Multiple Sclerosis Treatment

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MedicYatra provides the safe & best Multiple Sclerosis Treatment and procedure at its affiliate & trusted hospitals & clinics in various metro cities of India, like Mumbai, Delhi, Bangalore, Chennai, Pune etc.Our Associate Board certified doctors are extensively trained and vastly experienced and have performed hundreds of such cases at our state of the art JCI accredited hospitals & Clinics. Our aim is to provide you the best of the services at the most affordable costs. Don't forget to say hi at info@medicyatra.com

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  • Importance of early treatment : the ability to slow the frequency of relapses and the accumulation of disability diminishes as the disease progresses It is most beneficial to reduce the relapse rate at the earliest possible stage of the disease, because relapses represent severe short-term disability and contribute to accumulated long-term disability Early treatment of patients with limited disability with therapeutic agents that slow the demyelination process may help maintain patients in a less disabled state for a longer period of time. No therapy has been shown to reverse more advanced disability or arrest disease progression
  • Recommendation of the Executive Committee of the Medical Advisory Board of the Nat’l MS Society (www.nationalmssociety.org/Sourcebook-Early.asp) Immunomodulators include beta interferon 1b, beta interferon 1a, glatiramer acetate
  • These therapies are the cornerstones of MS treatment
  • Glucocorticoids - anti-inflammatory agents, reduce the inflammation and edema at the site of the myelin attack. With the inflammation calmed down, normal function returns more rapidly and the duration of the attack is reduced. To treat attack: the agent is typically given at high doses 3-5 days then tapered down for 1-3 weeks Commonly used steroids: Prednisone (PO) decadron (PO), solumedrol (IV) and ACTH (IM) (synthetic hormone to produce anti-inflammatory effects) *IV methyl prednisone is the treatment of choice during relapses but does not prevent relapses Side effects: osteoporosis, peptic ulcer, glucose intolerance and hypertension
  • No one knows what is totally going on with the activity of the immunomodulators, but we have some general understanding of what is happening at different times. (Interferon-beta ) helps to slow MS by reducing target recognition, repairing the damaged BBB, and reducing pro-inflammatory cytokines. BBB=blood brain barrier
  • Interferons (alpha, beta, gamma & others) are naturally occurring proteins produced by the body. Interferons have been found to have immunoregulatory, antiviral and antiproliferative properties. In general, interferons protect the body by inhibiting the multiplication of viruses It has been postulated that MS may be due to an immune disorder triggered by a viral infection. Since both viral infections and the immune system are modulated by interferons, the use of interferons has been studied in MS. The antiviral properties of interferons act to suppress background viral infection. The overall mechanism in beneficial effects of beta interferons is not established. Avonex is manufactured by Biogen. None of the INFs available today are approved for progressive disease. Studies are currently underway to evaluate INFs in these patients. The recently completed trial demonstrated that Avonex reduced the progression of disability by 27% vs. placebo in patients with SPMS. Full analysis still is pending.
  • Interferons (alpha, beta, gamma & others) are naturally occurring proteins produced by the body. Interferons have been found to have immunoregulatory, antiviral and antiproliferative properties. In general, interferons protect the body by inhibiting the multiplication of viruses It has been postulated that MS may be due to an immune disorder triggered by a viral infection. Since both viral infections and the immune system are modulated by interferons, the use of interferons has been studied in MS. The antiviral properties of interferons act to suppress background viral infection. The overall mechanism in beneficial effects of beta interferons is not established. Avonex is manufactured by Biogen. None of the INFs available today are approved for progressive disease. Studies are currently underway to evaluate INFs in these patients. The recently completed trial demonstrated that Avonex reduced the progression of disability by 27% vs. placebo in pts with SPMS. Full analysis is pending.
