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Friday, February 17, 2012

When MS Attacks - Fighting Flare-ups



Taking Care of Yourself During an MS Flare-Up

Call it a flare-up, call it an exacerbation, call it a relapse -- whatever you call it, you can't call it fun. Many people with relapsing-remitting multiple sclerosis can go days, weeks, months, or years without major changes in their symptoms, but then suddenly, an MS relapse hits.
How do doctors define an MS flare-up? There are a few key factors:
  • The development of a completely new symptom of MS. You’ve never had vision problems before, and suddenly you can’t see out of your left eye.  
  • Worsening of an existing symptom or one that you’ve experienced in previous relapses. Maybe you’ve had some numbness in your left leg before, but now you can’t feel anything above the knee.
  • It must last at least 24 hours. That’s because a flare-up is a signal from the brain that a new lesion is being formed. "You can’t lose myelin and regrow it faster than 24 hours," says Edward Fox, MD, PhD, clinical associate professor of neurology at the University of Texas Medical Branch and director of the MS Clinic of Central Texas. "If a symptom lasts less than 24 hours, it’s something transient that’s not related to a new lesion.
  • It will reach a plateau after awhile, and stop getting worse.
  • You may recover completely, with the symptom going away entirely, or there may be some permanent loss of function or sensation.
"Most exacerbations evolve over a period of days, sometimes over weeks. They can go on for as long as a year," says Bruce Cohen, MD, director of the MS Clinic at Northwestern University Feinberg School of Medicine. "Then they usually do improve, sometimes completely and sometimes not, but recovery can be quite slow."

How to Tell When an MS Relapse Isn’t a Relapse

Sometimes you may fear you’re having a relapse, but it’s really something else. For example:
  • The flu. If you have a fever or an infection, you may experience MS symptoms that feel like a flare-up, but it doesn’t mean that a new lesion has developed. "Rather, it’s a temporary disruption in areas of old damage where nerve impulses were conducting normally," says Patricia Coyle, MD, professor of neurology at the State University of New York at Stony Brook and director of the Stony Brook Comprehensive MS Center. So once you recover from the fever or infection, things should go back to normal relatively quickly.
  • Fatigue. Sometimes if you’re overworked, stressed, and not getting enough sleep, MS symptoms may trouble you more than usual. Getting rest and taking some time for yourself can put you back on track. (But if the fatigue continues, especially if it’s extreme, that may be a signal of an exacerbation.)
  • Short-term symptoms. If you wake up in the morning and your right arm is numb, but the numbness goes away after you shake it out, that’s not an exacerbation. Even if it happens every morning -- as long as the numbness goes away quickly, it’s probably related to your sleep position and not MS.
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Disclaimer:  'MS Views and News' (MSVN), does not endorse any products or services found on this blog. It is up to you to seek advice from your healthcare provider. The intent of this blog is to provide information on various medical conditions, medications, treatments, and procedures for your personal knowledge and to keep you informed of current health-related issues. It is not intended to be complete or exhaustive, nor is it a substitute for the advice of your physician. Should you or your family members have any specific medical problem, seek medical care promptly.
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MS and Memory


Information provided by Kevin K in Brevard Cty, Fl.



For many people, common symptoms of MS include impairment of some mental functions. Approximately half of all people with MS are affected by problems with memory, attention and concentration, as well as processing information. These problems can appear at both earlier and later stages of the disease.

Common Memory and Cognitive Symptoms

Short-term memory, such as remembering a person's name or phone number, is most affected by MS. Other examples of short-term memory impairment are forgetting to mail a letter, or walking into a room and forgetting what you were looking for. You may also have difficulty making decisions, scheduling events, and adjusting to surprises. Recognizing these symptoms is the first step in starting a management program.

Managing Memory

One way that everyone can manage memory is to write things down. You may even want to get a digital voice recorder. Also, memory skills can be improved by exercising them. Playing gamesand learning new tasks may help your brain develop new pathways. Things like word games and puzzles may help you improve attention, concentration, and organization — and they're fun.

Getting Help

If you feel that your memory is failing you more often, it may be time to find help. The first step is a mental function evaluation. This testing is usually performed by a neuropsychologist, and may take several hours to complete. Cognitive testing can be helpful in managing your MS. You may feel a sense of relief in knowing that there is a medical reason behind any memory problems you may be experiencing.



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Disclaimer:  'MS Views and News' (MSVN), does not endorse any products or services found on this blog. It is up to you to seek advice from your healthcare provider. The intent of this blog is to provide information on various medical conditions, medications, treatments, and procedures for your personal knowledge and to keep you informed of current health-related issues. It is not intended to be complete or exhaustive, nor is it a substitute for the advice of your physician. Should you or your family members have any specific medical problem, seek medical care promptly.
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Multiple Sclerosis and Bladder Function



For many people, living with MS means coping with decreased bladder function. That's because an MS lesion in the brain or spinal cord can block the signal from the nervous system that controls bladder muscles and the urinary sphincters that regulate the urine stream. This can create problems with either urine storage or emptying. People who cannot fully empty their bladders are at a higher risk for developing a urinary tract infection (UTI).

