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  • Image not available. The etiology of multiple sclerosis (MS) is unknown, and currently there is no cure.
  • Image not available.Multiple sclerosis is characterized by central nervous system demyelination and axonal damage, and appears to be autoimmune in nature.
  • Image not available. Multiple sclerosis is classified by the nature of progression over time into several categories which have different clinical presentations and responses to therapy.
  • Image not available. Diagnosis of MS requires evidence of dissemination of lesions over time and in multiple parts of the central nervous system and/or optic nerve, and is made primarily on the basis of clinical symptoms and examination. Diagnostic criteria also allow for the use of magnetic resonance imaging, spinal fluid evaluation, and evoked potentials to aid in the diagnosis.
  • Image not available. Acute exacerbations or relapses of MS can be disabling. When this is the case, acute exacerbations and relapses are treated with high-dose glucocorticoids, such as methylprednisolone, intravenously, with onset of clinical response typically within 3 to 5 days.
  • Image not available. Treatment of relapsing-remitting MS with the disease-modifying therapies (DMTs) interferon β (Avonex, Betaseron, Rebif, Extavia), glatiramer acetate (Copaxone), natalizumab (Tysabri), mitoxantrone (Novantrone) and fingolimod (Gilenya) can reduce annual relapse rate, lessen severity of relapses, slow progression of changes on magnetic resonance imaging scans, slow progression of disability, and slow cognitive decline. In addition, they have been shown to reduce the likelihood of developing a second attack after a first clinically isolated syndrome consistent with MS.
  • Image not available. In most cases, treatment with DMTs should begin promptly after the diagnosis of relapsing-remitting MS, or after a clinically isolated syndrome if the brain magnetic resonance imaging is suggestive of high risk of further attacks. Natalizumab, and other choices that have been associated with problematic adverse events, should be reserved for those patients who have failed one or more standard therapies and those with poor prognostic signs.
  • Image not available. The definition of treatment inadequacy for relapsing-remitting MS remains unclear, and therapy changes after “treatment failure” should be individualized.
  • Image not available. Although studies do not support the general use of any of the FDA-approved DMTs in patients with progressive forms of the illness, information derived from multiple studies suggests younger patients with progressive illness and those with either superimposed acute relapses or enhancing lesions on magnetic resonance imaging scans may benefit from some of the presently used DMTs.
  • Image not available. Patients suffering with MS frequently have symptoms such as spasticity, bladder dysfunction, fatigue, neuropathic pain, cognitive dysfunction, and depression that can require treatment. Patients must be counseled that therapies such as interferon β and glatiramer acetate will not relieve these symptoms. Depression is common in MS and can pose the risk of suicide.

Upon completion of the chapter, the reader will be able to:

  • 1. List four risk factors for multiple sclerosis (MS).
  • 2. Describe the etiology and pathophysiology of MS.
  • 3. Explain the concept of T-cell differentiation and plasticity in MS.
  • 4. Counsel a patient with MS on the goals of medication therapy.
  • 5. Recommend treatment for a patient with an acute exacerbation of MS.
  • 6. Define when it ...

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