptive robot therapy for MS subjects.

    Author: Elena Vergaro Valentina Squeri Giampaolo Brichetto Maura CasadioPietro Morasso Claudio Solaro Vittorio Sanguineti

    Source: Journal of NeuroEngineering and Rehabilitation 2010, 7:37 & 7thSpace Interactive © 2010 7thSpace Interactive (30/07/10)

    Effects of whole body vibration on strength and functional mobility in MS

    Vibration TechnologyAbstract
    The aim of this study was to examine the effectiveness of regular whole body vibration (WBV) training on lower limb muscle strength and functional mobility in individuals with multiple sclerosis.

    A single subject experimental design was replicated on three subjects.

    Phases included a 4-week baseline phase without intervention, 6 weeks of twice weekly WBV intervention on a VibroGym apparatus, and a 4-week baseline phase without intervention.

    During all phases, strength of the ankle plantarflexors and knee extensors was assessed twice weekly with the Nicholas Manual Muscle tester and functional mobility with the Timed Up and Go test.

    All subjects improved significantly in plantarflexor strength (p<0.05).

    One subject improved significantly in knee extensor strength bilaterally and one subject in the weaker leg. Two subjects improved significantly in functional mobility.

    These improvements in strength and mobility were maintained in the final baseline phase.

    In conclusion, regular WBV training can improve lower limb strength and mobility in some individuals with multiple sclerosis. Individuals who do not perform any other exercise, are in a moderate stage of disease progression, and have a more intensive exercise protocol in conjunction with WBV seem to benefit most. However, further high-quality studies are needed.

    Wunderer K, Schabrun SM, Chipchase LS.

    School of Health Sciences (Physiotherapy), University of South Australia, Adelaide, South Australia.

    Source: Physiother Theory Pract. 2010 Aug;26(6):374-84. & Pubmed PMID: 20658923 (29/07/10)

    Functional electrical stimulation device improves dropped foot in people with MS

    Funtional Electrical StimulationAbstract

    Background: Dropped foot is a common problem following multiple sclerosis. Functional electrical stimulation can elicit an active muscle contraction providing dorsiflexion and eversion.

    Objective: To determine if the Odstock dropped foot stimulator (ODFS), improved Activities of Daily Living for people with multiple sclerosis.Method: 64 people with unilateral dropped foot due to secondary progressive multiple sclerosis took part in a randomized controlled trial. Research volunteers were assigned to a group using the ODFS or a group who received physiotherapy exercises for 18 weeks. Outcome measures were the Canadian Occupational Performance Measure (COPM) and a falls diary.

    Results: Results of 53 research volunteers are reported. Improvements in performance and satisfaction scores were greater in the ODFS group than the exercise group; (p < 0.05). Use of the ODFS was also perceived as effective in reducing tripping and increasing walking distance. The median number of falls were 5 in the ODFS group and 18 in the exercise group (p = 0.036) over the study period.

    Conclusion: The study shows that people with multiple sclerosis using the ODFS increased their COPM performance and satisfaction scores of their identified problems of Activities of Daily Living more than a matched group who received physiotherapy exercises. ODFS users also experienced fewer falls.

    Esnouf J, Taylor P, Mann G, Barrett C.

    The National Clinical FES Centre, Salisbury District Hospital, Salisbury, Wiltshire, UK.

    Source: Mult Scler. 2010 Jul 2. & Pubmed PMID: 20601398. (14/07/10)

    Enhanced functional electrical stimulation system could aid MS patients
    FESThe approximately 100,000 people in the UK who suffer with multiple sclerosis (MS) could benefit from improvements being made to a technology that eases mobility by electrically stimulating improperly functioning muscles and nerves.

    A functional electrical stimulation (FES) system generates electrical impulses from skin surface electrodes placed on targeted nerves and muscles. These mild electric shocks make muscles contract and joints move.

    One of the most common FES systems helps lift the foot of people who find it difficult or sometimes impossible to move their ankle and toes upward, a common result of a stroke or MS. These systems use a foot switch to detect when a patient’s foot strikes the ground and lifts off. The signal from this switch is monitored by an embedded microcontroller that activates an electrical stimulator connected to electrodes on the leg muscles. 

    Dr Jon Cobb from the School of Design Engineering and Computing at Bournemouth University believes these systems could be safer and more comfortable for patients by designing them with fewer wires. With the use of wireless communications he also sees the opportunity for including more sensors and stimulators, making the overall systems more adaptive.

    Cobb has begun an up to three-year development programme with Oddstock Medical Limited to produce new wireless FES systems capable of adjusting their level of stimulation depending on a patient’s changing situation.

    He explained these new systems would be able to detect when a patient suddenly begins walking up an incline or stairs. It could also tell when a patient becomes tired.

    Cobb said this will require incorporating sensing technologies for monitoring such changes and providing feedback to the FES controller.

    ‘The controller itself has to exhibit an intelligent control philosophy to deal with the inherent uncertainty associated with this type of application,’ he added.

    According to the National Clinical FES Centre, the concept of FES was first put forward in 1960 when a team led by Russian medical researcher Wladimir Theodore Liberson found that their electrical stimulation device could be used to treat a patient with a dropped foot due to an upper motor neurone lesion. Since then the technique has become a respected way of aiding patients who have incurred damage to their central nervous system as a result of a variety of cases including stroke, MS, spinal cord injury, head injury or cerebral palsy.

    Cobb said Bournemouth researchers and Oddstock Medical Limited will develop their new and improved FES systems over the next two to three years. This will be followed by a clinical evaluation before commercialisation.

    Source: The Engineer (c) Centaur Communications Ltd (03/06/10)

    Approval granted for multiple sclerosis device

    RebismartAn electronic injection device designed to provide greater ease and comfort to multiple sclerosis patients has been approved for use in Australia.  

    RebiSmart, the first electronic injection device to be developed for patients suffering with the disease, will be introduced this weekend at a meeting of specialist MS nurses in Sydney.  

    UK based MS nurse Janette Curliss will be attending the two-day event to discuss the new technology, which has been welcomed by patients in both the European Union and Canada where it was launched last year.

    “RebiSmart has improved treatment options for our patients in the UK as it is simpler to use, particularly for patients who have recently begun treatment injections. 

    “We’ve had some particularly pleasing success using RebiSmart with patients  who have been experiencing problems with other treatment injectors, or who have been delaying or avoiding treatment to manage their multiple sclerosis because of injections,” Ms Curliss said. 

    A similar size to a mobile phone, the electronic injector holds a week's worth of treatment and allows patients to monitor their dosage history through the device's handset.  

    Using an interactive screen the electronic injector guides patients through the three step process with text and pictures RebiSmart allows patients a new opportunity to personalise their injections by selecting their preferred needle speed, depth and timing.

    Source: Pharamcy News ©2010 Reed Business Information (29/04/10)

    Fifty percent of MS patients avoid treatment over injectable delivery fears
    Injectable MS Treatments
    Around half of all multiple sclerosis (MS) patients that are eligible for treatment do not receive it and one in five of those patients that do begin therapy, delay doing so because of fear and anxiety over the treatment process, and not fear and anxiety about the disease.

    These observations are according to Patricia Kennedy, a nurse practitioner and consultant at Can Do Multiple Sclerosis, formerly The Heuga Center for MS, US, who presented at the 2nd Vetter Drug Management Leadership Conference in Germany.

    “If the injectable therapies that we have available today are good for MS, good for patients, and good for the future, why aren’t patients taking them?” questioned Kennedy. “It is important for industry to be aware of MS patients’ reasons for avoiding treatment and what they go through when facing the disease,” she added. She then urged delivery-device manufacturers to consider patient behaviour and feelings when developing new devices in order to increase a patient’s chances of initiating therapy and complying with long-term treatment.

    According to Kennedy, healthcare professionals face a number of challenges when dealing with MS patients, with those who are eligible for therapy opting out of treatment for a number of reasons, including: lack of belief that it is needed; fear of needles; the constant reminder of the disease each time they need to inject; lack of family support; and the financial burden of treatment.

    “Even in those patients that do begin treatment, it’s another challenge to keep them on it,” admitted Kennedy. She also advised of the problems that US healthcare systems currently face with disposal of syringes and sharp objects; this is a particular problem in more populated regions in the US.

    Education of patients and their support networks is incredibly important to help with patient compliance and disease management. However, Kennedy also provided advice to industry on how new device development might help MS patients to manage and control their disease since injection-related issues are still a primary cause for patient’s fear of starting therapy and is the main reason for lack of compliance.

    What can industry do?
    “The easier we can make it for a patient to administer treatment, the more likely it is that the medication is going to be used,” explained Kennedy. “In most cases, the smaller the needle, the better. Although a 29-gauge needle might be easier to use than a 30-gauge needle, and although both are small, the patient will opt for the slimmer 30-gauge every time. Psychologically, that’s what they want,” she added.

    According to Kennedy, patients want titrated, prefilled syringes that are marked clearly. Not only does this avoid any issues of efficient mixing and incorrect dosing, but MS patients often have vision problems. Kennedy also emphasized the importance of travel devices, such as pens. “Patients want devices that are easy to travel with because we live in a mobile society, and if we provide the option of transporting less bulky injections devices whilst they’re away from home, patients are more likely to comply with their medication,” she advised.

    In general, Kennedy also believes that injection devices could help patients immensely. “Most patients like injectors; even if the needle is a 30-gauge needle, patient’s don’t want to see it. So if you can hide the injector, then that’s good. It’s psychological,” she said. Injection devices not only help overcome the psychological barrier to injections, but they are also easier to use than syringes, which is especially beneficial for those patients that suffer from tremors. In addition, they help patients to obtain a consistent depth of injection and thus reduce the number of injection-related side effects.

    “I also believe that needless devices would help improve patient compliance with drug therapy,” added Kenney.

    The bottom-line for patients, according to Kennedy, is to provide them with delivery devices that are easy to use, offer choice and flexibility, with increased comfort.

    “What patients really want, first of all, is control over their MS — easily-injectable systems can help with that. They want to be self-effective, they want a medication that’s easy to use because then they’re not reminded about their MS, and if they’re reminded less often then life goes on and they’re able to pursue other things.

    “So in the future, I would urge industry to continue to make injectable devices that are more patient-friendly. We need to work together to decrease the number of non-users; let’s raise that 50% to 75%,” she insisted. “I doubt we’ll ever make 100%, but we can lessen the impact of MS on a person’s life by giving them maximum control and letting them get on with their life. If we treat people early with the medications, we already have available to us today, and treatment is consistent and easy to administer, it gives them hope for the future,” she concluded.

    Source: Pharmatech.com © 2009 Advanstar Communications, Inc (20/11/09)

    Human neurological disorders may be treated by carbon nanotubes without metal catalysts

    Carbon NanotubesA latest research from Brown University has identified as to why carbon nanotubes are likely to obstruct a critical signaling pathway in neurons. Apparently it is not the tubes but the metal catalysts which are used in the tube formation. This discovery shows that human neurological disorders may apparently be treated by carbon nanotubes without metal catalysts.

    Carbon nanotubes may have many thrilling possibilities; few of them may be in the area of the human nervous system. The current research has shown that carbon nanotubes may aid in regrowing nerve tissue or ferry drugs which may be used to mend damaged neurons related to disorders like epilepsy, Parkinson’s disease and possibly even paralysis.

    Yet some researches may have illustrated that carbon nanotubes seem to hamper with a critical signaling transaction in neurons. Supposedly they have a suspicion on the tube’s significance in treating neurological disorders. Apparently no one knew as to why the tubes were supposedly causing an issue.

    But the team of the researchers at Brown University has discovered that the tubes, apparently are not to be blamed. The scientists report that the metal catalysts which are used to form the tubes are the offenders, and that minuscule quantity of one metal ‘yttrium’ could delay neuronal activity. Even though other probable biological effects still need to be analyzed, the findings mean that carbon nanotubes without metal catalysts may be able to treat human neurological disorders.

    Lorin Jakubek, a Ph.D. candidate in biomedical engineering and lead author of the paper commented “We can purify the nanotubes by removing the metals. So, it's a problem we can fix.”

    Jakubek apparently carried single-walled carbon nanotubes to the laboratory of Diane Lipscombe who is a Brown neuroscientist. The researchers zeroed in on ion channels which seemed to be placed at the end of neuron’s axons. These channels are known to be gateways of sorts which are supposedly motivated by changes in the voltage across neurons’ membranes. When an electrical signal called as an action potential, is activated in neurons, these ion channels ‘open’, each designed to take in a certain ion. One such ion channel passes only calcium, a protein that is critical for transmitter release and thus for neurons to apparently correspond with each other.

    The scientists discovered that nickel and yttrium, two metal catalysts which may be used to form the single-walled carbon nanotubes, could be interfering with the ion channel’s ability to absorb the calcium. This was found by the experiments using cloned calcium ion channels in embryonic kidney cells.

    As its ionic radius is almost alike to calcium’s, yttrium it was found in particular got stuck and prevented calcium from entering and passing through. It’s an ion pore blocker mentions Lipscombe, who specializes in neuronal ion channels and is a corresponding author on the paper.

    The experiments apparently demonstrated that yttrium in trace amounts may be less than 1 microgram per milliliter of water and may disturb normal calcium signaling in neurons and other electrically active cells, an amount which is far lower than what had been thought to be safe levels. With nickel, the quantity needed to obstruct calcium signaling was supposedly 300 times higher.

    Robert Hurt, professor of engineering and a corresponding author on the paper commented “Yttrium is so potent that a very low nanotube dose” would be needed to affect neuronal activity.”

    Jakubek believed that she was surprised the metals supposedly turned out to be the reason. Based on the literature, she thought it would be the nanotubes themselves.

    This research was published in Biomaterials

    Source: Health Jockey.com ©2006-2009 Health Jockey (07/09/09)

    Next generation of Multiple Sclerosis drugs may be based on whole new delivery design
    Geosphere drug delivery

    If you're of a certain age, you'll remember Buckminster Fuller's distinctive "geodesic domes" - soccer-ball-shaped structures that the late futurist envisioned as ideal human domiciles. Tel Aviv University chemists remember them too - and are now putting them to use in the treatment of multiple sclerosis (MS).

    In partnership with a group of Prof. Howard Weiner from Brigham and Women's Hospital at Harvard Medical School, Dr. Michael Gozin from TAU's School of Chemistry is attempting to create the next generation MS drug based on a delivery platform of "buckyballs," small soccer-ball-shaped molecules sometimes called fullerenes. Made from pure carbon, the buckyballs can function as invigorating antioxidants to keep neurons in the brain alive and kicking.

    There is currently no cure for MS.

    Buckyballs and related carbon nanotubes have enormous potential to be used in sensors and electronic applications allowing scientists to manufacture much more smaller and faster processors. These carbon-based materials have a huge range of possibilities in nanotechnology applications as well.

    Until now, buckyball-derived therapeutics have not been used in medicine. But the TAU and Harvard teams believe that they may resolve issues related to this nanomaterial development, and are seeking to commercialise their patented invention. If successful, the TAU-Harvard collaboration could provide new hope to millions of MS sufferers, and would make Bucky himself proud.

    On the Medicine Ball

    The TAU team is the first in the world to have synthesized a brain-targeted antioxidant to treat affected neurons in the brain. Pre-clinical trials, the researchers report, proved successful in animal models. They are also attempting to apply the same technology to the treatment of Alzheimers disease, but a reliable and effective treatment for MS is their primary goal.

