Management of spasticity, pain, and paroxysmal phenomena in multiple sclerosis.

Multiple sclerosis (MS) is a disease with tremendous variability and innumerable symptoms. Among the more common symptoms is spasticity. Despite a lack of full knowledge of the physiology causing this phenomenon, successful treatments have been developed. Many of these have had a recent introduction. Pain and paroxysmal phenomena are surprisingly common in MS, but have not had the recognition their frequency deserves. It is not unusual to hear that they are rare in MS, but surprisingly they are all too common. Their management is changing as newer treatments are developed.

Medications used in the treatment of multiple sclerosis.

Recently, there have been numerous advances in the treatment of multiple sclerosis. This article focuses on reviewing the various forms of MS, managing its various symptoms, and possibly altering the course of the disease in an overall attempt to improve the quality of life of the patient.

Extended outpatient rehabilitation: its influence on symptom frequency, fatigue, and functional status for persons with progressive multiple sclerosis.

OBJECTIVE: To determine the influence of an extended outpatient rehabilitation program on symptom frequency, fatigue, and functional status for persons with multiple sclerosis (MS). DESIGN: Nonequivalent pretest/posttest control-group design, with posttest 1 year after initial assessment. Multiple regression analysis and analysis of covariance were used to control for symptom severity at the initial assessment and comorbid factors including depression, cognitive function, and social interaction. Effect sizes (ES) provided a descriptive measure of the change in outcomes. SETTING: Outpatient multidisciplinary rehabilitation clinic. PATIENTS: Forty-six patients with definite chronic progressive MS; 20 received treatment and 26 were in a nontreatment comparison group ("waiting list"). INTERVENTION: Rehabilitation services for 5 hours, 1 day per week, over 1 year. MAIN OUTCOME MEASURES: The MS-Related Symptom Checklist composite score, fatigue frequency, and selected items from the Rehabilitation Institute of Chicago Functional Assessment Scale. RESULTS: Receiving treatment was a significant predictor of reduced symptom frequency (partial r2 = .26) at the 1-year follow-up. The ES adjusted for baseline values indicated substantial reductions in symptom frequency for the treatment group (EStreatment = .27 vs ESwaitlist = -.32). Fatigue was significantly reduced at the time of follow-up for the treatment group compared with the waiting list group (EStreatment = .46 vs ESwaitlist = -.20). There were no statistically significant differences among groups regarding functional status, but there appeared to be less loss of functional status in the treatment group compared with the waiting list group (EStreatment = -.07 vs ESwaitlist = -.70). CONCLUSIONS: An extended outpatient rehabilitation program for persons with definite progressive MS appears to effectively reduce fatigue and the severity of other symptoms associated with MS.

Relationship of the antispasticity effect of tizanidine to plasma concentration in patients with multiple sclerosis.

BACKGROUND: Spasticity is a serious problem in multiple sclerosis (MS) and many patients do not achieve a satisfactory response to currently available oral antispasticity drugs. Tizanidine hydrochloride, an alpha 2-noradrenergic agonist, has been shown to have an antispasticity effect in single center trials of patients with MS. OBJECTIVE: To compare plasma concentrations of tizanidine with objective measures of muscle tone in patients with MS with moderate to severe spasticity. SETTING: Ten centers, all tertiary referral centers for the specialized treatment of patients with MS, in the United States and Canada. DESIGN: A randomized, double-blind, placebo-controlled, dose-response study of tizanidine hydrochloride (8 or 16 mg). PATIENTS: One hundred forty-two patients with spastic MS who were not taking any interfering medication, such as an antispasticity drug or other alpha-noradrenergic agonist, entered the trial. RESULTS: Tizanidine treatment reduced muscle tone significantly, as shown by improved Ashworth scores and increased knee swing amplitude recorded by the pendulum test, both of which correlated significantly with plasma concentration. Placebo had no significant effect on muscle tone. Dizziness, drowsiness, dry mouth, and fatigue were reported most often in the group treated with tizanidine at peak plasma concentration. CONCLUSIONS: Tizanidine reduces spasticity in MS, and both therapeutic effects and side effects are related to the plasma drug levels.

