Multiple Sclerosis

Asif Kiani

What is MS?

Multiple Sclerosis is a disease of the Central Nervous System (CNS). It is also thought of as an autoimmune disorder.

Fast Facts

   

Approximately 400,000 people in the US have MS. (2.5 million worldwide) Invisible disease. Not considered fatal. Not contagious. More common in northern European ancestry. Twice as common in women as men.

 

Myelin is made up of lipids and proteins. It acts as a type of insulation around the axon of nerves. Demyelinazation occurs when the myelin sheath becomes damaged.

In MS, this is the result of an abnormal autoimmune reaction.


Characterized by a sudden worsening of symptoms.
 

Last at least 24 hours Separated from last exacerbation by at least one month

 

Can last from a couple days to a few weeks. Followed by demyelinazation.


Symptoms are present in the same form as regular exacerbations except:

Something triggers the symptoms to come out.

Fever, infection, hot weather, etc.

When the trigger disappears the symptoms disappear as well.

 

Very unpredictable! Symptoms vary from one individual to the next, and also from one exacerbation to the next. Symptoms can fully disappear after exacerbations.

Symptoms include…
      

Fatigue Muscle Control problems Slurred speech Tremors Stiffness Bladder problems Pain

      

Depression Sexual dysfunction Numbness/Tingling Vertigo Vision problems Cognitive problems Paralysis

  

Can be difficult to diagnose because of the nature of the symptoms. No specific laboratory tests available to test for MS. MRI’s are most often used in diagnosing and monitoring MS.

Other tests that can be used are spinal taps and evoked potential tests

Types of MS

There are four main types of MS:
   

Relapsing/Remitting (RRMS) Secondary Progressive (SPMS) Progressive Relapsing/Remitting (PRMS) Primary Progressive (PPMS)

Relapsing/Remitting (RRMS)
  

This is generally the first diagnosis of MS in the 20’s to 30’s. Approximately 85% of cases. Women are twice as likely to have this diagnosis. Characterized by relapses or exacerbations followed by periods of remission.

Secondary Progressive (SPMS)

About half of individuals with RRMS will develop this type of MS after a number of years. This starts out as RRMS, however over time there will not be real recovery after relapses, just a worsening progression of symptoms.

Progressive Relapsing/Remitting (PRMS)

Characterized by relapses followed by periods of remission, however, during those periods of remission there is a general worsening of symptoms. Approximately 5% of cases.

Primary Progressive (PPMS)
   

There are no real remissions with this type of MS. Instead there is a gradual worsening of symptoms over time. Onset is generally around late 30’s to early 40’s. Men are just as likely as women to be diagnosed. Primary onset is in the spinal cord, but may travel to the brain. Individuals with this type of MS are less likely to suffer from brain damage. Approximately 10% of cases.

 

There is currently no cure for MS. Treatments focus on:

 

Slowing down the disease (disease modifying) Specific symptom treatment Exacerbation treatment

Disease Modifying Treatments

These treatments focus their effects on the autoimmune system. Interferon Drugs
  

Avonex Betaseron Rebif

 

Copaxone Novantrone

Beta Interferons (IFN-β)

These drugs include:

Beta interferon-1a
 

Avonex Rebif Betaseron (US) Betaferon (Europe)

Beta interferon-1b
 

Interferons (IFNs)
  

Interferons are a group of biochemicals that help regulate the immune system. These biochemicals are naturally occurring in the body. Gamma interferon’s (IFN-γ) are associated with the disease process in MS. Beta interferon’s (IFN-β) are used to treat MS.

How do IFN-β drugs work?

It is not completely known how these drugs work, however, the following is believed to be the best explanation:
   

Reduces levels of IFN-γ (gamma interferon) Blocks WBC from attacking myelin sheaths Stops T-Cells from releasing cytokines (immune system signaling molecules) Interferes with summoning new immune systems cells to inflammation sites.

Avonex (1996)

 

Used to treat RRMS, PRMS, and SPMS and single clinical episodes with MRI features consistent with MS Injection given once a week Side effects include: flu-like symptoms

Less common side effects include: depression, mild anemia, increased liver enzymes, allergic reactions, and heart problems.

