Multiple Sclerosis – Symptoms, Diagnosis, Treatment of Multiple Sclerosis – NY Times


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Multiple Sclerosis

Multiple sclerosis (MS) affects women more than men. The disorder is most commonly diagnosed between ages 20 and 40, but it can be seen at any age.

MS is caused by damage to the myelin sheath. This sheath is the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve signals slow down or stop.

The nerve damage is caused by inflammation. Inflammation occurs when the body’s own immune cells attack the nervous system. This can occur along any area of the brain, optic nerve, and spinal cord.

It is unknown what exactly causes MS. The most common thought is that a virus or gene defect, or both, are to blame. Environmental factors may also play a role.

You are slightly more likely to develop this condition if you have a family history of MS or you live in a part of the world where MS is more common.

Symptoms vary because the location and severity of each attack can be different. Attacks can last for days, weeks, or months. Attacks are followed by periods of reduced or no symptoms (remissions). Fever, hot baths, sun exposure, and stress can trigger or worsen attacks.

It is common for the disease to return (relapse). However, the disease may continue to get worse without periods of remission.

Nerves in any part of the brain or spinal cord may be damaged. Because of this, MS symptoms can appear in many parts of the body.

  • Loss of balance
  • Muscle spasms
  • Numbness or abnormal sensation in any area
  • Problems moving arms or legs
  • Problems walking
  • Problems with coordination and making small movements
  • Tremor in one or more arms or legs
  • Weakness in one or more arms or legs

Bowel and bladder symptoms:

Numbness, tingling, or pain:

Other brain and nerve symptoms:

  • Decreased attention span, poor judgment, and memory loss
  • Difficulty reasoning and solving problems
  • Depression or feelings of sadness
  • Dizziness and balance problems
  • Hearing loss

Speech and swallowing symptoms:

  • Slurred or difficult-to-understand speech
  • Trouble chewing and swallowing

Fatigue is a common and bothersome symptom as MS progresses. It is often worse in the late afternoon.

There is no known cure for multiple sclerosis at this time. But, there are treatments that may slow the disease. The goal of treatment is to control symptoms and help you maintain a normal quality of life.

Medicines are often taken long-term. These include:

  • Medicines to slow the disease
  • Steroids to decrease the severity of attacks
  • Medicines to control symptoms such as muscle spasms, urinary problems, fatigue, or mood problems

Medicines are more effective for the relapsing-remitting form than for other forms of MS.

  • Physical therapy, speech therapy, occupational therapy, and support groups
  • Assistive devices, such as wheelchairs, bed lifts, shower chairs, walkers, and wall bars
  • A planned exercise program early in the course of the disorder
  • A healthy lifestyle, with good nutrition and enough rest and relaxation
  • Avoiding fatigue, stress, temperature extremes, and illness
  • Changes in what you eat or drink if there are swallowing problems
  • Making changes around the home to prevent falls
  • Social workers or other counseling services to help you cope with the disorder and get assistance
  • Vitamin D or other supplements (talk to your doctor first)
  • Complementary and alternative approaches, such as acupressure or cannabis, to help with muscle problems

In-Depth Treatment

Back to Top Support Groups

Living with MS may be a challenge. You can ease the stress of illness by joining an MS support group. Sharing with others who have common experiences and problems can help you not feel alone.

Back to Top References

Houtchens MK, Lublin FD, Miller AE, Khoury SJ. Multiple sclerosis and other inflammatory demyelinating diseases of the central nervous system. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Saunders Elsevier; 2012:chap 54.

Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011;69:292-302.

Rubin S. Management of multiple sclerosis: an overview. Dis Mon. 2013;59:253-260.

More Information on This Topic

Review Date: 7/27/2014
Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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NH Real Estate Appraiser – Jack Lavoie, SRA – Accurate Appraisal Services


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Residential – Commercial – Consulting – Expert Witness

Professional, high quality, appraisal and valuation services for lenders, attorneys, homeowners, broker, corporations and more.

Jack Lavoie SRA. a designated member of the Appraisal Institute is one of the most respected and knowledgeable real estate and appraisal professionals in the Greater Manchester Bedford area, as well as throughout New Hampshire.

Jack’s unmatched experience, education and licensing level (holds a Certified General Appraiser license which is the highest level of licensing available) makes him uniquely qualified to provide you with the services you desire and need. With years of experience behind him and extensive high level training, he is prepared to handle a variety of property types and situations. Complex assignments are his specialty and Jack is the area’s 1st choice for taking on these difficult assingments.

In addition to experience and qualifactions, his service and communication with clients is top-notch. Whether it is an appraisal for divorce, bankruptcy, estate settlement, relocation, or an appraisal in conjunction with selling your home, Jack and his staff will treat it as THE most important appraisal ever. Because it is!.

Click link above

We provide professional appraisal reports, consulting and testimony for:

  • Bankruptcy Appraisals
  • Private Mortgage Insurance Removal
  • Estate Planning
  • Divorce Settlement
  • Tax Assessment Disputes
  • Guardianship appraisals
  • Foreclosure/Pre-Foreclosure
  • Buyers/Pre-Purchase
  • Expert Witness/Litigation
  • Cell Tower/Power Line Impact
  • Tax Abatements
  • Retrospective Valuations
  • Employee Relocation (ERC)
  • Estate Settlement
  • REO Valuations
  • Litigation
  • FHA 203K
  • Abutter impact
  • Sellers/Pre-Listing
  • Commerial/Investment

Attn Mobile User: The “Order an appraisal”, “Services” and “Ask Jack” links below are not currently working. Our web provider is actively working on this. To order an appraisal click the blue Order an Appraisal button above.

