Multiple Sclerosis
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Multiple Sclerosis
NIH - Medical Encyclopedia Multiple Sclerosis
"Multiple sclerosis (MS) usually affects woman more than men. The disorder most commonly begins between ages 20 and 40, but can strike at any age. The exact cause is not known, but MS is believed to result from damage to the myelin sheath, the protective material which surrounds nerve cells. It is a progressive disease, meaning the damage gets worse over time. Inflammation destroys the myelin, leaving multiple areas of scar tissue (sclerosis). The inflammation occurs when the body's own immune cells attack the nervous system. The inflammation causes nerve impulses to slow down or become blocked, leading to the symptoms of MS. Repeated episodes, or flare ups, of inflammation can occur along any area of the brain and spinal cord."
Highlighted ArticleThe role of MRI in the diagnosis of multiple sclerosis. (Adv Neurol. 2006)
"There is no single test that is diagnostic of MS, including MRI. The lesions detected with MRI are pathologically nonspecific. The principles of MS diagnosis are based on showing dissemination of white matter lesions in space and time. … The first important role for MRI in the diagnosis of MS allows for an early diagnosis of MS … The second important role for MRI in the diagnostic work-up of suspected MS patients is to rule out alternative diagnoses obvious on MRI, such as spinal stenosis and most brain tumors. Characteristic lesions that favor MS include Dawson Fingers, ovoid lesions, corpus callosum lesions, and asymptomatic spinal cord lesions. However, other white matter diseases can have similar appearances on MRI. … MRI evidence plays a supportive role in what is ultimately a clinical diagnosis of MS, in the appropriate clinical situation, and always at the exclusion of alternative diagnoses."
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Notes
The 2007 Treatment Guidelines section will contain the 2007 published guidelines. To view Guidelines from previous years, view year 2006 Treatment Guidelines and 2005 InfoMedlinks (Articles section) or our Monthly Online Newsletter (under the Guidelines section).
Multiple Sclerosis
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Device Therapy
Drug Side-Effects and Interactions
Interferon beta-1b exacerbates multiple sclerosis with severe optic nerve and spinal cord demyelination. (J Neurol Sci. 2007)
Drugs
Antibiotics 'could help slow MS'
Reduced effectiveness of long-term interferon-ß treatment on relapses in neutralizing antibody-positive multiple sclerosis patients: a Canadian multiple sclerosis clinic-based study (Multiple Sclerosis 2007)
A longitudinal observational study of a cohort of patients with relapsing-remitting multiple sclerosis treated with glatiramer acetate (European Journal of Neurology 2007)
Azathioprine for multiple sclerosis (Cochrane Database of Systematic Reviews 2007)
How effective are disease-modifying drugs in delaying progression in relapsing-onset MS? (NEUROLOGY 2007)
Caution Urged in Early MS Treatment "A new study shows that early treatment for multiple sclerosis cuts the risk of disability. But some experts say it's too soon to take a "treat-all approach" to MS. The international BENEFIT study tested a current trend -- giving MS treatments to patients at the first sign of what might be MS. The study showed that early treatment with Betaseron, one of three forms of beta-interferon approved for MS, cut the three-year risk of disability by 41% compared with delayed treatment. However, patients who got early treatment only reduced their overall three-year risk of disability by 14%. … Pittock notes that the BENEFIT trial does show, for the first time, that early beta-interferon treatment has a "beneficial effect on accumulation of confirmed disability in patients with a first event suggestive of multiple sclerosis." "
Early Interferon Treatment Delays MS "The Swiss results "provide more evidence to support the value of early treatment," she said. "There has been disagreement about whether early treatment is beneficial. This provides additional evidence that early treatment delays progression on a disability scale." An accompanying editorial by Dr. Sean Pittock, a neurologist at the Mayo Clinic, praised the study, saying, "Kappos and colleagues have set a new standard against which future extension trials will be compared." But Pittock said the results of the trial should be "interpreted with care, because the magnitude of benefit, although significant, is clinically small. This follow-up should not be misconstrued as evidence for a 'treat all' approach." "
New natural history of interferon-beta-treated relapsing multiple sclerosis. (Ann Neurol. 2007) "INTERPRETATION: IFN-beta slows progression in relapsing-remitting multiple sclerosis patients."
