Fast Facts: Multiple Sclerosis

G. Macaron, S.E. Hughes

Description

Multiple sclerosis (MS) is a leading cause of disability in young adults, carrying a considerable individual and societal economic burden. The development of disease-modifying therapies and updates to diagnostic criteria are leading us into a new era for MS management, both in the earliest disease phases and progressive MS. In this completely revised/fully updated edition of Fast Facts: Multiple Sclerosis, we present the most recent evidence on disease pathogenesis and all clinical aspects of the condition, as well as the latest on disease-modifying therapies and other potential treatments. Given the need for multidisciplinary management of MS, we have written this resource for the benefit of all health professionals involved in MS care. Table of Contents: • Epidemiology and genetics • Pathology • The clinical picture • Treatment of relapses and symptoms • Disease-modifying treatment • Emerging therapies • Special MS populations • Lifestyle considerations and the multidisciplinary team • Advanced MS

Sujets

• Neurology
• Médecine

Informations

• Publié par: S. Karger AG
• Date de parution: 05 mai 2021
• Nombre de lectures: 0
• EAN13: 9783318067996
• Langue: English
• Poids de l'ouvrage: 4 Mo

Extrait

Fast Facts: Multiple Sclerosis
First published 2000; second edition 2006; third edition 2014; fourth edition 2016
Fifth edition 2021
Text 2021 Stella E Hughes, Gabrielle Macaron
2021 in this edition S. Karger Publishers Ltd
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ISBN 978-3-318-06797-2
Hughes SE (Stella)
Fast Facts: Multiple Sclerosis/
Stella E Hughes, Gabrielle Macaron
Medical illustrations by Annamaria Dutto, Withernsea, UK.
Typesetting by Amnet, Chennai, India.
Printed in the UK with Xpedient Print.
Contents
List of abbreviations
Introduction
Epidemiology and genetics
Pathology
The clinical picture
Treatment of relapses and symptoms
Disease-modifying treatment
Emerging therapies
Special MS populations
Lifestyle considerations and the multidisciplinary team
Advanced MS
Useful resources
Index
List of abbreviations
9-HPT: 9-hole peg test
AAN: American Academy of Neurology
ACTH: adrenocorticotropic hormone
ADEM: acute disseminated encephalomyelitis
ADL: activities of daily living
AHSCT: autologous hematopoietic stem cell transplantation
AQP-4: aquaporin 4
bd: twice daily
CIS: clinically isolated syndrome
CNS: central nervous system
CSF: cerebrospinal fluid
CT: computed tomography
DHODH: dihydroorotate dehydrogenase
DIS: dissemination in space
DIT: dissemination in time
DMT: disease-modifying therapy
EAN: European Academy of Neurology
EBV: Epstein-Barr virus
ECTRIMS: European Committee of Treatment and Research in Multiple Sclerosis
EDSS: Expanded Disability Status Scale
EMA: European Medicines Agency
FDA: (US) Food and Drug Administration
FLAIR: fluid-attenuated inversion recovery
HLA: human leukocyte antigen
IFN- : interferon-beta
IgG: immunoglobulin G
IL: interleukin
INO: internuclear ophthalmoplegia
IPMSSG: International Pediatric Multiple Sclerosis Study Group
i.v.: intravenous
JC: John Cunningham (virus)
MHC: major histocompatibility complex
MOG: myelin oligodendrocyte glycoprotein
MRI: magnetic resonance imaging
MS: multiple sclerosis
MSFC: Multiple Sclerosis Functional Composite
MSN: multiple sclerosis specialist nurse
NEDA: no evidence of disease activity
NMO: neuromyelitis optica
NMOSD: neuromyelitis optica spectrum disorder
Nrf2: nuclear factor (erythroid-derived 2)-like 2
PCR: polymerase chain reaction
PEG: percutaneous enteral gastrostomy
PLEX: plasma exchange
PML: progressive multifocal leukoencephalopathy
POMS: pediatric-onset multiple sclerosis
PPMS: primary progressive multiple sclerosis
PRMS: progressive relapsing multiple sclerosis
RCT: randomized controlled trial
RIS: radiologically isolated syndrome
RRMS: relapsing remitting multiple sclerosis
S1P: sphingosine 1-phosphate
SDMT: Symbol Digit Modalities Test
SLE: systemic lupus erythematosus
SNRI: serotonin-norepinephrine reuptake inhibitor
SPMS: secondary progressive multiple sclerosis
STIR: short time inversion recovery
T25FW: timed 25-foot walk
TKI: tyrosine kinase inhibitor
TNF: tumor necrosis factor
UTI: urinary tract infection
UV: ultraviolet (light)
VCAM1: vascular cell adhesion molecule-1
WHO: World Health Organization
Introduction
Multiple sclerosis (MS) is a leading cause of disability in young adults, and it has a significant effect on patients quality of life, family plans and careers. By causing varying degrees of physical and cognitive disability, MS carries a considerable individual and societal economic burden.
