The management of multiple sclerosis: Current and future therapies

Abstract

Management of the patient with multiple sclerosis (MS) encompasses a number of distinct, if overlapping, areas. They include anticipation and prevention of problems, symptom control, drug therapies aimed at reducing disease activity and finally, rehabilitation and service delivery. The recent advent of new immunosuppressant treatments for MS is extremely exciting. Beta-interferons (1a and 1b) are now licensed worldwide and glatiramer acetate (Copaxane ®) is in use in the United States. Many more drugs, including intravenous immunoglobulin, mitoxantrone, methotrexate and cladribine, are undergoing trials and some are showing promising results. Future therapies with monoclonal antibodies and adhesion molecules are also undergoing extensive research. Realistically, however, these new treatments aimed at reducing disease activity will have little impact on existing problems or the degree of disability. Consequently, much of the management of a patient with MS relates to control of the vast array of symptoms. These range from the obvious problems of weakness and spasticity, ataxia and sphincter disturbance, to less common but still important problems such as visual, cognitive, swallowing and respiratory difficulties. Some of the most common, and to the patient most disabling, symptoms are fatigue, thermal sensitivity and pain, areas often neglected by the physician in the face of more obvious physical needs. Much can be done for the patient in all areas. A combination of education, physiotherapy and drug therapy is usually required but occasionally there is a place for more invasive treatments such as intrathecal baclofen administration for severe spasticity or thalamic surgery for cerebellar tremor. A multidisciplinary team approach is essential in the overall management of the patient with MS,

Gait analysis in multiple sclerosis: Characterization of temporal–spatial parameters using GAITRite functional ambulation system

“…Our findings in this large group of MS patients are similar to the results reported in previous studies [7][8][9][10][11][12], i.e. decreased gait velocity, shorter steps, increased double support time and decreased single support and swing times.…”

“…double support phase [7][8][9][10][11][12]. However, the characteristic abnormal gait patterns in MS have not been studied thoroughly in a large group of patients.…”

Assessing cost-effectiveness in the management of multiple sclerosis

“…It has been argued that the management of patients with MS should begin at the time of diagnosis 56. There are three aspects to the management of MS:13

the prevention of disease progression and relapse rates;

the treatment of acute exacerbations;

the treatment of chronic symptoms.

…”