    MS is an autoimmune disease that robs people of the ability to control their motor movements. No one knows exactly how many people are afflicted with MS. According to the National Institute of Neurological Disorders and Stroke, it is estimated that there are currently more than 350,000 people in the United States, who have been diagnosed with MS, where approximately 200 new cases are diagnosed each week. Current state-of-the-art therapies like the Israeli-invented Copaxone clearly help, but may not be enough, says Dr. Gozin, whose wide-ranging research has included work on classified projects for the U.S. Department of Defense.

    "Multiple sclerosis is a very serious clinical condition," says Dr. Gozin. "I had a dream, an idea for a new kind of drug." He took this idea to MS expert Prof. Howard Weiner at Harvard University, and the two began a collaboration.

    "I wanted to target with antioxidants specific receptors in the brain, which are involved in the disease progress, to stall the deterioration of motor function in MS sufferers," Dr. Gozin says. The US-Israeli researchers started from the belief that buckyballs, and brain-targeted moieties attached to them, may be able to achieve success in treating MS.

    A Dose of C60

    "We've created a molecule based on the C60 fullerene, a soccer-ball-shape, with great biomedical potential," says Dr. Gozin. The Tel Aviv University team, including graduate student Amnon Bar-Shir, was the first to synthesize and patent this application, which is "programmed" to target specific receptors in the brain. "We are presently working on the next generation of this type of molecules, containing less exotic and more natural building blocks," Dr. Gozin reports.


    Source: AZ Nanotechnology © 2009 by AZoM.com Pty.Ltd (20/03/09)

    A randomized trial to investigate the effects of functional electrical stimulation and therapeutic exercise on walking performance for people with MS
    Functional electrical stimulation

    Abstract

    Background

    (FES), is a means of producing a contraction in a paralyzed or weak muscle to enable function through electrical excitation of the innervating nerve.

    Objective

    This two-group randomized trial assessed the effects of single channel common peroneal nerve stimulation on objective aspects of gait relative to exercise therapy for people with secondary progressive multiple sclerosis (SPMS).

    Methods

    Forty-four people with a diagnosis of SPMS and unilateral dropped foot completed the trial. Twenty patients were randomly allocated to a group receiving FES and the remaining 24 to a group receiving a physiotherapy home exercise program for a period of 18 weeks.

    Results

    The exercise group showed a statistically significant increase in 10 m walking speed and distance walked in 3 min, relative to the FES group who showed no significant change in walking performance without stimulation. At each stage of the trial, the FES group performed to a significantly higher level with FES than without for the same outcome measures.

    Conclusion

    Exercise may provide a greater training effect on walking speed and endurance than FES for people with SPMS. FES may provide an orthotic benefit when outcome is measured using the same parameters. More research is required to investigate the combined therapeutic effects of FES and exercise for this patient group.

    Key Words: dropped foot, exercise, functional electrical stimulation, gait, multiple sclerosis, physiotherapy

    CL Barrett, GE Mann, PN Taylor*, and P Strike

    The National Clinical FES Centre, Department of Clinical Sciences and Biomedical Engineering, Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ, UK

    Source: Sage Publications © 2009 by SAGE Publications (17/03/09)

    NICE issues guidance on FES for dropped foot

    Functional Electrical Stimulation

    NICE (the National Institute for Health and Clinical Excellence) has issued guidance that says FES (functional electrical stimulation) is safe and can be considered for use in the NHS as a treatment for dropped foot.

    Dropped foot can occur when nerve messages to the leg are interrupted by damage to the brain or spinal cord. The foot or toes don't lift properly leading to problems walking and the risk of stumbling or falling. Existing treatments include physiotherapy or an ankle-foot splint.

    FES uses electrodes attached to the skin to trigger the nerves causing the foot to lift properly. Research supported by the MS Trust showed that using FES can help improve walking speed and confidence and reduce fatigue.

    The NICE guidance says that FES can be "offered routinely as a treatment option for people with drop foot caused by damage to the brain or spinal cord" if the doctor feels it is appropriate.

    Pam Macfarlane, Chief Executive of the MS Trust said, "We welcome NICE's guidance on the use of FES, although it is disappointing that they haven't referred more specifically to MS. We would really encourage anyone who thinks they may benefit, to talk to their health professionals as this guidance should ensure devices will be funded by the NHS where they are needed and therefore many more people with MS who experience dropped foot will be able to benefit from this treatment."

    Helen Yates, Chief Executive of the Multiple Sclerosis Resource Centre (MSRC) said, "We are delighted at NICE's positive guidance on the use of FES where the problem has arisen through brain or spinal cord damage. MSRC have fully supported the use of FES for people with dropped foot problems as a result of their MS.  The MS Trust's research confirmed what people with MS using the FES already knew, that this piece of equipment can prove immensely helpful in a number of ways."

    Source: Medical News Today © 2009 MediLexicon International Ltd and MSRC (30/01/09)

    High-tech Multiple Sclerosis treatment
    Bioness

    Walking up stairs is a big accomplishment now for Beth Hauserman. Six months ago, she ended up in the hospital.

    "I was 95 percent paralyzed on my right side, my face had dropped, couldn't move my arm, my hand, my leg," Beth said.

    The diagnosis was Multiple Sclerosis, a progressive disease that attacks the central nervous system. Her movement became very limited.

    "Probably half the time, I was in a wheel chair and would use a walker and people would have to move my leg and arm for me," Beth added.

    She has recovered somewhat but her leg needed help and thanks to a device called Bioness, she got it.

    "The first day I had it on, I was all smiles because I was able to lift my foot," Beth said.

    In M.S. patients, the brain and spinal cord are affected. Messages to control muscle movement can't be sent properly. Instead, with Bioness, electrical impulses are sent to the nerve which controls muscle movement.

    And it's all wireless.

    "The device that's strapped around her calf is what's stimulating the muscles in the leg, the device that fits into her shoe is actually a computer sensor that's able to detect how she's walking, how fast she's walking, the terrain," said Kristen Wilson, a therapist at Bryn Mawr Rehab Hospital where Beth goes for physical therapy.

    With a remote, Beth is able to control the intensity of the impulses.

    "I'm almost back to walking the way I was before," Beth said.

    She's able to walk a treadmill, something she says would never be possible without the help of Bioness.

    "I don't know if I'm ever going to get 100 percent back, but if this is it, I can deal with this," Beth said happily.

    Beth also started driving again, something she couldn't do six months ago. She is also a volunteer at Bryn Mawr Rehab Hospital, the place that helped her get back on her feet.

    The Bioness device Beth uses costs $6200, but is sometimes covered by insurance. The company also offers a rental program for patients. Bioness also has a device for hand rehabilitation.

    CBS Broadcasting Inc © MMIX, CBS Broadcasting Inc. (27/01/09)

    Eyes reveal health secrets of the brain

    Eyes

    The eyes may be the windows to the soul, but they also make pretty good peepholes into the brain. Thanks to an optical version of ultrasound, it is becoming possible to locate and monitor the growth of brain tumours, and to track neurodegenerative conditions like multiple sclerosis, Alzheimer's and Parkinson's disease - all by peering into the eye.

    The brain is connected to each eye by an optic nerve, so any degeneration of the brain caused by such diseases can also damage cells along the nerve and in the retina, says Helen Danesh-Meyer, an eye surgeon and neuro-ophthalmologist at the University of Auckland Medical School in New Zealand. Indeed, a loss of visual function is one of the first symptoms in many people with a neurodegenerative condition.

    Although evidence of a link between degeneration of the optic nerve and diseases such as Alzheimer's has been around since the late 1980s, without instruments capable of measuring the retinal changes accurately it is only recently that this knowledge could be put to use, says Danesh-Meyer.

    The accuracy of ophthalmological tools has greatly improved in the last few years. Developments include a type of laser-camera technique called Heidelberg retina tomography (HRT), and a laser device called GDx, both of which can be used to scan the shape and thickness of optical nerve fibres at the back of the eye.

    Both tools are now widely used to manage glaucoma, but in 2006 Danesh-Meyer became one of the first researchers to use them to study neurodegenerative diseases by looking at the region of the retina where ganglion cells meet to form the optic nerve - a region known as the optic nerve disc (OND). In a trial involving 40 Alzheimer's patients and 50 healthy volunteers, she was able to show that people with Alzheimer's had a distinctive enlargement to a cup-shaped part of their OND and a progressive thinning of the retinal nerve fibres within the disc.

    People with Alzheimer's have a distinctive shape to the disc of their optic nerve.

    Following this discovery, researchers have been using even more accurate instruments to track degenerative changes in the OND to monitor the progression of diseases like Alzheimer's, Parkinson's and MS. But it has been the emergence of optical coherence tomography (OCT) that appears most promising: it became commercially available in 2006 and is fast becoming a standard tool for the management of glaucoma and diabetic retinopathy. When applied to the OND, it produces highly detailed two and three-dimensional images of the subsurface retinal tissue, says Denise Valenti at Boston University, who has been using OCT to study Parkinson's and Alzheimer's.

    The technique works very much like ultrasound, but bounces light off the tissue instead of sound waves. One beam of light is fired at the tissue and another at a reference mirror. When the reflected beams have travelled an identical distance, interference will make their combined beam brighter than if the distances are different. So by reflecting one beam off of different layers of tissue, and moving the reference mirror until the combined reflected beam is brightest, the technique can measure the depths of each section of tissue and build up a detailed image of its structure. It has proved particularly useful in ophthalmology because the semi-transparent nature of retinal tissue makes it possible for OCT to penetrate to greater depths - up to several millimetres. When applied to the OND it can give information about both the shape and thickness of retinal nerve fibres, allowing even subtle changes to be tracked.

    Such changes can be used to monitor the progression of diseases non-invasively and relatively cheaply. Unlike MRI, which is expensive and can require patients to remain still for an hour or more, OCT is increasingly available in clinics and can be carried out in a few minutes. "It's extremely inexpensive compared to other tests," says Valenti.

    One possibility is to use OCT to monitor the effectiveness of treatments for neurodegenerative diseases, says Danesh-Meyer: "These drugs can have a lot of side effects, so if they are not having a benefit then you won't want to continue with them."

    Laura Balcer, a neurologist at the University of Pennsylvania School of Medicine in Philadelphia, has been using OCT on patients taking part in MS drug trials to try to establish if the system can accurately gauge drug efficacy. Such an objective tool would allow symptoms to be picked up that might otherwise go unreported, she says. "For example, OCT has already shown that even in people with MS whose eye function is normal, there are marked differences in OND shape and fibre thickness compared with healthy people. "MS researchers are very excited about OCT," she says.

    The technology is also proving its value as a tool for monitoring brain tumours, which can affect vision by pressing on the optic nerve. Such pressure will cause damage to different parts of the OND, depending on where in the brain the tumour is located, says Danesh-Meyer. What's more, the extent of the thinning of the nerve-disc fibre can also reveal whether vision will be restored upon removal of the tumour.

    In the case of one patient who was 24 weeks pregnant following several IVF attempts, OCT monitoring allowed surgeons to hold off on removing her brain tumour until well into the third trimester, when the fetus had a better chance of survival. The usual treatment would have been to operate immediately to prevent permanent vision loss, but this would have risked inducing premature labour. By monitoring the compression on the optic nerve to ensure it did not reach the point at which permanent damage was inevitable, Danesh-Meyer was able to keep tabs on the tumour's growth and delay the surgery. As a result, the baby was born safely and the patient kept her vision.

    The ultimate aim for many using OCT is to diagnose diseases before symptoms arise. The difficulty with this is that the thickness of retinal nerve fibres can vary from person to person, says Danesh-Meyer, so there is not always a clear baseline from which to compare patient scans.

    Eventually though, the low cost and simplicity of the technology may make it feasible for people to be given an OCT scan of each eye at a young age, to give doctors a record of their healthy retinal nerve, says Danesh-Meyer. With regular screening, some neurological conditions could be spotted incredibly early. "We're really just at the cusp of knowing where this is all going."

    Source: New Scientist Tech © Copyright Reed Business Information Ltd.(19/01/09)

    Virtual reality helps MS patients regain walking stability
    Gait Aid

    Studies performed over the last few years show many Multiple Sclerosis (MS) patients no longer have to live with a meandering or unsteady gait caused by their disease. According to a study published in the highly acclaimed medical journal "Neurology", closed-loop visual feedback helps MS patients improve their walking. Both stride length and walking speed improved dramatically helping MS patients walk safely.

    Better yet, a study published in the "Journal of Neurological Sciences" found that when closed-loop auditory feedback was combined with visual cues, MS patients showed even more improvement and confidence while walking.

    Based on concepts discovered while working on a NASA project helping helicopter pilots to safely navigate around tall objects, Professor Yoram Baram, CEO of Medigait LLC, created the GaitAid Virtual Walker. The Virtual Walker is a highly sophisticated device about the size of a cell phone paired with a set of high-tech eyeglasses. Professor Baram designed this device specifically to help patients with MS and other movement disorders regain their stability while walking.

    Medigait announces the re-introduction of the GaitAid Virtual Walker to the market after locating a reliable high quality US-based medical device company to build the device for them.

    The GaitAid Virtual Walker combines proven visual aids and audio feedback helping patients with MS and other movement disorders improve their stability while walking through a process called neuroplasticity. This process essentially rewires the patient's brain by creating new healthy circuits to bypass disease-damaged areas.

    The National Multiple Sclerosis Society estimates there are approximately 400,000 people in the United States with MS. World-wide about 2.5 million people suffer from MS.

    Because MS afflicts both the central and the peripheral nervous systems, not all MS patients show the same symptoms. However, a large percentage of MS patients exhibit loss of balance and muscle coordination affecting their ability to walk safely. Although a cure for MS hasn't been found, the GaitAid Virtual Walker offers a safe, effective, and non-pharmacological method of helping MS patients walk better leading to more productive and safer lives.

    Clinical studies have shown major improvements to walking speed and stride length in 70% to 85% of MS and other movement disorder patients. Some patients have been helped to the point of no longer needing the device except occasionally to maintain their improvement.

    Clinical studies appearing in medical journals, Neurology, Neural Processing Letters, and Journal of Neurological Sciences described the device as being effective but without the risk or possible adverse side effects caused by surgery and medication. Links to this information can be found at http://www.gaitaidmedical.net/studies.html

    "When I saw these positive results I was amazed, very excited, and gratified." -- Professor Yoram Baram Phd.

    "The results clearly indicate that the device helps patients with MS control their gait. The degree of improvement is proportional to the degree of impairment. The results support the potential role of the device as a rehabilitation modality in MS, and substantiate their specific implementation in efforts to alleviate, improve, and restore mobility in patients with gait disturbances due to neurological disorders in general." -- Ariel Miller, MD, Multiple Sclerosis Center, Carmel Medical Center and Rappaport Faculty of Medicine & Research Institute

    Source: MediGait LLC (03/11/08)

    Hope for those with Multiple Sclerois and other neurological diseases

    MS Brain

    Researchers are developing a technique that bypasses spinal injuries and nerve damage and allows patients to once again directly control movement through thought.

    They believe the breakthrough could lead in 10 years to a dramatic improvement in the quality of life of paraplegics allowing them to carry out simple tasks like holding coffee cups and eventually even helping them to walk again.

    The new "neuroprosthetic device" involves placing implants in the brain which are connected to a computer which in turn is connected to limb muscles.

    The results may have promising implications for millions of people around the world affected by spinal cord injuries and neurological diseases.

    "Potentially this could help people with spinal cord injuries to walk again, " said Chet Moritz who carried out the research with Eberhard Fetz.

    The team from the University of Washington have demonstrated that the new system works in monkeys whose arms were temporarily anaesthetised.

    In the study, published in Nature, the researchers trained a monkey to play a simple video game using its hand to twist a button on a control panel.

