May 2016 - Multiple Sclerosis Awareness Month
Multiple sclerosis treatment and research has long been a focus at the Montreal Neurological Institute and Hospital, known simply as The Neuro, an illustrious member of McGill University and the McGill University Health Centre. Indeed, The Neuro introduced Canada’s first MS clinic. The clinic’s highly specialized staff employs the latest research data and treatment methods in a clinical atmosphere of innovation and progress.
MS Clinical Care
Each year, around two thousand patients receive treatment at The Neuro’s MS Clinic. The clinic has the multidisciplinary staff needed to treat the many sides of multiple sclerosis, which range from a patient’s reduced mobility to the needs of family members who are trying to cope with the difficulties faced by their loved ones with MS. The MS Clinic’s staff includes neurologists, specialized nurses, physiotherapists, occupational therapists and social workers. As part of its innovative approach to research and treatment, the MS Clinic invites patients to participate in clinical trials of new MS drugs coordinated with The Neuro's Clinical Research Unit. For more information, please see http://cru.mcgill.ca/
The Neuro helps to develop first drug for Primary Progressive MS
Phase III clinical trials conducted at The Neuro’s Clinical Research Unit (CRU) have included some of the 732 patients who took part in the multi-site ORATORIO clinical trials of Ocrelizumab, the only drug that has been shown effective for Primary Progressive Multiple Sclerosis (PPMS), the type of MS characterized by the steady progressive deterioration in neurological function without preceding or concomitant relapses.
“The results of the ORATORIO clinical trial showed that Ocrelizumab reduced the progression of clinical disability in PPMS patients by 24% compared to placebo. The reduction was sustained for at least 12 weeks as measured by the Expanded Disability Status Scale (EDSS)” says Dr. Dalinda Liazoghli, group leader of the CRU. “It’s very exciting. Ocrelizumab is the first of several tested drugs to be able to affect the course of primary progressive disease”
The Neuro began clinical trials for the drug in early 2012. Patients who took part in the trial will continue to have access to it until it becomes available commercially as part of the open label phase of the ORATORIO trial. The drug is awaiting approval from Health Canada and from the U.S. Federal Drug Administration (FDA). It’s hoped that the drug will come on market in 2017. Ocrelizumab is the drug’s scientific name. It will be sold under a generic name still to be determined.
There are 13 disease-modifying drugs approved by the FDA for use in relapsing forms of MS, but no disease-modifying medication has yet been approved to treat PPMS.
The Neuro’s CRU also helped to develop Aubagio, a drug for patients with relapsing-remitting multiple sclerosis (RRMS) that was approved in Canada in 2014. The drug is taken orally once a day.
RRMS patients at The Neuro can also be prescribed the drug Lemtrada, administered by intravenous infusion. Like Aubagio, Lemtrada acts to reduce the frequency of relapses and delays the progression of physical disability.
One of the first MS drugs, Copaxone, is another drug that The Neuro’s patients may receive. Copaxone serves to produce immune cells that cause less damage to myelin, the protective sheath surrounding axons. Myelin deterioration has been linked to MS.
MS Research at The Neuro
More than 50 members of The Neuro's staff are conducting laboratory and clinical studies related to MS. They use the most advanced brain imaging technology and the latest cell biology tools to study the disease in all its aspects and at every stage. The Neuro's basic scientists and clinical physicians cooperate closely to translate research into patient therapies:
Dr. Yves Lapierre is the Director of the MS Clinic. A neurologist, Dr. Lapierre undertakes clinical drug trials and designs programs that prescribe MS drugs in the most effective way to prevent relapses.
Dr. Paul Giacomini is Associate Director of the MS Clinic. Using his expertise in MS and neuro-inflammatory disorders, Dr. Giacomini employs advanced neuroimaging techniques to conduct clinical trials to evaluate new therapies for relapsing and progressive MS. He also develops novel imaging techniques to identify the mechanisms of disease-modifying therapies. As well, Dr. Giacomini is active in medical education, and directs the McGill MS fellowship program.
Dr. Amit Bar-Or, neurologist and neuroimmunologist, researches the properties of immune cells, stem cells and their interactions with nerve cells. He is Associate Director (Translational) of the Neuro, and directs The Neuro's Experimental Therapeutics Program, which translates basic science findings into the development of novel therapies for MS. Dr. Bar-Or is also president of the Canadian Network of MS Clinics, a consortium of Canadian clinics for patients, clinical staff, physicians and researchers.
Dr. Jack Antel, is a neurologist who investigates how the interactions of nerve and immune cells might contribute to MS. He also studies glial cells and the factors that could lead to remyelination.
Dr. Alyson Fournier is a neuroscientist who is interested in nerve cell injuries and why they occur. Her research aims at finding ways to repair nerve cells damaged by MS.
Dr. Douglas Arnold is a neurologist with expertise in magnetic resonance imaging. He uses advanced MRI methods to investigate how MS affects the brain and how new MS therapies work.
Dr. Tim Kennedy is a neuroscientist conducting research into how myelin develops in early stages of growth and how it is maintained in the mature brain. His research aims to uncover new methods to stimulate re-myelination.
Dr. Daria Trojan is a Physiatrist who assesses and manages symptoms of MS patients. With the collaboration of a Sleep Specialist, Dr. John Kimoff, she is conducting a randomized, controlled clinical trial of a treatment for obstructive sleep apnea-hypopnea in MS patients with this condition.
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• Canada has one of the world's highest rates of MS - about 1,100 new cases each year. Some 50,000 Canadians have MS. More than one in five patients are in Quebec.
• MS is one of the most common neurological diseases among young Canadians. Children as young as two can develop MS. The disease typically strikes people in their prime years, between 15 and 40.
• Women are twice as likely as men to contract MS.
• MS attacks parts of a person's brain and spinal cord. Typical symptoms are extreme fatigue, visual and sensory problems, disequilibrium. Eventually, loss of muscle control leads to paralysis.
• MS can be detected in its early stages by MRI scans that reveal scars in the nervous system that are typical of the disease.
• The cause of MS is unknown. Evidence suggests that a major component is an auto-immune disease that affects myelin, a substance coating axons, the thin strands that carry signals between brain cells.
MS has several forms:
1. Relapsing-remitting MS at onset: the most common form, in which periods of acute symptoms alternate with periods of remission of variable duration although generally the disease will progress over time.
2. Primary progressive MS: the rarest form-symptoms worsen steadily from onset with no remissions.
3. Secondary progressive MS: this form occurs in patients with relapsing-remitting onset. Eventually their symptoms progress steadily without further remission.
The Montreal Neurological Institute and Hospital — The Neuro, is a unique academic medical centre dedicated to neuroscience. Founded in 1934 by the renowned Dr. Wilder Penfield, The Neuro is recognized internationally for integrating research, compassionate patient care and advanced training, all key to advances in science and medicine. The Neuro is a research and teaching institute of McGill University and forms the basis for the Neuroscience Mission of the McGill University Health Centre. Neuro researchers are world leaders in cellular and molecular neuroscience, brain imaging, cognitive neuroscience and the study and treatment of epilepsy, multiple sclerosis and neuromuscular disorders.