Experimental

There are nearly 60 years has been shown that injecting brain extracts from animals, in some cases cause an inflammatory disease of the central nervous system (CNS) and experimental allergic encephalitis (EAE). EAE is very similar to the human disease caused by the administration of the preparation containing fragments rabies vaccine ancient myelin. This form of encephalitis, in turn, is very similar to the pathology observed some forms of encephalomyelitis after infectious sometimes in children after a viral infection (measles, rubella, chicken pox, or otherwise). After infectious encephalomyelitis recurrent disease in humans.

Shortly thereafter, it was shown that it can cause chronic form of relapsing EAE in animals genetically engineered to have ready a few weeks or months and then after the initial recovery episode of paralysis, and the animals showed symptoms similar to those of the new MS. In addition, it was observed signs of harm in the central nervous system of these animals, similar to that of MS.

Better Understand The Disease

To better understand the disease better treatment

Although he does not know with certainty that the cause of MS is probably immune mediated process of environmental factors (perhaps viral infections) caused in genetically predisposed individuals. May be determined susceptibility for MS by multiple genes.

Current theories in favor of immune etiology of MS, it is not necessary little reminder theoretically. The immune system is to detect and destroy bacteria, viruses and other exotic materials (antigens). To do so, we must be able to distinguish any part of the anti-body, which is foreign to external influences. However, in certain medical conditions (autoimmune disease), the immune system no longer recognizes self components and MS attack, there is every reason to believe that the immune system attack the myelin occurs, a substance that form insulating sheath around the nerve fibers of many.

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Treatment, Main Issue

The main issue raised in this study, noted a small increase the size of the effect in each treatment group, and the probability of error of type 2 statistical (not identify the actual difference). It should in this context, it should be noted that the statistical methods are tools to detect the difference in the first place rather than similarity shows created can not be for lack of evidence of a difference to be considered as evidence of no difference.

It is extremely important not to extend corticosteroids, as is the custom that this treatment is associated with long-term complications. These complications include swelling spreads, the face of the moon, and psychosis, peptic ulcers, infections and acne. In the long term, can also cause treatment of serious side effects such as fractures, bone demineralization. Aseptic bone necrosis, and cataracts, high blood pressure and adrenal insufficiency

The Treatment of Patients

The treatment of patients suffering from PD consistently better than those who received placebo. After eight weeks of starting treatment, 32 p. The percent of patients in the placebo group developed an improvement of one point on a scale to assess disability (Expanded Disability within Center [EDSS]), while this number percent at 65. Percent in the group that received treatment with MP.

Another controlled study of recently in the UK, compared with MPIV MP by mouth. Patients were treated MS ninety within four weeks after the start of the outbreak. Of these patients, 38 MPIV (1000 mg / day for 3 days) and 42 MP oral (48 mg / day for 7 days, then 24 mg / day for 7 days and 12 mg / day for 7 days). Thus, the cumulative dose of methyl mg 3000 in Group D and 588 mg oral group. The primary endpoint was the difference between the two groups with regard to improving the EDSS (at least one point) after four weeks. Was measured no significant difference from pre-primary endpoint, or other parameters at one time or another during the study.

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Management Oral Steroids

Data on the effectiveness of oral steroids in the treatment of MS setbacks contradictory. In the study of optic neuritis mentioned above, in the months was observed after treatment, and increase the number of relapses in the group with oral prednisone placebo and treated by MPIV. However, among the experts to examine the results of this study, and there are many who reject the conclusion of the book is that oral prednisone for the subsequent increase in the frequency of relapses.

A recent study showed in Denmark effectiveness of methyl (MP) in the treatment of oral setbacks. Authors compared the effects of oral MP to placebo in patients who have suffered a series of less than 4 weeks. Received twenty-five patients and placebo and 26 500 mg / day given orally for 5 days MP, and cut from 10 days of treatment

Methyl Vein

As seen above, the administration of corticosteroids for a short period is the treatment of acute exacerbations of common MS. Between the different approaches, the intravenous administration methyl (MPIV) the most common, especially because it can be taking the drug over a short period (3 to 5 days per year), and quickly and cause relatively few side effects. Used widely in hospitals and clinics, as well as outpatient clinics. Treatment should be administered under medical supervision, because of side effects, although rare, include psychosis, peptic ulcer, and aseptic bone necrosis, infection, irregular heartbeat, and blood clots.

Some neurologists management periodic MPIV (For example, once a month) in patients who suffer from MS gradual, but is linked to this type of management to increase the risk of side effects and there is no evidence that the data. Changes in the course of the disease

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Oral Treatment

Studies have shown, followed by magnetic resonance imaging (MRI), and the effect of steroids by it shows a decrease in lesion that leads to improved in the presence of gadolinium. However, this effect did not last long, however, and new lesions appear within a week after treatment. If often use corticosteroids in the treatment of advanced, little is known about their optimal dose system. In particular, there is no consensus on the relative effectiveness of various compounds (for example, ACTH intramuscularly, steroids IV or oral steroids), and optimal dose of each track management or the possible need for "oral treatment with low after management IV therapy of short duration continue. MPIV replace some doctors with oral corticosteroids in the treatment of recurrent disease because of the convenience of this type of management and reduce costs. We presented data indicate that the methods are equally effective in acute exacerbations, but it's not very convincing. It is interesting to note that in many of the studies of corticosteroids by mouth (concentrated all forces operating on a relatively small), and different dose regimens. And other anti-inflammatory drugs such as nonsteroidal anti-inflammatory non-steroidal (NSAIDs), and acetylsalicylic acid (aspirin), indomethacin, ibuprofen and naproxen did not prove effective in the treatment of MS acute