    Then they paralysed the monkeys arm by chemically blocking the nerve controlling it and attached the device.

    Soon the monkey was able to play the game again using the artificial link.

    It will be at least a decade before the system could be used in human patients, according to Dr. Fetz.

    "This study demonstrates a novel approach to restoring movement through neuroprosthetic devices, one that would link a person's brain to the activation of individual muscles in a paralyzed limb to produce natural control and movements," said Joseph Pancrazio, PhD, a program director at the National Institute of Neurological Disorders and Stroke which helped fund the research.
     
    Source: Telegraph.co.uk © Telegraph Media Group Limited 2008 (16/10/08)

    Multiple Sclerosis patients feel the benefits of vibration therapy trial
    Vibration Therapy

    A trial to determine the benefits of vibration therapy for Multiple Sclerosis sufferers is having an immediate impact on participants, one stating that she could feel her feet again, and another saying the treatment left her legs tingling and buzzing like they hadn't felt in years.

    Study supervisor Dr Steve Stannard says the trial was devised to see whether side-to-side alternating vibration therapy was able to assist MS sufferers, who often became unable to move their muscles normally due to damage caused in the central nervous system.

    “People with MS have a neural condition which means that their brain often can't generate enough neural input to have their muscles contract and move in a fully co-ordinated way,” Dr Stannard says. “The vibration stimulus is thought to cause a reflex contraction of muscle so in MS patients this might be therapeutic - it's a way of side-stepping the brain and making the muscles contract.”

    Early childhood lecturer Therese Trail is one of the study's first participants. Although she has been diagnosed with MS for nine years, she believes she has had it for much longer.

    “I look well but there's a lot of things I can no longer do,” she says. “I can't walk round the block but I do what I can at the gym.”

    She says that the therapy gives her  “a good shake”.

    “I do think that on the days I have the treatment I can walk a little better  - it makes my legs all tingly.”

    Rachael Mason is conducting the trial as her Masters of Science Exercise Physiology project.

    “We wanted to apply vibration therapy to a group who could benefit the most,” she says. “People with MS, because they can't use their muscles in a fully co-ordinated way, often don't get any physical activity. Some of the health problems they end up with are in fact related to the fact they are not exercising so there is real potential for these people.”

    Ms Mason says that after graduating from Massey with a Bachelors degree in medical laboratory science, she started a postgraduate diploma in exercise physiology when this project came to her attention.

    “It just appealed to me because this was a very relevant study for young women, it is a quite debilitating illness which often affects women in their early 20s.”

    Ms Mason is working with MidCentral Health rehabilitation specialist Dr Greg Denny. He is completing detailed medical assessments of participants, before the therapy to ascertain their physical ability level.

    “Dr Denny does a full medical screening and a neurological examination. The disability can be broken down into seven components and, from there people's function can be graded as either normal or with a particular degree of disability.” Ms Mason says. “We then do a series of functional tests before and after participation in the study so we can see whether vibration therapy has been beneficial.”

    Participants must meet strict criteria to ensure the trial is safe and appropriate for them. With the first sessions underway, detailed results are expected early next year.

    The research has received funding from the Palmerston North Hospital Medical Research Foundation and is being supported by the local Multiple Sclerosis Society, with therapy sessions taking place in its Carnation House centre. The vibration equipment has been supplied by Massey. Professor Elwyn Firth, a musco-skeletal researcher, and vibration therapy expert Darryl Cochrane, who is completing his PhD in vibration therapy, are also supervising the trial.

    Manawatu Multiple Sclerosis Society field officer Kristin Leslie says the society is looking at purchasing its own machine in order to make vibration therapy available for more members.

    “I think because there's no cure for MS anything that may benefit our members is good,” Mrs Leslie says. “Hopefully this trial will prove to be beneficial,, improving people's mobility and balance and leading to a better quality of life.

    “We would like our own machine so other people, especially people who are more disabled than current participants, can benefit.”

    Source:  Massey University ©  Massey University 1998-2008 (10/10/08)

    Nanoparticles to deliver treatments to injured brain and spinal cord cells developed

    Nanotechnology

    Purdue University researchers have developed a method of using nanoparticles to deliver treatments to injured brain and spinal cord cells.

    A team led by Richard Borgens of the School of Veterinary Medicine's Center for Paralysis Research and Welden School of Biomedical Engineering coated silica nanoparticles with a polymer to target and repair injured guinea pig spinal cords. That research is being published in the October edition of the journal Small.

    The team then used the coated nanoparticles to deliver both the polymer and hydralazine to cells with secondary damage from a naturally produced toxin. That research was published in August by the journal Nanomedicine.

    Borgens' group had previously shown benefits of the polymer polyethylene glycol, or PEG, to treat rats with brain injuries and dogs with spinal cord injuries. PEG specifically targets damaged cells and seals the injured area, reducing further damage. It also helps restore cell function, Borgens said.

    In previous studies, PEG was mixed with saline and injected.

    "Composition and concentration limited how much PEG we could get to the injury," he said.

    "If you change the composition to make the PEG more potent, it produces ethylene glycol, the poison in antifreeze. If you change the concentration of PEG in another way, the solution becomes syrupy and difficult to inject."

    So the team - which includes Youngnam Cho of the Center for Paralysis Research, Riyi Shi of the center and Weldon School, and Albena Ivanisevic of Weldon School and the Department of Chemistry - turned to silica nanoparticles.

    "These particles are so tiny they can't be seen with a regular microscope. They are about the size of a large virus. So you can inject as many as you need. And they are safe inside bodies," Borgens said.

    In the first study, the researchers coated the nanoparticles with PEG to treat guinea pig spinal cord injuries. The treated spinal cord cells showed improved physiological functioning.

    In the second study, the researchers added both PEG and hydralazine, an antihypertension drug, to mesoporous silica nanoparticles. These nanoparticles have pores that can hold the drug, which is later delivered to the damaged cells. The hydralazine was added to fight off secondary damage to cells that occurs after the initial injury.

    "When cells are injured, they produce natural toxins," Borgens said. "Acrolein is the most poisonous of these toxins. It's an industrial hazard for which hydralazine is an antidote."

    Borgens and his team introduced acrolein into cells and then treated the cells with different combinations of hydralazine and/or PEG delivered by the mesoporous silica nanoparticles.

    They found that the treatment restored disrupted cell function caused by acrolein.

    The team concluded that the use of nanoparticles to deliver both PEG and hydralazine increased the effectiveness of earlier PEG-only treatment by controlling and concentrating release of the drug and the polymer, producing a dual treatment and prolonging the treatment's duration.

    The goal of Borgens' research is to improve the quality of life of those who have suffered head or spinal cord injuries.

    "All ambulances should have PEG on board," he said. "It can probably save thousands of people from more severe head and spinal damage."

    Financial support for the studies came from the state of Indiana and an endowment from Mari Hulman George.

    The researchers now are testing the PEG/hydralazine treatment on rats with brain injuries. By the end of the year, they hope to test the treatment on naturally injured paraplegic dogs.

    Source: Medical News Today © 2008 MediLexicon International Ltd (02/10/08)

    Nanomachines with potential to help with Multiple Sclerosis

    Nonomachines

    A $1.2 million grant from the National Institutes of Health (NIH) will support research led by Rudy Diaz, an associate professor in the Department of Electrical Engineering, to develop neural nanomachines.

    The grant is through the NIH EUREKA program, which is designed to fund projects exploring new frontiers in biomedical research.

    EUREKA is an acronym for Exceptional, Unconventional Research Enabling Knowledge Acceleration.

    Diaz, who also works in Arizona State University’s Center for Nanophotonics, will team with professors Thomas Moore and Hao Yan in the Department of Chemistry and Biochemistry to focus on assembling nanomachines designed to deliver electrical signals to neurons in the human body.

    Such technology promises to provide new types of bio-sensing and delivery devices that could be used to detect and treat a variety of human neurological disorders.

    The team’s goal is to gain new insights into the pathological obstruction of neural signals and the development of new and more precise neural-stimulation technology.

    With existing technology, viewing the “microscopic dynamics” of what is occurring in the human body at a cellular level “is like observing human activity on Earth from an orbiting satellite,” Diaz says.

    Even with the development of laser tweezers and nanoelectrodes, “most of our cellular bio-chemistry knowledge is still extracted from circumstantial evidence,” Diaz says.

    The method Diaz’s team proposes would permit “direct interaction with cells at the local level.” That would be achieved with a nanoscale structure that could be injected into the body, targeted to attach itself to certain clusters of cells and then controlled by chemical reactions triggered by light delivered either through the skin or via microscopic optical fibers.

    The team will molecularly assemble a nanodevice that is best described as a remotely powered and remotely controlled pacemaker.

    It will be built on a DNA chassis that includes antennas for receiving power and commands from the outside world, and batteries to store and deliver that power.

    The antennas are built of Noble metal nanospheres that take advantage of the plasmon resonance to amplify and focus light with nanometer precision.

    Artificial electrocytes – electric organ cells that work like batteries, such as those that naturally occur in fish such as electric eels – will be constructed from liposomes (fat cells) that will have ion pumps and ion gate molecules incorporated into their lipid membranes.

    The whole structure will have to be encapsulated in a DNA “cage” to prevent the components from being short-circuited by the body’s fluids.

    Under the correct wavelength of light, the power-receiving antennae would amplify the light to drive the electric charging of the artificial electrocyte.
    The structure would include a set of plasmonic antennae.

    These are microscopic metal nanostructures that behave as antennae in the presence of photons (light) the way metal antennas behave in the presence of radio waves.

    The antennas would be tuned to a different wavelength and coupled to the ion gates in the membranes to serve as light-activated switches to perform a “gate-opening” process that triggers the discharge of the artificial electrocyte chain, thus delivering an electrical impulse that can stimulate neurons.

    The research team hopes to prove the functionality of each component independently and to demonstrate that the entire assembly works as designed.

    These nanostructures could lead to advanced neuro-imaging sensors operating at the cellular scale. Such nanosensors delivered to their targets by chemical tags, or during surgical intervention, could reveal new details about the transmission of neural signals and of their pathological interruption.

    The light-powered artificial electrocyte could become a critical tool for improving microsurgery, and advancing the understanding of cellular biology.

    “Once you have such capabilities, it has the potential for application in deep brain stimulation, the treatment of brain damage, or such things as multiple sclerosis and Parkinson’s disease,” Diaz said.

    Source: Ira A. Fulton School of Engineering, Arizona State University (24.09/08)

    Gadofluorine M enhancement allows more sensitive detection of inflammatory CNS lesions than T2-w imaging: a quantitative MRI study

    MS MRI

    Magnetic resonance imaging plays a pivotal role in the diagnosis and treatment monitoring of multiple sclerosis.

    Currently available magnetic resonance-techniques only partly reflect the extent of tissue inflammation and damage.

    In the present study, application of the experimental magnetic resonance-contrast agent Gadofluorine M significantly increased the sensitivity of lesion detection in myelin-oligodendrocyte glycoprotein-induced experimental autoimmune encephalomyelitis, an animal model for multiple sclerosis.

    Gadofluorine M-enhancement on T(1)-weighted (T(1)-w) images utilizing a clinical 1.5 T magnetic resonance unit showed numerous lesions in optic nerve, spinal cord and brain, the majority of which were not detectable on standard T(2)-weighted (T(2)-w) and Gd-DTPA enhanced T(1)-w sequences.

    Quantitative assessment by pixel counts revealed highly significant differences in sensitivity in favour of Gadofluorine M. Gadofluorine uptake closely corresponded to inflammation and demyelination on tissue sections.

    These unique features of Gadofluorine M in visualizing inflammatory CNS lesions hold promise for future clinical development in multiple sclerosis.

    Source: Pubmed PMID: 18669504 (10/09/08)

    Reproducibility of optical coherence tomography in Multiple Sclerosis

    Optical coherence tomography

    Background  Optical coherence tomography (OCT) is a promising new method of quantifying axon thickness in the retinal nerve fiber layer (RNFL) that has been used predominantly by ophthalmologists to monitor glaucoma. Optical coherence tomography is being considered as a potential outcome measure in multiple sclerosis (MS) clinical trials, but no data exist on the reproducibility of this technique in MS centers.

    Objective  To determine the reproducibility of OCT measurement of mean RNFL thickness in the undilated eyes of healthy control subjects and patients with MS.

    Design  Prospective analysis of 4 healthy controls to determine interrater, intrarater, and longitudinal reproducibility. Cross-sectional analysis of 3 cohorts of patients with MS (n = 396) and healthy controls (n = 153).

    Setting  Multiple sclerosis clinics at 3 academic medical centers.

    Patients or Other Participants  Healthy controls and patients with MS.

    Main Outcome Measure  Thickness of RNFL.

    Results  We found excellent agreement with respect to interrater (intraclass correlation [ICC], 0.89), intrarater (ICC, 0.98), and intervisit (ICC, 0.91) results. Mean RNFL thickness did not vary significantly among research centers for patients with MS (93, 92, and 90 µm) or among healthy controls (103, 105, and 104 µm) by site.

    Conclusions  We demonstrate that mean RNFL thickness can be reproducibly measured by trained technicians in an MS center using the OCT-3 model. The RNFL measures from cohorts of age-matched controls and patients with MS from 3 different research centers were remarkably similar.

    Deanna Cettomai, BS; Mathew Pulicken, MBBS, MHS; Eliza Gordon-Lipkin, BS; Amber Salter, MPH; Teresa C. Frohman, BA; Amy Conger, BA; Xiao Zhang, PhD; Gary Cutter, PhD; Laura J. Balcer, MD, MSCE; Elliot M. Frohman, MD, PhD; Peter A. Calabresi, MD


    Source: Arch Neurol. 2008;65(9):1218-1222. (09/09/08)

    Device restores mobility after multiple sclerosis nerve damage

    Innovative Neurotronics Logo

    Michaelene Needham, has multiple sclerosis and relied on a cane and then a walker for years. Now the mother of three is finding new mobility and energy for her busy life.

    Needham, like other people with upper motor neuron injuries including stroke, spinal cord injury and cerebral palsy, can now walk with greater ease using the Walk-Aide System. The WalkAide is an orthotic device made by Innovative Neurotronics that helps people with foot drop, a condition that inhibits a person's ability to raise the front part of the foot.

    Approved by the U.S. Food and Drug Administration in 2006, the WalkAide uses advanced sensor technology to analyze the movement of the leg and foot. The system sends electrical signals to the peroneal nerve, which controls movement in the ankle and foot. Gentle electrical impulses activate the muscles to raise the foot at the appropriate time during the step cycle.

    The device, which is the size of a pager and fits just below the knee, includes a control unit, a flexible cuff and two electrodes. It must be prescribed by a doctor and, in Illinois, fitted by a licensed orthotist who has completed the WalkAide training program.

    "This is the biggest breakthrough in orthotics in 25 years," said Michael Oros, president of Scheck & Siress, the Chicago-based orthotic and prosthetic company that fitted Needham for the WalkAide. Patients with foot drop typically have used a plastic brace that fits inside their shoe and holds the foot at a 90-degree angle. "But with the WalkAide, the patient's own musculature pulls the foot up. It's a powerful feedback mechanism for patients. The WalkAide allows the patient to use their own muscles that in many cases have been dormant for 10 to 12 years."

    In addition to improving the patient's gait, the WalkAide increases mobility and independence, increases range of motion, reduces atrophy and improves circulation, said Oros, a board-certified prosthetist and orthotist.

    Needham, who was diagnosed with MS in 1991, started using a cane in 2004 and switched to a walker last September after she fell in her home. "That's when I started deteriorating," she said. "I couldn't walk far. I hung on to the walker and my legs dragged behind me. Because of the dragging, I was fatiguing. I could barely get through the grocery store."

