Medscape InDiscussion: Multiple Sclerosis

Most MS patients are women, often diagnosed during their childbearing years. Drs Anne Cross and Riley Bove discuss maternal health, IVF, birth control, and menopause when living with MS. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/977036). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Multiple Sclerosis https://emedicine.medscape.com/article/1146199-overview Teriflunomide (Rx) https://reference.medscape.com/drug/aubagio-teriflunomide-999771 Sphingosine 1-Phosphate Receptor Modulators https://reference.medscape.com/drugs/sphingosine-1-phosphate-receptor-modulators Natalizumab Prescribing Information https://www.tysabri.com/content/dam/commercial/tysabri/pat/en_us/pdf/tysabri_prescribing_information.pdf Association Between Breastfeeding and Postpartum Multiple Sclerosis Relapses https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6902174/ Perinatal Depression and Anxiety in Women With Multiple Sclerosis https://n.neurology.org/content/96/23/e2789 Risk Factors for Peripartum Depression in Women With Multiple Sclerosis https://journals.sagepub.com/doi/10.1177/13524585211041108 Long-Acting Reversible Contraception: Comparing Methods https://www.medscape.com/viewarticle/857253 Neonatal and Delivery Outcomes in Women With Multiple Sclerosis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625744/ Familial Risk of Early- and Late-Onset Multiple Sclerosis: A Swedish Nationwide Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373346

Drs Cross and Katz Sand discuss the science behind diet and lifestyle interventions for patients living with MS. Learn about studies underway to help clinicians better incorporate diet and lifestyle recommendations into practice. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/977035). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Multiple Sclerosis https://emedicine.medscape.com/article/1146199-overview Randomized-Controlled Trial of a Modified Mediterranean Dietary Program for Multiple Sclerosis: A Pilot Study https://www.msard-journal.com/article/S2211-0348(19)30383-9/fulltext Mediterranean Diet Is Linked to Less Objective Disability in Multiple Sclerosis https://journals.sagepub.com/doi/10.1177/13524585221127414 Dietary Factors and MRI Metrics in Early Multiple Sclerosis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515355/ Multiple Sclerosis Functional Composite (MSFC) https://www.nationalmssociety.org/For-Professionals/Researchers/Resources-for-MS-Researchers/Research-Tools/Clinical-Study-Measures/Multiple-Sclerosis-Functional-Composite-(MSFC) Kurtzke Expanded Disability Status Scale https://emedicine.medscape.com/article/2172461-overview How to Incorporate Diet Into Multiple Sclerosis Care https://www.medscape.com/viewarticle/972812

Drs Cross and Bainbridge discuss cannabis, safety issues, drug-drug interactions, potential liver toxicity, tolerance, and possible dependency for people living with MS. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/977034). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals. Resources Cannabinoids in Medicine: Limitless Hope or Hype? https://www.medscape.com/viewarticle/973874 Medicinal Cannabis: History, Pharmacology, and Implications for the Acute Care Setting https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312634/ Sativex Prescribing Information https://www.tga.gov.au/sites/default/files/auspar-nabiximols-130927-pi.pdf Epidiolex Prescribing Information https://pp.jazzpharma.com/pi/epidiolex.en.USPI.pdf Cannabinoid Poisoning Workup https://emedicine.medscape.com/article/833828-workup Cannabis and Psychosis: Recent Epidemiological Findings Continuing the "Causality Debate" https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2021.21111126 Cannabinoid Hyperemesis Syndrome https://www.ncbi.nlm.nih.gov/books/NBK549915/ Trial Evaluating Nabiximols Oromucosal Spray in Adult Participants With Multiple Sclerosis Spasticity https://investor.jazzpharma.com/news-releases/news-release-details/jazz-pharmaceuticals-announces-top-line-results-phase-3-trial