Effect of Exacerbations

The recovery rate of vision significantly faster in the group that received treatment with main interest MPIV were in patients whose visual acuity was 20/40 or less established at the outset. After six months there was no significant difference in visual acuity between the groups and the placebo MPIV. Oral prednisone given did not prove superior to placebo. It was surprising that during the month 6-24 follow-up, the risk of optic neuritis was higher repeated in both eyes were in patients treated with oral prednisone and MPIV by about 50 percent. Risk of outbreaks per cent of the new. Diagnosis of MS was the effect was greater in patients with higher risk of recurrence, ie, d. In those with brain lesions multiple MRI at baseline have led these results to the fact that it is not designed this study to evaluate the effect of sugary on exacerbations assessment later and there is no placebo group or protocol blinding for the group that received treatment by MPIV interpretation. Differences between the treatment groups was no longer significant after three years, which shows that the best MPIV slow the progression of MS, but without stopping.

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Exacerbation Vs Corticosteroids

It was found that corticosteroids reduce the duration and severity of relapses and speed recovery, but not beyond a reasonable doubt that the increase of the overall rate of recovery, or that change the course of the disease in the long term.

ACTH (adrenocorticotropic hormone or ACTH) first drug to have proven effective in the recovery of acute exacerbations. Was administered intravenously methyl (IV) over short periods and at high doses (500 to 1000 mg MPIV / day for 3-5 days) ACTH largely because of its reliability, convenience suppress its image improve safety and perhaps put its consistent and faster. The extrapolation of the results of the study on the treatment of optic neuritis (inflammation of the optic nerve primary treatment) by neurologists many MS attacks in general.

In this study, 457 patients were randomly with optic neuritis to 1000 mg / day for 3 days on MPIV, then 1 mg / kg / day. Oral prednisone for 11 days, orally, 1 mg / kg / day of prednisone by mouth for 14 days or placebo feature study cases of inflammation of the optic nerve is the fact that also fits this requirement to assess the parameters sensitive (for example, the visual field, and contrast sensitivity, color vision and visual acuity).

Exacerbation

At least 80 to 85 Percent of people with MS during periods of exacerbation of their symptoms go at one time or another. This is a large, and sometimes worsen, and attacks or crises that bear by the sudden onset of a neurological disorder known for at least 24 hours in the absence of fever or infection. Outbreak of symptoms varies greatly. Layouts magnetic resonance imaging (MRI) taken during deceleration often show new active lesions in the brain (it increases in the presence of gadolinium) or old pest activate or expanded. Although most episodes of spontaneous, most medical professionals agree on the necessity of the treatment if they have important functional implications are.

Corticosteroids are the cornerstone for many years for the treatment of acute exacerbations. Because immune and anti-inflammatory effects, to restore the integrity of the blood-brain barrier to facilitate the return of myelin edema and improve nerve impulses

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When Choosing a Particular Treatment

To consider when choosing a particular treatment (both medical and surgical, rehabilitation or replacement), it is very important that the scientific data on their effectiveness, risks and side effects. This is exactly the direction we set in the writing of this guide, our recommendations are based on peer-reviewed publications of scientific, whenever possible.

Assess the efficiency of treatment is the subject outside the scope of our mission is, in part because it is a parameter difficult to measure and varies depending on the type of management in health care in a particular place. However, we are an exception to this rule in Chapter 5, where we discuss alternative methods of treatment, both because they are not closely related to environmental health care is being run, because these processors are related, and non-medical and often a high price compared with the true benefits .

Completely new compared with previous editions, we have proposed guideline readings (in English) that the reader may consult, if they know more about the treatment, and how they were assessing their effectiveness and safety of the containment.

Studies in Alternative Treatments

Information is collected for studies in traditional and alternative treatments and. The Trials Register Cochrane controlled (Cochrane controlled trials register), which lists currently being evaluated, the results of randomized trials 4000 of alternative therapies, and more of an equal number of ongoing studies there are more than 200 reports of 0.40 treatments alternative assessment methodology in detail and you can find site (in English), and the Cochrane Library. Dr and Jeome, former editor of the Journal of Medical say that there will be two types of medicine, and traditional and alternative and: "There is only based medicine in the validated data, and other drugs, medicine, tangible results, which gives the results are uncertain .

"They complain that they have alternative means of treatment, but only so far, with the recognition that if the verification of scientific treatment, which proved its effectiveness and safety, it has no role in alternative medicine or traditional medicine" must, but replaced by assertions , speculation and the evidence is not scientific evidence. " They want "are equally alternative treatments for rigorous scientific evaluation of traditional remedies."

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