Multiple Sclerosis (nerves of the central nervous system)
Definition Multiple Sclerosis
Multiple sclerosis (MS) is a disease where the nerves of the central nervous system (brain and spinal cord or spinal cord) or degeneration worsens. Myelin, which provides a covering or insulation for nerves, improves delivery (conduction) of impulses along nerves and also is important to maintain the health of the nerves. In multiple sclerosis, inflammation causes the myelin eventually disappear. Consequently, the electrical impulses along nerves running slow, which is becoming more slowly. In addition, the nerves themselves become damaged. As more and more nerves are affected, a patient experiences a progressive interference with functions that are controlled by the nervous system such as vision, speech, walking, writing, and memories.
Approximately 350,000 people in the United States have multiple sclerosis. Typically, a patient diagnosed with multiple sclerosis between 20 and 50 years, but multiple sclerosis has been diagnosed in children and in the elderly. Multiple sclerosis is twice as likely to occur in Caucasians (white people) than in any other group. These women are two times more likely than men are affected by multiple sclerosis early in life.
Causes of Multiple Sclerosis
The cause of multiple sclerosis is still unknown. In the last 20 years, researchers have to concentrate (focus) on disorders of the immune system and genetics for explanations. The immune system is the body's defenses and is very organized and orderly. If triggered by an attacker (aggressor) or a foreign object, the immune system mounts a defense measures that identify and attack the invaders and then withdrew. This process is dependent on rapid communication among immune cells and the production of cells that can destroy the intruder. In multiple sclerosis, researchers suspect that a foreign agent such as a virus alters the immune system so that the immune system perceives myelin as an intruder and attacks. The attack by the immune system on the tissues that should protect the so-called autoimmunity, and multiple sclerosis is believed to be a disease of autoimmunity. Where some of the myelin may be repaired after illumination, some of the missing myelin and nerve endings are released from this cover (the demyelinated). Scarring also occurs, and the material deposited into the scarring and form plaques (plaques).
Multiple Sclerosis Reduced / inherited?
Although its role remains unclear, genetics may play a role in multiple sclerosis. European gipsies, Eskimo-Eskimo and African Bantu basically did not develop multiple sclerosis, where the native people Indians of North and South America, the Japanese and other Asian groups have a low incidence. The general population has less than one percent chance to ever get multiple sclerosis. The chance is increased in families where a relative degree one had the disease. So, a sister / brother, brother / sister, parent, or child of someone with multiple sclerosis from one to three percent chance of developing multiple sclerosis. In the same way, two identical twins have a chance of nearly 30% gain multiple sclerosis while the two are not identical twins have only a chance of 4% if one twin has the disease. These statistics suggest that genetic factors play a major role in multiple sclerosis. However, other data suggest that environmental factors also play an important role.
Types Of Multiple Sclerosis
There are clinical manifestations are different from multiple sclerosis. During an attack, a patient experiences a sudden deterioration in physical abilities normal which may range from mild to severe / severe. This attack, sometimes referred to as an exacerbation of multiple sclerosis, typically lasts more than 24 hours and generally more than a few weeks (rarely more than four weeks).
Approximately 65-80% of patients begin with Relapsing-Remitting (RR) MS, the most common type. In this type, patients experience a series of attacks followed by a loss of symptoms (remission) SCARA full or in part until another attack occurs (relapse). It may be weeks to decades between relapse-recurrence.
In Primary-Progressive (PP) MS, there is a gradual decline that continued in the physical abilities of a patient from the beginning rather than relapse-recurrence. Approximately 10% -20% of patients begin with PP-MS.
Patient-passien which began with RR-MS can then enter a phase where the recurrence, relapse is rare but more the inability to accumulate, and is said to have the type of Secondary-Progressive (SP) of multiple sclerosis. Approximately 50% of patients with RR-MS will develop SP-MS within 10 years. Progressive-Relapsing (PR) MS is a type of multiple sclerosis characterized by a continuous decline in abilities accompanied by sporadic attacks (occasionally). There are cases of multiple sclerosis that is lightweight and can be recognized only retrospectively after many years as well as rare cases of multiple sclerosis symptoms that progress very quickly (sometimes fatal) known as malignant or fulminant multiple sclerosis (Marburg variant).
Symptoms of Multiple Sclerosis
The symptoms of multiple sclerosis may be single or multiple and may range from mild to severe in intensity and short to long in duration (duration). Remission is wholly or partly from the initial symptoms occur in approximately 70% of patients with multiple sclerosis.
