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Multiple sclerosis update
Abstract
Multiple sclerosis (MS) is the most common central nervous system disease among young adults and the third leading cause of disability in the United States. It is estimated that 400,000 Americans have this disorder of the brain and spinal cord, which causes disruption in the smooth flow of electrical messages from the brain to nerves throughout the body. The clinical manifestations vary more in MS than any other neurologic disease. Because of the complexity of MS, a collaborative approach to care of these clients and their family is ideal. This article provides an update on the diagnosis, pharmacologic management, and collaborative care for patients and families.
... 1,2 This disease is variable and complex and benefits from multidisciplinary treatment. 3 There are 4 terms commonly used to characterize the course of MS: relapsingremitting, primary-progressive, secondary-progressive, and progressive-relapsing. 4 Signs and symptoms of MS have been categorized by their effects on major neurologic functional systems: pyramidal/motor, cerebellar/coordination, brainstem/cranial nerves, sensory, bowel and bladder, visual, mental/cerebral, and miscellaneous. ...
... 1,8,11,12 However, psychosocial treatment plans are critical because of the damaging effects of MS on qual-ity of life. 1 Chronic diseases, and chronic pain in particular, are associated with increased psychopathology (eg, depression), family/interpersonal difficulties, and functional impairments (eg, disability, unemployment). [1][2][3][4][5][6] Encouraging self-care is particularly important for adaptive coping and helps patients feel more in control in the face of the uncertainty of their disease and symptoms, particularly pain and depression. 2 Techniques such as stress management may also help reduce exacerbations of the disease. 1 The study most similar to the current investigation was conducted by Archibald et al 6 in 1994. They completed structured interviews regarding pain duration, severity, distress, role impact, and use of pain control methods with 85 patients with MS referred to their clinic. ...
This study investigated the pain management techniques used by patients with multiple sclerosis. Participants from a state branch of the National Multiple Sclerosis Society completed surveys asking for their "most" and "least" effective pain management techniques. Participants then rated these techniques as to their effectiveness. Ninety percent of participants reported pain, with usual pain being in the moderate range. Typical respondents reported several effective and ineffective pain management strategies including medication, physical manipulation, exercise, psychosocial or alternative techniques, and rest/sleep. The health care and quality of life of patients with multiple sclerosis might be significantly improved if these pain experiences and strategies were to receive more clinical and research attention.
... MS represents a wide range of symptoms such as muscle pain and cramp, insentience, sensory problems, vision complications, cognitive disorders, excretory problems, speech disabilities, pain, and fatigue [8,9]. Actually, 76-97% of the sufferers complain about fatigue [10][11][12][13]. ...
Introduction: Multiple sclerosis (MS) has a wide range of physiological and neuropsychological symptoms. Over 75% of MS patients complain about fatigue, which for many is one of their most debilitating symptoms, having a substantial impact on their quality of life and ability to carry out day-today tasks. Previous investigations on the effectiveness of different types of psychotherapy on MS fatigue are extremely limited. The aim of this study was to investigate the efficacy of Cognitive Behavioral Therapy (CBT) as a therapy for MS fatigue. Method: By using convenient sampling, 22 patients with fatigue symptoms (score of ≥5 on Fatigue Scale) were randomly assigned into experimental (n=11) and control (n=11) groups. The subjects in the experimental group attended eight 50-minute sessions of weekly CBT based on van Kessel's model, whereas the patients in the control group attended in eight 50-minute weekly sessions of relaxation training. All the subjects completed the fatigue scale at the end of the therapy and 12 weeks follow-up. Results: Analysis of Covariance (ANCOVA) data indicated that the CBT group reported greater reductions in fatigue symptoms. This is while the fatigue scores of both groups were decreased. Fatigue scores of the experimental group were significantly reduced in the follow-up assessment. Conclusion: Results indicated that cognitive behavioral therapy appears to be a clinically effective treatment for fatigue in MS patients and could be implemented as a complementary therapy for MS patients in order to promote their quality of life.
... Chronic diseases such as MS can affect all aspects of individual health. In the physical side, they cause sensory and cognitive impairment as well as sexual dysfunction and finally, change the patients' QOL (7). In the psychologic aspect, patients experience problems such as depression, anxiety, and problems in playing their role (8). ...
