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Multiple Sclerosis (MS)
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Treatment for MS
There is as yet no cure for Multiple Sclerosis (MS). Many patients do well with no therapy at all, especially since many medications have serious side effects and some carry significant risks. Naturally occurring or spontaneous remissions make it difficult to determine therapeutic effects of experimental treatments - however, the emerging evidence that MRIs can chart the development of lesions is already helping scientists evaluate new therapies.
In the past, the principal medications physicians used to treat MS were steroids possessing anti-inflammatory properties - these include:
- Adrenocorticotropic Hormone (better known as ACTH)
- Prednisone
- Prednisolone
- Methylprednisolone
- Betamethasone
- Dexamethasone
Studies suggest that * intravenous (IV) methylprednisolone may be superior to the more traditional intravenous ACTH for patients experiencing acute relapses - no strong evidence exists to support the use of these drugs to treat progressive forms of MS. Also, there is some indication that steroids may be more appropriate for people with movement, rather than sensory, symptoms.
While steroids do not affect the course of MS over time, they can reduce the duration and severity of attacks in some patients. The mechanism behind this effect is not known - one study suggests the medications work by restoring the effectiveness of the * blood/brain barrier. Because steroids can produce numerous adverse side effects (acne, weight gain, seizures, psychosis), they are not recommended for long term use.
One of the most promising MS research areas involves naturally occurring antiviral proteins known as * interferons. Three forms of beta interferon (Avonex, Betaseron, and Rebif) have now been approved by the Food and Drug Administration for treatment of relapsing-remitting MS. Beta interferon has been shown to reduce the number of exacerbations and may slow the progression of physical disability. When attacks do occur, they tend to be shorter and less severe. In addition, MRI scans suggest that beta interferon can decrease * myelin destruction.
Investigators speculate that the effects of beta interferon may be due to the drug's ability to correct an MS-related deficiency of certain white blood cells that suppress the immune system and / or its ability to inhibit gamma interferon, a substance believed to be involved in MS attacks. Alpha interferon is also being studied as a possible treatment for MS. Common side effects of interferons include:
- Fever
- Chills
- Sweating
- Muscle aches
- * Fatigue
- Depression
- Injection site reactions
Scientists continue their extensive efforts to create new and better therapies for MS. Goals of therapy are threefold: to improve recovery from attacks, to prevent or lessen the number of relapses, and to halt disease progression. Some therapies currently under investigation are discussed below.
Are Any MS Symptoms Treatable?
While some scientists look for therapies that will affect the overall course of the disease, others are searching for new and better medications to control the symptoms of Multiple Sclerosis (MS) without triggering intolerable side effects.
Many people with MS have problems with spasticity, a condition that primarily affects the lower limbs. Spasticity can occur either as a sustained stiffness caused by increased muscle tone or as spasms that come and go, especially at night. It is usually treated with muscle relaxants and tranquilizers.
- Baclofen (Lioresal), the most commonly prescribed medication for this symptom, may be taken orally or, in severe cases, injected into the spinal cord.
- Tizanidine (Zanaflex), used for years in Europe and now approved in the United States, appears to function similarly to Baclofen.
- Diazepam (Valium), Clonazepam (Klonopin), and Dantrolene (Dantrium) can also reduce spasticity.
Although its beneficial effect is temporary, physical therapy may also be useful and can help prevent the irreversible shortening of muscles known as contractures. Surgery to reduce spasticity is rarely appropriate in MS.
Weakness and ataxia (incoordination) are also characteristic of MS. When weakness is a problem, some spasticity can actually be beneficial by lending support to weak limbs. In such cases, medication levels that alleviate spasticity completely may be inappropriate. Physical therapy and exercise can also help preserve remaining function, and patients may find that various aids-such as foot braces, canes, and walkers-can help them remain independent and mobile. Occasionally, physicians can provide temporary relief from weakness, spasms, and pain by injecting a drug called phenol into the spinal cord, muscles, or nerves in the arms or legs. Further research is needed to find or develop effective treatments for MS-related weakness and ataxia.
Although improvement of optic symptoms usually occurs even without treatment, a short course of treatment with intravenous methylprednisolone (Solu-Medrol) followed by treatment with oral steroids is sometimes used. A trial of oral prednisone in patients with visual problems suggests that this steroid is not only ineffective in speeding recovery but may also increase patients' risk for future MS attacks. Curiously, prednisone injected directly into the veins - at ten times the oral dose - did seem to produce short term recovery. Because of the link between * optic neuritis and MS, the study's investigators believe these findings may hold true for the treatment of MS as well. A follow up study of optic neuritis patients will address this and other questions.
