Pell, Dr. Volmer did mention Gilenya but not specifically restrictive lung issues that I can remember anyway. His talk, “Progressive MS: Time to Reassess? Time to Treat?” ended with 2 sets of conclusions, this is the second set, which deals primarily with exercise and activity:
- Protecting neurons and thus Brain Reserve is the most important goal in treating MS and the rate of Brain Atrophy the most important MRI Predictor of long term outcomes.
- Exercise and living an active life increase Brain Reserve and probably delay the onset of progressive MS.
- Activity (Cognitive and Physical) is the only proven reparative therapy in MS to date.
- We have to treat early and effectively to prevent loss of neurons in order to give the patient a chance to age normally- e.g. preserve neurons and thus Brain Reserve.
The first set of conclusions, which seemed to be being presented for scientific scrutiny and which are better understood in conjunction with the narrative, are:
- RRMS, SPMS and PPMS are the same disease.
- MS is a disease of neurons as much as it is a disease of meyelin.
- Loss of neurons is ultimately the major cause of disability.
- Loss of Brain Reserve explains the onset of progressive MS and explains why patients in the progressive phase have less capacity to recover function.
- Once patients have functionally exhausted their brain reserve, we cannot stop progression of disability because normal aging and deconditioning will cause further loss of function even if the inflammatory disease is halted.
- Inflammatory disease in MS is decreasing as a function of age for unknown reasons, therefore DMTs will have less effect in older patients.
- Selection of patients for DMTs should be based on evidence of ongoing CNS inflammation, not on phenotype.
- Allowing subclinical cerebral atrophy to proceed in young adults will most likely lead to earlier onset of age related disability.
The talk hasn’t come on line yet but I will post a link to it when it does. You can sign up to receive notice of it when it becomes available plus see some of their other presentations at:
http://www.youtube.com/themscenter
I really need to go get on the trainer for a little neural regeneration therapy now.
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