Sunday, March 31, 2013

MULTIPLE SCLEROSIS

DIAGNOSIS AND TREATMENT OF MULTIPLE SCLEROSIS

  1. What is multiple sclerosis?
Multiple sclerosis is a demyelinating disease of central nervous system-CNS (brain and spinal cord), which is characterized by involvement of “multiple” parts of CNS.
The disease is also characterized by remissions (improvement of symptoms) and relapses (occurrence of new symptoms) over a period of time, causing “multiple” episodes of symptoms.  
Multiple sclerosis is an autoimmune disease, which means the antibodies produced in the body attacks own healthy tissues.

  1. What is the meaning of demyelination or demyelinating illness?
Nerves in central nervous system are like “electric wires”, that is, they have a central core surrounded by an insulation or covering. This covering of the nerves is called “myelin sheath”.
A disease, where the myelin sheath is affected or damaged is called a demyelinating disease or illness, and the process is called as demyelination. Multiple sclerosis is one of the most common demyelinating diseases of the CNS.

3. Who are the common people affected by multiple sclerosis?

·        Multiple sclerosis is commonly seen between the ages of 10 and 60 years, which means, it is uncommon in children below 10 years and those adults who are above 60 years of age.
·        Multiple sclerosis is typically more common in young women (between the ages of 18-36 years),
·        Multiple sclerosis is seen all over the world, probably more common in the West, as compared to Asian countries.
·        Also, the severity of multiple sclerosis seems to be lesser in Asians, leading to lesser degrees of disability, which has led some people to label Asian multiple sclerosis as relatively “benign form” of multiple sclerosis.

  1. What are the common symptoms of multiple sclerosis?
Common symptoms of multiple sclerosis include:
    • Sudden onset diminished vision in one or both eyes, which may get worse over a few days,
    • Numbness of arm or leg on one or both sides of body,
    • Weakness of arm or leg on one or both sides of body,
    • Imbalance while walking,
    • Bladder symptoms,
Less common symptoms of multiple sclerosis include
·        Memory disturbances,
·        Seizures or fits,
·        Depression
It is important to note that a patient with multiple sclerosis may have only one or more than one symptom described above at one point of time, or different symptoms may occur during multiple episodes of the disease.

  1. How is the diagnosis of multiple sclerosis confirmed?
A person who has one or more symptoms suspicious of multiple sclerosis should consult a neurologist. A neurologist would take history and do a clinical examination to ascertain the number of episodes of illness, and also to identify the affected the parts of central nervous system.
After that he would order for investigations to confirm the diagnosis of multiple sclerosis.

  1. What are the important investigations for confirming a diagnosis of multiple sclerosis?
  • MRI (Magnetic resonance imaging) of brain and spinal cord- this is the most important investigation. MRI shows the involvement of different parts of brain and spinal cord. The white matter of brain and spinal cord are typically affected in multiple sclerosis. The diseased part of brain and spinal cord are also referred to as “lesions” or “plaques”. A new or active lesion shows enhancement on MRI with contrast dye injection. In addition, there may be swelling around the active lesions. MRI is also able to distinguish new versus old lesions, and is useful to monitor the disease progression or improvement and also the effectiveness of treatment.
    • CSF (cerebrospinal fluid) analysis- CSF is removed by lumbar puncture (LP) by inserting a needle in lower back. In multiple sclerosis, the CSF protein is elevated; however, the number of white blood cells (WBCs) is either normal or only slightly elevated. CSF sugar is often normal. CSF is also tested for the presence of oligoclonal bands (OCBs), the presence of which indicates an active disease.
    • Evoked potential studies may be ordered to look for involvement of optic nerve (visual evoked potential or VEP) or spinal cord (somatosensory evoked potential).
    • Blood tests (such as ANA, Anti-dsDNA, ANCA, etc) may be ordered to exclude other diseases that can mimic multiple sclerosis.

  1. What are the current treatment options for multiple sclerosis?
Treatment of multiple sclerosis can be divided into two categories- treatment of acute episodes and treatment to prevent future relapses of disease.
Treatment for acute episodes:
Steroid injections are the preferred treatment options. The drug of choice is methylprednisolone given as injections in the veins over 3-5 days. Then, steroid tablets are given for 15-20 days.
Treatment to prevent relapses of disease:
The most preferred treatment is interferon injections (such as avonex, relibeta and rebif in India). Avonex and relibeta are given as injections in the muscles, once a week, whereas rebif is given as injections underneath the skin three times a week.
Other FDA-approved treatment options to prevent relapses of disease in multiple sclerosis are:
·        Glatiramer acetate (copaxone)- given as injection underneath the skin, once a day.
·        Fingolimod- oral capsule (0.5 mg) once daily.
·        Mitoxantrone- given as infusion in the vein, every three months (maximum 8-12 doses over two-three years),
·        Natalizumab (tysabri)- given as infusion in the vein, once every four weeks.
·        Dimethyl fumerate (tecfidera)- twice a day oral capsules.

 8. Is Multiple sclerosis curable?

As of today, there is no cure for multiple sclerosis. However, with current treatments, the disease can be kept under control and new relapses can be prevented.

9. Is multiple sclerosis always disabling?

Multiple sclerosis does cause disability in a significant number of people. However, more than two-thirds of patients suffering from multiple sclerosis are independent for their activities of daily living and are gainfully employed in a job. The good outcome depends on proper treatment as well as physical & occupational therapies.

10. Is multile sclerosis contagious or genetic?

Multiple sclerosis is not contagious and does not get transmitted from one affected person to another.

