Multiple sclerosis (MS) can be thought of as an inflammatory process involving different areas of the central nervous system (CNS) at various points in time. As the name suggests, multiple sclerosis affects many areas of the CNS.
Multiple sclerosis is more common in individuals of northern European descent. Women are more than twice as likely to develop multiple sclerosis as men.
Multiple sclerosis usually affects people between the ages of 20 and 50 years, and the average age of onset is approximately 34 years.
Multiple Sclerosis Symptoms
The symptoms of multiple sclerosis can be different from person to person. Visual, sensory, and motor signs and symptoms are all part of multiple sclerosis. The clinical manifestations are varied, and therefore there is a wide range of symptoms that can appear. Some people have mild cases of multiple sclerosis with little or no disability over the years. Others have more severe types of multiple sclerosis, requiring confinement to a wheelchair or bed. Still others may live their entire lives symptom-free (some individuals without multiple sclerosis symptoms are found incidentally to have multiple sclerosis lesions by MRI, or individuals in whom an examination of their brain after death unexpectedly reveals that they were affected by the disease). This variability makes it difficult in some cases to diagnose multiple sclerosis.
Treatment for MS:
Patients with multiple sclerosis have multiple needs, and the neurologist should be receptive and cooperative and try to allay fears, facilitate access to rehabilitation and orthotic equipment and home evaluations, and solve transportation issues. Bone densitometry studies are indicated for patients with MS who have received long-term corticosteroid treatment or are at higher osteoporosis risk from menopause or chronic immobility.
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Patients with more advanced forms of the disease who have lost all family support, are separated from their spouses, require constant psychiatric and nursing assistance, and are unable to walk are not rare. These patients create a challenge for the physician who is not trained in handling these demanding (administrative or ancillary) aspects of medical care. A social worker specialist can be instrumental in helping address these issues.
The physician should not underestimate the impact of fatigue symptoms on the patient's daily activities. Treatment with amantadine (Symmetrel) or modafinil (Provigil) is often attempted when no contraindications exist. Pemoline, a drug that was gaining attention by MS clinicians for the treatment of fatigue is no longer being used due to reports of rare fatal liver damage events during its use. The United States Food and Drug Administration (FDA) concluded that the overall risk of liver toxicity from pemoline outweighs the benefits. In May 2005, Abbott chose to stop sales and marketing of their brand of pemoline (Cylert) in the United States. In October 2005, all companies that produced generic versions of pemoline also agreed to stop sales and marketing of pemoline.
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