  • Berlex - chemical makeup: not glycosylated and the amino acid sequence is not identical to naturally occurring human form. Packaged as 8.6 million unit vial. Recommended dose is 250mcg = .25 mg or (1ml). The vial has overfill. When reconstituted with 1.2ml diluent, it equals .3mg. Need for lab tests: prior to beginning therapy and at periodic intervals thereafter (hgb, CBC & diff, platelet counts and blood chemistries including liver tests Side effects: most common is injection site reaction & occurs in approx. 50% of people (inflammation, pain, hypersensitivity) “flu-like symptoms” (only 3%-8% experience after 1st year)/ (pre-med with Tylenol) Depression has been reported Not recommended in pregnancy Neutralizing Abs developed. Betaseron produced in E.coli. Betaseron was approved in Canada and Europe for the treatment of SPMS. Two large multicenter clinical trials demonstrated that Betaseron delayed disease progression in patients with SPMS and reduced the frequency of relapses. Not approved in the U.S. for this indication as of today.
  • Side effects such as flu-like symptoms start about 3 to 6 hrs after the injection. The flu-like reactions usually resolve within the first 3 mo of therapy. To reduce the side effect, therapy may be started with a half-dose for 4 to 6 weeks and give injection at night. Pretreatment with ibuprofen or acetaminophen. Many patients can experience transient worsening in MS symptoms (increased spasticity) especially within the first 12 wks. CBC with dif and LFTs should be done monthly for the first 3 mo, then quarterly. Side effects may be depression, lack of interest, reduced appetite and pessimistic hopelessness. Suicide is the No. 3 reason for death for those with MS according to Dr. Kaplan a psychologist focusing on MS related depression that was interviewed on Larry King March 2004 NABS (neutralizing antibodies) have been a hot topic with the interferons. To date most physicians do not measure or rely on NABS to determine treatment. The American Academy of Neurology and the MS Council state that the utility of measuring NABs in uncertain. FDA and Biogen notified healthcare professionals of revisions to the WARNINGS, PRECAUTIONS/Drug Interactions and ADVERSE REACTIONS/Post-Marketing Experience sections and Medication Guide. Severe hepatic injury, including cases of hepatic failure, has been reported in patients taking Avonex. Asymptomatic elevation of hepatic transaminases has also been reported, and in some patients has recurred upon rechallenge. In some cases, these events have occurred in the presence of other drugs that have been associated with hepatic injury. The potential risk of Avonex used in combination with known hepatotoxic drugs or other products (e.g. alcohol) should be considered prior to Avonex administration, or when adding new agents to the regimen of patients already on Avonex .
  • Teva Neuroscience Copaxone-formerly known as copolymer-1 ( now comes in a pre-filled syringe and requires refrigeration). Medication can be left out of the refrigerator for seven days. The first nonsteroidal, noninterferon agent Designed to modify the immune processes Exact mechanism unknown (fools the body). May inhibit the immune response to myelin basic protein and possibly other myelin antigens. Side effects: Most common is injection site reaction (usually mild)- (redness, pain, inflammation, itching, lump at site). People using the autojector report less injection site reactions. Less common side effects, flushing, chest pain, nausea, anxiety and dizziness. No neutralizing antibody development. Drug of choice if the person is choosing to get pregnant. Treatment option for patients who don’t respond or don’t tolerate interferon 
  • All three of the manufacturer’s of the SQ injectible medications now provide free self injector’s for their patients. Berlex’s research demonstrates added comfort for the patient. Rebiject and the Autoject 2 for glass syringe for Copaxone both require a prescription.
  • Distributed by Serono. Traditionally used for various cancers such as ANLL, therapy of patients with pain related to hormone refractory prostate cancer. Very potent immunomodulator and immunosupressor. NOVANTRONE is indicated for reducing neurologic disability and/or the frequency of clinical relapses in patients with secondary progressive, progressive relapsing and worsening relapsing-remitting MS. NOVANTRONE is not indicated for primary progressive MS. Novantrone is not recommended for MS patients with a certain blood cell count, liver function test, or cardiac abnormalities; or for women who plan to become or are pregnant. Inhibits DNA replication by inhibiting topoisomerase II and reduces the number of B-cells, inhibits T-cell function and augmenting T-cell supressor activity.