Symptoms, Tests and Treatments

Determining with your healthcare provider what type of bladder dysfunction you have is usually straightforward. The most common method is to measure how much leftover or residual urine is in the bladder after it is emptied. This can be done either by inserting a catheter, removing the residual urine and measuring, or by taking images of the bladder using an ultrasound. In both cases, if the residual amount is less than 100ml, the problem may be storage. If it is greater than 100ml, the problem may be incomplete emptying.
Potential symptoms include:
  • Frequency
  • Urgency
  • Dribbles
  • Incontinence
  • Nocturia 
  • Difficulty starting to void
People with MS can help take control of their bladder function by taking certain medications as prescribed, being aware of their surroundings, and planning ahead. In some cases, your doctor may recommend Kegel exercises, or suggest using incontinence pads or catheters.
Typically, your neurologist will try several ways to treat bladder dysfunction; however, if he or she is unsuccessful, you may be referred to a urologist.

topic source



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Disclaimer:  'MS Views and News' (MSVN), does not endorse any products or services found on this blog. It is up to you to seek advice from your healthcare provider. The intent of this blog is to provide information on various medical conditions, medications, treatments, and procedures for your personal knowledge and to keep you informed of current health-related issues. It is not intended to be complete or exhaustive, nor is it a substitute for the advice of your physician. Should you or your family members have any specific medical problem, seek medical care promptly.
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Wednesday, February 15, 2012

Choosing an MS therapy to fit YOUR Lifestyle


Choosing the Right Therapy for YOU
By Cherie C. Binns RN BS MSCN
February 15, 2012

I receive a quarterly publication for MS Nurses entitled “Counseling Points” which may be found on the web at www.counselingpoints.com .  It is written by MS nurses for MS nurses to assist them in patient communication in the clinical setting of the MS Clinic.   The Winter issue for 2011 was entitled , Changing Treatment Paradigms in MS and dealt the fact that as we work with disease modifying therapies (DMTs) over time, one of the findings is that most of our first line therapies (Interferon Beta 1a and 1b(Betaseron, Evista, Rebif and Avonex) and Glaterimer Acetate (GA or Copaxone)  seem to be equally effective across the Board in preventing relapses andall have a high safety record.

For CIS (Clinically Isolated Syndrome) All of the lower dose interferons seemed to work quite well and only half of those with CIS went on to develop Multiple Sclerosis within 5 years of being treated with these medications.  Rebif (the highest dose Interferon) and Copaxone (GA) worked well over a 10 year span of use to prevent relapses and progression in the majority of patients who took them faithfully.

This article also stated that “As many as one quarter of people with MS discontinue therapy within the first 6 months of treatment, with studies showing that perceived lack of efficacy accounts for 30% to 52% of therapy discontinuation.”p6  (citations are in the article in the above web link).

Given the proven effectiveness of the drugs we have had available for the past 15+ years, why are patients so hesitant to stay on therapy?  For some, as in the above statement, they feel like it is not helping.  Is the Medical community giving patients false hope when prescribing a therapy to treat MS?  These therapies are designed to slow the progression of MS by slowing the frequency of relapses thereby preventing some nerve damage over time that could ultimately cause a Person with MS (PWMS) to leave the work force or develop secondary complications that would see an overall deterioration in their health.

So the big question is, how do you choose a therapy that is right for you in your circumstances and with your lifestyle?  




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Brain Imaging in Multiple Sclerosis



Magnetic resonance imaging (MRI) of the brain is useful in the diagnosis and treatment ofmultiple sclerosis (MS), an inflammatory, demyelinating condition of the central nervous system (CNS) that is generally considered to be autoimmune in nature. White matter tracts are affected, including those of the cerebral hemispheres, infratentorium, and spinal cord. MS lesions, known as plaques, may form in CNS white matter in any location; thus, clinical presentations may be diverse. Continuing lesion formation in MS often leads to physical disability and, sometimes, to cognitive decline.

