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Email: enquiry@medicyatra.comMultiple Sclerosis:            Principles,& treatment                     Presented By:      ...
Email: enquiry@medicyatra.com1-OverreviewCopyright @ Forever Medic Online Pvt. Ltd
Multiple Sclerosis                                               Email: enquiry@medicyatra.com Overview- Chronic, inflamma...
Email: enquiry@medicyatra.com                                                                                        MS Ov...
Email: enquiry@medicyatra.comPiere Marie Charcot                                           This disease without his      ...
Email: enquiry@medicyatra.com2-EthiologyCopyright @ Forever Medic Online Pvt. Ltd
Email: enquiry@medicyatra.com    Is MS a Hereditary Disease?     Genetic factors      First- and second-degree relatives ...
Email: enquiry@medicyatra.comMS plaques contain - Complement - Immunoglobulins - (These indicate disruption of BBB and loc...
Email: enquiry@medicyatra.com1. Research into the Causes of MS         Genetic                         Environmental      ...
Email: enquiry@medicyatra.com3-The Biology of MS    Copyright @ Forever Medic Online Pvt. Ltd
The Biology                                   Email: enquiry@medicyatra.com                                               ...
The Biology                                                                   Email: enquiry@medicyatra.com               ...
Email: enquiry@medicyatra.comHow could autoimmune responses cause MS?              Copyright @ Forever Medic Online Pvt. Ltd
The Biology                                                                 Email: enquiry@medicyatra.com                 ...
Email: enquiry@medicyatra.comAxonal Transection in Acute MS Lesions      .                    Copyright @ Forever Medic On...
The Biology                                                                                        Email: enquiry@medicyat...
Email: enquiry@medicyatra.com4-Pathophysiology   Copyright @ Forever Medic Online Pvt. Ltd
Email: enquiry@medicyatra.commechanism NORMAL CONDUCTION  ABNORMAL CONDUCTION            Copyright @ Forever Medic Online ...
Email: enquiry@medicyatra.comInflammation and Axonal Transection                                                          ...
MS                                                                Email: enquiry@medicyatra.com                           ...
Email: enquiry@medicyatra.comTreatment GoalsReduce (control) relapsesDelay disease progressionDelay disabilityAlleviate sy...
Email: enquiry@medicyatra.com   Early Treatment   The National MS Society recommends:   “Initiation of therapy with an   i...
Email: enquiry@medicyatra.comCurrent Therapies:Immunosuppressants and ImmunomodulatorsCorticosteroidsInterferons β : Beta...
Email: enquiry@medicyatra.comCorticosteroidsSymptomatic managementUsed in moderate-to-severeexacerbationsIV methylpredniso...
Email: enquiry@medicyatra.comInterferon BetaMechanism of ActionReduce the production of the TNFa ,known to induce damage t...
Email: enquiry@medicyatra.com    Interferons β:                                                                           ...
Email: enquiry@medicyatra.com    Interferons β:    Rebif    Interferon β-1a    Indication: relapsing/remitting forms of   ...
Email: enquiry@medicyatra.com    Interferons β:    Betaseron (interferon beta-1b)    Indication: Relapsing forms of MS    ...
Email: enquiry@medicyatra.com    Side Effects of Interferons    Common:                                                Unc...
Email: enquiry@medicyatra.com    Noninterferons:    Copaxone (glatiramer acetate) PFS    Indication: Reduction of frequenc...
Email: enquiry@medicyatra.com    Copaxone Mechanism of Action                              Synthetic chain of four amino a...
Email: enquiry@medicyatra.com                                        autoject® 2 for glass syringe                        ...
Email: enquiry@medicyatra.com    Antineoplastics:Nonantrone    Indication:    Reduction of    relapse rate and    clinical...
Email: enquiry@medicyatra.com    Antineoplastics:    Novantrone (cont.)    Reduces exacerbation rate    Prolongs time to f...
Email: enquiry@medicyatra.com    Novantrone    Mechanism of Action    Inhibits or prevents the development    of any uncon...
Email: enquiry@medicyatra.com    Novantrone    Side Effects    Moderate to severe      Bone marrow suppression          –...
Email: enquiry@medicyatra.com    Novantrone    Side Effects         Moderate to severe           Teratogenic effects     ...
Email: enquiry@medicyatra.com   Novantrone   Contraindications    LVEF < 50%    CHF    Baseline neutrophil count < 1500 ce...
Email: enquiry@medicyatra.com    Immunosuppressants    Show only slight evidence of benefit in    MS    Used only for prog...
Email: enquiry@medicyatra.com              Symptomatic Treatments          Problem             Symptoms                   ...
Email: enquiry@medicyatra.comConclusionEarly treatment may delay disabilityand enhance recovery from relapsesTreatment mus...
Email: enquiry@medicyatra.comChallengesChallenges for the person with MS   Physical difficulties   Financial concerns  ...
Email: enquiry@medicyatra.comResources and LinksSupport/Information   National MS Society (NMSS) 1-800-FIGHT-MS   Consor...
Email: enquiry@medicyatra.com5-SummaryCopyright @ Forever Medic Online Pvt. Ltd
Email: enquiry@medicyatra.com                                                                                     Conclusi...
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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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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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