Sunday, February 17, 2013

Pros and Cons of acute Multiple Sclerosis treatment with corticosteroids and plasmapheresis


Multiple Sclerosis (MS) treatment are divided in 5 major stages. Each stage has its own specific pros and cons, wich i will try to explain as simple as possible in this article.

The MS treatment has 5 stages:

  1. Treatment wich changes progress of the multiple sclerosis (interferon treatment).
  2. Acute MS or Exacerbation treatment.
  3. Symptomatic treatment.
  4. Treatment that lowers (stabilizes) progress of the MS.
  5. Rehabilitation.

The treatment with corticosteroids manifest with very strong effect for immune system and can suppress progress of the disease during acute exacerbation. These drugs can lower the the acute symptoms, during seizures, but they still has no effect of total MS progress or frequency and strength of other symptoms.

Corticosteroids are only prescribed during acute/exacerbating stage of multiple sclerosis in relapsing stage, when high increase of funkcional disorders are objectively noticed. (newly invoked or intensified muscular weakness, vision impairment, ataxia)
The corticosteroids lower the inflammation of the brain and spinal cord, this way lowering MS symptoms.
        Pros:

  • Very fast effect for severe MS cases.
  • Fully or partially compensated

       Cons:
In used within recommendations:
  • Sleeping issues
  • Emotional disfunctin ( fast emotional changes )
  • Depression, but usually after stopping medication.
If used high dosage for extensive period:
  • Internal bleeding
  • Weight gain
  • Diabetes
  • High blood pressure
  • Lowered resistance for disease, usually flu or common cold.

Plasmapheresis -  treatment when  patients blood are cleansed of some the blood components. The utility of this treatment for Multiple sclerosis are still not 100% proven.

It is used as secondary treatment for acute fulminant CNS demyelinating diseases that failed to respond to high dosage treatment of the corticosteroids.

The newest research has shown that based on Class 1 and Class 2 study trial , plasmapheresis can be used for adjunctive therapy.
It has high effect probability in relapsing form of Multiple sclerosis.

But because these research has included patients with different demyelinating diseases - it is not possible to objectively determinate that plasmapheresis is more or less effective for people who have different stages of MS.

The study has shown that Plasmapheresis can only be effective for acute Multiple Sclerosis cases that failed to respond to corticosteroids.

For those who want to read the original research we recommend  download PDF text from http://www.neurology.org/content/76/3/294.full.html 

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