ANSWERS: 2
  • Treatment There is no known definitive cure for multiple sclerosis. However, several types of therapy have proven to be helpful. Different therapies are used for patients experiencing acute attacks, for patients who have the relapsing-remitting subtype, for patients who have the progressive subtypes, for patients without a diagnosis of MS who have a demyelinating event, and for managing the various consequences of MS attacks. Treatment is aimed at returning function after an attack, preventing new attacks, and preventing disability. Management of acute attacks During symptomatic attacks, patients may be hospitalized. Patients in the United States are typically given high doses of intravenous corticosteroids, such as methylprednisolone, to end the attack sooner and leave fewer lasting deficits. When given to treat optic neuritis, although generally effective in the short term for relieving symptoms, corticosteroid treatments do not appear to have a significant impact on long-term recovery. Despite this fact, some neurologists recommend aggressive steroid treatment at the first signs of an exacerbation to reduce the duration in which inflammation persists in order to minimize the opportunity for damage to the nerves. Oral steroids tend to be given more often to patients in European nations, and they are frequently the only treatment offered to patients in countries where it is difficult to obtain the expensive disease-modifying medications. Recent findings suggest that oral steroid pills are just as effective at treating MS symptoms as intravenous treatment; the primary factor in the effectiveness of the treatment appears to be the high dosage over a short period of time, regardless of how the steroid is administered. Management of relapsing-remitting MS In the United States, as of 2006 there are six Food and Drug Administration (FDA)-approved treatments for patients with relapsing-remitting MS. Three are interferons: Interferon beta-1a (Avonex and Rebif) or beta-1b (Betaseron [in Europe and Japan Betaferon]). The interferons are medications derived from human cytokines which help regulate the immune system. A fourth medication is glatiramer acetate (Copaxone), a mixture of polypeptides which may protect important myelin proteins by substituting itself as the target of immune system attack. The fifth medication, mitoxantrone is effective but is limited by cardiac toxicity. Finally, the sixth medication is Natalizumab (marketed as Tysabri). Was finally aproved in May 2006 after a long process, due to PML cases in some patients. All six medications have been proven to be modestly effective at decreasing the number of attacks and slowing progression to disability. They differ primarily in ease of use, price, side effects, and the likelihood that extended use will decrease their effects. All these therapies are expensive and require frequent injections, with Avonex requiring weekly injections and Copaxone daily injections. All of the interferons can lose effectiveness after continued use, with Avonex being the least likely and Betaseron the most likely. This is the result of neutralizing antibodies against the interferons. The interferons all require laboratory monitoring of blood tests. Even with appropriate use of medication, most patients with relapsing-remitting MS still suffer from some attacks and subsequent disability. Side effects are covered below. Management of progressive MS Treatment of progressive MS is more difficult than relapsing-remitting MS, and many patients do not respond to any therapy. A wide range of medications have been used to try to slow the progression of disease. Many therapies have been shown to have some effect on disease progression and resulting disability, but most therapies have significant side effects which limit their long-term use. Therefore they are often appropriate only for the most rapidly progressive cases. Azathioprine, cladribine, and ciclosporin have all shown small benefits, which in most cases are outweighed by side effects such as an increased cancer risk. Mitoxantrone, a chemotherapy drug, offers a significant reduction in progression to disability, but causes dose-dependant cardiac toxicity which limits its long-term use. Bone marrow transplant, plasmapheresis, and total lymphoid irradiation (exposure to high doses of radiation in order to kill parts of the immune system) have been studied and are currently reserved for the most dire cases. Cyclophosphamide and methotrexate are chemotherapy drugs which can slow the progression of MS, but which also have a number of side effects. Frequent courses of high-dose corticosteroids, often given weekly or monthly, are also commonly employed to good effect. Interferons show promise in secondary progressive MS, but more data is needed to support widespread use. Management of demyelination without a diagnosis of MS Several studies have shown that starting treatment with interferon beta-1a during the initial attack (and prior to the second attack required for a definite diagnosis of MS) can decrease the chance that a patient will develop MS. A separate medication, intravenous immunoglobulin (IVIG) has also shown promise in reducing progression to MS in this set of patients. Therefore, in certain patients, it is important that therapy be started prior to definite diagnosis.[24][25] Management of the effects of MS Because much of the damage caused by MS is irreversible, management of the resulting deficits is very important. As for any patient with neurologic deficits, a multidisciplinary approach is key to limiting and overcoming disability. Physical therapy, occupational therapy, and supportive equipment such as wheelchairs and standing frames may be helpful. Speech therapy can help maintain quality of life. Treatment of emotional distress and depression should involve mental health professionals such as therapists, psychologists, and psychiatrists. Neurocognitive testing is important for determining the extent of cognitive deficits. Management of cognitive defects relies on lifestyle strategies, but also may respond to donepezil. Medications such as baclofen, tizanidine, dantrolene and Sativex have been shown to improve spasticity. Depression can be treated with a variety of antidepressants; selective serotonin reuptake