2005, volume 21, issue 3
Andrzej Friedman, Monika Nojszewska
Farmakoterapia w Psychiatrii i Neurologii, 2005, 3, 195-207
Rasagiline is a new, second generation drug with a potent, selective irreversible monoamine oxidase type B (MAO-B) inhibitor activity. In double-blind placebo controlled clinical trials its efficacy in the treatment for Parkinson's disease was established. Rasagiline as monotherapy improves motor symptoms of PD and additionally significantly decreases the 'off' time among patients with levodopa-induced motor fluctuations. Rasagiline is indicated for the treatment of idiopathic Parkinson's disease as monotherapy in early stages of the disease as well as adjuvant therapy with levodopa in advanced stages of PD.
Farmakoterapia w Psychiatrii i Neurologii, 2005, 3, 209-217
Multiple sclerosis (MS) is an inflammatory relapsing or progressive disorder of central nervous system white matter. Several mechanisms may be important to MS plaque formation: autoimmunity, infection, bystander demyelinisation and heredity. Although convincing proof is lacking, dietary factors and toxin exposure have been hypothesized.
MS can cause a wide variety of clinical features. Sensory symptoms are the most common presenting manifestation of in MS (numbness, paresthesias, burning and hyperesthesias). Pyramidal tract dysfunction is common in MS and causes weakness, spasticity, and loss of dexterity, hyperreflexia, and Babinski sign. Exercises or heat frequently worsens subtle deficits. The initial symptom of MS is optic neuritis (14-23% of patients). Cerebellar pathways are frequently involved during the course of MS, but predominant cerebellar syndrome is uncommon at onset. Fatigue is a pervasive symptom among MS patients that is not related to disability or depression. The temporal course of MS can be described by one of four categories: relapsing-remitting (RR), secondary progressive (SP), primary progressive (PP) and progressive relapsing (RR) and benign (BN). The term “clinical isolated syndrome” (CIS) refers to patients presenting with their first episode of demyelination. After 5-10 years of follow-up, the majority of patients with any asymptomatic cerebral lesions will develop definite MS (treatment implication). The diagnosis of MS is based on the demonstration of white matter lesions disseminated in time and space in the absence of another identifiable explanation. An international expert panel proposed new diagnostic criteria for MS in 2001 (Mc Donald at all). MRI of the head is the most sensitive test for MS and dissemination in time and space demonstrated by serial MRIs separated by at least 3 months would clarify the diagnosis.
Farmakoterapia w Psychiatrii i Neurologii, 2005, 3, 219-226
Aim. In this report methods most commonly used in the assessment patients suffering from Multiple Sclerosis are presented.
Review. Heterogenity and changeability of symptoms are characteristic for MS. The sequele of disease is disability and lowering of quality of life. Clinimetrics should be regarded as the measurement of clinical and patient relevant phenomena. Clinimetrics is a specific domain of knowledge that focuses on the construction and evaluation of clinical indexes. It enables objective observation of the course of disease and effects of treatment. In this article Kutzke's Neurologic Impairment in MS and Extended Disability Status Scale are presented. Questionnaires most frequent used for evaluation of quality of life in MS are described. The phenomenon of fatigue in MS is also mentioned.
Karl A. Baum
Farmakoterapia w Psychiatrii i Neurologii, 2005, 3, 227-234
Early intervention with disease-modifying substances in relapsing forms of multiple sclerosis is recommended to minimise damage to the central nervous system and improve clinical outcome. Beta-interferons have been administered successfully over the past 12 years in the treatment of relapsing-remitting MS. At least one beta-interferon (IFNβ-1b) has proven efficacy in secondary progressive MS.
Two partly blinded respectively blinded head-to-head comparative studies (INCOMIN, EVIDENCE) support the impression that high-dose, high-frequency beta-interferons are more effective.
Efficient strategies have been developed to prevent side-effects in a large proportion of patients. Beta-interferons are first-line therapeutics in MS treatment. With the aim of increasing the number of patients benefiting from treatment with beta-interferons, the phase III-trial BEYOND is currently ongoing to investigate the dose of 500 µg IFNβ-1b.
