Multiple Sclerosis Multiple sclerosis (MS) is a chronic inflammatory disease involving degeneration of CNS myelin, scarring (sclerosis or plaque formation), and loss of axons (Huether & McCance, 2017). MS is a diffuse and progressive disease. Patches of damage can occur throughout the brain and spinal cord. Genetically susceptible individuals undergo an autoimmune response to self or microbial agents which causes the disease. Onset tends to occur between ages 20 through 40 years and is more common in females. Signs and Symptoms MS causes paresthesia of the face, trunk, and limbs. Individuals may experience muscle weakness, visual disturbances, and at times, urinary incontinence may occur. Gait may be impaired. If there is cerebellar and corticospinal involvement, symptoms may involve nystagmus, ataxia, weakness of all four extremities, and possibly tremor and slurred speech. Onset, duration, and severity vary from person to person. Relapses and flares are common. Diagnosis and Treatment A history and physical examination, combined with an MRI, CSF findings, and evoked potentials are used to diagnose MS since there is no single test available to diagnose the disease. Goals of treatment include preventing exacerbations, preventing permanent neurological damage, and controlling symptoms. Medications to treat MS include corticosteroids, immunosuppressants, and immune system modulators. Interferon injectables and glatiramer acetate (GA) have been the mainstay treatments for the past 20 years and are still considered first-line treatment for relapsing-remitting forms of MS (English & Aloi, 2015). New drug therapies launched in 2010 have expanded treatment options.
Since this time new oral agents, modified release systems of older therapeutics, and new biologics have come to the forefront in treating MS (English & Aloi, 2015). The new agents are offering better administration routes, more dosing flexibility, and reducing relapses. The American Academy of Neurology has released a practice guideline to help healthcare professionals and people with MS choose among available disease-modifying therapies (National Multiple Sclerosis Society, 2018). This summary lists the different types of therapies along with the evidence of their effectiveness in reducing relapses and slowing progression, possible side effects, and when to consider switching therapies. Individuals with MS may be prescribed corticosteroids to reduce nerve inflammation. The only approved disease-modifying therapy that slows the worsening of primary progressive MS is ocrelizumab. It is a humanized immunoglobulin antibody proven to reduce relapse and slow worsening of disability. It is given by IV infusion. It has been shown to increase the risks of certain types of cancer, including breast cancer.
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- Summer '15
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