Multiple sclerosis: diagnosis and drugs to treat

Diagnosis of multiple sclerosis

The diagnosis of the disease is made by the neurologist on the basis of the symptoms. If the patient has no complaints or mild symptoms, the diagnosis may be delayed.
There is no test that alone can diagnose multiple sclerosis.
In addition, many diseases have the same symptoms.

Examinations and tests

The symptoms of MS can be very similar to those of many other nervous system disorders.
Fibromyalgia causes muscle pain, weakness, fatigue and difficulty concentrating. So you have to rule out this disorder when diagnosing.

Neurological examination indicates a reduction in nerve conduction in one part of the body or an increase in other areas of the body.

Among the disorders there are:
– abnormal nerve reflexes;
– decrease in the ability to move a part of the body;
– reduction of sensitivity;
– other functional losses of the nervous system.

An eye examination may reveal:
– abnormal pupil reactions;
– changes in the visual field or eye movement;
– rapid eye movements (nystagmus) caused by movement.

The examination for the diagnosis of MS includes:

  • Magnetic resonance imaging of the brain and spinal cord.
  • Lumbar puncture (spinal) for the analysis of cerebrospinal fluid.
  • Electromyography and testing of evoked potentials (these studies measure the conductivity of the nerves).
  • Blood test to rule out other diseases. For example, the doctor can check the levels of ANA antibodies and thus detect whether the patient has an autoimmune disease.

Medications used to treat MS

MS is not curable. The relapsing-remitting form can be controlled by therapies that reduce the number and severity of flare-ups.
These treatments slow the progression of MS. The drugs reduce the amount of myelin damage in the central nervous system.

The doctor prescribes them only to patients with the following forms of MS:

  • Relapsing-remitting MS
  • Progressive MS
  • Secondary-progressive MS

Beta-interferon is an injectable drug that is commercially available in four different forms.
Treatment with interferon is recommended in cases with at least two relapses in the last two years.

It can also be prescribed to patients with secondary-progressive MS. In this form, those affected have constant flare-ups; with each episode, her disability worsens.
There are mild side effects, including flu-like symptoms (headache, chills, and mild fever).

Beta-interferon must not be given to pregnant or lactating women.

Glatiramer acetate
Glatiramer acetate (Copaxone) is injected under the skin daily.
Glatiramer acetate is only used in the relapsing-remitting form of MS.
Like beta-interferon, glatiramer acetate must not be used in pregnant and breastfeeding women.

Teriflunomide (Aubagio) is a once-daily oral medication. It is well tolerated, although the following side effects may occur:

  • liver problems,
  • Nausea
  • Headache
  • Diarrhoea
  • Hair loss.

Teriflunomide is not given to people with severe liver problems or to pregnant women.

Natalizumab (Tysabri) is injected into the vein once every 28 days. The active substance may cause the following side effects:

  • Headache
  • Nausea
  • Vomit
  • Rash
  • Itch.

In rare cases, natalizumab causes progressive multifocal leukoencephalopathy (PML). PML is a rare but very serious disease: the myelin of nerve fibers is destroyed, similar to MS. This causes visual disturbances, speech disorders and paralysis.
Natalizumab is not recommended for treatment if:

  • there is an increase in frequency, severity and number of relapses (despite treatment with interferon and Copaxone);
  • one suffers from two or more episodes a year.

It is also important to note that the number of persons employed in the European Union is not the same The drug must also not be taken by patients with cancer or a weakened immune system (HIV-positive).

Fingolimod (Gilenya) is an oral medication taken once daily. The active ingredient is well tolerated. Nevertheless, some people may develop the following side effects:

  • Infections
  • visual disturbances (macular edema),
  • liver problems,
  • bradycardia (slow heart rate),
  • Arrhythmia (irregular heartbeat).

Because of these side effects, it is recommended to take the first doses in the hospital.
Fingolimod is recommended if there are flare-ups despite treatment with interferon.
Fingolimod must not be given to people with heart problems, adolescents under 18 years of age, pregnant and breastfeeding women.

Surgery for multiple sclerosis is a new invention by Dr. Zamboni and consists in widening the jugular vein, eliminating constrictions that occur in MS patients.

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