Fatigue, especially in the legs, is a common symptom of MS and may be both physical and psychological. Avoiding excessive activity and heat are probably the most important measures patients can take to counter physiological fatigue. If psychological aspects of fatigue such as depression or apathy (a lack of emotion or interest, without feeling) are evident, antidepressant medications may help. Other drugs that may reduce fatigue in some, but not all, patients include amantadine (Symmetrel), pemoline (Cylert), and the still - experimental drug aminopyridine.
People with MS may experience several types of pain. Muscle and back pain can be helped by aspirin or acetaminophen and physical therapy to correct faulty posture and strengthen and stretch muscles. The sharp, stabbing facial pain known as trigeminal neuralgia is commonly treated with carbamazapine or other anticonvulsant drugs or, occasionally, surgery. Intense tingling and burning sensations are harder to treat. Some people get relief with antidepressant drugs, others may respond to electrical stimulation of the nerves in the affected area. In some cases, the physician may recommend codeine.
As the disease progresses, some patients develop bladder malfunctions. Urinary problems are often the result of infections that can be treated with antibiotics. The physician may recommend that patients take vitamin C supplements or drink cranberry juice, as these measures acidify urine and may reduce the risk of further infections. Several medications are also available. The most common bladder problems encountered by MS patients are urinary frequency, urgency, or incontinence. A small number of patients, however, retain large amounts of urine. In these patients, catheterization may be necessary. In this procedure, a catheter or drainage tube is temporarily inserted (by the patient or a caretaker) into the urethra several times a day to drain urine from the bladder. Surgery may be indicated in severe, intractable cases. Scientists have developed a "bladder pacemaker" that has helped people with urinary incontinence in preliminary trials. The pacemaker, which is surgically implanted, is controlled by a hand held unit that allows the patient to electrically stimulate the nerves that control bladder function.
MS patients with urinary problems may be reluctant to drink enough fluids, leading to constipation. Drinking more water and adding fiber to the diet usually alleviates this condition. Sexual dysfunction may also occur, especially in patients with urinary problems. Men may experience occasional failure to attain an erection. Penile implants, injection of the drug papaverine, and electrostimulation are techniques used to resolve the problem. Women may experience insufficient lubrication or have difficulty reaching orgasm - in these cases, vaginal gels and vibrating devices may be helpful. Counseling is also beneficial, especially in the absence of urinary problems, since psychological factors can also cause these symptoms. For instance, depression can intensify symptoms of fatigue, pain, and sexual dysfunction. In addition to counseling, the physician may prescribe antidepressant or antianxiety medications. Amitriptyline is used to treat laughing / weeping syndrome.
Tremors are often resistant to therapy, but can sometimes be treated with drugs or, in extreme cases, surgery. Investigators are currently examining a number of experimental treatments for tremor.
Definitions For This Page - In Alphabetical Order
* Blood/Brain Barrier
Blood/Brain Barrier is a membrane that controls the passage of substances from the blood into the central nervous system.
* Fatigue
Fatigue is tiredness that may accompany activity or may persist even without exertion.
* Interferon
Pronounced - in-ter-FEER-on
Interferon is a biological response modifier (a substance that can improve the body's natural response to infections and other diseases). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and -gamma. The body normally produces these substances. They are also made in the laboratory to treat cancer and other diseases.
* Intravenous (IV)
Pronounced - IN-truh-VEE-nus
Intravenous, or IV, usually refers to a way of giving a drug or other substance through a needle or tube inserted into or within a vein.
* Myelin
Pronounced - MY-eh-lin
Myelin is a fatty covering insulating nerve cell fibers in the brain and spinal cord, myelin facilitates the smooth, high-speed transmission of electrochemical messages between these components of the central nervous system and the rest of the body. In Multiple Sclerosis (MS), myelin is damaged through a process known as demyelination, which results in distorted or blocked signals.
* Optic Neuritis
Optic Neuritis is an inflammatory disorder of the optic nerve that usually occurs in only one eye and causes visual loss and sometimes blindness. It is generally temporary.
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References:
NIH Publication No. 96-75
September 1996
www.ninds.nih.gov
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