  • Distributed by Serono. Traditionally used for various cancers such as ANLL, therapy of patients with pain related to hormone refractory prostate cancer. Very potent immunomodulator and immunosupressor. Inhibits DNA replication by inhibiting topoisomerase II and reduces the number of B cells, inhibits T-cell function and augmenting T-cell supressor activity. The only agent currently approved for progressive forms of MS.
  • 5/25/05 The Food and Drug Administration and Serono Inc. notified healthcare professionals in a letter that Serono's multiple sclerosis treatment Novantrone(mitoxantrone for injection concentrate) is associated with an increased risk of cardio-toxicity. The letter states that "cardiac monitoring of MS patients should be performed at baseline and prior to administration of every dose of Novantrone." According to the letter, post-marketing surveillance reports "have shown that diminished cardiac function may occur early on in the treatment with Novantrone." The new label also provides supplemental information about secondary acute myelogenous leukemia reported in patients who take the drug. The label says, "In a cohort of [Novantrone]-treated MS patients followed for varying periods of time, an elevated leukemia risk of 0.25 percent(2/802) has been observed."
  • Immunosuppressants - since MS is thought to be primarily of autoimmune origin, it is thought suppressing the immune system might be helpful. This is usually only used for chronic-progressive patients (show only slight evidence of benefits) Thiopurines: azathioprine(Imuran) Alkylating agents: Cyclophosphamide, Chlorambucil Methotrexate-being investigated for use, currently used for therapy in rheumatoid arthritis and cancer Note: IGIV-study between 1992-1996 showed that monthly administration seems to be at least as effective as therapy with interferon-B or copolymer 1 in improving clinical disability and reducing the rate of relapse for MS patients with relapsing-remitting MS .
  • Botox for urinary dysfunction is still considered Off Label.
  • Summary: People face many challenges in living with multiple sclerosis. The following organizations offer variety of services and programs to help cope with MS. National MS Society- network of 140 chapters and branches, offering programs and services including local referrals, information and education, professional and peer counseling, self-help groups, equipment assistance and more. (1.800.FIGHT.MS-New York, NY) Consortium of MS- a unique multi-disciplinary organization providing networking for all healthcare professionals specializing in the care of MS.(201.837.0727-New Jersey) MS Assoc. of America- provides day-to-day assistance through programs such as newsletter, social and support activities, barrier-free housing, free therapeutic equipment loans, and toll-free hotline., symptom management therapies and research, support groups, and public awareness. (800.833.4MSA Cherry Hill, NJ) MS Foundation(MSF) -offers information about both traditional and alternative options for treating MS.(800.441.7055 Fort Lauderdale, FL)
  • Summary: People face many challenges in living with multiple sclerosis. The following organizations offer variety of services and programs to help cope with MS. National MS Society- network of 140 chapters and branches, offering programs and services including local referrals, information and education, professional and peer counseling, self-help groups, equipment assistance and more. (1.800.FIGHT.MS-New York, NY) Consortium of MS- a unique multi-disciplinary organization providing networking for all healthcare professionals specializing in the care of MS.(201.837.0727-New Jersey) MS Assoc. of America- provides day-to-day assistance through programs such as newsletter, social and support activities, barrier-free housing, free therapeutic equipment loans, and toll-free hotline., symptom management therapies and research, support groups, and public awareness. (800.833.4MSA Cherry Hill, NJ) MS Foundation(MSF) -offers information about both traditional and alternative options for treating MS.(800.441.7055 Fort Lauderdale, FL)
