Treatment of multiple sclerosis

With physicians to establish a good doctor-patient relationship is very important. However, to find a good doctor seemed to get along is not so easy. Not all physicians are equally suitable for a certain patient . Family physicians to develop the disease process is for general medical care , but multiple sclerosis is not a "normal" diseases. Multiple sclerosis patients really need his own physician, physiatrists specializing in rehabilitation for multiple sclerosis disposal an increasingly important role , especially in patients with significant disabilities , need more physiatrists assistance. Often, however, the treatment of multiple sclerosis is tracking neurologist . Not all neurologists are the same, although all have been neurology specialist training in the differential diagnosis of neurological disorders , however diagnosed when the disease has been established , many neurologists are not good for long-term care , or not interested. Multiple sclerosis patients can require a long struggle with him a physician . Easy to say , but really want to find a professional caregiver , is not readily available . When looking for physicians , there are some factors to be considered. All doctors want to help patients , but due to the relationship between personality traits , some people with certain physicians is " substandard ." Some patients want physicians clearly told him how to do it , some people want another medical procedure can have a wide selection to a decision by himself . These approaches do not who is superior , but different views of patients and physicians get together , a doctor is not a pleasant experience it. So, try to understand what kind of personality he is a person , to find your " to come together ," physician . Patients who do not need to dominate the overall treatment process , not everything required to do according to their meaning ; patients are just understand that he has the final authority and honest with your doctor clearly explain , so there is usually the most good doctor-patient interaction. Another thing to remember is : a good physician is usually very busy, the number of patients are also many, especially physicians every patient wants to spend time take care of him , but the doctors have so much time to do so ? Therefore, it is best to look at before physicians to ask questions first think well, written on paper , lest temporarily forgot to ask . In addition, it is best to remember that all drugs are taking their names and doses . Not all doctors do everything, do not expect physicians to solve all problems. Patient to the physician to have a reasonable expectation . There may be a town in which you live , there is no a physician meet all your needs , If so, had to go to other cities and counties . You can also ask the other patients the same disease , which side we need to have your good physician . Your physician may be useful to you the medicine , it may not help. Do not have a default position to identify all of the drug " is not natural ", " useless ." Do not eat medicine , there is a clear therapeutic purposes, we take medicine ; however appropriate prescription drugs through physicians , we should not be afraid to take medicine . Large individual differences in multiple sclerosis , a treatment program either have no way to apply to all patients.Medications
    Treatment is mainly carried out in two aspects , one is delaying the deterioration of multiple sclerosis , the other is on the current symptoms , treatment.1 treatment slowed progressionIn recent years for relapsing forms of multiple sclerosis research, has invented some new treatments . The first method is to use a beta- interferon (beta interferons). Interferons are produced in vivo response to external stimuli out of the protein . For example, when a virus infection, the body will produce interferon . These interferons may affect the immune system. Interferon can be divided into three categories: A (alpha), B (beta) and C (gamma). IFN will be excited to the immune system, making the trip even more deterioration of multiple sclerosis . Interferon beta tends to calm the immune system , is good for multiple sclerosis . First listing of beta interferon Beta interferon-1b ​​( in the United States called Betaseron, other areas of Betaferon). Subsequently Beta interferon-1a (Avonex, Rebif) also followed the market. Beta interferon to reduce the frequency of recurrence , onset extend the time between onset and reduce the severity of the attack . The various effects are cumulative damage can be reduced . Nevertheless , interferon does not make the cause of disability better. Interferon just let the disease stabilized it. It is not a perfect drug , even the drug is being used may also be patients and allows the subsequent onset of a certain degree of deterioration in condition . Though who fit with interferon is still controversial, but it is clear that interferon may indeed affect the disease process of multiple sclerosis .Many patients with relapsing forms of multiple sclerosis , without immediate use of interferon ; because they may own course quite stable , no need to spend the money and withstand the possible side effects . Frequent episodes in patients only need to use this medicine. Since these two B -shaped dose interferon titer is not the same way , there may be one in some patients respond well , other patients for another better response . As for what kind of use , it would allow the physician to vexing enough.Both interferon therapy at the beginning of time have side effects . Possible side effects include fever , fatigue, and nausea . Location of the injection may cause skin reactions. Some users may be accompanied by depression . All the above effects are processable .Some patients with relapsing forms of multiple sclerosis , as side effects are too severe or ineffective , requiring "non- interferon " of treatment. Then Glatiramer acetate (Copaxone) is another option . This drug requires daily subcutaneous injection, studies have shown that this drug may also reduce the frequency of attacks , and may reduce the MRI abnormalities seen on the number .To emphasize that these expensive drugs , not every multiple sclerosis patients are needed. Deciding whether or not to use these drugs are not so straightforward simple , should have knowledge in this area and physicians have a good discussion and then decide .Other immunosuppressive agents : the use of immunosuppressive agents to reduce the immune function to reduce damage to myelin . Such drugs are Azathioprine, Cyclophosphamide, Methotrexate Cyclosporin, but should pay attention side effects.