    She was fit for the WalkAide in April after her doctor determined she was a candidate. Those eligible for the device must not wear a pacemaker, nor can they have a history of seizures, have a metal implant in or around the lower extremity or be pregnant. In addition, patients need an intact peroneal nerve for the device to work. People with progressive diseases such as MS may use it indefinitely, Oros said.

    "I keep it on all day, from 7 a.m. to 10 p.m.," said Needham. She uses the walker when walking long distances too. "I'm so excited about being able to do more. I'm building muscles and getting my strength back. My posture is better. ... It's finding all these muscles that didn't work for a while.

    "When I'd go to the grocery store I had to sit in the car and rest before going home, where I'd lie down again. Now I come home and I'm able to go to my next errand."

    Although the youngest person Scheck & Siress has fitted for the device is a teenager, Oros said children with cerebral palsy could benefit from the device. "Their gait is improved, they have better balance and they improve walking speed over time."

    The WalkAide costs around $5,000 for one foot and is currently not covered by insurance, according to Mary Ann Schultz, spokeswoman for Blue Cross and Blue Shield of Illinois, the state's largest insurer. The device gets a thumbs-up from Dr. Dusan Stefoski, professor of neurology and director of the Multiple Sclerosis Center at Rush University Medical Center. "I am astonished by the WalkAide," he said. "I've been in the field of MS since the late '70s and what I see is quite beautiful from a functional point of view."

    Source: Chicago Tribune © 2008, Chicago Tribune (26/08/08)

    New MRI contrast medium enables early diagnosis in animal model of Multiple Sclerosis

    MS Brain

    In an animal model of multiple sclerosis (MS), neuroradiologists and neurologists of the University hospitals of Heidelberg and Würzburg have been able to visualize inflammatory tissue damage, most of which had remained unrecognized up to now, with the aid of a new contrast medium, Gadofluorine M, in magnetic resonance imaging. The scientists have published their results in the online edition of the renowned medical journal Brain.

    In particular at the early stage of the disease, drug treatment is effective. Up to now, however, an early diagnosis is frequently not established with certainty, especially if no (or very few) inflammatory lesions are present on MRI. “With this new contrast medium, we were able to visualize five to ten times more foci of inflammation in comparison to conventional MRI images and contrast media”, reports Professor Dr. Martin Bendszus, Medical Director of the Department of Neuroradiology at the University hospital of Heidelberg.

    Previously unrecognized patches of demyelination visible in MRI

    MS is a chronic inflammatory disease of the central nervous system of unknown cause. It usually begins in young adults, and women are affected more frequently. In Germany, ap-proximately 120,000 patients are afflicted. MS is characterized by multiple inflammatory lesions in which nerve fibers lose their myelin sheath. These patches of demyelination cause neurological malfunctions that may regress upon remyelination. At later stages, MS may result in a loss of nerve fibers, leading to irreversible damage and persistent neurological symptoms. MRI plays a crucial role in the early diagnosis of MS and monitoring of the disease.

    The scientists from Heidelberg and Würzburg examined brains and spinal cords of animals at different stages of the disease with the new contrast medium and found significantly more inflammatory lesions than with conventional contrast media. Examinations of tissue sections from these lesions showed that these were actually foci of inflammation. The application of this new contrast medium was clearly superior to conventional contrast media, especially for the spinal cord or optical nerve, nerve regions that are particularly difficult to examine on MRI.

    New contrast medium accumulates better in MS lesions

    The results of the study could help dramatically improve the diagnostic work-up in MS with a potential impact on early treatment. “MS is the most frequent cause of occupational disability and handicap in young adults”, explains Professor Bendszus. “New therapies have a positive influence on the course of the disease, but are often not initiated at early stages since the diagnosis of MS is not yet established. ”

    The new contrast medium gadofluorine M supposedly visualizes MS lesions better because it binds especially well to certain components of the extracellular matrix of inflammatory foci. Because of this, it accumulates in these lesions in higher concentrations.

    Now, the next objective of the interdisciplinary working group is to further develop the new MRI contrast medium for application in clinical practice. As of now, the contrast medium is not yet approved. Additional preclinical tests are necessary for the planned clinical application.

    Source: Breakthrough Digest (04/08/08) 

    Israeli team developing Multiple Sclerosis drug revolution
    Could multiple sclerosis patients be spared the needle? A team from the Hebrew University of Jerusalem thinks it's possible. The team, headed by Prof. Elka Touitou, has developed a way to transmit medications to the brain through the nose. This breakthrough could change the way drugs to treat MS, an incurable disease, are administered, addressing a potential market worth $6 billion a year.

    The team, including doctoral student Shaher Duchi and Prof. Haim Ovadia, will be presenting their nasal drug delivery method at the Biomed Israel Conference 2008 this week. Touitou says the carrier they developed contains particles mere hundreds of nanometers in size that are found in biological membranes. These particles open a path for the drug to penetrate the nasal mucous membranes, whence they reach the brain.

    She sees Copaxone, the multiple sclerosis drug made by Teva Pharmaceutical Industries, as also potentially being administered using their nanoparticulate carriers.

    Today, multiple sclerosis drugs are delivered by injection. Efforts to develop oral versions have so far not gone well.

    Aside from sparing patients a jab, nasal delivery could also expedite the drug's effect, which could be a huge advantage in delivery of drugs such as painkillers, sleep agents, and medications to treat serious diseases, such as Parkinson's, that impair functioning.

    Moreover, all the substances used in making the nasal carriers have already been approved by the United States Food and Drug Administration, which should expedite the process of gaining approval for the nanoparticulate delivery system itself.

    Touitou also claimed that delivering Copaxone in combination with another drug - though she refused to say which - resulted in neuron growth in the brain. No such effect has been achieved by any of the drugs currently sold for MS.

    Source: Haaretz.com © Copyright 2008 Haaretz. (27/05/08)

    Possible new oral drug delivery system for Multiple Sclerosis Drugs

    Diabetics and multiple sclerosis patients could take their medicine via a capsule or a tablet instead of enduring multiple injections, because of a new development by a UT professor.

    Biomedical engineering professor Nikolaos Peppas and other researchers created a gel-like material that could coat a capsule that would deliver protein-based medicine, such as insulin.

    Diabetics, who usually inject themselves with insulin two to three times per day, could swallow a gel-coated capsule that would release insulin in their upper small intestine and allow it to enter the bloodstream. The gel will allow the insulin to withstand harsh acidic conditions in the stomach and travel to its final destination.

    "The capsules are like boats," Peppas said. "The particles in the capsules have anchors, and in the small intestine they are freed and they stick to the upper small intestine. They are stuck like little crabs, and they start to release insulin."

    Peppas said multiple sclerosis patients must have weekly intramuscular shots, and many cannot administer their own injections because they will faint. He also said that after the injections, the patients feel weak and dizzy and experience pain in their bones for up to a day and a half.

    "Being in a bed in pain, crying is not a solution to me," Peppas said. "Living with continuous worry is not a good life."

    Peppas said the new drug delivery method is more convenient and more comfortable for patients.

    "Nobody likes injections," he said. "The patients will like and accept the drug delivery system. It will improve their quality of life."

    Chemical engineering professor Keith Johnston, who specializes in pharmaceutical nanotechnology and protein-drug delivery, said the capsules are challenging to develop, but patients will prefer to take their medicine using the new drug technology.

    "It does have the potential to allow an alternative to using needles for an injection," Johnston said. "Patients would find it very attractive overall."

    The scientists have run tests on animals and cells, and they are in the process of licensing their technology so they can perform clinical studies and file the drug with the Food and Drug Administration.

    "No one has reported anything like this," Peppas said. "It's revolutionizing the field of protein delivery."

    Source: The Daily Texan (c) 2006 The Daily Texan and Texas Student Media (01/05/08)

    Eye test peers into heat-related multiple sclerosis symptoms
    A bodysuit that heats or cools a patient, combined with painless measurements of eye movements, is providing multiple sclerosis researchers at UT Southwestern Medical Center with a new tool to study the mysterious link between body temperature and severity of MS symptoms.

    The researchers studied an aspect of MS called Uhthoff’s phenomenon, named for the German ophthalmologist who reported in 1889 that some people have temporary vision problems after exercise or in hot weather. This and other symptoms of MS, such as fatigue or problems with coordination, worsen in the heat for most people with the disease.

    Although doctors and researchers have long known about Uhthoff’s phenomenon, there has been no way to objectively measure its severity or how it is related to body temperature.

    The UT Southwestern study, available online and appearing in the March 25 edition of the journal Neurology, demonstrated that as body temperature rises, the severity of an eye-movement disorder called INO, or internuclear ophthalmoparesis, also increases. When a person with INO looks rapidly from one object to another, one eye moves more slowly than the other. Normally, the eyes move at the same speed.

    INO can serve as an easy-to-measure “canary in a coal mine,” acting as a surrogate for other heat-related symptoms that are harder to measure, such as fatigue, mental confusion or bladder or bowel problems, said Dr. Elliot Frohman, professor of neurology and ophthalmology, director of the Multiple Sclerosis Program and Multiple Sclerosis Clinical Center at UT Southwestern and senior author of the study.

    The researchers’ tools were a whole-body suit, riddled with tubes for circulation of water, that can change body temperature; a pill-like thermometer that measures core body temperature after being swallowed; and an infrared camera that painlessly tracks eye movements.

    The study, conducted at UT Southwestern, included eight patients with MS who have INO, eight with MS but not INO, and eight healthy control subjects. Warm water in the body garment raised each subject’s normal temperature by one-half of a degree Celsius, and the cool water brought it down by one-half of a degree.

    The subjects also wore a lightweight device, fitted on a headband, that used infrared light to track their eye movements as they followed a random sequence of blinking lights.

    In the subjects with INO, increasing the body temperature worsened the differences between their two eyes’ relative motion. Conversely, cooling the body made the eyes synchronize better.

    Monitoring INO in a clinical setting could provide a sensitive test to determine a patient’s susceptibility to other heat-related MS symptoms, as well as a way to monitor the effectiveness of treatments, Dr. Frohman said.

    “With this new technique, we can objectively test new therapies that specifically treat a host of MS-related symptoms,” said Dr. Frohman.

    The next step in the research, Dr. Frohman said, is to use this system to measure the effectiveness of a drug that appears to relieve heat-induced symptoms in people with MS.

    “We’ve shown that by this method we can model the principal mechanisms that cause certain symptoms to worsen in people with MS,” he said

    Source: Huliq.com © 2008 Hareyan Publishing LLC (22/03/08)

    Multimodal evoked potentials to assess the evolution of multiple sclerosis: a longitudinal study

    Background:
    Evoked potentials are used in the functional assessment of sensory and motor pathways. Their usefulness in monitoring the evolution of multiple sclerosis has not been fully clarified.

    Objective:
    The aim of this longitudinal study was to examine the usefulness of multimodal evoked potential in predicting paraclinical (abnormal)outcomes of disease severity and as a prognostic marker in multiple sclerosis.

    Methods:
    Eighty four patients with clinically definite multiple sclerosis underwent Expanded Disability Status Scale (EDSS) and functional system scoring at study entry and after a mean (standard deviation) follow-up of 30.5 (11.7) months. Sensory and motor evoked potentials were obtained in all patients at study entry and at follow-up in 64 of them, and quantified according to a conventional score.

    Results:
    Cross-sectionally, the severity of each evoked potential score significantly correlated with the corresponding functional system for all but follow-up visual evoked potential and with EDSS for all but brain stem evoked potential. EDSS significantly correlated with global evoked potential score severity (baseline R = 0.60, follow-up R = 0.46, p<0.001). Using longitudinal analysis, only changes in somatosensory (perception of sensory stimuli) evoked potential scores were significantly correlated with changes of sensory functional system (R = 0.34, p = 0.006).

    However, patients with multiple sclerosis with disability progression at follow-up had more severe baseline evoked potential scores than patients who remained stable. Patients with severe baseline global evoked potential score (higher than the median value) had a risk of 72.5% to progress on disability at follow-up, whereas patients with multiple sclerosis with lower scores had a risk of only 36.3%.

    Conclusions:
    These results suggest that evoked potential is a good marker of the severity of nervous damage in multiple sclerosis and may have a predictive value regarding the evolution of disability.

    Source: Journal of Neurology, Neurosurgery & Psychiatry (20/03/08)

    Device helps Multiple Sclerosis patients' brains relearn how to walk
    Multiple sclerosis can be a devastating diagnosis, robbing patients of their ability to walk, among other things, but a new device is helping patients get back on their feet. It's called the Walk Aide.

    Photos of Vicki Olt, 57, show her hiking, biking, and running along the beach -- activities that virtually came to a halt several years ago.

    “My left side became somewhat paralyzed. That's the only way I can describe it,” said Olt.

    Olt was diagnosed with MS in 1987, but it wasn't until about seven years ago that her symptoms worsened.

    “I remember walking in the door just kind of thinking that's not my mom. She had changed so dramatically in about four months,” said Jessica Epstein, Olt’s daughter.

    Olt now suffers from a condition called "foot drop," making it difficult to walk.

    “You just can't lift your foot. Your first leg can take the step, but the second leg to follow it can't do it,” said Olt.

    A couple of weeks ago, she starting using the Walk Aide device, worn just below the knee.

    “Everything is self-contained in this one device. Once it's been programmed, it functions on a tilt sensor, so that the tilt of the lower limb and space tells the device when to turn on and off at the appropriate time,” said Denise Gouge, a rehab specialist with Innovative Neurotronics, the company that manufactures the Walk Aide.

    “There's little electrodes that sit inside this cuff that send signals to the nerve to lift the foot, and once that happens, it sends a signal back up to the brain and it kind of recreates that circuit so that the brain will, in essence, start to rewire,” said Gouge.

    “It was amazing because you could feel your toe come up,” said Olt. With the help of her Walk Aide, Olt can now walk again.

    The Walk Aide is designed for patients who suffer from "foot drop" due to conditions such as multiple sclerosis, stroke, cerebral palsy or a traumatic brain injury.

    It costs about $4,500.

    Source: KVUE Television © 2008 KVUE Television, Inc. (22/02/08)

    Brain in a Box: Woman With Multiple Sclerosis Shows Improvement
    Three years ago Debbie Gomez-Trost was living her dream, watching her triplets grow up and enjoying her new home.

    "Everything was golden," Gomez-Trost said. "We had kids we always wanted, the house we always wanted. Everything we wanted and then one day, somebody turned the switch off."

    That's when she received a devastating  diagnosis — she had multiple sclerosis, a progressive disease of the nervous system that disrupts communication between the brain and body. It can lead to loss of movement and paralysis, and there is no cure.

    "I was only 40 years old, my kids were 7, they were in first grade," she said. "Your whole life changes."

    Gomez-Trost worried most about her family. "I was afraid I wouldn't see them grow up," she said.

    As the disease progressed, everyday activities like walking up the stairs or chasing after her kids became more and more difficult and exhausting. Gomez-Trost had to give up the hobbies she once enjoyed and was pained by an uncomfortable brace she had to wear to help her paralyzed right leg.

    Struggling to walk, she experienced a condition called foot drop, where she could no longer flex her ankle and walk normally.

    "The fatigue was the thing I had to fight," she said. "It's very frustrating."

    She's a 'Ball of Fire Now'

    Then in the summer 2006, Gomez-Trost received a glimmer of hope in the form of a new device called the WalkAide that helps with footdrop.

    "It sends a stimulation to the appropriate nerve to help them pick up the foot to give them a normal gait pattern when they walk," said Brian Karban, an orthotist at Hanger Prosthetics and Orthotics.