Anna Członkowska, Dagmara Mirowska-Guzel
Farmakoterapia w Psychiatrii i Neurologii, 2005, 3, 235-240
Multiple sclerosis (MS) is chronic demyelinating disease of the central nervous system. It usually affects middle-age adults, causing disability which may render the patients unable to perform everyday-life activities, also with economic consequences. The aim of our study is to present the most important studies evaluating costs of MS in different countries and to compare their results with results obtained in Poland. Additionally we indicate on the problem of using alternative methods by MS patients concluding that this phenomenon should be considered as it might affect the total costs of MS.
Michael P. Barnes
Farmakoterapia w Psychiatrii i Neurologii, 2005, 3, 241-248
There is no doubt that spasticity is a significant cause of disability. Regrettably it is a condition that is often poorly treated and can result in a range of unnecessary complications, which can cause further problems for the disabled person and their family. There are now a number of effective treatment options. However, before such options are defined the specific goals of rehabilitation need to be clarified and an appropriate outcome measure chosen in order to determine when such goals are being met. The treatment should be multidisciplinary and input from either the rehabilitation physician, or neurologist, and a physiotherapist is essential. Involvement of the person with spasticity, and often their family, is also important in the education process. Relatively simple physiotherapy interventions can be remarkable helpful, including attention to positioning and seating. The role of the physician initially focuses on oral medication. Although we still have older drugs including diazepam, baclofen and dantrolene there are now more modern drugs including tizanidine and, more recently, gabapentin. However, most spasticity is focal in origin and thus requires focal treatment. Although phenol nerve blocks are sometimes helpful the use of botulinum toxin is now to be highly recommended. There is now clear evidence of the efficacy of botulinum toxin, which has been a significant advance in our management of spasticity. More advanced and difficult to treat problems can be alleviated by intrathecal baclofen or sometimes intrathecal phenol or, as a last resort, surgical intervention. The advent of lycra garments for the overall management of more diffuse spasticity is now becoming both fashionable and effective. In conclusion the management of spasticity is a significant challenge to the rehabilitation team and a combined approach can produce significant benefit for the disabled person.
Karl Hainz Mauritz
Farmakoterapia w Psychiatrii i Neurologii, 2005, 3, 249-251
The focus in multiple sclerosis research hadn't been placed on the effectiveness and methods of rehabilitation of MS patients for many years. It has recently been proven that complex rehabilitation diminishes symptoms of MS. Aerobic exercises not only preserves remaining motor function but also helps to regain physical strength after exacerbations.
Maciej Krawczyk, Iwona Plażuk
Farmakoterapia w Psychiatrii i Neurologii, 2005, 3, 253-257
Physiotherapy in multiple sclerosis (SM) remains the symptomatic treatment and deals with all the range of motor disturbances caused by this illness (form vegetative to smooth coordination problems). The mechanism of physiotherapy impact can be described as an intensive induction of the potentials of body systems with the compensation of behavior and also as a goal orientated stimulating of plastic changes in central nervous system. Goals of the therapy are to be defined by the patient and described as a particular function but not only as reduction of motor deficit. Methodology of the therapy should be constructed in the way which influents possibly most of pathological symptoms. Physiotherapy process should be a part of rehabilitation team work.
Lidia Darda-Ledzion, Jacek Zaborski, Anna Członkowska
Farmakoterapia w Psychiatrii i Neurologii, 2005, 3, 259-266
The lower urinary tract dysfunction's symptoms are common in multiple sclerosis (MS) patients and may be the main cause of social disability.
The aim of this paper is to pay special attention to lead the correct assessment of bladder symptoms and their impact on quality of life. Symptoms of neurogenic bladder dysfunction were assessed with multilane questionnaire including irritative and obstructive symptoms and common accepted urological scores (I-PSS, Madsen, Boyarsky). Functional bladder capacity and post-void residual (PVR) volume were measured ultrasonographycally.
Lower urinary tract dysfunction can occur as isolated manifestation of MS or can occur in each time of disease independently of disability. Therefore appropriate diagnostic procedures should be performed in each M.S. patient. The diagnosis of dysfunction should lead to perform correct treatment to improve function, quality of live and prevent live threading complications.
