Multiple sclerosis medical therapy: Difference between revisions

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===Spasticity===
===Spasticity===


  There is evidence, albeit limited, of the clinical effectiveness of [[baclofen]],<ref>;[http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682530.html Baclofen oral.] US National Library of Medicine (Medline) ([[2003-04-01]]). Retrieved on [[2007-10-17]].</ref> [[dantrolene]],<ref>[http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682576.html Dantrolene oral.] US National Library of Medicine (Medline) ([[2003-04-01]]). Retrieved on [[2007-10-17]].</ref> [[diazepam]],<ref>[http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682047.html Diazepam.] US National Library of Medicine (Medline) ([[2005-07-01]]). Retrieved on [[2007-10-17]].</ref> and [[tizanidine]].<ref>[http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601121.html Tizanidine.] US National Library of Medicine (Medline) ([[2005-07-01]]). Retrieved on [[2007-10-17]].</ref><ref name="pmid14636486">{{cite journal |author=Beard S, Hunn A, Wight J|title=Treatments for spasticity and pain in multiple sclerosis: a systematic review |journal=Health technology assessment (Winchester, England) |volume=7 |issue=40 |pages=iii, ix–x, 1–111 |year=2003 |pmid=14636486 |doi=}}</ref><ref name="pmid12166503">{{cite journal |author=Paisley S, Beard S, Hunn A, Wight J |title=Clinical effectiveness of oral treatments for spasticity in multiple sclerosis: a systematic review |journal=Mult. Scler. |volume=8 |issue=4 |pages=319–29 |year=2002|pmid=12166503 |doi=}}</ref> In the most complicated cases [[intrathecal]] injections of baclofen can be used.<ref name="pmid8529173">{{cite journal |author=Becker WJ, Harris CJ, Long ML, Ablett DP, Klein GM, DeForge DA |title=Long-term intrathecal baclofen therapy in patients with intractable spasticity |journal=The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques |volume=22 |issue=3 |pages=208–17 |year=1995 |pmid=8529173 |doi=}}</ref>
  There is evidence, albeit limited, of the clinical effectiveness of [[baclofen]],<ref>;[http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682530.html Baclofen oral.] US National Library of Medicine (Medline) ([[2003-04-01]]). Retrieved on [[2007-10-17]].</ref> [[dantrolene]],<ref>[http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682576.html Dantrolene oral.] US National Library of Medicine (Medline) ([[2003-04-01]]). Retrieved on [[2007-10-17]].</ref> [[diazepam]],<ref>[http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682047.html Diazepam.] US National Library of Medicine (Medline) ([[2005-07-01]]). Retrieved on [[2007-10-17]].</ref> and [[tizanidine]].<ref>[http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601121.html Tizanidine.] US National Library of Medicine (Medline) ([[2005-07-01]]). Retrieved on [[2007-10-17]].</ref><ref name="pmid14636486">{{cite journal |author=Beard S, Hunn A, Wight J|title=Treatments for spasticity and pain in multiple sclerosis: a systematic review |journal=Health technology assessment (Winchester, England) |volume=7 |issue=40 |pages=iii, ix–x, 1–111 |year=2003 |pmid=14636486 |doi=}}</ref><ref name="pmid12166503">{{cite journal |author=Paisley S, Beard S, Hunn A, Wight J |title=Clinical effectiveness of oral treatments for spasticity in multiple sclerosis: a systematic review |journal=Mult. Scler. |volume=8 |issue=4 |pages=319–29 |year=2002|pmid=12166503 |doi=}}</ref> In the most complicated cases [[intrathecal]] injections of baclofen can be used.<ref name="pmid8529173">{{cite journal |author=Becker WJ, Harris CJ, Long ML, Ablett DP, Klein GM, DeForge DA |title=Long-term intrathecal baclofen therapy in patients with intractable spasticity |journal=The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques |volume=22 |issue=3 |pages=208–17 |year=1995 |pmid=8529173 |doi=}}</ref>  
 
 
 
===Transverse myelitis===
 
Treatment is usually symptomatic only, corticosteroids being used with limited success.

Revision as of 14:47, 27 August 2012

Bladder

Treatment objectives are aliviation of symptoms of urinary dysfunction, treatment of urinary infections, reduction of complicating factors and preservation of renal function.Treatments can be classified in two main subtypes: pharmacological and non pharmacological.