    The device, about the size of an iPod, is strapped around the calf, and a gentle electric signal is sent from the device to the leg, telling the foot to lift and lower.

    The WalkAide helped regenerate communication between Gomez-Trost's brain and her foot.

    "When I first put it on all I could say was awesome, awesome," she said.

    Without the WalkAide, Gomez-Trost limped along with the help of a cane. Using the device, she is able to climb stairs with no visible limp.

    "With the WalkAide I was able to decrease the fatigue that my body was feeling," Gomez-Trost said. "When you have footdrop, inside your head you're having a conversation. You're telling your leg and foot, up down up down. So the WalkAide is kind of like a brain in a box. I don't have to think about it it's a naturally occurring event."

    Best of all, she can now keep up with her kids.

    "They're 9, I can't run foot for foot with them, but I can do the stairs really easy now," she said. "We go for walks again. I'm able to walk down the street again."

    Her husband, Bob Trost, said that the improvement has been monumental.

    "It's changed our whole family's life," Trost said. "I got my wife back. She's able to be with the kids. She's a ball of fire now, she's always on the go."

    Though Gomez-Trost still sometimes uses a cane, the WalkAide has made her more comfortable and boosted her confidence.

    "It's really changed my life a lot," she said. "Life-altering events really don't happen that much, and it happened to me."

    Source: ABC News Copyright © 2007 ABCNews Internet Ventures (30/01/08)

    New Device Helps People Walk

    Emily Bowers, 33, has been suffering from Multiple Sclerosis for more than 10 years.

    "To have a disease that's this debilitating is really hard on your personal life," she said. "It really does take the quality of your life away from you."

    For the last year, she has had to use some sort of walking aide to get around. She said without her cane, she'd fall to the floor with every step she takes.

    Bowers is like thousands of people suffering from neurological and muscular disorders, reported CBS station KTVT in Dallas.

    But a revolutionary new device at Presbyterian Hospital of Plano is helping people who have problems walking. It's called the Bioness L-300.

    The device comes in three parts: a foot sensor worn inside the shoe and two electrodes attached to the patient's leg. The device is completely customizable and is different for each person who uses it.

    Presbyterian Hospital of Plano is one of the first hospitals in the world to use the device.

    "I have people coming from three hours away just to come experience this technology," said Angela Williams, Bowers' rehabilitation specialist.

    "She put them on me and basically I was able to walk like a normal person," Bowers explained. "I could walk without my cane."

    However, as soon as she turned them off, her steps were slowed and painful.

    The device costs about $59,000 per leg, and Bowers said her insurance company refuses to pay for the devices.

    "I feel like I was given this gift of a miracle of walking again, and it was just ripped out from my hands," she said.

    Bowers filed an appeal with her insurance company and hopes to have the devices soon.

    Source: CBS Broadcasting Inc. © MMVII, All Rights Reserved.(28/12/07)

    Earlier Multiple Sclerosis Diagnosis May Be Possible Through New Detection Method
    German scientists at the Rheinische Friedrich-Wilhelms-Universitaet in Bonn, Germany, may have discovered a method for the early diagnosis of multiple sclerosis (MS). This would allow for patient treatment to begin earlier than through conventional diagnostic methods. Early treatment is crucial to delay the more debilitating phases of this non-curable disease as long as possible.

    MS is nowadays often categorised as an autoimmune disease, where the body's own immune system attacks the nervous system. However, the exact cause of the disease is still undetermined. The chronic and inflammatory disease affects the central nervous system. The symptoms can be debilitating. They range from sensual and visual problems to muscle weakness, speech impairment and impaired mobility. The symptoms can occur gradually, but more often in phases. Between phases some of the symptoms may even disappear. However, usually the neurological problems remain permanently. While MS is not curable, there are several treatment methods available to slow down the progression of the disease

    The German researchers used magnetic resonance spectroscopy (MRS) for their diagnostic quest. This allowed them to detect biochemical changes in the metabolites of the brain. The MS attack on the central nervous system begins with the gradual degeneration of the myelin sheath, which is a fatty layer around the neurons. The neurons carry information signals from the brain to the rest of the body. Without the fatty layer the neurons get damaged and begin to misfire the electric signal. The neurons can even die off due to a chronic inflammatory process that causes the molecules in the brain to shift. One of the substances that can change is N-Acetyl-Aspartat (tNAA). Healthy neurons contain a great amount of tNAA. However, damaged neurons show a significant loss of this particular substance. The tNAA-concentration can be measured through magnetic resonance spectroscopy (MRS).

    For the purpose of their study, the German Scientists tested 25 patients, who had some neurological problems that could indicate MS, but could also be symptoms of a variety of inflammatory diseases that affect the central nervous system, or even symptoms of stroke. Such symptoms can be sudden vision problems, loss of feeling, or even paralysis. Those symptoms may stay or can disappear. However, with conventional methods it is extremely difficult to diagnose with certainty the presence of MS. For the control group, the scientists chose 20 healthy people.

    The scientists measured the tNAA level of all 45 participants in the study. Six months after the measurement was taken, the scientists evaluated the patients to see, whether they had developed further MS symptoms. This was the case for nine patients. The tNAA measurements showed that the tNAA levels for these nine patients at the beginning of the study was about 13% lower compared to the levels of the control group. The remaining sixteen patients also showed lower tNAA levels at the beginning of the study, but only by about 6% compared to the control group.

    The scientists concluded a greatly reduced level of tNAA-concentration might be a good indicator that a patient is at high risk of developing further MS symptoms within a short time frame after the first symptoms occurred. To develop more symptoms within six months of the first symptoms indicate a fast progression of the disease. When the first symptoms occur, conventional methods are insufficient to diagnose MS. Especially for the patients with a fast progression of the disease, crucial treatment time is lost. The tNAA-concentration could be a signal to start treatment earlier than usual and to hopefully stop the fast progression of the disease.

    The German scientists indicate that other values had also changed in the MS-patients, which could further lead to MRS as a valuable detection tool for MS.

    Source: Associated Content © 2007 Associated Content Inc. (21/11/07)

    Accessible Technology Can Help People with Multiple Sclerosis, but Too Few Use It
    Research shows accessible technology can offer people with MS a wider range of life choices, yet relatively few are using accessible technologies that could help them overcome many of the visual, dexterity, mobility and cognitive challenges brought on by the disease.

    New research released this week shows that technology plays a vital role in helping many people with multiple sclerosis (MS) manage and live with their disease, yet relatively few are using accessible technologies that could help them overcome many of the visual, dexterity, mobility and cognitive challenges brought on by MS.

    The research study, titled Staying Connected: An Investigation of How Technology Affects People Living with MS, was commissioned by the MS Technology Collaborative, an alliance that includes Microsoft, the National Multiple Sclerosis Society (NMSS), and Bayer HealthCare Pharmaceuticals. StrategyOne, an applied-research consulting firm, conducted a telephone and online survey of 2,390 American adults with MS.

    According to the research study—the most comprehensive examination ever of how people with MS use technology in their personal and professional lives—70 percent of respondents say they are interested in using and keeping up with the latest technology, and nearly half agreed that technology plays a vital role in helping them live with MS. People with more severe types of MS, or those whose symptoms are more pronounced, place an even higher value on using technology to help them cope with their disease.

    Yet, despite the strong interest and belief in technology among people with MS, few actually use accessible technology to help mitigate their symptoms and make everyday tasks easier. The study found that while people with MS have heard of accessible technology, they need better information about how accessible technology can specifically help them address their MS symptoms. Thirty-three percent of those surveyed say they have trouble typing on a standard computer keyboard, for example, but only 5 percent say they have turned to technology for a solution, such as using an alternative keyboard or a voice recognition program. Similarly, 30 percent say they have trouble reading text on a standard screen, but only 6 percent have made adjustments to their computer settings, such as increasing font sizes or using screen magnifiers.

    MS is an unpredictable neurological disease that affects approximately 400,000 people in the United States, with a new case diagnosed every hour. Symptoms may include  fatigue, vision problems, tingling or numbness, poor balance, loss of coordination, trouble walking, or memory lapses. Yet, each case of MS is different: symptoms can be permanent or may come and go without warning. While there is no cure for MS, early treatment can help slow its progression, and technology can make it easier for many people with MS to stay employed, live more independently, and enjoy a broader range of life choices.

    “At Microsoft, we are dedicated to creating technology that adjusts to individuals’ needs as they change over the course of a day, a year, a lifespan – including those with MS or any other type of condition,” says Rob Sinclair, director of the Accessibility Business Unit at Microsoft. “We believe that technology will help people with MS maximize their abilities, even as those abilities change.”

    Source: Bink.nu Copyright © 1999-2007 Steven Bink and Ryan Hoffman. (26/10/07)

    Simple eye scan opens window to multiple sclerosis
    A five-minute eye exam might prove to be an inexpensive and effective way to gauge and track the debilitating neurological disease multiple sclerosis, potentially complementing costly magnetic resonance imaging to detect brain shrinkage - a characteristic of the diseases progression.

    A Johns Hopkins-based study of a group of 40 multiple sclerosis (MS) patients used a process called optical coherence tomography (OCT) to scan the layers of nerve fibers of the retina in the back of the eye, which become the optic nerve. The process, which uses a desktop machine similar to a slit-lamp, is simple and painless. The retinal nerve fiber layer is the one part of the brain where nerve cells are not covered with the fat and protein sheathing called myelin, making this assessment specific for nerve damage as opposed to brain MRI changes, which reflect an array of different types of tissue processes in the brain.

    Results of the scans were calibrated using accepted norms for retinal fiber thickness and then in comparison to an MRI of each of the patients brains - also calibrated using accepted norms. Experimenters found a correlation coefficient of 0.46, after accounting for age differences. Correlation coefficients represent how closely two variables are related -- in this case MRI of the brain and OComputerized axial tomography scans. Correlation coefficients range from -1 (a perfect opposing correlation) through 0 (no correlation) to +1 (a perfect positive correlation). In a subset of patients with relapsing remitting MS, the most common form of the disease, the correlation coefficient jumped to 0.69, suggesting an even stronger association between the retinal measurement and brain atrophy.

    This is an encouraging result, says Johns Hopkins neurologist Peter Calabresi, M.D., lead author of the study, which appears in the October 2007 issue of Neurology. MRI is an imperfect tool that measures the result of a number of types of tissue loss rather than specifically nerve damage itself. With OCT we can see exactly how healthy these nerves are, potentially in advance of other symptoms.

    In addition, says Calabresi, OComputerized axial tomography scans take roughly one-tenth as long and cost one-tenth as much as the MRI, which means they are faster and cheaper to use in studies that track the effectiveness of new therapys for MS.

    Approximately 400,000 people in the United States have MS, marked by an abnormal immune system that attacks and kills a persons own brain cells. As these neurons die, the volume of the brain decreases. MRI of the brain, which can measure total volume, has long been the primary tool used to monitor MS. But MRI, aside from being expensive and uncomfortable, is often misleading since brain inflammation - also a symptom of the disease - can skew brain volume readings. Also, the brain begins shrinking relatively late in the progression of the disease, so MRI isnt as good at detecting the disease in its early stages when therapys are most effective. OComputerized axial tomography scans look directly at the thickness, and therefore health, of the optic nerve, which is affected early on in the disease, often before the patient suffers permanent brain damage.

    Calabresi added that a number of of the disabilities suffered by MS patients - numbness, tingling, visual impairment, fatigue, weakness and bladder function disturbance - are the result of nerve cell degeneration, so a test that specifically measures nerve cell health is potentially the clearest picture of the status of the disease.

    He cautions that optic nerve damage can point to many diseases and is not a unique diagnostic tool for MS. However, he says, it certainly sends up a flag suggesting that MS might be present. And since optic nerve damage is one of the first recognizable symptoms of MS, doctors have a chance to identify the disease potentially before the patient suffers the physical limitations generally linked to its advanced stages.

    Treatments for MS cannot reverse the damage but they can arrest it, so the earlier we get someone on medicine the quicker we can stop the disease from causing more harm, says Calabresi. This tool may be useful as an outcome measure in MS clinical trials to assess the efficacy of neuroprotective drugs.

    In the study, scientists recruited 40 patients from the Johns Hopkins MS clinic. Twenty had relapsing remitting MS, 15 had secondary progressive MS, and five had primary progressive MS. Scientists also recruited 15 healthy control patients free from ophthalmological or neurological disease as a comparison group.

    Calabresi says his next step will be to look at changes in the fiber layer thickness in 100 patients over a period of three years.

    Source: MedicineWorld.org (16/10/07)

    Gamma knife thalamotomy for multiple sclerosis tremor
    Abstract

    Background

    Some patients with MS suffer from disabling tremor. Improvement with medical treatment is modest, at best. Stereotactic surgery targeting the vim nucleus of the thalamus has been successful in alleviating MS tremor. Gamma knife radiosurgery represents a minimally invasive alternative to radiofrequency lesioning and DBS that can provide improvement in patients suffering from essential and parkinsonian tremor. We reviewed our experience with GK thalamotomy in the management of six consecutive patients suffering from disabling MS tremor.

    Methods

    The median age at the time of radiosurgery was 46 years (range, 31 to 57 years). Intention tremor had been present for a median of three years (range 8 months to 12 years). One 4-mm isocenter was used to deliver a median maximum dose of 140 Gy (range, 130-150 Gy) to the vim nucleus of the thalamus opposite the side of the most disabling tremor. Clinical outcome was assessed using the Fahn-Tolosa-Marin scale.

    Results

    The median follow-up was 27.5 months (range, 5-46 months). All patients experienced improvement in tremor after a median latency period of 2.5 months. More improvement was noted in tremor amplitude than in writing and drawing ability. In four patients, the tremor reduction led to functional improvement. One patient suffered from transient contralateral hemiparesis, which resolved after brief corticosteroid administration. No other complication was seen.

    Conclusion

    Gamma knife radiosurgical thalamotomy is effective as a minimally invasive alternative to stereotactic surgery for the palliative treatment of disabling MS tremor.

    Source: Science Direct Copyright © 2007 Elsevier B.V. All rights reserved. (29/09/07)

    New imaging technique allows doctors to 'see' molecular activity
     On the left hand side of the brain you can see a red netlike structure showing the accumulation of the new agent on specific molecules within inflamed blood vessels. By contrast, the normal side of the brain shows no such effect. If this can be transferred to human use, diagnosis and treatment could start much earlier. Credit: University of Oxford.

    A new technique that will enable doctors to ‘see’ things happening at the molecular level using standard imaging techniques has been developed by Oxford scientists. The technique has initially been directed towards multiple sclerosis, but long-term it has the potential to be used for a vast range of health problems. The findings are published by Nature Medicine on Monday 24 September.

    Dr Robin Choudhury and colleagues at the University of Oxford have developed a marker that attaches itself to particular molecules involved in inflammation. As a result, these molecules ‘light up’ on MRI scans.

    The ‘VCAM-1’ molecule plays a key role in inflammation, which contributes to many diseases, including multiple sclerosis, arthritis, inflammatory bowel disease and atherosclerosis (a hardening and narrowing of the arteries which can lead to heart attack and stroke).

    By injecting into the body markers that attach themselves to VCAM-1 molecules, and which are visible under MRI scanning, the researchers were able to see on a scan exactly where the molecules were in operation, and in what quantities. The ultimate goal is to facilitate earlier diagnosis, guide treatment and provide more precise monitoring of disease progression.

    The team has developed the technique with a view to using it in multiple sclerosis (MS), an autoimmune disease that affects the central nervous system. In MS the body’s own immune system, through inflammation, attacks the fatty tissue surrounding nerve fibres ( myelin), which helps nerves carry signals, leading to a range of problems with vision and movement.