  • Multiple Sclerosis Treatment

    1. 1. Email: enquiry@medicyatra.comMultiple Sclerosis: Principles,& treatment Presented By: Medic YatraCopyright @ Forever Medic Online Pvt. Ltd
    2. 2. Email: enquiry@medicyatra.com1-OverreviewCopyright @ Forever Medic Online Pvt. Ltd
    3. 3. Multiple Sclerosis Email: enquiry@medicyatra.com Overview- Chronic, inflammatory, demyelinatingdisease its not common- Affects the myelin sheath and axonsof the Central Nervous System (CNS)- Progressive clinical or subclinicalcourse- Common cause of disabilityin young adults Copyright @ Forever Medic Online Pvt. Ltd
    4. 4. Email: enquiry@medicyatra.com MS OverviewWhat is Multiple Sclerosis (MS)?MS causes nerve damage over time Ms is not a common disease MS is not considered fatal, but it affects everyone differently http://www.spermbankcalifornia.coYou’re not alone m/buy-sperm-online.h Worldwide, 2.5 million people have MS MS currently affects 400,000 Americans Incidence & prevalence in iran is not clear Every week, 200 new people are diagnosed in the US Copyright @ Forever Medic Online Pvt. Ltd
    5. 5. Email: enquiry@medicyatra.comPiere Marie Charcot  This disease without his name is meaningless  His descriptions about disease is very precise Copyright @ Forever Medic Online Pvt. Ltd
    6. 6. Email: enquiry@medicyatra.com2-EthiologyCopyright @ Forever Medic Online Pvt. Ltd
    7. 7. Email: enquiry@medicyatra.com Is MS a Hereditary Disease? Genetic factors  First- and second-degree relatives are at increased risk  Risk is higher in siblings – Nontwin siblings (2%) – Monozygotic twins (30%) – Dizygotic twins (2.3%) Susceptibility gene  Major histocompatibility complex (MHC) on chromosome 6Source: http://www.msfacts.org/info/info_faq.html, http://www.ninds.nih.gov/disorders/multiple_sclerosis/detail_multiple_sclerosis.htm#54263215 and http://www.nationalmssociety.org/Sourcebook-Epidemiology.asp. Accessed May 17, 2006 Copyright @ Forever Medic Online Pvt. Ltd
    8. 8. Email: enquiry@medicyatra.comMS plaques contain - Complement - Immunoglobulins - (These indicate disruption of BBB and local production of Ig) -TFN(gamma) TNF, IL-2 There is strong evidences that it has immunological base 1-CSF changes (cells;oligoclonal bands) 2-Response to immunomodulators 3-Specific HLA Copyright @ Forever Medic Online Pvt. Ltd
    9. 9. Email: enquiry@medicyatra.com1. Research into the Causes of MS Genetic Environmental factors factors MS Immunological factors Copyright @ Forever Medic Online Pvt. Ltd
    10. 10. Email: enquiry@medicyatra.com3-The Biology of MS Copyright @ Forever Medic Online Pvt. Ltd
    11. 11. The Biology Email: enquiry@medicyatra.com of MSWhat does the centralnervous system do? BrainThe central nervous system (CNS)consists of the:1 Spinal Brain cord Spinal cord Optic nervesThe CNS is the body’s command center. Itinterprets sensory information and sendscommands to muscles3 Copyright @ Forever
    12. 12. The Biology Email: enquiry@medicyatra.com of MSHow does the CNS work?Messages travel to and from the CNS through nerve cells3Nerve Cell Myelin surrounds the nerve fibers, protecting them like the coating of a wire1 Myelin Nerve fibers (or axon)Cell body Nerve fibers (or axon) Myelin Copyright @ Forever Medic Online Pvt. Ltd
    13. 13. Email: enquiry@medicyatra.comHow could autoimmune responses cause MS? Copyright @ Forever Medic Online Pvt. Ltd
    14. 14. The Biology Email: enquiry@medicyatra.com of MS How does MS affect the CNS? In MS, cells of the immune system attack myelin and can cause permanent damage3 Areas where myelin has been Exposed nerve fibers are severed,Nerve Cell damaged interrupt communication causing permanent damage Copyright @ Forever Medic Online Pvt. Ltd