... is a chronic and progressive disease of neural system that damages Myelin sheath of neural cells and halts proper transfer of neural signals in central nervous system. This leads to sensory disorders, atrophy, cramp, sight disorder, cognitive disorders, fatigue, tremor, urine and excretion difficulties, sexual function disorder, disorder of balance system, amnesia, hearing impairment, speech problems, and numbness (Mc Guinness et al 1999 ,Marziniak et al 2011). The cause of the disease is unknown and there is no complete cure for it. ...
Background: Multiple Sclerosis is a chronic and progressive disease of central nervous system. The disease and its inabilities are threat to independence and capability of the patient to fill in their role in family and society. This makes the patient feel incompetent so that his image of body and health is degraded. Physical activity is one of the measures that considerably help the patient to cope with their condition, live, and fight the disease. Taking into account the positive effects of exercising on self-esteem and body_ image healthy people, the present study is an attempt to compare body-image and self-esteem among MS patients who does sport and those who do not. Materials and Methods: The participants were MS patients including 55 athlete MS patients and 59 non-athlete MS patients at age range 22-35. They were selected through convenience random sampling. The athlete MS patients were 16 men and 39 women with average age of 26.9±6.7, average height of 166±8.9cm, and average weight of 70.2±11.3kg. The non-athlete MS patients were 34 women and 25 men with average age of 27.5±8.3, average height of 168±4.2cm, and average weight of 68.4±1.8. All the participants were volunteers. Body-esteem was measured using Mandelson's body-esteem inventory, while self-esteem was assessed using Rosenberg self-esteem scale. Kolmogrov Smirnov test was used to check data distribution and the variables were compared by independent t-test (sig=0.05). Results and Discussions: The results of comparison of self-esteem and body-image between the two groups showed that the both indices were higher among athlete MS patients. As the findings showed, apparently, doing sport acts as an intermediary factor in improvement of self-esteem and adopting positive attitudes toward oneself. Conclusion: Consequently, sport can be one of the best and most effective approaches to improve and increase body-image and self-esteem among MS patients.
... En el mundo hay más de un millón de enfermos pero en unos países son muchos y en otros rarísimos. En Estados Unidos hay 400.000 enfermos con esclerosis múltiple 15,514 y en Etiopía no se encuentra prácticamente ninguno. ...
... The complement cascade of the immune response is important for innate protection from pathogenic organisms; however it is clear that complement also plays a role in many autoimmune diseases (Tsokos and Tedesco, 2006). Multiple sclerosis (MS) is the most common disease of the nervous system, afflicting over 400,000 Americans (Taggart, 1998). Pathologically, MS is characterized by loss of the myelin sheath surrounding nerves, resulting in conduction defects (Boyden, 2000). ...
Complement has been implicated as a potential effector mechanism in neurodegeneration; yet the precise role of complement in this process remains elusive. In this report, we have utilized the cuprizone model of demyelination-remyelination to examine the contribution of complement to disease. C1q deposition was observed in the corpus callosum of C57BL/6 mice during demyelination, suggesting complement activation by apoptotic oligodendrocyte debris. Simultaneously, these mice lost expression of the rodent complement regulatory protein, Crry. A soluble CNS-specific form of the Crry protein (sCrry) expressed in a transgenic mouse under the control of an astrocyte-specific promoter was induced in the corpus callosum during cuprizone treatment. Expression of this protein completely protected the mice from demyelination. Interestingly, sCrry mice had low levels of demyelination at later times when control mice were remyelinating. Although the sCrry transgenic mice had lower levels of demyelination, there was no decrease in overall cellularity, however there were decreased numbers of microglia in the sCrry mice relative to controls. Strikingly, sCrry mice had early recovery of mature oligodendrocytes, although they later disappeared. TUNEL staining suggested that production of the sCrry protein in the transgenic mice protected from a late apoptosis event at 3 weeks of cuprizone treatment. Our data suggest complement provides some protection of mature oligodendrocytes during cuprizone treatment but may be critical for subsequent remyelination events. These data suggest that temporal restriction of complement inhibition may be required in some disease settings.
