Medications, Treatments, Tests

Here is a page devoted to various treatments, tests and medications as well as links to provide you with more information.

Medications

Disease Modifying Drugs (DMD’s)

1.       Glatiramer – “Doctors believe that glatiramer works by blocking your immune system’s attack on myelin. You must inject this drug subcutaneously once daily. Side effects may include flushing and shortness of breath after “. ~Mayo Clinic Staff

2.            Beta interferons – These types of drugs — such as Avonex, Betaseron, Extavia and Rebif — appear to slow the rate at which multiple sclerosis symptoms worsen over time. Interferons can cause side effects, including liver damage, so you’ll need blood tests to monitor your liver enzymes”. ~Mayo Clinic Staff

3.            Fingolimod  – An oral medication given once daily, this works by trapping immune cells in lymph nodes. It reduces attacks of MS and short-term disability. To take this drug, you’ll need to have your heart rate monitored for six hours after the first dose because the first dose can slow your heartbeat (bradycardia). You’ll also need to be immune to the chickenpox virus (varicella-zoster virus). Other side effects include high blood pressure and visual blurring”. ~Mayo Clinic Staff

4.           Natalizumab “This drug is designed to work by interfering with the movement of potentially damaging   immune cells from your bloodstream to your brain and spinal cord. Tysabri is generally reserved for people who see no results from or can’t tolerate other types of treatments. This is because Tysabri increases the risk of progressive multifocal leukoencephalopathy — a brain infection that is usually fatal”. ~The Mayo Clinic Staff

5.              Mitoxantrone –This immunosuppressant drug can be harmful to the heart, and it’s associated with development of blood cancers like leukemia, so it’s usually used only to treat severe, advanced multiple sclerosis”. ~The Mayo Clinic

Muscle Relaxants for Spacticity

  1. Tizanidine – Zanaflex
  2. Baclofen – Lioresal

Common Medications for Fatigue

  1. Amantadine – Symmetrel
  2. modafinil  – Provigil

Some Treatments Given For Attacks

  1. Corticosteroids – “Your doctor may prescribe oral or intravenous corticosteroids to reduce inflammation in nerve tissue and shorten the duration and severity of flare-ups. Prolonged use of these medications isn’t recommended because evidence doesn’t suggest long-term effectiveness. Prolonged use may cause side effects such as osteoporosis and high blood pressure (hypertension)”.The Mayo Clinic
  2. Plasma exchange. “In plasma exchange, your blood is removed, and a machine separates your blood cells from your blood fluid (plasma). After your blood cells are mixed with a replacement solution, typically albumin or a synthetic plasma-like fluid, the blood cells and solution are returned to your body.Nearly 45 percent of people who don’t get relief from corticosteroids benefit from plasma exchange. It’s not clear why plasma exchange works, but doctors believe that replacing plasma may dilute the activity of the destructive factors in the immune system.Plasma exchange is effective for people who have sudden, severe attacks of MS-related disability who don’t benefit from high doses of corticosteroids. The treatment is most helpful in those who have a mild disability before the attack. Plasma exchange has no proven benefit beyond three months from the onset of neurologic symptoms”.The Mayo Clinic

