Central nervous system

MULTIPLE SCLEROSIS (MS)

The Problem

Multiple sclerosis is an autoimmune, inflammatory and demyelination disease that affects the Central Nervous System - that is the fatty myelin sheaths around the axons of the brain and spinal cord are damaged. More than2.5 million people in this world are estimated to beaffected by MS. MS usually affects people between the ages of 20 and 50 years, but any group can be affected. Women are more than twice as likely to develop MS as men. MS can cause a variety of symptoms, including changes in sensation, visual problems, muscle weakness, depression, difficulties with coordination and speech, severe fatigue, cognitive impairment, problems with balance, overheating, pain and sometimes hearing loss. [3] Principally, it is a disease of the "white matter" which is made up of nerve fibres. The "white matter" is responsible for transmitting communication signals both internally within the Central Nervous System and between the Central Nervous System and the nerves supplying rest of the body. If the myelin is disrupted in any way, the transmitted information is not only delayed, but it may also be misinterpreted by the brain. However nowadays, the actual causes still unknown. MS can be treated, but never be cured. So what are the current available treatments to help relieve the disorder symptoms?

A Possible Solution

Medications

There are several treatment choices for Multiple sclerosis. The three major drugs previously approved by FDA for the treatment of MS are known as ABC drugs. None of these drugs is a cure, but they can slow disease progression in many patients. Avonex and Betaseron are forms of the immune system protein beta interferon, while Copaxone is glatiramer acetate. All three have been shown to reduce the rate of relapses in the relapsing-remitting form of MS. Avonex may slow the progress of physical impairment, Betaseron may reduce the severity of symptoms, and Copaxone may decrease disability. All three drugs are administered by injection. [2]

Although the ABC drugs help to stop relapses and probably may keep patients in relatively good health for the short-term, but their long-term success has not been proven. Besides that, they don't work well for patients who have reached a steadily progressive stage of MS. [2] For the time being, new approaches to using current therapies are being researched especially using combinations of different types of agents when one agent alone is not effective. Clinical trials are now evaluating the safety and efficacy of combining cyclophosphamide (Cytoxan) and methylprednisolone (Medrol) in patients who do not respond to the ABC drugs, and of adding mitoxantrone (Novantrone), prednisone (Prelone), azathioprine (Imuran), or methotrexate (Rheumatrex) to betainterferon for further benefit. [1]

In addition, Miloxzantrone HCI (novantrone), a drug approved for cancer treatment, has been approved for treating patients with advanced or chronic multiple sclerosis. BUT, they may make people with multiple sclerosis very ill, especially if not used with caution. In clinical trials, mitoxantrone is a chemotherapy agent reduced the number of relapse episodes and slowed down the disease. Reserved for progressive forms of MS, it is given intravenously to help maintain mobility and reduce the number of flare-ups. However, there are serious side effects with the drug including heart problems, nausea, and hair thinning. [9]

Training in bowel and bladder care may be needed to prevent or compensate for incontinence. If the urge to urinate becomes great before the bladder is full, some drugs may be helpful, including propantheline bromide (Probanthine), oxybutynin chloride (Ditropan), or imipramine (Tofranil). Baclofen (Lioresal) may relax the sphincter muscle, allowing full emptying. Intermittent catheterization is effective in controlling bladder dysfunction. In this technique, a catheter is used to periodically empty the bladder. [2]

Fatigue may be partially avoidable with changes in the daily routine to allow more frequent rests. Amantadine (Symmetrel) and pemoline (Cylert) may improve alertness and lessen fatigue. Visual disturbances often respond to corticosteroids. Other symptoms that may be treated with drugs include seizures, vertigo, and tremor. Myloral, an oral preparation of bovine myelin, has recently been tested in clinical trials for its effectiveness in reducing the frequency and severity of relapses. Preliminary data indicate no difference between it and placebo. However, new research and treatment methods are currently being investigated and are expected to offer some hope to people with multiple sclerosis nowadays. [5]