As patients with MS in the United States get older, questions about therapies shift from treatment to discontinuation. Drs Cross and Corboy discuss the DISCOMS trial to address these questions. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/977033). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals. Resources The Prevalence of MS in the United States https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442006/pdf/NEUROLOGY2018886077.pdf Discontinuation of Disease Modifying Therapies (DMTs) in Multiple Sclerosis (MS) (DISCOMS) https://clinicaltrials.gov/ct2/show/NCT03073603 Stopping Disease-Modifying Therapy in Relapsing and Progressive Multiple Sclerosis https://journals.lww.com/co-neurology/Abstract/2021/08000/Stopping_disease_modifying_therapy_in_relapsing.18.aspx Discontinuation of Disease-Modifying Therapies (DMTs) in Multiple Sclerosis (MS): Extension of the DISCOMS Study https://www.ninds.nih.gov/health-information/clinical-trials/discontinuation-disease-modifying-therapies-dmts-multiple-sclerosis-ms-extension-discoms-study North American Registry for Care and Research in Multiple Sclerosis (NARCRMS) https://www.narcrms.org/ How MS Disability Is Measured https://www.webmd.com/multiple-sclerosis/disability-measured Treatment Switching and Discontinuation Over 20 Years in the Big Multiple Sclerosis Data Network https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010264/pdf/fneur-12-647811.pdf Natalizumab Discontinuation in a Dutch Real-world Cohort https://www.sciencedirect.com/science/article/abs/pii/S2211034821002418 Factors Associated With Fingolimod Rebound: A Single Center Real-life Experience https://www.sciencedirect.com/science/article/abs/pii/S2211034821005459 Serious Safety Events in Rituximab-Treated Multiple Sclerosis and Related Disorders https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480911/

Agoraphobia, online yoga, pregnancy, and vaccines are all on the table as Drs Anne Cross and Scott Newsome discuss the COVID-19 pandemic and how it affects their patients with MS. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/977031). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals. Resources Coronavirus Disease 2019 (COVID-19) https://emedicine.medscape.com/article/2500114-overview Multiple Sclerosis https://emedicine.medscape.com/article/1146199-overview COViMS Registry https://www.covims.org/ An Italian Programme for COVID-19 Infection in Multiple Sclerosis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191287/ Paxlovid Emergency Use Authorization https://labeling.pfizer.com/ShowLabeling.aspx?id=16474 Bebtelovimab Fact Sheet for Healthcare Providers https://www.fda.gov/media/156152/download Remdesivir Prescribing Information https://www.gilead.com/-/media/files/pdfs/medicines/covid-19/veklury/veklury_pi.pdf Evusheld Fact Sheet for Healthcare Providers https://www.fda.gov/media/154701/download New Diagnosis of Multiple Sclerosis in the Setting of mRNA COVID-19 Vaccine Exposure https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8656147/ COVID-19 in Patients With Neuromyelitis Optica Spectrum Disorders and Myelin Oligodendrocyte Glycoprotein Antibody Disease in North America: From the COViMS Registry https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8407145/ Neuro-Ophthalmologic Manifestations of Multiple Sclerosis https://emedicine.medscape.com/article/1214270-overview

Drs Anne Cross and Lauren Krupp talk about the latest research and their real-life experience identifying and treating cognitive dysfunction in patients with MS in the busy clinic setting. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/977030). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals. Resources Multiple Sclerosis https://emedicine.medscape.com/article/1146199-overview A Preliminary Validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) Tool in an Irish Population With Multiple Sclerosis (MS) https://www.msard-journal.com/article/S2211-0348(15)00111-X/fulltext Digital Cognitive Testing Uncovers Hidden Impairment in MS https://www.medscape.com/viewarticle/892482 MIND Diet Adherence Might Be Associated With a Reduced Odds of Multiple Sclerosis: Results From a Case-Control Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8857348/ Pediatric Multiple Sclerosis: Cognition and Mood https://n.neurology.org/content/87/9_Supplement_2/S82.long Experimental Autoimmune Encephalomyelitis (EAE) as a Model for Multiple Sclerosis (MS) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229753/ Cognitive Dysfunction in Early-Onset Multiple Sclerosis https://jamanetwork.com/journals/jamaneurology/fullarticle/780539