inhibitors (SSRIs) are most commonly employed. The anticonvulsant drugs gabapentin and carbamazepine and the antidepressant amitriptyline can improve pain and tingling sensations in certain cases. Fatigue can often be managed by amantadine, pemoline, methylphenidate, and modafinil. Bladder spasms can be treated by oxybutynin and trospium chloride. Erectile dysfunction may respond to sildenafil, vardenafil, or tadalafil. Therapies under investigation Scientists continue their extensive efforts to create new and better therapies for MS. One of the most promising MS research areas involves naturally occurring antiviral proteins known as interferons. Beta interferon has been shown to reduce the number of exacerbations and may slow the progression of physical disability. When attacks do occur, they tend to be shorter and less severe. In addition, there are a number of treatments under investigation that may curtail attacks or improve function. Over a dozen clinical trials testing potential therapies are underway, and additional new treatments are being devised and tested in animal models. A family of cholesterol-lowering drugs, the statins, have shown anti-inflammatory effects in animal models of MS. However, as of 2005 there is not sufficient evidence that statins are beneficial in the treatment of human MS patients with normal cholesterol levels. A recent study found that women who took vitamin D supplements were 40% less likely to develop MS than women who did not take supplements. However, this study does not provide enough data to conclude that vitamin D has a beneficial influence on ongoing MS. Furthermore, it could not distinguish between a beneficial effect of vitamin D and that of multivitamin supplements including vitamin E and various B vitamins, which may also exert a protective effect.[26] Low-dose naltrexone has been reported to reduce the progression and relapse rates in MS; however, as of 2005, the evidence is principally based on patient reports, and no formal studies have confirmed its effectiveness. Since the 1960s, a possible link between MS and mercury exposure from amalgam used to fill dental caries (cavities) has been explored. Although multiple studies[27] have shown no link between mercury amalgam and MS, a recent study [28] suggests an improvement after replacement of mercury amalgam in a small subset of people identified by a blood test called MELISA.[29] One study [30] has documented that MS patients with a history of head or neck trauma may benefit from upper cervical chiropractic care. A compound called inosine has had good results in phase I and is currently in phase II.[31] Three different ways of action have been proposed. First, it produces uric acid after ingestion[32], which is a natural antioxidant and a peroxinitrite scavenger[33] (peroxynitrite has been correlated with the axons degeneration[34]). Second, in has been shown that induces axonal rewiring and is used as a treatment for stroke,[35] and spinal cord injury [36] and third, it has shown neuroprotective and anti-inflammatory effects independently of the other two.[37] Currently it is being investigated by Boston Life Sciences under the name axosine A few doctors have begun experimenting with antibiotic protocols targeted against Chlamydophila pneumoniae. These protocols involve the use of at least three antimicrobial agents, and often more, to cover all the phases of the life cycle of that pathogen, and are applied for extended periods; they are thus not likely to be arrived at by chance. Anecdotal reports are favorable, but only one double-blind placebo-controlled trial[38] has been published, in which the number of patients studied was too small (four in each arm of the trial) to reach statistical significance in the primary outcome measure (volume of gadolinium-enhancing lesions, as viewed on MRI). A recent study in the United Kingdom revealed promising results when using a combination of mitoxantrone (an immunosuppressant drug normally used in cancer) and Glatiramer acetate (Copaxone). In an 'open' study of 27 patients with Relapsing Remitting MS, the combination was found to provide a rapid and sustained suppression of relapses in MS patients experiencing frequent, recurrent and disabling attacks (90% reduction in annualised relapse rate maintained, to date, for a mean of 36 months). A three year controlled study is now being launched at 10 centres across the UK.[39]. Side effects of medications for relapsing-remitting MS The two most common types of medications used to treat relapsing-remitting MS have significant side effects which warrant further discussion. Both the interferons and glatiramer acetate are available only in injectable forms, and both can cause irritation at the injection site. Interferons are produced in the body during illnesses such as influenza in order to help fight the infection. They are responsible for the fever, muscle aches, fatigue, and headache common during influenza infections. Many patients report influenza-like symptoms when using interferon to fight MS. This reaction often lessens over time and can be treated with over-the-counter fever reducers/pain relievers like paracetamol (acetaminophen), ibuprofen, and naproxen. Many patients choose not to take interferon due to the unpleasant experience of frequent injections and their subsequent side effects, citing a loss in their quality of life. Neurologists advocating for the use of these medications in modifying the progression of disease believe the long term benefits outweigh the short-term side effects. Interferons can cause liver damage, and laboratory blood tests must be monitored to ensure safe use. Some patients taking glatiramer acetate experience a "post-injection" reaction manifested by flushing, chest tightness, heart palpitations, breathlessness, and anxiety.
  • Yes Reiki can help multiple sclerosis but it is in addition to not a replacement for standard medical treatment. The way Reiki works is it keeps the energy inside your body flowing. When energy is blocked it can cause medical, spiritual, physical, emotional difficulties. Here are some good websites. http://www.healingreiki.com/ and http://www.angelpsychic.com/ (click on Reiki towards the middle of the list on the left)

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