Multiple sclerosis

Multiple sclerosis (MS) is a non-contagious chronic disease of the brain and spinal cord characterized by a variety of neurologic symptoms caused by demyelination of neurons. Multiple sclerosis results from attack by a patient's own immune system on their central nervous system and is thus categorized as an autoimmune disease.

Treatment

There is no known definitive cure for multiple sclerosis. However, several therapies have proven to be effective in its treatment. Different therapies are employed in different settings such as for patients experiencing acute attacks, for patients who have relapsing-remitting subtype, for patients who have the progressive subtypes, for patients without the diagnosis of MS who have a demyelinating event, and for management of the comorbid consequences of MS attacks. Treatment is aimed at returning function after an attack, preventing new attacks, and preventing disability.

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• Management of acute attacks

:During symptomatic attacks, patients are often hospitalized. They are typically given high doses of corticosteroids such as methylprednisolone intravenously for several days to increase the chances that the attack will end sooner and leave fewer lasting deficits. There is some support for oral (pills) steroids during an attack, but clinical practice varies. There is no data supporting steroids for prevention of MS after an initial attack.

Related Topics:
Hospital - Corticosteroid - Intravenous

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• Management of relapsing-remitting MS

:There are five FDA approved treatments for patients with relapsing-remitting MS. Three are interferons: Interferon beta-1a (Avonex and Rebif) or beta-1b (Betaseron ). The interferons are medications derived from human cytokines which help regulate the immune system. A fourth medication is glatiramer acetate (Copaxone), a mixture of polypeptides which are thought to protect important myelin proteins by substituting themselves as the target of attack from the immune system. The final medication, mitoxantrone is effective but is limited by cardiac toxicity. All five medications have been proven to be modestly effective at decreasing the number of attacks and slowing progression to disability. They differ primarily in ease of use, price, side effects, and likelihood that extended use will decrease their effects. All of the therapies are expensive and require frequent injections, with Avonex requiring weekly dosages and Copaxone daily. All of the interferons can lose effectiveness after continued use, with Avonex being the least likely and Betaseron the most likely. The interferons require monitoring blood work. Even with appropriate therapy, most patients with relapsing-remitting MS still suffer from some degree of attacks and subsequent disability. Side effects are covered below.

Related Topics:
FDA - Interferon - Interferon beta-1a - Avonex - Rebif - Beta-1b - Betaseron - Medication - Human - Cytokine - Glatiramer acetate - Copaxone - Polypeptides - Immune system - Mitoxantrone - Cardiac - Toxicity - Injection

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• Management of progressive MS

:Treatment of progressive MS is more difficult than relapsing-remitting MS and many patients do not respond to any therapy. A wide range of medications have been employed to slow the progression of disease; many therapies have been shown to have some effect on disease progression and resulting disability. Most therapies have significant side effects which limit their long-term use and are often appropriate only for the most aggressive cases. Azathioprine, cladribine, and cyclosporine have all shown small benefits which in each case are outweighed by side effects such as increased cancer risk. Mitoxantrone offers significant reduction in progression to disability, but causes dose-dependant cardiac toxicity which limits its long-term use. Natalizumab showed promise in early trials but has been withdrawn from the market in the United States because of association with progressive multifocal leukoencephalopathy. Bone marrow transplant, plasmapheresis, and total lymphoid irradiation (exposure to high doses of radiation in order to kill parts of the immune system) have been studied and are currently reserved for the most dire cases. Cyclophosphamide and methotrexate are commonly used and effective chemotherapeutics with a number of side effects which are outweighed by their ability to slow the progression of MS. Frequent courses of high dose steroids (weekly or monthly) are also commonly employed to good effect. Interferons show promise in secondary progressive MS, but more data is needed to support wide-spread use.