 (2) to treat the symptomsSymptomatic treatment of multiple sclerosis has been disposed of trunk. Symptoms of multiple sclerosis can be divided into the brain and spinal cord demyelination direct cause, and not the direct result of demyelination . Symptoms caused by the disease itself is called primary symptoms (primary symptoms), such as the site of the loss of myelin sheath tube movement , causing no strength . Loss of coordination and balance tube site of myelin , causing incoordination . A feeling of loss of myelin tube parts , causing numbness, pain , burning , or itching and other symptoms of flu science . Not difficult to imagine a combination of these symptoms are numerous , it is no wonder no two patients with multiple sclerosis symptoms are exactly the same. With primary symptoms, sometimes sub -onset complications. Secondary symptoms refers indirectly caused disease symptoms. For example, patients with stiff limb weakness , range of motion in the affected area becomes smaller , the formation of joint contractures , and long-term lack of activity , causing osteoporosis or fragile skin . Chronic disease may also alter individual perception on life , as well as the attitude of the face of pressure , resulting in depression, frustration , or career and marriage problems . These symptoms are referred to as three symptoms (tertiary symptoms). Therefore, patients with multiple sclerosis have to face , not just " a disease " so simple only. Really want to deal with multiple sclerosis, and should have to deal with their symptoms , improve physical function , and improve quality of life .o cramps :Spasm is stiff (stiffness) of the mean. When demyelination occurs in the nervous system associated with the regulation of muscle tone of the site , the result is often stiff or spasm. Because the brain and spinal cord have a lot of nerve and muscle tone , and therefore patients with multiple sclerosis spasticity is a very common problem . This rigid symptoms are usually very mild and do not cause special problems. In fact, patients sometimes need to provide stiffness and spasms , to help him to stand or move . But sometimes , stiffness, pain may be hard to level , and interferes with daily life .Spasticity• treatment of spastic exacerbating factors - infection, pain , Popi .• Perform complete stretching exercise program , including active and passive stretching.• Use the necessary corrective aids .• Drug• do not respond to drugs severe cramps, consider surgical treatment .Spasm drug treatment often good results. Baclofen acts on the spinal cord nerves controlling muscle spasms . This is the most used anticonvulsant drugs , the majority of patients a good response to this drug . Dosage should be based on the individual patient's condition carefully adjusted. No effect dose is too low , the dose is too high, it will produce a feeling of fatigue and weakness . Because the balance upright posture and require some degree of muscle tone. Baclofen is often used from the beginning to use smaller doses and gradually increase the dose until the maximum effect. Use this drug the most common mistake is too early to give up, a moderate dose has not added enough muscle relaxation was stopped . For Baclofen response , individual differences, some as long as 5 mg pills a day, a half stars is enough, someone will have time to eat eight , four times a day to eat enough . Tizanidine (Sirdalud), which is a newer anticonvulsant drugs , although effects in the spinal cord , but Baclofen role in the different regions. Compared with most other drugs , it reduces the ability of stiffness and spasms favorably , and less impact on muscle strength. However, this drug must be carefully and slowly increase the amount , because if the dose is increased too quickly , the patient will be very sleepy . Starting dose is 2-4 mg per day , the maximum daily dose is 36 mg. This drug is quite effective in difficult to treat patients who can be used with Baclofen and use . Other drugs, including diazepam, clonazepam , etc.Fatigue :o very surprisingly , patients with multiple sclerosis , the most difficult daily life can cause symptoms of fatigue. But for the patients themselves , this is not surprising . Fatigue is very often occurs , there are many types. Treatment strategies, including moderate exercise and rest . If a man has lost its ability to muscle atrophy and conditional (deconditioning) will ensue . This is another source of fatigue . Maintenance activities is necessary. For this fatigue exercise and proper disposal strategy is to maintain activity . Depression (Depression), may be accompanied by multiple sclerosis occurs, and cause significant fatigue. The reason for this may be because of appetite, sleep , or systemic depressed feeling. For this type of fatigue is basically going to understand it, a positive acceptance of antidepressant medication and psychotherapy . Multiple sclerosis patients with the most common fatigue , is called burnout (lassitude). Burnout is characterized by the gratuitous wanted to sleep in the daytime . This fatigue may be caused by the biochemical reactions . Certain changes in the chemical reaction of the drug in the brain , which may help this situation . For example Amantadine (PK-Merz), which was originally a type A influenza epidemic anti- viral drugs , but can also act on the nervous system. The newer antidepressants , including fluoxetine, paroxetine, and sertraline, the effect of this malaise has , even for people without depression are also effective . For moderate to severe fatigue symptoms, save energy, occupational therapy may help. Efficient completion of daily routine matters , such as dressing , washing , toileting , eating , etc., can leave some more energy to do other activities .
 o optic neuritis : often accompanied by pain in the eye , then there may be waning vision or even blindness , then injectable Steroids such as methylprednisolone followed by oral Steroids, sometimes vision can accelerate the recovery .o Pain: multiple sclerosis patients have experienced varying degrees of pain . Muscle pain , back pain can aspirin or acetaminophen treatment. Chronic pain such as needles tingling or burning sensation is difficult to treat , antiepileptic agents and antidepressants are also part of the analgesic effect.o bladder dysfunction : the disease process , patients due to poor nerve conduction , may not be saved or not fully voiding of urine , bladder dysfunction caused by prayer situation. General use of anti- cholinergic agents Dukes B ( such as Oxybutynin or propantheline) therapy. A small portion of patients should be inserted into the catheter to help urinate.3 The treatment of relapseo steroids , including : Solu-Medrol, (methyl-prednisolone), Decadron (dexamethasone), prednisolone , are still used for acute exacerbation of multiple sclerosis or acute exacerbation . They have little effect for multiple sclerosis itself , but can be made to reduce inflammation of the nerve function and rapid recovery . These drugs may have side effects, including : fluid retention , weight gain , diabetes, cognitive function , acne , peptic ulcer , osteoporosis, and cataracts. Steroid treatment may be obvious , but these drugs should be aware of these drugs by the physician to prescription use only appropriate . According to the patient's condition , steroids may be administered orally , intramuscularly or intravenously administered to . Best not for a long time continuous use of steroids , because of side effects may quickly accumulate .oMultiple sclerosis often in young people who attack, affecting the patient's family, work and life. Patients should pay attention to emotional stability , develop some hobbies, and try to hold a positive attitude . So as to enjoy a more abundant life , and more likely to be symptomatic improvement .