Our Commitment to You

As I have discussed earler, real estate values are not linear. Each year in New Hampshire, prices change and follow a predictable path like the graph illustrates. Prices rise in the spring, level off in the summer and early fall and decline in the late fall and winter. Check out “North End” Manchester as of […]. Read More

Even in years where the market seems stable, property values fluctuate over the course of the year. Historically, values increase in the spring and early summer, stabilize in summer and early fall and decrease over the winter season. This is attributed to several factors such as the “holiday season” and the harsh cold winters we […]. Read More

Tax abatements, Obtaining a Divorce Appraisal, “Does recessed lighting add value” and should I wait until spring to sell”? Home seller: Should I wait until spring to sell my house” (note: this person is located in Greater Manchester, NH) Jack: If your house is prepared to sell (cleaned, repaired. Read More

Try this short quiz to see which 2016 Presidential candidate you side with… http://www.isidewith.com/elections/2016-presidential-quiz?from=ThmUutAnS Jack Lavoie, SRA Designated member Appraisal Institute Accurate Appraisal Services a division of Jack Lavoie Real Estate, LLC 62 Quincy Drive Bedford, NH 03110 Office: (603) 644-1000 http://www.j. Read More


Types of MS and MS Treatment Options #multiple #sclerosis, #ms #types, #relapsing


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Patients usually experience a first neurologic event suggestive of MS known as Clinically Isolated Syndrome (CIS). It lasts for at least 24 hours, with symptoms and signs indicating either a single lesion (monofocal) or more than one lesion (multifocal) within the central nervous system. 1

There are 4 types of MS. They’re named according to the way the disease acts on the body over time. 2

The 4 Types of MS

  • Relapsing-Remitting MS (RRMS). This is the most common form of multiple sclerosis. About 85% of people with MS are initially diagnosed with RRMS. People with RRMS have temporary periods called relapses, flare-ups or exacerbations, when new symptoms appear 2
  • Secondary-Progressive MS (SPMS). In SPMS, symptoms worsen more steadily over time, with or without the occurrence of relapses and remissions. Most people who are diagnosed with RRMS will transition to SPMS at some point 3
  • Primary-Progressive MS (PPMS). This type of MS is not very common, occurring in about 10% of people with MS. PPMS is characterized by slowly worsening symptoms from the beginning, with no relapses or remissions 2
  • Progressive-Relapsing MS (PRMS). A rare form of MS (5%), PRMS is characterized by a steadily worsening disease state from the beginning, with acute relapses but no remissions, with or without recovery 2

The Importance of Early Treatment

If you are diagnosed with MS or a first-time MS event, you should consider talking about starting treatment as soon as possible with your healthcare team. Researchers have found that MS often causes more damage in the first year than in later years. 4

MS Treatment Options 5

There are various MS treatment options available today that have been shown to decrease the frequency of relapses and to delay disease progression. There are several ways that these treatment options can be taken. Some treatments use an injection—either subcutaneous (under the skin) or intramuscular (into the muscle) while others are given intravenously (via an infusion) or orally (by mouth).

  • Beta interferons are injectable medications used for the treatment of relapsing-remitting MS. Certain beta interferon products also may be used for a first clinical episode with MRI findings consistent with MS. Depending on the medication, injections for beta interferons can be either subcutaneous or intramuscular and dosing can vary from every other day to once a week
  • Glatiramer acetate is given by subcutaneous injection every day for the treatment of relapsing-remitting MS. It is also used for patients who have experienced a first clinical episode and have MRI findings consistent with MS
  • Fingolimod is a once-daily oral capsule indicated for the treatment of relapsing forms of MS to reduce the frequency of clinical exacerbations and to delay the accumulation of physical disability
  • Teriflunomide is a once-daily oral tablet used for the treatment of patients with relapsing forms of multiple sclerosis
  • Dimethyl fumarate is an oral capsule taken twice a day that is used to treat people with relapsing forms of MS
  • Mitoxantrone is a chemotherapeutic agent for the treatment of worsening relapsing-remitting MS, progressive-relapsing MS or secondary-progressive MS, and is used to reduce neurologic disability and/or the frequency of clinical exacerbations. It is administered intravenously by an infusion once every three months
  • Natalizumab is an intravenous medication reserved for patients with rapidly progressing MS or with high disease activity despite the use of an alternate MS therapy. It is administered once every four weeks
References:
  1. Kappos L, Polman CH. Freedman MS, et al. Treatment with interferon beta-1b delays conversion to clinically definite and McDonald MS in patients with clinically isolated syndromes. Neurology. 2006; 67: 1242-1249.
  2. Hooper K. Managing Progressive MS. New York, NY: National Multiple Sclerosis Society; 2011.
  3. Multiple Sclerosis: Just the Facts New York, NY; National Multiple Sclerosis Society;2011.
  4. Kuhlmann T, Lingfield G, Bitsch A, Schuchardt J, Bruck W. Acute axonal damage in multiple sclerosis is most extensive in early disease stages and decreases over time. Brain. 2002;125:2202-2212.
  5. National Multiple Sclerosis Society. The MS Disease – Modifying Medications. New York, NY: National Multiple Sclerosis Society; 2012.

MS RESOURCES