Pharmacological treatments vary greatly depending on the origin or type of dysfunction; however some examples of the medications used are:[1] alfuzosin for retention,[2] trospium and flavoxate for urgency and incontinency,[3][4] or desmopressin for nocturia.[5][6]

Non pharmacological treatments involve the use of pelvic floor muscle training, stimulation, biofeedback,pessaries, bladder retraining, and sometimes intermittent catheterization.[7]

Cognition

Interferons have demonstrated that can help to reduce cognitive limitations in multiple sclerosis.[8]Anticholinesterase drugs such as donepezil commonly used in alzheimer disease; although not approved yet for multiple sclerosis; have also shown efficacy in different clinical trials.[9][10][11]


Fatigue

There are also different medications used to treat fatigue; such as amantadine,[12][13] or pemoline;[14][15] as well as psichological interventions of energy conservation;[16][17] but the effects of all of them are small. For this reason fatigue is a very difficult symptom to manage.


Internuclear ophthalmoplegia

Different drugs as well as optic compensatory systems and prisms can be used to improve this symptoms.[18][19][20][21] Surgery can also be used in some cases for this problem.[22]


Optic neuritis

Systemic intravenous treatment with corticosteroids, which may quicken the healing of the optic nerve, prevent complete loss of vision, and delay the onset of other symptoms, is often recommended.


Trigeminal neuralgia

Usually it's successfully treated with anticonvulsants such as carbamazepine[23] or phenytoin[24] but others such as gabapentin[25] can be used. [26]


Lhermittes's sign and dysesthesias

Both Lhermitte's sign and painful dysesthesias usually respond well to treatment withcarbamazepine, clonazepam or amitriptyline. [27][28][29]


Spasticity

There is evidence, albeit limited, of the clinical effectiveness of baclofen,[30] dantrolene,[31] diazepam,[32] and tizanidine.[33][34][35] In the most complicated cases intrathecal injections of baclofen can be used.[36]


Transverse myelitis

Treatment is usually symptomatic only, corticosteroids being used with limited success.