The auditory P300 wave, also known as P3b, is an event-related potential component thought to reflect central information processes involved in stimulus evaluation or categorization. It is typically elicited using the oddball paradigm, which involves mixing low-probability target items with high-probability standard stimuli. Its latency is associated with the timing of cognitive processes such as stimulus evaluation and response preparation, while its amplitude is related to the amount of attentional resources engaged during the task. Despite decades of use in research settings, its application in clinical practice has been limited. Prolongation of latencies and reduction of amplitudes in the auditory P3b have been observed in both psychiatric and neurological conditions. This includes cases where traditional neuropsychological tests are challenging due to severe motor or speech dysfunctions, or in conditions characterized by subtle cognitive deficits. Additionally, specific laterality patterns in psychoses and a loss of P300 habituation in migraines have been described. The wealth of experimental evidence supports the use of this evoked potential, which can be elicited through a relatively simple paradigm, for objectively evaluating cognition in psychiatric and neurological patients, particularly in follow-up assessments. Therefore, the auditory P300 appears to be a valuable tool for monitoring the clinical course of patients with mental and neurological disorders in certain circumstances.
Introduction: The purpose of this study was to investigate the effectiveness of Lazarus multimodal therapy on enhancing health indices in individuals with multiple sclerosis. Method: The statistical society was all the patients with MS in Qazvin. A number of the patients conveniently were selected. Then using of GHQ questionnaire and clinical interview based on DSM4, 40 males and females were selected and finally assigned in two groups randomly (20 in experimental group and 20 in control group). From 20 patients of experimental group, 16 patients completed the treatment. Lazarus multimodal therapy was administered to the experimental group in twelve 90 minutes sessions during 3 months period. All subjects completed GHQ questionnaire before and after intervention and in follow-up period after 1 month. Results: The results of MANCOVA test showed that Lazarus multimodal therapy have significant effect on general health. The results of ANCOVA test also showed that Lazarus multimodal therapy significantly have decreased depression, anxiety, and social dysfunction but haven’t had significant effect on physical symptoms. These results remained in follow-up period. Conclusion: Lazarus multimodal therapy can enhance health indices in patients with multiple sclerosis.
Objectives:
To explore putative mediators of a mindfulness-based intervention to decrease distress in people with multiple sclerosis (MS) and to explore the patients' perspectives on this intervention.
Design:
We used an explanatory mixed methods design incorporating quantitative data from a pilot randomized control trial and a qualitative interview study with people who completed the mindfulness intervention.
Methods:
People with MS (n = 40) completed standardized measures of distress (outcome), and acceptance, decentring, self-compassion, and self-efficacy (potential mediators). Semi-structured interviews (n = 15) of patients' experiences of the mindfulness intervention were analysed deductively and inductively.
Results:
Decentring post-intervention explained 13% of the 3-month change in distress and between 27% and 31% of concurrent changes in distress. Acceptance changed only slightly, and as a result, the indirect effect accounts for only 2% of future distress and between 3% and 11% of concurrent distress. Qualitative data showed that acceptance and self-compassion needed more time to develop, whereas decentring could be implemented readily after being introduced in the sessions. Self-efficacy also had a large mediating effect. Participants in their interviews talked about group dynamics and prior expectations as essential elements that determine their engagement with the course and their level of satisfaction.
Conclusions:
Mindfulness interventions for people with a chronic progressive condition may benefit from focusing on helping them to accept daily challenges and teach them to recognize their thoughts and feelings, allowing time for acceptance and self-compassion to develop. Group dynamics also play a fundamental role in the success of the mindfulness interventions. Statement of Contribution What is already known on this subject? Mindfulness courses improve psychological well-being for people with chronic conditions. Mindfulness courses have been successful in improving psychological well-being and symptom management for people with multiple sclerosis but we do not know how these courses work. What does this study add? Decentering and self-efficacy appear to be key mechanisms leading to reduced distress. Acceptance and self-compassion may need more time and practice to develop. Group dynamics and expectations of the mindfulness courses were also important elements of mindfulness.
