Multiple Sclerosis – an overview<br />Andrew Chan<br />Dept. Neurology,  Ruhr-University Bochum, Germany<br />
Multiple Sclerosis<br /><ul><li>Most common neurological disease of young adults (~30 years, f>m: 1.9-3.1:1 )
Age, disability, cognitive/psychological  symptoms: implications for career, social life, society
Prevalence: 80-100/100.000, D: ~120.000 patients</li></ul>Genetic factors (HLA, non HLA-genes…)<br />Environmental factors...
Single factors probably not relevant<br /><ul><li>Combined risk models</li></ul>Ramagoalan et al. (2009), Lancet Neurol, 8...
Augustus Frederick d‘Este<br />(1794-1848)<br />·<br />·<br />·<br />·<br />„(...) and without any thing having<br />beend...
(Azathioprin)<br />(IVIG)c<br />Immunomodulatory escalation therapy <br />1995 vs. 2010 <br />vs. 2011 <br />(Cyclophospha...
Different point of view: physician and patients<br />Odds ratio (95% CI)<br />0.01<br />0.1<br />1<br />10<br />100<br />M...
MS and suicides: early during the disease<br />Stenager EN et al. JNNP (92)55:542<br />
Quality of life declines with disability<br />Patients with advanced MS have a quality of life <br />viewed by society as ...
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Dr. Andrew Chan - Overview of MS

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Dr. Andrew Chan from the Dept. of Neurology, Ruhr-University Bochum, Germany presents at the Brighter Futures for MS event held in Belgium on 12 Jan.

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Dr. Andrew Chan - Overview of MS

  1. 1. Multiple Sclerosis – an overview<br />Andrew Chan<br />Dept. Neurology, Ruhr-University Bochum, Germany<br />
  2. 2. Multiple Sclerosis<br /><ul><li>Most common neurological disease of young adults (~30 years, f>m: 1.9-3.1:1 )
  3. 3. Age, disability, cognitive/psychological symptoms: implications for career, social life, society
  4. 4. Prevalence: 80-100/100.000, D: ~120.000 patients</li></ul>Genetic factors (HLA, non HLA-genes…)<br />Environmental factors<br />(EBV?? Vit D...)<br />?<br />
  5. 5. Single factors probably not relevant<br /><ul><li>Combined risk models</li></ul>Ramagoalan et al. (2009), Lancet Neurol, 8:1078<br />
  6. 6. Augustus Frederick d‘Este<br />(1794-1848)<br />·<br />·<br />·<br />·<br />„(...) and without any thing having<br />beendonetomy Eyes, theycompletelyrecovered …“<br />·<br />„… I fell down about 5 timesfrommylegs…“<br />·<br />·<br />„thatmymakingwaterisattended<br />withdifficulty“<br />„I formed a liaisonwith a Young woman – <br />I find myactsofconnection a deficiencyofwholesomevigor (...)“<br />
  7. 7. (Azathioprin)<br />(IVIG)c<br />Immunomodulatory escalation therapy <br />1995 vs. 2010 <br />vs. 2011 <br />(Cyclophosphamid)<br /> Escalation therapy<br />Mitoxantronea<br />Disease activity<br />Natalizumabb<br />oral…<br />Beta-Interferon<br />GA<br />Only partial efficacy, Side effects, no cure… <br />Basic therapy<br />Corticosteroids<br />Plasma exchanged<br /> Relapse treatment<br />aChanges of these therapies at this stage of escalation not yet formally evaluated.<br />bIn cases of ≥2 severe relapses/year it may also be used as a basic therapy.<br />cConsidered in some European countries as second-line treatments but not indicated in France.<br />dOption in severe, steroid-resistant relapses.<br />MSTKG, Nervenarzt 2002<br />GA, glatiramer acetate; IVIG, intravenous immunoglobulin. <br />Wiendl H et al. J Neurol 2008;255:1449−63. <br />
  8. 8. Different point of view: physician and patients<br />Odds ratio (95% CI)<br />0.01<br />0.1<br />1<br />10<br />100<br />More important to clinicians<br />More important to patients<br />Rothwell et al., BMJ 1997<br />
  9. 9. MS and suicides: early during the disease<br />Stenager EN et al. JNNP (92)55:542<br />
  10. 10. Quality of life declines with disability<br />Patients with advanced MS have a quality of life <br />viewed by society as worse than death<br />1.0<br />0.8<br />0.6<br />0.4<br />0.2<br />0<br />–0.2<br />–0.4<br />Utility<br /> 0 1 2 3 4 5 6 6.5 7 8 9<br />EDSS status<br />EDSS, Expanded Disability Status Scale<br />Orme M, et al. Value Health 2007;10(1):54−60<br />
  11. 11. Costs: largest burden on the patient<br />Kobelt 2009. Access to innovative treatments in Multiple Sclerosis in Europe<br />
  12. 12. Summary<br /><ul><li>Disease with “1000 faces”
  13. 13. Not curable, but treatable: like other chronic diseases
  14. 14. Aim of treatment: no new symptoms, no side effects
  15. 15. Patient – Physician: only one of many important relationships
  16. 16. Patients and families carry financial burden of disease</li>

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