Contributors
RANDOLPH W. EVANS, MD (Source: Neurologic Clinics)
Source: Neurologic Clinics - September 28, 2023 Category: Neurology Source Type: research
Contents
David L. Perez and Sara A. Finkelstein (Source: Neurologic Clinics)
Source: Neurologic Clinics - September 28, 2023 Category: Neurology Source Type: research
Forthcoming Issues
Multiple Sclerosis (Source: Neurologic Clinics)
Source: Neurologic Clinics - September 28, 2023 Category: Neurology Source Type: research
Advances in Multiple Sclerosis Neurotherapeutics, Neuroprotection, and Risk Mitigation Strategies
The treatment of patients with relapsing multiple sclerosis (MS) has advanced tremendously over the past few decades. More efficacious therapies have been approved, which can significantly reduce the inflammatory process of relapsing MS. Neuroprotection by controlling this pathophysiology is important given our current limitations to control progressive MS and induce neurorepair. Here, the authors discuss the current landscape of neurotherapeutics for relapsing MS focusing on newer disease-modifying treatments and their use. Risk mitigation of these medications can greatly improve their safety and improve their benefit-ris...
Source: Neurologic Clinics - September 9, 2023 Category: Neurology Authors: Ahmad Abdelrahman, Enrique Alvarez Source Type: research
Relationship Between Multiple Sclerosis, Gut Dysbiosis, and Inflammation
Multiple sclerosis is associated with gut dysbiosis, marked by changes in the relative abundances of specific microbes, circulating gut-derived metabolites, and altered gut permeability. This gut dysbiosis promotes disease pathology by increasing circulating proinflammatory bacterial factors, reducing tolerogenic factors, inducing molecular mimicry, and changing microbial nutrient metabolism. Beneficial antiinflammatory effects of the microbiome can be harnessed in therapeutic interventions. In the future, it is essential to assess the efficacy of these therapies in randomized controlled clinical trials to help make dietar...
Source: Neurologic Clinics - August 30, 2023 Category: Neurology Authors: Larissa Jank, Pavan Bhargava Source Type: research
Contemporary Topics in Multiple Sclerosis
Multiple sclerosis (MS) is a complex neurologic disorder that affects millions of people worldwide. As our understanding of this condition evolves, so too does the landscape of contemporary topics surrounding MS. In this issue of Neurologic Clinics, we explore advancements in the field, including emerging themes around diagnostics, special patient populations, and treatments. (Source: Neurologic Clinics)
Source: Neurologic Clinics - August 26, 2023 Category: Neurology Authors: Carrie M. Hersh Tags: Preface Source Type: research
Multiple Sclerosis in Black and Hispanic Populations
Multiple sclerosis has historically been characterized as a disease that affects young women of European ancestry, but recent studies indicate that the incidence and prevalence of the disease is much higher in Black and Hispanic populations than previously recognized. There is evidence that there is a more severe disease course in these populations. , but the intersection of genetic underpinnings and social determinants of health (SDOH) is poorly understood due to the lack of diversity in clinical research. Improving health disparities will involve multiple stakeholders in efforts to improve SDOH and raise awareness about ...
Source: Neurologic Clinics - August 23, 2023 Category: Neurology Authors: Mitzi J. Williams, Christopher Orlando, Jemima Akisanya, Lilyana Amezcua Source Type: research
Clinical and Treatment Considerations for the Pediatric and Aging Patients with Multiple Sclerosis
Chronologic aging is associated with multiple pathologic and immunologic changes that impact the clinical course of multiple sclerosis (MS). Clinical phenotypes evolve across the lifespan, from a highly inflammatory course in the very young to a predominantly neurodegenerative phenotype in older patients. Thus, unique clinical considerations arise for the diagnosis and management of the two age extremes of pediatric and geriatric MS populations. This review covers epidemiology, diagnosis, and treatment strategies for these populations with nuanced discussions on therapeutic approaches to effectively care for patients livin...
Source: Neurologic Clinics - August 23, 2023 Category: Neurology Authors: Areeba Siddiqui, Jennifer H. Yang, Le H. Hua, Jennifer S. Graves Source Type: research
Bruton ’s Tyrosine Kinase Inhibitors for Multiple Sclerosis Treatment
Multiple sclerosis (MS) can cause significant disability to patients via relapse-associated worsening and progression independent of relapses. The causes of neuronal and myelin damage can include lymphocyte-mediated inflammation and microglial activation. Bruton ’s tyrosine kinase (BTK) is an enzyme that mediates B cell activation and the proinflammatory phenotype of microglia. Inhibiting BTK provides a novel therapeutic target for MS but also has a complicated pharmacology based on binding specificity, CNS penetration, half-life, and enzyme inhibition ch aracteristics. Multiple agents are being studied in phase 3 trials...
