Friday, July 20, 2012

Health Care and Multiple Sclerosis

There are various types of muscle disease that affect millions of Americans. Multiple Sclerosis, or MS, is one that is especially difficult and has no known cure at the present time. MS isn’t an easy disease to diagnose, according to the National MS Society. In the first place, there is no single test for multiple sclerosis. Second, the diagnosis cannot be made until the doctor finds evidence of two episodes of disease activity in the central nervous system that have occurred at different points in time — which means that confirming the diagnosis is sometimes a waiting game. And third, most MS symptoms can also be caused by other conditions, which means that the doctor needs to rule out all other possible explanations.

A group of drugs commonly given to people with multiple sclerosis (MS) may not actually have any effect on the progression of the disease, scientists recently said. Researchers at the University of British Columbia in Canada looked at the impact of beta interferons on the long-term disability progression of relapsing-remitting MS in 2,656 patients between 1985 and 2008. Some of the patients were given beta interferons while others were not, and the researchers found that the drugs were not associated with any significant change in the progression of disability, as reported by NetDoctor.co.uk.

Dr. Helen Tremlett, whose findings are published in the Journal of the American Medical Association, said the study provides “additional information to patients and clinicians about the longer-term effect of this class of drugs”. She added that beta interferons are “very helpful in reducing relapses” and urged patients not to stop taking these medicines. In July, 2012, a study in the journal Neurology found that effective stress management may help to reduce MS disease activity.

By themselves, there are no specific tests that can determine if a person has MS or is likely to have it in the future. Current diagnosis of definite MS involves both clinical (history and neurological exam) and paraclinical (MRI, Spinal Tap, Evoked potentials) evidence, according to the Multiple Sclerosis Foundation. The physician will ask about past surgeries, illnesses, allergies, any family neurological disorders including MS, geographic locations where you have lived, if adversely affected by heat, medications taken, history of substance abuse (alcohol, drugs, and tobacco).

During the neurological examination the physician will check for exaggerated reflexes such as Babinski's reflex, an upward movement of the big toe when the sole of the foot is stimulated. For patients with balance and gait difficulties, an eye examination is done to determine optic nerve damage. The physician must be able to find neurological evidence of lesions or plaques in at least two distinct areas of the Central Nervous System white matter, evidence that the plaques have occurred at different points in time, and most importantly, that these plaques have no other reasonable explanation thus ruling out other illnesses that mimic MS.

For some patients no tests beyond medical history and neurologic exam are necessary to diagnose. However, most physicians will not rely entirely on this type of evaluation and will do at least one other test to confirm the diagnosis. In this era, even a clear-cut diagnosis will usually be confirmed with an MRI of the brain, one of the major diagnostic tools currently used. Much more detail about MS can be found at their site: http://www.msfocus.org/ .

According to the National MS Society, in multiple sclerosis , damage to the myelin in the central nervous system (CNS), and to the nerve fibers themselves, interferes with the transmission of nerve signals between the brain and spinal cord and other parts of the body. This disruption of nerve signals produces the primary symptoms of MS, which vary depending on where the damage has occurred. Over the course of the disease, some symptoms will come and go, while others may be more lasting.

No two people have exactly the same symptoms, and each person’s symptoms can change or fluctuate over time. One person might experience only one or two of the possible symptoms while another person experiences many more. Most of these symptoms can be managed very effectively with medication, rehabilitation, and other management strategies. Much more material about MS can be found at their website: http://www.nationalmssociety.org/index.aspx .

There are two basic rules for diagnosing Multiple Sclerosis, according to this site: http://ms.about.com/od/multiplesclerosis101/a/ms_diagnosis.htm . Here are the two main criteria:

1. The person must have had at least two relapses (an episode where symptoms were present). These episodes must have been separated by at least one month.

2. There must be more than one lesion on the brain or spinal cord.

Multiple sclerosis means just that -- multiple (more than one), sclerosis (areas of damage; scarring or hardening). Here are the diagnostic categories:

• Negative: Negative means negative. You don’t have MS. It is possible for the doctor to give this diagnosis only when another definite diagnosis is made that can account for your symptoms.

• Possible: This means that you may have symptoms that look like MS, but your tests are normal. No other diagnosis which accounts for the symptoms has been confirmed.

• Probable: Many people fall into this category when they are first seen by a neurologist. You may have symptoms that look like MS and have had two separate episodes separated by at least a month, but normal findings on an MRI. You could also have an MRI that showed only one lesion in your brain or spine. In this case, your doctor will probably recommend repeating the MRI after a certain period of time (for instance, 3 months) to see if any other lesions appear. Depending on how certain your doctor is that you really do have MS, he may recommend that you consider starting an early therapy.

• Definite: Your case fits the diagnostic criteria above. You have had at least two attacks, separated in time, plus at least two areas of demyelination. Believe it or not, many people are relieved to receive a definite diagnosis of MS.

Also, information about treatment and care of MS can also be found on WebMD at this site: http://www.webmd.com/multiple-sclerosis/guide/multiple-sclerosis-treatment-care .

Multiple Sclerosis is a debilitating disease. MS has a profound impact on all parts of your life, including workplace issues, relationships and family, overall well-being and lifestyle choices. If you suspect that you may be experiencing symptoms, see your doctor right away. Although, MS is not curable, symptoms like memory loss, fatigue, bladder function, muscle spasms, and others can be managed for a time.

Until next time.

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