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Multiple Sclerosis is a chronic neurologic disease which causes a variety
of neurologic symptoms, including but not limited to weakness, numbness,
blindness, or dizziness. While there are no known cures for the disease,
the drugs developed over the last 10-15 years have markedly improved
the prognosis for patients with this disease. Many patients can now lead
a normal life, albeit while having to take medications. The diagnosis
of MS can be often relatively complicated and therefore should only be
made by experienced neurologists. The following pages will briefly review
the diagnostic tests and treatments for patients with MS.
Multiple sclerosis is a chronic disease of the nervous system, which
involves loss of the protective covering of nerves (called myelin). Symptoms
are varied but reflect damage to any part of the central nervous system.
Therefore patients can experience visual disturbances, weakness, abnormal
sensation and balance difficulties. There are several types of the disease:
1) relapsing-remitting: a form in which patients experience discrete
attacks interspersed with periods of little to no disease activity. 2)primary-progressive:
in which patients experience a slow a constant decline from the time
the disease starts, 3)secondary-progressive: in which patients start
as a relapsing remitting form and over 10-20 years start to slowly and
progressively decline without having discrete attacks anymore.
is diagnosed by a combination of a patient’s clinical history, neurologic
exam and laboratory testing. MRI scans of the brain show areas of the
brain involved with the inflammation, and these areas are known as white
matter lesions. In some cases the changes seen on MRI are so specific
that the disease can be diagnosed by this test alone. However, many people
have these white matter lesions and do not have MS. Therefore we may
need to use other testing. One of the other tests which is very helpful
is a lumbar puncture, or spinal tap. This relatively simple test allows
us to look at disease activity in the spinal fluid. Electrodiagnosis
is sometimes used to help in making the diagnosis of multiple sclerosis.
A special electrodiagnostic test known as visual evoked potentials are
used to study the quality of the main nerve that controls vision (the
optic nerve). Multiple sclerosis often affects the optic nerve and visual
evoked potentials are usually helpful in detecting these abnormalities.
There has been much research into the cause of this disease. Various
theories including viral and environmental have been proposed without
any confirmatory evidence. What is believed is that a person’s immune
system, which is supposed to fight bacteria and viruses and preserve
one’s health goes awry and starts to attack the myelin coating around
the nerves of the brain, optic nerves, and spinal cord.
There are a variety of FDA approved drugs to treat this disease. All
of these agents have been shown to slow down the progression of the disease
and to reduce the number of attacks. Each of these agents alter the
function of the patient’s immune system.
For relapsing remitting MS there
are six FDA approved agents. Three of these drugs are interferons which
is a chemical our body naturally makes during the course of an infection.
These are delivered as injections and include B-seron, Rebif, and Avonex
and Extario. Most of the people who takes these drugs have some side
effects but they are usually manageable. The other class of drug for
relapsing remitting MS is copaxone. Copaxone is a small piece of ther
myelin molecule which is injected daily. The last drug is given as an
infusion, called Tysabri.
There is a 1 in 100 chance of developing a severe
brain infection but otherwise this medication is well tolerated.
For secondary Progressive MS a chemotherapy agent, Mitoxantrone, has
been shown to slow down the progression of the disease as well.
agents are used in some cases including IVIG (Gammaglobulin), plasmaphresis,
or other chemotherapy drugs. However none of these agents have FDA approval.
are also numerous drugs available to help control the symptoms of MS,
even if we cannot reverse the damage. Pain, numbness, dizziness, incontinence,
and fatigue are very common symptoms in MS and all of these have effective
drugs that can improve these symptoms. Because of this it is important
to follow with neurologists who are accustomed to treating MS. We have
developed a special multidisciplinary clinic dedicated to helping patients
manage the symptoms of MS.
MS Clinical Trials
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Living Well With MS
There’s living with Multiple Sclerosis. And there’s living well with
Taking the right medication for you is only part of
treating your multiple sclerosis. Diet, fitness, stress relief — these
things matter to your overall health, too. When done properly, they may
make a big difference in helping you live a fuller life with multiple
Live well. Stay active. That’s MS Active Wellness. Visit the MS Active
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