    15. 15. Email: enquiry@medicyatra.comAxonal Transection in Acute MS Lesions . Copyright @ Forever Medic Online Pvt. Ltd
    16. 16. The Biology Email: enquiry@medicyatra.com of MSHow is MS monitored?.MRI showing no signs MRI showing an active MRI showingof damage lesion* permanent damage Active lesion Permanent damage These images may also help detect “silent” damage (lesions detected by MRI that do not result in symptoms)1 The impact of this damage depends on the destructiveness of the lesion and where it is located *The exact relationship between MRI findings and the clinical status of patients is unknown. Copyright @ Forever Medic Online Pvt. Ltd
    17. 17. Email: enquiry@medicyatra.com4-Pathophysiology Copyright @ Forever Medic Online Pvt. Ltd
    18. 18. Email: enquiry@medicyatra.commechanism NORMAL CONDUCTION ABNORMAL CONDUCTION Copyright @ Forever Medic Online Pvt. Ltd
    19. 19. Email: enquiry@medicyatra.comInflammation and Axonal Transection Main Disease Main Clinical Stage Component Outcome Early Inflammation and demyelination Relapses Late Atrophy, axonal loss, and Disability increasing tissue destruction (less Gd-defined inflammation, demyelination ongoing) Copyright @ Forever Medic Online Pvt. Ltd
    20. 20. MS Email: enquiry@medicyatra.com pathophysiologyWhat does the effect incentral nervous system1-All the symptoms are upper motor2-Dissamination in time & space2-Conduction block is cause of fatigue3-Agrravation with heat4-remyelination is not perfect5-plaques could be in silent areas Immunological pathological physiologic clinical Copyright @ Forever Medic Online Pvt. Ltd
    21. 21. Email: enquiry@medicyatra.comTreatment GoalsReduce (control) relapsesDelay disease progressionDelay disabilityAlleviate symptoms Copyright @ Forever Medic Online Pvt. Ltd
    22. 22. Email: enquiry@medicyatra.com Early Treatment The National MS Society recommends: “Initiation of therapy with an immunomodulator is advised as soon as possible following a definite diagnosis of MS with a relapsing course, and may be considered for selected patients with a first attack who are at high risk for MS.”Source: Recommendation of the Executive Committee of the Medical Advisory Board of the Nat’l MS Society www.nationalmssociety.org/Sourcebook-Early.asp. Accessed May 17, 2006. Copyright @ Forever Medic Online Pvt. Ltd
    23. 23. Email: enquiry@medicyatra.comCurrent Therapies:Immunosuppressants and ImmunomodulatorsCorticosteroidsInterferons β : Betaseron® (interferon β-1b) Avonex® (interferon β-1a) Rebif® (interferon β-1a)Immunosuppressants andimmunomodulators: Copaxone® (glatiramer acetate) Novantrone® (mitoxantrone)Symptomatic management Copyright @ Forever Medic Online Pvt. Ltd
    24. 24. Email: enquiry@medicyatra.comCorticosteroidsSymptomatic managementUsed in moderate-to-severeexacerbationsIV methylprednisolone 500 mg/day forfive days followed by oral prednisone(optional)Hasten clinical recoveryDelay recurrence of neurologic eventsDoes not alter the course of MS Copyright @ Forever Medic Online Pvt. Ltd
    25. 25. Email: enquiry@medicyatra.comInterferon BetaMechanism of ActionReduce the production of the TNFa ,known to induce damage to myelinReduce inflammation by: Switching cytokine production from type 1 (pro- inflammatory) to type 2 (anti-inflammatory) cells Decrease antigen presentation, to reduce the attack on myelinReduce the ability of immune cells tocross the blood-brain barrier, Copyright @ Forever Medic Online Pvt. Ltd
    26. 26. Email: enquiry@medicyatra.com Interferons β: Avonex-lyo-vial Avonex (Interferon β-1a) Indication: relapsing forms of MS Dose: 30 mcg IM once weekly Reduces rate of clinical relapse Reduces the development of new lesions May delay progression of disabilityThis page contains prescription brand drugs that are registered or registered trademarks of pharmaceutical manufacturers that are not affiliated with Caremark. Copyright @ Forever Medic Online Pvt. Ltd