Preferred examination

Radiologically, the use of MRI is revolutionizing the investigation, diagnosis, and even the treatment of MS (see the images below). Usually, MRI is the only imaging modality needed for imaging patients with MS, and it far surpasses all other tests with respect to its positive predictive value.
Sagittal T1-weighted MRI depicts multiple hypointeSagittal T1-weighted MRI depicts multiple hypointense lesions in the corpus callosum; this finding is characteristic of multiple sclerosis.Coronal fluid-attenuated inversion recovery (FLAIRCoronal fluid-attenuated inversion recovery (FLAIR) MRI in a patient with multiple sclerosis demonstrates periventricular high–signal intensity lesions, which exhibit a typical distribution for multiple sclerosis. FLAIR MRI is a highly sensitive sequence for lesion detection, particularly supratentorially.Axial T2-weighted MRI in a patient with multiple sAxial T2-weighted MRI in a patient with multiple sclerosis demonstrates numerous white matter plaques in a callosal and pericallosal white matter distribution.Axial diffusion-weighted MRI in a patient with mulAxial diffusion-weighted MRI in a patient with multiple sclerosis shows several hyperintense lesions, a feature of inflammatory disease activity.
One of the limitations of using MRI in patients with MS is the discordance occurring between lesion location and the clinical presentation. In addition, depending on the number and location of findings, MRI can vary greatly in terms of sensitivity and specificity in the diagnosis of MS. This is especially true of primary progressive MS, which may not show the classic discrete lesions of relapsing-remitting MS.
A clinician presented with an MRI report that details a few "nonspecific white matter lesions" that are "compatible with MS" is often frustrated with the lack of sensitivity and specificity of such a description. For this reason, imaging findings need to be described in detail, and preferably referenced to one of the published set of diagnostic criteria such as those by Paty[1] or Barkhof.[2] Finally, the specific patient's neurologic history and clinical findings must be correlated with the imaging to establish an accurate diagnosis.[3]
Plain radiographic studies have no positive predictive value in the diagnosis of multiple sclerosis, but occasionally, plain radiographs may be used to exclude mechanical bony lesions. Angiography also has a limited role in the diagnosis and management of MS, but when central nervous system (CNS) vasculitis is considered in a patient with undifferentiated findings, angiography may occasionally be considered.
Cerebrospinal fluid (CSF) analysis for oligoclonal banding or immunoglobulin G (IgG) levels is no longer routine in the investigation of MS, although this test may be of use when MRI is unavailable or MRI findings are nondiagnostic.[4]



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Disclaimer:  'MS Views and News' (MSVN), does not endorse any products or services found on this blog. It is up to you to seek advice from your healthcare provider. The intent of this blog is to provide information on various medical conditions, medications, treatments, and procedures for your personal knowledge and to keep you informed of current health-related issues. It is not intended to be complete or exhaustive, nor is it a substitute for the advice of your physician. Should you or your family members have any specific medical problem, seek medical care promptly.
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Without a cure, patients and doctors must find ways to keep the damage caused by MS to a minimum



There are three main strategies involved in the treatment of MS: 
Treating Attacks, Changing the course of the disease, and Treating symptoms

Treating attacks
The majority of MS patients have the relapsing-remitting form of the disease. This means they will experience periods without symptoms followed by episodes of acute symptoms that will last for at least 24 hours.
These episodes, or attacks, are commonly treated with steroids. These drugs reduce the inflammation that occurs during an attack.
Doctors prescribe steroids to reduce the intensity and length of an attack, and to cut down on any irreversible damage caused by the attack.
Some examples of steroids - which are known more formally as corticosteroids - used in the treatment of MS include:
  • Deltasone (prednisone)
  • Liquid Pred (prednisone)
  • Medicorten (prednisone)
  • Orasone (prednisone)
  • Intravenous methylprednisolone (an injected form of the drug Medrol)
As steroids can cause long-term side effects like high blood pressure and an increased risk of infection, doctors usually prescribe a high-dose, short-term treatment plan.
Steroids have no long-term effect on the progression of MS. As such, the benefits of long-term steroid use do not outweigh the risks of other health problems.
Changing the course of the disease
While some patients may have very mild symptoms and require little treatment, other patients need strong drug treatment to save them from irreversible damage to their nerves and bodies.
Over time, MS can take a huge toll on your central nervous system. As the disease progresses, the nerves in your brain and spinal cord can become permanently damaged.
In order to prevent this permanent damage, doctors commonly prescribe one of eight FDA-approved drugs for the long-term treatment of MS.
These drugs include:
  • Avonex (interferon beta-1a)
  • Betaseron (interferon beta-1a)
  • Extavia (interferon beta-1a)
  • Rebif (interferon beta-1a)
  • Copaxone (glatiramer injection)
  • Gilenya (fingolimod)
  • Tysabri (natalizumab injection)
  • Novantrone (mitoxantrone injection)
AvonexBetaseronExtavia, and Rebif are part of a class of drugs known as betainterferons. These drugs slow down the rate at which MS gets worse over time. Asinterferons can cause side effects like liver damage, patients taking these drugs should get frequent blood tests to keep an eye on the health of their liver.
Doctors prescribe Copaxone because it seems to block the immune system's attack on myelin - the protective layer that covers the nerves. This drug is taken through injection under the skin. Some patients have reported side effects including shortness of breath and flushing.

Continue reading 



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Disclaimer:  'MS Views and News' (MSVN), does not endorse any products or services found on this blog. It is up to you to seek advice from your healthcare provider. The intent of this blog is to provide information on various medical conditions, medications, treatments, and procedures for your personal knowledge and to keep you informed of current health-related issues. It is not intended to be complete or exhaustive, nor is it a substitute for the advice of your physician. Should you or your family members have any specific medical problem, seek medical care promptly.
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