Fortunately, we are entering a new era in the management of MS. Several recent studies support initiating treatment early in the disease course with higher-efficacy disease-modifying therapies in patients with relapsing-remitting MS. This approach has been associated with better long-term outcomes, specifically a lower risk of conversion to secondary progressive MS. Moreover, new molecules with the potential to induce myelin repair or halt the neurodegenerative process are in the pipeline for the treatment of progressive MS. Coupled with a recent update to the diagnostic criteria, clinicians can now diagnose and treat patients in the earliest phases of their disease.
In this new edition of Fast Facts: Multiple Sclerosis , we present the latest evidence on disease pathogenesis and all clinical aspects of the condition, as well as the latest on disease-modifying therapies and other potential treatments.
Given the need for multidisciplinary management of MS, we have written this resource for the benefit of all health professionals involved in the care of patients with this complex disease.
Acknowledgments. The authors wish to thank the authors of the third and fourth editions of this resource, Drs Michael Barnett, Omar Malik, Ann Donnelly, Mary Rensel and Orla Gray, for the strong foundation on which this new edition is based.
1 Epidemiology and genetics
Multiple sclerosis (MS) is a neurological condition resulting from inflammation and degeneration within the central nervous system (CNS). This inflammation can affect different sites at different times, producing a variety of symptoms and signs. Periods of relapse and remission occur in the early stages of the disease, and in most patients a slowly progressive course ensues within one to two decades of disease onset. The cause of MS is unknown, but dysregulation of the immune system is central to the pathogenesis of the disease.
Epidemiology
MS is the leading cause of neurological disability in the young and middle-aged populations of the developed world. Survey figures from 2020 suggest that it affects 2.8 million people worldwide. 1 Given the lack of complete surveillance data in some countries, this is likely to be an underestimate.
Prevalence. The worldwide prevalence of MS appears to be increasing. This is related to many factors, including improved counting methods, better diagnosis, global population growth, people with MS living longer (through improved treatment and support) and a true increase in disease incidence, especially in females.
The number of people with MS in a given population at any one time is usually expressed as cases per 100 000 population. Prevalence varies worldwide, but MS is most prevalent in northern European populations, especially in individuals of Nordic descent, and is notably more prevalent in temperate than equatorial regions. While, globally, the median estimated prevalence of MS is 36 per 100 000, 1 in some countries, prevalence exceeds 300 per 100 000.
Regionally, the median estimated prevalence of MS is greatest in Europe and the Americas (133 and 112 per 100 000, respectively). 1 However, prevalence varies significantly both within regions and within countries. For example, in Europe, San Marino and Germany have the highest prevalence of MS in the world (337 and 303 per 100 000, respectively), whereas some European countries have prevalence figures below 40 per 100 000. 1
In the Global Burden of Disease Study 2016, the highest age-standardized MS prevalence estimates (given as per 100 000 population) were in high-income North America (164.6), western Europe (127.0) and Australasia (91.1), and the lowest were in eastern and central sub-Saharan Africa (3.3 and 2.8, respectively) and Oceania (2.0). 2
Incidence. The number of new cases per 100 000 population per year can indicate changes in the risk of a disease within a population, and can signify whether the disease frequency is increasing in a population. It is not affected by changes in survival. The incidence of MS, which peaks at age 30, appears to be rising in both the northern and southern hemispheres, particularly in women. The median estimated global incidence of MS is 2.5 per 100 000 per year, but in some countries the incidence may exceed 10 per 100 000 per year. 3
Geo-epidemiology of MS. The prevalence of MS is significantly associated with latitude, particularly in populations of European descent ( Figure 1.1 ). The latitudinal gradient in MS has been confirmed by independent studies in Australia, New Zealand and the USA, with exceptions in Sardinia and northern Scandinavia. 4 In Australia, the age-standardize