  1. ↑ Ayuso-Peralta L, de Andrés C (2002). "[Symptomatic treatment of multiple sclerosis]". Revista de neurologia (in Spanish; Castilian). 35 (12): 1141–53. PMID 12497297.
  2. ↑ Information from the USA National library of medicine on alfuzosin[1]
  3. ↑ Information from the USA National library of medicine on trospium[2]
  4. ↑ Information from the USA National library of medicine on flavoxate [3]
  5. ↑ Bosma R, Wynia K, Havlíková E, De Keyser J, Middel B (2005). "Efficacy of desmopressin in patients with multiple sclerosis suffering from bladder dysfunction: a meta-analysis". Acta Neurol. Scand. 112 (1): 1–5. doi:10.1111/j.1600-0404.2005.00431.x. PMID 15932348.
  6. ↑ Information from the USA National library of medicine on desmopressin[4]
  7. ↑ Frances M Diro (2006) "Urological Management in Neurological Disease". [5]
  8. ↑ Montalban X, Rio J (2006). "Interferons and cognition". J Neurol Sci. 245 (1–2): 137–40. PMID 16626757.
  9. ↑ Christodoulou C, Melville P, Scherl W, Macallister W, Elkins L, Krupp L (2006). "Effects of donepezil on memory and cognition in multiple sclerosis". J Neurol Sci. 245 (1–2): 127–36. PMID 16626752.
  10. ↑ Porcel J, Montalban X (2006). "Anticholinesterasics in the treatment of cognitive impairment in multiple sclerosis". J Neurol Sci. 245 (1–2): 177–81. PMID 16674980.
  11. ↑ Information from the USA National library of medicine on donepezil[6]
  12. ↑ Pucci E, Branãs P, D'Amico R, Giuliani G, Solari A, Taus C (2007). "Amantadine for fatigue in multiple sclerosis". Cochrane database of systematic reviews (Online) (1): CD002818. doi:10.1002/14651858.CD002818.pub2. PMID 17253480.
  13. ↑ Amantadine. US National Library of Medicine (Medline) (2003-04-01). Retrieved on 2007-10-07.
  14. ↑ Weinshenker BG, Penman M, Bass B, Ebers GC, Rice GP (1992). "A double-blind, randomized, crossover trial of pemoline in fatigue associated with multiple sclerosis". Neurology. 42 (8): 1468–71. PMID 1641137.
  15. ↑ Pemoline. US National Library of Medicine (Medline) (2006-01-01). Retrieved on 2007-10-07.
  16. ↑ Mathiowetz VG, Finlayson ML, Matuska KM, Chen HY, Luo P (2005). "Randomized controlled trial of an energy conservation course for persons with multiple sclerosis". Mult. Scler. 11 (5): 592–601. PMID 16193899.
  17. ↑ Matuska K, Mathiowetz V, Finlayson M (2007). "Use and perceived effectiveness of energy conservation strategies for managing multiple sclerosis fatigue". The American journal of occupational therapy. : official publication of the American Occupational Therapy Association. 61 (1): 62–9. PMID 17302106.
  18. ↑ Leigh RJ, Averbuch-Heller L, Tomsak RL, Remler BF, Yaniglos SS, Dell'Osso LF (1994). "Treatment of abnormal eye movements that impair vision: strategies based on current concepts of physiology and pharmacology". Ann. Neurol. 36 (2): 129–41. PMID 8053648.
  19. ↑ Starck M, Albrecht H, Pöllmann W, Straube A, Dieterich M (1997). "Drug therapy for acquired pendular nystagmus in multiple sclerosis". J. Neurol. 244 (1): 9–16. PMID 9007739.
  20. ↑ Clanet MG, Brassat D (2000). "The management of multiple sclerosis patients". Curr. Opin. Neurol. 13 (3): 263–70. PMID 10871249.
  21. ↑ Menon GJ, Thaller VT (2002). "Therapeutic external ophthalmoplegia with bilateral retrobulbar botulinum toxin- an effective treatment for acquired nystagmus with oscillopsia". Eye (London, England). 16 (6): 804–6. PMID 12439689.
  22. ↑ Jain S, Proudlock F, Constantinescu CS, Gottlob I (2002). "Combined pharmacologic and surgical approach to acquired nystagmus due to multiple sclerosis". Am. J. Ophthalmol. 134 (5): 780–2. PMID 12429265.
  23. ↑ Information from the USA National library of medicine on carbamazepine[7]
  24. ↑ Information from the USA National library of medicine on phenytoin[8]
  25. ↑ Information from the USA National library of medicine on gabapentin[9]
  26. ↑ Solaro C, Messmer Uccelli M, Uccelli A, Leandri M, Mancardi GL (2000). "Low-dose gabapentin combined with either lamotrigine or carbamazepine can be useful therapies for trigeminal neuralgia in multiple sclerosis". Eur. Neurol. 44 (1): 45–8. PMID 10894995.
  27. ↑ Information from the USA National library of medicine on clonazepam[10]
  28. ↑ Information from the USA National library of medicine on amitriptyline[11]
  29. ↑ Moulin DE, Foley KM, Ebers GC (1988). "Pain syndromes in multiple sclerosis". Neurology. 38 (12): 1830–4. PMID 2973568.
  30. ↑ ;Baclofen oral. US National Library of Medicine (Medline) (2003-04-01). Retrieved on 2007-10-17.
  31. ↑ Dantrolene oral. US National Library of Medicine (Medline) (2003-04-01). Retrieved on 2007-10-17.
  32. ↑ Diazepam. US National Library of Medicine (Medline) (2005-07-01). Retrieved on 2007-10-17.
  33. ↑ Tizanidine. US National Library of Medicine (Medline) (2005-07-01). Retrieved on 2007-10-17.
  34. ↑ Beard S, Hunn A, Wight J (2003). "Treatments for spasticity and pain in multiple sclerosis: a systematic review". Health technology assessment (Winchester, England). 7 (40): iii, ix–x, 1–111. PMID 14636486.
  35. ↑ Paisley S, Beard S, Hunn A, Wight J (2002). "Clinical effectiveness of oral treatments for spasticity in multiple sclerosis: a systematic review". Mult. Scler. 8 (4): 319–29. PMID 12166503.
  36. ↑ Becker WJ, Harris CJ, Long ML, Ablett DP, Klein GM, DeForge DA (1995). "Long-term intrathecal baclofen therapy in patients with intractable spasticity". The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques. 22 (3): 208–17. PMID 8529173.
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