Clinic to in-home telemedicine reduces barriers to care for patients with MS or other neuroimmunologic conditions.

Objective: To describe the routine use of telemedicine-enabled neurologic care in an academic outpatient MS and neuroimmunology clinic and quantify its role in reducing patient burden.

Methods: Between January 2017 and December 2017, we surveyed patients and MS neurologists after 50 consecutive routinely scheduled televideo visits and a convenience sample of 100 in-clinic visits. Summary statistics were calculated and comparisons performed.

Disease-modifying therapies alter gut microbial composition in MS.

Objective: To determine the effects of the disease-modifying therapies, glatiramer acetate (GA) and dimethyl fumarate (DMF), on the gut microbiota in patients with MS.

Methods: Participants with relapsing MS who were either treatment-naive or treated with GA or DMF were recruited. Peripheral blood mononuclear cells were immunophenotyped.

Advanced Symptom Management in Multiple Sclerosis.

Meaningful symptom management can have a profound impact on quality of life. It can challenge time parameters during clinic, and therefore thought should be given to strategies that can improve efficiency and thereby make the undertaking more tenable. For any given symptom, the building blocks of care, such as vitamin D status, exercise/physical therapy, nutrition, and stress management, and ensuring disease-modifying therapy coverage, should be maximized.

Gut bacteria from multiple sclerosis patients modulate human T cells and exacerbate symptoms in mouse models.

The gut microbiota regulates T cell functions throughout the body. We hypothesized that intestinal bacteria impact the pathogenesis of multiple sclerosis (MS), an autoimmune disorder of the CNS and thus analyzed the microbiomes of 71 MS patients not undergoing treatment and 71 healthy controls. Although no major shifts in microbial community structure were found, we identified specific bacterial taxa that were significantly associated with MS.

Long-term evolution of multiple sclerosis disability in the treatment era.

Objective: To characterize the accrual of long-term disability in a cohort of actively treated multiple sclerosis (MS) patients and to assess whether clinical and magnetic resonance imaging (MRI) data used in clinical trials have long-term prognostic value.

Methods: This is a prospective study of 517 actively managed MS patients enrolled at a single center.

Results: More than 91% of patients were retained, with data ascertained up to 10 years after the baseline visit.

Rebound Syndrome in Patients With Multiple Sclerosis After Cessation of Fingolimod Treatment.

Importance: The appropriate sequencing of agents with strong immune system effects has become increasingly important. Transitions require careful balance between safety and protection against relapse. The cases presented herein highlight that rebound events after ceasing fingolimod treatment may happen even with short washout periods (4 weeks) and may perpetuate despite steroid treatment or the immediate use of fast-acting immune therapies, such as rituximab.

Reduction of CD8(+) T lymphocytes in multiple sclerosis patients treated with dimethyl fumarate.

Objective: To evaluate the influence of dimethyl fumarate (DMF, Tecfidera) treatment of multiple sclerosis (MS) on leukocyte and lymphocyte subsets.

Methods: Peripheral blood leukocyte and lymphocyte subsets, including CD3(+), CD4(+), and CD8(+) T cells; CD19(+) B cells; and CD56(+) natural killer (NK) cells, were obtained at baseline and monitored at 3 months, 6 months, and 12 months after initiation of DMF treatment.

Results: Total leukocyte and lymphocyte counts diminished after 6 months of DMF therapy.

Precision medicine in chronic disease management: The multiple sclerosis BioScreen.

We present a precision medicine application developed for multiple sclerosis (MS): the MS BioScreen. This new tool addresses the challenges of dynamic management of a complex chronic disease; the interaction of clinicians and patients with such a tool illustrates the extent to which translational digital medicine-that is, the application of information technology to medicine-has the potential to radically transform medical practice. We introduce 3 key evolutionary phases in displaying data to health care providers, patients, and researchers: visualization (accessing data), contextualization (understanding the data), and actionable interpretation (real-time use of the data to assist decision making).

Switching multiple sclerosis patients with breakthrough disease to second-line therapy.

Background: Multiple sclerosis (MS) patients with breakthrough disease on immunomodulatory drugs are frequently offered to switch to natalizumab or immunosuppressants. The effect of natalizumab monotherapy in patients with breakthrough disease is unknown.

Methods: This is an open-label retrospective cohort study of 993 patients seen at least four times at the University of California San Francisco MS Center, 95 had breakthrough disease on first-line therapy (60 patients switched to natalizumab, 22 to immunosuppressants and 13 declined the switch [non-switchers]).

Sex differences in multiple sclerosis.

Sex and sex hormones affect the CNS and the immune system differentially, and thus a sexual dimorphism may be anticipated across arenas in multiple sclerosis (MS). Information from the past few decades has elucidated the impact of sex on broad aspects of MS, such as susceptibility, disease course, and radiologic phenotypes. Specific concerns regarding family planning and managing reproductive issues influenced by MS are likely to arise, given the typical age of onset during reproductive years.