Background: It has been shown that adults with multiple sclerosis (MS) have less leg strength than their peers, as well as impaired balance, which led to an increased prevalence of falling in this population. The purpose of this study was to assess the effects of 8-weeks aquatic exercise training in balance, walking endurance and speed in women with MS. Methods: Twenty-one women patient with clinically-definite relapsing-remittent MS who were registered through the Isfahan MS Association (Iran) participated in this randomized clinical trial. Patients were randomized into two groups: exercise training (n = 10) or control (n = 11). The exercise training group participated in an 8-weeks aquatic exercise program of 45-60 minutes sessions, 3 days per week on alternate days; while the controls received standard medical care and follow-up. Balance, walking speed and walking endurance were measured by using the Berg Balance Scale, the 6-minute walk test (6MWT) and 6-minute walk time at baseline and after 4 and 8 weeks. The obtained data were analyzed using analysis of variance with repeated measures. Findings: After 2 months period, walking speed and endurance improved significantly in the exercise group compared with the controls (P < 0.05). The exercise group showed significant improvement in balance, walking speed and endurance during all of the aquatic exercise periods compared with baseline (P < 0.05). The difference in balance scores between the exercise and control groups was not significant after exercise-based water program (P > 0.05). Conclusion: The results showed that aquatic exercise training in women with MS improves balance, walking speed and endurance. However, aquatic exercise training may lead to additional benefit beyond optimal medical treatments and should be a cornerstone in the management of all patients with MS.
MS is a disease of the central nervous system affecting all economic, financial, social, and emotional aspects of individual,family and community. The aim of the present study was to compare of personality characteristics and short -term memory of patient with Multiple sclerosis and healthy individuals. The statistical society is all of the patient with multiple sclerosis in Tabriz and from which 325 samples were selected using random sampling as e sample volume. In order for gathering data NEO-PI-IR and wechsler Memory scale(W.M.S) were utilized.The data were analyzed using Independent two-sample t-test. The results indicated that there is a significant different between personality characteristics and short -term memory of patient with multiple sclerosis and healthy individuals.
Multiple Sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS) and can be characterized by acute exacerbations or gradual worsening of neurological function and disability. The course of the disease is highly variable and unpredictable, however, there are short and long-term favorable and unfavorable predictive factors, which may provide some information about the future pattern of the disease. Palliative care in MS is directed at symptom management, psychosocial support, and rehabilitation. The goal in palliative care is to achieve a high quality of life. The disease modifying agents, interferon beta, Glatiramer acetate and Mitoxantrone are the mainstay of treatment in MS. Symptomatic relief and counseling of patients with MS have a strong impact on quality of life.
There is evidence to support both the use of intravenous methylprednisolone (IVMP) in multiple sclerosis (MS) relapse and physiotherapy in the management of MS, but no studies have investigated the combination of steroids and rehabilitation together.
To evaluate the benefits of IVMP with planned, comprehensive multidisciplinary team (MDT) care compared to IVMP with standard care.
In this randomised controlled trial, patients confirmed to have had a definite MS relapse severe enough to warrant IVMP (1 g daily for three days) were randomised to two groups. The control group was managed according to the standard ward routine; the treatment group received planned coordinated multidisciplinary team assessment and treatment. Baseline assessments, including demographics and Expanded Disability Status Scale (EDSS) were carried out on both groups. The primary outcome measures were Guy's Neurological Disability Scale (GNDS), and Amended Motor Club Assessment (AMCA). The secondary measures were the Barthel Index (BI), Human Activity Profile (HAP), and Short Form Item 36 Health Survey (SF-36). All measures have published data on reliability and validity. Measures were administered at one and three months.
Forty subjects, including 27 females, completed data collection. There were no significant differences between the two groups at baseline. Results showed statistically significant differences in GNDS (p = 0.03), AMCA (p = 0.03), HAPM (p < 0.01), HAPA (p = 0.02), and BI (p = 0.02) at three months in favour of planned MDT care.
This study indicates that combining steroids with planned MDT care is superior to administering them in a standard neurology or day ward setting. Further research is necessary in order to confirm this finding.
More than 260,000 total joint replacements are performed every year in the United States. The University of New Mexico Hospital is a publicly held hospital that provides healthcare to many patients who are uninsured and indigent. More than 200 joint replacement surgeries are performed every year at University Hospital, Albuquerque, NM, resulting in an average length of stay of 5.7 days and other patient outcomes. The average cost ranges from 22,000 per procedure, with a reimbursement rate of 61%. Nursing care of these patients can be a challenge and an orthopaedic nurse case manager can effect positive patient outcomes.
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