    Compared to conventional MRI techniques, the new technique has the potential to reveal disease activity much earlier and, crucially, before tissue destruction has occurred. Earlier intervention with drug treatments guided by this information may alter disease progression.

    'Ordinarily, by the time lesions are visible, damage is already done,’ says Dr Choudhury. ‘Therefore molecular imaging techniques to accelerate diagnosis are urgently needed, and we think that this approach shows great potential.’

    The work has been carried out so far in mice, but the researchers are optimistic that the technique could translate to humans.

    ‘In the last few years our knowledge about the cellular and molecular basis of diseases, including MS, has expanded vastly, but we haven’t yet matched these with accompanying advances in imaging,’ says Dr Choudhury. ‘The new technique helps to address that issue.

    ‘The ultimate goal of this line of work is to develop tools than can accelerate diagnosis, guide specific therapies and monitor response to treatment. In the paper, we make a case as to how this could be applied to multiple sclerosis, but in fact this is a platform technology that, in theory, could be adapted for diagnosis in other brain diseases, cancer and coronary artery disease.’

    Source: University of Oxford

    Kingfisher Healthcare Launches Breakthrough Product in Europe
    Kingfisher Healthcare (KFH) announces the launch of KFH Energy, a product to alleviate fatigue and pain, two common problems associated with chronic diseases such as post polio syndrome, fibromyalgia and multiple sclerosis. KFH Energy is a patented, high-tech medical device for home use.

    The KFH Energy utilises Bio-Electric Stimulation Therapy (BEST) to deliver extremely low currents to the body. BEST works by enhancing the physiological processes at cellular level, documented effects include:

    - an increase in ATP production, the molecule that delivers energy to all cells in the body

    - increased synthesis of proteins, the building blocks of the body

    The founder and CEO of KFH, Dr Henk Snyman, said: "We are very proud to introduce such a superior and safe solution to the many people suffering from fatigue, pain and lack of stamina. We are dedicated to continuing research and are exploring further applications in ongoing clinical trials."

    The 1st clinical trial showed excellent results in post polio patients, and KFH has decided to support further research into the puzzling deterioration that many polio patients experience later in life. Dr Snyman indicated: "We are therefore very pleased to announce the creation of an annual Marianne Liefers Post polio Research Award, to the value of CAD$5.000. An independent panel will decide each year which project to support, and it is also recognition of the tireless and dedicated way in which Mrs Liefers - one of the first patient to be treated - has helped us to discover the positive effects that KFH Energy can have in the lives of people who had polio as children."

    Source: Kingfisher Healthcare (19/09/07)

    New MRI finding sheds light on multiple sclerosis disease progression
    Using magnetic resonance (MR) images of the brain, researchers have identified a new abnormality related to disease progression and disability in patients with multiple sclerosis (MS), according to a study published in the August issue of Radiology.

    “Based on these findings, physicians may be able to diagnose multiple sclerosis more accurately and identify patients at risk for developing progressive disease,” said the study’s lead author, Rohit Bakshi, M.D., associate professor of neurology and radiology at Harvard Medical School and director of clinical MS-MRI at Brigham and Women’s Hospital and Partners MS Center in Boston.

    MS is a chronic, autoimmune disease characterised by the destruction of myelin, the protective layers that surround nerve cells. It can affect numerous body functions, and symptoms may include visual and speech impairment, memory loss, depression, muscle weakness, loss of coordination, numbness, pain, bowel and bladder problems and sexual dysfunction.

    MS affects approximately 400,000 people in the United States and as many as 2.5 million worldwide, mostly women between the ages of 20 and 50, according to the National Multiple Sclerosis Society.

    There are four classifications of MS, but the two most common types are relapsing-remitting and secondary-progressive. Patients with relapsing-remitting MS will experience symptom flare-ups followed by periods of no disease progression. Patients with secondary- progressive MS exhibit an initial period of relapsing-remitting MS, followed by steady disease progression.

    Dr. Bakshi and colleagues retrospectively reviewed the T1 MRI data of 145 MS patients, including 112 women and 33 men. Ninety-two patients had relapsing-remitting MS, and 49 patients had secondary-progressive MS. The disease classification was unknown in four patients.

    The researchers found that T1-weighted MR images of the brains of MS patients often depict bright areas called hyperintense lesions, also known as areas of “T1 shortening,” and set out to determine if there was a relationship between the frequency and location of these lesions and disease progression, brain atrophy and disability in patients with MS.

    The analysis uncovered 340 T1 hyperintense lesions in 123 patients. Lesions were more likely to be present in patients with secondary-progressive MS. In addition, 71 percent of patients with secondary-progressive MS had multiple T1 hyperintense lesions, compared with 46 percent of relapsing-remitting MS patients.

    The total number of T1 hyperintense lesions was closely correlated with physical disability, disease progression and brain atrophy.

    “The findings suggest that T1 hyperintense lesions commonly occur in patients with MS and that the presence of multiple lesions indicates a risk for an advancing disease course,” Dr. Bakshi said. “These results further emphasize the importance of MR neuroimaging in the diagnosis and management of neurologic disorders such as MS.”

    Radiology is a monthly scientific journal devoted to clinical radiology and allied sciences. The journal is edited by Anthony V. Proto, M.D., School of Medicine, Virginia Commonwealth University, Richmond, Va. Radiology is owned and published by the Radiological Society of North America, Inc.

    The Radiological Society of North America (RSNA) is an association of more than 40,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. The Society is based in Oak Brook, Ill.

    “Multiple Sclerosis: Hyperintense Lesions in the Brain on Nonenhanced T1-weighted MR Images Evidenced as Areas of T1 Shortening.” Collaborating on this paper with Dr. Bakshi were Vallabh Janardhan, M.D., and Sonu Suri, M.D.

    Source: Generef.com © 2007 SpaceRef Interactive Inc. All rights reserved. (28/08/07)

    Brain test could help make earlier diagnoses
    A University of Minnesota scientist has discovered a way to detect Alzheimer's disease, schizophrenia and other brain disorders by using a device that tracks magnetic signals in the brain.

    Although the research is still in its early stages, it could lead to a relatively quick and painless test for a wide range of conditions that affect the brain, experts say.

    The scientist, Dr. Apostolos Georgopoulos, calls it an "elegantly simple test" that has been surprisingly accurate so far in assessing nearly 300 patients and healthy volunteers.

    He and his research team used a technology known as MEG (magnetoencephalography) at the VA Medical Center in Minneapolis to study people's brains as they stared at a point of light for 45 to 60 seconds.

    In a study published Wednesday, they found that they were able to identify six types of disorders "with 100 percent accuracy."

    They included patients with Alzheimer's, chronic alcoholism, schizophrenia, multiple sclerosis, Sjogren's syndrome (an autoimmune disease) and facial pain.

    What they found, Georgopoulos said, is that each disease affects the brain differently, and alters the way brain cells communicate with one another.

    There are no such tests for most brain diseases, which can be difficult and time-consuming to diagnose. They're usually identified over time by observing behavior, such as memory loss in Alzheimer's patients, and other external symptoms.

    Georgopoulos, a regents professor of neuroscience known internationally for his work on how the brain affects movement, said even he was surprised by the apparent accuracy of the test. "It's just too good to be true," he said in an interview. But the results have continued to hold up, he said, even after they concluded the initial study, which involved 142 patients.

    "We're approaching our 300th subject," he said, "and it looks better and better."

    A tool for tracking treatments?

    If it pans out, the new test could be used to diagnose brain disorders earlier, monitor their progress and track the effectiveness of new drugs and treatments.

    "I think it has that potential," said Georgopoulos, who also heads the Brain Sciences Center at the VA hospital.

    Tim Denison, a senior engineer who specialises in brain devices at Medtronic Inc., agrees. "I believe that if it works out how he's described it in the paper ... it could definitely help identify [diseases] much earlier and with greater precision," he said.

    At the same time, he and other scientists agree that more research is needed to prove its value.

    "This certainly is an innovative technique," said Dr. John Richert, executive vice president for research at the National MS [multiple sclerosis] Society in New York. But "it's not yet clear how helpful this technique will be as a diagnostic tool."

    He noted that there were only four MS patients in the study, and they appeared to have advanced disease. He wonders if the test could identify patients at earlier stages, when it's tougher to diagnose. "We need to know a lot more about this study and what it's detecting before we will know how useful it will be," he said.

    Currently, there are only several hundred MEG devices in the world, used mostly for research, Georgopoulos said. But that could change, he said, if the tests prove as effective as they seem.

    Georgopoulos developed a method for analysing the results, and holds a patent for it that he shares with the university and the VA. They have licensed that technology to a startup company, Orasi Medical Inc., in Edina.

    His research team plans to study the technique with other disorders, such as depression, autism, fetal alcohol syndrome, Parkinson's disease and post-traumatic stress disorder.

    The MEG device at the VA hospital cost about $2 million, including the specially built room that houses it on the fourth floor. Because of its powerful magnetic force, it must be sealed in a vault-like space.

    No risk to patients

    For patients, though, there is no risk of radiation or other dangerous exposure, Georgopoulos said. They lie on a gurney as a helmet covers the top of the head. By tracking tiny magnetic fields produced by electrical activity in the brain, the superfast device can monitor the way the brain cells communicate with one another. After only a minute, it has tens of thousands of bits of data, which can be analyzed by computer for distinct patterns.

    Georgopoulos said he got the idea after testing the device on 10 healthy volunteers and was struck by how identical their brain patterns were. When he tried the test on chronic alcoholics, who had agreed to be volunteers, the results were distinctly different.

    Eventually, he tested it on volunteers with six separate conditions, and found that each group had its own distinct pattern.

    Wednesday's study was published online by the British Journal of Neural Engineering.

    Source MSNBC © 2007 Microsoft (27/08/07)

    MRI criteria for multiple sclerosis in patients presenting with clinically isolated syndromes: a multicentre retrospective study
    Background

    The 2001 and 2005 McDonald criteria allow MRI evidence for dissemination in space (DIS) and dissemination in time (DIT) to be used to diagnose multiple sclerosis in patients who present with clinically isolated syndromes (CIS). In 2006, new criteria were proposed in which DIS requires at least one T2 lesion in at least two of four locations (juxtacortical, periventricular, infratentorial, and spinal-cord) and DIT requires a new T2 lesion on a follow-up scan. We applied all three criteria in a large cohort of CIS patients to assess their performance by use of conversion to clinically definite multiple sclerosis (CDMS) as the outcome.

    Methods

    Patients who had two MRI scans within 12 months of CIS onset were identified in four centres in the Magnims European research network. The specificity and sensitivity of MRI criteria for CDMS after 3 years was assessed in 208 patients. A Cox proportional hazards model was applied in a larger cohort of 282 patients that included all patients irrespective of length of follow-up.

    Findings

    The specificity of all criteria for CDMS was high (2001 McDonald, 91%; 2005 McDonald, 88%; new, 87%). Sensitivity of the new (72%) and 2005 McDonald (60%) criteria were higher than the 2001 McDonald criteria (47%). The Cox proportional hazards model showed a higher conversion risk for all three criteria in those with both DIS and DIT than those with either DIS or DIT alone. When all three criteria were included in the model, only the new criteria had an independent significant effect on conversion risk.

    Interpretation

    The new criteria are simpler than the McDonald criteria without compromising specificity and accuracy. The presence of both DIS and DIT from two MRI scans has a higher specificity and risk for CDMS than either DIS or DIT alone.

    Source: The Lancet Neurology Volume 6, Issue 8, August 2007, Pages 677-686 Copyright © 2007 Elsevier Ltd All rights reserved. (13/08/07)

    Optical coherence tomography in optic neuritis and multiple sclerosis: a review
    Abstract:

    Optical coherence tomography (OCT) is a new noninvasive high-resolution method that measures the retinal nerve fibre layer (RNFL) thickness. An overview of the use in optic neuritis (ON) and multiple sclerosis (MS) is presented. Literature survey of PubMed was carried out. RNFL thickness in eyes of healthy control subjects was 102.9-111.11μm, in eyes affected by ON 59.79-85μm, and in fellow eyes 82.73-99.8μm.

    All studies found a significant reduction in RNFL in eyes affected by ON compared with fellow eyes and eyes of healthy controls. Two out of three studies found a significant reduction in RNFL in fellow eyes compared with control eyes. RNFL thickness correlated with visual acuity, visual field, low-contrast letter acuity, contrast sensitivity, and colour vision.

    Correlations were also found with the optic nerve area evaluated by magnetic resonance imaging, neurologic impairment score, and increasing disease duration. One of two studies found a significant correlation with amplitudes of visual evoked potentials, neither correlated with latencies. OCT is a promising new tool for evaluating atrophy in patients with ON and MS.

    Source: European Journal of Neurology, Volume 14, Number 8, August 2007 , pp. 841-849(9) (02/08/07)

    New System Helps Experts See You Swallow

    Enjoying our breakfast, lunch and dinner wouldn't be possible without swallowing, and sometimes there's a problem with a person's swallow. It can actually makes eating dangerous. A new piece of equipment at St. Francis Health Center is helping experts get a good look at the problem.

    Most of us take it for granted- we chew and swallow, and it's on to the next tasty bite. But when there's a swallowing problem, food or liquid can go down the wrong pipe and lead to serious problems like choking or pneumonia.

    St. Francis Speech Pathologist Alisha Delgado says swallowing problems are common among the weak and elderly, people with Parkinson's, Multiple Sclerosis, and even open heart surgery patients. When someone suspects a problem, she now has a new way to look at it.

    It's called the Fiberoptic Endoscopic Evaluation of Swallow. Delgado says, "It allows us to evaluate the swallow in a different way than it's traditionally been done for several years, which is a video swallow."

    Delgado says the video swallow offers a lateral view, while the new FEES system offers a birds eye view. She numbs the inside of the patient's nose and then passes a scope through the nose and down into the throat. Then the patients takes drinks of water and bites of food coloured with blue dye. If anything misses the esophagus and gets into the airway, Delgado can see it.

    She says the nice thing about FEES is, there's no radiation like with the video swallow study, so it's acutally safer for the patient and anyone else in the room.

    "We're able to have the families and caregivers more involved, so we can explain as we're doing this, what we're seeing, and it helps the family members and the patient understand what the issues are and why we need to adjust their diet," says Delgado.

    So hopefully a good view of the problem will lead to a dinner free of danger.

    Delgado says another benefit of the FEES is because there's no radiation, there's no rush to get the study done, making it great for patients who fatique easily and need to go at a slower pace.

    Source: WIBW.co Gray Television Group, Inc. - Copyright © 2002-2007 (30/07/07)

    Markov model predicts short-term disability in multiple sclerosis
    The findings published in the June 12th issue of Neurology support the novel use of a Markov transitional model in predicting the short-term disability in patients with multiple sclerosis (MS).

    The standard statistical methods of survival analysis used to create clinical predictive models do not include the ongoing changing nature of MS, Dr. H. L. Weiner, of Harvard Medical School, Boston, and colleagues point out.

    However, "Markov transitional models incorporate the fluctuating nature of chronic diseases through the analysis of discrete states of progression and make use of all clinical information."

    In the current study, the authors developed covariate-specific short-term disability curves to predict the likelihood of disease progression using the Expanded Disability Status Scale (EDSS) at semiannual visits. They prospectively collected EDSS scores for 218 MS patients with relapsing-remitting disease or clinically isolated syndrome.

