Multiple Sclerosis (cont.)

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How is multiple sclerosis diagnosed?

Due to the broad range and subtleties of symptoms, multiple sclerosis may not be diagnosed for months to years after the onset of symptoms. Physicians, particularly neurologists, take detailed histories and perform complete physical and neurological examinations.

  • MRI (magnetic resonance imaging) scans with intravenous gadolinium help to identify, describe, and in some instances date lesions in the brain (plaques).
  • An electrophysiological test, evoked potentials, examines the impulses traveling through the nerves to determine if the impulses are moving normally or too slowly.
  • Finally, examining the cerebrospinal fluid that surrounds the brain and spinal cord may identify abnormal chemicals (antibodies) or cells that suggest the presence of multiple sclerosis.

Collectively, these three tests help the physician to confirm the diagnosis of multiple sclerosis. For a definite diagnosis of multiple sclerosis, dissemination in time (at least two separate symptomatic events or changes on MRI over time) and in anatomical space (at least two separate locations within the central nervous system, which can be demonstrated by MRI or neurological exam) must be demonstrated.

What are the treatments for multiple sclerosis?

There are many issues for the patient and physician to consider in treating multiple sclerosis. Goals may include:

  • improving the speed of recovery from attacks (treatment with steroid drugs);
  • reducing the number of attacks or the number of MRI lesions; or
  • attempting to slow progression of the disability (treatment with disease modifying drugs or DMDs); and
  • relief from complications due to the loss of function of affected organs (treatment with drugs aimed at specific symptoms).

Most neurologists will consider treatment with DMDs once the diagnosis of relapsing-remitting multiple sclerosis is established. Many will begin treatment at the time of the first attack of MS since clinical trials have suggested that patients in whom treatment is delayed may not benefit as much as patients who are treated early.

It is important for patients to talk to their doctor before deciding to go on therapy since DMDs differ in their uses (for example, one DMD may be used for slowing progressing disability but not for treatment of the first attack of MS; another DMD may be used for reducing relapses but not for slowing progressing disability). Finally, utilizing support groups or counseling may be helpful for patients and their families whose lives may be affected directly by multiple sclerosis.

Once goals have been set and a decision regarding DMDs has been made, initial therapy may include medications to manage attacks, symptoms, or both. An understanding of the potential side effects of drugs is critical for the patient because sometimes side effects alone deter patients from drug therapy. Patients may choose to avoid drugs altogether or choose an alternative drug that may offer relief with fewer side effects. A continuous dialogue between the patient and physician about the medications is important in determining the needs for treatment.

Although the efficacy of DMDs has been proven in clinical trials, their ability to decrease the frequency of relapses varies in patients with relapsing MS. It is difficult to clearly delineate these differences in the absence of comparative clinical trials, and physicians should consider this limitation in interpreting the reported relapse reduction rates from individual placebo-controlled trials. It is not acceptable to compare data across trials; however, the following relapse reduction rates vs. placebo for some of the DMDs from the pivotal trials are provided for general information purposes:

  • Avonex: 18% (annual relapse rate reduction)
  • Copaxone: 29% at 2 years
  • Rebif: 32% at 2 years
  • Betaseron and Extavia: 31% (annual relapse rate reduction)
  • Tysabri: 68% (annual relapse rate reduction)
  • Gilenya: 54% (annual relapse rate reduction)
  • Teriflunomide: 31% (annual relapse rate reduction)

In head-to-head trials in patients with relapsing MS, both Rebif and Gilenya have shown superiority to Avonex in reducing relapse rates and MRI lesions (EVIDENCE and TRANSFORMS trials, respectively).

Drugs known to affect the immune system have become the primary focus for managing multiple sclerosis. Initially, corticosteroids, such as prednisone (Deltasone, Liquid Pred, Deltasone, Orasone, Prednicen-M) or methylprednisolone (Medrol, Depo-Medrol), were widely used. However, since their effect on the immune system is nonspecific (general) and their use may cause numerous side effects, corticosteroids now tend to be used to manage only severe multiple sclerosis attacks (that is, attacks leading to physical disability or causing pain).

Medically Reviewed by a Doctor on 4/16/2013

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Multiple Sclerosis - Symptoms Question: The symptoms of multiple sclerosis can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
Multiple Sclerosis - Treatments Question: How do you manage your multiple sclerosis?
Multiple Sclerosis - Diagnosis Question: How many doctors did you go to before you received a multiple sclerosis diagnosis?
Multiple Sclerosis - Causes Question: Were you, a friend, or relative diagnosed with MS? What do you think the cause might be?
Multiple Sclerosis - Type Question: What type of multiple sclerosis do you have? How do you cope with the symptoms and your condition?


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