* Disturbances, visual disturbances may be the first symptoms of multiple sclerosis, but they usually subside. A patient may notice blurred vision, distortion of red-green (color desaturation), or monocular blindness (blindness in one eye) are sudden.
* Muscle weakness with or without difficulties with coordination and balance may occur early.
* Muscle cramps, fatigue, numbness, tingling and pain are common symptoms.
* There may be some loss of sensation, difficulty speaking, shaking, trembling, or dizziness.
Fifty percent of patients experience mental changes such as:
* Decreased concentration,
* Attention deficits,
* Some degree of memory loss (memory),
* Inability to perform tasks sequentially, or
* Disruptions in the decision / judgment.
Other symptoms may include:
* Depression,
* Maniac depression,
* Paranoia, or
* An uncontrollable urge to laugh and cry.
As the disease worsens, patients may experience sexual dysfunction or control the bowels and bladder are reduced. The heat seemed to intensify the symptoms of multiple sclerosis for about 60% of patients. Pregnancy seems to reduce the number of attacks.
Diagnosing Multiple Sclerosis
Caused by the wide limits and subtleties of symptoms, multiple sclerosis may be undiagnosed for many months to years after onset of symptoms. Doctors, especially specialists, neurologists, took detailed histories and perform physical examinations and nerve in full.
* MRI (magnetic resonance imaging) scans with intravenous gadolinium helps to identify, describe, and in some instances fall out wounds in the brain (plaques).
* An electro-physiological tests, which raises the potentials, examine the impulses that travel through the nerves to determine whether the impulses to move normally or too slowly.
* Finally, test the cerebro-spinal fluid that surrounds the brain and spinal cord may identify chemicals (antibodies) or abnormal cells that suggest the presence of multiple sclerosis.
Taken together, three of these tests help the doctor confirm the diagnosis of multiple sclerosis. For a definitive diagnosis of multiple sclerosis, dissemination in time (at least two symptomatic events or changes on a separate MRI) and indoor anatomy (eg, within the central nervous system) must be presented.
Treating Multiple Sclerosis
A lot of things for patients and physicians to consider in treating multiple sclerosis. These goals may include reducing the number of attacks, improve recovery from attacks, and try to slow the progression of the disease even further (treatment with drugs that modify disease). An additional goal is the liberation of the complications caused by loss of function of organs affected (treatment with drugs aimed at specific symptoms). Most experts would consider treatment with nerve drugs that modify the disease once a diagnosis of multiple sclerosis is established. Many will begin treatment at the time of the first attack of multiple sclerosis, because clinical trials have suggested that patients who delayed treatment may not get as much benefit as those patients treated early. Finally, use of support groups or counselors may be useful for patients and their families whose lives may be directly affected by multiple sclerosis.
Once goals have been established, initial treatment may include medications to control attacks, symptoms, or both. An understanding of the side effects of potential drugs are important to patients because of side effects sometimes alone deter patients from drug therapy. Patients may choose to avoid medications altogether, or choosing an alternative drug that may offer an exemption to the side effects are fewer. An ongoing dialogue between patients and physicians about drugs is important in determining the purposes for treatment.
The drugs are known to affect the immune system has become a major focus for controlling multiple sclerosis. Initially, corticosteroids such as prednisone (Deltasone, Liquid Pred, Deltasone, Orasone, Prednicen-M) or methylprednisolone (Medrol, Depo-Medrol), are used widely secar. However, because of their effects on the immune system is non-specific and their use may cause many side effects, corticosteroids are now likely to be used to control only the multiple sclerosis attacks are sudden and severe / severe.
Interferon
Since 1993, drugs that alter the immune system, especially interferon-interferon, have been used to control multiple sclerosis. Interferon-interferon is a protein messengers are created and used by the cells of the immune system to communicate with each other. There are different types of interferons-interferon, such as alpha, beta, and gamma. All of interferon-interferon has the ability to regulate the immune system and plays an important role in protecting against viral infections. Each interferon function differently, but their functions overlap (overlap). Interferon beta-interferon has been found useful in controlling multiple sclerosis. Interferon beta-1b (Betaseron ) is the first interferon approved for the control of RR-MS in 1993. In 1996, interferon beta-1a (Avonex ) received FDA approval for RR-MS.
