Multiple Sclerosis (cont.)
How is multiple sclerosis diagnosed?
Due to the broad range and subtleties of symptoms, multiple sclerosis may not be diagnosed for months to years after the onset of symptoms. Physicians, particularly neurologists, take detailed histories and perform complete physical and neurological examinations.
- MRI (magnetic resonance imaging) scans with intravenous gadolinium helps to identify, describe, and in some instances date lesions in the brain (plaques).
- An electro-physiological test, evoked potentials, examines the impulses traveling through the nerves to determine if the impulses are moving normally or too slowly.
- Finally, examining the cerebro-spinal fluid that surrounds the brain and spinal cord may identify abnormal chemicals (antibodies) or cells that suggest the presence of
multiple sclerosis.
Collectively, these three tests help the physician in confirming the diagnosis of
multiple sclerosis. For a definite diagnosis of multiple sclerosis, dissemination in time (at least two separate symptomatic events or changes on MRI) and in anatomical space (for
example, within the central nervous system) must be demonstrated.
How is multiple sclerosis treated?
There are many issues for the patient and physician to consider in treating
multiple sclerosis. Goals may include reducing the number of attacks, improving recovery from attacks, and attempting to slow further progression of the disease (treatment with disease-modifying drugs). An additional goal is relief from complications due to the loss of function of affected organs (treatment with drugs aimed at specific symptoms). Most neurologists will consider treatment with disease-modifying drugs once the diagnosis of
multiple sclerosis is established. Many will begin treatment at the time of the first
multiple sclerosis attack, since clinical trials have suggested that patients in whom treatment is delayed may not benefit as much as patients who are treated early. Finally, utilizing support groups or counseling may be helpful for patients and their families whose lives may directly be affected by
multiple sclerosis.
Once goals have been set, initial therapy may include medications
to manage attacks, symptoms, or both. An understanding of the
potential side effects of drugs is critical for the patient because
sometimes side effects alone deter patients from drug therapy.
Patients may choose to avoid drugs altogether or choose an
alternative drug that may offer relief with fewer side effects. A
continuous dialogue between the patient and physician about the
medications is important in determining the needs for treatment.
Drugs known to affect the immune system have become the primary focus for managing
multiple sclerosis. Initially, corticosteroids, such as prednisone
(Deltasone, Liquid Pred, Deltasone, Orasone, Prednicen-M) or methylprednisolone
(Medrol, Depo-Medrol), were widely used. However, since their effect on the immune system is non-specific and their use may cause numerous side effects, corticosteroids now tend to be used to manage only sudden, severe
multiple sclerosis attacks.
Interferon
Since 1993, medications that alter the immune system, particularly interferons, have been used to manage
multiple sclerosis. Interferons are protein messengers that cells of the immune system manufacture and use to communicate with one another. There are different types of interferons, such as alpha, beta, and gamma. All interferons have the ability to regulate the immune system and play an important role in protecting against viral infections. Each interferon functions differently, but the functions overlap. The beta interferons have been found useful in managing
multiple sclerosis. Interferon beta-1b (Betaseron®) was the first interferon approved to manage RR-MS in 1993. In 1996, interferon beta-1a (Avonex®) gained FDA approval for RR-MS.
Overall, patients treated with interferons experience fewer relapses or a longer interval between relapses. Clinical trials have also shown effects on slowing the accumulation of disability. The most common side effect is a flu-like syndrome that includes fever, tiredness, weakness, chills, and muscle aches. This syndrome tends to occur less frequently as therapy continues. Other common side effects are injection site reactions, changes in blood cell counts, and abnormalities of liver tests. Regular
liver tests and
blood counts are recommended for patients receiving interferon beta-1b. With the concomitant use of analgesics and local skin measures, the tolerability to interferons has increased.
Clinical trials of interferon beta drugs in patients with the first attack of
multiple sclerosis showed that in this early patient population, these drugs delay the onset of the second attack. Avonex® is administered intramuscularly once a week, Betaseron® is administered subcutaneously every other day, and Rebif® is administered subcutaneously three times per week.
Available interferon betas include:
IFN beta-1b (Betaseron®) that is used for the treatment of relapsing forms of multiple sclerosis, to reduce the frequency of clinical relapses. Patients with multiple sclerosis in whom efficacy has been demonstrated include patients who have experienced a first clinical episode and have MRI features consistent with multiple sclerosis.
IFN beta-1a (Rebif®) that is used for the treatment of patients with relapsing forms of multiple sclerosis to decrease the frequency of clinical relapses and delay the accumulation of physical disability. Efficacy of Rebif® in chronic progressive multiple sclerosis has not been established.
IFN beta-1a (Avonex®) that is used for the treatment of patients with relapsing forms of multiple sclerosis to slow the accumulation of physical disability and decrease the frequency of clinical relapses. Patients with multiple sclerosis in whom efficacy has been demonstrated include patients who have experienced a first clinical episode and have MRI features consistent with multiple sclerosis. Safety and efficacy in patients with chronic progressive multiple sclerosis has not been established.
Next: Other medications »
- interferon - Describes the medication interferon (Roferon-A, Intron-A, Rebetron, Alferon-N, Peg-Intron, Avonex, Betaseron, Infergen, Actimmune, Pegasys), a drug used in managing many diseases that involve the immune system.
- MRI (Magnetic Resonance Imaging Scan) - Medical information on magnetic resonance imaging (MRI) used in detecting structural abnormalities of the body. Learn uses, risks, and how to prepare for an MRI scan
- Muscle Spasms - Read about muscle spasms, their causes, diagnosis, treatment and prevention. Symptoms and signs include acute pain at the site of the muscle contractions (twitches or fasciculations).
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