What is Multiple sclerosis:
Multiple sclerosis also known as Disseminated sclerosis is the most common CNS demyelinating disease. The usual age onset is 20 to 40 years. In this disease there is recurrent attack of focal degenerative neurological disorders with predilection for involvement of the spinal cord , optic nerve and brain. The early attack is like a single symptom or sign ; most commonly optic neuritis followed by recovery.
Prevalence in India:
In India MS is a very common neurological disorders. There is about 1 million case in every year.
- Genetic susceptibility.
- Infectious agent.
- Immunologic mechanism.
The hallmark of multiple sclerosis is the presence of many scattered discreat areas of demyelination termed plaques. Grossly plaques are grey pink , swollen , sharply defined , usually bilateral areas in the white matter .
In histopathologic features; plaques are made up of accumulated lymphocytes and macrophages arround the sites where demyelination is already started. In addition there is loss of oligodendrocytes and presence of reactive astrocytes and lipid laden microglia ( macrophages).
- Stiffness and spasms in muscles.
- Bowel and bladder problem.
Treatment of Multiple sclerosis:
As disease become progressive, remission become infrequent and incomplete. The drugs are used mainly for prolongation of life and delay disease progression. In march ; 2017 FDA approved first drug for multiple sclerosis; that is OCRELIZUMAB.
- Disease modifying drugs: As MS is a autoimmune disease ; causes immune destruction of myelin sheath. These drugs work by curbing the immune system . They also reduce the number of flare-ups….include –
- Interferon beta 1b.
Both cut down the number of flare-up and slow down the advance of MS –
- Dimethyl fumarate.
- Interferon beta 1a
- Peginterferon beta 1a
The interferons are considered as very safe drugs for treating MS. Sometimes self injection can cause redness, warmth, itching and dimpling of skin.
Other Adverse effect of interferons are-
- Flu like symptoms – aches, chills,fatigue , fever.
- Increase risk of infections due to lowering down of white blood cell count and also decrease immunity.
In relapsing case of MS ; drugs like Teriflunomide causes sideeffects like nausea , hair loss.
Another drug Aubagio ; is detected as” BLACK BOX” warning by FDA due to its serious side effects ..like-
- Hepatitis or other liver disease.
- And may cause serious teratogenic effect if prescribed for pregnant women.
Gilenya ; another drug causes –
- For the treatment of Flare-ups:
1)High dose of steroides are given intravenously.
2)Another technique is plasmapheresis.
- For the Treatments of other symptoms:
1) For muscle stiffness and spasms: muscle relaxant Beclofen or sedative like clonazepam or diazepam.
3) Depression: antidepressants like leupropion or fluoxetine or sertraline.
4) bladder problem:oxybutynin.
Except the above drug therapy the doctor can give advise to have a little exercise and moderate walking everyday. It can relief from the symptoms of MS and gives a comfortable feeling to the patients.