Betaseron (1993)
  

Used to treat RRMS, PRMS, RPMS Injection given every other day Side effects include: flu-like symptoms and injection site reactions

Less common side effects include: allergic reactions, depression, increased liver enzymes, and decreased white blood cell count

Rebif (2002)
  

Used to treat RRMS, PRMS, and SPMS Injection given three times a week Side effects include: flu-like symptoms, injection site reactions

Less common side effects include: liver problems, depression, allergic reactions, and decreased white and red blood cell counts

Copaxone (COP-1) (1996)
   

Active ingredient is Glatiramer acetate Used to treat RRMS Injection given every day It’s believed that it works by changing the body’s T-cell immune response to myelin.

Changes T-cells from pro-inflammatory to anti-inflammatory.

Most common side effect is injection site reactions.
 

Less common side effects include: vasodilation and chest pain Some individuals have an injection reaction immediately following the injection. Characterized by anxiety, chest pain, palpatations, shortness of breath, and flushing. Lasts for approximately 15-30 minutes. No treatment is necessary and no long term effects have been reported.

Novantrone (2000)
     

Chemotherapeutic drug once used to treat cancer. It works by suppressing T-cells, B-cells, and macrophages Used for RRMS, PRMS, and SPMS Can’t be used for individuals with heart problems, liver diseases, and blood disorders Given 4 times a year by IV with a lifetime limit of 8-12 doses Side effects include: blue/green urine (up to 24 hours), infections, bone marrow supression (fatigue, bruising, decreased blood cell counts), nausea, decreased hair growth, bladder infections, mouth sores

Serious side effects include liver and heart damaged (Patients are monitored closely for these symptoms)

Symptom Treatment

The treatment of symptoms is something that is very common for individuals with MS. Regular, prescription drugs are used along with some over the counter drugs. Some individuals also use herbal remedies.

Exacerbation Treatment

Main treatment is corticosteroids
  

Solu-Medrol (Methylprednisolone) Deltasone (Prednisone) Decadron (Dexamethasone)

  

They have the ability to “close the damaged blood-brain barrier and reduce inflammation in the central nervous system.” Usually given by IV either in the hospital or as an outpatient.
 

4 day treatment course followed by decreasing oral corticosteroids Increased appetite, indigestion, nervousness/restlessness, trouble sleeping, headaches, increased sweating, increased hair growth (body and face)

Side effects

Annual Cost

It costs approximately $35,000 per year for the treatment of MS.

The individual costs of RR drugs (per year):
   

Novantrone* - $5,000 - $10,000 Copaxone – $16,000 Avonex & Betaseron - $19,000 Rebif - $23,000

In a lifetime, someone with MS will likely pay $3.2 million in treatment costs.

Psychosocial Issues
 

Anxiety, Anxiety, Anxiety Some medications can cause depression Some symptoms can greatly affect a person and make them feel inadequate

Personal Awareness

It’s important for individuals with MS to be aware of what they can and can not do.
 

Know your limits Don’t be afraid to ask for help

Vocational Issues

Not everyone chooses to disclose that they have MS.

Must disclose to get accommodations.

The main problem comes from a lack of knowledge about the disease by employers. Not many accommodations are really needed.

Most accommodations are simple – arrangement of furniture (desk, bookcases, filing cabinets, etc.)

Vocational Resources

Many individuals don’t seek out resources.
 

Don’t need them. Don’t know they exist.

  

Job Accommodation Network Occupational Therapy VESID

National Multiple Sclerosis Society (Upstate NY Chapter)

Serves 42 counties
 

Rochester to Binghamton to Albany North Country

  

Fundraising Self-help and support groups Offer a variety of different services

Services offered

Educational Programs
  

For individuals with MS For area doctors In-services for schools

   

Recreational Programs Online programs Referral information Publications

Adam’s Story

References and Resources


Donna Falvo – Medical and Psychosocial Aspects of Chronic Illness and Disability National Multiple Sclerosis Society WebMD Multiple Sclerosis International Foundation National Institute of Neurological Disorders and Stoke

Online Resources
   

Sign up to vote on this title
UsefulNot useful