1. Hot Topics

2. What’s new? Oral therapies; • Cladribine • Fingolimod • Fampridine • Sativex MS related guidelines Publications Websites

3. Cladribine • is a licensed cytotoxic agent for hairy cell leukaemia, license for MS expected 2011 • reduces or eliminates many cell types involved in MS e.g. T cells and B cells • reduces relapse rate by 58% (CLARITY study 2010) • dose dependant on weight • yearly course - taken once daily for 5 consecutive days repeated after four weeks • treatment for two years • has significant side effects including serious infections and raised risk of cancer

4. Fingolimod • licence expected 2011 • retains circulating lymphoctes in the lymph nodes • has anti inflammatory properties by reducing infiltrating T cells and macrophages in CNS • taken daily 0.5mg reduces, relapse rate by 54% (FREEDOM study 2010) • can cause reduction in lymphocytes • other side effects include bradycardia with first dose, cardiac irregularities, opportunistic infections, may predispose to malignancies especially skin cancers, macular oedema

5. Fampridine (Ampyra) • Potassium channel blocker • Improves function of demyelinated axons • Improves walking speed • High dose causes seizure • Can be used in conjunction with disease modifying therapies • Contraindications – history of seizure, renal insufficiency

6. Sativex • cannabis based treatment administered as sub lingual spray • full license expected 2010 • indications; second line treatment for spasticity, not likely to be licensed for pain • Side effects include sedation, neuropsychiatric effects, dizziness, fatigue, mucosal irritation

7. New Guidelines • Functional stimulation for foot drop of central neurological origin (NICE 2009) • UK consensus on the management of the bladder in MS (Fowler, C. J. et al 2009) • Neuropathic Pain: the pharmacological management of neuropathic pain in adults in non specialist settings (NICE 2010)

8. What’s new • MS Trust publication; MS and me (a self management guide to living with MS) • www.stayingsmart.org.uk (online resource for managing cognitive impairment) • www.shift.ms (website aimed at young people with MS)