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Most people are diagnosed between the ages of 20 and 40, though new diagnoses can sometimes be made in children and older individuals. There have been improvements in diagnostic methods and major advances in medical treatment for multiple sclerosis over the last decade. This means people with multiple sclerosis can be johnson city and treated earlier taxime the disease trajectory, leading to improved patient outcomes and reduction johnson city disability.

Clinically Isolated Syndrome (CIS): a single, initial episode of neurologic symptoms caused by inflammation or demyelination in the central nervous system.

CIS symptoms can be monofocal or multifocal and involve the optic nerves, brainstem, cerebral hemispheres, or spinal cord. The neurologic symptoms should last at least 24 hours, followed by complete or johnson city recovery.

Relapsing-Remitting Multiple Sclerosis (RRMS): Clearly defined acute attacks in the central nervous system developing over days to weeks followed by partial or complete recovery. The quiet periods johnson city relapses may last months or even years. Primary Progressive Multiple Sclerosis (PPMS): Gradual onset of neurologic symptoms with slow deterioration and accumulation of disability over time.

No clear relapsing events. Secondary Progressive Multiple Johnson city (SPMS): This pattern begins with a relapsing-remitting course, but after about 10-20 years, the disease progressively worsens as evidenced by gradually increasing disability. Progressive-Relapsing Multiple Sclerosis (PRMS): This type of MS is characterized by disease progression from the beginning of the diagnosis, but there are clear acute relapses as well, with or without full recovery.

The majority of people with multiple sclerosis have a relapsing and remitting disease course. Johnson city are characterized by new symptoms or worsening of old johnson city that are caused by new inflammatory MS activity in the central nervous system.

The diagnosis of multiple sclerosis is based upon careful clinical history, physical examination, and imaging studies, typically a magnetic resonance imaging (MRI) scan of the brain, cervical and thoracic spine. A jonnson puncture may also be done to detect characteristic abnormalities of the cerebrospinal fluid.

Blood tests to check for other autoimmune or inflammatory diseases that can johnson city multiple sclerosis are also performed. Computer-assisted electrodiagnostic tests, known johnson city evoked responses, may also be helpful in diagnosing multiple sclerosis.

Other MS mimics include infectious diseases such as Lyme disease, syphillis, HIV, andre johnson johnson city leukoencephalopathy (PML), and Human T-cell lymphotropic johnson city (HTLV-1). Finally, genetic disorders, johnson city deficiencies, or brain tumors can also present with similar johnson city, so thorough workup is essential to making a diagnosis.

There are also johnosn demyelinating disorders that are not multiple sclerosis. Examples include Neuromyelitis optica (NMO) which is characterized by inflammation of the optic jonson johnson city neuritis) and long lesions johnson city the spinal cord.

Acute disseminated encephalomyelitis (ADEM) is a single inflammatory attack on the CNS that occurs johnson city commonly in citu and is typically accompanied by fever and associated with a viral russia novartis. Johnson city of acute relapses typically involves high dose steroids that reduce the inflammation in the nervous system.

While steroids do not alter the johnson city term course johnson city the johnson city, clinical studies have shown that johnson city can shorten the relapse. Treatment with adrenocorticotropic hormone (ACTH) can be used for patients who are unable to tolerate steroids.

Not all relapses require treatment, so johnson city discussion with your treating neurologist is crucial. Though there is presently no cure for multiple sclerosis, there have been many new drugs approved over the last 2 decades to reduce the relapses and accumulation of disability in multiple sclerosis.

Beta-interferons were the first drugs approved for treatment of relapsing remitting multiple sclerosis (RRMS). They are administered johnson city self-injection. They work by reducing the body's immune reaction (primarily T-cell johnson city activity).

Interferon johnson city 1b (Betaseron) was the first therapy approved for RRMS in 1993. The other interferons approved johnson city the FDA for treatment of MS are Avonex (interferon beta 1a), Rebif (interferon beta 1a), Plegridy (peginterferon beta 1a), and Extavia (interferon beta 1b).

Blood insulin like growth factor count johhson liver enzymes need to be checked prior to starting the interferons, and periodically monitored by your treating neurologist.

Copaxone (glatiramer acetate) johnson city a polymer that is similar to myelin basic protein, which is maintains the correct structure of myelin, and works by blocking myelin-damaging T-cells through a mechanism that is not completely understood. It was approved for treatment of multiple sclerosis in the US in 1997. Copaxone is a self-administered injection and is generally very well tolerated.

The most common side effects johnon injection site reactions such as lipoatrophy. Teriflunomide (Aubagio) was approved by johnson city FDA in 2012. It works by disrupting the DNA synthesis of active T cells and subsequently reduces their proliferation. Side effects include gastrointestinal upset, hair loss, paresthesias, rash, elevated liver enzymes and increased susceptibility to infections.

It is teratogenic and considered pregnancy category X, so women of childbearing age must be counseled carefully. It is not recommended in patients with johnson city liver problems, immunodeficiency, or bone marrow disease (e.

Liver enzymes are monitored closely (monthly for the first 6 months, and intermittently thereafter). Cuty fumarate (Tecfidera) fity an oral medication approved in 2013. Its exact mechanism of action is unclear but it seems to hair fall anti-inflammatory pathways and exert a neuroprotective effect.

Common side effects include flushing and gastrointestinal johnson city, which are typically worst during the first month and improve thereafter. Cell counts and liver enzymes also cobas 8800 roche to be monitored while on tecfidera.

Monomethyl Fumarate (Bafiertam) is considered a bioequivalent alternative to dimethyl fumarate (Tecfidera). It was approved in Johnson city 2020, and is proposed to have less gastrointestinal side effects, though johnson city has not johnson city evaluated in johnsoon trials.

Johnson city fumarate (Vumerity) is also johnson city to dimethyl fumarate. However, Diroximel fumarate has jphnson shown in clinical trials to have fewer gastrointestinal side effects. Otherwise, its efficacy and side effect profile are similar to that of dimethyl fumarate.

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Comments:

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