Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 6853 msfocusmagazine.org – only attacking outside invaders (such as, bacteria, viruses, fungi, and even cancers), immune cells cross through the blood-brain barrier and attack a person’s own nerve cells and the protective covering around the nerves (myelin sheath). However, it appears that in progressive MS, instead of these immune cells seeping into the central nervous system and causing damage during relapses, the immune cells are already inside the CNS, constantly causing damage. This may explain why many MS medications cannot help cases of progressive MS – because those medications cannot pass through the blood-brain barrier. What are the treatment options for progressive MS? The first question is, “what do we mean by treatment?” We generally think of MS treat- ment as having three components: disease modification, symptom management, and rescue or relapse treatment (important in some people with progressive MS). Prior to 1993, there were no FDA-approved disease- modifying therapies for MS. In just over two decades we have seen an explosion in the treatment options with 13 separate branded medications and one branded generic. Yet, only one of these medications is approved for SPMS, and, as of this printing, there are currently no medications available that are approved for PPMS. The good news is that this may be about to change. What do we mean by a disease-modifying therapy? When a neurologist prescribes an MS disease-modifying medication, it is similar to when a doctor prescribes a blood pressure medication – the goal in that case is to prevent future heart attacks and strokes.You can think oftheseasproactivemedications–medications with the goal of preventing future relapses and progression of physical disability. What would disease modification look like in progressive MS? A number of strategies could be used, including: • Optimize regular (non-MS) health • Control other health conditions • Diet • Exercise • Reduce inflammation outside CNS • Reduce inflammation inside CNS • Slow or stop neurodegeneration • Repair damaged myelin (remyelination) • Repair damaged/broken axons What are some of the medications being studied for progressive MS? • Ocrelizumab – intravenous fourtimes ayear Positive results in ORATORIO studyof PPMS. Question remains whether population studied is similarto manypeoplewith PPMS. May be FDA-approved as early as the end of 2016. • Biotin – three times a day, orally. Seems to help progressive, but not RMS. Starting international phase III trial for progressive MS. • Siponimod – daily oral medication. In August 2016, a press release announced positive results in SPMS. More information should be available soon. • Ofatumumab – monthly subcutaneous injection. Being studied for relapsing MS. Decision being made to study in PPMS. What about stem cell treatments? • Stemcellsarefinallybeingstudiedvigorously in MS