There may be genetic predisposition to get multiple sclerosis but it is not a genetic disease in a strict sense, as most patients with multiple sclerosis do not give a positive family history.

11. Is multiple sclerosis fatal or lethal?

In more than 95% of patients with multiple sclerosis, it does not lead to death. However, in a minority (less than 3%) it may lead to death either due to the direct effect of the severe disease or another complication such as pneumonia or deep vein thrombosis.

I hope this article is useful for hundreds of patients with multiple sclerosis as well as their caregivers. In addition, if someone is looking for information on multiple sclerosis (MS), it should be useful.

For any additional information, please email me at drsudhirkumar@yahoo.com

DR SUDHIR KUMAR MD (Internal Medicine), DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad, India
Phone: 0091-40-23607777/60601066

13 comments:

Raman Gaba said...

My wife has been diagnosed with MS and her attending physician has recommended Avonex. Since avonex ia very costly, I came across the cheaper substitute, Relibeta. But relibeta has no reviews or very little information is available on the net.
Request your views on relibeta as the future course of treatment for my wife.

Thanks,
Raman
Ramangabain@gmail.com

Dr. Sudhir Kumar said...

Hi Mr Raman Gaba, Relibeta is a biosimilar of Avonex, and is produced by Reliance Life Sciences in Mumbai. It is effective and safe in the treatment of MS in Indian patients. I was a part of the original research which proved the safety and efficacy of Relibeta in India.
Best wishes,
Dr Sudhir Kumar MD DM

al muslimoon said...

DR My father is 67 yrs old andhe is complaining abbout forgetfulness just like kept money in one place and forgot.Is this due to lack of nutrients . wewould like to pay visit atyour clinic .Thankyou vv much for such a useful bolg .plz reply is it a matter of concern

al muslimoon said...

Dr My father is 67 yrs old andhe is complaining about forgetfulness like he kept money in one place and forgets is this due tolack of nutrients ,or a matter of concern , plz reply

shivi said...

Dr i am 30 yrs old and my MS was diagnosed 2 years back and i am taking Avonex from past 1 and a half year and also my MRI reports does not show any significant changes in lesions. i request you to kindly suggest me if i can stop taking Avonex or try taking it off for few weeks.

Sudheer P said...

Doctor, I am Sudheer from chennai. 28 yrs of age, diagnoised MS 7 yrs bck & was on avonex but with the recent relapse under wysolone now. can you please comment about fingolimod usage? Is it good for me?

Sudheer P said...

I am Sudheer,27 yrs of age & diagnosed MS 7 Yrs back. & was under avonex even after several relapses. Right now took solu medrol & under wysolone now. Soon starting interferon, can i use fingolimod tabs instead of avonex as it is so tough to afford. Please sujjest

G SIVA SANKARA REDDY said...

Dear sir

my mother aged 55years, suffering since last 10days with acute chronic left thigh pain, not able to sit/walk. pain relaxes only when sleeps. Pain felt from left side of the center of legs(telugu - gajjello) to left thigh, but left knee and below leg no pain.
Took MRI of 1)lumbar spine left 2) left thigh. The findings of lumbar spine are 3 discs are slipped. and no abnormality found in MRI of THIGH. None of the pain medications are working. pain not at all easing.Doctor is also not able to confirm whether disc slips maybe the cause or not, if yes among the three discs which disc is responsible for nerve compression. We not interested in surgery. Is there any thing can be done at your clinic to relieve chronic pain and to get back to normal activities.

please reply positively


G.SIVA SANKARA REDDY
KADAPA
9490542699

B Mahindar said...

Hi i'm from hyderabad
I'm having some symptoms which are listed below.
1.Burning like thing in both leg fingers(more in right leg fingers)- (from last 3 weeks)
2. A little blurred vision- (from 4-5 weeks)
3.Some times i feel warm head and when i close my hand i feel warm in my hands too.(from 2 weeks)

one more thing
- if i walk for some time, the pain in my leg fingers gone. And returns back after sometime
- After a nice sleep the blurred vision is gone. But it comes back during the day progression

My local doctor gave me these medicines for my burning fingers
- multivitamineral softgels N-vit after dinner
- Omee d in the morning


Are these the symptoms of multiple sclerosis

varun kumar said...

Hi I m from Varun Delhi 33 years old & suffering from MS from last 3 years. The initial problem was blurred vision & numbness on the left side of the face. I was recommended by Dr. to be hospitalized for 5 days for IV therapy & after that 20 days oral medicine as steroids. Vision got improved but again in a span of 6 months I suffered the same & got hospitalized again. This has happened thrice & finally I started interferons (RELIBETA). Since I was recommended this injection the very first time also but being an expensive treatment I haven't started then & finally started a year back. Want your recommendation as how can the vision be improved as I m suffering from blurred vision from last 2 years & difficulty in chewing from left side & sexual weakness too. Also knees get stiffed if I walk for 15~20 minutes.
Need your advice & recommendation as what treatment should I take to improve the partial disorders.

Regards
Varun Kumar

shilpi dhanetwal said...

hi, 6 months back i was given anesthesia n admitted to hospital, and then dr was some side effect due to which i cannot move now, severe leg pain all the time, please help me out, what should i do??

akansha jain said...

What is neuromyelitis optics disorder.what is t/t plz help me.its is urgent

Dr. Sudhir Kumar said...

Hi Akansha Jain, Neuromyelitis optica is an auto-immune disorder and can be treated with good medicines. I am ready to help you, if you wish so. I am available daily at Apollo Hospital, Hyderabad (Call 040-23607777/60601066 to book the appointment)