    The investigators applied their longitudinal data to a Markov transitional model and the patients' previous history of disability was used to predict subsequent short-term disability measured by EDSS. Once the model was fit, a probability matrix was generated for each subject based on specific clinical and MRI covariates.

    The researchers found that patients in the lowest baseline brain parenchymal fraction quartile and those in highest T2 lesion volume quartile experienced progression according to EDSS.

    In patients with a six-month EDSS of two, the probability of progressing to a sustained EDSS of three within three years was 0.277 for those with a low brain parenchymal fraction and a high T2 lesion volume.

    Whereas, the corresponding probability was 0.055 for patients with a high brain parenchymal fraction and a low T2 lesion volume.

    "Now that we have established this new method, we can further assess its value in the progressive stage of MS and its ability to evaluate the influence of additional covariates such as specific treatments, relapses, new MRI metrics, as well as immunologic and genetic markers on subsequent disability," Dr. Weiner's team concludes.

    Source: Medicexchange.com Copyright © 2007 Medicexchange PLC. All Rights Reserved. (22/06/07)

    MS Society Responds To Daily Mail Article On MS
    The Daily Mail carried an article headlined, "Goggles to help MS patients walk again", featuring claims that special goggles which use sound and visual effects can help 86% of people with MS to walk faster and take longer steps.

    Evidence for this comes from two very small studies and improvements in walking speed and stride length were slight. Few conclusions can be drawn from these studies at this early stage.

    Some previous research has indicated that sound and visual feedback can benefit people with MS, and using these together may be helpful to stabilise movement, but more research is needed before firm conclusions about the benefit or otherwise of these goggles can be drawn.

    Source: MS Society (16/05/07)

    Goggles to help MS patients walk again
    Goggles that play tricks on the brain are being used to help disabled patients walk.

    The high-tech spectacles have been developed for patients with Parkinson's disease and multiple sclerosis.

    They work by sending messages to the brain that help to get limbs moving smoothly again.

    Patients affected by these two incurable illnesses often suffer spasms where the body suddenly freezes.

    This happens when nerves in the muscles fail to send a signal back to the brain telling it whether the muscles are being used correctly.

    Many patients report that constant "freezing" in public is not just embarrassing but frightening, too.

    These spasms are unpredictable, which can make it dangerous if, for instance, the patient suffers one while crossing the road.

    In Parkinson's, spasms occur because of a shortage of a chemical transmitter, called dopamine, in the brain.

    MS patients are affected by them because the immune system attacks nerves in the brain.

    The goggles, developed by scientists at the Technion Institute in Israel, are already being used to help patients in Israel and the U.S.

    For years, doctors have known that patients affected by these spasms often start moving again when the brain is given a signal or a cue.

    This might be something simple, like placing a small object in front of the patient, so the brain is prompted to send a new signal to the muscles.

    The high-tech goggles make use of this, displaying an image of a tiled black-and-white floor in front of the patient's eyes.

    As the patient steps forward, a mobile phone-sized device clipped on to their belt transmits the tiled floor image through a wire to the corner of each eyepiece.

    The floor appears to move towards them as their body advances.

    This provides a continuous "prompt" for the brain to overcome frozen limbs.

    At the same time, two earphones connected to the device play a clicking sound every time the patient takes a step.

    When the patient is taking smooth, regular steps they hear a pleasant, rhythmic pulse.

    When they start to wobble or freeze, the sound becomes sharper and more irritating.

    Keeping the sound regular helps the patient to control their walking.

    In tests, up to 50 per cent of Parkinson's patients were able to walk faster and take longer steps using the device.

    Among MS patients, the figures were as high as 86 per cent.

    Parkinson's disease affects around 120,000 people in the UK and 10,000 new cases are diagnosed every year.

    Among the elderly, the risk of developing the disorder increases sharply.

    The condition develops when cells in the brain that control movement die off.

    The main symptoms include shaking, muscle stiffness and slowness of movement, and many sufferers eventually find it difficult to walk, talk, swallow or write.

    Multiple sclerosis affects an estimated 100,000 people in the UK and appears to be caused by the immune system turning against healthy cells in the body.

    Professor Yoram Baram, who developed the goggles, said: "Healthy people control their walking through sensory feedback from muscle nerves.

    "This reports on muscle control, telling the brain if they are using the muscles correctly.

    "But this feedback is damaged in Parkinson's disease, multiple sclerosis and among the elderly.

    "Our device has been tested at various centres in the U.S. and the preliminary results are very good."

    Source: Daily Mail ©2007 Associated Newspapers Ltd (08/05/07)

    MS drug makers try a new pitch: empathy
    Simulator lets doctors experience symptoms.

    When brain specialist Alejandra Gonzalez arrived at the Hynes Convention Center for a medical conference Monday, she did not expect to end her day standing on a treadmill wearing a pair of electrified neoprene gloves.

    Her interest was piqued by an exhibit at the American Academy of Neurology meeting that claimed it could create, in a perfectly healthy person, the disorienting symptoms of multiple sclerosis.

    So, flirting with being late for her 6:30 evening train, she pulled on the tight black gloves, climbed into a brushed-steel booth, and within a minute was wobbling on a treadmill, a blurry image in front of her, hot air blowing against her back.

    Her fingertips vibrated insistently.

    "I never thought that the tingling in the hands would be so bothersome," said Gonzalez, a doctor at Mount Sinai Hospital in New York who has a number of patients with multiple sclerosis, a disease in which the central nervous system slowly deteriorates.

    The machine, commissioned for the meeting by Cambridge drug maker Biogen Idec Inc. and Elan Pharmaceuticals Inc., drew a line of doctors like Gonzalez who were curious to experience how it might feel to have a perplexing disease known for its random, debilitating attacks on the brain and spine. With a video, headphones, and two wobbly treadmill tracks, the machine attempted to mimic the lack of coordination, blurred vision, and other signs of an attack.

    "Even though you try hard to imagine how they feel, it's just not possible," Gonzalez said of her patients.

    Welcome to the newest drug company marketing strategy: empathy. The four-minute simulation puts doctors in the shoes of a typical multiple sclerosis patient, a 30-something woman struggling to keep her life together as her body slips from her control.

    Designed by a New York marketing firm called the RJO Group, it joins a handful of other simulators built for drug companies in the last few years. One, also targeted at neurologists, simulates restless leg syndrome. Another chronicles the exhaustion and frustrations of cancer patients with anemia. One machine simulated heart failure by having doctors strap on a pressurized vest that squeezed their chests.

    "It's almost like an Epcot type of experience," said Robert O'Leary , RJO Group's founder.

    In a world of tight competition and increasing Food and Drug Administration scrutiny of their marketing tactics, drug companies are looking for ways to distinguish themselves. Medical meetings such as the American Academy of Neurology, at the Hynes in Boston this week, are peppered with high-end freebies such as computer memory sticks and cell phone chargers. But a simulator is still unusual.

    "They're always looking for something new," said John Mack , publisher of Pharma Marketing News and author of a watchdog blog on drug company marketing excess. He was not at the Hynes this week, but is familiar with the heart-failure simulator. "Doctors are very gadget-oriented, and they like this sort of thing," Mack said. "It's also very medically oriented."

    The marketing theory behind the simulator is that a more empathetic doctor is more likely to treat patients aggressively, which means prescribing more drugs. O'Leary said one survey showed that the strategy seems to work: Doctors emerged from the anemia simulator measurably more interested in treating patients' symptoms.

    "The whole thing was not to push the drug, it was to push the importance of treating the disease," said O'Leary.

    Mack, the marketing specialist, is skeptical. A cardiologist with a lot of experience treating congestive heart failure "probably knows all there is to know about being empathetic," he said.

    He does, however, believe simulators and other high-tech educational tools can fill important gaps in medical education, even if they are funded by companies that stand to profit from increased drug sales.

    "Obviously, pharma companies have a vested interest, but medical schools are just starting to teach doctors about bedside manner and having empathy for the patients," he said.

    Biogen Idec had four multiple sclerosis simulators built: Two depict the lives of a later-stage patient with advanced symptoms, and two depict recently diagnosed patients. A company spokeswoman would not discuss how much the simulators cost. Nor would O'Leary, except to say, "It's not inexpensive, as you can imagine."

    Once this week's conference winds down, Biogen Idec plans to take the machines on the road -- first to the BIO International Convention across town, which opens Sunday, and then on a national tour of neurology meetings and, possibly, hospitals and medical schools.

    The MS simulators took six months to build. To create the desired effects, specialists interviewed doctors and patients, searching for  symptoms that are not only typical, but can be reproduced with a video screen and mechanical devices.

    For the MS simulator on display at the Hynes, the firm produced a short video that brings to life the symptoms of a typical patient during an MS attack. The person in the booth dons a set of headphones and is promptly surrounded by a woman's voice and the ambient sounds of her life. At the store, she opens her wallet and the screen suddenly goes blurry, with an MS attack rendering the $20 bills impossible to distinguish from the singles. She tries to pick up a cup, and it falls out of her hand -- the drop simulated by a quick tug from a recessed cable.

    Art Mellor, a multiple sclerosis patient who runs a research foundation for the disease, went through the simulator an hour after it opened Monday, not long after Gonzalez. He was impressed by the way the coffee cup simulated the sudden loss of coordination -- "that's what it's like," he said -- and by the thick vibrating gloves. It wasn't so much the feeling while the battery-powered gloves were turned on, he said, but the eerie after-effect of taking them off -- a disturbing residual buzz that has become a permanent part of Mellor's life.

    Mellor said the booth could serve a valuable purpose, since multiple sclerosis patients often don't have outwardly detectable symptoms and must depend on doctors believing their verbal descriptions. Some patients, he said, get "the equivalent of 'suck it up,' or 'Oh, come on, it's not that bad.' "

    But there's one feeling the booth can't replicate. When the video ends, so do the symptoms for those in the simulator. Multiple sclerosis patients, however, are stuck with a degenerative disease that even the best drugs can inhibit only temporarily.

    "It's that slow build up over time that just eats away at you," Mellor said.

    Source: The Boston Globe © Copyright 2007 Globe Newspaper Company. (02/05/07)

    Auditory Device Makes Walking Easier For MS Patients
    A Technion Institute computer science researcher has devised an auditory feedback system which enables patients with multiple sclerosis (MS) to improve their gait.

    Professor Yoram Baram said that the apparatus, which is an updated version of a virtual reality visual feedback apparatus he developed a decade ago, can also help Parkinson's disease patients walk better.

    "Our earlier system was based on a visual feedback device - this one is an auditory feedback device that has a visual element to it," he explained. "The apparatus we built is the size of a Walkman and is worn on a belt. It measures body movement, processes it using a computer and then sends a signal to the ears through earphones."

    According to Baram, auditory feedback helps patients walk at a fixed pace because gait quality is expressed through a series of sounds that a person hears while walking.

    "The user hears a ticking sound which is synchronised to his steps, rather than hearing a rhythm track and having to respond to it. Now he hears his own steps. If the patient doesn't have a balanced, steady walk, all he needs to do is produce his own rhythm as an auditory cue," he said.

    The 400,000 Americans with MS, lack a simple, but integral element that healthy people have to control their walking - sensory feedback from muscle nerves, which report on muscle control, telling them if they are using their muscles correctly or not.

    "This feedback is damaged in Parkinson and MS patients and the elderly. Parkinson's results from the production of dopamine in the brain which affects muscle function, and MS develops when the patient's immune system attacks the white matter nerves in the brain," said Baram.

    The most common neurological disorder diagnosed in young adults, MS affects  eyesight, mobility, bladder and bowel control, and causes chronic pain and dizziness. 

    Together with Prof. Ariel Miller of the Technion's Rappaport Faculty of Medicine and the Multiple Sclerosis and Brain Research Center at the Carmel Medical Center in Haifa, Baram examined the influence of the auditory/visual apparatus on the gait quality of MS patients. Their work was recently published in the important scientific publication, Journal of the Neurological Sciences.

    In the study, on-line (device on) and residual short-term therapeutic effects on walking speed and stride length were measured in 14 randomly selected MS patients with gait disturbances. The results showed an average improvement of 12.84% on-line and 18.75% residually in walking speed. Average improvement in stride length was 8.30% on-line and 9.93% residually. According to Baram, the improvement results are particularly noteworthy when compared with the lack of change in healthy control subjects.

    Baram says that the virtual reality visual feedback apparatus developed 10 years ago influences more stride length while the auditory apparatus influences walking speed. Now that both devices have been integrated, the patient wears the visual feedback apparatus on his eyes and the earphones are connected to it.

    "Our findings also raise the possibility of understanding the processes that go on in the brain when processing the sensory information reaching it," he adds.

    Baram recently returned to the Technion after spending a year in the US conducting research on the device with MS and Parkinson's patients at the Neuroscience Institute at the University of Cincinnati, as well as at the Parkinson's Institute at Stanford University in California.

    "The device has been tested at all those places and the preliminary results are very good. We received very positive response from our colleagues at those institutions," he said.

    Baram, who holds a PhD in electrical engineering and computer science from MIT, once designed a mechanism for the U.S. National Aeronautics and Space Administration that helped helicopters navigate at low altitudes around obstacles such as electrical poles and trees. Several years after his work for NASA he was watching television and heard a man with Parkinson's describe how he found it easier to walk on a tiled floor since the grid pattern made the image more stable.

    Baram made a connection between his work for NASA and the Parkinson's patient's description. The design Baram later used for the visual device was based on the idea that optical images of fixed objects help people stabilise themselves, whether they are walking or flying a helicopter.

    One patient who tested the audio/visual system was Jack Rose, a 77-year-old Parkinson's patient from outside Cincinnati. He told The Cincinnati Enquirer that the grid "makes you feel like you have something to step over," which makes it easier to take that first step.

    At the neurology clinic, Rose and other study subjects walked on a special mat equipped with sensors that measure how fast they walk and the length of their steps.

    The information was fed into a computer so researchers could track people's progress. Rose's data showed his steps were short and close together at the start of the study session, and longer and faster at the end of it, indicating his progress from a slow shuffle to an easy, natural stride.

    According to Baram, the main reason for developing the auditory element of the device is because many of the patients are also handicapped by poor eyesight, for which the audio device compensates.

    "Some people don't see very well, and this provides an auditory channel option. In addition, the rhythmic sound device is less expensive than the relatively costly visual display," he said, adding that the combined device would probably cost in the area of $1,000.

    Now ensconced back at the Technion, Baram is concentrating on conducting further testing of the auditory/visual device and looking forward to the day when MS and Parkinson's patients will be walking steadier.

    Source: Medical News Today © 2007 MediLexicon International Ltd (16/04/07)

    Accessible Technology Can Offer Customisable Solutions to People with MS
    In today's fast-paced, digital environment, more people are embracing the technology that has revolutionised the way we conduct business, interact with our family and friends, and manage our households. For some people with multiple sclerosis (MS), technological advances may offer benefits, but they can also pose challenges. Due to some MS symptoms, everyday tasks such as seeing a blinking cursor on a computer screen, manipulating a mouse, or remembering when to take medication may prove difficult. Industry leaders think they may be able to change this.

    Recognising the advantages that technology can bring to people with MS, leaders from three specialty areas -- pharmaceutical, technology, and patient advocacy -- have come together to improve the way technology may help people with MS maintain their health and independence, have support for their life choices, and stay connected with their families, friends, and communities.

    In this landmark alliance known as the MS Technology Collaborative, Berlex, Inc., a U.S. affiliate of Bayer Schering Pharma AG, Germany; Microsoft Corp.; and the US National Multiple Sclerosis Society will work together to better understand the needs of people with MS and to help provide access to the technology and resources they need to stay connected to their communities and the world. A project steering committee comprised of people with MS from across the US will oversee these efforts to help ensure that the outcomes from the project truly address the unmet needs of the MS Community.