Symptomatic therapy of multiple sclerosis.

Despite decades of aggressive research into the cause and cure of multiple sclerosis (MS), a direct management strategy remains lacking. As research continues, patients who strive for an improved quality of life may attain it through the improved management of symptoms. Symptoms occur in MS as a consequence of loss of myelin (primary symptoms), as the result of primary symptoms (secondary symptoms), and because of psychological dysfunction associated with MS (tertiary symptoms). This paper emphasizes the recent developments in the management of primary symptoms including visual loss, weakness, spasticity, urinary and sexual dysfunction, and fatigue. The adjective multiple emphasizes the numerous potential symptoms of MS. It is through their management that people with MS may lead happier, more productive lives until a cause and cure are found.

Symptom management in multiple sclerosis.

Presently, the course of multiple sclerosis (MS) can be altered little, if at all. Appropriate symptom management, however, can change the course of lives and allow for more comfortable, healthier living despite significant disease. Symptoms in MS are divided into three broad categories. Those that result from actual demyelination include decreased vision, weakness, spasticity, bladder problems, ataxia, numbness, and decreased cognition. Secondary symptoms spring from the primary; these symptoms include contractures, urinary tract infections, megacolon, decubiti, decreased bony calcification, and muscle atrophy. Tertiary symptoms are the unavoidable psychological, vocational, and social problems that occur with chronic disease. This article reviews standard therapies, but the emphasis is on newer management solutions that may not have reached their full potential, though they add to the development of an appropriate life-management plan for persons with MS. The pharmacological approach to symptom management is emphasized, while understanding that rehabilitation and medications cannot be separated in the real life alleviation of MS symptoms.

New advances in symptom management in multiple sclerosis.

Even with exciting new advances in the immunology of multiple sclerosis (MS), a definitive, etiologically aimed management strategy remains elusive. New advances in symptom management provide the clinician the means of improving the quality of life of individuals with MS. Symptoms can be divided into three broad categories: those which stem from demyelination (primary), those coming from the complications of demyelination (secondary), and those which develop from the psychological aspects of chronic disease (tertiary). The modern clinician must be able to develop a life management plan involving symptom management in MS. This article develops some strategies based on newer advances in this area.

Primary CNS lymphoma presenting as multiple sclerosis. A case study.

A case is described of a patient who presented with multifocal neurologic disease compatible with a diagnosis of multiple sclerosis. The predominance of cognitive abnormality was unusual in this case. It was not until the patient's rapid clinical deterioration and radiographic findings mandated surgical intervention that a disseminated tumor involving the leptomeninges was identified and a diagnosis of primary CNS lymphoma was made. Postmortem examination confirmed the diagnosis of primary CNS lymphoma, and the classical pathologic findings of multiple sclerosis were also seen. This report illustrates interesting parallels in the clinical differentiation of these two diseases.

Field testing of a minimal record of disability in multiple sclerosis: the United States and Canada.

The IFMSS Minimal Record of Disability (MRD) in Multiple Sclerosis was field tested at eight medical centers in the U.S. and Canada. The goals were to conduct a qualitative and quantitative evaluation of the MRD. Assessment were completed on 249 patients with definite MS by neurologists and allied health professionals. Effective administration required some study and practice. Refinement of some unclear wording and awkward format will improve ease of administration. The MRD fit well into clinic routines and was accepted by staff and patients. Scoring presented few problems and these were related to overlap among the MRD scales, poor wording, and content not appropriate to MS. Quantitative evaluation of the MRD indicated that Incapacity Status primarily reflects disability in mobility and self-care when used as a composite score. Heterogeneity of content in Incapacity Status suggests that summed scores be used cautiously. Both Incapacity and Environmental Status had high levels of reliability and high correlations with established measures of impairment in MS. Inter-rater agreement of the ISS and ESS were also high. Once some necessary revisions are made, the MRD should be well on its way to achieving the IFMSS goal of developing a brief, reliable, valid, and appropriate instrument acceptable to a wide variety of workers in MS.