Practice guideline update summary: Vaccine-preventable infections and immunization in multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.

Objective: To update the 2002 American Academy of Neurology (AAN) guideline regarding immunization and multiple sclerosis (MS).

Methods: The panel performed a systematic review and classified articles using the AAN system. Recommendations were based on evidence, related evidence, principles of care, and inferences according to the AAN 2011 process manual, as amended.

Medical decisions are not just about the facts: What a life-threatening virus can teach us about empathy, psychology, and the practice of neurology.

Getting the facts about risk and benefit is a critical part of medical decision-making. But when doctors and patients disagree on what is reasonable risk, it takes more than a grasp of the data to establish the way forward. Our competence as physician-scientists relies on our ability to master the mechanics and information flow of our specialty.

The interferon beta therapies for treatment of relapsing-remitting multiple sclerosis: are they equally efficacious? A comparative review of open-label studies evaluating the efficacy, safety, or dosing of different interferon beta formulations alone or in combination.

Interferon beta preparations are the most widely used initial therapies prescribed for patients with relapsing-remitting multiple sclerosis. Phase III studies have demonstrated comparable efficacy on clinical measures of disease activity, variable benefits on radiological measures, and good overall tolerability. Subsequent clinical studies have attempted to compare directly the three available interferon beta preparations, reporting both safety and efficacy data.

When neurologist and patient disagree on reasonable risk: new challenges in prescribing for patients with multiple sclerosis.

New more powerful therapies for the treatment of multiple sclerosis may also confer a potential for unprecedented life-endangering side effects. How does a physician respond to a patient's request for a treatment the benefit of which cannot be clearly established as worth its risk? The current challenge with prescription of natalizumab (Tysabri(®), Biogen Idec) is used to illustrate how this conflict creates an opportunity to re-examine our goals as physicians and the nature of the physician-patient relationship. Understanding the physician's role in that partnership, and the ethical and psychological issues impacting on how reasonable risk is determined, can improve the neurologist's capacity to explicate such quandaries.

Sustained release oral fampridine in the treatment of multiple sclerosis.

Background: Fampridine-SR is under submission as the first drug to be FDA approved with an indication specifically for multiple sclerosis symptoms. Compounded forms of the active agent of Fampridine-SR (4-aminopyridine) have been used in clinical practice for many years. Clinical trials have now been completed that demonstrate a robust capacity of the drug to meet stringent statistical and clinically meaningful end points.

Challenges and opportunities: what we are learning from the clinical natalizumab experience.

The approval of natalizumab for relapsing forms of multiple sclerosis, and the subsequent voluntary suspension of its use due to an unexpected viral infection, is a cautionary tale of how much we have to learn about how to prioritize and perform the necessary research and development of novel therapeutics for human diseases, the ethics of placebo-controlled trials and the relationships between researchers, regulatory authorities and the pharmaceutical industry.

Increased CXCL8 (IL-8) expression in Multiple Sclerosis.

Multiple Sclerosis (MS) is a chronic inflammatory disease of the CNS which is characterized by large mononuclear cell infiltration and significant demyelination. CXCL8 is a chemo-attractant for both neutrophils and monocytes and triggers their firm adhesion to endothelium. In this study, we demonstrate that serum CXCL8 and CXCL8 secretion from PBMCs are significantly higher in untreated MS patients compared to controls and are significantly reduced in MS patients receiving interferon-beta1a therapy.