    MS is an unpredictable neurological disease that affects an estimated 400,000 people in the United States. A new case is diagnosed every hour. Often, MS is diagnosed in people between the ages of 20 to 50. It can cause vision problems, tingling or numbness, trouble maintaining balance,  fatigue or weakness, loss of coordination, problems with walking, or lapses in memory. These problems might be permanent, or they might come and go without warning. While there is no cure for MS, early and effective treatment is an important component of helping to control its progression. One goal of the MS Technology Collaborative is to explore the ways in which effective treatment and the use of accessible technology can together enhance the lives of people with MS.

    "Having MS means something different to each person with the disease, so we are especially excited to identify new and customisable solutions to help expand and simplify how people with MS stay connected to those around them," said Joyce Nelson, President and CEO, National MS Society. "We want to help people with MS connect and move forward in the world in ways that support their individual needs -- not the other way around."

    As a first step, the MS Technology Collaborative will conduct a survey of people with MS to understand how they use technology throughout their disease and in their professional and personal lives. By fully understanding how people with MS use technology, the MS Technology Collaborative aims to create a personalised, interactive, Web-based program that will deliver tailored information to each individual with MS. The survey will also explore how MS symptoms may have affected major decisions in their life.

    "At Microsoft, we are dedicated to creating technology that adjusts to individuals' needs as they change over the course of a day, a year, a lifespan -- including those with MS or any other type of condition," said Rob Sinclair, director of the Accessible Technology Group at Microsoft. "We believe that technology will help people with MS maximise their abilities, even as those abilities change."

    Another goal of the MS Technology Collaborative is to raise awareness of how existing technology can help fulfill personal and professional goals, showcasing how technology can flex to the changing needs of each person with MS. Altering screen settings on computers, using a trackball instead of a mouse, sending text messages to remind one when to take medication -- all may help a person with MS navigate daily challenges.

    Because MS is a highly variable and unpredictable disease and each person may experience a number of symptoms with varying degrees of severity and/or frequency, the MS Technology Collaborative will try to meet individualised needs by offering a robust, online portal of existing resources and information, including basic tips for selecting appropriate technology. For those not experiencing any symptoms related to their MS, the knowledge that there is a comprehensive resource with tips, testimonials and additional insights available to them may help mitigate their fears of what the future may hold.

    "Multiple sclerosis and its impact on people's lives needs to be fought on multiple fronts through effective treatment, comprehensive support systems, and practical technology tools," said Dr. Ludger Heeck, vice president and general manager of Specialized Therapeutics at Berlex.

    "Berlex was the pioneer in providing effective drug therapy and comprehensive support programs to people with MS, which allows us to bring a deep and specialised understanding of MS to this project. By combining the strengths of each Collaborative member with the personalised perspective offered by the steering committee, we believe this unique approach will have a strong, positive impact for people living with MS."

    MS Technology Collaborative

    In addition to conducting a survey; creating a personalised, interactive, Web-based program; and developing an online resource of relevant MS information; the MS Technology Collaborative will issue a comprehensive report based on the survey results, with a focus on the role technology and connectivity plays in the lives of people with MS. The report will be widely distributed by all members of the MS Technology Collaborative and will be available on the group's Web site at http://www.mymsmyway.com/ .

    Individuals interested in participating in this landmark survey or those wanting periodic program updates can register for additional information at http://www.mymsmyway.com/ .

    About the MS Technology Collaborative

    The MS Technology Collaborative's vision is to provide people with MS information resources and tools to create a connection between technology, community, and treatment options so they can stay connected to the world. The MS Technology Collaborative's membership includes Berlex, a pharmaceutical company that has been at the forefront of MS therapy development, starting with the introduction of the very first therapy for relapsing remitting MS and continuing with its innovative treatments in development today; Microsoft, a global technology leader; and the National Multiple Sclerosis Society, the largest MS research, service, and advocacy organization in the world.

    About the Participating Organizations

    Berlex
    Berlex, Inc. is a U.S. affiliate of Bayer Schering Pharma AG, Germany, which is a subsidiary of Bayer AG. Bayer AG is one of the world's leading, innovative companies in the healthcare and medical products industry and is based in Leverkusen, Germany. The company combines the global activities of the Animal Health, Consumer Care, Diabetes Care, and Pharmaceuticals divisions. The U.S. Pharmaceuticals division comprises the following business units: Women's Healthcare, Diagnostic Imaging, Specialized Therapeutics, Hematology/Cardiology, and Oncology. The company's aim is to discover and manufacture products that will improve human health worldwide, by diagnosing, preventing and treating diseases.

    National Multiple Sclerosis Society
    MS stops people from moving. The National Multiple Sclerosis Society exists to make sure it doesn't. We help each person address the challenges of living with MS, and through our 50 state network of chapters, we fund more MS research, provide more services to people with MS, offer more professional education and further more advocacy efforts than any other MS organisation in the world. The Society is dedicated to achieving a world free of MS. We are people who want to do something about MS now.

    Studies show that early and ongoing treatment with an FDA-approved therapy can reduce future disease activity and improve quality of life for many people with multiple sclerosis.

    Microsoft Accessible Technology Group
    For nearly 20 years, Microsoft has focused on developing accessible technology for everyone, including individuals who experience the world in different ways because of difficulties or disabilities. Accessible technology makes the computer more comfortable and easier to see, hear, and use.

    Microsoft
    Founded in 1975, Microsoft is the worldwide leader in software, services and solutions that help people and businesses realise their full potential.

    Source: PR Newswire Copyright © 1996-2003 PR Newswire Association LLC. All Rights Reserved. (20/03/07)

    Guardian Technologies' Advances Signature Mapping(TM) Initiatives
    Guardian Technologies International, Inc, a leading technology developer of intelligent imaging informatics solutions, for the homeland security and healthcare sectors, has completed the first round of clinical evaluations and a series of broad pilot studies involving multi-modalities and multiple diseases.

    Based on promising internal research and development results, Guardian commenced a broader survey that was designed to evaluate and validate the applicability of Signature Mapping™ to the medical imaging applications. A series of broad pilot studies involving multiple modalities and multiple diseases were undertaken through a collaborative effort with the Image Processing and Informatics Laboratory (IPI) at the University of Southern California. IPI provided clinical cases including radiographs with confirmed diagnoses, as well as medical imaging informatics expertise. Clinical study areas and imaging modalities were chosen based upon their ability to provide Guardian broad and deep insight into the capabilities of its core technologies.

    The initial pilot study chosen was multiple sclerosis (MS), a disease that has been diagnosed in over 400,000 Americans. Healthcare experts believe that over one million people currently live with multiple sclerosis today in the U.S. MS patients undergo multiple MRI scans that require the radiologist to quantify and report any changes to MS lesions over multiple studies and time. This evaluation process is a time-consuming and imprecise activity when performed without the benefits of an automated detection technology such as Signature Mapping™.

    Results of the MS study found that Signature Mapping™ algorithms are capable of accurately detecting lesions and, more importantly, provide accurate measurements of size and overall lesion volumes. Compared to clinical observers, Signature Mapping™ proved to be a more sensitive tool for detecting lesions that were considered marginal or undetectable and provided extremely accurate measurements, while reducing the radiologist analysis time to just seconds.

    Overall Guardian is extremely excited by its ability to add clinical value to difficult imaging problems in diagnostic radiology. Guardian was able to demonstrate its ability to easily transfer its Signature Mapping™ technologies to a new imaging industry application. The Signature Mapping™ technologies proved to be an effective tool for detection, segmentation, clarification, quantification and visualisation for specifically targeted diseases or anatomical structures. The technology shows broad modality and clinical adaptation for deployment in a wide variety of clinical diagnostic and therapeutic applications.

    Source: Business Wire (16/03/07)

    Impaired Short-term Motor Learning in Multiple Sclerosis: Evidence From Virtual Reality
    Authors: Leocani L, Comi E, Annovazzi P, Rovaris M, Rossi P, Cursi M, Comola M, Martinelli V, Comi G

    OBJECTIVE:  Virtual reality (VR) has been proposed as a potentially useful tool for motor assessment and rehabilitation. The objective of this study was to investigate the usefulness of VR in the assessment of short-term motor learning in multiple sclerosis (MS).

    METHODS: Twelve right-handed MS patients and 12 control individuals performed a motor-tracking task with their right upper limb, following the trajectory of an object projected on a screen along with online visual feedback on hand position from a sensor on the index finger. A pretraining test (3 trials), a training phase (12 trials), and a posttraining test (3 trials) were administered. Distances between performed and required trajectory were computed.

    RESULTS: Both groups performed worse in depth planes compared to the frontal (x,z) plane (P <.006). MS patients performed worse than control individuals in the frontal plane at both evaluations (P <.015), whereas they had lower percent posttraining improvement in the depth planes only (P =.03).

    CONCLUSIONS: The authors' VR system detected impaired motor learning in MS patients, especially for task features requiring a complex integration of sensory information (movement in the depth planes). These findings stress the need for careful customisation of rehabilitation strategies, which must take into account the patients' motor, sensory, and cognitive limitations.

    Source: Neurorehabil Neural Repair. 2007 (15/03/07)

    Professors Study Experimental Treatment for Neurodegenerative and Vascular Diseases
    Two professors from Central Michigan University have received a grant for $15,000 to support research for the treatment of serious central nervous system medical conditions by using a new nitrogen monoxide, or nitric oxide, controlled delivery system that could be worth $96 billion in worldwide sales.

    The project, "Application of Nitrogen Monoxide Releasing Polymer to Treat Neurodegenerative Diseases: Market Assessment and Clinical Studies," combines a new nitrogen monoxide delivery system with an alternative treatment option for Parkinson's and other diseases. The system was developed by chemistry professor Dillip Mohanty and psychology professor Justin D. Oh-Lee.

    "We envision our polymeric system can be used as a slow nitrogen monoxide-releasing, unobtrusive skin patch, in a manner which will allow nitrogen monoxide to cross into the blood stream through the skin, while the polymeric delivery vehicle does not touch the skin," Mohanty said.

    Using this method, the professors will be able to fill the demand for treatment without unwanted side effects, including resistance to drugs, which patients with Parkinson's disease develop over time. In addition to treating Parkinson's patients, nitrogen monoxide has been used as an alternative treatment option for serious medical conditions including Alzheimer's, multiple sclerosis, epileptic seizures, and erectile dysfunction.

    Mohanty and Oh-Lee hope their research will lead to a controlled, sustained and more affordable delivery system. Since nitrogen monoxide can be toxic when administered in high doses, the system will address that problem.

    "Findings from the proposed studies can provide a more accurate understanding of molecular mechanisms underlying nitrogen monoxide-induced neuroprotective effects and should accelerate the discovery of improved medical interventions for the treatment of neurodegenerative and vascular diseases," Oh-Lee said. "With positive outcomes, the technology used in our protocol is not only inexpensive and non-invasive, but patient compliance also is expected to be highly favourable in contrast to orally-delivered agents in the form of pills."

    Mohanty and Oh-Lee received CMU's first-ever challenge grant from the Michigan Universities Commercialization Initiative. The initiative's purpose is to encourage the incorporation of discoveries in university laboratories into commercial products.

    "This award is another important step in CMU becoming a player in the technology transfer and economic development area," said Craig Reynolds, CMU's research and program officer.

    Source: Newswise © 2007 Newswise. (26/02/07)

    Victhom Human Bionics announces the start of patient enrolment for its Neurostep(TM) clinical trial
    Victhom Human Bionics Inc. announces today that it received approval from the Ethics Review Board of the rehabilitation center where its clinical trial on gait disorders will be held. The Company received its Investigational Testing Authorization in December 2006 from Health Canada. The Neurostep(TM) is designed to treat, through neuromodulation, gait disorders (e.g., foot drop) secondary to a lesion of the central nervous system caused by conditions such as stroke or multiple sclerosis. Over one million patients in the U.S. and in Europe could benefit from this product.

    Dr. Guy Chamberland, M.Sc., Ph.D., Vice President Clinical and Regulatory Affairs, stated that the Company was initiating patient enrolment for its clinical trial this month. This will be the world's first human trial of a fully implantable Closed-Loop System (sensing and stimulation) for the peripheral nervous system.

    Mr. Stéphane Bédard, Executive Vice President and COO, stated that in light of the above, the Company is focusing the R&D activities of its NeuroBionix division on the clinical development of the Neurostep(TM) and aggressively pursuing the development of a closed-loop neuromodulator (neurosensing and neurostimulation of the peripheral nervous system) for the treatment of pathologies such as sleep apnea, obesity and chronic pain. Victhom also announced it has put on hold the preclinical development of a bladder neuroprosthesis for patients with spinal cord injury. This decision was made after a normal course review of the entire portfolio of programs under development and to optimise R&D expenses.

    Source: VICTHOM HUMAN BIONICS INC.(16/01/07)

    Polymer Microparticles Show Promise As Ingenious New Drug Delivery System
    Scientists in Georgia are reporting successful lab tests of new polymer microparticles that show promise as a long-sought way to deliver drugs directly into the cell structures responsible for inflammation.

    Those immune system structures, macrophages, devour and destroy foreign substances such as invading bacteria and cellular debris. However, they also release so-called reactive oxygen species that help cause arthritis, acute liver failure and other inflammatory diseases.

    In a report scheduled for the Jan. 17 issue of ACS' Bioconjugate Chemistry, a bi-monthly journal, Georgia Tech's Niren Murthy and colleagues at Emory University School of Medicine describe successful cell culture experiments with microparticles encapsulating superoxide dismutase (SOD). That compound is getting wide attention as a potential treatment for inflammatory diseases because it scavenges reactive oxygen species. One roadblock to clinical use of SOD, the researchers note, is the lack of a delivery system for SOD.

    The new polymer microparticles have several advantages over other potential delivery systems, the researchers state. The particles remain intact until reaching acid environments such as the phagosomes -- literal death chambers -- that form after macrophages engulf bacteria and other particles. Then the polymers breakdown, releasing their SOD directly at the site where inflammation begins.

    Note: This story has been adapted from a news release issued by American Chemical Society.

    Source: ScienceDaily Copyright © 1995-2007 ScienceDaily LLC (16/01/07)

    Virtual reality device aids people with MS
    Virtual reality visual feedback cues can help people with multiple sclerosis (MS) to walk more quickly and lengthen their stride, Israeli researchers report.

    Gait problems occur in roughly 85 percent of MS patients, Drs. Yoram Baram and Ariel Miller of Technion-Israel Institute of Technology in Haifa explain in the medical journal Neurology.

    A virtual reality system that incorporates the user's movements into a visual display that provides feedback has been shown to improve gait in patients with Parkinson's. The researchers tested a more advanced version of the device with 16 MS patients.

    The team found that patients whose walking speed was below the average for the group had a 13.5 percent improvement while using the device; those whose speed was already above average weren't helped much, seeing an improvement of just 1.5 percent.

    Patients then took a ten-minute break, and were tested without using the virtual reality system. The below-average patients showed a 24.5 percent residual improvement in speed, while those with above-average speed showed a 9.1 percent improvement.

    Tests of the device in healthy people did not show any improvement, and in fact it reduced speed and stride length.

    "This makes the results for the patients even more noteworthy, since improved apparatus and prolonged training are expected to reduce the burdening effect, hence, further improve performance," the researchers write.

    The findings support the use of virtual reality-based approaches to rehabilitation in patients with MS, as well as other types of neurological disorders, they conclude.

    Source: Neurology, (10/02/06)

    © Multiple Sclerosis Resource Centre

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