b"focusingoncorestabilitycanhelp.If you has rarely been studied. A new study set out tohave walking issues, including poor balance, determine the link between the use, the typemake sure to touch base with a knowledgeable of, and the timing of DMTs with the risk ofphysical therapist for help. transition to secondary progressive MSStudy measures inuence diagnosed. of menopause in MS Patients initially treated with glatiramerNew research aimed to evaluate the eect of acetate or interferon beta had a lower hazardmenopause in MS, including disease activity oftransitiontosecondaryprogressiveMSand disability progression, found a decrease in than matched untreated patients, as didthe annualized relapse rate compared with the ngolimod, natalizumab, and alemtuzumab.same period before menopause. The ndings Initial treatment with ngolimod, alemtuzumab,werepublishedinthejournalEuropean or natalizumab was associated with a lowerNeurology.risk of transition than initial treatment withglatiramer acetate or interferon beta. The chanceDr. Thrower: It has long been noted that of transition was lower when glatiramerhormones may aect how a womans MS is acetate or interferon beta was started withinbehaving. The most striking example of this ve years of disease onset vs. later. Whenis the eect of pregnancy on MS. Pregnancy glatiramer acetate or interferon beta weretends to have a drastic calming eect on MS, escalated to fingolimod, alemtuzumab, orespecially during the second and third trimesters. natalizumab within ve years versus later,The six months following delivery of the baby the chances of transition fell.may see a higher risk of relapse. Among patients with relapsing-remitting MS,So, if the hormonal changes of pregnancy initial treatment with ngolimod, alemtuzumab,can aect MS, how about menopause? This or natalizumab was linked to a lower risk ofstudy shows that the eects of menopause on transition to secondary progressive MS versusthe course of MS appear to be minimal. Relapse initial treatment with glatiramer acetate orrates decreased after menopause, but this could interferon beta. These ndings, consideredalso be attributed to normal aging. As we age, along with these therapies' risks, may helpour immune systems do tend to mellow. inform decisions about DMT selectionThis concept is called immune senescence The ndings were published in JAMA.and explains why we tend to see fewer signs Dr. Thrower: Early treatment of relapsing-of active MS inammation (new MRI lesions remitting MS matters. Weve known this foror relapses) in, say, a 70-year-old person as years now. We are becoming increasingopposed to a 20-year-old.aware that what we treat with may be just asStudy probes link between DMTs, important as when we start treatment.transition to secondary progressive MS Currently, there two schools of thought onWithin two decades of onset, 80 percent of how we use our existing therapies. Escalationuntreated patients with relapsing-remitting therapy describes the method of starting a safe,multiplesclerosischangetosecondary but modestly eective drug like glatiramerprogressive MS. The association between acetateoraninterferon.Ifthepatientdisease-modifying treatments, and this transition experiences new disease activity (relapses,59 msfocusmagazine.org"