There is a significant increase in the percentage of women with relapsing-remitting multiple sclerosis (RRMS) after age 45 compared with age 20. This may suggest that women tend to get RRMS later in life.
There is no single cause of MS. Many factors are involved in the development of MS. The specific mechanisms underlying progression from clinically isolated syndrome (CIS) to MS are still unclear. But there are some factors associated with a worse prognosis like younger age at onset, sporadic course, depression, and facial features.\n
About 2,300 people are diagnosed with multiple sclerosis annually in the U.S. This is based on the list of coded conditions in the National Inpatient Sample. It is likely to be an underestimate because some cases may not have been recorded, especially if they are self-reported. The number of new cases per million inhabitants per year ranged from 0.5 in 2005 to 5.0 in 2007. This article is protected by copyright. All rights reserved.
Patients with MS report significant improvements in HRQoL with better mobility and physical functioning as well as satisfaction with care, compared with health assessment before starting treatment. Results from a recent paper demonstrate that treatment has a positive impact on individuals' HRQoL.
Survival rate is high, but it depends on many factors including gender, age at onset of MS, disease type, EDSS score, and RRMS versus SPMS diagnosis. Most recent studies estimate a 5-year survival rate of 85% for women and 77% for men. Men with relapsing-remitting MS (RRMS) have a better prognosis than women or progressive MS patients. Women with RRMS have a relatively poor prognosis compared to men. MS patients younger than the age of 30 years have a worse prognosis than those older than 50 years.
The newest generation of anti-TNF therapies has been shown to significantly reduce relapses, disability progression, and new lesion development compared with placebo. This data supports the notion that TNF inhibitors are effective in preventing clinical relapses. Another recent advance has been the introduction of teriflunomide as an oral medication. Teriflunomide was approved by the FDA in 2010 for the treatment of MS patients whose disease failed to improve after two prior treatments with interferon beta-1a or -b. Other agents approved for the treatment of MS include fingolimod, natalizumab, mitoxantrone, and alemtuzumab.
The majority of patients found to be eligible for trial were considered to have a relatively good prognosis. However, there was considerable heterogeneity in the outcome measures used by the various centres. There is therefore a need for a standardised methodology to be used in future clinical trials.
There have been several medications shown to be effective in MS. In fact, many of these drugs have made it to the market. Still, there are certain drawbacks with current treatments for MS. Some of these include high doses of medication, long-term use of the same medication, side effects, and adherence issues. There are also some ongoing clinical trials looking at combination therapies that combine different medications into one. These newer therapies may make it easier for people with MS to take medications more efficiently, reduce side effects, and hopefully increase treatment satisfaction.
This patient is at risk for developing progressive multifocal leukoencephalopathy (PML). He is taking natalizumab, which is on the FDA's black box list of medications that could lead to PML. He tells me he has been taking natalizumab for 6 months, but his blood tests show that his Natalizumab does not reach its therapeutic target. I am not sure how long the blood tests will take to come back. If the test comes back positive for Natalizumab, then he should stop taking the drug, because it is one of the drugs that can cause PML.
Multiple sclerosis affects individuals differently depending on many factors like age, sex, race, location, and education level. MS patients are most commonly found during their twenties, menopause, and middle ages. There are many symptoms associated with MS such as sensory loss, muscle weakness, numbness, bowel/bladder problems, depression, and worsening fatigue. The debilitating nature of MS makes it difficult for people to live full lives.\n
Patients with a history of psychosis, particularly those who have a history of substance use disorders, need intensified psychiatric evaluation. Patients who experience such psychotic experiences need close monitoring and treatment in order to prevent the development of severe disease.