MS
Multiple Sclerosis ( MS)
Multiple sclerosis is a neurological disease that affects the brain and spinal cord. Common symptoms include loss of vision (optic neuritis), weakness in the limbs, imbalance, numbness or tingling, bowel or bladder poor control, fatigue, double vision, tingling or electric sensations in the upper spine. Any of these symptoms may present individually and usually last for several days (as relapses or MS attacks). Transient symptoms lasting less than a day are unlikely to be from multiple sclerosis. MS occurs due to an immune attack by the body targeting the insulation (myelin) covering the nerve cells leading to a loss of this myelin (demyelination) which prevents adequate conduction of impulses through the nerves. The loss of myelin occurs in the brain or spinal cord (central nervous system) sparing the peripheral nerves. With regrowth back of the myelin in a few days to weeks, improvement of symptoms occur (remissions). This leads to the common course of MS or relapsing remitting MS. Rarely a steady progression in neurological symptoms may occur from the onset ( primary progressive MS) or after several years of relapsing remitting MS ( secondary progressive MS).
Though being brought up in a temperate climate, mono infections, smoking and genetics are considered risk factors no clear etiology is established.
Many diseases may mimic MS
If fatigue is a prominent symptom anemia, low thyroid hormone levels, and chronic fatigue syndrome should be investigated.
If joint pains, rash and fever are present evaluation for lymes disease, lupus, or other immune diseases may be appropriate.
Correct diagnosis of MS is essential. Neurology consultation is necessary. (click here to see neurologists in your area)
Brain Imaging with MRI of the brain, MRI of the cervical and thoracic spine, evoked potential studies and lumbar punctures or spinal taps may be recommended. (click here for MRI facilities in your area)
Blood tests to look for other causes ( Lyme disease, infectious mononeucleosis, sarcoidosis, lupus, B12 deficiency, vitamin D levels).
Treatment for MS
Various medications are now available to treat MS. Attacks of MS are treated with intravenous steroids or solumedrol, or rarely with ACTH, or medrol dose pack. To decrease the relapse rate and prevent attacks of MS to help slow the progression your physician may prescribe the ABC drugs including
Avenox or interferon beta 1a (once a week, intramuscular with auto injection device) – Needs monitoring of liver functions, blood counts, and may cause flu like symptoms and rarely injection site reactions. Rarely neutralizing antibodies may develop which may decrease efficacy.
Betaseron interferon beta 1b ( every other day, subcutaneous injections with auto injection device). Needs monitoring of liver functions, blood counts, and may cause flu like symptoms and rarely injection site reactions. Higher incidence of neutralizing antibodies may develop which may decrease efficacy.
Copaxone (Glatiramer Acetate) ( three times a week or every day, subcutaneous injections with auto injection device). No need for monitoring. No flu like reaction. Rare injection site reactions. No neutralizing antibodies.
Rebif (Interferon beta 1a) ( three times a week, subcutaneous injections with auto injection device). Needs monitoring of liver functions, blood counts, and may cause flu like symptoms and rarely injection site reactions. Higher incidence of neutralizing antibodies may develop which may decrease efficacy.
Gilenya (Fingolimod) (Oral -Twice daily oral) Needs pre intake screening for varicella Ab, needs eye and heart exam, EKG, Echo, and first dose needs to be administered with cardiac monitoring for 6hrs. Needs monitoring of lymphocyte counts, LFTs.
Aubagio (BG12) (Oral - once daily) Needs monthly CBC, needs to be held for 2yrs if pregnancy planned. GI side effects, mild hair thinning, LFT elevation.
Tecfidera (dimethylfumarate) Needs q3months to yearly CBC. Flushing and GI side effects.
Tysabri (Natalizumab) monthly iv infusion- monitor CBC for lymphocyte counts. Needs screening for JC Papova virus Ab.
Mitoxantrone- once every 3 months iv infusion, needs monitoring of CBC and Echo before each dose, for heart failure and leukemia.
Plegridy ( pegylated Interferon beta1a) - sc injections once every 2 weeks. Just approved
Daclizumab ( is under study ) - a monoclonal antibody has shown promise with head to head trials and decreases relapse rate by almost 41% more than when compared with avonex.
|
|
Route/Freq |
Monitoring |
Neutraliz Ab |
Efficacy RR |
Preparation |
Pregnancy |
|
Avonex |
IM Once/wk |
LFT, CBC |
Rare |
33% |
|
Discont |
|
Betaseron |
Sc 3.5/wk |
LFT, CBC |
Yes |
33% |
|
Disont |
|
Rebif |
Sc 3/wk |
LFT, CBC |
Yes |
33% |
|
Discont |
|
Copaxone |
Sc 3/wk |
No |
No |
33% |
|
Safe: Cat. B |
|
Gilenya |
Oral BID |
Eye, CBC, |
No |
33% |
Eye, Heart, Varicella |
Discont |
|
Aubagio |
Oral QD |
LFT, CBC |
No |
33% |
Tb test |
Cat X, DC 2y |
|
Tecfidera |
Oral BID |
LFT,CBC |
No |
50% decr RR |
Tb test |
Discont |