    27. 27. Email: enquiry@medicyatra.com Interferons β: Rebif Interferon β-1a Indication: relapsing/remitting forms of MS Dose: 22 or 44 mcg SC 3 times per week Decreases frequency of relapse Delays the increase in the volume of lesions May delay progressionThis page contains prescription brand drugs that are registered or registered trademarks of pharmaceutical manufacturers that are not affiliated with Caremark. of disability Copyright @ Forever Medic Online Pvt. Ltd
    28. 28. Email: enquiry@medicyatra.com Interferons β: Betaseron (interferon beta-1b) Indication: Relapsing forms of MS Dose: 8 million IU SC every other day Reduces rate of clinical relapse Reduces the development of new lesions Delays the increase in the volume of lesionsThis page contains prescription brand drugs that are registered or registered trademarks of pharmaceutical manufacturers that are not affiliated with Caremark. Copyright @ Forever Medic Online Pvt. Ltd
    29. 29. Email: enquiry@medicyatra.com Side Effects of Interferons Common: Uncommon:  Flu-like symptoms  Severe depression  Chills  Suicide  Fever  Seizures  Muscle aches  Cardiac effects  Asthenia (weakness)  Anemia  Betaseron and Rebif  Elevated liver have injection site enzymes reactions  Severe hepatic injury, including cases of hepatic failure, has beenThis page contains prescription brand drugs that are registered or registered trademarks of pharmaceutical manufacturers that are not affiliated with Caremark. reported in patients taking Avonex Copyright @ Forever Medic Online Pvt. Ltd
    30. 30. Email: enquiry@medicyatra.com Noninterferons: Copaxone (glatiramer acetate) PFS Indication: Reduction of frequency of relapses in patients with RRMS Dose: 20 mcg SC once daily Reduces the frequency of exacerbations Moderately reduces the development of new lesionsThis page contains prescription brand drugs that are registered or registered trademarks of pharmaceutical manufacturers that are not affiliated with Caremark. Copyright @ Forever Medic Online Pvt. Ltd
    31. 31. Email: enquiry@medicyatra.com Copaxone Mechanism of Action Synthetic chain of four amino acids Structurally resembles the myelin basic protein molecule Believed to block the immune system from attacking myelinThis page contains prescription brand drugs that are registered or registered trademarks of pharmaceutical manufacturers that are not affiliated with Caremark. Copyright @ Forever Medic Online Pvt. Ltd
    32. 32. Email: enquiry@medicyatra.com autoject® 2 for glass syringe Rebiject® Auto Injectors Dispenses Copaxone Dispenses Rebif autoject® 2.25 Dispenses BetaseronAll provided free from manufacturer.Rebiject and Copaxone need a prescription.This page contains prescription brand drugs that are registered or registered trademarks of pharmaceutical manufacturers that are not affiliated with Caremark. Copyright @ Forever Medic Online Pvt. Ltd
    33. 33. Email: enquiry@medicyatra.com Antineoplastics:Nonantrone Indication: Reduction of relapse rate and clinical disability in patients with SPMS, PRMS or worsening RRMS Dose: 12 mg/m2 as short IV infusion (five minutes to 15 minutes every three months)This page contains prescription brand drugs that are registered or registered trademarks of pharmaceutical manufacturers that are not affiliated with Caremark. Copyright @ Forever Medic Online Pvt. Ltd
    34. 34. Email: enquiry@medicyatra.com Antineoplastics: Novantrone (cont.) Reduces exacerbation rate Prolongs time to first treated relapse Improves EDSS scores versus baselineThis page contains prescription brand drugs that are registered or registered trademarks of pharmaceutical manufacturers that are not affiliated with Caremark. Copyright @ Forever Medic Online Pvt. Ltd
    35. 35. Email: enquiry@medicyatra.com Novantrone Mechanism of Action Inhibits or prevents the development of any uncontrolled new or abnormal growth, such as a neoplasm or tumor Suppresses B-cell and T-cell immunityThis page contains prescription brand drugs that are registered or registered trademarks of pharmaceutical manufacturers that are not affiliated with Caremark. Copyright @ Forever Medic Online Pvt. Ltd