Source: Neurologic Clinics - August 23, 2023 Category: Neurology Authors: Benjamin M. Greenberg Source Type: research
Highly Effective Therapy Versus Escalation Approaches in Early Multiple Sclerosis
Treatment options for patients newly diagnosed with multiple sclerosis (MS) are expanding with the continuous development and approval of new disease-modifying therapies (DMTs). The optimal initial treatment strategy, however, remains unclear. The 2 main treatment paradigms currently employed are the escalation (ESC) approach and the early highly effective treatment (EHT) approach. The ESC approach consists of starting a lower- or moderate-efficacy DMT, which offers a potentially safer approach, while the EHT approach favors higher-efficacy treatment early in the disease course, despite a potential increase in risk. Random...
Source: Neurologic Clinics - August 21, 2023 Category: Neurology Authors: Nicole Bou Rjeily, Ellen M. Mowry, Daniel Ontaneda, Alise K. Carlson Source Type: research
Pathophysiology, Diagnosis, Treatment and Emerging Neurotherapeutic Targets for Progressive Multiple Sclerosis
More than one million individuals are impacted by progressive forms of multiple sclerosis. The literature examining the management of MS has focused primarily on relapsing forms of disease, and effective therapies targeting progressive mechanisms in MS remains a significant unmet need. Despite this, there are several encouraging potential therapeutics on the horizon. Improved understanding of mechanisms underlying MS progression, identification and validation of biomarkers, identification of novel therapeutic targets, and improved trial design are needed to further propel progress in the management of individuals with prog...
Source: Neurologic Clinics - August 21, 2023 Category: Neurology Authors: Alise K. Carlson, Robert J. Fox Source Type: research
Women ’s Health and Pregnancy in Multiple Sclerosis
Multiple sclerosis has a 3:1 female-to-male predominance and commonly presents in young adult women. The hormonal changes in women throughout their lifetime do affect the underlying pathology of multiple sclerosis, and the needs of women therefore change with age. Although multiple sclerosis does not adversely affect fertility or pregnancy, there are many factors to consider when caring for women throughout family planning, pregnancy, and the postpartum period. The care of these women and complex decisions regarding disease-modifying therapy use in family planning should be individualized and comprehensive. (Source: Neurologic Clinics)
Source: Neurologic Clinics - August 17, 2023 Category: Neurology Authors: Riley Bove, Paige Sutton, Jacqueline Nicholas Source Type: research
Updates in NMOSD and MOGAD Diagnosis and Treatment
Aquaporin-4-IgG positive neuromyelitis optica spectrum disorder (AQP4+NMOSD) and myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are antibody-associated diseases targeting astrocytes and oligodendrocytes, respectively. Their recognition as distinct entities has led to each having its own diagnostic criteria that require a combination of clinical, serologic, and MRI features. The therapeutic approach to acute attacks in AQP4+NMOSD and MOGAD is similar. There is now class 1 evidence to support attack-prevention medications for AQP4+NMOSD. MOGAD lacks proven treatments although clinical trials are now ...
Source: Neurologic Clinics - August 7, 2023 Category: Neurology Authors: Laura Cacciaguerra, Eoin P. Flanagan Source Type: research
Recent Advances in Diagnostic, Prognostic, and Disease-Monitoring Biomarkers in Multiple Sclerosis
Multiple sclerosis (MS) is a highly heterogeneous disease. Currently, a combination of clinical features, MRI, and cerebrospinal fluid markers are used in clinical practice for diagnosis and treatment decisions. In recent years, there has been considerable effort to develop novel biomarkers that better reflect the pathologic substrates of the disease to aid in diagnosis and early prognosis, evaluation of ongoing inflammatory activity, detection and monitoring of disease progression, prediction of treatment response, and monitoring of disease-modifying treatment safety. In this review, the authors provide an overview of pro...
Source: Neurologic Clinics - August 5, 2023 Category: Neurology Authors: Anibal Chertcoff, Raphael Schneider, Christina J. Azevedo, Nancy Sicotte, Jiwon Oh Source Type: research
Health, Wellness, and the Effect of Comorbidities on the Multiple Sclerosis Disease Course
Multiple sclerosis (MS) is a disease of the central nervous system characterized by inflammatory demyelination and neurodegeneration. Numerous disease-modifying therapies for MS exist but are only partially effective, making it essential to optimize all factors that may influence the course of the disease. This includes conscientious management of both mental and physical comorbidities, as well as a comprehensive strategy for promoting wellness in patients with MS. Thoughtful engagement of those living with MS through shared decision making and involvement of a multidisciplinary team that includes primary care, relevant sp...
Source: Neurologic Clinics - July 28, 2023 Category: Neurology Authors: Devon S. Conway, Amy B. Sullivan, Mary Rensel Source Type: research
