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nani · Sun Oct 16, 2005 5:54 am stages of MS

Progressive MS

About 15% of people with MS have a more progressive disease course from the start. Some never have any attacks but worsen slowly from the onset of their MS, experiencing symptoms such as tremor, poor coordination, difficulty walking, and other problems. Others have attacks followed by incomplete recovery of function. The residual losses build over time.

nani · Sun Oct 16, 2005 6:01 am Four Disease Courses Have Been Identified in MS

Four Disease Courses Have Been Identified in MS

Relapsing-Remitting MS (RRMS) is the most common form of the disease. It is characterized by clearly defined acute attacks with full recovery (1a) or with residual deficit upon recovery (1b). Periods between disease relapses are characterized by a lack of disease progression. Approximately 85% of people with MS begin with a relapsing-remitting course.

Secondary-Progressive MS (SPMS)
SPMS begins with an initial relapsing-remitting disease course, followed by progression of disability (2a) that may include occasional relapses and minor remissions and plateaus (2b). Typically, secondary-progressive disease is characterized by: less recovery following attacks, persistently worsening functioning during and between attacks, and/or fewer and fewer attacks (or none at all) accompanied by progressive disability. Of the 85% who start with relapsing-remitting disease, more than 50% will develop SPMS within 10 years; 90% within 25 years.

Primary Progressive MS (PPMS)
PPMS is characterized by progression of disability from onset, without plateaus or remissions (3a) or with occasional plateaus and temporary minor improvements (3b). Ten percent of people with MS are diagnosed with PPMS, although the diagnosis usually needs to be made after the fact-when the person has been living for a period of time with progressive disability but not acute attacks.

Progressive-Relapsing MS (PRMS)
PRMS, which is the least common disease course, shows progression of disability from onset but with clear acute relapses, with (4a) or without (4b) full recovery. Approximately 5% of people with MS appear to have PRMS at diagnosis.

The Assessment of Disease Progression
Physicians evaluate disease progression in three ways:

Radiographically—by looking for new lesions on MRI
Neurologically—by measuring changes in function on the neurologic examination
Functionally—by assessing the person's physical and cognitive abilities
The Treatment of Progressive Disease is divided into symptom management, psychosocial, and disease management strategies.

Symptom management and psychosocial strategies are particularly important during the progressive phase in order to maximize the person's comfort, maintain function, and prevent unnecessary complications in spite of any progression that may occur. These strategies include:

Medications and management strategies (e.g., to manage fatigue, bladder/bowel symptoms, spasticity, and pain)

Rehabilitation
physical therapy—to improve and/or maintain movement and function, with particular emphasis on physical mobility, balance, posture, and fatigue and pain management.
occupational therapy—to promote independence and enhance productivity at home and at work, with particular emphasis on upper body strength and coordination, the use of assistive technology, fatigue management, and compensatory strategies for impairments in intellectual functioning.
speech/language therapy—to promote effective communication and identify and address swallowing problems that can compromise a person's health, comfort, and safety.
cognitive remediation (by a neuropsychologist, occupational therapist, or speech/language pathologist)—to identify and address changes in intellection functions.

Wellness interventions
healthy diet—including foods that are low in fat and high in fiber, and adequate fluid intake.
adequate exercise—to maintain flexibility, enhance cardiovascular health and mood, and reduce fatigue.
stress management—to manage more comfortably and effectively the unavoidable stresses of everyday life.
focus on general health and well-being—to ensure that adequate attention is paid to overall health, appropriate prevention and health-maintenance strategies.

Psychosocial interventions
education—to ensure adequate knowledge about the disease, available treatment options, and valuable resources.
counseling—to promote and support effective coping, problem-solving, and planning by people with MS and their family members.
empowerment strategies—to enhance effective planning, problem-solving, and independence.
financial and life planning—to increase preparedness for the uncertain future.
Disease management for progressive disease has recently become the focus of increased attention by MS researchers and clinicians:

The interferons—interferon beta 1a (Avonex® and Rebif®) and interferon beta 1b (Betaseron®)-are approved for people with relapsing forms of MS, which includes those with secondary-progressive disease who have clinical relapses, as well as those with relapsing-progressive disease.

In October of 2000, the FDA approved Novantrone® (mitoxantrone for injection concentrate) "for reducing neurologic disability and/or the frequency of clinical relapses in patients with secondary-progressive, progressive-relapsing, or worsening relapsing-remitting MS." This is the first therapy approved in the United States for secondary-progressive or progressive-relapsing disease. The FDA approval criteria indicate that Novantrone®, which is administered by intravenous infusion, should only be used by those with normal heart function, and for no more than 2-3 years because of possible cumulative cardiac toxicity.

The following chemotherapy agents (although not specifically approved for MS) are being used by physicians in an effort to slow disease progression:
Imuran® (azathioprine)
Cytoxan® (cyclophosphamide)

Methotrexate

Trials for progressive disease are currently underway with the following:
Antegren® (natulizumab)—SPMS

Avonex® (interferon beta-1a)—PPMS; SPMS

bee venom—progressive disease

Betaseron® (interferon beta-1b)—PPMS; SPMS

bone marrow/peripheral stem cell transplantation—PPMS; SPMS; severely progressive

Campath® (alemtuzumab)—SPMS

cyclophosphamide—rapidly progressive disease

Immunoglobulin—SPMS

Schwann cell transplantation—SPMS

T cell vaccination—SPMS; progressive disea