Related Topics:
Azathioprine - Cyclosporine - Side effect - Cancer - Mitoxantrone - Cardiac - Toxicity - Natalizumab - United States - Progressive multifocal leukoencephalopathy - Bone marrow transplant - Plasmapheresis - Immune system - Cyclophosphamide - Methotrexate - Chemotherapeutics - Interferon

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• Management of demyelination without a diagnosis of MS

:Several studies have shown that starting treatment with interferon (Avonex or Rebif) during the initial attack (ie prior to the second attack required for definite diagnosis of MS) increases the chance that a patient will not develop MS. A separate medication, intravenous immunoglobulin (IVIG) has also shown promise in reducing progression to MS in this set of patients. Thus, it is important that therapy be started prior to definite diagnosis in certain patients.{{an|Jacobs}}{{an|Comi}}

Related Topics:
Interferon - Avonex - Rebif - Intravenous immunoglobulin

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• Management of the effects of MS

:In light of the current irreversibility of much of the damage caused by MS, management of the resultant deficits is of primary importance. As with any patient with neurologic deficits, a multi-disciplinary approach is key to limiting and overcoming disability. Physical therapy, occupational therapy, and speech therapy are all important components to a comprehensive approach to maintaining quality of life. Treatment of emotional distress and depression should involve mental health professionals such as therapists,psychologists, psychiatrists. Neurocognitive testing is important for determining the extent of cognitive deficits. Management of cognitive defects relies on lifestyle strategies, but also may respond to donepezil. Baclofen, tizanidine, and Sativex, have all been shown to improve spasticity. Depression can be treated with a variety of anti-depressants; selective serotonin reuptake inhibitors (SSRIs) are most commonly employed. The anticonvulsant drugs gabapentin and carbamazepine and the antidepressant amitriptyline can improve pain and tingling sensations in certain cases. Fatigue can often be managed by amantadine, pemoline, methylphenidate, and modafinil. Bladder spasms can be treated by oxybutynin and trospium chloride. Erectile dysfunction my respond to sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis).

Related Topics:
Physical therapy - Occupational therapy - Speech therapy - Therapist - Psychologist - Psychiatrist - Neurocognitive - Cognitive - Donepezil - Baclofen - Tizanidine - Sativex - Spasticity - Depression - Selective serotonin reuptake inhibitor - Anticonvulsant - Gabapentin - Carbamazepine - Amitriptyline - Amantadine - Pemoline - Methylphenidate - Modafinil - Sildenafil - Vardenafil - Tadalafil

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Therapies under investigation

• A family of cholesterol-lowering drugs, the statins, have shown anti-inflammatory effects in animal models of MS. However, so far there has not been provided sufficient evidence that statins are beneficial in the treatment of human MS patients with normal cholesterol levels.
• A recent study found that women who took vitamin D supplements were 40% less likely to develop multiple sclerosis than women who did not take supplements. However, this study does not provide enough data to conclude that vitamin D has a beneficial influence on ongoing MS. Furthermore it could not distinguish between a beneficial effect of vitamin D and multivitamin drugs including vitamin E and various B vitamins which may also exert a protective effect.(Munger, et. al., 2004)
• Low-dose-naltrexone (LDN) has been reported to reduce the rate of progression and relapse rate in MS, however evidence is so far principally based on patient reports and no formal studies have confirmed its effectiveness so far (as of 2005).
• Research in Sweden has suggested some forms of MS are linked to a rare allergic reaction to mercury in dental fillings. Replacing amalgam with ceramic substitute has been shown to halt or reverse symptoms in patients, who can be tested for allergy to dental metals with a test named MELISA.http://www.melisa.org/ms/msmetalallergy.html

Side effects of medications used to treat relapsing-remitting MS

The two most common types of medications used to treat relapsing-remitting MS have serious side effects which warrant further discussion. Both the interferons and glatiramer acetate are available only in injectable forms and can both cause irritation at the site of injection. Interferons are produced in the body during illnesses such as influenza in order to help fight the infection. They are responsible for the fever, aching, fatigue and headache headache common in influenza infection. Many patients report a similar constellation of symptoms when using interferon to fight MS. Although the reaction often lessens over time and can be treated with paracetamol or ibuprofen, many patients choose not to take interferon as a result, citing a loss in their quality of life. Additionally, interferon can cause liver damage and blood work must be done to ensure safe use. Patients taking glatiramer acetate often experience a "post-injection" reaction manifested by flushing, chest tightness, heart palpitations, breathlessness, and anxiety.

Related Topics:
Medication - Interferon - Glatiramer acetate - Influenza - Infection - Fever - Aching - Fatigue - Headache - Symptom - Paracetamol - Ibuprofen - Liver - Palpitation

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