    36. 36. Email: enquiry@medicyatra.com Novantrone Side Effects Moderate to severe  Bone marrow suppression – Neutropenia (decreased WBC and ANC) – Thrombocytopenia (decreased platelets) – Acute myelogenous leukemia  Cardiac toxicity – Congestive heart failure (CHF) – Decreased left ventricular ejection fraction (LVEF) – Maximum cumulative dose 140 mg/m2This page contains prescription brand drugs that are registered or registered trademarks of pharmaceutical manufacturers that are not affiliated with Caremark. Copyright @ Forever Medic Online Pvt. Ltd
    37. 37. Email: enquiry@medicyatra.com Novantrone Side Effects Moderate to severe  Teratogenic effects – Fetal growth retardation in rats – Shortened gestation period – Excreted in breast milk Mild to moderate  Increased liver enzymes  Nausea  Alopecia (hair loss - transient)This page contains prescription brand drugs that are registered or registered trademarks of pharmaceutical manufacturers that are not affiliated with Caremark. Copyright @ Forever Medic Online Pvt. Ltd
    38. 38. Email: enquiry@medicyatra.com Novantrone Contraindications LVEF < 50% CHF Baseline neutrophil count < 1500 cells/ mm3 Pre-existing myelosuppression Abnormal LFT Pregnancy, breastfeeding Cumulative lifetime dose ≥ 140 mg/m2This page contains prescription brand drugs that are registered or registered trademarks of pharmaceutical manufacturers that are not affiliated with Caremark. Copyright @ Forever Medic Online Pvt. Ltd
    39. 39. Email: enquiry@medicyatra.com Immunosuppressants Show only slight evidence of benefit in MS Used only for progressive MS Associated with serious side effects  Thiopurines (Imuran)  Methotrexate  Alkylating agents (Cytoxan)  CyclosporineThis page contains prescription brand drugs that are registered or trademarks of pharmaceutical manufacturers that are not affiliated with Caremark. Copyright @ Forever Medic Online Pvt. Ltd
    40. 40. Email: enquiry@medicyatra.com Symptomatic Treatments Problem Symptoms ManagementSpasticity Painful spasms in the Remove irritating factors lower and upper limbs Physical therapy, baclofen, diazepam, dantroleneParoxysmal phenomena Trigeminal neuralgia, carbamazepine, pain, tonic seizures Neurontin, phenytoinFatigue Feeling tired (morning or Energy conservation, early afternoon) amantidineDepression Common, occurs in high Anti-depressants percentage of patientsSexual dysfunction Inability to produce/ Behavioral therapy sustain an erection Viagra, MuseUrinary dysfunction Urgency, frequency and Detrol, Ditropan, Botox retention Copyright @ Forever Medic Online Pvt. Ltd
    41. 41. Email: enquiry@medicyatra.comConclusionEarly treatment may delay disabilityand enhance recovery from relapsesTreatment must be a cooperative effortbetween multidisciplinary team ofhealthcare providersMedications are not a cure for MS Copyright @ Forever Medic Online Pvt. Ltd
    42. 42. Email: enquiry@medicyatra.comChallengesChallenges for the person with MS Physical difficulties Financial concerns Social issues Emotional issues Copyright @ Forever Medic Online Pvt. Ltd
    43. 43. Email: enquiry@medicyatra.comResources and LinksSupport/Information National MS Society (NMSS) 1-800-FIGHT-MS Consortium of MS Centers 1-201-837-0727 MS Foundation 1-800-441-7055 MS Association of America 1-800-833-4MSA Copyright @ Forever Medic Online Pvt. Ltd
    44. 44. Email: enquiry@medicyatra.com5-SummaryCopyright @ Forever Medic Online Pvt. Ltd
    45. 45. Email: enquiry@medicyatra.com Conclusion Conclusion1-Multiple sclerosis is not a common Disease2-It’s the result of Different mechanisms3-the most probable mechanism is immunological Its clear that effective treatments depends on better undrestanding of mechanisms Copyright @ Forever Medic Online Pvt. Ltd

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