Multiple Sclerosis

  • Slightly more common in women than men, more often in whites than other races, most commonly first diagnosed in ppl between 20-40 years old
  • Appears to be a genetic factor
  • Autoimmune disease that causes the body to produce antibodies against myelin.  Demyelination of nerves causes impulses to travel more slowly & lead to decreased coordination
  • Diagnosis:  2 or more episodes separated by at least 6 months.  2 or more systems most be involved.  MRI shows MS plaques
  • Symptoms:  gait disturbances, fatigue, lack of coordination, vision problems, sensory problems, bladder & bowel issues, mild cognitive impairment, sexual dysfunction, optic neuritis, depression, partial or complete paralysis
  • Transitional MS occurs 5-10 years after diagnosis:  patients have a poor response to corticosteroids or low-dose interferons,  greater burden of disease on MRI, higher rate of recent relapse
  • Suicide rate is significantly higher in MS patients than normal ppl
  • People live on average 35 years following the diagnosis of MS (only decreases life expectancy by 2-3 years)
  • Treatment of Acute episodes:
    • oral prednisone for mild attacks
    • IV methylprednisolone for severe attacks
  • delay or shorten exacerbations
    • Interferons (avonex, rebif, betaseron):  Interferons cause flu like symptoms
    • Tysabri (natalizumab) is a selective adhesion molecule inhibitor (SAM) that has a black box warning for progressive multifocal leukoencephalopathy
    • Gilenya (fingolimod) is a S1P receptor modulator & was the first oral therapy developed for MS
      • It causes fewer T cells to attack nerves in the myelin sheath
      • SE:  heart block, elevated LFTs, macular edema, viral infections
  • Treatment of progressive MS:  mitoxantrone  (antiproliferative & immunomodulatory effects) slows the progression of the disease, decreases relapses & CNS lesions
  • Symptomatic therapies:
    • Fatigue (most common complaint of MS patients):  use amantadine
    • Vertigo:  use meclizine, promethazine or low dose valium
    • Muscle spasms:  use baclofen or valium
    • Depression:  use SSRIs or TCAs
    • UTIs:  use oxybutynin or baclofen/amitriptyline if its spasticity related
    • Pain:  use carbamazepine, phenytoin, TCAs or gabapentin

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