Overall, patients treated with interferon-interferon had fewer relapses, a relapse or longer intervals between relapse-recurrence. Experiments have also shown effects on slowing accumulation of disability. Side effects The most common is a syndrome such as influenza, including fever, tiredness, weakness, chills, and muscle aches. This syndrome tends to occur less frequently when therapy continues. Other side effects are common are injection site reactions, changes in blood cell counts, and abnormalities of liver tests. Liver tests and blood counts are regularly recommended remedy those patients who were receiving interferon beta-1b. With the simultaneous use of analgesics and the actions of local skin, lenience in interferon-interferon has increased.
Clinical trials of beta interferon drugs in patients with first attack of multiple sclerosis showed that in this early patient population, these drugs delay the onset of the second attack. Avonex is given intramuscularly once a week, Betaseron administered subcutaneously every other day, and Rebif administered subcutaneously three times per week.
Interferon Beta available include:
IFN beta-1b (Betaseron ) used for the treatment of relapsing forms of multiple sclerosis, to reduce the frequency of recurrence, clinical recurrence. Patients with multiple sclerosis that its effectiveness has been demonstrated include patients who have experienced a first clinical episode and have MRI features consistent with multiple sclerosis.
IFN beta-1a (Rebif ) used for the treatment of patients with relapsing forms of multiple sclerosis to reduce the frequency of recurrence, clinical recurrence and delay the accumulation of physical disability. The effectiveness of Rebif in chronic progressive multiple sclerosis who still has not been established.
IFN beta-1a (Avonex ) used for the treatment of patients with relapsing forms of multiple sclerosis uto slow accumulation of physical disability and reduce relapse-recurrence frekwenai from the clinic. Patients with multiple sclerosis that its effectiveness has been demonstrated include patients who have experienced a first clinical episode and MRI have features consistent with multiple sclerosis. Safety and efficacy in patients with chronic progressive multiple sclerosis who still has not been established.
Other Medications
Glatiramer acetate
Glatiramer acetate (Copaxone) is another drug approved to modify the disease to reduce the frequency of relapse-recurrence in RR-MS. Glatiramer acetate is a synthetic amino acid mixture (manmade) that might resemble a protein component of myelin. It is estimated that the immune system reaction against myelin in multiple sclerosis might be thwarted by glatiramer acetate. A reaction that occurs immediately after the injection of glatiramer acetate is common, affecting one in 10 patients. The reaction may involve flushing, chest pain or tightness, palpitations, fear, shortness of breath, tightness in the throat, or hives. The reaction usually disappears within 30 minutes and requires no maintenance. Some patients may be at risk of developing lipoatrophy, inflammation and damage of the tissue under the skin at the injection site. Glatiramer acetate is used to reduce the frequency of relapse-recurrence in patients with relapsing-remitting multiple sclerosis.
Natalizumab
Natalizumab is used as a monotherapy for the treatment of patients with relapsing forms of multiple sclerosis to delay the progression of physical disability and reduce relapse-recurrence frequency of clinic. Safety and efficacy of natalizumab for more than two years is unknown. Because natalizumab increases the risk of PML, it is generally recommended only for patients who have had an inadequate response to, or unable to tolerate multiple sclerosis therapies are changing.
Mitoxantrone
Mitoxantrone (Novantrone) is also approved by the FDA for the treatment of multiple sclerosis. Mitoxantrone is a chemotherapeutic drug that bring in the risk of side effects serious cardiac or cancer. Because side effects are serious, doctors tended to reserve its use for cases of more advanced or worsening of multiple sclerosis.
Mitoxantrone is used to reduce neurological disability and or frequency of recurrence, clinical recurrence in patients with secondary (chronic) progressive, progressive relapsing, or worsening relapsing-remitting multiple sclerosis (eg, patients with state of nerves is significantly abnormal between relapses -recurrence). Mitoxantrone is used in the treatment of patients with primary progressive multiple sclerosis.
Direction-Future Directions for Controlling Multiple Sclerosis
There is a great deal of ongoing research on multiple sclerosis, and they continue to be a focus on immune system therapies in the investigation. In addition, scientists are trying to develop techniques that allow brain cells to produce new myelin or the nerve to prevent death. Other approaches are promising including the use of precursor cells (neuronal stem or progenitor) that can be implanted into the brain or spinal cord (spinal cord) to re-inhabit areas that lose cells. Future therapies might involve methods that are designed to improve the impulses that travel through the nerves are damaged. Scientists also are investigating the effects of diet in multiple sclerosis.
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