Some Testing Done To Determine an MS Diagnosis or To Determine Progression

  1. neurological examination “assesses motor and sensory skills, the functioning of one or more cranial nerves, hearing and speech, vision, coordination and balance, mental status, and changes in mood or behavior, among other abilities.  Items including a tuning fork, flashlight, reflex hammer, ophthalmoscope, and needles are used to help diagnose brain tumors, infections such as encephalitis and meningitis, and diseases such as Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis (ALS), and epilepsy.  Some tests require the services of a specialist to perform and analyze results”.National Institutes of Health 
  2. Laboratory screening tests “of blood, urine, or other substances are used to help diagnose disease, better understand the disease process, and monitor levels of therapeutic drugs.  Certain tests, ordered by the physician as part of a regular check-up, provide general information, while others are used to identify specific health concerns.  For example, blood and blood product tests can detect brain and/or spinal cord infection, bone marrow disease, hemorrhage, blood vessel damage, toxins that affect the nervous system, and the presence of antibodies that signal the presence of an autoimmune disease.  Blood tests are also used to monitor levels of therapeutic drugs used to treat epilepsy and other neurological disorders.  Genetic testing of DNA extracted from white cells in the blood can help diagnose Huntington’s disease and other congenital diseases.  Analysis of the fluid that surrounds the brain and spinal cord can detect meningitis, acute and chronic inflammation, rare infections, and some cases of multiple sclerosis.  Chemical and metabolic testing of the blood can indicate protein disorders, some forms of muscular dystrophy and other muscle disorders, and diabetes.  Urinalysis can reveal abnormal substances in the urine or the presence or absence of certain proteins that cause diseases including the mucopolysaccharidoses.” – National Institutes of Health 
  3. Cerebrospinal fluid analysis (Spinal Tap)”involves the removal of a small amount of the fluid that protects the brain and spinal cord.  The fluid is tested to detect any bleeding or brain hemorrhage, diagnose infection to the brain and/or spinal cord, identify some cases of multiple sclerosis and other neurological conditions, and measure intracranial pressure.The procedure is usually done in a hospital.  The sample of fluid is commonly removed by a procedure known as a lumbar puncture, or spinal tap.  The patient is asked to either lie on one side, in a ball position with knees close to the chest, or lean forward while sitting on a table or bed.  The doctor will locate a puncture site in the lower back, between two vertebrate, then clean the area and inject a local anesthetic.  The patient may feel a slight stinging sensation from this injection.  Once the anesthetic has taken effect, the doctor will insert a special needle into the spinal sac and remove a small amount of fluid (usually about three teaspoons) for testing.  Most patients will feel a sensation of pressure only as the needle is inserted.A common after-effect of a lumbar puncture is headache, which can be lessened by having the patient lie flat.  Risk of nerve root injury or infection from the puncture can occur but it is rare.  The entire procedure takes about 45 minutes”. – National Institutes of Health
  4. Magnetic resonance imaging(MRI)” uses computer-generated radio waves and a powerful magnetic field to produce detailed images of body structures including tissues, organs, bones, and nerves.  Neurological uses include the diagnosis of brain and spinal cord tumors, eye disease, inflammation, infection, and vascular irregularities that may lead to stroke.  MRI can also detect and monitor degenerative disorders such as multiple sclerosis and can document brain injury from trauma.The equipment houses a hollow tube that is surrounded by a very large cylindrical magnet.  The patient, who must remain still during the test, lies on a special table that is slid into the tube.  The patient will be asked to remove jewelry, eyeglasses, removable dental work, or other items that might interfere with the magnetic imaging.  The patient should wear a sweat shirt and sweat pants or other clothing free of metal eyelets or buckles.  MRI scanning equipment creates a magnetic field around the body strong enough to temporarily realign water molecules in the tissues.  Radio waves are then passed through the body to detect the “relaxation” of the molecules back to a random alignment and trigger a resonance signal at different angles within the body.  A computer processes this resonance into either a three-dimensional picture or a two-dimensional “slice” of the tissue being scanned, and differentiates between bone, soft tissues and fluid-filled spaces by their water content and structural properties.  A contrast dye may be used to enhance visibility of certain areas or tissues.  The patient may hear grating or knocking noises when the magnetic field is turned on and off.   (Patients may wear special earphones to block out the sounds.)  Unlike CT scanning, MRI does not use ionizing radiation to produce images.  Depending on the part(s) of the body to be scanned, MRI can take up to an hour to complete.  The test is painless and risk-free, although persons who are obese or claustrophobic may find it somewhat uncomfortable.  (Some centers also use open MRI machines that do not completely surround the person being tested and are less confining.  However, open MRI does not currently provide the same picture quality as standard MRI and some tests may not be available using this equipment).  Due to the incredibly strong magnetic field generated by an MRI, patients with implanted medical devices such as a pacemaker should avoid the test.Functional MRI (fMRI) uses the blood’s magnetic properties to produce real-time images of blood flow to particular areas of the brain.  An fMRI can pinpoint areas of the brain that become active and note how long they stay active.  It can also tell if brain activity within a region occurs simultaneously or sequentially.  This imaging process is used to assess brain damage from head injury or degenerative disorders such as Alzheimer’s disease and to identify and monitor other neurological disorders, including multiple sclerosis, stroke, and brain tumors”.- National Institutes of Health
  5. Evoked potentials(also called evoked response)” measure the electrical signals to the brain generated by hearing, touch, or sight.  These tests are used to assess sensory nerve problems and confirm neurological conditions including multiple sclerosis, brain tumor, acoustic neuroma (small tumors of the inner ear), and spinal cord injury.  Evoked potentials are also used to test sight and hearing (especially in infants and young children), monitor brain activity among coma patients, and confirm brain death.Testing may take place in a doctor’s office or hospital setting.  It is painless and risk-free.  Two sets of needle electrodes are used to test for nerve damage.  One set of electrodes, which will be used to measure the electrophysiological response to stimuli, is attached to the patient’s scalp using conducting paste.  The second set of electrodes is attached to the part of the body to be tested.  The physician then records the amount of time it takes for the impulse generated by stimuli to reach the brain.  Under normal circumstances, the process of signal transmission is instantaneous.Auditory evoked potentials (also called brain stem auditory evoked response)are used to assess high-frequency hearing loss, diagnose any damage to the acoustic nerve and auditory pathways in the brainstem, and detect acoustic neuromas.  The patient sits in a soundproof room and wears headphones.  Clicking sounds are delivered one at a time to one ear while a masking sound is sent to the other ear.  Each ear is usually tested twice, and the entire procedure takes about 45 minutes.Visual evoked potentials detect loss of vision from optic nerve damage (in particular, damage caused by multiple sclerosis).  The patient sits close to a screen and is asked to focus on the center of a shifting checkerboard pattern.  Only one eye is tested at a time; the other eye is either kept closed or covered with a patch.  Each eye is usually tested twice.  Testing takes 30-45 minutes.

    Somatosensory evoked potentials measure response from stimuli to the peripheral nerves and can detect nerve or spinal cord damage or nerve degeneration from multiple sclerosis and other degenerating diseases.  Tiny electrical shocks are delivered by electrode to a nerve in an arm or leg.  Responses to the shocks, which may be delivered for more than a minute at a time, are recorded.  This test usually lasts less than an hour”. – National Institutes of Health

  6. Neuropsychological Testing
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2 Responses to Medications, Treatments, Tests

  1. Elaine says:

    Physical therapy is left out as a treatment. In my opinion and experience it can get a patient with MS out of a wheelchair and walking with bracing and stengthening exercised. It has worked wonders for me for over 25 years. They do an evaluation during your first appointment whichy can be tiring. Occupational therapy can help with adaptive equipment and organizing space or used for any hand issues you may have.

  2. Elaine says:

    My comment needs editing, e.g. exercised should be exercises. And whichy should be which. My hands are tired and I have neuropathy in my left hand.

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