Farmakoterapia w Psychiatrii i Neurologii, 2005, 3, 267-272
Pain syndromes are common in multiple sclerosis patients. Pain has significant influence for disability, quality of life and rehabilitation. Pain syndromes have been found in as many as at least half of patient population but may range as high as 83%. Based on the review of literature the pain syndromes are caused predominantly by damage of central nervous system and they have neurogenic pain nature. According to WHO classification pain syndromes were divided into neuropathic pain, somatic pain and psychogenic pain, but much often pain was classified according to a temporal course of symptom for acute and chronic syndromes. We present literature review and show the frequency of pain syndromes and current treatment as well. Therapy must be individualised for each patient and each pain syndrome and can influence disability and rehabilitation process.
Jacek Zaborski, Lidia Darda-Ledzion
Farmakoterapia w Psychiatrii i Neurologii, 2005, 3, 273-278
The sexual dysfunction is an important and often overlooked problem in MS patients. Sexual symptoms seem to be common in multiple sclerosis (MS) patients and may be main cause of social disability.
Sexual dysfunctions in MS patients are results: primary (direct physical), secondary (indirect physical: pain, fatigue, bladder and bowel dysfunction, spasticity) or tertiary (psychosocial: depression, mood disability, cognitive impairment) causes. It was shown that a rate of sexual dysfunction ranged from 70 up to 91%. No correlation of frequency and intensity of sexual symptoms with duration of disease, age of onset, form of disease and disability were found.
The first step of correct management in sexual dysfunction in MS patient depend on appropriate assessment. Treatment should be started with resolving secondary and tertiary dysfunction causes and after that with application PDG-5 inhibitors.
Farmakoterapia w Psychiatrii i Neurologii, 2005, 3, 279-282
Fatigue may be defined as a subjective lack of energy or feeling of exhaustion. In about 70% of cases fatigue is among three most disabling MS symptoms, and in part of patients the most severe symptom. Fatigue may be general or focal. Fatigue is made worse by stress, depression, prolonged physical activity and heat, having important impact on day-to-day activity, family and social life. Improvement is observed after resting and sleeping. There is an association between fatigue in MS patients and dysfunction of frontal cortex and basal ganglia. In the pathogenesis immune factors and changes in neutrotransmission play also a role. In pharmacological treatment positive effects were achieved with amantadine, modafinil, antidepressive drugs. Improvement was noticed after rehabilitation, psychotherapy and emotional support.
Farmakoterapia w Psychiatrii i Neurologii, 2005, 3, 283-287
Many patients with multiple sclerosis (MS) have or will develop some cognitive deficits. They worsen, aside from motor disorders, activities of daily living and reduce independence. This part of MS clinical picture is better known thanks to neuropsychological research studies and neuroimaging. Psychological rehabilitation and pharmacological agents may help to alleviate cognitive dysfunctions.
Andrzej Kwolek, Elżbieta Wieliczko
Farmakoterapia w Psychiatrii i Neurologii, 2005, 3, 289-292
Introduction. Sclerosis multiplex usually considers the young people. It leads to disability independently from the stage of disease. The aim of treatment is to achieve functional recovery and improve the quality of life.
Material and methods. We observed and examined 458 patients treated in Rehabilitation Ward in District Hospital in Rzeszow in the 1990-2004 years. The rehabilitation period for patients lasted from three to six weeks. At the beginning and the end of rehabilitation each patient was generally and neurologically examined and evaluated in functional scale Kurzkego (EDSS), Cendrowski number scale, logarithmical pain scale, Rankin scale, Barthel index. The rehabilitation program was established individually for each patient according to clinical status, stage of disease and complications. Conclusions and observations were verified during the rehabilitation team.
Results. We obtained the improvement of functional state in nearly all patients independently from sex, age, and stage of disease, complications. Complications during rehabilitation such as deterioration of neurological state concerned several patients.
Conclusions. The complex rehabilitation model in patients with multiple sclerosis has to characterize interdisciplinary approaching to each patient. The improvement of general mobility and consequently quality of life was achieved in most of examined patients (99 percent).