Social and Economic Implications

It is difficult to predict how multiple sclerosis will progress in any one person. Most people with MS will be able to continue to walk and function at their work for many years after their diagnosis. Sometimes, some people do not believe that they are ill, and refuse to adhere to treatment. If their thinking is too disorganized, they possibly forget to take their medications on time which will lead to undesirable effect on their health later. The factors associated with the mildest course of MS are being female, having the relapsing-remitting form, having the first symptoms at a younger age, having longer periods of remission between relapses, and initial symptoms of decreased sensation or vision rather than of weakness or incoordination. [4] Patients need take medications because the drugs do work on their illness, however with some side effects but they are getting better from this terrible illness.

Benefits and Risks

Although there is no known cure for multiple sclerosis, several therapies have proven helpful. The primary aims of therapy are returning function after an attack, preventing new attacks, and preventing disability. As with any medical treatment, medications used in the management of MS have several adverse effects on patients' health. [8]

Multiple Sclerosis causes a large variety of symptoms, and the treatments for these are equally diverse. Most symptoms can be treated and complications avoided with good care and attention from medical professionals. For an example, Vaccination against influenza can prevent respiratory complications, and contrary to earlier concerns, is not associated with worsening of symptoms. Preventing complications such as pneumonia, bed sores, injuries from falls, or urinary infection requires attention to the primary problems which may cause them. [6] Shortened life spans with MS are almost always due to complications rather than primary symptoms themselves. Moreover, people do get better after proper treatment, thus can have a chance to lead rewarding and meaningful lives in communities again. So, take medications can enhance a quality of life.

A number of treatments that may curtail attacks or improve function are still under investigation. Some of these treatments involve the combination of drugs that are already in use for multiple sclerosis, such as the joint administration of mitoxantrone and glatiramer acetate (Copaxone). However, most treatments already in clinical trials involve drugs that are used in other diseases. [1] These are alemtuzumab (trade name Campath), daclizumab (trade name Zenapax), inosine, BG00012, fingolimod, and teriflunomide, the active metabolite of the DMARD leflunomide. Alemtuzumab performed better than interferon beta-1a in relapsing-remitting MS reducing disability, imaging abnormalities and frequence of relapses, at the cost of increased autoimmunity problems. [3] Nevertheless, the side effects of this medication are still not known but may probably cause the people with MS become worsen.

On the other hand, it is a common for people worldwide to take medications only for daily functioning without adhere to other treatments including therapy. Sometimes, people always gives miniature reasons such as forgetting to take the medication, feeling that the medication is unnecessary perhaps due to disliking the resulting side effects of those drugs. Thus, the risk of relapse of symptoms may increase and cause repeated hospitalization.

Alternative Solutions

There is no known definitive and best cure for multiple sclerosis. Nonetheless, several types of therapy have proven by FDA to be helpful. Different therapies are used for patients experiencing acute attacks, for patients who have the relapsing-remitting subtype, for patients who have the progressive subtypes, for patients without a diagnosis of MS who have a demyelinating event, and for managing the various consequences of MS attacks. [7]

Some studies support the value of high doses of vitamins, minerals, and other dietary supplements for controlling disease progression or improving symptoms. Alpha-linoleic and linoleic acids, as well as selenium and vitamin E, have shown effectiveness in the treatment of MS. [2] The selenium and vitamin E act as antioxidants. In addition, the Swank diet (low in saturated fats), maintained over a long period of time, may retard the disease process. [7] Studies have also shown that t'ai chi can be an effective therapy for MS because it works to improve balance and increase strength. Besides that, people with MS need to take daily food according to the food pyramid for healthy lifestyle.

Relapsing-remitting symptomatic attacks can be treated. Patients are typically given high doses of intravenous corticosteroids, such as methylprednisolone, to end the attack sooner and leave fewer lasting deficits. [9] Patients' self-reporting indicates that many find benefit from a number of other medicines. Currently there are no approved treatments for primary progressive multiple sclerosis, though several medications are being studied and undergoing investigation.

