Multiple Sclerosis

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Multiple Sclerosis

• Sara Pooler
• Spring 2006

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What is MS?

• Multiple Sclerosis is a disease of the Central
  Nervous System (CNS).
• It is also thought of as an autoimmune disorder.

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Fast Facts

• Approximately 400,000 people in the US have MS.
  (2.5 million worldwide)
• Invisible disease.
• Not considered fatal.
• Not contagious.
• More common in northern European ancestry.
• Twice as common in women as men.

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Myelin

• Myelin is made up of lipids and proteins.
• It acts as a type of insulation around the axon
  of nerves.
• Demyelinazation occurs when the myelin sheath
  becomes damaged.
• In MS, this is the result of an abnormal
  autoimmune reaction.

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Exacerbations

• Characterized by a sudden worsening of symptoms.
• Last at least 24 hours
• Separated from last exacerbation by at least one
  month
• Can last from a couple days to a few weeks.
• Followed by demyelinazation.

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Pseudoexacerbations

• Symptoms are present in the same form as regular
  exacerbations except
• Something triggers the symptoms to come out.
• Fever, infection, hot weather, etc.
• When the trigger disappears the symptoms
  disappear as well.

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Symptoms

• Very unpredictable!
• Symptoms vary from one individual to the next,
  and also from one exacerbation to the next.
• Symptoms can fully disappear after exacerbations.

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Symptoms include

• Fatigue
• Muscle Control problems
• Slurred speech
• Tremors
• Stiffness
• Bladder problems
• Pain

• Depression
• Sexual dysfunction
• Numbness/Tingling
• Vertigo
• Vision problems
• Cognitive problems
• Paralysis

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Diagnosis

• Can be difficult to diagnose because of the
  nature of the symptoms.
• No specific laboratory tests available to test
  for MS.
• MRIs are most often used in diagnosing and
  monitoring MS.
• Other tests that can be used are spinal taps and
  evoked potential tests

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Types of MS

• There are four main types of MS
• Relapsing/Remitting (RRMS)
• Secondary Progressive (SPMS)
• Progressive Relapsing/Remitting (PRMS)
• Primary Progressive (PPMS)

http//www.nationalmssociety.org/What20is20MS.as
p
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Relapsing/Remitting (RRMS)

• This is generally the first diagnosis of MS in
  the 20s to 30s.
• Approximately 85 of cases.
• Women are twice as likely to have this diagnosis.
• Characterized by relapses or exacerbations
  followed by periods of remission.

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Secondary Progressive (SPMS)

• About half of individuals with RRMS will develop
  this type of MS after a number of years.
• This starts out as RRMS, however over time there
  will not be real recovery after relapses, just a
  worsening progression of symptoms.

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Progressive Relapsing/Remitting (PRMS)

• Characterized by relapses followed by periods of
  remission, however, during those periods of
  remission there is a general worsening of
  symptoms.
• Approximately 5 of cases.

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Primary Progressive (PPMS)

• There are no real remissions with this type of
  MS. Instead there is a gradual worsening of
  symptoms over time.
• Onset is generally around late 30s to early
  40s.
• Men are just as likely as women to be diagnosed.
• Primary onset is in the spinal cord, but may
  travel to the brain.
• Individuals with this type of MS are less likely
  to suffer from brain damage.
• Approximately 10 of cases.

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Treatment

• There is currently no cure for MS.
• Treatments focus on
• Slowing down the disease (disease modifying)
• Specific symptom treatment
• Exacerbation treatment

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Disease Modifying Treatments

• These treatments focus their effects on the
  autoimmune system.
• Interferon Drugs
• Avonex
• Betaseron
• Rebif
• Copaxone
• Novantrone

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Beta Interferons (IFN-ß)

• These drugs include
• Beta interferon-1a
• Avonex
• Rebif
• Beta interferon-1b
• Betaseron (US)
• Betaferon (Europe)

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Interferons (IFNs)

• Interferons are a group of biochemicals that help
  regulate the immune system.
• These biochemicals are naturally occurring in the
  body.
• Gamma interferons (IFN-?) are associated with
  the disease process in MS.
• Beta interferons (IFN-ß) are used to treat MS.

http//www.mult-sclerosis.org/ABCtreatments.html
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How do IFN-ß drugs work?

• It is not completely known how these drugs work,
  however, the following is believed to be the best
  explanation
• Reduces levels of IFN-? (gamma interferon)
• Blocks WBC from attacking myelin sheaths
• Stops T-Cells from releasing cytokines (immune
  system signaling molecules)
• Interferes with summoning new immune systems
  cells to inflammation sites.

http//www.mult-sclerosis.org/ABCtreatments.html
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Avonex (1996)

• Used to treat RRMS, PRMS, and SPMS and single
  clinical episodes with MRI features consistent
  with MS
• Injection given once a week
• Side effects include flu-like symptoms
• Less common side effects include depression,
  mild anemia, increased liver enzymes, allergic
  reactions, and heart problems.

