The Treatment of Acute Attacks

The treatment of acute attacks has changed little in the past decade. Cortisone medication including methylprednisolone, dexamethasone, prednisone, and others continue to be commonly used to shorten the attack. These potent anti-inflammatory drugs diminish the swelling within the brain and spinal cord that is seen as cells of the immune system invade and attack the nervous system. They do not appear to alter the long term course of the disease. They are clearly associated with osteoporosis, cataracts, psychological changes, skin acne, weight gain, and salt and water imbalance. Thus their effect on acute attacks must be weighed against potential problems from the treatment.

General drugs that affect the immune system include azathio-prine (ImuranĀ®) and methotrexate. These usually are given by mouth for the more chronic forms of MS. These also are major medications and must be administered with expertise. Studies do not show them to be as effective for relapsing MS as the newer medications, but for some people with either relapsing or progressive MS they may help to control progression of the disease.

Part 11

MANAGING MS SYMPTOMS

The new immune system medications provide true disease management for the first time. They clearly are not for everyone with MS and must be selected and used with expert advice. The backbone to MS management has been and continues to be the management of symptoms. Everyone with MS should be aware of the many ways that the symptoms of MS can be managed, with the goal of improved quality of life.

Symptoms in MS may be divided into those that are caused directly by demyelination within the brain and spinal cord and those that are not. Symptoms that are caused by the disease itself are called primary symptoms. If you lose myelin in the part of the brain or spinal cord that influences strength, you will develop weakness; if you lose myelin in the part that controls coordination, you will become uncoordinated; and if you lose myelin in the part that con trols sensation, you will develop numbness, pain, burning, or itching. It is quite simple to understand that the number of combinations is endless. That is why no two people with MS are exactly alike.

Symptoms in MS may be divided into those that are caused directly by demyeli-nation within the brain and spinal cord and those that are not.

People who have primary symptoms sometimes also suffer from problems that are only indirectly caused by the disease; these are called secondary symptoms. For example, some people who are weak and stiff develop decreased movement at the joints, which are called contractures, and immobility can lead to osteoporosis or skin breakdown.

Chronic disease may lead to changes in how one looks at life and tackles life's stresses. It may lead to depression, frustration, or vocational and marital problems. These are called tertiary symptoms.

Thus, to really tackle MS, the disease process should be modified whenever it is possible to do so; the symptoms of the disease should be managed to allow better function; and the person with the disease should be helped to improve his or her quality of life.

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