Evaluation

At this time, multiple sclerosis is incurable, although there is research taking place globally in an effort to find a treatment that will slow down the progression of this illness. In the meantime, there are a number of options which may make life more supportable. Some doctors prescribe ACTH, a steroid that accelerates the healing actions of the body to treat the symptoms of MS throughout life. Normally, treatments are being done to return the normal function after an attack, preventing new attacks, and preventing disability.

Though there is no scientific evidence that special diets are beneficial, anecdotal evidence suggests that diets such as gluten free diets or those low in animal fats do lend a hand. [1] Many people with MS seek out alternative therapies to relieve their symptoms. This may include acupuncture, homeopathy and yoga. For each person, the answer may be different and though MS has no cure, it is important for the sufferer to find a positive way of living with this illness. There is no known way to cure MS nowadays but we can still prevent it from become worse. Until the cause of the disease is discovered, this is unlikely to change. Good nutrition; adequate rest; avoidance of stress, heat, and extreme physical exertion; and good bladder hygiene may improve quality of life and reduce symptoms. [5]

Physical therapy helps the person with MS to strengthen and retrain affected muscles; to maintain range of motion to prevent muscle stiffening; to learn to use assistive devices such as canes and walkers; and to learn safer and more energy-efficient ways of moving, sitting, and transferring. [14]

Moreover, exercise and stretching programs are usually designed by the physical therapist and taught to the patient and caregivers for use at home. Exercise is an important part of maintaining function for the person with MS. Swimming is often recommended, not only for its low-impact workout, but also because it allows strenuous activity without overheating. [8] In a conclusion, MS sufferers must change their mindsets to a positive thinking that even they have MS illness; they still can live a good life.

Bibliography
  1. http://www.emedicinehealth.com/multiple_sclerosis/article_em.htm
  2. http://medical-dictionary.thefreedictionary.com/Multiple+Sclerosis
  3. http://health.moonlightchest.com/multiple_sclerosis.asp
  4. http://www.mymultiplesclerosis.gr/
  5. http://www.webmd.com/multiple-sclerosis/guide/multiple-sclerosis-overview-facts
  6. http://www.mayoclinic.com/health/multiple-sclerosis/DS00188
  7. http://www.knowledgebase-script.com/demo/article-762.html
  8. http://www.neurologychannel.com/multiplesclerosis/index.shtml
  9. http://www.pactrims2008.org/15-factors-suspected-of-causing-multiple-sclerosis
  10. http://www.medicinenet.com/multiple_sclerosis/article.htm
  11. http://en.wikipedia.org/wiki/Multiple_sclerosis
  12. http://www.mult-sclerosis.org/research.html
  13. http://thestar.com.my/health/story.asp?file=/2009/5/27/health/3955869&sec=health
  14. http://www.mult-sclerosis.org/whatisms.html
  15. http://www.mymultiplesclerosis.co.uk/index.html
  16. http://www.ninds.nih.gov/disorders/multiple_sclerosis/multiple_sclerosis.htm
  17. http://thestar.com.my/health/story.asp?file=/2006/3/5/health/13565882&sec=health
  18. http://emedicine.medscape.com/article/1146199-overview
  19. http://www.knowledgebase-script.com/demo/export.php?ID=762&type=PDF
  20. http://www.pmcare4u.com.my/html/jan09.html
  21. The Multiple Sclerosis Diet Book by R.L. Swank and B.B. Dugan, 1987
  22. Multiple sclerosis: the history of a diseaseBy T. J. Murray
  23. Facing the Cognitive Challenges of Multiple Sclerosis By Jeffrey N. Gingold
  24. Living with multiple sclerosis: a wellness approach By George H. Kraft, Marci Catanzaro

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