Randomized, double-blind, dose-comparison study of glatiramer acetate in relapsing-remitting MS. (Neurology. 2007)
Exercise
Effect of exercise training on quality of life in multiple sclerosis: a meta-analysis. (Mult Scler. 2007)
Physical training and multiple sclerosis. (Ann Readapt Med Phys. 2007) "Several studies have shown the benefits of physical training, with improvements in aerobic capacity, gait parameters and fatigue, and an influence on quality of life. Regular aerobic physical activity is necessary to maintain the benefit of physical training."
Effect of Aerobic Training on Walking Capacity and Maximal Exercise Tolerance in Patients With Multiple Sclerosis: A Randomized Crossover Controlled Study. (Phys Ther. 2007) "The results suggest that AT is more effective than NR in improving maximum exercise tolerance and walking capacity in people with mild to moderate disability secondary to MS."
General Information
Managing Multiple Sclerosis at an Early Stage
[Neurorehabilitation in multiple sclerosis: an overview.] (ev Neurol (Paris). 2007 )
Antidepressants Appear Ineffective in Relieving Depression in MS "A study of multiple sclerosis (MS) patients diagnosed with major depressive disorder (MDD) and/or dysthymia shows no relation between antidepressant use and improved outcomes."
[Rehabilitation therapy in multiple sclerosis.] (Rev Neurol. 2007)
Treatment for ataxia in multiple sclerosis. (Cochrane Database Syst Rev. 2007)
Guidelines
Immunotherapy
Internet Sites
Treatment Information
Drug-Food-Supplement Information
DrugDigest (drug interactions)
FDA - Drug Interactions: What You Should Know
NIH - Botanical Dietary Supplements: Background Information
NIH - Drug, Supplements, and Herbal Information
NIH - Herbal Supplements: Consider Safety, Too
NIH - Vitamin and Mineral Supplement Fact Sheets
Nutrition
Dietary interventions for multiple sclerosis. (Cochrane Database Syst Rev. 2007)
Other
Other Treatments
Repetitive transcranial magnetic stimulation of the motor cortex ameliorates spasticity in multiple sclerosis (NEUROLOGY 2007)
Experimental
Therapeutic potential and biological role of endogenous antioxidant enzymes in multiple sclerosis pathology (Brain Research Reviews 2007) "We propose that antioxidants may inhibit the development and progression of MS lesions and may therefore represent an attractive therapeutic target for the treatment of MS and other oxidative stress-related neurological diseases."
Radiotherapy
Supplements-Vitamins-CAM
Safety of vitamin D3 in adults with multiple sclerosis (American Journal of Clinical Nutrition 2007) "Conclusions: Patients' serum 25(OH)D concentrations reached twice the top of the physiologic range without eliciting hypercalcemia or hypercalciuria. The data support the feasibility of pharmacologic doses of vitamin D3 for clinical research, and they provide objective evidence that vitamin D intake beyond the current upper limit is safe by a large margin."
Fish Oil Might Help Relieve MS
Vitamin D levels in people with multiple sclerosis and community controls in Tasmania, Australia. (J Neurol. 2007) "CONCLUSION: The strong associations between disability, sun exposure and vitamin D status indicate that reduced exposure to the sun, related to higher disability, may contribute to the high prevalence of vitamin D insufficiency found in this population-based MS case sample. Active detection of vitamin D insufficiency among people with MS and intervention to restore vitamin D status to adequate levels should be considered as part of the clinical management of MS."
Surgery
Neurosurgical treatment of multiple sclerosis. (Neurol Res. 2006)
Transplantation
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