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Betaseron (1993)

• Used to treat RRMS, PRMS, RPMS
• Injection given every other day
• Side effects include flu-like symptoms and
  injection site reactions
• Less common side effects include allergic
  reactions, depression, increased liver enzymes,
  and decreased white blood cell count

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Rebif (2002)

• Used to treat RRMS, PRMS, and SPMS
• Injection given three times a week
• Side effects include flu-like symptoms,
  injection site reactions
• Less common side effects include liver problems,
  depression, allergic reactions, and decreased
  white and red blood cell counts

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Copaxone (COP-1) (1996)

• Active ingredient is Glatiramer acetate
• Used to treat RRMS
• Injection given every day
• Its believed that it works by changing the
  bodys T-cell immune response to myelin.
• Changes T-cells from pro-inflammatory to
  anti-inflammatory.
• Most common side effect is injection site
  reactions.
• Less common side effects include vasodilation
  and chest pain
• Some individuals have an injection reaction
  immediately following the injection.
  Characterized by anxiety, chest pain,
  palpatations, shortness of breath, and flushing.
  Lasts for approximately 15-30 minutes. No
  treatment is necessary and no long term effects
  have been reported.

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Novantrone (2000)

• Chemotherapeutic drug once used to treat cancer.
• It works by suppressing T-cells, B-cells, and
  macrophages
• Used for RRMS, PRMS, and SPMS
• Cant be used for individuals with heart
  problems, liver diseases, and blood disorders
• Given 4 times a year by IV with a lifetime limit
  of 8-12 doses
• Side effects include blue/green urine (up to 24
  hours), infections, bone marrow supression
  (fatigue, bruising, decreased blood cell counts),
  nausea, decreased hair growth, bladder
  infections, mouth sores
• Serious side effects include liver and heart
  damaged (Patients are monitored closely for these
  symptoms)

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Symptom Treatment

• The treatment of symptoms is something that is
  very common for individuals with MS.
• Regular, prescription drugs are used along with
  some over the counter drugs.
• Some individuals also use herbal remedies.

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Exacerbation Treatment

• Main treatment is corticosteroids
• Solu-Medrol (Methylprednisolone)
• Deltasone (Prednisone)
• Decadron (Dexamethasone)
• They have the ability to close the damaged
  blood-brain barrier and reduce inflammation in
  the central nervous system.
• Usually given by IV either in the hospital or as
  an outpatient.
• 4 day treatment course followed by decreasing
  oral corticosteroids
• Side effects
• Increased appetite, indigestion,
  nervousness/restlessness, trouble sleeping,
  headaches, increased sweating, increased hair
  growth (body and face)

http//www.nationalmssociety.org/Meds-Methylpredni
solone.asp
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Annual Cost

• It costs approximately 35,000 per year for the
  treatment of MS.
• The individual costs of RR drugs (per year)
• Novantrone - 5,000 - 10,000
• Copaxone 16,000
• Avonex Betaseron - 19,000
• Rebif - 23,000
• In a lifetime, someone with MS will likely pay
  3.2 million in treatment costs.

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Psychosocial Issues

• Anxiety, Anxiety, Anxiety
• Some medications can cause depression
• Some symptoms can greatly affect a person and
  make them feel inadequate

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Personal Awareness

• Its important for individuals with MS to be
  aware of what they can and can not do.
• Know your limits
• Dont be afraid to ask for help

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Vocational Issues

• Not everyone chooses to disclose that they have
  MS.
• Must disclose to get accommodations.
• The main problem comes from a lack of knowledge
  about the disease by employers.
• Not many accommodations are really needed.
• Most accommodations are simple arrangement of
  furniture (desk, bookcases, filing cabinets, etc.)

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Vocational Resources

• Many individuals dont seek out resources.
• Dont need them.
• Dont know they exist.
• Job Accommodation Network
• Occupational Therapy
• VESID

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National Multiple Sclerosis Society (Upstate NY
Chapter)

• Serves 42 counties
• Rochester to Binghamton to Albany
• North Country
• Fundraising
• Self-help and support groups
• Offer a variety of different services

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Services offered

• Educational Programs
• For individuals with MS
• For area doctors
• In-services for schools
• Recreational Programs
• Online programs
• Referral information
• Publications

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Adams Story
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References and Resources

• Books
• Donna Falvo Medical and Psychosocial Aspects of
  Chronic Illness and Disability
• Online Resources
• National Multiple Sclerosis Society
• WebMD
• Multiple Sclerosis International Foundation
• National Institute of Neurological Disorders and
  Stoke